WorldWideScience

Sample records for vein myocardial sleeves

  1. Increased extracellular collagen matrix in myocardial sleeves of pulmonary veins: an additional mechanism facilitating repetitive rapid activities in chronic pacing-induced sustained atrial fibrillation.

    Science.gov (United States)

    Chiu, Yung-Tsung; Wu, Tsu-Juey; Wei, Hao-Ji; Cheng, Ching-Chang; Lin, Nai-Nu; Chen, Ying-Tsung; Ting, Chih-Tai

    2005-07-01

    Increased ECM in canine PVs. Cell uncoupling due to fibrosis or increased extracellular collagen matrix (ECM) affects the formation of ectopic focal activity. Whether or not the increase of ECM also exists in the pulmonary veins (PVs) with rapid atrial pacing is unknown. We sought to test the hypothesis that in chronic atrial pacing dogs with sustained atrial fibrillation (AF), the amount of ECM was increased in both atria and the PVs. We induced sustained AF in dogs by rapid atrial pacing. Computerized mapping techniques were used to map both atria and the PVs. We also used histological assessment to quantify the amount of ECM. After 118+/-24 days of rapid atrial pacing, sustained AF was induced in 7 dogs. Repetitive rapid activities (RRAs) either continuously or intermittently arose from the PVs during sustained AF. Histological study shows that there was no fibrosis in both atrial free walls and the PVs. However, the amount of ECM was increased in these regions. The mean ECM surface area fraction at each region in the dogs with sustained AF was all significantly higher compared to the corresponding region in normal dogs. Similarly, the heterogeneity of the ECM surface area fraction at each region in the dogs with sustained AF was also all significantly higher compared to normal dogs. In chronic atrial pacing-induced sustained AF, structural remodeling (i.e., inhomogeneous increase of ECM) also involves the PVs. Reduced coupling of the myocytes in the PV due to histological changes may provide an additional mechanism facilitating RRAs.

  2. Splanchnic Vein Thrombosis - an Uncommon Complication after Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Tanja Carli

    2016-04-01

    Full Text Available Background: Laparoscopic sleeve gastrectomy (LSG is an innovative and relatively safe surgical approach for weight reduction in morbidly obese people. Splanchnic vein thrombosis (SVT is an extremely rare complication of LSG and, if not recognized, carries a high mortality rate. This paper highlights a potentially lethal condition of SVT after LSG. Case Report: A 37-year-old morbidly obese woman was referred to our institution for LSG. Three weeks after the intervention, she was readmitted with abdominal pain, vomiting, nausea, diarrhea, and fever with positive family anamnesis to viral disease. Abdominal X-ray as well as utrasonography were both normal, and no X-ray contrast medium leakage was observed. One week later, she was readmitted with septic condition. An abdominal computed tomography scan diagnosed lienal vein thrombosis along its whole length and partial thrombosis of the superior mesenteric vein. Conclusion: SVT presents very heterogeneously, which makes it extremely challenging to diagnose and to make an appropriate treatment decision. With regard to the high prevalence of obesity and the increasing frequency of LSG, prompt diagnosis and management are crucial.

  3. Portal Vein Thrombosis due to Prothrombin Gene Mutation following Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Murad Baba

    2015-01-01

    Full Text Available Introduction. Portomesenteric thrombosis is increasingly recognized as a complication of laparoscopic sleeve gastrectomy (LSG. It often presents with abdominal pain. We present a mother and her son who both developed portal vein thrombosis (PVT after LSG. Case Description. A 43-year-old woman presented complaining of sudden severe abdominal pain, two weeks after she had uncomplicated laparoscopic sleeve gastrectomy. CT scan of the abdomen and pelvis with IV contrast showed portal vein thrombosis and SMV thrombosis. Two weeks later her son had the same LSG for morbid obesity and presented with the same clinical picture. Thrombophilia workup showed heterozygous prothrombin gene mutation. Conclusions. A high index of suspicion is necessary to diagnose PVT; although rare, it can be potentially lethal. Anticoagulation therapy should be initiated immediately to limit the morbidities and improve the outcome. Patients with family history of thrombophilia should be investigated prior to any bariatric surgery and nonsurgical alternative treatments for morbid obesity should be strongly encouraged.

  4. Portomesenteric Vein Thrombosis, Bowel Gangrene, and Bilateral Pulmonary Artery Embolism Two Weeks after Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    David G. Darcy

    2015-01-01

    Full Text Available Sleeve gastrectomy and gastric bypass surgery are popular and effective options for weight loss surgery. Portomesenteric vein thrombosis (PMVT is a documented but rare complication of bariatric surgery. Proper surgical technique, careful postoperative prophylaxis, and early mobilization are essential to prevent this event. The diagnosis of PMVT in the postoperative period requires a high index of suspicion and early directed intervention to prevent a possibly fatal outcome. We present a case of PMVT complicated by small bowel ischemia resulting in gangrene that necessitated resection.

  5. Spontaneous, pro-arrhythmic calcium signals disrupt electrical pacing in mouse pulmonary vein sleeve cells.

    Directory of Open Access Journals (Sweden)

    Katja Rietdorf

    Full Text Available The pulmonary vein, which returns oxygenated blood to the left atrium, is ensheathed by a population of unique, myocyte-like cells called pulmonary vein sleeve cells (PVCs. These cells autonomously generate action potentials that propagate into the left atrial chamber and cause arrhythmias resulting in atrial fibrillation; the most common, often sustained, form of cardiac arrhythmia. In mice, PVCs extend along the pulmonary vein into the lungs, and are accessible in a lung slice preparation. We exploited this model to study how aberrant Ca(2+ signaling alters the ability of PVC networks to follow electrical pacing. Cellular responses were investigated using real-time 2-photon imaging of lung slices loaded with a Ca(2+-sensitive fluorescent indicator (Ca(2+ measurements and phase contrast microscopy (contraction measurements. PVCs displayed global Ca(2+ signals and coordinated contraction in response to electrical field stimulation (EFS. The effects of EFS relied on both Ca(2+ influx and Ca(2+ release, and could be inhibited by nifedipine, ryanodine or caffeine. Moreover, PVCs had a high propensity to show spontaneous Ca(2+ signals that arose via stochastic activation of ryanodine receptors (RyRs. The ability of electrical pacing to entrain Ca(2+ signals and contractile responses was dramatically influenced by inherent spontaneous Ca(2+ activity. In PVCs with relatively low spontaneous Ca(2+ activity (1.5 Hz, electrical pacing was less effective; PVCs became unpaced, only partially-paced or displayed alternans. Because spontaneous Ca(2+ activity varied between cells, neighboring PVCs often had different responses to electrical pacing. Our data indicate that the ability of PVCs to respond to electrical stimulation depends on their intrinsic Ca(2+ cycling properties. Heterogeneous spontaneous Ca(2+ activity arising from stochastic RyR opening can disengage them from sinus rhythm and lead to autonomous, pro-arrhythmic activity.

  6. Assessing risk factors, presentation, and management of portomesenteric vein thrombosis after sleeve gastrectomy: a multicenter case-control study.

    Science.gov (United States)

    Moon, Rena C; Ghanem, Muhammad; Teixeira, Andre F; De La Cruz-Munoz, Nestor; Young, Meredith K; Domkowski, Patrick; Radecke, Jason; Boyce, Stephen G; Rosenthal, Raul; Menzo, Emmanuel Lo; Blanco, David Gutierrez; Funes, David R; Jawad, Muhammad A

    2017-10-26

    Portomesenteric vein thrombosis (PMVT) is a rare complication of laparoscopic sleeve gastrectomy. To identify incidence, patient factors, diagnosis, and treatment of PMVT after laparoscopic sleeve gastrectomy in a large administrative data registry. Academic Hospitals and Private Practices, United States. A retrospective chart review of 5538 sleeve gastrectomy patients between January 1, 2008 and September 30, 2016 was performed at 5 bariatric centers in the United States. A total of 11 patients were identified as developing PMVT, and 3 controls for each patient were selected by matching age, sex, preoperative body mass index, and center. After adjusting for confounding variables, 2 patient factors significantly impacted the risk of PMVT after sleeve gastrectomy including personal history of malignancy (odds ratio 62, 95% confidence interval (CI) 1.4-99.9), and type 2 diabetes (odds ratio 12.7, 95% CI 1.2-137.3) compared with controls. Mean period from laparoscopic sleeve gastrectomy to presentation of PMVT was 19.3 ± 15.11 days (range, 8-62). All patients except 1 complained of abdominal pain as the main presenting symptom. Other complaints included nausea and vomiting, no bowel movement, decreased appetite, diarrhea, and dehydration, and leukocytosis was present in 45.5% of the patients. All diagnoses were made by using computed tomography. All initial treatments were anticoagulation, heparin drip being the most common method (90.9%). Of patients, 9 (81.8%) required a secondary anticoagulation therapy, and 1 (9.1%) patient required a reoperation. Incidence of PMVT is low after sleeve gastrectomy. A personal history of malignancy and type 2 diabetes increase the risk of PMVT. Increasing abdominal pain in a context of dehydration is common presenting symptoms with diagnosis confirmed by computed tomography. Anticoagulation is the standard treatment. There was no mortality associated with the occurrence of PMVT in this cohort. Copyright © 2017 American Society for

  7. Myocardial extracellular volume expansion and the risk of recurrent atrial fibrillation after pulmonary vein isolation.

    Science.gov (United States)

    Neilan, Tomas G; Mongeon, Francois-Pierre; Shah, Ravi V; Coelho-Filho, Otavio; Abbasi, Siddique A; Dodson, John A; McMullan, Ciaran J; Heydari, Bobak; Michaud, Gregory F; John, Roy M; Blankstein, Ron; Jerosch-Herold, Michael; Kwong, Raymond Y

    2014-01-01

    This study tested whether myocardial extracellular volume (ECV) is increased in patients with hypertension and atrial fibrillation (AF) undergoing pulmonary vein isolation and whether there is an association between ECV and post-procedural recurrence of AF. Hypertension is associated with myocardial fibrosis, an increase in ECV, and AF. Data linking these findings are limited. T1 measurements pre-contrast and post-contrast in a cardiac magnetic resonance (CMR) study provide a method for quantification of ECV. Consecutive patients with hypertension and recurrent AF referred for pulmonary vein isolation underwent a contrast CMR study with measurement of ECV and were followed up prospectively for a median of 18 months. The endpoint of interest was late recurrence of AF. Patients had elevated left ventricular (LV) volumes, LV mass, left atrial volumes, and increased ECV (patients with AF, 0.34 ± 0.03; healthy control patients, 0.29 ± 0.03; p ECV and left atrial volume (r = 0.46, p ECV and diastolic function (early mitral annular relaxation [E'], r = -0.55, p ECV was the strongest predictor of the primary outcome of recurrent AF (hazard ratio: 1.29; 95% confidence interval: 1.15 to 1.44; p ECV was associated with a 29% increased risk of recurrent AF. In patients with AF and hypertension, expansion of ECV is associated with diastolic function and left atrial remodeling and is a strong independent predictor of recurrent AF post-pulmonary vein isolation. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  8. OCT imaging of myocardium extending to pulmonary vein

    Science.gov (United States)

    Li, Zhifang; Dickfeld, Timm; Tang, Qinggong; Wang, Bohan; Chen, Yu

    2016-02-01

    In this study, we propose to use optical coherence tomography to enable a direct visualization of myocardium extending into the pulmonary vein (PV). The results showed that there are obvious differences in the morphology of myocardium and fibrous tissue in the transition region of myocardial sleeve, which is in agreement with the histological analysis. In addition, the myocardial area in transition point has three layers in the depth of 1 mm, and the depth-resolved myocardial fiber show different orientation in the different layers. This characteristic was applied for segmentation of the structures of myocardium extending into PV.

  9. Saphenous vein graft thrombus findings by scanning electron microscopy in a patient with acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Marcela Dias; Aguillera, André Haraguti [Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP (Brazil); Brilhante, José Joaquim; Caixeta, Adriano [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

    2013-07-01

    An eighty-year-old male patient with a history of prior (19 years) coronary artery bypass graft surgery was admitted to the hospital with non ST-segment elevation myocardial infarction (NSTEMI). During the hospital stay he was taking acetylsalicylic acid 100mg per day, a loading dose of 600mg clopidogrel, and low molecular weight heparin 1mg/kg twice a day. Twenty-four hours later the patient underwent coronary angiography, which showed a 90% obstruction in the mid portion of the saphenous vein graft to obtuse marginal with signs of degeneration and local thrombus (Figure 1). Thrombus aspiration was performed with a 6-Fr Export{sup ™} catheter (Medtronic, Santa Rosa, CA, USA), which removed small reddish colored fragments. They were fixed in 2,5% glutaraldehyde in a 0.1M sodium cacodilate buffer. The material was processed following the GOTO protocol in which the fragments were washed with osmium tetroxide and titanic acid, after which they were dried in a critical-point device and a golden bath. Scanning electron microscopy and high definition photos (3,000 to 27,221x magnification) were obtained by the FEI Quanta{sup ™} FEG SEM device (FEI Company, Hillsboro, OR, USA). The images showed that the thrombus was rich in activated platelets, with few erythrocytes or inflammatory cells. Many cholesterol crystals were observed (Figures 2 to). The fibrin networks were sparse and thin, which is compatible with a short ischemic time and recent thrombus formation.

  10. Gastric Sleeve Surgery

    Science.gov (United States)

    ... Teens With Diabetes Protecting Your Online Identity and Reputation ADHD Medicines Gastric Sleeve Surgery KidsHealth > For Teens > ... foods don't have a lot of nutritional value (dietitians sometimes call them "empty calories"). In addition ...

  11. Estudo microscópico das pontes de miocárdio sobre as veias cardíacas de suínos Microscopic study of the myocardial bridges over cardiac veins of pigs

    Directory of Open Access Journals (Sweden)

    Nadir Eunice Valverde Barbato de Prates

    1999-07-01

    Full Text Available Com o objetivo de fazer um estudo, em microscópio de luz, das pontes de miocárdio sobre as veias cardíacas, utilizaram-se 5 corações de suínos de ambos os sexos. Esses corações foram fixados em formol a 10%, por um período de 10 dias, embebidos em parafina e submetidos a cortes histológicos seriados de 15 m de espessura. A seguir, os cortes foram corados pelos métodos de Azan e Weigert-van Gieson. Verificou-se que as pontes de miocárdio eram constituídas por fibras da camada superficial do miocárdio. A parede dos segmentos venosos pré-pontino, pós-pontino e pontino das veias cardíacas magna e média de suínos era delgada e possuía características semelhantes. A túnica média apresentava modificações estruturais de acordo com a localização no plano subepicárdico: fibromuscular, próxima ao ápice cardíaco, e fibroelástica, no restante do trajeto. Sob o ponto de vista morfofuncional, as pontes de miocárdio podem ser consideradas como um fator coadjuvante do retorno venoso.Aiming to study the myocardial bridges over the cadiac veins on the optic microscope we used 5 pig hearts. The hearts were fixed in 10% formaldehyde for 10 days, embebbed in paraffin and were submitted to 15m histological serial sections. The sections were stained by Azan and Weigert-van Gieson methods.The myocardial bridges were composed by superficial layer of the myocadium. The great cardiac vein and middle cardiac vein showed similar features on their pre-pontine, pontine, and post-pontine segments. The vessel wall was thin. The middle layer of the veins showed structural changes during its subepicardial course: it was fibro-muscular near the cardiac apex and fibro-elastic on its remaing course were also observed. From a morphofunctional point of view these myocardial bridges may be considered an additional factor for the venous return.

  12. Increased Belching After Sleeve Gastrectomy

    NARCIS (Netherlands)

    Burgerhart, J.S.; Meeberg, P.C. van de; Mauritz, F.A.; Schoon, E.J.; Smulders, J.F.; Siersema, P.D.; Smout, A.J.

    2016-01-01

    INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is considered to be an effective procedure for patients with morbid obesity. Belching is frequently reported after this procedure, but it has not been well studied in the bariatric population. This study aims to assess the changes in belching

  13. Longitudinal sleeve gastrectomy: current perspectives

    Directory of Open Access Journals (Sweden)

    Soricelli E

    2014-05-01

    Full Text Available 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 life

  14. Sleeve gastrectomy with anti-reflux procedures.

    Science.gov (United States)

    Santoro, Sergio; Lacombe, Arnaldo; Aquino, Caio Gustavo Gaspar de; Malzoni, Carlos Eduardo

    2014-09-01

    Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors.

  15. Spontaneous loosening of hydroxyapatite peg sleeves.

    Science.gov (United States)

    Jordan, D R

    2001-11-01

    To report a new complication associated with pegging hydroxyapatite orbital implants: spontaneous loosening of the sleeve. Retrospective noncomparative case series. Four patients ranging in age from 38 to 60 years participated. Four patients are described who successfully received hydroxyapatite orbital implants with motility peg and sleeve systems. In each case spontaneous loosening of the sleeve developed. Clinical and surgical outcomes were assessed. Three patients had the peg and sleeve removed followed by repair of the peg hole, and one patient had placement of a larger diameter peg and sleeve system. All patients did well. Problems have been reported when motility coupling pegs are used with hydroxyapatite orbital implants. Spontaneous loosening of the sleeve is another potential complication to discuss with the patient considering an implant peg.

  16. Root cause analysis of thermal sleeve separation

    Energy Technology Data Exchange (ETDEWEB)

    Jo, J. C.; Jhung, M. J.; Yu, S. O.; Kim, H. J.; Yune, Y. K.; Park, J. Y

    2006-01-15

    Thermal sleeves in the shape of thin wall cylinder seated inside the nozzle part of each Safety Injection (SI) line at Pressurized Water Reactors (PWRs) have such functions as prevention and relief of potential excessive transient thermal stress in the wall of SI line nozzle part which is initially heated up with hot water flowing in the primary coolant piping system when cold water is injected into the system through the SI nozzles during the SI operation mode. Recently, mechanical failures that the sleeves were separated from the SI branch pipe and fell into the connected cold leg main pipe occurred in sequence at some typical PWR plants in Korea. To find out the root cause of thermal sleeve breakaway failures, the flow situation in the junction of primary coolant main pipe and SI branch pipe, and the vibration modal characteristics of the thermal sleeve are investigated in detail by using both Computational Fluid Dynamic (CFD) code and structure analysis finite element code. As the results, the transient response in fluid force exerting on the local part of thermal sleeve wall surface to the primary coolant flow through the pipe junction area during the normal reactor operation mode shows oscillatory characteristics with frequencies ranging from 17 to 18, which coincide with one of the lower mode natural frequencies of thermal sleeve having a pinned support condition on the circumferential prominence on the outer surface of thermal sleeve which is put into the circumferential groove on the inner surface of SI nozzle at the mid-height of the thermal sleeve. In addition, the variation of force on the thermal sleeve surface yields alternating torques in the directions of two rectangular axes which are perpendicular to the longitudinal axis of cylindrical thermal sleeve, which cause rolling, pitching and rotating motions of the thermal sleeve. Consequently, it is seen that this flow situation surrounding the thermal sleeve during the normal reactor operation can

  17. Sleeve Gastrectomy and Gastroesophageal Reflux Disease

    Science.gov (United States)

    Gill, Richdeep S.; Birch, Daniel W.; Karmali, Shahzeer

    2013-01-01

    Bariatric surgery, when combined with lifestyle and medical interventions, is a common and successful treatment modality in the obese patient. Laparoscopic sleeve gastrectomy is one such procedure that has increased in popularity as a definitive bariatric operation. Although laparoscopic sleeve gastrectomy has been shown to be effective in producing weight loss and improving type 2 diabetes mellitus, its effect on gastroesophageal reflux disease (GERD) has been inconsistent. This paper aims to summarize the available literature regarding GERD prevalence following laparoscopic sleeve gastrectomy, 8 studies demonstrate increased GERD prevalence, and 5 demonstrate decreased GERD prevalence following laparoscopic sleeve gastrectomy. The relationship between GERD and SG is complex and no clear relationship exists. The anatomic and physiologic changes caused by laparoscopic sleeve gastrectomy are discussed in the context of these inconsistent results. PMID:23956846

  18. Sleeve Gastrectomy and Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Michael Laffin

    2013-01-01

    Full Text Available Bariatric surgery, when combined with lifestyle and medical interventions, is a common and successful treatment modality in the obese patient. Laparoscopic sleeve gastrectomy is one such procedure that has increased in popularity as a definitive bariatric operation. Although laparoscopic sleeve gastrectomy has been shown to be effective in producing weight loss and improving type 2 diabetes mellitus, its effect on gastroesophageal reflux disease (GERD has been inconsistent. This paper aims to summarize the available literature regarding GERD prevalence following laparoscopic sleeve gastrectomy, 8 studies demonstrate increased GERD prevalence, and 5 demonstrate decreased GERD prevalence following laparoscopic sleeve gastrectomy. The relationship between GERD and SG is complex and no clear relationship exists. The anatomic and physiologic changes caused by laparoscopic sleeve gastrectomy are discussed in the context of these inconsistent results.

  19. Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy

    Science.gov (United States)

    Cesana, Giovanni; Uccelli, Matteo; Ciccarese, Francesca; Carrieri, Domenico; Castello, Giorgio; Olmi, Stefano

    2014-01-01

    AIM: To evaluate laparoscopic re-sleeve gastrectomy as a treatment of weight regain after Sleeve. METHODS: Laparoscopic sleeve gastrectomy is a common bariatric procedure. Weight regain after long-term follow-up is reported. Patients were considered for laparoscopic re-sleeve gastrectomy when we observed progressive weight regain and persistence of comorbidities associated with evidence of dilated gastric fundus and/or antrum on upper gastro-intestinal series. Follow-up visits were scheduled at 1, 3, 6 and 12 mo after surgery and every 6 mo thereafter. Measures of change from baseline at different times were analyzed with the paired samples t test. RESULTS: We observed progressive weight regain after sleeve in 11 of the 201 patients (5.4%) who had a mean follow-up of 21.1 ± 9.7 mo (range 6-57 mo). Three patients started to regain weight after 6 mo following Sleeve, 5 patients after 12 mo, 3 patients after 18 m. Re-sleeve gastrectomy was always performed by laparoscopy. The mean time of intervention was 55.8 ± 29.1 min. In all cases, neither intra-operative nor post-operative complications occurred. After 1 year follow-up we observed a significant (P sleeve in those patients affected by hypertension and diabetes. Joint problems and sleep apnea syndrome improved in all 11 patients. CONCLUSION: Laparoscopic re-sleeve gastrectomy is a feasible and effective intervention to correct weight regain after sleeve. PMID:24976903

  20. Does sleeve gastrectomy improve obstructive sleep apnea?

    National Research Council Canada - National Science Library

    Suliman, Lucy Abdel Mabood; Abdalla, Dina Abouelkheir

    2016-01-01

    .... Bariatric surgery provides a significant weight loss for morbidly obese patients. The aim of this study was to evaluate the effect of sleeve gastrectomy on OSA symptoms, sleep parameter, continuous positive airway pressure (CPAP...

  1. Varicose vein - noninvasive treatment

    Science.gov (United States)

    Sclerotherapy; Laser therapy - varicose veins; Radiofrequency vein ablation; Endovenous thermal ablation; Ambulatory phlebectomy; Transilluminated power phlebotomy; Endovenous laser ablation; Varicose vein ...

  2. Sleeve gastrectomy and anti-reflux procedures.

    Science.gov (United States)

    Crawford, Christopher; Gibbens, Kyle; Lomelin, Daniel; Krause, Crystal; Simorov, Anton; Oleynikov, Dmitry

    2017-03-01

    Obesity is an epidemic in the USA that continues to grow, becoming a leading cause of premature avoidable death. Bariatric surgery has become an effective solution for obesity and its comorbidities, and one of the most commonly utilized procedures, the sleeve gastrectomy, can lead to an increase in gastroesophageal reflux following the operation. While these data are controversial, sometimes operative intervention can be necessary to provide durable relief for this problem. We performed an extensive literature review examining the different methods of anti-reflux procedures that are available both before and after a sleeve gastrectomy. We reviewed several different types of anti-reflux procedures, including those that supplement the lower esophageal sphincter anatomy, such as magnetic sphincter augmentation and radiofrequency ablation procedures. Re-operation was also discussed as a possible treatment of reflux in sleeve gastrectomy, especially if the original sleeve becomes dilated or if a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion is deemed necessary. Sleeve gastrectomy with concomitant anti-reflux procedure was also reviewed, including the anti-reflux gastroplasty, hiatal hernia repair, and limited fundoplication. A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.

  3. Gastritis in patients undergoing sleeve gastrectomy

    OpenAIRE

    RATH-WOLFSON, LEA; Varona, Roy; Bubis, Golan; Tatarov, Alexander; Koren, Rumelia; Ram, Edward

    2017-01-01

    Abstract Laparoscopic sleeve gastrectomy (LSG) is a therapeutic option in severely obese patients. The aim of this study was to evaluate the presence of Helicobacter pylori (HP) gastritis and non-Helicobacter gastritis in the gastrectomy specimens, and its association to other variables. One hundred six sleeve gastrectomy specimens were examined histopathologically for the presence of gastritis and its relation to other factors like ethnicity, glycemic control, and postoperative complications...

  4. Intracellular calcium dynamics and anisotropic reentry in isolated canine pulmonary veins and left atrium.

    Science.gov (United States)

    Chou, Chung-Chuan; Nihei, Motoki; Zhou, Shengmei; Tan, Alex; Kawase, Ayaka; Macias, Edgar S; Fishbein, Michael C; Lin, Shien-Fong; Chen, Peng-Sheng

    2005-06-07

    Rapid activations due to either focal discharge or reentry are often present during atrial fibrillation (AF) in the pulmonary veins (PVs). The mechanisms of these rapid activations are unclear. We studied 7 isolated, Langendorff-perfused canine left atrial (LA) and PV preparations and used 2 cameras to map membrane potential alone (Vm, n=3) or Vm and intracellular calcium simultaneously (Ca(i), n=4). Rapid atrial pacing induced 26 episodes of focal discharge from the proximal PVs in 5 dogs. The cycle lengths were 223+/-52 ms during ryanodine infusion (n=13) and 133+/-59 ms during ryanodine plus isoproterenol infusion (n=13). The rise of Ca(i) preceded Vm activation at the sites of focal discharge in 6 episodes of 2 preparations, compatible with voltage-independent spontaneous Ca(i) release. Phase singularities during pacing-induced reentry clustered specifically at the PV-LA junction. Periodic acid-Schiff (PAS) stain identified large cells with pale cytoplasm along the endocardium of PV muscle sleeves. There were abrupt changes in myocardial fiber orientation and increased interstitial fibrosis in the PV and at the PV-LA junction. PV muscle sleeves may develop voltage-independent Ca(i) release, resulting in focal discharge. Focal discharge may also be facilitated by the presence of PAS-positive cells that are compatible with node-like cells. During reentry, phase singularities clustered preferentially at sites of increased anisotropy such as the PV-LA junction. These findings suggest that focal discharge caused by spontaneous calcium release and anisotropic reentry both contribute to rapid activations in the PVs during AF.

  5. Dilatation of Sleeve Gastrectomy: Myth or Reality?

    Science.gov (United States)

    Disse, Emmanuel; Pasquer, Arnaud; Pelascini, Elise; Valette, Pierre-Jean; Betry, Cecile; Laville, Martine; Gouillat, Christian; Robert, Maud

    2017-01-01

    The success of longitudinal sleeve gastrectomy (LSG) is perceived as being potentially limited by dilatation of the remaining gastric tube during the follow-up. The aim of this prospective study was to determine the incidence and the characteristics of sleeve dilatation during the first post-operative year. Gastric volumetry using 3D gastric computed tomography with gas expansion was performed in 54 successive subjects who underwent an LSG for morbid obesity at 3 and 12 months following surgery. Total gastric volume, volume of the gastric tube and the antrum, and diameter of the gastric tube were assessed after multiplanar reconstructions. An increase of at least 25 % of the total gastric volume was considered as sleeve dilatation. Percentage of excess BMI loss (%EBMIL) and daily caloric intakes were recorded during the first 18 months. Sixty-one percent of the subjects experienced sleeve dilatation 1 year after surgery. The gastric tube was mainly involved in the sleeve dilatation process (+91 %). Sleeve dilatation occurred especially in subjects with smaller total gastric volume at baseline (189 vs 236 ml, p = 0.02). Daily caloric intake was similar between the groups at each point of the follow-up. No difference concerning %EBMIL was observed between the groups during the 18 months of follow-up. Sleeve dilatation occurred in more than 50 % of the patients. Dilatation was not necessarily linked to an increase of daily caloric intake and insufficient weight loss during the first 18 months following surgery. Small LSG at baseline is at higher risk of dilatation.

  6. Sleeve fracture of the adult patella

    Science.gov (United States)

    Xie, Linjun; Xu, Hong; Zhang, Lizhi; Xu, Rong; Guo, Yingkun

    2017-01-01

    Abstract Rationale: The patellar fractures are common in adults, but rare in children. As a particular type of patellar fracture, however, sleeve fractures are almost always limited to children in the under 16's group. Patient concerns: Herein, we report a rare case of a 19-year-old healthy adult female who presented sleeve fracture at the superior pole of the left patella. The clinical and radiological features are found including joint effusion, anterior tilt of the patella and a shell of bone lying proximally to the patella. Diagnoses: Computed tomography and magnetic resonance imaging examination have been performed to further confirm the diagnosis of sleeve fracture, rupture of the quadriceps tendon and the cartilaginous injury. Interventions: Under general anaesthesia, she underwent open surgical procedures for reconstituting anatomically the fracture and repairing the rupture of the quadriceps tendon. Outcomes: Six months after the operation, she could fully use her left knee without any pain and disability. Lessons: Sleeve fractures of the patellar in adults are extremely rare, and our case is of interest for the first time occurring in healthy female adults. Our case report and literature review was aim to describe the clinic and imaging characteristics of superior pole sleeve fractures in adults, and highlight that physicians must be aware of this entity in adults so as to reduce misdiagnosis due to unfamiliarity. PMID:28796028

  7. Pressurizer with a mechanically attached surge nozzle thermal sleeve

    Science.gov (United States)

    Wepfer, Robert M

    2014-03-25

    A thermal sleeve is mechanically attached to the bore of a surge nozzle of a pressurizer for the primary circuit of a pressurized water reactor steam generating system. The thermal sleeve is attached with a series of keys and slots which maintain the thermal sleeve centered in the nozzle while permitting thermal growth and restricting flow between the sleeve and the interior wall of the nozzle.

  8. Inferior sleeve fracture of the patella

    Directory of Open Access Journals (Sweden)

    Shu-Yuan Lin

    2011-02-01

    Full Text Available Patella sleeve fracture is a rare fracture that only occurs in children. Diagnosis is difficult both clinically and radiologically. A high-riding patella and hemarthrosis are important signs when diagnosing this fracture. We report a case of an 11-year-old boy who suffered from patella sleeve fracture without visible bony fragments on a lateral radiograph. Open reduction with transosseous tunneling and patellotibial cerclage wiring for anastomosis protection was performed. Early weight bearing was achieved together with a satisfactory range of knee motion. Premature anterior physeal arrest was noted because of insertion of cerclage wire in the open physis. However, no genu recurvatum was present 2 years after the initial operation. An awareness of sleeve fracture, together with its characteristic clinical and radiological features, is important to avoid misdiagnosis and treatment delay. If the cerclage wire technique is used, care should be taken not to disturb the proximal tibial apophysis.

  9. Inferior sleeve fracture of the patella.

    Science.gov (United States)

    Lin, Shu-Yuan; Lin, Wei-Chun; Wang, Jing-Wein

    2011-02-01

    Patella sleeve fracture is a rare fracture that only occurs in children. Diagnosis is difficult both clinically and radiologically. A high-riding patella and hemarthrosis are important signs when diagnosing this fracture. We report a case of an 11-year-old boy who suffered from patella sleeve fracture without visible bony fragments on a lateral radiograph. Open reduction with transosseous tunneling and patellotibial cerclage wiring for anastomosis protection was performed. Early weight bearing was achieved together with a satisfactory range of knee motion. Premature anterior physeal arrest was noted because of insertion of cerclage wire in the open physis. However, no genu recurvatum was present 2 years after the initial operation. An awareness of sleeve fracture, together with its characteristic clinical and radiological features, is important to avoid misdiagnosis and treatment delay. If the cerclage wire technique is used, care should be taken not to disturb the proximal tibial apophysis. Copyright © 2011. Published by Elsevier B.V.

  10. The TaSST - Tactile Sleeve for Social Touch

    NARCIS (Netherlands)

    Huisman, Gijs; Darriba Frederiks, Aduén; Van Dijk, Betsy; Heylen, Dirk

    2013-01-01

    In this paper we outline the design process of TaSST (Tactile Sleeve for Social Touch), a touch-sensitive vibrotactile arm sleeve. The TaSST was designed to enable two people to communicate different types of touches over a distance. The touch-sensitive surface of the sleeve consists of a grid of

  11. The TaSST: Tactile sleeve for social touch

    NARCIS (Netherlands)

    Huisman, Gijs; Darriba Frederiks, Aduén; van Dijk, Elisabeth M.A.G.; Heylen, Dirk K.J.; Krose, Ben

    In this paper we outline the design process of the TaSST (Tactile Sleeve for Social Touch), a touch-sensitive vibrotactile arm sleeve. The TaSST was designed to enable two people to communicate different types of touch over a distance. The touch-sensitive surface of the sleeve consists of a grid of

  12. Myocardial Bridge

    Science.gov (United States)

    ... Sudden Cardiac Arrest Valve Disease Vulnerable Plaque Myocardial Bridge Related terms: myocardium, coronary arteries, myocardial ischemia Your ... surface of the heart. What is a myocardial bridge? A myocardial bridge is a band of heart ...

  13. Saphenous vein covered stenting for right coronary artery lesion containing thrombus.

    Science.gov (United States)

    Joseph, D; Bashi, V V; Guhathakurtha, S; Harilal, H; Jacob, A; George, T; Suguna, S

    1997-12-01

    Vein covered stenting to close coronary pseudoaneurysm and perforation and in the setting of acute myocardial infarction have been described. This case report describes saphenous vein covered stenting to exclude a large thrombus in a right coronary artery lesion. Vein covered stenting may be considered as an option when dealing with a thrombus containing lesion.

  14. Weight Loss with Sleeve Gastrectomy in Obese Type 2 Diabetes Mellitus: Impact on Cardiac Function.

    Science.gov (United States)

    Leung, Melissa; Xie, Mikey; Durmush, Ertugrul; Leung, Dominic Y; Wong, Vincent W

    2016-02-01

    Diabetic cardiomyopathy is an increasingly prevalent health issue, with no specific management options. We examined the impact of weight loss with sleeve gastrectomy on diabetic cardiomyopathy. Eight obese patients with type 2 diabetes undergoing sleeve gastrectomy had left ventricular (LV) systolic and diastolic function assessed by global longitudinal strain (GLS) and septal early diastolic velocity (e') using echocardiography, before and 9 months after surgery. Following surgery, mean weight loss was 28.0 ± 16 kg; body mass index (BMI) decreased from 44 ± 9 to 35 ± 6 kg/m(2) (p weight lost (ρ = 0.81, p = 0.015). LV septal e' velocities increased, and LV filling pressures decreased after surgery. Weight loss with sleeve gastrectomy in obese patients with type 2 diabetes is effective in improving glycaemic control in subjects with type 2 diabetes and results in significant improvement in both systolic and diastolic myocardial function.

  15. Impact of short-term hemodialysis catheters on the central veins: a catheter venographic study

    Energy Technology Data Exchange (ETDEWEB)

    Oguzkurt, Levent E-mail: loguzkurt@yahoo.com; Tercan, Fahri; Torun, Dilek; Yildirim, Tuelin; Zuemruetdal, Ayseguel; Kizilkilic, Osman

    2004-12-01

    Objective: To determine the incidence of pericatheter sleeve formation, thrombus formation, and stenosis of the central veins in hemodialysis patients with temporary catheters. Methods and material: In this prospective study, 57 patients (40 males, 17 females) with temporary dialysis catheters had catheter venography by pulling back the catheter just before removal. Patient's age range was 25-87 years (mean age, 51 years). The venographic studies were evaluated for pericatheter sleeve formation, thrombus formation, and stenosis of the brachiocephalic vein (BCV) and the superior vena cava (SVC). The IJV could only be evaluated if there was adequate filling during contrast administration. In a subgroup of patients who had had only right IJV or only right SCV catheters, impact of these catheters on the central veins was compared. Results: The catheter location was right internal jugular vein (IJV) in 26 cases, right subclavian vein (SCV) in 27 cases, left IJV in 1 case, and left SCV in 3 cases. Thirty-two patients (56%) had had only one temporary catheter and the rest had had more than one inserted. The mean dwell time for the catheters was 21 days (range 7-59 days). A pericatheter sleeve was detected on venography in 32 (56%) patients and thrombus formation was noted in 16 patients (28%). A total of 41 patients (72%) exhibited pericatheter sleeve and/or thrombus formation. While 19 of the 32 patients (59%) without previous catheterization had a sleeve around the catheter, only 13 (52%) of 25 patients who had had multiple catheters inserted had a sleeve (P>0.05). Of the eight patients (14%) with BCV stenosis, two had >50% stenosis. Only one patient (2%) had mild stenosis of the SVC. Three patients out of 15 (20%) who had diagnostic venography for the IJV had severe stenosis of the vein. Pericatheter sleeve formation was more frequent in women (P<0.05). However, there were no statistical differences with respect to pericatheter sleeve formation, luminal filling

  16. Performance of Grouted Splice Sleeve Connector under Tensile Load

    Directory of Open Access Journals (Sweden)

    A. Alias

    2016-05-01

    Full Text Available The grouted splice sleeve connector system takes advantage of the bond-slip resistance of the grout and the mechanical gripping of reinforcement bars to provide resistance to tensile force. In this system, grout acts as a load-transferring medium and bonding material between the bars and sleeve. This study adopted the end-to-end rebars connection method to investigate the effect of development length and sleeve diameter on the bonding performance of the sleeve connector. The end-to-end method refers to the condition where reinforcement bars are inserted into the sleeve from both ends and meet at the centre before grout is filled. Eight specimens of grouted splice sleeve connector were tested under tensile load to determine their performance. The sleeve connector was designed using 5 mm thick circular hollow section (CHS steel pipe and consisted of one external and two internal sleeves. The tensile test results show that connectors with a smaller external and internal sleeve diameter appear to provide better bonding performance. Three types of failure were observed in this research, which are bar fracture (outside the sleeve, bar pullout, and internal sleeve pullout. With reference to these failure types, the development length of 200 mm is the optimum value due to its bar fracture type, which indicates that the tensile capacity of the connector is higher than the reinforcement bar. It is found that the performance of the grouted splice sleeve connector is influenced by the development length of the reinforcement bar and the diameter of the sleeve.

  17. Nutrient deficiencies before and after sleeve gastrectomy.

    Science.gov (United States)

    van Rutte, P W J; Aarts, E O; Smulders, J F; Nienhuijs, S W

    2014-10-01

    Obesity is associated with nutritional deficiencies. Bariatric surgery could worsen these deficiencies. Fewer nutritional deficiencies would be seen after sleeve gastrectomy compared to the Roux-en-Y gastric bypass, but sleeve gastrectomy would also cause further deterioration of the deficiencies. The aim of this study was to determine the amount of pre-operative nutrient deficiencies in sleeve gastrectomy patients and assess the evolution of the nutritional status during the first post-operative year. Four hundred seven sleeve gastrectomy patients were assigned to a standardized follow-up program. Data of interest were weight loss, pre-operative nutrient status and evolution of nutrient deficiencies during the first post-operative year. Deficiencies were supplemented when found. Two hundred patients completed blood withdrawal pre-operatively and in the first post-operative year. pre-operatively, 5 % of the patients were anemic, 7 % had low serum ferritin and 24 % had low folic acid. Hypovitaminosis D was present in 81 %. Vitamin A had excessive levels in 72 %. One year post-operatively, mean excess weight loss was 70 %. Anemia was found in 6 %. Low-ferritin levels were found in 8 % of the patients. Folate deficiency decreased significantly and hypovitaminosis D was still found in 36 %. In this study, a considerable amount of patients suffered from a deficient micronutrient status pre-operatively. One year after surgery, micronutrient deficiencies persisted or were found de novo in a considerable amount of patients, despite significant weight loss and supplementation. Significant reductions were seen only for folate and vitamin D.

  18. Sleeve-forming gastrectomy is the right terminology.

    Science.gov (United States)

    Baltasar, Aniceto

    2015-05-01

    Gastric sleeve is the final result when a vertical or sleeve-forming gastrectomy is performed. There is controversy about the nomination of the procedure to make a lesser curvature gastric sleeve (LCS) since the term sleeve gastrectomy, used commonly, is grammatically a misnomer. Lexicon incorrectness should not be accepted scientifically for any nomination. The Spanish Royal Academy of Medicine and seven leaders of the International Federation for the Surgery of Obesity (IFSO) were consulted. Four past IFSO presidents, four chief editors of the Obesity Surgery journal and two presidents of national associations all agree that the sleeve gastrectomy term is a misnomer and sleeve-forming gastrectomy is proposed as the correct term.

  19. Laparoscopic Sleeve Gastrectomy: Our First 100 Patients

    Science.gov (United States)

    LeBlanc, Karl A.; Hausmann, Mark G.; Kleinpeter, Kenny; Allain, Brent W.; Romero, Roderick

    2010-01-01

    Background: Laparoscopic sleeve gastrectomy is becoming a popular procedure for the morbidly obese patient. Its utilization as a standalone procedure has good results with weight loss in short- and midterm reports. The aim of this study was to assess our technique and whether it warranted any modifications in the early postoperative period. Methods: Our first 100 consecutive patients undergoing laparoscopic sleeve gastrectomy were retrospectively reviewed. Data analysis was conducted at 3 and 6 months to assess the percentage of excess body weight loss and comorbidity status change. Results: The percentage of excess body weight loss at the 3- and 6-month marks was 34.2% and 49.1%, respectively. Comorbidities were also improved at the 3- and 6-month marks. Hypertension resolved in 38%, hyperlipidemia resolved in 19%, and diabetes in 46%. Complication rate during the first 6 months was 10%. Major complications included 2 patients with postoperative bleeding, 2 patients with acute renal failure from dehydration, and 1 postoperative bleeding patient who developed a gastric fistula. No surgical reintervention was required for any complication. Conclusion: Our technique is a safe method that is easily reproducible and does not require any modification. Laparoscopic sleeve gastrectomy is an excellent surgical option with a low complication rate. PMID:21605511

  20. A Review of Sleeve Gastrectomy Specimen Histopathology.

    Science.gov (United States)

    Kinsinger, Luke A; Garber, James C; Whipple, Oliver

    2016-11-01

    With the increasing popularity of sleeve gastrectomy, many stomach specimens are being evaluated. Understanding the significance and treatment for unexpected pathology is important. This study examines the incidence of relevant histopathology of sleeve gastrectomy specimens. It evaluates previous data for each histopathology and provides recommendations for treatment. In this study, a retrospective review was performed for 241 patients who underwent sleeve gastrectomy from 2009 to 2014 at a single institution. Of the specimens, 122 had no significant histopathology, 91 had gastritis, 13 had lymphoid aggregates, 5 had hyperplasia, 3 had intestinal metaplasia, 3 had gastrointestinal stromal tumors (GISTs), and 3 had gastric polyps. Of the GISTs all had a low mitotic rate and the size of the tumor ranged from 1.5 to 4.5 cm. The findings of metaplasia may be a marker for increased risk of malignancy and may require additional surveillance. The findings of GIST may warrant interval imaging to survey for recurrence, though the likelihood of recurrence for the tumors in this study is less than 2 per cent based on previous studies.

  1. Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Hakan Demirci

    2016-01-01

    Full Text Available Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low molecular weight heparin achieves recanalization in more than half of acute cases.

  2. Regional myocardial perfusion and performance

    NARCIS (Netherlands)

    H.C. Schamhardt (Henk)

    1980-01-01

    textabstractThe function of the heart is to pump blood from the veins into the arteries in response to the need of the tissues for oxygen and substrates. During its action the heart itself needs these nutrients. Factors that mainly determine the myocardial oxygen demand are (fig.0.1): heart rate,

  3. Bilateral Tibial Tubercle Sleeve Fractures in a Skeletally Immature Patient

    Directory of Open Access Journals (Sweden)

    Rasesh R. Desai

    2013-01-01

    Full Text Available Tibial tubercle sleeve fracture is a rare injury. In concept, it is similar to the patellar sleeve fracture in a skeletally immature patient. We describe a unique case of simultaneous bilateral tibial tubercle sleeve fractures in a 12-year-old boy. Radiographs and MRI confirmed the injury. The patient underwent open surgical repair of bilateral sleeve fractures with suture anchor fixation. At the final followup, 3 years after his initial injury, the patient demonstrated full knee function bilaterally without radiographic evidence of growth disturbances.

  4. Immediate continuous positive airway pressure (CPAP therapy after sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Asem A. Hewidy

    2016-07-01

    Conclusion: The use of immediate CPAP after sleeve gastrectomy in morbidly obese patients is effective in improving oxygenation, spirometric values, reducing atelectasis and decreasing postoperative pulmonary complications.

  5. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity.

    Science.gov (United States)

    Abu Dayyeh, Barham K; Rajan, Elizabeth; Gostout, Christopher J

    2013-09-01

    Obesity and its associated conditions, including type 2 diabetes and cardiovascular disease, have reached epidemic proportions. High-efficacy, high-risk surgical approaches are unlikely to meet the increasing burden of disease. Emerging endoscopic technologies have opened the door for endoscopic approaches to reproduce many of the benefits of GI weight loss surgery and thereby contribute to the effective treatment of obesity and its associated disorders. To demonstrate the technical feasibility of transoral endoscopic gastric volume reduction with an endoscopic suturing device in a fashion similar to sleeve gastrectomy for the treatment of obesity. Single-center, pilot feasibility study. Four human subjects with obesity. Transoral sleeve gastroplasty. Technical feasibility. We successfully used an endoscopic free-hand suturing system in 4 subjects, thus demonstrating the technical feasibility of a novel technique to mimic the anatomic manipulations created by surgical sleeve gastrectomy endoscopically. Pilot feasibility study with small number of subjects. Endoscopic sleeve gastroplasty for treatment of obesity is feasible. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  6. Endoscopic Sleeve Gastroplasty: How I Do It?

    Science.gov (United States)

    Lopez-Nava, G; Galvão, M P; Bautista-Castaño, I; Jimenez-Baños, A; Fernandez-Corbelle, J P

    2015-08-01

    Primary endoscopic weight loss therapies are of interest for access, simplicity, and economy. The objective of this manuscript is to describe the endoscopic sleeve gastroplasty used in 50 patients. The goal of this procedure is to reduce the gastric lumen into a tubular configuration, with the greater curvature modified by a line of sutured plications. General anesthesia with endotracheal intubation is needed. An endoscopic suturing system requiring a specific double-channel endoscope delivers full-thickness sets of running sutures from the antrum to the fundus. Patients are admitted and observed, with discharge planned within 24 h. Post-procedure outpatient care includes diet instruction with intensive follow-up by a multidisciplinary team. Voluntary oral contrast and endoscopy studies are scheduled to assess the gastroplasty at 3, 6, and 12 months. The technique was applied in 50 patients (13 men) with an average body mass index (BMI) of 37.7 kg/m(2) (range 30-47) with 13 having reached 1 year. Procedure duration averaged 66 min during which six to eight sutures on average were placed. All patients were discharged in less than 24 h. There were no major intra-procedural, early, or delayed adverse events. Weight loss parameters were satisfactory, mean BMI changes from 37.7 ± 4.6 to 30.9 ± 5.1 kg/m(2) at 1 year, and mean %TBWL was 19.0 ± 10.8. Oral contrast studies and endoscopy revealed sleeve gastroplasty configuration at least until 1 year of follow-up. Endoscopic sleeve gastroplasty is a safe, effective, and reproducible primary weight loss technique.

  7. Focus on Varicose Veins

    Science.gov (United States)

    ... plethysmography. These diagnostic tests are non-invasive and painless. How are varicose veins treated? Varicose veins are ... and mid-term results. • RF treatment involves controlled delivery of radio- frequency (RF) energy directly to a ...

  8. Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Ronny Cohen

    2015-01-01

    Full Text Available Portal vein thrombosis (PVT is the blockage or narrowing of the portal vein by a thrombus. It is relatively rare and has been linked with the presence of an underlying liver disease or prothrombotic disorders. We present a case of a young male who presented with vague abdominal symptoms for approximately one week. Imaging revealed the presence of multiple nonocclusive thrombi involving the right portal vein, the splenic vein, and the left renal vein, as well as complete occlusion of the left portal vein and the superior mesenteric vein. We discuss pathogenesis, clinical presentation, and management of both acute and chronic thrombosis. The presence of PVT should be considered as a clue for prothrombotic disorders, liver disease, and other local and general factors that must be carefully investigated. It is hoped that this case report will help increase awareness of the complexity associated with portal vein thrombosis among the medical community.

  9. What Are Varicose Veins?

    Science.gov (United States)

    ... often they develop in people who have certain genetic disorders, viral infections, or other conditions, such as ... all people who have varicose veins have a family history of them. Older ... or blue veins in a web or tree branch pattern. Often, these veins appear on the ...

  10. Staple line oversewing during laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Wang, H; Lu, J; Feng, J; Wang, Z

    2017-09-01

    Introduction This meta-analysis was performed to assess the possible benefits of staple line oversewing during laparoscopic sleeve gastrectomy. Methods A comprehensive search up to February 2017 was conducted on PubMed, the Web of Science™ and Embase™. All eligible studies were included, and the outcomes of staple line bleeding and leak, overall complications and operative time were pooled. Results A total of 7 randomised controlled trials involving 845 patients (428 cases and 417 controls) were analysed. There was no significant difference in staple line bleeding (relative risk [RR]: 0.858, 95% confidence interval [CI]: 0.343-2.143, p=0.742), leak (RR: 0.650, 95% CI: 0.257-1.644, p=0.363) or overall complications (RR: 0.913, 95% CI: 0.621-1.342, p=0.644) between the oversewing group and the patients who did not have oversewing. Oversewing of the staple line was associated with a longer operative time (weighted mean difference: 14.400, 95% CI: 7.198-21.602, p=0.000). Conclusions Oversewing the staple line during laparoscopic sleeve gastrectomy does not decrease the risk of staple line bleeding, leakage or overall complications but it does prolong the operative time.

  11. Laparoscopic sleeve gastrectomy modifies cholesterol synthesis but not cholesterol absorption.

    Science.gov (United States)

    De Vuono, S; Ricci, M A; Siepi, D; Boni, M; Gentili, A; Scavizzi, M; Daviddi, G; Labate, P; Roscini, A R; Lupattelli, G

    Each bariatric surgery procedure impacts differently on cholesterol synthesis and absorption. Although a restrictive procedure, sleeve gastrectomy resolves diabetes mellitus and, like mixed-type procedures, induces early changes in gastrointestinal hormones. To our knowledge the present study is the first to assess the effects of sleeve gastrectomy on cholesterol synthesis and absorption. 42 consecutive subjects with obesity and sleeve gastrectomy candidates were included in the study together with a control group of 20 subjects without obesity. Before sleeve gastrectomy and 10 months afterwards, all subjects underwent a clinical examination, blood tests, ultrasound visceral fat area estimation and determination of plasma lathosterol, campesterol and sitosterol concentrations. After sleeve gastrectomy, significant decreases were observed in BMI, waist circumference, visceral and subcutaneous fat, blood pressure, triglycerides, insulin and glucose levels, lathosterol and HOMA-IR. HDL-C and apolipoprotein AI levels increased significantly. No significant differences emerged in LDL-C, apolipoprotein B levels or cholesterol absorption markers. Lathosterol levels correlated significantly with BMI, visceral fat area and HOMA-IR. Differences in cholesterol intake after surgery were not significantly associated with differences in lathosterol, campesterol and sitosterol concentrations. Sleeve gastrectomy reduced the markers of cholesterol synthesis but did not modify cholesterol absorption. Changes in cholesterol synthesis and absorption were independent of variations in cholesterol intake, suggesting a specific sleeve gastrectomy-related effect. Copyright © 2016 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

  12. Edema de membro inferior secundário a exérese de veia safena magna para utilização como enxerto na revascularização do miocárdio Lower limb edema after great saphenous vein harvesting to be used as graft in myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Cleusa Ema Quilici Belczak

    2009-03-01

    Full Text Available CONTEXTO: A revascularização do miocárdio utilizando-se a veia safena magna ainda é procedimento cirúrgico bastante realizado na atualidade. O edema que surge no membro inferior operado causa grande desconforto e necessita ser melhor estudado. OBJETIVOS: Caracterizar o edema de membro inferior secundário a exérese da veia safena magna pela técnica de incisões escalonadas para sua utilização como enxerto venoso na revascularização do miocárdio. MÉTODOS: Foram selecionados aleatoriamente 44 indivíduos submetidos a exérese de veia safena magna para revascularização miocárdica há mais de 3 meses. Excluíram-se fatores que pudessem interferir na formação de edema dos membros inferiores. Foram avaliados por volumetria e perimetria maleolares ambos os membros inferiores. Considerou-se como presença de edema significativo a diferença de volume maior que 50 mL e maior de 2 cm em relação ao membro não-operado. Para a análise estatística foram empregados o teste do qui-quadrado, teste exato de Fisher, teste t de Student e o teste de McNemar. O nível de significância adotado foi de 5% (a = 0,05. RESULTADOS: Encontraram-se diferenças estatisticamente significativas (p BACKGROUND: Myocardial revascularization using the great saphenous vein is still a very common surgical procedure. The edema that occurs in the operated leg causes much discomfort and requires further studies. OBJECTIVES: To describe lower limb edema secondary to great saphenous vein harvesting using the bridge technique for use as venous graft in myocardial revascularization. METHODS: Forty-four individuals previously submitted to great saphenous vein harvesting for myocardial revascularization more than 3 months before were randomly selected. Patients with factors that might interfere with formation of lower limb edema were excluded. Both operated and non-operated legs were evaluated by volumetry and perimetry of the malleolar region. Differences greater than

  13. Identification of technical errors and hazard zones in sleeve gastrectomy using OCHRA : "OCHRA for sleeve gastrectomy".

    Science.gov (United States)

    van Rutte, Pwj; Nienhuijs, S W; Jakimowicz, J J; van Montfort, G

    2017-02-01

    The sleeve gastrectomy is an example of minimally invasive surgery. It is important to determine the critical steps of the procedure in order to reduce complications and increase safety and efficiency. The aim of this study was to detect the key elements of the sleeve gastrectomy and find the potential hazard zones of the procedure. Bariatric department of a large teaching hospital in the Netherlands. A prospective clinical observation study was performed including 60 sleeve gastrectomy procedures. An expert panel determined the key steps, and two experts assessed the procedures systematically for technical errors according to the principles of Observational Clinical Human Reliability Assessment (OCHRA). A total of 213 technical errors have been made, and the majority were made during mobilization of the greater curvature and during stapling of the stomach. In 44.6 %, errors had consequences and 96 additional actions were performed. There was a significant correlation between errors during opening of the lesser sac and postoperative complications, and between repositioning of the stapler and postoperative complications. In this study, the 13 key steps of the SG were defined, and OCHRA was considered a valuable assessment tool for surgical performance and potential hazard zones. Most consequential errors are made during dissection of the greater curvature and during stapling of the stomach. Errors during the start of mobilization of the greater curvature and repositioning of the stapler lead to longer duration of the procedure and are associated with a higher risk of postoperative complications.

  14. Myocardial Ischemia

    Science.gov (United States)

    ... pectoris: Chest pain caused by myocardial ischemia. www.uptodate.com/home. Accessed June 1, 2015. Deedwania PC. Silent myocardial ischemia: Epidemiology and pathogenesis. www.uptodate.com/home. Accessed June 1, 2015. Mann DL, ...

  15. Laparoscopic sleeve gastrectomy and gastroesophageal reflux

    Science.gov (United States)

    Stenard, Fabien; Iannelli, Antonio

    2015-01-01

    Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy (SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures, including avoiding an intestinal bypass. However, several published follow-up studies report an increased rate of gastroesophageal reflux (GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. However, the literature on this topic is ambivalent despite the potentially increased rate of GERDs that may occur after this common bariatric procedure. This article reviews the mechanisms responsible for GERD in obese subjects as well as the results after a SG with respect to GERD. Future directions for clinical research are discussed along with the current surgical options for morbidly obese patients with GERD and undergoing bariatric surgery. PMID:26420961

  16. Gastritis in patients undergoing sleeve gastrectomy

    Science.gov (United States)

    Rath-Wolfson, Lea; Varona, Roy; Bubis, Golan; Tatarov, Alexander; Koren, Rumelia; Ram, Edward

    2017-01-01

    Abstract Laparoscopic sleeve gastrectomy (LSG) is a therapeutic option in severely obese patients. The aim of this study was to evaluate the presence of Helicobacter pylori (HP) gastritis and non-Helicobacter gastritis in the gastrectomy specimens, and its association to other variables. One hundred six sleeve gastrectomy specimens were examined histopathologically for the presence of gastritis and its relation to other factors like ethnicity, glycemic control, and postoperative complications. Twelve patients had HP gastritis, 39 had non-HP gastritis, and 55 had normal mucosa. There was a statistical difference between the Arab and Jewish Israeli patients in our study. Twenty-eight of the Arab patients had HP gastritis and 48% had non-HP gastritis. In the Jewish population 6% had HP gastritis and 34% had non-HP gastritis. The preoperative glycemic control was worse in the gastritis group with a mean HbA1c of 8.344% while in the normal mucosa group the mean HbA1c was 6.55. After operation the glycemic control reverted to normal in most the diabetic patients. There were few postoperative complications however, they were not related to HP. There is a high incidence of gastritis in obese patients. The incidence of gastritis in the Arab population in our study was higher than that in the Jewish population. The glycemic control before surgery was worse in patients with gastritis than in the normal mucosa group. HP bares no risk for postoperative complications after LSG and does not affect weight loss. However a larger cohort of patients must be studied to arrive at conclusive results. PMID:28422853

  17. The Relation Between Laparoscopic Sleeve Gastrectomy and Ghrelin

    Directory of Open Access Journals (Sweden)

    Sema Çalapkorur

    2017-07-01

    Full Text Available Recently, obesity has become an important worldwide health problem. One of the obesity treatment alternatives is bariatric surgery methods and their efficiency is increasing from day to day. In laparoscopic Sleeve gastrectomy being a bariatric surgery method, as a result of stomach fundus excretion, levels of some hormones change. Therefore, weight losses seen after the treatment are related to these changes. Basically, it is claimed that, after laparoscopic Sleeve gastrectomy, levels of ghrelin hormones secreted by stomach fundus, being effective for appetite and getting foods change. Although there are many studies examining varieties of ghrelin levels after laparoscopic sleeve gastrectomy, there is no final judgment concerning the subject yet. In this review, in the light of literature knowledge, giving information regarding effects of laparoscopic sleeve gastrectomy on ghrelin levels is aimed.

  18. development of 100 mw gas turbine shaft sleeve puller

    African Journals Online (AJOL)

    88888888

    2012-11-03

    Nov 3, 2012 ... bDepartment of Mechanical Engineering, University of Benin, Nigeria. ... as part of a refurbishment programme of a power station in Delta State, Nigeria. ..... Figure 9: As-built photo of the shaft-sleeve puller mechanism.

  19. Developing of chromium cast steel on sleeves of heavy machines

    OpenAIRE

    J. Kilarski; A. Studnicki; J. Suchoń

    2010-01-01

    The results of investigations of hardness, impact resistance, abrasive and corrosive wear of selected chromium cast steel with destination on sleeves of heavy machines were introduced in the article. First results of exploational investigations talked over on the end.

  20. ENDOSCOPIC SLEEVE GASTROPLASTY - MINIMALLY INVASIVE THERAPY FOR PRIMARY OBESITY TREATMENT

    OpenAIRE

    GALVÃO-NETO,Manoel dos Passos; GRECCO,Eduardo; de Souza, Thiago Ferreira; Luiz Gustavo de QUADROS; SILVA, Lyz Bezerra; CAMPOS, Josemberg Marins

    2016-01-01

    ABSTRACT Background: Less invasive and complex procedures have been developed to treat obesity. The successful use of Endoscopic Sleeve Gastroplasty using OverStitch(r) (Apollo Endosurgery, Austin, Texas, USA) has been reported in the literature. Aim: Present technical details of the procedure and its surgical/ endoscopic preliminary outcome. Method: The device was used to perform plications along the greater curvature of the stomach, creating a tubulization similar to a sleeve gastrect...

  1. Remodeling Intestinal Flora with Sleeve Gastrectomy in Diabetic Rats

    OpenAIRE

    Xiaofei Huang; Pan Weng; Huixin Zhang; Yingli Lu

    2014-01-01

    Objective. As a complicated symbiotic system, intestinal flora is reported closely related to the development of type 2 diabetes recently. Sleeve gastrectomy is one of the approaches of bariatric surgery and could improve blood glucose control in type 2 diabetes patients. This study was to explore the relationship between remodeled intestinal flora and glucose metabolism in diabetic rats. Methods. 20 male diabetic rats were operated; 10 of them underwent sleeve gastrectomy, and 10 of them und...

