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Biomedical subjects

R W Feldtman

Publications and source records attributed to R W Feldtman.

At least 37 records · Page 2Linked to original sources
PubMed1979

Safe, cost-effective postoperative nutrition. Defined formula diet via needle-catheter jejunostomy.

To assess the safety and cost-effectiveness of needle-catheter jejunostomy for the purpose of feeding defined formula diet, we studied 199 consecutive patients who underwent major elective and emergency abdominal operations between July 1975 and June 1978 and in whom a needle-catheter jejunostomy was inserted. The complication rate was 2.5 per cent (1 per cent major and 1.5 per cent minor) during 7,238 patient-days of catheter exposure during which over 6 million calories were administered. There were no catheter-related deaths, bowel obstructions, bowel perforations, or intraperitoneal administration of feeding formula. The presence of a route of intestinal access and the use of defined formula diet in 111 patients who were unable to eat for over 10 days postoperatively resulted in a gross cost savings of almost $50,000 and a net savings of almost $33,000 by avoiding the necessity for central total parenteral nutrition. We belive the technique of needle-catheter jejunostomy is both safe and cost-effective in the administration of defined formula diet in the postoperative period, and we suggest that other surgeons gain experience with the technique to define its role in their own therapeutic armamentarium.

Adolescent↗
PubMed1978

Meeting exceptional nutritional needs. 1. Total parenteral nutrition.

The provision of adequate nutrition to hospitalized patients with exceptional caloric requirements has been a problem until the recent advent of intravenous hyperalimentation. With total parenteral nutrition (TPN), the nutritional needs of any patient can be met by infusion. TPN solution is hypertonic, and administration requires central venous cannulation. The subclavian vein is usually chosen as route of access to the superior vena cava. Strict aseptic technique must be used in inserting the catheter and making up and administering the solution. TPN is not without risk. Infection is always a possibility, as are metabolic alterations, such as electrolyte imbalance, fluid overload, osmotic dehydration, and essential fatty acid deficiency.

Catheterization↗
PubMed1978

Meeting exceptional nutritional needs. 2. Elemental enteral alimentation.

Elemental enteral alimentation (EEA) is an alternative to parenteral nutrition in patients with a functioning gastrointestinal tract and increased caloric requirements or in whom regular oral feeding is impossible or impractical. EEA is given by nasogastric, jejunostomy, or gastrostomy tube. It is useful in cases of short-gut syndrome, pancreatic disease, partial intestinal obstruction, colitis, neuropsychiatric cachexia, trauma, fistula, vascular insult, and renal and liver disease, as well as in patients being prepared for surgery or requiring hyperalimentation after surgery or abdominal irradiation. Strict attention must be paid to fluid and electrolyte status and to blood and urine glucose levels in patients receiving EEA. With use of a nasogastric tube, infection of the middle ear is a possible but uncommon complication.

Cachexia↗
PubMed1977

Bronchial carcinoid tumors in children and adolescents.

Thirteen histologically proven cases of bronchial carcinoid from the literature and eight cases from the Armed Forces Tumor Registry, all under 20 yr of age, are presented. Hemoptysis, cough, and pneumonia were the most frequent presenting complaints. Bronchoscopy defined the lesion in all 16 cases so studied. Gross and microscopic pathology is briefly described, and treatment in these cases outlined. A good long-term prognosis can be expected, except in those cases with a long delay in diagnosis.

Adolescent↗
PubMed1977

Practical role for ultrasound in diagnosis of deep venous thrombosis of lower extremities.

The Doppler Ultrasonic Velocity Detector has been shown to be of significant value in the evaluation of patients with suspected deep venous thrombosis. Our experience in 121 patients demonstrates a false-negative rate of 10% for "minimal" thrombophlebitis and 3.2% for ileofemoral thrombosis when the Doppler was used as a diagnostic aid. Since ileofemoral thrombosis represents the greatest threat to the patient in terms of pulmonary embolism, this appears to be a sensitive and specific technic for the detection of ileofemoral thrombosis.

Acute Disease↗
PubMed1977

Continual catheter administration of an elemental diet in infants and children.

Elemental diet offers a safe, simple, widely applicable technique for providing nutritional support in infants and children, thus protecting them against the hazards of malnutrition. Continual catheter administration of elemental diet provides an avenue of nutritional support free of many of the complications associated with total parenteral nutrition. Although mechanical and metabolic complications were avoided by rigid protocol compliance in our group of over 150 patients, further metabolic studies may suggest minor compositional changes providing a more optimal diet for premature and newborn infants.

Abnormalities, Multiple↗
PubMed1976

Hospital electrical safety.

Electrocution is an environmental hazard for hospital personnel and patients. The source is low-level alternating current, accidentally applied through indwelling electrodes which invade the normally protective high resistance of the body. Probably the greatest offender is the combination of electronic monitoring and the electrically operated bed. Preventive measures include education of medical personnel and the establishment of guidelines on leakage, coupled with periodic maintenance and inspection by trained technicians.

