Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications

PURPOSE: To determine the role of radiographic assessment in patients who underwent an adjustable laparoscopic gastric banding (ALGB) for the treatment of morbid obesity, and to evaluate the frequency and type of postoperative complications. MATERIALS AND METHODS: From September 1995 to March 1998, 98 consecutive patients (18 men, 80 women; mean age, 39 years; age range, 22-62 years) with morbid obesity (mean body weight, 132 kg; mean body mass index, 47.1 kg/m(2)) underwent ALGB. In all patients, fluoroscopy was performed postoperatively to confirm band position and to exclude perforation and at 6-8 weeks later to measure and adjust the stoma between the pouch and stomach for optimal weight loss. All patients underwent another examination 12 months postoperatively, whereas patients with unsatisfactory weight loss or patients suspected of having complications were examined earlier and on several occasions. RESULTS: Port puncture was feasible in all cases, and stomal adjustments could easily be repeated. Absolute (ie, total) weight loss after 1 year ranged from 8.8% to 39.2% (mean, 18.3%). Twenty patients showed unsatisfactory weight loss. No early complications occurred. Late complications occurred in 34 patients and included pouch dilatation (concentric or eccentric with posterior slippage), eccentric band herniation, band penetration, disconnection, axial pouch herniation, and port-site infection. CONCLUSION: ALGB is an effective method in the treatment of morbid obesity. Radiographic assessments are crucial in the management of weight loss and detection of postoperative complications.     

Prognostic markers of sepsis and septic shock

The first stage of systemic inflammatory response during sepsis and septic shock is the massive production of proinflammatory cytokines. Numerous clinical trials were done investigating various agents that were thought to stop this reaction. The results, however, were disappointing. Then it was realised that massive production of antiinflammatory cytokines could also be delirious. Persistent immunosuppression in the course of sepsis increased the risk of death. Therefore the proper balance between pro- and antiinflammatory mediators is extremely important and the methodologies available for monitoring immunological status in patients with sepsis and septic shock are currently of great interest.     

Diagnosis and treatment of hepatic cysts

Hepatic cysts are at the present time of widespread use of abdominal ultrasonography a frequent finding. The authors summarize contemporary diagnostic possibilities of liver cysts and submit variants of the therapeutic procedure in case of symptomatic liver cysts. They present their own experience with the treatment of hepatic cysts by the evaluation method combined with administration of 96% ethanol into the cyst. They compare this therapeutic procedure with the method of simple evaluation of the contents of the cyst. The method of evaluation of hepatic cysts under ultrasonographic control with subsequent administration of 96% alcohol appears to be more successful from the aspect of the long-term effect, manifested by the disappearance of clinical symptoms and non-refilling of the cyst.     

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??Multi-disciplinary team and conversion therapy for colorectal cancer with unresectable liver metastases??A report of 86 patients WEI-Ye*??YE Qing-hai??YU Yi-yi??et al. *Department of General Surgery, Zhongshan Hospital??Fudan University??Shanghai200032??China
Corresponding author??QIN Xin-yu??E-mail??qin.xinyu@zs-hospital.sh.cn
Abstract Objective To analyze safety and effect of the conversion therapy for initially unresectable colorectal liver metastases (CLMs) under the guidance of multi-disciplinary team (MDT). Methods The retrospective analysis was conducted for 86 patients with unresectable CLMs received MDT management and arrived conversion therapy successfully from January 2008 to December 2011 in Zhongshan Hospital of Fudan University. The perioperative and survival outcomes??prognostic factors were evaluated. Results During the mean follow-up of 41 months (24-68 months), according to the finding time of liver metastases of 86 patients??recurrence events were 73 patients??and 39 patients died. The 1 year??2 year and 3 year overall survival rate (OS) was 90.6%??75.6% and 65.1% respectively. The median OS time was ??47.5±3.1?? months. The 1 year??2 year and 3 year disease free survival rate (DFS) was 72.1%??48.8% and 31.4% respectively. The median DFS time was ??22.0±2.9?? months. The OS and DFS were no significant difference when compared 86 patients with initially unresectable CLMs successfully arrived conversion therapy with 99 patients with initial resectable CLMs??P >0.05??. The perioperative mortality rate was 1.5%??and operative complication rate was 24.4%. Tumor regression grade and early tumor shrink could predict the prognosis of CLM patients received conversion therapy. Conclusion The conversion therapy under the guidance of MDT mode is safe and effective for unresectable CLMs. The mid-term survival rate is similar with initially resectable CLMs??and long-term survival is expected.     

