Prenatal detection of an enteric duplication cyst.

Enteric duplication cysts are rare congenital malformations of unknown aetiology. Because of improvements in prenatal ultrasound, more and more duplication cysts are found prenatally and treatment is started early. We describe a case of enteric duplication cyst diagnosed prenatally and resected soon after birth. Early diagnosis and prompt surgical treatment are the best way to prevent associated morbidity.

Preliminary evidence of improvement of depressive symptoms but not impulsivity in cluster B personality disorder patients treated with quetiapine: an open label trial.

INTRODUCTION: Atypical antipsychotics might become a new treatment option for patients with an impaired impulse regulation as seen in cluster B personality disorders (PD). The aim of the present study is to investigate the efficacy and tolerability of quetiapine in patients with cluster B PD. METHODS: Fifteen in-patients with a DSM-IV diagnosis of borderline, histrionic, or narcissistic PD were treated for 8 weeks with quetiapine at a dose of 400 mg/day in an open-label fashion. Effects on impulsivity (Barratt Impulsiveness Scale, BIS), depressive symptoms (Hamilton Depression Scale, HAMD, and Beck Depression Inventory, BDI) and side effects (Dosage Record and Treatment Emergent Symptom Scale, DOTES) were assessed. RESULTS: Twelve patients completed the study. No positive effect on impulsivity (BIS) was found, but a significant improvement on depression scores (HAM-D and BDI) was noted. Adverse effects that might have been due to study medication were mainly anticholinergic and mild-to-moderate. DISCUSSION: The data of our preliminary open-label study do not argue for a general recommendation of quetiapine for the treatment of impulsivity in cluster B PD, but indicate positive effects on depressive symptoms.

Midgut volvulus in an adult patient.

The authors report on a case of midgut volvulus in a 27-year-old man who presented with bilious vomiting and acute abdominal pain. US demonstrated a reversal of the normal relationship between the superior mesenteric artery (SMA) and superior mesenteric vein (SMV). A clockwise whirlpool sign, diagnostic for midgut volvulus, was not visualised. In a further assessment, upper gastrointestinal series demonstrated obstruction in the second part of the duodenum highly suspicious of Ladd's bands. Malpositioning of bowel structures, as already suggested by the reversal of the SMA and SMV on ultrasound, and a distinctive whirl pattern due to the bowel wrapping around the SMA was demonstrated on CT. Furthermore angiography revealed focal twisting of the SMA. US is the first imaging modality to perform in suspicion of midgut volvulus. When inconclusive, CT is in our opinion the next stage in the diagnostic work-up.

Lap-Band erosion: incidence and treatment.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is an effective and safe surgical treatment for morbid obesity. Migration of the band through the stomach wall is a well-known late complication that may jeopardize the aim of the treatment--permanent weight reduction. METHODS: 301 patients were followed for > or = 2 years (mean 39 months) after a Lap-Band procedure. Cases of erosion were studied retrospectively. RESULTS: 5 patients (1.66%) developed erosions. Laparoscopic band removal was carried out in these 5 cases without complication. The first 4 have received a new Lap-Band, and all are doing well. CONCLUSION: Band erosion is a bothersome late complication after LAGB and requires band removal. Rebanding is a feasible option. Further study and longer follow-up are necessary to determine whether these patients will develop erosion again.

Late pouch dilation after laparoscopic adjustable gastric and esophagogastric banding: incidence, treatment, and outcome.

BACKGROUND: Pathologic late pouch dilation is the most frequent complication following gastric banding procedures for morbid obesity. In this study, possible predictive factors were sought. The treatment of these complications and the final outcome are discussed. METHODS: Between December 1994 and December 1997, 171 patients underwent laparoscopic adjustable banding for morbid obesity. 40 patients underwent classic gastric banding (Group 1), and 131 patients underwent esophagogastric banding (Group 2). RESULTS: Pouch dilation developed in 6 patients (15%) in Group 1 and 12 patients (9.2%) in Group 2. There were no significant predictive factors, although the complication occurred more frequently in patients with presurgical hiatus hernia. The type of dilation was different for each group, as was the surgical treatment. Laparoscopic repositioning of the band was always possible and was uncomplicated. The long-term outcome has been good, and weight loss has been maintained. CONCLUSIONS: A frequent complication following banding procedures for morbid obesity is pathologic late pouch dilation. In experienced hands, when appropriate surgical treatment is carried out, this is not a major problem. Nevertheless, efforts should be made to decrease the number of late dilations.

