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Biomedical subjects

H Silberman

Publications and source records attributed to H Silberman.

At least 55 records · Page 3Linked to original sources
PubMed1983

Demonstration of collagenase activity in adult Strongyloides ratti (Nematoda:Strongyloididae) and its absence in the infective larvae.

Larvae and adults of Strongyloides ratti were examined for collagenolytic activity on 14C proline-labelled, native, guinea-pig skin collagen substrate. The activity was measured by determining either the amount of hydroxyproline released or the amount of radioactivity in the solubilized fraction of the collagen substrate. Bacterial collagenase was used for enzyme control and trypsin served as substrate control. No collagenolytic activity was found in living larvae, their extracts or metabolites. The collagenolytic activity of the metabolites of adult worms appeared weak, whereas that of the extracts of the adults was pronounced. It is suggested that collagenase is active in the adult females at the time of migration in the intestinal mucosa during oviposition.

Animals↗
PubMed1983

Auxiliary canine hepatic transplantation without portal blood flow.

Auxiliary liver transplantation for acute reversible hepatic failure has been suggested as a way to provide temporary hepatic support. The major technical difficulty in such an operation is providing portal blood flow, although it is unclear if this is necessary for short-term function of such a graft. Three groups of five dogs each underwent common duct ligation and cholecystectomy. One week later all animals underwent an end-to-side portocaval shunt. In Group I dogs only a "sham" transplant was done while those in Group II also received an auxiliary hepatic graft without portal blood flow which had been perfused with iced Collins solution and immediately grafted. Group III received similar auxiliary hepatic grafts with 22 hours of cold ischemia time. Reductions in mean total serum bilirubin values to near normal, usually lasting for one week (Group I, 12.02 mg% +/- 1.23 SEM vs. Group II, 3.58 mg% +/- 0.52 SEM, p = 0.01) were observed. Although several livers stored for 22 hours demonstrated function, there was considerable evidence of ischemic injury.

Acute Disease↗
PubMed1983

Similar liver function abnormalities occur in patients receiving glucose-based and lipid-based parenteral nutrition.

Biochemical and histopathological evidence of hepatic dysfunction has been associated with the use of glucose-based total parenteral nutrition (TPN). In the present study liver indices, SGOT, SGPT, alkaline phosphatase, and bilirubin, were analyzed retrospectively during the course of total parenteral nutrition in 40 patients; 15 patients received a glucose-based system and 25 received a lipid-based system. Transient elevations in at least one of the measured parameters were found in a majority of patients receiving either system. These data confirm previous reports of liver function test abnormalities in patients receiving glucose-based total parentual nutrition. However, in contrast to results from prior studies, these derangements also were observed during the administration of a nutritional support system using lipids as the primary source of calories.

Adolescent↗
PubMed1983

Total parenteral nutrition with high or low nitrogen intakes in patients with acute renal failure.

This study was undertaken to assess the clinical and metabolic responses to total parenteral nutrition (TPN) in patients with acute renal failure who could not be nourished adequately through the enteral tract. The TPN provided either about 21 g/day of essential amino acids (EAA) or a larger quantity of essential and nonessential amino acids (ENAA); the ratio of essential to nonessential amino acids in the latter preparation was 1.0:1.0. Attempts were made to give sufficient ENAA nitrogen to equal or slightly exceed the urea nitrogen appearance (UNA). Five patients were randomly assigned to receive TPN with EAA (2.3 g of nitrogen per day) and six patients to receive ENAA (11.3 g of nitrogen per day). Hypotension with trauma or infarcted intestine was the cause of acute renal failure in 10 of the 11 patients. Three of the five patients receiving EAA recovered renal function, and two survived. In the patients receiving ENAA, as compared with those given EAA, UNA was significantly greater (14 +/- 7.4 [SD] vs. 7.5 +/- 3.0 g/day; P less than 0.01), and nitrogen balance, estimated from the difference between intake nitrogen and UNA was slightly, but not significantly, less negative (-3.0 +/- 4.0 vs. -5.2 +/- 2.9 g of nitrogen per day). These preliminary findings suggest that in comparison to TPN with EAA, there is no advantage to larger amounts of ENAA (76 +/- 13 g/day). Studies are indicated to assess whether a multifaced approach using TPN with ENAA and possibly a larger proportion of the branched-chain amino acids, higher energy intakes, anabolic agents, and continuous arterio-venous hemofiltration will improve morbidity and mortality in patients with acute renal failure.

Acute Kidney Injury↗
PubMed1982

Treatment of acute myelogenous leukemia: influence of three induction regimens and maintenance with chemotherapy or BCG immunotherapy.

