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Biomedical subjects

N B Ackerman

Publications and source records attributed to N B Ackerman.

At least 55 records · Page 3Linked to original sources
PubMed1982

Metabolic consequences from conversion of jejunoileal bypass to gastric bypass.

Conversion of jejunoileal bypass to gastric bypass was performed in 11 patients because of metabolic problems and physical discomforts, and in three patients because of insufficient weight loss. There was no mortality and little morbidity after operation. An additional mean weight loss of 6% occurred, and weight stabilized satisfactorily in most patients. Two patients regained significant weight. Serum cholesterol levels rose within a month in most patients, with a mean increase of 61%. However, levels remained within normal limits. Serum triglyceride levels did not change significantly, especially in patients whose weight remained stabilized. Plasma glucose levels remained normal in all patients, including four patients who had been clinically diabetic before jejunoileal bypass. These patients had become normoglycemic immediately after jejunoileal bypass, and remained normal after conversion to gastric bypass.

Blood Glucose↗
PubMed1982

Differential pulmonary auscultation in neonates.

Auscultation of neonates by means of conventional techniques is subject to many errors. Consequently, pediatricians rely on radiographs for much of their information regarding ventilation abnormalities. We report a method of simultaneous differential auscultation, using a double-headed stethoscope, which allows better auscultatory evaluation of neonates. The technique is simple and easily learned. The equipment used is inexpensive and easily constructed. The technique is most useful in emergency and transport situations when radiographs are not readily available.

Auscultation↗
PubMed1981

Changes in peripheral serum creatine phosphokinase (CPK) and lactic dehydrogenase (LDH) in acute experimental colonic infarction.

No satisfactory laboratory test for the early diagnosis of bowel infarction exists at this time. We have delineated changes in serum CPK levels after acute superior mesenteric artery infarction; whether or not comparable changes occur with inferior mesenteric artery infarction has not yet been determined. Furthermore, the changes in LDH associated with acute bowel infarction have not been documented. To determine the changes in serum CPK and LDH in acute colonic infarction, laparotomies were performed on dogs after peripheral baseline blood samples were drawn and each subject was randomly placed in one of three groups: laparotomy alone, acute colonic obstruction, and acute colonic infarction by ligation of the inferior mesenteric artery. The marginal artery of the colon was ligated at the peritoneal reflection and at the cecum to interrupt arterial collaterals. Blood samples were taken from each subject at intervals of three hours for 48 hours after injury. Serum from each sample was analyzed for total CPK and LDH by automated spectrophotometry. Isoenzymes were determined by agarose gel electrophoresis. Necropsies were conducted on all the dogs to confirm that the intended condition had been produced and that no intercurrent disease was present. The data support the conclusion that total CPK, total LDH and their isoenzymes become elevated in the peripheral serum after colonic infarction. The maximal elevations were all seen within the first 12 hours after acute colonic infarction. Total LDH and LDH(3), the most prevalent isoenzyme of LDH in bowel, do not become elevated in the serum to as high a level as CPK, but the combination of serum elevations in both enzyme systems may prove to be of diagnostic significance.

Acute Disease↗
PubMed1981

Observations on the improvements in carbohydrate metabolism in diabetic and other morbidly obese patients after jejunoileal bypass.

In most morbidly obese patients with diabetes, fasting plasma glucose levels decreased immediately after jejunoileal bypass operations, with patients often becoming normoglycemic before discharge from the hospital. All 12 patients who had required insulin or orally administered hypoglycemic agents preoperatively were able to discontinue the medication shortly after the operation. Oral glucose tolerance test curves in all morbidly obese patients had a flattened pattern, in the normal range, postoperatively. Serum insulin levels, which had been elevated preoperatively, decreased significantly, both in fasting and postglucose determinations. Results of intravenous glucose tolerance tests showed little change in the early period after operation. Improvement in carbohydrate metabolism may be due to several factors and does not appear to be dependent upon massive weight loss. Major factors may include decreased absorption of carbohydrates and amino acids, decreased oral caloric intake, increased insulin sensitivity and decreased output of gastric inhibitory polypeptide as well as the eventual weight loss.

