Biomedical subjects

L Flancbaum

Publications and source records attributed to L Flancbaum.

At least 55 records · Page 3Linked to original sources

PubMed1991

Limitations of percutaneous catheter drainage of abdominal abscesses.

During the past eight years, 119 patients with abdominal abscesses underwent percutaneous catheter drainage (PCD), including 76 who had successful treatment by the initial PCD, 19 who had recurrent abscesses after removal of drainage catheters and 24 who were outright failures and either died of sepsis or required surgical drainage. This study was designed to identify outcome variables that might be used prospectively to assess the therapeutic efficacy of PCD. Outcome variables included abscess size, daily drainage volume and location, presence of a gastrointestinal fistula, age, bacteriologic factors and response of the pulse rate, body temperature and leukocyte count of the patient to PCD. Ninety of 119 patients (76 per cent) ultimately had successful drainage of abscesses by PCD alone. The over-all mortality rate was 16 per cent (19 of 119), with a 75 per cent mortality rate in the failure group. Neither abscess size, bacteriologic findings nor pulse rate correlated with outcome. PCD failure was significantly greater in patients greater than or equal to 60 years (p less than or equal to 0.01) and in patients with pancreatic abscesses versus other locations (p less than or equal to 0.04). Drainage volume was significantly greater in PCD failures than among PCD successes at greater than or equal to 3 days after PCD (p less than or equal to 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗

PubMed1991

Hepatic portal venous gas identified by computed tomography in a patient with blunt abdominal trauma: a case report.

An abdominal computed tomographic (CT) scan in a middle-aged man injured in a high-speed motor vehicle accident demonstrated the presence of portal venous gas. Findings on initial peritoneal lavage were entirely negative. Exploratory celiotomy performed because of increasing abdominal pain and leukocytosis revealed gangrene of the cecum. This report illustrates the importance of the finding of portal venous gas on CT scan in patients with blunt abdominal trauma.

Abdominal Injuries↗

PubMed1990

The presence and significance of carnosine in histamine-containing tissues of several mammalian species.

Histamine is known to exert profound effects on the cardiovascular system in many mammals. Carnosine (beta-alanyl-L-histidine) is a dipeptide previously known to be present only in a few tissues. It is our hypothesis that carnosine serves as a non-mast cell reservoir for histidine, available for histamine synthesis during periods of physiologic stress. To validate this hypothesis, we demonstrated the existence of carnosine in multiple histamine-rich tissues in several mammalian species; documented a metabolic link between carnosine and histidine, histamine and 3-methylhistamine (a degradation product of histamine) in unstressed animals, and showed that tissue carnosine is decreased simultaneously with an increase in tissue histamine during stress.

Animals↗

PubMed1990

Effect of histamine antagonists on myocardial carcinine metabolism during compound 48/80-induced shock.

Carcinine (beta-alanylhistamine) is an imidazole dipeptide that exists in mammalian hearts, increases cardiac contractility, and is metabolically linked to carnosine (beta-alanylhistidine), a non-mast cell histidine and histamine precursor during stress. We have previously shown that tissue carnosine levels are regulated by H1 and H2 receptors. This study evaluated the effects of H1, H2, and mast cell degranulation blockers on metabolism of carcinine and related imidazoles during shock induced by compound 48/80, a mast cell degranulator. Fifty 125-g male Sprague-Dawley rats were divided into nine ip treatment groups: saline, 48/80, lodoxamide (LOD, mast cell degranulation inhibitor), diphenhydramine (DPH, H1 antagonist), cimetidine (CIM, H2 antagonist), LOD + 48/80, CIM + 48/80, DPH + 48/80, or DPH + CIM + 48/80. Heart tissue was analyzed at 30 min by HPLC. 48/80 caused decreases in myocardial carnosine (P less than 0.01) and histidine (P less than 0.0001) levels and concomitant increases in carcinine (P less than 0.01), histamine (P less than 0.01), and 3-methylhistamine (P less than 0.05) compared to those of controls. These changes were inhibited by LOD or DPH. Treatment with CIM significantly increased myocardial carcinine levels compared to 48/80 alone (P less than 0.001) without an additional effect on the other compounds. These data indicate that carcinine is involved in the cardiac response to stress via the carnosine-histidine-histamine pathway. Compound 48/80-induced shock increases histamine metabolism via this pathway resulting in mobilization of myocardial carnosine and histidine to carcinine and histamine; this effect is increased by H2 receptor blockade.