The effect of a synchronizing-recruiting drug schedule vs. myelotoxic therapy on remission rate and of Bacillus Calmette-Guerin on remission duration and survival of adults with acute myelogenous leukemia were studied in a prospective cooperative trial. After randomized remission induction with Arabinosyl Cytosine + vincristine + methotrexate + leucovorin (AVML), thioguanine + Ara-C + Daunorubin (TAD), or Daunorubicin + Ara-C (DA), complete remissions (CR) were consolidated with TAD or AVML. CRs were maintained with BCG vaccination (Tice strain) by the tine technique, or BCNU plus Ara-C (B/A), or no further therapy (NFT). Of 209 evaluable TAD patients, 105 (50%) achieved CR; of 187 DA, 97 (52%) achieved CR. AVML yielded only 15 CR among 59 patients (25%). The time to remission was significantly shorter with DA compared with TAD. Ninety-seven patients were randomized to maintenance therapy (35 B/A, 30 BCG, 32 NFT). There were no differences in remission duration (7, 8, 6 months) or survival (16, 22, 16 months, respectively). Manipulation of the cell cycle, as employed in this study, was not helpful. There may be a marginal effect of BCG, but our data fail to show a statistically significant benefit.

Adolescent↗
PubMed1982

Nutrition-related factors in acutely injured patients.

Parameters thought to reflect nutritional status were assessed in 25 critically ill postoperative patients who had been acutely injured. Results were compared with those fom a group of 28 critically ill postoperative patients who had not sustained trauma. The anthropometric measures were significantly better preserved in the previously healthy and presumably well-nourished trauma patients, but striking abnormalities were observed in both groups in albumin and transferrin levels, in the lymphocyte count, and in skin test reactivity. The latter findings suggest the influence of non-nutritional factors at least in the acutely injured patient. Anergy, although frequently observed in both groups of patients, was not predictive of mortality nor did the 44 surviving patients differ significantly in any of the other measured parameters from the nine patients who died. We conclude that, at present, the need for nutrition therapy for the acutely injured patient is best determined on traditional clinical grounds.

Adolescent↗
PubMed1982

The safety and efficacy of a lipid-based system of parenteral nutrition in acute pancreatitis.

Eleven patients with acute pancreatitis who received a lipid-based system of total parenteral nutrition were studied. The safety and efficacy of the intravenous feedings were assessed by comparing the clinical course and serum amylase and urinary diastase levels before treatment and during total parenteral nutrition. Lipid profiles were determined in four of the patients, and nutritional indices including nitrogen balance data were obtained in three patients. No exacerbations of pancreatitis were attributable to the intravenous feedings and the manifestations of the disease resolved or improved in eight patients. Nutritional indices stabilized or improved during total parenteral nutrition, and positive nitrogen balance was achieved in each of the three patients in whom it was measured. Significant hyperlipemia was not observed before or during the lipid infusions. The lipid-based system of parenteral nutrition was well tolerated and effective in this series of patients with pancreatitis.

Acute Disease↗
PubMed1981

Clinical and metabolic responses to parenteral nutrition in acute renal failure. A controlled double-blind study.

1. Thirty patients with acute renal failure who were unable to eat adequately were evaluated while they received parenteral nutrition with glucose alone (n = 7), glucose and 21 g/day essential amino acids (EAA, n = 11) or glucose, 21 g/day essential and 21 g/day nonessential amino acids (ENAA, n = 12). Energy intake did not differ with the three treatments. Patients were studied in a prospective double blind fashion. 2. Thirteen patients recovered renal function and 11 survived to leave the hospital. Those in whom renal failure was attributed to hypotension and/or sepsis had a poorer recovery of renal function (17%) and survival (17%). Recovery of renal function and survival was greater in patients on the medical service as compared to the surgical service and in those who received more energy. Recovery of renal function was worse in those treated with dialysis. There were no differences in recovery of renal function of survival among the three treatment groups. 3. Many patients were markedly catabolic as indicated by nitrogen balances, urea in nitrogen appearance rates (UNA), serum protein concentrations, and plasma amino acid levels. There was no correlation between the degree of catabolism and recovery of renal function or survival. Mean UNA in individual patients also correlated with body weight. Among the three groups, however, UNA was significantly less with the group receiving EAA as compared to ENAA. 4. Serum protein concentrations were lower than normal in all treatment groups. Serum albumin fell significantly during the treatment in the more catabolic patients. Plasma amino acid levels tended to fall in all three groups and concentrations at the end of the treatment were frequently lower than normal. 5. These data suggest that acute renal failure patients who are unable to eat adequately are often hypercatabolic and have a high mortality, particularly if hypotension or sepsis is the cause of renal failure. The improved survival in those with higher energy intakes, the high rate of net protein breakdown, the low serum protein levels and the reduced plasma concentrations of both essential and nonessential amino acids suggest that greater quantities of energy and both essential and nonessential amino acids may be beneficial to such patients.

Acute Kidney Injury↗
PubMed1980

Renal allografts retained in situ after failure.

Twenty-four renal allografts functioning up to six years from the date of transplantation were retained in situ from four days to five years following return of the patient to hemodialysis. Fifteen of the 24 kidneys were removed for specific indications within four days to ten months. The reasons for allograft nephrectomy included fever, hematuria, graft pain and tenderness, and severe hypertension. Nine patients remained asymptomatic with grafts retained three months to five years (median, two years) following return to hemodialysis. It appears safe to retain nonfunctioning grafts in asymptomatic patients, thereby avoiding an unnecessary operation when failure is due to chronic rejection or recurrent glomerulonephritis. Nevertheless, in many patients complications eventually develop for which the allograft will be removed.

