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Biomedical subjects

J G Kral

Publications and source records attributed to J G Kral.

At least 73 records · Page 4Linked to original sources
PubMed1989

Surgical treatment of obesity.

Surgical treatment of obesity by methods that have withstood over 5 years of clinical evaluation is effective in ameliorating and even curing manifest serious co-morbid diseases such as diabetes, hypertension, and respiratory distress in the majority of patients. Despite numerous shortcomings and limitations, surgical methods are the only viable alternative for achieving and maintaining substantial weight loss in dangerously obese patients and, therefore, represent a legitimate, often life-saving, intervention. Nevertheless, the magnitude of weight loss varies widely, as does the number of patients lost to follow-up or requiring multiple operations. Safety of performing the surgery and recognition and successful treatment of side effects in cooperating patients has improved greatly over the past 10 years. More effort needs to be put into improving patient selection to allocate patients to specific types of operations and to identify those patients who may not require surgery.

Gastric Bypass↗
PubMed1988

Gastric balloons: a plea for sanity in the midst of balloonacy.

Intragastric balloons have been suggested as a treatment for severe obesity, a degree of obesity associated with a relatively greater eating disorder or lack of control of energy balance. The premises that 250-500-ml balloons are able to simulate "satiety" in a 1700-ml stomach sufficiently to cause weight loss, that the stomach will not stretch to accommodate such a besoar (with or without ulcerating), and that behavioral modification is cost-effective in weight control in this population have not been corroborated. Experience from gastric restrictive surgery has demonstrated the conceptual failure of gastric satiety as a means of achieving and sustaining weight loss in a substantial percentage of morbidly obese patients. Other methods are needed to reduce the increased morbidity and mortality of severe obesity.

Body Weight↗
PubMed1988

Surgical treatment of regional adiposity. Lipectomy versus surgically induced weight loss.

Recognition of abdominal fat distribution as a significant risk factor raised the question whether surgical treatment of regional adiposity might be feasible or desirable. This is a review of cosmetic and therapeutic lipectomy in man and experimental lipectomy in rodents examining morphologic and metabolic aspects as well as conditions for growth and regrowth of adipose tissue. Potentially detrimental metabolic effects of lipectomy are discussed in the context of the "metabolic sink" hypothesis. Data are also presented on the distribution of weight loss after gastrointestinal surgery for morbid obesity. An obesity-related "elephantiasis" syndrome in superobese men is described. "Giant lipectomy" in one such case, removing a record 50 kg during one operation, with pre- and postoperative determination of body fat is reported. It is concluded that lipectomy is not a treatment for obesity with very rare exceptions. Regrowth of adipose tissue is possible under special circumstances. Surgically induced massive weight loss does not seem to cause preferential regional weight loss, though risk-reducing beneficial metabolic effects are achieved after gastrointestinal obesity surgery.

Adipose Tissue↗
PubMed1987

Differential binding of dexamethasone to ammonium sulfate precipitates of human adipose tissue cytosols.

Saturation analysis of the binding of [3H]dexamethasone [( 3H]DEX) to ammonium sulfate precipitates (ASPs) confirmed the presence of a limited-capacity, high-affinity binder in human adipose tissue cytosols. Various non-radioactive steroids competed with [3H]DEX for binding to the ASPs in the following sequence: dexamethasone (DEX) approximately equal to triamcinolone acetonide (TA) greater than progesterone (P) much greater than estradiol (E2). The steroid specificity of the binder precipitated by AS was consistent with the specificities reported for glucocorticoid receptors in a number of systems. In order to investigate possible regional differences, glucocorticoid binding to ASPs derived from adipose tissues removed from two different sites in the same subject was quantitated. ASPs of human omental adipose tissue bound significantly more [3H]DEX than did similar preparations of subcutaneous adipose tissue from the abdominal wall (116 +/- 32 vs. 50 +/- 22 fmol/mg protein; mean +/- SD; p less than 0.02). The findings are consistent with reports from other laboratories suggesting that intra-abdominal fat is more responsive to glucocorticoids than is subcutaneous adipose tissue.

Adipose Tissue↗
PubMed1987

Oral contraceptive absorption and sex hormone binding globulins in obese women: effects of jejunoileal bypass.

