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Biomedical subjects

W J Pories

Publications and source records attributed to W J Pories.

17 recordsLinked to original sources
PubMed1992

Surgical treatment of obesity and its effect on diabetes: 10-y follow-up.

Since 1980 we have performed the identical Greenville gastric bypass (GGB) procedure on 479 morbidly obese patients with an acceptable morbidity and a mortality rate of 1.2%. The weight loss in the series was well maintained over the follow-up period of 10 y. The GGB can control non-insulin-dependent diabetes mellitus (NIDDM) in most patients. The group of 479 patients included 101 (21%) with NIDDM and another 62 (13%) who were glucose impaired. Of these 163 individuals, 141 reverted to normal and only 22 (5%) remained with inadequate control of their carbohydrate metabolism. Those patients who were older or whose diabetes was of longer duration were less likely to revert to normal values. The gastric bypass operation is an effective approach for the treatment of morbid obesity. Along with its control of weight, the operation also controls the hyperglycemia, hyperinsulinemia, and insulin resistance of the majority of patients with either glucose impairment or frank NIDDM.

Adult↗
PubMed1992

Is type II diabetes mellitus (NIDDM) a surgical disease?

Since February 1, 1980, 515 morbidly obese patients have undergone the Greenville gastric bypass (GGB) operation. Of these, 212 (41.2%) were euglycemic, 288 (55.9%) were either diabetic or had glucose intolerance, and 15 (2.9%) were unable to complete the evaluation. After the operation, only 30 (5.8%) patients remained diabetic (and 20 of these improved), 457 (88.7%) became and have remained euglycemic, and inadequate data prevented classification of the other 28 (5.4%). The patients who failed to return to normal glucose values were older and their diabetes was of longer duration than those who did. The effect of the GGB was not only limited to the correction of abnormal glucose levels. The GGB also corrected the abnormal levels of fasting insulin and glycosylated hemoglobin in a cohort of 52 consecutive severely obese patients with non-insulin-dependent diabetes. The GGB effectively controls weight. If morbid obesity is defined as 100 pounds over ideal body weight, 89% of the patients are no longer "morbidly" obese within 2 years. In most patients, the control of the weight has been well maintained during the 11 years of follow-up; most of the upward creep in weight of 20.8% between 24 and 132 months was from the 49 (9.5%) patients who had staple line breakdowns between the large and small gastric pouches. Non-insulin-dependent diabetes, previously considered a chronic unrelenting disease, can be controlled in the severely obese by the gastric bypass. Whether the correction of glucose metabolism affects the complications of diabetes is unknown. Whether the gastric bypass should be considered for patients with advanced non-insulin-dependent diabetes but who are not severely obese deserves consideration. The GGB has an unacceptably high rate of staple line failure. Accordingly, the authors have recently changed their procedure to one that divides the stomach rather than partitions it with staples.

Adolescent↗
PubMed1991

Long-term studies of mental health after the Greenville gastric bypass operation for morbid obesity.

From February 1, 1980, to May 1, 1989, 462 patients underwent the Greenville gastric bypass at the East Carolina University School of Medicine. The operation effectively maintained satisfactory weight loss after 9 years (mean weight preoperatively, 293 lbs; at 24 months, 179 lbs; at 96 months, 194 lbs). The gastric bypass favorably affected non-insulin-dependent diabetes, hypertension, and physical and role functioning. In the most recent 157 patients, our studies were extended to study the effects of the gastric bypass on mental health. The significant improvements in mental health indices that were observed 6 and 12 months after surgery eroded by the end of 2 years. This return of the mental health indices to the preoperative status, plus the late occurrence of 3 suicides and 2 deaths from alcohol abuse among the total 462 patients, suggest that long-term follow-up and continued emotional support are essential ingredients for successful bariatric surgery.

Adult↗
PubMed1991

Decreased expression of glucose transporter in muscle from insulin-resistant patients.

We have observed that in vitro incubated human muscle fiber strips from obese patients with or without non-insulin-dependent diabetes mellitus (NIDDM) have reduced insulin-stimulated glucose transport rates compared with nonobese control patients. To investigate if the decrease in glucose transport is associated with a depletion of glucose transport protein, we performed Western blot analysis of muscle samples from nonobese control, obese nondiabetic, and obese NIDDM patients to measure the levels of the muscle-adipose tissue glucose transporter (GLUT-4) protein. Glucose transporter protein was depressed by 23% in the obese nondiabetic and 18% in the obese NIDDM group. The results were essentially the same in the rectus abdominus and vastus lateralis muscles. These data suggest that the decreased glucose transport rate observed in muscle of these obese patients with or without NIDDM may be due, at least in part, to a decreased expression of the "insulin-sensitive" (GLUT-4) glucose transporter. This alteration may play a role in the insulin resistance seen in obesity and diabetes.

