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Biomedical subjects

H Buchwald

Publications and source records attributed to H Buchwald.

At least 73 records · Page 4Linked to original sources
PubMed1987

Lipoprotein modification achieved by partial ileal bypass: five-year results of The Program on the Surgical Control of the Hyperlipidemias.

The Program on the Surgical Control of Hyperlipidemias (POSCH) is a multicentered, randomized, secondary intervention trial assessing the effect of lipoprotein modification achieved by partial ileal bypass (PIB) on overall mortality rates and the course of coronary heart disease. Of the 838 participants, 396 (196 control and 200 surgical patients) have complete 5-year lipoprotein results and are the basis of this report. After PIB, total cholesterol level decreased 24 +/- 1.2% (mean +/- SEM) and low-density lipoprotein cholesterol level fell 38 +/- 1.5% in comparison with control subjects. High-density lipoprotein (HDL) cholesterol level was not changed by PIB; however, a significant decrease in HDL occurred over 5 years in the control group (41.7 +/- 0.7 mg/dl versus 39.5 +/- 0.6 mg/dl, p less than 0.05). This led to consistently higher HDL levels in the surgical group in comparison with control subjects after PIB. Very low-density lipoprotein cholesterol and triglyceride levels were higher in the surgery group than in control subjects (24 +/- 7.6% and 21 +/- 5.4% at 5 years). Apolipoprotein B-100 was significantly lower, and apolipoprotein A-I and HDL-2 were significantly higher in the surgery group. These lipoprotein changes are greater than have been reported from any previous trial of dietary or pharmacologic intervention, including the Lipid Research Clinics-Coronary Primary Prevention Trial, which used cholestyramine. Based on available epidemiologic data, these changes predict a marked reduction in morbidity and mortality rates associated with coronary heart disease after PIB.

Adult↗
PubMed1987

Synergistic lipid-lowering effects of alfalfa meal as an adjuvant to the partial ileal bypass operation.

Partial ileal bypass (PIB) and ingestion of alfalfa are both known to lower plasma cholesterol (C) levels. During an 18-week period, the combined effects of both were studied in four randomized groups of rabbits receiving C-free, hypercholesterolemia-inducing, semisynthetic diets 3 weeks after sham or PIB surgery. The diets, with or without alfalfa, had similar overall compositions of fat, protein, carbohydrate, and fiber. We measured blood C, triglycerides (T), and lipoprotein fractions of both C and T at biweekly intervals. In vivo liver and small-bowel synthesis of C, fatty acids (FA), and nonsaponifiable lipids (NSL) were determined with radioactive 14C-acetate at the end of the study. The results were evaluated by means of analysis of variance using unweighted cell means. The combined PIB and alfalfa modalities significantly lower C levels in serum, plasma, low-density lipoproteins, and high-density lipoproteins by 66%, 71%, 85%, and 35%, respectively. However, due to alfalfa, a significant increase of 49% was observed in plasma T when both treatments were combined. Liver FA synthesis was significantly decreased (65%) with PIB and increased (161%) with alfalfa; when the two treatments are combined, a nonsignificant response was observed. Similarly, this inverse relationship for PIB and alfalfa was seen for C and NSL synthesis. Small-bowel FA synthesis was significantly decreased (72%) by the combination of PIB and alfalfa. We conclude that alfalfa suppresses, in part, the physiologic rebound effect of PIB surgery by increasing hepatic C and NSL synthesis; inversely, PIB surgery inhibits the additive effect in the liver synthesis of FA produced by alfalfa. Alfalfa and PIB alone, and synergistically, decrease total small-bowel lipid synthesis, specifically that of FA. Alfalfa is an effective adjuvant to PIB for reducing total and lipoprotein C fractions.

Analysis of Variance↗
PubMed1986

Cefamandole distribution in serum, adipose tissue, and wound drainage in morbidly obese patients.

Distribution and elimination of cefamandole 2 g iv were studied in 11 morbidly obese patients during a gastric bypass operation and again on the first postoperative day. Serum, subcutaneous adipose tissue, wound drainage, and urine were analyzed by high performance liquid chromatography for cefamandole and pharmacokinetic parameters from the intraoperative period were compared to those obtained postoperatively. Total body clearance was significantly greater (p less than 0.001) postoperatively (297 ml/min) than intraoperatively (254 ml/min). Volume changes were unpredictable but the elimination rate constant tended to increase postoperatively. Renal clearance and percentage of urinary recovery were significantly increased (p less than 0.01) postoperatively. The patients had a mean (+/- SD) volume of the central compartment of 10.3 (+/- 2.3) L, volume at steady state of 18.3 (+/- 3.9) L, and elimination rate constant of 1.67 (+/- 0.63) h-1. Tissue concentrations of cefamandole were highest during the first hour after drug administration and were less than 1 microgram/g after 3.5 hours. Mean wound drainage concentrations ranged between 10 and 12 micrograms/ml during a dosing interval and dropped to 7 micrograms/ml 12 hours after the last dose. Intraoperative dosing of cefamandole is required to maintain subcutaneous adipose tissue concentrations greater than 1 microgram/g during procedures longer than three hours in morbidly obese patients. A postoperative dose of cefamandole 2 g iv q6h will provide sustained and therapeutic concentrations in the wound drainage of morbidly obese patients.

