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Biomedical subjects

M Deitel

Publications and source records attributed to M Deitel.

At least 91 records · Page 5Linked to original sources
PubMed1991

Microorganisms in the Stomach During Vertical Banded Gastroplasty.

Vertical banded gastroplasty involves the cutting of a stapled window against an Ewald tube Passed perorally, and creation of a vertical staple-line partition. The channel at the window is banded by a polypropylene mesh collar. A study of the gastric rings removed at this operation found that the bacterial colonization rate was 46.8%, so that the potential for infection of the collar exists. The actual significance of this finding is unknown.

Journal Article↗
PubMed1991

Cardiac function in massively obese patients and the effect of weight loss.

Massively obese patients are at increased risk for heart disease. Blood volume and capillary flow are increased to supply the excess body mass, and there is a concomitant increase in preload and, often, afterload. The heart compensates for the expanded blood volume by increasing stroke volume and cardiac work to provide increased cardiac output. The result is left ventricular dilatation followed by eccentric left ventricular hypertrophy. Cardiac compensatory reserve is limited, leading, at times, to overt congestive failure. After reduction of the excess body fat, most of the cardiovascular derangements appear to reverse. The authors review the effect of massive obesity on the heart and the cardiovascular consequences of weight reduction.

Heart↗
PubMed1990

Severe secretory diarrhea with elevated gastrin-releasing peptide controlled by somatostatin analogue: a case report.

Gastrin-releasing peptide immunoreactivity has been seen in functioning endocrine tumours which are recognized as a major cause of secretory diarrhea. The authors describe a case of a 52-year-old woman who had secretory diarrhea (5 L/d) with markedly elevated gastrin-releasing peptide levels associated with islet cell hyperplasia. No tumour could be identified. The diarrhea was controlled by somatostatin analogue.

Diarrhea↗
PubMed1990

Dexon plus versus Maxon fascial closure in morbid obesity: a prospective randomized comparison.

A monofilament polyglyconate suture (Maxon) was developed as a longer-lasting suture associated with less potential for infection than braided polyglycolic acid suture (Dexon). The authors compared Dexon Plus and Maxon in a prospective randomized study of 84 consecutive morbidly obese patients who underwent vertical banded gastroplasty. Linea alba was closed with continuous running suture, reinforced with a few interrupted, sutures. After more than 2 years' follow-up, one seroma (2.4%), one wound infection (2.4%) and no hernias were found in the Dexon group. In contrast in the Maxon group there were three seromas (7.1%), four wound infections (9.5%) and four incisional hernias (9.5%, p less than 0.05). The hernias were noted between 2 and 10 1/2 months after the operation in two patients who had had wound infections and in two who had had seromas. When Maxon was used, the needle occasionally pulled off the suture and the ends beyond the knot projected rigidly. Dexon Plus was easier to handle in very fatty wounds.

Adult↗
PubMed1989

Physical stability of a total nutrient admixture for total parenteral nutrition.

The stability of a total nutrient admixture (TNA) has been postulated to be less than 7 days in refrigerated storage. When a TNA destabilizes, lipid particles coalesce and enlarge. Liposomes larger than 6 microns can obstruct pulmonary capillaries. A TNA containing 1500 ml of 7% Vamin, 1000 ml of 50% dextrose and 500 ml of 10% Intralipid, including the usual electrolytes, minerals and vitamins, was studied. Liposome size was measured in the original Intralipid and the TNA at intervals up to 14 days at 4 degrees C followed by 2 days at 22 degrees C. There was a small increase in liposome size up to 16 days. However, the number of particles larger than 6 microns was insignificant (by light microscopy, 3.9 +/- 2.4 [+/- SD] per 20 high-power fields; by Coulter counter, 99.8% smaller than 1.9 microns, with 0% larger than 6 microns; and by electron microscopy, 100% smaller than 2.0 microns). The osmolality and pH of the TNA were 1472 +/- 31 mOsm/kg and 5.5 +/- 0.1 respectively (mean +/- SD), with no significant change during the study times. The authors concluded that this TNA remains physically stable when refrigerated for 14 days and at room temperature for a further 2 days.

Amino Acids↗
PubMed1989

Endoscopy of vertical banded gastroplasty.

