Blood perfusion and bone formation before and after minimally invasive periacetabular osteotomy analysed by Positron Emission Tomography combined with Computed Tomography

Purpose

Sufficient blood perfusion is essential for successful bone healing after periacetabular osteotomy (PAO). The purpose of this study was to quantify blood perfusion and bone formation before and after PAO analysed by positron emission tomography (PET) combined with computed tomography (CT).

Methods

Twelve dysplastic patients (nine women) were included consecutively in the study and all were operated upon by the senior author (KS). Median age was 33 (23–55) years. Initially, two patients were PET scanned in a pilot study to test our models for calculation of the physiological parameters. The following ten patients had their hip joints PET/CT scanned immediately before PAO and three to four weeks after. Oxygen-15-water was used to quantify blood perfusion and Flourine-18-fluoride was used to produce quantitative images interpreted as new bone formation in the acetabular fragment.

Results

The blood perfusion of the operated acetabulum before surgery was 0.07?±?0.02 ml/min/ml, and after surgery 0.19?±?0.03 ml/min/ml (p?=?0.0003). Blood perfusion of the non-operated acetabulum was 0.07?±?0.02 ml/min/ml before PAO and 0.07?±?0.02 ml/min/ml after surgery (p?=?0.47). The fluoride-clearance per volume bone of the operated acetabulum was 0.02?±?0.01 ml/min/ml preoperatively, and 0.06?±?0.01 ml/min/ml postoperatively (p?=?0.0005). Fluoride-clearance of the non-operated acetabulum was 0.01?±?0.01 ml/min/ml before PAO and 0.02?±?0.01 ml/min/ml after PAO (p?=?0.49).

Conclusion

Blood perfusion and new bone formation increased significantly in the acetabular fragment. Thus, the results of this study do not support the concern about surgically damaged vascularity after PAO.     

Effects of Gastric Band Adjustments on Intraluminal Pressure

Background

Understanding of the effects of adjustments to laparoscopic adjustable gastric band (LAGB) volume is limited. Changes in intraluminal pressure may be important and explain patients reporting a tighter LAGB after saline is removed and an identical volume replaced.

Methods

Using high-resolution manometry, changes in the basal intraluminal pressure at the level of the LAGB in response to sequential, small alterations in LAGB volume were recorded. All fluid was removed from the LAGB and replaced, pressures and motility were reassessed.

Results

Sixteen patients (four males, age 45.4?±?13.2 years) participated. A linear increase (r ²?=?0.87?±?0.12) in intraluminal pressure was observed after a threshold volume was reached. The threshold volume varied considerably (1.0 to 5.8 ml). The gradient of the linear increase was 21.2?±?8.7 mmHg/ml. The mean basal intraluminal pressure at the level of the LAGB was initially 19.1?±?8.9 mmHg and increased to 37.0?±?20.4 mmHg (p?=?0.001) after removing and replacing the same volume of saline. There was an increase in distal esophageal peristaltic pressure (123.5?±?34.7 vs. 157.4?±?52.6 mmHg, p?=?0.003) and a decrease in the proportion of normal swallows (0.85?±?0.22 vs. 0.53?±?0.47, p?=?0.02). Nine patients also developed adverse symptoms.

Conclusions

Intraluminal pressure at the level of the LAGB is an objective measure of the restriction produced by LAGBs. The addition of fluid to the LAGB results in a linear increase in intraluminal pressure once a threshold volume is reached. The removal and replacement of the same volume of saline from the LAGB may temporarily increase intraluminal pressure.     

Feasibility and safety of transglottic bronchoscopy in mechanically ventilated sheep

Purpose

Although bronchoscopy can be safely performed through endotracheal tube in most intubated critically ill patients, sometimes it could lead to complications such as hypoxia and high airway pressures. Theoretically, transglottic bronchoscopy (TGB) does not interfere with mechanical ventilation and could avoid these complications. In a two-period crossover study, we compared this technique with trans-endotracheal tube bronchoscopy (TEB) in normal anesthetized sheep.

Methods

In five sheep, we did TGB first. The bronchoscope was introduced through the nasal nares and passed into the trachea via space between endotracheal tube and vocal folds. Heart rate, V _T, P _peak, and O₂ saturation were recorded. One week later, we did TEB. In another five sheep, we did TEB first and TGB later.

