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Περιέχει την περίληψηΜέσα στα πλαίσια της Κοινωνίας της Πληροφορίας οι βιβλιοθηκονόμοι διεκδικούν, άλλοτε πετυχημένα, άλλοτε όχι και τόσο, ένα πιο ενεργό και απαιτητικό ρόλο, προβάλλοντας το επιχείρημα πώς όσο μεγαλύτερη είναι η παραγωγή πληροφορίας και γνώσης και η παροχή πληροφόρησης τόσο mo απαιτητική είναι και η διαδικασία που αναγκάζεται να ακολουθήσει ο χρήστης ώστε να ικανοποιήσει τις ανάγκες του. Αλλά, η αναγκαιότητα του βιβλιοθηκονόμου (ως επιστήμονα της πληροφόρησης πλέον), του διαμεσολαβητή, δηλαδή, ανάμεσα στην πληροφορία και στον χρήστη, δικαιολογεί απαραιτήτως και την αναγκαιότητα για την ίδια τη Βιβλιοθήκη; Τεκμηριώνεται, δηλαδή, η ύπαρξη αυτού του οργανισμού ως μη κερδοσκοπικού, πολιτιστικού ιδρύματος που εξυπηρετεί όχι μόνο πληροφοριακές αλλά και ψυχαγωγικές, εκπαιδευτικές, κοινωνικοοικονομικές ανάγκες των επισκεπτών του; Και τότε, το έργο του βιβλιοθηκονόμου πώς προδιαγράφεται; Ποιο το περιεχόμενο και ο τρόπος της διαμεσολάβησης; Πρόκειται για σύνθεση ή μηχανιστική διάδοση της πληροφορίας; Αν η Πληροφορία διακινείται, στις μέρες μας κυρίως και πρωτίστως, με ηλεκτρονικά μέσα, τότε το αυτονόητο της ύπαρξης ενός απτού οικοδομήματος που στεγάζει την πληροφορία παύει να ισχύει και είτε πρέπει να καταλυθεί, είτε να εφευρεθεί από την αρχή, προσδίδοντας νέα επίκαιρα χαρακτηριστικά σε ένα αρχαιότατο κατασκεύασμα

Blind biliary limb dilatation (Candy cane syndrome) of jejuno-jejunal anastomosis after Roux en Y Gastric Bypass (with video)

International audienc

Evaluation of pressure in a plasma produced by laser ablation of steel

We investigated the time evolution of pressure in the plume generated by laser ablation with ultraviolet nanosecond laser pulses in a near-atmospheric argon atmosphere. These conditions were previously identified to produce a plasma of properties that facilitate accurate spectroscopic diagnostics. Using steel as sample material, the present investigations benefit from the large number of reliable spectroscopic data available for iron. Recording time-resolved emission spectra with an echelle spectrometer, we were able to perform accurate measurements of electron density and temperature over a time interval from 200 ns to 12 μs. Assuming local thermodynamic equilibrium, we computed the plasma composition within the ablated vapor material and the corresponding kinetic pressure. The time evolution of plume pressure is shown to reach a minimum value below the pressure of the background gas. This indicates that the process of vapor-gas interdiffusion has a negligible influence on the plume expansion dynamics in the considered timescale. Moreover, the results promote the plasma pressure as a control parameter in calibration-free laser-induced breakdown spectroscopy

Revision of Mason's procedure (vertical banded gastroplasty) to Roux-en-Y gastric bypass: role of an associated fundectomy in weight loss outcomes

