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L D MacLean

Publications and source records attributed to L D MacLean.

At least 37 records · Page 2Linked to original sources
PubMed1988

Revision of failed horizontal gastroplasty by vertical banded gastroplasty.

Eighteen patients who had undergone horizontal gastroplasty experienced postoperative weight gain due to technical failure (large orifice in 10 patients, staple-line disruption in 7 and a large pouch in 1). A vertical banded gastroplasty was used to correct the problem, with a resulting operative morbidity of 38.9%. This included perforation with peritonitis (five patients) and complete outlet obstruction (two patients). These complications appear to result from poor blood supply to the area of the anastomosis necessary in this conversion. This study indicates that it is not safe to use vertical banded gastroplasty for the failed horizontal gastroplasty.

Adult↗
PubMed1987

Nutrition after vertical banded gastroplasty.

The authors assessed the nutritional status of 60 morbidly obese patients by determining body composition, using multiple isotope dilution at 13.6 +/- 0.4 months following operation. Body weight was followed for an additional 12.3 +/- 0.8 months. Twenty-four patients lost more than 25% of their preoperative weight and were within 30% of ideal weight (a "good" result). At 1 year they had lost 41.4 +/- 1.8% of preoperative weight and the body mass index (BMI) decreased from 46.7 +/- 1.2 to 27.0 +/- 0.6 kg/m2. Despite rapid weight loss, malnutrition did not develop and their body composition became indistinguishable from that of normally nourished volunteers. Twenty-nine patients had a "satisfactory" result with more than 25% weight loss but were not within 30% of ideal. Their weight decreased by 34.8 +/- 1.0% as their BMI decreased from 55.4 +/- 1.2 to 36.0 +/- 0.8 kg/m2. Seven patients lost less than 25% of their preoperative weight (an "unsatisfactory" result). Malnutrition did not develop in any patient. In the authors' experience, in contrast to other weight reducing operations, vertical banded gastroplasty (VBG) results in rapid weight loss without the concomitant development of malnutrition even in patients who return to normal weight.

Blood Chemical Analysis↗
PubMed1986

Abnormalities in the cellular phase of blood fibrinolytic activity in systemic lupus erythematosus and in venous thromboembolism.

Fibrinolytic activities of whole blood and plasma were determined by 125I-fibrin radiometric assay in 16 normal subjects, and in 11 patients with systemic lupus erythematosus (SLE), 14 with progressive systemic sclerosis (PSS), 23 with venous thromboembolic disease, and 20 patients awaiting elective surgery. Mean whole blood and plasma activities for patients with PSS, and for those awaiting elective surgery, were similar to normal values, as was the mean plasma activity in patients with SLE. However, mean whole blood activity in SLE was significantly decreased compared with normals (p less than 0.05), with mean plasma activity accounting for 44% of mean whole blood activity (compared with 17% in normal subjects), representing a 67% decrease in mean calculated cellular phase activity in SLE, when compared with normals. Since the numbers of cells (neutrophils, monocytes) possibly involved in cellular activity were not decreased, the findings suggest a functional defect in fibrinolytic activity of one or more blood cell types in SLE. An additional finding was the participation of the cellular phase as well as the well-known plasma phase of blood in the fibrinolytic response to thromboembolism.

Female↗
PubMed1985

Shock. A century of progress.

The word shock has been used for at least a century in all clinical disciplines to describe a progressive but gradual collapse of vital organ functions. Important initial steps in understanding the problem began at the turn of the century by two means: clear clinical descriptions and the initiation of research into etiology and treatment. The growth of shock treatment and its promising future are discussed.

Blood Volume↗
PubMed1985

Significance of immunoreactivity in trauma.