Laparoscopic repositioning of an adjustable silicone gastric band for pouch dilatation and stoma obstruction.

Pouch dilatation with stoma obstruction is a well-known late complication after adjustable gastric banding operations for morbid obesity. Surgical treatment of this problem usually results in removal of the band, with or without replacement by another, or in repositioning of the band via laparotomy. We present the case of a patient with late pouch dilatation and stoma obstruction after placement of a Laparoscopic Adjustable Gastric Banding system (LAGB-Bioenterics) and in whom the adjustable band was laparoscopically opened, disconnected from the access port, and repositioned more proximally on the stomach. The postoperative course was uneventful. A postoperative radiographic contrast examination showed a correct repositioning of the band. The case demonstrates that the LAGB can be successfully opened and repositioned by a minimal invasive procedure. This is the first time to our knowledge that such a procedure has been reported.

Laparoscopic adjustable esophagogastric banding: a preliminary experience.

BACKGROUND: Laparoscopic adjustable gastric banding is an efficient surgical method in the treatment of morbid obesity. In order to reduce the number of complications, we have modified the technique to what we term 'laparoscopic adjustable esophagogastric banding'. METHODS: Between December 1994 and July 1997, 126 laparoscopic adjustable banding procedures were carried out. Of these, 40 underwent a gastric banding operation (group 1), and 86 underwent an esophagogastric banding procedure (group 2). RESULTS: The percentage loss of excess body weight curve was less rapid in group 2 compared to group 1 due to a different strategy in band filling. Follow-up to date shows that no problems with the pouch or the stoma have arisen in the esophagogastric banding group. CONCLUSIONS: Laparoscopic adjustable esophagogastric banding is a simpler and safer procedure than laparoscopic adjustable gastric banding. It also works as a very efficient anti-reflux procedure, at least in the short term. It appears to be equally efficient as a weight-reducing operation as gastric banding. Further follow-up of the patients involved is necessary in order to evaluate the results in the longer term.

[Approach to aortic aneurysms including the renal arteries: retroperitoneal method]. / Abord des anévrismes aortiques englobant les artères rénales: voie rétropéritonéale.

A pararenal aneurysm is a rare type of an abdominal aortic aneurysm. The authors report 25 cases out of 429 abdominal aneurysms. The diagnosis was based on a CT-scan and subsequent biplane arteriography. The most common type was the dorsal proximal aortic dilatation, involving the origin of 1 or 2 renal arteries. A retroperitoneal approach was used in 18 of the 25 patients. The most common complication was the retroperitoneal hemorrhage, necessitating reintervention. None of these patients died or developed renal insufficiency despite a suprarenal clamping during the proximal reconstruction.

[Treatment of intestinal atresia]. / Behandeling van dunne darmatresie.

Thirteen cases of intestinal atresia are described: 9 jejunal and 4 ileal. The duration of pregnancy was significantly shorter and the birthweight significantly lower in jejunal than in ileal atresia. The proximal intestine was strongly dilated in 8/9 cases with jejunal atresia. This group also contains several complex and extended varieties of atresia. The postoperative mortality was 8%. Gastrointestinal functional disturbances occurred only in the group treated for jejunal atresia. These disturbances were temporary and occurred postoperatively in 2 cases but reoperation was mandatory in another 2 cases, once without functional success. There were no problems in the other cases. Ileal atresia is easy to treat and the result is always good. In contrast, the situation is much more challenging in cases of jejunal atresia: prematurity, higher incidence of complex and extended gastrointestinal malformations, impossibility to resect the dilated proximal segment, presence of a long under-developed distal segment. No problems have been observed after construction of a double stoma and restoration of the intestinal continuity. However a proximal stoma leads to important fluid and electrolyte losses, necessitating total parenteral nutrition. Functional gastrointestinal disturbances are frequently observed after end-to-side anastomosis in Y with mucous fistula. An end-to-end anastomosis can be combined with enteroplasty of the proximal distended bowel segment, eventually including the duodenum. Although the enteroplasty technique is an important progress in the treatment of neonates with extended types of jejunal atresia, transit problems cannot always be prevented by this procedure.