Animals↗

PubMed1990

Existence of carcinine, a histamine-related compound, in mammalian tissues.

Carcinine (beta-alanylhistamine) was synthesized in vitro from histamine and beta-alanine. It was detected quantitatively using an HPLC method previously described for the quantification of the related compounds histamine, histidine, carnosine and 3-methylhistamine. Carcinine was identified in several tissue of the rat, guinea pig, mouse and human, and was then shown to be metabolically related in vivo to histamine, histidine, carnosine and 3-methylhistamine through radioisotopic labeling. The results demonstrate that carcinine may be concurrently quantitated using the same HPLC method as that used to measure histamine, histidine, carnosine and 3-methylhistamine. These findings suggest a role for carcinine in the carnosine-histidine-histamine metabolic pathway and in the mammalian physiologic response to stress.

Animals↗

PubMed1990

DRGs and the "negative" trauma workup.

We conducted a study to assess the financial impact of the diagnostic workup and care of 136 trauma patients admitted to our institution during a six-month period who were subsequently found to have only minor injuries (Injury Severity Score less than or equal to 9, Abbreviated Injury Score less than 3). The New Jersey DRG reimbursement system, an all-payer system, failed to provide adequate financial compensation overall, as the average loss per patient (operating cost minus reimbursement) was $508. Lost potential revenue (hospital charges minus reimbursement) was even greater, averaging $1,834 per patient. We conclude that the New Jersey DRG reimbursement system, in its current form, provides inadequate reimbursement for the system, in its current form, provides inadequate reimbursement for the proper workup and treatment of trauma patients with minor injuries. Because these patients are those most likely to help "subsidize" the care of sicker patients, changes in the system are necessary to allow hospitals to continue to provide state-of-the-art trauma care and to continue to minimize the number of preventable deaths due to trauma.

Adolescent↗

PubMed1990

The adequacy and cost effectiveness of routine resuscitation-area cervical-spine radiographs.

Portable resuscitation-area cervical-spine radiographs (PCS) frequently constitute a routine part of the emergency evaluation of patients suffering from blunt trauma. Their adequacy and cost were evaluated by reviewing the records of 92 consecutive trauma patients. Forty-seven of 74 patients (63.5%) had adequate PCS in that all seven cervical vertebrae were visualized. In 27 patients (36.5), all seven cervical vertebrae were not adequately visualized. Inadequate studies were most likely to occur in patients with abnormal vital signs on admission (56%) (P less than .01) and in those subsequently requiring general anesthesia (34.5%). Fifteen patients were intubated without difficulty by maintaining neck immobilization because of uncertainty regarding cervical-spine injuries. The annual cost of inadequate cervical-spine studies was estimated to be $31,000.00. Although the four cervical-spine injuries were diagnosed by the portable technique, routine PCS were frequently inadequate in visualizing all seven cervical vertebrae. Major decisions concerning intubation and surgery frequently had to be made before adequate radiographic evaluation could be completed. It is suggested that time and money are lost by routinely doing a single lateral portable cervical radiograph. It is more appropriate to obtain complete radiographic studies after life-threatening injuries are addressed while patients are treated using the standard techniques of neck immobilization.

Cervical Vertebrae↗

PubMed1990

Positive inotropic effect of carcinine in the isolated perfused guinea pig heart.

Carcinine (beta-alanylhistamine) is a recently discovered compound that is present in the hearts of several mammalian species, including man. Although the function of carcinine is unknown, its structural similarity to histamine, a compound known to have profound effects on the mammalian heart, and to carnosine (beta-alanylhistidine), a compound which we have previously shown to serve as a histamine source, led to the hypothesis that carcinine may play a role in mammalian cardiac physiology. We therefore administered several doses of carcinine (10, 25, 50, 75, and 100 micrograms) to isolated, perfused guinea pig hearts in a Langendorff apparatus. Carcinine exerted a dose-dependent positive inotropic effect, similar to that of histamine. Comparable doses of carnosine yielded no measurable change in contractility. We conclude that carcinine appears to be a positive inotrope in the mammalian heart, and may play a role in cardiac physiology via its metabolic link to histamine.

