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1: Plast Reconstr Surg.  2004 Apr 15;113(5):1391-9.  

Hemodynamics, electrolytes, and organ histology of larger-volume liposuction in
a porcine model.

Kenkel JM, Brown SA, Love EJ, Waddle JP, Krueger JE, Noble D, Robinson JB Jr,
Rohrich RJ.

Department of Plastic Surgery, University of Texas Southwestern Medical Center,
Dallas, 75390-9132, USA. jeffrey.kinkel@utsouthwestern.edu

Liposuction is a procedure that allows the surgical removal of excess adipose
tissue in healthy individuals. Lipoplasty is commonly performed with few
clinical side effects. However, with increased lipoaspirate volumes,
complications have been reported. In addition, the abnormal appearance of fat
cells in other tissues subsequent to lipoplasty has been reported in a small
number of cases. The authors examined whether larger-volume lipoplasty, in the
porcine model, resulted in disturbances in cardiac or pulmonary output levels,
electrolytes, and liver chemistry analyses or alterations in organ histology.
Nine adult porcine specimens were subjected to either lipoplasty (n = 6) with
the superwet technique or no lipoplasty (n = 3). Using a Swan-Ganz catheter,
cardiac output and pulmonary artery pressure measurements were obtained from
initial placement before lipoplasty until 48 hours postoperatively. Blood
analyte measurements were obtained. Upon euthanization, liver, kidney, and lung
specimens were collected and tissue sections were prepared. No significant
differences or trends were observed in cardiac parameters or blood analytes
between control and experimental groups. Significant elevations in serum
aspartate aminotransferase and alanine aminotransferase enzyme levels (p < 0.03)
were observed in animals postoperatively (10 to 48 hours) subjected to
lipoplasty compared with controls. Upon gross examination, the lung tissues of
animals subjected to lipoplasty unexpectedly demonstrated patchy petechial
hemorrhages on the pleural surface. Tissue sections revealed marked hemorrhagic
congestion and evidence of pulmonary edema. Fat emboli were also identified
within the pulmonary and renal systems.

PMID: 15060351 [PubMed]

2: Aesthetic Plast Surg. 2004 Mar 25   [Epub ahead of print] 

The Concentric Medial Thigh Lift.

Le Louarn C, Pascal JF.

The French Society of Plastic and Reconstructive Surgery, and the I.S.A.P.S,
Paris, France.

Plastic surgeons often are asked to perform horizontal medial thigh lifts
because the skin of this area has poor elasticity, inducing excess skin, and
also because there is upper fat deposit. This excess skin and fat lead to
irritation and even functional problems. But surgeons dislike this operation
because of its justified bad reputation. Obviously, this area is difficult to
manage because of the many possible side effects (e.g., healing difficulty, scar
migration, necrosis, effusions, pain) and unreliable results. A new way of
thinking is proposed to lighten this operation and make its more frequent use
possible.This horizontal technique presents several innovating points: A new
incision line located along the labia major in the perineal crease remains at
the same height backward. The incision never descends into the buttock fold.No
undermining whatsoever occurs even in the resection area. Liposuction is the key
to avoidance of any undermining. It is performed everywhere in the thigh, but
most importantly under the resection area where all the fat must be eliminated
to lighten the flap and favor its lifting.The resection removes only the skin
layers (epidermis and dermis) and not the liposucted tissue, which is very thin.
Consequently, all lymphatic and other vessels are preserved, and the healing
process is much easier. Moreover, there is no dead space after ascension of the
flap and no risk of effusion.The resection is realized on demand, depending on
the excess of skin brought on the incision line by each anchor suture.
Therefore, any tension on the skin closure is avoided.The direction of the skin
stretching is concentric toward the labia minor. Consequently, the length of the
scar is shortened at both the front and the rear.Anchor sutures pull a
nonundermined skin, thus drastically decreasing the risk of necrosis.In the past
2 years, 25 patients, most of them as outpatients, have undergone surgery using
this technique, with a real improvement in the quality of the result, as
compared with the results from the standard technique.

PMID: 15037958 [PubMed]

3: Clin Radiol.  2004 Mar;59(3):227-36.  

Technical aspects and complications of laparoscopic banding for morbid
obesity--a radiological perspective.

Roy-Choudhury SH, Nelson WM, El Cast J, Zacharoulis D, Kirkwood B, Sedman PC,
Royston CM, Breen DJ.

Department of Radiology, Hull and East Yorkshire Hospitals NHS Trust, Kingston
Upon Hull, UK.

Morbid obesity is a significant clinical problem in the western world. Various
surgical restrictive procedures have been described as an aid to weight
reduction when conservative treatments fail. Adjustable laparoscopic gastric
banding (LAPBAND) has been popularized as an effective, safe, minimally
invasive, yet reversible technique for the treatment of morbid obesity.
Radiological input is necessary in the follow-up of these patients and the
diagnosis of complications peculiar to this type of surgery. In this review we
will highlight the technical aspects of radiological follow-up and the lessons
learnt over the last 5 years.

Publication Types:
    Review, Tutorial

PMID: 15037134 [PubMed]

4: Ann Surg.  2004 Apr;239(4):433-7.  

Comment in:
    Ann Surg. 2004 Apr;239(4):438-40.

Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a
randomized prospective study.

Lujan JA, Frutos MD, Hernandez Q, Liron R, Cuenca JR, Valero G, Parrilla P.

Departamento de Cirugia General, Hospital Universitario Virgen de la Arrixaca,
30120 El Palmar, Murcia, Spain. jlujanm@teleline.es

OBJECTIVE: The objective of the study was to compare the results of open versus
laparoscopic gastric bypass in the treatment of morbid obesity. SUMMARY
BACKGROUND DATA: Gastric bypass is one of the most commonly acknowledged
surgical techniques for the management of morbid obesity. It is usually
performed as an open surgery procedure, although now some groups perform it via
the laparoscopic approach. PATIENTS AND METHODS: Between June 1999 and January
2002 we conducted a randomized prospective study in 104 patients diagnosed with
morbid obesity. The patients were divided into 2 groups: 1 group with gastric
bypass via the open approach (OGBP) comprising 51 patients, and 1 group with
gastric bypass via the laparoscopic approach (LGBP) comprising 53 patients. The
parameters compared were as follows: operating time, intraoperative
complications, early (<30 days) and late (>30 days) postoperative complications,
hospital stay, and short-term evolution of body mass index. RESULTS: Mean
operating time was 186.4 minutes (125-290) in the LGBP group and 201.7 minutes
(129-310) in the OGBP group (P < 0.05). Conversion to laparotomy was necessary
in 8% of the LGBP patients. Early postoperative complications (<30 days)
occurred in 22.6% of the LGBP group compared with 29.4% of the OGBP group, with
no significant differences. Late complications (>30 days) occurred in 11% of the
LGBP group compared with 24% of the OGBP group (P < 0.05). The differences
observed between the 2 groups are the result of a high incidence of abdominal
wall hernias in the OGBP group. Mean hospital stay was 5.2 days (1-13) in the
LGBP group and 7.9 days (2-28) in the OGBP group (P < 0.05). Evolution of body
mass index during a mean follow-up of 23 months was similar in both groups.
CONCLUSIONS: LGBP is a good surgical technique for the management of morbid
obesity and has clear advantages over OGBP, such as a reduction in abdominal
wall complications and a shorter hospital stay. The midterm weight loss is
similar with both techniques. One inconvenience is that LGBP has a more complex
learning curve than other advanced laparoscopic techniques, which may be
associated with an increase in postoperative complications.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 15024302 [PubMed]

5: Obes Surg.  2004 Feb;14(2):282-4.  

A potential complication of bi-level positive airway pressure after gastric
bypass surgery.

Vasquez TL, Hoddinott K.

Department of Surgery, St Luke's Hospital and Health Network, Bethlehem, PA
18015, USA. tito_vasquez@hotmail.com

BACKGROUND: Bi-level positive airway pressure (BIPAP) is a common treatment
modality for patients with obstructive sleep apnea (OSA), especially in the
morbidly obese population. To our knowledge, there have been no reports of any
adverse effects of BIPAP on patients who undergo weight loss surgical
procedures. METHODS: We report 2 patients who were treated with BIPAP in the
postoperative period following open Roux-en-Y gastric bypass (RYGBP). Their
clinical courses and outcomes are presented. RESULTS: The patients developed
massive bowel distention following treatment with BIPAP and subsequently
developed anastomotic leaks. CONCLUSION: BIPAP following RYGBP may not be a
completely benign treatment modality.We advise caution and careful monitoring
during the use of BIPAP after gastric bypass surgery.

PMID: 15018761 [PubMed]

6: Aesthetic Plast Surg. 2004 Mar 4   [Epub ahead of print] 

Experience with More Than 5,000 Cases in Which Monitored Anesthesia Care Was
Used for Liposuction Surgery.

Scarborough M D DA, Bain Herron M D J, Khan M D A, Bisaccia M D E.

Department of Dermatology, Columbia University, College of Physicians and
Surgeons, 161 Ft. Washington Avenue, 10032, New York, NY, USA.

BACKGROUND. Conscious sedation using monitored anesthesia care can provide a
clinical spectrum from relaxation to moderate anesthesia. This middle ground
between general anesthesia and "pure" tumescent liposuction can help facilitate
patient comfort and surgical proficiency during the procedure.OBJECTIVE. To
describe a method of liposuction surgery with monitored anesthesia care in which
a designated licensed and qualified individual is responsible for administration
of supplemental intravenous conscious sedation as well as continuous monitoring
of the patient.METHODS. Conscious sedation is induced with midazolam, and the
patient is titrated to level II-V on the Ramsey sedation scale with propofol.
The basic surgical technique is that of tumescent liposuction. However, the
supplemental conscious sedation allows the tumescent fluid to be infiltrated at
higher rates and fat extraction to be completed in a shorter period with minimal
or no discomfort.RESULTS. In the authors' experience with more than 5,000 cases
of liposuction surgery using this method, safety and efficacy have been proved.
No patients have experienced significant adverse effects.CONCLUSION. Tumescent
liposuction surgery with monitored anesthesia care provides a middle ground
between general anesthesia and purely tumescent liposuction.

PMID: 14994165 [PubMed]

7: J Assoc Nurses AIDS Care.  2004 Jan-Feb;15(1):15-29.  

HIV lipodystrophy syndrome: a primer.

Robinson FP.

College of Nursing, University of Illinois at Chicago, USA.

Treatment with highly active antiretroviral therapy (HAART) has been implicated
in the development of anthropomorphic and metabolic abnormalities termed HIV
lipodystrophy syndrome (or LDS). This primer offers a comprehensive overview of
LDS including epidemiology, hypothesized etiologies, and clinical consequences.
The evidence-based literature is reviewed for current treatment strategies
including discontinuation of specific antiretrovirals, pharmacological
management of dyslipidemia and insulin resistance, exercise training, facial
augmentation, liposuction, and hormonal therapy. Patient education, counseling,
and adherence are discussed.

Publication Types:
    Review, Academic

PMID: 14983558 [PubMed]

8: Plast Reconstr Surg.  2004 Feb;113(2):788-9.  

Comment on:
    Plast Reconstr Surg. 1998 Jul;102(1):280; author reply 280-1.

The possible protective effects of antioxidants in ultrasound-assisted

Topaz M, Assia EI, Meyerstein N, Meyerstein D, Gedanken A.

Publication Types:

PMID: 14758280 [PubMed]

9: Eur J Cardiothorac Surg.  2004 Feb;25(2):261-6.  

Clinical evaluation of a new fat removal filter during cardiac surgery.

de Vries AJ, Gu YJ, Douglas YL, Post WJ, Lip H, van Oeveren W.

Department of Anesthesiology, University Hospital Groningen, Hanzeplein 1, P.O.
Box 30.001, 9700 RB, Groningen, The Netherlands. a.j.de.vries@anest.azg.nl

OBJECTIVES: Fat microemboli are generated during cardiac surgery that are
associated with post-operative organ injury. Recently, a fat removal filter has
been developed, based on a polyester leukocyte depletion filter. However, the
efficacy of such a filter in a clinical setting is unknown. In this study we
tested the efficacy of this filter. METHODS: Coronary artery bypass patients
were randomly divided into two groups. Group I: filtration of cardiotomy suction
blood during cardiopulmonary bypass with a fat removal filter (n=14). Group II:
control patients without filtration (n=14). Filter efficacy was evaluated in
group I using biochemical assays and thin layer chromatography of blood samples
taken simultaneously before and after the filter. In addition, clinical and
biochemical markers for organ injury were determined in both groups. RESULTS:
The fat filter removed triglycerides (0.9+/-0.08 vs. 0.63+/-0.08 mmol l(-1),
P=0.004, paired t-test), leukocytes (4.3+/-0.8 x 10(9) vs. 2.3+/-0.6 x
10(9)l(-1), P=0.03), and platelets (116+/-26 x 10(9) vs. 75+/-21 x 10(9)l(-1),
P=0.003) from the blood samples taken before and after the filter.
Chromatography showed a significant reduction in free fatty acids, phospholipids
and triglycerides. Clinically, leukocyte counts were similar, but platelet
counts were higher (181+/-14 x 10(9) vs. 117+/-8.6 x 10(9)l(-1) control,
P<0.001) in group I on the first postoperative day. CONCLUSIONS: The fat filter
removed 40% fat, leukocytes and platelets from cardiotomy suction blood during
cardiac surgery. A larger scale study is necessary to determine clinical effects
on organ damage.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 14747124 [PubMed]

10: J Vasc Surg.  2004 Jan;39(1):263-5.  

Necrotizing fasciitis after ambulatory phlebectomy performed with use of
tumescent anesthesia.

Hubmer MG, Koch H, Haas FM, Horn M, Sankin O, Scharnagl E.

Division of Plastic Surgery, Department of Surgery, Karl-Franzens University
Hospital, Auenbruggerplatz 29, 8036 Graz, Austria. martin.hubmer@kfunigraz.ac.at

The high cost of treatment of varicose veins has an important role in public
health care. The search for a less expensive and office-based procedure led to
introduction of tumescent local anesthesia for use in ambulatory phlebectomy.
Although the overall infection rate is low, severe infection has been reported
after liposuction with tumescent anesthesia. We report necrotizing fasciitis, an
infection with a mortality rate of 30% to 50%, after ambulatory phlebectomy and
stripping of the long saphenous vein with use of tumescent anesthesia.

Publication Types:
    Case Reports

PMID: 14718851 [PubMed]

11: Urologiia.  2003 Nov-Dec;(6):14-8.  

[Local recurrence of renal cell carcinoma after nephrectomy]

[Article in Russian]

Pereverzev AS, Shchukin DV, Iliukhin IuA.

Despite significant advances in surgical oncourology, local recurrence of renal
cell carcinoma (RCC) remains a serious problem both for the doctor and the
patient. Our study of treatment outcomes in local recurrent RCC consisted in a
retrospective analysis of 13 patients with a local RCC recurrence in the renal
fossa treated with surgical resection alone between 1991 and 2003. Twelve
patients demonstrated no evidence of distant metastases at the time of the
recurrence. One patient had a synchronous metastasis to the contralateral
adrenal gland. A mean recurrence-free interval was 14.6 months (range 2-96
months) after nephrectomy. 46% patients demonstrated symptoms of weight loss,
fatigue and lumbar pains. The source of local recurrence in 2 patients was
metachronous metastases to the ipsylateral adrenal gland, in 1 patients--a tumor
thrombus in the remnant of the left renal vein, in 3--soft tissues of the renal
fossa and in 7--metastases to the regional lymph nodes. 13 resections were
performed with one intraoperative death and one immediate postoperative death.
Splenectomy was made in 2 patients, resection of the stomach in 1, distal
pancreatectomy in 1, resection of the inferior vena cava in 3, aorta in 1. The
average blood loss was 800 ml (300-4500 ml). Up to now 6 patients survived. Of 5
decreased patients 4 died of progressive disease in 1, 4, 10 and 16 months. 1
patient died of cause unrelated to cancer recurrence in 14 months. Out of 6
alive patients 4 have no signs of the disease for, on the average, 31.6 months
(range 4-78 months) and 2 patients have obvious progression of the disease
(1--repeated local recurrence, 1--distant metastases) 9 and 15 months after the
operation. We believe that an aggressive surgical approach to a local RCC
recurrence can produce an increase in disease-free survival and significantly
improve quality of life for such patients.

PMID: 14708237 [PubMed]

12: Plast Reconstr Surg.  2004 Jan;113(1):460-1.  

Don't try this at home: liposuction in the kitchen by an unqualified
practitioner leads to disastrous complications.

Desrosiers AE 3rd, Grant RT, Breitbart AS.

Publication Types:

PMID: 14707690 [PubMed]

13: Plast Surg Nurs.  2003 Fall;23(3):110-3; quiz 114.  

Body contouring of the trunk/thigh aesthetic unit.

Lockwood T.

Division of Plastic Surgery, University of Kansas Medical School, Kansas City,

Modern body lifting is an exciting frontier for patients and the plastic surgery
team. Aesthetic body contour deformities often involve multiple areas of the
trunk and thighs. Surgery must take into account the effect on the overall
aesthetic balance of the body. While the results can be dramatic and fulfilling,
the surgeries are labor-intensive and challenging, and the recovery requires
patient commitment and compliance.

Publication Types:
    Review, Tutorial

PMID: 14666805 [PubMed]

14: Plast Surg Nurs.  2003 Fall;23(3):101-8; quiz 109.  

Ultrasound-assisted lipoplasty.

Pine JL, Smith LJ, Haws MJ, Gingrass MK.

Plastic Surgery Center of Nashville, PLCC, Nashville, TN, USA.

The use of ultrasound-assisted lipoplasty (UAL) to assist in the removal of
subcutaneous fat has been practiced in Europe for nearly 15 years and over the
last 7 years has gained popularity in the United States. Liposuction is now one
of the most commonly performed cosmetic procedures by board-certified plastic
surgeons. This article will review the UAL procedure, its history, regulatory
issues, instrumentation and equipment needed. It will also review changes and
recent updates, clinical protocol, complications, and future considerations.

Publication Types:
    Review, Tutorial

PMID: 14666804 [PubMed]

15: Eat Weight Disord.  2003 Sep;8(3):218-24.  

Therapeutic outcome of adjustable gastric banding in morbid obese patients.

Hotter A, Mangweth B, Kemmler G, Fiala M, Kinzl J, Biebl W.

Department of Psychosomatics, University Clinic of Psychiatry, Innsbruck,
Austria. alexandra.hotter@tilak.or.at

We examined 77 obese patients treated with bariatric surgery in order to analyse
treatment success, and compare those with a good or a poor outcome. The
subjects, who were recruited one year after undergoing adjustable gastric
banding, were asked questions concerning their sociodemographic status,
postoperative course, past and present weight status, eating behaviours and
difficulties in changing eating habits. Furthermore, we also used two body image
questionnaires, and considered the patients' evaluations of positive and
negative changes, as well as their wishes for the future. There were no
preoperative differences between the 71% of patients in the good outcome group
and the 29% in the poor outcome group. With regard to the postoperative course,
the poor outcome group had more problems in adapting to new eating behaviours,
experienced significantly more post-surgical complications, and had a
persistently negative body evaluation. Both groups were satisfied with their
achieved weight loss achieved, and their improved self-esteem and mobility.
Adjustable gastric banding seems to be successful in inducing weight loss and
allowing a better quality of life. However, factors such as postoperative
complications, the ability and willingness to adopt new eating attitudes, and an
improved body image seem to be crucial for therapeutic outcome.

PMID: 14649786 [PubMed]

16: Dermatol Surg.  2003 Nov;29(11):1162.  

Comment on:
    Dermatol Surg. 2003 Feb;29(2):165-7; discussion 167.

Re.: The anatomic sites of postliposuction fat deposition.

Field LM.

Publication Types:
    Case Reports

PMID: 14641350 [PubMed]

17: Hautarzt.  2003 Dec;54(12):1185-9.  

[Autologous fat grafting]

[Article in German]

Schmeller W, Meier-Vollrath I.

Hanse-Klinik, Fachklinik fur Liposuktion und operativ-asthetische Dermatologie,
Lubeck. info@hanse-klinik.com

Autologous fat grafting is a standard method for soft tissue augmentation. The
method is commonly used for volume restoration of the ageing face. Furthermore,
atrophic scars, lipodystrophy and scleroderma en coup de sabre can be treated.
Following liposuction, the harvested fat can be reinjected immediately or stored
at minus 28 degrees C for at least 2 years. In most cases, several injections at
3 to 4 months intervals are needed for good long-term effects. The procedure is
used world-wide with good results and a minimum of side effects.

Publication Types:
    Review, Academic

PMID: 14634748 [PubMed]

18: Adv Dermatol.  2003;19:171-84.  

Current issues in liposuction.

Lawrence N.

Dermatology Surgery, Cooper Health System, Marlton, New Jersey, USA.

Publication Types:
    Review, Tutorial

PMID: 14626821 [PubMed]

19: Ann Fr Anesth Reanim.  2003 Nov;22(9):822-5.  

[Fat embolism after total hip prosthesis replacement preserving the femoral

[Article in French]

Messant I, Ouardirhi Y, Vernet M, Lile A, Girard C.

Departement d'anesthesie-reanimation, hopital general, CHU de Dijon, 3, rue du
Faubourg-Raines, BP 1519, 21033 Dijon, France. irene.messant@chu-dijon.fr

Fat embolism is a known complication of traumatology, especially in long bone
fractures. It may also occur in liposuction and articular surgery (0.1%). Fat
embolic events are most often clinically insignificant and difficult to
recognize since clinical manifestations are varied and there is no routine
laboratory or radiographic diagnosis. Classically, fat embolism syndrome
presents with the triad of pulmonary distress, mental status changes, and
cutaneous manifestations. We report the case of a 33-year-old woman who
developed acute respiratory distress 10 days after hip arthroplasty. Several
aetiologies such as fibrinocruoric pulmonary embolism, pulmonary aspiration and
bacterial pneumonia were discussed. Fat embolism was diagnosed, based on
suggestive clinical manifestations, radiographic and laboratory findings,
although fat embolism after hip arthroplasty without intramedullary
pressurization is infrequent.

Publication Types:
    Case Reports

PMID: 14612171 [PubMed]

20: Ann Chir Plast Esthet.  2003 Oct;48(5):299-306.  

[Aesthetic snapshot: study about cosmetic surgical procedures and complications]

[Article in French]

Knipper P, Jauffret JL.


A questionnaire was addressed to 600 members of the French Society of Plastic
Reconstructive and Aesthetic Surgery. Out of 19,000 interventions, thanks to the
analysis of 112 answers, we were able to get a good picture of the activity in
aesthetic surgery, showing the number and type of complications experienced
during each intervention. Cosmetic surgical procedure represents 35% of global
surgical activity of the French plastic surgeon. The most frequent interventions
are liposuction (19%), breast augmentation (16%), eye-lid surgery (14%),
abdominoplasty (12%), mammaplasty (10%), facelift (10%) and rhinoplasty (8%).
The techniques for which we register more than 10% of problems are:
abdominoplasty and mammaplasty. The techniques for which we register between 5%
and 10% of problems are: rhinoplasty, facelift and breast augmentation. The
techniques for which we register less than 5% of problems are: liposuction and
eye-lid surgery. On average, the most frequent cosmetic surgical procedures give
rise to 7% of complications.

PMID: 14599907 [PubMed]

21: Langenbecks Arch Surg.  2003 Dec;388(6):385-91. Epub 2003 Nov 04. 

Open-surgery management of morbid obesity: old experience-new techniques.

Husemann B.

Department of Surgery, Surgical Clinic of Dominikus-Krankenhaus, 40549,
Dusseldorf, Germany. chirurgie@dominikus.de

Bariatric surgery is well established to treat morbidly obese patients (BMI >40
kg/m(2)) with various techniques. Gastric-restriction procedures [adjustable
gastric band, vertical banded gastroplasty (VBG)] reduce caloric intake and are
well accepted (weight loss up to BMI 28-33 kg/m(2) after 5 years), but they are
less effective in super-obese patients and in sweet-eaters. For that group
combined techniques, such as duodenal switch, gastric bypass or bilio-pancreatic
diversion, could produce a better weight loss (between 60 and 160 kg or BMI of
25-30 kg/m(2)) with acceptable long-term side effect; however, due to
malabsorption, a lack of minerals and vitamins, even protein, could occur and
have dangerous side effects. Both basic techniques have their place in the
treatment of morbid obesity. The surgical approach-open or mini-invasive-is only
of minor importance. Technical complications should be avoided, especially band
dislocation (2-12%) or suture leak. Long-term follow-up is very important
because obesity is a chronic disease with a high risk of recurrence, even after
bariatric surgery.

Publication Types:
    Review, Tutorial

PMID: 14598173 [PubMed]

22: Minerva Ginecol.  2003 Oct;55(5):425-39.  

Polycystic ovary syndrome and ovulation induction.

Yildiz BO, Chang W, Azziz R.

Endocrinology and Metabolism Unit, Department of Internal Medicine, Hacettepe
University Faculty of Medicine, Sihhiye, Ankara, Turkey.

Polycystic ovary syndrome (PCOS) is likely the most common cause of anovulatory
infertility. Although many options are available for ovulation induction in
these patients, there is currently no evidence-based algorithm to guide the
initial and subsequent choices of ovulation induction methods. In obese women
with PCOS, mild to moderate weight loss results in improvement of ovulatory
dysfunction, and should be advocated at the onset of the evaluation. Clomiphene
citrate is currently the 1st line medical therapy for ovulation induction.
Glucocorticoids do not result in consistent ovulation and have significant side
effects. Exogenous pulsatile GnRH treatment has low ovulation and pregnancy
rates with a high risk of miscarriage. The most commonly used medical agents for
ovulation induction in clomiphene-resistant women with PCOS are parenteral
gonadotropins. Various gonadotropin preparations and different protocols are
available; however the risk of multiple pregnancy and ovarian hyperstimulation
is high with gonadotropin therapy. The frequent association between PCOS and
insulin resistance has prompted recent studies on the effect of
insulin-sensitizing agents on spontaneous and as an adjuvant to conventional
ovulation induction therapies. Overall, the improvement in ovulation with
insulin sensitizing drugs is modest, and unresolved issues such as variability
in ovarian response remain to be addressed in future studies. Nevertheless,
these agents may be beneficial in a subset of PCOS patients. Surgical ovulation
induction methods such as ovarian diathermy have been reported to be moderately
effective. However, due to the inherent associated risks and unknown effect on
long-term reproductive potential, this modality should be reserved for patients
who are clomiphene-resistant and unable or unwilling to proceed to gonadotropin

Publication Types:
    Review, Tutorial

PMID: 14581885 [PubMed]

23: Am Fam Physician.  2003 Oct 1;68(7):1311-8.  

Comment in:
    Am Fam Physician. 2003 Oct 1;68(7):1271, 1274, 1277.

Management of gastroesophageal reflux disease.

Heidelbaugh JJ, Nostrant TT, Kim C, Van Harrison R.

Department of Family Medicine, University of Michigan Medical School, Ann Arbor,
Michigan, USA. jheidel@umich.edu

The primary treatment goals in patients with gastroesophageal reflux disease are
relief of symptoms, prevention of symptom relapse, healing of erosive
esophagitis, and prevention of complications of esophagitis. In patients with
reflux esophagitis, treatment is directed at acid suppression through the use of
lifestyle modifications (e.g., elevating the head of the bed, modifying the size
and composition of meals) and pharmacologic agents (a histamine H2-receptor
antagonist [H2RA] taken on demand or a proton pump inhibitor IPPI] taken 30 to
60 minutes before the first meal of the day). The preferred empiric approach is
step-up therapy (treat initially with an H2RA for eight weeks; if symptoms do
not improve, change to a PPI) or step-down therapy (treat initially with a PPI;
then titrate to the lowest effective medication type and dosage). In patients
with erosive esophagitis identified on endoscopy, a PPI is the initial treatment
of choice. Diagnostic testing should be reserved for patients who exhibit
warning signs (i.e., weight loss, dysphagia, gastrointestinal bleeding) and
patients who are at risk for complications of esophagitis (i.e., esophageal
stricture formation, Barrett's esophagus, adenocarcinoma). Antireflux surgery,
including open and laparoscopic versions of Nissen fundoplication, is an
alternative treatment in patients who have chronic reflux with recalcitrant
symptoms. Newer endoscopic modalities, including the Stretta and endocinch
procedures, are less invasive and have fewer complications than antireflux
surgery, but response rates are lower.

Publication Types:
    Review, Tutorial

PMID: 14567485 [PubMed]

24: J Laparoendosc Adv Surg Tech A.  2003 Aug;13(4):285-9.  

Obesity surgery: a gastroenterologist's perspective.

Bedine MS.

Johns Hopkins University School of Medicine, Baltimore, Maryland 21093, USA.

Obesity is increasing at an alarming rate. Approximately 25% of adult women and
20% of adult men in the United States are obese. Obesity is increasing even more
rapidly in children. The incidence of type 2 diabetes mellitus, hypertension,
dyslipidemia, and liver disease is significantly increased in obese persons.
Traditional methods of diet, exercise, drugs, and behavior modification are
unsuccessful in the treatment of patients who are morbidly obese and have a body
mass index of 40 kg/m(2) or a body mass index of 35 kg/m(2) with comorbidity.
Multiple surgical alternatives to the traditional treatments are available and
have been successful. Considerable weight loss may be achieved and maintained.
Each procedure is associated with a variety of side effects and complications.
The selection of patients for bariatric surgery requires a careful evaluation of
their medical condition in addition to multiple psychological and social
factors. Postoperative care entails careful medical follow-up and long-term
support. Patients may have a difficult time adjusting to their new ability to
eat normally.

PMID: 14561258 [PubMed]

25: J Laparoendosc Adv Surg Tech A.  2003 Aug;13(4):271-7.  

Laparoscopic adjustable silicone gastric banding: complications.

DeMaria EJ.

College of Virginia, Richmond, Virginia 23298-0428, USA. edemaria@hsc.vcu.edu

Laparoscopic adjustable gastric banding is a procedure that is now approved by
the Federal Drug Administration for use in the United States to treat morbid
obesity. Numerous complications can occur as a result of the device. These
include both early technical complications as well as long-term problems such as
esophageal dilatation and failed weight loss. While improvements in surgical
technique may decrease early technical complications such as gastric prolapse,
long-term follow-up studies will be required to determine the ultimate success
of this device in controlling severe obesity.

Publication Types:
    Review, Tutorial

PMID: 14561256 [PubMed]

26: J Forensic Sci.  2003 Sep;48(5):1206.  

Semantic differences between "tumescent liposuction," "tumescent anesthesia,"
and "tumescent technique".

Platt MS, Cohle SD, Kohler LJ.

Publication Types:

PMID: 14535706 [PubMed]

27: Ann Surg.  2003 Oct;238(4):618-27; discussion 627-8.  

The duodenal switch operation for the treatment of morbid obesity.

Anthone GJ, Lord RV, DeMeester TR, Crookes PF.

Department of Surgery, University of Southerm California Keck School of
Medicine, Los Angeles, CA 90033-42, USA. ganthone@surgery.usc.edu

OBJECTIVE: To determine the safety and efficacy of the duodenal switch procedure
as surgical treatment of morbid obesity. SUMMARY BACKGROUND DATA: The
longitudinal gastrectomy and duodenal switch procedure as performed for morbid
obesity involves a 75% subtotal greater curvature gastrectomy and long limb
suprapapillary Roux-en-Y duodenoenterostomy. This results in a restricted
caloric intake and diversion of bile and pancreatic secretions to induce fat
malabsorption. Broad acceptance of this procedure has been impeded because of
concerns that the malabsorptive component may produce serious nutritional
complications. METHODS: Review of data collected prospectively from all patients
who underwent duodenal switch as the primary surgical treatment of morbid
obesity at a single institution during the 10-year period beginning September
1992. Operative morbidity and mortality, weight loss, volume of food intake, and
bowel function were recorded. Sequential measurements of serum albumin,
hemoglobin, and calcium levels were obtained to assess metabolic function and
nutrient absorption. RESULTS: Duodenal switch was performed as the primary
operation in 701 (81%) of a total 863 patients undergoing bariatric surgery
during the period of study. The average body mass index (BMI) was 52.8 (range,
34-95). Perioperative mortality was 1.4%, and morbidity (including leaks, wound
dehiscence, splenectomy, and postoperative hemorrhage) occurred in 21 patients
(2.9%). Weight loss averaged 127 pounds at 1 year, 131 at 3 years, and 118 at 5
or more years (% EBWL of 69%, 73%, and 66%, respectively). The mean number of
bowel movements was fewer than 3 per day. Patients reported and maintained a
mean restriction of 63% of their preoperative intake (approximately 1600
calories), with no specific food intolerance, at 3 or more years follow-up. At 3
years, serum albumin remained at normal levels in 98% of patients, hemoglobin in
52%, and calcium in 71%. No patients reported dumping, and marginal ulcers were
not seen. CONCLUSIONS: The longitudinal gastrectomy with duodenal switch is a
safe and effective primary procedure for the treatment of morbid obesity. It has
the advantage of allowing acceptable alimentation with a minimum of side effects
while producing and maintaining significant weight loss. These results are
achieved without developing significant dietary restrictions or clinical
metabolic or nutritional complications.

PMID: 14530733 [PubMed]

28: Dis Colon Rectum.  2003 Oct;46(10):1345-50.  

Local excision of large rectal villous adenomas: long-term results.

Pigot F, Bouchard D, Mortaji M, Castinel A, Juguet F, Chaume JC, Faivre J.

Colo-proctological Unit, Hopital Bagatelle, Talence, France.

PURPOSE: Transanal excision of rectal villous adenomas is a widely used surgical
technique, because it is a one-step procedure, requiring no sophisticated
instrumentation, and allowing complete histologic analysis of the excised tumor.
Therefore, it ranks alongside radical surgery and palliative destructive
procedures, but its results are highly variable in the published series. This
discrepancy may be explained by the variable completeness of tumor excision
because of potential dissection difficulties. Because intraoperative exposure
may be a major limiting factor, one of us (JF) has developed a tractable
cutaneomucous flap procedure to lower the rectal tumor to the anal verge, where
control of the dissection line is easier. This retrospective review of
consecutive patients operated on during ten-year period reports long-term
results after transanal excision for large rectal villous adenomas with the
tractable flap technique. PATIENTS: From 1978 to 1988, 207 consecutive patients
(100 males), mean age 68 (range, 24-90) years, were operated on for an
apparently benign villous rectal adenoma. Twenty-one patients (10 percent) were
referred after failure of previous treatments: 11 endoscopic, 8 surgical, 1
laser, 1 radiotherapy. Mean distance of lower tumor edge from anal margin was
5.6 (range, 0-13) cm and was <10 cm in 82 percent. RESULTS: Three patients (1.5
percent), including one with a Tis carcinoma, underwent a secondary treatment
for immediate gross failure of resection: one further local excision and two
palliative laser destructions. Immediate postoperative course was uneventful for
96 percent; there was one death from perineal gangrenous infection, four cases
of hemorrhage, and three urinary retentions. Subsequently one case of transient
fecal incontinence and 11 medically managed stenoses were noted. Mean size of
resected tumor was 5.4 (range, 1-17) cm. Deep excision margins concerned the
rectal muscular layers in 199 patients (96 percent) and perirectal fat in 8 (4
percent). Specimen margins were negative for cancer in 175 (85 percent) and
positive or unknown in 32 cases. Histologic evaluation demonstrated in situ
cancer in 28 (14 percent) and invasive carcinoma in 9 (4 percent). In three
patients (1 percent), two abdominoperineal resections were immediately performed
(one T2 with a mucinous contingent, one T3) and one adjuvant radiotherapy (one
undifferentiated T2). Four patients (2 percent) did not return for postoperative
evaluation. For the remaining 198 patients, mean follow-up was 74 +/- 34
(median, 75; range, 1-168) months. Forty-four died from unrelated causes.
Recurrence occurred in seven (3.6 percent) and was malignant in two, who
subsequently died. Specific recurrence-free probability was 99.5 percent at one
year, 96 percent at five years, and 95 percent at ten years. A lesion size >6 cm
(10 vs. 1 percent for smaller tumors) and the presence of an invasive carcinoma
(20 vs. 3 percent without invasive carcinoma) were significantly associated with
an increased probability of recurrence at five years. CONCLUSION: Providing that
adequate intraoperative exposure is obtained and advanced malignant tumors
receive immediate secondary treatment, transanal resection of clinically benign,
large rectal villous adenomas is safe and effective. It is an alternative to
rectal resection, which exposes the patient to potentially adverse effects, and
also to destructive procedures, which preclude any histologic evaluation of the

PMID: 14530673 [PubMed]

29: Gastric Cancer.  2003;6(3):134-41.  

Quantitative evaluation of reconstruction methods after gastrectomy using a new
type of examination: digestion and absorption test with stable isotope
13C-labeled lipid compound.

Takase M, Sumiyama Y, Nagao J.

The Third Department of Surgery, Toho University School of Medicine, Ohashi
Hospital, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.

BACKGROUND: Digestive and absorptive disorders may negatively influence
patients' nutrition, thus resulting in weight loss after gastrectomy. A
relationship thus seems to exist between the fat absorptive function and body
weight after gastrectomy; however, so far there has been no evidence to prove
this hypothesis. Therefore, in this study we evaluated fat absorption ability
using a stable isotope, (13)C-trioctanoin, based on the range of the gastrectomy
and the method of reconstruction, and we also determined the feasibility of this
test. METHODS: Among patients who had undergone gastrectomy for gastric cancer,
40 patients who had been operated on between 1 and 3 years previously were
evaluated. Ten patients had undergone the double-tract (DT) method, and 10
patients had received the Roux-en-Y (RY) method after a total gastrectomy.
Twenty patients who had undergone the Billroth I (BI) method after a distal
gastrectomy were the control group. In addition, 10 volunteers formed a healthy
control group for the (13)C-trioctanoin test. We also examined other six factors
related to nutrition after gastrectomy. RESULTS. The (13)C-trioctanoin test
showed, in relation to the reconstruction procedure, the highest average peak of
fat absorption in the BI group (which had food passage through the duodenum),
followed by the average peak of fat absorption in the DT group and the RY
groups. In a comparison of duration, at 60 min and 90 min after administration,
the BI group and DT group showed a significantly higher level than the RY group.
The peaking time (average time at peak level) showed a significant difference
between the RY group and the other groups. The absorption amount at an early
stage of absorption and the percent (%) dose showed a significant difference
between the RY group and the other groups. The RY group had significantly lower
fat absorption than the healthy controls. CONCLUSION: According to this study,
which evaluated fat absorption after different reconstructive procedures after
gastrectomy, the procedure that accommodated for the passage of food through the
duodenum showed better results for the absorption of medium-chain triglycerides,
and the patients also showed a better physiological state.

Publication Types:
    Evaluation Studies

PMID: 14520525 [PubMed]

30: Am J Clin Dermatol.  2003;4(10):681-97.  

Management of primary hyperhidrosis: a summary of the different treatment

Connolly M, de Berker D.

Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol, UK.

Hyperhidrosis is a common and distressing condition involving increased
production of sweat. A variety of treatment modalities are used to try to
control or reduce sweating. Sweat is secreted by eccrine glands innervated by
cholinergic fibers from the sympathetic nervous system. Primary hyperhidrosis
most commonly affects palms, axillae and soles. Secondary hyperhidrosis is
caused by an underlying condition, and treatment involves the removal or control
of this condition. The treatment options for primary hyperhidrosis involve a
range of topical or systemic medications, psychotherapy and surgical or
non-surgical invasive techniques. Topical antiperspirants are quick and easy to
apply but they can cause skin irritation and have a short half life. Systemic
medications, in particular anticholinergics, reduce sweating but the dose
required to control sweating can cause significant adverse effects, thus,
limiting the medications' effectiveness. Iontophoresis is a simple and well
tolerated method for the treatment of hyperhidrosis without long-term adverse
effects; however, long-term maintenance treatments are required to keep patients
symptom free. Botulinum toxin A has emerged as a treatment for hyperhidrosis
over the past 5-6 years with studies showing good results. Unfortunately,
botulinum toxin A is not a permanent solution, and patients require repeat
injections every 6-8 months to maintain benefits. Psychotherapy has been
beneficial in a small number of cases. Percutaneous computed tomography-guided
phenol sympathicolysis achieved good results but has a high long-term failure
rate. Surgery has also been shown to successfully reduce hyperhidrosis but, like
other therapies, has several complications and patients need to be informed of
these prior to undergoing surgery. The excision of axillary sweat glands can
cause unsightly scarring and transthoracic sympathectomy (either open or
endoscopic) can be associated with complications of compensatory and gustatory
hyperhidrosis, Horner syndrome and neuralgia, some of which patients may find
worse than the condition itself.

Publication Types:
    Review of Reported Cases

PMID: 14507230 [PubMed]

31: Am J Clin Dermatol.  2003;4(10):661-7.  

Skin-related complications of insulin therapy: epidemiology and emerging
management strategies.

Richardson T, Kerr D.

Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital,
Bournemouth, UK. tristan.richardson@rbch-tr.swest.nhs.uk

The incidence and prevalence of all types of diabetes mellitus is increasing at
an alarming rate. Modern therapy involves greater and earlier use of intensive
insulin regimens in order to achieve better control of blood glucose levels and
reduce the long-term risks associated with the condition. Insulin therapy is
associated with important cutaneous adverse effects, which can affect insulin
absorption kinetics causing glycemic excursions above and below target levels
for blood glucose. Common complications of subcutaneous insulin injection
include lipoatrophy and lipohypertrophy. The development of lipoatrophy may have
an immunological basis, predisposed by lipolytic components of certain insulins.
Repeated use of the same injection site increases the risk of lipoatrophy--with
time, patients learn that these areas are relatively pain free and continue to
use them. However, the absorption of insulin from lipoatrophic areas is erratic
leading to frequent difficulties in achieving ideal blood glucose control. With
the increasing use of modified, rapidly absorbed analog insulins (e.g. insulin
lispro, insulin aspart) the incidence of lipoatrophy occurring has decreased
over recent years. The likelihood of lipoatrophy can be reduced by regular
rotation of injection sites but once developed, practical benefits may be
obtained by insulin injection into the edge of the area, co-administration of
dexamethasone with insulin, or changing the mode of insulin delivery.
Lipohypertrophy is the most common cutaneous complication of insulin therapy.
Newer insulins have also reduced its prevalence considerably, although its
adverse effect on diabetic control is similar to lipoatrophy through impaired
absorption of insulin into the systemic circulation. Experience with liposuction
at these sites is limited, although good cosmetic results have been achieved.
Local allergic reactions to insulin are usually erythema, pruritus, and
induration. These allergic reactions are usually short-lived, and resolve
spontaneously within a few weeks. Useful adjuncts to managing allergic reactions
include addition of dexamethasone to the insulin injection, desensitization to
insulin, or a change in delivery system utilizing insulin pump therapy or
potentially inhaled insulins when these become available. The use of insulin
pump therapy in managing cutaneous complications of insulin therapy is
increasing, but this method itself carries risks of abscess formation and
scarring. Fortunately, with improved education of patients these are relatively
uncommon. Although many of the cutaneous manifestations are decreasing with the
use of newer insulins, they may still influence glycemic control and increase
the risk of hypoglycemia as well as have a cosmetic impact on a patient. The
introduction of novel therapies and newer delivery systems is likely to reduce
the cutaneous problems associated with long-term insulin use.

Publication Types:
    Review, Tutorial

PMID: 14507228 [PubMed]

32: Chirurg.  2003 Sep;74(9):808-14.  

[No problem with liposuction?]

[Article in German]

Lehnhardt M, Homann HH, Druecke D, Steinstraesser L, Steinau HU.

Universitatsklinik fur Plastische Chirurgie und Schwerbrandverletzte,
Handchirurgiezentrum, Operatives Referenzzentrum fur Gliedmassentumoren,
BG-Kliniken Bergmannsheil, Ruhr-Universitat Bochum. marcuslehnhardt@mac.com

Subcutaneous liposuction in tumescent technique is the most frequent aesthetic
plastic procedure in the United States. In Germany, nearly 250,000 liposuctions
are done per year by a variety of surgical and nonsurgical specialists including
plastic surgeons, dermatologists, gynecologists, oral surgeons, and
otolaryngologists in settings ranging from hospital operating rooms to
physicians' offices. The method is applied and promoted as an easy-to-learn
technique that is suited as an outpatient procedure. Although major
complications seem to be rare, there are definite risks, including death at a
rate of 1/5,000 procedures. Major risk factors are insufficient hygiene
standards, multiliter wetting solution infiltration, megavolume aspiration,
multiple cosmetic procedures in one setting, sedative and anesthetic drug
hangover threatening ventilation, permissive postoperative discharge, and
mistakes in patient selection. When major complications occur, office-based
practitioners may refer patients to hospital emergency departments, where
medical personnel unfamiliar with this procedure may underestimate the risk of
major complications.

Publication Types:
    Review, Academic

PMID: 14504792 [PubMed]

33: Plast Reconstr Surg.  2003 Oct;112(5):1435-41; discussion 1442-3.  

Lipoaspiration and its complications: a safe operation.

Cardenas-Camarena L.

Plastic Surgery Unit, Guadalajara, Jalisco, Mexico. plassurg@mail.udg.mx

Although lipoaspiration has been considered a safe surgical procedure for the
last 30 years, reports indicate that this procedure has a high index of
complications. This study was performed to analyze experience with patients in a
clinical practice for the past 8 years who underwent lipoaspiration, either
alone or in combination with another surgical procedure, and to compare the
results with previous reports in the literature. The patients were divided into
four groups: lipoaspiration alone of less than 5 liters, lipoaspiration alone of
more than 5 liters, lipoaspiration combined with abdominoplasty, and
lipoaspiration combined with another surgical procedure. Complications were
divided into minor or major, depending on previous reports, and statistical
analysis was used to determine any significant difference among the four groups.
From January of 1994 to December of 2001, 1047 patients underwent
lipoaspiration, either alone or in combination with another surgical procedure.
A 21.7 percent incidence of minor complications was noted, as well as a 0.38
percent incidence of major complications. Minor complications included palpable
and visible irregularities, seromas, cutaneous hyperpigmentation,
overcorrection, cutaneous slough, and local infection. Major complications
included fat embolism syndrome, cutaneous necrosis, and extended infection. No
statistical difference was noted among the groups studied. The incidence of
complications was similar to that in clinical reports in the world literature,
being of a low percentage rate when compared with the reports of other types of
surgical procedures. On the basis of these results, lipoaspiration continues to
be a safe surgical procedure, but to maximally avoid complications, one should
be mindful of all the factors that could predispose to them.

PMID: 14504529 [PubMed]

34: J Trauma.  2003 Sep;55(3):495-503; discussion 503.  

Intramedullary pressure increase and increase in cortical temperature during
reaming of the femoral medullary cavity: the effect of draining the medullary
contents before reaming.

Mueller CA, Rahn BA.

Clinic for Traumatology, University Clinic Freiburg, Germany.

BACKGROUND:Reaming is regarded as the most adverse aspect of the intramedullary
nailing procedure since it leads not only to impairment of the vessels but also
to an increase in intramedullary pressure and cortical temperatures which may in
turn lead to aseptic cortical necroses and pulmonary dysfunction. Intramedullary
pressure increase is considered to be the most detrimental of these factors.
METHODS: The aim of this study was to investigate the effect on intramedullary
pressure and cortical temperature of removing the medullary fat before reaming.
The fat was removed through a suction tube inserted proximally. The measurements
were made on pairs of human femora whereby in one group the contents of the
medulla were drained by suction before reaming. The pressure was measured in the
mid diaphysis and in the metaphysis. The temperature was measured in the mid
diaphysis. The femora were reamed in a water bath at 37 degrees C and at a
constant insertion force. RESULTS: In comparison to the group which was not
drained, the pressure for the 9.0 mm reamer in previously drained femora was
reduced as follows: positive diaphyseal pressure by 88% (reamer insertion);
positive metaphyseal pressure by 78% (reamer insertion); negative diaphyseal
pressure by 84% (reamer withdrawal); negative metaphyseal pressure by 65%
(reamer withdrawal). No significant difference was determined for temperature
increase (median suction, 39.7 degrees C; median without suction, 39.4 degrees
C). CONCLUSION: The removal of the medullary contents by suction before
inserting reaming instruments leads to a considerable and statistically
significant pressure reduction. If the medullary contents are not sucked out
before reaming or insertion of unreamed nails, high intramedullary pressure and
the risk of embolization is unaltered. Consequently new instruments should be
developed to facilitate the removal of the medullary contents before commencing
the reaming procedure or insertion of unreamed nails.

PMID: 14501893 [PubMed]

35: Handchir Mikrochir Plast Chir.  2003 Jul;35(4):225-32.  

[Liposuction of arm lymphoedema]

[Article in German]

Brorson H.

Das Lymphodemteam, Abteilung fur Plastische und Rekonstruktive Chirurgie, Malmo
Universitatsklinikum, Malmo, Schweden. Brorson@Plasticsurg.nu

Breast cancer is the most common disease in women, and up to 38 % develop
lymphoedema of the arm following mastectomy, standard axillary node dissection
and postoperative irradiation. Limb reductions have been reported utilising
various conservative therapies such as manual lymph drainage and pressure
therapy. Some patients with long-standing pronounced lymphoedema do not respond
to these conservative treatments because slow or absent lymph flow causes the
formation of excess subcutaneous adipose tissue. Previous surgical regimes
utilising bridging procedures, total excision with skin grafting or reduction
plasty seldom achieved acceptable cosmetic and functional results. Microsurgical
reconstruction involving lympho-venous shunts or transplantation of lymph
vessels has also been investigated. Although attractive in concept, the common
failure of microsurgery to provide complete reduction is due to the persistence
of newly formed subcutaneous adipose tissue which is not removed in patients
with chronic non-pitting lymphoedema. Liposuction removes the hypertrophied
adipose tissue and is a prerequisite to achieve complete reduction. The new
equilibrium is maintained through constant (24-hour) use of compression garments
postoperatively. Long-term follow-up (seven years) does not show any recurrence
of the oedema.

PMID: 12968220 [PubMed]

36: Obes Surg.  2003 Aug;13(4):642-8.  

Laparoscopic adjustable gastric banding for severe obesity.

Vella M, Galloway DJ.

Department of Surgical Gastroenterology, Gartnavel General Hospital, Glasgow,
Scotland, UK.

BACKGROUND: Morbid obesity is an increasingly common condition with serious
associated morbidity and decreased life expectancy. The only treatment with
long-term efficacy for this condition is surgical intervention. Laparoscopic
adjustable gastric banding (LAGB) is a procedure increasingly performed in
European centres and recently approved by the FDA in USA. This article reviews
its effectiveness and complications. METHODS: A literature search identified
relevant articles. RESULTS: LAGB results in approximately 60% (43-78%) excess
weight loss at 3 years with improvement in co-morbidities, with perioperative
mortality <0.5%. Potential complications include prolapse or pouch dilatation,
and port-related complications. Less common complications are intra-operative
gastric perforation and band erosion. Rate of reoperation varies greatly between
series, and is usually needed for band repositioning or port-related procedures,
many of the latter performed under local anesthesia. CONCLUSION: The available
data demonstrate that LAGB is a safe bariatric procedure, and is effective in
the short- and medium-term. Results of long-term follow-up are awaited.

Publication Types:
    Review Literature

PMID: 12935369 [PubMed]

37: Obes Surg.  2003 Aug;13(4):637-41.  

Dermalipectomy for body contouring after bariatric surgery in Aegean region of

Menderes A, Baytekin C, Haciyanli M, Yilmaz M.

Department of Plastic and Reconstructive Surgery, Dokuz Eylul University,
Faculty of Medicine, Izmir, Turkey.

BACKGROUND: The only proven effective long-term treatment for morbid obesity is
bariatric surgery. After surgery, additional problems may arise such as
redundant hanging skin and a poor body image. The patient's quality of life and
social acceptance may thus still be hindered. Body contouring operations remain
the only hope here. METHODS: Body contouring surgery was performed on 11
patients out of 38 who had had vertical banded gastroplasty. General
self-consciousness, social self-consciousness of appearance and sexual and
bodily self-consciousness of appearance were measured with a retrospective
questionnaire. RESULTS: Timing of body contouring surgery was determined
according to the demand of the patient and stabilization of the patient's weight
status. On average the first plastic surgery operation was performed after 17
(12-25) months. Mean age was 37.4 (34-65) and mean excess weight loss was 57.6
(37-129). In the 11 patients who underwent plastic procedures, a total of 23
such operations were performed, and 8 complications were encountered in these 23
operations. General self-consciousness and sexual bodily self-consciousness of
appearance showed improvement after bariatric surgery and further improvement
after the plastic surgery. CONCLUSION: For markedly redundant skin after massive
weight loss, dermalipectomy is the only treatment. This improves the patient's
general, sexual and bodily self-consciousness.

PMID: 12935368 [PubMed]

38: Dermatol Surg.  2003 Sep;29(9):925-7; discussion 927.  

Power liposuction: a report on complications.

Katz BE, Bruck MC, Felsenfeld L, Frew KE.

Department of Dermatology, College of Physicians and Surgeons, Columbia
University, New York, NY, USA.

BACKGROUND: Liposuction is the most commonly performed cosmetic surgical
procedure in the United States. Traditional liposuction (TL) performed under
general anesthesia has been associated with reports of major systemic
complications, including death. When TL is performed using only tumescent
anesthesia, there have been no reported deaths and few significant systemic
complications. Power liposuction (PL), a newer procedure in which a
reciprocating cannula is used to evacuate fat, has reported benefits over TL.
OBJECTIVE: To determine the complication rate associated with PL and to compare
it with TL (regardless of the type of anesthesia). METHODS: In this study, 207
consecutive PL cases performed with tumescent anesthesia between August 2000 and
May 2002 by a dermatologic surgeon (B.K.) and a plastic surgeon (M.B.) were
reviewed retrospectively to determine the number of complications associated
with the PL procedure. RESULTS: No systemic complications were identified, and
only three local complications (all seromas) were found. This represents a
complication rate of 1.4%. CONCLUSION: Our results demonstrate fewer
complications when performing PL using tumescent anesthesia compared with TL
using general anesthesia. When compared with TL using tumescent anesthesia, the
overall complication rate did not differ significantly. We conclude that in
addition to PL previously demonstrated benefits, the complication profile
compares favorably with TL under local tumescent anesthesia. Therefore, PL may
assume a more prominent role in the armamentarium of the surgeon performing

PMID: 12930334 [PubMed]

39: Wiad Lek.  2003;56(3-4):186-91.  

[Obesity and surgery]

[Article in Polish]

Wylezol MS, Pardela MS.

Katedry i Oddzialu Klinicznego Chirurgii Ogolnej i Naczyn w Zabrzu.

Obesity is a life-long, progressive, life-threatening, genetically related,
costly, multifactorial disease manifested by excessive fat storage. It is often
accompanied by multiple comorbidities including mainly hypertension, diabetes,
hyperlipidemia, hypoventilation, obstructive sleep apnea, degenerative arthritis
and psychosocial impairment which influence the patients quality of life and
ultimately limit their life expectancy. Conservative treatment of morbid and
extreme obesity including diet, physical activity, behaviour modifications or
pharmacotherapy is not effective in achieving a medically significant long-term
weight loss. The costs of such therapy often exceed the costs of the surgical
procedure. Surgical treatment of obesity was initiated over 50 years ago. Then
the surgical methods were to lead to an increased excretion but finally did not
prove useful. They were replaced by restrictive and malabsorption procedures.
The first methods including vertical banded gastroplasty (VBG) were introduced
in 1982 while gastric banding in 1985. The second method including gastric
bypasses or biliopancreatic diversion were implemented in the years 1966-1986.
There are also some methods joining these two techniques. Nowadays as a results
of minimally invasive surgery development, most of the operations can be
performed laparoscopically.

Publication Types:
    Review, Tutorial

PMID: 12923968 [PubMed]

40: Voen Med Zh.  2003 Jun;324(6):38-42.  

[Evaluation of blood loss by different methods of liposuction and technical
features of its performance]

[Article in Russian]

Nechaev EA, Efimenko NA, Danishchuk IV, Agapov KV.

PMID: 12916420 [PubMed]

41: Cancer Radiother.  2003 Aug;7(4):231-6.  

[Prospective study of accelerated postoperative radiation therapy in patients
with squamous-cell carcinoma of the head and neck]

[Article in French]

Zouhair A, Coucke PA, Azria D, Pache P, Stupp R, Moeckli R, Mirimanoff RO,
Ozsahin M.

Service de radio-oncologie, centre hospitalier universitaire vaudois CHUV, 1011,
Lausanne, Suisse. abderrahim.zouhair@chuv.hospvd.ch

PURPOSE: To assess the feasibility and efficacy of accelerated postoperative
radiation therapy (RT) in patients with squamous-cell carcinoma of the head and
neck (SCCHN). PATIENTS AND METHODS: Between December 1997 and July 2001, 68
patients (male to female ratio: 52/16; median age: 60-years (range: 43-81) with
pT1-pT4 and/or pN0-pN3 SCCHN (24 oropharynx, 19 oral cavity, 13 hypopharynx, 5
larynx, 3 unknown primary, 2 maxillary sinus, and 2 salivary gland) were
included in this prospective study. Postoperative RT was indicated because
extracapsular infiltration (ECI) was observed in 20 (29%), positive surgical
margins (PSM) in 20 (29%) or both in 23 patients (34%). Treatment consisted of
external beam RT 66 Gy in 5 weeks and 3 days. Median follow-up was 15 months.
RESULTS: According to CTC 2.0, acute morbidity was acceptable: grade 3 mucositis
was observed in 15 (22%) patients, grade 3 dysphagia in 19 (28%) patients, grade
3 skin erythema in 21 (31%) patients with a median weight loss of 3.1 kg (range:
0-16). No grade 4 toxicity was observed. Median time to relapse was 13 months;
we observed only three (4%) local and four (6%) regional relapses, whereas eight
(12%) patients developed distant metastases without any evidence of locoregional
recurrence. The 2 years overall-, disease-free survival, and actuarial
locoregional control rates were 85, 73 and 83% respectively. CONCLUSION: The
reduction of the overall treatment time using postoperative accelerated RT with
weekly concomitant boost (six fractions per week) is feasible with local control
rates comparable to that of published data. Acute RT-related morbidity is

Publication Types:
    Clinical Trial
    Clinical Trial, Phase II

PMID: 12914856 [PubMed]

42: Semin Radiat Oncol.  2003 Jul;13(3):290-301.  

Lymphedema management.

Cheville AL, McGarvey CL, Petrek JA, Russo SA, Taylor ME, Thiadens SR.

Department of Rehabilitation Medicine, University of Pennsylvania Health System,
Philadelphia, PA 19104, USA.

Lymphedema, defined as the abnormal accumulation of protein rich fluid
dysfunction of the lymphatic system, is a common sequela of cancer therapy. The
incidence is highest among patients who have undergone resection and irradiation
of a lymph node bed. Recently, increased attention has been focused on the
modification of anticancer therapies in an effort to minimize lymphatic
compromise. Sentinel lymph node biopsy is an example of a surgical procedure
developed to preserve lymphatic function. Concurrent with the development of
less invasive treatments, the field of lymphedema management has evolved rapidly
over the past decade. Combined manual therapy, often referred to as complex
decongestive physiotherapy (CDP), has emerged as the standard of care. CDP
combines compression bandaging, manual lymphatic drainage (a specialized massage
technique), exercise, and skin care with extensive patient education. Case
series collectively describing a mean 65% volume reduction in over 10,000
patients attest its efficacy. Pneumatic compression pumps were historically
widely used to control lymphedema. Their use as an isolated treatment modality
is now rare. Reliance on pumps diminished with the recognition that they may
exacerbate truncal and genital lymphedema, as well as injure peripheral
lymphatics when applied at high pressures. Many noncompressive approaches,
particularly the use of benzopyrone medications and liposuction, continue to be
used abroad.

Publication Types:
    Review, Tutorial

PMID: 12903017 [PubMed]

43: Plast Reconstr Surg.  2003 Aug;112(2):691; author reply 692.  

Comment on:
    Plast Reconstr Surg. 2002 Oct;110(5):1315-7.

Limited incision for breast surgery.

Biggs TM.

Publication Types:

PMID: 12900637 [PubMed]

44: Ned Tijdschr Geneeskd.  2003 Jul 12;147(28):1386.  

Comment on:
    Ned Tijdschr Geneeskd. 2002 Dec 14;146(50):2405-6.
    Ned Tijdschr Geneeskd. 2002 Dec 14;146(50):2430-5.

[Complications following liposuction]

[Article in Dutch]

Velthuis PJ.

Publication Types:

PMID: 12892019 [PubMed]

45: G Chir.  2003 Apr;24(4):137-43.  

[Idiopathic gynecomastia: our experience]

[Article in Italian]

Barbuscia M, Di Pietro N, Rizzo AG, Catalfamo A, Melita G, Sano M, Mancuso V,
Gorgone S.

Facolta di Medicina e Chirurgia Cattedra di Chirurgia dell'Apparato Digerente,
Universita degli Studi di Messina.

The Authors reporting their experience, discuss some concepts about physiologic
evolution of male and female breast. They distinguish between real and false
gynaecomastia; stressing the causes of abnormal development of male breast and
morphopathological characteristics of gynaecomastia. Careful diagnostic protocol
is necessary for a therapeutic approach based on traditional surgery or
liposuction: it depends on prevalence of glandular or adipose breast's tissue.

PMID: 12886753 [PubMed]

46: Orbit.  2003 Sep;22(3):183-91.  

Bone formation in hydroxyapatite tricalcium phosphate ceramic implants used in
the treatment of the postenucleation socket syndrome.

Adenis JP, Camezind P, Petit B, Pilon F, Robert PY, Boncoeur-Martel MP,
Camezind-Vidal MA, Rayanachekir NB, Labrousse F.

Department of Ophthalmology, Dupuytren University Hospital, Avenue Martin Luther
King, 87042 Limoges, France. pradenis@unilim.fr

PURPOSE: To determine the histopathologic changes in coralline hydroxyapatite
tricalcium phosphate (HA-TCP) blocks used in the treatment of the
postenucleation socket syndrome (PESS). METHODS: Twenty-four patients were
treated with HA-TCP blocks placed directly into the orbital fat to correct the
PESS. Eight of these patients required partial removal of the material for
various reasons between 32 and 371 days after the initial operation. The orbital
implants were decalcified and processed for light and electron microscopic
examination. RESULTS: Light microscopy demonstrated fibrovascular ingrowth into
the pores of the implant in all cases. Osteogenesis was observed in three cases
in the periphery of the implant. Ossification occurred in the implants after a
mean implantation duration of 276 days versus 67 days in cases without
ossification. CONCLUSION: Implants of HA-TCP, a new material used in
ophthalmology, demonstrate the presence of fibrovascular ingrowth, reflecting
the excellent biointegration of this material.

PMID: 12868027 [PubMed]

47: Br J Plast Surg.  2003 Apr;56(3):266-71.  

The effect of ultrasound-assisted liposuction and conventional liposuction on
the perforator vessels in the lower abdominal wall.

Blondeel PN, Derks D, Roche N, Van Landuyt KH, Monstrey SJ.

Department of Plastic and Reconstructive Surgery, University Hospital Gent,
Gent, Belgium.

Scientific reports of clinical in vivo research into the effects and
side-effects of ultrasonic-assisted liposuction (UAL) are scarce. Advocates of
UAL claim that the damage to vascular and nervous structures is limited and even
less than with conventional and/or tumescent liposuction (CL). The effect of
tumescent infiltration alone and combined with either CL or UAL was assessed by
performing injection studies of the panniculus adiposus of the lower abdominal
wall of 20 fresh cadavers and five abdominoplasty specimens. Besides the control
and infiltration groups (n=5 in each), there was an additional group of ten
cadaver flaps and five abdominoplasty flaps that underwent infiltration followed
by UAL in the right half of the flap and infiltration followed by CL in the left
half of the flap. Radiographs of these flaps were shown to a blinded panel of
ten plastic surgeons, who were asked to evaluate and compare the damage on the
basis of the number and magnitude of contrast-medium extravasations in the flap.
Vascular damage to the perforating vessels was seen even after infiltration
alone, although it was very limited. A variable amount of damage (ranging from
little to extensive) was observed in the CL and UAL groups. Statistical analysis
of the judgments of the observers could not show that either technique was less
damaging than the other. UAL is, therefore, probably more beneficial to the
surgeon than to the patient. The financial investment in the device is justified
for surgeons with large liposuction practices, mainly, and probably solely,
because of the reduced physical strain for the surgeon.

PMID: 12859923 [PubMed]

48: East Afr Med J.  2000 Apr;77(4):203-5.  

Lung resections in bronchiectasis due to lipoid pneumonia: a custom-design

Al-Malki TA.

Department of Surgery, College of Medicine, King Khalid University, and Asir
Central Hospital, Abha, Kingdom of Saudi Arabia.

OBJECTIVE: To see the effect of "custom-designed" surgical resection of some
severely damaged parts of the lungs in children with bronchiectasis caused by
forced feeding of children early in their lives with animal fat "ghee". DESIGN:
All children with bronchiectasis--post lipoid pneumonia--who failed to respond
to medical treatment had surgical removal of most affected parts of their lungs.
SETTINGS: Asir Central Hospital Abha, a referral hospital in Asir region of
Saudi Arabia and a Teaching Hospital for College of Medicine and Health
Sciences, King Khalid University, Saudi Arabia. SUBJECTS: Six children aged
between seven and 12 years with lipoid bronchiectasis were referred to
paediatric surgical service for surgical treatment. RESULTS: There was no
surgical mortality. Apart from mild cough, all the pre-operative symptoms of the
children disappeared. Two children died more than six months post-operatively
due to the extent of the original disease. CONCLUSION: Surgical resection
designed to remove the most affected parts of the lungs in diffuse-type
bronchiectasis is recommended when there is failure of medical treatment.

PMID: 12858904 [PubMed]

49: Am J Respir Crit Care Med.  2003 Oct 15;168(8):952-8. Epub 2003 Jul 03. 

Comment in:
    Am J Respir Crit Care Med. 2003 Oct 15;168(8):909-10.

Clinical diagnosis of hypersensitivity pneumonitis.

Lacasse Y, Selman M, Costabel U, Dalphin JC, Ando M, Morell F,
Erkinjuntti-Pekkanen R, Muller N, Colby TV, Schuyler M, Cormier Y; HP Study

Centre de Pneumologie, Hopital Laval, Universite Laval, Ste-Foy, Quebec, Canada.

The diagnosis of hypersensitivity pneumonitis (HP) is difficult and often relies
on histopathology. Our objective was to identify diagnostic criteria and to
develop a clinical prediction rule for this disease. Consecutive patients
presenting a condition for which HP was considered in the differential diagnosis
underwent a program of simple standardized diagnostic procedures.
High-resolution computed tomography scan and bronchoalveolar lavage (BAL)
defined the presence or absence of HP. Patients underwent surgical lung biopsy
when the computed tomography scan, BAL, and other diagnostic procedures failed
to yield a diagnosis. A cohort of 400 patients (116 with HP, 284 control
subjects) provided data for the rule derivation. Six significant predictors of
HP were identified: (1) exposure to a known offending antigen, (2) positive
precipitating antibodies to the offending antigen, (3) recurrent episodes of
symptoms, (4) inspiratory crackles on physical examination, (5) symptoms
occurring 4 to 8 hours after exposure, (6) and weight loss. The area under the
receiver operating characteristic curve was 0.93 (95% confidence interval:
0.90-0.95). The rule retained its accuracy when validated in a separate cohort
of 261 patients. The diagnosis of HP can often be made or rejected with
confidence, especially in areas of high or low prevalence, respectively, without
BAL or biopsy.

Publication Types:
    Validation Studies

PMID: 12842854 [PubMed]

50: Obes Surg.  2003 Jun;13(3):399-403.  

Laparoscopic revisional surgery for life-threatening stenosis following vertical
banded gastroplasty, together with placement of an adjustable gastric band.

Gavert N, Szold A, Abu-Abeid S.

Department of Surgery B, Tel Aviv Sourasky Medical Center, Israel.

BACKGROUND: Vomiting and extreme weight loss may be life-threatening when
stenosis develops following vertical banded gastroplasty. Often patients must
undergo revisional surgery. Once the stenosis is relieved, the majority of
patients will proceed to gain weight at an excessive rate. Placement of an
adjustable band during revisional surgery allows us to treat the stenosis while
limiting the patients' weight gain and preventing the return of morbid obesity.
Performing this operation laparoscopically reduces patient morbidity. PATIENTS
AND METHODS: 23 patients (16 female, 7 male) were referred because of severe
food intolerance following silastic ring or Dacron mesh vertical gastroplasty.
The patients were on average 1.75 years after the initial operation (range: 9
months - 6 years). All patients required repeat hospitalizations due to
excessive vomiting and dehydration. All patients underwent laparoscopic surgery,
with placement of an adjustable band in 21 patients. RESULTS: All operations
were performed laparoscopically without need for conversion to laparotomy. There
were no intra-operative complications, and all patients were discharged within
24 hours. Patients have been followed for a mean of 7 months (range 3 months to
16 months). All patients became food tolerant without vomiting. 15 patients
required inflation of the adjustable band in order to control excessive weight
gain. CONCLUSIONS: Laparoscopic adjustable gastric banding at the time of
revisional surgery for stenosis appears to be a safe and effective operation
that does not add morbidity to surgery, but does prevent the need for further
revisional surgeries when patients begin to gain excessive weight after relief
of their obstruction.

PMID: 12841901 [PubMed]

51: Obes Surg.  2003 Jun;13(3):360-3.  

Laparoscopic gastric bypass for morbid obesity with linear gastroenterostomy.

Korenkov M, Goh P, Yucel N, Troidl H.

Surgical Clinic, 2nd Department of Surgery, University of Cologne, Germany.

BACKGROUND: Laparoscopic gastric bypass (LGBP) is a well-established procedure
for the surgical management of morbid obesity. Most surgeons create the
gastroenteral anastomosis by using the circular EEA stapler. We describe an
alternative laparoscopic anastomotic technique using the EndoGIA linear stapling
device. METHODS: The stomach was proximally transected with a linear stapler (45
mm, Endo-GIA) to create a 15 to 20 ml pouch. Next, an antecolic Roux-en-Y
gastroenterostomy was performed, using the 45 mm Endo-GIA. The proximal loop of
the intestine was then separated from the anastomotic site by the Endo-GIA.
Finally, the Endo-GIA was used for the intraabdominal creation of a side-to-side
enteroenterostomy. RESULTS: Between June and August 2001, 5 patients with mean
BMI 56.7 kg/m(2)+/-7.3 underwent LGBP. All patients were seen 6 months
post-surgery. Operating time was 7.5 and 6.5 hours for the first 2 operations,
but was under 4.5 h for the next 3 cases. 1 patient suffered from perioperative
hypoxia leading to long-term artificial respiration. 6 weeks after surgery, 1
patient developed obstruction due to torsion of the enteroenterostomy and
required open revision. The 3 remaining patients made an uneventful recovery.
All patients lost considerable weight (mean 36.5 kg; [range 32 to 45] after 6
months). No stenosis or anastomotic leakage was noted. CONCLUSIONS: A linear
stapled anastomosis is an alternative to the use of the circular stapler.

PMID: 12841894 [PubMed]

52: Obes Surg.  2003 Jun;13(3):355-9.  

Early results after laparoscopic gastric bypass: EEA vs GIA stapled
gastrojejunal anastomosis.

Shope TR, Cooney RN, McLeod J, Miller CA, Haluck RS.

Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
17033, USA.

BACKGROUND: Various surgical techniques have been successfully applied to
isolated Roux-en-Y gastric bypass (RYGBP). Many surgeons rely on stapling
devices for the gastrojejunal (GJ) anastomosis. Early follow-up results were
compared for two laparoscopic techniques for GJ anastomosis: circular end-to-end
(EEA) and linear cutting (GIA) staplers. METHODS: Medical charts were
retrospectively reviewed of all patients who had undergone stapled GJ
anastomosis for isolated RYGBP over a 2-year period. The jejunal limb used for
GJ anastomosis was fashioned at 1 cm / unit body mass index (BMI). Patients were
grouped by GJ anastomotic technique, EEA or GIA, and the results compared.
RESULTS: 61 patients underwent RYGBP (EEA=32; GIA=29), with no differences in
preoperative BMI or co-morbidities. Mean (+/-SD) operative time was shorter for
the GIA group (EEA=180+/-56.1 minutes; GIA=145.3+/-27.9 minutes, P=0.003). There
were 2 early re-operations in the GIA group for anastomotic leaks. Postoperative
complications were not statistically different; however, there was an increased
incidence of wound infections in the EEA group vs the GIA group (21.9% vs 6.9%,
P=0.08). Follow-up at 6-8 months revealed an average percent excess weight loss
of 46.7%+/-12.2% for EEA and 51.4%+/-10.7% for GIA (P=0.25). Length of stay,
total hospital costs and operating-room costs were similar (P=0.34, 0.53 and
0.96 respectively). CONCLUSION: Operative time was significantly shorter in the
GIA group. Complications, length of stay, weight loss and costs were similar
between the groups. Selection of anastomotic technique may be based on surgeon
preference, operative time, and potential for serious complications.

PMID: 12841893 [PubMed]

53: Ann Chir Plast Esthet.  2003 Jun;48(3):187-93.  

[An unusual risk of liposuction: liposuction of a malignant tumor. About 2

[Article in French]

Voulliaume D, Vasseur C, Delaporte T, Delay E.

Service de chirurgie plastique et des brules, centre hospitalier St-Joseph
St-Luc, 20, quai Claude-Bernard, 69007, Lyon, France.

Liposuction is a simple and elegant way to treat fatty excess; it has been even
used for the treatment of lipomas and some gynecomasties. The goal of this
article is to present 2 patients with an unusual complication of this use: the
liposuction of a malignant tumor. The first patient consulted following the
liposuction of a "gynecomasty", which was in fact a breast cancer. The second
was treated by liposuction for an ankle "lipoma"; it proved to be a liposarcoma.
In order to avoid liposuction and dissemination of a malignant tumor, the
pre-operative investigations have to search clinical peculiarities evoking the
diagnosis: an unilateral "gynecomasty", irregular, hard or painless, in a
50-years-old patient, must incite the surgeon to perform a classical excision,
just as a recurrent "lipoma", deeply located, voluminous or quickly extensive,
situated on the limbs or in the humeroscapular area. Paraclinic investigations
may be indicated; doubtful cases must be right away rejected for liposuction,
and treated by a surgical excision with strict safety margins and complete
anatomopathologic examination of the lesion. Liposuction has become a very
useful technique for the plastic surgeon; however, we must not forget, despite
of its many advantages the risk for dissemination of an unknown malignant tumor.
Every surgeon must keep it in mind and prefer a surgical removal in atypical

Publication Types:
    Case Reports

PMID: 12837640 [PubMed]

54: Plast Reconstr Surg.  2003 Jul;112(1):71-82.  

Breast reduction with ultrasound-assisted lipoplasty.

Di Giuseppe A.

Department of Plastic and Reconstructive Surgery, Ancona University School of
Medicine, Italy. adgplasticsurg@atlavia.it

Ultrasound-assisted lipoplasty for reduction of fatty breasts and fixation has
been found to be a safe technique with promising aesthetic results when it is
applied in selected patients and performed by a surgeon with expertise with
ultrasound-assisted body contouring. From 1995 to 2000, 120 patients were
treated with ultrasound energy to decrease the fatty component of the breast
tissue and at the same time to lift the breast mound. Each patient was evaluated
preoperatively with mammograms for correct assessment of the nature and
consistency of the breast tissue. Only patients with fibrofatty and fatty breast
parenchyma were selected for breast reduction and fixation with
ultrasound-assisted lipoplasty. Patients with suspect mammograms (calcification)
and a strong family history of breast cancer were not considered. All the
prescreening and the postoperative long-term mammographic evaluations were
conducted by a radiologist with high competence in breast tissue resonance.
Patients' age ranged from 17 to 53 years. Total aspirate ranged from 300 to 1200
ml for size, of which 65 percent was supranatant (fat) and 35 percent was
infranatant (tumescence solution and blood). Patients were operated on while
they were under general anesthesia; more recently, pure tumescent anesthesia was
tried with success in minor cases. Breast dimensions were assessed with breast
sizers (before and after the operation), and breast measurements were assessed
using a classic breast drawing. Minimum follow-up of patients was 4 years.
Particular care was given to evaluating long-term breast tissue appearance
through mammographic studies and to looking for suspected calcifications. No
evidence of a suspect mass or calcifications was found during the 4-year
follow-up. The main advantages of the technique are a significant reduction in
breast volume (up to three cup sizes), significant breast lift (up to 5 cm), and
nearly invisible scars (1.5 cm in length at the inframammary sulcus and at the

PMID: 12832879 [PubMed]

55: Ann Chir.  2003 Apr;128(3):167-72.  

Comment in:
    Ann Chir. 2003 Apr;128(3):173-4.

[Plea in favour of external cervicotomy approach of Zenker's diverticulum: 73
cases reported]

[Article in French]

Jougon J, Le Taillandier-de-Gabory L, Raux F, Delcambre F, Mac Bride T, Velly

Service de chirurgie thoracique et des maladies de l'oesophage (Pr Velly),
hopital du Haut-Leveque, CHU de Bordeaux, avenue de Magellan, 33604 cedex,
Pessac, France. jacques.jougon@chu-bordeaux.fr 

INTRODUCTION: Zenker's diverticulum can be treated surgically or endoscopically.
The aim of this study was to assess results of surgical approach with
cervicotomy and diverticulectomy. PATIENTS AND METHODS: We retrospectively
studied the data of 73 patients (50 men and 23 women; mean age, 69 ans;
extremes: 43-98) consecutively operated on for a Zenker's diverticulum between
1987 and 2000. Surgical procedure included diverticulectomy associated with a
large myotomy and oesophageal calibration. Both early and long-term results were
compared with those of published series of patients treated by stapled
esophagodiverticulostomy. RESULTS: Clinical manifestations were: dysphagia
(97%), regurgitations (76%), aspirations (45%), weight loss (28%), lung
infection (21%), or halitosis (3%). No patient died postoperatively. The early
morbidity rate was 4% (3 patients). The mean delay for return of oral feeding
and the mean length of hospital stay were respectively 6 and 8 days. At
follow-up (mean follow-up, 6 years; extremes: 3 months-13 years), 72 patients
(99%) were satisfied and 1 patient felt partially improved. Analysis of
published results of series of endoscopic treatment revealed shorter lengths of
hospital stay but less favourable long-term results. CONCLUSIONS: Early
morbidity of surgical treatment of Zenker's diverticulum is low. Long term
functional results could be better after surgical diverticulectomy with myotomy
than after endoscopic stapled esophagodiverticulostomy.

PMID: 12821083 [PubMed]

56: Cochrane Database Syst Rev.  2003;(2):CD003641.  

Surgery for morbid obesity.

Colquitt J, Clegg A, Sidhu M, Royle P.

Southampton Health Technology Assessments Centre, University of Southampton,
Boldrewood, Mailpoint 728, Southampton, Hampshire, UK, SO16 7PX.

BACKGROUND: Obesity is associated with increased morbidity and mortality.
Surgery for morbid obesity may be considered when other conventional measures
have failed, and a number of procedures are available. However, the effects of
these surgical procedures compared with medical management and with each other
are uncertain. OBJECTIVES: To assess the effects of surgery for morbid obesity
on weight, comorbidities and quality of life. SEARCH STRATEGY: We searched the
Cochrane Controlled Trials Register (issue 4, 2001), Medline (SilverPlatter) up
to 2001, PubMed (Internet) 01/01/01-19/10/01, Embase (SilverPlatter) up to
09/2001, PsychINFO up to 10/2001, CINAHL (SilverPlatter) up to 07/2001, Science
and Social Sciences Citation Index up to 10/12001, British Nursing Index up to
07/2001, Web of Science Proceedings up to 06/2001, BIOSIS up to10/2001, AMED up
to 07/2001, National Research Register (issue 2, 2001), reference lists of
relevant articles, and handsearched relevant journals. We also contacted experts
in the field. Date of the most recent searches: October 2001. SELECTION
CRITERIA: Randomised controlled trials comparing different surgical procedures,
and randomised controlled trials and non-randomised controlled trials comparing
surgery with non-surgical management for morbid obesity. DATA COLLECTION AND
ANALYSIS: Data were extracted by one reviewer and checked independently by two
reviewers. Two reviewers independently assessed trial quality. MAIN RESULTS: 18
trials involving 1891 people were included. One randomised controlled trial and
one non-randomised controlled trial compared surgery with non-surgical
management, and 11 randomised controlled trials compared different surgical
procedures. The overall quality of the trials was variable, with just one trial
having adequate allocation concealment. A meta-analysis was not possible due to
differences in the surgical procedures performed, measures of weight change and
length of follow-up. Compared with conventional management, surgery resulted in
greater weight loss (23-28 kg more weight loss at two years), with improvements
in quality of life and comorbidities. Some complications of surgery occurred,
such as wound infection. Gastric bypass was associated with greater weight loss
and fewer revisions, reoperations and/or conversions than gastroplasty, but had
more side-effects. Greater weight loss and fewer side-effects and reoperations
occurred with adjustable gastric banding than vertical banded gastroplasty,
while vertical banded gastroplasty was associated with greater weight loss but
more vomiting than horizontal gastroplasty. Some postoperative deaths occurred
in the studies. Weight loss was similar between open and laparoscopic
procedures. Fewer serious complications occurred with laparoscopic surgery.
Laparoscopic surgery had a longer operative time, but resulted in reduced blood
loss, reduced proportion of patients requiring intensive care unit stay, reduced
length of hospital stay, reduced days to return to activities of daily living
and reduced days to return to work. REVIEWER'S CONCLUSIONS: The limited evidence
suggests that surgery is more effective than conventional management for weight
loss in morbid obesity. The comparative safety and effectiveness of different
surgical procedures is unclear.

Publication Types:
    Review, Academic

PMID: 12804481 [PubMed]

57: Transpl Immunol.  2003 Apr-Jun;11(2):207-14.  

Impact of graft length on surgical damage after intestinal transplantation in

Inoue S, Tahara K, Sakuma Y, Hori T, Uchida H, Hakamada Y, Murakami T, Takahashi
M, Kawarasaki H, Hashizume K, Kaneko M, Kobayashi E.

Division of Organ Replacement Research, Center for Molecular Medicine, Jichi
Medical School, 3311-1, Yakushiji, Minamikawachi, Kawachi, 329-0498, Tochigi,

BACKGROUND: Intestinal grafts greatly affect nutrition and immunology in the
host. The growth of the recipient and incidence of graft-versus-host disease
depend on graft length. A larger graft may affect the host immune system, but
little is known about how the length of the intestinal graft severely affects
surgical intervention. We developed a cervical small bowel transplantation (SBT)
rat model that minimized technical variations using a cuff method and studied
the effects of graft length on surgical damage in SBT. MATERIALS AND METHODS: We
transplanted a whole (70 cm) or partial (15 cm) intestine into a syngeneic rat
combination of LEW (MHC haplotype: RT1(l)) to LEW and evaluated changes in
perioperative hemodynamics and the endogenous endotoxin level. Natural killer
(NK) cell activity in the peripheral blood and the immunologic response of the
recipient spleen were also studied. RESULTS: In the whole SBT model, body weight
loss was more severe than in the segmental SBT model; the rats in the former
model often died, while all in the latter survived indefinitely. The systemic
blood pressure markedly decreased in the whole SBT group immediately after
reperfusion. The proliferative activity of splenic lymphocytes stimulated by
concanavalin A was also more severely inhibited in the former model than in the
latter postoperatively. NK cell activity in the whole SBT rats declined more
severely than the segmental SBT rats 3 days postoperatively. CONCLUSION: The
longer graft severely induced surgical intervention; and influenced host
immunosuppression, resulting in the higher mortality in rats undergoing whole

PMID: 12799205 [PubMed]

58: Drugs Aging.  2003;20(8):551-60.  

Sleep apnoea in the older adult : pathophysiology, epidemiology, consequences
and management.

Shochat T, Pillar G.

Sleep Lab, Technion-Israel Institute of Technology, Rambam Medical Center,
Haifa, Israel. tamar.shochat@slp.co.il

Sleep apnoea is a breathing disorder in sleep usually caused by repetitive upper
airway obstruction. Its primary symptoms include snoring, daytime sleepiness and
decreased cognitive functioning. Risk factors for the condition include obesity,
anatomical abnormalities, aging, and family history. It has been associated with
hypertension, cardiovascular and pulmonary diseases and increased mortality. The
prevalence of sleep apnoea increases with age, although the severity of the
disorder, as well as the morbidity and mortality associated with it, may
actually decrease in the elderly. A decline in cognitive functioning in older
adults with sleep apnoea may resemble dementia. Medical management of sleep
apnoea rarely relies on drug treatment, as the few drugs (antidepressants and
respiratory stimulants) tested for treatment have been found to be ineffective,
or cause tolerance or serious adverse effects and complications. The treatment
of choice for sleep apnoea is continuous positive airway pressure, a device
which generates positive air pressure through a nose mask, creating a splint
which keeps the airway unobstructed throughout the night. Weight loss
significantly decreases or eliminates apnoeas. Oral appliances are used to
enlarge the airway at night by moving the tongue and mandible forward.
Positional therapy involves avoiding the supine position during sleep in
patients who mostly have apnoeas while lying on their back. Surgical management
may also be considered, although with great caution in the elderly, because of
their increased risk of complications related to surgery. Surgical procedures
include nasal reconstruction, somnoplasty, laser-assisted uvuloplasty,
uvulopalatopharyngoplasty, genioglossus advancement and hyoid myotomy, and
maxillomandibular advancement for severe cases when other treatments have
failed. As a last option, tracheostomy may be performed.

Publication Types:
    Review, Tutorial

PMID: 12795623 [PubMed]

59: Plast Reconstr Surg.  2003 Jun;111(7):2483-4.  

A cheap device to perform ultrasound-assisted lipoplasty.

Lasso JM, Arenas D, Valiente A.

Publication Types:

PMID: 12794513 [PubMed]

60: Dis Colon Rectum.  2003 May;46(5):653-60.  

Risk factors for anastomotic leakage after left-sided colorectal resection with
rectal anastomosis.

Makela JT, Kiviniemi H, Laitinen S.

Department of Surgery, University of Oulu, Oulu, Finland.

PURPOSE: To identify the risk factors for anastomotic leakage after left-sided
colorectal resections with rectal anastomosis. METHODS: Forty-four patients with
anastomotic leakage identified from a computer-generated database were compared
with 44 control patients standardized for gender, age, and operative indication.
RESULTS: The mean hospital stay was significantly prolonged in the leakage
group, which resulted in a higher total cost of hospital treatment. The
preoperative variables significantly associated with anastomotic leakage
included malnutrition, weight loss, hypoalbuminemia, cardiovascular disease, two
or more underlying diseases, and use of alcohol. The surgery-related factors
that turned out to be significant were The American Society of Anesthesiologists
physical status, operation time greater than two hours, multiple blood
transfusions, intraoperative contamination of the operative field, and a short
distance of the anastomosis to the anal verge. Obesity, body mass index,
diabetes, smoking, serum hemoglobin, serum creatinine, serum bilirubin, bowel
preparation, mode of antibiotic prophylaxis, type of anastomosis, technique of
stapling, size of stapler used, and use of drain were nonsignificant variables.
Malnutrition, weight loss, use of alcohol, intraoperative contamination, long
operation time, and multiple blood transfusions remained significant in logistic
regression model. Eighty-six percent of the patients with three or more risk
factors of anastomotic leakage belonged to the leakage group. CONCLUSIONS:
Patients with multiple risk factors have higher risk for anastomotic leakage.
When patients have three or more risk factors, the creation of a protective
stoma should be considered in cases with a low rectal anastomosis, and all these
patients should be carefully monitored postoperatively for signs of possible

PMID: 12792443 [PubMed]

61: Int J Radiat Oncol Biol Phys.  2003 Jul 1;56(3):671-80.  

Dose-volume analysis of radiotherapy for T1N0 invasive breast cancer treated by
local excision and partial breast irradiation by low-dose-rate interstitial

Lawenda BD, Taghian AG, Kachnic LA, Hamdi H, Smith BL, Gadd MA, Mauceri T,
Powell SN.

Department of Radiation Oncology, Massachusetts General Hospital and Harvard
Medical School, Boston, MA 02114, USA.

PURPOSE: To evaluate the toxicity of partial breast irradiation (RT) using
escalating doses of low-dose-rate interstitial implant as the sole adjuvant
local therapy for selected T1N0 breast cancer patients treated by wide local
excision. The results of a European Organization for Research and Treatment of
Cancer study have demonstrated a significant local control benefit using
external beam RT to 65 Gy compared with 50 Gy. Thus, the tolerance of escalating
doses of partial breast RT should be determined, because this approach may
become a standard treatment for patients with early-stage breast cancer. METHODS
AND MATERIALS: Between 1997 and 2001, 48 patients with T1N0M0 breast cancer were
enrolled into an institutional review board-approved Phase I/II protocol using
low-dose-rate brachytherapy implants after wide local excision and lymph node
staging surgery. Brachytherapy was started 3-4 days after surgery at a dose rate
of 50 cGy/h, using (192)Ir sources evenly spaced to cover 3 cm around the
resection margins. Typically, 2-3 planes were used, with a median of 14
catheters (range 10-16). The total dose was escalated in three groups: 50 Gy (n
= 19), 55 Gy (n = 16), and 60 Gy (n = 13). The implant volume was calculated and
used to classify patients into quartiles: 76-127 cm(3) (n = 12), 128-164 cm(3)
(n = 12), 165-204 cm(3) (n = 12), and >204 cm(3) (n = 12). Cosmesis, patient
satisfaction, treatment-related complications, mammographic abnormalities,
rebiopsies, and disease status were recorded at each scheduled patient visit.
RESULTS: The median follow-up for all patients was 23.1 months (range 2-43).
Very good to excellent cosmetic results were observed in 91.8% of patients.
Ninety-two percent of patients were satisfied with their cosmetic outcome and
said they would choose brachytherapy again over the standard course of external
beam RT. Six perioperative complications occurred: two developed bleeding at the
time of catheter removal, two had abscesses, one developed a hematoma, and one
had a nonhealing sinus tract requiring surgical intervention. Significant
fibrosis (moderate-to-severe scarring and thickening of the skin and breast) was
noted in only 4 patients; 1 had received 55 Gy and 3 had received 60 Gy.
Abnormal posttreatment mammograms were seen in 19 patients. Eight patients
underwent rebiopsy for abnormalities found either by mammography or on physical
examination; all proved to be fat necrosis or post-RT changes. The rebiopsy
rates appeared to correlate with doses >/=55 Gy (6 [75%] of 8 compared with 29
[60%]of 48 overall) and implant volumes >/=128 cm(3) (7 [87.5%] of 8 compared
with 36 [75%] of 48 overall). To date, no local, regional, or distant
recurrences have been observed. CONCLUSION: Low-dose-rate implants up to 60 Gy
were well-tolerated overall. With an implant dose of 60 Gy, the incidence of
posttreatment fibrosis (25%) appeared to be increased. Only the long-term
follow-up of this and other implant studies will allow an understanding of the
total radiation dose necessary for tumor control and the volume of breast that
requires treatment.

Publication Types:
    Clinical Trial
    Clinical Trial, Phase I
    Clinical Trial, Phase II

PMID: 12788172 [PubMed]

62: J Gastrointest Surg.  2003 May-Jun;7(4):552-7.  

Laparoscopic vs. open biliopancreatic diversion with duodenal switch: a
comparative study.

Kim WW, Gagner M, Kini S, Inabnet WB, Quinn T, Herron D, Pomp A.

Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai School of
Medicine, New York, NY 10029, USA.

Biliopancreatic diversion with duodenal switch (BPD-DS) is a well-known emerging
open procedure that appears to be as effective as other bariatric operations and
has been shown to provide excellent long-term weight loss. Therefore we looked
at the safety and efficacy of the laparoscopic BPD-DS procedure compared to open
BPD-DS in superobese patients (body mass index >60). A retrospective study of 54
superobese patients (body mass index >60) was carried out from July 1999 to June
2001: laparoscopic BPD-DS in 26 patients and open BPD-DS in 28 patients. Median
preoperative body weight was 189.8 kg (range 155.1 to 271.2 kg) in the
laparoscopic BPD-DS group and 196.5 kg (range 160.3 to 298.9 kg) in the open
BPD-DS group. Median body mass index was 66.9 kg/m(2) in the laparoscopic group
and 68.9 kg/m(2) in the open group. The two groups were compared by means of the
unpaired t test, which yielded the following results: Major morbidity occurred
in six patients (23%) in the laparoscopic BPD-DS group and in five patients
(17%) in the open BPD-DS group (P = 0.63). There were two deaths in the
laparoscopic BPD-DS group (7.6% mortality) and one death (3.5% mortality) in the
open BPD-DS group (P = 0.51). Preoperative comorbidity was improved in eight
patients in the laparoscopic BPD-DS group and two patients in the open BPD-DS
group (P < 0.02). Laparoscopic BPD-DS is a technically feasible procedure that
results in effective weight loss similar to the open procedure. However, both
open and laparoscopic BPD-DS procedures are associated with appreciable
morbidity and mortality in the superobese population. Additional studies are
needed to determine the best surgical treatment for superobesity.

PMID: 12763415 [PubMed]

63: J Forensic Sci.  2003 May;48(3):697.  

Comment on:
    J Forensic Sci. 2002 Jan;47(1):205-7.

Commentary on: Platt MS, Kohler LJ, Ruiz R, Cohle SD, Ravichandran P. Deaths
associated with liposuction: case reports and review of the literature. J
Forensic Sci 2002;47(1): 205-207.

Coleman WP, Lawrence N.

Publication Types:

PMID: 12762554 [PubMed]

64: Crit Care Nurs Q.  2003 Apr-Jun;26(2):89-100.  

Bariatric surgery options.

Woodward BG.

South Mississippi Surgical Weight Loss, Biloxi, Miss, USA. bw@mssurgeons.com

There are multiple surgical procedures used for weight loss. The concept of
achieving malabsorption through manipulation of the gastrointestinal contract is
briefly discussed. Various surgical options are considered with their advantages
and disadvantages, namely vertical banded gastroplasty, gastric banding,
Roux-en-y gastric bypass, distal gastric bypass billiopancreatic diversion, and
duodental switch.

Publication Types:
    Review, Tutorial

PMID: 12744589 [PubMed]

65: Obes Surg.  2003 Apr;13(2):269-74.  

Determinants of long-term satisfaction after vertical banded gastroplasty.

Shai I, Henkin Y, Weitzman S, Levi I.

S. Daniel Abraham International Center for Health and Nutrition, Beer-Sheva,

BACKGROUND: The long-term usefulness of vertical banded gastroplasty (VBG) in
achieving weight loss is controversial, and adverse effects related to the
procedure may attenuate patient satisfaction. Our objective was to evaluate
patient satisfaction, and to identify parameters that are related to such
satisfaction, 3 to10 years after VBG. METHODS: All consecutive patients who
underwent VBG in one surgical ward were invited for a follow-up study 3 to 10
years after surgery. Questions relating to symptoms and quality of life were
evaluated in a personal interview using a structured questionnaire. RESULTS: Of
the 122 patients who underwent VBG from 1986 to 1992, 75 patients were located
and agreed to participate in the follow-up study. The average time since surgery
was 5.4 +/- 1.8 years. The average weight loss was 24.9 +/- 12.4%, representing
an excess body-weight loss of 58.6 +/- 30.4%. Overall, 65% of the patients were
satisfied with the results of surgery while 19% expressed dissatisfaction.
Significant improvement was seen in respiratory difficulties, ability to perform
physical exercise, and mental status. Successful weight loss and the frequency
of respiratory difficulties were the only independent parameters associated with
patient satisfaction. Although vomiting, gastroesophageal reflux and difficulty
in swallowing occurred in over two-thirds of the patients, their presence was
not correlated with patient dissatisfaction. CONCLUSION: Despite the presence of
a multitude of adverse effects, the majority of our patients were satisfied with
the long-term results of VBG. Successful weight loss and improvement in
respiratory difficulties were the major determinants of patient satisfaction.

PMID: 12740137 [PubMed]

66: Obes Surg.  2003 Apr;13(2):258-62.  

Taking posterior rectus sheath laparoscopically to reinforce the
gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass.

Kim WW, Gagner M, Biertho L, Waage A, Jacob B.

Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai School of
Medicine, New York, NY 10029, USA.

BACKGROUND: The Roux-en-Y gastric bypass (RYGBP) is now performed
laparoscopically widely with low morbidity and mortality. However, in some cases
long-term adequate weight loss is not satisfied because of dilatation of the
gastrojejunostomy. Therefore, a prosthetic material and bio-membranes have been
used to prevent dilatation. In this study, we used posterior rectus sheath by
laparoscopy, to evaluate feasibility and safety of the procedure. METHODS: 20
Yorkshire pigs, under general anesthesia, had a standard laparoscopic RYGBP. In
addition, 10 had their gastrojejunostomy anastomosis wrapped with 2x10 cm
posterior rectus sheath. Clinical and operative outcome after operation were
compared with the control group of laparoscopic RYGBP cases. RESULTS: The median
weight of the pigs was 46.1 kg (range 42-51) in the posterior rectus
sheath-applied group and 45.2 kg (range 42-49) in the control group. All
gastrojejunostomies in the posterior rectus sheath-applied group were
successfully reinforced laparoscopically. Both groups loss weight compared with
their normal growth weight, but there was no significant difference in the
median weight loss between the two groups. Two pigs in the posterior rectus
sheath-applied group developed a stenosis at the gastrojejunostomy anastomosis
following RYGBP. All pigs in the posterior rectus sheath-applied group were
found to develop hypertrophic smooth muscle and connective tissue scarring at
the gastrojejunostomy on histologic examination. CONCLUSION: Laparoscopic
application of posterior rectus sheath around the gastrojejunostomy in
laparoscopic RYGBP is feasible and safe. The sheath-applied group developed
stenosis and connective tissue scarring. Additional research is needed to
evaluate effectiveness in preventing dilation of the anastomosis.

PMID: 12740135 [PubMed]

67: Obes Surg.  2003 Apr;13(2):254-7.  

Treatment of dilated gastrojejunostomy with sclerotherapy.

Spaulding L.

Department of Surgery, Fletcher Allen Health Care/University of Vermont College
of Medicine, Burlington, VT 05403, USA. laurie.spaulding@brmednet.org

BACKGROUND: Dilation of the gastrojejunostomy after gastric bypass may result in
weight gain. Many surgical and medical treatments have met with poor results. A
feasibility study of endoscopic sclerotherapy (ST) of the gastrojejunostomy was
performed, based on the known risk of esophageal stricture in the treatment of
esophageal varices. METHODS: From 1991 to 2001, proximal Roux-en-Y gastric
bypass (RYGBP) was performed on 685 patients, with a follow-up rate of 60% at 5
years. 20 patients were identified with dilated gastrojejunostomy (DGJ) by
gastroscopy (EGD) performed for complaints of weight gain and marked increase in
volume tolerance. Sclerotherapy of the gastrojejunostomy was performed during
EGD. EGD was repeated 2 months after the sclerotherapy to measure the diameter
of the anastomosis and observe any complications. Weight and sense of satiety
were also measured, 2 and 6 months after ST. If necessary, the procedure was
repeated to achieve a diameter of 10 mm. RESULTS: Reducing the diameter of the
gastrojejunostomy to 9-10 mm was achieved in all patients, with an average of
1.3 treatments per patient. 15 patients (75%) lost weight. The average weight
loss was 5.8 kg (ranging from 0.5 to 17.3 kg) in 2 months. CONCLUSION:
Sclerotherapy successfully restores the desired anatomy of gastric bypass, but
exercise and dietary discretion remain critical elements of sustained weight

PMID: 12740134 [PubMed]

68: Plast Reconstr Surg.  2003 May;111(6):2082-7; discussion 2088-9.  

Wound healing problems in smokers and nonsmokers after 132 abdominoplasties.

Manassa EH, Hertl CH, Olbrisch RR.

Department of Plastic Surgery, Florence Nightingale Hospital, Kaiserwerther
Diakonie, Duesseldorf, Germany. dr.manassa@web.de

To study the effects of smoking on wound healing, the authors retrospectively
analyzed the records of 132 patients (121 women and 11 men) who had undergone
abdominoplasty in the previous 5 years. All patients had received a full
abdominoplasty, with large mobilization up to the ribs and a belly
transposition. Patients were excluded from the study if they had
arteriosclerosis, diabetes mellitus, or other systemic diseases, and if they had
received a simple pannus resection without a belly transposition.The following
study parameters were taken for analysis: age at the time of operation, body
mass index, preoperative weight loss, amount of resection, and smoking habits
indicated by the patients preoperatively. Smokers were interviewed by telephone
postoperatively concerning their perioperative smoking habits. Wound healing
problems were registered when medical intervention was necessary, such as
debridement, treatment for infection, lavage after fat necrosis, or a secondary
skin closure after skin slough. Hematoma and seroma were not considered to be
wound healing problems and were registered separately.Among the 132 patients,
53.8 percent admitted to smoking and 46.2 percent reported being nonsmokers. No
significant difference was seen between smokers and nonsmokers concerning age or
body mass index. Smokers reported consuming, on average, 18.4 cigarettes per
day. The rate of wound problems and wound dehiscence showed a statistical
difference between smokers and nonsmokers (p < 0.01); 47.9 percent of the
smokers showed wound healing problems before hospital discharge versus 14.8
percent of the nonsmokers. The patients had been asked to quit smoking 2 weeks
before the operation through 2 weeks postoperatively. The retrospective
telephone inquiry found that just 14.7 percent stopped smoking preoperatively
and only 41.2 percent quit temporarily after the operation.Smokers should be
informed about their possible higher risk of wound healing problems. Because it
seems impossible to turn smokers into nonsmokers, the authors continue to
perform abdominoplasties in smokers. During the operation, they try to mobilize
and resect less tissue and to immobilize patients for the critical first 3
postoperative days to prevent them from smoking.

PMID: 12711974 [PubMed]

69: Plast Reconstr Surg.  2003 May;111(6):1883-90.  

Long-term effects of polyacrylamide hydrogel on human breast tissue.

Christensen LH, Breiting VB, Aasted A, Jorgensen A, Kebuladze I.

Department of Pathology, Rigshospitalet, Copenhagen, Denmark.

Polyacrylamide hydrogel is an atoxic, stable, nonresorbable sterile watery gel
consisting of approximately 2.5% cross-linked polyacrylamide and nonpyrogenic
water. Polyacrylamide hydrogel is widely used in ophthalmic operations, drug
treatment, food packaging products, and water purification. In the former Soviet
Union, polyacrylamide hydrogel has been used in plastic and aesthetic surgery
for more than 10 years, and Kiev City Hospital treats approximately 300 women a
year for breast augmentation using the polyacrylamide hydrogel Interfall
(Contura SA, Montreux, Switzerland). Capsule shrinkage following these
injections has never been observed. The authors examined breast tissue samples
from a total of 27 women who had polyacrylamide hydrogel injected at Kiev City
Hospital up to 8 years and 10 months earlier. Age at operation, duration of
polyacrylamide hydrogel implantation, history of possible side effects to the
gel injection, other intercurrent diseases, the reason for present open breast
operation, and breast palpation findings before operation were in each case
compared with the histological findings on samples taken from breast tissue
bordering the gel. The gel presented itself as a dark violet, homogenous mass
with a rounded or ragged outline in large or medium-size deposits and as
elongated strands, which mimicked the extracellular matrix, in small deposits.
Histological findings of the breast tissue bordering the gel showed three
different patterns: large collections of gel gave rise to a thick, soft-looking
cellular membrane of macrophages and foreign-body giant cells; medium-size
deposits were surrounded by just a thin layer of macrophages; and small deposits
were not associated with any reaction in the surrounding tissue. Projections of
the cellular soft membrane, known as granulomas, were seen in six patients. The
granulomas were composed of macrophages, foreign-body giant cells, lymphocytes,
and blood cells. A thin layer of fibrous connective tissue was occasionally
present around the foreign-body membrane, but the thick fibrous capsule, which
has been described in connection with silicone implants, was completely absent.
The gel changes could be correlated to neither time since gel injection nor a
history of recent injury or inflammation. It is concluded that the
polyacrylamide hydrogel Interfall, which has been used in the former Soviet
Union, is stable over time, nondegradable, confined to the breast, and diffusion
and migration resistant. When the hydrogel is injected in medium-size or large
quantities a cellular foreign-body reaction occurs, but in small amounts it is
capable of splitting up individual connective tissue fibers and fat cells,
substituting for the extracellular connective tissue matrix without eliciting
any foreign-body reaction. As far as these data are concerned, polyacrylamide
hydrogel is well tolerated by the breast and does not give rise to severe
fibrosis, pain, or capsule shrinkage. However, to determine safety with more
certainty, a larger sample size would be necessary.

PMID: 12711948 [PubMed]

70: Perfusion.  2003 Mar;18 Suppl 1:69-74.  

The embolic potential of liquid fat in pericardial suction blood, and its

Engstrom KG.

Cardiothoracic Surgery, University Hospital Orebro, Sweden. kge@orebroll.se

Diffuse brain damage is a complex problem in cardiac surgery postoperatively.
Liquid fat from recycled pericardial suction blood (PSB) is an embolic source.
PSB can be discarded, but the recycling can be life saving, and methods have
been developed to remove the fat. Blood washing by centrifugation is suggested
to be the most effective method. In retained PSB, fat also separates without
centrifugation, which is a novel and simple approach. Alternatively, inline fat
filtration is easily accomplished but its effectiveness has been questioned. The
present study aimed to investigate this phenomenon. Fat was heat extracted from
retrieved pericardial fat tissue of coronary artery bypass graft (CABG) patients
(n = 6), and was mixed, 1.25%, with postoperative mediastinal-shed blood. The
mixture was filtered using a LipiGuard SB at constant flow rate. The filtration
was scaled down to 3 mL and performed under temperature control, 37 degrees C,
20 degrees C and 10 degrees C. At these temperatures fat removal was 46.9 +/-
6.1%, 61.5 +/- 7.0% and 76.8 +/- 5.0%, respectively, with a statistical
difference of P = 0.001. The improved fat removal at low temperature
dramatically increased filtration pressures (P < 0.001) and caused haemolysis (P
= 0.018). It is concluded that fat filtration is technically difficult. Cooling
of blood increases fat extraction, but with negative side effects due to filter

PMID: 12708768 [PubMed]

71: Sb Lek.  2002;103(2):213-22.  

[Are complications of gastric banding decreased with cuff fixation?]

[Article in Czech]

Kasalicky M, Fried M, Peskova M.

I. chirurgicka klinika 1. lekarske fakulty Univerzity Karlovy a Vseobecne
fakultni nemocnice, U Nemocnice 2, 128 08 Praha 2, Czech Republic. drmak@vfn.cz

The gastric bandage is reliable method for long time control of weight loss in
failed conservative cure of morbid obese patients. Since 1983 we have been
concerned with bariatric surgery at the First Surgical Department of General
Faculty Hospital of Charles University. 691 morbid obese patients (BMI 49.7
kg/m2, mean age of 38.1) underwent gastric banding (GB)--by laparotomy 58 obese
patients and since 1993 by laparoscopy 633 obese patients. After 12 months the
mean weight loss was 21.1 kg (14-32 kg) and after 24 month the mean weight loss
was 38.7 kg (27-73 kg). In period of 1993-1998 the most frequent late
complication in the group of 517 obese patients after laparoscopic nonadjustable
gastric banding (LNGB) was in 5.1% dilatation of upper gastric pouch or slippage
of anterior stomach wall above the band with vomiting and failure of gastric
evacuation. In majority we removed GB laparoscopically. To prevent this
complication we modified GB with fixing band with a cuff made from the anterior
gastric wall. To test the effectiveness of this method we implemented in
1998-1999 a prospective randomized study. In the group of 80 morbid obese
patients we created in 40 patients (n1-GB+C) LNGB with the cuff fixation and in
40 patients (n2-GB-C) without fixation. We followed-up of this patients after
LNGB was in 6 weeks, 6 months and 12 months with measurement of pouch volume by
endoscopy with calibrate endocannula. One year after GB in the group n1-GB+C the
mean increase of the pouch volume was 14.6 ml, i.e. 124% of the original size,
while in group n2-GB-C the mean increase of the pouch volume was 33.6 ml, i.e.
154.1% of the original size. The slippage or dilatation of the pouch was in
group nl in one case while in group n2 in three cases (p < 0.001).

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 12688144 [PubMed]

72: J Laparoendosc Adv Surg Tech A.  2003 Feb;13(1):11-5.  

Laparoscopic surgery in pregnancy: long-term follow-up.

Rizzo AG.

Department of Surgery, Washington Hospital Center, Washington, DC 20010, USA.

OBJECTIVE: To describe the long-term consequences of laparoscopic surgery during
pregnancy. SUMMARY BACKGROUND DATA: Laparoscopic surgery is well established in
the surgical community. Laparoscopic surgery in the pregnant patient is not yet
broadly accepted; concern has been for fetal wastage, effects of carbon dioxide
(CO(2)) on the developing fetus, and long-term sequelae during childhood
development. METHODS: This report documents 11 laparoscopic cases in pregnancy
with follow-up of 1 to 8 years. The patients were in their 16th to 28th week of
pregnancy. Two patients had chronic cholecystitis and biliary colic resulting in
weight loss and multiple admissions. Three patients had acute cholecystitis, and
three patients had acute appendicitis. Two patients underwent exploration for a
diagnosis of acute abdomen, and both were found to have small bowel obstruction.
All patients had general anesthesia and underwent an open Hasson trocar
procedure with end-tidal CO(2) monitoring, sequential compression devices, and
partial left decubitus positioning. Insufflation pressure was maintained at 10
mm Hg. The operative time ranged from 25 to 90 minutes. RESULTS: Successful
laparoscopic surgery was performed in 10 cases, with one conversion to an open
procedure. Intraoperative and postoperative fetal monitoring was performed for
at least 24 hours. No fetal distress or demise occurred, nor were any tocolytics
used. The resultant children were then monitored, and no evidence of
developmental or physical abnormalities was detected during the study period.
CONCLUSION: Laparoscopic surgery is now proving to be as safe as open surgery in
pregnancy. This article reports long-term follow-up with no deleterious effects
to either mothers or children.

PMID: 12676015 [PubMed]

73: Health Aff (Millwood).  2003 Mar-Apr;22(2):283-4; author reply 284.  

Comment on:
    Health Aff (Millwood). 2002 Jul-Aug;21(4):26-39.

Liposuction can be safe in offices.

Coldiron B.

Publication Types:

PMID: 12674436 [PubMed]

74: J Forensic Sci.  2003 Mar;48(2):471.  

Comment on:
    J Forensic Sci. 2002 Jan;47(1):205-7.

Commentary on: Platt MS, et al. Death associated with liposuction: case reports
and review of the literature. J Forensic Sci 2002;47(1):205-207.

Coldiron B.

Publication Types:

PMID: 12665025 [PubMed]

75: Dermatol Surg.  2003 Apr;29(4):433-5.  

Cigarette burn after tumescent anesthesia and intravenous sedation: a case

Grose DJ.

Australian Skin Clinics, Southport, Australia. dr.grose@ozskin.com

BACKGROUND: The tumescent anesthetic technique is widely used in cosmetic
surgery. It is a safe technique and is easily administered in an outpatient
setting. Tumescent anesthesia tends to have a prolonged duration of action,
which can be a cause of patient morbidity, especially where intravenous sedation
is also used. OBJECTIVE: To report a case in which a patient fell asleep while
smoking a cigarette not long after having tumescent anesthesia for liposuction.
The cigarette fell onto an anesthetized area of the patient's thigh, resulting
in a third-degree burn. The patient was not aware of the burn because of skin
anesthesia from the tumescent anesthetic solution and residual intravenous
sedation and tiredness. There was delay in reporting the burn because it was not
painful and because there was no significant damage to the compression hosiery
worn by the patient. CONCLUSION: The importance of advising patients in
postoperative instruction information literature to avoid contact with hot
objects, including hot drinks and smoking, after local anesthesia and sedation
is emphasized.

Publication Types:
    Case Reports

PMID: 12656830 [PubMed]

76: Rev Gastroenterol Mex.  2002 Oct-Dec;67(4):271-5.  

[Colonic stenosis secondary to non-steroid anti-inflammatory agents as a cause
of anemia and chronic diarrhea]

[Article in Spanish]

Remes-Troche JM, Contreras-Zurita K, Rios-Luna NP, Sierra-Ascencio M, Valdovinos

Departamento de Gastroenterologia, Instituto Nacional de Ciencias Medicas y
Nutricion Salvador Zubiran, Vasco de Quiroga # 15, Col. Seccion XVI, CP 14000,
Tlalpan DF. chemaremes@hotmail.com

Gastroduodenal mucosal injury is a widely recognized side effect of
non-steroidal antiinflammatory agents (NSAID). Distal small bowel and colon are
additional organs of the gastrointestinal tract exposed to deleterious effects
of these drugs. Inflammation and ulceration have been described as pathologic
damage associated with NSAID. Strictures of colon induced by NSAID are a new
entity characterized by diaphragm-like strictures. Most patients present with
anemia, obstructive symptoms, diarrhea, or weight loss. Endoscopic dilation,
surgical resection, symptomatic treatment, and interruption of NSAID ingestion
are treatment of choice. Only 23 cases of NSAID-related, colonic, diaphragm-like
strictures have been reported. Here we describe a case of concentric colonic
stricture related to naproxen and clinical features of this entity are

Publication Types:
    Case Reports

PMID: 12653075 [PubMed]

77: Rev Belge Med Dent.  2002;57(1):49-70.  

[Surgical technics in orthognathic surgery]

[Article in French]

Lemaitre A.

The goal of this paper is to explain simply the most used surgical technics in
orthognathic surgery. The author insists upon the noble structures met during
this surgery. He also insists upon the modifications of the facial mask by the
mobilisation of the different parts of the facial skeleton. Numerous schemas
illustrate and make easy the comprehension of this paper.

PMID: 12649978 [PubMed]

78: Obes Surg.  2003 Feb;13(1):128-31.  

Access-port complications after laparoscopic gastric banding.

Susmallian S, Ezri T, Elis M, Charuzi I.

Department of Surgery B, Wolfson Medical Center, Holon, affiliated with Sackler
School of Medicine, Tel Aviv, Israel. sergio9@bezeqint.net

BACKGROUND: The aim of this retrospective study was to identify complications
related to the access-port, after Lap-Band system placement by laparoscopy.
METHODS: The records of 333 morbidly obese patients who underwent laparoscopic
adjustable gastric banding (LAGB) were reviewed for the overall surgical
complications. Data was further analyzed regarding the complications related to
the access-port. RESULTS: From January 1999 to December 2001, the overall
complication-rate with the LAGB was 25.8%. 45 complications (13.5%) were related
to the access-port in 34 patients following LAGB placement. The 45 access-port
complications were distributed as follows: infection 51.1%, tubing disconnection
17.7%, dislodgment of the access-port 15.6%, leak of the reservoir 11.1%, and
skin ulceration by the port 4.45%. CONCLUSION: The integrity of the Lap-Band
system is essential to achieve the objective of the operation: weight loss.
Complications related to the access-port were relatively frequent, but

PMID: 12630627 [PubMed]

79: Aesthetic Plast Surg.  2002 Nov-Dec;26(6):477-82.  

If you continue to smoke, we may have a problem: smoking's effects on plastic

Akoz T, Akan M, Yildirim S.


Smoking causes various aero-digestive neoplasms, some cardiovascular diseases,
respiratory pathologies, and cardiovascular disorders. Surgeons have observed an
association between impaired wound healing and smoking. In plastic surgery,
cigarette smoking should be forbidden before and after surgery to prevent poor
surgical results. In this retrospective study, we presented four major
complications related with continuous smoking immediately after surgery.
Although we have strongly forbidden smoking for every patient, 4 patients did
not follow our advice and continued to smoke. One of them had a breast
reconstruction with a pedicled transverse rectus abdominis musculocutaneous
flap. Another patient had an abdominoplasty. The third and fourth patients had
digital replantation and they were chronic smokers. After their poor surgical
outcomes, these heavy smokers received close supervision, but managed to smoke,
anyway. Education, psychologic consultation, and sometimes refusing to perform
aesthetic or reconstructive surgery are required to minimize postoperative

PMID: 12621573 [PubMed]

80: Am J Ophthalmol.  2003 Mar;135(3):410-2.  

Transient impaired vision, external ophthalmoplegia, and internal
ophthalmoplegia after blepharoplasty under local anesthesia.

Oliva MS, Ahmadi AJ, Mudumbai R, Hargiss JL, Sires BS.

