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This Month in
Octomber 01, 2004

This Month in Archives of Surgery

Author Affiliations
 

GERALD W.PESKINMD

Arch Surg. 2004;139(10):1040. doi:10.1001/archsurg.139.10.1040

There are 2 articles dealing with bariatric surgery this month. The first, accompanied by an invited critique, deals with the effect of obesity surgery on the metabolic syndrome. Lee et al emphasize that the metabolic syndrome was prevalent in 52% of obese individuals enrolled in their program and that significant weight reduction markedly improved all aspects of the syndrome and resulted in a cure rate of 95.6%. The invited critique is more skeptical and stresses that there are many unanswered questions.

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The other article deals with the early effects of Helicobacter pyloriinfection in patients undergoing bariatric surgery. Ramaswamy et al note that 24% of their 99 consecutive patients tested positive for H pylori, and postoperative foregut symptoms were significant in 48% of this group (P= .02), well above that noted in the H pylori–negative group, after adjusting for age, sex, preoperative presence of antritis, type of surgery performed, and body mass index. They emphasize that H pyloritreatment should be given to this positive group.

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Modlin et al at the Department of Surgery at Yale University have reviewed the history and future of instrumentation related to visualization of the gastrointestinal tract. The imaging of disease has shifted from clinical features to radiology, ultrasonography, axial tomography, and magnetic resonance imaging. Nonvisible wavelength light has both diagnostic and therapeutic potential, and robotic devices may soon replace endoscopists and surgeons alike.

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Nontraumatic Perforation of the Bile Duct in Adults

In this small but significant series, Kang et al present a retrospective analysis of 11 patients who were diagnosed as having nontraumatic perforation of the bile ducts. The primary disease was common bile duct stones in the majority of cases. Nontraumatic perforation of the bile ducts should be suspected if perihepatic abscess or peritonitis is combined with biliary stone disease. Definitive treatment should include eradication of primary pathologic lesions and control of abscesses or peritonitis.

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Outcome and Prognostic Factors in Head Injuries With an Admission Glasgow Coma Scale Score of 3

Demetriades et al provide the data from 760 patients with head injury and an admission Glasgow Coma Scale score of 3. Patients with blunt and penetrating causation were revived separately. The authors concluded that patients with head injuries and an admission Glasgow Coma Scale score of 3 have a very poor prognosis, especially if related to penetrating trauma. However, these patients are an important source of organ donations and should be evaluated and resuscitated aggressively.

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Prospective Evaluation of Positron Emission Tomography in the Preoperative Staging of Esophageal Carcinoma

Much has been practiced regarding the value of positron emission tomography in the selection of patients with esophageal cancer for varied forms of treatment. Kneist et al analyzed a large series of patients and found that positron emission tomography was not characterized by greater accuracy in the detection of metastatic sites previously identified by computed tomography and did not exert an influence on the therapeutic procedure.

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