Electric Injuries↗
PubMed1976

Human skin burns induced by defibrillator default current.

The attachment of various types of electronic instrumentation to a patient can lead to hazardous interactions. Component malfunction in a single piece of equipment connected to a patient may be totally innocuous. However, the same fault occurring in an identical piece of equipment functioning as one component in a network of monitoring and electrosurgical equipment can result in severe burns or even electrocution. This paper describes interaction between a defective defibrillator paddle and an electrosurgical unit. Burns and ventricular fibrillation resulting from this malfunction and interaction are described in detail and the electrical circuits are analyzed.

Burns, Electric↗
PubMed1976

Pyloric stenosis: a 13-year experience in operative management.

Infantile hypertrophic pyloric stenosis is best treated surgically, after an appropriate period of rehydration and resuscitation. Our experience with this entity has resulted in the performance of fewer contrast studies to establish the diagnosis as well as the use of an operative technique which can be safely applied to the teaching environment.

Follow-Up Studies↗
PubMed1976

Doppler ultrasonic flow detection as an adjunct in the diagnosis of patent ductus arteriosus in premature infants.

Since ligation of a patent ductus arteriosus in the neonate with idiopathic respiratory distress syndrome seems to improve the clinical condition of the infant, we have attempted to identify those neonates earlier with the noninvasive Doppler ultrasonic technique, recording brachial arterial flow signals. Sixteen patients were studied. In the 5 with reversed brachial flow who were operated upon, ligation of a PDA resulted in improvement and postoperative correction of brachial flow reversal as evidenced by the Doppler ultrasonic technique.

Doppler Effect↗
PubMed1975

Dissimilar metals in a rib spreader a surgical electrical hazard.

A case is presented and electrochemical theory is discussed in a situation in which a battery was produced between two dissimilar metals in a Finochietto rib spreader. The problem developed in the thorax of a patient undergoing transthoracic cervical sympathectomy and resection of the first rib. Caution is advised in the use of dissimilar metals in patients undergoing surgery.

Adult↗
PubMedDate not supplied

Leiomyosarcoma of the rectum: the military experience.

Leiomyosarcoma of the rectum is a rare neoplasm and may behave in a highly malignant manner. Our experience with a single case prompted a review of the Armed Forces Central Medical Registry (AFCMR), where six other cases were found from the total AFCMR population. Four patients were treated with abdominoperineal (AP) resection; three had local excision only. Three patients developed metastatic disease and two of those died. The authors recommend prompt wide excision (AP resection) for any case of leiomyosarcoma of the rectum.

Adult↗
PubMedDate not supplied

An alternative approach to hospital electrical safety.

In the past, the only acceptable method for protecting hospital patients against the hazards of macroshock and microshock was equipotential grounding: a system whereby potential differences between conductive surfaces are minimized, and ground loops are eliminated, through use of a network of grounding conductors connected in a tree-branch configuration to a common reference point. Experience at a major medical facility involving attempts to create and maintain an equipotential grounding system has proven this method to be costly, impractical, and potentially hazardous. Recent improvements in the input circuitry of medical instrumentation and the rapid disappearance of explosive anesthetics from many hospital inventories now make it possible to suggest an alternative approach to electrical safety: the insulated environment.

Electric Conductivity↗
PubMedDate not supplied

Collateral cerebral vascular resistance in patients with significant carotid stenosis.

This study tests, the hypothesis that asymptomatic patients with hemodynamically significant internal carotid artery stenosis have a lower ipsilateral collateral cerebral vascular resistance and hence greater blood flow than their symptomatic cohorts. We measured internal carotid artery blood flow and cerebral perfusion pressures intraoperatively prior to and after carotid endarterectomy in 35 symptomatic and 10 asymptomatic patients with hemodynamically significant internal carotid artery stenosis. When the stenosis produced 30% or greater reduction in blood flow the calculated nondimensional normalized ratio of collateral cerebral vascular resistance of ipsilateral hemisphere cerebral vascular resistance was 1.15 +/- 0.83 (mean +/- SD) for the 10 asymptomatic patients and 2.98 +/- 1.89 for the 35 symptomatic patients (p = 0.0044). For the subgroup of 22 patients with 50% or greater reduction in internal carotid artery blood flow the resistance ratios were 0.782 +/- 0.541 for the 5 asymptomatic patients and 3.21 +/- 2.26 for the 17 symptomatic patients (p = 0.029). These results suggest that asymptomatic patients with hemodynamically significant internal carotid artery stenoses have a lower collateral cerebral vascular resistance than their symptomatic cohorts. The low collateral resistance may provide an adequate collateral cerebral blood flow to prevent ischemia and symptoms.

Blood Pressure↗