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Biomedical subjects

D Schroeder

Publications and source records attributed to D Schroeder.

17 recordsLinked to original sources
PubMed1992

Laparoscopy in the diagnosis and treatment of acute small bowel obstruction.

The surgical correction of acute small bowel obstruction is conventionally performed through a vertical laparotomy incision. The increasing use of the laparoscope for elective general surgery has led to an increase in its use for the diagnosis and treatment of acute abdominal conditions. The authors report five cases of acute small bowel obstruction treated with the aid of the laparoscope. All five patients were able to leave the hospital in the early postoperative period and remain symptom free. Laparoscopy is a useful technique in the management of selected cases of small bowel obstruction.

Acute Disease↗
PubMed1991

The protective efficacy of polyvalent pneumococcal polysaccharide vaccine.

BACKGROUND: Although the protective efficacy of pneumococcal polysaccharide vaccine has been demonstrated in randomized trials in young African gold miners, there has been controversy about its efficacy in older Americans at risk for serious pneumococcal infections. To assess the vaccine's protective efficacy against invasive pneumococcal infections, we conducted a hospital-based case-control study of the efficacy of pneumococcal vaccine in adults with a condition recognized to be an indication for receiving the vaccine. METHODS: From 1984 to 1990, adults in whom Streptococcus pneumoniae was isolated from any normally sterile site were identified by prospective surveillance in the microbiology laboratories of 11 large hospitals; those with an indication for pneumococcal vaccine were enrolled as case patients. For each case patient, one control was matched according to age, underlying illness, and site of hospitalization. We contacted all providers of medical care to ascertain each subject's history of immunization with pneumococcal vaccine. Isolates of S. pneumoniae were serotyped by an investigator unaware of the subject's vaccination history. RESULTS: Thirteen percent of the 1,054 case patients and 20 percent of the 1,054 matched controls had received pneumococcal vaccine (P less than 0.001). When vaccine was given in either its 14-valent or its 23-valent form, its aggregate protective efficacy (calculated as a percentage: 1 minus the odds ratio of having been vaccinated times 100) against infections caused by the serotypes represented in the vaccine was 56 percent (95 percent confidence interval, 42 percent to 67 percent; P less than 0.00001) for all 983 patients infected with a serotype represented in the vaccine, 61 percent for a subgroup of 808 immunocompetent patients (95 percent confidence interval, 47 percent to 72 percent; P less than 0.00001), and 21 percent for a subgroup of 175 immunocompromised patients (95 percent confidence interval, -55 percent to 60 percent; P = 0.48). The vaccine was not efficacious against infections caused by serotypes not represented in the vaccine (protective efficacy, -73 percent; 95 percent confidence interval, -263 percent to 18 percent; P = 0.15). CONCLUSIONS: Polyvalent pneumococcal vaccine is efficacious in preventing invasive pneumococcal infections in immunocompetent patients with indications for its administration. This vaccine should be used more widely.

Adolescent↗
PubMed1991

Postoperative fatigue: a prospective physiological study of patients undergoing major abdominal surgery.

We attempted to define the site of muscle action accounting for the apparent muscle weakness occurring with postoperative fatigue. A model of the normal pathway of muscle contraction is presented. A series of studies, designed to separate the elements of the pathway, was performed on 38 patients undergoing major abdominal surgery. Central fatigue was measured with Christensen's analogue, voluntary strength by grip strength, perceived effort by grading the difficulty of a set work load, involuntary muscle function by ulnar nerve stimulation, and muscle bulk represented by total body nitrogen, measured by in vivo neuron activation analysis. Fatigue increased for the first 2 weeks after operation, was back to pre-operative levels within 1 month, and improved further at 3 months. Grip strength fell after operation and returned to pre-operative levels within 3 months. Perceived effort rose after operation and returned to pre-operative levels by 3 months. Involuntary muscle function was unaffected by operation. Similarly, total body nitrogen fell in the first 2 weeks after operation but was improved on baseline levels at 3 months. However, there was no consistent correlation between the movement patterns of any of the muscle parameters and fatigue. The results suggest that fatigue after surgery is not accompanied by any muscular defect, and that the apparent muscular weakness is probably a secondary phenomenon to the central fatigue.

Abdomen↗
PubMed1990

Pneumococcal vaccine. Efficacy and associated cost savings.

