Biomedical subjects

G C Vitale

Publications and source records attributed to G C Vitale.

43 records · Page 3Linked to original sources

PubMed1985

Prophylactic postoperative nasogastric decompression. A prospective study of its requirement and the influence of cimetidine in 200 patients.

To determine the need for prophylactic nasogastric decompression following laparotomy and the influence of cimetidine, 200 consecutive patients who underwent major abdominal procedures were prospectively randomized into one of four limbs: no tube-placebo; no tube-cimetidine; tube-placebo; and tube-cimetidine. Patients were evenly distributed among these groups with respect to age, sex, alcohol and tobacco use, previous operations, and types of operations. There was significantly longer time until passage of flatus, bowel movement, and cessation of intravenous fluids in the tube group (p less than 0.05). Duration of postoperative stay increased from 11.4 to 14.1 days in the intubated patients (p less than 0.05). There was also significantly more pain with and frequency of swallowing, and nose/throat discomfort in the tube group. Nasogastric tubes reduced the incidence of vomiting from 28 in the no-tube group to 10 in the tube group (p less than 0.05), but most had only one or two episodes. Cimetidine did not affect either the incidence of vomiting or the duration of intubation, but was associated with a significant increase in pneumonias (p less than 0.05). Five patients without tubes initially, and seven patients with tubes had to have them inserted or replaced for vomiting or abdominal distention, which occurred equally in the placebo and cimetidine limbs. There were no cases of aspiration pneumonia, gastric dilatation, or wound dehiscence in the trial, and the four anastomotic leaks were divided equally between the tube and no-tube groups. The results indicated that prophylactic decompression was unnecessary in most patients and associated with increased morbidity and delayed return of gastrointestinal function. Cimetidine lowered nasogastric output on the first postoperative day (p less than 0.05), but did not prevent vomiting.

Cimetidine↗

PubMed1985

Computerized 24-hour esophageal pH monitoring: a new ambulatory technique using radiotelemetry.

A computerized telemetric system using a portable microprocessor receiving unit has been designed for clinical use in ambulatory 24-hour esophageal pH monitoring. The receiving unit can be used with either a pH-sensitive radiotelemetry pill or a standard intraesophageal pH probe. Esophageal pH data is collected under microprocessor control while the patient is in the usual home or work environment. Computerized plotting and analysis of the compiled pH data is performed at the conclusion of the ambulatory testing. The system has been successfully used in patients with symptoms of esophageal reflux and healthy volunteers with no symptoms. The development of a computer-based radiotelemetry system for prolonged monitoring of esophageal pH represents a substantial advance in existing investigational technology. It allows the use of new radiotelemetric techniques of esophageal pH recording with increased patient comfort and acceptance over a 24-hour ambulatory testing period. Microprocessor control of both data collection and analysis allows rapid interpretation of complex 24-hour esophageal pH tracings and greatly facilitates the performance of esophageal pH monitoring as a routine clinical investigation.

Adult↗

PubMed1985

Body composition in the cirrhotic patient with ascites: assessment of total exchangeable sodium and potassium with simultaneous serum electrolyte determination.

The precise mechanism of initiation and maintenance of the disturbed fluid and electrolyte balance in cirrhotic patients remains unclear. Measurement of total exchangeable potassium in 11 cirrhotic patients with ascites revealed marked depletion compared to 9 healthy volunteers. Total exchangeable potassium was 50.8 +/- 5.1 m moles/L TBW in the patient group compared to 75.2 +/- 3.4 m moles/L TBW in the control group (P less than 0.01, Mann-Whitney U Test). Total body exchangeable sodium measured 80.1 +/- 3.7 m mole/L TBW in the cirrhotic group, which is not significantly elevated compared to the value in healthy volunteers of 74.1 +/- 1.9 m mole/L TBW. Serum sodium was low in four of the cirrhotic patients (129-133 mEq/L); exchangeable sodium was low in only one of these four (53.4 m mole/L TBW). Serum potassium was low in two of the cirrhotics (2.6-2.9 mEq/L); total body potassium was depressed in both of these patients (43.5-50.1 m mole/L TBW). An additional three patients had a low total body potassium (29.6-48.9 m mole/L TBW) with normal serum levels (4.0-4.2 mEq/L). There was no correlation between serum and total exchangeable electrolyte levels (Pearson's regression, r = 0.16 and 0.23). This work confirms that serum levels are not reliable indicators of true body sodium and potassium stores. The decreased total exchangeable potassium appears to be related to loss of body cell mass rather than intracellular potassium depletion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1984

Computerized 24-hour ambulatory esophageal pH monitoring and esophagogastroduodenoscopy in the reflux patient. A comparative study.

