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Biomedical subjects

R E Brolin

Publications and source records attributed to R E Brolin.

At least 73 records · Page 4Linked to original sources
PubMed1987

Results of obesity surgery.

Assessment of the outcome of obesity operations is exceedingly complex. Currently there is no consensus among bariatric surgeons as to what constitutes successful weight loss. Furthermore, weight loss data must be regularly reevaluated to account for later regaining of lost weight. There is no question that surgically-induced weight loss results in improvement or resolution of obesity-related medical problems in most patients. Yet it is not known whether sustained long-term weight loss will result in extended amelioration of these medical problems. Analysis of outcome is further complicated by difficulties in maintaining consistent long-term follow-up in such a way that the benefits of weight loss can be objectively evaluated. The next decade should provide improvements in a number of these problem areas. The new computer registry of the American Society of Bariatric Surgery has access to thousands of bariatric surgical patients. This registry will hopefully provide for some standardization in analysis and reporting of results of bariatric operations. The registry may eventually be able to provide the type of actuarial analysis of long-term results necessary to assess the true impact of bariatric operations on the morbidity and mortality risks associated with morbid obesity. It is also probable that more sophisticated patient selection methods will improve the likelihood of successful weight loss both by excluding patients who are prone to failure and by identification of patient profiles that are better suited for treatment by one type of operation over another. In the final analysis, there is no question that morbid obesity poses an increased risk to health and longevity. Thus it is only logical that substantial weight loss in this group of patients could be expected to improve both longevity and quality of life, provided that the treatment methods employed are free of serious side-effects. At present, surgery offers the only realistic hope for successful weight loss in the morbidly obese.

Actuarial Analysis↗
PubMed1987

Myoelectric assessment of bowel viability.

A device capable of quantitative measurement of intestinal ischemic damage has been designed. The device is called the electrical contractility meter and employs a clip-on strain gauge transducer that delivers a precisely controlled electrical stimulus to the bowel. Threshold stimulus level (TSL) is the stimulus current in milliamperes (mA) that is necessary to produce a clearly defined smooth-muscle contraction. In 30 dogs, TSL was used to establish viability boundaries in 40 cm ischemic bowel segments. Bowel viability was assessed with the use of TSL in comparison with gross features (color, peristalsis) and blood flow measured by means of Doppler ultrasound at 2 cm intervals in the ischemic small-bowel segments. The TSL scale ranges to 100 mA and varied from a low of 22 +/- 2 mA in normal bowel outside the ischemic segment to 97 +/- 4 mA in grossly gangrenous bowel. There was a consistent correlation between rising TSL and worsening bowel color, disappearance of visible peristalsis, and progressive disappearance of audible Doppler signals. Resection and anastomosis were performed in three groups of 10 dogs at TSL measurements of 30 mA, 40 mA, and 50 mA, respectively. Dogs were killed and anastomoses were inspected on the tenth postoperative day. There were no leaks at TSL = 30 mA, one leak at TSL = 40 mA, and four leaks at TSL = 50 mA. The number of leaks at TSL = 50 mA was significantly greater than at TSL = 30 mA (p less than 0.04, Fisher's exact test). These results show that the quantitative myoelectric parameters established by this device provide a reliable in vivo assessment of bowel viability. The electrical contractility meter is easy to use and may have clinical applicability.

Animals↗
PubMed1987

The influence of debt, moonlighting, practice, oversupply and gender on career development of residents in university and independent training programs.

A survey of chief residents in general surgery was conducted to evaluate debt and moonlighting, planned practice characteristics, the influence of oversupply and gender. Debt and moonlighting were closely related. The latter also correlated statistically with the perceived oversupply of general surgeons. Most residents planned to practice in a suburban area, in a community or university affiliated hospital with some teaching responsibilities. General surgeons were those more likely to choose a rural area, a community hospital and no teaching responsibilities. Subspecialists were those more likely to choose an urban area, a university hospital and a complete teaching environment. Two-thirds of residents thought there was an oversupply of general surgeons. They were more likely to take fellowships, especially those in transplantation, vascular, trauma, oncologic and colorectal surgery. Women represented less than 10 per cent of chief residents. They differed from men in the types of fellowships chosen, moonlighting activity and interest in teaching.

Adult↗
PubMed1987

Disseminated atheroembolism from extensive degenerative atherosclerosis of the aorta.

