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 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.     

Weight Loss Outcome After Roux-en-Y Gastric Bypass: 10 Years of Follow-up

Background

By submitting obese people to surgical treatment, we hope they lose weight and stay slim. Long-term monitoring is essential to assess effectiveness of surgery. This study aims to evaluate weight loss over 10 years in an obese population undergoing banded Roux-en-Y gastric bypass (B-RYGBP).

Methods

The surgery was performed in 211 obese between May 1999 and December 2000. This prospective study evaluated excess weight loss (%EWL) and body mass index (BMI) during the period. We considered surgical treatment failure if %EWL was less than 50 %.

Results

We followed 54.9 % of the population (116 patients). Patients' %EWL was 67.6?±?14.9 % 1 year after surgery, 72.6?±?14.9 % after 2 years, 69.7?±?15.1 % after 5 years, 66.8?±?7.6 % after 8 years, and 67.1?±?11.9 % after 10 years postoperatively. Surgical treatment failure occurred in 16 patients (14.6 %) over 10 years.

Conclusions

B-RYGBP is a good technique to promote and maintain weight loss 10 years after surgery with low failure rate.     

Percutaneous dorsal root ganglion lysis with phenol for the treatment of pain associated with thoracic compression fracture

Background

Symptomatic thoracic compression fracture is one of the most common causes of back pain in elderly. Although vertebroplasty is widely utilized in patients when conservative treatment fails, we introduced an alternative percutaneous technique for the treatment of thoracic compression pain.

Methods

This in a retrospective study. The analysis was performed on 28 consecutive patients who underwent undergoing percutaneous dorsal root ganglion lysis with phenol for the treatment of pain associated with thoracic compression fracture. An acceptable treatment outcome was operationally defined as a pain intensity numerical rating scale (NRS) score of 3 or lower or EQ-5D index of 0.672 or higher. The primary outcome was pain relief and acceptable treatment outcome at 1 day, 1 week, 1 month, and 1 year.

Results

Of the 28 cases treated with our procedures, the change in mean NRS score between baseline and one day was ?2.5 (95 % CI ?1.6?～??3.4, p?<?0.001), between baseline and one week was ?4.7 (?4.1 to ?5.3, p?<?0.001), between baseline and one month was ?5.8 (?5.2 to ?6.5, p?<?0.001), and between baseline and one year was ?6.3 (?5.6 to ?7.1, p?<?0.001). An acceptable treatment outcome was 14 % one day after the procedure, 46 % at one week, 72 % at one month, and 84 % at one year. Complication rate was 3.6 %.

Conclusions

For thoracic compression fracture patients, percutaneous dorsal root ganglion lysis with phenol is an effective, and safe alternative treatment method worth considering. Pain relief is fast and persists for one year.     

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.     

Negligible Effect of Perioperative Epidural Analgesia Among Patients Undergoing Elective Gastric and Pancreatic Resections

Background

There are conflicting data regarding improvements in postoperative outcomes with perioperative epidural analgesia. We sought to examine the effect of perioperative epidural analgesia vs. intravenous narcotic analgesia on perioperative outcomes including pain control, morbidity, and mortality in patients undergoing gastric and pancreatic resections.

Methods

We evaluated 169 patients from 2007 to 2011 who underwent open gastric and pancreatic resections for malignancy at a university medical center. Emergency, traumatic, pediatric, enucleations, and disseminated cancer cases were excluded. Clinicopathologic data were reviewed among epidural (E) and non-epidural (NE) patients for their association with perioperative endpoints.

Results

One hundred twenty patients (71 %) received an epidural and 49 (29 %) did not. There were no significant differences (P?>?0.05) in mean pain scores at each of the four days (days 0–3) among the E (3.2?±?2.7, 3.2?±?2.3, 2.3?±?1.9, and 2.1?±?1.9, respectively) and NE patients (3.7?±?2.7, 3.4?±?1.9, 2.9?±?2.1, and 2.4?±?1.9, respectively). Within each of the E and NE patient groups, there were significant differences (P?<?0.0001) in mean pain scores from day 0 to day 3 (P?<?0.0001). Of the E patients, 69 % also received intravenous patient-controlled analgesia (PCA). Ileus (13 % E vs. 8 % NE), pneumonia (12 % E vs. 8 % NE), venous thromboembolism (6 % E vs. 4 % NE), length of stay [11.0?±?12.1 (8, 4–107) E vs. 12.2?±?10.7 (7, 3–54) NE], overall morbidity (36 % E vs. 39 % NE), and mortality (4 % E vs. 2 % NE) were not significantly different.

