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L H Stahlgren

Publications and source records attributed to L H Stahlgren.

At least 19 recordsLinked to original sources
PubMed1995

Glutamine prevents the biliary lithogenic effect of total parenteral nutrition in rats.

Long-term total parenteral nutrition (TPN) is known to be associated with pigment gallstones. The objectives of this study were to identify the lithogenic effects of TPN and to determine whether glutamine (GLN)-enriched TPN can prevent such changes. Eighteen male Wistar rats were randomly divided into three groups of six animals. A central line was inserted via the jugular vein. The CHOW group received an infusion of saline and chow ad libitum; the TPN group received a standard TPN solution; the GLN group received TPN solution identical to the TPN group except for the addition of 2% glutamine. Diets were isonitrogenous and isocaloric and fed for 7 days. On Day 7, following laparotomy, the bile duct was cannulated, and bile flow was measured and collected for assay of total and unconjugated bilirubin (TB & UCB) and of total and ionized calcium (TCa & iCa). Caval blood was obtained for liver function studies. The results demonstrated that the hepatic bile flow was decreased in the TPN group compared with the CHOW and the GLN groups. The bilirubin concentration of bile, especially unconjugated bilirubin, in the TPN group was significantly higher when compared with the CHOW and GLN groups (P < 0.01). The ionized calcium concentration of bile in the TPN group was also increased significantly when compared with the CHOW and GLN groups (P < 0.05). From these data, we conclude that TPN induces lithogenic effects in hepatic bile, including increased bilirubin and calcium concentrations and decreased hepatic bile flow. Addition of glutamine to the TPN solution prevents these lithogenic changes.

Animals↗
PubMed1994

Evaluation of intravenous ketorolac administered by bolus or infusion for treatment of postoperative pain. A double-blind, placebo-controlled, multicenter study.

BACKGROUND: Ketorolac is a nonsteroidal analgesic that may provide postoperative analgesia without opioid-related side effects. This double-blind, randomized, multicenter study evaluated the analgesic efficacy and safety of intravenous ketorolac in 207 patients during the first 24 h after major surgery. METHODS: Subjects were assigned to receive one of three analgesic regimens: a ketorolac infusion, ketorolac boluses, or placebo. All subjects had access to intravenous morphine via patient-controlled analgesia (PCA). Evaluations included PCA morphine used, pain assessment (categorical pain intensity scores and visual analogue pain scores), pain relief (categorical pain relief scores), sedation, presence of adverse events, and overall rating of regimens by study observers and patients. RESULTS: Patients in the ketorolac infusion group (but not the ketorolac bolus group) used less morphine (average 33 mg) than did the placebo group (44 mg) (P = 0.009). Significant differences favoring both ketorolac groups were seen in the pain intensity and the categorical pain relief scores at various time points during the study. At the termination of the study, compared with the placebo group, categorical pain intensity scores were lower in the ketorolac bolus group; visual analogue pain scores were lower in both ketorolac groups; and pain relief scores were higher in the ketorolac bolus group. The incidence of vomiting was significantly greater in the placebo group (27%) than in the ketorolac infusion group (12%) or bolus group (9%) (P = 0.032 and P = 0.005, respectively). The incidence of postoperative fever was 10% in the ketorolac bolus group and 25% in the placebo group (P = 0.013). Study observers noted less nursing difficulty while caring for patients in the ketorolac infusion group (P = 0.015). Study observers and patients in both ketorolac groups reported statistically significant overall drug superiority compared with placebo. CONCLUSIONS: It is concluded that intravenous boluses or infusions of ketorolac in conjunction with PCA morphine provide effective, safe analgesia after major surgery and improve on the response to PCA morphine alone.

Adult↗
PubMed1993

Intermittent sequential pneumatic compression in prevention of venous stasis associated with pneumoperitoneum during laparoscopic cholecystectomy.

