Bariatric surgery and diabetes remission: Sleeve gastrectomy or mini-gastric bypass?

AIM: To investigate the weight loss and glycemic control status [blood glucose, hemoglobin A1c (HbA1c) and hypoglycaemic treatment]. METHODS: The primary risk factor for type 2 diabetes is obesity, and 90% of all patients with type 2 diabetes are overweight or obese. Although a remarkable effect of bariatric surgery is the profound and durable resolution of type 2 diabetes clinical manifestations, little is known about the difference among various weight loss surgical procedures on diabetes remission. Data from patients referred during a 3-year period (from January 2009 to December 2011) to the University of Naples "Federico II" diagnosed with obesity and diabetes were retrieved from a prospective database. The patients were split into two groups according to the surgical intervention performed [sleeve gastrectomy (SG) and mini-gastric bypass (MGB)]. Weight loss and glycemic control status (blood glucose, HbA1c and hypoglycaemic treatment) were evaluated. RESULTS: A total of 53 subjects who underwent sleeve gastrectomy or mini-gastric bypass for obesity and diabetes were screened for the inclusion in this study. Of these, 4 subjects were excluded because of surgical complications, 7 subjects were omitted because young surgeons conducted the operations and 11 subjects were removed because of the lack of follow-up. Thirty-one obese patients were recruited for this study. A total of 15 subjects underwent SG (48.4%), and 16 underwent MGB (51.6%). After adjusting for various clinical and demographic characteristics in a multivariate logistic regression analysis, high hemoglobin A1c was determined to be a negative predictor of diabetes remission at 12 mo (OR = 0.366, 95%CI: 0.152-0.884). Using the same regression model, MGB showed a clear trend toward higher diabetes remission rates relative to SG (OR = 3.780, 95%CI: 0.961-14.872). CONCLUSION: Although our results are encouraging regarding the effectiveness of mini-gastric bypass on diabetes remission, further studies are needed to provide definitive conclusions in selecting the ideal procedure for diabetes remission

Intradermal absorbable sutures to close pilonidal sinus wounds: a safe closure method?

PURPOSE: The aim of this study was to demonstrate the safety of using intradermal absorbable sutures for pilonidal sinus skin closure. METHODS: The study was prospectively carried out in 203 patients randomized into two groups of patients. In the first group (103 patients), interrupted sutures were used; in the second group (100 patients), a continuous intradermal suture was used. We have analyzed the time off work, time to walk without pain, time to sit on the toilet without pain, wound infections, satisfaction rate and esthetic results. RESULTS: There were no significant differences between the groups with regard to the time off work, time to walk without pain and time to sit on a toilet without pain. There was also no significant difference between the groups with regard to the wound infection rates (p = 0.64). The study suggested that the patients' satisfaction was higher when an intradermal suture was used (p = 0.001). Similarly, a better cosmetic appearance of the scar was obtained with an intradermal suture (p = 0.01). CONCLUSIONS: Our results suggest that using intradermal sutures after excision and primary closure of the pilonidal sinus is safe and has advantages in terms of the cosmetic results and patient satisfaction

Outpatient surgical procedures: which is the ideal teaching procedure for a resident surgeon?

Aim. The aim of our study is to evaluate which surgical procedures can be considered the ideal teaching procedure for a resident surgeon. Materials and methods. This is a retrospective study. A chart review was performed on all patients who underwent inguinal hernia repair, saphenectomy, excision of pilonidal sinus and hemorrhoidectomy at our institution, between September 2000 and July 2011, and have at least 1 year of follow-up. We evaluated operative time and complications comparing the results obtained by resident or attending surgeon. Results. We obtained a higher operative time among the procedures performed by resident surgeons for all evaluated interventions. Whereas the occurrence of complications after hernia repair and excision and primary closure of pilonidal sinus were similar in case and control subjects (p = 0,1 and p = 0,1), the occurrence of complications after hemorrhoidectomy and saphenectomy was significantly higher in the case group (p = 0,08 and p = 0,1). Conclusion. Hernia repair and excision and primary closure of pilonidal sinus have to be considered the ideal teaching procedure in a residency program, giving to the young surgeon the opportunity of reach several skills that he needs to master most difficult surgical procedures. Saphenectomy and hemorrhoidectomy should be considered safe only if performed by a senior resident surgeon

Mini Gastric Bypass in the Treatment of Prader Willi Syndrome. A Case Report with Two Years of Follow Up

