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Biomedical subjects

A S McFee

Publications and source records attributed to A S McFee.

At least 19 recordsLinked to original sources
PubMed1990

A replicated five cluster MMPI typology of morbidly obese female candidates for gastric bypass.

This study clusters empirically into subgroups the preoperative MMPI profiles of morbidly obese females seeking a gastric bypass, assesses the replicability of clusters across different subject populations and tests the hypotheses that cluster inclusion bears a significant relationship to weight loss and post-operative follow-up behavior. One hundred seventy women participated: 85 were patients at The University of Texas Health Science Center at San Antonio, Texas (UTHSCSA), and 85 were from the Cherryhill Medical Surgical Center (CMSC), Albion, Michigan. A hierarchical cluster analytic technique was applied using the cosine measure and average linkage within groups method. Purification of the two samples resulted in seven groups with 59 cases in the UTHSCSA sample and six groups with 62 cases in the CMSC sample. Five groups containing 94 subjects (55 percent) replicated across the two samples (UTHSCSA = 44; CMSC = 50). Discriminant analysis yielded four statistically significant functions. The chi 2 test was employed to discern significant differences based on group inclusion. Demographic differences between the two geographic samples are discussed. One year follow-up studies found that personality type bears a significant relationship to indexed weight loss, follow-up appointment frequency, and follow-up duration for the San Antonio sample.

Adult↗
PubMed1989

The outcome index. A method of quality assurance in the special care area.

A method of quality assurance for a surgical intensive care unit is described. A system outcome score is devised, incorporating only easily obtained objective components that reflect the likelihood of death. Through the use of a derived outcome index, the actual mortality rate is compared with the predicted mortality rate as a method of monitoring the quality of care provided. Subroutines exist to identify errors in data entry, to detect malicious interference in patient care, to add nonscoring components for the purposes of clinical studies, and to facilitate retrieval of a concise summary of the major events during the stay of every patient admitted to the intensive care unit.

Abstracting and Indexing↗
PubMed1986

Effects of pH alterations and hypoxia on isolated human intestine.

Effects of hypoxia and pH alterations on the spontaneous contractions and responses to cholinergic stimuli or KCl were investigated in isolated human intestines. The longitudinal strip of human intestine showed spontaneous contractions. The spontaneous contraction was abolished by hypoxia with nitrogen gas substitution (95% N2 and 5% CO2) but not by substitution with acidic (pH 6.53) or alkaline (pH 7.75) solution. Contractile responses to acetylcholine (ACh) were not altered by treatment with hypoxia or pH alterations. KCl (10 mM)-induced contraction was inhibited by hypoxia but not by pH alterations. Transmural electrical stimulation elicited a transient contraction that was blocked by tetrodotoxin or atropine. Contractions induced by electrical stimulation at a low frequency (5 Hz) was not altered by hypoxia or pH alterations. The metabolic pathway related to energy generation and utilization for the spontaneous contraction and KCl-induced contraction seems to be more dependent on oxygen supply than that for ACh-induced contraction. The contractile mechanism in human intestine seems to be resistant to pH alterations.

Acetylcholine↗
PubMed1986

Hyperinsulinism, glucose-dependent insulinotropic polypeptide, and the enteroinsular axis in morbidly obese patients before and after gastric bypass.

The role of glucose-dependent insulinotropic polypeptide (GIP) in the hyperinsulinism of morbid obesity and its correction after gastric bypass was studied in 12 morbidly obese (150 +/- 15 kg) patients. After oral glucose, significant increases in serum glucose, insulin, and GIP levels occurred both before and after gastric bypass. Compared with preoperative values, fasting concentrations and integrated incremental areas for glucose, insulin, and GIP were decreased after a 25% weight loss after gastric bypass. The hyperinsulinism of morbid obesity and its amelioration after gastric bypass may be caused by markedly elevated levels of GIP before surgery and its reduced release after bypass. Reduced release of GIP after gastric bypass may partly occur because of exclusion of ingested glucose from contact with the mucosa of the duodenum and proximal jejunum, sites with the highest concentration of GIP.

Adult↗
PubMed1985

Neurotensin, vasoactive intestinal peptide, and Roux-en-Y gastrojejunostomy. Their role in the dumping syndrome.

This study evaluated the effect of gastric bypass on the glucose, insulin, vasoactive intestinal peptide (VIP), neurotensin, and motilin response to orally administered glucose in eight morbidly obese patients before and after operation. Preoperatively, all eight patients remained asymptomatic during an oral glucose tolerance test, which showed glucose intolerance and hyperinsulinism. Plasma VIP, neurotensin, and motilin remained below detectable levels for the entire test. At three months following gastric bypass (21% weight loss), all eight patients became acutely ill during a repeated oral glucose tolerance test and had the following symptoms: facial flushing (eight patients), palpitations (eight patients), nausea (seven patients), abdominal fullness (seven patients), pallor (four patients), diaphoresis (two patients), vomiting (two patients), and diarrhea (two patients). Significant release of neurotensin occurred in seven patients while three patients had release of VIP, further implicating these two peptides as part of the pathophysiologic spectrum of the "dumping syndrome."

