Gastric Cancer Following Bariatric Surgery: a Review

Background Bariatric procedures can induce a massive weight loss, that lasts more than 15 years after surgery; in addition they achieve important metabolic effects including diabetes resolution in the majority of morbidly obese patients. However some bariatric interventions may cause gastroesophageal reflux disease and other serious complications. The aim of our study is to evaluate the risk of cancer after bariatric surgery. Methods We performed a review of literature about the cases of gastric cancer arising after any bariatric procedure, including a case of adenocarcinoma incidentally discovered by the authors six months after Laparoscopic Adjustable Gastric Banding. Results Globally 17 case reports describing 18 patients were retrieved, including the case of the authors. The diagnosis of tumor was at mean of 8,6 years after bariatric surgery, respectively 9,3 after RYGB and 8,1 after restrictive procedures. The adenocarcinoma represented most cases (15 patients - 83%). In the patients with RYGB the adenocarcinoma was localized in the excluded stomach in 5 (83%) and in the pouch in 1 (17%). After a restrictive procedure the cancer was localized in the pouch in 5 patients (62,5%), in the pylorus in 2 patients (25%) and in lesser curvature only in 1 (12,5%). Conclusion Nowadays there is a lack of evidence about a connection between the late occurrence of gastric adenocarcinoma and the bariatric surgery. For this reason while the preoperative upper endoscopy is still mandatory, there is no need for a regular endoscopic evaluation of patients after surgery

Blasting and Passivation Treatments for ASTM F139 Stainless Steel for Biomedical Applications : Effects on Surface Roughness, Hardening, and Localized Corrosion

Due to the combination of good biofunctionality and biocompatibility at low cost, AISI 316 low carbon vacuum melting (LVM) stainless steel, as considered in ASTM F139 standard, is often the first choice for medical implants, particularly for use in orthopedic surgery. Proper surface finish must be provided to ensure adequate interactions of the alloy with human body tissues that in turn allows the material to deliver the desired performance. Preliminary studies performed in our laboratory on AISI 316LVM stainless steel surfaces modified by glass bead blasting (from industrial supplier) followed by different nitric acid passivation conditions disclosed the necessity to extend parameters of the surface treatments and to further consider roughness, pitting corrosion resistance, and surface and subsurface hardening measurements, all in one, as the most effective characterization strategy. This was the approach adopted in the present work. Roughness assessment was performed by means of amplitude parameters, functional parameters, and an estimator of the fractal dimension that characterizes surface topography. We clearly demonstrate that the blasting treatment should be carried out under controlled conditions in order to obtain similar surface and subsurface properties. Otherwise, a variation in one of the parameters could modify the surface properties, exerting a profound impact on its application as biomaterial. A passivation step is necessary to offset the detrimental effect of blasting on pitting corrosion resistance.Laboratorio de Investigaciones de Metalurgia Físic

Caracterización superficial de 316LVM blastinizado y pasivado para su aplicación como biomaterial

El objetivo del presente trabajo fue evaluar los efectos que producen el proceso de blastinizado y pasivados químicos en los parámetros de rugosidad, el comportamiento frente la corrosión por picado y el endurecimiento superficial. Con este fin se utilizó acero inoxidable austenítico AISI 316 LVM con diferentes preparaciones superficiales, todas basadas en blastinizado con partículas de sílice

Caracterización superficial de 316LVM blastinizado y pasivado para su aplicación como biomaterial

El objetivo del presente trabajo fue evaluar los efectos que producen el proceso de blastinizado y pasivados químicos en los parámetros de rugosidad, el comportamiento frente la corrosión por picado y el endurecimiento superficial. Con este fin se utilizó acero inoxidable austenítico AISI 316 LVM con diferentes preparaciones superficiales, todas basadas en blastinizado con partículas de sílice. (Párrafo extraído del texto a modo de resumen)Facultad de Ingenierí

Caracterización superficial de 316LVM blastinizado y pasivado para su aplicación como biomaterial

El objetivo del presente trabajo fue evaluar los efectos que producen el proceso de blastinizado y pasivados químicos en los parámetros de rugosidad, el comportamiento frente la corrosión por picado y el endurecimiento superficial. Con este fin se utilizó acero inoxidable austenítico AISI 316 LVM con diferentes preparaciones superficiales, todas basadas en blastinizado con partículas de sílice. (Párrafo extraído del texto a modo de resumen)Facultad de Ingenierí

Breast neuroendocrine tumors multidisciplinary treatment. Single experience in our Centre

Introduction: Breast Neuroendocrine Tumours (B-NETs) are rare entities; the incidence in Italy is about 1%. The great variability of manifestations and localizations made it very interested in studying. Only few cases are available in literature; actually this pathology is more difficult to treat because specific guidelines don’t exist for the treatment of primary metastatic NETs.Case presentation: The case concerns a 48-year-old woman with a diagnosis of Breast Neuroendocrine Tumours (B-NET). She was treated with multidisciplinary approach; the patient started neoadjuvant chemotherapy and then she underwent right radical mastectomy. No further chemotherapy treatment was performed. In the last ten years, no signs of local recurrence or metastases were observed.Conclusion: The presented case is very characteristic for its multidisciplinary approach.</p

Hypocalcaemia after total thyroidectomy: Could intact parathyroid hormone be a predictive factor for transient postoperative hypocalcemia?

