Thomas White

Respiration, Circulation and Anaesthetic Management in Obesity. Investigation before and after Jejunoileal Bypass

Some ventilatory and circulatory parameters were studied in 17 very obese patients before and after weight reduction following jejunoileal bypass. A low vital capacity and signs of impaired lung function with intrapulmonary shunting, increased alveolar‐arterial Po2 difference and low Pao2 were found. Although the spirometric values improved significantly after weight reduction, the ventilatory disturbance persisted. A normal response to inhalation of CO2 was seen. The total blood volume was high and did not change after weight reduction. However, if calculated as blood volume per kg body weight, the values were lower than normal, and they increased as a consequence of weight reduction. Cardiac output was slightly lower than normal in relation to oxygen consumption. Total peripheral resistance was normal. Arterial blood pressure, which was in the high normal range preoperatively, decreased significantly after weight reduction. Total doses of intravenous anaesthetic agents and muscle relaxants were the same as for patients of normal weight. The importance of preoperative evaluation and of respiratory care of obese patients undergoing elective surgery is stressed.

Glomerular filtration rate up to 10 years after urinary diversion of different types. A comparative study of ileal and colonic conduit, refluxing and antirefluxing ureteral anastomosis and continent caecal reservoir

To evaluate the influence of conduit type (ileal or colonic) and method of ureterointestinal anastomosis (refluxing or antirefluxing) on renal function in patients with urinary diversion, a prospective randomized trial was conducted in 1977-1984. During these years urinary diversion via a continent caecal reservoir emerged as an alternative to conduit diversion at our hospital, and these patients with continent reservoir were also included in the study. Total and separate glomerular filtration rate (GFR) were measured, the latter with scintillation camera renography, preoperatively and at follow-up in 70 patients. Measurements 2-10 years postoperatively showed slight to moderate decrease of GFR in all groups, with no significant difference between values according to conduit type or caecal reservoir or between refluxing and antirefluxing ureterointestinal anastomosis. Almost all of the anastomotic strictures involved the ureter that had been brought beneath the sigmoid mesentery, indicating that ischemia secondary to extensive ureteral mobilization is a likely cause of stricture in these cases.

Effect of Splenectomy on Anemia in Patients on Regular Dialysis Treatment

Splenectomy was performed in 7 patients on regular hemodialysis treatment who had disabling anemia. All patients had a short 51Cr red cell survival time and an increased splenic uptake of red cells verified by external counting and computer-aided scintigraphy. The need for blood-transfusions was eliminated in all except one. In all patients the hemoglobin concentration rose after splenectomy. This was probably an effect of a reduced plasma volume and the removal of a large pool of non-circulating red cells. No consistent changes in the red blood cell survival time or the red cell volume were observed. The white cell and the platelet counts in the blood rose to twice the preoperative value. No adverse effect of the splenectomy was observed.

Quantitative evaluation of tomographic 201-thallium myocardial scintigraphy

Myocardial 201Tl emission computed tomography was performed on 25 normal subjects and 27 patients with angiographically significant coronary artery disease. A semi-automatic computer program was designed to define the left ventricular myocardial volume in all short axis sections. Within this volume the relative mean myocardial pixel count was calculated. This parameter was found to separate the 2 patient groups with a sensitivity of at least 81% at a specificity of 100%.

Renal parenchymal function evaluated by scintillation camera renography before and after pyeloplasty for hydronephrosis.

Scintillation camera renography with Tc-DTPA was performed before and after pyeloplasty on 16 kidneys with urographic signs of pelviureteric obstruction causing hydronephrosis. Regional parenchymal renograms were generated, and the passage of Tc-DTPA through the parenchyma was measured and correlated to the change in separate glomerular filtration rate. Preoperative parenchymal passage of DTPA was significantly slower (p = 0.02) in kidneys with improved glomerular filtration rate after pyeloplasty than in those without such improvement. Postoperative passage of DTPA in parenchyma was almost identical with that in a reference series. This method seems to be clinically useful for evaluating cases of hydronephrosis and for predicting the outcome of pyeloplasty.