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Biomedical subjects

J R Kirkpatrick

Publications and source records attributed to J R Kirkpatrick.

At least 37 records · Page 2Linked to original sources
PubMed1983

Substrate composition and sepsis. Effects on immunity.

A randomized prospective study was performed to determine the effects of substrate composition on immunity in septic malnourished patients. A balanced substrate formula was administered to 11 patients with sepsis and 11 nonseptic patients. This provided 40 kcal/kg/day and 1 to 1.5 g of protein per kilogram each day with a carbohydrate-nitrogen ratio of 50:1. A 25% dextrose and 4.25% protein solution that provided 50 kcal/kg/day and 1 to 1.5 g of protein per kilogram each day with a carbohydrate-nitrogen ratio of 150:1 was provided to ten patients with sepsis and 11 without. Skin test conversion rates were not affected by substrate composition; however, the absolute lymphocyte count was significantly improved in septic patients who achieved positive nitrogen balance, regardless of the nutritional support regimen used. These findings suggest that substrate composition per se has no effect on immunologic responsiveness.

Amino Acids↗
PubMed1983

Aortocolic fistula: a rare cause of profuse rectal bleeding.

A 62-year-old man with multiple myeloma survived for 19 months following massive hemorrhage from an aortocolic fistula secondary to an aortoiliac aneurysm that was adherent to the sigmoid colon. The literature indicates that early death from multisystem failure is to be expected and that sepsis is an inevitable consequence of aortocolic fistula. However, in this case the patient did not die despite multisystem complications and his eventual death was unrelated to sepsis or graft complications. Reasons for the unexpected outcome are suggested. No survivors have been reported in the literature.

Aged↗
PubMed1982

Critical determinants of a successful gastric bypass: reservoir versus stoma.

Most investigators have emphasized that both a small reservoir and a narrow stoma are critical to the success of a gastric bypass. This prospective study was performed to test this clinical hypothesis. All patients had a similar 30-45 ml proximal gastric reservoir created; however, stoma size was determined by the lumen of the jejunum, averaging 3.2 cm in cross-sectional diameter. We found that stoma size had little effect on the success of the gastric bypass if a tiny (less than 45 ml) reservoir was consistently created and a Roux-en-Y anastomosis was used for reestablishing intestinal continuity. The avoidance of a small stoma virtually eliminates postbypass emesis as a major complication.

Adult↗
PubMed1981

Selective versus standard hyperalimentation. A randomized prospective study.

Fifty consecutive surgical patients were included in a randomized prospective study to determine the relative advantages and disadvantages of two types of nutritional support systems: one, selective hyperalimentation, relies on a balanced substrate formula, while the other, standard hyperalimentation, depends on carbohydrate and protein to satisfy the energy requirements of the patient. The patients who received the balanced substrate formula had significantly fewer complications than those receiving standard hyperalimentation, even though both groups achieved positive energy and nitrogen balance. The enhanced safety of selective hyperalimentation suggests its therapeutic superiority as a basic nutritional support system for a busy surgical service.

Glucose↗
PubMed1981

The therapeutic advantages of a balanced nutritional support system.

Twenty-two critically ill patients were entered into a 21-day prospective study to evaluate the feasibility of relying on a balanced nutritional support system to satisfy the needs of a diverse group of surgical patients. No patient sustained a serious complication related to glucose metabolism, and only two patients required insulin. Twenty-one of the patients achieved positive nitrogen balance during the study, and 13 had a significant weight gain not related to water retention. Documented sepsis was present in 50% of the patients but in spite of this, 91% had a successful course of therapy. The ease of management and metabolic efficiency of this approach encourages the use of fat as a primary energy substrate in a balanced nutritional support system to restore positive energy and nitrogen balance.

Adult↗
PubMed1981

The effect of nutritional support on immune competency in patients suffering from trauma, sepsis, or malignant disease.

Thirty-nine patients, 25 of whom were suffering from trauma, sepsis, or malignant disease, were studied prospectively to determine the immunologic value of improved protein-calorie balance in this setting. All were suffering from varying degrees of malnutrition, and 72% (P less than 0.05) of the patients with anergy-inducing disease processes were anergic at the time of evaluation. In the presence of disease-induced anergy, skin test reactivity was not helpful in measuring the therapeutic response to nutritional support; among severely wasted patients, significant elevations in absolute lymphocyte count and serum albumin suggest that these are useful parameters when following the severely wasted patient who has concomitant trauma, sepsis, or malignant disease.

Humans↗
PubMed1981

Glucose-dependent changes in growth hormone regulation associated with sepsis.

Major alterations in the glucose-mediated regulation of growth hormone are associated with sepsis; however, these alterations are not related to the rate of change in plasma glucose or changes in glucagon, epinephrine levels, or circulating levels of arginine. Alterations in the growth hormone regulatory mechanism occurred among septic patients who manifested severe glucose intolerance which was associated with suppression of insulin production. Inhibition of growth hormone release in these patients may have an adverse effect on amino acid movement, which lends further support to the concept that sustained hyperglycemia in the septic patient is undesirable.

Adult↗
PubMed1980

Sepsis, glucose intolerance, and protein malnutrition: a metabolic paradox.