  2. Biomechanical and functional efficacy of knee sleeves: A literature review.

    Science.gov (United States)

    Mohd Sharif, Nahdatul Aishah; Goh, Siew-Li; Usman, Juliana; Wan Safwani, Wan Kamarul Zaman

    2017-11-01

    Knee sleeves are widely used for the symptomatic relief and subjective improvements of knee problems. To date, however, their biomechanical effects have not been well understood. To determine whether knee sleeves can significantly improve the biomechanical variables for knee problems. Systematic literature search was conducted on four online databases - PubMed, Web of Science, ScienceDirect and Springer Link - to find peer-reviewed and relevant scientific papers on knee sleeves published from January 2005 to January 2015. Study quality was assessed using the Structured Effectiveness Quality Evaluation Scale (SEQES). Twenty studies on knee sleeves usage identified from the search were included in the review because of their heterogeneous scope of coverage. Twelve studies found significant improvement in gait parameters (3) and functional parameters (9), while eight studies did not find any significant effects of knee sleeves usage. Most improvements were observed in: proprioception for healthy knees, gait and balance for osteoarthritic knees, and functional improvement of injured knees. This review suggests that knee sleeves can effect functional improvements to knee problems. However, further work is needed to confirm this hypothesis, due to the lack of homogeneity and rigor of existing studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Tracheal cartilaginous sleeve association with syndromic midface hypoplasia.

    Science.gov (United States)

    Stater, Brian J; Oomen, Karin P Q; Modi, Vikash K

    2015-01-01

    We report 2 new cases of tracheal cartilaginous sleeve and perform a systematic literature review of all documented cases of this condition. We aim to increase awareness of this anomaly and provide recommendations for both intraoperative and postoperative management of patients with tracheal cartilaginous sleeve undergoing tracheostomy. We studied the clinical records of 2 children with tracheal cartilaginous sleeves and short tracheas treated at our institution. One of these patients had Beare-Stevenson syndrome, and the other had Crouzon syndrome. Both patients required tracheostomy for persistent upper airway obstruction, and both required custom-length tracheostomy tubes. Bronchoscopy and needle localization were beneficial in performing tracheostomy on these patients. All documented cases of tracheal cartilaginous sleeve in the literature were found to be associated with midface hypoplasia secondary to syndromic craniosynostosis. Seventy-five percent of cases required tracheostomy. Tracheal cartilaginous sleeve can be associated with Beare-Stevenson syndrome. In infants with midface hypoplasia associated with a craniosynostosis syndrome undergoing tracheostomy, the surgeon must be prepared to encounter and manage tracheal cartilaginous sleeve intraoperatively. Bronchoscopy and needle localization can be beneficial when performing tracheostomy in these patients. Customized, shorter-length tracheostomy tubes should be considered for these patients.

  4. Deep Vein Thrombosis

    African Journals Online (AJOL)

    OWNER

    CONCLUSION: Deep Venous Thrombosis is a common disease with fatal and serious long term burdensome complications. ... WAJM 2009; 28(2): 77–82. Keywords: Deep Vein Thrombosis, Venous Thrombosis,. Phlebothrombosis. ... phlebitic syndrome, ulcers and varicose veins. In surgical patients with malignant disease ...

  5. Vein Problems Related to Varicose Veins

    Science.gov (United States)

    ... Examples of these factors include family history, older age, gender, pregnancy, overweight or obesity , lack of movement, and leg trauma. Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve ...

  6. A gastroplastia em manga (sleeve gastrectomy e o diabetes mellitus Sleeve gastrectomy and diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Alexandre Ciro Andriani

    2008-09-01

    Full Text Available RACIONAL: O tipo 2 da diabete mellitus é muito frequente entre os pacientes de obesidade morbida. Ja foi provado cientificamente que o bypass gástrico pode curá-lo. Existem poucos relatos de que a gastroplastia em manga apresenta resultado promissores na cura desta forma de diabete. OBJETIVO: Apresentar resultados da glicemia em pacientes operados com a gastroplastia em manga mostrando sua possibilidade de controlar o dibetes. MÉTODO: Um estudo prospectivo envolvendo 15 pacientes foi realizado nos quais as dosagens sericas da glicose foram medidas no pré e pós-operatório. Para que houvesse homogeneidade da amostra, critérios de inclusão e exclusão foram estabelecidos com base nos pacientes com IMC de 35 a 40. Todos os pacientes foram submetidos a técnica cirurgica de gastroplastia em manga. O seguimento se deu em atendimento ambulatorial. RESULTADOS: Todos os pacientes foram operados pela técnica referida e seus níveis glicêmicos computados no pré, pós-operatório e no seguimento. CONCLUSÃO: A gastroplastia em manga cura o diabetes mellitus mostrando queda logo após a operação e mantendo-a ao longo do seguimento.BACKGROUND: The type 2 diabetes mellitus is very frequent among morbid obese patients. It has already been proven that the gastric bypass surgery may cures diabetes mellitus. There are few related studies to sleeve gastroplasty and diabetes. However, promising results exist. AIM: To analyse the glicemic results in patients submmitted to sleeve gastroplasty. METHODS: A 11 months prospective study on 15 patients was dome measuring their glycemic levels pre and postoperatively. The basic inclusion criteria was body mass index (BMI between 35 and 40 kg/m². All patients were operated by sleeve gastroplasty. RESULTS: All 15 patients lowered their glycemic level on their imidiate postoperative period and some achieved normal levels. CONCLUSIONS: The sleeve gastroplasty cures diabetes by lowering the plasma glucose and have

  7. All carbon coaxial supercapacitors based on hollow carbon nanotube sleeve structure

    Science.gov (United States)

    Zang, Xiaobei; Xu, Ruiqiao; Zhang, Yangyang; Li, Xinming; Zhang, Li; Wei, Jinquan; Wang, Kunlin; Zhu, Hongwei

    2015-01-01

    All carbon coaxial supercapacitors based on hollow carbon nanotube (CNT) sleeve structure are assembled and tested. The key advantage of the structure is that the inner core electrode is variable from CNT sleeve sponges, to CNT fibers, reduced graphene oxide fibers, and graphene woven fabrics. By changing core electrodes from sleeve sponges to CNT fibers, the electrochemical performance has been significantly enhanced. The capacitance based on sleeve sponge + CNT fiber double the capacitances of double-sleeve sponge supercapacitors thanks to reduction of the series and internal resistances. Besides, the coaxial sleeve structure possesses many other features, including high rate capacitance, long cycle life, and good flexibility.

  8. A common Shox2-Nkx2-5 antagonistic mechanism primes the pacemaker cell fate in the pulmonary vein myocardium and sinoatrial node.

    Science.gov (United States)

    Ye, Wenduo; Wang, Jun; Song, Yingnan; Yu, Diankun; Sun, Cheng; Liu, Chao; Chen, Fading; Zhang, Yanding; Wang, Fen; Harvey, Richard P; Schrader, Laura; Martin, James F; Chen, YiPing

    2015-07-15

    In humans, atrial fibrillation is often triggered by ectopic pacemaking activity in the myocardium sleeves of the pulmonary vein (PV) and systemic venous return. The genetic programs that abnormally reinforce pacemaker properties at these sites and how this relates to normal sinoatrial node (SAN) development remain uncharacterized. It was noted previously that Nkx2-5, which is expressed in the PV myocardium and reinforces a chamber-like myocardial identity in the PV, is lacking in the SAN. Here we present evidence that in mice Shox2 antagonizes the transcriptional output of Nkx2-5 in the PV myocardium and in a functional Nkx2-5(+) domain within the SAN to determine cell fate. Shox2 deletion in the Nkx2-5(+) domain of the SAN caused sick sinus syndrome, associated with the loss of the pacemaker program. Explanted Shox2(+) cells from the embryonic PV myocardium exhibited pacemaker characteristics including node-like electrophysiological properties and the capability to pace surrounding Shox2(-) cells. Shox2 deletion led to Hcn4 ablation in the developing PV myocardium. Nkx2-5 hypomorphism rescued the requirement for Shox2 for the expression of genes essential for SAN development in Shox2 mutants. Similarly, the pacemaker-like phenotype induced in the PV myocardium in Nkx2-5 hypomorphs reverted back to a working myocardial phenotype when Shox2 was simultaneously deleted. A similar mechanism is also adopted in differentiated embryoid bodies. We found that Shox2 interacts with Nkx2-5 directly, and discovered a substantial genome-wide co-occupancy of Shox2, Nkx2-5 and Tbx5, further supporting a pivotal role for Shox2 in the core myogenic program orchestrating venous pole and pacemaker development. © 2015. Published by The Company of Biologists Ltd.

  9. A common Shox2–Nkx2-5 antagonistic mechanism primes the pacemaker cell fate in the pulmonary vein myocardium and sinoatrial node

    Science.gov (United States)

    Ye, Wenduo; Wang, Jun; Song, Yingnan; Yu, Diankun; Sun, Cheng; Liu, Chao; Chen, Fading; Zhang, Yanding; Wang, Fen; Harvey, Richard P.; Schrader, Laura; Martin, James F.; Chen, YiPing

    2015-01-01

    In humans, atrial fibrillation is often triggered by ectopic pacemaking activity in the myocardium sleeves of the pulmonary vein (PV) and systemic venous return. The genetic programs that abnormally reinforce pacemaker properties at these sites and how this relates to normal sinoatrial node (SAN) development remain uncharacterized. It was noted previously that Nkx2-5, which is expressed in the PV myocardium and reinforces a chamber-like myocardial identity in the PV, is lacking in the SAN. Here we present evidence that in mice Shox2 antagonizes the transcriptional output of Nkx2-5 in the PV myocardium and in a functional Nkx2-5+ domain within the SAN to determine cell fate. Shox2 deletion in the Nkx2-5+ domain of the SAN caused sick sinus syndrome, associated with the loss of the pacemaker program. Explanted Shox2+ cells from the embryonic PV myocardium exhibited pacemaker characteristics including node-like electrophysiological properties and the capability to pace surrounding Shox2− cells. Shox2 deletion led to Hcn4 ablation in the developing PV myocardium. Nkx2-5 hypomorphism rescued the requirement for Shox2 for the expression of genes essential for SAN development in Shox2 mutants. Similarly, the pacemaker-like phenotype induced in the PV myocardium in Nkx2-5 hypomorphs reverted back to a working myocardial phenotype when Shox2 was simultaneously deleted. A similar mechanism is also adopted in differentiated embryoid bodies. We found that Shox2 interacts with Nkx2-5 directly, and discovered a substantial genome-wide co-occupancy of Shox2, Nkx2-5 and Tbx5, further supporting a pivotal role for Shox2 in the core myogenic program orchestrating venous pole and pacemaker development. PMID:26138475

  10. Carbon dioxide embolism during laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Amir Abu Zikry

    2011-01-01

    Full Text Available Bariatric restrictive and malabsorptive operations are being carried out in most countries laparoscopically. Carbon dioxide or gas embolism has never been reported in obese patients undergoing bariatric surgery. We report a case of carbon dioxide embolism during laparoscopic sleeve gastrectomy (LSG in a young super obese female patient. Early diagnosis and successful management of this complication are discussed. An 18-year-old super obese female patient with enlarged fatty liver underwent LSG under general anesthesia. During initial intra-peritoneal insufflation with CO 2 at high flows through upper left quadrant of the abdomen, she had precipitous fall of end-tidal CO 2 and SaO 2 % accompanied with tachycardia. Early suspicion led to stoppage of further insufflation. Clinical parameters were stabilized after almost 30 min, while the blood gas analysis was restored to normal levels after 1 h. The area of gas entrainment on the damaged liver was recognized by the surgeon and sealed and the surgery was successfully carried out uneventfully. Like any other laparoscopic surgery, carbon dioxide embolism can occur during bariatric laparoscopic surgery also. Caution should be exercised when Veress needle is inserted through upper left quadrant of the abdomen in patients with enlarged liver. A high degree of suspicion and prompt collaboration between the surgeon and anesthetist can lead to complete recovery from this potentially fatal complication.

  11. Outcome of sleeve gastrectomy as a primary bariatric procedure.

    Science.gov (United States)

    van Rutte, P W J; Smulders, J F; de Zoete, J P; Nienhuijs, S W

    2014-05-01

    Sleeve gastrectomy is being performed increasingly in Europe. Data on long-term outcome would be helpful in defining the role of sleeve gastrectomy. The aim of this study was to evaluate the outcome of sleeve gastrectomy as a primary bariatric procedure. Medical charts of all patients who underwent a primary sleeve gastrectomy at the authors' institution between August 2006 and December 2012 were reviewed retrospectively using a prospective online data registry. For evolution of weight loss and co-morbidity, only patients with follow-up of at least 1 year were included. A subgroup analysis was done to compare patients with an intended stand-alone procedure and those with an intended two-stage procedure. A total of 1041 primary sleeve gastrectomies were performed in the study period. Median duration of surgery was 47 min, and median hospital stay was 2 days. Intra-abdominal bleeding occurred in 27 patients (2·6 per cent) and staple-line leakage in 24 (2.3 per cent). Some 866 patients had at least 1 year of follow-up. Mean excess weight loss was 68.4 per cent after 1 year (P sleeve gastrectomy; reflux or dysphagia was the indication in 34 (48 per cent) of these patients. Sleeve gastrectomy is a safe and effective bariatric procedure. Maximum weight loss was achieved after 4 years. Long-term results regarding weight loss and co-morbidities were satisfactory. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  12. Myocardial Bridging

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2016-02-01

    Full Text Available Abstract Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features of the bridges vary significantly. Alterations of the endothelial morphology and the vasoactive agents impact on the progression of atherosclerosis of myocardial bridging. Patients may present with chest pain, myocardial infarction, arrhythmia and even sudden death. Patients who respond poorly to the medical treatment with β-blockers warrant a surgical intervention. Myotomy is a preferred surgical procedure for the symptomatic patients. Coronary stent deployment has been in limited use due to the unsatisfactory long-term results.

  13. Endoscopic Sleeve Gastroplasty, Laparoscopic Sleeve Gastrectomy, and Laparoscopic Band for Weight Loss: How Do They Compare?

    Science.gov (United States)

    Novikov, Aleksey A; Afaneh, Cheguevara; Saumoy, Monica; Parra, Viviana; Shukla, Alpana; Dakin, Gregory F; Pomp, Alfons; Dawod, Enad; Shah, Shawn; Aronne, Louis J; Sharaiha, Reem Z

    2018-02-01

    Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure. Initial studies demonstrated an association of ESG with weight loss and improvement of obesity-related comorbidities. Our aim was to compare ESG to laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB). We included 278 obese (BMI > 30) patients who underwent ESG (n = 91), LSG (n = 120), or LAGB (n = 67) at our tertiary care academic center. Primary outcome was percent total body weight loss (%TBWL) at 3, 6, 9, and 12 months. Secondary outcome measures included adverse events (AE), length of stay (LOS), and readmission rate. At 12-month follow-up, LSG achieved the greatest %TBWL compared to LAGB and ESG (29.28 vs 13.30 vs 17.57%, respectively; p ESG had a significantly lower rate of morbidity when compared to LSG or LAGB (p = 0.01). The LOS was significantly less for ESG compared to LSG or LAGB (0.34 ± 0.73 vs 3.09 ± 1.47 vs 1.66 ± 3.07 days, respectively; p ESG is a safe and feasible endobariatric option associated with low morbidity and short LOS in select patients.

  14. Congenital preduodenal portal vein

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Jin; Hwang, Mi Soo; Huh, Young Soo; Park, Bok Hwan [College of Medicine, Youngnam University, Gyeongsan (Korea, Republic of)

    1991-03-15

    Congenital preduodenal portal vein, first reported by Knight in 1921, is an extremely rare congenital anomaly in which the portal vein passes anteriorly to the duodenum rather than posteriorly in its normal location. It is of surgical significance because it may cause difficulties in operations involving the gall bladder, biliary duct, or duodenum. Recently, we experienced 2 cases of preduodenal portal vein. One was found during surgical exploration for the diagnosis and correction of malrotation of the bowels and the other in a 3 day-old male newborn associated with dextrocardia, situs inversus, and duodenal obstruction by diaphragm. We report these 2 cases with a review of the literature.

  15. Remodeling Intestinal Flora with Sleeve Gastrectomy in Diabetic Rats

    Science.gov (United States)

    Huang, Xiaofei; Weng, Pan; Zhang, Huixin; Lu, Yingli

    2014-01-01

    Objective. As a complicated symbiotic system, intestinal flora is reported closely related to the development of type 2 diabetes recently. Sleeve gastrectomy is one of the approaches of bariatric surgery and could improve blood glucose control in type 2 diabetes patients. This study was to explore the relationship between remodeled intestinal flora and glucose metabolism in diabetic rats. Methods. 20 male diabetic rats were operated; 10 of them underwent sleeve gastrectomy, and 10 of them underwent sham operation. Meanwhile 10 male normal rats underwent sleeve gastrectomy as control. The animals' weight and FBG had been measured. The composition changes of intestinal flora were detected by 16S rDNA sequence analysis. Results. In diabetic rats, weight and fasting blood glucose decreased significantly after sleeve gastrectomy. However, there was no significant change for weight and blood glucose in normal rats after operation. The intestinal flora of diabetic rats reduced in the proportion of Firmicutes and increased in the proportion of Bacteroidetes after sleeve gastrectomy. Conclusion. The change of dominant microorganisms in intestinal flora might play an important role in the glucose metabolism. PMID:25165722

  16. Remodeling intestinal flora with sleeve gastrectomy in diabetic rats.

    Science.gov (United States)

    Huang, Xiaofei; Weng, Pan; Zhang, Huixin; Lu, Yingli

    2014-01-01

    As a complicated symbiotic system, intestinal flora is reported closely related to the development of type 2 diabetes recently. Sleeve gastrectomy is one of the approaches of bariatric surgery and could improve blood glucose control in type 2 diabetes patients. This study was to explore the relationship between remodeled intestinal flora and glucose metabolism in diabetic rats. 20 male diabetic rats were operated; 10 of them underwent sleeve gastrectomy, and 10 of them underwent sham operation. Meanwhile 10 male normal rats underwent sleeve gastrectomy as control. The animals' weight and FBG had been measured. The composition changes of intestinal flora were detected by 16S rDNA sequence analysis. In diabetic rats, weight and fasting blood glucose decreased significantly after sleeve gastrectomy. However, there was no significant change for weight and blood glucose in normal rats after operation. The intestinal flora of diabetic rats reduced in the proportion of Firmicutes and increased in the proportion of Bacteroidetes after sleeve gastrectomy. The change of dominant microorganisms in intestinal flora might play an important role in the glucose metabolism.

  17. What Are Varicose Veins?

    Science.gov (United States)

    ... these factors include family history, older age, gender, pregnancy, overweight or obesity , lack of movement, and leg trauma. Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment ...

  18. Preventing Deep Vein Thrombosis

    Science.gov (United States)

    ... methods that contain estrogen or hormone therapy for menopause symptoms Certain illnesses, including heart failure, inflammatory bowel disease, and some kidney disorders Obesity Smoking Varicose veins Having a tube in a ...

  19. Popliteal vein aneurysm.

    Science.gov (United States)

    Falkowski, A; Poncyljusz, W; Zawierucha, D; Kuczmik, W

    2006-06-01

    The incidence of a popliteal vein aneurysm is extremely low. Two cases of this rare venous anomaly are described. The epidemiology, morphology, and diagnostic methods are discussed and the potentially dangerous complications and treatment methods are presented.

  20. Arterialização seletiva da veia interventricular anterior: opção de revascularização miocárdica Selective arterialization of the anterior interventricular vein: a choice for myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Kubrusly

    1992-12-01

    Full Text Available O objetivo deste trabalho é referir dois casos cirúrgicos, onde, após ressecção de aneurisma de ventrículo esquerdo, a revascularização do miocárdio através da artéria interventricular anterior (AIA não foi possível. Utilizando-se a artéria torácica interna (ATI esquerda, optou-se pela anatomose com a veia interventricular anterior (VIA com ligadura próxima, para estabelecimento do fluxo retrógrado e evitar a formação de fístula artenovenosa. Não houve mortalidade e os resultados a curto prazo são encorajadores. Testes de perfusão miocárdica com radioisótopos no pré e no pós-operatório, assim como angiografia do sistema coronário e da artéria torácica interna esquerda pré e pós-operatória são apresentados e discutidos. O objetivo da cirurgia de aneurisma ventricular é a recomposição geométrica do ventrículo esquerdo e revascularização de possíveis áreas isquémicas. Na impossibilidade de revascularização direta da artéria interventricular anterior, a técnica citada demonstra ser facilmente exeqüível e, a curto prazo, com bons resultados.The purpose of this study is to report two surgical cases, whereby after the repair of the left ventricular aneurysm, the myocardial revascularization of the interventricular anterior artery (IAA was not possible. Using the left internal thoracic artery it was decided to perform anastomosis with the interventricular anterior (IAA and its cephalad ligation, in order to obtain a retrograde flow and to avoid an arteriovenous fistula formation. There was no mortality and the results are optimistic in a short follow-up of these two patients. Myocardial perfusion tests and pre and post-operative angiography of the coronary system and the left internal thoracic artery are assessed and discussed. The geometrical reconstruction of the left ventricle and the revascularization of the ischemic areas play major role in the repair of postinfarction ventricular aneurysm. When it

  1. Myocardial Ischemia

    Science.gov (United States)

    ... occurs when blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques (atherosclerosis). If the plaques rupture, you can have a heart attack (myocardial infarction). Myocardial ischemia occurs when blood flow ...

  2. Endoscopic sleeve gastroplasty: the learning curve.

    Science.gov (United States)

    Hill, Christine; El Zein, Mohamad; Agnihotri, Abhishek; Dunlap, Margo; Chang, Angela; Agrawal, Alison; Barola, Sindhu; Ngamruengphong, Saowanee; Chen, Yen-I; Kalloo, Anthony N; Khashab, Mouen A; Kumbhari, Vivek

    2017-09-01

     Endoscopic sleeve gastroplasty (ESG) is gaining traction as a minimally invasive bariatric treatment. Concern that the learning curve may be slow, even among those proficient in endoscopic suturing, is a barrier to widespread implementation of the procedure. Therefore, we aimed to define the learning curve for ESG in a single endoscopist experienced in endoscopic suturing who participated in a 1-day ESG training program.  Consecutive patients who underwent ESG between February 2016 and November 2016 were included. The performing endoscopist, who is proficient in endoscopic suturing for non-ESG procedures, participated in a 1-day ESG training session before offering ESG to patients. The outcome measurements were length of procedure (LOP) and number of plications per procedure. Nonlinear regression was used to determine the learning plateau and calculate the learning rate.  Twenty-one consecutive patients (8 males), with mean age 47.7 ± 11.2 years and mean body mass index 41.8 ± 8.5 kg/m 2 underwent ESG. LOP decreased significantly across consecutive procedures, with a learning plateau at 101.5 minutes and a learning rate of 7 cases ( P  = 0.04). The number of plications per procedure also decreased significantly across consecutive procedures, with a plateau at 8 sutures and a learning rate of 9 cases ( P  < 0.001). Further, the average time per plication decreased significantly with consecutive procedures, reaching a plateau at 9 procedures ( P  < 0.001).  Endoscopists experienced in endoscopic suturing are expected to achieve a reduction in LOP and number of plications per procedure in successive cases, with progress plateauing at 7 and 9 cases, respectively.

  3. Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity.

    Science.gov (United States)

    Jain, Deepanshu; Bhandari, Bharat Singh; Arora, Ankit; Singhal, Shashideep

    2017-11-01

    Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confirmed via esophagogastroduodenoscopy or oral contrast study at the end of study specific follow up interval (the longest being 6 months). Individual studies reported a technical success rate for intact gastric sleeve from as low as 50% to as high as 100%. A statistically significant p ESG an attractive option to consider among other bariatric therapies.

  4. Self Touch to Touch Others: Designing the Tactile Sleeve for Social Touch

    NARCIS (Netherlands)

    Huisman, G.; Darriba Frederiks, A.; van Dijk, B.; Kröse, B.; Heylen, D.

    2013-01-01

    In this paper we present the concept and initial design stages of the TaSST (Tactile Sleeve for Social Touch). The TaSST consists of a soft pressure-sensitive input layer, and an output layer containing vibration motors. A touch to ones own sleeve is felt as a vibration on the sleeve of another

  5. Self touch to touch others : designing the tactile sleeve for social touch

    NARCIS (Netherlands)

    Huisman, Gijs; Darriba Frederiks, Aduén; Heylen, Dirk; Van Dijk, Betsy; Kröse, Ben

    2013-01-01

    In this paper we present the concept and initial design stages of the TaSST (Tactile Sleeve for Social Touch). The TaSST consists of a soft pressure-sensitive input layer, and an output layer containing vibration motors. A touch to ones own sleeve is felt as a vibration on the sleeve of another

  6. Graduated cementing of casings with use of type MSTs sleeves

    Energy Technology Data Exchange (ETDEWEB)

    Yeremenko, V.V.; Kogan, E.V.; Milshteyn, V.M.; Trifonov, V.L.

    1984-01-01

    VNIIKRneft has developed special sleeves to perform the graduated cementing of casings. This paper describes the graduated cementing technique, with the use of the MSTs1-146 sleeves (146 mm diameter production strings, located at a depth of 2,830 m), at Well No 40-Bochkarevskaya, and a depth of 2,607 m at Well No 32Solotskaya, Kuybyshevneft Association. Test results proved out the reliability of domestically produced units. The paper lists requirements that must be observed in order to produce high quality work with graduated cementing.

  7. Laparoscopic Sleeve Gastrectomy versus Laparoscopic Banded Sleeve Gastrectomy: First Prospective Pilot Randomized Study

    Directory of Open Access Journals (Sweden)

    Valeria Tognoni

    2016-01-01

    Full Text Available Introduction. The placement of ring or band around the gastric tube might prevent the dilation after Laparoscopic Sleeve Gastrectomy (LSG. We describe the first randomized study comparing LSG and Laparoscopic Banded Sleeve Gastrectomy (LBSG. Material and Method. Fifty obese patients were enrolled in the study between January 2014 and January 2015. We analysed differences in operative time, complication rate, mortality, and BMI between the two groups over a period of 12 months. Results. Twenty-five patients received LSG (group A and 25 LBSG (group B. The mean preoperative BMI was 47.3±6.58 kg/m2 and 44.95±5.85 kg/m2, respectively, in the two groups. There was no statistical relevant difference in operative time. No intraoperative complications occurred. Mean BMI registered after 3, 6, and 12 months in groups A and B, respectively, were 37.86±5.72 kg/m2 and 37.58±6.21 kg/m2 (p=0.869, 33.64±6.08 kg/m2 and 32.03±5.24 kg/m2 (p=0.325, and 29.72±4.40 kg/m2 and 27.42±4.47 kg/m2 (p=0.186; no statistical relevant difference was registered between the two groups. Conclusion. LBSG is a safe and feasible procedure. The time required for the device positioning did not influence significantly the surgical time. The results of bodyweight loss did not document any statistically significant differences among the two groups, even though LBSG group showed a mean BMI slightly lower than that of the control group.

  8. AN INVESTIGATION OF FASHION DESIGN AND PATTERN MAKING OF LADIES' JACKETS WITH DIFFERENT TYPES OF SLEEVES

    Directory of Open Access Journals (Sweden)

    Zlatina Kazlacheva

    2016-12-01

    Full Text Available The patterns of raglan, semi raglan, kimono, and dropped shoulder sleeves are made on one and the same constructional bases. In the constructional base the front and back in the underarm there are parts which have to be set to the both - the bodice and the sleeve. For the front and the back that is possible if the sleeve and a part of the bodice are separated by a design constructional seam. The type and design of the sleeve depends by the directions of the design constructional seam. If the seam joins the underarm and the neckline, or area around the neckline the type of sleeve is raglan. If the seam connects the underarm and the shoulder the type of sleeve is semi raglan. The type of the sleeve is kimono if the design constructional seam divides the bodice or the sleeve. In the dropped shoulder sleeve design constructional seam is located under the shoulder. The use of the main design principles, the possibilities for combinations between the four types of sleeves and the design with application of 3D elements are investigated. Raglan, semi raglan, kimono and dropped shoulder sleeves can be combined each other. In combined sleeves only one of seams which define the types of the sleeves is with decorative constructional function. The other ones have only decorative function. Design constructional seams which define the types of the sleeves can be used as contours of location or fixation of all types of 3D elements: pleats, goffers, flounces, tucks gathers, and draperies. The results of the investigation of application of the main design principles, combinations between different types of sleeves and possibility for the use of 3D elements facilitate the process of fashion design and pattern making and gives opportunity for variety of models.

  9. Dorsal Slit‑Sleeve Technique for Male Circumcision

    African Journals Online (AJOL)

    sleeve technique was effectively used in our center with good outcome. So far we have circumcised. 100 neonates with this method over a 4-year period. There was one (1.0%) neonate who had reactionary hemorrhage and this was addressed ...

  10. Patellar Sleeve Fracture With Ossification of the Patellar Tendon.

    Science.gov (United States)

    Damrow, Derek S; Van Valin, Scott E

    2017-03-01

    Patellar sleeve fractures make up greater than 50% of all patellar fractures. They are essentially only seen in the pediatric population because of the thick periosteum and the distal patellar pole apophysis in this group. These fractures can lead to complications if not treated appropriately and in a timely fashion. Complications of missed or untreated patellar sleeve fractures include patella alta, anterior knee pain, and quadriceps atrophy. These can all result in severe limitations in activity. The authors describe a case of a 16-year-old boy who sustained a patellar sleeve fracture 3 years prior to presentation. On presentation, he had patella alta, diminished strength, 5° of extensor lag, and radiographs that revealed bone formation along the patellar tendon. Despite this, he was able to maintain a high level of activity. This case report explores how the patient could have maintained a high level of activity despite having a patellar sleeve fracture. Also, because of the delayed presentation, the patella was ossified and the quadriceps was retracted, which led to a novel approach to reconstructing his distal extensor mechanism. This approach included a V-Y advancement of the quadriceps tendon and patellar tendon reconstruction using the patient's hamstring tendon (semitendinosus). This technique, combined with physical therapy postoperatively, resulted in his return to varsity high school soccer. To the best of the authors' knowledge, this technique has not been reported for this rare condition. [Orthopedics. 2017; 40(2):e357-e359.]. Copyright 2016, SLACK Incorporated.

  11. Association between postprandial symptoms and gastric emptying after sleeve gastrectomy

    NARCIS (Netherlands)

    Burgerhart, J.S.; Rutte, P.W. van; Edelbroek, M.A.; Wyndaele, D.N.; Smulders, J.F.; Meeberg, P.C. van de; Siersema, P.D.; Smout, A.J.P.M.

    2015-01-01

    BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure. However, postprandial symptoms can compromise its beneficial effect. It is not known if a changed gastric emptying and these symptoms are related. This study aimed to assess the association between postprandial

  12. Laparoscopic sleeve gastrectomy for morbid obesity: 5-year results.

    Science.gov (United States)

    Alexandrou, Andreas; Athanasiou, Antonios; Michalinos, Adamantios; Felekouras, Evangelos; Tsigris, Christos; Diamantis, Theodoros

    2015-02-01

    Data concerning the long-term efficacy of laparoscopic sleeve gastrectomy in the treatment of morbid obesity remain scarce. In this retrospective, the authors present 5-year follow-up of 30 patients having undergone laparoscopic sleeve gastrectomy. Since 2004, 30 patients underwent laparoscopic sleeve gastrectomy and completed 5 years of follow-up. Five patients were subsequently subjected to laparoscopic Roux-en-Y gastric bypass and were excluded from further analysis. The remaining 25 patients comprised the study population. Mean excess weight loss was 65.2 ± 6.1%, 64.7 ± 5.6%, 62 ± 4.9%, 58.2 ± 5.5%, and 56.4 ± 5.8% for the first 5 years, respectively. There were no deaths, nor any major morbidity. Remission of comorbidities was observed in 40% to 80.9% of cases. Laparoscopic sleeve gastrectomy is a safe and effective means of treatment of morbid obesity both in the short and in the long term. More research is needed to better predict which patient will benefit most from this operation. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Weight Loss after Sleeve Gastrectomy in Super Superobesity

    Directory of Open Access Journals (Sweden)

    J.-M. Catheline

    2012-01-01

    Full Text Available Objective. This prospective study evaluated laparoscopic sleeve gastrectomy for its safety and efficiency in excess weight loss (%EWL in super superobese patients (BMI >60 Kg/m2. Results. Thirty patients (33 women and 7 men were included, with mean age of 35 years (range 18 to 59. Mean preoperative BMI was 66 Kg/m2 (range 60 to 85. The study included one patient with complete situs inversus and 4 (14% with previous restrictive gastric banding. The mean operative time was 120 minutes (range 80 to 220 min and the mean hospital stay was 7.5 days (4 to 28 days. There was no postoperative mortality or need for a laparotomy conversion. Two subphrenic hematomas, one gastric fistula, and one pulmonary embolism, were the major complications. After 18 months 17 (77% had sufficient weight loss and six had insufficient results, leading to either re-sleeve gastrectomy (3, or gastric bypass (2. Three years after the initial laparoscopic sleeve gastrectomy, the mean EWL was 51% (range 21 to 82. Conclusion. The laparoscopic sleeve gastrectomy is a safe and efficient operating procedure for treating super superobesity. In the case of insufficient weight loss, a second-stage operation like resleeve gastrectomy or gastric bypass can be proposed.

  14. The gastric sleeve: losing weight as fast as micronutrients?

    NARCIS (Netherlands)

    Aarts, E.O.; Janssen, I.M.; Berends, F.J.

    2011-01-01

    BACKGROUND: Recently, the laparoscopic sleeve gastrectomy (LSG) has become popular as a single-stage procedure for the treatment of morbid obesity and its co-morbidities. However, the incidence of micronutrient deficiencies after LSG have hardly been researched. METHODS: From January 2005 to October

  15. Efficacy of camera sleeve in conveyance of conduits.

    Science.gov (United States)

    Bharathi, R Saranga

    2017-02-28

    Esophageal substitutes need conveyance from the abdomen into the neck for restoration of alimentary continuity. Reports suggest that the use of plastic camera sleeve may prove advantageous in restoring conveyance. This study aims to evaluate the practicability of this approach, specifically, in laparoscopy-assisted surgeries. The efficacy of camera sleeve in conduit transposition was prospectively evaluated over 2 years. The following parameters were assessed: success/failure; time taken; blood loss; adequacy of length of the conduit delivered into the neck; conduit orientation; ease of procedure through different routes; conduit damage; complications; and drawbacks. The technique was used in 25 consecutive patients. Two ileo-colonic, 13 gastric, and 10 colonic conduits were transposed. Posterior mediastinal, retro-sternal, and ante-sternal routes were used in 15, 8, and 2 cases, respectively. There were no failures. The technique was easy to adopt. It added < 10 minutes to the procedure. It entailed no additional blood loss. Adequate length of the conduit was transposed into the neck, atraumatically. Conduits maintained their orientation without effort. Although no complications per se were associated with its use, extra conduit length became transposed into the neck, twice, necessitating its trimming/adjustment. In one case, traction suture became avulsed from the conduit, midway in the tunnel. This could easily be rectified by pulling out the sleeve from the neck, which brought up the conduit along with it, as desired. Use of camera sleeve proves efficacious in interposition of esophageal substitutes.

  16. Retained copper sleeve of cu-T IUCD

    African Journals Online (AJOL)

    Dr Adaji

    Case Report. A 47-year old para 7+1 five alive presented at the. Reproductive Health center for removal of a copper-T intrauterine contraceptive device following a clinical diagnosis of pelvic inflammatory disease. The device was inserted the previous year. After easy removal , it was observed that the copper sleeve on one ...

  17. Developing of chromium cast steel on sleeves of heavy machines

    Directory of Open Access Journals (Sweden)

    J. Kilarski

    2010-10-01

    Full Text Available The results of investigations of hardness, impact resistance, abrasive and corrosive wear of selected chromium cast steel with destination on sleeves of heavy machines were introduced in the article. First results of exploational investigations talked over on the end.

  18. Association between postprandial symptoms and gastric emptying after sleeve gastrectomy

    NARCIS (Netherlands)

    Burgerhart, Jan S.; van Rutte, Pim W. J.; Edelbroek, Michela A. L.; Wyndaele, Dirk N. J.; Smulders, Johannes F.; van de Meeberg, Paul C.; Siersema, Peter D.; Smout, André J. P. M.

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure. However, postprandial symptoms can compromise its beneficial effect. It is not known if a changed gastric emptying and these symptoms are related. This study aimed to assess the association between postprandial symptoms and

  19. Prosthetic bioabsorbable mesh for hiatal hernia repair during sleeve gastrectomy.

    Science.gov (United States)

    Clapp, Benjamin

    2013-01-01

    Laparoscopic sleeve gastrectomy has become a valuable primary bariatric operation. It has an acceptable complication profile and amount of weight loss. However, one of the most distressing complications to the patient is reflux postoperatively. There is thought to be a relationship between a hiatal hernia and postoperative reflux. There is disagreement on how to address a hiatal hernia intraoperatively, and the use of mesh is controversial. Our objectives were to examine the use of a prosthetic bioabsorbable mesh for repair of a large hiatal hernia during a sleeve gastrectomy and to examine the incidence of reflux and mesh-related complications in the near term. This is a case series of patients with hiatal hernia undergoing a primary sleeve gastrectomy. None of the patients had a previous hiatal hernia repair. Three patients with large hiatal hernias diagnosed preoperatively or intraoperatively were included. The hiatus of the diaphragm was repaired with a posterior crural closure, and a piece of prosthetic bioabsorbable mesh was placed posteriorly to reinforce the repair. There were 3 patients. The mean follow-up period was 12 months. There were no mesh-related complications. One of the patients needed to resume proton pump inhibitors to control reflux. The use of a prosthetic bioabsorbable mesh to repair a hiatal hernia simultaneously with a sleeve gastrectomy is safe. There were no mesh-related complications at 1 year.

  20. Surgical management of chronic fistula after sleeve gastrectomy.

    Science.gov (United States)

    Nedelcu, A Marius; Skalli, Mehdi; Deneve, Eric; Fabre, Jean Michel; Nocca, David

    2013-01-01

    There is no clear definition of the chronic leak after sleeve gastrectomy. There are several endoscopic approaches, including endoprothese, endoscopic clips, endoscopic sealing glue, or balloon dilation. In case of failure of the endoscopic treatment, a definitive surgical approach can be attempted. The objective was to evaluate the surgical treatment of chronic leak after sleeve gastrectomy. From November 2010 through March 2012, 8 patients with chronic gastric fistula after laparoscopic sleeve gastrectomy had definitive surgical repair. The initial intervention, the diagnosis and management of the fistula, and the endoscopic approach were carefully reviewed. Five patients had their original laparoscopic sleeve gastrectomies performed at another hospital, while 3 had laparoscopic sleeve gastrectomy at our institution. The mean period of time from the diagnosis of the fistula to definitive surgical treatment was 14.4 months (range 5-44 months). Seven patients initially had surgical drainage by laparoscopy (5) and by laparotomy (2), with concomitant feeding jejunostomy in 6 patients. The endoscopic treatment consisted of endoprothese in 4 patients, endoscopic sealing glue in 2 patients, and sequential approach with glue and prosthesis in 2 other patients. One patient was treated exclusively by endoscopic approach with no surgical drainage. The surgical procedures performed for chronic fistula were gastrojejunal lateral anastomosis (4), Roux-en-Y gastric bypass (2), and gastrectomy with esojejunal anastomosis (2). Four patients presented with postoperative fistula, with a mean healing time of 32 days (range 22-63 days). No mortality was recorded. In chronic forms of fistulas with no improvements by endoscopic approach, the surgical treatment can be a solution. It remains a difficult procedure with a high percentage of leakage, but this type of fistula is more easily tolerated by the patient and heals faster. Crown Copyright © 2013. Published by Elsevier Inc. All

  1. Portal Vein Thrombosis

    Science.gov (United States)

    Chawla, Yogesh K.; Bodh, Vijay

    2015-01-01

    Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion. PMID:25941431

  2. [Deep vein thrombosis prophylaxis.

    Science.gov (United States)

    Sandoval-Chagoya, Gloria Alejandra; Laniado-Laborín, Rafael

    2013-01-01

    Background: despite the proven effectiveness of preventive therapy for deep vein thrombosis, a significant proportion of patients at risk for thromboembolism do not receive prophylaxis during hospitalization. Our objective was to determine the adherence to thrombosis prophylaxis guidelines in a general hospital as a quality control strategy. Methods: a random audit of clinical charts was conducted at the Tijuana General Hospital, Baja California, Mexico, to determine the degree of adherence to deep vein thrombosis prophylaxis guidelines. The instrument used was the Caprini's checklist for thrombosis risk assessment in adult patients. Results: the sample included 300 patient charts; 182 (60.7 %) were surgical patients and 118 were medical patients. Forty six patients (15.3 %) received deep vein thrombosis pharmacologic prophylaxis; 27.1 % of medical patients received deep vein thrombosis prophylaxis versus 8.3 % of surgical patients (p < 0.0001). Conclusions: our results show that adherence to DVT prophylaxis at our hospital is extremely low. Only 15.3 % of our patients at risk received treatment, and even patients with very high risk received treatment in less than 25 % of the cases. We have implemented strategies to increase compliance with clinical guidelines.

  3. Cucumber vein yellowing virus

    Science.gov (United States)

    Cucurbits are an important crop of temperate, subtropical and tropical regions of the world. Cucumber vein yellowing virus (CVYV) is a major viral pathogen of cucurbits. This chapter provides an overview of the biology of CVYV and the disease it causes....

  4. Squash vein yellowing virus

    Science.gov (United States)

    Cucurbits are an important crop of temperate, subtropical and tropical regions of the world. Squash vein yellowing virus (SqVYV) is a major viral pathogen of cucurbits. This chapter provides an overview of the biology of SqVYV and the disease it causes....

  5. What Causes Varicose Veins?

    Science.gov (United States)

    ... Examples of these factors include family history, older age, gender, pregnancy, overweight or obesity , lack of movement, and leg trauma. Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve ...

  6. Deep Vein Thrombosis

    Centers for Disease Control (CDC) Podcasts

    2012-04-05

    This podcast discusses the risk for deep vein thrombosis in long-distance travelers and ways to minimize that risk.  Created: 4/5/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/5/2012.

  7. Portal Vein Thrombosis: Recent Advance.

    Science.gov (United States)

    Qi, Xingshun

    2017-01-01

    Portal vein thrombosis is a life-threatening vascular disorder of the liver. In this chapter, I will review the recent advance regarding the epidemiology, etiology, management, and prognosis of portal vein thrombosis.

  8. Single-incision sleeve gastrectomy versus laparoscopic sleeve gastrectomy. A 2-year comparative analysis of 600 patients.

    Science.gov (United States)

    Lakdawala, Muffazal; Agarwal, Aditi; Dhar, Shilpa; Dhulla, Neha; Remedios, Carlyne; Bhasker, Aparna Govil

    2015-04-01

    This is a 2-year study to evaluate the feasibility; outcomes in terms of postoperative pain, weight loss, and complication rates; and cosmesis of the single-incision sleeve gastrectomy versus the conventional multiport sleeve gastrectomy. A prospective comparative analysis was done in 300 patients in each arm who underwent laparoscopic sleeve gastrectomy and single-incision sleeve gastrectomy from September 2009 till January 2012. Both groups were matched for age and BMI. Postoperative pain scoring was done using visual analogue scale. Outcomes in terms of pain score, scar satisfaction score, excess weight loss, resolution of co-morbidities, and complications were compared in both groups at the end of 6 months, 1 year, and 2 years. Female patients preferred to undergo single-incision sleeve gastrectomy. Operating time and intraoperative blood loss were comparable in both groups. Visual analogue scale (VAS) scoring revealed lesser postoperative pain in the single-incision group. Excess weight loss and resolution of co-morbidities were also comparable in both groups at 6 months, 1 year, and 2 years. Incisional hernia was seen in 3 patients (1%) in the single-incision group. Leak rate was comparable. Cosmetic satisfaction was superior in patients who underwent single-incision surgery. Surgical outcomes are comparable in both groups at the end of 2 years. The myth of high long-term incisional hernia rate after single-incision surgery has been dispelled. Single-incision surgery is less painful with better cosmesis. It has come of age and should no longer be considered as an experimental procedure.

  9. Concerns and Discomforts of Pregnancy - Varicose Veins

    Science.gov (United States)

    Concerns and Discomforts of Pregnancy - Varicose Veins Varicose veins are enlarged veins you may see on your legs. They can itch, ... Healthy Roads Media project www. healthyroadsmedia. org English - Concerns and Discomforts of Pregnancy (Varicose Veins) Last reviewed 2012

  10. Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention.

    Science.gov (United States)

    Nath, Anand; Yewale, Sayali; Tran, Tung; Brebbia, John S; Shope, Timothy R; Koch, Timothy R

    2016-12-21

    To evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG). VSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage. Of 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids. Narrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients.

  11. Should recent smoking be a contraindication for sleeve gastrectomy?

    Science.gov (United States)

    Haskins, Ivy N; Nowacki, Amy S; Khorgami, Zhamak; Schulz, Karen; Heinberg, Leslie J; Schauer, Phillip R; Brethauer, Stacy A; Aminian, Ali

    2017-07-01

    One of the ultimate goals of bariatric and metabolic surgery is to decrease cardiovascular morbidity and mortality. Obese individuals who smoke tobacco are at an increased risk of cardiovascular events and may benefit the most by positive effects of bariatric surgery on cardiometabolic risk factors. The safety profile of sleeve gastrectomy in patients who smoke has not yet been characterized. To investigate the independent effect of smoking on early postoperative morbidity and mortality of laparoscopic sleeve gastrectomy. American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. All patients undergoing primary laparoscopic sleeve gastrectomy from 2010 to 2014 were identified within the NSQIP database. Thirty-day postoperative outcomes for smokers, defined as patients who smoked within the year before surgery, were compared with nonsmokers. A total of 33,714 people underwent sleeve gastrectomy; 30,418 (90.2%) patients were nonsmokers, whereas 3296 (9.8%) patients smoked within a year before surgery. Among the 17 examined individual adverse events, patients who smoked were more likely to experience an unplanned reintubation (odds ratio [OR] = 1.88, 95% confidence interval [CI]: 1.01-3.50). Patients in the smoking group were significantly more likely to experience a composite morbidity event (4.3% versus 3.7%, P = .04), serious morbidity event (.9% versus .6%, P = .003), and 30-day mortality (0.2% versus .1%, P = .0004). The length of hospital stay, unplanned readmission, and readmission rates were comparable between the 2 groups. These differences in the composite morbidity event, serious morbidity event, and mortality persisted even when those patients with chronic obstructive pulmonary disease, used as a surrogate for end-stage pulmonary effects of smoking, were excluded from the analysis. Sleeve gastrectomy is a well-tolerated procedure in nonsmokers and smokers. However, patients who have smoked within a year before sleeve

  12. [Wernicke's encephalopathy following sleeve gastrectomy for morbid obesity].

    Science.gov (United States)

    Landais, A; Saint-Georges, G

    2014-11-01

    Bariatric restrictive interventions, as sleeve gastrectomy or gastric banding can cause metabolic complications, especially when vomiting is present, such as thiamine deficiency that can lead to Wernicke's encephalopathy. A 31-year-old man with a 47kg/m(2) body mass index presented with Wernicke's encephalopathy, with ophtalmoplegia, nystagmus, ataxia and confusion, followed by a Korsakoff syndrome, occurring two months after a sleeve gastrectomy. MRI showed hyperintense signals on T2 and FLAIR image in both thalamus, periaqueducal area and mamillary bodies. A close clinical and biological monitoring is required in the first year after surgery, especially if vomiting occurs. Early diagnostic and treatment are needed to avoid severe sequelae. Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  13. Loss-of-control eating following sleeve gastrectomy surgery.

    Science.gov (United States)

    Ivezaj, Valentina; Kessler, Erin E; Lydecker, Janet A; Barnes, Rachel D; White, Marney A; Grilo, Carlos M

    2017-03-01

    Postoperative loss-of-control (LOC) eating is related to poorer weight loss outcomes after bariatric surgery, but little is known about LOC eating after sleeve gastrectomy surgery. To examine LOC eating severity and weight loss after sleeve gastrectomy SETTING: University School of Medicine, United States METHODS: Participants were 71 individuals (84.5% female; n = 60) who underwent sleeve gastrectomy surgery within the previous 4 to 9 months and reported LOC eating at least once weekly during the previous 28 days. LOC eating was assessed using the Eating Disorder Examination (EDE) Bariatric Surgery Version. Current mean age and body mass index were 47.3 (SD = 10.1) years and 37.9 (SD = 8.2) kg/m2. Two groups, bariatric binge-eating disorder (Bar-BED) and loss-of-control eating only (LOC-only), were created based on modified binge-eating disorder (BED) criteria, which excluded the "unusually large quantity of food" criterion due to limited gastric capacity postsurgery. Bar-BED criteria mirrored BED criteria and consisted of the following: at least 12 LOC eating episodes over the prior 3 months (once weekly), 3 of 5 associated symptoms, marked distress over LOC eating, and lack of regular compensatory behaviors. Based on these revised criteria, 49.3% (n = 35) were classified as the Bar-BED group and 50.7% (n = 36) as the LOC-only group. Compared with the LOC-only group, the Bar-BED group had significantly greater EDE global and subscale scores and lower percent weight loss by 6 months postsurgery. Findings suggest LOC eating that parallels BED postsurgery is associated with poorer outcomes after sleeve gastrectomy including poorer weight loss and greater severity of eating-disorder psychopathology. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  14. Sleeve resection for delayed presentation of traumatic bronchial transection.

    LENUS (Irish Health Repository)

    Mohamed, H Y

    2010-02-01

    Tracheobronchial disruption is uncommon in blunt chest trauma. Many of these patients die before reaching the hospital. In the majority of survivors diagnosis is occasionally delayed resulting in complications like airway stenosis and lung collapse. Thus it is important to have radiological follow up after severe thoracic trauma. Sleeve resection can be an excellent option to conserve lung tissue in delayed presentation of bronchial transection.

  15. Bar and Sleeve Attachment: A Report of Two Cases

    OpenAIRE

    Rao, Yogesh; Yadav, Pankaj; D’Souza, Mariette; Singh, Jagjeet; Jain, Anurag

    2013-01-01

    Patients with the anterior defects either due to trauma, congenital or pathological can be treated with conventional removable or fixed partial denture. The lost soft tissue structures are not replaced by the conventional treatment option. Andrews bridge is combination of both removable and fixed partial denture and fulfills all the requirements like phonetics, hygiene, aesthetics and comfort. This article describes the bar and sleeve attachment as the best treatment option in these types of ...

  16. Prediction Model for Hemorrhagic Complications after Laparoscopic Sleeve Gastrectomy: Development of SLEEVE BLEED Calculator.

    Science.gov (United States)

    Janik, Michal R; Walędziak, Maciej; Brągoszewski, Jakub; Kwiatkowski, Andrzej; Paśnik, Krzysztof

    2017-04-01

    Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric procedures. Hemorrhagic complications (HC) after surgery are common and require surgical revision. Accurate estimation of the risk of postoperative HC can improve surgical decision-making process and minimize the risk of reoperation. The aim of the present study was to develop a predictive model for HC after LSG. The retrospective analysis of 522 patients after primary LSG was performed. Patients underwent surgery from January 2013 to February 2015. The primary outcome was defined as a surgical revision due to hemorrhagic complications. Multiple regression analysis was performed. The rate of hemorrhagic complications was 4 %. The mean age of patients was 41.0 (±11.6) years and mean BMI was 47.3 (±7.3) kg/m2. Of the 12 examined variables, four were associated with risk of HC. Protective factors for HC were no history of obstructive sleep apnea (odds ratio [OR] 0.22; 95 % CI 0.05-0.94) and no history of hypertension (OR 0.38; 95 % CI 0.14-1.05). The low level of expertise in bariatric surgery (OR 2.85; 95 % CI 1.08-7.53) and no staple line reinforcement (OR 3.34; 95 % CI 1.21-9.21) were associated with higher risk of HC. The result revealed the association between hemorrhagic complications and the following factors: obstructive sleep apnea, hypertension, level of expertise in bariatric surgery, and reinforcement of the staple line. The risk assessment model for hemorrhagic complications after LSG can contribute to surgical decision-making process.

  17. Intraoperative Patterns of Gastric Microperfusion During Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Delko, Tarik; Hoffmann, Henry; Kraljevic, Marko; Droeser, Raoul A; Rothwell, Lincoln; Oertli, Daniel; Zingg, Urs

    2017-04-01

    Laparoscopic sleeve gastrectomy (LSG) has become a very popular surgical treatment for the treatment of morbidly obese patients. Staple line leaks are the major cause of severe morbidity. Reasons for leaks might be hyperpressure (mechanical theory) or hypoperfusion (vascular theory) of the narrow gastric tube. This study assessed microperfusion patterns of the stomach during LSG using visible light spectroscopy (VLS), a method to measure tissue oxygenation (saturated O2 (StO2)). The study population comprised 20 patients undergoing LSG. Real-time intraoperative microperfusion measurements were performed at nine different ventral stomach localizations in the antrum, body, and fundus at the beginning of the operation, after mobilization of the greater curve and after sleeve resection. There were 17 women and 3 men, mean age 42.9 years, mean BMI 45.6 kg/m2. There were no staple line leaks. StO2% values dropped substantially in the most cephalad area of measurement at the greater curve after mobilization (56 versus 49 %) and after resection (60 versus 49.5 %). The reduction in StO2 in the most cephalad area from before mobilization of the stomach to resection was 9.5 % (p sleeve resection of the stomach.

  18. Laparoscopic median gastrectomy for stenosis following sleeve gastrectomy.

    Science.gov (United States)

    Kalaiselvan, Ramya; Ammori, Basil J

    2015-01-01

    Laparoscopic sleeve gastrectomy (LSG) has become an established primary bariatric procedure. Gastric stenosis after LSG has been reported in a few studies and often occurs at the level of incisura or midbody because of a technical operative error and could be associated with a leak. This can be managed by endoscopic dilations or revision surgery. The objective of this study is to describe a novel technique to deal with sleeve stenosis and its outcome. Two patients presented with sleeve stenosis after LSG and underwent a novel technique. The patients were followed up for 18 months. We describe a novel technique of laparoscopic median gastrectomy in 2 patients that involved resection of the stenotic segment followed by a hand-sewn, gastrogastric, end-to-end anastomosis. Both patients had successfully recovered from stenosis related symptoms, although one required an endoscopic dilation of the anastomosis. Laparoscopic median gastrectomy is a feasible and effective option in patients who have failed conservative management of stenosis after LSG and in whom there is a desire to avoid seromyotomy or conversion to gastric bypass. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  19. Severe Insulin Resistance Improves Immediately After Sleeve Gastrectomy.

    Science.gov (United States)

    Sharma, Rahul; Hassan, Chandra; Chaiban, Joumana T

    2016-01-01

    Introduction. Obese individuals exhibit insulin resistance often leading to adverse health outcomes. When compared with intensive medical therapy, bariatric surgery has shown better outcomes mainly in terms of insulin resistance and glycemic control. Using the Homeostasis Model Assessment of insulin resistance (HOMA-IR), we report herein a case illustrating a drastic improvement in severe insulin resistance after sleeve gastrectomy in the immediate postoperative period. Case Report. A patient with long-standing history of morbid obesity, type 2 diabetes, obstructive sleep apnea, hypertension, and severe insulin resistance (requiring approximately 2 units of insulin per kg per day) was enrolled in the medical weight management program for 6 months during which he lost 40 lbs and his insulin requirements decreased. He then underwent a sleeve gastrectomy and did not require insulin therapy as of postoperative day 1. His HOMA-IR improved by about 76% between day 1 and day 14 postoperatively. Conclusion. Sleeve gastrectomy leads to a drastic improvement in severe insulin resistance as early as the first postoperative day.

  20. Human tissue thickness measurements from excised sleeve gastrectomy specimens.

    Science.gov (United States)

    Rawlins, Logan; Rawlins, Melissa P; Teel, Donovan

    2014-03-01

    Little basic science data exists regarding the thickness of transected stomach as the limits of smaller gastric sleeves are created closer to the lesser curvature in laparoscopic sleeve gastrectomy (SG). We sought to determine the tissue thickness trends along the staple line and examine what factors might predispose to thicker tissue. This was a single-center, single-surgeon nonrandomized prospective study of patients undergoing SG. Excised SG specimens, with patient consent, underwent tissue measurement at multiple predetermined locations and at the midpoint of each fired staple cartridge. After 9 months, ending in July 2012, we met our goal enrollment of 50 gastric sleeve specimens. Most of the patients were female (80 %) and white (92.5 %). Average age was 42 years (range, 19-60 years), and average body mass index (BMI) was 49 kg/m(2) (range, 34-82 kg/m(2)). Tissue thickness was significantly different (p 50 kg/m(2)) and gender (male) are associated with increased tissue thickness, but only in the antrum. Surgeons should consider using a thicker staple load, such as black, when these factors are present. Also, significant changes in tissue thickness at the fourth and fifth staple fires suggest stepwise alteration in staple cartridge color selection.

  1. Severe Insulin Resistance Improves Immediately After Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Rahul Sharma MD

    2016-01-01

    Full Text Available Introduction. Obese individuals exhibit insulin resistance often leading to adverse health outcomes. When compared with intensive medical therapy, bariatric surgery has shown better outcomes mainly in terms of insulin resistance and glycemic control. Using the Homeostasis Model Assessment of insulin resistance (HOMA-IR, we report herein a case illustrating a drastic improvement in severe insulin resistance after sleeve gastrectomy in the immediate postoperative period. Case Report. A patient with long-standing history of morbid obesity, type 2 diabetes, obstructive sleep apnea, hypertension, and severe insulin resistance (requiring approximately 2 units of insulin per kg per day was enrolled in the medical weight management program for 6 months during which he lost 40 lbs and his insulin requirements decreased. He then underwent a sleeve gastrectomy and did not require insulin therapy as of postoperative day 1. His HOMA-IR improved by about 76% between day 1 and day 14 postoperatively. Conclusion. Sleeve gastrectomy leads to a drastic improvement in severe insulin resistance as early as the first postoperative day.

  2. Elastic Knee Sleeves Limit Anterior Tibial Translation in Healthy Females

    Directory of Open Access Journals (Sweden)

    Robert Csapo, Simona Hosp, Ramona Folie, Robert Eberle, Michael Hasler, Werner Nachbauer

    2016-03-01

    Full Text Available Knee sleeves or braces represent auxiliary tools that have repeatedly been used by athletes, in an attempt to increase knee stability and, thus, reduce the risk of (recurrent ligamentous injuries. Since ACL injuries typically occur in situations involving either torsion or hyperextension of the knee, it has been speculated that braces might protect the ACL by countering excessive anterior translation of the tibia with respect to the femur (Beynnon et al., 1997. However, the preponderance of in vivo studies to test this hypothesis was performed in cohorts of patients suffering from existent ligamentous (Branch et al., 1988; Colville et al., 1986 or other knee injury (Beynnon et al., 1997; Fleming et al., 2000. This complicates the extrapolation of results to healthy subjects. Further, the braces used in these studies were mostly rigid constructs that consisted of either uni- or bilateral hinged bars (Rishiraj et al., 2009. Such braces might hinder performance (Veldhuizen et al., 1991 and would be rejected by the vast majority of healthy athletes. For these reasons, we would like to use this letter to the editor to report the results of our experiments investigating whether a relatively light elastic knee sleeve would limit the degree of anterior tibial translation in computerized arthrometry tests as performed in a sample of non-injured subjects. We recruited ten female college students (age: 23.4 ± 3.2 yrs, height: 1.68 ± 0.05 m, mass: 59.9 ± 5.5 kg who were free of acute or previous injury or any form of orthopaedic disease of the knee joints. The anterior displacement of the tibia was measured using the GNRB® computerized arthrometer (GeNouRob, Laval, France. With subjects lying in the supine position, the lower leg was firmly fixed with plastic caps mounted over the ankle joint and patella. An electrical pressure pad then exerted increasing pressure of up to 250 N on the calf, while a motion sensor, which was positioned on the ventral

  3. Technical Details of Laparoscopic Sleeve Gastrectomy Leading to Lowered Leak Rate: Discussion of 1070 Consecutive Cases

    Science.gov (United States)

    Sasse, Kent C.