Department of Ophthalmology, University of Washington, Seattle, Washington
98195-6485, USA.

PURPOSE: To report a case of transient bilateral vision impairment with external
ophthalmoplegia and internal ophthalmoplegia after blepharoplasty under local
anesthesia. DESIGN: Interventional case report. METHODS: A 70-year-old man
underwent bilateral upper blepharoplasty under local anesthesia. During orbital
fat removal additional anesthetic was injected into both medial fat pads for
pain control. RESULTS: Immediate postoperative examination revealed bilateral
decreased visual acuity and internal ophthalmoplegia in the right eye. An
exotropia was present with marked limitation of right eye adduction. These
findings resolved completely 3 hours postoperatively. CONCLUSIONS: Local
anesthesia during blepharoplasty can enervate the optic nerve, ciliary ganglion,
and extraocular muscle nerves. Local anesthesia should be injected judiciously
during orbital fat removal to avoid this reversible but alarming event.
Copyright 2003 by Elsevier Science Inc.

Publication Types:
    Case Reports

PMID: 12614773 [PubMed]

81: J Clin Monit Comput.  2000 Jan;16(1):77-9.  

Mega-dose lidocaine dangers seen in "tumescent" liposuction.

de Jong RH.

Publication Types:

PMID: 12578098 [PubMed]

82: Obes Surg.  2002 Dec;12(6):812-8.  

Open versus laparoscopic vertical banded gastroplasty: a randomized controlled
double blind trial.

Davila-Cervantes A, Borunda D, Dominguez-Cherit G, Gamino R, Vargas-Vorackova F,
Gonzalez-Barranco J, Herrera MF.

Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion
Salvador Zubiran, Vasco de Quiroga 15, Tlalpan 14000 Mexico City, Mexico DF.

BACKGROUND: Vertical banded gastroplasty (VBG) is a frequently used surgical
procedure for the treatment of morbid obesity. It can be done open (OVBG) or
laparoscopic (LVBG). The aim of this double-blind randomized clinical trial was
to compare the postoperative outcome and 1-year follow-up of 2 cohorts of
patients who underwent either OVBG or LVBG. PATIENTS AND METHODS: 30 patients
with morbid obesity were randomized into 2 groups (14 OVBG and 16 LVBG). Pain
intensity, analgesic requirements, respiratory function, and physical activity
were blindly analyzed during the first 3 postoperative days. Complications,
weight loss, and cosmetic results after 1 year follow-up were evaluated.
RESULTS: Both groups were highly comparable before surgery. Surgical time was
longer in the laparoscopic procedure. Patients in this group required less
analgesics during the first postoperative day. There was an earlier recovery in
the expiratory and inspiratory forces, as well as faster recovery of physical
activities in patients who underwent LVBG. Postoperative complications were more
frequent in the open group. Excess body weight loss after 1 year was similar in
both groups. Cosmetic results were significantly better in the laparoscopic
group. CONCLUSIONS: LVBG had advantages over the open procedure in terms of
analgesic requirements, respiratory function, postoperative recovery, and
cosmetic results.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 12568187 [PubMed]

83: Plast Reconstr Surg.  2003 Feb;111(2):945-6.  

Large-volume tumescent anesthesia for extensive liposuction in oriental
patients: lidocaine toxicity and its safe dose level.

Oba H.

Publication Types:

PMID: 12560731 [PubMed]

84: J Obstet Gynaecol.  2002 Nov;22(6):583-5.  

Surgical induction of ovulation in polycystic ovarian disease.

El-Sheikhah A.

Southmead Hospital, Bristol, UK.

The current lines of treatment of an ovulatory infertility due to polycystic
ovarian disease lie between weight loss, insulin sensitising agents, clomiphene
citrate, gonadotrophin therapy, or finally ovarian cauterisation. This review is
looking at some of the current evidence for surgical and medical lines of

PMID: 12554240 [PubMed]

85: J Am Anim Hosp Assoc.  2003 Jan-Feb;39(1):47-51.  

Gastric outflow obstruction after ingestion of wood glue in a dog.

Horstman CL, Eubig PA, Cornell KK, Khan SA, Selcer BA.

Department of Small Animal Medicine, College of Veterinary Medicine, Veterinary
Teaching Hospital, The University of Georgia, Athens, Georgia 30602-7391, USA.

A 2-year-old, male, mixed-breed dog presented with a 12-day history of vomiting,
depression, and weight loss after ingestion of industrial-strength wood glue
containing diphenylmethane diisocyanate as its active ingredient. A diagnosis of
gastric foreign body was made from survey abdominal radiographs. A large
aggregate of solidified wood glue was surgically removed, and the dog recovered
uneventfully. Fourteen other cases have been reported to the Animal Poison
Control Center at the American Society for the Prevention of Cruelty to Animals
(ASPCA). Eight of those 14 cases required surgical intervention. All cases
recovered completely.

Publication Types:
    Case Reports
    Review of Reported Cases

PMID: 12549613 [PubMed]

86: Atherosclerosis.  2003 Feb;166(2):253-9.  

Prolonged endothelial-dependent and -independent arterial dysfunction induced in
the rat by short-term feeding with a high-fat, high-sucrose diet.

Naderali EK, Williams G.

Neuroendocrine & Obesity Biology Unit, Department of Medicine, University of
Liverpool, Daulby Street, Liverpool L69 3GA, UK. naderali@liverpool.ac.uk

Obesity induced by long-term consumption of a fat-rich diet causes marked
endothelial dysfunction. In this study we aimed to determine whether endothelial
impairment is due to obesity or the diet per se. Wistar rats were fed either
standard laboratory chow throughout (controls), or given a highly palatable diet
(diet-fed) for 3 days, or fed the diet for 3 days and then returned to chow for
3 further days before sacrifice (diet-to-chow). Body weight, fat and
gastrocnemius muscle mass, and plasma levels of glucose, insulin and leptin were
all comparable between the three groups. Diet-fed rats had significantly raised
plasma non-esterified fatty acids (NEFA; P=0.0005) and triglyceride levels
(P=0.00001). The diet-to-chow group had intermediate plasma NEFA and
triglyceride levels (significantly higher than in controls, P=0.019 and P=0.0035
for NEFA and triglycerides, respectively). There were no changes in
noradrenaline and KCl responses in mesenteric arteries, whereas vasorelaxation
to both carbamylcholine and sodium nitroprusside were significantly attenuated
in the diet-fed group (by up to 18%; P=0.00001). Both these responses remained
largely impaired in the diet-to-chow group. By contrast, histamine-induced
vasorelaxation was comparable between all three groups. Thus, short-term feeding
with a palatable diet induces marked endothelium-dependent and -independent
arterial dysfunction. These effects occurred in the absence of obesity and
largely persisted after removal of the palatable diet. Diet per se can have
important detrimental effects on arterial function, which may be mediated by
raised NEFA and/or triglyceride levels.

PMID: 12535737 [PubMed]

87: Dermatol Surg.  2003 Jan;29(1):1-6.  

Efficacy, safety, and cost of office-based surgery: a multidisciplinary

Balkrishnan R, Hill A, Feldman SR, Graham GF.

Department of Dermatology, Wake Forest University School of Medicine,
Winston-Salem, North Carolina 27104, USA. rbalkris@wfubmc.edu

An increasing number of media reports on patient safety risks arising from
office-based surgery procedures, as well as growing concerns about patient
safety issues in general, have brought office-based surgery as well as its
practitioners into focus and placed this very cost-effective medical practice in
the eye of the media and regulators. Concerted efforts are now being made to
understand the causes and true incidence of patient safety risk associated with
office-based surgery and to find ways to minimize this risk.

Publication Types:

PMID: 12534504 [PubMed]

88: Health Aff (Millwood).  2003 Jan-Feb;22(1):285; author reply 285-6.  

Comment on:
    Health Aff (Millwood). 2002 Jul-Aug;21(4):26-39.

Liposuction procedures: how, not where.

Castrow FF 2nd.

Publication Types:

PMID: 12528869 [PubMed]

89: Ned Tijdschr Geneeskd.  2002 Dec 14;146(50):2430-5.  

Comment in:
    Ned Tijdschr Geneeskd. 2002 Dec 14;146(50):2405-6.
    Ned Tijdschr Geneeskd. 2003 Jul 12;147(28):1386.

[Necrotising fasciitis and myositis as serious complications after liposuction]

[Article in Dutch]

Nagelvoort RW, Hulstaert PF, Kon M, Schuurman AH.

Afd. Plastische, Reconstructieve en Handchirurgie, Universitair Medisch Centrum,
Heidelberglaan 100, 3584 CX Utrecht.

Three days after liposuction of the lower abdomen, a 41-year-old woman was
admitted for toxic shock-like syndrome with necrotising fasciitis and myositis,
caused by Lancefield-group-A beta-haemolytic streptococci. The patient was
treated by radical debridement of the skin, subcutis, fasciae and part of the
pectoral muscle, plus antibiotics. Postoperatively she required artificial
respiration for respiratory insufficiency. One week after the operation the
wound was covered by transplantation of autologous skin. The patient survived,
but was seriously disfigured. Necrotising fasciitis is a progressive soft-tissue
infection, characterised by widespread necrosis of the superficial and deep
fascia, often associated with severe systemic toxic reactions. Unless quickly
recognised and aggressively treated, the course is often fatal. Due to the
absence of cutaneous findings in the early stages, diagnosis is difficult.
Important diagnostic aids are routine laboratory tests, contrast-MRI and a
combination of the finger test and frozen-section biopsy. Treatment consists of
early radical debridement, broad-spectrum antibiotics and supportive care. In a
later stage, soft-tissue reconstruction with autografts or artificial skin
grafts and skin transposition can be performed.

Publication Types:
    Case Reports

PMID: 12518522 [PubMed]

90: Ned Tijdschr Geneeskd.  2002 Dec 14;146(50):2405-6.  

Comment in:
    Ned Tijdschr Geneeskd. 2003 Jul 12;147(28):1386.

Comment on:
    Ned Tijdschr Geneeskd. 2002 Dec 14;146(50):2430-5.

[Complications following liposuction]

[Article in Dutch]

van der Horst CM.

Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Plastische
Chirurgie, Postbus 22.660, 1100 DD Amsterdam.

Liposuction is one of those interventions without a medical indication that are
usually performed in private clinics. The control over these clinics is
regulated by the government. The control of specialists who are members of a
scientific society is the responsibility of the society in question. Liposuction
can be fatal and a number of serious complications are known to occur, but the
frequency is unknown. The physician should discuss these possible consequences
with the patient before the intervention, and adequate aftercare if
complications occur must be provided.

Publication Types:

PMID: 12518516 [PubMed]

91: Plast Reconstr Surg.  2003 Jan;111(1):425-9; discussion 430-1.  

Is there evidence for excessive free radical production in vivo during
ultrasound-assisted liposuction?

Herr J, Hofheinz H, Hertl C, Olbrisch RR, Wieland E.

Department of Plastic Surgery, Florence Nightingale Krankenhaus, Dusseldorf,

The surgical technique of ultrasound-assisted liposuction has become a standard
procedure for the treatment of lipodystrophy. However, little is known about the
impact of this therapy on fatty tissue on the molecular level. There are
concerns about possible adverse effects related to the high-intensity ultrasound
energy, because in vitro studies have shown a substantial generation of free
radicals. In this study, the authors investigated whether ultrasound waves can
create an excessive free radical production in vivo by measuring lipid
peroxidation products in the form of malondialdehyde equivalents. For this
purpose, the thiobarbituric acid-reactive substances (TBARS) assay was chosen.
In this test, malondialdehyde, a major product of lipid peroxidation, reacts
with thiobarbituric acid to produce a pink adduct that can be measured
spectrophotometrically. The authors determined oxidation products in 28
aspirates of 17 treated patients before ultrasound-assisted liposuction (0
minutes) to establish a baseline concentration and at 2, 5, and 10 minutes after
the treatment was begun. Median malondialdehyde concentration of the control
group (conventional liposuction, 0 minutes) was 3.40 nmol of malondialdehyde per
gram of adipose tissue. Median concentrations after 2, 5, and 10 minutes of
ultrasound-assisted liposuction were 7.45 (n = 28), 8.84 (n = 21), and 4.07 (n =
8) nmol malondialdehyde per gram adipose tissue, respectively. The differences
were not statistically significant. The data suggest that there is no excessive
formation of lipid oxidation products in response to free radicals. The
antioxidative capacity of adipose tissue does not seem to be overwhelmed by the
standard application regimen of ultrasound-assisted liposuction.

PMID: 12496615 [PubMed]

92: Plast Reconstr Surg.  2003 Jan;111(1):398-413.  

Belt lipectomy for circumferential truncal excess: the University of Iowa

Aly AS, Cram AE, Chao M, Pang J, McKeon M.

Department of Surgery, Division of Plastic Surgery, University of Iowa, Iowa
City, USA. al-aly@uiowa.edu

When some patients with circumferential truncal excess undergo traditional
abdominoplasty, the trunk is not addressed as a unit. Belt lipectomy, a
procedure that combines abdominoplasty with circumferential excision of skin and
fat, is often more ideal for these patients. In this article, the authors review
the literature on belt lipectomy and evaluate their series of 32 patients who
underwent belt lipectomy at the University of Iowa. The evolution and current
preoperative markings, intraoperative surgical technique, and postoperative care
are described. The patients' charts and their preoperative and postoperative
photographs were examined retrospectively. It was found that belt lipectomy
improved abdominal contour, abdominal wall laxity, mons pubis ptosis, back
rolls, waist contour, and buttocks contour. Initially, the procedure was
performed on post-weight-reduction patients only, but its indications were
extended to three other groups: patients who were 30 to 50 pounds overweight,
patients of normal weight who desired a significant overall truncal improvement,
and an obese patient with persistent intraabdominal excess. The improvements
were significant in all groups of patients except for the latter patient.
Complications included a 37.5 percent seroma rate, a 9.3 percent pulmonary
embolus rate, and one dehiscence that required reoperation. The authors
concluded that belt lipectomy should be seriously considered for patients who
present with circumferential truncal excess and for a select group of
normal-weight patients. It is not recommended for the obese patient with
excessive intraabdominal content. Furthermore, belt lipectomy should be
undertaken only in patients who are well informed about the possible risks and

PMID: 12496613 [PubMed]

93: Arch Otolaryngol Head Neck Surg.  2002 Dec;128(12):1357-60.  

Retained ventilation tubes: should they be removed at 2 years?

El-Bitar MA, Pena MT, Choi SS, Zalzal GH.

Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's
National Medical Center, 111 Michigan Ave NW, Washington, DC 20010, USA.

OBJECTIVES: To assess the complications of ventilation tubes that were retained
in children for 2 years or longer and the necessity of removal. DESIGN: A
retrospective chart review of all patients who underwent ventilation tube
removal from 1997 to 2000, with the exclusion of patients with craniofacial
anomalies. SETTING: A tertiary children's hospital. PATIENTS: One hundred
twenty-six children with ventilation tubes that were retained for 2 years or
longer. INTERVENTIONS: Ventilation tube removal and tympanic membrane (TM)
patching. MAIN OUTCOME MEASURES: Otorrhea, formation of granulation tissue, TM
perforation, development of cholesteatomas, and tube reinsertion. RESULTS: A
total of 126 patients aged 2(1/2) to 14 years (59 girls and 67 boys) underwent
removal of their ventilation tubes after 2 years or more. The patients were
divided into 2 groups. Group 1 included 67 patients (29 girls and 38 boys) who
were younger than 7 years at the time of tube removal. The tubes were retained
for 2 to 5(1/2) years (mean retention time, 3.3 years). Group 2 included 59
patients (30 girls and 29 boys) aged 7 years and older at the time of tube
removal. The tubes were retained for 2 to 10(1/2) years (mean retention time,
4.2 years). Complications such as otorrhea, formation of granulation tissue, and
TM perforation were seen in 10.3%, 13.8%, and 5.2% of the patients with tube
retention of 2 to 3 years, compared with 40.0%, 40.0%, and 46.7% of patients
with tube retention of more than 5 years. In group 1, transient otorrhea,
formation of granulation tissue, and TM perforation occurred in 13.4%, 7.4%, and
6.0% of the patients, respectively, after 2 years of tube retention. In group 2,
similar complications occurred in 23.7%, 25.4%, and 27.1% of the patients,
respectively. Forty-six patients in group 1 underwent TM patching (31 with paper
and 15 with absorbable gelatin film, with a success rate of 91.3%; however, 8
patients (11.9%) required tube reinsertion. In group 2, patching of the TM was
done in 40 patients (13 with paper, 24 with absorbable gelatin film, and 3 with
fat), with a success rate of 67.5%. Tube reinsertion was necessary in 1.7% of
the patients in group 2. No cholesteatoma was encountered. CONCLUSIONS: Higher
complication rates are seen in children when ventilation tubes are retained
longer than 2 years. Children 7 years and older have a higher incidence of
complications from the tube retention than children younger than 7 years. Early
removal of ventilation tubes in children younger than 7 years of age, when the
risk for otitis media is still present, may result in the need for tube

PMID: 12479719 [PubMed]

94: Dermatol Surg.  2002 Dec;28(12):1184-7; discussion 1187.  

Should dermatologic surgeons discontinue hormonal therapy prior to tumescent

Butterwick KJ.

Scripps-XIMED Medical Center, La Jolla, California 92037, USA.

Publication Types:
    Review, Tutorial

PMID: 12472505 [PubMed]

95: Scand J Gastroenterol.  2002 Nov;37(11):1246-52.  

Gastro-oesophageal reflux in obese subjects: influence of overweight, weight
loss and chronic gastric balloon distension.

Mathus-Vliegen EM, Tygat GN.

Dept. of Gastroenterology and Hepatology, Academic Medical Centre, University of
Amsterdam, The Netherlands. e.mathus-vliegen@amc.uva.nl

BACKGROUND: Gastro-oesophageal reflux is an obesity-related health risk assumed
to improve after weight loss. Prolonged intragastric balloon distension might
oppose this. The purpose of the study was to investigate the prevalence of
gastro-oesophageal reflux in untreated obese subjects and to study the
consequences of weight loss with or without intragastric balloon treatment.
METHODS: Patients participating in a randomized double-blind, sham-controlled
trial received balloon or sham treatment for the first 13 weeks. Thereafter, all
subjects received a balloon for the remaining year. Twenty-four-hour pH
recordings were made at the start, after 13 weeks of balloon or sham treatment,
after 26 and 52 weeks of balloon treatment and 13 weeks after balloon removal.
RESULTS: Group-wise, pH data of 42 untreated patients (BMI 43.4 kg/m2) were
highly abnormal. On an individual level, 22 subjects (52%) had some evidence of
reflux, 17 patients (40%) showed pathological total reflux times and 8 (19%) had
combined total, upright and supine reflux with grade B reflux oesophagitis in
only one patient. Albeit poorly, oesophageal acid exposure was related to body
weight and visceral fat distribution. A reduction in acid reflux was observed in
sham-treated weight-losing subjects, whereas in balloon-treated subjects supine
reflux and duration of the longest reflux increased. In the second 13-week
period, the initially improved pH values worsened by balloon placement in
sham-treated subjects. Values in balloon-balloon-treated subjects stabilized.
After 52 weeks, acid reflux levelled off at pretreatment values and further
improved after balloon removal. At these times, decreased visceral fat masses
correlated significantly with diminished oesophageal exposure to acid.
CONCLUSIONS: Obesity predisposed to gastro-oesophageal reflux. Body weight loss
and, strikingly, visceral fat loss resulted in improved reflux parameters.
Adverse effects on acid reflux by gastric balloon distension wore off over time.

Publication Types:
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial

PMID: 12465720 [PubMed]

96: Environ Health Perspect.  2002 Dec;110(12):A767-72.  

Influence of nutrient intake on blood lead levels of young children at risk for
lead poisoning.

Gallicchio L, Scherer RW, Sexton M.

Department of Epidemiology and Preventive Medicine, University of Maryland
School of Medicine, Baltimore 21201, USA. lgallic@epi.umaryland.edu

Although removal of lead paint hazards from at-risk houses remains the primary
means of preventing elevated blood lead among young children, reduction of risk
through nutritional factors has also been of interest. In this study we
evaluated the effect of nutrient intake on blood lead levels by analyzing
whether the intakes of certain dietary components a) were associated with blood
lead levels independent of lead exposure or b) modified the effect of lead
exposure on blood lead. Subjects were 205 children from low-income families who
were approximately 1 year of age and living in old, urban houses. The data
collected for each child included blood lead level, nutritional status, and
amount of lead exposure, which was assessed from samples of household dust.
Multiple linear regression analyses showed a statistically significant positive
association between lead exposure and blood lead. Statistically significant
positive associations were found between blood lead and total fat as well as
blood lead and saturated fat, independent of lead exposure and age of the child.
Regression modeling and stratified analysis showed that mean blood lead
increased with increasing lead exposure as well as with increasing caloric
intake, suggesting that caloric intake modifies the association between lead
exposure and blood lead. The findings from this study, if replicated in other
studies, support a dietary intervention to reduce the amount of total calories,
total fat, and saturated fat among children 1 year of age at risk for lead
exposure, while maintaining adequate intake of these dietary components. Our
results also reinforce recommendations that removal of lead paint hazards from
at-risk houses should be the primary means of preventing lead exposure.

PMID: 12460816 [PubMed]

97: Dermatol Surg.  2002 Nov;28(11):1022-6.  

Gravimetrically controlled efficacy of subcorial curettage: a prospective study
for treatment of axillary hyperhidrosis.

Proebstle TM, Schneiders V, Knop J.

Department of Dermatology, University of Mainz, Mainz, Germany.

BACKGROUND: Botulinum toxin A (BTX-A) proved to be effective for the treatment
of axillary hyperhidrosis by means of gravimetry. Quantitatively controlled
studies for surgical treatment are lacking so far. OBJECTIVE: To prospectively
test the efficacy of subcorial axillary curettage by gravimetric evaluation of
pre- and postsurgical sweat rates. METHODS: Conservatively pretreated patients
received subcorial curettage under tumescent local anesthesia using a sharp
spoon. Sweat rates of each axilla were determined gravimetrically before and 4-8
weeks after surgery. Evaluation was performed with respect to baseline sweat
rates greater than 50 mg/min (group A), greater than 25 and less than 50 mg/min
(group B), and less than 25 mg/min (group C). Side effects and patients' ratings
were also recorded. RESULTS: Of 42 treated patients, 38 could be evaluated
completely. In 29 axillae of group A (high sweat rates), an average reduction
from the baseline of 85.6 mg/min to 21.6 mg/min could be achieved (P <.0001).
Corresponding values for 22 axillae of group B (medium sweat rates) were 36.8
mg/min and 16.5 mg/min (P <.0001). In 25 axillae with low sweat rates (group C),
a significant reduction in sweat rates could not be achieved. The results
remained almost stable during a median follow-up of 11 months (range 4-24
months). Only minor side effects were observed and patient satisfaction was high
in groups A and B. CONCLUSION: Subcorial curettage is an effective treatment of
axillary hyperhidrosis for patients with baseline sweat rates greater than 25

Publication Types:
    Evaluation Studies

PMID: 12460297 [PubMed]

98: Dermatol Surg.  2002 Nov;28(11):979-86.  

HIV-associated facial lipoatrophy.

James J, Carruthers A, Carruthers J.

Division of Dermatology and Department of Ophthalmology, University of British
Columbia, Vancouver,British Columbia, Canada.

BACKGROUND: HIV-infected individuals are living long, healthy lives. They are
now concerned with less life-threatening problems, especially lipodystrophy.
OBJECTIVE: To review the current state of our knowledge about lipodystrophy in
HIV-infected individuals. METHODS: The literature was reviewed and analyzed for
relevant information. In addition, our clinical experience of managing such
individuals was utilized. RESULTS: Lipodystrophy and facial lipoatrophy and
their relationship to HIV-infection are discussed. Their differences are noted.
The spectrum of appearance in individuals with facial lipoatrophy is described
and a severity scale suggested which should be of value in assessing the results
of treatment. CONCLUSION: Lipodystrophy and lipoatrophy are intimately related
to infection with HIV. In consequence, facial lipoatrophy is a major stigma for
HIV-infected individuals and can have dramatic effects on their self-esteem and
socialization. Effective treatment is essential.

Publication Types:
    Review, Tutorial

PMID: 12460289 [PubMed]

99: Dermatol Surg.  2002 Nov;28(11):971-8.  

The safety of liposuction: results of a national survey.

Housman TS, Lawrence N, Mellen BG, George MN, Filippo JS, Cerveny KA, DeMarco M,
Feldman SR, Fleischer AB.

Department of Dermatology, Wake Forest University School of
Medicine,Winston-Salem, North Carolina 27157, USA.

BACKGROUND: Liposuction procedures are increasing in frequency and may be
performed in hospitals, ambulatory surgery centers, or physician offices. Deaths
associated with liposuction and previous surveys of liposuction safety have
raised concern about the safety of office-based surgery. OBJECTIVE: To determine
the safety of office-based, tumescent liposuction among dermatologic surgeons.
METHODS: A survey mailed out to dermatologic surgeons in August 2001 requested
retrospective information regarding the number of patients undergoing
liposuction, the setting in which the procedures were performed, and the
complications that occurred during the 7-year period from 1994 to 2000. A
detailed complication record was requested for each serious adverse event or
death reported. Surveys were mailed to 517 worldwide members of the American
Society for Dermatologic Surgery (ASDS) listed as performing liposuction; 505
had adequate contact information. The main outcome mesure was the rate of
serious adverse events (SAEs) or deaths per 1000 liposuction procedures for each
service setting and for each level of conscious sedation. RESULTS: The overall
response rate was 89% (450/505), and of these, 78% (349/450) perform
liposuction. A total of 267 dermatologic surgeons completed the survey; 261
provided data on 66,570 liposuction procedures. No deaths were reported. The
overall serious adverse event rate was 0.68 per 1000 cases. The SAE rates were
higher for hospitals and ambulatory surgery centers than for nonaccredited
office settings. SAE rates were also higher for tumescent liposuction combined
with intravenous or intramuscular sedation than combined with oral or no
sedation. CONCLUSION: Office-based tumescent liposuction performed by
dermatologic surgeons is safe, with a lower complication rate than
hospital-based procedures. Future legislation should recognize the proven safety
of this procedure as performed by dermatologic surgeons in their offices.

PMID: 12460288 [PubMed]

100: Obes Surg.  2002 Oct;12(5):699-702.  

Band infection with splenoportal venous thrombosis: an unusual but severe
complication of gastric banding.

Calmes JM, Bettschart V, Raffoul W, Suter M.

Department of Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne,

BACKGROUND: Band infection after gastric banding is a relatively rare
complication. In most cases, it is manifested by abdominal pain associated with
fever, and/or an abscess surrounding the access port. The treatment of choice
consists of band removal and antibiotic therapy, and is usually effective.
METHODS: Among the 322 patients having undergone gastric banding in our
department, we report a 31-year-old woman who developed an infection of the band
complicated by splenic and portal vein thrombosis 21 months after gastric
banding. RESULTS: BMI was 40.9 kg/m2 when she underwent gastric banding.
Postoperative course was uneventful, and excess weight loss reached 105% after
18 months. An abdominoplasty combined with bilateral mammoplasty and thigh
dermolipectomy were performed. About 3 weeks later, she developed an otitis with
fever and left upper abdominal pain. Despite antibiotics, pain and fever
persisted. The operative wounds showed no sign of infection, and there was no
sign of peritonitis. Computerized tomography showed a left subdiaphragmatic
abscess surrounding the catheter and thrombosis of the splenic and portal veins.
Treatment consisted of band removal, antibiotics and heparin. Recovery was
uneventful with complete resolution of the thrombosis. CONCLUSIONS: Late band
infection after gastric banding is rare, and is usually secondary to band
erosion. Our case demonstrates that severe band infection can be caused by any
infection causing bacteremia. Prompt band removal along with antibiotic therapy
is the treatment of choice. Rapid treatment of any infection is mandatory in
patients with a gastric band. Antibiotic prophylaxis during surgical and dental
procedures could be useful in these patients.

Publication Types:
    Case Reports

PMID: 12448396 [PubMed]

101: Obes Surg.  2002 Oct;12(5):639-42.  

Laparoscopic Roux-en-Y gastric bypass--evaluation of three different techniques.

Abdel-Galil E, Sabry AA.

Department of Surgery, Ahmed Maher Teaching Hospital, 233 Ramsis St., Cairo,
Egypt. essam218331@hotmail.com

BACKGROUND: The Roux-en-Y gastric bypass (RYGBP) is one of the ideal operations
for morbid obesity. The minimal invasive laparoscopic technique has been
performed to shorten the operative time and to reduce the complications of the
open surgery. METHODS: From Jan 1999 through Jan 2001, laparoscopic RYGBP
(LRYGBP) was attempted in 90 patients. Median age was 30, with median
preoperative BMI 47. The preoperative nutritional habits and comorbidities were
recorded. LRYGBP was done by three different techniques in three equal groups.
In the first group, the gastrojejunostomy was constructed by passing the EEA
anvil transorally, using a pull-wire technique. In the second group, the
gastrojejunostomy was fashioned with a totally handsewn technique. In the third
group, the gastrojejunostomy was performed with an endo-cutter cartridge and the
anastomotic incision was closed with an endo TA30 stapler. RESULTS: The results
were nearly identical in the three groups. Average excess weight loss at 1 year
was 70%. The mean operating time was 120 min in the first group, 100 min in the
second group and 75 min in the third group. Esophageal injury was the most
common problem in the first group. Incidence of gastrojejunostomy stenosis was
higher in the second group (36.6%). Incidence of internal herniation was higher
in the second (17%) and first (13.6%) groups than in the third group (3.3%).
CONCLUSION: Whichever technique is used to construct the gastrojejunostomy,
LRYGBP is a safe, effective and technically feasible operation for morbidly
obese patients. We recommend the technique of constructing the gastrojejunostomy
with an endocutter cartridge and closing the anastomotic incision with an endo
TA stapler, as it saved time and reduced the incidence of the essential
complications in gastric bypass surgery.

Publication Types:
    Evaluation Studies

PMID: 12448384 [PubMed]

102: Int J Pediatr Otorhinolaryngol.  2002 Dec 2;66(3):291-6.  

Synchronous fat plug myringoplasty and tympanostomy tube removal in the
management of refractory otorrhoea in younger patients.

Liew L, Daudia A, Narula AA.

Department of Otorhinolaryngology-Head and Neck Surgery, Leicester Royal
Infirmary, Leicester LE1 5WW, UK. lennyliew@ukgateway.net

OBJECTIVE: Tympanostomy tubes are associated with many complications, the most
common being recurrent otorrhoea, in many cases resistant to medical treatment.
With the associated vestibulo-cochlear toxicity of many topical antibiotics,
their use is dose limited. Removal of the tympanostomy tube has been shown to
cure the otorrhoea, however, it is associated with a high persistent perforation
rate of 10-28%. A synchronous fat plug myringoplasty was performed with tube
removal in an attempt to reduce the residual perforation rate. METHODS: A
retrospective study of 13 consecutive children, nine male and four female, mean
age 9.1 years (median=9, range 2-15), with a total of 15 ears (left=6, right=9)
had either Shah Tubes (n=5), Shepard Tubes (n=1) or Shah Long Term Tubes (n=9)
in-situ for middle ear effusions. The tubes were removed for recurrent
otorrhoea. The tubes had been in-situ for a mean of 38.8 months (median=31,
range 9-84 months). All ears had recurrent infections, with a variable response
to topical antibiotics. All were under the care of one specialist, who performed
all the procedures. At the time of tube removal, a standard fat graft
myringoplasty was done. RESULTS: The procedure was successful in 15 of the 15
ears, and all perforations had closed by 3 weeks. Pure tone audiometry improved
in 11 ears, remained the same in two and worsened in two (0-10 and 11-15 dBA,
respectively). There were no complications arising from the procedure. Mean
follow up was 13.7 months (median=9, range 3-31). None of the patients have
re-perforated, but two have required re-ventilation of their middle ear for
middle effusions, and one of these two has also undergone subsequent
adeno-tonsillectomy. CONCLUSIONS: Our experience in this small series shows that
the removal of a tympanostomy tube for recurrent otorrhoea can be successfully
managed with a fat plug myringoplasty, with the benefit of a reduction in the
persistent perforation rate following tympanostomy tube removal. It is a simple
technique that requires little extra operating time with no significant

PMID: 12443819 [PubMed]

103: Cleve Clin J Med.  2002 Nov;69(11):897-903.  

Bariatric surgery for morbid obesity: why, who, when, how, where, and then what?

Choban PS, Jackson B, Poplawski S, Bistolarides P.

Bariatric Treatment Center of Ohio, Columbus, USA. choban.1@osu.edu

Bariatric surgery is not a cure, but it can take weight off and keep it off,
improve most obesity-related conditions, reduce the risk of premature death, and
improve quality of life. Given the interest in the procedure, primary care
physicians need to understand the risks and benefits to help patients determine
if this therapy is a good option, and they need to know the health changes that
may occur after surgery when following these patients.

Publication Types:
    Review, Tutorial

PMID: 12430975 [PubMed]

104: Am J Otolaryngol.  2002 Nov-Dec;23(6):345-50.  

Autologous fat injection to treat leakage around tracheoesophageal puncture.

Perie S, Ming X, Dewolf E, St Guily JL.

Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Faculte de
Medecine Saint Antoine, Universite Paris VI, Hopital Tenon, 4 rue de la Chine,
75020 Paris, France.

PURPOSE: To evaluate prospectively autologous fat injection as a treatment for
leakage around tracheoesophageal puncture. PATIENTS AND METHODS: For ten
patients who exhibited leakage of saliva or liquid around their
tracheoesophageal puncture, autologous fat injection was carried out into the
tracheoesophageal wall around the maintained prosthesis. Short-term success was
evaluated at one month, and long-term follow-up was continued as long as the
patients remained alive. The effectiveness of the procedure was evaluated based
on the presence or absence of leakage around the puncture as the patient
swallowed methylene blue liquid. Patients were adjudged completely improved when
no leakage of blue liquid was observed, partially improved when a slight stasis
was evident, or unimproved when a marked leakage of blue liquid was noted.
RESULTS: Short-term success was achieved for 6 patients, 2 patients partially
improved, and the procedure failed for 2 others. Long-term success (from 10 to
65 months) was achieved in all 4 of the completely improved patients who were
free of disease, including 1 patient who required an additional injection.
Removal of the puncture was later carried out in the 2 others for cervical node
metastases or tracheal tumor. Definitive or transitional puncture closure or
removal of the prosthesis was required in 3 partially or unimproved patients,
whereas 1 partially improved patient died of lung metastasis 3 months later.
CONCLUSIONS: Fat injection around a voice prosthesis is a procedure that may be
conducted as an alternative to other conservative techniques to decrease the
size of the puncture. Close endoscopic observation is required however to
eliminate secondary tumor that might expand the size of the puncture. Copyright
2002, Elsevier Science (USA). All rights reserved.)

PMID: 12430126 [PubMed]

105: Rev Prat.  2002 Sep 15;52(14):1561-6.  

[Diagnosis and management of chronic pancreatitis]

[Article in French]

Buscail L.

Service de gastro-enterologie et nutrition Centre hospitalier universitaire de
Rangueil 31403 Toulouse. buscail.l@chu-toulouse.fr

Chronic calcifying pancreatitis is mainly due to chronic alcohol consumption.
The first years of its evolution are marked by a painful disease and often
weightloss as well as complications including acute pancreatitis, pseudocysts,
compression of common bile duct, pleural effusion ascitis, and gastrointestinal
bleedings. Between five and ten years evolution, pain is less frequent but risk
for pseudocyst or jaundice still remains. Ten years after the onset of the
disease pancreatic pain disappears while pancreas becomes calcified and
fibrotic. Only diabetes and exocrine insufficiency are present at this stage.
Medical treatment is mainly based on alcohol withdrawal, analgesics and
restoration of normal nutritional status. Pain could be decreased but sometimes
endoscopic, radiologic or surgical procedures are required. Insulin is often
proposed for diabetes while exocrine insufficiency is substituted by
gastro-resistant microgranules pancreatic extracts.

Publication Types:
    Review, Tutorial

PMID: 12412304 [PubMed]

106: J Chir (Paris).  2002 Sep;139(4):214-7.  

[Surgical treatment of morbid obesity by gastrojejunal bypass using laparoscopic
roux-en-Y (gastric short circuit)]

[Article in French]

Msika S.

Service de Chirurgie Generale et Digestive, Hopital Louis Mourier, Colombes,

PMID: 12410137 [PubMed]

107: J Chir (Paris).  2002 Sep;139(4):194-204.  

[Surgery of morbid obesity in the adult: clinical efficacy of different surgical

[Article in French]

Msika S.

Service de Chirurgie Generale et Digestive, Hopital Louis Mourier, Colombes,
France. simon.msika@lmr.ap-hop-paris.fr

Obesity is defined as morbid when the Body Mass Index (BMI) exceeds 40 kg/m(2).
The initial approach should be a multidisciplinary medical assessment. The three
principal surgical interventions practiced in France are: placement of an
adjustable gastroplasty ring, vertical banded gastroplasty, and Roux-en-Y
gastric bypass (short circuit). The indications for surgical therapy are those
defined by recent consensus conferences: Morbid Obesity (BMI 40), Major Obesity
(BMI 35) with associated factors of co-morbidity, or stable or worsening obesity
of five years duration resistant to multidisciplinary medical management for a
least a year. Studies of these three surgical techniques with at least one year
of follow-up shows significant average weight loss on the order of 20-50 kg.
Studies of adjustable ring gastroplasty show an average loss of 45% of excess
weight at one year; maintenance of weight loss beyond one year is not yet well
documented. Long term results of vertical banded gastroplasty and gastric bypass
are better defined. Initial weight loss for vertical banded gastroplasty is
about 61%; some patients maintain this weight loss and others tend to regain
some of their excess weight. For gastric bypass, the initial weight loss is
about 68% of excess weight and there is a greater tendency to maintain this
weight loss. Comparative studies, mostly from North America and of variable
methodologic quality, conclude that weight loss with gastric bypass is superior
to that with vertical banded gastroplasty. The indications for the respective
techniques vary according to the severity of the obesity (BMI), and to the
patient's eating habits. Gastric bypass which has the best short and long term
results may be best reserved for patients with the most severe obesity or
co-morbid conditions.

Publication Types:
    Review, Tutorial

PMID: 12410135 [PubMed]

108: Biol Res Nurs.  2002 Oct;4(2):73-84.  

Changes in nutritional status and postoperative outcomes in elderly CABG

DiMaria-Ghalili RA.

West Virginia University, School of Nursing, Charleston Division, 25304, USA.

OBJECTIVES: To systematically examine the pattern of nutritional status over
time in older people undergoing elective coronary artery bypass grafting (CABG)
and the extent to which nutritional status affects health outcomes
postdischarge. DESIGN: The sample consisted of 91 community-dwelling
English-speaking persons > or = 65 (72.27 +/- 4.85) years of age with normal
cognitive function and no active cancer. Data collected prospectively at 3 time
points (preoperatively, postoperatively on day 5, and 4 to 6 weeks
postdischarge) included serum albumin, transferrin, and calculated Body Mass
Index (BMI). The Short-Form 36 Health Status Survey Questionnaire was
administered 4 to 6 weeks postdischarge as a primary health outcome measure.
RESULTS: Nutritional status changed over time. For albumin and transferrin, the
pattern of change corresponded to the phases of surgical stress (P = 0.001). The
BMI decreased from preoperative to 4 to 6 weeks postdischarge (P = 0.001), and
this decrease explained 13.8% of the variance in physical health 4 to 6 weeks
postdischarge (P = 0.008). The change in the BMI corresponds to an average
weight loss of 5% from preoperative to postdischarge. CONCLUSIONS: Older people
undergoing CABG who lose significant weight from preoperative to postdischarge
are more likely to have lower self-reported physical health.

PMID: 12408213 [PubMed]

109: Surgery.  2002 Oct;132(4):767-73; discussion 773-4.  

Hospital costs and risk factors associated with complications of the ileal pouch
anal anastomosis.

Swenson BR, Hollenbeak CS, Koltun WA.

Department of Surgery, Section of Colon and Rectal Surgery, Penn State College
of Medicine, Hershey, Pa 17033-0850, USA.

BACKGROUND: The purpose of this study was to estimate the costs associated with
the most common complications of the ileal pouch anal anastomosis (IPAA) and
identify factors that predispose to them. METHODS: Hospital costs of 135
patients undergoing the IPAA were combined with information abstracted from
charts. Logistic and linear regression modeling were used to estimate the
marginal costs for the most common IPAA complications and determine factors
predisposing to their occurrence. RESULTS: The average overall cost for the IPAA
was $20,865. Just more than half (53%) of patients experienced complications,
the 3 most common being small-bowel obstruction (24.4%), pelvic/abdominal sepsis
(6.7%), and dehydration (5.9%). The average cost to treat an episode of
small-bowel obstruction was $6709. Treatment of pelvic/abdominal sepsis averaged
$9268 per occurrence, whereas dehydration averaged $4860. Steroid use > 3 months
before colectomy significantly increased the risk for any complication (P =.02).
No factors were found to be good predictors of bowel obstruction. However, age >
42 years and low patient hematocrit were significant predictors of dehydration
as a complication (P <.05). Trending toward significance were urgent operation
and weight loss greater than 5%. CONCLUSIONS: The most common complications of
the IPAA are small-bowel obstruction, pelvic/abdominal sepsis, and dehydration.
Complications were responsible for approximately 44% of the overall cost of an
IPAA. Factors that increase risk of IPAA complications are steroid use, low
hematocrit, age > 42 years, nonelective procedures, and preoperative weight

PMID: 12407364 [PubMed]

110: Surgery.  2002 Oct;132(4):724-7; discussion 727-8.  

Long-term data indicate a progressive loss in efficacy of adjustable silicone
gastric banding for the surgical treatment of morbid obesity.

Doherty C, Maher JW, Heitshusen DS.

Department of Surgery, College of Medicine, University of Iowa, Iowa City, Iowa
52242-1086, USA.

BACKGROUND: Many short-term follow-up reports on the efficacy of the adjustable
silicone gastric band (ASGB) and its modification for laparoscopic insertion
(Lap-Band) for the surgical treatment of morbid obesity have been reported in
the surgical literature. However, long-term studies are lacking. METHODS:
Between March 17, 1992, and January 7, 1997, 45 females and 17 males
consecutively entered this prospective study. Forty ASGB and 22 Lap-Band were
implanted. Mean age was 34 years (range 19-51); mean height was 171 cm (range
152-190); mean weight was 145 kg (range 100-214). Weight loss and adverse events
associated with the device were observed over time. RESULTS: There was no
operative mortality. Thirty intra-abdominal reoperations were necessary to
correct complications related to the implanted ASGB and the Lap-Band. In the
ASGB cohort, the body mass index (BMI) decreased from 50 to 36 over a 3-year
period and then increased to 44 at 8 years after operation. In the Lap-Band
cohort the BMI decreased from 47 to 40 at 1 year and then increased to 43 at 6
years after operation. Twenty-seven implantable devices (18 ASGB, 9 Lap-Band)
have been removed to date. CONCLUSION: The results of this study do not support
the use of ASGB devices for the surgical treatment of morbid obesity. The
Lap-Band is less effective than ASGB.

PMID: 12407358 [PubMed]

111: Best Pract Res Clin Gastroenterol.  2002 Oct;16(5):783-95.  

Other disease associations with non-alcoholic fatty liver disease (NAFLD).

Allard JP.

Toronto General Hospital, 200 Elizabeth St, Eaton 9-217A, Toronto, Ontario, M5G
2C4, Canada.

Non-alcoholic fatty liver disease (NAFLD) is usually seen in middle-aged women
with obesity, non-insulin-dependent diabetes mellitus and/or hyperlipidaemia.
NAFLD has also been associated with other conditions. Surgical procedures to
treat obesity such as jejunoileal bypass and gastroplasty as well as massive
small bowel resection have been associated with NAFLD. Mechanisms such as rapid
weight loss, certain nutritional deficiencies and bacterial overgrowth have been
proposed. Other nutritional conditions such as extreme malnutrition and total
parenteral nutrition can also cause NASH. This can be due to abnormal glucose
and fat metabolism, deficiencies like carnitine, essential fatty acid and
choline or, in the case of parenteral nutrition, excess of calories, glucose or
lipids. Several drugs have also been implicated as well as some inborn errors of
metabolism and, more rarely, other diseases.

Publication Types:
    Review, Tutorial

PMID: 12406445 [PubMed]

112: Zhonghua Zheng Xing Wai Ke Za Zhi.  2002 Jul;18(4):221-3.  

[A comparative study on external ultrasonic, internal ultrasonic and simple
negative pressure liposuction operations under tumescent anesthesia]

[Article in Chinese]

Hu Z, Gao J, Qi X.

Department of Plastic Surgery, Nanfang Hospital, First Military Medical
University, Guangzhou 510515, China.

OBJECTIVE: To compare the effects of the external ultrasonic, the internal
ultrasonic and simple negative pressure liposuction operations under tumescent
anesthesia. METHODS: The fat volume, operative time, complications and other
indexes of liposuction in 276 cases were collected and compared. RESULTS:
External ultrasonic liposuction rapidly emulsified the fat with the least
complication. The effects of the internal ultrasonic liposuction was next to the
external ultrasonic method while the simple negative pressure liposuction had
the poorest effects. CONCLUSION: The external ultrasonic liposuction operation
is a safe and effective method for local overweight reduction.

PMID: 12382574 [PubMed]

113: J Oral Maxillofac Surg.  2002 Oct;60(10):1131-4.  

Histologic examination of pedicled buccal fat pad graft in oral submucous

Chao CK, Chang LC, Liu SY, Wang JJ.

Dental Department, The Kaohsiung Military General Hospital, Taiwan, ROC.

PURPOSE: This report evaluates the wound healing process of buccal fat pad (BFP)
grafted on a defect of the buccal mucosa for oral submucous fibrosis (OSF).
PATIENTS AND METHODS: Sixteen patients with limitation of mouth opening under
the diagnosis of OSF were surgically treated by cutting the fibrotic bands on
the buccal mucosa (10 bilateral and 6 unilateral). The defects created were then
covered by a BFP graft. The bulging BFP was trimmed postoperatively on a weekly
basis until it was fully epithelialized. The specimens were stained and examined
microscopically. RESULTS: Inflammatory cell infiltrate, blood vessel congestion,
and fibrinous exudates covering the BFP were obvious by week 2. At week 3, blood
vessel congestion and fat cell number decreased markedly. Evidence of stratified
squamous epithelium with parakeratosis was seen in the margin of the BFP graft.
At week 4, the number of fat cells decreased significantly and the original BFP
was almost completely replaced by granulation tissue. The original BFP was fully
covered by stratified squamous epithelium by week 5. CONCLUSIONS: The BFP graft
has been widely used for covering exposed defects created by fibrotic band
excision for the improvement of mouth opening limitation. The healing process
was documented microscopically by weekly observation. Copyright 2002 American
Association of Oral and Maxillofacial Surgeons

Publication Types:
    Clinical Trial

PMID: 12378485 [PubMed]

114: Ann Surg.  2002 Oct;236(4):422-8; discussion 428.  

Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective
randomized trial.

Tran K, Van Eijck C, Di Carlo V, Hop WC, Zerbi A, Balzano G, Jeekel H.

Departments of General Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The

OBJECTIVE: Using a prospective randomized study to assess postoperative
morbidity and pancreatic function after pancreaticoduodenectomy with
pancreaticojejunostomy and duct occlusion without pancreaticojejunostomy.
SUMMARY BACKGROUND DATA: Postoperative complications after
pancreaticoduodenectomy are largely due to leakage of the
pancreaticoenterostomy. Pancreatic duct occlusion without anastomosis of the
pancreatic remnant may prevent these complications. METHODS: A prospective
randomized study was performed in a nonselected series of 169 patients with
suspected pancreatic and periampullary cancer. In 86 patients the pancreatic
duct was occluded without anastomosis to pancreatic remnant, and in 83 patients
a pancreaticojejunostomy was performed after pancreaticoduodenectomy.
Postoperative complications were the endpoint of the study. All relevant data
concerning patient demographics and postoperative morbidity and mortality as
well as endocrine and exocrine function were analyzed. At 3 and 12 months after
surgery, evaluation of weight loss, stools, and the use of antidiabetics and
pancreatic enzyme was repeated. RESULTS: Patient characteristics were comparable
in both groups. There were no differences in median blood loss, duration of
operation, and hospital stay. No significant difference was noted in
postoperative complications, mortality, and exocrine insufficiency. The
incidence of diabetes mellitus was significantly higher in patients with duct
occlusion. CONCLUSIONS: Duct occlusion without pancreaticojejunostomy does not
reduce postoperative complications but significantly increases the risk of
endocrine pancreatic insufficiency after duct occlusion.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 12368670 [PubMed]

115: Int J Oral Maxillofac Surg.  2002 Aug;31(4):364-6.  

Intraoral transmental suction lipectomy.

Mommaerts MY, Abeloos JV, De Clerq CA, Neyt LF.

Department of Surgery, General Hospital St John, Bruges, Belgium.

Intraoral transmental suction lipectomy (TMSL) is performed by entering the
suction canula through the chin osteotomy/ostectomy gap into the sub- and/or
supraplatysmal fat tissue layers. The aim of the study was to know patients' and
operators' satisfaction with the procedure, and to know the kind and frequency
of the complications. Twenty patients were consecutively treated and reviewed
after a minimum of 5 years. All were satisfied with the overall results. It
proved difficult to differentiate between the results of the liposuction and
those of the genioplasty and/or orthognathic profile correction. From a
surgeon's point of view, 11 showed excellent, nine good and one moderate
results. Complications included one local subcutaneous infection, four transient
neurosensory disturbances at the lower lip and two marginal branch weaknesses.
All complications were resolved by the time of the long-term follow-up
appointment. TMSL offers the psychological advantage of being performed without
skin incision. Cosmetic results and complications are similar to those obtained
with the transcutaneous liposuction techniques.

Publication Types:
    Evaluation Studies

PMID: 12361067 [PubMed]

116: J Dermatolog Treat.  2001 Dec;12(4):189-90.  

On the safety of liposuction.

Lowe NJ.

Publication Types:

PMID: 12241626 [PubMed]

117: Surg Endosc.  2002 Dec;16(12):1653-7. Epub 2002 Sep 23. 

Outcome analysis of laparoscopic Roux-en-Y gastric bypass for morbid obesity.
The first 116 cases.

Papasavas PK, Hayetian FD, Caushaj PF, Landreneau RJ, Maurer J, Keenan RJ,
Quinlin RF, Gagne DJ.

Minimally Invasive Surgery, West Penn Allegheny Health System, 4800 Friendship
Avenue, Pittsburgh, PA 15224, USA.

BACKGROUND: Morbid obesity has been described as a continuing epidemic affecting
a growing portion of our population. We report an outcome analysis of our early
experience with laparoscopic Roux-en-Y gastric bypass (LRYGB) in the treatment
of morbid obesity. METHODS: Two surgeons performed 116 consecutive LRYGBs at a
single institution, creating a 25-ml pouch and a 90- to 150-cm Roux limb. The
prospectively collected data included patient demographics, comorbidities,
postoperative weight loss, and complications. RESULTS: All eight conversions to
an open procedure occurred early during the experience of the surgeons. The mean
operating room time for the first 50 cases was 272 min, which decreased to 198
min with experience. The mean length of hospital stay was 3 days. There were 34
complications in 27 patients (23.3%), 14 of which (12%) required reoperation. At
18 months postoperatively, the patients had lost 77% of their excess weight, and
their body mass index had decreased from a mean of 49.3 to 32.6 kg/m2. As a
result of LRYGB, 25% of the patients were rendered completely free of any
pharmacologic treatment for their preexisting comorbidities. CONCLUSIONS:
Although technically challenging, LRYGB can be performed safely with excellent
long-term results. The mean operating room time and conversion rate improved
with experience. As this study showed, LRYGB achieves an excellent rate of
weight loss and improvement in preoperative comorbidities with a minimal length
of hospital stay and an acceptable complication rate.

PMID: 12239643 [PubMed]

118: Surgery.  2002 Aug;132(2):200-4.  

Tissue-engineered colon exhibits function in vivo.

Grikscheit TC, Ogilvie JB, Ochoa ER, Alsberg E, Mooney D, Vacanti JP.

Department of Surgery, Massachusetts General Hospital, Harvard Medical School,
Center for the Integration of Medicine and Innovation in Technology, Boston
02114, USA.

BACKGROUND: Postcolectomy morbidities include important changes in enterohepatic
circulation, stool microbiology, and absorption. The surgical substitution of an
ileal pouch for the absent colon also has a number of serious complications. We
report in vivo colon replacement by tissue-engineered colon (TEC) in lieu of an
ileal pouch. METHODS: End-ileostomies were created in 22 male Lewis rats. In 11
animals, side-to-side ileum-TEC anastomosis was performed 1 cm from the stoma.
This group was compared with end-ileostomy alone. Serial weights were measured,
and animals were harvested sequentially for assessment of histologic signs of
pouchitis. Transit times, stool dry and wet weights, and serum and stool colon
function markers were collected. RESULTS: Animals survived 41 days. Weight loss
was more than 1.5 times greater in the end-ileostomy alone group compared with
the ileum-TEC group. Transit times were significantly longer in the ileum-TEC
group than the end-ileostomy alone group, with lower stool moisture content and
higher total serum bile acids. Animals without TEC had statistically significant
hyponatremia, elevated serum urea nitrogen, and lower stool short chain fatty
acids (13.5 micromol/kg vs 84.2) with an abnormal distribution. CONCLUSIONS: TEC
successfully recapitulates some major physiologic functions of native large
intestine in vivo.

PMID: 12219012 [PubMed]

119: Plast Reconstr Surg.  2002 Sep 15;110(4):1158-64; discussion 1165-6.  

Laboratory and histopathologic comparative study of internal ultrasound-assisted
lipoplasty and tumescent lipoplasty.

Cardenas-Camarena L, Andino-Ulloa R, Mora RC, Fajardo-Barajas D.

Jalisco Plastic Surgery Institute, The Reconstructive Surgery Institute of
Jalisco, The Jalisco Dermatological Institute, Jalisco, Mexico.

Despite the advantages of using internal ultrasound-assisted lipoplasty instead
of the classic tumescent lipoplasty, such as reduced bleeding and tissue damage,
the authors found no objective or comparative study of these techniques in
humans. For this reason, they conducted a clinical study to determine the amount
of bleeding and tissue damage caused by each of the techniques. A simple
clinical assay was accomplished at the Jalisco Plastic Surgery Institute on
seven female patients scheduled for abdominal lipectomy. Two similar sections of
the surgical area were marked for lipoplasty techniques: classic tumescent
lipoplasty on one side and internal ultrasound-assisted lipoplasty on the other.
Both areas were treated simultaneously by surgeons experienced in each
technique. Laboratory tests and histologic studies were performed on the
aspirated material and the manipulated tissue, respectively. The fluids sent to
the laboratory were analyzed to determine the amount of bleeding and tissue
damage. In the laboratory, the degree of lesion and tissue damage was evaluated
in the dermis, nerves, blood vessels, and adipose cells. With internal
ultrasound-assisted lipoplasty, indicators of tissue damage such as glutamic
oxalacetic transaminase, pyruvic oxalacetic transaminase, cholinesterase, and
myoglobin showed higher values than with tumescent lipoplasty. The same was
found for hemoglobin levels and in the histologic data indicative of tissue
damage; both values were statistically significant at < 0.001. Internal
ultrasound-assisted lipoplasty was not demonstrated to be more innocuous or to
have a selective effect in adipose cells, and it generally resulted in more
tissue damage and bleeding than the classic tumescent technique.

PMID: 12198431 [PubMed]

120: Obes Surg.  2002 Aug;12(4):564-8.  

Long-term results of laparoscopic adjustable gastric banding for the treatment
of morbid obesity.

Belachew M, Belva PH, Desaive C.

State University of Liege, Free University of Brussels, CHR Huy, Belgium.

BACKGROUND: Since the first laparoscopic adjustable gastric banding (LAGB)
operation on September 1, 1993, there have been important publications related
to this procedure. The majority of the articles reported surgical technique and
short-term results. Long-term results of LAGB are lacking. The authors report
long-term data (at least 4 years) from 3 major bariatric centers in Belgium that
perform LAGB routinely. METHODS: The 3 centers applied the same patient
selection criteria, the same standard surgical technique, the same laparoscopic
band (Lap-Band) and the same follow-up program. 763 patients have been enrolled.
Sex ratio was 22% male/78% female. Mean age was 34 years, and mean preoperative
BMI was 42 kg/m2. RESULTS: The follow-up rate was 90%, and the minimum follow-up
time was 4 years. The average BMI after 4 years was 30 kg/m2. Early
complications were: gastric perforation 4 (0.5%); large bowel perforation 1
(0.1%); bleeding 1 (0.1%); and conversion to open 10 (1.3%). Late complications
were: erosion 7 (0.9%); total food intolerance 59 (8%); access port problems 20
(2.5%); re-operations 80 (11.1%); death 1 (0.1%). CONCLUSION: Long-term results
of LAGB have been rarely reported, although publications on the procedure are
copious. Our long-term data found that BMI evolution is good, the complication
and re-operation rates are acceptable and the overall long-term results of the
Lap-Band system are good.

Publication Types:
    Multicenter Study

PMID: 12194552 [PubMed]

121: Ann Plast Surg.  2002 Aug;49(2):219-20.  

Bilateral brachial plexus palsy after a prolonged surgical procedure of
reduction mammaplasty, abdominoplasty, and liposuction.

Akinbingol G, Borman H, Maral T.

Publication Types:
    Case Reports

PMID: 12187358 [PubMed]

122: Arq Gastroenterol.  2002 Jan-Mar;39(1):39-47.  

Study of morbidity in orthotopic small intestine transplantation with Wistar
rats. Experimental study.

Lee AD, Gama-Rodrigues J, Galvao FH, Waitzberg DL.

Department of Gastroenterology, Discipline of Digestive System Surgery,
University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.

BACKGROUND: Transplantation of the small intestine is a surgical procedure
currently under investigation for its possible application in the treatment of
patients with short bowel syndrome, aiming at the reintroduction of an oral
diet. AIM: To define the morbidity and mortality of intestinal transplantation
in small animals using microsurgery. Intra and postoperative morbidity and
mortality were studied in Wistar rats submitted to orthotopic intestinal
allotransplantation. MATERIAL AND METHOD: The animals were divided into three
groups: group A (37 donor animals), group B (37 recipient animals), and group C
(10 control animals). Group B was divided into three subgroups according to
survival time. Subgroup TI consisted of animals that died during surgery or due
to causes directly related to surgical intervention, subgroup T2 consisted of
animals that died between the 4th and 29th postoperative day, and subgroup T3
consisted of animals that survived after 30 days. Transplanted animals were
evaluated in terms of surgical technique used (vascular and intestinal
anastomosis), graft quality, surgical time, and clinical parameters. The animals
that died by the 29th postoperative day were submitted to autopsy and the
remaining ones were sacrificed after 30 days. RESULT: There was a high rate of
complication of a surgical nature. Early mortality rate, i.e., mortality up to
the third postoperative day, was 54% with vascular anastomosis being the major
cause of death. Surgical time was evaluated in a restricted and homogeneous
group and showed a strong prognostic value in terms of successful
transplantation. Clinical parameters such as weight loss, reduction of
ingestion, reduction of motor activity and diarrhea were directly correlated
with acute rejection. CONCLUSION: The experimented intestinal transplant is a
procedure companied by considerable morbidity and mortality due to surgical
complications in postoperative period, vascular anastomosis and total surgical

PMID: 12184165 [PubMed]

123: Dermatol Surg.  2002 Aug;28(8):710-2; discussion 713.  

Office surgical incidents: 19 months of Florida data.

Coldiron B.


BACKGROUND: In 1999-2000 a series of sensational articles were published in the
lay media emphasizing the hazards of office surgery. Since then 31 state medical
boards or legislatures have, or are in the process of drafting regulations
restricting office procedures. OBJECTIVE: To determine the nature, incidence and
scope of injuries and deaths resulting from office procedures. METHODS:
Mandatory reporting by physicians to a neutral central agency of all office
surgical incidents that resulted in death, serious injury, or transfer to a
hospital in the State of Florida from February 2000 to September 2001. Telephone
and Internet follow up to determine reporting physician board status, hospital
privilege status, and office accreditation status. RESULTS: In 19 months there
were 43 procedure related-complications and eight deaths. Liposuction under
general anesthesia was the single most common cause of incidents and deaths.
There were no injuries or deaths reported with liposuction with tumescent
anesthesia. 50% of offices reporting incidents or deaths were accredited by an
independent accrediting agency. There were no incidents or deaths reported due
to the anesthesia when using conscious sedation anesthesia, or intramuscular
sedation or analgesia 98% of physicians reporting incidents or deaths had
hospital privileges and were board certified. Anesthesiologists or nurse
anesthetists provided all general anesthesia, and deep sedation. There were no
physicians performing procedures outside their scope of specialty training.
CONCLUSION: Liposuction under general anesthesia deserves closer scrutiny.
Office accreditation is not associated with fewer patient injuries and deaths.
Restrictions on tumescent liposuction, conscious sedation and intramuscular
sedation and analgesia would not yield any saved lives or fewer injuries since
these modes of anesthesia resulted in no injuries or deaths. Board certification
and hospital privilege requirements for office practice would have very little
effect since the vast majority of reporting physicians already had these
credentials. These data do not show an emergent hazard to patients from office
surgery This data strongly contradicts the lay media portrayal of the dangers of
office procedures. Mandatory reporting of office incidents should be strongly
supported, and this data should be available for analysis after protecting
patient confidentiality.

PMID: 12174063 [PubMed]

124: Am J Surg.  2002 Aug;184(2):97-102.  

Laparoscopic adjustable gastric banding for the treatment of morbid obesity.

Evans JD, Scott MH, Brown AS, Rogers J.

Department of Surgery, Whiston Hospital, Merseyside, UK. jimevans@doctors.org.uk

BACKGROUND: This prospective study evaluated the effectiveness and safety of
laparoscopic adjustable gastric banding (LAGB) for morbid obesity. METHODS:
Ninety-five consecutive patients (89 female; median age 38 years, range 19 to
69) underwent LAGB for morbid obesity. Median weight and body mass index were
123.2 (88.9 to 228.6) kg and 45 (32.7-76.4) kg/m(2) respectively. Significant
coexistent disease was present in 52 (55%) patients. RESULTS: Median excess
weight loss was 53% (range 96.9% to 12.1%) and 62% (range 107.5% to 32.3%) at 1
and 2 years respectively (P <0.001). Median operative time was 90 (range 35 to
285) minutes and inpatient stay 2 (range 1 to 10) days. Early complications were
seen in 17 (18%) patients most commonly nausea/vomiting or dysphagia. Late
complications were seen in 25 (26.3%) patients, most frequently vomiting or
reflux due to band slippage or pouch dilatation. There was 1 (1%) operative
death. CONCLUSIONS: LAGB is an effective operation for morbid obesity that
results in equivalent weight loss to open surgical procedures.

PMID: 12169351 [PubMed]

125: J Thorac Cardiovasc Surg.  2002 Aug;124(2):377-86.  

Fat contamination of pericardial suction blood and its influence on in vitro
capillary-pore flow properties in patients undergoing routine coronary artery
bypass grafting.

Appelblad M, Engstrom G.

Heart Center, Department of Surgery and Perioperative Science, Division of
Cardiothoracic Surgery, Umea University Hospital, S-901 85 Umea, Sweden.

OBJECTIVE: Neurologic dysfunction after cardiopulmonary bypass might be due to
arterial microembolization. Pericardial suction blood is a possible source of
embolic material. Our aim was to determine the capillary-pore flow ability of
pericardial suction blood. METHODS: Pericardial suction blood from patients
undergoing coronary bypass was collected, and pericardial suction blood and
venous blood were sampled at the end of cardiopulmonary bypass and before
reinfusion of pericardial suction blood. Pericardial suction blood was (n = 10)
or was not (n = 10) prefiltered through a 30-microm cardiotomy screen filter
before capillary in vitro analysis. Additionally, in 8 patients the plasma
viscosity was measured, and in 5 of these patients, pericardial suction blood
capillary deposits were evaluated by using a microscopy-imprint method and fat
staining. Capillary flow was tested through 5-microm pore membranes. Tested
components were plasma, plasma-eliminated whole-blood resuspension, and
leukocyte/plasma-eliminated erythrocyte resuspension. Initial filtration rate
and clogging slope expressed the blood-to-capillary interaction. RESULTS: The
plasma-flow profile of pericardial suction blood was highly impaired, with a 47%
reduction in initial filtration rate (P <.001) and a 142% steeper clogging slope
flow deceleration (P <.01). This difference was not due to a change in
pericardial suction blood viscosity, such as by free hemoglobin, which
corresponded to 5.7% of the erythrocytes. There were no differences in
resuspended whole blood or erythrocytes. The cardiotomy filter had no effect.
Microscopy suggested the presence of capillary fat deposits in pericardial
suction blood that were not seen with venous plasma (P <.05). The pericardial
suction blood volume was 458 +/- 42 mL and contained 95.6 +/- 9.3 g/L
hemoglobin. CONCLUSIONS: The pericardial suction blood plasma capillary flow
function was highly impaired by liquid fat. Pericardial suction blood hemoglobin
appears worth recovering after fat removal, despite profound hemolysis.

PMID: 12167799 [PubMed]

126: Aesthetic Plast Surg.  2002 May-Jun;26(3):193-6.  

Ultrasound-assisted lipolysis of the omentum in dwarf pigs.

Faga A, Valdatta L, Mezzetti M, Buoro M, Thione A.

Pavia, Italy. afaga@fsm.it

Successful surgical treatment of medium degree obesity by subcutaneous
liposuction has been reported in the literature. In obesity, most adipose tissue
is visceral, mainly omental, and the resection of omentum is a mutilating
procedure for the intestinal tract. Because of this, we planned to reduce
omental adipose tissue by an apparently conservative approach:
ultrasound-assisted lipolysis.The purpose of this study was to assess the
feasibility and safety of this procedure in an animal experimental model,
drawing clinical and autoptic patterns.We chose pigs because they are
functionally analogous to humans, although they store less fat in the omentum,
whose structure looks like a veil.Four male dwarf pigs were fed, since weaning,
with hyperlipidic fodder. When they were eight months old, they were operated on
under general anesthesia in our laboratory for experimental surgery. After
laparotomy, the omentum was delivered and treated with ultrasound for 1 hour.
Before and just after the sonication, biopsies were drawn from omentum and
processed for histologic findings.After 50 days, the surviving animals were
sacrificed and autopsied; specimens from omentum, liver, and spleen were
histologically processed.Two animals died during the operation, while the two
surviving animals were in good general condition.Macro and microscopic
observations demonstrated that the ultrasound can liquefy omental fat, sparing
its fibrous network in the immediate time; during the postoperative period, an
intense inflammatory reaction developed; macroscopic observation evidenced
fibrous adhesions of the omentum to the surrounding organs; the connective
tissue network was thickened and the whole omentum was twisted on itself.The
high mortality rate could be due either to the surgical learning curve or to
casualty or to lethal effects of ultrasound on the cardiac conductive system;
the inflammatory peritoneal reaction could be specifically due to ultrasound or
to surgical handling.

PMID: 12140698 [PubMed]

127: Biochim Biophys Acta.  2002 Jul 11;1583(2):133-40.  

Role of hepatic lipase and scavenger receptor BI in clearing phospholipid/free
cholesterol-rich lipoproteins in PLTP-deficient mice.

Kawano K, Qin S, Vieu C, Collet X, Jiang XC.

Department of Anatomy and Cell Biology, SUNY Downstate Medical Center, Brooklyn,
NY 11203, USA.

Phospholipid transfer protein knock-out (PLTP0) mice have defective transfer of
phospholipids (PL) from triglyceride-rich lipoproteins (TRL) into high-density
lipoproteins (HDL). In this study, we examined the role of diet, hepatic lipase
(HL) and scavenger receptor BI (SRBI) in determining the accumulation of excess
PL and free cholesterol (FC, "surface remnants") in plasma of PLTP0 mice. PL and
FC accumulated in the very low-density lipoprotein (VLDL)-LDL region of PLTP0
mice on a highly saturated, coconut oil-based diet, but not on chow or milk-fat
based Western diets. Accumulation of PL and FC was dramatically increased in
PLTP0/HL0 mice, compared to PLTP0 mice, but only on the coconut oil diet.
Turnover studies indicated that the coconut oil diet was associated with delayed
catabolism of PL of PL/FC-rich particles. Incubation of these particles with
primary hepatocytes in the presence of SRBI neutralizing antibody indicated that
SRBI was primarily responsible for removal of FC and PL on the Western diet. In
hepatocytes of coconut oil-fed mice, removal of FC and PL from these particles
by SRBI was markedly reduced, even though SRBI protein expression levels were
unchanged. These studies indicate that HL and SRBI both have major role in the
clearance of PL and FC of surface remnants in PLTP0 mice. SRBI appears to be
dysfunctional in coconut oil diet-fed animals, possibly related to changes in
hepatocyte membrane fatty acid composition.

PMID: 12117557 [PubMed]

128: Endocr Pract.  2002 May-Jun;8(3):177-83.  

Results of use of metformin and replacement of starch with saturated fat in
diets of patients with type 2 diabetes.

Hays JH, Gorman RT, Shakir KM.

Christiana Care Health Services, Inc., Cardiology Research, Newark, Delaware
19718, USA.,

OBJECTIVE: To improve glycemic control by substituting saturated fat for starch,
to identify any adverse effect on lipids masked by the extensive use of
metformin and lipid-lowering drugs, and to attempt to separate dietary effects
from effects of multiple drugs. METHODS: We undertook a retrospective review of
medical records of patients who completed 1 year of follow-up after dietary
prescription. The study subjects included 151 patients in the diet group (whose
dietary instructions included high saturated fat but starch avoidance) and 132
historical control subjects (who were allowed unlimited monounsaturated fat but
had restriction of starch in their diets). RESULTS: Hemoglobin A1c (HbA1c)
levels improved in both study groups (-1.4 +/- 0.2% [P<0.001]; 95% confidence
interval [CI], -1.9 to -0.9). Use of metformin was associated with a decrease in
HbA1c (-0.12 +/- 0.003%/mo [P<0.001]; 95% CI, -0.17 to -0.07). The diet group
had an additional decrease of -0.7 +/- 0.2% (P<0.001; 95% CI, -1.1 to -0.3).
Weight increase was associated with the use of insulin (+0.3 +/- 0.07 kg/mo
[P<0.001]; 95% CI, 0.2 to 0.5), sulfonylurea (+0.18 +/- 0.06 kg/mo [P<0.01]; 95%
CI, 0.05 to 0.30), and troglitazone (+0.7 +/- 0.2 kg/mo [P<0.005]; 95% CI, 0.3
to 1.2). Although not statistically significant, metformin therapy showed a
trend for weight loss (-0.14 +/- 0.08 kg/mo; P = 0.07). An additional weight
loss was noted in the diet group (-2.65 +/- 0.62 kg [P<0.001]; 95% CI, -3.87 to
-1.44). Hydroxymethylglutaryl-coenzyme A reductase inhibitor use was associated
with reduced total cholesterol level (-1.7 +/- 0.6 mg/dL per month [P<0.005];
95% CI, -2.9 to -0.5). The diet group had an additional decrease of -13.0 +/-
4.5 mg/dL (P<0.001; 95% CI, -21.9 to -4.1). No significant effect of the diet on
triglyceride, low-density lipoprotein, or high-density lipoprotein levels was
detected. CONCLUSION: Addition of saturated fat and removal of starch from a
high-monounsaturated fat and starch-restricted diet improved glycemic control
and were associated with weight loss without detectable adverse effects on serum

PMID: 12113629 [PubMed]

129: Arch Toxicol.  2002 Jun;76(5-6):316-25. Epub 2002 May 04. 

Severe 2,3,7,8-tetrachlorodibenzo- p-dioxin (TCDD) intoxication: kinetics and
trials to enhance elimination in two patients.

Geusau A, Schmaldienst S, Derfler K, Papke O, Abraham K.

Department of Dermatology, Division of Immunology, Allergy and Infectious
Diseases, University of Vienna, Medical School, Wahringer Gurtel 18-20, 1090
Vienna, Austria. alexandra.geusau@akh-wien.ac.at

In spring 1998, two women were diagnosed with severe 2,3,7,8-tetrachlorodibenzo-
p-dioxin (TCDD) intoxication. Over the following 3 years, TCDD levels were
monitored under various attempts to enhance its elimination, and the half-lives
were evaluated. Olestra, a non-digestible, non-absorbable dietary fat
substitute, was continuously administered to the patients either as pure
substance or in potato-chips. Additionally, in the more severely contaminated
patient, we studied whether low-density lipoprotein (LDL)-apheresis, an
extracorporeal means of blood lipid elimination, was effective in reducing the
TCDD body burden. The blood concentrations initially measured in spring 1998
were 144,000 pg/g blood fat in patient 1 and 26,000 pg/g in patient 2, the
highest levels ever measured in adults. In March 2001, concentrations in blood
fat were 35,900 and 9,500 pg/g, corresponding to overall elimination half-lives
of 560 days (1.5 years) in patient 1 and 1050 days (2.9 years) in patient 2,
which are considerably shorter than median values of 7-9 years reported for
background and moderate exposure levels. Calculations of the TCDD half-lives and
measurements of TCDD elimination via different routes allowed the calculation of
an unidentified route of elimination, representing 78 and 62% of the overall
elimination in patient 1 and 2, respectively, probably due to an induced hepatic
metabolism caused by the high TCDD exposure. As previously reported,
administration of olestra was found to be effective in increasing the fecal
excretion of TCDD. Due to the short half-lives in our patients, the effect of
olestra on the overall elimination was relatively small, but is expected to be
much greater for 'normal' half-lives. LDL-apheresis was shown to eliminate TCDD,
corresponding to the eliminated blood fat. When employed twice a week, the
amount of TCDD excreted by this method was comparable to fecal excretion. In
view of costs and time involved, LDL-apheresis does not seem to be justified for
enhancement of TCDD elimination.

Publication Types:
    Clinical Trial

PMID: 12107649 [PubMed]

130: Curr Opin Clin Nutr Metab Care.  2002 Jul;5(4):435-40.  

Preoperative nutritional support at home in head and neck cancer patients: from
nutritional benefits to the prevention of the alcohol withdrawal syndrome.

Bertrand PC, Piquet MA, Bordier I, Monnier P, Roulet M.

Nutrition Unit, University Hospital, Lausanne, Switzerland.

PURPOSE OF REVIEW: Preoperative nutritional support in severely malnourished
patients decreases complications after major surgery. This review summarizes
previous studies on head and neck cancer patients undergoing surgery, and offers
recommendations on preoperative nutritional support based on the literature and
our experience. RECENT FINDINGS: Head and neck cancer has a large impact on the
patient's quality of life and a high mortality rate. Aggressive surgical
resection followed by soft-tissue and osseous reconstruction is the gold
standard of treatment. The incidence of postoperative complications is high at
20-50%. Malnutrition and alcohol withdrawal syndrome are often present, and are
considered risk factors for developing wound infection after head and neck
cancer surgery. Proactive intervention by preoperative nutritional support may
correct nutrient deficiencies, minimize malnutrition-related morbidity and
mortality, reduce the length and cost of hospitalization, and may prevent
alcohol withdrawal syndrome. Nutritional support given preoperatively for 7-10
days decreases postoperative complications by approximately 10% in malnourished
patients with weight loss of 10% or more. Oral liquid supplements and enteral
nutrition are useful to support head and neck cancer patients preoperatively.
Enteral nutrition is safer, more physiological, less expensive and practicable
at home compared with parenteral nutrition, which is not usually indicated in
these patients. SUMMARY: Enteral nutrition is efficient in preoperative phase to
prevent postoperative complications. However evidence is insufficient to
conclude that preoperative immune-enhancing enteral feeding provides any
supplementary benefit by comparison with a standard diet. Our experience with
the preoperative approach in head and neck cancer patients is reported in this

Publication Types:
    Review, Tutorial

PMID: 12107380 [PubMed]

131: J Am Assoc Gynecol Laparosc.  2002 Aug;9(3):380-3.  

Laparoscopic retrieval of perforated intrauterine devices at University
Hospital, Jamaica.

Wynter SH, DaCosta V, Frederick J, Wynter H.

Department Obstetrics and Gynaecology, University Hospital of the West Indies,
Mona Campus, Kingston, Jamaica.

Four intraabdominal, copper, T-shaped intrauterine devices (IUDs) were retrieved
laparoscopically after the rare complication of complete perforation of the
uterine wall. After the IUDs were located by ultrasound and radiographs,
laparoscopy was performed under general anesthesia. The devices were easily
located and all procedures were uncomplicated. In two cases anterior wall
perforations with adhesion formation around the device were seen in the region
of the uterovesical fold. Two IUDs were found adjacent to bowel, one in
pararectal fat. Three surgeries were performed as day cases; the fourth patient,
a diabetic, was kept for observation for 1 day.

PMID: 12101340 [PubMed]

132: Int J Radiat Oncol Biol Phys.  2002 Jul 15;53(4):889-97.  

Preliminary results of a phase I/II study of HDR brachytherapy alone for T1/T2
breast cancer.

Wazer DE, Berle L, Graham R, Chung M, Rothschild J, Graves T, Cady B, Ulin K,
Ruthazer R, DiPetrillo TA.

Department of Radiation Oncology, New England Medical Center, Tufts University
School of Medicine, Boston, MA 02111, USA. Dwazer@lifespan.org

PURPOSE: To investigate the feasibility, toxicity, cosmetic outcome, and local
control of high-dose-rate (HDR) brachytherapy alone without whole breast
external beam irradiation for early-stage breast carcinoma. METHODS AND
MATERIALS: Between June 1997 and August 1999, 32 women diagnosed with a total of
33 AJCC Stage I/II breast carcinomas underwent surgical breast excision and
postoperative irradiation using HDR brachytherapy interstitial implantation as
part of a multi-institutional clinical Phase I/II protocol. Eligible patients
included those with T1, T2, N0, N1 (< or =3 nodes positive), and M0 tumors of
nonlobular histologic features with negative surgical margins, no extracapsular
lymph node extension, and a negative postexcision mammogram. Brachytherapy
catheters were placed at the initial excision, reexcision, or either sentinel or
full-axillary sampling. Direct visualization, surgical clips, and ultrasound
and/or CT scan assisted in the delineation of the target volume, defined as the
excision cavity plus a 2-cm margin. High-activity 192Ir (3-10 Ci) was used to
deliver 340 cGy/fraction, 2 fractions/d, for 5 consecutive days, to a total dose
of 34 Gy to the target volume. Source position and dwell times were calculated
using standard volume optimization techniques. RESULTS: The median follow-up of
all patients was 33 months, and the mean patient age was 63 years. The mean
tumor size was 1.3 cm, and 55% had an extensive intraductal component. Three
patients had positive axillary nodes. Two patients experienced moderate
perioperative pain that required narcotic analgesics. No peri- or postoperative
infections occurred. No wound healing problems and no significant skin reactions
related to the implant developed. The Radiation Therapy Oncology Group late
radiation morbidity scoring scheme was applied to the entire 33-case cohort. In
the assessment of the skin, 30 cases were Grade 0-1 and 3 cases were Grade 2.
Subcutaneous toxicity was scored as 11 patients with Grade 0, 3 with Grade 1, 8
with Grade 2, 3 with Grade 3, and 8 with Grade 4. Clinically evident fat
necrosis occurred in 8 patients at a median of 7.5 months after HDR
brachytherapy completion. The only variables significantly associated with Grade
3-4 toxicity were the number of source dwell positions and the volume of tissue
encompassed by the prescription isodose shell. The global cosmetic scores after
a minimum of 18 months' follow-up were 0 cases with poor, 4 with fair, 5 with
good, and 24 with excellent scores. One case of ipsilateral breast tumor
recurrence was diagnosed 23 months after HDR brachytherapy, for a 4-year
actuarial recurrence rate of 3%. This failure appeared to be a new primary
tumor, because it was histologically distinct from the initial tumor and was
located 9 cm from the initial tumor bed and 3 cm from the edge of the implant
volume. CONCLUSION: Radiotherapy of the tumor bed alone with HDR interstitial
brachytherapy is associated with a 33% incidence of Grade 3-4 s.c. toxicity, but
with generally favorable overall cosmetic results. The risk of toxicity appears
to be primarily related to the implant volume. With limited follow-up, the
incidence of ipsilateral breast tumor recurrence was low.

Publication Types:
    Clinical Trial
    Clinical Trial, Phase I
    Clinical Trial, Phase II

PMID: 12095554 [PubMed]

133: Obes Surg.  2002 Jun;12(3):354-7.  

Apolipoprotein-E genotype and the risk of developing cholelithiasis following
bariatric surgery: a clue to prevention of routine prophylactic cholecystectomy.

Abu Abeid S, Szold A, Gavert N, Goldiner I, Grynberg E, Peretz H, Konikoff FM.

Tel-Aviv Sourasky Medical Center, Minerva Center for Cholesterol Gallstones and
Lipid Metabolism in the Liver, Sackler Faculty of Medicine, Tel Aviv University,
Israel. dr_subhi@tasmc.health.gov.il

BACKGROUND: Obesity and especially rapid weight loss following bariatric surgery
are known risk factors for cholelithiasis. Since the risk may be high,
prophylactic cholecystectomy has been advocated. Apolipoprotein (Apo) E, an
important carrier protein in cholesterol metabolism and trafficking, is believed
to play a role in gallstone pathogenesis. In particular, the Apo E4 allele has
been suggested to be associated with cholesterol cholelithiasis. The aim of this
study was to assess the incidence of postoperative cholelithiasis in our patient
population and to determine a possible correlation with the Apo-E genotype.
METHODS: 134 morbidly obese patients undergoing gastric restrictive surgery
[laparoscopic assisted gastric banding (LAGB) or silastic ring vertical
gastroplasty (SRVG)] had abdominal ultrasound before and 6 to 12 months after
operation, to determine the presence of gallstones. None of the patients
enrolled in the study had gallstones before surgery. They did not have a
prophylactic cholecystectomy or receive bile salt treatment. Apo-E genotypes
were determined by Polymerase Chain Reaction restriction enzyme analysis.
RESULTS: 10 patients (7.5%) developed postoperative cholelithiasis. The
incidence of cholelithiasis in each ApoE genotype was: E2/E3--1/20 (5%),
E3/E3--3/91 (3%), E3/E4--6/21 (29%), and E4/E4--0/2. ApoE allele frequencies in
the study population were identical to those of a healthy control population.
The mean BMI dropped from 43.6 to 29.4 kg/m2. CONCLUSIONS: The occurrence of
postoperative gallstones was low in our population. However, in subjects with
the Apo-E3/E4 genotype, the incidence is of practical significance. These data
suggest that Apo-E genotyping may be useful in selecting patients for gallstone
prevention (surgical or medical) when undergoing bariatric surgery. Further
testing in larger patient populations may be able to give more definite
guidelines in the future.

PMID: 12087994 [PubMed]

134: Obes Surg.  2002 Jun;12(3):408-11.  

Laparoscopic Roux-en-Y gastric bypass for severe gastroesophageal reflux after
vertical banded gastroplasty.

Bloomberg RD, Urbach DR.

Minimally Invasive Surgery Program, Toronto Western Hospital, Department of
Surgery, University of Toronto, Toronto, ON, Canada.

BACKGROUND: Vertical banded gastroplasty (VBG) is sometimes associated with
complications such as pouch obstruction, dilatation, and gastroesophageal
reflux. This occasionally requires surgical revision, in many cases to a
Roux-en-Y gastric bypass (RYGBP). CASE REPORT: A 47-year-old woman with severe
obesity developed severe symptoms of stenosis of the pouch outlet and
gastroesophageal reflux 15 years after VBG. Laparoscopic conversion to a RYGBP
was performed. At 9-month follow-up, she lost an additional 32 kg and had
complete resolution of her reflux. CONCLUSION: In this patient, laparoscopic
re-operative RYGBP produced additional weight loss, and improved
gastroesophageal reflux that occurred many years after having a VBG.
Laparoscopic conversion of a VBG to RYGBP is feasible, and may confer the
benefits of other minimally invasive abdominal procedures to this high-risk
patient group.

Publication Types:
    Case Reports

PMID: 12082898 [PubMed]

135: Obes Surg.  2002 Jun;12(3):391-4.  

Laparoscopic adjustable esophagogastric banding: preliminary results.

Capizzi FD, Boschi S, Brulatti M, Cuppini A, Di Domenico M, Fogli L, Papa V,
Patrizi P.

Department of General Surgery, Bellaria Hospital, Via Altura, 3, 40139, Bologna,

BACKGROUND: Laparoscopic gastric banding is effective in surgical treatment of
morbid obesity, but has had the drawback of specific complications, like
slippage and gastric erosion. To prevent such complications, modifications have
been used, including high retrogastric positioning above the bursa omentalis,
complete anterior fixation by gastro-gastric stitches over the band, and
reduction of the pouch volume to < or = 15 ml. These technical variants may
induce dysphagia. METHODS: We adopted a different technique, consisting of
placement of the band (9.75 cm BioEnterics Lap-Band) around the esophagus just
above the cardia, to induce an amplification of the dysphagic mechanism. No
fixation stitches were used. RESULTS: From January 1999 to March 2001, 80
consecutive patients (16 males, 64 females, mean age 41 years, average BMI 45)
were operated this way. All operations were completed laparoscopically. However,
in 1 patient the procedure had to be interrupted for bleeding from a large fatty
liver injury by the retractor. Complications included 2 cases of slippage: an
early one after 24 h, requiring surgical removal, and a late one after 9 months,
treated by laparoscopic repositioning. The third complication, a reactive
esophageal stenosis, occurred in a transsexual male on estrogen treatment, that
needed replacement with a wider Swedish band. Band adjustment was required in 28
patients, one time in 22 cases and twice in the other 6. Mean BMI decreased from
45 to 38 after 6 months, remaining at 37 after 24 months, while excess weight
was reduced by 50% at 24 months. CONCLUSIONS: The technique has a re-educational
function, in that patients are induced to chew thoroughly, to introduce small
morsels of food and to prolong the mastication time, in order to avoid
dysphagia. Laparoscopic adjustable esophagogastric banding gave no problem if
well positioned, and promoted new alimentary habits through a dysphagic
mechanisms, inducing significant excess weight loss.

Publication Types:
    Clinical Trial

PMID: 12082894 [PubMed]

136: Obes Surg.  2002 Jun;12(3):385-90.  

Laparoscopic banding: selection and technique in 830 patients.

Favretti F, Cadiere GB, Segato G, Himpens J, De Luca M, Busetto L, De Marchi F,
Foletto M, Caniato D, Lise M, Enzi G.

Obesity Center, University of Padova, Padova, Italy. ffavret@tin.it

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) with the Lap-Band has
been our first choice operation for morbid obesity since September 1993. Results
in terms of complications and weight loss are analyzed. METHODS: 830 consecutive
patients (F 77.9%) underwent LAGB. Initial body weight was 127.9 +/- SD 23.9 kg,
and body mass index (BMI) was 46.4 +/- 7.2 kg/m2. Mean age was 37.9 (15-65).
Steps in LAGB were: 1) establishment of reference points for dissection (equator
of the balloon inflated with 25 cc air and left crus); 2) creation of a
retrogastric tunnel above the bursa omentalis; 3) creation of "virtual" pouch;
4) embedding the band. RESULTS: Mortality was 0, conversion 2.7%, and follow-up
97%. Major complications requiring reoperation developed in 3.9% (36 patients).
Early complications were 1 gastric perforation (requiring band removal) and 1
gastric slippage (requiring repositioning). Late complications included 17
stomach slippages (treated by band repositioning in 12 and band removal in 5), 9
malpositions (all treated by band repositioning), 4 gastric erosions by the band
(all treated by band removal), 3 psychological intolerance (requiring band
removal), and 1 HIV positive (band removed). A minor complication requiring
reoperation in 91 patients (11%) was reservoir leakage. 20% of patients who had
% excess weight loss < 30 had lost compliance to dietetic, psychological and
surgical advice. BMI declined significantly from the initial 46.4 +/- 7.2 to
37.3 +/- 6.8 at 1 year, 36.4 +/- 6.9 at 2 years, 36.8 +/- 7.0 at 3 years, and
36.4 +/- 7.8 at 5 years. CONCLUSION: LAGB is a relatively safe and effective

PMID: 12082893 [PubMed]

137: Obes Surg.  2002 Jun;12(3):380-4.  

Laparoscopic adjustable gastric banding at a U.S. center with up to 3-year

Rubenstein RB.

State University of New York at Stony Brook, NY, USA. msr018@aol.com

BACKGROUND: We present our results from the "B" trial (the 2nd U.S. FDA-approved
clinical trial) with the laparoscopic adjustable gastric band (LAGB) or Lap-Band
System, regarding weight loss, complications, and effect on co-morbidities with
up to 3-year follow-up. METHODS: Between March 1999 and June 2001, 63 morbidly
obese patients underwent LAGB following accepted ASBS/SAGES guidelines and
protocol requirements. All bands were placed via the classic high peri-gastric
dissection above the lesser sac, corresponding to the equator of the
calibration-tube balloon. Frequent follow-up by a multidisciplinary program was
maintained. RESULTS: All procedures were performed laparoscopically with no
conversion to laparotomy. Operative time decreased from a mean of 197 minutes
for the first 10 patients to 120 minutes for the last group. Average hospital
stay was 1.4 days. Perioperative complications included 1 intraoperative gastric
perforation, which was closed and did not prevent band placement, and 5 port
problems. Gastric slippage occurred in 9 patients (14.2%), 3 of whom were
revised to a gastric bypass and 6 who had the band removed. Three additional
bands were removed due to infection (1), band erosion (1) and a cluster of
gastric symptoms (1). Percent excess weight loss averaged 27.2 at 6 months
(range 1-68), 38.3 at 1 year (range 10-77), 46.6 at 2 years (range 16-89), and
53.6 at 3 years (range 21-94). Before surgery, 46 of 63 patients (73%) suffered
from a serious comorbidity. Following LAGB, all categories showed marked
improvement. CONCLUSIONS: In this study up to 3 years, LAGB provided a safe and
sustainable weight loss. Significant resolution of serious co-morbidities was
common. A U.S. bariatric practice achieved results comparable to those in the
international literature. The primary requisites to achieve optimal results
include careful patient selection, the refined surgical technique, and a
comprehensive long-term patient management program.

Publication Types:
    Clinical Trial

PMID: 12082892 [PubMed]

138: Obes Surg.  2002 Jun;12(3):328-34.  

A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit.

Chaves LC, Faintuch J, Kahwage S, Alencar Fde A.

Obesity Surgery Group, Hospital Ofir Loyola, Belem, Para, Brazil.

BACKGROUND: Wernicke-Korsakoff syndrome and peripheral neuropathy are very
uncommon in bariatric surgical practice. The literature indicates that these
complications tend to strike patients receiving unbalanced diets or undergoing
rapid weight-loss. METHODS: In a retrospective analysis of the initial
experience of a bariatric team in the city of Belem, Para, in northern Brazil, 5
cases were diagnosed in the first year, 4 of them following gastric bypass and
the last one after therapy with an intragastric balloon. RESULTS: All episodes
followed periods of severe vomiting, which certainly interfered with intake of
food as well as of routine vitamin supplements, resulting in severe
polyneuropathy and other neurologic manifestions, mostly damaging motility of
lower limbs. Therapy consisted of pharmacologic doses of vitamin B1 along with
restoration of adequate diet and multivitamin prescriptions. Physical therapy
was employed to prevent atrophy and accelerate normalization of muscle strength.
All patients responded to this program after variable intervals without
significant sequelae. CONCLUSIONS: Thiamine-related neurologic derangements were
a cause for much concern and prolonged morbidity in this series, but responded
to vitamin B1 replenishment. A high degree of clinical suspicion in bariatric
patients and urgent therapeutic intervention whenever postoperative vomiting
persists for several days, especially during the first 2-3 months after
operation, are the safest approach to these uncommon episodes. It is speculated
whether peculiarities in the regional diet of this area in Brazil could have
influenced the high incidence of the neurologic aberrations.

PMID: 12082882 [PubMed]

139: Toxicon.  2002 Jul;40(7):851-6.  

Gossypol, a component in cottonseed, induced increases in cytosolic Ca2+ levels
in Chang liver cells.

Cheng JS, Liu CP, Lo YK, Chou KJ, Lin MC, Su W, Law YP, Chou KJ, Wang JL, Chen
WC, Jan CR.

Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta Chung 1st
Road, Taiwan.

The effect of gossypol, a compound found in cottonseed, on intracellular free
Ca2+ levels ([Ca2+](i)) in Chang liver cells were evaluated using fura-2 as a
fluorescent Ca2+ indicator. Gossypol (0.2-5microM) increased [Ca2+](i) in a
concentration-dependent manner with an EC(50) value of 1.5microM. The [Ca2+](i)
response was composed of an initial rise and a slow decay to a sustained phase
within 5min after drug application. Removal of extracellular Ca2+ markedly
reduced the [Ca2+](i) signals by 80+/-2%. Preincubation with 0.1mM La3+ or
10microM nimodipine abolished the Ca2+ influx. Gossypol (5microM)-induced
release of intracellular Ca2+ was reduced by 75% by pretreatment with 1microM
thapsigargin (an endoplasmic reticulum Ca2+ pump inhibitor) to deplete the
endoplasmic reticulum Ca2+. Conversely, pretreatment with gossypol abolished
thapsigargin-induced Ca2+ release. After pretreatment with 5microM gossypol in
Ca2+-free medium for several min, addition of 3mM Ca2+ induced a [Ca2+](i)
increase of a magnitude nine-fold greater than control. Gossypol
(5microM)-induced Ca2+ release was not affected by inhibiting phospholipase C
with 2microM
ione (U73122). Together, this study shows that gossypol induced significant
[Ca2+](i) increases in Chang liver cells by releasing Ca2+ from intracellular
pools in a phospholipase C-dissociated fashion and by causing La3+- and
nimodipine-sensitive Ca2+ influx.

PMID: 12076637 [PubMed]

140: Surgery.  2002 Jun;131(6):625-9.  

Lap-band failures: conversion to gastric bypass and their preliminary outcomes.

Kothari SN, DeMaria EJ, Sugerman HJ, Kellum JM, Meador J, Wolfe L.

Medical College of Virginia of Virginia Commonwealth University, Department of
Surgery, Richmond 23298, USA.

BACKGROUND: The LAP-BAND is designed to be an adjustable laparoscopically placed
gastric restriction device for the treatment of severe obesity. The purpose of
this study was to assess the outcome in patients who had failed to effectively
lose weight with this device and were converted to a gastric bypass. METHODS: A
retrospective chart review was performed of all LAP-BANDS placed in patients at
our institution from March 1996 to June 1998. RESULTS: 36 LAP-BANDS were placed.
To date, 18 of 36 (50%) have been removed. Fourteen of 18 were simultaneously
converted to a gastric bypass. Indications for conversion included: failed
weight loss (5), failed weight loss with esophageal dilatation (5), failed
weight loss with leaking band (2), and symptomatic esophageal dilatation (1).
Median time to conversion after LAP-BAND placement was 38.2 months. Median
follow-up after conversion to gastric bypass was 8.3 months. Nineteen percent
excess weight loss occurred after LAP-BAND placement. Forty-three percent excess
weight loss occurred after conversion to gastric bypass (P =.025). CONCLUSIONS:
In our experience, the LAP-BAND is associated with a high frequency of
inadequate weight loss. Conversion to gastric bypass in this subset of patients
is technically challenging but results in superior weight loss in a shorter time

PMID: 12075174 [PubMed]

141: Surg Endosc.  2002 Sep;16(9):1362-3. Epub 2002 Jun 20. 

Laparoscopic pancreas-preserving distal duodenectomy for duodenal stricture
related to nonsteroidal antiinflammatory drugs (NSAIDs).

Ammori BJ.

Royal Gwent Hospital, Newport, Gwent, United Kingdom NP20 2UB. Bammori@aol.com

BACKGROUND: Chronic ingestion of nonsteroidal antiinflammatory drugs (NSAIDs)
has rarely been associated with the development of intestinal diaphragm-like
strictures. We have explored the role of laparoscopic surgery for the management
of NSAID-related long distal duodenal strictures. METHOD: A 49-year-old woman
had been on NSAID therapy (ibuprofen) for backache more than 2 years. She showed
symptoms of gastric outlet obstruction and gastrointestinal blood loss, and
investigations showed a long stricture in the third and fourth parts of the
duodenum. She underwent a laparoscopic pancreas-preserving distal duodenectomy
with duodenojejunal anastomosis. RESULT: Relaparoscopy on postoperative day 1
for bleeding showed no active source of bleeding. The patient's subsequent
recovery was uneventful, and she was discharged on postoperative day 4. Further
symptomatic strictures developed 2 months later at the previously ulcerated
pylorus and distal duodenal bulb and were managed by a laparoscopic Roux-en-Y
gastrojejunostomy. The patient was discharged on postoperative day 3, but
represented 2 months later with symptomatic stenosis at the gastrojejunostomy
which was managed by a laparoscopic revision gastrojejunostomy. Discharged on
the postoperative day 2, she had regained weight and remained symptom free at
follow-up assessment 3 months later. CONCLUSION: Laparoscopic
pancreas-preserving distal duodenectomy for the management of benign duodenal
strictures is feasible and safe. Moreover, we have demonstrated the beneficial
role of relaparoscopy for the management of postoperative complications and for
revision surgical procedures.

Publication Types:
    Case Reports

PMID: 12072993 [PubMed]

142: J Forensic Sci.  2002 Jan;47(1):205-7.  

Comment in:
    J Forensic Sci. 2003 Mar;48(2):471.
    J Forensic Sci. 2003 May;48(3):697.

Deaths associated with liposuction: case reports and review of the literature.

Platt MS, Kohler LJ, Ruiz R, Cohle SD, Ravichandran P.

Summit County Medical Examiner's Office, Akron, OH 44308, USA.

Tumescent liposuction is a common cosmetic procedure that is performed as an
outpatient service in physician's offices and is largely believed to be safe.
The protuberant areas of the body containing the undesirable fat deposits are
injected with normal saline containing lidocaine and epinephrine for pain
control and hemostasis, and the waterlogged cells are suctioned out via cannula
through a small incision. We recently encountered three cases in which deaths
were attributed to this procedure. Two showed fat embolization in the lung and
one died from fluid overload. The osmium tetroxide post-fixed lung sections
showed fat emboli in the interstitial capillaries and arterioles. We reviewed
the recent literature and found that pulmonary thromboemboli, fat embolization,
fluid overload, and lidocaine and epinephrine intoxication are found at autopsy
in many cases. Forensic pathologists responsible for determining the cause and
manner of death should become familiar with the postmortem findings and risks of
liposuction therapy and communicate them to their clinical colleagues and

Publication Types:
    Case Reports
    Review, Tutorial

PMID: 12064654 [PubMed]

143: AORN J.  2002 May;75(5):956, 959-61, 963-4 passim; quiz 980-3, 985-6.  

Outpatient laparoscopic Nissen fundoplication.

Todd S, Corsnitz D, Ray S, Nassar J.

Surgical Physicians, Advanced Laparoscopic Surgery, Harrisburg, Pa., USA..

Gastroesophageal reflux disease affects more than 40% of Americans, causing
heartburn and reflux of gastric contents into the esophagus when bending or
lying down. Lifestyle modification, such as weight loss and a diet rich in
protein and low in fat and glucose, should increase the patient's resting lower
esophageal sphincter pressure. Avoiding exacerbating substances, such as mint,
chocolate, alcohol, and tobacco, also may reduce symptoms. Medications may be
prescribed to reduce persistent symptoms, although no medication currently
available cures the disease process. Patients who need antireflux medication
regularly for four to six weeks or more may be candidates for laparoscopic
Nissen fundoplication. Patients who do not want to take antireflux medication
for the rest of their lives, cannot afford the medication for an extended period
of time, or suffer significant side effects from the medication also are
candidates. This article describes performing Nissen fundoplication
laparoscopically on an outpatient basis. The average length of hospital stay has
been decreased to two to three hours when performed laparoscopically on an
outpatient basis from 10 days for the open procedure and two to three days when
performed laparoscopically on an inpatient basis. The incidence of recurrent
heartburn is less than 2% when the procedure is performed laparoscopically and
does not appear to be clinically significant.

Publication Types:
    Case Reports
    Review, Tutorial

PMID: 12063945 [PubMed]

144: Eur J Radiol.  2002 Apr;42(1):40-51.  

Histological findings in surgical specimens after core biopsy of the breast.

Tardivon AA, Guinebretiere JM, Dromain C, Deghaye M, Caillet H, Georgin V.

Department of Radiology, Institut Gustave-Roussy, 39 rue Camille Desmoulins,
94805 Cedex, Villejuif, France. tardivon@igr.fr

Pathological changes induced by needling procedures found in breast surgical
specimens are rare but can induce misinterpretation or compromise the definitive
histological analysis. These abnormal findings depend on the interval between
the core biopsy and excision. Early findings are local haemorrhage, disrupted
tissue and epithelial cell displacement, whereas, fibrosis, fat necrosis and
inflammatory reaction are observed later in time. The radiologists must be aware
of these histological pitfalls and must consider the benefits of their core
biopsies (indications, surgeon's question, number of samples).

Publication Types:
    Review, Tutorial

PMID: 12039019 [PubMed]

145: Croat Med J.  2002 Jun;43(3):306-11.  

Survival of primary arteriovenous fistula in 463 patients on chronic

Puskar D, Pasini J, Savic I, Bedalov G, Sonicki Z.

Department of Urology, Dubrava University Hospital, Avenija Gojka Suska 6, 10000
Zagreb, Croatia. damir.puskar@zg.tel.hr

AIM: To assess the survival of the primary arteriovenous fistula created for
dialysis in 463 chronic hemodialysis patients, because the main causes of
morbidity among such patients are associated with vascular access-related
complications. METHOD: We analyzed 269 (58%) men and 194 (42%) women with median
age of 58 years (range 12-83), who underwent 0-14,784 (median 1,584) hours of
hemodialysis. Data analyzed were age, gender, body weight loss during
hemodialysis session, smoking habits, cause of renal failure, diabetes,
myocardial infarction, stroke, malignant neoplasm, arterial hypertension or
hypotension, drugs (salicylates, dipyridamole, coumarin anticoagulants, heparin,
oral antidiabetics, insulin), number of hemodialysis sessions and hours of
hemodialysis per week, fistula location, platelet count, hematocrit, institution
in which the fistula had been created, and dialysis center where the fistula had
been used. Kaplan-Meier and univariate analysis (Mantel-Cox and generalized
Wilcoxon test) with 0.05 statistical significance were used for data analysis,
and the outcome of the fistula survival was determined with logistic regression.
RESULTS: Out of 597 patients with primary arteriovenous fistula, 134 patients
were lost to follow-up. In the remaining 463 patients the fistula survival was
73%, 63%, 52%, 44%, 36%, 10%, 3%, and <1% after 1, 2, 3, 4, 5, 10, 15, and 20
years, respectively. Factors affecting the survival of arteriovenous fistula
were administration of heparin (p=0.004) and dipyridamole (p=0.012),
hemodialysis-dependent hypotension (p=0.045), diabetes (p=0.009), presence of
malignant neoplasm (p=0.003), institution in which the fistula had been created
(p<0.001) or used (p=0.037), hours of hemodialysis per week (p=0.023), and
number of hemodialysis sessions per week (p=0.007). CONCLUSION: Primary
arteriovenous fistula survival was shorter in end-stage renal disease patients
with diabetes, hypotension, who underwent less than 3 hemodialysis sessions (<12
h) per week without heparin administration. Insufficient surgical experience,
dipyridamole administration, and concomitant neoplasm contributed to
arteriovenous fistula failure.

PMID: 12035137 [PubMed]

146: Surgery.  2002 May;131(5):484-90.  

Morbidity and mortality of gastrectomy for cancer in Department of Veterans
Affairs Medical Centers.

Grossmann EM, Longo WE, Virgo KS, Johnson FE, Oprian CA, Henderson W, Daley J,
Khuri SF.

Department of Surgery, Saint Louis University School of Medicine and the St
Louis VA Medical Center, MO 63110-0250, USA.

BACKGROUND: The purpose of this study was to define risk factors that predict
30-day morbidity and mortality after gastrectomy for cancer in Veterans Affairs
(VA) Medical Centers. METHODS: The VA National Surgical Quality Improvement
Program prospectively collected data on 708 patients undergoing gastrectomy for
cancer in 123 participating VA medical centers from 1991 to 1998. Independent
variables included 68 preoperative patient characteristics and 12 intraoperative
variables; the dependent variables were 21 defined adverse outcomes and death.
Predictive models for 30-day morbidity and mortality were constructed by using
stepwise logistic regression analysis. RESULTS: The 30-day morbidity rate was
33.3% (236 of 708). The overall 30-day mortality rate was 7.6% (54 of 708).
Significant positive predictors of morbidity (P <.05) included current
pneumonia, American Society of Anesthesiologists class IV (threat to life),
partially dependent functional status, dyspnea on minimal exertion, preoperative
transfusion, extended operative time, and increasing age. Significant positive
predictors of mortality (P <.05) included do not resuscitate status, prior
stroke, intraoperative transfusion, preoperative weight loss, preoperative
transfusion, and elevated preoperative alkaline phosphatase level. CONCLUSIONS:
Risk factors predicting morbidity and mortality rates at VA hospitals after
gastrectomy for gastric cancer are reported by using a prospectively collected,
multi-institutional database. Assigning relative weights to factors associated
with adverse outcomes may help improve patient care.

PMID: 12019399 [PubMed]

147: Clin Infect Dis.  2002 Jun 1;34(11):1500-7. Epub 2002 May 10. 

An outbreak of Mycobacterium chelonae infection following liposuction.

Meyers H, Brown-Elliott BA, Moore D, Curry J, Truong C, Zhang Y, Wallace Jr RJ.

County of Orange Health Care Agency/Public Health, Santa Ana, CA, 92706, USA.

Among 82 patients who underwent liposuction performed by a single practitioner
in a 6-month period, 34 (41%) developed cutaneous abscesses. An organism
identified as Mycobacterium chelonae by polymerase chain reaction
restriction-enzyme analysis was recovered from cultures of samples from 12 of
those patients. DNA large restriction-fragment pattern analysis by pulsed-field
gel electrophoresis demonstrated that a strain of M. chelonae recovered from
biofilm in the piped-water system in one of the physician's offices differed by
only 2 restriction fragments from the 12 patient isolates, which differed from
each other by 0 or 1 restriction fragment. A detailed retrospective cohort study
that included interviews with former employees and statistical analysis of risk
factors indicated that inadequate sterilization and rinsing of surgical
equipment with tap water were likely sources of mycobacterial contamination.
This is the first reported outbreak of nosocomial infection due to M. chelonae
in which a source has been identified and the first to occur in association with
liposuction in patients in the United States.

PMID: 12015697 [PubMed]

148: Skin Res Technol.  2002 Feb;8(1):19-22.  

The influence of body mass index on skin susceptibility to sodium lauryl

Loffler H, Aramaki JU, Effendy I.

Department of Dermatology, University of Marburg, Germany.

BACKGROUND: The influence of nutrition on the physiological functions of man is
well studied. Numerous diseases can be exacerbated by obesity. However, it has
not yet been determined whether body weight and body mass index (BMI), as an
indicator of a high body fat store, can influence skin sensitivity. OBJECTIVE:
This study investigates the correlation between body mass index and the
epidermal functions, evaluated by bioengineering methods, before and after an
irritant patch test with sodium lauryl sulphate (SLS). METHODS: Epidermal
functions were evaluated using an evaporimeter, chromameter and
laser-Doppler-flowmeter. Patch testing was conducted for 48 h with two different
concentrations of SLS (0.25% and 0.5%) on the forearms of healthy volunteers.
Measurements were performed 24h after patch removal. RESULTS: Obese individuals
showed significantly increased transepidermal water loss (TEWL), skin blood flow
and skin colour (red) as compared to a control group. However, the degree of
skin sensitivity to SLS was not correlated with BMI. CONCLUSION: Basal
biophysical parameters of the skin are primarily correlated with the BMI. This
may be caused by obesity-induced physiological changes, e.g. increased sweat
gland activity, high blood pressure and physiological temperature-regulating
system. The epidermal barrier function, as evaluated after SLS patch testing is,
however, not correlated with a high BMI, indicating a normal skin barrier.

Publication Types:
    Clinical Trial
    Controlled Clinical Trial

PMID: 12005116 [PubMed]

149: Plast Reconstr Surg.  2002 May;109(6):2141-5.  

Long-term results of surgical correction of postliposuction contour

Chang KN.

California Pacific Medical Center and Division of Plastic and Reconstructive
Surgery, University of California-San Francisco, USA. kningchang@hotmail.com

Publication Types:
    Case Reports

PMID: 11994627 [PubMed]

150: Ugeskr Laeger.  2002 Apr 8;164(15):2049-50.  

[Recommendations from the Danish Society of Plastic and Reconstructive Surgery
and its quality assurance committee]

[Article in Danish]

Alsbjorn B, Siemssen S, Tei T.

PMID: 11985008 [PubMed]

151: Eur J Dermatol.  2002 May-Jun;12(3):219-23.  

Current therapeutic strategies for hyperhidrosis: a review.

Togel B, Greve B, Raulin C.

University Dermatological Clinic, Heidelberg, Germany.

Overproduction of sweat by the exocrine sweat glands is called hyperhidrosis. It
is differentiated into two forms - a localised (e.g. axillary, palmar and
plantar hyperhidrosis) and a generalised form that affects the entire skin.
Patients with increased sweat production often suffer from enormous psychosocial
stress because they are restricted in both their private and professional lives.
If the hyperhidrosis is not caused by a primary disease (e.g. hyperthyroidism or
phaeochromocytoma) that can be treated, with elimination of the sweating
problem, then only symptomatic treatment is possible. For axillary
hyperhidrosis, local application of aluminium chloride seems to be the method of
choice; an alternative is botulinum toxin whose efficacy for 3 to 9 months is an
advantage. Surgical options should not be considered until conservative methods
have failed. Curettage with a scraper and liposuction are reliable and safe
treatments for axillary hyperhidrosis. The method of choice in treating
palmoplantar hyperhidrosis is tap water iontophoresis. Adding anticholinergic
substances to the water produces a more rapid therapeutic success that also
lasts longer. Botulinum toxin can be an effective and promising alternative.
Surgical treatment, i.e. sympathectomy, does bring about a long-term resolution
of the problem, but should only be considered in well-justified cases because of
the highly invasive character of the procedure. The use of systemic
anticholinergic medication for patients with localised or generalised tendency
to sweat can be tried, but is often limited because of the profile of adverse
effects. It can be stated that in spite of the interesting and promising new
alternatives, especially using botulinum toxin, the tried-and-true procedures
such as tap water iontophoresis and aluminium chloride salts still have a firm
place in the treatment of hyperhidrosis.

Publication Types:
    Review, Tutorial

PMID: 11978559 [PubMed]

152: J Biol Chem.  2002 Jun 28;277(26):23525-33. Epub 2002 Apr 25. 

Hypercholesterolemia promotes a CD36-dependent and endothelial nitric-oxide
synthase-mediated vascular dysfunction.

Kincer JF, Uittenbogaard A, Dressman J, Guerin TM, Febbraio M, Guo L, Smart EJ.

University of Kentucky Medical School, Department of Physiology, Lexington,
Kentucky 40536, USA.

Numerous studies have implicated either the presence or absence of CD36 in the
development of hypertension. In addition, hypercholesterolemia is associated
with the loss of nitric oxide-induced vasodilation and the subsequent increase
in blood pressure. In the current study, we tested the hypothesis that
diet-induced hypercholesterolemia promotes the disruption of agonist-stimulated
nitric oxide generation and vasodilation in a CD36-dependent manner. To test
this, C57BL/6, apoE null, CD36 null, and apoE/CD36 null mice were maintained on
chow or high fat diets. In contrast to apoE null mice fed a chow diet, apoE null
mice fed a high fat diet did not respond to acetylcholine with a decrease in
blood pressure. Caveolae isolated from in vivo vessels did not contain
endothelial nitric-oxide synthase and were depleted of cholesterol. Age-matched
apoE/CD36 null mice fed a chow or high fat diet responded to acetylcholine with
a decrease in blood pressure. The mechanism underlying the vascular dysfunction
was reversible because vessels isolated from apoE null high fat-fed mice
regained responsiveness to acetylcholine when incubated with plasma obtained
from chow-fed mice. Further analysis demonstrated that the plasma low density
lipoprotein fraction was responsible for depleting caveolae of cholesterol,
removing endothelial nitric-oxide synthase from caveolae, and preventing nitric
oxide production. In addition, the pharmacological removal of caveola
cholesterol with cyclodextrin mimicked the effects caused by the low density
lipoprotein fraction. We conclude that the ablation of CD36 prevented the
negative impact of hypercholesterolemia on agonist-stimulated nitric
oxide-mediated vasodilation in apoE null mice. These studies provide a direct
link between CD36 and the early events that underlie
hypercholesterolemia-mediated hypertension and mechanistic linkages between CD36
function, nitric-oxide synthase activation, caveolae integrity, and blood
pressure regulation.

PMID: 11976335 [PubMed]

153: Obes Surg.  2002 Apr;12(2):280-4.  

Laparoscopic adjustable gastric banding: surgical and radiological approach.

Zacharoulis D, Roy-Chadhury SH, Dobbins B, Kumar H, Goutzamani E, Boyle CJ,
Sedman PC, Royston CM.

Department of Upper GI Surgery, Hull Royal Infirmary, Anlaby Road, East
Yorkshire HU3 2JZ, UK.

BACKGROUND: The laparoscopically-placed adjustable gastric band (LAGB) is a
minimally invasive, adjustable and completely reversible operation. We report 3
years experience. METHODS: Between May 1998 and January 2001, we operated on a
consecutive series of 50 patients (8 male/42 female). Mean age of patients was
37 years (30-48). Mean preoperative BMI was 43 kg/m2 (range 38-55). RESULTS:
Mean operative time was 130 minutes (range 75-150), and the conversion rate was
6%. Mean hospital stay was 2.8 days (range 2-10). Postoperatively 7/50 (14%) of
patients had dysphagia and subsequently 2 (4%) developed gastric pouch
dilatation. 2/50 (4%) had non-fatal pulmonary embolism and 2/50 (4%) developed
gastroesophageal reflux. Overall morbidity was 32%. There has been no mortality.
6 weeks postoperatively, patients had adjustment of the band by the
radiologists. Follow-up has been up to 30 months. Mean excess weight loss at 6
months was 30% (range 26-35%, N = 50), at 12 months 52% (range 44-55%, N = 42),
at 24 months 60% (range 55-65%, N = 14) and at 30 months 62% (range 58-64%, N =
8). 5 patients have reached their ideal body weight. CONCLUSIONS: LAGB is safe
and effective, even early in the learning curve. The radiologist plays a
distinct role. A multi-disciplinary team approach is essential for optimal
results. Long-term results are pending.

PMID: 11975229 [PubMed]

154: Obes Surg.  2002 Apr;12(2):261-4.  

Outcome of gastric bypass patients.

Holzwarth R, Huber D, Majkrzak A, Tareen B.

University of North Dakota School of Medicine and Health Sciences, Grand Forks,

BACKGROUND: The authors analyzed previously studied outcomes of Roux-en-Y
gastric bypass (RYGBP), examined pre-surgical factors of post-surgical outcomes,
and examined some of the psychosocial benefits. METHODS: A retrospective chart
review was conducted of 138 patients who underwent RYGBP between 1997 and 2000.
Pre-surgical BMI, cholesterol, blood pressure, creatinine, number of
antidepressant/glycemic drugs, and hemoglobin were recorded. Post-surgical
follow-up was reviewed to examine changes. RESULTS: Statistically significant
changes were found in BMI, hypertension, cholesterol and glycemic control.
Surgery was found to reduce creatinine from a pre-surgery average of 1.14 to
1.01 (n = 11, p = .0015)). Patients with early post-operative complications
(defined as length of stay > 6 days or re-hospitalization within 1 month
following surgery) had an average BMI of 57.58 (n = 23) vs a BMI of 49.9 (n =
103) in those who did not experience any complications (p = 0.0004). There was a
statistically significant decrease in the rate of anti-depressant use following
surgery. 49 patients were on antidepressants before surgery vs 38 following
surgery (p = .0016). CONCLUSION: RYGBP significantly improves hypertension,
hyperlipidemia and type II diabetes, and may also improve kidney function.
Patients with higher pre-surgical BMIs are at greater risk for post-surgical
complications. Postoperative antidepressant use appears to decrease.

