A ten-year experience with bacterial aortitis.

Twenty-one patients with bacterial aortitis were treated in four institutions over a 10-year period. Clues to the diagnosis were a pulsatile mass; fever; positive blood culture; CT scan revealing aortic nodularity, an aneurysm of irregular configuration, or air in the aortic wall; and angiography revealing a lobulated aneurysm. The most commonly identified organisms were Salmonella and Staphylococcus. Excision with in situ repair was performed in nine patients; 11 patients underwent extraanatomic bypass grafting with aortic ligation. In situ graft repair was performed when the infected aorta could be removed entirely or when the thoracic or suprarenal aorta was involved. Axillofemoral bypass grafting was used when infection was extensive. There were eight disease-related deaths. No graft infections were encountered in patients who survived.

Transthoracic gastric stapling. Effective new surgical approach to morbid obesity.

"There is a consensus that jejunoileal bypass is no longer an acceptable operation for the treatment of morbid obesity because of well-documented serious complications." Over the past 3 years, experience with the gastric stapling procedure has shown it to be a safe and effective operation for the surgical treatment of morbid obesity. The purpose of the operation is to establish a very small proximal gastric reservoir with a tiny outlet for passage of digested food into the distal stomach. By permitting a comfortable intake of only 2 ounces at a time, the procedure affords an average weight loss of 8 pounds per month. At the Naval Regional Medical Center, Oakland, California (NRMC-O), a new approach to gastric stapling using a transthoracic, transdiaphragmatic technique has been initiated. The transthoracic approach offers the following advantages over the transabdominal approach: (1) better and easier exposure, (2) less chance of splenic injury, (3) a thinner layer of subcutaneous fat through which to dissect, (4) decreased problem with postoperative ileus, and (5) decreased incidence of wound infection and dehiscence. Twenty patients have undergone this procedure at NRMC-O over the past 16 months with no significant morbidity and no deaths. Th average operative time is 2 hours and the average hospital stay in 8 days. Beneficial metabolic and endocrine effects of weight loss have been recorded through our computerized data bank. The data confirm that gastric stapling is a safe and effective procedure and that the transthoracic approach offers ease of exposure and minimizes postoperative complications.