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Biomedical subjects

R M Goldstein

Publications and source records attributed to R M Goldstein.

86 records · Page 5Linked to original sources
PubMed1989

Cytomegalovirus infection in orthotopic liver transplantation.

We retrospectively studied 175 orthotopic liver transplants in 151 patients. Of the 151 patients, 59 (39.1%) were diagnosed as having cytomegalovirus (CMV) infection. The rate of infection in patients treated for rejection was 48.8% as compared to 26.2% in patients without rejection (P less than 0.01). Antirejection therapy was associated with culture-positive cases in 33 out of 43 patients as compared to 9 out of 16 patients who had CMV antibody titer elevations. Patients were treated with gancyclovir if they had simultaneous positive cultures from multiple sites and were seriously ill. Eighteen of the 19 patients thus treated had side effects, one of which was serious (bone marrow hypoplasia). Cultures became negative in 15 out of 17 (88%) of the surviving patients. Patient survival was similar to our overall survival rate of 87%.

Antiviral Agents↗
PubMed1985

Temperature response to antipyretic therapy in children: relationship to occult bacteremia.

The response of rectal temperature to antipyretic therapy was studied in an attempt to identify a clinical characteristic that would distinguish children with occult bacteremia from those with sterile cultures of blood. Children 3-24 months of age with initial temperature recordings of 38.9 degrees C or greater had a blood culture drawn and received a standard dose (10mg/kg) of either aspirin or acetaminophen. Temperature was again recorded 60-120 minutes later. During the period of investigation, 255 patients were studied; 16 had bacteremia, and 239 had sterile blood cultures. There was no difference in the response to antipyretic therapy between the two groups. The mean decrease in temperature for each was similar (1.3 versus 1.05 degrees C, P = 0.14). The authors conclude that response to antipyretic therapy does not distinguish children who are bacteremic from those who are not.

Acetaminophen↗
PubMed1985

The effects of total parenteral nutrition on gastrointestinal growth and development.

Total parenteral nutrition (TPN) is vital for the nutritional support of infants with disorders of the gastrointestinal tract that prevent adequate enteral intake. Studies in adult rodents maintained on TPN have demonstrated intestinal atrophy and decreased activity of the brush border enzymes of the small bowel mucosa. We studied the effects of TPN during the phase of rapid intestinal growth and development in piglets. Matched groups of three 6-week-old weaned piglet littermates received a glucose (45 g/kg/d), amino acid (8 g/kg/d), and fat (2.5 g/kg/d) solution intravenously (IV) or by gastrostomy (GF), or were given hog chow (Chow) at an equivalent caloric value for three weeks. No differences were noted in the mean weight gain (13-15 g/kg/d), total serum protein (4.5-4.8 g/dL), BUN (9-12 mg/dL), or Hct (25% to 30%). The IV and GF animals, compared to the Chow animals, had decreased growth of the stomach, small bowel, and pancreas with decreased small bowel mucosal disaccharidase activity. The IV group, compared to Day 0 animal measurements, had decreased small bowel length and weight and pancreatic weight. Histology of the proximal small bowel mucosa in the IV animals showed decreased mucosal depth, villus height, crypt depth, and epithelial cell number from the crypt base to the midvillus. These findings suggest that stomach, small bowel, and pancreatic growth are dependent on the route of administration and/or the composition of the diet, the small bowel mucosa and the pancreas atrophies in young piglets maintained on TPN, the activity of some intestinal brush border disaccharidases are decreased in the small bowel in piglets maintained on either an intravenous or an intragastric infusion of a TPN solution.

Animals↗
PubMed1985

Reasons for possible failure of inoculation to enhance biodegradation.

Pseudomonas strains capable of mineralizing 2,4-dichlorophenol (DCP) and p-nitrophenol (PNP) in culture media were isolated from soil. One DCP-metabolizing strain mineralized 1.0 and 10 micrograms of DCP but not 2.0 to 300 ng/ml in culture. When added to lake water containing 10 micrograms of DCP per ml, the bacterium did not mineralize the compound, and only after 6 days did it cause the degradation of 1.0 microgram of DCP per ml. The organism did not grow or metabolize DCP when inoculated into sterile lake water, but it multiplied in sterile lake water amended with glucose or with DCP and supplemental nutrients. Its population density declined and DCP was not mineralized when the pseudomonad was added to nonsterile sewage, but the bacterium grew in sterile DCP-amended sewage, although not causing appreciable mineralization of the test compound. Addition of the bacterium to nonsterile soil did not result in the mineralization of 10 micrograms of DCP per g, although mineralization was evident if the inoculum was added to sterile soil. A second DCP-utilizing pseudomonad failed to mineralize DCP when added to the surface of sterile soil, although activity was evident if the inoculum was mixed with the soil. A pseudomonad able to mineralize 5.0 micrograms of PNP per ml in culture did not mineralize the compound in sterile or nonsterile lake water. The bacterium destroyed PNP in sterile sewage and enhanced PNP mineralization in nonsterile sewage. When added to the surface of sterile soil, the bacterium mineralized little of the PNP present at 5.0 micrograms/g, but it was active if mixed well with the sterile soil.(ABSTRACT TRUNCATED AT 250 WORDS)

Chlorophenols↗
PubMedDate not supplied

Hepatic tumor imaging using iron oxide MRI: comparison with computed tomography, clinical impact, and cost analysis.

