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Biomedical subjects

G M Levine

Publications and source records attributed to G M Levine.

At least 19 recordsLinked to original sources
PubMed1992

Impact of a quality assurance program on gastrointestinal endoscopy.

The impact of a quality assurance committee on documentation and use of gastrointestinal endoscopy was assessed. The committee, fulfilling Joint Commission on Accreditation of Healthcare Organizations criteria, performed retrospective (1984-1985) and prospective (1986-1988) reviews of all endoscopies. Criteria were developed from American College of Physicians and American Society for Gastrointestinal Endoscopy guidelines. All reviews of procedures that were questioned were returned to physicians for clarification. After reconsideration of the response, procedures were judged either justified or unjustified. There has been significant improvement in the quality of endoscopy reporting and documentation. The rate of questioned procedures decreased from 21.6% (95% confidence interval (CI), 20.1-23.1) in 1984-1985 to 9.2% (95% CI, 7.9-10.4) (P less than 0.01) in 1988. Improvement in use was reflected in the significant decrease in the rate of unjustified procedures from 8.2% (95% CI, 7.2-9.2) in 1984-1985 to 1.5% (95% CI, 1.0-2.0) (P less than 0.01) in 1988. Most importantly, this process curtailed the previously noted 10% annual increase in the number of endoscopic procedures (P less than 0.01).

Endoscopy, Gastrointestinal↗
PubMed1992

Nutrition support team recommendations can reduce hospital costs.

Providing nutrition support may be costly to hospitals under the prospective payment system. A nutrition support team, however, can be effective in controlling costs. To demonstrate the importance of the nutrition support team and to quantify the potential cost savings that can be achieved, a retrospective review of the effect of our team on hospital costs was conducted for the 12-month period of October 1989 to September 1990. The team supervises but does not regulate the use of total parenteral nutrition (TPN). During this time period, 176 patients received TPN. In 14 patients, the use of TPN was inappropriate, representing $65,349 in excess costs. After the cost of providing enteral nutrition to these patients (estimated at $2,430) was deducted, a net loss of $62,919 occurred. Nutrition support team action saved an additional $45,186 in hospital charges when recommendations to discontinue TPN were eventually heeded. Nutrition support team approval before TPN is initiated would achieve cost savings.

Academic Medical Centers↗
PubMed1990

Nuclear medicine studies of aging: X. Relationship of liver and spleen lengths at age 65 years and older.

For 3 groups of patients aged 65 years or greater, liver and spleen lengths were measured from calibrated radiocolloid images. Length relationships between liver (L) and spleen (S) were examined in terms of S as a function of L, as well as (S/L) and (L-S) vs S or L. Liver and spleen lengths were the least well correlated in these patients. The S/L ratio vs S produced the most significant correlation in all 3 groups. This suggests a complex but describable relationship between liver and spleen lengths in the overall aging population, and provides a baseline for comparing the effects of various diseases on S and L.

Aged↗
PubMed1989

Comparison of different caloric substrates on intestinal adaptation in the rat.

We compared the relative efficacy of medium- and long-chain triglycerides and dextrose on intestinal adaptation. Parenterally nourished rats received an isocaloric luminal infusion of one of these three substrates for 1 wk into either the jejunum or the ileum. Intestinal mass (mucosal weight and protein content) as well as the in vivo absorption of 5 mM glucose, valine, and aspartic acid were measured. In the jejunum, long-chain triglycerides were the most trophic, whereas in the ileum, long-chain triglycerides and dextrose were equally effective, but significantly more trophic than medium-chain triglycerides. In general, absorptive function was better maintained by dextrose and medium-chain triglycerides than long-chain triglycerides in the jejunum or by dextrose in the ileum. These data demonstrate that the jejunum and ileum respond differently to caloric substrates. Medium-chain triglycerides do not appear to have a clear superiority to long-chain triglycerides or dextrose in producing intestinal adaptation.

Adaptation, Physiological↗
PubMed1989

Gastric pertechnetate contribution to blood pool images.

During a cardiac blood pool study (Tc-99m erythrocytes), there was an apparent "cold" area in the left lobe of the liver. At one hour, the prior void appeared to have filled in, suggesting an intrahepatic hemangioma. However, the changing pattern of radioactivity, and its shape, indicated that this actually represented Tc-99m pertechnetate in the gastric wall and stomach cavity. In a second case, the interval between intravenous injection of stannous pyrophosphate and Tc-99m pertechnetate was prolonged. Changing activity, again in the gastric wall and cavity, obscured part of the liver. This cleared with time, allowing hepatic evaluation. Thus, gastric pertechnetate can contribute to blood pool images of the heart or liver and multiple images may be needed to separate this component from nearby tissues.

Aged↗
PubMed1988

Impact of age, sex, race, and functional complaints on hydrogen (H2) production.