Animals↗

PubMed1990

High-dose phenylephrine infusion in the hemodynamic support of septic shock.

A 75-year-old man with hyperdynamic septic shock and vasodilation was successfully supported hemodynamically for 88.5 hours through the use of a continuous infusion of phenylephrine at dosages up to 360 micrograms/min. The only other vasoactive compound administered was dopamine at a dosage of 3.4 micrograms/kg/min. Hemodynamic evaluation indicated improvements in mean arterial pressure, cardiac output, and oxygen transport parameters during the period of hemodynamic support, which did not indicate a detrimental effect on perfusion of vital organs and tissues despite the use of this vasoconstrictor. Phenylephrine's pharmacologic properties may represent an advantage for its use as a vasoconstrictor over catecholamines such as norepinephrine and dopamine, particularly in patients who develop tachyarrhythmias with these agents. The pharmacology, dosage, and appropriate monitoring of therapy with phenylephrine in patients with septic shock are discussed.

Acute Kidney Injury↗

PubMed1990

Effect of H1 and H2 receptor blockers on mobilization of myocardial carnosine to histamine during compound 48/80-induced shock in young rats.

Histamine exerts profound effects on the cardiovascular system during shock mediated by H1 and H2 receptors. The source of histamine is uncertain. It is our hypothesis that carnosine serves as a nonmast-cell reservoir for histidine, utilized for histamine synthesis during shock. We have shown that treatment of older rats with compound 48/80, a mast cell degranulator, produces age-dependent lethal stress, which is prevented by lodoxamide (LOD), a mast cell degranulation inhibitor, is exacerbated by H2 receptor blockade, and is accompanied by increased mobilization of myocardial carnosine to histidine and histamine. This study was designed to evaluate the effects of H1 and H2 blockers on carnosine mobilization to histamine during 48/80-induced shock in young rats. Fifty male SD rats (125 g) were divided into nine groups: saline; LOD; H1 blocker diphenhydramine (DPH); H2 blocker cimetidine (CIM); 48/80; LOD + 48/80; DPH + 48/80; CIM + 48/80; and DPH + CIM + 48/80. All rats were sacrificed 30 min after final injections and hearts were analyzed via HPLC. There was a reduction in myocardial carnosine (P less than or equal to 0.01) and histidine (P less than or equal to 0.001) and a simultaneous increase in histamine (P less than or equal to 0.01, P less than or equal to 0.001) in animals receiving 48/80 or CIM + 48/80, respectively, compared to controls or groups pretreated with LOD, DPH, or DPH + CIM. These results indicate that 48/80-induced shock increases mobilization of myocardial carnosine and histidine to histamine, which supports a role for carnosine as a nonmast-cell histamine source.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

Changing patterns in perforated peptic ulcer disease.

We reviewed our experience with 88 consecutive patients (49 men and 39 women) treated for perforated peptic ulcer between January 1983 and May 1988. The mean age was 61 years (range, 15-89); 63 per cent were more than 60 years of age and 44 per cent were more than 70 years of age. One third of patients had a prior history of peptic ulcer disease. Thirty-nine patients (44%) were taking ulcerogenic drugs (28 were using nonsteroidal anti-inflammatory drugs, 6 were using steroids alone, and 5 were using both). Twenty-eight patients (32%) were taking antacid/H2-blockers, including 15 patients with history of ulcer disease and 11 patients taking ulcerogenic drugs. Concurrent systemic diseases were present in 63 per cent of patients; 12 patients were hospitalized for other illnesses at the time of perforation. Abdominal pain was the chief complaint in 83 patients (94%) and 52 patients (59%) had peritonitis. Leukocytosis was present in 49 patients (56%). Pneumoperitoneum was noted in 65 per cent. The duodenal bulb was the site of perforation in 62 per cent, the pyloric region in 20 per cent, and the gastric body in 18 per cent. A definitive ulcer procedure (V + P, V + A) was performed in 32 patients (38%); 51 patients (58%) had plication, and the remaining five patients did not undergo surgery. A delay in diagnosis and therapy of less than 24 hours occurred in 20 (23%) patients. Mortality was 24 per cent, and correlated significantly with age more than 60 years, but not with treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

Effect of histamine receptor antagonists on mortality in compound 48/80-induced shock.

