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Biomedical subjects

K N Apelgren

Publications and source records attributed to K N Apelgren.

33 records · Page 2Linked to original sources
PubMed1988

Principles for use of intraoperative enteroscopy for hemorrhage from the small bowel.

Most patients with bleeding from the small bowel are frequently difficult to diagnose and treat because the rate of bleeding is slow and because this is the "blind area" of gastrointestinal endoscopy. We used a colonoscope passed by mouth intraoperatively in order to determine the site of bleeding in four patients. All patients required resection with one requiring laser therapy as well. We found that the following principles were important in maximizing the value of this technique: (1) Good communication between the endoscopist and operating surgeon during the procedure, (2) clamping the distal small bowel to prevent air accumulation in the colon (3) examining the bowel on the way in and avoiding the use of suction to minimize scope trauma artifact, (4) turning off the room lights in order to examine the transilluminated bowel externally, (5) examining the entire small bowel if possible, and (6) marking each site externally with a suture as it is identified.

Aged↗
PubMed1987

Timber rattlesnake venom-induced myokymia: evidence for peripheral nerve origin.

Facial and limb myokymia occurred in four consecutive cases of timber rattlesnake envenomation and represents the "fasciculations" frequently reported in this entity. The facial myokymia disappears within hours of antivenin therapy and the limb myokymia by increasing serum ionized calcium. These observations suggest that the action of the venom is a biochemical one, increasing peripheral nerve excitability.

Action Potentials↗
PubMed1987

Triple lumen catheters. Technological advance or setback?

Multilumen central venous catheters are commonly used in hospitalized patients. This study evaluated the incidence of bacterial or fungal growth from the tips of 119 catheters removed for mechanical failure, no longer needed, or suspected catheter sepsis. Results showed an overall catheter contamination (less than 15 colonies) rate of 23.5 per cent and an overall catheter infection (greater than 15 colonies) rate of 14.3 per cent. Use of these catheters for delivering nutritional support solutions should be minimized or avoided.

Catheters, Indwelling↗
PubMed1985

Effectiveness of cyclic intragastric feeding as a circadian zeitgeber in the squirrel monkey.

To investigate the mechanism of circadian synchronization by oral food consumption, we tested the effectiveness of cyclic intragastric feeding in synchronizing squirrel monkeys to a 24-hour schedule. Five monkeys were prepared with intragastric catheters and were studied free-ranging within a cage in an environmentally controlled chamber with continuous monitoring of body temperature (every 15 min) and locomotor activity (every 30 min). A balanced mixture of dextrose, amino acids, fat emulsion, vitamins and minerals was infused from 0800-2000 every day via the gastrostomy, first during a 12-hour light and 12-hour dark cycle (lights on 0800-2000 hours), and then subsequently in constant illumination. Serial phase analysis was performed by computing cycle-by-cycle acrophases of best-fitting sinusoids. One animal was synchronized by the feeding regimen while four others exhibited relative coordination. We conclude from these results that the timing of intragastic feeding may have only a weak synchronizing effect on primate circadian rhythms and that pre-gastric cues associated with oral food ingestion contribute to entrainment by feeding schedules.

Animals↗
PubMed1983

Nutritional care of the critically ill patient.

Nutritional care is a supportive measure. Just as ventilatory support does not "cure" underlying pulmonary disease, nutritional support may not in itself resolve the disease that causes inadequate intake of nutrients. In the setting of multimodality care in the ICU, the provision of calories and protein to maintain the body cell mass is the initial goal. Such an approach will minimize feeding complications yet prevent nutritional debility. An acceptably low rate of complications is possible but can only be achieved by strict attention to detail. When the acute phase of the disease resolves, more vigorous nutritional support is possible and will restore body composition to normal.

Adult↗
PubMed1982

Comparison of nutritional indices and outcome in critically ill patients.

Seventeen critically ill patients were studied prospectively to determine the relationship of serum albumin, creatinine-height index (CHI) and weight-height index (WHI) to clinical outcome. Use of the conventional "normal values" as cut-offs failed to discriminate between survivors and nonsurvivors better than chance alone. A serum albumin less than 2.5 g/dl correctly separated 93% of the patients in terms of survival prognosis.