International audienceBACKGROUND: Vertical banded gastroplasty (VBG) presents a significant rate of long-term complications, and revisions are often necessary. Conversion to Roux-en-Y gastric bypass (RYGB) seems to be preferred, but literature data remain limited. OBJECTIVES: To analyze the indications, safety, results of conversions from VBG to RYGB, and to identify predictive factors of success or failure. SETTING: Two specialized centers of bariatric surgery. METHODS: This bicentric retrospective study included all the patients who benefited from a conversion from VBG to RYGB between 2008 and January 2020. Demographic characteristics, indications, preoperative workups, intraoperative data, complications, and weight loss results were analyzed. RESULTS: During the study period, 85 patients underwent a conversion to RYGB. The mean body mass index (BMI_ before conversion was 40.6 kg/m(2). 82.3% of the patients were converted because of weight loss failure and 17.6% because of a complication of their VBG. The global rate of complications was 25%. After an average follow-up of 35 months and a rate of loss to follow-up of 33%, the mean BMI was 33.5 kg/m. The weight loss success rate according to Reinhold's criteria was 64.7%, and resolution of complications was obtained in 89.1%. The association of a fundectomy was a predictive factor of weight loss (odds ratio, .27; P = .04), whereas primary failure of the VBG was a predictive factor of failure. CONCLUSION: Conversion from VBG to RYGB remains the procedure of choice to achieve satisfying weight loss and resolution of functional complications. The addition of a fundectomy appeared to have a significant positive impact on weight loss outcomes

Should we wait for metabolic complications before operating on obese patients? Gastric bypass outcomes in metabolically healthy obese individuals

International audienceBACKGROUND: A subgroup of obese patients without metabolic disorders has been identified and defined as metabolically healthy but morbidly obese (MHMO). OBJECTIVES: To compare Roux-en-Y gastric bypass (RYGB) outcomes between MHMO and metabolically unhealthy morbidly obese (MUMO) patients to assess whether the obesity phenotype could affect the results. SETTING: A university-affiliated tertiary care center. METHODS: One hundred nineteen consecutive patients underwent RYGB; 102 completed the 2-year follow-up and were divided into 2 groups (MHMO and MUMO) according to Wildman criteria, including blood pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), fasting blood sugar, C-reactive protein (CRP), and homeostasis model assessment of insulin resistance (HOMA-IR). Weight loss and metabolic parameter changes were analyzed. RESULTS: Twenty-one of 102 (20.6%) patients were identified as MHMO; they were mostly women (90.5%) and were significantly younger than MUMO patients (39.4 +/- 9.1 yr versus 47.2 +/- 10, P = .001); 12.6% were lost to follow-up. MHMO phenotype was significantly associated with a greater percentage of excess body mass index loss (P = .03), independent of gender, age, and redo procedures. All metabolic parameters were significantly improved 2 years after surgery in the MUMO group. HOMA-IR, CRP, and triglycerides were significantly lower 2 years after surgery in the MHMO group, whereas fasting blood sugar and HDL-C were unchanged. At 2 years of follow-up, 92.3% of the population was metabolically healthy. CONCLUSIONS: RYGB is an effective procedure to achieve weight loss and had a strong positive metabolic effect in both MHMO and MUMO phenotypes. RYGB led to an increase of the metabolically healthy status and may prevent or delay the onset of metabolic disorders

Impact of sleeve gastrectomy volumes on weight loss results: a prospective study

International audienceBACKGROUND: Causes of weight loss failure after sleeve gastrectomy (SG) are still controversial. The impact of the size of the sleeve continues to be debated. OBJECTIVE: The aim of our study was to determine the impact of sleeve volumes assessed at 3 months using gastric computed tomography (CT) on weight loss at 18 months. SETTING: University Hospital, France. METHODS: Sixty-seven obese patients eligible for SG were prospectively evaluated. Sleeve volumes were assessed postsurgery using 3-dimensional gastric CT with gas at 3 months and weight loss outcomes recorded up to 18 months. The population was divided into 2 groups: the first tertile (n = 22) with the smallest gastric volume was defined as the "small sleeve" group (SSG) and the rest of the population (n = 45) was defined as the "without small sleeve" group (WSSG). RESULTS: No patients were lost to follow-up. In the SSG, overall gastric volume was 133+/-7 mL versus 264+/-11 mL for the WSSG (P\textless.0001). Percentage excess body mass index loss (%EBMIL) during the first postoperative 18 months was significantly greater in the SSG compared with the WSSG (P = .04). Although the volume of the gastric tube was not correlated with weight loss (r =-.04, P = .78), there was a negative linear correlation between the volume of the antrum and the %EBMIL at 18 months (r =-.39, P = .005). A narrow gastric tube was also associated with a high digestive intolerance and reflux. CONCLUSION: Our data suggest that performing the sleeve with a not-too-small bougie size and a radical antrectomy could improve weight loss and digestive tolerance

