36 research outputs found
Is type II diabetes mellitus (NIDDM) a surgical disease?
Since February 1, 1980, 515 morbidly obese patients have undergone
the Greenville gastric bypass (GGB) operation. Of these,
212 (41.2%) were euglycemic, 288 (55.9%) were either diabetic
or had glucose intolerance, and 15 (2.9%) were unable to complete
the evaluation. After the operation, only 30 (5.8%) patients remained
diabetic (and 20 of these improved), 457 (88.7%) became
and have remained euglycemic, and inadequate data prevented
classification of the other 28 (5.4%). The patients who failed to
return to normal glucose values were older and their diabetes
was of longer duration than those who did. The effect of the
GGB was not only limited to the correction of abnormal glucose
levels. The GGB also corrected the abnormal levels of fasting
insulin and glycosylated hemoglobin in a cohort of 52 consecutive
severely obese patients with non-insulin-dependent diabetes. The
GGB effectively controls weight. If morbid obesity is defined as
100 pounds over ideal body weight, 89% of the patients are no
longer "morbidly" obese within 2 years. In most patients, the
control of the weight has been well maintained during the 11
years of follow-up; most of the upward creep in weight of 20.8%
between 24 and 132 months was from the 49 (9.5%) patients
who had staple line breakdowns between the large and small
gastric pouches. Non-insulin-dependent diabetes, previously
considered a chronic unrelenting disease, can be controlled in
the severely obese by the gastric bypass. Whether the correction
of glucose metabolism affects the complications of diabetes is
unknown. Whether the gastric bypass should be considered for
patients with advanced non-insulin-dependent diabetes but who
are not severely obese deserves consideration. The GGB has an
unacceptably high rate of staple line failure. Accordingly, the
authors have recently changed their procedure to one that divides
the stomach rather than partitions it with staples. Originally published Annals of Surgery, Vol. 215, No. 6, June 199
The Future of Rheumatoid Arthritis and Hand Surgery - Combining Evolutionary Pharmacology and Surgical Technique
Rheumatoid arthritis is a systemic autoimmune disease of uncertain aetiology, which is characterized primarily by synovial inflammation with secondary skeletal destructions
Minimally invasive surgery and cancer: controversies part 1
Perhaps there is no more important issue in the care of surgical patients than the appropriate use of minimally invasive surgery (MIS) for patients with cancer. Important advances in surgical technique have an impact on early perioperative morbidity, length of hospital stay, pain management, and quality of life issues, as clearly proved with MIS. However, for oncology patients, historically, the most important clinical questions have been answered in the context of prospective randomized trials. Important considerations for MIS and cancer have been addressed, such as what are the important immunologic consequences of MIS versus open surgery and what is the role of laparoscopy in the staging of gastrointestinal cancers? This review article discusses many of the key controversies in the minimally invasive treatment of cancer using the proâcon debate format
International Consensus Statement on Rhinology and Allergy: Rhinosinusitis
Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICARâRS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICARâRSâ2021 as well as updates to the original 140 topics. This executive summary consolidates the evidenceâbased findings of the document. Methods: ICARâRS presents over 180 topics in the forms of evidenceâbased reviews with recommendations (EBRRs), evidenceâbased reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICARâRSâ2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidenceâbased management algorithm is provided. Conclusion: This ICARâRSâ2021 executive summary provides a compilation of the evidenceâbased recommendations for medical and surgical treatment of the most common forms of RS
Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.
OBJECTIVE: This report documents that the gastric bypass operation provides long-term control for obesity and diabetes. SUMMARY BACKGROUND DATA: Obesity and diabetes, both notoriously resistant to medical therapy, continue to be two of our most common and serious diseases. METHODS: Over the last 14 years, 608 morbidly obese patients underwent gastric bypass, an operation that restricts caloric intake by (1) reducing the functional stomach to approximately 30 mL, (2) delaying gastric emptying with a c. 0.8 to 1.0 cm gastric outlet, and (3) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy. Even though many of the patients were seriously ill, the operation was performed with a perioperative mortality and complication rate of 1.5% and 8.5%, respectively. Seventeen of the 608 patients (< 3%) were lost to follow-up. RESULTS: Gastric bypass provides durable weight control. Weights fell from a preoperative mean of 304.4 lb (range, 198 to 615 lb) to 192.2 lb (range, 104 to 466) by 1 year and were maintained at 205.4 lb (range, 107 to 512 lb) at 5 years, 206.5 lb (130 to 388 lb) at 10 years, and 204.7 lb (158 to 270 lb) at 14 years. The operation provides long-term control of non-insulin-dependent diabetes mellitus (NIDDM). In those patients with adequate follow-up, 121 of 146 patients (82.9%) with NIDDM and 150 of 152 patients (98.7%) with glucose impairment maintained normal levels of plasma glucose, glycosylated hemoglobin, and insulin. These antidiabetic effects appear to be due primarily to a reduction in caloric intake, suggesting that insulin resistance is a secondary protective effect rather than the initial lesion. In addition to the control of weight and NIDDM, gastric bypass also corrected or alleviated a number of other comorbidities of obesity, including hypertension, sleep apnea, cardiopulmonary failure, arthritis, and infertility. Gastric bypass is now established as an effective and safe therapy for morbid obesity and its associated morbidities. No other therapy has produced such durable and complete control of diabetes mellitus