Conclusions

Routine use of epidurals in this group of patients does not appear to be superior to PCA.     

Cinacalcet effects on the perioperative course of patients with secondary hyperparathyroidism

Purpose

Since its registration in 2004, the calcimimetic agent cinacalcet has been established as an alternative treatment for secondary hyperparathyroidism (SHPT). Working by allosteric activation of the calcium-sensing receptor, cinacalcet can lower parathyroid hormone (PTH) and calcium (Ca) in patients with SHPT. The influence of calcimimetics on the perioperative course has been unclear so far.

Methods

We retrospectively analyzed the data of patients with primary operation for SHPT between 2004 and 2011, comparing the perioperative course of patients with and without preoperative cinacalcet treatment.

Results

Fifty-six patients had cinacalcet therapy, and 54 patients had no calcimimetic medication prior to surgery. Gender, age, hemodialysis, and medical treatment were similar in both groups. Also, PTH levels were similar preoperatively and postoperatively (preoperative, 1,249?±?676 vs. 1,196?±?601 pg/ml; postoperative, 86?±?220 vs. 62?±?91 pg/ml). Patients with cinacalcet preoperatively had significant lower Ca levels preoperatively (2.49?±?0.25 vs. 2.61?±?0.24 mmol/l) and postoperatively (1.75?±?0.37 vs. 1.86?±?0.35 mmol/l) and had a higher rate of oral Ca substitution postoperatively (93 vs. 74 %). The risk for postoperative persistent disease was slightly higher in these patients compared to those without preoperative cinacalcet therapy (5 vs. 0 %, not significant).

Conclusions

In our experience, cinacalcet did not alter the perioperative course in SHPT patients.     

Laparoscopic Adjustable Gastric Banded Plication: Evolution of Procedure and 2-Year Results

Background

Laparoscopic adjustable gastric banded plication (LAGBP) is a new restrictive bariatric procedure combining adjustable banding and greater curvature plication of the stomach. This study aimed to report the evolution of this surgical technique and analyze the surgical results.

Methods

Eighty patients who underwent LAGBP were enrolled in this study. The band-first technique was used in 50 patients from May 2009 to June 2011 and was then changed to the plication-first technique from July 2011 to October 2011. Patients' demographics and pre- and postoperative data, including complications and weight loss, were collected and analyzed.

Results

Eighty patients (26 men and 54 women) with a mean age of 30.75?±?8.68 years and a mean body mass index of 38.05?±?4.73 kg/m² were evaluated with a mean follow-up of 10.52 (1–24)?months. The average operation duration and hospital stay were 92.85?±?35.86 min and 1.73?±?1.04 days, respectively. No intraoperative complications or surgical mortality was observed in this series. Four (8 %) postoperative complications occurred with the band-first technique and one (3 %) with the plication-first technique. Mean excess weight loss (percentage) at 6, 12, 18, and 24 months were 42.59?±?13.67, 56.38?±?19.89, 57.59?±?19.88, and 65.84?±?17.36 %, respectively. The frequency of band adjustment was 2.44?±?2.21 times in 2 years.

Conclusions

In this present 2-year result, LAGBP using plication-first technique revealed fewer complications and good weight loss. Longer follow-up is still necessary to be accepted as a stand-alone bariatric procedure.     

A Prospective Proteomic-Based Study for Identifying Potential Biomarkers for the Diagnosis of Cholangiocarcinoma

Background

Cholangiocarcinoma (CCA) is becoming a common fatal hepatic tumor. Early detection of CCA is hampered by the absence of a sufficiently accurate and noninvasive diagnostic test. Proteomic analysis would be a powerful tool to identify potential biomarkers of this cancer.

Aims

This study aims to identify new protein markers that are specific for CCA using proteomic approaches and to evaluate the performance of S100 calcium-binding protein A9 (S100A9) and chaperonin-containing TCR1, subunit 3 (CCTγ) as diagnostic markers for screening test of CCA.