The roles of histamine and H1 and H2 receptors in shock are uncertain. We have found that treatment of aged rats with compound 48/80 (a mast cell degranulator) produced lethal (LD99) shock which was completely prevented by lodoxamide (LOD), a mast cell degranulation inhibitor. This study evaluated the effect of H1 and H2 receptors and age on mortality of 48/80-induced shock in rats. To assess survival, 65 young male (125 g), 65 mature male (250 g) and 30 aged male (500 g) SD rats were placed in groups and treated intraperitoneally with saline; 48/80; LOD + 48/80; the H1 blocker diphenhydramine (DPH) + 48/80; the H2 blocker cimetidine (CIM) + 48/80; or DPH and CIM + 48/80. Rats were observed for 30 min or until death. All 125 g rats survived. Of the 250 g rats, 50% of 48/80-treated and 100% of CIM + 48/80-treated rats died; all others survived. All 500 g 48/80- and CIM + 48/80-treated rats died; all other 500 g rats survived. For all ages, survival differences between saline-, 48/80-, and CIM + 48/80-treated rats were highly significant (P less than or equal to 0.0001). In addition, both 48/80 and CIM + 48/80 greatly reduced mean survival time in the 250 g and 500 g groups (P less than or equal to 0.0001) compared to all other treatments. Both LOD and DPH were protective against 48/80, and DPH was also protective against CIM + 48/80, for both absolute survival and mean survival time (P less than or equal to 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

Percutaneous catheter drainage of abdominal abscesses associated with perforated viscus.

Improvements in radiologic localization have made percutaneous catheter drainage (PCD) the initial procedure of choice for many intra-abdominal abscesses (IAA). During the past seven years 154 patients underwent PCD for treatment of abdominal abscesses. Fourteen of these patients had PCD as the initial treatment for IAA secondary to a perforated viscus and subsequently underwent an elective one-stage operation to treat the underlying disease. Etiologies of the abscesses included perforated appendicitis in six patients, sigmoid diverticulitis in three patients, Crohn's ileitis in two patients, and one case each of perforated gastric ulcer, perforated sigmoid carcinoma, and perforated gallbladder. Initial localization of the abscess was achieved by either CT or ultrasound. Seven abscesses were localized in the right lower quadrant, four were localized in the liver, and one was localized each in the left flank, right flank, subhepatic space, and pelvis. All patients subsequently underwent a definitive elective operation for their primary disease including six interval appendectomies, four sigmoid colectomies, two small-bowel resections, one subtotal gastrectomy and one cholecystectomy. There were no complications due to PCD and no deaths occurred. We conclude that PCD can be successfully performed as the initial treatment for IAA associated with a perforated viscus, obviating the first stage of the traditional two-stage surgical approach.

Abdomen↗

PubMed1990

Morphine cholescintigraphy.

Radionuclide cholescintigraphy (RC) is a useful adjunctive diagnostic tool for the identification of acute cholecystitis. False-positive rates, that is, nonvisualization, of 10 to 38 per cent have been reported in patients with factors associated with nonfilling of the gallbladder, such as prolonged fasting and the administration of total parenteral nutrition, pancreatitis, alcoholism or other critical illnesses. The administration of morphine sulfate increases resting pressure of the common bile duct because of constriction of the sphincter of Oddi, and increases the likelihood of gallbladder visualization. We administered morphine sulfate (0.05 to 0.1 milligram per kilogram given intravenously) to 68 patients (including 25 critically ill patients) suspected of having biliary sepsis and who demonstrated nonvisualization of the gallbladder by RC at 30 to 60 minutes. Visualization of the gallbladder occurred within 60 minutes after the administration of morphine sulfate in 38 patients and within 30 minutes in 36 of the 38, aiding in exclusion of the diagnosis of acute cholecystitis in 37 patients. Acute cholecystitis was confirmed by laparotomy in 28 of the remaining 31 patients. There were two false-positive and one false-negative scans, yielding a sensitivity rate of 97 per cent, a specificity rate of 95 per cent, positive and negative predictive values of 0.93 and 0.97, and an accuracy of 96 per cent for this investigative procedure. We conclude that administration of morphine sulfate in conjunction with RC in seriously ill patients enhances the reliability of this test.