Results

P _peak increased and V _T and O₂ saturation decreased during TEB (53.2?±?5.7 vs. 27.6?±?0.6, P?=?0.002; 210?±?32 vs. 285?±?26, P?=?0.002; 94.3?±?1.3 vs. 97.5%?±?0.5, P?=?0.041, respectively), but not during TGB. The only statistically significant abnormal finding during TGB was a mild tachycardia (96.7?±?5.7 vs. 94.7?±?5.5, P?=?0.034).

Conclusion

Although TGB is time consuming and less convenient than TEB, it has minimal interference with mechanical ventilation. Expertise with this technique could be useful in patients with anticipated significant hypoxia and high airway pressures during bronchoscopy.     

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.     

Association of polymorphisms in CYP19A1 and CYP3A4 genes with lower urinary tract symptoms, prostate volume, uroflow and PSA in a population-based sample

Purpose

The known importance of testosterone for the development of benign prostatic hyperplasia (BPH) prompted us to test the hypothesis whether polymorphisms of two genes (CYP19A1 and CYP3A4) involved in testosterone metabolism are associated with clinical BPH-parameters.

Methods

A random sample of the population-based Herne lower urinary tract symptoms cohort was analysed. All these men underwent a detailed urological work-up. Two polymorphisms in the CYP19A1 gene [rs700518 in exon 4 (A57G); rs10046 at the 3??UTR(C268T)] and one in the 3??UTR of CYP3A4 [rs2740574 (A392G)] were determined by TaqMan assay from genomic DNA of peripheral blood. These polymorphisms were correlated to clinical and laboratory BPH-parameters.

Results

A total of 392 men (65.4?±?7.0?years; 52?C79?years) were analysed. Mean International Prostate Symptom Score (IPSS; 7.5), Q _max (15.4?ml/s), prostate volume (31?ml) and prostate specific antigen (PSA) (1.8?ng/ml) indicated a typical elderly population. Both polymorphisms in the CYP19A1 gene were not correlated to age, IPSS, Q _max, prostate volume and post-void residual volume. Serum PSA was higher in men carrying the heterozygous rs10046 genotype (2.0?±?0.1?ng/ml) than in those with the CC-genotype (1.7?±?0.2?ng/ml, P?=?0.012). Men carrying one a mutated allele of the CYP3A4 gene had smaller prostates (27.0?±?2.0 vs. 32?±?0.8?ml, P?=?0.02) and lower PSA levels (1.6?±?0.3 vs. 1.9?±?0.1?ng/ml).

Conclusions

The inconsistent associations observed herein and for other gene polymorphisms warrant further studies. In general, the data regarding the association of gene polymorphism to BPH-parameters suggest that this disease is caused by multiple rather than a single genetic variant. A rigorous patient selection based on anatomo-pathological and hormonal profile may possible reduce the number of confounders for future studies thus enabling a more detailed assessment of the association between genetic factors and BPH-parameters.     

Whole-body single-frequency bioimpedance analysis in pediatric hemodialysis patients

Background

We hypothesized that the percent change in resistance (%RΔ) from bioimpedance analysis (BIA) measurements during hemodialysis (HD) can provide information on pediatric HD patients’ hydration status.

Methods

Whole-body single-frequency BIA measurements were obtained before HD, each hour on HD, and after HD during two HD sessions. Pre-and post-HD weights, blood pressures, Crit-Line® measurements, and intradialytic symptoms were collected on the day of the BIA measurements.

Results

One hundred and thirty BIA measurements were obtained from 14 HD patients. The group was 43 % girls, and the mean age was 13.2?±?4.4 years. Percent change in resistance was 13.5?±?10.8 % at the end of HD; %RΔ correlated with percent body weight change (%BWΔ) following HD (r?=??0.83, P?<?0.01), as well as with percent blood volume change (%BVΔ) (r?=??0.79, P?<?0.01). The %RΔ was similar between patients with and without hypertension immediately before HD and was greater in those with intradialytic symptoms (19.1?±?7.7 %) than in those without (9.9?±?11.2 %) (P?=?0.02). Patients with left ventricular hypertrophy (LVH) had lower %RΔ (7.2?±?9.7 %) than those without (19.5?±?7.7 %) (P?=?0.03). Left ventricular mass index (LVMI) also correlated strongly with %RΔ (r?=??0.79, P?=?0.004) and %BWΔ (r?=?0.82, P?=?0.002).

Conclusions

Our study showed that %RΔ strongly correlates with %BWΔ and %BVΔ and that %RΔ also correlated with intradialytic symptoms and LVMI.     

