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Biomedical subjects

J B Freeman

Publications and source records attributed to J B Freeman.

At least 19 recordsLinked to original sources
PubMed1990

Feeding jejunostomy: a safe adjunct to laparotomy.

It is well established that a feeding jejunostomy is an invaluable adjuvant for use in critically ill and malnourished patients. What is not well known are the complications of inserting these tubes. Some surgeons are reluctant to insert feeding tubes unless the indications are very clear. From their experience with the insertion of 133 feeding jejunostomy tubes during a 3-year period, the authors conclude that the complications associated with the insertion of such tubes are few and that the procedure is justified even if the tube is never used.

Enteral Nutrition↗
PubMed1989

Comparison of Marlex and Gore-tex to repair abdominal wall defects in the rat.

Marlex and Gore-tex, two prosthetic materials used to close abdominal wounds, were compared with respect to strength and adhesion formation. A 2.5 X 3.5-cm full-thickness area of abdominal wall was excised in 32 CD rats. The defect was repaired using identically sized patches of Marlex or 1-mm Gore-tex, determined by alternate assignment, and sutured with continuous 4-0 Gore-tex. Adhesion formation was graded at necropsy and recorded photographically in each animal. The mean adhesion index (none = 0, maximal = 4) was 1.37 +/- 0.12 and 2.62 +/- 0.12 (mean +/- SEM) for Gore-tex and Marlex groups respectively (p less than 0.005, unpaired t-test). A template was used to fashion 2-cm coronal strips of abdominal wall for tensile-strength testing. The relative strengths were 2.67 +/- 0.14 and 3.02 +/- 0.16 kg/cm (mean +/- SEM) for the Gore-tex and Marlex groups respectively (NS). Histologically, there were more epithelioid giant cells and less collagen formation in the Gore-tex group. Abdominal wall reconstruction with Gore-tex resulted in wound strength equal to that of Marlex and fewer adhesions. Gore-tex is preferred when prosthetic material and viscera are in close proximity.

Abdominal Injuries↗
PubMed1987

The use of endoscopy after gastric partitioning for morbid obesity.

Fiberoptic endoscopy is an important diagnostic modality for evaluating the patient with upper gastrointestinal tract symptoms following gastric restrictive operations. The specific indications for endoscopy after obesity surgery include stoma evaluation in patients who fail to lose adequate weight; stomal stenosis; esophagitis; surveillance of the excluded pouch; and suspicion of a marginal ulcer after gastric bypass.

Anastomosis, Roux-en-Y↗
PubMed1986

Prevention of superficial phlebitis during peripheral parenteral nutrition.

Fifty-four patients receiving peripheral parenteral nutrition consisting of 3.5 percent amino acids in a 5 percent dextrose solution were randomly assigned in a double-blind fashion to receive this solution with or without an antiphlebitic mixture (1000 IU heparin, 5 mg hydrocortisone, and 1.8 mEq sodium hydroxide as a buffer). The addition of antiphlebitic mixture resulted in a marked and highly significant reduction in the incidence of phlebitis and a prolongation of the number of phlebitis-free hours during infusion of peripheral parenteral nutrition (p less than 0.005).

Aged↗
PubMed1986

Serum alanine aminotransferase to aspartate aminotransferase ratio and degree of fatty liver in morbidly obese patients.

We evaluated the change in serum alanine aminotransferase (ALT; EC 2.6.1.2) to serum aspartate aminotransferase (AST; EC 2.6.1.; ALT/AST) ratio with the degree of fatty liver in morbidly obese patients. A total of 31 patients were included in the study. Fatty liver was graded as 0 to 4+. The mean and SD of AST and ALT were not significantly different between groups of patients with various grades of fatty liver. There was, however, a significant correlation between the ALT/AST ratio and the degree of fatty infiltration of the liver. This, we believe, implies damage mainly to the plasma membrane allowing loss of cytoplasmic enzymes rather than loss of mitochondrial enzymes.

