Barriers to medication adherence and its relationship with outcomes in pediatric dialysis patients

Background

Medication adherence is a major factor determining outcome in children with chronic disease. Children with end-stage renal disease are challenged with requirements for renal replacement therapy in addition to complicated medication regimens.

Methods

We assessed barriers to medication adherence in 22 pediatric patients receiving chronic dialysis [63.6 % hemodialysis (HD), 36.4 % peritoneal dialysis (PD); age 15.9?±?0.7 years, dialysis vintage 31.6?±?6.5 months]. Adherence was assessed by a 16-question survey with a maximum score (difficulty) of 64.

Results

The overall mean adherence score was 30.9?±?2.4 (range 16–49; median? 27.5). There was a trend for lower adherence scores in patients on HD (27.5?±?2.9) compared to those on PD (36.8?±?3.7) (p?=?0.06). Compared to HD patients, the mean score/question was significantly higher in PD patients (1.7?±?0.2 vs. 2.4?±?0.2, respectively; p?=?0.006). Of the 16 questions, HD and PD patients gave a mean response of ≤1.2 for five and zero questions, respectively. Neither gender, age nor dialysis vintage was related to adherence scores. There was also a trend for adherence scores to be higher in females (35.6?±?3.7) than in males (27.5?±?2.9) (p?=?0.1), but this difference did not reach statistical significance. Markers of mineral bone disease were similar in HD and PD patients. Among all targets in HD and PD patients combined, there was no relationship between adherence scores and number of targets reached (r?=??0.09, p?=?0.7).

Conclusion

There are many barriers to medication adherence in pediatric patients receiving dialysis. In our patient group the difficulties were more evident in patients receiving PD than in those receiving HD.     

Semiquantitative analysis of indocyanine green videoangiography for cortical perfusion assessment in superficial temporal artery to middle cerebral artery anastomosis

Background

Postoperative hyperperfusion may lead to severe neurological complications after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. However, there are no reliable modalities to predict the occurrence of postoperative hyperperfusion during surgery. The purpose of this study is to evaluate whether a semiquantitative analysis of indocyanine green (ICG) videoangiography could be useful in predicting postoperative hyperperfusion after STA-MCA anastomosis.

Methods

This study included seven patients who underwent STA-MCA anastomosis due to occlusive carotid artery diseases. During surgery, ICG videoangiography was performed before and after bypass procedures, and ICG intensity–time curves were semiquantitatively analyzed to evaluate hemodynamic changes by calculating maximum intensity, time to peak (TTP), and blood flow index (BFI).

Results

Maximum intensity significantly increased from 252.6?±?132.5 to 351.7?±?151.9 after bypass (p?<?0.001). TTP was significantly shortened from 12.9?±?4.4 s to 9.8?±?3.7 s (p?<?0.001). Furthermore, BFI significantly increased from 33.9?±?28.1 to 74.6?±?88.4 (p?<?0.05). Postoperative hyperperfusion was observed in five of seven patients 1 day after surgery. The ratio of BFI before and after bypass procedures was significantly higher in patients with postoperative hyperperfusion than those without, 2.5?±?1.1 and 1.5?±?0.4, respectively (p?=?0.013).

Conclusions

These findings suggest that semiquantitative analysis of ICG videoangiography is helpful in predicting occurrence of hyperperfusion after STA-MCA anastomosis in patients with occlusive carotid artery diseases.     

Antioxidant Treatment Attenuates Intestinal Mucosal Damage and Gut Barrier Dysfunction After Major Hepatectomy. Study in a Porcine Model

Background

This study aims to evaluate whether injury of gut mucosa in a porcine model of post-hepatectomy liver dysfunction can be prevented using antioxidant treatment with desferrioxamine.

Methods

Post-hepatectomy liver failure was induced in pigs combining major (70%) liver resection and ischemia/reperfusion injury. An ischemic period of 150 minutes, was followed by reperfusion for 24 h. Animals were randomly divided into a control group (n?=?6) and a desferrioxamine group (DFX, n?=?6). DFX animals were treated with continuous IV infusion of desferrioxamine 100 mg/kg. Intestinal mucosal injury (IMI), bacterial and endotoxin translocation (BT) were evaluated in all animals. Intestinal mucosa was also evaluated for oxidative markers.

