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Biomedical subjects

R P Rapp

Publications and source records attributed to R P Rapp.

At least 91 records · Page 5Linked to original sources
PubMed1981

Early prediction of outcome in head-injured patients.

The relationship between Glasgow Coma Scale (GSC) scores obtained during the 1st week after head injury and outcome at 1 year was analyzed in 170 patients. Seventy-two of 76 patients with initial GCS scores of 3 or 4 lived, and only one had a favorable outcome. Favorable and unfavorable outcomes were almost equally divided when the initial GCS scores were in the intermediate range of 5, 6, or 7. No patients with an initial GCS score in this intermediate range that subsequently worsened had a favorable outcome, while over 80% of those improving to a score higher than 7 had a favorable outcome. Only 12% of those persisting with a score of 5, 6, or 7 for 1 week had favorable outcome. Outcome predictions using the multiple logistic model were made for this intermediate group of patients based on GCS scores and data on midline shift derived from computerized tomography (CT). The patients with initial scores of 5, 6, or 7 with midline shifts of less than 4.1 mm on initial CT scanning had a significantly higher favorable outcome rate compared with patients with a larger shift. However, outcome prediction made by combining shift data and initial GCS scores are not significantly more accurate than predictions based solely on initial GCS scores. Combining 48-hour GCS scores and shift data significantly improves predictive accuracy based only on coma scores. The data obtained by combining GCS scores at 72 hours and 1 week and shift data is marginally significant for improving accuracy of outcome predictions. It is concluded that GCS scores and shift data are highly accurate indicators of outcome in head-injured patients.

Adolescent↗
PubMed1980

Electronic flow control and roller clamp control in intravenous therapy: a clinical comparison.

In a prospective clinical study, an electronic intravenous (IV) rate controller was compared with a standard roller clamp for control of IV infusions. The electronic IV rate controller was associated with fewer complications and more accurate fluid therapy than was the roller clamp. There was also a substantial savings of nursing time and a potential for cost savings when the electronic IV rate controller was used.

Humans↗
PubMed1980

Parenteral safflower oil emulsion (Liposyn 10%): safety and effectiveness in treating or preventing essential fatty acid deficiency in surgical patients.

The safety and effectiveness of a 10% safflower oil emulsion in treating or preventing essential fatty acid deficiency was tested in a prospective study of 15 surgical patients requiring total parenteral nutrition for two to four weeks. Three dosage regimens were evaluated including: Group I: 4% of calories as linoleate daily (five patients), Group II: 4% of calories as linoleate every other day (two patients), and Group III: 8% of calories every other day (eight patients). Patients were monitored for laboratory changes from baseline specifically in those areas where previous fat emulsions have caused serious deviations. No significant changes were noted in hematologic parameters, coagulation studies, cholesterol and triglyceride serum levels. Although there were sporadic mild deviations in liver function changes in several patients, no clinically significant adverse effects could be directly attributed to infusion of the fat emulsion. Three patients had baseline triene/tetraene ratios of 0.4 or greater, indicative of essential fatty/acid deficiency, and these ratios dropped to less than 0.4 within eight days of beginning therapy with the parenteral fat emulsion. The remaining 12 patients maintained a normal triene/tetraene ratio of less than 0.4 throughout the 28 day study period. All three dosage regimens were considered effective for treatment and prevention of essential fatty acid deficiency.

Cholesterol↗
PubMed1980

Infection in a functioning ventriculoperitoneal shunt treated with intraventricular gentamicin.

A case of successful treatment of a functioning ventriculoperitoneal (VP) shunt infection with high doses of intraventricular gentamicin sulfate is reported. The VP shunt reservoir of a four-month-old girl with hydrocephalus became infected. The scalp wound was debrided and intravenous methicillin sodium, 200 mg every six hours, was administered. When culture and sensitivity tests later showed Enterobacter cloacae, methicillin was discontinued. Intraventricular gentamicin, 2 mg/day, and intravenous carbenicillin, 400 mg/kg/day, were administered. Gentamicin dosage was increased twice over the next eight days to 6 mg/day. The trough cerebrospinal fluid (CSF) gentamicin level at 2 mg/day was 1.7 micrograms/ml, at 4 mg/day was 0.7 microgram/ml and at 6 mg/day was 19.6 micrograms/ml. Gentamicin was discontinued after 14 days; carbenicillin was continued for 7 more days. For a second shunt infection with Klebsiella pneumoniae, intraventricular gentamicin and intravenous chloramphenicol were given for 21 days. Previous reports of ventricular shunt infections are reviewed. The report indicates that it is possible to achieve therapeutic CSF levels of gentamicin in patients with patent VP shunts by administering 2--5 times (depending on ventricle size) the usual intraventricular dose.

Cerebrospinal Fluid Shunts↗
PubMed1979

Oral phenytoin loading in adults: rapid achievement of therapeutic plasma levels.

Oral loading doses of phenytoin were estimated from a simplified pharmacokinetic model. Twenty patients were administered a calculated average dose of 19.1 mg per kilogram of phenytoin divided into two to four increments given over 3 to 21 hours (10.55 +/- 4.74, mean +/- SD). Plasma samples drawn 2 to 22 hours (10.75 +/- 4.32, mean +/- SD) after completion of the loading dose resulted in therapeutic levels ranging from 8.1 to 18.0 microgram per milliliter (11.42-11.37 +/- 2.41, mean +/- SD). Thus, this regimen in which no increment of the loading dose exceeds 600 mg is sufficient to achieve and maintain therapeutic plasma concentrations 18 to 24 hours after initiation of the loading dose.

