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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
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
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
lipoplasty.
Topaz M, Assia EI, Meyerstein N, Meyerstein D, Gedanken A.
Publication Types:
Comment
Letter
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:
Letter
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,
MO, USA.
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
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
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
Comment
Letter
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
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
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
stem]
[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.
email@docteur-knipper.com
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
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
therapy.
Publication Types:
Review
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
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.
mabedine@jhmi.edu
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
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:
Letter
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
tumor.
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
modalities.
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
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
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
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.
cmueller@ch11.ukl.uni-freiburg.de
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
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
Turkey.
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
liposuction.
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
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
acceptable.
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
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:
Comment
Letter
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:
Comment
Letter
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
approach.
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
Group.
Centre de Pneumologie, Hopital Laval, Universite Laval, Ste-Foy, Quebec, Canada.
yves.lacasse@med.ulaval.ca
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.
michael.korenkov@uni-koeln.de
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
patients]
[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.
delphine.voulliaume@mageos.com
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
cases.
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
axilla).
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
JF.
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.
j.colquitt@soton.ac.uk
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
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
rats.
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,
Japan.
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
SBT.
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
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:
Letter
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
leak.
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
implant.
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:
Comment
Letter
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
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,
Israel.
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
loss.
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.
liserh01870christensen@rh.dk
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
elimination.
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
occlusion.
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.
anne.g.rizzo@medstar.net
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:
Comment
Letter
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:
Comment
Letter
PMID: 12665025 [PubMed]
75: Dermatol Surg. 2003 Apr;29(4):433-5.
Cigarette burn after tumescent anesthesia and intravenous sedation: a case
report.
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
AM.
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
discussed.
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
preventable.
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
surgery.
Akoz T, Akan M, Yildirim S.
tayfunakoz@yahoo.com
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
complications.
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:
News
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:
Letter
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
treatment.
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
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
perspective.
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:
Congresses
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:
Comment
Letter
PMID: 12528869 [PubMed]