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Severe obesity is a well-known risk factor for atherosclerosis and cardiovascular disease. Obesity is also a defining characteristic of the metabolic syndrome, a group of conditions associated with metabolic dysfunction and cardiovascular risk. The cardiovascular abnormalities that occur as a consequence of extreme obesity and its associated conditions contribute to an increase in all-cause mortality and morbidity as will as reduced life expectancy. This article will summarize the available information regarding the pathophysiology of cardiovascular disease in obesity, the impact of obesity on cardiac structure and function, and the major benefits afforded by surgical weight loss. [ABSTRACT FROM AUTHOR]

About 60% of patients with type 2 diabetes achieve remission after Roux-en-Y gastric bypass (RYGB) surgery. No accurate method is available to preoperatively predict the probability of remission. Our goal was to develop a way to predict probability of diabetes remission after RYGB surgery on the basis of preoperative clinical criteria.

Taste-signaling proteins, which are expressed in the oral cavity and the gastrointestinal tract, may be involved in regulating metabolism and immunity via oral-gut-brain circuit. This study aimed to determine if these genes are expressed and altered in the jejunum of patients with extreme obesity after bariatric surgery. Reverse transcription polymerase chain reaction revealed that phospholipase C beta 2 and transient receptor potential channel M5 expressions were downregulated whereas Gustducins expression level remained unchained in the jejunum of patients with a body mass index >50. Our data suggest that taste-signaling dysregulation might contribute to obesity.

OBJECTIVE: To examine the safety and efficacy of multiple doses of PGG-glucan (poly- [ 1-6]-B-Dglucopyranosyl-[ 1-3]-B-D-glucopyranose) in high-risk patients undergoing major thoracic or abdominal surgery. DESIGN: An interventional, multicenter, double-blind, randomized, placebo-controlled study. SETTING: Four university-affiliated medical centers. PATIENTS: Sixty-seven high-risk patients undergoing major thoracic or abdominal surgery. INTERVENTION: Patients were randomized in a 1:1:1:1 ratio to receive saline placebo or PGG-glucan at a dose of 0.1 mg/kg, 0.5 mg/kg, and 1.0 mg/kg or 2.0 mg/kg. One dose was administered before surgery and three doses were administered after surgery. MAIN OUTCOME MEASURES: To examine the safety and efficacy of PGG-glucan infusion and to identify potentially important factors for a planned phase III study. RESULTS: A dose-response trend with regard to infection incidence among patients who received PGG-glucan was observed. Serious infections occurred in four patients who received placebo and in three patients who received PGG-glucan at a dose of 0.1 mg/kg. However, only one patient who received PGG-glucan at a high dose had a serious infection. The incidence and severity of adverse events was comparable in all groups. CONCLUSIONS: PGG-glucan was generally safe and well tolerated, may decrease postoperative infection rates, and warrants further investigation in a planned phase III trial.(Arch Surg. 1994;129:1204-1210)

OBJECTIVE: To compare the respiratory rate to tidal volume ratio with the oxygen cost of breathing to see which could more accurately predict the outcome of ventilator weaning for surgical patients. DESIGN: Prospective comparison of two modalities used to predict the likelihood of successful ventilator weaning. PATIENTS: Twenty-eight consecutive patiens with chronic respiratory insufficiency requiring long-term mechanical ventilation in the surgical intensive care unit at New England Deaconess Hospital, Boston, Mass, were studied. MAIN OUTCOME MEASURES: The oxygen cost of breathing and the respiratory rate to tidal volume ratio were measured during spontaneous breathing. Patients extubated within 2 weeks of being studied were designated as extubated while patients not extubated within this period or requiring reintubation were recorded as not extubated. RESULTS: The oxygen cost of breathing predicted succesful extubation in all five patients who were extubated, and failure in 20 of 23 patients who could not be extubated (sensitivity, 100%; specificity, 87%). In contrast, the respiratory rate to tidal volume ratio predicted extubation for only two of five patients who were extubated and predicted failure in only 12 of 23 patients who could not be extubated (sensitivity, 40%; specificity, 52%). CONCLUSION: For this group of patients requiring prolonged ventilation, the oxygen cost of breathing proved to be a more reliable predictor of both successful extubation and failure.(Arch Surg. 1994;129:269-274)

Liver replacement has become a viable treatment option for select patients with severe acute or chronic hepatic failure. Evaluation of potential candidates is discussed along with current techniques for donor organ retrieval, recipient implantation, and postoperative immunosuppression.

