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Biomedical subjects

G G Stanford

Publications and source records attributed to G G Stanford.

17 recordsLinked to original sources
PubMed1994

Effect of interferon gamma on infection-related death in patients with severe injuries. A randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To assess the efficacy of interferon gamma in reducing infection and death in patients sustaining severe injury. DESIGN: Multicenter, randomized, double-blind, placebo-controlled trial with observation for 60 days and until discharge for patients with major infection on day 60. SETTING: Nine university-affiliated level 1 trauma centers. PATIENTS: Four hundred sixteen patients with severe injuries, assessed by Injury Severity Score and degree of contamination. INTERVENTION: Recombinant human interferon gamma, 100 micrograms, was administered subcutaneously once daily for 21 days (or until patient discharge if prior to 21 days) as an adjunct to standard antibiotic and supportive therapy. MAIN OUTCOME MEASURES: Incidence of major infection, death related to infection, and death. RESULTS: Infection rates were similar in both treatment groups; however, patients treated with interferon gamma experienced fewer deaths related to infection (seven [3%] vs 18 [9%]; P = .008) and fewer overall deaths (21 [10%] vs 30 [14%]; P = .17). While 12 early deaths (days 1 through 7) occurred in each treatment group, late death occurred in 18 placebo-treated patients and nine in interferon gamma-treated patients. The results were dominated by findings at one center, which had the highest enrollment and higher infection and death rates. Statistical analysis did not eliminate the possibility of an unidentified imbalance between arms as an explanation for the results. CONCLUSION: Further evaluation is required to determine the validity of the observed reduction in infection-related deaths in patients treated with interferon gamma.

Adolescent↗
PubMed1994

The stress response to trauma and critical illness.

The stress response is a protective system that defends the body from external and internal threats. When the body is confronted with an over-whelming threat, the response becomes uncontrolled, resulting in damage to the body and frequently death. Knowledge of the strengths and pitfalls of this system is important in understanding the responses of the body to trauma and critical illness.

Critical Illness↗
PubMed1993

Documentation of clinical interventions in nutritional support.

The implementation of this documentation system has been a success. The SPF pharmacists' participation has been excellent. All of the original objectives have been met. The results collected have been responsible for more than validating the clinical functions of the pharmacists. They have been used to create CQI indicators, improve the work flow in the IV room, and enhance the evaluation process. The pharmacists work as a team to ensure that all interventions are documented. The results obtained, including numbers and trends, are reported on a monthly basis to the NSCPS, the sterile product formulation manager, and the director of Pharmacy Services. Although the documentation is considered to be a requirement for the pharmacists, they are continually encouraged through constant feedback from the managers. This feedback included individual recognition for exceptional interventions and reports of the impact of the interventions on pharmacy service. The biggest problem with the present system was the time-consuming task of entering the data into the Paradox computer database. This will soon be resolved by the implementation of a bar code system to automate this process. The pharmacists will be able to document the information from the interventions with a hand-held bar code wand. At the end of each day, the information can be automatically downloaded into the Paradox computer database.

Clinical Pharmacy Information Systems↗
PubMed1991

Hypomagnesemia is common following cardiac surgery.

Hypomagnesemia is a common disorder in noncardiac surgical patients in the postoperative period, but the effect of cardiac surgery on serum magnesium concentrations remains unclear. The authors hypothesized that cardiac surgery is associated with hypomagnesemia, and prospectively studied 101 subjects (60 +/- 13.1 years of age) undergoing coronary artery revascularization (n = 70), valve replacement (n = 24), or both simultaneously (n = 7). Blood samples and clinical biochemical data were collected before induction of anesthesia, prior to cardiopulmonary bypass (CPB), immediately after CPB, and on postoperative day 1. Blood samples were analyzed for ultrafilterable magnesium, total magnesium, ionized calcium, parathyroid hormone, and free fatty acid concentrations. Outcome variables were also determined. Eighteen of 99 (18.2%) subjects had hypomagnesemia preinduction and this number increased to 71 of 100 (71.0%) following cessation of CPB (P less than 0.05). Patients with postoperative hypomagnesemia had a higher frequency of atrial dysrhythmias (22 of 71 [31.0%] v 3 of 29 [10.3%], P less than 0.05) and required prolonged mechanical ventilatory support (22 of 63 [34.9%] v 4 of 33 [12.1%], P less than 0.05). Hypomagnesemia is common following cardiac surgical procedures with CPB and is associated with clinically important postoperative morbidity.

