Metabolic Implications of Obesity,Weight Loss and Energy Expenditure following Gastric Restrictive Surgery

This review examines the energetics and metabolic parameters which influence the effectiveness of gastric restrictive surgery in achieving weight loss in the clinically severely obese patient. Among the subjects discussed are the metabolic determinents and consequences of obesity, energy expenditure and its components, factors other than dietary restriction and weight loss which affect energy expenditure, and the metabolic risk factors for weight gain. The role of exercise is reviewed, including the effects of exercise on energy balance and the thermic effect of food. The value of combining exercise with diet restriction, the effect of caloric restriction on the capacity to exercise and the place of exercise in the obese diabetic are examined. Finally, the metabolic consequences of gastric restrictive surgery, the adaptive response to surgically induced weight loss and nutritional recommendations following gastric restrictive surgery are reviewed.     

Late complications following autologous and homologous fat transplantation for breast augmentation

Summary Three cases of homologous and one of autologous free fat block transplantation for breast augmentation were seen 10 to 20 years after operation due to late complications. Displacement of heavy tumors, local mastitis or disrupted capsules following local trauma led to admission. The calcified centrally necrotic cysts were treated by subcutaneous mastectomy or local enucleation and immediate reconstruction by subpectoral augmentation with silicone-gel implants or reduction mammoplasty.     

Review of skull base surgery approaches: With special reference to pediatric patients

Summary The techniques of skull base surgery attempt to maximize the exposure of a cranial base lesion while using the least amount of brain retraction. Cranial base surgery is not a new area of neurosurgical or otolaryngologic interest, but instead represents a resurgence of efforts to treat difficult lesions involving the cranial base. This resurgence of interest and effort is a product of recent advances in microanatomical knowledge of the cranial base, advances in microsurgical technique, improved neurophysiologic monitoring, and improved collaborative relationships between neurosurgery, otolaryngology and plastic surgery. Furthermore, improved neuroanesthetic techniques allow the surgeon to proceed with surgery without undue concern about time, and improved neuroimaging techniques provide the surgeon with detailed knowledge of the three dimensional characteristics of the tumor and surrounding structures [1].This review will focus on the surgical management of cranial base tumors primarily affecting the pediatric population.Little has been written on the techniques of skull base surgery as they apply to the pediatric population, since cranially-based tumors are a relatively rare occurrence in this patient population. In most instances, however, many of the 'standard' skull base approaches can be applied to the pediatric patient with few modifications, and in our experience, the pediatric patients have tolerated these approaches as well as their adult counterparts.     

Cost-benefit analysis of transesophageal echocardiography in cardiac surgery

This article evaluates the costs and outcomes associated with TEE during and after cardiac surgery. The costs include the direct and indirect costs--the complications of TEE. The outcomes include the positive consequences or the benefits: money and lives saved. The article uses liberal (high) estimates of the direct and indirect costs of TEE and conservative (low) estimates of the benefits. The exact cost or benefit depends on the number of cases performed. The analysis shows that patients having surgery for congenital heart disease derive the greatest overall benefit: around $600 per case studied. Patients having valvular repair surgery derive the next greatest benefit: around $450 per case studied. In contrast patients having valve replacement have an overall cost of around $150 per case studied. Patients having surgery for coronary artery disease also derive an overall benefit: around $100-$300 per case studied, depending upon assumptions regarding TEE's role in prevention of intraoperative strokes. This analysis indicates that the financial benefits of TEE are substantial and frequently outweigh costs in patients requiring cardiac surgery.     

Refluent testicular autotransplantation by Domini's method

Autotransplantation presently constitutes the best option for the surgical treatment of non-palpable retained intra-abdominal testes. Silber first proposed this technique in 1978; it is not suitable in children under 3 years of age because of the small caliber of the testicular artery. In 1986 Dòmini, mindful of the problem of arterial vascularisation, carried out refluent testicular autotransplantation (RTAT), where a natural anastomosis between the testicular and deferential arteries is used. Venous drainage is guaranteed by performing a microsurgical anastomosis between the internal spermatic and inferior epigastric veins.At our institution this technique has been employed since 1990, replacing staged orchidopexy. We report a 2-year experience (1990–1992) in seven children who underwent RTAT and discuss the results obtained and the technique used.     