Results

DFX animals had significantly lower IMI score (3.3?±?1.2 vs. 1.8?±?0.9, p?<?0.05), decreased BT in the portal circulation at 0 and 12 h of reperfusion (p?=?0.007 and p?=?0.008, respectively), decreased portal endotoxin levels at 6 (p?=?0.006) and 24 h (p?=?0.004), decreased systemic endotoxin levels (p?=?0.01) at 24 h compared to controls. Also, 24 h post-reperfusion mucosal malondialdehyde and protein carbonyls were decreased in DFX animals compared to controls (4.1?±?1.2 vs. 2.5?±?1.2, p?=?0.05 and 0.5?±?0.1 vs. 0.4?±?0.1, p?=?0.04 respectively).

Conclusion

Desferrioxamine seems to attenuate mucosal injury from post-hepatectomy liver dysfunction possibly through blockage of iron-catalyzed oxidative reactions.     

Influence of Eating Profile on the Outcome of Laparoscopic Sleeve Gastrectomy

Background

The aim of this study was to assess the eating profile of patients after laparoscopic sleeve gastrectomy (LSG) and its impact on weight loss.

Methods

One hundred ten patients who underwent LSG were interviewed using Suter questionnaire and revised Questionnaire on Eating and Weight Patterns in follow-up visits. Eating patterns were assessed preoperatively and postoperatively. Patients were divided into six groups according to the timing point of assessment. Group 1 (n?=?10) included patients <3 months, group 2 (n?=?11) 3–6 months, group 3 (n?=?11) 6–12 months, group 4 (n?=?39) 1–2 years, group 5 (n?=?23) 2–3 years, and group 6 (n?=?16) >3 years. The excess weight loss (EWL) was correlated with the results.

Results

The total score of the Suter questionnaire was 15.0?±?5.87, 20.3?±?7.07, 26.2?±?1.54, 23.8?±?4.25, 24.65?±?2.8, and 23.43?±?4.14 for the groups 1–6, respectively (p?<?0.0001). No significant differences were denoted when long-term follow-up groups 3 to 6 were compared. No association was found between the preoperative eating pattern and EWL. Postoperatively, 91 patients modified their eating pattern. Postoperative eating pattern was significantly correlated with EWL (p?=?0.015). Patients with normal and snacking eating pattern achieve the best EWL (63.57?±?21.32 and 60.73?±?20.62, respectively). Binge eating disorder and emotional patterns had the worst EWL (42.84?±?29.42 and 34.55?±?19.34, respectively).

Conclusions

Better food tolerance is detected after the first postoperative year after LSG. The postoperative eating patterns seem to affect excessive weight loss.     

Calcaneal ultrasound reference ranges for Australian men and women: the Geelong Osteoporosis Study

Summary

Heel ultrasound is a more portable modality for assessing fracture risk than dual-energy X-ray absorptiometry and does not use ionising radiation. Fracture risk assessment requires appropriate reference data to enable comparisons. This study reports the first heel ultrasound reference ranges for the Australian population.

Introduction

This study aimed to develop calcaneal (heel) ultrasound reference ranges for the Australian adult population using a population-based random sample.

Methods

Men and women aged ≥20 years were randomly selected from the Barwon Statistical Division in 2001–2006 and 1993–1997, respectively, using the electoral roll. Broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) were measured at the heel using a Lunar Achilles Ultrasonometer. Gender-specific means and standard deviations for BUA, SOS and SI were calculated for the entire sample (men 20–93 years, n?=?1,104; women 20–92 years, n?=?914) and for participants aged 20–29 years (men, n?=?157; women, n?=?151). Associations between ultrasound measures and age were examined using linear regression.

Results

For men, mean ± standard deviation BUA, SOS and SI were 118.7?±?15.8 dB/MHz, 1,577.0?±?43.7 m/s and 100.5?±?20.7, respectively; values for women were consistently lower (111.0?±?16.4 dB/MHz, P?<?0.001; 1,571.0?±?39.0 m/s, P?=?0.001; and 93.7?±?20.3, P?<?0.001, respectively). BUA was higher in young men compared with young women (124.5?±?14.4 vs 121.0?±?15.1 dB/MHz), but SOS (1,590.1?±?43.1 vs 1,592.5?±?35.0 m/s) and SI (108.0?±?19.9 vs 106.3?±?17.7) were not. The relationships between age and each ultrasound measure were linear and negative across the age range in men; associations were also negative in women but non-linear.