Adult↗
PubMed1985

Pancreatic islet hormone response to oral glucose in morbidly obese patients.

Pancreatic islet peptides, as well as other gastrointestinal hormones, have been implicated in both the pathogenesis of obesity and the etiology of associated metabolic derangements. This study evaluated the pancreatic islet and gastrointestinal (GI) hormone response to oral glucose in 20 morbidly obese (151% above ideal body weight) patients. Glucose intolerance, hyperinsulinism, and exaggerated gastric inhibitory polypeptide (GIP) release occurred following glucose ingestion. Significant release of PP occurred in 14 patients, while only six patients had release of somatostatin. No significant changes in plasma concentrations of glucagon occurred. Since GIP is insulinotropic in the presence of hyperglycemia, the hyperinsulinism of morbid obesity may be secondary to the abnormally high glucose-stimulated GIP levels in these patients. Failure of glucagon suppression in response to oral glucose many contribute to the hyperglycemia noted. Somatostatin and pancreatic polypeptide may be responsible for some of the metabolic derangements of morbid obesity.

Adult↗
PubMed1985

Management of blunt and penetrating external esophageal trauma.

The records of 26 patients with external blunt or penetrating esophageal trauma were reviewed to determine clinical features and results of therapy. Twenty-one injuries (four blunt, 17 penetrating) were to the cervical esophagus, and five to the thoracic esophagus. Major physical signs included subcutaneous air, neck hematoma, and blood in the nasogastric tube. Helpful roentgenographic findings were cervical and/or mediastinal air, mediastinal widening, pleural effusion, and pneumothorax (15%). Nine of 12 (75%) contrast studies and five of six (83%) esophagoscopies were positive. Twenty-four patients had associated injuries, the most common of which was tracheal (14 patients) (64%). All patients were managed by prompt surgical exploration, primary closure, and drainage. There were three early deaths. Thirteen patients had postoperative complications, four of which were esophageal leaks. Two of the leaks caused mediastinitis, pleural sepsis, and led to death. They were not treated by early esophageal exclusion or excision. There were no significant strictures or esophageal sequelae in the other patients. It is concluded that early primary closure and drainage results in a relatively high incidence of survival. If a thoracic esophageal leak occurs, aggressive management of prompt esophageal exclusion or excision is necessary to control sepsis and improve survival.

Adolescent↗
PubMed1984

Radiologic evaluation before gastric bypass for morbid obesity.

During a 4 year period, 69 patients received gastric bypass with stapling and Roux-Y gastrojejunostomy for morbid obesity. The results of 67 preoperative radiologic evaluations of the gastrointestinal tract were analyzed. Of these patients, 17.9 percent (12 of 67) had previous cholecystectomy for cholelithiasis; 14.6 percent (10 of 67) had cholelithiasis found on preoperative evaluation. This gave an overall incidence of gallbladder disease of 32.8 percent. The upper gastrointestinal examination revealed four patients with hiatal hernia, three with reflux, and one with evidence of reflux esophagitis. Two patients had one duodenal diverticulum each. Ten small bowel follow-through examinations were performed, six of which revealed no abnormalities and four of which were consistent with previous jejunoileal bypass. Results of air-contrast barium enema showed 1 patient with a cecal mass which was subsequently found to be a fatty iliocecal valve and 16 patients had diverticulosis without evidence of diverticulitis. The remainder of the findings of all studies were unremarkable. When all is considered, including radiation dose, difficulty in performing examinations, and cost, we conclude that because of the low incidence of significant abnormalities, routine preoperative evaluation of these patients should only include radiographic or sonographic evaluation of the gallbladder. Other examinations should be obtained if the patients have current symptoms or previous gastrointestinal disease or gastric surgery.

Adult↗
PubMed1984

Gastric stapling for morbid obesity: gastrointestinal response in a rat model.

