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Biomedical subjects

J R Kirkpatrick

Publications and source records attributed to J R Kirkpatrick.

At least 19 recordsLinked to original sources
PubMed1995

Peritoneovenous shunt for palliation of gynecologic malignant ascites.

BACKGROUND: Ascites is a common sequela of advanced or recurrent gynecologic malignancies, such as carcinoma of the ovary, fallopian tube, or endometrium. Symptomatic treatment with repeated paracentesis is the initial management after failure of chemotherapy. STUDY DESIGN: This study was done to evaluate the safety and effectiveness of a peritoneovenous shunt (PVS) in the palliation of these patients with recurrent ascites. A retrospective review of 25 patients having a PVS between 1982 and 1992 was performed. RESULTS: The 25 patients consisted of 21 patients with carcinoma of the ovary, two with primary carcinoma of the peritoneum, one with carcinoma of the endometrium, and one patient with carcinoma of the fallopian tube. The mean weight and abdominal girth decreased after shunt insertion (p < 0.001). Gastrointestinal dysfunction and dyspnea also improved with PVS insertion. There was no change in mean Karnofsky score after placement of a PVS. Two patients died within ten days postoperatively. The median survival period was 80 days and shunt occlusion occurred in four patients. CONCLUSIONS: The insertion of a PVS is effective in relieving refractory malignant ascites in gynecologic malignancies. The impact on quality of life requires further study.

Ascites↗
PubMed1991

Prevention of central venous catheter sepsis: a prospective randomized trial.

A prospective randomized trial was undertaken to evaluate the influence of routine 72-hour catheter exchange and the use of an implantable collagen cuff in preventing central venous catheter infection in critically ill patients requiring multiple lumen central venous access. Patients were randomized to one of four groups, which determined whether the central venous catheter placed would be removed at 3 or 7 days and whether an implantable collagen cuff would be used or not. Upon removal, cultures of the central line tip, the insertion site, and peripheral blood were obtained. One hundred and fifty-nine catheters were studied in 85 patients during a 14-month period. There were 26 (16.4%) episodes of catheter colonization and four (2.5%) episodes of catheter infection in the entire population. Catheter colonization rates (same organisms cultured from catheter tip and skin site) were 14.5 per cent at 3 days and 18.4 per cent at 7 days. Infection rates (same organism cultured from catheter tip and peripheral blood culture) were 2.4 per cent at 3 days and 2.6 per cent at 7 days. With regard to the use of the collagen cuff, colonization rates were 14.5 per cent with the use of the cuff and 18.1 per cent without the use of the cuff. Infection rates were 5.3 per cent with the use of the cuff and 0 per cent without the use of the cuff. None of these differences reached statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMed1990

Endotoxin and calcium effect on metabolism.

The effects of calcium and endotoxin were investigated in vivo and in vitro using the A/J, retired white male breeder mouse model. Intravenous administration of increasing calcium doses (3.75, 4.37, and 4.75 mg Ca/g-BW) resulted in increasing serum calcium levels (11.4, 14.4, 15.2, respectively vs. animals not injected, 9.5 mg/dl). Mice injected with E. coli bacterial endotoxin after injection of calcium demonstrated significantly (P less than 0.05) lowered serum calcium concentrations (10.5, 12.1, 12.5, respectively). The magnitude of serum calcium reduction was related to the level just prior to endotoxin administration. Mitochondria were incubated using a Percoll purification step. The effect of pretreating the animal in vivo with calcium, endotoxin or calcium plus endotoxin versus control was investigated in both liver and skeletal muscle. When mitochondria were incubated in medium containing EGTA (free Ca less than 1 X 10(-9)). no significant difference between groups was observed in either (RCR) or mitochondrial calcium content. When mitochondria were incubated in EGTA buffers containing calcium (free Ca approximately 7 X 10(-7) liver, 1 X 10(-7) muscle) significant differences in RCR and mitochondrial calcium content were observed. Liver RCR increased significantly with calcium or endotoxin pretreatment (2.20, 2.43 vs. 1.86). Muscle mitochondrial RCR significantly decreased with calcium administration (5.02 vs. 6.79). Both liver and muscle mitochondrial calcium content significantly decreased (2.54 vs. 27.32, and 6.46 vs. 25.82 nMole Ca/mg mitochondrial protein). Preloading with calcium prevented the decline in mitochondrial calcium content. Findings suggest that the reduction in intramitochondrial calcium content during endotoxemia could be an effector of metabolic derangement specifically through calcium-dependent intramitochondrial enzymes.

Animals↗
PubMed1988

Enhancement of mitochondrial function in sepsis.

