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Biomedical subjects

R A Forse

Publications and source records attributed to R A Forse.

At least 109 records · Page 6Linked to original sources
PubMed1979

Protein malnutrition following intestinal bypass for morbid obesity.

Intestinal bypass surgery, performed for weight reduction in the morbidly obese patient, is frequently complicated by the development and hepatic complications. In 44 morbidly obese individuals, 55 inches of proximal jejunum were anastomosed, end to side, to 5 inches of distal ileum. All the patients were followed with body composition measurements, performed by multiple isotope dilution, prior to and at regular time intervals following bypass surgery. In 33 patients a decrease in body fat accounted for the entire postbypass weight loss, while the lean body mass remained normal in both size and composition. In these patients, at 1 year, body weights had decreased by 24.4 +/- 2.1%, while the body cell masses had decreased by 2.1 +/- 7.1%. In the remaining 11 patients, the postbypass weight loss resulted from a loss of both body fat and body cell mass. Their body weights at 1 year had decreased by 27.0 +/- 3.0%, while the body fat and body cell mass. Their body weights at 1 year had decreased by 27.0 +/- 3.0%, while the body cell masses decreased by 22.0 +/- 6.1%. Furthermore, their body compositions were characteristic of protein malnutrition with a contracted body cell mass and an expanded extracellular mass. Six of these 11 patients have required admission to hospital on 10 occasions because of malaise, anorexia, debilitating weakness, hypokalemia, and abnormal liver function. They were treated for 14.5 +/- 1.9 days with an intravenous infusion of amino acids without additional nonprotein calories. The body composition, initially characteristic of malnutrition, became normal. Their symptoms disappeared and hepatic function returned to normal. Subsequently a high-protein diet was required to prevent a recurrence of symptoms and to maintain a normal body composition. The data indicate that protein malnutrition developed in 11 of 44 patients undergoing jejunoileal bypass for weight reduction.

Adult↗
PubMed1978

Mediastinoscopy for diagnosing diseases of the lung other than primary carcinoma.

Mediastinoscopy is an efficient method of assessing lymphatic spread in carcinoma of the lung. It is also valuable in providing a definitive diagnosis of other lung diseases. At the Montreal Chest Hospital Centre diagnostic mediastinoscopy was performed in 60 patients with diseases of the lung other than primary carcinoma. All had preoperative radiologic evidence of hilar adenopathy. A definitive diagnosis was obtained in 91.7% of cases. Nonspecific adenitis was diagnosed in four patients and in none was there evidence of serious intrathoracic disease subsequently. Morbidity was minimal and there were no deaths. Mediastinoscopy is a safe, accurate and efficient aid in the evaluation of primary or secondary disease of the anterior intrathoracic lymphatic system.

Adolescent↗
PubMedDate not supplied

Laparoscopy/thoracoscopy for staging: I. Staging endoscopy in surgical oncology.

The application of laparoscopy to the staging of solid abdominal tumors is reviewed. The current evidence support the use of laparoscopy particularly in hepatic tumors. There is evidence that the hospital length of stay for a patient with a nonresectable hepatic tumor can be reduced from 5.6 +/- 0.4 days with a laparotomy to 1.5 +/- 0.3 days with a laparoscopy. Where the palliative and bypass issues are not limiting, cases of pancreatic and gastric carcinoma also appear to benefit in having a staging laparoscopy before a formal laparotomy for resection. Current instrumentation does produce limits, but with future prospects of laparoscopic ultrasound, and tumor staining, staging laparoscopy will become an important diagnostic tool in surgical oncology.

Abdominal Neoplasms↗
PubMedDate not supplied

Laparoscopic surgery for colon and rectal cancer.

Laparoscopic techniques are now being applied to increasing numbers of general surgical procedures. Technical feasibility, margins, number of lymph nodes, and recurrence rates need to be assessed with the application of this new technique to colon or rectal malignancies. Technically, the right colon, sigmoid, and proximal rectum appear to be the most amenable to laparoscopic assisted or complete laparoscopic resection. Early results from a registry of laparoscopic assisted colectomies shows that there is no significant difference in the number of lymph nodes in the lymphovascular bundle compared to conventional colon resections. Early retrospective reports indicate that there may be a significant decrease in post op length of stay. We conclude that the technique of laparoscopic assisted colectomy for colon or rectal cancer needs to follow the same oncologic principles as that of conventional surgery, and ultimately a trial will be needed to compare conventional and laparoscopic cancer resections of the large bowel.

Colectomy↗
PubMedDate not supplied

Body composition changes in patients with human immunodeficiency virus infection.