    2017-01-01

    Introduction Laparoscopic sleeve gastrectomy is a widely utilized and effective surgical procedure for dramatic weight loss in obese patients. Leak at the sleeve staple line is the most serious complication of this procedure, occurring in 1–3% of cases. Techniques to minimize the risk of sleeve gastrectomy leaks have been published although no universally agreed upon set of techniques exists. This report describes a single-surgeon experience with an approach to sleeve leak prevention resulting in a progressive decrease in leak rate over 5 years. Methods 1070 consecutive sleeve gastrectomy cases between 2012 and 2016 were reviewed retrospectively. Patient characteristics, sleeve leaks, and percent body weight loss at 6 months were reported for each year. Conceptual and technical changes aimed towards leak reduction are presented. Results With the implementation of the described techniques of the sleeve gastrectomy, the rate of sleeve leaks fell from 4% in 2012 to 0% in 2015 and 2016 without a significant change in weight loss, as depicted by 6-month change in body weight and percent excess BMI lost. Conclusion In this single-surgeon experience, sleeve gastrectomy leak rate has fallen to 0% since the implementation of specific technical modifications in the procedure. PMID:28761766

  4. Technical Details of Laparoscopic Sleeve Gastrectomy Leading to Lowered Leak Rate: Discussion of 1070 Consecutive Cases

    Directory of Open Access Journals (Sweden)

    David L. Warner

    2017-01-01

    Full Text Available Introduction. Laparoscopic sleeve gastrectomy is a widely utilized and effective surgical procedure for dramatic weight loss in obese patients. Leak at the sleeve staple line is the most serious complication of this procedure, occurring in 1–3% of cases. Techniques to minimize the risk of sleeve gastrectomy leaks have been published although no universally agreed upon set of techniques exists. This report describes a single-surgeon experience with an approach to sleeve leak prevention resulting in a progressive decrease in leak rate over 5 years. Methods. 1070 consecutive sleeve gastrectomy cases between 2012 and 2016 were reviewed retrospectively. Patient characteristics, sleeve leaks, and percent body weight loss at 6 months were reported for each year. Conceptual and technical changes aimed towards leak reduction are presented. Results. With the implementation of the described techniques of the sleeve gastrectomy, the rate of sleeve leaks fell from 4% in 2012 to 0% in 2015 and 2016 without a significant change in weight loss, as depicted by 6-month change in body weight and percent excess BMI lost. Conclusion. In this single-surgeon experience, sleeve gastrectomy leak rate has fallen to 0% since the implementation of specific technical modifications in the procedure.

  5. Investigation of Causes of Scrap Occurrence in Thread Cutting on Steel Sleeves for Motorcar Industry

    Directory of Open Access Journals (Sweden)

    Marušić, V.

    2007-01-01

    Full Text Available This paper studies causes of scrap occurrence, wear and breakage of cutters during thread cutting of steel sleeves poured in Al die castings of motor car engine components. It was concluded that the reason for occurrence of problems with thread cutting of sleeves most probably should be attributed to the fact whether hardness value reaches 200 HB or over 250 HB. The most probable reason for over wear and consequently to breakage of cutters and scrap occurrence, although castings display top quality, lies in the fact that the internal diameter of sleeves frequently falls down under minimally allowed tolerances for threaded sleeves.

  6. Laparoscopic sleeve gastrectomy with transgastric visualization: another step toward totally NOTES procedures.

    Science.gov (United States)

    Elazary, Ram; Schlager, Avraham; Khalaileh, Abed; Mintz, Yoav

    2014-10-01

    Laparoendoscopic single-site sleeve gastrectomy is gaining acceptance. However, totally natural orifice translumenal endoscopic surgery (NOTES) in morbidly obese patients is still controversial due to safety and technical issues. To this end, we have developed a technique for sleeve gastrectomy in which the surgical field view is achieved through transgastric approach and the operating channel will eventually be through the vagina to form a dual lumen totally NOTES procedure for sleeve gastrectomy. As a step toward this approach, we performed a single abdominal incision in order to simulate the transvaginal route. This study is another step toward combined transvaginal and transgastric totally NOTES sleeve gastrectomy. A combined NOTES and single trocar sleeve gastrectomy was performed on 8 porcine animal models. The endoscope was inserted through the gastric wall and served as the vision source for the procedure. A second endoscope was inserted via the transabdominal trocar together with the surgical instruments. Sleeve gastrectomy was performed on 8 porcine models. The operative time for the first procedure was 5 hours, but after determining the technique, the time was reduced by half. Combined NOTES and single trocar sleeve gastrectomy is feasible in a porcine model. We achieved an excellent view of the surgical field through the transgastric approach. We believe that in the near future, combining the transgastric visualization of the surgical field together with a transvaginal approach may enable performing a total NOTES sleeve gastrectomy procedure. This hypothesis will be studied in further animal experiments before implementation in humans. © The Author(s) 2013.

  7. Feasibility and profitability of chain integration by NCPAK on flower sleeves products in European market

    NARCIS (Netherlands)

    Yan, X.

    2008-01-01

    In this report, the author describes that the EU flower sleeve wholesalers are the chain leader of the flower sleeve supply chain from China to the EU market. Their strategy changes can easily put NCpak, in full name, 'Sun Hing Plastic Bag Company', a Hong Kong enterprise based on Shenzhen City,

  8. Esophageal adenocarcinoma five years after laparoscopic sleeve gastrectomy. A case report

    Directory of Open Access Journals (Sweden)

    Fernando Gabriel Wright

    2017-01-01

    Conclusion: We present a case of an esophageal adenocarcinoma five years after a laparoscopic sleeve gastrectomy for morbid obesity. There is need to better determine the relationship between sleeve gastrectomy and gastroesophageal reflux disease in order to prevent its related complications, such as esophageal adenocarcinoma.

  9. Nylon Sleeve for Cavity Amplifier Holds Tuning Despite Heat

    Science.gov (United States)

    Derr, Lloyd

    1964-01-01

    The problem: Detuning of cavity amplifiers with change in temperature. This results in deterioration of the performance of the amplifier at its design frequency. In cavity amplifiers and filters it is desirable that constant performance be maintained regardless of thermal changes. These changes often cause an "off resonance shift" in a cavity filter and a deterioration of performance in a cavity amplifier. The solution: Mount the tuning probe in a nylon sleeve. Thermal expansion and contraction of the nylon nullifies unwanted capacitive and inductive changes in the resonant elements.

  10. Laparoscopic 'sleeve' caecectomy for idiopathic solitary caecal ulcer mimicking appendicitis.

    Science.gov (United States)

    Sran, Harkiran; Sebastian, Joseph; Doughan, Samer

    2015-08-04

    Idiopathic ulcer of the caecum is a rare condition of unknown aetiology. Its clinical presentation may mimic various pathologies, including appendicitis, inflammatory bowel disease and caecal malignancy. A definitive diagnosis is rarely established preoperatively, and is usually only confirmed histologically following surgical resection. We report a case of a young patient with caecal ulceration presenting with symptoms and signs of appendicitis, in whom laparoscopic anterior 'sleeve' caecectomy was performed to excise an inflammatory-looking mass involving the caecum. Histological examination demonstrated a deep mucosal ulcer and subsequent colonoscopy did not reveal any further pathology. 2015 BMJ Publishing Group Ltd.

  11. Leiomyosarcoma of the renal vein

    Directory of Open Access Journals (Sweden)

    Lemos Gustavo C.

    2003-01-01

    Full Text Available Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We presented a case of renal vein leiomyosarcoma detected in a routine study. The primary treatment was complete surgical removal of the mass. In cases where surgical removal is not possible the prognosis is poor, with high rates of local recurrence and distant spread.

  12. Association of radiographic morphology with early gastroesophageal reflux disease and satiety control after sleeve gastrectomy.

    Science.gov (United States)

    Toro, Juan P; Lin, Edward; Patel, Ankit D; Davis, S Scott; Sanni, Aliu; Urrego, Hernan D; Sweeney, John F; Srinivasan, Jahnavi K; Small, William; Mittal, Pardeep; Sekhar, Aarti; Moreno, Courtney C

    2014-09-01

    Variable gastric morphology has been identified on routine upper gastrointestinal series after laparoscopic sleeve gastrectomy. This test might give us useful information beyond the presence of leak and obstruction. The aim of this study is to standardize a morphologic classification of gastric sleeve based on water-soluble contrast upper gastrointestinal series, and to determine possible clinical implications. One hundred morbidly obese patients underwent laparoscopic sleeve gastrectomy and had routine upper gastrointestinal on postoperative day 1 or 2. Images were reviewed by 4 radiologists who were blinded to outcomes, and sleeve shape was classified as upper pouch, lower pouch, tubular, or dumbbell. Inter-observer agreement was calculated. Clinical outcomes including weight loss, satiety control, and reflux symptoms were recorded. Comparisons were determined by 1-way ANOVA and t-test. Mean age was 46 ± 12 years and mean BMI was 45.1 ± 6 kg/m(2). Overall inter-observer agreement level for the sleeve shape classification was 76.3%. Sleeve shapes were tubular in 37%, dumbbell in 32%, lower pouch in 22%, and upper pouch in 8%. Mean excess body weight loss at 1, 3, and 6 months was 16.8%, 29.9%, and 39.1%, respectively. Excess body weight loss was not associated with sleeve shape. Mean hunger score was 213 ± 97, and patients with dumbbell shape had higher hunger scores (p = 0.003). Mean reflux score was 5.7 ± 8. Upper pouch shape was associated with greater severity of reflux symptoms (p = 0.02). This study suggests a standardized radiographic classification of gastric sleeve morphology. Although sleeve shape is not correlated with weight loss, gastric sleeves with retained fundus result in lower satiety control and higher severity of reflux symptoms. An adequate resection of the gastric fundus might avoid this potential complication. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Duodenal-jejunal bypass with sleeve gastrectomy versus the sleeve gastrectomy procedure alone: the role of duodenal exclusion.

    Science.gov (United States)

    Lee, Wei-Jei; Almulaifi, Abdullah M; Tsou, Jun-Juin; Ser, Kong-Han; Lee, Yi-Chih; Chen, Shu-Chun

    2015-01-01

    Laparoscopic sleeve gastrectomy (SG) has become accepted as a stand-alone procedure as a less complex operation than laparoscopic duodenojejunal bypass with sleeve gastrectomy (DJB-SG). The aim of this study was to compare one-year results between DJB-SG and SG. University hospital. A total of 89 patients who received a DJB-SG surgery were matched with a group of SG that were equal in age, sex, and body mass index (BMI). Complication rates, weight loss, and remission of co-morbidities were evaluated after 12 months. The mean preoperative patient BMI in the DJB-SG and SG groups was similar. There were more patients with type 2 diabetes mellitus (T2DM) in the DJB-SG group than in the SG group. The mean operative time and length of hospital stay (LOS) were significantly longer in the DJB-SG group than in the SG group. At 12 months after surgery, the BMI was lower and excess weight loss higher in DJB-SG than SG. Remission of T2DM was greater in the DJB-SG group. Low-density lipoprotein, total cholesterol, and metabolic syndrome (MS) improved after operation in both groups. In this study DJB-SG was superior to SG in T2DM remission, triglyceride improvement, excess weight loss, and lower BMI at 1 year after surgery. Adding duodenal switch to sleeve gastrectomy increases the effect of diabetic control and MS resolution. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  14. Duodenal endoluminal barrier sleeve alters gut microbiota of ZDF rats.

    Science.gov (United States)

    Kim, T; Holleman, C L; Ptacek, T; Morrow, C D; Habegger, K M

    2017-03-01

    The combination of energy dense diets and reduced energy expenditure in modern society has escalated the prevalence of obesity and obesity-related comorbidities. Among these disease states, type-2 diabetics (T2D) are disproportionately associated with obesity, suggesting a shared etiology. In conjunction with defects in hormonal and inflammatory states, obesity and T2D are also characterized by dysbiosis. We have recently described the beneficial effects of duodenal nutrient exclusion, as induced by the duodenal endoluminal sleeve (DES); including body weight loss, prevented fat mass accumulation, and improved glucose tolerance in the ZDF rat, a rodent model of obesity and type-2 diabetes (T2D). To assess the relative role of DES on hindgut microbiota in the context of these metabolic changes, we analyzed cecal samples from rats implanted with a duodenal endoluminal sleeve (DES), or a sham control of this procedure. A group of pair-fed (pf) sham controls was also included to account for changes induced by reduced body weight and food intake. Analysis of hindgut microbiota following DES in the ZDF rat elucidated discrete changes in several microbial populations including a reduction in Paraprevotella family members of the Clostridiales order along with an increase in Akkermansia muciniphila and species of the Allobaculum and Bifidobacterium genera. Altogether, these observations suggest that like Roux-en Y gastric bypass (RYGB) and Metformin, regulation of gut microbiota may be a contributing factor to the therapeutic effects of DES.

  15. Laparoscopic Gastric Sleeve and Micronutrients Supplementation: Our Experience

    Directory of Open Access Journals (Sweden)

    D. Capoccia

    2012-01-01

    Full Text Available Background. Laparoscopic gastric sleeve (LGS has been recently introduced as a stand-alone, restrictive bariatric surgery. Theoretically, LGS attenuates micronutrients deficiencies and associated complications that were typically observed following malabsorptive procedures. The aim of this study was to assess some micronutrients and mineral deficiencies in patients undergoing LGS. Methods. In the period between July 2008 and April 2010, 138 obese patients (110 females and 28 males with mean BMI 44.4 kg/m2 ± 6.5, mean age 43.9±10.9 years were enrolled and underwent LGS. Patients were followed up with routine laboratory tests and anthropometric measurements and assessed for nutritional status, as regards vitamin B12, folic acid, iron, hemoglobin, calcium, and vitamin D, every three months throughout 12 months. Results. 12 months after sleeve, patients did not show iron deficiency and/or anemia; plasma calcium levels were in the normal range without supplementation from the sixth month after the operation. Vitamin B12 and folic acid were adequately supplemented for all the follow-up period. Vitamin D was in suboptimal levels, despite daily multivitamin supplementation. Conclusion. In this study, we showed that LGS is an effective surgery for the management of morbid obesity. An adequate supplementation is important to avoid micronutrients deficiencies and greater weight loss does not require higher dosage of multivitamins.

  16. Local collapse of gas pipelines under sleeve repairs

    Energy Technology Data Exchange (ETDEWEB)

    Otegui, J.L.; Urquiza, S.; Rivas, A. [Universidad Nacional de Mar del Plata (Argentina). CONICET; Trunzo, A. [Transportadora de Gas del Norte (Argentina)

    2000-07-01

    Local collapse of the pipe wall under full encirclement sleeve reinforcements is associated with breaks and blow outs that cause large gas losses and abrupt depressurisation in gas pipelines. Although these defects do not represent an imminent risk of failure, they should be eliminated because they impede the normal passage of the instrumented pig for internal inspection. Four failed repairs were experimentally evaluated, and the effects of different geometric factors were numerically assessed via non-linear numerical modelling of fluid flow and pipe response. All possible causes of the appearance of these defects and measures to minimise their occurrence were evaluated. The position of the repaired portion with respect to the blow out, local geometry of the repair and previous defects, and the amount of gas caught in the interstice between the pipe and the reinforcement, have an important part in the event. The measures for the prevention of this problem involve the use of fillers and improved construction of repair sleeves. (author)

  17. Adaptive Algorithm for the Quality Control of Braided Sleeving

    Directory of Open Access Journals (Sweden)

    Miha Pipan

    2014-09-01

    Full Text Available We describe the development and application of a robot vision based adaptive algorithm for the quality control of the braided sleeving of high pressure hydraulic pipes. With our approach, we can successfully overcome the limitations, such as low reliability and repeatability of braided quality, which result from the visual observation of the braided pipe surface. The braids to be analyzed come in different dimensions, colors, and braiding densities with different types of errors to be detected, as presented in this paper. Therefore, our machine vision system, consisting of a mathematical algorithm for the automatic adaptation to different types of braids and dimensions of pipes, enables the accurate quality control of braided pipe sleevings and offers the potential to be used in the production of braiding lines of pipes. The principles of the measuring method and the required equipment are given in the paper, also containing the mathematical adaptive algorithm formulation. The paper describes the experiments conducted to verify the accuracy of the algorithm. The developed machine vision adaptive control system was successfully tested and is ready for the implementation in industrial applications, thus eliminating human subjectivity.

  18. Endoscopic sleeve gastroplasty for the treatment of obesity.

    Science.gov (United States)

    Lopez-Nava, Gontrand; Galvão, Manoel P; da Bautista-Castaño, Immacula; Jimenez, Amaya; De Grado, Teresa; Fernandez-Corbelle, Juan Pedro

    2015-05-01

    Emerging endoscopic techniques are minimally invasive and can mimic the anatomic alterations achieved by surgical sleeve gastrectomy. The objective of this study was to evaluate endoscopic sleeve gastroplasty. This was a prospective, single-center study of 20 patients who underwent flexible endoscopic suturing for endoluminal gastric volume reduction. A multidisciplinary team provided postprocedure care. Patient status and weight were recorded at baseline, and at 1, 3, and 6 months after the procedure. There were no adverse events and all patients were discharged in less than 24 hours. Baseline mean body mass index was 38.5 kg/m(2), and mean age was 45.8 years. Initial body weight (108.5 ± 14.9 kg) was significantly reduced. Following the procedure, the mean body weight reduction was 8.2 ± 2.5 kg at 1 month (% of initial weight loss 7.6 %; P gastroplasty can be effective for the treatment of patients with obesity. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Dynamics of uranium vein mineralization

    Energy Technology Data Exchange (ETDEWEB)

    Petrosyan, R.V. (Ministerstvo Geologii SSR, Moscow)

    1981-01-01

    The formation of uraniun vein deposits and the essence of consanguinity of the mineralization and wall metasomatites are considered. The formation of uranium mineralization is analysed from the positions of Korzhinsky D. S. : the formation of metasomatite aureole and associated vein ores take place as a result of the development of one solution flow while the formation of mineral vein associations occurs on the background of continuous filtration of the solution during metasomato is due to a repeated (pulse) half-opening of fractures and their filling with a part of filtrating solution. The analysis of the available information on the example of two different uranium manifestations permits to reveal certain relations both in the character of wall rock alterations and between the metasomatosis and the formation of ore minerals in veins. The conclusion is made that spatial-time correlations of vein formations with wall metasomatites attest that the pulse formation of ores in veinlets occurs on the background and in interrelation with a consecutive precipitation of components in the aureole volume. The analysis of element migration dynamics in wall aureole carried out from the positions of the Korzhinsky hypothesis of the advance wave of acid components that takes into account the interaction of continuous and pulse mechanisms of solution movement permits to avoid contradictions when interpreting the processes of wall rock alterations and vein ore-forming, and permits to make a common scheme of vein ore-genesis.

  20. Varicose Vein Treatment (Endovenous Ablation of Varicose Veins)

    Science.gov (United States)

    ... surgery. Most of the veins treated are effectively invisible even to ultrasound 12 months after the procedure. ... understanding of the possible charges you will incur. Web page review process: This Web page is reviewed ...

  1. Fratura na patela em crianças (fraturas do tipo "sleeve" Patellar fractures in children (sleeve-type fractures

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici

    2005-01-01

    Full Text Available Os autores descrevem um caso raro de fratura de patela num paciente de 11 anos de idade onde o diagnóstico inicial não foi realizado. O diagnóstico "sleeve fracture" ou fratura por desluvamento foi revisado quanto a diversos aspectos como o diagnóstico clínico, o auxílio por meio de imagem e o tratamento mais adequado. Concluíram que, embora rara, a fratura deve ser lembrada e que o tratamento mais adequado é o cirúrgico.The authors describe a rare case of patellar fracture in an 11 year-old patient in whom an early diagnosis was not provided. The sleeve fracture - or ungloving fracture - diagnosis was reviewed for various aspects such as clinical diagnosis, imaging tests aid and most suitable treatment. They concluded that, although rare, this kind of fracture should always be remembered, and that the most suitable treatment is surgery.

  2. Use and Outcomes of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass: Analysis of the American College of Surgeons NSQIP.

    Science.gov (United States)

    Young, Monica T; Gebhart, Alana; Phelan, Michael J; Nguyen, Ninh T

    2015-05-01

    Laparoscopic sleeve gastrectomy is gaining popularity in the United States. However, few studies have examined outcomes of sleeve gastrectomy compared with those of the "gold standard" bariatric operation: Roux-en-Y gastric bypass. Using the American College of Surgeons National Surgical Quality Improvement Program database, clinical data were obtained for all patients who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass between 2010 and 2011. Main outcomes measures were risk-adjusted 30-day serious morbidity and mortality. We analyzed 24,117 patients who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass for the treatment of morbid obesity. Gastric bypass comprised 79.5% of cases and sleeve gastrectomy comprised 20.5%; the proportion of sleeve gastrectomy cases increased from 14.6% in 2010 to 25.8% in 2011. On univariate analysis, sleeve gastrectomy had a shorter mean operative time (101 vs 133 minutes, p sleeve gastrectomy, gastric bypass patients had higher risk-adjusted 30-day serious morbidity (odds ratio [OR] 1.32; 95% CI1.11 to 1.56, p sleeve vs 0.15% for bypass). Use of laparoscopic sleeve gastrectomy is increasing on a national level. Compared with laparoscopic gastric bypass, laparoscopic sleeve gastrectomy is associated with lower 30-day risk-adjusted serious morbidity and equivalent 30-day mortality. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Sleeve gastrectomy and Roux En Y gastric bypass: current state of metabolic surgery.

    Science.gov (United States)

    Torgersen, Zachary; Osmolak, Angela; Forse, Robert Armour

    2014-10-01

    Roux En Y gastric bypass (RYGB) is considered the bariatric gold standard. Recently, sleeve gastrectomy has gained significant popularity. Early evidence suggests sleeve gastrectomy as a well tolerated and efficacious alternative to RYGB. This article compares RYGB and sleeve gastrectomy by reviewing and summarizing recently published clinical trials. Surgery remains the most effective therapy for obese patients meeting criteria. Excess weight loss in short-term follow-up appears similar between RYGB and sleeve gastrectomy. Long-term data on sleeve gastrectomy are limited. RYGB is more effective in producing resolution and remission of type II diabetes mellitus, particularly in patients at high risk for relapse. RYGB and sleeve gastrectomy are similar in their reduction of other obesity-related comorbid conditions with the exception of gastroesophageal reflux disease. RYGB has slightly higher overall morbidity but mortality is similar. RYGB and sleeve gastrectomy are well tolerated and effective bariatric operations and represent metabolic surgery. More prospective, long-term data are needed. Both procedures benefit specific groups of patients better than the other. Research defining the obese patient's metabolic state and the metabolic response to both operations will ultimately allow physicians to optimally match patient and procedure.

  4. Changes in Tissue Oxygen Saturation in Response to Different Calf Compression Sleeves

    Science.gov (United States)

    Dermont, T.; Morizot, L.; Bouhaddi, M.; Ménétrier, A.

    2015-01-01

    Aim. The purpose was to examine the changes in tissue oxygen saturation (StO2) in response to the application of different commercially available calf compression sleeves. Methods. Eight subjects came to the laboratory to complete a session in seated position including 10 min of quiet rest followed by 3 min measuring calf StO2 without compression sleeves and then alternating of 3 min of passive rest and 3 min measuring StO2 with calf compression sleeves. A total of 15 different commercially available compression sleeves were studied in a randomized order. Calf StO2 was recorded using near-infrared spectroscopy. Results. StO2 was significantly increased with all compression sleeves (p < 0.05) compared with no compression (from +6.9% for the least effective to +22.6% for the most effective). Large differences were observed between compression sleeves (p < 0.05). StO2 was positively correlated with compression pressure (p < 0.05; r = 0.84). Conclusion. This study shows that wearing compression sleeves from various brands differently affects tissue oxygen saturation. Differences were linked to the compression pressure: higher compression pressures were associated with higher StO2. PMID:26464899

  5. Immediate effects of an elastic knee sleeve on frontal plane gait biomechanics in knee osteoarthritis.

    Directory of Open Access Journals (Sweden)

    Raphael Schween

    Full Text Available Osteoarthritis of the knee affects millions of people. Elastic knee sleeves aim at relieving symptoms. While symptomatic improvements have been demonstrated as a consequence of elastic knee sleeves, evidence for biomechanical alterations only exists for the sagittal plane. We therefore asked what effect an elastic knee sleeve would have on frontal plane gait biomechanics.18 subjects (8 women, 10 men with osteoarthritis of the medial tibiofemoral joint walked over ground with and without an elastic knee sleeve. Kinematics and forces were recorded and joint moments were calculated using an inverse dynamics approach. Conditions with sleeve and without sleeve were compared with paired t-Tests.With the sleeve, knee adduction angle at ground contact was reduced by 1.9 ± 2.1° (P = 0.006. Peak knee adduction was reduced by 1.5 ± 1.6° (P = 0.004. The first peak knee adduction moment and positive knee adduction impulse were decreased by 10.1% (0.74 ± 0.9 Nm • kg-1; P = 0.002 and 12.9% (0.28 ± 0.3 Nm • s • kg-1; P < 0.004, respectively.Our study provides evidence that wearing an elastic knee sleeve during walking can reduce knee adduction angles, moments and impulse in subjects with knee osteoarthritis. As a higher knee adduction moment has previously been identified as a risk factor for disease progression in patients with medial knee osteoarthritis, we speculate that wearing a knee sleeve may be beneficial for this specific subgroup.

  6. A Vein Map Biometric System

    Directory of Open Access Journals (Sweden)

    Felix Fuentes

    2013-08-01

    Full Text Available There is increasing demand world-wide, from government agencies and the private sector for cutting-edge biometric security technology that is difficult to breach but userfriendly at the same time. Some of the older tools, such as fingerprint, retina and iris scanning, and facial recognition software have all been found to have flaws and often viewed negatively because of many cultural and hygienic issues associated with them. Comparatively, mapping veins as a human barcode, a new technology, has many advantages over older technologies. Specifically, reproducing a three-dimensional model of a human vein system is impossible to replicate. Vein map technology is distinctive because of its state-of-the-art sensors are only able to recognize vein patterns if hemoglobin is actively flowing through the person

  7. Portal Vein Thrombosis in non cirrhotic patients

    NARCIS (Netherlands)

    M.C.W. Spaander (Manon)

    2010-01-01

    textabstractExtrahepatic portal vein thrombosis (EPVT) is the most common cause of portal hypertension in non- cirrhotic patients. EPVT has been defined as an obstruction of the extrahepatic portal vein with or without involvement of the intrahepatic portal veins. Although the portal vein accounts

  8. Laparoscopic sleeve gastrectomy: More than a restrictive bariatric surgery procedure?

    Science.gov (United States)

    Benaiges, David; Más-Lorenzo, Antonio; Goday, Albert; Ramon, José M; Chillarón, Juan J; Pedro-Botet, Juan; Roux, Juana A Flores-Le

    2015-01-01

    Sleeve gastrectomy (SG) is a restrictive bariatric surgery technique that was first used as part of restrictive horizontal gastrectomy in the original Scopinaro type biliopancreatic diversion. Its good results as a single technique have led to a rise in its use, and it is currently the second most performed technique worldwide. SG achieves clearly better results than other restrictive techniques and is comparable in some aspects to the Roux-en-Y gastric bypass, the current gold standard in bariatric surgery. These benefits have been associated with different pathophysiologic mechanisms unrelated to weight loss such as increased gastric emptying and intestinal transit, and activation of hormonal mechanisms such as increased GLP-1 hormone and decreased ghrelin. The aim of this review was to highlight the salient aspects of SG regarding its historical evolution, pathophysiologic mechanisms, main results, clinical applications and perioperative complications. PMID:26557004

  9. Validation of sleeve of straight union type B for leaks

    Energy Technology Data Exchange (ETDEWEB)

    Teutonico, Mauricio; Fazzini, Pablo [Gie S.A., Buenos Aires (Argentina)

    2009-07-01

    Analytic study and experimental validation of type B sleeve with overlapping, were done in order to determine whether they are suitable for used as permanent leaks repair in hydrocarbons transport lines. All relevant background of this type of repair was analyzed, following the guidelines defined by applicable regulations (ASME B31.8 and ASME B31.4) and modeled by finite elements methods. Solicitations under internal pressure of each one of the reinforcement parts were analyzed. All solicitations involved in welded unions were studied, so as the reinforcement effectiveness when it is filled with internal gap filler. Experimental tests were developed, consisted on the reinforcement installation upon damaged pipes and the following hydrostatic test. These tests were assisted by a digitalized measurement, to determine the solicitations at different parts of the reinforcement; strain gauges were used for this task. (author)

  10. Incretin response to a standard test meal in a rat model of sleeve gastrectomy with diet-induced obesity.

    Science.gov (United States)

    Al-Sabah, Suleiman; Alasfar, Fahad; Al-Khaledi, Ghanim; Dinesh, Reshma; Al-Saleh, Mervat; Abul, Habib

    2014-01-01

    Currently, the most effective treatment for obesity is bariatric surgery. Gastroduodenal bypass surgery produces sustained weight loss and improves glycemic control and insulin sensitivity. Previous studies have shown that sleeve gastrectomy (SG) produces similar results and implicate changes in incretin hormone release in these effects. Male Sprague-Dawley rats were divided into four groups; lean control (lean), diet-induced obesity (DIO), DIO animals that had undergone SG (SG), and DIO animals that had undergone a sham operation (sham). After a 2-week recovery period, the incretin response to a standard test meal was measured. Blood sampling was performed in free-moving rats at various time points using chronic vascular access to the right jugular vein. There was a significant increase in the bodyweight of DIO animals fed a high-fat/high-sugar diet compared with the lean animals, which was reversed by SG. DIO caused an impairment of the GLP-1 response to a standard test meal, but not the GIP response. SG resulted in a dramatic increase in the GLP-1 response to a standard test meal but had no effect on the GIP response. A rapid rise in blood sugar was observed in the SG group following a standard test meal that was followed by reactive hypoglycemia. SG dramatically increases the GLP-1 response to a standard test meal but has no effect on GIP in a rat model of DIO.

  11. De novo gastric adenocarcinoma 1 year after sleeve gastrectomy in a transplant patient

    Directory of Open Access Journals (Sweden)

    M. Masrur

    2016-01-01

    Conclusions: No direct relation has been established between sleeve gastrectomy and the development of gastric cancer. Robotic procedures allow for complex multiorgan resections, while preserving the benefits of minimally invasive surgery.

  12. Gypsum veins in Triassic Moenkopi mudrocks of southern Utah: Analogs to calcium sulfate veins on Mars

    Science.gov (United States)

    Young, B. W.; Chan, M. A.

    2017-01-01

    Well-exposed gypsum veins in the Triassic Moenkopi formation in southern Utah, USA, are similar to veins at Endeavour and Gale Craters on Mars. Both Moenkopi and Mars veins are hydrated calcium sulfate, have fibrous textures, and crosscut other diagenetic features. Moenkopi veins are stratigraphically localized with strontium and sulfur isotope ratios similar to primary Moenkopi sulfate beds and are thus interpreted to be sourced from within the unit. Endeavour veins seem to be distributed by lithology and may have a local source. Gale veins cut across multiple lithologies and appear to be sourced from another stratigraphic interval. Evaluation of vein network geometries indicates that horizontal Moenkopi veins are longer and thicker than vertical veins. Moenkopi veins are also generally oriented with the modern stress field, so are interpreted to have formed in the latest stages of exhumation. Endeavour veins appear to be generally vertical and oriented parallel to the margins of Cape York and are interpreted to have formed in response to topographic collapse of the crater rim. Gale horizontal veins appear to be slightly more continuous than vertical veins and may have formed during exhumation. Abrupt changes in orientation, complex crosscutting relationships, and fibrous (antitaxial) texture in Moenkopi and Mars veins suggest emplacement via hydraulic fracture at low temperatures. Moenkopi and Mars veins are interpreted as late-stage diagenetic features that have experienced little alteration since emplacement. Moenkopi veins are useful terrestrial analogs for Mars veins because vein geometry, texture, and chemistry record information about crustal deformation and vein emplacement.

  13. Theoretical Vibration Analysis Regarding Excitation due to Elliptical Shaft Journals in Sleeve Bearings of Electrical Motors

    OpenAIRE

    Ulrich Werner

    2012-01-01

    This paper shows a theoretical vibration analysis regarding excitation due to elliptical shaft journals in sleeve bearings of electrical motors, based on a simplified rotordynamic model. It is shown that elliptical shaft journals lead to kinematic constraints regarding the movement of the shaft journals on the oil film of the sleeve bearings and therefore to an excitation of the rotordynamic system. The solution of the linear differential equation system leads to the mathematical description ...

  14. Endoscopic sleeve gastroplasty (the Apollo method): a new approach to obesity management

    OpenAIRE

    Gontrand López-Nava-Breviere; Inmaculada Bautista-Castaño; Juan Pedro Fernández-Corbelle; Marta Trell

    2016-01-01

    Background: Many obese patients cannot lose weight or reject conventional obesity management. Endoscopic sleeve gastroplasty (the Apollo method) is a pioneering coadjuvant, interventionist technique for the integral management of obesity. Objectives: The goals of this study were to report safety and efficacy results obtained at 6 months in patients undergoing endoscopic sleeve gastroplasty. Material and methods: A prospective study was performed in 55 patients (13 males, 42 females) who were ...

  15. Design of a Soft Robotic Elbow Sleeve with Passive and Intent-Controlled Actuation

    Directory of Open Access Journals (Sweden)

    Tze Hui Koh

    2017-10-01

    Full Text Available The provision of continuous passive, and intent-based assisted movements for neuromuscular training can be incorporated into a robotic elbow sleeve. The objective of this study is to propose the design and test the functionality of a soft robotic elbow sleeve in assisting flexion and extension of the elbow, both passively and using intent-based motion reinforcement. First, the elbow sleeve was developed, using elastomeric and fabric-based pneumatic actuators, which are soft and lightweight, in order to address issues of non-portability and poor alignment with joints that conventional robotic rehabilitation devices are faced with. Second, the control system was developed to allow for: (i continuous passive actuation, in which the actuators will be activated in cycles, alternating between flexion and extension; and (ii an intent-based actuation, in which user intent is detected by surface electromyography (sEMG sensors attached to the biceps and triceps, and passed through a logic sequence to allow for flexion or extension of the elbow. Using this setup, the elbow sleeve was tested on six healthy subjects to assess the functionality of the device, in terms of the range of motion afforded by the device while in the continuous passive actuation. The results showed that the elbow sleeve is capable of achieving approximately 50% of the full range of motion of the elbow joint among all subjects. Next, further experiments were conducted to test the efficacy of the intent-based actuation on these healthy subjects. The results showed that all subjects were capable of achieving electromyography (EMG control of the elbow sleeve. These preliminary results show that the elbow sleeve is capable of carrying out continuous passive and intent-based assisted movements. Further investigation of the clinical implementation of the elbow sleeve for the neuromuscular training of neurologically-impaired persons, such as stroke survivors, is needed.

  16. Pulmonary Vein, Dorsal Atrial Wall and Atrial Septum Abnormalities in Podoplanin Knockout Mice With Disturbed Posterior Heart Field Contribution

    NARCIS (Netherlands)

    Douglas, Yvonne L.; Mahtab, Edris A. F.; Jongbloed, Monique R. M.; Uhrin, Pavel; Zaujec, Jan; Binder, Bernd R.; Schalij, Martin J.; Poelmann, Robert E.; Deruiter, Marco C.; Gittenberger-De Groot, Adriana C.

    The developing sinus venosus myocardium, derived from the posterior heart field, contributes to the atrial septum, the posterior atrial wall, the sino-atrial node, and myocardium lining the pulmonary and cardinal veins, all expressing podoplanin, a coelomic and myocardial marker. . We compared

  17. Commercialization of vein contrast enhancement

    Science.gov (United States)

    Lovhoiden, Gunnar; Deshmukh, Harshal; Vrancken, Carlos; Zhang, Yong; Zeman, Herbert D.; Weinberg, Devin

    2003-07-01

    An ongoing clinical study of an experimental infrared (IR) device, the Vein Contrast Enhancer (VCE) that visualizes surface veins for medical access, indicates that a commercial device with the performance of the existing VCE would have significant clinical utility for even a very skilled phlebotomist. A proof-of-principle prototype VCE device has now been designed and constructed that captures IR images of surface veins with a commercial CCD camera, transfers the images to a PC for real-time software image processing to enhance the vein contrast, and projects the enhanced images back onto the skin with a modified commercial LCD projector. The camera and projector are mounted on precision slides allowing for precise mechanical alignment of the two optical axes and for measuring the effects of axes misalignment. Precision alignment of the captured and projected images over the entire field-of-view is accomplished electronically by software adjustments of the translation, scaling, and rotation of the enhanced images before they are projected back onto the skin. This proof-of-principle prototype will be clinically tested and the experience gained will lead to the development of a commercial device, OnTarget!, that is compact, easy to use, and will visualize accessible veins in almost all subjects needing venipuncture.

  18. Single-Incision Sleeve Gastrectomy Using a Novel Technique for Liver Retraction

    Science.gov (United States)

    Choh, Mark; Gorodner, Maria V.

    2010-01-01

    Introduction: Laparoscopic sleeve gastrectomy has rapidly gained popularity in the field of bariatric surgery, mainly due to its low morbidity and mortality. Traditionally, 4 to 6 trocars are used. Single-access surgery has emerged as an attempt to decrease incisional morbidity and enhance cosmetic benefits. We present our initial 7 patients undergoing single-incision laparoscopic sleeve gastrectomy using a novel technique for liver retraction. Methods: Patients who underwent single-incision laparoscopic sleeve gastrectomy between March 2009 and May 2009 were analyzed. A 4-cm left paramedian incision was used. Laparoscopic sleeve gastrectomy was performed in a standard fashion using a 40 French bougie. Results: Seven patients underwent single-incision sleeve gastrectomy at the University of Illinois at Chicago. They were all female with a mean age of 34 years. Preoperative BMI was 49kg/m2 (range, 39 to 64). There were no intraoperative complications. Mean operative time was 103 minutes. Estimated blood loss was minimal. All 7 patients were discharged on postoperative day 2 and were doing well without any complications at 3.1±0.7 months after surgery. Conclusion: Single-incision laparoscopic sleeve gastrectomy is safe and feasible and can be performed without changing the existing principles of the procedure. Our technique for internal liver retraction provides adequate exposure and is reproducible. Development of improved standard instrumentation is required for this technique to become popular. PMID:20932374

  19. Classification of myocardial infarction

    DEFF Research Database (Denmark)

    Saaby, Lotte; Poulsen, Tina Svenstrup; Hosbond, Susanne Elisabeth

    2013-01-01

    The classification of myocardial infarction into 5 types was introduced in 2007 as an important component of the universal definition. In contrast to the plaque rupture-related type 1 myocardial infarction, type 2 myocardial infarction is considered to be caused by an imbalance between demand...... and supply of oxygen in the myocardium. However, no specific criteria for type 2 myocardial infarction have been established....

  20. Transient myocardial ischemia after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1995-01-01

    Ambulatory ST-segment monitoring is a relatively new device in the evaluation of myocardial ischemia. The method is unique in allowing us to continuously examine the patient over an extended period of time in a changing environmental milieu. In survivors of acute myocardial infarction the prevale...

  1. Assessment of the quality of Internet information on sleeve gastrectomy.

    Science.gov (United States)

    Corcelles, Ricard; Daigle, Christopher R; Talamas, Hector Romero; Brethauer, Stacy A; Schauer, Philip R

    2015-01-01

    The Internet is an important source of information for morbidly obese patients who are potential candidates for bariatric procedures. Over the past few years, there is growing demand for sleeve gastrectomy because of perceived technical ease balanced with excellent outcomes. The aim of this study was to assess the quality and content of available internet information pertaining to sleeve gastrectomy. Our hypothesis is that this information is inconsistent and inaccurate. A total of 50 websites were analyzed in September 2013. We used the search term "sleeve gastrectomy" to identify sites on the most common internet search engines: Google, Yahoo, Bing, and Ask. Based on popularity of use, 20 websites were obtained through the Google engine and 10 sites by each of the others. Websites were classified as academic, physician, health professional, commercial, social media, and unspecified. Quality of information was evaluated using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and the Health on the Net code (HONcode) seal accreditation. The DISCERN score varies from 0-80 points and is based on 16 questions that evaluate publication quality and reliability. The JAMA benchmark criteria range from 0-4 points assessing website authorship, attribution, disclosure, and currency. HONcode certification was assessed as present or absent website accreditation. Duplicate and inaccessible websites were excluded from the analysis. We identified 43 websites from the United States, 6 from Mexico, and 1 from Australia. The average DISCERN and JAMA benchmark scores for all websites were 46.3±14.5 and 1.6±1.1, respectively, with a median DISCERN of 48.5 (range, 16-76) and JAMA score of 2.0 (range, 0-4). Website classification distribution was 21 physician, 11 academic, 7 commercial, 5 social media, 4 unspecified, and 2 health professional. The average DISCERN and JAMA benchmark scores were 55.4±13.4 and 2.4±1.0 in the academic group, 49

  2. Immunohistochemistry comparing endoscopic vein harvesting vs. open vein harvesting on saphenous vein endothelium.

    Science.gov (United States)

    Nezafati, Mohammad Hassan; Nezafati, Pouya; Amoueian, Sakineh; Attaranzadeh, Armin; Rahimi, Hamid Reza

    2014-06-17

    The present study attempts to compare the immunohistochemistry (IHC) of von Willebrand factor (vWf) , endothelial cadherin, Caveolin and endothelial Nitric Oxide Synthase (eNOS) in VasoView Endoscopic Vein Harvesting (EVH) versus traditional Open Vein Harvesting (OVH) techniques for Coronary Artery Bypass Graft (CABG) Surgery performed in Javad al Aemeh Hospital of Mashhad, Iran in 2013,. Forty-seven patients were scheduled for CABG (30 EVH and 17 OVH) among whom patients with relatively same gender and similar age were selected. Three separate two cm vein samples were harvested from each patient's saphenous vein. Each portion was collected from distal, middle and proximal zones of the saphenous vein. The tissues were deparaffinized, and antigen retrieval was done using EZ-retriever followed by an immunohistochemistry evaluation with vWf, e-cadherin, Caveolin and eNOS. In addition, demographic questioner as of Lipid profile, FBS, BMI, and cardiovascular risk factors were collected. Data analyses, including parametric and nonparametric tests were undertaken using the SPSS 16 software. A P value  0.05). Qualitative report of vWf, e-cadherin, Caveolin and eNOS reveals no significant difference between the EVH and OVH (P > 0.05). This study indicates that VasoView EVH technique causes no endothelial damage in comparison with OVH. This study could be a molecular confirmation for the innocuous of EVH technique.

  3. Myeloid-related protein-14 regulates deep vein thrombosis

    Science.gov (United States)

    Wang, Yunmei; Gao, Huiyun; Kessinger, Chase W.; Schmaier, Alvin; Jaffer, Farouc A.; Simon, Daniel I.

    2017-01-01

    Using transcriptional profiling of platelets from patients presenting with acute myocardial infarction, we identified myeloid-related protein-14 (MRP-14, also known as S100A9) as an acute myocardial infarction gene and reported that platelet MRP-14 binding to platelet CD36 regulates arterial thrombosis. However, whether MRP-14 plays a role in venous thrombosis is unknown. We subjected WT and Mrp-14–deficient (Mrp-14-/-) mice to experimental models of deep vein thrombosis (DVT) by stasis ligation or partial flow restriction (stenosis) of the inferior vena cava. Thrombus weight in response to stasis ligation or stenosis was reduced significantly in Mrp-14-/- mice compared with WT mice. The adoptive transfer of WT neutrophils or platelets, or the infusion of recombinant MRP-8/14, into Mrp-14-/- mice rescued the venous thrombosis defect in Mrp-14-/- mice, indicating that neutrophil- and platelet-derived MRP-14 directly regulate venous thrombogenesis. Stimulation of neutrophils with MRP-14 induced neutrophil extracellular trap (NET) formation, and NETs were reduced in venous thrombi harvested from Mrp-14-/- mice and in Mrp-14-/- neutrophils stimulated with ionomycin. Given prior evidence that MRP-14 also regulates arterial thrombosis, but not hemostasis (i.e., reduced bleeding risk), MRP-14 appears to be a particularly attractive molecular target for treating thrombotic cardiovascular diseases, including myocardial infarction, stroke, and venous thromboembolism. PMID:28570273

  4. Anomalous branching pattern of the portal vein: right posterior portal vein originating from the left portal vein.

    Science.gov (United States)

    Yasaka, Koichiro; Akai, Hiroyuki; Kiryu, Shigeru

    2017-05-01

    To introduce a rare variant branching pattern of the portal vein with clinical relevance. A 55-year-old man was examined by contrast-enhanced computed tomography to investigate the cause of fever and mildly elevated hepatic enzyme levels. Based on computed tomography, liver abscesses were identified which may have caused the fever and elevated hepatic enzyme levels. And a variation in the branching pattern of the portal vein was also detected in this patient, which has not been reported previously; the right posterior portal vein originated from the end of the horizontal part of the left portal vein. Identification of this rare branching pattern of the portal vein prior to hepatectomy, liver transplantation, and portal vein embolization is considered important to prevent complications. A rare variant in which the right posterior portal vein originated from the left portal vein was identified. Recognition of this variant may be important prior to surgical or interventional radiological strategies.

  5. Extrahepatic Portal Vein Obstruction and Portal Vein Thrombosis in Special Situations: Need for a New Classification

    Science.gov (United States)

    Wani, Zeeshan A.; Bhat, Riyaz A.; Bhadoria, Ajeet S.; Maiwall, Rakhi

    2015-01-01

    Extrahepatic portal vein obstruction is a vascular disorder of liver, which results in obstruction and cavernomatous transformation of portal vein with or without the involvement of intrahepatic portal vein, splenic vein, or superior mesenteric vein. Portal vein obstruction due to chronic liver disease, neoplasm, or postsurgery is a separate entity and is not the same as extrahepatic portal vein obstruction. Patients with extrahepatic portal vein obstruction are generally young and belong mostly to Asian countries. It is therefore very important to define portal vein thrombosis as acute or chronic from management point of view. Portal vein thrombosis in certain situations such as liver transplant and postsurgical/liver transplant period is an evolving area and needs extensive research. There is a need for a new classification, which includes all areas of the entity. In the current review, the most recent literature of extrahepatic portal vein obstruction is reviewed and summarized. PMID:26021771

  6. Myocardial imaging. Coxsackie myocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Wells, R.G.; Ruskin, J.A.; Sty, J.R.

    1986-09-01

    A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1.

  7. Rare sleeve fracture of the superior patella pole in an adult due to forceful passive physiotherapy following cast immobilization.

    Science.gov (United States)

    Ro, Kyung-Han; Park, Jong-Hoon; Kim, Myo-Jong; Lee, Dae-Hee

    2014-03-01

    Sleeve fractures are generally restricted to children or adolescents, and usually occur at the lower patella pole. Here we report on a superior pole sleeve fracture in an adult that occurred following forceful passive physiotherapy after cast immobilization. To our knowledge, this is the first report of a superior pole sleeve fracture in an otherwise healthy adult. The case highlighted that a diagnosis of a superior patella pole sleeve fracture in an adult can easily be missed because it is a rare injury, and hence is unlikely to be suspected by physicians. Copyright © 2013 Elsevier B.V. All rights reserved.

  8. How Are Varicose Veins Diagnosed?

    Science.gov (United States)

    ... Examples of these factors include family history, older age, gender, pregnancy, overweight or obesity , lack of movement, and leg trauma. Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve ...

  9. How Are Varicose Veins Treated?

    Science.gov (United States)

    ... Examples of these factors include family history, older age, gender, pregnancy, overweight or obesity , lack of movement, and leg trauma. Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve ...

  10. Does single-port laparoscopic sleeve gastrectomy result in improved short-term perioperative outcomes compared to conventional multi-port laparoscopic sleeve gastrectomy?

    Science.gov (United States)

    Lo, Charlene; Latin, Ladoris; Fariñas, Ángel; Cruz Pico, Christian X; Postoev, Angelina; Ibikunle, Christopher; Sanni, Aliu

    2015-10-01

    A best evidence topic in bariatric surgery was written according to a structured protocol. The question asked whether single-port laparoscopic sleeve gastrectomy produces better short-term perioperative outcomes compared to the conventional multi-port laparoscopic sleeve gastrectomy in the treatment of morbid obesity. A Pubmed search generated 82 papers, 6 of which represented the best evidence to answer the clinical question. Of the 6, 1 paper was an updated analysis of the same patient cohort. The evidence on this subject is good. Five papers were level III, nonrandomized studies, 2 of which were prospective and 3 were retrospective cohort studies. The sixth paper was a level II, randomized, prospective study. We conclude that single-port laparoscopic sleeve gastrectomy results in less use of postoperative analgesia and better cosmetic satisfaction compared to multi-port laparoscopic sleeve gastrectomy in the short-term. The two groups showed comparable results in terms of mean operative time, mean hospitalization, and percentage excess weight loss. There was no difference in rate of postoperative complications including trocar site incisional hernia, staple line leaks, and bleeding. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  11. Complications, Reoperations, and Nutrient Deficiencies Two Years after Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Nicole Pech

    2012-01-01

    Full Text Available Background. The aim of this study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a follow-up of two years. Methods. Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included operative time, complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results. From September 26, 2005 to May 28, 2009, 82 patients (female : male = 48 : 34 with a mean age of 43.3 years (range: 22–64 and a preoperative BMI of 52.5 kg/m² (range: 36.8–77.0 underwent SG. Major complications were observed in 9.8% of the patients, with 1 death. During follow up 51.2% of patients were supplemented with iron, 36.6% with zinc, 37.8% with calcium, 26.8% with vitamin D, 46.3% with vitamin B12 and 41.5% with folic acid. %EWL was 54.3, 65.3 and 62.6% after 6, 12 and 24 months. Conclusion. SG as a single step procedure is an effective bariatric intervention. Nutritional deficiencies after SG can be detected by routine nutritional screening. Our results show that Vitamin B12 supplementation should suggest routinely after SG.

  12. Psychological changes in morbidly obese patients after sleeve gastrectomy.

    Science.gov (United States)

    Melero, Yolanda; Ferrer, José Vicente; Sanahuja, Angel; Amador, Lydia; Hernando, Denise

    2014-01-01

    The aim of this study is to observe the psychological changes at one year postop in a group of patients undergoing laparoscopic vertical sleeve gastrectomy (GVL) and multidisciplinary follow- up. A total of 46 patients with a BMI-35 or higher, who were selected for GVL, completed psychological testing. After GVL surgery, patients received psychological, nutritional, and medical attention during 12 months, and they retook the same tests. Psychological tests showed an improvement on almost all scales tested, except perfectionism. The most significant change was in the benchmark for Eating Disorders with an improvement of 89% for bulimia (P<.01), and 55% for body dissatisfaction (P<.01) and ineffectiveness (P<.01). In quality of life there was an improvement of 57% in the change in health status (P<.01). During our study, a protocol involving GVL and multidisciplinary follow-ups seems proved to be an effective intervention for improving bulimic symptoms and quality of living. The results of these psychological changes are similar to Roux-en-Y Gastric bypass but different to vertical banded gastroplasty or adjustable gastric band, according to previous studies. However, long-term studies are necessary to confirm this trend. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  13. Nutritional deficiencies after sleeve gastrectomy: can they be predicted preoperatively?

    Science.gov (United States)

    Ben-Porat, Tair; Elazary, Ram; Yuval, Jonathan B; Wieder, Ariela; Khalaileh, Abed; Weiss, Ram

    2015-01-01

    Nutritional deficiencies are common among morbidly obese patients. Data are scarce for patients who have undergone laparoscopic sleeve gastrectomy (LSG). The aim of the study is to clarify the prevalence of deficiencies and to identify risk factors for postoperative deficiencies. Hebrew University, Israel. Preoperative and 1-year postoperative data were collected. We included anthropometric parameters, obesity-related co-morbidities, and laboratory findings. There were 192 candidates. Seventy-seven of them completed follow-ups at 12 months. Before surgery, 15% had anemia. Deficiencies of iron, folate, and B12 were 47%, 32%, and 13%, respectively. Women were more deficient in iron (56% women, 26% men, Psurgery, low levels of vitamin D and elevated parathyroid hormone (PTH) were 99% and 41%, respectively. One year postsurgery, the deficiencies of hemoglobin and vitamin B12 worsened (20% and 17%, Pdeficiencies of iron, folate, vitamin D, and PTH improved (28%, 21%, 94%, and 10%, respectively). Deficiencies of hemoglobin, folate, and B12 before surgery were predictors for deficiencies 1 year after surgery (P = .006 OR = .090; P = .012 OR = .069; P = .062 OR = .165, respectively). LSG had a modest effect on nutritional deficiencies in our patients at 1-year postsurgery. Focusing on the preoperative nutritional status and tailoring a specific supplemental program for each individual should prevent postoperative deficiencies. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  14. Morbidity and mortality after neoadjuvant therapy and sleeve lobectomyin N2-disease

    Directory of Open Access Journals (Sweden)

    Corinna LUDWIG

    2008-10-01

    Full Text Available Background and objective Sleeve resections were introduced to preserve lung function in patients with limited pulmonary reserve. Increasing experience with sleeve resection has reduced the rate of pneumonectomy below 10%. The aim of the study was to assess the outcome after neoadjuvant chemo- or chemoradiotherapy and sleeve resection in patients with N2 non-small cell lung cancer. Methods Retrospective analysis of 41 patient records between 01.01.2005 and 31.12.2007 underwent induction therapy in N2-disease followed by tracheobronchial sleeve resection. These patients were compared to the overall results after sleeve resection in our institution. Data analysed were; length of chest tube drainage in days, length of hospital stay, complications, morbidity and hospital mortality. Results In 178 patients, an anatomical bronchoplastic resection was performed. Preoperative chemotherapy in N2-disease (n =42 was given in 30 patients and radiochemotherapy in 11 patients. The length of the operation was between 94 min-493 min (average 143 min. Chest tubes were removed on average after 5 days. Patients were discharged after 10 days. R0-resection was possible in 90%. The overall complication rate was 27% (11/41. The rate of bronchial anastomotic leakage was 9.7%(4/41. Two patients with postoperative respiratory insufficiency and mechanical ventilation, 1 patient with technical failure required early correction of the suture and one patient with a necrosis of the anastomosis. 30-day hospital mortality rate was 2.4% (1/41. Conclusion Sleeve resection after neoadjuvant therapy has a higher local morbidity (anastomotic insufficiency 9.7% vs 2.8%. This may be explained by the quality of the surrounding tissue after neoadjuvant therapy, which compromises healing of the anastomosis. However, the results are comparable to those without induction therapy interms of radicality, and 30-d mortality rate (P >0.05. We therefore believe that sleeve resection after

  15. GERD and acid reduction medication use following gastric bypass and sleeve gastrectomy.

    Science.gov (United States)

    Barr, Alex C; Frelich, Matthew J; Bosler, Matthew E; Goldblatt, Matthew I; Gould, Jon C

    2017-01-01

    Gastroesophageal reflux disease is a common comorbid medical condition of obesity. Laparoscopic sleeve gastrectomy has been associated with de novo and worsening GERD following surgery. For this reason, patients who suffer from GERD and are considering bariatric surgery are often counseled to undergo gastric bypass. Given this practice, we sought to determine acid reduction medication (ARM) utilization in bariatric surgical patients who undergo one of these procedures prior to surgery and at 1 year following surgery. A retrospective review of prospectively maintained data on patients to undergo gastric bypass or sleeve gastrectomy between November 2012 and December 2014 was conducted after IRB approval. ARM utilization and Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) scores [range 0 (no symptoms)-50 (severe GERD)] were compared prior to surgery and at 1 year postoperatively. 334 patients underwent an eligible procedure in the study interval. 147 patients (44 %) had data on both preoperative and 1 year postoperative ARM use (93 gastric bypass and 54 sleeve gastrectomy). ARM utilization prior to surgery in gastric bypass patients did not reach statistical significance when compared to sleeve gastrectomy (40.9 vs. 26 %, p = 0.07). GERD-HRQL scores were greater prior to surgery in gastric bypass patients (GERD-HRQL 8.2 vs. 1.9; p sleeve gastrectomy patients had a significantly higher rate of overall ARM use (48.1 vs. 16.1 %, p sleeve; p = 0.72). Laparoscopic sleeve gastrectomy is associated with a significantly increased likelihood that acid reduction medications will be necessary for GERD symptom control 12 months postoperatively when compared to gastric bypass.

  16. Preoperative ultrasound mapping of the saphenous vein

    DEFF Research Database (Denmark)

    Levi, Niels; Schroeder, T

    1997-01-01

    A prospective series of 92 patients had their greater saphenous vein assessed with duplex ultrasound scanning prior to planned infrainguinal bypass procedures. Sixteen (17%) bypass procedures thrombosed within the first week postoperatively. A naturally occurring optimal vein diameter was discove......A prospective series of 92 patients had their greater saphenous vein assessed with duplex ultrasound scanning prior to planned infrainguinal bypass procedures. Sixteen (17%) bypass procedures thrombosed within the first week postoperatively. A naturally occurring optimal vein diameter...

  17. Preoperative mapping of the saphenous vein

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Sillesen, H; Nielsen, Tina G

    1995-01-01

    A consecutive series of 92 patients had their greater saphenous vein assessed with duplex ultrasound scanning prior to planned infrainguinal bypass procedures. A naturally occurring optimal vein diameter was discovered. It was significantly correlated with higher postoperative ankle-brachial pres......A consecutive series of 92 patients had their greater saphenous vein assessed with duplex ultrasound scanning prior to planned infrainguinal bypass procedures. A naturally occurring optimal vein diameter was discovered. It was significantly correlated with higher postoperative ankle...

  18. Cephalic veins in coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Licht, P; Jakobsen, Erik; Lerbjerg, G

    1996-01-01

    Various alternative conduits for aortocoronary bypass grafting have been suggested when the saphenous vein quality is inadequate. During a 10-year period we have used the cephalic vein in 39 patients. Eighteen entered an angiographic follow-up study. A total of 31 arm vein grafts were used with 43...... bypass operations....

  19. Numerical Simulation of the Liquid-Gas Interface Shape in the Shot Sleeve of Cold Chamber Die Casting Machine

    Science.gov (United States)

    Han, Tsung-Hsien; Kuo, Jer-Haur; Hwang, Weng-Sing

    2007-10-01

    A mathematical model has been developed to simulate the flow pattern of molten metal and to predict the liquid-gas interface shape in the shot sleeve of a cold chamber die casting machine during the injection stage. The flow pattern in the shot sleeve is known to be closely related to the extent of gas entrapment of molten metal in the sleeve during the injection operation. In this study, a Variable Spacing Even Mesh (VSEM) method is proposed to incorporate with a computational fluid dynamics technique, named SOLA-MAC, to simulate the flow pattern in the shot sleeve. SOLA-MAC can deal with free surface flow problems while the VSEM method is used to handle the problem where the space in the shot sleeve keeps decreasing as the plunger moves to push the molten metal. The model is then tested on the shot sleeve of a cold chamber die casting machine. Four plunger speeds are tested to demonstrate the effects on the flow pattern of molten metal in the shot sleeve. The critical speed found in this study is 38 cm/s and it is close to the reported critical speed under the conditions that the space between the plunger and the sleeve end is 5 cm in diameter and 30 cm in length, and the fill ratio is 50%. As the plunger speed is slower than the critical speed, the wave front propagates along the sleeve faster than the plunger and reflects against the end wall of the sleeve. The remaining air in the shot sleeve is entrained as the wave front enters to the gate. As the plunger speed is higher than the suggested critical speed, the melt is immediately pushed higher in front of the plunger and forms a surge. The surge traps air in the early stage of the injection process.

  20. Metabolic Effects of Sleeve Gastrectomy in a Female Rat Model of Diet-Induced Obesity

    Science.gov (United States)

    Brinckerhoff, Tatiana Z.; Bondada, Sandhya; Lewis, Catherine E.; French, Sam; DeUgarte, Daniel A.