Vertical banded gastroplasty is the most common operation for morbid obesity. Postoperative gastroscopy was needed 91 times in 79 of 696 patients for 1) abdominal pain (23), 2) excess vomiting (22), 3) inadequate weight loss (14), 4) excess weight loss (13), 5) and a sudden increase in eating capacity (7). A normal appearance consisted of a clean gastric channel 6.8 +/- 1.4 SD cm long, with a rosette 46.6 +/- 2.1 cm from the incisors and, with insufflation, an 11 mm scope passed through this pseudopylorus snugly, but without difficulty. In Group 1, no problem was seen in the channel, and cholecystitis was found to be the cause. In Group 2, no problem was observed in ten (poor teeth and chewing), six experienced stasis or pill ulcerations, four had bezoars (fragmented or removed with basket), and two had intraluminal mesh. In Group 3, the scope floated through too large an outlet (greater than or equal to 13 mm) in eight, and no cause was seen in six (gorgers, sweets-eaters). In Group 4, tightness or stricture resolved with dilatations (Eder-Puestow; Savary; balloon dilators) in six, but seven required re-operation. In Group 5, the scope travelled through four breakdowns in the partition and three outlets were too large. Gastroscopy viewed problems accurately, indicated treatment and suggested modifications in gastroplasty technique.

Abdomen↗
PubMed1988

Vertical banded gastroplasty as an antireflux procedure.

Vertical banded gastroplasty creates a channel by two applications of the TA-90 stapler from an end-to-end anastomosis window above the crow's foot to the angle of His, against a 32 F. tube along the lesser curvature. The caudad end of the channel is restricted by a 5 cm collar. Thirty-one obese patients more than 45 kg overweight were studied by interview, barium swallow, endoscopy, and manometry. These procedures were repeated 13 +/- 5.5 weeks postoperatively, after resolution of operative edema and before extensive weight loss. Preoperative symptoms included heartburn in 24 patients, regurgitation in 17 patients, and aspiration in 2 patients, and barium swallow demonstrated hiatal hernia in 7 patients and reflux in 7 patients (5 with hiatal hernia). In addition, endoscopy detected mild esophagitis in 3 patients, and hiatal hernia in 11 patients. Postoperatively, the incidence of heartburn decreased in all patients, barium swallow showed slow channel emptying but no hiatal hernia or reflux, and endoscopy did not identify any esophagitis. Preoperative lower esophageal sphincter pressure was 14.5 +/- 7.2 mm Hg. Postoperatively, the vertical banded gastroplasty channel had an initial peak (collar) pressure of 19.2 +/- 7.8 mm Hg (p less than 0.01 compared with preoperative lower esophageal sphincter pressure), a channel pressure of 9.5 +/- 6 mm Hg, a lower esophageal sphincter pressure of 20.1 +/- 7.7 mm Hg (p less than 0.005), and a channel length of 6.8 +/- 1.4 cm. Vertical banded gastroplasty creates a high pressure channel, inhibiting reflux of gastric juice without the need for any additional procedure.

Adult↗
PubMed1988

Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery.

A clinical study was undertaken to assess gynecologic-obstetric changes in morbidly obese women who lost greater than or equal to 50% of their excess weight with bariatric surgery. The 138 females (109 of reproductive age), age 35 +/- 9 SD yr, weighed 124 +/- 23 kg before surgery and 79 +/- 13 kg after weight loss had stabilized. Menstrual irregularities were present in 40.4% of premenopausal patients preoperatively; after massive weight loss, cycles were abnormal in 4.6% (p less than 0.001). Infertility problems were present preoperatively in 29.3% Of these, nine tried to conceive after weight loss and were successful. During past pregnancies, medical complications were frequent (hypertension 26.7%, pre-eclampsia 12.8%, diabetes 7.0%, and deep vein thrombosis 7.0%). After weight-loss stabilization, these obstetric complications did not occur. Incidence of urinary stress incontinence decreased from 61.2% to 11.6% (p less than 0.001). Gynecologic-obstetric changes tended to normalize after loss of massive body weight.

Adolescent↗
PubMed1988

Percutaneous endoscopic gastrostomy by the "pull" and "introducer" methods.

After 28 patients, studied prospectively, underwent percutaneous endoscopic gastrostomy (PEG) by the Ponsky "pull" technique, another 28 patients underwent PEG by the Russell "introducer" method. These two groups were compared retrospectively with 28 patients who had previously undergone Stamm gastrostomy as an independent operation performed by the same group of surgeons. All procedures were done within a 5-year period. The major indication for gastrostomy was the inability to swallow due to neurologic diseases; a similar number of patients in each group also had pharyngeal blockage, cachexia, respiratory failure and inhalation burns. Percutaneous endoscopic gastrostomy could be done most appropriately under local anesthesia, the "introducer" method requiring less time than the "pull" method, which in turn required less time than the Stamm gastrostomy. Feeding was generally instituted successfully 24 hours after PEG compared with 3 days after Stamm gastrostomy. "Introducer" PEG was not associated with peristomal infection, and the authors postulate that the peristomal infections in the "pull" PEG group were due to oropharyngeal bacteria brought through the abdominal wall by that technique.

