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Summary. Plasma concentrations of vitamin D metabolites in −17 non‐pregnant women, 22 pregnant women at delivery, and in eight lactating women 3 and 16 days after delivery, were compared with those in a postpartum hypoparathyroid patient treated with 1α‐hydroxyvitamin D (1α‐OHD). The mean concentration of 1,25‐dihydroxy vitamin D [1,25–(OH)2D] was 203 (SD 61) pmol/1 in the pregnant, and 86 (SD 27) pmol/1 in the non‐pregnant women (P<0.0005). The levels 3. and 16 days after delivery were similar [57 (11) compared with 62 (19) pmol/1], and lower than the non‐pregnant value (P<0.01). The 25‐hydroxyvitamin D (25‐OHD) concentration remained unchanged between the 3rd and 16th days after delivery, whereas the 24,25‐dihydroxyvitamin D [24,25‐(OH)2D] level increased from 2.7 (SD 1.8) to 3.7 (SD 2.3)nmol/l (P<0.025). The patient temporarily required an increased supplement of 1α‐OHD during pregnancy, but a dose which was appropriate before pregnancy resulted in marked hypercalcaemia and a rise of 1,25‐(OH)2D concentration within 16 days of delivery despite lactation. The results suggest that the metabolic need for the active vitamin D metabolite 1,25‐(OH)2D is increased during pregnancy and rapidly reduced during early lactation in healthy and hypoparathyroid women.

ObjectiveTo compare gastric banding (GB) and vertical banded gastroplasty (VBG) with respect to postsurgical gastroesophageal reflux (GER) and to investigate the role of preexisting hiatus hernia. Summary Background DataGB and VBG have for a long time been used in the treatment of morbidly obese patients. The introduction of laparoscopic techniques has renewed the interest in these operations. The long-term results after GB have, however, been poor. VBG was suggested to have antireflux properties because it involves repositioning and retaining the gastroesophageal junction within the abdomen and constructing an elongated intraabdominal tube. MethodsForty-three morbidly obese patients accepted for GB or VBG were evaluated for GER before and at regular intervals after surgery. All patients were questioned about adverse symptoms and need for antireflux medication. Both before and after surgery, 24-hour pH measurement and upper gastrointestinal endoscopies were performed. ResultsThe prevalence of heartburn and acid regurgitation among patients treated with GB increased from 14% and 13% to 63% and 69%, respectively. Heartburn and acid regurgitation were present before surgery in 32% and 23% of patients treated with VBG, percentages unchanged by the procedure. The 24-hour reflux time increased significantly from 6.4% to 30.9% in patients treated with GB but was essentially unchanged in patients treated with VBG. The prevalence of esophagitis after GB and VBG was 75% and 20%. Acid inhibitors were needed in 81% of patients after GB and 29% of patients after VBG. ConclusionsThe prevalence of GER was unchanged by VBG, but VBG did not demonstrate antireflux properties. The incidence of GER increased markedly after GB.

A 16-year-old girl with transsphenoidal meningocele and signs of hypothalamic insufficiency is presented. Hormonal disturbances have been reported in only three similar cases in the literature. The radiological criteria for the diagnosis are discussed with emphasis on the differential diagnosis of a persistent cranipharyngeal canal. Based on the present case and studies of the pertinent literature we propose that all patients exhibiting signs of dysraphism of the base of the skull should be thoroughly investigated for hormonal disturbances. Children with cleft palate should be examined for possible concomitant dysraphism of the skull.