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Biomedical subjects

D M Grace

Publications and source records attributed to D M Grace.

At least 19 recordsLinked to original sources
PubMed1992

Gastric restriction procedures for treating severe obesity.

Gastric restriction procedures are operations to decrease gastric volume. They are the most common, simple, and safe operations for the treatment of severe obesity. The original horizontal gastroplasties were unsuccessful but modern operations such as vertical banded gastroplasty, silastic ring gastroplasty, and gastric banding produce good weight loss with improvement in health. Although late weight gain does occur, satisfactory 5-y results are available and are presented. Patient selection, complications, mechanism of action, and future studies are also discussed. Long-term data with complete patient follow-up and randomized trials comparing modern operations with nonoperative treatment are still needed.

Gastroplasty↗
PubMed1990

Increased volume and decreased emptying of the gallbladder in large (morbidly obese, tall normal, and muscular normal) people.

Impaired gallbladder emptying has been suggested as a possible factor in the pathogenesis of gallstones. Obese people have an increased incidence of gallstones, but there is no evidence of this in nonobese large people. This study was undertaken to determine if abnormal gallbladder motility is present in obese people. Fasting gallbladder volumes were determined using real-time ultrasound in 18 morbidly obese subjects whose weights were in a steady state [45 kg (100 lb) over ideal weight or twice expected weight for age and height; 9 males, 9 females], 18 age- and sex-matched volunteers of average size, and 18 nonobese large normal males (9 tall, 9 muscular). Gallbladder emptying studies with 99mtechnetium-diisopropyliminodiacetic acid were performed using 200 ml of 10% cream as a stimulus. The small-volume liquid fatty meal contained 113indium-diethylenetriaminepentaacetic acid to control for differences in gastric emptying in obesity. The gallbladder emptying rate in large people, both obese and nonobese, was less than that in normals of average size (p = 0.05). Fasting gallbladder volumes in large people were: obese, 41 ml (37-66 ml) (median; 95% confidence limits); nonobese large normal, 40 ml (27-43 ml). These values were greater than in normals of average size [17 ml (14-21 ml) (p = 0.03)]. Postprandial gallbladder volumes were also greater in large people: obese, 15 ml (8-23 ml); nonobese large normal, 20 ml (13-23 ml) compared with 2 ml (1-5 ml) in normals of average size (p less than 0.05). There were no differences between obese and nonobese large people. There were no differences in gastric emptying rates or in cholecystokinin, gastrin, motilin, and secretin release between obese and normal subjects. Gallbladder volume is crudely proportional to body size. Although fasting and postprandial volumes are greater in obesity, this is also present in nonobese, relatively size-matched controls. These data do not support a role for impaired gallbladder emptying in gallstone formation in obese patients whose weights are in a steady state.

Adult↗
PubMed1990

A longitudinal study of smoking status and weight loss following gastroplasty in a group of morbidly obese patients.

A study of morbidly obese patients was carried out to determine the frequency of preoperative smoking, the effect of smoking status on weight loss after vertical banded gastroplasty, and the effect of gastroplasty on postoperative smoking. There were 93 of 104 eligible patients (89.4 percent) available for study, 86 percent female and 14 percent male. All had a gastroplasty more than one year before with a mean follow-up of 22.9 +/- 7.8 months. Preoperative and postoperative weights were 124.4 +/- 19.5 kg and 89.4 +/- 17.9 kg for females and 156.5 +/- 22.3 kg and 102 +/- 17.4 kg for males. Preoperatively 38 percent smoked (females 36.7 percent, males 46.2 percent) and 57 percent were heavy smokers (greater than 25 cigarettes per day). Ten smokers quit postoperatively but seven nonsmokers started smoking. Those who smoked before operation lost more weight (43.26 kg) than nonsmokers (34.97 kg) and ex-smokers (32.41 kg); P less than 0.05. Those who smoked postoperatively lost more weight (44.47 kg) than nonsmokers (35.06 kg) and ex-smokers (33.07 kg); P less than 0.05. Because of the health risks of smoking, cessation is encouraged in spite of the advantage in weight loss for smokers after gastroplasty. More effective methods of controlling smoking and severe obesity are needed.

Adult↗
PubMed1988

Pathological gamblers are neither impulsive nor sensation-seekers.

Ten pathological gamblers, ten alcoholics, ten heroin addicts and twenty five non-patients were compared using Zuckerman's Sensation Seeking Scale (SSS) and Barratt's Impulsivity Scale (BIS). The pathological gamblers did not differ from the non-patient group on either measure. Drug addicts scored significantly higher and alcoholics significantly lower than the pathological gamblers and the non-patient group on the SSS, while drug addicts scored significantly higher than the other groups on the BIS. The difficulties in defining impulsivity are discussed. It is suggested that the classification of pathological gambling as a disorder of impulse control should be reconsidered.