Adult↗
PubMed1986

Nonoperative management of stomal stenosis after gastroplasty for morbid obesity.

Over a period of six years, 33 of 172 (19 per cent) patients who had gastric partitioning had stomal stenosis develop which was defined as an inability to drink fluids or swallow saliva, or both. All were managed conservatively in the hospital or on an outpatient basis. This consisted of total parenteral nutrition and endoscopy to evaluate the stoma with or without dilation; Eder-Puestow dilaters and long term jejunostomy feeding were used. Thirteen of these patients were dilated a total of 36 times. Three required three to six dilations each, up to the maximum size (45F). There were no complications. Twenty-nine required repletion by combined parenteral and enteral nutrition. Three required jejunostomy insertion as a separate procedure. Patients were observed for six to 60 months. Thirty-two did well. Gastrogastrostomy was required in one patient with a stenosis after the second gastroplasty. Three patients who were dilated regained over 20 per cent of their ideal weight.

Acute Disease↗
PubMed1985

Colonization of intravascular catheters in the intensive care unit.

A prospective study of intravascular catheters (arterial, Swan-Ganz, and central venous) in two hospitals with similar intensive care units revealed an overall 25 percent colonization rate (more than 15 colony counts). Arterial catheters had the lowest colonization rate and central venous catheters had the highest. Arterial, Swan-Ganz, and central venous catheters are possible sources of nosocomial infections and septicemia. They should be inserted only when necessary. A critical review of our data and the literature suggests that future studies should examine the potential benefits of assiduous insertion technique, improved dressing care, intravascular delivery systems, and the choice of catheter.

Candida albicans↗
PubMed1985

Relationship between body weight and total leukocyte count in morbid obesity.

The authors studied the relationship between total leukocyte count and body weight in 42 morbidly obese patients (weight range, 101.5-206.8 kg). None of the patients had a recent history of infection, hematologic disorders, chronic respiratory disease, or were smoking more than 5 cigarettes/day. The range of total leukocyte count was 4.2-12.0 X 10(9) cells/L. Twelve of the 42 patients had a leukocyte count of 10 X 10(9) cells/L. There was a significant correlation between body weight (kg) and total leukocyte count (r = 0.68, P less than 0.001). Morbid obesity should be considered as one of the causes of physiologic leukocytosis.

Adult↗
PubMed1985

Colonization of intravascular monitoring devices.

This randomized prospective study of all invasive catheters inserted in our ICU tested the hypothesis that daily dressing changes would reduce the 25% infection rate associated with these catheters. Significant growth was noted in eight (7%) of 133 vs. nine (6.7%) of 135 skin cultures from patients whose dressings and infusion tubings were changed at 24 vs. 72 h, respectively. Catheter tip cultures were positive in six (5.9%) of 102 vs. eight (7.5%) of 107 for the 24- and 72-h groups, respectively. Paradoxically, blood cultures were positive in three (6.7%) of 45 vs. 12 (23.1%) of 52 from the 24- and 72-h groups, respectively (p less than .03). However, there was no correlation between the positive blood cultures and the organisms cultured from the catheter tips.

Bacteria↗
PubMed1985

Relationship between serum sodium and blood pressure in morbid obesity.

We evaluated the relationship between blood pressure and serum sodium level in morbidly obese patients. Forty patients had at least 2-3 blood pressure measurements and two measurements of serum sodium. The correlation between serum sodium and systolic blood pressure was 0.66 (p less than 0.01). The correlation between diastolic pressure and serum sodium was 0.40 (p less than 0.025). Our observation linking serum sodium to blood pressure provides a lead to study mechanisms common to regulation of blood sodium and blood pressure in morbid obesity.

Adult↗
PubMed1985

Preventing superficial phlebitis during infusion of crystalloid solutions in surgical patients.

