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Biomedical subjects

S J Dudrick

Publications and source records attributed to S J Dudrick.

At least 55 records · Page 3Linked to original sources
PubMed1984

Long-term alimentation by a new indwelling tube gastrostomy technique.

Use of a Gore-Tex peritoneal catheter as a feeding gastrostomy tube can virtually eliminate the complications associated with long-term feeding gastrostomy. The tube consists of a radiopaque 18 F silicone rubber catheter having a toadstool-shaped, expanded polytetrafluorethylene flange and cuff around its midportion. Epithelial tissue grows into the interstices of the Gore-Tex flange, and fibroplasia incorporates the cuff into the tissue, fixing the tube firmly in place and preventing its inadvertent removal. In addition, the tissue ingrowth creates a physiologic barrier that prevents efflux of intragastric contents and discourages influx of microorganisms or other contaminants along the gastrostomy tract. Thus far, Gore-Tex feeding gastrostomies have been placed for two to 11 months in six critically ill malnourished patients who required long-term or permanent gastrostomy feeding. No complications have occurred, patient safety and satisfaction have been greatly increased, efficacy of nutritional rehabilitation has been enhanced, and the patients' quality of life has been vastly improved.

Adult↗
PubMed1983

Effect of serum source on protein-free diet lymphocyte blastogenesis.

The influence of protein depletion on serum factors in PHA lymphocyte blastogenesis was studied in a rat model. Buffalo rats were divided randomly into two groups and fed either a protein-free (PF) diet or a regular 25% protein diet (RD). At weekly intervals, lymph node lymphocytes were cultured with PHA in either autologous or pooled 10% rat serum. For weeks 2 through 6, PHA stimulated blastogenesis of lymphocytes from rats maintained on PF diet incubated with autologous serum decreased significantly compared with RD lymphocytes cultured with RD serum. At week 4, PHA blastogenesis of PF lymphocytes cultured with RD serum was similar to that of RD lymphocytes incubated with RD serum. AT weeks 5 and 6, PHA stimulation of PF lymphocytes assayed with RD serum was depressed compared with RD lymphocytes cultured with RD. For weeks 4 through 6, blastogenesis of RD lymphocytes assayed with PF serum decreased significantly compared with RD lymphocytes incubated with RD serum. Three weeks of protein repletion of rats previously on a PF diet for 6 weeks restored PHA blastogenesis to that observed for lymphocytes from animals in the RD group. The data suggested that suppression of PHA blastogenesis of lymphocytes from rats maintained on PF diet involved a serum factor in the early stages of protein depletion and an additional defect (not serum related) in lymphocyte blastogenesis after prolonged protein depletion. In addition, this defect was corrected after a period repletion.

Animals↗
PubMed1983

Percutaneous insertion of a cuffed catheter with a long subcutaneous tunnel for intravenous hyperalimentation.

An indwelling silicone rubber Dacron-cuffed catheter placed in a long subcutaneous tunnel reduces the incidence of catheter-related sepsis and facilitates dressing changes by the patient, but often necessitates tedious dissection to cannulate a satisfactory tributary of a central vein. Modification of the percutaneous technique for introducing pervenous pacing leads allows placement of central venous feeding catheters without open dissection. A Teflon sheath introducer designed to separate along its longitudinal axis is advanced into a subclavian or femoral vein over a guidewire previously inserted through a percutaneously placed needle. The "peel apart" sheath allows the insertion of the catheter and the subsequent removal of the introducer. C-arm fluoroscopy facilitates and verifies catheter placement. Experience in 31 adult and five pediatric patients has proven this technique to be simple, safe, and expedient within an average operative time of only 20 minutes (12 to 30 min). Successful insertion through the femoral vein as well as insertion under local anesthesia has been achieved without adverse effects. This technique has distinct advantages over previous techniques and lends itself well to the implantation of indwelling central venous catheters on an outpatient or treatment room basis with obviously improved cost-benefit and risk-benefit ratios.

Adult↗
PubMed1983

Intravenously administered amino acids with either dextrose or lipid as nutritional support in surgical patients.

