Implantable Gastric Stimulation for the Treatment of Severe Obesity

The prevalence of obesity is growing worldwide at an alarming rate. Current medical therapies are often ineffective and surgical treatments result in weight loss but have significant risk. Implantable Gastric Stimulation (IGS) offers a novel approach to weight loss. Simply stated, the IGS system electrically stimulates the stomach with a pacemaker-like device. The device is implanted in a brief minimally invasive procedure. Investigation in over 500 patients globally has proven it to be safe and seemly free of long-term sequelae. With refinements in patient selection and device application, the weight loss results have been steadily improving. The IGS may someday become a reliable and safe surgical option for weight loss.     

Mechanical Evaluation of a Ruptured Swedish Adjustable Gastric Band

Background: Leakage of a laparoscopically placed Swedish adjustable gastric band (SAGB) was observed 2 1/2 years after placement. The band was evaluated for mechanical inaccuracies by a laboratory. Methods: The ruptured SAGB was investigated microscopically and wall thicknesses were measured. An unused SAGB was tested, both empty and filled, for mechanical deformity after exposure to saline solution. Results: A permanent transformation of the silicone rubber was found, caused by bowing of the device. 2 tears were present at the end of a kink.The mean wall thickness was within acceptable limits. Exposure of the gastric band to saline solution did not cause any sign of permanent deformity of the silicone rubber. Conclusion:The rupture of the gastric band did not seem to be caused by a production error. Long-term deformity, in combination with a continuous dynamic load, may increase the risk of tearing. Long-term follow up is recommended for patients treated with this device.     

Fatal Pulmonary Embolism after Bariatric Operations for Morbid Obesity: A 24-Year Retrospective Analysis

Background: Pulmonary embolism (PE) is a leading cause of death following gastric bypass operations for morbid obesity. Although its incidence appears to be stable, the number of bariatric operations performed annually is increasing considerably; hence, the isolated fatal PE is no longer a rare occurrence. The records of patients undergoing bariatric surgical operations since 1979 were reviewed to determine specific factors that increased the risk of developing a fatal PE. Both recommended and optional indications for prophylactic inferior vena cava (IVC) filter placement in patients considered at high risk were also examined. Materials and Methods: Between September, 1979 and March, 2003, 5,554 operations were performed for clinically severe obesity. These operations included jejuno-ileal bypass, horizontal gastroplasty, Roux-en-Y gastric bypass with a 30-cc pouch, modified biliopancreatic diversion, the Sapala-Wood Micropouch? gastric bypass (Micropouch^SM), Lap-Band?, and revisions. 12 fatal pulmonary emboli (0.21 %) were identified. All but 1 embolus occurred within 30 days following surgery. Results: In 11 of 12 patients, at least 1 co-morbidity known to increase the risk of postoperative venous thromboembolism (VTE) was identified. 4 co-morbidites were common to 4 patients (33%): venous stasis disease (VSD), BMI ≥ 60, truncal obesity, and obesity hypoventilation syndrome/sleep apnea syndrome (OHS/SAS). 6 of 12 patients (50%) had a BMI ≥ 60. Another 6 had chronic leg swelling with stasis dermatitis. 2 patients experienced a previous PE, and 1 patient reported a history of deep vein thrombosis (DVT). Conclusion: 4 patients (33%) demonstrated a combination of risk factors (VSD, BMI ≥ 60, truncal obesity, OHS/SAS) recognized as significant for the development of postoperative VTE. In such patients, prophylactic IVC filter placement is highly recommended. Filter placement for other factors, such as age, body build, hypercoagulable state, etc., should be considered on an individual basis.     

Removal of intra-abdominal intrauterine device by laparoscopy

Objective: In this study, we aimed to evaluate the cases in which intra-abdominal intrauterine devices (IUDs) were removed by laparoscopy. Methods: A retrospective study, from 1994 to 2000 was carried out with eight patients who underwent laparoscopy for the removal of an IUD. The patients admitted to our clinic with 'lost IUD' were examined by pelvic ultrasonography, X-ray and hysteroscopy. IUDs were found to be extrauterine but within the abdominal cavity. The IUDs were removed by operative laparoscopy. Results: The mean age of the patients was 31.5 years. The mean duration of usage of IUD was 5.5 years. The IUD was located in the cavity of Douglas in four cases, in the posterior wall of the uterus (perimetrium) in one case and in the conglomerated mass bordered by the intestines in three cases. The types of the IUDs were Cu-T 380A (n = 5), Multiload (n = 1) and Lippes-Loop (n = 2). The mean laparoscopic operation time was 25 min. No major complications (intestinal or vessel injuries) or minor problems occurred. Laparotomy was not necessary in any of the eight cases. All cases were treated as out-patients and discharged on the same day. After counselling, three women requested sterilization, which was performed at the same laparoscopy session by the administration of bilateral Yoon rings, and other family planning methods were chosen by five women. There were no problems when cases were followed at the 10th and 30th postoperative days. Discussion: Our results support the idea that, in cases of extrauterine but intra-abdominal IUD, laparoscopic removal of the IUD must be the first choice of therapy.     

