Ernst J. Drenick

Effect on hepatic morphology of treatment of obesity by fasting, reducing diets and small-bowel bypass.

Abstract Liver biopsies in 41 grossly obese subjects were evaluated during massive weight reduction (more than 100 lb). The subjects comprised three groups who had been treated by prolonged fasting, low-calorie dieting and intestinal bypass surgery. The first two groups manifested a transient increase in the degree of hepatocellular degeneration and focal necrosis along with progressive diminution of fatty infiltration during acute weight loss. Late follow-up biopsies revealed histologically normal livers. In contrast, bypass surgery was followed, variously, by massive fatty changes, cholestasis, polynuclear inflammatory infiltrates, diffuse fibrosis, bile-duct proliferation and fatal hepatic necrosis. Morphologic changes occurred while liver-function tests were still within normal limits. Follow-up biopsy examinations are the only reliable means of judging whether a bypass procedure is causing progressive parenchymal damage.

Occurrence of Acute Wernicke's Encephalopathy during Prolonged Starvation for the Treatment of Obesity

THE more liberal use of prolonged starvation in the treatment of obesity has posed a number of questions regarding the metabolic requirements of body tissues under these conditions. The need for vitamin supplementation has not been studied adequately as yet. It has been held that total fasting does not result in vitamin B1 deficiency because vitamin need and vitamin excretion diminish after a few days.1 2 3 Ziporin et al.4 have postulated that thiamine requirements decrease with a lowering of caloric intake. Similarly, it has been noted that thiamine requirements fall with diminishing physical activity.5 In the starving obese subject endogenous fat .xa0.xa0.

Bypass enteritis: A new complication of jejunoileal bypass for obesity

Four patients who had jejunoileal bypass for morbid obesity had increased frequency of diarrhea, diffuse abdominal tenderness and distention, and fever to 104 degrees F. Roentgenographic studies disclosed multiple distended loops in the bypassed bowel with few air fluid levels. Two of these patients underwent operation for suspected peritonitis from abscess or obstruction. No abscess or mechanical obstruction was found. The bypassed bowel contained many subserosal gas-filled blebs. The remaining two patients were treated with antibiotics and showed prompt improvement. Bypass enteritis must be considered in the postoperative period in patients undergoing surgery for morbid obesity. It responds to antibiotics and appropriate electrolyte therapy. The presumed factor is overgrowth of enteric bacteria in the distal portion of the bypassed bowel. Accurate diagnosis will obviate the need for surgical exploration to exclude peritonitis.

The relation of BSP retention during prolonged fasts to changes in plasma volume

Abstract Obese subjects who fasted or consumed very low calorie diets developed abnormal BSP retention. Sodium loading during fasting tended to raise plasma volumes and effected an improvement in BSP clearance. Conversely, a sodium and water diuresis had the opposite effect. The fasting ketoacidosis seemed unrelated to the change in BSP levels. The phenomenon of the acute rise in BSP retention with fasting may thus be explained by a reduction in hepatic blood flow secondary to a fall in plasma volume and the prompt improvement with refeeding by the reverse mechanism. Parenchymal liver damage need not be invoked as a cause of high BSP levels. These findings suggest that transiently abnormal BSP levels in some acute disease state may reflect the result of hypovolemia.

Acute symptomatic ketoacidosis following growth hormone administration in prolonged fasting.

Abstract Human growth hormone (HGH) was administered to four obese males after fasts of 26 to 52 days. Within hours after the injection severe postural hypotension, faintness, nausea, vomiting and muscle cramps developed. Improvement occurred spontaneously despite continued fasting. In most instances, serum FFA and ketones rose and blood CO2 content fell, suggesting an exaggeration of the preexisting fasting acidosis. Urinary losses of Na, Ca, Mg and phosphate increased along with a rise in titratable acidity. A concomitant expansion of the exchangeable Na pool suggested mobilization of Na from storage sites, presumably bone. It appears that the precarious clinical adjustment peculiar to prolonged fasting is disturbed by the increasing ketosis resulting from the calorigenic stimulus and lipolytic effect of HGH. Mineral losses and the mobilization of sodium are a sequel to the accentuation of the acidosis and the clinical symptoms result from the redistribution of water and electrolytes among body compartments in marginally depleted subjects.

Effect of Prolonged Fasting on Olfactory Threshold

This study is concerned with two hypotheses: (a) prolonged fascing results in a change in olfactory threshold; and (b) thresholds are differentially affected for food-related stimuli and neutral substances. These hypotheses derive from studies reporting threshold changes after brief fascing and studies indicating effects of need on perception. Seventeen obese men averaging 312 lb., hospitalized for treatment of obesity, were kept on 0 to 300 calorie diets for periods of up to 3 mo., during which time weight loss averaged a pound a day per man. Olfactory thresholds for methyl salicylate (food-related) and benzene (neutral) were determined periodically by Jones (1956) forced-choice sniffing technique, a method which eliminates the problem of differences in criterion among Ss and the errors of anticipation inherent in the traditional method of limits. Order of presentation of the two substances was randomized, and the two were separated in time by at least 15 min. For each substance, initial measurements were compared with determinations made after 1 wk., and after 1, 2, and 3 mo. of fasting. For seven Ss who changed from 0 to 300 calories, the last fascing mean was compared with the mean after a week of the 300-calorie regime. Not one of the 10 t tests yielded a value high enough for statistical significance or even high enough to warrant hope that a very large N following the same trend might produce values with statistical significance. Thus hypothesis (a) is not confirmed and hypothesis (b), which is dependent on hypothesis (a), is nor confirmed. The variability of thresholds obtained was no greater than might be expected in the course of repeated measurements without fasting, as indicated both by comparison with variability reported by Jones (1955) and by variability obtained in a group of six non-obese, non-fasting controls tested under the same conditions. Thus it does not seem reasonable to blame the lack of significant results on excessive variability. A more reasonable speculation is that effects reported by others may be specific to minor or brief deprivation rather than to prolonged extreme deprivation such as was experienced by these men, who counted the time since the last meal in weeks rather than in hours.

Reserpine in peptic ulcer.

SummaryReserpine was added to the routine measure in the treatment of peptie lesions of the upper gastrointestinal tract in 13 patients. In addition to its tranquilizing effect it seemed to be beneficial in the relief of nausea and vomiting. It had no deleterious effect on symptoms or course of the disease and it seemed to have no influence on gastric acidity.