OBJECTIVES: To determine whether pneumoperitoneum and reverse Trendelenburg's position used during laparoscopy impede common femoral venous flow and whether calf-length intermittent sequential pneumatic compression (ISPC) overcomes this impedance. DESIGN: Using Doppler ultrasonography, peak systolic velocities in the common femoral vein were measured in patients undergoing laparoscopic cholecystectomy with peritoneal insufflation of carbon dioxide. Measurements were obtained during three intervals: preoperatively with the patients in the supine position; after induction of general anesthesia with the patients in the supine position; and after insufflation to 13 to 15 mm Hg with the patients in the 30 degrees reverse Trendelenburg position (both with and without ISPC). Mean arterial pressure and heart rate were obtained concurrently. Measurements of preoperative and postoperative calf and thigh circumferences were obtained. SETTING: A tertiary care center. PATIENT PARTICIPANTS: A consecutive sample of 20 patients 30 to 70 years of age (15 women and five men) who underwent laparoscopic cholecystectomy and met the inclusion criteria. MAIN OUTCOME MEASURES: Peak systolic velocity, mean arterial pressure, heart rate, and calf and thigh circumferences. RESULTS: The combination of pneumoperitoneum to 13 to 15 mm Hg and a 30 degrees reverse Trendelenburg position significantly decreased peak systolic velocity in the common femoral vein from a preoperative mean of 0.24 +/- 0.025 m/s to 0.14 +/- 0.011 m/s, or a 42% decrease. Intermittent sequential pneumatic compression reversed that effect, returning peak systolic velocity to 0.27 +/- 0.021 m/s. The mean difference between preoperative peak systolic velocity and peak systolic velocity with a combination of pneumoperitoneum, reverse Trendelenburg's position, and ISPC was 0.03 +/- 0.03 m/s but was not significant. Anesthesia alone caused a mean increase in preoperative peak systolic velocity from 0.24 +/- 0.025 m/s to 0.3 +/- 0.032 m/s. Mean arterial pressure levels, heart rate, and calf and thigh circumferences did not change significantly. CONCLUSIONS: This study demonstrated a significant reduction in common femoral venous flow during laparoscopic cholecystectomy coincident with pneumoperitoneum and reverse Trendelenburg's position. Intermittent sequential pneumatic compression reversed that effect, returning peak systolic velocity to normal.

Adult↗
PubMed1987

Is resection appropriate for adenocarcinoma of the pancreas? A cost-benefit analysis.

Our data support the contention that biliary bypass combined with gastric bypass is the treatment of choice for the majority of patients with adenocarcinoma of the pancreas. Compared with resection, operative morbidity and mortality rates were lower, length of hospitalization was shorter, and the cost of treatment was lower. There was no significant difference in survival. In choosing candidates for resection, the surgeon must balance the meager chances for cure (less than 1 percent) with the considerable operative hazard and the risk of lethal, costly complications. In our view, resection should be considered only for physiologically young patients with small localized lesions. These patients should be referred to surgeons specializing in pancreatic surgery who have had operative mortality rates of less than 10 percent. Pancreatic resection must, therefore, be deprived of its appeal as a procedure to which every surgeon must aspire.

Adenocarcinoma↗
PubMed1981

Myelolipoma of the adrenal gland.

We report the 14th case of myelolipoma of the adrenal gland. Recommendations for appropriate diagnostic and therapeutic methods are made. Myelolipoma of the adrenal gland is a rare non-functioning tumor composed of lipoid and hematopoietic elements. The most consistent complaint is abdominal pain caused by hemorrhage within the tumor. We identified an association with obesity and hypertension. Ultrasound combined with computed tomography is useful in diagnosis. With expanded use of these studies, myelolipoma will be recognized more frequently. Definitive diagnosis and treatment are accomplished by simple excision; radical surgery is unnecessary.

Adrenal Gland Neoplasms↗
PubMed1980

Indications and accuracy of operative cholangiography.

We have demonstrated that operative cholangiography can be done accurately, rapidly, and without any increase in morbidity. We recommend that operative cholangiography be performed routinely on all patients undergoing cholecystectomy for these reasons: (1) It permits accurate demonstration of the presence or absence of intraductal calculi, thereby decreasing the number of unnecessary duct explorations. (2) It permits demonstration of the number and size of common duct stones, when their presence is highly suspected. (3) It permits recognition of a small but substantial number of patients with unsuspected common duct stones. (4) It permits demonstration of operative ductal anatomy, thereby reducing the chance of inadvertent iatrogenic injury. (5)It permits recognition of unsuspected biliary or periampullary tumors. (6) It is an accurate method and facilitates the performance and accurate interpretation of postoperative T-tube cholangiography.

Catheterization↗
PubMed1980

Fundoplication for major reflux in patients with gallstones.

Patients referred with gallstones were screened for symptoms of reflux. Positive clinical history led to investigation with an upper gastrointestinal series as well as esophageal pH and manometric studies to identify and quantify reflux. Selected patients with symptomatic reflux in whom major or surgical reflux was discovered underwent the combined procedures of cholecystectomy and fundoplication. In all, 250 patients with gallstones were screened. Sixty patients with symptoms of reflux were considered for further study; of that group, 48 patients had major reflux, 38 of whom underwent the combined operative procedures. Fundoplication alone or in combination with cholecystectomy was carried out on 126 occasions upon 121 patients without a death. The combination of fundoplication and cholecystectomy did not prolong the hospital stay significantly, did not materially increase the incidence of postoperative complications and did not compromise the control of reflux symptoms. The postfundoplication syndrome did not occur following the combined procedures and was observed in only one patient in the entire series. Results of our study justify the liberization of indications for fundoplication in selected patients with gallstones who fulfill the criteria of major reflux, as already outlined.

Cholecystectomy↗