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Biomedical subjects

R M Roumen

Publications and source records attributed to R M Roumen.

51 records · Page 3Linked to original sources
PubMed1994

Gastric tonometry in multiple trauma patients.

Splanchnic ischemia, leading to intestinal mucosal damage, is thought to be common in patients after severe trauma. The adequacy of mucosal oxygenation can indirectly be determined by gastric intramucosal pH (pHi) measurement. We prospectively examined the posttraumatic gastric pHi values in 15 multiple trauma patients. In all patients gastric pHi was measured using a tonometer via the nasogastric route. A pHi value < or = 7.32 was used to differentiate between normal and low gastric pHi. Six hours after the injury four patients showed abnormally low pHi levels. Four other patients with normal initial pHi values exhibited low pHi values during one or more of the next measuring periods. Three of these eight patients developed major complications (two, ARDS) and two of them subsequently died. The seven remaining patients never had abnormal pHi levels and all patients had an uncomplicated recovery. Although intestinal ischemia was expected to be a common condition in multiple trauma patients, no consistent pattern of abnormal pHi measurements in the direct posttraumatic course could be discovered. No correlation was found between initial pHi values (at 6 hours) and ISS, shock, and lactic acidosis or APACHE II scores on admission. It is concluded that monitoring gastric pHi is useful in severely injured patients admitted to the ICU.

Adolescent↗
PubMed1994

Is early osteosynthesis safe in multiple trauma patients with severe thoracic trauma and pulmonary contusion?

The timing of osteosynthesis of major fractures in patients with multiple injuries is still disputed. Recently questions have been raised as to the possible detrimental effects of this treatment on pulmonary function in patients who have additional thoracic trauma. In this study the charts of 57 consecutive patients with multiple injuries including thoracic trauma were analyzed. Thirty patients without major fractures were compared with 27 patients with major fractures treated by early osteosynthesis. Despite a significantly higher Injury Severity Score (ISS) in in the group with major fractures, there was no significant difference in pulmonary function between the two groups. We conclude that the presence of thoracic trauma should not be regarded as a contraindication for early surgical stabilization of major fractures.

Adolescent↗
PubMed1993

Intestinal permeability after severe trauma and hemorrhagic shock is increased without relation to septic complications.

After thermal injury, alterations in intestinal permeability have been demonstrated and have correlated with subsequent infections. We measured intestinal permeability on the second day after severe trauma and hemorrhagic shock (ruptured abdominal aneurysm). The mean (+/- SD) lactulose-mannitol (L/M) excretion ratio was 0.012 +/- 0.005 in seven healthy control subjects, 0.069 +/- 0.034 in 11 severely traumatized patients, and 0.098 +/- 0.093 in eight patients with aneurysm, indicating a significant increase of intestinal permeability in both patient groups. No significant correlation was found between L/M ratios and age, severity of injury or shock, lactate levels on admission, APACHE (acute physiology and chronic health evaluation) II score, daily pulmonary gas exchange parameters, or mean multiple organ failure scores. No difference in intestinal permeability between patients with and without subsequent infections could be demonstrated. In 11 patients we looked for endotoxin in the systemic circulation. In six patients endotoxemia was present immediately after admission and before the L/M test. However, during the L/M test and 1 day afterward no circulating endotoxin was observed. The present data provide evidence for the hypothesis that increased intestinal permeability and subsequent infectious complications are independent phenomena, frequently seen in patients after severe trauma or hemorrhagic shock.

Adolescent↗
PubMed1993

Intestinal permeability is increased after major vascular surgery.

PURPOSE: In experimental animals increased intestinal permeability has been demonstrated after ischemia and reperfusion injury. In this study we determined intestinal permeability in patients after elective or emergency aortic aneurysm repair; the latter patients were in severe shock on hospital admission. METHODS: A dual sugar absorption test, with lactulose and mannitol as markers, was used to measure intestinal permeability on the second day between 24 and 30 hours after hospital admission. RESULTS: The lactulose/mannitol excretion ration was 0.012 +/- 0.005 in seven healthy control subjects, 0.118 +/- 0.116 in seven patients having elective operation, and 0.098 +/- 0.093 in eight patients having emergency operation, indicating a significant increase of intestinal permeability in both patient groups (p < 0.01). No significant difference was found in intestinal permeability between patients of the elective and emergency groups. CONCLUSIONS: A significant increase in intestinal permeability commonly occurs in patients after elective and emergency major vascular surgery. It is suggested that this is mainly due to reperfusion injury rather than the ischemic period of the intestine itself.

Adult↗
PubMed1993

Cytokine patterns in patients after major vascular surgery, hemorrhagic shock, and severe blunt trauma. Relation with subsequent adult respiratory distress syndrome and multiple organ failure.

