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Biomedical subjects

J B Freeman

Publications and source records attributed to J B Freeman.

At least 55 records · Page 3Linked to original sources
PubMed1982

The radiology of gastroplasty for morbid obesity.

From experience with 101 patients, the radiologic features of gastroplasty for the surgical treatment of morbid obesity are described. Prompt recognition of surgical complications requires familiarity with expected postoperative appearances. Early complications are: (a) gastric leak with subphrenic abscess, (b) stomal edema and (c) staple dehiscence. Failure to continue to lose weight after surgery results from stretching of the pouch and/or stoma, or delayed staple disruption, due to persistent over-eating.

Edema↗
PubMed1981

Parenteral nutrition by peripheral vein.

Peripheral parenteral nutrition can provide perioperative nutritional support to patients with inadequate oral intake in whom total parenteral nutrition with hypertonic dextrose administered by a central vein cannot be undertaken because of sepsis, subclavian vein thrombosis, or lack of expertise and familiarity. Peripheral parenteral nutrition may be indicated in patients with marginal nutritional status whose postoperative course and period of starvation are unpredictable and in patients being started on a total enteral nutrition regimen. In patients with increased requirements because of stress or malnutrition who need full nutritional support by a peripheral method, the lipid system is indicated. In certain instances, large enough volumes can be infused to provide sufficient calories and protein for nutritional repletion. Protein-sparing therapy is indicated for nutritional maintenance in patients who do not clearly require full support by total parenteral nutrition but who are taking insufficient calories and protein orally. Peripheral parenteral nutrition avoids the risks of subclavian vein catheterization but requires that adequate peripheral veins are available. The metabolic complications are minimal compared with those of total parenteral nutrition, and the nutritional management of the diabetic patient is greatly simplified. Several techniques of preserving peripheral veins and prolonging their use have been discussed.

Body Weight↗
PubMed1981

Traumatic abdominal wall hernia.

Traumatic abdominal hernias are uncommon. A case is presented of a 49-year-old man who struck his abdomen on the handlebars of a snowmobile. Local pain, bruising, and reducible swelling with cough impulse suggest the diagnosis. Lateral or oblique X-rays and use of contrast material are recommended. Differentiation from a preexisting hernia may be important medicolegally. Incision, if necessary, should be very carefully made. In the present case surgical repair was followed by uneventful recovery.

Abdominal Injuries↗
PubMed1981

Feeding jejunostomy under local anesthesia.

A feeding jejunostomy may be performed with ease and safety under local anesthesia. The authors describe their technique. The tube is easy to maintain and replace and avoids some of the problems of feeding gastrostomies. In patients with major nutritional problems and a functioning intestinal tract the need for parenteral nutrition may be eliminated.

Anesthesia, Local↗
PubMed1980

Low side-to-side sigmorectal anastomosis with intestinal staplers.

The radiologic appearance of a side-to-side stapled sigmoid to rectal anastomosis is described. Barium which collects in the stump of the sigmoid may give the false appearance of a anastomotic leak and unnecessarily delay colostomy closure. Oblique views and observation in the radiologic suite for emptying of the distal stump will confirm this condition.

Adenocarcinoma↗
PubMed1980

Rational use of elemental and nonelemental diets in hospitalized patients.

Study A included 30 patients who received immediate postoperative enteral feeding with a nonelemental diet. The nonelemental diet was well tolerated. Study patients rapidly achieved nitrogen equilibrium and had a cumulative nitrogen balance of -11.1 g verus -46.7 g for the control group. In part B, 16 patients with varying degrees of bowel dysfunction received elemental and nonelemental diets in a crossover design. Patients with moderate small bowel impairment tolerated nonelemental better than the elemental diets. In those patients with more severe bowel impairment, the elemental diet was better tolerated. Nitrogen balance for both types of diet was similar in both groups of patients. It is concluded that nonelemental diets are better tolerated in most patients with moderate degrees of small bowel abnormality. In patients with severe bowel abnormality, elemental diets may be better tolerated, but nonelemental diets should still be the initial formula.