    2011-01-01

    Background While females disproportionately undergo bariatric surgery, rodent models investigating mechanisms of bariatric surgery have been limited to males. Female rodent models can also potentially allow us to understand the effects of surgical intervention on future generations of offspring. Sleeve gastrectomy is an attractive weight loss procedure for reproductive-age female patients as it avoids the malabsorption associated with intestinal bypass. Objectives We sought to evaluate the impact of sleeve gastrectomy on young female rats with diet-induced obesity. Settings David Geffen School of Medicine at UCLA Methods Sprague Dawley female rats were fed a 60% high-fat diet. At 12 weeks of age, animals underwent either sleeve gastrectomy or sham surgery. Animals were sacrificed four weeks after surgery. A chemistry panel was performed, and serum adipokines and gut hormones were assayed. Homeostasis model assessment score (HOMA) was calculated. Liver histology was graded for steatosis. Two-sample t-test was used to compare groups. Results Sleeve gastrectomy was associated with significant weight loss (5±6% vs. −4±6%; pSleeve gastrectomy appears to result in weight loss and improvements in adiponectin and leptin via mechanisms independent of ghrelin in a female model of diet-induced obesity. PMID:22093377

  1. Staple Line Reinforcement Methods in Laparoscopic Sleeve Gastrectomy: Comparison of Burst Pressures and Leaks.

    Science.gov (United States)

    Timucin Aydin, M; Aras, Orhan; Karip, Bora; Memisoglu, Kemal

    2015-01-01

    Laparoscopic sleeve gastrectomy is a technically simple and popular bariatric operation with acceptable results. However, leaks can occur in long staple lines, for which various reinforcement methods are used. We compared nonreinforced stapling in laparoscopic sleeve gastrectomy with 3 staple line reinforcement methods: suturing, absorbable buttressing material, and fibrin glue. From March 1 until September 30, 2014, 118 patients with body mass index >40 kg/m(2) underwent sleeve gastrectomy and were enrolled in 4 groups, depending on the type of reinforcement used. The resected stomach specimens were treated with the same methods of reinforcement as used in the surgeries in the corresponding patients and then insufflated until a burst occurred. The burst pressures of the resected stomach specimens and adverse postoperative events were recorded. Five postoperative leaks occurred in the reinforcement groups (fibrin glue, 2; absorbable buttresses, 2; sutures, 1); no leaks were evident in the no-reinforcement group. Suturing afforded the highest burst pressure and took the longest to perform of the methods. There was no correlation between the leaks and burst pressures. All of the leaks occurred in the proximal fundus in the resected stomach specimens and in the affected patients. Although most surgeons use additional reinforcement on long staple lines in sleeve gastrectomy, there is no consensus about its necessity. We did not show any benefit of such reinforcement methods over proper stapling technique alone. Laparoscopic sleeve gastrectomy without staple line reinforcement is safe and avoids additional costs for reinforcement materials.

  2. Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management.

    Science.gov (United States)

    Raess, Philipp W; Baird-Howell, Marilyn; Aggarwal, Rajesh; Williams, Noel N; Furth, Emma E

    2015-01-01

    Laparoscopic vertical sleeve gastrectomy is used with increasing frequency as a therapeutic option for morbid obesity. Before the procedure, patients undergo a rigorous preoperative evaluation including double contrast upper gastrointestinal radiographic series at our institution. Patients undergoing sleeve gastrectomy are presumed to have no significant gastric pathology. To investigate the prevalence of histopathologic findings requiring clinical follow-up in sleeve gastrectomy specimens. University Hospital, United States. Retrospective review was conducted of all primary vertical sleeve gastrectomy specimens performed for morbid obesity at our institution from July 2008 until August 2012 (N = 248). Unanticipated findings warranting clinical follow-up were identified in 8.4% of cases and included cases of H. pylori gastritis, autoimmune gastritis with microcarcinoid formation, necrotizing vasculitis, and intestinal metaplasia. H. pylori was identified in 5.2% of all cases and in 33.3% of cases of gastritis. Neoplasms were identified at laparoscopy in 2 additional cases (0.8%). Surgeons and pathologists should be aware of the high prevalence of diagnoses requiring clinical follow-up in vertical sleeve gastrectomy specimens. Copyright © 2015. Published by Elsevier Inc.

  3. Sleeve fracture of the adult patella: Case report and review of the literature.

    Science.gov (United States)

    Xie, Linjun; Xu, Hong; Zhang, Lizhi; Xu, Rong; Guo, Yingkun

    2017-08-01

    The patellar fractures are common in adults, but rare in children. As a particular type of patellar fracture, however, sleeve fractures are almost always limited to children in the under 16's group. Herein, we report a rare case of a 19-year-old healthy adult female who presented sleeve fracture at the superior pole of the left patella. The clinical and radiological features are found including joint effusion, anterior tilt of the patella and a shell of bone lying proximally to the patella. Computed tomography and magnetic resonance imaging examination have been performed to further confirm the diagnosis of sleeve fracture, rupture of the quadriceps tendon and the cartilaginous injury. Under general anaesthesia, she underwent open surgical procedures for reconstituting anatomically the fracture and repairing the rupture of the quadriceps tendon. Six months after the operation, she could fully use her left knee without any pain and disability. Sleeve fractures of the patellar in adults are extremely rare, and our case is of interest for the first time occurring in healthy female adults. Our case report and literature review was aim to describe the clinic and imaging characteristics of superior pole sleeve fractures in adults, and highlight that physicians must be aware of this entity in adults so as to reduce misdiagnosis due to unfamiliarity.

  4. Crimped braided sleeves for soft, actuating arm in robotic abdominal surgery.

    Science.gov (United States)

    Elsayed, Yahya; Lekakou, Constantina; Ranzani, Tommaso; Cianchetti, Matteo; Morino, Mario; Arezzo, Alberto; Menciassi, Arianna; Geng, Tao; Saaj, Chakravarthini M

    2015-01-01

    This paper investigates different types of crimped, braided sleeve used for a soft arm for robotic abdominal surgery, with the sleeve required to contain balloon expansion in the pneumatically actuating arm while it follows the required bending, elongation and diameter reduction of the arm. Three types of crimped, braided sleeves from PET (BraidPET) or nylon (BraidGreyNylon and BraidNylon, with different monofilament diameters) were fabricated and tested including geometrical and microstructural characterisation of the crimp and braid, mechanical tests and medical scratching tests for organ damage of domestic pigs. BraidPET caused some organ damage, sliding under normal force of 2-5 N; this was attributed to the high roughness of the braid pattern, the higher friction coefficient of polyethylene terephthalate (PET) compared to nylon, and the high frequency of the crimp peaks for this sleeve. No organ damage was observed for the BraidNylon, attributed to both the lower roughness of the braid pattern and the low friction coefficient of nylon. BraidNylon also required the lowest tensile force during its elongation to similar maximum strain as that of BraidPET, translating to low power requirements. BraidNylon is recommended for the crimped sleeve of the arm designed for robotic abdominal surgery.

  5. Phaco-emulsification in completely vitrectomized eyes: Intraoperative analysis of modified phaco sleeve

    Directory of Open Access Journals (Sweden)

    Rajesh S Joshi

    2016-01-01

    Full Text Available Purpose: The purpose was to evaluate the results of modified sleeve in phacoemulsification of cataract in completely vitrectomised eyes, Materials and Methods: Twenty-five previously completely vitrectomized eyes of 23 patients having visually significant cataract were included. After through evaluation they underwent phaco-emulsification by phaco chop with a modified sleeve via temporal clear corneal incision. The modified sleeve was made by creating a small round port of approximate 1 × 1 mm size at the proximate end of the sleeve in line with the already existing ports. This port faced the posterior capsule while performing phacoemulsification. Patients were observed for any intraoperative complications. Result: The most common indication for pars plana vitrectomy in our study group was vitreous hemorrhage due to diabetic retinopathy [13 out of 25 eyes (52%]. Intraoperative findings included miosis [seen in 3 (12% eyes] and posterior capsular plaque [seen in 2(8% eyes]. No other significant intraoperative complications (posterior capsular tear, dropped nucleus were observed. Average effective phaco time was 33 sec. (±15.11. Conclusion: Though cataract surgery in postvitrectomized eyes is a challenging situation, modified sleeve prevents anterior chamber fluctuation and avoids complications arising out of it, making the surgery safe.

  6. Recurrence of superficial vein thrombosis in patients with varicose veins.

    Science.gov (United States)

    Karathanos, Christos; Spanos, Konstantinos; Saleptsis, Vassileios; Tsezou, Aspasia; Kyriakou, Despina; Giannoukas, Athanasios D

    2016-08-01

    To investigate which factors other than history of superficial vein thrombosis (SVT) are associated with recurrent spontaneous SVT episodes in patients with varicose veins (VVs). Patients with a history of spontaneous SVT and VVs were followed up for a mean period of 55 months. Demographics, comorbidities, and thrombophilia screening test were analyzed. Patients were grouped according to the clinical-etiology-anatomy-pathophysiology classification. A multiple logistic regression analysis with the forward likelihood ratio method was undertaken. Thirteen patients out of 97 had a recurrence SVT episode during the follow-up period. All those patients were identified to have a thrombophilia defect. Protein C and S, antithrombin, and plasminogen deficiencies were more frequently present in patients without recurrence. Gene mutations were present in 38% in the nonrecurrence group and 77% in the recurrence group. After logistic regression analysis, patients with dislipidemia and mutation in prothrombin G20210A (FII) had an increased risk for recurrence by 5.4-fold and 4.6-fold, respectively. No deep vein thrombosis or pulmonary embolism occurred. Dislipidemia and gene mutations of F II are associated with SVT recurrence in patients with VVs. A selection of patients may benefit from anticoagulation in the short term and from VVs intervention in the long term. © The Author(s) 2015.

  7. Unusual termination of the right testicular vein | Woldeyes | Anatomy ...

    African Journals Online (AJOL)

    The testicular veins are formed by the veins emerging from the testis and epididymis forming the pampiniform venous plexus. The right testicular vein drains into inferior vena cava and the left testicular vein to the left renal vein. Testicular veins display a great variability with regard to their number, course and sites of ...

  8. The Impact of Sleeve Gastrectomy on Hyperlipidemia: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Khalid Al Khalifa

    2013-01-01

    Full Text Available Background. Weight loss and reduction in comorbidities can be achieved by longitudinal sleeve gastrectomy (LSG. Existing evidence suggests that LSG resolves or improves hyperlipidemia in morbidly obese patients. The aim of this study was to systematically review the effect of LSG on hyperlipidemia. Methods. A systematic literature search was conducted from English-language studies published from 2000 to 2012 for the following databases: MEDLINE, EMBASE, CINAHL, PubMed, Clinical evidence, Scopus, Dara, Web of Sciences, TRIP, Health Technology Database, Cochrane library, and PsycINFO. Results. A total of 4,211 articles were identified in the initial search, and 4,185 articles were excluded based on the exclusion criteria. Twenty-six studies met the inclusion criteria for this systematic review, involving 3,591 patients. The mean preoperative body mass index (BMI was 48±7.0 kg/m2 (range 37.2–65.3. The mean postoperative BMI was 35 ± 5.9 kg/m2 (range 26.3–49. The mean percentage of excess weight loss (EWL was 63.1% (range 37.7–84.5, with a mean followup of 19.1 months (range 6–60. The mean levels of pre and post operative cholesterol were 194.4 ± 12.3 mg/dL (range 178–213 and 181 ± 16.3 mg/dL (range 158–200, respectively. Conclusion. Most patients with hyperlipidemia showed improvement or resolution of lipid profiles after LSG. Based on this systematic review, LSG has a significant effect on hyperlipidemia in the form of resolution or improvement in the majority of patients.

  9. Gastric histopathologies in patients undergoing laparoscopic sleeve gastrectomies.

    Science.gov (United States)

    Almazeedi, Sulaiman; Al-Sabah, Salman; Al-Mulla, Ahmed; Al-Murad, Ahmed; Al-Mossawi, Abdulsamad; Al-Enezi, Khaled; Jumaa, Talib; Bastaki, Waleed

    2013-03-01

    With 80 % of its population overweight, 47.5 % obese, and having the eighth fattest population worldwide, Kuwait has a serious obesity problem. This has led to widespread practice of bariatric surgery, with little or no studies regarding operative findings and patient follow-up. This study aims to identify the prevalent gastric histopathologies of the patients who have undergone laparoscopic sleeve gastrectomy (LSG) at Amiri Hospital, Kuwait. A retrospective study was done of the gastric pathology specimen results of 656 patients who underwent LSG at Amiri Hospital from 2008 to 2012. Of the 656 patients, the average age was 33 years, and 480 (73.2 %) were female while 176 (26.8 %) were male. The histopathology results identified 488 (74.4 %) cases with chronic gastritis, 63 (9.6 %) with follicular gastritis, and 12 (1.8 %) with atrophic gastritis. A total of 12 (1.8 %) cases showed findings other than gastritis, including four (0.6 %) cases of gastric polyps, three (0.5 %) cases of granulomatous disease, and one (0.2 %) case each of the following: gastro-intestinal stromal tumor, gastro-intestinal autonomic nerve tumor, intestinal metaplasia, collagenous gastritis, and crypt cell apoptosis. Helicobacter pylori was discovered in 48 (7.3 %) of the patients. The majority of gastric histopathology results after LSG in this study had an element of chronic gastritis (74.4 %), which is in keeping with previous studies showing its high prevalence among the obese population. However, a few cases had clinically significant pathologies, and this may alter post-operative management. In view of these results, routine histological examination of the gastric specimens is highly recommended.

  10. The Impact of Sleeve Gastrectomy on Hyperlipidemia: A Systematic Review

    Science.gov (United States)

    Al Khalifa, Khalid; Alsayed, Abdul Rahim; Violato, Claudio

    2013-01-01

    Background. Weight loss and reduction in comorbidities can be achieved by longitudinal sleeve gastrectomy (LSG). Existing evidence suggests that LSG resolves or improves hyperlipidemia in morbidly obese patients. The aim of this study was to systematically review the effect of LSG on hyperlipidemia. Methods. A systematic literature search was conducted from English-language studies published from 2000 to 2012 for the following databases: MEDLINE, EMBASE, CINAHL, PubMed, Clinical evidence, Scopus, Dara, Web of Sciences, TRIP, Health Technology Database, Cochrane library, and PsycINFO. Results. A total of 4,211 articles were identified in the initial search, and 4,185 articles were excluded based on the exclusion criteria. Twenty-six studies met the inclusion criteria for this systematic review, involving 3,591 patients. The mean preoperative body mass index (BMI) was 48 ± 7.0 kg/m2 (range 37.2–65.3). The mean postoperative BMI was 35 ± 5.9 kg/m2 (range 26.3–49). The mean percentage of excess weight loss (EWL) was 63.1% (range 37.7–84.5), with a mean followup of 19.1 months (range 6–60). The mean levels of pre and post operative cholesterol were 194.4 ± 12.3 mg/dL (range 178–213) and 181 ± 16.3 mg/dL (range 158–200), respectively. Conclusion. Most patients with hyperlipidemia showed improvement or resolution of lipid profiles after LSG. Based on this systematic review, LSG has a significant effect on hyperlipidemia in the form of resolution or improvement in the majority of patients. PMID:24286009

  11. Complications and nutrient deficiencies two years after sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Pech Nicole

    2012-07-01

    Full Text Available Abstract Background The aim of this systematic study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG during a median follow-up of two years. Methods Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL. Results From September 26, 2005 to May 28, 2009, 100 patients (female: male = 59:41 with a mean age of 43.6 years (range: 22–64 and a preoperative BMI of 52.3 kg/² (range: 36–77 underwent SG. The mean operative time was 86.4 min (range: 35–275. Major complications were observed in 8.0 % of the patients. During the follow-up period, 25 patients (25.0 % underwent a second bariatric intervention (22 DS and 3 RYGBP. Out of the total 100 patients, 48 % were supplemented with iron, 33 % with zinc, 34 % with a combination of calcium carbonate and cholecalciferol, 24 % with vitamin D, 42 % with vitamin B12 and 40 % with folic acid. The patients who received only a SG (n = 75 had %EWL of 53.6, 65.8 and 62.6 % after 6, 12 and 24 months, respectively. Conclusions SG is a highly effective bariatric intervention for morbidly obese patients. Nutritional deficiencies resulting from the procedure can be detected by routine nutritional screening. Results of the study show that Vitamin B12 supplementation should suggested routinely.

  12. Poor Health Behaviors Prior to Laparoscopic Sleeve Gastrectomy Surgery.

    Science.gov (United States)

    Oved, Irit; Vaiman, Inbal Markovitz; Hod, Keren; Mardy-Tilbor, Limor; Torban, Yakov; Dagan, Shiri Sherf

    2017-02-01

    Identifying eating and lifestyle behaviors prior to bariatric surgery may assist in better selecting and preparing patients and might lead to improved success rate. The current study aimed to assess eating behaviors and lifestyle trends among laparoscopic sleeve gastrectomy (LSG) candidates and to compare those trends between genders. This descriptive study was conducted in the bariatric clinic at the Haifa Assuta Medical Center. Data was gathered from medical records of LSG candidates that were evaluated before surgery in our institution between 2008 and 2011. The data included demographics, comorbidities, anthropometrics, weight management history, and lifestyle parameters. Eating pattern and eating habits were determined by eating habits questionnaires. A total of 266 LSG surgery candidates (71.4 % female) with an average age of 40.7 ± 10.9 years and pre-surgery BMI of 42.4 ± 4.8 kg/m2 were studied. More than half of the patients have family history of obesity and their onset of obesity was before the age of 18 years (54.5 and 57.9 %, respectively). Most of the patients reported on poor eating habits and sedentary lifestyle: 65.1 % do not eat regular meals, 70.3 % skip over breakfast, 61.9 % presented loss of control eating, 45 % frequently consume sweets, and 80.1 % were classified as none active. There were no differences in eating patterns or lifestyle parameters between genders. High occurrence of unhealthy eating habits and a non-active lifestyle were detected in morbid obese candidates for LSG surgery. More efforts should be directed towards nutritional and lifestyle education prior to the surgery.

  13. [Laparoscopic sleeve gastrectomy (LSG) in adolescents with morbid obesity].

    Science.gov (United States)

    Landau, Zohar; Karplus, Gideon; Hanukoglu, Aaron; Abiri, Shirli; Levy, Anat; Serour, Francis

    2011-10-01

    Morbid obesity has become a significant health problem for the pediatric population. The medical impact of obesity in youth is determinant. Conservative methods for weight loss are disappointing and therefore, bariatric surgery should be considered. To present the experience of laparoscopic sleeve gastrectomy in adolescents with morbid obesity, treated by the pediatric multi-disciplinary obesity clinic. All patients (n=7, all female) participated in a weight loss program for at least 6 months without success. At referral, the mean age was 16.2 years (range 13.8 - 18 years), mean body mass index (BMI in kg/m2) was 44.4 (range 38.9-55.2). All suffered from various co-morbidities of obesity: type 2 diabetes, insulin treated (n=1), hypertension (n=5), fatty liver (n=2), obstructive sleep apnea (n=2) and pseudotumor cerebri (n=1). There were no intra- or postoperative complications. After a mean follow-up of 15.1 months (range 5-25 months), all patients but one had reduced BMI (mean BMI of 32.55). In all subjects who lost weight, remission or improvement of the co-morbidities was noted. In this study, with a mean follow-up of 15.1 months, LSG was proven to be a safe and effective option of bariatric surgery in adolescents, resulting in a significant weight loss and remission or improvement of co-morbidities. We suggest that LSG might be considered as a single intervention for morbid obesity in adolescents. Long-term studies are needed to evaluate the efficacy of LSG and other bariatric surgeries in adolescents.

  14. Preoperative Weight Loss and Operative Outcome After Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Watanabe, Atsushi; Seki, Yosuke; Haruta, Hidenori; Kikkawa, Eri; Kasama, Kazunori

    2017-10-01

    Use of a preoperative diet before bariatric surgery to improve postoperative complications and weight loss has been reported. However, evidence supporting this diet for laparoscopic sleeve gastrectomy (LSG) is insufficient. We aimed to investigate postoperative outcomes influenced by preoperative diet before LSG. This study included 247 patients who underwent LSG after preoperative weight management. They were classified according to preoperative weight changes (group 1, weight gain; group 2, 0-3.0% total weight loss (TWL); group 3, 3.1-5.0% TWL; group 4, >5.1% TWL) and investigated for early postoperative complications and weight loss at 1 year. There were 37 patients in group 1, 79 in group 2, 64 in group 3, and 67 in group 4. There were no statistical differences in initial physical status among the 4 groups. The median BMI declined to 27.6 kg/m2 in the entire group. Although the average %TWL during the combined preoperative and postoperative periods showed no statistical differences (P = 0.69), the average %TWL during the postoperative period decreased gradually as the extent of preoperative weight loss increased (P = 0.01). The early postoperative complication rate for the entire group was 6.9%; it tended to be lower as the extent of preoperative weight loss increased. However, a multiple logistic regression model demonstrated that the preoperative diet was not a statistical predictor of reduced early postoperative complications (P = 0.28). The extent of preoperative weight loss statistically affected postoperative weight loss. A preoperative diet might have minor advantages in reducing the risk of early postoperative complications.

  15. Splenic infarction as a complication of laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Maciej Michalik

    2011-06-01

    Full Text Available Introduction: Laparoscopic sleeve gastrectomy (LSG as a stand-alone or a first step in the biliopancreatic diversion –duodenal switch (BPD-DS procedure is frequently the surgery of choice for the 21st century’s epidemic of morbid obesity.To date, LSG as a relatively new method has few complications reported and analysed.Aim: The article describes splenic infarction, not reported so far, a potentially serious complication of LSG, analyses itscauses, and suggests a considerate treatment and follow-up protocol.Material and methods: During the observation period between March and November 2008, 24 LSG patients(20 female and 4 male were enrolled with mean body mass index of 44 kg/m2. All LSG procedures were recorded.Computerized statistical software Statistica 7 StatSoft, Krakow, Poland was used for analysis. Statistical significancewas calculated with nonparametric tests (p < 0.05.Results: In 4 patients (17% splenic infarction was diagnosed intraoperatively. Consecutive angio-CT scan confirmedinfarction of the upper splenic pole with 12% to 33% of the splenic pulp affected. Two out of 4 patients had oneminor perioperative complication. There were no significant differences between patients. Video analysis excludedpossible technical errors.Conclusions: The described analysis suggests short gastric vessels and upper terminal splenic artery branch dissectionas possible causative factors of splenic infarction in the course of LSG. We suggest a considerate protocol with abdominalcavity inspection at the beginning and end of the procedure, angio-CT scans, prophylactic LMWH, initial broadspectrum intravenous antibiotics, and appropriate follow-up with neither splenectomy nor related immunization.

  16. [Histoautoradiographic study of the heart in experimental myocardial ischemia].

    Science.gov (United States)

    Makhova, A N; Shliapnikov, V N

    1979-01-01

    Autoradiographic examinations of the heart muscle in experimental myocardial necroses using 3H-thymidine, revealed a high DNA synthesis in the connective tissue cells in the zone of necrosis in the acute period of infarction and its subsequent decrease. Deviations from this regularity were observed when relapses of necrosis developed. The activation of DNA synthesis occurred to a lesser extent in stromal cells of the periinfarction and remote zones of the heart. Muscle cells incorporated 3H-thymidine extremely rarely. When myocardial infarction was combined with aterosclerosis, relapses of necrosis occurred frequently, and morphological changes in many arteries and veins were accompanied by 3H-thymidine incorporation into the nuclei of the endothelium, smooth cells and adventitial cells. Inhibition of DNA synthesis in connective tissue cells of various heart zones was observed in cases of combined myocardial infarction and aterosclerosis and hypertension.

  17. Theoretical Vibration Analysis Regarding Excitation due to Elliptical Shaft Journals in Sleeve Bearings of Electrical Motors

    Directory of Open Access Journals (Sweden)

    Ulrich Werner

    2012-01-01

    Full Text Available This paper shows a theoretical vibration analysis regarding excitation due to elliptical shaft journals in sleeve bearings of electrical motors, based on a simplified rotordynamic model. It is shown that elliptical shaft journals lead to kinematic constraints regarding the movement of the shaft journals on the oil film of the sleeve bearings and therefore to an excitation of the rotordynamic system. The solution of the linear differential equation system leads to the mathematical description of the movement of the rotor mass, the shaft journals, and the sleeve bearing housings. Additionally the relative movements between the shaft journals and the bearing housings are deduced, as well as the bearing housing vibration velocities. The presented simplified rotordynamic model can also be applied to rotating machines, other than electrical machines. In this case, only the electromagnetic spring value cm has to be put to zero.

  18. Robotic versus Laparoscopic Sleeve Gastrectomy for Morbid Obesity: a Systematic Review and Meta-analysis.

    Science.gov (United States)

    Magouliotis, Dimitrios E; Tasiopoulou, Vasiliki S; Sioka, Eleni; Zacharoulis, Dimitrios

    2017-01-01

    We aim to review the available literature on obese patients treated with robotic or laparoscopic sleeve gastrectomy, in order to compare the clinical outcomes and intraoperative parameters of the two methods. A systematic literature search was performed in PubMed, Cochrane Library and EBSCOhost databases, in accordance with the PRISMA guidelines. Sixteen studies met the inclusion criteria incorporating 29,787 patients. Robotic sleeve gastrectomy (RSG) technique showed significantly higher mean operative time and increased length of hospital stay. Post-operative incidence of leakage, wound infection and bleeding, along with weight reduction, were comparable. The majority of the studies assessing charges found increased cost in RSG population. Well-designed, randomized controlled studies, comparing RSG to laparoscopic sleeve gastrectomy (LSG), are necessary to assess further their clinical outcomes and cost-effectiveness.

  19. Impact of the sleeve thickness on the armature eccentricity in a solenoid valve

    Directory of Open Access Journals (Sweden)

    Goraj Robert

    2016-06-01

    Full Text Available Most studies on solenoid valves (SVs assumed that the armature is concentrically positioned in the sleeve. Under this assumption the transversal component of the magnetic force is equal zero. The article presents an analytical calculation model for the estimation of the armature eccentricity. Using this model the eccentricity was calculated as a function of the sleeve thickness and the hydraulic clearance between the armature and the sleeve. After finding the eccentricity also the permeance of the radial air gap was calculated. This permeance has a direct influence on the drop of the magnetomotive force in the magnetic circuit and finally influences also the axial component of the magnetic force. In the article a calculation of both transversal and axial components of the magnetic force was carried out and presented in the appendix to the article.

  20. Robot-assisted sleeve gastrectomy in morbidly obese versus super obese patients.

    Science.gov (United States)

    Bhatia, Parveen; Bindal, Vivek; Singh, Rahul; Gonzalez-Heredia, Raquel; Kalhan, Sudhir; Khetan, Mukund; John, Suviraj

    2014-01-01

    This study evaluates our technique for robot-assisted sleeve gastrectomy for morbidly obese and super obese patients and our outcomes. A retrospective analysis of patients who underwent robot-assisted sleeve gastrectomy at a single center was performed. The procedure was performed with the da Vinci Si HD Surgical System (Intuitive Surgical, Sunnyvale, California). The staple line was imbricated with No. 2-0 polydioxanone in all cases. The super obese (body mass index≥50 kg/m2) subset of patients was compared with the morbidly obese group in terms of demographic characteristics, comorbidities, operative times, perioperative complications, and excess body weight loss. A total of 35 patients (15 female and 20 male patients) with a mean body mass index of 48.17±11.7 kg/m2 underwent robot-assisted sleeve gastrectomy. Of these patients, 11 were super obese and 24 were morbidly obese. The mean operative time was 116.3±24.7 minutes, and the mean docking time was 8.9±5.4 minutes. Mean blood loss was 19.36±4.62 mL, and there were no complications, conversions, or perioperative deaths. When compared with the morbidly obese patients, the super obese patients showed no significant difference in operative time, blood loss, and length of hospital stay. There was a steep decline in operating room times after 10 cases of robot-assisted sleeve gastrectomy. This study shows the feasibility and safety of robot-assisted sleeve gastrectomy. Robotic assistance might help overcome the operative difficulties encountered in super obese patients. It shows a rapid reduction in operative times with the growing experience of the entire operative team. Robot-assisted sleeve gastrectomy can be a good procedure by which to introduce robotics in a bariatric surgery center before going on to perform Roux-en-Y gastric bypass and revision procedures.

  1. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers.

    Science.gov (United States)

    Varela, J Esteban; Nguyen, Ninh T

    2015-01-01

    Analysis of a recent single state bariatric surgery registry revealed that laparoscopic sleeve gastrectomy was the most common bariatric procedure starting in 2012. The objective of this study was to examine the trend in utilization of laparoscopic sleeve gastrectomy performed at academic medical centers in the United States. Using ICD-9 diagnosis and procedure codes, clinical data obtained from the University HealthSystem Consortium database for all bariatric procedures performed for the treatment of severe obesity between October 1, 2011, and June 30, 2014. Quarterly trends in utilization for the 4 most commonly performed bariatric operations were examined, and comparisons between procedures were performed. A total of 54,953 bariatric procedures were performed. Utilization of laparoscopic sleeve gastrectomy increased from 23.7% of all bariatric procedures during the fourth quarter of 2011 to 60.7% during the second quarter of 2014 while laparoscopic gastric bypass decreased from 62.2% to 37.0%, respectively. Utilization of laparoscopic sleeve gastrectomy surpassed that of laparoscopic gastric bypass in the second quarter of 2013 (50.6% versus 45.8%). During the same time period, utilization of open gastric bypass fell from 6.6% to 1.5%, and the use of laparoscopic adjustable gastric banding decreased from 7.5% to .8%. Within the context of U.S. academic medical centers, there has been a significant increase in the utilization of laparoscopic sleeve gastrectomy, which has surpassed laparoscopic gastric bypass utilization since 2013. Laparoscopic sleeve gastrectomy is now the most commonly performed bariatric procedure at the national level within academic centers. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  2. A pilot study investigating early postoperative changes of plasma polyunsaturated fatty acids after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Aslan, Mutay; Aslan, Ibrahim; Özcan, Filiz; Eryılmaz, Ramazan; Ensari, Cemal Ozben; Bilecik, Tuna

    2014-04-03

    This study aimed to determine early postoperative changes of plasma polyunsaturated fatty acids (PUFAs) following laparoscopic sleeve gastrectomy (LSG). Ten obese patients (mean BMI: 51.10 ± 11.59 kg/m²) underwent LSG and eleven normal weight control patients (mean BMI: 24.37 ± 2.33 kg/m²) underwent laparoscopic abdominal surgery. Fasting blood samples were collected prior to surgery, at day 1 after surgery and after postoperation oral feeding. Plasma levels of arachidonic acid (AA, C20:4n6), dihomo-gamma-linolenic acid (DGLA, C20:3n6), eicosapentaenoic acid (EPA, C20:5n3) and docosahexaenoic acid (DHA, C22:6n3) were determined by an optimized multiple reaction monitoring (MRM) method using ultra fast-liquid chromatography (UFLC) coupled with tandem mass spectrometry (MS/MS). Prostaglandin E₂ (PGE2) was measured in serum samples by enzyme immunoassay. A significant decrease was observed in insulin and HOMA IR levels in sleeve gastrectomy patients after postoperation oral feeding compared to preoperation. Plasma AA levels and AA/EPA ratio were significantly increased in sleeve gastrectomy patients after postoperation oral feeding compared to postoperation day 1. Serum PGE2 levels and AA/DHA ratio was significantly higher in sleeve gastrectomy patients at preoperation, postoperation day 1 and after postoperation oral feeding when compared to control group patients. Increased peripheral insulin sensitivity associated with LSG may play a role in the significant increase of plasma AA levels in sleeve gastrectomy patients following postoperation oral feeding. The significant increase in PGE2 levels and AA/DHA ratio in sleeve gastrectomy group patients also confirms the presence of a proinflammatory state in obesity.

  3. Can Sleeve Gastrectomy "Cure" Diabetes? Long-term Metabolic Effects of Sleeve Gastrectomy in Patients With Type 2 Diabetes.

    Science.gov (United States)

    Aminian, Ali; Brethauer, Stacy A; Andalib, Amin; Punchai, Suriya; Mackey, Jennifer; Rodriguez, John; Rogula, Tomasz; Kroh, Matthew; Schauer, Philip R

    2016-10-01

    The aim of the study was to assess long-term metabolic effects of laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes (T2DM) and to identify predictive factors for long-term diabetes remission and relapse. LSG has become the most common bariatric operation worldwide. Its long-term metabolic effects in patients with T2DM are, however, unknown. Outcomes of 134 patients with obesity with T2DM who underwent LSG at an academic center during 2005 to 2010 and had at least 5 years of follow-up were assessed. At a median postsurgical follow-up of 6 years (range: 5-9), a mean body mass index loss of -7.8 ± 5.1 kg/m (total weight loss: 16.8% ± 9.7%) was associated with a reduction in mean glycated hemoglobin (HbA1c, -1.3 ± 1.8%, P diabetes medications (-1, P diabetes remission (HbA1c cure" (continuous complete remission for ≥5 years) was achieved in 3%. Long-term relapse of T2DM after initial remission occurred in 44%. Among patients with relapse, 67% maintained glycemic control (HbA1c diabetes medications at baseline predicted less long-term remission (odds ratio 0.19, 95% confidence interval 0.07-0.55, P = 0.002) and more relapse of T2DM (odds ratio 8.50, 95% confidence interval: 1.40-49.20, P = 0.02). Significant improvement in triglycerides (-53.7 ± 116.4 mg/dL, P cure" of T2DM, however, occur infrequently.

  4. Management of Distal Gastric Leak After Laparoscopic Sleeve Gastrectomy by Double Pigtail Catheter

    Directory of Open Access Journals (Sweden)

    Mani Habibi

    2016-07-01

    Full Text Available Gastric leakage postsurgery is the most feared complication of laparoscopic sleeve gastrectomy due to the difficulty of its management. While gastric leakagemanagement postsurgery is often performed using internal drainage catheters accompanied by self-expandable metal stents, endoscopic internal drainage by double pigtail catheter has recently become a recommended approach. Here we describe our treatment of a patient who experienced distal gastric leakage after undergoing laparoscopic sleeve gastrectomy using double pigtail catheter and our treatment recommendations based on the patient outcome.

  5. Early results of a Canadian laparoscopic sleeve gastrectomy experience.

    Science.gov (United States)

    Behrens, Carola; Tang, Bao Q; Amson, Bradley J

    2011-04-01

    Sleeve gastrectomy (SG) is a relatively new bariatric procedure with a number of advantages compared with Roux-en-Y gastric bypass. However, SG also has a number of disadvantages and associated risks. We sought to examine perioperative complications and outcomes of laparoscopic SG (LSG) in a single major Canadian bariatric surgery centre (Victoria, BC). Since June 2008, LSG has been performed at our centre and we reviewed the cases of all patients. We conducted a retrospective chart review in April 2010. Thirty-four patients had LSG, and none was lost to follow-up. Indications for LSG over other bariatric procedures were patient preference (n=28), severe obesity with a body mass index (BMI) greater than 60 kg/m(2) (n=5) and severe upper abdominal adhesions (n=1). All but 1 of the cohort were women, and the average age was 48 (standard deviation [SD] 11) years. Preoperatively, the average BMI was 50.3 (SD 7.7) kg/m(2). Preoperative obesity-related comorbidity rates were 56% (n=19) for type 2 diabetes mellitus (T2DM), 50% (n=17) for hypertension, 32% (n=11) for dys lipidemia, 62% (n=21) for obstructive sleep apnea (OSA), 62% (n=21) for knee and/or hip pain and 44% (n=15) for depression and/or anxiety. The mean duration of surgery was 74 (SD 21) minutes. There were 2 major perioperative complications: 1 staple line leak and 1 staple line hemorrhage. The median stay in hospital was 1 day. Postoperative upper gastrointestinal imaging studies were conducted in 11 patients; 1 was positive for staple line leak. Histopathology on the excised gastric segments revealed chronic helicobacter pylori gastritis in 2 patients and small gastrointestinal stromal tumours in 1 patient. The mean postoperative follow-up interval was 10 months. Weight loss averaged 27.4 (SD 9.0) kg. Overall weight loss was 3.3 (SD 1.8) kg/month. Resolution occurred in 74% of patients with T2DM, 53% with hypertension, 45% with dyslipidemia, 76% with OSA, 38% with joint pain and 20% with depression

  6. Myocardial Fibrosis in Athletes.

    NARCIS (Netherlands)

    Schoor, F.R. van de; Aengevaeren, V.L.; Hopman, M.T.E.; Oxborough, D.L.; George, K.P.; Thompson, P.D.; Eijsvogels, T.M.H.

    2016-01-01

    Myocardial fibrosis (MF) is a common phenomenon in the late stages of diverse cardiac diseases and is a predictive factor for sudden cardiac death. Myocardial fibrosis detected by magnetic resonance imaging has also been reported in athletes. Regular exercise improves cardiovascular health, but

  7. Acute myocardial infarction.

    Science.gov (United States)

    Reed, Grant W; Rossi, Jeffrey E; Cannon, Christopher P

    2017-01-14

    Acute myocardial infarction has traditionally been divided into ST elevation or non-ST elevation myocardial infarction; however, therapies are similar between the two, and the overall management of acute myocardial infarction can be reviewed for simplicity. Acute myocardial infarction remains a leading cause of morbidity and mortality worldwide, despite substantial improvements in prognosis over the past decade. The progress is a result of several major trends, including improvements in risk stratification, more widespread use of an invasive strategy, implementation of care delivery systems prioritising immediate revascularisation through percutaneous coronary intervention (or fibrinolysis), advances in antiplatelet agents and anticoagulants, and greater use of secondary prevention strategies such as statins. This seminar discusses the important topics of the pathophysiology, epidemiological trends, and modern management of acute myocardial infarction, focusing on the recent advances in reperfusion strategies and pharmacological treatment approaches. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Normal hepatic vein patterns on ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hae Jin; Chae, Yoo Soon; Park, Hea Yeoung; Park, Bok Hwan; Kim, Yang Sook [Maryknoll Hospital, Busan (Korea, Republic of)

    1987-02-15

    Understanding of the anatomy of the hepatic vein is important in manipulation for transplantation of the liver, hepatectomy and the treatment of hepatic trauma with avulsion of the hepatic vein. Demonstrated of the inferior right hepatic vein (IRHV) is also important; in some cases of hepatocellular carcinoma, thrombus can be seen in the IRHV; in primary Budd-Chiari syndrome, the IRHV is main draining vein; during hepatectomy, the postero-inferior segment of the right lobe and draining IRHV can be preserved. For some 10 months ultrasound examination was done in a total of 124 patients with normal liver function with special emphasis on the hepatic vein, their branches, and the IRHV, and analysed in terms of branching pattern and relative size of the hepatic vein and the detection rate of the IRHV.

  9. Review Paper: Myocardial Rupture After Acute Myocardial Infarction ...

    African Journals Online (AJOL)

    Myocardial rupture complications after acute myocardial infarction are infrequent but lethal. They mainly involve rupture of the ventricular free wall, ventricular septum, papillary muscle, or combined. We compare features of different kinds of myocardial ruptures after acute myocardial infarction by reviewing the clinical ...

  10. Endoscopic sleeve gastroplasty (the Apollo method: a new approach to obesity management

    Directory of Open Access Journals (Sweden)

    Gontrand López-Nava-Breviere

    2016-04-01

    Full Text Available Background: Many obese patients cannot lose weight or reject conventional obesity management. Endoscopic sleeve gastroplasty (the Apollo method is a pioneering coadjuvant, interventionist technique for the integral management of obesity. Objectives: The goals of this study were to report safety and efficacy results obtained at 6 months in patients undergoing endoscopic sleeve gastroplasty. Material and methods: A prospective study was performed in 55 patients (13 males, 42 females who were subjected to the Apollo technique; mean age was 43.5 years (range 25-60 and mean BMI was 37.7 kg/m² (range 30-48. All received multidisciplinary follow-up for weight loss. Weight changes and presence of complications were assessed. Through the endoscope a triangular pattern suture is performed consisting of approximately 3-6 transmural (mucosa to serosa stitches, using a cinch device to bring them nearer and form a plication. Results: A total of 6-8 plications are used to provide a tubular or sleeve-shaped restriction to the gastric cavity. No major complications developed and patients were discharged at 24 hours following the procedure. Endoscopic and radiographic follow-up at 6 months post-procedure showed a well preserved tubular form to the stomach. After 6 months patients had lost 18.9 kg and 55.3% of excess weight. Conclusions: Endoscopic sleeve gastroplasty, together with dietary and psycho-behavioral changes, is a safe, effective technique in the coadjuvant management of obese patients.

  11. Clinical–radiologic evaluation of the complications of laparoscopic sleeve gastrectomy: Value of multidetector CT

    Directory of Open Access Journals (Sweden)

    Tamir A. Hassan

    2015-12-01

    Conclusions: As LSG is performed increasingly and frequently, it is essential for radiologists to recognize the normal postoperative anatomy and identify the complications of this procedure. CT is an important imaging tool to diagnose suspected complications of laparoscopic sleeve gastrectomy procedure to ensure accurate diagnosis.

  12. Three-Trocar Sleeve Gastrectomy vs Standard Five-Trocar Technique: a Randomized Controlled Trial.

    Science.gov (United States)

    Consalvo, Vincenzo; Salsano, Vincenzo; Sarno, Gerardo; Chaze, Iphigenie

    2017-12-01

    Bariatric surgery is a treatment for morbid obesity. Different surgical procedures have been described in order to obtain excess weight loss (EWL), but currently laparoscopic sleeve gastrectomy is the most commonly performed procedure throughout the world. Reducing abdominal wall trauma and increasing the aesthetic result are important goals for all bariatric surgeons. We conducted a randomized, controlled trial in order to assess if the three-trocar sleeve gastrectomy can be safely carried out or should be abandoned. From September 2016 to February 2017, 90 patients were enrolled in our trial. Each patients was evaluated by a multidisciplinary team before surgery. Two groups were created after application of the inclusion and exclusion criteria. The primary endpoint was to define the features of early post-operative complications of patients in group 1 (the three-trocar technique-the experimental group) compared to group 2 (five-trocar technique-the control group). The secondary endpoints were to evaluate any differences between the two groups concerning post-operative pain and patients' satisfaction with the aesthetic results. There was no difference between the two groups concerning age, sex distribution, weight, and BMI. The rate of co-morbidities was similar in both groups. Operative time was inferior in the control group, but patient satisfaction was better in the three-trocar sleeve gastrectomy group. The three-trocar sleeve gastrectomy can be safely carried out with a modest increase in operative time, without additional early surgical complications and with a greater patient aesthetic satisfaction. researchregistry2386.

  13. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease : a systematic review and meta-analysis

    NARCIS (Netherlands)

    Oor, Jelmer E; Roks, David J; Ünlü, Çagdas; Hazebroek, Eric J

    BACKGROUND: The effect of sleeve gastrectomy (SG) on the prevalence of gastroesophageal reflux disease (GERD) remains unclear. We aimed to outline the currently available literature. DATA SOURCES: All relevant databases were searched for publications examining the effect of laparoscopic SG on GERD.

  14. Gastroesophageal Reflux Management with the LINX® System for Gastroesophageal Reflux Disease Following Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Desart, Kenneth; Rossidis, Georgios; Michel, Michael; Lux, Tamara; Ben-David, Kfir

    2015-10-01

    Laparoscopic sleeve gastrectomy (LSG) has gained significant popularity in the USA, and consequently resulted in patients experiencing new-onset gastroesophageal reflux disease (GERD) following this bariatric procedure. Patients with GERD refractory to medical therapy present a more challenging situation limiting the surgical options to further treat the de novo GERD symptoms since the gastric fundus to perform a fundoplication is no longer an option. The aim of this study is to determine if the LINX® magnetic sphincter augmentation system is a safe and effective option for patients with new gastroesophageal reflux disease following laparoscopic sleeve gastrectomy. This study was conducted at the University Medical Center. This is a retrospective review of seven consecutive patients who had a laparoscopic LINX® magnetic sphincter device placement for patients with refractory gastroesophageal reflux disease after laparoscopic sleeve gastrectomy between July 2014 and April 2015. All patients were noted to have self-reported greatly improved gastroesophageal reflux symptoms 2-4 weeks after their procedure. They were all noted to have statistically significant improved severity and frequency of their reflux, regurgitation, epigastric pain, sensation of fullness, dysphagia, and cough symptoms in their postoperative GERD symptoms compared with their preoperative evaluation. This is the first reported pilot case series, illustrating that the LINX® device is a safe and effective option in patients with de novo refractory gastroesophageal reflux disease after a laparoscopic sleeve gastrectomy despite appropriate weight loss.

  15. Effect of vertical sleeve gastrectomy in melanocortin receptor 4-deficient rats

    NARCIS (Netherlands)

    Mul, J.D.; Begg, D.P.; Alsters, S.I.; van Haaften, G.; Duran, K.J.; D'Alessio, D.A.; le Roux, C.W.; Woods, S.C.; Sandoval, D.A.; Blakemore, A.I.; Cuppen, E.; van Haelst, M.M.; Seeley, R.J.

    2012-01-01

    Bariatric surgery is currently the most effective treatment for obesity. Vertical sleeve gastrectomy (VSG), a commonly applied bariatric procedure, involves surgically incising most of the volume of the stomach. In humans, partial loss of melanocortin receptor-4 (MC4R) activity is the most common

  16. Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens: Prevalence, Risk Factors, and Value of Routine Histopathologic Examination

    OpenAIRE

    Safaan, Tamer; Bashah, Moataz; El Ansari, Walid; Karam, Mohsen

    2017-01-01

    Background Laparoscopic sleeve gastrectomy (LSG) is a common surgical therapeutic option for obese patients, with debate about the value of routine histopathologic examination of LSG specimens. We assessed the following: prevalence of different histopathologic changes in LSG specimens, risk factors associated with premalignant and with frequent histopathologic changes, and whether routine histopathologic examination is warranted for LSG patients with nonsignificant clinical history. Methods R...

  17. Rotor losses in laminated magnets and an anisotropic carbon fiber sleeve

    NARCIS (Netherlands)

    Van der Geest, M.; Wolmarans, J.J.; Polinder, H.; Ferreira, J.A.; Zeilstra, D.

    2012-01-01

    High speed fault tolerant permanent magnet machines have strong asynchronous airgap harmonics, making them susceptible to rotor eddy-current losses. These losses can be reduced by using novel high resistivity materials like plastic bonded magnets and carbon fiber reinforced retaining sleeves. This

  18. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  19. Endoscopic sleeve gastroplasty (the Apollo method): a new approach to obesity management.

    Science.gov (United States)

    López-Nava Breviere, Gontrand; Bautista-Castaño, Inmaculada; Fernández-Corbelle, Juan Pedro; Trell, Marta

    2016-04-01

    Many obese patients cannot lose weight or reject conventional obesity management. Endoscopic sleeve gastroplasty (the Apollo method) is a pioneering coadjuvant, interventionist technique for the integral management of obesity. The goals of this study were to report safety and efficacy results obtained at 6 months in patients undergoing endoscopic sleeve gastroplasty. A prospective study was performed in 55 patients (13 males, 42 females) who were subjected to the Apollo technique; mean age was 43.5 years (range 25-60) and mean BMI was 37.7 kg/m2 (range 30-48). All received multidisciplinary follow-up for weight loss. Weight changes and presence of complications were assessed. Through the endoscope a triangular pattern suture is performed consisting of approximately 3-6 transmural (mucosa to serosa) stitches, using a cinch device to bring them nearer and form a plication. A total of 6-8 plications are used to provide a tubular or sleeve-shaped restriction to the gastric cavity. No major complications developed and patients were discharged at 24 hours following the procedure. Endoscopic and radiographic follow-up at 6 months post-procedure showed a well preserved tubular form to the stomach. After 6 months patients had lost 18.9 kg and 55.3% of excess weight. Endoscopic sleeve gastroplasty, together with dietary and psycho-behavioral changes, is a safe, effective technique in the coadjuvant management of obese patients.

  20. Periodontitis and myocardial hypertrophy.

    Science.gov (United States)

    Suzuki, Jun-Ichi; Sato, Hiroki; Kaneko, Makoto; Yoshida, Asuka; Aoyama, Norio; Akimoto, Shouta; Wakayama, Kouji; Kumagai, Hidetoshi; Ikeda, Yuichi; Akazawa, Hiroshi; Izumi, Yuichi; Isobe, Mitsuaki; Komuro, Issei

    2017-04-01

    There is a deep relationship between cardiovascular disease and periodontitis. It has been reported that myocardial hypertrophy may be affected by periodontitis in clinical settings. Although these clinical observations had some study limitations, they strongly suggest a direct association between severity of periodontitis and left ventricular hypertrophy. However, the detailed mechanisms between myocardial hypertrophy and periodontitis have not yet been elucidated. Recently, we demonstrated that periodontal bacteria infection is closely related to myocardial hypertrophy. In murine transverse aortic constriction models, a periodontal pathogen, Aggregatibacter actinomycetemcomitans markedly enhanced cardiac hypertrophy with matrix metalloproteinase-2 activation, while another pathogen Porphyromonas gingivalis (P.g.) did not accelerate these pathological changes. In the isoproterenol-induced myocardial hypertrophy model, P.g. induced myocardial hypertrophy through Toll-like receptor-2 signaling. From our results and other reports, regulation of chronic inflammation induced by periodontitis may have a key role in the treatment of myocardial hypertrophy. In this article, we review the pathophysiological mechanism between myocardial hypertrophy and periodontitis.

  1. Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Nguyen, Ninh T; Nguyen, Brian; Gebhart, Alana; Hohmann, Samuel

    2013-02-01

    Laparoscopic sleeve gastrectomy is gaining popularity in the US; however, there has been no study examining the use of sleeve gastrectomy at a national level and its impact on the use of other bariatric operations. The aim of this study was to examine contemporary changes in use and outcomes of bariatric surgery performed at academic medical centers. Using ICD-9 diagnosis and procedure codes, clinical data obtained from the University HealthSystem Consortium database for all bariatric procedures performed for the treatment of morbid obesity between October 1, 2008 and September 30, 2012 were reviewed. Quartile trends in use for the 3 most commonly performed bariatric operations were examined, and a comparison of perioperative outcomes between procedures was performed within a subset of patients with minor severity of illness. A total of 60,738 bariatric procedures were examined. In 2008, the makeup of bariatric surgery consisted primarily of gastric bypass (66.8% laparoscopic, 8.6% open), followed by laparoscopic gastric banding (23.8%). In 2012, there was a precipitous increase in use of laparoscopic sleeve gastrectomy (36.3 %), with a concurrent reduction in the use of laparoscopic (56.4%) and open (3.2%) gastric bypass, and a major reduction in laparoscopic gastric banding (4.1%). The length of hospital stay, in-hospital morbidity and mortality, and costs for laparoscopic sleeve gastrectomy were found to be between those of laparoscopic gastric banding and laparoscopic gastric bypass. Within the context of academic medical centers, there has been a recent change in the makeup of bariatric surgery. There has been an increase in the use of laparoscopic sleeve gastrectomy, which has had an impact primarily on reducing the use of laparoscopic adjustable gastric banding. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Simultaneous laparoscopic paraesophageal hernia repair and sleeve gastrectomy in the morbidly obese.

    Science.gov (United States)

    Pham, David V; Protyniak, Bogdan; Binenbaum, Steven J; Squillaro, Anthony; Borao, Frank J

    2014-01-01

    Morbid obesity is associated with increased rates of hiatal and paraesophageal hernias. Although laparoscopic sleeve gastrectomy is gaining popularity as the procedure of choice for morbid obesity, there is little data regarding the management of paraesophageal hernias found intraoperatively. The aim of this study was to evaluate the feasibility and benefits of a combined sleeve gastrectomy and paraesophageal hernia repair in morbidly obese patients. From May 2011 to February 2013, 23 patients underwent laparoscopic sleeve gastrectomy combined with the repair of a paraesophageal hernia. Only 4 patients had a large hiatal hernia documented preoperatively on esophagogastroduodenoscopy (EGD). The body mass index (BMI), operative time, length of stay, and complications were evaluated. The average operative time was 165 minutes (115-240 minutes) and length of stay was 2.83 days (2-6 days). All patients were female except for one, with an average age of 53.4 years and a BMI of 41.9 kg/m(2). There were no complications during the procedures. Mean follow-up was 6.16 months (1-19 months), and mean excess weight loss was 39%. The average cost of admission for a combined procedure ($10,056), was slightly higher than a laparoscopic sleeve gastrectomy ($8905) or laparoscopic paraesophageal hernia repair ($8954) done separately. Laparoscopic sleeve gastrectomy combined with a paraesophageal hernia repair is well-tolerated and feasible in morbidly obese patients. Surgeons should be aware that preoperative EGD is not effective at diagnosing large hiatal or paraesophageal hernias. Surgeons with the skill set to repair paraesophageal hernias should do a combined procedure because it is well-tolerated, feasible, and can reduce the cost of multiple hospital admissions. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  3. [Outcomes, controversies and gastric volume after laparoscopic sleeve gastrectomy in the treatment of obesity].

    Science.gov (United States)

    García-Díaz, Juan José; Ferrer-Márquez, Manuel; Moreno-Serrano, Almudena; Barreto-Rios, Rogelio; Alarcón-Rodríguez, Raquel; Ferrer-Ayza, Manuel

    2016-01-01

    Laparoscopic sleeve gastrectomy is a surgical procedure for the treatment of morbid obesity. However, there are still controversies regarding its efficiency in terms of weight reduction and incidence of complications. In this prospective study, the experience is presented of a referral centre for the treatment of morbid obesity with laparoscopic sleeve gastrectomy. A prospective study on 73 patients subjected to laparoscopic sleeve gastrectomy from February 2009 to September 2013. Patients were followed-up for a period of 12 months, evaluating the development of complications, reduction of gastric volume, and the weight loss associated with the surgery, as well as their impact on the improvement of comorbidities present at beginning of the study. There was a statistically a significantly reduction between the preoperative body mass index (BMI) and the BMI at 12 months after laparoscopic sleeve gastrectomy (p < 0.001), despite there being an increase in the gastric volume during follow-up, measured at one month and 12 months after surgery (p < 0.001). Five patients (6.85%) had complications, with none of them serious and with no deaths in the whole series. Laparoscopic sleeve gastrectomy is a safe and effective technique for the treatment of morbid obesity. Its use is associated with a significant reduction in the presence of comorbidities associated with obesity. Multicentre studies with a longer period of monitoring are required to confirm the efficacy and safety of this surgical technique. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  4. Metabolic effects of sleeve gastrectomy in female rat model of diet-induced obesity.

    Science.gov (United States)

    Brinckerhoff, Tatiana Z; Bondada, Sandhya; Lewis, Catherine E; French, Samuel W; DeUgarte, Daniel A

    2013-01-01

    Although women disproportionately undergo bariatric surgery, the rodent models investigating the mechanisms of bariatric surgery have been limited to males. Female rodent models can also potentially allow us to understand the effects of surgical intervention on future generations of offspring. Sleeve gastrectomy is an attractive weight loss procedure for reproductive-age female patients because it avoids the malabsorption associated with intestinal bypass. We sought to evaluate the effect of sleeve gastrectomy on young female rats with diet-induced obesity at the University of California, Los Angeles, David Geffen School of Medicine. Sprague-Dawley female rats were fed a 60% high-fat diet. At 12 weeks of age, the rats underwent either sleeve gastrectomy or sham surgery. The rats were killed 4 weeks after surgery. A chemistry panel was performed, and the serum adipokines and gut hormones were assayed. The homeostasis model assessment score was calculated. The liver histologic findings were graded for steatosis. The 2-sample t test was used to compare the results between the 2 groups. Sleeve gastrectomy was associated with significant weight loss (5% ± 6% versus -4% ± 6%; P resistance or steatohepatitis after 11 weeks of high-fat diet. Despite these limitations, additional gender-specific studies are warranted given that most bariatric surgeries are performed in women. Sleeve gastrectomy appears to result in weight loss and improvements in adiponectin and leptin by way of mechanisms independent of ghrelin levels in a female model of diet-induced obesity. Copyright © 2013 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  5. Anticorrosive field joint coating qualification, heat shrinkable sleeve; Qualificacao de revestimento anticorrosivo para juntas de campo, mantas termocontrateis

    Energy Technology Data Exchange (ETDEWEB)

    Cabral, Glaucia B.; Koebsch, Andre; Castinheiras Junior, Wilson [PETROBRAS, Rio de Janeiro, RJ (Brazil)

    2005-07-01

    The main objective of this job is to present the quality requirements fixed by PETROBRAS for anticorrosive field joint coating for buried pipelines, industrially coated with PE-3L. It describes the used system - polyethylene based heat shrinkable sleeve - comparing with the existent on the pipeline. So, it exposes the suppliers' qualification stages, which include test carried out for the materials, for the sleeve set and for the coating after its application on the joint field. Finally, it shows that the experience, which has been gotten in the qualification, consolidated the quality control systematic that have been carry out during the sleeves acquisition and application at the pipeline construction. (author)

  6. Shock Veins as Recorders of Shock Pressures in Chondrites: Pressure Histories from Thin vs. Thick Veins

    Science.gov (United States)

    Xie, Z.; Sharp, T.; Decarli, P.

    2004-12-01

    High-pressure minerals are generally found within or adjacent to shock-induced melt veins and melt pockets in highly shocked chondrites. The minerals that crystallize in the melt veins and pockets and the distribution of these minerals provide a record of crystallization and quench histories that can be used to constrain shock pressure and pulse duration. Most previous investigations have focused on relatively thick veins (>100 μ m in width) because they tend to contain high-pressure minerals that are observable using petrography or scanning electron microscopy. However, the mineralogy of thin shock veins can provide additional constraints on the pressure history of shocked meteorites. Because shock veins cool predominantly by conduction to the surrounding matrix, rather than by adiabatic decompression, the timing of shock-vein crystallization depends strongly on vein thickness and position within the veins. Therefore, the thinnest melt veins, which solidify within tens of nanoseconds after melting, provide a brief crystallization history at the time of formation whereas thicker veins provide a longer history that may reflect crystallization during decompression. If thin veins form during compression or early in the shock pulse, they will likely record the equilibrium shock pressure or the peak pressure. The goal of this study is to characterize the mineralogy of thin melt veins and to compare the results to those of thicker veins in the same samples. We have investigated three L chondrites that contain a wide range of melt vein sizes. These include Tenham (several μ m to 600 μ m in width), Roy (10 μ m to 150 μ m in width) and Umbarger (35 μ m to 300 μ m in width). Thick veins in these samples have been previously investigated using FESEM and TEM, resulting in crystallization pressures of approximately 25, 20 and 18 GPa for Tenham, Roy and Umbarger, respectively. Thin veins from these samples were investigated using TEM. Three thin veins in Tenham show three

  7. Disfunção endotelial causada pela pressão aguda de distensão em veias safenas humanas utilizadas para revascularização do miocárdio Endothelium dysfunction caused by acute pressure distension of human saphenous vein used for myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Fernanda Viaro

    2007-06-01

    Full Text Available OBJETIVO: Estudar as alterações morfofuncionais induzidas por pressão de distensão, em veias safenas humanas utilizadas para revascularização do miocárdio. MÉTODO: Foram estudadas veias safenas de 20 pacientes, distribuídas em quatro grupos experimentais: controle, 100, 200 e 300 mmHg, submetidos a distensões pressóricas com solução de Krebs por 15 segundos. A metodologia utilizada incluiu: 1 Imunohistoquímica do CD34; 2 Estudo in vitro da reatividade vascular em câmaras de órgãos. RESULTADOS: Os principais achados experimentais foram: 1 A partir da pressurização com 200 mmHg, observou-se uma tendência à diminuição da expressão do CD34, tornando-se estatisticamente significante com 300 mmHg; 2 Não houve comprometimento da contratilidade e dos relaxamentos estudados in vitro. CONCLUSÕES: Embora o estudo in vitro não tenha demonstrado comprometimento da reatividade vascular das veias estudadas, o estudo imunohistoquímico do CD34 mostrou que existe disfunção endotelial com pressurizações de 300 mmHg.OBJECTIVE: To study morphofunctional alterations induced by brief pressure increases in human saphenous veins utilized in coronary artery bypass grafting. METHOD: Saphenous veins of 20 patients undergoing coronary artery bypass grafting, were distributed into four experimental groups, control, 100 mmHg, 200 mmHg and 300 mmHg, and submitted to pressure distention over 15 seconds using Krebs solution. The evaluation included CD34 immunohistochemistry and an In vitro vascular reactivity study in organ chambers. RESULTS: The main experimental findings were 1 From pressures of 200 mmHg there was a tendency to reduce the CD34 expression which became statistically significant at 300 mmHg; 2 There was no impairment of the contraction and relaxation as evidenced by in vitro vascular reactivity tests. CONCLUSION: Although vascular reactivity impairment was not demonstrated in vitro, the CD34 expression, measured by

  8. Internal Jugular Vein Cannulation; Anatomical Surface Markings ...

    African Journals Online (AJOL)

    We report the case of a female patient scheduled for skin grafting of chronic Burulli ulcers who had a history of difficult peripheral vein cannulation. She had undergone numerous central venous cannulations and unsuccessful peripheral vein cut-downs in the past. On two separate occasions she had central venous ...

  9. Generating and analyzing synthetic finger vein images

    NARCIS (Netherlands)

    Hillerström, Fieke; Kumar, Ajay; Veldhuis, Raymond N.J.

    2014-01-01

    Abstract: The finger-vein biometric offers higher degree of security, personal privacy and strong anti-spoofing capabilities than most other biometric modalities employed today. Emerging privacy concerns with the database acquisition and lack of availability of large scale finger-vein database have

  10. Deep vein thrombosis and pulmonary embolism

    NARCIS (Netherlands)

    Di Nisio, Marcello; van Es, Nick; Büller, Harry R.

