Three-Year Experience of Pouch Dilatation and Slippage Management after Laparoscopic Adjustable Gastric Banding

Purpose

Pouch dilatation and band slippage are the most common long-term complications after laparoscopic adjustable gastric banding (LAGB). The aim of the study is to present our experience of diagnosis and management of these complications.

Materials and Methods

The pars flaccida technique with anterior fixation of the fundus was routinely used. All band adjustments were performed under fluoroscopy. We analyzed the incidence, clinico-radiologic features, management, and revisional surgeries for treatment of these complications. We further presented the outcome of gastric plication techniques as a measure for prevention of these complications.

Results

From March 2009 to March 2012, we performed LAGB on 126 morbidly obese patients. Among them, 14 patients (11.1%) were diagnosed as having these complications. Four patients (3.2%) had concentric pouch dilatations, which were corrected by band adjustment. Ten (7.9%) had eccentric pouch with band slippage. Among the ten patients, there were three cases of posterior slippage, which were corrected by reoperation, and seven cases of eccentric pouch dilatation with anterior slippage. Three were early anterior slippage, which was managed conservatively. Two were acute anterior slippage, one of whom underwent a revision. There were two cases of chronic anterior slippage, one of whom underwent a revision. The 27 patients who underwent gastric plication did not present with eccentric pouch with band slippage during the follow-up period.

Conclusion

The incidence of pouch dilatation with/without band slippage was 11.1%. Management should be individualized according to clinico-radiologic patterns. Gastric plication below the band might prevent these complications.     

Maternal choline supplementation differentially alters the basal forebrain cholinergic system of young‐adult Ts65Dn and disomic mice

Down syndrome (DS), trisomy 21, is a multifaceted condition marked by intellectual disability and early presentation of Alzheimer's disease (AD) neuropathological lesions including degeneration of the basal forebrain cholinergic neuron (BFCN) system. Although DS is diagnosable during gestation, there is no treatment option for expectant mothers or DS individuals. Using the Ts65Dn mouse model of DS that displays age‐related degeneration of the BFCN system, we investigated the effects of maternal choline supplementation on the BFCN system in adult Ts65Dn mice and disomic (2N) littermates at 4.3–7.5 months of age. Ts65Dn dams were maintained on a choline‐supplemented diet (5.1 g/kg choline chloride) or a control, unsupplemented diet with adequate amounts of choline (1 g/kg choline chloride) from conception until weaning of offspring; post weaning, offspring were fed the control diet. Mice were transcardially perfused with paraformaldehyde, and brains were sectioned and immunolabeled for choline acetyltransferase (ChAT) or p75‐neurotrophin receptor (p75^NTR). BFCN number and size, the area of the regions, and the intensity of hippocampal labeling were determined. Ts65Dn‐unsupplemented mice displayed region‐ and immunolabel‐dependent increased BFCN number, larger areas, smaller BFCNs, and overall increased hippocampal ChAT intensity compared with 2N unsupplemented mice. These effects were partially normalized by maternal choline supplementation. Taken together, the results suggest a developmental imbalance in the Ts65Dn BFCN system. Early maternal‐diet choline supplementation attenuates some of the genotype‐dependent alterations in the BFCN system, suggesting this naturally occurring nutrient as a treatment option for pregnant mothers with knowledge that their offspring is trisomy 21. J. Comp. Neurol. 522:1390–1410, 2014. © 2013 Wiley Periodicals, Inc.     

缝隙连接在血管内皮和平滑肌细胞中的作用及其与高血压的关系

细胞间的直接通讯--缝隙连接在控制和协调血管功能方面起重要作用。缝隙连接是沟通相邻细胞质膜的唯一一类通道,为离子、小分子代谢物质、第二信使等细胞间信号分子的直接交换提供一个通道。血管内皮细胞和平滑肌细胞表达多种类型缝隙连接蛋白(connexin,Cx),多种Cx 在心血管系统中的共同表达并协调一致地工作,对心血管系统的发育、平滑肌和内皮细胞功能的整合、以及对血管壁细胞功能协调等起着重要作用。在血管发生疾病时Cx表达相应发生改变,以与缝隙连接调节血管紧张度和动脉血压的作用相一致。本综述讨论了在血管内皮和平滑肌细胞在生理和病理情况下(以高血压为例)缝隙连接对血管结构和功能的影响。     

Posterior Femoral Condylar Offset After Total Knee Replacement in The Risk of Knee Flexion Contracture

The aim of this study was to clarify the risk of knee flexion contracture associated with a posterior femoral condylar offset after total knee replacement (TKR). Radiographs from 100 healthy Japanese volunteers were included in the study. We evaluated femoral component posterior offset in various implants and compared them with the normal Japanese knee. Posterior offset of the femoral condyle is up to a maximum of 4.7 times greater than that of the healthy Japanese knee in all knee implants. Excess posterior offset of the femoral condyle in TKR prostheses may cause knee joint flexion contracture due to the relative shortening of the posterior soft tissue.     

Influence of internal-gap width and cement type on the retentive force of zirconia copings in pullout testing

Objectives

The purpose of this study was to evaluate the influence of internal-gap width and cement type on the retentive force of zirconia copings.

Methods

A CAD/CAM system was used to mill 48 identical abutments on extracted human molars and fabricate 48 zirconia copings. The internal-gap width for cement was set to 40 μm or 160 μm (n = 24 each). Three cement types (Panavia F, RelyX Unicem, and RelyX Luting) were used with each internal-gap width (n = 8/cement type). The intaglio surfaces of the copings were airborne-particle abraded, and each coping was cemented onto the corresponding abutment using the indicated luting agent. After 10,000 cycles of thermocycling, the retentive force was evaluated by pullout tests. Kruskal–Wallis and Wilcoxon Rank Sum tests were used for data analysis (α = 0.05).

Results

In the 40-μm gap groups, Panavia F had the highest mean retentive force compared to RelyX Unicem and RelyX Luting (P < 0.000). In 160-μm gap groups, RelyX Unicem had the highest mean retentive force compared to Panavia F and RelyX Luting (P < 0.000).

Conclusions

With the increase in internal gap width, a resin cement with self-etching agents as a co-initiator for autopolymerization resulted in significantly decreased retentive force, whereas a resin-modified glass ionomer cement or a self-adhesive resin cement did not. Use of resin cements rather than resin-modified glass ionomer cements improved the retentive force of zirconia copings regardless of the amount of internal gap width.