Malnutrition characterized by weight loss and often extreme wasting generally develops when patients progress from infection with human immunodeficiency virus (HIV) to AIDS. There is evidence that before the development of AIDS, HIV-infected patients without weight loss show early signs of malnutrition, defined as an increase in the ratio of extracellular mass (ECM) to body cell mass (BCM). As part of a dietary intervention study, body composition measurement were obtained at baseline and after 6 wk in 18 patients with HIV infection and CD4 counts between 140 and 740 cells/mm3. Only one patient had a prior weight loss (3.7 kg); patients gained 2 pounds after 3 wk of dietary supplementation of 500 kcal daily. Bioelectrical impedance was used to measured body compartments. The average ECM/BCM ratio (0.77 +/- 0.13) was within the normal range (0.83 +/- 0.16) indicating the absence of malnutrition by this criterion. Most measurements of BCM (kg) approximated normal values, while several for BCM (kg) exceeded normal. BCM (kg) correlated poorly with the ECM/BCM ratio (r2 = 0.08; P = 0.11) in contrast to ECM (kg), which was well correlated (r2 = 0.82; P = 0.00). In addition, there was a significant correlation of body mass index (BMI) with the ECM/BCM ratio (r2 = 0.38; P = 0.00) and with ECM (r2 = 0.244; P = 0.003) indicating that overweight patients may be more likely to be considered malnourished than normal weight patients using this ratio. Without use of bioelectrical impedance, these subtle changes might be missed. Once significant weight loss has occurred coupled with decreases in BCM (kg), the ECM/BCM ratio may be more reflective of malnutrition. These conjectures will require prospective evaluation, but for now it seems reasonable to include bioelectrical impedance as a potentially useful tool in the evaluation of malnutrition in this population.

Adult↗
PubMedDate not supplied

Anastomotic and regional blood flow following esophagogastrectomy in an opossum model.

Adenocarcinoma of the esophagus is increasing in incidence. The primary treatment is surgical resection, which is associated with considerable risk of anastomotic dehiscence and stricture. Decreased blood flow has been suggested as one of the factors contributing to these anastomotic failures. Our hypothesis was that anastomotic blood flow was decreased secondary to gastric and esophageal mobilization and would be increased by endogenous nitric oxide. Five opossums underwent esophagogastrectomy. Gastric and esophageal blood flow was measured following laparotomy, esophageal and gastric mobilization, esophagogastric resection and anastomosis, and L-arginine infusion. Radioactive microspheres were used to measure blood flow in the mucosa and muscularis of the esophagogastric anastomosis, esophagus, and stomach. Contrary to our hypothesis, blood flow in the anastomosis was maintained if not increased following esophagogastrectomy. However, the blood flow to the gastric mucosa adjacent to the anastomosis may be decreased. This suggests a possible redistribution of gastric blood flow to supply the anastomosis. If prolonged, this may contribute to poor anastomotic healing. L-Arginine infusion had no effect on blood flow at the anastomosis.

Anastomosis, Surgical↗
PubMedDate not supplied

Nutritional management of hypoglycemia.

PURPOSE: People with type 1 diabetes who follow an intensive management program have an increased risk of hypoglycemia, particularly overnight. New strategies for the nutritional management of hypoglycemia are essential. METHODS: The unique properties of foods that affect blood glucose are reviewed, with special attention to a new medical food bar designed to reduce the incidence of nocturnal hypoglycemia. RESULTS: All carbohydrate-containing foods affect blood glucose, but each causes a different rise in concentration. Consuming a variety of conventional foods with different glycemic indices can help control hypoglycemia. A new medical food bar that provides a sequential triphasic release of glucose from sucrose, protein, and uncooked cornstarch can help control blood glucose levels. CONCLUSIONS: Hypoglycemia can be avoided by consuming foods with varying glycemic indices. A new medical food bar that provides sequential release of glucose into the bloodstream may also help control blood glucose levels.

Diabetes Mellitus, Type 1↗
PubMedDate not supplied

Sites of conditional essential fatty acid deficiency in end stage liver disease.

BACKGROUND: End stage liver disease (ESLD) is a devastating illness. Its protean manifestations involve many different aspects of disturbed hepatic function. One consequence of ESLD is a decrease in plasma levels of very long chain polyunsaturated fatty acids (VL-PUFAs), particularly arachidonic acid (AA) and docosahexaenoic acid (DHA), the former important for eicosanoid metabolism and the latter for retinal and brain membrane structure. The purpose of this study was to define the VL-PUFA changes in liver disease by comparing plasma and tissue levels of VL-PUFAs in controls to patients with ESLD. METHODS: Fatty acid profiles from plasma, red blood cell (RBC) membranes, muscle, liver, and fat tissue from ESLD patients undergoing liver transplants were measured and compared with control patients undergoing elective liver resection. RESULTS: Fatty acid profiles from plasma and RBC membranes showed significant decreases in AA and DHA levels in patients with ESLD compared with controls. However, there were no significant differences in tissue fatty acid composition between ESLD patients and controls. CONCLUSIONS: ESLD affects the liver's ability to maintain circulating levels of AA and DHA, and thereby presumably RBC membrane levels. However, solid tissues appear not to be affected by ESLD. Although the mechanism for these changes remains to be defined, it is consistent with hepatic impairment of elongation and desaturation to produce VL-PUFA for transport. The present results also suggest that dietary interventions to include preformed VL-PUFA rather than their precursors, linoleic and alpha linolenic acid, would be needed to normalize plasma VL-PUFA levels in patients with ESLD.

