Early appearance of the metabolic syndrome in socially reared bonnet macaques

Among 250 laboratory-born bonnet macaques living in social groups and maintained on commercial monkey chow, we measured weight, crown-rump length, sagittal abdominal diameter (SAD), and fasting serum insulin, glucose, triglycerides, high-density lipoproteins, low-density lipoproteins, and total cholesterol. Body mass index (BMI = weight/crown-rump length(2)), and insulin resistance determined by the insulin/glucose ratio (IGR) and homeostasis model assessment, were measured. We defined the metabolic syndrome using a composite score based on morphometry, insulin resistance, and serum lipid levels, analogous to clinical criteria. Elevated BMI was associated with significantly greater SAD, insulin, IGR, homeostasis model assessment, and triglycerides. Among 120 adult monkeys aged 5-17 yr, males (n = 48) had higher BMI, SAD, insulin, and IGR levels than females, independent of age. Sixteen of 113 adult monkeys and five of 36 peripubertal subjects, aged 3-4 yr (14%), met our criteria for the metabolic syndrome, as did four of 12 monkeys, aged 20-28 yr. Markers of the metabolic syndrome are present by 3-4 yr of age in our colony and are observed across the life span in the absence of conventional obesifying interventions. Socially reared and housed bonnet macaques may provide a useful model for studying the pathogenesis, prevention, and treatment of the metabolic syndrome.     

Septal Course of Left Anterior Descending Artery From the Right Aortic Sinus in Tetralogy of Fallot: A Benign Anomaly and Important Lessons Learned

The proximal course of an anomalously arising coronary artery is a decisive factor in the surgical approach for tetralogy of Fallot (TOF). Studies have shown that echocardiography provides a good anatomic definition of the ostium and proximal epicardial course of coronary arteries [1, 2]. This report describes a case of TOF with an atrioventricular canal defect whose preoperative echocardiography showed abnormal origin of the left anterior descending artery (LAD) from right aortic sinus, which was interpreted as crossing the right ventricular outflow tract. Perioperative inspection did not show any abnormal vessel crossing the outflow, and corrective surgery was performed. At the echocardiographic evaluation after surgery, it was noted that the abnormal LAD arising from right aortic sinus was taking a septal course in relation to the posterior aspect of the pulmonary annulus. It is important to recognize this anomalous course because it is benign with no surgical implications.     

Do Independent Sector Treatment Centres (ISTC) Impact on Specialist Registrar Training in Primary Hip and Knee Arthroplasty?

INTRODUCTION

The introduction of Modernising Medical Careers (MMC) is likely to reduce specialist registrar (SpR) operative experience during higher surgical training (HST). A further negative impact on training by local Independent Sector Treatment Centres (ISTCs) could reduce experience, and thus competence, in primary joint arthroplasty at completion of higher surgical training.

PATIENTS AND METHODS

Retrospective case note and radiograph analysis of patients receiving primary hip and knee arthroplasty in a teaching hospital, before and after the establishment of a local ISTC. Patients and operative details were recorded from the selected case notes. Corresponding radiographs were assessed and the severity of the disease process assessed.

RESULTS

Fewer primary hip and knee replacements were performed by SpRs in the time period after the establishment of an ISTC.

Conclusions

ISTCs may adversely affect SpR training in primary joint arthroplasty.     

Laparoscopic Cholecystectomy for Acute Cholecystitis: Does Timing Matter?

Acute cholecystitis is a common cause of acute abdominal pain and the definitive treatment is laparoscopic cholecystectomy. When to perform surgery remains controversial. To find out whether laparoscopic cholecystectomy can be performed for acute cholecystitis irrespective of the time since onset of acute symptoms. A total of 200 laparoscopic cholecystectomies performed for acute cholecystitis were evaluated for duration of surgery, conversion rates, biliary and other organ injury, and postoperative stay. Kruskal–Wallis tests, Mann–Whitney tests, and paired t-tests using SPSS software. Thirty patients underwent laparoscopic cholecystectomy within 48 h of onset of symptoms (group 1), 60 patients underwent surgery between 48 h and 6 weeks of onset of symptoms (group 2), and 110 patients underwent surgery after 6 weeks of onset of symptoms (group 3). While the duration of surgery was significantly shorter in group 3 compared to groups 1 and 2 (57.5 min vs. 53.5 min vs. 34.2 min), there were no conversions or major biliary or other organ injury in any of the three groups. Postoperative stay was also comparable between the three groups (3 days vs. 3.1 days vs. 3.08 days). Laparoscopic cholecystectomy can safely be performed at any time after the onset of acute cholecystitis.