Biomedical subjects

P Levin

Publications and source records attributed to P Levin.

At least 19 recordsLinked to original sources

PubMed1990

Hospital and catchment area antibiotic utilization and bacterial sensitivity in primary infections following gastric surgery in Huddinge, Sweden.

The relationship between hospital and catchment area utilization of antimicrobial agents and the antibiotic sensitivity of bacteria isolated from primary infections has been studied after 750 gastric operations performed between 1972 and 1986 at the Huddinge University Hospital. Over 80% of the antibiotics were used in the catchment area. Penicillins (G and V) overall were the most commonly used drugs and comprised 37% of the total antibiotic consumption in 1977-1986. Narrow-spectrum antibiotics dominated throughout the period under investigation. No change in the bacterial resistance to antimicrobial agents was found over time. Many strains of Klebsiella/Enterobacter and E. coli resistant to ampicillin and tetracyclines were recovered throughout the period under investigation. No aerobic Gram-negative bacteria were resistant to gentamicin. All Bacteroides strains except two were sensitive to cefoxitin. Tetracyclines and ampicillin/amoxycillin were mainly used in the catchment area, and cefoxitin and aminoglycosides were almost exclusively used in the hospital. Antimicrobial agents primarily used for out-patients in the catchment area seemed to have more influence on the susceptibility of microorganisms isolated from post-operative infections than agents primarily used in the hospital.

Anti-Bacterial Agents↗

PubMed1990

The causes of cancelled elective surgery.

We reviewed causes of cancelled elective surgery in a community hospital. Over a 6-month period, during which 4100 operating room procedures were completed, cancellations occurred in 13% of cases scheduled for outpatient surgery, 9% of cases scheduled for admission the same day, and 17% of cases scheduled for inpatient surgery. Dental procedures had significantly higher rates of cancellation among outpatient procedures, and cardiovascular surgical procedures had significantly higher rates among inpatient procedures. Chart review of cancelled inpatient cases showed 43% due to administrative reasons with unsigned consent the most common cause. Medical factors were responsible in the remaining cases, with reevaluation of the surgical condition and associated medical illnesses equally common as reasons in this category. Appreciation of the usual reasons for cancellation can improve utilization by permitting administrators and providers to anticipate those cases in which problems might arise so that additional attention can be paid to them.

Appointments and Schedules↗

PubMed1990

Postoperative hospital retention following ambulatory surgery in a hospital-based program.

In an effort to learn more about resource utilization on ambulatory surgery in hospital departments of surgery and its impact on quality of care, we reviewed the causes of postoperative hospital retention following ambulatory surgery in a hospital-based program. Of 1971 patients operated on in a 6-month period, 188 were retained for a rate of 9.5%. Of these, 71 (3.6%) were retained for observation and 42 (2.1%) for surgery more extensive than planned. The remaining 75 (3.8%) patients represent complications of surgery or anesthesia. The age distribution of patients with complications was the same as the group overall with a single mode at about 30 years, while the distribution of patients retained for observation or who were admitted the day of surgery was bimodal with a second peak at about 70 years. All surgical specialties had comparable rates of postoperative retention, except gynecology which was significantly lower. Many of the patients had multiple procedures or surgery more extensive than planned.

Age Factors↗

PubMed1989

Septic complications in relation to factors influencing the gastric microflora in patients undergoing gastric surgery.

Postoperative septic complications and micro-organisms found in primary infections were studied in 750 gastric operations performed between 1972 and 1986. The overall rate of primary infections was 23%. The infection rates were related to the diagnosis and to factors that could influence the colonization of the stomach. No significant differences in the rates of postoperative infections were found between patients who had received preoperative antibiotic prophylaxis and those who had not. In all groups of patients, aerobic and anaerobic gram-positive and gram-negative bacteria and yeasts were isolated in primary infections. Enterobacteriaceae, enterococci and Bacteroides fragiis were more frequent in patients with gastric bleeding or carcinoma.

Adolescent↗

PubMed1988

Estrogen-secreting adrenal tumor responsive to ACTH: localization by adrenal venous sampling.

In a 48-year-old man with gynecomastia but no other signs of feminization, routine evaluation revealed only minimally elevated serum estrogens. The diagnosis of an estrogen-secreting adrenal tumor was suggested by CT and confirmed by adrenal venous sampling. This tumor was found to be ACTH-responsive. Results in this patient are compared with those in normal volunteers, in whom adrenal venous sampling failed to localize estrogen secretion and in whom ACTH did not increase estrogens.

Adrenal Cortex Neoplasms↗

PubMed1988

Intraoperative decisions based on angioscopy in peripheral vascular surgery.

