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D Simonowitz

Publications and source records attributed to D Simonowitz.

At least 19 recordsLinked to original sources
PubMed1986

Enteral versus parenteral nutritional support following laparotomy for trauma: a randomized prospective trial.

Although enteral nutrition is considered more 'physiologic' than parenteral nutrition, there is greater published experience with parenteral nutrition in trauma patients. To compare the efficacy of these two techniques, we prospectively randomized multiple trauma patients during their admission laparotomy to receive either central venous parenteral nutritional (TPN: n = 23) or enteral nutrition by jejunostomy (Jej: n = 23). Nutritional support began on the first postoperative day; the study period continued a maximum of 14 days. There were no significant differences between the two groups in age, sex, injury severity, estimated caloric needs (3,322 TPN; 3,114 Jej), hours to achieve full prescription (77 PTN; 79 Jej), or the number of days on nutritional support (22 TPN; 25 Jej). Average daily caloric intakes, nitrogen balance results, and complication rates were also comparable. These results suggest that early postoperative jejunostomy feeding is a safe and efficacious choice for multiple trauma patients undergoing laparotomy.

Adult↗
PubMed1985

Cimetidine clearance in the obese.

Six subjects with normal weight (mean weight = 62 kg) and six obese subjects (mean weight = 140 kg) were given a single intravenous cimetidine infusion of 600 mg over 10 to 15 minutes. Both groups of subjects had normal serum creatinine levels and were matched with respect to age, desirable body weight, height, renal function, and sex. Compared with subjects of normal weight, obese subjects had higher cimetidine systemic (1147 and 637 ml/min) and renal (808 and 318 ml/min) clearances. Volume of distribution at steady state was of the same order for the two groups (82 and 84 L), but the t 1/2 was shorter in the obese group (1.2 and 1.9 hr). Obese subjects had lower cimetidine sulfoxide serum concentrations and greater cimetidine sulfoxide renal clearance (856 and 509 ml/min). Cimetidine systemic clearance and cimetidine sulfoxide renal clearance values were of the same order in the two groups when normalized by the value of weight raised to the 0.76 and 0.5 powers. Under the assumptions of an average weight of 70 kg and that average serum concentrations produced by cimetidine, 300 mg iv every 6 hours, are appropriate, people with normal renal function and body weight usually receive 48 mg/day/weight0.76. This same dosage in obese individuals with normal serum creatinine values should result in the same average steady-state serum concentrations. In our obese subjects, the mean cimetidine dose would have been approximately 500 mg iv every 6 hours.

Adult↗
PubMed1982

Pancreatitis associated with primary hyperparathyroidism.

Two series of patients treated for primary hyperparathyroidism are reviewed for the incidence of associated pancreatitis. In an earlier series of 150 hyperparathyroid patients, six had documented pancreatitis as one of the primary clinical manifestations. Review of a more recent series failed to uncover a single case of pancreatitis in 26 patients with primary hyperparathyroidism. The incidence of pancreatitis associated with hyperparathyroidism appears to be steadily decreasing, possibly reflecting the earlier diagnosis of parathyroid disease, which is due to widespread screening testing methods currently available.

Adult↗
PubMed1980

Preoperative CEA level: a prognostic test in patients with colorectal carcinoma.

Preoperative and postoperative carcinoembryonic antigen (CEA) levels were evaluated in 42 patients with colorectal carcinoma. Preoperative CEA values correlated inversely with survival at a statistically significant level and provided prognostic information not available by pathologic staging. Postoperative plasma CEA can accurately predict recurrent disease and may, when serial values are elevated, serve as an indication for a second-look procedure.

Carcinoembryonic Antigen↗
PubMed1980

Trauma to major visceral veins: an underemphasized cause of accident mortality.

In the period 1970-1978, a mortality rate of 44% resulted in 45 patients who suffered major intra-abdominal venous injuries. An especially grave prognosis accompanied wounds to the inferior vena cava and the hepatic and portal venous systems. Management of damage to major veins presents several difficulties. Exposure is poor; veins tear easily when clamped or sutured; exsanguination can occur as rapidly as with arterial trauma; because of low intraluminal pressure, postoperative chances of thrombosis and occlusion are high; veins (unlike arteries) have no intrinsic vasomotor capabilities to halt bleeding. Finally, the misconception persists that venous wounds are less serious than comparable arterial injuries. Simple pressure by packs or hand often controls bleeding: otherwise clamps, balloons, hemostats, or ligation can be selectively chosen. Our experience suggests that atrial-caval shunting without prior identification and control of the bleeding site is doomed to failure.

Abdomen↗
PubMed1979

Inflammatory tissue reaction in rabbit bowel injected with Crohn's homogenates.

