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Biomedical subjects

J D Halverson

Publications and source records attributed to J D Halverson.

At least 19 recordsLinked to original sources
PubMed1998

Laparoscopic anterior gastroplasty. A preliminary report of a new technique.

BACKGROUND: The treatment of the morbidly obese patient is difficult because compliance with dietary regimens is poor. As a result, most weight reduction programs fail very quickly. Surgical treatment, on the other hand, provides a reliable method for sustained weight reduction. The most frequently performed procedure has been the vertical banded gastroplasty. Adaptation of the standard open procedure to laparoscopic techniques has been technically difficult and imprecise. We have developed, in the laboratory, an anterior wall banded gastroplasty that can be performed precisely and reproducibly using laparoscopic techniques. METHODS: Five Yorkshire pigs were used in attempt to laparoscopically perform the standard vertical banded gastroplasty. The procedure was difficult and was associated with a risk of staple line leak and with bleeding along the lesser curvature of the stomach. Furthermore, a reproducible pouch of proper dimension could not be created reliably. Fifteen animals were then used to develop a new technique using a small gastric pouch based on the anterior gastric wall. RESULTS: A reproducible pouch, 4 cm in length, was created over an 18-Fr nasogastric tube. A standard polyproylene band of 5.2 cm in length was utilized at the gastric pouch outlet. CONCLUSIONS: This operation can be reproduced accurately and has not demonstrated any leaks on postmortem examination.

Abdominal Muscles↗
PubMed1996

Small bowel fistulas.

The treatment of small bowel fistulas remains a difficult problem. Spontaneous closure rates of 30% are currently being achieved after 4 to 6 weeks of conservative therapy with bowel rest, TPN, octreotide, and control of sepsis. Resection of the fistulous bowel is warranted if fistula closure has not occurred by 4 to 6 weeks.

Enteral Nutrition↗
PubMed1992

Metabolic risk of obesity surgery and long-term follow-up.

Protein-calorie deprivation occurs after weight reduction operations and creates a potential for micronutrient deficiency syndromes. Whether clinical deficiency occurs depends primarily on the nature of the operation carried out. Current procedures include those that mainly diminish intake and those that shunt either food or digestive enzymes to minimize the absorption of ingested food. The metabolic price that some patients pay postoperatively makes the choice of operation and the quality of follow-up critical to the patient's well-being. Restrictive operations (gastroplasty) are devoid of long-term metabolic complications. Gastric bypass patients rarely have deficiency syndromes but often develop micronutrient deficiencies. Malabsorptive procedures carry the highest risk and malnutrition, with multiple micronutrient deficiencies, may supervene despite close medical follow-up.

Follow-Up Studies↗
PubMed1992

The use of hepatobiliary scintigraphy in patients with acalculous biliary colic.

Twelve patients with biliary colic had no evidence of gallstones but underwent cholecystokinin-augmented hepatobiliary scintigraphy that revealed gallbladder ejection fractions of less than 35%. All 12 patients underwent cholecystectomy. Biliary colic was relieved in all patients at a mean postoperative follow-up of 2.5 years. The biliary colic in these patients was probably caused by abnormal gallbladder emptying, itself apparently produced by either cystic duct obstruction or abnormal motility. Biliary abnormality was seen at operation in most patients, and all patients had abnormalities of the gallbladder or cystic duct seen grossly or histologically. These abnormalities included cystic duct stenosis or adhesions, chronic inflammation, and cholesterolosis.

Adult↗
PubMed1991

Squamous cell carcinoma of the anal canal.

Between 1979 and 1988, 33 patients with squamous cell carcinoma of the anal canal were treated with chemoradiation. There were 24 women and 9 men, from 37 to 90 years of age (median: 63 years). Complete tumor regression occurred in 29 of the 33 patients (88%), only one of whom later developed recurrence. In the other four patients, there was persistent tumor after 3 months; three of these patients died within 2 years; and one is alive with distant metastases 2 years later. During the first 5 years of the study, seven patients with complete tumor regression underwent planned abdominoperineal resection following chemoradiation. Four of the abdominoperineal resection specimens were free of tumor, but three were not. These three patients, who had abdominoperineal resection within 3 months of chemoradiation, are disease-free. Ten of the 29 patients who had complete tumor regression had biopsies of the primary site 3 months after treatment. All biopsies were negative for residual carcinoma. At present, 26 patients (79%) are alive and disease-free from 2 to 10 years post-treatment (median: 4 years). Two patients died of unrelated causes, four of cancer, and one is alive with cancer. Complications of the chemoradiation required surgical intervention in two patients, and two others developed severe hematologic toxicity, for a complication rate of 12% (4 of 33 patients). There was no treatment-related mortality. These results support the efficacy of chemoradiation treatment for carcinoma of the anal canal. They suggest that abdominoperineal resection no longer need be part of the planned initial management, and that posttreatment biopsy of the primary site is unnecessary, unless palpable or visible abnormalities are present 3 months after treatment.

Adult↗
PubMed1989

Spontaneous healing of jejunoileal bypass-induced osteomalacia.

