Biomedical subjects

K J Printen

Publications and source records attributed to K J Printen.

At least 37 records · Page 2Linked to original sources

PubMed1978

Venous thromboembolism in the morbidly obese.

Obesity has been considered as a high risk factor in the development of thromboembolism. To test the validity of this hypothesis, the records of 564 morbidly obese patients who underwent gastric bypass for control of their obesity were reviewed. Four patients, 0.7 per cent, had proved fatal pulmonary emboli and three demonstrated detectable, but not fatal, embolization. Fifty-seven patients were studied prospectively with Doppler examinations of the lower extremities, and only one patient had a transient abnormality of venous thrombosis of the calf, which proved to be associated with a nonfatal pulmonary embolus. The morbidly obese patients are not at high risk from thromboembolism, and the prophylactic use of low dose heparin, which may increase known wound morbidity, is discouraged. Doppler ultrasound of the lower extremities, however, has proved usefulness to differentiate deep venous thrombosis of the lower extremity from other causes of pain in the leg of the morbidly obese.

Adolescent↗

PubMed1978

Cholecystectomy during pregnancy.

While cholecystitis has definitely been associated with pregnancy, performance of cholecystectomy during pregnancy seem to be a rare occurrence. To document this observation we reviewed the records of all cholecystectomies performed during a 10-year period on women between the ages of 16 and 45 in a university hospital and a busy community hospital. Six of the 749 cholecystectomies performed at the university hospital occurred during pregnancies of from four to 26 weeks' gestation. Four of the patients were operated on emergently after an average of one week of conservation management. In no instance did the operation induce premature labor or abortion. Operative cholangiography was performed in four of the patients without detriment to the fetus. This review indicates that the need to perform cholecystectomy during pregnancy is rare, but that it can be performed with minimal risk to the fetus regardless of gestation.

Acute Disease↗

PubMed1978

Vagal innervation of the bypassed stomach following gastric bypass.

Gastric bypass, a 90% gastric exclusion, has been used successfully for surgical treatment of morbid obesity since 1967. Early concern as to its ulcerogenic potential has not materialized, but the physiological activity of the excluded stomach has not been studied fully. To determine whether the excluded segment retained any vagal innervation, 25 patients underwent preoperative Hollander tests of their intact stomachs. The test was repeated after operation, after the patients had resumed normal oral intake. Postoperative specimens were collected from a gastrostomy placed in the excluded stomach at the time of the gastric bypass. Percentage changes in volume and total acid for both the intact and excluded stomachs followed the same pattern with insulin injection after 45 minutes at both testings, pH values were identical. These observations, which indicate vagal innervation of the excluded stomach, together with previously published histalog acid-response data and the observed marginal ulcer incidence of one per 193 years of patient follow-up, demonstrate that normal gastric physiology is maintained after bypass and confirm that it is not an ulcerogenic procedure.

Gastric Acidity Determination↗

PubMed1978

Gastric bypass for obesity after ten years experience.

Over 625 patients having gastric bypass for the treatment of morbid obesity are currently being followed at the University of Iowa. Many innovations have increased operative exposure, greatly reduced operating time, and improved the effectiveness and safety of the operation. Recent weight figures show that a 55 percent loss of excess weight can be expected. Several comparative studies between gastric and jejunoileal bypass show that gastric bypass, while producing identical weight loss, has few of the many complications such as liver failure, renal and gallstone formation, diarrhea, enteritis, that are commonly associated with jejunoileal bypass. Stomal ulcer occurrence has been only 2 percent. Imporvements in diabetes mellitus and hypertension can be expected with weight loss. Other effects of gastric bypass were determined by use of a questionnaire. It is concluded, by surgeons having experience with both gastric and jejunoileal bypass, that gastric bypass is the treatment of choice for morbid obesity when nonoperative measures fail.

Adult↗

PubMed1977

Morbid obesity in Cushing's syndrome: a nonentity?

Review of twenty-nine surgically proven cases of Cushing's syndrome disclosed that only three patients met criteria of morbid obesity. The history and physical signs and symptoms of morbid obesity contrast markedly with Cushing's syndrome. Investigation for Cushing's syndrome should not be included in the routine preoperative evaluation of morbidly obese patients.

Adolescent↗

PubMed1977

Elective splenectomy in the elderly patient.

This report reviews 10 years' experience with elective splenectomy in patients over 55 years of age. Of 55 patients, 25 were over the age of 65. The majority of splenectomies (41) were performed for hematological disorders exclusive of lymphoma, but including ITP, hypersplenism (both primary and secondary), Felty's syndrome and myeloid metaplasia. Sixty-eight per cent of these patients responded to splenectomy with sustained elevation of platelet counts while 70 per cent responded to sustained elevation of leukocyte counts. Sixteen of the hematological patients received a preoperative trial of steroid therapy in an attempt to alleviate leukopenia or thrombocytopenia with a 37.5 per cent (6 of 16) success rate. There was no correlation between the response to preoperative steroid therapy and response to splenectomy. These data correspond favorably to previous published material in the younger aged patients. There was no difference in the postoperative complication rate related to drainage or nondrainage of the splenic bed. However, eight other complications occurred for a morbidity rate of 14.5 per cent in addition to complications related to drainage of the splenic bed (8%). A 9 per cent (5 of 55) mortality rate was related to the patients' pre-existing diseases and appears acceptable in light of hematological response rate and quoted mortality rates for splenectomy over age 65.

