Henry Buchwald

TREATMENT OF A TYPE II DIABETIC BY A TOTALLY IMPLANTABLE INSULIN INFUSION DEVICE

Abstract The feasibility of treating type II diabetes by continuous intravenous infusion of insulin delivered by a totally implanted pump was tested in a 54-year-old man. An acceptable degree of blood glucose control was maintained while the patient carried on with his normal daily activities.

Protracted parenteral drug infusion in ambulatory subjects using an implantable infusion pump.

This study demonstrates the feasibility of ambulatory heparin therapy and its potential for successful treatment of refractory thromboembolic disease. The proven capability of the implantable infusion pump to provide long-term heparin infusion in ambulatory subjects suggests that it may have application in the delivery of other parenteral drugs as well.

Changes in Atherosclerotic Lesions Following Surgical Cholesterol Reduction

Surgical procedures specifically employed to lower the plasma cholesterol concentration include partial ileal bypass, portacaval shunt, and various biliary drainage operations. These operations have all been used clinically and in the animal laboratory to assess changes in atherosclerotic plaque lesions induced by marked cholesterol reduction. Interesting and promising data have been derived from these studies.

Partial Ileal Bypass: A Test of the Lipid-Atherosclerosis Hypothesis

In 1962, we postulated that a partial ileal bypass operation should result in a significant cholesterol reduction by a 2-fold mode of action: (1) interference with the enterohepatic cholesterol cycle and, thereby, a direct drain on the body cholesterol pool; and (2) interference with the enterohepatic bile acid cycle, resulting in a marked increase in bile acid synthesis from the cholesterol pool and, thereby, an indirect drain of the body cholesterol pool. The original laboratory assessment of this hypothesis was carried out in the rabbit and the pig (Buchwald 1963a, 1963b, 1964; Buchwald and Gebhard 1964, 1968, 1974; Gebhard and Buchwald 1970), and was confirmed in the rabbit (Okuboye et al. 1968), the dog (Scott et al. 1966), the Rhesus monkey (Scott et al. 1977), and the white Carneau pigeon (Gomes et al. 1971). The first partial ileal bypass operation in humans specifically for circulating cholesterol concentration reduction was performed in May of 1963. Since then our series has grown to approximately 250 patients and reports of other series have been published from both sides of the Atlantic.

Selected Papers on Lipid Metabolism

In patients with various manifestations of atherosclerotic vascular disease, hypertriglyceridemia is very common To determine whether the hypertriglyceridemia is caused by an increased influx or decreased removal of plasma TG requires a reliable method for estimating plasma TG turnover rate [197]. This study deals with the evaluation of such methods.

Selected Papers on Nutritional Studies

In a previous experiment Thomasson et al. [1465] investigated the influence on blood lipids concentration of ten dietary fats with a widely divergent fatty acid composition. Glyceryl trilaurate, olive oil (containing about 70% oleic acid) and safflower oil (containing about 70% linoleic acid) and mixtures of these fats were given as liquid formula diets (LFD) (containing 50 cal% of fat) to Trappists and Trappistines for six weeks. The experimental fats appeared to have a clear influence on free cholesterol, esterified cholesterol, and phospholipid concentrations in the blood, the ratios of these three lipid classes being constant.