Diet Coke or not?
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Carbonated Beverages↗
Biomedical subjects
M Deitel
Publications and source records attributed to M Deitel.
Pheochromocytoma producing multiple vasoactive peptides.
Pheochromocytomas may produce several vasoactive peptides. We studied a 39-year-old man who presented with paroxysmal flushing and abdominal pain with normal blood pressure. Laboratory and radiologic studies established the diagnosis of right adrenal pheochromocytoma, and histologic and ultrastructural examination showed the tumor to be a typical pheochromocytoma. Tissue culture yielded large quantities of norepinephrine and epinephrine. However, immunohistochemical studies, tissue assays, and in vitro cultures documented production of several peptides, including calcitonin gene-related peptide and vasoactive intestinal polypeptide in tumor cells. The patient has been asymptomatic after tumor resection. Production of multiple peptides by this tumor may account for the flushing and lack of hypertension, despite elevated catecholamine levels in this patient.
Adrenal Gland Neoplasms↗
Emulsion stability in a total nutrient admixture for total parenteral nutrition.
A total parenteral nutrition solution containing lipid was tested up to 28 days at 4 degrees C followed by an additional 2 days at 22 degrees C (room temperature) for stability of the emulsion. The total nutrient admixture (TNA) contained 1000 ml 10% FreAmine, 1000 ml 50% dextrose, 500 ml 10% Soyacal, electrolytes, vitamins and trace elements. Stability was determined by direct observation, light and electron microscopy, Coulter counter, pH, osmolality, and fatty acid profile. Samples were tested when fresh at 0 hours, after 2 days at 22 degrees C, 14 days at 4 degrees followed by 2 days at 22 degrees C, and 28 days at 4 degrees C followed by 1 and 2 days at 22 degrees C. Light microscopy measured particles greater than 2 microns in diameter; 99% of these particles were less than 6 microns, with no increase with time. Electron microscopy found that lipid particle size increased slightly up to 30 days, at which time the mean diameter was 0.36 +/- 0.01 micron. Coulter counter studies found that lipid droplet diameter increased while at 22 degrees C; however, on day 30, 99% of the particles were less than 1.97 microns. Mean pH and osmolality were 6.35 +/- 0.04 and 1880 +/- 14.5 mOsm/kg, respectively, with no change over time. Analysis of fatty acids by gas chromatography showed that fatty acid profiles and amounts of triglyceride, phospholipid and total lipid did not change. Thus, the emulsion in the TNA was stable for 28 days refrigeration, followed by 2 days at room temperature.
Drug Stability↗
Morbid obesity: selection of patients for surgery.
Massive obesity is associated with serious co-morbidities. After failure of extensive conservative measures, surgical procedures have developed as the only successful method for sustained weight loss. Criteria for operation are: presence of serious diseases associated with morbid obesity; greater than 45 kg above ideal weight or body mass index greater than 40 kg/m2 for usually greater than 5 years; failure of sustained weight loss on extensive conservative regimens; commitment to lifelong follow-up; and acceptable operative risk. Angina pectoris itself is not a contraindication to these operations. Patients who do not quite meet the weight criteria may still be candidates for an obesity operation in certain instances, e.g., debilitating musculoskeletal pains in weight-bearing joints, diabetes, significant hypertension, reflux esophagitis, urinary stress incontinence. Although current operations result in lasting weight loss of greater than 50% of excess weight in the majority of patients, the surgical candidate must understand and accept the principles of the procedures, the potential for serious complications, the dietary necessities, and occasional failures.
Body Mass Index↗
Augmented production of heparin-binding mitogenic proteins by preadipocytes from massively obese persons.
Basic fibroblast growth factor (bFGF) stimulates the replication of preadipocytes and inhibits their differentiation. In this study we explored whether the same or related polypeptides were produced locally and acted by paracrine/autocrine mechanisms in adipose tissue. Omental preadipocytes from 7 lean and 10 massively obese (> 170% reference) subjects were grown to confluence in subculture. Total RNA was hybridized with a synthetic deoxynucleotide for human bFGF. In the case of all cell strains, there was expression of two major bFGF transcripts, 7.0 and 3.7 kb. Although there was considerable variation in the degree of expression, preadipocytes from massively obese subjects revealed much greater expression than did cells from the lean (P < 0.001). In studies of conditioned media prepared with preadipocytes, the presence of proteins belonging to the heparin-binding (fibroblast) growth factor family was indicated by Western blot analysis, for a 66-kD protein with anti-(1-24)bFGF, and for a 32-kD protein with anti-(40-63)bFGF antibodies. The relative quantity of the 66-kD protein correlated with body mass index at r = 0.72. bFGF-related proteins probably function normally to maintain an appropriate complement of adipocyte precursors. The augmented expression of heparin-binding growth factors in preadipocytes from some massively obese people probably contributes to the excessive cellularity of their fat depots.
Adipose Tissue↗
Management of papillary carcinoma arising in thyroglossal-duct anlage.
