Biliopancreatic diversion. Clinical experience.

AIM: Biliopancreatic diversion (BPD) has been accepted as an effective surgical treatment of morbid obesity. The paper presents the results of a personal clinical experience with this procedure, with special focus on the quality of life. METHODS: From January 1, 1992 to June 30, 2002, 122 patients (F/M: 108/14, mean age: 40.2 years, range 21-61) underwent BPD. Mean preoperative body weight was 122.4 kg (range 91-200), with a mean Body Mass Index of 49.1 kg/m2 (range 38-78). Three of these patients were converted from a previous vertical banded gastroplasty to BPD (1 patients with stomach preservation). After at least a 36-month follow-up, 10 patients underwent abdominal dermolipectomy (8 associated to incisional hernia repair, 1 associated to thigh dermolipectomy). RESULTS: Mean postoperative hospital stay was 12 days (range: 11-30). Follow-up is currently in progress in all patients. Weight loss of initial overweight was 75% in 88 patients with a 36-month follow-up, with excellent long-term weight maintenance. Protein deficiency was the main specific complication, encountered in 6 patients (4.9%). Beneficial effects, other than those consequent to weight loss, included permanent normalization of serum cholesterol and glucose without any medication and on a totally free diet. Almost 80% of the patients reported an improvement in their self-esteem, physical activity, work condition and social life. CONCLUSIONS: This clinical experience supports the effectiveness and safety of BPD, despite some criticism. The small number of side effects and complications, the excellent weight loss and the recovery of most co-morbidity leads to a great improvement in quality of life.

Biliopancreatic diversion: clinical experience.

BACKGROUND: Biliopancreatic diversion (BPD), by ad hoc stomach resection (AHS-BPD) has been accepted as an effective surgical treatment for morbid obesity. METHODS: Between 1.1.1992 and 31.7.1996, 59 patients (54 females, five males, mean age 40.3 years, range 23-61 years) underwent AHS-BPD. Mean preoperative body-weight was 121.2 kg (range 94-160), with a mean body mass index of 48.6 (range 35-64). Three of these patients were converted from a previous vertical banded gastroplasty to AHS-BPD (one patient with stomach preservation). After at least 36 months follow-up, seven patients underwent abdominal dermolipectomy (five with associated incisional hernia repair, one with thigh dermolipectomy). RESULTS: Mean post-operative hospital stay was 13 days (range 10-30 days). Follow-up is currently in progress in all patients. Excess body weight-loss was 78% in 33 patients with 24 months follow-up, with excellent long-term weight loss maintenance. Protein deficiency was the main specific complication, encountered in two patients (3.4%). Mortality was one patient (1.7%), due to pulmonary embolus. CONCLUSIONS: This clinical experience supports the effectiveness and safety of AHS-BPD, despite some criticism. This procedure appears to be suitable for patients with clinically severe obesity who will poorly tolerate food intake restriction but will accept long-term follow-up. Careful preoperative clinical assessment and selection of patients who will be reliable in long-term follow-up are the keys to success with AHS-BPD, both in terms of weight loss and reduction of specific metabolic complications.

Nitrite/nitrate balance during photoinduced cerebral ischemia in the rat determined by high-performance liquid chromatography with UV and electrochemical detection.

A specific and simple method for the direct simultaneous detection of extracellular nitrite (NO2-) and nitrate (NO3-) has been developed, using high-performance liquid chromatography separation with UV and electrochemical detection in series. These stable endproducts of nitric oxide (NO.) were determined in dialysis perfusate obtained through in vivo brain microdialysis during and after experimental photoinduced cerebral ischemia in rats. The chromatographic conditions were optimized with a reversed-phase column (250 x 46 mm) using 10 mM n-octylamine pH 6.0 as a mobile phase. Absorbance was measured at 220 nm for NO3- detection; electrochemical detection was performed at +0.7 V for NO2- evaluation. This assay system holds the advantages of in vivo consecutive measurements, high precision, good reproducibility, technical simplicity, fast response (about 7 min), and wide availability.

[The use of somatostatin in the therapy of acute pancreatitis]. / Uso della somatostatina nella terapia della pancreatite acuta.

The authors report their experience in the use of somatostatin in severe acute pancreatitis. From 1985 to 1990, 169 patients with severe acute pancreatitis have been observed in the Surgery Division of "S. Andrea" Hospital in Vercelli. After the introduction, the evaluation of methods employed and results obtained, the authors conclude that somatostatin can give a good response in this kind of patient without side effects or complications.

[Perioperative treatment with thymostimulin in patients with stomach and colorectal neoplasms. Our experience with 114 cases]. / Trattamento perioperatorio con timostimolina in pazienti affetti da neoplasia dello stomaco e del colon retto. Nostra esperienza su 114 casi.

The authors report their experience about the use of the timostimoline in the perioperative time in 114 cases of gastric and rectum cancer. They think that this method can be of help for neoplastic patients about the time of surgical stress.

[Our experience in the use of somatostatin in upper digestive hemorrhages]. / La nostra esperienza sull'uso della somatostatina nelle emorragie digestive alte.

The paper illustrates the Authors' personal experience of the use of somatostatin in high digestive hemorrhages. Endoscopy continues to be the principal method for hemorrhage diagnosis and therapy and the additional use of somatostatin undoubtedly accelerates recovery by blocking gastric and pancreatic secretions and blood flow at the splanchnic level.

[Observations in sclerosing cholangitis]. / Alcune osservazioni sulla colangite sclerosante.

Sclerosing cholangitis is a rare liver disease of unknown etiology with a slow but progressive course. The authors report their experience and illustrate some surgical procedures to preserve bile duct patency in view of a liver transplantation program.