    2016-01-01

    Deep vein thrombosis and pulmonary embolism, collectively referred to as venous thromboembolism, constitute a major global burden of disease. The diagnostic work-up of suspected deep vein thrombosis or pulmonary embolism includes the sequential application of a clinical decision rule and D-dimer

  11. Evaluation of apoptosis in varicose vein disease complicated by superficial vein thrombosis.

    Science.gov (United States)

    Filis, Konstantinos; Kavantzas, Nikolaos; Dalainas, Ilias; Galyfos, George; Karanikola, Evridiki; Toutouzas, Konstantinos; Tsioufis, Constantinos; Sigala, Fragiska

    2014-07-01

    The factors contributing to superficial vein thrombosis (SVT) in patients with varicose vein disease are unclear. Differences in vein wall apoptotic activity could be associated with the pathogenesis of SVT. The aim of the study is to address the role of the programmed cell death in the vein wall by comparing varicose veins with history of SVT to uncomplicated varicose veins. Vein segments from the proximal part of the great saphenous vein (GSV), the distal part of the vein and from a varicose tributary, from 16 patients with varicose vein disease and one episode of SVT, were evaluated for the immunohistochemical expression of pro-apoptotic (Bax, p53, Caspase 3, BCL-6, BCL-xs), anti-apoptotic (BCL-xl and BCL-2) and proliferation (Ki-67) markers. The results of this study were compared to the results from the evaluation of 19 patients suffering from uncomplicated varicose vein disease and 10 healthy GSVs as controls. Overall, there was increased apoptosis in the distal part of GSV compared to the proximal part documented by increased expression of Bax (p SVT showed significant differences among the three different anatomic locations. In the proximal GSV, only BCL-xs was higher in patients with SVT (p = 0.029). In the tributaries, Bax, BCL-xl and Ki-67 were higher in patients with SVT (p SVT shows increased pro-apoptotic activity compared to uncomplicated disease and normal veins. Whether increased vein wall cell apoptosis is a causative factor for SVT in varicose veins disease or a repairing mechanism of the thrombosis itself needs further research.

  12. CONTROL OF COCOA POD BORER AND PHYTOPHTHORA POD ROT USING DEGRADABLE PLASTIC POD SLEEVES AND A NEMATODE, Steinernema carpocapsae

    Directory of Open Access Journals (Sweden)

    Ade Rosmana

    2013-05-01

    Full Text Available Cocoa pod borer (CPB; Conopomorpha cramerella and Phytophthora pod rot (PPR; Phytophthora palmivora are serious pest and disease on cocoa plantations in Indonesia. Both pest and disease have been controlled with limited success using cultural practices such as pruning, frequent harvesting, sanitation, plastic sleeving, and chemical pesticides. An experiment was conducted on cocoa plantings in Pinrang Regency, South Sulawesi during the wet season of 2008/09 to test the effect of pod sleeving (with transparent degradable and non-degradable plastic bags and nematode application on CPB and PPR infestation. The nematode, Steinernema carpocapsae (10,000 active juveniles per pod was sprayed three times at intervals of 10 and 20 days. Pod damage by CPB was observed at harvest time, while PPR disease incidence was evaluated every week until harvest time. Results showed that all pods in the field were infested by CPB as indicated in control samples. Pod sleeving using both non-degradable and degradable plastics significantly reduced pod damage by CPB, from 62.3% in the control treatment compared to 8.4% in the CPB treatment. A combination of pod sleeving and nematode application had a synergistic reduction of pod damage by CPB resulting in totally healthy pods. Pod sleeving with degradable and non-degradable plastics also reduced pod damage by PPR significantly. Pod sleeving with non-degradable plastic suppressed the disease incidence almost zero until 6 weeks after sleeving and the rate of disease incidence was 3.6% per week. However, with degradable plastic, the disease suppression was even longer (7 weeks after sleeving, indicating that the degradable plastic is more effective. Combination of sleeving and nematode application slightly increased PPR infection. Sleeved pods in general had lower rates of PPR infection compared to pods treated with nematode or untreated pods (control. In these two applications, the rate of disease incidence was 7.8% and 8

  13. Uniportal video-assisted thoracoscopic right upper sleeve lobectomy and tracheoplasty in a 10-year-old patient

    OpenAIRE

    Gonzalez-Rivas, Diego; Marin, Jessica Correa; Granados, Juan Pablo Ovalle; Llano, Juan David Urrea; Cañas, Sonia Roque; Arqueta, Alonso Oviedo; de la Torre, Mercedes

    2016-01-01

    Tracheobronchial pediatric tumors are very rare and procedures like pneumonectomy are seldomly indicated due to the associated morbidity. If a surgical approach is considered, the ideal oncological technique would be the minimally invasive sleeve resection, allowing preservation of lung parenchyma (very important in pediatric patients). Here we present the first report of a thoracoscopic right upper tracheo-bronchial sleeve lobectomy in a pediatric patient. A 10-year-old female patient, who r...

  14. Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test.

    Science.gov (United States)

    Mans, Esther; Serra-Prat, Mateu; Palomera, Elisabet; Suñol, Xavier; Clavé, Pere

    2015-09-01

    The relation between hunger, satiation, and integrated gastrointestinal motility and hormonal responses in morbidly obese patients after sleeve gastrectomy has not been determined. The objective was to assess the effects of sleeve gastrectomy on hunger, satiation, gastric and gallbladder motility, and gastrointestinal hormone response after a liquid meal test. Three groups were studied: morbidly obese patients (n = 16), morbidly obese patients who had had sleeve gastrectomy (n = 8), and nonobese patients (n = 16). The participants fasted for 10 h and then consumed a 200-mL liquid meal (400 kcal + 1.5 g paracetamol). Fasting and postprandial hunger, satiation, hormone concentrations, and gastric and gallbladder emptying were measured several times over 4 h. No differences were observed in hunger and satiation curves between morbidly obese and nonobese groups; however, sleeve gastrectomy patients were less hungry and more satiated than the other groups. Antrum area during fasting in morbidly obese patients was statistically significant larger than in the nonobese and sleeve gastrectomy groups. Gastric emptying was accelerated in the sleeve gastrectomy group compared with the other 2 groups (which had very similar results). Gallbladder emptying was similar in the 3 groups. Sleeve gastrectomy patients showed the lowest ghrelin concentrations and higher early postprandial cholecystokinin and glucagon-like peptide 1 peaks than did the other participants. This group also showed an improved insulin resistance pattern compared with morbidly obese patients. Sleeve gastrectomy seems to be associated with profound changes in gastrointestinal physiology that contribute to reducing hunger and increasing sensations of satiation. These changes include accelerated gastric emptying, enhanced postprandial cholecystokinin and glucagon-like peptide 1 concentrations, and reduced ghrelin release, which together may help patients lose weight and improve their glucose metabolism after

  15. Sleeve Gastrectomy Decreases Body Weight, Whole-Body Adiposity, and Blood Pressure Even in Aged Diet-Induced Obese Rats.

    Science.gov (United States)

    Moncada, Rafael; Rodríguez, Amaia; Becerril, Sara; Méndez-Giménez, Leire; Valentí, Víctor; Ramírez, Beatriz; Cienfuegos, Javier A; Fernández, Secundino; Catalán, Victoria; Gómez-Ambrosi, Javier; Frühbeck, Gema

    2016-07-01

    Aging and obesity are two conditions associated with increased risk of cardiovascular disease. Our aim was to analyze whether an advanced age affects the beneficial effects of sleeve gastrectomy on weight loss and blood pressure in an experimental model of diet-induced obesity (DIO). Young (6-month-old) and old (18-month-old) male Wistar DIO rats (n = 101) were subjected to surgical (sham operation and sleeve gastrectomy) or dietary interventions (pair-fed to the amount of food eaten by sleeve gastrectomized animals). Systolic (SBP), diastolic (DBP), and mean (MBP) blood pressure values and heart rate (HR) were recorded in conscious, resting animals by non-invasive tail-cuff plethysmography before and 4 weeks after surgical or dietary interventions. Aging was associated with higher (P weight and subcutaneous and perirenal fat mass as well as mild cardiac hypertrophy. Sleeve gastrectomy induced a reduction in body weight, whole-body adiposity, and serum total ghrelin in both young and old DIO rats. The younger group achieved a higher excess weight loss than the older group (164 ± 60 vs. 82 ± 17 %, P weight was observed after sleeve gastrectomy independently of age. Our results provide evidence for the effectiveness of sleeve gastrectomy without increased operative risk in body weight and blood pressure reduction even in aged animals via endocrine changes that go beyond the mere caloric restriction.

  16. [Portal vein embolization: Present and future].

    Science.gov (United States)

    Piron, Lauranne; Deshayes, Emmanuel; Escal, Laure; Souche, Regis; Herrero, Astrid; Pierredon-Foulongne, Marie-Ange; Assenat, Eric; le Lam, Ngo; Quenet, François; Guiu, Boris

    2017-05-01

    Portal vein embolization consists of occluding a part of the portal venous system in order to achieve the hypertrophy of the non-embolized liver segments. This technique is used during the preoperative period of major liver resection when the future remnant liver (FRL) volume is insufficient, exposing to postoperative liver failure, main cause of death after major hepatectomy. Portal vein embolization indication depends on the FRL, commonly assessed by its volume. Nowadays, FRL function evaluation seems more relevant and can be measured by 99mTc labelled mebrofenin scintigraphy. Portal vein embolization procedure is mostly performed with percutaneous trans-hepatic access by using ultrasonography guidance and consists of embolic agent injection, such as cyanoacrylate, in the targeted portal vein branches with fluoroscopic guidance. It is a safe and well-tolerated technique, with extremely low morbi-mortality. Portal vein embolization leads to sufficient FRL hypertrophy in about 80% of patients, allowing them to undergo surgery from which they were initially rejected. The two main reasons of non-resection are tumor progression (≈15% of cases) and FRL insufficient hypertrophy (≈5% of cases). When portal vein embolization is not enough to obtain adequate FRL regeneration, hepatic vein embolization may potentiate its effect (liver venous deprivation technique). Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  17. Portal vein gas in emergency surgery

    Directory of Open Access Journals (Sweden)

    Mahmood Hind

    2008-07-01

    Full Text Available Abstract Background Portal vein gas is an ominous radiological sign, which indicates a serious gastrointestinal problem in the majority of patients. Many causes have been identified and the most important was bowel ischemia and mesenteric vascular accident. The presentation of patients is varied and the diagnosis of the underlying problem depends mainly on the radiological findings and clinical signs. The aim of this article is to show the clinical importance of portal vein gas and its management in emergency surgery. Methods A computerised search was made of the Medline for publications discussing portal vein gas through March 2008. Sixty articles were identified and selected for this review because of their relevance. These articles cover a period from 1975–2008. Results Two hundreds and seventy-five patients with gas in the portal venous system were reported. The commonest cause for portal vein gas was bowel ischemia and mesenteric vascular pathology (61.44%. This was followed by inflammation of the gastrointestinal tract (16.26%, obstruction and dilatation (9.03%, sepsis (6.6%, iatrogenic injury and trauma (3.01% and cancer (1.8%. Idiopathic portal vein gas was also reported (1.8%. Conclusion Portal vein gas is a diagnostic sign, which indicates a serious intra-abdominal pathology requiring emergency surgery in the majority of patients. Portal vein gas due to simple and benign cause can be treated conservatively. Correlation between clinical and diagnostic findings is important to set the management plan.

  18. Radiological features of azygous vein aneurysm.

    Science.gov (United States)

    Choudhary, Arabinda Kumar; Moore, Michael

    2014-04-01

    Mediastinal masses are most commonly associated with malignancy. Azygous vein aneurysm is a very rare differential diagnosis of mediastinal mass. We report here three cases of azygous vein aneurysm including children and adult patients. In the pediatric patient it was further complicated by thrombosis and secondary pulmonary embolism. We describe the radiological features on CXR, MRI, CT, PET-CT, US and angiogram and their differential diagnosis. Imaging findings of continuity with azygous vein, layering of contrast medium on enhanced CT and dynamic MRA showing filling of the mass at the same time as the azygous vein without prior enhancement will be strongly suggestive of azygous vein aneurysm with transtracheal ultrasound being the definitive test in these patients. It is important to keep a vascular origin mass in the differential diagnosis of mediastinal masses. Also, in young healthy patients with pulmonary embolism, a vascular etiology such as azygous vein aneurysm should be carefully evaluated. This article will help the clinicians to learn about the imaging features of azygous vein aneurysm on different imaging modalities.

  19. Valsalva and gravitational variability of the internal jugular vein and common femoral vein: Ultrasound assessment

    Energy Technology Data Exchange (ETDEWEB)

    Beddy, P. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland)]. E-mail: pbeddy@eircom.net; Geoghegan, T. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Ramesh, N. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Buckley, O. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); O' Brien, J. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Colville, J. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Torreggiani, W.C. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland)

    2006-05-15

    Purpose: Central venous cannulation via the common femoral vein is an important starting point for many interventions. The purpose of this study was to determine the optimum conditions for cannulation of the femoral vein and to compare these with the relative changes in the internal jugular vein. Methods: High-resolution 2D ultrasound was utilised to determine variability of the calibre of the femoral and internal jugular veins in 10 healthy subjects. Venous diameter was assessed during the Valsalva manoeuvre and in different degrees of the Trendelenburg position. Results: The Valsalva manoeuvre significantly increased the size of the femoral and internal jugular veins. There was a relatively greater increase in femoral vein diameter when compared with the internal jugular vein of 40 and 29%, respectively. Changes in body inclination (Trendelenburg position) did not significantly alter the luminal diameter of the femoral vein. However, it significantly increased internal jugular vein diameter. Conclusions: Femoral vein cannulation is augmented by the Valsalva manoeuvre but not significantly altered by the gravitational position of the subject.

  20. Gastric Wall Thickness and the Choice of Linear Staples in Laparoscopic Sleeve Gastrectomy: Challenging Conventional Concepts.

    Science.gov (United States)

    Abu-Ghanem, Yasmin; Meydan, Chanan; Segev, Lior; Rubin, Moshe; Blumenfeld, Orit; Spivak, Hadar

    2017-03-01

    Little evidence is available on the choice of linear staple reloads in laparoscopic sleeve gastrectomy (LSG). Previous literature recommends matching closed staple height (CSH) to tissue-thickness (TT) to avoid ischemia. Our objective was to examine feasibility and safety of "tight" hemostatic (CSH/TT sleeve ischemia. Stepwise regression analysis revealed that body mass index (P < 0.001), hypertension (P < 0.01), and male gender (P < 0.001) were associated with increased gastric TT. Our study suggests that reloads with CSH/TT <1 in LSG including staples with CSH of 1 mm on body and fundus are safe. The results challenge the concept that tight stapling cause's ischemia. Since tight reloads are designed to improve hemostasis, their application could have clinical benefit.

  1. Simple, Safe, and Cost-Effective Technique for Resected Stomach Extraction in Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Serhan Derici

    2016-01-01

    Full Text Available Background. Laparoscopic sleeve gastrectomy (LSG has become a popular operation during the recent years. This procedure requires resection of 80–90% of the stomach. Extraction of gastric specimen is known to be a challenging and costly stage of the operation. In this paper, we report results of a simple and cost-effective specimen extraction technique which was applied to 137 consecutive LSG patients. Methods. Between October 2013 and October 2015, 137 laparoscopic sleeve gastrectomy surgeries were performed at Dokuz Eylul University General Surgery Department, Upper Gastrointestinal Surgery Unit. All specimens were extracted through a 15 mm trocar site without using any special device. Results. We noticed one superficial incisional surgical site infection and treated this patient with oral antibiotics. No cases of trocar site hernia were observed. Conclusion. Different techniques have been described for specimen extraction. This simple technique allows extraction of specimen safely in a short time and does not require any special device.

  2. Management of a case of left tracheal sleeve pneumonectomy under cardiopulmonary bypass: Anesthesia perspectives

    Directory of Open Access Journals (Sweden)

    Aman Jyoti

    2014-01-01

    Full Text Available The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB. Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization from the extensive vascular raw area left after pneumonectomy. Meticulous peri-operative planning and optimal post-operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.

  3. DURABILITY-RELATED CHARACTERISTICS OF DOUBLE-LAYER STRUCTURES OF PIPELINES CONNECTED TO POLYMERIC SLEEVES

    Directory of Open Access Journals (Sweden)

    Orlov Vladimir Alexandrovich

    2012-10-01

    The ultimate objective of the software programme is to assess the applicability of the trenchless repair method involving a polymeric sleeve in each specific case by taking account of the environment and the condition of the pipeline. The software is also capable of developing the requirements to be fulfilled by subcontractors in order to assure the appropriate quality of any repair work performed and the reliability of any pipeline sections repaired.

  4. Effect of Yaw Angle and Ambient Wind on Fabric Penetration of a Simulated Sleeve

    Science.gov (United States)

    2015-08-20

    3/4 in. ID) was immersed in a bed of silica beads. The dryer/conditioner eliminated water vapor and most of the ethanol evidenced by a pre-drying...Reference 6 describes the bench top set up in greater detail. Component (sleeve) pressure was measured by a 10-in.-of- water and a 20-in.-of- water ...material tested: two commercial filter bags manufactured by Donaldson Company, Inc. ( Dura -Life and Tetratex (PTFE)), Kimberly-Clark Corp. Kleenguard

  5. The Effectiveness of Motivational Interviewing on Adherence to Treatment in Obese Patients Undergoing Sleeve Gastrectomy Surgery

    Directory of Open Access Journals (Sweden)

    2017-03-01

    Full Text Available Abstract Background & aim: Adherence is the degree of patient's success to do the health experts recommendations. The aim of present research was study the effects of motivational interviewing on adherence to in obese patients undergoing sleeve gastrectomy surgery. Methods: The design of present semi- experimental study was pre-test, post-test with control group. The statistical population included all obese patients (BMI≥35 that undergone laparoscopic sleeve gastrectomy surgery in Shiraz Ghadir Mother & Child Subspecialty Hospital, during the winter of 1394 and the spring of 1395. 30 of them were selected by using available sampling method and they randomly were asssigned to experimental (n=15 and control groups (n=15. The post bariatic surgery self-management behaviors questionnaire was used to collect data in two steps (pre-test and post-test. Motivational interviewing was implemented for the experimental group in four weeks (each week a 1/5 hour session. Data were analysed by using multivariate covariance analysis (MANCOVA. Results: MANCOVA results show that motivational interviewing led to a statistically significant difference between pre-test and post-test BSSQ total scores (P0/07. Conclusion: According to this study results, implementation of motivational interviewing is effective and appropriate in order to enhance adherence and self-management behaviors, achieve favorable weight loss & reduce postoperative complications, in obese patients undergoing sleeve gastrectomy surgery, but it appears that longer interventions are necessary to increase the rate of physical activity. Keywords: Motivational Interviewing, Adherence, Obese Patients, Sleeve Gastrectomy Surgery

  6. Myocardial revascularization in patient with situs inversus totalis: case report

    Directory of Open Access Journals (Sweden)

    Soncini da Rosa George Ronald

    2002-01-01

    Full Text Available This is a report of an unusual case of a patient, with dextrocardia and a "situs inversus totalis". She presented angina pectoris during an ECG stress test. The coronary arteriography revealed severe obstruction in the main left coronary artery. The patient underwent coronary artery bypass grafting surgery. We did not find a similar case in the national medical literature. The myocardial revascularization performed utilizing the right mammary artery for anterior descending artery and saphenous vein grafts for first diagonal branch and first marginal branch.

  7. Protein C deficiency in a patient of acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Tamzeed Ahmed

    2009-01-01

    Full Text Available A 42-year old male presented with acute myocardial infarction with no discernable risk factors; he never smoked; did not suffer from diabetes and had a well controlled blood pressure with single medication; plasma concentration of total cholesterol was on the upper normal limit, high and low density lipoprotein, cholesterol and triglyceride being normal. In addition to a single antihypertensive he received Allupurinol(Xanthine Oxidase inhibitorfor hyperuricaemia. Coronary angiogram revealed ectatic epicardial coronary arteries. The patient developed deep vein thrombosis of right leg after four days of the coronary angiogram. Coagulation analysis revealed protein C deficiency. The recognition of protein C deficiency as a risk factor for myocardial infarction is important as anticoagulators prevent further thrombotic events whereas inhibitors of platelet aggregation are ineffective. Ibrahim Med. Coll. J. 2009; 3(1: 34-35

  8. Myocardial reverse remodeling.

    Science.gov (United States)

    Hellawell, Jennifer L; Margulies, Kenneth B

    2012-06-01

    Despite an extensive literature defining the mechanisms and significance of pathological myocardial remodeling, there has been no comprehensive review of the inverse process, often labeled reverse remodeling. Accordingly, the goal of this review is to overview the varied settings in which clinically significant reverse remodeling has been well documented. When available, we reviewed relevant randomized, controlled clinical trials, and meta-analyses with sufficient cardiac imaging data to permit conclusions about reverse remodeling. When these types of studies were not available, relevant case-control studies and case series that employed appropriate methodology were reviewed. Regression of pathological myocardial hypertrophy, chamber shape distortions, and dysfunction occurs in a wide variety of settings. Although reverse remodeling occurs spontaneously in some etiologies of myocardial dysfunction and failure, remodeling is more commonly observed in response to medical, device-based, or surgical therapies, including β-blockers, revascularization, cardiac resynchronization therapy, and valve surgery. Indeed, reverse remodeling following pathophysiologically targeted interventions helps validate that the targeted mechanisms are propelling and/or sustaining pathological remodeling. The diverse clinical settings in which reverse remodeling has been observed demonstrates that myocardial remodeling is bidirectional and occurs across the full spectrum of myocardial disease severity, duration, and etiology. Observations in several settings suggest that recovered hearts are not truly normal despite parallel improvements at organ, tissue, and cellular level. Nevertheless, the link between reverse remodeling and improved outcomes should inspire further research to better understand the mechanisms responsible for both reverse remodeling and persistent deviations from normalcy. © 2010 Blackwell Publishing Ltd.

  9. Myocardial tissue engineering.

    Science.gov (United States)

    Jawad, Hedeer; Lyon, Alex R; Harding, Sian E; Ali, Nadire N; Boccaccini, Aldo R

    2008-01-01

    Regeneration of the infarcted myocardium after a heart attack is one of the most challenging aspects in tissue engineering. Suitable cell sources and optimized biocompatible materials must be identified. In this review, we briefly discuss the current therapeutic options available to patients with heart failure post-myocardial infarction. We describe the various strategies currently proposed to encourage myocardial regeneration, with focus on the achievements in myocardial tissue engineering (MTE). We report on the current cell types, materials and methods being investigated for developing a tissue-engineered myocardial construct. Generally, there is agreement that a 'vehicle' is required to transport cells to the infarcted heart to help myocardial repair and regeneration. Suitable cell source, biomaterials, cell environment and implantation time post-infarction remain obstacles in the field of MTE. Research is being focused on optimizing natural and synthetic biomaterials for tissue engineering. The type of cell and its origin (autologous or derived from embryonic stem cells), cell density and method of cell delivery are also being explored. The possibility is being explored that materials may not only act as a support for the delivered cell implants, but may also add value by changing cell survival, maturation or integration, or by prevention of mechanical and electrical remodelling of the failing heart.

  10. Is it necessary to perform full pathologic review of all gastric remnants following sleeve gastrectomy?

    Science.gov (United States)

    Hansen, S K; Pottorf, B J; Hollis, H W; Rogers, J L; Husain, F A

    2017-12-01

    This study attempts to determine if enough pathological abnormalities in gastric remnants from sleeve gastrectomy exist to warrant full pathologic evaluation in all remnants. Data was collected on patients undergoing sleeve gastrectomy between 08/01/2011 and 06/30/2014. Significant abnormalities were classified as any pathology that might require follow-up or treatment beyond standard follow-up. Age, comorbidities, gender, and Helicobacter pylori titers were analyzed and compared with pathology specimens using 95% confidence intervals and Phi contingency coefficients. Full pathologic evaluation was available for 351/387 patients (91.2%). No examples of malignancy or dysplasia were identified. Gastritis was the most common abnormality. There was a statistically significant association between preoperative H. pylori and significantly abnormal pathology (p = 0.003). Other comorbidities had no association. These results suggest that full pathologic evaluation of the gastric remnant following sleeve gastrectomy is unnecessary, particularly when gross pathology is not noted at initial operation. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Laparoscopic sleeve gastrectomy for morbid obesity with natural orifice specimen extraction (NOSE).

    Science.gov (United States)

    Gunkova, P; Gunka, I; Zonca, P; Dostalik, J; Ihnat, P

    2015-01-01

    An experience with laparoscopic sleeve gastrectomy using the natural orifice specimen extraction (NOSE) technique. Bariatric surgery is nowadays the only long term effective obesity treatment method. Twenty one consecutive patients underwent laparoscopic sleeve gastrectomy with the use of natural orifice specimen extraction (NOSE) in the Surgical Clinic of Faculty Hospital Ostrava between May 2012 and August 2012. Inclusion criteria were the body mass index (BMI) higher than 35 kg/m2 or higher than 32 kg/m2 accompanied with relevant comorbidities. Among 21 patients in this series, there were three men (14.3%) and 18 women (85.7%). Their mean age was 40.9±10.2 years. Their mean preoperative BMI was 40.4±4.6 kg/m2. No patient had previous bariatric surgery, one patient had laparoscopic fundoplication. All operations were completed laparoscopically with no conversions to an open procedure. In two cases, laparoscopic cholecystectomy was performed and the gallbladder was extracted along with the gastric specimen by transgastric approach. Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure with low morbidity and mortality. Based on our initial experiences it could be an indication for NOSE with transgastric approach. Obese patients would benefit from this approach due to the elimination of wound complications (Tab. 2, Fig. 3, Ref. 22).

  12. Is Sleeve Gastrectomy Always an Absolute Contraindication in Patients with Barrett's?

    Science.gov (United States)

    Gagner, Michel

    2016-04-01

    The incidence of esophageal adenocarcinoma is not rising at the same rate as severe obesity, and incidence-based mortality is marginally going down since 2000. Laparoscopic sleeve gastrectomy (LSG) is now the preferred operation for weight loss in several countries including the USA. Recent objective studies of reflux before and 2 years after LSG show improvement by GERD Symptom Assessment Scale score, DeMeester score, total acid exposure, as well as unchanged lower esophageal sphincter pressure measurements. Therefore, sleeve gastrectomy improves symptoms and reduces reflux in most morbidly obese patients with preoperative reflux. At the last LSG consensus conference, 94.5% of experts mentioned Barrett's esophagus to be a major contraindication for the performance of LSG, a change from 2011 (81%). But the actual incidence of Barrett's is only 1% in the severely obese. Therefore, 99% of patients should be able to get a LSG. Further, after 25 years of duodenal switch operations (which includes a sleeve gastrectomy, there are still no reports of esophageal adenocarcinoma. Hence, LSG is not a contraindication in GERD patients without Barrett's.

  13. Endoscopic Treatment of Early Gastric Obstruction After Sleeve Gastrectomy: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Mariana Nuno Costa

    2016-01-01

    Full Text Available Morbid obesity is an epidemic and complex disease which imposes a multidisciplinary approach. Laparoscopic sleeve gastrectomy has become a frequent procedure given its efficacy and safety compared to other surgical options. However, it isn’t free from complications. Lax gastric fixation or incorrect positioning of the stomach during surgery can result in early gastric outlet obstruction caused by a volvulus-like mechanism by rotation of the stomach around its anatomic axes. This report refers to two cases of post sleeve gastric torsion resulting in persisting vomiting after initiating oral intake. The diagnosis was confirmed by upper gastrointestinal-contrast study and gastroscopy. In both cases, a fully covered self-expandable metallic stent was inserted which prompted the gastric lumen to become permeable resulting in symptomatic resolution. The stents were removed endoscopically after two and three months. Beyond more than three years of follow-up, the patients remain asymptomatic and no recurring “stenosis” was noticed. In these cases the use of fully covered self-expandable metallic stents demonstrated to be effective and safe in the treatment of post sleeve gastric torsion.

  14. The efficacy of sleeve technique in primary nasolacrimal duct obstruction with a high lacrimal sac

    Directory of Open Access Journals (Sweden)

    Kyoung-Nam Kim

    2014-01-01

    Full Text Available Purpose: To evaluate the efficacy of a sleeve technique during endoscopic dacryocystorhinostomy (DCR in primary nasolacrimal duct obstruction (NLDO patients with a high lacrimal sac. Materials and Methods: The medical records of 45 patients (49 cases undergoing endoscopic DCR for primary NLDO with a high lacrimal sac were retrospectively reviewed. In 19 patients (21 cases, the thick maxilla covering the common canalicular opening was removed using a drill and a bicanalicular silicone tube was inserted (group 1. In 26 patients (28 cases, instead of removal of the thick maxilla, a sleeve was inserted into the bicanalicular silicone tube (group 2. At 6 months postoperatively, the success rate was evaluated and the size of the intranasal mucosal ostium was measured. Results: The success rates in group 1 and 2 was 90.5% and 96.4%, respectively (P = 0.400. The intranasal mucosal ostium in group 1 and 2 measured 1.7 ± 0.7 mm and 3.1 ± 1.0 mm, respectively, and the difference was significant (P = 0.042. Conclusions: In primary NLDO patients with a high lacrimal sac, DCR inserting a silicone tube and a sleeve together had a satisfactory success rate without using a drill. In comparison with traditional surgical methods, it helped enlarge the size of the intranasal mucosal ostium.

  15. Sleeve Gastrectomy Reduces Body Weight and Improves Metabolic Profile also in Obesity-Prone Rats.

    Science.gov (United States)

    Moncada, Rafael; Becerril, Sara; Rodríguez, Amaia; Méndez-Giménez, Leire; Ramírez, Beatriz; Catalán, Victoria; Gómez-Ambrosi, Javier; Gil, M Jesús; Fernández, Secundino; Cienfuegos, Javier A; Valentí, Víctor; Frühbeck, Gema

    2016-07-01

    Susceptibility to obesity is associated with a notable inter-individual variation. The aim of the present study was to compare the effectiveness of sleeve gastrectomy (SG) on weight loss and metabolic profile in obesity-prone (OP) rats vs animals that are non-susceptible to obesity (NSO). Young male Wistar rats (n = 101) were put in a diet-induced obesity (DIO) programme with ad libitum access to a high-fed diet (HFD) during 12 months. Body weight and food intake were regularly registered. Thereafter, rats were ranked by final body weight to identify the obesity-prone (OP) (n = 13) and non-susceptible to obesity (NSO) (n = 14) animals. OP and NSO rats were submitted to surgical interventions (sham operation, SG and pair-fed to the amount of food eaten by sleeve-gastrectomized rats). Body weight, food intake, energy expenditure, body temperature, fat pads weight, and metabolic profiling were analysed 4 weeks after surgical or dietary interventions. SG in both OP and NSO rats decreased body weight as compared to sham and pair-fed groups (P weight loss achieved in sleeve-gastrectomized OP and NSO rats was higher than that of pair-fed ones (P obesity-prone rats also benefit from surgery responding effectively to SG, as evidenced by the significant body weight reduction and the metabolic profile improvement.

  16. Calf Compression Sleeves Change Biomechanics but Not Performance and Physiological Responses in Trail Running.

    Science.gov (United States)

    Kerhervé, Hugo A; Samozino, Pierre; Descombe, Fabrice; Pinay, Matthieu; Millet, Guillaume Y; Pasqualini, Marion; Rupp, Thomas

    2017-01-01

    Introduction: The aim of this study was to determine whether calf compression sleeves (CS) affects physiological and biomechanical parameters, exercise performance, and perceived sensations of muscle fatigue, pain and soreness during prolonged (~2 h 30 min) outdoor trail running. Methods: Fourteen healthy trained males took part in a randomized, cross-over study consisting in two identical 24-km trail running sessions (each including one bout of running at constant rate on moderately flat terrain, and one period of all-out running on hilly terrain) wearing either degressive CS (23 ± 2 mmHg) or control sleeves (CON, biomechanics (kinematics, vertical and leg stiffness) were determined at 12 km·h(-1) at the beginning, during, and at the end of both sessions. Exercise-induced Achilles tendon pain and delayed onset calf muscles soreness (DOMS) were assessed using visual analog scales. Results: Muscle oxygenation increased significantly in CS compared to CON at baseline and immediately after exercise (p 6 on a 10-cm scale) with no difference between conditions. However, Achilles tendon pain was significantly lower after the trial in CS than CON (p biomechanics and lower limb muscle functional capabilities toward a more dynamic behavior compared to control session. However, wearing compression sleeves did not affect performance and exercise-induced DOMS, while it minimized Achilles tendon pain immediately after running.

  17. Bronchogenic Carcinoma with Cardiac Invasion Simulating Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Anirban Das

    2016-01-01

    Full Text Available Cardiac metastases in bronchogenic carcinoma may occur due to retrograde lymphatic spread or by hematogenous dissemination of tumour cells, but direct invasion of heart by adjacent malignant lung mass is very uncommon. Pericardium is frequently involved in direct cardiac invasion by adjacent lung cancer. Pericardial effusion, pericarditis, and tamponade are common and life threatening presentation in such cases. But direct invasion of myocardium and endocardium is very uncommon. Left atrial endocardium is most commonly involved in such cases due to anatomical contiguity with pulmonary hilum through pulmonary veins, and in most cases left atrial involvement is asymptomatic. But myocardial compression and invasion by adjacent lung mass may result in myocardial ischemia and may present with retrosternal, oppressive chest pain which clinically may simulate with the acute myocardial infarction (AMI. As a result, it leads to misdiagnosis and delayed diagnosis of lung cancer. Here we report a case of non-small-cell carcinoma of right lung which was presented with asymptomatic invasion in left atrium and retrosternal chest pain simulating AMI due to myocardial compression by adjacent lung mass, in a seventy-four-year-old male smoker.

  18. Myocardial Lineage Development

    Science.gov (United States)

    Evans, Sylvia M.; Yelon, Deborah; Conlon, Frank L.; Kirby, Margaret L.

    2010-01-01

    The myocardium of the heart is composed of multiple highly specialized myocardial lineages, including those of the ventricular and atrial myocardium, and the specialized conduction system. Specification and maturation of each of these lineages during heart development is a highly ordered, ongoing process involving multiple signaling pathways and their intersection with transcriptional regulatory networks. Here, we attempt to summarize and compare much of what we know about specification and maturation of myocardial lineages from studies in several different vertebrate model systems. To date, most research has focused on early specification, and while there is still more to learn, less is known about factors that promote subsequent maturation of myocardial lineages required to build the functioning adult heart. PMID:21148449

  19. Severe acute myocardial infarction and peripheral thrombosis in patient with bladder cancer

    Directory of Open Access Journals (Sweden)

    Ahmet Seyfeddin Gürbüz

    2017-12-01

    Full Text Available Cancer-associated thrombosis worsens the lives of patients substantially. Venous manifestations of cancer-associated thrombosis include deep vein thrombosis and pulmonary embolism. Arterial events include stroke and myocardial infarction. In this patient, myocardial infarction and cardiogenic shock are associated with diffuse coronary thrombosis together with peripheral thrombosis. He had surgery because of bladder carcinoma. Severe hypercoagulable condition probably facilitated by cancer itself and surgery caused multivessel coronary and peripheral intense thrombus burden. Intracoronary 10 mcg/kg tirofiban bolus and 15 mg tissue plasminogen activator (tPA were administered respectively before revascularization and thrombectomy operation was performed. Complete revascularization was achieved.

  20. Prospective analysis of endoscopic vein harvesting.

    Science.gov (United States)

    Patel, A N; Hebeler, R F; Hamman, B L; Hunnicutt, C; Williams, M; Liu, L; Wood, R E

    2001-12-01

    Utilization of bridging vein harvesting (BVH) of saphenous vein grafts (SVG) for coronary artery bypass grafting (CABG) results in large wounds with great potential for pain and infection. Endoscopic vein harvesting (EVH) may significantly reduce the morbidity associated with SVG harvesting. A prospective database of 200 matched patients receiving EVH and BVH was compared. The patients all underwent CABG done over a period of 4 months (April to August 2000). Patients were excluded if they had prior vein harvesting. The EVH and BVH group included 100 patients each with similar demographics. The patients in the EVH group had significantly fewer wound complications, mean days to ambulation, and total length of stay (P BVH in patients undergoing CABG.

  1. Leiomyosarcoma of the great saphenous vein.

    Science.gov (United States)

    El Khoury, M; Mesurolle, B; Trassard, M; Cherel, P; Talma, V; Hagay, C

    2006-10-01

    Peripheral vascular leiomyosarcomas are rare. A case of leiomyosarcoma of the great saphenous vein diagnosed pre-surgically by MRI and fine-needle aspiration is presented. Characteristics of the tumour and imaging features are discussed.

  2. Hepatic vein obstruction (Budd-Chiari)

    Science.gov (United States)

    ... MedlinePlus Site Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Hepatic vein obstruction (Budd-Chiari) URL of this page: // ...

  3. Primary leiomyosarcoma of the innominate vein.

    Science.gov (United States)

    Illuminati, Giulio; Miraldi, Fabio; Mazzesi, Giuseppe; D'urso, Antonio; Ceccanei, Gianluca; Bezzi, Marcello

    2007-01-01

    Primary venous leiomyosarcoma is rare. We report the case of a primary leiomyosarcoma of the left innominate vein, with neoplastic thrombus extending into the left jugular and subclavian veins. The tumor was curatively resected en bloc with anterior mediastinal and laterocervical lymphatics, through a median sternotomy prolonged into left cervicotomy. Primary venous sarcomas may be associated with prolonged survival in individual cases, with curative resection recommended as the standard treatment, in the absence of distant spread.

  4. CT in thrombosed dilated posterior epidural vein

    Energy Technology Data Exchange (ETDEWEB)

    Bammatter, S.; Schnyder, P.; Preux, J. de

    1987-05-01

    The authors report a case of thrombosis of the distal end of an enlarged right posterior epidural vein. The patient had a markedly narrow lumbar canal due to L5 spondylolisthesis. The dilated vein and the thrombosis were displayed by computed tomography but remained unrecognized until surgery. Pathogenesis of this condition is discussed. A review of the English, French and German literature revealed no prior radiological reports of a similar condition.

  5. Retrotracheal aberrant left brachiocephalic vein: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Yigit, Adalet E.; Haliloglu, Mithat; Karcaaltincaba, Musturay; Ariyurek, Macit O. [Hacettepe University Faculty of Medicine, Department of Radiology, Ankara (Turkey)

    2008-03-15

    We present a child with double aberrant left brachiocephalic vein (ALBCV) that was an incidental finding on CT. The anterior and thin branch was above the aortic arch and behind the truncus brachiocephalicus and drained into the superior vena cava (SVC). The posterior and thick branch of the ALBCV coursed posterior to the trachea and oesophagus and joined with the azygos vein before draining into the SVC. To our knowledge, retrotracheal ALBCV has not been previously described. (orig.)

  6. Efficacy of varicose vein surgery with preservation of the great safenous vein

    Directory of Open Access Journals (Sweden)

    Bernardo Cunha Senra Barros

    Full Text Available OBJECTIVE: To evaluate the efficacy of surgical treatment of varicose veins with preservation of the great saphenous vein. METHODS: We conducted a prospective study of 15 female patients between 25 and 55 years of age with clinical, etiologic, anatomic and pathophysiologic (CEAP classification 2, 3 and 4. The patients underwent surgical treatment of primary varicose veins with great saphenous vein (GSV preservation. Doppler ultrasonography exams were carried out in the first and third months postoperatively. The form of clinical severity of venous disease, Venous Clinical Severity Score (VCSS was completed before and after surgery. We excluded patients with history of deep vein thrombosis, smoking or postoperatively use of elastic stockings or phlebotonics. RESULTS: All patients had improved VCSS (p <0.001 and reduction in the diameter of the great saphenous vein (p <0.001. There was a relationship between VCSS and the GSV caliber, as well as with preoperative CEAP. There was improvement in CEAP class in nine patients when compared with the preoperative period (p <0.001. CONCLUSION: The varicose vein surgery with preservation of the great saphenous vein had beneficial effects to the GSV itself, with decreasing caliber, and to the symptoms when the vein had maximum caliber of 7.5 mm, correlating directly with the CEAP. The decrease in GSV caliber, even without complete abolition of reflux, leads to clinical improvement by decreasing the reflux volume.

  7. Measuring myocardial perfusion

    DEFF Research Database (Denmark)

    Qayyum, A A; Kastrup, J

    2015-01-01

    Recently, focus has changed from anatomical assessment of coronary arteries towards functional testing to evaluate the effect of stenosis on the myocardium before intervention. Besides positron-emission tomography (PET), cardiac MRI (CMR), and cardiac CT are able to measure myocardial perfusion......-known and is used in routine clinical practice. However, PET uses radioactive tracers and has a lower spatial resolution compared to CMR and CT. CMR and CT are emerging techniques in the field of myocardial perfusion imaging. CMR uses magnetic resonance to obtain images, whereas CT uses x-rays during first...

  8. Veins improve fracture toughness of insect wings.

    Directory of Open Access Journals (Sweden)

    Jan-Henning Dirks

    Full Text Available During the lifetime of a flying insect, its wings are subjected to mechanical forces and deformations for millions of cycles. Defects in the micrometre thin membranes or veins may reduce the insect's flight performance. How do insects prevent crack related material failure in their wings and what role does the characteristic vein pattern play? Fracture toughness is a parameter, which characterises a material's resistance to crack propagation. Our results show that, compared to other body parts, the hind wing membrane of the migratory locust S. gregaria itself is not exceptionally tough (1.04±0.25 MPa√m. However, the cross veins increase the wing's toughness by 50% by acting as barriers to crack propagation. Using fracture mechanics, we show that the morphological spacing of most wing veins matches the critical crack length of the material (1132 µm. This finding directly demonstrates how the biomechanical properties and the morphology of locust wings are functionally correlated in locusts, providing a mechanically 'optimal' solution with high toughness and low weight. The vein pattern found in insect wings thus might inspire the design of more durable and lightweight artificial 'venous' wings for micro-air-vehicles. Using the vein spacing as indicator, our approach might also provide a basis to estimate the wing properties of endangered or extinct insect species.

  9. Conservative hemodynamic surgery for varicose veins.

    Science.gov (United States)

    Criado, Enrique; Luján, Salvador; Izquierdo, Luis; Puras, Enrique; Gutierrez, Miguel; Fontcuberta, Juan

    2002-03-01

    Conservative hemodynamic surgery for varicose veins is a minimally invasive, nonablative technique that preserves the saphenous vein and helps avoid excision of varicosities. It represents a physiologic approach to the surgical treatment of varicose veins based on knowledge of the underlying venous pathophysiology gained through detailed duplex scanning. A change in venous hemodynamics is attained through fragmentation of the blood column by interruption of the refluxing saphenous trunks, closure of the origin of the refluxing varicose branches, and preservation of the communicating veins that drain the incompetent varicose veins into the deep venous system. After surgery, varicose veins regress through a reduction in hydrostatic pressure and efficient emptying of the superficial system by the musculo-venous pump. Obvious advantages of this technique are that it is done in an ambulatory setting, minimizes the risk of surgical complications, and permits a rapid return to full activity. The long-term hemodynamic improvement and recurrence rate of this technique remain to be established. Copyright 2002 by W.B. Saunders Company

  10. Diagnosis and treatment of superficial vein thrombosis.

    Science.gov (United States)

    Bauersachs, R M

    2013-08-01

    Superficial vein thrombosis (SVT) is a common disease, characterized by an inflammatory-thrombotic process in a superficial vein. Typical clinical findings are pain and a warm, tender, reddish cord along the vein. Until recently, no reliable epidemiological data were available. The incidence is estimated to be higher than that of deep-vein thrombosis (DVT) (1/1000). SVT shares many risk factors with DVT, but affects twice as many women than men and frequently occurs in varicose veins. Clinically, SVT extension is commonly underestimated, and patients may have asymptomatic DVT. Therefore, ultrasound assessment and exclusion of DVT is essential. Risk factors for concomitant DVT are recent hospitalization, immobilization, autoimmune disorders, age > 75 years, prior VTE, cancer and SVT in non-varicose veins. Even though most patients with isolated SVT (without concomitant DVT or PE) are commonly treated with anticoagulation for a median of 15 days, about 8% experience symptomatic thromboembolic complications within three months. Risk factors for occurrence of complications are male gender, history of VTE, cancer, SVT in a non-varicose vein or SVT involving the sapheno-femoral junction (SFJ). As evidence supporting treatment of isolated SVT was sparse and of poor quality, the large, randomized, double-blind, placebo-controlled CALISTO trial was initiated assessing the effect of fondaparinux on symptomatic outcomes in isolated SVT. This study showed that, compared with placebo, 2.5 mg fondaparinux given for 45 days reduced the risk of symptomatic thromboembolic complications by 85% without increasing bleeding. Based on CALISTO and other observational studies, evidence-based recommendations can be made for the majority of SVT patients. Further studies can now be performed in higher risk patients to address unresolved issues.

  11. Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy achieve comparable weight loss at 1 year.

    Science.gov (United States)

    Yaghoubian, Arezou; Tolan, Amy; Stabile, Bruce E; Kaji, Amy H; Belzberg, Gary; Mun, Edward; Zane, Robert

    2012-12-01

    Laparoscopic sleeve gastrectomy has gained popularity as a weight loss surgical option for morbidly obese patients. Although initial studies have shown weight loss and comorbidity resolution comparable to those after laparoscopic Roux-en-Y gastric bypass (RYGB), many of these studies are limited by the small patient size. Thus, the purpose of this study was to compare the outcomes of laparoscopic sleeve gastrectomy and laparoscopic RYGB. A retrospective chart review of all morbidly obese patients who underwent laparoscopic RYGB or sleeve gastrectomy between 2007 and 2009 at an HMO hospital was conducted. Data points collected included age, gender, completion of a preoperative weight loss program, initial body mass index (BMI), pre- and postoperative weights, and presence of diabetes mellitus (DM), hypertension (HTN), osteoarthritis, obstructive sleep apnea, and gastroesophageal reflux disease (GERD). Outcomes measures included excess weight loss, resolution of comorbidities, postoperative complications, and mortality. A total of 345 laparoscopic RYGBs and 192 sleeve gastrectomies were performed. On average, the patients who received RYGB were younger (46 vs 48 years, P = 0.05) and had higher BMI (47 vs 43 kg/m(2), P sleeve gastrectomy completed a preoperative weight loss program. The median length of hospital stay for both groups was 3 days. The complication rate in both groups was 9 per cent. The incidence of gastric leak was 1 per cent in both groups. There was only one mortality, which occurred in the RYGB group. The postoperative resolution of DM was comparable in both groups. The RYGB group had greater resolution of HTN (48 vs 34%, P = 0.03) and GERD (73 vs 34%, P sleeve gastrectomy achieved superior excess weight loss compared with RYGB (72 vs 61%, P = 0.0015). After adjusting for age and BMI, the excess weight loss for RYGB and sleeve gastrectomy was similar at 12 months (t parameter estimate -0.06, P = 0.08). Laparoscopic RYGB and sleeve gastrectomy had

  12. Corrosion cast study of the canine hepatic veins.

    Science.gov (United States)

    Uršič, M; Vrecl, M; Fazarinc, G

    2014-11-01

    This study presents a detailed description of the distribution, diameters and drainage patterns of hepatic veins on the basis of the corrosion cast analysis in 18 dogs. We classified the hepatic veins in three main groups: the right hepatic veins of the caudate process and right lateral liver lobe, the middle hepatic veins of the right medial and quadrate lobes and the left hepatic veins of both left liver lobes and the papillary process. The corrosion cast study showed that the number of the veins in the Nomina Anatomica Veterinaria and most anatomical textbooks is underestimated. The number of various-sized hepatic veins of the right liver division ranged from 3 to 5 and included 1 to 4 veins from the caudate process and 2 to 4 veins from the right lateral liver lobe. Generally, in all corrosion casts, one middle-sized vein from the right part of the right medial lobe, which emptied separately in the caudal vena cava, was established. The other vein was a large-sized vein from the remainder of the central division, which frequently joined the common left hepatic vein from the left liver lobes. The common left hepatic vein was the largest of all the aforementioned hepatic veins.

  13. Thrombosed aneurysm of saphenous vein coronary artery bypass grafting

    Energy Technology Data Exchange (ETDEWEB)

    Queiroz, Rodolfo Mendes; Nastri Filho, Rogerio; Ferez, Marcus Antonio; Costa, Mauro Jose Brandao da; Laguna, Claudio Benedini; Valentin, Marcus Vinicius Nascimento, E-mail: rod_queiroz@hotmail.com [Documenta - Hospital Sao Francisco, Ribeirao Preto, SP (Brazil). Departamento de Radiologia e Diagnostico por Imagem; Hospital Sao Francisco, Ribeirao Preto, SP (Brazil). Centro de Terapia Intensiva

    2017-06-15

    We describe the case of a male patient, aged 76 years, referred for cardiac investigation due to retrosternal chest pain and dyspnea. He had a history of acute myocardial infarction and angioplasties in the last 30 years, including a saphenous vein coronary artery bypass grafting (SVCABG). Echocardiogram showed hypoechoic oval formation near the right ventricle, suggesting a pericardial cyst. Computed angiotomography revealed a predominantly fusiform and thrombosed aneurysmal dilation of the SVCABG to the right coronary artery. SVCABG aneurysms are very rare and potentially fatal. They usually appear in the late postoperative period, and patients are often asymptomatic. On radiography, it is frequently presented as enlargement of the mediastinum, with echocardiography, computed tomography and magnetic resonance imaging being very useful for diagnosis. Coronary angiography is the gold standard to detect these cases. Our report illustrates a rare situation arising late from a relatively common surgery. Due to its severity, proper recognition in the routine assessment of patients with a similar history is essential. (author)

  14. Comparison of Reinforcement Techniques Using Suture on Staple-Line in Sleeve Gastrectomy.

    Science.gov (United States)

    Rogula, Tomasz; Khorgami, Zhamak; Bazan, Martin; Mamolea, Cristina; Acquafresca, Pablo; El-Shazly, Omar; Aminian, Ali; Schauer, Philip

    2015-11-01

    Sleeve gastrectomy is a common procedure in recent years for treatment of morbid obesity however leak from staple-line is its main challenging complication. Despite numerous studies regarding leak after sleeve gastrectomy, there is still no conclusion on reinforcement of staple-line in this procedure. The purpose of this study was to compare two methods of oversewing staple-line versus no reinforcement. Resected stomachs of 30 patients undergoing laparoscopic sleeve gastrectomy were evaluated for bursting pressure immediately after extraction from the abdomen. Reinforcement technique was applied in random order to 3 segments of the staple-line on each specimen: continuous Lembert's sutures, continuous through-and-through sutures, and no reinforcement. Bursting pressure was determined by injection of methylene blue solution into lumen of resected stomach and recording pressure at which leakage occurs. Location of leak, intragastric pressure, and volume at first leak were recorded. Baseline characteristics of patients were similar in randomized groups for order of reinforcement technique. Mean ischemia time of specimens was 17.4 ± 10.4 min. No leaks were observed in segments reinforced with Lembert's oversewing technique. The through-and-through reinforcement segments were first to leak in 21 out of 30 cases (70 %) with mean leak pressure of 570 mmHg and mean leak volume of 399 ml. Leakage occurred in 9 segments (30 %) with no reinforcement with a leak pressure of 329 mmHg and volume of 380 ml. In vitro, Lembert's suture reinforcement technique on stapled human stomach is associated with less leakage rate in comparison to through-and-through reinforcement and non-reinforced staple-line.

  15. Single-Incision Laparoscopic Sleeve Gastrectomy: Review and a Critical Appraisal.

    Science.gov (United States)

    Dimitrokallis, Nikolaos; Alexandrou, Andreas; Schizas, Dimitrios; Angelou, Anastasios; Pikoulis, Emmanouil; Liakakos, Theodoros

    2017-03-01

    Single-incision laparoscopic surgery has attracted a great deal of interest in the surgical community in recent years, including bariatric surgery. Single-incision laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative to the multiport laparoscopic procedure; however, it has yet to meet wide acceptance and application. We aim to summarize existing data on SILSG and check the procedure's feasibility, technical details, safety, and, if possible, outcomes. We checked the most important databases for studies concerning SILSG and included all these that summarized the criteria placed and contained the data needed for this review. We excluded case reports. Nineteen studies complied with the criteria of our review, containing a total of 1679 patients. Their mean age has been 38.91 years and the mean preoperative body mass index has been 41.8 kg/m2. In majority of cases (60.5%), a left upper quadrant incision has been preferred and in 97.6%, a commercially available multiport system has been picked. A wide variety of instruments have been used and mean operating time has been 94.6 minutes. One conversion to open surgery has been reported and 7.4% required the placement of additional ports. There was a complication rate of 7.38% (most common being bleeding with a rate of 2.5%) and a reoperation rate of 2.8%. Mean excess weight loss for a follow-up of 1 year was achieved in 53.7% of patients and was 70.06%. A tendency for less analgesia and better wound satisfaction has been reported. SILSG is safe and feasible. However, there is insufficient evidence to recommend it as the new gold standard for sleeve gastrectomy in the place of conventional laparoscopic sleeve gastrectomy. Randomized controlled trials are needed to analyze the results and the possible benefits of this technique.

  16. Good clinical and radiographic outcome of cementless metal metaphyseal sleeves in total knee arthroplasty.

    Science.gov (United States)

    Thorsell, Martin; Hedström, Margareta; Wick, Marius C; Weiss, Rüdiger J

    2017-11-06

    Background and purpose - The number of revision total knee arthroplasties (TKA) is continuously increasing, leading to a growing need for reliable management of metaphyseal bone loss. We evaluated patients operated with a TKA using metal metaphyseal sleeves for bone defects with a minimum 5-year follow-up. Patients and methods - 37 patients had been operated on. 3 patients died and 3 patients were lost during follow-up. Of the 31 remainders (20 women), 9 had been operated on with a primary TKA and 22 with a revision TKA at the index surgery. The mean age at surgery was 69 (54-89) years and the mean follow-up time was 7.4 (5-12) years. Bone defects were classified according to the Anderson Orthopaedic Research Institute classification (tibia: type I n = 9, type II n = 5 and type III n = 17; femur: type I n = 12, type II n = 3 and type III n = 16). Results - At final follow-up one-third experienced an improvement concerning walking aids and walking distance. Except for 1 patient, all had full extension and a mean knee flexion of 110 (90-140) degrees. VAS pain at rest was 13 (SD 25) and on movement 30 (SD 31). 7 patients were reoperated due to: infection (n = 4), periprosthetic fracture (n = 1), skin necrosis (n = 1), and wound rupture (n = 1). The cumulative 5-year survival rate for reoperation was 77% (CI 63-92) and for revision 97% (CI 91-100). At the time of final follow-up, the sleeves showed good osseointegration with no signs of progressive radiolucency or migration. Interpretation - Titanium sleeves are a promising option in managing difficult cases with metaphyseal bone defects in TKA, providing a stable construct with good medium-term radiographic outcome.

  17. Enabling recruitment success in bariatric surgical trials: pilot phase of the By-Band-Sleeve study.

    Science.gov (United States)

    Paramasivan, S; Rogers, C A; Welbourn, R; Byrne, J P; Salter, N; Mahon, D; Noble, H; Kelly, J; Mazza, G; Whybrow, P; Andrews, R C; Wilson, C; Blazeby, J M; Donovan, J L

    2017-11-01

    Randomized controlled trials (RCTs) involving surgical procedures are challenging for recruitment and infrequent in the specialty of bariatrics. The pilot phase of the By-Band-Sleeve study (gastric bypass versus gastric band versus sleeve gastrectomy) provided the opportunity for an investigation of recruitment using a qualitative research integrated in trials (QuinteT) recruitment intervention (QRI). The QRI investigated recruitment in two centers in the pilot phase comparing bypass and banding, through the analysis of 12 in-depth staff interviews, 84 audio recordings of patient consultations, 19 non-participant observations of consultations and patient screening data. QRI findings were developed into a plan of action and fed back to centers to improve information provision and recruitment organization. Recruitment proved to be extremely difficult with only two patients recruited during the first 2 months. The pivotal issue in Center A was that an effective and established clinical service could not easily adapt to the needs of the RCT. There was little scope to present RCT details or ensure efficient eligibility assessment, and recruiters struggled to convey equipoise. Following presentation of QRI findings, recruitment in Center A increased from 9% in the first 2 months (2/22) to 40% (26/65) in the 4 months thereafter. Center B, commencing recruitment 3 months after Center A, learnt from the emerging issues in Center A and set up a special clinic for trial recruitment. The trial successfully completed pilot recruitment and progressed to the main phase across 11 centers. The QRI identified key issues that enabled the integration of the trial into the clinical setting. This contributed to successful recruitment in the By-Band-Sleeve trial-currently the largest in bariatric practice-and offers opportunities to optimize recruitment in other trials in bariatrics.

  18. Leaks in fixed-ring banded sleeve gastrectomies: a management approach.

    Science.gov (United States)

    Foo, Jonathan W; Balshaw, James; Tan, Michael H L; Tan, Jeremy T H

    2017-08-01

    The use of a Fobi ring to prevent pouch dilation is sometimes used in Roux-en-Y gastric bypass (RYGB). Recently, it has been extrapolated to laparoscopic sleeve gastrectomy (LSG) procedures by placing a fixed-ring band a few centimeters below the gastroesophageal junction (GEJ). What is the consequence if a patient develops a leak? Tertiary metropolitan referral center, Australia. Over 18 months, all patients with either a conventional LSG or a fixed-ring banded sleeve gastrectomy (BLSG) who presented with a proven leak complication were included. The management approaches along with the surgical, endoscopic, and percutaneous procedures used were examined. Six patients had a BLSG leak and 6 had a LSG leak. All patients had leak resolution. There was no significant difference in body mass index (BMI), time to leak, initial white cell count (WCC), and C-reactive protein (CRP) levels between the 2 groups. LSG patients required a median of 2 endoscopic procedures (range: 1-3). Stents were deployed in 3 patients. All BLSG patients required a single surgical intervention with laparoscopic washout, drainage, removal of band±feeding jejunostomy. One stent was deployed in 1 BLSG patient. BLSG leak resolution was found at 34±12 days versus 85±12 days in the LSG group (P< .05). The BLSG is a new modification of the sleeve gastrectomy procedure. This study presents a management strategy for leak resolution employed in BLSG patients. The presence of a foreign body as a persistent nidus of infection mandates band removal. Copyright © 2017 American Society for Bariatric Surgery. All rights reserved.

  19. Structure and properties of braided sleeve preforms for chemical vapor infiltration

    Energy Technology Data Exchange (ETDEWEB)

    Starr, T.L.; Fiadzo, O.G.; Hablutzel, N. [Georgia Inst. of Tech., Atlanta, GA (United States). School of Materials Science and Technology

    1998-04-01

    In all composites the properties and structure of the reinforcement strongly influence the performance of the material. For some composites, however, the reinforcement also affects the fabrication process itself exerting an additional, second order influence on performance. This is the case for the chemical vapor infiltration (CVI) process for fabrication of ceramic matrix composites. In this process the matrix forms progressively as a solid deposit, first onto the fiber surfaces, then onto the previous layer of deposit, ultimately growing to fill the inter-fiber porosity. The transport of reactants to the surfaces and the evolved morphology of the matrix depend on the initial reinforcement structure. This structure can vary greatly and is controlled by such factors as fiber size and cross-section, the number of filaments and amount of twist per tow or yarn, and the weave or braid architecture. Often the choice of reinforcement is based on mechanical performance analysis or on the cost and availability of the material or on the temperature stability of the fiber. Given this choice, the composite densification process--CVI--must be optimized to attain a successful material. Ceramic fiber in the form of cylindrical braided sleeve is an attractive choice for fabrication of tube-form ceramic matrix composites. Multiple, concentric layers of sleeve can be placed over a tubular mandrel, compressed and fixed with a binder to form a freestanding tube preform. This fiber architecture is different than that created by layup of plain weave cloth--the material used in most previous CVI development. This report presents the results of the investigation of CVI densification of braided sleeve preforms and the evolution of their structure and transport properties during processing.