Methods

Two-dimensional differential gel electrophoresis (2-D DIGE) coupled with matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry were used to analyze and screen biomarker candidates in the proteomes of five human CCA samples and five healthy control samples. Subsequently, two potential biomarkers, S100A9 and CCTγ, were chosen for validation and analysis by immunohistochemical methods using CCA tissue microarrays.

Results

Twenty protein spots were significantly elevated and five protein spots were downregulated in all patients (p?<?0.05). The positive rate was significantly higher in patients with CCA (48?±?35 %) compared with the normal liver control group (5?±?10 %, p?<?0.001), the hepatocellular carcinoma group (15?±?20 %, p?<?0.001), and the cirrhosis group (12?±?16 %, p?<?0.001). A greater proportion of patients with CCA were positive for CCTγ (72?±?18 %) compared with the normal liver control group (43?±?22 %, p?<?0.001), the hepatocellular carcinoma group (45?±?20 %, p?<?0.001), and the cirrhosis group (39?±?25 %, p?<?0.001).

Conclusions

Combined comparative proteomic analysis using 2-D DIGE and MALDI-TOF is an effective method for identifying differentially expressed proteins in CCA tissues. The expression of S100A9 and CCTγ showed promise as novel diagnostic markers for CCA.     

Efficacy of Laparoscopic Sleeve Gastrectomy and Intensive Medical Management in Obese Patients with Type 2 Diabetes Mellitus

Background

There are a dearth of studies comparing laparoscopic sleeve gastrectomy (LSG) and intensive medical treatment (IMT) in obese type 2 diabetes mellitus (T2DM) patients. This study compares these modalities in terms of weight loss, metabolic parameters and quality of life (QOL) score.

Methods

We evaluated the efficacy of LSG (n?=?14) vs. IMT (n?=?17) comprising of low calorie diet, exenatide, metformin and if required insulin detemir in 31 obese T2DM patients with BMI of 37.9?±?5.3kg/m² and target HbA1c?<?7 %. The mean (±SD) age of the patients was 49.6?±?11.9 years and 74 % were women. The mean duration of diabetes was 8.5?±?6.1 years and mean HbA1c was 8.6?±?1.3 %. Primary end point was excess body weight loss (EBWL) at the final follow-up.

Results

The mean duration of follow-up was 12.5?±?5.0 (median 12) months. EBWL was 61.2?±?17.6 % and 27.4?±?23.6 % in LSG and IMT group respectively (p?<?0.001). Glycemic outcomes improved in both with mean HbA1c of 6.6?±?1.5 % in LSG and 7.1?±?1.2 % in IMT group. In LSG group, there was resolution of diabetes and hypertension in 36 and 29 % of patients respectively while none in the IMT group. HOMA-IR, hsCRP, ghrelin and leptin decreased while adiponectin increased significantly in LSG compared to IMT group. QOL score improved in LSG as compared to IMT.

Conclusions

In obese T2DM patients, LSG is superior to IMT in terms of weight loss, resolution of comorbidities and QOL score.     

Does lean tissue mass accrual during adolescence influence bone structural strength at the proximal femur in young adulthood?

Summary

The purpose of this study was to identify whether young adult bone structural strength at the hip is associated with adolescent lean tissue mass (LTM) accrual. It was observed that those individuals who accrued more LTM from adolescence to adulthood had significantly greater adult bone structural strength at the hip.

Introduction

The purpose of this study was to identify whether young adult bone cross-sectional area (CSA), section modulus (Z), and outer diameter (OD) at the hip were associated with adolescent LTM accrual.

Methods

One hundred three young adult participants (55 males, 48 females) were tertiled into adolescent LTM accrual groupings. LTM accrual was assessed by serial measures using dual energy X-ray absorptiometry (DXA) from adolescence to young adulthood (21.3?±?1.3 years). CSA, Z, and OD at the narrow neck (NN) and femoral shaft (S) sites of the proximal femur were assessed in young adulthood (21.3?±?4.5 years), using hip structural analysis. Group differences were assessed using an analysis of covariance, controlling for adult height, weight, sex, and physical activity levels.

Results

It was found that individuals with higher adjusted adolescent LTM accrual had significantly greater adult adjusted values of NNCSA (2.49?±?0.06 vs 2.77?±?0.07 cm²), NN Z (1.18?±?0.04 vs 1.37?±?0.04 cm³), NN OD (3.07?±?0.04 vs 3.21?±?0.04 cm), SCSA (3.45?±?0.08 vs 3.88?±?0.09 cm³), and SZ (1.77?±?0.05 vs 2.00?±?0.05 cm³) than individuals with lower LTM accrual (p?<?0.05).

