Blunt abdominal trauma: evaluation and indications for laparotomy.
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Abdominal Injuries↗
Biomedical subjects
R Latifi
Publications and source records attributed to R Latifi.
Short-term cholesterol lowering decreases size and severity of perfusion abnormalities by positron emission tomography after dipyridamole in patients with coronary artery disease. A potential noninvasive marker of healing coronary endothelium.
BACKGROUND: Cholesterol lowering over 1- to 3-year trials is associated with modest regression or no progression of focal coronary artery stenoses compared with progression in controls, a decrease in cardiac events proportionately more than the modest improvement in percent stenosis, and in experimental animals improved endothelial-mediated coronary vasodilation. METHODS AND RESULTS: Accordingly, we hypothesized that there would be improvement in size and severity of perfusion abnormalities by rest-dipyridamole positron emission tomography (PET) imaging in a randomized intensive cholesterol-lowering trial with each patient studied after a baseline control period, a 90-day intensive cholesterol-lowering treatment, and a final control period off cholesterol-lowering regimens. Completely automated, objective measures of size and severity of perfusion abnormalities on rest-dipyridamole PET images were made by computer algorithm in 12 patients with coronary artery disease. There were statistically significant decreases (improvement) in size and severity of perfusion abnormalities by rest-dipyridamole PET on comparison of baseline control with perfusion abnormalities after intensive 90-day cholesterol lowering and significant increases (worsening) in size and severity after the final control period, respectively, as follows. (1) The percent of left ventricle outside 2.5 SD of normal values on the dipyridamole-to-rest ratio image of normalized counts was 22 +/- 20% after the initial control period, 13 +/- 14% after the treatment period, and 26 +/- 22% after the final control period with a significant decrease (improvement) occurring between the initial control and treatment periods (P = .02) and an increase (worsening) occurring between the treatment and final control periods (P = .009). (2) The percent of left ventricle with a ratio of < or = 0.66 in the dipyridamole-to-rest ratio image of normalized counts was 11 +/- 13% after the initial control period, 5.8 +/- 10% after the treatment period, and 14 +/- 19% after the final control period with a significant decrease (improvement) occurring between the initial control and treatment periods (P = .04) and an increase (worsening) occurring between the treatment and final control periods (P = .02). (3) The myocardial quadrant on the polar display with the lowest average activity expressed as a percent of maximal activity was 0.81 +/- 0.18 after the initial control period, 0.87 +/- 0.014 after the treatment period, and 0.77 +/- 0.23 after the final control period with significant improvement occurring between the initial control and treatment periods (P = .05) and worsening occurring between the treatment and final control periods (P = .05). CONCLUSIONS: These results suggest that relatively short-term, intensive cholesterol lowering over 90 days improves myocardial perfusion capacity before anatomic regression of stenoses occurs and that such improvement, or deterioration after withdrawal of lipid-lowering treatment, can be followed noninvasively by dipyridamole PET, reflecting the integrated flow capacity of the entire coronary arterial/arteriolar vascular system affected by diffuse atherosclerosis.
Adult↗
Nutritional support in liver failure.
The most important manifestations of advanced liver disease are malnutrition, encephalopathy, and hepatorenal syndrome. Appropriate and optimal nutritional and metabolic support with specially formulated solutions enriched in branched-chain amino acids, together with other advanced treatments such as plasmapheresis, hemofiltration, and continuous arteriovenous hemodialysis, can correct the most important metabolic and clinical aberrations and temporarily improve the quality of life. However, the ultimately poor prognosis of patients with severe liver failure has not been altered significantly to date by the provision of nonspecific or specifically tailored nutrient regimens. The prognosis appears to depend on the arrest, correction, or reversal of the primary pathophysiologic process.
Enteral Nutrition↗
Nutritional management of acute and chronic pancreatitis.
Acute pancreatitis often results in a catabolic state characterized by profound hemodynamic, metabolic, cardiovascular, pulmonary, hematologic, and renal aberrations. Parenteral nutrition and metabolic support are essential if morbidity and mortality are to be minimized. In chronic pancreatitis, nutritional management ranges from fundamental dietary manipulation with or without administration of appropriate digestive enzymes to enteral supplementation with modular chemically defined diets to total parenteral nutrition, depending on the stage, severity, and manifestations of the disease. In prescribing nutrient substrates in both acute and chronic pancreatitis, consideration must be given to their effects on pancreatic enzyme secretion if optimal results are to be achieved.
Acute Disease↗
Nutritional management of inflammatory bowel disease.
The etiology and specific treatment of Crohn's disease and ulcerative colitis are unknown, and the treatment strategy for patients with inflammatory bowel disease is essentially symptomatic and supportive. The malnutrition that frequently accompanies inflammatory bowel disease is a manifestation of intestinal failure and should be vigorously corrected with total parenteral nutrition, elemental diets, or both. Evidence exists for the value of total parenteral nutrition and elemental diets as primary therapy for inflammatory bowel disease in selected patients. Judicious nutritional therapy remains a cornerstone in the adjunctive management of these patients.
Enteral Nutrition↗
Management of the short-bowel syndrome.
The patient with short-bowel syndrome after massive small-intestinal resection represents one of the greatest clinical challenges a general surgeon must face. Maintaining optimal nutritional and metabolic support until maximum bowel adaptation can occur is the top priority of therapy. Currently, no operative procedure for adjunctive management of the short-bowel syndrome is sufficiently safe and effective to recommend its routine use. Long-term parenteral nutrition remains the cornerstone of successful management.
Antacids↗
Arrest and reversal of atherosclerosis with parenteral nutrition.
In a large subset of patients with atherosclerotic cardiovascular disease, all medical and surgical treatment alternatives have been exhausted or have proved to be ineffective. Intravenous infusion of specially formulated amino acid solutions, developed in the animal laboratory, has been efficacious in arresting and reversing atherosclerosis in humans for the first time. It is anticipated that the principles derived from these precise parenteral studies will eventually permit development of oral and enteral dietary formulations effective for the systemic control and management of atherosclerosis.
Animals↗