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Biomedical subjects

M Deitel

Publications and source records attributed to M Deitel.

At least 73 records · Page 4Linked to original sources
PubMed1992

Pheochromocytoma producing multiple vasoactive peptides.

Pheochromocytomas may produce several vasoactive peptides. We studied a 39-year-old man who presented with paroxysmal flushing and abdominal pain with normal blood pressure. Laboratory and radiologic studies established the diagnosis of right adrenal pheochromocytoma, and histologic and ultrastructural examination showed the tumor to be a typical pheochromocytoma. Tissue culture yielded large quantities of norepinephrine and epinephrine. However, immunohistochemical studies, tissue assays, and in vitro cultures documented production of several peptides, including calcitonin gene-related peptide and vasoactive intestinal polypeptide in tumor cells. The patient has been asymptomatic after tumor resection. Production of multiple peptides by this tumor may account for the flushing and lack of hypertension, despite elevated catecholamine levels in this patient.

Adrenal Gland Neoplasms↗
PubMed1992

Emulsion stability in a total nutrient admixture for total parenteral nutrition.

A total parenteral nutrition solution containing lipid was tested up to 28 days at 4 degrees C followed by an additional 2 days at 22 degrees C (room temperature) for stability of the emulsion. The total nutrient admixture (TNA) contained 1000 ml 10% FreAmine, 1000 ml 50% dextrose, 500 ml 10% Soyacal, electrolytes, vitamins and trace elements. Stability was determined by direct observation, light and electron microscopy, Coulter counter, pH, osmolality, and fatty acid profile. Samples were tested when fresh at 0 hours, after 2 days at 22 degrees C, 14 days at 4 degrees followed by 2 days at 22 degrees C, and 28 days at 4 degrees C followed by 1 and 2 days at 22 degrees C. Light microscopy measured particles greater than 2 microns in diameter; 99% of these particles were less than 6 microns, with no increase with time. Electron microscopy found that lipid particle size increased slightly up to 30 days, at which time the mean diameter was 0.36 +/- 0.01 micron. Coulter counter studies found that lipid droplet diameter increased while at 22 degrees C; however, on day 30, 99% of the particles were less than 1.97 microns. Mean pH and osmolality were 6.35 +/- 0.04 and 1880 +/- 14.5 mOsm/kg, respectively, with no change over time. Analysis of fatty acids by gas chromatography showed that fatty acid profiles and amounts of triglyceride, phospholipid and total lipid did not change. Thus, the emulsion in the TNA was stable for 28 days refrigeration, followed by 2 days at room temperature.

Drug Stability↗
PubMed1992

Morbid obesity: selection of patients for surgery.

Massive obesity is associated with serious co-morbidities. After failure of extensive conservative measures, surgical procedures have developed as the only successful method for sustained weight loss. Criteria for operation are: presence of serious diseases associated with morbid obesity; greater than 45 kg above ideal weight or body mass index greater than 40 kg/m2 for usually greater than 5 years; failure of sustained weight loss on extensive conservative regimens; commitment to lifelong follow-up; and acceptable operative risk. Angina pectoris itself is not a contraindication to these operations. Patients who do not quite meet the weight criteria may still be candidates for an obesity operation in certain instances, e.g., debilitating musculoskeletal pains in weight-bearing joints, diabetes, significant hypertension, reflux esophagitis, urinary stress incontinence. Although current operations result in lasting weight loss of greater than 50% of excess weight in the majority of patients, the surgical candidate must understand and accept the principles of the procedures, the potential for serious complications, the dietary necessities, and occasional failures.

Body Mass Index↗
PubMed1992

Augmented production of heparin-binding mitogenic proteins by preadipocytes from massively obese persons.

