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Biomedical subjects

D B Hill

Publications and source records attributed to D B Hill.

At least 37 records · Page 2Linked to original sources
PubMed1994

Arterial oxygen saturation during emergency esophagogastroduodenoscopy. The effects of nasal oxygen.

Cardiopulmonary events account for many of the serious gastrointestinal endoscopy complications. Pulse oximetry monitoring detects hypoxemia to allow prevention of complications. Alternatively, prophylaxis by continuous nasal oxygen during the procedure may offset any tendency toward oxygen desaturation. We monitored patients with major upper gastrointestinal hemorrhage by pulse oximetry during emergency upper endoscopy on room air or while receiving supplemental nasal oxygen (2 l/min). Desaturation (SpO2 < 90%) occurred in 80% of patients undergoing emergency procedures on room air but in only 25% of those receiving supplemental oxygen. For comparison, patients without significant cardiac or pulmonary disease undergoing elective procedures were studied on room air and desaturation only occurred in 29%. Thus, arterial oxygen desaturation as measured by pulse oximetry occurs more often during emergency than elective endoscopy. Supplemental oxygen decreases desaturation during emergency endoscopy but does not abolish it. We recommend that supplemental oxygen be used during emergency endoscopy to decrease desaturation, but it should not substitute for patient monitoring.

Administration, Inhalation↗
PubMed1994

Endotoxin administration to humans inhibits hepatic cytochrome P450-mediated drug metabolism.

In experimental animals, injection of gram-negative endotoxin (LPS) decreases hepatic cytochrome P450-mediated drug metabolism. To evaluate this phenomenon in a human model of gram-negative sepsis, LPS was administered on two consecutive days to healthy male volunteers during which time a cocktail of antipyrine (AP-250 mg), hexobarbital (HB-500 mg), and theophylline (TH-150 mg) was ingested and the apparent oral clearance of each drug determined. Each subject had a control drug clearance study with saline injections. In the first experiment, six subjects received the drug cocktail 0.5 h after the first dose of LPS. In the second experiment, another six subjects received the drug cocktail 0.5 h after the second dose of LPS. In both experiments, LPS caused the expected physiologic responses of inflammation including fever with increases in serum concentrations of TNF alpha, IL-1 beta, IL-6, and acute phase reactants. In the first experiment, only minor decreases in clearances of the probe drugs were observed (7-12%). However in the second experiment, marked decreases in the clearances of AP (35, 95% CI 18-48%), HB (27, 95% CI 14-34%), and TH (22, 95% CI 12-32%) were seen. The decreases in AP clearance correlated with initial peak values of TNF alpha (r = 0.82) and IL-6 (r = 0.86). These data show that in humans the inflammatory response to even a very low dose of LPS significantly decreases hepatic cytochrome P450-mediated drug metabolism and this effect evolves over a 24-h period. It is likely that septic patients with much higher exposures to LPS have more profound inhibition of drug metabolism.

Administration, Oral↗
PubMed1993

Serum insulin-like growth factor-I concentrations in the recovery of patients with anorexia nervosa.

Anorexia nervosa (AN) can result in extreme malnutrition, and these patients frequently require inordinately large amounts of calories to gain weight during refeeding therapy. Insulin-like growth factor-I (IGF-I) is a polypeptide that mediates many of the anabolic effects of growth hormone. Low levels of IGF-I have been associated with malnutrition and can cause poor weight gain. To clarify the potential relationship of IGF-I to weight gain, serial serum IGF-I, retinol-binding protein and prealbumin levels were measured at admission, 2 weeks and 4 weeks, in 14 consecutive consenting patients admitted for treatment of AN. Baseline IGF-I levels were lower in the patients compared to age-matched controls (mean 20.8 +/- 2.5 vs 32.9 +/- 2.9 nmol/L, p < 0.01). In patients with no weight gain, IGF-I levels were static. There was a stepwise increment in the IGF-I values related to weight gain. Retinol-binding protein and prealbumin, proteins commonly used to assess nutritional status, did not demonstrate important correlations with weight gain. Further studies are required to determine whether or not initial low IGF-I levels impede weight gain in AN patients and whether treatment with IGF-I (possibly in combination with growth hormone) may be of benefit in this disease process.

