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Biomedical subjects

H J Sugerman

Publications and source records attributed to H J Sugerman.

At least 163 records · Page 9Linked to original sources
PubMed1984

Stomal disruption in gastric partition in morbid obesity (comparison of radiographic and endoscopic diagnosis).

Twenty-two patients who had gastric partition surgery for morbid obesity and subsequently developed stomal dilatation were evaluated with both upper gastrointestinal barium examinations and upper endoscopy. Both examinations were positive in eight patients. Endoscopy alone was positive in 14, but retrospective view of the upper gastrointestinal series was positive in nine of the patients. The authors stress the importance of a dedicated radiologist in performing these difficult examinations and the need for specific measurements of the stomal diameter.

Dilatation, Pathologic↗
PubMed1983

Gamma scintigraphic localization of platelets labeled with indium 111 in a focus of infection.

To determine if autologous platelets would localize in a focus of infection, a pyogenic abscess was created in the left hind limb of dogs, using previously processed human stool, while an identical surgical procedure without bacterial inoculation was performed on the right hind limb. Autologous platelets labeled with indium 111 (500 microCi) were administered intravenously to five control dogs that had not undergone surgery, to eight dogs two hours following stool inoculation, and to five dogs 24 hours after stool inoculation. A statistically significant scintigraphic increase in tracer activity was apparent within 24 hours in each animal at the site of abscess creation. Tissue samples, obtained at 48 hours after the administration of labeled platelets, revealed a significant increase in percent dose of 111In per gram of infected muscle compared with control muscle. These studies show that platelets localize at the site of bacterial infection.

Abscess↗
PubMed1983

Failure of various agents to decrease oleic acid pulmonary albumin leak.

Computerized pulmonary gamma scintigraphy has been shown to be a sensitive technique for the measurement of albumin flux in oleic acid pulmonary microvascular injury. In this technique technetium-99m-tagged human serum albumin is administered intravenously and lung:heart radioactivity ratios are constructed. This ratio remains constant unless there is a net flux of albumin from the vascular space into the lung, when a rising ratio is seen, called the "slope of injury" or SI. Gamma scintigraphy provides a method to rapidly screen the ability of various possible therapeutic agents to reduce the flux of albumin in experimental ARDS. In this study, 0.05 ml/kg oleic acid produced a significant increase in the SI. None of the agents tested (30 mg/kg methylprednisolone, 12.5 mg/kg ibuprofen, 4 mg/kg MK-447, a superoxide radical scavenger, or 140 mg/kg calcium gluconate) were able to alter the scintigraphically measured increased albumin flux produced by 0.05 ml/kg oleic acid.

Albumins↗
PubMed1983

Radionuclide evaluation of lung trauma.

Nuclear medicine imaging procedures can play a significant role in evaluating the pulmonary complications that are seen in trauma patients. A quantitative method for measuring increased pulmonary capillary permeability that uses Tc-99m HSA allows early diagnosis of acute respiratory distress syndrome (ARDS) and accurately differentiates this condition from pneumonia or cardiogenic pulmonary edema. This technique may be of great value in following the response to therapy. The use of 133Xe to diagnose inhalation injury remains an important diagnostic tool, particularly at hospitals with specialized burn units. Regional decreases in ventilation-perfusion images reliably localize aspirated foreign bodies. Radionuclide techniques that are used to demonstrate gastropulmonary aspiration remain controversial and require further clinical evaluation. Pulmonary perfusion imaging, although nonspecific, may provide the earliest clue for correct diagnosis of fat embolism, air embolism, contusion, or laceration. Furthermore, the possibility of perfusion abnormality due to these uncommon conditions must be remembered whenever trauma patients are evaluated for pulmonary thromboembolism with scintigraphy. Occasionally, liver or spleen scintigraphy may be the most appropriate procedure when penetrating chest trauma also involves these subdiaphragmatic organs.

Adolescent↗
PubMed1983

Unsuspected right ventricular dysfunction in shock and sepsis.

Monitoring of ventricular function by central venous (CVP) and pulmonary wedge pressures (PCW) was compared with ejection fraction and end-diastolic volume (gated pool scan) in patients resuscitated from hypovolemic and septic shock. Sixteen patients were studied within 24 hours of resuscitation and all showed depressed right ventricular ejection (RVEF) and/or an increased end-diastolic volume (RVEDVI). Group I (eight patients, hypovolemia and sepsis) had low RVEF (mean, 0.30), high RVEDVI (mean 129.2 ml/m2), and nearly normal left ventricular function (LVEF 0.63 and LVEDVI 63.6 ml/m2), compared to angiographic normals (RVEF 0.52, RVEDVI 55.8 ml/m2; nL LVEF 0.59, LVEDVI 52.3 ml/m2). Group II (3 patients, all septic) had better RVEF (mean, 0.54) but high RVEDVI (mean, 121.1 ml/m2) with normal LVEF (mean, 0.67) and high LVEDVI (mean LVEDVI 107.2 ml/m2). Group III consisted of five patients (hypovolemia and sepsis) who had biventricular depression (RVEF 0.25 and LVEF 0.29) and elevated EDVI. The mortality rate for group I (25%) was significantly less than for groups II and III (100% and 80%, respectively), and could be correlated with failure to improve RV function. Follow-up studies in ten patients showed improvement in seven which correlated with increased RVEF and reduced RVEDVI. Comparing survivors to non-survivors showed no predictability on the basis of initial studies but a significantly larger RVEDVI and RV stroke work index in non-survivors' follow-up studies. No correlation could be made with left ventricular performance, and there were no correlations between PCWP and LVEDVI or CVP and RVEDVI. A significant negative correlation was seen between RVEF and pulmonary vascular resistance (r = -0.34, p less than 0.05). Both LVEDVI and RVEDVI were correlated significantly with cardiac index and with each other. RV dysfunction occurs after resuscitation of hypovolemia and sepsis without reliable alteration in filling pressure and is likely related to myocardial ischemia as well as increased pulmonary vascular resistance. Survival seems to depend on improvement in RV performance, which can be measured at the bedside by cardiac scintigraphy.

