Secondary hyperparathyroidism and osteopenia in women following gastric exclusion surgery for obesity

Gastric exclusion has been introduced as a surgical treatment for morbid obesity. We describe two women who had undergone gastric bypass for obesity with metabolic bone disease and secondaryhyperparathyroidism. In one patient transiliac bone biopsy after double tetracycline labelling demonstrated histologic evidence of hyperparathyroidism with osteitis fibrosa cystica. Six additional women who had undergone gastric exclusion were evaluated. Serum phosphorus, calcium, and creatinine were normal in all but one patient who had hypocalcemia. Serum immunoreactive parathyroid hormone was elevated in seven of eight patients and urinary calcium was 2 mmol/d (80 mg/24 h) in 6 patients. Lumbar spine bone mineral density was 86±7 (mean±SE) per cent of predicted and femoral neck bone mineral density was 89±6 per cent of predicted. Women who have had gastric exclusion for obesity may develop secondary hyperparathyroidism which could result in loss of bone mass.Deceased     

Predeposit Autologous Blood Donation: a survey of patient attitudes

Attitudes to autologous blood donation have been surveyed in a group of 38 postoperative bariatric patients. Only two patients (5%) declined to participate. Twenty-eight of 38 (70%) successfully predeposited autologous blood. Twenty-five of 28 donors (90%) had done so at the suggestion of their surgeon. Concern about contracting AIDS was the motivating factor in the majority of patients (21 patients, = 55%). Lack of infectious complications in general was cited by an additional four (11%). All respondents would donate autologous blood in the future, and would recommend the procedure to others who were about to undergo elective surgery. There was an increase from 29% to 50% who stated that, following their autologous donation experience, they would consider being homologous volunteer blood donors in the future.     

Long-term Result of Treatment of Prader-Willi Syndrome by Scopinaro's Bilio-pancreatic Diversion. Study of Three Cases and the Effect of Dextrofenfluramine on the Postoperative Evolution

The Prader-Willi syndrome shortens the life of patients due to the morbid obesity which it entails. The compulsive hyperphagia associated with it makes a dietetic treatment or a gastroplasty difficult. This study presents the case-histories of three patients suffering from the Prader-Willi syndrome who were operated on by means of a Scopinaro's bilio-pancreatic diversion. Following a marked reduction the first year, the weight loss stabilized and then tended to diminish. The observation of three cases which continued for two and a half to six years did not reveal any considerable metabolic problems. The deficiency of iron, vitamins D and B12 as well as folic acid had to be made up by supplementation. These results are comparable with the most favorable ones in the literature. Even if the effect on the weight loss is not spectacular, the operation manages to hold off the development of the obesity, inexorable for those with the Prader-Willi syndrome, and prevents lethal complications, without having notable side effects. Lifting coercive dietary measures improves the quality of life.     

Obesity Surgery Poly-parametric Patient Auto-evaluation

A simple auto-evaluation sheet is presented for the proper assessment of the patient's condition after surgery. Stress is put not only on weight loss, but on other important factors as well.     

Pharmacological aspects of anaesthesia for implantation of the artificial lens

During the placement of an artificial lens the ophthalmic surgeon must be guaranteed an immobile operation site and so-called soft eye. Based on our experience with more than 1000 lens implantation operations in the Rotterdam Eye Hospital over the past three years, the following conclusions can be drawn: The pharmacological agents available to the anaesthetist are sufficient for providing optimal conditions under general anaesthesia for lens implantation techniques by the eye surgeon. Hypotensive techniques are not regarded as being appropriate because of the inherent risks involved. Classical neuroleptic techniques are best avoided in the elderly. Controlled ventilation is preferable in order to avoid the deleterious side effects of hypercarbia. Constant vigilance on the part of the anaesthetist during the operation is a very important sine qua non for a tranquil course both during the anaesthetic and in the post-operative period. The routine administration of antiemetic agents after a lens implantation operation is advisable this holds true also for prevention of the Central Anticholinergic Syndrome by means of physostigmine, in patients who have received inhalation anaesthetics, particularly enflurane or, flunitrazepam.     