PMID: 11975225 [PubMed]

155: Maturitas.  2002 Apr 15;41 Suppl 1:S25-46.  

The impact of testosterone imbalance on depression and women's health.

Rohr UD.

Department of Gynecology and Obstetrics, Gynecological Oncology, University
Hospital, Hufelandstrasse 55, D-45122, Essen, Germany. ufk@uni-essen.de

Women suffer more often from depression than males, indicating that hormones
might be involved in the etiology of this disease. Low as well as high
testosterone (T) levels are related to depression and well-being in women, T
plasma levels correlate to depression in a parabolic curve: at about 0.4-0.6
ng/ml plasma free T a minimum of depression is detected. Lower levels are
related to depression, osteoporosis, declining libido, dyspareunia and an
increase in total body fat mass. Androgen levels in women decrease continuously
to about 50% before menopause compared to a 20-year-old women. Androgen levels
even decline 70% within 24 h when women undergo surgical removal of the ovaries.
Conventional oral contraception or HRT cause a decline in androgens because of
higher levels of SHBG. Hyperandrogenic states exist, like hirsutism, acne and
polycystic ovary syndrome. Social research suggests high androgen levels cause
aggressive behavior in men and women and as a consequence may cause depression.
Higher androgen values are more pronounced at young ages and before and after
delivery of a baby and might be responsible for the "baby blues". It was found
that depression in pubertal girls correlated best with an increase in T levels
in contrast to the common belief that "environmental factors" during the time of
growing up might be responsible for emotional "up and downs". T replacement
therapy might be useful in perimenopausal women suffering from hip obesity, also
named gynoid obesity. Abdominal obesity in men and women is linked to type 2
diabetes and coronary heart diseases. Testosterone replacement therapy in
hypoandrogenic postmenopausal women might not only protect against obesity but
also reduce the risk of developing these diseases. Antiandrogenic progestins
might be useful for women suffering from hyperandrogenic state in peri- and
postmenopause. Individual dosing schemes balancing side effects and beneficial
effects are absolutely necessary. Substantial interindividual variability in T
plasma values exists, making it difficult to utilize them for diagnostic
purposes. Therefore a "four-level-hormone classification scheme" was developed
identifying when estradiol (E) and T levels are out of balance. (1) Low E-low T
levels are correlated with osteoporosis, depression, and obesity; (2) high E-low
T with obesity, decreased libido; (3) high T-low E levels with aggression,
depression, increased libido, and substance abuse; (4) high E-high T with type
II diabetes risk, breast cancer and cardiovascular risk. Testosterone delivery
systems are needed where beneficial and negative effects can be balanced. Any
woman diagnosed for osteoporosis should be questioned for symptoms of

Publication Types:
    Review, Tutorial

PMID: 11955793 [PubMed]

156: Int J Radiat Oncol Biol Phys.  2002 Apr 1;52(5):1293-302.  

Is the therapeutic index better with gemcitabine-based chemoradiation than with
5-fluorouracil-based chemoradiation in locally advanced pancreatic cancer?

Crane CH, Abbruzzese JL, Evans DB, Wolff RA, Ballo MT, Delclos M, Milas L, Mason
K, Charnsangavej C, Pisters PW, Lee JE, Lenzi R, Vauthey JN, Wong AB, Phan T,
Nguyen Q, Janjan NA.

Pancreatic Tumor Study Group, Department of Radiation Oncology, The University
of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.

PURPOSE: To retrospectively compare the toxicity and efficacy of concurrent
gemcitabine-based chemoradiation with that of concurrent 5-fluorouracil
(5-FU)-based chemoradiation in patients with unresectable pancreatic cancer.
PATIENTS AND METHODS: Between September 1996 and May 2000, 114 patients with
localized unresectable adenocarcinoma of the pancreas were treated with
concurrent chemoradiation. Locally advanced unresectable disease was defined as
low-density tumor in contact with the superior mesenteric artery (SMA) or celiac
artery, or occlusion of the superior mesenteric-portal venous confluence.
Fifty-three patients were selected to receive gemcitabine in 7 weekly cycles
(250-500 mg/m(2)) with concurrent radiotherapy (median dose 30 Gy, range 30-33
Gy in 10-11 fractions). The remaining 61 patients received continuous-infusion
5-FU (200-300 mg/m(2)) with concurrent radiotherapy (30 Gy in 10 fractions).
Radiotherapy was delivered to the primary tumor and regional lymphatics.
Patients receiving gemcitabine and those receiving 5-FU had a similar mean
Karnofsky performance status (KPS, 89% vs. 86%), distribution of tumor grade
(43% vs. 33% poorly differentiated), and percent weight loss (all p = NS).
However, patients treated with gemcitabine had a significantly larger median
maximum cross-sectional tumor area (TA, 8.8 cm(2) vs. 5.7 cm(2), p = 0.046) and
were significantly younger (median age 60 vs. 68 years, p <0.001). Severe acute
toxicity (ST) was defined as toxicity requiring a hospital stay of more than 5
days, mucosal ulceration with bleeding, more than 3 dose deletions of
gemcitabine or discontinuation of 5-FU, or toxicity resulting in surgical
intervention or death. Kaplan-Meier analysis was used to calculate the actuarial
rate of local progression on imaging (LP), the rate of distant metastasis (DM),
and the overall survival (OS) rate. The imaging was reviewed in resected
patients. RESULTS: Patients receiving gemcitabine developed significantly more
ST during treatment (23% vs. 2%, p < 0.0001) than did those receiving 5-FU.
Patients treated with gemcitabine had a similar 10-month LP rate (62% vs. 61%),
10-month DM rate (55% vs. 47%), 1-year OS rate (42% vs. 28%), and median OS
duration (11 months vs. 9 months) to patients treated with 5 FU (all p = NS).
Five patients who received gemcitabine and 1 patient who received 5-FU underwent
margin-negative pancreaticoduodenectomy after chemoradiation. Three patients had
a short segment (10 cm(2) (p = 0.03) and poor differentiation (p = 0.07) were associated with
a worse survival duration; however, other factors, such as KPS and weight loss
>10% and age did not influence OS. CONCLUSION: Despite the selection of
healthier patients to receive gemcitabine, there was a significantly higher
severe toxicity rate than with 5-FU. The median and 1-year survivals were not
significantly different with the use of concurrent gemcitabine; however, the
tumors treated were significantly larger. Additionally, a small number of
patients with minimal arterial involvement whose disease met our radiographic
definition of unresectable disease had margin-negative resections after
treatment with gemcitabine-based chemoradiation. These possible benefits and the
high rate of severe toxicity define a very narrow therapeutic index for
concurrent gemcitabine-based chemoradiation given by this schedule of

PMID: 11955742 [PubMed]

157: Chir Ital.  2002 Jan-Feb;54(1):87-90.  

Sclerosing encapsulating peritonitis: a rare complication of peritoneal
dialysis. A case report.

Mitaritonno M, Occhionorelli S, De Tullio D, Fonte VP.

Department of Clinical Methodology and Surgical Technologies, Section of General
Surgery, Policlinico Universitario, Piazza G. Cesare, 11, 70124 Bari, Italy.

Sclerosing encapsulating peritonitis is a typical, but at the same time, not so
frequently observed complication of peritoneal dialysis. The aim of this article
is to report on the authors' clinical and surgical experience with this disease.
After a review of the international literature and a description of the typical
clinical features of this disease, the authors describe a case of sclerosing
encapsulated peritonitis observed in their surgical department, on its mode of
onset (intestinal occlusion), clinical behaviour and surgical treatment. The
treatment of the patient consisted in the removal of fibrous tissue, resection
of a necrotic ileal loop and intestinal reconstruction by an end-to-end
ileo-ileal anastomosis. From the technical point of view the result was good and
resolution of the intestinal occlusion was obtained. Cardiocirculatory
complications arose on 6th postoperative day were the cause of the patient's
death. Sclerosing encapsulating peritonitis is a rare complication of peritoneal
dialysis, but it should be borne in mind whenever a patient with a history of
peritoneal dialysis reports episodes of abdominal pain, nausea and vomiting
associated with weight loss. This kind of peritonitis may require surgical and
non-surgical treatment, though laparotomy provides us with a reliable diagnosis
and may be considered essential to resolve the intestinal obstruction.

Publication Types:
    Case Reports

PMID: 11942017 [PubMed]

158: Ren Fail.  2002 Jan;24(1):103-7.  

Acute renal failure after thrombotic agent therapy due to excessive bleeding
after cosmetic liposuction.

Lee JG, Lee JS, Lee YK, Song CS, Cho JM.

Department of Internal Medicine, Eulji Medical College, 280-1, Hagyel-Dong,
Nowon-Gu, Seoul, 139-711, Korea. ljg1128@eulji.or.kr

Suction lipoplasty is practiced popularly for obesity control and cosmetic
purposes and severe complications are rare. We report the first documented case
of acute renal failure, with anuric period, that developed after excessive
bleeding following cosmetic liposuction. The use of homocoagulase and the
presence of rhabdomyolysis might have contributed to the acute renal failure and
disseminated intravascular coagulation observed in this case.

Publication Types:
    Case Reports

PMID: 11921693 [PubMed]

159: Atlas Oral Maxillofac Surg Clin North Am.  1998 Sep;6(2):73-85.  

Liposculpture of the cervicofacial region.

Alexander RW.

Department of Surgery, University of Texas Health Science Center at San Antonio,
San Antonio, Texas, USA.

PMID: 11905374 [PubMed]

160: Aesthetic Plast Surg.  2002 Jan-Feb;26(1):20-2.  

Severe abdominal wall necrosis after ultrasound-assisted liposuction.

Cedidi CC, Berger A.

Ferdinand-Sauerbruch Klinikum, Klinik fur Plastiche- une Handchirurgie,
Universitat Witten Herdecke, Arrenbergerstrasse 20, D-42117 Wuppertal, Germany.

The complicated case of a 44-year-old white female following ultrasound-assisted
liposuction of the entire abdomen is presented. In this case the postoperative
course was complicated by hematoma, treated conservatively. During following
weeks extensive cutaneous necrosis over the abdomen developed. After four weeks
the patient presented to our institution with purulent discharge. After surgical
revision, requiring excision of the abdominal wall necrosis, a significant
residual abdominal wall defect remained. After three further revisions, removal
of residual necrotic fat, irrigation, and temporary coverage with a synthetic
dressing, infection cleared. At this point, split thickness skin grafting was
possible. The healing in of the skin grafts was complete, eventually enabling
wound closure and successful reconstruction of the abdominal wall.

Publication Types:
    Case Reports

PMID: 11891592 [PubMed]

161: Aesthetic Plast Surg.  2002 Jan-Feb;26(1):17-9.  

Does liposuction influence lipidogram in females: in vivo study.

Vandeweyer E.


Suction lipectomy is one of the most commonly performed cosmetic procedures that
is ideally indicated for the treatment of minimal to moderate localized fat
deposits. The safety of the procedure has been addressed regarding patient
selection, complications and results. Little is known about the impact of
liposuction on lipid metabolism during and immediately after the procedure. Ten
consecutive patients operated on for moderate volume liposuction (mean 1470 cc,
range 500-2800 cc) were included in the present study. Blood samples analysis
were obtained preoperatively (T1), 20 minutes after the beginning of the
procedure (T2), one hour (T3), and four hours postoperatively (T4). The levels
of total cholesterol, HDL cholesterol, LDL cholesterol,triglycerides,
lipoprotein lipase, A1 lipoprotein, and B lipoprotein were measured from T1 to
T4. All the values were increased at T2 and T3, but remained under upper normal
values and nearly complete return to baseline was observed at T4, underlining
the safety of the procedure on a metabolic basis.

PMID: 11891591 [PubMed]

162: Aesthetic Plast Surg.  2002 Jan-Feb;26(1):1-9.  

Ultrasound-assisted lipoplasty (UAL) in breast surgery.

Goes JC, Landecker A.


Breast surgery has evolved significantly since the increased demand for reduced
scars led to the development of minimal incision techniques. Ultrasound-assisted
lipoplasty (UAL) presents important advantages when compared to traditional
liposuction, such as preservation of connective structures and significant skin
retraction capability. Other factors such as a favorable side-effect profile,
satisfactory aesthetic results, and virtually inconspicuous scars have led us to
utilize UAL in virtually all of the different breast surgery modalities carried
out in our practice.Important aspects of patient selection, markings, surgical
technique, and postoperative care are outlined. Ultrasonic energy is applied
through superficial tunnels that lie radial to the mammary cone, with
preservation of elements such as the areola, mammary ducts, and the central part
of the breast's base which contains the perforators that supply the gland. Deep
treatment should be applied onto adipose tissue regions and should preferably be
performed in the peripheral and subcutaneous layers of the breast, with
conservation of the central glandular cone to ensure maintenance of anterior
projection.In selected cases, UAL is a valuable adjunct to procedures such as
symmetrization, reduction mammaplasty, and breast reconstruction, permitting
both volume reduction and shaping through three-dimensional retraction of
connective tissue and skin. The excellent preliminary results support new
indications and future developments of the technique.

PMID: 11891589 [PubMed]

163: Lipids.  2002 Jan;37(1):27-32.  

Assessment of dietary and genetic factors influencing serum and adipose fatty
acid composition in obese female identical twins.

Kunesova M, Hainer V, Tvrzicka E, Phinney SD, Stich V, Parizkova J, Zak A,
Stunkard AJ.

Obesity Management Centre, Third Medical Department, First Medical School,
Charles University, Prague, Czech Republic. marie.kunesova@lfl.cuni.cz

Fourteen pairs of obese female monozygotic twins were recruited for a study of
genetic influences on serum and adipose fatty acid (FA) composition. Following 1
wk of inpatient stabilization, fasting serum and adipose tissue obtained by
surgical excision were analyzed by thin-layer and gas chromatography. Intrapair
resemblances (IPR) for individual FA were assessed by Spearman rank correlation
and by analysis of variance and were found in serum cholesteryl esters (CF),
triglycerides (TG), and adipose TG. With two exceptions (CE linoleate and
adipose eicosapentaenoate), these IPR were limited to the nonessential FA.
Palmitate had significant IPR in four lipid fractions; in serum CE and adipose
TG palmitate was strongly correlated with multiple measures of adiposity. In
contrast to other lipid fractions, serum phosphatidylcholine (PC) FA had 12 [PR,
of which 6 were essential FA including arachidonate (r = 0.76, P < 0.0005),
eicosapentaenoate (r = 0.78, P < 0.0005), and docosahexaenoate (r = 0.86, P<
0.0001). The PC [PR could not be explained by analysis of preadmission 7-d food
records. After dividing the pairs into two groups differing and nondiffering
according to fat intake of individuals in the pair, there was no evidence of a
gene-environment interaction between fat intake and FA composition. The IPR for
nonessential FA indicate that there is active genetic control of either food
choices or postabsorptive metabolic processing. The high level of IPR in the PC
fraction in contrast to the other lipid fractions suggests strong genetic
influence over selection of specific FA for this membrane fraction independent
of diet.

Publication Types:
    Twin Study

PMID: 11876260 [PubMed]

164: J Clin Oncol.  2002 Mar 1;20(5):1405-10.  

Maximizing local control and organ preservation in stage IV squamous cell head
and neck cancer With hyperfractionated radiation and concurrent chemotherapy.

Adelstein DJ, Saxton JP, Lavertu P, Rybicki LA, Esclamado RM, Wood BG, Strome M,
Carroll MA.

Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation,
Cleveland, OH 44195, USA. adelstd@ccf.org

PURPOSE: Results are reported from an aggressive chemoradiotherapy protocol for
advanced squamous cell head and neck cancer. PATIENTS AND METHODS: Patients with
advanced squamous cell head and neck cancer were treated with hyperfractionated
radiation therapy (72 Gy at 1.2 Gy twice per day) and two courses of concurrent
chemotherapy with fluorouracil (1,000 mg/m(2)/d) and cisplatin (20 mg/m(2)/d),
both given as 96-hour continuous intravenous infusions during weeks 1 and 4 of
radiation therapy. Primary-site resection was reserved for residual or recurrent
primary-site disease after chemoradiotherapy. Neck dissection was considered for
N2 or greater disease, irrespective of clinical response, and for residual or
recurrent neck disease after nonoperative treatment. RESULTS: Forty-one patients
with stage IV disease were treated. Toxicity was significant, with grade 3 to 4
mucositis in 98%, dysphagia in 88%, and skin reaction in 85%. Neutropenic fever
requiring hospitalization occurred in 51%. Despite feeding tube placement in 35
patients (85%), the mean weight loss during chemoradiotherapy was 13.3% of
initial body weight. One patient died during treatment as a result of a
pulmonary embolus. At a median follow-up period of 30 months, the 3-year
Kaplan-Meier projected overall survival was 59%, disease-specific survival 69%,
likelihood of local control without surgical resection 91%, and local control
with surgical resection 97%. The likelihood of distant disease control at 3
years was 74%, and distant metastases were present in eight of 13 patients who
died. CONCLUSION: This chemoradiotherapy schedule produces considerable but
manageable toxicity. Survival and organ preservation are excellent for this
poor-prognosis patient cohort. Distant metastases are the most common cause of
treatment failure.

PMID: 11870186 [PubMed]

165: Eur Radiol.  2002 Jan;12(1):231-6. Epub 2001 Sep 06. 

Detachable balloon embolization of an aneurysmal gastroduodenal arterioportal

Defreyne L, De Schrijver I, Vanlangenhove P, Kunnen M.

Department of Radiology and Medical Imaging, Ghent University Hospital, De
Pintelaan 185, 9000 Gent, Belgium. Luc.Defreyne@rug.ac.be

Extrahepatic arteriovenous fistulas involving the gastroduodenal artery and the
portal venous system are rare and almost always a late complication of gastric
surgery. Secondary portal hypertension and mesenteric ischemia may provoke
abdominal pain, upper and lower gastrointestinal hemorrhage, diarrhea, and
weight loss. Until recently, surgical excision has been the therapy of choice
with excellent results. The authors report a case of gastroduodenal
arterioportal fistula with a rare large interpositioned aneurysm in a
cardiopulmonary-compromised patient who was considered a non-surgical candidate.
The gastroduodenal arterioportal fistula was occluded endovascularly by means of
a detachable balloon. A survey of the literature of this rare type of
arterioportal fistula is included.

Publication Types:
    Case Reports
    Review of Reported Cases

PMID: 11868102 [PubMed]

166: Ann Plast Surg.  2002 Mar;48(3):246-51.  

Laser blepharoplasty in Asians.

Kang DH, Choi JH, Koo SH, Park SH.

Department of Plastic & Reconstructive Surgery, Korea University Medical Center,
Seoul, Korea.

Traditional blepharoplasty removes periorbital wrinkles by cutting and
stretching the skin. However, this method has a substantial risk of producing
ectropion or scleral show. In addition, fine periocular wrinkles may persist
because this method does not change skin texture. The pulsed CO2 laser has
recently become a primary surgical tool in treating aging eyelids. Periorbital
wrinkles vary in depth not only from person to person, but also among different
races. Compared with whites, most Asians have a thicker dermis, so more laser
passes and a higher power may be required to remove periorbital wrinkles, but
concerns about hyperpigmentation and prolonged erythema have limited its use on
Asian skin. In this study, 346 patients underwent laser blepharoplasty at the
Korea University Medical Center and at Dr Choi's Aesthetic Clinic. They were
followed for 12 months on average from September 1995 to September 1999. The CO2
laser was used in resurfacing periorbital wrinkles, transcutaneous skin
excision, and transconjunctival blepharoplasty, including fat removal. The
authors assessed the benefit of using the UltraPulse CO2 laser in Asian
blepharoplasty. They found that 291 patients (84%) had good to excellent
results. The incidence of side effects was very low. Prolonged erythema occurred
in 19 patients (5%) and hyperpigmentation occurred in 35 patients (10%), but the
erythema disappeared spontaneously within 2 months and the hyperpigmentation
could be managed readily by the topical use of retinoids and hydroquinone cream.
Therefore, the authors conclude that postoperative hyperpigmentation is no
longer a problem limiting laser resurfacing in Asian blepharoplasty. The
UltraPulse CO2 laser is a safe and effective rejuvenation method for treating
aging eyelids in Asians.

PMID: 11862027 [PubMed]

167: J Assoc Acad Minor Phys.  2001 Jul;12(3):129-36.  

Bariatric surgery for severe obesity.

Sugerman HJ.

Department of Surgery, Medical College of Virginia, Virginia Commonwealth
University, Richmond, Virginia 23298-0519, USA. hsugerma@hsc.vcu.edu

Severe obesity is associated with multiple comorbidities and is refractory to
dietary management with or without behavioral or drug therapies. There are a
number of surgical procedures for the treatment of morbid obesity, including
purely gastric restrictive, a combination of malabsorption and gastric
restriction or primary malabsorption. The purely gastric restrictive procedures,
including vertical banded gastroplasty and laparoscopic adjustable silicone
gastric banding, do not provide adequate weight loss. African-American patients
do especially poorly after the banding procedure with the loss of only 11% of
excess weight in one study. Gastric bypass (GBP) is associated with the loss of
66% of excess weight at 1 to 2 years after surgery, 60% at 5 years and 50% at 10
years. For unknown reasons, African-American patients lose significantly less
weight than Caucasians after GBP. There is a risk of micronutrient deficiencies
after GBP, including iron deficiency anemia in menstruating women, vitamin B12,
and calcium deficiencies. Prophylactic supplementation of these nutrients is
necessary. Recurrent vomiting after bariatric surgery may be associated with a
severe polyneuropathy and must be aggressively treated with endoscopic
dilatation before this complication is allowed to develop. The malabsorptive
procedures include the partial biliopancreatic bypass (BPD) and BPD with
duodenal switch (BPD/DS). The BPD appears to cause severe protein-calorie
malnutrition in American patients; the BPD/DS may be associated with less
malnutrition. Weight loss failure after GBP does not respond to tightening a
dilated gastrojejunal stoma or reducing the size of the gastric pouch. These
patients may require conversion to a malabsorptive distal GBP, similar to the
BPD. However, because of the risk of severe protein-calorie malnutrition and
calcium deficiency BPD should be reserved for patients with severe obesity
comorbidity. The risk of death following bariatric surgery is between 1% and 2%
in most series but is significantly higher in patients with respiratory
insufficiency of obesity. In most patients, surgically induced weight loss will
correct hypertension, type II diabetes mellitus, sleep apnea, obesity
hypoventilation syndrome, gastroesophageal reflux, venous stasis disease,
urinary incontinence, female sexual hormone dysfunction, pseudotumor cerebri,
degenerative joint disease pains, as well as improved self-image and

Publication Types:
    Review, Tutorial

PMID: 11851201 [PubMed]

168: Int J Obes Relat Metab Disord.  2002 Feb;26(2):193-9.  

A pilot study of long-term effects of a novel obesity treatment: omentectomy in
connection with adjustable gastric banding.

Thorne A, Lonnqvist F, Apelman J, Hellers G, Arner P.

Department of Surgery, Karolinska Institute at Huddinge University Hospital,
Stockholm, Sweden.

AIM: To determine whether visceral fat reduction in connection with bariatric
surgery could improve weight loss and metabolic profile of obese subjects.
PATIENTS AND METHODS: In a one-center, randomized and controlled pilot trial we
assigned 50 subjects with severe obesity (body mass index >35 kg/m(2)) to either
adjustable gastric banding (AGB) alone (11 men and 14 women), or AGB plus
surgical removal of the total greater omentum (11 men and 14 women). The
patients were followed at regular intervals for 2 y and examined at 0 and 24
months with respect to body composition and metabolic profile. RESULTS: No
significant differences between control and omentectomized patients were
observed at baseline. The removed greater omentum constituted 0.8+/-0.4%
(mean+/-s.d.) of total body fat. At 2 y follow-up there was an expected decrease
in body weight and an improvement in metabolic profile in both groups. Although
omentectomized subjects tended to lose more weight than control subjects the
difference was not statistically significant and changes in waist-to-hip ratio
and saggital diameter did not differ between groups. However, the improvements
in oral glucose tolerance, insulin sensitivity and fasting plasma glucose and
insulin were 2-3 times greater in omentectomized as compared to control subjects
(P from 0.009 to 0.04), which was statistically independent of the loss in body
mass index. No differences in blood lipids between the groups were recorded. No
adverse effects related to omentectomy were observed. CONCLUSIONS: Omentectomy,
when performed together with AGB, has significant positive and long-term effects
on the glucose and insulin metabolic profiles in obese subjects.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 11850750 [PubMed]

169: Lipids.  2001 Dec;36(12):1289-305.  

Factors affecting the storage and excretion of toxic lipophilic xenobiotics.

Jandacek RJ, Tso P.

The University of Cincinnati, Department of Pathology, Ohio 45267, USA.

Lipophilic toxins have been introduced into the environment both as functional
compounds, such as pesticides, and as industrial waste from incineration or the
manufacture of electrical transformer components. Among these substances are
compounds that are carcinogenic and that affect the endocrine system. Accidental
high exposures of humans to some lipophilic toxins have produced overt disease
symptoms including chloracne and altered liver function. These toxic materials
have been the recent focus of international effort to reduce or eliminate
classes of halogenated hydrocarbons from the environment. Evidence of the
widespread distribution of lipophilic toxins in the biosphere has been obtained
by analyses of human tissues and human milk. The principal route of entry of
lipophilic toxins into humans is through the food chain, and most of them are
stored in adipose tissue. A common route of excretion is in bile, but there is
also evidence of nonbiliary excretion into the intestine. Enterohepatic
circulation of many of these compounds slows their removal from the body.
Substances that interrupt the enterohepatic circulation of compounds that enter
the intestine by the biliary and nonbiliary routes increase the rate of their
removal from the body and reduce their storage half-lives. Reduction in body
fat, along with these dietary substances that interrupt enterohepatic
circulation, further enhances the excretion rate. Areas for further research
include optimizing regimens for body burden reductions, understanding the nature
of nonbiliary excretion, and following the effects of tissue redistribution
during loss of body fat.

Publication Types:
    Review, Academic

PMID: 11834080 [PubMed]

170: Kongressbd Dtsch Ges Chir Kongr.  2001;118:669-70.  

[Pitfalls in liposuction]

[Article in German]

Schwarz M.

Zentrum ambulante Chirurgie, Stuhlingerstrasse 22-24, 79106 Freiburg.

Liposuction is an easy to learn technique that suits as an outpatient procedure.
Tight budgets have led to a widespread and sometimes uncritical use. The
possible mistakes and dangers in patient selection, informed consent, pre- and
post-OP management are discussed. Other points are the monitoring and the proper
use of compression bandages.

PMID: 11824338 [PubMed]

171: Facial Plast Surg.  1999;15(3):243-53.  

Complications of blepharoplasty.

Gausas RE.

Division of Oculoplastic and Orbital Surgery, Department of Ophthalmology,
University of Pennsylvania Medical Center, Scheie Eye Institute, Myrin Circle,
51 North 39th St., Philadelphia, PA 19104, USA.

Blepharoplasty is one of the most commonly performed surgeries for rejuvenation
of the periorbital region, yet its complexity is often underappreciated. The
surgeon must have a precise understanding of the underlying anatomy from skin to
orbital rim and must recognize which components require surgery to achieve a
desired aesthetic result in each individual. Understanding the limitations
imposed by a particular patient's anatomy and conveying realistic aesthetic
expectations are essential to avoid complications. The underpinning of
successful blepharoplasty is an awareness of potential complications (Table 1)
and understanding how best to avoid them and how to manage them.

PMID: 11816087 [PubMed]

172: J Laparoendosc Adv Surg Tech A.  2001 Dec;11(6):377-82.  

Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up.

Higa KD, Ho T, Boone KB.

Valley Surgical Specialists Medical Group, Inc., Fresno, California, USA.

BACKGROUND: The purpose of this study is to evaluate our experience with the
laparoscopic gastric bypass. The technique, weight loss data, and complications
are described. METHODS: 1,500 consecutive patients were evaluated prospectively.
All patients met NIH criteria for bariatric surgery. Although there have been
modifications with respect to staplers, suture material, and dissection
techniques, the basic anatomical construct has remained the same, including
performing a completely hand-sewn gastrojejunostomy. RESULTS: There were no
anastomotic leaks from the hand-sewn gastrojejunostomy. Operative times now are
consistently 60 minutes or less, although the learning curve is quite long.
Average hospital stay was 1.5 days. Average excessive weight loss was 69% at one
and two years and 62% at three years. Overall complication rate was 14.8%.
Perioperative death rate was 0.2%. CONCLUSIONS: The laparoscopic gastric bypass
is a viable alternative to traditional open techniques. It is as safe and
effective and can be performed with equal or greater efficiency. Adoption of
hand-suturing techniques helps to improve the surgeon's skill and ability to
cope with the occasional stapler misfire or complication.

PMID: 11814129 [PubMed]

173: Facial Plast Surg.  2000;16(3):269-82.  

Achieving the "natural look" in rhytidectomy.

Perkins SW.

Meridien Plastic Surgery Center, Dept of Otolaryngology-Head and Neck Surgery,
Indiana University School of Medicine, Indianapolis, IN, USA.

Achieving the "natural look" in rhytidectomy and satisfying my aging face
patient population are the primary motivating factors that have guided me to
develop my personal philosophy and technique for facelifting. The following
article will consider how to achieve the "natural look" in rhytidectomy using
the modified deep plane-extended SMAS rhytidectomy technique, including the
benefits derived from this efficient face-lift technique. It outlines how to
give proper individualized consideration to each patient from the initial
consultation, through the preoperative evaluation and workup, as well as
anatomic indications for the type of face lift to be performed. In addition, the
article covers possible postoperative complications and how to determine when
secondary rhytidectomies or tuck-ups are indicated.

PMID: 11802574 [PubMed]

174: N Z Med J.  2001 Nov 9;114(1143):505-6.  

Professional misconduct--liposuction surgery.

[No authors listed]

PMID: 11797888 [PubMed]

175: Int J Oncol.  2002 Feb;20(2):419-27.  

Induction chemotherapy followed by concomitant chemoradiation therapy in
advanced head and neck cancer: a phase II study for organ-sparing purposes
evaluating feasibility, effectiveness and toxicity.

Mantovani G, Proto E, Massa E, Mulas C, Madeddu C, Mura L, Mudu MC, Astara G,
Murgia V, Gramignano G, Ferreli L, Camboni P, Lusso MR, Mocci M, Tore G, Mura M,
Amichetti M, Maccio A.

Department of Medical Oncology, Policlinico Universitario, University of
Cagliari, Cagliari 09042, Italy. mantovan@pacs.unica.it

The purpose of the study was to assess response rate, clinical outcome,
organ/function preservation and toxicity in head and neck cancer patients
treated with induction chemotherapy followed by concomitant chemoradiotherapy
and, when necessary, limited surgery. The study design was a phase II
non-randomized trial in hospitalized patients setting. The treatment plan
consisted of 3 cycles of induction chemotherapy with cisplatin, fluorouracil
(5-FU), l-leucovorin and interferon alpha2b (PFL-IFN) followed by 7 cycles of
5-FU, hydroxyurea and concomitant radiation for 5 days (FHX) for a total
radiation dose of 70 Gy. 13 Cis-retinoic acid was added to treatment regimen for
chemoprevention and a systematic prophylaxis of mucositis was administered to
all patients during FHX. Conservative surgical resection was reserved to
patients with no optimal response (PR > or =70%), whereas radical surgery was
performed as salvage treatment. Twenty-six patients were treated at one
institution: more than 90% had stage IV disease and only 19.2% had laryngeal
cancer. Eighty-one percent of patients had performance status 0 and 23.1% of
patients had >5% weight loss at the start of treatment. Nineteen patients were
analyzed for response to PFL-IFN: 3/19 (15.8%) patients achieved a CR and 7/19
(36.8%) achieved a PR for an ORR of 52.6%. FHX was administered on protocol to
12 patients: 6 patients (50%) had CR, 1 patient (8.3%) had PR for an ORR of
58.3%, 2 patients (16.7%) had SD and 3 patients (25%) had PD. At the completion
of FHX, no patient underwent local therapy according to treatment plan. At a
median follow-up time of 13.5 months (range 1-28+) at June 2001, among 26
patients enrolled 12 (46.1%) were still alive and 9 (75%) of them were
progression-free. The median duration of response was 9 months (range 0-25+),
the median progression-free survival was 10.5 months (range 0-28+), the median
overall survival time was 9 months (range 1-22). The toxicity was significant
and consisted mainly of mucositis and, to a lesser extent,
neutropenia/thrombocytopenia. In the present study, the low serum levels of
leptin and the high serum levels of proinflammatory cytokines in advanced stage
cancer patients were confirmed. In conclusion, this sequential induction
chemotherapy and chemoradiotherapy program has been found moderately active and
significantly toxic; moreover, the long overall treatment duration must be taken
into consideration. For these reasons, this regimen could not be recommended for
a phase III randomized study.

Publication Types:
    Clinical Trial
    Clinical Trial, Phase II
    Randomized Controlled Trial

PMID: 11788911 [PubMed]

176: Ann Endocrinol (Paris).  2001 Sep;62(4 Pt 2):S31-6.  

[Surgery for obesity]

[Article in French]

Simon C, Chabrier G.

Service de Medecine Interne et Nutrition, Hopital de Hautepierre, 67098
Strasbourg. chantal.simon@chru-strasbourg.fr

With the development of new surgical techniques (laparoscopic procedure,
adjustable gastric banding) bariatric surgery is still increasing. In France
about 10,000 adjustable gastric banding have been performed during the last
year, as well as a thousand of gastric operations and approximately fifty
gastric by-pass. The surgical approach has a real efficacy on weight loss and is
associated with a reduction in comorbid conditions. However its long-term
efficacy, its effects on quality of life, its nutritional consequences and the
surgical-linked complication incidence are only poorly evaluated, especially for
adjustable gastric banding. Therefore bariatric surgery indications should be
thoroughly examined. As recommended by the experts, surgical treatment for
obesity should be restricted to patients presenting morbid obesity, and this
despite a multidisciplinary medical treatment. Long-term post-surgical follow-up
is necessary and may be an important determinant of long-term efficacy.
Considering the growing number of this type of intervention outside of any
evaluation, a national register is recommended.

Publication Types:
    Review, Tutorial

PMID: 11787369 [PubMed]

177: Obes Surg.  2001 Dec;11(6):699-707.  

Band erosion: incidence, etiology, management and outcome after banded vertical
gastric bypass.

Fobi M, Lee H, Igwe D, Felahy B, James E, Stanczyk M, Fobi N.

Center for Surgical Treatment of Obesity, 21520 S. Pioneer Blvd., Suite 204,
Hawaiian Gardens, CA 90716, USA. FOBIMAL@aol.com

BACKGROUND: Prosthetic devices have been used in bariatric operations to control
the outlet of the gastric pouch and thus maintain weight loss. A complication of
these prostheses is erosion or migration into the gastric lumen. The transected
banded vertical gastric bypass (TBVGBP) is one of the modifications of gastric
bypass. This modification has a silastic ring placed around the pouch to form
the stoma. METHOD: The records of patients with band erosion (BE) after this
operation were reviewed, to determine the incidence, etiology, management and
outcome during a 9-year period. RESULTS: From May 1992 through May 2001, 2,949
primary and secondary TBVGBP were performed through the Center for Surgical
Treatment of Obesity, utilizing 3 hospitals. 48 patients (1.63%) were documented
to have BE: 40 documented by us and 8 by subsequent treating surgeons or at
other facilities. Presenting symptoms were weight regain (18), stenosis or
obstruction (17), pain (9), bleeding (7), and 5 were incidental findings. Some
patients presented with more than one symptom. 8 were treated expectantly with
spontaneous extrusion of the band. 16 bands have been removed endoscopically in
14 patients. 26 patients had open surgical revision, with 12 having band removal
only and 14 band removal and revision of either the gastroenterostomy with or
without band replacement or conversion to a distal Roux-en-Y gastric bypass
(DRYGBP). Two patients who had revision to DRYGBP were re-revised to a longer
common limb because of protein malnutrition. Three patients who had revision of
the gastroenterostomy with band removal and replacement developed leaks that
were managed non-surgically. Two of these re-eroded and the band was removed
endoscopically with a subsequent revision to a DRYGBP. There was no death due to
BE. CONCLUSION: BE is an uncommon complication of TBVGBP. Infection, previous
bariatric operations and surgical technique play a role in BE. BE is best
managed by endoscopic removal but can be treated expectantly or by open surgical
intervention. Band removal without replacement or revision to DRYGBP may result
in weight regain.

PMID: 11775567 [PubMed]

178: Ann Plast Surg.  2002 Jan;48(1):109-10.  

Abdominoplasty and seroma.

Hafezi F, Nouhi AH.

Publication Types:

PMID: 11773745 [PubMed]

179: Plast Reconstr Surg.  2001 Dec;108(7):2168.  

Subcutaneous scarring and ultrasound-assisted liposuction.

Persoff MM.

Publication Types:

PMID: 11743438 [PubMed]

180: Plast Reconstr Surg.  2001 Dec;108(7):2100.  

Comment on:
    Plast Reconstr Surg. 2001 May;107(6):1562-9.

Comment on zones of adherence: role in minimizing and preventing contour
deformities in liposuction.

Fredricks S.

Publication Types:

PMID: 11743365 [PubMed]

181: Gynecol Oncol.  2001 Dec;83(3):518-22.  

Panniculectomy with simultaneous gynecologic oncology surgery.

Tillmanns TD, Kamelle SA, Abudayyeh I, McMeekin SD, Gold MA, Korkos TG, Johnson

Department of Gynecologic Oncology, University of Oklahoma Health Science
Center, Oklahoma City, Oklahoma 73190, USA. todd-tillmans@ouhsc.edu

OBJECTIVE: The objective was to report the utility and morbidity of
panniculectomy in obese gynecologic oncology patients undergoing exploratory
laparotomy. METHODS: A retrospective chart review of 41 consecutive women who
had a panniculectomy as part of an abdominal gynecologic oncology procedure
between July 1996 and May 2000 was performed. Obese patients possessing a large
pannus, the majority with a BMI > or = 30 kg/m(2), were included. Demographic,
preoperative, operative, and postoperative data were obtained. Statistical
analyses were performed using Statistical Analysis System (SAS) Version 6.13.
RESULTS: Panniculectomy was performed on 41 patients with a mean age of 55,
weight of 126 kg, and BMI of 48 kg/m(2). The most common comorbidities in this
population were hypertension, diabetes, and osteoarthritis. Wound infection
occurred in 4 (9.8%) patients; 88% of the patients received a hysterectomy. The
average EBL was 358 cc. Operative time and length of hospital stay were on
average 203 min and 5.5 days, respectively. A prior history of diabetes
increased the risk of early complications (P = 0.03). Late complications were
more likely to occur in older women (P = 0.05). Wound complications were
increased in patients with larger BMI's (P = 0.05). CONCLUSIONS: This study
supports the safety of the panniculectomy procedure in this high-risk group of
morbidly obese patients for whom a technical advantage may be achieved by
improved operative exposure.

PMID: 11733965 [PubMed]

182: Aesthetic Plast Surg.  2001 Nov-Dec;25(6):421-6.  

Prospective study of clinical findings and changes in 56 Trilucent implant

Munker R, Zorner C, McKiernan D, Opitz J.

Klinik fur Asthetisch-Plastische Chirurgie, Stuttgart, Germany.

Between 1995 and 1998 we implanted 88 Trilucent implants in 48 patients. The
experience of 56 explantations in 30 patients are presented in this prospective
study. Of 48 patients, 32 returned for review after we wrote to them.
Twenty-seven elected to have their implants exchanged immediately for a
fourth-generation cohesive silicon implant and three decided to have the
implants removed and not replaced. In 14 patients it was clinically obvious that
the volume of the implant had changed, although not all patients realized this.
The absence of capsular contraction was notable (unanimously Baker II), so that
most patients were asymptomatic and had to be convinced of the need for
explantation. However, perioperatively, 55% of the implants had thickening or
color change caused by the peroxidation of the triglyceride content. Typically
the implant capsule was adherent to the surrounding tissues, especially
pectoralis major. This prolonged operative time (184 min, on average) and
hemostasis was a problem. During the study we developed a standardized operative
technique, which enabled us to reduce operative times. Special attention had to
be paid to the selection of the new implant volume, because many patients had
become accustomed to the increase in the size of their breasts caused by the
peroxidation of the implant content. Forty-three percent of patients
preoperatively expressed the wish to have even bigger breasts than before.
Nearly all of our patients at the three-month postoperative follow-up were
happier with the new implants than before. It became apparent that after only
two to three years there were obvious oxidative changes in the implants in
asymptomatic patients. Based on our study result, the recommendations regarding
explantation of Trilucent implants seem justified.

PMID: 11731847 [PubMed]

183: Br J Plast Surg.  2001 Dec;54(8):684-6.  

Histological examination of the capsules surrounding Trilucent breast implants.

McArthur PA, Green AR, Hancock K, Green AR.

Mersey Regional Plastic Surgery Centre, Whiston Hospital, Liverpool, UK.

Following a statement by the UK Medical Devices Agency (MDA), soya-oil-filled
Trilucent implants for breast augmentation were withdrawn from sale in March
1999. The most recent report on the toxicity of the Trilucent implant suggests
that one of the breakdown products of the filler is an aldehyde with an explicit
risk of genotoxic and teratogenic effects. Explantation of all these prostheses
was advised by the MDA in June 2000. No guidance regarding capsulectomy was put
forward by any publication. The operation of capsulectomy confers an increased
morbidity compared with simple prosthetic replacement. This study looks at the
capsules of 18 consecutive patients who had received Trilucent implants for
cosmetic breast augmentation, and who had undergone explantation and
capsulectomy. The mean duration of implantation was 3 years (range: 2 years to 4
years 9 months). The capsules were examined histologically. The significant
features of all the capsules included a florid foreign-body type reaction,
synovial metaplasia, a villous hyperplasia and the presence of refractile
material within the substance of the capsule. It is postulated that the
refractile material is filler material that has bled through the wall of the
intact Trilucent implant, and as such would represent a potential genotoxic
hazard. Until such time as this potential hazard has been investigated fully and
a conclusion reached, we recommend acceptance of the increased morbidity, and
the performance of capsulectomies when explanting Trilucent implants. Copyright
2001 The British Association of Plastic Surgeons.

Publication Types:
    Evaluation Studies

PMID: 11728111 [PubMed]

184: Plast Reconstr Surg.  2001 Nov;108(6):1753-63; discussion 1764-7.  

Large-volume liposuction: a review of 631 consecutive cases over 12 years.

Commons GW, Halperin B, Chang CC.

Department of Plastic Surgery, Stanford University Medical Center, Stanford, CA,

Since the advent of epinephrine-containing wetting solutions and sophisticated
fluid management techniques, increasingly larger and larger volumes of
liposuction aspirations have been reported. Unfortunately, with these larger
volumes of liposuction being routinely performed, greater rates of complications
have also been reported, with the worst of these resulting in deaths. In a
response to the increasing concerns over the safety of large-volume liposuction,
a critical review of the senior author's own series has been performed to
evaluate risks and benefits and to recommend guidelines for safe and effective
large-volume liposuction. A retrospective chart review was performed on 631
consecutive patients who underwent liposuction procedures of at least 3000 cc
total aspirate. All procedures were performed by the same senior surgeon between
January of 1986 and March of 1998. Before September of 1996, traditional
liposuction techniques were used. After September of 1996, ultrasound-assisted
liposuction was performed. The superwet technique of fluid management was
employed for all procedures performed after 1991. The particulars of the
surgical and anesthetic techniques used are reviewed in the article. Data
collection included preoperative patient demographics, preoperative and
postoperative weights and measurements, and preoperative and postoperative
photographs. Total aspirate volumes, fluid intakes, and fluid outputs were
measured, and all complications were tallied. Average follow-up was 1
year.Results showed the majority of patients to be women, aged 17 to 74 years
old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal
chart weight. Total aspirate volumes ranged from 3 to 17 liters, with 94.5
percent of these under 10 liters. Fluid balance measurements showed an average
of 120 cc/kg positive fluid balance at the end of the procedure, with none of
these patients experiencing any significant fluid balance abnormalities.
Cosmetic results were good, with a 2- to 6-inch drop from preoperative
measurements, depending on the area treated. Ten percent of patients experienced
minor skin contour irregularities, with most of these patients not requiring any
additional surgical procedures. One year after surgery, 80 percent of patients
maintained stable postoperative weights. No serious complications were
experienced in this series. The majority of the complications consisted of minor
skin injuries and burns, allergic reactions to garments, and postoperative
seromas. The more serious complications included four patients who developed
mild pulmonary edema and one patient who developed pneumonia postoperatively.
These patients were treated appropriately and went on to have uneventful
recoveries. The results show that large-volume liposuction can be a safe and
effective procedure when patients are carefully selected and when anesthetic and
surgical techniques are properly performed. Meticulous fluid balance
calculations are necessary to avoid volume abnormalities, and experience is
mandatory when performing the largest aspirations. Cosmetic benefits are
excellent, and overall complication rates are low.

PMID: 11711959 [PubMed]

185: Arch Facial Plast Surg.  2001 Oct-Dec;3(4):277-9.  

Group A streptococcal fasciitis after submental tumescent liposuction.

Beeson WH, Slama TG, Beeler RT, Rachel JD, Picerno NA.

Beeson Aesthetic Surgery Institute, 13590 N Meridian St, Carmel, IN 46032, USA.

Tumescent liposuction is a procedure with a good safety record. Local infection
is rare but can result in devastating consequences. We report a rare case of
group A streptococcal fasciitis complicating tumescent liposuction and highlight
the importance of early diagnosis and treatment of this condition. A 62-year-old
woman presented 8 days after submental liposuction and a platysmal plication
procedure with signs and symptoms of cervical fasciitis. Microbiological
analysis confirmed a group A streptococcal infection. By using early aggressive
medical and surgical treatments, the disease was arrested before the onset of
any necrotizing process. A high index of suspicion is required to make an early
diagnosis of this potentially disfiguring and life-threatening infection.

Publication Types:
    Case Reports

PMID: 11710866 [PubMed]

186: Aesthetic Plast Surg.  2001 Sep-Oct;25(5):388-9.  

A novel iatrogenic dermopigmentation: liposculpting-tattoo.

Ruedlinger R.

Publication Types:
    Case Reports

PMID: 11692256 [PubMed]

187: Infection.  2001 Oct;29(5):291-2.  

Unusual complication of breast implants: Brucella infection.

Memish ZA, Alazzawi M, Bannatyne R.

Dept. of Infection Prevention and Control, King Fahad National Guard Hospital,
Riyadh, Saudi Arabia. memish@ngha.med.sa

Brucellosis is hyperendemic in Saudi Arabia. We report infection in a breast
implant as an unusual complication of laboratory-acquired brucellosis. A
48-year-old female developed fever, rigors, headache, arthralgia and weight
loss. A blood culture for Brucella was positive. A 6-week course of antibiotics
effected a clinical and bacteriological cure but the resolution was short-lived.
Six weeks later a relapse of her febrile symptoms occurred together with the
appearance of a breast abscess. Cultures of the abscess and blood yielded
brucella. A second course of antibiotics together with surgical drainage and
subsequent reconstruction resulted in a cure.

Publication Types:
    Case Reports

PMID: 11688912 [PubMed]

188: Acta Chir Belg.  2001 Jul-Aug;101(4):179-84.  

Lesser curvature Roux-en-Y gastric bypass as an alternative procedure to failed
vertical banded gastroplasty: surgical technique and short-term results.

Denoel C, Denoel A, Coimbra C, Heymans O.

Department of Abdominal Surgery, Centre Hospitalier Regional de la Citadelle
(CHR) de Liege, Liege, Belgium.

PURPOSE: The incidence of revisional surgery for failed vertical banded
gastroplasty has increased markedly over the last years. Conversion to gastric
bypass is considered as a good alternative with satisfactory long term weight
loss without further revisional surgery. Nevertheless, significant morbidity and
mortality is still associated with this procedure. New technical aspects make it
safer and more effective. The aim of the work is to expose a surgical bypass
technique to attempt to reduce morbidity. PATIENTS AND METHODS: Thirty patients
have undergone conversions from failed vertical banded gastroplasty to a lesser
curvature Roux-en-Y Gastric Bypass. Surgical technique is described in detail
and early complications and initial weight loss were analyzed (mean follow-up:
12 months). RESULTS: The key points of the operation were the small vertical
pouch, the complete transection of the distal bypassed stomach, the
interposition of a jejunal limb between the two gastric shares and the
latero-lateral gastrojejunal anastomosis without proximal ring interposition.
For the entire series, we noticed one major complication, an acute pancreatitis
causing anastomotic fistula and four mild complications, one bleeding on the
excluded stomach, one bronchopneumonia, one pleural effusion and one wound
dehiscence. The percentage of excess weight loss attained 56.1% at one year
follow-up. CONCLUSIONS: There have been tremendous improvements in the safety of
gastric bypass over the years. One year follow-up indicates that our surgical
bypass procedure is secure with a low complication rate.

PMID: 11680061 [PubMed]

189: J Korean Med Sci.  2001 Oct;16(5):558-66.  

Clinical characteristics of constrictive pericarditis diagnosed by echo-Doppler
technique in Korea.

Yang HS, Song JK, Song JM, Kang DH, Lee CW, Nam GB, Choi KJ, Kim YH, Hong MK,
Kim JJ, Park SW, Park SJ, Song H, Lee JW, Song MG.

Division of Cardiology, Asan Medical Center, University of Ulsan College of
Medicine, Seoul, Korea.

A retrospective analysis of clinical data of 71 patients with constrictive
pericarditis (CP) diagnosed by echo-Doppler technique (mean age, 49+/-17) was
done. In 27 patients (38%), the etiology was unknown, and the three most
frequent identifiable causes were tuberculosis (23/71, 32%), cardiac surgery
(8/71, 11%), and mediastinal irradiation (6/71, 9%). Pericardiectomy was
performed in 35 patients (49%) with a surgical mortality of 6% (2/35), and 11
patients (15%, 11/ 71) showed complete resolution of constrictive physiology
with medical treatment. Patients with transient CP were characterized by absence
of pericardial calcification, shorter symptom duration, and higher incidence of
fever, weight loss, and tuberculosis. The 5-yr survival rates of patients with
transient CP and those undergoing pericardiectomy were 100% and 85+/-6%,
respectively, which were significantly higher than that of patients without
undergoing pericardiectomy (33+/-17%, p=0.0083). Mediastinal irradiation, higher
functional class, low voltage in ECG, low serum albumin, and old age were the
independent variables associated with a higher mortality. Tuberculosis is still
the most important etiology of CP in Korea, and not infrequently, it may cause
transient CP. Early diagnosis and decision-making using follow-up
echocardiography are crucial to improve the prognosis of patients with CP.

PMID: 11641523 [PubMed]

190: Arch Surg.  2001 Oct;136(10):1171-6.  

Laparoscopic gastric banding in older patients.

Nehoda H, Hourmont K, Sauper T, Mittermair R, Lanthaler M, Aigner F, Weiss H.

Department of General Surgery, University Hospital of Innsbruck, Anichstrasse
35, 6020 Innsbruck, Austria. hermann.nehoda@uibk.ac.at

HYPOTHESIS: Older patients experience the same benefits from a laparoscopic
gastric banding (LGB) operation as younger patients. DESIGN: A case series of
320 morbidly obese and superobese patients who underwent LGB within a 46-month
period. SETTING: University Hospital Innsbruck, General Surgical Department,
Innsbruck, Austria. PATIENTS: A consecutive sample of 320 patients who met the
criteria for a bariatric procedure and were aged 18 years or older. Patients
were divided into the following 2 age groups: younger patients (group A, 18-49
years) and older patients (group B, > or =50 years). INTERVENTION: Laparoscopic
gastric banding with an adjustable gastric band. MAIN OUTCOME MEASURES:
Clinicopathologic features, including weight loss, complications, length of
hospital stay, and operative times, were reviewed retrospectively, and a
multivariate analysis was carried out. RESULTS: Of 320 patients, we identified
68 older patients (21.5%, group B). The mean postoperative follow-up period was
12 months (range, 6-28 months). The average preoperative weight was 127.8 kg
(body mass index [calculated as weight in kilograms divided by the square of
height in meters], 44.29). The average total weight loss was 4.3 kg per month
for the first 3 months, reaching an average total of 31.0 kg after 1 year. The
excess weight loss after 12 months was 68%. Complications requiring reoperation
occurred in 10.3% of patients. Ninety-seven percent of the patients reported an
improvement in their comorbid conditions. CONCLUSIONS: Older patients receive
the same benefits from LGB as younger patients, with an acceptable postoperative
complication rate. Presently, our upper age limit is 70 years.

PMID: 11585511 [PubMed]

191: Dermatol Clin.  2001 Jul;19(3):483-9, ix.  


Narins RS.

Department of Dermatology, New York University School of Medicine, New York,

This is a basic overview of liposuction. Liposuction is the removal of fat using
cannulas (tubes) inserted through tiny incisions into the adipose tissue. When
done correctly, nice results can be safely achieved with a very easy procedure.

PMID: 11599405 [PubMed]

192: JAMA.  2001 Oct 3;286(13):1575-6.  

Comment on:
    JAMA. 2001 May 23-30;285(20):2582.

Liposuction in medical offices.

de Jong RH.

Publication Types:

PMID: 11585472 [PubMed]

193: Dis Colon Rectum.  2001 Sep;44(9):1362-4.  

Nonsteroidal anti-inflammatory drug-induced strictures of the colon: report of a
case and review of the literature.

Israel LH, Koea JB, Stewart ID, Wright CL, Frankish PD.

Department of Surgery, North Shore Hospital, Auckland, New Zealand.

The phenomenon of strictures of the colon induced by nonsteroidal
anti-inflammatory drugs is a newly recognized pathologic entity that has gained
little exposure in the surgical literature to date. A further case is reported
and the clinical features of this entity are discussed. Most patients present
with symptoms suggestive of malignancy, namely anemia, obstructive symptoms, or
weight loss. Pathologic changes are characterized by diaphragm-like strictures
with submucosal fibrosis. Surgical resection to exclude malignancy and treat
symptoms along with cessation of the nonsteroidal anti-inflammatory drug is the
treatment of choice.

Publication Types:
    Case Reports

PMID: 11584216 [PubMed]

194: Clin Orthop.  2001 Sep;(390):173-81.  

Efficacy of intraarticular hyaluronic acid injections in knee osteoarthritis.

Evanich JD, Evanich CJ, Wright MB, Rydlewicz JA.

Medical College of Wisconsin, Department of Orthopaedic Surgery, Milwaukee, USA.

Intraarticular injections of hyaluronic acid have been advocated for treatment
of symptomatic knee osteoarthritis. Appropriate indications and favorable
patient response factors, such as radiographic disease severity and age, are not
clearly defined for this therapy. The current review of 80 knees with
symptomatic osteoarthritis treated with hyaluronic acid revealed that
approximately 2/3 of treated knees received 2/3 relief of pain. Hyaluronic acid
treatment is not appropriate for all patients with knee osteoarthritis. Overall,
less than 50% of treated knees achieved satisfactory results, and only 35%
reported increased activity. Twenty-two patients (28% of knees; 22 knees)
underwent surgery within 7 months of their index injection, suggesting an
inadequate response to treatment. The treatment is not without complication
because 11 patients (15% of knees; 12 knees) experienced adverse reactions,
including one case of septic arthritis. The authors recommend intraarticular
hyaluronic acid only for patients with symptoms and significant surgical risk
factors and for patients with mild radiographic disease in whom conservative
treatment has failed (physical therapy, weight loss, nonsteroidal
antiinflammatory medication, and intraarticular steroid injection). It is
inadvisable to treat patients with a complete collapse of joint space or bone
loss with intraarticular hyaluronic acid, given their poor clinical response.

Publication Types:
    Clinical Trial

PMID: 11550864 [PubMed]

195: Plast Reconstr Surg.  2001 Sep 15;108(4):1084.  

A suggested solution for tumescent liposuction.

Pestana ID.

Publication Types:

PMID: 11547180 [PubMed]

196: Clin Nutr.  2001 Oct;20(5):439-43.  

Influence of parenteral nutrition on postoperative recovery in an experimental
model of peritonitis.

Sitges-Serra A, Hernandez R, Maestro S, Fernandez N, Girvent M, Sancho JJ.

Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain.

BACKGROUND AND AIMS: There seems to be no clear-cut indications for routine TPN
support after major elective surgery. The present study was designed to
investigate whether TPN could improve the results of standard surgical care for
acute peritonitis (laparotomy plus antibiotics). ANIMALS AND METHODS:
Peritonitis was induced in 48 New Zealand rabbits (day -2). On day 0,
appendectomy and peritoneal lavage were performed, ceftriaxone (250 mg, i.m./24
h.) was started and animals were randomly assigned to receive regular fluids
(RF), glucose-based TPN (G-TPN) or isocaloric fat-based TPN (F-TPN) for 6 days.
MAIN OUTCOME MEASURES: Balance studies (days 1-3), s-albumin, thyroid hormones
and urinary catecholamines were determined at various points of the experiment.
At postmortem, wound infection, residual intra-abdominal infection and
laparotomy wound breaking strength were recorded. RESULTS: Peritonitis produced
a fall in weight, s-albumin and T3. At day 6, weight-loss was more pronounced in
RF than in G-TPN or F-TPN (-7 vs 1.5 vs -1.2%;P=0.0001) but s-albumin and T3
concentrations were similar. Diuresis (377 vs 268 vs 269 mL/3 days; P=0.01) was
higher and water balance lower (373 vs 511 vs 480 mL/3 days; P=0.01) in Group
RF. Although the differences were not statistically significant (P<0.2),
persistent infection and wound breaking strength were slightly worse in the
pooled TPN groups compared with the RF group (19 vs 6% and 542 vs 701 g,
respectively). CONCLUSIONS: TPN failed to improve relevant biochemical markers
and clinical outcome after laparotomy for peritonitis. Copyright 2001 Harcourt
Publishers Ltd.

PMID: 11534939 [PubMed]

197: Ultrasound Med Biol.  2001 Jun;27(6):851-9.  

EPR analysis of radicals generated in ultrasound-assisted lipoplasty simulated

Topaz M, Motiei M, Gedanken A, Meyerstein D, Meyerstein N.

Hillel Yaffe Medical Center, Hadera, Israel. topazmd@netvision.net.il

The generation of various radicals by application of continuous wave (CW)
high-intensity ultrasound energy (HIUE) to an aqueous biologic medium containing
spin traps, under conditions simulating ultrasound-assisted lipoplasty (UAL),
was demonstrated by EPR spectroscopy. The addition of water- soluble
antioxidants, ascorbic acid and glutathione to the wetting solution
substantially reduces the levels of hydroxyl radicals in the sonicated medium.
These findings provide direct evidence for the generation of cavitation in the
simulated intercellular environment, corroborating previous data, and pointing
out that generation of transient cavitation in clinical UAL and other
therapeutic and surgical applications of ultrasound is possible. The findings
indicate that the effect of transient cavitation in aqueous biologic media may
be similar to the effects of ionizing radiation, and raise the question of the
long-term biosafety of the use of CW HIUE in UAL. The introduction of
biocompatible water-soluble antioxidants to the sonicated medium may be utilized
to suppress accumulation of radicals and reduce their possible adverse effects.

PMID: 11516545 [PubMed]

198: Ann Plast Surg.  2001 Aug;47(2):115-8.  

Liposuction as an adjunct procedure in reduction mammaplasty.

Price MF, Massey B, Rumbolo PM, Paletta CE.

Division of Plastic and Reconstructive Surgery, St Louis University Hospital, MO
63110-0250, USA.

Liposuction has been recognized as a useful adjunct to breast reduction surgery
for fine contouring of adjacent areas to achieve aesthetic balance and
preservation of nipple sensation. In particular, the liposuction technique has
provided an acceptable way of treating the "fat roll" of the lateral portion of
the breast, which extends to the axilla and lateral chest. The purpose of this
study was to review the authors' approach to adjunctive lipoplasty with breast
reduction surgery and to review their experience. Examination of their own
results in 70 consecutive women who underwent reduction mammaplasty in 1998 by
the senior surgeon did not reveal any substantial difference in the complication
rate of those women who had adjunctive liposuction with their breast reduction
surgery vs. those who did not. All complications such as fat necrosis,
cellulitis, and seromas were confined to the breast and were not related to the
liposuction. Furthermore, there was no additional morbidity associated with
ultrasonic liposuction compared with traditional suction-assisted lipectomy.
Their experience indicates that patients undergoing reduction mammaplasty may
benefit aesthetically from adjunct lateral chest wall liposuction without
additional morbidity.

PMID: 11506317 [PubMed]

199: Dtsch Tierarztl Wochenschr.  2001 Jul;108(7):283-90.  

[Animal-derived feeds as possible vectors for bovine spongiform encephalopathy
(BSE) in Germany. 1. Comparative risk assessment for a single animal food of
animal origin]

[Article in German]

Kamphues J, Zentek J, Oberthur RC, Flachowsky G, Coenen M.

Institut fur Tierernahrung, Tierarztliche Hochschule Hannover.

The occurrence of BSE cases in Germany after the ban of meat and bone meal for
ruminant feed in 1994 requires a detailed investigation of animal derived
feedstuffs regarding their specific risks as vectors for the disease. Accepting
the theory that BSE is a prion transmitted disease, the theoretical infectious
potential was calculated for animal derived feedstuffs. This calculation was
based on the assumption, that risk material (brain, spinal cord) of one
clinically diseased cattle was rendered in the process as established in Germany
(133 degrees C, 3 bar, 20 min) or, alternatively, that one diseased animal was
slaughtered resulting in normal processing of the by-products for human food
production. From this risk assessment it became obvious that meat and bone meal
was one, but probably not the most important source for the spreading of BSE.
Taking into account the high sensitivity of calves it can be speculated that
certain products, e.g. from bone processing (bone meal) and fat melting (mixed
animal fats), commonly used for the formulation of milk replacers, might have
been more important as pathways. As it can't be excluded retrospectively that
infected meat and bone meal was imported from the UK, this non-calculable
influence may have been related to the significance of the other products. The
calculation model underlines that efficient removal of specified risk material
(brain, spinal cord) and adequate processing (133 degrees C, 3 bar, 20 min) or
alternatively other equivalent treatments of fats are prerequisites for
minimising the risk of feed borne transmission of BSE by animal derived
feedstuffs. The epidemiological consequences are part of a subsequent paper.

PMID: 11505845 [PubMed]

200: Obes Surg.  2001 Aug;11(4):491-5.  

Outcome of biliopancreatic diversion in subjects with Prader-Willi Syndrome.

Marinari GM, Camerini G, Novelli GB, Papadia F, Murelli F, Marini P, Adami GF,
Scopinaro N.

Semeiotica Chirurgica R, University of Genoa School of Medicine, Largo Rosanna
Benzi 8, 16132 Genova, Italy. marinari@unige.it

BACKGROUND: In Prader-Willi Syndrome (PWS), mental retardation and compulsive
hyperphagia cause early obesity, the co-morbidities of which lead to short
life-expectancy, with death usually occurring in their 20s. Long-term weight
loss is mandatory to lengthen the survival; therefore, the lack of compliance in
voluntary food restriction requires a surgical malabsorptive approach. METHODS:
15 PWS subjects were submitted to biliopancreatic diversion (BPD) and followed
(100%) for a mean period of 8.5 (4-13) years. BPD consists of a distal
gastrectomy with a long Roux-en-Y reconstruction which, by delaying the meeting
between food and biliopancreatic juices, causes an intestinal malabsorption.
Indication for BPD was BMI > 40 or > 35 with metabolic complications.
Preoperative mean age was 21 +/- 5 years, mean weight 127 +/- 26 kg, and mean
Body Mass Index (BMI, kg/m2) 53 +/- 10. According to Holm's criteria, all of the
subjects had a total score > or = 8. IQ assessment was performed in each
subject, with a mean score of 72 +/- 10. An arbitrary lifestyle score was given
to each subject. RESULTS: No perioperative complications were observed. Percent
excess weight loss (%EWL) was 59 +/- 15 at 2 years and 56 +/- 16 at 3 years, and
then progressive regain occurred; at 5 years %EWL was 46 +/- 22 and at 10 years
40 +/- 27. Spearman rank test failed to demonstrate any correlation between
weight loss at 5 years and patient data, except with lifestyle score (Spearman r
= 0.8548, p < .0001). Current mean age is 31 +/- 7 years. CONCLUSION: BPD has to
be considered for its value in prolonging and qualitatively improving the PWS
patient's life.

PMID: 11501362 [PubMed]

201: Obes Surg.  2001 Aug;11(4):475-81.  

Obesity-associated disorders before and after weight reduction by vertical
banded gastroplasty in morbidly vs super obese individuals.

Melissas J, Christodoulakis M, Schoretsanitis G, Sanidas E, Ganotakis E,
Michaloudis D, Tsiftsis DD.

Bariatric Unit, Department of Surgical Oncology, University Hospital, Medical
School, University of Crete, Heraklion, Crete, Greece. melissas@med.uoc.gr

BACKGROUND: The amount of excess weight which must be lost in order to cure or
to improve disorders associated with obesity remains unknown. This study was
designed to compare super obese and morbidly obese patients in terms of weight
reduction following VBG and to investigate the effects of postoperative weight
changes to preexisting co-morbidities. METHODS: 125 patients underwent VBG.
Group A consisted of 80 morbidly obese patients (64%) and group B consisted of
45 super obese patients (36%). Preoperative examination was planned to identify
and determine the severity of any disorders associated with obesity, that the
patients may have had. Following VBG, all patients were followed-up at regular
time periods, for at least 2 and up to 4 years. The progress of preexisting
co-morbidities was evaluated and carefully recorded. RESULTS: Among the 80
patients of Group A, there were 240 total co-morbidities (3 per patient), and in
group B there were 196 co-morbidities (4.35 per patient) preoperatively. Dyspnea
during fatigue and arthritis were found at statistically higher incidence in the
super obese category. At the end of the second postoperative year, greater
weight loss in terms of number kilograms was seen in patients in group B, but
these patients did not reach a BMI lower than 35, while patients in group A had
mean BMI below 30. In group A, 66% of the co-morbidities completely resolved,
19% significantly diminished and 15% remain unchanged. In group B, the
respective percentages were 53%, 27.5% and 19.5%. However, after weight
reduction by VBG a significant number of co-morbidities remain in the super
obese patients (92 or 2.044 per/patient), and this is believed to be due to the
greater remaining excess weight. CONCLUSION: Reduction of body weight by VBG is
associated with resolution or improvement of a significant number of the
obesity-associated disorders. However, super obese patients remain obese after
surgery, and this results in two-fold higher remaining morbidity.

PMID: 11501359 [PubMed]

202: Plast Reconstr Surg.  2001 Aug;108(2):577-8.  

Comment on:
    Plast Reconstr Surg. 1995 Sep;96(3):603-15.
    Plast Reconstr Surg. 2000 Oct;106(5):1197-1202; discussion 1203-5.

Combined liposuction with abdominoplasty.

Heppe HP.

Publication Types:

PMID: 11496215 [PubMed]

203: Plast Reconstr Surg.  2001 Aug;108(2):556-61; discussion 562-3.  

Body mass index: risk predictor for cosmetic day surgery.

de Jong RH.

Department of Anesthesiology, Jefferson Medical College, Philadelphia, PA, USA.

Body mass index (BMI; weight per unit surface area) is the scientific yardstick
by which overweight is gauged relative to the population norm. The contrary
association between obesity and diabetes or hypertension is only too well known.
Less appreciated is the heightened sensitivity to respiratory depressants such
as sedatives and analgesics in the obese (BMI >/= 30) and the increased
incidence of sleep apnea in the morbidly obese (BMI >/= 35)-either or both of
which raise the risk of cosmetic surgery when sedation or anesthesia is
contemplated. Guided by the BMI, a gender-independent measure of fatness, the
surgeon now can inform the patient of her or his relative operative risk and
offer an objective rationale for advising overnight hospitalization rather than
office-based day surgery.The BMI is readily calculated when height and weight
are expressed in metric units, much less so when measured in foot-pound units.
In fact, the calculations are sufficiently cumbersome that the BMI remains
underused in U.S. office surgery. The author's complimentary "BMI Calculator"-an
Excel workbook available on-line to society members-is designed so that office
staff need enter only height (in feet and inches) and weight (in pounds) to
print the BMI for the patient's permanent record.The BMI places patient weight
relative to height in proper perspective for aesthetic surgery, whether with
sedation or under general anesthesia. The BMI ought to be as routine a part of
the preoperative assessment as blood pressure or hemoglobin content.

PMID: 11496206 [PubMed]

204: Dermatol Surg.  2001 Aug;27(8):735-8.  

The efficacy of powered liposuction.

Coleman WP 3rd, Katz B, Bruck M, Narins R, Lawrence N, Flynn TC, Coleman WP,
Coleman KM.

Department of Dermatology, Tulane University Health Sciences Center, New
Orleans, Louisiana, USA.

BACKGROUND: Powered liposuction is a relatively new innovation for more
efficient removal of adipose tissue. OBJECTIVE: To evaluate the effectiveness of
powered liposuction in removing adipose tissue when compared to traditional
liposuction. METHODS: Four powered liposuction devices were evaluated in the
power on mode vs. the power off. The fat extracted in each of these modes was
measured in a mucous specimen trap. RESULTS: There was increased fat extraction
in the powered mode for all instruments. The increased rate of fat extraction
varied from 20 to 45% between instruments. the overall increased extraction in
powered vs. nonpowered mode was 30%. CONCLUSION: The powered liposuction devices
tested significantly increase the efficacy of subcutaneous fat removal during

Publication Types:
    Evaluation Studies

PMID: 11493297 [PubMed]

205: Clin Exp Rheumatol.  2001 Jul-Aug;19(4):484.  

Sclerodermic lesions after liposuction in a patient with Raynaud's phenomenon
and anti-centromeric antibodies.

Galeazzi M, De Pita O, Porciello G, Bellisai F.

Publication Types:
    Case Reports

PMID: 11491519 [PubMed]

206: Postgrad Med J.  2001 Aug;77(910):506-11.  

Pharyngeal pouch (Zenker's diverticulum).

Siddiq MA, Sood S, Strachan D.

Department of Otorhinolaryngology, Head and Neck Surgery, Bradford Royal
Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK. azher@excite.co.uk

Pharyngeal pouches occur most commonly in elderly patients (over 70 years) and
typical symptoms include dysphagia, regurgitation, chronic cough, aspiration,
and weight loss. The aetiology remains unknown but theories centre upon a
structural or physiological abnormality of the cricopharyngeus. A diagnosis is
easily established on barium studies. Treatment is surgical via an endoscopic or
external cervical approach and should include a cricopharyngeal myotomy.
Unfortunately pharyngeal pouch surgery has long been associated with significant
morbidity, partly due to the surgery itself and also to the fact that the
majority of patients are elderly and often have general medical problems.
External approaches are associated with higher complication rates than
endoscopic procedures. Recently, treatment by endoscopic stapling
diverticulotomy has becoming increasingly popular as it has distinct advantages,
although long term results are not yet available. The small risk of developing
carcinoma within a pouch that is not excised remains a contentious issue and is
an argument for long term follow up or treating the condition by external
excision, particularly in younger patients.

Publication Types:
    Review, Tutorial

PMID: 11470929 [PubMed]

207: Lab Anim.  2001 Jul;35(3):213-22.  

Influence of buprenorphine analgesia on post-operative recovery in two strains
of rats.

Jablonski P, Howden BO, Baxter K.

Monash University, Department of Surgery, Monash Medical Centre, Clayton,
Victoria, Australia.

The objective of this study was to establish an effective post-operative
analgesic regimen for Sprague-Dawley (SD) and Dark Agouti (DA) rats.
Buprenorphine (0.01 or 0.05 mg/kg), a partial mu opioid agonist, was
administered subcutaneously immediately on completion of a standardized surgical
procedure, involving anaesthesia, laparotomy and visceral manipulation. Two of
the four treatment groups and the saline control group received a second
injection 9 h later. Behavioural observations by three independent observers
provided no information in assessing pain in this model. All rats lost weight,
consumed less food and water after surgery. On the first day, both SD and DA
rats receiving buprenorphine lost less weight than untreated control groups.
Using weight loss as an efficacy criterion, low-dose buprenorphine, given once
or twice, provided effective analgesia in SD rats. A higher single dose provided
no additional benefit and a second dose was detrimental, reducing body weight
and food intake. In DA rats, the high dose, given twice, appeared to be more
effective than the lower dose. All DA cage cohorts consumed < 10% pre-operative
food despite buprenorphine treatment, suggesting a higher dosage may be
necessary. However, all SD and 80% DA rats who received no buprenorphine gained
body weight on the second day, whereas most of the buprenorphine-treated rats
continued to lose weight for another 2 days, despite increased food consumption
by both strains. Buprenorphine may adversely affect intestinal function over a
number of days due to its enterohepatic circulation; this effect may be more
severe in DA rats. Adverse metabolic effects of buprenorphine and other opioids
may preclude their use in the future if it can be shown that non-steroidal
anti-inflammatory drugs (NSAIDs) provide equally effective analgesia.

PMID: 11459404 [PubMed]

208: J Wound Ostomy Continence Nurs.  2001 Jul;28(4):219-22.  

Surgical and nonsurgical options for a patient with a retracted stoma and
peristomal skin crease.

Haugen V, Loehner D.

Fairview Southdale Hospital, Edina, Minnesota 55435, USA.

Publication Types:
    Case Reports

PMID: 11452259 [PubMed]

209: Am J Surg.  2001 May;181(5):454-8.  

A prospective evaluation of dietary status and symptoms after near-total
esophagectomy without gastric emptying procedure.

Ludwig DJ, Thirlby RC, Low DE.

Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical
Center, 1100 9th Avenue, C6-GSUR, Seattle, WA 98111, USA.

BACKGROUND: After esophagectomy, the stomach is the most commonly utilized
reconstructive conduit. There remains debate among surgeons regarding the
requirements for pyloroplasty/pyloromyotomy following reconstruction. We present
a series of patients having undergone near total esophagectomy and
reconstruction with gastric tube without gastric emptying procedure to analyze
critically these patients' ability to reestablish a subjectively acceptable and
nutritionally adequate eating pattern without significant side effects of early
satiety, dumping, or diarrhea. METHODS: Between 1991 and 1998, 48 patients
underwent esophagectomy utilizing this technique and were available for
long-term follow-up and nutritional assessment. Patient weights were recorded at
2 weeks, 6 months, and 1 year and a telephone interview conducted at a mean of
36 months postoperatively for the evaluation of eating patterns and symptoms. A
subgroup of these patients (32 of 48) completed a 3-day dietary record that was
assessed by a certified nutritionist. This patient group included 10 patients
(21%) who had received perioperative chemoradiotherapy. RESULTS: Dietary intake
was characterized as normal or minimally limited in 41 patients (85%). Those who
had received perioperative chemoradiotherapy needed no significant increased
time to return to a normal dietary baseline (6.1 versus 5.9 months). Mean weight
loss prior to surgery was 3 kg. Weight loss continued for the first 6 months
(mean 10 kg); however, 63% were able to gain weight from 6 months to 1 year
following surgery (mean 3 kg). Most patients were overweight prior to operation
(mean 115% of ideal body weight) and achieved a new postoperative baseline (mean
104% of ideal body weight) at 1 year. Patients demonstrated a mean daily caloric
intake of 2,179 kilocalories per day, which was 98% of recommended according to
their ideal body weight. Postoperative symptoms of short-term nausea (19%),
occasional dysphagia with certain foods (38%), mild increased stool frequency
(15%), and occasional regurgitation (25%) were noted. CONCLUSIONS: Near-total
esophagectomy with verticalized gastric tube without a gastric emptying
procedure is well tolerated and allows a return to subjectively acceptable and
nutritionally appropriate dietary eating pattern without significant associated
side effects.

PMID: 11448442 [PubMed]

210: Br J Plast Surg.  2001 Jul;54(5):396-9.  

Emergency treatment of accidental infusion leakage in the newborn: report of 14

Casanova D, Bardot J, Magalon G.

Department of Plastic and Reconstructive Surgery, Hopital de la Conception,
Marseilles, France.

Infusion leakage in the paediatric population of the intensive-care unit is
known to cause skin necrosis and significant scarring around tendons, nerves and
joints, extending the length of hospital stay. We report a series of 14 newborn
children affected by accidental infusion leakage, and their early treatment with
Gault's procedure: saline flush-out and liposuction. The results were good:
there was no skin impairment in 11 cases and three cases of skin necrosis healed
spontaneously. Early treatment of toxic infusion leakage in neonates is
recommended to avoid skin necrosis at the site of extravasation. The two
procedures proposed by Gault are simple and effective in such cases. They should
be employed as early as possible in order to dilute and remove the toxin from
the subcutaneous tissue. Copyright 2001 The British Association of Plastic

PMID: 11428769 [PubMed]

211: Surg Endosc.  2001 Apr;15(4):393-7. Epub 2001 Feb 06. 

Laparoscopic gastric bypass as a reoperative bariatric surgery for failed open
restrictive procedures.

de Csepel J, Nahouraii R, Gagner M.

Division of Laparoscopic Surgery, Mount Sinai Medical Center, One Gustave L.
Levy Place, #1103, New York, NY 10029, USA.

An estimated 2% of men and 6% of women in the United States are morbidly obese.
These patients have a mortality rate that is six to twelve times greater than
their normal-weight peers. In these extreme cases of overweight, only surgical
intervention can produce substantial and sustained weight loss. However, up to
20% of these patients will require reoperation for failure to achieve or
maintain an adequate weight loss. Reoperative bariatric surgery can be
challenging and has traditionally been performed as an open procedure. We
present seven female patients who underwent a laparoscopic Roux-en-Y gastric
bypass after failing to achieve their weight-loss goals with prior open
restrictive procedures. Their average BMI before surgical revision was 42.2
kg/m2. Mean operative time was 4 h 20 min, and length of hospital stay was 4.1
days. There were three complications in two patients and no deaths. Our initial
experience suggests that laparoscopic gastric bypass is a safe and feasible
reoperative bariatric procedure. Confirmation awaits a larger series of patients
with follow-up data.

PMID: 11395822 [PubMed]

212: Plast Reconstr Surg.  2001 Jun;107(7):1869-73.  

Complications of abdominoplasty in 86 patients.

van Uchelen JH, Werker PM, Kon M.

Department of Plastic, Reconstructive, and Hand Surgery, Division of Surgery,
University Medical Center Utrecht, The Netherlands.

A total of 101 consecutive abdominoplasty patients were reviewed
retrospectively. Of these, 14 male (mean age at time of operation, 34.3 years;
range, 23 to 53 years) and 72 female (mean age at time of operation, 38.9 years;
range, 19 to 64 years) patients had adequate documentation for inclusion in this
study.Complications were recorded as either wound complications (wound
infection, partial wound dehiscence, seroma, hematoma, and skin edge necrosis)
or complications after surgery (deep vein thrombosis, pulmonary emboli, ileus,
sensibility disorder of the skin of the thighs, and death). The complications
were subsequently correlated for sex, race, the patient's age at surgery, body
mass index before surgery, and the seniority of the surgeon.Nine male patients
(64.3 percent) and 11 female patients (15.3 percent) had wound complications.
Almost 10 percent of our patients sustained an injury to the lateral cutaneous
nerve of the thigh.Male patients should be informed about their possible higher
risk of complications, and special attention must be given by the surgeon to the
prevention of such complications.Moreover, specific attention must be given to
the preservation of the lateral cutaneous nerves of the thigh in both male and
female patients undergoing abdominoplasties.

PMID: 11391211 [PubMed]

213: Nephrol Dial Transplant.  2001 Jun;16(6):1273-6.  

Severe obesity in haemodialysis: the utility of bioimpedance vector analysis.

Fusaro M, Munaretto G, Urso M, Bonadonna A, Mastrosimone S, Virga G, Piccoli A.

Nephrology and Dialysis Units, Hospital of Chioggia, Strada Madonna Marina 500,
I-30015 Chioggia (VE), Italy.

Publication Types:
    Case Reports

PMID: 11390733 [PubMed]

214: Br J Oral Maxillofac Surg.  2001 Jun;39(3):196-203.  

Effect of partial immobilization on reconstruction of ankylosis of the
temporomandibular joint with an autogenous costochondral graft:an experimental
study in sheep.

Matsuura H, Miyamoto H, Ishimaru J, Kurita K, Goss AN.

Oral and Maxillofacial Surgery Unit, Dental School, The University of Adelaide,
Adelaide, South Australia. matsuura@dpc.aichi-gakuin.ac.jp

The purpose of this study was to show the effect of partial immobilization of a
costochondral graft reconstruction of an ankylosed temporomandibular joint (TMJ)
in five adult sheep. Ankylosis was induced in all right TMJs. At three months, a
graft was inserted and partially immobilized. Three months after the second
operation, four sheep were killed by an overdose with pentothal. One sheep was
killed at one month because of infection. Functionally, the body weight, which
decreases with ankylosis, did not recover after insertion of the graft and the
range of jaw movements got worse. Histologically, the grafts were well attached
to the mandibular rami in three of four joints. In one joint, the graft showed
signs of resorption and a foreign body reaction. We conclude that, if the
reconstructed joint is partially immobilized, then there will be a degree of
reankylosis. There was also a high failure rate.

PMID: 11384116 [PubMed]

215: ANZ J Surg.  2001 May;71(5):309-17.  

Ultrasound-assisted lipoplasty.

Cooter R, Babidge W, Mutimer K, Wickham P, Robinson D, Kiroff G, Chapman A,
Maddern G.

Australian Safety and Efficacy Register of New Interventional
Procedures-Surgical (ASERNIP-S), Royal Australian College of Surgeons, North

BACKGROUND: Ultrasound-assisted lipoplasty (UAL) has been associated with
particular types of complications and uncertain long-term effects arising from
interactions between ultrasonic energy and living tissue. The present review
seeks to address these issues. METHODS: Search strategy Three search strategies
were devised to retrieve literature from Medline, Current Contents, Embase and
Cochrane Library databases up until April 2000. Study selection Inclusion of
papers was largely determined using a predetermined protocol. English language
papers were selected. Acceptable study designs included randomized controlled
trials, controlled clinical trials, case series or case reports. Data collection
and analysis Thirty-six papers met the inclusion criteria. They were tabulated
and critically appraised in terms of methodology and design, outcomes, and the
possible influence of bias, confounding and chance. Other papers were also
included to provide background material. RESULTS: There was little high-level
evidence available comparing UAL and suction-assisted lipoplasty (SAL), with no
conclusive evidence that UAL has a safety benefit, although low-quality evidence
suggests that UAL is associated with reduced surgeon fatigue as well as
increased operating times, slower aspiration rates and an increased learning
curve. There is inadequate evidence to determine whether the theoretical
potential for DNA damage from ultrasound is realized in the clinical setting.
CONCLUSIONS: The evidence base for UAL is inadequate to determine the
procedure's safety and efficacy. The potential for DNA damage must be
investigated with appropriate in vivo animal models. Recommendations for the
safe use of UAL are discussed.

Publication Types:
    Review, Tutorial

PMID: 11374483 [PubMed]

216: Transplantation.  2001 Apr 27;71(8):1076-88.  

Reduction in immunosuppression as initial therapy for posttransplant
lymphoproliferative disorder: analysis of prognostic variables and long-term
follow-up of 42 adult patients.

Tsai DE, Hardy CL, Tomaszewski JE, Kotloff RM, Oltoff KM, Somer BG, Schuster SJ,
Porter DL, Montone KT, Stadtmauer EA.

Hematologic Malignancies Program, University of Pennsylvania Cancer Center,
Philadelphia 19104, USA. detsai@mail.med.upenn.edu

BACKGROUND: Posttransplant lymphoproliferative disorder (PTLD) is an
Epstein-Barr virus-associated malignancy that occurs in the setting of
pharmacologic immunosuppression after organ transplantation. With the increased
use of organ transplantation and intensive immunosuppression, this disease is
becoming more common. We explore reduction in immunosuppression as an initial
therapy for PTLD. METHODS: We analyzed our organ transplant patient database to
identify patients with biopsy-proven PTLD who were initially treated with
reduction of their immunosuppressive medications with or without surgical
resection of all known disease. RESULTS: Forty-two adult patients were included
in this study. Thirty patients were treated with reduction in immunosuppression
alone. Twelve patients were treated with both reduction in immunosuppression and
surgical resection of all known disease. Thirty-one of 42 patients (73.8%)
achieved a complete remission. Of those patients who were treated with reduction
in immunosuppression alone, 19 of 30 (63%) responded with a median time to
documentation of response of 3.6 weeks. Multivariable analysis showed that
elevated lactate dehydrogenase (LDH) ratio, organ dysfunction, and multi-organ
involvement by PTLD were independent prognostic factors for lack of response to
reduction in immunosuppression. In patients with none of these poor prognostic
factors, 16 of 18 (89%) responded to reduction in immunosuppression in contrast
to three of five (60%) with one risk factor and zero of seven (0%) with two to
three factors present. The analysis also showed that increased age, elevated LDH
ratio, severe organ dysfunction, presence of B symptoms (fever, night sweats,
and weight loss), and multi-organ involvement by PTLD at the time of diagnosis
are independent prognostic indicators for poor survival. With median follow-up
of 147 weeks, 55% of patients are alive with 50% in complete remission.
CONCLUSIONS: Reduction in immunosuppression is an effective initial therapy for
PTLD. Clinical prognostic factors may allow clinicians to identify which
patients are likely to respond to reduction in immunosuppression.

PMID: 11374406 [PubMed]

217: Plast Reconstr Surg.  2001 Apr 15;107(5):1285-91; discussion 1292.  

Lipoplasty claims experience of U.S. insurance companies.

Bruner JG, de Jong RH.

University of California at Davis, Davis, CA, USA.

An analysis of medical liability claims for lipoplasty (liposuction) from
January of 1985 through June of 1998 compared the insurance industry experience
of plastic surgeons with that of other physicians. The Data Sharing Project
database of the Physician Insurers Association of America, a trade association
of professional liability companies owned and operated by medical professionals
that collectively insure approximately 60 percent of America's private practice
physicians, was queried. Of the nearly 45,000 total entries in the database, 292
were claims for adverse events related to lipoplasty or liposuction. These raw
data were stratified by physician specialty, severity of complication, practice
location, patient gender, indemnity payment, and other insurance
industry-relevant variables.To simplify interspecialty comparisons, we
normalized the claims rate to incidents per 100 insured physicians. The indexed
lipoplasty claims rate was 3.0 per 100 insured plastic surgeons and 4.1 for
other surgeons; the indexed lipoplasty claims rate for nonsurgical specialists
was 2.5 per 100 insured dermatologists and 2.3 for other nonsurgeons. The higher
claims rate for surgeons most likely reflects the wider scope of full-service
aesthetic surgery performed by surgical specialists. Nearly two-thirds of claims
(65.4 percent) during the 13-year survey period were the result of
hospital-based lipoplasty; 20.9 percent were office-based claims. The prevalence
of hospital-based claims may be a consequence of both historical bias introduced
by hospital-based specialty surgery in the early years and prudent patient
safety considerations during performance of complex or prolonged procedures in
more recent years.Two-thirds of the claims (67 percent) arose from
informed-consent or breach-of-contract issues, far higher than the 26 percent
aggregate claims norm. The mean indemnity payment was $94,534 per lipoplasty
claim; claims paid against board-certified specialists averaged $83,350.
Consistent with national lipoplasty demographics, 87 percent of claims were
brought by women and 13 percent were brought by men. Seven fatalities (three
women and four men) were noted; cause of death is not recorded in this type of

PMID: 11373574 [PubMed]

218: STEP Perspect.  1999 Winter;99(1):6-7.  

Unsolved mystery of fat redistribution.

[No authors listed]

AIDS: The first serious examination of the cause of lipodystrophy took place at
the 12th World AIDS Conference. Lipodystrophy, or fat redistribution syndrome,
is characterized by high levels of fat in the blood and fat deposits in the back
of the neck, abdomen, or breasts. The disorder can also be accompanied by a loss
of fat in the extremities, face and buttocks. Many cases of lipodystrophy in
PWAs have been linked to therapy with PIs. Researchers have also found the
syndrome in PWAs who have not taken PIs. Common treatments used for
lipodystrophy include growth hormones, diet and exercise, anabolic steroids, and
liposuction. Several studies presented at the conference examined how to
effectively combat HIV, while managing lipodystrophy symptoms. The most common
methods involved either switching to a non-PI regimen or adding a drug to treat
the complication. 

Publication Types:
    Newspaper Article

PMID: 11367164 [PubMed]

219: Posit Aware.  1999 Jul-Aug;10(4):59-63.  

Understanding and treating protease paunch.

Vazquez E.

AIDS: The changes and complications in metabolic status and lipodystrophy
stemming from HIV treatment are examined. Research results from international
conferences are discussed; topics include mechanisms of action and outcomes of
recent treatments for lipodystrophy. These therapies cite the benefits of diet
and exercise and the use of liposuction. Also examined are studies that
investigated the effects of switching HIV protease drugs. Concluding comments
address the possible connection between heart disease and lipodystrophy. 

Publication Types:
    Newspaper Article

PMID: 11366810 [PubMed]

220: Posit Dir News.  1999 Winter;11(1):20-2.  

Update on lipodystrophy.

[Article in English, Spanish]

Gaucher M.

AIDS: Lipodystrophy is defined as the defective metabolism of fat, and it is
characterized by distinct physical changes, such as an increased waist size or
an accumulation of fatty tissue at the base of the neck. Lipodystrophy may be
linked with protease inhibitor use and is sometimes called crixi-belly or
buffalo hump. High triglyceride levels are associated with lipodystrophy and can
lead to increased chances of heart disease, hardening of the arteries, and
pancreatitis. Women at risk for lipodystrophy should consider using a different
form of birth control if they are taking oral contraceptives. Contact
information is provided. 

Publication Types:
    Newspaper Article

PMID: 11366100 [PubMed]

221: Obes Surg.  2001 Feb;11(1):66-9.  

Comment in:
    Obes Surg. 2003 Apr;13(2):317.

Use of adjustable silicone gastric banding for revision of failed gastric
bariatric operations.

Kyzer S, Raziel A, Landau O, Matz A, Charuzi I.

Department of Surgery B, Wolfson Medical Center, Holon, Israel.

BACKGROUND: Revision of gastric bariatric operations is sometimes technically
difficult and may fail to achieve prolonged weight reduction. The use of the
adjustable silicone gastric banding (ASGB) offers a new approach for these
revisions. METHODS: ASGB was performed as a revisional procedure on 37 patients
whose initial bariatric operations were as follows: silastic ring vertical
gastroplasty (21), gastric bypass (12), horizontal gastroplasty (3) and vertical
banded gastroplasty (1). RESULTS: The length of the procedure varied from 55 to
145 minutes (mean 83 minutes). Intraoperative complications included two fundic
tears which were sutured without any postoperative sequelae. Five patients
needed reoperation during the first postoperative year due to gastric volvulus
(1), tubing tear (1) and development of postoperative ventral hernia (3). BMI
fell from 44.8+/-SD 8.07 to 33.4+/-6.9 kg/m2 for patients operated with BMI
higher than 35 kg/m2 and from 29.2+/-3.32 to 25.4+/-2.8 kg/m2 for patients
operated with BMI lower than 35 kg/m2. CONCLUSIONS: ASBG can be performed with
revisions with an acceptable complication rate and postoperative weight

PMID: 11361171 [PubMed]

222: Obes Surg.  2001 Feb;11(1):18-24.  

Prospective comparative evaluation of stapled versus transected silastic ring
gastric bypass: 6-year follow-up.

Fobi MA, Lee H, Igwe D Jr, Stanczyk M, Tambi JN.

Center for Surgical Treatment of Obesity, Hawaiian Gardens, CA, USA.

BACKGROUND: The effect of transecting vs. stapling the stomach in continuity in
the banded gastric bypass (GBP) operation was studied. METHOD: 50 patients, 25
in each group, were enrolled into a prospective study to determine if
transecting the stomach vs. stapling it in continuity in performing GBP for
obesity decreases the incidence of gastro-gastric fistula formation without
increased morbidity. RESULTS: The patient profiles in the 2 groups were very
similar. The peri-operative complications included 1 splenic capsular injury in
each group, controlled without a splenectomy. There was 1 anastomotic leak in
the stapled and 1 bleeding from the cut edge of the bypassed stomach in the
transected group, both requiring re-operations in the immediate postoperative
period. There was no peri-operative mortality. The percent follow-up after 6
years was 80% and 88% in the stapled and transected groups respectively. The
incidence of late complications of solid food intolerance, ventral incisional
hernia, cholelithiasis and small bowel obstruction was similar in both groups.
There were 8 gastro-gastric fistulas in the stapled group and 1 in the
transected group. The reduction in body mass index and percent excess weight
loss (66%) were similar in both groups. CONCLUSION: The incidence of
gastro-gastric fistula may be reduced in GBP procedures by transecting the
stomach as opposed to stapling it in continuity, without an increase in
morbidity or mortality or any loss in the effectiveness of the operation.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 11361162 [PubMed]

223: Obes Surg.  2001 Apr;11(2):229-31.  

Initial experience with laparoscopic adjustable gastric banding and pouch
dilatation: two cases.

Neri A, Mariani F, Testa M, Piccolomini A, Vuolo G, Guarnieri A, Carli AF, Di
Cosmo L.

Centro di Studio Interdisciplinare per il Trattamento della Grande Obesita,
Surgical Sciences Institute, University of Siena, Italy.

BACKGROUND: Late proximal pouch dilatation (LPPD) has occurred occasionally
following gastric banding for morbid obesity. At present, laparoscopic
conservative resetting and oversuturing of the band is considered the standard
procedure for pouch dilatation without any important posterior component.
METHODS: Two cases of LPPD are presented, which occurred in our initial
experience with the Lap-Band, corrected via a laparoscopic approach. RESULTS:
The reintervention was necessary in both patients, with conservative
laparoscopic repositioning and oversuturing of the band in the first case and
laparoscopic substitution of the gastric band in the second. We have not
observed further complications, and weight loss has been maintained in a midterm
outcome in both cases (30 and 18 months follow-up). CONCLUSIONS: LPPD can be
corrected with a conservative laparoscopic surgical approach, without
complications and negative functional effects on mid-term outcome.

PMID: 11357837 [PubMed]

224: Obes Surg.  2001 Apr;11(2):183-9.  

Revisional bariatric surgery--safe and effective.

Jones KB Jr.

Christus Schumpert Health System and Doctors Hospital, Shreveport/Bossier City,
LA, USA. pbsurgkj@aol.com

BACKGROUND: Revision operations have traditionally been considered difficult and
associated with a high complication and long-term failure rate. This paper
demonstrates that revision and/or conversions to Roux-en-Y gastric bypass are
generally safe as well as effective in long-term weight maintenance and control
of co-morbidities. METHODS: A retrospective study from January 1989 through
August 1999 was done involving 141 patients who had had various gastroplasty
(118), gastric banding (6), jejunoileal bypass (3), or loop (2) and Roux-en-Y
gastric bypass (RYGBP) procedures (12), with either technical failures or poor
long-term maintained weight loss. RESULTS: The demographics were: mean
pre-operative weight at original surgery 264 lbs (120 kg); postop weight at a
mean elapsed time since surgery of 5 years, 4 months: 188 lbs (85 kg), or a mean
excess weight loss of 59%. The mean BMI dropped from a pre-op 45 to a post-op
31. There were 7 complications which required emergency surgery (5%), which
included 4 leaks, 2 subphrenic abscesses, and 1 wound dehiscence. Other
complications included 4 hernias, 3 staple-line failures, 1 transient renal
failure, and 3 incidences of peptic ulcer disease requiring surgery, giving a
total major complication rate of 13% in 17 patients, with no deaths. An earlier
experience of this author comparing conversion RYGBP vs revision gastroplasty
found better morbidity rates and weight loss with those converted to RYGBP.
CONCLUSION: Converting failed gastric limiting and other bariatric procedures to
RYGBP was safe and effective. Technical approaches to each problem type
encountered are presented.

PMID: 11355024 [PubMed]

225: Ann Plast Surg.  2001 May;46(5):573-4.  

Long-standing seroma after ultrasound-assisted liposuction.

Agaoglu G, Erol OO.

Publication Types:
    Case Reports

PMID: 11352435 [PubMed]

226: Med Health R I.  2001 Apr;84(4):142-3.  

"But are you really sure?": requiring psychiatric proof of patients' informed
consent prior to elective surgery.

Geffroy M, Vernaglia LW.

Publication Types:
    Case Reports

PMID: 11347355 [PubMed]

227: Environ Int.  2000 Aug;26(1-2):17-22.  

Upgrading the conventional grease trap using a tube settler.

Chu W, Ng FL.

Department of Civil & Structural Engineering, Hong Kong Polytechnic University,
Hung Hom, Kowloon, Hong Kong. cewchu@polyu.edu.hk

Grease traps are widely used by most restaurants and food processing industries
in Hong Kong to reduce oil and grease to an acceptable level before it can be
discharged to public sewers. To meet demanding effluent standards in the future,
it is necessary to polish the effluent by upgrading the conventional trap
design. This study evaluated the possibility of upgrading traditional grease
traps by installing tube settlers inside the trap. Their efficiency of removing
chemical oxygen demand (COD) and oil/grease was examined to justify the
performance. It was found that installing a tube settler is a feasible and cheap
way to upgrade the conventional grease trap, since it improved oil/grease
removal efficiency by 8-10% compared to the conventional design. In addition, a
remarkable improvement in COD removal was observed following a very short
hydraulic detention time after the installation of tube settlers. This ensured
acceptable effluent quality under peak flowrates. Two mathematical models were
also proposed to facilitate trap design.

Publication Types:
    Evaluation Studies

PMID: 11345733 [PubMed]

228: Zentralbl Gynakol.  2001 Mar;123(3):153-7.  

[Liposuction for "body contouring" in gynecology]

[Article in German]

Regidor PA, Schmidt M, Walz KA, Regidor M, Winkler UH, Bier UW, Schindler AE.

Abteilung fur Gynakologie des Zentrums fur Frauenheilkunde der Universitat-GH
Essen. pedro-antonio.regidor@uni-essen.de

OBJECTIVES: The aim of this study was to describe the possible use of the
ultrasound-assisted liposuction and liposuction with the tumescent technique for
the contouring and remodelling of superficial fat areas of women in the field of
gynaecology. PATIENTS AND METHODS: Between 1997 and 1999 85 healthy female
patients underwent a liposuction in the department of gynaecology of the
university of Essen. The patients were divided into two groups. Thirty patients
(group 1) underwent an ultrasound-assisted liposuction whereas the remaining 55
patients (group 2) were operated using only the tumescent technique. RESULTS:
From the operated 582 body areas a large volume liposuction with the aspiration
of more than 1,000 cc fat was performed in 48.2% of the cases. In the remaining
51.8% of the cases aspiration volumes between 300 and 1,000 cc fat were
obtained. No statistically significant differences could be observed when
comparing the aspirat volumes between both treatment groups (p > 0.05). Serious
complications were not observed. DISCUSSION: Our data could show, that
liposuction is an extremely safe method for eliminating surperficial fat depots
in the sense of body contouring in gynaecology, but that it should not be used
for the reduction of obese body volumes. If ultrasound-assisted liposuction is
really superior to liposuction with the tumescent technique remaining uncertain,
no time gain could be observed due to this technique.

Publication Types:
    Evaluation Studies

PMID: 11340956 [PubMed]

229: Harv Womens Health Watch.  2001 Apr;8(8):8.  

By the way, doctor. I know about the benefits of liposuction. But what about the
downside? Does it cause much pain? How long does it take to recover? What about
regaining fat in the same location?

Robb-Nicholson C.

PMID: 11340041 [PubMed]

230: Ann Plast Surg.  2001 Apr;46(4):357-63.  

An outcomes analysis and satisfaction survey of 199 consecutive

Hensel JM, Lehman JA Jr, Tantri MP, Parker MG, Wagner DS, Topham NS.

Northeastern Ohio Universities College of Medicine, Rootstown, OH, USA.

Abdominoplasty is a popular body-contouring procedure. In this study the authors
review retrospectively 199 abdominoplasty patients during a 15-year period to
identify factors that affect overall outcome. Patients included 190 women and 9
men. The complication rate was 32% with few major complications (1.4%). The
revision rate was 43%, and was related to fine-tuning the aesthetic appearance.
Patients were divided into four groups based on tobacco use and history of
diabetes and hypertension. There was no significant difference in revision rates
or major complications between the subgroups. Minor complication rates, however,
were significantly higher in smokers and patients with diabetes and/or
hypertension. Complication and revision rates in patients undergoing
intra-abdominal procedures combined with abdominoplasty were not significantly
different from those patients undergoing abdominoplasty alone. A patient survey
revealed symptom improvement in 95% of patients. Eighty-six percent of patients
were satisfied with their result, and 86% would recommend abdominoplasty to a
friend. The authors conclude that abdominoplasty is a safe and satisfying
procedure, whether performed alone or in conjunction with another procedure.
Patients are pleased with the outcome and have improvement in their symptoms,
with minimal health risk. There is, however, a significant incidence of minor
complications, related primarily to wound healing. These complications are
increased significantly in smokers and patients with diabetes and/or
hypertension. Revision rates are not different significantly between the
subgroups. When complications do occur or revisions are required, they are minor
and managed easily in an office setting.

PMID: 11324875 [PubMed]

231: Int J Radiat Oncol Biol Phys.  2001 May 1;50(1):107-11.  

Clinically evident fat necrosis in women treated with high-dose-rate
brachytherapy alone for early-stage breast cancer.

Wazer DE, Lowther D, Boyle T, Ulin K, Neuschatz A, Ruthazer R, DiPetrillo TA.

Department of Radiation Oncology, New England Medical Center, Tufts University
School of Medicine, No. 359 750 Washington Street, Boston, MA 02111, USA.

PURPOSE: To investigate the incidence of and variables associated with
clinically evident fat necrosis in women treated on a protocol of high-dose-rate
(HDR) brachytherapy alone without external-beam whole-breast irradiation for
early-stage breast carcinoma. METHODS AND MATERIALS: From 6/1997 until 8/1999,
30 women diagnosed with Stage I or II breast carcinoma underwent surgical
excision and postoperative irradiation via HDR brachytherapy implant as part of
a multi-institutional clinical Phase I/II protocol. Patients eligible included
those with T1, T2, N0, N1 (< or = 3 nodes positive), M0 tumors of nonlobular
histology with negative surgical margins, no extracapsular lymph-node extension,
and a negative postexcision mammogram. Brachytherapy catheters were placed at
the initial excision, re-excision, or at the time of axillary sampling. Direct
visualization, surgical clips, ultrasound, or CT scans assisted in delineating
the target volume defined as the excision cavity plus 2-cm margin. High activity
(192)Ir (3-10 Ci) was used to deliver 340 cGy per fraction, 2 fractions per day,
for 5 consecutive days to a total dose of 34 Gy to the target volume. Source
position and dwell times were calculated using standard volume optimization
techniques. Dosimetric analyses were performed with three-dimensional
postimplant dose and volume reconstructions. The median follow-up of all
patients was 24 months (range, 12-36 months). RESULTS: Eight patients (crude
incidence of 27%) developed clinically evident fat necrosis postimplant in the
treated breast. Fat necrosis was determined by clinical presentation including
pain and swelling in the treated volume, computed tomography, and/or biopsy. All
symptomatic patients (7 of 8 cases) were successfully treated with 3 to 12
months of conservative management. Continuous variables that were found to be
associated significantly with fat necrosis included the number of source dwell
positions (p = 0.04), and the volume of tissue which received fractional doses
of 340 cGy, 510 cGy, and 680 cGy (p = 0.03, p = 0.01, and p = 0.01,
respectively). Other continuous variables including patient age, total excised
tissue volume, tumor size, number of catheters, number of days the catheters
were in place, planar separation, dose homogeneity index (DHI), and uniformity
index (UI) were not significant. Discrete variables including the
presence/absence of DCIS, sentinel versus full axillary nodal assessment,
receptor status, presence/absence of diabetes, and the use of chemotherapy or
hormone therapy were not found to have a significant association with the risk
of fat necrosis. CONCLUSIONS: In this study of HDR brachytherapy of the breast
tumor excision cavity plus margin, treatment was planned and delivered in
accordance with the dosimetric parameters of the protocol resulting in a high
degree of target volume dose homogeneity. Nonetheless, at a median follow-up of
24 months, a high rate of clinically definable fat necrosis occurred. The
overall implant volume as reflected in the number of source dwell positions and
the volume of breast tissue receiving fractional doses of 340, 510, and 680 cGy
were significantly associated with fat necrosis. Future dosimetric optimization
algorithms for HDR breast brachytherapy will need to include these factors to
minimize the risk of fat necrosis.

Publication Types:
    Clinical Trial
    Multicenter Study

PMID: 11316552 [PubMed]

232: Am J Med Sci.  2001 Apr;321(4):249-79.  

Pulmonary complications of obesity.

Koenig SM.

Department of Medicine, University of Virginia School of Medicine and the
University of Virginia Health System, Charlottesville 22908-00546, USA.

Obesity can profoundly alter pulmonary function and diminish exercise capacity
by its adverse effects on respiratory mechanics, resistance within the
respiratory system, respiratory muscle function, lung volumes, work and energy
cost of breathing, control of breathing, and gas exchange. Weight loss can
reverse many of the alterations of pulmonary function produced by obesity.
Obesity places the patient at risk of aspiration pneumonia, pulmonary
thromboembolism, and respiratory failure. It is the most common precipitating
factor for obstructive sleep apnea and is a requirement for the obesity
hypoventilation syndrome, both of which are associated with substantial
morbidity and increased mortality. There are numerous medical and surgical
therapies for obstructive sleep apnea and obesity hypoventilation. Weight
reduction in the obese is among the most effective of these measures.

Publication Types:
    Review, Academic

PMID: 11307867 [PubMed]

233: Head Neck.  2001 May;23(5):383-8.  

The buccal fat pad flap in oral reconstruction.

Dean A, Alamillos F, Garcia-Lopez A, Sanchez J, Penalba M.

Department of Oral and Maxillofacial Surgery, Reina Sofia University Hospital,
C/ Jose Ma Martorell 4, 2 -2, 14005 Cordoba, Spain. ADF10101@teleline.es

BACKGROUND: The aim of this study is to describe the surgical technique,
indications, advantages, and possible complications of the buccal fat pad flap
and to report our clinical experience with this flap for intraoral
reconstruction after tumor removal. METHODS: The flap has been used to
reconstruct oral defects after tumor resection in 32 patients, who have been
retrospectively analyzed. RESULTS: Adequate closure of the defect was achieved
during surgery in all cases. In one case, there was partial loss of the flap;
this was treated conservatively. In five cases there was some retraction in the
reconstructed area. CONCLUSIONS: Buccal fat pad as a flap offers an adequate
reconstructive option to be born in mind when reconstructing small to medium
defects in the oral cavity. It is a simple and quick surgical technique with a
low incidence of complications. Copyright 2001 John Wiley & Sons, Inc.

PMID: 11295812 [PubMed]

234: Ann Dermatol Venereol.  2001 Feb;128(2):127-9.  

Comment in:
    Ann Dermatol Venereol. 2001 Feb;128(2):111-3.

[Surgical treatment of Verneuil's disease (hidradenitis suppurativa): 15 cases]

[Article in French]

Lamfichekh N, Dupond AS, Destrumelle N, Runser C, Humbert P, Mantion G.

Service de Chirurgie Generale et Digestive, CHG "Andre Boulloche", Montbeliard.

INTRODUCTION: Verneuil's disease (hidradenitis suppurativa) is a chronic
inflammatory, suppurating and fistulizing disease of apocrine sweat
gland-bearing skin. The aim of this study was to describe the surgical
treatment, conducted in 15 patients suffering from this disease.PATIENTS AND
METHODS: We retrospectively analyzed 15 observations (9 men, 6 women, mean age
38.6). The mean delay between beginning of the symptoms and diagnosis was 55.5
months. Surgery was conducted at the stage of abscesses, fistulization and
keloids in all patients. The first surgical step was wide and deep excision of
affected skin and subcutaneous fat. The second step was secondary intention
healing, or ideal suture, Z plasty or dorsalis major flap.RESULTS: Only four
patients had complications: two axillary strictures, one anal margin stenosis
and one hypertrophic scarring. Three relapses occurred, treated by excision
under local anesthesia.CONCLUSION: Surgical treatment seems to be the only
definitive treatment of Verneuil's disease.

PMID: 11275587 [PubMed]

235: Ann Chir.  2001 Feb;126(1):51-7.  

[Laparoscopic gastroplasty for morbid obesity: prospective study of 300 cases]

[Article in French]

Chevallier JM, Zinzindohoue F, Cherrak A, Blanche JP, Berta JL, Altman JJ,
Cugnenc PH.

Service de chirurgie digestive et generale, hopital
Boucicaut-Laennec-Georges-Pompidou, 20-40, rue Leblanc, 75908 Paris, France.

STUDY AIM: Laparoscopic gastric banding for morbid obesity is noninvasive and
reversible. The aim of this prospective study was to report the preliminary
results of this procedure in the first 300 patients. PATIENTS AND METHODS: From
April 1997 to January 2000, 300 patients were laparoscopically operated for
severe obesity: 266 women, 34 men, with a mean age of 40.1 years (range: 16-66).
The mean preoperative weight was 118 kg (range: 85-195) and the mean body mass
index (BMI) was 43.6 kg/m2 (range: 35.1-65.8). This is a recent and complete
series with a mean follow-up of 10 months (range: 3-31). The primary endpoint
was excessive weight loss (EWL) and the secondary endpoints were tolerance and
morbidity. RESULTS: There were no postoperative deaths. The mean operating time
was 129 minutes (range: 50-380). A conversion to laparotomy was necessary in 11
patients. The mean hospital stay was 4.76 days (range: 3-42). There were 29
complications (9.6%), 16 among the first 50 procedures: 14 patients underwent an
abdominal reoperation (2 perforations, 3 early slippages, 7 late slippages, 2
incisional hernias); 6 had respiratory complications with 2 ARDS and 9 developed
a complication related to the port. At one year, BMI decreased from 43.6 to 33.7
kg/m2 and EWL reached 44.2%; 80% of the patients lost 60% of their excess
weight. CONCLUSION: Our experience is encouraging with an acceptable
complication rate (5%) after 50 procedures. Slippage remains the main reason for
close surveillance. Half of the excess weight can be comfortably lost in one
year when the whole medical and surgical staff provide close support for each

PMID: 11255972 [PubMed]

236: Aesthetic Plast Surg.  2000 Nov-Dec;24(6):395-400.  

Comparative evaluation of traditional, ultrasonic, and pneumatic assisted
lipoplasty: analysis of local and systemic effects, efficacy, and costs of these

Scuderi N, Paolini G, Grippaudo FR, Tenna S.

Recently ultrasound assisted liposuction (UAL) and pneumatic assisted
liposuction (PAL) have been introduced as an attempt to improve the results and
reduce the pitfalls of standard liposuction (SAL). Until now no studies
comparing, at the same time, UAL, PAL, and SAL have been published. The aim of
this study was to analyze these methods from the surgeon's point of view,
focusing not only on aesthetic results but also on local and systemic trauma,
efficacy, handling, and cost. Forty-five cosmetic patients affected by local
lipodystrophy, divided into three equal groups, have undergone liposuction with
the three above-mentioned techniques. Quantitative and qualitative analysis of
lipoaspirates, together with blood chemistry, local and systemic complications,
time to aspirate 100 cm3, distress, fatigue, and costs of the procedures, has
been recorded. Our results showed bloodier lipoaspirates in SAL and a higher
percentage of triglycerides in UAL lipoaspirates. Blood tests revealed a slight
decrease in the postoperative Hb in SAL only. Early complications observed were
four erythemas in PAL, three ecchymoses in SAL, and one long-lasting edema in
UAL. Aesthetic results rated by independent viewers were similar for all
methods. Efficacy was higher in the PAL group (4 min x 100 cm3 fat aspirated)
than in SAL (7 min x 100 cm3 fat) and UAL (10 min x 100 cm3 fat). Surgeon's
distress was higher in PAL than in SAL and UAL. Surgeon's fatigue was much lower
in the PAL group than in the others. Costs expressed as multiples of 1 unit (1
unit = $500 U.S.) were highest for UAL, low for PAL, and lowest for SAL. In
conclusion, PAL and UAL caused reduced vascular injury, UAL being more selective
for adipocyte removal. Complications of UAL and PAL were mostly related to the
longer learning curve of these methods. The UAL procedure was much more
expensive than PAL and, especially, SAL. PAL proved to be a handy technique,
with the most favorable cost/benefit ratio, and seems to be the best option for
busy liposuction practices or fast office procedures, even though the choice of
the ideal technique always depends on the surgeon's preference.

Publication Types:
    Evaluation Studies

PMID: 11246425 [PubMed]

237: Am J Clin Oncol.  2001 Feb;24(1):91-5.  

Pilot study of concurrent 5-fluorouracil/paclitaxel plus radiotherapy in
patients with carcinoma of the esophagus and gastroesophageal junction.

Schnirer II, Komaki R, Yao JC, Swisher S, Putnam J, Pisters PW, Roth JA, Ajani

Department of Gastrointestinal Medical Oncology and Digestive Diseases, The
University of Texas M.D. Anderson Cancer Center, Houston 77030-4095, USA.

Preoperative concurrent chemotherapy and radiotherapy can be highly effective
but are often associated with significant rates of morbidity and even mortality.
We studied the toxicity of continuous infusion of 5-fluorouracil (5-FU) and
weekly paclitaxel combined with radiotherapy. Patients had histologic proof of
local-regional carcinoma of the esophagus or gastroesophageal (GE) junction, a
Karnofsky performance status of 70 or greater, and normal liver, renal, and bone
marrow functions. Chemotherapy consisted of continuous infusion of 5-FU (300
mg/m2/d) for 5 days a week for 5 weeks, plus paclitaxel (45 mg/m2) given during
3 hours every week for 5 weeks. Based on the tumor location and its
resectability, the total dose of concurrent radiation varied between 45 Gy and
50.4 Gy. Nine men and one woman, with a median age of 61 years, were evaluated.
One had GE junction cancer, six had distal esophageal cancer, and three had
midesophageal cancer. Weight loss, nausea, vomiting, and dysphagia of grades I
and II were noted. The hematologic toxicity was mild. No patients required
transfusion. There was no leukopenia or thrombocytopenia. None of the patients
was hospitalized during chemoradiation; all patients completed treatment as
outpatients. Five patients had subsequent surgical resections: one had a
pathologically complete response, and two had a partial response (>90%
necrosis). Continuous infusion of 5-FU plus paclitaxel given concurrently with
radiotherapy was well tolerated. We plan to study this regimen further in upper
gastrointestinal cancers.

Publication Types:
    Clinical Trial

PMID: 11232959 [PubMed]

238: Plast Reconstr Surg.  2001 Jan;107(1):293.  

Lipoma of the abdomen after suction lipectomy.

Abner ML.

Publication Types:

PMID: 11228634 [PubMed]

239: J Burn Care Rehabil.  2001 Jan-Feb;22(1):1-5.  

Tourniquet and subcutaneous epinephrine reduce blood loss during burn excision
and immediate autografting.

Djurickovic S, Snelling CF, Boyle JC.

Royal Jubilee Hospital, Victoria, British Columbia, Canada.

Blood loss has been reduced using both tourniquets and epinephrine-injected
subeschar during burn wound excision. This study quantified and compared blood
loss in extremities distal to an inflated tourniquet with that after subeschar
infusion of 1:1,000,000 epinephrine in saline into the trunk or proximal
extremities. Tangential excision of eschar to viable dermis or fat was followed
by immediate application of meshed autograft. Blood loss was calculated by
determining the difference of preoperative and postoperative hemoglobin values
and the volume of whole blood administered between these. With tourniquets for
limbs, 2.07 +/- 0.34% of circulating blood volume per 1% body surface excised
was lost; whereas after epinephrine injection 3.42 +/- 0.39% of blood volume per
1% body surface excised was lost (P < 0.05). Both methods effectively reduced
blood loss when compared with excision followed by delayed autograft
application. Where there was a choice the tourniquet was more effective.

Publication Types:
    Clinical Trial

PMID: 11227678 [PubMed]

240: Atlas Oral Maxillofac Surg Clin North Am.  2000 Sep;8(2):81-97.  

Adjunctive cervicofacial liposuction.

Ziccardi VB.

Department of Oral and Maxillofacial Surgery, University of Medicine and
Dentistry of New Jersey, New Jersey Dental School, Newark, New Jersey, USA.

Submental liposuction is an adjunctive surgical procedure that allows for the
relatively predictable soft tissue recontouring of the cervicofacial region
(Figs. 13 to 17). It may be performed independently as an outpatient procedure
under intravenous sedation or as an adjunctive procedure during orthognathic
surgery. Surgical complications are rare and are usually preventable with
appropriate patient selection and surgical technique. Submental liposuction is a
useful tool for enhancing the esthetic benefits of orthognathic surgery.