We evaluated the efficacy and cost savings of the pneumococcal pneumonia vaccine in a retrospective cohort study of 762 vaccinated and 1161 randomly selected unvaccinated age-sex matched persons in Blue Cross/Blue Shield of Minnesota using medical and pharmaceutical claims. The pneumonia incidence and the ratio of incidence in the postvaccination to prevaccination periods (rate ratio) were examined in the vaccine group by sex and risk factors. Vaccination significantly reduced pneumonia incidence, with overall efficacy of 69% and higher efficacy in women (86%) than in men (33%). We assigned persons to risk categories based on disease conditions as recorded in the claims by the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnostic codes. In the risk categories, efficacy varied from 50% to 75% and was confounded by sex. Immunocompromised and immunocompetent women had high efficacy (83% to 88%), while immunocompetent and immunocompromised men had lower efficacy (33%). Persons with a precondition of pneumonia exhibited similar vaccine efficacy to the overall cohort relative to the comparison group. Projected costs of pneumonia cases are 3.6 times the observed costs of vaccination and postvaccination pneumonia costs. We conclude that the pneumococcal pneumonia vaccine is efficacious in persons having had pneumonia, persons "at risk" of developing pneumonia, or persons over 50 years of age, and it corresponds to overall savings of $141 per person.

Aged↗
PubMed1990

Dietary management of the patient with massive enterectomy.

We present two cases who required massive enterectomy and who represent different points in the spectrum of this disease. We discuss their management from a nutritional stand-point and show details of energy uptake and expenditure for one of our patients. This describes our approach to this problem, and we hope it will be of use to others when dealing with patients following massive enterectomy.

Adaptation, Physiological↗
PubMed1990

Interpleural catheter for analgesia after cholecystectomy: the surgical perspective.

Sixteen otherwise healthy women undergoing cholecystectomy were randomized to receive postoperative analgesia either by continuous infusion of papaveretum (n = 8), or by continuous interpleural infusion of bupivacaine (n = 8). Postoperative pain was assessed by linear analogue and ventilatory capacity. Changes in body protein were measured by in vivo neutron activation analysis. Clinical course was also noted. Pain scores were significantly lower in the interpleural group over the first 48 h (P less than 0.02). Ventilatory capacity was also significantly better for the first 24 h (P less than 0.025). There was no evidence of shortened postoperative ileus; hospital stay and postoperative fatigue were similar for the two groups. Weight and protein losses over a 2 week period were similar in the two groups. It is concluded that the apparent advantages in patient comfort and mobility offered by interpleural infusion are most marked in the first 48 h postoperatively, with an advantage in ventilatory capacity over the first 24 h.

Adult↗
PubMed1988

Effects of dietary retinoids upon growth and differentiation of tumors derived from several murine embryonal carcinoma cell lines.

We have examined the effects of dietary retinoids upon the growth and differentiation of seven embryonal carcinoma lines in mice. The control diet contained 4000 IU/mg retinyl palmitate; the other diets contained 2 x 10(5) IU/mg retinyl palmitate, 50 mg/kg all-trans-retinoic acid (RA), 100 mg/kg RA, and no retinoid. The RA-containing diets had little influence on tumor latency or incidence but did suppress growth of many of the tumors. Decreased tumor mass was, in most but not all instances, accompanied by an increased proportion of differentiated cells. Increased differentiation was most commonly quantitative rather than qualitative; i.e., there was a larger proportion of the same types of differentiated cells seen in tumors from the control diet group rather than an increase in the spectrum of cell types observed. Notably, tumors from two differentiation-defective embryonal carcinoma lines were refractory to both the differentiation-inducing and growth-suppressing properties of dietary RA. Taken together, our results suggest that dietary RA can reduce teratocarcinoma growth in part by promoting differentiation but that other mechanisms are likely to be involved. The therapeutic benefits that we observed with dietary RA were compromised by adverse effects, including failure of the mice to gain weight as effectively as those on the control diet. The effects of elevated levels of retinyl palmitate, or its omission from the diet, were much less striking than that of RA. Both modifications tended to decrease tumor latency but had little effect, if any, upon ultimate tumor mass. Elimination of retinoid from the diet failed to significantly reduce degree of differentiation in tumors which normally differentiate extensively in animals on retinoid-containing diets. Excess retinyl palmitate led to a marginal increase in differentiation in F9 tumors and a statistically significant increase in differentiation in OC15-S1 tumors. Tumors from other embryonal carcinoma lines did not contain elevated levels of differentiated cells. The interpretation of these results is complicated by our observations that although our dietary alteration in levels of palmitate were dramatic, they resulted in much more modest differences in circulating retinoid levels when compared with mice on the control diet.

Animals↗
PubMed1988

Management of intrahepatic bile-duct injuries: presentation of two cases.

Blunt injury causing laceration of the intrahepatic bile-ducts is fortunately rare. Two cases are presented: neither was diagnosed until 48 h after initial presentation. Both were managed by laparotomy, placement of drains in the liver lacerations, and intravenous nutrition until the leaks had stopped spontaneously. The literature is reviewed and two other cases discussed. Such injuries, once diagnosed, should be treated by surgical placement of drains right at the site of leak.

Adult↗
PubMed1986

Double appendix.

