Search

Background Bariatric surgery offers patients with morbid obesity and related diseases short- and long-term benefits to their health and quality of life. Evidence-based medicine is integral in the evaluation of risk versus benefit; however, data are lacking for several high-risk patient populations, including the elderly. Objectives This study assessed morbidity and mortality data for patients age ≥70 undergoing laparoscopic sleeve gastrectomy (SG) or laparoscopic Roux-en-Y gastric bypass (RYGB). Setting University Hospital, Bronx, New York, United States using national database. Methods We used the American College of Surgeons-National Surgical Quality Improvement Project database for years 2005–2016 and identified patients who underwent primary SG or RYGB. Patients age ≥70 were assigned to the over age 70 (AGE70+) cohort and younger patients were assigned to the under age 70 (U70) cohort. Postoperative length of stay and 30-day morbidity and mortality were assessed. Results A total of 1498 patients age ≥70 underwent nonrevisional bariatric surgery, including 751 (50.1%) SG and 747 (49.9%) RYGB. AGE70+ was associated with increased mortality and increased rates of cardiac, pulmonary, renal, and cerebrovascular morbidity. AGE70+ patients had longer mean length of stay, and were more likely to require transfusion and return to operative room. When stratified by procedure, rates of organ-space surgical site infection, acute renal failure, urinary tract infection, myocardial infarction, deep vein thrombosis/thrombophlebitis, and septic shock were significantly increased in AGE70+ patients undergoing RYGB but not SG. Impaired functional status was associated with increased rates of morbidity and mortality for AGE70+ patients and for U70 patients, although the small number of patients within each category limited statistical analysis. Conclusions Evaluation of risk versus benefit is performed on a case-by-case basis, but evidence-based medicine is critical in empowering surgeons and patients to make informed decisions. The overall rate of morbidity and mortality for AGE70+ patients undergoing bariatric surgery was increased relative to U70 patients. Rates of several adverse events, including acute renal failure and myocardial infarction, were increased in AGE70+ patients undergoing RYGB but not SG, suggesting that SG may be the preferred procedure for elderly patients with organ-specific risk factors. The increased rates of morbidity and mortality observed for patients with impaired functional status supports consideration of functional status when evaluating preoperative risk.

Naldemir, Ibrahim Feyyaz/0000-0002-0804-7378 WOS: 000428231100063 PubMed: 29277494 The occipital bone is a complex structure due to its anatomy and accessory sutures. Fracture - accessory suture differential diagnosis should be performed carefully in patients with a history of head trauma [4]. In this case report we wanted to emphasize that accessory sutures can be difficult to diagnose in patients with head trauma. We also specified the points to be considered in the suture - fracture differentional diagnosis. A bilateral, symmetrical fissure line was observed in the occipital bone basal part of the patient who was admitted to our emergency department due to head trauma. The patient was followed up with accessory suture and then discharged after paying attention to important points in the differential diagnosis. (C) 2017 Elsevier Inc. All rights reserved.

Intraocular miniaturized image transmission systems are developed to restore vision in patients with irreversible destruction of the anterior ocular segment (i.e. chemical burns, explosion trauma, trachoma) and high risk for corneal transplantation, provided that the posterior ocular segment is intact. To ensure safety of such a device biocompatibility tests were conducted. In the present study the effects of light and temperature in various intensities and the toxicity of the implanted materials on neural function in the rabbit retina in-vivo was investigated. All tests give encouraging results concerning the feasibility of intraocular miniaturized image transmission systems.

Angiotensin-converting enzyme (ACE) levels are known to be elevated in several granulomatous lung diseases. We prospectively studied 21 patients with smear- or culture-proved diagnosis of tuberculosis by measuring their ACE levels. ACE microvial(Ventrex, Ventrex Laboratories Inc, Portland, Me) radioassay system was used. The mean ACE value of our 21 patients (14 males, 7 females; mean age, 56 years) was 5.69 U, which was higher than the control group of healthy volunteers (n = 5, mean value, 4.14 U). We found that 4 (19%) of the 21 samples had ACE values higher than the expected range (P

A 73-year-old man with metastatic pheochromocytoma demonstrated areas of elevated I-131 MIBG uptake and no Tc-99m sestamibi uptake in the presence of marked blood flow, suggesting P-glycoprotein-mediated multidrug resistance. Tc-99m sestamibi scintigraphy may be used in predicting the chemotherapeutic response of P-glycoprotein-related cytotoxic drugs such as anthracyclines, vinca alkaloids, and epipodophyllotoxins. Moreover, in metastatic pheochromocytoma, it may change the therapy strategy, such as cytotoxic chemotherapy versus targeting therapy with 1-131 MIBG or combined therapy with the addition of a P-glycoprotein-reversing agent, provided that the patient is surveyed first with Tc-99m sestamibi and 1-131 MIBG.

Four blood isolates, 12 pneumonia isolates, and seven colonizing isolates of Branhamella catarrhalis were compared with respect to their ability to grow in normal human serum and in convalescent serum of a patient with B. catarrhalis bacteremia. Disease-causing isolates showed seven of 16 serum-resistant strains (43 percent) compared with one of seven (13 percent) colonizing strains. Bacteremic strains were not more serum-resistant than pneumonia-causing strains. Trypsin zones of inhibition were higher for disease-causing strains. There was no correlation between source of isolation and colistin sensitivity or ability to hemagglutinate red blood cells.