Adult↗
PubMed1991

Use of inotropic agents in critical illness.

Inotropic agents are useful in increasing oxygen delivery in critically ill patients. The need for inotropic support requires careful assessment of all the available cardiovascular variables. Following the decision to stimulate contractility, the choice of inotrope should take into consideration the adrenergic receptor populations and their effects on the distribution of blood flow. All the inotropes should be administered for a predetermined effect. If this response is not realized, the inotrope should be discontinued. The indiscriminate use of these powerful but dangerous drugs should be discouraged. However, in periods of decreasing oxygen delivery and consumption, these agents improve tissue oxygenation and prevent the development of isolated or multiple organ dysfunction.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1991

Factors affecting morbidity following hepatic trauma. A prospective analysis of 482 injuries.

During a 5-year period, 482 patients with liver injuries were studied prospectively: 65% resulted from penetrating and 35% from blunt injuries. The injuries were graded by the hepatic injury scale (grades I to VI); transfusion requirements and perihepatic abscesses correlated with increasing scores. Minor surgical techniques were needed in 338 patients and 144 patients required major techniques. Omental packing was used in 60% of the major injuries and yielded 7% mortality and 8% abscess rates. Gauze packs were used for management of 10% of major injuries and yielded 29% mortality and 30% abscess rates. The patients were randomized to no drain, closed suction, or sump drainage and respective perihepatic abscess rates were 6.7%, 3.5%, and 13% (p less than 0.03; suction compared to closed suction). Multivariate analysis demonstrated increasing abdominal trauma indices and transfusion requirements as well as sump drainage to be associated independently with perihepatic infection.

Adolescent↗
PubMed1990

Hypocalcemia in experimental pancreatitis occurs independently of changes in serum nonesterified fatty acid levels.

Hypocalcemia and lipid abnormalities commonly occur in acute pancreatitis. Experimentally, increased plasma concentrations of free fatty acids (NEFA) can lower the serum calcium (Ca). We hypothesized that changes in blood-ionized calcium might parallel changes in NEFA concentration in pancreatitis. This hypothesis was tested in a model of severe necrotizing pancreatitis and a model of mild edematous pancreatitis. Adult male Sprague-Dawley rats (300-400 g) were randomized to receive: 100 microL sodium glycodeoxycholic acid (GDOC 34 mmol/L) infused into the pancreatic duct to produce severe necrotizing pancreatitis (Group 1); 100 microL 0.9% NaCl (NS) infused into the pancreatic duct (Group 2); Sham laparotomy (Group 3); A 6 h IV infusion of cerulein (5 mucg/kg/h) to produce mild edematous pancreatitis (Group 4); and a 6 h IV infusion of NS (Group 5). A significant time dependent decrease in blood-ionized Ca concentration, compared to normal rats, was observed in both GDOC-pancreatitis (0.836 +/- .057 vs 1.069 +/- .038 mmol/L p less than 0.001) and cerulein pancreatitis (0.988 +/- .028 vs 1.069 +/- .038 p less than 0.05), which was maximal 24 h after induction of pancreatitis. The degree of hypocalcemia correlated with the severity of pancreatitis (GDOC 0.836 +/- .057 vs cerulein 0.988 +/- .028 p less than .001). Hypocalcemia was not observed in any of the control groups. All experimental and control groups had significantly increased baseline NEFA concentrations compared with normal rats (p less than 0.001); however, no further increase in NEFA concentration occurred in conjunction with the observed time-dependent decline in ionized calcium concentrations. Although the NEFA concentrations observed in these experiments were comparable to those measured in human acute pancreatitis (exclusive of hyperlipemic pancreatitis), the time course of the changes suggests that increases in serum NEFA concentrations in experimental pancreatitis are not the primary factor mediating hypocalcemia.

