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R K Tompkins

Publications and source records attributed to R K Tompkins.

130 records · Page 8Linked to original sources
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The effect of total parenteral nutrition or elemental diet on pancreatic proteolytic activity and ultrastructure.

Previous reports regarding the effect of an elemental diet (ED) on pancreatic secretion have been conflicting. This study was designed to assess the effect of a high-nitrogen ED or total parenteral nutrition (TPN) on proteolytic activity in the pancreatic exocrine cell. Forty-eight dogs were divided into 12 groups of 4 each. Group I (control) was fed commercial dog food. Groups II, III, and IV received 1, 2, and 3 days, respectively, of 25% glucose with 4.25% amino acids. Groups V, VI, and VII received 1, 2, and 3 days, respectively, of 25% glucose with 2.75% amino acids. Groups VIII, IX, and X received 3 days of ED given orally, via gastrostomy or jejunostomy, respectively. Groups XI and XII received 1 day each of either 2.75% amino acids or 25% glucose. The pancreas of each dog was then resected and processed for electron microscopy, or minced and analyzed for tryptic activity expressed as micromoles of benzoyl arginine ethyl ester (BAEE) digested per milligram of pancreatic protein. There were no significant differences in ultrastructure or in the levels of pancreatic tryptic activity between the control and the 11 experimental groups. It appears that during the short period of our treatment with TPN as well as ED, the exocrine cell retains its normal content of proteolytic enzyme. Reports of others that pancreatic secretion volume decreases with TPN and ED, coupled with our findings of stable intracellular tryptic activity, indicate that the synthesis and release of proteolytic enzymes have actually been reduced by TPN and ED. Thus, TPN or ED should benefit the patient with pancreatitis by decreasing pancreatic secretion as well as pancreatic proteolytic enzyme synthesis.

Amino Acids↗
PubMedDate not supplied

Hospitals and physicians: an organizational model for a changing healthcare environment.

New reimbursement methods are forcing hospitals and physicians to work more closely together to retain patients and improve efficiency. In the last 10 years, most academic medical centers have reorganized hospital-physician relationships to maximize revenues and assure a stable flow of patients. This article examines the organizational model adopted by Pacific Medical Center in Seattle (formerly the U.S. Public Health Service Hospital), when it was transferred from federal to community control in 1981. Planners analyzed the history and mission of the institution, the community being served, and the legal options in the state. The chosen organizational structure is outlined, and the authors present the strengths and weaknesses of the model. The implications for other healthcare institutions considering restructuring are discussed.

Governing Board↗