  20. The anatomy of the cardiac veins in mice

    Science.gov (United States)

    Ciszek, Bogdan; Skubiszewska, Daria; Ratajska, Anna

    2007-01-01

    Although the cardiac coronary system in mice has been the studied in detail by many research laboratories, knowledge of the cardiac veins remains poor. This is because of the difficulty in marking the venous system with a technique that would allow visualization of these large vessels with thin walls. Here we present the visualization of the coronary venous system by perfusion of latex dye through the right caudal vein. Latex injected intravenously does not penetrate into the capillary system. Murine cardiac veins consist of several principal branches (with large diameters), the distal parts of which are located in the subepicardium. We have described the major branches of the left atrial veins, the vein of the left ventricle, the caudal veins, the vein of the right ventricle and the conal veins forming the conal venous circle or the prepulmonary conal venous arch running around the conus of the right ventricle. The venous system of the heart drains the blood to the coronary sinus (the left cranial caval vein) to the right atrium or to the right cranial caval vein. Systemic veins such as the left cranial caval, the right cranial caval and the caudal vein open to the right atrium. Knowledge of cardiac vein location may help to elucidate abnormal vein patterns in certain genetic malformations. PMID:17553104

  1. Axillary artery injury after an anterior shoulder fracture dislocation and “periosteal sleeve avulsion of the rotator cuff” (SARC. Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Ash Chehata

    2017-04-01

    Full Text Available We present the rare complication of an axillary artery injury associated with an anterior dislocation of the humerus and what we believe to be the first reported periosteal sleeve avulsion of the entire rotator cuff (SARC. We review the literature and discuss the cause of this unusual injury pattern. Keywords: Axillary artery, Shoulder fracture dislocation, Periosteal sleeve avulsion, SARC

  2. Outcomes of laparoscopic proximal gastrectomy with esophagojejunal reconstruction for chronic staple line disruption after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Thompson, Charles E; Ahmad, Hira; Lo Menzo, Emanuele; Szomstein, Samuel; Rosenthal, Raul J

    2014-01-01

    Sleeve gastrectomy is now a frequently performed bariatric procedure for severely obese patients and may have the lowest frequency of short-term or long-term complications. The aim of this study is to describe our experience in managing chronic proximal leaks with a proximal gastrectomy and Roux-en-Y esophagojejunostomy (PGEJ). A retrospective review was performed of all patients having proximal chronic staple-line disruptions (CSLD) after undergoing laparoscopic sleeve gastrectomy. Fifteen patients had proximal CSLD and were treated with PGEJ. There was 1 (6.6%) releak in this group, which resolved with nonoperative treatment. Other postoperative morbidities in this series included partial small bowel obstruction (n = 1) and subhepatic bile collection (n = 1), both of which resolved without operative intervention. PGEJ appears to be a safe and effective procedure for chronic staple-line disruptions after sleeve gastrectomy. © 2014 American Society for Bariatric Surgery Published by American Society for Metabolic and Bariatric Surgery All rights reserved.

  3. Repair boundary for parent tube indications within the upper joint zone of hybrid expansion joint (HEJ) sleeved tubes

    Energy Technology Data Exchange (ETDEWEB)

    Cullen, W.K.; Keating, R.F. [Westinghouse Electric, Pittsburgh, PA (United States)

    1997-02-01

    In the Spring and Fall of 1994, and the Spring of 1995, crack-like indications were found in the upper hybrid expansion joint (HEJ) region of Steam Generator (S/G) tubes which had been sleeved using Westinghouse HEJ sleeves. As a result of these findings, analytic and test evaluations were performed to assess the effect of the degradation on the structural, and leakage, integrity of the sleeve/tube joint relative to the requirements of the United States Nuclear Regulatory Commission`s (NRC) draft Regulatory Guide (RG) 1.121. The results of these evaluations demonstrated that tubes with implied or known crack-like circumferential parent tube indications (PTIs) located 1.1 inches or farther below the bottom of the hardroll upper transition, have sufficient, and significant, integrity relative to the requirements of RG 1.121. Thus, the purpose of this report is to provide background information related to the justification of the modified tube repair boundary.

  4. Parks' coloanal sleeve anastomosis for treatment of postirradiation rectovaginal fistula

    Energy Technology Data Exchange (ETDEWEB)

    Nowacki, M.P.; Szawlowski, A.W.; Borkowski, A.

    1986-12-01

    Postirradiation rectovaginal fistula is a complex problem in colorectal surgery. The modified Parks procedure curettage of rectal mucosa heavily damaged by radiation is introduced. Fifteen cases of coloanal sleeve anastomosis for the repair of rectovaginal postirradiation fistula are described. All patients previously were irradiated heavily because of carcinoma of the uterine cervix. Three patients had simultaneous repair of vesicovaginal fistula. One postoperative death was observed. Of the surviving patients, functional results have been good in 11. In the seven patients with difficult stripping of the rectal mucosa, surgical curettage was performed. The latter procedure is suggested as the method of choice in relevant cases.

  5. Sleeve gastrectomy telementoring: a SAGES multi-institutional quality improvement initiative.

    Science.gov (United States)

    Nguyen, Ninh T; Okrainec, Allan; Anvari, Mehran; Smith, Brian; Meireles, Oz; Gee, Denise; Moran-Atkin, Erin; Baram-Clothier, Evelyn; Camacho, Diego R

    2018-02-01

    Sleeve gastrectomy is a relatively new procedure that developed as a result of rapid innovation in the field of bariatric surgery. As with any newly developed operation, there is a learning curve that potentially can be associated with higher morbidity. Real-time surgical mentoring reduces the learning curve effect but can be time intensive for the mentor. The aim of this initiative was to evaluate the feasibility, effectiveness, and satisfaction of surgical telementoring for laparoscopic sleeve gastrectomy. This is the first national specialty society effort to determine if the "remote presence" of an expert surgeon (mentor) can help practicing surgeons improve skills. The experience of 15 surgical trainees (mentees) who performed laparoscopic sleeve gastrectomy under real-time telementoring by 7 mentors was reviewed. Telementoring was implemented using the Visitor1 ® remote presence system with two-way live audio and video communication. The receiving platform utilized a conventional laptop, iPad, or iPhone. The mentee followed a structured telementoring program including didactic learning, live case teleobservation, and telementoring of 2-3 cases. A survey on the quality of the telecommunication and effectiveness of the mentoring was performed by the mentor and mentee on a scale of "exceeded," "met," "almost met," or "failed to meet" expectations. The overall telementoring experience was rated on a scale of 1 for "poor" to 5 for "excellent." Based on the mentees' survey, the overall telementoring experience was rated as 4.8. Despite the mentees having experience with laparoscopic sleeve gastrectomy, most commented that the telementoring experience was an excellent educational tool and they learned some new techniques they plan to apply it in their practice. Based on the mentors' survey, the overall telementoring experience was rated as 4.7. All mentors stated that they were satisfied with the telementoring sessions and there were no unexpected intraoperative

  6. SLEEVE GASTRECTOMY AND FUNDOPLICATION AS A SINGLE PROCEDURE IN PATIENTS WITH OBESITY AND GASTROESOPHAGEAL REFLUX

    Science.gov (United States)

    LASNIBAT, Juan Pablo; BRAGHETTO, Italo; GUTIERREZ, Luis; SANCHEZ, Felipe

    2017-01-01

    ABSTRACT Background: Bariatric surgery in Chile has seen an exponential increase in recent years, especially in sleeve gastrectomy. Its use is currently discussed in patients suffering from gastroesophageal reflux disease. Different options have been considered for the management of these patients but up to now laparoscopic Roux-en-Y gastric bypass seems to be the best option. Sleeve gastrectomy plus concomitant fundoplication or hiatal hernia repair also has been suggested in patients having reflux or small hiatal hernia. Aim: To present a cohort of obese patients with gatroesophageal reflux undergoing this procedure, which seeks to provide the benefits of both laparoscopic gastric sleeve (LSG) and antireflux surgery focused on the evaluation of presence of reflux and BMI after surgery, and to compare the result observed in this cohort with a previous group of obese patients without reflux submitted to sleeve gastrectomy alone. Methods: Retrospective case series in 15 patients who underwent this surgery between the years 2003 and 2012. Clinical records were analyzed and values ​​of 24 hr pH monitoring, esophageal manometry and clinical outcome were recorded. Results were compared to a previous series of patients who underwent LSG. No statistical analyses were made. Results: Group A consisted of 15 patients submitted to LSG plus fundoplication. 93% (n=14) were female. Mean age was 46.2 years. Mean preoperative body mass index (BMI) was 33.9. All patients had altered pH monitoring and manometry preoperatively. There was one minor complication corresponding to a seroma. There was no perioperative mortality. Group B consisted of 23 obese patients who underwent LSG. These patients developed de novo reflux, hypotensive LES and esophagitis after the surgery. Group A patients showed improvement in esophageal pH monitoring and manometry at three months. During long-term follow-up, six underwent revision surgery, four for weight regain, one regained weight associated

  7. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide

    Science.gov (United States)

    Sarkhosh, Kourosh; Birch, Daniel W.; Sharma, Arya; Karmali, Shahzeer

    2013-01-01

    Obesity is a common disease affecting adults and children. The incidence of obesity in Canada is increasing. Laparoscopic sleeve gastrectomy (LSG) is a relatively new and effective procedure for weight loss. Owing to an increase in the number of bariatric surgical procedures, general surgeons should have an understanding of the complications associated with LSG and an approach for dealing with them. Early postoperative complications following LSG that need to be identified urgently include bleeding, staple line leak and development of an abscess. Delayed complications include strictures, nutritional deficiencies and gastresophageal reflux disease. We discuss the principles involved in the management of each complication. PMID:24067520

  8. FXR is a molecular target for the effects of vertical sleeve gastrectomy

    DEFF Research Database (Denmark)

    Ryan, Karen K; Tremaroli, Valentina; Clemmensen, Christoffer

    2014-01-01

    Bariatric surgical procedures, such as vertical sleeve gastrectomy (VSG), are at present the most effective therapy for the treatment of obesity, and are associated with considerable improvements in co-morbidities, including type-2 diabetes mellitus. The underlying molecular mechanisms contributing......-X receptor, also known as NR1H4). We therefore examined the results of VSG surgery applied to mice with diet-induced obesity and targeted genetic disruption of FXR. Here we demonstrate that the therapeutic value of VSG does not result from mechanical restriction imposed by a smaller stomach. Rather, VSG...... molecular underpinning for the beneficial effects of this weight-loss surgery....

  9. Superficial vein thrombosis with hemorrhagic cerebral infarction

    Directory of Open Access Journals (Sweden)

    Yu-wei CONG

    2016-01-01

    Full Text Available Background Cerebral superficial vein thrombosis was rare and often misdiagnosed or missed for its various etiological factors, and complicated and nonspecific clinical manifestations. This paper reported one case of superficial vein thrombosis in right fronto-parietal lobe with hemorrhagic infarction. The anatomy of superficial vein, pathophysiological points, diagnosis and treatment of superficial vein thrombosis were reviewed to help to reduce missed diagnosis or misdiagnosis. Methods and Results A 18-year-old male patient had suffered from progressive headache for 4 years and weakness of left limbs for 2 d. Head MRI showed circular space-occupying lesion in right fronto-parietal lobe. Magnetic resonance venography (MRV examination showed the front two-thirds of the superior sagittal sinus was not clear. The lesions were removed and decompressive craniectomy was conducted, showing the brain tissue was pale, partly yellow or dark red, and superficial venous engorgement. Histological observation showed pial superficial vein thrombosis and subpial encephalomalacia, and multifocal hemorrhage of cerebral cortex and local parenchymal hemorrhage. A large number of "grid cells" and vascular "cuff" phenomenan were visible in surrounding tissue, and the parenchymal blood vessel proliferation was obvious. Left hand activity of the patient was obviously limited after the operation. Conclusions Clinical diagnosis of superficial vein thrombosis with hemorrhagic infarction is difficult, and brain imaging and serological examination can provide certain help. Much attention should be paid to the multidisciplinary diagnosis and treatment to reduce misdiagnosis or missed diagnosis, and gather clinical experience. DOI: 10.3969/j.issn.1672-6731.2016.01.007

  10. Predictors of Increased Length of Hospital Stay Following Laparoscopic Sleeve Gastrectomy from the National Surgical Quality Improvement Program.

    Science.gov (United States)

    Fletcher, Reid; Deal, Rebecca; Kubasiak, John; Torquati, Alfonso; Omotosho, Philip

    2017-12-05

    Laparoscopic sleeve gastrectomy is the most commonly performed bariatric procedure in the USA. Identifying preoperative risk factors for prolonged postoperative hospital stay will help appropriately select patients for fast-track protocols and avoid costly readmissions. To date, there has been no large national database analysis of risk factors for prolonged length of stay following laparoscopic sleeve gastrectomy. Laparoscopic sleeve gastrectomy procedures reported to the American College of Surgeons National Surgical Quality Improvement Program between 2009 and 2012 were reviewed. Open procedures and revisional procedures were excluded. Baseline patient characteristics and preoperative lab values were reviewed. Univariate analysis was conducted to identify patient factors that predicted prolonged hospitalization (defined as ≥ 3 days). Multivariate logistic regression was used to identify factor associated with prolonged length of stay. We identified 11,430 patients who underwent laparoscopic sleeve gastrectomy. The median length of stay was 2 days and 18.4% required hospitalization ≥ 3 days. Multivariate analysis revealed that female sex, age greater than 65, body mass index greater than 50, chronic obstructive pulmonary disease, hypertension, renal insufficiency, anemia, and prolonged operative time were significantly associated with prolonged hospital stay. Preoperative patient characteristics as well as operative details predict prolonged length of stay following laparoscopic sleeve gastrectomy. As the utilization of fast-track protocols in bariatric surgery programs expands, these data may be used to assist in the selection of patients who may be inappropriate for rapid discharge from the hospital after sleeve gastrectomy as well as guide medical optimization strategies preoperatively.

  11. Sleeve Gastrectomy Reduces Hepatic Steatosis by Improving the Coordinated Regulation of Aquaglyceroporins in Adipose Tissue and Liver in Obese Rats.

    Science.gov (United States)

    Méndez-Giménez, Leire; Becerril, Sara; Moncada, Rafael; Valentí, Víctor; Ramírez, Beatriz; Lancha, Andoni; Gurbindo, Javier; Balaguer, Inmaculada; Cienfuegos, Javier A; Catalán, Victoria; Fernández, Secundino; Gómez-Ambrosi, Javier; Rodríguez, Amaia; Frühbeck, Gema

    2015-09-01

    Glycerol constitutes an important metabolite for the control of lipid accumulation and glucose homeostasis. Our aim was to investigate the potential role of aquaglyceroporins, which are glycerol channels mediating glycerol efflux in adipocytes (AQP3 and AQP7) and glycerol influx (AQP9) in hepatocytes, in the improvement of adiposity and hepatic steatosis after sleeve gastrectomy in an experimental model of diet-induced obesity (DIO). Male Wistar DIO rats (n = 161) were subjected to surgical (sham operation and sleeve gastrectomy) or dietary interventions [fed ad libitum a normal diet (ND) or a high-fat diet (HFD) or pair-fed to the amount of food eaten by sleeve-gastrectomized animals]. The tissue distribution and expression of AQPs in biopsies of epididymal (EWAT) and subcutaneous (SCWAT) white adipose tissue and liver were analyzed by real-time PCR, Western blot, and immunohistochemistry. Four weeks after surgery, DIO rats undergoing sleeve gastrectomy showed a reduction in body weight, whole-body adiposity, and hepatic steatosis. DIO was associated with a tendency towards an increase in EWAT AQP3 and SCWAT AQP7 and a decrease in hepatic AQP9. Sleeve gastrectomy downregulated AQP7 in both fat depots and upregulated AQP3 in EWAT, without changing hepatic AQP9. Aqp7 transcript levels in EWAT and SCWAT were positively associated with adiposity and glycemia, while Aqp9 mRNA was negatively correlated with markers of hepatic steatosis and insulin resistance. Our results show, for the first time, that sleeve gastrectomy, a widely applied bariatric surgery procedure, restores the coordinated regulation of fat-specific AQP7 and liver-specific AQP9, thereby improving whole-body adiposity and hepatic steatosis.

  12. Converting a Sleeve Gastrectomy to a Gastric Bypass for Weight Loss Failure-Is It Worth It?

    Science.gov (United States)

    Nevo, Nadav; Abu-Abeid, Subhi; Lahat, Guy; Klausner, Joseph; Eldar, Shai M

    2017-09-10

    Sleeve gastrectomy (SG) is gaining popularity and has become the procedure of choice for many bariatric surgeons. Long-term weight loss failure is not uncommon. The preferred revisional procedure for these patients is still under debate. The objective of this study was to assess the safety and efficacy of laparoscopic gastric bypass as a revisional surgery for sleeve gastrectomy patients with weight loss failure. The study was done at a bariatric surgery center in a university hospital. We reviewed our prospectively collected database and identified all patients who underwent conversion of a sleeve gastrectomy to a gastric bypass for weight loss failure. Data on patient demographics, baseline characteristics, and outcomes of bariatric surgery were retrieved. Twenty-three patients with a mean body mass index (BMI) of 41.6 kg/m2 (range 34.1-50.1 kg/m2) underwent conversion to a gastric bypass. Four patients underwent a gastric band prior to the sleeve gastrectomy, and two patients underwent a re-sleeve gastrectomy prior to conversion to a gastric bypass. At a mean follow-up of 24 months (range 9-46 months), the average body mass index (BMI) decreased to 33.8 kg/m2 and the excess body mass index loss (EBMIL) was 42.6%. Diabetes, hypertension, dyslipidemia, and obstructive sleep apnea resolved or improved in 44.4, 45.5, 50, and 50% of the patients, respectively. Three patients developed early postop complications (13%), while late complications occurred in four patients (17%). Converting a sleeve gastrectomy to a gastric bypass for weight loss failure is safe, yet weight loss benefit is limited.

  13. Mechanical behavior of pre tensioned metallic sleeves for pipeline repair; Comportamento mecanico de luvas metalicas pre tensionadas para reparo de dutos terrestres

    Energy Technology Data Exchange (ETDEWEB)

    Meniconi, Luiz C.M.; Paes, Marcelo T. Piza [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil). Centro de Pesquisas; Frainer, Vitor [Rio Grande do Sul Univ., Porto Alegre, RS (Brazil). Dept. de Metalurgia. Lab. de Metalurgia Fisica (LAMEF); Souza Filho, Byron G. de [PETROBRAS Transportes S.A. (TRANSPETRO), Rio de Janeiro, RJ (Brazil); Patricio, Wagner [Foxoil do Brasil Ltda., Macae, RJ (Brazil)

    2005-07-01

    Two different methods for pre-tensioning of metallic sleeves for pipeline repair were appraised: mechanic, by means of hydraulic jacks, and thermal, trough the use of oxyacetylene torches. Hydraulic jacks promote an 'in situ' forming of the sleeves, once they impose loads rather than displacements. There is no need of a perfect match between the external diameter of the pipe and the internal diameter of the sleeve. The thermal method, on the other hand, needs a tight fit between the sleeve and the pipe to assure that thermal expansion will turn into elastic deformation. Test specimens were built with four different defect types: crack, dent, gouged dent and thickness loss due to corrosion. The use of pre-tensioned sleeves led to failure pressures 39% above the hydro test pressure, at least. All the specimen failures occurred outside the reinforced area. (author)

  14. Deep vein thrombosis: a clinical review

    Directory of Open Access Journals (Sweden)

    Kesieme EB

    2011-04-01

    Full Text Available Emeka Kesieme1, Chinenye Kesieme2, Nze Jebbin3, Eshiobo Irekpita1, Andrew Dongo11Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Nigeria; 2Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Nigeria; 3Department of Surgery, University of Port Harcourt Teaching Hospital, Port-Harcourt, NigeriaBackground: Deep vein thrombosis (DVT is the formation of blood clots (thrombi in the deep veins. It commonly affects the deep leg veins (such as the calf veins, femoral vein, or popliteal vein or the deep veins of the pelvis. It is a potentially dangerous condition that can lead to preventable morbidity and mortality.Aim: To present an update on the causes and management of DVT.Methods: A review of publications obtained from Medline search, medical libraries, and Google.Results: DVT affects 0.1% of persons per year. It is predominantly a disease of the elderly and has a slight male preponderance. The approach to making a diagnosis currently involves an algorithm combining pretest probability, D-dimer testing, and compression ultrasonography. This will guide further investigations if necessary. Prophylaxis is both mechanical and pharmacological. The goals of treatment are to prevent extension of thrombi, pulmonary embolism, recurrence of thrombi, and the development of complications such as pulmonary hypertension and post-thrombotic syndrome.Conclusion: DVT is a potentially dangerous condition with a myriad of risk factors. Prophylaxis is very important and can be mechanical and pharmacological. The mainstay of treatment is anticoagulant therapy. Low-molecular-weight heparin, unfractionated heparin, and vitamin K antagonists have been the treatment of choice. Currently anticoagulants specifically targeting components of the common pathway have been recommended for prophylaxis. These include fondaparinux, a selective indirect factor Xa inhibitor and the new oral selective direct thrombin inhibitors (dabigatran and selective

  15. Intravenous infusion of bone marrow mesenchymal stem cells improves myocardial function in a rat model of myocardial ischemia.

    Science.gov (United States)

    Wang, Tong; Tang, Wanchun; Sun, Shijie; Ristagno, Giuseppe; Huang, Zitong; Weil, Max Harry

    2007-11-01

    We investigated the effects of three different sites for delivery of bone marrow mesenchymal stem cells (MSCs) in a rat model of myocardial ischemia. Prospective, randomized, controlled study. University affiliated research institute. Male Sprague-Dawley rats. A thoracotomy was performed under general anesthesia. Myocardial ischemia was induced by ligation of the left anterior descending coronary artery. One month later, animals were randomized to receive 5 x 10(6) MSCs labeled with PKH26 in phosphate buffer solution or phosphate buffer solution alone as a placebo by injection into right femoral vein, directly into the left ventricular (LV) cavity, or into the ischemic zone in the anterior ventricular free wall. Echocardiographically measured myocardial function, including ejection fraction and fractional shortening, was quantitated 2 wks and 4 wks after administering MSCs or phosphate buffer solution. Hemodynamics, including cardiac index, LV dP/dt40, LV negative dP/dt, and LV diastolic pressure were measured 4 wks after administering MSCs or phosphate buffer solution. MSCs were counted in 5-microm sections obtained with cryostat from each harvested heart. Significant improvements in ejection fraction, fractional shortening, cardiac index, LV dP/dt40, LV negative dP/dt, and LV diastolic pressure followed injection of MSCs, regardless of the site of injection. However, the number of MSCs counted in the heart sections was significantly greater after direct myocardial injection. Independently of the site of injection and regardless of the different concentration of bone marrow mesenchymal stem cells identified in the myocardium, myocardial function was comparably improved in all groups of animals treated with MSCs.

  16. [Effects of atorvastatin and CoQ(10) on myocardial energy metabolism in rabbits with hypercholesterolemia].

    Science.gov (United States)

    Qu, Run-bo; Lu, Yu-sa; Gong, Fei-yu

    2012-07-10

    To explore the interventional effects of atorvastatin and CoQ(10) on myocardial energy metabolism in rabbits with hypercholesterolemia. Forty male New Zealand white rabbits were randomly divided into 5 groups: i.e. normal control, high cholesterol, statin, coenzyme Q(10) 1 and coenzyme Q(10) 2. After feeding for 6 weeks, the fasting blood samples were collected through ear marginal vein and the serum level of total cholesterol was determined. Myocardium was sampled for ultrastructures by electron microscopy; high-performance liquid chromatography (HPLC) was used to measure myocardial mitochondria adenosine triphosphate (ATP) and coenzyme CoQ(10). Ultraviolet spectrophotometry was used to measure the activities of mitochondrial complexes II and IV. In high cholesterol group, myocardial fibers were arrayed disorderly with partial rupture and dissolution. There was mitochondrial swelling with disorderly and fuzzy cristae. As compared with the controls, the activities of mitochondrial respiratory chain complexes II and IV declined (5.39 ± 0.53 vs 12.95 ± 0.99, 1.89 ± 0.26 vs 6.65 ± 0.95, P myocardial ultrastructural changes and impaired mitochondrial energy metabolism. Atorvastatin reduces the myocardial structural damage and the combination of atorvastatin and CoQ(10) may further improve the myocardial mitochondrial energy metabolism.

  17. Randomized trial of Roux-en-Y gastric bypass versus sleeve gastrectomy in achieving excess weight loss.

    Science.gov (United States)

    Ignat, M; Vix, M; Imad, I; D'Urso, A; Perretta, S; Marescaux, J; Mutter, D

    2017-02-01

    Robust data on quality of life (QoL) after different techniques of bariatric surgery are sparse. This RCT compared excess weight loss (EWL) and QoL after sleeve gastrectomy versus Roux-en-Y gastric bypass (RYGB). Obese patients were assigned randomly to RYGB or sleeve gastrectomy. The primary outcome measure was EWL. Secondary outcomes included QoL, co-morbidity, adverse events, vitamin and glycolipid status. QoL was assessed before and annually after surgery, using the Moorehead-Ardelt Quality of Life Questionnaire II (M-A-QoLQII) and Gastrointestinal Quality of Life Index (GIQLI). One hundred patients were enrolled, 45 in the RYGB group and 55 in the sleeve gastrectomy group. Mean postoperative EWL at 1, 2, 3 and 5 years was 80·4, 79·8, 83·0 and 74·8 per cent respectively after RYGB, and 83·0, 77·8, 66·3 and 65·1 per cent after sleeve gastrectomy (P = 0·017). Mean M-A-QoLQII score before surgery and at 1, 2, 3 and 5 years after operation was 0·5, 1·6, 1·7, 2·1 and 1·4 respectively after RYGB, and 0·3, 1·7, 1·5, 1·5 and 1·2 after sleeve gastrectomy. Mean GIQLI score before and at 1, 2, 3, 5 years after RYGB was 96·4, 113·8, 113·3, 113·4, 111·7, compared with 90·7, 113·9, 114·5, 113·1 and 113·0 for sleeve gastrectomy. The improvement was significant compared with preoperative values (P < 0·001 for M-A-QoLQII and GIQLI), with no difference between groups (P = 0·418 and P = 0·323 respectively). RYGB resulted in higher readmission rates (P = 0·002) and length of hospital stay (P = 0·006) than sleeve gastrectomy. RYGB and sleeve gastrectomy resulted in equivalent, long-standing QoL improvement. RYGB resulted in more stable weight loss but was associated with higher readmission rates. Registration number: NCT02475590. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

  18. A randomized controlled trial comparing the effectiveness of functional knee brace and neoprene sleeve use after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Birmingham, Trevor B; Bryant, Dianne M; Giffin, J Robert; Litchfield, Robert B; Kramer, John F; Donner, Allan; Fowler, Peter J

    2008-04-01

    Despite a lack of evidence for their effectiveness, functional knee braces are commonly prescribed to patients after anterior cruciate ligament (ACL) reconstruction. This trial was conducted to compare postoperative outcomes in patients using an ACL functional knee brace and patients using a neoprene knee sleeve. Patients using a brace will have superior outcomes than those using a sleeve. Randomized controlled clinical trial; Level of evidence, 1. One hundred fifty patients were randomized to receive a brace (n = 76) or neoprene sleeve (n = 74) at their 6-week postoperative visit after primary ACL reconstruction with hamstring autograft. Patients were assessed preoperatively, then 6 weeks and 6, 12, and 24 months postoperatively. Outcome measures included disease-specific quality of life (Anterior Cruciate Ligament-Quality of Life [ACL-QOL] Questionnaire), anterior tibial translation (KT-1000 arthrometer side-to-side difference), the single-limb forward hop test (limb symmetry index), and Tegner Activity Scale. Outcomes at 1 and 2 years were compared after adjusting for baseline scores. Subjective ratings of how patients felt while using the brace/sleeve were also collected for descriptive purposes using a questionnaire. Four a priori directional subgroup hypotheses were evaluated using tests for interactions. There were no significant differences between brace (n = 62) and sleeve (n = 65) groups for any of the outcomes at 1- and 2-year follow-ups. Adjusted mean differences at 2 years were as follows: -0.94 (95% confidence interval [CI], -7.52 to 5.64) for the ACL-QOL Questionnaire, -0.10 mm (95% CI, -0.99 to 0.81) for KT-1000 arthrometer side-to-side difference, -0.87% (95% CI, -8.89 to 7.12) for hop limb symmetry index, and -0.05 (95% CI, -0.72 to 0.62) for the Tegner Activity Scale. Subjective ratings of confidence in the knee provided by the brace/sleeve were higher for the brace group than the sleeve group. Subgroup findings were minimal. Adverse events were

  19. Image Quality Enhancement Using the Direction and Thickness of Vein Lines for Finger-Vein Recognition

    Directory of Open Access Journals (Sweden)

    Young Ho Park

    2012-10-01

    Full Text Available On the basis of the increased emphasis placed on the protection of privacy, biometric recognition systems using physical or behavioural characteristics such as fingerprints, facial characteristics, iris and finger-vein patterns or the voice have been introduced in applications including door access control, personal certification, Internet banking and ATM machines. Among these, finger-vein recognition is advantageous in that it involves the use of inexpensive and small devices that are difficult to counterfeit. In general, finger-vein recognition systems capture images by using near infrared (NIR illumination in conjunction with a camera. However, such systems can face operational difficulties, since the scattering of light from the skin can make capturing a clear image difficult. To solve this problem, we proposed new image quality enhancement method that measures the direction and thickness of vein lines. This effort represents novel research in four respects. First, since vein lines are detected in input images based on eight directional profiles of a grey image instead of binarized images, the detection error owing to the non-uniform illumination of the finger area can be reduced. Second, our method adaptively determines a Gabor filter for the optimal direction and width on the basis of the estimated direction and thickness of a detected vein line. Third, by applying this optimized Gabor filter, a clear vein image can be obtained. Finally, the further processing of the morphological operation is applied in the Gabor filtered image and the resulting image is combined with the original one, through which finger-vein image of a higher quality is obtained. Experimental results from application of our proposed image enhancement method show that the equal error rate (EER of finger-vein recognition decreases to approximately 0.4% in the case of a local binary pattern-based recognition and to approximately 0.3% in the case of a wavelet transform

  20. [Bonsai induced acute myocardial infarction].

    Science.gov (United States)

    Ayhan, Hüseyin; Aslan, Abdullah Nabi; Süygün, Hakan; Durmaz, Tahir

    2014-09-01

    Incidences of drug abuse and cannabis have increased in young adults, recently. Cannabis induced myocardial infarction has rarely been reported in these people. There is no any literature about a synthetic cannabinoid, being recently most popular Bonsai, to cause myocardial infarction. In this case report we presented a 33-year-old male patient who developed acute myocardial infarction after taking high doses of Bonsai.

  1. Clinical Significance of the Soleal Vein and Related Drainage Veins, in Calf Vein Thrombosis in Autopsy Cases with Massive Pulmonary Thromboembolism

    Science.gov (United States)

    Kageyama, Norimasa

    2015-01-01

    Objective: To clarify the histopathological characteristics of deep vein thrombosis (DVT) resulting in lethal pulmonary thromboembolism (PE). Subjects and Methods: We investigated 100 autopsy cases of PE from limb DVT. The distribution and chronology of DVT in each deep venous segment were examined. Venous segments were classified into three groups: iliofemoral vein, popliteal vein and calf vein (CV). The CV was subdivided into two subgroups, drainage veins of the soleal vein (SV) and non drainage veins of SV. Results: Eighty-nine patients had bilateral limb DVTs. CV was involved in all limbs with DVT with isolated calf DVTs were seen in 47% of patients. Fresh and organized thrombi were detected in 84% of patients. SV showed the highest incidence of DVTs in eight venous segments. The incidence of DVT gradually decreased according to the drainage route of the central SV. Proximal tips of fresh thrombi were mainly located in the popliteal vein and tibioperoneal trunk, occurring in these locations in 63% of limbs. Conclusions: SV is considered to be the primary site of DVT; the DVT then propagated to proximal veins through the drainage veins. Lethal thromboemboli would occur at proximal veins as a result of proximal propagation from calf DVTs. PMID:27087868

  2. Portal-to-right portal vein bypass for extrahepatic portal vein obstruction.

    Science.gov (United States)

    Long, Li; Jinshan, Zhang; Zhen, Chen; Qi, Li; Ning, Dong; Mei, Diao; Wei, Cheng

    2017-11-04

    Rex shunt (mesenteric-to-left portal vein bypass) is considered a more physiologically rational treatment for EHPVO than other portosystemic systemic shunts in children. However, about 13.6% of children with EHPVO do not have usable left portal veins and up to 28.1%. Rex operations in children are not successful. Hence, a Rex shunt in these children was impossible. This study reports a novel approach by portal-to-right portal vein bypass for treatment of children with failed Rex shunts. Eight children (age 6.1years, range 3.5-8.9years) who underwent Rex shunts developed recurrent gastrointestinal bleeding and hypersplenism 13months (11-30months) postoperatively. After ultrasound confirmation of blocked shunt, they underwent exploration. Three patients were found to have right portal vein agenesis. Five patients (62.5%) were found to have the patent right portal vein, with the diameter of 3-6mm. Four patients underwent bypass between the main portal vein in the hepatoduodenal ligament and the right portal vein by interposing an inferior mesenteric vein autograft, whereas the remaining patient underwent a bypass using ileal mesenteric vein autograft. The operations took 2.3h (1.9-3.5h). The estimated blood loss was 50ml (30-80ml), with no complication. The portal venous pressure dropped from 34.6cmH2O (28-45 cmH2O) before the bypass to 19.6cmH2O (14-24cmH2O) after the bypass. The 5 patients were followed up for 10.2months (4-17months) and the post-operative ultrasound and CT angiography confirmed the patency of all the grafts and disappearance of the portal venous cavernova in all five patients. The portal-to-right portal vein bypass technique is feasible and safe for treatment of children with EHPVO who have had failed Rex shunts. Our preliminary result indicates that this technique extends the success of Rex shunt from left portal vein to right portal vein and open a new indication of physiological shunt for some of the children who not only have had failed Rex

  3. Myocardial Calcinosis a Case Report

    Directory of Open Access Journals (Sweden)

    Naciye Özeren

    2014-07-01

    Full Text Available Myocardial calcification (myocardial calcinosis is a rare condition in the literature. Meta-static or dystrophic calcification can be seen in two types. Chronic renal failure, hemodialysis, sec-ondary hyperparathyroidism, hypercalcemia, the blood calcium level as high phenomena that are associated with metastatic calcification. In dystrophic calcification, normal blood calcium levels, normal kidney functions, normal coronary artery are observed. Myocardial calcification as a result of congestive heart failure, fatal arrhythmias, heart valve dysfunction, myocardial infarction may occur. Case: 35 years old Syrian male. In the civil war in Syria bombing injured as a result, nearly two months in various hospitals and treated for renal failure developing died. Evaluated within the scope of forensic autopsy has been decided. At autopsy; scar tissue due to previous operations, in-ternal examination in both kidneys logy was found the abse formation. Microscopy: Lobular pneu-monia, atelectasis, edema in the lung. Retroperitoneal active chronic inflammation, inflammatory exudate, bleeding, abscesses and abscess wall was detected. The coronary arteries were normal. myocardial more pericardial and myocardial tissue including tissue calcification was found in the common. Renal failure caused by a lack of calcium in blood as myocardial calcinosis was evaluat-ed. These deposits often may actually on the whole body, generally, vessels, kidneys, lungs, interstitial tissues of gastric mucosa holds. Pericardium and in myocardial tissue is extremely rare, interesting case is presented here. Key Words: Hypercalcemia, Calcification, Myocardial.

  4. An unusual case: right proximal ureteral compression by the ovarian vein and distal ureteral compression by the external iliac vein

    Directory of Open Access Journals (Sweden)

    Halil Ibrahim Serin

    2015-12-01

    Full Text Available A 32-years old woman presented to the emergency room of Bozok University Research Hospital with right renal colic. Multidetector computed tomography (MDCT showed compression of the proximal ureter by the right ovarian vein and compression of the right distal ureter by the right external iliac vein. To the best of our knowledge, right proximal ureteral compression by the ovarian vein together with distal ureteral compression by the external iliac vein have not been reported in the literature. Ovarian vein and external iliac vein compression should be considered in patients presenting to the emergency room with renal colic or low back pain and a dilated collecting system.

  5. [Sleeve fracture of the patella: A diagnosis not to be underestimated].

    Science.gov (United States)

    Le Petit, C; Desdoits, A; Laquievre, A; Dolet, N; Bronfen, C

    2016-04-01

    Fracture of the patella is quite rare in children. However, sleeve fractures of the patella are specific to the child. We report on the case of a 12-year-old boy who suffered complete functional incapacity with hemarthrosis and symptoms that suggested rupture of the extensor apparatus. It occurred after abrupt extension of the knee during a high jump. The x-ray showed an ascended patella. The diagnosis was made and emergency surgical exploration showed a sleeve fracture. Surgical repair provided a good result, with a 2-year follow-up. A literature review found 59 cases in 20 studies with a majority of case reports with only two series over ten cases. The ages and mechanisms are identical to those observed in our study. Diagnosis is difficult and must be clearly determined. The two important signs are the ascension of the patella and the depression to its lower extremity. The prognosis is most often conditioned by rapid surgical repair. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  6. Architecture and permeability of post-cytokinesis plasmodesmata lacking cytoplasmic sleeves.

    Science.gov (United States)

    Nicolas, William J; Grison, Magali S; Trépout, Sylvain; Gaston, Amélia; Fouché, Mathieu; Cordelières, Fabrice P; Oparka, Karl; Tilsner, Jens; Brocard, Lysiane; Bayer, Emmanuelle M

    2017-06-12

    Plasmodesmata are remarkable cellular machines responsible for the controlled exchange of proteins, small RNAs and signalling molecules between cells. They are lined by the plasma membrane (PM), contain a strand of tubular endoplasmic reticulum (ER), and the space between these two membranes is thought to control plasmodesmata permeability. Here, we have reconstructed plasmodesmata three-dimensional (3D) ultrastructure with an unprecedented level of 3D information using electron tomography. We show that within plasmodesmata, ER-PM contact sites undergo substantial remodelling events during cell differentiation. Instead of being open pores, post-cytokinesis plasmodesmata present such intimate ER-PM contact along the entire length of the pores that no intermembrane gap is visible. Later on, during cell expansion, the plasmodesmata pore widens and the two membranes separate, leaving a cytosolic sleeve spanned by tethers whose presence correlates with the appearance of the intermembrane gap. Surprisingly, the post-cytokinesis plasmodesmata allow diffusion of macromolecules despite the apparent lack of an open cytoplasmic sleeve, forcing the reassessment of the mechanisms that control plant cell-cell communication.

  7. De novo hiatal hernia of the gastric tube after sleeve gastrectomy.

    Science.gov (United States)

    Amor, Imed Ben; Debs, Tarek; Kassir, Radwan; Anty, Rodolphe; Amor, Virginie Ben; Gugenheim, Jean

    2015-01-01

    Sleeve gastrectomy (SG) is a frequently used surgical procedure for the treatment of morbid obesity. Several complications of SG have been described; however, de novo hiatal hernia of the gastric tube, as a complication of SG, has not been described in the literature. Here, we report a case of a hiatal hernia 2 years after SG. In the case reported here, the hiatal hernia was associated with weight regain. The mechanisms responsible for the herniation of the pouch are difficult to identify. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass is an effective treatment for this complication. Its management is safe and effective. Obesity itself is an independent risk factor for hiatal hernia, found preoperatively in more than half of the morbidly obese patients. This predisposition is explained by higher intra-gastric pressure due to intra-abdominal or visceral fat, reduced inferior oesophageal sphincter pressure, and oesophageal motility problems. To our knowledge, this is the first described case of hiatal hernia of the gastric tube after SG. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Numerical Analysis and Experimental Study of Hard Roofs in Fully Mechanized Mining Faces under Sleeve Fracturing

    Directory of Open Access Journals (Sweden)

    Zhitao Zheng

    2015-11-01

    Full Text Available Sudden falls of large-area hard roofs in a mined area release a large amount of elastic energy, generate dynamic loads, and cause disasters such as impact ground pressure and gas outbursts. To address these problems, in this study, the sleeve fracturing method (SFM was applied to weaken a hard roof. The numerical simulation software FLAC3D was used to develop three models based on an analysis of the SFM working mechanism. These models were applied to an analysis of the fracturing effects of various factors such as the borehole diameter, hole spacing, and sleeve pressure. Finally, the results of a simulation were validated using experiments with similar models. Our research indicated the following: (1 The crack propagation directions in the models were affected by the maximum principal stress and hole spacing. When the borehole diameter was fixed, the fracturing pressure increased with increasing hole spacing. In contrast, when the fracturing pressure was fixed, the fracturing range increased with increasing borehole diameter; (2 The most ideal fracturing effect was found at a fracturing pressure of 17.6 MPa in the model with a borehole diameter of 40 mm and hole spacing of 400 mm. The results showed that it is possible to regulate the falls of hard roofs using the SFM. This research may provide a theoretical basis for controlling hard roofs in mining.

  9. Alternative design of pipe sleeve for liquid removal mechanism in mortar slab layer

    Science.gov (United States)

    Nazri, W. M. H. Wan; Anting, N.; Lim, A. J. M. S.; Prasetijo, J.; Shahidan, S.; Din, M. F. Md; Anuar, M. A. Mohd

    2017-11-01

    Porosity is one of the mortar’s characteristics that can cause problems, especially in the room space that used high amount of water, such as bathrooms. Waterproofing is one of the technology that normally used to minimize this problem which is preventing deep penetration of liquid water or moisture into underlying concrete layers. However, without the proper mechanism to remove liquid water and moisture from mortar system, waterproofing layer tends to be damaged after a long period of time by the static formation of liquid water and moisture at mortar layer. Thus, a solution has been proposed to drain out water that penetrated into the mortar layer. This paper introduces a new solution using a Modified Pipe Sleeve (MPS) that installed at the mortar layer. The MPS has been designed considering the percentage surface area of the pipe sleeve that having contact with mortar layer (2%, 4%, 6%, 8% and 10%) with angle of holes of 60°. Infiltration test and flow rate test have been conducted to identify the effectiveness of the MPS in order to drain out liquid water or moisture from the mortar layer. In this study shows that, MPS surface area 10%, angled 60°, function effectively as a water removal compared to other design.

  10. Portal vein aneurysm and portal biliopathy.

    Science.gov (United States)

    Kurtcehajic, Admir; Vele, Esved; Hujdurovic, Ahmed

    2016-10-01

    Highlight Kurtcehajic and colleagues present a rare case of congenital portal vein aneurysm (PVA) with biliopathy. Symptoms associated with PVA occur in less than 10% of cases. Imaging modalities showed the PVA partially compressing the common and right hepatic ducts. Conservative treatment markedly lowered bilirubin levels and relieved the abdominal pain. © 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  11. Portal vein thrombosis complicating appendicitis | Ayantunde | West ...

    African Journals Online (AJOL)

    Appendicitis is still the most common acute surgical abdomen all over the world and its complications may be grave. We report an adult case of acute appendicitis complicated by Portal Vein Thrombosis (PVT) and ascending portomesenteric phlebitis treated successfully with antibiotics and anticoagulation with no residual ...

  12. vein thrombosis in elective hip replacement

    African Journals Online (AJOL)

    With the decision tree and these costs, the cost of the various modalities of prophylaxis was then detennined. Results. The probability, detennined by the forum, of developing a deep-vein thrombosis (DYD when no prophylaxis is used was 0.5, with a mortality rate of 2.1 %. The cost of this decision was R875. No prophylaxis ...

  13. Endovascular vein harvest: systemic carbon dioxide absorption.

    Science.gov (United States)

    Maslow, Andrew M; Schwartz, Carl S; Bert, Arthur; Hurlburt, Peter; Gough, Jeffrey; Stearns, Gary; Singh, Arun K

    2006-06-01

    Endovascular vein harvest (EDVH) requires CO(2) insufflation to expand the subcutaneous space, allowing visualization and dissection of the saphenous vein. The purpose of this study was to assess the extent of CO(2) absorption during EDVH. Prospective observational study. Single tertiary care hospital. Sixty patients (30 EDVH and 30 open-vein harvest) undergoing isolated coronary artery bypass graft surgery. Hemodynamic, procedural, and laboratory data were collected prior to (baseline), during, and at it the conclusion (final) of vein harvesting. Data were also collected during cardiopulmonary bypass (CPB). Data were compared by using t tests, analysis of variance, and correlation statistics when needed. There were significant increases in arterial CO(2) (PaCO(2), 35%) and decreases in pH (1.35%) during EDVH. These were associated with increases in heart rate, mean blood pressure, and cardiac output. Within the EDVH group, greater elevations (>10 mmHg) in PaCO2 were more likely during difficult harvest procedures, and these patients exhibited greater increase in heart rate. Elevated CO(2) persisted during CPB, requiring higher systemic gas flows and greater use of phenylephrine to maintain desired hemodynamics. EDVH was associated with systemic absorption of CO(2). Greater absorption was more likely in difficult procedures and was associated with greater hemodynamic changes requiring medical therapy.

  14. CORPOROPLASTY WITH SAPHENOUS VEIN GRAFT IN THE

    African Journals Online (AJOL)

    less rigid erections and are currently re- sponding to oral measures and lCl. Penile numbness occurred in four patients with dorsal plaques, and it was self limiting within six months. We encountered no complaint of penile shortening or impo- tence. Conclusion The saphenous vein presents a reasonable alternative grafting ...

  15. Combined central retinalartery and vein occlusion complicating ...

    African Journals Online (AJOL)

    Orbital Cellulitis is a dreaded ophthalmologic disease. Itmay destroy vision and the eye andmay even become life threatening. Often visual loss is the result of exposure and subsequent destruction of ocular tissue commonly the cornea and the uvea. We report a case of combined central retinal artery and vein occlusion ...

  16. Preduodenal portal vein: A potential laparoscopic cholecystectomy ...

    African Journals Online (AJOL)

    Variations of biliary anatomy are well described. Those of most relevance to the operative surgeon are the variations of the extrahepatic ducts and their relationships to the right hepatic artery and its branches. We describe another even rarer congenital anomaly of a preduodenal portal vein. Its embryological derivation and ...

  17. Retinal Vein Occlusion in Benin City, Nigeria

    African Journals Online (AJOL)

    neovascularization). A diagnosis of CRVO was made in the presence of generalized, scattered hemorrhages consisting of dot, blot, or flame shaped hemorrhages located in the superficial or deep layers of the retina, retinal edema, venous dilatation, and areas of occluded veins. BRVO or HRVO was characterized by retinal ...

  18. Portal vein thrombosis in patients with cirrhosis

    DEFF Research Database (Denmark)

    von Köckritz, Leona; De Gottardi, Andrea; Trebicka, Jonel

    2017-01-01

    Portal vein thrombosis (PVT) is frequent in patients with liver cirrhosis and possible severe complications such as mesenteric ischemia are rare, but can be life-threatening. However, different aspects of clinical relevance, diagnosis and management of PVT are still areas of uncertainty...

  19. Who Is at Risk for Varicose Veins?

    Science.gov (United States)

    ... Examples of these factors include family history, older age, gender, pregnancy, overweight or obesity , lack of movement, and leg trauma. Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve ...

  20. How Can Varicose Veins Be Prevented?

    Science.gov (United States)

    ... Examples of these factors include family history, older age, gender, pregnancy, overweight or obesity , lack of movement, and leg trauma. Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve ...

  1. Small saphenous vein: where does reflux go?

    Directory of Open Access Journals (Sweden)

    Guillermo Gustavo Rossi

    2013-06-01

    Full Text Available BACKGROUND: The anatomy of small saphenous vein (SSV is very variable because of its complex embryological origin. SSV incompetence often causes reflux that goes to the perforating veins, sometimes not respecting the anatomical course. OBJECTIVE: To analyze differences in reflux direction and reentry in the SSV. METHODS: In this prospective, observational study, 60 lower limbs with SSV incompetence of 43 patients were assessed using a color Doppler ultrasound protocol. RESULTS: Reentry variations were grouped into four types and subtypes. Percentage results were: Type A, perforating veins on the medial side = 25/60 cases (41.66%; subtypes: Cockett, Sherman, paratibial and vertex; Type B, lateral malleolus and perforating veins on the lateral side (fibular 17-26 cm = 15/60 cases (25%; subtypes: fibular and malleolus; Type C, two branches = 19/60 cases (31.66%; subtypes: gastrocnemius and Cockett, gastrocnemius and malleolus, and/or fibular, Cockett and malleolus, Cockett-vertex and fibular; Type D, reflux in the superficial system = 1/60 cases (1.66%. CONCLUSION: On most of the lower limbs assessed, reflux did not follow the classical anatomic course. Our findings demonstrated a high degree of variation in reflux/reentry, but no SSV anatomical variations. Reflux seems to, either look for the most accessible anatomical connection for reentry or be originated in the distal area and then reach the SSV.

  2. Percutaneous portal vein access and transhepatic tract hemostasis.

    Science.gov (United States)

    Saad, Wael E A; Madoff, David C

    2012-06-01

    Percutaneous portal vein interventions require minimally invasive access to the portal venous system. Common approaches to the portal vein include transjugular hepatic vein to portal vein access and direct transhepatic portal vein access. A major concern of the transhepatic route is the risk of postprocedural bleeding, which is increased when patients are anticoagulated or receiving pharmaceutical thrombolytic therapy. Thus percutaneous portal vein access and subsequent closure are important technical parts of percutaneous portal vein procedures. At present, various techniques have been used for either portal access or subsequent transhepatic tract closure and hemostasis. Regardless of the method used, meticulous technique is required to achieve the overall safety and effectiveness of portal venous procedures. This article reviews the various techniques of percutaneous transhepatic portal vein access and the various closure and hemostatic methods used to reduce the risk of postprocedural bleeding.

  3. Incidental retroaortic left innominate vein in adult patient

    Directory of Open Access Journals (Sweden)

    Alexandre Semionov, MD, PhD

    2017-09-01

    Full Text Available Retro-aortic left innominate vein is a rare vascular abnormality, usually associated with congenital heart disease. Here we report a case of isolated retro-aortic left innominate vein in an adult female.

  4. Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) - Blood Clot Forming in a Vein

    Science.gov (United States)

    ... Facebook Tweet Share Compartir Deep Vein Thrombosis and Pulmonary Embolism (DVT/PE) are often underdiagnosed and serious, but ... bloodstream to the lungs, causing a blockage called pulmonary embolism (PE). If the clot is small, and with ...

  5. Evaluation of left renal vein entrapment using multidetector computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Poyraz, Ahmet K.; Onur, Mehmet R. [Dept. of Radiology, Firat Univ. School of Medicine, Elazig (Turkey)], e-mail: akursadpoyraz@yahoo.com.tr; Firdolas, Fatih [Dept. of Urology, Firat Univ. School of Medicine, Elazig (Turkey); Kocakoc, Ercan [Dept. of Radiology, Bezmialem Vakif Univ., School of Medicine, Istanbul (Turkey)

    2013-03-15

    Background: Nutcracker syndrome, also called left renal vein entrapment syndrome, is a cause of non-glomerular hematuria with difficulties in diagnosis. Multidetector computed tomography (MDCT) is a powerful tool to prevent unnecessary diagnostic procedures. Purpose: To retrospectively determine the prevalence of nutcracker phenomenon and nutcracker syndrome seen in MDCT in consecutive patients. Material and Methods: The institutional review board approved the study and waived the requirement for informed consent. Abdominal contrast-enhanced MDCT scans were reviewed from 1000 consecutive patients. MDCT scan assessment included renal vein diameter measurements and evaluation for the presence of anterior or posterior left renal vein entrapment. Electronic medical records and urine analysis reports of patients with left renal vein entrapment were reviewed. Student's t test was used to assess differences in renal vein diameter in patients with left renal vein entrapment. Results: Left renal vein entrapment was observed in 10.9% (109), retroaortic left renal vein in 6.5% (65), entrapment of left renal vein between superior mesenteric artery and aorta in 4.1% (41), and circumaortic left renal vein in 0.3% (3) of patients. Mean diameters of right (8.8 {+-} 1.9 mm) and unentrapped left (8.9 {+-} 1.8 mm) renal veins were not significantly different (P = 0.1). The mean diameter of anterior entrapped left renal veins (10.3 {+-} 2 mm) was significantly greater (P = 0.04) than contralateral renal veins (8.6 {+-} 2.1 mm) in their widest portion. In 8.8% of patients with the left renal vein entrapment, urine analysis showed isomorphic hematuria or proteinuria with no other known cause. Varicocele and pelvic congestion were seen in 5.5% of patients with the left renal vein entrapment. Conclusion: Left renal vein entrapment is not a rare entity and renal nutcracker phenomenon might be underdiagnosed.

  6. Vein visualization: patient characteristic factors and efficacy of a new infrared vein finder technology.

    Science.gov (United States)

    Chiao, F B; Resta-Flarer, F; Lesser, J; Ng, J; Ganz, A; Pino-Luey, D; Bennett, H; Perkins, C; Witek, B

    2013-06-01

    We investigated the patient characteristic factors that correlate with identification of i.v. cannulation sites with normal eyesight. We evaluated a new infrared vein finding (VF) technology device in identifying i.v. cannulation sites. Each subject underwent two observations: one using the conventional method (CM) of normal, unassisted eyesight and the other with the infrared VF device, VueTek's Veinsite™ (VF). A power analysis for moderate effect size (β=0.95) required 54 samples for within-subject differences. Patient characteristic profiles were obtained from 384 subjects (768 observations). Our sample population exhibited an overall average of 5.8 [95% confidence interval (CI) 5.4-6.2] veins using CM. As a whole, CM vein visualization were less effective among obese [4.5 (95% CI 3.8-5.3)], African-American [4.6 (95% CI 3.6-5.5 veins)], and Asian [5.1 (95% CI 4.1-6.0)] subjects. Next, the VF technology identified an average of 9.1 (95% CI 8.6-9.5) possible cannulation sites compared with CM [average of 5.8 (95% CI 5.4-6.2)]. Seventy-six obese subjects had an average of 4.5 (95% CI 3.8-5.3) and 8.2 (95% CI 7.4-9.1) veins viewable by CM and VF, respectively. In dark skin subjects, 9.1 (95% CI 8.3-9.9) veins were visible by VF compared with 5.4 (95% CI 4.8-6.0) with CM. African-American or Asian ethnicity, and obesity were associated with decreased vein visibility. The visibility of veins eligible for cannulation increased for all subgroups using a new infrared device.

  7. Adventitial cystic disease of the common femoral vein presenting as deep vein thrombosis

    Directory of Open Access Journals (Sweden)

    Young-Kyun Kim

    2016-07-01

    Full Text Available Adventitial cystic disease of the common femoral vein is a rare condition. We herein report the case of a 50-year-old woman who presented with painless swelling in her left lower leg that resembled deep vein thrombosis. She underwent femoral exploration and excision of the cystic wall. The presentation, investigation, treatment, and pathology of this condition are discussed with a literature review.

  8. Efficacy of varicose vein surgery with preservation of the great safenous vein.

    Science.gov (United States)

    Barros, Bernardo Cunha Senra; Araujo, Antonio Luiz de; Magalhães, Carlos Eduardo Virgini; Barros, Raimundo Luiz Senra; Fiorelli, Stenio Karlos Alvim; Gatts, Raphaella Ferreira

    2015-01-01

    To evaluate the efficacy of surgical treatment of varicose veins with preservation of the great saphenous vein. We conducted a prospective study of 15 female patients between 25 and 55 years of age with clinical, etiologic, anatomic and pathophysiologic (CEAP) classification 2, 3 and 4. The patients underwent surgical treatment of primary varicose veins with great saphenous vein (GSV) preservation. Doppler ultrasonography exams were carried out in the first and third months postoperatively. The form of clinical severity of venous disease, Venous Clinical Severity Score (VCSS) was completed before and after surgery. We excluded patients with history of deep vein thrombosis, smoking or postoperatively use of elastic stockings or phlebotonics. All patients had improved VCSS (p caliber, as well as with preoperative CEAP. There was improvement in CEAP class in nine patients when compared with the preoperative period (p caliber, and to the symptoms when the vein had maximum caliber of 7.5 mm, correlating directly with the CEAP. The decrease in GSV caliber, even without complete abolition of reflux, leads to clinical improvement by decreasing the reflux volume.

  9. Portal vein thrombosis after reconstruction in 270 consecutive patients with portal vein resections in hepatopancreatobiliary (HPB) surgery.

    Science.gov (United States)

    Miyazaki, Masaru; Shimizu, Hiroaki; Ohtuka, Masayuki; Kato, Atsushi; Yoshitomi, Hiroyuki; Furukawa, Katsunori; Takayashiki, Tsukasa; Kuboki, Satoshi; Takano, Shigetsugu; Suzuki, Daisuke; Higashihara, Taku

    2017-07-01

    This study was aimed to evaluate the occurrence of portal vein thrombosis after portal vein reconstruction. The portal veins were repaired with venorrhaphy, end-to-end, patch graft, and segmental graft in consecutive 270 patients undergoing hepato-pancreto-biliary (HPB) surgery. Portal vein thrombosis was encountered in 20 of 163 of end-to-end, 2 of 56 of venorrhaphy, and 2 of 5 of patch graft groups, as compared with 0 of 46 of segmental graft group (p Portal vein thrombosis occurred more frequently after hepatectomy than after pancreatectomy (p portal vein blood flow was more sufficiently achieved in the early re-operation within 3 days after surgery than in the late re-operation over 5 days after surgery (p portal vein reconstruction. The revision surgery for portal vein thrombosis should be performed within 3 days after surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study.

    Science.gov (United States)

    Pawanindra, Lal; Vindal, Anubhav; Midha, Manoj; Nagpal, Prashant; Manchanda, Alpana; Chander, Jagdish

    2015-10-01

    Pre- and post-operative stomach volumes can be important determinants for effectiveness of laparoscopic sleeve gastrectomy (LSG) in causing weight loss. There is little existing data on the volumes of stomach preoperatively and that excised during LSG. This study was designed to evaluate the change in gastric volume after LSG using multi-detector CT and to correlate it with early post-operative weight loss. Twenty consecutive patients with BMI ≥ 40 kg/m(2) and medical comorbidities underwent LSG between October 2011 and October 2013 and were analysed prospectively. The pre-operative stomach volume was measured by MDCT done 1-3 days before the surgery. LSG was performed in the standard manner using a 36F bougie. The volume of excised stomach was measured by distending the specimen with saline. MDCT of the upper abdomen was repeated 3 months postoperatively to calculate the gastric sleeve volume. Weight loss and resolution of comorbidities were documented. The mean pre-operative weight of patients was 123.90 kg, and the mean pre-operative stomach volume on MDCT was 1,067 ml. The stomach volume on pre-operative MDCT correlated with pre-operative weight and BMI. The mean volume of the excised stomach was 859 ml when measured by distension of the specimen and 850 ml on MDCT. After 3 months post surgery, the mean volume of gastric sleeve on MDCT was 217 ml, and the mean weight of the patients was 101.22 kg. The volume of the excised stomach calculated by MDCT correlated with the weight loss achieved 3 months postoperatively. However, no correlation was seen between the gastric sleeve volume 3 months postoperatively and weight loss during this period. MDCT is a good method to measure gastric volume before and after LSG. Early post-operative weight loss (3 months) correlates well with the volume of the excised stomach but not with that of the gastric sleeve.

  11. Effect of Sleeve Plunge Depth on Microstructure and Mechanical Properties of Refill Friction Stir Spot Welding of 2198 Aluminum Alloy

    Science.gov (United States)

    Yue, Yumei; Shi, Yao; Ji, Shude; Wang, Yue; Li, Zhengwei

    2017-10-01

    Refill friction stir spot welding (RFSSW) is a new spot welding technology, by which spot joint without keyhole can be obtained. In this work, RFSSW was used to join 2-mm-thick 2198-T8 aluminum alloy sheets and effects of the sleeve plunge depth on microstructure and lap shear properties of the joints were mainly discussed. Results showed that when using small plunge depths of 2.4 and 2.6 mm, joints showed good formation and no defects were observed. Incomplete refilling defect was observed with increasing plunge depth due to material loss during welding. Size of the grains at sleeve-affected zone (SAZ) is smaller than that at the pin-affected zone, and the size becomes bigger with increasing the plunge depth. More secondary phase particles can be observed at SAZ with increasing the sleeve plunge depth. The lap shear failure load firstly increased and then decreased with increasing the sleeve plunge depth. The maximum failure load of 9819 N was attained with plug fracture mode when using 2.6 mm. Fracture morphologies show ductile fracture mode.

  12. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch

    NARCIS (Netherlands)

    Homan, J.; Betzel, B; Aarts, E.O.; Laarhoven, K.J. van; Janssen, I.M.C.; Berends, F.J.

    2015-01-01

    BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain and other complications are reported. Demand for secondary surgery is rising, partly for these reasons.

  13. Uniportal video-assisted thoracoscopic right upper sleeve lobectomy and tracheoplasty in a 10-year-old patient.

    Science.gov (United States)

    Gonzalez-Rivas, Diego; Marin, Jessica Correa; Granados, Juan Pablo Ovalle; Llano, Juan David Urrea; Cañas, Sonia Roque; Arqueta, Alonso Oviedo; de la Torre, Mercedes

    2016-09-01

    Tracheobronchial pediatric tumors are very rare and procedures like pneumonectomy are seldomly indicated due to the associated morbidity. If a surgical approach is considered, the ideal oncological technique would be the minimally invasive sleeve resection, allowing preservation of lung parenchyma (very important in pediatric patients). Here we present the first report of a thoracoscopic right upper tracheo-bronchial sleeve lobectomy in a pediatric patient. A 10-year-old female patient, who received multiple antibiotic treatments for recurrent pneumonia without improvement, was diagnosed with a right upper lobe (RUL) carcinoid tumor. The patient was proposed for uniportal thoracoscopic surgery. The patient was placed in a lateral decubitus position and a single 3 cm incision was performed at the anterior level of 4 th intercostal space. A right upper lobectomy with a tracheo-bronchial sleeve resection using the uniportal technique was successfully performed. The postoperative course was uneventful and the patient was discharged home on the 7 th postoperative day. The bronchoscopic control showed excellent caliber of the anastomosis with no complications. The uniportal video-assisted thoracoscopic surgery (VATS) approach is an excellent option for endobronchial tumor management in pediatric patients, offering a quick recovery and low morbidity. The performance of a thoracoscopic sleeve anastomosis in young patients is crucial and should only be performed by very experienced thoracoscopic surgeons.

