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Biomedical subjects

L Wise

Publications and source records attributed to L Wise.

At least 271 records · Page 15Linked to original sources
PubMed1975

Studies on bile salt deconjugation following small bowel bypass procedures.

Using the glycine-l-14C-cholic acid (14C-GCA) test, bile salt deconjugation and excretion were studied in 26 subjects with morbid exogenous obesity before and at selected intervals after jejuno-ileal bypass. In the preoperative group there was no malabsorption or intestinal bacterial deconjugation of the bile salts. In the immediate postoperative period (with relative sterilization of the bowel) there was only a trace of 14C in the breath, but the fecal 14C was highly elevated, indicating severe malabsorption without bacterial activity. In the 8 to 10 day postoperative period both the breath and fecal 14C content were highly elevated, indicating malabsorption and normal bacterial activity. Five to 8 months postoperatively both the breath and fecal 14C content showed only moderate elevation, indicating adaptation. It is suggested that the 14C-GCA test is useful in evaluating the adequacy of small bowel bypass procedures and also in following the adaptive response after the bypass. A significant increase in the breath and fecal 14C soon after surgery followed by rapid decrease suggests an adequate bypass and unusually fast adaptation. If the increase in the breath and fecal 14C soon after the bypass is only moderate, then that suggests an inadequate bypass.

Bile Acids and Salts↗
PubMed1975

Choice of abdominal operative incision in the obese patient: a study using blood gas measurements.

Although many factors may influence the choice of the operative incision, physiologic safety in terms of the degree of postoperative hypoxemia should be considered. No data currently exist to delineate in markedly obese patients the effect of the operative incision on the extent or duration of this hypoxemia. Fifty-four consecutive patients of both sexes, scheduled for elective jejunoileal bypass for morbid exogenous obesity, were studied. In 23 patients the operation was performed through a transverse incision and in 25 patients through a vertical incision. In 6 patients, cholecystectomy was also performed in addition to the jejunoileal bypass. Postoperatively there was a significant fall in PAO2 both in the transverse and vertical incision groups and this continued through day 4. On day 5 statistically significant hypoxemia was present only in the vertical incision group. In addition, the decrease in PaO2 was significantly greater on days 4 and 5 in the vertical group than in the transverse group. On days 2 and 3 again the mean decrease in PaO2 was greater in the vertical group but this was not statistically significant. The effect of added cholecystectomy on PaO2 was studied in 6 women with midline incisions. The results were compared with 6 subjects who had small bowel bypass without cholecystectomy and who were matched for incision, age weight, girth/height ratio, weight/height ratio, smoking habit, and percentage of predicted ERV. In both groups there was a significant fall of PAO2 from day 1 through day 4, but there was no significant difference between the two groups. Although the numbers studied were small, these limited results would suggest that the type of incesion rather than the intraoperative procedure is the important factor in determining postoperative PAO2 changes. These studies also suggest that in patients with an increased potential for postoperative hypoxemia (i.e., markedly obese), the transverse abdominal approach shoudl always be seriously considered.

Blood Pressure↗
PubMed1975

Postoperative arterial blood gas measurement in obese patients: effect of position on gas exchange.

The effect of position change on blood gas exchange was studied in 22 markedly obese, otherwise healthy, women both preoperatively and postoperatively. There was a statistically significant decrease in arterial oxygen tension and a simultaneous reduction both in the arterial carbon dioxide tension and the base excess with the assumption of the supine versus the semirecumbent position on postoperative days one and two. However, no positional difference was demonstrable in any variable by the third postoperative day. This study indicates that in obese patients during the first 48 hours after abdominal surgery, assumption and maintenance of the semirecumbent posture is a valuable therapeutic adjunct to improve arterial oxygenation.

Adult↗
PubMed1975

Spontaneous pyeloduodenal and renocolic fistulas.

Twenty-seven previously reported cases of pyeloduodenal fistulas are reviewed and the first case of a simultaneously occurring pyeloduodenal and renocolic fistula is reported. Pyeloduodenal fistulas appear to result from an inflammatory process originating in the kidney, frequently are associated with calculi, and are best managed surgically with nephrectomy and closure of the fistula.

Colonic Diseases↗
PubMed1975

Gastric bullae. An early roentgen finding in corrosive gastritis following alkali ingestion.

