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Biomedical subjects

L Wise

Publications and source records attributed to L Wise.

At least 253 records · Page 14Linked to original sources
PubMed1977

Abnormalities of liver function following extensive jejunoileal bypass and resection in rats.

A greater than 90% jejunoileal bypass similar to the type performed in man for morbid exogenous obesity was performed in 70 adult female Wister rats; in an additional 70 rats a greater than 90% jejunoileal resection was performed. The control group consisted of 46 rats, which were not subjected to any experimental measures. Following operation the bypass group demonstrated a significantly greater weight loss than did the resection group. Total plasma protein, albumin, and glutamic oxalacetic transaminase all decreased from the control in both the resection and bypass groups; the decrease, however, was more significant in the bypass than in the resected group. These results suggest the possible production of a hepatotoxic factor in the excluded small bowel segment.

Alanine Transaminase↗
PubMed1977

Studies of the surgical scrub.

A study comparing the relative efficacy of a five versus a ten minute surgical scrub was carried out using random sampling of personnel scrubbing for routine scheduled hospital surgical procedures. Scrubbing for five minutes was found to be equally as effective as scrubbing for ten minutes. Betadine was compared to pHisoHex as a scrubbing agent and found to be statistically more effective in degerming the skin following a five minute scrub. As a result of this study, a routine preoperative surgical scrub of five minutes' duration, using Betadine as the scrubbing agent, is recommended.

Hand↗
PubMed1976

Studies on the effect of small bowel bypass for massive obesity on gastric secretory function.

Gastric secretory function was studied in 20 morbidly obese patients both before and after jejuno-ileal bypass. The mean postoperative weight loss was 99.2 pounds during a mean postoperative followup period of 12.6 months. The gastric secretory values we studied included basal and histalogstimulated volume, pH, concentration, and output. No statistically significant changes were observed in any of these variables. Therefore it is suggested that jejuno-ileal bypass, as performed for morbid obesity, is probably not an ulcerogenic procedure.

Adolescent↗
PubMed1976

Intraoperative arterial oxygenation in obese patients.

Although obese patients have been shown to represent a particularly high risk group with respect to hypoxemia both pre and postoperatively, no data exist to delineate the intraoperative arterial oxygenation pattern of these patients. Furthermore, no one has studied the effects of a change in operative position or a subdiaphragmatic laparotomy pack on arterial oxygenation (PaO2). Sixty-four adults undergoing jejunoileal bypass for morbid exogenous obesity, with a mean weight of 142.0 +/- 31.4 kg and a mean age of 33.3 +/- 10.4 years, were studied. Twenty-five patients (Group I) were maintained in the supine position throughout the operative procedure, while the remaining 39 patients (Group II) were changed to a 15 degrees head down position 15 minutes after a control blood sample was taken. Four additional markedly obese patients were studied to determine the effect of an abdominal pack of PaO2 values. The following findings were demonstrated: 1) 40% oxygen did not uniformly produce adequate arterial oxygenation for intra-abdominal surgery in otherwise healthy obese patients; 2) placement of a subdiaphragmatic abdominal laparotomy pack without a change in operative position resulted in a consistent fall in PaO2 in each patient to less than 65 mm Hg even though 40% oxygen was being administered; and 3) a change from supine to a 15 degrees head down operative position resulted in a significant (P less than 0.001) reduction in mean PaO2 (73.0 +/- 26.3 mm Hg). Seventy-seven per cent of these patients demonstrated PaO2 values of less than 80 mm Hg on 40% oxygen. Because of these findings, serious consideration should be given to the routine use of the Trendelenberg position intraoperatively in obese patients. However, if one elects this posture, prudence would dictate careful monitoring and maintenance of arterial oxygenation. Certainly, in obese patients, the intraoperative combination of the head down position and a subdiaphragmatic laparotomy pack should be avoided. In addition, since our data were collected in obese but otherwise healthy, young patients free of cardiorespiratory disease, special attention should be directed at the continuous measurement of arterial oxygenation in the older obese patient with either intrinsic dysfunction of vital organs (heart, lung, liver, kidney) or surgical disorders (peritonitis, sepsis).

