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Biomedical subjects

R L Ruberg

Publications and source records attributed to R L Ruberg.

53 records · Page 3Linked to original sources
PubMedDate not supplied

Evaluation of erythropoietin levels in the anemia of thermal injury.

Thermal injury is associated with an anemia of multifactorial etiology. Erythropoietin is a hormone that increases red blood cell production in response to tissue hypoxia and is now being produced in a recombinant form for treatment of some anemias. How erythropoietin levels change in response to thermal injury has not been adequately investigated to date. We studied 27 patients with burns of 10% to 85% total body surface area by serially measuring hemoglobin, hematocrit, reticulocyte count, and erythropoietin levels. Erythropoietin levels were determined by radioimmunoassay. Measurements were taken at admission, before surgery, and after surgery, or at least weekly for a period of up to 4 weeks. Twenty-five of the patients had a reticulocytopenic anemia by the end of the first postburn week. Twenty-three patients remained anemic throughout the study period. Erythropoietin levels increased appropriately as the patients became anemic. Erythropoietin levels related to hemoglobin in a logarithmic fashion with a correlation of -0.869. No differences were found on the basis of burn size or age. This study indicates that the anemia of thermal injury is associated with reticulocytopenia and an elevation of endogenous erythropoietin.

Adolescent↗
PubMedDate not supplied

Serum zinc concentrations: contamination from laboratory equipment.

The following experiment was designed because of high serum zinc reported in patients who were reciving total parenteral nutrition (TPN) concentrations. Blood samples were collected, divided into 3 containers: a clean glass control test tube, a vacuum collecting tube with a rubber stopper, and paraffin clot activator. It was found that compared to glass control tubes, vacuum collection with rubber stoppers contributed an average of 76 +/- 14 microgram/dl of zinc as contaminants. Moreover, tubes with a rubber stopper and clot activator contributed 198 +/- 42 microgram/dl of zinc as contaminants. It is concluded that care must be used to avoid trace element contaminants when plasma zinc concentrations are analyzed. Without proper methodology, including selection of the container in which the sample is taken, erroneous results will be reported.

Blood Chemical Analysis↗
PubMedDate not supplied

Albumin in TPN solutions: potential savings from a prospective review.

As a result of the common usage of albumin in total parenteral nutrition (TPN) solutions at The Ohio State University Hospitals, a review of the use of this product was performed. Albumin therapy in 18 patients was evaluated using prospective criteria. Therapy was considered appropriate if the serum albumin level was less than or equal to 3.0 g%. Using these criteria, 12 of 18 patients (67%) received albumin in the TPN solution. Of these 12 patients, 7 received albumin unnecessarily. During the 3-week review, a total of 168 vials of 50 ml, 25% albumin (2100 g) were administered to patients with serum albumin concentrations greater than 3.0/100 ml at a cost of $6,014. Over a year, this could mean over $100,00 in costs which could be eliminated. Criteria for use of albumin in malnourished patients receiving TPN are not well established. This study demonstrated that developing simple criteria for the prospective review of albumin in TPN solutions and using them to monitor albumin therapy closely, can result in very significant cost savings to patients receiving TPN.

Adult↗
PubMedDate not supplied

Evaluation of Opsite catheter dressings for parenteral nutrition: a prospective, randomized study.

A prospective, randomized study compared the use of Opsite and standard gauze/tape dressings in 261 patients receiving parenteral nutrition. Eighty-four patients had a source of external drainage and were evaluated as a separate group. Catheter-related sepsis was assessed by blood culture, catheter tip culture, clinical sepsis, and clinical defervescence of fever after catheter removal. Although no statistically significant difference between Opsite and standard dressings could be identified, Opsite-treated patients consistently had increased parameters of catheter-related sepsis in all comparisons. As used here, Opsite is probably not a suitable catheter dressing system for parenteral nutrition.

Bandages↗
PubMedDate not supplied

Evaluation of nitrogen utilization in patients receiving total parenteral nutrition.