Anergy is a crude measure of host resistance which may be due to malnutrition, but is probably more often due to inappropriate host responses to surgery and injury. Severe injury and infection decrease chemotaxis and the migration of neutrophils to areas of irritation. Lymphocytes from anergic patients are not properly functional in the DTH reaction, probably because of circulatory inhibitors in vivo. These lymphocytes can elicit a response when cultured in normal serum in vitro. B cell function is also impaired in anergic patients in that they do not respond to tetanus toxoid in vivo or in vitro. There is no randomized study which shows conclusively that one should delay elective surgery in anergic patients who are malnourished. Active immunization may become a reality in the prevention of surgical infections. Immunomodulators which favourable affect T and B cell function may also become a part of our armamentarium.

Antigen-Antibody Reactions↗
PubMed1985

State of the art.

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Anti-Bacterial Agents↗
PubMed1983

Fatty acid supply and organ phospholipid turnover in two canine shock models.

Serum free fatty acid (FFA) flux is decreased in shock. The question arose whether the limited availability of FFA would result in a fuel deficit in organs containing no stored lipid and also in the slower turnover of organ phospholipids. The fasting dog's lung, stomach, heart, and liver contained little or no triglyceride, while skeletal muscle, diaphragm, and occasionally intestine had large lipid stores. The replacement rate of lipid fuels and the turnover rate of the fatty acyl moieties of phospholipids were determined by radioactive tracer methods in several organs of dogs in shock due to controlled cardiac tamponade or hemorrhage and their respective controls. In the normotensive controls one-third of the FFA available was directly oxidized; the rest was temporarily incorporated into phospholipids and triglycerides. This incorporation represents replacement of lipid fuels in the organs. Both shock models caused a similar decrease in the total FFA flux and a similar pattern of redistribution among organs. Organs other than heart, lung, and diaphragm replenished their lipid stores slowly in shock. This could cause a fuel deficit in liver and stomach, neither of which have large triglyceride stores. FFA incorporation into phospholipids was slower than esterification into triglycerides in all organs except diaphragm and skeletal muscle both in shock and in normotension. The rate of phospholipid turnover decreased significantly in shock in liver, intestine, and stomach, but increased in heart and lung. Thus liver and stomach are the organs most likely to be affected by the decreased availability of FFA in shock.

Animals↗
PubMed1983

Nutrition following gastric operations for morbid obesity.

Nutritional status after 238 gastric operations designed to reduce caloric intake and body weight to within 30% of ideal was assessed by measuring body composition using the multiple isotope dilution technique. Body cell mass (BCM) and body fat were quantitated before and at 24 months after operation. Malnutrition was defined as a total exchangeable sodium (Nae) to total exchangeable potassium (Ke) ratio greater than 1.22. Data were collected on 96 patients. All had lost a mean of 26% of preoperative weight by 24 months. Significant malnutrition occurred in 47 patients whose Nae/Ke ratio ranged from 1.23 to 2.17 (1.45 +/- 0.03). There was a 34% reduction in body fat. The malnourished patients lost 10% more BCM by 24 months than did the normally nourished group. Malnutrition resolved as the stoma enlarged in 19 patients, and dietary counselling helped eight patients. Eighteen patients required reoperation to establish a larger orifice, and endoscopic dilatation was successful in two patients. Administration of a liquid diet via the gastrostomy was required for prolonged periods in some malnourished patients. Seventeen patients who had lost weight rapidly over a short time had low vitamin B12, thiamine, and serum and RBC folate levels. One patient had a markedly decreased serum thiamine level with neuropathy. Symptoms of weakness, easy fatigability, and lassitude were found in the malnourished patients. Low thiamine and serum folate levels were also seen in patients ingesting a liquid diet of 750 kcal with a standard multivitamin supplement. Malnutrition was not seen in these patients. In the 49 patients who remained well nourished, BCM decreased by 19%, but the Nae/Ke remained normal. Weight loss was well tolerated, and no patients required reoperation or supplemental liquid diet to increase caloric or protein intake. The degree of malnutrition in patients after gastric operations is as great as following intestinal bypass but is not associated with liver failure. Malnutrition with vitamin deficiency is a great potential hazard in patients who undergo intake-limiting operations, especially if the goal of the operation is to restore near-normal weight. Current operations are successfully designed to maintain a small orifice size, so that the risks of malnutrition are likely to increase in the future.

Adult↗