Search

Abstract Obesity is an increasing problem in Scotland and Laparoscopic Adjustable Gastric Bands (LAGB) are an effective method of weight reduction. Most outcome data are reported from high volume units with extensive experience or dedicated bariatric practice. We aimed to assess an experienced laparoscopic surgeon's outcome working outwith a dedicated bariatric practice in the west of Scotland.Methods All LAGB procedures performed by a single surgeon were prospectively assessed from 1997 to 2004. LAGB were inserted using pars flaccida approach. Patient selection was based on BMI >35 or significant obesity related co-morbidities. Outcomes included percentage excess weight loss (%EWL) and excess BMI loss (EBL). We assessed total operating time to assess the learning curve for LAGB placement.Results 125 patients were assessed (107 F:18 M). 123 patients were in regular follow-up (98%). Median age was 44 years (range 25-63). Mean follow-up was 34 months (range 11-91). Median initial BMI was 49 (range 37-73). 31% were BMI 35-45, 36% were BMI 45-50 and 33% were BMI>50. %EWL at 1,3 and 5 years was 45, 58 and 74, respectively. EBL at 1, 3 and 5 years was 11.7, 16.1, and 21.7, respectively. Complications included 4 converted procedures, 1 failed band insertion after conversion and reoperation for removal in five. Eight patients had tubing access port problems requiring intervention. The median overall total operation time was 80 minutes (range 50 - 160).Conclusions In this cohort LAGB insertion by an experienced laparoscopic surgeon is safe with few re-operations. Satisfactory weight loss is obtained and patient compliance with follow-up is high.

Biological membranes are known to contain compositional heterogeneities, often termed rafts, with distinguishable composition and function, and these heterogeneities participate in vigorous transport processes. Membrane lipid phase coexistence is expected to modulate these processes through the differing mechanical properties of the bulk domains and line tension at phase boundaries. In this contribution, we compare the predictions from a shape theory derived for vesicles with fluid phase coexistence to the geometry of giant unilamellar vesicles with coexisting liquid-disordered (Ld) and liquid-ordered (Lo) phases. We find a bending modulus for the Lo phase higher than that of the Ld phase and a saddle-splay (Gauss) modulus difference with the Gauss modulus of the Lo phase being more negative than the Ld phase. The Gauss modulus critically influences membrane processes that change topology, such as vesicle fission or fusion, and could therefore be of significant biological relevance in heterogeneous membranes. Our observations of experimental vesicle geometries being modulated by Gaussian curvature moduli differences confirm the prediction by the theory of Juelicher and Lipowsky.

ObjectiveCardiac transplant recipients often develop hypertension as a side effect of immunosuppressive treatment. The aim of this study was to use the serial endomyocardial biopsies taken to monitor rejection to study the early and sequential arterial changes in human myocardial resistance arteries as hypertension develops.MethodsAt least 14 biopsies were studied from each of 23 patients, divided into a normotensive group (12 patients with a diastolic pressure never greater than 90 mm Hg) and a hypertensive group (11 patients with more than 10% of diastolic pressure measurements above 100 mm Hg). Morphometric analysis of between 30 and 50 arteries and arterioles in two widely separated histological levels from each biopsy was undertaken using an Optomax image analyser.ResultsThere was a correlation between blood pressure, particularly diastolic pressure, and rate of medial thickening of intramyocardial coronary resistance arteries and arterioles (P = 0·0025). There was also a correlation between serum cyclosporin A concentrations and mean artery wall thickness (P = 0·003).ConclusionsHypertension and cyclosporin A treatment are associated with significant wall thickening of intramyocardial resistance vessels in cardiac allograft recipients. These changes may be functionally and clinically important.

Relates a US Marine Corps helicopter pilot's experience while on a terrain flight with his instructor. Problems in flying at night; Loss of general orientation.

We predict localization in a strained, random aggregate of identical elasto-frictional particles. As triaxial compression proceeds, pairs of particles deform subject to local equilibrium and anisotropy develops because of contact deletion and the dependence of contact stiffness on the average strain. The combination of the deviations of the particle displacements from the average strain and the induced anisotropy results in a relation between increments in average strain and average stress that does not possess the major symmetry. This leads to the possibility of a discontinuity in a component of the incremental strain at a predicted value of the shear strain and a predicted orientation relative to the axis of greatest compression. [ABSTRACT FROM AUTHOR]

We provide a theoretical analysis to support the presence of both slow and fast compression waves in an unconsolidated, fully saturated, granular material. We derive the constitutive relation for such an aggregate based upon a micro-mechanics analysis. In doing this, we take in account the coupling between the solid particles and fluid. As a consequence of this coupling, the lubrication layer provides a connection between particles, both when they are separating and when they are compressing. The predictions of the speed and attenuation of the fast compression waves compare well with experimental data over the range of frequencies for which the nonlinear dissipation associated with the relative velocities between solid and fluid is negligible. Slow waves are also predicted without comparison, because of the absence of clear experimental data. Predictions of the speed and attenuation for the shear wave are also provided and show a good agreement with experimental data when surface roughness is taken into account. • A constitutive relation for a fully saturated granular material in the presence of compressive and shear waves. • Solid–fluid interaction to model a typical pair of particles in the aggregate. • Slow compressive wave in unconsolidated fully saturated granular materials. • Comparison between theoretical prediction and experimental data. [ABSTRACT FROM AUTHOR]