Adult↗
PubMed1981

Changes in serum total creatine phosphokinase (CPK) and its isoenzymes caused by experimental ligation of the superior mesenteric artery.

The changes in serum total CPK and its isoenzymes have not been delineated in acute mesenteric infarction. As measurement of serum CPK levels could conceivably be a useful diagnostic test for bowel infarction, this experiment was performed to assess changes in serum CPK levels in bowel infarction in dogs, using sham operation and talc peritonitis as controls. Laparotomies were performed in 20 dogs, and each was as signed randomly to one of three groups: those having laparotomy (LAP), talc peritonitis (PER), and superior mesenteric artery infarction (MAI). Mixed venous blood samples were obtained from all subjects for 30 hours after surgery. All animals were killed, and complete autopsies were performed. Confirmation of infarction and determination of its extent were obtained through both gross and microscopic examination of the gut in canines subjected to arterial infarction. Total serum CPK levels were determined by spectrophotometric analysis. Agarose gel electrophoresis was used to determine the levels of each of the isoenzymes. Significant elevations of CPK and CPK-MM occurred nine hours after injury. CPK-BB reached maximum elevation by six hours, while CPK-MB did not reach its maximum until 24 hours after injury. From data in the study we conclude that total CPK and its isoenzymes become elevated in the serum of canines subjected to experimental superior mesenteric artery infarction. That CPK-BB elevations peak in the first 12 hours after injury and CPK-MB in the second 12 hours after injury may be of particular diagnostic significance.

Animals↗
PubMed1981

Polle syndrome: chronic diarrhea in Munchausen's child.

A child with a complex history of chronic diarrhea and a seizure disorder, with multiple nondiagnostic previous evaluations, is presented. Under careful observation and with minimal diagnostic studies, the source of this child's chronic disorder was confirmed to be exogenous drug administration by the mother. Polle syndrome, a child-abuse variant of Munchausen syndrome, must be considered as part of an aberrant family social setting by adult or pediatric physicians who uncover a chronic factitious disease. More attention to psychosocial history gathering may preclude well-meaning, but unwarranted, multiple diagnostic endeavors.

Cathartics↗
PubMed1981

The effects of cooling, freezing and thawing on vascular permeability and perfusion in experimental liver metastases.

The effects of cooling and freezing temperatures on vascular perfusion in solitary Walker carcinosarcomas implanted in the liver were studied in Sprague-Dawley rats. With cooling to above freezing temperatures, perfusion with Microfil decreased significantly in both the encircling tumor plexus as well as in the internal tumor circulation. Freezing and thawing produced acute, significant increases of arterial perfusion in encircling and internal tumor circulations. Tumor vascular permeability, as measured by an Evans blue extraction method, increased tremendously as a result of freezing and thawing. Significant rises in permeability were observed at five minutes to 24 hours, with peak activity at six hours. The tumor circulation appeared to respond to the insult of freezing and thawing in a manner similar to that of normal blood vessels, whereas results of previous studies have shown different reactions to chemical vasoactive agents. The acute increases of perfusion and permeability in the tumors as a result of freezing and thawing could be useful as a means of improving the concentration of antitumor agents.

Animals↗
PubMed1980

Enterostomal varices secondary to portal hypertension: progression of disease in conservatively managed cases.

A follow-up of patients with portal hypertension who were bleeding from enterostomal varices in ileostomies or colostomies demonstrated the progression of disease and poor prognosis. Repeated episodes of hemorrhage became more frequent, liver function deteriorated, and death from hepatic failure finally occurred. The hemorrhagic episodes seemed to contribute to the deterioration of the patients' conditions. Portasystemic shunting to eliminate enterostomal bleeding should be considered for the patient who is an acceptable operative risk. If major surgery is contraindicated, local hemostatic measures offer, temporarily, palliative alleviation of bleeding, but the ultimate prognosis is grave.

Colostomy↗
PubMed1980

The blood supply of experimental liver metastases. V. Increased tumor perfusion with epinephrine.

