Sudden death after open gastric bypass surgery

Purpose: Gastric bypass surgery has become a relatively low-risk bariatric surgical intervention in a high-risk patient population (Nguyen et al., Arch Surg, 141:445-449, 2006; Buchwald et al. JAMA, 13:1724-1737, 2004). Surgical interventions in patients suffering from morbid obesity are typically associated with excess morbidity (Parikh et al., Am Surg, 73:959-962, 2007). Though overall mortality after bariatric surgery is <1% is low (Mason et al., Obes Surg, 17:9-14, 2007), some surgical complications such as anastomotic leaks, staple line disruption and bowel obstruction may still impact on postoperative outcome (Parikh et al., Am Surg, 73:959-962, 2007; Mason et al., Obes Surg, 17:9-14, 2007). Early symptoms are often missed, as clinical presentation may be discreet, inexistent or falsely attributed to obesity. Methods: This case report refers to a patient in whom discomfort and agitation associated with a rise in temperature heralded a fulminant septic shock syndrome precipitating his death. Literature on early complications and management after gastric bypass is reviewed. Conclusion: A high level of suspicion should be present in the case of an unexpected postoperative deterioration of the patient's general condition. Time to treat may be very short (Mason et al., Obes Surg, 17:9-14, 2007). Computed tomography is mandatory to rule out pulmonary embolism and bypass obstructio

Gastric necrosis complicating lately a Nissen fundoplication: Report of a case

Background: Gastric necrosis after Nissen fundoplication is a rare and life-threatening complication described in paediatric surgery and in some experimental models. Prompt diagnosis and appropriate therapy of acute gastric dilatation is mandatory to avoid potentially fatal gastric necrosis. Case report: This case report is the first one to describe a gastric necrosis in an adult as a late and very severe complication after Nissen fundoplication. Gastric dilatation and subsequent necrosis occurred 14years after Nissen fundoplication because of small bowel obstruction based on adhesions. Conclusion: Early diagnosis and treatment of gastric dilatation after Nissen fundoplication are essential to prevent from severe secondary complications but can be difficult to establish because of atypical symptom

Factors Influencing the Success of In Vivo Sentinel Lymph Node Procedure in Colon Cancer Patients: Swiss Prospective, Multicenter Study Sentinel Lymph Node Procedure in Colon Cancer

Background: The sentinel lymph node (SLN) procedure has the potential to provide relevant improvement in nodal staging in colon cancer patients. However, there remains room for improvement for SLN identification and sensitivity. Therefore, the objective of the present investigation was to analyze factors influencing the success of the SLN procedure in colon cancer patients. Methods: One hundred seventy-four consecutive colon cancer patients were prospectively enrolled in this multicenter study and underwent in vivo SLN procedure with isosulfan blue 1% followed by open standard oncologic colon resection. Several patient-, tumor-, and procedure-related factors possibly influencing the SLN identification and sensitivity were analyzed. Results: Sentinel lymph node identification rate and accuracy were 89.1 and 83.9%, respectively. Successful identification of SLN was significantly associated with the intraoperative visualization of blue lymphatic vessels (p<0.001) and with female gender (p=0.024). True positive SLN results were significantly associated with higher numbers of SLN (p=0.026) and with pN2 stage (p=0.004). There was a trend toward better sensitivity in patients with lower body mass index (BMI) (p=0.050). Conclusions: The success of the SLN procedure in colon cancer patients depends on both procedure-related factors (intraoperative visualization of blue lymphatic vessels, high number of SLN identified) and patient factors (gender, BMI). While patient factors can not be influenced, intraoperative visualization of blue lymphatics and identification of high numbers of SLN are key for a successful SLN procedur

A remark on Schatten-von Neumann properties of resolvent differences of generalized Robin Laplacians on bounded domains

In this note we investigate the asymptotic behaviour of the $s$-numbers of the resolvent difference of two generalized self-adjoint, maximal dissipative or maximal accumulative Robin Laplacians on a bounded domain $\Omega$ with smooth boundary $\partial\Omega$. For this we apply the recently introduced abstract notion of quasi boundary triples and Weyl functions from extension theory of symmetric operators together with Krein type resolvent formulae and well-known eigenvalue asymptotics of the Laplace-Beltrami operator on $\partial\Omega$. It will be shown that the resolvent difference of two generalized Robin Laplacians belongs to the Schatten-von Neumann class of any order $p$ for which $p>(dim\Omega-1)/3$. Moreover, we also give a simple sufficient condition for the resolvent difference of two generalized Robin Laplacians to belong to a Schatten-von Neumann class of arbitrary small order. Our results extend and complement classical theorems due to M.Sh.Birman on Schatten-von Neumann properties of the resolvent differences of Dirichlet, Neumann and self-adjoint Robin Laplacians

