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Biomedical subjects

J B Freeman

Publications and source records attributed to J B Freeman.

At least 19 recordsLinked to original sources
PubMed1998

Rush to judgment? Child protective services and allegations of sexual abuse.

Two hundred and ninety-three randomly selected cases from a child protection service agency in a large western New York county were examined to test the hypothesis that sexual abuse allegations are investigated and processed more intensively than cases alleging other types of maltreatment. Contrary to the hypothesis, allegations of sexual abuse were substantiated at a lower rate, not investigated more intensively, and not offered more services than were other cases.

Attitude of Health Personnel↗
PubMed1997

Weight loss after extended gastric bypass.

BACKGROUND: Gastric bypass (GBP) is the most effective method for controlling morbid obesity. Previously we showed that extending the length of the Roux limb increased weight loss. We have done over 400 obesity operations during the past 20 years. The current study consists of patients from the last 10 years of our experience and compares short to extended Roux-en-Y GBP. METHODS: Data from all patients operated at the Ottawa General Obesity Clinic were entered into a database on an ongoing basis, and those from the past 10 years were analyzed. All patients had standardized preoperative investigations and postoperative follow-up. Details of these and of the operative technique are provided in the manuscript. RESULTS: The preoperative weight and BMI were 129 +/- 2 kg, and 46 +/- 2 kg/m2, respectively. The mean weight loss prior to surgery was -2 +/- 21 kg. The results were classified, by percentage weight loss as: 'excellent' = > 35%; 'good' = 25-34%; 'poor' = 15-24%; and 'failure' = < 15%. Sixty-five patients (69%) were available for 2-year follow-up. At this time, mean percentage weight loss was 34 +/- 2 versus 40 +/- 1 for the short Roux (45-135 cm) and long Roux (180-225 cm) groups, respectively (P < 0.01). There were no deaths, leaks, splenectomies or intra-abdominal infections. The incidence of hernia and/or reoperation for bowel obstruction was 35/121 or 29%. The overall incidence of diarrhea was 16/121 (13%) and 6/121 (5%) at 12 and 24 months. Quality of life is significantly impaired in at least three of these patients, all with extended limbs. Major vitamin deficiencies, alterations in liver functions, or other metabolic complications did not occur. CONCLUSIONS: Gastric bypass is the procedure of choice for morbid obesity. Weight loss is marginally improved in proportion to the length of the Roux limb but at a risk of diarrhea, which occasionally may not manifest itself for 8 to 12 months. It is important that methods be devised to correct follow-up, incisional hernias and diarrhea.

Adolescent↗
PubMed1996

Child age and caseworker attention in child protective services investigations.

Infants and toddlers are at increased risk for severe/fatal abuse, often at the hands of male perpetrators. This paper examined whether child maltreatment cases involving younger children receive more casework services, overall caseworker activity (e.g., home visits, phone contacts), and are more likely to be substantiated, particularly if a male perpetrator is involved. The randomly selected sample consisted of 293 child abuse and neglect reports in a large county in Western New York in 1993. Hierarchical regression analyses showed that younger children generally receive more overall services and caseworker activity, and that while age makes a significant contribution after the decision has been made to substantiate a case, it does not have the same effect on the initial decision of whether or not to substantiate. Gender of the perpetrator did not reliably predict caseworker attention.

Adolescent↗
PubMed1990

Feeding jejunostomy: a safe adjunct to laparotomy.

It is well established that a feeding jejunostomy is an invaluable adjuvant for use in critically ill and malnourished patients. What is not well known are the complications of inserting these tubes. Some surgeons are reluctant to insert feeding tubes unless the indications are very clear. From their experience with the insertion of 133 feeding jejunostomy tubes during a 3-year period, the authors conclude that the complications associated with the insertion of such tubes are few and that the procedure is justified even if the tube is never used.

Enteral Nutrition↗
PubMed1989

Comparison of Marlex and Gore-tex to repair abdominal wall defects in the rat.

