BioEnterics Intragastric Balloon (BIB): a short-term, double-blind, randomised, controlled, crossover study on weight reduction in morbidly obese patients.

BACKGROUND: The BioEnterics Intragastric Balloon (BIB) System in association with restricted diet has been used for the short-term treatment of morbid obesity. Aim of this study was to evaluate the real, short term, efficacy of the BIB for weight reduction in morbidly obese patients by using a prospective, double-blind, randomised, sham-controlled, crossover study. METHODS: Patients were recruited from January 2003 to December 2003. After selection, they were randomly allocated into two groups: BIB followed by sham procedure after 3 months (Group A), and sham procedure followed by BIB after 3 months (Group B). All endoscopic procedures were performed under unconscious intravenous sedation. The BioEnterics Intragastric Balloon (Inamed Health; Santa Barbara, CA, USA) was filled by using saline (500 ml) and methylene blue (10 ml). Patients were discharged with omeprazole therapy and diet (1000 kcal). Patients were followed up weekly by a physician blinded to randomisation. In both groups mortality, complications, BMI, BMI reduction and %EWL were considered. Data were expressed as mean +/- s.d., except as otherwise indicated. Statistical analysis was performed by means of Student's t-test, Fisher's exact test or chi (2) with Yates correction; P < 0.05 was considered significant. RESULTS: A total of 32 patients were selected and entered the study (8M/24F; mean age: 36.2 +/- 5.6 years, range 25-50 years; mean BMI 43.7+/-1.5 kg/m(2), range 40-45 kg/m(2); mean %EW: 43.1 +/- 13.1, range: 35-65). All patients completed the study. Mortality was absent. Complications related to endoscopy, balloon placement and removal were absent. Mean time of BIB positioning was 15 +/- 2 min, range 10-20 min. After the first 3 months of the study, in Group A patients the mean BMI significantly (P < 0.001) lowered from 43.5 +/- 1.1 to 38.0 +/- 2.6 kg/m(2), while in Group B patients the decrease was not significant (from 43.6 +/- 1.8 to 43.1 +/- 2.8 kg/m(2)). The mean %EWL was significantly higher in Group A than in Group B (34.0 +/- 4.8 vs 2.1 +/- 1%; P < 0.001). After crossover, at the end of the following 3 months, the BMI lowered from 38.0 +/- 2.6 to 37.1 +/- 3.4 kg/m(2) and from 43.1 +/- 2.8 to 38.8 +/- 3.1 kg/m(2) in Groups A and B, respectively. CONCLUSIONS: The results of this study show that treatment of obese patients with BioEnterics Intragastric Balloon is a safe and effective procedure. In association with appropriate diet it is significantly effective in weight reduction when compared to sham procedure plus diet. The BIB procedure can play a role in weight reduction in morbidly obese patients or in the preoperative treatment of bariatric patients.

Laparoscopic splenectomy for non-traumatic diseases.

At present, laparoscopic splenectomy (LS) is mostly indicated in hematologic benign diseases, and in case of normal size spleen it is considered the gold standard. The technique is under a continuous evolution and several studies have demonstrated feasibility and safety of laparoscopic approach also in case of massive splenomegaly, malignant diseases and even in the treatment of selected cases traumatic lesions. LS is an advanced surgical procedure that requires a management of a full trained team involved in the preoperative preparation, surgical strategy and postoperative care. A fully comprehension of the impact of the surgical strategy is needed to plan the treatment of diseases that often are managed in a multidisciplinary setting. Indications and contraindications to surgery does not differ significantly from open traditional splenectomy, but the nature of the disease and the volume of the spleen can greatly influence the operation. A preoperative study with definition of these parameters along with a standard preparation to surgery is required. Over the years the technique has been developed and adapted to respond to emergent necessities related to those parameters. Anterior, semilateral, later and hand assisted approaches offer advantages and drawbacks that should be weighed in each case. They depend on surgeons preferences but most of the time are related to the preoperative studies, even when new surgical tools (i.e. harmonic scalpel and radiofrequency). No randomized, prospective trials have been conducted, however several studies with strong evidence have shown that less surgical trauma, intraoperative blood loss, early hospital discharge, rapid return to normal activities and better cosmesis can be obtained with a laparoscopic approach.

Management of abdominal lymphoproliferative diseases in the era of laparoscopy.