Cysts of the thyroglossal duct are common congenital abnormalities. They present as asymptomatic midline cervical swellings. The risk of malignant change is low; only 103 cases have been reported in the world literature, 85% of which were papillary adenocarcinomas. The appropriate treatment for this condition remains controversial. The authors describe three patients who had papillary carcinoma contained within a thyroglossal-duct rest. All were treated by cyst resection and thyroid suppression, but without thyroidectomy and radioactive thyroid ablation. Postoperatively, all patients remained disease free, with no recurrence at follow-up ranging from 10 to 29 years. Isolated papillary carcinomas arising from primitive thyroid remnants, associated with a palpably normal thyroid gland at surgery and a negative thyroid scan, can be treated adequately by excising the thyroglossal mass.
Carcinoma, Papillary↗
A family exhibiting carotid body tumours.
The authors describe the surgery carried out for 11 carotid body tumours (CBTs) that were found in three generations of a Greek family. Eight patients with CBTs were operated upon at St. Joseph's Health Centre, Toronto, within 1 year. Three patients had bilateral CBTs, which were removed in two stages. Only one of the CBTs occurred in a female. Seven CBTs were excised by meticulous subadventitial dissection. In the eighth, a previous attempt at removal in another hospital had proved unsuccessful, and excision of the tumour required ligation of the external carotid artery and partial excision of the carotid bulb. The authors conclude that most CBTs can be excised directly without ligation, shunts or bypasses. In eight operations carried out on five patients, the only complication was a transient neuropraxia of the hypoglossal nerve that resolved within 2 weeks.
Adult↗
Primary colorectal anastomosis with the intracolonic bypass tube.
BACKGROUND: Intracolonic bypass with primary colocolonic or colorectal anastomosis may be an effective option in the operative management of complicated colonic disease when adequate bowel preparation is not possible. A pliable latex tube is anchored to mucosa and submucosa 3 centimeters proximal to a site of colocolonic anastomosis and later spontaneously evacuated by way of the rectum. METHODS: Twenty-nine consecutive patents who required urgent colorectal operations in the presence of unprepared bowel underwent left colon resection with intracolonic bypass and primary anastomosis. These patients would have otherwise undergone multistage procedures for the management of the colorectal disorders. Demographic data, APACHE II scores, and type and frequency of complications were recorded. RESULTS: Between July 1, 1990, and June 30, 1991, 31 patients were eligible for entry in the study. Two patients ultimately had contraindications for the use of intracolonic bypass. The causes encountered included complicated diverticular disease, colonic carcinoma, sigmoid volvulus, and iatrogenic colorectal injury. Complications included wound infection (7), myocardial infarction (2), prolonged ileus (1), deep vein thrombosis (2), and anastomotic leak (2). Postoperative myocardial infarction and subsequent multiorgan system failure were responsible for the only death in this study. CONCLUSIONS: Intracolonic bypass permits a safe primary anastomosis where multistage procedures would otherwise be required. Avoidance of colostomy and the attendant socioeconomic benefits warrants further study of this method.
Aged↗
A simple method for laparoscopic cholangiography.
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Cholangiography↗
Cardiac function in massively obese patients and the effect of weight loss.
Massively obese patients are at increased risk for heart disease. Blood volume and capillary flow are increased to supply the excess body mass, and there is a concomitant increase in preload and, often, afterload. The heart compensates for the expanded blood volume by increasing stroke volume and cardiac work to provide increased cardiac output. The result is left ventricular dilatation followed by eccentric left ventricular hypertrophy. Cardiac compensatory reserve is limited, leading, at times, to overt congestive failure. After reduction of the excess body fat, most of the cardiovascular derangements appear to reverse. The authors review the effect of massive obesity on the heart and the cardiovascular consequences of weight reduction.
Heart↗
Effect of weight loss on musculoskeletal pain in the morbidly obese.
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Back Pain↗
Severe secretory diarrhea with elevated gastrin-releasing peptide controlled by somatostatin analogue: a case report.
Gastrin-releasing peptide immunoreactivity has been seen in functioning endocrine tumours which are recognized as a major cause of secretory diarrhea. The authors describe a case of a 52-year-old woman who had secretory diarrhea (5 L/d) with markedly elevated gastrin-releasing peptide levels associated with islet cell hyperplasia. No tumour could be identified. The diarrhea was controlled by somatostatin analogue.
Diarrhea↗
Dexon plus versus Maxon fascial closure in morbid obesity: a prospective randomized comparison.
A monofilament polyglyconate suture (Maxon) was developed as a longer-lasting suture associated with less potential for infection than braided polyglycolic acid suture (Dexon). The authors compared Dexon Plus and Maxon in a prospective randomized study of 84 consecutive morbidly obese patients who underwent vertical banded gastroplasty. Linea alba was closed with continuous running suture, reinforced with a few interrupted, sutures. After more than 2 years' follow-up, one seroma (2.4%), one wound infection (2.4%) and no hernias were found in the Dexon group. In contrast in the Maxon group there were three seromas (7.1%), four wound infections (9.5%) and four incisional hernias (9.5%, p less than 0.05). The hernias were noted between 2 and 10 1/2 months after the operation in two patients who had had wound infections and in two who had had seromas. When Maxon was used, the needle occasionally pulled off the suture and the ends beyond the knot projected rigidly. Dexon Plus was easier to handle in very fatty wounds.
