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.     

Development of a fatted male phenomenon in California sea lions

A captive colony of male sea lions (Zalophus californianus) living in northern California shows an annual weight fluctuation related to their reproductive season. Seasonal fattening, which is associated with an increase in territorial displays, starts developing at 5 years of age, when a sagittal crest first becomes apparent, and becomes more prominent as the males reach full maturity.     

Endogenous Endophthalmitis Among Patients with Candidemia

Thirty-eight patients with fungemia were examined prospectively for development of endophthalmitis. Endophthalmitis was present in 10 of 27 (37%) patients with Candida albicans fungemia. Only one patient with nonalbicans fungemia developed endophthalmitis. Of the preselected factors studied, only hemodialysis and parenteral hyperalimentation correlated with an increased incidence of endophthalmitis. Antibody titers by latex agglutination were of little predictive value for endophthalmitis. Antigen titers by latex agglutination were performed in four cases with endophthalmitis. Antigenemia was demonstrated in three of the four patients, all of whom had negative antibody serologies. Although inconclusive, the preliminary data indicate the test may prove to be of clinical value. Periodic ophthalmoscopic examinations should be considered mandatory in the evaluation of patients with fungemia.     

Malignant group B streptococcal endocarditis associated with saline-induced abortion.

A 20-year-old woman developed acute group B streptococcal endocarditis following saline-induced abortion. In the pre-antibiotic era, most cases of group B streptococcal endocarditis occurred in parturient or postabortal women. Currently, this disease is rarely described in obstetrical patients, and no previous cases following saline-induced abortion have been reported. Purulent pericarditis and a perivalvular abscess were present in our patient and represent only the second instance in which these findings have been documented in this disease.     

Using silver to reduce catheter-associated urinary tract infections

Many thousands of urinary tract infections (UTIs) are linked to the insertion of an indwelling urethral catheter (Saint et al 2000). Catheterisation is often prolonged unnecessarily (Saint et al 2002), thereby increasing the infection risk. In this audit of 133 medical and surgical patients who were catheterised in an acute NHS hospital trust, the potential of a new silver alloy hydrogel-coated catheter to reduce the rate of infection was demonstrated. Benefits were indicated in terms of reducing clinical risk to the patient and the financial costs associated with treating catheter-associated UTIs, representing a substantial cost saving for the NHS.