PubMed Health⌕ Search

Biomedical subjects

K Sriram

Publications and source records attributed to K Sriram.

11 recordsLinked to original sources
PubMed1989

Absorption of cobalamin (vitamin B12) administered via jejunostomy.

Absorption of cobalamin (Cbl) administered via feeding jejunostomy (J) was compared with that given by mouth (PO) to study the role of transgastric passage in its binding to gastric Intrinsic Factor and subsequent ileal absorption. Modified Schilling tests were performed on 10 patients, each patient serving as his own control. A labeled Cbl capsule was dissolved in 10 cc of water, 7 cc (containing approximately 0.4 microCi 57Co) measured in a syringe and administered PO or via J, followed by 30 cc of water. The remaining solution was used for counting. Starting 1 hour later, following 1 mg of IM cyano-Cbl USP to saturate body storage sites of Cbl, urine was accurately collected for 24 hours and a 4-ml aliquot analyzed for 57Co. Results are expressed as % of tracer excreted in the urine (normal: greater than 7%). The test was repeated in 1 week through the alternate route using the identical protocol. In the eight patients in whom results could be analyzed, absorption was 21.18 +/- 5.83% in J group (range: 5.8-51.9%) and 9.75 +/- 2.62% in PO group (range: 1.9-24.2%). This difference was highly significant p = 0.02) using the paired Student's t-test. Route of the first test (PO or J) made no difference. It is concluded that cobalamin (vitamin B12) administered via jejunostomy is absorbed to a degree significantly greater than that given by mouth.

Administration, Oral↗
PubMed1989

Clinical zinc deficiency during adequate enteral nutrition.

Deficiency of zinc (Zn), resulting in characteristic skin changes resembling those seen in acrodermatitis enteropathica, has been reported in patients on total parenteral nutrition, but rarely in patients on long-term enteral feeding. Reported here is a patient who developed characteristic skin changes while he was receiving what was considered to be a balanced liquid enteral diet. The skin rash resolved with Zn supplementation.

Enteral Nutrition↗
PubMed1989

The continent gastrostomy.

In an attempt to facilitate long-term care and patient acceptance of gastrostomy feeding, the technique of permanent Janeway gastrostomy was modified. Using an auto-stapling device, a full-thickness gastric tube (6 cm long and 1.5 cm in diameter at its base) is created from the anterior wall of the stomach, based on the greater curve, with special attention to its vasculature. The base is invaginated into the stomach wall to create a tight valve. After skin closure, the terminal 1 cm is excised and the mucosa is sutured flush with the skin. A #10 French tube is inserted and positioned perpendicularly. A gastrostomy thus created will allow intermittent cannulation without leakage of gastric contents. Results of this procedure in 26 patients show a postoperative wound infection incidence of 3.8 per cent. With a mean follow up of 257 days, the gastrostomy was continent in 87 per cent of patients.

Gastrostomy↗
PubMed1979

Phenothiazine effect on gastrointestinal tract function.

Clinical evidence indicates that phenothiazines, specifically chlorpromazine (CPZ), used extensively in the treatment of patients with mental and/or neurologic disorders produce an ileus characterized by pseudoobstruction with an extended barium transit time of eight to ten days. Postoperatively, these patients have a protracted ileus, lasting from ten to fourteen days. In our present study we investigated the mechanism of action by which phenothiazines block gastrointestinal tract function as well as the possible reversal of this effect by pharmacologic agents. Guinea pigs were injected intraperitoneally with CPZ at a dose of 30 mg/kg/day for five to seventeen days. This caused deleterious effects in the gastrointestinal tract, such as cessation of peristalsis of small intestine and colon, and marked distension of the cecum. In vitro pharmacologic studies were performed on the electrically stimulated longitudinal muscle-myenteric plexus of the guinea pigs. We found that phenothiazines interfered with the neuromuscular mechanism of the intestine, as exemplified by a lack of response to electrical current stimulation. The effect was protracted, lasting at least 24 hours. These effects were reversed by the administration of the anticholinesterase, physostigmine (PGM), provided the block was less than 80 per cent. The paralytic ileus produced was similar to that found in man.

Animals↗
PubMed1975

Acute neurological complications in the treatment of scoliosis. A report of the Scoliosis Research Society.

A survey conducted by the Scoliosis Research Society found eighty-seven patients with acute neurological complications resulting from the treatment of scoliosis. The incidence of these complications was determined to be 0.72 per cent. Seventy-four major complications involving the spinal cord were reported, half of them complete paraplegia and half partial paraplegia. Thirty-six per cent recovered completely, 32 per cent had partial recovery, and 32 per cent had no return of function. Thirteen minor complications involving cranial and peripheral nerves were reported. Major complications occurred in forty-two cases of posterior spine fusion with Harrington instrumentation and in twenty cases of posterior spine fusion without instrumentation. Six patients became paraplegic following skeletal traction alone.

Adolescent↗
PubMedDate not supplied

Neutropenia due to copper deficiency in total parenteral nutrition.

Copper (Cu) deficiency has been reported both in pediatric and adult patients on total parenteral nutrition (TPN). Manifestations of Cu deficiency are usually hematologic in the adult. A 56-yr-old patient with a history of subtotal gastrectomy underwent massive small bowel resection and partial colectomy in 1977. TPN was initiated. Intravenous (iv) trace mineral supplements were not available in 1977 at our institution. By June 1978, the patient manifested neutropenia with a white blood cell (WBC) count of 2000/mm3 and 39% neutrophils or a total neutrophil count (TNC) of 780/mm3. The serum Cu level at that time was 5 micrograms/dl (normal, 70-140), and the serum zinc (Zn) level was low, although within normal limits. Oral supplementation with Cu and Zn tablets proved ineffective. Twice weekly infusions of fresh frozen plasma were begun in April 1979, and intravenous chromium supplementation started in September 1979, but neither the WBC count nor the TNC improved. Intravenous Cu and Zn were approved in October 1979, and were added to the TPN formula. Within 2 weeks, the WBC count rose to 6300/mm3, and the neutrophils increased to 83% with a TNC of 5229. After 12 weeks, the serum Cu level rose to 80 micrograms/dl. The increase in WBC count and percentage of neutrophils can be attributed to the addition of Cu to the TPN infusate.

Agranulocytosis↗