Basic fibroblast growth factor (bFGF) stimulates the replication of preadipocytes and inhibits their differentiation. In this study we explored whether the same or related polypeptides were produced locally and acted by paracrine/autocrine mechanisms in adipose tissue. Omental preadipocytes from 7 lean and 10 massively obese (> 170% reference) subjects were grown to confluence in subculture. Total RNA was hybridized with a synthetic deoxynucleotide for human bFGF. In the case of all cell strains, there was expression of two major bFGF transcripts, 7.0 and 3.7 kb. Although there was considerable variation in the degree of expression, preadipocytes from massively obese subjects revealed much greater expression than did cells from the lean (P < 0.001). In studies of conditioned media prepared with preadipocytes, the presence of proteins belonging to the heparin-binding (fibroblast) growth factor family was indicated by Western blot analysis, for a 66-kD protein with anti-(1-24)bFGF, and for a 32-kD protein with anti-(40-63)bFGF antibodies. The relative quantity of the 66-kD protein correlated with body mass index at r = 0.72. bFGF-related proteins probably function normally to maintain an appropriate complement of adipocyte precursors. The augmented expression of heparin-binding growth factors in preadipocytes from some massively obese people probably contributes to the excessive cellularity of their fat depots.

Adipose Tissue↗
PubMed1992

Pulmonary Complications in Obesity Surgery.

Massively obese patients undergoing abdominal surgery frequently develop pulmonary complications. The basis of this predilection, syndromes and suggestions to reduce risk are discussed.

Journal Article↗
PubMed1992

A Jejuno-ileal Bypass Patient Presenting with Recurrent Renal Stones due to Primary Hyperparathyroidism.

In the past, jejuno-ileal (JI) bypass operations were performed for the treatment of massive intractable obesity. This procedure is known to be complicated by numerous malabsorptive syndromes, occasionally resulting in electrolyte abnormalities and oxalate renal calculi. Recurring renal stones and oxalate nephropathy are cause to reverse the JI bypass. However, investigation of recurring renal stones should be done to exclude causes that are not secondary to the bypass procedure itself. We present a patient 13 years post JI bypass with recurring renal calculi due to primary hyperparathyroidism.

Journal Article↗
PubMed1992

Diet Coke or Not?

Many obese patients are attempting to diet. Furthermore, many gastric restrictive procedures permit the ready flow of liquids, and the individual may want to be assured that the liquid is in the "non-calorie" form. Many obese patients have diabetes, and an incorrect or misrepresented beverage can result in elevated plasma glucose with a disruption in glycemic control. The studies below have been extended for orange-flavored carbonated beverages (Orange Crush, Fanta Orange, etc.) with the same findings-no color change with the diet drink and immediate brown color change with the regular drink on the Diastix.

Journal Article↗
PubMed1992

Sleep-related Disorders in the Obese.

Obesity is a well-known cause of upper airway narrowing, respiratory failure and resulting hypoxemia and hypercapnia, and cardiac arrhythmias during sleep. Obese patients are prone to snore loudly and to develop obstructive sleep apnea syndrome and also obesity-hypoventilation syndrome. Repeated nocturnal upper airway obstruction may cause respiratory failure and cor pulmonale and frequent awakenings, and result in nocturnal choking, with daytime drowsiness, somnolence and irritability. The purpose of this article is to review the evidence for these accepted facts and to consider a variety of new information that relates to the pathogenesis, symptomatology and treatment of sleep disorders caused by obesity.

Journal Article↗
PubMed1992

Management of papillary carcinoma arising in thyroglossal-duct anlage.

Cysts of the thyroglossal duct are common congenital abnormalities. They present as asymptomatic midline cervical swellings. The risk of malignant change is low; only 103 cases have been reported in the world literature, 85% of which were papillary adenocarcinomas. The appropriate treatment for this condition remains controversial. The authors describe three patients who had papillary carcinoma contained within a thyroglossal-duct rest. All were treated by cyst resection and thyroid suppression, but without thyroidectomy and radioactive thyroid ablation. Postoperatively, all patients remained disease free, with no recurrence at follow-up ranging from 10 to 29 years. Isolated papillary carcinomas arising from primitive thyroid remnants, associated with a palpably normal thyroid gland at surgery and a negative thyroid scan, can be treated adequately by excising the thyroglossal mass.

Carcinoma, Papillary↗
PubMed1992

A family exhibiting carotid body tumours.