Conclusion

These data provide reference standards to facilitate the assessment of fracture risk in an Australian population using heel ultrasound.     

Comparison of Gastrojejunal Anastomosis Techniques in Laparoscopic Roux-en-Y Gastric Bypass: Gastrojejunal Stricture Rate and Effect on Subsequent Weight Loss

Background

Different gastrojejunal anastomotic (GJA) techniques have been described in laparoscopic Roux-en-Y gastric bypass (LRYGB). There is conflicting data on whether one technique is superior to the other. We aimed to compare hand-sewn (HSA), circular-stapled (CSA) and linear-stapled (LSA) anastomotic techniques in terms of stricture rates and their impact on subsequent weight loss.

Methods

A prospectively collected database was used to identify patients undergoing LRYGB surgery between March 2005 and May 2012. Anastomotic technique (HSA, CSA, LSA) was performed according to individual surgeon preference. The database recorded patient demographics, relevant comorbidities and the type of GJA performed. Serial weight measurements and percentage excess weight loss (%EWL) were available at defined follow-up intervals.

Results

Included in the data were 426 patients, divided between HSA (n?=?174, 40.8 %), CSA (n?=?110, 25.8 %) and LSA (n?=?142, 33.3 %). There was no significant difference in the stricture rates (HSA n?=?17, 9.72 %; CSA n?=?9, 8.18 %; LSA n?=?8, 5.63 %; p?=?0.4006). Weight loss was similar between the three techniques (HSA, CSA and LSA) at 3 months (40.6 %?±?16.2 % vs 35.92 %?±?21.42 % vs 48.21 %?±?14.79 %; p?=?0.0821), 6 months (61.48 %?±?23.94 % vs 58.16 %?±?27.31 % vs 60.18 %?±?22.26 %; p?=?0.2296), 12 months (72.94 %?±?19.93 % vs 69.72?±?21.42 % vs 66.05 %?±?17.75 %; p?=?0.0617) and 24 months (73.29 %?±?22.31 % vs 68.75 %?±?24.71 % vs 69.40 %?±?23.10 %; p?=?0.7242), respectively. The stricture group lost significantly greater weight (%EWL) within the first 3 months compared to the non-stricture group (45.39 %?±?16.82 % vs 39.22 %?±?21.93 %; p?=?0.0340); however, this difference had resolved at 6 months (61.29 %?±?18.50 % vs 59.79 %?±?23.03 %; p?=?0.8802) and 12 months (71.59 %?±?18.67 % vs 68.69 %?±?22.19 %; p?=?0.5970).

Conclusions

There was no significant difference in the rate of strictures between the three techniques, although the linear technique appears to have the lowest requirement for post-operative dilatation. The re-intervention rate will, in part, be dictated by the threshold for endoscopy, which will vary between units. Weight loss was similar between the three anastomotic techniques. Surgeons should use techniques that they are most familiar with, as stricture and weight loss rates are not significantly different.     

Validation and evaluation of the volumetric measurement of cerebellopontine angle cistern as a prognostic factor of microvascular decompression for primary trigeminal neuralgia

Background

The aim of this study was to analyze the prognostic factors of trigeminal neuralgia (TN) after microvascular decompression (MVD), and to evaluate the volumetric parameters of the cerebellopontine angle (CPA) cistern as a pathogenic factor and imaging predictor.

Methods

This retrospective study included 70 patients with primary TN treated with pure MVD, followed up for at least 1 year and evaluated by high-resolution MR imaging. The volume of the CPA cistern was calculated bilaterally, and the “Cistern Deviation Index” was defined to represent degree of deviation of the CPA cistern. Clinical data and volumetric parameters were compared between patients with TN and age- and sex-matched controls without TN, and between the recurrent and non-recurrent patients.