We have previously reported that osteomalacia may develop in patients relatively soom after jejunoileal (JI) bypass surgery. The present study was designed to determine the course of JI bypass osteomalacia in an untreated group of patients. We performed serial iliac crest biopsies on nine patients at 46 and 79 months (mean) following operation. We found that the amount of osteoid (unmineralized bone matrix) decreased (P less than 0.05) with time, while trabecular bone mass increased (P less than 0.05). Although three patients were osteomalacic at the original biopsy, no patient had evidence of osteomalacia at the second bone biopsy. Based upon these patients, we conclude that the mineralization defect, when it occurs after JI bypass, does not cause clinically significant bone disease and does not persist late postoperatively.

Female↗
PubMed1988

Successful management of catastrophic gastrointestinal involvement in polyarteritis nodosa.

A patient with polyarteritis nodosa developed necrotizing enterocolitis, as indicated by pneumatosis intestinalis seen on computed tomographic scans of the abdomen. Despite immunosuppressive therapy and concomitant resolution of the intramural and portal venous gas and general clinical improvement, on 2 occasions (between 20 and 30 days later) the patient developed bowel infarctions and perforations that necessitated bowel resection. Leaks developed at anastomotic sites, but were not closed surgically. However, these sites and the lower quadrants of the abdomen were drained, and the patient was given total parenteral nutrition. Over a 2-month period the patient completely recovered from this nearly always fatal gastrointestinal complication of polyarteritis nodosa. The medical, surgical, and radiographic approach we used may be applicable to the management of similar cases in the future.

Biopsy↗
PubMed1988

Hemic micronutrients following vertical banded gastroplasty.

Serum iron, folate, B12 and total iron binding capacity (TIBC) were obtained preoperatively and at 6-month intervals in 40 morbidly obese patients who underwent VGB. Deficiencies of hemic micronutrients rarely occurred following VBG. Hemoglobin and hematocrit levels were within normal limits at all times. Some patients experienced transitory depression of nutrients at six months postoperatively, during the period of most rapid weight loss and lowest dietary intake. These levels return to normal by one year in almost all cases. Low B12 levels were observed in four patients at 1 year. All had been above 120 per cent overweight and had lost in excess of 100 pounds in the first postoperative year. These data indicate that hemic micronutrients remain at normal levels following VBG. B12 levels should be followed to determine possible need for supplementation other than that provided by usual daily multivitamin preparations in patients above 120 per cent ideal weight loss exceeding 100 lbs in the first postoperative year.

Female↗
PubMed1987

Vitamin and mineral deficiencies following obesity surgery.

Any obesity operation, whether malabsorptive or based upon the production of early satiety, produces weight loss by causing a net reduction in the delivery of nutrients to the portal circulation. The malabsorption caused by jejunoileal bypass produces numerous severe micronutrient deficiencies along with other potentially damaging conditions. Although there are numerous reports of such deficiencies following gastric restrictive procedures (particularly gastric bypass), the conditions are almost always more easily treated than those after intestinal bypass, and resultant clinical illnesses are rare. Physicians should be aware that any obesity procedure carries a risk of nutritional deficiency.

Avitaminosis↗
PubMed1986

Micronutrient deficiencies after gastric bypass for morbid obesity.

Gastric stapling for morbid obesity has been popularized, in part, because of an apparent lack of metabolic sequelae. Of our series of prospectively studied gastric bypass patients, 74 patients have been followed for more than 1 year. Anemia developed in more than one-third of the patients. Nearly two-thirds of the patients developed decreased levels of vitamin B12, and other abnormalities were commonly seen (folate, 38%; iron, 49%; potassium, 56%). While prompt recognition and treatment has prevented development of a clinical deficiency syndrome in most patients, 12 per cent became anemic most likely because of micronutrient deficiency related to the bypass. More than 10,000 gastric restriction operations are carried out for morbid obesity each year in this country. Previous reports of thiamine deficiency-related neurologic sequelae, immune paralysis, and marrow suppression, together with the micronutrient deficiencies and anemia herein reported make long-term frequent metabolic assessment of these patients essential.

Anemia↗
PubMed1984

Obstructive sleep apnea in the morbidly obese. An indication for gastric bypass.

Two morbidly obese patients were described as having severe obstructive sleep apnea syndrome with several apneic periods occurring during sleep that produced substantial oxygen desaturation and, in one patient, cardiac arrhythmias. These patients, by dieting, had noted specific "trigger" weights at which they would manifest symptoms of lethargy, hypersomnolence, and snoring. Both were treated with tracheostomy, and after several days without apnea their cardiac and respiratory status stabilized and they underwent loop gastric bypass. Successful weight loss ensued and repeated sleep studies disclosed no further apneic periods (with the tracheostomies occluded), and so their tracheostomies were removed. We consider sleep apnea syndrome to be an indication for bariatric surgery.

Adult↗
PubMed1984

The role of concentrated sodium solutions in the resuscitation of patients with severe burns.