We describe the technique of intraoperative angioscopy for delineation of peripheral vascular anatomy. Angioscopes with outer diameters of 0.85-2.9 mm have been used during 86 peripheral vascular procedures. Angioscopic inspections were performed during 68 femoral popliteal bypasses, four aortofemoral bypass grafts, one abdominal aortic aneurysm, two extra anatomic axillary femoral bypass grafts, and 11 other vascular procedures. We obtained useful images in 73 of 86 procedures (85%), thereby yielding 118 angioscopic inspections (53 arteries, 37 anastomoses, and 28 vein grafts). Changes in intraoperative management based on angioscopic findings included revision of five of 37 (14%) anastomoses, deletion of four of 31 (13%) completion angiograms, revision of eight of 17 (47%) in situ venous valves, and repetition of thrombectomy in six of seven (86%) cases. In 22 of 73 (30%) peripheral angioscopies, potential causes of graft occlusion were recognized. Complications from intraoperative angioscopy have included one anastomotic flap from intimal disruption that required anastomotic revision. Three small flaps, possibly resulting from angioscopic trauma, were recognized but appeared to have no clinical significance. In conclusion, intraoperative angioscopy provides visual assessment of luminal patency and anastomotic anatomy. This assessment alters intraoperative procedures in some cases and cannot be obtained by angiography.

Adult↗

PubMed1985

Glucose metabolism in glucose-intolerant older people during chromium supplementation.

The effects of chromic chloride (CrCl3) administered orally for 12 weeks to five elderly subjects with glucose intolerance were assessed. Pretreatment and posttreatment, the hyperglycemic clamp technique was employed to determine glucose utilization, beta-cell sensitivity to glucose, and tissue sensitivity to insulin. In addition, erythrocyte insulin binding was studied. Urinary chromium excretion increased approximately 5 fold indicating good compliance with supplementation. The oral glucose tolerance curves following supplementation were lowered from 60 to 120 minutes but only the 60-minute values were significantly lowered. In agreement with this was significantly increased glucose utilization during the hyperglycemic clamp studies. Tissue sensitivity to insulin, receptor affinity, and total insulin binding were unchanged by supplementation while beta-cell sensitivity to glucose increased following supplementation (P less than 0.04), and explained the increased glucose utilization. HDL and LDL and total cholesterol levels were slightly lower after chromium supplementation, but no change reached statistical significance. The LDL/HDL cholesterol ratio was unchanged. This study shows small but statistically significant effects of CrCl3 on carbohydrate metabolism. The clinical relevance of these effects, that is, their prophylactic or therapeutic significance, remains to be determined.

Aged↗

PubMed1985

The diagnostic value of the 24 hour integrated concentration of plasma aldosterone.

The 24-hour urinary excretion rate of aldosterone, the 24-hour integrated concentration of plasma aldosterone (IC-ALDO) and the morning plasma aldosterone levels from a single, discrete venipuncture of 92 subjects (30 normal subjects, 62 patients with mild, essential hypertension) were compared, using the variance ratio method, to 12 patients with primary aldosteronism. The variance of the IC-ALDO was significantly lower than the respective variances of the 24-hour urinary excretion of aldosterone (P less than 0.01) and of the discrete, morning plasma levels of aldosterone (P less than 0.01). The clinical usefulness of this diagnostic procedure depends on its ability to discriminate between healthy subjects and various hypertensive patients. Because of its narrower variance and enhanced discriminatory ability, the 24-hour IC-ALDO may have useful application in diagnosis of various disorders of aldosterone secretion. We have found the IC-ALDO completely separated 11 of 12 primary aldosteronism patients (mean 36 +/- 17) from essential hypertensive controls (mean 9.6 +/- 4.1) (P less than 0.01). When IC-ALDO was combined with integrated concentration of plasma renin activity in an ALDO/RENIN ratio, all 12 primary aldosteronism patients were diagnosed.

Adolescent↗

PubMed1984

Duplex scanning of the carotid arteries.

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Carotid Artery Diseases↗

PubMed1983

Hemodynamic monitoring of patients undergoing abdominal aortic surgery.

Cardiac decompensation is clearly the major complication of aortic reconstructive surgery that leads to morbidity. Major changes in intravascular volume, third spacing, and increased systemic vascular resistance are extremely stressful to the diseased heart. Hemodynamic monitoring is readily available to provide an accurate evaluation of myocardial sensitivity and to allow for appropriate pharmacologic manipulation to preclude cardiac catastrophe. We believe all patients undergoing abdominal aortic reconstructive surgery should receive the benefit of pulmonary artery catheterization and intraarterial monitoring. The only requirement is a staff of surgeons, anesthesiologists, and nurses capable of correct interpretation of the data and use of drug therapy based on this information. The benefits are an accurate assessment of cardiac function with the ability to modulate the patient's hemodynamic values, preventing volume shifts, hypertensive and hypotensive crises, and abnormal fluctuations in preload and afterload, and ultimately a safer perioperative course.

Aged↗

PubMed1979