The adaptive response of the gastrointestinal tract to gastric stapling was studied in a Zucker (fafa) genetically obese rat model. The effects of gastric stapling in rats with a Roux-en-Y gastrojejunostomy were compared to Roux-en-Y and intact controls. Rats (225 to 275 g) were divided into three groups: group I (GI), Roux-en-Y, stapled, ad libitum fed; group II, Roux-en-Y, unstapled; and group III, intact (laparotomy only). Groups II and III were further subdivided into group IIA (GIIA) and group IIIA (GIIIA), pair-fed to GI; and group IIB (GIIB) and Group IIIB (GIIIB), fed ad libitum. All rats were fed a diet of liquid rat formula and rat food (50:50 cal ratio). After 2 wk rats were killed and the liver, pancreas, and stomach removed, weighed, and tissue taken for histology. The intestine was divided into three segments corresponding to the excluded segment (1, duodenum), transposed segment (2, jejunum), and ileal segment (3), with tissue taken for histology. Liver lipid, pancreatic amylase, serum amylase and gastrin, and intestinal mucosal protein and DNA were measured. Weight gain, g/14 days, was: GI, 24.1 +/- 7.8; GIIA, 17.0 +/- 2.0; GIIB, 42.6 +/- 4.8; GIIIA, 17.6 +/- 4.7; GIIIB, 54.6 +/- 8.9. All rats were in positive N balance. Liver weight and lipid were similar in all groups. Pancreatic mass was significantly increased in all Roux-en-Y animals, while amylase activity per g tissue was significantly less than in intact animals. Stapled rats had atrophy of the glandular portion of the stomach, decreased stomach mucosal weight, and lower serum gastrin concentration compared with all other rats (p less than 0.01). In stapled rats, segment weight and mucosal weight were lower in the excluded segment, and higher in the transposed segment, compared to all other rats. Tissue pathology was found only in stapled rats: gastric atrophy, focal fibrosis of gastric wall, peritonitis, minimal to mild multifocal hepatitis, and mild periductal fibrosis of the pancreas. There are significant early adaptive and pathological changes after gastric stapling in the rat.

Adaptation, Physiological↗
PubMed1982

Diverticulitis of the right colon.

The authors' experience with right-sided diverticulitis is reviewed. The symptoms among 18 patients were continuous right lower quadrant abdominal pain and periumbilical pain radiating to the right lower quadrant. Only three patients had nausea and vomiting. Twelve patients (67 per cent) had an abnormally high white blood cell count; three had granulocytosis. Barium enema examination was not a helpful diagnostic aid; and in only two patients was the preoperative diagnosis correct. The operative procedures undertaken were right colectomy with ileotransverse colostomy (15 patients), partial right colectomy with ileoascending colostomy (two patients), and diverticulectomy and appendectomy (one patient). There were no deaths; the average hospital stay was 14.2 days (range 5 to 30 days). The authors conclude that there is no characteristic clinical pattern pointing to this diagnosis; diagnostic maneuvers are usually unrewarding; right hemicolectomy is a safe and expeditious procedure; and open cecotomy is not favored, as recommended in the medical literature, to establish the diagnosis.

Adult↗
PubMed1979

A simplified technique for loop colostomy closure.

Stapling instruments have been used for gastrointestinal anastomoses and reconstruction with increasing regularity. A technique for loop colostomy closure employing a stapling device is described. This approach provides a secure closure while avoiding major contaimination.

Colostomy↗
PubMed1978

Peritoneal mesothelioma in a male pseudohermaphrodite with asymmetrical gonadal differentiation.

A diffuse peritoneal mesothelioma occurring in a patient with male pseudohermaphroditism and asymmetrical gonadal differentiation (mixed gonadal dysgenesis) is described. Malignancies of mesodermal origin, usually derivatives of the urogenital ridge, appear to occur with increased frequency in male pseudohermaphrodites. This appears to be the first reported instance of a mesothelioma in a male pseudohermaphrodite with mixed gonadal dysgenesis. The clinical and pathologic features of this tumor, including the electron microscopic findings, are presented.

Disorders of Sex Development↗
PubMed1977

Bowel obstruction and the long tube stent.

Fifty-eight cases of intestinal obstruction requiring operative intervention were reviewed. Enterolysis alone as the treatment for bowel obstruction as a result of adhesions appears to be as good or better than the long tube stent. Patients treated with enterolysis alone had a shorter period of postoperative ileus, a shorter hospital confinement following operation, and fewer recurrent obstructions. These patients also had a longer interval between episodes of reobstruction than did those treated with an intraluminal long tube stent.

Adolescent↗
PubMed1976

Gastric devascularization: an alternate approach to the surgical treatment of massive, diffuse hemorrhage from gastritis.

During a three-year period on the surgical services at the University of Texas in San Antonio, eight critically ill patients had various types of gastric devascularization to control erosive hemorrhagic gastritis. Among these patients were two women and one child. There were five chronic alcoholics, one aspirin abuser, one severely burned patient, and one patient with sepsis. Esophagogastroscopy was used in six patients but was diagnostic in only three. All of the patients were given intensive medical preoperative care, including an average of eight units of blood each. In four of the five known alcoholics, preoperative tests showed severely deranged clotting function. All of the patients received at least a four-point gastric vessel ligation. In addition, four had gastrotomies, three had vagotomies and pyloroplasties, and two had "complete" gastric vessel ligation. There was no significant rebleeding in five patients. Of the three patients with significant recurrent gastric hemorrhage, two were chronic alcoholics with poor clotting function, and neither was considered operable. One patient, the child, had massive rebleeding one week after gastric devascularization with vagotomy and pyloroplasty and required a subtotal gastrectomy. Of the four patients who ultimately died, three were chronic alcoholics and one had sepsis.

Adult↗
PubMed1969

Heat stroke.

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Adult↗