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Biomedical subjects

E E Mason

Publications and source records attributed to E E Mason.

At least 55 records · Page 3Linked to original sources
PubMed1980

Stomal ulcers after gastric bypass.

Introduction of gastric bypass as treatment for morbid obesity in 1966 caused over its ulcerogenic potential as an antral exclusion procedure. However, in only 20 of our 653 patients has marginal ulceration developed. Predominant symptoms were epigastric pain, occult gastrointestinal bleeding, and vomiting. Barium contrast roentgenography was as diagnostically accurate as endoscopy in these lesions. Objective measurement ensuring creation of a gastric reservoir of 50 mL maximum size reduced the incidence of marginal ulcer from 3.8% to 0.98%. Upper pouch size determined the mode of therapy. Nonoperative therapy was successful in patients with small pouches, but did not relieve symptoms of patients with large reservoirs. Truncal vagotomy and resection of redundant upper pouch was the preferred operative approach in these patients.

Adult↗
PubMed1980

Gastric bypass in morbid obesity.

Gastric operations for the treatment of morbid obesity have been standardized. They require close adherence to specifications for success. The upper stomach volume should be measured intraoperatively and fashioned to a capacity of 50 ml at a pressure of 25 to 30 cm of saline. The outlet should be no larger than 12 mm in diameter. The necessity for bypassing the remainder of the stomach and duodenum has not been established. Early maintenance of gastric decompression and immediate supervision and education of patients regarding new eating habits are crucial in the prevention of gastric rupture. Long-term care is usually minimal, but patients should be followed at least at 6 weeks, 6 months, 1 year, and at yearly intervals thereafter. Increasing numbers of intestinal bypass operations are being replaced by gastric bypass or gastroplasty. Many surgeons who once used intestinal bypass have decided to use the stomach operations instead because of the much less complicated long-term care required after the gastric procedures.

Avitaminosis↗
PubMed1979

Risk reduction in gastric operations for obesity.

Although nearly devoid of late complications, gastric operations for obesity have resulted in 4.7% early postoperative perforations. For patients over 39 years of age who perforated, the first 11 patients died and the last 9 survived. Perforations are equally common in upper stomach, anastomosis, and lower stomach. They have become more frequent with the 50 ml upper stomach volume and 12 mm stoma that are required to assure optimum weight control. Perforation is as common with gastroplasty as with gastric bypass. If it occurs, it is normally within the first ten postoperative days. Acute dilatation and rupture of the stomach can happen if all the nasogastric tube holes are in the jejunum after gastric bypass. Erosion of the stomach by the hard end of the nasogastric tube has occurred when the tube was positioned in the upper stomach. This paper is dedicated to the prevention of death by early recognition and aggressive management of perforation and by prevention of perforations through careful attention to the details of these operations and early postoperative care.

Adult↗
PubMed1979

The effects of a high-fiber diet on bile acid pool size, bile acid kinetics, and biliary lipid secretory rates in the morbidly obese.

A high-fiber diet has been suggested as one reason for the low incidence of gallstones in some populations. Therefore the authors tested the effects of a high-fiber diet on biliary secretory kinetics and bile salt kinetics in morbidly obese volunteers. Bile salt pool sizes were reduced by 50%, and their half-lives were decreased 70% after the subjects had spent 6 weeks on the high-fiber diet. Bile acid enterohepatic circulation times also were shortened dramatically. However, the lithogenicity of bile did not decrease, and bile remained supersaturated with with cholesterol. Fasting bile samples tended to be even more lithogenic than before the subjects follwed the diet. In these obese subjects, a high-fiber diet failed to reduce the tendency to secrete cholesterol-saturated bile.

Adult↗
PubMed1978

Venous thromboembolism in the morbidly obese.

Obesity has been considered as a high risk factor in the development of thromboembolism. To test the validity of this hypothesis, the records of 564 morbidly obese patients who underwent gastric bypass for control of their obesity were reviewed. Four patients, 0.7 per cent, had proved fatal pulmonary emboli and three demonstrated detectable, but not fatal, embolization. Fifty-seven patients were studied prospectively with Doppler examinations of the lower extremities, and only one patient had a transient abnormality of venous thrombosis of the calf, which proved to be associated with a nonfatal pulmonary embolus. The morbidly obese patients are not at high risk from thromboembolism, and the prophylactic use of low dose heparin, which may increase known wound morbidity, is discouraged. Doppler ultrasound of the lower extremities, however, has proved usefulness to differentiate deep venous thrombosis of the lower extremity from other causes of pain in the leg of the morbidly obese.

Adolescent↗
PubMed1978

Gastric bypass for obesity after ten years experience.

Over 625 patients having gastric bypass for the treatment of morbid obesity are currently being followed at the University of Iowa. Many innovations have increased operative exposure, greatly reduced operating time, and improved the effectiveness and safety of the operation. Recent weight figures show that a 55 percent loss of excess weight can be expected. Several comparative studies between gastric and jejunoileal bypass show that gastric bypass, while producing identical weight loss, has few of the many complications such as liver failure, renal and gallstone formation, diarrhea, enteritis, that are commonly associated with jejunoileal bypass. Stomal ulcer occurrence has been only 2 percent. Imporvements in diabetes mellitus and hypertension can be expected with weight loss. Other effects of gastric bypass were determined by use of a questionnaire. It is concluded, by surgeons having experience with both gastric and jejunoileal bypass, that gastric bypass is the treatment of choice for morbid obesity when nonoperative measures fail.

