Search

Gastric bypass (GBP) has been the most common surgical way to treat obesity and its comorbidities. Late abdominal pain may occur by gastro-jejunal ulcers, gallstones, internal herniation or, rarely, intussusception. In an area with more than 1000 GBPs performed yearly, three patients with primary small bowel volvulus causing abdominal pain and requiring emergency or semi-urgent surgery were identified. Patients' histories, radiology, and surgery performed are presented. Weight loss followed by mesenteric narrowing of the root and thus relative elongation may make rotation of the small bowel mesentery possible. Such a torsion might be an overlooked differential diagnosis in obscure abdominal pain after GBP.

Background Anastomotic leak is one of the most serious complications following bariatric laparoscopic Roux-en-Y gastric bypass (LRYGB), and associated with high morbidity rates and prolonged hospital stay. Timely management is of utmost importance for the clinical outcome. This study evaluated the approach to suspected leakage in a high-volume bariatric surgery unit. Methods All consecutive patients who underwent LRYGB performed by the same team of surgeons were registered prospectively in a clinical database from September 2005 to June 2012. Suspected leaks were identified based on either clinical suspicion and/or associated laboratory values, or by a complication severity grade of at least II using the Clavien–Dindo score. Results A total of 6030 patients underwent LRYGB during the study period. The leakage rate was 1·1 per cent (64 patients). Forty-five leaks (70 per cent) were treated surgically and 19 (30 per cent) conservatively. Eight (13 per cent) of 64 patients needed intensive care and the mortality rate was 3 per cent (2 of 64). Early leaks (developing in 5 days or fewer after LRYGB) were treated by suture of the defect in 20 of 22 patients and/or operative drainage in 13. Late leaks (after 5 days) were managed with operative drainage in 19 of 23 patients and insertion of a gastrostomy tube in 15. Patients who underwent surgical treatment early after the symptoms of leakage developed had a shorter hospital stay than those who had symptoms for more than 24 h before reoperation (12·5 versus 24·4 days respectively; P < 0·001). Conclusion Clinical suspicion of an anastomotic leak should prompt an aggressive surgical approach without undue delay. Early operative treatment was associated with shorter hospital stay. Delays in treatment, including patient delay, after symptom development were associated with adverse outcomes.

BACKGROUND: Conversion operations after vertical banded gastroplasty (VBG) are sometimes performed because of vomiting and/or acid regurgitation. Primary operation with gastric bypass (GBP) is known to reduce gastroesophageal reflux (GERD). Previous studies have not been designed to differentiate between the effects of the altered anatomy and of the ensuing weight loss. No series has reported data on acid reflux before and after conversion from VBG to GBP. METHODS: We invited eight VBG patients with current symptoms of GERD. All had intact staple lines as assessed by barium meal and gastroscopy. Acid reflux was quantified using 48-h Bravo capsule measurements. Conversion operations were performed creating an isolated 15-20-ml pouch; the previously banded part of gastric wall was excised. Gastrojejunostomy was made end to end with a 28-mm circular stapler. The study is based on five patients consenting to early postoperative endoscopy and pH measurement. RESULTS: All patients were women with a mean age of 49.5 years and BMI of 36.3. Time since VBG was 132.1 months. Time from conversion to second measurement was 46.6 days and BMI at that time 32.7. There was no mortality and no serious morbidity. All patients improved clinically and no patient had to go back on proton pump inhibition or antacids. Total time with pH < 4.0 was reduced from 18.4% to 3.3% (p < 0.05). DeMeester score was reduced from 58.1 to 15.9 (p < 0.05). CONCLUSIONS: The effect of converting VBG-operated patients to GBP results in a near-normalisation of acid reflux parameters and a discontinuation of proton pump inhibitor medication.

Objective: To elucidate the activity and expression of cyclic nucleotide phosphodiesterase (PDE) families in omental (OM) and subcutaneous (SC) adipose tissue and adipocytes, and to study alterations in their activity in human obesity. Design: Cross-sectional, translational research study. Patients: In total, 25 obese and 9 non-obese subjects undergoing gastrointestinal surgery participated in the study. Results: Inverse correlations between PDE activities and body mass index (BMI) were seen in both SC and OM adipose tissue. Inverse correlations between total PDE and PDE3 activity and BMI were seen in OM adipocytes but not in SC adipocytes. In both SC and OM adipose tissue of obese patients, total PDE and PDE3 activities were decreased compared with the controls. In SC adipose tissue of Type 2 diabetes (T2D) patients, the PDE activity not inhibitable by PDE3 or PDE4 inhibitors (PDEn) was increased compared with obese non-diabetic patients. In addition to PDE3 and 4 isoforms, PDE7B, PDE9A and PDE10A proteins were also detected in adipose tissue or adipocytes. Conclusions: Multiple PDE families are present in human adipose tissue and their activities are differentially affected by obesity and T2D.