Hole Solutions in the 1d Complex Ginzburg-Landau Equation

The cubic Complex Ginzburg-Landau Equation (CGLE) has a one parameter family of traveling localized source solutions. These so called 'Nozaki-Bekki holes' are (dynamically) stable in some parameter range, but always structually unstable: A perturbation of the equation in general leads to a (positive or negative) monotonic acceleration or an oscillation of the holes. This confirms that the cubic CGLE has an inner symmetry. As a consequence small perturbations change some of the qualitative dynamics of the cubic CGLE and enhance or suppress spatio-temporal intermittency in some parameter range. An analytic stability analysis of holes in the cubic CGLE and a semianalytical treatment of the acceleration instability in the perturbed equation is performed by using matching and perturbation methods. Furthermore we treat the asymptotic hole-shock interaction. The results, which can be obtained fully analytically in the nonlinear Schroedinger limit, are also used for the quantitative description of modulated solutions made up of periodic arrangements of traveling holes and shocks.Comment: 20 pages (RevTex) , 7 figures (postscript

Surgical Treatment of Acute Recurrent Diverticulitis: Early Elective or Late Elective Surgery. An Analysis of 237 Patients

Background: The optimal timing of elective surgery in diverticulitis remains unclear. We attempted to investigate early elective versus late elective laparoscopic surgery in acute recurrent diverticulitis in a retrospective study. Method: Data of patients undergoing elective laparoscopic surgery for diverticulitis were retrospectively gathered, including Hinchey stages I-II a/b. the primary endpoint was in-hospital complications according to the Clavien-Dindo classification. Secondary endpoints were surgical complications, operative time, conversion rate, and length of hospital stay. Results: Of 237 patients, 81 (34%) underwent early elective operation (group A) and 156 (66%) underwent late elective operation (group B). In-hospital complications developed in 32% in group A and in 34% in group B (risk difference 2%, 95% Confidence Interval (95% CI): −11%, 14%). Higher age (p=0.048) and borderline higher American Society of Anesthesiologists score (p=0.056) were risk factors for in-hospital complications. Severe surgical complications occurred in 9% of patients in group A and 10% in group B (risk difference 2%, 95% CI: −6%, 9%). Conversion rate was 9% in group A and 3% in group B (p=0.070). Severity of disease did not seem to have an impact on complications or length of hospital stay. The median postoperative hospital stay was 8days in both groups (interquartile range 6-10). Mean operative time was 220min (SD 64) in group A and 202min (SD 48) in group B. Conclusions: This is the first study comparing early versus late elective surgery for diverticulitis in terms of the postoperative outcome using a validated classification. Although the retrospective setting and large confidence intervals don't allow definitive recommendations, these results are of utmost importance for the design of future prospective, randomized controlled trial

Spectral Boundary of Positive Random Potential in a Strong Magnetic Field

We consider the problem of randomly distributed positive delta-function scatterers in a strong magnetic field and study the behavior of density of states close to the spectral boundary at $E=\hbar\omega_{c}/2$ in both two and three dimensions. Starting from dimensionally reduced expression of Brezin et al. and using the semiclassical approximation we show that the density of states in the Lifshitz tail at small energies is proportio- nal to $e^{f-2}$ in two dimensions and to $\exp(-3.14f\ln(3.14f/\pi e)/ \sqrt(2me))$ in three dimensions, where $e$ is the energy and $f$ is the density of scatterers in natural units.Comment: 12 pages, LaTex, 5 figures available upon request, to appear in Phys. Rev.

Mammotome: Less Invasive than ABBI with Similar Accuracy for Early Breast Cancer Detection

We performed a prospective analysis of two consecutive biopsy cohorts investigated by the same team to compare the Mammotome system with the ABBI procedure. From April 1997 to August 2003 a series of 413 nonpalpable mammographic lesions in 387 women (median age 56 years, range 30-84 years) were stereotactically biopsied in the University Hospital of Basel, Switzerland. Until October 1999 the ABBI system was applied exclusively, it was subsequently superseded by the Mammotome device in our clinic. Main outcome measures were accuracy, technical demand, and morbidity. Sensitivity (97.3%/96.8%), negative predictive value (99.2%/98.7%), and diagnostic accuracy (99.4%/99.1%) regarding the detection of malignancy were excellent for both techniques (ABBI/Mammotome). The Mammotome procedure was faster and less invasive, thus causing significantly less morbidity. The larger specimen obtained by the ABBI procedure resulted in more detailed histology. In conclusion, recommend the Mammotome system as the method of choice for detecting nonpalpable early breast cance