Conclusions

These findings suggest that the amount of LTM accrued from adolescence to young adulthood has a positive influence on adult bone structural strength at the proximal femur.     

Hands-off-Zeiten durch AED-Sprachanweisungen

Background

Hands-off intervals during cardiopulmonary resuscitation (CPR) diminish the likelihood of success. The influence of voice prompts from an automated external defibrillator (AED) on the length of CPR interruption was investigated.

Material and methods

In a randomized, one-way blinded manikin CPR study we prospectively assessed intervals between the start of voice prompting and the start of execution by participants for a shockable and a non-shockable rhythm. Difficulties with executing AED voice prompts were assessed by a questionnaire. The influence on the length of CPR interruptions was evaluated in a post hoc analysis.

Results

Mean hands-off intervals measured in 57 voluntary participants accounted for 38.5?% of the total CPR time. Hands-off intervals between defibrillation and chest compressions were significantly shorter when CPR started with a non-shockable rhythm (6.5?±?3.5 s versus 9.0?±?5.5 s, p?<?0.043) and when participants rated the voice prompts as very good or good compared to middle or bad (7.1?±?4.5 s versus 11.3?±?4.7 s, p?<?0.020).

Conclusions

Confusing voice prompts that potentially delay CPR need to be identified and modified.     

Konventionelle und geschlechtsspezifische kreuzbandersetzende Knietotalendoprothesenimplantation

Introduction

To address anatomical gender differences in total knee arthroplasty (TKA) specific total knee prostheses have been developed for women. Potential benefits of these modified prostheses are currently under debate. The present study investigated whether the modified design features bring benefits compared to uni-sex TKA.

Methods

A total of 80 prospectively blinded and randomized patients underwent implantation of unilateral TKAs with NexGen LPS Gender Solutions (Zimmer, Warsaw, USA, group gender-specific GS prosthesis, n?=?40) or NexGen LPS Flex (Zimmer, Warsaw, USA, control group standard prosthesis ST, n?=?40) The follow-up was carried out 10 days and 6 weeks postoperatively. Clinical data and the subjective assessment of quality of life were evaluated using the Knee Society Clinical Rating System (KSS), the short form 36-item health survey (SF-36) and the Western Ontario and McMaster Universities OA Index (WOMAC).

Results

The two groups showed equal values in KSS, SF-36 and WOMAC preoperatively and ten days postoperatively the GS group reached an average KSS knee score of 62.6?±?16.1 points (ST group 56.9?±?14.7, p?=?0.184) and a functional score of 28.5?±?12.1 (ST group 24.3?±?15.3, p?=?0.082). In the overall score the GS group reached 91.1?±?24.1 points (ST group 81.0?±?27.1, p?=?0.104). The GS group reached a knee score of 85.5?±?14.4 points (ST group 77.8?±?16.8, p?=?0.03) and a functional score of 68.1?±?20.7 points (ST group 62.3?±?18.5, p?=?0.185) 6 weeks postoperatively. In the overall score the GS group reached 153.7?±?30.7 points (ST group 139.6?±?32.4, p?=?0.048). The analysis of SF-36 and WOMAC showed no significant differences at all time points. No evidence of loosening or migration was observed in both groups.

Conclusions

Based on the data presented, gender-specific TKA type NexGen LPS Gender Solutions has advantages in terms of early functional outcome. This result is not reflected in the patient satisfaction and is not considered to be clinically relevant.     

Comparative effects of teriparatide and ibandronate on spine bone mineral density (BMD) and microarchitecture (TBS) in postmenopausal women with osteoporosis: a 2-year open-label study

Summary

Treatment effects over 2 years of teriparatide vs. ibandronate in postmenopausal women with osteoporosis were compared using lumbar spine bone mineral density (BMD) and trabecular bone score (TBS). Teriparatide induced larger increases in BMD and TBS compared to ibandronate, suggesting a more pronounced effect on bone microarchitecture of the bone anabolic drug.

