Dietary Changes after Vertical Banded Gastroplasty

Background: Gastric restriction surgery relies on obstruction to oral intake by formation of a gastric pouch. Therefore, the therapeutic effect is closely related to intolerance for different types of food, and an ingestion of an unbalanced diet. We investigated dietary changes after VBG and their associations with therapeutic success. Methods: 70 patients (4 men, 66 women, median age 32) with a median preoperative BMI of 44.6 were examined ≥ 3 years after VBG. Weight reduction, nutritional changes (type ofdiet,number of daily meals,amount of food that could be ingested, intolerance for different types of food, frequency of vomiting), satisfaction with results, and willingness to undergo the operation once again were investigated. Results: The average reduction of the BMI was 13, with sufficient weight loss in 80%. 36% were eating a solid, 43% a soft, and 21% a liquid diet. Weight reduction did not depend on the type of diet eaten but on the ingestion of sweets. 93% indicated they could take only small amounts of food. The average number of daily meals was 3. 76% reported an intolerance for some type of food (most often meat, fruit, or vegetable). Vomiting was the most common problem and occurred in 71%. 71% indicated a high level of satisfaction with the results of the operation, and 96% said they would undergo the operation again. Conclusions:The investigation demonstrated successful weight reduction despite dietary changes in 80% of patients after VBG. Weight reduction was not influenced by type of diet but depended on consumption of sweets.     

The Biliopancreatic Diversion with the Duodenal Switch: Results Beyond 10 Years

The BPD/DS, if properly performed, has the best long-term weight loss of any bariatric operation. It is easy to reverse or revise, has the least marginal ulcers, cures the highest percentage of co-morbidities, has the least failures, and permits normal although smaller meals. It is our opinion that the BPD/DS should be considered as the gold standard bariatric operation.     

Laparoscopic Adjustable Gastric Banding Results after 2 Years with Two Different Band Types

Background: Laparoscopic gastric banding is the most common operation in Europe for morbid obesity. Many devices from different companies are now available. The aim of this study was to compare the results over a 2-year period of 2 types of band: the Lap-Band ? and the Minimizer? band. Methods: In a non-randomized study, 2 consecutive groups were prospectively analyzed. Group A consisted of 120 patients who received the Lap-Band ? , and group B consisted of 68 patients who received the Minimizer band which contains eyelets. All the bands were placed above the lesser sac by the perigastric approach. Results: 4 early complications were observed in group A (1 phlebitis, 1 pneumopathy and 2 early displacements of the band); and 1 in group B (1 retention of urine). After a follow-up of 2 years, the displacement rate of the band was 10.8% in group A and 0% in group B. One gastric erosion was observed in group B, but not in group A. After 2 years, the average loss of excess weight was 50% in both groups. Conclusion: With the Minimizer band, we did not observe any slipping, and the efficacy with respect to weight loss was equivalent to the Lap-Band?     

Outcome after Laparoscopic Adjustable Gastric Banding – 8 Years Experience

Background: Laparoscopic adjustable gastric banding (LAGB) has been our choice operation for morbid obesity since 1994. Despite a long list of publications about the LAGB during recent years, the evidence with regard to long-term weight loss after LAGB has been rather sparse. The outcome of the first 100 patients and the total number of 984 LAGB procedures were evaluated. Methods: 984 consecutive patients (82.5% female) underwent LAGB. Initial body weight was 132.2 ± 23.9 SD kg and body mass index (BMI) was 46.8 ± 7.2 kg/m². Mean age was 37.9 (18-65). Retrogastric placement was performed in 577 patients up to June 1998. Thereafter, the pars flaccida to perigastric (two-step technique) was used in the following 407 patients. Results: Mortality and conversion rates were 0. Follow-up of the first 100 patients has been 97% and ranges in the following years between 95% and 100% (mean 97.2%). Median follow-up of the first 100 patients who were available for follow-up was 98.9 months (8.24 years). Median follow-up of all patients was 55.5 months (range 99-1). Early complications were 1 gastric perforation after previous hiatal surgery and 1 gastric slippage (band was removed). All complications were seen during the first 100 procedures. Late complications of the first 100 cases included 17 slippages requiring reinterventions during the following years; total rate of slippage decreased later to 3.7%. Mean excess weight loss was 59.3% after 8 years, if patients with band loss are excluded. BMI dropped from 46.8 to 32.3 kg/m². 5 patients of the first 100 LAGB had the band removed, followed by weight gain; 3 of the 5 patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP) with successful weight loss after the redo-surgery. 14 patients were switched to a "banded" LRYGBP and 2 patients to a LRYGBP during 2001-2002. The quality of life indices were still improved in 82% of the first 100 patients. The percentages of good and excellent results were at the highest level at 2 years after LAGB (92%). Conclusions: LAGB is safe, with a lower complication rate than other bariatric operations. Reoperations can be performed laparoscopically with low morbidity and short hospitalizations. The LAGB seems to be the basic bariatric procedure, which can be switched laparoscopically to combined bariatric procedures if treatment fails. After the learning curve of the surgeon, results are markedly improved. On the basis of 8 years long-term follow-up, it is an effective procedure.     