Perception of efficacy and safety as determinants for use and discontinuation of birth control methods in Muslim Jordanian women

Objective: This study was conducted to identify the perceptions of working Muslim Jordanian women regarding the efficacy and safety of their contraceptive methods, and whether these perceptions affected method choice or discontinuation. Methods: A prospective study on 207 married working women of reproductive age was conducted between March and June 2002. Results: The majority of women were using an intrauterine device (IUD), fewer were using traditional methods and oral contraceptive pills. Effectiveness was the main reason for choosing IUD and pill methods, while concerns about safety were the main reason for discontinuation. Safety was the main reason for choosing traditional methods and poor efficacy was the reason for discontinuation. Conclusion: Health-care professionals need to increase the use of proper contraceptive methods and compliance by providing counseling services and correcting any misperceptions regarding birth control methods before and during use.     

Paediatric cochlear implant durability: the Nottingham experience

Abstract

Objective To determine durability of cochlear implant devices in a large paediatric cohort.

Design Retrospective review of database records of children consecutively implanted between 1989 and March 2002.

Methods The records of 363 children were studied. The review examined cases requiring explantation of the implant device for device failure with or without reimplantation.

Results 15 failures were identified. The failure rates based on failures per number of implanted devices as well as cumulative user experience were 4.0% and 0.8% respectively.

Conclusions As implant programmes grow, so will the number of children requiring device explantation and reimplantation. This will have implications on implant programme development and resource allocation.     

A Framework for Good Practice: Managing Failures in a Cochlear Implant Service

Cochlear implants can provide the recipient and their family with wonderful outcomes in terms of their improved access to sound and to speech. However the experience of a cochlear implant failing is distressing for all concerned. Clinicians endeavour to ensure that the process of confirming the failure, re-implantation and subsequent rehabilitation is as smooth as possible. In order to benefit from each others experience, a working party of cochlear implant centre coordinators and representatives from the Ear Foundation met on a number of occasions to draw up a protocol which could be used widely throughout the British Cochlear Implant Group. The protocol indicates quality standards of clinical care to be used in the event of device failure.     

改良外固定法治疗髌骨骨折24例疗效观察

采用改良外固定法治疗髌骨骨折24例,随访18例,疗效满意,现报道如下。临床资料24例中男13例,女11例;年龄最小20岁,最大62岁;屈膝跌倒致伤者21例,直接撞击伤3例;横型骨折20例,粉碎型骨折2例,下极骨折2例,均属新鲜骨折。     

Disaster with a New Type of Band for Gastric Banding

Background: Laparoscopic gastric banding has become an established therapy for morbid obesity. Typical complications are band dislocation, pouch dilatation and stomach slippage. A new type of adjustable silicone band with eyes for suture fixation was proposed to avoid these complications. The experience with this new kind of band is reported. Methods: Between April 1998 and August 1998, 15 morbidly obese patients were treated by laparoscopic adjustable gastric banding using a new band type (manufactured by MEDING, Heinsberg, Germany).The band was fixed by single sutures using the eyes at each side of the buckle. There were 13 women and 2 men, with mean age 34 (range 21-54) years and mean body-weight 138.6 (range 113-213) kg. Results: Intraoperative complications did not occur. Postoperatively 8 patients (53%) had increasing capacity for food intake and 2 (13%) had uncharacteristic abdominal pain. Radiographs revealed band rupture in 13 of 15 patients 3-11 months postoperatively. These patients were operated laparoscopically using a new technique for band change. Now, a Lap-bandTM (Bioenterics, Carpinteria, CA, USA) was inserted and fixed to the ventral stomach with three sutures similar to a ventral fundoplication. Radiographic and clinical follow-up have been uneventful in all patients until now. Conclusion: This series demonstrated: 1) the importance of clinical follow-up; 2) a material defect of a new band type; and 3) development of a new laparoscopic technique for band change.     

Placement of the GaBP Ring System in the Banded Gastric Bypass Operation

Currently, bariatric surgeons fashion the band or ring reinforcement prosthesis, to control the stoma in the vertical banded gastroplasty and gastric bypass operations for morbid obesity. To meet this need, the GaBP Ring system has been developed in various sizes, and consists of 4 main parts to provide a means for inserting a ring around the gastric pouch in the banded gastric bypass or the vertical banded gastroplasty. The pre-manufactured and sterilized device provides for better standardization and quality control than individually surgeon-fashioned devices. The GaBP Ring system is described, and the technique of placement and the pertinent initial clinical results are presented.