PMID: 11212559 [PubMed]

241: US News World Rep.  2000 Feb 21;128(7):56-8.  

When liposuction goes wrong, the result can be deadly.

Cohen G.

Publication Types:

PMID: 11184129 [PubMed]

242: Dermatol Surg.  2001 Feb;27(2):207-8.  

Liposuction Council Bulletin.

Cox S.

PMID: 11207702 [PubMed]

243: JAMA.  2001 Jan 17;285(3):266-8.  


Matarasso A, Hutchinson OH.

PMID: 11176823 [PubMed]

244: Plast Reconstr Surg.  2001 Jan;107(1):240-2.  

Management of gynecomastia due to use of anabolic steroids in bodybuilders.

Babigian A, Silverman RT.

University of Massachusetts Medical Center, Worcester, USA.

Use of anabolic steroids is one of many possible causes for gynecomastia.
Optimal surgical treatment for this entity involves a combination of liposuction
and direct excision. A series of 20 patients treated for anabolic
steroid-induced gynecomastia presented. Postoperative complications included two
hematomas, one seroma (bilateral), and three recurrences. Recurrence may be
related hormonally active retained subareolar tissue.

PMID: 11176630 [PubMed]

245: Plast Reconstr Surg.  2001 Jan;107(1):15-9.  

Correction of sunken and/or multiply folded upper eyelid by fascia-fat graft.

Lee Y, Kwon S, Hwang K.

Department of Reconstructive Plastic Surgery at Seoul National University
Hospital, Korea. yhlee@medicine.snu.ac.kr

Sunken and/or multiply folded upper eyelid is one of the common, troublesome
complications that can occur after Oriental blepharoplasty. In addition to
orbital volume depletion, the traumatic surgical procedure of excessive fat
removal might result in a varying degree of adhesion and injury to the orbital
septum. Adhesiotomy followed by a restoration of volume is generally believed to
be the logical way to correct such deformity. To restore volume and prevent
re-adhesion, local tissues of the upper eyelid, free-fat graft, and dermis-fat
graft have been used. However, local tissues are usually insufficient because of
previous surgery, and the survival rate of grafted fat is often unpredictable.
Moreover, the heaviness of the dermis-fat composite makes it a less than
satisfactory choice. The authors value the use of free fascia-fat composite
grafts for the treatment of such disfigurements. The fascia-fat composite is
expected to have a better survival rate than free fat alone and to be lighter
than a dermis-fat composite. In addition, the fascia-fat composite is abundant
throughout the body and provides anatomical structure more similar to that of
the repair site, namely, the damaged orbital septum and fat. The authors prefer
the mons pubis, preauricular, and temporal areas for the donor site depending on
the status of the damage. They treated 13 patients with sunken and/or multiply
folded upper eyelids by fascia-fat composite grafts and obtained satisfactory

PMID: 11176595 [PubMed]

246: J Urol.  2001 Feb;165(2):660-6.  

Cyclophosphamide-induced hemorrhagic cystitis in rats that underwent
colocystoplasty: experimental study.

Rodo J, Farre X, Martin E.

Department of Surgery, Hospital Sant Joan de Deu and Department of Pathology,
Hospital Clinic, Barcelona, Spain.

PURPOSE: Cyclophosphamide and its derivatives induce hemorrhagic cystitis. A
substantial number of patients receive bladder augmentation or replacements
using bowel. If patients who have undergone colocystoplasty need treatment with
cyclophosphamide before or after the operation, does hemorrhagic cystitis
develop? We evaluated the histological changes produced in the colon wall and
bladder related to cyclophosphamide and its derivatives in rats that underwent
colocystoplasty. MATERIALS AND METHODS: Sprague-Dawley rats of each sex were
grouped according to whether they received a single 200 mg./kg. dose of
cyclophosphamide, underwent colocystoplasty, underwent each technique or served
as controls. The technique of colocystoplasty was the same in all groups.
Results were analyzed according to previously reported criteria, by the gross
appearance of the bladder and colon segment used for colocystoplasty, and by
histological changes. RESULTS: Two weeks after surgery colocystoplasty had not
resulted in secondary changes in the implanted colon segment or original
bladder, while there were only nonspecific changes of an inflammatory type in
the anastomotic area. After cyclophosphamide administration the animals lost
considerable weight and in the bladder area we observed hemorrhagic cystitis
that was greater in males than in females, and greater in isolated bladder than
when the bladder was sutured to the colon segment. In the colon there was no
inflammation or hemorrhage damage of the hemorrhagic cystitis type in the
bladder. A total of 12 days after colocystoplasty there were no secondary
histological changes except in the anastomotic area. A single 200 mg./kg. dose
of cyclophosphamide caused substantial weight loss and hemorrhagic cystitis.
Cystitis was quantitatively greater in males than in females and greater in
isolated bladder than in bladder anastomosed to the colon. CONCLUSIONS:
Administering a single dose of cyclophosphamide did not result in lesions in the
colon segment used for colocystoplasty analogous to those of the bladder, such
as hemorrhagic cystitis.

PMID: 11176454 [PubMed]

247: J Neurosci Res.  2001 Jan 15;63(2):185-95.  

Change of oligosaccharides of rat brain microsomes depending on dietary fatty
acids and learning task.

Yoshida S, Miyazaki M, Zhang QZ, Sakai K, Fujimoto I, Ikenaka K, Ikemoto A,
Watanabe S, Okuyama H.

Research Laboratory Center, Oita Medical University, Hasama-cho, Japan.

We have analyzed oligosaccharide chains in brain microsomes of rats fed an n-3
polyunsaturated fatty acid-deficient (safflower oil group; S group) or -rich
(perilla oil group; P group) diet before and after brightness-discrimination
learning tasks. The amount of concanavalin A-binding sites (mainly mannoside) of
the brain microsomes was found to be significantly less in the S group than the
P group before the learning task. Detailed analysis of glycoprotein glycans
demonstrated that high mannose type oligosaccharides were dominant in brain
microsomes before the learning task in both dietary groups, whereas
multiantennary complex-type oligosaccharides became dominant after the learning
task and especially a tetra-antennary glycan, that had a core structure of the
glycan of neural cell adhesion molecule, was more increased in the S-group than
the P group. When polysialylated glycans were analyzed on serotonin-conjugated
HPLC column, the glycans in the S-group microsomes before the learning task
contained larger amount of higher affinity-polysialylated glycans to serotonin
column than those in the P-group, and also contained larger amount of
phosphoglycans that showed also high affinity to serotonin column than the
P-group. Removal of mannoside from microsomes by alpha-mannosidase-treatment
changed the membrane surface physical property, especially permittivity, as
revealed by analysis of the interaction with 1-anilinonaphthalene-8-sulfonate.
These results suggest that high mannose content and several multiantennary
glycans including polysialylated and phospho-glycans were changed by dietary n-3
fatty acid deficiency and learning task in rat brain microsomal glycoproteins
and that these changes may affect membrane functions through changes of membrane
surface physical properties and reactivity against serotonin. Copyright 2001
Wiley-Liss, Inc.

PMID: 11169628 [PubMed]

248: Anesth Analg.  2001 Feb;92(2):341-3.  

Fat elimination from autologous blood.

Booke M, Van Aken H, Storm M, Fritzsche F, Wirtz S, Hinder F.

Klinik und Poliklinik fur Anasthesiologie und operative Intensivmedizin,
University of Munster, 48129 Munster, Germany.

Bowl-based autotransfusion devices reduce the amount of fat found in shed blood,
but cannot completely eliminate fat particles. When fat is seen on the surface
of the processed blood, this blood should be filtered with a leukocyte removal
filter before retransfusion.

PMID: 11159228 [PubMed]

249: J Clin Endocrinol Metab.  2001 Feb;86(2):482-4.  

Fertility and body composition after laparoscopic bilateral adrenalectomy in a
30-year-old female with congenital adrenal hyperplasia.

Bruining H, Bootsma AH, Koper JW, Bonjer J, de Jong FF, Lamberts SW.

Department of Medicine, University Hospital Rotterdam, 3000 CA Rotterdam.

Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is caused by an
inborn defect in the 21-hydroxylase gene (CYP21), leading to virilization of
female patients and causing ambiguous genitals in the majority of female
infants. Adult women may suffer from loss of libido, irregular or absent cycles,
and reduced fertility, despite intensive medical treatment. These problems have
stimulated the search for alternative treatment modalities. We present an adult
female patient, who was difficult to treat medically and whose clinical
situation markedly improved after laparoscopic bilateral adrenalectomy. The
procedure was well tolerated and without side effects. Postoperatively the
elevated serum progesterone and 17-hydroxyprogesterone levels, as well as the
undetectable LH levels, normalized. The procedure resulted in marked clinical
improvement. Within 12 months after surgery she lost 11 kg in weight. This
weight loss consisted mainly of adipose tissue. Acne disappeared, and she had a
regular 4-week menstrual cycle, with progesterone levels that are compatible
with a luteal phase. The introduction of laparoscopic techniques may give an
impulse to the application of surgical therapy at a larger scale in patients
with 21-hydroxylase deficiency who are difficult to treat with adrenal
suppression therapy.

Publication Types:
    Case Reports

PMID: 11157995 [PubMed]

250: Plast Reconstr Surg.  1999 Dec;104(7):2154-62.  

Retrobulbar hematoma and blepharoplasty.

Wolfort FG, Vaughan TE, Wolfort SF, Nevarre DR.

Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.,

Retrobulbar hematoma leading to visual impairment is a rare but serious
complication associated with elective blepharoplasty. A review of the literature
addressing etiology, prevention, and management is presented. Removal of
anterior orbital fat associated with traction and rupture of vessels within
posterior orbital fat is currently most strongly supported as the cause of
retrobulbar hematoma after blepharoplasty. Optic nerve ischemia is identified as
the likely cause of visual impairment. Specific recommendations for avoidance
and management of acute retrobulbar hematoma are offered. Recent background
animal and human research is summarized.

Publication Types:
    Review, Tutorial

PMID: 11149784 [PubMed]

251: Am Surg.  2000 Dec;66(12):1116-22; discussion 1122-3.  

Surgical experience with nonfunctioning neuroendocrine tumors of the pancreas.

Matthews BD, Heniford BT, Reardon PR, Brunicardi FC, Greene FL.

Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
28203, USA.

Nonfunctioning neuroendocrine tumors of the pancreas are rare slow-growing
tumors with a more indolent natural history compared with pancreatic
adenocarcinoma. This retrospective report reviews the surgical experience with
nonfunctioning neuroendocrine tumors in an academic referral center. Statistical
analysis was performed using Student's t test and Kaplan-Meier method compared
with log-rank tests. Thirty-eight patients (24 males and 14 females) underwent
surgery for a neuroendocrine tumor of the pancreas from 1984 through 1999.
Twenty-eight patients with a mean age of 59.9 years had nonfunctioning islet
cell tumors and 10 patients with a mean age of 59.1 years had functioning islet
cell tumors (four gastrinomas, three glucagonomas, two insulinomas, and one
vipoma). The nonfunctioning islet cell tumors were located in the head, neck, or
uncinate process in 14 patients (50%), the body in seven (25%), and the tail in
seven (25%). Operative procedures for the nonfunctioning islet cell tumors
included nine pancreaticoduodenectomies, 12 distal pancreatectomies, three
palliative bypasses, and four exploratory laparotomies without a resection or
bypass. Mean survival for the four patients explored and not resected or
bypassed was 7 months. Median survival for node-negative patients was 124
months, for node-positive patients 75 months, and for patients with metastasis
to the liver 9 months. Estimated 2-year actuarial survival for the node-negative
patients was 77.8 per cent, for node-positive patients 71.4 per cent, and for
patients with metastasis to the liver 36.4 per cent. Six patients (60%) with
node-negative disease, three (43%) with node-positive disease, and one (9%) with
metastasis to the liver are alive at a mean follow-up of 41.8 months (range
1-167). Significant differences in median survival and 2-year survival were
demonstrated between the node-positive/node-negative patients and those with
metastasis to the liver (P = 0.003). Patients with localized nonmetastatic
disease should be considered for pancreatic resection as estimated median
survival is 75 months or greater. Hepatic metastasis is a major predictor of

PMID: 11149582 [PubMed]

252: Ann Chir Plast Esthet.  2000 Dec;45(6):604-9.  

[Thromboembolism in plastic surgery: review of the literature and proposal of a
prophylaxis algorithm]

[Article in French]

Abs R.

There is still less incidence of venous thromboembolic accidents in plastic
surgery (% of unknown deep vein thrombosis and pulmonary embolism unknown) than
in general surgery (6 to 12% of deep vein thrombosis and 0.3 to 1.1% of
pulmonary embolism). However, these accidents present a dangerous and dreaded
complication. Based on the recommendations of the Assistance Publique--Hopitaux
de Paris and on a recently published medical study, an algorithm of preventive
measures is proposed. The combination of the type of surgical procedure
(liposuction, dermolipectomy and abdominoplasty) and the predisposing individual
patient risk factors (age, obesity, varicose veins, estrogens, venous
thromboembolism history, inherited disorders of coagulation) defines the level
of thromboembolic risk which can be mild, moderate or high. Prevention is based
on general guidelines (early mobilization, leg elevation, etc.); in addition, at
every level of potential risk, the use of low molecular weight heparin (LMWH)
and/or wearing anti-thrombosis stockings, as well as surveillance of detection
of venous thromboembolism, notably the duplex venous scanning of lower limbs,
will be adapted to each patient. This algorithm is a means to elaborate a
rational, but unfixed strategy or protocol of prevention to reduce the risk of
venous thromboembolic complications, and if they occur, to detect them at an
early stage and to treat them in order to avoid evolution towards pulmonary
embolism, notably mortal pulmonary embolism.

Publication Types:
    Review, Tutorial

PMID: 11147120 [PubMed]

253: Plast Reconstr Surg.  2000 Dec;106(7):1614-8; discussion 1619-23.  

Comment in:
    Plast Reconstr Surg. 2001 Oct;108(5):1449-51.

Abdominal dermolipectomies: early postoperative complications and long-term
unfavorable results.

Chaouat M, Levan P, Lalanne B, Buisson T, Nicolau P, Mimoun M.

Plastic, Aesthetic, Reconstructive, and Burn Surgery Unit, Rothschild Hospital,
Paris, France. marcchaouat@worldonline.fr

A retrospective study was done on a population of 258 women who had undergone
surgery for abdominal dermolipectomy between January of 1991 and May of 1996.
The postoperative complications and flaws seen at long-term follow-up are
discussed. The surgical techniques used, with or without lipoaspiration, were
the infraumbilical plasty and full plasties with horizontal or inverted T scars.
Six types of postoperative complications were noted: hemorrhage in 1.2 percent,
lymphorrhea in 10.9 percent, infection in 7 percent, skin necrosis in 6.6
percent, secondary dehiscence of the scar in 2.3 percent, and thromboembolic
accidents in 1.2 percent. No significant difference was found in the rate of
necrosis development between patients who did and did not undergo
lipoaspiration. However, a statistically significant difference was seen in the
rate of skin necrosis between the T-type plasty (35.5 percent) and the other two
procedures (1.43 percent for infraumbilical plasties and 4.60 percent for full
plasties with horizontal scar). With regard to the flaws found at long-term
follow-up, the rate of above-scar fat folds and/or dog-ears was 27.9 percent,
and the rate of defective scars was 26 percent. No significant difference was
found with regard to the rate of flaws. The rate of all secondary surgical
procedures was 29.1 percent, but performance of secondary procedures depended on
the willingness of the patient and on the surgeon's judgment. Abdominoplasty
procedures involve a high risk of early complications. The rate of skin necrosis
is clearly augmented in cases of T-type plasty. The need for secondary surgical
correction is frequent, and the patient should be reminded of this possibility
during preoperative consultation.

PMID: 11129195 [PubMed]

254: Plast Reconstr Surg.  2000 Dec;106(7):1566-9.  

Overgrowth of fat autotransplanted for correction of localized steroid-induced

Latoni JD, Marshall DM, Wolfe SA.

Division of Plastic Surgery, University of Miami School of Medicine, Miami
Children's Hospital, Fla 33125, USA. awolfemd@bellsouth.net

A case is presented in which regional subcutaneous atrophy in the lateral thigh
after steroid injection was treated with autologous fat grafting. More than 1
year after treatment, an increase in the volume of the transplanted site
necessitated a secondary procedure to debulk the area. We believe that this is a
case in which the transplanted adipocytes (or preadipocytes) survived and
subsequently (for an unclear reason) increased significantly in volume. This
case report supports the cell survival theory of fat autotransplantation. Animal
studies using radioisotope-labeled lipocytes might provide further understanding
of the mechanisms of fat graft "survival."

Publication Types:
    Case Reports

PMID: 11129186 [PubMed]

255: Neurol Med Chir (Tokyo).  2000 Nov;40(11):597-601.  

Prevention of cerebrospinal fluid leakage and delayed loss of preserved hearing
after vestibular schwannoma removal: reconstruction of the internal auditory
canal in the suboccipital transmeatal approach--technical note.

Yamakami I, Kobayashi E, Ono J, Yamaura A.

Department of Neurosurgery, Chiba University School of Medicine.

The suboccipital transmeatal approach uses packing of a muscle or fat graft into
the internal auditory canal (IAC) to prevent postoperative cerebrospinal fluid
(CSF) leakage. However, preserved hearing after removal of vestibular
schwannomas may decline over time because of the progressive constriction of
cochlear vascular supply due to scarring of the IAC. We propose a surgical
technique for IAC reconstruction, which separates the preserved cochlear nerve
and vasculature from the graft, and regains the CSF space in the IAC. Prior to
the drilling of the posterior wall of the IAC, the dura mater of the petrous
bone forming the posterior wall of the IAC is harvested for IAC reconstruction.
After completion of tumor removal, a "roof" of the IAC is reconstructed using
the dura mater, and a muscle or fat graft soaked with fibrin glue is placed on
the "roof" of the IAC. The IAC was reconstructed using this technique in 26
consecutive patients with vestibular schwannomas who underwent tumor removal via
the suboccipital transmeatal approach. Postoperative magnetic resonance imaging
confirmed the regained CSF space in the IAC. No delayed hearing loss occurred in
four patients with preserved hearing. No CSF leakage occurred after surgery.
This new technique of IAC reconstruction may prevent delayed hearing loss as
well as postoperative CSF leakage after removal of vestibular schwannomas via
the suboccipital transmeatal approach.

Publication Types:
    Case Reports

PMID: 11109800 [PubMed]

256: J Neurol Sci.  2000 Dec 1;181(1-2):132-6.  

Liposuction and ischemic optic neuropathy. Case report and review of literature.

Minagar A, Schatz NJ, Glaser JS.

University of Miami, Department of Neurology (D4-5), P.O. Box 016960, 3310,
Miami, FL, USA. Aminagar@AOL.com

Ischemic optic neuropathy occurred in a patient following liposuction.
Perioperative anemia and hypotension may be the cause of this complication.
Correction of anemia with transfusion improved the hemoglobin and hematocrit but
the right eye remained blind. Liposuction should be added to the list of the
surgical procedures that may produce ischemic optic neuropathy as an isolated

Publication Types:
    Case Reports

PMID: 11099723 [PubMed]

257: Ann Chir Plast Esthet.  2000 Oct;45(5):531-47.  

["Vertical, triangular mammaplasty technique". Description, indications, six
year retrospective study]

[Article in French]

Flageul G, Karcenty B.

The authors present a new mammaplasty technique with a vertical scar: the
vertical triangular technique (VTT). A retrospective study was carried out on 82
patients, for six years, with a minimal hindsight of one year, an average
glandular resection of 190 g and average liposuction of 60 mL. The technical
principles are based on mammary liposuction of the basis, the inferior pole and
the axillary extension, the glandular cavity of the inferior pole of the breast,
the conical shape of the breast and the lower scar cutaneous bursa. The pitfalls
and traps to avoid are described: the liposuction must be large enough except
concerning segment IV, the cutaneous pinch must be hyper-corrected, the lower
subcutaneous mastectomy must be complete, while a perfect suture of the
glandular pillars conditions the shape of the future mammary cone. Short-term
complications (7.5%) are the slackening of the bursa and seroma. Medium-term
complications (< 10%) are the residual distortion of the bursa, an
insufficiently tightened pinch, and a glandular resection defect. Analysis of
the results of the VTT makes it possible to determine the long-term stability of
the shape of the breasts, and to notice that the scar gain does not affect the
morphological quality.

PMID: 11094832 [PubMed]

258: Ann Chir Plast Esthet.  2000 Oct;45(5):522-5.  

[Assisted liposuction of lipomas]

[Article in French]

Mole B.

Assisted liposuction of lipomas is the partial or sometimes complete aspiration
of the subcutaneous benign lipomas followed by the blind resection of their
membrane. This procedure limits the scar and the risk of recurrence. The author
purposes here this technical note.

PMID: 11094830 [PubMed]

259: J Wound Ostomy Continence Nurs.  2000 Nov;27(6):319-20.  

Comment on:
    J Wound Ostomy Continence Nurs. 2000 Jan;27(1):42-5.

Use of becaplermin gel and Kollagen Medifil particles.

Tomaselli NL.

Publication Types:

PMID: 11096412 [PubMed]

260: Aesthetic Plast Surg.  2000 Sep-Oct;24(5):344-7.  

Rapidly fatal necrotizing fasciitis after aesthetic liposuction.

Heitmann C, Czermak C, Germann G.

Dept. of Plastic and Hand Surgery, University of Heidelberg, Germany.

Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection
involving primarily the superficial fascia and subcutaneous tissue. The disease
is caused by Streptococcus pyogenes or synergistic infection of anaerobic and
facultative anaerobic bacteria. Further characteristics are severe, intolerable
pain and a mortality rate of 30 to 50%. The NF can be initiated after surgical
procedures, minor trauma, trivial scratches, in the setting of a chronic wound,
or even in apparently intact skin. The age of the patient is not relevant for
the prognosis of NF. As it is shown in this reported case, a young and
previously healthy patient died after aesthetic liposuction in the course of a
NF. Necrotizing fasciitis is a rare disease, therefore, it is important to
review its diagnostic and clinical features, because only early diagnosis and
prompt, radical surgery improves the survival rate.

Publication Types:
    Case Reports

PMID: 11084695 [PubMed]

261: Heart Surg Forum.  2000;3(2):108-12.  

Retaining the aortic fat pad during cardiac surgery decreases postoperative
atrial fibrillation.

Davis Z, Jacobs HK, Bonilla J, Anderson RR, Thomas C, Forst W.

Cardiac Surgery Associates, The Edward Cardiovascular Institute, Edward
Hospital, Naperville.

BACKGROUND: Atrial arrhythmias are a common and serious complication of cardiac
surgical procedures. Reports describing pericardiac neurogenic tissue led us to
hypothesize that removal of the aortic fat pad could cause an autonomic
imbalance and contribute to atrial arrhythmias following cardiac surgery.
METHODS: Patients (n=131) underwent either conventional cardiopulmonary bypass
surgery (CPB) or off-pump coronary artery bypass (OPCAB) surgery. The aortic fat
pad was either left intact or removed. The incidence of de novo atrial
arrhythmias during the patient's hospital stay was tabulated. Patients with
peri-operative myocardial infarction or pre-existing atrial or supraventricular
arrhythmias were excluded. RESULTS: Demographics, preoperative medications, ASA
and NYHA classifications, and complication rates (other than for atrial
arrhythmias) did not differ among the groups. The STS-predicted mortality was
higher in the CPB/Fat-Pad-Removed group (2.23 +/- 1.89) than in either the
OPCAB/Fat-Pad-Intact (1.09 +/- 0.80) or OPCAB/Fat-Pad-Removed (1.02 +/- 0.62)
groups (p < 0.05). Atrial arrhythmias were present in 19 of 131 patients
(14.5%). Logistic regression demonstrated a significantly elevated atrial
arrhythmia rate when the fat pad was removed (odds ratio = 3.49, 95% bounds =
1.09 to 11.18, p = 0.035). Neither the pump status nor the cross product of pump
status by fat pad status were significant in this pilot study. CONCLUSIONS:
Retaining the aortic fat pad during coronary artery bypass surgery is correlated
with a decreased incidence of postoperative atrial arrhythmias.

Publication Types:
    Clinical Trial

PMID: 11074963 [PubMed]

262: Arch Facial Plast Surg.  2000 Oct-Dec;2(4):274-8.  

Minimal-incision endoscopic face-lift.

Maloney BP, Schiebelhoffer J.

Premier Image Cosmetic and Laser Surgery PA, 4553 N Shallowford Rd, Suite 20-B,
Atlanta, GA 30338, USA.

Ptosis of the midfacial tissues with resultant deepening of the melolabial
folds, vertical lengthening of the lower eyelid, and depression of the oral
commissure are generally only slightly improved with traditional superficial
musculoaponeurotic system (SMAS) suspension or rhytidectomy techniques.
Subperiosteal, deep plane, and composite rhytidectomies have evolved in an
attempt to rejuvenate these areas. This article reviews a series of patients who
underwent an endoscopic subperiosteal face-lift either as an isolated procedure
or in conjunction with an SMAS rhytidectomy. Although all patients showed good
initial improvement, patients with thin faces and well-defined facial bone
structure maintained the best long-term result. Complications were minimal, with
no permanent facial nerve injuries observed. The endoscopic subperiosteal
face-lift is a useful technique as an isolated procedure or in conjunction with
facial liposuction or SMAS suspension rhytidectomy. Arch Facial Plast Surg.

PMID: 11074724 [PubMed]

263: Arch Facial Plast Surg.  2000 Oct-Dec;2(4):264-8.  

Endoscopic liposhaving for neck recontouring.

Schaeffer BT.

Department of Otolarynology and Communications Disorders, Long Island Jewish
Medical Center, New Hyde Park, NY, USA. LIFacialMD@aol.com.

OBJECTIVE: To describe a modified technique of liposuction that combines
endoscopic techniques and a soft tissue shaver for neck recontouring. DESIGN:
Nonrandomized, nonblinded, retrospective evaluation of endoscopic liposhaving
for patients requiring neck recontouring in a facial plastic surgery practice.
INTERVENTIONS: Endoscopic liposhaving was performed on 5 patients undergoing
neck recontouring with platysma plication using a small submental incision. MAIN
OUTCOME MEASURES: Subjective evaluation by the surgeon. RESULTS: Direct
visualization with the endoscope ensures complete removal of excess fat while
maintaining a small amount of fat over the platysma muscle and on the skin flap.
The fat was easily and precisely removed with minimal trauma and edema. There
were no resulting facial nerve injuries, dimpling, hematomas, or significant
asymmetries. CONCLUSIONS: Endoscopic liposhaving for neck recontouring is a
precise and less traumatic method of lipectomy than the current techniques.
Direct fat visualization with an endoscope allows more accuracy than the
external visualization and palpation relied on in conventional liposuction or
direct liposhaving. Using these 2 newer modalities can lead to quicker recovery
time. There are no known previous reports of use of these 2 techniques together.
Arch Facial Plast Surg. 2000;2:264-268

PMID: 11074722 [PubMed]

264: Arch Dermatol.  2000 Nov;136(11):1347-52.  

Skin and wound infection by rapidly growing mycobacteria: an unexpected
complication of liposuction and liposculpture. The Venezuelan Collaborative
Infectious and Tropical Diseases Study Group.

Murillo J, Torres J, Bofill L, Rios-Fabra A, Irausquin E, Isturiz R, Guzman M,
Castro J, Rubino L, Cordido M.

Department of Infectious Diseases and Microbiology, Hospital Privado, Centro
Medico de Caracas, Venezuela.

OBJECTIVE: To describe 10 patients with skin and soft tissue infection caused by
rapidly growing mycobacteria after cosmetic liposuction and liposculpture.
DESIGN: Case series. SETTINGS: Eight private geographically separate surgical
facilities from a single metropolitan area. PATIENTS: Eight patients with
definite and 2 with presumptive cases of skin and soft tissue infection caused
by rapidly growing mycobacteria after cosmetic surgery procedures during a
24-month period. Microorganisms were isolated from the purulent drainage
obtained from wounds or fistulas in 8 cases and were identified as Mycobacterium
fortuitum (3 cases) and Mycobacterium abscessus (5 cases) by routine
microbiologic techniques. Acid-fast bacilli were observed on
Ziehl-Neelsen-stained smears in the 2 remaining cases, but these ultimately
failed to grow. In 2 of the surgical units, no apparent environmental
predisposing factors were identified after thorough microbiologic environmental
investigation. Clinically, all patients exhibited signs of inflammation,
microabscesses, and purulent wound drainage within 24 months of abdominal and/or
thigh liposuction or homologous fat tissue injection. INTERVENTION: A combined
therapeutic approach including surgical drainage, debridment, and prolonged (>3
months) treatment with combined antimicrobial agents including clarithromycin
was used in all cases. RESULTS: Nine of 10 patients responded to the combined
therapeutic approach, and no evidence of infection was present during at least
12 months of follow-up. CONCLUSION: To our knowledge, this is the first series
of patients with rapidly growing mycobacterial infections to be described after
liposuction and liposculpture. Rapidly growing mycobacteria should be included
in the differential diagnosis of skin and soft tissue infection after cosmetic

Publication Types:
    Case Reports

PMID: 11074697 [PubMed]

265: OR Manager.  2000 Mar;16(3):11.  

Deaths after liposuction studied.

[No authors listed]

PMID: 11066803 [PubMed]

266: Gynecol Oncol.  2000 Nov;79(2):318-23.  

Computed tomography guided core needle biopsy diagnosis of pelvic actinomycosis.

Lee YC, Min D, Holcomb K, Buhl A, DiMaio T, Abulafia O.

Department of Obstetrics and Gynecology, State University of New York Health
Science Center at Brooklyn, NY, USA.

BACKGROUND: Pelvic actinomycosis is a chronic suppurative inflammatory disease
caused by the anaerobic Gram-positive bacilli Actinomyces israelii. The
propensity of this disease to simulate gynecological malignancies has been
described previously. The great majority of these patients were diagnosed with
actinomycotic diseases during or after exploratory laparotomy, but rarely
preoperatively. We reviewed the literature pertaining the management of pelvic
actinomycosis. CASE: A nulliparous woman with a long history of intrauterine
contraceptive device (IUD) and recent Papanicolaou smear findings consistent
with the presence of actinomyces presented with chronic vague lower abdominal
pain, weight loss, poor appetite, and recent increase in abdominal girth
associated with a large immobile pelvic mass. Transcutaneous computed tomography
guided core needle biopsy established the diagnosis of pelvic actinomycosis
obviating immediate surgical intervention. Intravenous and subsequent long-term
oral penicillin therapy was constituted and resulted in a significant decrease
in the size of the pelvic mass. CONCLUSION: In patients presenting with pelvic
masses and a history of IUD placement, actinomycotic infection should be
considered and diagnosis attempted by imaging guided needle biopsy. Furthermore,
this case suggested that correct nonsurgical diagnosis of pelvic actinomycosis
followed by prolonged antibiotic therapy might eliminate the need for extensive
extirpative surgery and assist in maintaining future fertility. Copyright 2000
Academic Press.

Publication Types:
    Case Reports
    Review of Reported Cases

PMID: 11063665 [PubMed]

267: Nutrition.  2000 Oct;16(10):976-82.  

The future of obesity research.

Greenway FL, Smith SR.

Outpatient Clinic, Pennington Biomedical Research Center, Baton Rouge,
Louisiana, USA. greenfl@pbrc.edu

As endocrinologists, we view better treatment as the goal of obesity research.
The ideal obesity treatment would reduce body fat substantially, with
preferential loss from the visceral compartment, and preserve lean tissue with a
minimum of side effects. Obesity has been recognized as a chronic disease since
1985. Chronic diseases recognized before obesity may predict the future of
obesity research. Initial treatments of chronic diseases commonly arise from
empirical observations. These observations often stimulate basic research into
the physiologic mechanisms responsible. Such cross-fertilization between the
clinic and basic science is desirable and expected. As more is learned about the
physiology of obesity, treatments can be expected to use more downstream
mechanisms with less unwanted side effects, the reliance on surgical treatments
can be expected to decline, and molecular approaches are likely to play an
increasingly important role. With a better physiologic understanding of obesity,
advanced clinical endpoints will become more important and molecular approaches
are likely to play a more important role in discovery and treatment. Due to the
availability of molecular approaches, obesity treatment is expected to advance
faster than chronic disease research of the past.

Publication Types:
    Review, Tutorial

PMID: 11054604 [PubMed]

268: Semin Thorac Cardiovasc Surg.  2000 Jul;12(3):201-5.  

Laparoscopy or thoracoscopy for achalasia.

Nguyen NT, Wang P, Follette D.

Department of Surgery, University of California, Davis, Health System,
Sacramento, USA.

Achalasia is an esophageal motor disorder of unknown etiology. Typical
manometric findings include aperistalsis of the esophageal body coupled with
elevated pressure and incomplete relaxation of the lower esophageal sphincter
during swallowing. Medical treatments consist of pneumatic dilatation or
injections of botulinum toxin. Surgical treatment consists of Heller's myotomy
with or without an antireflux procedure. Relief of dysphagia symptoms can be
achieved in 85% to 94% of patients undergoing surgical treatment. In the past
decade, the minimally invasive approach for the treatment of achalasia has been
proven feasible, safe, and effective. We review the role of thoracoscopy and
laparoscopy and address controversies in the management of patients with

Publication Types:
    Review, Tutorial

PMID: 11052187 [PubMed]

269: Plast Reconstr Surg.  2000 Oct;106(5):1211-2.  

Comment on:
    Plast Reconstr Surg. 2000 Jan;105(1):436-46; discussion 447-8.

Deaths associated with liposuction.

Berg D.

Publication Types:

PMID: 11039393 [PubMed]

270: Plast Reconstr Surg.  2000 Oct;106(5):1197-1202; discussion 1203-5.  

Comment in:
    Plast Reconstr Surg. 2001 Aug;108(2):577-8.

Liposuction as an adjunct to a full abdominoplasty revisited.

Matarasso A.


PMID: 11039391 [PubMed]

271: Lipids.  2000 Sep;35(9):1027-32.  

Study of individual trans- and cis-16:1 isomers in cow, goat, and ewe cheese
fats by gas-liquid chromatography with emphasis on the trans-delta3 isomer.

Destaillats F, Wolff RL, Precht D, Molkentin J.

Institut des Sciences et Techniques des Aliments de Bordeaux, Talence, France,

Low-temperature gas-liquid chromatography (GLC) was applied to study the
distribution profiles of isomeric trans- and cis-hexadecenoic acids in ruminant
(cow, goat, and ewe) milk fat after their fractionation by argentation
thin-layer chromatography (Ag-TLC). The fat was extracted from cheeses (12
samples of each species), the most common foods made with goat and ewe milks.
The predominant trans-16:1 isomer is palmitelaidic acid (the delta9 isomer), but
it does not exceed one-third of the total group, which itself represents 0.17%
(cow), 0.16% (goat), and 0.26% (ewe) of the total fatty acids. The trans-delta3
16:1 isomer, which is reported for the first time in ruminant lipids and which
likely comes from the animals' feed, is present at a level of ca. 10% of the
trans-16:1 acid group. Otherwise, all isomers with their ethylenic bond between
positions delta4 and delta14 are observed in the three species studied, roughly
showing the same relative distribution pattern. Quantitatively, the trans-16:1
isomers only represent ca. 5% of the sum of the trans-16:1 plus trans-18:1
isomers, and they appear of little importance in comparison. It is inferred from
this and recent studies that some previously reported data that were established
for consumption assessments dealt in fact mainly with iso-17:0 acid, which was
confused with (and added to) trans-delta9 (palmitelaidic) acid; consequently,
these results were large over-estimates. Regarding the cis-16:1 acids, the
delta9 isomer is the prominent constituent as expected, but the second-most
important isomer is the delta13 isomer. It does not appear that trans-16:1
isomers are from ruminant milk fats of great nutritional importance as compared
with trans-18:1 isomeric acids. As for trans18:1 isomers, the combination
Ag-TLC/GLC is a necessary procedure to quantitate trans-16:1 acids accurately
and reliably. Ag-TLC allows removal of interfering branched 17:0 acids and
cis-16:1 acids, and low-temperature GLC permits an accurate measurement of all
individual isomers most of which with baseline resolution.

PMID: 11026624 [PubMed]

272: Curr Gastroenterol Rep.  2000 Oct;2(5):389-94.  

Approach to patients with refractory constipation.

Wofford SA, Verne GN.

Division of Gastroenterology, Hepatology, and Nutrition, University of Florida,
Department of Medicine, Veterans Administration Medical Center, Research Service
(151), 1601 SW Archer Road, Gainesville, FL 32608, USA.

Constipation is a very frequent problem, particularly in elderly patients.
Constipation is a common reason for patients to seek medical advice, and it
accounts for a large number of different prescription and over-the-counter
medications. In many cases, no definite cause can be found. Most patients
respond to conservative therapy with increased fiber and fluid intake alone.
Patients with constipation that is more difficult to control or with alarm
symptoms (eg, blood in stool, sudden onset, weight loss, or decreasing stool
caliber) warrant further investigation. A variety of medical, behavioral, and
surgical therapies can be employed to help these more refractory patients.

Publication Types:
    Review, Tutorial

PMID: 10998666 [PubMed]

273: Acta Oncol.  2000;39(3):407-20.  

Liposuction gives complete reduction of chronic large arm lymphedema after
breast cancer.

Brorson H.

Department of Plastic and Reconstructive Surgery, Malmo University Hospital,

About one-third of all women treated for breast cancer develop arm lymphedema.
In addition to the worry of the cancer itself, the swollen and heavy arm is both
a physical and a psychosocial handicap for the patients. Previous surgical and
conservative treatments have not always given satisfactory and permanent
results, conceivably because lymphedema causes hypertrophy of the subcutaneous
adipose tissue. From this point of view, liposuction (LS) combined with
Controlled Compression Therapy (CCT) is an interesting approach, as the
hypertrophied adipose tissue is effectively removed and the outcome sustained by
wearing a compression garment. Pre- and postoperative arm edema volumes were
measured using the water displacement technique. Skin blood flow was recorded
using Laser Doppler imaging. Lymph transport in the arm was assessed by indirect
lymphoscintigraphy. LS + CCT reduced the arm edema volume completely, compared
with a 50% decrease following CCT alone. The use of a compression garment after
liposuction is necessary in order to maintain the normalized arm volume. LS +
CCT did not affect the already impaired lymph transport; it merely increased
skin microcirculation. A reduced incidence of cellulitis was noted.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial
    Review, Tutorial

PMID: 10987239 [PubMed]

274: Plast Reconstr Surg.  2000 Sep;106(3):740-1.  

Comment on:
    Plast Reconstr Surg. 2000 Jan;105(1):436-46; discussion 447-8.

Paraspinous muscle hemorrhage as a potential source of liposuction mortality.

Buescher TM.

Publication Types:
    Case Reports

PMID: 10987498 [PubMed]

275: AIDS Read.  2000 Aug;10(8):479-85.  

Comment in:
    AIDS Read. 2000 Aug;10(8):482-3.

Switching from a PI-based to a PI-sparing regimen for management of metabolic or
clinical fat redistribution.

Moyle G, Baldwin C.

Chelsea and Westminster Hospital, London.

Concerns regarding metabolic perturbations occurring during protease inhibitor
(PI)-based regimens have led to investigation of switching from a PI-based to a
non-nucleoside reverse transcriptase inhibitor- or abacavir-based regimen. There
appear to be considerable benefits to switching from a PI-based regimen to one
of these PI-sparing regimens. In particular, patients appear generally pleased
with the improved administration characteristics of the new regimens, and
improvements in quality of life have been reported. However, resolution of the
metabolic abnormalities that may arise during PI therapy is incomplete.
Peripheral or subcutaneous fat mass improvements are not evident in the studies
reported to date. Weight gain, probably in part due to removal of PI-related
dietary restrictions, has been observed and may lead to improvements in
appearance. Maintenance of virologic control varies among studies but is
generally in the range of 85% to 100% of the patients receiving the PI-sparing
regimen. The extent of prior drug exposure (or drug resistance) in patients
entering the studies may be a key risk factor for loss of virologic control.

PMID: 10967808 [PubMed]

276: Surgery.  2000 Sep;128(3):392-8.  

Severe dysphagia after laparoscopic fundoplication: usefulness of barium meal
examination to identify causes other than tight fundoplication--a prospective

Le Blanc-Louvry I, Koning E, Zalar A, Touchais O, Savoye Collet C, Denis P,
Ducrotte P.

Digestive Tract Research Group, Rouen University Hospital, Rouen, France.

Background. The aim of this study was to determine the results of a barium meal
examination after laparoscopic wrap in symptomatic patients (SPs) with no upper
endoscopic anomalies and no increase in inferior esophageal sphincter pressure
(SPs). Radiologic results were compared with results from patients with no
symptoms (ASPs) and were compared with the surgical findings in patients who
underwent reoperation. Methods. Twenty SPs were included 27 +/- 6 months after a
total wrap (n = 13 Nissen procedures) or a posterior wrap (n = 7 Toupet
procedures) performed in several hospitals in Haute Normandie. All patients had
severe symptomatic dysphagia with epigastric pain (n = 18 patients) and/or
marked weight loss (n = 16 patients). Control subjects were 31 consecutive ASPs
within our center who were prospectively included 4 +/- 1 months after a Nissen
(n = 6 patients) or a Toupet (n = 25 patients) procedure. A barium meal
examination was performed in all patients and interpreted by 3 independent
observers who knew that the patients had undergone a wrap but who did not know
whether the patients had symptoms.Fifteen of the 20 SPs underwent a second
operation. Results. Barium meal examination was more often abnormal in SPs than
in ASPs (17/20 vs 4/31 patients; P <.001), whichever the type of wrap. Two
abnormal radiologic results were observed in both groups: an esophageal barium
level and an esogastric plication. Only a high barium level in the esophagus was
more frequently observed in SPs than in ASPs (P <.05). Three radiologic results
were specifically observed in SPs: a long cardial narrowing beginning above the
wrap, a mediogastric plication, and a gastric volvulus. A comparison of
radiologic anomalies and surgical findings showed that (1) a radiologic long
cardial narrowing was explained by fibrotic stenosis of the muscular esophageal
hiatus (n = 6 patients), (2) a mediogastric plication (n = 4 patients) was due
to gastric volvulus (n = 3 patient) or to gastric wrap (n = 1 patient), and (3)
results of volvulus (n = 5 patients) indicated a gastric volvulus. Additional
surgical procedures resulted in the disappearance of symptoms in 13 of 15
patients. Conclusions. After laparoscopic fundoplication when upper endoscopy
and esophageal manometry are normal, results of a barium meal examination can
explain the cause of dysphagia in almost all patients. Three radiologic results
were specific for SPs and indicated major morphologic disturbances that could
not be treated by endoscopic dilation but that could be treated by additional
surgical procedures.

PMID: 10965309 [PubMed]

277: Am J Physiol Regul Integr Comp Physiol.  2000 Sep;279(3):R936-43.  

Subcutaneous lipectomy causes a metabolic syndrome in hamsters.

Weber RV, Buckley MC, Fried SK, Kral JG.

Department of Surgery, State University of New York, Health Science Center at
Brooklyn, Brooklyn, New York 11203, USA.

The insulin resistance syndrome X is related to excess intra-abdominal adipose
tissue. With lipectomy of >50% of subcutaneous adipose tissue (SQAT) in
nonhibernating, adult female Syrian hamsters on high-fat (HF; 50 calorie%) diet
and measurements of oral glucose tolerance, oral [(14)C]oleic acid disposal,
serum triglycerides, serum leptin, liver fat, perirenal (PR) adipose tissue
cellularity, and body composition, we studied the role of SQAT. Sham-operated
(S) animals on HF or low-fat (LF; 12.5 calorie%) diets served as controls. After
3 mo there was no visible regrowth of SQAT but HF diet led to similar levels of
body weight and body fat in lipectomized and sham-operated animals. Lipectomized
(L) animals had more intra-abdominal fat as a percentage of total body fat,
higher insulinemic index, a strong trend toward increased liver fat content, and
markedly elevated serum triglycerides compared with S-HF and S-LF. Liver and PR
adipose tissue uptake of fatty acid were similar in L-HF and S-HF but reduced
vs. S-LF, and were inversely correlated with liver fat content and insulin sums
during the oral glucose tolerance test. In summary, lipectomy of SQAT led to
compensatory fat accumulation implying regulation of total body fat mass. In
conjunction with HF diet these lipectomized hamsters developed a metabolic
syndrome with significant hypertriglyceridemia, relative increase in
intra-abdominal fat, and insulin resistance. We propose that SQAT, via disposal
and storage of excess ingested energy, acts as a metabolic sink and protects
against the metabolic syndrome of obesity.

PMID: 10956251 [PubMed]

278: Ther Umsch.  2000 Jul;57(7):449-53.  

[Noninvasive alternatives to CPAP in therapy of obstructive sleep apnea

[Article in German]

Fritsch K, Bloch KE.

Abteilung fur Pneumonologie, Universitatsspital Zurich.

Non-surgical treatment of the sleep apnea syndrome comprises behavioral
modification such as sleep hygiene, weight reduction, and positional training as
an adjunct to standard therapy with continuous positive airway pressure (CPAP)
applied via a nasal mask. For patients who cannot tolerate or are not willing to
use CPAP for psychological or other reasons, removable intraoral appliances that
advance the mandible during sleep are a valuable treatment alternative.
Randomised controlled trials have confirmed effectiveness of intraoral
appliances in relieving symptoms and measured sleep and respiratory
disturbances. Side effects including hypersalivation, mucosal dryness, tooth and
temporo-mandibular joint discomfort are common but usually mild. To timely
detect effects of oral appliances on occlusion and on the temporo-mandibular
joint longterm orthodontic monitoring is advisable.

Publication Types:
    Review, Tutorial

PMID: 10953652 [PubMed]

279: Ann Plast Surg.  2000 Aug;45(2):214-5.  

A new tool to eliminate hyperpigmentation in liposuction scars.

Gasperoni C, Salgarello M, Cimino A, Gasperoni P.

Publication Types:

PMID: 10949358 [PubMed]

280: Johns Hopkins Med Lett Health After 50.  2000 Sep;12(7):6-7.  

Middle management: stomach-slimming options.

[No authors listed]

PMID: 10948882 [PubMed]

281: J Am Coll Surg.  2000 Aug;191(2):149-55; discussion 155-7.  

A comparison study of laparoscopic versus open gastric bypass for morbid

Nguyen NT, Ho HS, Palmer LS, Wolfe BM.

Department of Surgery, University of California, Davis, Health System,
Sacramento, USA.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (GBP) has been previously
described, but a comparative study between laparoscopic and open GBP has not
been reported. The purpose of this study was to compare surgical outcomes
oflaparoscopic GBP with those of open GBP for treatment of morbid obesity. STUDY
DESIGN: From August 1998 to September 1999, we prospectively collected outcome
data on 35 patients with body-mass indices between 40 kg/m2 and 60 kg/m2 who
underwent laparoscopic GBP. Demographics, operative data, perioperative
complications, and weight losses were collected and compared with those obtained
from a retrospective chart review of 35 patients with body-mass indices between
40 kg/m2 and 60 kg/m2 who underwent open GBP before August 1998. RESULTS: Age,
gender, preoperative body-mass index, preoperative comorbidity, and earlier
abdominal surgery were similar in both groups. All laparoscopic operations were
completed without conversion to laparotomy. Mean operative time, operative blood
loss, length of intensive care stay, and length of hospital stay were
significantly less after laparoscopic GBP than after open GBP (p<0.05). There
was no 30-day mortality in either group. At 1-year followup, analysis of the
percentage of excess body weight loss showed no significant difference between
the two groups (p<0.05). CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass is
technically feasible and safe. Laparoscopic GBP confers the clinical benefits of
laparoscopy and an initial weight loss similar to that of open GBP.

PMID: 10945358 [PubMed]

282: Baillieres Best Pract Res Clin Endocrinol Metab.  1999 Apr;13(1):149-72.  

Surgical intervention for the severely obese.

Albrecht RJ, Pories WJ.

Department of Surgery, East Carolina University School of Medicine, Greenville,
North Carolina, USA.

Severe obesity is a grave disease in the U.S. as well as other industrialized
nations. This disease has many ramifications on both an individual and social
levels. It affects 12.5 million people in the U.S., according to national survey
data. The health risks of severe obesity include hypertension, hyperlipidaemia,
cardiomyopathy, diabetes, hypoventilation disorders, increased risk of
malignancy, cholelithiasis, degenerative arthritis, infertility, and
psychosocial impairments. Medical weight reduction programmes have rarely
achieved long-term success. Most authorities now agree that bariatric surgery is
the treatment of choice for well-informed and motivated obese patients with
acceptable operative risks, who strongly desire substantial weight loss or who
have severe impairments because of their weight. Surgery is indicated for
patients with a BMI greater than 40 kg/m2, or for those with serious medical
co-morbidities and a BMI greater than 35 kg/m2. Three procedures, the adjustable
silicone gastric banding (ASGB), vertical gastric banding (VBG), and gastric
bypass (GB), have produced the best results to date. Each of these procedures is
much more effective than dietary therapies. Each has advantages and
disadvantages, with GB producing greater sustained weight loss in the long-term,
with a slightly higher risk of metabolic complications. All can be done with
surprisingly low operative mortality. The pronounced weight loss induced with
these operations can relieve and bring co-morbid diseases, such as diabetes and
hypertension, once thought to be only barely controllable, into full long-term

Publication Types:
    Historical Article
    Review, Tutorial

PMID: 10932682 [PubMed]

283: Obes Surg.  2000 Jun;10(3):230-2.  

A technique of stapled gastrojejunostomy for open gastric bypass results in
increased wound complication-rate.

Madigan JD, Morales DL, Bessler M.

New York Presbyterian Center for Obesity Surgery, New York, NY, USA.

BACKGROUND: Gastric bypass may be facilitated by a stapled gastrojejunostomy.
This study compared two different techniques for performing this critical
anastomosis in open surgery. METHODS: 67 consecutive patients were
retrospectively studied for weight loss, hospital length of stay, anastomotic
stricture, wound complication, and incisional hernia. 49 patients had a two
layer hand-sutured gastrojejunostomy over a 34 Fr bougie via a laparotomy
(sutured). 18 patients had a stapled gastrojejunostomy using the technique of
Wittgrove and Clark via a laparotomy (stapled). All patients received
prophylactic intravenous antibiotics preoperatively. RESULTS: Initial BMI, % of
excess weight lost at 6 weeks and 6 months, and hospital length of stay were not
statistically different between the groups. However, the rate of wound
complication and incisional hernia rate were significantly higher in the stapled
group when compared to the sutured group (p< 0.01). CONCLUSIONS: Based on these
data we suggest that the technique of Wittgrove and Clark for performing the
gastrojejunostomy should not be used in open gastric bypass as it results in
increased rates of wound complication and incisional hernia.

PMID: 10929153 [PubMed]

284: J Appl Physiol.  2000 Aug;89(2):823-39.  

Physiology of a microgravity environment invited review: microgravity and
skeletal muscle.

Fitts RH, Riley DR, Widrick JJ.

Department of Biology, Marquette University, Milwaukee, WI 53201, USA.

Spaceflight (SF) has been shown to cause skeletal muscle atrophy; a loss in
force and power; and, in the first few weeks, a preferential atrophy of
extensors over flexors. The atrophy primarily results from a reduced protein
synthesis that is likely triggered by the removal of the antigravity load.
Contractile proteins are lost out of proportion to other cellular proteins, and
the actin thin filament is lost disproportionately to the myosin thick filament.
The decline in contractile protein explains the decrease in force per
cross-sectional area, whereas the thin-filament loss may explain the observed
postflight increase in the maximal velocity of shortening in the type I and IIa
fiber types. Importantly, the microgravity-induced decline in peak power is
partially offset by the increased fiber velocity. Muscle velocity is further
increased by the microgravity-induced expression of fast-type myosin isozymes in
slow fibers (hybrid I/II fibers) and by the increased expression of fast type II
fiber types. SF increases the susceptibility of skeletal muscle to damage, with
the actual damage elicited during postflight reloading. Evidence in rats
indicates that SF increases fatigability and reduces the capacity for fat
oxidation in skeletal muscles. Future studies will be required to establish the
cellular and molecular mechanisms of the SF-induced muscle atrophy and
functional loss and to develop effective exercise countermeasures.

Publication Types:
    Review, Tutorial

PMID: 10926670 [PubMed]

285: JSLS.  2000 Apr-Jun;4(2):159-62.  

Laparoscopic removal of a perforated intrauterine device from the perirectal

Silva PD, Larson KM.

Gundersen Luthern, La Crosse, Wisconsin, USA. psilva@gundluth.org

BACKGROUND: The intrauterine device (IUD) was a very common form of birth
control in the United States. The most serious potential complication of IUD use
is uterine perforation. Uterine perforation is common among women with "lost"
IUDs and can cause severe morbidity and mortality and should be carefully
managed. The recommended treatment is removal of the perforating IUD. This can
usually be managed laparoscopically unless bowel perforation or other severe
sepsis is present. METHODS: An intra-abdominal IUD was removed laparoscopically
from the perirectal fat of a 49-year-old woman who had been diagnosed over 20
years earlier with an "expelled" IUD. CONCLUSIONS: It is important that the
possibility of uterine perforation be considered in anyone who has had a
diagnosis of an expelled IUD without actual confirmation that the IUD is no
longer present in the body. In any woman who presents with pelvic pain and a
history of a "lost" IUD, the surgeon should have a high index of suspicion and
obtain radiological studies. It may be advisable to question women about
possible IUD use when they present with pelvic pain of unknown origin.

Publication Types:
    Case Reports

PMID: 10917124 [PubMed]

286: Int J Clin Pract.  2000 May;54(4):212-6.  

Chronic hepatitis C beta-interferon-induced severe hypertriglyceridaemia with
apolipoprotein E phenotype E3/2.

Homma Y, Kawazoe K, Ito T, Ide H, Takahashi H, Ueno F, Matsuzaki S.

Department of Internal Medicine, Tokai University School of Medicine, Kanagawa,

The mechanisms of hypertriglyceridaemia and changes in plasma lipoprotein
subfractions by beta-interferon treatment were studied in a hepatitis C patient
with apo E phenotype E3/2. Plasma levels of triglyceride (TG) were increased by
treatment with 6 x 10(6) beta-interferon and reached 8.06 mmol/l at 4 weeks of
treatment. Low energy and low fat diet reduced them to half the maximal level.
Plasma levels of LDL1 (1.019 < d < 1.045)-C, LDL2 (1.045 < d < 1.063)-C, HDL2-C
and HDL3-C were 0.39, 0.31, 0.21 and 0.28 mmol/l, respectively, which are low,
but the plasma levels of IDL, which is a remnant of TG-rich lipoproteins, was
normal at 7 weeks of treatment. The distribution of plasma lipoprotein
subfractions returned to normal after interferon treatment was discontinued. The
mass and activity of lipoprotein lipase (LPL) were reduced to half the baseline
level by interferon treatment. The activity of hepatic triglyceride lipase
(HTGL) which transforms IDL to LDL was normal. The patient's apo E phenotype was
E3/2; with that phenotype the removal of TG-rich lipoproteins and IDL through
the receptors of the remnant and LDL is impaired. But the IDL plasma level was
normal, probably because of normal HTGL activity and high LDL-receptor activity.
Lymphocyte LDL-receptor activity was double that of the control. We conclude
that interferon caused the low mass and activity of LPL which in turn caused the
hypertriglyceridaemia. And no retention of the remnant of TG-rich lipoproteins
in this patient with apo E3/2 and low levels of LDL subfractions was due to the
active removal of them through LDL-receptors as well as the impaired production
of them by suppression of LPL by interferon.

Publication Types:
    Case Reports

PMID: 10912307 [PubMed]

287: J Bone Joint Surg Am.  2000 Jul;82-A(7):1050-1.  

Comment in:
    J Bone Joint Surg Am. 2001 Apr;83-A(4):623.


Capozzi JD, Rhodes R.

Department of Orthopaedics, Mount Sinai Medical Center, New York, NY 10128, USA.

J. S. is a sixty-five-year-old man who was treated at another hospital with
arthroscopic debridement of an infection at the site of a right total knee
replacement and was placed on long-term intravenous antibiotics. He signed out
of that hospital against medical advice. One month later, he presented at our
hospital with recurrent sepsis of his knee. Knee aspiration yielded frank pus
with a white blood-cell count of 80,000 cells per cubic millimeter.
Gram-staining demonstrated gram-positive cocci. The patient was placed on
intravenous antibiotics. The patient appeared cachectic, reporting a sixty-pound
(27.2-kilogram) weight loss over the past year. A metastatic workup, including a
chest radiograph, an abdominal sonogram, prostate-specific antigen, a complete
blood-cell count, erythrocyte sedimentation rate, and a
purified-protein-derivative skin test, was negative; however, an occult neoplasm
could not be excluded. The patient displayed episodes of confusion,
disorientation, and argumentative behavior. Medical and psychiatric consults did
not determine whether this behavior was due to previous substance abuse or a
primary psychiatric disorder. Nevertheless, psychiatrists at our institution
determined that the patient lacked decisional capacity. Attempts were made to
salvage the knee replacement, and the patient underwent an extensive surgical
debridement of the knee with insertion of drains. He was placed on intravenous
antibiotics. The plan was for the patient to be managed with long-term oral
suppressive antibiotics. After treatment, the patient was transferred to a
skilled-nursing facility. Psychiatrists at the nursing facility deemed the
patient to have decisional capacity, and the patient was permitted to leave the
facility. He was discharged without antibiotics. Several weeks later, he
presented at our hospital with a grossly purulent knee. The orthopaedic options
were reviewed with the patient and his brother. Removal of the components was
recommended. The patient did not want to "lose" his knee replacement, and he
refused surgical intervention. We did not believe that the infection could be
either controlled or eradicated with the components in place.

Publication Types:
    Case Reports

PMID: 10901317 [PubMed]

288: Khirurgiia (Mosk).  2000;(6):27-9.  

[Transesophageal gastrostomy]

[Article in Russian]

Maslov VI.

For gastrostomy after thoracic esophagus extirpation its distal stump was used.
It is confirmed, that transesophageal gastrostomy has a number of advantages.
Pezzer's catheter can be used as gastrostomic tube which self-fixes in given
position and secures reliable gastrostoma sealing. Suturing of the stomach to
parietal peritoneum around gastrostoma is not more necessary. Deformation and
reduction of the stomach size are excluded and stomach is kept ready for
subsequent plastic replacement of the oesophagus. The operation gets
oncologically more radical as a result of removal of paraesophageal cellular fat
and potentially metastatic lymph nodes during mobilization of the oesophagus and
cardia distal stump. The routine technique of transesophageal gastrostomy is
described. This technique is applied in 17 patients. Complications were not

Publication Types:
    Case Reports

PMID: 10900840 [PubMed]

289: Surg Endosc.  2000 Jun;14(6):532-6.  

Comment in:
    Surg Endosc. 2000 Aug;14(8):697-9.

A 3-year experience with laparoscopic gastric banding for obesity.

Suter M, Bettschart V, Giusti V, Heraief E, Jayet A.

Department of Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne,

BACKGROUND: The introduction of laparoscopic techniques-especially that of
gastric banding-and the fact that conservative management does not provide
satisfactory long-term results in patients with morbid obesity has resulted in a
marked increase in the demand for bariatric surgery in our department since
1995. In this paper, we present our experience during the first 3 years with
this approach. METHODS: Data for all patients who had bariatric surgery at our
institution were collected prospectively. They were analyzed for the purpose of
this study. RESULTS: A total of 150 patients were operated on between December
1995 and December 1998 (37 months). There were 130 women and 20 men, with a mean
age of 37.5 years (range, 19-62). The mean initial excess body weight was 102.9%
(range, 58-191%), and the mean initial body mass index (BMI) was 44. 6 kg/m(2)
(range, 35.1-64.1). A Lapband was used in 101 cases and a SAGB in 47 cases. In
two patients in whom conversion was necessary, we performed a vertical banded
gastroplasty. Duration of surgery decreased over time from 210 min (first 20
cases) to 73 min (last 20 cases). Six patients (4%) developed major
complications, one of whom died. The median duration of postoperative hospital
stay was 3 days. The mean follow-up was 17 months. In all, 24 patients (16%)
developed late complications, and 22 (14.6%) required reoperation, mainly for
band slippage and/or pouch dilatation (14 cases). An incorrect surgical
technique used for the first 30 patients (Lapband within the lesser sac) was
responsible for more than half of these complications. The mean excess weight
loss was 34% at 6 months, 55% at 1 year, and 56% at 2 years. Compared to
vertical banded gastroplasty (197 cases between 1981 and 1995), postoperative
morbidity was greatly decreased, late morbidity was similar, and weight loss was
equivalent. CONCLUSIONS: Laparoscopic gastric banding is followed by a weight
reduction that is similar to that observed after vertical banded gastroplasty,
with a much lower postoperative morbidity, a shorter hospital stay, and an
earlier resumption of normal activities. If these results can be confirmed by
long-term follow-up, laparoscopic gastric banding will be confirmed as the
restrictive procedure of choice for morbid obesity.

PMID: 10890959 [PubMed]

290: Ann Plast Surg.  2000 Jun;44(6):644-5.  

Koebner phenomenon: what you don't know may hurt you.

Mendez-Fernandez MA.

Plastic Surgery Associates of Redding and Mercy Medical Center, CA, USA.

Koebner phenomenon is the development of isomorphic pathological lesions in
distant wounds of patients with pre-existing cutaneous diseases. More frequent
in patients with psoriasis, it can occur in the presence of other cutaneous
pathologies. Surgeons should be aware of this entity and warn patients about its
possible occurrence.

Publication Types:
    Case Reports

PMID: 10884082 [PubMed]

291: Heart.  2000 Jul;84(1):25-30.  

Infective endocarditis: clinical spectrum, presentation and outcome. An analysis
of 212 cases 1980-1995.

Netzer RO, Zollinger E, Seiler C, Cerny A.

Division of Cardiology, University Hospital, Inselspital Bern, Freiburgstrasse,
3013 Bern, Switzerland.

OBJECTIVE: To evaluate recent changes in the spectrum and clinical presentation
of infective endocarditis and to determine predictors of outcome. DESIGN: A
retrospective case study. METHODS: Demographic, clinical, and echocardiographic
characteristics were examined in 212 patients who fulfilled the Duke criteria
for infective endocarditis between January 1980 and December 1995 to assess
changes in clinical presentation and survival. RESULTS: Clinical presentation
and course did not change significantly during the study period despite the
concurrent introduction of new diagnostic tools (for example, transoesophageal
echocardiography). In-hospital mortality was 15% and remained unchanged.
Neurological symptoms on admission, arthralgia, and weight loss were all
independent risk factors for adverse outcome (odds ratios 26.1, 6.2, and 4.2,
respectively). Age, prosthetic valve disease, previous antibiotic treatment,
renal insufficiency, surgical treatment, and the type of valve involved were not
predictive of mortality. In contrast to all other major reports, Streptococcus
viridans was the most common causative organism in intravenous drug users (52%).
CONCLUSIONS: Despite the introduction of new diagnostic tools, the course of
infective endocarditis has remained unchanged over a period of 16 years.
Evidence of early dissemination of the disease to other sites was associated
with adverse outcome. Even in elderly patients, early aggressive treatment seems
to be effective.

PMID: 10862581 [PubMed]

292: Plast Reconstr Surg.  2000 Jun;105(7):2589-92; discussion 2593.  

Traumatic abdominal wall pseudolipoma following suction-assisted lipectomy.

Sharma S, Perrotti JA, Longaker MT.

Institute of Reconstructive Plastic Surgery at the New York University Medical
Center, NY 10016, USA. sheelny@hotmail.com

Publication Types:
    Case Reports

PMID: 10845316 [PubMed]

293: Dermatol Surg.  2000 Jun;26(6):588-90.  

Mycobacterium fortuitum infection following neck liposuction: A case report.

Behroozan DS, Christian MM, Moy RL.

University of California, Los Angeles, West Los Angeles VA Medical Center, Los
Angeles, California, USA.

Publication Types:
    Case Reports

PMID: 10848943 [PubMed]

294: J Ambul Care Manage.  2000 Apr;23(2):64-73.  

Is the physician office the wild, wild west of health care?

Quattrone MS.

ECRI, Plymouth Meeting, Pennsylvania, USA.

Elective, office-based surgery has captured the interest of consumers and, more
recently, the attention of state health care regulatory agencies. In most states
today, patients can undergo cosmetic surgery, liposuction, endoscopy,
colonoscopy, microlaparoscopy, and various other procedures requiring sedation
or anesthesia in physician offices even though no regulatory safeguards that
would ordinarily benefit patients in accredited or licensed facilities exist.
Media accounts of deaths and serious injuries associated with liposuction and
anesthesia performed in physician offices resulted in legislative and regulatory
initiates, such as those in California and New Jersey. Increased regulatory
oversight, changes in patterns of reimbursement, and greater consumer awareness
of safety and quality-of-care issues should aid in reducing the risks of
office-based surgery.

PMID: 10848394 [PubMed]

295: Plast Reconstr Surg.  2000 May;105(6):2267-8.  

Breast milk lidocaine levels in tumescent liposuction.

Dryden RM, Lo MW.

Publication Types:
    Case Reports

PMID: 10839430 [PubMed]

296: Plast Reconstr Surg.  2000 May;105(6):2244-8; discussion 2249-50.  

Large-volume liposuction complicated by retroperitoneal hemorrhage: management
principles and implications for the quality improvement process.

Talmor M, FAhey TJ 2nd, Wise J, Hoffman LA, Barie PS.

Department of Surgery, New York Presbyterian Hospital-Cornell Medical Center, NY
10021, USA. miatmd@aol.com

Large-volume liposuction can be associated rarely with major medical
complications and death. The case of exsanguinating retroperitoneal hemorrhage
that led to cardiopulmonary arrest in an obese 47-year-old woman who underwent
large-volume liposuction is described. Extensive liposuction is not a minor
procedure. Performance in an ambulatory setting should be monitored carefully,
if it is performed at all. Reporting of adverse events associated with
outpatient procedures performed by plastic surgeons should be mandated.
Hemodynamic instability in the early postoperative period in an otherwise
healthy patient may be due to fluid overload, lidocaine toxicity, or to
hemorrhagic shock and must be recognized and treated aggressively. Guidelines
for the safe practice of large-volume liposuction need to be established.

Publication Types:
    Case Reports

PMID: 10839425 [PubMed]

297: Plast Reconstr Surg.  2000 May;105(6):2161-74; discussion 2175-9.  

Ultrasound-assisted lipectomy using the solid probe: a retrospective review of
100 consecutive cases.

Beckenstein MS, Grotting JC.

Plastic Surgery Clinic in Birmingham, Ala., USA.

Ultrasound-assisted lipectomy using the solid probe is a predictable and safe
method that can yield excellent results. This method is particularly useful and
is indicated when the subdermis must be approached to smooth out surface
irregularities and/or to stimulate skin retraction. The authors present their
method using the solid probe and a retrospective study of their first 100
consecutive cases. The indications for using the solid probe, its advantages and
disadvantages, associated complications, and representative cases are presented.

Publication Types:
    Case Reports

PMID: 10839419 [PubMed]

298: Dermatol Surg.  2000 May;26(5):433-5.  

Effect of external ultrasound postliposuction: a side-to-side comparison study.

Butterwick KJ, Tse Y, Goldman MP.

Dermatology Associates of San Diego County, Inc., San Diego, California 92024,
USA. dadee7@cts.com

BACKGROUND: External ultrasound (EUS) has been used as a therapeutic modality
for more than 30 years by multiple medical specialists, primarily for
stimulating the repair of soft tissue injuries and relieving pain. It has also
been used to treat postoperative swelling after liposuction. There are no
controlled studies documenting the objective and subjective effects of EUS
following liposuction. OBJECTIVE: The purpose of this preliminary study was to
evaluate the role of EUS in the relief of postoperative symptoms following
traditional tumescent liposuction. METHODS: Twenty-five patients underwent
tumescent liposuction of the abdomen or hips. Within 2 weeks after the
procedure, a double-blind study was initiated in which EUS therapy was applied
at therapeutic energies to one-half of the treated area, while the other side
was treated with placebo settings. Patients were treated biweekly for a total of
six to eight treatments. Both objective and subjective parameters were assessed
during the subsequent side-by-side evaluations by the patient and observer.
RESULTS: After four treatments, 18 of 25 patients had the same postoperative
symptoms on each side. Two had fewer symptoms on the EUS side and five were
worse on the EUS side. After completion of all treatments, 17 of 25 again had
the same symptoms on the therapeutic and placebo sides. Three had improved
symptoms and five were worse on the EUS side. The subjective findings revealed
that all patients believed the treatment helped significantly on both the
placebo and EUS-treated sides. CONCLUSION: EUS after liposuction of the abdomen
at the study parameters provided no objective benefit compared to placebo in
postoperative recovery. Patient acceptance and perception of benefit are high.
Further studies are needed to determine the optimal timing and energies required
for therapeutic value.

Publication Types:
    Clinical Trial
    Controlled Clinical Trial

PMID: 10816230 [PubMed]

299: Plast Reconstr Surg.  2000 Apr;105(5):1909.  

Comment on:
    Plast Reconstr Surg. 1985 Aug;76(2):307-9.

Failure to remove soft tissue injected with liquid silicone with the use of
suction and honesty in scientific medical reports.

Spira M.

Publication Types:

PMID: 10809140 [PubMed]

300: Obes Surg.  2000 Apr;10(2):179-81; discussion 182.  

Failure of biliopancreatic diversion in Prader-Willi syndrome.

Grugni G, Guzzaloni G, Morabito F.

Department of Auxology, IRCCS S. Giuseppe Hospital, Istituto Auxologico Italiano
Foundation, Verbania, 28921 Italy. gragru@jumpy.it

BACKGROUND: Prader-Willi syndrome (PWS) is the most common genetic obesity.
Excessive weight gain follows failure-to-thrive in early infancy; in adolescents
and young adults, excess body weight can exceed 100%. The hyperphagia associated
with PWS is responsible for the early mortality. Dietary restriction, alone or
combined with anorexic drugs, are ineffective to induce a permanent weight loss.
Thus, surgical treatment of morbid obesity in PWS has been attempted, but
gastric restrictive operations are unable to produce stable weight loss. In a
small number of patients, favorable results have been reported with
biliopancreatic diversion (BPD). CASE REPORT: A 24-year-old woman with PWS,
Pickwickian, at age 21 weighed 80 kg (BMI= 50) and underwent BPD. RESULTS: 3
years after the BPD she regained 21 of the 26 kg lost; somnolence and
respiratory difficulties were the same as before surgery. The patient now
presents severe reduction of bone mass density, hypochromic anemia,
hypoproteinemia, and diarrhea associated with eating. CONCLUSION: The regain of
weight following BPD suggests that this procedure alone is not adequate for
long-term control of obesity in PWS.

Publication Types:
    Case Reports

PMID: 10782182 [PubMed]

301: Obes Surg.  1991 Dec;1(4):381-387.  

Biliopancreatic Diversion with Gastrectomy as Surgical Treatment of Morbid

Marceau P, Biron S, St Georges R, Duclos M, Potvin M, Bourque RA.

Department of General Surgery, Laval Hospital, Sainte-Foy, Quebec, G1V 4G5

The best procedure for the treatment of morbid obesity has not yet been defined.
Biliopancreatic diversion is one of the techniques available, but its results
have not been sufficiently documented and the addition of a subtotal gastrectomy
to the diversion so as to avoid leaving a blind non-functioning stomach, is
still questionable. The purpose of this paper is to report our experience with
our first 149 consecutive patients who were treated by biliopancreatic diversion
with subtotal gastrectomy for morbid obesity. Operative mortality was 3% and
morbidity 12%. The weight loss was marked during the first 6 months and
decreased during the following 12 months. The weight stabilized at 2 years and
there was subsequently a small increase. In only two out of 48 cases was the
weight loss less than 25% of the initial weight at 2 years. The undesirable
side-effects were diarrhea in 6%, vomiting in 9% and dyspepsia in 4%. The
intervention leads to a malabsorption of carotene, iron, albumin and calcium.
Except for carotene the deficiencies were corrected by oral supplement. In two
patients, with resistant deficiencies, the diversion was reversed. Eighty-eight
percent of the patients are satisfied with this intervention. At 2 years, 70%
have reached their weight loss objective without any major side-effects or
nutritional deficiencies, but in 14% the outcome of the procedure must be
considered unsatisfactory. Biliopancreatic diversion with subtotal gastrectomy
is a major operation, but it gives encouraging results so far.

PMID: 10775939 [PubMed]

302: Presse Med.  2000 Mar 11;29(9):469-75.  

[Epidural lipomatosis]

[Article in French]

Levy-Weil FE, Feldmann JL.

Service de Rhumatologie, Centre Hospitalier Victor Dupouy, Argenteuil.

ONSET: Epidural lipomatosis is a rare disorder defined as a pathological
overgrowth of normal epidural fat. It is more often associated with
administration of exogenous steroid with variable duration and doses.
Furthermore, it may occur in some patients in the absence of exposure to
steroids but generally associated with obesity. Whatever the predisposing
factor, the majority of these patients are men. The causal effect of epidural
lipomatosis in the development of spinal cord or radicular compression is
generally well accepted. DIAGNOSIS: The diagnosis of epidural lipomatosis can be
established by melography, computed tomography (CT) and magnetic resonance
imaging (MRI). MRI is considered the imaging procedure of choice, allowing an
assessment of the extent of lipomatosis and, as well as CT, an identification of
the lipomatous tissue. Most cases of epidural lipomatosis with corticosteroid
use occur in the thoracic region, while most idiopathic cases occur in the
lumbar region. TREATMENT: Management of treatment depends on the severity of the
neurological signs and the patient's background. The most common treatment for
epidural lipomatosis with corticosteroid use consists in surgical decompression
but with a high risk of postoperative mortality. In some cases however, medical
treatment includes corticosteroid withdrawal or reduction and calorie
restriction, leading to clinical improvement. Treatment for idiopathic epidural
lipomatosis is more often medical, based on weight loss and physical therapy
with generally successful outcome. The pathogenesis of epidural lipomatosis
remains unknown but different suggested hypotheses may lead to a metabolic
disorder as the underlying cause.

Publication Types:
    Review, Tutorial

PMID: 10745936 [PubMed]

303: Acta Chir Plast.  1999;41(4):103-6.  

An infiltration technique for reduction mammaplasty: results in 192 consecutive

O'Donoghue JM, Chaubal ND, Haywood RM, Rickard R, Desai SN.

Department of Plastic Surgery, Stoke Mandeville NHS Trust Hospital, Aylesbury,
Bucks, United Kingdom.

The use of local anaesthetic infiltration with adrenaline is now considered safe
in reduction mammaplasty. However, the technique of infiltration by those who
support its use is often unclear. Any technique must take account of the
neurovascular anatomy of the breast if it is to be effective. We propose the use
of a large volume of dilute local anaesthetic (20 ml of 1% lignocaine and 1 mg
of adrenaline made up to 400 ml with 0.9% saline) which is placed judiciously in
the retroglandular space 15 minutes prior to surgery. The results in 96
consecutive patients (192 breasts) who had an inferior pedicle technique were
analysed. The breast complication rate was 9.36% and the patient complication
rate 19.79%. Postoperative blood loss ranged from 0 to 305 ml with a mean of
56.03 ml and a median of 50 ml. The described method could be considered a
variation of the tumescent technique used in liposuction. The results is an
almost bloodless dissection with minimal postoperative blood loss. It should be
possible to dispense with the use of drains in most cases.

PMID: 10743712 [PubMed]

304: Semin Laparosc Surg.  2000 Mar;7(1):55-65.  

Laparoscopic gastroplasty (adjustable silicone gastric banding).

Cadiere GB, Himpens J, Vertruyen M, Germay O, Favretti F, Segato G.

Gastro Intestinal Surgery Department, CHU Saint-Pierre, Brussels, Belgium.

Until now, for treatment of morbid obesity in the long term, surgery remained as
the final option. For 40 years, surgeons looked at the best procedure. Among the
restrictive procedures (gastroplasty), the laparoscopic adjustable silicone
banding is the least invasive surgical treatment of morbid obesity. Between
October 1992 and January 1998, we performed this procedure on 652 patients.
Median body mass index was 45 (range, 35-65). Median hospital stay was 3 days
(range, 2-10 days). The mean operative time was 80 minutes (range, 40-240
minutes). Four patients (0.6%) presented early complications: bleeding (1
patient), gastric perforation (2 patients), and pneumonia (1 patient).
Forty-seven (7.2%) patients presented late complications and needed to be
reoperated. There is one case of mortality. Loss of mass body weight was 62% in
2 years. According to these results, laparoscopic adjustable silicone gastric
banding seems to be a safe and efficient technique.

PMID: 10735916 [PubMed]

305: Chirurg.  2000 Feb;71(2):134-9.  

[20 years small intestinal bypass surgery. What is left?]

[Article in German]

Husemann B.

Chirurgische Klinik, Dominikus-Krankenhaus, Dusseldorf.

The jejunoileostomy was a frequently used surgical procedure to treat morbid
obese patients (obesity grade III) from 1970 to 1980. The observed weight loss
was very good, 50-60 kg during the first 18 months after operation (n = 288).
Even obesity-induced side effects were improved significantly. However, negative
consequences and complications were seen all too often: chronic loss of
electrolytes, protein and vitamins and diarrhea with perianal skin problems.
Reoperations were often necessary due to renal stone formation,
cholecystolithiasis or blind loop syndrome. Therefore this procedure was
abandoned in favor of operations such as vertical banded gastroplasty or the
adjustable gastric band. However, in special cases similar operations may be
helpful if gastric restriction has failed.

PMID: 10734580 [PubMed]

306: Obes Surg.  1995 Nov;5(4):419-423.  

'Hybrid' Bariatric Surgery: Bilio-pancreatic Diversion and Duodenal Switch-
Preliminary Experience.

Baltasar M, Bou R, Cipagauta LA, Marcote E, Herrera GR, Chisbert JJ.

The Surgical Service, 'Virgen do los Lirios' Hospital, ALCOY, Alicante, 03804,

BACKGROUND: Hybrid, combined or mixed bariatric surgery is the combination of a
degree of 'malabsorption' (as achieved by the intestinal bypass) with a
'restriction' (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 multi-systemic 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.

PMID: 10733838 [PubMed]

307: Obes Surg.  1995 Nov;5(4):387-392.  

Long-term Results on Quality of Life of Surgical Treatment of Obesity with
Vertical Banded Gastroplasty.

Wyss C, Laurent-Jacard A, Burckhardt P, Jayet A, Gazzola L.

Medical Policlinic, University Hospital, CHUV, Lausanne, 1011, Switzerland.

BACKGROUND: Few papers assess quality of life after vertical banded gastroplasty
(VBG). METHODS: 100 patients with severe obesity (preoperatively mean BMI 41.7
kg m(2)) answered an interview 60 (+/- 2.5) months after VBG. RESULTS: There was
no fatal outcome. Nine patients had pulmonary embolus; ten patients required
reoperation because of stomal stenosis. Of the 89 patients that still bore a
gastroplasty at the moment of the interview, 65 had lost more than 40% of their
excess weight (= "success'). Improvement in quality of life of these 89 patients
was reflected by significant diminution of depression and back pains.
Significant diminution of arterial hypertension and improvement of professional
satisfaction, and of social, physical, and sexual activity was significantly
related to weight loss. CONCLUSION: VBG resulted generally in a favorable
long-term effect on quality of life. However, patients should be informed
preoperatively about potential side-effects such as possible persistent vomiting
after several years, esophagitis and gastritis, restriction in the choice of
foods and prolongation of meals.

PMID: 10733832 [PubMed]

308: Obes Surg.  1995 Nov;5(4):357-363.  

Favorable Long-term Results with the End-to-Side Jejunoileal Bypass.

Sylvan A, Sjolund B, Janunger K.

Department of Surgery, University Hospital, Umea, Umea, S-90185, Sweden.

BACKGROUND: Although jejunoileal bypass (JIB) causes long-standing weight loss,
it is no longer recommended as a surgical treatment of morbid obesity due to
adverse effects. METHODS: JIB was performed on 87 morbidly obese subjects with a
mean age of 35 years. Complete follow-up on 95% of the patients included
monitoring weight, metabolic parameters and liver biopsies up to 25 years
postoperatively. RESULTS: The mean (+/- SD) Body Mass Index (BMI) was reduced
from 41.5 +/- 5.8 kg m(2) preoperative, to 26.7 +/- 3.8 kg m(2) at 2 years and
29.7 +/- 3.9 kg m(2) at 16 years follow-up. More than 60% loss of initial excess
weight was achieved by 88% of the patients at four years and by 75% at 16 years
follow-up. Reversal of the bypass was performed in 3% of the patients and
revisions in 8% of the patients. There was no 30-day hospital mortality but
there was one (1 %) late bypass-related death. Complications included urinary
calculi in 39% of the patients, electrolyte disturbances in 25% and transient
liver failure in 5.5%. Liver biopsies taken more than 13 years postoperatively
in 44 patients revealed no cirrhosis. All patients were normoglycemic and
normolipemic at follow-up. CONCLUSIONS: The majority of the patients have an
acceptable weight reduction, few serious adverse effects but several beneficial
effects after more than 16 years. The JIB deserves a reconsideration as an
alternative in obesity surgery.

PMID: 10733826 [PubMed]

309: Obes Surg.  1995 Aug;5(3):302-307.  

Biliopancreatic Diversion, with Distal Gastrectomy, 250 cm and 50 cm Limbs:
Long-term Results.

Marceau S, Biron S, Lagace M, Hould FS, Potvin M, Bourque RA, Marceau P.

Department of General Surgery, Laval University, Laval Hospital, Sainte-Foy,
Quebec, G1V 4G5, Canada.

BACKGROUND: Since 1984, biliopancreatic diversion (BPD) has been our procedure
of choice in the treatment of morbid obesity. Better understanding of long-term
outcome following BPD is needed. METHODS: We report the results of our first
consecutive 92 patients who underwent BPD more than 5 years ago. Of these 92,
only 82 were available for a recent formal evaluation after a mean of 79 months.
RESULTS: Weight loss, was maintained over the years at 62% of initial excess
weight; the success rate for losing more than 50% of initial excess weight was
72%. The gastrointestinal side-effects decreased with time, but diarrhea was
still present in 13%. The average number of daily stools was 3 +/- 1.0. Of the
patients, 76% were free from any gastrointestinal side-effects, taking normal
diet and having normal stools. Malabsorption, however, was still present. A
third of patients had laboratory values slightly below normal levels for
hemoglobin, albumin and calcium. These values were mostly without clinical
manifestation and were well tolerated by the patients. Regarding associated
diseases, 75% were cured or improved following BPD. In 14 patients, reoperation
was required to improve diarrhea or serum albumin. In these patients, the common
channel was lengthened from 50 to 100 cm. The revision was successful in 11 and
did not cause significant weight gain. CONCLUSIONS: BPD, as proposed by
Scopinaro, was an efficient surgical treatment of morbid obesity that allowed
normal eating habits and despite malabsorption was well tolerated by the great
majority of patients.

PMID: 10733816 [PubMed]

310: Obes Surg.  2000 Feb;10(1):54-7.  

Report on bariatric surgery in the Ukraine.

Sayenko VF, Lavryk AS, Stetsenko OP.

Department of Surgery of the Gastrointestinal Tract, Institute of Clinical and
Experimental Surgery of the Academy of Medical Sciences of the Ukraine, Kiev.

BACKGROUND: Morbid obesity (MO) is a problem internationally, including in the
Ukraine. We present the surgical treatment of MO in the Ukraine over the last 15
years, during which intestinal bypasses and various gastric reduction procedures
were performed. METHODS: 198 patients with MO underwent: jejunoileal (JI) bypass
64, non-adjustable gastric banding (NGB) 34, Roux-en-Y gastric bypass (RYGBP) 1,
horizontal gastroplasty 1, vertical banded gastroplasty (VBG) 2, and abdominal
lipectomy 96. The 96 men and 102 women weighed 160-290 kg (mean 210+/-SD18 kg).
Mean body mass index was >60 kg/m2. These patients had a high incidence of
hypertension, diabetes, sleep apnea, menstrual disorders, impotency in men and
infertility in women. RESULTS: At 1 year, after JI bypass 61 patients lost a
mean of 62+/-17 kg and after NGB 11 kg. After JI bypass, 1 patient died in the
early postoperative period from acute respiratory insufficiency and 2 died in
the first year from acute liver insufficiency. The JI bypass was reversed in 2
patients due to uncontrollable malabsorption syndrome; 1 year after reversal,
the weight of these patients exceeded their preoperative weight. In the early
postoperative period, 1 patient died after NGB and 1 after RYGBP, from acute
respiratory insufficiency. Postoperative weight loss was associated with
decrease in the co-morbidities of MO, but after JIB, there was a high incidence
of bypass enteritis, excessive malabsorption, formation of renal stones and
gallstones. After NGB, no complications have been identified. Isolated lipectomy
was performed in 44 patients, lipectomy combined with a bariatric operation in
31, and lipectomy after loss of the excess body weight in 21. CONCLUSIONS:
Bariatric surgery was very effective in weight loss, accompanied by reduction or
disappearance of the co-morbidities of MO, with considerable improvement in
quality of life.

PMID: 10715646 [PubMed]

311: Obes Surg.  2000 Feb;10(1):26-32.  

Comment in:
    Obes Surg. 2001 Feb;11(1):100.

Adjustable silicone gastric banding: a series with three cases of band erosion.

de Jonge IC, Tan KG, Oostenbroek RJ.

Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands.

BACKGROUND: Among the various operations used for surgical treatment of morbid
obesity, adjustable silicone gastric banding (ASGB) is the least invasive. Many
good results have been described. During extended follow-up, however, serious
complications may occur. We briefly describe our results with ASGB and will
focus on three cases of band erosion. METHODS: From January 1996 to December
1998, 91 patients underwent laparoscopic adjustable gastric banding in our
clinic. Follow-up until now is 100%. RESULTS: Body Mass Index (BMI) in this
series decreased from 44.7 at time of operation to 34.8 at 18 months of
follow-up (42 patients). Complications, minor and major, occurred in 27.5%.
Three patients are described in which the gastric band migrated and had to be
removed operatively. CONCLUSIONS: Satisfactory weight loss can be established by
ASGB. However, serious and potentially lethal complications can occur. In view
of the former Angelchik esophageal antireflux prosthesis, abandoned because of
its notorious migration, we must be aggressive in evaluating band migration.
Thus, we plead for international registration of adjustable silicone gastric

Publication Types:
    Case Reports

PMID: 10715640 [PubMed]

312: Obes Surg.  2000 Feb;10(1):15-21.  

The Swedish Adjustable Gastric Band: laparoscopic technique and preliminary

Catona A, La Manna L, Forsell P.

Department of Surgery at Casa Di Cura Beato Matteo, Vigevano, Provincia di
Pavia, Italy.

BACKGROUND: The laparoscopic technique for the Swedish Adjustable Gastric Band
(SAGB) has been developed based on the previously established open technique.
METHODS: From March 1996-June 1997, laparoscopic SAGB was attempted in 85
consecutive obese patients (77 women and 8 men). The average preoperative BMI
was 44 (34-59). RESULTS: All operations except one were completed by
laparoscopy. One patient had to be converted because of unfavorable anatomic
conditions. The average operating time was 40 minutes. There were no immediate
perioperative complications. All patients were followed for 1 year. During this
period 2 patients developed esophagitis and 3 patients experienced repeated
vomiting. There were no other complications. At 1 year follow-up the average BMI
was 33 (21-46).The excess weight loss was 54% (17-100%). CONCLUSION: Early
results are encouraging. No significant complications related to the technique
were registered. One-year weight loss was equal to what was achieved by open
surgery. Laparoscopic SAGB will be established as an attractive alternative for
surgical treatment of morbid obesity.

PMID: 10715638 [PubMed]

313: AIDS.  2000 Jan 7;14(1):51-7.  

Effect of ritonavir on lipids and post-heparin lipase activities in normal

Purnell JQ, Zambon A, Knopp RH, Pizzuti DJ, Achari R, Leonard JM, Locke C,
Brunzell JD.

Department of Medicine, University of Washington, Seattle 98195, USA.

BACKGROUND: Intensive therapy of HIV infection with highly active antiretroviral
therapy (HAART) dramatically reduces viral loads and improves immune status.
Abnormalities of lipid levels, body fat distribution, and insulin resistance
have been commonly reported after starting HAART. Whether the lipid
abnormalities result from changes in metabolism after an improvement in HIV
status or are partly attributable to the effects of protease inhibitor use is
unknown. METHODS: Twenty-one healthy volunteers participated in a 2 week
double-blind, placebo-controlled study on the effect of the protease inhibitor
ritonavir on total lipids, apolipoproteins, and post-heparin plasma lipase
activities. RESULTS: Those taking ritonavir (n = 11) had significantly higher
levels of plasma triglyceride, VLDL cholesterol, IDL cholesterol, apolipoprotein
B, and lipoprotein (a) compared with placebo (n = 8). HDL cholesterol was lower
with therapy as a result of a reduction in HDL3 cholesterol. Post-heparin
lipoprotein lipase (LpL) activity did not change but hepatic lipase activity
decreased 20% (P < 0.01) in those taking ritonavir-compared with placebo.
Although all lipoprotein subfractions became triglyceride enriched, most of the
increase in triglyceride was in VLDL and not in IDL particles. CONCLUSION:
Treatment with ritonavir in the absence of HIV infection or changes in body
composition results in hypertriglyceridemia that is apparently not mediated by
impaired LpL activity or the defective removal of remnant lipoproteins, but
could be caused by enhanced formation of VLDL. Long-term studies of patients
with HIV infection receiving HAART will be necessary to determine the impact of
these drugs and associated dyslipidemia on the risk of coronary artery disease.

Publication Types:
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial

PMID: 10714567 [PubMed]

314: AORN J.  2000 Feb;71(2):370, 373-5, 377 passim; quiz 386-90.  

Body contouring with ultrasound-assisted lipoplasty.

Moss R, Moss CJ, Broadway DR.

Lipoplasty (i.e., liposuction) is the most commonly performed cosmetic surgical
procedure in the United States. During the past 20 years, there have been
dramatic technological advancements in both surgical technique and equipment
used to improve postoperative outcomes. As a result, perioperative nurses are
faced with the challenge of providing quality care for this patient population
in a variety of ambulatory surgical settings with highly specialized equipment.
Perioperative team members play significant roles in the coordination of
individualized patient-focused care, which includes detailed instructions and
education, appropriate use and care of equipment, and postoperative follow-up.
The efforts of the team members contribute to positive surgical outcomes, as
well as to overall patient satisfaction.

Publication Types:
    Case Reports
    Review, Tutorial

PMID: 10707267 [PubMed]

315: Int J Radiat Oncol Biol Phys.  2000 Mar 1;46(4):873-81.  

Investigation of the comparative toxicity of 5-FU bolus versus 5-FU continuous
infusion circadian chemotherapy with concurrent radiation therapy in locally
advanced rectal cancer.

Thrall MM, Wood P, King V, Rivera W, Hrushesky W.

Stratton VAMC, Albany, NY 12208, USA.

PURPOSE: To compare the relative toxicities of bolus versus infusional 5-FU
chemotherapy administrated concurrently during external beam irradiation in
patients with locally advanced rectal cancer following surgical extirpation.
METHODS: A total of 26 eligible patients were retrospectively identified as
having been treated for rectal adenocarcinoma at the Stratton VAMC between 1989
and 1997. A comparative analysis of treatment dose intensities, treatment delays
and toxicities in these patients was performed. RESULTS: Significantly less WBC
toxicity was observed in the patients receiving infusional 5-FU chemotherapy.
The other toxicities, with the exception of skin toxicity, were generally less
frequent in the 5-FU infusional group. When the toxicities were corrected for
5-FU dose intensity, to yield toxicity per mg of 5-FU, statistically significant
differences were found for hematological toxicity (WBC and platelets), and for
gastrointestinal toxicity (frequency and severity of diarrhea and weight loss).
The majority of patients receiving infusional 5-FU therapy were treated using a
circadian pattern of treatment peaking around the time of the radiation therapy.
Patients receiving infusional 5-FU were able to tolerate over twice the dose
intensity as those receiving bolus administration. Local recurrence rate in all
patients was 3.8% comparing favorably to other reported studies. Distant
recurrence frequency was also acceptable at 34.6% for the group. CONCLUSION:
Infusional 5-FU chemotherapy compared with bolus therapy during pelvic radiation
minimizes toxicity to the patient while maximizing the dose of 5-FU that can be
delivered. As infusional 5-FU therapy during radiation has previously been shown
to increase disease free duration and survival, infusional 5-FU should be
considered as an acceptable standard of care to prevent local recurrence of
rectal adenocarcinoma following its resection. Shaping this infusional 5-FU
chemotherapy within the day so that most of the daily dose is delivered around
the time of the radiation therapy may further modify the toxic therapeutic ratio
of combined modality therapy.

PMID: 10705008 [PubMed]

316: Ann Plast Surg.  2000 Feb;44(2):125-33; discussion 133-4.  

Comment in:
    Ann Plast Surg. 2000 Dec;45(6):676-7.

Breast reduction outcome study.

Mizgala CL, MacKenzie KM.

Section of Plastic Surgery, Ochsner Clinic LLC and Alton Ochsner Medical
Foundation, Tulane University School of Medicine, New Orleans, LA 70121, USA.

The outcome of 75 consecutive bilateral breast reduction procedures on 73
patients (65 inferior pedicle and 9 superior pedicle with inverted-T closure,
and 1 ultrasonic-assisted lipoplasty) is evaluated. Fifty-six surveys at an
average follow-up of 35 months, 36 standardized examinations at an average
follow-up of 31 months, 52 paired preoperative/postoperative photographs, and 73
chart reviews comprise the data. Mean age at surgery was 32 years. Of the
patients surveyed, there were 51 whites, 18 blacks, and 4 other races. The
majority of survey respondents reported improvement in breast appearance (93%),
self-esteem (85%), posture (84%), and activity level (77%). The percentage of
patients free of back pain rose from 9% preoperatively to 59% postoperatively.
Some decrease in nipple sensitivity was noted by survey in 34 nipple-areolar
complexes (31%), and clinical examination detected decreased sensitivity in 16%
of nipples. Thirty-one percent of patients reported improvement in their
intimate relationship postoperatively and 65% reported no change. Ninety-five
percent felt they had made the right decision in having breast reduction
surgery. Physical examination revealed excellent maintenance of shape and
impressive fading of surgical scars over the years in the majority of patients.
The postoperative aesthetic result depends on several important preoperative
factors, including skin tone, breast shape, and degree of ptosis. Adverse
sequelae included infection (1.3%), nipple cyanosis (1.3%) but no nipple-areolar
necrosis, and wound dehiscence (4.0%) but no skin flap necrosis. Late
complications included underresection requiring reoperation (4.0%), fat necrosis
(2.7%), hypertrophic scars (6.7%), and pseudoptosis (12.0%). Breast reduction
surgery results in a good outcome for most patients, with high patient
satisfaction. Patients are accepting of the large T-pattern scar that fades
surprisingly well with time in exchange for symptomatic relief and substantial
improvement in breast size and shape.

PMID: 10696037 [PubMed]

317: Acta Neurol Scand.  2000 Feb;101(2):79-84.  

Weight gain following unilateral pallidotomy in Parkinson's disease.

Ondo WG, Ben-Aire L, Jankovic J, Lai E, Contant C, Grossman R.

Department of Neurology, Baylor College of Medicine, Houston, TX, USA.

OBJECTIVE: To determine the clinical correlates and infer pathogenesis of weight
gain following pallidotomy in patients with Parkinson's disease (PD).
BACKGROUND: Surgical ablation of the globus pallidus internus (GPi) improves
levodopa induced dyskinesias, moderately improves most other "cardinal"
manifestations of PD, and has been noted to result in increased weight. METHODS:
We incorporated Unified Parkinson's Disease Rating Scales (UPDRS) subscales, the
Beck depression inventory and feeding questionnaire data into a linear
regression model in order to determine which post-surgical change(s) may lead to
weight gain over the first year following pallidotomy, n = 60. RESULTS: The mean
weight gain 1 year after pallidotomy was 4.0 +/- 4.1 kg. Improvement in "off"
motor scores (P < 0.005), especially gait subscores (P<0.0001), and to a lesser
extent improvement in "on" motor scores (P<0.05) predicted weight gain. Changes
in dyskinesia ratings, mood, food intake, dysphagia, levodopa dose, weight loss
in the year prior to pallidotomy, age, and duration of PD did not correlate with
subsequent weight gain. CONCLUSION: The high correlation between
post-pallidotomy weight gain and "off" motor scores, suggests that this
phenomenon is related to some change in underlying homeostasis associated with
changes in the cardinal manifestations of PD itself, rather than secondary
changes resultant from the surgery.

PMID: 10685852 [PubMed]

318: Br J Plast Surg.  1999 Sep;52(6):500-2.  

Pseudocyst formation after abdominoplasty--extravasations of Morel-Lavallee.

Zecha PJ, Missotten FE.

Department of Plastic and Reconstructive Surgery, Heilig Hart Ziekenhuis,
Leuven, Belgium.

A soft tissue injury can lead to the formation of a pseudocyst in the
subcutaneous adipose tissue, due to a seroma, haematoma or fat necrosis. These
cysts were first described in 1853 by the French physician Morel-Lavallee. He
observed the phenomenon in the lower limb in women after a tangential trauma
with separation of the fatty layers. A similar condition can occur following
surgery of the abdomen, when performing liposuction and subcutaneous dissection
with a large dead space. In this report we present two cases with large
pseudocysts in the abdominal wall, which were seen in long term follow-up after
an abdominoplasty performed elsewhere. The pathogenesis, the treatment and the
literature are discussed.

Publication Types:
    Case Reports
    Review of Reported Cases

PMID: 10673930 [PubMed]

319: Aesthetic Plast Surg.  1999 Nov-Dec;23(6):379-85.  

Power-assisted lipoplasty (PAL): A clinical pilot study comparing PAL to
traditional lipoplasty (TL).

Fodor PB, Vogt PA.

The subject of this paper is a study designed to compare power-assisted
lipoplasty (PAL) to traditional lipoplasty (TL) in 30 patients. PAL was used on
one side and TL was used on the matching contralateral body area. In PAL, a
cannula powered by medical-grade nitrogen (N(2)) reciprocates between 2000 and
4000 cpm with a 2-mm stroke. The device is commercially offered by MicroAire
Surgical Instruments. While there was no difference in the speed of recovery or
in the aesthetic quality of the result between the two sides, PAL was found
considerably superior as far as ease of fat extraction.

Publication Types:
    Clinical Trial

PMID: 10629291 [PubMed]

320: Plast Reconstr Surg.  2000 Jan;105(1):109-10.  

Extravasation injuries and emergency suction as treatment.

Vandeweyer E, Heymans O, Deraemaecker R.

Plastic and Reconstructive Surgery Department, Jules Bordet Institute for
Cancer, Brussels, Belgium.

To evaluate the efficiency of emergency suction in extravasation injuries of
contrast medium, records of 11 patients treated for extravasation injuries with
a combination of suction and saline washout were reviewed. All of the patients
were treated in the first 2 hours after injury. The mean extravasated volume was
55 cc. There were no surgery-related complications, and all the patients
experienced a relief of their preoperative pain. Except for two patients with
blisters at admission, none of them suffered skin or soft-tissue necrosis. Mean
time to complete healing was 9 days. Emergency suction therapy is safe and
effective in preventing the skin and soft-tissue necrosis associated with
extravasation injuries of hyperosmolar contrast medium.

PMID: 10626979 [PubMed]

321: Obes Surg.  1999 Oct;9(5):433-42.  

Comment in:
    Obes Surg. 2000 Feb;10(1):68-9.

Vertical banded gastroplasty versus standard or distal Roux-en-Y gastric bypass
based on specific selection criteria in the morbidly obese: preliminary results.

Kalfarentzos F, Dimakopoulos A, Kehagias I, Loukidi A, Mead N.

Nutrition Support and Morbid Obesity Clinic, University Hospital of Patras, Rio,

BACKGROUND: Predicting successful outcomes after bariatric surgical procedures
has been difficult, and the establishment of specific selection criteria has
been a subject of ongoing research. In an effort to choose the most appropriate
surgical procedure for each patient, we have established a specific set of
selection criteria for each procedure based on degree of obesity, preoperative
dietary habits, eating behavior, and various metabolic features. METHODS: From
June 1994 to December 1998, 90 bariatric surgical procedures were performed at
the authors' institution by a single surgeon (F.K.) based on specific selection
criteria. Vertical banded gastroplasty (VBG) was performed in 35 patients,
standard Roux-en-Y gastric bypass (RYGB) in 38 patients, and distal RYGB in 17
patients. All patients were monitored postoperatively 1, 3, 6, and 12 months and
once per year thereafter, with an additional visit at 18 months in distal RYGB
patients. RESULTS: Early postoperative morbidity (<30 days) did not differ
significantly between the three groups and averaged 9% of total patients.
Long-term postoperative morbidity (>30 days) included 9 incisional hernias (2 in
the VBG group, 5 after RYGB, and 2 in the distal RYGB group). There were 6 cases
of staple-line disruption, 4 after VBG and 2 after standard RYGB, 1 of which
resulted in stomal ulcer. Early postoperative mortality was 0%, and long-term
mortality was 1.1%, which was due to pulmonary embolism in 1 standard RYGB
patient on the 65th postoperative day. Average percentage of excess weight loss
(%EWL) was 62% the first year, 61% the second year, and 50% the third year in
VBG patients, and 63.6%, 65%, and 63.3%, respectively, in standard RYGB
patients. In distal RYGB patients, where the patient number was significantly
smaller, the %EWL at 1 and 2 years, respectively, was 51% and 53%. The most
significant metabolic/nutritional complication was the appearance of
hypoproteinemia (hypoalbuminemia) in 1 distal RYGB patient 20 months after
surgery, which was corrected by total parenteral nutrition and subsequent
increase in dietary protein intake. Significant improvement or resolution of
preexisting comorbid conditions was observed in all patient groups. The
postoperative quality of eating, as evaluated by variety of food intake and
frequency of vomiting, was significantly better in RYGB patients. CONCLUSIONS:
These results show that selection of the bariatric surgical procedure to be
performed in each patient based on specific criteria leads to acceptable weight
loss, improvement in preexisting comorbid conditions, and a high degree of
patient satisfaction in most patients. On the basis of our own observations as
well as those of others, our selection criteria have become more strict over
time and our selection of VBG as the operation of choice increasingly

Publication Types:
    Clinical Trial

PMID: 10605899 [PubMed]

322: Dermatol Surg.  1999 Oct;25(10):755-66.  

Modified tumescent liposuction.

Fulton JE, Rahimi AD, Helton P.

Fulton Skin Institute, Newport Beach, California, USA.

BACKGROUND: Tumescent liposuction has been found to be safe and effective.
However, there are still many refinements that may be possible, such as varying
the size and tips of the cannulas, varying the types of infiltrate and
associated anesthesia, and the method of compression. OBJECTIVE: To examine
possible variables in tumescent liposuction techniques such as the most
efficient liposuction cannulas, to determine an effective tumescent fluid, and
to examine the extent of compression provided by different garments. METHODS:
Patient markings, tumescent fluid formulas, methods of infiltration, types of
cannulas, skin incisions, and compression garments were compared between the
pure tumescent technique and modified tumescent liposuction. RESULTS: The most
efficient cannulas were those with three staggered ports, such as the Mercedes,
Cobra-keel, Giorgio Fischer, and Accelerator II tips. When these are combined
with modified tumescent fluids and sedation, it is possible to perform total
body liposuction in a safe and efficient manner. Multiple ports and compression
garments are beneficial to reduce bruising and focal areas of inflammation.
CONCLUSION: The tumescent liposuction technique will continue to be improved. So
far, with more efficient cannulas and more efficient tumescent fluids, combined
with sedation, it has been possible to increase the yield and decrease the
required time for the technique. We call this modified tumescent liposuction.

PMID: 10594576 [PubMed]

323: Aesthetic Plast Surg.  1999 Sep-Oct;23(5):303-6.  

Analysis of methods for reporting severe and mortal lipoplasty complications.

Daane SP, Rockwell WB.

New York, New York, USA.

During the past 2 years, media attention has focused on catastrophic outcomes
associated with liposuction. A critical review of the lipoplasty literature was
undertaken to determine the incidence of severe and mortal complications.
Reported lipoplasty complications and patient outcome studies published in the
English literature through January 1, 1999, were reviewed. From these and from
ASPRS questionnaire surveys of experienced, board-certified plastic surgeons, it
is apparent that (1) plastic surgeons do not often voluntarily report severe and
mortal complications (either as case reports or in self-reported series), and
(2) while survey studies provide the most accurate estimate of complications due
to lipoplasty, they are subject to an underreporting bias because they exclude
complications occurring in the hands of residents and junior attendings. The
mortality from lipoplasty procedures is higher than the 0.003 to 0.02% reported
in the literature and may be as high as 0.1%.

Publication Types:
    Review, Tutorial

PMID: 10541841 [PubMed]

324: Plast Reconstr Surg.  1999 Nov;104(6):1814-20; discussion 1821-2.  

Suction-assisted lipectomy for lipodystrophy syndromes attributed to
HIV-protease inhibitor use.

Wolfort FG, Cetrulo CL Jr, Nevarre DR.

Beth Israel-Deaconess Medical Center, Harvard Medical School, Boston, Mass, USA.

The addition of HIV-protease inhibitors to the arsenal of therapies for the
treatment of HIV infection has resulted in significant suppression of viral load
such that HIV-positive individuals experience reduced morbidity and extended
life expectancy. Recently, a number of syndromes have been described involving
abnormal fat distribution that may be associated with prolonged HIV-protease
inhibitor therapy. These syndromes include hypertrophy of the cervicodorsal fat
pad ("buffalo hump"); a tendency toward increased central adiposity ("protease
paunch"); adiposity in the submental, mandibular, and lateral cheek regions of
the face; and hypertrophy of adipose tissue in the breast in women. A peripheral
lipodystrophy, or fat-wasting, in the extremities and face (particularly the
malar and nasolabial fold regions) has also been observed. As these patients
live longer and healthier lives, many are beginning to seek surgical correction
of the disfigurements. In this regard, we present a review of the literature
regarding these recently described syndromes to familiarize plastic and
reconstructive surgeons with the unique deformities encountered in this
ever-increasing patient population. We also present our results with
suction-assisted lipectomy for treatment of these deformities. Physical
findings, pathogenesis, and surgical management are discussed.

Publication Types:
    Review, Tutorial

PMID: 10541186 [PubMed]

325: Plast Reconstr Surg.  1999 Nov;104(6):1900-2; discussion 1903-6.  

Lidocaine is not necessary in liposuction.

Perry AW, Petti C, Rankin M.

Section of Plastic Surgery at the University of Medicine and Dentistry of New
Jersey-Robert Wood Johnson Medical School, Franklin Park, USA.

Lidocaine is an integral part of most wetting solutions used in liposuction.
Although the Physician's Desk Reference states that the permissible dose of
lidocaine is 7 mg/kg, doses as high as 75 mg/kg have been used in liposuction.
Lidocaine is used in the wetting solution even when the procedure is performed
under epidural or general anesthesia. The justification for this is a reduction
in postoperative pain. This study compared the pain between paired, mirrored
sides of 10 patients when lidocaine was used on only one side. There was no
statistically significant difference between the postoperative pain at 5, 30,
60, and 120 minutes and on the first postoperative day. Because there was no
difference in pain whether or not lidocaine was used, and because lidocaine is
potentially toxic and lethal, this study concludes that lidocaine is not
necessary in liposuction.

Publication Types:
    Clinical Trial

PMID: 10541196 [PubMed]

326: Plast Reconstr Surg.  1999 Nov;104(6):1823-5; discussion 1826-7.  

Ketamine-assisted intravenous sedation with midazolam: benefits and potential

Gruber RP, Morley B.

Stanford University, Oakland, Calif, USA. rgruber@pacbell.net

A review of 134 cases of ketamine-induced intravenous sedation was undertaken.
It was concluded that (1) whereas properly titrated midazolam with low-dose
ketamine (0.5 mg/kg) can provide almost complete absence of behavioral problems
and complete analgesia, transient oxygen desaturation may be seen, and (2) the
induction phase of ketamine is an opportunity for the surgeon to rehearse mask

PMID: 10541187 [PubMed]

327: Int J Radiat Oncol Biol Phys.  1999 Nov 1;45(4):941-9.  

The treatment of high-grade soft tissue sarcomas with preoperative

Prosnitz LR, Maguire P, Anderson JM, Scully SP, Harrelson JM, Jones EL, Dewhirst
M, Samulski TV, Powers BE, Rosner GL, Dodge RK, Layfield L, Clough R, Brizel DM.

Department of Radiation Oncology, Duke University Medical Center, Durham, NC
27710, USA. prosnitz@radonc.duke.edu

PURPOSE: To explore the use of a novel program of preoperative radiation and
hyperthermia in the management of high-grade soft tissue sarcomas (STS). METHODS
AND MATERIALS: Eligible patients were adults over 18 with Grade 2 or 3 STS,
surgically resectable without a local excision prior to referral to Duke
University Medical Center and without distant metastases. Patients were staged
generally with CT and/or MR imaging. The diagnosis was established with fine
needle aspiration or incisional biopsy. Patients were then treated with 5000 to
5040 cGy, 180-200 cGy per fraction. Chemotherapy was usually not employed.
Generally two hyperthermia treatments per week were given with a planned thermal
dose of 10-100 CEM 43 degrees T90. Invasive thermometry and thermal mapping were
done in all patients. Surgical resection was planned 4-6 weeks after the
completion of radiation and hyperthermia. RESULTS: Ninety-seven patients were
treated on study between 1984 and 1996. Follow-up ranged from 12 to 155 months
(median 32). All tumors were high-grade in nature, 44 greater than 10 cm in size
(maximum tumor diameter), 43 5-10 cm in size, 10 less than 5 cm. Seventy-eight
of the 97 tumors were located in an extremity. Of the 97 patients, 48 remain
alive and continually free of disease following initial therapy. Of the
remaining 49 patients, 44 have relapsed (34 dead, 10 living with disease), 3
have died secondary to complications of therapy, and 2 have died of unrelated
causes. Ten-year actuarial overall survival, cause-specific survival, and
relapse-free survival are 50, 47, and 47% respectively. The predominant pattern
of failure has been distant metastases with only 2 patients developing local
failure alone. Ten-year actuarial local control for extremity tumors is 94%, 63%
for the 19 patients with tumors at sites other than the extremity. Of the 78
patients with extremity lesions, 63 have had limb preservation and remain
locally controlled. Overall 38 patients experienced 57 major complications.
There were 3 deaths, one due to adriamycin cardiomyopathy and two secondary to
wound infections. Four patients required amputation secondary to postoperative
wound healing problems. Complications directly attributable to hyperthermia
occurred in 15 patients with 11 instances of second- or third-degree burns and
two instances of subcutaneous fat necrosis. The hyperthermia complications were
generally not severe and either healed readily or were excised at the time of
surgical resection of the primary tumor. CONCLUSIONS: For these aggressive
high-grade soft tissue sarcomas, this treatment program of preoperative
thermoradiotherapy provided excellent local regional control for extremity
lesions (95%) and satisfactory local regional control (63%) of nonextremity
sarcomas, but did not appear to influence the rate of distant metastases or
survival. Complications were frequent but apart from the direct thermal burns,
not too different from those reported for preoperative radiotherapy alone. More
effective adjuvant systemic therapy is necessary to impact favorably on

PMID: 10571201 [PubMed]

328: Fertil Steril.  1999 Nov;72(5):905-9.  

Hypogonadotropic hypogonadism in obese women after biliopancreatic diversion.

Di Carlo C, Palomba S, De Fazio M, Gianturco M, Armellino M, Nappi C.

Department of Obstetrics and Gynecology, University of Naples Federico II,

OBJECTIVE: To evaluate a particular form of weight-related amenorrhea occurring
in severely obese patients after biliopancreatic diversion, a surgical procedure
designed to cause weight loss. DESIGN: Prospective, open, controlled clinical
trial. SETTING: Department of Gynecology and Obstetrics, University of Naples
"Federico II", Naples, Italy. The surgical procedures were performed in various
hospitals in the Naples metropolitan area. PATIENT(S): Eight severely obese
women (mean [+/-SD] age, 26.9+/-5.3 years) who underwent biliopancreatic
diversion (group A) and eight healthy women of normal weight (mean [+/-SD] age,
25.8+/-5.6 years) (group B). INTERVENTION(S): Biliopancreatic diversion,
hormonal evaluation, and LH pulsatility evaluation. MAIN OUTCOME MEASURE(S):
Weight parameters, hormone levels, and LH pulsatility amplitude and frequency
before surgery and at the onset of amenorrhea after surgery, and the response of
LH pulsatility to the infusion of naloxone at the onset of amenorrhea.
RESULT(S): All patients lost weight after surgery and became amenorrheic after 3
months, when they had lost 25% of their basal weight but were still obese. The
hormonal picture at that time was one of hypothalamic amenorrhea with
significantly reduced LH pulsatility frequency and amplitude. The alterations in
LH pulsatility were not modified by naloxone infusion. CONCLUSION(S): Obese
patients who undergo dramatic weight loss may be affected by hypothalamic
amenorrhea when still obese. Endogenous opioid activity does not play a
significant role in this kind of hypogonadotropic hypogonadism.

Publication Types:
    Clinical Trial
    Controlled Clinical Trial

PMID: 10560998 [PubMed]

329: Clin Plast Surg.  1999 Jul;26(3):363-8, vii.  

A practical guide to ultrasound-assisted lipoplasty.

Baker JL Jr.

Department of Plastic Surgery, University of South Florida, Tampa, USA.

This article provides practical guidelines for plastic surgeons to incorporate
ultrasound-assisted lipoplasty into their practice. Tips for improved results
are provided and methods to avoid complications are discussed. The author also
weighs the advantages and disadvantages of ultrasound-assisted lipoplasty and
suction-assisted lipoplasty.

PMID: 10549436 [PubMed]

330: Clin Plast Surg.  1999 Jul;26(3):481-524, ix.  

Report from the conference on ultrasound-assisted liposuction safety and

Young VL, Schorr MW.

Division of Plastic and Reconstructive Surgery, Washington University School of
Medicine, St. Louis, Missouri, USA.

The authors report on the Ultrasound-Assisted Liposuction (UAL) Safety and
Effects conference held in St. Louis, Missouri, in November 1998. The meeting
was convened to discuss how internal UAL works (its physics and mechanisms of
action), gain a basic knowledge of the interaction between acoustic energy and
tissue, identify safety concerns potentially related to thermal effects and free
radical production, and define future research questions. Those attending
represented multiple scientific disciplines: plastic surgery, physics, lipid
chemistry, cancer biology, and medical biophysics. Participants agreed that
scientists do not yet understand the mechanisms of UAL action, although multiple
mechanisms are probably involved, such as mechanical forces, cavitation, and
thermal effects. Additional research has revealed that long-term complications
or negative bioeffects--including DNA damage and oxidation-free radical
attack--are probably not serious safety concerns with UAL. Several areas
deserving future investigation were proposed.

Publication Types:

PMID: 10549445 [PubMed]

331: Clin Plast Surg.  1999 Jul;26(3):463-79, ix.  

Physical acoustics of ultrasound-assisted lipoplasty.

Weninger K, Camara C, Putterman S.

Department of Physics, University of California, Los Angeles, USA.

The acoustic fields generated by probes and cannulas used for
ultrasound-assisted lipoplasty (UAL) are sources of cavitation and
sonoluminescence. The localized stress fields and heating caused by cavitation
are strong enough to lyse cells and, in the authors' opinion, constitute the
means of therapeutic action of UAL. The spectrum of sonoluminescence extends
into the ultraviolet. Various devices have been calibrated and various issues
relating to health risks are discussed.

Publication Types:
    Review, Tutorial

PMID: 10549444 [PubMed]

332: Clin Plast Surg.  1999 Jul;26(3):441-5, ix.  

Liability in suction-assisted lipoplasty: a different perspective.

Gorney M.

Department of Medical Affairs, Doctors' Company, Napa, California, USA.

In this article, the author discusses liability issues for suction-assisted
lipoplasty (SAL) and ultrasound-assisted lipoplasty (UAL) that every plastic
surgeon should consider. The article reviews factors affecting SAL insurance,
discusses the outlook for the new UAL procedure based on experiences with
previous breakthrough procedures, and closes with a call for all plastic
surgeons to exercise great care in patient selection.

PMID: 10549442 [PubMed]

333: Clin Plast Surg.  1999 Jul;26(3):431-9, viii-ix.  