Psychosocial Functioning Before and After Laparoscopic Adjustable Gastric Banding: a Cross-Sectional Study

Background: The aim of this cross-sectional study was to examine short and long-term physical, mental and, particularly, social quality of life (QoL) of patients with severe obesity after laparoscopic adjustable gastric banding (LAGB). Methods: 250 patients (221 female, 29 male, mean age 39.6 years, age range 22-61) filled out questionnaires to evaluate several aspects of QoL: 93 patients before LAGB, 48 with a follow-up duration of 8 through 24 months, and 109 patients 25 through 68 months after LAGB. Results: Compared with patients before surgery, patients after surgery, in both follow-up groups, had lower weight and co-morbidity, felt and functioned better on physical and psychological dimensions of QoL, and on most aspects of social QoL. No significant differences emerged between the two postoperative groups. On average, the postoperative QoL was still lower than the age norm group. Mutual correlations between QoL and weight outcome were very low up to 2 years after surgery, but more strongly associated >2 years after surgery. Conclusion: LAGB could be a long-term solution to morbid obesity with regard to both weight and QoL outcome. The findings of our study emphasize the importance of including social QoL variables in outcome research. They further suggest that when the follow-up duration increases, especially in patients who are single, intervention and consultation should be simultaneously directed at weight and psychosocial variables.     

介导癌症发病及肿瘤靶向治疗中TLR4的作用

目的:评估TLR4与肿瘤发病的关系,并探讨其在肿瘤治疗中的作用。方法:以"TLR4、肿瘤(tumor)"为关键词,使用PubMed和CNKI数据库对2005-01-2010-12发表的文章进行分别和联合检索。纳入标准:1)TLR4的基本资料介绍;2)TLR4在肿瘤组织中的表达研究;3)TLR4在肿瘤治疗中的作用。根据纳入标准分析43篇文献。结果:TLR4的在胃癌、B细胞淋巴瘤、肝细胞癌、结肠癌、膀胱癌和前列腺癌等多种恶性肿瘤组织及细胞中阳性表达。TLR4是把双刃剑,一方面促进肿瘤的发展,另一方面对某些肿瘤的生长起抑制作用。结论:TLR4及TLR4的寡核苷酸基因多态性与肿瘤发生发展密切相关。TLR4有望成为肿瘤治疗的新靶点。     

3种银杏叶制剂治疗冠心病心绞痛的成本—效果分析

目的:比较3种银杏叶制剂治疗冠心病心绞痛的成本-效果。方法:将103例符合诊断标准的冠心病心绞痛患者按照不同的用药方案分成A组(34例)、B组(35例)、C组(34例)。A、C组分别给予生产厂商及规格不同(2mL vs.5mL)的舒血宁注射液20mL、B组给予银杏达莫注射液20mL,3组均静脉滴注,qd,治疗14d后观察疗效,并进行成本-效果分析。结果:3组心绞痛改善总有效率分别为70.59%、91.43%、73.53%。成本分别为5207.86元、3575.46元、5065.06元,成本-效果比分别为7377.62、3910.60、6888.43。结论:与A、C组比较,B组治疗方案成本-效果比更优。     

Prokineticin 2/Bv8 is expressed in Kupffer cells in liver and is down regulated in human hepatocellular carcinoma