Adolescent↗
PubMed1993

Increased plasma interleukin-8 concentrations in alcoholic hepatitis.

Patients with alcoholic hepatitis often have hepatic polymorphonuclear leukocyte infiltration and neutrophilia. Interleukin-8 is a cytokine that stimulates neutrophil chemotaxis and release of lysosomal enzymes. It is made by several types of cells, including fibroblasts, Kupffer cells and hepatocytes. In this study, serial plasma interleukin-8 concentrations were measured with enzyme-linked immunosorbent assay in 40 consecutive patients with moderate-to-severe alcoholic hepatitis over a 6-mo period. Two control groups included 10 patients without clinically important liver disease admitted for treatment of alcohol dependence and 12 healthy male volunteers. The mean plasma interleukin-8 level on admission was markedly increased: 695 +/- 146 pg/ml in the alcoholic hepatitis patients. The alcohol-dependent control group and the normal volunteer controls had mean interleukin-8 concentrations of 106 +/- 28 pg/ml and 10 +/- 5 pg/ml, respectively. Initially increased interleukin-8 levels in alcoholic hepatitis patients decreased to a mean of 182 +/- 42 pg/ml over the first month; levels had decreased further to 124 +/- 79 pg/ml after 6 mo. Increased interleukin-8 concentrations in patients with alcoholic hepatitis suggest a role for interleukin-8 in the neutrophilia and hepatic polymorphonuclear leukocyte infiltration of alcoholic hepatitis.

Alanine Transaminase↗
PubMed1992

Noninvasive detection of Helicobacter pylori colonization in stomach using [11C]urea.

Helicobacter pylori is associated with chronic type B gastritis. Diagnosis can be made on gastric biopsy specimens and noninvasively using [13C]- or [14C]urea breath tests. Both breath tests require meticulous breath collection, and false positive results are possible from urease producing oral-pharyngeal flora. We used [11C]urea, a positron-emitting radionuclide allowing dynamic imaging, to measure metabolism of urea in the stomach of biopsy documented H. pylori-positive patients. [11C]urea was synthesized from 11CO2 produced using a Van de Graaff accelerator and administered with [99mTc]DTPA to control for loss of radioactivity via gastric emptying. Images were obtained externally by gamma camera every minute and 11CO2 was monitored in the breath continuously for 30 min. An H. pylori-positive patient exhibited a 99mTc/11C activity ratio of 2:1 in the stomach 10-20 min following administration, compared to a 1:1 ratio in a negative control, indicating metabolism of urea to 11CO2 with subsequent diffusion of 11C activity out of the stomach. The 11C activity in the breath peaked at 10-20 min in the H. pylori-positive patients. The short half-life of carbon-11 (20.4 min) alleviates radiation safety concerns and results in low absorbed radiation doses to patients.

Breath Tests↗
PubMed1992

Increased plasma interleukin-6 concentrations in alcoholic hepatitis.

Interleukin-6 (hepatocyte stimulating factor) is a 26 kd cytokine that plays a major role in the acute phase response, especially the hepatic aspects of the acute phase response. Patients with alcoholic hepatitis manifest many aspects of the acute phase response. In this 6-month study we evaluated serial plasma interleukin-6 levels in 30 consecutive patients with moderate to severe alcoholic hepatitis. Mean admission plasma interleukin-6 activity was markedly increased (49.8 +/- 8.5 U/ml, normal less than 5 U/ml) in patients with alcoholic hepatitis, and levels decreased with clinical improvement to 15.6 +/- 6.1 U/ml at 6 months. Admission interleukin-6 activity correlated significantly (r = 0.82) with the severity of liver disease as assessed by the discriminant function of Maddrey. Also measured were selected assays postulated to be regulated by interleukin-6, including serum albumin (2.3 +/- 0.1 gm/dl), which was significantly depressed; alpha 1-acid glycoprotein (52 +/- 5 mg/dl), which was within normal limits; and IgA (827 +/- 70 mg/dl) and C-reactive protein (3.03 +/- 0.51 mg/dl), which were significantly elevated. Interleukin-6 activity fell over time in a pattern similar to that of bilirubin and C-reactive protein. We suggest that plasma interleukin-6 may not only regulate many aspects of the acute phase response but also may be a marker of inflammation and severity of disease in alcoholic hepatitis.

