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Biomedical subjects

H J Sugerman

Publications and source records attributed to H J Sugerman.

At least 127 records · Page 7Linked to original sources
PubMed1990

Clinical predictors of infection of central venous catheters used for total parenteral nutrition.

To identify predictors of infection in catheters used for total parenteral nutrition (TPN), clinical and microbiological data were prospectively collected on 169 catheter systems (88 patients). Based on semiquantitative catheter cultures, infection was associated with a positive insertion site skin culture taken close to the time of catheter removal (relative risk [RR] = 4.50), especially one yielding greater than or equal to 50 colonies of an organism other than coagulase-negative staphylococci. Infection was also associated with erythema at the insertion site greater than 4 mm in diameter (RR = 2.93). In a subset of 67 catheters for which blood cultures were obtained, infection was also associated with a positive peripheral venous blood culture (RR = 5.90) and a positive central venous blood culture obtained through the catheter (RR = 5.44). Based on a logistic regression model, periodic cultures of the insertion site should be useful in evaluating subsequent fever in stable patients with indwelling central venous catheters. Another source of fever is likely if inflammation is absent and there is either no colonization or there is colonization by less than 50 colonies of coagulase-negative staphylococci at the insertion site. Conversely, the catheter should be removed and cultured semiquantitatively if the site is colonized by an organism other than coagulase-negative staphylococci. We suggest that blood culture results add little to the risk estimate in these situations.

Adult↗
PubMed1990

Gastrointestinal hormone responses to meals before and after gastric bypass and vertical banded gastroplasty.

The purpose of the study was to examine the gastrointestinal hormone responses to meals in morbidly obese patients before and after Roux-en-Y gastric bypass (GBP; n = 9) or vertical banded gastroplasty (VBG; n = 7). On consecutive days before and after operation, we measured changes in peripheral blood levels of glucose, insulin, enteroglucagon, serotonin, vasoactive intestinal polypeptide (VIP), and cholecystokinin (CCK) in response to a standardized glucose or protein-fat meal. The percentage of excess weight lost at 6 months after operation was 66.3% +/- 4% and 41.8% +/- 5% for GBP and VBG, respectively (p less than 0.01). The 3-hour integrated glucose response to a glucose meal decreased from 145.3 +/- 33.7 to 75.8 +/- 15.7 g min/L (p less than 0.02) after GBP. This was associated with a decrease in 3-hour integrated insulin response from 22.8 +/- 8.2 to 10.5 +/- 4.9 mU min/L. Vertical banded gastroplasty patients had lesser reductions of hyperglycemia and hyperinsulinemia. Neither the CCK, serotonin, nor VIP responses to meals were altered by either operation. The 3-hour integrated enteroglucagon response to glucose increased markedly in GBP patients after operation from 11.8 +/- 6 to 133.4 +/- 38 nmol min/mL (p less than 0.02). This increase in enteroglucagon occurred at the same time as development of dumping symptoms, which occurred exclusively in GBP patients after glucose but not protein. We conclude that (1) GBP surgery for morbid obesity results in amelioration of glucose intolerance and hyperinsulinemia, (2) CCK does not mediate an endocrine satiety effect of surgery, (3) GBP is associated with an exaggerated enteroglucagon response to glucose, and (4) enteroglucagon appears to be a marker of the dumping syndrome in GBP patients.

Adult↗
PubMed1990

Increased survival time after delayed histamine and prostaglandin blockade in a porcine model of severe sepsis-induced lung injury.

A combination of cimetidine, diphenhydramine, and ibuprofen has been shown to be an effective treatment in a porcine model of septic acute lung injury. The present study was designed to evaluate this therapy in a delayed treatment survival model. Three groups of animals were studied: a control group (C, n = 6) received a sham infusion of 0.9% saline; a septic group (Ps, n = 5) received a continuous infusion of live Pseudomonas aeruginosa organisms; and a treatment group (CID, n = 6) received P. aeruginosa plus cimetidine 150 mg, ibuprofen 12.5 mg/kg, and diphenhydramine 10 mg/kg given at 90 min after P. aeruginosa infusion, and hourly thereafter. Group Ps developed fulminant acute lung injury and hypodynamic septic shock. CID therapy ameliorated temporarily the progressive course of hypoxemia and increased extravascular lung water (EVLW), delayed the onset of cardiovascular deterioration, and improved significantly survival time. It was concluded that CID therapy given at 90 min after the onset of lethal continuous P. aeruginosa infusion improved significantly animal survival time by improving temporarily hypoxemia and increase in EVLW and delaying cardiovascular collapse.