OBJECTIVE: This study investigates the course of serum cytokine levels in patients with multiple trauma, patients with a ruptured abdominal aortic aneurysm (AAA), and patients undergoing elective AAA repair and the relationship of these cytokines to the development of adult respiratory distress syndrome (ARDS) and multiple organ failure (MOF). SUMMARY BACKGROUND DATA: Severe tissue trauma, hemorrhagic shock, and ischemia-reperfusion injury are pathophysiologic mechanisms that may result in an excessive uncontrolled activation of inflammatory cells and mediators. This inflammatory response is thought to play a key role in the development of (remote) cell and organ dysfunction, which is the basis of ARDS and MOF. METHODS: The study concerns 28 patients with multiple trauma, 20 patients admitted in shock because of a ruptured AAA, and 18 patients undergoing elective AAA repair. Arterial blood was serially sampled from admission (or at the start of elective operation) to day 13 in the intensive care unit, and the serum concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1 beta, and IL-6 were determined. RESULTS: Twenty-two patients died, 15 within 48 hours and 7 after several weeks, as a result of ARDS/MOF. At hospital admission and after 6 hours, these nonsurvivors had significantly higher plasma TNF-alpha and IL-1 beta levels than did the survivors. At the same measuring points, TNF-alpha and IL-1 beta were significantly more elevated in patients with ruptured AAA than in traumatized patients. However, IL-6 was significantly higher in the traumatized patients. In 10 patients, ARDS/MOF developed, and 41 had an uncomplicated course in this respect. Those with ARDS/MOF exhibited significantly different cytokine patterns in the early postinjury phase. TNF-alpha and IL-1 beta levels were higher mainly on the first day of admission; IL-6 concentrations were significantly elevated in patients with ARDS/MOF from the second day onward. The latter cytokine showed a good correlation with the daily MOF score during the whole 2-week observation period. CONCLUSIONS: In the early postinjury phase, higher concentrations of these cytokines are associated, not only with an increased mortality rate, but also with an increased risk for subsequent ARDS and MOF. These data therefore support the concept that these syndromes are caused by an overwhelming autodestructive inflammatory response.

Aged↗
PubMed1993

Scoring systems and blood lactate concentrations in relation to the development of adult respiratory distress syndrome and multiple organ failure in severely traumatized patients.

In 56 patients with multiple trauma with ISSs > or = 33 we prospectively collected data of seven scoring systems (ISS, TS, TRISS, GCS, PTS, APACHE II, SSS) and sequentially determined blood lactate concentrations. These data were analyzed in relation to the patients later developing adult respiratory distress syndrome (ARDS) and multiple organ failure (MOF). Twenty-two patients developed ARDS, and 18 developed MOF. Of the mentioned scoring systems only ISS, PTS, and SSS were predictive of subsequent ARDS, and only ISS and SSS were predictive of subsequent MOF. Lactate concentrations at days 2, 3, and 4 were significantly different between patients with and without subsequent ARDS, MOF, or both. Surprisingly, APACHE II scores did not correlate with subsequent ARDS or MOF, nor did they show any significant relation with lactate concentrations at any time. By stepwise regression analysis ISS, SSS, and lactate level at day 3 were the most significant variables toward the development of ARDS and MOF. It is concluded that scoring systems directly grading the severity of groups of trauma patients have predictive value for late and remote complications such as ARDS and MOF, whereas scoring systems that grade the physiologic response to trauma--although clearly related to mortality--have no such predictive value.

Adolescent↗
PubMed1993

Endotoxemia after major vascular operations.

PURPOSE: Endotoxemia has been associated with syndromes such as adult respiratory distress syndrome and multiple organ failure. Translocation of endotoxins from the gut has been demonstrated to occur experimentally in animals after splanchnic ischemia. METHODS: We investigated endotoxemia in 11 patients with hemorrhagic shock caused by a ruptured abdominal aortic aneurysm and in five patients after elective abdominal aortic aneurysm repair. Endotoxin was measured quantitatively with a limulus assay with a detection limit of 12.5 pg/ml. RESULTS: In 7 of the 11 patients admitted to the hospital with an acute condition endotoxin was present on admission (range 15 to 25 pg/ml), even before resuscitation and operation were started. In patients treated electively endotoxin was noticed after cross-clamping of the aorta in four of five patients (mean +/- SEM: 18.9 +/- 4.6 pg/ml). After reperfusion endotoxemia increased and was present in all patients (22.8 +/- 2.8 pg/ml). All five patients treated electively had an uneventful recovery without specific organ failures or infectious complications. CONCLUSIONS: It is concluded that systemic endotoxemia as monitored by the limulus assay is a common finding in patients after major vascular operation. Hemorrhagic shock resulting in splanchnic ischemia may lead to endotoxemia. Ischemia and especially reperfusion after aortic cross-clamping also result in endotoxin translocation. However, the low concentrations of systemic circulating endotoxin found were not related to subsequent adverse effects of either the patients treated for acute conditions or in the electively treated patients.

Aged↗
PubMed1992

Scoring systems for predicting outcome in acute hemorrhagic necrotizing pancreatitis.