Introduction: Prader-Willi syndrome (PWS) is a genetic disorder mainly characterized by hyperphagia and early-childhood onset obesity. Because of behavioral and cognitive problems causing the failure of any dietary control program, bariatric surgery appears to be the appropriate therapy in these patients. In this study we present our experience of treating PWS-associated obesity with laparoscopic mini-gastric bypass (LMGBP). This is the second published case of PWS treated by LMGB so far. Patient and Method: A 16 y.o. boy with PWS, BMI of 54,8 Kg/m2 , hypertension and frequent severe sleep apnea crisis, was referred to our department. The patient underwent a LMGB at about 190 cm from the Treitz ligament. Main preoperative parameters as BMI, ghrelin levels, CPK. Hb A1C, arterial pressure and EGA were respectively: 54,8 Kg/m2 ; 1163,7 pg/ml; 148 u/L; 5,9%; 150/100 mm/Hg; 95% sat O2. Results: The postoperative period was uneventful and the young patient was discharged five days following surgery. Two years later main parameters are: BMI 40.6 with an EWL of 44 %; fasting plasma acyl ghrelin 353,1 pg/ml; CPK 65 u/L; Hb A1C 5,1 %; arterial pressure 130/75 mmHg without therapy and 99% sat O2. The resolution of sleep apnea disorder has been recorded as well. An oral multivitamin and iron implementation is daily administered in order to treat iron deficiency anemia. Conclusion: Although larger series and longer follow up are needed, according to these data, LMGBP seems to be a valid approach for the treatment of PWS associated obesity

Outpatient surgical procedures: which is the ideal teaching procedure for a resident surgeon?

Aim. The aim of our study is to evaluate which surgical procedures can be considered the ideal teaching procedure for a resident surgeon. Materials and methods. This is a retrospective study. A chart review was performed on all patients who underwent inguinal hernia repair, saphenectomy, excision of pilonidal sinus and hemorrhoidectomy at our institution, between September 2000 and July 2011, and have at least 1 year of follow-up. We evaluated operative time and complications comparing the results obtained by resident or attending surgeon. Results. We obtained a higher operative time among the procedures performed by resident surgeons for all evaluated interventions. Whereas the occurrence of complications after hernia repair and excision and primary closure of pilonidal sinus were similar in case and control subjects (p = 0,1 and p = 0,1), the occurrence of complications after hemorrhoidectomy and saphenectomy was significantly higher in the case group (p = 0,08 and p = 0,1). Conclusion. Hernia repair and excision and primary closure of pilonidal sinus have to be considered the ideal teaching procedure in a residency program, giving to the young surgeon the opportunity of reach several skills that he needs to master most difficult surgical procedures. Saphenectomy and hemorrhoidectomy should be considered safe only if performed by a senior resident surgeon

Diabetes Resolution Following Bariatric Surgery. Efficacy of Mini Gastric Bypass and Sleeve Gastrectomy

Introduction: Type 2 diabetes mellitus is now a global health priority. The World Health Organization estimates that between 2000 and 2030 the number of diabetic patients will increase by 114%. Although it is worth notice that bariatric surgery could treat the diabetes, little is known about which procedure should be preferred. In order to evaluate the efficacy of sleeve gastrectomy (LSG) and mini gastric by-pass (LMGB), we have designed a comparative study on obese diabetic patients who undergone bariatric surgery. Methods: We have retrospectively evaluated a prospective database of all obese and diabetic patients who have undergone bariatric surgery, between January 2010 and January 2012, including for the analysis 15 LSG and 16 LMGB. We have assessed the efficacy of these procedures in the treatment of diabetes evaluating fasting blood glucose (FPG) and glycosylated haemoglobin (HbA1c) level. Results: Demographical and clinical outcomes were similar between the groups (p = NS). Whereas no statistical difference were found, a trend towards better results was obtained among the patients who undergone LMBG in order to treatment of diabetes. More in details, after one year of follow-up, 87,5% of patients who underwent LMGB and 72,5% of patients who underwent LSG have a normal value of FPG (p = 0,2). Similarly we obtained a normal HbA1c respectively in 75% and 63,3% of patients who underwent LMGB and LSG (p = 0,1). Conclusions: Although more comparative studies are needed to give definitive conclusion, a trend towards better results was obtained aftermini gastric bypass

