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Biomedical subjects

J J Skillman

Publications and source records attributed to J J Skillman.

At least 55 records · Page 3Linked to original sources
PubMed1982

Modification of the Hemoccult slide test for occult blood in gastric juice.

The Hemoccult slide test is used frequently to test for the presence of occult blood in samples of gastric juice obtained from critically ill patients. The purpose of this study was to investigate the accuracy of this test to determine the presence of blood in human gastric juice at various pH values. Gastric aspirates were collected from 10 patients who had nasogastric tubes and were receiving nothing by mouth. These aspirates were adjusted to a range of pH values varying from 1 to 8. The aspirates were then tested by the Hemoccult slide method. The tests were repeated after (1) addition of whole blood and (2) subsequent addition of antacid. False negative results were found when the pH was below 2 and false positive results were found when the pH was between 2 to 4. When 3 drops of aspirate were added to 1 ml of a 0.2 M borate buffer at pH 8.6, and the Hemoccult slide test was performed on the resulting mixture, false negative and false positive reactions were eliminated. We conclude that the addition of the gastric juice sample to a borate buffer before performing the Hemoccult slide test makes this a reliable method of determining the presence or absence of occult blood.

Color↗
PubMed1981

Effect of isocaloric fat or glucose on albumin synthesis and nitrogen balance in patients receiving amino acid infusion.

Twelve patients who had undergone colon operations were randomized prospectively in the postoperative recovery room. Seven received a hypocaloric intravenous solution consisting of 3.5% amino acids plus 2.5% glucose and five received 3.5% amino acids plus 10% fat. Nitrogen balance data indicated that isocaloric amounts of glucose and fat seem equally effective when combined with amino acids. Although the albumin synthesis rates (measured by the 14C technique on the fourth postoperative day) were not significantly different between the two groups, when the results were included with pooled data from previous similar studies, there was a statistically significant difference which indicated a higher rate of albumin synthesis in patients who received the combination of amino acids and fat compared with those who received amino acids and glucose P < 0.05). In this clinical setting, fat may favor the uptake and synthesis of amino acids into visceral proteins, while glucose may have a more direct role in the synthesis of skeletal muscle protein.

Aged↗
PubMed1980

Antacid versus cimetidine in preventing acute gastrointestinal bleeding. A randomized trial in 75 critically ill patients.

Over a 15-month period, 75 critically ill patients at risk of acute gastrointestinal bleeding were randomized into two groups: one group (38 patients) received the H2-blocker cimetidine intravenously at an initial dosage of 300 mg every six hours, and the other group (37 patients) received antacid (Mylanta II) through a nasogastric tube at an intial dosage of 30 ml every hour. Gastric pH was measured hourly and titrated above 3.5. Upper-gastrointestinal-tract bleeding occurred in seven of 38 cimetidine-treated patients but in none of 37 antacid-treated patients (P less than 0.01). When antacid titration was added to the cimetidine regimen in four of seven patients with bleeding, all four stopped bleeding. Renal failure, sepsis, peritonitis, hypotension, respiratory failure, jaundice, multiple trauma, and major operative procedures were associated with an increased incidence of bleeding. Cimetidine does not adequately protect seriously ill patients from acute upper-gastrointestinal-tract bleeding. Antacid is better for this purpose.

Acute Disease↗
PubMed1980

Thromboembolism after insertion of the Mobin-Uddin caval filter.

The occurrence, in one patient, of a life-threatening pulmonary embolus 3 days following insertion of a Mobin-Uddin umbrella filter promoted a review of our experience with this device. Over the past 5 years, 41 patients had umbrella filters inserted at the Beth Israel Hospital. Five patients (12%) had proven or probable pulmonary embolization following filer placement. In four of the seven autopsied patients, thrombus was found on the cardiac side of the umbrella, and in one of these patients a fresh embolus was also found in the pulmonary artery. We conclude that the standard (nonheparin-impregnated) Mobin-Uddin umbrella device offers incomplete protection against pumonary embolization in patients who cannot concurrently receive anticoagulant drugs.

Adult↗
PubMed1980

Albumin synthesis and nitrogen balance in postoperative patients.