Adult↗
Gastric bezoar complicating gastric stapling.
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Bezoars↗
Erosion of Marlex band and silastic ring into the stomach after gastroplasty.
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Equipment Failure↗
Physical stability of a total nutrient admixture for total parenteral nutrition.
The stability of a total nutrient admixture (TNA) has been postulated to be less than 7 days in refrigerated storage. When a TNA destabilizes, lipid particles coalesce and enlarge. Liposomes larger than 6 microns can obstruct pulmonary capillaries. A TNA containing 1500 ml of 7% Vamin, 1000 ml of 50% dextrose and 500 ml of 10% Intralipid, including the usual electrolytes, minerals and vitamins, was studied. Liposome size was measured in the original Intralipid and the TNA at intervals up to 14 days at 4 degrees C followed by 2 days at 22 degrees C. There was a small increase in liposome size up to 16 days. However, the number of particles larger than 6 microns was insignificant (by light microscopy, 3.9 +/- 2.4 [+/- SD] per 20 high-power fields; by Coulter counter, 99.8% smaller than 1.9 microns, with 0% larger than 6 microns; and by electron microscopy, 100% smaller than 2.0 microns). The osmolality and pH of the TNA were 1472 +/- 31 mOsm/kg and 5.5 +/- 0.1 respectively (mean +/- SD), with no significant change during the study times. The authors concluded that this TNA remains physically stable when refrigerated for 14 days and at room temperature for a further 2 days.
Amino Acids↗
Endoscopy of vertical banded gastroplasty.
Vertical banded gastroplasty is the most common operation for morbid obesity. Postoperative gastroscopy was needed 91 times in 79 of 696 patients for 1) abdominal pain (23), 2) excess vomiting (22), 3) inadequate weight loss (14), 4) excess weight loss (13), 5) and a sudden increase in eating capacity (7). A normal appearance consisted of a clean gastric channel 6.8 +/- 1.4 SD cm long, with a rosette 46.6 +/- 2.1 cm from the incisors and, with insufflation, an 11 mm scope passed through this pseudopylorus snugly, but without difficulty. In Group 1, no problem was seen in the channel, and cholecystitis was found to be the cause. In Group 2, no problem was observed in ten (poor teeth and chewing), six experienced stasis or pill ulcerations, four had bezoars (fragmented or removed with basket), and two had intraluminal mesh. In Group 3, the scope floated through too large an outlet (greater than or equal to 13 mm) in eight, and no cause was seen in six (gorgers, sweets-eaters). In Group 4, tightness or stricture resolved with dilatations (Eder-Puestow; Savary; balloon dilators) in six, but seven required re-operation. In Group 5, the scope travelled through four breakdowns in the partition and three outlets were too large. Gastroscopy viewed problems accurately, indicated treatment and suggested modifications in gastroplasty technique.
Abdomen↗
Vertical banded gastroplasty as an antireflux procedure.
Vertical banded gastroplasty creates a channel by two applications of the TA-90 stapler from an end-to-end anastomosis window above the crow's foot to the angle of His, against a 32 F. tube along the lesser curvature. The caudad end of the channel is restricted by a 5 cm collar. Thirty-one obese patients more than 45 kg overweight were studied by interview, barium swallow, endoscopy, and manometry. These procedures were repeated 13 +/- 5.5 weeks postoperatively, after resolution of operative edema and before extensive weight loss. Preoperative symptoms included heartburn in 24 patients, regurgitation in 17 patients, and aspiration in 2 patients, and barium swallow demonstrated hiatal hernia in 7 patients and reflux in 7 patients (5 with hiatal hernia). In addition, endoscopy detected mild esophagitis in 3 patients, and hiatal hernia in 11 patients. Postoperatively, the incidence of heartburn decreased in all patients, barium swallow showed slow channel emptying but no hiatal hernia or reflux, and endoscopy did not identify any esophagitis. Preoperative lower esophageal sphincter pressure was 14.5 +/- 7.2 mm Hg. Postoperatively, the vertical banded gastroplasty channel had an initial peak (collar) pressure of 19.2 +/- 7.8 mm Hg (p less than 0.01 compared with preoperative lower esophageal sphincter pressure), a channel pressure of 9.5 +/- 6 mm Hg, a lower esophageal sphincter pressure of 20.1 +/- 7.7 mm Hg (p less than 0.005), and a channel length of 6.8 +/- 1.4 cm. Vertical banded gastroplasty creates a high pressure channel, inhibiting reflux of gastric juice without the need for any additional procedure.
Adult↗