We have observed $23.2 \pm 6.0_{-0.9}^{+1.0}$ purely-leptonic decays of $D_s^+ -> \mu^+ \nu_\mu$ from a sample of muonic one prong decay events detected in the emulsion target of Fermilab experiment E653. Using the $D_s^+ -> \phi \mu^+ \nu_\mu$ yield measured previously in this experiment, we obtain $B(D_s^+ --> \mu^+ \nu_\mu) / B(D_s^+ --> \phi \mu^+ \nu_\mu) =0.16 \pm 0.06 \pm 0.03$. In addition, we extract the decay constant $f_{D_s}=194 \pm 35 \pm 20 \pm 14 MeV$.

Background: Although treatment failure after Vertical Banded Gastroplasty (VBG) is not uncommon, the safety of the procedure makes it the most widely used form of bariatric surgery. The reasons for failure may be either technical, such as staple-line dehiscence, or psychological inability on the part of the patient to adjust to the small stomach pouch and to its consequences. Methods: We carried out prospective testing of a cohort of consecutive VBG candidates, using a battery of psychological tests consisting of the ‘Three Factor Eating Questionnaire’, ‘Hopkins Symptom Check List (HSCL)’, ‘Mood Adjective Check List (MACL)’, ‘Karolinska Scales of Personality (KSP)’, and two projective tests, the ‘Meta-Contrast Technique (MCT)’ and the ‘Perceptgenetic Object Relation Test (PORT)’. The patients had been scheduled for surgery on clinical considerations only, and the results of the psychological testing were not disclosed to the surgeons until after the follow-up. Results: Mean preoperative Body Mass Index (BMI) was 42.0 (sd 9.9). Patients were extensively tested during the 3 weeks prior to surgery. There were no operative complications. Patients were tested psychologically again after 3 years. Their mean BMI then was 32.3 (sd 5.6). Thirteen patients had lost more than 50% of their overweight (BMI mean 29.6; sd 1.1), seven patients had lost less than 50% (BMI mean 37.0; sd 1.6; p = 0.0043). These two groups were compared. The single factor that correlated consistently with an unsatisfactory weight loss was preoperative signs of depression (p = 0.04). Stepwise discriminant analysis using three preoperative factors(Hunger, Verbal aggression and Socialization) correctly classified 90% of the patients who had lost

Surgery is the only therapeutic modality that has shown lasting results in the treatment of morbid obesity. Ability to lose weight by voluntary dieting has been associated with unsatisfactory weight loss after gastroplasty. This report examines the effect of preoperative inter-maxillary fixation (IMF) on weight reduction induced by vertical banded gastroplasty (VBG). Twenty-four patients entered the study and were randomly assigned to either 10 weeks of IMF or 10 weeks on the waiting-list. Patient groups were similar in respect to age, gender and Body Mass Index (BMI). All patients were urged to lose weight preoperatively. Patients in the IMF group lost 18 kg (-12 to -36; median, range) and the waiting list group lost 3 kg (+ 3 to -30) during the 10 weeks prior to surgery. Total weight loss from time of inclusion to 24 months postoperatively was the same in both groups. Our results suggest that weight loss up to 2 years after VBG is not Influenced by short-term preoperative IMF. Although we found no obvious advantage in having patients pre-treated by IMF, our findings indicate that jaw wiring can be used for patients in whom moderate preoperative weight loss is desired without endangering the effect of VBG on body weight development.

We report results on D0 and D+ production in proton-emulsion interactions at s =38.7 GeV. A fit to the form (1−|xF|)n exp (−bp 2 T ) yields n=6.9 +1.9 −1.8 and b=0.84 +0.10 −0.08 (GeV/c)−2. The total inclusive cross section, is assuming linear A dependence, is measured to be 38±3(stat.) ±13 (sys.) μb for the D0 and 38±9±14 μb for the D+. A comparison of these results with previous measurements indicates that nuclear effects do not strongly influence charm production. The predictions of QCD are in good agreement with our data.

