Joel B. Freeman

Analysis of gallbladder bile in morbid obesity

Thirty-seven per cent of our grossly obese patients selected for gastric bypass had cholesterol gallstones. To document the composition of the biliary lipids prior to weight loss, the bile taken from eleven obese patients at the time of gastric bypass was analyzed and the results compared with those in eleven nonobese patients undergoing elective surgery. There was extreme supersaturation of both gallbladder and hepatic bile in all obese patients. The gallbladder bile of all obese patients fell well outside the micellar zone whereas the bile from all but one of the controls fell within the micellar zone. These data provide biochemical support for the clinical association of obesity and cholesterol gallstone formation and are evidence against the possibility that gastric bypass is a lithogenic operation.

Failure rate with gastric partitioning for morbid obesity.

One hundred twenty-two morbidly obese patients were selected for gastric partitioning from a multidisciplinary obesity clinic over a 4 year period. Initial early success was not a guarantee against cessation of weight loss or the regaining of lost weight. By emphasizing criteria for success and failure, both from our series and the literature, we showed an alarming increase in the failure rates for this procedure which is predicated on the fact that those lost to follow-up were probably failure patients. Numerous articles in the literature contain inadequate data because they refer to pounds rather than percentage of weight loss, they fail to consider revisions as failures, they do not provide 24 month follow-up data, and they do not take into account the possibility that those lost to follow-up are failure patients. The operation carries mortality and serious morbidity rates of 0 to 3 percent and 4 to 10 percent, respectively, with an average 28 percent weight loss at 24 months and a minimal failure rate of 50 percent. The alarming increase in the number of these procedures being carried out across the continent makes it mandatory for surgeons to accurately collect and register their data until the long-term effects and results are known. Gastric partitioning, although probably not experimental, is still developmental. The widespread use and possibly abuse of these operations may result in discreditation of the surgical approach to morbid obesity which would be unfortunate since it is the only practical method at this time for dealing with the problem.

Prevention of superficial phlebitis during peripheral parenteral nutrition

Fifty-four patients receiving peripheral parenteral nutrition consisting of 3.5 percent amino acids in a 5 percent dextrose solution were randomly assigned in a double-blind fashion to receive this solution with or without an antiphlebitic mixture (1000 IU heparin, 5 mg hydrocortisone, and 1.8 mEq sodium hydroxide as a buffer). The addition of antiphlebitic mixture resulted in a marked and highly significant reduction in the incidence of phlebitis and a prolongation of the number of phlebitis-free hours during infusion of peripheral parenteral nutrition (p less than 0.005).

The effect of hepatectomy on body water distribution

Abstract A multitude of pathophysiological abnormalities contribute to the alterations of body water distribution in liver failure. Total body water, extracellular water plasma volume, and red cell volume were measured before and after hepatectomy. If the first group of seven dogs, the volum measurements were carried out at 4 hr posthepatectomy while in the second group of five dogs, these measurements were performed 8 hr postoperatively. There were no significant alterations in the distribution of body water after hepatectomy. It can be concluded that neither the absence of the liver as a homeostatic controller of body water distribution, nor the surgical trauma of hepatectomy and portacaval shunt causes significant alterations in the distribution of body water in the dog during the first 8 hr after the surgical procedure. The cause of death in the anhepatic dog is not secondary to a redistribution of extracellular water and electrolytes in the intracellular compartment.

A simple method for long-term intestinal and intravenous cannulation in animals

Abstract A simple, inexpensive, rapid method for construction of venous or intestinal catheters has been described. These catheters may be tailored to suit individual needs. A technique for insertion has been described which has proved to be reliable and free of complications.

Hyperparathyroidism: Ectopic parathyroid glands

A patient with a parathyroid adenoma located beneath the throid capsule and within a benign thyroid adenoma is reported on. To the best of our knowledge, this lesion has not previously been reported. This case points out the difficulties that may be encountered when it is necessary to locate a missing parathyroid gland in a patient with multinocular goiter. In this clinical setting there may be a role for use of the various technics recommended for preoperative localization of a parathyroid adenoma.

Low side-to-side sigmorectal anastomosis with intestinal staplers

The radiologic appearance of a side-to-side stapled sigmoid to rectal anastomosis is described. Barium which collects in the stump of the sigmoid may give the false appearance of a anastomotic leak and unnecessarily delay colostomy closure. Oblique views and observation in the radiologic suite for emptying of the distal stump will confirm this condition.

Simultaneous infusion of crystalloid solutions during long-term parenteral nutrition

Abstract A safer and more secure technic for the administration of additional solutions during long-term parenteral nutrition is described. This technic has contributed towards a reduction in septicemia.