Diabetes Mellitus↗
PubMed1991

Adipose tissue glucose transporters in NIDDM. Decreased levels of muscle/fat isoform.

We investigated the mechanism of peripheral insulin resistance in the adipose tissue of obese and non-insulin-dependent diabetes mellitus (NIDDM) patients at the level of the glucose-transport effector system. Freshly isolated adipocytes from obese nondiabetic and obese NIDDM subjects had decreased insulin sensitivity and responsiveness for glucose-transport stimulation compared with control subjects, with more pronounced changes associated with obese NIDDM patients. The relative abundance of muscle/fat glucose-transporter isoform in the three groups of subjects was determined by Western-blot analysis of detergent-soluble adipose tissue extracts with monoclonal antibody 1F8. Obesity per se had no effect on adipose tissue muscle/fat glucose-transporter isoform (3150 +/- 660 vs. 4495 +/- 410 counts/min [cpm]/mg protein). Furthermore, decreased levels of muscle/fat isoform in adipose tissue of NIDDM patients were also reflected in isolated adipocytes. Our results demonstrate that insulin resistance in isolated adipocytes of NIDDM patients could at least partly be due to a significant depletion of adipose tissue muscle/fat glucose-transporter isoform.

Adipose Tissue↗
PubMed1979

Stewart-Treves syndrome. A lethal complication of postmastectomy lymphedema and regional immune deficiency.

Lymphangiosarcoma is a fatal complication of postmastectomy lymphedema. The pathogenesis of lymphangiosarcoma in chronic lymphedema is a combination of two factors. First, the edematous region responds in a manner similar to "immunologically privileged sites." Second, because of its anatomic and physiologic properties, it is a favorable site for the development of mutant cell populations for reasons that are not fully understood. As a result, these mutant cells, with their genetically nonidentical antigens, escape recognition by the host's impaired immune surveillance mechanism. The failure to promote a sufficient immune response allows unrestricted tumor growth to take place, resulting in the ultimate death of the patient. Available therapeutic measures are equally unsatisfactory. Emphasis is placed on periodic examination of the lymphedematous extremity, aggressive treatment of established lymphedema and infections, and surgical preservation of lymphatic channels during breast cancer surgery.

Aged↗
PubMed1979

Mineral metabolism of the healing arterial wall.

The mineral metabolism of healing arterial walls was studied by measuring the accumulation of several radioisotopes at the site of vascular repair in rats. Each rat was subjected to a 1-cm full-thickness aortotomy and then immediately injected by tail vein with c 5 muCi of one of the following radioisotopes: chromic chloride Cr 51 or sodium chromate Cr 51; ferrous chloride Fe 59 or ferric chloride Fe 59; manganous chloride Mn 54; selenious acid Se 75; strontium chloride Sr 85; or zinc chloride Zn 65. At intervals of 1, 2, 4, 6, and 10 days after operation and injection, groups of four rats for each radioisotope were killed, aortas dissected, and the specific radioactivity of healing vascular tissue compared with that of adjacent normal artery. There were sharp and statistically significant differences in the preferential accumulation of the radioisotopes in healing compared with normal aorta. Zinc appeared to be the element most involved in vascular repair, followed by selenium and chromium.

Animals↗
PubMed1978

[Mammary carcinoma (author's transl)].

The new discoveries concerning mammary carcinoma promise hope and offer surgeons a demanding challenge. Many more opportunities can now be offered to patients suffering from this dreaded disease, including new diagnostic methods, a wide range of operations, various adjuvant applications of radiotherapy and chemotherapy, a wholly new armamentarium of hormonal and chemical approaches to advanced disease, cosmetic reconstruction, and gentle terminal care. Some of the new findings are true breakthroughs, others remain mirages. Especially in the choice of the type of mastectomy, surgeons must be cautious: The new is not necessarily the best.

Antineoplastic Agents↗
PubMed1978

Incidental cholecystectomy during major abdominal surgery in the elderly.