Results

The transposition procedure had a better outcome than the interposition procedure (P?<?0.001). There was a significant difference in the volume of CPA cistern between the affected and unaffected side (152.1?±?50.1 vs. 179.9?±?63.7 mm³, P?<?0.001) in patients with TN, while no significant difference between the right and left side (158.7?±?44.6 vs. 163.1?±?49.8 mm³, P?=?0.162) in controls. The Cistern Deviation Index was significantly larger in controls than in patients with TN (P?=?0.048), and in the non-recurrent patients than in recurrent patients (P?=?0.040).

Conclusion

We demonstrated that the volumetric parameters of the CPA cistern are a marker for understanding the pathogenesis of TN and useful for predicting the recurrence after MVD. The Cistern Deviation Index might contribute to deciding the surgical approach.     

Laparoscopic Sleeve Gastrectomy Using 42-French Versus 32-French Bougie: The First-Year Outcome

Background

The optimal size of bougie in laparoscopic sleeve gastrectomy (LSG) remains controversial. The aim of this study was to evaluate the first-year outcome of LSG using two different sizes of bougies.

Methods

This study used a single institute retrospective case-control study of two groups of patients. Group A (N?=?66) underwent LSG using 42-Fr and group B (N?=?54) using 32-Fr bougies. A medication score was applied to assess the change in comorbid conditions.

Results

Groups A and B's age (39.5?±?12 vs. 43.6?±?12.3 years), weight (119?±?17 vs. 120?±?20), and BMI (42.8?±?3.8 vs. 43.6?±?6.9 kg/m²), respectively, were comparable (p?=?NS). Comorbid conditions were type 2 diabetes (T2DM) in 19 (29 %) vs. 23 (43 %) patients, hypertension in 22 (33 %) vs. 18 (33 %) patients, and gastroesophageal reflux (GERD) in 28 (42 %) vs. 10 (19 %) patients, respectively. At 1 year, group A vs. B BMI was (29.4?±?5 vs. 30?±?5 kg/m²) and excess weight loss was 67 vs. 65 %, respectively (p?=?NS). Postoperatively, T2DM (79 vs. 83 %), hypertension (82 vs. 61 %), and GERD (82 vs. 60 %) (p?=?NS), respectively, in groups A vs. B did not require previous medications anymore. Complications were comparable.

Conclusions

Our data suggest that using a 42-Fr or 32-Fr bougie does not influence LSG first-year weight loss or resolution of comorbid conditions. Long-term data is needed to conclude this issue.     

The Effect of Weight Loss on the Cardiac Structure and Function After Laparoscopic Adjustable Gastric Banding Surgery in Morbidly Obese Individuals

Background

Herein, we investigate the anthropometric, biochemical and left ventricle (LV) geometry changes following the laparoscopic adjustable gastric banding (LAGB) operation in morbidly obese individuals.

Methods

Eighty-three morbidly obese participants (mean age, 46.1?±?11.5 years; 30.1 % men), scheduled for elective LAGB were examined before and 12 months after the surgery. LV geometry and diastolic function were investigated by 2-dimensional echocardiography, whereas laboratory tests assessed the glycaemic, serum lipid and inflammatory marker profiles.

Results

Twelve months after the operation, body mass index (BMI) decreased from 46.9?±?7.2 kg/m² to 40.1?±?8.2 kg/m² (p?p?p?2.7 vs. 52.0?±?12.3 g/m^2.7, p?p?=?0.0001) and BMI (ß?=?0.26, p?=?0.015) were both associated with diminished LV mass. Additionally, a statistically significant correlation between LV mass and changes in BMI (R?=?0.29, p?=?0.007), waist circumference (R?=?0.32, p?=?0.004), LV end-diastolic diameter (R?=?0.63, p?=?0.0001) and E-wave deceleration time (R?=??0.24, p?=?0.03) were observed within our study population.

Conclusions

LV mass decreases 12 months after LAGB surgery, but no improvements in LV geometry and function occur. The regression of LV mass is better predicted by weight loss than by reduction in blood pressure or changes in metabolic parameters.     