Exercise-induced inhibition of remodelling is focally offset with fatigue fracture in racehorses

Summary

Bone remodelling is inhibited by high repetitive loading. However, in subchondral bone of racehorses in training, eroded surface doubled in association with fatigue fracture and there was greater surrounding trabecular bone volume suggesting trabecular modelling unloads the bone focally, allowing damage repair by remodelling.

Introduction

Remodelling replaces damaged bone with new bone but is suppressed during high magnitude repetitive loading when damage is most likely. However, in cortical bone of racehorses, at sites of fatigue fracture, focal porosity, consistent with remodelling, is observed in proportion to the extent of surrounding callus. Focal areas of porosity are also observed at sites of fatigue damage in subchondral bone. We hypothesised that fatigued subchondral bone, like damaged cortical bone, is remodelled focally in proportion to the modelling of surrounding trabecular bone.

Methods

Eroded and mineralizing surfaces and bone area were measured using backscattered scanning electron microscopy of post-mortem specimens of the distal third metacarpal bone in 11 racehorses with condylar fractures (cases) and eight racehorses in training without fractures (controls).

Results

Cases had a two-fold greater eroded surface per unit area at the fracture site than controls (0.81?±?0.10 vs. 0.40?±?0.12 mm^?1, P?=?0.021) but not at an adjacent site (0.22?±?0.09 vs. 0.30?±?0.11 mm^?1, P?=?0.59). Area fraction of surrounding trabecular bone was higher in cases than controls (81?±?2 vs. 72?±?2 %, P?=?0.0020) and the eroded surface at the fracture site correlated with the surrounding trabecular area (adjusted R ²?=?0.63, P?=?0.0010).

Conclusion

In conclusion, exercise-induced inhibition of remodelling is offset at sites of fatigue fracture. Modelling of trabecular bone may contribute to unloading these regions, allowing repair by remodelling.     

Braun Gastrointestinal Bypass Surgery Exerts Similar Hypoglycemic Effects, with Minimal Operation Time and Earlier Functional Recovery, than Roux-en-Y Bypass in Type 2 Diabetic Rats

Background

Despite the beneficial hypoglycemic and potentially curative effects in type 2 diabetes, large stomach volume deficits caused by Roux-en-Y gastrointestinal bypass (RYGB) surgery increase complications. Hypoglycemic effects of Braun surgery and RYGB surgery, both modified to maximally preserve stomach volume, were compared in rat type 2 diabetes models.

Methods

Three-month-old, male Goto-Kakizaki (GK) rats (n?=?40) were randomly divided into equal groups and not treated (control) or treated with sham surgery (sham group), modified stomach-preserving Braun gastrointestinal bypass (Braun group), or modified RYGB (RYGB group). Pre- and postoperative body weight and water intake were recorded, along with operative and defecation times. Fasting blood glucose at 12 h, and blood glucose 180 min after intragastric glucose administration, were measured at weeks 1, 2, 3, 4, 10, and 11 along with glycosylated hemoglobin (preoperatively, week 11).

Results

Statistically similar (P?>?0.05) increased body weight and decreased water intake, fasting blood glucose, blood glucose after intragastric glucose administration, and glycosylated hemoglobin were observed in Braun and RYGB groups compared with control and sham groups (P?<?0.05). By week 1, RYGB and Braun groups exhibited sustained reductions in fasting blood glucose from 13.0?±?4.1 to 6.9?±?1.4 mmol/L and 12.4?±?4.4 to 7.3?±?0.9 mmol/L, respectively (P?<?0.05); mean operative times were 139.1?±?4.9 and 81.6?±?6.4 min, respectively; and postoperative defecation times were 74.3?±?3.1 and 29.4?±?4.1 h, respectively (P?<?0.05).

Conclusions

Stomach volume-preserving Braun gastrointestinal bypass surgery was faster and produced hypoglycemic effects similar to RYGB bypass surgery, potentially minimizing metabolic disruption.     

IL-17A-mediated sRANK ligand elevation involved in postmenopausal osteoporosis

Summary

The role of proinflammatory IL-17 cytokine was studied in postmenopausal bone loss between 31 osteopenic and 41 osteoporotic women. The effect of serum IL-17A, soluble receptor activator of NF-κB (sRANK) ligand, and osteoprotegerin (OPG) levels on lumbar bone mineral densities was measured. The results demonstrated an increased IL-17A-mediated sRANK ligand elevation in postmenopausal osteoporotic bone loss.

