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Biomedical subjects

M Deitel

Publications and source records attributed to M Deitel.

At least 109 records · Page 6Linked to original sources
PubMed1985

The Angelchik antireflux prosthesis.

A silicone collar containing circumferential tape was tied around the cardio-esophageal junction in eight patients with symptomatic, refractory reflux, who were not good candidates for a standard antireflux procedure. A fine polypropylene tie or clip secured the knot. In two patients with large hiatal defects, the crura were approximated loosely. Mean operating time, including one cholecystectomy and one ventral hernia repair, was 51 minutes. Patients who underwent this simple operation had a combination of hypertension, heart disease, obesity and old age, and two had undergone horizontal gastroplasty previously for morbid obesity. The reflux was associated with hiatal hernia in seven of the eight patients. Preoperative studies included barium swallow roentgenography in all eight patients, and endoscopy, manometry and Bernstein test in six. All the studies were repeated postoperatively. Follow-up ranged from 17 to 48 months (mean 37.8 +/- 10.6 months). Postoperatively, there was a significant (p less than 0.01) improvement in symptoms, endoscopic findings and lower esophageal sphincter pressures. No prosthesis has migrated yet.

Adult↗
PubMed1984

"Pink urine" in morbidly obese patients following gastric partitioning.

A pink coating on the inner surface of plastic urinary tubing, which gave the impression that the urine was pink, had frequently been noted 4 to 24 hours following gastric partitioning by means of a stapler in morbidly obese patients. A study was therefore done in 187 such patients as well as in 14 patients of normal weight who had undergone abdominal surgery of comparable magnitude. Postoperatively "pink urine" was observed in 32% of the obese patients but in none of the nonobese patients; however, a pink sediment remained following centrifugation of urine collected postoperatively from all the obese patients. Microscopy of this sediment showed crystals of uric acid dihydrate; these were infrequent in the preoperative specimens but present in high concentration in the postoperative specimens, particularly those of "pink urine". X-ray diffraction analysis confirmed the nature of the crystals. Preoperatively the obese patients had high-normal serum levels of uric acid. Postoperatively in all the groups of patients the serum levels of uric acid decreased while the urine levels and the urinary clearance of uric acid increased; the last two values, however, were significantly greater, both preoperatively and postoperatively, in those who were morbidly obese. Compared with the patients who did not have "pink urine" the patients with "pink urine" were significantly more obese and had a significantly lower postoperative urine pH. The latter also had a marked postoperative increase in urine osmolality and were the only patients to have a significant postoperative decrease in urine output. Thus, the pink colour of this group's urine was attributed to precipitation of uric acid crystals, fostered by a decrease in pH and an increase in concentration of the urine.

Adult↗
PubMed1984

Treatment of tuberculous masses in the neck.

Tuberculous cervical lymphadenitis was diagnosed in 23 patients from 1970 to 1980; 21 of them were immigrants. The masses ranged in diameter from 1.5 to 5.5 cm. The posterior triangle was involved in 11 patients, the anterior triangle in 7 and both triangles in 5 (3 bilateral). Excisional node biopsy was performed in all. Acid-fast bacilli were identified on the smear in only 12 patients. Caseation necrosis was present in 19 specimens; the other 4 were comparable with sarcoidosis. However, all cultures grew Mycobacterium tuberculosis, which was corroborated in all by guinea-pig inoculation. No chest roentgenograms showed active pulmonary tuberculosis. Chemotherapy was given for 12 to 18 months. In three patients masses continued to enlarge for 5 months after initiation of chemotherapy, but then regressed and disappeared completely within 12 months. No recurrences were present in any patients (follow-up more than 2.5 years, mean 5.4 years).

Adolescent↗
PubMed1984

Duodenal obstruction secondary to congenital web in an adult.