Use of risedronate to prevent bone loss following a single course of glucocorticoids: findings from a proof-of-concept study in inflammatory bowel disease

Summary

We performed a randomised controlled trial (RCT) to determine whether risedronate 35 mg once weekly prevents bone loss following an 8-week reducing course of prednisolone given for an exacerbation of inflammatory bowel disease (IBD). The greatest change in bone mineral density (BMD) was at Ward’s triangle (WT), which fell by 2.2% in the placebo group, compared with a reduction of 0.8% in the risedronate group.

Introduction

Whether bisphosphonates can prevent bone loss associated with intermittent glucocorticoid (GC) therapy is unknown, reflecting the difficulty in performing RCTs in this context.

Method

To explore the feasibility of RCTs to examine this question, lumbar spine (LS; L2–4) and hip dual X-ray absorptiometry (DXA) scans were performed in 78 patients commencing a GC therapy course for a relapse of IBD. They were then randomised to receive placebo or risedronate 35 mg weekly for 8 weeks, after which the DXA scan was repeated.

Results

For LS BMD, there was no change in the placebo group (0.1?±?0.4, p?=?0.9), but there was an increase after risedronate (0.8?±?0.4, p?=?0.04; mean%?±?SEM by paired Student’s t test). There were small decreases in both groups at the total hip (?0.5?±?0.3, p?=?0.04; ?0.5?±?0.3, p?<?0.05, placebo and risedronate, respectively). At WT, BMD fell after placebo (?2.2?±?0.5, p?=?0.001) but not risedronate (?0.8?±?0.5, p?=?0.09; p?=?0.05 for between-group comparison).

Conclusion

RCTs can be used to examine whether bisphosphonates prevent bone loss associated with intermittent GC therapy, providing metabolically active sites such as WT are employed as the primary outcome.     

Diagnosis of Diabetes Remission After Bariatic Surgery May be Jeopardized by Remission Criteria and Previous Hypoglycemic Treatment

Background

Controversy exists regarding type 2 diabetes (T2D) remission rates after bariatric surgery (BS) due to heterogeneity in its definition and patients' baseline features. We evaluate T2D remission using recent criteria, according to preoperative characteristics and insulin therapy (IT).

Methods

We performed a retrospective study from a cohort of 657 BS from a single center (2006–2011), of which 141 (57.4 % women) had T2D. We evaluated anthropometric and glucose metabolism parameters before surgery and at 1-year follow-up. T2D remission was defined according to 2009 consensus criteria: HbA1c <6 %, fasting glucose (FG) <100 mg/dL, and absence of pharmacologic treatment. We analyzed diabetes remission according to previous treatment.

Results

Preoperative characteristic were (mean?±?SD): age 53.9?±?9.8 years, BMI 43.7?±?5.6 kg/m², T2D duration 7.4?±?7.6 years, FG 160.0?±?54.6 mg/dL, HbA1c 7.6?±?1.6 %. Fifty-six (39.7 %) individuals had IT. At 1-year follow-up, 74 patients (52.5 %) had diabetes remission. Percentage weight loss (%WL) and percentage excess weight loss (%EWL) were associated to remission (35.5?±?8.1 vs. 30.2?±?9.5 %, p?=?0.001; 73.6?±?18.4 vs. 66.3?±?22.8 %, p?=?0.037, respectively). Duration of diabetes, age, and female sex were associated to nonremission: 10.3?±?9.4 vs. 4.7?±?3.8 years, p?<?0.001; 55.1?±?9.3 vs. 51.2?±?9.9 years, p?=?0.017; 58.9 vs. 33.3 %, p?=?0.004, respectively. Prior treatment revealed differences in remission rates: 67.1 % in case of oral therapy (OT) vs. 30.4 % in IT, p?<?0.001. OR for T2D remission in patients with previous IT, compared to those with only OT, were 0.157–0.327 (p?<?0.05), adjusting by different models.

Conclusions

Consensus criteria reveal lower T2D remission rates after BS than previously reported. Prior insulin use is a main setback for remission.     

Can stronger pelvic muscle floor improve sexual function?

Introduction and hypothesis

This study aims to evaluate the association between pelvic floor muscle (PFM) strength and sexual functioning.

Methods

Retrospective chart review of consecutive all women who were referred with a primary complaint of sexual dysfunction. Women underwent standardized clinical evaluation including pelvic muscle strength which was ranked from 0 (weak) to 2 (strong). The duration of pelvic muscle contraction was also recorded in seconds. Sexual function was evaluated by using a validated questionnaire, the Female Sexual Function Index (FSFI).