In most cases of alkali ingestion, the stomach is protected from injury by its contents and gastric acidity, so that the esophagus is usually the main site of injury. The authors describe a case of severe corrosive gastritis following ingestion of a large amount of alkali. Huge gastric bullae, an unusual manifestation, were an early roentgen finding. As healing occurred, the stomach was reduced to a shrunken, aperistaltic pouch.

Blister↗
PubMed1975

Studies on the healing of anastomoses of small and large intestines.

It is well known that large intestine anastomoses tend to leak much more frequently than do small intestine anastomoses. These studies were undertaken to elucidate the pathophysioplogic basis of this phenomenom. Single layer interrupted silk suture anastomoses were performed in both the distal part of the ileum and the distal part of the colon in 29 dogs. The anastomoses were resected at one through eight days and 19 to 31 days after operations. Collagen response, vascular response and bursting strength at the site of anastomoses were investigated. The results demonstrated a statistically significant decrease in the collagen and vascular response of the large versus the small intestine. This differential response may play a role in the mechanism of the relatively high incidence of suture line separations observed after colonic anastomoses.

Animals↗
PubMed1975

The effects of small-bowel resection or bypass on the rat skeleton.

The bones of adult rats became progressively osteopenic 1 to 5 weeks following jejunoileal bypass or resection. These changes were accompanied by increased levels of metaphyseal enzyme activities as well as by loss of histochemically identifiable osteoid. Osteoid tissue and the ability to mineralize skeletal collagen were recovered more rapidly and fully in the resection group than in the bypass group. Metaphyseal alkaline phosphatase concentrations increased in both groups coincident with the elevated lysosomal enzymes levels, and the skeletons showed a calcium deficit (low Ca/HOPr ratio) within the first 3 weeks. In resected rats the osteopenia and bone blood chemistry were consistent with hyperparathyroidism secondary to impared Ca absorption. In bypassed rats the results suggest that the osteopenia might be related to the release of a "resorptive factor" from the excluded intestinal segment.

Acid Phosphatase↗
PubMed1974

Postoperative hypoxemia in obese patients.

Although obese patients represent a high risk group and reports document the occurrence of sudden unexplained deaths in the early postoperative period, no data exist to delineate the existence, extent or duration of hypoxemia in obese subjects. Twenty adults undergoing jejunoileal bypass for morbid exogenous obesity, with a mean weight of 144.0 +/- 24.7 kg and a mean age of 34.1 +/- 8.3 years, were studied. While breathing room air, arterial blood was collected from each patient, placed in ice and analyzed within ten minutes. A preoperative sample was taken; then samples were analyzed two hours postoperatively and on postoperative days one through five. Preoperatively in the obese patients there was a significant reduction in arterial oxygen tension, mean 75.1 +/- 11.1 mm Hg, as against 92.4 +/- 4.0 mm Hg in control patients matched for age. There was also a difference in the slope of the regression equation of PaO(2) vs. age; the regression coefficient being significantly greater in the obese group (0.9 vs. 0.46). Postoperatively there was a further fall in PaO(2). Decrease in mean PaO(2) in the obese group in mm Hg averaged -9.2 two hours postoperatively (p < 0.001), -15.0 on day one (p < 0.001), -15.5 on day two (p < 0.001), -11.7 on day three (p < 0.001) and -5.1 on day four (p < 0.01). PaCO(2) was not significantly different from the preoperative control. Base excess was elevated on days two, three and four; 3.1 mEq/ L(p. < .001), 3.6 mEq/L(p < .001) and 1.9 mEq/L(p <.05) respectively. Our findings indicate that in obese patients: 1) Preoperatively the fall in PaO(2) with increasing age is greater than in control subjects; 2) Starting with a low basal PaO(2) during postoperative days one through four, the fall in CaO(2) often reaches dangerous levels; and 3) Elevation of blood buffer on days two, three and four can further depress respiration at a time when the PaO(2) has been shown to be at its lowest levels. This hypoventilation due to metabolic alkalosis can further accentuate the already existent hypoxemia. Because of these findings, we suggest careful monitoring of arterial blood gases in obese patients and the administration of oxygen and appropriate electrolyte solutions postoperatively to reduce the increased morbidity and mortality.

Acid-Base Equilibrium↗