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Biomedical subjects

J B Freeman

Publications and source records attributed to J B Freeman.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1985

Gastric by-pass surgery in morbidly obese patients markedly decreases serum levels of vitamins A and C and iron in the peri-operative period.

We studied changes in serum levels of carotene, vitamins A, C, B12 and folate and iron in the immediate perioperative period after gastric by-pass surgery in nine morbidly obese patients and in six patients undergoing abdominal surgery. All parameters were measured preoperatively and 48 h postoperatively. Marked decreases occurred for vitamin A (2.04 +/- 0.45 mumol/l to 0.92 +/- 0.39 mumol/l, P less than 0.01), vitamin C (26 +/- 11.2 mumol/l to 4.9 +/- 4.0 mumol/l, P less than 0.01), iron (15 +/- 5.8 mumol/l to 4 +/- 2.7 mumol/l, P less than 0.01). A significant change also occurred for carotene (1.7 +/- 0.42 mumol/l to 1.25 +/- 0.48 mumol/l, P less than 0.05). No significant changes were seen for vitamins B12 and folate. Only changes in vitamins A and C were significantly greater in the morbidly obese patients compared to the control group of six patients. These changes likely represent redistribution of vitamins rather than enhanced urinary excretion.

Adult↗
PubMed1985

Long-term follow-up of concomitant band ligation and sclerotherapy for internal hemorrhoids.

From 1978 to 1983, 111 patients with symptomatic internal hemorrhoids were treated as outpatients by a modification of the Barron ligation technique. Each ligated hemorrhoid was injected with a sclerosant. Follow-up, available for 94 of the patients, ranged from 2 to 60 months (mean 18 months). Presenting symptoms were bleeding in 75 (80%) of the 94 patients, pain in 46 (49%), pruritus in 22 (23%) and prolapse in 24 (26%). Results were excellent in 51 (54%) patients, good in 20 (21%) and fair in 9 (10%). Fourteen (15%) patients had unsatisfactory results; only 4 of these required hemorrhoidectomy. The other 10 had residual symptoms but did not require further treatment. Nine patients had minor complications, which included pain lasting 24 to 72 hours in seven, bleeding in one and syncope in one. The addition of sclerotherapy to traditional band ligation for the management of internal hemorrhoids has the advantages of exciting a greater inflammatory reaction between the mucosa and submucosa and preventing premature slipping of the band. The authors conclude that this method of therapy is effective for symptomatic hemorrhoids and that surgical hemorrhoidectomy is seldom indicated.

Adult↗
PubMed1984

Complications of gastric partitioning for morbid obesity.

Death rates for the morbidly obese are at least 11 times higher than for the nonobese, although the most popular and frequently cited study involved men only. In addition to the risk of disease, morbidly obese patients are subject to social and economic discrimination. This severely impairs their ability to function in society. The benefits from weight loss include frequent amelioration of complications, such as hypertension, cardiorespiratory disease, diabetes, and so forth. But a reduction in the mortality with weight loss has not yet been demonstrated, and many obese patients are in apparent good health for years. Surgery seems to offer the only hope for these unfortunate patients, but it is important to avoid over enthusiastic approaches until long-term, prospective studies clearly establish efficacy and unsuspected complications. The literature suffers from short follow-up periods and lack of standardization of the operative procedure. Various methods of reporting results have made comparison and interpretation difficult.

Anesthesia↗
PubMed1984

Clinical comparison of Michel and Proximate clips used for abdominal wound closure.

For many years Michel clips (Down Surgical, Mississauga, Ont.) have been used to close wounds and results have been good, but several newer clips are now available (e.g., Proximate; Ethicon Sutures Ltd.), which are said to be easier to use and produce a better scar. However, they are much more expensive. The authors carried out a prospective controlled study in which 30 patients with abdominal incisions had half of the skin incision closed with Michel clips and the other half with Proximate clips. They assessed ease of insertion and removal, and appearance of the wound immediately after removal and 2 months later. Ethicon Proximate clips were, in general, slightly easier to insert, less uncomfortable to remove in 8 of the 30 patients and gave a better immediate cosmetic result in 9 patients. However, there was no difference in the appearance of the wound 2 months later. The authors do not consider that Ethicon Proximate clips offer an advantage over the much less expensive Michel clips.

Abdomen↗
PubMed1984

Healing of a gastrocutaneous fistula in the presence of Marlex.

A gastric leak with perigastric abscesses developed after a revision gastroplasty reinforced with Marlex, performed on a 34-year-old, morbidly obese woman. The site of the leak and the abscesses were drained but the Marlex could not be excised. The woman remained on long-term enteral nutrition at home and her fistula healed despite the presence of the Marlex mesh. She continued to lose weight and was well 8 months after the fistula had healed.

Abscess↗
PubMed1983

Failure rate with gastric partitioning for morbid obesity.

