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Since 1982, the medical literature as well as the lay press discussed an artificial bezoar, the gastric bubble, as an adjuvant in the treatment of morbid obesity. Approved by the FDA, the Garren-Edwards Gastric Bubble has been reported by the company to have been placed over 17,000 times. Due to a reported increased rate of deflation after three months, removal and reimplantation of a new bubble is recommended. After deflation, some difficulty in retrieval of the bubble has been reported. The authors report a new technique for bubble extraction. The bubble is visualized through a gastroscope and deflated using bicap cautery. The gastroscope is removed. The endo-overtube is placed on the gastroscope and this assembly is reintroduced through the esophagus to the level of the GE junction. The deflated bubble is visualized, grasped with a forceps, and withdrawn into the endo-overtube until becoming wedged. The entire assembly (gastroscope, overtube, forceps, and gastric bubble) are removed. With this technique, bubble removal has been simplified and has decreased the procedure length to approximately fifteen minutes.

Serial endocrine studies were performed during the refeeding of a group of nine young women who presented with amenorrhea associated with injudicious dieting. No significant psychopathology was disclosed by the Lanyon Psychological Screening Inventory in any of the patients, six of whom were single and three married and infertile. The mean weight before refeeding was 81.6% of the normal for height. The mean initial serum follicle-stimulating hormone concentration was within the limits of normal for young women of reproductive age, but the serum luteinizing hormone (LH) concentration and the vaginal maturation score were low. As weight was regained, the serum LH concentration increased (the pooled r for LH versus percent normal weight = 0.85) and the vaginal maturation score rose (the pooled r for vaginal maturation score versus percent normal weight = 0.93). When a mean weight of 96.6% of normal was reached after a mean of 5.3 (range, 2 to 11) months of refeeding, spontaneous menses occurred. The initial cycle was ovulatory in two instances and anovulatory in five, as determined by basal body temperature patterns, plasma progesterone concentrations, and endometrial biopsies. With continued weight gain, menstruation became regular and the three married patients conceived.

To determine the efficacy of meperidine in controlling shivering during epidural anaesthesia for Caesarean section, forty-six parturients were studied. After delivery of the infant, shivering patients received either a single dose of intravenous meperidine 50 mg, or saline in a randomized double-blind fashion. Shivering was classified on a scale of 0 to 3 (grade 0 = none, grade 3 = severe shivering that was distressing to the patient and interfered with monitoring). Shivering and other variables were recorded at epidural placement, skin incision, delivery, and 2, 5, 15, 30 and 60 minutes following injection. Administration of meperidine resulted in a significant decrease in both the overall incidence of shivering (87 to 35 per cent, p less than 0.01) and severity of shivering (grade 3:57 to 0 per cent, p less than 0.01), compared with saline (incidence: 87 to 83 per cent, grade 3:57 per cent, no change). This effect was apparent within two minutes of drug injection and persisted throughout the study period. There were no differences in vital signs, oxygen saturation or temperature between groups. The incidence of nausea was similar, although patients receiving meperidine were more drowsy at two and five minutes following injection (p less than 0.01) compared with patients in the saline group. There were no differences in level of consciousness at the later intervals. The mechanism of action of meperidine on shivering remains to be elucidated.