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At least 199 records · Page 11Linked to original sources
PubMed1985

[Contribution of amino acid deficiency to primary hypothyroidism associated with protein-calorie malnutrition].

A 68-year-old male patient without any previous thyroidal disease developed three times of transient primary hypothyroidism associated with protein-calorie malnutrition (PCM). Because of his diabetes mellitus, alcoholic hepatitis, chronic pancreatitis and blind loop syndrome, his nutritional balance was easily disturbed leading to PCM. Although he recurrently developed primary hypothyroidism associated with PCM, this condition was completely restored by protein-calorie repletion. The possibility of dietary iodine deficiency was negated by the observation that his daily urinary iodine secretion was more than 4 mg/day. Plasma amino acid analysis revealed severe depletion of phenylalanine, tyrosine and other essential amino acids and raised the possibility that this hypothyroidism was caused by amino acid deficiency. In order to clarify the mechanisms of this primary hypothyroidism, we have investigated the change of thyroid functions during protein-calorie repletion by total parenteral nutrition (TPN). We then removed iodine from the nutrients for TPN to ascertain that iodine deficiency was not the cause of the primary hypothyroidism in the present case. In spite of the removal of iodine, serum T4 and T3 suddenly increased from 1.1 micrograms/dl and less than 25 ng/dl to 3.5 micrograms/dl and 59 ng/dl, respectively, in a few days after the beginning of TPN. They continued to increase thereafter and reached 6.3 micrograms/dl and 115 ng/dl in 6 weeks. Serum free T4 also showed a sudden increase from 0.56 ng/dl to 1.7 ng/dl after TPN and remained above 1.3 ng/dl thereafter. Serum reverse T3 showed a rapid increase after TPN, but, 4 weeks later, returned to the previous level before TPN. Serum TSH decreased from 120 microU/ml to 17 microU/ml in a few days after TPN and reached a level within normal range in 4 weeks. Serum TBG gradually increased from 10.7 micrograms/ml to 29.2 micrograms/ml in 6 weeks. These results show that the T4 synthesis was extremely impaired by PCM in spite of the strong stimulation by TSH and that this suppression of T4 synthesis by PCM led the patient recurrently to the primary hypothyroidism. We have next investigated the possibility whether the deficiency of phenylalanine and tyrosine could cause a suppression of T4 synthesis because tyrosine is an important substrate of T4. For this purpose we removed phenylalanine and tyrosine from TPN and added iodine to prevent iodine deficiency due to prolonged iodine-depleted nutrition. Reduction of phenylalanine and tyrosine resulted in a marked decrease in serum T4, T3 and TBG in 7 weeks, but gave no change to free T4. Serum TSH remained within normal range.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1985

Glucagon and small-bowel mucosa.

Numerous functional and structural effects of pharmacological dosages of glucagon on the small-intestinal mucosa have been demonstrated. In addition, clinical conditions associated with elevated concentrations of plasma glucagon may go along with alterations of the intestinal mucosa. The physiological and pathophysiological relevance of these findings, however, is questionable in view of the heterogeneity of the findings, of the complexity of the experimental systems used and of the methodological problems involved. With respect to possible trophic effects on the small-bowel mucosa enteroglucagon is of special importance. Numerous diseases in which increased intestinal mucosal growth has been shown are associated with elevated plasma concentrations of enteroglucagon. Our results concerning radiation damage, the time course of plasma enteroglucagon levels during antimitotic treatment, the small intestinal resection and the experimental blind loop syndrome are discussed. An outlook will be given as to the use of monoclonal antibodies in the development of glucagon as well as enteroglucagon deficiency states for the study of the physiological relevance of these two regulatory peptides.

Adaptation, Physiological↗
PubMed1979

[Reintervention after choledocho-duodenostomy].

Shrinkage of the anastomosis and blind loop syndrome with impacted stones or sludge in the retroduodenal common bile duct caused by papillary stenosis are the main reasons for an ineffective choledochoduodenostomy. The clinical picture is that of an ascending cholangitis. 30 choledochoduodenostomy repairs were performed in our hospital. The operative treatment is described in detail. In a follow-up of 30 patients there was only one case with a persisting chronic cholangitis.

Cholangitis↗
PubMed1979

[Radiographic findings after duodenal surgery (author's transl)].