Object. Primary chondrosarcoma of the spine is extremely rare. During the last 43 years only 21 patients with this disease were registered at The University of Texas M. D. Anderson Cancer Center. The purpose of this study was to examine the demographic characteristics, treatments, and outcomes of this set of patients. Methods. Medical records for 21 patients were reviewed. Age, sex, race, clinical presentation, tumor histology, tumor location in the spinal column, treatments, surgical details, and response to treatment were recorded. Surgical procedures were categorized as either gross-total resection or subtotal excision of tumor. Neurological function was assessed using Frankel's functional classification. Time to recurrence and survival analyses were performed using the Kaplan—Meier method. The median age of patients was 51 years, with fairly equal gender representation. Eighteen patients underwent at least one surgical procedure for a total of 28 surgical procedures: seven radical resections and 21 subtotal excisions. Radiation therapy was used in conjunction with 10 of the 28 surgical procedures. The median Kaplan—Meier estimate of overall survival for the entire group was 6 years (range 6 months–17 years). Tumors recurred after 18 of the 28 procedures. Kaplan—Meier analysis revealed a statistically significant difference in the per-procedure disease-free interval after gross-total resection relative to subtotal excision (exact log rank 3.39; p = 0.04). The addition of radiation therapy prolonged the median disease-free interval from 16 to 44 months, although this was not statistically significant (exact log rank 2.63; p = 0.16). Conclusions. Our results suggest that gross-total resection of the chondrosarcoma provides the best chance for prolonging the disease-free interval in patients. Subtotal excision should be avoided whenever possible. Addition of radiation therapy does not appear to lengthen significantly the disease-free interval in this patient population.

The treatment of diseases that require multiple transfusions over a long time is frequently complicated by the lack of an available venous route. The bone marrow has been suggested as an alternate ...

• In five patients with annular tinea corporis, the tritiated thymidine labeling indexes were determined in the rim, center, and intermediate areas of the lesion and compared with normal skin. Labeling indexes at the rim were much higher than those of normal skin (mean, 4.2 times). Labeling indexes elsewhere in the lesion were not significantly different from those of normal skin. Histologic examination showed epidermal thickening in all areas of the lesion as compared with normal skin. This study suggests that there is an increased epidermal turnover at the rim of annular dermatophytosis that may be important in the pathophysiology and morphogenesis of such lesions. ( Arch Dermatol 112:485-488, 1976)

To the Editor.— I read the article by Drs. Leon N. Sussman and Harvey Lozman, "Arteriovenous Fistula for Self-Treatment of Hemophilia" (230: 437, 1974) with great interest. More than three years ago, Dr. Harold Greenberg and I reported the creation of an arteriovenous fistula for the administration of blood in a patient with von Willebrand disease and implied that this technique could be used for other intravenous medications when veins were not available ( N Engl J Med 285:787, 1971). I assume that Drs. Sussman and Lozman and the editors ofThe Journalmissed our article since it was not mentioned in the text or references. As pointed out previously by us, and now by Dr. Sussman and Dr. Lozman, the creation of an arteriovenous fistula for transfusion or intravenous medications can be a valuable procedure on selected patients.

PATHOLOGIC PICTURE After Monckeberg's first description of the pathologic picture of calcific aortic stenosis, in 1904, this lesion for years was reported only rarely and was recognized only at postmortem examination. In recent years, however, clinical and roentgenologic studies have allowed its recognition during life without difficulty. Various authors (Monckeberg, Ribbert, Margolis, Ziellessen and Barnes, Giese, Martens and others) have investigated the underlying pathologic condition, and their findings will be reviewed here as they are necessary for a better understanding of the clinical and roentgenographic aspects. The involvement affects the aortic ring, primarily at the roots of the valves. In the first stage of the disease only the outer layer at the site of the sinus of Valsalva is affected. Calcification then extends into the leaflets or into one of the commissures, bulges into the sinuses of the valves or forms radiating or circular buckles within the valves themselves. Deposits

Considerable interest has been aroused in the last few years regarding the roentgen diagnosis of mural thrombi. Yet, in reviewing the literature on this subject, I find that few mural thrombi have been roentgenologically recognized during life and the diagnosis confirmed by necropsy. From my own experience and that of other observers it is apparent that calcified mural thrombi usually occur in mitral stenosis and are commonly situated in the left auricle. Only 5 cases of mural thrombosis have been reported in the literature. These consist of 3 cases of calcified mural thrombi reported by Scholz,1Besser and Schilling2and Heeren3and 2 cases of noncalcified mural thrombi reported by Arendt4and Fussl.5 Prompted by this situation, I wish to report a case of calcified mural thrombus in which the condition was recognized during life and the diagnosis confirmed by necropsy. Roentgenoscopic and aimed roentgenographic

The skin of patients with lupus erythematosus (LE) and related diseases was examined for cytoplasmic tubular aggregates (CTA) before and after ultraviolet light (UVL) irradiation. All the biopsy specimens from active skin lesions of patients with LE contained CTA. Eight (44.4%) of 18 patients with systemic lupus erythematosus (SLE) and one (11.1%) of 9 patients with discoid lupus erythematosus (DLE) had CTA in visibly normal skin. Following a ten-day course of UVL irradiation to visibly normal skin, the percentage of patients with CTA increased two fold and five fold, respectively. Cytoplasmic tubular aggregates appear to be an abnormal cell constituent and may represent a cell reaction product. The possibility that these structures are a neoantigenic product or a virus responsible for disease cannot be excluded. The technique of UVL irradiation is a tool to study the nature of these aggregates.