Short-term Results of Laparoscopic Mini-Gastric Bypass

Background: The laparoscopic mini-gastric bypass (MGB) is a modification of Mason's loop gastric bypass, but with a long lesser curvature tube. With weight loss results similar to laparoscopic Roux-en-Y gastric bypass (LRYGBP), the MGB is a simpler operation with a low complication rate. Controversy exists concerning the efficacy and side-effects of this procedure. This report presents the technique of laparoscopic MGB and its results in 423 patients. Methods: From October 2001 to October 2004, 423 consecutive patients (87 males and 336 females) underwent laparoscopic MGB (LMGB) for morbid obesity. Mean age was 30.8 years, preoperative mean weight 120.3 kg and mean BMI 44.2 kg/m². Results: All procedures were completed laparoscopically. Mean operative time was 130.8 minutes, and mean hospital stay was 5.0 days. 18 minor early complications (4.3%) were encountered, and 7 major complications (1.7%) occurred. Marginal ulcers were noted in 34 patients (8.0%) during follow-up, and anemia was found in 41 patients (9.7%). Mean BMI decreased to 29.2 and 28.4 kg/m² at 1-year and 2-year follow-up, with mean excess weight loss 69.3% and 72.2%. The Gastrointestinal Quality of Life Index improved significantly 1 year after the operation. Conclusions: LMGB has a low complication and mortality rate. The learning curve is less steep than for LRYGBP, whereas the efficacy is similar.     

Terminal loop cutaneous ureterostomy in renal transplantation: an under utilized urinary diversion technique

PURPOSE: We evaluated the effectiveness of terminal loop cutaneous ureterostomy as a means of urinary drainage in kidney transplant recipients during a 20-year period. MATERIALS AND METHODS: Five cadaveric and 2 living related patients underwent kidney transplantation with terminal loop cutaneous ureterostomy between 1984 and 2004. These patients had no usable bladder or they were not suitable candidates for intermittent catheterization. RESULTS: Followup was 20 months to 17 years. One patient underwent stomal revision 5 months after renal transplantation. Current serum creatinine 4 years later was 166 mumol/l. The remaining 6 patients had no evidence of ureteral obstruction and rarely had bacteriuria or urinary tract infections. Four patients had a functioning allograft with normal serum creatinine. One patient died with a normally functioning allograft and the remaining patient lost his graft due to chronic rejection. No patient in this series lost the graft due to a urological cause. Overall outcomes included excellent allograft function with minimal infection or stomal stenotic complications. CONCLUSIONS: Terminal loop cutaneous ureterostomy is a simple, safe and alternative means of urinary diversion in patients with renal transplant and a defunctionalized lower urinary tract.     

A double-blind, prospective, randomised, controlled clinical trial of minimally invasive dynamic hip screw fixation of intertrochanteric fractures

Objective

To compare minimally invasive dynamic hip screw (MIDHS) fixation with conventional dynamic hip screw (CDHS) fixation for treatment of intertrochanteric femoral fracture.

Methods

Of the 66 participants in this double-blind study, 35 were randomised to MIDHS and 31 to CDHS fixation. Main outcome measurements were wound size, haemoglobin decrease, blood transfusion rate, pain score, analgesic consumption, Elderly Mobility Scale score, hip screw position, tip-apex distance, union rate, time to healing and complication rate.

Results

The groups had similar preoperative clinical data. Postoperatively the MIDHS group had significantly smaller wound size, less blood loss, lower blood transfusion rates, pain scores and rates of analgesic consumption, and higher early Elderly Mobility Scale scores. There were no significant differences in fracture alignment, hip screw position, tip-apex distance, union rate, time to healing or complication rate.

Conclusion

MIDHS fixation of intertrochanteric fractures is effective and safe and significantly reduces blood loss, pain and rehabilitation period, without sacrificing reduction alignment, screw position, fixation stability or bone healing.     

Discrepancy between chronological age and evaluated dental age using the Demirjian system in Western Australian children

The aims of this work were to assess dental age using the Demirjian system and to evaluate the discrepancy between chronological and dental age among children residing in Western Australia. Forty panoramic radiographs of 5- to 11-year-old children taken at the paediatric clinic of a dental hospital in Western Australia were selected. The developmental stage of each left permanent mandibular tooth excluding the third molar was assessed by three trained examiners. Estimated dental age using the Demirjian system was compared with the chronological age of each child. The accuracy of the Demirjian system in this group of children was 42.5%. The difference between chronological age and dental age was significant (t = 4.066, df = 39, p < 0.001). Dental age estimation for Caucasian children had greater accuracy (χ² = 5.013, df = 1, p = 0.025). Gender and orthodontic concerns were not related to the accuracy of the Demirjian system (p ≥ 0.481). The discrepancy between chronological and dental age using the Demirjian system was significant when assessing the Western Australian population although it was more accurate for Caucasian children. The accuracy was similar between subjects with and without orthodontic concerns.     

Computed tomography of the craniocervical junction in rheumatoid arthritis

Thirty-three patients with rheumatoid arthritis had computed tomographic examination of the craniocervical junction. This demonstrated soft tissue features which have not previously been described in published reports. A low attenuation lesion between the odontoid and the transverse ligament shown in 11 patients was considered a premonitory sign of rupture of the transverse ligament or a manifestation of active disease. Computed tomography revealed spinal cord compression in 3 patients and ligamentous changes in the transverse ligament and the alar and spinal ligaments in 26 patients. Erosion of the odontoid was shown in 19 patients and subluxation in 20 patients. No relationship could be found between the clinical signs and symptoms and the radiological abnormalities except in the case of cord compression.     