Adolescent↗
PubMed1987

Substitution of mixed amino acids resembling soy protein for mixed amino acids resembling casein in the diet reduces plasma cholesterol in slowly, but not rapidly fed nor fasted baboons.

Studies of cholesterol and triglyceride metabolism were conducted under steady-state conditions in conscious restrained female baboons to ascertain whether the cholesterol- and triglyceride-lowering effects of soy protein v casein in nonrodents can be explained by differences in amino acid composition between the two proteins and whether the lipid-lowering effects of soy protein are influenced by fasting or the rate of feeding, ie, the nutritional state. The metabolic changes underlying the changes in serum cholesterol and triglyceride concentration were also investigated. Isocaloric diets consisting of 45% mixed amino acids (soy or casein type), 50% glucose and 5% corn oil, including all nutritional requirements, were infused intraduodenally for five days. There were no differences in lipid levels between the soy and casein diets in fasting baboons (days 4 or 5) or when the daily diet (calculated to equal 24 hours of energy utilization) was given rapidly by constant intraduodenal infusion over seven hours (day 4). During rapid feeding there was, unexpectedly, no significant change in plasma cholesterol concentration, but the estimated rate of cholesterol oxidation to bile acids fell significantly by 38 +/- 6% (from 39 +/- 4 to 24 +/- 3 mg/d). Significant differences between the soy and casein diets were observed only in the fed state produced by the slow constant isocaloric intraduodenal infusions of the diets [5.8 mg mixed amino acids (soy or casein type) plus 7.2 mg glucose/min/kg body wt0.75] on day 5. These diets were calculated to equal the simultaneous rate of energy utilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed1987

Pancreatic endocrine responses to nutrients and bombesin after segmental pancreas autotransplantation in dogs.

The capacity of autotransplanted (ATP) distal pancreas segments with systemic venous and peritoneal exocrine drainage to support physiologic control of plasma glucose levels was tested, and compared with the functions of "simulated autotransplants" (SATP) prepared with similar dissection and peritoneal exocrine drainage, but with hepatic portal venous drainage, in dogs. In ATP in the postabsorptive state, plasma levels of glucose, immunoreactive insulin (IRI) and immunoreactive glucagon (IRG1) were normal. Autotransplants resulted in impaired glucose tolerance after meals with impaired early insulin responses, and the normal brisk rise of IRG1 in the plasma was delayed and reduced through the first 30 min of feeding. In ATP, also, the response to bombesin was abnormal; the normal stimulation of release of both IRI and IRG1 was delayed in both cases. In studies of responses to oral and intravenous glucose in ATP and SATP dogs, similar mild degrees of glucose intolerance were found with both routes of administration; however, whereas in ATP dogs increases of IRI were highly exaggerated with both routes of administration of glucose, in SATP dogs plasma IRI rose from subnormal levels in the postabsorptive state through subnormal increments with both routes of administration. Further studies are necessary to determine the relative importance of denervation and reduction of the mass of the pancreas in these effects, and to assess the significance of the differences in blood insulin levels in the two preparations.

Administration, Oral↗
PubMed1987

Patient selection for obesity surgery.

Patients selected for gastroplasty should be at least 45 kg above ideal weight, between the ages of 18 and 50, and operated on in a center with good results, where team assessment and long-term follow-up is emphasized. Referral by a family doctor who provides local care and support is important. Medical complications need not be present because the idea is to prevent them, but problems such as sleep apnea, adult onset diabetes mellitus, hypertension, osteoarthritis, and infertility, which may be corrected by weight loss, increase the indication for gastroplasty. Patients should have social support and be intelligent enough to understand the postoperative diet and the need for regular follow-up. Those with a history of psychiatric admission require careful preoperative assessment by psychiatrist or psychologist and close follow-up and support. Patients should have made a good supervised attempt at dieting, have had stable weight for 3 to 5 years preoperatively, and have stopped smoking at least 6 weeks prior to operation. Tests to assess personality factors, eating habits, and motivation are developing, but more precise methods of selecting patients for gastroplasty and predicting successful and uncomplicated weight loss are still needed.

Age Factors↗
PubMed1987

Smoking habits of the morbidly obese prior to gastroplasty.

Smokers weigh less on average than nonsmokers, but there is little data on the smoking habits of the severely obese. Cigarette smoking increases the risk of cardiovascular disease and may add to the existing risk among obese individuals. The purpose of this article is to report on smoking habits of a group of morbidly obese individuals being considered for surgery, to compare these smoking levels to those in the general population, and to assess the relationship between smoking and hypertension in this group. In Canada as in other countries, smoking prevalence has decreased in recent years, but it remains a major health problem.

Adolescent↗
PubMed1987

Recognition and management of Marlex erosion after horizontal gastroplasty for morbid obesity.