BACKGROUND: The surgical management of hepatic tumors has traditionally relied on preoperative contrast-enhanced computed tomography (CECT) in combination with intraoperative ultrasonography (IOUS). Unfortunately, the ability to detect and characterize hepatic tumors by using CECT is limited, and IOUS frequently reveals additional disease that alters the operative approach. Recent advances in hepatic magnetic resonance imaging (MRI) may improve preoperative tumor detection and characterization; however, little is known about how MRI compares with CECT or about the clinical impact and cost considerations of liver MRI. METHODS: A retrospective chart review was performed to compare iron oxide (Feridex [Fe])-MRI with CECT in the preoperative imaging of hepatic neoplasms, as well as to determine the clinical impact and overall healthcare costs associated with Fe-MRI. RESULTS: Of approximately 1000 patients who underwent abdominal MRI at a single institution during a 20-month period, 57 were identified who underwent Fe-MRI evaluation of the liver. Indications for imaging included suspected metastases (n = 43), an indeterminate hepatic mass (n = 9), or primary hepatic cancer (n = 5). Overall, Fe-MRI identified a total of 157 lesions (mean, 2.75 per patient; range, 0-14). CECT was performed in 50 patients, of whom 35 had primary or metastatic cancer. Fe-MRI identified more lesions than CT (n = 136 vs. 77; P = .016), and the average size of lesion detected by Fe-MRI was significantly smaller than that by CECT (2.5 vs. 3.4 cm; P = .018). Comparison of CECT and Fe-MRI findings with IOUS and pathological specimens showed a significant difference in sensitivity (MRI, 86%; CECT, 58%; P<.001), and IOUS changed the operative approach in only 5% of those imaged with Fe-MRI. Overall, Fe-MRI altered the clinical management in 67% of patients imaged (n = 38 of 57), which corresponded to an overall net cost savings of $108,368 ($1,901 per patient). CONCLUSIONS: Fe-MRI is a powerful imaging technique, with greater hepatic tumor detection sensitivity than CECT. Moreover, it is an economically feasible imaging method that will alter the clinical management in most patients imaged.

Adult↗
PubMedDate not supplied

Early enteral nutrition support in patients undergoing liver transplantation.

BACKGROUND: The purpose of this study was to determine the effects of early postoperative tube feeding on outcomes of liver transplant recipients. METHODS: Fifty transplant patients were randomized prospectively to receive enteral formula via nasointestinal feeding tubes (tube-feeding [TF] group) or maintenance i.v. fluid until oral diets were initiated (control group). Thirty-one patients completed the study. Resting energy expenditure, nitrogen balance, and grip strength were measured on days 2, 4, 7, and 12 after liver transplantation. Calorie and protein intakes were calculated for 12 days posttransplant. RESULTS: Tube feeding was tolerated in the TF group (n = 14). The TF patients had greater cumulative 12-day nutrient intakes (22,464 +/- 3554 kcal, 927 +/- 122 g protein) than did the control patients (15,474 +/- 5265 kcal, 637 +/- 248 g protein) (p < .002). Nitrogen balance was better in the TF group on posttransplant day 4 than in the control group (p < .03). There was a rise in the overall mean resting energy expenditure in the first two posttransplant weeks from 1487 +/- 338 to 1990 +/- 367 kcal (p = .0002). Viral infections occurred in 17.7% of control patients compared with 0% of TF patients (p = .05). Although other infections tended to occur more frequently in the control group vs the TF group (bacterial, 29.4% vs 14.3%; overall infections, 47.1% vs 21.4%), these differences were not statistically significant. Early posttransplant tube feeding did not influence hospitalization costs, hours on the ventilator, lengths of stay in the intensive care unit and hospital, rehospitalizations, or rejection during the first 21 posttransplant days. CONCLUSIONS: Early posttransplant tube feeding was tolerated and promoted improvements in some outcomes and should be considered for all liver transplant patients.

Adult↗
PubMedDate not supplied

Simultaneous heart and kidney transplantation: a report of three cases and review of the literature.

Three cases of combined heart and kidney transplantation are presented. All three patients suffered from end-stage kidney disease, one chronic glomerulonephritis, two diabetic nephropathy. Ages of the patients were 22, 30, and 39 years, respectively. Two of the patients had the diagnosis of dilated cardiomyopathy and the third had ischemic heart disease. Patient follow-up is from 6 to 30 months. None of the patients have had a heart rejection and only one has had a kidney rejection. Cardiac and renal function remain excellent in all three patients. Glomerular filtration rates range from 53 to 77 ml/min. These three cases are compared with other reported cases in the literature. Combined heart and kidney transplantation may be of benefit in selected persons.

Adult↗