Introduction

IL-17 proinflammatory cytokine is a new inducer of bone loss. Postmenopausal osteoporosis represents a cross talk between estrogen deprivation and increased immune reactivity. The role of IL-17 was studied in the bone loss of postmenopausal osteoporosis.

Methods

Serum IL-17A, sRANK ligand, and OPG levels were investigated on bone mineral densities (BMDs) in the total lumbar (L1–L4) region in 18 pre- and 72 postmenopausal women. IL-17A, sRANK ligand, OPG levels, and BMDs were measured with enzyme-linked immunosorbent assay (ELISA) and dual-energy X-ray absorptiometry (DXA).

Results

Increased serum IL-17A, sRANK ligand, and OPG levels were demonstrated in postmenopausal osteoporotic women compared to osteopenic women (3.65?±?0.61 vs 3.31?±?0.43 ng/ml for IL-17A, P?<?0.007; 2.88?±?0.84 vs 2.49?±?0.61 ng/ml for sRANK ligand, P?<?0.027; and 1.43?±?0.07 vs 1.39?±?0.07 ng/ml for OPG, P?<?0.038). In postmenopausal women, IL-17A levels correlated inversely with total lumbar BMDs (P?<?0.008, r?=??0.279) and positively with sRANK ligand levels (P?<?0.0001, r?=?0.387) or the ratio of sRANK ligand and OPG (P?<?0.013, r?=?0.261), but did not with OPG levels alone.

Conclusion

Increased IL-17A levels are involved in postmenopausal osteoporosis, playing a role in the bone-resorpting processes.     

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.     

Infection surveillance in transsphenoidal pituitary surgery - comparison of lipopolysaccharide-binding-protein, interleukin 6, C-reactive protein, white blood cell count, erythrocyte sedimentation rate and body temperature

Background

One of the major concerns in transsphenoidal surgery are infections because the approach to the pituitary includes a route of microbial colonization. To minimize the associated morbidity and mortality, a surveillance program is crucial to monitor for perioperative infections.

Methods

For 1 year, we analysed body temperature (BT), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), C-reactive protein (CRP), interleukin 6 (IL-6) and lipopolysaccharide-binding-protein (LBP) following elective transsphenoidal pituitary surgery. Samples were collected on admission, day 1, 3 and 7 as well as 3 months postoperatively.

Results

In 116 patients, all data were available. No postoperative infections occurred within the first postoperative week. BT (37.6?±?0.6, baseline 37.0?±?0.5 °C), WBC (11,366?±?2,541, baseline 6,861?±?2,123/μl), CRP (25.3?±?22.6, baseline 3.1?±?6 mg/l), IL-6 (12?±?13, baseline 2.7?±?2.6 pg/ml), and LBP (11.3?±?4.9, baseline 5.7?±?2.7 μg/ml) peaked on day 1 postoperatively (each p?=?0.001), while ESR peaked on day 3 (25?±?16, baseline 13?±?11 mm/h, p?=?0.001). BT and IL-6 normalized by day 3 and CRP by day 7, while ESR (23?±?16 mm/h, p?=?0.001), WBC (7,807?±?2,750/μl, p?=?0.001) and LBP (7.3?±?2.6 μg/ml, p?=?0.028) were still increased by day 7.

Conclusion

The present study establishes normative values for an infection surveillance following transsphenoidal pituitary surgery. CRP, a convenient and reasonable priced parameter, is affected by the procedure for the first postoperative week. IL-6 is more robust and allows a close monitoring on the expense of additional pricing. ESR, WBC and LBP are sustained affected by surgery, and do not offer any advantage. Since no infections were observed, we were unable to calculate the respective sensitivity and specificity.     

Effect of Carbohydrate Restriction in Patients with Hyperinsulinemic Hypoglycemia after Roux-en-Y Gastric Bypass

Background

Hyperinsulinemic hypoglycemia is a rare complication of Roux-en-Y gastric bypass (RYGB) surgery. Meals with a high carbohydrate (carb) content and high glycemic index (GI) may provoke these hypoglycemic attacks. The aim of this study is to assess the effects of reducing meal carb content and GI on glycemic responses in patients with post-RYGB hypoglycemia.