The effects of epinephrine on the vascular perfusion of solitary Walker tumors implanted in the liver were studied in Sprague-Dawley rats. Colored silicone rubber (Microfil) solutions were injected into the arterial and portal circulations in each animal, and specimens were studied under a stereomicroscope. Internal vascular volume was calculated on the basis of the interference of light passing through the central portions of the tumors by Microfil-filled vessels. Intraarterial epinephrine, in doses of 100 or 10 micrograms, markedly increased vascular perfusion in the encircling plexus and the internal tumor circulation compared with control animals. Internal vascular volume was significantly increased from 9.4 percent in controls to 22.5 percent in epinephrine-treated animals. Increased perfusion was also seen when epinephrine was administered through the portal system, and in larger tumors after intraarterial administration. Internal tumor vessels were capillary-like in appearance.

Animals↗
PubMed1980

Failure of histamine type mediators to enhance vascular permeability in experimental liver metastases.

The effects of histamine, bradykinin, serotonin and reactive hyperemia on vascular permeability in Walker carcinosarcomas and host liver tissue were studied in rats. A quantitative Evans blue technique was used to assess vascular permeability. While the expected increases in permeability occurred in the liver five minutes after the administration of the histamine type drugs, the drugs failed to increase vascular permeability in the tumors at all the time periods studied. The liver responded variably at 30 minutes after drug administration, and all effects had disappeared at six hours. The only increase in vascular permeability seen in the tumors was that occurring five minutes after the establishment of reactive hyperemia. Results of these studies demonstrate further differences between newly formed tumor vessels and well established vessels of the host tissue.

Animals↗
PubMed1979

Perforated appendicitis in an incarcerated inguinal hernia.

Although perforated appendicitis in an incarcerated hernia is an uncommon condition, the clinical manifestations vary from relatively benign to much more serious, depending on whether the septic process is limited to the hernial canal and sac or if there is intraperitoneal contamination. The patient described in this report had minimal symptoms other than a slightly tender, irreducible inguinal hernia. He easily tolerated resection of the appendix and contiguous inguinal tissues, with a primary repair of the inguinal hernia.

Acute Disease↗
PubMed1979

Comparison of changes in intestinal length and circumference after 90 per cent bypass and 90 per cent resection.

Compensatory hypertrophy was compared in rats that had undergone 90 per cent small intestinal resection and rats that had undergone 90 per cent small intestinal bypass. Increases in intestinal length and circumference occurred rapidly in both groups and were virtually identical. Lengthening was more pronounced in the jejunum; increase in circumference was greater in the ileum. Increases in length and circumference of the appendix were seen in both experimental groups. These studies suggest that compensatory hypertrophy can occur in patients after either intestinal bypass or resection, and that patients with bypasses have a less difficult postoperative course because of their preexisting obesity.

Animals↗
PubMed1979

Improved exposure for excision of rectal carcinomas: initial experiences with a pubic resection technique.

Preliminary experiences with a transpubic approach for carcinoma of the rectum are described. By excising a wedge of pubic bone and freeing the left lateral attachments of the bladder, the entire length of rectum can be exposed, down to the level of the levator muscles. Dissection of the tumor can be performed under direct vision, even in unfavorable anatomic and pathologic situations. Low rectal anastomoses, at levels of 1--2 cm above the anus, may be performed with greater ease. It is felt that urinary problems should be uncommon and that orthopedic complications should not occur since sacroiliac articulations are not disturbed by retraction.

Aged↗
PubMed1979

Obstructive, pseudo-obstructive and enteropathic syndromes after jejunoileal bypass.

We have encountered two patients with volvulus of the small intestine at the ileocolic anastomosis, occurring after jejunoileal bypass. This uncommon complication is generally seen many months after bypass and may be difficult to diagnose. Barium enema examination was helpful in one patient. If there are acute, severe abdominal symptoms, mechanical obstruction and early operation should be considered. Attention has been called to other intestinal syndromes with obstructive features developing after jejunoileal bypass, and these have been compared.

Adult↗