Postoperative Morbidity of Biliopancreatic Diversion Depending on Common Limb Length

Background Laparoscopic gastric bypass, currently the most popular surgical method for bariatric therapy, have proved to be effective in weight loss, but some matters regarding its long-term efficacy for super-obese patients (BMI >50 kg/m²) have arisen. Biliopancreatic diversion (BPD) is a complex technique that has shown good results in the treatment of the super-obese patient. We analyze our >5 years results, evaluating weight loss, morbidity and mortality of this operation, depending on the length of the common and alimentary limbs. Methods We studied two series of patients: 150 patients with BPD of Scopinaro (50–200 cm) and 70 patients with modified BPD (75–225 cm). The results have been analyzed in terms of weight loss, co-morbidity improvement, and postoperative morbidity using BAROS. Results Range of follow-up is 1–12 years. Weight loss was slightly higher for the Scopinaro group than for the Modified group but with no significant difference. There was more prevalence of malnutrition and of iron deficiency in the Scopinaro group (16% and 60%) than in the modified group (2% and 40%), with similar postoperative morbidities. Conclusion The modified BPD method (75–225 cm) shows long-term effectiveness in weight loss and comorbidity improvement for super-obesity. Proteins, vitamins and oligoelement deficits appear distant in time, and thus it is necessary to maintain strict followup of these patients and supplement against deficiencies for the rest of their lives.     

Dysfunction of the pupillary light reflex following migraine headache

Using pupillometry and sympathetic skin responses we compared the changes in local and systemic autonomic function within one week of a migraine attack. We investigated whether the measurement of the pupillary light reflex provides further information on the pathophysiology of migraine. Forty-two migraine patients and forty-two healthy age-matched controls were included. The parameters that were measured were the amplitude of the pupillary light reflex, the pupil size at the beginning of the measurement, the latency, the velocity of constriction and the velocity at the end of the dilatation. The average pupil size was 6.43 mm in the migraine group and 6.7 mm in the control group (p < 0.01). Reduced velocity of constriction and smaller amplitude of constriction in migraine patients within two days of an attack were signs of a parasympathetic dysfunction (p < 0.05). The sympathetic skin response did not differ significantly between migraine sufferers and controls. These findings indicate that both parasympathetic and sympathetic nerves supplying the eye are involved in migraine headache presumably due to effects on the pericarotid sympathetic fibers and involvement of trigeminal-parasympathetic reflexes. Received: 24 July 2001, Accepted: 16 July 2002 Correspondence to K. Schepelmann, M. D.     

Study on enhancement of fibronectin-mediated bacillus Calmette-Guérin attachment to urinary bladder wall in rabbits

To clarify whether intravesical usage of fibrin clot stabilizer epsilon-aminocaproic acid (EACA) or p-aminomethyl benzoic acid (PAMBA) and different injuries enhance fibronectin (FN)-mediated bacillus Calmette-Guérin (BCG) attachment to bladder wall. Thirty New Zealand male white rabbits were randomly divided into five groups and the bladder wall of each rabbit was injured by electrocautery, cryocautery or knife cutting on left lateral wall, right lateral wall and posterior wall in different groups, respectively. Different drug was instilled into the bladder: Group A: pure PBS; B: PBS and radiolabeled BCG (³H-BCG); C: EACA and ³H-BCG; D: PAMBA and ³H-BCG; E: heparin and ³H-BCG. After instillation, each injured and non-injured bladder wall were surgically harvested and digested. The quantity of BCG attachment was detected by liquid scintillation counter (scintillation times per min, STPM). Quantity of BCG attachment to injured bladder wall was significantly (P < 0.01) greater than that of non-injured one, no matter which injury was performed. The BCG attachment to bladder wall in Group C or Group D was significantly (P < 0.05) greater than that of Group B. The quantity of BCG attachment to bladder of Group E was significantly (P < 0.05) less than that of Group B, C and D, respectively. Intravesical instillation of fibrin clot stabilizer (PAMBA, EACA) enhances FN-mediated BCG attachment to bladder wall while heparin inhibits this process. Injuries; e.g., cutting, cryocautery or electrocautery of bladder wall can significantly increase BCG attachment to the bladder wall.     

The Impact of Obesity and Metabolic Surgery on Chronic Inflammation

Background

Obesity and metabolic surgery is known to improve chronic inflammatory status. Whether improvement is related to anatomical changes or weight loss is still to debate.

Objective

The aim of this clinical trial is to compare the different bariatric procedures sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and One-anastomosis gastric bypass (OAGB), pertaining to their effects on inflammation markers.

Methods

Patients who underwent SG, RYGB, or OAGB as a primary treatment for severe obesity were included. The data collected preoperatively (T0) and 1, 3, and 6 (T6) months after surgery included gender, weight, comorbidities and toxic habits at baseline, body mass index (BMI), waist circumference, total body weight loss in % (TBWL), leukocyte count in ×?10³/μl, C-reactive protein (CRP) in mg/l, HbA1c in %, aspartate transaminase in U/l, alanine transaminase in U/l, gamma-glutamyltransferase in U/l, bilirubin in mg/dl, cholesterol in mg/dl, and triglycerides in mg/dl.

Results

Four hundred sixty-eight patients were included. Drop-out rate was 25.8% at T6. Preoperatively the mean value of leukocytes and CRP was 7.4?×?10³/μl?±?2 and 10.5 mg/l?±?8.1. At T6, mean value of leukocytes and CRP was 7.1?×?10³/μl?±?1.9 (p?=?0.075) and 7.2 mg/l?±?9.5 (p?<?0.001). TBWL % at T6 was 24.2?±?7.6 in the SG, 25.8?±?5.9 in the RYGB and 25.5?±?4.6 in the OAGB group. Comparing SG, RYGB, and OAGB in relation to leukocyte count and CRP no significant difference was seen between the groups.