Diet↗
PubMed1978

Idiopathic chronic intestinal pseudo-obstruction. Use of central venous nutrition.

Patients with idiopathic chronic intestinal pseudo-obstruction suffer from malnutrition because of inability to maintain adequate oral intake without the development of obstructive symptoms. We have successfully used central venous nutrition in two patients with this syndrome, both on a short-term and long-term home-maintenance basis. Hyperalimentation can provide adequate nutrition in patients with intestinal pseudo-obstruction until normal bowel function returns or until definitive therapy for this chronic disease is found.

Child↗
PubMed1978

Symposium on nutritional requirements of the surgical patient. 2. Peripheral parenteral nutrition.

During total parenteral nutrition hypertonic (25%) dextrose combined with 5% amino acid solutions must be used to achieve the necessary non-protein calorie/nitrogen ratio of 150:1. The resultant hyperosmolarity prohibits utilization of peripheral veins and makes cannulation of the subclavian vein mandatory. This exposes the patient to the risks of infection and technical complications, but these are uncommon and less important than the deleterious effects of chronic starvation. However, under certain clinical conditions it is possible to supply partial parenteral nutrition through peripheral veins, thereby avoiding the dangers of subclavian catheterization. Three such techniques--the intralipid system, protein sparing and infusion of the "P-900" solution--have been used with moderate success. The composition of the solutions and the techniques used are described.

Amino Acids↗
PubMed1977

Isolated histiocytic lymphoma of the spleen causing fever and hypercalcemia.

Differentiating between primary and ectopic or pseudohyperparathyroidism may be difficllt, but certain aspects of the patient's clinical history as well as laboratory tests may be helpful. We present an unusual case report of a patient who had massive splenomegaly secondary to a localized histiocytic lymphoma. On the basis of a lower serum parathormone level for a given serum calcium increase combined with normal serum phosphorous and chloride values, the diagnosis of psuedohyperparathyroidism was made and was confirmed when the patient's serum calcium level and temperature returned to normal following splenectomy.

Aged↗
PubMed1977

Absence of the biochemical symptoms of essential fatty acid deficiency in surgical patients undergoing protein sparing therapy.

The biochemical symptoms of essential fatty acid deficiency appear within 7 to 10 days of fat-free total parenteral nutrition using glucose-amino acid mixtures. The linoleic acid (C18:2W6) content of all plasma lipid fractions decreases greatly and plasma eicosatrienoic acid (C20:3W9) increases. We have measured the fatty acid composition of the plasma lipid fractions in six surgical patients receiving parenteral nutritional solutions containing only amino acids, and completely free of glucose, before and after 10 to 14 days of such therapy. Biochemical symptoms of essential fatty acid deficiency did not occur. The fatty acid composition of all plasma lipid fractions remained unchanged after this time period. Mobilization of linoleic acid from the adipose tissue occurred with this treatment in contrast to the inhibition of lipolysis of adipose tissue triglyceride produced by continuous infusions of hypertonic glucose-amino acid mixtures.

Adult↗
PubMed1977

Calcium requirements during total parenteral nutrition in well-nourished individuals.

Eleven patients, receiving all nutrition intravenously, were given varying doses of calcium (0-20 mg/kg/day) to determine an optimal level for calcium administration during postoperative parenteral nutrition. During each study period, nitrogen, phosphorus, vitamin, and caloric intakes were constant. Negative calcium balance resulted when less than 2 mg Ca++/kg body weight was given daily. During excessive urinary calcium losses, serum calcium concentration remained in the normal range. Increasing calcium intake to approximately 5 mg/kg/day (500 mg/day) yielded an apparent retention of calcium, as did higher doses. Serum calcium did not rise at this time. Urinary calcium excretion was directly proportional to calcium intake. The preliminary data suggest that a minimum dose of 5 mgCa++/kg/day is necessary to attain equilibrium between intake and urinary output. This value is higher than recent suggestions for calcium replacement during intravenous feeding.

Adult↗