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Hypertension is a major health risk factor in patients who are morbidly obese. Two hundred eighty-nine morbidly obese patients undergoing gastric restrictive surgery were evaluated for the presence of hypertension (blood pressure greater than or equal to 160/90 mm Hg or currently undergoing antihypertensive therapy) pre- and post-operatively. Of 74 (26%) preoperatively hypertensive patients, 67 (91%) were available for follow-up. Preoperative hypertension resolved in 66% (44 of 67) of patients following gastric restrictive surgery. Superobese and morbidly obese patients had similar reductions in hypertension after surgery (69% versus 63%). Patients not receiving antihypertensive preoperatively had a greater reduction of hypertension than those medically treated preoperatively (78% versus 58%). The amount of weight loss significantly predicted the reduction of hypertension, whereas follow-up weight achieved did not. The amount of weight loss for patients with resolved and persistent hypertension were 89.3% [+ or -] 5.6 lbs ( mean [+ or -] standard error of the mean [SEM]) and 66.0 [+ or -] 8.3 lbs, respectively (p < 0.02). For patients with resolved hypertension, follow-up weights for the morbidly obese and superobese were 162.0 [+ or -] 10.8 lbs (133% [+ or -] 4% ideal body weight [IBW]) and 220.4 [+ or -] 9.5 lbs (170% [+ or -] 7% IBW). Gastric restrictive surgery is effective therapy for hypertension in morbidly obese patients. Patients need not achieve weights approaching IBW to enjoy the benefits of gastric restrictive surgery on hypertension.

Hypoalbuminemia (low blood levels of albumin, a protein to which many substances in blood are bound) is thought to be associated with a poor prognosis for patients who are seriously ill. Several important roles have been postulated for this protein, including maintenance of proper water balance and binding to toxic agents to remove them from the circulation. For these reasons, administration of albumin (albumin replacement therapy) to seriously ill patients has been advocated. This treatment, however, is costly, and its effects have not been proven in a randomized, prospective study. To investigate this issue, 40 hypoalbuminemic, critically ill patients who had been referred for nutritional assessment and total parenteral nutrition (nutrition delivered directly into a large vein, bypassing the digestive system) were randomly assigned to either a treatment (18 patients) or a nontreatment group (22 patients). Those in the treatment group received albumin, in addition to their total nutritional support, until their blood levels had reached 25 grams per liter. They were then maintained at that level. Data were obtained regarding mortality, the rate of major complications, length of hospital stay, intensive care (ICU) stay, length of time patients were dependent on a ventilator (breathing machine), and their tolerance for enteral feeding (food delivered into the digestive tract). In addition, an APACHE II (acute physiology and chronic health evaluation) score was recorded for each patient before and after treatment, and nutritional status was observed. Results showed that blood albumin levels reached 25 grams per liter sooner for the treatment group than the nontreatment group (four days vs nine days, respectively). However, no differences were found in mortality or major complication rates, or in any other variables measured. The cost of albumin was approximately $1,000 per patient. Albumin levels in the nontreatment group in this study increased with time, while those in the treatment group declined, indicating that improved health results in higher levels, and that albumin supplementation has, at best, a transitory effect. In general, it appears that albumin supplementation in critically ill patients is not warranted. (Consumer Summary produced by Reliance Medical Information, Inc.)

BACKGROUND: The most sensitive and specific method of detecting colorectal cancer hepatic metastases has been shown to be a combination of careful intraoperative palpation and intraoperative ultrasound. Although there has been growing interest in laparoscopic surgical therapy for colorectal cancer, the ability of this technique to adequately evaluate the liver for small metastases has been unknown. This study was undertaken to compare laparoscopic liver ultrasound to the gold standard of open palpation and intraoperative ultrasound in detecting hepatic metastases from colorectal cancer. METHODS: A preliminary animal model was first performed in adult pigs. Eighteen liver 'lesions' were created with chlorhexidine gluconate under laparoscopic guidance. A blinded surgeon then performed laparoscopic liver ultrasound followed by open ultrasound and palpation, comparing the accuracy of these techniques in detecting the lesions. In a second study, 15 patients undergoing laparotomy for colorectal cancer underwent preliminary laparoscopic liver ultrasound followed by open palpation and intraoperative ultrasound to compare these methods of liver evaluation. RESULTS: Laparoscopic liver ultrasound detected 17 of 18 lesions created in the pig livers, for a sensitivity of 94.4%. There were two false negatives, for a specificity of 77.7%. Laparoscopic liver ultrasound detected 4 of the 5 liver metastases in the human study, for a sensitivity of 80%. There was a single false negative, for a specificity of 90.9%. Several technical difficulties and their solutions are discussed. CONCLUSIONS: With several technical modifications guided by our initial experience, we believe laparoscopic liver ultrasound can be an effective way of evaluating the liver for metastases during laparoscopic colorectal resection for cancer. Am J Surg. 1998;176:262-264. [C] 1998 by Excerpta Medica, inc.