Outcome Following Bariatric Surgery in Super versus Morbidly Obese Patients: Does Weight Matter?

Background: Numerous investigators have attempted to identify prognostic indicators for successful outcome following bariatric surgery. The purpose of this study was to determine whether degree of obesity affects outcome in super obese [>225% ideal body weight (IBW)] versus morbidly obese patients (160-225% IBW) undergoing gastric restrictive/bypass procedures. Methods: Since 1984, 157 patients underwent either gastric bypass or vertical banded gastroplasty. Super obese (78) and morbidly obese (79) patients were followed prospectively, documenting outcome and complications. Results: Super obese patients reached maximum weight loss 3 years following bariatric surgery, exhibiting a decrease in body mass index (BMI) from 61 to 39 kg/m² and an average loss of 42% excess body weight (EBW). Morbidly obese patients had a decrease in BMI from 44 to 31 kg/m² and carried 39% EBW at 1 year. After their respective nadirs, each group began to regain the lost weight with the super obese exhibiting a current BMI of 45 kg/m² (61% EBW) versus 34 kg/m² (52% EBW) in the morbidly obese at 72 months cumulative follow-up. Currently, loss of 50% or more of EBW occurred in 53% of super obese patients versus 72% of morbidly obese (P < 0.01). Twenty-six percent of super obese patients returned to within 50% of ideal body weight (IBW) while 71% of morbidly obese were able to reach this goal (P < 0.01). Co-morbidities and complications related to surgery were similar in each group. Conclusions: Super obese patients have a greater absolute weight loss after bariatric surgery than do morbidly obese patients. Using commonly utilized measures of success based on weight, morbidly obese patients tend to have better outcomes following bariatric surgery.     

GLUCOCORTICOID-UNRESPONSIVE FEVER IN A PATIENT WITH WEBER-CHRISTIAN DISEASE

SUMMARY Weber-Christian disease, a disease of unknown aetiology, is characterised by relapsing febrile episodes and systemic panniculitis. Glucocorticoid therapy is often useful during acute phases of the disease. This report describes a patient in whom hyperpyrexia did not respond to high-dose glucocorticoid treatment, yet did respond to a non-steroidal anti-inflammatory drug (NSAID).     

Comparison of the sphygmooscillographic method with the direct and auscultatory methods of measuring blood pressure

Objective. The objective of this study was to compare blood pressure (BP) measured by the sphygmooscillographic method with that measured by the direct and auscultatory methods.Methods. In 15 adult patients undergoing cardiac surgery, blood pressure was measured by the sphygmooscillographic and direct methods simultaneously on the same upper extremity. In another group of 86 children and 11 adults, blood pressure was measured by the sphygmooscillographic and auscultatory methods simultaneously, with one cuff. For the sphygmooscillographic measurement, we used sphygmomanometer-S, which measures blood pressure on the basis of the amplitude height (oscillometric) and the morphology (sphygmographic) of pulse waves recorded by a transducer placed in the cuff.Results. The systolic and diastolic blood pressure measured by the sphygmooscillographic method were both 2 mm Hg higher than those from the direct method; the mean blood pressure was 0.6 mm Hg higher. These differences were not significant. Compared with the auscultatory method, sphygmooscillographic systolic values were higher by 7 mm Hg, while diastolic values were lower by 9 mm Hg. These differences were significant.Conclusions. Blood pressure measurements obtained by the sphygmooscillographic method correlate well with the direct method for measuring blood pressure in children and adults; but, they do not correlate well with the auscultatory method.     

益母草防治初发期急性肾小管坏死的实验研究

ＳＤ成年雄性大鼠，禁止１６小时，肌注甘油引起急性肾小管坏死（ＡＴＮ），于其初发期给予不同药液，观察到益母草组３、２４及４８小时Ｂｃｒ升高值，２４及４８小时ＢＵＮ升高值均明显低于自来水组和单纯禁水组，而与校正对照异搏停组近似，肾组织损伤程度亦明显减轻。结果表明，益母草对初发期急性肾小管坏死（ＩＡＴＮ）有一定的防治作用。     

Treatment of chronic hepatitis C: Improved combination therapy

There has been considerable progress in the treatment of chronic hepatitis C since the first report that interferon (IFN) monotherapy was effective in 1989. Early results were meager, with sustained loss of hepatitis C virus from blood in fewer than 10% of cases. The combination of IFN with the oral nucleoside analogue ribavirin was a major breakthrough in clinical hepatology; it led to dramatic increases in treatment responses, with 30% to 40% of patients clearing virus. Pegylated IFNs that have prolonged activity and can be dosed once a week have now replaced standard IFNs. The combination of pegylated IFN with ribavirin is the new standard of care; it causes sustained loss of virus in more than half of treated patients. Treatment responses continue to be highly dependent on viral genotype. Patients with genotype 1, the most common type in the United States, have a sustained clearance rate of 42% to 46%, whereas those with genotype 2 or 3 have a response rate approaching 80%.     

Ninety-Six Five-Year Survivors After Liver Resection for Metastatic Colorectal Cancer

Background: Studies have consistently confirmed the benefit of liver resection for metastatic colorectal cancer. Few reports, however, have a long enough followup or sufficient 5-year survivors to study the clinical course of patients beyond 5 years.

Study Design: From July 1985 through December 1991, 456 patients underwent liver resection for colorectal metastases. Ninety-six actual 5-year survivors (21%) were identified and their clinical course retrospectively reviewed.

Results: Five-year survivors (n = 96) were more likely to have a Duke’s B primary colorectal carcinoma, fewer than four metastatic lesions, unilobar disease, and a negative histologic margin when compared with patients not surviving 5 years (n = 298). Forty-four (46%) of the 96 five-year survivors had a recurrence after hepatectomy. Of these 44, 19 (43%) were rendered disease free after further treatment. Overall, 71 of the 96 five-year survivors were free of disease at last followup. The actuarial 10-year survival of this group was 78%.

Conclusions: Patients that are disease free 5 years after liver resection are likely to have been cured by liver resection. Patients should be aggressively followed for recurrence because of the potential for further treatment and longterm survival.