Methods

Fourteen patients with post-RYGB hypoglycemia underwent two meal tests: a mixed meal test (MMT) with a carb content of 30 g and a meal test with the low GI supplement, Glucerna SR 1.5® (Glucerna meal test (GMT)). Plasma glucose and serum insulin levels were measured for a period of 6 h.

Results

Peak glucose levels were reached at T ₃₀ during GMT and at T ₆₀ during MMT, and they were 1.5?±?0.3 mmol/L lower during GMT than during MMT (7.5?±?0.4 vs 9.0?±?0.4 mmol/L, P?T ₃₀ plasma, insulin was 30.7?±?8.5 mU/L higher during GMT than during MMT (P?Conclusion A 30-g carb-restricted meal may help to prevent post-prandial hypoglycemia in patients with post-RYGB hypoglycemia. The use of a liquid, low GI, supplement offers no additional advantage.     

Vitamin D status of children receiving chronic dialysis

Background

Patients receiving chronic dialysis therapy are presumed to be at risk for 25(OH) D₃ deficiency, but little information is available on its prevalence, manifestations of deficiency, and the impact of ergocalciferol supplementation.

Methods

A single-center, retrospective study of 51 prevalent pediatric patients on hemodialysis or peritoneal dialysis was conducted to address these issues.

Results

Forty of 51 (78.4 %) patients had low (<30 ng/ml) 25(OH) D₃ levels. Of these, 2 % had values?12 years, non-Caucasian race and?>?12-month duration of dialysis were significantly associated with low 25(OH) D₃ levels (p?=?0.006, p?=?0.05, and p?=?0.04, respectively). Twenty-three of the 40 patients deficient in 25(OH) D₃ received repletion therapy with ergocalciferol and had a follow-up level at an average of 2 months following completion of a single course of therapy; 14 (60 %) of the levels were normal. Mean baseline intact parathyroid hormone (iPTH) for patients with 25(OH) D₃ levels?≤?30 was 478.68?±?474.01 pg/ml and treatment with ergocalciferol was not associated with a significant decrease in the mean iPTH value (p?=?0.45).

Conclusions

We conclude that low 25(OH) D₃ levels are common in pediatric patients receiving dialysis and require attention in accordance with current practice guidelines.     

Prosthetic Graft for Superior Mesenteric-Portal Vein Reconstruction in Pancreaticoduodenectomy: A Retrospective,Multicenter Study

Background

The use of prosthetic grafts for superior mesenteric-portal vein reconstruction (SMPVR) after pancreaticoduodenectomy (PD) with venous resection remains controversial. We evaluated the effectiveness and safety of using polytetrafluoroethylene (PTFE) interposition grafts for SMPVR after PD.

Methods

We identified 76 patients who underwent PD with segmental vein resection for pancreatic head and periampullary neoplasms at three centers between January 2007 and June 2012. The venous reconstruction technique depended on the length of venous involvement. Forty-two and 34 patients underwent SMPVR with primary anastomosis and SMPVR with PTFE interposition grafts, respectively. The postoperative morbidity, mortality, and patency were compared. For the patients with pancreatic ductal adenocarcinoma (n?=?65), survival was compared between the SMPVR with primary anastomosis (n?=?36) and SMPVR with PTFE interposition graft groups (n?=?29).

Results

Patients undergoing SMPVR with PTFE grafts had larger tumor sizes (3.4?±?0.9 cm, 2.9?±?0.9 cm, P?=?0.016), longer operative durations (492.9?±?107.5 min, 408.8?±?78.8 min, P?<?0.001), and greater blood loss (986.8?±?884.5 ml, 616.7?±?485.5 ml, P?=?0.040) compared to those undergoing SMPVR with primary anastomosis. However, 30-day postoperative morbidity and mortality did not differ (29.4 and 2.9 %, respectively, for PTFE grafts and 33.3 and 7.1 %, respectively, for primary anastomosis). There were no cases of graft infection. The estimated cumulative patency of SMPVR 6 and 12 months after surgery did not differ (87.9 and 83.5 % after PTFE grafts, respectively, and 94.4 and 86.4 % after primary anastomosis, respectively). For patients who underwent surgery for pancreatic ductal adenocarcinoma, there were no significant differences in the median survival time (11 vs. 12 months) or the 1-, 2-, and 3-year survival rates (35.7, 12.5, and 4.2 vs. 36.4, 17.3, and 8.7 %, respectively) for the PTFE and primary anastomosis groups.