The surgical management of disseminated atheroembolism was studied in seven patients. The diagnosis of disseminated atheroembolism from extensive degeneration of the thoracic and abdominal aorta was based on clinical evidence of cutaneous atheroembolism, angiographic demonstration of irregular aortic plaques, and findings of cholesterol emboli in tissue specimens. All patients had severe cardiopulmonary disease. In four cases treatment consisted of palliative axillobifemoral bypass with ligation of the external iliac arteries to exclude the proximal aortic source of emboli to the feet. Three patients underwent intestinal resection for visceral atheroembolism. Permanent access for hemodialysis was required in four patients. All patients died within 6 months of the diagnosis of disseminated atheroembolism. Surgical therapy has three roles in disseminated atheroembolism: prevention of further atheroembolism with its attendant peripheral or visceral organ damage; amputation or resection of irretrievably damaged tissue; and provision of chronic hemodialysis access. The optimal treatment is thoracoabdominal reconstruction of the aorta. In the high-risk patient, axillobifemoral bypass with iliac ligation may be used to treat recurrent painful atheroembolism to the feet. Continuing atheroembolism to the visceral and pelvic circulation, renal failure, and progressive asthenia are associated with the poor prognosis of patients with this disease.

Aged↗
PubMed1986

Quantitative myoelectric determination of bowel viability.

A new device designed to quantitatively measure viability in ischemic bowel was studied in 20 dogs. This strain gauge device is clipped on the serosal surface and can rapidly deliver an electrical stimulus. The threshold stimulus level (TSL) was the stimulus necessary to produce a clearly defined smooth muscle contraction. TSL was compared with blood flow measured by Doppler ultrasound at 2-cm intervals in 30-cm ischemic segments as a determinant of bowel viability. Doppler readings were taken from the bowel wall (BW), peripheral arteriolar branches of the marginal artery (PA), and marginal artery (MA), itself, at each 2-cm interval. Bowel color and peristalsis were correlated with Doppler and TSL data. TSL scale ranged from 0 to 100 mA and varied from 21 +/- 2 mA in normal bowel to 98 +/- 2 mA in gangrenous bowel. At the locus of the last audible Doppler signal in the BW, PA, and MA, mean TSL readings were 27 +/- 5, 34 +/- 6, and 48 +/- 16 mA, respectively. These readings were each significantly greater than the TSL of normal bowel at P less than or equal to 0.0001 level. Portions of each ischemic segment were resected and reanastomosed. Absence of Doppler signals in the BW and PA did not preclude healing of ischemic bowel. These data suggest that TSL measurement is more sensitive than either Doppler ultrasound or gross visual evaluation in assessment of bowel viability.

Animals↗
PubMed1986

Examination of the low proliferative capacity of human jejunal intraepithelial lymphocytes.

The proliferation of human jejunal intraepithelial lymphocytes (IEL) was examined to determine how it differed from that of peripheral blood (PB) T lymphocytes. The IEL were mainly T lymphocytes of the cytotoxic-suppressor (T8+) phenotype. They demonstrated lower proliferative responses to various stimuli (2,501 +/- 565 ct/min with phytohaemagglutinin; PHA) compared to unseparated PB T lymphocytes (73,678 +/- 2,495) or the T8+ subset (68,939 +/- 10,053 ct/min) (P less than 0.001). This low proliferative response was also a characteristic of the T8+ T lymphocytes in the lamina propria (4,606 +/- 1,226 ct/min) but not the T4+ subset (43,447 +/- 10,188 ct/min) (P less than 0.05). These findings were not due to isolation techniques or to differences in kinetics. Mixing experiments revealed that the IEL did not contain cells which suppressed proliferation. In addition, the IEL could be stimulated by mitogens, as they produced the same amount of interleukin 2 (IL-2) and IL-2 receptors as did PB T lymphocytes. Although the lectin-induced proliferative response of IEL was unaltered by the addition of autologous macrophages and minimally increased by IL-2, it was markedly enhanced by the addition of sheep red blood cells (SRBC). The enhancing effect of SRBC was not due to T cell recognition of xenogenic antigens on the erythrocytes since neither allogeneic non-T lymphocytes nor other xenogenic erythrocytes produced the same effect. Both intact SRBC and membrane fragments from osmotically lysed cells augmented lymphocyte proliferation. Thus, jejunal IEL could be activated by mitogen and proliferated as much as PB T lymphocytes if exposed to a membrane component found on SRBC.

Adult↗
PubMed1986

Colon interposition for extreme short bowel syndrome: a case report.

Successful use of colon interposition has not been previously reported in an adult with short bowel syndrome. This article describes the course of a 34-year-old woman who had interposition of an 18 cm segment of sigmoid colon between 5 cm of proximal jejunum and 7 cm of terminal ileum after midgut volvulus. The rationale for use of colon interposition in cases of extreme short syndrome is discussed.