Lidocaine in ultrasound-assisted lipoplasty.

Matarasso A.

Department of Plastic Surgery, Albert Einstein College of Medicine, Bronx, New
York, USA.

The doses of lidocaine used for lipoplasty often exceed what is commonly
recommended for other surgical procedures. When using these high volumes of
lidocaine and wetting solutions, a variety of safety issues must be considered.
The author knows of no other plastic surgery operation in which the safety of
the procedure is so influenced by the medications administered. Each component
of the wetting solution--the alkalized fluid, the epinephrine, and the
lidocaine--has an individual and interrelated role. The absorption of lidocaine
with epinephrine after subcutaneous installation for lipoplasty probably
represents a unique situation, and the concepts presented should not necessarily
be extrapolated to other types of procedures.

Publication Types:
    Review, Tutorial

PMID: 10549441 [PubMed]

334: Clin Plast Surg.  1999 Jul;26(3):423-9, viii.  

An anesthesiologist's perspective of lipoplasty.

Rubinstein EH.

Department of Anesthesiology, University of California, Los Angeles, USA.

Pulmonary edema and local anesthetic toxicity are potential complications of the
use of large volumes of infiltrate during lipoplasty. In most patients, these
unfavorable developments are prevented by physiologic and pharmacologic
mechanisms. The latter may be inadequate in some patients, however, and it is
imperative to identify and monitor those patients to minimize their high risk
for fluid overload or CNS toxicity.

PMID: 10549440 [PubMed]

335: Clin Plast Surg.  1999 Jul;26(3):409-22.  

A review and examination of ultrasound for lipoplasty.

Mourad PD, Crum LA.

Department of Acoustics and Electromagnetics, University of Washington, Seattle,

Ultrasonic lipoplasty occurs through a complex and describable but currently
unquantified series of processes. Ample opportunity exists for the creation of
deleterious effects, such as burning tissue and destroying blood vessels and
nerves; however, as reported by others, the skilled user seems able to avoid
these problems. The possibility of free radical-induced cancer being caused by
ultrasonic lipoplasty seems extremely unlikely to the authors. Still, the
authors cannot categorically rule out the possibility of significant long-term,
harmful, biologic effects caused by free-radical production. All the authors
have been able to do is produce an extremely generous upper bound on hydrogen
peroxide production and note the uphill climb that any free radical would have
to surmount to do lasting damage. Also, users should ensure that no preexisting
cancers are present in the fatty tissue or adjoining tissue. Finally, these and
other issues, concerns, and hypotheses would all benefit from significant tests
on appropriate animal models.

Publication Types:
    Review, Tutorial

PMID: 10549439 [PubMed]

336: Clin Plast Surg.  1999 Jul;26(3):341-54, vii.  

Lipoplasty complications and their prevention.

Gingrass MK.

Institute for Aesthetic and Reconstructive Surgery, Nashville, Tennessee, USA.

Liposuction is a very popular plastic surgical procedure with acceptably low
risks; however, any surgical procedure has some inherent risks. It is imperative
that the surgeon has a clear understanding of possible complications associated
with liposuction, as well as their prevention and treatment. This article
addresses a comprehensive list of complications associated with liposuction in
general and, where applicable, addresses differences in risk between
ultrasound-assisted lipoplasty and suction-assisted lipoplasty.

Publication Types:
    Review, Tutorial

PMID: 10549434 [PubMed]

337: J Clin Psychiatry.  1999;60 Suppl 21:31-6.  

Nonpharmacologic and pharmacologic management of weight gain.

Greenberg I, Chan S, Blackburn GL.

Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass 02215,

Obesity increases the risk of several serious health problems, including heart
disease, type II diabetes mellitus, hypertension, and osteoarthritis. Patients
taking certain psychotropic medications may gain a significant amount of weight
(as much as a 5% increase in body weight within 1 to 2 months), placing them at
risk for obesity. Body weight monitoring and prudent drug selection are the best
approaches to preventing weight gain in patients taking psychotropic drugs. When
weight gain (> 5% of initial body weight) is unavoidable, intervention
counseling should begin. Nonpharmacologic measures for managing weight gain
include a balanced deficit diet of 1000 calories and higher, depending on the
patient's weight; 30 to 60 minutes of physical activity daily; and behavioral
training to restrain excess caloric intake. Each of these measures requires a
considerable commitment on the part of the patient and works best with support
from the physician and weight-loss support groups. Drug therapy for weight loss
is available (at present, sibutramine is the only approved appetite suppressant
in the United States); however, for most patients already being treated with a
psychotropic agent, the risks (such as drug interactions, adverse events,
compliance problems) of adding an antiobesity agent probably outweigh the
benefits. Surgical intervention for obesity should be reserved for morbidly
obese patients whose disease is intractable to medical therapy.

Publication Types:
    Review, Tutorial

PMID: 10548140 [PubMed]

338: Acta Orthop Belg.  1999 Sep;65(3):295-301.  

Growth disturbance of the ilium after splitting the iliac apophysis and iliac
crest bone harvesting in children: a retrospective study at the end of growth
following unilateral Salter innominate osteotomy in 21 children.

Rossillon R, Desmette D, Rombouts JJ.

Department of Orthopedic Surgery, Universite Catholique de Louvain, Brussels,

The morphology of the iliac bone was assessed at the end of growth on AP x-rays
of the pelvis in 21 children who had previously undergone unilateral pelvic
osteotomy. The nonoperated side was used as a reference. There were 13 girls and
8 boys. Age at operation varied from 12 months to 12 years with a mean of 3
years and 10 months. The patients were distributed in 2 groups depending on
their age at operation: before age 5 (group A, 16 cases) or after age 5 (group
B, 5 cases). The mean age at follow-up was 15 years and 2 months (range 11-19
years). The end of pelvic growth was established by Risser stage IV. Distinct
hypoplasia of the ilium due to premature growth arrest was observed in 16 cases:
12 in group A and 4 in group B. Other changes in the morphology of the ilium
were noted, e.a. increased height of the ilium which was noted in 12 cases. The
cosmetic prejudice was however minor, as compared with the radiological changes.
In the authors' opinion, the alar hypoplasia was related to growth disturbances
due to repeated splitting of the iliac apophysis. To prevent this complication
the authors recommend avoiding the use of an electrocautery to incise the iliac
apophysis and cutting the Kirschner wires so that their proximal ends lie within
the subcutaneous fat, in order to avoid repeated splitting of the apophysis at
the time of hardware removal.

PMID: 10546352 [PubMed]

339: Dermatol Clin.  1999 Oct;17(4):899-902, viii.  

Morbidity and mortality related to liposuction. Questions and answers.

Hanke CW, Coleman WP 3rd.

Department of Otolaryngology-Head and Neck Surgery, Indiana University School of
Medicine, Indianapolis, USA.

Reports of fatalities following liposuction have lead to investigations by state
medical boards. The risk of complications and fatalities is clearly different
for liposuction under local anesthesia and intravenous sedation. Thousands of
patients have been treated with true tumescent liposuction as described by
dermatologist Dr. Jeffrey A. Klein, with no reports of fatalities. Patients
should seek physicians who are experienced in this extremely safe method of

PMID: 10526720 [PubMed]

340: Dermatol Clin.  1999 Oct;17(4):805-13, vi-vii.  

"Three-dimensional tumescent liposculpture" of the abdomen, waist, and flanks.

Cook WR Jr.

Coronado Skin Medical Center, Inc., California, USA.

Treating the entire area as a cosmetic unit is the best approach to tumescent
liposculpture of the abdomen, waist, and flanks. This "Three-Dimensional
Tumescent Liposculpture" procedure is performed under tumescent local anesthesia
with optional intraoperative external ultrasound. Areas treated are the abdomen,
waist, flanks, and infrascapular fat pad if indicated. Postoperatively, patients
show a flatter abdomen, a smaller and better-defined waist (the "Cook waist"),
reduction of unsightly bulges, and a smoother, better proportioned and more
attractive overall contour. Patient recovery is rapid with minimal

PMID: 10526712 [PubMed]

341: Dermatol Clin.  1999 Oct;17(4):761-71.  

Ultrasonic-assisted liposuction. Internal and external.

Lawrence N, Coleman WP 3rd.

Department of Clinical Medicine, Cooper Health System, Marlton, New Jersey, USA.

UAL has not provided the promised ideal of "fat dissolution without surgery." In
extremely fibrous areas and second procedure liposuction, internal UAL may be a
valuable tool once it is further perfected. UAL equipment continues to evolve
and as it improves we hope to see a better safety profile, a mechanism for
smaller entrance sites, and greater time efficiency in the procedure.

Publication Types:
    Review, Tutorial

PMID: 10526708 [PubMed]

342: Dermatol Clin.  1999 Oct;17(4):881-9, viii.  

Post-tumescent liposuction care. Open drainage and bimodal compression.

Klein JA.

The goals of post-liposuction care must be to minimize edema, bruising, and
patient discomfort. The postoperative pain and edema resulting from sutured
incisions and prolonged post-liposuction compression is an irrational remnant
from the days before the tumescent technique. This article discusses various
issues involving post-liposuction care.

PMID: 10526718 [PubMed]

343: Dermatol Clin.  1999 Oct;17(4):865-79, vii-viii.  

Liposuction of the knees, calves, and ankles.

Lillis PJ.

Department of Dermatology, University of Colorado Health Sciences Center, Lake
Loveland Dermatology, USA.

Lipodystrophy of the knees, calves, ankles, and neck are somewhat unique in
comparison to other sites because they are more difficult to camouflage. The
calves and ankles, in particular, are less dependent on body weight and more
resistant to diet and exercise. Calf and ankle lipodystrophy is usually present
from early adolescence.

PMID: 10526717 [PubMed]

344: Dermatol Clin.  1999 Oct;17(4):849-63, vii.  

Liposuction of the thigh.

Bernstein G.

Department of Medicine, University of Washington, School of Medicine, Seattle,

This article discusses liposuction of the thigh. All aspects of preoperative
evaluation, anesthesia, operative technique, and postoperative care are
reviewed. Issues relating to safety are emphasized as are aesthetic dimensions
of liposuction of the thigh.

Publication Types:
    Review, Tutorial

PMID: 10526716 [PubMed]

345: Dermatol Clin.  1999 Oct;17(4):823-34, vii.  

Liposuction of the abdomen. The basics.

Pollack SV.

Department of Medicine (Dermatology), University of Toronto, Ontario, Canada.

As one of the most frequent regions treated by liposuction in both men and
women, the abdomen presents unique learning opportunities for the liposuction
surgeon. Because of anatomic variation, the upper abdomen is more fibrous than
the lower abdomen, requiring a slightly different approach to achieve optimal
fat removal. The periumbilical area also provides unique challenges for the
operator and care must be taken to avoid leaving a ring of residual fat.
Potentially excellent skin retraction in the area, combined with relatively
aggressive fat removal can lead to dramatic results including, in some cases,
significant contraction of a long-standing panniculus. In this article, the
basic techniques and potential pitfalls of abdominal liposuction are presented
in detail.

PMID: 10526714 [PubMed]

346: Dermatol Clin.  1999 Oct;17(4):815-22, vi.  

Contouring the female buttocks. Liposculpting the buttocks.

Lack EB.

Center for Liposculpture and Cosmetic Surgery Ltd., Des Plaines, Illinois, USA.

Body sculpting has progressed during the past decade to a point where cosmetic
units may be sculpted to improve contours which blend imperceptibly and
appropriately with adjacent cosmetic units. The buttocks is ideally suited for
sophisticated contouring as its frame is determined by the hips, thighs, and
lower back and its proportions are balanced by the anterior projection of the
breasts. In addition, ethnic differences in the shape and proportions of the
buttocks create a variety of aesthetically pleasing variations in size and
shape. The article attempts to elucidate these considerations combined with a
logical surgical approach to achieve pleasing results in body sculpting.

PMID: 10526713 [PubMed]

347: Dermatol Clin.  1999 Oct;17(4):799-804, vi.  

Liposuction of the chest and back.

Matarasso SL.

Department of Dermatology, University of California School of Medicine, San
Francisco, USA.

Subcutaneous fat deposition on the chest and back is notoriously diet and
exercise resistant. The "top heavy" appearance is a source of frustration for
patients as well as surgeons. Fortunately, with advent of tumescent liposuction
surgery the disparity between the upper and lower torso can now be reconciled.

PMID: 10526711 [PubMed]

348: Dermatol Clin.  1999 Oct;17(4):783-97.  

Liposuction of the arms.

Lillis PJ.

Department of Dermatology, University of Colorado Health Sciences Center, Lake
Loveland Dermatology, USA.

Liposuction of arms when properly performed with realistic expectations is
almost always a "patient pleaser." Patients routinely marvel at the degree of
skin contraction that typically occurs. Before and after photos, even as early
as 1 week, routinely show dramatic skin contraction when significant volumes of
fat are removed although textural changes may evolve for weeks to months (Figs.
14-19). Only the lower abdomen and neck consistently obtain such profound and
predictable contraction. I am convinced that historically liposuction of the
arms has been performed in a substandard fashion. Inadequate fat removal will
often produce irregularity and will always result in less than maximal skin
contraction. As I have performed progressively larger-volume cases, the
indications for brachioplasty, in my opinion, are nearly nonexistent. My present
approach, except in the most extreme cases, is to initially recommend
liposuction and possibly even a second liposuction prior to performing or
recommending brachioplasty. Even massive arms with good skin tone will usually
obtain an aesthetically pleasing result when treated properly. Massive arms with
poor skin tone, however, may not. One does not "burn bridges," however, by
performing liposuction alone in these questionable candidates. If brachioplasty
is subsequently desirable, in spite of the major drawback of the resultant scar,
it can be performed at a later date. In summary, the key concepts for maximizing
the potential of liposuction of the arms are to perform thorough but gentle fat
removal and to avoid immediate subdermal fat removal or trauma to the underside
of the dermis.

PMID: 10526710 [PubMed]

349: Dermatol Clin.  1999 Oct;17(4):751-9, v-vi.  

Anesthetic formulation of tumescent solutions.

Klein JA.

There is no standard or official recipe for the tumescent anesthetic solutions.
The actual concentrations of lidocaine and epinephrine should depend on the
areas to be treated and clinical situation. This article discusses the safe
usage of tumescent solutions and the proper procedures and precautions to take
when mixing these solutions.

PMID: 10526707 [PubMed]

350: Plast Reconstr Surg.  1999 Oct;104(5):1534-6; discussion 1537-8.  

Acute hearing loss after liposuction.

Hecksteden K, Bucheler M, Bootz F.

Department of Otolaryngology, Head and Neck Surgery, University of Leipzig,

Publication Types:
    Case Reports

PMID: 10513939 [PubMed]

351: Plast Reconstr Surg.  1999 Oct;104(5):1524-31; discussion 1532-3.  

Combined gluteoplasty: liposuction and lipoinjection.

Cardenas-Camarena L, Lacouture AM, Tobar-Losada A.

Reconstructive Surgery Institute of Jalisco, Mexico.

From April of 1995 to August of 1998, 62 female and four male patients had
gluteoplasties. To improve the gluteal region, two techniques that create
excellent results in other parts of the body, liposuction and lipoinjection,
were combined. The ages of the patients ranged from 18 to 52 years (mean, 31
years). Liposuction was done with a tumescent technique in the lumbosacral,
trochanteric, and subgluteal region to improve gluteal shape. The amount of fat
aspirated was only that necessary to obtain the desired contour. In all cases,
liposuction was also performed in other areas. Lipoinjection was done with
round-tip cannulas in different planes of the gluteal region, and the fat was
applied in small strips. The quantity of fat infiltrated varied from 120 to 280
cc per gluteus, with a mean of 210 cc. The results were evaluated by the
patients and the surgical team with preoperative and postoperative photographs.
Follow-up ranged from 3 months to 3 years and 5 months, with a mean of 17
months. No patient was dissatisfied with the results, and more than 90 percent
considered their results good or excellent. Liposuction complications consisted
of four seromas, six visible irregularities, and two palpable irregularities.
Lipoinjection complications occurred in 16 gluteus regions (12 percent); all had
gluteal temporal hyperemia and erythema, which resolved with conservative
treatment except in one case (4 cc of sterile material corresponding to fat
necrosis was drained in that patient). No irregularities or depressions occurred
in the gluteus. One case of probable fat embolism syndrome had a satisfactory
evolution. This gluteoplasty technique is simple and low in cost, with minimal
morbidity and very good results. It is important to note that a good result does
not depend on a great amount of fat infiltration but rather on a harmonious way
of combining both surgical procedures: fat elimination by liposuction and
gluteus augmentation by lipoinjection.

PMID: 10513938 [PubMed]

352: Am J Otol.  1999 Sep;20(5):660-6.  

No cerebrospinal fluid leaks in translabyrinthine vestibular schwannoma removal:
reappraisal of 200 consecutive patients.

Falcioni M, Mulder JJ, Taibah A, De Donato G, Sanna M.

Gruppo Otologico, Piacenza, Italy.

OBJECTIVE: The objective of this study was to validate measures taken to reduce
the number of cerebrospinal fluid (CSF) leaks after removal of vestibular
schwannomas to 0. STUDY DESIGN: This study was a retrospective case review.
SETTING: The study was conducted at an otology/neurotology tertiary referral
center (Gruppo Otologico, Piacenza, Italy). PATIENTS: Three hundred thirty-one
vestibular schwannoma patients were studied. INTERVENTIONS: The enlarged
translabyrinthine approach (TLA) was used in all cases, with a number of
modifications in the last 200 patients. It was extended in 22 patients with
blind sac closure of the external meatus, removal of the posterior bony canal
wall, and obliteration of the Eustachian tube and middle ear. MAIN OUTCOME
MEASURES: Whether patients had a leak through the wound, the nose
(rhinoliquorrhea), or the ear (otoliquorrhea) was assessed. RESULTS: In an early
group, the percentage of CSF leaks was 6.9%. On the basis of the evaluated
causes, as time went by, technical modifications evolved. They consisted of 1)
the total conservation of the fascioperiosteal flap, 2) obliteration of all
petrosal cells possibly communicating with the middle ear, 3) removing the incus
in a correct way, 4) closing the attic with periosteum, 5) obliterating the
surgical cavity, leaving strips of abdominal fat with their medial ends inside
the cerebellopontine angle, 6) suturing the musculo-periosteal layer in a
correct way, and 7) fixing the skin flap to the underlying surface. The
application of these modifications resulted in a total absence of CSF leaks in
200 consecutive patients thereafter. Also, no cases of meningitis were
encountered. CONCLUSIONS: To our knowledge, this is the first series of 200
consecutive vestibular schwannoma patients operated by means of the enlarged TLA
without a single CSF leak. When the appropriate measures are taken, the number
of CSF leaks after removing tumors through the enlarged TLA must and can be
reduced to 0.

PMID: 10503591 [PubMed]

353: N Engl J Med.  1999 Sep 23;341(13):1002-3.  

Comment on:
    N Engl J Med. 1999 May 13;340(19):1471-5.

Deaths related to liposuction.

Schnur P, Penn J, Fodor PB.

Publication Types:

PMID: 10498479 [PubMed]

354: N Engl J Med.  1999 Sep 23;341(13):1001-2; author reply 1002-3.  

Comment on:
    N Engl J Med. 1999 May 13;340(19):1471-5.

Deaths related to liposuction.

Rigel DS, Wheeland RG.

Publication Types:

PMID: 10498478 [PubMed]

355: N Engl J Med.  1999 Sep 23;341(13):1001; author reply 1002-3.  

Comment on:
    N Engl J Med. 1999 May 13;340(19):1471-5.

Deaths related to liposuction.

Talmor M, Barie PS.

Publication Types:
    Case Reports

PMID: 10498477 [PubMed]

356: N Engl J Med.  1999 Sep 23;341(13):1001; author reply 1002-3.  

Comment on:
    N Engl J Med. 1999 May 13;340(19):1471-5.

Deaths related to liposuction.

Klein JA.

Publication Types:

PMID: 10498476 [PubMed]

357: N Engl J Med.  1999 Sep 23;341(13):1000-1; author reply 1002-3.  

Comment on:
    N Engl J Med. 1999 May 13;340(19):1471-5.

Deaths related to liposuction.

Vermeulen C, Serra M, Roujeau JC.

Publication Types:
    Case Reports

PMID: 10498475 [PubMed]

358: N Engl J Med.  1999 Sep 23;341(13):1000; author reply 1002-3.  

Comment on:
    N Engl J Med. 1999 May 13;340(19):1471-5.

Deaths related to liposuction.

Ginsberg MM, Gresham L.

Publication Types:
    Case Reports

PMID: 10498474 [PubMed]

359: Obes Surg.  1999 Jun;9(3):244-9.  

Obesity: an innately incurable disease?

Husemann BJ.

Surgical Clinic of Dominikus-Krankenhaus, Dusseldorf, Germany.

BACKGROUND: Staple-line disruption is a common complication after vertical
banded gastroplasty (VBG). METHODS: Of 655 patients who underwent VBG, a hole
across the partition developed in 46 (7.02%). RESULTS: The original excellent
weight loss from a BMI of 49.2 +/- 6.9 kg/m2 to 31.9 +/- 6.1 kg/m2 stopped with
staple-line dehiscence, and all 46 patients regained weight, even to their
original weight. After operative revision by restapling (n = 24/46) or
implantation of an adjustable band (n = 10/46), patients reduced their body
weight once more (to BMI 31.2 +/- 5.9 or 33.8 +/- 5.8). CONCLUSION: Obese
patients need the food-intake reducing operations maintained lifelong; the real
cause of obesity is not curable until now, and only the main symptom,
"overweight," can be improved by therapy.

PMID: 10484309 [PubMed]

360: Obes Surg.  1999 Aug;9(4):381-4.  

Late pouch dilation after laparoscopic adjustable gastric and esophagogastric
banding: incidence, treatment, and outcome.

Niville E, Dams A.

Department of Abdominal Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.

BACKGROUND: Pathologic late pouch dilation is the most frequent complication
following gastric banding procedures for morbid obesity. In this study, possible
predictive factors were sought. The treatment of these complications and the
final outcome are discussed. METHODS: Between December 1994 and December 1997,
171 patients underwent laparoscopic adjustable banding for morbid obesity. 40
patients underwent classic gastric banding (Group 1), and 131 patients underwent
esophagogastric banding (Group 2). RESULTS: Pouch dilation developed in 6
patients (15%) in Group 1 and 12 patients (9.2%) in Group 2. There were no
significant predictive factors, although the complication occurred more
frequently in patients with presurgical hiatus hernia. The type of dilation was
different for each group, as was the surgical treatment. Laparoscopic
repositioning of the band was always possible and was uncomplicated. The
long-term outcome has been good, and weight loss has been maintained.
CONCLUSIONS: A frequent complication following banding procedures for morbid
obesity is pathologic late pouch dilation. In experienced hands, when
appropriate surgical treatment is carried out, this is not a major problem.
Nevertheless, efforts should be made to decrease the number of late dilations.

PMID: 10484297 [PubMed]

361: Surg Today.  1999;29(8):741-6.  

Comparison of the effects of various anticancer agents on intestinal anastomosis
after intraperitoneal administration.

Arikan AY, Senel FM, Akman RY, Can C.

Department of General Surgery, Abant Izzet Baysal University, Duzce Medical
School, Bolu, Turkey.

In this study, the effects of intraperitoneal 5-fluorouracil (5-FU), cisplatinum
(Cis), adriamycin (Adr), and methotrexate (MTX) administration on rat intestinal
anastomosis were compared. Cis and MTX led to significant weight loss in the
first 5 days compared with the control group. Within 14 days all rats except the
MTX group nearly reached their preoperative weight. No remarkable weight loss or
systemic toxicity was observed among the 5-FU and Adr groups. The anastomosis
bursting pressure (ABP) at 1 week was significantly lower than that of the
control group (P < 0.01 and P < 0.005, respectively). On day 14 the anastomosis
bursting pressure in the Cis group was similar to that of the control group but
was significantly lower in the MTX group (P < 0.002). Histopathologically, MTX
avoided the development of a mucosal layer at the anastomosis site and led to
ulcer formation in some of the rats. The ABPs at 7 and 14 days were similar to
those in the control group. Neither of the agents had any significant mechanical
or histopathologic adverse effects on anastomosis. According to the results of
our study, MTX impaired the healing of the anastomosis, and we thus conclude
that the intraperitoneal administration of this agent is not safe. On the other
hand, Cis showed a detrimental effect on the anastomosis, particularly in the
early phase, but this effect disappeared in the late phase. Cis thus should not
be administered in the early postoperative phase. As a result, 5-FU and Adr were
found to be the safest agents as they did not delay wound healing and did not
reduce the anastomotic strength.

PMID: 10483749 [PubMed]

362: Nutrition.  1999 Sep;15(9):677-82.  

Symptoms after total gastrectomy on food intake, body composition, bone
metabolism, and quality of life in gastric cancer patients--is reconstruction
with a reservoir worthwhile?

Liedman B.

Department of Surgery, Sahlgrenska University Hospital, Goteborg, Sweden.

Gastric cancer is worldwide one of the most common causes of cancer death.
Operation is the only treatment at this time that cures some patients. The side
effects of the operation are, however, considerable, and include postoperative
weight loss, loss of appetite, and other metabolic and nutritional changes. The
recovery is very slow and incomplete. Reconstruction with different types of
pouches has been asserted to facilitate the nutritional recovery, but results
from different studies are somewhat contradictory. Malnutrition, osteoporosis,
osteomalacia, and impaired quality of life are often but not always described.
We can, however, establish that after a total gastrectomy, gastric cancer
patients are very much at risk for these complications, which are probably
caused by impaired food intake and steathorrhea even when the patients are cured
from their cancer disease. In order to minimize the nutritional problems, it is
crucial to avoid anastomotic narrowing and bile reflux. Roux-en-Y reconstruction
seems to be the method of choice. Evidence from several randomized studies now
speak in favor of including some type of pouch in the reconstruction. The most
commonly used pouch today is the jejunal J-pouch. How the effect is exerted is
not clear. Probably both the reservoir function of the pouch and changes in
intestinal transit time are important. The importance of nutritional
surveillance of these patients should not be underestimated, and most of the
observed differences from various reports are probably due to dissimilarity in
the follow-up protocols. A patient surviving his/her cancer has a decreased risk
of developing severe disturbances in bone metabolism, food intake, body
composition, and quality of life if the patient is under concerned nutritional
surveillance and reconstructed with a pouch.

Publication Types:
    Review, Academic

PMID: 10467612 [PubMed]

363: Anasthesiol Intensivmed Notfallmed Schmerzther.  1999 Jul;34(7):447-9.  

[Fatal fat embolism from an infected femoral shaft during surgical removal of a
hip endoprosthesis]

[Article in German]

Uslu N, Gorg C.

Klinik fur Anasthesiologie und Operative Intensivmedizin der Universitat Koln.

Publication Types:
    Case Reports

PMID: 10464524 [PubMed]

364: Plast Reconstr Surg.  1999 Sep;104(3):819-22.  

Is liposuction safe?

Rohrich RJ, Beran SJ.

Department of Plastic Surgery, the University of Texas Southwestern Medical
Center, Dallas 75235-9132, USA. rrohric@mednet.swmed.edu

PMID: 10456537 [PubMed]

365: Plast Reconstr Surg.  1999 Sep;104(3):764-70.  

Vertical mammaplasty: early complications after 250 personal consecutive cases.

Lejour M.

Institut Medical Edith Cavell, Brussels, Belgium. mlej4240@euronet.be

No surgeon likes to face complications. It takes effort to treat them personally
and more effort to note, count, analyze, and demonstrate them. The author
carefully followed 250 personal consecutive patients (476 breasts) who underwent
vertical mammaplasties between 1990 and 1998; studying the complications and
their relationship with the types of breasts and patients was very instructive.
The main observations from this study follow. The most frequent benign
complication was seroma (5 percent of breasts), which usually required one or
two aspirations after surgery. Hematomas occurred in six patients (1.2 percent
of breasts), who had all had mastopexies. Hematomas required immediate surgical
evacuation. The major complication of breast reduction, i.e., areola necrosis,
was rare (only two partial necroses occurred), but it left deformities that were
difficult to correct. Infection without tissue necrosis was rare (two cases),
and healing complications happened in only 5.4 percent of all cases. Healing
complications were directly related to the size and fat content of the breasts.
None occurred in mastopexy cases. For reductions, delayed skin healing was
observed in 5 percent of cases and delayed breast tissue healing in 3 percent of
cases. More healing complications occurred after liposuction of the breast,
which was performed in the more fatty breasts. Delayed healing of skin and
breast tissue was bothersome because healing was slow, but it left only a
moderate deformity. In cases of delayed healing, frequent dressings, rinsing the
wound with antiseptic solutions, giving antibiotics if needed, and refraining
from early surgical intervention are the keys to success. Good personal contact
with the patient, especially if healing is slow, is the best way of helping her
and avoiding aggressive attitudes. In conclusion, this survey revealed few
complications; however, it does show that the risk of delayed and slow healing
is greater in larger breasts. In obese patients, a simpler operation may be
indicated, such as liposuction with skin reduction alone or a free nipple graft,
as long as the patient is not motivated to obtain the best possible result.

PMID: 10456529 [PubMed]

366: Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi.  1997 Jul;13(4):276-8.  

[Histologic study on complication reducing effects of the tumescent technique in

[Article in Chinese]

Zhao Y, Song Y, Zhuang Q.

Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing.

The purpose of this experiment was to investigate how the tumescent technique
reduces complications in liposuction. Histologic examinations revealed that the
septa of fat are attached to the deep surface of the dermis and to the fascia
superficialis. It is important to retain the septa that contain the perforating
vessels and nerves during liposuction. The correct choices for instrument and
suction pump can minimize trauma to tissues and reduce complications.

PMID: 10452013 [PubMed]

367: Int J Dermatol.  1999 Jul;38(7):551-4.  

Efficacy of lipectomy and liposuction in the treatment of multiple symmetric

Martinez-Escribano JA, Gonzalez R, Quecedo E, Febrer I.

Department of Dermatology, Virgen de la Arrixaca Hospital, Murcia, Spain.

BACKGROUND: Multiple symmetric lipomatosis (MSL) is a rare disease characterized
by enlarging, symmetric, nonencapsulated, fat deposits mainly on the neck and
upper trunk. Liposuction and lipectomy, although palliative, are the treatments
of choice, especially indicated when vital structures are compromised.
OBJECTIVE: Our purpose was to evaluate the efficacy and safety of liposuction
and lipectomy in the treatment of MSL. METHODS: We have examined two patients
diagnosed with MSL who presented with symptoms derived from the compression of
vascular, nervous, and/or respiratory tract structures. One was treated with
lipectomy and the other with liposuction. RESULTS: A rapid resolution of the
clinical symptoms was achieved with both therapies. The patient who was treated
with lipectomy suffered from a compression of the left brachial plexus by scar
tissue as an adverse effect, requiring a second surgical procedure. Liposuction
only provoked a mild autoinvolutive hematoma in the other case. No clinical
recurrences were observed at 3 and 2 years of follow-up respectively.
CONCLUSIONS: We consider both lipectomy and liposuction as safe and effective
techniques for the treatment of MSL patients. Although liposuction is usually
associated with less adverse effects than lipectomy, location of the lipomas
must be carefully considered before choosing one technique over another.

Publication Types:
    Case Reports

PMID: 10440290 [PubMed]

368: Acta Chir Plast.  1999;41(2):50-3.  

Suction lipectomy.

Duskova M, Kufa R, Leamerova E.

Department of Plastic Surgery, 3rd Medical School, Charles University, Prague,
Czech Republic.

Suction lipectomy is a very effective and safe method, if performed by an
experienced plastic surgeon. The authors demonstrate using a group of 284
patients operated on at the University Clinic of Plastic Surgery in Prague
between 1994-1998, indications, the method and complications.

PMID: 10439518 [PubMed]

369: J Hand Surg [Br].  1999 Jun;24(3):390.  

Comment on:
    J Hand Surg [Br]. 1998 Oct;23(5):666-8.

Surgical management after doxorubicin and epirubicin extravasation.

Fleming A, Butler B, Gault D.

Publication Types:

PMID: 10433467 [PubMed]

370: Ann N Y Acad Sci.  1999 Jun 30;880:308-18.  

Exocrine pancreatic function following pancreatectomy.

Ghaneh P, Neoptolemos JP.

Department of Surgery, Royal Liverpool University Hospital, UK.

Pancreatic exocrine insufficiency can follow major pancreatic resection and
result in the malabsorption of fat, causing symptoms of steatorrhea, abdominal
pain and weight loss. The extent of malabsorption will depend on the original
disease process and the type and extent of surgical resection. The steatorrhea
can be severe and difficult to control, and patients may require high doses of
pancreatic enzyme supplements. There have been few studies that have looked at
the treatment of steatorrhea postpancreatectomy, and very few randomized
studies. Results of the latter have demonstrated that after treatment with oral
pancreatic supplements over a third of postpancreatectomy patients still have
significant levels of steatorrhea. These results show that even using the best
available agents the complete elimination of steatorrhea following major
pancreatic resection is not possible at the present time. This indicates a need
for further effective therapies.

Publication Types:
    Review, Tutorial

PMID: 10415875 [PubMed]

371: Neurosurgery.  1999 Jul;45(1):162-5.  

Symptomatic spinal epidural lipomatosis after local epidural corticosteroid
injections: case report.

Sandberg DI, Lavyne MH.

Division of Neurosurgery, Weill Medical College of Cornell University, New York
Presbyterian Hospital, New York, USA.

OBJECTIVE AND IMPORTANCE: Spinal epidural lipomatosis, which causes symptomatic
compression of neural elements, is a well known but uncommon complication of
Cushing's syndrome. Spinal epidural lipomatosis has been reported frequently in
association with chronic systemic corticosteroid therapy, but thus far only one
case has been attributed to local epidural corticosteroid injections. CLINICAL
PRESENTATION: We report another case of symptomatic spinal epidural lipomatosis
after epidural corticosteroid injections. This is the first such case documented
by magnetic resonance imaging and confirmed with surgical exploration.
INTERVENTION: The patient's symptoms of neurogenic claudication resolved after
lumbar laminectomy in the region of previous corticosteroid injections and the
removal of epidural fat, which was compressing the thecal sac. CONCLUSION: This
case should alert clinicians that epidural lipomatosis, which causes symptomatic
thecal sac compression, is a possible complication, not only of systemic
glucocorticoid therapy, but also of local epidural corticosteroid injections.

Publication Types:
    Case Reports

PMID: 10414580 [PubMed]

372: Biomed Tech (Berl).  1999 May;44(5):142-5.  

[Possibilities of avoiding an intra-femoral increase in pressure during hip
revision surgery]

[Article in German]

Porsch M, Schmidt J, Raabe T.

Klinik und Poliklinik fur Orthopadie der Universitat zu Koln.

An earlier experimental study carried out by us revealed an increase in
intrafemoral pressure during removal of cement in hip revision arthroplasty.
This increase is greater while removing cement from the distal femoral shaft.
Maximum pressure increases occurred while removing the medullary plug (cement
stopper), and the measured pressure of more than 150 mmHg is associated with an
increased risk of fat embolism. The present study shows that this phenomenon can
be avoided through the use of cannulated instruments.

PMID: 10413988 [PubMed]

373: Health News.  1999 Jun 25;5(8):5.  

Leery of liposuction.

[No authors listed]

Publication Types:

PMID: 10397030 [PubMed]

374: Md Med J.  1999 May-Jun;48(3):116-8.  

Fat embolism syndrome in a case of abdominal lipectomy with liposuction.

Scroggins C, Barson PK.

Department of Plastic Surgery, Bowie Health Center, Maryland, USA.

Fat embolism syndrome is reported in a patient who underwent abdominoplasty and
suction lipectomy for body contouring. Within 48 hours after surgery, she
experienced adult respiratory distress syndrome, secondary to fat embolism
syndrome. This was proven on bronchoscopy by evidence of fat laden macrophages.
Aggressive respiratory support over 12 days resulted in patient survival.

Publication Types:
    Case Reports

PMID: 10394227 [PubMed]

375: Ann Surg Oncol.  1999 Jun;6(4):395-7.  

Head and neck cancers associated with Madelung's disease.

Chan ES, Ahuja AT, King AD, Lau WY.

Department of Surgery, The Chinese University of Hong Kong, Shatin.

BACKGROUND: Madelung's disease is a rare lipodystrophy that presents with
multiple fatty masses in the neck, trunk, and upper extremities. The fatty
accumulation is considered a benign disease, but compression of the
aerodigestive tract may occur in long-standing disease. METHODS: Eight Chinese
patients with Madelung's disease were reviewed. All were male, aged 48 to 67
years, with a history of disease ranging from 4 to 20 years. Two of the eight
patients developed aerodigestive symptoms and were subsequently found to have
head and neck cancers. These two patients are described. RESULTS: The possible
mechanism that may account for an increase in malignant tumors of the airway in
this group of patients is the synergistic effect of smoking and alcohol abuse as
risk factors for both Madelung's disease and malignant tumors of the airway.
Currently it is recommended that these patients should have their fatty lesions
removed surgically. The removal of fat facilitates examination of the neck for
signs of cervical lymphadenopathy in malignant disease. CONCLUSIONS: Patients
with Madelung's disease should be followed regularly. The development of
aerodigestive symptoms should be fully investigated with endoscopy and imaging.
The cause of symptoms should not be attributed to fatty compression until a
carcinoma of the upper airway has been excluded.

Publication Types:
    Case Reports

PMID: 10379862 [PubMed]

376: Life Sci.  1999;64(24):2299-306.  

Fluctuation of serum leptin level in rats after ovariectomy and the influence of
estrogen supplement.

Chu SC, Chou YC, Liu JY, Chen CH, Shyu JC, Chou FP.

Department of Food Health, Chungtai Institute of Health Science and Technology,
Chung Shan Medical and Dental College, Taichung, Taiwan.

In order to understand the mechanism of increasing body fat in perimenopausal
and postmenopausal women, an ovariectomy-induced obesity model was used to study
the role of leptin. In this investigation, a long-term study lasted for 13 weeks
was conducted to monitoring the change of serum leptin level in rats after the
loss of estrogen, and also to examine the influence of estrogen replacement. The
results showed that three weeks after the removal of ovaries the body weight of
Ovx rats was already significantly higher than the other two groups, and
continued to gain more weight thereafter. Accompanying with the significant
weight gain was the changes in the serum leptin levels. The leptin concentration
declined gradually during the first half of experimental period, dropping down
to an almost undetectable level at week 7 (0.216+/-0.132 ng/ml). Subsequently,
its concentration began to elevate, and by the end of experiment leptin level
was significantly higher (3.182+/-0.936 ng/ml) than the value before the
operation (0.818+/-0.242 ng/ml). This fluctuation of serum leptin level caused
by ovariectomy was eliminated by the replacement of estrogen. The present data
indicate that ovariectomy-induced weight gain is caused by the early drop in
leptin level. The later rise in leptin production is connected to the increased
body weight probably originated from a reduced sensitivity in leptin signal.

PMID: 10374920 [PubMed]

377: Plast Reconstr Surg.  1999 Jun;103(7):2016-25; discussion 2026-8.  

Sensory changes after traditional and ultrasound-assisted liposuction using
computer-assisted analysis.

Trott SA, Rohrich RJ, Beran SJ, Kenkel JM, Adams WP Jr, Robinson JB Jr.

Department of Plastic Surgery, University of Texas Southwestern Medical Center,
Dallas 75235-9132, USA.

Postoperative sensory changes (i.e., hypesthesias) that occur after
suction-assisted lipoplasty (SAL) are expected clinical sequelae. These
disturbances usually return to normal within several weeks to months
postoperatively. The presumed mechanism of injury is direct trauma to the
peripheral nerves from the suction cannula. In addition, the potential for
demyelination of peripheral nerves secondary to cavitation during
ultrasound-assisted liposuction (UAL) is well known. Quantitative data
describing hypesthesia after both procedures are limited. The purpose of this
study was to objectively evaluate the severity and duration of postoperative
hypesthesia after liposuction to better educate patients preoperatively.
Furthermore, the authors use the three-stage UAL technique and wanted to
determine whether a clinical difference in sensory return existed between
suction- and ultrasound-treated areas. A total of 21 patients underwent
liposuction performed by the senior author (RJ.R.). The abdomen, flanks, thighs,
and medial knees were tested for objective sensation with the Pressure Specified
Sensory Device preoperatively and at 2, 6, and 10 weeks postoperatively. A total
of 102 sites were tested. On average, the SAL-treated areas improved to normal
sensation by 6 weeks, whereas the UAL-treated areas took, on average, 10 weeks
to recover. The severity of the hypesthesia was not correlated with larger
aspiration volumes or longer UAL exposure time per site. At 10 weeks, 90 percent
of UAL-treated patients and 89 percent of liposuction patients overall had
recovered normal sensation. This study provides the body-contouring surgeon with
good, objective data with which to educate patients regarding sensory return
after liposuction.

PMID: 10359269 [PubMed]

378: Plast Reconstr Surg.  1999 Jun;103(7):1868-73; discussion 1874-5.  

Liposuction technique and lymphatic lesions in lower legs: anatomic study to
reduce risks.

Frick A, Hoffmann JN, Baumeister RG, Putz R.

Department of Surgery, Klinikum Grosshadern, and the Institute of Anatomy,
University of Munich, Germany. africk@gch.med.uni-meunchen.de

Liposuction is a standard procedure in plastic surgery. Especially, lipectomy
with suction of the lower extremities has been of greater interest in recent
years. Until now, however, there was no definite information about the integrity
of epifascial lymph collectors during this procedure. To study the effect of
liposuction devices on lymph vessel injury, postmortem lymphatic preparations
were done in five human cadavers (10 lower extremities). Conventional
liposuction with a blunt 4-mm cannula and a dry technique was used. Adiposuction
was performed either in parallel to the extremity axis and, therefore, in
parallel to the superfascial lymph vessels or transversally in an 80- to
90-degree angle to the extremity. Careful surgical preparation of the regions
followed. A specific macroscopic lymph vessel injury score was applied to
differentiate 3 degrees of lymph vessel lesions according to the extravasation
of patent blue. In all lower extremities, postmortem lymph flow occurred as
indicated by patent blue staining of the lymph vessels. Lymph vessel injury was
more severe in areas where liposuction was performed transversally, vertical to
the extremity's axis, than in those after a longitudinal procedure. The
difference was statistically significant (p < 0.01). The volumes of
adipoaspirate and of the compared regions were comparable between both groups,
verified by circumference measurements. Longitudinal liposuction of the lower
extremities is unlikely to cause major lesions of epifascial lymph vessels and,
therefore, should be preferred in comparison to liposuction vertical to the

PMID: 10359247 [PubMed]

379: Sb Lek.  1998;99(3):291-5.  

Bariatric surgery at First Surgical Department in Prague--Czech
Republic--history and some technical aspects of the procedures.

Fried M, Peskova M, Kasalicky M.

First Surgical Department, 1st Faculty of Medicine, Charles University, Czech

BACKGROUND: There is an increasing number of obese population in the Czech
Republic in last twenty years. In 1983 we were one of the first surgical
departments in the country who started with bariatric surgery on regular basis.
METHODS: In the period from 1983 to 1986 we performed vertical banded
gastroplasties (VBG) in our department. Because of high rate of various
complications arising both from the stomach and from the wound we switched in
1986 to less "aggressive" non-adjustable gastric banding. In 1993 we performed
the first round the world laparoscopic non-adjustable banding. In 1994 we
started with laparoscopic placement of adjustable gastric bands. RESULTS: In the
group of 52 patients who underwent VBG and were followed-up, acceptable weight
loss results (-40.5 kg) were achieved in 24 months following surgery. The
postoperative complications were high, 17.3% of gastric staple line disruption
and 15.3% of wound complications--incisional hernias, discharge etc. Since 1986
we performed non-adjustable gastric banding in 150 patients with the weight loss
of -38.4 kg in 24 months following surgery. There was no change in the wound
complications rate, but the complications arising from the stomach and the band
decreased to 6.3%. Since June 1993 we performed 268 procedures laparoscopically
either with non-adjustable bands or since 1994 with the adjustable bands. The
wound complication rate decreased to 0.9% and one complication (6.6%) was
connected with the adjustable band. CONCLUSIONS: Because of the high rate of
postoperative complications connected in our experience with VBG we started with
gastric bandings in 1986. Since than the number of complications arising from
the stomach decreased substantially. With the laparoscopic technique used in
bariatric surgery there was another decrease in wound healing problems. With the
adjustable GB a significant decrease in the stomach related complications
occurred. Shorter hospital stay is related to the laparoscopic technique. The
long-term weight loss results are not significantly different among the
procedures mentioned above.

PMID: 10358427 [PubMed]

380: Physiol Behav.  1999 May;66(3):473-9.  

Lipectomy, body weight, and body weight set point in rats.

Michel C, Cabanac M.

Departement de physiologie, Faculte de medecine, Universite Laval, Quebec,
Canada. michel.cabanac@phs.ulaval.ca

Adult, Wistar male rats were lipectomized or sham lipectomized. The
food-hoarding behavior was measured repeatedly and plotted against the animals'
body weights. Body weight set point was estimated as the intercept of regression
line of hoarding with the X axis. Body fat content was measured with a TOBEC
body composition analyzer. Body weight set point, fat content, and girth were
obtained initially, after surgery, and after recovery. The hoarding threshold
was lowered for 2 weeks after surgery, from 561 +/- 20 to 512 +/- 19 g
(lipectomized), and from 582 +/- 15 to 558 +/- 14 g (sham lipectomized). After a
4-week recovery, all rats reached their prelipectomy body weight set point and
regained their initial body fat. Five weeks after surgery, no significant
difference was found between the body weight set points of lipectomized and
sham-lipectomized rats. This indicates that the body weight set point was not
mainly modulated by fat depots. The transient lowering of the set point is
thought to be due to surgical stress.

PMID: 10357436 [PubMed]

381: Obes Surg.  1999 Apr;9(2):183-7.  

Laparoscopic adjustable gastric banding: a prospective 4-year follow-up study.

Miller K, Hell E.

Second Surgical Department, Landeskrankenanstalten Salzburg, Austria.

BACKGROUND: A body mass index of > or =40 kg/m2 represents clinically severe
obesity and warrants operative treatment if requested. The adjustable silicone
gastric band and the Swedish adjustable gastric band are recently produced
laparoscopic gastric restrictive devices. The aim of this study was to assess
all complications linked to both the available gastric bands in a long-term
follow-up. METHODS: In a prospective study, the effects, complications, and
outcomes of this procedure were analyzed. The complications found were divided
into early and general complications, and complications correlated to the bands.
The technique of laparoscopic adjustable gastric banding is described. Follow-up
was performed by the operating team. RESULTS: Between July 1994 and August 1998,
the authors operated on 158 patients and performed 102 adjustable silicone
gastric bandings and 54 Swedish adjustable gastric bandings. The mean age at
surgery was 36 years (range 17-72). The mean preoperative weight was 136 kg
(89-230). Of 158 patients who underwent laparoscopic procedures, 156 (98%) could
be followed up (mean 28 months; duration of follow-up, 6 weeks to 46 months). In
early postoperative complications that required operation, one trocar wound
hematoma (0.6%) and one wound infection of the port site (0.6%) were observed.
The late complications that required reoperation were two pouch dilatations
(1.3%), three band leakages (2%), one band migration (0.6%), and one late
infection of the port (0.6%). A debanding operation was necessary in one patient
because of esophageal dysmotility disorder. No early or late postoperative
mortality was registered. The overall reoperation rate is currently about 7%.
CONCLUSION: The operation is safe and effective. Moreover, adjustable gastric
banding is fully reversible and is adjustable to the patient's needs. This study
verifies the importance of correct operating technique. The authors' study and
experience clearly indicate that laparoscopic adjustable gastric banding is an
attractive alternative in the surgical treatment of morbid obesity.

Publication Types:
    Clinical Trial

PMID: 10340775 [PubMed]

382: Obes Surg.  1999 Apr;9(2):161-5.  

Biliopancreatic diversion for treatment of morbid obesity: experience in 180
consecutive cases.

Totte E, Hendrickx L, van Hee R.

Academic Surgical Center Stuivenberg, Antwerp, Belgium. totte@village.euunet.be

BACKGROUND: Biliopancreatic diversion (BPD) by Scopinaro's method is used by
many as a surgical treatment for morbid obesity. The authors present their
results in 180 consecutive cases. METHOD: Between June 1995 and May 1998, the
authors performed BPD by Scopinaro's method on 180 patients (36 men) with morbid
obesity, mean age 35.8 years (range 18-58 years), mean body mass index (BMI)
48.8 kg/m2 (range 35-66 kg/m2). RESULTS: In all cases, a gradual decrease in
weight was obtained: the mean BMI at 1 month was 40.3 kg/m2, at 6 months 34
kg/m2, at 1 years 32 kg/m2, at 18 months 30.2 kg/m2, and at 36 months 28.8
kg/m2. At the same time a significant improvement in the pathologic conditions
associated with morbid obesity was observed. Postoperative complications were
two duodenum blowout syndromes requiring prolonged intensive care, and an 18%
rate of incisional hernias. Conversion to normal small bowel continuity was
necessary in three cases. Protein malnutrition developed in 2 patients (1.1%),
in 1 patient coinciding with addiction to cocaine. One patient could not
psychologically accept the physical changes and requested conversion.
Anastomotic ulceration was seen in 11% of the patients. Operation for late
obstruction occurred in 2 patients. There was no mortality. CONCLUSIONS:
Although BPD by Scopinaro's method is technically complex, it is safe and

Publication Types:
    Clinical Trial

PMID: 10340770 [PubMed]

383: Clin Plast Surg.  1999 Apr;26(2):317-35; x.  

Safety issues in ultrasound-assisted large-volume lipoplasty.

Gilliland MD, Commons GW, Halperin B.

Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.

Ultrasound-assisted large volume lipoplasty is controversial because of the
potential for increased morbidity and mortality. The plastic surgeon must pay
attention to details in patient selection, anesthesia considerations,
intraoperative fluid balance, and the technical aspects of ultrasound-assisted
lipoplasty to be consistently successful. The avoidance or early detection of
complications such as intracavitary penetrations, fluid overload, hypovolemia,
deep venous thrombosis, and lidocaine toxicity requires frequent examination by
the surgeon. When properly executed, large volume lipoplasty can be gratifying
to both patient and surgeon.

Publication Types:
    Case Reports
    Review, Tutorial

PMID: 10327274 [PubMed]

384: Clin Plast Surg.  1999 Apr;26(2):289-93; ix.  

Wetting solutions in ultrasound-assisted lipoplasty.

Fodor PB, Watson JP.

Division of Plastic Surgery, University of California, Los Angeles, USA.

Wetting solutions play a crucial role in traditional lipoplasty by reducing
blood loss in the aspirate and diminishing postoperative ecchymosis and edema.
From the inception of ultrasound-assisted lipoplasty a "wet environment" has
been considered essential for efficient fat emulsification and for control of
thermal side effects. This article reviews the historical role of wetting
solutions in lipoplasty and examines the risks of their use in an overzealous
manner. The authors provide safety guidelines for maximizing the benefits of
wetting solutions in traditional and ultrasound-assisted lipoplasty while
minimizing their side effects and complications.

Publication Types:
    Review, Tutorial

PMID: 10327270 [PubMed]

385: Clin Plast Surg.  1999 Apr;26(2):187-204; vii.  

Analysis and introduction of a technology: Ultrasound-assisted Lipoplasty Task

Fredricks S.

Plastic Surgery Department, Baylor College of Medicine, Houston, Texas, USA.

This article provides an overview of the findings of the Ultrasound-Assisted
Lipoplasty Task Force and presents its original and updated reports on the
safety and efficacy of the new lipoplasty procedures. The author reviews the
equipment, techniques, complications, and postoperative care associated with the
latest procedures. Ongoing research and recommendations to the practitioner are

Publication Types:
    Review, Tutorial

PMID: 10327259 [PubMed]

386: N Engl J Med.  1999 May 13;340(19):1471-5.  

Comment in:
    N Engl J Med. 1999 Sep 23;341(13):1000-1; author reply 1002-3.
    N Engl J Med. 1999 Sep 23;341(13):1000; author reply 1002-3.
    N Engl J Med. 1999 Sep 23;341(13):1001-2; author reply 1002-3.
    N Engl J Med. 1999 Sep 23;341(13):1001; author reply 1002-3.
    N Engl J Med. 1999 Sep 23;341(13):1001; author reply 1002-3.
    N Engl J Med. 1999 Sep 23;341(13):1002-3.

Deaths related to liposuction.

Rao RB, Ely SF, Hoffman RS.

New York City Poison Control Center, Department of Surgery-Emergency Medicine,
New York University Medical Center, NY 10016, USA. raorama@pol.net

BACKGROUND: The technique of tumescent liposuction involves the subcutaneous
infusion of a solution containing lidocaine, followed by the aspiration of fat
through microcannulas. Although the recommended doses of lidocaine are as high
as 55 mg per kilogram of body weight, few safety data are available. Since
reporting of adverse events associated with tumescent liposuction is not
mandatory, the incidence of complications and deaths is unknown. METHODS: We
identified 5 deaths after tumescent liposuction among 48,527 deaths referred to
the Office of Chief Medical Examiner of New York City between 1993 and 1998. The
patients' records and postmortem examination results were reviewed to identify
common contributory factors. RESULTS: The five patients had received lidocaine
in doses ranging from 10 to 40 mg per kilogram. Other drugs, such as midazolam,
were also administered. Three patients died as a result of precipitous
intraoperative hypotension and bradycardia with no definitively identified
cause. Postmortem blood lidocaine concentrations in two of the patients were 5.2
and 2 mg per liter. One patient died of fluid overload, and one died of deep
venous thrombosis of calf veins with pulmonary thromboembolism after tumescent
liposuction of the legs. CONCLUSIONS: Tumescent liposuction can be fatal,
perhaps in part because of lidocaine toxicity or lidocaine-related drug

Publication Types:
    Case Reports

PMID: 10320385 [PubMed]

387: Aesthetic Plast Surg.  1999 Mar-Apr;23(2):93-100.  

Total corporal contouring with megaliposuction (120 consecutive cases).

Alegria Peren P, Barba Gomez J, Guerrero-Santos J.

The purpose of this study is to present the authors' long-term experience with
total corporal contouring with megaliposuction. The evolution of body reshaping
in one operative setting including simultaneous head and neck contouring, upper
and lower extremity recontouring, and creation of an aesthetic trunk and
abdominal form is discussed. Patient evaluation, operative techniques,
postoperative management, and long-term results are emphasized. From February
1994 to February 1997, 120 consecutive patients underwent total corporal
contouring with tumescent (Hunstad formula)-technique, classic liposuction.
There were 10 males and 110 females. The average age of all patients was 28
years. Preoperative evaluation emphasized corporal shape and proportions. No
other open procedures were performed simultaneously in these patients. The
authors' postoperative regimen is discussed. The average amount of aspirated
material in these series was 14,000 ml (range, 8000-20,000 ml). No blood
transfusions were required. Complications included only hypopigmentation (N = 2)
and postoperative seromas requiring aspiration (N = 12). Follow-up examination
took place at 3 months to 3 years, with an average of 14 months. All patients
underwent a metamorphosis from an amorphic shape to one that follows the normal
body contours and profiles. The goals of megaliposuction are no longer just to
reduce body fat and body mass. Individually planned surgery for these patients
should be based upon obtaining normal symmetrical body proportions. Total
corporal contouring and reshaping can now be safely performed, offering hope and
predictable outcomes to this patient population. Patient evaluation, operative
technique, postoperative care, and long-term results are presented.

PMID: 10227908 [PubMed]

388: Orthopedics.  1999 Apr;22(4):395-8; discussion 398-9.  

Fracture of the patella following total knee arthroplasty.

Le AX, Cameron HU, Otsuka NY, Harrington IJ, Bhargava M.

Department of Orthopedic Surgery, University of California, San Francisco
Medical Center, USA.

The charts of 21 patients (22 knees) with significant radiographic changes of
the patella after total knee arthroplasty were reviewed. The average patient age
was 73 years, and average follow-up after arthroplasty was 7.3 years. Lateral
release, fat pad excision, quadriceps tendon release, and previous surgery were
implicated in the etiology of fracture of the patella. Five cases had type 1
pattern (sclerosis, fragmentation, and no fracture), 5 cases had type 2 pattern
(undisplaced fracture and fragmentation), and 12 cases had type 3 pattern
(displaced fracture and fragmentation). Type 1 and 2 patterns required no
surgical treatment and were rated good to excellent according to the Hospital
for Special Surgery Disability Score Sheet. Patients with a type 3 pattern who
did not undergo surgery were rated poor to fair, while patients with a type 3
pattern who underwent surgical treatment (patellectomy, removal of the patellar
component, or excision arthroplasty for infection) were rated good. Patellectomy
is the treatment of choice for patients with displaced fractures of the patella.
A classification system for the pattern of patellar changes is proposed.

PMID: 10220054 [PubMed]

389: Lancet.  1999 Apr 10;353(9160):1244.  

Liposuction for protease-inhibitor-associated lipodystrophy.

Ponce-de-Leon S, Iglesias M, Ceballos J, Ostrosky-Zeichner L.

Publication Types:
    Case Reports

PMID: 10217093 [PubMed]

390: Am J Forensic Med Pathol.  1999 Mar;20(1):101.  

"Tumescent" liposuction alert: deaths from lidocaine cardiotoxicity.

de Jong RH, Grazer FM.

Publication Types:

PMID: 10208349 [PubMed]

391: J Laparoendosc Adv Surg Tech A.  1999 Feb;9(1):23-30.  

Laparoscopic gastric banding for morbid obesity.

Weiner R, Wagner D, Bockhorn H.

Chirurgische Klinik, Frankfurt am Main, Germany. R.Weiner@em.uni-frankfurt.de

Morbid obesity is a serious disease that is responsible for several comorbid
conditions. Body mass indices > 40 require surgical procedures if diet programs
fail. Laparoscopic adjustable gastric banding (LAGB), a more recently introduced
gastric restrictive procedure, was designed to be a minimally invasive and
reversible operation. 184 patients (164 women, 20 men) with a mean body mass
index of 47.8 kg/m2 (range 36-79) were operated on. All patients had been
excessively overweight for > 5 years. Each patient was given general anesthesia,
and an adjustable LAP-BAND was implanted laparoscopically. The pouch size was 15
ml in all cases; and 3-4 sutures were placed to prevent dislocation. The
conversion rate was 0%. The median operating time was 65 min (range 45-190). The
mortality was 0%. The mean hospital stay was 5 days (range 4-6). The mean excess
weight loss was 16% in 4 weeks, 23% in 3 months, 31% in 6 months, 58% in 1 year,
and 87% in 2 years. The patient satisfaction index was 97.6%. Once a surgeon has
acquired the necessary laparoscopic surgical experience, LAGB is a feasible,
safe, and simple procedure with excellent postoperative results. LAGB does not
permanently modify the anatomy of the stomach and maintains the natural
continuity of the alimentary tract, while at the same time ensuring a steady
weight reduction in morbidly obese patients. The fact that the gastric band can
be applied laparoscopically is a significant advantage in this group of
high-risk patients, who have less pain, faster postoperative recovery, more
rapid return to normal activities, fewer wound infections, fewer hernia
problems, and better cosmetic results. The rate of postoperative complications
is approximately 9%. In 1.1% of patients, erosion occurred, and in 2.2%,
slippage of the band. The rate of port-related complications was 3.2%.
Reoperations were necessary in 6.4% of the patients.

PMID: 10194689 [PubMed]

392: Plast Reconstr Surg.  1999 Apr;103(5):1534.  

Treatment of dysesthesias secondary to ultrasonic lipoplasty.

Perez JA.

Publication Types:

PMID: 10190458 [PubMed]

393: Plast Reconstr Surg.  1999 Apr;103(5):1533-4.  

Tumescent liposuction and median nerve compression.

Young KB, Commons G, Halperin B.

Publication Types:

PMID: 10190457 [PubMed]

394: Eur J Gastroenterol Hepatol.  1999 Feb;11(2):115-9.  

An interval report on prospective investigation of adjustable silicone gastric
banding devices for the treatment of severe obesity.

Doherty C, Maher JW, Heitshusen DS.

Department of Surgery, University of Iowa School of Medicine, Iowa City, USA.

A review and updated report of an ongoing prospective investigation of two
different adjustable silicone gastric banding devices is presented. One cohort
of this study includes 40 subjects who have had a band placed by laparotomy. A
second cohort includes 22 subjects who have had a newly designed adjustable
silicone gastric band (ASGB) placed by laparoscopic or open technique. The goal
of this investigation is to evaluate the achievement of sustained weight loss
without the need for re-operation. Because of the frequent need for re-operation
to correct life-threatening complications or ineffectiveness of ASGB devices,
present clinical data indicate that improvements to the implantable system and
the operative technique need to be made and verified by long-term study. At this
point in development, ASGB remains an investigative procedure that has not
fulfilled the scientific requirements of an accepted surgical treatment for
severe obesity.

PMID: 10102220 [PubMed]

395: Eur J Gastroenterol Hepatol.  1999 Feb;11(2):105-14.  

Gastric banding for morbid obesity.

Oria HE.

Department of Surgery, Spring Branch Medical Center, Houston, Texas, USA.

Recent advances in laparoscopy have renewed the interest in gastric banding
techniques for the control of severe obesity. This method entails encircling the
upper part of the stomach using bands made of synthetic materials, creating a
small upper pouch that empties into the lower stomach through a narrow,
non-stretchable stoma. The reduced capacity of the pouch and the restriction
caused by the band diminish caloric intake, depending on important technical
details, thus producing weight loss comparable to vertical gastroplasties,
without the possibility of staple-line disruption and lesser incidence of
infectious complications. However, distension of the pouch, slippage of the band
and entrapment of the foreign material by the stomach have been described. To
reduce the likelihood of these occurrences, reviewing the literature of the past
20 years is important to surgeons new in the bariatric field. Understanding the
development of this procedure helps in avoiding mistakes made during the
evolutionary process. The simplicity and non-invasiveness of the technique, low
morbidity, ease of revision, and especially its complete reversibility, make
gastric banding a first-line choice in bariatric surgery. However, as in other
pure restrictive methods, and perhaps more important than surgical refinements,
patient compliance with the behavioural changes imposed by the procedure is
critical for a successful outcome.

Publication Types:
    Review, Tutorial

PMID: 10102219 [PubMed]

396: Eur J Gastroenterol Hepatol.  1999 Feb;11(2):89-91.  

Gastroplasty procedures, particularly vertical banded gastroplasty.

Terry BE.

Department of General Surgery, University of Missouri, Columbia 65212, USA.

Vertical banded gastroplasty (VBG), the most frequently performed restrictive
procedure to control severe obesity, was developed by Mason in 1982. The
procedure evolved from experiential trials of earlier concepts and the timely
availability of instrumentation to allow stapled vertical partition of the
stomach. Success requires precise technical mastery and optimal patient
compliance to provide permanent governance of satiety. The objective of weight
control--to reverse co-morbidities of obesity, while causing minimal metabolic
deficiencies--has been achieved in a wide selection of patients. The super-obese
may be a group whose needs fall beyond the control of the VBG. Vertical ringed
gastroplasty (VRG) performs similarly to VBG. Other types of gastroplasty have
yet to prove reliable over time. Laparoscopic banded gastroplasty is reversible,
adjustable and attractive to patients. Laparoscopic VBG must prove equivalent
technical precision to that of open procedures before it can be useful.
Deterrents to success such as staple-line failure, band erosion, behavioural
backsliding, lack of teeth, large pouch syndrome and a super-obese candidate
underscore the tenacity of severe obesity, the disease, as an adversary.
Control, not cure, is possible.

PMID: 10102216 [PubMed]

397: Eur J Gastroenterol Hepatol.  1999 Feb;11(2):77-84.  

Performance standards in bariatric surgery.

Oria HE, Brolin RE.

Department of Surgery, Spring Branch Medical Center, Houston, Texas, USA.

A bariatric surgeon is a fully trained general or gastrointestinal surgeon who
has demonstrated specialized knowledge in the management of patients who suffer
from morbid obesity and its complications. In addition to appropriate formal
surgical training, preceptorships with experienced surgeons, preferably members
of international bariatric societies, are highly desirable. Active participation
in meetings of these societies, continuing medical education and knowledge of
the current literature are necessary to maintain the required skills to treat
these complex patients. Bariatric surgery should be performed at institutions
that provide the necessary equipment, facilities and support systems for this
particular population. When analysing outcomes of obesity surgery, long-term
weight loss reports should include the number of patients followed and the time
period of follow-up. Complications and re-operations should be presented, as
well as modifications of techniques when various operations are compared. Weight
loss should not be the only criterion used to define success or failure.
Objective assessment of improvement in medical conditions related to obesity,
and reliable measurements of quality of life after surgery should also be
included in the final outcome analysis.

PMID: 10102214 [PubMed]

398: Fortschr Med.  1999 Jan 30;117(3):40-2.  

[Tumescent technique for local anesthesia. Use and prospectives of aa new
anesthetic method]

[Article in German]

Augustin M, Vanscheidt W, Sattler G, Schopf E, Sommer B.

Universitats-Hautklinik, Freiburg/Br.

The tumescent technique for local anesthesia (TLA) involves the infiltration of
the subcutaneous fatty tissue with a large volume of a diluted local anesthetic.
This large added volume increases the tension in the tissue, creating more
favorable conditions for the action of the analgesic and for dermatological
operative measures. Originally developed for use in the area of liposuction, TLA
has since proved to have advantages over other forms of analgesia in numerous
other dermatological indications. Overall, TLA is an effective and practical
analgesic technique associated with comparatively few side effects that has been
shown to be very useful in surgery of the skin.

PMID: 10087636 [PubMed]

399: Plast Reconstr Surg.  1999 Mar;103(3):1095.  

Comment on:
    Plast Reconstr Surg. 1998 Jul;102(1):235-7.

Median nerve compression with tumescent fluid administration.

Duncan RE.

Publication Types:

PMID: 10077123 [PubMed]

400: Plast Reconstr Surg.  1999 Mar;103(3):1094-5.  

Comment on:
    Plast Reconstr Surg. 1998 Jul;102(1):235-7.

Acute carpal tunnel syndrome: related to the tumescent technique?

Worland RG.

Publication Types:

PMID: 10077122 [PubMed]

401: Plast Reconstr Surg.  1999 Mar;103(3):984-9.  

The effects of ultrasonic energy on peripheral nerves: implications for
ultrasound-assisted liposuction.

Howard BK, Beran SJ, Kenkel JM, Krueger J, Rohrich RJ.

Department of Plastic and Reconstructive Surgery, University of Texas
Southwestern Medical Center, Dallas 75235-9132, USA.

The integration of ultrasound-assisted liposuction with traditional
suction-assisted lipoplasty has extended the role of liposuction in body
contouring. Although there are ample data regarding the effects of ultrasound on
peripheral nerves from studies with the Cavitron ultrasound surgical aspirator,
there is little information concerning the effects of modern ultrasound body
contouring equipment on neural tissue. This study was designed to evaluate the
functional and histologic effects of ultrasound energy on rat peripheral nerves
(sciatic nerves) using a commonly-used ultrasound-assisted liposuction
generator. After the application of ultrasound to exposed rat sciatic nerves,
operative magnification was used to assess any visible injury. The sciatic
function index was serially measured to quantify immediate and long-term
functional effects on the nerves. Our results showed immediate visible injury
using low amplitude settings (level 6), but no functional evidence of injury
until much higher settings were used (level 9). All animals in the groups with
initial functional impairment had returned to normal or near-normal function at
completion of the study (51 days). Histologic examination revealed no evidence
of damage in the low amplitude groups. Histologic analysis of the high amplitude
groups displayed diffuse infiltration of the nerve, with foamy histiocytes and
an increased number of mast cells, consistent with remote neural injury followed
by myelin breakdown and repair.

PMID: 10077094 [PubMed]

402: Obes Surg.  1999 Feb;9(1):77-9.  

Patients with morbid obesity don't get life-saving bone marrow transplants.

Clarke B, Engler H.

Department of Veterans Affairs, Medical Center, Augusta, Georgia, USA.

When the patient, a registered nurse, was surgically treated for morbid obesity
she initially lost 54.5 kg. Approximately 2 years after gastric bypass, she
received a diagnosis of chronic myelogenous leukemia and subsequently underwent
a successful allogenic bone marrow transplant (BMT). When her surgical history
was taken at the transplant facility, the significant weight loss and gastric
bypass were discussed. She was informed that at 140 kg, she would not have been
eligible nor considered a candidate for transplant. A search of the literature
and a survey of other facilities confirmed this view as typical. The reasons
cited were that the chemotherapy dosage required for the morbidly obese weight
level would cause fatal organ damage as opposed to organ-sparing dosages, which
would not eradicate all leukemic cancer cells. An additional general view was
that the morbidly obese could not survive the rigors of the transplant
preoperative regimen. This patient had an uneventful recovery and remains
disease-free today, 3 years after BMT and 5 years after gastric bypass, with a
sustained total weight loss of 73 kg.

Publication Types:
    Case Reports
    Review, Tutorial

PMID: 10065591 [PubMed]

403: Obes Surg.  1999 Feb;9(1):62-5.  

Laparoscopic surgery for morbid obesity: preliminary results from SICE registry
(Italian Society of Endoscopic and Minimally Invasive Surgery).

Toppino M, Morino M, Bonnet G, Nigra I, Siliquini R.

Dipartimento di Discipline Medico-Chirurgiche, University of Turin, Italy.

Publication Types:
    Clinical Trial

PMID: 10065587 [PubMed]

404: Obes Surg.  1999 Feb;9(1):29-32.  

Vertical banded gastroplasty-gastric bypass with and without the interposition
of jejunum: preliminary report.

Zorrilla PG, Salinas RJ, Salinas-Martinez AM.

Center for the Surgical Treatment of Severe Obesity, Hidalgo Medical Center,
Mexico. zorrilla@nl1.telmex.net.mx

BACKGROUND: The complications of the gastric pouch in gastric bypass surgery are
well known. Since the first report of this surgery 30 years ago, new technical
aspects that make it safer and more effective have been implemented. METHODS: As
a modification of gastric bypass, the authors have performed 305 vertical banded
gastroplasty-gastric bypass procedures. Two groups of patients underwent the
procedure: Group I (n = 206) without a limb of jejunum interposed between the
gastric pouch and the excluded stomach, and Group II (n = 99) with a limb of
jejunum interposed between the pouch and the stomach. The results regarding
excess weight loss and complications of the gastric pouch during the first year
after surgery were compared. RESULTS: Age, sex, initial weight, body mass index,
and percentage of ideal weight were similar in both groups. Excess weight loss
was also similar. The complications in Group I were 1 leak, 3 left subphrenic
abscesses, 2 erosive gastritis with bleeding, 1 stenosis of the
gastrojejunostomy, 1 perforated ulcer, and 4 marginal ulcers with bleeding. Two
patients in Group II developed bleeding from the staple-line. CONCLUSIONS: These
preliminary data suggest that complications of the gastric pouch can be reduced
by interposing a limb of jejunum between the pouch and the excluded stomach.
This is an early experience; long-term results are pending.

Publication Types:
    Clinical Trial

PMID: 10065577 [PubMed]

405: Clin Plast Surg.  1999 Jan;26(1):103-7.  

Continuing issues. Ultrasound-assisted lipoplasty.

Calobrace MB.

Department of Surgery, University of Louisville School of Medicine, Kentucky,

Ultrasound-assisted lipoplasty (UAL), the newest technological advancement in
cosmetic surgery, has created significant discussion and controversy over the
past few years. This article provides the reader with an update on the current
status and continuing issues associated with UAL. The author discusses the role
of the Task Force that was created to evaluate this new technology, reviews the
regulatory issues and clinical studies concerning UAL and describes its benefits
and limitations.

PMID: 10063458 [PubMed]

406: Eur J Surg Suppl.  1998;(582):128-31.  

Laparoscopic surgery for morbid obesity.

Hallerback B, Glise H, Johansson B, Johnson E.

Department Surgery, Northern Alvsborg Hospital, Trollhattan, Sweden.

Morbid obesity, defined as a body mass index (BMI), i.e. weight (kg)/height (m2)
over 36 for males and 38 for females, is a common condition and a threat for
health, life and individual well being. Hitherto, surgery is the only effective
treatment for weight reduction. Surgical methods can be malabsorptive, reducing
the patients ability to absorb nutrients, or restrictive, reducing the capacity
of food intake. Exclusively malabsorptive methods have been abandoned due to
severe side effects. Restrictive methods, gastroplasties, reduces the compliance
capacity of the stomach. Two types are performed laparoscopically, the vertical
banded gastroplasty and the adjustable gastric banding. The proximal gastric by
pass is also performed laparoscopically and is a combination of a restrictive
proximal gastroplasty and a malabsorptive Roux-en-Y gastro-jejunal anastomosis.
With laparoscopic adjustable gastric banding mean BMI was reduced from 41 kg/m2
to 33 kg/m2 (n = 43) after one year. Two years after surgery mean BMI was 30
kg/m2 (n = 16). The different operative techniques are further discussed in this

PMID: 10029379 [PubMed]

407: JAMA.  1999 Feb 10;281(6):504-5.  

From the Centers for Disease Control and Prevention. Rapidly growing
mycobacterial infection following liposuction and liposculpture--Caracas,
Venezuela, 1996-1998.

[No authors listed]

PMID: 10022092 [PubMed]

408: Aesthetic Plast Surg.  1999 Jan-Feb;23(1):16-22.  

Mega-liposuction: analysis of 1520 patients.

Ali Eed MD.

Fifteen hundred and twenty cases of liposuction/liposculpture were performed at
Dr. M. Erfan & Bagedo Hospitals and King Abdulaziz University Hospital in Jeddah
from January 1983 to December 1994. These cases were mostly females. The age
group was from 16-65 years. Multiple procedures were performed in 11.68% of
these cases. The change in hemoglobin and the hematocrit ratio pre- and
post-operatively, and the incidence of complications, were studied. The
percentage of surface area operated upon rather than the amount of fat removed
was the most important relevant factor.

PMID: 10022932 [PubMed]

409: Aesthetic Plast Surg.  1999 Jan-Feb;23(1):5-15.  

Large-volume liposuction in 181 patients.

Albin R, de Campo T.

Liposuction is a commonly performed cosmetic surgery procedure that is
associated with complications, including fatalities. Many of these have been
associated with large-volume liposuction. During 1998 the American Society of
Plastic Surgery Task Force on Lipoplasty and the Plastic/Cosmetic Surgery
Committee of the Medical Board of California have both arbitrarily defined
large-volume liposuction as greater than 5000 cc and asked that surgeons not
remove any more than this volume except in specific circumstances such as a
hospital-type setting [1]. This study includes 181 patients who have had greater
than this amount of total aspirate removed in a single procedure. From January
1, 1996, to February 11, 1997, we used tumescent liposuction only (31 patients).
From February 12, 1997, to June 30, 1998, we used a combination of ultrasonic
liposuction using the Lysonix 2000 Ultrasonic Liposuction Unit and tumescent
liposuction (150 patients). During the last part of the latter series we
calculated the blood loss of 45 patients derived from preop and 5-day postop
hematocrits. The results show that (1) there is no correlation between the
aspirate volume and the calculated blood loss; (2) the majority of the
calculated blood loss is not in the cannister; and (3) no deaths occurred, but
one patient suffered a deep venous thrombosis and two patients suffered
pulmonary emboli. As others have pointed out [2-6] large-volume liposuction can
be performed relatively safely if this procedure is treated with the respect it
deserves and the practitioner exercises sound surgical judgment, uses
appropriate technique, and does not try to cut corners to save money for the
patient by performing this surgery in minimal settings.

PMID: 10022931 [PubMed]

410: Lymphology.  1998 Dec;31(4):156-72.  

Liposuction reduces arm lymphedema without significantly altering the already
impaired lymph transport.

Brorson H, Svensson H, Norrgren K, Thorsson O.

Department of Plastic and Reconstructive Surgery, Malmo University Hospital,

In a prospective study, 20 patients with arm lymphedema after breast cancer
treatment underwent liposuction combined with Controlled Compression Therapy
(CCT) or CCT alone. Indirect lymphoscintigraphy (ILS) was used to study lymph
kinetics before and after intervention. Lymphoscintigrams from the
contralateral, non-edematous arm were characterized by prompt transit of the
radiotracer (99mTc-albumin nanocolloid) to the axillary nodes, whereas tracer
accumulation as dermal backflow characterized tracer transport in the
lymphedematous arm. Neither liposuction with CCT nor CCT alone, changed this ILS
profile. Liposuction combined with CCT reduced arm edema volume by (median) 115%
(range 92-179%), whereas CCT alone decreased arm edema volume by only 54% (range
7-81%) (p = 0.008). Because liposuction in conjunction with CCT was not
associated with further impairment to an already restricted lymph transport, we
recommend this therapy (liposuction with external compression) for chronic arm
lymphedema, as it reduces edema volume safely, rapidly, and more efficiently
than external compression alone. Moreover, it does not worsen an already
impaired lymph transport in the lymphedematous upper extremity.

Publication Types:
    Clinical Trial
    Controlled Clinical Trial

PMID: 9949387 [PubMed]

411: Br J Anaesth.  1998 Oct;81(4):615.  

A complication of peribulbar block in a patient with exophthalmos.

Clarke PM, Kozeis N.

Department of Anaesthesia, Gloucestershire Royal Hospital.

A patient with marked exophthalmos secondary to thyroid eye disease presented
for tarsorrhaphy and removal of orbital fat. A single superolateral peribulbar
injection was performed. After injection of 3.5 ml of local anaesthetic
solution, the globe suddenly dislocated anteriorly. This complication has not
been described previously. In patients with exophthalmos, general anaesthesia
should be considered as the method of choice for ophthalmic procedures.

Publication Types:
    Case Reports

PMID: 9924245 [PubMed]

412: Plast Reconstr Surg.  1999 Jan;103(1):291-3.  

Giant liponecrotic pseudocyst after breast augmentation by fat injection.

Castello JR, Barros J, Vazquez R.

Department of Plastic Surgery, Hospital Ramon y Cajal, Madrid, Spain.

A case in which a growing and painful mass developed in the breast 10 months
after fat injection following trochanteric and abdominal liposuction is
described. Treatment included lumpectomy and breast reconstruction in a second
stage by bilateral subpectoral augmentation mammaplasty with textured gel-filled
prostheses. Histologic examination revealed a liponecrotic pseudocyst. The
development of pseudocysts and microcalcifications after breast autologous fat
injection is a complication that warns against using this technique for breast

Publication Types:
    Case Reports

PMID: 9915193 [PubMed]

413: Eur J Ophthalmol.  1998 Oct-Dec;8(4):246-52.  

Treatment of proptosis with fat removal orbital decompression in Graves'

Adenis JP, Robert PY, Lasudry JG, Dalloul Z.

Service d'Ophtalmologie, C.H.U. Dupuytren, Faculte de Medecine, Limoges, France.

PURPOSE: Retrospective evaluation of 41 proptosis reduction procedures using fat
removal orbital decompression (FROD) according to a modified Olivari's
technique. METHODS: Trans-septal excision of extraconal and intraconal fat was
done under the microscope through the upper and lower eyelid blepharoplasty
approach. Proptosis was measured with a Hertel exophthalmometer. RESULTS: Mean
excision of 7.31 + 1.9 ml (range 3.25-12 ml) of orbital fat reduced proptosis on
average by 4.7 + 2.4 mm (range 1-11 mm). Side effects were few, limited only to
ocular motility disturbances. There was no significant effect on visual fileds.
A postoperative drop in IOP was noted in patients with preoperative IOP above 21
mmHg. Efficient palpebral lengthening can be achieved with combined section of
the levator aponeurosis horns in the upper eyelid, and/or auricular cartilage
graft in the lower eyelid. CONCLUSIONS: FROD reduces proptosis in Grave's

PMID: 9891897 [PubMed]

414: Chirurgie.  1998 Nov;123(5):468-73.  

[Late morbidity after esophagectomy for cancer: is partial esophagectomy

[Article in French]

Labbe F, Pradere B, Tap G, Bloom E, Gouzi JL.

Service de chirurgie digestive, centre hospitalier universitaire Purpan,
Toulouse, France.

PURPOSE: The aim of this study is to report late postoperative complications
occurring after oesophagectomy for cancer over a 12-month period and to compare
the incidence of these complications according to the level of the anastomosis.
PATIENTS AND METHOD: This study included 106 consecutive patients 51% with
subtotal oesophagectomy (thoracic anastomosis), and 49% with total
oesophagectomy (cervical anastomosis). The two groups were comparable for age,
mean weight loss before surgery, life expectancy, number of positive margins,
TNM grading, size and tumour differentiation. RESULTS: Late morbidity concerned
67.9% of the 106 patients. Predominant complications were dysphagia (32.1% of
the 106), gastro-esophageal reflux (25.5% of the 106), and diarrhoea (18.8% of
the 106). Among all the factors causing dysphagia, evaluated by logistic
regression, the level of anastomosis was only found significant with a 20.4%
occurrence for thoracic anastomosis and 44.2% for cervical anastomosis (P =
0.012). All the other complications were similar in the two groups. CONCLUSION:
Functional results of oesophagectomy for cancer are poor. As partial
oesophagectomy morbidity is lower, total oesophagectomy should not be proposed
in all cases of oesophageal cancer.

PMID: 9882916 [PubMed]

415: MMWR Morb Mortal Wkly Rep.  1998 Dec 18;47(49):1065-7.  

Rapidly growing mycobacterial infection following liposuction and
liposculpture--Caracas, Venezuela, 1996-1998.

[No authors listed]

During October 1996-March 1998, nine patients in eight hospitals in Caracas,
Venezuela, acquired surgical-site infections (SSI) caused by rapidly growing
mycobacteria (RGM). All episodes of RGM infection occurred within 2 months after
liposuction or liposculpture (aesthetic surgical procedures). This report
describes the findings of an epidemiologic investigation of this cluster by the
Venezuelan Ministry of Health and underscores the importance of sterilizing
surgical equipment to prevent nosocomial infections.

PMID: 9879630 [PubMed]

416: Dtsch Med Wochenschr.  1998 Dec 11;123(50):1512-6.  

[Benign symmetrical lipomatosis ("peripheral lipodystrophy") during
antiretroviral therapy of HIV infection]

[Article in German]

Fischer T, Schworer H, Ramadori G.

Abteilung Gastroenterologie und Endokrinologie, Medizinischen Klinik der
Universitat Gottingen.

HISTORY AND ADMISSION FINDINGS: A 29-year-old hemophiliac with HIV infection for
which he was receiving antiretroviral treatment (ART) with indinavir, zidovudine
and zalcitabine reported increasing swelling of the neck. Physical examination
noted a soft to doughy swelling, not sensitive to pressure, extending from the
neck to between the shoulder blades. INVESTIGATIONS: Ultrasonography and
magnetic resonance imaging revealed the swelling to consist of an accumulation
of subcutaneous fat without capsule. Cytology demonstrated benign fatty tissue.
Blood triglycerides totalled 667 mg/dl. DIAGNOSIS, TREATMENT AND COURSE: The
typical location, absence of a capsule and the cytological finding confirmed the
clinical diagnosis of drug-induced benign symmetrical lipomatosis (BSL, also
called peripheral lipodystrophy) in ART. A connection with the
hyperlipoproteinaemia is supported by the observation that the patient used to
have a normal fat metabolism; the onset of BSL coincided with a massive increase
in triglyceride levels. The hyperglyceridaemia and clinical signs improved on a
low-fat diet. CONCLUSIONS: BSL can occur in the course of ART in HIV infection,
when reverse-transcriptase inhibitors or protease inhibitors are being taken.
Medication should not be changed, when antiretroviral treatment is adequate. To
reduce the symptoms low-fat diet should be tried, as well as administration of
HMG-CoA-reductase inhibitors or, if necessary, surgical liposuction.

Publication Types:
    Case Reports

PMID: 9879280 [PubMed]

417: JSLS.  1998 Jul-Sep;2(3):263-8.  

The fate of retained gallstones following laparoscopic cholecystectomy in a
prairie dog model.

Bonar JP, Bowyer MW, Welling DR, Hirsch K.

Department of Surgery, David Grant USAF Medical Center, Travis Air Force Base,
California, USA.

BACKGROUND AND OBJECTIVES: Reported complications of retained gallstones
following laparoscopic cholecystectomy (LC) are increasing. This study was
undertaken to evaluate the effects of retained gallstones following LC in a
prairie dog model. METHODS: Twenty-seven prairie dogs with diet-induced
gallstones were divided into three groups of nine. Group I (control) had LC with
removal of stones. Group II had LC followed by return of native stones
intra-abdominally. Group III had LC followed by return of infected stones
(stones dipped in Escherichia coli) intra-abdominally. Animals were euthanized
at two months and the character and extent of intra-abdominal adhesions were
scored. RESULTS: Adhesions were present in 56% of animals in Group I, 89% in
Group II, and 100% in Group III. The character and extent of adhesions in groups
II & III were significantly greater than the control group (p < 0.03). Group III
exhibited the highest degree of adhesions when compared to control (p < 0.007).
Histopathology revealed evidence of micro-abscess formation, foreign body giant
cell reaction, and fat necrosis adjacent to retained stones. CONCLUSION:
Retained intra-abdominal gallstones, especially if infected, are associated with
increased adhesions and inflammatory response in this LC model. Further
investigation into the long-term consequences of this entity is warranted.

PMID: 9876751 [PubMed]

418: Cancer.  1998 Dec 15;83(12 Suppl American):2788-97.  

Breast radiotherapy and lymphedema.

Meek AG.

Department of Radiation Oncology, University Medical Center, Stony Brook, New
York 11794-7028, USA.

BACKGROUND: Breast radiotherapy has a low incidence of long term complications.
Lymphedema is the most commonly reported complication and adversely affects the
quality of life of the breast carcinoma patient. Although its incidence is
decreasing, lymphedema still remains a significant concern for patients and
their physicians. With the indications for radiotherapy in breast carcinoma
management broadening, current strategies to prevent radiation-related
lymphedema should be applied and new strategies should be developed. METHODS: A
review of the literature addressing lymphedema as a complication of radiotherapy
in breast carcinoma management was performed. RESULTS: Arm, breast, and truncal
edema occur after primary breast carcinoma management. The literature supports
the view that radiotherapy contributes to arm and breast edema. Lymphedema
occurs most commonly in patients who have both axillary radiotherapy and
surgery, is often triggered by a soft tissue infection, and is more common in
obese patients. The incidence of arm edema is decreasing due to more
conservative surgical treatment of the axilla and possibly due to more
conservative management of the breast. Trends in breast edema are less
discernible. Single-modality treatment of the axilla is associated with a very
low incidence of arm edema. CONCLUSIONS: Lymphedema continues to be a problem in
the care of the breast carcinoma patient. More conservative surgery combined
with careful patient selection for nodal radiotherapy reduces its incidence.
Radiotherapy technique, prompt treatment of soft tissue infections, and weight
loss in obese patients each can contribute to prevention. The risk of lymphedema
is greatly surpassed by the benefits of radiotherapy in the care of the breast
carcinoma patient.

Publication Types:
    Review, Tutorial

PMID: 9874399 [PubMed]

419: J Cardiovasc Pharmacol.  1998 Dec;32(6):913-9.  

Long-term alpha1-adrenergic blockade attenuates diet-induced dyslipidemia and
hyperinsulinemia in the rat.

Fajardo N, Deshaies Y.

Department of Physiology, School of Medicine, Laval University, Quebec, Quebec,

This study evaluated the ability of alpha1-adrenergic blockade to interfere with
the development of diet-induced hyperlipidemia and deterioration of insulin
action. Diets having extremely divergent effects on glucose and lipid metabolism
were contrasted. Rats were fed for 4 weeks either a nonpurified diet (chow) or a
hyperlipidemic (HL) purified diet containing 40% energy as sucrose, 40% as fat,
and 20% as casein. Half of each dietary cohort was given the alpha1-adrenergic
antagonist prazosin (3 mg/kg/day in the food). Blood was collected in the fasted
state (10 h after food removal) and 2 h after the intake of a meal. In the
fasted state, plasma triacylglycerols (TGs) were higher in rats fed the HL diet
than in those given chow and were not affected by long-term treatment with
prazosin. Postprandially, plasma TG increased twofold in the chow-fed group,
with or without long-term prazosin. In contrast, prazosin reduced by more than
half the eightfold increase in TG that followed intake of the high-fat meal
(Diet x Blocker interaction; p < 0.002) in the HL cohort. The HL-fed animals
also displayed fasting hypercholesterolemia (+30%; p < 0.0001), which was
prevented by long-term treatment with prazosin. Likewise, the 50% increase in
plasma cholesterol that followed meal ingestion only in the HL cohort was
blunted by the alpha1-blocker (Diet x Blocker interaction; p < 0.001). Long-term
prazosin also abolished fasting hyperinsulinemia in the HL cohort, whereas it
did not alter fasting insulin in chow-fed animals (Diet x Blocker interaction; p
< 0.005). Measurement of postprandial lipoprotein lipase activity in several
tissues did not suggest the involvement of changes in the absolute availability
of the enzyme as a determinant of the hypotriacylglycerolemic action of the
alpha1-blocker. Thus long-term alpha1-adrenergic blockade, with minimal effects
in rats fed a hypolipidemic diet, strongly attenuates several of the fasting and
postprandial alterations in plasma variables of lipid and glucose metabolism
induced by an extremely lipogenic diet.

PMID: 9869496 [PubMed]

420: Plast Reconstr Surg.  1998 Dec;102(7):2480-9.  

Simultaneous face lifting and skin resurfacing.

Fulton JE.

Although face lifting and skin resurfacing both produce dramatic facial
rejuvenations, the simultaneous combination has never been popularized. The
development of new methods of lifting and resurfacing may now allow a
reevaluation of this combination. The objective was to evaluate the safety and
efficacy of this combined face lift and skin resurfacing. The facial skin was
resurfaced with a trichloroacetic acid peel or a "short-pulse" CO2 laser and,
then, lifted after liposuction and superficial musculoaponeurotic system
tightening. A dramatic rejuvenation was produced in these 25 cases. There were
no incidents of persistent erythema, pigmentation, hyperpigmentation, or
full-thickness flap necrosis. Side effects were the usual sequelae of edema and
ecchymoses. The small areas of "dusky" erythema of the skin flaps were no more
significant than those after a face lift alone. By following the guidelines
developed in this report, the combination of controlled skin resurfacing with
face lifting is safe and effective. Other procedures, such as blepharoplasties,
can also be added. After one recovery period of 6 to 8 weeks, these patients
reported that they looked 15 to 20 years younger. The complexion continued to
improve during the 1-year follow-up period.

Publication Types:
    Clinical Trial

PMID: 9858190 [PubMed]

421: Ned Tijdschr Geneeskd.  1998 Aug 29;142(35):1946-50.  


[Article in Dutch]

Bloemenkamp DG, Scholten E, Kon M.

Plastische en Reconstructieve Chirurgie, Utrecht.

Liposuction is a frequently applied technique in aesthetic plastic surgery, with
which subcutaneous adipose tissue can be removed. In recent decades new
techniques of liposuction were developed. This led to better results and fewer
complications. Liposuction is indicated as symptomatic treatment of obesity and
(or) lipomas. Liposuction is not without risks; patients have to be informed of
practical consequences and possible complications of the technique.

Publication Types:
    Review, Tutorial

PMID: 9856186 [PubMed]

422: South Med J.  1998 Dec;91(12):1143-8.  

Disorders associated with clinically severe obesity: significant improvement
after surgical weight reduction.

Melissas J, Christodoulakis M, Spyridakis M, Schoretsanitis G, Michaloudis D,
Papavasiliou E, Tsiftsis D.

Department of Surgical Oncology, University Hospital of Heraklion, Crete,

BACKGROUND: Surgical treatment for patients with clinically severe obesity
mainly aims to reduce morbidity. METHODS: Sixty-two patients were examined for
disorders associated with morbid obesity before and after surgical weight
reduction by vertical banded gastroplasty. All patients were followed-up for 12
to 48 months. RESULTS: At the end of the first postoperative year, 84% of the
patients had lost at least 50% of their excess weight. Of the 218 weight-related
pathologic conditions existing before the operation, 131 (60%) were completely
cured, 50 (23%) showed significant improvement, and only 37 (17%) remained
unchanged. The same percentages were obtained for patients followed tip for 24,
36, and 48 postoperative months. CONCLUSIONS: Surgical treatment of clinically
severe obesity has a significant effect on the health of the patients by
eliminating the associated disorders.

PMID: 9853727 [PubMed]

423: Aesthetic Plast Surg.  1998 Nov-Dec;22(6):401-3.  

Liposculpture with ultrasound: biomedical considerations.

Bruno G, Amadei F, Abbiati G.

The authors, after a careful review of the scientific literature and on the
basis of biophysical concepts with their own experience, conclude that
high-intensity ultrasounds (US) are responsible for some biological lesions,
which are partly unknown. US can cause burns and skin necrosis; thus, our
employment of this technique must be correct, justified, and practiced very
carefully and shrewdly and its advantages versus traditional liposuction must be

Publication Types:
    Review, Tutorial

PMID: 9852170 [PubMed]

424: Aesthetic Plast Surg.  1998 Nov-Dec;22(6):399-400.  

Comment on:
    Aesthetic Plast Surg. 1995 Jul-Aug;19(4):379-80.

Lipoplasty-another plea for safety!

Fodor PB.

Publication Types:

PMID: 9852169 [PubMed]

425: J Gastrointest Surg.  1998 Jan-Feb;2(1):102-8.  

Prospective investigation of complications, reoperations, and sustained weight
loss with an adjustable gastric banding device for treatment of morbid obesity.

Doherty C, Maher JW, Heitshusen DS.

Department of Surgery, School of Medicine, University of Iowa, Iowa City, Iowa,

The purpose of this study was to determine prospectively the safety and efficacy
of an adjustable silicone gastric band and reservoir system for the treatment of
morbid obesity. Between 1992 and 1995, forty primary procedures were performed.
Twenty-six females and 14 males entered the study. The mean age of the subjects
was 34 years (range 19 to 51 years). Mean body mass index was 50 kg/m2 (range 39
to 75 kg/m2). There were no deaths. Mean body mass index (in kg/m2) at follow-up
visits was 38.4 at 1 year, 38.0 at 2 years, 40.2 at 3 years, and 40.4 at 4
years. These decreases were significant at P <0. 001. Thirty-two reoperations
(12 intra-abdominal procedures and 20 abdominal wall procedures) have been
necessary to maintain efficacy or correct complications. At the four-year
interval, the reoperation rate of 80% was unsatisfactory. The excess weight loss
has been 41% for those subjects who have an intact gastric band system and
continue in the study. Improvements to the implantable band and/or operative
technique must be implemented and studied long term if this procedure is to
become an accepted surgical treatment for severe obesity.

PMID: 9841975 [PubMed]

426: Dig Dis Sci.  1998 Nov;43(11):2493-9.  

Long-term consequences after jejunoileal bypass for morbid obesity.

Hocking MP, Davis GL, Franzini DA, Woodward ER.

Department of Surgery, University of Florida College of Medicine, Gainesville
32608, USA.

This study assesses the long-term results of jejunoileal bypass (JIB) in 43
prospectively followed patients whose surgical bypass remained intact. Follow-up
was 12.6+/-0.25 years from JIB. Weight loss and improved lipid levels, glucose
tolerance, cardiac function, and pulmonary function were maintained. Adverse
effects such as hypokalemia, cholelithiasis, and B12 or folate deficiency
decreased over time. The incidence of diarrhea remained constant (63% vs 64% at
five years), while the occurrence of hypomagnesemia increased (67% vs 43% at
five years, P < 0.05). Nephrolithiasis occurred in 33% of patients. Hepatic
fibrosis developed in 38% of patients and was progressive. Overall, after more
than 10 years, 35% of patients appeared to benefit from JIB as defined by
alleviation of preoperative symptoms and the development of only mild
complications (vs 47% at five years). On the other hand, irreversible
complications appeared to outweigh any benefit derived from the JIB in 19% (vs
no patients at five years; P < 0.01). In summary, patients with JIB remain at
risk for complications, particularly hepatic fibrosis, even into the late
postoperative period.

PMID: 9824141 [PubMed]

427: Plast Reconstr Surg.  1998 Nov;102(6):2220-9.  

Safety considerations and fluid resuscitation in liposuction: an analysis of 53
consecutive patients.

Trott SA, Beran SJ, Rohrich RJ, Kenkel JM, Adams WP Jr, Klein KW.

Department of Plastic and Reconstructive Surgery, University of Texas
Southwestern Medical Center, Dallas 75235-9132, USA.

There is no agreement as to appropriate fluid resuscitation in patients
undergoing liposuction. This has assumed greater significance, as surgeons have
undertaken larger volume aspirations (> or = 4 liters) and the potential
complications of hypovolemia and fluid overload have materialized. This
prospective study of 53 consecutive healthy patients undergoing liposuction
using a superwet technique served to develop general guidelines for safe
perioperative fluid management, especially in regard to large-volume
aspirations. In this context, "aspirate" is defined as the total fat and fluid
that is removed during liposuction. All patients were monitored using standard
noninvasive hemodynamic monitoring. Thirty-six patients were monitored
perioperatively with Foley catheters. The 53 patients underwent liposuction
alone. We did not include patients who underwent concurrent aesthetic surgical
procedures because our intention was to establish fluid administration
guidelines for the liposuction patient. There were no significant complications
in our series. The intraoperative fluid ratio, defined as (intravenous fluid +
infiltrate)/aspirate, was 2.1 for the small-volume group and 1.4 for the
large-volume group. These values were significantly different (p < .001, t
test). Average urine output in the operating room and recovery room and on the
floor was satisfactory (> 0.5 to 1 cc/kg/hr) and did not relate to volume
aspirated (p = 0.21, 0.91, and 0.6, respectively, t test). Four patients who
underwent "large-volume" aspirations (> or = 4 liters) had transient
hypotension, which was immediately responsive to crystalloid fluid boluses in
the first postoperative hours. All other patients required only maintenance
intravenous crystalloid postoperatively until oral intake had been resumed.
There were no statistically significant differences in postoperative fluid
administration between the small- and large-volume groups. Ninety-three percent
of patients were discharged within 24 hours of surgery. Our suggested guidelines
for fluid resuscitation based on this retrospective study are as follows: (1)
small volume (< 4 liters aspirated): maintenance fluid + subcutaneous wetting
solution; (2) large volume (> or = 4 liters aspirated): maintenance fluid +
subcutaneous wetting solution + 0.25 cc of intravenous crystalloid per cc of
aspirate removed after 4 liters. This formula has since been used in the care of
94 patients who have undergone liposuction exclusively. All patients have had
unremarkable hospital courses. These guidelines do not replace sound clinical
judgment. Good communication between the surgeon and anesthesiologist is
critical to optimal patient care and safety.

PMID: 9811024 [PubMed]

428: Am Surg.  1998 Nov;64(11):1043-9.  

Intraoperative radiotherapy in the combined-modality management of pancreatic

Schuricht AL, Spitz F, Barbot D, Rosato F.

Department of Surgery, Pennsylvania Hospital, Philadelphia 19107, USA.

The purpose of this study is to assess the feasibility, clinical tolerance,
local control, and survival rates using a combined-modality treatment program of
intraoperative radiation, chemotherapy, and external beam radiation for the
management of patients with pancreatic cancer. One hundred eighty patients with
biopsy-proven adenocarcinoma of the pancreas have been treated by a single
surgical practice between 1979 and 1992. Of these, 105 had locally advanced but
unresectable primary tumors (stages 2 and 3). All patients were treated with a
program of multimodality therapy, including surgery, chemotherapy, and radiation
therapy. Three groups were identified. Group I (33 patients) received
intraoperative radiation therapy (IORT) as part of their treatment. Group II (43
patients) received intraoperative radiation in the form of iodine-125 (I-125)
implantation. Group III (29 patients) received no intraoperative radiation. All
three groups were comparably similar with respect to age at presentation, amount
of preoperative weight loss, preoperative symptoms, and tumor location. Overall
perioperative mortality was 4.8 per cent (five patients), with no difference
between groups noted. Perioperative complications occurred in 32 (30.4%) of the
105 patients. Complications occurred in only 18.1 per cent of patients in Group
I (IORT), compared with 39.5 per cent of Group II (I-125) patients (P < 0.01).
Group III patients (no intraoperative radiation) experienced complications in
31.0 per cent of cases (P = 0.09 vs Group I). Actuarial survival was 18 months
for Group I (IORT) versus 15 months for Group II (I-125). One- and 2-year
actuarial survival rates were 60 and 17 per cent for patients in Group I (IORT)
and 56 and 19 per cent for Group II (I-125). Actuarial local control rates for
patients receiving IORT (Group I) was 70 per cent at 2 years. Patients with
pancreatic cancer historically have poor survival and local control rates
despite aggressive chemotherapy and radiation. The addition of intraoperative
radiation to the combined modality management of pancreatic cancer offers
markedly improved survival rates and local control with minimal morbidity for
patients with unresectable disease. Intraoperative radiation in the form of IORT
can be delivered with a significantly fewer complications than I-125 seed

PMID: 9798766 [PubMed]

429: Plast Reconstr Surg.  1998 Oct;102(5):1690-7.  

Minimizing complications of ultrasound-assisted lipoplasty: an initial
experience with no related complications.

Tebbetts JB.

Numerous complications and increased operating times were reported with
ultrasonically assisted lipoplasty in the first several months after
introduction of the technology in the United States. The purpose of this study
was to review early reported complications and management regimens, evaluate
possible causes of problems, and apply indications and techniques to attempt to
minimize complications during an initial experience with this technique
beginning in January of 1997. Seven specific indications and modifications of
existing techniques were developed and applied to an initial clinical series of
70 consecutive patients who underwent ultrasound-assisted suction lipoplasty
between January 10, 1997, and August 1, 1997. Follow-up ranged from 1 to 7
months. No perioperative or postoperative complication occurred in any patient
in this series. In this series of ultrasound-assisted lipoplasty cases,
application of the following criteria resulted in a series of 70 patients with 1
to 7-month follow-up without complications: (1) selecting patients with well
localized fat deposits who were no more than 20 percent above their ideal body
weight; (2) infusing a solution of Ringer's Lactate containing 1 cc of 1:1000
epinephrine per 1000 cc into the area of fat removal, stopping infusion when the
tissues first become firm, not infusing to marked tissue turgor or skin
induration; (3) restricting the level of energy application to a minimum of 1 cm
from the undersurface of the dermis; (4) limiting ultrasonic energy application
in each area to approximately 1 minute per estimated 100 cc of total aspirate in
a wet to superwet environment; (5) not performing ultrasound-assisted lipoplasty
in the same area as another procedure that could potentially compromise tissue
vascularity; (6) using a Lysonix 2000 generator and 5-mm golf tee tip probe at a
power setting of 8 to apply ultrasonic energy to the area of fat removal,
ceasing energy application when tissue resistance to the passage of the probe
decreases and moving the cannula as rapidly as tissue resistance allows; and (7)
using a standard elastic garment without adherent foam or other materials for 2
weeks postoperatively, encouraging all normal activity immediately, and
restricting aerobic activities for 2 weeks.

PMID: 9774032 [PubMed]

430: Ann Chir Plast Esthet.  1997 Jun;42(3):281-2.  

Comment on:
    Ann Chir Plast Esthet. 1997 Feb;42(1):31-6.

[Skin necrosis after ultrasound lipolysis]

[Article in French]

Bussien R, Maillard GF.

Publication Types:

PMID: 9768167 [PubMed]

431: Ann Chir Plast Esthet.  1997 Feb;42(1):31-6.  

Comment in:
    Ann Chir Plast Esthet. 1997 Jun;42(3):281-2.

[Severe cutaneous necrosis after ultrasound lipolysis. Medicolegal aspects and

[Article in French]

Grolleau JL, Rouge D, Chavoin JP, Costagliola M.

Service de Chirurgie Plastique Reconstructrice et Esthetique, CHU de Toulouse,
Hopital Rangueil.

The authors report the case of a young patient who developed extensive skin
necrosis after ultrasound liposuction of the medial surface of the thigh. These
lesions required excision, split-skin graft and installation of an expansion
prosthesis. The medicolegal aspects of this case are discussed, in particular
the responsibility of the doctor who performed this damaging procedure, from
three points of view: damage, fault, causality. In this case, the damage
corresponded to necrosis which can be due to a chemical, infectious or thermal
mechanism. It is responsible for serious damages due to the number of
operations, the length of hospital stay, immobilization, rehabilitation and the
time off work. The aesthetic damage, the pretium doloris, and the inconvenience
are certainly considerable, but was there fault in this case? Fault by
clumsiness if the equipment was used abnormally; fault by negligence or
imprudence when the equipment was not approved or when the operator was not a
qualified physician, submitting his patient to undue risks. The causality is
envisaged in the case of chemonecrosis and burns. It would be strongly presumed
in a civil procedure in case of non-approved equipment. The authors are in
favour of a hypothesis of a burn and review the current state of ultrasound
liposuction, which was the subject of an intense media campaign several years

Publication Types:
    Case Reports

PMID: 9768133 [PubMed]

432: Aesthetic Plast Surg.  1998 Sep-Oct;22(5):318-28.  

High-tech facelift.

Ramirez OM.

Lutherville, Maryland, USA.

Recent technological advances in our specialty have made us reappraise the way
we approach facial rejuvenation. Some of these technological interfaces have
made it possible, in the author's experience, to improve results and to tackle
difficult aesthetic problems. The purpose of this paper is to report how we
combine these technological advances in an effort to improve the aesthetic
outcomes. These technological advances are: laser skin resurfacing, endoscopy,
newer fat grafting procedures, and new alloplastic materials for bone
augmentation. Other technological advances are consultations via the Internet,
computer imaging for simulation of possible outcomes, etc. Endoscopy is
routinely used in our facial rejuvenative procedures, almost always for the
forehead, often for the midface and less often for the neck. Fat grafting
procedures using newly adapted concepts are used for the brow, glabella, tear
trough deformity, cheeks, lips, chin, nasolabial folds, marionette lines, and
other areas of soft tissue depressions apparent before or after the lifting
procedures. This has allowed us to restore the tridimensional volume and treat
the soft tissue atrophy. Patients with significant skeletal soft tissue
disproportion due to aging, loss of dentition, prior trauma or congenital
defects may receive one or more of the following implants: glabella, cheek,
piriformis, angle of the mandible, mandibular body glove type of implant,
prejawl implant, chin overlay or a glove type of implant. Our preference is for
a porous polyethylene material because of its tissue ingrowth inductiveness.
Individuals who have damaged skin due to solar exposure, aging, smoking, etc.,
may receive Ultrapulse CO2 laser resurfacing at the same operative setting (more
often) or in a delayed fashion. The Versapulse laser is also needed for the
treatment of some skin changes secondary to aging such as telangiectasias
(Variable Pulse Green) and brown spots (Q-Switch 532). The high-tech facelift
has allowed us to treat the severely damaged skin, fat atrophy, bone atrophy in
many patients, at the same time that the lifting procedure is performed. This
provides a more comprehensive approach to facial rejuvenation. The combination
of different techniques and technologies maximizes the effectiveness and
minimizes the potential side effects of each one. Scars in the forehead and
scalp are avoided. Incision and fat removal in the lower eyelid are often
unnecessary. It provides a more precise vertical lifting with correction of the
tear trough deformity and gives a tridimensional restoration of the facial
volume. The facial disharmony is treated at every level starting from the facial
skeletal support to the most external envelope (skin). Over 200 patients have
been treated this way with a minimal rate of complications. The high-tech facial
rejuvenation has allowed us to improve the surgical results of our patients
compared with previous isolated techniques. The combination of each one of the
techniques require a precise understanding of the limits and benefits of each.
Case examples of the different combinations will be shown.

Publication Types:
    Case Reports

PMID: 9767696 [PubMed]

433: Scand J Gastroenterol.  1998 Aug;33(8):839-46.  

Adult patients receiving home parenteral nutrition in Denmark from 1991 to 1996:
who will benefit from intestinal transplantation?

Jeppesen PB, Staun M, Mortensen PB.

Dept. of Medicine CA, Rigshospitalet, University of Copenhagen, Denmark.

BACKGROUND: Small-bowel transplantation is an alternative to home parenteral
nutrition (HPN) in patients with gut failure. Our aim was to report the
indication, diagnosis, morbidity, mortality, and intestinal adaptation in the
total cohort of Danish patients receiving HPN at any time during the 5 years
between 1 January 1991 and 31 December 1995. The data were analysed against the
option of transplantation. RESULTS: HPN was given to 129 patients; 59 (46%) had
inflammatory bowel disease (15% died), 26 (20%) had cured cancers (42% died),
and 44 (34%) had other diseases (dysmotility, surgical complications, infarcts,
and so forth; 27% died). Of these, 60% were new in the HPN program, but only 19%
received HPN all 5 years; 31 % had terminated HPN, 19% permanently, and 25%
died. Only four deaths were HPN-related. In December 1995, 73 patients were
receiving HPN in Denmark, for a prevalence of 13.9 per million, which is the
highest in Europe but 10-fold lower than in the United States. CONCLUSIONS: Gut
failure was the only indication for HPN in Denmark. Weight loss without gut
failure, such as disseminated cancer and acquired immunodeficiency syndrome, was
not an indication for HPN. Survival after small-bowel transplantation should be
assessed against a sizeable mortality among candidates receiving HPN, and this
depends on diagnosis and age. In an HPN population comparable with the Danish, a
quarter is likely to die within a period of 5 years, a quarter will terminate
HPN, and the others survive with HPN. Small-bowel transplantation can be a
lifesaving procedure in the small fraction of foreseeable HPN-related deaths,
mainly caused by liver failure. Transplantation will not improve survival in
most adult HPN patients, and only an improved quality of life after
transplantation justifies this procedure in most HPN patients.

PMID: 9754732 [PubMed]

434: Arch Surg.  1998 Sep;133(9):988-92.  

Transfusion timing and postoperative septic complications after gastric cancer
surgery: a retrospective study of 179 consecutive patients.

Bellantone R, Sitges-Serra A, Bossola M, Doglietto GB, Malerba M, Franch G,
Pacelli F, Crucitti F.

Istituto di Clinica Chirurgica, Universita Cattolica del Sacro Cuore, Roma,

BACKGROUND: Immunosuppression associated with homologous blood transfusion was
first observed in renal allograft transplantation. Clinical effects of
transfusion-induced immunosuppression in surgical patients have been debated in
the literature for more than a decade with contradictory results. OBJECTIVE: To
investigate whether homologous blood transfusions significantly affect
postoperative septic morbidity and mortality in patients undergoing elective
surgery for gastric cancer. DESIGN: Case series. SETTING: Hospitalized care.
PATIENTS: The hospital records of 209 patients who underwent elective surgery
for gastric cancer at the Department of Surgery of the Hospital del Mar,
Autonomous University of Barcelona in Spain, and at the Department of Surgery of
the Catholic University of Rome in Italy from April 1984 to December 1990 were
reviewed, and 179 patients were included in the study. MAIN OUTCOME MEASURES:
The following variables were entered into univariate and multivariate analyses
to identify factors potentially affecting postoperative septic morbidity:
demographic data, weight loss, preoperative serum albumin level and lymphocyte
count, type and duration of operative procedure, amount and timing of blood
transfusion, and stage of disease. RESULTS: Univariate analysis showed that a
large quantity of blood transfused (> 1500 mL) and transfusion in the
postoperative period (group C) were associated with a worse clinical outcome.
Postoperative transfusion was an independent predictor of septic morbidity in
multivariate analysis. CONCLUSIONS: Despite transfusion-induced
immunomodulation, homologous blood transfusion should not be considered a risk
factor for postoperative septic morbidity in patients undergoing elective major
abdominal surgery. The timing-response relationship between transfusions and
septic morbidity in multivariate analysis may be the effect of uncontrolled
confounders such as variation of volemia induced by stress response in patients
who were developing or had just developed infectious complications.

PMID: 9749853 [PubMed]

435: Ann Dermatol Venereol.  1998 Feb;125(2):108-10.  

[Salmonella enteritidis septicemia manifesting as a suppurated thrombophlebitis]

[Article in French]

Leccia MT, Aubry-Artignan S, Brion JP, Voirin L, Beani JC, Amblard P.

Service de Dermatologie, CHU A. Michallon, Grenoble.

BACKGROUND: Non-typloid salmonella can cause septicemia and extradigestive
disorders in immunodepressed adults. These frequent diseases can be
life-threatening. CASE REPORT: A 76-year-old woman was treated with
corticosteroid therapy for 1 year for suppurated thrombophlebitis of the right
greater saphenous vein. Weight loss, fever at 41 degrees C and Salmonella
enterididis isolated from blood cultures and skin samples led to the diagnosis
of septicemia with multiple septic foyers including the venous endothelium and
surrounding soft tissue. DISCUSSION: In Western countries, there has been an
uprise in the frequency of low-grade salmonella infections by food poisoning
usually causing acute diarrhea. S. enterididis can also cause severe infectious
syndromes with multiple septic localizations, main in patients with a
compromised immune reaction. In our cases, Salmonella enteritidis septecemia was
revealed by an unusual situation. In the literature, inaugural signs usually
involve the heart or arteries, but our patient had isolated foyers involving the
superficial venous network. This is exceptional especially since there was no
iatrogenic venous catheter insult. For our patient, favoring factors were the
long-term corticosteroid therapy and altered venous network. The portal of entry
could not be clearly identified but the discovery of a sigmoid diverticulosis
would be an argument favoring a digestive origin. Medical and surgical
management with resection of the necrosed tissues and two adapted antibiotics in
a long-term regimen led to a successful outcome.

Publication Types:
    Case Reports

PMID: 9747225 [PubMed]

436: Anesthesiology.  1998 Sep;89(3):782-4.  

Early fat embolism after liposuction.

Fourme T, Vieillard-Baron A, Loubieres Y, Julie C, Page B, Jardin F.

Department of Pathology, Hopital Ambroise Pare, Boulogne, France.

Publication Types:
    Case Reports

PMID: 9743418 [PubMed]

437: Obes Surg.  1997 Jun;7(3):189-97.  

A decade of change in obesity surgery. National Bariatric Surgery Registry
(NBSR) Contributors.

Mason EE, Tang S, Renquist KE, Barnes DT, Cullen JJ, Doherty C, Maher JW.

Department of Surgery, Iowa City, Iowa, USA.

BACKGROUND: The International (formerly National) Bariatric Surgery Registry
began collecting data in January 1986. The aim of this study was to examine
changes in the practice of surgical treatment of severe obesity that occurred
during the decade of 1986 through 1995, as observed in the IBSR data. METHODS:
All data submitted to the IBSR during the decade were transferred to the IBM
mainframe computer for analysis. Characteristics of operative type populations
were compared over time using analysis of variance (ANOVA) for age, body mass
index (BMI), operative weight and Chi-square (chi2) test for gender. RESULTS:
There has been a steady increase over the decade in mean patient weight. The
operations used have changed from predominantly 'simple' operations to more
frequent use of 'complex' operations. Within the categories of 'simple' and
'complex', an increase in the variety of operations occurred. As a group,
patients with 'simple' operations have been heavier, more often male and public
pay patients than those who have undergone 'complex' operations. One year weight
loss was greater for Roux-en-Y gastric bypass (RGB) than vertical banded
gastroplasty (VBG), but follow-up rates were too low to study the relative
merits of the operations used. The reported incidence of operative mortality and
serious complications (leak with peritonitis, abscess and pulmonary embolism)
remained low. CONCLUSIONS: These observations and their implications can be
summarized in three statements which relate to action for improved patient care
in the beginning of the new century: (1) increasing weight of candidates for
surgical treatment during this decade indicates the need for earlier use of
operative treatment before irreversible complications of obesity can develop;
(2) low risk of obesity surgery, decreasing postoperative hospital stay, and
early weight control support the continued and increased use of surgical
treatment; (3) continued widespread use of both 'simple' and 'complex'
operations with increased modifications of standard RGB and VBG procedures
emphasizes the need for standardized long-term data and analyses regarding both
weight control and postoperative side-effects.

PMID: 9730547 [PubMed]

438: Obes Surg.  1997 Feb;7(1):26-9.  

Biliopancreatic diversion: clinical experience.

Nanni G, Balduzzi GF, Capoluongo R, Scotti A, Rosso G, Botta C, Demichelis P,
Daffara M, Coppo E.

Division of General Surgery, S. Andrea Hospital, Vercelli, Italy.