Animals↗
PubMed1990

A prospective assessment of the Garren-Edwards Gastric Bubble and bariatric surgery in the treatment of morbid obesity.

Morbid obesity is a serious medical hazard, and effective alternatives to surgery have been unsuccessful. In 1985, the Garren-Edwards Gastric Bubble (GEGB) was offered as an adjunct to dietary and behavioral therapy for weight loss treatment. The safety and efficacy of the GEGB were compared with bariatric surgery, the current standard for the treatment of morbid obesity. Fifty-seven patients received GEGB and 77 underwent bariatric surgery. GEGB patients were divided into two groups: those who attended group therapy and those who did not. This study showed that bariatric surgery was far more effective in reducing excess body weight during a 12-month period compared with the GEGB plus group therapy and the GEGB alone. The morbidity from bariatric surgery was greater than in the GEGB-treated groups, while the cost for uncomplicated cases for a year's treatment was comparable. It is concluded that the GEGB does not offer an effective alternative to bariatric surgery in the treatment of morbid obesity.

Adult↗
PubMed1990

Ranitidine compared to cimetidine in multiagent pharmacological treatment of porcine Pseudomonas ARDS.

The effects of two pharmacologically distinct histamine H2 receptor antagonists were studied in combination with ibuprofen (I) and diphenhydramine (D) in a porcine model of septic ARDS. Cimetidine (C) is reported as having direct oxygen radical scavenging abilities and is an inhibitor of cytochrome P-450, whereas ranitidine (R) acts solely by H2 receptor blockade. Four groups were studied: Group Ps (n = 8) received a continuous infusion of live Pseudomonas aeruginosa 5 x 10(8) CFU/ml at 0.3 ml/20kg/min, Group C (n = 6) received a control saline infusion, and the treatment groups received I (12.5 mg/kg) and D (10 mg/kg) in combination with either C (150 mg, CID, n = 6) or R (25 mg, RID, n = 5) given at 20 and 120 minutes after the onset of Ps. Pulmonary (PAP) and systemic (SAP) arterial pressures, cardiac index (CI), PaO2, thermal cardiogreen extravascular lung water (EVLW) and scintigraphically determined pulmonary albumin flux (slope index, SI) were measured. Ps infusion produced significant (p less than 0.05) cardiovascular collapse, hypoxemia and increased EVLW and SI. Both CID and RID temporarily reversed pulmonary arterial hypertension and maintained PaO2, EVLW, SAP and CI at control levels throughout the study, and significantly improved SI at 180 min. These results suggest that cimetidine and ranitidine act in this combination therapy primarily as H2 receptor antagonists.

Animals↗
PubMed1989

Weight loss with vertical banded gastroplasty and Roux-Y gastric bypass for morbid obesity with selective versus random assignment.

In a previous study, Roux-Y gastric bypass was found to be significantly more effective than vertical banded gastroplasty for weight loss in morbid obesity, especially for patients addicted to sweets, probably as a result of dumping syndrome symptoms. This study evaluated the ability to selectively assign nonsweet eaters to vertical banded gastroplasty and sweet eaters to gastric bypass. Compared with random assignment, the percentage excess weight lost at 2 years improved significantly with both groups combined. In the vertical banded gastroplasty group, the percentage increased from 41 +/- 19 to 55 +/- 19 percent. With selective assignment, the percentage excess weight lost with gastric bypass was still better than that with vertical banded gastroplasty. Weight loss with gastric bypass was still superior to that of vertical banded gastroplasty but at the expense of more complications. Gastric bypass was ineffective in 19 percent of the super obese patients. A combined restrictive, malabsorptive procedure may be necessary in such persons.

Anastomosis, Roux-en-Y↗
PubMed1989

Sulindac-induced acute pancreatitis mimicking gallstone pancreatitis.

Two patients with sulindac-induced acute pancreatitis presented clinically with abdominal pain, right upper-quadrant tenderness, markedly increased serum amylase values, and hyperbilirubinemia, findings initially suggestive of gallstone pancreatitis. Ultrasound examinations were negative for gallstones. One patient was inadvertently treated two years later with sulindac with recurrence of abdominal pain, marked hyperamylasemia, and jaundice. Clinical resolution was rapid with each episode following discontinuation of sulindac.