The relative efficacy of exogenous fat or glucose in preserving lean body mass in surgical patients is controversial. In this study, peripheral intravenously administered amino acids with either lipid or dextrose were given to well nourished patients undergoing elective total cystectomy and ileal diversion. Patients were well matched for age, sex, nutritional status and degree of operative stress. Twenty-eight patients received 1.2 grams per kilogram per day of amino acids plus either dextrose (440 kilocalories per day) (17 patients) or 10 per cent fat emulsion (550 kilocalories per day) (11 patients) for three days preoperatively and seven days postoperatively. No significant differences between the groups were noted in mean nitrogen balances during the preoperative and postoperative periods or in the mean cumulative adjusted (for change in blood urea nitrogen and body weight) nitrogen balances for the total study time. Mean nitrogen excretion per 100 nonprotein calories infused was also similar. Changes in mean body weight, blood urea nitrogen, serum glucose and serum albumin were similar in the two groups. No deaths or major infectious complications occurred in either group. In well nourished patients matched for age, sex, nutritional status and degree of operative stress, the addition of either hypocaloric fat or dextrose to intravenously infused amino acid solutions resulted in an equivalent metabolic and clinical outcome.

Aged↗
PubMed1983

Adaptation to amino acid infusion in patients undergoing operation.

Urine ketone levels were measured in patients receiving peripheral amino acid solutions, and the results were correlated with changes in nitrogen balance. Thirty well-nourished patients who were to undergo cystectomy were placed on liquid, noncarbohydrate diets 3 days before operation, and no oral intake was allowed until 7 days after operation. Crystalline amino acid (1.3 to 1.5 gm/kg/day) solutions were infused continuously from 3 days before to 7 days after operation. Blood was obtained 3 days before and 3, 7, and 10 days after operation; 24-hour urine outputs were determined daily. Qualitative urine acetone levels were determined four times daily. During the infusion period, 14 (47%) patients developed ketonuria (group I); 16 patients did not (group II). The mean serum glucose levels ranged from 99 to 107 mg/dl in group I and from 108 to 113 mg/dl in group II (P less than 0.05). The mean serum transferrin level decreased after operation to 117 mg/dl in group I and 97 mg/dl in group II. The mean cumulative adjusted nitrogen balance was -24 +/- 8 gm in group I and -47 +/- 9 gm in group II (P less than 0.05). No patient developed sepsis. Qualitative testing of urinary ketones correlated with significant alterations in blood urea nitrogen, serum glucose, transferrin, and cumulative adjusted nitrogen balance. The bedside determination of urinary ketones may be useful in assessing a patient's adaptation to peripheral amino acid infusions.

Acidosis↗
PubMed1983

Delayed hypersensitivity skin testing: response rates in a surgical population.

The results of this study indicate that skin test responses should be measured at both 24 and 48 hours post-injection and considered reactive or positive if induration of greater than or equal to 5 mm. is noted at either time. The practice of measuring responses at 48 hours only is neither appropriate nor recommended as it may produce a large percentage of false negative results. Erythema without induration was noted in a small percentage of patients. Future studies should evaluate the efficacy of erythema greater than or equal to 15 mm. in the absence of induration as a reactive response to mumps antigen. The validity of data interpretation must ultimately be based on correlations with morbidity and mortality. Streptokinase-streptodornase, mumps, and trichophyton were the three antigens with highest response rates, and this battery detected 94% of the reactive or positive responses to the five-antigen battery.

Adolescent↗
PubMed1982

Effects of systemic hyperthermia and intrahepatic infusion with 5-fluorouracil.

Potential hepatotoxicity from systemic hyperthermia (43 degrees C) +/- simultaneous hepatic artery infusion with 5-FU was evaluated in an animal model. Twenty-two dogs had aorta-vena caval shunts (8 mm Dacron grafts) placed, and 10 of these dogs had silastic catheters inserted in their hepatic arteries. Two weeks later, Group I (n = 8) was heated to 43 degrees C for one hour (distal esophageal + intrahepatic temperature) using the shunts and blood-heat exchangers; Group II (n = 6) was heated to 43 degrees C for one hour with simultaneous intrahepatic infusion of 5-FU (10 mg/kg); Group III (n = 8) was shamheated (37 degrees C) and underwent a one hour intrahepatic infusion with 5-FU (10 mg/kg). Serum alkaline phosphatase, SGOT, SPGT (IU/ml) and bilirubin were measured, and liver biopsies were obtained at 0 and 1 hour, at one and seven days. Mean SGOT levels increased significantly (P less than 0.05) in Group II from 19 +/- 2 to 31 +/- 6 and 63 +/- 18 at one hour and one day; these levels rose slightly in Group I from 31 +/- 5 to 40 +/- 8 and 47 +/- 8 at one hour and one day. Hepatocellular enzyme levels returned to normal at seven days in both groups. Mean SGOT and SGPT levels remained similar in Group III at all time periods. No significant differences in mean serum alkaline phosphatase or bilirubin levels were noted. There was no histologic evidence of hepatocellular necrosis at any time period. Survival was 6/8, 5/6 and 8/8 dogs in Groups I, II, and III, respectively. Systemic hyperthermia to 43 degrees C for one hour in dogs does not adversely affect serum hepatic enzymes or cell structure; reversible serum hepatic enzyme changes occurred when hyperthermia was combined with hepatic artery infusion with 5-FU.

