Revisional Surgery for Severe Obesity with Fascia Banded Stoma Roux-en-Y Gastric Bypass

The fascia banded stoma Roux-en-Y gastric bypass (RYGBP) has been effective both as a primary and revision operation for severe obesity or failure of another operation. Since May 1984, 361 primary and 100 revisional fascia banded RYGBP operations have been reported. Weight loss achieved a mean body mass index of 30 for primary and 31 for revision patients at most recent follow-up of 3-6 years (mean 4.3 years) postoperatively. Mean overweight was 28% for primary, and 34% for revision patients. Eighty percent of primary and 79% of revision patients were within 50% of ideal weight. Revision rates for these patients were 0 for primary and 1% for revision patients. Operative mortality was 0 for primary and 1% for revision patients. Since morbidity and mortality, although low, are higher for revision than primary surgery, it is important to use an effective primary operation.     

Holmium:YAG- und erbium :YAG-infrarotlaser-osteotomie

Zusammenfassung Die knochenablative Wirksamkeit der gepulsten Festkörperlaser Holmium:YAG ( = 2120 nm) and Erbium:YAG ( = 2940 nm) wurde im Tierversuch vergleichend untersucht. Als Modell für eine klinische Anwendung wurden partielle Oberkiefer-, Unterkiefer-und Nasenbeinosteotomien an der Ratte durchgeführt. In einer ersten Versuchsreihe wurden die unmittelbare klinische Wirkung und das histologische Wirkungsprofil dieser Infrarotlaser am Hartgewebe erforscht und die Temperaturgradienten im Knochen während der Laseranwendung gemessen. Die geringe Ausdehnung der Schädigungszone im Randbereich der Laserinzisionen und das für den Erbium:YAG-Laser praktisch atraumatische, athermische Knochenabtragungsvermögen läßt die neuen Infrarotlaser als ideale Schneidegeräte für Osteotomien erscheinen.

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Holmium:YAG laser and erbium:YAG laser infrared laser osteotomy

Summary The in-vivo bone ablation characteristics of a pulsed solid-state erbium:YAG laser were compared to those of a pulsed solid-state holmium:YAG laser. Partial osteotomies in the maxillary, the mandibulary, and the nasal bones of white rats were performed. The tissue response was examined by light microscopy. Thermal gradients following the laser application were also measured. Over all energy levels tested the erbium:YAG laser produced ablation of bone with minimal thermal damage to the adjacent tissue. The results of this study are promising for future application of the infrared holmium-and erbium:YAG lasers in otorhinolaryngology.

     

Syringe liposculpture: A two-year experience

Syringe liposcupture is a method that combines two relatively new techniques of plastic surgery: syringe liposuction and fat grafting. We can reshape the face and the body by removing localized fat deposits and reinjecting this fat where needed. When we do not reinject, we call the technique reduction liposculpture. In 1989 we introduced a new technique—superficial syringe liposculpture—to treat patients with flaccid skin, superficial irregularities or depressions, cellulite, and liposuction sequelae. The technique combines syringe liposculpture, superficial liposuction, and our method of treating skin irregularities by breaking the fibrous adherences and injecting fat superficially.     

Secondary hyperparathyroidism and osteopenia in women following gastric exclusion surgery for obesity

Gastric exclusion has been introduced as a surgical treatment for morbid obesity. We describe two women who had undergone gastric bypass for obesity with metabolic bone disease and secondaryhyperparathyroidism. In one patient transiliac bone biopsy after double tetracycline labelling demonstrated histologic evidence of hyperparathyroidism with osteitis fibrosa cystica. Six additional women who had undergone gastric exclusion were evaluated. Serum phosphorus, calcium, and creatinine were normal in all but one patient who had hypocalcemia. Serum immunoreactive parathyroid hormone was elevated in seven of eight patients and urinary calcium was 2 mmol/d (80 mg/24 h) in 6 patients. Lumbar spine bone mineral density was 86±7 (mean±SE) per cent of predicted and femoral neck bone mineral density was 89±6 per cent of predicted. Women who have had gastric exclusion for obesity may develop secondary hyperparathyroidism which could result in loss of bone mass.Deceased     

Predeposit Autologous Blood Donation: a survey of patient attitudes

Attitudes to autologous blood donation have been surveyed in a group of 38 postoperative bariatric patients. Only two patients (5%) declined to participate. Twenty-eight of 38 (70%) successfully predeposited autologous blood. Twenty-five of 28 donors (90%) had done so at the suggestion of their surgeon. Concern about contracting AIDS was the motivating factor in the majority of patients (21 patients, = 55%). Lack of infectious complications in general was cited by an additional four (11%). All respondents would donate autologous blood in the future, and would recommend the procedure to others who were about to undergo elective surgery. There was an increase from 29% to 50% who stated that, following their autologous donation experience, they would consider being homologous volunteer blood donors in the future.     