Results

One hundred seventy-six women with a mean age of 37?±?11 years were included. Women with strong or moderate PFM scored significantly higher on the FSFI orgasmic and arousal domains than women with weak PFM (5.4?±?0.8 vs. 2.8?±?0.8, and 3.9?±?0.5 vs. 1.7?±?0.24, respectively; P?<?0.001). The duration of PFM contraction was correlated with FSFI orgasmic domain and sexual arousal (r?=?0.26, P?<?0.001; r?=?0.32, P?<?0.0001, respectively).

Conclusions

Our findings suggest that both the orgasm and arousal function are related to better PFM function.     

Long-Term Outcomes of Laparoscopic Surgery for Advanced Transverse Colon Cancer

Background

The role of laparoscopic surgery for advanced transverse colon cancer (TCC) remains controversial, especially in terms of long-term oncologic outcomes.

Methods

This retrospective cohort study enrolled 157 consecutive patients who underwent curable resections for advanced TCC between January 2002 and June 2011 (laparoscopic-assisted colectomy (LAC), n?=?74; open colectomy (OC), n?=?83). Short-term outcomes and oncologic long-term outcomes were compared between the two groups.

Results

Compared to the OC group, patients in the LAC group had less blood loss (LAC vs. OC, 79.6?±?70.3 vs. 158.4?±?89.3 ml, p?<?0.001), faster return of bowel function (2.6?±?0.7 vs. 3.8?±?0.8 days, p?<?0.001), and shorter postoperative hospital stay (10.3?±?3.7 vs. 12.6?±?6.0 days, p?=?0.007). Conversions were required in four (5.4 %) patients. Rates of short-term complication, mortality, and long-term complication were comparable between the two groups. The median follow-up time was 54 (26–106) months in the LAC group and 58 (29–113) months in the OC group (p?=?0.407). There were no statistical differences in the rates of 5-year overall survival (73.6 vs. 71.1 %, p?=?0.397) and 5-year disease-free survival (70.5 vs. 66.7 %, p?=?0.501) between the two groups.

Conclusions

Laparoscopic surgery for advanced TCC yield short-term benefits while achieving equivalent long-term oncologic outcomes.     

Laparoscopic Greater Curve Plication in Asia: Initial Experience

Background

This study aimed to evaluate the effectiveness and safety of laparoscopic greater curve plication (LGCP) for the treatment of obesity in ethnic Chinese in Hong Kong.

Methods

Twenty-seven consecutive Chinese patients (23 females; mean age 37.6?±?8.9 years) received LGCP for the treatment of obesity from September 2010 to December 2011. Mean baseline body weight (BW) and body mass index (BMI) were 84.6?±?17.5 kg and 31.2?±?4.7 kg/m², respectively.

Results

All procedures were performed laparoscopically with conversion to open surgery in one patient. There was neither mortality nor any postoperative complications. Mean follow-up was 10.6?±?6.5 months. Mean procedure time was 117.9?±?22.3 min and mean hospital stay was 2.6?±?0.7 days. Mean BMI loss was 4.1?±?1.6, 4.8?±?2.0 and 5.2?±?2.5 kg/m² at 3, 6 and 12 months. Mean % EBL was 67.3?±?42.1, 66.4?±?35.9 and 60.2?±?25.5 % at 3, 6 and 12 months. Mean % EBL in BMI >35 group (n?=?7) was 38.2?±?11.1, 43.5?±?14.0 and 50.6?±?21.6 % at 3, 6 and 12 months. Mean % EBL in BMI <35 group (n?=?20) was 76.5?±?44.2, 76.5?±?38.2 and 65.0?±?27.0 % at 3, 6 and 12 months.

Conclusions

LGCP is safe and effective in achieving significant weight loss in obese ethnic Chinese patients. However, weight loss in BMI <35 is more pronounced. It is a very valid alternative to other procedures in Asian population.     

Is the mid-term outcome of free right internal thoracic artery with a proximal anastomosis modification inferior to in situ right internal thoracic artery?

