Esophageal and Gastric Malignancies After Bariatric Surgery: a Retrospective Global Study

Background: Bariatric surgery can influence the presentation, diagnosis, and management of gastrointestinal cancers. Esophagogastric (EG) malignancies in patients who have had a prior bariatric procedure have not been fully characterized. Objective: To characterize EG malignancies after bariatric procedures. Setting: University Hospital, United Kingdom. Methods: We performed a retrospective, multicenter observational study of patients with EG malignancies after bariatric surgery to characterize this condition. Results: This study includes 170 patients from 75 centers in 25 countries who underwent bariatric procedures between 1985 and 2020. At the time of the bariatric procedure, the mean age was 50.2 ± 10 years, and the mean weight 128.8 ± 28.9 kg. Women composed 57.3% (n = 98) of the population. Most (n = 64) patients underwent a Roux-en-Y gastric bypass (RYGB) followed by adjustable gastric band (AGB; n = 46) and sleeve gastrectomy (SG; n = 43). Time to cancer diagnosis after bariatric surgery was 9.5 ± 7.4 years, and mean weight at diagnosis was 87.4 ± 21.9 kg. The time lag was 5.9 ± 4.1 years after SG compared to 9.4 ± 7.1 years after RYGB and 10.5 ± 5.7 years after AGB. One third of patients presented with metastatic disease. The majority of tumors were adenocarcinoma (82.9%). Approximately 1 in 5 patients underwent palliative treatment from the outset. Time from diagnosis to mortality was under 1 year for most patients who died over the intervening period. Conclusion: The Oesophago-Gastric Malignancies After Obesity/Bariatric Surgery study presents the largest series to date of patients developing EG malignancies after bariatric surgery and attempts to characterize this condition.info:eu-repo/semantics/publishedVersio

Régimes de retraite d’employeur et incitations à la retraite anticipée au Canada

Given the current trend towards population ageing in Canada, we consider the financial incentives inherent in thirteen registered pension plans (that represent 20% of private and public sector employees covered by a registered pension plan) and their impact on the decision of older workers to retire early from the labour market. Three measures are employed to evaluate these incentives for a representative individual with a constant annual income of $38,000 and with 25 years of tenure at age 50 in the base case scenario. These three measures are the punctual value of benefits, the value associated with an additional year of work and, finally, the maximum present value of the stream of pension benefits. The first measure reflects only the value of a year’s worth of benefits upon retirement and does not account for a worker’s life expectancy or inter-temporal preferences. The other two measures are derived from the presented discounted value of benefits evaluated between the moment when retirement occurs and age 90 (when death occurs with a probability of 1). A discount rate of 4$ et 25 ans d’ancienneté à l’âge de 50 ans dans le scénario de base. Ces trois mesures sont la valeur ponctuelle des prestations, la valeur d’une année supplémentaire sur le marché du travail et, finalement, la valeur actualisée maximale. La première mesure ne tient compte que du montant annuel que recevrait le travailleur dès son départ à la retraite peu importe son horizon de vie ou sa préférence pour le temps. Les deux autres mesures sont calculées en utilisant le concept de valeur actualisée sur l’horizon compris entre le moment de la retraite et l’âge de 90 ans (le moment où la probabilité de mourir est égale à 1) avec un taux d’escompte inter-temporel égal à 4 %. Nos résultats indiquent que les régimes étudiés présentent de fortes incitations financières à la retraite anticipée. En effet, il semble presque toujours financièrement avantageux de prendre sa retraite avant l’âge de 60 ans - souvent même autour de 55 ans - et ce quelle que soit la mesure des incitations retenue. Des scénarios alternatifs (faisant varier le salaire, le niveau d’ancienneté, ainsi que l’âge à partir duquel les prestations sont demandées) et des tests de sensibilité produisent essentiellement les mêmes conclusions.

Les personnes âgées ont-elles perdu du terrain pendant la reprise économique ?

This paper examines the evolution of elderly families’ relative income. Its main objectives are to assess whether the income of elderly families has been following a downward trend in recent years and to compare their financial situation to that of non-elderly families. We use data from the 1981 to 1997 Survey of Consumer Finances and from the 1998 Survey of Labour and Income Dynamics. The incomes of elderly families have remained constant or have slightly increased during the period considered. Although elderly families’ market incomes have remained below that of non-elderly families, the gap between elderly and non-elderly families measured in terms of after-tax income appears considerably narrower. The difference is further reduced when income is adjusted by an equivalence scale that accounts for family size and size of the area of residence. Moreover, the median after-tax income of the poorest 25% of elderly families surpassed that of non-elderly families in the beginning of the ‘90s. Finally, our projections indicate that the economic boom of the late ’90s has not weakened the relative situation of elderly families. Cette analyse retrace l’évolution du revenu relatif des familles âgées. Ses principaux objectifs consistent à vérifier s’il existe une tendance à la baisse du revenu des familles âgées et à comparer leur situation financière à celle des familles non-âgées. Les données utilisées proviennent de l’Enquête sur les finances de consommateurs de 1981 à 1997 et de l’Enquête sur la dynamique du travail et du revenu de 1998. Le revenu des familles âgées est resté constant voire même a légèrement augmenté entre 1981 et 1998 alors que celui des familles non-âgées a diminué. S’il est vrai que le revenu du marché des familles âgées est demeuré inférieur à celui des familles non-âgées, l’écart entre les familles âgées et non-âgées s’amenuise lorsque mesuré en termes de revenu après impôt. La différence est d’autant moindre lorsque le revenu est ajusté par un facteur d’équivalence tenant compte de la taille des familles et de leur région de résidence. De plus, le revenu médian après impôt du quart le plus pauvre des familles âgées surpasse celui des familles non-âgées les plus pauvres depuis le début des années ’90. Les mêmes conclusions prévalent lorsque l’analyse repose sur deux mesures de la situation relative des familles âgées autres que le revenu médian. Enfin, nos projections indiquent que la situation relative des familles âgées ne s’est pas détériorée suite à la reprise économique de la fin des années ’90.

A patient with an aberrant pulmonary blood supply and recurrent infection

A case of intralobar pulmonary sequestration presenting with recurrent episodes of infection is reported. Pulmonary sequestration is a rare congenital malformation characterized by accessory lung tissue with no direct connection to the tracheobronchial tree and is supplied by an aberrant systemic artery. The aberrant artery is key to both diagnosis and treatment. The correct diagnosis may be suspected on clinical grounds and should be confirmed by identifying the lesion and aberrant artery on imaging studies. Surgical resection is curative, taking particular care not to injure the aberrant artery, which may result in devastating intraoperative hemorrhage