Post-operative pain and inflammatory reaction reduced by injection of a corticosteroid

Summary In a controlled crossover study, identical surgical procedures, the prophylactic removal of bilateral non-erupted 3rd molar teeth, were performed on two separate occasions in 24 healthy patients. Prior to each procedure, either betamethasone 9 mg (Celeston Chronodose^®) or placebo was administered intramuscularly, in a randomized fashion. Objective and subjective assessments were recorded for paired comparison of the post-operative course, including swelling, pain, trismus, local temperature, bleeding, wound-healing and preference for treatment. In 23 patients, less swelling occurred when betamethasone was given pre-operatively. The mean reduction on the 3rd and 6th post-operative days was 55% (p<0.001) and 69% (p<0.001), respectively. Pain assessments (visual analogue scale) were significantly lower after the corticosteroid injection; mean response: 1st evening 17 vs 56 mm, 2nd evening 5 vs 37 mm, and 3rd evening 2 vs 13 mm. No significant correlation between the steroid-induced reduction in swelling and pain could be made. This may indicate that dissociation may exist between pain and other inflammatory events like swelling. No clinically apparent infection or other disturbance of wound-healing was noted after corticosteroid administration. This treatment course was preferred by 23 of the 24 patients.     

Inhibition of mixed lymphocyte reaction by thoracic duct lymph: removal of inhibitory effect by thoracic duct drainage in lung cancer.

The inhibitory effect of the thoracic duct lymph of a patient with lung cancer on the "one-way" mixed lymphocyte reaction without cytoxicity is unequivocally demonstrated. The effect seems to be dose related. A moderate inhibition of mixed lymphocyte reaction is still observed, even if the responding cells are preincubated in the thoracic duct lymph for 1 hr only prior to the addition of stimulating cells. The inhibitory effect of thoracic duct lymph on the mixed lymphocyte reaction is no longer evident when the material is added 1-4 days after the beginning of culture. These observations suggest that the mechanism of the inhibitory effect of thoracic duct lymph may be a simple attachment of inhibitory factors to the receptor sites on the responding lymphocytes, causing interference in cell to cell interaction. The inhibitory effect of thoracic duct lymph collected 1 week after the thoracic duct drainage on mixed lymphocyte reaction is significantly lower than that of thoracic duct lymph collected at the beginning of the procedure. This indicates that the blocking effect of thoracic duct lymph can be easily removed by this technique; which is technically feasible in man. The interrelationship of the tumor-specific blocking factor, thoracic duct drainage, and tumor growth pattern are discussed with respect to the potential usefulness of this procedure as adjuvant immunotherapy in the management of patients with neoplastic diseases.     

小切口白内障手术中后囊膜破裂一期人工晶体植入术临床疗效分析

目的评价小切口白内障摘除术术中后囊膜破裂的原因及处理方法.方法回顾分析1 05 6例小切口白内障手术联合人工晶体植入术,其中术中51例后囊膜破裂,玻璃体溢出,行前段玻璃体切割术联合一期后房型人工晶体植入术.结果本组患者手术中后囊膜破裂发生率为4.8%,全部行一期后房型人工晶体植入术,其中5例囊袋内固定植入,42例睫状沟固定植入和4例DGR人工晶体双襻缝线固定法植入.术后矫正视力大于或等于0.3者46例(90.2%);矫正视力大于或等于0.05,低于0.3者4例(7.8%);矫正视力低于0.05者1例(2.0%).结论前段玻璃体切割术为小切口白内障摘除术中后囊膜破裂一期人工晶体植入提供了安全有效的保证.     

保留乳房手术在早期乳腺癌治疗中的临床观察

目的 :探讨早期乳腺癌保留乳房手术的原则及近期疗效。方法 :对 2 8例早期乳腺癌病例实施保乳手术 ,手术方式为肿块广泛切除加腋窝淋巴结清扫 ,术后常规辅助放疗和化疗。结果 :2 8例均存活 ,术后均无局部复发 ,无远处转移 ,双乳均保持良好乳房外形。结论 :对早期乳腺癌实施保乳综合治疗疗效可靠 ,可作为早期乳腺癌治疗的首选方法。     

羟甲唑啉在鼻内镜手术中的应用

目的：探讨经甲唑啉(商品名：达芬霖)在鼻内镜手术中的应用价值。方法：观察在68例鼻内镜手术中应用经甲唑啉对患者的脉搏、纤毛运动的影响及出现反跳的时间。结果：在经甲唑啉应用前后，68例患者的脉搏变化差异无显著性意义(P＞0．05)；10例慢性鼻窦炎患者的纤毛移动率差异无显著性意义(P＞0．05)；降低鼻血流量约50％；作用持续时间长达6h。结论：经甲唑啉作为鼻教膜血管减充剂和麻醉辅助药，常规用于鼻内镜手术，安全、有效。