In a continuing prospective randomized study in a series of patients in the postoperative state, the rate of albumin synthesis was measured using the 14C carbonate technique. The majority of the patients studied were subjected to partial or total colectomy, and each patient was randomized to receive a hypocaloric intravenous regimen consisting of 3.5% amino acids (essential and nonessential) or 3.5% amino acids with 2.5% glucose. A mean (+/- SEM) of 75.7 +/- 2.7 gm/day of amino acids was given to the seven patients in the amino acid group. A mean of 74.0 +/- 5.9 gm/day of amino acids and 52.8 +/- 4.2 gm/day of glucose was infused in the group of five patients given amino acids with glucose. The albumin synthetic rate (mg/kg/day) measured on the fourth day after operation in the amino acid alone group was 233.9 +/- 27.9 as compared to 204.1 +/- 24.4 in the group given amino acids with glucose (P = NS). The urea synthesis rates (mg/kg/day) in the two groups were 334.2 +/- 47.8 and 250.3 +/- 27.5, respectively, and the net Kjeldahl nitrogen balances (grams per day) were -4.98 +/- 1.92 and -2.68 +/- 1.49, respectively. We conclude that infused amino acids promote the synthesis of albumin equally effectively in the presence or absence of a small amount of added glucose. Glucose may reduce slightly the pool of amino nitrogen available for albumin and urea synthesis by diverting some of the infused amino acids from protein synthesis by the liver to muscle.

Adult↗
PubMed1978

Antacid titration in the prevention of acute gastrointestinal bleeding: a controlled, randomized trial in 100 critically ill patients.

We randomized 100 critically ill patients at risk of developing acute gastrointestinal ulceration and bleeding into two groups. One (51 patients) received antacid prophylaxis, and the other (49 patients) received no specific form of prophylaxis. Hourly antacid titration kept the pH of the gastric contents above 3.5. Two of the 51 patients who received antacid prophylaxis and gastrointestinal bleeding. Twelve of the 49 control patients bled (P less than 0.005). Of the 12 patients in the control group who bled, seven were placed on antacid medication, and all seven apparently stopped bleeding. Analysis of all the patients showed that an increasing prevalence of respiratory, failure, sepsis, peritonitis, jaundice, renal failure and hypotension was correlated with a greater frequency of bleeding. No patients required operative treatment to control bleeding. These data indicate that the occurrence of acute gastrointestinal bleeding in critically ill patients can be reduced by antacid titration.

Acute Disease↗
PubMed1978

Albumin uptake by skin, skeletal muscle and lung in living and dying patients.

Quantitative changes in albumin and water content which occur in skin and muscle tissue obtained by biopsy from clean surgical incisions at the time of skin incision and at the time of wound closure were assessed in seven patients who had major abdominal and vascular operations. Biopsies from skin, muscle and pulmonary tissue were obtained in a second group of nine patients who had thoracotomy for suspected bronchogenic carcinoma. The intravascular albumin mass decreased linearly with the duration of the operation (r = 0.69, p <0.01) and was correlated significantly with a linear increase of extravascular albumin content in muscle (r = 0.63, p < 0.01). A significant increase of extravascular albumin occurred from the time of incision to the time of wound closure in the skin and muscle samples from both groups (p < 0.05-p < 0.001). Extravascular albumin and water content were assessed in a third group of three postoperative patients who died with acute respiratory failure. Although the concentration of extravascular albumin in pulmonary tissue taken from this group was not different from the thoracotomy group, calculations based on the mean combined post mortem lung weights showed two to three times more extravascular albumin content. The histopathological findings are consistent with these changes. Thoracotomy was not associated with an abnormal increase in pulmonary extravascular albumin and water content, possibly because albumin does not gain access to the pulmonary extravascular space in increased amounts during operation in this clinical setting.

Albumins↗
PubMed1978

Prevention of deep vein thrombosis in urological patients: a controlled, randomized trial of low-dose heparin and external pneumatic compression boots.

A prospective, randomized clinical trial in 83 patients undergoing open urological operations was performed to compare the relative prophylactic efficacy of low-dose heparin and external pneumatic compression (EPC) of the calves in comparison to no treatment in the prevention of deep vein thrombosis (DVT). The diagnosis of deep vein thrombosis was established by the I125 fibrinogen scan and contrast phlebography. The data indicate that EPC is more effective than no treatment (p less than 0.04) and more effective than low-dose heparin (p less than 0.04) in the prevention of DVT. There was one pulmonary embolus in each of the three groups, and in the treatment groups this occurred without evidence of DVT.

Adult↗