  14. Concurrent Mesh Repair of a Morgagni and Umbilical Hernia during a Laparoscopic Sleeve Gastrectomy in a Morbidly Obese Individual

    Directory of Open Access Journals (Sweden)

    N.R Kosai

    2016-10-01

    Full Text Available Morgagni Hernia is a rare form of diaphragmatic hernia. It is mainly asymptomatic and often identified incidentally during surgery. Tension-free synthetic mesh repair is the preferred treatment modality. However, the use of synthetic mesh concurrently during a clean-contaminated surgery such as sleeve gastrectomy remains controversial due to the remote possibility of mesh infection. A middle-aged female 2 with BMI of 47 Kg/m was admitted electively for laparoscopic sleeve gastrectomy with concurrent umbilical hernia repair. Intra-operatively, a left Morgagni Hernia containing omentum and a segment of transverse colon was noted. She underwent a laparoscopic sleeve gastrectomy and simultaneous laparoscopic tension-free composite mesh repair of both Morgagni and umbilical hernia. Outpatient review three months later revealed excess weight loss of almost 30% with no recurrence of either hernia. In conclusion, the advantages of concurrent hernia repair during bariatric surgery outweigh the risk of mesh infection and should be performed to prevent future risk of visceral herniation and strangulation. Laparoscopic mesh repair of a Morgagni Hernia and umbilical hernia in the setting of an electively planned sleeve gastrectomy is feasible, effective and safe in the hands of a trained laparoscopic surgeon.

  15. Effect of Sleeve Plunge Depth on Microstructure and Mechanical Properties of Refill Friction Stir Spot Welding of 2198 Aluminum Alloy

    Science.gov (United States)

    Yue, Yumei; Shi, Yao; Ji, Shude; Wang, Yue; Li, Zhengwei

    2017-09-01

    Refill friction stir spot welding (RFSSW) is a new spot welding technology, by which spot joint without keyhole can be obtained. In this work, RFSSW was used to join 2-mm-thick 2198-T8 aluminum alloy sheets and effects of the sleeve plunge depth on microstructure and lap shear properties of the joints were mainly discussed. Results showed that when using small plunge depths of 2.4 and 2.6 mm, joints showed good formation and no defects were observed. Incomplete refilling defect was observed with increasing plunge depth due to material loss during welding. Size of the grains at sleeve-affected zone (SAZ) is smaller than that at the pin-affected zone, and the size becomes bigger with increasing the plunge depth. More secondary phase particles can be observed at SAZ with increasing the sleeve plunge depth. The lap shear failure load firstly increased and then decreased with increasing the sleeve plunge depth. The maximum failure load of 9819 N was attained with plug fracture mode when using 2.6 mm. Fracture morphologies show ductile fracture mode.

  16. Composting municipal biosolids in polyethylene sleeves with forced aeration: Process control, air emissions, sanitary and agronomic aspects.

    Science.gov (United States)

    Avidov, R; Saadi, I; Krassnovsky, A; Hanan, A; Medina, Sh; Raviv, M; Chen, Y; Laor, Y

    2017-09-01

    Composting in polyethylene sleeves with forced aeration may minimize odor emissions, vectors attraction and leachates associated with open windrows. A disadvantage of this technology is the lack of mixing during composting, potentially leading to non-uniform products. In two pilot experiments using biosolids and green waste (1:1; v:v), thermophilic conditions (>45°C) were maintained for two months, with successful control of oxygen levels and sufficient moisture. Emitted odors declined from 1.5-3.8×10 5 to 5.9×10 3 -2.3×10 4 odor units m -3 -air in the first 3weeks of the process, emphasizing the need of odor control primarily during this period. Therefore, composting might be managed in two phases: (i) a closed sleeve for 6-8weeks during which the odor is treated; (ii) an open pile (odor control is not necessary). Reduction of salmonella, E. coli and coliforms was effective initially, meeting the standards of "Class A" biosolids; however, total and fecal coliforms density increased after opening the second sleeve and exceeded the standard of 1000 most probable number (MPN) per g dry matter. Compost maturity was achieved in the open piles following the two sleeves and the final compost was non-phytotoxic and beneficial as a soil additive. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Biological conduit small gap sleeve bridging method for peripheral nerve injury: regeneration law of nerve fibers in the conduit

    Directory of Open Access Journals (Sweden)

    Pei-xun Zhang

    2015-01-01

    Full Text Available The clinical effects of 2-mm small gap sleeve bridging of the biological conduit to repair peripheral nerve injury are better than in the traditional epineurium suture, so it is possible to replace the epineurium suture in the treatment of peripheral nerve injury. This study sought to identify the regeneration law of nerve fibers in the biological conduit. A nerve regeneration chamber was constructed in models of sciatic nerve injury using 2-mm small gap sleeve bridging of a biodegradable biological conduit. The results showed that the biological conduit had good histocompatibility. Tissue and cell apoptosis in the conduit apparently lessened, and regenerating nerve fibers were common. The degeneration regeneration law of Schwann cells and axons in the conduit was quite different from that in traditional epineurium suture. During the prime period for nerve fiber regeneration (2-8 weeks, the number of Schwann cells and nerve fibers was higher in both proximal and distal ends, and the effects of the small gap sleeve bridging method were better than those of the traditional epineurium suture. The above results provide an objective and reliable theoretical basis for the clinical application of the biological conduit small gap sleeve bridging method to repair peripheral nerve injury.

  18. Behandling med duodenal-jejunal bypass-sleeve ved svær overvægt

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  19. Myocardial perfusion modeling using MRI

    DEFF Research Database (Denmark)

    Larsson, H B; Fritz-Hansen, T; Rostrup, Egill

    1996-01-01

    In the present study, it is shown that it is possible to quantify myocardial perfusion using magnetic resonance imaging in combination with gadolinium diethylenetriaminopentaacetic acid (Gd-DTPA). Previously, a simple model and method for measuring myocardial perfusion using an inversion recovery...

  20. Diurnal variations in myocardial metabolism

    Science.gov (United States)

    The heart is challenged by a plethora of extracellular stimuli over the course of a normal day, each of which distinctly influences myocardial contractile function. It is therefore not surprising that myocardial metabolism also oscillates in a time-of-day dependent manner. What is becoming increasin...

  1. Repair of postinfarct ventricular septal defect and total myocardial revascularization in a case of dextrocardia with situs inversus.

    Science.gov (United States)

    Kuthe, Sachin A; Mohite, Prashant N; Sarangi, Siddharth; Mathews, Sarin; Thingnam, Shyam K; Reddy, Sreenivas

    2011-01-01

    We report a case of an elderly man who suffered an acute myocardial infarction (MI) with the complication of a post-MI ventricular septal defect (VSD). Situs inversus with dextrocardia was diagnosed during the course of hospitalization. Total myocardial revascularization was achieved using saphenous vein conduits. The VSD was approached through the right ventricle and repaired with a polytetrafluoroethylene patch. Although several cases of coronary artery bypass grafting (CABG) in the presence of dextrocardia have been reported in the literature, this is the first case of repair of a post-MI VSD along with CABG.

  2. Primary varicose veins: Frequency, clinical significance and surgical treatment

    Directory of Open Access Journals (Sweden)

    Vasić Dragan M.

    2004-01-01

    Full Text Available INTRODUCTION According to the definition of the World Health Organization, varicose veins represent abnormally enlarged superficial veins having baggy or cylindrical shape. The most frequent cause of primary varicose veins is the insufficiency of long saphenous vein (LSV, but especially the basin of its connection with femoral vein and perforating veins. OBJECTIVE The objectives of these investigations were: the determination of insufficiency incidence of SSV in cases of LSV insufficiency; the establishment of association of insufficiency of perforating veins of the basin of LSV and SSV; the study of the results of surgical treatment of insufficiency and varicosity of both short and long saphenous veins. METHODS In this study, 100 patients (66 women and 34 men, average age 52.1 years, with clinical symptoms showing the insufficiency and varicosity of long saphenous vein with no change of deep vein system were examined. Ultrasonographic examinations were made using Color Doppler probes - 7.5 and 3.75 MHz (Toshiba Corevison SSA 350 A; the development of incompetence of long saphenous vein (LSV and short saphenous vein (SSV at the level of the junction as well as other incompetent valves were examined. The reflux was defined as a retrograde flow of the duration longer than 0.5 seconds. RESULTS The insufficiency of short saphenous vein was determined by ultrasonographic examination in 34%, while the insufficiency of perforating veins in 80% of patients. 40% of patients were operated (33.3% of females, and 52.9% of males. The most frequent indications for surgical treatment of superficial veins insufficiency were: strong varicosities, clear symptoms and signs, superficial thrombophlebitis and conditions after superficial thrombophlebitis. Surgical treatment was applied in 16% of patients due to recurrence in the basin of long saphenous vein, and in 6% of cases because of the recurrence in the basin of short saphenous vein. Data analysis failed to

  3. Improved outcomes of cardiopulmonary resuscitation in rats with myocardial infarction treated with allogenic bone marrow mesenchymal stem cells.

    Science.gov (United States)

    Wang, Tong; Tang, Wanchun; Sun, Shijie; Ristagno, Giuseppe; Xu, Tingyan; Weil, Max Harry

    2009-03-01

    We hypothesized that rats in which myocardial infarction had been treated with mesenchymal stem cells (MSCs) would have better outcomes following the global myocardial ischemia of cardiac arrest and cardiopulmonary resuscitation (CPR) compared with rats in which myocardial infarction had been treated with phosphate buffer solution (PBS). Prospective, randomized controlled study. University-affiliated research institute. Male Sprague-Dawley rats. Myocardial infarction was induced in 18 male Sprague-Dawley rats. Four weeks later, animals were randomized to receive 5 x 10 MSCs labeled with red fluorescent dye gel (PKH26) in PBS or a PBS-alone injection into right femoral vein. Echocardiographically measured myocardial function, including ejection fraction, left ventricular end-diastolic volume, and left ventricular end-systolic volume, was quantitated 2 and 4 weeks after administering MSCs or PBS. Four weeks after MSCs or PBS injection, 6 minutes of ventricular fibrillation (VF) and 6 minutes of CPR were performed before defibrillation. Myocardial function, including cardiac index, left ventricular, dP/dt max (dP/dt max), left ventricular negative dP/dt min (-dP/dt min), and left ventricular diastolic pressure, was measured before inducing VF and hourly following return of spontaneous circulation. Labeled MSCs were observed in 5-mum cryostat sections from each harvested heart. Significant improvements in ejection fraction, left ventricular end-diastolic volume, left ventricular end-systolic volume, cardiac index, dP/dt max, -dP/dt min, and left ventricular diastolic pressure followed injection of MSCs before inducing VF. Following return of spontaneous circulation, myocardial function was significantly better in animals pretreated with MSCs; this was associated with significantly increased duration of postresuscitation survival. Myocardial function before and after CPR and duration of survival after CPR were significantly improved in animals in which myocardial

  4. ClariVein® - Early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins.

    Science.gov (United States)

    Tang, T Y; Kam, J W; Gaunt, M E

    2017-02-01

    Objectives This study assessed the effectiveness and patient experience of the ClariVein® endovenous occlusion catheter for varicose veins from a large single-centre series in the UK. Methods A total of 300 patients (371 legs) underwent ClariVein® treatment for their varicose veins; 184 for great saphenous vein (GSV) incompetence, 62 bilateral GSV, 23 short saphenous vein (SSV), 6 bilateral SSV and 25 combined unilateral great saphenous vein and SSV. Patients were reviewed at an interval of two months post procedure and underwent Duplex ultrasound assessment. Postoperative complications were recorded along with patient satisfaction. Results All 393 procedures were completed successfully under local anaesthetic. Complete occlusion of the treated vein was initially achieved in all the patients, but at eight weeks' follow-up, there was only partial obliteration in 13/393 (3.3%) veins. These were all successfully treated with ultrasound-guided foam sclerotherapy. Procedures were well tolerated with a mean pain score of 0.8 (0-10). No significant complications were reported. Conclusions ClariVein® can be used to ablate long and short saphenous varicose veins on a walk-in-walk-out basis. Bilateral procedures can be successfully performed, and these are well tolerated as can multiple veins in the same leg. Early results are promising but further evaluation and longer term follow-up are required.

  5. Calf Compression Sleeves Change Biomechanics but Not Performance and Physiological Responses in Trail Running

    Directory of Open Access Journals (Sweden)

    Hugo A. Kerhervé

    2017-04-01

    Full Text Available Introduction: The aim of this study was to determine whether calf compression sleeves (CS affects physiological and biomechanical parameters, exercise performance, and perceived sensations of muscle fatigue, pain and soreness during prolonged (~2 h 30 min outdoor trail running.Methods: Fourteen healthy trained males took part in a randomized, cross-over study consisting in two identical 24-km trail running sessions (each including one bout of running at constant rate on moderately flat terrain, and one period of all-out running on hilly terrain wearing either degressive CS (23 ± 2 mmHg or control sleeves (CON, <4 mmHg. Running time, heart rate and muscle oxygenation of the medial gastrocnemius muscle (measured using portable near-infrared spectroscopy were monitored continuously. Muscle functional capabilities (power, stiffness were determined using 20 s of maximal hopping before and after both sessions. Running biomechanics (kinematics, vertical and leg stiffness were determined at 12 km·h−1 at the beginning, during, and at the end of both sessions. Exercise-induced Achilles tendon pain and delayed onset calf muscles soreness (DOMS were assessed using visual analog scales.Results: Muscle oxygenation increased significantly in CS compared to CON at baseline and immediately after exercise (p < 0.05, without any difference in deoxygenation kinetics during the run, and without any significant change in run times. Wearing CS was associated with (i higher aerial time and leg stiffness in running at constant rate, (ii with lower ground contact time, higher leg stiffness, and higher vertical stiffness in all-out running, and (iii with lower ground contact time in hopping. Significant DOMS were induced in both CS and CON (>6 on a 10-cm scale with no difference between conditions. However, Achilles tendon pain was significantly lower after the trial in CS than CON (p < 0.05.Discussion: Calf compression did not modify muscle oxygenation during ~2 h 30

  6. Five-year results of laparoscopic sleeve gastrectomy for the treatment of severe obesity.

    Science.gov (United States)

    Nocca, David; Loureiro, Marcelo; Skalli, El Mehdi; Nedelcu, Marius; Jaussent, Audrey; Deloze, Melanie; Lefebvre, Patrick; Fabre, Jean Michel

    2017-08-01

    Since 2011, the most used bariatric technique in France has been the sleeve gastrectomy. There are still few studies exploring the medium and long-term results of this technique. To describe medium-long-term (5 years) results of a cohort of CHU Montpellier experience in sleeve gastrectomy for morbid obesity. All patients that underwent laparoscopic sleeve gastrectomy (LSG) from January 2005 to June 2013 were included in this study. A total of 1050 patients were operated. 72.86% were women. The mean preoperative BMI was 44.58 kg/m(2) (±7.71). A total of 183 patients (18.5%) were super-obese (BMI > 50 kg/m(2)). LSG was proposed as primary procedure, and also after failure of adjustable gastric banding in 169 patients (16.9%) or after vertical banded gastroplasty in 7 cases (0.7%). There were 38 postoperative gastric fistulas (3.8%) and 3 of them required some kind of bypass to be definitively treated. There were also 34 hemorrhages (3.4%) of which 21 were reoperated for hemostasis. Two gastric stenoses at the angulus (0.2%) were managed with dilation or RYGB. Overall reoperative rate was 6.8%. One patient died of pulmonary embolism. Most common late complication was GERD (39.1%). After 3, 4 and 5 years of LSG, the average of %EBL was, respectively, 75.95% (±29.16) (382 patients), 73.23% (±31.08) (222 patients) and 69.26% (±30.86) (144 patients). The success rate at 5 years was 65.97% (95 patients). The improvement or remission of comorbidities was found, respectively, in 88.4 and 57.2% of diabetic patients; 76.9 and 19.2% for hypertensive patients and 98 and 85% for patients with sleep apnea syndrome. LSG is a bariatric surgery technique that presents a very good risk/benefit ratio. Five-year results are very convincing. GERD is the main long-term complication.

  7. The air matters – sleeve air cavity as a marker guiding image-guided helical tomotherapy to target cervical cancer

    Directory of Open Access Journals (Sweden)

    Ya-Ting Jan

    2016-02-01

    Full Text Available Purpose : Radiotherapy with concurrent chemotherapy has been recommended as standard treatment for locally advanced cervical cancer. To validate the main tumor location before each high-precision helical tomotherapy (HT fraction, the development of a more reliable marker or indicator is of clinical importance to avoid inadequate coverage of the main tumor. Material and methods: A 61-year-old woman with cervical cancer, TMN stage cT2b2N1M1, FIGO stage IVB was presented. Extended field external beam radiotherapy (EBRT with concurrent chemotherapy and the interdigitated delivery of intracavitary brachytherapy was performed. Helical tomotherapy equipped with megavoltage cone beam computed tomography (MV-CBCT was used for image-guided radiotherapy. For the insertion of tandem of brachytherapy applicator, a silicone sleeve with a central hollow canal was placed into the endocervical canal with the caudal end stopping at the outer surface of the cervical os, and making contact with the distal boundary of the cervical tumor during the entire brachytherapy course. Results : In the remaining EBRT fractions, we found that the air cavity inside the central hollow canal of the sleeve could be clearly identified in daily CBCT images. The radiation oncologists matched the bony markers to adjust the daily setup errors because the megavoltage of the CBCT images could not provide a precise boundary between the soft tissue and the tumor, but the sleeve air cavity, with a clear boundary, could be used as a surrogate and reliable marker to guide the daily setup errors, and to demonstrate the primary tumor location before delivery of each HT fraction. Conclusions : The application of the sleeve during the interdigitated course of HT and brachytherapy in this patient provided information for the feasibility of using the sleeve air cavity as a surrogate marker for the localization of the main primary tumor before the daily delivery of image-guided HT.

  8. Internal vein texture and vein evolution of the epithermal Shila-Paula district, southern Peru

    Science.gov (United States)

    Chauvet, Alain; Bailly, Laurent; André, Anne-Sylvie; Monié, Patrick; Cassard, Daniel; Tajada, Fernando Llosa; Vargas, Juan Rosas; Tuduri, Johann

    2006-07-01

    The epithermal Shila-Paula Au-Ag district is characterized by numerous veins hosted in Tertiary volcanic rocks of the Western Cordillera (southern Peru). Field studies of the ore bodies reveal a systematic association of a main E-W vein with secondary N55-60°W veins—two directions that are also reflected by the orientation of fluid-inclusion planes in quartz crystals of the host rock. In areas where this pattern is not recognized, such as the Apacheta sector, vein emplacement seems to have been guided by regional N40°E and N40°W fractures. Two main vein-filling stages are identified. stage 1 is a quartz-adularia-pyrite-galena-sphalerite-chalcopyrite-electrum-Mn silicate-carbonate assemblage that fills the main E-W veins. stage 2, which contains most of the precious-metal mineralization, is divided into pre-bonanza and bonanza substages. The pre-bonanza substage consists of a quartz-adularia-carbonate assemblage that is observed within the secondary N45-60°W veins, in veinlets that cut the stage 1 assemblage, and in final open-space fillings. The two latter structures are finally filled by the bonanza substage characterized by a Fe-poor sphalerite-chalcopyrite-pyrite-galena-tennantite-tetrahedrite-polybasite-pearceite-electrum assemblage. The ore in the main veins is systematically brecciated, whereas the ore in the secondary veins and geodes is characteristic of open-space crystallization. Microthermometric measurements on sphalerite from both stages and on quartz and calcite from stage 2 indicate a salinity range of 0 to 15.5 wt% NaCl equivalent and homogenization temperatures bracketed between 200 and 330°C. Secondary CO2-, N2- and H2S-bearing fluid inclusions are also identified. The age of vein emplacement, based on 40Ar/39Ar ages obtained on adularia of different veins, is estimated at around 11 Ma, with some overlap between adularia of stage 1 (11.4±0.4 Ma) and of stage 2 (10.8±0.3 Ma). A three-phase tectonic model has been constructed to explain the

  9. Biometric Authentication Using Infrared Imaging of Hand Vein Patterns

    Science.gov (United States)

    Bhattacharyya, Debnath; Shrotri, A.; Rethrekar, S. C.; Patil, M. H.; Alisherov, Farkhod A.; Kim, Tai-Hoon

    Hand vein patterns are unique and universal. Vein pattern is used as biometric feature in recent years. But, it is not very much popular biometric system as compared to other systems like fingerprint, iris etc, because of the higher cost. For conventional algorithm, it is necessary to use high quality images, which demand high-priced collection devices. There are two approaches for vein authentication, these are hand dorsa and hand ventral. Currently we are working on hand dorsa vein patterns. Here we are putting forward the new approach for low cost hand dorsa vein pattern acquisition using low cost device and proposing a algorithm to extract features from these low quality images.

  10. Primary leiomyosarcoma of saphenous vein presenting as deep venous thrombosis.

    Science.gov (United States)

    Fremed, Daniel I; Faries, Peter L; Schanzer, Harry R; Marin, Michael L; Ting, Windsor

    2014-12-01

    Only a small number of venous leiomyosarcomas have been previously reported. Of these tumors, those of saphenous origin comprise a minority of cases. A 59-year-old man presented with symptoms of deep vein thrombosis and was eventually diagnosed with primary leiomyosarcoma of great saphenous vein origin. The tumor was treated with primary resection and femoral vein reconstruction with autologous patch. Although extremely rare, saphenous leiomyosarcoma can present as deep vein thrombosis. Vascular tumors should be included in the differential diagnosis of atypical extremity swelling refractory to conventional deep vein thrombosis management. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  11. Thermal stimulation of intra-abdominal veins in conscious rabbits.

    Science.gov (United States)

    Cranston, W I; Hellon, R F; Townsend, Y

    1978-01-01

    1. Infusions of hot and cold Hartmann's solution were given into the hepatic portal vein and inferior vena cava of conscious rabbits. Similar infusions were given into an ear vein as controls. The time integral of the displacement of brain temperature was measured. 2. There was no evidence for the presence of warm sensors in the inferior vena cava, portal vein, liver or hepatic vein, and no evidence for a concentration of cold sensors in the inferior vena cava. 3. There may be cold-sensitive elements in the portal vein or the tissue perfused by blood passing through it. PMID:650560

  12. Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy – Case report

    Directory of Open Access Journals (Sweden)

    Jianlin Tang

    2014-12-01

    Conclusion: The lessons we learned are (1 Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2 Synthetic graft is an alternative for internal jugular vein graft. (3 Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4 It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival.

  13. Deep dorsal vein arterialisation in vascular impotence.

    Science.gov (United States)

    Wespes, E; Corbusier, A; Delcour, C; Vandenbosch, G; Struyven, J; Schulman, C C

    1989-11-01

    A series of 12 patients with vasculogenic impotence (4 arterial lesions; 8 arterial and venous lesions) underwent deep dorsal vein arterialisation after pre-operative assessment by a multidisciplinary approach. Cumulative graft patency was 58% (7 of 12 patients) up to 21 months but only 4 patients developed almost normal erections. Digital angiography, with and without the intracavernous injection of papaverine, was performed during follow-up to determine the vascular physiological status. At flaccidity, the corpora cavernosa were never opacified in the absence of a venocorporeal shunt. The penile glans was always visualised. Opacification of the deep dorsal vein and the circumflex system decreased with penile rigidity, resulting from their compression between Buck's fascia and the tunica albuginea. Intracavernous pressure recorded before and after the surgical procedure showed a marked increase when a caverno-venous shunt was performed. Hypervascularisation of the glans occurred in 2 cases. The relevance of this new surgical technique and its functional mechanism are discussed.

  14. Antioxidative mechanism in the course of varicose veins.

    Science.gov (United States)

    Horecka, Anna; Biernacka, Jadwiga; Hordyjewska, Anna; Dąbrowski, Wojciech; Terlecki, Piotr; Zubilewicz, Tomasz; Musik, Irena; Kurzepa, Jacek

    2017-01-01

    Objective Our objective was to evaluate the state of oxidative stress in the great saphenous varicose vein wall and blood of varicose vein patients taken from the antecubital vein. Methods The superoxide dismutase, reduced glutathione (GSH) and total antioxidant status were measured with commercially available colorimetric kits in erythrocytes, plasma and varicose vein wall of 65 patients (second degree of clinical state classification, etiology, anatomy and pathophysiology) aged 22-70 (49 women, 16 men) in comparison to normal great saphenous vein walls collected from 10 patients who underwent coronary artery bypass graft and blood collected from 20 healthy individuals. Results A statistically significant decrease (p < 0.001) in superoxide dismutase activity in erythrocytes and the increase (p < 0.05) in superoxide dismutase activity in varicose vein has been observed. There have been no significant changes in the concentration of GSH in plasma and in varicose vein. The decreased concentration of total antioxidant status in plasma (p < 0.001) and in varicose vein wall (p < 0.05) in comparison to the control has been noticed. Conclusion The varicose vein patients are affected by oxidative stress. Our results indicate impaired antioxidant defense mechanism in the blood of varicose vein patients. In contrast to the blood, an increased process of antioxidant defense in the varicose vein wall was noticed.

  15. Augmented reality based real-time subcutaneous vein imaging system.

    Science.gov (United States)

    Ai, Danni; Yang, Jian; Fan, Jingfan; Zhao, Yitian; Song, Xianzheng; Shen, Jianbing; Shao, Ling; Wang, Yongtian

    2016-07-01

    A novel 3D reconstruction and fast imaging system for subcutaneous veins by augmented reality is presented. The study was performed to reduce the failure rate and time required in intravenous injection by providing augmented vein structures that back-project superimposed veins on the skin surface of the hand. Images of the subcutaneous vein are captured by two industrial cameras with extra reflective near-infrared lights. The veins are then segmented by a multiple-feature clustering method. Vein structures captured by the two cameras are matched and reconstructed based on the epipolar constraint and homographic property. The skin surface is reconstructed by active structured light with spatial encoding values and fusion displayed with the reconstructed vein. The vein and skin surface are both reconstructed in the 3D space. Results show that the structures can be precisely back-projected to the back of the hand for further augmented display and visualization. The overall system performance is evaluated in terms of vein segmentation, accuracy of vein matching, feature points distance error, duration times, accuracy of skin reconstruction, and augmented display. All experiments are validated with sets of real vein data. The imaging and augmented system produces good imaging and augmented reality results with high speed.

  16. Pharmacological assessment of adrenergic receptors in human varicose veins.

    Science.gov (United States)

    Miller, V M; Rud, K S; Gloviczki, P

    2000-06-01

    Experiments were to characterize pharmacologically adrenergic receptors in human varicose veins to the natural transmitter norepinephrine and to an extract of Ruscus. Greater saphenous veins and varicose tributaries from patients undergoing elective surgery for primary varicose disease and portions of greater saphenous veins from patients undergoing peripheral arterial reconstruction (control) were suspended for the measurement of isometric force in organ chambers. Concentration response curves were obtained to norepinephrine or the extract of Ruscus aculeatus in the absence and presence of selective antagonists of alpha, and alpha2 adrenergic receptors. Norepinephrine and Ruscus extract caused concentration-dependent contractions in all veins. Contractions to norepinephrine were greater in control veins than in varicose tributaries. Contractions to the extract were greater in varicose tributaries than in greater saphenous veins from varicose patients. Contractions to norepinephrine were reduced similarly by alpha and alpha2-adrenergic agonists in control and varicose veins but to a greater extent by alpha2-blockade in greater saphenous veins from varicose patients. Contractions to Ruscus extract were not reduced by alpha-adrenergic blockade in control veins but were reduced by alpha2-adrenergic blockade in varicose veins. These results suggest a differential distribution of alpha adrenergic receptors on greater saphenous veins from non-varicose patients compared to those with primary varicose disease. Venotropic agents from plant extract probably exert effects by way of multiple receptor and non-receptor mediated events.

  17. Sclerotherapy and foam sclerotherapy for varicose veins.

    Science.gov (United States)

    Coleridge Smith, P

    2009-12-01

    To review published evidence concerning treatment of varicose veins using ultrasound-guided foam sclerotherapy (UGFS) to assess the safety and efficacy of this treatment. Medical literature databases including MedLine, Embase and DH-DATA were searched for recent literature concerning UGFS. Papers describing the early results and later outcome have been assessed and their main findings were included in this summary. Few randomized studies have been published in this field and much of the available data come from clinical series reported by individual clinicians. It is clear that foam sclerotherapy is far more effective than liquid sclerotherapy and that ultrasound imaging allows the treatment to be delivered accurately to affected veins. There is evidence that 3% polidocanol foam is no more effective than 1% polidocanol foam. The optimum ratio of gas to liquid is 4:1, although a range of ratios is reported in the published work. There is a wide variation in the volume used as well as the method by which it is injected. The use of carbon dioxide foam reduces the systemic complications, particularly visual disturbance, as compared with air foams. Very few serious adverse events have been reported in the literature despite the widespread use of this method. Rates of recanalization of saphenous trunks following UGFS are similar to those observed after endovenous laser and endovenous RF ablation of veins, as well as the residual incompetence after surgical treatment. UGFS is a safe and effective method of treating varicose veins. The relative advantages or disadvantages of this treatment in the longer term have yet to be published.

  18. Varicose veins of the pelvis men

    Directory of Open Access Journals (Sweden)

    O. B. Zhukov

    2016-01-01

    Full Text Available Syndrome of pelvic venous congestion in men and of prostate particularly in contrast to women disease is poorly known. Classification of varicose pelvic veins in men does not exist. In this paper we analyzed their own data on the diagnosis and treatment of venous congestion in the pelvic and prostate in patients with varicocele. Classification of prostate varicose are also offered by us.

  19. Deep Vein Thrombosis after Coronary Angiography

    Directory of Open Access Journals (Sweden)

    Vivek Singh Guleria

    2015-01-01

    Full Text Available Deep vein thrombosis (DVT is a rare but potentially serious complication of coronary angiography (CAG, incidence being just 0.05%. Only a few clinical cases of DVT after diagnostic transfemoral catheterization have been reported. Here, we describe the case of a 54-year-old woman who developed significant DVT after CAG without venous thromboembolism (VTE and, which was treated with anticoagulants.

  20. Atypical ultrasonographic presentation of ovarian vein thrombosis.

    Science.gov (United States)

    Graupera, B; Pascual, M A; Garcia, P; Di Paola, R; Ubeda, B; Tresserra, F

    2011-01-01

    Ovarian vein trombosis (OVT) is a pathologic entity classically considered as a postpartum complication and only rarely associated with other diseases. Due to its vague symptoms, it is usually underdiagnosed. However its consequences can be fatal. We report a case of an incidental finding of ovarian thrombosis in an asymptomatic 45-year-old woman who underwent surgery due to the ultrasonographic finding of a para-ovarian cyst.

  1. Ultrasonic Vein Detector Implementation for Medical Applications

    OpenAIRE

    Taheri, Seyedd Arash

    2013-01-01

    Nowadays, taking blood samples from a human forearm and using Cephalic, Basilic, and Median Cubital veins to perform various injections can be considered as one of the most routine medical procedures for diagnostic purposes. Most human patients don’t need to waste a lot of time in clinics waiting for the nurses and/or doctors to locate an applicable venipuncture site. However, minority of individuals who suffer from obesity, cancer, and other similar medical complications have to go to excruc...

  2. Deep vein thrombosis: diagnosis, treatment, and prevention

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, W.P.; Youngswick, F.D.

    Deep vein thrombosis (DVT) is a dangerous complication that may present after elective foot surgery. Because of the frequency with which DVT occurs in the elderly patient, as well as in the podiatric surgical population, the podiatrist should be acquainted with this entity. A review of the diagnosis, treatment, prevention, and the role of podiatry in the management of DVT is discussed in this paper.

  3. Absent right superior caval vein in situs solitus

    DEFF Research Database (Denmark)

    Lytzen, Rebekka; Sundberg, Karin; Vejlstrup, Niels

    2015-01-01

    Introduction In up to 0.07% of the general population, the right anterior cardinal vein obliterates and the left remains open, creating an absent right superior caval vein and a persistent left superior caval vein. Absent right superior caval vein is associated with additional congenital heart...... disease in about half the patients. We wished to study the consequences of absent right superior caval vein as an incidental finding on prenatal ultrasonic malformation screening. Material and methods This is a retrospective case series study of all foetuses diagnosed with absent right superior caval vein...... at the national referral hospital, Rigshospitalet, Denmark, from 2009 to 2012. RESULTS: In total, five cases of absent right superior caval vein were reviewed. No significant associated cardiac, extra-cardiac, or genetic anomalies were found. Postnatal echocardiographies confirmed the diagnosis and there were...

  4. Myocardial Production of Plasminogen Activator Inhibitor-1 is Associated with Coronary Endothelial and Ventricular Dysfunction after Acute Myocardial Infarction.

    Science.gov (United States)

    Shimizu, Takuya; Uematsu, Manabu; Yoshizaki, Toru; Obata, Jun-Ei; Nakamura, Takamitsu; Fujioka, Daisuke; Watanabe, Kazuhiro; Watanabe, Yosuke; Kugiyama, Kiyotaka

    2016-05-02

    Although plasminogen activator inhibitor-1 (PAI-1) is abundantly expressed in infarcted myocardium, the pathogenic role of myocardial PAI-1 remains unknown. This study examined whether PAI-1 in the infarcted lesion contributes to coronary endothelial dysfunction and left ventricular (LV) dysfunction in patients with acute myocardial infarction (AMI). Plasma levels of PAI-1 activity and tissue-plasminogen activator (tPA) antigen were measured 2 weeks and 6 months after MI by ELISA in plasma obtained from the aortic root (AO) and anterior interventricular vein (AIV) in 28 patients with a first AMI due to occlusion of the left anterior descending coronary artery (LAD). Coronary blood flow responses in LAD to intracoronary infusion of acetylcholine (ACh) and left ventriculography were measured at the same time points: 2 weeks and 6 months after MI. The trans-myocardial gradient of PAI-1 from AO to AIV, reflecting production/release of PAI-1 in the infarcted lesion, was inversely correlated with the coronary blood flow response to ACh 6 months after MI (r=-0.43, p=0.02) and with the percentage change in LV regional motion in the LAD territory from 2 weeks to 6 months after MI (r=-0.38, p=0.04). The trans-myocardial gradient of tPA level showed no significant correlations. PAI-1 produced in the infarcted myocardium and released into the coronary circulation is associated with endothelial dysfunction in resistance vessels of the infarct-related coronary arteries and with progressive dysfunction of the infarcted region of the left ventricle in AMI survivors.

  5. Deep vein thrombosis and pulmonary embolism.

    Science.gov (United States)

    Di Nisio, Marcello; van Es, Nick; Büller, Harry R

    2016-12-17

    Deep vein thrombosis and pulmonary embolism, collectively referred to as venous thromboembolism, constitute a major global burden of disease. The diagnostic work-up of suspected deep vein thrombosis or pulmonary embolism includes the sequential application of a clinical decision rule and D-dimer testing. Imaging and anticoagulation can be safely withheld in patients who are unlikely to have venous thromboembolism and have a normal D-dimer. All other patients should undergo ultrasonography in case of suspected deep vein thrombosis and CT in case of suspected pulmonary embolism. Direct oral anticoagulants are first-line treatment options for venous thromboembolism because they are associated with a lower risk of bleeding than vitamin K antagonists and are easier to use. Use of thrombolysis should be limited to pulmonary embolism associated with haemodynamic instability. Anticoagulant treatment should be continued for at least 3 months to prevent early recurrences. When venous thromboembolism is unprovoked or secondary to persistent risk factors, extended treatment beyond this period should be considered when the risk of recurrence outweighs the risk of major bleeding. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Laser photocoagulation for retinal vein occlusion

    Directory of Open Access Journals (Sweden)

    K. A. Mirzabekova

    2015-03-01

    Full Text Available Retinal vein occlusion (RVO is one of the leading causes of permanent vision loss. In adults, central retinal vein occlusion (CRVO occurs in 1.8% while branch retinal vein occlusion (BRVO occurs in 0.2%. Treatment strategy and disease prognosis are determined by RVO type (ischemic/non-ischemic. Despite numerous studies and many current CRVO and BRVO treatment approaches, the management of these patients is still being debated. Intravitreal injections of steroids (triamcinolone acetate, dexamethasone and vascular endothelial growth factor (VEGF inhibitors (bevacizumab, ranibizumab were shown to be fairly effective. However, it is unclear whether anti-VEGF agents are reasonable in ischemic RVOs. Laser photocoagulation remains the only effective treatment of optic nerve head and/or retinal neovascularization. Laser photocoagulation is also indicated for the treatment of macular edema. Both threshold and sub-threshold photocoagulation may be performed. Photocoagulation performed with argon (514 nm, krypton (647 nm, or diode (810 nm laser for macular edema provides similar results (no significant differences. The treatment may be complex and include medication therapy and/or surgery. Medication therapy includes anti-aggregant agents and antioxidants, i.e., emoxypine which may be used in acute RVO as well as in post-thrombotic retinopathy. 

  7. Laser photocoagulation for retinal vein occlusion

    Directory of Open Access Journals (Sweden)

    K. A. Mirzabekova

    2015-01-01

    Full Text Available Retinal vein occlusion (RVO is one of the leading causes of permanent vision loss. In adults, central retinal vein occlusion (CRVO occurs in 1.8% while branch retinal vein occlusion (BRVO occurs in 0.2%. Treatment strategy and disease prognosis are determined by RVO type (ischemic/non-ischemic. Despite numerous studies and many current CRVO and BRVO treatment approaches, the management of these patients is still being debated. Intravitreal injections of steroids (triamcinolone acetate, dexamethasone and vascular endothelial growth factor (VEGF inhibitors (bevacizumab, ranibizumab were shown to be fairly effective. However, it is unclear whether anti-VEGF agents are reasonable in ischemic RVOs. Laser photocoagulation remains the only effective treatment of optic nerve head and/or retinal neovascularization. Laser photocoagulation is also indicated for the treatment of macular edema. Both threshold and sub-threshold photocoagulation may be performed. Photocoagulation performed with argon (514 nm, krypton (647 nm, or diode (810 nm laser for macular edema provides similar results (no significant differences. The treatment may be complex and include medication therapy and/or surgery. Medication therapy includes anti-aggregant agents and antioxidants, i.e., emoxypine which may be used in acute RVO as well as in post-thrombotic retinopathy. 

  8. Late results of mucosal proctectomy and colo-anal sleeve anastomosis for chronic irradiation rectal injury

    Energy Technology Data Exchange (ETDEWEB)

    Browning, G.G.P.; Varma, J.S.; Smith, A.N.; Small, W.P.; Duncan, W.

    1987-01-01

    Ten patients with severe chronic irradiation injury to the rectum were treated by mucosal proctectomy and colo-anal sleeve anastomosis. The indications were: recurrent rectal bleeding (five), stricture (three), fistula (one) and intractable pain (one). Overall follow-up has ranged from 8 to 77 months (mean 40 months). In the present survivors (n=7) the follow-up ranges from 18 to 77 months (mean 52 months). Six patients have been followed up for more than 3 years and four for more than 5 years. There was no operative mortality. Three anastomotic strictures occurred but the protecting stoma could be closed in all but one patient. Continence was acceptable although urgency and frequency of defaecation were troublesome symptoms. The operation is recommended for life-threatening, haemorrhagic chronic irradiation injury to the rectum.

  9. Mechanistic comparison between gastric bypass vs. duodenal switch with sleeve gastrectomy in rat models.

    Directory of Open Access Journals (Sweden)

    Yosuke Kodama

    Full Text Available BACKGROUND: Both gastric bypass (GB and duodenal switch with sleeve gastrectomy (DS have been widely used as bariatric surgeries, and DS appears to be superior to GB. The aim of this study was to better understand the mechanisms leading to body weight loss by comparing these two procedures in experimental models of rats. METHODS: Animals were subjected to GB, DS or laparotomy (controls, and monitored by an open-circuit indirect calorimeter composed of comprehensive laboratory animal monitoring system and adiabatic bomb calorimeter. RESULTS: Body weight loss was greater after DS than GB. Food intake was reduced after DS but not GB. Energy expenditure was increased after either GB or DS. Fecal energy content was increased after DS but not GB. CONCLUSION: GB induced body weight loss by increasing energy expenditure, whereas DS induced greater body weight loss by reducing food intake, increasing energy expenditure and causing malabsorption in rat models.

  10. A Fatal Case of Wernicke’s Encephalopathy after Sleeve Gastrectomy for Morbid Obesity

    Directory of Open Access Journals (Sweden)

    Dimitrios K. Manatakis

    2014-01-01

    Full Text Available Wernicke’s encephalopathy is an acute neuropsychiatric disorder, due to thiamine (vitamin B1 deficiency. It is traditionally described in chronic alcohol abusers; however obesity surgery is an emerging cause, as the number of bariatric procedures increases. A high index of clinical suspicion is required, since initial symptoms may be nonspecific and the classic triad of ophthalmoplegia, gait and stance disorders, and mental confusion is present only in one-third of patients. Laboratory tests can be within normal range and typical MRI brain lesions are found only in 50% of cases. Aggressive supplementation with intravenous thiamine should not be delayed until confirmation of diagnosis, as it may fully reverse symptoms, but almost half the patients will still display permanent neurological deficit. We present our experience with a fatal case of Wernicke’s encephalopathy, following laparoscopic sleeve gastrectomy for morbid obesity.

  11. The success of sleeve gastrectomy in the management of metabolic syndrome and obesity

    Science.gov (United States)

    Shabbir, Asim; Dargan, Dallan

    2015-01-01

    Abstract The rapid reversal of diabetes, hypertension, hyperlipidaemia and obesity by surgical means has challenged accepted doctrines regarding the management of metabolic syndrome. Sleeve gastrectomy, which developed initially as a preparatory procedure for biliopancreatic diversion with duodenal switch, has seen an exponential rise in popularity as an effective lone laparoscopic bariatric procedure. Superior excess weight loss, a low complication rate, and excellent food tolerance, combined with a short hospital stay, have made this the procedure of choice for patients and surgeons across the globe. High volume centres nurture the ongoing development of experienced and specialized teams, pathways and regimens. Optimum surgical outcomes allow minimization of metabolic syndrome, reducing cardiovascular and cerebrovascular risk. PMID:25859262

  12. Numerical and Experimental Study of Producing Two-Step Flanges by Extrusion with a Movable Sleeve

    Directory of Open Access Journals (Sweden)

    Winiarski G.

    2017-06-01

    Full Text Available The paper presents a new metal forming process for producing two-step external flanges on hollow parts. With this method, the flange is extruded by a movable sleeve, which moves in the opposite direction to the punch. This reduces the phenomenon of buckling of the tube wall, which allows extruding flanges with relatively large volumes. The new method was applied to produce a two-step flange on the end of a tubular billet made of 6060 aluminum alloy. This cold metal forming process was designed based on numerical simulations and experimental tests. The effect of the basic technological parameters on metal flow was investigated and limitations of the process were identified. The experimental results confirmed the possibility of forming a two-step flange with a diameter that is approximately twice as big as the external diameter of the tubular billet.

  13. Portomesenteric venous thrombosis after laparoscopic sleeve gastrectomy: A case report and a call for prevention

    Directory of Open Access Journals (Sweden)

    Parveen Bhatia

    2015-01-01

    Full Text Available Postoperative portomesenteric venous thrombosis (PMVT is being increasingly reported after bariatric surgery. It is variable and often a nonspecific presentation along with its potential for life-threatening and life-altering outcomes makes it imperative that it is prevented, detected early and treated optimally. We report the case of a 50-year-old morbidly obese man undergoing a laparoscopic sleeve gastrectomy who developed symptomatic PMVT two weeks postsurgery, which was successfully treated by anticoagulant therapy. We provide postulates to the etiopathological mechanism for this thrombotic entity. The growing recognition that obesity and bariatric surgery create a procoagulant state regionally and systemically provides impetus for designing the ideal protocol for PMVT prophylaxis, which could be more common than currently believed. We support the early screening for PMVT in the postbariatric surgical patient with unexplainable or intractable abdominal symptoms. The role of routine surveillance and the ideal duration of post-PMVT anticoagulation is yet to be elucidated.

  14. Changes in Gut Hormones After Roux en Y Gastric bypass, Sleeve Gastrectomy, and Adjustable Gastric Banding

    Directory of Open Access Journals (Sweden)

    Miroslav Ilić

    2015-12-01

    Full Text Available The obesity epidemic has burdened healthcare systems worldwide. Bariatric surgery is currently the most effective method for long-term weight loss in obese adults, but the exact mechanism of weight loss is poorly understood. Bariatric procedures were initially classified by their presumed mechanism of action into restrictive, malabsoptive, or mixed procedures; however, due to recent advancements in the field of neuroendocrinology, hormones are increasing being recognized as important regulators of satiation, hunger, and energy expenditure. Studies examining changes in gut hormones following bariatric surgery have yielded conflicting results and the relationship between these hormones and weight loss is nothing but clear. This review will summarize the effect of Roux en Y gastric bypass, sleeve gastrectomy and adjustable gastric banding on various gut hormones including ghrelin, cholecystokinin, glucagon-like polypeptide-1, peptide YY3, and pancreatic polypeptide. Furthermore, the relationship between these hormones and weight loss will be examined.

  15. Intravenous Administration of Lycopene, a Tomato Extract, Protects against Myocardial Ischemia-Reperfusion Injury.

    Science.gov (United States)

    Tong, Chao; Peng, Chuan; Wang, Lianlian; Zhang, Li; Yang, Xiaotao; Xu, Ping; Li, Jinjin; Delplancke, Thibaut; Zhang, Hua; Qi, Hongbo

    2016-03-03

    Oral uptake of lycopene has been shown to be beneficial for preventing myocardial ischemia-reperfusion (I/R) injury. However, the strong first-pass metabolism of lycopene influences its bioavailability and impedes its clinic application. In this study, we determined an intravenous (IV) administration dose of lycopene protects against myocardial infarction (MI) in a mouse model, and investigated the effects of acute lycopene administration on reactive oxygen species (ROS) production and related signaling pathways during myocardial I/R. In this study, we established both in vitro hypoxia/reoxygenation (H/R) cell model and in vivo regional myocardial I/R mouse model by ligating left anterior artery descending. TTC dual staining was used to assess I/R induced MI in the absence and presence of acute lycopene administration via tail vein injection. Lycopene treatment (1 μM) before reoxygenation significantly reduced cardiomyocyte death induced by H/R. Intravenous administration of lycopene to achieve 1 μM concentration in circulating blood significantly suppressed MI, ROS production, and JNK phosphorylation in the cardiac tissue of mice during in vivo regional I/R. Elevating circulating lycopene to 1 μM via IV injection protects against myocardial I/R injury through inhibition of ROS accumulation and consequent inflammation in mice.

  16. Intravenous Administration of Lycopene, a Tomato Extract, Protects against Myocardial Ischemia-Reperfusion Injury

    Directory of Open Access Journals (Sweden)

    Chao Tong

    2016-03-01

    Full Text Available Background: Oral uptake of lycopene has been shown to be beneficial for preventing myocardial ischemia-reperfusion (I/R injury. However, the strong first-pass metabolism of lycopene influences its bioavailability and impedes its clinic application. In this study, we determined an intravenous (IV administration dose of lycopene protects against myocardial infarction (MI in a mouse model, and investigated the effects of acute lycopene administration on reactive oxygen species (ROS production and related signaling pathways during myocardial I/R. Methods: In this study, we established both in vitro hypoxia/reoxygenation (H/R cell model and in vivo regional myocardial I/R mouse model by ligating left anterior artery descending. TTC dual staining was used to assess I/R induced MI in the absence and presence of acute lycopene administration via tail vein injection. Results: Lycopene treatment (1 μM before reoxygenation significantly reduced cardiomyocyte death induced by H/R. Intravenous administration of lycopene to achieve 1 μM concentration in circulating blood significantly suppressed MI, ROS production, and JNK phosphorylation in the cardiac tissue of mice during in vivo regional I/R. Conclusion: Elevating circulating lycopene to 1 μM via IV injection protects against myocardial I/R injury through inhibition of ROS accumulation and consequent inflammation in mice.

  17. Gastritis in patients undergoing sleeve gastrectomy: Prevalence, ethnic distribution, and impact on glycemic.

    Science.gov (United States)

    Rath-Wolfson, Lea; Varona, Roy; Bubis, Golan; Tatarov, Alexander; Koren, Rumelia; Ram, Edward

    2017-04-01

    Laparoscopic sleeve gastrectomy (LSG) is a therapeutic option in severely obese patients. The aim of this study was to evaluate the presence of Helicobacter pylori (HP) gastritis and non-Helicobacter gastritis in the gastrectomy specimens, and its association to other variables.One hundred six sleeve gastrectomy specimens were examined histopathologically for the presence of gastritis and its relation to other factors like ethnicity, glycemic control, and postoperative complications.Twelve patients had HP gastritis, 39 had non-HP gastritis, and 55 had normal mucosa. There was a statistical difference between the Arab and Jewish Israeli patients in our study. Twenty-eight of the Arab patients had HP gastritis and 48% had non-HP gastritis. In the Jewish population 6% had HP gastritis and 34% had non-HP gastritis. The preoperative glycemic control was worse in the gastritis group with a mean HbA1c of 8.344% while in the normal mucosa group the mean HbA1c was 6.55. After operation the glycemic control reverted to normal in most the diabetic patients. There were few postoperative complications however, they were not related to HP.There is a high incidence of gastritis in obese patients. The incidence of gastritis in the Arab population in our study was higher than that in the Jewish population. The glycemic control before surgery was worse in patients with gastritis than in the normal mucosa group. HP bares no risk for postoperative complications after LSG and does not affect weight loss. However a larger cohort of patients must be studied to arrive at conclusive results.

  18. Open total gastrectomy with Roux-en-Y reconstruction for a chronic fistula after sleeve gastrectomy.

    Science.gov (United States)

    Bruzzi, Matthieu; Douard, Richard; Voron, Thibault; Berger, Anne; Zinzindohoue, Franck; Chevallier, Jean-Marc

    2016-12-01

    Surgery appears to be the best treatment option for a chronic fistula after laparoscopic sleeve gastrectomy (LSG). Conservative procedures (conversion into a Roux-en-Y gastric bypass, Roux-limb placement) have proven their feasibility and efficacy, but an open total gastrectomy (TG) is sometimes required in challenging situations. To assess outcomes from 12 consecutive patients who underwent surgery for a post-sleeve gastrectomy chronic fistula (PSGCF) between January 2004 and February 2012. University public hospital, France. Patients with a PSGCF who underwent surgery were included in this retrospective study. Mortality, morbidity (i.e., Clavien-Dindo score), weight loss, and nutritional status were assessed. Twelve of 57 patients (21%) with a post-LSG leak developed a PSGCF. There were 3 men (25%). Mean age was 39±9 years and mean preoperative body mass index was 35±5 kg/m2. All 12 patients underwent an open total gastrectomy with an esojejunostomy (TG). Conservative procedures were considered but not possible. The mean follow-up period was 38±11 months. The mean delay between LSG and TG was 12±6 months. Intraoperative discovery of multiple (>2) gastric fistulas was reported in 9 patients (75%). There were no deaths, but morbidity rate was 50%. Early postoperative fistula occurred in 3 patients (anastomosis n = 1, duodenal stump n = 2). None of these patients required further surgery. The median healing time of the fistula was 37 days (range 24-53). Promising results from weight loss and nutritional status were found at the end of the follow-up. A salvage open TG is a well-tolerated and reproducible salvage procedure for cases of a PSGCF, when conservative procedures are not possible. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  19. Pylorus preserving loop duodeno-enterostomy with sleeve gastrectomy - preliminary results

    Science.gov (United States)

    2014-01-01

    Background Bariatric operations mostly combine a restrictive gastric component with a rerouting of the intestinal passage. The pylorus can thereby be alternatively preserved or excluded. With the aim of performing a “pylorus-preserving gastric bypass”, we present early results of a proximal postpyloric loop duodeno-jejunostomy associated with a sleeve gastrectomy (LSG) compared to results of a parallel, but distal LSG with a loop duodeno-ileostomy as a two-step procedure. Methods 16 patients underwent either a two-step LSG with a distal loop duodeno-ileostomy (DIOS) as revisional bariatric surgery or a combined single step operation with a proximal duodeno-jejunostomy (DJOS). Total small intestinal length was determined to account for inter-individual differences. Results Mean operative time for the second-step of the DIOS operation was 121 min and 147 min for the combined DJOS operation. The overall intestinal length was 750.8 cm (range 600-900 cm) with a bypassed limb length of 235.7 cm in DJOS patients. The mean length of the common channel in DIOS patients measured 245.6 cm. Overall excess weight loss (%EWL) of the two-step DIOS procedure came to 38.31% and 49.60%, DJOS patients experienced an %EWL of 19.75% and 46.53% at 1 and 6 months, resp. No complication related to the duodeno-enterostomy occurred. Conclusions Loop duodeno-enterosomies with sleeve gastrectomy can be safely performed and may open new alternatives in bariatric surgery with the possibility for inter-individual adaptation. PMID:24725654

  20. Gastric leaks post sleeve gastrectomy: Review of its prevention and management

    Science.gov (United States)

    Abou Rached, Antoine; Basile, Melkart; El Masri, Hicham

    2014-01-01

    Gastric sleeve gastrectomy has become a frequent bariatric procedure. Its apparent simplicity hides a number of serious, sometimes fatal, complications. This is more important in the absence of an internationally adopted algorithm for the management of the leaks complicating this operation. The debates exist even regarding the definition of a leak, with several classification systems that can be used to predict the cause of the leak, and also to determine the treatment plan. Causes of leak are classified as mechanical, technical and ischemic causes. After defining the possible causes, authors went into suggesting a number of preventive measures to decrease the leak rate, including gentle handling of tissues, staple line reinforcement, larger bougie size and routine use of methylene blue test per operatively. In our review, we noticed that the most important clinical sign or symptom in patients with gastric leaks are fever and tachycardia, which mandate the use of an abdominal computed tomography, associated with an upper gastrointrstinal series and/or gastroscopy if no leak was detected. After diagnosis, the management of leak depends mainly on the clinical condition of the patient and the onset time of leak. It varies between prompt surgical intervention in unstable patients and conservative management in stable ones in whom leaks present lately. The management options include also endoscopic interventions with closure techniques or more commonly exclusion techniques with an endoprosthesis. The aim of this review was to highlight the causes and thus the prevention modalities and find a standardized algorithm to deal with gastric leaks post sleeve gastrectomy. PMID:25320526

  1. Laparoscopic sleeve gastrectomy leads to reduction in thyroxine requirement in morbidly obese patients with hypothyroidism.

    Science.gov (United States)

    Aggarwal, Sandeep; Modi, Shrey; Jose, Toney

    2014-10-01

    The impact of laparoscopic sleeve gastrectomy (LSG) on various co-morbidities including type II diabetes mellitus, hypertension, and sleep apnea is well established. However, its effect on hypothyroidism has not been given due attention evidenced by the scant literature on the subject. The purpose of this report is to assess the change in thyroxine (T4) requirement in morbidly obese patients with clinical hypothyroidism after LSG. We conducted a retrospective review of morbidly obese patients on T4 replacement therapy for clinical hypothyroidism who underwent LSG from August 2009 to July 2012 at our institution. Of the 200 patients who underwent LSG during this period, 21 (10.5 %) were on T4 replacement therapy preoperatively for clinical hypothyroidism. Two patients were lost to follow-up. The remaining 19 patients were categorized into two groups. Group 1 comprised 13 patients with decreased T4 requirements after LSG. Group 2 comprised six patients in whom the T4 dose remained unaltered. The mean change in T4 requirement in group 1 was 42.07 % (12-100 %). Group 1 patients had a significantly higher mean preoperative body mass index (48.7 vs. 43.0 kg/m(2); p = 0.03) than the group 2 patients. There was a significant correlation between the percentage excess weight loss and the percentage change in T4 requirement in group 1 (r = 0.607, p = 0.028). Sleeve gastrectomy has a favorable impact on hypothyroid status as seen by a reduction in T4 requirement in the majority of morbidly obese patients with overt hypothyroidism.

  2. Laparoscopic sleeve gastrectomy as first-line surgical treatment for morbid obesity among adolescents.

    Science.gov (United States)

    Ejaz, Aslam; Patel, Pankti; Gonzalez-Heredia, Raquel; Holterman, Mark; Elli, Enrique F; Kanard, Robert

    2017-04-01

    The increasing prevalence of obesity has necessitated the increasing use of bariatric surgery in the adolescent population. Outcomes following laparoscopic sleeve gastrectomy (LSG) among adolescents, however, have not been well-studied. We report outcomes following LSG as a first-line surgical therapy in patients under 21years of age. All patients who underwent LSG as a primary surgical option for morbid obesity were identified at the University of Illinois at Chicago between 2006 and 2014. Standard clinicopathologic and outcomes data were recorded. We identified 18 patients (13 females, 5 males) who underwent LSG. Mean patient age was 17.8±1.7years. Mean BMI among all patients was 48.6±7.2kg/m2 and did not differ by gender (P=0.68). One patient (5.6%) experienced a 30-day perioperative complication (pulmonary embolism). Median LOS following LSG was 3days (IQR: 2, 3). 2 patients (11.1%) were readmitted within 30-days because of feeding intolerance that resolved without invasive intervention. At a median follow-up of 10.6 (range: 0-38) months, percent excess weight loss (%EWL) among all patients was 35.6%. Among patients with at least 2years follow-up (n=3), %EWL was 50.2%. Laparoscopic sleeve gastrectomy in morbidly obese adolescents is a safe and feasible option. Short- and long-term weight loss appears to be successful following LSG. As such, LSG should be strongly considered as a primary surgical treatment option for all morbidly obese adolescents. Level IV. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Endoscopic sleeve gastroplasty with 1-year follow-up: factors predictive of success

    Science.gov (United States)

    Lopez-Nava, G.; Galvao, M.; Bautista-Castaño, I.; Fernandez-Corbelle, J. P.; Trell, M.

    2016-01-01

    Background and study aims: Bariatric endoscopy has emerged as an aid in the nonsurgical treatment of obesity. The objective of this study is to critically provide the results and follow-up of endoscopic sleeve gastroplasty 1 year after the procedure. Patients and methods: Prospective single-center follow-up study of 25 patients (5 men, 20 women) who underwent flexible endoscopic suturing for endoluminal gastric volume reduction. A multidisciplinary team provided post-procedure care. Patient outcomes were recorded at 1 year after the procedure. Linear regression analysis was done to evaluate the variables associated with best results at 1 year of follow-up. Results: Mean body mass index (BMI) was 38.5 ± 4.6 kg/m2 (range 30 – 47) and mean age 44.5 ± 8.2 years (range 29 – 60). At 1 year, 22 patients continued with the follow-up (2 dropped out at 6 months and 1 at 3 months). There were no major intra-procedural, early, or delayed adverse events. Mean BMI loss was 7.3 ± 4.2 kg/m2, and mean percentage of total body weight loss was 18.7 ± 10.7 at 1 year. In the linear regression analysis, adjusted by initial BMI, variables associated with %TBWL involved the frequency of nutritional (β = 0.563, P = 0.014) and psychological contacts (β = 0.727, P = 0.025). The number of nutritional and psychological contacts were predictive of good weight loss results. Conclusions: Endoscopic sleeve gastroplasty is a feasible, reproducible, and effective procedure to treat obesity. Nutritional and psychological interaction are predictive of success. PMID:26878054

  4. The vertebral venous plexuses: the internal veins are muscular and external veins have valves.

    Science.gov (United States)

    Stringer, Mark D; Restieaux, Matthew; Fisher, Amanda L; Crosado, Brynley

    2012-07-01

    The internal and external vertebral venous plexuses (VVP) extend the length of the vertebral column. Authoritative sources state that these veins are devoid of valves, permitting bidirectional blood flow and facilitating the hematogenous spread of malignant tumors that have venous connections with these plexuses. The aim of this investigation was to identify morphologic features that might influence blood flow in the VVP. The VVP of 12 adult cadavers (seven female, mean age 79.5 years) were examined by macro- and micro-dissection and representative veins removed for histology and immunohistochemistry (smooth muscle antibody staining). A total of 26, mostly bicuspid, valves were identified in 19 of 56 veins (34%) from the external VVP, all orientated to promote blood flow towards the internal VVP. The internal VVP was characterized by four main longitudinal channels with transverse interconnections; the maximum caliber of the longitudinal anterior internal VVP veins was significantly greater than their posterior counterparts (P < 0.001). The luminal architecture of the internal VVP veins was striking, consisting of numerous bridging trabeculae (cords, thin membranes and thick bridges) predominantly within the longitudinal venous channels. Trabeculae were composed of collagen and smooth muscle and also contained numerous small arteries and nerve fibers. A similar internal venous trabecular meshwork is known to exist within the dural venous sinuses of the skull. It may serve to prevent venous overdistension or collapse, to regulate the direction and velocity of venous blood flow, or is possibly involved in thermoregulation or other homeostatic processes. © 2011 Wiley Periodicals, Inc.

