The physiological and clinical effects of loperamide treatment versus placebo were investigated in a randomized, double-blind, crossover study in patients operated with restorative proctocolectomy. Sixteen patients operated with endoanal mucosectomy and a handsewn ileal pouch-anal anastomosis and 14 patients operated with abdominal proctocolectomy and stapling of the pouch to the top of the anal canal were studied. While loperamide treatment increased resting anal pressure in both groups of patients by approximately 20% (P < 0.05), squeeze pressure was not affected. Loperamide did not affect pouch volume or contractility. Sensory thresholds and the recto/pouch-anal inhibitory reflex were not influenced by loperamide treatment. Clinical function was improved, with a reduced bowel frequency and an improved nighttime continence, with less soiling (P < 0.05) as well as need to wear a protective pad.

Longer operating times and increased perioperative bleeding may be explanatory factors behind increased postoperative complication rates for CRC patients with higher BMI. In underweight patients, advanced disease may be a reason for a higher 30-day mortality. To improve outcome, specific precautions are suggested when operating on under- as well as overweight CRC patients. We also suggest that the registry introduces a better marker than BMI for central visceral fat-the link between obesity and cancer development. Further studies are needed to analyze the findings in detail and to study long-term effects.

The clinical manovolumetric, and functional results of restorative proctocolectomy were studied in patients randomly allocated to construction of either a J-shaped pouch (n = 29) or a pouch fashioned by the folding technique used for the Kock continent ileostomy (K-pouch) (n = 26). A complete endoanal mucosectomy was performed, and the pouches were all constructed from 30-cm lengths of ileum. There were no deaths and no significant difference in postoperative morbidity. Anal pressures were equal in the two groups. The K-pouch expanded more favourably postoperatively, and its volume at 1 year was significantly greater than that of the J-pouch (355 +/- 71 ml (SD); range, 225-495, versus 264 +/- 81 ml; range, 75-440; p less than 0.001). The pouches had similar motility patterns and sensory pressure thresholds. Initially after closure of the loop ileostomy there was a tendency for better functional outcome in K-pouch patients. At 1 year the overall distribution of functional defects did not differ, and the defaecation frequency was about equal in the groups.

Serum S-100B values within 6 hours after head trauma in children were significantly higher in patients with intracranial pathology compared with those without intracranial complications. Identification of these high-risk patients already in the emergency department is of major importance, and we suggest that S-100B could be a valuable diagnostic tool in addition to those used in clinical practice today.