Adult↗
PubMed1976

The surgical management of toxic dilatation of the colon: a report of 28 cases and review of the literature.

Experience with 28 patients with toxic dilatation of the colon is reviewed. The operative mortality in this series was 32% (9/28). Eight of the 9 patients who died were found to have colonic perforations at operation; in contrast, the group of patients with no perforations had a mortality rate of only 6%. Colonic perforation and sepsis were the most significant factors contributing to mortality and morbidity in this series. A review of the literature showed an overall operative mortality rate of 19.5% for patients with toxic megacolon; the mortality rate was 41% for patients with perforations and 8.8% for patients without perforations. It appears that the keystone to successful management is the avoidance of colonic perforation and sepsis; protracted medical management of toxic megacolon seems to have been at least partly responsible for these complications. Sixteen of the 18 survivors following subtotal colectomy required removal of the rectum within 9 months because of continued symptoms and disease in the rectal stump.

Adolescent↗
PubMed1976

Intussusception following jejunoileal bypass: case report and review of the literature.

Jejunoileal bypass carries a number of potential complications, one of which is intussusception of the excluded segment. The incidence of this complication is probably about one to two per cent. The usual symptoms consist of intermittent episodes of colicky abdominal pain. The roentgenographic diagnosis is difficult because the condition occurs at the blind end of the excluded segment and it is not possible to reflux contrast material to this area. If the intussusception is associated with severe gastrointestinal hemorrhage, selective angiography may provide the diagnosis.

Adult↗
PubMed1976

Role of emergency laparotomy in acute pancreatitis.

Two hundred and thirty-seven cases of acute pancreatitis were reviewed and the etiology and prognostic features were analyzed. The following were found to adversely affect prognosis: female sex, old age and low blood pressure, jaundice or disorientation on admission. The results also indicate that if a patient survives the first attack of acute pancreatitis, he is unlikely to have an overwhelming fatal attack later on. One hundred and ninety-four patients were treated conservatively, with a mortality rate of 8.8 per cent and morbidity rate of 20 per cent. Thirteen patients were semi-electively operated on for biliary tract disease with no mortality. The remaining 30 patients underwent emergency laparotomy. The mortality in this latter group was 23 per cent and the morbidity rate was 77 per cent. These results suggest that emergency laparotomy should only be advised for specific indications. In addition, our data suggest that if laparotomy is performed for acute pancreatitis, the peripancreatic area should not be drained unless an abscess or pancreatic necrosis is present.

Acute Disease↗
PubMed1976

Pneumatosis cystoides intestinalis: an unusual complication of jejunoileal bypass.

A case of pneumatosis cytoides intestinalis associated with jejunoileal bypass is reported. The association of increased colonic gas, secondary to fermentation of undigested lactose in the colon, and the reflux of the excessive gas into the excluded segment of small bowel and dissection of the gas into the bowel wall and mesentery are postulated as the causes of pneumatosis cystoides intestinalis in patients with jejunoileal bypass.

Colon, Sigmoid↗
PubMed1976

The pathogenesis of diarrhea after bypass of the small intestine.

Certain aspects of the pathogenesis of the diarrhea after bypass procedures of the small intestine for obesity have been evaluated. In the late postoperative period, a significant increase occurred in fecal weight and in fecal bile salt and free fatty acid output. There was a significant direct correlation between fecal weight and fecal bile salt output. There was no significant correlation between fecal weight and fecal fatty acid output. This suggests that, after bypass procedures of the small intestine, bile salts play a more significant role in the pathogenesis of diarrhea than do free fatty acids.

Bile Acids and Salts↗
PubMed1976

Wound infection: a prospective study of 7519 operations.