The authors describe the surgery carried out for 11 carotid body tumours (CBTs) that were found in three generations of a Greek family. Eight patients with CBTs were operated upon at St. Joseph's Health Centre, Toronto, within 1 year. Three patients had bilateral CBTs, which were removed in two stages. Only one of the CBTs occurred in a female. Seven CBTs were excised by meticulous subadventitial dissection. In the eighth, a previous attempt at removal in another hospital had proved unsuccessful, and excision of the tumour required ligation of the external carotid artery and partial excision of the carotid bulb. The authors conclude that most CBTs can be excised directly without ligation, shunts or bypasses. In eight operations carried out on five patients, the only complication was a transient neuropraxia of the hypoglossal nerve that resolved within 2 weeks.

Adult↗
PubMed1992

Primary colorectal anastomosis with the intracolonic bypass tube.

BACKGROUND: Intracolonic bypass with primary colocolonic or colorectal anastomosis may be an effective option in the operative management of complicated colonic disease when adequate bowel preparation is not possible. A pliable latex tube is anchored to mucosa and submucosa 3 centimeters proximal to a site of colocolonic anastomosis and later spontaneously evacuated by way of the rectum. METHODS: Twenty-nine consecutive patents who required urgent colorectal operations in the presence of unprepared bowel underwent left colon resection with intracolonic bypass and primary anastomosis. These patients would have otherwise undergone multistage procedures for the management of the colorectal disorders. Demographic data, APACHE II scores, and type and frequency of complications were recorded. RESULTS: Between July 1, 1990, and June 30, 1991, 31 patients were eligible for entry in the study. Two patients ultimately had contraindications for the use of intracolonic bypass. The causes encountered included complicated diverticular disease, colonic carcinoma, sigmoid volvulus, and iatrogenic colorectal injury. Complications included wound infection (7), myocardial infarction (2), prolonged ileus (1), deep vein thrombosis (2), and anastomotic leak (2). Postoperative myocardial infarction and subsequent multiorgan system failure were responsible for the only death in this study. CONCLUSIONS: Intracolonic bypass permits a safe primary anastomosis where multistage procedures would otherwise be required. Avoidance of colostomy and the attendant socioeconomic benefits warrants further study of this method.

Aged↗
PubMed1991

Effect of Weight Loss in the Morbidly Obese Patient with Severe Disability.

An impairment can result in disability which can result in handicap. In Canada, disabilities have been based on 17 activities of daily living (ADL), nine of which may be due to massive obesity. Severe disability (SD) is inability to perform three or more of these ADL. During 1985, all patients with SD who underwent weight loss surgery were surveyed. Of 120 morbidly obese patients, 44 fulfilled the SD criteria. Effect of weight loss was observed over 5 years in 42 SD patients (initial mean body mass index 47.8 final 27.8), two being lost to follow-up. Disability became moderate (unable to do one or two of the ADL) in three, mild (difficult but able to perform) in 17, and disappeared in 22 patients. Two who regained lost weight redeveloped SD.

Journal Article↗
PubMed1991

Radiological Features after Vertical Banded Gastroplasty.

More than 1300 vertical banded gastroplasty operations have been performed at our hospital since November 1982. We describe the radiologic findings based on 159 of these patients, who were referred for radiologic contrast studies. Patients were referred because of abdominal pain, excess vomiting, excess weight loss, inadequate weight loss or regain of weight. The pre-contrast plain film was an important indicator of staple-line abnormalities. The radiographic findings could be divided into: abnormalities of the partition, abnormalities of the banded outlet, and ulcers and extragastric leaks.

Journal Article↗
PubMed1991

An Apparatus for Visualizing and Videotaping Obesity Operations.

A video camera has difficulty in gaining access for obesity operations. A 7-ft aluminum arm (boom) has been mounted on a sturdy tripod. A camera at one end of the boom enables easy direct videotaping, without interfering with the operating table

Journal Article↗
PubMed1991

The Etiology of Obesity.

Obesity likely results from a genetically predetermined body mass set-point that exerts control of body weight through alterations in basal metabolic rate. This set-point may be further influenced by learned eating behaviour, perception of body image, socioeconomic status and the availability of food. This article examines the complex etiology and pathogenesis of obesity from biological, sociocultural and psychological perspectives. Endocrine abnormalities and defective brown fat thermogenesis are also examined and found not to be primary etiologic factors in the development of obesity.

Journal Article↗