Conclusion

CRP but not leukocyte count decreased after all three bariatric procedures but without any significance between the three groups. Surgically induced weight loss and not anatomical changes might play an important role for improvement in chronic inflammation.

Trial Registration

The National Clinical Trials number was NCT02697695 (https://clinicaltrials.gov/ct2/show/NCT02697695).

     

Treatment of brain oligometastases with hypofractionated stereotactic radiotherapy utilising volumetric modulated arc therapy

Stereotactic radiosurgery (SRS) is commonly used to treat brain metastases, particularly in the oligometastatic setting. This study analyses our initial experience in treating oligometastatic brain disease using Volumetric Modulated Arc Therapy (VMAT) to deliver hypofractionated stereotactic radiotherapy (HFSRT). Sixty-one patients were treated with HFSRT with a median dose of 24 Gy (range 22–40 Gy) in a median of three fractions (range 2–10 fractions). With a median follow-up of 23 months, the local control rate was 74 % for the entire cohort. Local control was 87 % for patients who had surgery with no radiological evidence of residual disease followed by HFSRT compared with 69 % in patients treated with HFSRT alone. The overall median time post radiotherapy to local failure was 8.6 months and to extracranial failure was 7.9 months. The mean time to distant brain failure was 9.9 months. Twenty-two patients (36 %) died during the study with median time to death of 4.4 months. Median overall survival (OS) from treatment was 21 months and 12 month OS was 60 %. Our experience with HFSRT using VMAT for oligometastatic brain metastases in the post-operative setting demonstrates comparable local control and survival rates compared with international published data. In the intact brain metastasis setting, local control using the dose levels and delivery in this cohort may be inferior to radio-surgical series. Local control is independent of histology. Careful selection of patients remains critical.     

A survey of visual function in an Austrian population of school-age children with reading and writing difficulties

Background  

To describe and compare visual function measures of two groups of school age children (6-14 years of age) attending a specialist eyecare practice in Austria; one group referred to the practice from educational assessment centres diagnosed with reading and writing difficulties and the other, a clinical age-matched control group.     

Influence of previous treatments on repeat surgery for recurrent craniopharyngiomas in children

Purpose

Craniopharyngioma is a common pediatric brain tumor, with a high rate of recurrence after primary treatment. This retrospective study investigated the effect of various primary treatments on surgical strategies and outcomes for recurrent craniopharyngiomas.

Methods

The study population comprised 35 children (mean age 8.77 years, range 1–16 years) with recurrent craniopharyngioma re-operated from January 1990 to January 2009. The recurrent craniopharyngiomas were excised whenever possible. For analysis, the patients were divided into four groups according to the primary treatment: radical tumor resection (A), incomplete tumor resection (B), radiotherapy + incomplete tumor resection (C), and Ommaya reservoir placement + incomplete tumor resection (D).

Results

Group B had a significantly shorter recurrence-free interval than groups A, C, or D. Outcomes were significantly different among the four groups. The hypothalamic status scores of groups A (2.38 ± 0.27) and C (2.28 ± 0.42) were significantly higher than that of group B (1.64 ± 0.20). There were no statistical differences between any two other groups.

Conclusions

In children, the primary treatments for craniopharyngioma should be considered when choosing the surgical strategy for recurrence. Radiotherapy before repeated surgery can result in a worse functional outcome and hypothalamic-pituitary function.

     

Anti-tumor Effect of All-<Emphasis Type="BoldItalic">Trans</Emphasis> Retinoic Acid Loaded Polymeric Micelles in Solid Tumor Bearing Mice

Purpose All-trans retinoic acid (ATRA) polymeric micelles were developed for parenteral administration. The distribution characteristics and antitumor activities of ATRA polymeric micelles were evaluated after intravenous administration to mice bearing CT26 solid tumors. Methods ATRA incorporated in poly(ethylene glycol)-poly(benzyl aspartate) block copolymer was prepared by the evaporation method. The levels of [³H]ATRA in blood and tissue including tumor were determined by measuring the radioactivity after injection into mice. The tumor volume and the survival of the mice were determined to assess the anticancer activity. Results The delivery of ATRA by polymeric micelles prolonged the blood circulation and enhanced the accumulation of ATRA in the tumor tissue compared with the administration of free ATRA. Tumor growth was significantly delayed and the survival time of mice was prolonged following the treatment by ATRA polymeric micelles demonstrating the improved anticancer activity of ATRA. Conclusion Polymeric micelles are a promising and effective carrier of ATRA in order to enhance tumor delivery and they have a promising potential application in the treatment of solid tumors.     

Hypertension and dementia

Hypertension is one of the principal risk factors for cerebrovascular diseases. Several epidemiologic studies have also indicated a positive correlation between cognitive decline or dementia and blood pressure level. Indeed, the results of most longitudinal studies show that cognitive functioning is often inversely proportional to blood pressure values measured 15 or 20 years previously. Cerebral infarcts, lacunae, and white matter changes are implicated in the pathogenesis of vascular dementia, but may also favor the development of Alzheimer’s disease. Microcirculation disorders and endothelial dysfunctions are also advanced to explain the deterioration in cognitive functions in hypertensive subjects. Data from recent therapeutic trials open the way to the prevention of dementia (vascular or Alzheimer’s type) by antihypertensive treatments and must be confirmed by other studies.