Wound infection was prospectively studied in 7,519 consecutive operations after preoperative classification as clean, clean-contaminated, and infected. The overall infection rate was 3.9 per cent. Clean, 3.2 per cent; clean-contaminated, 4.4 per cent; contaminated, 12.4 per cent; infected, 16.2 per cent. Wound infection was not seasonally related or dependent on changes in house staff. In clean cases, the predominant role of Staphylococcus aureus (37%) has been superceded by enterococci (44%). In clean-contaminated cases, enterococci (43.5%) were the most common, followed by Escherichia coli (40.0%). In contaminated wounds, E. coli was most common (40.0%). The infected case category grew mixed flora (E. coli, 82 per cent; enterococci, 54 per cent, and Pseudomonas aeruginosa, 43 per cent). Nosocomial organisms were important only in the contaminated (14%) and infected (43%) categories. Antibiotic therapy before cultures are available should include agents with activity against enterococci as well as S aureus, and E. coli in clean cases.

Bacteria↗
PubMed1975

Lactose and milk intolerance: clinical implications.

We studied 166 hospitalized male patients to determine the clinical importance of tolerance-test-determined "lactose intolerance," assumed to affect most of the world's adults. Abnormal lactose tolerance tests were found in 81% of 98 blacks, 12% of 59 whites of Scandinavian or Northwestern European extraction, and three of nine non-European whites. Seventy-two per cent of the "lactose-intolerant" subjects had previously realized that milk drinking could induce abdominal and bowel symptoms. Two hundred and forty milliliters of low-fat milk produced gaseousness or cramps in 59% of 44 "lactose-intolerant" men, and 68% were symptomatic with the equivalent amount of lactose. None of 18 "lactose-tolerant" men noted symptoms with milk or lactose. Refusal to drink 240 ml of low-fat milk served with meals correlated significantly with "lactose-intolerance": 31.4% versus 12.9% among "lactose-tolerant" patients. "Lactose intolerance" is common in adults and is a clinically relevant problem.

Adult↗
PubMed1975

Biliary and urinary calculi: pathogenesis following small bowel bypass for obesity.

Of 93 patients with small bowel bypass for massive exogenous obesity, three developed calcium oxalate urinary calculi, four stones in their gallbladder, and one developed both gallstones and urinary calculi during a mean follow-up period of 17.6 plus or minus 9.0 months. The urinary oxalate excretion increased from 21.6 to 67.8 mg/24 hours (P smaller than .001); simultaneously, the urinary output decreased from 1,775 to 1,101 ml/24 hours (P smaller than .001). Postoperatively, there was a significant increase in the rate of bile salt synthesis from 1.6 to 4.9 gm/day (P smaller than .02) and in the bile sale glycine/taurine ratio from 4.6 to 6.8 (P smaller than .05). It is suggested that the postbypass increase in the biliary glycine/taurine ratio, with its consequent decrease in the zeta potential of the micelles in bile, is at least partly responsible for the increased incidence of cholelithlasis. The pathogenic basis for the increased incidence of urinary calculi is hyperoxaluria, which is probably related to an increased bile salt and glycine synthesis.

Adult↗
PubMed1975

The role of additives in allergic vasculitis during intravenous hyperalimentation.

A 39-year-old woman who had previously undergone a jejunoileal bypass for morbid obesity was receiving intravenous hyperalimentation. The patient developed allergic vasculitis while receiving fluid which contained a multi-vitamin solution. Rechallenge with this preparation resulted in an exacerbation of her skin lesions. The possible role of such additives in the development of unusual hypersensitivity reactions is discussed.

Adult↗
PubMed1975

Choriocarcinoma and bilateral renal metastases.

A case of choriocarcinoma presenting with metastases to both kidneys is reported. The epidemiologic and pathologic aspects of gestational choriocarcinoma are briefly discussed. Prior reports of renal metastases with choriocarcinoma are reviewed, and the fairly typical clinical presentation for this entity is emphasized.

Adult↗