Acute Disease↗
PubMed1990

Early detection of myocardial contusion and its complications in patients with blunt trauma.

Myocardial contusion remains an elusive clinical entity, which consumes a disproportionate amount of scarce and expensive critical care resources for the purpose of cardiac monitoring. This study attempts to define a group of patients at high risk who can be identified from the available data present at the time of admission. All patients admitted with the suspicion of a myocardial contusion over a 3-year period were retrospectively studied. The records were examined for history, physical findings, electrocardiographic (ECG) results, creatine kinase levels, Injury Severity Score (ISS), and echocardiographic findings. A diagnosis of a myocardial contusion was made if patients had an ECG consistent with acute injury, increased creatine kinase-MB, or an abnormal echocardiogram consistent with acute injury. Patients were stratified into two groups: Group 1 patients satisfied the criteria for a myocardial contusion and Group 2 patients lacked sufficient evidence to substantiate this diagnosis. The records were then examined for the presence of factors available in the emergency room that might be predictive of a myocardial contusion or its complications. A total of 88 patients were evaluated; 27 of these were found to have a myocardial contusion (Group 1) with 61 patients placed in Group 2 (no myocardial contusion). Group 1 patients had an abnormal admission ECG (p less than 0.05), and an ISS greater than or equal to 10 (p less than 0.05). Multivariate analysis identified two factors predictive of a myocardial contusion: an abnormal ECG and an ISS greater than 10. When these two predictors were absent, the probability of a myocardial contusion was 1%. No predictors of a complication of a myocardial contusion were identified. These data suggest that a combination of easily obtained variables in the emergency department can be used to select a patient population at high risk for myocardial contusion. Prospective evaluation of these variables is necessary.

Adult↗
PubMed1990

Circulating interleukin-1 and tumor necrosis factor in septic shock and experimental endotoxin fever.

Interleukins (IL) -1 beta and -1 alpha and tumor necrosis factor (TNF-alpha) were measured by radioimmunoassay in plasma samples from 44 healthy individuals, 15 patients in septic shock, and 6 volunteers infused with endotoxin. Plasma IL-1 alpha levels were low (40 pg/ml) or undetectable in all situations. In 67% of the healthy subjects, plasma IL-1 beta levels were less than 70 pg/ml. Septic patients had higher plasma IL-1 beta levels (120 +/- 17 pg/ml, P = .001); those of surviving patients were higher than those of patients who died (P = .05). Plasma TNF-alpha concentrations in septic individuals were elevated (119 +/- 30 pg/ml) and correlated with severity of illness (r = .73, P = .003), but no correlation was observed between plasma IL-1 beta and TNF-alpha concentrations in individual samples. Infusion of endotoxin caused a twofold elevation of IL-1 beta, from a baseline of 35 +/- 5 pg/ml to a maximum of 69 +/- 27 pg/ml at 180 min (P less than .05). Peak TNF-alpha levels after endotoxin infusion were 15 times higher than IL-1 beta levels, were attained more rapidly (90 min), and as with the septic patients, did not correlate with IL-1 beta levels. These data support the concept that plasma IL-1 beta and TNF-alpha concentrations are regulated independently and are associated with different clinical outcomes.

Adolescent↗
PubMed1990

Serum prolactin concentrations in patients with the acquired immunodeficiency syndrome.