Explore the source record for details and available documents.

Adult↗
PubMed1977

A new scoring system for the Spraings Multiple Choice Bender Gestalt Test.

A new scoring procedure to be used with Spraings' technique for administering the Bender-Gestalt test in a multiple choice format is presented. Scoring weights are used instead of simply scoring each item right or wrong. The evidence presented suggests that this method of scoring would increase the value of Spraings' test in the diagnosis of perceptual deficits.

Adult↗
PubMedDate not supplied

Hypotension and endoscopic stigmata of recent haemorrhage in bleeding peptic ulcer: risk models for rebleeding and mortality.

Clinical and endoscopic data were collected prospectively in 1050 patients with bleeding peptic ulcer admitted between September 1985 and July 1989 to the care of one surgical team. Seventy-nine patients underwent therapeutic endoscopy soon after admission and in 129 patients either immediate or early elective surgery was performed. Eight hundred and forty-two patients, in whom therapeutic endoscopy was not performed at any stage, underwent initial conservative management and data from this latter group are now presented. Shock on admission was defined as systolic blood pressure (BP) less than or equal to 100 mmHg on presentation. There were 10 deaths of 147 shocked patients (6.8%) compared with only 25 deaths of 695 patients (3.6%) not in shock (P less than 0.08). Bleeding recurred in 30 patients (20.4%) shocked on presentation but in only 96 (13.8%) with a BP greater than 100 mmHg (P less than 0.05). Twenty-one of 358 patients (5.9%) with endoscopic stigmata of recent haemorrhage (ESRH) died, but only 14 of 484 patients (2.9%) without such stigmata (P less than 0.05) died. In shocked patients rebleeding was evident in 21 of 73 (28.8%) cases with ESRH but in only 9 of 74 (12.2%) patients in whom ESRH were absent (P less than 0.02). In the absence of fresh blood at endoscopy rebleeding occurred in 22 of 124 (17.8%) shocked patients and only 74 of 629 (11.8%) of those not shocked on presentation (P less than 0.07). When ulcer size was documented rebleeding rates for ulcers less than or equal to 1 cm, less than or equal to 2 cm and greater than 2 cm in size were 54 of 485 (11.1%), 30 of 142 (21.2%) and 12 of 44 (27.3%) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Bioelectrical impedance analysis for body composition: clinical evaluation in general surgical patients.

Body composition was measured in 112 surgical patients and eight normal subjects by bioelectrical impedance analysis (BIA), and the results compared with our standard five-compartment method utilizing in vivo neutron activation analysis and tritium dilution space to measure fat-free mass and total body water. In a population with a mean fat-free mass of 49.2 kg by the latter method, BIA underestimated fat-free mass by 1.3 kg, with a standard deviation (SD) of 4.0 kg. Total body water was overestimated by 0.5 liter, with SD of 0.47 liter, when compared to a mean tritium dilution space of 36.7 liter. Changes in total body water which occurred over a treatment period of at least 1 week were also measured by the two methods. The change as measured by isotopic dilution could be estimated from the change as measured by BIA with a standard error of 2.25 liter. Although the results suggest that BIA should not be used as a research tool, it is concluded that in clinical practice, when nutrient requirements are being estimated, fat-free mass measured by BIA may have a useful place.

Adolescent↗
PubMedDate not supplied

Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing.

Thirty-two patients undergoing bowel resection were randomized to receive either immediate postoperative nasojejunal feeding with full strength Osmolite solution for 56 hours (n = 16) or routine postoperative hypocaloric fluids and gradual reintroduction of diet (n = 16). Body composition changes were measured at 14 days after operation with in vivo neutron activation analysis, the wound healing response by subcutaneous implantation of Gortex tubes, and muscle function by grip strength, maximum ventilatory volume, and stimulation of the ulnar nerve at the wrist. Postoperative fatigue up to 3 months after operation was assessed using a 10-point analogue. Successful immediate enteral nutrition was established in 12 of the 16 patients. Enterally fed patients had a mean daily caloric intake of 1179 +/- 388 kcal/d (mean +/- SD) over the first 4 postoperative days compared with 382 +/- 71 kcal/d for the controls (p less than 0.0001). The amount of hydroxyproline accumulating in the Gortex tubes was also significantly greater (2.5 +/- 1.1 nmol/g tube vs 1.5 +/- 0.8 nmol/g tube; p less than 0.02). However, the amount and composition of the weight lost was not significantly different. Muscle function was not preserved, and postoperative fatigue occurred to an equal extent in both groups. Complications were similar in both groups, except for a preponderance of bowel obstructions in the controls. The time to passage of first flatus and first bowel motion, although shorter in the fed group, did not reach significance (p = 0.07). We conclude that immediate enteral nutrition is feasible and results in an improved wound healing response.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