Aortic injuries following stents in bariatric surgery: our experience

Background: Due to the large number of laparoscopic sleeve gastrectomy (LSG) performed over the last decade, the management of the leak following LSG has been increasingly reported. The role of covered Self Expandable Metal Stents (cSEMS) for the treatment of the leak is still controversial because of the poor tolerance and high risk of complications. Objectives: The aim of the present study was to analyze the foregut wall perforation and aorta injuries, a very rare but potentially fatal complication, related to the treatment of the leak following LSG using cSEMS. Setting: Private hospital, France. Methods: An audit was conducted in 2 French tertiary bariatric endoscopic centers focusing on aortic injuries after cSEMS use for leak. We examined and classified the initial procedure, leak characteristics, primary endoscopic treatment, and outcome of endoscopic complication for each eligible case. Results: A total of 5 patients were identified with foregut wall perforation and aorta injuries. All stents were deployed for staple line leak following LSG. The recorded mortality in case of esophageal-aortic injuries related to cSEMS use was 80%. Conclusion: cSEMS are potentially effective tools for the management of foregut leaks in bariatric surgery. The biggest challenges with this approach are stent migration and poor quality of life. Caution is required due to the risk of fatal complications such as foregut wall perforation and aortic injury

Laparoscopic treatment of the hepatic cysts

Sectia Chirugie, Spitalul Municipal de Urgență, Moinesti, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Scop. Prezentarea avantajelor metodei laparoscopice în tratamentul chisturilor hepatice. Material şi metodă. Acest studiu prezintă experienţa noastră în tratamentul laparoscopic pentru 57 de cazuri de chisturi hepatice (42 de cazuri de chisturi seroase şi 15 cazuri de chisturi hidatice selectionate: univezicular, necomplicat, localizat în segmentele hepatice laparoscopice) reprezentând 1,89% din 3010 operații laparoscopice efectuate în perioada “2006-2010”. În 49 de cazuri (85,97%), chistul hepatic a fost unic. Indicația de tratament laparoscopic a fost pusă pe criterii clinice, biologice, imagistice și antecedentele bolnavului. În 45 de cazuri (78,95%), chisturile hepatice au fost localizate în lobul drept, dimensiunile fiind de 6-16 cm. Rezultate. Nu au fost înregistrate cazuri de conversie. Complicaţii postoperatorii au fost la 3 dintre pacienţi (5,26%): supurative - 2 abcese şi o fistula biliara. Durata medie de spitalizare a fost de 4,8 zile, iar perioada postoperatorie a fost fără recidive. La toate cazurile s-a practicat și colecistectomia. Pentru chisturile seroase a fost utilizataă tehnica Lin. Cele 12 cazuri de chisturi hidatice au fost rezolvate prin tehnica Lagrot (după inactivarea cu ser hiperton 20%), iar alte 3 cazuri prin chistectomie ideală. Rezultatele sunt argumente care ne determină să recomandăm această cale de abordare laparoscopică pentru tratamentul chistului hepatic. Pentru cele 15 cazuri profilaxia recidivelor postoperatorii a fost efectuată prin administrare de Albendazol. Concluzie. Chirurgia laparoscopică este o metodă sigură şi eficientă de tratare a pacienților cu chisturi hepatice seroase, iar pentru cazurile selectate de chisturi hidatice este o alternativă la chirurgia clasică. Aceasta respecta principiile chirurgiei deschise, beneficiind de avantajele chirurgiei minim invazive: confort postoperator, dureri minime, spitalizare scurtă, reinsertie socială rapidă.Aim. The evaluation of the advantages of the laparoscopic method in surgery of hepatic cysts. Material and method. This study presents our experience in laparoscopic solution of 57 cases of hepatic cysts (42 cases of serous cysts and 15 selected cases of hydatid cysts: univesicular, uncomplicated, localized in laparoscopic hepatic segments) presenting 1,89 % from one 3010 laparoscopic interventions performed between “2006-2010”. In 49 of cases (85,97%) the hepatic cyst was unique. Laparoscopic treatment of the hepatic cysts was attempted in all patients who had clinical, biological, imaging, and following the patient history. In 45 cases (78,95%) the hepatic cysts were located in the right lobe, with dimensions between 6-16 cm. Results. There weren’t any cases of conversion. In 3 of patients (5,26%) postoperative complications were recorded: suppurative – 2 abscesses and one biliary fistula. The mean hospital stay was 4,8 days, and the postoperative period to a year was without recurrences. In all cases, we performed the cholecystectomy, too. For the serious cysts was used the Lin technique was. In 12 cases of hydatid cysts were performed the Lagrot technique (after inactivation with hypertonic saline 20%), and the other 3 cases were performed by ideal cystectomy. The results are arguments for us to recommend this way of laparoscopic approach for the treatment of hepatic cyst. For the 15 cases, prophylaxis of postoperative recurrence was performed by administration of Albendazole. Conclusions. Laparoscopic surgery is a safe and effective method of treating patients with hepatic serous cysts, and for the selected cases of hydatids cysts, it is an alternative to classic surgery. It respects the principles of open surgery, with all the benefits of laparoscopic surgery: postoperative comfort, minimal pain, short hospital stay, rapid social reintegration

Quantum and classical criticalities in the frustrated two-leg Heisenberg ladder

This talk was about the frustration-induced criticality in the antiferromagnetic Heisenberg model on the two-leg ladder with exchange interactions along the chains, rungs, and diagonals, and also about the effect of thermal fluctuations on this criticlity. The method used is the bond mean-field theory, which is based on the Jordan-Wigner transformation in dimensions higher than one. In this paper, we will summarize the main results presented in this talk, and report on new results about the couplings and temperature dependences of the spin susceptibility.Comment: 6 pages, 4 figures, talk presented at the Theory Canada 3 conference in 2007, submitted to the Canadian Journal of Physic

Computationally designed libraries of fluorescent proteins evaluated by preservation and diversity of function

To determine which of seven library design algorithms best introduces new protein function without destroying it altogether, seven combinatorial libraries of green fluorescent protein variants were designed and synthesized. Each was evaluated by distributions of emission intensity and color compiled from measurements made in vivo. Additional comparisons were made with a library constructed by error-prone PCR. Among the designed libraries, fluorescent function was preserved for the greatest fraction of samples in a library designed by using a structure-based computational method developed and described here. A trend was observed toward greater diversity of color in designed libraries that better preserved fluorescence. Contrary to trends observed among libraries constructed by error-prone PCR, preservation of function was observed to increase with a library's average mutation level among the four libraries designed with structure-based computational methods

Applications of phase-contrast velocimetry sequences in cardiovascular imaging.

AIMS: To describe and illustrate the main applications of phase-contrast flow quantification in cardiovascular imaging. CONCLUSION: Phase-contrast velocimetry sequences provide an accurate, reliable, reproducible and non-invasive study of blood flow, information which is sometimes not available from other investigation methods. The haemodynamic information obtained from these complement MRI angiography images. They appear to have a range of clinical applications, firstly improving pathophysiological understanding but also contributing to the treatment and follow-up strategy after surgical or endovascular treatment