Marlex and Gore-tex, two prosthetic materials used to close abdominal wounds, were compared with respect to strength and adhesion formation. A 2.5 X 3.5-cm full-thickness area of abdominal wall was excised in 32 CD rats. The defect was repaired using identically sized patches of Marlex or 1-mm Gore-tex, determined by alternate assignment, and sutured with continuous 4-0 Gore-tex. Adhesion formation was graded at necropsy and recorded photographically in each animal. The mean adhesion index (none = 0, maximal = 4) was 1.37 +/- 0.12 and 2.62 +/- 0.12 (mean +/- SEM) for Gore-tex and Marlex groups respectively (p less than 0.005, unpaired t-test). A template was used to fashion 2-cm coronal strips of abdominal wall for tensile-strength testing. The relative strengths were 2.67 +/- 0.14 and 3.02 +/- 0.16 kg/cm (mean +/- SEM) for the Gore-tex and Marlex groups respectively (NS). Histologically, there were more epithelioid giant cells and less collagen formation in the Gore-tex group. Abdominal wall reconstruction with Gore-tex resulted in wound strength equal to that of Marlex and fewer adhesions. Gore-tex is preferred when prosthetic material and viscera are in close proximity.

Abdominal Injuries↗
PubMed1987

The use of endoscopy after gastric partitioning for morbid obesity.

Fiberoptic endoscopy is an important diagnostic modality for evaluating the patient with upper gastrointestinal tract symptoms following gastric restrictive operations. The specific indications for endoscopy after obesity surgery include stoma evaluation in patients who fail to lose adequate weight; stomal stenosis; esophagitis; surveillance of the excluded pouch; and suspicion of a marginal ulcer after gastric bypass.

Anastomosis, Roux-en-Y↗
PubMed1986

Prevention of superficial phlebitis during peripheral parenteral nutrition.

Fifty-four patients receiving peripheral parenteral nutrition consisting of 3.5 percent amino acids in a 5 percent dextrose solution were randomly assigned in a double-blind fashion to receive this solution with or without an antiphlebitic mixture (1000 IU heparin, 5 mg hydrocortisone, and 1.8 mEq sodium hydroxide as a buffer). The addition of antiphlebitic mixture resulted in a marked and highly significant reduction in the incidence of phlebitis and a prolongation of the number of phlebitis-free hours during infusion of peripheral parenteral nutrition (p less than 0.005).

Aged↗
PubMed1986

Serum alanine aminotransferase to aspartate aminotransferase ratio and degree of fatty liver in morbidly obese patients.

We evaluated the change in serum alanine aminotransferase (ALT; EC 2.6.1.2) to serum aspartate aminotransferase (AST; EC 2.6.1.; ALT/AST) ratio with the degree of fatty liver in morbidly obese patients. A total of 31 patients were included in the study. Fatty liver was graded as 0 to 4+. The mean and SD of AST and ALT were not significantly different between groups of patients with various grades of fatty liver. There was, however, a significant correlation between the ALT/AST ratio and the degree of fatty infiltration of the liver. This, we believe, implies damage mainly to the plasma membrane allowing loss of cytoplasmic enzymes rather than loss of mitochondrial enzymes.

Adult↗
PubMed1986

Nonoperative management of stomal stenosis after gastroplasty for morbid obesity.

Over a period of six years, 33 of 172 (19 per cent) patients who had gastric partitioning had stomal stenosis develop which was defined as an inability to drink fluids or swallow saliva, or both. All were managed conservatively in the hospital or on an outpatient basis. This consisted of total parenteral nutrition and endoscopy to evaluate the stoma with or without dilation; Eder-Puestow dilaters and long term jejunostomy feeding were used. Thirteen of these patients were dilated a total of 36 times. Three required three to six dilations each, up to the maximum size (45F). There were no complications. Twenty-nine required repletion by combined parenteral and enteral nutrition. Three required jejunostomy insertion as a separate procedure. Patients were observed for six to 60 months. Thirty-two did well. Gastrogastrostomy was required in one patient with a stenosis after the second gastroplasty. Three patients who were dilated regained over 20 per cent of their ideal weight.

Acute Disease↗
PubMed1985

Colonization of intravascular catheters in the intensive care unit.