Adult↗
PubMed1983

Comparison of Greenfield filter and vena caval ligation for experimental septic thromboembolism.

Septic thromboembolism resulting from the placement of infected autologous thrombi was studied in three groups of ten dogs each following vena caval ligation (VCL) or Greenfield filter (GF) placement with or without antibiotic treatment. All the dogs that did not receive antibiotic therapy died, and the shortest survival time was after acute VCL. Dogs with GF and with delayed embolism after VCL survived significantly longer than did the control animals. Antibiotic therapy consisting of ampicillin and clindamycin resulted in survival except for one control dog with lung abscess. Cultures of the GF and contained thrombus were negative after 2 weeks. However, after VCL, two died of sepsis and two survivors had caval abscess. In a group of six dogs with VCL and delayed embolism, there were four deaths from sepsis and one survivor found to have a caval abscess. To test secondary infection of a trapped thrombus, in 12 dogs with GF and a sterile thrombus we created an extremity abscess with a fecally contaminated sponge, which resulted in death from sepsis in six animals within 3 days. Surgical drainage and antibiotic treatment of the remaining six resulted in survival in five dogs. Cultures of filters and emboli showed heavy contamination in the untreated animals and in one treated dog that died within 24 hours. The remainder had sterile filters and emboli. The presence of sepsis does not preclude use of the Greenfield filter, which is well tolerated in the face of septic embolism and allows sterilization with antibiotic treatment. Prophylactic antibiotic therapy seems advisable for any patient with a filter during a procedure that may produce bacteremia.

Animals↗
PubMed1982

Comparative scintigraphy in oleic acid pulmonary microvascular injury.

Computerized gamma scintigraphy revealed a significant (p less than 0.001) rising lung:heart radioactivity ratio, which has been called "slope of injury" or "slope index", with both 99mTechnetium-tagged human serum albumin (99mTc-HSA) and 99mTechnetium-tagged red blood cells (99Tc-RBC) after 0.05 or 0.2 ml/kg iv oleic acid administration to dogs. This slope index was significantly greater with 99mTc-HSA than 99mTc-RBC (p less than 0.001). These findings verify that the scintigraphic 99mTc-HSA slope of injury is a result of a pulmonary capillary protein leak and not oleic acid induced changes in pulmonary blood or air volume. The leak of red blood cells noted with scintigraphy was confirmed by light microscopy and examination of the tracheal edema fluid. The leak of albumin, however, was much greater than the leak of red blood cells by microscopy and tracheal fluid examination, confirming the scintigraphic data. This study provides further evidence that computerized gamma scintigraphy will be of value for the diagnosis of permeability pulmonary edema and its response to treatment.

Animals↗
PubMed1982

Scintigraphy and radiography in oleic acid pulmonary microvascular injury: effects of positive end-expiratory pressure (PEEP).

Using computerized gamma scintigraphy, 10-cm H2O PEEP did not alter the rate of capillary protein leakage in dogs following pulmonary microvascular injury with 0.01 to 0.2 ml/kg oleic acid. A rising lung:heart radioactivity ratio, or 'slope of injury,' was seen during PEEP which paralleled the 'slope of injury' had PEEP not been used. A sudden decrease in lung and heart count activity (p less than 0.001) and decreased lung:heart radioactivity ratio (p less than 0.001) occurred with PEEP at all doses of oleic acid studied. An apparent improvement in the standard chest roentgenogram was seen within 2 minutes following PEEP in dogs given 0.2 ml/kg oleic acid. However, progression of the radiographic infiltrate occurred in these animals during 30 minutes of PEEP. When all vessels leading to and from the heart and lungs were ligated, PEEP produced a 60% fall in count activity over the lung without any change in cardiac radioactivity. The apparent radiographic improvement and 2/3 of the fall in lung radioactivity with PEEP were due to an increased pulmonary air volume and 1/3 due to a decreased pulmonary blood volume. The decreased cardiac output with PEEP must be secondary to decreased ventricular filling rather than decreased ventricular function.