Experimental evidence suggests that prolactin is an important immunomodulator hormone. Because this endocrine-immune link may represent a potential new therapeutic avenue, we considered its application in states of immunodeficiency. We hypothesized that serum prolactin concentrations might be abnormal in AIDS. To test this hypothesis, we measured serum prolactin concentrations in blood samples obtained from patients who had either AIDS (n = 15) or AIDS-related complex (n = 12), asymptomatic subjects who were antibody-positive for human immunodeficiency virus (HIV) (n = 10), HIV antibody-negative homosexual subjects (n = 10), and heterosexual HIV antibody-negative controls (n = 21). We found no difference in the serum prolactin concentrations between the five subject groups. We conclude that circulating prolactin values are not altered by HIV infection; however, the possibility that prolactin administration may modulate immune function remains to be tested.

AIDS-Related Complex↗
PubMed1990

Hypothyroidism and pleural effusions.

Serous effusions have been thought to be an unusual complication of hypothyroidism and most commonly have been associated with ascites, pericardial fluid and heart failure. Pleural fluid as an isolated finding in hypothyroidism is apparently rare and complete analysis of these hypothyroid-associated pleural effusions has not been described. To determine the frequency, chemical characteristics and clinical associations of hypothyroidism and pleural effusions, the medical records of 128 patients with hypothyroidism (defined by an increased serum TSH concentration) were reviewed. The majority of effusions in patients with hypothyroidism were due to other diseases. Effusions solely due to hypothyroidism appeared to be a real entity. These effusions were borderline between exudates and transudates and showed little evidence of inflammation.

Aged↗
PubMed1989

Hypertonic saline resuscitation in a porcine model of severe hemorrhagic shock.

The purpose of this study was to investigate the effect of 7.5% hypertonic saline solution (HTS) as the initial solution in resuscitation of a pig in shock. Twenty-two animals were bled 50% of their blood volume over 30 minutes and maintained in shock for 60 minutes. The 14 survivors were divided into two groups. The first group was given 20 mL/kg of lactated Ringer's solution (LR) over a ten-minute period, while the second group was given 10 mL/kg of HTS. Both groups were then given LR at 2 mL/kg/min until the mean arterial pressure reached 80 mm Hg. The HTS group achieved a more rapid rise in mean arterial pressure over the first ten minutes of resuscitation. During this period, the cardiac index increased significantly more in the HTS group when compared with the LR group. All animals in the HTS group developed an adequate urine output. Only two animals in the LR group developed an adequate urine output. Hypertonic saline solution markedly improved survival, and there were significant improvements in hemodynamics. This was accomplished with smaller volumes of resuscitation fluid and may prove useful under conditions where intravascular access is limited.

Animals↗
PubMed1989

The pharmacotherapy of septic shock.

Septic shock is a common clinical problem in the intensive care setting. The high mortality rate associated with septic shock, regardless of age, reflects the inadequacy of available therapeutic approaches. The purpose of this article is to review the current pharmacologic approaches to the treatment of septic shock with an emphasis on the pathophysiologic correlations of these treatments.

Adrenergic Agonists↗
PubMed1989

Catecholamines: study of interspecies variation.

In the last three decades, numerous articles on plasma catecholamine concentrations in various settings have been published in the medical literature. Despite this abundance of information, no summary article has analyzed the species variations in circulating catecholamine concentrations. In this paper, the plasma catecholamine responses to various stresses in 31 animal groups have been compiled from greater than 200 publications (with greater than 5000 animal subjects). Primitive cartilaginous fish such as the shark and the lamprey have the highest reported basal plasma catecholamine concentrations. Birds, mammals, and teleost fish have the lowest concentrations. The lower circulating catecholamine concentrations parallel anatomical changes in the development of the adrenal medulla and the development of the nervous system. Decapitation, hypoxia, hemorrhage, and hypothermia are the experimental conditions associated with the greatest stress-induced changes in plasma catecholamine concentrations. The differences in experimental design are tabulated to afford the reader an opportunity to compare catecholamine levels among species. The table provides a detailed guide to normal concentrations and normal responses in 31 species. This report gives a dynamic overview of catecholamine concentrations in human and animal physiology and may be particularly helpful to investigators involved in catecholamine research.

Animals↗