In order to evaluate factors that may influence H2 generation, the effects of age, sex, race, and functional complaints on breath H2 were studied in 62 subjects. These included 34 young hospital employees, 17 healthy ambulatory elderly subjects, and 11 patients with functional bowel disease. The ability to produce H2 was defined by an increase in breath H2 to greater than 20 parts per million within 4 hr of ingesting 10 g of the nonabsorbable sugar lactulose. Overall, 21% of subjects were nonproducers, and the incidence of nonproduction did not vary among the groups. The elderly subjects had significantly greater breath H2 concentrations than the younger subjects at 150 minutes (P less than 0.05). Sex, race, and functional complaints did not influence H2 production. These findings indicate that patient's age and potential inability to make H2 need to be considered in the routine interpretation of H2 breath tests.

Adult↗
PubMed1988

Luminal and metabolic regulation of jejunal amino acid absorption in the rat.

Studies were carried out to determine the role of luminal amino acids and metabolic balance in in vivo amino acid absorption. Previous in vitro studies have shown that adaptation of amino acid transport is a complex phenomenon. In the first series of experiments, parenterally nourished rats received a 7-day jejunal infusion of either 3% aspartic acid, glutamine, lysine, valine, or mixed amino acids. A single-pass perfusion was performed to determine the effects of infusates on 5 mM valine, aspartic acid, and lysine absorption. Compared with controls receiving luminal saline, prior glutamine infusion increased valine absorption; prior valine, glutamine, and aspartic acid infusion significantly increased aspartic acid absorption; and prior valine and lysine infusion significantly increased lysine absorption. The mixed amino acid solution had no effect. The effects of metabolic balance were examined by comparing fasted rats with parenterally fed and orally fed rats. Within 24 h fasting significantly increased valine and aspartic acid absorption, despite a significant decrease in intestinal mass.

Administration, Oral↗
PubMed1979

Delayed esophageal perforation after pneumatic dilatation for the treatment of achalasia.

Two cases of delayed esophageal perforation following a pneumatic dilatation for the treatment of achalasia are presented. Esophagrams obtained immediately after pneumatic dilatation failed to reveal a perforation. Increasing symptoms prompted repeat contrast studies, at which time an esophageal perforation was demonstrated. The occurrence of delayed esophageal perforation after pneumatic intrumentation is emphasized. An ischemic etiology for this delayed perforation is postulated.

Dilatation↗
PubMed1977

Direct and indirect effects of dextrose and amino acids on gut mass.

Oral intake of an elemental diet maintains small intestinal mucosal mass compared to the atrophy seen after intravenous infusion of the same diet. The greatest difference in intestinal mass occurs in the proximal bowel and is thought to occur because of rapid absorption in the proximal small bowel. This study was designed to determine the effects of the individual components of the elemental diet and their site of administration within the small bowel on small intestinal mass. Rats were maintained on intravenous alimentation and the proximal gut (by intragastric infusion) or the ileum was continuously infused with equal volumes of 30% dextrose, 5% dextrose, 5% amino acids, saline, or 30% mannitol. After 1 week of combined intravenous alimentation and gut infusion, the rats were killed and parameters of small intestinal epithelial mass were determined sequentially for the entire bowel. Although saline- and mannitol-infused controls did not differ from uninfused intravenously fed rats, proximal infusion of 30% dextrose reproduced the effects of a complete elemental diet. Proximal infusion of amino acids but not 5% dextrose had a limited effect on the duodenum and jejunum. Ileal infusion of 30% dextrose led to local hyperplasia of the site of infusion and in addition produced hyperplasia of the proximal gut. Ileal amino acid infusion, but not 5% dextrose infusion, led to local ileal hyperplasia. We conclude that: (1) intraluminal dextrose and amino acids have direct effects in maintaining gut mass (2) the gut is more responsive to amino acids compared to 5% dextrose, and (3) ileal 30% dextrose infusion leads to remote effects in the proximal gut, perhaps mediated by hormonal or neurovascular factors.

Amino Acids↗
PubMed1976

Small-bowel resection. Oral intake is the stimulus for hyperplasia.

Small-bowel resection leads to hyperplasia of the residual small intestine, However, the factors initiating small-bowel hyperplasia are not clearly understood, although oral intake either by direct contact with the small bowel or via hormonal or neurovascular factors has been suggested as the major stimulus. In order to determine whether oral intake is an obligatory prerequisite for small-intestinal hyperplasia, we compared rats one week after undergoing a 70-cm proximal intestinal resection with sham-operated animals. Resected, orally fed rats demonstrated small-intestinal hyperplasia, whereas resected and sham-operated intravenously alimented rats did not. There were no differences in gut weight, mucosal weight, mucosal protein, or DNA between resected or sham-operated intravenously alimented rats. These data provide direct experimental proof that oral intake is a necessary stimulus for small-intestinal hyperplasia after resection.

Animals↗