Plasma levels of two oral contraceptive gestagens were studied during 24 hour oral challenges in seven morbidly obese women after jejunoileal bypass comparing the results to unoperated normal controls. To study binding and transport of the gestagens, sex hormone binding globulin levels were determined in these patients, in normal-weight controls, and in unoperated morbidly obese patients. The unoperated morbidly obese patients had significantly decreased levels of sex hormone binding globulin, compared to normal-weight controls and to the jejunoileal bypass patients, whose levels were similar to the controls. The jejunoileal bypass patients had a reduced capacity to absorb oral contraceptive gestagens, although the plasma levels were of the same magnitude found in normal subjects using lower doses of gestagens. However, the gestagen to sex hormone binding globulin ratio was lower in jejunoileal bypass patients, implying reduced biologic activity and thus reduced contraceptive efficiency of the gestagen. There were no enzymatic or morphologic signs of liver dysfunction. No correlations were found between plasma gestagen levels and number or volume of stools, fecal fat excretion, or intravenous C-cholic acid load. It is concluded that caution must be exercised in prescribing oral contraceptives to jejunoileal bypass patients.

Administration, Oral↗
PubMed1987

Adipose tissue of morbidly obese patients: clinical implications of distribution, morphology, and metabolism.

As a consequence of their increased total adipose tissue mass, morbidly obese patients have many more fat cells than individuals of normal weight and the cells are enlarged compared to normal. Contrary to earlier beliefs, fat cell numbers can increase throughout adult life. Once formed, fat cells do not undergo involution. Thus, it seems that an individual who has reached the morbidly obese state maintains an increased amount of body fat that limits his/her ability to achieve and maintain commonly accepted levels of "ideal" body weight. Recently the distribution of adipose tissue has been shown to be an important predictor of obesity-associated morbidity and mortality in large population studies. A "male" or central distribution of fat is a significant risk factor for the development of diabetes, hyperlipidemia, hypertension, and coronary heart disease. Sex- and site-specific variations in the distribution of adipose tissue cell size and metabolic activity have been demonstrated that may be of etiologic importance for the development of serious comorbid conditions in obesity.

Adipose Tissue↗
PubMed1987

Malabsorptive procedures in surgical treatment of morbid obesity.

There is no ideal operation for morbid obesity and there probably never will be one. The disease is multifaceted, with unknown polyfactorial etiology. The multitude of surgical methods attests to the frustrations in trying to palliate the morbidly obese. Gastric restriction on its own is proving inadequate for the heaviest patients ("super obese"), for patients with preferences for "sweets," and for patients who have had failure of previous surgery, whether it be jejunoileal bypass or gastroplasty. The current trend toward performing malabsorptive procedures is symptomatic. Experimentation with varying sizes and configurations of gastric remnants in combination with varying lengths of small intestine in continuity is reminiscent of the early experience with jejunoileal bypass. That era has been called by some respected and influential surgeons the "dark ages of surgery." Very few of the tens of thousands of patients would agree with this assessment. Nevertheless, Payne was convinced that the "malignant abuse of all of these operations. . . could result in the abandonment of the only practical method. . . for the treatment of the morbidly obese patient." Jejunoileal bypass operations can be "salvaged" by vigorous medical management. When that fails, there are several surgical options for dealing with the blind loop, short of reanastomosing the bowel. New malabsorptive operations have been developed and are being rigorously scrutinized by relatively few dedicated surgeon-scientists. The most important lesson learned from the many severe late complications of jejunoileal bypass is that operations for morbid obesity need to be studied intensely and for a sufficiently long period of time before they can be considered ready for routine use.

Anastomosis, Roux-en-Y↗
PubMed1987

Quality of life assessment in obesity: physical, psychological, and social function.

This article examines the value of including patients' well being in the clinical assessment of obesity. It also deals with health status measures and the current state of so-called quality-of-life research. The few and limited studies of quality of life in obesity are reviewed and preliminary results of our own work are presented.

Adaptation, Psychological↗
PubMed1987

Sex differences in regional distribution of fat cell size and lipoprotein lipase activity in morbidly obese patients.

Adipose tissue distribution is an important predictor of obesity-associated morbidity and mortality. A central ('male') fat distribution is associated with increases in intra-abdominal adipose tissue which might be of metabolic importance. Although many recent studies have pointed out significant regional differences in the size and metabolism of subcutaneous fat cells intra-abdominal depots have not been systematically examined. We compared fat cell sizes (FCS) and lipoprotein lipase activity (LPLA) of two internal (omental, mesenteric) and four subcutaneous (SQ) sites (femoral, gluteal, abdominal, epigastric) in morbidly obese patients (26 premenopausal women and 14 men). Men had larger internal FCS than women while women had larger SQ FCS in the gluteal and femoral depots. Mesenteric FCS were largest of all sites in men. In women, omental fat cells were the smallest of all sites sampled but omental fat cells were as large as SQ sites in men. A more central distribution of fat in women (high waist/hip ratio) was associated with large mesenteric fat cells. Calculation of total fat cell number based on SQ FCS only, revealed sex differences that were eliminated by also using intra-abdominal FCS in the calculation. Averaged across all six sites, women had higher LPLA than men. Higher LPL activities were found in the lower-body subcutaneous sites with enlarged fat cells in women. However, the relative enlargement of intra-abdominal FCS in men was not associated with increased LPLA. In conclusion, sex- and site-specific variations in the distribution of FCS and LPLA in internal and SQ fat depots emphasize the importance of analyzing these depots in studies of fat cell number and adipose tissue metabolism.

