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Biomedical subjects

J B Freeman

Publications and source records attributed to J B Freeman.

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

The current status of protein sparing.

Solutions of crystalline amino acids infused without dextrose produce a marked improvement in nitrogen balance. Increasing the infusion level of amino acid from 1.0 to 1.7 grams per kilogram further improves nitrogen balance. The addition of dextrose to the amino acid solutions did not affect nitrogen balance and proved that the role of insulin during protein sparing has been overemphasized. Nitrogen balance is slightly, but not significantly, superior when nonprotein dextrose calories are administered. However, amino acid solutions are isotonic and can be infused peripherally, whereas adding dextrose doubles the concentration and renders peripheral infusion more difficult. Protein sparing may be useful for short term nutritional support when the potential risks of total parenteral hyperalimentation are not justified. Endogenous body fat is mobilized. Hence, protein sparing also prevents the development of fatty acid deficiency and may be useful in treating fatty infiltration of the liver. Protein sparing provides suboptimal caloric replacement and should only be used for temporary nutritional support until oral alimentation is resumed or until there is an absolute indication for intravenous hyperalimentation. Expense and the fact that most patients do well after elective abdominal operations militate against the proposition that amino acids should become a routine substitute for 5 per cent dextrose therapy post-operatively.

Amino Acids↗
PubMed1977

Canine pancreatic exocrine secretory response to low- and high-fat elemental diets.

Elemental or chemically defined diets are used in a variety of gastrointestinal disorders to sustain enteral nutrition, avoid the potential danger of central venous hyperalimentation and reduce intestinal and pancreatic secretions. The two diets available commercially are used interchangeably despite important differences in composition. The present study compared pancreatic exocrine secretory responses to these two diets in dogs. Infusion of high- and low-fat elemental diets resulted in less enzymatic output than a standard blenderized diet. Pancreatic volume and bicarbonate content were similar with the low-fat elemental diet and the blenderized diet, but volume was increased by 30% and bicarbonate increased nearly twofold during infusion of the high-fat elemental diet. The results support the hypothesis that a low-fat elemental diet is preferable for intragastric feeding when the therapeutic goal is to minimize pancreatic secretion.

Animals↗
PubMed1977

Sputum cytology: a valuable addition to the investigation of hypercalcemia.

In this paper we report two patients with asymptomatic hypercalcemia, one with primary and the other with ectopic hyperparathyroidism, in whom cytologic examination of the sputum led to the diagnosis of carcinoma of the lung despite the presence of normal chest roentgenograms. Sputum cytology is a simple, inexpensive and accurate test which should be included in the diagnostic regimen for hypercalcemia.

Carcinoma, Squamous Cell↗
PubMed1976

Transcervical thymectomy: an integral part of neck exploration for hyperparathyroidism.

Thirty-two neck explorations for hyperparathyroidism were done in 18 months. The indication for transcervical thymectomy was a failure to locate either inferior gland. Six of eight patients had adenomatous or hyperplastic glands located within or adjacent to the thymus. One infrathymic lesion was a parathyroid carcinoma and the other was a functioning parathyroid cyst. The abnormal parathyroid gland was not visible in any of these six patients until the thymus had been removed. Had this step been omitted, a sternotomy would probably have been required. Two patients had bilateral normal parathyroid glands within or deep to the thymus. Unless some normal parathyroid tissue has been identified and preserved, the indiscriminate use of transcervical thymectomy could result in the inadvertent excision of both inferior glands and possible iatrogenic hypoparathyroidism.

Humans↗
PubMed1976

Hyperparathyroidism: ectopic parathyroid glands.

A patient with a parathyroid adenoma located beneath the throid capsule and within a benign thyroid adenoma is reported on. To the best of our knowledge, this lesion has not previously been reported. This case points out the difficulties that may be encountered when it is necessary to locate a missing parathyroid gland in a patient with multinocular goiter. In this clinical setting there may be a role for use of the various technics recommended for preoperative localization of a parathyroid adenoma.

Adenoma↗
PubMed1976

The elemental diet.

The elemental diet is a precisely formulated, predigested liquid diet capable of providing adequate nutrition for growth, development and tissue repletion in normal and debiliatated patients. It can be used as the sole means of nutritional support for a variety of gastrointestinal problems provided that there is an adequate length of small intestine with functioning mucosa. The elemental diet also can be used to supplement either intravenous or other enteral feedings to prevent a chronic hypocaloric state. Although safer and less complicated to administer than its intravenous counterpart, there are, nonetheless, certain important policies which must be rigidly observed to assure successful treatment and to prevent complications. Similar to intravenous hyperalimentation, administration is best carried out under the auspices of experienced and interested personnel who have a specific interest in surgical nutrition.

Diet↗
PubMed1975

Metabolic effects of amino acid vs dextrose infusion in surgical patients.

We tested the hypothesis that during infusion of amino acids without dextrose, there is less insulin stimulation, which, in turn, permits lipolysis. The results suggest that dextrose infusion stimulates insulin and inhibits lipolysis. During administration of crystalline amino acids without dextrose, nitrogen balance improved substantially from control values obtained during dextrose infusion, while the level of serum-free fatty acids and ketone bodies rose and that of serum immunoreactive insulin fell. Infusion of amino acids at 1.7 gm/kg appeared slightly more efficient than infusion at 1.0 gm/kg and did not stimulate insulin or inhibit lipolysis. Protein sparing may be useful in certain specific clinical situations. However, the results must be interpreted cautiously, primarily because it is difficult to establish the relationship between improvement in nitrogen balance and the derived clinical benefit. Absolute proof of the efficacy of this technique awaits further studies using indexes that more accurately measure protein synthesis.