We present results on charm pair correlations measured in proton-emulsion interactions at s =38.7 GeV. The predictions of leading order QCD for the distributions in invariant mass, rapidity gap, xF, and polar angle in the charm pair CMS are qualitatively consistent with our measurements. The mean pT of the pairs is equal within errors to that measured in dilepton production at the same energy and mass range.

The fraction {ital f} of {ital D}{sup 0} semimuonic decays which occur through the {ital K}{mu}{nu} mode has been measured in a hybrid emulsion spectrometer. Analysis of 124 semimuonic {ital D}{sup 0}-decay candidates gives {ital f}=0.32{plus minus}0.05 (stat) {plus minus}0.05 (syst). From this measurement and existing data on the {ital D}{sup 0} semileptonic branching ratio and lifetime, we obtain the branching ratio {ital R}({ital D}{sup 0}{r arrow}{ital K}{sup {minus}}{mu}{sup +}{nu})=(2.4{plus minus}0.4{plus minus}0.5)% and partial decay rate {Gamma}({ital D}{sup 0}{r arrow}{ital K}{sup {minus}}{mu}{sup +}{nu})=(5.6{plus minus}0.9{plus minus}1.2){times}10{sup 10} s{sup {minus}1}.

A hybrid apparatus consisting of a movable emulsion target and a magnetic spectrometer was used in a fixed target Fermilab Tevatron experiment to study the production of heavy quarks by high-energy hadron beams. High-resolution silicon microstrip detectors were used for precise tracking in the dense particle environment. Details of the experimental apparatus, including the data acquisition system, are described.

Potential problem highlighted

OBJECTIVE: In a large, prospective Swedish national cohort, we investigated individual birth characteristics for women who had undergone bariatric surgery and their obstetric outcome and made comparisons with all other women during the same period. less thanbrgreater than less thanbrgreater thanSTUDY DESIGN: The cohort consisted of 494,692 women born 19731983 of which 681 women who had undergone bariatric surgery constituted the index group. less thanbrgreater than less thanbrgreater thanRESULTS: The index women more often have parents with lower sociodemographic status and are more often born large for gestational age. The women surgically treated before their first child had a shorter gestational length, their children had lower birthweight, and were more often born small for gestational age compared with the children born to the reference mothers. Women whose child was born before their bariatric surgery more often had a cesarean section, and their children were more often large for gestational age. less thanbrgreater than less thanbrgreater thanCONCLUSION: Preconception bariatric surgery in obese women may be associated with improved obstetric outcomes.

Objective: Investigate the effect of a liquid diet, and of vertical banded gastroplasty, on gastro-oesophageal reflux in morbidly obese patients.Design: Prospective study, patients being their own controls.Setting: University hospital, Sweden.Subjects: 25 morbidly obese patients, listed for vertical banded gastroplasty.Interventions: 24 hour ambulatory intra-oesophageal pH-monitoring three weeks before operation and repeated after 10-14 days on a liquid very low calorie diet, and finally three weeks after operation, while still on a liquid very low calorie diet.Main outcome measures: Percentage of time that pH in the oesophagus was ≤4.Results: There were no changes in the amount of reflux, either after a liquid diet or after vertical banded gastroplasty.Conclusions: Neither the liquid diet nor vertical banded gastroplasty alone had any appreciable effect on gastro-oesophageal reflux.

To assess the quality of life of patients 1 1/2-5 1/2 years after vertical banded gastroplasty for morbid obesity.Retrospective study by questionnaire.University hospital, Sweden.102 of the 127 patients (80%) operated on for morbid obesity between January 1989 and February 1993 responded to the questionnaire. 74 patients who underwent routine cholecystectomy were matched for age and time of surgery, of whom 55 (74%) responded to the questionnaire and acted as controls.Standardised questionnaire of 112 items, 28 of which referred to problems with eating (Gothenburg Quality of Life Scale).Differences in scores between the groups.Gastroplasty caused profound changes in patients' lives, cholecystectomy did not. This was reflected in self esteem, relations with partners, and social networking for both sexes. There was no difference between groups in overall quality of life, the mean (SEM) scores for women being 5.32 (0.09) compared with 5.33 (0.07) and for men 5.32 (0.17) compared with 5.40 (0.14).Vertical banded gastroplasty seems to offer morbidly obese patients not only reduction in weight but also improved quality of life.