Arachidonic Acid↗
PubMedDate not supplied

Serum albumin and nutritional status.

Serum albumin concentration is frequently used to define nutritional status. To validate this relationship, 161 body composition studies were performed on 102 patients simultaneously with protein electrophoresis. The body cell mass represented by the exchangeable potassium to total body water ratio correlated significantly (p < 0.001) with the serum albumin concentration (r = 0.59) and significantly (p < 0.001) to total protein (r = 0.59). However, in both cases the 95% confidence limits about the regression were wide. In 24 of 54 patients (44%) with a normal nutritional state, as defined by body composition, the serum albumin was abnormal. In 12 of 107 (11.2%) patients with malnutrition, the serum albumin was normal. Patients with more than one study were divided into 3 groups depending on the changes in their nutritional state as defined by their body composition. Serum albumin did not consistently reflect the significant body compositional changes observed. The data indicate that serum albumin is a valid measure of nutritional state for epidemiological surveys. However, due to the low sensitivity and specificity it is a poor parameter for evaluating the individual patient's nutritional state.

Body Composition↗
PubMedDate not supplied

Total parenteral nutrition with Vamin and Intralipid.

The present study was undertaken to evaluate the efficacy of total parenteral nutrition (TPN) with a solution containing 10% fructose and 7% crystalline amino acid (Vamin), administered with equal volumes of a 10% soybean oil emulsion (Intralipid). The two solutions are available in separate sterile containers and therefore solution preparation is not required. Because the 10% Intralipid emulsion is isotonic, a central venous catheter is no required. Patients referred for TPN were randomly allocated to receive either the Vamin and Intralipid combination or a solution containing 2.5% L-amino acids (Travasol) and 25% dextrose. The efficacy of each solution was assessed by determining body composition of multiple isotope dilution, at the onset, at 2-week intervals during, and at the completion of, TPN. In 49 patients receiving Vamin and Intralipid, 109 body composition studies were performed to evaluate 61 periods of TPN of 14.6 +/- 0.5 days duration. One hundred and sixty-seven studies were performed in 73 patients receiving TPN with hypertonic dextrose to evaluate 92 periods of TPN of 15.3 +/- 0.5 days. In the absence of preexisting malnutrition, both solutions maintained body composition. In the presence of preexisting malnutrition, TPN with the Vamin and Intralipid combination maintained, but did not improve, body composition. However, TPN with the hypertonic dextrose solution resulted in a significant improvement in the nutritional state with an increase in the body cell mass, a accompanied by a contraction of the extracellular mass, accompanied by a contraction of the extracellular mass. Conventional TPN with 2.5% crystalline amino acids and hypertonic dextrose was superior to TPN with Vamin and Intralipid.

Amino Acids↗
PubMedDate not supplied

Response to total parenteral nutrition in the extremely malnourished patient.

Changes in serum albumin levels and body weight are often used as indicators of the efficiency of a nutritional support regimen. Patients with moderate nutritional depletion demonstrate two distinct patterns of response during refeeding. The first is characterized by a decrease in the previously expanded extracellular fluid space with a rise in serum albumin and a loss of weight and the second by continued fluid retention with weight gain and no rise in serum albumin concentration. The second pattern has been observed in patients with ongoing stress such as infection. This study examines severely malnourished patients with no apparent inflammatory complications and demonstrates that this group responds to nutritional support in a pattern similar to that seen in the stressed patient. Eight patients with profound malnutrition were studied during the 1st week of nutritional support. Nitrogen balance was measured and the findings confirmed that all patients were anabolic. Sodium balances were used as an indicator of changes in the extracellular fluid compartment. Body weight and serum albumin were assessed daily. Body weight increased from 59 +/- 4 to 62 +/- 4% of normal (p less than 0.01) while serum albumin changed insignificantly (3.00 +/- 0.27 to 2.85 +/- 0.23 g/100 ml, NS) during the initial week of an adequate nutritional support regimen (nitrogen balance was +21.0 +/- 4.3 g, p less than 0.05). These changes were associated with a positive sodium balance (+215 +/- 20 mEq, p less than 0.05). These data confirm that some extremely malnourished patients do not experience a diuresis during the initial phase of nutritional support but rather may retain water and increase body weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Comparison of gas exchange measurements with a mouthpiece, face mask, and ventilated canopy.

This study compared gas exchange measurements obtained by using a mask, mouthpiece, and ventilated canopy in 30 normal, healthy volunteers. The ventilated canopy and its gas analyzers had an accuracy for oxygen consumption of 98.0 +/- 0.8% and for carbon dioxide production of 100.1 +/- 1.1%. The study indicates that the apparatus used for gas exchange measurement will significantly affect the measurements. The magnitude of the effect is a significant 7.9% increase for oxygen consumption with a mouthpiece and a significant 7.1% increase with a face mask. Carbon dioxide production was significantly increased 10.2% with a mouthpiece and 4.1% with a face mask. There were no differences in the respiratory quotient. The specific purpose for collecting gas exchange measurements will determine whether these differences are of practical significance.

Adult↗