Glucose intolerance and its hormonal influence was examined in patients with sepsis. Eighteen patients were included in the protocol, which studied the response to a standard intravenous glucose tolerance test (GTT) in the postoperative stressed, septic, and septic protein malnourished (depressed albumin level) states. Four groups could be defined: stress (1), sepsis with depressed albumin level and normal glucose tolerance (2), sepsis with mild glucose intolerance and normal albumin levels (3), and sepsis with severe glucose intolerance and depressed albumin (4). Serial hormone levels were measured during the GTT, including insulin, glucagon, epinephrine, and human growth hormone values. Each group demonstrated a characteristic hormone profile. In a comparison with controls, group 2 was associated with mild suppression of insulin; group 3 exhibited mild glucose intolerance, hyperglucagonemia, and increased insulin; and group 4 demonstrated severe glucose intolerance, hyperglucagonemia, and marked suppression of growth hormone production.

Glucagon↗
PubMed1980

The actions of motilin, luteinizing hormone releasing hormone, cholecystokinin, somatostatin, vasoactive intestinal peptide, and other peptides on rat cerebral cortical neurons.

The effects of a number of neuronally localized peptides have been ascertained on corticospinal and other unidentified neurons in the rat cerebral cortex. Motilin, somatostatin, and luteinizing hormone releasing hormone excited most of the corticospinal neurons on which they were tested. Cholecystokinin. Met-enkephalin, vasoactive intestinal peptide, and neurotensin also excited some corticospinal neurons. Many nonidentified neurons were excited by all of these peptides. Met-enkephalin had a depressant action on some (14%) corticospinal neurons. Leu-enkaphalin depressed many identified and nonidentified neurons and had an excitatory action on a few neurons. Both excitatory and inhibitory actions of the enkephalins were antagonized by naloxone. Thyrotropin-releasing hormone had predominantly depressant actions on the spontaneous firing of corticospinal and nonidentified neurons but did excite some unidentified cortical neurons. Secretin had no effect on the firing of most of the neurons tested.

Animals↗
PubMed1980

A logical solution to the perforated ulcer controversy.

Until recently, the Graham patch was the undisputed method of management for a perforated duodenal ulcer. Results of our experience with 186 patients treated at Wayne State University Affiliated Hospitals from 1970 through 1978 dispute this concept and suggest that a definitive operation is the procedure of choice. One hundred and thirty-seven of the patients were treated with an omental patch, and 47 underwent a definitive operation; 114 of the patients were available for an 18 month follow-up study. It was found that previous ulcer symptoms were not an accurate predictor of the need for a subsequent definitive operation and that mortality was determined by the age and condition of the patient at the time of operation rather than by the choice of operation itself. It is recommended that the perforation itself is an indication for a definitive operation unless the patient is in a state of shock at the time of operation. Vagotomy and pyloroplasty have proved to be safe, reliable, definitive operations in this situation.

Aged↗
PubMed1979

Motilin excites neurons in the cerebral cortex and spinal cord.

The 22 amino acid polypeptide motilin was tested by iontophoretic application onto neurons in the rat cerebral cortex and by perfusion over the isolated hemisected toad spinal cord. Motilin (25--150 nA) excited identified cortico-spinal neurons and other deep spontaneously firing cortical cells. Excitation developed relatively rapidly and lasted for up to 60 sec after the application. Motilin was a potent excitant (threshold concentration 2.5 x 10(-9) M) of neurons in the amphibian spinal cord, eliciting a depolarization of dorsal root terminals and motoneurons. Its effects were substantially reduced after tetrodotoxin, suggesting a primary site of action on spinal cord interneurons.

Animals↗
PubMed1979

Is clonidine an adenosine antagonist?

Clonidine has been reported to possess the ability to block the depressant actions of purine compounds on the firing of rat cerebral cortical neurons. In studies on rats anaesthetized either with nitrous oxide and methoxyflurane or urethane, it was not possible to confirm this observation. Rather clonidine enhanced the depressant actions of iontophoretically applied adenosine and adenosine 5'-monophosphate (5'-AMP).

Adenosine↗
PubMed1979

Actions of various gastrointestinal peptides on the isolated amphibian spinal cord.

The effects of a number of peptides which are found in the gastrointestinal tract have been ascertained on the direct current recorded dorsal and ventral root responses of the isolated hemisected toad spinal cord. Motilin, substance P, bombesin, neurotensin, and thyrotropin releasing hormone had potent depolarizing actions on dorsal root terminals and motoneurons. These substances evoked discernable effects at concentrations as low as 10--7 M, or even lower with motilin. The effects of motilin, neurotensin, and thyrotropin-releasing hormone were greatly reduced or abolished by perfusion of the preparation with tetrodotoxin. Adrenocorticotrophic hormone, secretin, and pancreozymin (cholecystokinin) also depolarized dorsal root terminals and motoneurons. The effects of secretin and cholecystokinin were not abolished by tetrodotoxin. Leu- and Met-enkephalin had weak hyperpolarizing actions on the dorsal and ventral root potentials of repetitively stimulated preparations. Gastrin, gastric inhibitory peptide, glucagon, and somatostatin had no apparent effects on the responses of the preparation. Angiotensin and vasopressin both had rather weak depolarizing effects on the dorsal and ventral roots.

Animals↗
PubMed1979

Theophylline antagonizes flurazepam-induced depression of cerebral cortical neurons.

Intravenously administered theophylline (50--100 mg/kg) antagonized the depressant actions of adenosine and flurazepam on rat cerebral cortical neurons. When assessed in conjunction with recent reports that theophylline competes with diazepam for binding sites in brain tissue, this finding suggests that one action of the benzodiazepines may be exerted at a purinergic receptor associated with central neurons.

Adenosine↗