Body Height↗
PubMed1981

Malnutrition in veterans administration surgical patients. Updated standards.

A prospective nutritional assessment of 106 hospitalized Veterans Administration surgical patients was performed; 60 healthy, age-matched outpatient veterans were studied for controls. Standard biochemical and anthropometric indices were measured. Malnutrition was defined for each index as a value more than 2 SD below the mean established from the VA control population, the values from which were also compared with conventionally accepted published standards of malnutrition. Striking discrepancies in the incidence of abnormal nutritional indices in our patients were observed, depending on which standard was used. The frequencies of abnormal in our surgical patients using VA control values or published norms, respectively, were: albumin level, 43% vs 19%; hematocrit value, 38% vs 27%; total iron-binding capacity, 30% vs 37%; arm muscle circumference, 11% vs 0%; and triceps skin fold, 19% vs 35%. Future studies of nutritional assessment in hospitalized patients should use control subjects closely related to the target population in age and other demographic variables.

Anthropometry↗
PubMedDate not supplied

Is laparoscopic better than open appendectomy?

Laparoscopic appendectomy is becoming increasingly popular as surgeons strive to manage surgical problems via minimally invasive techniques. We reviewed our early experience in 38 patients with laparoscopic appendectomy and compared it to open appendectomies done during the same time period. We found no difference in hospital costs, stay, or wound infection rate. There was a significant difference in OR time: the laparoscopic approach took longer. We conclude that this new approach is not clearly superior to open appendectomy despite theoretical advantages. Newer instruments and further studies are needed.

Adult↗
PubMedDate not supplied

Protein-calorie malnutrition in patients with colorectal cancer.

Protein-calorie malnutrition, as determined by anthropometric measures and laboratory tests, was assessed in 17 preoperative patients with colorectal cancer and 47 control patients. The cancer patients had significant deficits in visceral protein and skeletal muscle and no deficit in fat stores. Greater attention should be given to preoperative nutritional assessment and to the correction of protein deficits.

Anthropometry↗
PubMedDate not supplied

A complication of direct right atrial catheterization for total parenteral nutrition.

A markedly malnourished man with Crohn's disease and superior vena cava thrombosis required direct right atrial catheterization for total parenteral nutrition. After 3 wk the catheter had migrated to the right pleural space, necessitating removal. An inferior vena cava line via the left saphenous vein was then utilized until the patient's death 10 wk later from pneumonitis. Technical suggestions for avoiding this complication and alternative venous access sites are discussed.

Cardiac Catheterization↗
PubMedDate not supplied

Answering the fat emulsion contamination question: three in one admixture vs conventional total parenteral nutrition in a clinical setting.

Fat emulsions (FE) support microbial growth when inoculated in vitro; dextrose/amino acid solutions (D/AA) do not. Can FE be safely added to D/AA when delivered over 24 hrs? We attempted to answer this question by culturing both conventional (C) total parenteral nutrition (TPN), in which the FE and D/AA are given separately, and the 3-in-1 admixture TPN, in which all components are delivered in one bag. Two-hundred TPN fluid cultures were obtained serially by collecting 1 ml of fluid from the distal-most connection when the TPN was changed every 24 hrs. Quantiative and qualitative cultures were obtained. One hundred sixty-six (83%) were negative. Of the 34 (17%) positive cultures, 15 (17% of 88) were from the conventional system whereas 19 (17% of 112) were from the 3-in-1 system. Six clinically septic patients furnished 11 TPN fluid specimens which grew greater than 400 colonies/ml. Seven (8% of 88) of these were from the conventional system whereas four (3.6% of 112) were from the 3-in-1 system. All had distant sites of sepsis. The 23 remaining positive TPN fluid cultures grew less than 25 colonies/ml, with 20 growing Staphylococcus epidermidis. All of these patients were clinically well and there was no significant difference in the distribution of positive cultures between the conventional system (9%) and the 3-in-1 system (13%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