Food intake in relation to pouch volume, stoma diameter, and pouch emptying after gastroplasty for morbid obesity.

This study investigated possible determinants of food intake change after gastroplastry. Preoperatively and 6 and 12 months postoperatively, 27 morbidly obese patients were prospectively examined with 7-day food registration and radiologic measurement of pouch volume and stoma diameter. Pouch emptying was determined as the mean transit time by a scintigraphic method. None of the measured variables was found to influence the change in food intake taking place during the first 6 months, when most of the weight loss was observed. Between 6 and 12 months, the change of stoma diameter was positively associated with the change of solid foods consumed (by weight, p = 0.01; by energy content, p = 0.02). The change of pouch volume was negatively associated with the change of energy from beverages (p = 0.005). In conclusion, it seems impossible to tailor the reduction of food intake through adjustments of the surgical dimensions, at least within the ranges of our observations. Increased food consumption and decreased energy intake with beverages may be caused by late dilations, or vice versa.

Pouch emptying of solid foods after gastroplasty for morbid obesity.

To obtain information on possible determinants of weight loss after horizontal gastroplasty, pouch emptying was prospectively investigated in 27 morbidly obese patients. A scintigraphic method was used. Examinations were carried out every 6 months until 2 years after surgery. Pouch emptying was described by means of delay, time until half emptying, mean transit time, and emptying rate. The measures all showed a significant (p less than 0.05) acceleration of pouch emptying during the first 6 months after gastroplasty. Thereafter pouch emptying was unaltered. No significant association could be detected between measures of pouch emptying and weight loss. From calculation of 95% confidence intervals for coefficients of correlation it proved very unlikely that pouch emptying is an important determinant of weight loss.

Joint distension arthrography for disabling hip pain. A controlled clinical trial.

Thirty-eight patients (age 27-73 years) with unilateral hip pain, restricted movement of the hip joint and radiologically no or only slight osteoarthrosis were studied in a double-blind controlled clinical trial. Twenty-one patients received active treatment with hip joint distension arthrography and 17 received placebo treatment. All patients were assessed clinically on entry, the day after and 3 months after treatment. The incidences of subjective improvement were similar in the two groups. Apart from a slight deterioration in the treated group of hip flexion, abduction and lateral rotation at the one-day assessment, neither group showed any change in the registered movements of the hip joint compared with the assessment on entry. The measured intermalleolar distance at maximal straight-leg abduction was the sole variable which tended to increase (p = 0.05) 3 months after active treatment. Thus, the therapeutic effect of a single treatment with joint distension seems to be dubious.

Ultrasonography versus roentgenography in suspected instances of cholecystolithiasis.

In a consecutive series of 102 patients with no jaundice and with symptoms of cholecystolithiasis, the predictions from both ultrasonography and cholecystography were compared with the final diagnosis. The accuracy of both examinations was high. However, in 38 per cent, single dose oral cholecystography failed to visualize the gallbladder whereas ultrasonography was conclusive in all patients. Judged by a simple scoring system, ultrasonography obtained a significantly better score than cholecystography (p less than 0.01) and an insignificantly better score than combined oral and intravenous cholecystography (0.05 less than p less than 0.1). Ultrasonography is recommended as the primary investigation in suspected instances of cholecystolithiasis.

Multiple sclerosis: periphlebitis retinalis et cerebro-spinalis. A correlation between periphlebitis retinalis and abnormal technetium brain scintigraphy.

Periphlebitis retinae (PR) in multiple sclerosis (MS) is seen as transitory infiltrations around veins in the otherwise normal retina. Cellular infiltrations have been found around veins in the central nervous system (CNS), where it has been suggested that they are the first event in plaque formation. Technetium brain scans are usually normal in MS patients, but transitory abnormal scans of the cerebrum have been found in MS patients during acute attack or exacerbation. In order to test the hypothesis that active PR is a sign of simultaneous disease activity in the CNS, 29 technetium brain scans were carried out on 14 MS patients with active PR and on 15 MS patients without any signs of PR. Significantly more of the patients with active PR, compared with MS patients with previous PR, displayed abnormal brain scans. This indicates that a disruption of the blood brain barrier (BBB) and active PR occur simultaneously in MS.

Peyronie's disease and erectile failure.

A total of 20 patients with Peyronie's disease, including 15 with erectile failure and 5 with normal potency, underwent evaluation with dynamic xenon washout and infusion cavernosography. Abnormal drainage from the cavernous body was found in 13 of the 15 patients with erectile failure and in none of the 5 potent patients (p less than 0.01), indicating that this condition seems to be the underlying pathological mechanism leading to erectile impotence in patients with Peyronie's disease.