Congenital duodenal web, although rare, may be more common than presently appreciated. The possibility of this condition should be considered in the differential diagnosis of duodenal obstruction in the adult. It should be treated surgically either by duodenotomy with excision of the web or by duodenojejunostomy. The results are excellent, as illustrated by the authors in their report of a 58-year-old man with this condition, who was treated by duodenojejunostomy.

Acute Disease↗
PubMed1983

A technique for gastrostomy.

A technique for gastrostomy has been described which includes circumferential, staggered interrupted sutures and an omental seal. The technique minimizes gastric necrosis and intraperitoneal leaks.

Gastrostomy↗
PubMed1983

Nutrition and the patient requiring mechanical ventilatory support.

Respiratory function in mechanically ventilated patients (VP) is adversely affected by starvation and hypermetabolic stress. These patients are more successfully managed and extubated if proper nutritional support is provided. The features of metabolism and respiratory function in VP require moderation in glucose, fat, and protein administration. In delivering energy to VP, attention must be given to nearby tracheostomy sites complicating the parenteral route and airway-cuff problems that may inhibit effective enteral feeding.

Energy Metabolism↗
PubMed1982

Abdominal surgery in patients undergoing long-term peritoneal dialysis.

Nineteen patients undergoing long-term peritoneal dialysis (LTPD) required abdominal operations--11 elective and 8 emergency. The preoperative hemoglobin level was 9.0 +/- 2.6 gm/dl, and the serum albumin was 28.8 +/- 4.9 gm/L. There was one death in the elective group (an inguinal herniorrhaphy) and four deaths in the emergency group (three spontaneous colonic perforations and one strangulated ventral hernia). Wound complications occurred in five patients. To obtain an indication of nutritional status of patients on intermittent LTPD and high-protein diets, 17 in-center patients underwent nutritional assessment, and deficiencies in delayed hypersensitivity skin testing and total lymphocyte counts were prevalent. Wounds require secure, watertight closure to prevent dialysis leakage. In elective abdominal surgery, LTPD should be carried out shortly preoperatively to delay dialysis for a few days after operation and to decrease defective platelet function. Preoperative transfusion for anemia is generally unnecessary. Drains should be avoided or removed before resumption of LTPD. Abdominal wall hernias should be repaired electively. Constipation should be avoided. Marked protein loss accompanies peritonitis. In certain instances, transfer to hemodialysis is indicated.

Abdomen↗
PubMed1981

Studies with a safflower oil emulsion in total parenteral nutrition.

The prevention of essential fatty acid deficiency and the provision of adequate amounts of energy are two major concerns in total parenteral nutrition. Since earlier preparations of fat emulsion used to supplement the usual regimen of hypertonic glucose and amino acids have widely varying clinical acceptability, a new product, a safflower oil emulsion available in two concentrations (Liposyn), was evaluated. In four clinical trials the emulsion was used as a supplement to total parenteral nutrition. In five surgical patients 500 ml of the 10% emulsion infused every third day prevented or corrected essential fatty acid deficiency; however, in some cases in infusion every other day may be necessary. In 40 patients in severe catabolic states the emulsion provided 30% to 50% of the energy required daily: 10 patients received the 10% emulsion for 14 to 42 days, 9 patients received each emulsion in turn for 7 days, and 21 patient received the 20% emulsion for 14 to 28 days. All the patients survived and tolerated the lipid well; no adverse clinical effects were attributable to the lipid infusions. Transient mild, apparently clinically insignificant abnormalities in the results of one or more liver function tests and eosinophilia were observed in some patients. Thus, the safflower oil emulsion, at both concentrations, was safe and effective as a source of 30% to 50% of the energy required daily by seriously ill patients.

Adolescent↗
PubMed1981

Maternal nutrition in pregnancy. Part I: a review.

Maternal undernutrition may result in a greater deprivation of the fetus than has previously been believed. The infant not only may be "light for dates" but also has an increased risk of perinatal disability or death secondary to gross neurologic and developmental abnormalities. This article reviews current knowledge of the energy, protein, iron, vitamin, sodium and calcium requirements in pregnancy, with special reference to the management of the underweight and overweight pregnant women.