Adult↗
PubMed1977

Gastric bypass for morbid obesity.

Gastric bypass operations have been performed on more than 500 patients at the University of Iowa for the treatment of morbid obesity. With this procedure, almost the entire small intestine remains available for absorption, and the metabolic complications which have been described after jejuno-ileal bypass surgery have not occurred. The results with regard to weight loss are encouraging.

Humans↗
PubMed1977

Gastric bypass for morbid obesity in patients more than fifty years of age.

Morbid obesity, a weight twice that ideal for a given height, has evolved as a disease of affluent societies. Surgical treatment of this disorder has largely involved intestinal bypass procedure. Thirty-six patients more than 50 years of age have undergone a gastric bypass for the treatment of morbid obesity. The 28 females as well as the eight males were part of a group of 503 patients undergoing gastric bypass for treatment of morbid obesity. The mean age was 55 years, with extremes at 50 and 68 years, respectively. Weight loss was 40 per cent less than for the younger patients, averaging only 29 kilograms after two years, and the operative mortality was four times that for younger patients. The cause of limited weight loss after gastric bypass in this older age group of patients is unclear. However, unless there is specific value to be obtained from a modest weight loss, gastric bypass is not recommended as treatment for morbid obesity in patients more than 50 years of age.

Aged↗
PubMed1976

Transcervical thymectomy: an integral part of neck exploration for hyperparathyroidism.

Thirty-two neck explorations for hyperparathyroidism were done in 18 months. The indication for transcervical thymectomy was a failure to locate either inferior gland. Six of eight patients had adenomatous or hyperplastic glands located within or adjacent to the thymus. One infrathymic lesion was a parathyroid carcinoma and the other was a functioning parathyroid cyst. The abnormal parathyroid gland was not visible in any of these six patients until the thymus had been removed. Had this step been omitted, a sternotomy would probably have been required. Two patients had bilateral normal parathyroid glands within or deep to the thymus. Unless some normal parathyroid tissue has been identified and preserved, the indiscriminate use of transcervical thymectomy could result in the inadvertent excision of both inferior glands and possible iatrogenic hypoparathyroidism.

Humans↗
PubMed1976

Effect of gastric bypass on gastric secretion.

Gastric bypass as a 90 per cent gastric exclusion operation was used in 393 patients with massive obesity to limit food intake. Stomal ulcer has occurred in 1.8 per cent of such patients or one ulcer per 140 man years of observation. The studies of indwelling fundic pH and of gastric acid secretion from the excluded stomach indicate that acid secretion is reduced after gastric bypass but that the acid, unbuffered by food in the excluded stomach, results in a lowered gastrin secretion after a meal. Thus, gastric bypass in inhibitory to acid secretion in most morbidly obese patients who do not have known acid peptic disease.

Achlorhydria↗
PubMed1976

The mechanism of increased gallstone formation in obese human subjects.

Cholesterol gallstones occur three times more frequently in morbidly obese subjects than in normal controls. The present study tests the hypothesis that obese subjects develop gallstones because of relative and absolute excess cholesterol excretion in bile. The steady-state kinetics of biliary lipid excretion and bile acid pool sizes were determined in eight healthy obese subjects without gallstones by a noninvasive technique. Aliquots of resting gallbladder bile were obtained on consecutive days. Hepatic bile excretion was constantly sampled during the infusion of a liquid isocaloric cholesterol-free formula containing a dilution indicator over two 12 hour periods on consecutive days. Gallbladder bile of seven of eight subjects was saturated consistently with cholesterol. Mean hourly hepatic cholesterol excretion in bile was 0.232 mM. per hour, three times greater than that of normal subjects and twice that of subjects with gallstones. Phospholipid and bile acid excretion were 0.73 and 1.88 mM. per hour, respectively. The excretion rates of these cholesterol-solubilizing components of bile are higher than in normal subjects but are insufficient to compensate for the increased cholesterol excretion. The bile acid pool sizes were normal (X = 2.72 Gm.) but the daily synthesis of bile acids was increased (X = 0.86 Gm. of cholic acid). We conclude that the clinically observed high correlation of cholelithiasis with obesity is due to increased hepatic secretion of cholesterol which precipitates as cholesterol gallstones.

Absorption↗
PubMed1976

Metabolic considerations in reconstitution of the small intestine after jejunoileal bypass.

Intestinal bypass is a reversible procedure which has been used with success in the surgical treatment of morbid obesity. Nine patients with intestinal bypass were forced to undergo reconstitution of the gastrointestinal tract due to severe symptoms of short gut syndrome. Meticulous attention to detail must be exercised in the preoperative preparation of this type of patient. Parenteral hyperalimentation may be necessary to return the patient to adequate nutrition. No attempt at revision should be made until the patient is nutritionally and metabolically reconstituted.

Adult↗