Biomedical subjects
L Backman
Publications and source records attributed to L Backman.
Enzyme-enzyme complexes between aspartate aminotransferase and malate dehydrogenase from pig heart muscle.
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Immunological function in patients operated on with small intestinal shunts for morbid obesity.
Obese individuals, operated on with intestinal shunts, have been investigated with regard to immunological functions. After operation strong increases in skin reactions of immediate and delayed type were observed. Analysis of total WBC and differential counts, percentage T lymphocytes, immunoglobulin concentrations, and lymphocyte reactivity yielded no explanation of the findings.
Morphological changes of the small intestine following jejuno-ileal shunt in obese subjects.
The forty-seven patients in this study suffered of massive obesity and underwent jejuno-ileal shunt operations. Seventeen of them had a second laparotomy for various reasons. At both operations, a number of measurements were made; the length of the functioning jejunal and ileal segments and, in biopsies, the intestinal villus height were determined. The second laparotomies were not performed until at least 6 months after establishment of jejuno-ileal bypass. The mean length of functioning jejunum was increased by 33% (p less than 0.05) and the mean elongation of functioning ileum by 73% (p less than 0.001). The mean villus height in functioning jejunum increased by 33% (p less than 0.001) and in functioning ileum by 70% (p less than 0.001). The mean villus height in the jejunal blind loop decreased by 30% (p less than 0.001). The demonstrated hypertrophic changes in the functioning part of the small intestine following jejuno-ileal bypass represent the morphological basis of functional intestinal adaptation. The effect of this adaptation is clearly shown in the characteristic weight diagram of an obese patient after bypass operation: the loss of weight cases, a period of stability ensues and then the patient begins to regain weight to some extent.
[Kidney stone--a complication caused by intestinal shunt in treatment of obesity].
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Cell size and the antilipolytic effect of insulin in human subcutaneous adipose tissue.
Lipolysis was studied in subcutaneous adipose tissue removed under local or general anaesthesia from subjects with marked difference in body weight and from obese subjects before and after intestinal shunt operations. The release of glycerol was measured in sections of adipose tissue incubated for two hours in bicarbonate buffer containing 4 per cent bovine albumin with no glucose added. The larger fat cells were more insulin sensitive than the smaller. A positive relationship was observed between the fat cell size and the antilipolytic effect of insulin (100 muU/ml). Insulin had no significant effect on the lipolytic effect of the catecholamines, when this is calculated as the increment in the glycerol release above the basal.
Skin reduction plasties following intestinal shunt operations for treatment of obesity.
A unique group of more than 100 selected cases were treated surgically for massive obesity, a mal-absorption syndrome, by an intestinal shunt used to obtain significant weight reduction. The loss of skin elasticity of the slimming patient leads to a "redundant skin syndrome" creating dermatologic-cosmetic as well as psychiatric problems. A series of reductive skin plasties were performed beginning when the patient's body weight had been stable for some months. The redundant skin was found mainly in two contralateral areas: on both sides of the axillae: on the medial aspect of the upper arm and laterally below the breast, and on both sides of the inguinal ligament, on the lower abdomen and on the medial aspect of the thigh. Thirty-eight patients of the group had skin reduction plasties. The operations were performed on each site separately with a few months' interval. Operative techniques and results are presented.
The rate of weight loss after intestinal bypass operations for obesity. An analysis of factors of significance.
The postoperative period after small intestine bypass operations could be subdivided into five. Analysis of the rate of weight loss during the period of constant weight loss (period II) in 80 subjects gave a mean rate of 0.011 weight-index units (Broca) per week (range 0.023-0.003) or 0.79 kg per week (range 1.81-0.22). After both end-to-end and end-to-side jejuno-ileostomy the rate of weight loss during period II was correlated to initial body weight. After end-to-end jejuno-ileostomy the rate of weight loss was also correlated to the length of the distal eleum in function, either as absolute value or as a fraction of the total small intestinal length. The absence of these correlations after end-to-side jejuno-ileostomy might be due to a more variable reflux in to the bline loop after this operation. It is suggested that a small intestinal bypass operation should not be performed as a standardized procedure with predetermined segments of the small intestine in function, but rather as an operation designed for each patient.
Fatty acid patterns of serum triglycerides and subcutaneous adipose tissues after ileal bypass in obesity.