An approach to some dilemmas and complications of office oral surgery*

This article reviews an eclectic collection of problems. There is no particular reason why any one of them was chosen other than that they are more likely to occur in the course of practice than some other complications such as an oro-antral fistula or trauma to the lingual nerve or tissue emphysema. These latter and some other predicaments were discussed in the course of the talks given by the author at the 28th Australian Dental Congress in March 1995. The problems discussed in this paper are:

• 1 1. Dentoalveolar abscess anaesthesia.
• 2 2. Inability to obtain effective anaesthesia.

The complications:

• 2 1. Post-extraction haemorrhage.
• 2 2. Syncope.
• 3 3. Postoperative infection.

     

胃癌术后早期应用中药联合化疗临床观察

对４３例胃癌术后患者早期给予中药同时联合化疗,通过与４１例同类手术后常规治疗的对照组比较,前者术后吻合口和切口的并发症均无明显增加（Ｐ＜０．０５）,全血细胞也无明显减少（Ｐ＞０．０５）。同时,由于早期应用中药和营养支持,治疗组营养状况的改善明显高于对照组（Ｐ＜０．０５）,临床研究表明,胃癌术后早期给予中药联合化疗是可行的。     

New anastomosis technique for (laparoscopic) instrumental small-diameter anastomosis

This study presents a new technique for visceral anastomosis. The principle consists of connecting the two parts to be anastomosed around a reabsorbable stent which is transluminally introduced into a small-diameter viscus, where it is fixed. Advancing a larger tube along the axis of the machine, the larger, perforated viscus is inverted and pulled over the stent, and finally a rubber band pops off the machine endoluminally in order to fix the intestinal walls in seroserosal contact onto the stent. To evaluate this micro anastomosis, a biliary bypass (choledochojejunostomy and roux-en-y-loop) was performed in ten pigs. Nine of ten animals showed biliary bypass with good runoff in contrast radiography and completely reabsorbed stent after a 3-month follow-up. Weight gain, bilirubin, and alkaline phosphatase were normal. This technology demonstrates a safe and quick way to perform instrumental micro anastomosis without remnant foreign material.Presented as a poster at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, TN, USA, 18–19 April 1994     

‘Hybrid’ Bariatric Surgery: Bilio-pancreatic Diversion and Duodenal Switch - Preliminary Experience

Background: Hybrid, combined or mixed bariatric surgery is the combination of a degree of ‘malabsorption’ (as achieved by the intestinal bypass) with a ‘rrestriction’ (as achieved by gastric bypass or gastroplasty), thereby simultaneously reducing the absorption of fats in the small bowel and decreasing the intake of food. Methods: A modification of the bilio-pancreatic diversion (BPD) with a duodenal switch procedure, vertical lineal gastrectomy and preservation of the pylorus, has been used in 23 patients. The antropyloric pump and 4 cm of the duodenum are left intact to preserve physiologic gastric emptying and to prevent anastomotic ulcer. The use of staplers and continuous running sutures reduces surgical risks and operative time. Results: One patient, converted from a vertical gastroplasty, had an intrathoracic esophageal perforation and died of multisystemic organ failure, a mortality rate of 4.5%. One patient had a partial dehiscence of the laparotomy wound. Three patients developed subcutaneous seromas. Mean weight losses during the first 4 months were 13, 11, 6 and 5 kg, with a loss of 70% of excess weight in patients approaching 1 year. No patient needs treatment for diarrhea. No serious secondary side-effects have been detected. Conclusion: This operation appears to result in very satisfactory weight loss, improved quality of life, and a low incidence of complications.