Usefulness of low-dose spiral CT of the chest in regular follow-up of postoperative non-small cell lung cancer patients: Preliminary report

OBJECTIVES: There is no consensus for the best postoperative follow-up in patients after complete resection of non-small cell lung cancer. Low-dose computed tomography of chest proves valuable in screening primary lung cancer and may be a useful tool in postoperative surveillance. METHODS: In part 1, 30 patients who underwent surgical resection of non-small cell lung cancer and were at the first (n = 14), second (n = 9), or fifth (n = 7) annual postoperative surveillance were selected chronologically and subjected to chest radiography, low-dose computed tomography, and standard-dose computed tomography to verify the diagnostic accuracy of low-dose computed tomography. In part 2, 43 patients were prospectively enrolled and followed up regularly after complete resection of non-small cell lung cancer. The follow-up protocol included physical examination, sputum cytology, serum carcinoembryonic antigen, chest radiography, and low-dose computed tomography every 3 months in the first 2 years postoperatively until tumor recurrence. RESULTS: In part 1, tumor recurrence was detected by standard-dose computed tomography in 7 cases. Low-dose computed tomography and chest radiography missed 1 and 5 of 7 cases, respectively. In part 2, tumor recurrence was found in 14 cases with 19 metastatic sites. Thirteen of the 14 (92.9%) cases were detected by scheduled visiting and 11 (78.6%) detected by low-dose computed tomography including the 7 without symptoms. Of the 19 recurrent sites found in 14 patients, 11 ones (57.9%) were detected by low-dose computed tomography. CONCLUSIONS: Low-dose computed tomography may be of considerable value in early detection of tumor recurrence in postoperative non-small cell lung cancer patients. Further large prospective studies are needed to verify this issue.     

Multislice computed tomography angiography in pediatric liver transplantation

BACKGROUND: Preoperative delineation of any vascular anomalies offers planning for possible alteration of surgical procedures, especially in pediatric recipients undergoing living-related liver transplantation. PURPOSE: We assess the efficacy of three-dimensional (3D) multislice computed tomography (CT) angiography in the hope of replacing conventional angiography as the pretransplant evaluation of the hepatic vascular system for potential recipients of liver transplantation. METHODS: 3D CT angiography was performed in 38 children with biliary atresia. Conventional angiography was also performed in the first 15 patients. Twelve patients underwent living-related liver transplantation. The findings on 3D CT angiography were compared with conventional angiography and operative findings. RESULTS: 3D CT angiography was successfully performed in 37 pediatric patients. All findings of 3D CT angiography on hepatic artery, portal vein, and inferior vena cava paralleled those of catheter angiography and operative findings. Four patients were unsuitable to receive living grafts because of pathologic insults of the hepatic artery (one patient) and the portal vein (three patients). Three patients were advised to undergo a venous graft for portal anastomoses. Eight patients demonstrated portosystemic shunts that may require closure. CONCLUSION: 3D CT angiography proves to be a better tool in the demonstration of the vascular system and identification of pathologic insults in pediatric patients. It is superior to conventional angiography because it is less invasive, more convenient, and more efficient in providing thorough preoperative information that would have a major impact on patient selection and surgical planning.     

Responsiveness and Minimal Clinically Important Differences after Cholecystectomy: GIQLI Versus SF-36

Introduction  To compare responsiveness and minimal clinically important differences (MCID) between the Gastrointestinal Quality of Life (GIQLI) and the Short Form 36 (SF-36), we prospectively analyze 159 patients undergoing cholecystectomy at two tertiary academic hospitals. Patients and Methods  All patients completed the disease-specific GIQLI and the generic SF-36 before and 3 months after surgery. Scores using these instruments were interpreted by generalized estimating equation before and after cholecystectomy. The bootstrap estimation was used to derive 95% confidence intervals for differences in the responsiveness estimates. Results and Discussion  Mean changes in all GIQLI and the SF-36 subscales were statistically significant (p < 0.05). Comparisons of effect size (ES), standardized response means (SRM), and relative efficiency (>1) indicated that the responsiveness of the GIQLI was superior to that of the SF-36. In the equivalence test, all lower or upper confidence limits presented no equivalence (>5), indicating good MCID. The ES and SRM for emotions and physical function in the GIQLI significantly differed from those of the SF-36 (p < 0.05). Conclusion  The data in this study indicate that clinicians and health researchers should weight disease-specific measures more heavily than generic measures when evaluating treatment outcomes.     

Geriatric hemodialysis rehabilitation care

The 2 objectives of this review are to provide background information about functional status in older dialysis patients and to discuss the utility of geriatric dialysis rehabilitation. We performed a literature search using PubMed and MedLine. All relevant texts were reviewed for information on functional status and disability in the renal population and in the general population. Data pertaining to geriatric rehabilitation and geriatric dialysis rehabilitation were also reviewed. We show how disability and functional limitations are more prevalent in populations with advanced stages of chronic kidney disease (CKD) compared with those with only mild stages of CKD. We describe data showing that dedicated geriatric dialysis rehabilitation units, using interdisciplinary care models, result in more than 70% of patients meeting their rehabilitation goals and being successfully discharged home. Nephrologists increasingly will be faced with problems arising from functional decline. We conclude by offering suggestions for future changes that may help to stem the rising tide of dialysis disability.