Extensive preoperative workup in diffuse esophageal leiomyomatosis associated with Alport syndrome influences surgical treatment: A case report

Introduction: Diffuse esophageal leiomyomatosis is a rare disease. Misdiagnosis is frequent and previous surgeries can complicate surgical management. The only treatment described for severe symptomatic cases is esophagectomy. Presentation of case: We describe a case of diffuse esophageal leiomyomatosis associated with Alport syndrome in a 21 year-old female where endoscopic ultrasonography (EUS) with concomitant fluoroscopy and 3D-gastric computed tomography (3D-GCT) modified surgical management. Discussion: The diagnosis of diffuse esophageal leiomyomatosis is difficult but can be greatly facilitated by extensive endoscopic and radiologic workup. Esophagectomy should only be entertained after complete anatomic mapping of the lesions, especially after previous surgeries. Conclusion: EUS and 3D-GCT should strongly be considered as part of routine preoperative workup in these patients

Third bariatric procedure for insufficient weight loss or weight regain: how far should we go?

International audienceBACKGROUND: Revisional procedures in bariatric surgery are increasing with several debated failure risk factors, such as super obesity and old age. No study has yet evaluated the outcomes and risks of a third bariatric procedure indicated for weight loss failure or weight regain. OBJECTIVES: To assess failure risks of a third bariatric procedure according to Reinhold's criteria (percentage excess weight loss [%EWL] ≤50% and/or body mass index [BMI] ≥35 kg/m(2)). SETTING: A university-affiliated tertiary care center, France. METHODS: From 2009 to 2019, clinical data and weight loss results of patients who benefited from 3 bariatric procedures for weight loss failure or weight regain were collected prospectively and analyzed using a binary logistic regression. Weight loss failure was defined according to Reinhold's criteria. RESULTS: Among 1401 bariatric procedures performed, 336 patients benefited from 2 or more procedures, and 45 had a third surgery. Eleven patients that were reoperated on because of malnutrition or gastroesophageal reflux disease were excluded from the final analysis. Among 34 patients with 3 procedures because of weight loss failure or regain, mean BMI was 48.3 ± 8.3 kg/m(2), and mean age was 30 ± 10.7 years. Three out of 34 patients (9%) presented a severe complication (Dindo-Clavien IIIb) and 2 (6%) had a minor one. Achieving Reinhold's weight loss criteria after the second bariatric procedure was a significant predictor of success of the third procedure (β = 2.9 ± 1.3 S.E.). CONCLUSION: Not reaching Reinhold's criteria after a second bariatric procedure was identified as a significant risk factor of failure of a third procedure. A third surgery should be carefully discussed especially in case of primary failure of previous procedures

Dilatation of Sleeve Gastrectomy: Myth or Reality?

International audienceOBJECTIVES: The success of longitudinal sleeve gastrectomy (LSG) is perceived as being potentially limited by dilatation of the remaining gastric tube during the follow-up. The aim of this prospective study was to determine the incidence and the characteristics of sleeve dilatation during the first post-operative year. MATERIALS AND METHODS: Gastric volumetry using 3D gastric computed tomography with gas expansion was performed in 54 successive subjects who underwent an LSG for morbid obesity at 3 and 12 months following surgery. Total gastric volume, volume of the gastric tube and the antrum, and diameter of the gastric tube were assessed after multiplanar reconstructions. An increase of at least 25 % of the total gastric volume was considered as sleeve dilatation. Percentage of excess BMI loss (%EBMIL) and daily caloric intakes were recorded during the first 18 months. RESULTS: Sixty-one percent of the subjects experienced sleeve dilatation 1 year after surgery. The gastric tube was mainly involved in the sleeve dilatation process (+91 %). Sleeve dilatation occurred especially in subjects with smaller total gastric volume at baseline (189 vs 236 ml, p = 0.02). Daily caloric intake was similar between the groups at each point of the follow-up. No difference concerning %EBMIL was observed between the groups during the 18 months of follow-up. CONCLUSIONS: Sleeve dilatation occurred in more than 50 % of the patients. Dilatation was not necessarily linked to an increase of daily caloric intake and insufficient weight loss during the first 18 months following surgery. Small LSG at baseline is at higher risk of dilatation