Failed gastroplasty for morbid obesity. Revised gastroplasty versus Roux-Y gastric bypass

Forty-six percent of 122 gastroplasties for morbid obesity failed. This included a failure rate of 71 percent for a single staple line without stomal reinforcement, 37 percent for a double staple line and a central stoma reinforced with 2-0 polypropylene, and 42 percent for the Gomez gastroplasty. Revisional procedures were performed in 44 patients. Ten underwent revision of a failed gastroplasty using a gastrogastrostomy and 34 had conversion to a Roux-Y gastric bypass. Patients who had revisional gastroplasty as a second procedure had a significantly higher failure and complication rate than those converted to gastric bypass. Four of these 10 patients were subsequently converted to gastric bypass as their third weight reduction procedure. Conversion of a failed gastroplasty to a Roux-Y gastric bypass is a difficult procedure that carried a significantly higher complication rate in our study than that of a group of 46 patients who underwent a primary gastric bypass procedure. Of 26 patients followed for more than 1 year after conversion to Roux-Y gastric bypass, the average weight loss was 66 +/- 18 percent of their excess body weight. This was comparable to 16 patients who had undergone a primary gastric bypass more than 1 year previously and had lost 69 +/- 17 percent of their excess body weight.     

Clinical Utility of Pre-Exercise Stress Testing in People With Diabetes

Background

Although suggested by practice guidelines, the need for pre-exercise stress testing in asymptomatic people with diabetes remains controversial. We examined the utility of screening with pre-exercise stress testing in patients with diabetes.

Key Studies in Medical Education from 2017: A Narrative Review

Education, like clinical medicine, should be based on the most current evidence in the field. Despite the overwhelming breadth of literature in medical education, pediatric educators desire and need to incorporate best practices into their educational approaches. This article provides an overview of 18 articles from the literature in 2017 that the authors consider to be key articles in the field of pediatric medical education. The 7 authors, all medical educators with combined leadership experience and expertise across the continuum of pediatric medical education, used an iterative, staged process to review more than 1682 abstracts published in 2017. This process aimed to identify a subset of articles that were most relevant to educational practice and most applicable to pediatric medical education. In the process, pairs of authors independently reviewed and scored abstracts in 13 medical education-related journals and reached consensus to identify the abstracts that best met these criteria. Selected abstracts were discussed using different pairs to select the final articles included in this review. This paper presents summaries of the 18 articles that were selected. The results revealed a cluster of studies related to feedback, coaching, and observation; trainee progression, educator development, trainee entrustment, culture, and climate; and the medical student experience. This narrative review offers a useful tool for educators interested in keeping informed about the most relevant and valuable information in the field of medical education.     

Dysosmia and dysgeusia presenting as depression

Disorders of taste and smell are underrecognized and often misdiagnosed. Two cases are described in which patients mistakenly thought to suffer from depression actually had unnoticed drug-induced dysosmia and dysgeusia. Also reviewed are psychiatric, neurologic, and medical disorders and drugs that cause abnormalities of taste and smell, and some behavioral aspects of food aversions. Three groups, all of whom may superficially appear depressed, must be distinguished from each other: 1) patients with dysosmia or dysgeusia, 2) patients with primary neuropsychiatric illness with olfactory or gustatory hallucinations, and 3) patients with conditioned taste aversions.