A prospective study of intravascular catheters (arterial, Swan-Ganz, and central venous) in two hospitals with similar intensive care units revealed an overall 25 percent colonization rate (more than 15 colony counts). Arterial catheters had the lowest colonization rate and central venous catheters had the highest. Arterial, Swan-Ganz, and central venous catheters are possible sources of nosocomial infections and septicemia. They should be inserted only when necessary. A critical review of our data and the literature suggests that future studies should examine the potential benefits of assiduous insertion technique, improved dressing care, intravascular delivery systems, and the choice of catheter.

Candida albicans↗
PubMed1985

Relationship between body weight and total leukocyte count in morbid obesity.

The authors studied the relationship between total leukocyte count and body weight in 42 morbidly obese patients (weight range, 101.5-206.8 kg). None of the patients had a recent history of infection, hematologic disorders, chronic respiratory disease, or were smoking more than 5 cigarettes/day. The range of total leukocyte count was 4.2-12.0 X 10(9) cells/L. Twelve of the 42 patients had a leukocyte count of 10 X 10(9) cells/L. There was a significant correlation between body weight (kg) and total leukocyte count (r = 0.68, P less than 0.001). Morbid obesity should be considered as one of the causes of physiologic leukocytosis.

Adult↗
PubMed1985

Colonization of intravascular monitoring devices.

This randomized prospective study of all invasive catheters inserted in our ICU tested the hypothesis that daily dressing changes would reduce the 25% infection rate associated with these catheters. Significant growth was noted in eight (7%) of 133 vs. nine (6.7%) of 135 skin cultures from patients whose dressings and infusion tubings were changed at 24 vs. 72 h, respectively. Catheter tip cultures were positive in six (5.9%) of 102 vs. eight (7.5%) of 107 for the 24- and 72-h groups, respectively. Paradoxically, blood cultures were positive in three (6.7%) of 45 vs. 12 (23.1%) of 52 from the 24- and 72-h groups, respectively (p less than .03). However, there was no correlation between the positive blood cultures and the organisms cultured from the catheter tips.

Bacteria↗
PubMed1985

Relationship between serum sodium and blood pressure in morbid obesity.

We evaluated the relationship between blood pressure and serum sodium level in morbidly obese patients. Forty patients had at least 2-3 blood pressure measurements and two measurements of serum sodium. The correlation between serum sodium and systolic blood pressure was 0.66 (p less than 0.01). The correlation between diastolic pressure and serum sodium was 0.40 (p less than 0.025). Our observation linking serum sodium to blood pressure provides a lead to study mechanisms common to regulation of blood sodium and blood pressure in morbid obesity.

Adult↗
PubMed1985

Preventing superficial phlebitis during infusion of crystalloid solutions in surgical patients.

Thirty patients who received routine intravenous therapy (3.3% dextrose and 0.3% normal saline at a rate of 100 mL/h) were randomized prospectively into two groups to receive an antiphlebitic mixture of heparin-hydrocortisone-sodium bicarbonate or placebo in a double-blinded fashion for 4 to 7 days. The code was then broken and the data were analysed using chi 2 analysis with respect to the clinical grade and incidence of phlebitis. Phlebitis developed in 2 of 14 study and 10 of 16 control patients. All study patients tolerated their intravenous lines longer and needed less restarting. The antiphlebitic mixture effectively prevented superficial infusion phlebitis in patients receiving dextrose-saline solutions.

Anticoagulants↗
PubMed1985

Vertical banded gastroplasty: assessment of efficacy.

We previously demonstrated unacceptably high failure rates with horizontal gastroplasty. Shortly thereafter, vertical banded gastroplasty was introduced. Since April 1982 we have operated on 56 patients who were carefully selected and closely followed. There were 10 men and 46 women, aged 15 to 54 years (mean age 36 years) with preoperative weights of 93.5 to 198.6 kg (mean 125.9 kg). The mean weight loss at 6 to 12 months was 36 +/- 10 kg, or 30% of body weight. At 18 months, data were available for 48 of the 56 patients. Their weight losses were 44 +/- 11 kg, or 35% of body weight. Eight patients were lost to follow-up. The weight of nine additional patients plateaued before they lost 30% of their starting weights and another eight patients have started to regain weight after achieving satisfactory weight loss. Included are two patients with severe stenoses who regained all weight lost.

Adolescent↗