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When viewed from hospitals or the Department of Health, general practitioners may seem embedded in their local communities, ideally placed to act as 'the patients' advocate.'[1] But the view from [...]

What does being professional look like? Does it mean that you do the ‘right’ thing, even when no-one is looking? How do you evaluate your professionalism knowledge, values and behaviour? How do you identify and address underperformance in professionalism? How can you transfer your professionalism to different circumstances?

Case reports are presented on three patients treated for morbid obesity by vertical gastroplasty. Prior to surgery the patients had diabetes which required insulin, up to 200 units per day, or oral hypoglycaemics for its control. Six months after surgery the diabetes had been resolved in all three patients, and they were no longer dependent on medication. Subjective reports from the patients suggests that their quality of life improved significantly.

A prospective study of biochemical changes after vertical banded gastroplasty for morbid obesity, in 94 patients (10 males and 84 females, ages ranging from 18 to 59 years) has been carried out. Liver function tests and electrolyte estimations were performed preoperatively, during hospitalisation for surgery, at 6 weeks and at 6 months postoperatively, and demonstrated no significant changes in liver function in these patients 6 months after surgery. The study concludes that there is no increase in the risk of liver damage or electrolyte disturbance after vertical gastroplasty, but that there may be subtle hepatic changes present as gall bladder disease developed in 18 patients postoperation (19%).

Background: The prevalence of obesity in families of patients seeking surgical treatment for their severe obesity was investigated. Methods: Patients listed for surgery (vertical gastroplasty) for severe obesity (BMI >35) were interviewed and asked for details of the numbers of members of the immediate family who were at least 6.5 kg overweight. The data collected on 87 morbidly obese patients were compared to data from a group of 50 patients, all of whom had a BMI of less than 25 and were not overweight, who were acting as controls. Results: Obese patients had significantly more overweight family members than normal weight controls (p = 0.004). Conclusion: The prevalence of overweight in the families of obese patients may be genetically and environmentally influenced.

Background: Nutritional complications following surgery for morbid obesity include both vitamin and mineral deficiency. Severe cases of zinc deficiency can lead to alopecia, diarrhoea, emotional disorders, weight loss, intercurrent infection, bullous-pustular dermatitis and hypogonadism in males. Hair loss may occur after vertical gastroplasty (VG). Methods: Diffuse hair loss occurred in 47 out of 130 patients who underwent VG. All patients had been routinely advised to take a multivitamin supplement, but 47 developed hair loss despite taking the supplement. These patients were then prescribed Zinc Sulphate 200 mg three times a day. There was no alteration in the vitamin supplementation. Results: Arrest of hair loss and regrowth occurred in all patients. However, five patients reported recurrence of hair loss after stopping zinc. This loss was reversed within 6 months of recommencing zinc 600 mg daily. Ten control patients had no hair loss after gastrointestinal surgery. Conclusion: Significant hair loss occurred in about one-third of patients after VG, and was reversed by zinc supplementation.