Acute Disease↗
PubMed1988

Hemodynamic dysfunction in obesity hypoventilation syndrome and the effects of treatment with surgically induced weight loss.

Obesity hypoventilation syndrome (OHS), defined as a PaO2 less than or equal to 55 mmHg and/or PaCo2 greater than or equal to 47 mmHg, was found in approximately 8% of morbidly obese patients undergoing gastric surgery for morbid obesity and was frequently associated with clinically significant pulmonary hypertension and cardiac dysfunction. Forty-six morbidly obese patients, 26 with and 20 without OHS, underwent preoperative pulmonary artery catheterization. Although the two groups had similar values for percent ideal body weight, blood pressure, and cardiac index, the OHS patients had significantly higher mean pulmonary artery pressures (PAP), p less than 0.0001, and pulmonary artery occlusion pressures (PAOP), p less than 0.01. Eighteen OHS patients were restudied 3-9 months after gastric surgery. PaO2 increased from 50 +/- 10 to 69 +/- 14 mmHg, p less than 0.0001, and PaCO2 decreased from 52 +/- 7 to 42 +/- 4 mmHg, p less than 0.0001), after the loss of 42 +/- 19% excess weight. These changes were associated with significant decreases in PAP (from 36 +/- 14 to 23 +/- 7 mmHg, p less than 0.0001) and PAOP (from 17 +/- 7 to 12 +/- 6 mmHg, p less than 0.01). Significant correlations were noted between PAP and PAOP (r = +0.8, p less than 0.0001) and PAP and PaO2 (r = -0.6, p less than 0.0001). Both left ventricular dysfunction, defined as a PAOP greater than or equal to 18 mmHg, as well as pulmonary artery vasoconstriction, defined as PAEDP greater than 5 mmHg above PAOP, contributed to pulmonary hypertension in OHS patients. In conclusion, weight loss after gastric surgery for morbid obesity significantly improved arterial blood gases and hemodynamic function in OHS patients.

Adult↗
PubMed1988

Vitamin E, vitamin B-6, vitamin B-12, and folate status of gastric bypass surgery patients.

The vitamin E, vitamin B-6, vitamin B-12, and folate status of 22 gastric bypass subjects aged 23 to 60 years was evaluated before surgery and at 6 and 12 months after surgery. Before surgery, 77% of subjects had adequate plasma vitamin E levels; 36%, adequate plasma pyridoxal phosphate levels; 100%, adequate plasma vitamin B-12 levels; and 45%, adequate plasma folate levels. The food intake of all subjects was sharply reduced after surgery. After surgery, subjects were classified into three vitamin supplement groups on the basis of average daily vitamin supplement intake. Subjects taking higher levels of supplements containing the vitamins in question had significantly higher plasma concentrations of the vitamins than those taking low or moderate levels. The mean plasma vitamin values in the moderate supplement group were indicative of adequate status for all vitamins, but plasma vitamin B-12 levels at 12 months post-surgery were significantly lower than pre-surgery levels. In the low supplement group, mean plasma vitamin levels were in or near marginal or deficient ranges. The majority of subjects consuming supplements of vitamin E, vitamin B-6, and folate near the US RDA maintained normal vitamin status. Subjects taking more than 100 micrograms vitamin B-12 daily had adequate vitamin B-12 status. Significant correlations (r = .67 to .94) were observed between vitamin supplement levels and the respective plasma vitamin concentrations.

Adult↗
PubMed1987

Single-dose antibiotic prophylaxis for biliary surgery. Cefazolin vs moxalactam.

Cefazolin was compared with moxalactam for single-dose prophylaxis against infection in a double-blind, prospective, randomized trial of 90 patients undergoing cholecystectomy. Risk factors for infection were present in 65 (72%) of the 90 patients and were evenly distributed. Antibiotic levels in plasma, bile, and tissue measured when the cystic duct was divided were similar for both drugs. Age greater than 65 years but not recent cholecystitis or type of antibiotic was predictive of recovery of bacteria from bile cultures. Wound infections occurred in two patients receiving cefazolin and one patient receiving moxalactam for an overall infection rate of 3%. No toxic reactions to antibiotics, including bleeding disorders, were observed. In conclusion, no significant difference in prophylactic efficacy was detected in this comparison of a first-generation with a third-generation cephalosporin. Because of its lower cost and narrower antimicrobial spectrum, however, cefazolin should remain the agent of choice.

Adult↗
PubMed1987

Serotonin receptor blockade improves cardiac output and hypoxia in porcine ARDS.