Background: vertical banded gastroplasty can be performed with a short post-operative hospital stay without this giving rise to more complications. An increased number of patients can be expected after the NIH consensus statement on Bariatric Surgery. Before cost-effective short stay units are employed for such surgery, patients' attitudes to short-term care should be investigated. Methods: we compared patient satisfaction in two groups of patients. They had been randomized to have a vertical banded gastroplasty in either a normal ward or a short stay unit, open Monday 7 am to Friday 1 pm. Results: there were no differences in patient satisfaction with either length of stay or quality of stay, despite the fact that short-stay unit patients stayed significantly shorter post-operatively (3.25 (0.62) days vs 4.70 (0.95); p = 0.0004; mean (sd)). Conclusion: it appears that vertical banded gastroplasty can be performed with a short post-operative hospital stay without discomfort to the patient.

The effects of two different forms of anticholinergic medication on endoscopic quality and patient discomfort were studied in 235 consecutively observed out-patients. Patients were randomized to receive either scopolamine i.v. and placebo transdermally, saline i.v. and saline transdermally, or placebo i.v. and scopolamine transdermally. No differences could be observed between the groups with respect to gastric motor function or endoscopic quality (as judged by the endoscopist), or discomfort during endoscopy (as judged by the patient). Transdermally applied scopolamin resulted in a significant increase (2p = 0.002) in post-endoscopy discomfort due to dryness of the mouth. The findings speak against the use of i.v. scopolamine (20 mg) or transdermally applied scopolamine (0.5 mg) in endoscopy of the upper gastrointestinal tract.

Using a hybrid emulsion spectrometer installed in the Fermilab wide-band neutrino beam, we located a total of 3855 neutrino interactions in the fiducial volume of our target. For 122 charmed-particle decays found in these interactions, we present distributions of x , y , charm-muon angular projection, Feynman- X , and the fragmentation Z . We find that the number of strange quarks in the nucleon sea is 4.2±2.1±2.6% of the number of down quarks.

We report final results for the D/sup + -/, F/sup + -/, and ..lambda../sub c//sup +/ lifetimes measured with a hybrid emulsion spectrometer in the wide-band neutrino beam at Fermilab. In total, 3886 neutrino and antineutrino interactions were located in the fiducial volume of the emulsion. From these interactions we have unambiguously identified 6 F/sup + -/ and 13 ..lambda../sub c//sup +/ decays, for which the fitted lifetimes are tau(F/sup + -/) = (2.6/sub -0.9//sup +1.6/) x 10/sup -13/ s and tau(..lambda../sub c//sup +/) = (2.0/sub -0.5//sup +0./ 7) x 10/sup -13/ s. 28 other decays are consistent with a D/sup +/ or D/sup -/ hypothesis. From these events, we obtain a D/sup + -/ lifetime of (11.1/sub -2.9//sup +4.4/) x 10/sup -13/ s.

We have found 122 charmed-particle decays among 3855 neutrino interactions located in the fiducial volume of a hybrid emulsion spectrometer installed in the Fermilab wide-band neutrino beam. We obtain an average relative charmed-particle production cross section of σ(ν μ → c μ − ) σ(ν μ →μ − ) =4.9 −0.6 +0.7 % , at an average neutrino energy of 22 GeV. We also obtain a production rate of σ(ν μ → c c ν μ ) σ(ν μ →ν μ ) =0.13 −0.11 +0.31 % , if we assume that there was an undetected muon, a limit of σ(ν μ → c c μ − ) σ(ν μ → c μ − ) CL ) can be obtained. Other cross section ratios and limits are also presented.

We report final results for the ${D}^{0}$ lifetime measured with a hybrid emulsion spectrometer in the wide-band neutrino beam at Fermilab. In a total of 3886 neutrino and antineutrino interactions located in the emulsion fiducial volume, we have found 58 ${D}^{0}$ decays, from which we determine the lifetime to be (${4.3}_{\ensuremath{-}0.5\ensuremath{-}0.2}^{+0.7+0.1}$) \ifmmode\times\else\texttimes\fi{} ${10}^{\ensuremath{-}13}$ s.