Background Hypocalcemia, the most common complication of thyroidectomy, is a transient condition in up to 27% of patients and a permanent condition approximately 1% of patients. The aim of this prospective study was to evaluate reliability of postoperative intact parathyroid hormone (iPTH) assessment for predicting clinically relevant postthyroidectomy hypocalcemia for a safe early discharge of patients with no overtreatment. Methods Seventy-five consecutive patients (age 51 ± 13 years [mean ± SD]) undergoing total or completion thyroidectomy with no concomitant parathyroid diseases or renal failure were included in the present study. Serum iPTH level was determined before and 2 hours after thyroidectomy. Serum calcium concentration was determined 1 day before and 2 days postoperatively. Results The occurrence of postoperative hypocalcemia was correlated both with the absolute and relative iPTH decrease, determined as a ratio of the preoperative value (P <.0001). There was a greater difference in relative decrease in iPTH between patients remaining normocalcemic and those with hypocalcemia present on the second postoperative day. Hypocalcemic patients on the second postoperative day had a 62% relative decrease in iPTH 2 hours after thyroidectomy. Conclusion The relative decrease in serum iPTH was greater in patients with hypocalcemia arising on the second postoperative day rather than in patients who remained normocalcemic. The relative decrease in iPTH determined 2 hours after total thyroidectomy together with the serum calcium concentration 24 hours after thyroidectomy proved to be useful predictors of sustained hypocalcemia and might change the clinical management of patients after thyroid surgery to support a longer hospitalization in these selected patients

Downregulation of Interleukin- (IL-) 17 through Enhanced Indoleamine 2,3-Dioxygenase (IDO) Induction by Curcumin: A Potential Mechanism of Tolerance towards Helicobacter pylori

The anti-inflammatory and antimicrobial properties of curcumin suggest its use as an anti-Helicobacter pylori (H. pylori) agent, but mechanisms underlying its helpful activity are still not clear. Indoleamine 2,3-dioxygenase (IDO) promotes the effector T cell apoptosis by catalyzing the rate-limiting first step in tryptophan catabolism, and its high expression in H. pylori-infected human gastric mucosa attenuates Th1 and Th17 immune response. The aim of this study was to investigate the role of curcumin in modulating the expression of IL-17 and IDO in H. pylori-infected human gastric mucosa. In an organ culture chamber, gastric biopsies from 35 patients were treated with and without 200 μM curcumin. In H. pylori-infected patients (n=21), IL-17 was significantly lower, both in gastric biopsies (p=0.0003) and culture supernatant (p=0.0001) while IDO significantly increased (p<0.00001) in curcumin-treated sample compared with untreated samples. In a subgroup of H. pylori-infected patients (n=15), samples treated with curcumin in addition to IDO inhibitor 1-methyl-L-tryptophan (1-MT) showed a higher expression of IL-17 compared with untreated samples and curcumin-treated alone (p<0.00001). Curcumin downregulates IL-17 production through the induction of IDO in H. pylori-infected human gastric mucosa, suggesting its role in dampening H. pylori-induced immune-mediated inflammatory changes

Post-activation potentiation increases recruitment of fast twitch fibers: a potential practical application in runners

To determine the relationship between fatigue and post-activation potentiation, we examined the effects of sub-maximal continuous running on neuromuscular function tests, as well as on the squat jump and counter movement jump in endurance athletes. The height of the squat jump and counter movement jump and the estimate of the fast twitch fiber recruiting capabilities were assessed in seven male middle distance runners before and after 40 min of continuous running at an intensity corresponding to the individual lactate threshold. The same test was then repeated after three weeks of specific aerobic training. Since the three variables were strongly correlated, only the estimate of the fast twitch fiber was considered for the results. The subjects showed a significant improvement in the fast twitch fiber recruitment percentage after the 40 min run. Our data show that submaximal physical exercise determined a change in fast twitch muscle fiber recruitment patterns observed when subjects performed vertical jumps; however, this recruitment capacity was proportional to the subjects' individual fast twitch muscle fiber profiles measured before the 40 min run. The results of the jump tests did not change significantly after the three-week training period. These results suggest that pre-fatigue methods, through sub-maximal exercises, could be used to take advantage of explosive capacity in middle-distance runner

The role of a multidisciplinary approach in the choice of the best surgery approach in a super-super-obesity case

Introduction: Obesity is a multifactorial chronic disease caused by a combination of hereditary, metabolic, dietary, cultural, social and psychological factors. Conservative treatments, such as diet and physical exercises, revealed a lack of long-term efficacy in patients with an extremely high BMI (>60 kg/m2). Methods: We present a multidisciplinary approach in a patient with an extremely high BMI: a twenty-one years old woman with a BMI 102 kg/m2 (body weight 313 kg × height 175 cm) disabled to walk with severe depression and a psychological pattern of sweet eater and binge eating disorder. She was also amenorrheic and suffered from metabolic syndrome. The psychological assessment and the social-familial support were defined as priorities. Afterward, physical rehabilitation, behavior therapy, hypocaloric diet followed by intragastric balloon were planned as preoperative treatment. Finally a surgical program was scheduled: Sleeve Gastrectomy as first step of Biliopancreatic Diversion with Duodenal Switch. Results: Sixteenth months after the Sleeve Gastrectomy the weight was 130 kg (Excess Weight Loss = 74%) with a resumption of the menstrual cycle and a normalization of the metabolic syndrome. Conclusion: Due to the results obtained with both surgery and an excellent psychological supporting network we decided not to perform the expected Biliopancreatic Diversion with Duodenal Switch. The timing of bariatric surgery in superobesity patients is a milestone, but the cooperation among the specialists is essential for the choice of the best successful surgery. The multidisciplinary team should point to a comprehensive tailored management, considering motivation, compliance and adherence to a long-term follow-up as the keys for surgical success. © 2014 Surgical Associates Ltd