Between 1979 and 1982, 162 patients underwent horizontal gastroplasty in which polypropylene mesh (Marlex) was used to support the greater curve channel. There were no deaths and early weight loss was good. The operation was stopped because of late weight gain. Marlex erosion was recognized by endoscopy in 10 (6%) patients between 27 and 60 months after operation. Two other patients with Marlex erosion had the gastroplasty performed elsewhere. The patients' symptoms were abdominal pain, vomiting or weight gain. The Marlex was often difficult to resect because the inflammatory mass was adherent to spleen or pancreas. Reconstruction by Roux-en-Y gastric bypass or vertical banded gastroplasty allowed continued weight loss and gastrogastrostomy, although technically easier, resulted in weight gain. The author concludes that long-term follow-up is necessary after any gastroplasty or gastric bypass procedure especially when foreign material is used to support the stoma.

Adult↗
PubMed1987

Psychosocial risk factors in gastric surgery for obesity: identifying guidelines for screening.

This study aimed to isolate psychological predictors of outcome from horizontal reinforced gastric surgery for morbid obesity. Fifty-seven patients were assessed pre-operatively and 1 year after surgery. Prior inpatient psychiatric history (but not outpatient history), MMPI scale elevations, negative life events, and low social support (predictors) related significantly to medical complications and satisfaction with results of surgery, but not weight loss (outcome). Prior inpatient psychiatric history and low social support also predicted psychological complications postoperatively. Demographic factors failed to predict any aspects of outcome. Multiple regression analyses of the four significant predictors explained 43 percent of the variance in medical complications, 42 percent in satisfaction, and 31 percent in psychological complications. Inpatient psychiatric history was the strongest single predictor in all cases.

Adult↗
PubMed1987

Smoking status among a group of morbidly obese men and women referred for gastroplasty.

The smoking habits of all morbidly obese patients referred for possible gastroplasty (between January 1, 1983 and December 31, 1985) were assessed. There were 240 patients, 198 women 83 percent) and 42 men (17 percent). Mean age for women was 38 +/- 9 years and weight 121 +/- 17 kg. Men were 36 +/- 9 years old and weighed 154 +/- 24 kg. Forty percent of each group smoked cigarettes daily and 10 percent of women and 12 percent of men were ex-smokers. Twenty percent of the females and 47 percent of the males were heavy smokers (greater than 25 cigarettes per day). Female ex-smokers were much more apt to be on treatment for hypertension than non-smokers (55 vs 10 percent, P less than 0.001). These morbidly obese patients in Southern Ontario smoked more heavily and in higher proportion than reported for adults in Ontario or Canada. Low socioeconomic status may partially explain these results. Better methods of controlling smoking and eating are needed for the morbidly obese.

Adult↗
PubMed1987

Meralgia paresthetica after gastroplasty for morbid obesity.

In three morbidly obese patients (mean weight 169 kg), severe hip pain developed immediately after gastroplasty. The differential diagnosis included thrombophlebitis, osteoarthritis and lumbar disc protrusion. The pattern of pain and associated numbness was characteristic of compression of the lateral cutaneous nerve of the thigh, a condition known as meralgia paresthetica. The likely cause was compression of the thigh by the metal post of the Gomez retractor. Only the most obese patients suffered this syndrome and all symptoms resolved spontaneously within 3 months.

Adult↗
PubMed1986

The effects of cimetidine and ranitidine with and without metoclopramide on gastric volume and pH in morbidly obese patients.

The efficacy of preanaesthetic intravenous cimetidine versus ranitidine with and without metoclopramide for acid aspiration prophylaxis was assessed in 60 morbidly obese patients in a double-blind manner. Group 1 patients received cimetidine 300 mg + saline. Group 2 patients received cimetidine 300 mg + metoclopramide 10 mg. Group 3 patients received ranitidine 100 mg + saline. Group 4 patients received ranitidine 100 mg + metoclopramide 10 mg. Gastric fluid was aspirated for analysis of volume and pH following induction of anaesthesia. All four premedication regimens were equally effective in reducing the gastric volume and acidity and the inclusion of metoclopramide had no additive effect. Although statistically not significant, two patients in the cimetidine groups remained at risk (volume greater than 25 ml and pH less than 2.5) while no patients in the ranitidine groups remained so.

Adult↗
PubMed1986

Gastric emptying before and after transverse gastroplasty for morbid obesity.

Twenty-three morbidly obese patients underwent gastric emptying studies (Tc-99m egg salad sandwich--a semisolid meal) preoperatively, and at three months and 12 months postoperatively to evaluate the effect of transverse gastroplasty on gastric emptying and to determine the predictive value of this study for weight loss. At three months pouch emptying was variable with nine of 23 patients having prolonged half-times, and 14 shortened half-times compared with preoperative values, despite both groups having identical weight loss. At 12 months pouch half-times returned to baseline. The data suggests that this type of gastroplasty causes weight loss solely by reducing the gastric volume resulting in reduced meal volume. Weight loss is not related to impaired pouch emptying, which might result in a prolonged feeling of fullness. Gastric emptying studies neither preoperatively nor postoperatively have weight loss predictive value for this particular operation.

Adult↗