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Fireworks injuries are common and often affect children. Such injuries should be considered high energy trauma in the emergency room and taken care of according to the principles of the Advanced Trauma Life Support (ATLS).A 7-year-old boy was a victim of an explosion when he set off illegal fireworks. During evaluation in the emergency department he presented with a superficial laceration on the belly and extensive hand injury. Upon examination he had small-intestinal perforation that required immediate resection. The patient recovered well, but suffered permanent damage to the hand.Potentially life threatening injuries may accompany hand injuries after modern illegal fireworks. Hand injuries are serious. Despite prolonged treatment, they often result in permanent disability. The structured approach to trauma according to ATLS was important in detecting an accompanying abdominal trauma in this case.

A 74-year-old male patient with a history of myelodysplastic syndrome (MDS) presented with an ulcerative skin lesion on his left lower leg. Recent blood and bone marrow counts indicated a transformation of MDS into an acute myelogenous leukemia (AML). Histopathological examination of biopsies of the lesion revealed a cutaneous localization of AML, a so-called 'chloroma' (granulocytic or myeloid sarcoma).

Insufficient weight loss after gastric band placement is generally linked to band-related complications or a persistently unhealthy diet.A 47-year-old woman with a history of gastric band placement presented with complaints of decreased mobility, dyspnoea, gastro-oesophageal reflux and a progressive increase in abdominal girth. Initially, these symptoms were attributed to an unhealthy diet. However, additional testing showed a large intra-abdominal multicystic lesion originating from the ovaries. The patient was operated and two large serous cystadenomas were removed, after which the symptoms disappeared almost immediately.Abdominal complaints after bariatric surgery can often be explained by surgical complications or unhealthy eating habits. Although the cause of certain complaints is sometimes obvious, alternative diagnoses need to be considered. If the abdominal girth in middle-aged women increases, ovarian disorders must always be considered in the differential diagnosis and appropriate additional diagnostic testing need to be carried out.

Evaluation of the long-term results of bariatric surgery with an adjustable gastric band for the treatment of morbid obesity.Retrospective, descriptive.From September 1991-September 1993, 30 patients (6 males, 24 females) received an adjustable gastric band because of morbid obesity, being the first group in the Netherlands. The long-term data on these patients: weight loss, band adjustments, complications, reoperations and patient satisfaction, were collected using a medical record survey and a questionnaire and then analysed.Before the operation, the mean BMI was 42.5 kg/m2 (SD: 5.7) and the mean excess body weight was 50.8 kg (SD: 16.7). The mean follow-up time for all patients was 15.3 years (SD: 5.4) and for the responders to the questionnaire, 17.7 years (SD: 0.7); three patients died during follow-up. After surgery, the mean BMI was reduced to 34.7 kg/m2 (SD: 6.4). The mean excess body weight loss of the entire group was 38.1% (SD: 67.8) and of the patients who still had a gastric band in situ, 27.9% (SD: 67.4). In 15 patients, the gastric band reservoir was replaced at least once. The gastric band was replaced in 18 patients due to complications and eventually permanently removed in 6 patients. Of the respondents, 62% were satisfied with the weight loss and 52% were satisfied with regard to possible side effects and complications.The treatment of morbid obesity with an adjustable gastric band in this very first group of patients has resulted in substantial weight loss, but also a high rate of complications and reoperations. Treatment of these kinds of complications is an important aspect of bariatric surgery today. The efficacy of gastric banding is therefore currently under debate.