Age Factors↗

PubMed1977

Gastric bypass for morbid obesity in patients more than fifty years of age.

Morbid obesity, a weight twice that ideal for a given height, has evolved as a disease of affluent societies. Surgical treatment of this disorder has largely involved intestinal bypass procedure. Thirty-six patients more than 50 years of age have undergone a gastric bypass for the treatment of morbid obesity. The 28 females as well as the eight males were part of a group of 503 patients undergoing gastric bypass for treatment of morbid obesity. The mean age was 55 years, with extremes at 50 and 68 years, respectively. Weight loss was 40 per cent less than for the younger patients, averaging only 29 kilograms after two years, and the operative mortality was four times that for younger patients. The cause of limited weight loss after gastric bypass in this older age group of patients is unclear. However, unless there is specific value to be obtained from a modest weight loss, gastric bypass is not recommended as treatment for morbid obesity in patients more than 50 years of age.

Aged↗

PubMed1976

Effect of gastric bypass on gastric secretion.

Gastric bypass as a 90 per cent gastric exclusion operation was used in 393 patients with massive obesity to limit food intake. Stomal ulcer has occurred in 1.8 per cent of such patients or one ulcer per 140 man years of observation. The studies of indwelling fundic pH and of gastric acid secretion from the excluded stomach indicate that acid secretion is reduced after gastric bypass but that the acid, unbuffered by food in the excluded stomach, results in a lowered gastrin secretion after a meal. Thus, gastric bypass in inhibitory to acid secretion in most morbidly obese patients who do not have known acid peptic disease.

Achlorhydria↗

PubMed1976

Mobile cecal syndrome in the adult.

The mobile cecal syndrome is primarily a disease of children. However, it may be present as a precursor of frank cecal volvulus in approximately 50 per cent of the cases. Symptoms are intermittent colicky right lower quadrant pain with tenderness over McBurney's point and hyperactive high-pitched bowel sounds during the attack. After the attack, the patient is asymptomatic. Three cases of young women with mobile cecal syndrome are presented to illustrate the clinical course and surgical therapy. The mobile cecal syndrome should be considered in the differential diagnosis of right lower quadrant pain from obscure causes.

Abdomen, Acute↗

PubMed1976

Metabolic considerations in reconstitution of the small intestine after jejunoileal bypass.

Intestinal bypass is a reversible procedure which has been used with success in the surgical treatment of morbid obesity. Nine patients with intestinal bypass were forced to undergo reconstitution of the gastrointestinal tract due to severe symptoms of short gut syndrome. Meticulous attention to detail must be exercised in the preoperative preparation of this type of patient. Parenteral hyperalimentation may be necessary to return the patient to adequate nutrition. No attempt at revision should be made until the patient is nutritionally and metabolically reconstituted.

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

Gastric bypass for morbid obesity in children and adolescents.

This report reviews 25 patients 20 yr of age or younger who were treated for morbid obesity by gastric bypass or gastroplasty. Eighteen genetically normal obese adolescents averaged 15% body weight loss 6 mo after operation and 25% weight loss 36 mo postoperatively; the eight males lost more weight than did the ten females. Seven younger children had Prader-Willi syndrome; six of them lost weight postoperatively although not so dramatically as the genetically normal obese patients. Four patients required later revisions to reduce the size of the gastric pouch or stoma. These operations were performed with acceptable morbidity and no mortality. Growth in height was not interrupted and no metabolic problems were encountered postoperatively. Gastric bypass is a safe and effective method of controlling body weight in morbidly obese children and adolescents.

Adolescent↗

PubMed1975

Optimizing results of gastric bypass.

Gastric bypass is an extensive gastric exclusion operation used in patients who are more than twice their ideal weight. Most of the early postoperative deaths observed in 3% of 442 patients during the initial 9 years, could have been prevented by more attention to operative technique and early recognition and correction of leaks when they occurred. The best weight loss can be produced by adherence to three components of the operation: 1) Bypass of stomach and duodenum, 2) a small fundic segment and 3) a small (12 mm diameter) gastroenterostomy stoma. The average patient of 142 kg can expect to have a weight of around 107 kg at 1 year 103 kg at 5 years. Revision of a large stoma to a smaller (9 mm) diameter can induce further weight loss in some patients whose loss has been inadequate. The 1.8% incidence of stoma ulceration may be lowered with the present emphasis on a smaller fundic pouch, but could increase with longer observation. Presently stoma ulcers occur once in every 140 patient years at risk.

Adolescent↗

PubMed1975

Acute postoperative wound complications after gastric surgery for morbid obesity.

The acute postoperative wound complications of 225 morbidly obese patients undergoing gastric bypass were compared against the complications observed in 225 normal-sized individuals who underwent elective gastric resection for peptic ulcer disease. Not only were there more wound infections (8.9 percent to 5.3 percent) in the obese population, but these infections inflicted more serious complications and a significantly increased hospital stay. While the exact cause of the increase in infections in the obese patients is unclear, it is a real phenomenon to be dealt with in surgery for obesity.

Acute Disease↗

PubMed1974