BACKGROUND: Biliopancreatic diversion (BPD), by ad hoc stomach resection
(AHS-BPD) has been accepted as an effective surgical treatment for morbid
obesity. METHODS: Between 1.1.1992 and 31.7.1996, 59 patients (54 females, five
males, mean age 40.3 years, range 23-61 years) underwent AHS-BPD. Mean
preoperative body-weight was 121.2 kg (range 94-160), with a mean body mass
index of 48.6 (range 35-64). Three of these patients were converted from a
previous vertical banded gastroplasty to AHS-BPD (one patient with stomach
preservation). After at least 36 months follow-up, seven patients underwent
abdominal dermolipectomy (five with associated incisional hernia repair, one
with thigh dermolipectomy). RESULTS: Mean post-operative hospital stay was 13
days (range 10-30 days). Follow-up is currently in progress in all patients.
Excess body weight-loss was 78% in 33 patients with 24 months follow-up, with
excellent long-term weight loss maintenance. Protein deficiency was the main
specific complication, encountered in two patients (3.4%). Mortality was one
patient (1.7%), due to pulmonary embolus. CONCLUSIONS: This clinical experience
supports the effectiveness and safety of AHS-BPD, despite some criticism. This
procedure appears to be suitable for patients with clinically severe obesity who
will poorly tolerate food intake restriction but will accept long-term
follow-up. Careful preoperative clinical assessment and selection of patients
who will be reliable in long-term follow-up are the keys to success with
AHS-BPD, both in terms of weight loss and reduction of specific metabolic

PMID: 9730534 [PubMed]

439: Obes Surg.  1997 Aug;7(4):345-51.  

The Swedish Adjustable Gastric Banding (SAGB) for morbid obesity: 9 year
experience and a 4-year follow-up of patients operated with a new adjustable

Forsell P, Hellers G.

Department of Surgery, Huddinge University Hospital, Sweden.

BACKGROUND: We have developed an adjustable gastric band in which the stoma
diameter can be adjusted from the outside. A standardized technique was employed
and the application of our band in terms of weight loss and complication rate
was evaluated METHODS: Between August 1990 and November 1991, 50 patients (15
men and 35 women) were operated on by laparotomy. Their mean age at surgery was
41 (19-60) years. Mean preoperative weight was 134 (106-181) kg and the mean BMI
was 46 kg/m2 (range 33-59 kg/m2). RESULTS: No patient was lost to follow-up.
Four were excluded from the study (brain tumor, pregnancy and two reoperations).
The remaining 46 were followed for at least 4 years. At follow-up, mean weight
was 80 kg and mean BMI was 27.5 kg/m2. The patients had lost a mean of 54 kg.
Two patients (4%) had abdominal reoperation because of technical problems. There
was one incisional hernia and one minor wound infection, but no other
significant complications. CONCLUSION: This relatively simple method appears to
be at least as good as the other operations, and weight loss can be adjusted to
patient comfort. Currently, the procedure is being performed laparoscopically.

PMID: 9730522 [PubMed]

440: Obes Surg.  1997 Aug;7(4):322-5.  

Vertical banded gastroplasty-gastric bypass in Mexican patients with severe
obesity: 1 year experience.

Zorrilla PG, Salinas RJ, Salinas-Martinez AM.

Center for the Surgical Treatment of Severe Obesity, Hidalgo Medical Center,
Monterrey, Mexico.

BACKGROUND: Different surgical alternatives for the treatment of severe obesity
have been described. The two most common surgical procedures are the Vertical
Banded Gastroplasty (VBG) and the Roux-en-Y Gastric Bypass (GBP). METHODS: This
work describes the results seen during the first 12 months after a surgical
technique named Vertical Banded Gastroplasty-Gastric Bypass on 221 Mexican
patients with severe obesity operated on between March 1993 and August 1996.
RESULTS: 73.3% of the patients were female with an average age of 33.4 years
with a standard deviation (SD) of 10 years. The initial mean overweight was 62.2
kg (SD = 26.5 kg). The percentage of ideal weight was 202.3% (SD = 39.4%). The
initial body mass index (BMI) was 44.9 kg/m2 (SD = 9.1). The average of excess
weight loss in a year was 81.2% (SD = 15.6%) and the BMI was lowered to 26.7
kg/m2 (SD = 5.9). An interesting finding was that the greater the initial
overweight, the lesser the resulting weight loss (r = 0.57, P < 0.001).
CONCLUSIONS: The procedure was fairly easy to perform. The results were
excellent in terms of weight loss and postoperative complications. It is an
early experience and the long-term results are still inconclusive; regular
check-ups should indicate the procedure's long-term effectiveness.

PMID: 9730518 [PubMed]

441: Obes Surg.  1997 Aug;7(4):317-20; discussion 321.  

Vertical banded gastroplasty: first experience in Russia.

Yashkov YI, Timoshin AD, Oppel TA.

Department of Liver, Bile Ducts and Pancreatic Surgery, National Research Center
of Surgery, Russian Academy of Medical Sciences, Moskow.

BACKGROUND: The first experience of vertical banded gastroplasty (VBG) in the
Russian National Research Center of Surgery is presented. METHODS: From November
1992 to October 1996, 24 morbidly obese patients (mean body weight 147.7 kg, BMI
52.1 kg/m2) underwent VBG according to Mason. RESULTS: The early complication
rate was 20.8%. The mean excess weight loss (EWL) after weight stabilization
(first 12 patients) was 48.0% in the whole group and 53.9% (range 36.0-73.0%) in
10 patients without staple-line disruptions. Significant positive changes in
obesity related diseases were noted. Nine of 23 patients presented with
incisional hernias some months after operation. CONCLUSION: The impression of
VBG is favorable; however, gaining further experience with the standard
techniques and increasing the long-term results are necessary.

PMID: 9730517 [PubMed]

442: Obes Surg.  1997 Dec;7(6):513-5.  

42-month preliminary follow-up of the silastic ring vertical banded

Stoner J, Stoner P, Sytsma J.

Davenport Medical Center, Iowa, USA.

BACKGROUND: The authors review preliminary experience with silastic ring
vertical gastroplasty (SRVG). METHODS: Of 202 patients who underwent SRVG, 191
are more than 3 months postoperation and of these 165 were accessible for
review. RESULTS: Pouch volume could not be readily measured. The TA90BN stapler
was occasionally difficult to apply exactly at the angle of His. There was one
subphrenic abscess, one gastric bleed, and one dehiscence. Vomiting occurred in
eight patients who required reoperation: ring removal, three; cholecystectomy,
one; conversion to vertical banded gastroplasty, one; conversion to Roux-en-Y
gastric bypass, three. There was no mortality. Weight loss has been satisfactory
to 42 months. CONCLUSION: SRVG has been a relatively simple operation, with
acceptable morbidity and weight loss thus far.

PMID: 9730510 [PubMed]

443: Obes Surg.  1997 Dec;7(6):489-94.  

Silastic ring gastric bypass: results in 64 patients.

Crampton NA, Izvornikov V, Stubbs RS.

Wakefield Gastroenterology Centre, Wakefield Hospital, Wellington, New Zealand.

BACKGROUND: The silastic ring gastric bypass (SRGB) was introduced by Fobi in
1989, in an effort to combine the advantages of the Roux-en-Y gastric bypass
with those of the vertical banded gastroplasty, while avoiding the disadvantages
of each. METHODS: The results of our first 64 patients who underwent SRGB with a
5.5 cm ring have been reviewed with particular attention to weight loss, short-
and medium-term morbidity and patient satisfaction. Most patients have had
regular follow-up, and those not seen during the last 6 months were sent a
postal questionnaire. RESULTS: The patients included 52 females and 12 males,
ranging in age from 23 to 59 years (median age=39 years) at the time of surgery.
Median preoperative weight, body mass index (BMI) and % excess weight were 126
kg (range 89-253 kg), 44 kg/m2 (range 36-78 kg/m2) and 113 (range 76-209)
respectively. There were no serious postoperative complications and no deaths.
Median hospital stay was 7 days (range 5-14 days). Eight patients (13%) are
known to have had a staple-line dihiscence. Eighteen patients (28%) have had
major difficulties with eating, and in nine (14%) of these the silastic ring has
been removed with resolution of the eating problems, but some gain in weight. In
the 54 patients with follow-up data at 2 years, median weight was 78 kg (range
55-137 kg), median BMI was 27 kg/m2 (range 20-43 kg/m2) and mean +/- SD % excess
weight loss was 69+/-16. After 2 years of follow-up, eight of 54 patients (15%)
were unhappy with the results of the procedure. CONCLUSION: SRGB is an
effective, safe and well-tolerated procedure for achieving weight loss in the
morbidly obese. The principal drawbacks relate to staple-line problems and
eating difficulties related to the silastic ring. A 5.5 cm ring is probably too
small to be ideal.

PMID: 9730506 [PubMed]

444: Obes Surg.  1997 Dec;7(6):479-84.  

Symptomatic and clinical improvement in morbidly obese patients with
gastroesophageal reflux disease following Roux-en-Y gastric bypass.

Smith SC, Edwards CB, Goodman GN.

Rocky Mountain Associated Physicians, Salt Lake City, Utah, USA.

BACKGROUND: Patients who suffer with gastroesophageal reflux Disease (GERD)
endure a worsening of symptoms as their weight increases. When medical treatment
of this condition in the morbidly obese patients fails, surgical intervention
may be indicated. Choosing a procedure which not only helps achieve weight
control but which also relieves symptoms and complications of GERD is the goal.
We present a review of patients who have undergone Roux-en-Y Gastric Bypass
(RYGBP) and related procedures for this disease. METHODS: One hundred
eighty-eight patients undergoing surgery for morbid obesity and for GERD in
1992-1996 were contacted by mail or phone. All of these patients had undergone
preoperative esophagogastroduodenoscopy to grade the severity of their disease.
Their preoperative symptoms were compared to those experienced postoperatively.
RESULTS: One hundred thirty patients underwent a RYGBP with modified Hill
fundopexy, 22 patients underwent a distal gastrectomy with modified Hill
fundopexy, 8 patients underwent distal gastrectomy alone and 28 patients
underwent RYGBP alone. There have been no deaths. There were nine surgical
complications, eight early and one at 2.5 years postoperation. Follow-up is 4-48
months. The average BMI dropped from 43 to 30.2 kg/m2. Whereas all patients were
on some form of medical therapy before surgery, only 14 reported the need for
medication postoperatively. CONCLUSIONS: Surgical intervention for weight
control and treatment of GERD has been highly successful in our experience both
with respect to weight control and to the reduction of reflux symptoms.
Depending upon endoscopic and operative findings a RYGBP with or without an
antireflux procedure can provide dramatic improvement. Gastrectomy with
antireflux modifications is appropriate in selected cases.

PMID: 9730504 [PubMed]

445: Obes Surg.  1998 Apr;8(2):218-24.  

Converting vertical banded gastroplasty to a lesser curvature gastric bypass:
technical considerations.

Capella RF, Capella JF.

Department of Surgery, Pascack Valley Hospital, Westwood, NJ, USA.

BACKGROUND: Vertical banded gastroplasty (VBG) is occasionally followed by poor
weight loss or complications requiring reoperation. Several studies have
analyzed the morbidity and mortality associated with conversions of VBG to
gastric bypass, but few have described the actual technique. The most frequent
complications related to this type of reoperation are gastrointestinal leaks.
MATERIALS AND METHODS: The authors analyzed 60 consecutive conversions from VBG
to lesser curvature gastric bypass, performed on 60 patients. The cases were
analyzed for surgical technique, complications and weight loss. In all the cases
the operation was limited to the lesser curvature of the stomach, and certain
technical maneuvers were done to facilitate the creation of the pouch and
anastomosis. RESULTS: There were three major complications, and two patients
required reoperation. There were no gastrointestinal leaks or mortality.
Percentage weight loss at 5 years was similar to primary gastric bypasses.
CONCLUSION: Converting failed or complicated VBGs to lesser curvature gastric
bypasses are safe and effective weight loss operations. By performing several
specific technical maneuvers and limiting the operation to the highly vascular
lesser curvature, complications can be reduced to a minimum.

PMID: 9730398 [PubMed]

446: Obes Surg.  1998 Apr;8(2):215-7.  

Gastrointestinal complications after vertical banded gastroplasty.

Papakonstantinou A, Alfaras P, Komessidou V, Hadjiyannakis E.

First Surgical Department, EVANGELISMOS Hospital, Athens, Greece.

BACKGROUND: Gastric surgical procedures for morbid obesity may have occasional
serious complications. The vertical banded gastroplasty according to Mason's
technique (VBG) is a common procedure for morbid obesity. The aim of this study
is to present the complications in the gastrointestinal (GI) tract after VBG and
to discuss their treatment. METHODS: In this study 260 morbidly obese patients
(62 males and 198 females) underwent VBG. RESULTS: Complications in the GI tract
were encountered as follows: narrowing of the communicating lumen of the two
parts of the stomach in four patients, dehiscence of the vertical stomach staple
line in three patients, cholelithiasis in 12 patients, gastric perforation in
four patients, postoperative fistulas in three patients, serious hepatic failure
in one patient, significant gastritis and esophagitis in 32 patients, intestinal
obstruction in five patients and frequent prolonged vomiting in 23 patients. The
authors attempted to treat all these complications conservatively. In 22
patients, however, a new procedure was necessary. In some cases a partial
gastrectomy was necessary. CONCLUSION: VBG is considered to be a satisfactory
procedure for weight loss in morbid obesity, but has occasional complications
from the GI tract, besides the complications from the other systems. Thus, this
procedure should be performed only when absolute indications exist.

PMID: 9730397 [PubMed]

447: Dermatol Surg.  1998 Aug;24(8):934.  

Comment on:
    Dermatol Surg. 1997 Dec;23(12):1137-40.

Minimizing pain for liposuction anesthesia.

Lycka BA.

Publication Types:

PMID: 9723067 [PubMed]

448: Dermatol Surg.  1998 Aug;24(8):871-4.  

Safety of ultrasonic-assisted liposuction (UAL) using a non-water-cooled
ultrasonic cannula. A report of six cases of disproportionate fat deposits
treated with UAL.

Lack EB.

Center for Liposculpture and Cosmetic Surgery, Des Plaines, Illinois 60016, USA.

BACKGROUND: There has been much medical investigation and much public relations
in the media regarding ultrasonic liposuction. With different methodologies and
instrumentation for applying ultrasonic energy to soft tissue in conjunction
with liposuction, there is appropriate confusion and skepticism in the medical
community. OBJECTIVE: To present case reports that delineate the possible
morbidities and/or safety of one method of application of ultrasonic energy to
enhance liposuction--ultrasonic assisted Liposuction (UAL) performed with a
non-water-cooled ultrasonic cannula. METHODS: Description of six cases in which
this procedure was performed and their follow-up over a 4-week period. RESULTS:
Much of the morbidity described in these six cases was indistinguishable from
that noted following standard tumescent liposuction with micro cannulas. There
is a significant risk of heat necrosis of soft tissue with this procedure, which
can be minimized with proper technique. CONCLUSIONS: UAL with a non-water-cooled
cannula can be performed safely when proper education regarding its usage is
followed. However, surgeons wishing to perform this technique must be willing to
experience a significant learning curve.

Publication Types:
    Case Reports

PMID: 9723052 [PubMed]

449: Dermatol Surg.  1998 Aug;24(8):857-65.  

Small volume fat transfer.

Fulton JE, Suarez M, Silverton K, Barnes T.

Fulton Skin Clinic, Newport Beach, California 92660, USA.

BACKGROUND: The use of autologous fat has been advocated for tissue augmentation
for over a century. However, this technique remains controversial and many
investigators have made suggestions to increase its potential. OBJECTIVES: To
develop a less traumatic method to collect, purify, and reinject fat to obtain
more dramatic augmentations for the cosmetic improvement of contours and tissue
defects. METHODS: Fat was collected from the donor site following tumescent
infiltration of tissue. A "vented" syringe with an atraumatic Mercedes tip was
used to collect the fat and, after washing with lactated Ringers or saline, the
fat was transferred to small syringes for controlled injections. Small filaments
of fat were placed in multi-layers throughout the area of the defect or area of
desired contour change. The unused fat was frozen for a second or third
injection session. RESULTS: The fat transfer method yielded augmentations of
40%-120% of injected volume in the 339 areas treated. After 45-60 days, the
implant was stabilized and remained for the length of our study (up to 10
years). In several cases excessive fat had to be removed. Other than slight
bruising, occasional divots at the donor site, and three cases of bacterial
infection, the autologous tissue transfer was an uncomplicated event.
CONCLUSION: Fat grafting has proven to be a safe and effective procedure for
correcting and enhancing tissue defects and contour deficiencies.

PMID: 9723050 [PubMed]

450: World J Surg.  1998 Sep;22(9):981-6.  

Liposuction: procedure for focal volume reduction and body contour remodeling.

Fuente del Campo AF, Rojas Allegretti E, Fernandes Filho JA, Gordon CB.

Department of Plastic and Craniofacial Surgery, Universidad Nacional Autonoma de
Mexico, Hospital Infantil de Mexico, Mexico, D.F., Mexico.

Liposuction is the most commonly used procedure for focal reduction of body fat
deposits and remodeling the body contour. The procedure consists in aspirating
fat from lamellar deposits using a vacuum source connected to a cannula that is
passed bluntly through fatty tissue. Adjuncts to the procedure include
infiltration of solutions to aid in fat removal or to limit blood loss and the
application of ultrasonic energy to lyse fat cells before suction aspiration.
Surgical history, theory, procedures, indications, potential complications, and
guidelines are discussed herein.

PMID: 9717425 [PubMed]

451: World J Surg.  1998 Sep;22(9):955-63.  

Laparoscopic adjustable gastric banding.

Belachew M, Legrand M, Vincent V, Lismonde M, Le Docte N, Deschamps V.

Service de Chirurgie Universitaire, Centre Hospitalier Hutois, Huy, Belgium.

We introduced open adjustable silicone gastric banding (ASGB) for treatment of
morbid obesity in our institution in 1991. It was done in a prospective study
comparing ASGB with vertical banded gastroplasty (VBG) with regard to weight
loss. After 200 cases of open ASGB and 210 VBG procedures and the encouraging
weight loss results, we started laparoscopic placement of the adjustable
silicone band. The initial work was done in an animal laboratory program where a
new surgical protocol has been established. Details of the laparoscopic
dissection around the stomach in a deep operative field and fatty atmosphere
have been developed, and a laparoscopically implantable version of the
adjustable silicone band (LAGB) has been devised. The first human laparoscopic
ASGB procedure was performed in our institution on September 1, 1993. Altogether
350 patients had undergone adjustable silicone gastric banding (LASGB)
procedures by May 1997 (277 women, 73 men). All the patients were morbidly
obese, with an average preoperative weight of 118 kg (92-200 kg). The mean BMI
was 43 kg/m2 (36-65 kg/m2). The conversion rate to laparotomy has been low
(1.4%). Early complications have been rare, and pouch dilatation and stomach
slippage have been the only significant late complications. The rate of these
complications has been considerably improved by reducing the pouch volume and
using more gastrogastric sutures. Evaluation of postoperative weight loss of
LASGB patients compared with our VBG and ASGB (open) patients showed a similar

PMID: 9717421 [PubMed]

452: World J Surg.  1998 Sep;22(9):936-46.  

Biliopancreatic diversion.

Scopinaro N, Adami GF, Marinari GM, Gianetta E, Traverso E, Friedman D, Camerini
G, Baschieri G, Simonelli A.

Department of Surgery, University of Genoa School of Medicine, Italy.

Biliopancreatic diversion (BPD) has made reacceptable the malabsorptive approach
to the surgical treatment of obesity. The procedure, in a series of 2241
patients operated on during a 21-year period, caused a mean permanent reduction
of about 75% of the initial excess weight. The indefinite weight maintenance
appears to be due to the existence of a threshold absorption capacity for fat
and starch, and thus energy, and the weight loss is partly due to increased
resting energy expenditure. Beneficial effects other than those consequent to
weight loss or reduced nutrient absorption included permanent normalization of
serum glucose and cholesterol without any medication and on totally free diet in
100% of cases, both phenomena being due to a specific action of the operation.
Operative mortality was less than 0.5%. Specific late complications included
anemia, less than 5% with adequate iron or folate supplementation (or both);
stomal ulcer, reduced to 3.2% by oral H2-blocker prophylaxis; bone
demineralization, increasing up to the fourth year and tending to decrease
thereafter, with need of calcium and vitamin D supplementation; neurologic
complications, totally avoidable by prompt vitamin B administration to patients
at risk; protein malnutrition, which was reduced to a minimum of 3% with 1.3%
recurrence, in exchange with a smaller weight loss, by adapting the volume of
the gastric remnant and the length of the alimentary limb to the patient's
individual characteristics. It is concluded that the correct use of BPD, based
on the knowledge of its mechanisms of action, can make the procedure an
effective, safe one in all hands.

PMID: 9717419 [PubMed]

453: World J Surg.  1998 Sep;22(9):925-35.  

Gastric bypass operation for obesity.

Fobi MA, Lee H, Holness R, Cabinda D.

Cedars Sinai Medical Center, Los Angeles 90048, USA.

Gastric bypass is considered by many to be the gold standard for surgical
treatment of obesity. Gastric bypass was a natural evolution from gastric
operations that were used for the treatment of peptic ulcer disease. Gastric
bypass, first described in 1967, has undergone many modifications. It presently
exists as a hybrid operation. Gastric bypass operation has been extensively
scrutinized and evaluated against other operations for the treatment of obesity.
Co-morbidities due to severe obesity are usually ameliorated or arrested after
the weight loss from gastric bypass. Gastric bypass operation is now being
performed with a perioperative morbidity of less than 10%. The average
percentage excess weight loss with gastric bypass is 70%. The success rate,
defined as 50% excess weight loss after at least 2 years of follow-up, is 85%.
The metabolic deficiencies of gastric bypass are controllable with supplemental
intake. This report with special references to the Fobi pouch operation, a
modification of gastric bypass done by the author, presents the evolution,
modifications, risk, outcome, and future trends of gastric bypass for treatment
of obesity.

PMID: 9717418 [PubMed]

454: Urology.  1998 Aug;52(2):203-7.  

One-incision nephroureterectomy endoscopically assisted by transurethral
ureteral stripping.

Angulo JC, Hontoria J, Sanchez-Chapado M.

Department of Urology, Hospital Principe de Asturias, Alcala de Henares, Madrid,

OBJECTIVES: Ureteral endoscopic surgery has been proposed as the first step of
nephroureterectomy, either open or laparoscopic, to obviate the low abdominal
incision. We present our experience with a technique of one-incision
nephroureterectomy endoscopically assisted by transurethral ureteral stripping.
METHODS: Standard nephrectomy is performed after placement of a Chevassu
ureteral catheter. The lumbar ureter is sectioned and the catheter tip tied to
the top of the distal portion of the ureter, which is later intussuscepted when
the catheter is pulled out. Transurethral resection through the muscular wall
and into the perivesical fat is performed around the everted ureteral orifice,
and the bladder spontaneously closes with an indwelling Foley catheter. Since
1989, we have used this technique in 21 patients with urothelial malignancies of
the renal pelvis or calyces (15 patients), renal cell carcinoma (2 patients),
renal cholesteatoma (1 patient), or reflux nephropathy (3 patients). RESULTS:
Two patients required a low abdominal incision for removal of retained ureter
after unsuccessful stripping. The rest underwent this procedure without
complications or adverse effects. Mean follow-up was 44.6 +/- 11.4 months (range
4 to 76). Three patients presented with bladder tumor but no recurrences were
detected in the resected area of the bladder or the retroperitoneum.
CONCLUSIONS: Endoscopically assisted nephroureterectomy allows removal of an
adequate cuff of bladder with the distal ureter and generally obviates extending
the incision or performing a second one. It can be an attractive option in
selected cases, without apparent risk of neoplastic urine contamination in the

PMID: 9697782 [PubMed]

455: Dermatol Surg.  1998 Jul;24(7):755-8.  

Comment in:
    Dermatol Surg. 1999 Feb;25(2):152.

Tumescent anesthesia for dermatologic surgery. Cosmetic and noncosmetic

Namias A, Kaplan B.

Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel.

BACKGROUND: Tumescent anesthesia was originally described by Klein and Lillis
for liposuction surgery. Its extension to many other interventions in
dermatologic surgery (cosmetic and noncosmetic) has provided a significant
contribution in the performance of safe, ambulatory, and simplified procedures.
OBJECTIVE: To demonstrate the validity of the technique in various procedures.
METHODS: Over the course of 1 year all large reconstruction or cosmetic surgery
was performed using tumescent anesthesia. In a total of 242 cases performed, the
advantages and disadvantages of the procedure were analyzed. RESULTS: Tumescent
anesthesia was found to be very effective in achieving adequate anesthesia for
performance of the reconstructive or cosmetic procedures. Good patient
compliance was achieved with no serious sequelae. CONCLUSION: Tumescent
anesthesia is one the most substantial progressions in the field of cosmetic and
reconstructive surgery, with advantages that by far outnumber the few

PMID: 9693670 [PubMed]

456: Br J Surg.  1998 Jul;85(7):931-3.  

Effect of growth hormone treatment on the healing of left colonic anastomoses in
protein-malnourished rats.

Karahasanoglu T, Altinli E, Hamzaoglu I, Paksoy M, Yesildere T, Alemdaroglu K.

Department of Surgery, Istanbul University Cerrahpasa Medical School, Istanbul
University Veterinary Faculty, Turkey.

BACKGROUND: Malnutrition is known to affect wound healing but it is not known
with certainty whether or not postoperative hyperalimentation can reverse this
defect. The present study was designed to examine the effects of recombinant
human growth hormone (hGH) on left colonic anastomoses in malnourished rats.
METHODS: Experimental animals were allocated randomly into four groups. In
groups 1 and 2 animals were fed with normal diet for 10 days before surgery. In
groups 3 and 4 animals were fed with a low-protein diet. Left colonic
anastomoses were performed in all animals. Following surgery, rats in groups 1
and 3 received hGH whereas rats in groups 2 and 4 were injected with saline as
control. Bursting pressure and hydroxyproline levels on day 4 after operation
were used to determine anastomotic healing. Results: Bursting pressure was lower
in the malnourished rats than those fed with normal diet (P< 0.05). Bursting
pressure was higher in normally fed rats which were given hGH. No significant
differences could be noted between malnourished control rats and those receiving
hGH. CONCLUSION: These results suggest that hGH strengthened the left colonic
anastomoses in rats fed a normal diet, but could not reverse the negative
effects of malnutrition on colonic anastomoses.

PMID: 9692566 [PubMed]

457: Adv Ren Replace Ther.  1998 Jul;5(3):157-67.  

Erratum in:
    Adv Ren Replace Ther 1998 Oct;5(4):353.

Sclerosing peritonitis in continuous ambulatory peritoneal dialysis patients: one
center's experience and review of the literature.

Afthentopoulos IE, Passadakis P, Oreopoulos DG, Bargman J.

Toronto Western Hospital, Ontario, Canada.

Sclerosing peritonitis (SP) is a severe life-threatening condition for patients
undergoing continuous ambulatory peritoneal dialysis (CAPD). This report reviews
our experience and that reported in the literature concerning the prevalence of
SP in CAPD patients, predisposing factors, and in particular, the role of
peritonitis, its clinical presentation, diagnosis, treatment, and prevention. A
total of 1,288 end-stage renal disease (ESRD) patients entered our peritoneal
dialysis (PD) program between September 1977 and September 1997, seven of whom
(0.54%) developed SP. The annual incidence of SP was 0.37 per 1,000 patient
years, male-to-female ratio was 2.5 (M/F:5/2), mean age was 39+/-16 (median, 37;
range, 23 to 61) years, and the median duration on CAPD was 62 (range, 12 to
144) months. Five patients were on CAPD for > or =4 years and two for less than
4 years before they were diagnosed with SP. All SP patients presented with
clinical symptoms suggestive of intestinal obstruction, and five patients had
decreased solute or fluid removal and had to increase the daily dialysate volume
(3/7) or the tonicity of the fluid (4.25%) (3/7) or to combine a regular
hemodialysis (HD) session with CAPD (2/7). There was a mean weight loss of 5+/-6
(median, 2; range, 0 to 18) kg. All patients had an episode of peritonitis at a
mean time of 2+/-1 (median, 1; range, 1 to 3) months before the diagnosis of SP.
The peritonitis was due to Staphylococcus aureus in four and Staphylococcus
epidermidis, fungi, and Escherichia coli in one each. The definitive diagnosis
of SP was established by laparotomy in four patients or postmortem examination
in one patient, while in the remaining two there was no surgical confirmation;
however, we believe the diagnosis was extremely likely because of the presence
of clinical and radiologic criteria for SP. After the diagnosis of SP, all
patients had their catheters removed, CAPD was discontinued permanently, and
they were transferred to HD. Although there are isolated case reports of
successful outcomes after surgical intervention, especially in patients in whom
a peritoneal "cocoon" is related to severe peritonitis, usually the prognosis
following surgery is poor. Treatment with immunosuppressive agents has been
reported to be beneficial in the treatment of SP, although this has not been
confirmed by all investigators. Among our SP patients, five (72%) died of sepsis
(3/5) in a mean period of 10+/-5 (median, 9; range, 6 to 17) months after the
diagnosis of SP and two are still alive on HD. SP is a rare but serious
complication of CAPD. Severe peritonitis, especially in patients on dialysis for
more than 4 years, may lead to SP As the prevalence of SP increases in patients
on long-term CAPD, early detection is important because of the high morbidity
and mortality associated with this condition.

Publication Types:
    Review Literature

PMID: 9686626 [PubMed]

458: Rev Cubana Med Trop.  1997;49(1):64-8.  

[Factors associated with the incurability of epidemic neuropathy in Cuba]

[Article in Spanish]

Perez Rodriguez A, Isla A, Fernandez I, Mas Lago P.

Instituto de Medicina Tropical Pedro Kouri.

56 patients were surveyed and reexamined at the Center for Medical and Surgical
Research (CMSR) a year after the onset of the neuropathy epidemic. The possible
factors associated with the occurrence were investigated to be studied together
with the disease persistence, including the antibody titre of 33 of them, who
had a previous serology against the biological agent (strain 47/IPK) isolated
from the cerebrospinal fluid of a sick patient. A fourth of the patients (15
cases) were still ill. The loss of weight and the smoking habit were stressed as
the factors most associated with the persistence of the clinical manifestations
of epidemic neuropathy. In spite of the fact that the small number of patients
who underwent the checkup limited the study, this is a basic document about the
existent situation a year after the problem happened.

PMID: 9685964 [PubMed]

459: Carcinogenesis.  1998 Jul;19(7):1209-15.  

Proliferation, development and DNA adduct levels in the mammary gland of rats
given 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine and a high fat diet.

Snyderwine EG, Davis CD, Schut HA, Roberts-Thomson SJ.

Chemical Carcinogenesis Section, Laboratory of Experimental Carcinogenesis,
Division of Basic Sciences, National Cancer Institute, NIH, Bethesda, MD
20892-4255, USA.

2-Amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) is a heterocyclic amine
derived from cooked meat that is a mammary gland carcinogen in rats. A
carcinogenic dose-regimen of PhIP (75 mg/kg, p.o., 10 doses, once per day) was
administered to 43-day old female Sprague-Dawley rats, and the rats were then
placed on a defined high fat (23.5% corn oil) or low fat (5% corn oil) diet for
up to 6 weeks. At various times after carcinogen and diet, and prior to
carcinogenesis, we examined the percentage of proliferating cells in terminal
end bud (TEB) epithelial structures of the rat mammary gland by proliferating
cell nuclear antigen staining, mammary gland architecture by whole mounting, and
PhIP-DNA adduct levels in mammary epithelial cells by the 32P-post-labeling
assay. Immediately after dosing, the percentage of proliferating epithelial
cells in TEBs was significantly higher in PhIP-treated rats than in control rats
receiving vehicle only [7.5 +/- 0.9% (n = 99) versus 4.2 +/- 0.6% (n = 127),
respectively]. The mammary glands of PhIP-treated rats showed a significantly
lower density of alveolar buds (ABs) and a higher density of TEBs than control
rats, which suggests that PhIP exposure partially inhibited the normal glandular
differentiation of TEBs to ABs. After 6 weeks on the diet, proliferation in TEBs
was statistically higher in rats given PhIP plus a high fat diet than in rats
given vehicle plus a low fat diet. The mammary glands from rats on a high fat
diet also showed a statistically higher density of TEBs when compared with rats
on a low fat diet [2.08 +/- 0.34% versus 1.04 +/- 0.20%, respectively (n = 6)].
PhIP-DNA adduct levels were relatively high in mammary epithelial cells of
treated rats. At 3 h after the last dose of PhIP, DNA adduct levels [relative
adduct labeling (RAL) x 10(7), mean +/- SE] were 10.5 +/- 1.7 (n = 8) and 0.9
+/- 0.2 (n = 7) in epithelial cells isolated from mammary gland and in the
liver, respectively. DNA adduct removal rates from the mammary gland were not
different between rats on the high fat and low fat diets. Adducts were still
detected after 6 weeks on either diet. Thus, events that occurred prior to
neoplasia in the mammary glands of PhIP-treated rats include formation of
PhIP-DNA adducts at relatively high levels, and enhanced proliferation in TEBs
(putative sites of origin of mammary gland carcinomas) and partial inhibition of
TEB differentiation. The high fat diet, a promoter of PhIP-induced mammary gland
carcinogenesis, appeared to sustain the proliferative effect of PhIP in mammary
gland TEBs at a time when PhIP-DNA adducts are still detectable. These early
events may contribute to the targeting and carcinogenicity of PhIP to the
mammary gland of rats.

PMID: 9683179 [PubMed]

460: N C Med J.  1998 Jul-Aug;59(4):244-7.  

Tumescent liposuction. Fat removal for medical and cosmetic purposes.

Rostan EF, Madani S, Clark RE.

Dermatologic Surgery and Cutaneous Oncology Unit, Duke University Medical
Center, Durham 27710, USA.

Publication Types:
    Review, Tutorial

PMID: 9682594 [PubMed]

461: J Med Assoc Ga.  1998 Jan;87(1):39-43.  

Plastic surgery for men.

Weiss HA.

PMID: 9666649 [PubMed]

462: Plast Reconstr Surg.  1998 Jul;102(1):213-20.  

Comment in:
    Plast Reconstr Surg. 1998 Jul;102(1):280; author reply 280-1.

The tissue effects of ultrasound-assisted lipoplasty.

Kenkel JM, Robinson JB Jr, Beran SJ, Tan J, Howard BK, Zocchi ML, Rohrich RJ.

Department of Plastic and Reconstructive Surgery at the University of Texas
Southwestern Medical Center, Dallas 75235-9132, USA.

The objective of our study was to investigate the effects of ultrasonic energy
on tissues, using a porcine model, performed under various instrumental and
procedural parameters. Domestic pigs were anesthetized and prepared for surgery.
An incision was made on the side of the hip randomly assigned to the right or
left side. Tumescence solution was infiltrated via a blunt tip, small diameter
cannula, followed by performance of standard liposuction. On the contralateral
side, a similar incision was made. For ultrasonic liposuction experiments
without the sheath, a percutaneous introducer was inserted into the incision,
which was protected at the entry site from contact with the cannula. Tumescence
solution was infiltrated via a blunt tip, small diameter cannula, and then the
site was treated with ultrasonic energy at maximum output from the machine with
liposuction concurrent through the hollow cannula. The experiments with the
sheath did not require a pretreatment with tumescence solution but consisted of
tumescence solution pumped through the sheath at a low infusion rate, with
concurrent treatment utilizing ultrasonically assisted liposuction through the
central lumen of the cannula. In all cases, the lipoaspirate was preserved for
biochemical analysis. After treatment, the pigs were euthanized, and samples for
histopathology were taken. The pigs were then perfused with a radio-opaque
solution through the left ventricle following preperfusion with saline. The
groups were ultrasound-assisted liposuction with sheath (n = 3),
ultrasound-assisted without sheath (n = 4), and tumescence alone (n = 1), with
standard liposuction performed on the contralateral side for all
ultrasound-assisted liposuction animals. The lipoaspirates from the
ultrasonically assisted liposuction with the sheath showed significantly less
blood loss (measured as hemoglobin in the aspirate) than standard liposuction (p
= 0.012) at comparable levels of fat (measured as triglycerides in the
aspirate). The lipoaspirates from ultrasound-assisted liposuction without the
sheath showed blood loss comparable to that experienced with standard
liposuction. The ratio of hemoglobin to triglyceride was lowest in the
ultrasound-assisted group with (p = 0.01) and without (p = 0.06) the sheath when
compared to traditional liposuction. In both of these treated groups, the
radiograms of the perfused areas showed significantly less vascular disruption
when compared with suction-assisted liposuction. Histopathologic examination of
specimens taken from various treated areas showed substantial tissue damage
comparable in ultrasound- and suction-assisted liposuction treated groups. This
preliminary experimental study showed that ultrasound-assisted lipoplasty is
comparable to traditional suction-assisted lipoplasty. Treatment with ultrasound
provided more significant hemoglobin/triglyceride ratios, indicative of more
lipid aspirated per hemoglobin lost, and better preservation of vascular tissues
as demonstrated by our perfusion studies. Treatment with the sheath showed a
significantly lower hemoglobin release with a diminished volume infused into the
subcutaneous space during the procedure.

PMID: 9655430 [PubMed]

463: Plast Reconstr Surg.  1998 Jul;102(1):280; author reply 280-1.  

Comment in:
    Plast Reconstr Surg. 2004 Feb;113(2):788-9.

Comment on:
    Plast Reconstr Surg. 1998 Jul;102(1):213-20.

Long-term possible hazardous effects of ultrasonically assisted lipoplasty.

Topaz M.

Publication Types:

PMID: 9655465 [PubMed]

464: Plast Reconstr Surg.  1998 Jul;102(1):235-7.  

Comment in:
    Plast Reconstr Surg. 1999 Mar;103(3):1094-5.
    Plast Reconstr Surg. 1999 Mar;103(3):1095.

Acute median nerve compression associated with tumescent fluid administration.

Lombardi AS, Quirke TE, Rauscher G.

Department of Surgery, University of Medicine and Dentistry of New Jersey, New
Jersey Medical School, Newark, USA.

Publication Types:
    Case Reports

PMID: 9655434 [PubMed]

465: Dermatol Surg.  1998 Jun;24(6):689-91.  

Comment on:
    Dermatol Surg. 1997 Dec;23(12):1169-74.
    Dermatol Surg. 1997 Dec;23(12):1194-5.

Titanic tumescent anesthesia.

de Jong RH, Grazer FM.

Publication Types:

PMID: 9648581 [PubMed]

466: Hautarzt.  1998 May;49(5):351-60.  

[Tumescence local anesthesia. Improvement of local anesthesia methods for
surgical dermatology]

[Article in German]

Sommer B, Sattler G.

Hautklinik am Klinikum Darmstadt, Akademisches Lehrkrankenhaus der
Universitatsklinik Frankfurt.

The tumescent technique of local anesthesia was developed by J. Klein ten years
ago to facilitate liposuction surgery. Tumescent anesthesia not only became the
standard technique for liposuction, but proved to be of great value for other
surgical problems in dermatology. Meanwhile, several noncosmetic uses for
tumescent anesthesia were pioneered by dermatologic surgeons. This first review
of the tumescent technique in German literature will focus on its specific
advantages and disadvantages when applied in different fields of dermatologic
surgery. Our own experience will be discussed, as well as future developments.

Publication Types:
    Review, Tutorial

PMID: 9642555 [PubMed]

467: Nephrol Dial Transplant.  1998 Jun;13(6):1446-51.  

Intestinal absorption and biliary secretion of cholesterol in rats with
nephrotic syndrome.

Pahl MV, Oveisi F, Khamiseh G, Vaziri ND.

Department of Medicine, University of California, Irvine, USA.

BACKGROUND: Nephrotic syndrome (NS) results in hypercholesterolemia which is
attributed to increased production and decreased removal of cholesterol-rich
lipoproteins. Adjustments in intestinal absorption are reportedly involved in
cholesterol homeostasis. We, therefore, studied the intestinal absorption and
biliary excretion of cholesterol in NS. METHODS: We studied intestinal
absorption (by in vivo perfusion and in vitro everted sac incubation techniques)
and biliary secretion (by common bile duct cannulation) of cholesterol in rats
with puromycin-induced NS. The results were compared with those obtained from
pair-fed control (PF) animals, those given free access to food (NL) or those fed
a hypercholerolemic diet (H-chol group). Micellar solutions of Krebs' phosphate
buffer containing trace amounts of [14C]inulin and [3H]cholesterol, as well as
different concentrations of unlabeled cholesterol, were used for absorption
studies. RESULTS: The NS and H-chol groups showed severe and comparable
hypercholesterolemia. No significant difference was found in the rate of biliary
cholesterol secretion among the study groups. Likewise, the rates of in vivo and
in vitro cholesterol absorptions in the NS and H-chol groups were comparable
with one another and similar to those found in the NL and PF groups. The rate of
in vitro cholesterol absorption was directly proportional to its concentration
in the incubation media at low concentrations. However, the absorption rate
showed a pattern consistent with saturable transport at high cholesterol
concentrations in all groups. CONCLUSIONS: We conclude that intestinal
absorption and biliary secretion of cholesterol are not appreciably influenced
by either nephrotic or diet-induced hypercholesterolemia in rats. The data
further suggest that cholesterol absorption may be a saturable process.

PMID: 9641174 [PubMed]

468: Arch Surg.  1998 Jun;133(6):652-6.  

Effects of carbon dioxide pneumoperitoneum, air pneumoperitoneum, and gasless
laparoscopy on body weight and tumor growth.

Bouvy ND, Giuffrida MC, Tseng LN, Steyerberg EW, Marquet RL, Jeekel H, Bonjer

Department of Surgery, University Hospital Rotterdam, Dijkzigt, The Netherlands.

BACKGROUND: The oncologic consequences of intraperitoneal carbon dioxide (CO2)
insufflation during the laparoscopic resection of cancer are under debate. The
effect of other insufflating gases or gasless laparoscopy on cancer requires
study. OBJECTIVE: To study body weight and tumor growth in rats after CO2
pneumoperitoneum, air pneumoperitoneum, and gasless laparoscopy. METHODS: On day
1, an 8-mg bolus of ROS-1 tumor was placed under the renal capsule of both
kidneys in rats. In experiment A, rats had either CO2 insufflation (n=10) or a
gasless laparoscopic bowel resection (n=10) on day 3 and were humanely killed
after 7 days. In experiment B, rats had either a laparoscopic bowel resection
with CO2 insufflation (n=11) or insufflation with air (n=11) on day 3 and were
killed after 7 days. In both experiments, postoperative weight loss and tumor
growth were measured, and the differences were tested with an analysis of
covariance. RESULTS: Renal subcapsular tumor growth in the group having gasless
laparoscopy was less than that in the group having CO2 pneumoperitoneum (P=.04).
Postoperative weight loss in these groups showed no differences (P=.55). No
differences in tumor growth or weight loss were found between rats having
insufflation with CO2 and those having insufflation with air (P=.61 and P=.68,
respectively). CONCLUSIONS: The restoration of body weight after a laparoscopic
surgical procedure was similar with CO2, air, or gasless laparoscopy. Gasless
laparoscopy was associated with less renal subcapsular tumor growth than was
insufflation with CO2. Therefore, the application of gasless techniques in
laparoscopic oncologic surgical treatment demands further study.

PMID: 9637466 [PubMed]

469: Hum Reprod.  1998 Apr;13(4):880-3.  

Management of chylous ascites following laparoscopic presacral neurectomy.

Chen FP, Lo TS, Soong YK.

Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital,
Taiwan, ROC.

Chylous ascites is an extremely rare complication of laparoscopic presacral
neurectomy (LPSN), and treatment is still controversial. Four patients
undergoing LPSN for dysmenorrhoea or chronic pelvic pain were complicated with
chylous ascites. Two were successfully treated with bipolar cauterization and
one, after the failure of initial treatment by bipolar cauterization, was then
effectively managed by compression with Gelform and closure of the peritoneum of
the presacral area by suture through laparoscopy. The fourth patient had
persistent chyle leakage from the drainage tube after electrocauterization and
was finally cured by conservative management including removal of the drainage
tube and a low-fat diet for 3 weeks. Chylous ascites has not been reported in
laparoscopic presacral neurectomy. Management that is quick, effective and
subjects the patients to the least amount of suffering is still unresolved.
Repeated laparoscopy can be considered to identify the possibility of injury to
lymphatic vessels, to relieve abdominal distention due to chyle accumulation,
and to apply electrocauterization or compression with Gelform and closure of the
peritoneum. Conservative treatment with a low-fat diet may need a longer time.
The use of a drainage tube may provide negative pressure allowing a continuous
leakage of chyle. However, more controlled study is required to identify the
most proper and effective management.

Publication Types:
    Case Reports

PMID: 9619541 [PubMed]

470: Aesthetic Plast Surg.  1998 May-Jun;22(3):180-4.  

Toxic shock syndrome in plastic surgery patients: case report and review of the

Holm C, Muhlbauer W.

Department of Plastic and Reconstructive Surgery, Klinikum Bogenhausen, Academic
Teaching Hospital, Munich, Germany.

Toxic shock syndrome (TSS) is a rapidly developing disease, which may be lethal
if not recognized and treated early. TSS unrelated to menstruation comprises an
increasing proportion of the cases reported to the Centers for Disease Control
during recent years, and a review of the literature reveals that TSS has is
reported with increasing frequency in plastic surgical patients as well. The
majority of reports relates to aesthetic plastic surgical procedures such as
rhinoplasty, augmentation mammaplasty liposuction, and chemical peeling, but
cases of TSS following reconstructive breast surgery with musculocutaneous flaps
have also been reported. A common denominator seems to be that TSS occurs
unexpectedly in healthy patients. Nonmenstrual TSS is apparently associated with
a higher mortality rate than TSS associated with menstruation. We report on a
case of TSS after exchange of silicone implants and resection of a siliconoma in
a 59-year-old woman. Details of the case and a review of the literature are

Publication Types:
    Case Reports

PMID: 9618183 [PubMed]

471: Prog Neuropsychopharmacol Biol Psychiatry.  1998 Feb;22(2):425-33.  

Evidence suggesting that gonadal hormones influence benzodiazepine
withdrawal-induced weight loss in rats.

Pires JG, Monteiro KC, Alvarenga SO, Costa MG, Gomes MA, Futuro-Neto HA.

Department of Physiological Sciences, Universidade Federal do Espirito Santo,
Vitoria, Brazil.

1. In experimental animals, benzodiazepine (BZ) withdrawal syndrome includes
anorexia and acute weight loss. The literature shows several sex-based
differences in the expression of BZ dependence; however, the authors did not
find studies dealing with the influence of gonadal hormones on BZ
withdrawal-induced weight loss. Thus, this study was designed to investigate the
effects of castration on diazepam (DZ) withdrawal-induced weight loss in rats.
2. Male (260-330 g) or female (220-260 g) Wistar rats were anesthetized with
ether and submitted to surgical castration or sham-operation. Seven days later,
recovered from the surgery, the animals were injected i.p. with DZ (4 mg kg-1
day-1) or appropriate vehicle (VEH; 2 ml kg-1 kg-1 day-1) for 28 days. In the
next 7 days, the rats received the same doses of DZ (four groups) or VEH (eight
groups). Weights of all animals were recorded daily to the nearest gram at 09:00
h. To assess the degree of weight loss and make statistical comparisons, weights
over days 29-34 were expressed as percentage of those recorded in the morning of
day 28. 3. Sham-operated female rats from the group DZ-VEH showed a small but
statistically significant weight loss on days 29 and 30 (P < 0.05) when compared
with groups VEH-VEH and DZ-DZ. Ovariectomized rats, however, did not show any
significant change in body weight from days 29-34. 4. Sham-operated male rats
did not exhibit any significant weight loss after DZ withdrawal. Orchidectomized
animals, however, showed a small but statistically significant weight loss on
day 31 (P < 0.05) when compared with groups VEH-VEH and DZ-DZ. 5. These results
show a gonadal influence on DZ withdrawal-induced weight loss in Wistar rats; in
particular, they also suggest that female hormones (progesterone and/or
estrogen) facilitate whilst male hormones inhibit this phenomenon.

PMID: 9608611 [PubMed]

472: Am J Surg.  1998 May;175(5):367-70.  

Resectional gastric bypass is a new alternative in morbid obesity.

Curry TK, Carter PL, Porter CA, Watts DM.

General Surgery Service, Madigan Army Medical Center, Tacoma, Washington
98431-5000, USA.

BACKGROUND: Severe obesity is a common serious health problem in the United
States. Medical therapy is often ineffective. A variety of surgical procedures
have been employed for treatment of morbid obesity. Surgical therapy continues
to evolve. METHODS: Eighty-five patients have undergone subtotal gastrectomy and
retrocolic Roux-en-Y gastrojejunostomy for weight control at our institution. We
refer to this procedure as resectional gastric bypass (RGB). Thirty-eight
patients have undergone RGB as conversion from failed or problematic prior
bariatric procedures. Forty-seven patients have had RGB as their primary
bariatric procedure. RESULTS: Twenty-six patients undergoing RGB for conversion
of an anatomically or functionally failed prior bariatric procedure have had
mean additional weight loss of 37% excess body weight (EBWL) in 18 months
follow-up. Twelve patients undergoing RGB for intractable side effects of prior
bariatric procedures have all had clinical improvement. Forty-seven patients
undergoing RGB as a primary procedure have had EBWL of 53%, in mean follow-up of
11 months. For the entire series, major complications were one anastomotic leak,
one reexploration for suspected subphrenic abscess, and one major pulmonary
embolus. These patients recovered. There was no mortality in the series.
CONCLUSIONS: Resectional gastric bypass is a new alternative for salvage of a
failed or problematic prior bariatric procedure. It is also effective as a
primary weight control operation.

PMID: 9600279 [PubMed]

473: South Med J.  1998 May;91(5):487-92.  

Fatal and near-fatal complications of liposuction.

Barillo DJ, Cancio LC, Kim SH, Shirani KZ, Goodwin CW.

US Army Institute of Surgical Research, US Army Burn Center, Brooke Army Medical
Center, Fort Sam Houston, Tex 78234, USA.

Cosmetic liposuction is considered to be safe and effective in properly selected
patients and is widely done as an outpatient or office procedure. When major
complications occur, office-based practitioners may refer patients to a hospital
emergency department, where medical personnel unfamiliar with this procedure may
underestimate the risk of serious infection or other major complications. We
present two cases of massive necrotizing fasciitis treated in a burn center
after liposuction surgery. One patient died, and the second required lengthy
hospitalization, extensive debridement, and split-thickness skin grafting of 22%
of the total body surface area. Pain out of proportion to clinical findings is a
hallmark of necrotizing fasciitis and should prompt consideration of this entity
even in the absence of cutaneous signs of infection. Definitive diagnosis is
made by biopsy and rapid section histologic analysis. Liposuction may result in
major complications or death. Emergency department physicians or general
surgeons may be called upon to manage such complications and should be aware of
these risks.

Publication Types:
    Case Reports

PMID: 9598863 [PubMed]

474: Adv Exp Med Biol.  1998;434:189-99.  

Minimizing process induced prooxidant stresses.

Evans RJ, Jones TS.

Kalsec, Inc., Kingsport, Tennessee 37663, USA.

The adverse effects of trace metals, heat, steam and other conditions
encountered in food processing relate to the acceleration of development of
rancidity. Measures to retard oxidation of lipids, vitamins, pigments and
proteins include elimination of prooxidants, removal of oxygen and use of blends
of inhibitors formulated for specific substrates.

Publication Types:
    Review, Tutorial

PMID: 9598200 [PubMed]

475: Dis Colon Rectum.  1998 May;41(5):654-7.  

Surgical management of a long efferent loop after J-pouch ileoanal

Klingler PJ, Branton SA, Floch NR, Metzger PP.

Department of Surgery, Mayo Clinic Jacksonville, Florida 32224, USA.

PURPOSE: To demonstrate a simple and effective repair of a poorly constructed
ileal J-pouch with an extensive long efferent limb. METHOD: A retrospective case
review was performed. RESULTS: The surgical procedure described preserves
additional ileum and enlarges the ileal reservoir. The procedure succeeded in
resolving the patient's complaints of partial obstruction, weight loss, and
increased stool frequency. At five-month follow-up, the patient was doing well
with three to six stools daily. Evaluation of the new ileal J-pouch showed no
signs of inflammation, and the pouch size measured more than 20 cm compared with
12 cm preoperatively. CONCLUSIONS: Repair of a long efferent limb by this simple
stapling technique is feasible, simple, and effective, with an excellent
clinical result. It preserves valuable small intestine and enlarges the capacity
of the reservoir, leading to better functional outcome.

Publication Types:
    Case Reports

PMID: 9593252 [PubMed]

476: Plast Reconstr Surg.  1998 May;101(6):1751-3.  

Comment on:
    Plast Reconstr Surg. 1997 Feb;99(2):514-9; discussion 520-6.

The tumescent technique.

Coleman WP 3rd, Lawrence N, Lillis PJ, Narins R.

Publication Types:
    Historical Article

PMID: 9583536 [PubMed]

477: Aesthetic Plast Surg.  1998 Jan-Feb;22(1):16-9.  

Pectoralis major ruptures postsuction lipectomy for surgical management of

Khan JI, Ho-Asjoe M, Frame JD.

Department of Experimental Dermatology, Royal London Hospital Medical School,
Essex, England, United Kingdom.

Over the last decade, suction-assisted lipoplasty has been shown to be a safe
and reliable procedure in the hands of trained individuals. A large number of
plastic surgeons employ liposuction as an adjunct to surgery for gynecomastia
with excellent results and low morbidity. An unusual problem, traumatic rupture
of the pectoralis major muscle, has been observed by us in a patient who had
undergone the procedure. The physical deficit arising from the injury may go
unnoticed in all but the most physically active people, and surgeons should be
wary of the possibility of this previously unreported complication.

Publication Types:
    Case Reports

PMID: 9456349 [PubMed]

478: Obes Surg.  1998 Feb;8(1):53-9.  

Distal gastric bypass/duodenal switch procedure, Roux-en-Y gastric bypass and
biliopancreatic diversion in a community practice.

Rabkin RA.

Pacific Institute of Surgery for Obesity, Ventura, California 93003, USA.

BACKGROUND: Hybrid procedures combining purely restrictive and purely
malabsorptive components to achieve stable long-term weight reduction have
evolved since the 1970s. In a solo surgical community-based practice over the
period 1984-1997, three different hybrid procedures were utilized as primary
operations in patients who had not had prior bariatric surgery. METHODS:
Restrospective comparison of 32 patients who underwent biliopancreatic diversion
(BPD), 138 patients who underwent distal gastric bypass Roux-en-Y (RGB) and 105
patients undergoing distal gastric bypass/duodenal switch procedure (DS) with
2-4 year follow-up in 37 DS patients. RESULTS: Height, initial weight and
initial body mass index (BMI) were similar in the three groups. The DS patients
were older. Mean BMI at 2 years fell from 49 to 29 kg/m2 in both DS and RGB.
Mean percentage maximum preoperative weight lost was 40% in both the DS and RGB
groups. Two-year mean percentage excess weight lost in DS was 78%, compared to
74% in RGB. There were no operative deaths and no ulcers in the DS group.
CONCLUSION: DS is an important new option for primary treatment of morbid
obesity. It can be performed safely, with up to 4 year follow-up showing stable
weight loss.

PMID: 9562488 [PubMed]

479: Obes Surg.  1998 Feb;8(1):49-52.  

Two years of practice in adjustable silicone gastric banding (LAP-BAND):
evaluation of variations of body mass index, percentage ideal body weight and
percentage excess body weight.

Forestieri P, Meucci L, De Luca M, Formato A, De Werra C, Chiacchio C.

University Federico II of Naples, Department of General and Oncological Surgery,

BACKGROUND: In the treatment of morbid obesity, surgery had been the only method
of obtaining a good and enduring weight loss. Although the procedure of choice
is still a matter of debate, among gastric restriction procedures LAP-BAND has
become our first choice. METHODS: We report the results from 62 morbidly obese
patients operated in the period October 1994-December 1996. Their
characteristics were: mean age 35.6 years, mean body weight 130.6 kg, mean
height 162.3 cm, mean body mass index (BMI) 49.9 kg/m2, mean percentage ideal
body weight (%IBW) 215.7 and mean excess weight (EW) 69.57 kg. RESULTS:
Twenty-four months after surgery we found a mean BMI of 39.3, a mean %IBW of
168.6 and a mean % EW loss of 88.5. We removed the band in two patients: one
after 9 months because of stoma stenosis and pouch enlargement in a woman who
had been lost at follow-up, and the other for gastric slippage occurring after
18 months due to incorrect fixation of the band. CONCLUSION: Our results led us
to consider LAP-BAND as the surgical approach for severe obesity among those
patients selected for gastric restriction; indeed, it was very safe as well as
effective and was rarely followed by complications.

PMID: 9562487 [PubMed]

480: Obes Surg.  1998 Feb;8(1):39-43.  

Laparoscopic adjustable esophagogastric banding: a preliminary experience.

Niville E, Vankeirsbilck J, Dams A, Anne T.

Department of Abdominal Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.

BACKGROUND: Laparoscopic adjustable gastric banding is an efficient surgical
method in the treatment of morbid obesity. In order to reduce the number of
complications, we have modified the technique to what we term 'laparoscopic
adjustable esophagogastric banding'. METHODS: Between December 1994 and July
1997, 126 laparoscopic adjustable banding procedures were carried out. Of these,
40 underwent a gastric banding operation (group 1), and 86 underwent an
esophagogastric banding procedure (group 2). RESULTS: The percentage loss of
excess body weight curve was less rapid in group 2 compared to group 1 due to a
different strategy in band filling. Follow-up to date shows that no problems
with the pouch or the stoma have arisen in the esophagogastric banding group.
CONCLUSIONS: Laparoscopic adjustable esophagogastric banding is a simpler and
safer procedure than laparoscopic adjustable gastric banding. It also works as a
very efficient anti-reflux procedure, at least in the short term. It appears to
be equally efficient as a weight-reducing operation as gastric banding. Further
follow-up of the patients involved is necessary in order to evaluate the results
in the longer term.

PMID: 9562485 [PubMed]

481: Obes Surg.  1998 Feb;8(1):29-34.  

Vertical banded gastroplasty at more than 5 years.

Baltasar A, Bou R, Arlandis F, Martinez R, Serra C, Bengochea M, Miro J.

The Surgical Service, Virgen de los Lirios Hospital, Alcoy, Alicante, Spain.

BACKGROUND: Optimal evaluation of the results of surgery for morbid obesity
requires a long-term follow-up for at least 5 years. METHODS: One hundred
patients were operated by vertical banded gastroplasty (VBG) and revised with a
follow-up of no less than 5 years. Sixty patients were morbidly obese with a
body mass index (BMI) of between 40 and 50 kg/m2, and 40 were super-obese with a
BMI of >50 kg/m2. Follow-up included 93 patients (93%). RESULTS: Initial
surgical mortality was nil. Twenty-five patients required surgery for
complications related to the technique (25%) and one patient died due to
pulmonary embolism after a re-stapling operation. The percentage excess weight
loss was 54.3%, and the BMI was 33 kg/m2 for the 84 patients followed to 5 years
post VBG. Only 40 out of 92 patients (43.5%), obtained the weight loss benefit
due to the operation. None of them is able to eat a regular diet, and the
quality of food intake has been severely affected in some of them. CONCLUSIONS:
VBG is, in our experience, a safe and technically simple operation, but the
long-term results are questionable. The reoperation rate was high, and weight
loss and quality of life are superior with other operations.

PMID: 9562483 [PubMed]

482: Ann Plast Surg.  1998 Apr;40(4):382-7.  

Soft-tissue complications of intra-arterial chemotherapy for extremity sarcomas.

Bezwada HP, Granick MS, Long CD, Moore JH Jr, Lackman RL, Weiss AJ.

Department of Surgery, Allegheny University Hospital, Philadelphia, PA, USA.

High-grade sarcomas have a high rate of local recurrence as well as distant
metastases. This has led to the development of intra-arterial chemotherapy (IAC)
as part of a multimodal approach to control local disease and/or reduce the
extent of surgical resection. Intra-arterial catheters are positioned by an
interventional radiologist into the feeding vessels of the tumor. Adriamycin and
5-fluorodeoxyuridine are infused intra-arterially. Cisplatinum, with or without
granulocyte colony stimulating factor, is given systemically. Patients usually
experience acute self-limited soft-tissue inflammation in the treated area. In
our experience of 118 patients, 3 patients experienced soft-tissue necrosis that
required excision and reconstruction. The first was treated for synovial sarcoma
of a metatarsal. After IAC with Adriamycin, she sloughed the skin, subcutaneous
tissue, and some of the posterior compartment musculature of her calf. This
tissue was debrided. A gastrocnemius flap and skin graft were used for coverage.
She is free of disease and ambulatory. The second patient was treated with IAC
Adriamycin for a radial head chondrosarcoma. She developed soft-tissue slough,
which became infected with Pseudomonas. She required extensive debridement of
the skin, subcutaneous tissue, and muscle, and was subsequently reconstructed
with a latissimus flap and a split-thickness skin graft (STSG). She later
developed a local recurrence requiring amputation. The latissimus was elevated
and used to cover the distal stump. She also is free of disease. The third
patient was treated with IAC Adriamycin for Ewing's sarcoma of the right femur.
This was complicated by fat necrosis and persistent pain. Subsequent
radiotherapy only worsened her symptoms. She underwent wide excision and muscle
flap/STSG repair, which relieved her pain. She is currently ambulatory and free
of disease. In conclusion, as the use of IAC continues, its complications may
become more common. Our experience with this previously unknown entity is
illustrated and therapeutic options are discussed.

Publication Types:
    Case Reports

PMID: 9555993 [PubMed]

483: Pacing Clin Electrophysiol.  1998 Mar;21(3):624-6.  

Lipoinjection as a treatment of pacemaker pocket neuralgia.

Gubner RE, Sands MP, Gross JR.

Department of Cardiology, Skagit Valley Hospital, Mt. Vernon, Washington, USA.

Chronic severe pacemaker pocket neuralgia secondary to inadequate subcutaneous
tissue between the pacemaker and overlying skin typically is treated by surgical
pocket revision or relocation of the system. A case of this complication
successfully treated by lipoinjection is reported. Additional experience is
needed to confirm the usefulness of the technique as a means of providing
symptomatic relief without the risks associated with more invasive procedures.

Publication Types:
    Case Reports

PMID: 9558698 [PubMed]

484: BMJ.  1998 Feb 21;316(7131):576.  

Office surgery in Florida to be reviewed.

Charatan FB.

Publication Types:
    Case Reports

PMID: 9518906 [PubMed]

485: Breast Cancer Res Treat.  1997 Nov-Dec;46(2-3):225-37.  

Dietary fat and breast cancer metastasis by human tumor xenografts.

Rose DP, Connolly JM.

Division of Nutrition and Endocrinology, American Health Foundation, Valhalla NY
10595, USA.

Human breast cancer cell lines growing as xenografts in athymic nude mice have
been used to examine the effects of dietary fat and fatty acids on tumor
progression. The estrogen independent MDA-MB-435 cell line has the advantage
that it metastasizes consistently to the lungs and forms quantifiable secondary
nodules when injected into the mammary fat pads. With these breast cancer cells,
the stimulating effects of polyunsaturated omega-6 fatty acids on both primary
tumor growth and metastasis were demonstrated; in contrast, the long-chain
omega-3 fatty acids were inhibitory. The model can also be adapted to examine
dietary fatty acids, and inhibitors of their metabolism, as experimental
adjuvant therapy after surgical excision of the primary tumors. Unfortunately,
estrogen dependent human breast cancer cells do not metastasize, or do so
rarely, in nude mice; in consequence, it is not possible to use the model to
study estrogen-fatty acid interactions on the metastatic process. In addition to
metastasis from a primary location, intravenous injection of MDA-MB-435 cells
into the nude mouse host, particularly when combined with studies using
Matrigel-based in vitro invasion assays, permits further dissection of the steps
in the metastatic cascade which are influenced by dietary fatty acids. The
results obtained by these several approaches have demonstrated distinct roles
for the cyclooxygenase and lipoxygenase-mediated products of omega-6 fatty acid
metabolism, and suggest new approaches to experimental breast cancer therapy.

Publication Types:
    Review, Tutorial

PMID: 9478277 [PubMed]

486: Plast Reconstr Surg.  1998 Apr;101(4):1090-102; discussion 1117-9.  

Extending the role of liposuction in body contouring with ultrasound-assisted

Rohrich RJ, Beran SJ, Kenkel JM, Adams WP Jr, DiSpaltro F.

Department of Plastic and Reconstructive Surgery at the University of Texas
Southwestern Medical Center, Dallas 75235-9132, USA.

The initial experience with ultrasound-assisted liposuction in treating
difficult fibrous areas, such as gynecomastia, hitherto not uniformly responsive
to traditional suction-assisted lipoplasty, has led to the evolution and
improvement of ultrasound-assisted liposuction techniques. This prospective
study examined 114 consecutive patients treated with ultrasound-assisted
liposuction over a 13-month period, from September of 1996 to September of 1997.
The means by which this procedure helps achieve fat contouring differs from that
of suction-assisted lipoplasty. Ultrasound-assisted liposuction removes fat
through a fat emulsification process termed "cavitation," whereas
suction-assisted lipoplasty achieves contouring through the mechanical avulsion
of fat. The technique for the use of ultrasound-assisted liposuction has changed
significantly from our initial series of patients to our current technique. To
optimize the benefits of both ultrasound-assisted and traditional
suction-assisted lipoplasty, we use a three-stage technique consisting of
infiltration, ultrasound-assisted sculpturing, and suction-assisted lipoplasty
for evacuation and final contouring. This has decreased our operative time,
minimized complications, and optimized our body contouring results. Data were
collected intraoperatively, including treatment times, treatment volumes, and
treatment areas for both suction-assisted and ultrasound-assisted lipoplasty. A
total of 114 patients were treated with ultrasound-assisted liposuction between
September of 1996 and September of 1997. There were 23 male patients and 91
female patients. In general, the average total volume removed with this
procedure decreased by about 50 percent throughout the series, whereas the
suction-assisted lipoplasty volume increased correspondingly by 50 percent.
Overall, suction-assisted lipoplasty volume was approximately two times
ultrasound-assisted liposuction volume in the same area. Exceptions to this
include the dense fibrous areas such as the back and male breast, where
aspiration volumes were approximately equal. The total ultrasound-assisted
liposuction treatment times were reduced after our initial 30 patients, and
suction-assisted lipoplasty times increased. Total aspiration rates in our later
patients averaged 36.2 cc/per minute for ultrasound-assisted and 58.4 cc/per
minute for suction-assisted lipoplasty, whose rates were approximately 1.5 to 2
times faster than for ultrasound-assisted liposuction in most areas. After using
this technology in our initial series of 30 patients, it became apparent that
ultrasound was not a substitute for suction-assisted lipoplasty but rather a
natural complement. We have found that the marriage of the techniques enhances
results and minimizes complications, such as seromas, which have been reported
to be 11.4 percent with ultrasound-assisted liposuction alone and are 2.6
percent in our series.

PMID: 9514347 [PubMed]

487: Plast Reconstr Surg.  1998 Apr;101(4):1103-16; discussion 1117-9.  

Personal experience with ultrasound-assisted lipoplasty: a pilot study comparing
ultrasound-assisted lipoplasty with traditional lipoplasty.

Fodor PB, Watson J.

Division of Plastic and Reconstructive Surgery at the University of California,
Los Angeles School of Medicine, USA.

Body contouring with traditional suction-assisted lipoplasty is currently the
most commonly performed aesthetic surgical procedure. In competent hands,
traditional lipoplasty has a low complication rate, a short recovery period, and
a high patient satisfaction rate. Body contouring with ultrasound-assisted
lipoplasty has recently gained considerable attention, and its proponents have
claimed many benefits over the traditional method. This pilot study consists of
one surgeon's clinical experience with ultrasound-assisted lipoplasty in 100
cases. In 63 of these patients, ipsilateral traditional lipoplasty and
contralateral ultrasound-assisted lipoplasty were done on one or more body
areas. These patients were blinded in the study. Complication rates, lipocrits
from the aspirate, postoperative ecchymosis, postoperative swelling, patient
satisfaction, and surgeon satisfaction were then compared for each patient
studied. Ten randomly selected patients were also evaluated by an independent
panel of reviewers who compared ecchymosis and swelling in ultrasound-assisted
versus traditional lipoplasty-treated areas. Their observations in this subset
of 10 patients were subjected to statistical analysis. This initial pilot study
failed to prove most of the benefits attributed to ultrasound-assisted
lipoplasty by other surgeons. However, the method is an evolving technology, and
the authors remain optimistic about the role of ultrasound in body sculpting

PMID: 9514348 [PubMed]

488: Plast Reconstr Surg.  1998 Mar;101(3):872.  

Comment on:
    Plast Reconstr Surg. 1996 Nov;98(6):988-96; discussion 997-8.

Superficial liposculpture of the face and neck.

Hoefflin SM.

Publication Types:

PMID: 9500431 [PubMed]

489: Am Surg.  1998 Feb;64(2):178-81.  

Suction-assisted lipectomy for the correction of stomal dysfunction.

Margulies AG, Klein FA, Taylor JW.

Division of Plastic Surgery, The University of Tennessee Medical Center,
Knoxville 37920, USA.

Poorly fitting appliances for urinary or fecal stream stomas can lead to
frequent leaking and subsequent social embarrassment, stomal stenosis,
hyperkeratosis, skin breakdown, and increased cost secondary to frequent
changing. Obese patients with abnormal skin folds frequently are more prone to
these problems. Herein is described the use of suction-assisted lipectomy for
abdominal wall contouring in an effort to improve and simplify appliance
application as well as lengthen appliance life. Between 1989 and 1996, five
patients (three females, two males) ages 13 to 47 years, were treated with
abdominal wall suction-assisted lipectomy in an attempt to improve stomal
function. Preoperatively, an average of 1.25 appliance changes a day were
required for leaking. Three patients had one procedure removing 400 to 600 cc of
fat. Two patients had staged suction, removing a total of 900 to 1600 cc of fat.
At 6-month follow-up, the average appliance life was 4 days, and the incidence
of skin problems and leaking was markedly reduced. The technique of
suction-assisted lipectomy is a simple outpatient procedure with low morbidity
that can successfully be used to improve stomal function in obese patients with
poorly fitting appliances secondary to skin folds, poor body habitus, or
abdominal scarring.

PMID: 9486894 [PubMed]

490: J Natl Cancer Inst.  1998 Feb 4;90(3):226-33.  

Diet during adolescence and risk of breast cancer among young women.

Potischman N, Weiss HA, Swanson CA, Coates RJ, Gammon MD, Malone KE, Brogan D,
Stanford JL, Hoover RN, Brinton LA.

Division of Cancer Epidemiology and Genetics, National Cancer Institute,
Bethesda, MD 20892-7366, USA.

BACKGROUND: A variety of breast cancer risk factors pertain to a woman's
adolescence and may be related to nutritional influences. We assessed risk of
early-onset breast cancer related to diet during adolescence in a case-control
study. METHODS: Study participants were accrued from the following three
geographical regions covered by cancer registries: Atlanta, GA; Seattle/Puget
Sound, WA; and central New Jersey. Case patients (n = 1647) were newly diagnosed
with breast cancer, and control subjects (n = 1501) were identified by
random-digit-dialing techniques. In an interview, each subject was asked to
recall the frequency of consumption and portion size of 29 key food items at
ages 12-13 years. Mothers of a subset of respondents completed questionnaires,
and food groups were recalculated after removal of foods with poor agreement
between mother and daughter. Logistic regression analyses were used to calculate
odds ratios and 95% confidence intervals. RESULTS: When high versus low
quartiles of consumption were compared, there was a suggestion of a reduced risk
associated with high consumption of fruits and vegetables, although this finding
was not statistically significant. Slight increases (of borderline statistical
significance) in risk of breast cancer were found for intake of chicken or
high-fat meat. Intake of animal fat, high-fat foods, high-fat snacks and
desserts, or dairy products during adolescence had no apparent influence on
breast cancer risk. Removal of foods suspected to be poorly recalled by the
daughters did not change any of the risk estimates. CONCLUSION: These data do
not provide evidence for a strong influence of dietary intakes during
adolescence on risk of early-onset breast cancer.

PMID: 9462680 [PubMed]

491: Obes Res.  1997 Nov;5(6):595-602.  

Use of very low-calorie diet in preoperative weight loss: efficacy and safety.

Pekkarinen T, Mustajoki P.

Department of Medicine, Helsinki University Hospital, Finland.

We report the efficacy of a very low-calorie diet (VLCD)-based weight reduction
program in patients with morbid obesity whose elective surgery had been
postponed because of being overweight. The safety of weight loss on the immune
system will also be evaluated. Thirty patients (mean age, 50 years; weight, 125
kg; BMI, 44 kg/m2) were treated. The program consisted of a 7-week to 24-week
VLCD period, supported by individual sessions with a therapist, and of a
refeeding period of 1 month before surgery. Two patients discontinued, and the
mean weight loss of the remaining 28 patients was 19.6 kg (15% of initial
weight). In 23 patients, weight loss was 10% or more of the initial weight.
After weight loss, 15 patients underwent surgery, 4 patients did not need an
operation, and the remaining 9 patients were not operated on for various
reasons. The numbers of circulating leukocytes, neutrophils, basophils,
monocytes, CD3+, CD4+, CD8+, and natural killer cells did not change
significantly by the ninth week on VLCD or by the end of the program. However,
there was a significant (p < 0.05) decrease in the immunoglobulinM serum
concentration during the program. In conclusion, a VLCD program is suitable for
preoperative weight reduction in morbid obesity and seems not to compromise the
immune system.

PMID: 9449145 [PubMed]

492: J Clin Anesth.  1997 Dec;9(8):668-70.  

Malignant ventricular dysrhythmias in a patient with isovaleric acidemia
receiving general and local anesthesia for suction lipectomy.

Weinberg GL, Laurito CE, Geldner P, Pygon BH, Burton BK.

Department of Anesthesiology, University of Illinois College of Medicine,
Chicago, USA.

We report the occurrence of severe ventricular arrhythmias in a patient with
isovaleric acidemia during general anesthesia for suction lipectomy. The timing
of events and character of the ECG changes are most consistent with bupivacaine
toxicity after subcutaneous injection of tumescence solution containing this
local anesthetic. The patient had previously documented carnitine deficiency, a
condition which, we speculate, may lower the threshold for bupivacaine induced
cardiotoxicity. We review clinical considerations in isovaleric acidemia and
conclude that the use of bupivacaine in these patients probably should be

Publication Types:
    Case Reports

PMID: 9438897 [PubMed]

493: Dermatol Surg.  1997 Dec;23(12):1169-74.  

Comment in:
    Dermatol Surg. 1998 Jun;24(6):689-91.

Lidocaine toxicity with tumescent liposuction. A case report of probable drug

Klein JA, Kassarjdian N.

Department of Dermatology, University of California, Irvine, USA.

Publication Types:
    Case Reports
    Review of Reported Cases

PMID: 9426661 [PubMed]

494: Wiad Lek.  1997;50 Suppl 1 Pt 2:447-51.  

[The effect of nutritional support on the perioperative course in patients after
extensive surgical procedures]

[Article in Polish]

Kalacinski J, Kalacinska B, Kurczych K, Wojdylo A.

Oddzialu Chirurgii Ogolnej, Apteki Szpitalnej Szpitala Miejskiego w Oswiecimiu.

Nutritional treatment in patient undergoing extensive surgical procedures is a
condition of shortening of catabolic phase of postoperative period. Giving a
basal quantity of nutritional components, authors tried to do a clinical
evaluation of treated patients and possibilities of the nutritional treatment in
a provincial hospital. 51 patients was fed parenterally or/and enterally,
all-in-one admixtures or with multi- bottles system, with using of
peristaltic/infusion pump or gravity. Patients were divided into 4 groups: 1.
treated with laparostomy because of pancreatic necrosis or complications of
acute pancreatitis, 2. with complications after total or subtotal gastrectomy,
3. with complications after extensive resections of jejunum or colon Clinical
status, weight loss, accessible laboratory investigations were studied. Authors
gave on the average: energy 32 kcal/kg b.m./day, protein 0.15 gN/kg b.m./day,
potassium 1.15 mEq/kg b.m./day. In 37 patients appeared weight loss av. 4.8 kg.
In 20 patients with decreased serum protein level or blood cell count-plasma and
erythrocytes were applied. In examined groups 9 persons died because of
myocardial infarction, pulmonary embolism, intestinal necrosis with peritonitis,
lesions of CNS following trauma, sepsis. Conclusions: 1. Effective treatment of
postoperative complications is possible with application of nutritional
treatment. 2. Adequate (not excessive) nutritional components administration
should be applied intravenously, enterally or by both of them.

Publication Types:
    Clinical Trial

PMID: 9424921 [PubMed]

495: Arterioscler Thromb Vasc Biol.  1997 Nov;17(11):2737-43.  

Enhanced endothelin-B-receptor-mediated vasoconstriction of small porcine
coronary arteries in diet-induced hypercholesterolemia.

Hasdai D, Mathew V, Schwartz RS, Smith LA, Holmes DR Jr, Katusic ZS, Lerman A.

Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic,
Rochester, Minn. 55905, USA.

The coronary vasoconstrictor effects of endothelins, mediated by both endothelin
ETA and ETB receptors, may be differentially altered in pathophysiological
states associated with endothelial dysfunction and elevated endothelin levels.
Experimental hypercholesterolemia is associated with coronary endothelial
dysfunction and increased circulating endothelin concentrations. These studies
were designed to test the hypothesis that experimental hypercholesterolemia is
characterized by a differentially altered coronary contractile response to ETA-
and ETB-receptor stimulation, in vitro. Pigs were fed either a normal or a
high-cholesterol diet for 10 to 13 weeks. Changes in the intraluminal diameter
of pressurized small coronary arteries (< 481 +/- 25 microns in diameter) to
cumulative concentrations (10(-10) to 10(-6) mol/L) of endothelin-1 (ET-1), and
sarafotoxin 6c (S6c), a specific ETB-receptor agonist, were measured using a
video dimension analyzer. The maximal contraction attained with ET-1 was greater
than with S6c in both normal (86 +/- 7% versus 47 +/- 7%, P = .001) and
hypercholesterolemic (77 +/- 6% versus 37 +/- 7%, P < .001) pigs. At 10(-10)
mol/L, vessels from hypercholesterolemic pigs manifested greater contraction to
both ET-1 (23 +/- 6% versus 8 +/- 3%, P = .02) and S6c (17 +/- 5% versus 4 +/-
2%, P = .02). Incubation of arteries from hypercholesterolemic pigs with BQ-788
(ETB-receptor antagonist), but not FR-139317 (ETA-receptor antagonist), altered
the contractile response to ET-1 at 10(-10) mol/L. Removal of the endothelium
abolished the difference in response to S6c between normal and
hypercholesterolemic pigs. These studies demonstrate that experimental
hypercholesterolemia is characterized by enhanced coronary vasoconstriction to
endothelins in vitro, the mechanism of which is mediated mainly through the ETB
receptor. Thus, the ETB receptor has a role in regulation of coronary artery
tone in both the steady-state and pathophysiological states.

PMID: 9409250 [PubMed]

496: Urol Nefrol (Mosk).  1997 Sep-Oct;(5):27-30.  

[The urological complications of contraception using intrauterine coils]

[Article in Russian]

Derevianko IM, Derevianko TI, Ryzhkov VV.

Being a foreign body, intrauterine coil causes decubitus and inflammation of the
adjacent tissues. Long-term carriage of the coil may give rise to endometritis,
myometritis, parametritis, salpingo-oophoritis, tubo-ovarian inflammatory
infiltrates. These infiltrates invade retroperitoneal pelvic fat and may
obstruct pelvic ureters. Ureteral obstruction may bring about
ureterohydronephrosis, pyelonephritis and renal calculi. The coil may be also
responsible for chronic pyelonephritis. The authors have treated 64 females aged
18-45 years with urological complications due to intrauterine coils which stayed
from 6 months to 14 years. 34 of them presented with attack of acute
pyelonephritis, 29 with renal colic and acute pyelonephritis, 26 with renal
calculi. To arrest renal colic and attack of acute pyelonephritis ureteral
catheterization and renal pelvis drain were performed in 31 patients. One
patient has undergone ureterolithotomy. 8 patients rejected removal of the coil
and had recurrent renal colics and acute pyelonephritis attacks. Removal of the
coil arrested pyelonephritis and lithogenesis in the kidney. In one case of coil
removal there was injury to the uterine cervix and urinary bladder eventuating
in vesicovaginal fistula.

PIP: According to various authors the frequency of inflammatory complications 
associated with the use of IUDs ranges from 2% to 8%.  Gynecological surgery on 
account of purulent, inflammatory disease of the adnexa uteri associated with 
IUD use (4-7%), damaging the urinary bladder and the ureters, is not uncommon.  
At the urological clinic of Stavropol, Russia, a total of 64 women who were in 
the 18-64 year age range, had urological complications, and had worn IUDs for 6 
months to 14 years were observed.  34 of them presented with acute 
pyelonephritis attacks, 29 of them with renal colic and acute pyelonephritis, 
and 26 with renal calculi.  In 22 women the acute pyelonephritis attacks were 
treated with antibiotics and uro-antiseptics.  19 of the 29 women who had renal 
colic and acute pyelonephritis underwent catheterization and drainage of the 
renal pelvis, and all of them passed fine kidney stones after the removal of 
their catheters.  Urethral catheterization and drainage of the renal pelvis were
 performed in 31 patients in order to arrest renal colic and acute
pyelonephritic  attacks.  The catheters stayed in for 2-3 days.  For all these
women removal of  the IUD was recommended.  1 patient underwent
ureterolithotomy.  8 patients  rejected the removal of the IUD and had recurrent
renal colics and acute  pyelonephritis attacks.  Removal of the IUD arrested
pyelonephritis and  lithogenesis in the kidneys.  In 1 case of IUD removal
injury to the uterine  cervix and urinary bladder occurred, resulting in a
vesicovaginal fistula.  The  report concludes with the case of a 44-year old
patient who had worn a plastic  IUD for 14 years. 

Publication Types:
    Case Reports

PMID: 9412010 [PubMed]

497: Plast Reconstr Surg.  1997 Nov;100(6):1623-5.  

Ultrasound-assisted liposuction.

Teimourian B.

Publication Types:

PMID: 9385998 [PubMed]

498: Plast Reconstr Surg.  1997 Dec;100(7):1932-3.  

Comment on:
    Plast Reconstr Surg. 1997 Feb;99(2):514-9; discussion 520-6.

Subcutaneous infiltration in suction-assisted lipoplasty.

Shuster BA, Commons GW, Halperin B.

Publication Types:

PMID: 9393502 [PubMed]

499: Plast Reconstr Surg.  1997 Dec;100(7):1867-74.  

Use of preoperative subcutaneous "wetting solution" and epidural block
anesthesia for liposuction in the office-based surgical suite.

Knize DM, Fishell R.

Department of Surgery, University of Colorado Health Sciences Center, Denver,

Uniform saturation of subcutaneous fat using the "wetting solution" formula
described by Klein for his "tumescent technique" has been shown to decrease
operative blood loss associated with liposuction procedures and to eliminate the
requirement for general anesthesia for selected patients. However, we found this
infusate provided an inadequate level of anesthesia for many of our patients. We
use preoperative infusion of Klein's epinephrine and lidocaine containing
wetting solution in our lipoplasty practice only for control of blood loss and
postoperative pain. Our anesthetic of choice for liposuction is the epidural
block technique, which provides consistent intraoperative comfort for the
patient. We report our experience with 85 consecutive lipoplasty patients who
underwent liposuction under epidural anesthesia after subcutaneous fat perfusion
with Klein's wetting solution. Our epidural block technique uses the rapidly
metabolized local anesthetic agent, chloroprocaine, which has the lowest
systemic toxicity risk of any local anesthetic agent. Chloroprocaine's
anesthetic characteristics are particularly well suited for the outpatient
surgery patient with few undesirable side effects.

PMID: 9393487 [PubMed]

500: Dermatol Surg.  1997 Oct;23(10):871-7.  

Complications of injectable synthetic polymers in facial augmentation.

Maas CS, Papel ID, Greene D, Stoker DA.

Department of Otolaryngology-Head and Neck Surgery, University of California,
San Francisco, USA.

BACKGROUND: Injectable synthetic materials have been used for augmentation of
soft tissue defects, correction of wrinkles, and augmentation of facial features
such as the nasal dorsum. Success has been limited by inflammatory reactions,
material migration, and the difficulty of removal should complications occur.
OBJECTIVE: To evaluate complications resulting from soft tissue augmentation
with injectable alloplastic materials. METHODS: Retrospective review of seven
cases. Clinical history, treatment, histopathologic findings, and outcomes are
assessed. RESULTS: Inflammatory reaction and tissue damage were refractory to
antibiotics and steroids, and surgery was required to remove the foreign
material. Histologic examination revealed giant cell foreign body reaction in
all cases. CONCLUSION: Injectable synthetic polymers can produce significant
complications including deformity and inflammatory tissue destruction, the
control of which is complicated by the difficulty of removing the materials.
Removable tissue fillers, such as e-PTFE, or natural materials such as collagen,
autologous, fat, or Alloderm, should be considered instead.

Publication Types:
    Case Reports

PMID: 9357494 [PubMed]

501: Aesthetic Plast Surg.  1997 Nov-Dec;21(6):403-7.  

Vertical mammaplasty as secondary surgery after other techniques.

Lejour M.

Brussels, Belgium.

Vertical mammaplasty, a technique that avoids submammary scars, has proved to be
a reliable method of breast reduction because it is adaptable to most cases and
produces beautiful and durable results. What about secondary cases? In the last
14 cases referred for secondary mammaplasty, at 1-19 years after their initial
surgery, patients' indications were poor shape (14), visible and improperly
located scars (9), excess volume (8), asymmetry of the areolas (5) or the
breasts (1), insufficient volume (2), and asymmetry with reconstructed breast
(2). The original scars were inverted T (10), periareolar (2), oblique (1) or
vertical (1). Their appearance was a concern for nine patients. All patients but
one, who had long submammary scars surrounded by heavy stitch marks requiring
correction, could benefit from a vertical mammaplasty. This avoided long months
of scar redness and visibility along the submammary folds. Good symmetry and
shape could be obtained in all cases by adjusting the markings to the needs.
Liposuction was a great help to remove volume without endangering the blood
supply of the areolas, possibly transforming reductions in simple mastopexies.

PMID: 9354601 [PubMed]

502: J Chir (Paris).  1997 Jul;134(2):76-9.  

[Surgical treatment of gynecomastia]

[Article in French]

Casanova D, Magalon G.

Service de Chirurgie Plastique, Reparatrice et Esthetique, Hopital de La
Conception, Marseille.

Surgical treatment of gynaecomastia is easy. When medical treatment is
insufficient, surgery can improve the deformations with a minimal scarring.
After morphological aspects and surgical objects description, the authors
explain surgical techniques and indications.

PMID: 9378789 [PubMed]

503: Plast Reconstr Surg.  1997 Oct;100(5):1363-4.  

Comment on:
    Plast Reconstr Surg. 1997 Jan;99(1):215-9.

Tumescent liposuction complicated by pulmonary edema.

Pitman GH.

Publication Types:

PMID: 9326813 [PubMed]

504: Minerva Chir.  1997 Jun;52(6):801-5.  

[Lipoemulsification versus lipoaspiration. Comparison of intraoperative blood
loss and surgery time]

[Article in Italian]

Palmieri B, Bosio P, Catania N, Gozzi G.

Cattedra di Semeiotica Chirurgica, Universita degli Studi, Modena.

Blood loss due to liposuction is one of the main problems in this kind of
surgery, blood volume being up to 30%-35% of the whole liposucked volume. We
studied the possible lower impact of ultrasound lipolysis in order to obviate
this non negligible problem. For this purpose we treated 10 patients, females,
aged between 28 and 55, such obese to overweight between 50% and 200%. These
patients underwent ultrasound lipolysis surgery after any dietetic or any other
treatment against obesity. No patient dropped out of the study. Each patient was
treated, under general anesthesia, in a region included between an imaginary
horizontal line passing through the umbilicus and another one through the middle
of the femur. Thirty minutes after a bilateral infiltration with an epinephrine
solution (1:500000 diluted, 28 C) 2 1 volume each side, the right side was
treated with the liposucking cannula (0.4 cm diameter), the left one underwent
ultrasound lipolysis with a titanium probe (0.5 cm diameter, SMEI Casale
Monferrato, Italy). A liposucking probe every 10 minutes into the left side was
inserted. Haemoglobin was detected (according to the method of Goodpasture) in
the liposucked material. The result showed a statistically significant
difference between the blood rate in the lipoaspirate and that one in the
ultrasound lysed material. Ultrasound lipolysis is slower than lipoaspiration,
but it also shows less risk of hemorrhage and fat embolism.

PMID: 9324665 [PubMed]

505: Liver Transpl Surg.  1997 Jan;3(1):23-7.  

Liver transplantation for jejunoileal bypass-associated cirrhosis: allograft
histology in the setting of an intact bypassed limb.

D'Souza-Gburek SM, Batts KP, Nikias GA, Wiesner RH, Krom RA.

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
55905, USA.

Jejunoileal bypass (JIB) is a well known cause of steatohepatitis, which may, on
occasion, progress to cirrhosis and require liver transplantation. We report 3
patients who underwent orthotopic liver transplantation (OLT) for
steatohepatitic cirrhosis secondary to JIB in which the JIB was left intact. All
3 patients have demonstrated recurrent steatosis in the graft after liver
transplantation. In two of the cases, the changes are moderately severe, whereas
in one case the changes are mild. All 3 patients have essentially normal liver
function tests and are clinically asymptomatic; 1 of the patients has undergone
removal of the JIB 2.5 years after transplantation. Control hepatic allografts
in patients with primary biliary cirrhosis and primary sclerosing cholangitis
show negligible fatty change, and in patients who receive transplants for
alcoholic steatohepatitis, they rarely (2 of 20 patients) contain greater than
10% fat. We conclude that transplantation alone is not associated with
subsequent steatosis. Presence of JIB is, therefore, a continuing risk factor
for steatosis in patients who have undergone OLT. Reversal of JIB after OLT may
be considered if fatty changes are severe or associated with significant

Publication Types:
    Case Reports

PMID: 9377754 [PubMed]

506: Arch Otolaryngol Head Neck Surg.  1997 Oct;123(10):1144.  

Comment in:
    Arch Otolaryngol Head Neck Surg. 1998 Nov;124(11):1271-2.

Comment on:
    Arch Otolaryngol Head Neck Surg. 1996 Nov;122(11):1161-7.

The liposhaver in facial plastic surgery.

Shiffman MA.

Publication Types:

PMID: 9339995 [PubMed]

507: Microsurgery.  1996;17(7):386-90.  

Gluteal thigh flap used as a fascio-cutaneous free flap.

Monstrey S, van Landuyt K, Blondeel P, Tonnard P, Matton G.

Department of Plastic Surgery, University Hospital, Gent, Belgium.

The gluteal thigh flap is a myofascio-cutaneous flap receiving its blood supply
from a descending branch of the inferior gluteal artery. The gluteal thigh flap
was first described by Hurwitz in 1980; since then numerous articles have
reported on the successful use of this flap, as a transposition or a pedicled
island flap, to cover wounds in the sacrogluteal and perineal regions. In
contrast to its widespread use as a pedicled flap, employment of the gluteal
thigh flap as a free flap is almost unreported in the literature, despite its
extremely low donor morbidity and numerous articles on successful (other) free
flap reconstructions based on the (same) inferior gluteal artery (e.g., in
breast reconstruction). In this article we report on the successful use of the
gluteal thigh flap as a purely fascio-cutaneous free flap in limb
reconstruction. The literature on the microvascular anatomy of the gluteal thigh
flap is reviewed in detail, and a precise description is given of the
preoperative measures and surgical manoeuvres required to increase the
reliability of this free flap. From the anatomical data and the problems
encountered in this case, it should be concluded that, despite the many
advantages of this flap and an ultimately successful outcome, the gluteal thigh
flap is not a first choice flap for microvascular transfer.

Publication Types:
    Case Reports

PMID: 9379887 [PubMed]

508: Laryngorhinootologie.  1997 Jun;76(6):351-7.  

[Facial wrinkles--ultrapulsed CO2 laser: alternative or supplement to surgical
face lift?]

[Article in German]

Raulin C, Drommer RB, Schonermark MP, Werner S.

Praxis fur Dermatologie, Philbologie und Allergologie.

BACKGROUND: For many years, the treatment of facial wrinkles has been performed
exclusively by dermabrasion, chemical peeling, or surgical face lifting.
However, the recently introduced carbon dioxide lasers which emit ultrashort
coherent light beams enable the cosmetic surgeon to ablate superficial epidemic
layers with absent or very limited side effects. The purpose of this paper is to
compare laser skin resurfacing with classical face lifting and discuss the
potentials and limitations of each method. METHODS AND PATIENTS: Three patients
suffering from facial wrinkles on photoaged skin were treated with the
ultrapulsed CO2 laser (UltraPulse 5000 C; wavelength 10,600 nm, pulse duration
0.6 to 0.9 ms, maximum pulse energy 500 mJ). This laser guarantees vaporization
of very thin superficial skin layers without scarring and with minimizing
lateral thermal injury due to extreme short pulse duration. A special handpiece
(CPG) permits an exact approach and a bloodless ablation of relatively large
areas of facial skin. The fourth patient underwent a surgical face lift due to
the depth of wrinkles. RESULTS: Excellent cosmetic results were achieved in all
three patients with superficial wrinkles who were treated by laser skin
resurfacing. When treating deeper wrinkles, e.g., glabella or nasolabial fold,
the surgical face lift is the preferred method. CONCLUSION: Ultrapulsed CO2
laser treatment expands the therapeutic options for superficial facial wrinkles,
especially for perioral, periorbital, forehead, and cheeks wrinkles. It proves
to be a safe and effective method with very limited if any side effects.
Nevertheless, deeper wrinkles are still a domain of the classical face lift. The
combination of both methods may improve the overall outcome in the future.

Publication Types:
    Case Reports

PMID: 9333279 [PubMed]

509: Mutat Res.  1997 Aug 1;378(1-2):23-30.  

Formation and persistence of DNA adducts of
2-amino-3-methylimidazo[4,5-f]quinoline (IQ) in CDF1 mice fed a high omega-3
fatty acid diet.

Schut HA, Wang CL, Twining LM, Earle KM.

Department of Pathology, Medical College of Ohio, Toledo 43614, USA.

The potent bacterial mutagen 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) is
carcinogenic in the CDF1 mouse, affecting the liver, lungs and forestomach. IQ
forms DNA adducts in both target- and non-target organs of the CDF1 mouse. The
chemopreventive effects of menhaden oil (MO), a fish oil high in omega-3 fatty
acids, are well known. Because DNA adduct formation is considered to be a
critical event in the initiation of carcinogenesis, we have assessed the effects
of dietary MO on IQ-DNA adduct formation. For the duration of the study, young
adult, male CDF1 mice were maintained on either powdered chow diet, AIN-76A
diet, or AIN-76A diet modified to contain 19% MO (19% MO diet). After 2 weeks on
these diets, all animals received 0.01% (w/w) IQ in the diet for the next 3
weeks. Groups of 4 animals were killed 1, 2, 4, 6, 8 or 12 days thereafter for
analysis of IQ-DNA adducts by 32P-postlabeling. IQ-DNA adduct patterns were
qualitatively similar in the liver, lungs, stomach, small intestine, cecum,
colon, kidneys, heart and spleen. Adduct levels in the liver, lungs, stomach and
colon decreased significantly during the 12-day study period, but only to a
relatively small extent and only with certain of the diets. On day 1, the 19% MO
diet significantly decreased (35.8-90.0%) adduct levels in the stomach, cecum,
colon and kidneys, when compared to chow diet or AIN-76A diet. On day 12, adduct
levels in the liver, stomach, heart and spleen were decreased (36.5-64.7%) as a
result of MO feeding. With the exception of the liver, heart and spleen on day
12, there were no significant differences in organ adduct levels between the
chow diet and the AIN-76A diet. It is concluded that feeding 0.01% (w/w) IQ in
the diet for 3 weeks results in a relatively slow rate of adduct removal and
that this rate is largely independent of the type of diet. Dietary MO inhibits
IQ-DNA adduct formation only in certain target- and non-target organs of the
CDF1 mouse, a finding similar to our previous results in the F344 rat. MO may
affect the initiation phase of IQ tumorigenesis by inhibiting IQ-DNA adduct
formation in certain target organs.

PMID: 9288882 [PubMed]

510: J Surg Oncol.  1997 Aug;65(4):263-7; discussion 267-8.  

Local resection and brachytherapy confined to the lumpectomy site for early
breast cancer: a pilot study.

Perera F, Engel J, Holliday R, Scott L, Girotti M, Girvan D, Chisela F,
Venkatesan V.

Department of Radiation Oncology, London Regional Cancer Centre, Ontario,

BACKGROUND AND OBJECTIVES: The commonest site of local breast recurrence after
breast conservation surgery is the primary tumor bed. We have tested the
feasibility of outpatient high dose rate brachytherapy to the primary tumor bed
as the only radiation. Our technique relies on the placement of surgical clips
to mark the tumor bed. METHODS: Between March 1992 and January 1996, 39 patients
with clinical T1 T2 breast cancer were enrolled in this pilot study. The first
13 patients had intraoperative implantation of the breast. The remaining 26
patients had outpatient postoperative implantation under general anesthesia (2
patients) or local anaesthesia (24 patients). High dose rate brachytherapy was
given twice daily at least 6 hours apart for a total dose of 37.2 Gy in 10
fractions over 5-7 days. RESULTS: Three patients had mild clinical cellulitis
responding to oral antibiotics. One patient had a small sinus in the lumpectomy
scar requiring local excision to heal. Four patients developed fat necrosis at
the lumpectomy site at 4 (1 patient), 13 (1 patient), and 18 months (2 patients)
post radiotherapy. Patient rated satisfaction with treatment was high. At a
median followup of 20 months, one infield local recurrence has been salvaged by
wider resection and postoperative conventional external beam radiation.
CONCLUSIONS: Except for fat necrosis, which may be associated with this
technique, complications have been minimal. Outpatient implantation under local
anesthesia is feasible. Longer followup is required to establish the local
control rates.

Publication Types:
    Review of Reported Cases

PMID: 9274791 [PubMed]

511: Aesthetic Plast Surg.  1997 Jul-Aug;21(4):230-2.  

Cutaneous hyperpigmentation caused by liposuction.

Mateu LP, Hernandez JJ.

A wide range of sequels have been described as derived from a bad technique or a
bad indication of liposuction. We present the cases of three patients who
underwent a syringe liposuction of hips and lower limbs and had cutaneous
hyperpigmentation as a sequel in the treated zone. We review the ethiopatogenic
circumstances and their evolution.

Publication Types:
    Case Reports

PMID: 9263542 [PubMed]

512: Tidsskr Nor Laegeforen.  1997 Jun 10;117(15):2166-9.  

[Surgical treatment of obesity. Is gastric wrapping an alternative?]

[Article in Norwegian]

Fannelop TO, Aune S, Woxholt G, Michelsen JB.

Kirurgisk avdeling, Vest-Agder Sentralsykehus, Kristiansand.

To remedy the disabling side effects of gastric banding, a group of eleven
patients were re-operated with gastric wrapping. Encouraging results led us to
perform primary gastric wrapping straight away in fourteen additional patients.
There were few serious complications. A comparison of the performance of the two
groups is based on observations four years later. In the first group, a mean
body-mass-index (BMI) of 41 +/- 4 SD was noted before banding, 32 +/- 8 SD at
conversion to wrap and 31 +/- 9 SD at control. The mean BMI in the second group
was reduced from 40 +/- 5 SD to 32 +/- 6 SD after primary gastric wrapping.
Radiographic control showed a shortening of the wraps in both groups, with pouch
formation in half of the cases, uncorrelated to weight loss. It appears that
gastric wrapping can be a useful revisional procedure in patients who do not
tolerate gastric banding. Primary gastric wrapping produces results comparable
to those of gastric banding. Modifications in our version of gastric wrapping
are discussed with reference to the original method and other surgical

PMID: 9235703 [PubMed]

513: Scand J Plast Reconstr Surg Hand Surg.  1997 Jun;31(2):137-43.  

Complete reduction of lymphoedema of the arm by liposuction after breast cancer.

Brorson H, Svensson H.

Department of Plastic and Reconstructive Surgery, Malmo University Hospital,

The incidence of lymphoedema of the arm after mastectomy ranges between 8% and
38%, and it is an appreciable problem from both functional and social aspects.
Conservative and previous surgical regimens have not been completely successful.
In the light of these experiences, liposuction clearly constitutes an
interesting new surgical approach, which is potentially capable of effecting
predictable and reliable improvements in patients with lymphoedema. Twenty eight
women with lymphoedema of the arm after breast cancer were consecutively treated
by liposuction. Limb compression with a compression garment was instituted
immediately after operation. All patients had been given radiotherapy after the
operation for breast cancer. Mean preoperative volume of oedema was 1845 ml
(range 570-3915), and mean volume of aspirate was 2250 ml (range 1000-3850);
volume of aspirate correlated linearly with the volume of preoperative oedema.
There were no major surgical complications, but blood transfusion was necessary
in eight patients whose volume of aspirate exceeded 2000 ml. After 12 months (n
= 24), an average reduction in volume of oedema of 106% was found. Such a
normalisation can be expected in patients with oedema that amounts to about 2500
ml. Although the oedema cannot be completely removed in more severe cases,
substantial reduction is beneficial from both functional and cosmetic aspects.
We conclude that liposuction is safe and effective for reducing lymphoedema of
the arm after operations for breast cancer. In a one-stage procedure, oedematous
and hypertrophic fat tissue can be removed with an excellent clinical outcome.

PMID: 9232698 [PubMed]

514: Plast Reconstr Surg.  1997 Jun;99(7):2118-20.  

Comment in:
    Plast Reconstr Surg. 1998 Apr;101(4):1149-50.

Pedicle modification in the Lejour vertical scar reduction mammaplasty.

van der Lei B.

Publication Types:

PMID: 9180759 [PubMed]

515: Mayo Clin Proc.  1997 Jun;72(6):551-7; quiz 558.  

Surgical treatment of obesity: who is an appropriate candidate?

Balsiger BM, Luque de Leon E, Sarr MG.

Gastroenterology Research Unit, Mayo Clinic Rochester 55905, USA.

The increasing prevalence and far-reaching medical, social, and economical
implications of obesity have made it a national health-care crisis in the United
States. About one in every three persons is at least 20% above "ideal" body
weight, and approximately 5% have direct weight-related serious health problems
(morbid obesity), including hypertension, hyperlipidemia, coronary artery
disease, adult-onset diabetes mellitus, degenerative osteoarthropathy, and
obstructive sleep apnea. Morbidly obese patients have an estimated 6- to 12-fold
increase in mortality. In addition, they have a substantially diminished quality
of life, not only physically but also psychosocially due to overt and occult
prejudice. Weight reduction must be aggressively pursued in these patients.
Medically supervised weight-control programs have been ineffective because
patients cannot maintain pronounced long-term weight loss. In contrast, current
operative methods have been proved to be effective in helping patients achieve
and maintain permanent weight reduction. Several operations have been designed
and assessed; with these procedures, weight loss is achieved by inducing
malabsorption, maldigestion, early satiety, or a combination of these outcomes.
Although these operations have associated side effects and limitations, the
expected benefits outweigh the risks. For optimal results, patients must be
carefully selected and treated by a multidisciplinary group.

Publication Types:
    Review, Tutorial

PMID: 9179140 [PubMed]

516: Photochem Photobiol.  1997 May;65(5):877-83.  

Delivery of benzoporphyrin derivative, a photosensitizer, into atherosclerotic
plaque of Watanabe heritable hyperlipidemic rabbits and balloon-injured New
Zealand rabbits.

Allison BA, Crespo MT, Jain AK, Richter AM, Hsiang YN, Levy JG.

Department of Surgery, University of British Columbia, Vancouver, Canada.

In this study we compared the plasma distribution and arterial accumulation of a
photosensitizer, benzoporphyrin derivative (BPD), in two models of
atherosclerosis: the spontaneous lesions of the Watanabe heritable
hyperlipidemic (WHHL) rabbit and induced lesions of the balloon-injured,
cholesterol-fed New Zealand white (NZW) rabbit. Selective uptake and retention
of a photosensitizer by the abnormal portion of a vessel is a necessity in order
for photodynamic therapy to become a successful modality for inhibition of
intimal hyperplasia, selective removal of atherosclerotic tissue or imaging of
diseased arteries. Liposome-based formulations were compared to freshly isolated
native low density lipoprotein (LDL) and acetylated-LDL (Ac-LDL) as delivery
vehicles for BPD. Plasma distribution of the photosensitizer was analyzed by KBr
density gradient ultracentrifugation. Although the delivery vehicle influenced
plasma distribution immediately postinjection, BPD subsequently partitioned
according to the plasma concentration of the lipoproteins. Photosensitizer level
in plaque and normal artery specimens was determined by ethyl acetate extraction
and spectrofluorometric measurement. The measurement of BPD in normal and
atherosclerotic arterial tissue demonstrated a selective accumulation in
atherosclerotic tissue. Preassociation with LDL and Ac-LDL enhanced accumulation
of BPD in atherosclerotic tissue when compared with normal artery (mean ratios
of 2.8 and 4.1 were achieved, respectively). These results indicate that the
preferential uptake of BPD by atherosclerotic plaque can be enhanced by
preassociation with plasma lipoproteins, suggesting that light activation could
lead to a highly selective destruction of diseased vascular tissue.

PMID: 9155261 [PubMed]

517: J Child Neurol.  1997 Apr;12(3):200-4.  

Recurrent cerebellar gliomas: salvage therapy with oral etoposide.

Chamberlain MC.

Department of Neurosciences, University of California, San Diego, La Jolla
92093-8421, USA.

The purpose of this investigation was to assess the toxicity and activity of
chronic oral etoposide in the management of children with recurrent juvenile
pilocytic cerebellar astrocytomas. Twelve children with recurrent juvenile
pilocytic cerebellar astrocytomas, refractory to surgical resection,
radiotherapy, and chemotherapy were treated with chronic oral etoposide.
Treatment related complications included alopecia, diarrhea, weight loss, and
thrombocytopenia. Three children required transfusion and one child developed
neutropenic fever. No treatment related deaths occurred. Six children
demonstrated either a radiographic response or stable disease with a median
duration of 7 months. Oral etoposide was well tolerated, produced modest
toxicity, and had apparent activity in this small cohort of children with
recurrent juvenile pilocytic cerebellar astrocytomas.

Publication Types:
    Clinical Trial
    Clinical Trial, Phase II

PMID: 9130095 [PubMed]

518: Plast Reconstr Surg.  1997 Apr;99(5):1463-4.  

Unusual complication in liposuction due to metals hypersensitivity.

de la Cruz Lopez M, Maiz J, Vidal C, Penide L.

Publication Types:
    Case Reports

PMID: 9105381 [PubMed]

519: Plast Reconstr Surg.  1997 Apr;99(5):1433-6; discussion 1437-8.  

Liposuction of the kneecap area.

Chamosa M.

This paper discusses the basic concepts of the aesthetics of all kneecap areas
looking for the proportions and comprehensive treatment by means of liposuction.
I detected and described an anatomic trait that I find frequently among my
clinical cases, which is that of there being a certain amount of unsightly
adipose tissue along the medial region extending from the widest portion of the
knee down to the protrusion of the calf muscles (gastrocnemius) and extending to
the crest of the tibia. This is adipose tissue, which, when found, deforms the
normal leg to a great extent, shaping it into a sort of straight column. This
paper discusses ways to avoid any damage to the osteoarticular structures when
liposuction is done in the kneecap area. Liposuction of the knee area is a
simple but laborious technique. It is essential to be highly familiar with the
anatomy of the knee and constantly bear in mind the aesthetic appearance being
sought. This must be proportioned to the lower limb, since the correction of one
area usually leads to a lack of balance in contour of the lower limbs.

PMID: 9105376 [PubMed]

520: Plast Reconstr Surg.  1997 Apr;99(5):1273-81.  

Simultaneous osseous genioplasty and meloplasty.

Wider TM, Spiro SA, Wolfe SA.

Division of Plastic and Reconstructive Surgery, University of Miami School of
Medicine, Fla, USA.

A review was done of the records of 50 patients who had osseous genioplasty
performed at the same sitting as face lifting and, in many cases, submental
lipectomy over a 20-year period by the senior author. The types of genioplasties
were sliding advancement (40), lengthening with interpositional bone graft (7),
and reduction (3). In 9 patients, chin implants were removed, generally because
of inadequate chin projection or implant erosion. Three patients were operated
on under local anesthesia, the remainder under general anesthesia. Associated
procedures, done in 46 patients, included rhinoplasty, forehead lifting,
blepharoplasty, lateral canthopexy, excision of buccal fat pads, reduction
mammaplasty, and abdominoplasty. In 4 patients, associated maxillofacial
procedures were performed, including Le Fort I and III osteotomies, two-jaw
surgery, mandibular advancement with sagittal splitting, and orbital expansion.
The perceived advantages of osseous genioplasty were greater versatility in
dealing with problems in other than the sagittal plane, the possibility of
greater chin projection, and a tightening of the submental musculature.
Complications occurred in 10 patients. These included two hematomas requiring
aspiration in the office, a prolapsed submandibular gland requiring later
excision, a transient weakness of the marginal mandibular nerve, a transient
numbness of the lower lip on one side, four revisions of scars resulting from
the face lifting, and one localized wound infection in the parasymphyseal area
that resolved with oral antibiotics. The most common complaint, which came from
8 female patients at some time from 1 month to 3 years postoperatively, was that
the chin was "too strong." In 6 of these patients, most of whom were operated on
early in the series, some of the chin projection was reduced by burring. Osseous
genioplasty can be performed safely along with face lifting and submental
lipectomy. The degree of advancement necessary in aesthetic surgical patients is
generally less than that required in reconstructive patients. Patient
satisfaction is great unless the chin is overly advanced.

PMID: 9105353 [PubMed]

521: Bull Cancer.  1997 Mar;84(3):254-8.  

[Axillary lymphadenectomy prepared by fat aspiration versus functional axillary
lymphadenectomy: preliminary results of a randomized prospective study]

[Article in French]

Giard S, Laurent JC, Dron AM, Lefebvre D.

Service de chirurgie, Center Oscar-Lambret, Lille, France.

The objective of this study is to compare morbidity between 2 surgical
procedures of axillary clearance: functional lymphadenectomy by classical
dissection versus axillary dissection prepared by liposuction (Suzanne's
procedure). Two hundred consecutive patients treated for breast cancer were
included in a prospective randomized trial between 1st January, 1995 and 31st
January, 1996 (Huriet's law). The assessment (number of nodes, postoperative
stay, drainage duration, rate of seromas, number of complications, evaluation of
mobility and sensitive disorders) was done on the first, fifth, tenth and thirty
postoperative days. There is no significant difference between the 2 groups. The
rate of seromas decreased significantly only for fat patients (8/25 versus
21/34, p < 0.05) and for the patients treated with radical mastectomy (17/37
versus 28/39, p < 0.05). In this preliminary study, liposuction does not change
postoperative effects of axillary clearance, except for fat patients or after
total mastectomy. The liposuction seems to facilitate a better anatomical
dissection and a better preservation of the nervous and vascular elements.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 9207870 [PubMed]

522: Hepatogastroenterology.  1997 Mar-Apr;44(14):582-7.  

Gastric banding in the treatment of morbid obesity.

Fried M, Peskova M.

First Surgical Department, Charles University Teaching Hospital, Prague, Czech

BACKGROUND/AIMS: Obesity appears to be an epidemic problem now. Thirty percent
of men and 40% of women in the fifth decade are obese (> 20% over ideal weight).
Extreme obesity in itself decreases life expectancy and is associated with the
early development of cardiopulmonary disorders, hypertension, diabetes and many
other disorders. The non-operative treatment of extreme obesity rarely leads to
permanent weight reduction. Various operative procedures such as vertical banded
gastroplasties, malabsorptive operations or gastric bandings have been suggested
for the production of permanent weight loss. A relatively high incidence of
morbidity following "laparotomy" procedures for obesity treatment prompted us to
start laboratory studies in 1991 on laparoscopic gastric banding. MATERIAL AND
METHODS: In June 1993 we performed the world's first "laparoscopic" gastric
banding in a human and since then, we have operated on more than 60 patients
using this method. RESULTS: The 5-year mean post-operative weight loss of -37.4
kilograms, with significant blood pressure decreases at 1-year follow-up and
with no significant changes noted in the levels of RBC, electrolytes and
transaminase. CONCLUSION: The "laparoscopic" approach in gastric banding enabled
us to shorten hospital stay and decrease post-operative complications

PMID: 9164541 [PubMed]

523: Arch Surg.  1997 Mar;132(3):233-40.  

Heller myotomy is superior to dilatation for the treatment of early achalasia.

Anselmino M, Perdikis G, Hinder RA, Polishuk PV, Wilson P, Terry JD, Lanspa SJ.

Department of Surgery, Creighton University School of Medicine, Omaha, Neb, USA.

OBJECTIVES: To study the pretreatment characteristics that predispose a patient
to rupture and to compare the outcome after dilatation with the outcome after
surgical myotomy. DESIGN: A survey of all patients treated for achalasia at the
Creighton University Medical Center, Omaha, Neb, during a 16-year period.
Clinical examination and testing of consenting patients at 12 months and longer
after treatment. SETTING: Tertiary referral center. PATIENTS: Of the 61
patients, 55 were treated with dilatation. Esophageal rupture developed in 8
patients (14.5%) with achalasia after pneumatic dilatation; these patients
underwent surgery for the rupture. Dilatation failed in 8 other patients; these
patients underwent a surgical myotomy. Six patients underwent a primary surgical
myotomy. MAIN OUTCOME MEASURES: Duration of symptoms, weight loss, lower
esophageal sphincter resting pressure and relaxation, amplitude and quality of
distal esophageal contractions (assessed by manometry), 24-hour esophageal pH,
and maximal esophageal diameter (assessed by barium swallow examination).
RESULTS: Surgical myotomy at a mean (+/-SEM) of 44.9 +/- 18.6 months alleviated
dysphagia in 13 (93%) of the 14 patients compared with only 12 (39%) of the 31
patients after dilatation at a mean (+/-SEM) of 55.0 +/- 11.7 months (P < .001).
Of the 14 patients who underwent surgical myotomy, 13 (93%) were able to return
to a normal diet compared with only 2 (7%) of the 31 patients who underwent
dilatation (P < .001). Compared with patients without perforations, patients
with perforations after pneumatic dilatation had pretreatment characteristics
consistent with "early" disease: shorter symptom duration (20.1 +/- 5.4 vs 68.9
+/- 4.9 months, P < .001), less weight loss (4.7 +/- 1.2 vs 10.3 +/- 0.8 kg, P <
.001), a less dilated esophagus (24.0 +/- 1.8 vs 45.6 +/- 3.0 mm, P < .005),
lower lower esophageal sphincter resting pressures (19.3 +/- 2.6 vs 34.2 +/- 1.3
mm Hg, P < .001), a greater percentage of lower esophageal sphincter relaxation
(47.6% +/- 4.9% vs 20.7% +/- 2.1%, P < .001), and a lower percentage of
synchronous contractions in the distal esophageal body (66.2% +/- 4.9% vs 85.3%
+/- 2.3%, P < .005). (All data given as the mean [+/-SEM].) All patients with
pneumatic perforations were successfully treated by thoracotomy and surgical
repair. CONCLUSIONS: Surgical myotomy provides a better long-term outcome. The
early disease stage is associated with perforation after pneumatic dilatation.
Surgical myotomy rather than balloon dilatation should be considered in patients
with early achalasia.

Publication Types:
    Clinical Trial

PMID: 9125019 [PubMed]

524: Nihon Arukoru Yakubutsu Igakkai Zasshi.  1997 Feb;32(1):27-45.  

[Effects of long-term ethanol administration (1). Effects of long-term ethanol
administration on kidney studied at several periods of time during the

[Article in Japanese]

Omoto M, Imai T, Seki K, Nomura R, Nomoto K.

Department of Environmental and Occupational Health, Toho University, School of
Medicine, Japan.