Conclusions

PTFE grafts could provide a safe and effective option for venous reconstruction after PD in patients with segmental vein resection.     

Using stress MRI to analyze the 3D changes in apical ligament geometry from rest to maximal Valsalva: a pilot study

Introduction and hypothesis

A method was developed using 3D stress magnetic resonance imaging (MRI) and was piloted to test hypotheses concerning changes in apical ligament lengths and lines of action from rest to maximal Valsalva.

Methods

Ten women with (cases) and ten without (controls) pelvic organ prolapse (POP) were selected from an ongoing case–control study. Supine, multiplanar stress MRI was performed at rest and at maximal Valsalva and was imported into 3D Slicer v. 3.4.1 and aligned. The 3D reconstructions of the uterus and vagina, cardinal ligament (CL), deep uterosacral ligament (USL_d), and pelvic bones were created. Ligament length and orientation were then measured.

Results

Adequate ligament representations were possible in all 20 study participants. When cases were compared with controls, the curve length of the CL at rest was 71 ±16 mm vs. 59?±?9 mm (p?=?0.051), and the USL_d was 38?±?16 mm vs. 36?±?11 mm (p?=?0.797). Similarly, the increase in CL length from rest to strain was 30?±?16 mm vs. 15?±?9 mm (p?=?0.033), and USL_d was 15?±?12 mm vs. 7?±?4 mm (p?=?0.094). Likewise, the change in USL_d angle was significantly different from CL (p?<?0.001).

Conclusions

This technique allows quantification of 3D geometry at rest and at strain. In our pilot sample, at maximal Valsalva, CL elongation was greater in cases than controls, whereas USL_d was not; CL also exhibited greater changes in ligament length, and USL_d exhibited greater changes in ligament inclination angle.     

FGF 19 and Bile Acids Increase Following Roux-en-Y Gastric Bypass but Not After Medical Management in Patients with Type 2 Diabetes

Background

This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment.

Methods

Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n?=?15) or RYGB (n?=?15).

Results

Mean HbA1c decreased from 9.7 to 6.4 % after RYGB and from 9.1 to 6.1 % in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5?±?0.5) was less than in the IMM group (4.6?±?0.3). After RYGB, FGF19 increased in the fasted (93?±?15 to 152?±?19 pg/ml; P?=?0.008) and postprandial states (area under the curve (AUC), 10.8?±?1.9 to 23.4?±?4.1 pg?×?h/ml?×?10³; P?=?0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×10³, 6.63?±?1.3 to 15.16?±?2.56 μM?×?h; P?=?0.003) and decreased after IMM (AUC ×10³, 8.22?±?1.24 to 5.70?±?0.70; P?=?0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r?=?0.54, P?=?0.04) and trended negatively with HbA1c (r?=??0.44; P?=?0.09); these associations were not observed after IMM.

Conclusions

BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.

     

Effects of tidal volume and PEEP on arterial blood gases and pulmonary mechanics during one-lung ventilation

Purpose

The main problem of one-lung ventilation (OLV) is hypoxemia. The use of a high tidal volume for preventing hypoxemia during OLV is controversial. We compared the effects of a high tidal volume versus a low tidal volume with or without PEEP on arterial oxygen tension (PaO₂) and pulmonary mechanics during OLV.

Methods

Sixty patients (age range, 16–65?years; ASA I, II) who underwent wedge resection with video-assisted thoracostomy during OLV were assigned to three groups: group I received a high tidal volume (10?ml/kg) (n?=?20), group II received a low tidal volume (6?ml/kg) (n?=?20), and group III received a low tidal volume (6?ml/kg) with PEEP (5?cmH₂O) (n?=?20). Patient hemodynamics, pulmonary mechanics, and arterial blood gases were measured before (T₀) OLV and 5 (T₁), 15 (T₂), 30 (T₃), and 45?min (T₄) after OLV.

Results

The PaO₂/FiO₂ ratios of group II and III were significantly decreased and the incidence of hypoxemia was significantly higher in groups II and III than in group I (P?Conclusion During OLV, mechanical ventilation with a low tidal volume with or without PEEP increased hypoxemia as compared to that when performing OLV with a high tidal volume.     

Estrogen inhibits vaginal tropoelastin and TGF-β1 production

Introduction and hypothesis

The aim of this study was to quantify the effects of estrogen on vaginal smooth muscle cell (SMC) tropoelastin and transforming growth factor (TGF)-β1 production.