Adult↗
PubMed1975

Analysis of gallbladder bile in morbid obesity.

Thirty-seven per cent of our grossly obese patients selected for gastric bypass had cholesterol gallstones. To document the composition of the biliary lipids prior to weight loss, the bile taken from eleven obese patients at the time of gastric bypass was analyzed and the results compared with those in eleven nonobese patients undergoing elective surgery. There was extreme supersaturation of both gallbladder and hepatic bile in all obese patients. The gallbladder bile of all obese patients fell well outside the micellar zone whereas the bile from all but one of the controls fell within the micellar zone. These data provide biochemical support for the clinical association of obesity and cholesterol gallstone formation and are evidence against the possibility that gastric bypass is a lithogenic operation.

Adolescent↗
PubMed1975

Evaluation of amino acid infusions as protein-sparing agents in normal adult subjects.

Blackburn et al. (1, 2) reported nitrogen equilibrium and/or positive balance in surgical patients maintained on a 3% amino acid solution at a level of 1 g/kg body weight per day. We have measured nitrogen balance and fat mobilization in six normal adult volunteers durig the infusion of two compositionally different amino acid solutions at 1 g/kg body weight per day, and compared these to values noted during isocaloric infusion of glucose solutions. Nitrogen balance was negative during all infusion periods, but was significantly less negative (P smaller than 0.01) during amino acid infusion periods (--5.8 plus or minus 1.1 g/day) than during glucose infusion (--9.8 plus or minus 1.8 g/day). No significant differences in nitrogen balance were noted between amino acid infusion periods, despite compositional differences in solutions. Elevated plasma levels of free fatty acids (0.71 plus or minus 0.37 mM) and ketone bodies (1.3 plus or minus 0.3 mM) observed during amino acid infusion periods reflected the availability of body lipids as energy substrate. The disparity between our results and those reported by Blackburn et al. (1, 2) may in part reflect the previous nutritional debilitation of the surgical subjects studied by these investigators.

Adult↗
PubMed1975

Is childhood thyroid cancer a lethal disease?

The clinical, pathological, surgical, postoperative findings and survivorship of 58 patients younger and 513 patients older than 21 years at the time of diagnosis with thyroid neoplasms are reported. The younger patients have a predominance of well differentiated carcinomas which are more likely to be follicular. The lesions tend to be more advanced at the time of diagnosis, are treated by more aggressive surgery in the younger patients and are associated with a much better prognosis. Lack of progression of well to poorly differentiated neoplasms and a greater sensitivity to and dependence upon TSH in young patients, are two factors which may contribute to the striking difference in the prognosis of well differentiated thyroid carcinoma related to age.

Adenocarcinoma↗
PubMed1975

Cholecystokinin cholangiography and analysis of duodenal bile in the investigation of pain in the right upper quadrant of the abdomen without gallstones.

Thirty-one patients with recurrent symptoms of the biliary tract and repeated normal oral cholecystograms were studied by a combination of cholecystokinin cholangiography and biliary drainage. Ten patients had reduplication of their symptons because of dyskinetic contractions or obstruction of the cystic duct, and seven patients had delayed gallbladder emptying without pain due to hypokinetic contractions. Five patients had abnormal duodenal bile characterized by supersaturation and the presence of crystals or bacteria. Based upon these studies, 22 patients had cholecystectomy and 20 were cured, while two showed improvement. There were no therapeutic failures. Cholecystokinin cholangiography capably detects the presence of neuromuscular disease of the gallbladder wall, whereas the oral cholecystogram tests for mucosal function or the presence of filling defects. An additional group of patients who have cholesterosis, cholecystitis, or cholelithiasis missed by the oral cholecystogram will not be diagnosed by cholecystokinin cholangiography unless the duodenal bile is also examined.

Abdomen↗
PubMed1975

Hyperparathyroidism: evaluation of four decades of parathyroid surgery.

A review of 98 patients with hyperparathyroidism operated on at the University of Iowa during a 45-year period reveals a very great increase in the frequency of the clinical diagnosis. More patients are being operated on each year and more glands are being removed or biopsied. The proportion of patients in whom light microscopic examination of the parathyroid reveals hyperplasia remains less than 25%. Better methods are needed for identification of hyperplasia. Clinically, a few patients in whom the diagnosis of adenoma is made appear later to have more diffuse parathyroid disease. At present, however, when an adenoma is found, the decision to perform subtotal removal of apparently normal parathyroid tissue is made only reluctantly. The conclusion drawn from this review is that patients with hyperparathyroidism must be studied more intensively and followed for many years, whether or not an operation is performed. Although the diagnosis of hyperparathyroidism is now made readily and operative treatment seems to be more effective, much has yet to be learned about hyperparathyroidism.

Adenoma↗
PubMed1975

Development and evaluation of use of cholecystokinin in the diagnosis of acalculous gallbladder disease.

The need to differentiate patients with acalculous gallbladder disease who would benefit from cholecystectomy and those who would not led to the search for a procedure that would be of value in this respect. For this purpose, cholecystokinin (CCK) has been used, and many reports have indicated that CCK does identify patients in whom the gallbladder is the source of pain. A review of papers dealing with CCK as a diagnostic aid suggests, however, that some radiographic evaluations have not been subjected to adequate, unbiased interpretation and that some follow-up studies have been incomplete and of short duration. Despite these objections there is evidence that CCK can be useful as a diagnostic aid, and further, continued, well-designed studies are indicated.

Cholecystography↗