Localized duodenal lymphoma masquerading as a duodenal ulcer.

A 64-year-old woman presented with atypical abdominal pain, weight loss, melena and hematemesis. Reactivation of a peptic ulcer was diagnosed and she was treated with antacids and cimetidine. When her symptoms recurred 4 months later, a perforated duodenal ulcer was noted on roentgenograms. At laparotomy this proved to be a perforated, localized lymphoma of the duodenum. This case highlights an important consideration in the management of duodenal ulcers. Patients who present with a previously diagnosed peptic ulcer, who demonstrate atypical symptoms and remain refractory to treatment should undergo endoscopic examination and biopsy to rule out an occult localized duodenal lymphoma.

A review of obesity and its management in 263 cases.

Obesity is defined with reference to hte probable cellular differences in adolescent and maturity-onset obesity. The aetiology and pathogenesis of obesity are briefly discussed. A multifactorial approach was used to treat 263 patients for obesity. This regimen included strict diet, programmed exercise, psychotherapy and medication. D-Phendimetrazine bitartrate in the long-acting form proved an excellent anorexiant for routine use. Fenfluramine was a valuable adjuvant drug for refractory cases. A detailed analysis of the results shows an over-all classified mean weight loss of 14,3%. Interrelationships between degree of overweight, age, degree of weight loss, etc., are critically examined. The most important conclusion was the need for close medical supervision and encouragement both during and after the formal weight loss programme.