Gastric banding in the treatment of morbid obesity. Factors influencing immediate and long-term results.

Gastric banding for morbid obesity was performed on 73 patients between April 1983 and December 1986. Early complications occurred in 16% and late complications in 15% of the cases. A second operation was performed on 12 patients, with removal of the band in 11 (15%). Initial weight loss was rapid. Re-examination of 67 patients indicated that this initial loss was followed by a time-related weight gain. Weight reduction occurred as a fairly constant proportion of preoperative weight, irrespective of the degree of obesity. Weight loss to body mass index less than or equal to 30 seems to be a realistic expectation only for moderately overweight patients, not for the hyperobese. Older patients had least weight loss. The data suggest that dietary restrictions will still be needed after gastric banding.

Doxifluridine (5'-dFUrd) in patients with advanced colorectal carcinoma. A phase II study.

Infusion of 5'-dFUrd (2.0-3.0 g/m2 over 1 h on days 1-5 every 3rd week) resulted in one partial response in 21 patients with advanced and progressing colorectal cancer. No patient had received chemotherapy before the 5'-dFUrd trial. Hematological and gastrointestinal toxicity were generally mild. In 4 patients peripheral neurotoxicity was diagnosed during treatment, whereas transient cerebellopathy was observed in one. Cardiac side effects (repeated angina pectoris following 5'-dFUrd infusion) led to discontinuation of treatment after two courses in one patient. It is concluded that 5'-dFUrd at the above doses is not superior to conventional 5-FU treatment in colorectal cancer. Neurological and cardiac side effects are rare but may be a problem in individual patients.

Short time prophylaxis with ornidazole in elective colo-rectal surgery.

A study of 100 patients given short time prophylaxis against anaerobic infections in association with colo-rectal surgery is presented. The patients were randomly allocated into two groups receiving either ornidazole (Tiberal) or doxycycline (Vibramycin) for 3 days. Ornidazole concentrations in serum, subcutaneous fat, and intestinal wall were measured in 10 patients. No infection of anaerobic etiology was noticed in the ornidazole group, in contrast to 5 anaerobic infections in the doxycycline group. This difference is statistically significant (p less than 0.05). The pharmacokinetic results indicate that a 3-day treatment with ornidazole gives a sufficient plasma steady state concentration, while the preoperative loading dose should be given less than 24 h prior to operation. The necessity of prophylaxis against both aerobic and anaerobic infections in colo-rectal surgery is emphasized.

Surgical repair of isolated ventricular septal defects in the first year of life.

Since October 1975, 6 infants ranging in age from 5 to 9 months and weighing from 5.2 to 7.8 kg have been treated with primary closure of ventricular septal defect (VSD) at Ullevål Hospital. The indications for operation were large left-to-right shunts combined with persistence of heart failure in 4 patients, a large left-to-right shunt only in one and elevated pulmonary arterial resistance in one patient. Conventional cardiopulmonary bypass was used in all cases. There were no early or late deaths during the mean observation period of 17.3 months (range 3--25 months). One patient developed a recurrent VSD and was successfully re-operated on 8 months after the first operation; otherwise no signs of recurrence were found. The growth and weight gains have been satisfactory and the psychosomatic development of all the infants has been normal. All are in sinus rhythm with right bundle branch block in 4. Cardiac arrhythmias have not been in evidence.

The continent reservoir ileostomy: review of a collective series of thirty-six patients from three surgical departments.

A reservoir ileostomy was created in 36 patients. Three patients died from septic complications in the postoperative period, and one patient died from rectal carcinoma during the observation period. In six patients the reservoirs were removed during the observation period because of nipple-valve extrusion, nonspecific ileitis of the reservoir, or recurrence of Crohn's disease. Complications from the reservoir and its outlet were quite frequent and included fistula formation in eight patients, nipple-valve extrusion in 12 patients, nonspecific ileitis of the reservoir in five patients, and stenosis of the nipple in one patient. Malabsorption of vitamin B12 and fat due to a stagnant loop syndrome was found in four of seven patients examined for this. Fifteen patients underwent 25 reoperations for complications from the reservoir and its outlet. Twenty-six patients still have their reservoirs. Twenty-five of them are continent. They do not wear external appliances and they empty their reservoirs with a tube two to five times daily. One patient is incontinent due to an unrepaired nipple-valve extrusion.

Renal angiomyolipoma (hamartoma). Profuse retroperitoneal hemorrhage caused by benign kidney tumour.

A case of renal angiomyolipoma in a 38-year-old female is reported. The chief symptoms were abdominal pain and hypovolemia caused by massive retroperitoneal hemorrhage. A brief survey is given of the pathology, symptomatology, and the diagnostic possibilities with special reference to the radiologic diagnosis.