Body Weight↗
PubMed1981

Maternal nutrition in pregnancy. Part II: the implications of previous gastrointestinal operations and bowel disorders.

Pregnant patients who have undergone a gastrointestinal operation for morbid obesity or who have active inflammatory bowel disease or hyperemesis gravidarum run a risk of undernutrition or even severe malnutrition with an increased risk of spontaneous abortion or fetal damage. This article reviews the medical and nutritional management of these gastrointestinal conditions.

Digestive System Surgical Procedures↗
PubMed1981

Nutritional support in long term intensive care with special reference to ventilator patients: a review.

Patients requiring long term intensive care and/or prolonged ventilatory support, are frequently undergoing progressive malnutrition, occasionally complicated by a hypercatabolic state. Sepsis, fever and the requirements for postoperative healing will add further nutritional demands on such patients. In contrast to starvation, critically ill patients maintained on protein-free energy-deficient diet do not adapt to utilization of their lipid to provide energy needs. Mobilization of endogenous fat stores is reduced, and this reduction leads to increased gluconeogenesis from amino acids derived from muscle protein to meet the increased energy needs. Low serum albumin, possible low surfactant production, devitalization of the alveolo-capillary membrane and impaired immunocompetence could contribute to the development of pulmonary transudation, alveolar collapse, low compliance and pulmonary infection. Such sequelae of a protein-free energy-deficient diet would delay weaning patients off prolonged mechanical ventilation. Nutritional assessment, which may be determined serially, and means of nutritional support are outlined.

Critical Care↗
PubMed1981

Management of duodenal fistulas.

A review of records of 27 patients with duodenal fistulas admitted to St. Joseph's Health Centre in Toronto since 1969, when total parenteral nutrition (TPN) was instituted, showed that in 19 patients the fistula formed after gastric resection, pyloroplasty or transduodenal sphincteroplasty. The remaining fistulas resulted from delayed presentation of perforated duodenal ulcers, trauma suffered in motor vehicle accidents and disease in neighbouring organs. Management included early nasogastric suctioning, withholding oral intake, draining the fistula contents, protecting the skin effectively, replacing fluid and electrolytes and administering TPN to suppress secretions and to promote anabolism. In seven patients who had associated duodenal obstruction in this intensely inflamed area, a gastrojejunostomy was performed. In no instance was a direct attack made on the fistula. In 25 patients (92.6%) the fistula healed spontaneously in an average of 21 days. Two patients (7.4%) died with patent fistulas. It appears that a direct surgical attack on duodenal fistulas is rarely necessary. With appropriate management, the majority will heal spontaneously. Total parenteral nutrition is the cornerstone of therapy and gastrojejunostomy is invaluable in certain cases.

Adolescent↗
PubMed1980

Treatment of parotid neoplasms.

Over a 25-year period 124 patients were admitted to St. Joseph's Hospital, Toronto with parotid neoplasms; 102 had benign and 22 had malignant lesions. Of 75 pleomorphic adenomas, 26 were enucleated and 11 of them (42%) recurred; no instances of recurrence followed parotidectomy. In 19 patients with Warthin's tumour there were no recurrences following any of the methods of excision. Mucoepidermoid carcinoma occurred in nine patients; eight tumours were of low-grade malignancy. All were treated by parotidectomy and there were no recurrences. Four patients had malignant mixed tumour--two with long-standing parotid masses; in three patients this malignant tumour occurred years after regional radiotherapy. Facial weakness was permanent in three patients after total parotidectomy. The correct treatment of parotid neoplasms is superficial parotidectomy or, for deep lobe tumours, total parotidectomy. Radiotherapy is used for unresectable or suspected residual carcinoma.

Adenolymphoma↗