Search

Vertical banded gastroplasty (VBG) is today the most widely performed bariatric operation. The procedures used previously for the same purpose resulted in metabolic derangements and other pathologies during pregnancy. In a retrospective study we compared the reproductive performance of nine women prior to VBG and after it. Of eighteen pregnancies prior to the operation, seven ended with miscarriage, while only one of fourteen pregnancies conceived after the operation was aborted. The rate of spontaneous conception was greatly increased after the operation and there were fewer complications in the course of the pregnancies. From the obstetrician and gynecologist's point of view VBG seems to be a good treatment for morbid obesity.

I derive here the spectral window of the acousto-optic folded spectrum analyzer proposed by [K. Wagner and D. Psaltis, Proc. Soc. Photo-Opt. Instrum. Eng. 564, 209-223 (1985)]. This window function turns out to be quite informative. It clarifies important characteristics that distinguish this system from the more conventional digital spectrum analyzers, and it clarifies the relationships between various system design parameters and helps guide their selection. The spectral window of one specific implementation of a finer-resolution version of this analyzer (the super-fine-resolution variant suggested in the above reference) is also determined. Analysis shows that for certain narrow-frequency ranges this window has two main lobes separated by a large number of super-fine frequency-resolution bins. This characteristic makes it unacceptable in many applications.

We report 2 cases of aortic coarctation in women aged 18.5 and 24 years, respectively. In 1 the malformation was found during gestation, while the other became pregnant after the diagnosis was made. Both had uneventful pregnancies and delivered healthy babies. Coarctation of the aorta is found in approximately 7% of those with congenital heart disease. The clinical diagnosis is made from the absence of femoral artery pulsations and low arterial pressure in arteries originating distal to the coarctation and hypertension in those proximal to it. Since it occurs mainly in males and is usually corrected during infancy, its incidence in pregnancy is low. Maternal morbidity may be high, since pregnancy increases the risk of aortic rupture or dissection, as well as of cerebral hemorrhage from rupture of an aneurysm of the circle of Willis. Surgical repair before conception reduces the risk of aortic complications during pregnancy, and also decreases the incidence of fetal complications, such as IUGR or congenital heart disease. The outcome of pregnancy is also influenced by coexistence of other malformations, such as bicuspid aortic valve which leads to infective endocarditis. In uncomplicated coarctation, pregnancy and delivery are usually uneventful. Cesarean section is done mainly for obstetric indications.

A 32-year-old multiparous woman had progressive swelling of the right arm at 32 weeks' gestation, accompanied by cyanosis and a preserved radial pulse. Phlebography demonstrated a 5-cm thrombus in the axillary vein. No known etiologic factors were found. Intravenous heparin administration resulted in rapid resolution of the clinical findings. Subcutaneous heparin 10,000 U/day was administered for secondary prophylaxis until cesarean at 39 weeks, during which a full dose was administered without complications. Axillary vein thrombosis during pregnancy may be diagnosed by either phlebography or duplex scanning, and preferably should be treated by heparin. Thrombolytic therapy is justified mainly for life-threatening complications such as pulmonary embolism.

A case is presented of sudden onset dysphonia in a 59-year-old man caused by acute vocal cord paralysis due to bleeding within a hyperplastic lower right parathyroid gland. There were no laboratory findings of hyperparathyroidism nor coagulation disorder. Acute onset of vocal cord paralysis is rarely associated with benign processes; the current case is the first associated with parathyroid hyperplasia.

10 059 civil servants and municipal employees, aged 40--65, were examined in the Israeli Ischaemic Heart Disease Study. 475 (4.72%) died during a 7-year follow-up. High density lipoprotein (HDL) cholesterol levels were determined in the last 6562 men entering the study. 305 (4.65%) of these men died. Coronary heart disease (CHD) accounted for 37% of the total deaths. A "J" shaped relation which persisted after removing data on early mortality (first 2 years) was observed between total cholesterol and total mortality. An inverse relation was observed between HDL cholesterol and total mortality. Multivariate analysis of the data to adjust for possible confounding effects of additional mortality risk factors demonstrated that total cholesterol made no independent contribution to total mortality, but that the contribution of low HDL to mortality persisted after adjustment. CHD mortality consistently increased with rising concentrations of total cholesterol. CHD mortality rates decreased markedly with increasing HDL cholesterol concentrations. After adjustment for age and other risk factors the relation of coronary mortality to HDL cholesterol emerged as the dominant one. There was no clear-cut association between total of HDL cholesterol and cancer mortality. These results indicate that, particularly in older age-groups, measures designed to increase HDL cholesterol may prove as valuable in preventing CHD as those designed to reduce low density lipoprotein cholesterol.

A technique designed to create a permanent, wide open, and stable tracheal stoma is based on two corresponding U-shaped flaps: one from the anterior tracheal wall, the other from the skin in the suprasternal notch. The method described in this article has proved to be efficient, practical, well tolerated, and readily reversible. Its applications when indicated may reduce the side effects and complications associated with tracheostomy. Our clinical experience with this technique covers eight patients who tolerated the procedure well. The follow-up period exceeds 2 years.

Among the conditions which can cause epistaxis are intranasal or nasopharyngeal foreign bodies. A living foreign body, or parasite, in the nose or nasopharynx is rare in western countries, but in other parts of the world is a fairly common cause of epistaxis. In the past 5 years 17 cases of epistaxis due to infestation with leeches were treated in our 2 departments. In 14 patients, 9-27 years old, the complaint was of recurrent episodes of mild epistaxis and blood-spitting several days before admission. 3 patients were admitted hemorrhaging profusely from the nose and mouth. Examination showed a green-brown mass protruding from the nasopharynx behind the soft palate, which is every case was a blood-engorged leech. Treatment consisted of removing the leech by applying a forceps to the middle of the leech's body and giving a quick pull. Bleeding ceased immediately after removal of the leech. All the patients had drunk water from brooks, streams or fresh water lakes. Therefore, in areas in which leeches are present only boiled or filtered water should be drunk.

We report a case of quadruplet birth in a young oligomenorrheic woman, who had been prescribed clomiphene citrate for two consecutive cycles. She conceived following cessation of treatment and an intervening menstruation. Ultrasonic follow-up which concurred with the last menstrual period dating indicated multiple ovulation as a sustained effect of clomiphene citrate medication.

Rhinoscleroma may present a diagnostic problem when encountered outside endemic region. Two young men from Gaza with tumor-like masses of scleroma in the nasal cavities and the nasopharynx are described. Histological examination of biopsy material from the nasal lesions showed pathognomonic Mikulicz cells, and cultures grew Klebsiella rhinoscleromatis. Both patients responded well to antibiotic treatment.

Although a common enough condition in the general population, quinsy is rare in children and even rarer in infants. In most cases the diagnosis is easy on the basis of the suggestive clinical picture. A case is presented of a peritonsillar abscess in a 7-month-old baby. Here, the diagnosis was somewhat doubtful, due to the uncharacteristic clinical appearance and the young age of the patient. Some of the dangers of an inadequate antibiotic treatment are briefly discussed.