Adolescent↗
PubMed1980

Management of Crohn's disease involving the duodenum, including duodenal cutaneous fistula.

Crohn's disease involving the duodenum is rare and is usually associated with Crohn's disease elsewhere in the alimentary tract. Seven patients were treated at the Los Angeles County-University of Southern California Medical Center with complications of Crohn's disease involving the duodenum. These included two patients with abscess and duodenoileocolocutaneous fistulas, two with gastrointestinal tract bleeding, one with gastric outlet obstruction, and two with symptoms of small-bowel disease only. Four of the seven were successfully treated nonoperatively with a variety of modalities, including ulcer regimen, sulfasolazine, adrenocortical steroids, enteric rest, and total parenteral nutrition. Three patients required surgery, one for intractable bleeding and two for enterocutaneous fistulas. The majority of patients with duodenal Crohn's disease can be treated nonoperatively, with resolution of symptoms and roentgenographic healing of lesions. Surgical intervention is only advocated for those patients with complications that do not resolve with nonoperative therapy.

Adult↗
PubMed1980

Leiomyosarcoma of the gastrointestinal tract: should we consider metastasis to regional lymph nodes?

About one third of leiomyosarcomas of the gastrointestinal tract do develop metastasis; and nearly 90% of the metastasis are intra-abdominal. It is said that leiomyosarcoma rarely involves regional nodes, although two series reported 8% of leiomyosarcomas of the stomach and 7% of the small intestines had nodal metastasis at initial operations (mostly of limited resections). It is suggested that wider resection of primary tumor with adjacent mesentery may reveal higher frequency of occult nodal metastasis and might prevent some of the loco-regional relapse and sarcomatosis.

Gastrointestinal Neoplasms↗
PubMed1980

Response of renal allograft recipients to pneumococcal vaccine.

Antibody responses to pneumococcal polysaccharide vaccine were compared in a control group of 17 normal adults and in a group of 27 adult patients with stable renal function (serum creatinine 0.8--2.1 mg/dl) seven months to nine years following renal transplantation. Using the indirect hemagglutination technique, antibody titers to 13 of the 14 capsular antigens contained in the vaccine were determined for each patient just prior to and again three weeks following immunization. There was no significant difference between the two groups in the proportion of patients responding with a fourfold rise in titer to 12 of the 13 antigens tested. The response rate to antigen type 3 was reduced in the transplant group (p less than 0.05). Mean fold increase in indirect hemagglutination titers was likewise determined for each antigen, and a reduced response in the transplant group was noted only to antigen type 23 (p = 0.037). Immunosuppressed renal allograft recipients appear capable of mounting a nearly normal antibody response to pneumococcal vaccine.

Adult↗
PubMed1980

Hyperalimentation in patients with cancer.

Hyperalimentation can improve nutrition in patients with cancer. It has proved to be effective in the management of certain postoperative complications. Some patients are able to receive antitumor therapy who would otherwise be denied treatment because of severe malnutrition. The morbidity of chemotherapy and radiation therapy may be decreased, delivery of greater doses of chemotherapy is possible and responses to chemotherapy may be enhanced. Hyperalimentation can reverse the nutritional components of the immunodepression of malignant disease. Although it may stimulate tumor growth in animals, hyperalimentation has had no adverse clinical consequences to date.

Humans↗
PubMed1980

Management of external gastrointestinal fistulas with glucose and lipids.

Thirty-one patients with 35 external gastrointestinal fistulas were initially managed conservatively with total parenteral nutrition. Patients received the centrally infused glucose system or the peripherally infused lipid system, or both systems, in sequence. Eighteen of the fistulas closed spontaneously, and nine patients died. Eleven of the 15 fistulas managed exclusively with the lipid system closed spontaneously. The results of this retrospective study attest, in general, to the value of total parenteral nutrition and, in particular, to the value of the lipid system which appears equally effective, at least in a subset of patients with fistulas.

Adolescent↗
PubMed1979

Antibody-dependent cell-mediated cytotoxicity tests for immunosuppression monitoring of transplant patients.

The antibody-dependent cell-mediated cytotoxicity (ADCC) effector activity and phytohemagglutinin (PHA) response of kidney transplant patients were monitored by a new whole blood microassay that permitted performance of 20 tests using only 1 ml of blood. Eleven patients were followed on as many as 55 different occasions with these tests. The ADCC activity of dialysis patients was essentially the same (78% chromium release as compared with 83% in normal controls). However, patients with kidney transplants undergoing immunosuppression had approximately one-half the chromium release (40%). Daily fluctuation in the chromium release could not be used as a predictor of subsequent rejection. The PHA response was as much as 50-fold less in the immunosuppressed patients. Both values also tended to be slightly higher among patients who were doing well than those who were doing poorly. This may reflect the need for greater immunosuppression in the rejecting patients.

Antibody-Dependent Cell Cytotoxicity↗