Animals↗
PubMed1982

Computerized scintigraphic technique for the evaluation of adult respiratory distress syndrome: initial clinical trials.

Eleven patients with suspected adult respiratory distress syndrome (ARDS) and five control patients were studied using a computerized gamma imaging and analysis technique and 99mTc-labeled human serum albumin. The heart and right lung were imaged, lung:heart ratio was plotted vs. time, and a linear regression was fitted to the data points displayed. The slope of this fit was termed the "slope index." An index value of 2 standard deviations greater than the control mean was considered positive. Radiographs from the six positive studies revealed typical diffuse air-space disease. Radiographs from two of the five negative studies demonstrated air-space consolidation. Both of these patients had elevated pulmonary capillary wedge pressure, cardiomegaly, and clinical course consistent with cardiogenic pulmonary edema. These preliminary data demonstrated a good correlation between positive slope index and clinical ARDS.

Adult↗
PubMed1982

Hemodynamics, oxygen consumption and serum catecholamine changes in progressive, lethal peritonitis in the dog.

A progressive, lethal canine peritonitis model was developed using the intraperitoneal injection of previously processed, frozen human stool. Of 15 dogs with fecal contamination, seven died within 24 hours and eight died over two to nine days, with a mean of five days. The model was associated with an initial hyperdynamic state which became quite variable as sepsis progressed. The cardiac index in the septic dogs correlated directly with the arteriovenous oxygen content difference. Evidence of multiple system organ failure and a significant increase in norepinephrine levels was noted in the septic dogs. The serum catecholamine levels were inversely correlated with the systemic blood pressure but did not correlate with the systemic vascular resistance or the cardiac index. This implies a lack of responsiveness of resistance vessels or the heart to catecholamines in this severely septic dog model.

Alkaline Phosphatase↗
PubMed1981

Gastroplasty for respiratory insufficiency of obesity.

Three patients with the obesity hypoventilation syndrome and one patient with the sleep apnea syndrome underwent gastroplasty for weight reduction. A tracheostomy was also performed in the patient with sleep apnea. The PaO2 rose from an average of 51 +/- 9 to 71 +/- 5 torr and the PaCO2 fell from an average of 51 +/- 21 to 41 +/- 6 torr within two to ten months following bariatric surgery. The improved arterial blood gases were associated with an increased forced vital capacity in each patient. The change in maximum voluntary ventilation was variable. Sleep capneography demonstrated cure of the patient with sleep apnea permitting removal of the tracheostomy. All four patients have returned to productive lives in society. Given proper pre- and postoperative care, patients with respiratory insufficiency tolerate the operation well. Respiratory insufficiency associated with morbid obesity should be considered an indication for the gastroplasty procedure, rather than a contraindication as previously suggested.

Adult↗
PubMed1981

Sensitivity of scintigraphy for detection of pulmonary capillary albumin leak in canine oleic acid ARDS.

Computerized gamma scintigraphy was shown in this study to be a sensitive technique for the detection and kinetic analysis of a pulmonary capillary protein leak. A rising lung:heart radioactivity of 'slope of injury' was found at each dose of intravenous oleic acid in dogs from 0.01 to 0.20 ml/kg (p less than 0.01). This 'slope of injury' was proportional to the dose of oleic acid (r = +0.97; p less than 0.004) and was more sensitive than changes in arterial oxygen tension, standard chest radiography, bloodless wet:dry lung weight, or alveolar epithelial membrane permeability. Only standard light microscopy and right lymphatic duct flow were able to document the leakage of protein detected by gamma scintigraphy at 0.01 ml/kg oleic acid.

Albumins↗
PubMed1981

Effects of pulmonary vascular recruitment on gamma scintigraphy and pulmonary capillary protein leak.

Pulmonary vascular recruitment (PVR) was altered and lung-heart radioactivity ratio (L:H) measured using 99mTc-tagged human serum albumin (Tc-HSA) in five dogs each by inflating a left atrial balloon (LAB) to produce a 20 mm Hg pulmonary capillary wedge pressure (PCWP) or opening a 5 mm diameter aortoinferior caval shunt (ACS) before and after oleic and injury. Cardiac output (CO), pulmonary arterial pressure (PAP), and PCWP were measured with each alteration in PVR. In an additional 10 dogs, multiple doses of Tc-HSA, administered over 5 hours, 2 hours after 0.1 ml/kg oleic acid, produced parallel "slopes of injury" over the 5-hour period. Each rise in PVR was associated with an acute increase in L:H but demonstrated no significant increase in slope after equilibration. Closure of the ACS or LAB deflation returned the L:H to projected baseline. A "slope of injury" (P less than 0.001) was seen after the administration of oleic acid, which was significantly (P less than 0.01) steeper with an increased PVR. This was confirmed by repeat doses of Tc-HSA. This study confirmed the following hypotheses: (1) the "slope of injury" curves were reproducible so that the effects of experimental interventions on the rate of protein leak could be determined; (2) the L:H rapidly became constant after an acute change in PVR prior to oleic acid injury: and (3) a raised PVR would increase the rate of albumin leak after pulmonary microvascular injury.

Animals↗