Administration, Oral↗
PubMed1979

Final inline filtration: a means of decreasing the incidence of infusion phlebitis.

Infusion phlebitis is the most common complication of intravenous therapy. Six methods of reducing the incidence of infusion phlebitis including inline final filtration, buffers, heparin, hydrocortisone, heparin-hydrocortisone combinations, and frequent set changes were tested in a two part randomized prospective double-blind study of 266 surgical patients. Patients who received filtered fluids had a significantly decreased incidence of infusion phlebitis as compared with that of controls (P = 0.0000001). Of the other methods tested, only the heparin-hydrocortisone combinations achieved any significant decrease in phlebitis (P less than 0.5). Therefore, inline filtration is a highly effective means of decreasing the incidence of infusion phlebitis and should be considered as a routine part of intravenous therapy.

Buffers↗
PubMed1979

Sepsis in rabbits following administration of contaminated infusions through filters of various pore sizes.

The effects of three final filter pore sizes on sepsis and survival times in rabbits infused with contaiminated intravenous fluids were compared. Intravenous fluids were administered for up to 12 hours to five groups of rabbits. Groups 2, 3 and 4 received fluids, contaminated with Gram-negative rods, that were filtered with 0.22-, 1.0- and 5.0-micrometers filters, respectively. Rabbits in Groups 1 and 5 received uncontaminated and contaminated fluids, respectively, neither of which was filtered. Cultures were taken of blood and of fluid below the filters, and rabbit survival times were recorded. At 6, 8 and 12 hours, Group 2 survival time was not significantly different from that of the negative control; the survival times for Groups 3, 4 and 5 were significantly less than for the negative control. Fluid and blood cultures of Group 2 were negative or statistically indistinguishable from those of Group 1. Cultures for Groups 3, 4 and 5 were positive. The study suggests that 1.0- and 5.0-micrometers inline final filters have no beneficial effect on survival following infusion of contaminated fluids, but that 0.22-micrometer inline final filters increase survival time.

Animals↗
PubMed1978

Dopamine-phenytoin interaction. A cause of hypotension in the critically ill.

Five critically ill patients received dopamine hydrochloride intravenously to support their blood pressure. When seizures developed, intravenous phenytoin sodium therapy was begun. Coincident with the infusion of phenytoin, the blood pressure, which was stable on the dopamine infusion, declined rapidly. Analysis of these cases led to a hypothesis that the interaction of dopamine and phenytoin produced the hypotension. When this hypothesis was tested in the normovolemic dog, intravenous dopamine produced no change in the blood pressure, and the addition of a phenytoin infusion had little effect. In animals rendered hypovolemic and hypotensive by bleeding, intravenous dopamine returned the blood pressure to the prebleeding level. At this point, an infusion of phenytoin produced a sustained decrease in the blood pressure. The mechanism of this action may be related to a combination of catecholamine depletion and myocardial depression.

Adult↗
PubMed1978

Increased doses of phenytoin for infants.

A case report describing the problems of using conventional phenytoin dosages to achieve control of myoclonic seizures in a 6-month-old infant weighing less than 10 kg is presented. The physiologic explanations for the necessary phenytoin dosage adjustment in infants weighing less than 20 kg are discussed. It is suggested that more rapid metabolism, a larger volume of distribution and impaired gastrointestinal absorption may be responsible for the higher phenytoin dosages needed in such patients. Methods of determining appropriate dosage regimens, based on Michaelis-Menten pharmacokinetic principles or on body surface area, are discussed. Monitoring of plasma phenytoin concentrations is necessary to provide therapeutic levels of phenytoin and to prevent toxicity.

Drug Administration Schedule↗
PubMed1977

Double-blind study to investigate methods to prevent cephalothin-induced phlebitis.

Methods which might be useful in preventing cephalothin-induced phlebitis following intravenous administration of the buffered drug were investigated. One hundred and twenty adult orthopedic patients were assigned randomly to either a control group or one of five treatment groups. The treatment regimens studied were: addition of hydrocortisone phosphate 10 mg to each liter of intravenous fluid; addition of heparin 1,000 units to each liter of intravenous fluid; addition of heparin 500 units and hydrocortisone phosphate 1 mg to each liter of intravenous fluid; addition of heparin 1,000 units and hydrocortisone phosphate 10 mg to each liter of intravenous fluid; and filtration of intravenous solutions through a 0.22-mum inline filter. All patients in the study received intravenous buffered cephalothin at a dosage of 1 g every six hours for a minimum of 48 hours. Phlebitis was assessed every 12 hours according to predetermined criteria. Significant differences were found in the incidence of phlebitis at 48 hours between the control group and the last three study groups (see above). It is concluded that postinfusion phlebitis following cephalothin administration can be reduced by the concomitant addition of heparin and hydrocortisone to the intravenous solution or by the use of an inline 0.22-mum final filter.

Adolescent↗
PubMed1976

Membrane filters. Additional safety for intra-arterial infusions.

The addition of a 0.45mu in-line membrane-filter to the delivery system for intra-arterial infusion therapy is a simple and inexpensive means of providing additional safety. The filter decreases particulate and microorganism infusion by removing all measurable particles and most bacterial and fungal organisms. Since air will not pass through the filter, air embolism is prevented. In addition, in the event of set disruption, the filter will prevent bleeding via red blood cells clogging the membrane.

Filtration↗