Endoscopy↗
PubMed1988

Revision of failed horizontal gastroplasty by vertical banded gastroplasty.

Eighteen patients who had undergone horizontal gastroplasty experienced postoperative weight gain due to technical failure (large orifice in 10 patients, staple-line disruption in 7 and a large pouch in 1). A vertical banded gastroplasty was used to correct the problem, with a resulting operative morbidity of 38.9%. This included perforation with peritonitis (five patients) and complete outlet obstruction (two patients). These complications appear to result from poor blood supply to the area of the anastomosis necessary in this conversion. This study indicates that it is not safe to use vertical banded gastroplasty for the failed horizontal gastroplasty.

Adult↗
PubMed1987

Major intestinal complications of radiotherapy. Management and nutrition.

Hospitalization was required in 57 patients for intestinal injuries following radiotherapy for carcinoma of the cervix, endometrium, ovary, bladder, rectum, and other primary sites. Intestinal complications included stenosis, perforation, rectal ulcer, and rectovaginal, ileovaginal, and ileovesical fistula; 27 patients had multiple intestinal complications. Operation was necessary in 33 patients, as follows: bowel resections, 18; colostomy alone, five; adhesiolysis, five; ileocolic bypass, three; and Hartmann's procedure for sigmoid perforation, two. Five anastomotic leaks and six postoperative deaths occurred. Causes of death among the remaining patients included residual cancer (ten), de novo bowel cancer (two), radiation injury (four), and unrelated causes (six). Resection to uninvolved bowel, omental wrap of anterior resection anastomosis, avoidance of unnecessary adhesiolysis, and long-tube orientation seemed to contribute to successful operations. Nutritional support was used for repletion, post-operative fistulas, and short-gut syndrome.

Adult↗
PubMed1987

Incidence of symptomatic gallstones after bariatric operations.

Incidence of gallstones in morbidly obese patients and further development of symptomatic gallstones with weight loss after bariatric operations were studied. Of the 552 patients with mean preoperative weight 210.4 per cent of ideal, jejunoileal bypass has been performed upon 63, horizontal gastric partitioning in 184 and vertical banded gastroplasty in 305. Cholecystectomy had been done previously upon 146 patients (26.4 per cent). A further 67 patients (12.1 per cent) underwent cholecystectomy at the time of bariatric surgical treatment for diagnosed gallstones. The remaining 339 patients at risk of having cholelithiasis develop after a bariatric operation have been observed for more than one to 12 years; symptomatic gallstones requiring cholecystectomy developed in 39. Of these 339 patients, 17 had the symptomatic gallstones in the first year, 17 in the second year and only five from two to 12 years postoperatively. The pathologic type of stone was cholesterol in 87 per cent and mixed in 13 per cent (the latter were patients who underwent jejunoileal bypasses). In the 339 patients, 280 had lost greater than or equal to 50 per cent and 59 had lost less than 50 per cent of excess weight; symptomatic gallstones developed in 33 of the 280 in the former group and six of the 59 in the latter (p = 0.06). Although no complications resulted, concomitant cholecystectomy was often difficult in these massively obese patients, whereas cholecystectomy after weight loss has been relatively easy. Routine cholecystectomy at the time of these operations does not appear justified.

Adult↗
PubMed1986

Vertical banded gastroplasty: results in 233 patients.

The authors describe their experience with vertical banded gastroplasty in 233 patients for whom the follow-up ranged from 12 to 30 months. There were no deaths. Intraoperatively, two gastric perforations and one esophageal perforation occurred; these were closed and drained. A postoperative leak was treated promptly by removal of the collar, drainage and gastrostomy. There were three instances of late obstruction, due in one to mesh adhering to liver and in two to stenoses; gastrogastrostomy was followed by regained weight. Removal of the collar was also associated with failure to lose adequate weight. Rare complications were intraluminal erosion of mesh and staple-line breakdown. The gallbladder was still present in 175 patients; of these, 25 had gallstones and underwent a cholecystectomy at the time of gastroplasty. Of the other 150, symptomatic gallstones subsequently developed in 13. At 12 months after gastroplasty 80% of patients had lost at least 50% of excess weight and at 24 months 83% had lost 50% or more of excess weight (15 patients lost to follow-up). To avoid failures, the collar circumference should not be more than 5.0 cm. A small experience suggests that revision of a failed horizontal gastroplasty to vertical banded gastroplasty is hazardous.

Adolescent↗