Adipose Tissue↗
PubMed1986

A new peritoneovenous shunt.

For today's most common peritoneovenous shunt catheters, the high incidence of complications (disseminated intravascular coagulation [DIC], pulmonary problems, clotting of the intravascular end, and shunt kinking) results in limited use. We have designed a new peritoneovenous shunt catheter in which we improved mechanical biocompatibility with respect to both the peritoneum and the vasculature. The device consists of: a multimicroorifice ascites filter in a double-chambered collecting device, a tubular compression pump with an intratubular check-valve, and a check-valve catheter at the intravascular end for positive exclusion of blood by reflux or back diffusion. This configuration filters the proteinaceous material from the ascites fluid, transports the filtrate into the blood stream, maintains patency, act to prevent DIC by inhibiting the creation and transport of microthrombi into the cardiovascular system, and eliminates clot formation at the intravascular end.

Aged↗
PubMed1985

Quantitative assessment of left ventricular function after myocardial infarction using the minnesota Q-QS codes for resting electrocardiograms.

The electrocardiogram as a quantitative predictor of left ventricular systolic function was investigated in subjects with one myocardial infarction. The first 509 consecutive subjects to enter the Program of Surgical Control of Hyperlipidemia were studied by selective left ventriculography. Electrocardiograms taken during a prior hospitalization of the subjects for acute myocardial infarction were classified according to the Minnesota Q-QS codes. This study showed that the lower (ie, the more significant) Q-QS codes were highly correlated with reduced left ventricular function as measured both by a lower ejection fraction and by a greater number of left ventricular segments showing abnormal systolic motion. In addition, the location of segmental wall motion abnormalities correlated with the electrocardiographic site of the Q-QS code.

Adult↗
PubMed1985

Implantable infusion pump management of insulin resistant diabetes mellitus.

Diabetes mellitus with resistance to insulin administered subcutaneously or intramuscularly (DRIASM) is a rare and brittle form of Type I diabetes, found predominantly in young females and characterized by inadequate glycemic response to subcutaneous or intramuscular insulin administration. DRIASM leads to frequent ketoacidosis and obligatory hospitalization for administration of intravenous insulin. The use of a totally implantable infusion pump effected dramatic improvement in the treatment of five patients with this difficult form of diabetes. Frequency of clinical ketoacidosis was reduced from 37 episodes per year to 0.4 episodes per year (99%), and average in-hospital days per month were reduced from 20.8 days to 2.2 days (89%) with a mean follow-up period of 14.4 months. Cost savings were approximately +10,000 per patient month. Quality of life was greatly improved for these individuals.

Adolescent↗
PubMed1985

Nonenzymatic glycation of fibronectin and alterations in the molecular association of cell matrix and basement membrane components in diabetes mellitus.

This study reports the nonenzymatic glycation of plasma fibronectin in vivo in diabetic dogs and also in vitro by incubation of human plasma fibronectin with excess glucose. Although no difference is observed in the total plasma fibronectin level, the nonenzymatic glycation of fibronectin is increased 2.3-fold in inbred male beagle dogs made diabetic with alloxan in comparison with age-matched controls. The extent of non-enzymatic glycation of fibronectin is shown to be proportional to blood glucose levels. HPLC reverse-phase analysis of the hydrolyzed amino acids and glyco-amino acids from plasma fibronectin samples of normal and diabetic dogs show that nonenzymatic glycation occurs only on lysine residues. When purified human plasma fibronectin was incubated in vitro with 500 mM glucose, the extent of nonenzymatic glycation of fibronectin was observed to increase proportionately with time. Ligand binding assays conducted in solution with varying concentrations of 3H-heparin in the presence of a constant amount of normal or nonenzymatically glycated human plasma fibronectin gave virtually identical binding curves. However, the binding of 3H-heparin to normal fibronectin could be increased fourfold by the concomitant addition of normal gelatin (denatured calfskin collagen). If in vitro glycated fibronectin and/or in vitro glycated gelatin are added under this latter condition with 3H-heparin, there is a tremendous decrease in the expected heparin binding seen with normal levels of nonenzymatic glycation. Other experiments were performed to quantitate the binding of 3H-labeled fibronectin to gelatin-coated nitrocellulose filters. Nonenzymatic glycation of fibronectin in vitro resulted in markedly decreased binding of 3H-fibronectin to collagen.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed1985

Gastritis after gastric bypass surgery.