A gastroduodenostomy as part of partial gastric resection may change function and morphology of the duodenum in a typical fashion. End to side anastomosis may produce a blind pouch. An end to end anastomosis may lead to postanastomotic dilatation, which may mimick a duodenal bulb (a so called "neo -- or pseudobulb"). Abnormal duodenal peristalsis with atony may follow vagotomy, pyloroplasty, gastroduodenostomy or excisional duodenal biopsy and may thus result in functional obstruction. A blind loop syndrome may develop after bypass procedures for duodenal stenosis.

Common Bile Duct↗
PubMed2005

Laparoscopic revision of bariatric procedures: is it feasible?

Reoperative bariatric surgery is required in 10 per cent to 20 per cent of patients secondary to weight regain or complications of the previous procedure. This study evaluates the feasibility of performing the revision procedure laparoscopically. A retrospective review of all patients undergoing revision of a previous weight loss procedure between October 1998 and November 2003 was conducted. Demographics, indications for surgery, operative findings, and complications were reviewed. Thirty-nine revisions were performed in 37 patients. Indications for revision were failure to lose weight (22), gastric outlet stricture (10), refractory gastroesophageal reflux (GERD) (6), and blind loop syndrome (1). All 39 procedures were revised to Roux-en-Y gastric bypass (RYGBP), with 18 open revisions (OR) and 21 laparoscopic revisions (LR). Ten of the 21 LR (48%) were converted to an open procedure due to adhesions or unclear anatomy. Early complications requiring operation were noted in five procedures (two OR, three LR). Nine patients (seven OR, two LR) required surgery at least 3 months following their revision. One patient died (LR). The difference in body mass index (kg/m2) (BMI) pre- and post-op was 43.3+/-9.9 versus 37.4+/-9.2, P = 0.01 (follow-up 5 months), but no significant BMI differences between LR and OR patients were seen. Revisional bariatric surgery is associated with more complications requiring surgery early in the laparoscopic population versus more late complications in those approached open. Revisional bariatric surgery can be approached laparoscopically and with acceptable morbidity comparable to patients whose revision is approached open.

Adult↗
PubMed1989

[Principles of epithelial transport mechanisms: importance for pathophysiologic understanding, differential diagnosis and treatment of diarrheal diseases].

First, general principles of epithelial transport and the epithelial barrier function are described. The cellular mechanisms of Na-glucose cotransport, electrogenic Cl-secretion, and electrogenic Na-absorption are presented. Second, the pathophysiology of epithelial transport systems and their regulation is given as far as relevant for the onset of diarrhea. This includes congenital deficiency of transport proteins and mucosal transformation as e.g. during celiac disease, tropical sprue, and the blind loop syndrome. Finally, regulation of epithelial transport by the enteric nervous system, GI-peptides, hormones, and the intestinal immune system is discussed in respect to disturbances of this regulation as for example seen in the presence of bacterial enterotoxins.

Diarrhea↗
PubMed1988

Ileogastrostomy for morbid obesity.

Jejunoileal bypass procedures for morbid obesity have been associated with numerous side effects, due mainly to the blind-loop syndrome. To overcome this, the authors describe a new procedure, ileogastrostomy, that they have performed in 50 patients. All had good weight loss and returned to work. Patient satisfaction with the operation was high and self-esteem increased. There were no deaths or severe complications. Stool frequency and foul-smelling stools were still problems but improved with time. Stomal ulceration occurred at 3 months in three patients but resolved within 1 month when treated with H2 blocking agents and was not encountered later than 3 months in any patient.

Body Weight↗
PubMed1979

[Bile acids II. Physiopathologic and clinical aspects (author's transl)].

It is generally accepted that the bile acids are responsible for pathologies as a result of deficiency or by toxic action. Quantitative deficiency is difficult to evaluate but the normal pool of bile acids is generally considered to be between 2 and4 grams. Daily loss and replacement by synthesis is thought to be between 500 and 700 mg. There is experimental evidence to demonstrate the toxic action of certain bile acids on metabolic structures and processes. There is no doubt that alterations in the metabolism of bile acids give rise to certain pathologic aspects in some diseases of the gastrointestinal tract or the hepatobiliary system. There are other conditions, on the other hand, in which the study of these acids may reveal significant physiopathologic implications. The first group includes terminal ileopathy, blind loop syndrome, gastric ulcer, gastritis, cholestasis, cirrhosis of the liver, and cholelithiasis. In the second group are such diverse conditions as acute pancreatitis, cancer of the colon, endocrine disturbances, some hyperlipidemias, and others. Much of the present day understanding of the physiopathology of the bile acids will probably have to be revised in the nex few years, in view of the rapid advances being made in this field.