Brachyury, a vaccine target, is overexpressed in triple-negative breast cancer

Patients diagnosed with triple-negative breast cancer (TNBC) have a high rate of tumor metastasis and a poor prognosis. The treatment option for these patients is currently chemotherapy, which results in very low response rates. Strategies that exploit the immune system for the treatment of cancer have now shown the ability to improve survival in several tumor types. Identifying potential targets for immune therapeutic interventions is an important step in developing novel treatments for TNBC. In this study, in silico analysis of publicly available datasets and immunohistochemical analysis of primary and metastatic tumor biopsies from TNBC patients were conducted to evaluate the expression of the transcription factor brachyury, which is a driver of tumor metastasis and resistance and a target for cancer vaccine approaches. Analysis of breast cancer datasets demonstrated a predominant expression of brachyury mRNA in TNBC and in basal vs luminal or HER2 molecular breast cancer subtypes. At the protein level, variable levels of brachyury expression were detected both in primary and metastatic TNBC lesions. A strong association was observed between nuclear brachyury protein expression and the stage of disease, with nuclear brachyury being more predominant in metastatic vs primary tumors. Survival analysis also demonstrated an association between high levels of brachyury in the primary tumor and poor prognosis. Two brachyury-targeting cancer vaccines are currently undergoing clinical evaluation; the data presented here provide rationale for using brachyury-targeting immunotherapy approaches for the treatment of TNBC

Optimisation of isolation of richly pure and homogenous primary human colonic smooth muscle cells

Background. Inherent properties of gastrointestinal smooth muscle can be assessed using isolated cell suspensions. Currently available isolation techniques, based on short 2-h enzymatic digestion, however, present the disadvantage of low cellular yield with brief viability. These features are an important limiting factor especially in studies in humans in which tissue may not be available daily and mixing of samples is not recommended. Aims. To optimise the isolation procedure of cells from human colon to obtain a richly pure primary smooth muscle cell preparation. Methods. Slices of circular muscle layer, obtained from surgical specimens of human colon, were incubated overnight in Dulbecco's modified eagle's medium supplemented with antibiotics, foetal bovine serum, an ATP-regenerating system and collagenase. On the following day, digested muscle strips were suspended in HEPES buffer, and spontaneously dissociated smooth muscle cells were harvested and used either immediately or maintained in suspension for up to 72 h. Cell yield, purity, viability, contractile responses, associated intracellular calcium signals and RNA and protein extraction were evaluated and compared to cell suspensions obtained with the current short digestion protocol. Results and conclusion. The overnight isolation protocol offers the advantage of obtaining a pure, homogeneous, long-life viable cell suspension that maintains a fully differentiated smooth muscle phenotype unchanged for at least 72 h and that allows multiple functional/ biochemical studies and efficient RNA extraction from a single human specimen. © 2004 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved

Safety and efficacy of saphenectomy in elderly patients.

Aim. The aim of this study is to evaluate safety and efficacy of saphenactomy in elderly patients. Patients and methods. A total of 358 patients with varicose veins of the lower limbs treated between January 2001 and December 2011. 213 of these were patients under 65 years old and 145 patients were over this age. We have evaluated shortand long-term complications to compare the results among young and elderly patients. Results. Postoperative complications that occurred were: infection, haematoma, nerve injury (paresthesia and pain) and deep vein thrombosis. Although a trend towards better results was observed among the young patients, no significant differences were shown in our experience. Conclusion. Elective saphenectomy has a good outcome also in the elderly patients. The slightly higher rate of complications that occurred in older patients is not significant and does not support advising against the use of this surgical approach in the elderly. So in our opinion saphenectomy is quite safe and feasible also in patients over 65 years

Safety and efficacy of saphenectomy in elderly patients

Aim. The aim of this study is to evaluate safety and efficacy of saphenactomy in elderly patients. Patients and methods. A total of 358 patients with varicose veins of the lower limbs treated between January 2001 and December 2011. 213 of these were patients under 65 years old and 145 patients were over this age. We have evaluated short- and long-term complications to compare the results among young and elderly patients. Results. Postoperative complications that occurred were: infection, haematoma, nerve injury (paresthesia and pain) and deep vein thrombosis. Although a trend towards better results was observed among the young patients, no significant differences were shown in our experience. Conclusion. Elective saphenectomy has a good outcome also in the elderly patients. The slightly higher rate of complications that occurred in older patients is not significant and does not support advising against the use of this surgical approach in the elderly. So in our opinion saphenectomy is quite safe and feasible also in patients over 65 years