Nutrition following gastric operations for morbid obesity.

Nutritional status after 238 gastric operations designed to reduce caloric intake and body weight to within 30% of ideal was assessed by measuring body composition using the multiple isotope dilution technique. Body cell mass (BCM) and body fat were quantitated before and at 24 months after operation. Malnutrition was defined as a total exchangeable sodium (Nae) to total exchangeable potassium (Ke) ratio greater than 1.

Epidemiologic health study of workers in an aluminum smelter in British Columbia. Effects on the respiratory system.

A health survey was carried out on all white males in an aluminum smelter in British Columbia. The survey consisted of a medical-occupational questionnaire, spirometry, chest radiography, and environmental monitoring. We have compared the results of a respiratory survey in 713 workers in the office and casting department with no significant exposure to air contaminants (control workers) with those of 797 potroom workers: 495 who spent more than 50% of their working time in the potroom (high exposure) and 302 workers who spent less than 50% of their working time in the potroom (medium exposure).

Metabolism of prolonged shock.

Dogs in shock due to controlled cardiac tamponade for 4 or 12 h were studied to determine which of the metabolic changes characteristic of early shock persisted if the shock state was prolonged. Moderate hyperglycemia and severe lactacidemia were present in the first few hours but the levels returned to near normal values by the end of 12 h. The entry rate of lactic acid into the circulation as well as the rate of glycogenolysis was high in the first 4 h but decreased thereafter even though skeletal muscle glycogen stores were not exhausted.

Randomness and order in the topology of settlement systems.

"The frequency distribution of settlement links forms the basis of a linear programming methodology which can be utilized to analyze the structure of settlement systems. The resulting index of system topology is compared to a more conventional measure, Geary's contiguity coefficient, which may be applied when the problem is conceptualized as one of spatial autocorrelation on a k-color map. The index of linkage similarity that is introduced appears to have a useful advantage over the Geary measure.

Exogenous amino acids as fuel in shock.

It has been suggested that in shock branched-chain amino acids are preferentially oxidized resulting in continued proteolysis and stimulated gluconeogenesis. To determine if exogenous amino acids could be used as fuel in shock, dogs rendered hypotensive by controlled cardiac tamponade and normotensive controls were infused with amino acid mixtures and individual amino acids. When Nephramine, a mixture rich in branched-chain amino acids, was infused, plasma alpha-amino nitrogen levels rose but urea output did not increase in either the control state or in shock, suggesting that these amino acids were not rapidly deaminated to serve as fuels.

Lymphocyte function in anergic patients.

The lymphocyte function of anergic surgical patients who are at increased risk for sepsis and mortality was studied. In vitro lymphocyte responses appear to be normal in most instances, in that over 80% of patients showed a normal response in a standardized mixed leucocyte culture reaction. Similarly, 56% of the lymphocytes from anergic patients showed a positive in vitro proliferative response with PPD.

Reliability of skin testing as a measure of nutritional state.

The reliability of skin testing to assess the nutritional state was evaluated in 257 patients who received total parenteral nutrition (TPN). The nutritional state was assessed by determining body composition, by multiple-isotope dilution. Immunocompetence was simultaneously evaluated by skin testing with five recall antigens.

The predictive role of delayed hypersensitivity in preoperative patients.

Seven hundred and twenty-seven surgical patients who were skin tested with recall antigens prior to operation were analyzed. The analysis included preoperative diagnosis, operative intervention, postoperative septic complications and death. The normal skin test responders were of similar age and had equal degrees of surgical procedures performed compared with patients who were anergic.

Oxygen consumption during spontaneous ventilation with continuous positive airway pressure: assessment in normal volunteers and patients with acute respiratory failure.

Continuous positive airway pressures (CPAP) of 0.49 kPa and 0.98 kPa were applied to ten healthy volunteers and nine critically ill patients with acute respiratory failure.

Intestinal bypass for morbid obesity: a consecutive personal series.

Forty-five patients who underwent end-to-side jejunoileal bypass, with 51 cm in circuit, were followed up from 8 months to 8 years (average 3.4 years). There was no early or late mortality but morbidity was considerable; it included inadequate weight loss or late gain in 22%, malnutrition and liver failure in 11%, severe diarrhea and electrolyte imbalance in 11%.

The role of stress hormones in the catabolic metabolism of shock.

The role of catecholamines in shock metabolism in dogs was studied by comparing the metabolism of shock due to cardiac tamponade, shock with catecholamine depletion from prior reserpine adminstration and metabolism in the normal dog with continuous epinephrine infusion. It was concluded that the high serum concentrations of catecholamines in shock probably cause the increased blood lactate, initial hyperglycemia and, possibly, the poor free fatty acid oxidation seen in shock, but do not cause the increased protein catabolism of shock. With the simultaneous infusion of glucagon, cortisol and epinephrine in physiologic dosages, catabolic metabolism similar to that observed in shock was established in the normal dog.

Therapeutic approaches to anergy in surgical patients. Surgery and levamisole.

Skin tests (ST) in 1332 patients are associated with increased morbidity from sepsis. Patients with normal skin tests had a 7% major sepsis rate and 2% mortality rate. Thirty-six per cent of anergic (A) patients and 21% of relatively anergic (RA) patients died; 52% of A patients and 34% of RA patients had sepsis.

Protein malnutrition following intestinal bypass for morbid obesity.

Intestinal bypass surgery, performed for weight reduction in the morbidly obese patient, is frequently complicated by the development and hepatic complications. In 44 morbidly obese individuals, 55 inches of proximal jejunum were anastomosed, end to side, to 5 inches of distal ileum. All the patients were followed with body composition measurements, performed by multiple isotope dilution, prior to and at regular time intervals following bypass surgery.