AIM： TO study the implication of prokineticin 1 （PKI/EGVEGF） and prokineticin 2 （PK2/13v8） in hepatocellular carcinoma angiogenesis.
METHODS： The gene induction of PK1/EG-VEGF and PK2/Bv8 was investigated in 10 normal, 28 fibrotic and 28 tumoral livers by using real time PCR. Their expression was compared to the expression of VEGF （an angiogenesis marker）, vWF （an endothelial cell marker） and to CD68 （a monocyte/macrophage marker）. Furthermore, the rnRNA levels of PK1/EG-VEGF, PK2/Bv8, prokineticin receptor 1 and 2 were evaluated by real time PCR in isolated liver cell populations. Finally, PK2/Bv8 protein was detected in normal liver paraffin sections and in isolated liver cells by immunohistochernistry and immunocytochemistry.
RESULTS： PK2/Bv8 mRNA but not PK1/EG-VEGF was expressed in all types of normal liver samples examined. In the context of liver tumor development, we reported that PK2/13v8 correlates only with CD68 and showed a significant decrease in expression as the pathology evolves towards cancer. Whereas, VEGF and vWF mRNA were significantly upregulated in both fibrosis and HCC,as expected. In addition, out of all isolated liver cells examined, only Kupffer cells （liver resident macrophages） express significant levels of PK2/Bv8 and its receptors, prokineticin receptor 1 and 2.
CONCLUSION： In normal liver PK2/Bv8 and its receptors were specifically expressed by Kupffer cells. PK2/Bv8 expression decreased as the liver evolves towards cancer and did not correlate with HCC angiogenesis.     

Re-operation after Laparoscopic Adjustable Gastric Banding Leads to a Further Decrease in BMI and Obesity-related Co-morbidities: Results in 33 Patients

Background: Laparoscopic adjustable gastric banding (LAGB) is a safe technique with few direct postoperative complications. However, long-term complications such as slippage and pouch dilatation are a well-known problem and re-operations are necessary in a substantial number of patients. In this study, the results of laparoscopic re-operations after LAGB are evaluated. Methods: 33 patients had a re-operation because of failed LAGB. 29 patients had major re-operation and 4 patients minor re-operation under local anesthesia. The charts of these patients were retrospectively studied. Results: Mean time between the first band placement and re-operation was 28.1 ± 17.6 months. The cause of band dysfunction was anterior slippage (n=17), band erosion (n=5), band intolerance (n=3), posterior slippage (n=2) and band leakage (n=2). Symptoms of band dysfunction were vomiting (n=16), pyrosis (n=13), nausea (n=8), retrosternal pain (n=11) and regurgitation (n=5). Laparoscopic refixation of the band was performed in 19 patients: the band was replaced in 4 patients while in 1 patient the band was removed; in 3 patients, the laparoscopic procedure was converted to open surgery; 5 patients underwent conversion to a bypass procedure (biliopancreatic diversion in 3 and gastric bypass in 2). There were no direct postoperative complications except for wound infections (n=2). Postoperative follow-up was 100% with a mean period of 34 ± 19 months. BMI decreased further from 37.5 ± 6.4 kg/m² before re-operation to 33 ± 7 kg/m². Obesity-related co-morbidity also decreased further or completely dissolved. 3 patients (9%) again developed anterior slippage and a second laparoscopic re-operation was necessary. Conclusions: A laparoscopic re-operation for band-related complications after LAGB is safe and feasible. With band slippage, a laparoscopic refixation was possible in 89%. Re-operation leads to further decrease in BMI and obesity-related co-morbidities.     

Weight Reduction after an Early Version of the Open Gastric Bypass for Morbid Obesity: Results after 23 Years

Background: While numerous promising short-term results of open gastric bypass for morbid obesity were published, the long-term outcome of earlier versions was somewhat disappointing. Thus, it was not until 1993 that this procedure was reintroduced with current modifications and now performed laparoscopically. Published long-term results of gastric bypass are still lacking. Methods: Out of an original population of 195 patients, we retrospectively analyzed the outcome of 98 patients (82 women, 16 men, mean age 32 years [range 17-54], mean weight 132 kg [range 65-200], mean BMI 46.6 kg/m²) operated on in Erlangen with mean follow-up 22.9 years (range 16.5-25.4). 3 different bariatric operations were performed: horizontal gastroplasty (HGP, n=18), stapled Roux-en-Y gastric bypass (S-RYGBP, n=14) and transected Roux-en-Y gastric bypass (T-RYGBP, n=66). BMI and percentage of excess weight loss (%EWL) were calculated at time 0, and after 1, 2, 3, 10, 15, 20 and 25 years. Results: Statistically significant weight loss was found for the whole patient population at every postoperative time-point compared to preoperative values. Maximal weight loss was achieved mainly during the first 3 years. However, initial and long-term outcome after HGP was significantly worse than after S-RYGBP or T-RYGBP. Gender did not significantly influence the results. Conclusion: Traditional open gastric bypass resulted in acceptable and safe long-term weight reduction. It may be assumed that laparoscopic gastric bypass with modern tiny pouch volumes based on the lesser curvature achieves even better and life-long weight reduction.