Adipose Tissue↗
PubMed1986

An unusual presentation of colon cancer.

A rare case of asymptomatic cancer of the ascending colon presenting as a subcutaneous groin mass is reported. At the time of right hemicolectomy with resection of the groin mass there was no sign of incontinuity spread or lymph blockage. Sequential determination of carcinoembryonic antigen levels (CEA) in serum reflected the reduction in tumor mass after surgery as well as subsequent recurrences of disease in the groin and in the lung after 2 years. Immunoperoxidase staining of the primary tumor and the metastases showed strong positivity for CEA confirming the origin of the serum CEA. There have been no signs of liver involvement. The route of spread of this unusual metastasis is not known.

Adenocarcinoma↗
PubMed1986

Laboratory studies of eating behavior in women with bulimia.

This report describes a standard procedure for studying the disordered eating behavior of bulimic patients in a laboratory setting. Test meals were given to eight normal weight women with bulimia under four different conditions on non-consecutive days. On day 1 they were asked to consume as much as they "would normally eat" by means of a straw from an opaque container holding 1500 g of a palatable liquid food. An eating monitor recorded the pattern of consumption. Five patients showed abnormalities of either excessive eating or acceleration of the rate of eating. On the second and third days they were given standardized amounts of an array of foods. They were instructed to eat normally on one of these days and to eat as much as they could on the other, in counterbalanced order. All patients ate to excess when they were asked, over a 28 to 90 min period, and consumed a mean of 4477 kcal (range 2083-8499 kcal) with a macronutrient composition similar to that of the typical American diet. They all vomited afterwards. On the day they were asked to eat normally, five patients overate and vomited, two ate very little, and one refused to participate. On the fourth day patients were asked to eat as much as they could of a single item, ice cream. Six patients consumed a mean of 1545 kcal (range 741-2919 kcal); one patient ate only 85 kcal; and one patient refused to participate. There were large and significant correlations among the sizes of the various meals consumed in excess.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Effects of ileal interposition on body weight and intestinal morphology in dogs.

Interposition of a segment of terminal ileum into the proximal jejunum has been shown to cause weight loss and hypertrophy of the pancreas and intestines of rats. To further evaluate the potential of ileal interposition as an anti-obesity procedure, weight loss, liver histology and intestinal morphology were studied in normal adult mongrel dogs. A 40 to 45-cm segment of distal ileum was transposed isoperistaltically on its vascular pedicle to the proximal jejunum (n = 14). Control dogs (n = 4) underwent transection and reanastomosis without interposition. Interposition resulted in a mean weight loss of 3.9 kg or 16 percent of body weight, over a 12-week period compared to a mean gain of 2.6 kg (11 percent of preop.) in the controls (P less than 0.025). Liver histology (n = 3) showed minimal fatty infiltration in one dog. Grossly, the transposed ileal segment did not show any consistent elongation or thickening of the bowel wall. Microscopically, there was complete jejunalization of the mucosa of the ileal segment which was indistinguishable histologically from the adjacent jejunal mucosa. Because of the variability of the weight response (-8.6 to +0.9 kg), further studies are required to evaluate the potential of this experimental procedure to achieve weight loss.

Animals↗
PubMed1985

Absorption of an oral contraceptive gestagen in ulcerative colitis before and after proctocolectomy and construction of a continent ileostomy.

Plasma 1-norgestrel (1-Ng) levels after administration of a common oral contraceptive in fertile women (mean age 29 +/- 5 yrs) with mild ulcerative colitis before or after proctocolectomy with a conventional ileostomy or a continent ileostomy reservoir were determined and compared to those of a group of healthy volunteers serving as controls. Before operation, peak and 10-hour levels of 1-Ng were not statistically different from control. Levels in patients with either type of ileostomy were slightly lower than controls, but were only statistically significantly lower in patients with continent ileostomy (p less than 0.05). In a subgroup of patients studied both before and after proctocolectomy with construction of a continent ileostomy, there was a slight reduction in peak and 10-hour levels compared to control. After administration of the pill directly into the reservoir, significant levels of 1-Ng in plasma were found with peak and 10-hour levels approximately one-half of those achieved after oral administration. Although the material is small, it suggests that patients with mild ulcerative colitis and with small ileal resections (8.8 +/- 8 cm) can use combined contraceptive pills containing 1-norgestrel with confidence. Caution should be exercised, however, in prescribing "mini-pills" to patients after proctocolectomy and ileal resection.

Adult↗