Background

We investigated the mid-term results of free right internal thoracic artery (RITA) grafts used in an aorto-coronary fashion with a modified proximal anastomosis.

Methods

The subjects were 214 patients who underwent coronary artery bypass grafting with anastomosis to the left circumflex arteries using the RITA as a free graft (Group A: 158 patients) or an in situ graft (Group B: 56 patients). In Group A, the proximal end of the free RITA was anastomosed onto the ascending aorta interposing free graft tissue or to part of its own tissue as a cuff.

Results

The number of RITA anastomoses was 1.38?±?0.50 in Group A and 1.04?±?0.19 in Group B (P?P?=?0.159), however, the number of cardiac events was decreased in Group A (Hazard Ratio 2.55, 95?% CI 1.03?C6.33, P?=?0.043). The graft patency was evaluated in 187 of 214 patients, and at 1, 3 and 5?years was 97.0, 97.0 and 97.0?% in Group A, and 97.9, 92.5 and 80.5?% in Group B (P?=?0.378), respectively.

Conclusion

By modifying the proximal anastomosis of the free RITA, cardiac events may be decreased, while survival and graft patency comparable with in situ RITA can be obtained, and a significantly larger number of targets can be revascularized.     

The Relationships Between IGF-1 and CRP, NO, Leptin, and Adiponectin During Weight Loss in the Morbidly Obese

Background

The relationship between C-reactive protein (CRP), nitric oxide (NO), leptin, adiponectin, and insulin growth factor 1 (IGF-1) is poorly defined in morbidly obese patients before and after gastric bypass and, in some cases, is controversial.

Methods

We examined the plasma of 34 morbidly obese patients before and 1, 6, and 12 months after Roux-en-Y gastric bypass surgery.

Results

Obese people had more CRP (21.3?±?1.8 μg/ml) and leptin (36.9?±?4.0 ng/ml) than those in the control group (nonobese people: CRP?= 6.9?±?0.9 μg/ml, p?<?0.0001; leptin?= 7.5?±?0.4 ng/ml, p?<?0.0001). However, they had less NO (30.4?±?2.7 nmol/ml), IGF-1 (77.5?±?6.6 ng/ml), and adiponectin (11.1?±?1.0 μg/ml) than those in the control group (NO?= 45.8?±?3.9 nmol/ml, p?=?0.0059; IGF-1?= 202.0?±?12.0 ng/ml, p?<?0.0001; adiponectin?= 18.0?±?2.0 μg/ml, p?<?0.0001). During weight loss, the amount of CRP and leptin decreased until they reached the nonobese values, but the level of NO remained lower than in nonobese people, even 1 year after surgery. The linear regression slopes were negative and very significant for leptin (p?=?0.0005) and CRP (p?=?0.0018) but were less significant for NO (p?=?0.0221). IGF-1 displayed a very good linear regression (both negative and significant) with some anthropometric parameters, including body mass index (p?=?0.0025), total fat (p?=?0.0177), and the percentage of fat (p?<?0.0001).

Conclusion

For the first time, we report the relationship between IGF-1 and CRP, NO, leptin, and adiponectin. For all these parameters, the best and most widely demonstrated improvements in comorbidities before and during weight loss in morbid obesity were associated with CRP and leptin.     

Weight Loss and Weight Regain—5-Year Follow-Up for Circular- vs. Linear-Stapled Gastrojejunostomy in Laparoscopic Roux-en-Y Gastric Bypass

Background

Weight regain (WR) occurs in some patients after laparoscopic Roux-en-Y gastric bypass (LRYGBP). Loss of restriction due to dilation of the gastrojejunostomy (GJS) or the gastric pouch might be the main cause for WR. With different techniques available for the establishment of the GJS, the surgical technique might influence long-term success.

Methods

We present a 5-year follow-up for weight loss and WR of a matched-pair study comparing circular stapled (CSA) to linear stapled (LSA) GJS in a series of 150 patients who underwent primary antecolic antegastric LRYGBP. Complete 5-year follow-up was obtained for 79 % of the patients.

