Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity

BACKGROUND: A scoring system for clinical assessment of mortality risk has been previously proposed for bariatric surgery (Demaria EJ, Portenier D, Wolfe L, Surg Obes Relat Dis. 2007;3:34-40.). The Obesity Surgery Mortality Risk Score (OS-MRS) was developed from a single institution experience of 2075 patients. The current study provides multicenter validation of the value of the OS-MRS. The OS-MRS assigns 1 point to each of 5 preoperative variables, including body mass index>or=50 kg/m2, male gender, hypertension, known risk factors for pulmonary embolism (previous thromboembolism, preoperative vena cava filter, hypoventilation, pulmonary hypertension), and age>or=45 years. Patients with total score of 0 to 1 are classified as 'A' (lowest) risk group, score 2 to 3 as 'B' (intermediate) risk group, and score 4 to 5 as 'C' (high) risk group. METHODS: Prospectively-collected data from 4431 consecutive patients undergoing a primary gastric bypass at 4 bariatric programs recruited to validate the proposed system were analyzed to assess OS-MRS as a means of stratifying surgical mortality risk. RESULTS: There were 33 total deaths for an overall mortality for the validation cohort of 0.7% consistent with published standards. Mortality for 2164 class A patients was 0.2%, for 2142 class B patients was 1.1%, and for 125 class C patients was 2.4%. Mortality was significantly different between each of the class A, B, and C groupings (P<0.05, chi2). Mortality was 5-fold greater in the class B group than in class A. Only 6 patients with all 5 risk factors were identified. Class C patients (n=125, 3% of total cohort) were characterized by a 12-fold greater mortality than the lowest risk group (A) and a disproportionate 9% of all mortalities. CONCLUSION: The OS-MRS was found to stratify mortality risk in 4431 patients from 4 validation centers that were nonparticipants in the original defining cohort study. The score represents the first validated scoring system for risk stratification in bariatric surgery and is anticipated to aid informed consent discussions, guide surgical decision-making, and allow standardization of outcome comparisons between treatment centers.     

Genetic,molecular and functional analyses of complement factor I deficiency

Complete deficiency of complement inhibitor factor I (FI) results in secondary complement deficiency due to uncontrolled spontaneous alternative pathway activation leading to susceptibility to infections. Current genetic examination of two patients with near complete FI deficiency and three patients with no detectable serum FI and also close family members revealed homozygous or compound heterozygous mutations in several domains of FI. These mutations were introduced into recombinant FI and the resulting proteins were purified for functional studies, while transient transfection was used to analyze expression and secretion. The G170V mutation resulted in a protein that was not expressed, whereas the mutations Q232K, C237Y, S250L, I339M and H400L affected secretion. Furthermore, the C237Y and the S250L mutants did not degrade C4b and C3b as efficiently as the WT. The truncated Q336x mutant could be expressed, in vitro, but was not functional because it lacks the serine protease domain. Furthermore, this truncated FI was not detected in serum of the patient. Structural investigations using molecular modeling were performed to predict the potential impact the mutations have on FI structure. This is the first study that investigates, at the functional level, the consequences of molecular defects identified in patients with full FI deficiency.     

Incidence of hypothyroidism after radiotherapy for nasopharyngeal carcinoma

Objectives: The thyroid gland is frequently affected by radiotherapy applied for the treatment of head and neck tumors. Hypothyroidism is observed as a late side effect of radiotherapy, especially seen in the patients who have surgery in the treatment procedure. Methods: We evaluated the radiation-induced hypothyroidism for a selected type of head and neck cancer—nasopharyngeal cancer (NPC)—which does not include surgery involving the thyroid gland in the treatment. Results: We observed 12 patients (14%) who developed hypothyroidism, two of which were subclinical hypothyroidism. The patients with hypothyroidism were statistically significantly younger than the euthyroid patients, but there were no statistically significant differences among the two groups in disease stages, radiotherapy neck doses, and gender. Conclusions: We recommend life-long TSH screening after RT to the neck owing to the incidence of RT-induced hypothyroidism and the importance of early thyroid hormone replacement therapy in patients becoming hypothyroid for maintaining optimal quality of life.     

Total thyroidectomy: initial experience of a territorial reference center

Authors report their initial experience in surgical treatment of thyroid diseases in an area with high percentage of thyroid tumors. Since January 2006, we examinated 428 patients. By clinical features, hormonal profile, imaging and US-guided FNAB, we selected 134 of them for surgery; 93 patients underwent thyroidectomy in January-November 2006. The Authors analyse therapeutic choises and surgical techniques, stressing the high percentage of thyroid neoplasms.     

Does Helicobacter pylori infection play a role in lung cancer?

BACKGROUND: Helicobacter pylori infection is a world-wide common disease and leads to many gastrointestinal and respiratory illnesses. It is suggested that one of these respiratory illnesses is lung cancer. METHODS: Forty-three patients with non-small cell lung cancer and 28 control subjects have been included to this study. H. pylori status of the patients and controls was determined by immunoblot for the detection of IgG (RIDA Blot Helicobacter). All subjects were examined to evaluate the presence of VacA and CagA gene. RESULTS: Seropositivity of anti H. pylori IgG was significantly higher in cancer patients than in control groups, 40 (93%) and 12 (42%), respectively (P<0.01). Although both VacA and CagA seropositivity was high in lung cancer patients, only VacA positivity was statistically significant when compared with control subjects, 35 (81%) and 11 (42%), respectively (P<0.05). CONCLUSION: H. pylori infection may be associated with development of lung cancer.