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Biomedical subjects

Henry Buchwald

Publications and source records attributed to Henry Buchwald.

7 recordsLinked to original sources
PubMed2002

Overall mortality in the program on the surgical control of the hyperlipidemias.

BACKGROUND: The Program on the Surgical Control of the Hyperlipidemias (POSCH), a secondary intervention trial, was the only lipid/atherosclerosis randomized clinical trial that used a surgical modality--partial ileal bypass. POSCH provided solid evidence for the clinical and arteriographic benefits of lipid profile normalization. Few longterm followup reports have been published in this field. This report concerns overall mortality, the primary endpoint of POSCH, with a mean followup of 18 years (range 15.5 to 23.0 years). STUDY DESIGN: Overall mortality data were compiled from reports to the POSCH clinics, followup telephone calls, death certificates, and the US National Death Index. RESULTS: There were 144 deaths in the control group (n = 417) and 120 deaths in the intervention group (n = 421), using intent-to-treat analysis. The risk reduction in the intervention group was 0.201 (20%); the risk ratio was 0.799, or 0.8 (95% confidence intervals, 0.628 to 1.018, p = 0.07). The proportion of patients alive was 65.7% in the control group and 72.0% in the intervention group, for a difference of 6.3% in the intervention group (p = 0.05). Kaplan-Meier survival analysis (p = 0.046) and disease-free intervals analysis at 70% survival (p < 0.001) were confirmatory. The gain in life expectancy in the intervention group was 2.7 years. CONCLUSIONS: Longterm followup POSCH data demonstrate that lipid profile normalization will decrease overall mortality and will maintain a persistent and constant increase in life expectancy.

Adult↗
PubMed2002

Lipid modulation and liver function tests. A report of the Program on the Surgical Control of the Hyperlipidemias (POSCH).

BACKGROUND: Statin drugs are known to cause dose-dependent abnormalities in liver function tests (LFTs), with elevations three times the upper limits of normal of the aminotransferase enzymes in up to 2.5% of patients on the highest prescribable doses. The Program on the Surgical Control of the Hyperlipidemias (POSCH) trial employed no hypocholesterolaemic drugs and used a surgical procedure, partial ileal bypass, as the intervention modality. METHODS: Serum total bilirubin, alkaline phosphatase and serum glutamic-oxaloacetic transaminase (SGOT) (equivalent to aspartate aminotransferase [AST]), were the LFTs obtained in POSCH at baseline, 3 months, annually for 5 years, and at 7 or 10 years postrandomization. RESULTS: Abnormal values were found for total bilirubin in seven of 416 control group (CG) patients (1.68%) and in 34 of 373 intervention group (IG) patients (9.16%) (P = 0.001); for alkaline phosphatase, in 28 of 378 (7.41%) and in 41 of 326 (12.58%) (P = 0.0214); and for SGOT, in 102 of 412 (24.76%) and in 161 of 372 (43.28%) (P = 0.001). Values twice the upper limit of normal occurred in 1 CG and 1 IG patient for total bilirubin and for alkaline phosphatase, and in 11 CG and 7 IG patients for SGOT (NS). Values three times the upper limit of normal did not occur in any patient for total bilirubin or alkaline phosphatase, and occurred in 3 CG and 5 IG patients for SGOT (NS). CONCLUSIONS: In POSCH, the IG demonstrated statistically significant mild increases for total bilirubin, alkaline phosphatase and SGOT levels, with no significant increases in values twice or greater the upper limits of normal.

Alkaline Phosphatase↗
PubMed2002

A bariatric surgery algorithm.

BACKGROUND: Three premises underlie this formulation of an algorithm: 1) there is no gold standard operation; 2) the bariatric surgeon should be able to perform more than one bariatric operation; and 3) a patient can be broadly matched to an operation. METHODS: Literature review and interpretation. RESULTS: The 5 currently clinically-tested bariatric procedures, ranked from least to most weight loss, are: 1) gastric banding (GB); 2) vertical banded gastroplasty (VBG); 3) Roux-en-Y gastric bypass (RYGBP); 4) biliopancreatic diversion (BPD) or duodenal switch (DS); and 5) long-limb Roux-en-Y gastric bypass (LLRYGBP). The following diagram for decision-making takes into consideration body mass index (BMI); age; gender, race, and body habitus (GRH); and comorbidities (CoM): This diagram can be converted to an equation; OC = 1.0+BMI Number (1 to 6) +/- 0.5 (age <40>) +/- 0.5 (GRH, Favorable or Unfavorable) +/- 1 (CoM, Low or High), where OC = operative category: GB = 0 to 3, VBG = 2 to 5, RYGBP = 3 to 6, BPD/DS = 4 to 7, and LLRYGBP = 6 to 9. Overlap between OCs integers allows for surgeon and patient preference. CONCLUSIONS: A diagram or equation algorithm for operative selection in the morbidly obese has been constructed.

Algorithms↗
PubMed2002

Evolution of operative procedures for the management of morbid obesity 1950-2000.

BACKGROUND: At the turn of the 21st century, obesity is the epidemic with the greatest prevalence in the United States. Fifteen million people, 1 out of 20, in this country have a body mass index (BMI) > or = 35 kgm2. Obesity is not only a medical problem, but also a social, psychological, and economic problem. At present, the morbidly obese are refractory to diet and drug therapy, but have a substantial, sustained weight loss after bariatric surgery. METHODS: This chronology of the landmark operations in bariatric surgery is based on a review of the medical literature. RESULTS: Bariatric surgery can be classified into 4 categories: malabsorptive procedures, malabsorptive/restrictive procedures, restrictive procedures, and other, experimental procedures. The prototype of malabsorptive procedures and the first operation performed specifically to induce weight loss was the jejunoileal bypass. The problems associated with this operation caused its demise. Today's popular malabsorptive procedures are the biliopancreatic diversion and the duodenal switch. Malabsorptive/restrictive surgery currently is predicated on the Roux-en-Y gastric bypass, both the traditional short-limb, and the long-limb for the super obese. Restrictive procedures are represented by the banded and ringed vertical gastroplasty, as well as gastric banding. Experimental procedures include gastric pacing. All of these operations can be performed by open surgery and laparoscopically. CONCLUSIONS: Since bariatric surgery is the only broadly successful treatment for morbid obesity, it is incumbent on all physicians to be familiar with current bariatric operations, and to understand the evolution of bariatric surgery.

Digestive System Surgical Procedures↗