Role of total parenteral nutrition in the treatment of complications following surgery for morbid obesity

Although morbidly obese patients are assumed to be overnourished, they require the same intake of nitrogen postoperatively as other patients to achieve anabolism and to spare endogenous protein. Total parenteral nutrition was employed in six morbidly obese patients with complications following gastric partitioning that precluded oral intake and was considered essential to their recovery.

Living placement and absenteeism in community-based training programs

A survey of client absenteeism in community-based training facilities was conducted. Results indicated that clients who resided with their natural parents were absent more frequently than were clients who resided in community living facilities. In addition, absenteeism was not related to level of intellectual functioning or to age. Sex differences approached significance as female clients were found to be absent more often than were male clients; however, the duration of the absences was shorter, resulting in no significant difference between sexes in total days absent.

Correction of hypersplenism following distal splenorenal shunt

The effect of splenorenal shunt on hypersplenism was assessed in 47 patients with splenomegaly, 26 of whom had significant thrombocytopenia or leukopenia. Of 16 patients with thrombocytopenia, platelet count returned to normal in 15 (94%) following operation, an improvement which was statistically highly significant (P less than 0.001). Of 16 patients with leukopenia, leukocyte count returned to normal in 11 (69%), also a highly significant improvement (P less than 0.001). Dramatic relief of hypersplenism occurs in the majority of patients following splenorenal shunt. Thrombocytopenia is more consistently corrected than is leukopenia. The etiology of liver disease appeared not to be a factor, but leukopenia was corrected more consistently in alcoholic than in nonalcoholic patients, while there was no difference in the postoperative response of thrombocytopenia to the operation. Long-term follow-up in 26 patients demonstrated sustained improvement in 57% of patients with preoperative leukopenia and 78% of patients with thrombocytopenia. Since significant improvement in leukopenia and thrombocytopenia will occur following the distal splenorenal shunt, hypersplenism is not a contraindication to this procedure.