The correlation between gastric emptying time and the response of GIP and enteroglucagon to oral glucose in duodenal ulcer patients.

Simultaneous 50-g oral glucose tolerance tests and measurements of gastric emptying time were performed in 11 duodenal ulcer patients. Gastric emptying time, measured by the gamma-camera technique, and the response of gastric inhibitory polypeptide (GIP) and enteroglucagon to the oral load showed a significant negative correlation. The GIP response and the insulinogenic index were significantly positively correlated. It is concluded that the increased GIP and insulin response to glucose among duodenal ulcer patients may be explained by increased gastric emptying, known to occur in these patients. The study has not given new information on the possible physiological role of enteroglucagon.

Haemodynamic findings after insertion of the Lillehei-Kaster valve in the mitral ostium.

Clinical deterioration after insertion of prosthetic mitral valves may be caused by myocardial failure or valve dysfunction or a combination of both. The need for a method to decide which is predominantly causative is obvious. This study describes the haemodynamic findings with special reference to prosthesis rheology among 13 patients with lillehei-Kaster valves in the mitral ostium. Three patients were re-operated on because clinical signs of valvular dysfunction. Our investigation indicates that stroke volumes of less than 35 ml were useful in predicting valve dysfunction and that pulmonary wedge and mean arterial pressure at rest were significantly increased in this group of patients. It is advocated that such haemodynamic findings should lead to further evaluation of valve gradient and valve flow.

Measurement of bone mineral content (BMC) of the lumbar spine, II. correlation between forearm BMC and lumbar spine BMC.

A comparison between forearm bone mineral content (BMC) and lumbar BMC was made in post-menopausal women. Women without symptoms, women with clinical spinal osteoporosis, and women with prednisone-treated rheumatoid arthritis were studied. A conventional two-dimensional single-photon osteodensitometer was used for measurement of forearm BMC. A new two-dimensional dual-photon osteodensitometer was used for measurement of lumbar BMC. Its radioactive source was 153Gadolinium. The mean lumbar BMC was significantly reduced in women with clinical spinal osteoporosis (P < 0.001). The mean forearm of BMC of those patients was normal. Thus, forearm BMC was a poor indicator of spinal osteopenia. If forearm BMC was used to predict lumbar BMC erroneously high results were obtained in women with clinical spinal osteoporosis, and erroneously low values were obtained in prednisone-treated women with rheumatoid arthritis.

Debanding and repair of ventricular septal defect: a new technique for older patients.

Between October 1972 and April 1977 15 patients underwent definitive repair of a ventricular septal defect (VSD) and reconstruction of the pulmonary artery at the banding site. This report presents pre- and post-operative haemodynamic data in 12 patients, seven to 22 years after banding (mean 13.4). Banding of the pulmonary artery was performed before the age of 6 months (mean 4). The indications were increased pulmonary blood flow and intractable heart failure. As we had previously become dissatisfied with patch angioplasty of the main pulmonary artery, we introduced a new technique in this group of excising the site of the band and anastomosing the pulmonary artery end-to-end. The gradient between the right ventricle and pulmonary artery was abolished completely in nine cases and reduced to below 30 mmHg in the remaining three patients. This technique is used only in older patients in whom the banding has persisted for a long time. In children under 2 years of age we usually remove the band and dilate the pulmonary artery.

Hemodynamics, compartments and the renin-aldosterone system in chronic heart failure.

In 12 patients with chronic mitral or aortic disease plasma renin activity (PRA) and aldosterone secretion rate (ASR) were correlated to hemodynamics, kidney function, plasma and interstitial fluid volume, and plasma sodium concentration, both in the congestive state (I) and after sodium depletion (II). PRA (I) and ASR (I) were normal or slightly elevated and increased normally after sodium depletion. A significant inverse correlation between plasma concentration (I + II) and PRA (I + II) was found. Further an abnormal inverse correlation between increments in PRA and cumulative sodium loss was demonstrated. By contrast, no correlations were found between PRA and ASR on one hand and pressures, kidney function or compartments on the other, neither in I - elevated pressures in the atria, low renal plasma flow, large compartments, nor in II - reduced pressures and compartments, almost unchanged kidney function. It is concluded that PRA hardly plays any primary role in the maintenance of sodium and fluid retention in human chronic congestive heart failure.