Forty-four elderly patients with an average age of seventy-eight years were found to have cholelithiasis during unrelated major abdominal surgery. Thirty-nine of them underwent incidental cholecystectomy, one had cholecystostomy, and four had no surgical treatment of their gallbladder disease. Of the thirty-nine patients with an incidental cholecystectomy, none died and only sixteen had nonfatal complications. Of these complications, only one was clearly related to the cholecystectomy and resolved spontaneously. The results compare favorably with other reports of similar procedures in elderly patients. Incidental cholecystectomy does not seem to significantly alter the mortality and morbidity of elderly patients undergoing major abdominal surgery. We advocate incidental cholecystectomy for cholelithiasis in elderly patients as long as the gallbladder is easily accessible and the condition of the patient warrants the additional procedure.

Abdomen↗
PubMed1977

Implications of the inhibition of animal tumors by dietary zinc deficiency.

Because zinc is an essential nutrient for tissue growth, cellular division, protein synthesis, and DNA and RNA replication, it also ought to play a critical role in the growth of tumors. To test this thesis, a series of experiments were performed to test the effect of zinc deficiency on the lethality of a variety of solid and ascites tumors in mice and rats. Specifically, the following models were tested: Walker 256 carcinosarcomas, solid and ascites forms in rats; three mouse leukemias (L5178yf, L1210, and P388) in CDF, male mice; and Lewis lung carcinoma in C57BI/6 male mice. Rats receiving a zinc-deficient diet showed marked reduction of tumor growth, both of solid or ascites models, and this was accompanied by striking increase in survival. Survival of mice with transplanted leukemia was also significantly prolonged by zinc deficiency. In addition, growth of the Lewis lung carcinoma was inhibited, but the survival through increased, was probably limited by the adverse effects of zinc deficiency. The results suggest that tumor inhibition is a general effect of zinc deficiency, irrespective of cell type, cell growth rate, species, or site of growth. There are numerous potential applications of zinc metabolism to the diagnosis, therapy, and understanding of cancer.

Animals↗
PubMed1976

External diversion for palliative treatment of malignant tracheoesophageal or bronchoesophageal fistulas.

The creation of cervical esophagostomy, distal esophageal ligation, and a feeding gastrostomy in combination with an external bypass device for the treatment of malignant tracheoesophageal and bronchoesophageal fistulas offers a simple and rational approach for a critical situation in which more extensive surgical procedures are neither warranted nor more effective.

Bronchial Fistula↗
PubMed1976

Extra-anatomic bypasses for aortoiliac disease in high-risk patients.

A series of 75 patients, with an average age of 65 years, underwent the following extra-anatomic bypasses involving the crossover femorofemoral principle: femorofemoral (F-F), 54 patients; aortofemorofemoral (A-F-F), 12 patients; common iliac-femorofemoral (CI-F-F), six patients; and axillofemorofemoral (Ax-F-F), three patients. Fifty eight of the 75 patients (77 percent) initially presented with rest pain or gangrene. The operative mortality rate in this high-risk group of patients was 4 percent. Analysis by the life-table method showed the graft patency rate to be 91.1 percent at one year and 87.4 percent at 18 months. There have been no graft failures or deaths in the series of 20 patients followed longer than 18 months. Two amputations followed graft failures and nine of the remaining 11 amputations were done in patients with patent grafts during the same period of hospitalization, reflecting the severity of their gangrene upon admission. High-risk patients who are not suitable for crossover F-F grafts without an inflow procedure may be suitable for a CI-F-F or A-F-F bypass before being considered for an Ax-F-F bypass.

Adult↗
PubMed1975

Cardiac tamponade.

Cardiac tamponade is an insidious and often fatal complication which can occur on any service, in many diseases, and at any age. The increasing pressure within the pericardium prevents ventricular filling and depresses cardiac output, coronary and systemic perfusion, and venous return. Compensatory mechanisms may protect the patient for some time, but prompt diagnosis and rapid decompression are usually required and must be followed by meticulous evaluation and treatment of the underlying disease.

Cardiac Tamponade↗
PubMed1975

Arterial-venous magnesium gradients in hypovolemic shock: an indication of the irreversible state.

Arterial-venous magnesium differences were examined in mongrel dogs stressed with reversible and lethal hypovolemia. Increases in serum Mg with hemorrhage have long been known to occur in both humans and animals, yet, increased blood Mg levels have not been viewed as an indicator of the irreversible shock state. The magnesium gradient was shown to be a good indicator of cell destruction which is consistent with lethal shock.

Animals↗