The effects of the serotonin receptor blocker, ketanserin, were studied in a porcine Pseudomonas adult respiratory distress syndrome model. Swine, weighing 14-30 kg, were anesthetized and ventilated with 0.5 FiO2 and 5 cm H2O positive end expiratory pressure. Three groups were studied: saline control (C, n = 9), continuous intravenous Pseudomonas aeruginosa, 5.0 X 10(8)CFU/kg/min (Ps, n = 8), and Pseudomonas and intravenous ketanserin, 0.2 mg/kg, given at 20 and 120 min after the onset of the Pseudomonas infusion (KET, n = 5). Pulmonary arterial (PAP) and systemic arterial (SAP) pressures, cardiac index (CI), thermal Cardio-Green extravascular lung water (EVLW), pulmonary albumin flux (slope index, SI), arterial blood gases, and whole blood serotonin levels were measured and pulmonary shunt and pulmonary (PVRI) and systemic (SVRI) vascular resistance indices were calculated. At 3 hr the Ps group demonstrated significant (P less than 0.05) increases in PAP (34 +/- 1 vs C 13 +/- 2 mm Hg), EVLW (14.4 +/- 2.2 vs C 4.3 +/- 1.2 ml/kg), SI (2.05 +/- 0.23 X 10(-3) vs C 0.38 +/- 0.09 X 10(-3) U/min), pulmonary shunt (67 +/- 15% vs C 9 +/- 3%), PVRI (1599 +/- 89 vs C 184 +/- 14 dyn X sec X cm-5/m2), and SVRI (4542 +/- 774 vs C 2087 +/- 129 dyn X sec X cm-5/m2) and decreases in CI (0.9 +/- 0.1 L/min/m2 vs C 2.8 +/- 0.2 L/min/m2), PaO2 (93 +/- 17 Torr vs C 203 +/- 15 Torr) and arterial blood serotonin concentration (23.5 +/- 13% decrease from basal). Treatment with ketanserin was associated with maintenance of PaO2 (KET 207 +/- 5 mm Hg vs C 203 +/- 15 mm Hg), pulmonary shunt (KET 8 +/- 3% vs C 9 +/- 3%), and CI (KET 2.3 +/- 0.1 L/min/m2 vs C 2.8 +/- 0.2 L/min/m2) at control levels and attenuated the Pseudomonas-induced increase in PVRI (873 +/- 37 vs Ps 1599 +/- 89 dyn X sec X cm-5/m2) and SVRI (2089 +/- 287 vs Ps 4542 +/- 774 dyn X sec X cm-5/m2), but did not alter the development of pulmonary edema. These data indicate that serotonin plays a role in the development of the V/Q mismatch and arterial hypoxemia observed in this model by a mechanism independent of changes in microvascular injury and permeability and was probably a result of reduced peripheral bronchiolar constriction.

Animals↗
PubMed1987

A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters.

Vertical banded gastroplasty (VBGP) was compared with Roux-en-Y gastric bypass (RYGBP) in a randomized prospective trial that included preoperative dietary separation of "sweets eaters" versus "non-sweets eaters." Randomization was stopped at 9 months after 20 patients had undergone each procedure because a greater weight loss (p less than 0.05) was noted after RYGBP than VBGP. This difference became more significant (p less than 0.001) at each 3-month interval through 3 years, when patients who had VBGPs had lost 37 +/- 20% of excess weight compared with 64 +/- 19% for patients who had RYGBPs. The members of the groups were comparable with regard to age, sex, eating habits, morbidity rates before surgery, ideal body weight, and weight before surgery. Although there was no significant difference between the loss of excess weight in "sweets eaters" (69 +/- 17%) or "non-sweets eaters" (67 +/- 17%) after RYGBP at 1 year, "sweets eaters" who had VBGPs lost significantly less excess weight (36 +/- 13%) than did "non-sweets eaters" who had VBGPs (57 +/- 18%), p less than 0.02, or "sweets eaters" who had RYGBPs, p less than 0.0001. No significant differences were noted for electrolytes, renal or liver function tests, and most vitamins between patients who had VBGPs and RYGBPs; however, patients who had RYGBPs had lower (p less than 0.05) serum vitamin B12 levels (286 +/- 149 pg/dl) than did patients who had VBGPs (461 +/- 226 pg/dl) at 2 years. By 3 years, the vitamin B12 levels were equal in members of the two groups. Five patients who had RYGBPs required endoscopic stomal dilatation for stomal stenosis and one had a marginal ulcer develop, which responded to cimetidine. RYGBP was clearly superior to VBGP for "sweets eaters," probably because of the development of dumping syndrome symptoms. However, RYGBP was associated with a larger number of correctable problems. Thus, it is important to evaluate a patient's eating habits before surgery for morbid obesity; "non-sweets eaters" probably should be treated with VBGP and "sweets eaters" with RYGBP.