Acute Disease↗

PubMed1989

Evaluation of blood-warming devices with the apparent thermal clearance.

Hypothermia (less than 35 C) associated with massive transfusions is a serious clinical problem. Maintenance of normal temperatures in this setting is essential and requires the use of rapid and efficient blood-warming devices. The optimal design of such units should include a low priming volume, large heat transfer area, low pressure drop, the ability to operate at high flow rates, and the capability of warming blood from 4 to 32 C, or higher, without untoward effects. We have previously formulated a theoretic model for blood warmers and described a measure of the intrinsic efficiency of these devices, the apparent thermal clearance (VT,cl). In this study, we tested four different types of commercially available blood warmers (the single-coil immersion heater; the single-channel dry wall electric heater; the multichannel countercurrent heat exchanger; and the single-channel, countercurrent heat exchanger) and determined the apparent thermal clearance values using saline and packed red blood cells. The results indicate that only the single-channel countercurrent unit is efficient enough to meet the established requirements. The apparent thermal clearance provides a useful and rigorous means for comparing and evaluating blood-warming devices.

Blood Transfusion↗

PubMed1989

The effect of viable omentum on early bile leakage and healing of liver lacerations.

In order to determine if omental tissue accelerates the healing of liver lacerations, simulated bile leakage and collagen biosynthesis were studied in 53 rabbits. After creating a standardized complex liver laceration, hemostasis was obtained by vessel ligation and electrocoagulation. The wound was either left open (OP) or viable omentum sutured to its base (OM). Simulated bile leakage was noted in all of eight animals (four OM, four OP) studied on day of injury. None of 18 OM and two of 17 OP animals demonstrated extravasation of dye from the wound on the second and third postinjury day (N.S.). The ratio of mRNA for alpha 1(I) procollagen/actin, used as an indicator of wound healing, was 56.3 +/- 7.8 for OM and 50.6 +/- 12.1 for OP at the wound edge, and 63.5 +/- 18.6 and 69.2 +/- 7.5, respectively, for RNA isolated from the scar (N.S.). For alpha 1(III) procollagen mRNA, the ratio was 23.9 +/- 3.5 for OM and 22.4 +/- 8.3 for OP at the wound edge, and 32.4 +/- 6.5 and 31.8 +/- 7.9, respectively, for RNA isolated from the scar (N.S.). There was no difference in the scar hydroxyproline content between the two repair methods. In this model of hepatic injury and repair, bile leakage was minimal by the second postinjury day with both repair methods. Placing the omentum in liver lacerations did not contribute to accelerated wound healing as measured by simulated bile leakage and collagen biosynthesis.

Animals↗

PubMed1989

Effects of compound 48/80 and exogenous histamine on wound healing in mice.

Compound 48/80 has previously been shown to improve wound healing in rats, presumably through stimulation of histidine decarboxylase activity and mobilization of histamine from mast cells. In the present study, C57Bl/6 mice were wounded by dorsal skin incision followed by treatment with compound 48/80, exogenous histamine, or the combination of 48/80 plus histamine. Skin-breaking strength was significantly increased over saline-injected controls by the combined treatment with 48/80 and histamine. Neither 48/80 or histamine alone had any influence on wound healing. Histamine content of skin at the wound site was significantly reduced by 48/80 treatment, but was unaffected by 48/80 plus histamine or histamine given alone. In contrast, stomach and leg muscle histamine levels were significantly increased beyond those of unwounded, wounded saline- or 48/80-injected mice. These results were also confirmed in CD mice, and are in contrast to findings in rats in which treatment with 48/80 alone significantly improved wound healing of similarly injured animals.

Animals↗

PubMed1989

A simplified approach to techniques of splenic salvage.

Splenic salvage or partial splenectomy may be simplified by following these basic steps. The spleen is completely mobilized from all of its attachments so that it is tethered only by its blood supply. Appropriate hilar and short gastric vessels are ligated, and devitalized splenic tissue is débrided. Parenchymal bleeding is controlled by compression using horizontal mattress sutures placed through pledgets of folded sheets of oxidized cellulose.

Humans↗