Ambulatory 24-hour esophageal pH monitoring and esophagogastroduodenoscopy were performed in 72 patients with symptoms suggestive of gastroesophageal reflux. Additionally, 22 asymptomatic healthy volunteers underwent pH monitoring. In patients with classic reflux symptoms and endoscopic esophagitis, a mean of 5.41 minutes/hour of reflux below pH 4 was found compared to 0.70 minutes/hour in controls (p less than 0.0001). The mean number and duration of reflux events in this group were 1.51 events/hour and 4.0 minutes/event, compared with 0.31 events/hour and 2.26 minutes/event in volunteers (p less than 0.001, p less than 0.01). A new system for ambulatory esophageal pH monitoring is presented using a pH-sensitive radiotelemetry pill or a pH probe and computerized methods for ambulatory data collection, analysis, and storage. An overall sensitivity of 76% was obtained with a 91% selectivity for detection of acid reflux in 51 patients having classic symptoms of gastroesophageal reflux. Ambulatory pH monitoring was positive for acid reflux in seven of 11 patients with normal endoscopic findings. Conversely, eight of 12 patients with normal pH monitoring had endoscopic esophagitis. In 19 patients presenting with atypical symptoms or previous gastric surgery, endoscopic findings were normal in 15. Nine of these 15 were identified as acid refluxers by pH monitoring. A combined approach using both pH monitoring and endoscopy is warranted for maximal detection and quantification of disease. A clear clinical role for pH monitoring is seen in the early diagnosis of acid reflux, particularly in patients having normal endoscopic findings with nonspecific gastrointestinal complaints or previous gastric operations.

Adult↗

PubMed1983

Successful management of injuries to the extraperitoneal rectum.

We reviewed the records of 32 patients having extraperitoneal rectal trauma in the six-year period ending December 31, 1981. There were 23 penetrating injuries and nine blunt injuries. All patients were resuscitated and examined digitally by sigmoidoscope. Complete diverting colostomy and washout evacuation of the defunctionalized rectal segment were performed routinely. Dilatation of the anal sphincter and lavage with two to three liters of dilute povidone-iodine solution permitted cleansing of the rectal segment of all particulate fecal material. Retrorectal suction drains were inserted in 30 patients; the two remaining patients required abdominoperineal resection and gauze packing of the pelvis for control of hemorrhage. The mortality rate due to rectal injury was 3 per cent. Complications occurred in 5 patients (16%).

Accidents, Traffic↗

PubMed1981

The injured colon: relationships of management to complications.

One hundred thirty-seven patients who sustained intraperitoneal colon wounds were admitted to the University of Louisville Hospital during the three-year period ending December 31, 1979. One hundred twenty penetrating wounds and 17 blunt injuries were treated. An intraoperative classification system was employed, in which Grade 1 injuries were characterized by minimal contamination, the absence of associated organ injuries, minimal shock, and no significant delay between injury and definitive operation. All of these were managed by single-layer closure. More severe wounds were treated by colostomy or exteriorization. The overwhelming majority of the patients (116) sustained Grade 2 injuries. Twenty-two patients (16%) died. Nine deaths (6% of the patients) were directly attributable to the colon wounds. Twenty-five Grade 1 injuries were treated by primary suture closure with a single complication (3% of the patients). Nine wounds were exteriorized for later reinsertion into the peritoneal cavity, but only two patients were spared colostomy by this method. Right colon injuries were, clearly, more severe than left or sigmoid colon wounds. Intraoperative classification allowed selection of a group of patients in whom suture repair was safe. Colostomy was associated with the lowest complication rate for Grade 2 and 3 wounds.

Adult↗

PubMedDate not supplied

The use of ERCP in the management of common bile duct stones in patients undergoing laparoscopic cholecystectomy.

The purpose of this study was to evaluate the indications and results of endoscopic retrograde cholangiopancreatography (ERCP) for gallstone disease since the advent of laparoscopic cholecystectomy. In our personal series of 410 consecutive cases of laparoscopic cholecystectomy, we found 17 common bile duct (CBD) stones; seven were identified by preop ERCP, nine at laparoscopy by intraoperative cholangiography, and one postop by ERCP. We have performed preop ERCP in 21 patients (5.1%); CBD stones were found in seven. Our indications for preop ERCP were elevated liver function tests, dilatation of the common duct by ultrasound, or a history of jaundice/pancreatitis, and all stones were successfully removed by endoscopic sphincterotomy. At laparoscopic cholecystectomy nine patients were found to have stones; one was treated with laparoscopic methods, four with open CBD exploration, and four by postop endoscopic sphinecterotomy. Post-laparoscopic cholecystectomy, five patients underwent ERCP for pain or increased liver function tests suggestive of common duct stones. One of the five was found to have stones and these were successfully removed by endoscopic sphincterotomy. ERCP is very useful as a diagnostic and therapeutic modality in laparoscopic cholecystectomy patients with suspected CBD stones. Elevated liver function tests and dilated CBD by ultrasound are the most accurate predictors of stones. Endoscopic sphincterotomy is a more effective route, at present, for stone removal than a laparoscopic approach.

Adolescent↗