Introduction

The trabecular bone score (TBS) is an index of bone microarchitecture, independent of bone mineral density (BMD), calculated from anteroposterior spine dual X-ray absorptiometry (DXA) scans. The potential role of TBS for monitoring treatment response with bone-active substances is not established. The aim of this study was to compare the effects of recombinant human 1–34 parathyroid hormone (teriparatide) and the bisphosphonate ibandronate (IBN), on lumbar spine (LS) BMD and TBS in postmenopausal women with osteoporosis.

Methods

Two patient groups with matched age, body mass index (BMI), and baseline LS BMD, treated with either daily subcutaneous teriparatide (N?=?65) or quarterly intravenous IBN (N?=?122) during 2 years and with available LS BMD measurements at baseline and 2 years after treatment initiation were compared.

Results

Baseline characteristics (overall mean ± SD) were similar between groups in terms of age 67.9?±?7.4 years, body mass index 23.8?±?3.8 kg/m², BMD L1–L4 0.741?±?0.100 g/cm², and TBS 1.208?±?0.100. Over 24 months, teriparatide induced a significantly larger increase in LS BMD and TBS than IBN (+7.6 %?±?6.3 vs. +2.9 %?±?3.3 and +4.3 %?±?6.6 vs. +0.3 %?±?4.1, respectively; P?<?0.0001 for both). LS BMD and TBS were only weakly correlated at baseline (r ²?=?0.04) with no correlation between the changes in BMD and TBS over 24 months.

Conclusions

In postmenopausal women with osteoporosis, a 2-year treatment with teriparatide led to a significantly larger increase in LS BMD and TBS than IBN, suggesting that teriparatide had more pronounced effects on bone microarchitecture than IBN.     

Reconstructive surgery using interference screw fixation for painful accessory navicular in adult athletes

Objective

To examine the effectiveness of a new technique for reattaching the posterior tibial tendon (PTT) using a bone tunnel and interference screw after resection of the accessory navicular for painful accessory navicular (type II) in adult athletes.

Methods

Ten adult athletes (7 male, 3 female; mean age 30?years, range 23–45) underwent reconstruction using a bone tunnel with an interference screw for a painful accessory navicular. All patients complained of pain on the medial aspect of the foot after eversion sprain during sports activities and radiographs revealed type II accessory navicular. Clinical evaluation with the American Orthopaedic Foot and Ankle Society Ankle–Hindfoot Scale (AOFAS) and visual analogue scale (VAS) before surgery was compared with that at most recent follow up (mean 30?months, range 24–39).

Results

Mean AOFAS score improved from a preoperative 62.8?±?2.9 points (range 61–82) to a postoperative 92.1?±?7.0 points (range 83–100; p?p?Conclusions The presented technique reconstructs the bone-tendon interface of the PTT at the primary navicular with sufficient fixation after resection of the accessory navicular, which preserves the strength of the PTT in adult athletes with an intractably painful accessory navicular.     

Revision to Malabsorptive Roux-En-Y Gastric Bypass (MRNYGBP) Provides Long-Term (10?Years) Durable Weight Loss in Patients with Failed Anatomically Intact Gastric Restrictive Operations

Background

Twenty percent of gastric restrictive operations require revision. Conversion to Proximal Roux-en-Y gastric bypass (PRNYGBP) is associated with weight regain. Forty-one percent of these fail to achieve a body mass index (BMI)?<?35. Few report follow-up (F/U) or quality of life (QOL) beyond 5 years. We report the long-term effectiveness of MRNYGBP as a revision.

Methods

Retrospective chart review of patients (1993?C2005) with a failed gastric restrictive operation (S1) at least a year out from revision (S2) to a MRNYGBP: small lesser curve 22?±?10 (11?C55) cm³ pouch, long biliopancreatic limb, 150 cm alimentary limb, 141?±?24 (102?C190) cm common channel. Staple-line disruptions were excluded.

