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Biomedical subjects

H W Scott

Publications and source records attributed to H W Scott.

At least 73 records · Page 4Linked to original sources
PubMed1977

Results of jejunoileal bypass in two hundred patients with morbid obesity.

Two hundred massively obese patients were submitted to four variations of jejunoileal bypass during the last decade. The operative mortality rate was 2.5 per cent. Nonfatal postoperative complications occurred in patients who had the small intestine shortened to 18 to 20 inches by end-to-end jejunoileostomy. In follow-up periods up to ten years, there have been nine late fatalities, five of which were unrelated to jejunoileal bypass. Despite late complications which have included renal stones, enterohepatic syndrome and ventral hernia, 66 per cent of the survivors have achieved good results by the criteria used. Metabolic improvements include a profound and sustained reduction in plasma concentrations of cholesterol and triglyceride.

Adolescent↗
PubMed1976

Jejunoileal bypass procedures in morbid obesity: preoperative psychological findings.

Seventy patients who averaged 155% overweight and requested jejunoileal bypass surgery as a treatment intervention for morbid obesity were studied preoperatively for prominent psychological characteristics. By use of standard personality tests and a structured psychiatric interview, it was found that 89% were judged to be psychologically favorable risks for the operation. Most frequently the diagnostic opinion was of a mild personality disorder.

Adult↗
PubMed1976

Pheochromocytoma: present diagnosis and management.

In the 25-year period 1950-1975 forty-four patients with pheochromocytoma were observed at Vanderbilt University Affiliated Hospitals. Bilateral adrenal tumors occurred in 3 patients (6.8%) and extra-adrenal tumors occurred in 7 others (16%), 33 patients (75%) had single tumors arising in one of the adrenal glands; in one of these 5 years after operation, a malignant tumor developed in the same renal fossa. Five of the 44 patients (11.3%) proved to have malignant tumors and died with metastases. In 11 patients in the earlier years of this study the clinical diagnosis was not made and the tumor was identified by the pathologist at autopsy. There was a single postoperative fatality among the 33 patients in whom the clinical diagnosis was made. Seventy per cent of all survivors with benign tumors have remained normotensive during followup periods of one to 20 years.

Adolescent↗
PubMed1976

Hemorrhagic necrosis of pheochromocytoma associated with phentolamine administration.

A case of ruptured pheochromocytoma is presented, the pathophysiology discussed, and the literature reviewed. Evidence is presented that the use of alpha-adrenergic blockade in general, and phentolamine in particular, may predispose to this complication. Twelve cases of massive hemorrhagic necrosis with or without rupture were found in the literature, including the present case. Six had no operation; one survived. Six had immediate operation; 4 survived. An additional case of hemorrhage into a small pheochromocytoma following phentolamine is presented. This tumor was neither ruptured nor massively necrotic, but the case supports the hypothesis that alpha-adrenergic blockade may cause hemorrhage within the pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed1976

Psychological adaptation to jejunoileal bypass for morbid obesity.

Psychological adaptation to jejunoileal bypass procedures in 34 morbidly obese patients was evaluated preoperatively and followed postoperatively for an average of 23 months. Preoperative emotional disturbances were mainly those of mild personality disorders with passive-aggressive, passive-dependent, and emotionally immature traits. Following discharge from the hospital, nine patients (or 24 per cent) developed psychiatric difficulties, characterized by either increased neurotic symptoms and interpersonal problems, or the emergence of psychosis. Male patients and those with the greatest weight loss were statistically more likely to have psychiatric complications. The remaining patients expressed satisfaction with the operation, noted relief from the burden of dieting, experienced less excitement associated with eating, and felt more self-confident and hopeful.

Adaptation, Psychological↗
PubMed1976

Protective effects of ileal bypass versus administration of clofibrate on experimental hypercholesterolemia and atherosclerosis in monkeys.

This study was designed to compare the ability of distal intestinal bypass versus clofibrate administration to prevent the development of atherosclerosis and hypercholesterolemia in monkeys on a standardized atherogenic regimen. Three groups of monkeys were studied: one group was submitted to intestinal bypass, one group was fed clofibrate, and one group served as dietary controls. Serum cholesterol levels and group served as dietary controls. Serum cholesterol levels and gross atheromatous lesions were studied. Clofibrate offered moderate protection against experimental hypercholesteroiemia and atherosclerosis, but in animals with surgical bypass of the distal one third of the small intestine, the protection appeared to be more complete.

Animals↗
PubMed1975

Surgical treatment of popliteal artery injuries.

Twenty-seven patients with injury to the popliteal artery and associated structures were operated on during the past 15 years. There was no operative or hospital deaths. The limb salvage rate was 56%; the amputation rate was 44%. Those patients with penetrating injuries were found to have a much better salvage rate (85%) than those with blunt trauma (29%). Preoperative arteriography and immediate repair of the popliteal artery by either end-to-end anastomosis or a vein graft is advocated for these patients. Popliteal vein injuries should be repaired when possible by lateral suture or end-to-end anastomosis. Fasciotomy is advocated on a selected basis.

Adolescent↗
PubMed1975

Surgical management of Menetrier's disease with protein-losing gastropathy.

Three patients with Menetrier's disease and protein-losing gastropathy who were studied during a 12 year period have been presented. The characteristic findings which differentiate them from patients with hypertrophic hypersecretory gastropathy, including the Zollinger-Ellison syndrome, are: 1) hypertrophy of gastric mucosa with giant rugal folds involving the fundus, cardia and body of the stomach but sparing the antrum; 2) muscosal hypertrophy consisting of gastric mjcus-secreting cells while parietal cells and chief cells are diminished in number and may be absent from many microscopic sections; 3) gastric secretion of large volume containing excess mucus, low to absent hydrochloric acid and protein concentration 5 or 6 times normal (1.7 mg/ml); 4) hypoalbuminemia and hypoglobulinemia due to loss of serum proteins fron gastric mucosa into the gastric lumen; 5) rare association with gastric ulcer. Unlike the Zollinger-Ellison syndrome none of our patients had duodenal ucler or multiple endocrine adenomatosis or a family history of these conditions. We have found no authenticated reports in the literature which document a relationship of Menetrier's disease ( as defined above) with multiple endocrine adenomatosis. Menetrier's disease with protein-losing gastropathy is a potentially lethal disorder of unknown cause with no specific treatment. Resection of the site of gastric protein losses as first done by Waugh is logical and effective. One of our three patients died in hospital before gastrectomy was done. Two others have done well for 11 months and 12 years, respectively, after total gastrectomy with Roux-en-Y esophagojejunostomy and Hunt-Lawrence jejunal pouch.

Adult↗
PubMed1975

Body composition in morbidly obese patients before and after jejunoileal bypass.

A clinical and body compositional study has been made of 150 patients with morbid obesity and their responses to four different dimensional alterations of jejunoileal bypass. Total body potassium was estimated by measuring 40K with the whole body counter and total body water by tritiated water dilution. Body compositional data derived from these measurements were compared in the 4 groups during followup periods up to 4 years and related to clinical results. Initially, patients were two or more times overweight due to excess (60 to 65%) body fat and increased hydration (21%) of lean tissues. The 80 end-to-end jejunoileal bypass procedures of Groups 3 and 4 (30 cm jejunum to 15 or 20 cm ileum) had better weight losses and clinical results in followup were rated "good" in 60% and 81% respectively. These results were accompanied by a greater degree of improvement in body composition than was observed in the other groups under study.

Adolescent↗
PubMed1974

Pheochromocytoma.

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Adrenal Gland Neoplasms↗