Results

Excess BMI loss (EBL) at 3 months was better with the CSA (p?=?0.02) and comparable thereafter. The 5-year %EBL was 67.3?±?23.2 vs. 73.3?±?24.3 % (CSA vs. LSA, p?=?0.19) WR of?>?10 kg from nadir was found in 24 patients (16 %) with higher incidence in CSA than in LSA patients (20 % vs. 12 %). The %WR was comparable for both groups, 16?±?13 vs. 15?±?19 % (CSA vs. LSA, p?=?0.345). Eleven patients underwent surgical re-intervention for WR by placement of a non-adjustable band (n?=?2), adjustable band (n?=?7) and conversion to distal gastric bypass (n?=?2).

Conclusions

CSA and LSA lead to comparable weight loss in this 5-year follow-up. More patients in the CSA group had WR. Weight regain of more than 10 kg was found in one out of seven patients within 5 years postoperatively.     

Outcomes of Laparoscopic Sleeve Gastrectomy in Patients Older than 60 Years

Background

Morbidity and mortality following laparoscopic sleeve gastrectomy (LSG) occur at acceptable rates, but its safety and efficacy in the elderly are unknown.

Methods

A retrospective review was performed of all patients aged >60 years who underwent LSG from 2008 to 2012. These patients were 1:2 matched, by gender and body mass index (BMI) to young patients, 18?<?age?<?50. Data analyzed included demographics, preoperative and postoperative BMI, postoperative complications, and improvement or resolution of obesity-related comorbidities.

Results

Fifty-two morbid obese patients older than 60 years underwent LSG (mean age, 62.9?±?0.3 years). These were matched to 104 young patients, age 18–50 years (mean age, 35.7?±?0.8 years). Groups did not differ in male gender (44 vs. 43 %, p?=?0.9), preoperative BMI (42.6?±?0.7 vs. 42.6?±?0.6, p?=?0.97), and length of follow-up (17?±?2 vs. 22?±?1.4 months, p?=?0.06). Obesity-related comorbidities were significantly higher in the older group (96 vs. 65 %, p?<?0.001). Excess weight loss (EWL) was higher in the younger group (75?±?2.4 vs. 62?±?3 %, p?=?0.001). Older patients had a significantly higher rate of a concurrent hiatal hernia repair (23 vs. 1.9 %, p?<?0.001). Overall postoperative minor complication rate was higher in the older group (25 vs. 4.8 %, p?<?0.001). This included atrial fibrillation (9.5 %), urinary tract infection (7 %), trocar site hernia (4 %), dysphagia, surgical site infection, bleeding, bowel obstruction, colitis, and nutritional deficiency (2 %, each). No perioperative mortality occurred. Comorbidity resolution or improvement was comparable between groups (88 vs. 80 %, p?=?0.13).

Conclusions

LSG is safe and very efficient in patients aged >60, despite higher rates of perioperative comorbidities.     

Colorectal Surgery After Kidney Transplantation: Characteristics of Early vs. Late Posttransplant Interventions

Background

The majority of colorectal complications after kidney transplantation reportedly occur <1 year of transplant. We aimed to identify differences in complications in the early and late posttransplant period.

Methods

We retrospectively reviewed kidney transplant recipients undergoing colorectal resection from 1 June 2000 to 1 June 2012 at a single institution, comparing patients by posttransplant year (<1 vs. >1 year). Measured outcomes included major complications, postoperative length of stay, perioperative mortality, reoperations, and readmissions.

Results

We identified 45 patients aged 31–77 (median 55). Gastrointestinal malignancy (31 %), diverticular disease (24 %), and ischemic colitis (16 %) were the most common indications for surgery. The early group (n?=?9) had more cases of ischemic colitis (44 vs. 6 %, p?=?0.01), emergent operations (100 vs. 33 %, p?=?0.0003), blood transfusion (78 vs. 31 %, p?=?0.02), longer length of stay (23.2?±?12 vs. 11.7?±?10 days, p?=?0.02), and higher mortality rate (33 vs. 6 %, p?=?0.05 compared to the late group (n?=?36)). There were no significant differences in major complications, reoperations, or readmissions.

Conclusions

Kidney transplant recipients undergoing colorectal resection <1 year of transplant have a higher incidence of emergency surgery and ischemic colitis compared with those with >1 year posttransplant. Despite these findings, patients with grafts <1 year had a similar postoperative complication rate to patients with grafts >1 year.