Hepatitis, Alcoholic↗
PubMed1990

The case for hospital diversification into long-term care.

Since the market for long-term care (LTC) services is expected to grow rapidly in the years ahead, the case for hospital diversification into LTC is a strong one. This article discusses the major LTC diversification options, the cost of entry, potential profitability, potential problems, and recommendations for implementing them.

Alabama↗
PubMed1990

Right ventricular thrombosis after peritoneovenous shunt: nonoperative treatment with successful outcome.

Complications of peritoneovenous shunt for intractable ascites include a high propensity to malfunction, facilitation of infection, and the induction of coagulopathies. Right heart thrombosis is a rarely encountered adverse effect, the management of which has not yet been defined. We report a patient with an extensive right heart thrombus in the setting of a blocked peritoneovenous shunt that was discovered incidentally and treated expectantly with subsequent complete resolution and satisfactory outcome.

Adult↗
PubMed1982

Periodic medical review: the impact in Pennsylvania.

Periodic Medical Review (PMR) of all Medicaid beneficiaries in skilled nursing facilities (SNFs) in Pennsylvania was implemented in fiscal year 1973-74. In this study, the authors explored the impact of PMR through its first four annual review periods. Because over two thirds of all SNF patients who were determined (over the four-year period) to require lower levels of care were identified during the first year of the program, the study was focused on the impact of first-year reviews on patient placements and nursing home industry characteristics in the subsequent years. Although the results did not strongly show that PMR had significant long-term effects, the general conclusions reached were that: 1) first year PMR decisions altered (in the intended direction) SNF patient placements and structural characteristics of the nursing home industry in Pennsylvania; 2) the initial impact of PMR was still apparent by the fourth year, but much weaker; and 3) the PMR review team may have been more lenient in their decisions concerning appropriate levels of care for reviewed SNF patients after the first year.

Aged↗
PubMed1978

Cost analysis and the HSA: a framework.

A high priority in the mandate established for health systems agencies is the containment of health care costs. In this paper, a suggested framework for the analysis of costs in a health service area is presented. The health service area cost profile is derived by classifying data in nine categories of variables. Cost analysis involves the identification of relationships among measures in different profile categories. A general process for cost analysis is described. The process includes the comparative analyses of the health service area cost profile, historical and projected cost profiles, and cost profiles for sub-areas and areas outside the health service area.

Costs and Cost Analysis↗
PubMedDate not supplied

Osmotic diarrhea induced by sugar-free theophylline solution in critically ill patients.

It is widely accepted that early enteral nutrition is beneficial to critically ill patients. Diarrhea is a common problem in this setting and is often erroneously ascribed to enteral feedings. More often medications cause the diarrhea. Multiple cases of severe diarrhea associated with the use of a sugar-free theophylline solution (SFTS) were discovered by a nutrition support team. SFTS may induce an osmotic diarrhea because it contains sorbitol. A 55-year-old man admitted for a dissecting aneurysm was started on isotonic formula enteral feedings and within a day of starting SFTS developed severe diarrhea. The sorbitol-induced osmotic diarrhea persisted for 36 of his 83 days of hospitalization with direct cost for the evaluation of this diarrhea being $4,250. His prolonged hospitalization cost $166,200. A retrospective review of 20 consecutive patients receiving SFTS revealed that 15 patients had diarrhea for 2 or more consecutive days compared with 20 patients receiving iv aminophylline, of whom only two patients had diarrhea. Furthermore, SFTS was administered to healthy volunteers and a prominent breath hydrogen response was noted. The polyalcohol sorbitol is used as a sweetner in "sugar-free" products and not quantified on labeling because it is considered an inactive ingredient. Nutritionists should be aware that medicinal solutions can contain enough sorbitol to create a laxative effect which is an easily reversible cause of diarrhea in enterally fed patients.

Adult↗