As the practical uses of parenteral feeding have increased, so too have the possibilities for complications. By following certain guidelines involving catheter placement, placement technique, and patient positioning, one can minimize the chance for complications, thus allowing for more effective utilization of parenteral nutritional support.

• We present our experience from 1982 to the present in treating 33 patients with recurrent cancers (colorectal, 22; gynecologic, six; breast, two; melanoma, two; and lung, one) secondarily involving the genitourinary tract. All patients had severe symptoms that required palliation. Endoscopically placed stents relieved ureteral obstruction in 18 (75%) of 24 patients with widespread metastatic disease. Two patients required percutaneous nephrostomy tubes, and five required open operations. Good to excellent palliation was achieved in 23 of 24 patients. Mean survival in the group with diffuse metastases was 13 months (range, six to 29 months). Nine patients with localized recurrences underwent surgical procedures. For localized pelvic recurrences, total exenteration (with or without intraoperative radiotherapy) provided excellent palliation with low morbidity. At the time of this report, five of six such patients had no evidence of disease, and one had a small asymptomatic pelvic recurrence, with a mean follow-up of 13 months (range, five to 19 months).(Arch Surg 1987;122:493-498)

• The management of regional tumor recurrence in the pelvis traditionally has been a difficult problem for surgeons and oncologists. The only meaningful therapy for these patients is a potentially curative re-resection. The records and operative reports of 29 patients with regional pelvic tumor recurrence treated between 1981 and 1986 were reviewed. The operative procedures performed included three bowel resections, six abdominoperineal resections, eight pelvic exenterations, eight resections of tumor recurrence, and four conservative procedures. There was one operative death in this group. Significant morbidity was noted in the group but was clustered in a small number of patients operated on early in the series. The median follow-up in this series was 13 months (range, two to 51 months). Nineteen (65%) of the patients are surviving at a median follow-up of ten months (range, two to 51 months). The median survival (following resection) in the ten patients (35%) who died was 18 months. In 15 (52%) of the patients, a complete resection was performed. In this group, the survival is 80% with a median follow-up of 11 months. Seven (37%) are surviving with no evidence of disease. Palliation of symptoms occurred in 23 (79%) of the 29 patients. Radical resection of tumor recurrence in the pelvis can be performed with acceptable mortality and complication rates. This therapy should be considered for further clinical trials combining surgical and adjuvant therapy in patients with regional pelvic tumor recurrence.(Arch Surg 1987;122:457-460)

Liver resection is an increasingly common procedure. Despite the wide variety of indications, the preoperative and postoperative care are similar. Recent work has brought to light the significant alterations in fluid and electrolytes, hemostasis, metabolism, and pulmonary function that may occur, and a thorough understanding of these changes is required to minimize the morbidity and mortality rates. Postoperative hepatic failure is a devastating complication, and careful patient selection is required to avoid this. Better methods of evaluating functional hepatic reserve are needed.

Pulmonary hypertension has recently been indentified as a risk factor for adverse events and mortality after gastric bypass surgery. This condition can be present in association with obstructive sleep apnea, obesity hypoventilation, obese cardiomyopathy, and chronic thromboembolism. Since this is a modifiable risk factor and may be overlooked in the evaluation of bariatric candidates, bariatric surgeons and team members should become more familiar with guidelines for current diagnosis, prognosis assessment, and treatment. Improved diagnosis and severity assessment will enhance the patient selection and optimization process in bariatric surgery. [ABSTRACT FROM AUTHOR]