304 research outputs found
Longitudinal sleeve gastrectomy: current perspectives
Emanuele Soricelli, Giovanni Casella, Giorgio Di Rocco, Adriano Redler, Nicola BassoDepartment of Surgical Sciences, Policlinico Umberto I, Sapienza, University of Rome, ItalyAbstract: Since the early 2000s, laparoscopic sleeve gastrectomy has increasingly gained consensus in bariatric surgery, thanks to good to excellent results in terms of weight loss and comorbidity resolution, and to simpler technical aspects than in Roux-en-Y gastric bypass and biliopancreatic diversion. In yearly consensus summits, surgical indications, technical details, and management of complications, together with continuous update of data concerning clinical outcome, have been debated on the basis of increasing collective experience. In experimental studies and clinical trials, the pathophysiological mechanisms of weight loss and remission of cardiometabolic comorbidities subsequent to sleeve gastrectomy have been extensively discussed. The aim of this paper is to offer a review of state of the art laparoscopic sleeve gastrectomy and to focus attention on the currently most debated topics and future prospects of this procedure.Keywords: sleeve gastrectomy, type 2 diabetes mellitus, gastroesophageal reflux disease, revisional, quality of lif
Partial Medial Meniscectomy Using Needle Arthroscopy and a Standardized Local Anesthetic Protocol
Needle arthroscopic procedures of the knee offer potential advantages over standard arthroscopic procedures. The small size of the instruments allows for surgery without the use of a scalpel or suture, potentially decreased recovery times, and potentially reduced complication rates compared with traditional arthroscopy. In some patients, the procedure can be performed without the use of either general anesthesia or sedation. The purpose of this article is to provide a standardized technique guide for needle arthroscopic partial medial meniscectomy under local anesthesia
High Prevalence of Anterolateral Ligament Abnormalities on MRI in Knees With Acute Anterior Cruciate Ligament Injuries. A Case-Control Series From the SANTI Study Group
Background: Broad variation in the reported rate of magnetic resonance imaging (MRI)âdetected abnormalities of the anterolateral structures of the anterior cruciate ligament (ACL)âinjured knee suggests a lack of reliability that has limited the use of MRI in clinical decision making. Purpose/Hypothesis: The aim of this study was to use MRI to determine the prevalence and spectrum of abnormalities of the anterolateral structures in acute ACL-injured knees, using the contralateral uninjured knee as a reference. We hypothesized that MRI evaluation of the acutely injured knee (using the uninjured knee as a reference) would allow reliable identification of abnormalities of the anterolateral structures. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with acute ACL injury underwent MRI scan of both knees. Images were evaluated by 3 observers. Inter- and intraobserver reliabilities were determined for MRI parameters of anterolateral ligament (ALL) injury by use of the kappa (Îș) test. Univariate and multivariate analyses were conducted to test associations between ALL abnormality and associated injuries. Results: A total of 34 patients were evaluated. Of these, 30 patients (88.2%) had at least 1 ALL abnormality in the ACL-injured knee (increased signal: n = 27[79.4%]; increased thickness: n = 15[44.1%]; tapering: n = 7[20.6%]; irregularities in the path of the ALL fibers: n = 21[61.7%]). Asymmetries of the genicular vessels were observed in 21 patients (61.7%). ALL abnormality was significantly associated with lateral joint capsular tears (P <.001). No correlation was found between ALL lesions and iliotibial band lesions (P =.49). Inter- and intraobserver reliabilities were very good concerning ALL signal changes and femoral and tibial bone bruises (Îș coefficient, 0.81-1). Conclusion: MRI evaluation of the ALL was associated with good and very good inter- and intraobserver reliabilities, and it demonstrated abnormalities of the ALL in the majority of acutely ACL-injured knees. The index of suspicion for ALL injury should be elevated by the presence of lesions of the lateral capsule. This suggests that the ALL is part of a wider area of the lateral capsule that is often injured simultaneously in an acute ACL tear
Genome-wide meta-analysis in alopecia areata resolves HLA associations and reveals two new susceptibility loci
Alopecia areata (AA) is a prevalent autoimmune disease with 10 known susceptibility loci. Here we perform the first meta-analysis of research on AA by combining data from two genome-wide association studies (GWAS), and replication with supplemented ImmunoChip data for a total of 3,253 cases and 7,543 controls. The strongest region of association is the major histocompatibility complex, where we fine-map four independent effects, all implicating human leukocyte antigen-DR as a key aetiologic driver. Outside the major histocompatibility complex, we identify two novel loci that exceed the threshold of statistical significance, containing ACOXL/BCL2L11(BIM) (2q13); GARP (LRRC32) (11q13.5), as well as a third nominally significant region SH2B3(LNK)/ATXN2 (12q24.12). Candidate susceptibility gene expression analysis in these regions demonstrates expression in relevant immune cells and the hair follicle. We integrate our results with data from seven other autoimmune diseases and provide insight into the alignment of AA within these disorders. Our findings uncover new molecular pathways disrupted in AA, including autophagy/apoptosis, transforming growth factor beta/Tregs and JAK kinase signalling, and support the causal role of aberrant immune processes in AA
Segond's fracture: a biomechanical cadaveric study using navigation
Background Segondâs fracture is a well-recognised radiological
sign of an anterior cruciate ligament (ACL) tear.
While previous studies evaluated the role of the anterolateral
ligament (ALL) and complex injuries on rotational
stability of the knee, there are no studies on the biomechanical
effect of Segondâs fracture in an ACL deficient
knee. The aim of this study was to evaluate the effect of a
Segondâs fracture on knee rotation stability as evaluated by
a navigation system in an ACL deficient knee.
Materials and methods Three different conditions were
tested on seven knee specimens: intact knee, ACL deficient
knee and ACL deficient knee with Segondâs fracture. Static
and dynamic measurements of anterior tibial translation
(ATT) and axial tibial rotation (ATR) were recorded by the
navigation system (2.2 OrthoPilot ACL navigation system
B. Braun Aesculap, Tuttlingen, Germany).
Results Static measurements at 30 showed that the mean
ATT at 30 of knee flexion was 5.1 ± 2.7 mm in the ACL
intact condition, 14.3 ± 3.1 mm after ACL cut
(P = 0.005), and 15.2 ± 3.6 mm after Segondâs fracture
(P = 0.08). The mean ATR at 30 of knee flexion was
20.7 ± 4.8 in the ACL intact condition, 26.9 ± 4.1 in
the ACL deficient knee (P[0.05) and 30.9 ± 3.8 after
Segondâs fracture (P = 0.005). Dynamic measurements
during the pivot-shift showed that the mean ATT was
7.2 ± 2.7 mm in the intact knee, 9.1 ± 3.3 mm in the
ACL deficient knee(P = 0.04) and 9.7 ± 4.3 mm in the
ACL deficient knee with Segondâs fracture (P = 0.07).
The mean ATR was 9.6 ± 1.8 in the intact knee,
12.3 ± 2.3 in the ACL deficient knee (P[0.05) and
19.1 ± 3.1 in the ACL deficient knee with Segondâs
lesion (P = 0.016).
Conclusion An isolated lesion of the ACL only affects
ATT during static and dynamic measurements, while the
addition of Segondâs fracture has a significant effect on
ATR in both static and dynamic execution of the pivot-shift
test, as evaluated with the aid of navigation
Right colon angiodysplasia and lower limb chronic obstructive arteropathy: simultaneous endovascular treatment
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