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Biomedical subjects

M Shabot

Publications and source records attributed to M Shabot.

7 recordsLinked to original sources

An enterprise web viewing system for clinical and administrative data

The authors will demonstrate the comprehensive web based viewing system for clinical and administrative data in widespread use in the Cedars-Sinai Health System. This system encompasses over a dozen disparate systems of varying ages, each of which originally had a unique user interface. The clinical viewing system is called Web/VS and is assessable from 400 clinical workstations in patient care areas as well as any network or remotely-connected workstation. The web viewing system includes a firewall and token based authentication system which allows secure access from the Internet. Encrypted wireless access to web-clipped clinical information is now in use by many physicians carrying Palm VII personal digital assistants.

Journal Article↗

Calcium supplementation decreases rectal epithelial cell proliferation in subjects with sporadic adenoma.

The results of three small clinical trials examining the effect of calcium carbonate supplementation on the proliferation cytokinetics of the rectal epithelium in subjects with a current history of sporadic adenoma are reported. In six subjects, a daily administration of 1500 mg of calcium carbonate for 90 days failed to significantly suppress thymidine labeling in normal-appearing mucosa of the rectum. However, a daily dose of 2000 mg of calcium significantly (P = 0.008) altered mucosal proliferation in a second set of six subjects after a 30-day trial. Finally, a placebo-controlled trial of calcium (2000 mg) was conducted in which 20 subjects were randomized to groups receiving a 4-week intervention with calcium (or placebo), followed by the alternative treatment (placebo or calcium). The results of the study show a marked suppression of rectal proliferation during the calcium phase of the study but not during the placebo phase. This study adds to accumulating evidence showing that calcium supplementation regulates the proliferative behavior of colonic epithelium in the individual at high risk for colon cancer. Longer term trials of calcium supplementation will ascertain whether a continuing benefit from increasing dietary calcium translates into inhibition of adenoma recurrence.

Adenoma↗

Integrated computerized databases for medical data management beyond the bedside.

Computers are beginning to be utilized extensively for direct patient care, assisting nursing and medical staff with data collection and review at the bedside. However, most clinical data management systems are optimized for bedside patient care and offer limited resources for multi-patient data analysis. At Cedars-Sinai Medical Center, a network of computer systems has been developed to provide linkages between clinical, administrative and outcome data for Surgical Intensive Care Unit (SICU) patients. Increasingly, such data is needed to evaluate the relationship between severity of illness and patient outcome and the utilization of expensive critical care resources. Over the parts 3 years, comprehensive data on 6,755 consecutive SICU patients receiving 18,394 days of care have been accumulated by our PDMS. Using linkages constructed to other hospital systems and databases, trends for severity of illness, severity adjusted survival, census, bed utilization, nursing utilization and many other parameters have been constructed. These linkages are valuable in documenting cost-effective and medically-effective patient care practices.

Computer Communication Networks↗

Diagnostic role of gastrointestinal hormones in patients with chronic pancreatitis.

Thirty-three patients with chronic pancreatitis were studied in an effort to correlate release of gastrointestinal hormones (GIH) with the degree of pancreatic insufficiency. A prospective examination was conducted of fat-stimulated release of pancreatic polypeptide (PP), cholecystokinin (CCK), and neurotensin. Seventy-two-hour fecal fat determination, endoscopic retrograde pancreatography (ERP), and the bentiromide-PABA test were used to correlate the clinical stage of disease. The ERP was classified as positive only if the changes were advanced (or "marked") according to the Cambridge Classification. Five patients were defined to have mild disease, 13 moderate, and 15 severe. Any patient with clinical evidence of chronic pancreatitis and ERP changes that were less than advanced and had normal fecal fat and bentiromide tests received a grade of mild. Patients with one abnormal test were graded moderate, and those with two or three abnormal results were graded severe. In the 33 patients, the integrated 60-minute release of pancreatic polypeptide (PP) was 37.4 +/- 6.1 ng-60 min/ml in those five patients with mild disease, 102.3 +/- 10.3 ng-60 min/ml in the 13 patients with moderate disease, and 7.6 +/- 2.2 ng-60 min/ml in the 15 patients with severe disease. The integrated 60-minute release of neurotensin was 3.8 +/- 0.4 ng-60 min/ml in mild disease, 2.0 +/- 0.3 ng-60 min/ml in moderate disease, and 0.2 +/- 0.1 ng-60 min/ml in severe disease. CCK release did not correlate with the severity of disease. Enhanced release of PP appeared to correlate well with moderate stage of chronic pancreatitis, and depressed PP release with severe disease. Stimulated levels of PP and neurotensin appear to be useful in the diagnosis and staging of chronic pancreatitis. It is concluded that measurement of fat-stimulated release of PP and neurotensin may be useful to assess severity of disease in patients with chronic pancreatitis.

Adult↗

Achalasia secondary to hepatocellular carcinoma.

Achalasia of the esophagus can result from adenocarcinoma of the stomach or from other tumors that originate in organs adjacent to the esophagus. To the best of our knowledge, we are the first to report achalasia secondary to an hepatic neoplasm. Our patient had typical clinical, radiographic, and manometric features of achalasia with no evidence of direct tumor involvement of the esophagus on barium swallow, computed tomography, angiography, or endoscopy.

Carcinoma, Hepatocellular↗

Antral gastrin concentration in gastric ulcer disease. The finding of high concentrations in a few patients.

Antral gastrin concentratin (AGC) was measured in forceps biopsy specimens of prepyloric mucosa obtained at endoscopy in 65 patients with various kinds of gastric ulcer and in 31 nonulcer control patients. AGC in 32 patients with a lesser curvature gastric ulcer, 10.0 +/- 2.0 (mean +/- 1 SE) ng gastrin/mg tissue was significantly less (P < 0.01) than AGC in 31 nonulcer control patients, 14.4 +/- 1.4. AGC was similar to the control values in 23 patients with a pyloric channel ulcer, 15.2 +/- 1.7; 5 patients with a greater curvature ulcer, 15.0 +/- 4.8; and 3 patients with both duodenal and gastric ulcers, 15.8 +/- 0.7. AGC was significantly greater (P < 0.01) than the control values in 3 patients with a vagotomy and pyloroplasty and a gastric ulcer, 29.8 +/- 5.0. In contrast with most lesser curvature gastric ulcer patients who had low AGC, 3 gastric ulcer patients had antral gastrin values which were about three times the mean AGC of the controls. Two of these patients had fasting serum gastrin values which were more than twice the mean control fasting serum gastrin. Meal-stimulated integraed gastrin responses in these 3 patients ranged from three to nine times the mean control response. These findings suggest that a high AGC may account for a few instances of increased serum gastrin concentrations in gastric ulcer patients.

Adult↗