Thirty patients who received routine intravenous therapy (3.3% dextrose and 0.3% normal saline at a rate of 100 mL/h) were randomized prospectively into two groups to receive an antiphlebitic mixture of heparin-hydrocortisone-sodium bicarbonate or placebo in a double-blinded fashion for 4 to 7 days. The code was then broken and the data were analysed using chi 2 analysis with respect to the clinical grade and incidence of phlebitis. Phlebitis developed in 2 of 14 study and 10 of 16 control patients. All study patients tolerated their intravenous lines longer and needed less restarting. The antiphlebitic mixture effectively prevented superficial infusion phlebitis in patients receiving dextrose-saline solutions.

Anticoagulants↗
PubMed1985

Vertical banded gastroplasty: assessment of efficacy.

We previously demonstrated unacceptably high failure rates with horizontal gastroplasty. Shortly thereafter, vertical banded gastroplasty was introduced. Since April 1982 we have operated on 56 patients who were carefully selected and closely followed. There were 10 men and 46 women, aged 15 to 54 years (mean age 36 years) with preoperative weights of 93.5 to 198.6 kg (mean 125.9 kg). The mean weight loss at 6 to 12 months was 36 +/- 10 kg, or 30% of body weight. At 18 months, data were available for 48 of the 56 patients. Their weight losses were 44 +/- 11 kg, or 35% of body weight. Eight patients were lost to follow-up. The weight of nine additional patients plateaued before they lost 30% of their starting weights and another eight patients have started to regain weight after achieving satisfactory weight loss. Included are two patients with severe stenoses who regained all weight lost.

Adolescent↗
PubMed1985

Gastric by-pass surgery in morbidly obese patients markedly decreases serum levels of vitamins A and C and iron in the peri-operative period.

We studied changes in serum levels of carotene, vitamins A, C, B12 and folate and iron in the immediate perioperative period after gastric by-pass surgery in nine morbidly obese patients and in six patients undergoing abdominal surgery. All parameters were measured preoperatively and 48 h postoperatively. Marked decreases occurred for vitamin A (2.04 +/- 0.45 mumol/l to 0.92 +/- 0.39 mumol/l, P less than 0.01), vitamin C (26 +/- 11.2 mumol/l to 4.9 +/- 4.0 mumol/l, P less than 0.01), iron (15 +/- 5.8 mumol/l to 4 +/- 2.7 mumol/l, P less than 0.01). A significant change also occurred for carotene (1.7 +/- 0.42 mumol/l to 1.25 +/- 0.48 mumol/l, P less than 0.05). No significant changes were seen for vitamins B12 and folate. Only changes in vitamins A and C were significantly greater in the morbidly obese patients compared to the control group of six patients. These changes likely represent redistribution of vitamins rather than enhanced urinary excretion.

Adult↗
PubMed1985

Long-term follow-up of concomitant band ligation and sclerotherapy for internal hemorrhoids.

From 1978 to 1983, 111 patients with symptomatic internal hemorrhoids were treated as outpatients by a modification of the Barron ligation technique. Each ligated hemorrhoid was injected with a sclerosant. Follow-up, available for 94 of the patients, ranged from 2 to 60 months (mean 18 months). Presenting symptoms were bleeding in 75 (80%) of the 94 patients, pain in 46 (49%), pruritus in 22 (23%) and prolapse in 24 (26%). Results were excellent in 51 (54%) patients, good in 20 (21%) and fair in 9 (10%). Fourteen (15%) patients had unsatisfactory results; only 4 of these required hemorrhoidectomy. The other 10 had residual symptoms but did not require further treatment. Nine patients had minor complications, which included pain lasting 24 to 72 hours in seven, bleeding in one and syncope in one. The addition of sclerotherapy to traditional band ligation for the management of internal hemorrhoids has the advantages of exciting a greater inflammatory reaction between the mucosa and submucosa and preventing premature slipping of the band. The authors conclude that this method of therapy is effective for symptomatic hemorrhoids and that surgical hemorrhoidectomy is seldom indicated.

Adult↗