To determine the preferable reconstruction of gastrointestinal continuity after gastric bypass, we studied by endoscopic, chemical, and histologic analyses 28 randomly selected patients with a loop gastroenterostomy, a loop gastroenterostomy plus enteroenterostomy between the afferent and efferent loops, and a Roux-en-Y anastomosis. Total bile acid levels for the three groups were: 5092 +/- 1673 mumol/L, 1638 +/- 581 mumol/L, and 404 +/- 384 mumol/L, respectively. The incidence of gastritis by endoscopy was 71% in the standard loop bypass, 45% in the enteroenterostomy group, and 13% in the Roux-en-Y group. Histologic abnormalities were present in 86% of the patients who underwent standard loop bypass, in 91% of those with an additional enteroenterostomy, and in 63% of the Roux-en-Y group. There was poor correlation of symptoms and objective findings. In our study Roux-en-Y reconstruction after gastric bypass, in comparison with loop gastroenterostomy or loop gastroenterostomy with an additional enteroenterostomy, is less likely to result in bile in the stomach, endoscopic changes, and histologic abnormalities.

Adult↗
PubMed1985

Reduction of plasma cholesterol and LDL-cholesterol by continuous intravenous insulin infusion.

We studied lipid profiles in 10 patients with insulin-requiring type II diabetes. Patients began the study under conventional subcutaneous insulin injection therapy. Treatment was then optimized on subcutaneous therapy and finally converted to continuous intravenous therapy from a single flow rate implantable pump. Pump management proved reliable and safe. Implantable pump therapy showed a statistically significant reduction in the average plasma cholesterol level from 205.7 to 184.7 mg/dl. The mean low-density lipoproteins (LDL)-cholesterol level decreased from 114.6 to 108.1 mg/dl, the high-density lipoproteins (HDL)-cholesterol average changed from 50.6 to 51.0 mg/dl, and the HDL/LDL ratio increased from 0.478 to 0.500. Glycemic control did not improve on single-rate intravenous therapy compared with intensive conventional subcutaneous injection during the short observation period. The authors conclude that additional studies should be performed to confirm the improvement in the lipid profile on intravenous pump therapy.

Adult↗
PubMed1984

Suppression of weight gain by glucagon in obese Zucker rats.

Glucagon has been shown to lower blood lipids and to decrease food intake and body weight in short-term studies in man and animals. There is evidence of decreased secretion of glucagon in human obesity. The Zucker obese rat suffers from a genetic type of obesity and has an absolute reduction in circulating glucagon concentration. The effect of long-term administration of glucagon on the body weight in obese Zucker rats was studied. Glucagon caused a marked (-20%) reduction of body weight in obese Zucker rats with no change in feed intake. Urine glucose, urea nitrogen, creatinine, and ketone content, as well as serum triglyceride, cholesterol, alkaline phosphatase, creatinine, and insulin levels remained unchanged. Weights of perirenal fat, kidneys, and heart also remained unchanged. However, glucagon injection in obese Zucker rats caused significant decrease in serum glucose, and increases in SGOT, liver weight, and liver lipid and glycogen content. Further investigations are needed concerning the safety of chronic glucagon administration for weight control.

Adipose Tissue↗
PubMed1984

Searching for the best weight reduction operation.

At the University of Minnesota under the supervision of one staff surgeon both jejunoileal bypass (JIB) and gastric bypass (GIB) operations have been performed for weight reduction in morbidly obese individuals. During the last 14 years 727 patients underwent end-to-end (40 to 4 cm) JIB and more than 570 patients underwent GIB. This report is based on a comparison of 205 JIBs performed between July 1975 and July 1979, 106 Alden-loop type GIBs (GIB-loop) performed between July 1975 and July 1979, 53 loop GIBs with enteroenterostomies between the limbs of the loop (GIB-EE) performed between May 1980 and May 1981, and 57 Roux-en-Y GIBs (GIB-Roux) performed between May 1981 and May 1982. Adequate weight loss occurred in 80% of the patients who returned for follow-up in all groups. The percentage of excess body weight loss was similar for the first year (65% for JIB, 62% for GIB-loop, 69% for GIB-EE, and 71% for GIB-Roux). The operative mortality and the immediate morbidity rates were uniformly low. The long-term complications for JIB were 37.7% arthralgia, 7.1% oxalate urolithiasis, 5.6% incisional hernia, and 1.4% liver failure. The complications for GIB-loop were 10.2% nausea/vomiting, 1.9% bile reflux gastritis, and 2.8% anastomotic problems; for GIB-EE 23% nausea/vomiting, 7% bile gastritis, 4.6% incisional hernia, and 3.7% anastomotic problems; and for GIB-Roux 16% nausea/vomiting and 1.7% anastomotic problems. The anastomotic problems consisted of afferent loop obstructions and stomal stenosis; there were no leaks. At 1 year plasma cholesterol reduction for JIB averaged 42% (p less than 0.001), GIB-loop 14% (p less than 0.001), GIB-EE 7% (NS), and GIB-Roux 17% (p less than 0.001). One year after operation 49% of 88 JIB patients showed progression of liver disease on sequential biopsy specimens and 20% improvement. In the 78 GIB patients with sequential biopsies, liver disease progressed in 8% and improved in 65%. In summary, comparable therapeutic weight reduction occurred with all the assessed procedures; however, the GIB-Roux was associated with far fewer serious long-term complications. At this time the GIB-Roux procedure is the weight reduction operation we recommend.

Alkaline Phosphatase↗