The kidney is an important organ having not only excreting function but also
other functions such as production of the substances that activates a living
body, enzymatic reaction, immunization etc. For several years we have carried
out experiments of ethanol administration to rats and involved observations of
various organs including the kidney. Thus we have recognized no small effect of
ethanol on the kidney. After ethanol administration, the ethanol and its
metabolites go through kidneys and are excreted into urine, and their content of
the urine is higher than that of the blood. Their content of the kidney is
higher than that of the liver. In view of all these facts, the ethanol effect on
kidney is easily assumed. In this study a comparison between effect of ethanol
on kidney and that of the liver was made at several periods of time during the
administration. Under short, a week ethanol administration, the direct action
that exerts on cells is as follows: in the kidney swelling of glomerula and
tubules, proliferation of mesangial cells, and hyaline drop in tubular
epithelial cells are seen; in the liver storing of small fat drops and
enlargement of Kupffer cells are observed. Under long, two month administration,
products like ethanol metabolites-protein adducts and hyaline in tubular
epithelial cells as their removal reaction are observed in the kidney; in the
liver, enlargement of Kupffer cells in shown. Under long administration of six
and eleven months, kidney shows atrophy of tubular epithelial cells, urinary
casts, and cell infiltration to interstitial tissue; liver shows fat storing and
bile duct proliferation. These changes found through the effects of age appear
in the experimented rats earlier than the control. In addition thickening of
basement membrane of glomerulus, PAS positive deposits in glomerulus, and
proliferation of mesangial cell are observed in the kidney. It was apparently
observed that effects of ethanol on the kidney appeared earlier than those on
the liver.

PMID: 9103838 [PubMed]

525: J Clin Oncol.  1997 Feb;15(2):712-22.  

Potential impact on survival of improved tumor downstaging and resection rate by
preoperative twice-daily radiation and concurrent chemotherapy in stage IIIA
non-small-cell lung cancer.

Choi NC, Carey RW, Daly W, Mathisen D, Wain J, Wright C, Lynch T, Grossbard M,
Grillo H.

Department of Radiation Oncology, Massachusetts General Hospital, Harvard
Medical School, Boston 02114, USA. choi.noah@mgh.harvard.edu

PURPOSE: The main objectives of this study were (a) to ascertain the feasibility
and toxicity of preoperative twice-daily radiation therapy and concurrent
chemotherapy, surgery, and postoperative therapy in stage IIIA (N2)
non-small-cell lung cancer (NSCLC), and (b) to evaluate tumor response,
resection rate, pathologic tumor downstaging, and survival. METHODS: Eligibility
included biopsy-proven N2 lesion (stage IIIA) by mediastinoscopy, Karnofsky
performance score > or = 70, and weight loss less than 5% in the 3 months before
diagnosis. The treatment program consisted of two courses of preoperative
cisplatin, vinblastine, and fluorouracil (5-FU); 42 Gy concurrent radiation at
1.5 Gy per fraction in two fractions per day; surgery on day 57; and one more
course of postoperative chemotherapy and 12 to 18 Gy of concurrent twice-daily
radiation. RESULTS: Forty-two patients with stage IIIA (N2) NSCLC (27 men and 15
women, age 38 to 77 years) were enrolled onto this prospective study. Forty of
42 patients tolerated the intended dose (42 Gy) of preoperative radiation and 37
of 39 resected patients received prescribed postoperative radiation. The
intended dose of chemotherapy was given in 100%, 70%, and 60% of patients for
the first, second, and third courses of chemotherapy. Marked dysphagia that
required intravenous hydration was noted in 14% of patients (six of 42).
Myelotoxicities included grade > or = 3 granulocytopenia in 23% and
thrombocytopenia in 6% of 113 chemotherapy courses. Febrile neutropenia that
required hospital admission was noted in 9% of 113 chemotherapy courses.
Surgical resection was performed in 93% of patients. Treatment-related mortality
was noted in 7% of patients. The overall survival rates by the Kaplan-Meier
method were 66%, 37%, and 37% at 2,3, and 5 years, respectively, with a median
follow-up time of 48 months. Pathologic examination of the surgical specimen
showed a downward shift in tumor extent from stage IIIA (N2) to stage II (N1) in
33%, to stage I (NO) in 24% (10 of 42), and to stage 0 (TONO) in 9.5%, for a
total of 67%. The degree of tumor downstaging was also translated into a
survival benefit: 5-year survival rates from the time of surgery were 79%, 42%,
and 18% for postoperative tumor stages 0 and I, II, and III, respectively (P =
.04). CONCLUSION: Concurrent chemoradiotherapy using twice-daily radiation is an
effective induction regimen that resulted in 67% tumor downstaging, and an
encouraging 37% 5-year survival rate. The degree of tumor downstaging may be a
useful intermediate end point for survival benefit in stage IIIA (N2) NSCLC.

PMID: 9053497 [PubMed]

526: Nutrition.  1997 Jan;13(1):26-31.  

Comment in:
    Nutrition. 1997 Jan;13(1):54-5.

Response of severely malnourished patients to preoperative parenteral nutrition:
a randomized clinical trial of water and sodium restriction.

Gil MJ, Franch G, Guirao X, Oliva A, Herms R, Salas E, Girvent M, Sitges-Serra

Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain.

Preoperative parenteral nutrition (PPN) may be beneficial for severely
malnourished patients who are candidates for a major elective surgical
procedure. The response to PPN, however, has not been thoroughly investigated.
Expansion of the extracellular water compartment may occur in some patients,
producing a further decrease in the serum albumin concentration and increasing
the postoperative complications. Our aims were to investigate the occurrence of
and factors associated with water and sodium retention during PPN and its impact
on postoperative respiratory complications. Forty-one patients with
gastrointestinal cancer and severe malnutrition (weight loss > 15% and/or serum
albumin < 35 g/L) were randomly allocated to two groups receiving isocaloric
isonitrogenous PPN for 10 d. The Standard PPN Group (SG, n = 19) received 70% of
nonprotein calories as glucose, 45 cc of water.kg-1.d-1, and 140 mEq/d of sodium
chloride; and the Modified Group (MG, n = 22) received 70% of calories as fat,
30 cc of water.kg-1.d-1, and no sodium. Weight and albumin changes, diuresis,
sodium and water balances, and postoperative complications were recorded. At the
end of PPN, the SG showed a higher weight gain (0.8 versus -1.5 kg, P = 0.0001)
and albumin decrease (-0.7 versus 2.3 g/L, P = 0.006). Diuresis and sodium
balance were greater in the SG (1,230 versus 959 mL/d, P = 0.003 and 40 versus
-27 mEq/d, P = 0.001). Weight changes correlated with water (r2 = 0.46, P =
0.001) and sodium (r2 = 0.62, P = 0.0001) balances. Inappropriate responses to
PPN in both groups (expansion or depletion of the extracellular water
compartment) were associated with a significant increase in pulmonary
postoperative complications. During PPN, extracellular water expansion--as
determined by increasing weight and lowering of the serum albumin
concentration--and aggressive fluid therapy to treat water and sodium depletion
seem crucial to the development of postoperative respiratory complications.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 9058444 [PubMed]

527: Plast Reconstr Surg.  1997 Jan;99(1):257-8.  

Scars at cannula sites for liposuction.

Stone A, Rispler J.

Publication Types:

PMID: 8982220 [PubMed]

528: Plast Reconstr Surg.  1997 Jan;99(1):215-9.  

Comment in:
    Plast Reconstr Surg. 1997 Oct;100(5):1363-4.

Tumescent liposuction complicated by pulmonary edema.

Gilliland MD, Coates N.

Division of Plastic and Reconstructive Surgery, Baylor College of Medicine,
Houston, Texas.

In tumescent liposuction, large volumes of dilute lidocaine and epinephrine are
infused subcutaneously to prepare fat for extraction. Reported cardiopulmonary
complications of tumescent liposuction have been few, and the anesthetic and
hemodynamic advantages are several. We report an instance of pulmonary edema in
a healthy 55-year-old male body-builder who received 7900 cc subcutaneous and
2200 cc intravenous fluid. With normal cardiopulmonary and renal function, the
patient responded promptly to intravenous diuretics without sequelae. Out of
over 900 patients who have had tumescent liposuction with up to 15 liters
infused parenterally, this is the first case of pulmonary edema.

Publication Types:
    Case Reports

PMID: 8982207 [PubMed]

529: Acta Anaesthesiol Sin.  1996 Dec;34(4):247-51.  

[Removal of femoral interlocking nail-induced pulmonary embolism under spinal
anesthesia--a case report]

[Article in Chinese]

Chen FC, Cherng CH, Hwang SJ, Wong CS, Ho ST.

Department of Anesthesiology, Tri-service General Hospital, National Defense
Medical Center, Taipei, Taiwan, R.O.C.

Most of the lower limb surgeries are done under spinal anesthesia. This 21
year-old male had undergone open reduction with interlocking nail for his right
femoral fracture and was scheduled for removal of interlocking nail. Spinal
anesthesia was performed and a sensory block up to T8 level was achieved. During
removing of the nail, the patient complained of chest pain, dyspnea and
headache. Consequently, tachycardia and hypotension were observed. Then he
coughed up pink frothy sputum. Ephedrine 5 mg was given to raise his blood
pressure. About 3 min later, he recovered from the hypotension. Arterial blood
gas analysis showed hypoxemia and hypercapnia. After endotracheal intubation, he
was sent to surgical intensive care unit. In surgical intensive care unit, fat
globules in urine, anemia and thrombocytopenia were noted. Chest roentgenogram
showed patchy pulmonary infiltrates in the left lower lobe. A pulmonary artery
catheter was inserted for pulmonary measurement, which read pulmonary artery
pressure 45/28 mmHg, wedge pressure 14 mmHg, and cardiac output was 5-34 L/min.
Supportive treatment which included steroid therapy, and O2 therapy with
positive end-expiratory pressure was initiated under the impression of pulmonary
embolism. The course in surgical ICU was uneventful and he left there three days
later and was discharged on the fifth hospitalization day.

Publication Types:
    Case Reports

PMID: 9084555 [PubMed]

530: Int J Radiat Oncol Biol Phys.  1996 Dec 1;36(5):1147-53.  

Postoperative radiotherapy for head and neck squamous cell carcinomas:
feasibility of a biphasic accelerated treatment schedule.

Sanguineti G, Corvo' R, Vitale V, Lionetto R, Foppiano F.

Servizio di Oncologia Radioterapica, Istituto Nazionale per la Ricerca sul
Cancro, Genova, Italy.

PURPOSE: It has been suggested that postoperative tumor cell proliferation may
influence the outcome of advanced head and neck squamous cell carcinomas treated
by surgery and postoperative radiotherapy. This Phase I pilot study was
undertaken to determine the feasibility of a biphasic accelerated radiotherapy
regimen with early and late concomitant boost delivery for postoperative
treatment of patients with advanced head and neck cancers. METHODS AND
MATERIALS: From April 1993 to April 1994, 29 patients with advanced head and
neck cancers were enrolled in this study after they underwent complete surgical
resection. The basic radiation course delivered a median dose of 49 Gy in 25
fractions over 5 weeks at 1.8-2 Gy/fraction. The concomitant boost was delivered
to the high-risk areas as a second daily fraction during the first (1.4
Gy/fraction) and fifth weeks (1.6 Gy/fraction). The total dose to the high-risk
areas was 64 Gy in 35 fractions over 5 weeks. RESULTS: Twenty-seven patients
(93%) completed the treatment without interruptions. Only two patients
experienced severe acute toxicity requiring treatment breaks of 6 and 8 days,
respectively. All patients developed confluent mucositis; in 69% of the cases it
covered >50% of the treated surface. No patient developed Grade 5
(ulceration/bleeding) mucosal reaction. Mucositis required a median time of 7
weeks for complete healing (range 3-43). Two patients developed transient bone
exposure. The median weight loss was 5.5% of pretreatment body weight (range
1.2-17.1%), and four patients required nutritional assistance with nasogastric
feeding tube. CONCLUSION: The results of this study show that this biphasic
acceleration regimen is feasible with acceptable acute toxicity.

Publication Types:
    Clinical Trial
    Clinical Trial, Phase I

PMID: 8985037 [PubMed]

531: Dermatol Surg.  1996 Nov;22(11):921-7.  

Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction.

Ostad A, Kageyama N, Moy RL.

Department of Dermatology, New York University School of Medicine, New York,

BACKGROUND: The safe upper limit of lidocaine dosage in tumescent anesthesia for
liposuction has been reported to be 35 mg/kg. OBJECTIVE: This study was
undertaken to: 1) evaluate the safety of tumescent anesthesia in liposuction
when lidocaine doses greater than 35 mg/kg are required, 2) determine the time
interval when the peak plasma lidocaine level occurs following administration of
tumescent anesthesia, and 3) assess if the safety of large volume tumescent
anesthesia is due to significant lidocaine removed by liposuction. METHODS:
Sixty patients who underwent liposuction with a mean lidocaine dose of 57 mg/kg
were prospectively evaluated for development of any signs or symptoms of
lidocaine toxicity by multiple interviews over a 24-hour period. In addition,
another 10 patients who received a mean lidocaine dose of 55 mg/kg had serial
plasma lidocaine level measurements over a 24-hour period following liposuction.
The lidocaine level of the aspirate was also measured to assess any significant
lidocaine removed by liposuction. RESULTS: No evidence of lidocaine toxicity was
found based on subjective evaluation of 60 patients as well as determined by
plasma sampling of 10 patients. The peak plasma lidocaine concentration occurred
at approximately 4 or 8 hours after infusion of tumescent anesthesia. The
24-hour plasma lidocaine level suggests that residual lidocaine is present in
the subcutaneous tissue allowing for postoperative analgesia beyond this time. A
negligible amount of lidocaine was removed by liposuction as determined by the
lidocaine level of the aspirate. CONCLUSION: This study suggests that tumescent
anesthesia with a total lidocaine dose of up to 55 mg/kg is safe for use in

PMID: 9063507 [PubMed]

532: J Am Soc Nephrol.  1996 Nov;7(11):2453-60.  

Middle-sized molecule fractions isolated from uremic ultrafiltrate and normal
urine inhibit ingestive behavior in the rat.

Anderstam B, Mamoun AH, Sodersten P, Bergstrom J.

Department of Clinical Science, Karolinska Institute, Huddinge University
Hospital, Stockholm, Sweden.

Uremic patients with suppressed food intake may regain appetite soon after
starting dialysis, presumably because of the removal of one or more toxic
factors that suppress appetite. To investigate this matter, this study used a
new experimental model in free-moving, unstressed male Wistar rats (300 to 350
g) with feeding catheters channeled from the top of the skull to the oral
cavity. When the rats recovered from surgery, they were tested under
standardized conditions by being given an intraoral infusion (1 mL/min) of a 1 M
sucrose solution or a 97 g/L protein solution or a mixed solution of
carbohydrate, protein, and fat (Fortimel (Nutricia Nordica AB, Stockholm,
Sweden)) while the time (volume) of ingestion was recorded. Solutions to be
tested for their ability to inhibit ingestion were injected intraperitoneally
(lp) and the intraoral infusion was started 20 min later. Plasma ultrafiltrate
was collected from end-stage renal failure patients by isolated ultrafiltration
at the beginning of their first hemodialysis and pooled. Ultrafiltrate was also
obtained by filtering pooled plasma from healthy volunteers in vitro, using the
same type of dialyzer and cellulose acetate membranes as those used in the
uremic patients. Morning urine samples from healthy volunteers were pooled and
subjected to the same in vitro filtration procedure as the normal plasma.
Intraperitoneal injection of 20 mL normal ultrafiltrate had no effect on sucrose
ingestion, whereas injection of 20 mL uremic ultrafiltrate reduced the ingestion
of sucrose solution by 23% and the ingestion of Fortimel by 17%. Ten mL of
ultrafiltrate from normal urine reduced the sucrose intake by 42%. The pooled
ultrafiltrates from normal and uremic plasma and normal urine were subjected to
molecular filtrations using a series of membranes with known cut-off points. The
filtrations yielded four concentrated fractions with molecular weight ranges of
0.1 to 0.5 kilodaltons (kd), 0.5 to 1 kd, 1 to 5 kd, and 5 to 10 kd,
respectively; the plasma fractions were concentrated a factor of about 25:1 and
the urine fractions by about 15:1. After an ip injection of 2 mL of each
concentrated plasma fraction, only the 1 to 5 kd fraction from the uremic
ultrafiltrate inhibited sucrose intake, whereas the corresponding fraction from
the normal ultrafiltrate had no effect. After injection of 1, 3, and 5 mL of the
concentrated fractions of uremic ultrafiltrate, a dose-dependent inhibition of
sucrose intake was achieved with the 1 to 5 kd fraction and, to a lesser extent,
with the 5 to 10 kd fraction. Intraperitoneal injection of 0.5, 1.0, and 2 mL of
the concentrated 1 to 5 kd fraction, but not of the other fractions from normal
urine, also resulted in a dose-dependent inhibition of sucrose intake. The 1 to
5 kd fractions from the uremic ultrafiltrate and the normal urine ultrafiltrate
also inhibited protein intake in a dose-dependent manner. These results suggest
that one or more toxic compounds in the middle-molecule weight range, which are
normally excreted in the urine, accumulate in uremia and suppress food intake.

PMID: 8959639 [PubMed]

533: Plast Reconstr Surg.  1996 Nov;98(6):988-96; discussion 997-8.  

Comment in:
    Plast Reconstr Surg. 1997 Aug;100(2):552-3.
    Plast Reconstr Surg. 1997 Jul;100(1):284.
    Plast Reconstr Surg. 1998 Mar;101(3):872.

Superficial liposculpture of the face and neck.

Goodstein WA.

Division of Plastic Surgery at the U.C.L.A. School of Medicine, USA.

The capacity to benefit from scar tissue retraction beneath the intact skin has
been demonstrated by a number of surgeons working in the superficial fat over
the past decade. The efforts to achieve predictable skin retraction have largely
overlooked the importance of the mechanism of removal of fat, focusing instead
on the depth of the surgical plane and the vacuum pressure utilized. Recent
experimental and clinical evidence has pointed out the role of mechanical
dislodgment as a key factor in fat removal. A modification of an existing
cannula design has been utilized to achieve predictable skin retraction in the
face and neck in a series of 75 patients with follow-up from 3 months to 3
years. Facial and cervical flap elevation with this instrument (with or without
deep tissue tightening and skin excision) has consistently enhanced results,
improving skin tone and facial contours and at the same time diminishing both
recovery and operative time. The combination of the technique described and
existing techniques such as endoscopic and composite lift approaches may offer
enhancement of achievable results.

PMID: 8911468 [PubMed]

534: Br J Surg.  1996 Oct;83(10):1468-72.  

Effects of vertical-banded gastroplasty on bone and mineral metabolism in obese

Cundy T, Evans MC, Kay RG, Dowman M, Wattie D, Reid IR.

Department of Medicine, University of Auckland School of Medicine, New Zealand.

The surgical treatment of obesity can have adverse effects on bone, but there
are few published data on the effects of vertical-banded gastroplasty. Serial
measurements of bone mineral density at the lumbar spine and three upper femoral
sites, using dual-energy X-ray absorptiometry, and also of biochemical indices
of bone and mineral metabolism at intervals up to 2 years after operation were
performed in 18 patients with morbid obesity who had vertical-banded
gastroplasty. Bone mineral density measurements were also made in age- and
sex-matched non-obese controls. Bone density before operation was significantly
greater in the obese than in the controls (P < 0.02 at all sites). The obese
patients lost weight rapidly after vertical-banded gastroplasty (mean weight
loss 29 kg at 1 year, P < 0.001). This was accompanied by a measurable loss of
bone density from the trochanter and Ward's triangle sites in the upper femur (P
< 0.05), but not from the lumbar spine. Bone density values remained stable over
14 months in the controls. Hydroxyproline excretion increased significantly (P <
0.005), indicating an increase in bone resorption. Alkaline phosphatase levels
decreased significantly (P < 0.001), but this probably represents the reversal
of hepatic steatosis. There was no evidence of hyperparathyroidism or vitamin D
deficiency. In conclusion, vertical-banded gastroplasty causes modest bone
density loss from femoral sites, but not the lumbar spine. The difficulties of
assessing bone density changes in the obese are discussed.

PMID: 8944476 [PubMed]

535: Br J Oral Maxillofac Surg.  1996 Oct;34(5):467-70.  

Comment in:
    Br J Oral Maxillofac Surg. 1999 Apr;37(2):151-2.

Madelung's disease: an uncommon disorder of unknown aetiology?

Parmar C, Blackburn C.

Department of Oral and Maxillofacial Surgery, University Hospital Nottingham,

A case of Madelung's disease (benign multiple symmetrical lipomatosis,
Launois-Bensaude syndrome) is described. The characteristic clinical features,
associations with chronic alcoholism and a review of the current literature is

Publication Types:
    Case Reports
    Review, Tutorial

PMID: 8909745 [PubMed]

536: Clin Plast Surg.  1996 Oct;23(4):575-98.  

Ultrasonic assisted lipoplasty. Technical refinements and clinical evaluations.

Zocchi ML.

Aesthetic Plastic and Reconstructive Surgery, Torino, Italy.

Since the late 1970s, when suction-assisted lipoplasty was developed, many
surgeons have tried to improve methodology to get more predictable results and
reduce potential side effects and complications. Ultrasonic assisted lipoplasty,
in which fat tissues are selectively targeted by the surgical action, represents
the most advanced and innovative evolution of traditional liposuction, offering
reduced trauma and blood loss and a more specific and complete treatment of the
very superficial fat layers. The author describes the physical and technical
principles of this technique, with a complete overview of his clinical
experience, including tricks, traps, and complications.

PMID: 8906391 [PubMed]

537: Ann Plast Surg.  1996 Oct;37(4):415-7.  

Insulin-induced lipohypertrophy treated by liposuction.

Barak A, Har-Shai Y, Ullmann Y, Hirshowitz B.

Department of Plastic Surgery, Carmel Medical Center, Haifa, Israel.

Lipohypertrophy is one of the local side effects of repeated subcutaneous
insulin injections. This case report demonstrates the successful cosmetic and
therapeutic treatment of two lipohypertrophic masses in the lower abdomen of a
young diabetic patient by suction-assisted lipectomy.

Publication Types:
    Case Reports

PMID: 8905051 [PubMed]

538: Nutr Hosp.  1996 Sep-Oct;11(5):279-85.  

Role of immediate postoperative feeding on colonic anastomoses resistance. An
experimental study in a rat model.

Garcia-Olmo D, Paya J, Garcia-Olmo DC.

Experimental Surgery Unit, Albacete General Hospital, Spain.

PURPOSE: This study was performed to investigate whether immediate postoperative
feeding induced changes on colonic anastomoses resistance. On the other hand,
results was compared with a hyoscine-induced deep paralytic ileus status.
METHODS: Sixty-three Sprague-Dawley rats were divided into three groups: Group 1
(n = 20; colonic anastomosis + water "ad libitum" + 1 cc of saline solution
subcutaneously, daily); Group 2 (n = 21; colonic anastomosis + water and
standard rat chow "ad libitum" + 1 cc of saline solution subcutaneously, daily);
and Group 3 (n = 22; colonic anastomosis + water "ad libitum" + 2 mg/100 g body
weight hyoscine N-butylbromide in 1 cc subcutaneously, daily). Body weight, food
intake and water consumption were recorded on a daily basis. Surviving rats (20
in each group) were sacrificed 4 days after surgery and adhesions were
evaluated. Each segment containing an anastomosis was removed and the bursting
pressure was determined; the diameter and Lapace's law were used to calculate
Bursting wall tension (BWT). RESULTS: The cause of death during the early
postoperative period was dehiscence in 2 cases (1 in Group 2 and 1 in Group 3).
A rat died in Group 3 due to non-specific side effects. Weight loss was
significantly lower and water consumption significantly higher in Group 2 (Food)
than in others groups. BWT was lower in Group 2 than in the other groups (53.61
x 10(3) dynes/cm +/- 24.51 x 10(3) dynes/cm in Group 1, 48.94 x 10(3) dynes/cm
+/- 18.53 x 10(3) dynes/cm in Group 2 and 65.09 x 10(3) dynes/cm +/- 28.59 x
10(3) dynes/cm in Group 3). Nevertheless only comparison between Group 2 (Food)
and Group 3 (Hyoscine) showed statistically significant difference (p = 0.03).
In all cases leakage of dye was observed at the anastomotic line. General
adhesion scores in Group 2 (Food Intake) were similar than Group 1 (Water only)
and higher than in Group 3 (Hyoscine) (p = 0.036).

PMID: 9113145 [PubMed]

539: Br J Urol.  1996 Sep;78(3):472-3.  

Liposuction for retracted urostomy.

Sharma S, Bryson JR.

Mersey Regional Plastic Surgery Centre, Whiston Hospital, Prescot, UK.

Publication Types:
    Case Reports

PMID: 8881970 [PubMed]

540: World J Surg.  1996 Sep;20(7):900-6; discussion 907.  

Progression of metastases and symptom improvement from laparotomy in midgut
carcinoid tumors.

Makridis C, Rastad J, Oberg K, Akerstrom G.

Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden.

A total of 121 consecutive patients with midgut carcinoid tumors underwent
regular clinical control and 158 laparotomies for abdominal symptoms with 1 to
11 years (mean 5.2 years) of follow-up. Metastases were present in 93% of the
patients at study inclusion and developed at initially uninvolved sites with an
overall probability of 0.38. Patients without initial tumor spread developed
mesenteric or liver metastases with the probability of 0.25 (mean delay 12
years), whereas those with mesenteric metastases exhibited a probability 0.56 to
develop liver metastases (mean delay 6.1 years). Spread to extraabdominal sites
in patients with mesenteric and liver metastases exhibited a probability of 0.22
(mean delay 4.3 years), and this spread was especially frequent (probability
0.60) in patients with only liver metastases at inclusion. Patients without the
carcinoid syndrome (52%) mainly suffered from more or less episodic abdominal
pain, nausea, and diarrhea. Marked mesenteric fibrosis detected at surgery (n =
59) generally was accompanied by symptoms of abdominal pain and weight loss, and
it often required urgent intervention due to intestinal obstruction or ischemia.
Complete or partial symptom alleviation was accomplished in 82% of the operated
patients, and generally was most auspicious after primary acute or subacute
procedures (n = 54). The complete or partial symptom improvements after surgery
lasted for mean 5.3 years and tended to be longer after elective (n = 50) than
acute operations. The findings substantiate encouraging results of laparotomy in
a compromised cohort of patients with midgut carcinoid tumors. Because the
patients also displayed a generally slow progression of metastases, liberal
indications for laparotomy should prevail in symptomatic and possibly also
asymptomatic individuals with midgut carcinoid tumors.

PMID: 8678969 [PubMed]

541: Ann Chir Plast Esthet.  1996 Aug;41(4):385-8.  

[Internal hemorrhage in abdominal dermolipectomy. 2 reported cases, one of which
needing emergency surgical repair of aortic fissure]

[Article in French]

Fogli A, Saboye J.

The authors report two very exceptional and similar cases. In the first case,
during abdominal lipectomy, the surgical team was confronted suddenly with an
internal hemorrhage requiring prompt resuscitation by the anesthetist.
Laparatomy revealed an aortic fissure, one centimeter above the iliac
bifurcation. Bleeding was controlled by clamping the aorta, followed by suturing
of the fissure. Surgery was then completed uneventfully. The second patient
developed a retroperitoneal hematoma confirmed by postoperative CT scan during
lipectomy and liposuction. No further treatment was required after control of
the hemorrhage. No such cases have been reported in the literature and the
etiology of these cases remains unclear.

Publication Types:
    Case Reports

PMID: 9183888 [PubMed]

542: J Spinal Disord.  1996 Aug;9(4):326-33.  

Vertical transmission of the hip rolls due to wearing of TLSO for scoliosis.

Korovessis P, Stamatakis M, Baikousis A, Kirkos C, Kavouris A.

Orthopaedic Department, General Hospital Agios Andreas, Patras, Greece.

Cosmesis is important in the treatment of adolescent patients with idiopathic
scoliosis. It has been shown that although bracing reduces the rib hump, it
induces several complications. The aim of this study was to describe a new
disturbing complication due to wearing a thoracolumbosacral orthosis (TLSO) for
adolescent idiopathic scoliosis: the vertical transmission of the hip rolls
(trochanteric lipomatosis) in girls and its pathogenetic mechanisms.
Trochanteric lipomatosis is common in the female population, particularly after
adolescence, and is responsible for the characteristic appearance of the hip
rolls. No data have been reported concerning vertical transmission of normal
trochanteric lipomatosis with subsequent disturbance of aesthetic appearance
while wearing the TLSO. In this prospective study, 300 consecutive adolescent
girls who were treated with the TLSO for progressive idiopathic scoliosis were
followed and evaluated for development of any vertical transmission of the hip
rolls after application of the brace for an average of 2.5 years after
termination of the treatment. Almost simultaneously, 290 age-matched, randomly
selected adolescent girls served as controls and were examined by two unbiased
observers during the school screening program to estimate the prevalence of
trochanteric lipomatosis in female adolescents of the same geographic area. In
this series, bracing reduced the thoracic scoliosis from 34.4 +/- 5 degrees to
18.5 +/- 6 degrees and the lumbar scoliosis from 29.4 +/- 4 degrees to 16.7 +/-
4 degrees 6 months after initiation of brace wearing. The average prevalence of
normal trochanteric lipomatosis in girls in the control group was 26% (range,
12.2-68.4%) for the ages 9-14 years and was increasing with the age and weight.
No correlation was found between amount of reduction of scoliosis and prevalence
of the complication. Vertical transmission of the hip rolls was observed in 69
(23%) of the girls with scoliosis 6 months after initiation of brace wearing and
was positively correlated with the rigidity of the scoliotic curvature (p <
0.05) and the amount of reduction of the curvature (p < 0.05). Seven (8.8%)
girls discontinued brace wearing because of psychological distress related to
the deformity around the hip rolls, whereas 51 (73%) additional girls underwent
suction lipoplasty during or after the termination of the brace wearing, because
of persistent and disturbing lipomatosis. Recurrence of significant lipomatosis
was observed in 3 (5.8%) of the girls who underwent lipoplasty. Physicians who
are involved with treatment of scoliosis with bracing should be aware of this
aesthetic complication. Brace wearing should not attempt maximum correction of
scoliosis, thus avoiding excessive force on the body, and should be ordered only
in patients with immature spines, curves of > 25 degrees, and radiologically
justified progression. Suction lipoplasty seems to be a safe method of treatment
and should be advised in cases with unaesthetic vertical transmission of the hip

PMID: 8877961 [PubMed]

543: J Chir (Paris).  1996 Jul;133(5):226-8.  

[Treatment of morbid obesity by adjustable silicone gastric banding. A new
surgical technique of gastroplasty for obesity]

[Article in French]

Lecomte P, Marmuse JP.

Hopital Bichat, Service de Chirurgie Generale, Paris.

Among the various procedures used for surgical treatment of morbid obesity, the
adjustable silicone gastric banding is in full development. It is also a gastric
restrictive procedure and in addition it enables to adjust percutaneously the
size of the stoma by inflating or deflating the inflatable portion of the band
via an injection reservoir placed within the rectus sheath. In a small serie of
15 patients the efficacity of adjustable silicone gastric banding seems to be
similar to that of the vertical banded gastroplasty, as far as weight reduction
and improvement in the obesity associated comorbidity are concerned. In
addition, this technique has two major advantages: absence of failure from
staple line disruption, and a good food tolerance because the stoma size is
adjustable to the patient's need. In contrast to other gastroplasties, the
adjustable silicone gastric banding procedure is fully reversible after cutting
the prothesis, and can be done under laparoscopy.

PMID: 8999044 [PubMed]

544: Gut.  1996 Jul;39(1):9-12.  

Risk factors of oesophageal perforation during pneumatic dilatation for

Borotto E, Gaudric M, Danel B, Samama J, Quartier G, Chaussade S, Couturier D.

Service d'Hepatogastroenterologie, Hopital Cochin, Paris, France.

BACKGROUND/AIMS: Pneumatic dilatation of the oesophagus is a well established
treatment for achalasia. Oesophageal perforation is the most serious
complication that occurs in 2% to 6% of cases. The aim of this retrospective
survey was to identify predictive risk factors for perforation in a consecutive
series of 218 patients with achalasia. METHODS: Between 1983 and 1993, 270
pneumatic dilatations were performed in 218 patients. A Witzel dilator was used
in 58 cases and a Rigiflex dilator in 212. Eight oesophageal perforations
occurred (3%). The clinical, radiological, endoscopic, manometric, and technical
data for the eight perforated patients were compared with those of 30 patients
randomly sampled among those without perforation. RESULTS: All perforations
occurred during the first dilatation. Perforations were fewer during dilatations
with the Rigiflex dilator than with the Witzel dilator (2.4% v 5.2%).
Perforations were all located above the cardia, on the left side of the
oesophagus. In a multivariate analysis, a small weight loss and a high amplitude
of oesophageal contractions in the group of patients with perforations were
predictive of complications (respectively, p = 0.001 and p = 0.026). A
contraction amplitude higher than 70 cm H2O in the lower part of the oesophagus
was observed in three of eight patients with perforations but was not seen in
any of the 30 patients without perforation (p < 0.01). CONCLUSIONS: This
identification of risk factors should facilitate the choice between pneumatic
dilatation or a surgical approach.

PMID: 8881799 [PubMed]

545: Cardiovasc Drugs Ther.  1996 Jul;10(3):379-85.  

Effect of dietary supplementation with fish oil on cyclosporine A-induced
vascular toxicity.

Berkenboom G, Brekine D, Unger P, Richelle M, Carpentier Y, Fontaine J.

Department of Cardiology, Erasme Hospital, Belgium.

We wished to determine whether dietary supplementation with fish oil prevents
the vascular toxicity of cyclosporine (Cx). In a first set of experiments, we
assessed the endothelial function of aortas isolated from rats supplemented for
6 weeks with fish oil (FO), administered by gavage, and providing 150 mg/kg/day
of eicosapentaenoic acid and 100 mg/kg/day of docosahexaenoic acid. FO treatment
altered neither acetylcholine- and histamine-induced relaxations, nor
serotonin-induced contractions (NS vs. control group). Thereafter, three groups
of rats were treated in parallel. Group 1 received FO supplementation (by
gavage) for 6 weeks, and Cx (10 mg/kg/day po) was added during the last 2 weeks,
group 2 received Cx only (10 mg/kg/day po) for 2 weeks, and group 3 served as a
control. Both acetylcholine-and histamine-induced relaxations were reduced in
group 2 compared with the control group, as indicated by the area under the
curve (AUC), which was significantly higher: 296 +/- 17 vs. 138 +/- 32, and 392
+/- 38 vs. 318 +/- 25 for acetylcholine and histamine, respectively. In group 1,
AUC for acetylcholine remained significantly different from the control (241 +/-
31 vs. 138 +/- 32), whereas AUC for histamine was 367 +/- 28 (NS vs. control).
The serotonin-induced contractions were also enhanced in group 2 compared with
those of the control group, and this alteration was not attenuated in group 1.
After mechanical removal of the endothelium, the increased responsiveness to
serotonin persisted in groups 1 and 2, suggesting this functional alteration to
be located in the smooth muscle cells. Thus, in the rat the attenuation of
Cx-induced vascular toxicity by fish oil supplementation is only partial, that
is, it involves a slight improvement in endothelial function, but with
persistence of functional changes in smooth muscle.

PMID: 8877082 [PubMed]

546: Dermatol Surg.  1996 Jul;22(7):595-8.  

Comment in:
    Dermatol Surg. 1997 May;23(5):401-2.

Current status of tumescent liposuction in the United States. National survey

Hanke CW, Bullock S, Bernstein G.

Department of Dermatology, Indiana University Medical Center, Indianapolis
46202-5267, USA.

BACKGROUND. Tumescent liposuction is an extremely safe method of liposuction
that can be performed entirely under local anesthesia. OBJECTIVE. To determine
evolving trends in the current practice of tumescent liposuction in 15,336
patients treated by 66 dermatologic surgeons. METHODS. A survey questionnaire
was sent to 1,778 Fellows of the American Society for Dermatologic Surgery in
February 1994. The comprehensive questionnaire requested information on the
number of patients treated with tumescent liposuction, complications, and
various practice issues. RESULTS. Sixty-six dermatologic surgeons provided data
on 15,336 patients; 44,014 body areas were treated. The complications that
developed were infrequent and minor and have been reported previously. The
average amount of fat removed per patient was 1,276 cc. An average of 33 cc of
blood was lost per patient per procedure. Cannulas of 4.0 mm or less in diameter
were commonly used. The abdomen and outer thighs were the most common areas
treated in women. The flanks/love handles and abdomen were the most common areas
treated in men. Intraoperative monitoring of vital signs was common.
CONCLUSIONS. Tumescent liposuction is an evolving technique that has virtually
eliminated blood transfusions and the major complications of liposuction under
general anesthesia. Large amounts of fat can be removed using small diameter
cannulas. The fat can be safely removed with a minimum risk of minor

PMID: 8680781 [PubMed]

547: Ann Chir Plast Esthet.  1996 Jun;41(3):299-307.  

[Value of liposuction for the improvement of cervicofacial contour]

[Article in French]

Mole B.

Cervicofacial liposuction, a simple procedure with a rapid postoperative course,
has become an essential technique in many facial "reconstruction" indications,
for rejuvenation or morphological reconstruction objectives. It can be performed
on an outpatient basis and complications are extremely rare. However, its
results remain unpredictable, as they depend on secondary cutaneous retraction,
an unpredictable individual factor. However, it is unable to resolve all
situations and can be associated with various simple or complex procedures which
clearly and reciprocally improve results. The author report his 10-year
experience of cervicofacial liposuction.

PMID: 8949510 [PubMed]

548: J Chir (Paris).  1996 Jun;133(4):155-8.  

[Cancer of the gallbladder. A surgical experience. A propos of 143 cases]

[Article in French]

Arnaud JP, Casa C, Jacob JP, Ronceray J, Becouarn G, Bergamaschi R.

CHU Angers, Service de Chirurgie Viscerale.

The records of 143 patients with gallbladder carcinoma operatively treated
between 1975 and 1995 were retrospectively reviewed. Abdominal pain was the most
common symptom and was present in 103 patients (72%). Jaundice was present in 83
patients (58%) and weight loss in 68 (47.5%). Pre-operative diagnosis was made
in 40.5% of the patients. Surgical procedures included cholecystectomy alone
(16.8%), cholecystectomy with resection of the hepatic bed and lymphadenectomy
(11%), cholecystectomy with biliary drainage (57.3%), and exploration with
biopsy (14%). Surgery was considered as curative in 21.5% of the patients.
Overall five-year survival rate was 11%. Actuarial 5-year survival rate was
100%, 29% and 23% in patients with T1, T2 and T3 tumors. The five-year survival
rate was nil in patients with T4 and T5 cancers.

PMID: 8761067 [PubMed]

549: Tumori.  1996 May-Jun;82(3):264-5.  

Chylopericardium following right thoracotomy for lung cancer.

Mizushima Y, Yoshida Y, Inoue A, Sugiyama S, Hamazaki T, Kobayashi M.

First Department of Internal Medicine, Toyama Medical and Pharmaceutical
University, Japan.

A 69-year-old woman underwent the right upper lobectomy, a partial resection of
right segment 6 (rt S6) and removal of mediastinal lymph nodes (LN) for
adenocarcinoma of the lung (rt S2), stage IIIA (T2N2M0). A chest computerized
tomography (CT) taken one month after the operation revealed a pericardial
effusion which was milky in color, and contained high levels of triglycerides
(TG) of 615 mg/dl (serum, 217 mg/dl). Cytology of effusion for malignant cells
was negative. The pericardial effusion gradually decreased in one month by
restriction of her fat intake. Chylopericardium following right thoracotomy for
lung cancer is extremely rare.

Publication Types:
    Case Reports

PMID: 8693609 [PubMed]

550: Aesthetic Plast Surg.  1996 May-Jun;20(3):201-6.  

Ten year evolution of liposuction.

Troilius C.

Malmo, Sweden.

The author very briefly reviews the evolution of liposuction beginning with the
pioneering work of Yves-Gerard Illouz, through the contributions of Doctors
Toledo, Gasparotti, Klein, and Zocchi. This brief historical review is
accompanied by cases demonstrating his experiences with these techniques.

PMID: 8670395 [PubMed]

551: Aesthetic Plast Surg.  1996 May-Jun;20(3):207-11.  

Postliposuction histologic alterations of adipose tissue.

Carpaneda CA.

Brasilia, Brazil.

The author studied seven patients who received suction assisted lipectomy prior
to classic abdominal dermolipectomies. The liposuction sessions were performed
180, 150, 60, 30, 15, 12, 8, and 5 days before the abdominoplasties. Histologic
studies disclosed extensive amounts of dead adipocytes and free fat within the
aspirated area. The pockets left behind were filled with serum hemorrhagic
material and evolved to the healing process. Collagen synthesis was increased
initially then followed by gradual decrease and a remodeling process. Our
findings suggest that liposuction techniques preserve some vessels and nerves,
but the final resolution may take several months or years, depending on the
amount of tissue damage.

PMID: 8670386 [PubMed]

552: Int J Radiat Oncol Biol Phys.  1996 May 1;35(2):351-6.  

Feasibility study of the treatment of primary unresectable carcinoma of the
pancreas with 103Pd brachytherapy.

Raben A, Mychalczak B, Brennan MF, Minsky B, Anderson L, Casper ES, Harrison LB.

Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New
York, NY 10021, USA.

PURPOSE: The purpose of this study was to assess the feasibility of 103Pd
brachytherapy in the management of primary unresectable carcinoma of the
pancreas. METHODS AND MATERIALS: Between August 1988 and January 1992, 11
patients with biopsy-proven primary unresectable adenocarcinoma of the pancreas
were treated with 103Pd brachytherapy during laparotomy. The median age was 66
(range 57-70). The most common presenting symptoms were weight loss (eight
patients), pain (six patients), and nausea/vomiting (four patients). Less common
symptoms were jaundice (two patients), early satiety (two patients), and ascites
(one patient). All patients underwent laparotomy and surgical staging. Eight
patients had T3N0M0 disease, two patients had T3N1M0 disease, and one patient
had T3N1M1 disease. The surgical procedure performed was biliary bypass in six
patients, biopsy only in four patients, and gastric bypass in one patient. The
average tumor dimension was 4.0 cm. The median activity, matched peripheral dose
(MPD) and implanted volumes were 95.3 mCi, 124.4 Gy, and 33 cm3, respectively.
The median initial dose rate was 0.21 Gy per hour. Five patients received
postoperative external beam radiation therapy (median 45 Gy) and seven patients
received chemotherapy postoperatively. The median follow-up was 7 months (range
1-19). RESULTS: The median survival for the entire group of patients was 6.9
months. Ten of 11 patients have died, with 1 patient presently alive and
receiving chemotherapy for metastatic disease to the liver, but without local
progression radiographically. Five of 11 patients (45%) were locally controlled,
defined as either a complete response or freedom from progression at the site of
the implant as evaluated by computed tomography scan. In the other six patients,
the median time to local progression was 6.9 months. Five patients developed
distant metastases (four liver, one subcutaneous nodule). Two patients failed in
regional sites (one omentum, one paraaortic lymph node). Four of 11 patients
(36%) developed acute postoperative complications that included one gastric
outlet obstruction, one duodenal perforation, and two with sepsis. One of 11
patients (9%) developed a late complication of radiation enteritis 5 months
after implantation. The median survival for patients experiencing complications
was 1.7 months as compared to 8.4 months for the patients who did not develop a
complication (p = 0.10). Pain relief was obtained in five out of six (83%) of
the patients presenting with pain for a median duration of 24 weeks. Local
control did not appear to be related to the MPD, dose rate, implanted volume,
treatment with external beam irradiation, or the use of chemotherapy. Patients
were more likely to develop a complication if the MPD was greater than 115 Gy
(four out of six patients) as compared to those whose MPD was less than 115 Gy
(one out of five patients) (p = 0.12). CONCLUSIONS: Because there was no
improvement in median survival over conventional modalities, and the
complication rate was high; we do not recommend 103Pd brachytherapy as a
component of the treatment of unresectable adenocarcinoma of the pancreas.

PMID: 8635943 [PubMed]

553: Arch Surg.  1996 May;131(5):561-5.  

Comment in:
    Arch Surg. 1997 Apr;132(4):452.

Recurrent acute pancreatitis caused by afferent loop stricture after gastrectomy.

Mithofer K, Warshaw AL.

Department of Surgery, Massachusetts General Hospital, Boston, USA.

Afferent loop obstruction after gastrectomy and Billroth II gastrojejunostomy is
only rarely diagnosed as the cause of recurrent acute pancreatitis. Three
patients are described in whom afferent loop stricture after gastrectomy and
Billroth II reconstruction manifested as recurrent pancreatitis 13 to 24 years
after the initial procedure. Late onset, nonspecific symptoms, and other
simultaneous gastrointestinal pathologic features promoted a chronic clinical
course in all patients. Symptoms included acute abdominal pain, vomiting,
jaundice, hyperamylasemia, weight loss, and anemia. A thorough history, barium
examination, cholescintigraphy, and endoscopy were central in establishing the
diagnosis. The pathogenesis of stricture formation is thought to be ischemic
mucosal damage from intestinal crossclamping. Surgical decompression provided
lasting relief of the symptoms. Afferent loop stricture should be considered in
the different diagnosis in patients with recurrent acute pancreatitis and
previous gastrectomy with Billroth II reconstruction.

Publication Types:
    Case Reports

PMID: 8624206 [PubMed]

554: Dtsch Med Wochenschr.  1996 Apr 26;121(17):543-9.  

Comment in:
    Dtsch Med Wochenschr. 1996 Jul 26;121(30):963.

[Comparison of the quality of life after subtotal and total gastrectomy for
stomach carcinoma]

[Article in German]

Roder JD, Stein HJ, Eckel F, Herschbach P, Henrich G, Bottcher K, Busch R,
Siewert JR.

Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen
Universitat Munchen.

OBJECTIVE: To compare quality of life after subtotal gastrectomy (STG) and total
gastrectomy of various types, in view of the fact that, with T1 and T2 gastric
carcinoma of intestinal type in the distal third of the stomach, subtotal
gastrectomy is similar to total gastrectomy regarding the extent of
lymphadenectomy and prognosis. PATIENTS AND METHODS: Quality of life was
measured by standardised questionnaires given to 36 patients after subtotal
gastrectomy (22 men, 14 women; mean age 63 [27-79] years): general physical
complaints (GPC); contentment with life (CL); psychosocial stress (PSS). The
results were compared with those previously obtained in 58 patients with total
gastrectomy (46 men, 12 women; mean age 63.4 [36-74] years) and
oesophagojejunostomy (OJS) (n = 29) or oesophagojejunoplication and pouch (OJPP)
(n = 29). RESULTS: Weight loss of patients after OJPP was not significantly
different from that of patients after STG, but it was significantly higher after
OJS (13.5 +/- 8.6 kg; P < 0.0006). Patients with STG had significantly more
general complaints (P < 0.05) and greater discontent with life (P < 0.05) than
those with OJPP. Specific analysis of gastric complaints showed greatest
dissatisfaction with gastrointestinal functions in patients after STG (P <
0.0004), less also after OJS compared with OJPP (P < 0.01). CONCLUSIONS:
Subtotal gastrectomy for gastric carcinoma has no advantages over total
gastrectomy with oesophagojejunoplication and pouch as regards weight loss,
gastrointestinal complaints, psychosocial stress and general contentment. The
poor quality of life seems to have its functional correlate in increased
intestino-oesophageal reflux with incompetent cardia and after Billroth II

PMID: 8620823 [PubMed]

555: Facial Plast Surg.  1996 Apr;12(2):171-83.  

Transcutaneous lower blepharoplasty.

Adamson PA, Strecker HD.

Department of Otolaryngology, University of Toronto, Ontario, Canada.

Transcutaneous lower blepharoplasty as a standard procedure for cosmetic lower
blepharoplasty is being replaced by transconjunctival blepharoplasty and laser
resurfacing techniques. Nevertheless, there remain specific indications for the
transcutaneous approach and its modifications. The accomplished facial plastic
surgeon will be able to choose the appropriate technique based on the patient's
concerns, the eyelid pathology, and his or her clinical experience.

PMID: 9220731 [PubMed]

556: Ann Thorac Surg.  1996 Mar;61(3):969-72.  

Isolated lung perfusion with doxorubicin reduces cardiac and host toxicities
associated with systemic administration.

Ng B, Hochwald SN, Burt ME.

Thoracic Oncology Laboratory, Memorial Sloan-Kettering Cancer Center, New York
10021, USA.

BACKGROUND: For patients with malignant neoplasms metastatic to lung, systemic
chemotherapy in doses high enough to achieve significant survival improvement is
often limited by host toxicity. Isolated single-lung perfusion offers the
advantage of delivering high-dose organ-specific chemotherapy while minimizing
systemic toxicity. We compared the cardiac and systemic toxicities associated
with intravenous administration versus isolated single-lung perfusion with
doxorubicin. METHODS: Thirty-three male Fischer 344 rats weighing 275 to 300 g
were randomized into three groups: normal control rats (n = 11), intravenous
doxorubicin (7/mg/kg) (n = 11), and isolated left lung perfusion with 320
micrograms doxorubicin/mL (n = 11). Animals undergoing isolated single-lung
perfusion were anesthetized with pentobarbital, intubated, and ventilated, and
then had left thoracotomy with cannulation of the pulmonary artery and a
pulmonary venotomy; pulmonary artery and vein were clamped proximally. Animals
were perfused for 10 minutes at a rate of 0.5 mL/min, followed by a 5 minute
rinse with buffered hespan solution. Arteriotomy and venotomy were repaired and
circulation was restored. Daily weights were recorded. On day 24, cardiac output
was determined in all groups by injection of radiolabeled chromium 51
microspheres. RESULTS: Animals treated with 7 mg/kg intravenous doxorubicin had
a significant weight loss as compared with those treated with isolated lung
perfusion (209.2 +/- 29.9 g versus 302.3 +/- 10.1 g; p < 0.01). Animals treated
with isolated single-lung perfusion, after recovering from surgical stress,
resumed normal growth pattern. Significant cardiac toxicities were seen in
intravenously treated animals; cardiac index (27.4 +/- 6.9 versus 39.4 +/1 6.3
mL/min/100g body weight and heart weights (0.56 +/- 0.04 versus 0.88 +/- 0.09 g)
were reduced in the intravenously treated group as compared with the group
treated with isolated single-lung perfusion. In addition, severe hematologic
toxicities are associated with intravenous doxorubicin administration.
CONCLUSIONS: Intravenous administration of doxorubicin is associated with severe
host toxicities, which include weight loss, decreased cardiac function, and
hematologic toxicity. Isolated lung perfusion with high-dose doxorubicin is well
tolerated and is associated with minimal host toxicity.

PMID: 8619727 [PubMed]

557: Surgery.  1996 Mar;119(3):261-8.  

Biliopancreatic diversion for obesity at eighteen years.

Scopinaro N, Gianetta E, Adami GF, Friedman D, Traverso E, Marinari GM, Cuneo S,
Vitale B, Ballari F, Colombini M, Baschieri G, Bachi V.

Department of Surgery, University of Genoa School of Medicine, Italy.

BACKGROUND: Surgical attempts to treat obesity began because of the discouraging
results of conservative medical treatment, which successfully achieved initial
weight loss but failed to maintain it. Gastric restrictive procedures, currently
the most popular surgical methods for obesity therapy, have proved to be
effective in initiating weight loss, but some concerns regarding their long-term
efficacy in weight maintenance have arisen. METHODS: Of a total of 1968 obese
patients who underwent biliopancreatic diversion since 1976, the last
consecutive 1217 underwent the "ad hoc stomach" type of diversion with a 200 cm
alimentary limb, a 50 cm common limb, and a gastric volume varying between 200
and 500 ml. Mean age was 37 years old (11 to 69 years), and mean excess weight
was 117%. Maximum follow-up was 115 months with nearly 100% participation.
RESULTS: In the last half of the series, operative mortality was 0.4% with no
general complications and with early surgical complications of wound dehiscence
and infection (total, 1.2%) and late complications of incisional hernia (8.7%)
and intestinal obstruction (1.2%). Mean percent loss initial excess weight (IEW)
at 2, 4, 6, and 8 years was 78 +/- 16, 75 +/- 16, 78 +/- 18, and 77 +/- 16 in
the patients with IEW up to 120% and 74 +/- 12, 73 +/- 13, 73 +/- 12, and 72 +/-
10 in those with IEW more than 120%. A group of 40 patients who underwent the
original "half-half" biliopancreatic diversion maintained a mean 70% reduction
of IEW during a 15-year follow-up period. Specific late complications included
anemia (less than 5%), stomal ulcer (2.8%), protein malnutrition (7% with 1.7%
requiring surgical revision by common limb elongation or by restoration).
Clinical problems from bone demineralization were minimal in the short term and
almost absent in the long term. CONCLUSIONS: Biliopancreatic diversion is a very
effective procedure but is potentially dangerous if used incorrectly.

PMID: 8619180 [PubMed]

558: Plast Surg Nurs.  1996 Winter;16(4):215-22; quiz 223-4.  

Erratum in:
    Plast Surg Nurs 1997 Spring;17(1):42.

Liposuction: an overview.

Springer RC.

Liposuction, the most popular cosmetic surgical procedure today, can offer a
substantial benefit to the realistic, well-motivated patient. Continual
perioperative assessment and early intervention serve to maximize recovery and
minimize complications.

Publication Types:
    Review, Tutorial

PMID: 9060766 [PubMed]

559: Int J Colorectal Dis.  1996;11(6):287-93.  

Morbidity of medical therapy for ulcerative colitis: what are we really saving?

Sher ME, Weiss EG, Nogueras JJ, Wexner SD.

Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale
33309, USA.

AIM: The true morbidity, cost and disability of medical therapy for ulcerative
colitis are seldom delineated and are even less frequently compared to analogous
parameters associated with surgical therapy. Therefore, we sought to assess and
contrast medical versus surgical therapy for patients hospitalized due to severe
ulcerative colitis. MATERIALS AND METHODS: Patients were matched for age,
duration and severity of disease based upon Truelove and Witts' activity index,
colonoscopic and histologic appearance and APACHE (Acute Psychological and
Chronic Health Evaluation) II scores. Morbidity, cost and disability of 20
medically treated patients who required at least one hospital admission were
compared to 20 patients treated by a three stage restorative proctocolectomy.
Demographic data, number of hospital admissions, length of stay, total hospital
charges including consultant's, surgeon's, and anesthesiologist's fees,
morbidity of each approach and disability were assessed. Statistical analysis
was performed using Mann-Whitney and Fisher exact tests. Significance was
considered as P < 0.05. RESULTS: The mean age was 53.6 years in the medical
group and 48.1 years in the surgical group (P = NS) and the average duration of
disease was 10.5 years and 9.5 years, respectively (P = NS). The same severity
of pancolitis was noted in both groups; APACHE scores of 13 and 14 in the
medical and surgical groups, respectively, were noted. The total number of
hospital admissions and total combined length of stay per patient in each group
were not significant. Total mean hospital cost for the medical group was
$28,477.00 per patient versus $33,041.00 for the three stage restorative
proctocolectomy (P = NS). The mean duration of disability in the medical group
was 6.4 months per patient versus 5.0 months in the surgical group (P = NS).
However, patients in the medical group required more transfusions (25%) than did
those in the surgical group (0%) (P < 0.05) and significant weight loss was more
common in the medical group (45%) compared to the surgical group (5%) (P <
0.01). All patients in the surgical group were permanently weaned from steroids.
Furthermore, while 65% of patients in the medical group had significant
steroid-related complications, the major surgical complication rate was only 15%
(P < 0.01). CONCLUSION: Medical treatment was associated with a significantly
higher overall morbidity than surgical therapy. Additionally, a three stage
restorative proctocolectomy was performed at no additional hospital cost or
subsequent disability in patients with severe ulcerative colitis. The value of
prolonged medical therapy in this select group of patients is questionable.

PMID: 9007625 [PubMed]

560: Khirurgiia (Mosk).  1996;(3):46-9.  

[Surgical interventions in patients with a history of alimentary constitutional

[Article in Russian]

Markov VK, Leont'eva MS, Guznov IG, Munir A, Gorbunov AS.

Surgical removal of a fat "flap" is a last step of surgical treatment of
patients with 3-d and 4-th stage of alimentary obesity. This kind of surgery
makes sense only 12-24 months after "small stomach" creation. During this period
the weight is stable. A detailed clinical examination and prophylaxis helps to
avoid septic and thromboembolic complications that may cause death and usually
appear short time after the operation. To minimize postoperative complications
and to decrease a risk of repeated anaesthesia and time of stay in a hospital it
is necessary to make some concomitant small surgical procedure (cholecystectomy,

PMID: 8965446 [PubMed]

561: Nephrol Dial Transplant.  1996;11 Suppl 3:142-5.  

Dialysis-related amyloidosis: visceral involvement and protein constituents.

Campistol JM, Argiles A.

Renal Transplantation Unit, Hospital Clinic i Provincial, University of
Barcelona, Spain.

beta 2-M amyloidosis mainly concerns dialysis patients and typically presents
with osteoarticular symptoms. In order to precise the incidence and gravity of
visceral involvement, subcutaneous abdominal fat aspirates, skin and rectal
biopsies, as well as echocardiograms were performed in 26 patients with severe
beta 2-M amyloidosis. Visceral amyloidosis was confirmed in 58% and the numbers
were even higher when including heart abnormalities suggestive of amyloidosis
(81%). Clinical manifestations of visceral involvement were usually not severe
and include odynophagia, gastrointestinal haemorrhage, intestinal obstruction,
kidney stones, myocardial dysfunction and subcutaneous tumours. The removal and
synthesis rates of beta 2-M were assessed during dialysis. Serum 131I-beta 2-M
levels decreased by 5-10% with cuprophane and by 40-45% with polysulfone and
polyacrylonitrile membranes. These reduction rates were higher than those found
with unlabelled beta 2-M suggesting an increased synthesis or release during
dialysis. The protein constituents of amyloid deposits were studied. Two
different preparative methods to extract the proteins from amyloid deposits were
used. TCA precipitation showed the presence of several proteins which were not
observed with PBS homogenizing and resuspending in guanidine. The protein
constituents of amyloid fibrils were studied by both, two dimensional gel
electrophoresis (2D-gel) as well as protein sequencing after gel filtration.
Similarly, the technical approach used for protein analysis greatly influenced
the results. It was observed that 2D-gel displayed the presence of proteins
which were missed by the gel filtration technique. Some of the proteins
contained in amyloid deposits in addition to beta 2-M, were identified as globin
chains, kappa and lambda light chains of immunoglobulins, and alpha 2
macroglobulin. A putative participation of these other protein constituents on
the pathogenesis of beta 2-microglobulin amyloidosis is discussed.

Publication Types:
    Review, Tutorial

PMID: 8840330 [PubMed]

562: Chirurgie.  1996;121(2):101-7.  

[Surgical treatment of esophageal cancer in patients over 70 years of age]

[Article in French]

Thomas P, Hardwigsen H, Lienne P, Giudicelli R, Perrier H, Giovannini M, Seitz
JF, Reboud E, Fuentes P.

Service de Chirurgie thoracique et des Maladies de l'oesophage, hopital
Sainte-Marguerite, Marseille.

As the population continues to age, septuagenarian patients with esophageal
cancer are frequently referred for surgical treatment. The aim of this study was
to analyze with respect to their age the outcome of 386 patients who underwent
esophagectomy and simultaneous reconstruction from 1979 to 1994. The portion of
patients of 70 years of age and older (14.5%) has slightly increased during the
period. Location to the lower third of the esophagus and adenocarcinoma type
were prevalent in the 56 elderly patients (Group I), but postsurgical TNM
staging was identical to that of the 330 younger patients (Group II). Other
clinical features, i.e., preoperative weight loss and presence of co-morbid
diseases, however, were comparable in both groups. Pulmonary function, as
assessed by spirometry, was significantly worse among the older patients, but
blood gas determinations were not different. Operative mortality was comparable
among the 2 groups (10.7% vs 11.2%). Major morbidity included anastomotic leak
(10.7% vs 13.6%) and pulmonary complications (17.9% vs 20.6%) in both groups.
Long term survival was not different in elderly patents (5-year rate: 17%) when
compared with that of younger patients (18.9%). These data suggest that 1)
esophagectomy can be performed in selected septuagenarian patients with an
acceptable risk, and 2) long-term survival with excellent functional status is
attainable in this age group in a portion of these patients.

Publication Types:
    Review, Tutorial

PMID: 8763113 [PubMed]

563: Ann Chir.  1996;50(2):139-45.  

[Long-term results of vertical banded gastroplasty for morbid obesity]

[Article in French]

Frering V, Honnorat D, Riou JP, Partensky C.

Federation des Specialites Digestives, Hopital Edouard-Herriot, LYON.

Morbid obesity, defined by Body Mass Index (BMI) > 40 kg/m2, has an adverse
effect on longevity due to a variety of illnesses. Among the numerous techniques
proposed to control morbid obesity, Vertical Banded Gastroplasty (VBG) changes
eating behavior. The aim of this study was to analyse the long term results of
VBG. MATERIAL AND METHODS: Between October 1987 and July 1993, 62 patients, 7
men and 55 women, from 20 to 68 years old (Mean: 37.4 +/- 9 ans), underwent VBG
for morbid obesity. Preoperative mean weight and BMI were 123 +/- 27 kg and 47.3
+/- 9.8 kg/m2 respectively. Associated diseases were diabetes mellitus (n = 31),
hypertension (N = 29), hypercholesterolemia (N = 10), hypertriglyceridemia (N =
21) and joint diseases (N = 18). RESULTS: VBG was performed with a 50 mm marlex
mesh in 20 cases and with a 47 to 50 mm silastic ring in 42 cases. On patient
died 3 years later from alcoholic liver cirrhosis and 4 were lost to follow-up.
With a mean follow-up of 31 months, mean weight and BMI were 86 +/- 21 kg (p <
0.001) and 32.1 +/- 9.8 kg/m2 (p < 0.001) respectively. Removal of the ring was
performed in 3 cases, 1 because of neurologic complications and 2 at the
patient's request. Eight patients (13%) failed to achieve satisfactory weight
loss. Diabetes mellitus and hypertension resolved in 19 cases,
hypercholesterolemia resolved in 7 cases and hypertriglyceridemia resolved in
11. CONCLUSION: VBG provides significant weight loss which reduces the frequency
of medical disorders associated with obesity. This result was achieved in 87% of
patients. The surgical procedure for morbid obesity must be decided conjointly
with endocrinologist, psychiatrist and surgical staff for good long-term

PMID: 8762264 [PubMed]

564: Ann Plast Surg.  1996 Jan;36(1):76-9.  

Chronic, burning facial pain following cosmetic facial surgery.

Eisenberg E, Yaari A, Har-Shai Y.

Pain Relief Clinic, Rambam Medical Center, Haifa, Israel.

Chronic, burning facial pain as a result of cosmetic facial surgery has rarely
been reported. During the year of 1994, two female patients presented themselves
at our Pain Relief Clinic with chronic facial pain that developed following
aesthetic facial surgery. One patient underwent bilateral transpalpebral surgery
for removal of intraorbital fat for the correction of the exophthalmus, and the
other had classical face and anterior hairline forehead lifts. Pain in both
patients was similar in that it was bilateral, symmetric, burning in quality,
and aggravated by external stimuli, mainly light touch. It was resistant to
multiple analgesic medications, and was associated with significant depression
and disability. Diagnostic local (lidocaine) and systemic (lidocaine and
phentolamine) nerve blocks failed to provide relief. Psychological evaluation
revealed that the two patients had clear psychosocial factors that seemed to
have further compounded their pain complaints. Tricyclic antidepressants (and
biofeedback training in one patient) were modestly effective and produced only
partial pain relief.

Publication Types:
    Case Reports

PMID: 8722989 [PubMed]

565: Plast Surg Nurs.  1996 Spring;16(1):49-50.  

Preoperative and postoperative instructions for liposuction of jowl and chin.

Gellis MB.

PMID: 8710983 [PubMed]

566: Indian J Exp Biol.  1996 Jan;34(1):61-5.  

Toxicological evaluation of mowrah (Madhuca latifolia Macbride) seed meal.

Cherian KM, Gandhi VM, Mulky MJ.

Environmental Safety Laboratory, Hindustan Lever Ltd, Bombay, India.

Mowrah (M. latifolia) seeds yield 40-50% edible fat and the meal contains
saponins besides protein and high level of carbohydrates. The toxicity of the
meal was evaluated as it has a potential for use in animal feedstuffs. The meal
was fed to young and adult rats at levels of 10 to 40% in diet. The animals
showed marked inhibition of feed intake and loss of body weight resulting in
mortalities. Histopathological examination revealed a gradation of damage from
slight erosion of the tip of villi of intestinal mucous membrane to complete
necrosis and destruction of it, with increasing amounts of mowrah seed meal in
diets. The other significant change was a severe vacuolar degeneration of kidney
tubular cells. Detoxification or complete removal of the toxins is necessary for
utilization of the meal as animal feedingstuff.

PMID: 8698410 [PubMed]

567: Pediatr Nephrol.  1995 Dec;9(6):753-5.  

Chylous ascites complicating neonatal peritoneal dialysis.

Melnick JZ, McCarty CM, Hunchik MP, Alexander SR.

Department of Pediatrics, University of Texas, Dallas 75235-9063, USA.

We report the development of chylous ascites in a neonate as an uncommon
complication during continuous peritoneal dialysis. Cloudy dialysis fluid
containing many white blood cells might confuse the diagnosis of chylous ascites
with infective peritonitis and result in inappropriate use of antibiotics.
Resolution may be critical, since chyle removal during dialysis may result in
profound immunosuppression and malnutrition due to lymphocyte and fat losses.
After 4 weeks on a modified diet, the chyle leak resolved. The patient returned
to breast milk and continues nighttime continuous-cycle peritoneal dialysis
without further chyle leak.

Publication Types:
    Case Reports

PMID: 8747121 [PubMed]

568: Cancer Lett.  1995 Nov 27;98(1):71-6.  

Enhancement of GST-P positive liver cell foci development by a medium-term
carcinogenicity bioassay using repeated administration of D-galactosamine.

Kim HC, Lee YS, Furukawa F, Nishikawa A, Takahashi M.

Toxicology Research Center, Korea Research Institute of Chemical Technology,
Yusongku, Daejon, South Korea.

This study was performed for developing a new medium-term carcinogenicity
bioassay treated with D-galactosamine (DGA) as a non-surgical method without
partial hepatectomy (PH). In male F344 rats initiated with diethylnitrosamine
(DEN, 200 mg/kg i.p.), enhancing effects of DGA (300 mg/kg i.p.) given twice 3
weeks apart during the promotion procedure with 2-acetylaminofluorene (2-AAF,
0.01% in diet) were compared along with those of PH by analyzing preneoplastic
glutathione S-transferase placental form positive (GST-P+) hepatocyte foci as
endpoint marker lesions. The DGA treatment did not affect the body weight gain
whereas the PH treatment caused a transient body weight loss. Although both
bioassay protocols were effective to detect the potential hepatocarcinogenicity
of 2-AAF, the number and area of GST-P positive foci per cm2 were larger in the
bioassay using DGA than in that using PH, the number being statistically
significant (P < 0.05). Our results thus suggest that the present bioassay
protocol with repeated administration of DGA instead of PH may offer a new and
sensitive method to screen large numbers of environmental carcinogens.

PMID: 8529208 [PubMed]

569: Aesthetic Plast Surg.  1995 Nov-Dec;19(6):505-9.  

Periorbital aesthetic surgery with the KTP laser.

Ginsbach G.

The eyes are regarded as the windows to the soul. Many expressions of mood may
be derived from the appearance of the eyes--mad, sad, bad, criminal, sweet,
friendly, mystic. In addition, love and flirtatiousness, self-consciousness,
pride, modesty, anger, youth, and age are shown in the expression of our eyes.
The eyes and the periorbital region therefore challenge our surgical skill to
improve the patient's overall well-being to be looked at each day in the mirror.
The potassium titanyl phosphate (KTP) laser in many indications helps us to
fulfill the patient's expectations concerning pain, oozing, bruising, swelling,
outpatient surgery, and early return to work and normal social activities. With
the cutting fiber device, an accurate removal of skin and fat or even tumors is
possible in this region with practically no side effects. The frontal lift,
eyebrow lift, direct or through coronal incision, as well as temporal lifting
are easily accessible and carried out by this device. Glabellar frowns may also
be removed endoscopically. Further, the KTP laser may be used for
transconjunctival blepharoplasty.

Publication Types:
    Case Reports

PMID: 8638485 [PubMed]

570: Int J Obes Relat Metab Disord.  1995 Sep;19 Suppl 3:S56-60.  

A critical review of a personal series of 1000 gastroplasties.

Desaive C.

Centre Hospitalier Universitaire de Liege, Belgium.

Introduction: In a world suffering from famine, it is paradoxical to find in
Belgium and in most Western countries a marked tendency to obesity. A recent
study has revealed that one Belgian out of five is overweight. The literature
has provided evidence that behaviour modification or dietary therapy do not
result in long term weight loss for severe obese. As a result, more and more
obese people are treated by surgery and we present here our personal experience
of bariatric surgery during the last eight years. All the surgical procedures
have been performed by a single surgeon as part of a multidisciplinary approach
that also involves internists, dieticians, psychiatrists and basic scientists.

PMID: 8581079 [PubMed]

571: Plast Reconstr Surg.  1995 Sep;96(4):990.  

Tattoo after the use of disposable liposuction cannula.

Uzunismail A.

Publication Types:
    Case Reports

PMID: 7652079 [PubMed]

572: Plast Reconstr Surg.  1995 Sep;96(3):620-6.  

Incidence of calcifications in the breast after surgical reduction and

Abboud M, Vadoud-Seyedi J, De Mey A, Cukierfajn M, Lejour M.

Department of Plastic Surgery, University Hospital Brugmann, Free University of
Brussels, Belgium.

Liposuction of the breast in combination with vertical mammaplasty was applied
to 250 breasts among 386 reductions of large breasts performed in 2 years (1989
to 1991). To evaluate the possible damage to the breast caused by this combined
procedure, especially in terms of the occurrence of the postoperative
development of calcifications, a comparative study of preoperative and
postoperative mammograms was undertaken in 60 randomly selected cases (120
breasts), 34 with and 26 without liposuction. Altogether, 13 calcifications (11
percent) were discovered during the 6- to 30-month follow-up, representing the
lowest rate reported in the literature. Deep intraparenchymal calcifications
were more frequent after liposuction; most (5 of 7) were macrocalcifications.
None could be confused with malignant calcifications because they were more
scattered, more regular, and less numerous. Attempts to evaluate the fat content
of breasts via preoperative mammography failed to prove this examination a
useful way to predict the viability of breast liposuction.

PMID: 7638286 [PubMed]

573: J Clin Oncol.  1995 Aug;13(8):2072-6.  

Comment in:
    Arch Neurol. 1996 Jan;53(1):57.

Recurrent chiasmatic-hypothalamic glioma treated with oral etoposide.

Chamberlain MC, Grafe MR.

Department of Neurosciences, University of California, San Diego, La Jolla
92093-0812, USA.

PURPOSE: Chiasmatic-hypothalamic gliomas are not amenable to surgical resection
and therefore are treated with either radiotherapy or chemotherapy. Here we
report the use of etoposide (VP-16) administered on a chronic oral schedule as a
novel chemotherapeutic approach. PATIENTS AND METHODS: Fourteen patients, aged 2
to 15 years, were treated with VP-16 after clinical and neuroradiographic tumor
progression. Thirteen patients had received prior radiotherapy, and 12 received
prior nitrosourea-based chemotherapy. VP-16 was administered orally, each cycle
consisting of 50 mg/m2/d on day 1 through 21 and 36 through 57. Clinical and
neuroradiographic evaluations were performed during days 58 through 72 before
initiation of each cycle of therapy. Complete blood counts were performed
weekly. RESULTS: Treatment-related complications included the following: partial
alopecia (seven patients); diarrhea (six); weight loss (five); neutropenia
(four); and thrombocytopenia (four). Three patients required transfusion (three
RBC; two platelet), and one patient required antibiotic treatment of neutropenic
fever. There were no treatment-related deaths. Fourteen patients were
assessable, five of whom demonstrated a radiographic response (one complete and
four partial); and three patients demonstrated stable disease, with a median
duration of response of 8 months. CONCLUSION: Chronic oral VP-16 is well
tolerated, produces modest toxicity, and has apparent activity in this small
cohort of patients with recurrent chiasmatic-hypothalamic gliomas.

Publication Types:
    Clinical Trial
    Duplicate Publication

PMID: 7636550 [PubMed]

574: J Am Coll Surg.  1995 Aug;181(2):160-4.  

Reversal of small intestinal bypass operations and concomitant vertical banded
gastroplasty: long-term outcome.

Economou TP, Cullen JJ, Mason EE, Scott DH, Doherty C, Maher JW.

Department of Surgery, University of Iowa College of Medicine, Iowa City, USA.

BACKGROUND: Long-term complications of jejunoileal bypass (JIB) have been
reported, prompting restoration of intestinal continuity and concomitant
performance of vertical banded gastroplasty (VBG) for weight control. The aim of
this study was to evaluate the presentation and reversal of JIB complications,
late complications, mortality, and long-term weight control in patients who have
undergone JIB reversal and concomitant VBG. STUDY DESIGN: From 1981 to 1994, 37
patients were treated for complications from JIB that included diarrhea (73
percent), arthritis (46 percent), malnutrition (22 percent), urolithiasis (19
percent), electrolyte disorders (19 percent), and lack of weight loss (8
percent). Four patients required preoperative parenteral nutrition to correct
protein and electrolyte imbalances. Surgical management of all 37 patients
included restoration of bowel continuity and VBG during the same operative
procedure. RESULTS: Postoperative complications occurred in 11 patients,
including prolonged ileus in seven patients, pancreatitis in three patients, and
infectious complications in two. There were no deaths. Late morbidity included
staple line dehiscence in four patients, incisional hernia in three patients,
and reversal of the VBG in one. All patients with diarrhea, malnutrition,
electrolyte disorders, and lack of weight loss had resolution of their symptoms,
while urolithiasis and arthritis resolved in 86 and 53 percent of patients,
respectively. In patients available for five-year follow-up evaluation, weight
changes were small, shifting from a preoperative weight of 87 +/- 19 to 90 +/-
19 kg at five years (mean +/- SD). CONCLUSIONS: Restoration of intestinal
continuity combined with VBG is a safe and effective operation that will reverse
most of the long-term complications of JIB and provide stable weight control for
up to five years.

PMID: 7627389 [PubMed]

575: J Vet Intern Med.  1995 Jul-Aug;9(4):272-6.  

Medical management of right dorsal colitis in 5 horses: a retrospective study

Cohen ND, Carter GK, Mealey RH, Taylor TS.

Department of Large Animal Medicine and Surgery, College of Veterinary Medicine,
Texas A&M University, College Station 77843-4475, USA.

Right dorsal colitis in horses has been associated with administration of
phenylbutazone. Although reports of right dorsal colitis in this species have
described surgical treatment associated with a poor prognosis, we have had
success treating this condition medically. This report describes 5 horses with
right dorsal colitis confirmed during celiotomy that were initially managed
medically. All horses had a history of intermittent abdominal pain; weight loss
was noted in only 1 horse. The doses (2.0 to 4.6 mg/kg PO bid) and duration (5
to 30 days) of administration of phenylbutazone were not unusually high relative
to those recommended (4.4 mg/kg PO bid). Hypoproteinemia and hypoalbuminemia
were observed in all horses at the time of admission; packed cell volume was low
in 4 horses, and hypocalcemia was also observed in 4 horses. Three of 5 horses
(60%) appeared to respond to dietary management and discontinuation of
administration of nonsteroidal anti-inflammatory drugs. Dietary management
consisted of feeding pelleted feed, and restricting or eliminating roughage for
a period of at least 3 months. Two horses developed strictures of the right
dorsal colon. One horse that developed a colonic stricture, possibly because its
owners did not comply with recommendations for management, was subsequently
treated surgically. The remaining horse that developed a stricture of the right
dorsal colon was euthanized. These data indicate that some horses with right
dorsal colitis can be successfully managed with medical treatment.

PMID: 8523325 [PubMed]

576: Hinyokika Kiyo.  1995 Jul;41(7):553-6.  

[Post-TUR-P stress urinary incontinence successfully treated by periurethral
injection of autologous fat to the prostate: a case report]

[Article in Japanese]

Ishizaka K, Koga H, Kamata S, Nagamatsu H, Yamada T.

Department of Urology, Tokyo Medical and Dental University School of Medicine.

A 77-year-old man had been suffering from stress urinary incontinence for 2
years since he had received transurethral resection of prostate (TUR-P) for
benign prostatic hypertrophy. A 60-min pad test yielded 3 g of urine. Prostatic
urethra was widely open and the external sphincteric injury was suggested
because of the short membraneous urethra on the urethrogram. Urethral pressure
profile indicated his maximal urethral closing pressure (MUCP) of 24 cmH2O and
functional urethral length of 1.6 cm and cystometry demonstrated an underactive
bladder, indicating that his incontinence was caused by sphincteric injury.
Autologous fat injection therapy was performed in the lithotomy position under
spinal anesthesia. Fifteen ml of subcutaneous fat was obtained from his lower
abdomen by liposuction through a 15G needle, and 10 ml was injected submucosally
from the perineum at 6 o'clock area of the prostatic apex under the guidance of
transrectal echography using a 15G needle. The patient became completely dry
after the procedure. MUCP and FUL increased to 35 cmH2O and 1.9 cm,
respectively, although longer follow up is necessary. The advantage of
autologous fat injection to the prostate for post-TUR-P SUI patients is briefly

Publication Types:
    Case Reports

PMID: 7545351 [PubMed]

577: Aesthetic Plast Surg.  1995 Jul-Aug;19(4):379-80.  

Comment in:
    Aesthetic Plast Surg. 1998 Nov-Dec;22(6):399-400.

Wetting solutions in aspirative lipoplasty: a plea for safety in liposuction.

Fodor PB.

Publication Types:

PMID: 7484477 [PubMed]

578: Aesthetic Plast Surg.  1995 Jul-Aug;19(4):335-9.  

Viability of fat obtained by syringe suction lipectomy: effects of local
anesthesia with lidocaine.

Moore JH Jr, Kolaczynski JW, Morales LM, Considine RV, Pietrzkowski Z, Noto PF,
Caro JF.

The results of transplantation of free autologous fat obtained by blunt syringe
suction lipectomy are unpredictable. We examined if adipose tissue viability is
compromised by using syringe suction lipectomy and by infiltration of the tissue
with local anesthetics. As reference, we used adipose tissue samples excised
during elective surgery. Fat obtained intraoperatively and by lipectomy was
digested with collagenase to isolate adipocytes. The mechanical damage
associated with sample handling and cell isolation in both procedures was
similar and did not exceed 6% of the total cell mass. In addition, cells
isolated from intraoperative and lipectomy samples did not differ functionally,
responded similarly to insulin stimulation of glucose transport and
epinephrine-stimulated lipolysis, and retained the same growth pattern in
culture. Since during fat transplantation the graft is exposed to local
anesthetics at both the donor and the recipient sites, we reexamined adipocyte
function in the presence of lidocaine. Lidocaine potently inhibited glucose
transport and lipolysis in adipocytes and their growth in culture. That effect,
however, persisted only as long as lidocaine was present; after washing, the
cells were able to fully regain their function and growth regardless of whether
the exposure was as short as 30 minutes or as long as 10 days. These results
indicate that adipose tissue obtained by syringe lipectomy consists of fully
viable and functional adipocytes, but local anesthetics may halt their
metabolism and growth.

PMID: 7484471 [PubMed]

579: Recenti Prog Med.  1995 Jun;86(6):220-5.  

[Ultrasonic suction lipectomy. A mini-invasive treatment of obesity]

[Article in Italian]

Palmieri B, Bosio P, Catania N, Gozzi G.

Cattedra di Semeiotica Chirurgica, Universita, Modena.

The safety of ultrasounds lipolysis in the treatment of local obesity and
lipodystrophies versus suction lipectomy (less blood loss because of a lower
impact on blood vessels network, and less mortality) induced us to combine these
mini-invasive techniques in the treatment of obese patients. Between 1991 and
1994 we treated 205 patients (146 females, 59 males, 18-59 range age), affected
by 1st degree obesity (44.4%), 2nd degree obesity (27.3%) and 3rd degree obesity
(28.3%), accordingly to the following schedule: 1) general anesthesia; 2)
subdermal infiltration of the operating sites of a cold sodium chloride (0.9%)
epinephrine solution (1:10(5), 8 degrees C); 3) 0.5 cm cutaneous incisions; 4)
introduction of titanium tips as ultrasounds source; 5) insertion of suction
lipectomy probes to remove the adipose tissue destroyed by ultrasounds; 6)
drainage of the wide subcutaneous space; 7) setting of elastic bandages.
Mortality was zero and very low side effects have been observed. We report an
improvement of blood glucose and triglycerides level and blood pressure 30 days
after surgery. Fair late postoperative improvement of the blood glucose
tolerance test have been seen in 3 cases.

PMID: 7624580 [PubMed]

580: Scand J Plast Reconstr Surg Hand Surg.  1995 Jun;29(2):161-5.  

Blood loss during suction-assisted lipectomy with large volumes of dilute

Samdal F, Amland PF, Bugge JF.

Department of Plastic Surgery, Norwegian National Hospital, University Hospital
of Oslo.

The amount of blood lost during liposuction with the "dry" or classic "wet"
techniques has been a cause for concern. In the present study 26 consecutive
patients who underwent syringe-assisted liposuction with the "superwet" or
"tumescent" technique had their blood loss recorded prospectively. The mean (SD)
volume aspirated was 2448 (1368) ml and the mean (SD) drop in haemoglobin
concentration was 11 (7) g/l. The haemoglobin concentration was measured in both
the fluid and the fat fraction of the aspirate, and the mean (SD) amount of
whole blood was 16.5 (9.3) ml/litre of aspirate. The present study shows that
blood loss is considerably reduced when the "super-wet" or "tumescent" technique
is used, compared with the reported amount lost by authors who used the "dry" or
classic "wet" techniques.

PMID: 7569814 [PubMed]

581: Nippon Sanka Fujinka Gakkai Zasshi.  1995 May;47(5):457-64.  

[Changes in natural killer (NK) activity and fertility during the establishment
of experimental endometriosis in the rat]

[Article in Japanese]

Ishikawa N.

Department of Obstetrics and Gynecology, National Defense Medical College,

We examined the effect of experimental endometriosis (EE) on natural killer (NK)
activities and fertilizability in the rat. EE was induced by autotransplantation
of an endometrial fragment to the peritoneal wall. As a sham, abdominal fat
tissue was implanted in the same way. NK activities of spleen cells were
measured by means of a 4-hr 51Cr-release assay. Results: (1) NK activities were
significantly lower in EE than those in the sham (p < 0.001). (2) NK activity
was recovered by surgical excision of the endometrial implant, but not increased
by the administration of Danazol (100 mg/kg/day) or Buserelin (25
micrograms/kg/day) for 4 weeks. (3) The supernatant of endometriotic tissue
cultures markedly suppressed NK activity. (4) The number of pups with EE was
significantly smaller than in the controls (p < 0.05), but no difference between
the two groups was observed in the number of oocytes in the Fallopian tube.
Conclusion: (1) Splenic NK activity decreases at the time of the establishment
of EE. (2) NK activity recovers after the removal of the implanted tissue. (3)
Danazol and Buserelin have no effect on the NK activity in EE. (4) EE reveals
some adverse effects on the postovulatory phase of fertility.

PMID: 7775812 [PubMed]

582: Dermatol Surg.  1995 May;21(5):459-62.  

Safety of tumescent liposuction in 15,336 patients. National survey results.

Hanke CW, Bernstein G, Bullock S.

Department of Dermatology, Indiana University School of Medicine, Indianapolis,

BACKGROUND. Tumescent liposuction is a new method of liposuction under local
anesthesia that has been developed by dermatologic surgeons. OBJECTIVE. To
determine the safety of tumescent liposuction in a large group of patients
treated by dermatologic surgeons. METHODS. A survey questionnaire was sent to
1,778 Fellows of the American Society for Dermatologic Surgery in February 1994.
The comprehensive questionnaire requested information on numbers of patients
treated with tumescent liposuction and complications that occurred. RESULTS.
Sixty-six dermatologic surgeons provided data on 15,336 patients. The
complications that were reported were infrequent and minor. There were no
serious complications such as death, embolism (pulmonary or fat), hypovolemic
shock, perforation of peritoneum or thorax, or thrombophlebitis. Blood
transfusions were not required in any of the 15,336 patients and there were no
admissions to the hospital for treatment of complications. CONCLUSIONS.
Tumescent liposuction is an exceptionally safe method of liposuction under local
anesthesia that eliminates the necessity of general anesthesia and blood
transfusions. Tumescent liposuction is safer than liposuction under general
anesthesia and results in fewer complications.

PMID: 7743109 [PubMed]

583: Arch Neurol.  1995 May;52(5):509-13.  

Comment in:
    Arch Neurol. 1996 Jan;53(1):57.

Recurrent chiasmatic-hypothalamic glioma treated with oral etoposide.

Chamberlain MC.

Department of Neurosciences, University of California-San Diego, USA.

BACKGROUND: Chiasmatic-hypothalamic gliomas are not amenable to surgical
resection and therefore are treated with either radiotherapy or chemotherapy.
Etoposide (VP-16), administered on a long-term oral schedule, represents a novel
chemotherapeutic approach. PATIENTS AND METHODS: Fourteen patients (age range, 2
to 15 years) were treated with etoposide following tumor progression as
determined by clinical and neuroradiographic examinations. Thirteen patients had
received prior radiotherapy, and 12 received prior nitrosourea-based
chemotherapy. Etoposide was administered orally; each cycle consisted of 50
mg/m2 per day on days 1 to 21 and days 36 to 57. Clinical and neuroradiographic
examinations were performed from days 58 to 72 prior to the start of each cycle
of therapy. Complete blood cell counts were performed weekly. RESULTS:
Treatment-related complications included partial alopecia (n = 7), diarrhea (n =
6), weight loss (n = 5), neutropenia (n = 4), and thrombocytopenia (n = 4).
Three patients required a transfusion (ie, red blood cell [n = 3] and platelet
[n = 2] transfusions), and one patient required antibiotic treatment of
neutropenic fever. There were no treatment-related deaths. Fourteen patients
were evaluable; in eight of these 14 patients, a response was demonstrated
radiographically (complete response [n = 1], partial response [n = 4], and
stable disease [n = 3]), with a median duration of response of 8 months.
CONCLUSIONS: Long-term treatment with oral etoposide was well tolerated by the
patients in this study, and etoposide was a relatively nontoxic chemotherapeutic
agent with apparent activity in this small cohort of patients who had recurrent
chiasmatic-hypothalamic gliomas.

Publication Types:
    Clinical Trial
    Duplicate Publication

PMID: 7733847 [PubMed]

584: Dtsch Med Wochenschr.  1995 Apr 21;120(16):560-4.  

[Iatrogenic esophageal perforation in inoperable esophageal carcinoma. Its
therapy with a plastic-coated metal stent]

[Article in German]

Hoppe M, Wagner HJ, Klose KJ.

Abteilung fur Strahlendiagnostik, Medizinisches Zentrum fur Radiologie,
Universitat, Marburg.

A 60-year-old man was admitted to hospital because of severely impaired
swallowing, retrosternal pain and marked weight loss. History and physical
examination of the patient, whose general condition was obviously much reduced,
pointed to carcinoma of the oesophagus. Contrast-medium swallow demonstrated
subtotal stenosis in the oesophagus. Computed tomography and magnetic resonance
imaging showed a space-occupying mass originating from the oesophagus, in close
relationship to the trachea, main bronchi and descending aorta. Biopsy confirmed
the diagnosis of oesophagus carcinoma and exploratory thoracotomy excluded
curative surgical treatment. An attempt was made to introduce a feeding tube
endoscopically to provide nutritional palliation. But the oesophagus was
perforated during this manoeuvre and resulted in an oesophagobronchial fistula
with subsequent mediastinitis and mediastinal emphysema. Using a self-expandable
plastic-covered metal stent it was possible to cover the perforation and
overcome the patient's dysphagia. The mediastinitis healed under intravenous
administration of cefotaxim (2 g three times daily), netilmicin (400 mg daily)
and metronidazole (500 mg three times daily), for 5 days.

Publication Types:
    Case Reports
    Review of Reported Cases

PMID: 7736946 [PubMed]

585: Med Econ.  1995 Apr 24;72(8):18-9, 23-4, 29 passim.  

Are your pockets $15 million deep?

Rice B.

PMID: 10141909 [PubMed]

586: Plast Reconstr Surg.  1995 Apr;95(5):829-36.  

Liposuction as an adjunct to a full abdominoplasty.

Matarasso A.

The safety and locations for liposuction over the aesthetic unit of the abdomen
in situations where a full (type IV) abdominoplasty was combined with
liposuction were studied. The locations were determined based on the axial- and
random-pattern blood supplies of the anterior abdominal wall. By using these
areas and technical guidelines to enhance success, the combined procedures were
undertaken in a consecutive series of patients. The efficacy of the procedures
was assessed by patient acceptance and by the difference in the incidence of
complications from an abdominoplasty alone group. The complication rates of the
two groups were found to be similar, although it was ascertained that medically
higher-risk situations, smoke exposure, and disregard for interacting vascular
territories were detrimental to combined surgery. In addition, four suction
areas (SA 1-4) were delineated, and the results suggested that certain areas are
more reliable than others, that each suction area interacts with and affects
neighboring areas, and that these are germane in preoperative planning. A
risk-profile classification was established, and this proved beneficial for
initial patient screening.

Publication Types:
    Clinical Trial
    Controlled Clinical Trial

PMID: 7708866 [PubMed]

587: Eur J Pharmacol.  1995 Mar 16;292(3-4):277-85.  

Modulation of TCDD-induced wasting syndrome by portocaval anastomosis and
vagotomy in Long-Evans and Han/Wistar rats.

Tuomisto J, Andrzejewski W, Unkila M, Pohjanvirta R, Linden J, Vartiainen T,
Tuomisto L.

Department of Toxicology, National Public Health Institute, Kuopio, Finland.

Portocaval anastomosis and vagotomy operations were performed in Long-Evans
(L-E) and Han/Wistar (H/W) rats to elucidate the mechanism of anorexia induced
by TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin). TCDD-sensitive L-E rats were
given a sublethal (5 micrograms/kg) or a lethal dose (20 micrograms/kg) by
gavage 5-8 weeks after portocaval anastomosis. TCDD-resistant H/W rats were
given a nonlethal dose (500 or 7200 micrograms/kg). The shunt operation did not
reduce lethality from TCDD. The effect on wasting of the marginally toxic dose
of 5 micrograms/kg in L-E rats was potentiated by the portocaval operation, and
the lethal dose was effective in both shunted and sham-operated L-E rats. TCDD
failed to decrease food intake and body weight in shunted rats of H/W strain at
either dose level though it did so in sham-operated controls. The lack of effect
may be due to the already reduced weight of shunted rats at the time of TCDD
dosing. TCDD anorexia was not explained by changes in histamine or serotonin
(5-HT) turnover in the brain. Vagotomy did not influence lethality after TCDD,
although reduction in food intake was somewhat blunted in H/W rats. The results
seem to indicate that the anorectic effect of TCDD is modified when portal blood
bypasses the liver. The mechanisms remain to be elucidated in detail, but the
results do not favor the role of liver as the only or the major initiator of
TCDD anorexia. Little evidence was found to support a crucial role of vagal
afferent input.

PMID: 7796867 [PubMed]

588: Plast Reconstr Surg.  1995 Mar;95(3):603-5.  

Comment on:
    Plast Reconstr Surg. 1993 Nov;92(6):1085-98; discussion 1099-100.

Tumescent technique with local anesthesia for liposuction.

Stone A.

Publication Types:

PMID: 7870797 [PubMed]

589: Nutr Hosp.  1995 Mar-Apr;10(2):110-4.  

[Surgical jejunostomy as a route for enteral nutrition]

[Article in Spanish]

Bertullo H, Olano E, Ferradas A, Barrial N, Tihista S.

Unidad de Nutricion, Centro de Asistencia del Sindicato Medico, Montevideo,

Ostomies are the nutritional route of choice when artificial nutrition could be
necessary during more than thirty days. The surgical jejunostomy (SJ) is
especially indicated in the patient undergoing major surgery of the digestive
tract and the complications thereof. The present retrospective revision includes
57 cases of SJ followed during more than five days. The patients needed surgical
treatment in nearly 80%. For the SJ the Witzel technique was used, with 18 Fr or
more catheters. The mixes used were polymeric, in a closed circuit. The patients
were a mean 60 +/- 13 years of age and 68.4% were male. They presented a medium
level of undernourishment, with a 13% weight loss and a mean albumin level of
30.6 +/- 6.8 g/1000 cc. The Index of Nutritional Risk on average was 71.7
(normal 100). Complications appeared in 9/57 cases (15.7%), with the jejunostomy
beginning to be used on average 2.3 +/- 2.4 days after surgery. Some form of
support previous to the SJ was necessary in 31/57 patients, and 37/57 had
another nutritional route in addition to the jejunostomy during an average of
8.9 +/- 11.1 days. In 49/57 patients (85.9%), 75% of the estimated calories were
obtained in an average of 6.4 +/- 4.0 days, and in 42/57 patients (73.6%), 100%
of the calories were obtained in an average of 8.6 +/- 3.0 days. Intolerance to
the artificial nutrition occurred in 29/57 cases (50.8%), with diarrhoea being
the most frequent in 16/57 (28.0%). The jejunostomy lasted for a mean of 28.4

PMID: 7756387 [PubMed]

590: Scand J Plast Reconstr Surg Hand Surg.  1995 Mar;29(1):1-8.  

Syringe-assisted microliposuction for cervical rejuvenation. A five year

Samdal F, Amland PF, Abyholm F.

Department of Plastic Surgery, Norwegian National Hospital, Oslo.

During a five year period, 71 patients (age range 24-72 years) underwent
syringe-assisted liposuction of the neck as the only operation for facial
rejuvenation. The patients were seen after one week and three months, and 66
patients were re-examined 5-58 months (mean 31) postoperatively. There were no
complications except for slight skin laxity (n = 10), transient hypoaesthesia,
and temporary subcutaneous scarring (nodules). In some patients improvement
occurred more than 12 months post-operatively. The patients evaluated the result
according to a four grade scale; very satisfied (n = 41), satisfied (n = 21),
less satisfied (n = 4), and dissatisfied (n = 1). All patients except one would
recommend the procedure to other patients with similar problems. We conclude
that syringe-assisted liposuction of the neck is a simple, safe, and rewarding
procedure even in many elderly patients.

PMID: 7597384 [PubMed]

591: Int J Radiat Oncol Biol Phys.  1995 Jan 15;31(2):261-6.  

Radical radiotherapy for early nonsmall cell lung cancer.

Graham PH, Gebski VJ, Langlands AO.

Department of Radiation Oncology, Westmead Hospital, NSW, Australia.

PURPOSE: To evaluate the results of a departmental treatment policy in a
consecutive series of patients with nonsmall cell carcinoma of the lung. A
second purpose was to estimate the survival of patients treated with radical
intent. A third purpose was to estimate the impact of comorbidity on the
selection of patients for treatment and on its outcome. METHODS AND MATERIALS:
The records of 720 consecutive patients referred to a single Department of
Radiation Oncology between 1979 and 1985 were reviewed. One hundred fifty
patients with early stage (Stage I and II disease) were studied in detail and
the results are presented for the outcome of 103 patients treated by radical
radiotherapy. All patients were followed for a minimum period of five years or
until death. RESULTS: Patients referred for radiation therapy were elderly and
usually had squamous cell carcinoma of the lung. Comorbidity was significant as
was weight loss which occurred in a third of patients. The overall survival of
patients treated with radical intent was 13%. In a small subgroup of patients
with T1 tumors without weight loss and aged under 70 survival reached 50% at 5
years with no treatment-related mortality and with insignificant
treatment-related morbidity. CONCLUSION: Highly selected subsets of patients
suitable for treatment with radiotherapy can be defined equally as well as
highly selected subsets of patients can be selected for surgery. Treatment
outcome can be surprisingly good in these subsets indicating that the treatment
of nonsmall cell lung cancer, particularly in older patients without comorbidity
should not automatically be by a surgical approach.

PMID: 7836078 [PubMed]

592: Magn Reson Med.  1995 Jan;33(1):8-17.  

Migration and accumulation of silicone in the liver of women with silicone
gel-filled breast implants.

Pfleiderer B, Garrido L.

NMR Center, Department of Radiology, Massachusetts General Hospital, Charlestown

1H NMR localized spectroscopy (STEAM), combined with echocardiography (ECG),
respiratory gating, and water and fat suppression, was used to quantify silicone
concentrations in the liver of women with silicone gel-filled breast implants.
Localized spectroscopy was performed on 15 patients with silicone gel-filled
breast prostheses and on eight volunteers with no implants. The 1H spectra in
the liver of patients showed silicone resonances from 0.3 to -0.8 ppm,
attributable to protons in the methyl groups of silicone. The presence of
silicone in the liver could first be detected 3-4 years after breast prostheses
implantation. No correlation between silicone concentrations and implantation
times was observed. However, our results indicated that silicone concentrations
may reflect implant integrity: detectable silicone concentrations in the liver
appeared to be higher when the implants were ruptured than when the implants
appeared intact. Moreover, new resonances in the range of -2.6 to -4 ppm were
observed in most patients after long-term implantation. As these species
increase with implantation time, the new resonances may reflect chemically
changed silicone (paramagnetically shifted silicon complexes bound to iron)
accumulated over time. The sensitivity of 1H NMR localized spectroscopy is
sufficient to detect silicon concentrations as low as 0.20 mM. Results from one
patient whose implants had been removed 14 months prior to the NMR examination
showed no detectable silicone in the liver, indicating that it may have been
excreted via bile or degraded to silica and high coordinated silicon complexes.
Quantitative 1H localized spectroscopy of the liver in women with silicone
gel-filled breast implants may provide valuable information concerning silicone
accumulation and degradation in vivo, as well as about the kinetics of its
elimination from the body after implant removal.

PMID: 7891539 [PubMed]

593: Ann Surg.  1994 Dec;220(6):782-90.  

Weight loss and dietary intake after vertical banded gastroplasty and Roux-en-Y
gastric bypass.

Brolin RL, Robertson LB, Kenler HA, Cody RP.

Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick.

OBJECTIVE. The purpose of this study was to learn whether preoperative eating
habits can be used to predict outcome after vertical banded gastroplasty (VBG)
and Roux-en-Y gastric bypass (RYGB). BACKGROUND SUMMARY. Several independent
randomized and sequential studies have reported significantly greater weight
loss after RYGB in comparison with VBG. Although the mechanism responsible for
weight loss after both procedures is restriction of intake rather than
malabsorption, the relationships between calorie intake, food preferences, and
postoperative weight loss are not well defined. METHODS. During the past 5
years, 138 patients were prospectively selected for either VBG or RYGB, based on
their preoperative eating habits. All patients were screened by a dietitian who
determined total calorie intake and diet composition before recommending VBG or
RYGB. Thirty patients were selected for VBG; the remaining 108 patients were
classified as "sweets eaters" or "snackers" and had RYGB. Detailed recall diet
histories also were performed at each postoperative visit. RESULTS. Early
morbidity rate was zero after VBG versus 3% after RYGB. There were no deaths.
Mean follow-up was 39 +/- 11 months after VBG and 38 +/- 14 months after RYGB.
Mean weight loss peaked at 74 +/- 23 lb at 12 months after VBG and 99 +/- 24 lb
at 16 months after RYGB (p < or = 0.001). Twelve of 30 VBG patients lost > or =
50% of their excess weight versus 100 of 108 RYGB patients (p < or = 0.0001).
Milk/ice cream intake was significantly greater postoperatively in patients who
underwent VBG versus patients who underwent RYGB after 6 months (p < or =
0.003), whereas solid sweets intake was significantly greater after VBG during
the first 18 months postoperatively (p < or = 0.004). Revision of VBG was
performed in 6 of 30 patients (20%) for complications or poor weight loss,
whereas only 2 of 108 patients who underwent RYGB required surgical revisions (p
< or = 0.001). CONCLUSIONS. These data show that VBG adversely alters
postoperative eating behavior toward soft, high-calorie foods, resulting in
problematic postoperative weight loss. Conversely, RYGB patients had
significantly greater weight loss despite inferior preoperative eating habits.
The high rate of surgical revision in conjunction with inconsistent
postoperative weight loss has led us to no longer recommend VBG as treatment for
morbid obesity.

Publication Types:
    Clinical Trial

PMID: 7986146 [PubMed]

594: Ann Chir Plast Esthet.  1994 Dec;39(6):744-9.  

[Liposuction as a help for radiologists. Technical note]

[Article in French]

Vanwijck R, Lengele B.

Service de Chirurgie Plastique et de Microchirurgie Reconstructrice, Cliniques
Universitaires Saint-Luc, Bruxelles, Belgique.

Based on a series of eight cases of severe extravasations of contrast medium
injected under pressure, the authors suggest the use of liposuction for the
elimination of the toxic agent and of the infiltrated cellular tissue. If
applied promptly, this simple and semi-conservative treatment salvages the skin
and prevents the development of scar sequelae of the soft tissues.

Publication Types:
    Case Reports

PMID: 7661557 [PubMed]

595: Nutr Clin Pract.  1994 Dec;9(6):247-50.  

Erratum in:
    Nutr Clin Pract 1995 Apr;10(2):79.

Possible folate deficiency with postsurgical infection.

Stolzenberg R.

A 51-year-old obese woman was transferred to our hospital for management of a
complicated laparoscopic cholecystectomy accompanied by fever and malaise. A
liver abscess was discovered. On postoperative day 52 it was noted that the
patient's tongue was magenta and sore and that she had altered taste, pallor,
severe weight loss, diarrhea, and poor appetite and mood. A dermatology consult
suggested that her tongue abnormalities were most likely nutrition-related, and
a hematologic blood smear was suggestive of folate deficiency. Premorbidly, the
patient had consumed a diet chronically low in folate and had received estrogen
therapy for 15 years. Throughout the patient's hospitalization, she had bouts of
fever and received numerous antibiotics. Within a month of initiating nutrition
support and vitamin/mineral supplements, her nutritional status improved
dramatically. This patient's poor diet, long-term estrogen use, surgical stress,
infection, and lack of early nutrition support may have contributed to her
possible folate deficiency and her prolonged hospital stay.

Publication Types:
    Case Reports

PMID: 7476802 [PubMed]

596: Urology.  1994 Nov;44(5):783-8.  

Perianastomotic injection of autologous fat at the time of radical retropubic

Lepor H, Guerena M, Dixon CM.

Department of Urology, New York University School of Medicine, New York.

OBJECTIVES. The present study represents the first attempt to improve urinary
continence following radical prostatectomy (RP) by perianastomotic injection of
autologous fat at the time of the surgical procedure. METHODS. A total of 15
consecutive men with clinically localized carcinoma of the prostate underwent
nerve-sparing radical retropubic prostatectomy (RRP) with perianastomotic
injection of autologous fat. The autologous fat was obtained using a liposuction
cannula connected to a power aspirator. The fat was harvested from the adipose
tissue immediately adjacent to the lower midline incision. After the pelvic
floor musculature was perforated, a total of 30 mL of autologous fat was
injected through a 12 gauge angiocatheter under cystoscopic guidance. RESULTS.
There were no complications resulting from the harvesting or injection of the
autologous fat. All of the patients were evaluated for 6 months. Of the 15
patients, 12 (80%) achieved total urinary control within 6 months. The average
time required to achieve total urinary continence was 89 days. None of the
patients experienced total or nocturnal incontinence. Of the 3 patients with
stress urinary incontinence (SUI), 2 required 2 small pads per day and 1
required 3 pads per day. Only 1 patient reported that the level of bother
resulting from the incontinence was severe. CONCLUSIONS. The preliminary
experiences with the perianastomotic fat injection at the time of RRP are
encouraging. Determining the ultimate safety and effectiveness of this technique
requires longer follow-up in expanded series of patients.

Publication Types:
    Clinical Trial
    Review, Multicase

PMID: 7974959 [PubMed]

597: Ann Chir Plast Esthet.  1994 Oct;39(5):623-45.  

[Cervical face lift]

[Article in French]

Thion A.

In the context of cervical facelift, classical techniques, constituting the
basis for current techniques or still in use, are described in terms of the
incisions, detachments and treatment of the deep adipose, muscular and glandular
planes. The author then describes the technique commonly used in modern cervical
restructuration before describing the possible complications and defects.

PMID: 7771748 [PubMed]

598: Dis Colon Rectum.  1994 Sep;37(9):890-6.  

Perineal wound management after abdominoperineal rectal excision for carcinoma
with unsatisfactory hemostasis or gross septic contamination: primary closure
vs. packing. A multicenter, controlled trial. French Association for Surgical

Delalande JP, Hay JM, Fingerhut A, Kohlmann G, Paquet JC.

PURPOSE: This study was designed to compare the results of two methods on the
rate of postoperative perineum healing. PATIENTS AND METHODS: In this
prospective, randomized, multicenter trial of 234 consecutive patients
undergoing abdominoperineal rectal excision for carcinoma, 48 had unsatisfactory
hemostasis or intraoperative gross septic contamination. Three patients were
withdrawn because of protocol violation. Of the 45 remaining patients, 21 were
randomized to undergo primary closure of the perineum with drainage while 24
underwent packing. Preoperative factors (sex, age, degree of obesity, weight
loss, anemia, or presence of ascites), intraoperative findings (Dukes stage,
degree of hemostasis, gross septic contamination), and postoperative oncologic
courses (recurrence, mortality rate) were similar in both groups. All patients
were followed for at least 12 months or until their demise. RESULTS: There was
no significant difference in the number of early (one vs. zero) or late (five
vs. four) deaths between primary closure and packing groups, respectively.
Median duration of hospital stay was 25 and 27 days, respectively. Primary
closure was associated with a significantly higher rate of healed perineums at
one month (30 percent vs. 0 percent) (P = 0.01) and a shorter delay to complete
cicatrization (median, 47 vs. 69 days) (P < 0.01). From three months onward,
there was no difference in healing between the two groups, but two patients in
the packing group had not healed at one year. Conversely, hematoma, perineal
abscess, and reoperations were significantly more frequent (P < 0.01) in the
primary closure group. CONCLUSION: Primary closure associated with drainage
after abdominoperineal resection for carcinoma expedites perineal healing but
morbidity is higher.

Publication Types:
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial

PMID: 8076488 [PubMed]

599: Ann Plast Surg.  1994 Aug;33(2):209-10.  

Transverse rectus abdominis musculocutaneous flaps after liposuction of the

Godfrey PM, Godfrey NV.

Department of Surgery, St. Vincent's Hospital and Medical Center, New York, NY.

We describe a patient for whom bilateral transverse rectus abdominis
musculocutaneous flap breast reconstruction was successfully accomplished
several years after liposuction of the lower abdominal tissues making up the
flaps. A history of liposuction within the area of a proposed musculocutaneous
flap does not preclude use of that flap. Issues related to flap elevation in
sites of previous liposuction are discussed.

Publication Types:
    Case Reports

PMID: 7979056 [PubMed]

600: Dermatol Nurs.  1994 Aug;6(4):239-45; quiz 245-6.  

Liposuction: a surgical intervention to improve body contour.

Bergmann KS, Johannsen LL.

Liposuction surgery continues to gain popularity despite adverse media
attention. The advent of syringe-assisted liposuction is replacing suction
machines, offering a more precise surgical technique as well as fewer risks and
predictable results. However, aligning patient expectations with realistic goals
continues to challenge health professionals involved in the emerging field of
cosmetic dermatologic surgery.

PMID: 7946843 [PubMed]

601: Br J Anaesth.  1994 Jun;72(6):702-4.  

Use of liposuction and saline washout for the treatment of extensive
subcutaneous extravasation of corrosive drugs.

Martin PH, Carver N, Petros AJ.

Cardiac Intensive Care Unit, Royal Liverpool Children's NHS Trust.

We report a case of extensive subcutaneous extravasation of corrosive drugs used
during cardiac resuscitation, in a neonate undergoing cardiac catheterization.
Early management with hyaluronic acid, liposuction and saline washout of the
extravasated fluid prevented development of any tissue damage. This simple
technique was easy to use and extremely effective.

Publication Types:
    Case Reports

PMID: 8024922 [PubMed]

602: J Surg Res.  1994 May;56(5):452-6.  

The roles of nutritional depletion and drug concentration in
5-fluorouracil-induced inhibition of colonic healing.

Graf W, Weiber S, Jiborn H, Pahlman L, Glimelius B, Zederfeldt B.

Department of Surgery, Akademiska sjukhuset, Uppsala, Sweden.

This study was performed to investigate whether poor nutrition is responsible
for 5-fluorouracil (5-FU)-induced inhibition of large bowel healing and if the
concentration of intraperitoneal (ip) 5-FU affects anastomotic healing. Male
Wistar rats underwent a left colonic resection and were randomly assigned to a
control group (n = 9, ip NaCl, normal diet), a nutritional depletion group (n =
12, ip NaCl, restricted diet), or a 5-FU group (n = 12, ip 5-FU, normal diet).
Treatment was started immediately after surgery and continued until sacrifice
after 7 days. Although the weight loss in the nutritional depletion group
exceeded that in the 5-FU group, the anastomotic and skin breaking strength was
lower in the latter group compared with that in the former group (P < 0.01 and P
< 0.05, respectively). There were no significant differences in breaking
strength between the nutritional depletion group and controls. A second series
of male Wistar rats were similarly operated on and randomly assigned to a
control group (n = 6, ip NaCl), a 5-FU high-concentration group (n = 10, (5
mg/ml ip 5-FU) or a 5-FU low-concentration group (n = 10, (1 mg/ml ip 5-FU). The
5-FU dose was the same in the two latter groups. The anastomotic breaking
strength on Day 7 was reduced to a similar extent in the 5-FU groups (P < 0.01).
These results indicate that the impaired anastomotic healing after ip 5-FU is
not mainly due to nutritional factors or drug concentration.

PMID: 8170146 [PubMed]

603: Plast Reconstr Surg.  1994 Apr;93(5):907-12.  

The health status of women following cosmetic surgery.

Wells KE, Cruse CW, Baker JL Jr, Daniels SM, Stern RA, Newman C, Seleznick MJ,
Vasey FB, Brozena S, Albers SE, et al.

Department of Surgery, University of South Florida College of Medicine, Tampa.

A retrospective study was performed to determine the frequency of new symptoms
and diseases after silicone breast implantation. Questionnaires were mailed to
826 women who made up a breast implant group (n = 516) and a control group who
had undergone blepharoplasty (n = 124), liposuction (n = 111), or rhinoplasty (n
= 75). Responses were obtained from 370 women (45 percent); however, 68 of these
patients (18 percent) were considered ineligible. The overall response rate was
59 percent for the breast implant group and 46 percent for controls. The 302
eligible women included patients with silicone breast implants (n = 222) and
controls (n = 80). Women with implants were significantly younger than controls,
the median age of women with breast implants being 37 years compared with 46.5
years for controls (p < 0.0001). We compared the incidence of 23 symptoms and 4
connective-tissue diseases after cosmetic surgery in the two groups. The
symptoms of swollen glands under arms (p < 0.05) and tender glands under arms (p
< 0.01) were statistically more frequent in the breast implant group. The
symptom change in skin color was more common in the controls (p < 0.001). The
Bonferroni correction for multiple (27) endpoints adjusts the 5 and 1 percent
significance cutoff points to 0.00185 and 0.00037, respectively, leaving only
change of skin color significant at the 5 percent level on the adjusted data. No
cases of scleroderma or lupus were found, and the incidence of arthritis was not
significantly different between the implant and control groups.

PMID: 8134482 [PubMed]

604: Ann Chir Plast Esthet.  1994 Apr;39(2):251-4.  

[Liposuction and extensive cutaneous necrosis. Apropos of a clinical case]

[Article in French]

Mole B.

The massive use of hypertonic solution in subcutaneous tissue inevitably causes
a necrotic reaction whose severity is directly correlated to the extent of
infiltration, involving, as in the present case, all of the abdomen and the
anteromedial surface of the thighs. This infiltration was performed for
ultrasound treatment as part of liposuction in which the cutaneous swelling must
be particularly marked in order to obtain full benefit from this technique. The
direct action of ultrasound itself cannot be incriminated in this case. The
present case developed was abdominocrural necrosis requiring six weeks of
hospitalisation, including twelve days in the intensive care unit and skin cover
by split skin grafts after debridement. Although this complication is not
specific to liposuction, the quantities of saline regularly infiltrated with
this technique carry a high risk of this complication, for which the doctor is
inevitable responsible, even if it is due to a confusion on the part of
paramedical staff.

Publication Types:
    Case Reports

PMID: 7872644 [PubMed]

605: Dtsch Med Wochenschr.  1994 Mar 25;119(12):414-7.  

[The treatment of type-1 diabetics with insulin-induced lipohypertrophy by

[Article in German]

Hauner H, Olbrisch RR.

Diabetes-Forschungsinstitut an der Universitat, Dusseldorf.

Extensive areas of lipohypertrophy at the insulin injection sites on both
thighs, upper arms and buttocks had developed in a 22-year-old woman with type 1
diabetes. Tissue biopsy showed fat cells of normal size, while the stromal cells
in primary culture from the lipohypertrophy tissue demonstrated a greater degree
of new fat-cell formation than normal fat tissue, i.e. there was fat-cell
hyperplasia. Although the patient avoided these sites for insulin injection
during the subsequent 18 months, the amount of excessive fat tissue did not
decrease. As the very obvious fat pads distressed the patient, local liposuction
was applied without complication at the six affected sites, removing a total of
2,000 ml of fat.-Liposuction is a low-risk curative procedure for removing
extensive insulin-induced lipohypertrophic tissue and quickly achieves a
cosmetically satisfactory result.

Publication Types:
    Case Reports

PMID: 8143555 [PubMed]

606: J Urol.  1994 Mar;151(3):607-11.  

Comment in:
    J Urol. 1995 Jan;153(1):162-3.

Periurethral injection of autologous fat for the treatment of sphincteric

Santarosa RP, Blaivas JG.

Squire Urologic Clinic, Columbia-Presbyterian Medical Center, New York, New

A total of 15 women with stress incontinence and 6 men with post-prostatectomy
sphincteric incontinence underwent periurethral injection of autologous fat
while under local anesthesia. The fat was harvested from the abdominal wall by
liposuction. Preoperative evaluation consisted of a micturition diary,
questionnaire, semiquantitative pad test, cystoscopy and urodynamics. Sequential
injections were performed at 1 to 3-month intervals. Results were assessed by
subjective patient scores, pad tests and clinical evaluation performed at
intervals. Followup was 12 to 30 months (mean 18). Only 1 man and none of the
women with urethral hypermobility had lasting improvement. Of the 15 women 12
had intrinsic sphincteric deficiency (type 3 stress incontinence) and they were
our most successful group. Of the 12 women 10 (83%) were improved (mean score of
8.8-7 before injection compared to 1.87 after injection) at 1 month following
the initial injection. Of the 9 patients who continued with the treatment 7
(78%) noticed lasting improvement objectively and subjectively after 1 to 4
injections (mean 2.4). We believe that this technique shows sufficient promise
as an alternative therapy for sphincteric incontinence to warrant continued
clinical investigation.

PMID: 8308969 [PubMed]

607: Plast Reconstr Surg.  1994 Mar;93(3):645-6.  

Repositioning the orbicularis oculi muscle.

Boskovic DM.

Publication Types:
    Case Reports

PMID: 8115531 [PubMed]

608: Plast Reconstr Surg.  1994 Mar;93(3):522-9; discussion 530-2.  

The nasolabial fold: a challenge, a solution.

Guyuron B, Michelow B.

Department of Surgery, Case Western Reserve University, Cleveland, Ohio.

A prominent nasolabial fold results from a combination of relaxation and
thinning of the facial skin and selective fat deposits lateral to the fold. The
surgical approach described herein has been used to correct the pronounced
nasolabial fold for the last 3 years. First, the temple incision is positioned
at the anterior hairline rather than in the hair-bearing skin. This permits
removal of the maximum amount of skin without concern for posterior
transposition of the temple hair, and, more important, it transmits a more
effective pulling force to the nasolabial fold due to the more advantageous
proximity. Second, a strip of fat is added under the fold in the subcutaneous
plane (immediately under the fold) after extensive undermining of the skin
through a rhytidectomy flap. Third, removal of the fat lateral to the fold
reduces the buccal projection and thereby lends an appearance of flatness. This
report covers 35 patients (8 males and 27 females) who underwent this
problem-oriented approach with an average follow-up of 23 months. Complications
included one localized hematoma (managed conservatively) and one expanding
hematoma (which required evacuation). Two incidents of graft dislodgment were
discovered early in the study, following which all grafts were fixed to the
overlying nasolabial groove with a through-and-through 5-0 catgut suture.
Partial resorption of the graft was considered the rationale for undercorrection
in 6 patients (17.1 percent). The remaining 29 patients (82.9 percent) had good
to excellent results.