Recent reports from our laboratory have challenged the concept that sepsis selectively damages or interferes with mitochondrial function. To address the lingering skepticism that mitochondrial assays in surviving animals might not detect this "injury," we injected rats with a lethal dose of Escherichia coli endotoxin and compared hepatic, cardiac, and skeletal muscle mitochondrial function in these animals with that of control rats. Mitochondrial function was serially determined during a four-hour postmortem period by measuring the respiratory control ratio, the adenosine diphosphate-oxygen ratio, and protein levels. Hepatic mitochondria ceased to function within 30 minutes of the time of death. Cardiac and skeletal muscle mitochondria functioned normally up to four hours after death in both septic and control animals. Mitochondria from septic animals had a significantly higher respiratory control ratio than those from control rats. Thus, sepsis appears to enhance rather than damage mitochondrial function up to four hours after death.

Animals↗
PubMed1987

Jejunoileal bypass. A legacy of late complications.

Since 1977, we have managed 56 patients (36 Payne and 20 Scott bypasses) with late (one to 18 years) complications resulting from a jejunoileal bypass. All patients underwent a one-stage conversion of the jejunoileal bypass to a gastric bypass. Patients were classified according to postbypass weight, the need for nutritional support, the type and severity of complication, and the time interval between jejunoileal bypass and the onset of the complication and correction of the complication. There were no operative deaths; one patient died 18 months after surgery of cirrhosis. The complication rate was 34%; however, most complications were minor. Our experience with this procedure has shown it to be highly effective in correcting complications other than polyarthritis. When coupled with nutritional support, it is safe even in malnourished patients.

Adult↗
PubMed1985

The relationship of insulin production to glucose metabolism in severe sepsis.

Basal glucose metabolism was evaluated in eight stable, infected patients by measuring hepatic glucose production rates in relation to stress endocrine profile and by comparing these data to five injured, noninfected patients. All patients exhibited normal total-body oxygen consumptions and cardiac indices. Fasting basal insulin values were similar in both groups (6 microU/cc) despite a significantly higher plasma glucose level in septic patients (106 +/- 14 mg/dL) compared to nonseptic patients (88 +/- 10 mg/dL). Septic patients exhibited splanchnic glucose production and calculated glucose clearance rates, 53% and 34% higher, than injured nonseptic patients, respectively. In addition, septic patients exhibited a decreased pancreatic insulin secretory response to an intravenous glucose tolerance test as evidenced by a significantly depressed peak insulin value (17 microU/cc) relative to injured patients (77 microU/cc). These findings indicate that insulin suppression is evident in sepsis even in the absence of shock and suggest that sepsis-related basal hyperglycemia does not appear to be associated with peripheral insulin resistance.

Aged↗
PubMed1985

The significance of hypoalbuminemia following injury and infection.

Serum albumin and absolute hepatic albumin synthetic rates were measured in ten seriously ill injured and septic patients using the (14C) carbonate technique. Although it is commonly believed that serum albumin levels (SAL) reflect hepatic function and visceral protein status in hospitalized patients, no relationship was found between these two measured parameters in this patient population. A depressed mean serum albumin level of 1.98 +/- 0.50 gm/dl (range: 1.25-2.69 gm/dl) was associated with a supranormal mean albumin synthetic rate of 215 +/- 121 mg/kg/day (range: 21-447 mg/kg/d). No significant mean SAL and albumin synthetic rate differences were noted between injured nonseptic and septic patient populations. Since albumin synthesis was elevated in most of these stressed patients these findings support the view that extravascular protein redistribution and/or increased peripheral catabolism are the major factors responsible for hypoalbuminemia in critically ill patients.

Aged↗
PubMed1984

Gastrojejunal disruptions. Changing concepts in management.

From 1973 through 1983, 197 patients were treated at Harper-Grace Hospital, Detroit, according to a protocol designed to minimize the effects of possible gastrojejunal disruption. All had high-risk resections or bypasses of the stomach reconstructed with an end-to-end Roux-en-Y anastomosis using a long (100-cm) jejunal limb. Eighteen anastomoses leaked, producing fever, pain, and mild respiratory distress in 14 patients and peritonitis with shock in four. Nine of the 14 patients without shock avoided surgery, requiring only antibiotics and nutritional support. The other five had a subphrenic abscess, necessitating drainage. The four patients with shock were treated with staged intestinal discontinuity, nutritional support, and reestablishment of gastrointestinal continuity at a later date. Seventeen patients (94%) survived this serious complication, a significant improvement compared with the mortality of historical controls.

Humans↗
PubMed1983

Substrate composition and sepsis. Effects on immunity.