Adult↗
PubMed1986

Career development of residents in university and independent training programs: the influence of special training fellowships, type of practice, specialization, and research.

General surgical chief residents in all approved training programs were surveyed to evaluate the influence of fellowships, specialization, and research. Respondents represented 76% of programs and 60% of residents. Most chief residents plan to take post-residency fellowships. This is most common among those from university training programs and residents planning an academic career. Vascular surgery and cardiothoracic surgery represent half of all fellowships. Sixty-two percent of residents plan to enter private practice compared with 28% who plan to join a medical school faculty. More than one third of university trainees plan an academic career. More than 90% plan fellowships. The practice of general surgery alone or combined with a specialty was more common among trainees from independent training programs. Practice of a subspecialty was more common among university trainees. More than 80% of residents did research during training. Research leading to publication was more common among university trainees planning academic careers and least common among future general surgeons. This survey suggests that general surgery is predominant among residents in independent training programs who then enter private practice. University programs produce subspecialists who are predominant among future academic surgeons. This trend has vital implications for the future of academic general surgery.

Adult↗
PubMed1986

Critical analysis of retained and residual common duct stones.

Two-hundred and seven consecutive patients with suspected choledocholithiasis were treated at three university-affiliated hospitals. Twenty-one patients had residual common bile duct (CBD) stones documented after previous biliary tract operations and 28 patients had retained stones in the CBD on predischarge postoperative t-tube cholangiograms. Use of operative cholangiography was analyzed to determine correlation with the incidence of retained and residual CBD stones. Operative cystic duct cholangiography was not done in any patient who developed residual stones after simple cholecystectomy. Twenty-five of the 28 patients (86%) with retained stones either left the operating room with an abnormal postexploration cholangiogram or did not have a postexploration cholangiogram. Only three patients (10%) had falsely negative postexploration t-tube cholangiograms. The percentage of abnormal postoperative CBD exploration cholangiograms that showed filling defects as opposed to ampullary obstruction was significantly higher in patients with retained stones versus patients not having retained stones (P less than or equal to 0.0009). The vast majority of cases of retained and residual stones could be attributed to poor surgical judgment regarding either use or interpretation of operative cholangiography.

Gallstones↗
PubMed1985

Gastrointestinal myoelectric activity in fasting and nonfasting canine models of ileus.

We studied postoperative gastrointestinal (GI) tract myoelectric activity (MEA) in three fasting and nonfasting models of ileus. After implantation of a gastric cannula and bipolar electrodes in the antrum, duodenum, proximal jejunum, midjejunum, terminal ileum, and ascending and descending colon, five dogs underwent ileus-producing laparotomies, including handling, in which the entire GI tract was manually crushed, obstruction, in which a distal ileal obstruction was created and released 24 hours later, and peritonitis, in which an ileal perforation was created and closed 24 hours later. The fasting 24-hour postoperative colonic MEA in the handling and obstruction models was significantly less than control levels but returned to normal by 48 hours. The nonfasting 24-hour postoperative duodenal and jejunal MEA in the obstruction model was significantly less than control levels. These significantly decreased MEA levels persisted for 72 hours. Nonfasting 24-hour postoperative ileal and colonic MEA in the peritonitis model was significantly greater than control levels and remained significantly elevated for 48 to 72 hours before returning to normal.

Action Potentials↗
PubMed1985

Gastrointestinal myoelectric activity in mechanical intestinal obstruction.

Experiments were designed to study the effect of duration of small bowel obstruction (SBO) on rate of recovery of fasting and nonfasting GI myoelectric activity (MEA) in 10 dogs. Two weeks after implantation of a gastric cannula and bipolar silver electrodes in the antrum, duodenum, proximal and midjejunum, terminal ileum, right and left colon, complete SBO was created in the distal ileum. Duration of SBO was 24 hr in group I (five dogs) and 48 hr in group 2 (five dogs). MEA was recorded on 5 consecutive postop days after creating SBO. Water (500 cc) was given via cannula 90 min after release of SBO and on subsequent days after 90 min of fasting MEA recording. Control data were pooled from MEA recordings obtained on 10th and 12th days after electrode implant, each dog serving as its own control. On the day of SBO release there were no significant differences in MEA between groups 1 and 2. Twenty-four hours after SBO release, group 2 fasting and nonfasting jejunal and ileal MEA was significantly decreased vs group 1 and control levels. These significantly decreased jejunal and ileal MEA levels persisted for 48 hr after SBO release. After water by cannula, group 2 antral MEA was significantly less than group 1 and control levels and remained at these low levels for 72 hr after SBO release. Colonic MEA in group 1 and group 2 was not significantly decreased vs control levels. These data suggest that the colon does not play a regulatory role in ileus caused by SBO. These results also imply that prolonged ileus can be avoided by early operation for mechanical SBO.

