Gastric Plication Can Reduce Slippage Rate After Laparoscopic Gastric Banding

Background:

Laparoscopic insertion of a gastric band for weight reduction is increasingly performed in obese and morbidly obese patients. Complication rates after gastric band insertion are reduced by using certain techniques.

Patients and Methods:

This was a prospective study of all patients who underwent laparoscopic adjustable gastric band (LAGB) insertion at our unit. This procedure is performed through the classical 4-port technique and the use of a liver retractor. The pars flaccida method is performed in all patients, and the gold finger, a malleable instrument, is used to guide the band through the retroesophageal window in patients with difficult anatomy. Band slippage is avoided by using 2 types of gastric plication, depending on the anatomical characteristics of the stomach. Outcomes and morbidity are recorded, and patients are followed up in outpatient clinics.

Results:

Laparoscopic adjustable gastric band (LAGB) insertion was performed in 464 patients. A single consultant surgeon performed all procedures over a 2-year period. From August 2005 through August 2007, 380 (81.89%) women and 84 (18.10%) men were included in this study. The mean age was 41 years (range, 21 to 62). The mean body mass index was 43 (range, 35 to 62). Morbidity included dysphagia, epigastric pain, port displacement, port infection, erosion, and acute respiratory distress. Only one (0.21%) case of band slippage was reported. The mean follow-up was 26 months (range, 18 to 42).

Conclusion:

Laparoscopic gastric plication adds greater security and provides optimum gastric band placement. It is an effective method to reduce slippage after gastric band insertion.     

Hysteroscopic endometrial ablation using the Hydro ThermAblator in an outpatient hysteroscopy clinic: feasibility and acceptability

STUDY OBJECTIVE: To assess the feasibility and patient acceptability of global endometrial ablation using the Hydro ThermAblator (HTA) in an outpatient hysteroscopy clinic setting under local anaesthesia. DESIGN: A prospective cohort study (Canadian Task Force classification II-2). SETTING: University hospital in the United Kingdom. PATIENTS: Forty patients with medication-resistant menorrhagia. INTERVENTION: Oral mefenamic acid was administered 8 hours before the procedure. A combined cervical/paracervical block using lignocaine 1% adrenaline 1:200,000 was used before hysteroscopic endometrial ablation using the HTA device. MEASUREMENTS AND MAIN RESULTS: A successful procedure was defined as a completed HTA treatment cycle. Failure was defined as premature termination or inability to carry out the HTA procedure after scheduling the patient. Pain scores were estimated at three stages during and after the procedure using a visual-analog scale. A questionnaire was used before discharge to assess acceptability. Forty patients were successfully treated. The median pain score during the ablation was 6.4 (range 4.0-8.9). Eighty-eight percent of patients found the procedure acceptable. No serious complications occurred. All patients were discharged home within 2 hours of the procedure. CONCLUSION: Selected patients suffering from menorrhagia may be treated with the HTA device using local anesthesia in an outpatient setting.     

Facial paralysis during air travel: case series and literature review

Objective: We report three cases of recurrent, unilateral facial palsy associated with air travel. Method: The three cases are presented, along with a brief literature review concerning barotrauma and its association with air travel and facial palsy. Results: All three patients experienced unilateral facial paralysis during air travel, accompanied by additional symptoms which varied between cases. Symptoms resolved spontaneously in all cases. Two patients received ventilation tube insertion to prevent further recurrence. Computed tomography scanning revealed no bony defect in two patients, while the third exhibited dehiscence of the facial canal which may have contributed to the condition. Conclusion: Available evidence suggests that eustachian tube dysfunction can contribute to increased pressure within the middle ear, leading to neuropraxia of the facial nerve. Cases of facial paralysis associated with air travel are under-reported. Since there is no evidence-based management protocol for this condition, further investigation of its pathology is encouraged in order to improve our understanding.     

Efficacy of peripheral androgen blockade in prostate cancer patients with biochemical failure after definitive local therapy: results of Cancer and Leukemia Group B (CALGB) 9782

BACKGROUND:

The treatment for prostate cancer patients with biochemical failure after local therapy remains controversial. Peripheral androgen blockade using a combination of a 5‐alpha reductase inhibitor and an antiandrogen may allow control of the prostate‐specific antigen (PSA). Because testosterone levels are not suppressed, this approach may be associated with less morbidity than conventional gonadal androgen suppression.

METHODS:

All patients had undergone previous definitive local therapy and had evidence of a rising PSA >1ng/mL, with no evidence of recurrent disease. Patients received both finasteride, 5 mg orally per day, and flutamide, 250 mg orally 3× a day. Patients were followed for a PSA response and quality of life assessment.

RESULTS:

Ninety‐nine of 101 accrued patients were eligible. A ≥80% PSA decline was seen in 96 (96%) patients. The median time to PSA progression was 85 months. With a median follow‐up of 10 years, the median survival time had not been reached, and the 5‐year overall survival rate was 87%. Toxicity was mild, with 18 patients stopping for toxicity; 15 had diarrhea, 4 had gynecomastia, and 3 had transaminase elevation. Baseline Functional Assessment of Cancer Therapy Prostate Module and Treatment Outcome Index scores decreased by 5 points each at 6 months after enrollment.

CONCLUSIONS:

The use of the finasteride/flutamide combination is feasible, and results in PSA declines of ≥80% in 96% of patients with serologic progression after definitive local therapy. There were no unexpected toxicities, and the change in quality of life was mild. Further evaluation of this or a similar regimen in a controlled clinical trial is warranted. Cancer 2012. © 2011 American Cancer Society.