One hundred twenty-two morbidly obese patients were selected for gastric partitioning from a multidisciplinary obesity clinic over a 4 year period. Initial early success was not a guarantee against cessation of weight loss or the regaining of lost weight. By emphasizing criteria for success and failure, both from our series and the literature, we showed an alarming increase in the failure rates for this procedure which is predicated on the fact that those lost to follow-up were probably failure patients. Numerous articles in the literature contain inadequate data because they refer to pounds rather than percentage of weight loss, they fail to consider revisions as failures, they do not provide 24 month follow-up data, and they do not take into account the possibility that those lost to follow-up are failure patients. The operation carries mortality and serious morbidity rates of 0 to 3 percent and 4 to 10 percent, respectively, with an average 28 percent weight loss at 24 months and a minimal failure rate of 50 percent. The alarming increase in the number of these procedures being carried out across the continent makes it mandatory for surgeons to accurately collect and register their data until the long-term effects and results are known. Gastric partitioning, although probably not experimental, is still developmental. The widespread use and possibly abuse of these operations may result in discreditation of the surgical approach to morbid obesity which would be unfortunate since it is the only practical method at this time for dealing with the problem.

Adolescent↗
PubMed1983

Safety and efficacy of a new peripheral intravenously administered amino acid solution containing glycerol and electrolytes.

A multicenter study was conducted to compare a new peripheral intravenously given solution containing 3 per cent amino acids, 3 per cent glycerol and a complete pattern of maintenance electrolytes--ProcalAmine--with an isonitrogenous amino acid control solution--FreAmine III--in patients undergoing elective gastrointestinal or vascular operations. Fifty-two patients received the control solution and 48 patients received the experimental solution in a double-blind, randomized trial for five consecutive postoperative days. A complete hematologic and biochemical assessment was carried out daily throughout the five day infusion period and two days after the termination of infusion. Nitrogen balance data were collected on each infusion day. Results indicate that the glycerol containing solution is safe and contributes to an improvement in nitrogen homeostasis on a daily and cumulative basis. The presence of ketosis was not related to an improvement in nitrogen balance. In conclusion, the addition of glycerol to dilute amino acid solutions is safe and improves nitrogen balance in the postoperative period. Additionally, use of the nonreducing sugar, glycerol, allows the manufacturer to sterilize amino acids and an energy substrate in a single unit. By precluding the need for admixing in the hospital pharmacy, risk of contamination may be reduced.

Amino Acids↗
PubMed1982

Effects of magnesium infusions on magnesium and nitrogen balance during parenteral nutrition.

The effects of magnesium infusions on urinary and fecal magnesium excretion, serum magnesium and nitrogen balance were examined in seven well-nourished and three nutritionally depleted adult surgical patients receiving total parenteral nutrition. They were maintained on constant nitrogen and caloric intake for 14 +/- 2 days. Magnesium doses ranged from 0 to 664 mg/d and were given in varying crossover patterns. In both groups, urinary magnesium excretion increased as the amount of magnesium infused increased but, at comparable magnesium infusions, depleted patients excreted significantly less magnesium. Renal conservation was most pronounced in well-nourished patients on magnesium-free intake and in depleted patients given 70 mg magnesium daily. Urinary magnesium losses were 40 +/- 5 mg/d and 33 +/- 8 mg/d, respectively, in these two groups. Endogenous fecal magnesium excretion was minimal and ranged from 2 to 38 mg/d. At each level of magnesium intake, serum levels of well-nourished patients were normal. With infusions of less than 200 mg/d, serum magnesium concentrations in depleted subjects averaged 1.6 mg/dl. Reduced urinary magnesium excretion as well as borderline serum levels measured in depleted adults suggest that the magnesium dosage should be higher than that usually recommended during total parenteral nutrition. In both groups a positive correlation between magnesium and nitrogen balance was noted.

Humans↗
PubMed1982

Use of glycerol in peripheral parenteral nutrition.

Peripheral parenteral nutrition avoids the use of central lines and is a useful means of nutritional support for selected patients. Amino acids alone have been used for peripheral parenteral nutrition and have been shown to give near nitrogen equilibrium. The addition of small amounts of dextrose to amino acids further improves nitrogen balance, but at the expense of making the solutions unsterilizable and unstable by standard techniques. Glycerol is a nonprotein calorie source that can be autoclaved with amino acids and stored. Fasting patients about to undergo major abdominal surgery were randomly allocated to receive 3% amino acids with or without 3% glycerol. The solution was infused by peripheral vein for 5 days, starting the morning following surgery. Routine monitoring, blood tests, and nitrogen balance tests were performed during this time. No adverse reactions to either solution were encountered. Liver function tests, electrolytes, and hematologic values were similar in both groups. The cumulative nitrogen balance was better in the amino acid plus glycerol group (+5 +/- 3.3 gm) than in the amino acid group (-9.7 +/- 3 gm) (P less than 0.02). Serum insulin levels were higher and serum free fatty acids lower in the amino acid plus glycerol group. Glycerol levels rose and plateaued by the third day in the amino acid plus glycerol patients. Amino acids plus glycerol is safe solution to administer by peripheral vein. The addition of glycerol improves nitrogen balance as compared to amino acids alone.

Amino Acids↗