Homogenates from the terminal ileum of a patient with Crohn's disease with granulomas were prepared as snap-frozen or fresh and were injected into the ascending colonic walls of New Zealand white rabbits. Control animals were injected with 1 per cent bovine serum albumin alone. The rabbit bowel was examined after 1 year, and lesions were noted in each of the rabbits injected with Crohn's disease homogenate, irrespective of the type of tissue preparation. The observed lesions were diffuse and occurred both at the injection site and in the terminal ileum. These changes were not noted in the control group. This work confirms earlier results in the same animal model and suggests that either fresh or snap-frozen homogenates will produce the intestinal lesion but that bovine albumin alone will not.

Animals↗
PubMed1978

Guidelines in the management of patients with pancreatic abscess.

A systematic approach to the management of patients with pancreatic abscess is presented. The method includes an aggressive diagnostic approach relying on radiographic and ultrasound examinations, adequate transperitoneal drainage of the abscess, coupled with gastrostomy and feeding jejunostomy. The importance of nutritional support using an elemental diet administered through a jejunostomy is emphasized.

Abscess↗
PubMed1978

Reflux gastritis.

Explore the source record for details and available documents.

Gastritis↗
PubMed1977

Pancreatic fistula: management guided by endoscopic retrograde cholangiopancreatography.

A patient with a persistent external pancreatic fistula was studied by endoscopic cholangiopancreatography (ERCP). The ERCP demonstrated the probable site of the fistula and a high-grade, main pancreatic ductal stricture. This information prompted early, successful surgical correction of the pancreatic fistula by drainage into a Roux-en Y jejunal loop.

Abscess↗
PubMed1977

Azathioprine-associated acute pancreatitis.

Azathioprine therapy in a patient with granulomatous ileocolitis was associated with an attack of acute pancreatitis, which was confirmed by laparotomy. Recurrence of pancreatitis occurred after rechallenge with a single dose of azathioprine.

Acute Disease↗
PubMed1977

The operative treatment of Crohn's disease in childhood.

Fifteen pediatric patients have been presented who required operative treatment for Crohn's disease. This disease is associated with severe side-effects in children, especially maturation and growth arrest. There are clear indications for surgical treatment: fistula, chronic obstruction, hemorrhage and perforation. Failure to grow, when associated with obstruction of the small intestine, is an urgent indication for operation. From our observations, we conclude that growth arrest in these patients occurs because of malnutrition. In a majority of patients, chronic obstruction of the small intestine contributes significantly to this malnutrition. Operative treatment is one of conservative resection, and the operative mortality is nil. The majority of patients with growth arrest will grow postoperatively. Operative treatment of Crohn's disease is carried out for its complications, and treatment is quite effective in relieving these complications, although the disease itself may persist.

Adolescent↗
PubMed1977

Carcinoembryonic antigen levels in pancreatic carcinoma.

Plasma carcinoembryonic antigen (CEA) levels were correlated with the stage of the tumor in 43 patients who underwent laparotomy for histologically proven pancreatic adenocarcinoma. Elevated CEA levels were noted in one third of the patients with tumors localized to the pancreas. When the carcinoma had extended beyond the pancreas or distant metastases were present, 78% of patients had elevated levels. Of the entire group of patients, 72% had elevated CEA levels.

Adenocarcinoma↗
PubMed1977

The production of an unusual tissue reaction in rabbit bowel injected with Crohn's disease homogenates.

Recent reports have suggested a transmissible factor in the etiology of Crohn's disease, which had yet to be confirmed. The specificity of the transmission was tested with a disease control of ulcerative colitis as well as normal bowel. Twenty New Zealand White rabbits received inoculum of tissue homogenates from the terminal ileum of normal, ulcerative colitic, and Crohn's disease patients. This inoculum was injected into the wall of the ascending colon and the animals were examined after one year. Changes were noted consistently only in those animals receiving the Crohn's disease inoculum. These changes consisted of thickened bowel wall with increased mucosal folds, thickened mesenteric fat with some creeping, irregular areas of thin colonic mucosa, and hyperplastic mesenteric lymph nodes. The terminal ileum distant from the inoculum site was smooth with atrophic changes only in the Crohn's inoculated group of animals. These animals also had discrete collections of macrophages in colon or sacculus, mucosal and submucosal edema, and chronic inflammation of the colon. However, the characteristic features of Crohn's disease were not reproduced.

Animals↗
PubMed1976

The treatment of incidental thyroid cancer.

Thirty-eight patients with incidental thyroid carcinoma were reviewed. Thyroid lobectomy was adequate therapy in 15 to 17 patients. Both patients in whom lobectomy alone was inadequate had received prior irradiation. Five patients had antecedent head and neck irradiation, and in three of them, multicentric foci of tumor developed. Lobectomy alone was inadequate in three of these patients; they required thyroidectomy. A clinical recurrence developed in only two of 38 patients, and both of them had received previous irradiation. Reoperation in previously dissected areas was associated with an increased rate of complications. Lobectomy in nonirradiated and total thyroidectomy in irradiated patients cured the majority of patients suffering from incidental carcinoma of the thyroid.

Adolescent↗