Methods

Primary SMC were incubated with estradiol, and cell proliferation was assessed by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay at 48 h. Supernatants were collected and tropoelastin and TGF-β1 levels measured.

Results

SMC proliferation was significantly increased by estradiol [relative cell number, mean ± standard error (SE), estradiol 0.1 μM 116?±?19 % of control (P?=?NS), 1 μM 127?±?13 % of control (P?<?0.05), 10 μM 153?±?26 % of control, (P?<?0.05)]. Tropoelastin production was significantly decreased by estrogen [mean ± SE, estradiol 0.1 μM 78?±?2 % of control (P?<?0.05), 1 μM 76?±?4 % of control (P?<?0.05), 10 μM 67?±?3 % of control, (P?<?0.05)]. In addition, TGF-β1 production was significantly decreased [mean ± SE, estradiol 0.1 μM 96?±?4 % of control (P?=?NS), 1 μM 84?±?6 % of control (P?<?0.05), 10 μM 70?±?6 % of control, (P?<?0.05)].

Conclusion

Estrogen increases vaginal SMC proliferation and inhibits tropoelastin and TGF-β1 production.     

Volume of Resected Stomach as a Predictor of Excess Weight Loss After Sleeve Gastrectomy

Background

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of obesity. The objective of this study was to evaluate the volume of the resected stomach (VRS) as a predictor of the percentage of excess weight loss (%EWL) 1 year after LSG.

Methods

This was a single-surgeon study of prospectively collected data of patients who underwent LSG at Jordan University Hospital (February 2009 to February 2012). The VRS was measured using a standardized technique. The %EWL was calculated at 3, 6, and 12 months postoperatively. The correlation between the VRS and %EWL was statistically evaluated.

Results

Ninety patients underwent LSG during the study period. Of these, 73 patients (57 female) completed at least 1 year of follow-up and were analyzed; their body mass index was 45?±?7.6 kg/m² (33–81). The VRS was 1,337.4?±?435.2 ml (600–2,800). The %EWL was 33.6?±?11.1 % at 3 months, 48.6?±?15.5 % at 6 months, and 56.8?±?18.9 % at 12 months. A significant correlation was observed between the VRS and %EWL at 1 year (p?=?0.003). Patients with a VRS of >1,100 ml (n?=?43) achieved significantly greater %EWL at 12 months than did those with a VRS of ≤1,100 (n?=?30). Removal of >1,100 ml of gastric volume was associated with a sensitivity and specificity of 75.5 and 46.2 %, respectively, for achieving a %EWL of ≥50 %.

Conclusion

The VRS can be used as an indicator of excess weight loss 1 year after LSG.     

The early cardiovascular changes in pediatric patients with systemic lupus erythematosus

Background

In patients with systemic lupus erythematous (SLE) late-onset deaths are due to morbid cardiovascular changes (CVCs). Inflammatory and immune-mediated mechanisms are involved in promoting atherosclerosis development in SLE that is reflected in both functional and morphological changes in the cardiovascular system. The aim of our study was to determine the presence of these changes in pediatric SLE patients.

Methods

Fifty-one consecutive patients (13 male, 38 female) with SLE and 25 healthy controls were included in the study. Arterial stiffness was assessed by carotid–femoral pulse wave velocity (PWVcf) and augmentation index (AIx), as measured by the Vicorder. Carotid intima-media thickness (cIMT) and the left ventricular mass index (LVMi) were also determined.

Results

Patients with SLE, despite equivalent exposure to “traditional” cardiovascular risk factors, presented a higher mean PWVcf and AIx than controls (6.56?±?1.45 vs. 5.29?±?0.67 m/s, P =0.01 and 14.7?±?8.1 vs. 9.36?±?3.59 %, P = 0.02, respectively). SLE patients had greater values of cIMT and LVMi than controls (0.54?±?0.06 vs. 0.35?±?0.12 mm, P?=?0.00 and 32.4?±?10.8 vs 28.8?±?1.5, P?=?0.01, respectively). Nine patients had left ventricular hypertrophy (LVMi >38 g/m^2.7). There was no significant difference in PWV, AIx, cIMT and LVMi values between presence of hypertension or nephritis within SLE patients. We found significant correlations between all parameters and activity scores.

Conclusions

Our results demonstrate that functional and morphological CVCs are independent of traditional risk factors in pediatric SLE patients and correlate with SLE disease activity scores in the early disease stages.