Lysosomes and essential fatty acid deficiency

Experimental wound healing in essential fatty acid deficiency

Clinical reports have suggested that essential fatty acid deficiency (EFAD) may cause delayed healing. One hundred weanling rats were placed on normal or EFAD diets. After 4 wk in control and 6 wk in EFAD animals comparative studies were performed as follows: (1) skin and fascial incisions were tested for tensile strength up to 5 wk, (2) single layer small bowel, (3) colonic anastomoses were studied for anastomotic bursting strength to 14 days, ana (4) 20% partial thickness burns were followed to healing and autoradiographic analysis of healing epiothelium performed. After 4 wk on diet, EFAD rats showed chemical and clinical evidence of deficiency, while control rats remained normal. There was no significant difference in tensile strength of ventral skin incisions with underlying fascial incisions between control and EFAD rats during the study, but solitary dorsal skin incisions were significantly stronger after three weeks in control animals. Bursting pressures in colonic and small bowel anastomoses were not significantly different between control and EFAD groups. However, colonic suture line disruption occurred in 42% of EFAD rats as opposed to 17% of control animals. Highly significant differences in the healing rate of partial-thickness burns were noted. Control rats healed completely by 21 days while EFAD rats had not completely healed at 120 days postburn. Observation of the burn wounds indicated that wound contraction was impaired. These studies suggest that skin healing is the prime area affected by EFAD although colonic healing may have been affected as well.

Jejunoileal bypass for morbid obesity. A critical appraisal

One hundred one carefully screened morbidity obese patients underwent jejunoileal bypass and were followed closely over a mean follow-up period of 32 months. Although there were no operative deaths, three per cent of patients died postoperatively of liver failure or its complications. A fourth patient died of a pulmonary embolus after reoperation, and the fifth patient died cachectic with severe diarrhea after excessive weight loss. Nineteen per cent of the patients required restoration of intestinal continuity (reversal), most for either liver failure or late fluid and electrolyte derangements. All but two survived reversal and are doing well despite massive weight gain. Fifty-eight per cent of the patients had major complications which either required major reoperation (reversal, cholecystectomy or incisional hernia repair) or were potentially life-threatening (liver failure, hepatic fibrosis or urinary tract stones). As described in other series, abnormalities in serum electrolytes and vitamins were seen. In addition, hypovitaminosis D occurred in a number of patients and as with other serum parameters measured, was time-dependent in that improvement was seen in most patients over the postoperative interval studied. Because of the high rate of complications and reversals, we believe that jejunoileal bypass should be reserved for patients with morbid obesity whose lives are imminently threatened by obesity or its sequellae.