Results

Thirty-eight (37 F, 1 M) patients aged 46?±?8 (17?C56) years underwent conversion to a MRYGBP 8?±?5 (2?C23) years after: gastroplasty 25, adjustable gastric band 13 for weight regain (79%), gastroesophageal reflux disease (GERD; 29%), and band problems (24%). S1 provided only 24?±?25% excess weight loss (EWL; 5.9?±?6.3 BMI drop) and caused GERD in 32% of patients (p?=?0.0124). There were no deaths or leaks. BMI dropped from 41.4?±?7.8 to 27.3?±?5.6 (down 20.5?±?8.3 from S1), 80.1?±?23.3% EWL (n?=?32) at year 1 (p?<?0.0001). This was maintained for 10 years. BMI was 28?±?4 (21.5?C31.9), 75.6?±?21.1% EWL (57.3?C109.6) (n?=?5) at 10 years. Super obese patients had better 9.95% EWL after S2 (p?=?0.0359). QOL (5?=?excellent): 4.5?±?0.5 (3?C5). F/U: 5.1?±?3.3 (1?C13) years with 83.3% F/U 10-year rate. Labs at 3 years (n?=?10): Alb 3.8?±?0.4, Prot 6.8?±?0.6, Iron 47.6?±?33.3, VitD 15.1?±?7.43, PTH 54.5?±?27.2, B12 620.1?±?676.5, Hct 34?±?4.3.

Conclusions

Revision MRNYGBP provides excellent durable long-term weight loss after failed gastric restrictive operations. Non-compliant patients are at a higher risk for malnutrition, anemia, and osteoporosis.     

A 5-Year Experience of Laparoscopic Adjustable Gastric Banding in China

Background

Laparoscopic adjustable gastric banding (LAGB) has been our operation of choice for morbid obesity since 2003. The aim of this study was to review 5 years of LAGB procedures at a single institution in China.

Methods

All patients who underwent LAGB at our institution from June 2003 to November 2009 were analyzed retrospectively. A telephone survey of patients was conducted in 2010.

Results

This study included 188 Chinese patients, of which 69.7 % were female and 8 (4.3 %) were super-obese (body mass index (BMI) >50 kg/m²). The mean age of patients was 27.2?±?9.1 years (range, 14–55 years), mean weight was 106.8?±?24.7 kg (range, 67–230 kg), and mean BMI was 37.5?±?6.2 kg/m² (range, 26.1–61.7 kg/m²). The mortality rate was 0 %. Six bands were removed (four for slippage). One operation was converted to an open procedure. Ninety-eight patients were surveyed by telephone. The mean weight loss was 17.6?±?12.5 kg, and the mean follow-up time was 23.6 months. Percentage excess weight loss (%EWL) at 3 months, 6 months, 1 year, and 2 years was 27.8?±?16.4, 39.0?±?23.1, 44.1?±?27.3, and 43.1?±?28.4 %, respectively. The nonresponder rate (%EWL <30 %) at 2 years was 33.3 % (20/60). Weight regain of more than 10 kg from nadir was observed in 10 of the 98 patients (10.2 %).

Conclusions

LAGB is a relatively safe procedure with few major complications. However, a minority of morbidly obese patients did not benefit sufficiently from their surgery.     

Hospital burden of vertebral fractures in France: influence of vertebroplasty

Summary

We described the whole population of patients hospitalized for vertebral fractures in France in 2009. Only 6.4 % of them were operated by vertebroplasty; these patients were younger and healthier than non-operated patients.

Introduction

This study aims to describe the burden of vertebral fractures from the 2009 French Hospital National Database in acute care in people aged 60 years and over, with or without vertebroplasty.

Methods

All stays due to nonmalignant and nontraumatic vertebral fractures as primary cause were selected. Patients’ characteristics were described and compared between patients with or without vertebroplasty. The in-patient mortality was compared to the one related to hip and upper humerus fracture in patients hospitalized during the same year.

Results

In 2009, 13,624 patients were hospitalized for vertebral fracture. Men accounted for 29.3 % of cases. Length of stay was 9.6?±?8.2 days, higher in patients with at least one comorbidity than in patients without (11.2?±?8.6 and 7.8?±?7.2 days, respectively). The in-patient mortality was 0.9 %; it was 3.8 and 1.1 % for hip and upper humerus fractures, respectively. Vertebroplasty was performed in 6.4 % of them. Patients with vertebroplasty were younger (mean age of 75?±?8 versus 79?±?9 years), had a less duration of stay (7?±?7.5 versus 9.8?±?8.2 days), less comorbidities (at least one comorbidity, 45 versus 54 %), and less in-patient mortality (0.1 versus 0.9 %). Rehospitalization for vertebral fracture occurred in 9 and 6 % of the patient with and without vertebroplasty.

Conclusion

This is the first French study assessing the national burden of vertebral fractures based on hospital data. In-hospital death rate is lower in patients with vertebroplasty, who are younger and have less comorbidities than the general population with vertebral fractures.     

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.     

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.