Gastric bypass for morbid obesity: a medical--surgical assessment.

With the operative modifications and dietary guidelines described in this report, death and complications from gastric bypass were minimal, and weight loss was marked. Ninety per cent of a group of 69 patients lost more than half of their excess weight within the first two years after operation. Stringent preselection of patients for operation was crucial to the success of the operation, and marked alterations of eating behavior was necessary to achieve the weight loss. Mild electrolyte deficiencies and hypovitaminosis occurred in up to one-fourth of the patients. While none of these abnormalities was harmful to the patients, and all were easily corrected, their occurrence demonstrates the importance of long-term follow-up after the operation. We conclude that gastric bypass, with a 50-60 cc pouch and a small (1-1.2 cm) gastrojejunostomy, remains the operation of choice for morbid obesity.     

Schneider-oriented psychiatric diagnosis in Germany compared with New York and London

It has long been known^1–3 that there were considerable differences in diagnostic rates generated by mental hospitals in America and Britain. However, Kramer⁴ was the first to systematically calculate the rates of various psychiatric diagnostic categories for the two countries. He found that the frequency in England and Wales for schizophrenia was one third lower, and for manic-depressive illness nine times higher, than the rates in the United States. At this point the U.S.-U.K. Diagnostic Project⁵ was designed to discover why such discrepancies existed.The main question posed by the U.S.-U.K. Study⁵ had been: are the reported differences in the diagnostic percentages for mental hospitals in the United States and Great Britain brought about by actual symptomatologic differences in the patients admitted in the two areas, or can diagnostic differences between countries by mainly responsible? The basic conclusion of this study was that the reported differences are largely, though not entirely, due to differences in diagnostic criteria used in New York and London.Another study⁶ indicated that the diagnostic criteria used in London did not differ appreciably from those applied in other English centers. However, it seemed that the broad New York concept of schizophrenia did not extend to Illinois or California,⁷ nor did it reach North Carolina.⁸ There appeared to be a gradient across the United States from east to west, though in California the prevailing concept of schizophrenia was considerably wider than that used in Great Britain.⁹     

Hemodynamic studies using a CT scanner.

New CT software programs allow rapid-sequence images to be obtained. During a period of 12 sec, multiple CT images can be produced, so that the progression of contrast flow at intervals of 1 sec or less can be followed. In addition, as many as 16 consecutive 3-sec scans can be performed, or arbitrary time intervals inserted between scans. The rapidity with which the contrast medium enters and leaves a specific tissue may be a valuable, non-invasive diagnostic tool in differentiating enhancing lesions. Other potential applications are mentioned.     

Diagnostic image (252). A woman with complaints of tinnitus, hearing loss and headache

A 42-year-old woman complained of tinnitus, hearing loss and headache. Many years ago she had been treated for a vestibular schwannoma and cutaneous neurofibroma. MRI revealed bilateral vestibular schwannomas and multiple meningiomas due to neurofibromatosis type 2.     

The prediction of violence and homicide in young men

In this prospective study, the authors predicted violence and homicide in 3 representative school samples (N = 1,517). Participants were part of a longitudinal, multiple cohort study on the development of delinquency in boys from late childhood to early adulthood in Pittsburgh, Pennsylvania. Thirty-three participants were convicted of homicide, 193 participants were convicted of serious violence, whereas another 498 participants self-reported serious violence. Predictors of violence included risk factors in the domains of child, family, school, and demographic characteristics. Boys with 4 or more violence risk factors were 6 times more likely to later commit violence in comparison with boys with fewer than 4 risk factors (odds ratio [OR] = 6.05). A subset of risk factors related to violence also predicted homicide among violent offenders. Boys with 4 or more risk factors for homicide were 14 times more likely to later commit homicide than violent individuals with fewer than 4 risk factors (OR = 14.48). Implications for the prevention of violence and homicide are discussed.     

Evaluation of the clinical applicability of proton beams in definitive fractionated radiation therapy

We report on the treatment of 317 patients treated either wholly or in part with proton beams at the Harvard Cyclotron Laboratory. These include: 130 patients treated for definitive radiation therapy of choroidal melanoma; 17 patients treated for tumors of the base of skull, cervical spine and cranium, which abut structures of the central nervous system (CNS); 23 patients treated for sarcomas of soft tissue and bone; 65 patients treated for carcinoma of the prostate; 14 patients treated for carcinoma of the rectum and anus; and 23 patients treated for squamous carcinoma of the oral cavity and oro-pharynx. Data on causes of failure and morbidity of treatment are presented. Overall the results are judged to be extremely encouraging. In particular, the treatment of the choroidal melanomas and sarcomas abutting CNS structures have clear clinical value, and the treatment of prostatic tumors and tumors of the head and neck are thought to be promising.