Five scoring systems for predicting the severity and outcome of acute haemorrhagic necrotizing pancreatitis were retrospectively evaluated in 39 patients. The respective scores were Ranson, Imrie, APACHE II, multiple organ failure (MOF) and Sepsis Sensitivity Score (SSS). Twenty-two (56%) of the patients died. The survivors were significantly younger than the non-survivors, 68% of whom died within 3 weeks of admission to the intensive care unit. Stay in the unit was significantly longer in the former group. Sensitivity in prediction of death was best with APACHE II score greater than 9 (96%) and Ranson score greater than or equal to 3 (95%). Of the five scores, MOF greater than or equal to 4 gave the best equilibration between sensitivity (73%) and specificity (76%) and the strongest prediction of lethal outcome (80%). Although the independent factor age had low sensitivity (55%), it showed the highest values for specificity (88%) and prediction of death (86%). APACHE II scoring is concluded to be best for grading the severity of disease on admission to intensive care, while the MOF score is best for monitoring the degree of organ dysfunction and the intensity of supportive treatment.

Acute Disease↗
PubMed1992

Serum interleukin-6 and C reactive protein responses in patients after laparoscopic or conventional cholecystectomy.

OBJECTIVE: To investigate the acute phase inflammatory response to surgical trauma after laparoscopic and conventional cholecystectomy. DESIGN: Prospective open study. SETTING: University Hospital in The Netherlands. SUBJECTS: 21 patients with symptomatic cholelithiasis admitted for elective cholecystectomy who had had no previous upper abdominal operations. INTERVENTIONS: 12 patients underwent conventional, and 9 patients laparoscopic, cholecystectomy. Circulating interleukin-6 (IL-6) and C reactive protein concentrations were measured 6, 12, 24 and 48 hours after operation. MAIN OUTCOME MEASURE: Changes in IL-6 and C reactive protein concentrations, and comparison of operative blood loss and length of stay in hospital. RESULTS: Those treated by laparoscopic cholecystectomy lost significantly less blood (median 60 compared to 100 ml) and spent significantly fewer days in hospital (median 2 compared with 7 days), (p < 0.01 in each case). The only changes in circulating IL-6 concentrations were seen in patients over the age of 60 years who underwent conventional cholecystectomy. There were significant differences in C reactive protein concentrations between the two operations at both 24 and 48 hours after the operation (p < 0.01 in each case). CONCLUSION: We conclude that laparoscopic cholecystectomy reduces the acute phase inflammatory response compared with the conventional operation; there seems to be no relevant correlation between plasma concentrations of IL-6 and C reactive protein; the presence of IL-6 does not affect the response of C reactive protein to trauma; and the response of IL-6 to trauma is age dependent.

Adult↗
PubMed1991

Unstable Colles' fractures in elderly patients. A randomised trial of external fixation for redisplacement.

We report the results of a prospective randomised controlled trial of the management of 101 Colles' fractures in patients over the age of 55 years. Within two weeks of initial reduction 43 fractures had displaced with either more than 10 degrees dorsal angulation or more than 5 mm radial shortening. These patients were randomly divided into two groups: 21 were remanipulated and held by an external fixator; in the control group of 22 patients, the redisplacement was accepted and conservative treatment was continued. Patients treated with external fixation had a good anatomical result, but their function was no better than that of the control group. We found no correlation between final anatomical and functional outcome, and concluded that the severity of the original soft-tissue injury and its complications are the major determinants of functional end result.

Aged↗
PubMedDate not supplied

The impact of 5-FU-based bolus chemotherapy on survival in patients with advanced colorectal cancer.

BACKGROUND: An analysis was performed to evaluate whether bolus chemotherapy with 5-fluorouracil (5-FU) and leucovorin (LV) improves survival for patients with advanced colorectal cancer (ACC). PATIENTS AND METHODS: Two groups of patients were selected from a database which included all patients with colorectal cancer treated in our hospital since 1984. The first group consisted of all patients with irresectable metastases diagnosed between January 1984 and December 1989, who had a performance status of 0 or 1, and were younger than 76 years old. The second group consisted of all patients with irresectable metastases--younger than 76 years old and with a performance status of 0 or 1--who were started on chemotherapy between January 1994 and December 1997. In the first period chemotherapy was never given and in the second period chemotherapy was given to all motivated patients. None of the patients had received a previous metastasectomy or isolated liver perfusion. For chemotherapy, age, location of the metastases, type of surgical intervention for the primary tumor, Hemoglobin, Lactate Dehydrogenase and Carcinoembryonic Antigen concentration we evaluated the relationship with survival. Variables which showed a significant relation with survival in the univariant analysis (logrank test, p < 0.05) were entered into a proportional hazards regression analysis. RESULTS: In the univariant analysis chemotherapy and location of metastases showed a significant relation with survival. The median survival was 11 months for patients who had received chemotherapy and 8 months for untreated patients (p = 0.009). Chemotherapy and location of metastases both retained their significance in a proportional hazards regression analysis. CONCLUSION: In our study group chemotherapy added 3 months to the median life expectancy for patients with ACC.

Aged↗