A group of 9 obese subjects with a mean body weight of 140 kg was treated for their obesity with a jejuno-ileal intestinal shunt. During the first post-operative year their mean body weight decreased to 100 kg. Fatty acid patterns of triglycerides inserum and subcutaneous adipose tissue were studied at intervals during one year after surgery. Myristic and palmitic acids' contents of serum triglycerides were found to decrease during this period of time, whereas the fatty acid pattern of triglycerides in adipose tissue was practically unchanged. Triglycerides, cholesterol, albumin, and lactate dehydrogenase in serum decreased during the first year after operation, whereas aminotransferases showed a transient elevation. It is put forward that these findings are consistent with starvation rather than liver dysfunction.
Amino acid pattern in plasma before and after jejuno-ileal shunt operation for obesity.
The amino acid pattern in plasma was studied in a reference group (n=26) and in three groups of massive obese subjects (n=9, 8, and 9 respectively) before and at intervals after jejuno-ileostomy. The obese subjects had preoperatively an amino acid pattern significantly different from that in the reference group. The concentrations of lysine, tyrosine, 1/2 cystine, and glutamic acids were higher, and aspargin, glutamine, serine, and glycine were lower than in the reference group. During the post-operative period the amino acid pattern changed significantly; thus serine, glycine, and taurine increased and valine, lysine, leucine, tryptophan, thyrosine, 1/2 cystine, and citrulline decreased. The amino acid pattern in the obese group with the longest post-operative observation time and a stable body weight differed significantly from that in the reference group only with regard to a low valine concentration and high concentration of taurine and glutamatic acid.
Some somatic complications after small intestinal bypass operations for obesity. Possible factors of significance in the incidence.
The complications after intestinal bypass operations in 103 massively obese subjects were recorded postoperatively for a maximum of 5 years. The surgical procedures were jejuno-ileostomy, end-to-side (op. I) in 35, and end-to-end with ileocaecostomy (op. II) in 68 cases. Wound dehiscence was the cause of the sole early postoperative death. The early complications found were those commonly seen after abdominal surgery, namely wound infection (n=24), wound dehiscence (n=5), anastomotic leak (n=2), leg thrombosis (n=2). One of the latter 2 patients probably also had pulmonary embolism. In 6 cases early intestinal obstruction occurred; 3 of them required reoperation. The late complications were divided into unspecific and specific in relation to the surgically induced malabsorption. Their incidence was analysed in 80 subjects observed for longer than 1.5 years after the operation. Unspecific late complications consisted of intestinal obstruction in 5 cases and incidional hernias in 18 cases. Intussusception was not seen. There seemed to be no increase in the incidence of gallstone disease or gastroduodenal ulcer after the operation. Specific late complications were electrolyte disturbances (ED) in 13, signs of liver injury (LI) in 9, urinary-tract calculi (UTC) in 15, and immunopathy (IM) in 19 cases. The IM group had skin rashes, arthralgia, and fever. Besides these somatic complications, a number of specific pyschictric complications were also observed (not published). Three subjects died after the operation with signs of liver insufficiency. The following factors were found to be of importance in the occurence of the specific complications ED and LI: 1. The presence of preoperative abnormalities in serum-electrolyte concentration and pathological liver tests, mainly occuring in the heavies patients. 2. Most ED and LI occurred during the period of main weight loss, in general during the first postoperative year. ED and LI did not appear after body weight had stabilised. 3. The rate of weight loss: ED and LI occurred, with a few exceptions, in the subjects with a rate of weight loss higher than 0.0130 weight-index units per week during the period of constant weight loss (see article).
Malabsorption of hydrochlorothiazide following intestinal shunt surgery.
Hydrochlorothiazide 775mg was administered orally to 5 patients who had undergone intestinal shunt operations for obesity 1.5 to 6 years previously. Postoperative weight loss averaged 53.4kg. The concentrations of hydrochlorothiazide in plasma and urine were determined with gas/liquid chromatography. The mean area under the plasma concentration time curve during 9h in 4 of the patients was 889ng/ml.h. Mean total urinary recovery of hydrochlorothiazide amounted to 23.0mg in the 5 patients, which corresponds to approximately half that seen in healthy volunteers. The gastrointestinal hydrochlorothiazide appears to be substantially reduced after intestinal shunt surgery.