A randomized prospective study was performed to determine the effects of substrate composition on immunity in septic malnourished patients. A balanced substrate formula was administered to 11 patients with sepsis and 11 nonseptic patients. This provided 40 kcal/kg/day and 1 to 1.5 g of protein per kilogram each day with a carbohydrate-nitrogen ratio of 50:1. A 25% dextrose and 4.25% protein solution that provided 50 kcal/kg/day and 1 to 1.5 g of protein per kilogram each day with a carbohydrate-nitrogen ratio of 150:1 was provided to ten patients with sepsis and 11 without. Skin test conversion rates were not affected by substrate composition; however, the absolute lymphocyte count was significantly improved in septic patients who achieved positive nitrogen balance, regardless of the nutritional support regimen used. These findings suggest that substrate composition per se has no effect on immunologic responsiveness.

Amino Acids↗
PubMed1983

Aortocolic fistula: a rare cause of profuse rectal bleeding.

A 62-year-old man with multiple myeloma survived for 19 months following massive hemorrhage from an aortocolic fistula secondary to an aortoiliac aneurysm that was adherent to the sigmoid colon. The literature indicates that early death from multisystem failure is to be expected and that sepsis is an inevitable consequence of aortocolic fistula. However, in this case the patient did not die despite multisystem complications and his eventual death was unrelated to sepsis or graft complications. Reasons for the unexpected outcome are suggested. No survivors have been reported in the literature.

Aged↗
PubMed1982

Critical determinants of a successful gastric bypass: reservoir versus stoma.

Most investigators have emphasized that both a small reservoir and a narrow stoma are critical to the success of a gastric bypass. This prospective study was performed to test this clinical hypothesis. All patients had a similar 30-45 ml proximal gastric reservoir created; however, stoma size was determined by the lumen of the jejunum, averaging 3.2 cm in cross-sectional diameter. We found that stoma size had little effect on the success of the gastric bypass if a tiny (less than 45 ml) reservoir was consistently created and a Roux-en-Y anastomosis was used for reestablishing intestinal continuity. The avoidance of a small stoma virtually eliminates postbypass emesis as a major complication.

Adult↗
PubMed1981

Selective versus standard hyperalimentation. A randomized prospective study.

Fifty consecutive surgical patients were included in a randomized prospective study to determine the relative advantages and disadvantages of two types of nutritional support systems: one, selective hyperalimentation, relies on a balanced substrate formula, while the other, standard hyperalimentation, depends on carbohydrate and protein to satisfy the energy requirements of the patient. The patients who received the balanced substrate formula had significantly fewer complications than those receiving standard hyperalimentation, even though both groups achieved positive energy and nitrogen balance. The enhanced safety of selective hyperalimentation suggests its therapeutic superiority as a basic nutritional support system for a busy surgical service.

Glucose↗
PubMed1981

The therapeutic advantages of a balanced nutritional support system.

Twenty-two critically ill patients were entered into a 21-day prospective study to evaluate the feasibility of relying on a balanced nutritional support system to satisfy the needs of a diverse group of surgical patients. No patient sustained a serious complication related to glucose metabolism, and only two patients required insulin. Twenty-one of the patients achieved positive nitrogen balance during the study, and 13 had a significant weight gain not related to water retention. Documented sepsis was present in 50% of the patients but in spite of this, 91% had a successful course of therapy. The ease of management and metabolic efficiency of this approach encourages the use of fat as a primary energy substrate in a balanced nutritional support system to restore positive energy and nitrogen balance.

Adult↗
PubMed1981

The effect of nutritional support on immune competency in patients suffering from trauma, sepsis, or malignant disease.

Thirty-nine patients, 25 of whom were suffering from trauma, sepsis, or malignant disease, were studied prospectively to determine the immunologic value of improved protein-calorie balance in this setting. All were suffering from varying degrees of malnutrition, and 72% (P less than 0.05) of the patients with anergy-inducing disease processes were anergic at the time of evaluation. In the presence of disease-induced anergy, skin test reactivity was not helpful in measuring the therapeutic response to nutritional support; among severely wasted patients, significant elevations in absolute lymphocyte count and serum albumin suggest that these are useful parameters when following the severely wasted patient who has concomitant trauma, sepsis, or malignant disease.

Humans↗
PubMed1981

Glucose-dependent changes in growth hormone regulation associated with sepsis.

Major alterations in the glucose-mediated regulation of growth hormone are associated with sepsis; however, these alterations are not related to the rate of change in plasma glucose or changes in glucagon, epinephrine levels, or circulating levels of arginine. Alterations in the growth hormone regulatory mechanism occurred among septic patients who manifested severe glucose intolerance which was associated with suppression of insulin production. Inhibition of growth hormone release in these patients may have an adverse effect on amino acid movement, which lends further support to the concept that sustained hyperglycemia in the septic patient is undesirable.

Adult↗