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??Objective To evaluate the effect of plugging tests in the diagnosis and interventional treatment of pediatric patients with patent duct arteriosus complicated with severe pulmonary hypertension ??PAH??. Methods??All the clinical data of 5 patients of PDA with severe PAH were retrospectively reviewed??including the heart catheterization data??the relevant parameters before and after acute pulmonary vasodilator tests and the changes of Pp??Ps??PVRI??and aortic blood oxygen saturation before and after the plugging tests. Results??Only 1 patient was with dynamic PAH according to heart catheterization test??however??for the other 4 patients it was difficult to judge the property of PAH. Acute pulmonary vasodilator tests were performed in 5 patients and 4 were diagnosed with dynamic PAH. Plugging tests were conducted in 5 patients and all of them were diagnosed with dynamic PAH. All the patients underwent interventional therapy well and the follow-up results were good. Conclusion??For PDA patients with severe PAH??plugging test diagnosis can be made on the properties of the PAH and if the determination is dynamic??the intervention treatment can be completed at the same time. This method can effectively avoid the limitations of cardiac catheterization and acute pulmonary vasodilator testing evaluation of PAH properties.     

Addition of a defibrillation electrode in the low right atrium to a right ventricular lead does not reduce ventricular defibrillation thresholds

Transvenous unipolar active can defibrillation systems have proven to be effective in treating ventricular tachyarrhythmias. However, a further reduction of ventricular defibrillation thresholds (V-DFT) would increase the longevity, reduce the size of pulse generators, and help to avoid additional leads in patients with inacceptable high V-DFTs. In a finite difference computer model, the extension of the right ventricular (RV) defibrillation coil into the low right atrium led to a 40% reduction of unipolar V-DFT. To evaluate this finding, we conducted a prospective, randomized study in 11 patients receiving an ICD. Extension of the RV electrode was simulated by adding a second coil placed in the low right atrium with the same polarity. Using a binary search protocol, V-DFT was determined with and without the additional electrode in each patient. Total shock impedance was significantly lower in the two coil (low RA) configuration, compared to the single coil (RV) configuration. Corresponding values were 49.9 +/- 6.7 Ohm and 61.1 +/- 9.3 Ohm, respectively (P < 0.01, paired t-test). However, there was no reduction, but even a nonsignificant increase in V-DFTs. Mean V-DFT in the RV configuration was 12.0 +/- 5.6 J and 16.3 +/- 7.8 J in the low RA configuration (P = 0.09, paired t-test). Despite a reduction in total impedance, the addition of a defibrillation coil in the low right atrium does not reduce ventricular defibrillation thresholds.     

下前牙区即刻种植同期引导骨再生结合帐篷式植骨术实施种植修复临床观察（附1例报告）

随着生活水平及治疗技术的提高,种植修复成为越来越多患者的选择。良好的牙槽嵴和牙龈解剖形态的保存或重建是修复体获得满意美学效果和长期稳定性的先决条件。下前牙是牙周炎的好发牙位,下前牙松动脱落伴随下颌骨的吸收势必会造成软硬组织缺陷。文章完整展示了1例罹患重度牙周病变的下前牙即刻种植、同期引导骨再生结合帐篷式植骨术创造良好硬组织三维条件,获得最终较好种植修复效果的具体实施步骤,积累了针对此类问题的临床经验。     

22-j?hriger Sportler mit Sinusarrest und Pausen bis 7?Sekunden

A 22-year-old athlete with nocturnal asymptomatic episodes of transient sinus arrest/sinoatrial block up to 7.3?s and recurrent inappropriate sinus tachycardias which had been incidentally found during Holter electrocardiography diagnostics is presented. In spite of extensive diagnostic work-up including invasive procedures like coronary angiography and electrophysiological study, no causal etiology was found. Based on the normal findings and the lack of symptoms, we decided not to implant a permanent pacemaker. After 14?months, the patient is still asymptomatic. Howerver, the 24-h Holter electrocardiography shows unchanged frequency of nocturnal transient sinus arrest episodes.