This two phase study evaluates nitrogen utilization by the body as a function of fixed caloric intake but different nitrogen loads. Nitrogen use by the body was estimated from measures of nitrogen balance, net protein utilization, and urea accumulation rate. Phase 1 of this study included 411 measurements of nitrogen use in 120 patients assigned, according to clinical condition, to receive one of the four following therapies: dextrose (D) 25%, amino acids (CAA) 4.25% (Group 1); D 35%, CAA 4.25% (Group 2); D 25%, CAA 21.3% (Group 3); or D 35%, CAA 21.3% (Group 4). Forty patients in Phase 2 were assigned in a randomized, prospective, double blind manner, to receive one of the following regimens; D 35%, CAA 2.75% (Group 5); D 25%, CAA 2.75% (Group 6); D 35%, CAA 4.25% (Group 7); or D 25%, CAA 4.25% (Group 8). In Phase 1, positive nitrogen balance was achieved with the exception of Group 3 where neither the estimated caloric nor nitrogen needs of the patients were met. It appeared that protein utilization was maximal in patients receiving the therapy of highest calorie:nitrogen ratio (Group 4). Phase 2 patients achieved positive nitrogen balance to the same extent (p greater than 0.05) and although net protein utilization improved from 53 to 71%/d as the calorie:nitrogen ratio was increased, the differences were not significant (p greater than 0.05). There was a significant improvement in total iron binding capacity in Phase 2 patients (p less than 0.01) that was most prominent at the lower concentrations of amino acids (high cal:n ratio) (Groups 5 and 6). Smaller amounts of nitrogen appear adequate in producing a positive nitrogen balance and may be better utilized in hospitalized patients if the patients' caloric requirements are achieved.

Adolescent↗
PubMedDate not supplied

Clinical effect of nonthrombotic total parenteral nutrition catheters.

Radiographic evidence of subclavian vein thrombosis has been shown to occur in 33% of total parenteral nutrition patients. This incidence can be significantly reduced to 8% when heparin is administered concomitantly in total parenteral nutrition solutions. To evaluate the thrombotic risk of a newly developed polyurethane catheter, 20 concurrent patient pairs were prospectively cannulated with either a standard polyethylene catheter plus heparin or a polyurethane catheter without heparin in a sequential statistical study. Radionuclide venograms (Tc99m) were performed within 72 hr of catheterization, at biweeky intervals, and at termination of total parenteral nutrition administration. No patient in either group developed clinical (pain, arm swelling, collateral veins) or venogram evidence of thrombosis after catheterization during an overall cannulation period of 820 days. Use of polyurethane catheters and elimination of heparin in total parenteral solutions may be particularly important since contraindications to heparin use are common. Additionally, heparin elimination can decrease admixture work and confusion (ie, subcutaneous heparin double dosing) without increasing the risk of subclavian vein thrombosis.

Adult↗
PubMedDate not supplied

Heparin does not reduce catheter sepsis during total parenteral nutrition.

Although it is recognized that the addition of heparin to total parenteral nutrition solutions reduces subclavian vein thrombosis from percutaneous polyethylene catheters, it does not affect the low thrombosis rate associated with polyurethane catheters. It has been suggested that heparin also reduces catheter sepsis during total parenteral nutrition. We reviewed the sepsis rate in 86 patients randomized to receive iv nutrition with or without heparin through polyethylene, polyvinyl, and polyurethane catheters. Blood was drawn from febrile patients for culture; if positive, catheters were removed and the tips cultured. Catheters were considered infected if blood and catheter tips were positive, or if fever disappeared within 48 hr after catheter removal, even if cultures were negative. Catheter sepsis occurred in two patients in both groups. It appears that heparin does not reduce sepsis from percutaneous subclavian vein catheters. Although its use may be indicated to reduce thrombosis associated with polyethylene catheters, there is no indication for its use to reduce sepsis with either type of catheter.

Bacterial Infections↗