Bile Acids and Salts↗
PubMed1982

Management of duodenal diverticula.

Duodenal diverticula are not uncommon. Uncomplicated diverticula require no treatment. In the period 1970 to 1980, 104 patients with symptoms presented at the Vancouver General Hospital and the Swedish Hospital in Seattle. Of these, 26% presented with pain and 24% with anemia. Malabsorption and benign tumours were noted infrequently. Fifteen patients were treated surgically for pain, perforation, hemorrhage, tumour, blind loop syndrome and obstruction of the duodenum, biliary tract or pancreatic duct. Two patients died. The second part of the duodenum was involved in 82% and the third part in 10%. Anatomical variations are common in the area of the ampulla; these should be anticipated before operation. Surgical procedures in the area may be technically demanding and associated with high mortality and morbidity. The choice of procedure depends on the urgency and nature of the complication of the diverticulum. Endoscopic retrograde cholangiopancreatography can play a role in evaluating the possible significance of the diverticulum and the anatomy of the area. In some cases endoscopic sphincterotomy may be possible. In some situations diverticulectomy is contraindicated.

Adult↗
PubMed1977

Complications following operation in the previously irradiated abdominopelvic cavity.

Twenty-three patients underwent 32 operations in a previously irradiated abdominopelvic cavity. The overall postoperative morbidity rate was 62% and the mortality rate was 6.2%. The data from this series do not support small bowel bypass as the only acceptable method of management of surgical radiation enteritis. Wide resection with primary anastomosis reduces the long-term morbidity of the "blind-loop syndrome", perforation and fistulization of the isolated loop, and does not have an increased mortality.

Abdomen↗
PubMed1977

Location of the site of bacterial bile-salt deconjugation by combining abdominal scintigraphy with expired C-14.

A combined 14CO2 bile-salt breath and scintigraphic test has proved useful in determining the site of bile-salt deconjugation by bacteria. Data suggest that the procedure can be shortened to less than 8 hr with Tc-99m sulfur colloid abdominal scintigrams added to locate the labeled meal. Moreover the cumulative 14CO2 excretion, which is an indes of the rate of bile-salt deconjugation, gives clearer separation than peak specific activity between normals and either high or low deviations from normal, The test should be helpful in a number of difficult diagnostic problems involving chronic diarrhea, and offers as well both as well both a guide to appropriate therapy and a monitor for relapse in enfected blind-loop syndromes,

Bile Acids and Salts↗
PubMed1996

[Surgery in childhood at the hospital for basic and routine general management].

Pediatric surgery in general surgical hospitals involves treatment of blunt thoracic trauma, blunt abdominal trauma and acute abdominal and inguinal surgery. Special surgical techniques are: opening of the bursa omentalis to detect pancreas ruptures; partial liver resections in deep organ ruptures instead of wound readaptation due to postoperative bleeding, gall bladder fistulae and rising infections; organ-protecting spleen resections. Appendectomy is indicated in children in cases of non-inflammatory, congenital chronic abdominal pain (dissociated visceral growth); side-to-side anastomosis is contraindicated because of the "blind-loop syndrome". The megacolon detected intraoperatively has seven different causes necessitating a colostomy and further diagnostic procedures in special hospitals. Incarcerated hernias in newborns have a 6-times higher recurrence rate, Bassini operations are contraindicated.

Abdomen, Acute↗
PubMed1977

Intestinal anastomosis.

The long-term results of 370 cases of intestinal anastomosis are described. 121 cases were studied in detail. There were 61 duodenal, 43 small intestinal, and 17 colon anastomoses. The follow-up examinations permitted the following conclusions: 1. The long-term results of duodenoduodenostomy and duodenojejunostomy are similar. 2. Resection of a duodenal membrane was often followed by stenosis. 3. End-to-end anastomosis of small intestine and colon give good long-term results, but after side-to-side anastomoses, 24% of the cases will develop a closed loop syndrome.

Adolescent↗