Long-term Result of Treatment of Prader-Willi Syndrome by Scopinaro's Bilio-pancreatic Diversion. Study of Three Cases and the Effect of Dextrofenfluramine on the Postoperative Evolution

The Prader-Willi syndrome shortens the life of patients due to the morbid obesity which it entails. The compulsive hyperphagia associated with it makes a dietetic treatment or a gastroplasty difficult. This study presents the case-histories of three patients suffering from the Prader-Willi syndrome who were operated on by means of a Scopinaro's bilio-pancreatic diversion. Following a marked reduction the first year, the weight loss stabilized and then tended to diminish. The observation of three cases which continued for two and a half to six years did not reveal any considerable metabolic problems. The deficiency of iron, vitamins D and B12 as well as folic acid had to be made up by supplementation. These results are comparable with the most favorable ones in the literature. Even if the effect on the weight loss is not spectacular, the operation manages to hold off the development of the obesity, inexorable for those with the Prader-Willi syndrome, and prevents lethal complications, without having notable side effects. Lifting coercive dietary measures improves the quality of life.     

Obesity Surgery Poly-parametric Patient Auto-evaluation

A simple auto-evaluation sheet is presented for the proper assessment of the patient's condition after surgery. Stress is put not only on weight loss, but on other important factors as well.     

Pharmacological aspects of anaesthesia for implantation of the artificial lens

During the placement of an artificial lens the ophthalmic surgeon must be guaranteed an immobile operation site and so-called soft eye. Based on our experience with more than 1000 lens implantation operations in the Rotterdam Eye Hospital over the past three years, the following conclusions can be drawn: The pharmacological agents available to the anaesthetist are sufficient for providing optimal conditions under general anaesthesia for lens implantation techniques by the eye surgeon. Hypotensive techniques are not regarded as being appropriate because of the inherent risks involved. Classical neuroleptic techniques are best avoided in the elderly. Controlled ventilation is preferable in order to avoid the deleterious side effects of hypercarbia. Constant vigilance on the part of the anaesthetist during the operation is a very important sine qua non for a tranquil course both during the anaesthetic and in the post-operative period. The routine administration of antiemetic agents after a lens implantation operation is advisable this holds true also for prevention of the Central Anticholinergic Syndrome by means of physostigmine, in patients who have received inhalation anaesthetics, particularly enflurane or, flunitrazepam.     

Post-operative pain and inflammatory reaction reduced by injection of a corticosteroid

Summary In a controlled crossover study, identical surgical procedures, the prophylactic removal of bilateral non-erupted 3rd molar teeth, were performed on two separate occasions in 24 healthy patients. Prior to each procedure, either betamethasone 9 mg (Celeston Chronodose^®) or placebo was administered intramuscularly, in a randomized fashion. Objective and subjective assessments were recorded for paired comparison of the post-operative course, including swelling, pain, trismus, local temperature, bleeding, wound-healing and preference for treatment. In 23 patients, less swelling occurred when betamethasone was given pre-operatively. The mean reduction on the 3rd and 6th post-operative days was 55% (p<0.001) and 69% (p<0.001), respectively. Pain assessments (visual analogue scale) were significantly lower after the corticosteroid injection; mean response: 1st evening 17 vs 56 mm, 2nd evening 5 vs 37 mm, and 3rd evening 2 vs 13 mm. No significant correlation between the steroid-induced reduction in swelling and pain could be made. This may indicate that dissociation may exist between pain and other inflammatory events like swelling. No clinically apparent infection or other disturbance of wound-healing was noted after corticosteroid administration. This treatment course was preferred by 23 of the 24 patients.     

小切口白内障手术中后囊膜破裂一期人工晶体植入术临床疗效分析

目的评价小切口白内障摘除术术中后囊膜破裂的原因及处理方法.方法回顾分析1 05 6例小切口白内障手术联合人工晶体植入术,其中术中51例后囊膜破裂,玻璃体溢出,行前段玻璃体切割术联合一期后房型人工晶体植入术.结果本组患者手术中后囊膜破裂发生率为4.8%,全部行一期后房型人工晶体植入术,其中5例囊袋内固定植入,42例睫状沟固定植入和4例DGR人工晶体双襻缝线固定法植入.术后矫正视力大于或等于0.3者46例(90.2%);矫正视力大于或等于0.05,低于0.3者4例(7.8%);矫正视力低于0.05者1例(2.0%).结论前段玻璃体切割术为小切口白内障摘除术中后囊膜破裂一期人工晶体植入提供了安全有效的保证.