The efficiency of ispaghula husk in relieving gastrointestinal symptoms in patients with ulcerative colitis in remission was studied in a placebo-controlled trial running for 4 months. Twenty-nine patients (81%) completed the trial; four withdrew after colitis relapse (three while receiving placebo). Grading of symptoms judged ispaghula to be consistently superior to placebo (p less than 0.001) and associated with a significantly higher rate of improvement (69%) than placebo (24%) (p less than 0.001). The results show that ispaghula can be helpful in the management of gastrointestinal symptoms in quiescent ulcerative colitis.

The need for protective transverse colostomy in low anterior resection using the EEA stapler was tested in a randomized series of 50 patients, half of whom received peroperative protective colostomy. Gastrografin enema on the tenth postoperative day showed a leakage frequency of 30 per cent in both groups. Clinical leakage was noted in 4 per cent (one patient) in the colostomy group and 12 per cent (three patients) in the noncolostomy group. Protective colostomy was followed by stenosis in nine instances, compared with only two in the noncolostomy group (2 alpha = 0.05). Routine protective colostomy should not be used in low anterior resection when the EEA stapling instrument is used. The occasional clinical leakage, which may appear in the postoperative period, can be revealed by close observation and successfully treated by an emergency colostomy. The majority of patients with anterior resection of the rectum, therefore, can be spared the inconvenience and cost of temporary colostomy.

The relationship between obesity and alterations in adipose tissue metabolism and lipid transport was studied in fourteen obese subjects before and after a weight reduction of 4-22 kg. Blood glucose and plasma insulin patterns after peroral glucose intake improved significantly, and plasma glucagon levels decreased markedly after treatment. Plasma triglyceride and total cholesterol levels were not altered, but there was a 20% (P less than 0.05) increase in HDL concentrations. Plasma free fatty acid and glycerol concentrations decreased, in parallel to a decrease in lipolysis rate in vitro. Lipoprotein lipase and hepatic lipase activities in postheparin plasma, as well as the intravenous fat tolerance test, were normal and did not change significantly after weight loss. Lipoprotein lipase activity in adipose tissue, expressed per cell, was elevated and did not change after weight reduction. Also, the enzyme activity did not increase after glucose intake before or after treatment. The lack of effect on lipoprotein lipase activity and regulation in combination with significant improvements of other aspects of lipid and glucose transport is consistent with the view that alterations in LPL activity and regulation may represent an early and possibly primary defect in the development of obesity.

Outpatient follow-up in patients operated upon due to carcinoma of the colon and rectum is usually performed, due to a high rate of recurrence and with the aim of finding a curable recurrence. Due to the enormous cost of an extended follow-up system, a careful evaluation of the benefit is needed. The aim of the present investigation was to study the efficacy of the different tools in an extended follow-up. One hundred ninety patients with carcinoma of the colon and rectum were--apart from traditional clinical follow-up--followed with an extensive laboratory battery including carcinoembryonic antigen (CEA), erythrocyte sedimentation rate (ESR), hemoglobin (Hb), electrophoresis, ALP, and GT. Forty-seven recurrences were found. Thirty-one of these recurrences were first detected by a rise in CEA. Seven cases were detected at clinical follow-up and six cases due to symptoms suggestive of recurrence. The predictive value of a positive test was 79.4% for CEA but very low for the other tests studied. A negative value for any of the tests in the battery was usually accurate. Follow-up after colorectal carcinoma should include CEA as the only laboratory parameter. Postoperative colonoscopy for removal of missed synchronous lesions, chest X-ray, and endoscopic investigations of the anastomotic region also seem to be of value.

We have studied effects of weight reduction after gastroplasty on glucose and lipid metabolism in 15 grossly obese subjects. Their body weight decreased from 127 +/- 13 to 97 +/- 14 kg 6 months after surgery and remained essentially stable 8 months later. There was a marked improvement of lipid and carbohydrate metabolism with significant reductions in blood glucose, plasma insulin and glucagon levels, and in glucose tolerance. Lipoprotein lipase activity in adipose tissue was in the upper reference range and lipoprotein lipase activity in postheparin plasma tended to be low. Plasma triglyceride, cholesterol and low-density lipoprotein cholesterol concentrations decreased significantly, while high-density lipoprotein cholesterol levels tended to rise. Concomitantly, there was an increase in triglyceride clearance rate. Most of these changes were significantly correlated to the reduction in body weight/body fat, indicating that the metabolic improvements are due to body fat reduction as such.