Animals↗
PubMed1982

Parenteral nutrition in esophageal cancer patients.

A review of operative therapy in 244 patients with esophageal cancer from 1960 to 1980 was done to evaluate the impact of TPN in 72 patients treated from 1973 to 1980 with 43 non-TPN patients treated during the same period and to 129 patients operated upon before 1973. Mean age, sex distribution, site, stage, and treatment of the disease were similar for the two study groups. The TPN group lost less weight during treatment (3 lbs vs. 11 lbs) and had fewer overall complications postoperatively (24% vs. 41%). Significant reductions in major wound, infectious, and postoperative complications were noted in these patients who received at least 5 days of preoperative TPN compared with postoperative TPN or the non-TPN groups (4% vs. 24% and 23%). Malnourished esophageal cancer patients can more safely undergo aggressive operative therapy and radiation treatment when adequate perioperative nutritional support is added to the treatment armamentarium.

Adenocarcinoma↗
PubMed1982

Nutrition in orthopaedic surgery.

One hundred and twenty-nine patients undergoing orthopaedic surgical procedures were found to have an average incidence of clinical and subclinical malnutrition of 42.4 per cent per patient. The lowest incidence of nutritional depletion was identified in patients undergoing total hip-replacement surgery (28.6 per cent), followed by the elective surgical group (35.3 per cent) and patients with multiple trauma and femoral fractures (58.6 per cent). Trauma and major surgery were shown to induce a state of malnutrition and a loss of immunocompetence. A significant (p less than 0.05) correlation between subnormal nutritional indices and the development of complications was identified. A comprehensive approach to the detection and correction of malnutrition in orthopaedic patients is described.

Adolescent↗
PubMed1981

Serum zinc levels in lung cancer patients.

Serum zinc concentrations were determined in 26 extensive squamous cell lung cancer patients and were tested for correlations with survival, response to therapy, nutritional status indices, and various host defense characteristics. Subnormal serum zinc levels were found in 24 of the 26 patients. The mean serum zinc concentration was 43.2/micrograms 100 ml +/- 3.6 S.E.M. (normal = 80-100 micrograms/100 ml). A significant (P = 0.007) survival advantage was demonstrated for those patients with pretreatment zinc concentrations greater than 45 micrograms%, but serum zinc levels did not correlate with response to chemotherapy (also significantly affecting survival). Decreased serum zinc concentrations were significantly associated with decreased neutrophil migration measured by the skin window technique and with decreased triceps skin fold thickness but not with any of the other host defense and nutritional induces measured. These data suggest that further studies are indicated to examine the role of serum zinc concentration as a possible sensitive prognostic characteristic and to determine if zinc administration may be of therapeutic benefit in cancer patients.

Adult↗
PubMed1981

Effects of enteral and parenteral nutrition on tumor response to chemotherapy in experimental animals.

The effects of oral and intravenous nutrition on host and tumor responses to graded doses of methotrexate (MTX) were evaluated in 150 adult Sprague-Dawley rats. All animals were inoculated with Walker-256 carcinosarcoma and were fed a regular diet for ten days before assigning them to three dietary groups. Group I (n = 64) received a constant intravenous infusion of 30% dextrose-5% amino acids (IVH), group II (n = 64) received an identical solution orally ad libitum, and group III (n = 22) received a regular diet ad libitum. Animals in groups I and II were then divided into three subgroups each that received either 20 mg/kg, 40 mg/kg, or 60 mg/kg of MTX intramuscularly. Ten days later, all surviving animals were killed. Animals fed the 30% dextrose-5% amino acid diet orally and given 20 mg/kg and 40 mg/kg of MTX lost slightly less body weight when compared with their IVH counterparts. In the 60 mg/kg treatment group, orally fed animals lost 52 gm of body weight compared with 23 gm in IVH animals. IVH rats given 20 mg/kg and 40 mg/kg of MTX demonstrated significant inhibition of tumor growth and decreased tumor weight/body weight ratios when compared with orally fed rats. No improvement in tumor response to 60 mg/kg of MTX was observed, however, when IVH animals were compared with orally fed rats. In a second study, nutrient intake was maintained at a constant level by intravenous infusion in one group and intrajejunal infusion in another group of tumor-bearing rats. Host and tumor responses to 20 mg/kg of MTX were similar in both groups of animals.

Administration, Oral↗