Short- and long-term efficacy of intragastric air-filled balloon (Heliosphere® BAG) among obese patients.

BACKGROUND: Obesity is an increasing health problem worldwide. The intragastric balloon as a temporary endoscopic treatment of obesity can play an important role among the aforementioned group of obese individuals. It can also be used as a preoperative test before subjecting patients to restrictive bariatric surgery. Furthermore, the intragastric device may be applied to patients affected by severe obesity as a "bridge treatment" before they undergo major surgery in order to reduce chances of operation-related risks. To date, there are insufficient data in the literature on the long-term results of the intragastric balloon. METHODS: Our study includes an analysis of our experience with Heliosphere® BAG from 2006 through to 2010, concerning early weight loss and weight loss maintenance over at least 18 months since the device's removal. The 32 patients who completed the 6-month treatment had recorded a mean weight loss of 12.66 kg and a mean overweight loss of 24.37 % (SD, 12.74). RESULTS: A total of 16 patients are subjected to an 18-month follow-up. Their pretreatment and long-term body mass index (BMI) were calculated: 6 months later, when devices were removed, they showed a mean weight of 99.75 kg (SD, 17.90; p < 0.001) and a mean weight loss of 13.62 kg and 26.14 % (SD, 12.79). 18 months after removing Heliosphere® BAG, the 16 patients' mean BMI was 37.28 kg/m² (SD, 5.41; p = 0.004), with a mean weight of 103.56 kg (SD 17.25; p = 0.0125), and a mean weight loss of 9.8 kg or 18.2 % (SD, 12.07). CONCLUSIONS: Heliosphere® BAG enables modest short-term weight loss with little side effects, although mid/long-term follow-up may entail partial weight gain. We believe it can be considered a useful bridge treatment in bariatric surgery in order to reduce chances of preoperative risks.

[Gastric leiomyoblastoma. (Review of the literature in the light of a case)]. / Leiomioblastoma gastrico. (Revisione della letteratura alla luce di un caso giunto alla nostra osservazione).

Gastric leiomyoblastoma is a rare benign neoplasm, arising from the smooth muscle cell, that may become malignant. The most important symptoms are epigastric pain, sideropenic anaemia and upper GI bleeding, but frequently the diagnostic iter is difficult and definitive diagnosis is made only with histology after laparotomy. A personal case is reported and Literature data are reviewed; stress being laid on the uncertain biological evolution that influence mostly the choice of therapy.

[Colonic diverticulosis complicated with perforation. Analysis of several prognosis variables and criteria for emergency surgery]. / La malattia diverticolare del colon complicata da perforazione. Analisi di alcune variabili prognostiche e criteri di scelta chirurgica in urgenza.

The aim of this study was to analyse the clinical course, surgical strategy and results in patients with perforated large bowel diverticulitis. Over a 15-year period ending in January 1997, 25 patients (13 males and 12 females; mean age 64.1 years) underwent operation for perforation of acute diverticulitis. Depending on the symptoms, the spreading of the peritonitis and the patient general state, different surgical techniques were performed: primary resection and anastomosis with and without defunctioning colostomy (5), primary left hemicolectomy (1), Hartmann's resection (13), Mikulicz's procedure (4), suture and drainage with diverting colostomy (2). The overall mortality was 16%, while morbidity rate was 44%; these results were strictly related to the severity of clinical manifestations and peritoneal contamination. Therefore it must be stressed that a good surgical timing is essential. Our experience and literature data show that primary resection and anastomosis with and without colostomy have good results when the patient is fit, the sepsis is localized and satisfactory bowel preparation is achievable. By contrast, purulent and faecal peritonitis are still usually best treated by Hartamnn's procedure. Finally, it is submitted to surgeons's experience to choose, at any situation, the best procedure regarding age and general state, local findings and extent of peritonitis.