Clinical Trials as Topic↗
PubMed1987

Treatment of porcine Pseudomonas ARDS with combination drug therapy.

A combination drug therapy (Poly-5: ibuprofen 12.5 mg/kg, methylprednisolone 30 mg/kg, cimetidine 150 mg, diphenhydramine 10 mg/kg, and ketanserin 0.2 mg/kg) given at 20 and 120 minutes after starting continuous intravenous Pseudomonas (Ps, 5 X 10(8) CFU/20 kg/min) was studied in three groups of swine: saline control (C, n = 9), Ps alone (Ps, n = 8), and Ps plus Poly-5 (n = 5). PaO2, systemic (SAP) and pulmonary arterial (PAP) pressures, cardiac index (CI), thermal-cardiogreen extravascular lung water (EVLW), pulmonary albumin flux (slope index, SI), and arterial blood serotonin levels (5-HT) were measured. Ps produced significant (p less than 0.05) increases in PAP, EVLW, and SI with decreases in PaO2, CI, and SAP. 5-HT fell significantly compared to baseline. Poly-5 prevented (p less than 0.05) the rise in EVLW and SI and the fall in PaO2 and CI compared to Ps. PAP and SI were maintained at C until 90 and 150 minutes, respectively. SAP fell significantly from C at 30, 60, and 180 minutes. 5-HT was significantly lower than Ps throughout, and significantly lower than baseline at 180 minutes. Combined blockade of arachidonic acid metabolites, histamine, and serotonin receptors prevented hypoxemia, increased pulmonary capillary permeability, and cardiovascular deterioration in this porcine septic ARDS model.

Animals↗
PubMed1987

Successful treatment of adult respiratory distress syndrome by histamine and prostaglandin blockade in a porcine Pseudomonas model.

Porcine Pseudomonas adult respiratory distress syndrome (ARDS) has been shown to respond to combination therapy of 150 mg of cimetidine, 12.5 mg/kg of ibuprofen, 10 mg/kg of diphenhydramine, 0.2 mg/kg of ketanserin, and 30 mg/kg of methylprednisolone (CIDKM or Poly-5) given at 20 and 120 minutes after the onset of a continuous infusion of liver Pseudomonas aeruginosa, 5 X 10(8) colony-forming units (CFU) ml at 0.3 ml/20 kg/min. The present study was designed to determine the minimal, effective therapy by selective deletion of individual agents from CIDKM. Eight groups were studied: saline control (S, n = 9), Pseudomonas control (P, n = 8), and the following Pseudomonas plus treatment groups (each n = 5): CIDKM (cimetidine, ibuprofen, diphenhydramine, and ketanserin), CID (cimetidine, ibuprofen, and diphenhydramine), IC (ibuprofen and cimetidine), ID (ibuprofen and diphenhydramine), and CD (cimetidine and diphenhydramine). Pseudomonas alone produced severe ARDS with significant (p less than .05) decreases in PAO2 cardiac index, and systemic arterial pressure and significant increases in pulmonary artery pressure, extravascular lung water (EVLW) and scintigraphically determined pulmonary albumin flux measured as slope index (SI). Full therapy, CIDKM or Poly-5, showed significant improvement in all parameters. Deletion of methylprednisolone did not significantly effect any parameter measured. The deletion of ketanserin, leaving CID, did not alter treatment efficacy, except for a significant decline in cardiac index at 3 hours. Deletion of ibuprofen from CID resulted in a failure to reverse pulmonary arterial hypertension, hypoxemia, elevated EVLW, and increased SI. Removal of either cimetidine or diphenhydramine from CID resulted in significant increases in EVLW compared with control levels and SI compared with both control levels and CID. These results indicate that a combination of both histamine H1 and H2 receptor blockers and the cyclooxygenase inhibitor, ibuprofen, is effective and essential in the treatment of hypoxemia, early pulmonary hypertension, and pulmonary microvascular injury in this fulminant model of porcine Pseudomonas ARDS.

Animals↗