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Biomedical subjects

M Deitel

Publications and source records attributed to M Deitel.

151 records · Page 9Linked to original sources
PubMedDate not supplied

Effect of nutritional support on weaning patients off mechanical ventilators.

The provision of adequate nutritional support to ventilator patients (VP), although important, is still overlooked in many hospitals. All VP in our intensive care unit from July 1977 to June 1979 were reviewed; only those who were on ventilators for 3 or more days (range 3-25) were included, but those ventilated after cardiac arrest with possible brainstem damage were excluded. Group A included 33 VP (22 surgical, 11 medical) who received a protein-free, energy-deficient routine IV diet (1650 kJ/day as dextrose in water or electrolyte solution); group B had 14 VP who received nutritional support as TPN or nasogastric tube feeding (8300-12600 kJ/day with optimum nitrogen). In group A, 18 (54.5%) of the 33 VP were able to be weaned off the ventilator compared to 13 (92.8%) of the 14 VP in group B (p less than 0.05). Of medical VP, 10 (90.9%) of 11 in group A were weaned compared with 3 (100%) of 3 in group B (not significant). However, of surgical VP, only 8 (36.3%) of 22 in group A were able to be weaned off mechanical ventilation compared with 10 (90.9%) of 11 in group b (p less tha 0.01); this was likely highly significant in surgical patients because of greater metabolic demand for wound healing and more severe sepsis.

Enteral Nutrition↗
PubMedDate not supplied

The handling of glucose and insulin response before and after weight loss with jejuno-ileal bypass: a preliminary report.

Glucose and insulin response were studied in morbidly obese patients before and after jejuno-ileal bypass. Postbypass studies were performed after weight loss greater than 30% (9-48 mon). Six-hour oral glucose tolerance tests were performed on 33 patients before bypass and on 13 of these 33 patients after bypass. Thirteen patients had preoperative intravenous glucose tolerance tests performed, and 11 had postbypass intravenous glucose tolerance tests performed. Plasma insulins were drawn concomitantly. Before bypass, fasting blood sugars and insulins were elevated and both glucose intolerance and hyperinsulinemia were found on the tests. After bypass, oral glucose tolerance test curves were flat (malabsorption effect), while intravenous glucose tolerance tests revealed nonsignificant changes in the glucose curves but plasma insulin response returned toward normal (p greater than 0.05). The glucose intolerance and hyperinsulinemia found in these massively obese patients reverted toward normal after weight loss from jejuno-ileal bypass. Thus elevated plasma insulin does not appear to be a primary etiological factor in obesity.

Adult↗
PubMedDate not supplied

An outbreak of Staphylococcus epidermidis septicemia.

During 45 wk from August 1980 to June 1981, the catheter sepsis rate increased from a prior 2 to 34% (23 of 68 patients on intravenous hyperalimentation). The causative organism was Staphylococcus epidermidis, grown on blood cultures in 21 of the 23 patients and on the catheter-tips of all 23. Routine cultures of the catheter-tips of the 45 patients who received intravenous hyperalimentation during this period with no evidence of catheter sepsis grew S. epidermidis on three catheter-tips (6.7%), possibly contamination during catheter removal. Sepsis resolved within 24 hr after catheter removal, with no antibiotics given for the sepsis. The organism had identical antibiograms on the blood and catheter-tip cultures in each patient, but antibiograms varied between patients. In these complex patients undergoing multiple medical events, the intravenous hyperalimentation nurse recorded that iv tubing in septic patients had leaked solution at the attachment to the catheter hub, and a review of nursing notes on charts of patients who had been on intravenous hyperalimentation revealed that a leak had been noted in the patients who subsequently had catheter sepsis. The leak was due to a manufacturing defect resulting in a decrease in diameter of the plastic connection of the iv tubing, which produced a loose attachment to the hub. The problem was remedied by switching to a Luer-lok attachment. However, in July 1982, two patients had separation of the Luer due to a manufacturing defect in the threads, followed by a catheter sepsis. Sepsis from the local contamination was not manifest until 5.4 +/- 2.7 days later. Quality control by manufacturers is emphasized.

Catheters, Indwelling↗
PubMedDate not supplied

Metabolic bone disease in a patient on long-term total parenteral nutrition: a case report with review of literature.

A 38-yr-old woman with Crohn's disease and short bowel on home total parenteral nutrition was studied. Metabolic bone assessments were done prospectively. Daily total parenteral nutrition included 500 IU vitamin D2, 6 to 8 mmol calcium, 10 to 15 mmol phosphorus, 12 to 16 mmol magnesium, and trace elements including zinc, cooper, and chromium. After 6 months, while asymptomatic, chemistries and x-rays were normal. Calcium bone index was 0.79. The bone biopsy showed mild hyperkinetic picture. At 26 months, she had a spontaneous rib fracture and bone pains in the hands and lower back. Chemistries were normal except that calcium bone index was 0.75. Bone biopsy showed mild osteomalacia. Vitamin D2 was withdrawn for 2 months and then restarted at 1000 IU/wk. She improved symptomatically for 4 months, but then developed rib fractures, and the bone pains recurred. After 48 months, chemistries were normal, except that the calcium bone index was 0.57 and bone biopsy showed regression of osteomalacia toward normal. Vitamin D2 was now withdrawn for 6 months, resulting in loss of bone pain. Vitamin D2 may produce a metabolic bone disease, requiring prolonged withdrawal for improvement.

Adult↗
PubMedDate not supplied

Avoidance of a colostomy by nutritional techniques.

Total parenteral nutrition or elemental diet has frequently replaced the use of a proximal stoma. Since 1969, data on patients receiving these non-residue nutritional methods have been collated daily; there were 63 patients where the surgeon believed that a proximal stoma would otherwise have been indicated. In 35 patients, these methods were used prophylactically perioperatively and in 28 patients, they were instituted postoperatively after complications occurred; in both groups, there was a very high rate of successful outcome. Modern nutritional support avoided fecal bulk while maintaining nutrition, and appeared to accomplish the equivalent of a diverting proximal stoma with considerable success in other than Crohn's disease.

Colonic Diseases↗
PubMedDate not supplied

Gastroesophageal reflux in the massively obese.

Symptom review, barium swallow, endoscopy and esophageal manometry were performed on 55 massively obese patients, greater than twice ideal weight. Symptoms of reflux and/or heartburn were present in 40 patients (72.7%). Symptoms were present in 81.5% of the 27 patients aged greater than or equal to 35 yr and 64.3% of the 28 patients less than 35 yr (p less than 0.01). Upper GI series showed hiatal hernia in 16 and spontaneous reflux in 9 patients (7 with hiatal hernias). Endoscopy revealed hiatal hernia and/or esophagitis in 17 patients. Mean lower esophageal sphincter (LES) pressure was 15.2 +/- 7.3 mmHg, with 47.3% of patients having subnormal pressure (less than 15). Patients greater than or equal to 35 yr had reduced LES pressure 11.9 +/- 6.4 mmHg, whereas patients less than 35 yr had LES pressure 18.6 +/- 6.7 (p less than 0.001). Of patients greater than or equal to 35 yr, 70.4% had subnormal LES pressure compared to 25.0% less than 35 yr. Incidence of reduced LES pressure increased as the graded severity of esophageal symptoms increased. Patients greater than or equal to 35 yr had significantly lower LES pressure and higher incidence of reflux symptoms than those younger. For comparison, asymptomatic control groups greater than or equal to and less than 35 yr showed no difference in LES pressure.

Adult↗