PMID: 8115507 [PubMed]

609: Scand J Plast Reconstr Surg Hand Surg.  1994 Mar;28(1):33-7.  

Alkalisation of lignocaine-adrenaline reduces the amount of pain during
subcutaneous injection of local anaesthetic.

Samdal F, Arctander K, Skolleborg KC, Amland PF.

Department of Plastic Surgery, Norwegian National Hospital, Oslo.

A double blind, randomised controlled trial was performed to compare the amount
of pain experienced after subcutaneous infiltration of lignocaine with
adrenaline, and the same anaesthetic buffered to pH 7.1-7.3, in patients
undergoing liposuction (n = 8), blepharoplasty (n = 7), mammaplasty (n = 6), and
in volunteers (n = 10). A linear analogue pain scale was used to access pain. In
all four groups the buffered solution caused significantly less pain (p < 0.001
except for mammaplasty--p = 0.02).

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 8029650 [PubMed]

610: Cardiovasc Surg.  1994 Feb;2(1):85-7.  

Retroperitoneal caval filter as a source of abdominal pain.

Goldman KA, Adelman MA.

Department of Surgery, Division of Vascular Surgery, New York University Medical
Center, New York 10016.

A patient with a Mobin-Uddin vena caval filter placed 10 years earlier was
referred with abdominal pain, nausea, anorexia and weight loss. Diagnostic
studies confirmed that the filter was in an extracaval position in the
retroperitoneum, with the filter struts impinging on the right kidney, duodenum
and colon. Following surgical removal of the filter the patient is now
symptom-free with good appetite and weight gain.

Publication Types:
    Case Reports

PMID: 8049932 [PubMed]

611: Dysphagia.  1994 Winter;9(1):22-5.  

Deterioration of feeding behavior following surgical treatment of drooling.

Stevenson RD, Allaire JH, Blasco PA.

Kluge Children's Rehabilitation Center, Department of Pediatrics,
Charlottesville, VA 22903.

Few adverse effects of the surgical treatment of drooling are reported in the
literature. This report describes a young man with severe extrapyramidal
cerebral palsy and profuse drooling whose oral feeding behavior deteriorated
following bilateral submandibular gland excision and parotid duct rerouting.
Before surgery the patient had safe, functional oral feeding skills, and eating
was enjoyable. Following surgery he developed progressive feeding difficulties,
weight loss, and aspiration pneumonia. His deterioration led to the placement of
a feeding gastrostomy and the end of all oral feedings. Surgery had a disturbing
and apparently irreversible negative impact on the patient's quality of life.

Publication Types:
    Case Reports

PMID: 8131421 [PubMed]

612: Radiographics.  1994 Jan;14(1):67-86.  

Evaluation of the postoperative stomach and duodenum.

Smith C, Deziel DJ, Kubicka RA.

Department of Diagnostic Radiology, Rush-Presbyterian-St Luke's Medical Center,
Chicago, IL 60612.

Patients who undergo a gastric or duodenal operation present challenging
problems to the physician. Currently, gastric or duodenal operations are
performed to correct peptic ulcer disease and its complications, resect benign
or malignant masses, and control obesity. Indications for surgery in patients
with peptic ulcer disease include hemorrhage, perforation, obstruction, ulcer
intractability, and the inability to exclude malignancy in a gastric ulcer.
Neoplasms of the stomach and duodenum require resection, depending on their
benign or malignant nature, their location, the extent of disease, and the
underlying physiologic status of the patient. Most clinically significant
gastroduodenal masses are malignant and require formal anatomic resection,
usually with distal or total gastrectomy. Stapling procedures have been shown to
be effective in reducing excess body weight with creation of a small gastric
pouch to restrict the outlet and cause early satiety, decreased caloric intake,
and weight loss. Reliable radiologic findings depend on a thorough understanding
of the complex anatomic and physiologic alterations that occur after surgery and
familiarity with appropriate techniques of examination. With this background,
complications unique to the surgical procedure as well as general complications
found in all postoperative patients with be detected quickly and accurately.

PMID: 8128067 [PubMed]

613: Aesthetic Plast Surg.  1994 Spring;18(2):161-3.  

Toxic shock syndrome associated with suction-assisted lipectomy.

Rhee CA, Smith RJ, Jackson IT.

Institute for Craniofacial and Reconstructive Surgery, Providence Hospital,
Southfield, MI 48075.

Toxic shock syndrome (TSS) is a serious, potentially life-threatening condition
resulting from an exotoxin of Staphylococcus aureus. Presenting symptoms include
high fever, diarrhea, nausea, and vomiting progressing to hypotension, oliguria,
conjunctival hyperemia, and an erythematous rash over the trunk, abdomen, and
extremities. TSS has been associated both with and without the use of tampons
during menstruation, postsurgical infections, and stab wounds, and can occur in
postrhinoplasty patients with and without nasal packing. There has been one case
reported in the literature of TSS associated with suction-assisted lipectomy
(SAL). This article discusses the diagnosis and treatment of two cases in which
the patients developed TSS after outpatient use of SAL. In the first case, an
abdominoplasty and SAL were performed in a healthy young female. The second case
involved the harvesting of abdominal fat via syringe suction and subsequent
facial fat injection in a female with systemic lupus erythematosus and severe
facial atrophy.

Publication Types:
    Case Reports
    Review of Reported Cases

PMID: 8017220 [PubMed]

614: Eur J Cardiothorac Surg.  1994;8(3):162-4.  

Should we stitch the subcutaneous fat layer following saphenous vein excision
for coronary revascularization?

el Gamel A, Dyde J, Perks J, Shaw R.

Department of Cardiothoracic Surgery, Walsgrave Hospital Coventry, UK.

We report a prospective trial to establish whether a subcutaneous fat stitch
reduces the incidence of haematoma formation, infection and wound dehiscence
following saphenous vein excision for coronary revascularization. Two groups of
patients undergoing coronary revascularization were studied. In the first group
of 100 patients the saphenous vein was harvested from both legs. Legs were
randomized to have either a fat stitch or no fat stitch during wound closure. By
using both legs of each patient we eliminated the effect of general factors on
wound healing, thus the patients acted as their own controls. In the second
group of 200 patients, the saphenous vein was harvested from the thigh, and
patients randomly allocated to either a fat stitch or no fat stitch during wound
closure. The wounds were examined daily for 7 days, and again after 6 weeks at
the follow-up. There was no difference in the rate of wound complication in the
fat stitch groups (9%) compared with the no fat stitch groups (8%), however, the
fat stitch groups required more surgical intervention for skin edge necrosis. It
appears that closure of the subcutaneous fat following saphenectomy is
unnecessary, and may be detrimental to skin healing.

Publication Types:
    Clinical Trial
    Randomized Controlled Trial

PMID: 8011354 [PubMed]

615: Aesthetic Plast Surg.  1994 Fall;18(4):405-6.  

Liponecrotic cysts after augmentation mammaplasty with fat injections.

Maillard GF.

A 26-year-old woman underwent breast augmentation with fat injections from
trochanteric liposuction. After one year firm lumps developed in both breasts.
Surgical treatment included excising the cysts through an inframammary approach.
Volume replacement consisted of a silicone gel prosthesis inserted through an
axillary retropectoral approach. In a second stage, a supra-areolar dermopexy
was done to centralize the nipple-areola complex.

Publication Types:
    Case Reports

PMID: 7817891 [PubMed]

616: Aesthetic Plast Surg.  1994 Fall;18(4):363-71.  

Endoscopic full facelift.

Ramirez OM.

This article demonstrates the efficacy of endoscopic techniques in total facial
rejuvenation. The author has introduced the total subperiosteal dissection to
the endoscopic forehead lift. This concept has been extended to the rejuvenation
of the central and lower third of the face. Patients up to the late 40s can have
a total facelift without skin excisions. In older patients, the introduction of
endoscopic techniques helps to minimize some of the undesirable sequelae of the
traditional open procedures such as alopecia, scalp paresthesias, and facial
edema of the subperiosteal lift. The author also introduces a new, more
efficacious method of midface suspension.

Publication Types:
    Clinical Trial

PMID: 7817884 [PubMed]

617: J Fr Ophtalmol.  1994;17(11):686-91.  

[Orbital decompression by the Olivari technique]

[Article in French]

Adenis JP, Robert PY.

Service d'Ophtalmologie, Hopital universitaire Dupuytren, Limoges.

Orbital decompression using Olivari's method is described: extraconal fat is
removed surgically from the orbit. Intraconal fat is also removed with the help
of a microscope. Removal of at least 5 cc of orbital fat is necessary to reduce
exophthalmos. Usually between 5 cc to 10 cc of fat are removed.

PMID: 7722230 [PubMed]

618: Chirurgie.  1994-95;120(9):544-5.  

[Surgical complications of lipo-aspiration]

[Article in French]

De Saint-Jorre G, Lalardrie JP.

Centre medico-chirurgical Foch, Suresnes.

PMID: 7641567 [PubMed]

619: Int J Radiat Oncol Biol Phys.  1993 Dec 1;27(5):1107-12.  

Effect of irradiation on healing of newly made colonic anastomoses in the rat.

Biert J, Wobbes T, Hendriks T, Hoogenhout J.

Department of General Surgery, University Hospital, Nijmegen, The Netherlands.

PURPOSE: Short-term effects of radiotherapy on the healing process of newly made
colonic anastomoses are investigated by measuring the anastomotic strength in a
rat model. METHODS AND MATERIALS: Four groups of Wistar rats were used. In all
groups, rats underwent a 1 cm sigmoid resection with end-to-end anastomosis.
Group I served as a control group. In group II the anastomosis was irradiated
after closure of the abdominal wall with a single dose of 20 Gy of 250 kV x
rays. Group III was irradiated with a single dose of 20 Gy while the abdominal
wall was not closed, and the surrounding tissues were carefully covered by a
lead plate, simulating intra-operative radiotherapy. Group IV was treated as
group III, but a larger dose of 25 Gy was applied. Animals were sacrificed 3 or
7 days after the operation. General condition of the rats was determined by
observation, weight loss, serum protein and albumin at sacrifice. Anastomotic
healing was evaluated by inspection, bursting pressure, hydroxyproline and
protein contents of the anastomotic segment. RESULTS: Direct postoperative
externally irradiated rats (group II) showed a marked weight loss,
hypoproteinaemia and hypo-albuminaemia because of involvement of small bowel in
the irradiated volume. With respect to anastomotic healing there were no
significant differences between control and irradiated groups. CONCLUSION: These
data suggest that the application of a single dose of irradiation (20 and 25 Gy)
on colonic anastomoses given in a direct postoperative or intraoperative model
has no measurable side effect on the early healing of newly made colonic
anastomoses. Direct postoperative external irradiation results in unwanted side
effects in the adjacent bowel.

PMID: 8262835 [PubMed]

620: Plast Reconstr Surg.  1993 Nov;92(6):1085-98; discussion 1099-100.  

Comment in:
    Plast Reconstr Surg. 1994 Dec;94(7):1096-7.
    Plast Reconstr Surg. 1994 Jul;94(1):216.
    Plast Reconstr Surg. 1994 Jul;94(1):216-7.
    Plast Reconstr Surg. 1995 Mar;95(3):603-5.

Tumescent technique for local anesthesia improves safety in large-volume

Klein JA.

Department of Dermatology, University of California, Irvine.

The tumescent technique for local anesthesia improves the safety of large-volume
liposuction ( > or = 1500 ml of fat) by virtually eliminating surgical blood
loss and by completely eliminating the risks of general anesthesia. Results of
two prospective studies of large-volume liposuction using the tumescent
technique are reported. In 112 patients, the mean lidocaine dosage was 33.3
mg/kg, the mean volume of aspirated material was 2657 ml, and the mean volume of
supernatant fat was 1945 ml. The mean volume of whole blood aspirated by
liposuction was 18.5 ml. For each 1000 ml of fat removed, 9.7 ml of whole blood
was suctioned. In 31 large-volume liposuction patients treated in 1991, the mean
difference between preoperative and 1-week postoperative hematocrits was -1.9
percent. The last 87 patients received no parenteral sedation. In a second
study, a 75-kg woman received 35 mg/kg of lidocaine on two separate occasions,
first without liposuction and 25 days later with liposuction; peak plasma
lidocaine concentrations occurred at 14 and 11 hours after beginning the
infiltration and were 2.37 and 1.86 micrograms/ml, respectively.

PMID: 8234507 [PubMed]

621: J Intern Med.  1993 Nov;234(5):489-92.  

Diabetic lipohypertrophy treated with suction-assisted lipectomy.

Samdal F, Amland PF, Sandsmark M, Birkeland KI.

Department of Plastic Surgery, Norwegian National Hospital, Oslo.

OBJECTIVES. To investigate the effectiveness of liposuction as treatment for
lipohypertrophy in insulin-treated diabetic patients. DESIGN. Open clinical
study. SETTING. Norwegian National Hospital, Oslo. SUBJECTS. Five consecutive
diabetic patients operated on for insulin-induced lipohypertrophy.
INTERVENTIONS. Syringe-assisted liposuction under local anaesthesia. MAIN
OUTCOME MEASURES. Change in contours assessed by pre- and postoperative
photographs, and by the patients' and surgeon's evaluations according to a
four-point graded scale. RESULTS. Good or excellent results were obtained in all
patients. Small surface irregularities were seen in two patients who had large
volumes of fat removed from the proximal anterior thighs. Apart from this no
side-effects or complications occurred. CONCLUSIONS. Insulin-induced
lipohypertrophy ('insulin tumours') can be treated successfully with

PMID: 8228793 [PubMed]

622: Ann Plast Surg.  1993 Oct;31(4):379.  

Comment on:
    Ann Plast Surg. 1993 Apr;30(4):367-70.

Re: Use of tissue expanders in reconstruction after excision of multiple large
silicone granulomas.

Boskovic DM.

Publication Types:
    Case Reports

PMID: 8239442 [PubMed]

623: Ann Thorac Surg.  1993 Oct;56(4):838-44; discussion 844-6.  

Transhiatal esophagectomy for carcinoma of the esophagus.

Vigneswaran WT, Trastek VF, Pairolero PC, Deschamps C, Daly RC, Allen MS.

Section of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.

One hundred thirty-one patients (107 men and 24 women) underwent transhiatal
esophagectomy for carcinoma of the esophagus. Median age was 65.3 years (range,
30 to 89 years). Signs and symptoms were present in 130 patients, which included
dysphagia in 96 (73.3%) and weight loss (median, 7.7 kg) in 52 (39.7%). The
cancer involved the gastroesophageal junction in 94 patients, the lower half of
the intrathoracic esophagus in 25, the upper half in 10, and multiple sites in
2. An adenocarcinoma was present in 101 patients (77.1%), squamous cell
carcinoma in 29 (22.1%), and adenosquamous cell in 1 (0.8%). The cancer was
classified as stage 0 in 4 patients, stage I in 16, stage IIA in 26, stage IIB
in 18, stage III in 65, and stage IV in 1. The stomach was used to replace the
esophagus in all patients. Operative mortality was 2.3%. Anastomotic leak
developed in 32 patients; 6 leaks were not clinically significant, 12 healed
with drainage alone, and 14 required further surgical intervention. Follow-up
ranged from 1 month to 6.7 years (median, 1.4 years). Currently, 42 patients are
alive, 34 without evidence of recurrence. Overall 5-year survival was 20.8% and
varied according to stage. Five-year survival was 47.5% for patients with stage
I disease compared with 37.7% for patients in stage II and only 5.8% 4-year
survival for patients in stage III. Cell type also influenced survival.
Five-year survival for patients with adenocarcinoma was 27.1% compared with zero
for patients with squamous cell carcinoma (p < 0.03).(ABSTRACT TRUNCATED AT 250

PMID: 8215660 [PubMed]

624: Arch Otolaryngol Head Neck Surg.  1993 Sep;119(9):993-9.  

Transconjunctival blepharoplasty. Complications and their avoidance: a
retrospective analysis and review of the literature.

Palmer FR 3rd, Rice DH, Churukian MM.

Department of Otolaryngology-Head and Neck Surgery, University of Southern
California, School of Medicine, Los Angeles.

The transconjunctival approach to lower eyelid blepharoplasty is becoming
increasingly popular. From 200 transconjunctival blepharoplasties performed
between 1984 and 1991, 40 randomly selected cases were reviewed to identify the
complications associated with this technique. This represents the largest
reported series (to our knowledge) in the English-language otolaryngology head
and neck surgery literature. A review of the literature was performed to compare
this series with reported complications associated with this approach, as well
as to compare the reported complications from the transcutaneous method.
Discussion on how to best avoid these complications is included. We found that
the transconjunctival approach avoided the most common complication associated
with transcutaneous blepharoplasty, lower lid malposition. Inadequate fat
removal, the most common complication when the transconjunctival method was
used, was believed to be best avoided by the careful graded and through removal
of herniated lower lid fat. Patients exhibiting prominent fat without excess
lower lid skin were found to be ideal candidates for transconjunctival

Publication Types:
    Review of Reported Cases

PMID: 8357600 [PubMed]

625: J Clin Oncol.  1993 Sep;11(9):1809-16.  

Subcutaneous interleukin-2 plus interferon alfa-2a in metastatic renal cancer:
an outpatient multicenter trial.

Vogelzang NJ, Lipton A, Figlin RA.

Department of Medicine, University of Chicago, IL 60637-1470.

PURPOSE: A prospective multicenter phase II trial was undertaken to define the
activity of a low-dose subcutaneous regimen of interleukin-2 (IL-2) and
interferon alfa-2a (IFN) in patients with metastatic renal cancer. PATIENTS AND
METHODS: Between December 1990 and October 1991, 42 patients with metastatic
renal cancer who had received no prior immunotherapy were treated with IL-2 (4 x
10(6) U) days 1 through 4 and IFN (9 x 10(6) U) day 1 and 4 each week of a
4-week treatment course followed by a 2-week rest period. Maximum duration of
therapy was 1 year. Concomitant therapy with acetaminophen, diphenhydramine, and
indomethacin was recommended. Treatment was administered on an outpatient basis.
RESULTS: With a median follow-up duration of 18 months, responses occurred in
five of 42 patients (12%; 95% confidence interval [Cl], 2% to 22%). One
pathologic complete remission, one surgical complete remission, and three
partial remissions occurred. Toxicity was modest, with a symptom complex of
rash, fever, anorexia, fatigue, mild weight loss, lymphocytosis, and
eosinophilia occurring in 85% to 90% of patients. Renal dysfunction (creatinine
> 2 mg/dL) occurred in 19% of patients, while three patients (7%) refused
further IL-2 and IFN. No toxic deaths occurred. The median survival duration was
14.5 months. CONCLUSION: This outpatient low-dose subcutaneous regimen induced
mild toxicity, a modest response rate, and an excellent median survival duration
in previously untreated patients. Phase III trials are now needed to compare
IL-2 plus IFN with IL-2 alone or to various IL-2/IFN regimens. However, the
major task is to identify unique new agents with activity in renal cancer.

Publication Types:
    Clinical Trial
    Clinical Trial, Phase II
    Multicenter Study

PMID: 8355047 [PubMed]

626: J Biomed Mater Res.  1993 Aug;27(8):1057-62.  

Quantification of in vitro endothelial cell adhesion to vascular graft material.

Wigod MD, Klitzman B.

Plastic Surgery Research Laboratories, Duke University Medical Center, Durham,
North Carolina 27710.

This study tests the hypothesis that denucleating vascular graft material and
binding cell adhesion molecules increases endothelial attachment. Removal of gas
nuclei (denucleation) increases the available surface area of biomaterials for
modification and/or cell adhesion, while adhesion molecules provide specific
attachment sites. Microvascular endothelial cells (MVEC) were isolated from fat,
fluorescently labeled, and allowed to settle onto expanded
polytetrafluoroethylene (ePTFE) vascular patches. Patch treatments included
fibronectin alone (F), gas denucleation followed by fibronectin (D/F),
denucleation followed by the surfactant tridodecylmethylammonium chloride
(TDMAC) (D/T), denucleation followed by TDMAC followed by fibronectin (D/T/F),
or denucleation followed by TDMAC followed by a synthetic polymer with numerous
arginine-glycine-aspartic acid sequences (D/T/R). After 1 h of incubation, the
45 mm2 patch area covered with microvascular endothelial cells was assessed
using computer-aided fluorescence microscopy. Initial graft coverage with D/T
(26.2 +/- 2.4 mm2) and D/T/F (25.9 +/- 2.1 mm2) was better than with F (16.8 +/-
2.5 mm2) (P < .05). Patches were then exposed to a detachment stress and
coverage was again measured. Following stress, coverage was greater with D/T
(20.7 +/- 3.4 mm2) and D/T/F (20.7 +/- 2.0 mm2) than with D/T/R (8.4 +/- 1.8
mm2) or F (3.6 +/- 0.9 mm2) (P < .001). Percent retention of cells following
stress was better with D/T and D/T/F than with D/T/R, D/F, or F (P < .0001).
Scanning electron micrographs were consistent with the qualitative findings. The
results indicate that TDMAC alone or with fibronectin increases adhesion of
human microvascular endothelial cells to denucleated ePTFE.

PMID: 8408118 [PubMed]

627: J Am Vet Med Assoc.  1993 Jul 1;203(1):92-5.  

Erratum in:
    J Am Vet Med Assoc 1993 Sep 15;203(6):869.

Gastroduodenal ulceration associated with flunixin meglumine administration in
three dogs .

Vonderhaar MA, Salisbury SK.

Department of Veterinary Clinical Sciences, School of Veterinary Medicine,
Purdue University, West Lafayette, IN 47907-1248.

In 3 clinically ill dogs, signs of gastroduodenal ulceration were first noticed
within 7 days of beginning flunixin meglumine administration and included
pyrexia, anorexia, weight loss, vomiting, melena, pain on abdominal palpation,
and abdominal distention. One dog was euthanatized and 2 dogs recovered after
surgical repair of the perforated ulcers and treatment of peritonitis. Prolonged
administration of flunixin meglumine should be avoided, especially in
debilitated dogs or when concurrently administering other nonsteroidal
anti-inflammatory drugs or corticosteroids.

Publication Types:
    Case Reports

PMID: 8240550 [PubMed]

628: Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi.  1993 Jul;9(4):241-2.  

[Prevention and treatment of common complications following suction lipectomy]

[Article in Chinese]

Peng FR.

PMID: 8221315 [PubMed]

629: Diabetes Care.  1993 Jun;16(6):929-30.  

Severe insulin-induced lipohypertrophy successfully treated by liposuction.

Hardy KJ, Gill GV, Bryson JR.

Department of Medicine, Arrowe Park Hospital, Wirral, United Kingdom.

OBJECTIVE--To examine the usefulness of liposuction surgery on diabetic patients
with lipohypertrophy. RESEARCH DESIGN AND METHODS--We treated a diabetic patient
who suffered from severe localized thigh lipohypertrophy. When she did not
respond to conventional treatment of resting the injection site, we recommended
liposuction surgery. RESULTS--Our patient's lipohypertrophy was immediately
cured by the liposuction procedure. CONCLUSIONS--Liposuction surgery could be
useful in patients with diabetic lipohypertrophy who do not respond to more
conservative treatments.

Publication Types:
    Case Reports

PMID: 8325209 [PubMed]

630: Arch Otolaryngol Head Neck Surg.  1993 May;119(5):535-9; discussion 540-1. 

The male facelift. An analysis of 115 cases.

Lawson W, Naidu RK.

Department of Otolaryngology, Mount Sinai Medical Center, New York, NY 10027.

Based on the anatomic differences in female and male cervicofacial skin, a
retrospective study of 115 male facelifts was undertaken to identify those
factors that contributed to a satisfactory esthetic result and the avoidance of
complications. Incision modifications are reported, as well as the need for
ancillary procedures (in 37% of the patients) to obtain facial rejuvenation. An
increased incidence of hematomas (9.6%) was noted.

Publication Types:
    Review, Tutorial

PMID: 8484943 [PubMed]

631: Minerva Chir.  1993 Apr 15;48(7):337-40.  

[Laparocele. A late complication of bariatric surgery]

[Article in Italian]

Bajardi G, Ricevuto G, Mastrandrea G, Latteri M, Pischedda G, Rubino G, Valenti
D, Florena M.

Dipartimento di Discipline Chirurgiche, Universita degli Studi di Palermo.

In this paper the authors consider the problem of incisional hernias as late
complications of bariatric surgery. After a description of relationships between
obesity and incisional hernias they report their experience on this topic,
consisting of 56 patients submitted to bilio-pancreatic diversion between March
1989 and September 1991, for surgical treatment of morbid obesity. Incisional
hernias developed in 28% of cases. Analysis of some risk factors like
infections, epidemiological patterns, materials and techniques used to suture
the abdominal wall, has not allowed identification of significant associations
with incisional hernias occurrence. Only early reinterventions (3 cases) have
always determined a subsequent development of incisional hernias. The authors
confirm the close relationship existing between obesity and incisional hernias.
They suggest incisional hernia repair to be undertaken once weight loss has
terminated and stabilized, and in the absence of other specific or aspecific
morbid obesity surgery complications.

PMID: 8327180 [PubMed]

632: Plast Reconstr Surg.  1993 Apr;91(5):962-3.  

Comment in:
    Plast Reconstr Surg. 1993 Dec;92(7):1420-1.

Comment on:
    Plast Reconstr Surg. 1992 Jun;89(6):1068-79; discussion 1080-2.

Reducing blood loss associated with lipectomy.

Pitman GH.

Publication Types:

PMID: 8460205 [PubMed]

633: Surgery.  1993 Apr;113(4):380-8.  

A gastroplasty that avoids stapling in continuity.

MacLean LD, Rhode BM, Forse RA.

Department of Surgery, Royal Victoria Hospital and McGill University, Montreal,
Quebec, Canada.

BACKGROUND. Staple line perforations have been the principal cause of failure
after vertical-banded gastroplasty in patients followed at least 4 years at our
institution. In the present study an operation was devised that created a
vertical-banded gastroplasty not dependent on staple lines to avoid this
complication. METHODS. One hundred two patients with a body mass index (BMI)
greater than 35 kg/m2 underwent vertical-banded gastroplasty from Jan. 1 to Dec.
30, 1986, with an orifice size of 45 to 47 mm external circumference and
division between the vertical staple lines to prevent gastric pouch to gastric
fundus fistula. RESULTS. Ninety-eight of the patients have been followed up for
a minimum of 4 years. Sixty-two percent of patients obtained an excellent or
good final result after 4.5 +/- 0.1 years. This was a BMI of less than 35 kg/m2
or less than 50% excess weight. This acceptable long-term result was achieved
90% of the time if the patient was obese (BMI, 35 to 40 kg/m2) before surgery
and in 75% of patients who were morbidly obese (BMI, 40 to 50 kg/m2) but in only
30% of patients who were superobese (BMI > 50 kg/m2) before surgery. Staple line
disruption was markedly reduced; however, stenosis or failure to lose weight or
late weight gain required reoperation in 36% of the patients. CONCLUSIONS.
Gastric bypass was superior to reversal or revision of the gastroplasty as a
remedial operation. This study again questions the value of vertical-banded
gastroplasty in the treatment of obesity even when staple line disruption is
markedly diminished.

PMID: 8456393 [PubMed]

634: Minerva Med.  1993 Mar;84(3):135-9.  

[Symmetric multiple lipomatosis with Charcot's joint and neuropathic ulcer.
Description of a clinical case]

[Article in Italian]

Biasi D, Caramaschi P, Carletto A, Baracchino F, Botto M, Pacor ML, Bambara LM.

Istituto di Patologia Speciale Medica, Universita degli Studi di Verona.

Multiple symmetric lipomatosis (MSL) (or Madelung's disease or Launois-Bensaude
syndrome) is a rare inherited disease clinically characterized by a massive
development of large symmetric unencapsulated lipomas on the subcutaneous tissue
of face, neck, trunk and arms, resulting in a grotesque aspect of the patient.
Less frequently the accumulation of excessive fatty tissue can spread deeply to
the superficial fascia. Peripheral neuropathy, macrocytic anemia and chronic
hepatopathy have been reported to cohesist. Macrocytic anaemia and chronic
hepatopathy are probably secondary to high alcohol consumption, that is
frequently associated. MSL, that was first described by Sir Benjamin Brodie in
1846, affects mainly the men (ratio man/woman 30:1), with an incidence in
Mediterranean area of 1:25.000 men; the ages at onset range from 20 to 50 years.
It is not known yet the pathway of inheritance and the molecular basis of the
genetic defect responsible for the development of fat accumulation. It has been
postulated a defective lipolytic response to catecholamines; this altered
response could be due to an abnormal amount or a defective function of
Gs-protein, the coupler between beta-adrenergic receptors on the surface of
adipocytes and adenylate cyclase, or, alternatively, the defect could be in the
catalytic unit of adenylate cyclase. The number and function of alpha- and
beta-adrenergic receptors and the lipolytic response to cAMP (the second
messenger) are normal. Recently it has been hypothesized that the defective
lipolysis is due to a disorder in the mitochondria of brown fat, whose
distribution is similar to the peculiar position of the lipomas in this
pathology; the brown fat, unlike white adipose tissue, has abundant
mitochondria. The alcohol abuse, frequently present in these subjects, might
facilitate the clinical expression of the molecular defect. The therapy of
lipomas is essentially surgical, but this approach is not easy, because the
lipomas are not capsulated and extremely vascularized. Moreover the surgical
excision is not always a successful treatment for the lipomas as they frequently
recurrent after a short period from the exeresis. In this report we describe a
59-years old white man, alcohol abuser, with a typical clinical picture of MSL,
developed when he was 37 years old. The patient presented multiple lipomas
around the shoulders, face, neck and arms, that had been surgically excised
eight times. Magnetic resonance imaging showed the presence of fat deposits also
in the mediastinum, that caused a tracheal compression. Hepatic cirrhosis and
serious side effects from peripheral neuropathy, represented by Charcot's joint
and neuropathic ulcer on the sole foot were observed.(ABSTRACT TRUNCATED AT 400

Publication Types:
    Case Reports

PMID: 8388091 [PubMed]

635: Arch Otolaryngol Head Neck Surg.  1993 Feb;119(2):193-6.  

Postoperative platysmal band deformity. A pitfall of submental liposuction.

Kamer FM, Minoli JJ.

UCLA School of Medicine.

Submental liposuction is an established advance in treatment of the aging neck.
However, its misapplication may result in an aesthetic deformity involving
postoperative anterior platysmal banding. To identify preoperative conditions
relating to this sequela, we retrospectively analyzed 301 patients treated with
submental liposuction. Submental obesity and an anatomic pattern of platysmal
nondecussation were found to be significant correlates in the development of
postoperative anterior platysmal banding.

PMID: 8427683 [PubMed]

636: Scand J Plast Reconstr Surg Hand Surg.  1993;27(1):9-14.  

Circulation of blood and viability after blunt suction lipectomy in pig buttock

Dillerud E, Heden P.

Department of Experimental Surgery, Karolinska Institute, Stockholm, Sweden.

Bilateral buttock flaps were raised in 13 Yorkshire pigs, and the viability and
superficial blood flow were assessed by injection of fluorescein and laser
Doppler flowmetry. One flap was then chosen at random from each pig to be
defatted by blunt suction lipectomy. The opposite flap served as the control.
Five and 30 minutes after lipectomy, the experimental flaps showed a 31% and 37%
decrease in laser Doppler values (p < 0.05 and p < 0.01, respectively), measured
6 cm proximal to the margin of the fluorescein dye. There was no reduction in
the values in the controls. One week after liposuction, the median area of flap
necrosis in treated flaps was 4,615 mm2 (range 735-6,748) and in controls 4,104
mm (1,576-5,879). This difference was not significant (p = 0.24). Blunt suction
lipectomy of the skin flaps did not significantly decrease the viability. The
decreased skin circulation shown by laser Doppler soon after lipectomy may be a
minor or temporary phenomenon.

PMID: 8493490 [PubMed]

637: Aesthetic Plast Surg.  1993 Winter;17(1):49-51.  

Use of Reston foam in liposuction.

Schlesinger SL, Kaczynski AJ.

Maui Plastic Surgery Corporation, Kahului, HI 96732.

Use of Reston foam along with a pressure garment after liposuction results in
three salutary effects: less waviness in the skin surface, a more comfortable
recovery, and less blood loss and ecchymoses. Free fat cells are thought to be
redistributed evenly by the pressure of the foam plus the pressure garment. The
result is a smoother skin surface with less waviness. Reston foam is also
comfortable under the pressure garment and there is less immediate postoperative
tenderness. In addition, the use of the foam, in conjunction with the pressure
garment, results in less postoperative bleeding and bruising. Consequently,
there is also a decrease in the amount of postoperative fall in hematocrit.
Since there is less of a drop in hematocrit and hemoglobin, there is also less
postoperative anemia. The mechanism involved in the reduction in blood loss is
thought to be a combination of overcoming capillary pressure and stabilization
of the skin and subsurface blood vessels.

PMID: 8430530 [PubMed]

638: J Am Vet Med Assoc.  1993 Jan 1;202(1):83-5.  

Aldrin intoxication and clearance of associated dieldrin residues in a group of
feedlot cattle.

Casteel SW, Satalowich FT, Kendall JD, Rottinghaus GE, Gosser HS, Schneider NR.

Veterinary Medical Diagnostic Laboratory, College of Veterinary Medicine,
University of Missouri, Columbia 65211.

A sudden onset of bizarre neurologic dysfunction was found in 8 of 90
mixed-breed feeder calves. Seven other calves were dead, and 3 more died during
the next week. A diagnosis of organochlorine toxicosis was made when rumen and
abomasal contents from 1 of the calves revealed 22.4 and 20.6 micrograms of
aldrin/g of ingesta, respectively. Complete feeds retrieved from self-feeders
contained 54 and 528 micrograms of aldrin/g of feed. The initial concentration
range in fat from 40 live calves was 6.01 to 42.44 micrograms of dieldrin/g of
fat. Additional fat samples were analyzed to verify residue compliance until the
entire herd was clear of residue 18 months after removal of the contaminated
ration. The range of apparent half-lives for dieldrin in body fat of heifers and
steers was 69 to 231 and 53 to 116 days, respectively. These findings
demonstrate the considerable variability in apparent half-life of dieldrin in
field cases. In cases of dieldrin-contaminated livestock, veterinarians and
regulatory personnel must accurately determine the necessary slaughter
withholding times so that informed economic decisions are made in the best
interest of the producer while enhancing the probability of a safe food supply.
Excretion rates of dieldrin from field-contaminated cattle may not be consistent
with results obtained under experimental conditions.

PMID: 8420911 [PubMed]

639: Aesthetic Plast Surg.  1993 Summer;17(3):199-203.  

Syringe liposculpture revisited.

Mandel MA.

Syringe liposculpture was introduced by Fournier almost a decade ago. Recent
advances have improved the technique, making it easier for the surgeon to use.
To determine the efficacy of the syringe in reducing morbidity, groups of
patients who had between 1200 and 1500 mL of adipose tissue removed were
evaluated using different infiltration and power source (syringe vs machine)
regimens. There was less blood lost when the syringe was used. In addition,
syringe-treated patients appeared to heal faster, return to work in a shorter
period of time, and have less pain. The advantages of the syringe technique are
considerable and increase the safety factor of the liposculpture procedure.

PMID: 8213313 [PubMed]

640: Int J Adult Orthodon Orthognath Surg.  1993;8(4):237-43.  

Recovery following orthognathic surgery: mandibular bilateral sagittal split
osteotomy and Le Fort I osteotomy.

Dickerson HS, White RP Jr, McMichael DL, Turvey TA, Phillips C, Mohorn DJ.

Oral and Maxillofacial Surgery, School of Dentistry, University of North
Carolina, Chapel Hill 27599-7450.

Thirty-eight patients, who underwent orthognathic surgery, reported their
recovery period upon returning to work or school and returning to full activity.
Twenty-six patients had isolated bilateral sagittal split osteotomies (BSSO) and
12 had isolated Le Fort I osteotomies (LFI). At 1 to 2 weeks postoperatively,
50% of the BSSO group had returned to work or school while none of the LFI group
had returned. By 3 to 4 weeks, 81% of the BSSO group had returned to work or
school while nearly one half of the LFI group still had not returned. The BSSO
group returned to full activity earlier than the LFI group, although the
differences were not statistically significant. Hemoglobin, hematocrit, weight,
and vital signs were determined preoperatively and for 6 weeks postoperatively.
The LFI group had a larger mean estimated blood loss, length of operation, and
weight loss.

PMID: 8182295 [PubMed]

641: Tumori.  1992 Dec 31;78(6):388-91.  

Surgical and adjuvant radiation therapy of resectable retroperitoneal soft
tissue sarcomas in adults.

Testolin A, Pozza F, Dal Fior S, Bolzicco GP, Panizzoni GA, Gasparini G.

St. Bortolo Regional Hospital, Vicenza, Italy.

Primary soft tissue sarcoma of the retroperitoneum is a rare disease. A series
of 11 evaluable adult patients with retroperitoneal soft tissue sarcomas is
reported. These patients were treated with complete surgery and adjuvant
radiation therapy (total dose from 50 to 64 Gy) using an 18 MeV linear
accelerator. After a median follow-up of 48 months (range, 6-84), 4 patients had
a local-regional recurrence, 3 had distant metastases, and 4 died of progressive
disease. Four-year estimated disease-free survival was 54.5% and overall
survival was 70%. Treatment was well tolerated by most patients: 7 patients
experienced moderate gastrointestinal toxicity, mainly nausea and diarrhea,
during radiotherapy; 2 cases had weight loss > 15% at the end of the therapy;
and chronic ileitis was observed in 2 cases. We conclude that adjuvant
radiotherapy seems to reduce the incidence of local-regional recurrences in
these patients. No radiation-induced irreversible injury was observed, but one
young woman had amenorrhea after radiotherapy. Controlled clinical trials are
warranted to define the role and effectiveness of adjuvant radiotherapy and/or
chemotherapy in retroperitoneal soft tissue sarcomas.

PMID: 1297234 [PubMed]

642: Carcinogenesis.  1992 Nov;13(11):2009-15.  

32P-postlabeling analysis of the formation and persistence of DNA adducts in
mammary glands of parous and nulliparous mice treated with benzo[a]pyrene.

Walker MP, Jahnke GD, Snedeker SM, Gladen BC, Lucier GW, DiAugustine RP.

Laboratory of Biochemical Risk Analysis, National Institute of Environmental
Health Sciences, Research Triangle Park, NC 27709.

The susceptibility of the rodent mammary gland to known chemical carcinogens can
vary with the stage of gland development. Full-term pregnancy (parity) can
confer permanent structural and functional changes in the gland that are
associated with decreased breast cancer risk in humans and protection from
mammary carcinogenesis in rodents. In this study, the formation and persistence
of benzo[a]pyrene (B[a]P)-derived DNA adducts in vivo was determined in the
abdominal mammary organs of adult nulliparous and parous BALB/c mice treated
orally with the carcinogen. Mammary DNA isolated from animals in both groups
revealed only one major adduct on TLC maps by P1-nuclease 32P-postlabeling
analysis. The major adduct co-migrated with the (+)-enantiomer of anti-BPDE-dGp.
Much lower levels of the (-)-enantiomer were detected. Most of the adduct
quantitated was probably contributed by cells of the stromal compartment, since
the gland-free organ (cleared fat pad) generated essentially equivalent profiles
and level of adduct by 32P-postlabeling. Comparable levels of the B[a]P-derived
adduct were observed in the intact mammary organ of both nulliparous and parous
mice during a time course from 1 to 28 days after treatment. In both cases,
adduct removal occurred exponentially with a half-life of approximately 16 days.
The capacity for de novo formation of reactive metabolites by the mammary organ
was demonstrated in vitro: digests of DNA from mammary mince exposed to B[a]P
generated an adduct on TLC maps that also co-migrated with the (+)-anti-BPDE-dGp
standard. Thus, our cumulative findings confirm the capacity of mammary cells to
form potentially carcinogenic DNA adducts; however, the functional changes that
occur in the mouse mammary gland as a result of parity did not influence the
profile, level or persistence of adduct following exposure to a known
carcinogen. Other factors, such as changes in mammary cell cycle kinetics or
responsiveness to promotional stimuli may be more causally related to reduction
in incidence of neoplasia observed in parous animals.

PMID: 1423869 [PubMed]

643: Radiology.  1992 Nov;185(2):407-10.  

Comment in:
    Radiology. 1993 Mar;186(3):906-7.

Silicone breast implants in vivo: MR imaging.

Gorczyca DP, Sinha S, Ahn CY, DeBruhl ND, Hayes MK, Gausche VR, Shaw WW, Bassett

Iris Cantor Center for Breast Imaging, Department of Radiological Sciences,
School of Medicine, University of California, Los Angeles 90024-1721.

This study was designed to evaluate pulse sequences and patient positioning for
MR imaging of silicone breast implants in patients. One hundred forty-three
patients (281 silicone implants) underwent imaging over a 21-month period. The
combination of a T2-weighted fast spin echo technique (SE), T2-weighted fast SE
with water suppression, and T1-weighted SE with fat suppression is recommended
to reliably differentiate silicone from other breast tissues and to identify
intracapsular and extracapsular ruptures or leaks. Seventy of the 143 patients
underwent removal of their silicone implants. The sensitivity for detection of
silicone implant rupture was 76%, with a specificity of 97%. Positioning the
patient prone improved image quality.

PMID: 1410346 [PubMed]

644: Arch Surg.  1992 Oct;127(10):1164-7; discussion 1167-8.  

Transhiatal esophagectomy for carcinoma of the esophagus and cardia. Experience
with 160 cases.

Gelfand GA, Finley RJ, Nelems B, Inculet R, Evans KG, Fradet G.

Department of Surgery, University of British Columbia, Vancouver.

We reviewed our experience from 1979 to 1990 with 160 cases of transhiatal
esophagectomy for carcinoma of the lower esophagus and cardia to evaluate trends
in patient selection, management, and outcome. Patients treated in the past 6
years (n = 110) and those treated before 1985 (n = 50) were similar in terms of
age and sex distribution, medical history, and weight loss. The majority of
tumors seen were adenocarcinoma, with patients in the latter group having
significantly lower stages. Significant decreases in anesthetic time, units of
blood transfusions, chest tube insertions, length of postoperative ventilation,
incidence of postoperative pneumonia, and length of hospital stay were seen
during the past 6 years. Wound infections increased significantly during the
same period. The decrease in the 30-day mortality rate from 6% to 0.9% was not
significant. Survival rates did not differ between groups, with overall rates of
62%, 40%, and 21% at 1, 2, and 5 years, respectively.

PMID: 1417480 [PubMed]

645: Kidney Int Suppl.  1992 Oct;38:S165-71.  

Nutritional aspects on peritoneal dialysis.

Lindholm B, Bergstrom J.

Department of Renal Medicine, Karolinska Institute, Huddinge University
Hospital, Stockholm, Sweden.

Peritoneal dialysis is associated with metabolic and nutritional abnormalities
due to the combined effects of uremia per se, glucose absorption from the
dialysate and a variety of catabolic factors, such as protein and amino acid
losses into the dialysate, poor appetite possibly reflecting insufficient
removal of small solutes, and recurrent episodes of peritonitis. Signs of
protein-energy malnutrition are common, especially in patients with minimal or
no residual renal function. Variables that best correlate with the degree of
malnutrition include serum albumin, midarm muscle circumference, clinical signs
of muscle wasting and loss of subcutaneous fat, and a history of anorexia. The
incidence of malnutrition is higher in females than in males and in diabetics
than in non-diabetics. CAPD patients generally have a lower protein intake than
HD patients, but may have a lower average protein requirement than HD patients.
Progression of malnutrition may occur in CAPD patients due to the synergistic
effects of loss of residual renal function, underdialysis, anorexia and
inadequate dietary intake. In underdialyzed CAPD patients, the amount of
dialysis should be increased and measures should be taken to increase the supply
of energy and protein. The use of amino acid-based dialysis fluid may provide
new opportunities for compensation of dialytic losses of protein and amino
acids, normalization of essential amino acids, supplementation of inadequate
dietary protein intake, and improvement of the nutritional status in CAPD

Publication Types:
    Review Literature

PMID: 1405370 [PubMed]

646: Eur J Surg.  1992 Oct;158(10):531-6.  

Association between perioperative blood transfusion and postoperative infection
in patients having elective operations for gastrointestinal cancer.

Braga M, Vignali A, Radaelli G, Gianotti L, Di Carlo V.

Department of Surgery, Scientific Institute H San Raffaele, University of Milan,

OBJECTIVE--To assess the effect of blood transfusion on the development of
infection after elective operations for gastrointestinal and pancreatic cancer.
DESIGN--Prospective open study. SUBJECTS--285 consecutive patients admitted with
gastric, colorectal, and pancreatic cancer, 215 of whom were suitable for the
study. MAIN OUTCOME MEASURES--Sex, age, total iron binding capacity, measurement
of haemoglobin and serum albumin concentration, assessment of immune response by
delayed hypersensitivity skin test, and weight loss were recorded, as were
duration of operation, operative blood loss, and pathological TNM stage of the
disease. RESULTS--Sixty patients (28%) developed infections postoperatively.
Univariate analysis showed that the development of infection was significantly
associated with the amount of blood transfused (p < 0.001), operative blood loss
(p < 0.05), and length of operation (p < 0.01), but not weight loss (p = 0.07)
or delayed hypersensitivity response (p = 0.08). Multiple logistic analysis
showed that blood transfusion was a significant independent variable only when
more than 1,000 ml were transfused (odds ratio 6.5, p < 0.05).
CONCLUSION--Transfusion of more than 1,000 ml of blood is an independent risk
factor in the development of infection postoperatively in patients undergoing
operations for gastrointestinal cancer.

PMID: 1360824 [PubMed]

647: J Pediatr.  1992 Jun;120(6):892-8.  

Treatment of children with homozygous familial hypercholesterolemia: safety and
efficacy of low-density lipoprotein apheresis.

Uauy R, Zwiener RJ, Phillips MJ, Petruska ML, Bilheimer DW.

Department of Pediatrics, University of Texas Southwestern Medical Center,
Dallas 75235-9063.

We evaluated the safety and efficacy of dextran sulfate low-density lipoprotein
(LDL) apheresis in the treatment of three children (aged 6, 7, and 10 years)
with severe familial homozygous hypercholesterolemia and undetectable LDL
receptor activity. A total of 35 double plasma volume procedures were performed.
The ranges of the mean decreases of the three patients in plasma lipid
concentrations after LDL apheresis (p less than 0.0001) were as follows: total
cholesterol, 76% to 79%; LDL-cholesterol, 78% to 81%; very low density
lipoprotein cholesterol, 69% to 75%; high-density lipoprotein cholesterol, 27%
to 40%; and triglycerides, 34% to 68%. There were statistically significant but
clinically and biologically irrelevant changes in hematologic indexes, serum
chemistry values, immunoglobulin levels, complement activity, and plasma
concentrations of fat-soluble vitamins. Simple correlation analysis of the
variables affecting total cholesterol removal showed significant correlation
coefficients (r values) for preapheresis total cholesterol values (r = 0.70; p
less than 0.01) and preapheresis LDL-cholesterol values (r = 0.61; p less than
0.01). A multiple regression model explained 82% of the variance based on the
preapheresis cholesterol concentration, volume of whole blood processed, and the
serum albumin concentration. Side effects of the LDL-apheresis treatments were
rare and included abdominal cramping and urticaria. Two procedures were aborted
because of intravenous access problems in the younger children. This study
confirms that LDL apheresis using a dextran sulfate affinity column is
efficacious in rapidly lowering total and LDL-cholesterol concentrations.
Furthermore, the procedure is safe and well tolerated by children as young as 6
years of age. This treatment may prevent the progression of atherosclerosis in
children with homozygous familial hypercholesterolemia and may therefore avert
early death.

Publication Types:
    Case Reports

PMID: 1593349 [PubMed]

648: Eur J Pediatr Surg.  1992 Jun;2(3):162-4.  

A rare complication due to sulfuric acid ingestion.

Tamisani AM, Di Noto C, Di Rovasenda E.

Surgical Emergency and Pediatric Surgery Department, Giannina Gaslini Institute,
Genoa, Italy.

The authors present a case of pyloric and duodenal obstruction in an 8-year-old
child, resulting from accidental ingestion of sulfuric acid. A marked pyloric
and duodenal cicatrizing stenosis resulting from ingestion of sulfuric acid is
seen infrequently, especially in pediatric age. Sulfuric acid produces a
coagulation necrosis of the gastric mucosa and submucosa, and the process may
involve the entire thickness of the gastric wall, with subsequent ulceration and
fibrosis. This dynamic pathophysiologic event imposes postponement of surgical
intervention because of various time length between ingestion of acid and onset
of gastric outlet obstruction (17 days to 5 years). Clinical features included
postprandial epigastric distress, repeated non-bilious vomiting, and marked
weight loss. The authors also discuss the various surgical procedures that were
employed to relieve the obstruction. Notwithstanding a potential risk of
malignant evolution, a gastro-jejunostomy is the treatment of choice because of
the age of the patient, and good postoperative results are confirmed by barium

Publication Types:
    Case Reports

PMID: 1498108 [PubMed]

649: Plast Reconstr Surg.  1992 Jun;89(6):1068-79; discussion 1080-2.  

Comment in:
    Plast Reconstr Surg. 1993 Apr;91(5):962-3.

Large-volume suction lipectomy: an analysis of 108 patients.

Courtiss EH, Choucair RJ, Donelan MB.

Department of Surgery, Harvard Medical School, Newton Lower Falls, Mass.

Suction lipectomy was initially advocated for the treatment of localized
collections of fat and for the removal of less than 1500 ml of material.
However, many patients wished to have multiple areas treated or had diffuse
collections of fat. In such instances, the removal of over 1500 ml of material
and circumferential lipectomy are necessary to provide optimal aesthetic
results. However, when over 1500 ml of material is removed, anesthetic
requirements, fluid replacement, and treatment of blood loss become important if
the operation is to be performed safely. We have treated 108 patients who had
over 1500 ml of material removed. Eight-eight percent of the patients were
female; 12 percent were male. Using the body-mass index, 3 percent of patients
were underweight, 70 percent were normal weight, and 27 percent were overweight.
Fifty-five patients (51 percent) had 1500 to 2499 ml of material removed, 26
patients (24 percent) had 2500 to 3499 ml removed, 16 patients (15 percent) had
3500 to 4499 ml removed, and 11 patients (10 percent) had over 4500 ml removed.
All patients were treated in the hospital; 44 percent were admitted after
surgery. A total of 227 units of autologous and 2 units of homologous blood were
transfused. As measured by a computerized monitor, the average amount of blood
in the material removed from thighs was 30 percent; from abdomens, the blood
loss was 45 percent. The aesthetic results were generally excellent. No
complications were encountered. A few patients developed undesired sequelae, the
most common of which was seroma formation, which occurred in 19 percent of those
who had suction of abdominal-wall fat. We believe that large-volume suction
lipectomy is safe and efficacious, provided attention is directed to such
important aspects of patient care as anesthesia, fluid replacement, and blood

PMID: 1306040 [PubMed]

650: Diabet Med.  1992 May;9(4):395-6.  

Treatment of insulin lipohypertrophy with liposuction.

Bodansky HJ, Browning FS.

Professorial Medical Unit, General Infirmary, Leeds, UK.

Publication Types:
    Case Reports

PMID: 1600715 [PubMed]

651: Arch Phys Med Rehabil.  1992 May;73(5):482-5.  

Complications associated with intermittent pneumatic compression.

Lachmann EA, Rook JL, Tunkel R, Nagler W.

Department of Rehabilitation Medicine, New York Hospital-Cornell Medical Center,
NY 10021.

The intermittent pneumatic compression device (IPCD) is prophylaxis for
prevention of deep-venous thrombosis (DVT). This pneumatic leg sleeve has been
used extensively in high-risk surgical patients, without complication. We
describe two cases, one with peroneal neuropathy and the other with compartment
syndrome, associated with IPCD use during surgery. Case 1 involves a patient
with pancreatic cancer and weight loss who developed bilateral peroneal nerve
palsies during surgery. Case 2 involves a patient with bladder cancer who
developed lower leg compartment syndrome during prolonged surgery in the
lithotomy position. These cases are unusual for several reasons. First, patients
wearing IPCDs during surgery are at increased risk of neurovascular compression.
Second, significant weight loss may predispose the peroneal nerve to injury from
intermittent compression garments. Third, patients undergoing surgery in the
lithotomy position are at risk of compartment syndrome. Therefore, physicians
may wish to use another method of DVT prophylaxis in surgical patients with
cancer or significant weight loss, or those who are undergoing procedures in the
lithotomy position.

Publication Types:
    Case Reports

PMID: 1580778 [PubMed]

652: Am J Perinatol.  1992 May;9(3):154-8.  

Right-sided hydrothorax and central venous catheters in extremely low
birthweight infants.

Seguin JH.

Department of Pediatrics, University of Kansas Medical Center, Kansas City

Central venous catheters (CVCs) have become more common in the care of very low
birthweight newborns. Nutrition is enhanced, fluid delivery is more secure, and
stress from the intervention of starting new IVs is reduced. Complications of
these devices include infection, thrombus or embolus, damage to vessels and
organs, and extravascular collections of fluid. Pleural fluid collections can
occur due to superior vena caval obstruction with obstruction of lymphatic
drainage, and erosion or perforation of the catheter through the vein into the
pleural space. Three infants weighing less than 1000 gm had CVCs placed in an
antecubital vein. Severe respiratory compromise developed in 1 at 5, 1 at 6, and
1 at 40 hours after line placement, and chest radiograph suggested fluid in the
right pleural space. Milky fluid was found in two cases in which the infants
received lipid emulsion and parenteral nutrition fluid (PNF). Bright yellow
fluid, resembling PNF, was found in the third, not receiving lipids. None of the
patients was enterally fed. The tips of the CVCs were adjusted to a more
peripheral location and there was no recurrence of pleural fluid, nor were signs
of superior vena cava syndrome seen. Etiologies for the unilateral hydrothorax
include vein perforation and erosion, but another cause is discussed. A right
pleural fluid collection in a patient with a CVC tip in the right subclavian
vein is a serious problem, which may be solved with repositioning of the CVC
instead of removal.

PMID: 1575833 [PubMed]

653: Plast Reconstr Surg.  1992 May;89(5):996-8.  

Comment on:
    Plast Reconstr Surg. 1991 Aug;88(2):239-46; discussion 247-9.

An author's statistics about liposuction are questioned.

Grazer FM, Mathews W.

Publication Types:

PMID: 1561281 [PubMed]

654: Tidsskr Nor Laegeforen.  1992 Mar 20;112(8):1023-5.  

[Liposuction. What results can be expected?]

[Article in Norwegian]

Dillerud E.

Fornebuklinikken, Lysaker.

Suction lipoplasty, comprising 3,511 procedures in 2,009 patients, was followed
up prospectively for six to 12 months over a five-year period. 88% of the
procedures led to patient satisfaction and 3.4% of dissatisfaction. Males were
more dissatisfied than females. The most common general complications were
excessive bleeding and complications from anaesthesia. The most common local
complications were hypertrophic scarring and skin problems caused by external
factors. 379 undesired results were registered at the six-month or 12-month
follow-up. The results and rate of complications showed medial thigh, buttock,
ankle and face to be the most difficult locations for suction. The age group 20
to 49 years emerged as the group with least complications.

PMID: 1553725 [PubMed]

655: Am J Clin Nutr.  1992 Feb;55(2 Suppl):567S-570S.  

Gastrointestinal malabsorptive procedures.

O'Leary JP.

Louisiana State University Medical Center, New Orleans 70112.

Morbid obesity is a complex disease, the etiology of which is clearly
multifactorial. The weight loss produced by intestinal shunting procedures has
been profound and the etiology of the weight loss is clearly more complex than
rapid intestinal transit and gross malabsorption of foodstuffs. The best known
surgically produced malabsorptive procedure for the treatment of morbid obesity
is the jejunoileal bypass. This procedure produces substantial weight loss but
has been associated with late postoperative complications that make its use
problematical. Other procedures (biliary bypass, biliopancreatic diversion, and
long limb Roux-en-Y gastric bypass) have not been associated with liver
dysfunction. Varying degrees of malnutrition are frequently associated with
these procedures. Careful study of the patients with these procedures is

Publication Types:
    Review, Tutorial

PMID: 1733128 [PubMed]

656: Am J Gastroenterol.  1992 Jan;87(1):6-15.  

Benefits and risks of an intensive very-low-calorie diet program for severe

Anderson JW, Hamilton CC, Brinkman-Kaplan V.

Metabolic Research Group, University of Kentucky College of Medicine, Lexington.

Comprehensive very-low-calorie diet (VLCD) programs are the preferred treatment
for selected obese individuals. They combine energy intakes of 400-800 kcal/day
with medical monitoring and intensive lifestyle education. Typical VLCD patients
have median body mass indexes of 36 kg/m2 and have median ages of 40 years.
About 70% are female. Commonly associated medical problems include hypertension
in 50%, hyperlipidemia in 41%, and diabetes mellitus or glucose intolerance in
14%. Typical weight loss with VLCD is around 21 kg in 16 wk. Reductions of 8-13%
in blood pressure, 5-15% in serum total cholesterol, 5-20% in low-density
lipoprotein-cholesterol, 15-50% in triglycerides, and decreases in blood glucose
and glycohemoglobin in diabetic individuals accompany weight loss.
VLCD-associated side effects can be managed medically without discontinuing
treatment. Lifestyle education promotes long-term weight maintenance of
approximately 56% 2 yr after VLCD treatment. Weight losses using comprehensive
VLCDs allow moderately to morbidly obese persons to achieve greater benefits
than other nonsurgical treatments and should be considered before opting for
surgical treatment.

Publication Types:
    Review, Academic

PMID: 1728126 [PubMed]

657: Aesthetic Plast Surg.  1992 Summer;16(3):237-45.  

A new safe and aesthetic approach to suction abdominoplasty.

Illouz YG.

Suction abdominoplasties are associated with a number of surgical complications,
mainly in obese people and diabetic patients. The aesthetic result is often
spoiled by poor balance caused by improper distance between the "guide points"
of an harmonious abdomen (e.g., minimum of 10 cm between the pubic scar and the
umbilicus). Almost all surgical complications are caused by extensive
undermining and can be avoided by an en bloc resection without any undermining
(the suction lipectomy of the upper flat creates a "mesh undermining" which is
almost as efficient). A new neo-umbilicoplasty, described here, can be situated
in the "right position" with good aesthetic results.

PMID: 1626461 [PubMed]

658: Gastrointest Radiol.  1992 Summer;17(3):207-10.  

Adjustable silicone gastric banding for obesity.

Pomerri F, Liberati L, Curtolo S, Muzzio PC.

Department of Radiology, University of Padua, Italy.

Adjustable gastric banding is the least invasive operation for morbid obesity.
Forty-eight patients underwent surgical adjustable gastric banding between March
1990 and August 1991. In 15 of these patients, radiological examination was
performed in the early postoperative period because of dysphagia and vomiting,
revealing stenosis of the stoma in all cases (caliber less than 0.3 cm); in all
patients we easily punched, with fluoroscopically guided observation, the
inflatable portion and obtained a true calibration of the gastric banding. In
seven patients radiological examination was performed 2 months after surgical
treatment because of a lack of weight loss. Radiological findings explain
surgical failure, revealing a too wide stoma in four patients, the absence of a
gastric pouch due to a too high position of the band in two, and the caudal
sliding of the banding in one patient.

PMID: 1612302 [PubMed]

659: Eur Surg Res.  1992;24(2):103-11.  

Cytostatics and anastomotic healing in the intestine: an experimental study on
the effect of parenteral nutrition.

de Roy van Zuidewijn DB, Hendriks T, Wobbes T, de Man B, de Boer HH.

Department of General Surgery, St. Radboud University Hospital, Nijmegen, The

The effects of parenteral nutrition on the healing of experimental ileal and
colonic anastomoses constructed on the 3rd day of a 5-day cytostatics course
were investigated. Intravenous saline alone already reduced weight loss induced
by cytostatics while parenteral nutrition almost completely prevented
postoperative loss of weight. A negative effect of cytostatics on anastomotic
bursting strength was found in the ileum 7 days after operation. Parenteral
feeding negated this effect but had no positive effect on anastomotic
hydroxyproline content. Thus, parenteral nutrition increases the strength of
intestinal anastomoses, constructed during a cytostatics regimen, but
intravenous saline alone also appears to have a similar effect.

PMID: 1582427 [PubMed]

660: Aesthetic Plast Surg.  1992 Spring;16(2):159-65.  

Comment in:
    Aesthetic Plast Surg. 1992 Fall;16(4):371.

Felman double-liposuction cannula.

Felman G.

This article presents the design of a new double-liposuction cannula that can be
used in major lipodystrophy. The new cannula enables constant flow of sterile
solution during liposuction to wash out the remaining destroyed fat tissue and
blood clots in "tunnels."

PMID: 1570779 [PubMed]

661: Nutr Cancer.  1992;18(2):113-22.  

Influence of dietary fat intake on local recurrence and progression of
metastases arising from MDA-MB-435 human breast cancer cells in nude mice after
excision of the primary tumor.

Rose DP, Connolly JM.

Division of Nutrition and Endocrinology, American Health Foundation, Valhalla,
NY 10595.

This study was performed to evaluate the effect of dietary fat on the recurrence
and metastasis of human breast cancer solid tumors growing in nude mice after
surgical excision of the primary tumor. Female nude mice were fed either a high-
(23% corn oil) or a low-fat (5% corn oil) diet, and 7 days later 1 x 10(6)
MDA-MB-435 human breast cancer cells were injected into a thoracic mammary fat
pad. Tumors at the injection site grew more rapidly in the animals fed the
high-fat diet. Nineteen of 30 animals in each dietary group had tumors with a
surface are > or = 1 cm2 within 10 weeks of injection, at which point the tumors
were excised and the animals were followed for another eight weeks. Tumors
recurred at the excision site in 8 of 19 animals fed the high-fat diet and in 9
of 19 animals fed the low-fat diet; however, the growth rate was more rapid in
the group fed the high-fat diet. Lung metastases occurred with similar frequency
in the two groups with local recurrences, but with a positive correlation
between recurrent tumor weight (greater in the animals fed the high-fat diet)
and the severity of lung metastatic involvement. In the mice without recurrence,
4 of 11 (36%) animals in the group fed the high-fat diet had macroscopic lung
metastases compared with only one mouse, with minimal involvement, in the group
fed the low-fat diet.

PMID: 1437649 [PubMed]

662: Aesthetic Plast Surg.  1992 Fall;16(4):287-98.  

Ultrasonic liposculpturing.

Zocchi M.

The author describes a revolutionary body contouring technique based on the
surgical use of ultrasonic energy. It allows the selective destruction of only
excess adipose tissue. The technique is based on three fundamental steps: (1)
preparation of the areas to be treated with a large infiltration of a special
solution, (2) treatment of the areas with ultrasonic energy through special
titanium probes, (3) manual remodeling of the treated areas to eliminate the
fluid from the bursted adipocytes (fatty acids). The advantages of this new
technique are selective destruction of just the undesired tissues, elimination
of the fluid from the adipose tissues, and the possibility of a real "lifting"
of the skin of the treated areas, and a reduction of physical strain on the
surgeon. The author has already treated more than 280 patients with excellent
results and without contraindications or undesired side effects. The fundamental
steps of ultrasonic liposculpturing, including a description of the physical
principles on which the technique is based, are presented.

PMID: 1414652 [PubMed]

663: Plast Surg Nurs.  1992 Winter;12(4):148-51, 154.  

Complications of suction-assisted lipoplasty.

Pettis DK, Vogt PA.

The potentially fatal, surgical, and aesthetic complications of suction-assisted
lipoplasty are discussed in this article. Prevention through early detection and
risk management will be emphasized.

PMID: 1292032 [PubMed]

664: Ann Dermatol Venereol.  1992;119(9):659-66.  

[Calcifying panniculitis]

[Article in French]

Buchet S, Blanc D, Humbert P, Derancourt C, Arbey-Gindre F, Atallah L, Agache P.

Service de Dermatologie I, Hopital St-Jacques, Besancon.

We report a case of calcifying panniculitis which occurred in a 67-year old
woman suffering from chronic renal failure and primarily involved anticoagulant
injection sites. Calcifying panniculitis is a rare condition belonging to the
spectrum of calciphylaxis first described by Selye in 1962. This disease seems
to imply necessarily a specific morbid background including renal failure
together with calcium-phosphate metabolism impairment. Following the action of a
so-called "challenger" (in the present case calcium heparinate [Calciparine], a
subcutaneously administered anticoagulant drug), the lesions start as painful
subcutaneous nodules soon turning into plaques of necrosis. The area involved
mainly includes the abdomen and thighs, due to the preferential distribution of
fat and the classical use of such regions for subcutaneous injections. In our
patients, histological examination disclosed an initial involvement of
subcutaneous fat vessels mimicking mediacalcosis, soon followed by
calcium-phosphate deposits within interadipocyte spaces. An electron microscopy
study confirmed the presence of calcium crystals within the cytoplasms of some
connective tissue cells and the extracellular matrix. From a review of the
literature, it seems reasonable to normalize the calcium-phosphate product by
reducing hyperparathyroidism as a first therapeutic step. Then, wide surgical
excision of the necrotic areas should be performed to rule out any possibility
of self worsening of the lesions and provide the best chance of healing without
superinfection. The use of diphosphonates on pathophysiological grounds is

Publication Types:
    Case Reports
    Review of Reported Cases

PMID: 1285593 [PubMed]

665: Spine.  1991 Dec;16(12):1365-71.  

Symptomatic spinal epidural lipomatosis induced by a long-term steroid
treatment. Review of the literature and report of two additional cases.

Roy-Camille R, Mazel C, Husson JL, Saillant G.

Service d'Orthopedie Traumatologie, Hopital de la Pitie-Salpetriere, Paris,

Spinal epidural lipomatosis associated with Cushing's syndrome is an uncommon
complication (11 reported cases). Two additional symptomatic cases with
neurologic deficit are described. Steroid treatment was systemic in the first
case and local with epidural injections in the second. The second case is unique
because no similar observations have yet been reported. In most cases, a
preoperative computed tomographic scan establishes the diagnosis by
demonstrating dural compression by an adipose mass. Myelography is far less
specific. In some cases, the exact diagnosis is made at the time of surgery. The
treatment is primarily surgical, with laminectomy over the length of the
compression and the removal of the compressing fat. Neurologic recovery is
dependent on two factors: the level of the compression and the adequacy of

Publication Types:
    Case Reports
    Review of Reported Cases

PMID: 1771466 [PubMed]

666: J Med Assoc Ga.  1991 Nov;80(11):631-3.  

Abdominal lipectomy as an office procedure.

Cochran TA.

Because of the increasing cost of hospitalization, many plastic surgeons have
tried to make cosmetic surgery more affordable by performing procedures in the
office operating room under local anesthesia and sedation. Standard abdominal
lipectomy has classically been considered a procedure to be carried out in the
hospital under general anesthesia. Following is the author's technique for
performing the procedure under local anesthesia in the office setting.

PMID: 1779205 [PubMed]

667: Br J Surg.  1991 Nov;78(11):1348-51.  

Transhiatal oesophagectomy for oesophageal carcinoma.

Gurkan N, Terzioglu T, Tezelman S, Sasmaz O.

Department of General Surgery, Istanbul Medical Faculty, Istanbul University,

Between 1979 and 1990 transhiatal oesophagectomy and reconstruction with stomach
was performed in 148 patients with carcinoma of the oesophagus. Ninety-seven
patients were men and 51 were women; ages ranged from 21 to 88 years with a mean
of 57.4 years. Dysphagia and weight loss were the usual clinical symptoms. The
mean duration of symptoms was 14 weeks. Squamous cell carcinoma was present in
129 patients (87.2 per cent), 18 patients (12.2 per cent) had adenocarcinoma,
and one had lymphoma (0.7 per cent). In two-thirds of the patients tumours were
located in the middle thoracic (50 of 148 patients) or distal thoracic
oesophagus (59 of 148 patients). Three-quarters of the patients had tumours
determined as stage III. The mean length of hospital stay after operation was
12.8 days. Anastomotic leakage occurred in 15 cases (10.1 per cent). Pulmonary
complications other than pneumothorax were observed in 36 cases (24.3 per cent).
The 30-day postoperative mortality rate was 8.1 per cent (12 of 148 patients).
Respiratory insufficiency was observed as the major cause of death (six of 12
patients). Mediastinitis due to necrosis of the transposed stomach in the
mediastinum was the cause of death in three cases. Two-year actuarial survival
rates in patients with cervical, upper, middle and lower thoracic tumours were
20, 22, 26 and 30 per cent respectively. Transhiatal oesophagectomy is safe and
offers limited morbidity and mortality, although pulmonary complications and
anastomotic leakage in the early postoperative period still pose a significant
risk, especially for elderly patients in poor condition.

PMID: 1760700 [PubMed]

668: Clin Plast Surg.  1991 Oct;18(4):815-22.  

Gynecomastia. Liposuction and excision.

Mladick RA.

Plastic Surgery Center, Inc., Virginia Beach, Virginia.

Lipoplasty has facilitated the correction of gynecomastia and improved the
morbidity and end results. The author details his technique of combining
lipoplasty with excision for gynecomastia.

Publication Types:
    Review, Tutorial

PMID: 1934894 [PubMed]

669: Cancer Nurs.  1991 Oct;14(5):261-9.  

Nutrition support. Making the difficult decisions.

Lin EM.

Bone Marrow Transplant Program, Hospital of the University of Pennsylvania.

Weight loss and cachexia are common characteristics associated with the cancer
patient. Although the wasted appearance seems the same in each person, the
causes are varied. Studying a patient's history and identifying surgical causes
to weight loss or weight loss as a result of treatment complications assists in
the consideration of nutritional support. Nutritional parameters combined with
the oncology nurse's knowledge of the patient, disease process, and treatment
side effects place the nurse in the position to help identify options for
nutritional support. The oncology nurse's expertise assists in the decision
making process, since it is often not appropriate to institute nutritional
support in the inpatient setting nor extend it to the home situation. Objective
assessment parameters for home parenteral nutrition assist the nurse in making
some of these decisions. The conflicts that arise within the decision making
process are usually not clearcut nor easily resolvable. Home parenteral
nutrition brings to the forefront requirements and variables that are often not
consciously addressed when hyperalimentation is instituted in the inpatient

Publication Types:
    Case Reports
    Review, Tutorial

PMID: 1933846 [PubMed]

670: Dan Med Bull.  1991 Oct;38(5):405-7.  

Surgical treatment of morbid obesity. A survey of overall outcome 1968-1989.

Gjorup IE, Gotzsche PC, Baden H, Andersen B.

Department of Surgical Gastroenterology D, Herlev Hospital.

This survey evaluates benefits and costs from a policy of employing surgical
treatment in selected cases of morbid obesity. Between 1968 and 1978, we used
end-to-side jejunoileal bypass. Despite many satisfied patients, complications
were frequent and severe. For the next decade, we employed various types of
gastric surgery. We eventually assessed a gastric balloon, but without success.
Median duration of follow-up was 132 months in 145 patients with
jejunoileostomy, 103 months in seven gastric bypass patients, and 36 months in
108 gastroplasty patients. Three patients were lost to follow-up. There have
been four deaths after intestinal shunt and one after gastroplasty. The median
re-admission rate was 1.6 per patient, while the median number of re-operations
was 2.0 after intestinal shunt and 0.8 after gastric interventions. The median
weight loss in our 260 patients was 32.1% of the preoperative weight. Outcome
was good in 38.8%, acceptable in 40.4% and poor in 11.5% while there were 9.2%
failures. Truly satisfactory outcomes, however, were rare, owing possibly to a
negative relationship between weight loss and complications. Only 8.8% have
obtained a stable normal weight without any side-effects.

PMID: 1802626 [PubMed]

671: J Clin Gastroenterol.  1991 Oct;13(5):521-4.  

Celiac sprue after surgery of the upper gastrointestinal tract. Report of 10
patients with special attention to diagnosis, clinical behavior, and follow-up.

Bai J, Moran C, Martinez C, Niveloni S, Crosetti E, Sambuelli A, Boerr L.

Small Bowel Section, Hospital Nacional de Gastroenterologia Dr. Carlos B.
Udaondo, Buenos Aires, Argentina.

The clinical onset of celiac sprue (CS) may be precipitated by upper digestive
tract surgery. We report a series of 10 patients who developed CS after diverse
types of peptic ulcer surgery. Six were male and 4 female. Gastrectomy with
Billroth II anastomosis was performed in 5 patients, truncal vagotomy and
pyloroplasty in 2, parietal cell vagotomy and pyloroplasty in 1, and vagotomy
with gastrojejunal anastomosis in 2. We found that eight patients had had
previous symptoms that suggested CS. Symptoms occurred early in the
postoperative period. Severe diarrhea and striking weight loss were the most
prominent clinical findings. The response to gluten-free diet was independent of
the type of surgical procedure performed and was similar to that observed in the
general celiac population.

PMID: 1744387 [PubMed]

672: Ann Surg.  1991 Sep;214(3):276-87; discussion 287-8.  

Chronic visceral ischemia. Three decades of progress.

Cunningham CG, Reilly LM, Rapp JH, Schneider PA, Stoney RJ.

Department of Surgery, University of California, San Francisco 94143.

Symptomatic visceral atherosclerosis is a major surgical challenge because of
its life-threatening course and the complexity of its definitive operative
treatment. Evolution in the operative approach to the visceral aorta and
progress in the intraoperative management of patients undergoing complex
vascular reconstructions prompted a review of the authors' cumulative experience
in the surgical management of chronic visceral ischemia. Among all patients
undergoing visceral revascularization at the University of California, San
Francisco during the past three decades, 74 patients were identified whose
primary reconstruction used transaortic endarterectomy (TA TEA) (n = 48) or
antegrade bypass (AB) (n = 26), the authors' preferred revascularization
techniques. The two treatment groups were comparable in gender distribution,
age, presenting symptoms, and physical findings, although the amount of
preoperative weight loss was greater in the AB group (35.8 +/- 19.5 versus 22.4
+/- 12.0, p = 0.003). The groups were also comparable in the prevalence of
atherosclerosis risk factors, symptomatic vascular disease at other sites, and
previous vascular operations. However associated renal artery atherosclerosis
was slightly greater in the TA TEA group (58.3% versus 23.1%, p = 0.07) when
compared to the AB group. Antegrade bypass was usually performed
transabdominally (88.5%), while TA TEA was approached thoracoretroperitoneally
(75.0%). Celiac revascularization was almost universal in both treatment groups,
but the TA TEA group underwent significantly more frequent superior mesenteric
artery (SMA) revascularization (93.8% versus 46.2%, p = 0.0001) and slightly
more frequent inferior mesenteric repair (18.8% versus 3.8%, p = 0.07) than the
AB group. In addition the frequency of combined renal and visceral repair (25.0%
versus 0.0%, p = 0.01) as well as combined aortic, renal, and visceral repair
(22.9% versus 3.8%, p = 0.03) was significantly greater in the TA TEA group. The
obligatory interval of renal and visceral ischemia did not differ between the
two approaches. The perioperative mortality rate was 12.2% and was the same for
TA TEA (14.6%) and AB (7.7%). Overall the incidence of complications was the
same with either operative approach, although patients in the TA TEA group
tended to have multiple complications (17.1% versus 0.0, p = 0.03) and all
significant pulmonary complications occurred in this group. Two patients were
lost to follow-up. The cumulative percentage of patients who remained
asymptomatic following AB or TA TEA was (respectively) 95.8% and 97.3% at 1 year
and 86.5% and 86.1% at 5 years. Both of these operative approaches provide
durable symptom relief with acceptable operative morbidity and mortality

PMID: 1929609 [PubMed]

673: Plast Reconstr Surg.  1991 Aug;88(2):250-8.  

The trauma of suction-assisted lipectomy cannula on flap circulation in rats.

Ozcan G, Shenaq S, Baldwin B, Spira M.

Microsurgery Research Laboratory, Baylor College of Medicine, Houston, Tex.

The effect of suction-assisted lipectomy on cutaneous blood vessels of inguinal
skin flaps was studied and compared in 191 rats. Different types of cannula tips
were used; the number of passes was standardized. In one experiment, following
suctioning, 3 X 2 cm groin island flaps based on inferior epigastric pedicles
were raised and then reattached. Fluorescein dye study and microangiography were
performed to evaluate flap viability. Flap survival was determined clinically
and by histologic examination on the fifth postoperative day. Three-sided
inguinal random-pattern flaps were raised in a second experiment and reattached
following suctioning. On the fifth postoperative day, surviving flap areas were
measured using standard photographs and an imaging computer and were compared
with controls. Results showed that cannula passes accompanied by vacuum are
harmful to vessels, while those unaccompanied by vacuum are not. The greater the
number of suctioning passes, the more trauma there is to vessels and the greater
is the likelihood of flap necrosis. Conical and spatula tips were more harmful
to vessels than spherical, cobra, keel cobra, or Fournier tips. These results
support the conclusion that suction-assisted lipectomy enhances the possibility
of skin necrosis by traumatizing the vascular pedicle of a flap, especially when
it is used as an adjunct to flap elevation.

PMID: 1852817 [PubMed]

674: Plast Reconstr Surg.  1991 Aug;88(2):239-46; discussion 247-9.  

Comment in:
    Plast Reconstr Surg. 1992 May;89(5):996-8.

Suction lipoplasty: a report on complications, undesired results, and patient
satisfaction based on 3511 procedures.

Dillerud E.

Fornebu Clinic, Lysaker, Norway.

Suction lipoplasty comprising 3511 procedures in 2009 patients was followed up
prospectively for 6 to 12 months over a 5-year period. Eighty-eight percent of
the procedures led to patient satisfaction and 3.4 percent led to
dissatisfaction. Males were more dissatisfied than females. No mortality, deep
thrombosis, pulmonary embolism, hypotension, or respiratory distress (fat emboli
syndrome) was registered. Excessive bleeding and complications from anesthesia
were the most common general complications. No hematoma, skin slough, or damage
to adjacent organs occurred. Hypertrophic scarring and skin problems caused by
external factors were the most common local complications. Only one clinical
bacterial infection occurred. Three hundred and seventy-nine undesired results
were registered by the 6-month follow-up, and 213 revisions because of
asymmetry, underresection, or skin problems were performed. A total of 121
procedures unexpectedly required secondary suction, skin excision, or fat
grafting. Forty-five sequelae were not corrected by revisions. Medial thigh,
buttock, ankle, and facial suction emerged as the most difficult locations with
regard to the results and complication rate. The age group 20 to 49 years
emerged as the least troublesome.

PMID: 1852816 [PubMed]

675: Zhonghua Wai Ke Za Zhi.  1991 Aug;29(8):503-5, 526.  

[Gastrojejunocolic fistula. Report of 5 cases]

[Article in Chinese]

Zhang SY.

Peking Union Medical College Hospital, Beijing.

Gastrojejunocolic fistula is rare complication of recurrent peptic ulcer disease
after gastrectomy and gastrojejunostomy. This paper reported five cases of
gastrojejunocolic fistula. It's etiological, clinical, and surgical features
were briefly discussed. The symptoms of gastrojejunocolic fistula are diarrhea,
upper abdominal pain, gastrointestinal bleeding, fecal vomiting, anasarca, and
weight loss. The physical examinations and laboratory studies revealed
malnutrition. The diagnosis is most reliably and frequently made by barium enema
and gastroscopy. Surgical treatment of gastrojejunocolic fistula includes
one-stage resection, complete remove of antral mucosa; vagotomy; partial
re-resection of the gastric stump; excision of the fistulous connection with the
colon. TPN or TEN should be administered in patients suffering from malnutrition
with TEN as the first choice in those when a nasoenteric tube could placed into
the jejunum.

Publication Types:
    Case Reports

PMID: 1813247 [PubMed]

676: Arch Esp Urol.  1991 Jun;44(5):595-600.  

[Treatment of urinary stress incontinence using paraurethral injection of
autologous fat]

[Article in Spanish]

Gonzalez de Garibay AS, Castillo Jimeno JM, Villanueva Perez I, Figuerido
Garmendia E, Vigata Lopez MJ, Sebastian Borruel JL.

Servicio de Urologia, Hospital Virgen del Camino, Pamplona, Navarra, Espana.

The authors present the late results (greater than 1 year) in the treatment of
urinary incontinence in 15 women with stress urinary incontinence and 5 men with
post-adenomectomy incontinence using endoscopic injection of autologous fat
tissue obtained by microliposuction. Good results were achieved in 23% of the
cases with stress urinary incontinence and in 0% of those with post-adenomectomy
incontinence. Although the results are disappointing, they are not very
different from those obtained with teflon injection. Furthermore, the technique
is simple, has no complications and it costs very little to obtain the
autologous graft material. A historical review of free fat grafting and
injection of liposuction fatty tissue is performed and the hypotheses that have
been put forward recently relative to the fate of the fat graft are discussed.

Publication Types:
    Review, Tutorial

PMID: 1759876 [PubMed]

677: J Toxicol Environ Health.  1991 Jun;33(2):197-212.  

Elimination of PBBs in rats. Effect of mineral oil and/or feed restriction.

Polin D, Bursian SJ, Underwood MS, Wiggers PA, Biondo N, Su I, Braselton WE,
Render JA.

Department of Animal Science, Michigan State University, East Lansing 48824.

Rats were fed polybrominated biphenyls (PBBs) at 0.1 to 100.0 ppm for 14 d and
then treated to hasten the removal of PBBs with 0, 5, or 10% mineral oil (MO)
and/or 0, 15, 30, or 45% feed restriction (FR) for 21 d. PBB body burdens were
determined at d 14 and expressed on a log-log basis by Y = 0.91X + 2.179 (r2 =
0.974), where X = log of PBB concentration in diet (ppm) and Y = log of PBB body
burden (micrograms). After 21 d withdrawal, body burdens were expressed by the
equation Y = 0.787X + 2.218 (r2 = 0.95). The most effective withdrawal treatment
was 10% MO + 45% FR producing a reduction of body burdens inversely related to
prior body burdens (69% at 0.1 ppm to 23% at 100 ppm). Body weights and fat
content were significantly (p less than or equal to .05) reduced by feed
restriction, with fat content only 39% of controls at 21 d off. Mortality
averaged 0, 13.6, and 35.8% for rats fed 0, 5, or 10% MO, and 25, 15, 8.6, and
3.7% for rats feed restricted at 0, 15, 30, and 45%, respectively.
Histopathology of the dead and moribund rats indicated that the clinical signs
were not characteristic of PBB toxicity. In a second experiment, safflower oil
at 3.5% or excess vitamins prevented the mortality and clinical signs associated
with MO during withdrawal from 100 ppm PBBs. Based on these data and those in
the literature, PBBs interfere with vitamin utilization.

PMID: 1646894 [PubMed]

678: Plast Reconstr Surg.  1991 Apr;87(4):768-70.  

Treatment of exogenous steroid-induced "buffalo-type" facial and neck obesity
with suction lipectomy.

La Trenta GS, Grant RT, Hoffman LA.

Department of Surgery (Plastic Surgery), New York Hospital-Cornell Medical
College, N.Y.

Publication Types:
    Case Reports

PMID: 2008476 [PubMed]

679: Ann Plast Surg.  1991 Mar;26(3):293.  

Comment on:
    Ann Plast Surg. 1990 Jul;25(1):48-52.

Re: Fat embolism after liposuction.

Dillerud E.

Publication Types:

PMID: 2029144 [PubMed]

680: Curr Probl Cancer.  1991 Mar-Apr;15(2):61-104.  

Non-small cell lung cancer. Part I: Biology, diagnosis, and staging.

Ihde DC, Minna JD.

Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Squamous, large cell, and adenocarcinoma, collectively termed non-small cell
lung cancer (NSCLC), are diagnosed in approximately 75% of patients with lung
cancer in the United States. The treatment of these three tumor cell types is
approached in virtually identical fashion because, in contrast to small cell
carcinoma of the lung, NSCLC more frequently presents with localized disease at
the time of diagnosis and is thus more often amenable to surgical resection but
less frequently responds to chemotherapy and irradiation. Cigarette smoking is
etiologically related to the development of NSCLC in the great majority of
cases. Genetic mutations in dominant oncogenes such as K-ras, loss of genetic
material on chromosomes 3p, 11p, and 17p, and deletions or mutations in tumor
suppressor genes such as rb and p53 have been documented in NSCLC tumors and
tumor cell lines. NSCLC is diagnosed because of symptoms related to the primary
tumor or regional or distant metastases, as an incidental finding on chest
radiograph, or rarely because of a paraneoplastic syndrome such as hypercalcemia
or hypertrophic pulmonary osteoarthropathy. Screening smokers with periodic
chest radiographs and sputum cytologic examination has not been shown to reduce
mortality. The diagnosis of NSCLC is usually established by fiberoptic
bronchoscopy or percutaneous fine-needle aspiration, by biopsy of a regional or
distant metastatic site, or at the time of thoracotomy. Pathologically, NSCLC
arises in a setting of bronchial mucosal metaplasia and dysplasia that
progressively increase over time. Squamous carcinoma more often presents as a
central endobronchial lesion, while large cell and adenocarcinoma have a
tendency to arise in the lung periphery and invade the pleura. Once the
diagnosis is made, the extent of tumor dissemination is determined. Since most
NSCLC patients who survive 5 years or longer have undergone surgical resection
of their cancers, the focus of the staging process is to determine whether the
patient is a candidate for thoracotomy with curative intent. The dominant
prognostic factors in NSCLC are extent of tumor dissemination, ambulatory or
performance status, and degree of weight loss. Stages I and II NSCLC, which are
confined within the pleural reflection, are managed by surgical resection
whenever possible, with approximate 5-year survival of 45% and 25%,
respectively. Patients with stage IIIa cancers, in which the primary tumor has
extended through the pleura or metastasized to ipsilateral or subcarinal lymph
nodes, can occasionally be surgically resected but are often managed with
definitive thoracic irradiation and have 5-year survival of approximately

Publication Types:
    Review, Academic

PMID: 1649734 [PubMed]

681: J Otolaryngol.  1991 Feb;20(1):69.  

Comment on:
    J Otolaryngol. 1990 Aug;19(4):267-73.

Cervical liposuction: results and controversies.

Kane N.

Publication Types:

PMID: 2030543 [PubMed]

682: Crit Care Med.  1991 Feb;19(2):304-5.  

Intraoperative cardiac arrest in a young woman undergoing liposuction.

Mantz J, Baglin AC, Portal V, Rohan JE, Loirat P.

Publication Types:
    Case Reports

PMID: 1989775 [PubMed]

683: Tidsskr Nor Laegeforen.  1991 Jan 20;111(2):236-7.  


[Article in Norwegian]

Brattebo G.

Publication Types:

PMID: 1998191 [PubMed]

684: Aesthetic Plast Surg.  1991 Winter;15(1):81-4.  

A critical look at abdominal lipectomy following morbid obesity surgery.

Young SC, Freiberg A.

Toronto Western Hospital, Ontario, Canada.

This article reviews a series of 26 consecutive nonaesthetic post-morbid-obesity
weight loss patients undergoing abdominal lipectomy. Patient satisfaction was
assessed by a questionnaire. All patients obtained symptomatic relief but
surprisingly most had expected to look better following surgery, indicating the
importance of discussing this aspect preoperatively. Technical modifications to
remedy some of these problems are discussed.

PMID: 1994654 [PubMed]

685: Aesthetic Plast Surg.  1991 Winter;15(1):67-71.  

Obesity can be treated by suction lipoplasty when combined with other

Ersek RA, Philips C, Schade K.

The development of serial suction lipoplasty enables us to remove substantial
amounts of subcutaneous fat safely and dependably on an outpatient basis, and
free our patients of the worry of exogenous blood transfusion. Many
practitioners and researchers do not advocate suction for the treatment of
obesity, but rather regard it as a means of treating localized small deposits of
fat or "figure faults." The reason for their caution is that the amounts of fat
to be removed from the obese patient would require extensive hospitalization,
transfusion, and increased risk of complications. Liposuction, when performed as
a series, can make the treatment of obesity as safe as the treatment of smaller
figure faults. We now use serial suction as an adjunct to other surgical and
dietary methods for the control of obesity.

Publication Types:
    Case Reports

PMID: 1994652 [PubMed]

686: Heart Lung.  1991 Jan;20(1):87-90.  

Malassezia furfur fungemia associated with central venous catheter lipid
emulsion infusion.

Weiss SJ, Schoch PE, Cunha BA.

Infectious Disease Division, Winthrop-University Hospital, Mineola, NY 11501.

Malassezia furfur has been associated with fungemias in infants after prolonged
intravenous lipid emulsion alimentation. Most cases of M. furfur fungemia
reported in the literature involved neonates and required catheter removal for
cure. M. furfur is probably an underreported problem in neonates as well as
adults with central venous catheters, receiving lipid emulsions, because the
organism requires selective enrichment media for growth, for example,
Sabouraud's dextrose agar with sterile olive oil overlay. This case report of M.
furfur fungemia in a neonates is unique because the neonate recovered on
discontinuation of the lipid emulsion, without removal of the central venous

Publication Types:
    Case Reports

PMID: 1988397 [PubMed]

687: Plast Reconstr Surg.  1991 Jan;87(1):66-75.  

Skin retraction following suction lipectomy by treatment site: a study of 500
procedures in 458 selected subjects.

Goddio AS.

I identified 500 suction lipectomy procedures involving sites on the body and in
the cervicofacial region in 458 selected patients and studied the influence of
treatment site on postoperative skin retraction by comparing preoperative and
postoperative skin condition. Postoperative skin condition was evaluated first
in the immediate postoperative period (second or third day); then at a more
remote date (after at least 2 months of follow-up). On the body, restoration of
the preoperative condition of the skin was obtained in 94.6 percent of treatment
sites in the immediate postoperative period; after a longer follow-up, this
proportion was 87.9 percent because of delayed development of modifications. The
time interval needed to obtain a stable result increased with increasing age,
regardless of the nature of this result, as well as with the total amount of fat
removed. On the neck, liposuction improved or even eliminated preexisting skin
looseness, and this improvement was even more noticeable as follow-up increased.
The neck thus appears as the site of choice for suction lipectomy. On the face,
in contrast, favorable results deteriorated over time, a finding that leads me
to advocate combination with a face-lift whenever ptosis is present. Thus
treatment site obviously has a substantial impact on the potential of the skin
for retracting postoperatively.

PMID: 1984283 [PubMed]

688: Clin Exp Hypertens A.  1991;13(5):917-23.  

Effects of canrenone on RRM-sucrose hypertension in WKY.

Preuss HG, al Karadaghi P, Yousufi A, MacArthy P.

Department of Medicine (Nephrology Division), Georgetown University Medical
Center, Washington, D.C.

Ingestion of a diet high in sucrose content by WKY rats having reduced renal
mass (RRM) via a unilateral nephrectomy causes a significant elevation of
BP--greater than might be expected from either condition alone. The same
findings occur whether the added sucrose calories replace protein or fat. The
elevated BP differential remained throughout the 6 months of the study. In some
ways, these results resemble a well recognized model of hypertension produced by
the removal of 70-80% of renal mass plus excess salt consumption (RRM-salt).
When the RRM-sucrose WKY were given canrenone, an agent which is a digoxin
antagonist, the BP decreased significantly simulating previous findings in
RRM-salt. Therefore, like the RRM-salt model, evidence suggests that the
RRM-sucrose model is also caused, at least in part, by a digoxin-like factor

PMID: 1773523 [PubMed]

689: Carcinogenesis.  1990 Dec;11(12):2093-5.  

Effects of a high fat diet on liver DNA methylation in rats exposed to

Camus AM, Bereziat JC, Shuker DE, Hietanen E, Wild CP, Montesano R, Bartsch H.

International Agency for Research on Cancer, Lyon, France.

Previous experiments have shown that a high fat diet changes incidence and
tumour sites by N-nitroso-dialkylamines. The purpose of this study was to
examine the effect of high and low fat diet on DNA methylation 6 weeks after the
end of a chronic N-nitrosodimethylamine (NDMA) exposure (total dose 150 mg/kg).
The concentration of O6-methyldeoxyguanosine (O6-MedG) in liver DNA was measured
by immunoassays. The level of O6-MedG persisted 6 weeks after the last dose of
NDMA and was 6-fold higher (P less than 0.05) in animals on high fat as compared
to low fat diet. In another experiment, in which rats on a low and high fat diet
received a single NDMA dose (2 mg/kg), the time-dependent removal of O6-MedG
from liver and the hepatic O6-methylguanine DNA-alkyltransferase activity was
not modified by the type of diet. These results indicate that a high fat diet
enhances DNA methylation in the liver, after chronic treatment by NDMA, and that
this effect is likely to be responsible for an increased incidence of liver

PMID: 2265464 [PubMed]

690: S Afr Med J.  1990 Dec 1;78(11):693-5.  

Fulminant adult respiratory distress syndrome after suction lipectomy. A case

Boezaart AP, Clinton CW, Braun S, Oettle C, Lee NP.

Department of Anaesthesia, Johannesburg Hospital.

The adult respiratory distress syndrome developing within 24 hours in a patient
who underwent suction lipectomy for body contouring under general anaesthesia is
reported. During surgery, in which a total of 1.3 l of suction matter was
removed, the patient became haemodynamically unstable and mildly hyperthermic.
Subsequently, clinical signs and symptoms of the fat embolism syndrome
developed. Aggressive haemodynamic and respiratory support over an 8-day period
resulted in patient survival. Malignant hyperthermia was excluded as cause for
the clinical presentation on muscle biopsy and in vitro caffeine contracture
studies. Although usually complication-free, suction lipectomy may be associated
with life-threatening incidents. Even suction volumes as low as 1.3 l have
potential hazards, therefore the procedure merits regular postoperative
observation and re-assessment.

Publication Types:
    Case Reports

PMID: 2251620 [PubMed]

691: Tidsskr Nor Laegeforen.  1990 Nov 20;110(28):3627-31.  

[Liposuction. A new and valuable tool in the armamentarium of the surgeons]

[Article in Norwegian]

Samdal F, Abyholm F.

Plastikkirurgisk avdeling Haukeland sykehus, Bergen.

Since its introduction in 1975 liposuction has become an increasingly popular
technique and, in the United States today, is the most commonly performed
procedure in cosmetic surgery. However, this technique is also useful in the
treatment of a number of other conditions such as gynecomastia and
lipomas/lipomatosis, and as an adjuvant procedure to surgical procedures such as
reduction mammoplasty, abdominoplasty, and defattening of flaps. The article
describes the technique and its indications and possible complications.

PMID: 2260063 [PubMed]

692: Pacing Clin Electrophysiol.  1990 Nov;13(11 Pt 1):1356-9.  

Intraventricular migration of an ICD patch.

Siclari F, Klein H, Troster J.

Department of Cardiac Surgery, Hanover Medical School, Federal Republic of

A 42-year-old man presented with fever and weight loss 12 months after ICD
replacement. After unsuccessful search for an infected focus and a specific
antibiotic treatment ICD pocket was explored and Staphylococcus epidermidis was
cultured. Following generator explanation fever recurred and at a second
operation one ICD patch was found to have perforated in the right ventricular
cavity. Explanation of the patches was performed on cardiopulmonary bypass, the
patient survived the operation and infection was eradicated.

Publication Types:
    Case Reports

PMID: 1701885 [PubMed]

693: Harefuah.  1990 Oct;119(7-8):209-12.  

[Liposuction present status 1990]

[Article in Hebrew]

Moscona R.

Publication Types:
    Review, Tutorial

PMID: 2258097 [PubMed]

694: J Surg Res.  1990 Sep;49(3):239-43.  

Contradictory effects of uncomplicated versus complicated abdominal surgery on
the hepatic capacity for urea synthesis in rats.

Heindorff H, Almdal T, Vilstrup H.

Division of Hepatology, Rigshospitalet, Copenhagen, Denmark.

Female Wistar rats weighing 217 g were subjected to two types of surgical
stress: uncomplicated (hysterectomy) and complicated (spleen and uterus ligated,
crushed, and left in situ). Liver function as assessed by amino-N conversion was
measured as the capacity for urea-N synthesis preoperatively (control animals)
and on Days 1, 3, and 6 postoperatively. Uncomplicated surgery transiently
increased the capacity for urea-N synthesis by 30% the first postoperative day
(P less than 0.001). Complicated surgery decreased the capacity for urea-N
synthesis to 55% throughout the investigation period (P less than 0.001). This
was not due to a general change in liver mass since galactose elimination
capacity remained constant. The increase in the capacity for urea-N synthesis
after uncomplicated surgery is probably due to glucagon since plasma glucagon
increased whereas plasma insulin and blood glucose remained unchanged after
amino acid loading. The persistent decrease in the capacity for urea-N synthesis
in complicated surgery is not due to changes in these regulators: glucagon
increased, insulin decreased, and the rats were hypoglycemic. All changes are
expected to increase the capacity for urea-N synthesis. The mechanism for the
emergence of these two distinct metabolic patterns is not known. The phenomenon
is probably important for interpretation of metabolic data on clinical stress.

PMID: 2203948 [PubMed]

695: Aust N Z J Surg.  1990 Aug;60(8):621-3.  

Feeding jejunostomy: is its routine use in major upper gastrointestinal surgery

Cade RJ.

St Vincent's Hospital, Melbourne, Victoria, Australia.

An audit of jejunostomy feeding following major oesophagogastric surgery was
carried out. The aim was to measure caloric and nitrogen intake, weight change,
and to record complications. Twenty consecutive patients undergoing elective
upper gastrointestinal surgery resulting in either an oesophagogastric or
oesophagojejunal anastomosis were studied prospectively. In the eighteen cases
whose catheters functioned, average calorie and nitrogen intake per day over the
first 10 postoperative days was 1360 Kcal and 7.2 g respectively and average
weight loss at 10 days was 1.3 kg. There was one major complication due to
catheter dislodgement, resulting in an extraperitoneal abscess and subsequent
small bowel fistula. In one other case the catheter was blocked from the
immediate postoperative period and this could not be remedied. In the eighteen
patients who were fed via the jejunostomy for 10 days, mild diarrhoea occurred
in eight cases, but was easily managed. As experience with the technique
increased, there was a significant increase in the amount of calories and
nitrogen administered. This audit has demonstrated that provided care is taken
with the technique of insertion of the jejunostomy catheter, satisfactory
nutritional support can be provided in patients following oesophageal
anastomoses with a low morbidity rate.

PMID: 2117914 [PubMed]

696: Hautarzt.  1990 Jul;41(7):405.  


[Article in German]

Muller RP.

Dermatologische Klinik, Kreiskrankenhaus, Lemgo.

PMID: 2401631 [PubMed]

697: Md Med J.  1990 Jul;39(7):667-9.  

Liposuction: blood loss and autotransfusion.

Kanter MA, Kanter WR.

Department of Surgery, Baltimore County General Hospital.

Blood loss usually is not clinically significant during liposuction, but the
need for transfusion increases with the amount of tissue removed. Autologous
blood donations in preparation for significant blood loss are widely accepted by
patients and physicians.

PMID: 2398785 [PubMed]

698: Dermatol Clin.  1990 Jul;8(3):539-51.  

Reduction syringe liposculpturing.

Fournier PF.

French Society of Aesthetic Surgery, Paris.

The use of the syringe has been an advance in reduction and incremental
liposculpturing. A real democratization in the medicosurgical group has been
possible due to the simplification of the equipment. The shock-absorbing action
of the syringe makes the operation safer and allows more fat to be removed and
better results to be obtained because one does perfectly symmetrical work. The
syringe is a unit of measurement in this surgery of volume.

PMID: 2379337 [PubMed]

699: Dermatol Clin.  1990 Jul;8(3):463-8.  

Blood loss during liposuction.

Dolsky RL.

Department of Plastic and Reconstructive Surgery, Haverford Community Hospital,

1. For every 100 cc of aspirate, the average blood content in the aspirate is
18% for females and 23.6% for males. 2. For every 100 cc of aspirate, the
average total body blood loss is 37.6 cc for females and 123.2 cc for males. 3.
For every 100 cc of aspirate, the average blood loss into the wound (third space
loss) is 19.6 cc for females and 99.6 cc for males. 4. For every 100 cc of
aspirate, the average decrease in absolute hematocrit is 0.38 for females and
0.88 for males. 5. Males have 3.03 times as much blood loss as females during
liposuction. 6. A delay of 15 minutes between the injection of local epinephrine
and the onset of liposuction will decrease blood loss by 21.9%. 7. The
traditional French Illouz cannula and the American cobra cannula cause
approximately the same amount of blood loss. 8. There is no difference in the
amount of blood loss when the concentration of epinephrine is diluted from
1:200,000 to 1:400,000. 9. The dry technique resulted in 3.4 times as much
bleeding compared with the techniques utilizing epinephrine solutions. 10. The
surgeon cannot predict the exact blood loss in an individual patient undergoing
liposuction. The results are quite variable from one patient to the next.

PMID: 2379334 [PubMed]

700: Dermatol Clin.  1990 Jul;8(3):451-5.  

The "standard technique" of liposuction. Viewpoint from a plastic surgeon.

Replogle SL.

University of Colorado Health Sciences Center, Denver.

So, do I recommend the tumescent technique to accomplish liposuction contouring?
You bet. Is it the "standard technique"? Not yet, but it probably will become so
as it is better known and safety issues are addressed. The tumescent technique
also offers a variety of possibilities for research and application for other

PMID: 2379332 [PubMed]

701: J Bone Joint Surg Am.  1990 Jul;72(6):811-4.  

Intra-articular fibrous bands. Patellar complications after total knee

Thorpe CD, Bocell JR, Tullos HS.

Division of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas

A syndrome of patellofemoral dysfunction, consisting of painful popping,
catching, grinding, or jumping of the patellar component, can complicate total
knee replacement. From October 1983 to March 1988, eleven of 635 total knee
replacements had this syndrome. On arthroscopic evaluation, the dysfunction of
the patellofemoral articulation was found to be secondary to intra-articular
fibrous bands. In eight patients, a transverse fibrous band prevented the
patella from seating well in the sulcus of the femoral component. In four
patients, the fibrous band extended from the superolateral border of the patella
to the infrapatellar fat pad, tethering the patella laterally. In one patient,
the fibrous band extended from the distal pole of the patella to the
intracondylar notch, tethering the patella inferiorly. In all patients, the
symptoms resolved after arthroscopic removal of the fibrous bands.

PMID: 2365714 [PubMed]

702: Dermatol Clin.  1990 Jul;8(3):563-8.  

The safety of dermatologic liposuction surgery.

Hanke CW, Lee MW, Bernstein G.

Indiana University School of Medicine, Indianapolis.

The safety of liposuction surgery begins with appropriate preoperative
evaluation and patient selection. Operative considerations include the type of
anesthesia used, the volume of fat aspirated, and the liposuction technique
utilized. Results from a recent survey revealed that liposuction surgery can be
extremely safe when done under local anesthesia with conservative fat removal.

Publication Types:
    Review, Tutorial

PMID: 2199111 [PubMed]

703: Dermatol Clin.  1990 Jul;8(3):425-37.  

The tumescent technique. Anesthesia and modified liposuction technique.

Klein JA.

Department of Dermatology, University of California, Irvine.

Using the tumescent technique, liposuction can remove large volumes of fat with
minimal blood loss. A maximal safe dosage of dilute lidocaine using the
tumescent technique is estimated to be 35 mg/kg. The slow infiltration of a
local anesthetic solution of lidocaine and epinephrine minimizes the rate of
systemic absorption and reduces the potential for toxicity. Dilution of
lidocaine (0.05% of 0.1%) and epinephrine (1:1,000,000) further delays
absorption and reduces the magnitude of peak plasma lidocaine concentrations.
Using the tumescent technique for liposuction, peak plasma lidocaine levels
occur 12 hours after the initial injection. Clinically significant local
anesthesia persists for up to 18 hours. For liposuction, it is not necessary to
use local anesthetics, which are longer acting and potentially more cardiotoxic
than lidocaine.

Publication Types:
    Review, Tutorial

PMID: 2199105 [PubMed]

704: Dermatol Clin.  1990 Jul;8(3):415-9.  

Perils and pearls of liposuction.

Asken S.

Cosmetic Surgery Center of Connecticut, Westport.

Facial and body liposuction has become a liposculpturing technique. As is
usually the case, the more one performs a particular procedure, the more one
realizes its difficulties, dangers, and challenges. The surgeon should never
perform liposuction in a routine and casual manner. Such an approach can only
lead to problems because each patient has different requirements. The goal of
this chapter is to inspire the reading physician to approach each case as if it
were the first one, i.e., with a great deal of prudence. This will lead to
better results and fewer complications.

Publication Types:
    Review, Tutorial

PMID: 2199104 [PubMed]

705: Ann Plast Surg.  1990 Jul;25(1):48-52.  

Comment in:
    Ann Plast Surg. 1991 Mar;26(3):293.

Fat embolism syndrome after liposuction: a case report and review of the

Laub DR Jr, Laub DR.

Medical College of Wisconsin, Milwaukee.

There have been three previous case reports of fat embolism syndrome (FES) after
lipectomy. We present a case of FES diagnosed by pulmonary angiography. It seems
likely that there is an incidence of subclinical fat embolization after
liposuction, but conservative patient selection and aggressive postoperative
management can lessen the morbidity and mortality of FES.

Publication Types:
    Case Reports
    Review of Reported Cases

PMID: 2198844 [PubMed]

706: Ann Ital Chir.  1990 Jul-Aug;61(4):365-9.  

[Horizontal gastroplasty in the surgical treatment of morbid obesity]

[Article in Italian]

Doldi SB.

Istituto di Chirurgia Generale e di Oncologia Chirurgica, Universita degli Studi
di Milano.

PMID: 2082772 [PubMed]

707: Ann Ital Chir.  1990 Jul-Aug;61(4):359-64.  

[Latero-lateral jejunoileal bypass in the surgical treatment of severe obesity]

[Article in Italian]

Montorsi W, Doldi SB, Longoni F.

Istituto di Chirurgia Generale e di Oncologia Chirurgica Universita degli Studi
di Milano.

PMID: 2082771 [PubMed]

708: Hosp Pract (Off Ed).  1990 Jun 15;25(6):67-78.  

LDL cholesterol: its regulation and manipulation.

Dietschy JM.

Department of Medicine, University of Texas Southwestern Medical Center, Dallas.

Elevated plasma LDL cholesterol concentrations result primarily from two
mechanisms: LDL overproduction and loss of hepatic receptor-dependent LDL
removal. This knowledge can be used to lower plasma cholesterol and thereby
retard or even reverse atherosclerosis. Pharmacologic agents are useful, as are
dietary approaches.

PMID: 2112146 [PubMed]

709: Plast Reconstr Surg.  1990 Jun;85(6):994-5.  

Comment on:
    Plast Reconstr Surg. 1989 Jun;83(6):997-1004.

Complications of suction-assisted abdominoplasty combined with other surgical

Dillerud E.

Publication Types:

PMID: 2349303 [PubMed]

710: Aust Vet J.  1990 Jun;67(6):223-6.  

Premature farrowings caused by feeding cottonseed meal.

Love RJ, Peacock AJ, Evans G.

Department of Animal Health, Camden, New South Wales.

Increasing the level of cottonseed meal (CSM) in sow diets from less than 5% to
10% increased the incidence of premature farrowings (gestation length less than
111 days) from 1.1% to 2.7% (p less than 0.001) and reduced the mean gestation
length from 114.07 +/- 1.53 to 113.70 +/- 1.59 days (p less than 0.0001).
Survival of piglets born prematurely was poor. After removal of CSM from the
diet there was a residual effect lasting several weeks before the gestation
length returned to normal. Experimental feeding of diets containing 20% and 40%
CSM to small groups of sows caused significant shortening of gestation length
and 3 of 26 sows fed 40% CSM farrowed prematurely. The mechanism by which CSM
causes this effect has yet to be determined.

PMID: 2222366 [PubMed]

711: Lakartidningen.  1990 May 23;87(21):1873-6.  

[Liposuction--six years experience in Sweden]

[Article in Swedish]

Niechajev I.

Lidingo-kliniken, Stockholm.

PMID: 2362476 [PubMed]

712: Postgrad Med.  1990 May 1;87(6):187-8, 193-5.  

Liposuction. What it will and won't do.

Berggren RB.

Department of Surgery, Ohio State University College of Medicine, Columbus.

Liposuction is used most often to contour the body. Usually, it is done on an
outpatient basis under general or regional anesthesia. Results are better in
patients who have good skin turgor and are at or near their ideal weight. The
recovery period is short and relatively pain-free. While there have been serious
complications in a few cases, the procedure is safe when done by experienced
physicians who are careful in selecting patients and cautious about the
magnitude of the procedure they perform. Patient satisfaction is high,
particularly when patients are selected carefully and are well-informed
concerning the expected outcome.

Publication Types:
    Review, Tutorial

PMID: 2186399 [PubMed]

713: Plast Reconstr Surg.  1990 Apr;85(4):638-9.  

Complications of autografting fat obtained by liposuction.

Montanana Vizcaino J, Baena Montilla P, Benito Ruiz J.

Publication Types:
    Case Reports

PMID: 2315407 [PubMed]

714: J Chir (Paris).  1990 Apr;127(4):191-8.  

[The repair of recurrent postoperative incisional hernias. Objectives and
therapeutic indications (68 cases)]

[Article in French]

Champetier J, Letoublon C, Chaland P, Alnaasan I, Bouchard F, Granger P.

Service de Chirurgie Generale et de Chirurgie Digestive, C.H.U. de Grenoble,
Hopital Nord.

Among 327 surgical repairs of incisional hernias done between 1974 and 1989, 68
repairs (21%) were performed because of a primary treatment failure. Failed
primary attempts of cure had been unique in 71%, and multiple in 29% of cases;
their procedure had been essentially suture or herniorrhaphy. Site of recurrent
incisional hernia (R.I.H.), was midline or lateral incision in respectively 84%
and 16% of cases. Size of R.I.H. was considered as large in two third of cases.
Operation was performed electively in majority of cases (93%). More than half of
the patients were "prepared" by preoperative pneumoperitoneum and/or weight
reducing regimen. Mersilene* mesh was used in 81% of cases. Results of treatment
of R.I.H. are reported, depending on procedure. Among 55 cures by use of
Mersilene* mesh, 1 patient died (from myocardial infarction), and 5 recurrences
occurred, 4 of which from sepsis. Study of complications and failures suggests:
1) careful attention to indications, 2) advantages of a large size Mersilene*
mesh, 3) attention to preoperative treatment, especially weight loss regimen and
progressive pneumoperitoneum.

PMID: 2141845 [PubMed]

715: Plast Reconstr Surg.  1990 Mar;85(3):442-5.  

Comment in:
    Plast Reconstr Surg. 1991 May;87(5):997-8.

Subcutaneous pseudobursa secondary to suction and surgery.

Ersek RA, Schade K.

Department of Plastic Surgery, University of Texas Medical Science Center,

Suction lipectomy has been used throughout the regions of the body to remove
vast amounts of subcutaneous fat. The blunt technique allows for a multiplicity
of small (4 to 6 mm) channels to be created and the fat removed by suction with
little disturbance of the overlying skin, the supporting septa, vessels, or
nerves. Abdominolipectomy has been successfully performed for decades, in which
large amounts of skin and subcutaneous fat are removed by sharp dissection. The
undermining involved in an adbominolipectomy extending from the xiphoid to pubis
and laterally to the level of the iliac crest and then supplemented by the
suction technique has led to the formation, in some cases, of chronic seromas
not relieved by multiple aspirations. Healing and contractions of these seromas
causes a deformity of the overlying skin, because it is puckered and drawn upon
itself. This results in the formation of a subcutaneous pseudobursa lined by
collagen sheets but no epithelial cells. We present 9 patients who have
demonstrated this phenomenon. We suggest that in the largest resections, safety
is best served by waiting a period of at least 6 weeks between suction and
subsequent resection.

Publication Types:
    Case Reports

PMID: 2304996 [PubMed]

716: Pathol Res Pract.  1990 Feb;186(1):180-6.  

The influence of portocaval shunting on inner ear structures.

Lohle E, Beck C, Scholmerich J, Baumgartner U.

Department of ENT, Freiburg, FRG.

In rats with a portocaval shunt the cells of the inner ear were examined in an
ultrastructural study. In 15 rats a porto-caval shunt (PCS) was constructed.
Control rats underwent identical procedures but no anastomosis was produced
(SOP). The control rats were pair-feeded. PCS rats developed an increased
urinary zinc excretion associated with weight loss, alopecia, lethargy and
atrophy of the testes. The serum zinc concentration in PCS rats was
significantly reduced. In the inner ear we found ultrastructurally an increasing
number of lysosomes and a severe damage of the myelin sheath of the granular
ganglion cells. The myelin sheath was split and filled with great myelin
figures. In the outer hair cells resulted in an increasing number of lysosomes.
In the stria vascularis and in Reissner's membrane a vacuolization of the tissue
appeared. The results of this study show that rats with a porto-caval
anastomosis serve as a pathophysiological model of zinc impoverishment like
porto-caval shunting in patients with liver cirrhosis.

PMID: 2315212 [PubMed]

717: J Am Vet Med Assoc.  1990 Feb 1;196(3):455-8.  

Treatment of right dorsal ulcerative colitis in a horse.

Simmons TR, Gaughan EM, Ducharme NG, Dill SG, King JM, Anderson WI.

Department of Clinical Sciences, New York State College of Veterinary Medicine,
Cornell University, Ithaca 14853-6401.

Excessive administration of phenylbutazone was associated with development of
right dorsal ulcerative colitis. The clinical signs of right dorsal colitis
include chronic colic and weight loss. The laboratory abnormalities include
panhypoproteinemia and a high WBC count in the abdominal fluid. Medical
management of the chronic colic and protein-losing enteropathy associated with
the ulcerative lesions in the right dorsal colon and surgical bypass of the
right dorsal colon did not result in long-term resolution of clinical signs.
Resection of the ulcerated right dorsal colon through a right lateral approach
at the 16th rib resulted in resolution of intestinal protein loss and colic. The
results of this case suggest that surgical resection of the ulcerated right
dorsal colon may be the recommended treatment for right dorsal ulcerative

Publication Types:
    Case Reports

PMID: 2298678 [PubMed]

718: Cancer.  1990 Jan 15;65(2):358-61.  

Primary ileocecal lymphoma. A study of 22 patients.

Auger MJ, Allan NC.

Department of Clinical and Laboratory Haematology, Western General Hospital,
Edinburgh, Scotland.

Twenty-two patients with primary ileocecal non-Hodgkin's lymphoma were reviewed.
Abdominal pain (67%), altered bowel habits (50%), and weight loss (50%) were the
most common presenting symptoms and an abdominal mass was palpable in 50%.
Sixteen (73%) had histologic evidence of local lymph node involvement at
diagnosis and another two (9%) had nonhistologic evidence of nodal involvement.
An abdominal computed tomography (CT) scan was the most helpful staging
investigation. Twenty-one (95.5%) patients underwent surgical resection of their
disease. Subsequent chemotherapy, with or without radio-therapy, appeared to
prolong survival (median, 34 months versus 14 months). There were three
treatment-related deaths. Neither the age of the patient nor the stage of
disease at presentation (Ann Arbor) appeared to influence survival. Adequate
initial surgery combined with chemotherapy may provide optimum therapy in
patients with primary ileocecal lymphoma.

PMID: 2295058 [PubMed]

719: Aesthetic Plast Surg.  1990 Summer;14(3):193-4.  

Suction-assisted lipectomy in the older patient.

Forshan VR, Hintzman D.

A retrospective study of 158 suction-assisted lipectomy patients ranging in age
from 50 to 81 years was completed in order to determine the success of the
technique in this subset of older patients. These were primarily cosmetic
procedures of the trunk and extremities. The patients presented with a typical
wide spectrum of systemic medical disorders as one would expect in this age
group. The study revealed no mortalities and limited suboptimal aesthetic
results consisting of insufficient fat removal, requiring secondary suctioning,
and waviness or asymmetry. We feel that with adequate preoperative explanation
and planning suction-assisted lipectomy can be a rewarding procedure in patients
of all ages.

PMID: 2399849 [PubMed]

720: Ann Chir.  1990;44(5):362-7.  

[Does jejunoileal bypass still have a place in the surgical treatment of morbid

[Article in French]

Doldi BS, Vita PM, Restelli A, Micheletto G, Longoni F, Caspani P, Montorsi W.

Instituto di Chirurgia Generale ed Oncologia Chirurgia della Universita' degli
studi di Milano, Italia.

Jejuno-ileal bypass has been widely used for the surgical treatment of morbid
obesity since 1954, but from 1978 onwards the operation has met with increasing
disfavor, especially in the USA as a result of its unacceptably high
complication rate. From 1982 onwards, 235 morbidly obese patients had a
side-to-side jejuno-ileal bypass in our Department. Our data concerning weight
loss and