BACKGROUND: The treatment of lymphoproliferative diseases requires extensive histological, immunohistochemical, and cytogenetic diagnosis. The aim of this study was to analyze the results of 66 laparoscopic procedures in the diagnosis, staging, and restaging of hematological malignancies localized in the abdominal cavity. METHODS: Between July 1993 and March 1998, 64 consecutive patients (28 male and 36 female; mean age 46.6 years, range 7 to 69) with diagnosed or suspected lymphoproliferative diseases were referred for primary diagnosis or reassessment and for staging/restaging. RESULTS: Sixty-two out of 66 procedures (93.9%) were completed laparoscopically. CONCLUSIONS: The minimally invasive approach, in the management of lymphoproliferative diseases, is able not only to provide an adequate specimen for proper diagnostic techniques, but also, when compared with open surgery, to offer a large number of advantages.

Minimally invasive approach for the treatment of idiopathic varicocele.

Laparoscopic ligation of the spermatic veins represents a new approach for the treatment of the idiopathic varicocele. This procedure was performed in 28 consecutive patients. The diagnosis was based on physical examination and Doppler ultrasonography. The indications for surgery were (a) infertility and abnormal semen analyses (15 patients), (b) scrotal pain (six patients), and (c) psychological reasons (seven patients). One patient underwent concomitant hernioplasty. Two cases presented with a recurrence after 6 and 12 months, respectively. The mean operative time was 34 +/- 11 min in unilateral cases and 47 +/- 9 min in bilateral cases. In one patient with left inguinal hernia and varicocele, the operative time was 70 min. All patients were discharged the day after operation without antibiotics and analgesics and resumed normal activity within 5 to 9 days, depending on age and occupation. Postoperative semen analyses (at 12 months' follow-up) were obtained from seven patients and demonstrated an improvement in semen motility (preoperative 40% versus postoperative 56%). This study confirms that laparoscopic treatment of varicocele is safe, minimally invasive, and, according to National Health Service fees, less costly than radiological occlusion procedures.

[Echographic and ERCP-manometric study of gallbladder and Oddi's sphincter behavior in biliary colic in patients with cholelithiasis. Effects of cerulein]. / Studio ecografico e CPRE-manometrico del comportamento della colecisti e dello sfintere di Oddi in corso di colica biliare in pazienti con colelitiasi. Effetto della ceruleina.

In a previous study, we have shown that caerulein relieves biliary colic pain in gallstone patients. This study was initiated to determine gallbladder and sphincter of Oddi behaviour during biliary colic and their response to caerulein. In 10 gallstone patients gallbladder volume was measured by real-time ultrasonography during a biliary colic episode and 72 hours after cessation of pain, before and after caerulein administration. Basal sphincter of Oddi pressure was determined by CPRE manometry in 10 gallstone patients during biliary colic and three days after cessation of pain, before and after caerulein. The results of this study show that, during biliary colic, gallbladder volume is 8 times greater than in the post-colic state. Basal sphincter of Oddi pressure was also significantly higher during biliary colic than in the post-colic state. Caerulein relieved in all cases the biliary colic pain while reducing gallbladder volume and decreasing the sphincter of Oddi.

[Digestive hemorrhage in a patient with multiple neurofibromatosis]. / Emorragia digestiva in paziente con neurofibromatosi multipla.

Neurofibromatosis is an autosomal dominant trait with variable expressivity clinically defined by the coexistence of multiple cafè au lait spots, subcutaneous neurofibromas and Lisch nodules. Hemorrhage from intestinal neurofibromas or related tumors may be life-threatening because often inaccessible and therefore difficult to locate. The Authors report a case of gastrointestinal hemorrhage in a 68 year old patient with neurofibromatosis who had an episode of melena from duodenal ulcer endoscopically detected 5 years earlier. Endoscopy failed to discover the site of bleeding; this was successfully demonstrated by angiography: superior mesenteric arteriography disclosed 32 hypervascular masses supplied by a digiunal branch and by the oleo-colic artery. Because of continuing hemorrhage the patient was submitted to surgery. The exploration demonstrated ulcerated neurofibromatous neoplasms at the level of the digiunum and terminal ileum, with a Meckel's diverticulum and gallbladder stones. Intestinal resection, right emicolectomy, Meckel's diverticulum resection and colecystectomy were performed. Review of the literature demonstrates angiography is the most reliable imaging modality for detecting such tumors.

[Primary muscular echinococcosis: a clinical case]. / Echinococcosi primitiva muscolare: caso clinico.

Muscular localization of echinococcosis is considered unusual. The authors report a case of such uncommon hydatid localization. Pathogenetic hypotheses are discussed.

[Hyperamylasemia or macroamylasemia? A clinical case]. / Iperamilasemia o macroamilasemia? Caso clinico.

The authors report a case of macroamylasaemia and discuss diagnostic implications especially in surgical emergencies. In fact, laboratory findings of hyperamylasaemia may lead to erroneus diagnosis or even to useless surgical operations.