Sigmoidoscopic neurosurgery? Treatment of an unusual complication of ventriculoperitoneal shunting.

A 16-year-old male with acute hydrocephalus due to bilateral acoustic neuromata was treated successfully with a ventriculoperitoneal shunt before formal neuroma resection. However, 2 years postoperatively, he noticed the distal shunt per rectum while defaecating. Subsequent removal was successfully performed using a flexible sigmoidoscope.

Liver Biopsies Following Ileogastrostomy.

Patients who have had ileogastrostomy for the treatment of morbid obesity require close, long-term follow-up. One concern in patients undergoing any form of intestinal bypass surgery is that of possible liver damage. To assess for possible liver damage in morbidly obese patients undergoing ileogastrostomy, we undertook a prospective study of liver biopsies in 12 consecutive patients. Preoperative and 2-year postoperative biopsies of the liver were planned. There were six liver biopsies available for comparison both pre- and post-operatively. The biopsies showed changes of fatty infiltration both pro- and post-operatively. There were no differences in the degree of fatty infiltration, or of other histological parameters which we measured. There were no cases of cirrhosis of the liver recorded.

Morphological and functional alterations to a sub-group of regulatory peptides in human pancreas and intestine after jejuno-ileal bypass.

The effect of ileo-gastrostomy on insulin and cholecystokinin secretion and the endocrine cells containing cholecystokinin, somatostatin, motilin, secretin, neurotensin and enteroglucagon was studied. Fasting and postprandial plasma samples collected pre- and post-operation demonstrated significant changes in circulating insulin and cholecystokinin. Fasting and postprandial insulin levels decreased three months after ileo-gastrostomy (postprandial pre-operation 40 +/- 8 microU/ml compared to 15 +/- 24 microU/ml post-operation, P < 0.02). The postprandial levels of cholecystokinin were significantly increased (pre-operation 7.1 +/- 1.1 pg/ml compared to 12.2 +/- 1.7 pg/ml post-operation, P < 0.02). Quantification of the endocrine cell populations in the jejunum in-continuity three months after ileo-gastrostomy demonstrated an hyperplasia of cholecystokinin-, secretin-, gastric inhibitory polypeptide-, motilin- and somatostatin-containing cells. In samples of the ileum taken from within the bypass loop the neurotensin- and somatostatin-containing cells were unaffected while the enteroglucagon-containing cells were significantly increased in number. Ileo-gastrostomy resulted in significant alterations to the abundance of regulatory peptide-containing endocrine cells and to circulating levels of insulin and cholecystokinin. These changes are implicated in the dramatic weight loss associated with the operation.

Follow-up of patients who have undergone ileogastrostomy.

Patients who have had ileogastrostomy for the treatment of morbid obesity require close, long-term follow-up. From a prospective study of a large number of variables in 12 consecutive patients, and from experience with more than 200 patients who have undergone this procedure since 1982, a protocol has evolved. The authors outline the associated morbid conditions, operative complications and biochemical alterations that are important in the management of these patients.

Experimental Pasteurella multocida pneumonia in calves.

Pasteurella multocida was isolated from the lungs of calves that died on a farm in the south of England. This organism was inoculated experimentally into 13 calves by the intratracheal route: in all but two of the calves mild clinical disease resulted and at necropsy, three or four days later, pneumonic consolidation involving up to 22 per cent of the lung was observed. P multocida was isolated from all but two of the lungs. Of two calves inoculated intravenously with P multocida, one showed mild clinical disease and slight pneumonic consolidation at necropsy and the other remained normal. Control calves inoculated intratracheally and intravenously with sterile broth showed no signs of illness and no pneumonic consolidation. Histologically the lung lesions comprised a fibrinous bronchopneumonia with variable sized areas of coagulative necrosis, extensive deposition of fibrin and massive dilatation and oedema of the interlobular and pleural lymphatics. It is concluded that P multocida should receive more recognition as a primary pathogen.

Effect of a new macrolide antibiotic (tilmicosin) on pneumonia experimentally induced in calves by Mycoplasma bovis and Pasteurella haemolytica.

Two gnotobiotic calves were treated once with tilmicosin (20 mg kg-1) six hours before they were infected by the intratracheal route with Mycoplasma bovis and Pasteurella haemolytica serotype 1. This treatment prevented colonisation of the lungs by P haemolytica and considerably reduced colonisation by M bovis, and the clinical scores and the extent of pneumonic consolidation, compared with two untreated gnotobiotic calves, both of which had to be killed in extremis for humanitarian reasons within 24 hours of infection. In a second experiment, 10 conventionally reared calves were similarly exposed to infection and, at the onset of clinical disease, five were treated once with tilmicosin (20 mg kg-1). Colonisation by P haemolytica and M bovis, the clinical scores and extent of pneumonic consolidation were suppressed or greatly reduced in the treated compared with the untreated calves, one of which had to be killed in extremis two days after infection. It was concluded that tilmicosin had a beneficial effect.