Action Potentials↗
PubMed1985

Laboratory evaluation of four techniques of stapled gastroplasty.

Four techniques of stapled gastroplasty including unreinforced horizontal gastroplasty (UHG), suture-reinforced horizontal gastroplasty (SHG), Marlex banded horizontal gastroplasty (HBG), and Marlex banded vertical gastroplasty (VBG) were studied in mongrel dogs. Twelve dogs survived operations by each technique and were killed in groups of four at 3, 6, and 12 weeks after operation. Five deaths caused by leaks occurred after UHG (one), SHG (one), and HBG (three). Disruption of the staple line occurred after UHG (four), HBG (one), and VBG (three). Mean stomal diameter at death for UHG (2.1 cm) and SHG (1.5 cm) was substantially greater than the initial diameter of 0.9 cm. Mean stomal diameter at death for HBG (1.4 cm) and VBG (1.3 cm) was only slightly larger than the initial diameter of 1.2 cm. There was no correlation between the degree of stomal dilatation and time of death. There was no evidence of erosion of Marlex through the gastric wall in dogs that survived to the time of death. These data suggest that stomal reinforcement with Marlex mesh effectively limits dilatation and is safe when sutured to itself rather than to the stomach. Reinforcement of the stapled partition with sutures may be necessary to eliminate staple-line disruption.

Animals↗
PubMed1984

Partial small bowel obstruction.

From January 1976 through December 1980, 91 patients were admitted to Middlesex General Hospital in New Brunswick, N.J. with an initial diagnosis of partial small bowel obstruction. Postoperative adhesions accounted for 79% of the cases. Eighty of the 91 patients (88%) were managed successfully by tube decompression with 67 (74%) showing clinical or radiographic improvement within the first 24 hours. The mean duration of hospitalization for the nonoperative group was 6.9 days, 5.3 days for patients managed with nasogastric tubes versus 10.8 days for those managed with long tubes (P less than or equal to 0.008). Of the 11 patients who required operation, the mean preoperative hospital stay was 7.7 days, and four patients suffered nonfatal postoperative complications. None of the 91 patients developed strangulation. A barium upper gastrointestinal series was performed in 13 cases and was reliable in the determination of the need for operative intervention in each case. More efficient treatment of partial small bowel obstruction can be accomplished with a nasogastric tube as opposed to a long tube and by earlier use of barium upper gastrointestinal contrast studies in cases that do not resolve after 48 hours of tube decompression.

Female↗
PubMed1984

Percutaneous catheter versus open surgical drainage in the treatment of abdominal abscesses.

In the past 3 years, percutaneous catheter drainage (PCD) was performed for 24 abdominal and retroperitoneal abscesses while open surgical drainage (OSD) was used for treatment of 24 similar abscesses at the affiliated hospitals of UMDNJ-Rutgers Medical School. Although the method of treatment was arbitrarily selected by the attending physician, the two groups were similar with respect to abscess location, underlying illnesses, and previous operations. In the PCD group, 17 of 24 abscesses developed after operations versus 16 of 24 in the OSD group. Location of abscesses were: PCD group: abdominal (9), renal (5), pelvic (4), subphrenic (3), hepatic (2), pancreatic (1); OSD group: abdominal (10), renal (4), subphrenic (4), pelvic (3), hepatic (2), pancreatic (1). With PCD, the abscesses were localized by ultrasound or computerized tomography scan; a 20- or 22-gauge needle passed into the cavity, followed by progressively larger guide wires, dilators, and catheters; the pus evacuated; and abscess cavity thoroughly irrigated with sterile saline. Percutaneous catheter drainage was successful in 22 of 24 cases. There were two inconsequential complications. The mean post-PCD hospital stay was 11.7 days. With OSD, five patients developed major complications, including three deaths from sepsis. The mean post-OSD stay for surviving patients was 21.2 days. The advantages of PCD versus OSD are: 1) precise noninvasive localization of abscesses, 2) avoidance of general anesthesia, 3) avoidance of major complications, and 4) shorter postdrainage hospital stay. Open surgical drainage should be reserved for cases where PCD fails to control sepsis, close fistulae, or when noninvasive scanning either fails to demonstrate a discrete abscess in the face of intra-abdominal sepsis or identifies an abscess that cannot be percutaneously drained without traversing the bowel.

Abdomen↗