Seventy-four severely burned patients were resuscitated with intravenous crystalloid solutions that varied in their average sodium concentration. No colloid solution was used. During the first 24 hours, when requirements were greatest, 21 patients received fluids containing less than 150 mEq sodium/L, nearly all of which was lactated Ringer's solution, while for 31 patients the fluids contained more than 199 mEq sodium/L; the remaining 22 patients were treated with fluids of intermediate sodium content (150 to 199 mEq/L). Detailed, computer-assisted analysis of the data was performed. There were no significant intergroup differences in mean hourly urine output, which was in the targeted range of 0.5 to 1 ml/kg, or in urinary sodium excretion. Both the sodium and water loads administered were significantly larger in patients who died than in survivors (P less than 0.0025). This observation is new. The use of concentrated sodium solutions did not increase the sodium requirement, but water loads were significantly lower in patients who received the most concentrated sodium solutions compared to those resuscitated with the least concentrated sodium solutions (P less than 0.014). The data suggest that minimizing the water loads during resuscitation by increasing the sodium content of the administered fluid might improve the chance for survival of severely burned patients.

Acute Disease↗
PubMed1984

Psychologic assessment of morbidly obese patients undergoing gastric bypass: a comparison of preoperative and postoperative adjustment.

Thirty-three morbidly obese patients underwent gastric bypass operation after intensive medical and psychiatric evaluation. Five psychometric tests were administered before and after operation. The study patients were found to have less self-esteem and more depressive traits than a normal population. This did not change after operation despite weight loss. High levels of optimism were not associated with better weight loss. However, patients who understood before operation that the success of the operation depended upon changing their eating behavior lost more weight. After operation patients expressed satisfaction with life and a new freedom from constant hunger. There was a reported decrease in organic symptoms, an increase in social activities, an improvement in interpersonal relationships, and a social usefulness not experienced previously. In selected patients with no active psychiatric disease or psychologic instability, gastric bypass, coupled with consistent postoperative reinforcement, produces behavioral changes that can lead to permanent weight loss without concomitant psychologic deterioration.

Adult↗
PubMed1983

Assessment of patients with failed gastric operations for morbid obesity.

The success of gastric restriction procedures for morbid obesity depends on a persistently small gastric pouch and stoma, an intact staple line, and, of equal importance, dietary compliance. Evaluation of patients with either excessive or inadequate weight loss should be directed at determining both the technical adequacy of the operation and the depth of understanding the patient has of his or her role in the success of the procedure. Because of the poor prognosis for weight loss, patients who are not likely to be complaint or who demonstrate a lack of understanding of the behavioral modification required to ensure the success of the procedure should not have reoperation, even if a large pouch or stoma or a disrupted staple line is seen on an upper gastrointestinal series.

Adult↗
PubMed1983

Lipoprotein levels in morbidly obese patients with massive, surgically-induced weight loss.

Abnormalities in lipoprotein metabolism are among the risk factors for atherosclerotic cardiovascular disease frequently present in patients with morbid obesity. We have examined the effects of dietary restriction induced by gastric bypass surgery on plasma lipoprotein levels in 22 morbidity obese patients. Operation induced weight loss in all patients. Postoperatively (12 +/- 7 mo), triglycerides decreased from 146.4 +/- 67 (mean +/- S.D. before operation) to 104 +/- 44 mg/dl (p less than 0.01), total cholesterol decreased from 187 +/- 52 to 166 +/- 39 mg/dl (p less than 0.025), LDL cholesterol levels decreased from 119 +/- 42 to 104 +/- 36 mg/dl (p less than 0.038), and HDL cholesterol levels increased from 40.1 +/- 10.1 to 45.2 +/- 9.5 mg/dl (p less than 0.012). HDL cholesterol to LDL cholesterol ratio increased from 0.37 +/- 0.13 to 0.48 +/- 0.21 (p less than 0.01). The results of apo A-1, A-2 and B determinations (n = 12) paralleled the changes in lipoprotein levels. Apo A1/Apo A2 ratio increased suggesting an increase in the concentration of HDL2. We conclude that weight loss following gastric bypass surgery is associated with favorable changes in lipoprotein metabolism which may help prevent or delay the development of atherosclerotic cardiovascular disease. The mechanism responsible for the lipoprotein changes remains to be determined.

Adult↗
PubMed1983

Cutaneous anergy and marrow suppression as complications of gastroplasty for morbid obesity.

Although serious morbidity from gastric restriction for morbid obesity is rare, outflow tract dilation after gastroplasty has become a well-recognized complication, and reoperation to decrease outflow tract size has become increasingly common. We report the case of a patient who developed outflow tract obstruction with subsequent malnutrition, recurrent infections, and marrow suppression. Extensive immunologic evaluation revealed impaired cutaneous reactivity to a battery of recall antigens. Other in vitro T cell functions, B cell functions, neutrophil respiration, and quantification of complements were within normal limits. The patient's immunodeficiency was attributed to protein-calorie malnutrition and was corrected with total parenteral nutrition. Recovery of immune function with renutriture was demonstrated, and coincident resolution of infection and marrow suppression also occurred. Because of the reversibility of the immunologic abnormality with appropriate nutritional therapy, it is important to consider and treat malnourishment in connection with any operation in which oral intake is severely limited.

Adult↗