Deficiency of fat soluble vitamins after jejunoileal bypass surgery for morbid obesity.

Significant vitamin A, E, or 25-hydroxy D deficiency occurred in 76% of 40 patients studied up to 6 years after jejunoileal bypass surgery for morbid obesity. Vitamin A was significantly lower in those who had lost 30% of their initial weight than in those who had lost less weight; however, there was no correlation of vitamin A, E, or D levels, time elapsed since surgery, or with daily intake of vitamins as subnormal values were found despite multivitamin supplementation and consumption of twice the recommended daily allowance of vitamin A. Functional derangement of retinal adaptation to darkness secondary to vitamin A deficiency was found in four of nine stable, healthy patients studied at least 18 months after surgery. There was no linear relationship between vitamin A levels and dark adapted final thresholds or with serum albumin, prothrombin time, or degree of steatorrhea. Three patients with abnormal adapted final thresholds were treated with vitamin A. Total daily intake of up to 65,000 IU of vitamin A daily for several months resulted in normalization of function in all.

The prevention of bypass enteritis after jejunoileal bypass for morbid obesity.

The symptoms of bypass enteritis are disabling sequelae in many patients after jejunoileal bypass. This is a preliminary report of efforts to devise a valve to prevent reflux into the bypassed intestine after jejunoileal bypass. Valve I (42 cases) was formed by dividing the ileum, everting the proximal end as one matures an ileostomy, and inserting this into the distal ileum. Only 12 of these valves were competent. Valve II (six cases) was formed by dividing the ileum and merely inserting the proximal bowel into the distal, allowing it to evert spontaneously as with an unmatured ileostomy. In two cases the valve was competent, but four cases became obstructed and this valve is mentioned only to be condemned. Valve III (19 cases) is similar to an isoperistaltic Kock valve, except that the intussuscepted ileum is first divested of its mesentery. All such valves have been competent. All 33 patients with a competent valve have been free of the stigmata of bypass enteritis, whereas 54% of 156 patients showed the symptoms of enteritis after conventional jejunoileal bypass.

Thrombosis of the digital vessels secondary to oral contraceptives.

PIP: A 27-year-old woman who used oral contraceptives for 2 years and had 2 incidents of blurred vision followed by painful "blood-red" fingers is described. Contraceptive treatment was stopped. Most fingers of both hands were characterized by bluish, cyanotic, apparent pregangrenous discoloration. All laboratory tests were within normal range except; latex agglutination (weakly reactive), LE preparation (weakly positive twice, normal once), globulin immunoeletrophoresis (slightly elevated IgM), and blood volume determination (500 ml deficit of whole blood). 500 ml daily of low molecular weight dextran for 4 days was the only treatment. Gradually over 2 weeks cyanosis and pain ebbed. The hypothesis that this thromboembolic trouble is linked to the pill is circumstantial, but episodes of blurred vision are symptomatic of retinal vessel thrombosis. Erythema or pain in finger tips is the first sign of difficulty and should produce cessation of the pill.^ieng