  5. Absence of Middle Hepatic Vein Combined with Retro-Aortic Left Renal Vein: a Very Rare Case Report

    Directory of Open Access Journals (Sweden)

    Sezer Akçer

    2012-06-01

    Full Text Available The hepatic and renal veins drain into the inferior vena cava. The upper group of hepatic veins consists of three veins which extend to the posterior face of the liver to join the inferior cava. The left renal vein passes anterior to the aorta just below the origin of the superior mesenteric artery. We detected a variation in the hepatic and renal veins in a multislice CT angiogram of a nine-year-old male patient in the Radiology Department of Afyon Kocatepe University Medical School. The upper group hepatic veins normally drains into the inferior vena cava as three separate trunks, namely the right, left and middle. In our case, we found that only the right and left hepatic veins existed and the middle hepatic vein was absent. Furthermore, the left renal vein, which normally passes anterior to the abdominal aorta, was retro-aortic. Left renal vein variations are of great importance in planning retroperitoneal surgery and vascular interventions. Knowledge of a patient’s hepatic vein and renovascular anatomy and determining their variations and anomalies are of critical importance to abdominal operations, transplantations and preoperative evaluation of endovascular interventions.

  6. Myocardial perfusion modeling using MRI

    DEFF Research Database (Denmark)

    Larsson, H B; Fritz-Hansen, T; Rostrup, Egill

    1996-01-01

    In the present study, it is shown that it is possible to quantify myocardial perfusion using magnetic resonance imaging in combination with gadolinium diethylenetriaminopentaacetic acid (Gd-DTPA). Previously, a simple model and method for measuring myocardial perfusion using an inversion recovery...... in the anterior myocardial wall were (mean +/- SD) Ki = 54 +/- 10 ml/100 g/min, lambda = 30 +/- 3 ml/100 g, Vb = 9 +/- 2 ml/100 g, delta T = 3.2 +/- 1.1 s. These results are in good agreement with similar results obtained by other methods....

  7. Multiple variations in the azygos venous system: a preaortic interazygos vein and the absence of hemiazygos vein.

    Science.gov (United States)

    Ozdemir, B; Aldur, M M; Celik, H H

    2002-02-01

    Multiple variations of the azygos venous system were detected during routine dissection. The hemiazygos vein was underdeveloped. On the left side of the thorax, posterior intercostal veins between the 8th and 11th intercostal spaces and the subcostal vein drained into the azygos vein independently. In addition, the posterior 4th, 5th, 6th and 7th intercostal veins united and formed two superior and inferior trunks. The superior common trunk, at the level of the T4 vertebra, crossed the vertebral column obliquely, lying anterior to the aorta and posterior to the esophagus, opening into the azygos vein at the level of the T4 vertebra. The other structures in this part were normal. There were different courses of the azygos vein system. This variation is important in mediastinal surgery and also in the interpretation of radiographs.

  8. Depression following myocardial infarction

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær

    2013-01-01

    Myocardial infarction (MI) is a severe life event that is accompanied by an increased risk of depression. Mounting evidence suggests that post-MI depression is associated with adverse outcomes, but the underlying mechanisms of this association remain unclear, and no previous studies have examined...... whether the mental burden of MI is so heavy that it increases the risk of suicide. Although post-MI depression is common and burdensome, the condition remains under-recognised and under-treated. The development of new strategies to improve the quality of care for people with post-MI depression requires...... thorough understanding of the mechanisms that influence the prognosis as well as knowledge of the present care provided. The purpose of this PhD thesis is accordingly subdivided into four specific aims: 1. To estimate the prevalence of depression in people with MI after three months, and to estimate...

  9. Unusual arrhythmogenic myocardial disease

    Directory of Open Access Journals (Sweden)

    Christer Backman

    2014-01-01

    Full Text Available A twenty-two-year-old lady, with a 2-year history of recurrent tachyarrhythmia, presented with an episode of arrhythmia preceded by sore throat followed by chills, cough and exertional breathlessness, while abroad. She was commenced on penicillin V for 10 days with no improvement and because of worsening cough with purulent sputum she was prescribed broad-spectrum antibiotics and her chills disappeared. Two months later she had a relapse when she felt extremely tired, when a casualty ECG showed right bundle branch block and anterior T-wave inversion. An echocardiogram showed normal size cardiac chambers but the left ventricular basal posterior wall was hypokinetic with a bright echodense 2x3 cm subendocardial segment suggestive of localized fibrosis (Figure 1. The same finding was confirmed with Gadolinium enhanced CMR scan (Figure 2 which suggested a prior myocardial injury. The ejection fraction was normal at the time of CMR.

  10. MULTIMODAL IMAGING IN VORTEX VEIN VARICES.

    Science.gov (United States)

    Veronese, Chiara; Staurenghi, Giovanni; Pellegrini, Marco; Maiolo, Chiara; Primavera, Laura; Morara, Mariachiara; Armstrong, Grayson W; Ciardella, Antonio P

    2017-03-22

    The aim of this study is to describe the clinical presentation of vortex vein varices with multimodal imaging. The authors carried out a retrospective case series of eight patients (7 female, 1 male) with an average age of 60.2 years (min 8, max 84, median 68.5) presenting with vortex vein varices. All patients were evaluated at the Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy and at Luigi Sacco Hospital, University of Milan, Milan, Italy. Patients underwent complete ophthalmologic examinations, including best corrected visual acuity, intraocular pressure, anterior segment, and fundus examination. Imaging studies, including fundus color photography, near-infrared reflectance imaging, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and spectral-domain enhanced depth imaging optical coherence tomography were also performed. Ultra-widefield fluorescein angiography and ultra-widefield indocyanine angiography using the Heidelberg Retina Angiograph and the Staurenghi 230 SLO Retina Lens were used to demonstrate the disappearance of all retinal lesions when pressure was applied to the globe. All eight cases initially presented to the emergency room. One patient presented secondary to trauma, two patients presented for suspected hemangioma, whereas the other five were referred to the authors' hospitals for suspected retinal lesions. On examination, retinal abnormalities were identified in all 8 patients, with 7 (87.5%) oculus dexter and 1 (12.5%) oculus sinister, and with 1 (12.5%) inferotemporally, 3 (37.5%) superonasally, 3 (37.5%) inferonasally, and 1 (12.5%) inferiorly. Fundus color photography showed an elevated lesion in seven patients and a nonelevated red lesion in one patient. In all patients, near-infrared reflectance imaging showed a hyporeflective lesion in the periphery of the retina. Fundus autofluorescence identified round hypofluorescent rings surrounding weakly hyperfluorescent lesions in all

  11. Moderating the Enthusiasm of Sleeve Gastrectomy: Up to Fifty Percent of Reflux Symptoms After Ten Years in a Consecutive Series of One Hundred Laparoscopic Sleeve Gastrectomies.

    Science.gov (United States)

    Mandeville, Yannick; Van Looveren, Ruth; Vancoillie, Peter-Jan; Verbeke, Xander; Vandendriessche, Katrien; Vuylsteke, Patrick; Pattyn, Paul; Smet, Bart

    2017-07-01

    Laparoscopic sleeve gastrectomy (LSG) has become a popular one-stage bariatric procedure with a proven efficacy on weight loss. However, the relationship between LSG and gastroesophageal reflux disease (GERD) remains a subject of debate. The objective is to determine the long-term effect of LSG on weight loss and reflux disease. A retrospective analysis of 100 consecutive patients who underwent an LSG between January 2005 and March 2009 was performed. The effect of LSG on weight evolution and the relationship between preoperative and postoperative GERD symptoms and PPI dependency was analyzed. A mean follow-up of 8.48 years (range 6.1-10.3) was achieved. We observed a long-term % excess weight loss (%EWL) of 60%. A significant increase in reflux symptoms and use of PPIs was seen. Seventeen percent suffered from reflux disease preoperatively versus 50% at the end of the postoperative follow-up (RR = 2.5882, 95% CI [1.6161-4.1452], p value = 0.0001). The chance of developing de novo reflux after LSG was 47.8% (32/67). Reflux disease was present in 7 of the 26 patients who underwent a secondary Roux-en-Y gastric bypass (RYGB). In four of these seven patients, reflux disease disappeared completely after the secondary RYGB (57.1%). A satisfactory long-term effect on weight loss was achieved. However, a significant increase in GERD and PPI dependency after LSG was noted. New onset GERD was seen in more than 40% of the study population. Conversion to RYGB is a good option in patients with refractory reflux disease after LSG.

  12. Gastight and liquid tight seal of the metal pole sleeve of a battery. Gas- und fluessigkeitsdichte Abdichtung der metallischen Polbuchse eines Akkumulators

    Energy Technology Data Exchange (ETDEWEB)

    Holland, G.

    1985-03-14

    The connection between cell lid and pole sleeve can leak particularly under thermal load. The advance according to the information is that the lid is solidly connected or made in one piece with a counter-bearing box projecting on the inside. At least 1 circular groove for a silicon or neoprene rubber sealing, ring is cut out of the inside of the counter-bearing box or the outside of the pole sleeve. Additional notches etc can be milled for further sealing which accommodate either elastic washers, or elastic acid and oil resistant sealing compound (Vaseline, bitumen etc.). A sliding space is provided at the end of the pole sleeve projecting at the outside where if mechanical forces and/or increased gas pressure occur, the pole sleeve permits movement with the gastight welded pole, without leaking.

  13. Gastight and liquid tight seal of the metal pole sleeve of a battery with a plastic lid. Gas- und fluessigkeitsdichte Abdichtung der metallischen Polbuchse eines Akkumulators zum Kunststoffdeckel

    Energy Technology Data Exchange (ETDEWEB)

    Holland, G.

    1982-04-22

    The connection between cell lid and pole sleeve can leak particularly under thermal load. The advance according to the information is that the lid is solidly connected or made in one piece with a counter-bearing box projecting on the inside. At least 1 circular groove for a silicon or neoprene rubber sealing ring is cut out of the inside of the counter-bearing box or the outside of the pole sleeve. Additional notches etc can be milled for further sealing, which accommodate either elastic washers, or elastic acid and oil resistant sealing compound (Vaseline, bitumen etc.). A sliding space is provided at the end of the pole sleeve projecting at the outside, where if mechanical forces and/or increased gas pressure occur, the pole sleeve permits movement with the gastight welded pole, without leaking.

  14. Effectiveness and Safety of Sleeve Gastrectomy, Gastric Bypass, and Adjustable Gastric Banding in Morbidly Obese Patients: a Multicenter, Retrospective, Matched Cohort Study

    NARCIS (Netherlands)

    Dogan, K.; Gadiot, R.P.; Aarts, E.O.; Betzel, B; Laarhoven, C.J. van; Biter, L.U.; Mannaerts, G.H.; Aufenacker, T.J.; Janssen, I.M; Berends, F.J.

    2015-01-01

    BACKGROUND: Laparoscopic adjustable gastric band (LAGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most performed procedures worldwide (92 %) nowadays. However, comparative clinical trials are scarce in literature. The objective of this study

  15. Anatomic Variation of Facial Vein in Carotid-Cavernous Fistula and Trans-Facial Vein Embolization.

    Science.gov (United States)

    Luo, Chao-Bao; Chang, Feng-Chi; Teng, Michael Mu-Huo; Ting, Ta-Wei

    2015-07-01

    Trans-facial vein (FV) embolization via the internal jugular vein is an alternative approach to embolization of carotid cavernous fistulas (CCFs). The purpose of this study is to report the anatomic variation of FVs and our experience of trans-FV embolization of CCFs. Over 6 years, 26 patients (12 men and 14 women; age range 27-72 years old) with CCFs underwent trans-FV embolization because of anterior drainage of fistulas. We retrospectively analyzed angioarchitecture of the CCFs focusing on the anatomic variations of FVs and angiographic and clinical outcomes after embolization. FVs drained to the internal jugular vein in 10 (38%) cases; FVs unexpectedly emptied into the external jugular vein in 16 (62%) cases. All FVs entered into the internal jugular vein at the level of the hyoid bone. In cases with fistulas to the FV and EJV, the termination of FVs was variable including superior (n = 5), inferior (n = 1), or at the level of the hyoid bone (n = 10). Successful microcatheterization via different insertions of FVs to jugular veins was achieved in all cases. One patient had a small residual fistula, and 2 patients had fistula recurrence. Temporary impairment of cranial nerve III or VI occurred in 4 patients. The mean clinical follow-up time was 18 months. Trans-FV embolization is an effective and safe method to manage CCFs with anterior drainage. However, anatomic variations of the FV exist, and a careful work-up of fistula venous drainage before trans-FV embolization is essential to reduce erroneous attempts, procedure time, and periprocedural risk. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Automated detection of periventricular veins on 7 T brain MRI

    Science.gov (United States)

    Kuijf, Hugo J.; Bouvy, Willem H.; Zwanenburg, Jaco J. M.; Viergever, Max A.; Biessels, Geert Jan; Vincken, Koen L.

    2015-03-01

    Cerebral small vessel disease is common in elderly persons and a leading cause of cognitive decline, dementia, and acute stroke. With the introduction of ultra-high field strength 7.0T MRI, it is possible to visualize small vessels in the brain. In this work, a proof-of-principle study is conducted to assess the feasibility of automatically detecting periventricular veins. Periventricular veins are organized in a fan-pattern and drain venous blood from the brain towards the caudate vein of Schlesinger, which is situated along the lateral ventricles. Just outside this vein, a region-of- interest (ROI) through which all periventricular veins must cross is defined. Within this ROI, a combination of the vesselness filter, tubular tracking, and hysteresis thresholding is applied to locate periventricular veins. All detected locations were evaluated by an expert human observer. The results showed a positive predictive value of 88% and a sensitivity of 95% for detecting periventricular veins. The proposed method shows good results in detecting periventricular veins in the brain on 7.0T MR images. Compared to previous works, that only use a 1D or 2D ROI and limited image processing, our work presents a more comprehensive definition of the ROI, advanced image processing techniques to detect periventricular veins, and a quantitative analysis of the performance. The results of this proof-of-principle study are promising and will be used to assess periventricular veins on 7.0T brain MRI.

  17. Quantification of deep medullary veins at 7 T brain MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kuijf, Hugo J.; Viergever, Max A.; Vincken, Koen L. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); Bouvy, Willem H.; Razoux Schultz, Tom B.; Biessels, Geert Jan [University Medical Center Utrecht, Department of Neurology, Brain Center Rudolf Magnus, Utrecht (Netherlands); Zwanenburg, Jaco J.M. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands)

    2016-10-15

    Deep medullary veins support the venous drainage of the brain and may display abnormalities in the context of different cerebrovascular diseases. We present and evaluate a method to automatically detect and quantify deep medullary veins at 7 T. Five participants were scanned twice, to assess the robustness and reproducibility of manual and automated vein detection. Additionally, the method was evaluated on 24 participants to demonstrate its application. Deep medullary veins were assessed within an automatically created region-of-interest around the lateral ventricles, defined such that all veins must intersect it. A combination of vesselness, tubular tracking, and hysteresis thresholding located individual veins, which were quantified by counting and computing (3-D) density maps. Visual assessment was time-consuming (2 h/scan), with an intra-/inter-observer agreement on absolute vein count of ICC = 0.76 and 0.60, respectively. The automated vein detection showed excellent inter-scan reproducibility before (ICC = 0.79) and after (ICC = 0.88) visually censoring false positives. It had a positive predictive value of 71.6 %. Imaging at 7 T allows visualization and quantification of deep medullary veins. The presented method offers fast and reliable automated assessment of deep medullary veins. (orig.)

  18. Computed tomographic evaluation of the portal vein in the hepatomas

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kee Hyung; Lee, Seung Chul; Bae, Man Gil; Seo, Heung Suk; Kim, Soon Yong; Lee, Min Ho; Kee, Choon Suhk; Park, Kyung Nam [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    1986-10-15

    Computed tomography and pornographic findings of 63 patients with hepatoma, undergone hepatic angiography and superior mesenteric pornography for evaluation of tumor and thrombosis of portal vein and determination of indication of transcatheter arterial embolization for palliative treatment of hepatoma from April, 85 to June, 86 in Hanyang university hospital, were reviewed. The results were as follows: 1. In 36 cases, portal vein thrombosis was detected during photography. Nineteen of 37 cases which revealed localized hepatoma in the right lobe of the liver showed portal vein thrombosis; 9 of 11 cases of the left lobe; 8 of 14 cases which were involved in entire liver revealed thrombosis. One case localized in the caudate lobe showed no evidence of invasion to portal vein. 2. Twenty-four of 34 cases with diffuse infiltrative hepatoma revealed portal vein thrombosis and the incidence of portal vein thrombosis in this type were higher than in the cases of the nodular type. 3. The portal vein thrombosis appeared as filling defects of low density in the lumen of the portal veins in CT and they did not reveal contrast enhancement. 4. CT revealed well the evidence of obstructions in the cases of portal vein thrombosis and the findings were well-corresponded to the findings of the superior mesenteric photography. 5. Five of the cases of the portal vein thrombosis were missed in the CT and the causes were considered as due to partial volume effect of enhanced portal vein with partial occlusion or arterioportal shunts. 6. Six of 13 cases with occlusion of main portal vein showed cavernous transformation and they were noted as multiple small enhanced vascularities around the porta hepatis in the CT. According to the results, we conclude that CT is a useful modality to detect the changes of the portal veins in the patients of the hepatoma.

  19. Pressure-Temperature History of Shock-Induced Melt Veins

    Science.gov (United States)

    Decarli, P. S.; Sharp, T. G.; Xie, Z.; Aramovich, C.

    2002-12-01

    Shock-induced melt veins that occur in chondrites commonly contain metastable high-pressure phases such as (Mg,Fe)SiO3-perovskite, akimotoite, ringwoodite, and majorite, that crystallized from the melt at high pressure. The metastable high-pressure minerals invert rapidly to stable low-pressure phases if they remain at high temperatures after the pressure is released. Although shock compression mechanisms permit rapid heating of the vein volume, adiabatic cooling on decompression is negligible because of the relative incompressibility of the material in the vein. The presence of metastable mantle minerals in a vein thus implies that the vein was quenched via thermal conduction to adjacent cooler material at high pressure. The quenching time of the vein can be determined from ordinary heat flow calculations (Langenhorst and Poirier, 2000), given knowledge of the vein dimensions and the temperatures at the time of vein formation in both the vein and the surrounding material. We have calculated a synthetic Hugoniot for the Tenham L6 chondrite to estimate bulk post-shock and shock temperatures as a function of shock pressure. Assuming a superliquidus temperature of 2500°C for the melt vein, we use a simple thermal model to investigate then thermal histories of melt veins during shock. The variation in crystallization assemblages within melt veins can be explained in terms of variable cooling rates. Survival of (Mg,Fe)SiO3-perovskite in Tenham (Tomioka and Fugino, 1997) requires that melt veins cooled to below 565°C before pressure release, which further constrains shock pressure, duration of the pressure pulse and cooling histories.

  20. Acute Thrombosis of Left Portal Vein during Right Portal Vein Embolization Extended to Segment 4.

    Science.gov (United States)

    Shaw, Colette M; Madoff, David C

    2011-06-01

    Portal vein thrombosis (PVT) is an uncommon, but potentially devastating complication of portal vein embolization (PVE). Its occurrence relates to both local and systemic risk factors. In the setting of PVE, precipitating factors include injury to the vessel wall and reduced portal flow. Contributory factors include portal hypertension, hypercoagulopathy, inflammatory processes, malignancy, pregnancy, oral contraceptive use, and asplenia. The goal of therapy is to prevent thrombus progression and lyse existing clot. Hepatectomy is impossible if adequate recanalization has not occurred and/or overt portal hypertension develops. The mechanisms for thrombus development, its diagnosis, management, and prognosis are discussed.

  1. Portal vein and mesenteric vein gas: CT features; Aeroportie ety aeromesenterie: donnees TDM

    Energy Technology Data Exchange (ETDEWEB)

    Schmutz, G.; Fournier, L.; Le Pennec, V.; Provost, N.; Hue, S.; Phi, I.N. [Centre Hospitalier Universitaire, 14 - Caen (France)

    2001-04-01

    Portal vein and mesenteric vein gas are unusual conditions with a complex and nuclear pathogenesis. Mesenteric ischemia frequently causes such pathological conditions but a variety of other causes are known: inflammatory bowel disease, bowel distension, traumatic and iatrogenic injury, intra-abdominal sepsis, and idiopathic conditions. This pathologic entity is favored by intestinal wall alterations, bowel distension and sepsis. The prognosis is frequently fatal, especially when associated with extended bowel necrosis although in the majority of the cases, outcome is favorable without surgery. (author)

  2. Biomarkers in acute myocardial infarction

    National Research Council Canada - National Science Library

    Chan, Daniel; Ng, Leong L

    2010-01-01

    .... Biomarkers have been used to assist with timely diagnosis, while an increasing number of novel markers have been identified to predict outcome following an acute myocardial infarction or acute coronary syndrome...

  3. Cardiac mapping and pulmonary vein isolation using a novel ablation catheter with tip minielectrodes.

    Science.gov (United States)

    Heringhaus, Florian; Lotz, Tanja; Loehr, Lena; Gelep, Julia; Lask, Sebastian; Kara, Kaffer; Mügge, Andreas; Wutzler, Alexander

    2017-11-01

    Pulmonary vein isolation (PVI) is a standard treatment for atrial fibrillation (AF). Identification of gaps in the ablation line is difficult. Tip-ring electrograms from ablation catheters represent relative large areas of myocardial tissue. Recently, an ablation catheter with three minielectrodes (ME) on the catheter tip with closer interelectrode spacing was introduced. The aim of our study was to evaluate the novel electrodes during PVI. PVI was performed with an irrigated ablation catheter equipped with conventional electrodes and three additional radial tip electrodes. Detection of pulmonary vein potentials (PVPs), local signal amplitude, amplitude reduction during ablation, and loss of capture after ablation were compared between the ME and the conventional tip-ring electrodes. Thirty-one patients (mean age 67.8 ± 10.3 years, 45.2 % men) were included. A total of 306 mapping/lesion points were analyzed. A PVP was significantly more often obtained with the ME compared to the conventional tip-ring electrodes (99.2% vs 83.5%, P PVP mapping and ablation is increased when ME are used. ME may facilitate catheter ablation of AF in the future. © 2017 Wiley Periodicals, Inc.

  4. Prospective Comparison and Quality of Life for Single-Incision and Conventional Laparoscopic Sleeve Gastrectomy in a Series of Morbidly Obese Patients.

    Science.gov (United States)

    Porta, Andrea; Aiolfi, Alberto; Musolino, Cinzia; Antonini, Ilaria; Zappa, Marco Antonio

    2017-03-01

    Laparoscopic sleeve gastrectomy has gained a wide acceptance in the surgical community with an increasing popularity in the field of bariatric surgery. Simultaneously more surgeons have become acquainted with the single port techniques and sleeve gastrectomy has been regarded as an ideal field of application. Literature is scarce about operative and clinical outcomes of single port sleeve gastrectomy compared to conventional laparoscopy. The primary purpose of the study was to compare operative outcomes in the two study groups. Assessment and comparison of functional outcomes in terms of quality of life between groups was also performed. Prospective data on 130 consecutive patients who underwent randomized SI or CL sleeve gastrectomy were collected between January 2009 to December 2014. Preoperative parameters, outcomes, post-operative functional results and quality of life, according to the short-form SF-36 questionnaire, were evaluated and compared between groups. 65 patients underwent conventional laparoscopic (CL) and 65 single incision (SI) sleeve gastrectomy. Operative time, post-operative pain, in-hospital stay, and complications were similar in the two groups. No difference emerged with respect to passage of flatus and resumption of oral intake (p = NS). Cosmetic results were excellent in SI patients with higher satisfaction rates. Post-operative quality of life was significant higher compared to baseline (p sleeve gastrectomy is safe, effective and comparable to the conventional laparoscopic technique in terms of outcomes. Post-operative quality of life is comparable between the two procedures.

  5. Cyclic nucleotides and production of prostanoids in human varicose veins.

    Science.gov (United States)

    Nemcova, S; Gloviczki, P; Rud, K S; Miller, V M

    1999-11-01

    Experiments were designed to determine the production of prostacyclin and thromboxane and the activation of cyclic nucleotides in human varicose and nonvaricose veins and to determine whether these second messenger pathways were differentially activated by the venotropic extract of Ruscus aculeatus. The experiments were designed to characterize the activity of cyclic nucleotides and the production of prostaglandins in human varicose and nonvaricose veins. Segments of the greater saphenous veins and the adjacent tributaries were obtained from patients who underwent vein stripping and excision of primary varicose veins. The saphenous veins from the patients who underwent peripheral arterial bypass grafting were used as controls. The segments of veins were incubated in Krebs-Ringer bicarbonate solution in the presence of venotropic extract of Ruscus aculeatus (10(-3) g/mL) or in water-miscible organic solvent (dimethyl sulfoxide, 10(-3) g/mL), for 1, 5, and 10 minutes at 37 degrees C. The nonspecific phosphodiesterase inhibitor (3-isobutyl-1-methylxanthine, 10(-4) g/mL) was used to block cyclic nucleotide degradation in some samples. Tissue and media samples were collected. Tissue concentrations of both cyclic adenosine monophosphate and cyclic guanosine monophosphate (cAMP and cGMP, respectively) and media concentrations of 6-ketoprostaglandin-F(1)(alpha) (the stable metabolite of prostacyclin) and thromboxane B(2) (the stable metabolite of thromboxane A(2)) were measured by means of radioimmunoassay. Cyclooxygenase 2 was measured with Western blot analysis. The varicose veins showed greater levels of cAMP but not of cGMP at all time points as compared with the control veins. Prostanoid production was not significantly altered in the varicose veins. Stimulation with Ruscus aculeatus increased the cAMP concentration in the varicose veins but did not affect the cGMP levels. The ratio between 6-ketoprostaglandin-F(1)(alpha) and thromboxane B(2) was two-fold greater in

  6. Vestibular tributaries to the vein of the vestibular aqueduct

    DEFF Research Database (Denmark)

    Hansen, Jesper Marsner; Qvortrup, Klaus; Friis, Morten

    2010-01-01

    CONCLUSION: The vein of the vestibular aqueduct drains blood from areas extensively lined by vestibular dark cells (VDCs). A possible involvement in the pathogenesis of an impaired endolymphatic homeostasis can be envisioned at the level of the dark cells area. OBJECTIVES: The aim of this study...... was to investigate the vascular relationship between the vein of the vestibular aqueduct and the vestibular apparatus, with focus on the VDCs. METHODS: Sixteen male Wistar rats were divided into groups of 6 and 10. In the first group, 2 µm thick sections including the vein of the vestibular aqueduct, utricle...... relation to the VDCs in the utricle and the crista ampullaris of the lateral semicircular canal in the vestibular apparatus. One major vein emanated from these networks, which emptied into the vein of the vestibular aqueduct. Veins draining the saccule and the common crus of the superior and posterior...

  7. Central Retinal Vein Occlusion Revealing Coelic Disease

    Directory of Open Access Journals (Sweden)

    Hana ZOUBEIDI

    2016-11-01

    Full Text Available Introduction: Thrombosis has been widely reported in coeliac disease (CD but central retinal vein occlusion (CRVO is rarely described. Case presentation: A 27-year-old woman presented with acute visual loss and was diagnosed with CRVO. Her protein S and protein C levels were low and CD was diagnosed on the basis of endoscopic, immunological and histological results. A gluten-free diet resulted in favourable evolution. Conclusion: CD should be considered in young patients with thrombosis, especially if in an unusual location. Treatment is based on a gluten-free diet.

  8. Portal vein thrombosis in patients with cirrhosis

    Science.gov (United States)

    von Köckritz, Leona; De Gottardi, Andrea; Praktiknjo, Michael

    2017-01-01

    Abstract Portal vein thrombosis (PVT) is frequent in patients with liver cirrhosis and possible severe complications such as mesenteric ischemia are rare, but can be life-threatening. However, different aspects of clinical relevance, diagnosis and management of PVT are still areas of uncertainty and investigation in international guidelines. In this article, we elaborate on PVT classification, geographical differences in clinical presentation and standards of diagnosis, and briefly on the current pathophysiological understanding and risk factors. This review considers and highlights the pitfalls of the various treatment approaches and prophylactic treatments. Finally, we review the controversial issue of clinical impact of PVT on prognosis, especially considering liver transplantation and future perspectives. PMID:28533912

  9. Unilateral pulmonary vein atresia: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, So Hwa; Kim, Ki Jun [Dept. of Radiology, Incheon St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Incheon (Korea, Republic of)

    2014-01-15

    Unilateral pulmonary vein atresia is a rare congenital anomaly. Its symptoms begin to manifest in childhood and a broad spectrum of clinical severity has been described, ranging from asymptomatic, recurrent pulmonary infection, severe hemoptysis, to death. Only a few adult cases with this condition, with no or mild symptoms, have been reported. Pulmonary angiography has been typically used for definite diagnosis. However, pulmonary angiography may be replaced with the current developing multidetector CT. This report presents an adult case with mild symptoms, diagnosed by multidetector CT.

  10. Pediatric aneurysms and vein of Galen malformations

    Science.gov (United States)

    Rao, V. R. K.; Mathuriya, S. N.

    2011-01-01

    Pediatric aneurysms are different from adult aneurysms – they are more rare, are giant and in the posterior circulation more frequently than in adults and may be associated with congenital disorders. Infectious and traumatic aneursyms are also seen more frequently. Vein of Galen malformations are even rarer entities. They may be of choroidal or mural type. Based on the degree of AV shunting they may present with failure to thrive, with hydrocephalus or in severe cases with heart failure. The only possible treatment is by endovascular techniques – both transarterial and transvenous routes are employed. Rarely transtorcular approach is needed. These cases should be managed by an experienced neurointerventionist. PMID:22069420

  11. Bilateral sleeve fractures of the patella in a 12-year-old boy with hereditary spastic paraparesis and crouch gait.

    Science.gov (United States)

    Malone, Ailish; Kiernan, Damien; O Brien, Tim

    2013-12-04

    This is the first reported case of bilateral sleeve fractures of the patellae in a child with crouch gait. A 12-year-old boy with hereditary spastic paraparesis (HSP), who was found to have mid-stance crouch of 20° on previous gait analysis, presented with pain of gradual onset and limited mobility. There was no history of trauma. Three-dimensional gait analysis showed that extensor mechanism function during loading response was intact, but knee flexion in swing was significantly reduced, indicating protective guarding by rectus femoris. X-rays showed bilateral minimally displaced sleeve fractures of the patellae. These were treated with immobilisation in cylinder casts in extension for 4 weeks. Follow-up X-rays showed that the fractures had successfully united and the patient progressed to full weight bearing and mobility as tolerated.

  12. Robotically Assisted Single Anastomosis Duodenoileal Bypass after Previous Sleeve Gastrectomy Implementing High Valuable Technology for Complex Procedures

    Directory of Open Access Journals (Sweden)

    Ramon Vilallonga

    2015-01-01

    Full Text Available Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve. We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed.

  13. Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review

    NARCIS (Netherlands)

    Wichers, Iris M.; Di Nisio, Marcello; Büller, Harry R.; Middeldorp, Saskia

    2005-01-01

    The aim of this systematic review was to summarize the evidence from randomized controlled trials (RCT) concerning the efficacy and safety of medical or surgical treatments of superficial vein thrombosis (SVT) for the prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE). A

  14. Marginal vein is not a varicose vein; it is a venous malformation

    Directory of Open Access Journals (Sweden)

    Byung-Boong Lee

    2014-12-01

    Full Text Available Marginal vein (MV is one form of venous malformation (VM; MV is not a varicose vein. MV is the outcome of defective development during the later stage of embryogenesis while the vein trunk is formed. It is an embryonic vein tissue remnant remaining on birth following the failure of normal involutional process. MV is the most common VM involved to Klippel-Trenaunay syndrome (KTS; together with the lymphatic malformation, MV is one of two clinically most important congenital vascular malformation components among KTS. MV causes chronic venous insufficiency (CVI due to a unique condition of avalvulosis (lack of venous valve development it accompanies with. Besides, it accompanies a high risk of venous thromboembolism (VTE due to its structural defect with a lack of smooth muscle cell to form the media properly as a truncular VM infrequently causing fatal pulmonary embolism. Therefore, the MV is indicated for the surgical excision whenever feasible not only for the prevention of VTE and CVI but also for abnormal long bone growth known as vascular bone syndrome as well as lymphatic complication precipitated by MV.

  15. Vein mechanism simulation study for deep vein thrombosis early diagnosis using cfd

    Science.gov (United States)

    Ibrahim, Nabilah; Aziz, Nur Shazilah Abd; Manap, Abreeza Noorlina Abd

    2017-04-01

    Using a Computational Fluid Dynamics (CFD) technique, this work focus on the analysis of pressure, velocity, and vorticity of blood flow along the popliteal vein. Since the study of early stage of Deep Vein Thrombosis (DVT) becomes essential to prevent the pulmonary embolism (PE), those three parameters are analysed to assess the effect of different opening between two valves of a normal popliteal vein. When only one valve is simulated, the result of pressure shows that the highest and lowest velocities are 15.45 cm/s and 0.73 cm/s, respectively. From the visualization of observed data, however, the different size of orifice between the first and second valves influencing the velocity and vorticity of the blood flow. The rotational motion of blood particle at the same region increases the probability of blood accumulating which is associated with the development of thrombus. Thus, a series of experiment has been conducted by changing the size of valve orifice for the first and second valves along the vein distribution. The result of the CFD simulation shows a significant variation in blood flow in terms of velocity and vorticity.

  16. Ten years of experience with Parks' coloanal sleeve anastomosis for the treatment of post-irradiation rectovaginal fistula

    Energy Technology Data Exchange (ETDEWEB)

    Mowacki, M.P. (Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw (Poland). Dept. of Surgical Oncology)

    1991-12-01

    Twenty-four cases of coloanal sleeve anastomosis for the repair of rectovaginal post-irradiation fistula are described. All patients were previously irradiated because of carcinoma of the uterine cervix. Eleven patients had simultaneous repair of vesicovaginal fistula. One postoperative death was observed. Of the 23 surviving patients, functional results were good in 18. In 16 patients with difficult stripping of the rectal mucosa, surgical curettage was performed. The latter procedure is suggested as a useful method in relevant cases. (author).

  17. One Year Follow-up Results after Sleeve Gastrectomy in Type 2 Diabetes Mellitus Patients with Morbid Obesity

    Directory of Open Access Journals (Sweden)

    Dejeu Viorel

    2016-06-01

    Full Text Available Background and aims: Bariatric surgery has been shown to be superior to nonsurgical approaches in terms of weight loss and remission of type 2 diabetes (T2DM and metabolic syndrome. This prospective, single-center, follow-up study assessed percentage of excessive weight loss (%EWL, glycosylated hemoglobin (HbA1c levels, prescribed antidiabetes drugs and diabetes remission rates in obese T2DM patients who underwent laparoscopic sleeve gastrectomy.

  18. Addressing the challenges of sleeve gastrectomy in end-stage renal disease: Analysis of 100 consecutive renal failure patients.

    Science.gov (United States)

    Kim, Young; Shi, Junzi; Freeman, Christopher M; Jung, Andrew D; Dhar, Vikrom K; Shah, Shimul A; Woodle, E Steve; Diwan, Tayyab S

    2017-08-01

    While previous studies have demonstrated short-term efficacy of laparoscopic sleeve gastrectomy in candidates awaiting renal transplantation, the combination of morbid obesity and end-stage renal disease presents unique challenges to perioperative care. We demonstrate how increasing experience and the development of postoperative care guidelines can improve outcomes in this high-risk population. Single-center medical records were reviewed for renal transplantation candidates undergoing laparoscopic sleeve gastrectomy between 2011 and 2015 by a single surgeon. Postoperative care protocols were established and continually refined throughout the study period, including a multidisciplinary approach to inpatient management and hospital discharge planning. The first 100 laparoscopic sleeve gastrectomy patients were included and divided into 4 equal cohorts based on case sequence. Compared with the first 25 patients undergoing laparoscopic sleeve gastrectomy, the last 25 patients had shorter operative times (97.8 ± 27.9 min vs 124.2 ± 33.6 min), lower estimated blood loss (6.6 ± 20.8 mL vs 34.0 ± 38.1 mL), and shorter hospital duration of stay (1.7 ± 2.1 days vs 2.9 ± 0.7 days) (P < .01 each). Readmission rates, complications, and 1-year mortality did not differ significantly. Increasing experience and the development of clinical care guidelines in this high-risk population is associated with reduced health care resource utilization and improved perioperative outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Effect of an Outer Sleeve on an Inflatable Balloon Tamp in Terms of Height Restoration Under Simulated Physiological Load.

    Science.gov (United States)

    Peppelman, Walter C; Beutler, William; Gordon, Michael; Chintakunta, Suresh R; O'Halloran, Damien; Bucklen, Brandon

    2017-04-01

    An in vitro biomechanical study. The aim of this study was to determine the effect of an optional sleeve on height restoration and compare it with the fracture reduction achieved by a commercially available inflatable bone tamp under simulated physiological load (110 N). Loss of reduction after bone tamp deflation before cement injection still remains a concern. The optional sleeve surrounds the bone tamp to help maintain height during the kyphoplasty procedure while filling the created cavity with bone cement on the contralateral side. Eighteen osteoporotic vertebral bodies (VBs) (T11-L4) were alternately assigned to 1 of the 2 treatment groups: group A: KYPHON (Kyphon Inc.) and group B: AFFIRM with sleeve (Globus Medical Inc.). The VBs were compressed axially at a rate of 5 mm/min until compressed to 40% of the initial anterior height. The fractured VBs then underwent kyphoplasty with cement augmentation while still maintaining load (110 N). The augmented VBs were then recompressed and anterior VB height (mm) and wedge angle (degrees) were measured initially after mechanically creating an anterior wedge fracture, and after repairing the compression fracture. The effect of kyphoplasty on vertebral height, kyphotic angle, cement volumes, and inflation pressures were compared between the treatment groups. Failure load (N) data were compared between intact and repaired VBs. Average percentage of lost VB height restored in group A was 30%, compared with 56% for group B. The mean changes in wedge angle were similar to those of vertebral height measurements. No significant difference in mean inflation pressures (group A: 175±37 psi; group B: 160±36 psi) were found between the 2 groups. Average percentage increase in failure load was 241% and 212% in groups A and B, respectively. Some height restoration was observed using the commercially available bone tamp in fractured VBs under simulated physiological load. The use of an outer sleeve significantly enhanced height

  20. Cardiopexy with Ligamentum Teres in Patients with Hiatal Hernia and Previous Sleeve Gastrectomy: An Alternative Treatment for Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Gálvez-Valdovinos, Ramiro; Cruz-Vigo, José Luis; Marín-Santillán, Ernesto; Funes-Rodríguez, Juan Francisco; López-Ambriz, Gustavo; Domínguez-Carrillo, Luis Gerardo

    2015-08-01

    Fifty percent of patients who have undergone sleeve gastrectomy have gastroesophageal reflux disease (GERD). Surgical reinforcement of the lower esophageal sphincter is necessary to prevent acid reflux. Here, we describe ligamentum teres cardiopexy, a surgical technique that reinforces the lower esophageal sphincter and restores its competence with a new valve, in patients with previous sleeve gastrectomy and hiatal hernia. Included in the study were 15 patients (age, 35.6 ± 15.2 years; 13 females [86.6 %]; mean pre-cardiopexy body mass index, 21.94 kg/m(2)) with sleeve gastrectomy who presented with hiatal hernia and gastroesophageal reflux disease and underwent ligamentum teres cardiopexy. In this procedure, the ligamentum teres is released from its umbilical connection and the hernia reduced by manual traction, freeing the last 3-5 cm of esophagus in the abdomen. The distal ligamentum teres is fixed with one stitch to the apex of the angle of His, one at the gastroesophageal junction, and one joining the gastric fundus to the esophagus. The remainder of the ligamentum teres is fixed over itself with four to six stitches, forming a necktie cardiopexy. The procedure concludes with diaphragmatic crus closure. After 6 months, 13 patients (86.6 %) achieved successful results, defined as resolution of GERD, no proton-pump inhibitor (PPI) use, and manometry measurement over 12 mmHg after surgery. Two patients (13.3 %) required continued proton-pump inhibition. Ligamentum teres cardiopexy combined with closure of the gastric crus is a good alternative treatment for gastroesophageal reflux disease in patients with previous sleeve gastrectomy and hiatal hernia.

  1. [Portal perfusion with right gastroepiploic vein flow in liver transplant].

    Science.gov (United States)

    Mendoza-Sánchez, Federico; Javier-Haro, Francisco; Mendoza-Medina, Diego Federico; González-Ojeda, Alejandro; Cortés-Lares, José Antonio; Fuentes-Orozco, Clotilde

    Liver transplantation in patients with liver cirrhosis, portal vein thrombosis, and cavernous transformation of the portal vein, is a complex procedure with high possibility of liver graft dysfunction. It is performed in 2-19% of all liver transplants, and has a significantly high mortality rate in the post-operative period. Other procedures to maintain portal perfusion have been described, however there are no reports of liver graft perfusion using right gastroepiploic vein. A 20 year-old female diagnosed with cryptogenic cirrhosis, with a Child-Pugh score of 7 points (class "B"), and MELD score of 14 points, with thrombosis and cavernous transformation of the portal vein, severe portal hypertension, splenomegaly, a history of upper gastrointestinal bleeding due to oesophageal varices, and left renal agenesis. The preoperative evaluation for liver transplantation was completed, and the right gastroepiploic vein of 1-cm diameter was observed draining to the infrahepatic inferior vena cava and right suprarenal vein. An orthotopic liver transplantation was performed from a non-living donor (deceased on January 30, 2005) using the Piggy-Back technique. Portal vein perfusion was maintained using the right gastroepiploic vein, and the outcome was satisfactory. The patient was discharged 13 days after surgery. Liver transplantation was performed satisfactorily, obtaining an acceptable outcome. In this case, the portal perfusion had adequate blood flow through the right gastroepiploic vein. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  2. Portal Vein Thrombosis After Splenic and Pancreatic Surgery.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Priego, Pablo

    2017-01-01

    The portal vein is formed by the confluence of the splenic and superior mesenteric veins, which drain the spleen and small intestine respectively. Occlusion of the portal vein by thrombus typically occurs in patients with cirrhosis and/or prothrombotic disorders. However, portal vein thrombosis (PVT) can also happen after determined surgeries. Moreover, PVT can have serious consequences depending on the location and extent of the thrombosis, including hepatic ischemia, intestinal ischemia, portal hypertension… In this chapter, we will review the incidence, management and prophylaxis of PVT after splenectomy, pancreas transplantation, pancreatic surgery and in the setting of acute and chronic pancreatitis.

  3. A rare case of branch retinal vein occlusion following Sirsasana

    National Research Council Canada - National Science Library

    Balamurugan, Anugraha; Srikanth, Krishnagopal

    2016-01-01

    .... It is also known to cause causes raised intraocular pressure, decompression retinopathy, glaucomatous visual field defects, central retinal vein occlusion, progression of glaucoma, optic neuropathy...

  4. Myocardial scintigraphy in the diagnosis of myocardial contusion

    Energy Technology Data Exchange (ETDEWEB)

    Terashima, Masayoshi; Shinoda, Mitsutaka; Iwama, Hiroshi; Hirama, Hisao; Hoshino, Toshiaki; Urabe, Shinpei [Central Aizu General Hospital, Fukushima (Japan); Meguro, Taiichiroh

    1996-04-01

    To assess the clinical value of a new fatty acid imaging tracer, {sup 123}I-{beta}-methyl iodophenyl pentadecanoic acid (BMIPP), I-BMIPP and thallium-201 (Tl) dual imaging was performed at rest in fifteen patients with mild blunt chest trauma (mean AIS thoracic 1.4{+-}0.51, mean ISS 6.47{+-}3.50, mean RTS 7.69{+-}0.43). All patients were prospectively evaluated on the basis of serial electrocardiograms (ECG) and cardiac enzyme studies (total CPK). Tl and BMIPP dual scintigrams were performed within 10 days following admission. SPECT images were divided into seven segments, and the segmental images were visually scored according to tracer uptake on a 3 (severely decreased tracer uptake) to 0 (normal) scale. Nine patients had scintigraphic defects and were considered to have a myocardial contusion. ECG findings, AIS, ISS, and CPK levels failed to distinguish between scintigraphically positive patients and scintigraphically negative patients. Five of the 14 hypoperfused segments on BMIPP imaging, showed normal Tl uptake, one showed lower BMIPP uptake than Tl, and the remaining eight showed similar distribution of both tracers. The mismatch between tracer uptake on BMIPP images and Tl images was thought to reflect impaired myocardial fatty acid metabolism. Thus, mild blunt chest trauma results in a higher frequency of traumatic myocardial injury than previously recognized, and BMIPP is a promising radio-pharmaceutical for evaluating impaired myocardial fatty acid metabolism in patients with myocardial contusion. (author).

  5. Can deep vein thrombosis be predicted after varicose vein operation in women in rural areas?

    Science.gov (United States)

    Warot, Marcin; Synowiec, Tomasz; Wencel-Warot, Agnieszka; Daroszewski, Przemysław; Bojar, Iwona; Micker, Maciej; Chęciński, Paweł

    2014-01-01

    Chronic venous disease is a group of symptoms caused by functional and structural defects of the venous vessels. One of the most common aspects of this disease is the occurrence of varicose veins. There are many ways of prevention and treatment of varicose veins, but in Poland the leading one is still surgery. As in every medical procedure there is the possibility of some complications. One of them is deep vein thrombosis (DVT). The diagnosis of DVT can be difficult, especially when access to a specialist is limited, such as in case of rural patients. The aim of the study. The aim of the study was estimation of the influence of LMWH primary prophylaxis on the formation of postoperative DVT, as well as sensitivity and specificity of clinical examination and D-dimer value in diagnosis of postoperative DVT in women. The study was conducted in a group of 93 women operated on in the Department of General, Vascular Surgery and Angiology at the Karol Marcinkowski University of Medical Sciences in Poznań, Poland. The patients had undergone a varicose vein operation and were randomly divided into two groups: A - 48 women receiving LMWH during two days of the perioperative period, B - 45 women receiving LMWH during seven days of the perioperative period. There was no significant difference in the postoperative DVT complications in both groups. The value of D-dimer > 0.987 mcg/ml and swelling > 1.5 cm of shin (in comparison to the preoperative period) plays a significant role in diagnosis of DVT. The extended primary prophylaxis with LMWH does not affect the amount or quality of thrombotic complications after varicose vein operation. If the DVT occurs, the evaluation of the D - dimer and careful clinical examination can be a useful method for its diagnosis.

  6. Can deep vein thrombosis be predicted after varicose vein operation in women in rural areas?

    Directory of Open Access Journals (Sweden)

    Marcin Warot

    2014-09-01

    Full Text Available [b]Introduction[/b]. Chronic venous disease is a group of symptoms caused by functional and structural defects of the venous vessels. One of the most common aspects of this disease is the occurrence of varicose veins. There are many ways of prevention and treatment of varicose veins, but in Poland the leading one is still surgery. As in every medical procedure there is the possibility of some complications. One of them is deep vein thrombosis (DVT. The diagnosis of DVT can be difficult, especially when access to a specialist is limited, such as in case of rural patients. [b]The aim of the study.[/b] The aim of the study was estimation of the influence of LMWH primary prophylaxis on the formation of postoperative DVT, as well as sensitivity and specificity of clinical examination and D-dimer value in diagnosis of postoperative DVT in women. [b]Materials and methods[/b]. The study was conducted in a group of 93 women operated on in the Department of General, Vascular Surgery and Angiology at the Karol Marcinkowski University of Medical Sciences in Poznań, Poland. The patients had undergone a varicose vein operation and were randomly divided into two groups: A – 48 women receiving LMWH during two days of the perioperative period, B – 45 women receiving LMWH during seven days of the perioperative period. [b]Results[/b]. There was no significant difference in the postoperative DVT complications in both groups. The value of D-dimer > 0.987 mcg/ml and swelling > 1.5 cm of shin (in comparison to the preoperative period plays a significant role in diagnosis of DVT. [b]Conclusions[/b]. The extended primary prophylaxis with LMWH does not affect the amount or quality of thrombotic complications after varicose vein operation. If the DVT occurs, the evaluation of the D – dimer and careful clinical examination can be a useful method for its diagnosis.

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

    Science.gov (United States)

    Milone, Marco; Di Minno, Matteo Nicola Dario; Leongito, Maddalena; Maietta, Paola; Bianco, Paolo; Taffuri, Caterina; Gaudioso, Dario; Lupoli, Roberta; Savastano, Silvia; Milone, Francesco; Musella, Mario

    2013-01-01

    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

  8. What are the long-term results 8 years after sleeve gastrectomy?

    Science.gov (United States)

    Noel, Patrick; Nedelcu, Marius; Eddbali, Imane; Manos, Thierry; Gagner, Michel

    2017-07-01

    Laparoscopic sleeve gastrectomy (LSG) became the most frequent bariatric procedure performed in France (2011) and in the United States (2013), but studies reporting long-term results are still rare. Private hospital, France. This is a retrospective analysis of a prospective cohort of 168 patients who underwent LSG between 2005 and 2008. The objective of this study was to present the 8-year outcome concerning weight loss, modification of co-morbidities, and to report the revisional surgery after sleeve. The preoperative mean body mass index was 42.8 kg/m2 (31.1-77.9), 35 patients were super obese, and 64 patients had a previous gastric band. For LSG as a definitive bariatric procedure, 8 years of follow-up data were available for 116 patients (follow-up: 69%). Of the remainder, 23 patients underwent revisional surgery and 29 were lost to follow-up. For the entire cohort, the mean excess weight loss (EWL) was 76% (0-149) at 5 years and 67% (4-135) at 8 years, respectively. Of the 116 patients with 8 years of follow-up, 82 patients had>50% EWL at 8 years (70.7%). Percentages of co-morbidities resolved were hypertension, 59.4%; type 2 diabetes, 43.4%; and obstructive sleep apnea, 72.4%. Twenty-three patients had revisional surgery for weight regain (n = 14) or for severe reflux (n = 9) at a mean period of 50 months (9-96). Twelve patients underwent resleeve gastrectomy, 6 patients underwent conversion to a bypass, and 5 patients to duodenal switch (1 single anastomosis duodeno-ileostomy). A total of 31% of patients reported gastroesophageal reflux symptoms at 8 years. At 8 years postoperatively, the LSG as a definitive bariatric procedure remained effective for 59% of cases. The results appear to be more favorable especially for the non-super-obese patients and primary procedures. LSG is a well-tolerated bariatric procedure with low long-term complication rates. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  9. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial.

    Science.gov (United States)

    Peterli, Ralph; Wölnerhanssen, Bettina Karin; Peters, Thomas; Vetter, Diana; Kröll, Dino; Borbély, Yves; Schultes, Bernd; Beglinger, Christoph; Drewe, Jürgen; Schiesser, Marc; Nett, Philipp; Bueter, Marco

    2018-01-16

    Sleeve gastrectomy is increasingly used in the treatment of morbid obesity, but its long-term outcome vs the standard Roux-en-Y gastric bypass procedure is unknown. To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss, changes in comorbidities, increase in quality of life, and adverse events. The Swiss Multicenter Bypass or Sleeve Study (SM-BOSS), a 2-group randomized trial, was conducted from January 2007 until November 2011 (last follow-up in March 2017). Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers, 217 patients were enrolled and randomly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period. Patients were randomly assigned to undergo laparoscopic sleeve gastrectomy (n = 107) or laparoscopic Roux-en-Y gastric bypass (n = 110). The primary end point was weight loss, expressed as percentage excess body mass index (BMI) loss. Exploratory end points were changes in comorbidities and adverse events. Among the 217 patients (mean age, 45.5 years; 72% women; mean BMI, 43.9) 205 (94.5%) completed the trial. Excess BMI loss was not significantly different at 5 years: for sleeve gastrectomy, 61.1%, vs Roux-en-Y gastric bypass, 68.3% (absolute difference, -7.18%; 95% CI, -14.30% to -0.06%; P = .22 after adjustment for multiple comparisons). Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass (60.4%) than after sleeve gastrectomy (25.0%). Gastric reflux worsened (more symptoms or increase in therapy) more often after sleeve gastrectomy (31.8%) than after Roux-en-Y gastric bypass (6.3%). The number of patients with reoperations or interventions was 16/101 (15.8%) after sleeve gastrectomy and 23/104 (22.1%) after Roux-en-Y gastric bypass. Among patients with morbid obesity, there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux

  10. Neonatal vitelline vein aneurysm with thrombosis: prompt treatment should be needed

    Science.gov (United States)

    Kim, Soo-Hong; Yu, Hyeong Won; Jo, Heui Seung

    2015-01-01

    Vitelline veins are a pair of embryonic structures. The veins develop the portal vein system. Serious problems occur if the vitelline vein does not regress and becomes an aneurysm. Thrombus formation in the vitelline vein aneurysm could lead to portal vein thrombosis and portal hypertension unless promptly and correctly treated. Though vitelline vein aneurysm is an extremely rare anomaly, it rapidly progresses to portal vein thrombosis that requires prompt diagnosis and treatment. We reported a case of neonatal vitelline vein aneurysm and thrombosis that was cured by prompt operation. PMID:26665130

  11. Doppler-guided cannulation of internal jugular vein, subclavian vein and innominate (brachiocephalic) vein--a case-control comparison in patients with reduced and normal intracranial compliance.

    Science.gov (United States)

    Schummer, Wolfram; Schummer, Claudia; Niesen, Wolf-Dirk; Gerstenberg, Hendrik

    2003-09-01

    A case-control comparison of Doppler guidance on the success rate of central venous cannulation in patients with normal or reduced intracranial compliance. A single operator performed central venous access procedures with continuous wave Doppler guidance. It was used on patients on a ventilator. The position of patients with reduced intracranial compliance (RIC) was not changed for the procedure. Patients with normal intracranial compliance (NIC) were put in the Trendelenburg position. We prospectively evaluated 249 Doppler-guided central venous access procedures performed over a 12-month period at our 10-bed neuro-intensive care unit at a university hospital. The group with RIC included 26 males and 35 females (n=61) aged 16-79 years. In this group 155 Doppler-guided cannulation procedures (62%) were performed. The group with NIC (n=52) comprised 29 males and 23 females aged 34-76 years; 94 Doppler-guided cannulation procedures (38%) were carried out. The veins cannulated in RIC and NIC, respectively, were: right innominate vein: 24/18, left innominate vein 26/12, right subclavian vein 12/7, left subclavian vein 25/14, and right internal jugular vein 33/18 and left internal jugular vein 35/24. The absence of one left internal jugular vein was identified in the NIC group. The success rate of first needle pass in patients with RIC was 92% and in patients with NIC 89%. This study showed that Doppler guidance allows the cannulation of central veins in patients with RIC placed in head-up position. Cannulation can be ensured and first-pass needle placement maximised.

  12. Further evidence of Mirafiori lettuce big-vein virus but not of Lettuce big-vein associated virus with big-vein disease in lettuce.

    Science.gov (United States)

    Sasaya, Takahide; Fujii, Hiroya; Ishikawa, Koichi; Koganezawa, Hiroki

    2008-04-01

    Mirafiori lettuce big-vein virus (MLBVV) and Lettuce big-vein associated virus (LBVaV) are found in association with big-vein disease of lettuce. Discrimination between the two viruses is critical for elucidating the etiology of big-vein disease. Using specific antibodies to MLBVV and LBVaV for western blotting and exploiting differences between MLBVV and LBVaV in host reaction of cucumber and temperature dependence in lettuce, we separated the two viruses by transfering each virus from doubly infected lettuce plants to cucumber or lettuce plants. A virus-free fungal isolate was allowed to acquire the two viruses individually or together. To confirm the separation, zoospores from MLBVV-, LBVaV-, and dually infected lettuce plants were used for serial inoculations of lettuce seedlings 12 successive times. Lettuce seedlings were infected at each transfer either with MLBVV alone, LBVaV alone, or both viruses together, depending on the virus carried by the vector. Lettuce seedlings infected with MLBVV alone developed the big-vein symptoms, while those infected with LBVaV alone developed no symptoms. In field surveys, MLBVV was consistently detected in lettuce plants from big-vein-affected fields, whereas LBVaV was detected in lettuce plants not only from big-vein-affected fields but also from big-vein-free fields. LBVaV occurred widely at high rates in winter-spring lettuce-growing regions irrespective of the presence of MLBVV and, hence, of the presence of the big-vein disease.

  13. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade

    NARCIS (Netherlands)

    Henriques, JPS; Zijlstra, F; van 't Hof, AWJ; de Boer, MJ; Gosselink, M; Hoorntje, JCA; Suryapranata, H; Dambrink, Jan Hendrik Everwijn

    2003-01-01

    Background-Angiographic successful reperfusion in acute myocardial infarction has been defined as TIMI 3 flow. However, TIMI 3 flow does not always result in effective myocardial reperfusion. Myocardial blush grade (MBG) is an angiographic measure of myocardial perfusion. We hypothesized that

  14. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade

    NARCIS (Netherlands)

    Henriques, Jose P. S.; Zijlstra, Felix; van 't Hof, Arnoud W. J.; de Boer, Menko-Jan; Dambrink, Jan-Henk E.; Gosselink, Marcel; Hoorntje, Jan C. A.; Suryapranata, Harry

    2003-01-01

    Angiographic successful reperfusion in acute myocardial infarction has been defined as TIMI 3 flow. However, TIMI 3 flow does not always result in effective myocardial reperfusion. Myocardial blush grade (MBG) is an angiographic measure of myocardial perfusion. We hypothesized that optimal

  15. Myocardial infarction in children: Two interesting cases

    Directory of Open Access Journals (Sweden)

    Suryawanshi Suresh

    2011-01-01

    Full Text Available Myocardial infarction in children is extremely rare and can have various etiologies. The following two case reports highlight rare but important causes of myocardial infarction in children.

  16. Extended Sleeve Products Allow Control and Monitoring of Process Fluid Flows Inside Shielding, Behind Walls and Beneath Floors - 13041

    Energy Technology Data Exchange (ETDEWEB)

    Abbott, Mark W. [Flowserve Corporation, 1978 Foreman Drive Cookeville, TN 38506 (United States)

    2013-07-01

    Throughout power generation, delivery and waste remediation, the ability to control process streams in difficult or impossible locations becomes increasingly necessary as the complexity of processes increases. Example applications include radioactive environments, inside concrete installations, buried in dirt, or inside a shielded or insulated pipe. In these situations, it is necessary to implement innovative solutions to tackle such issues as valve maintenance, valve control from remote locations, equipment cleaning in hazardous environments, and flow stream analysis. The Extended Sleeve family of products provides a scalable solution to tackle some of the most challenging applications in hazardous environments which require flow stream control and monitoring. The Extended Sleeve family of products is defined in three groups: Extended Sleeve (ESV), Extended Bonnet (EBV) and Instrument Enclosure (IE). Each of the products provides a variation on the same requirements: to provide access to the internals of a valve, or to monitor the fluid passing through the pipeline through shielding around the process pipe. The shielding can be as simple as a grout filled pipe covering a process pipe or as complex as a concrete deck protecting a room in which the valves and pipes pass through at varying elevations. Extended Sleeves are available between roughly 30 inches and 18 feet of distance between the pipeline centerline and the top of the surface to which it mounts. The Extended Sleeve provides features such as ± 1.5 inches of adjustment between the pipeline and deck location, internal flush capabilities, automatic alignment of the internal components during assembly and integrated actuator mounting pads. The Extended Bonnet is a shorter fixed height version of the Extended Sleeve which has a removable deck flange to facilitate installation through walls, and is delivered fully assembled. The Instrument Enclosure utilizes many of the same components as an Extended Sleeve

  17. Staple line reinforcement during laparoscopic sleeve gastrectomy: does it affect clinical outcomes?

    Science.gov (United States)

    Glaysher, Michael; Khan, Omar A; Mabvuure, Nigel Tapiwa; Wan, Andrew; Reddy, Marcus; Vasilikostas, Georgios

    2013-01-01

    Although laparoscopic sleeve gastrectomy (LSG) is safe and efficacious treatment for morbid obesity, this procedure is associated with major staple line complications including leakage and bleeding. Staple-line reinforcement (SLR) either through suturing or buttressing with biological or synthetic material has been suggested as a method to prevent these complications. A Best Evidence Topic was constructed to address the question of whether SLR reduced these and other complications. MEDLINE, EMBASE and CINAHL searches up to October 2012 returned 97 unique results, of which nine (one meta-analysis, two randomised controlled trials (RCTs), six prospective cohort studies) provided the best evidence to answer this clinical question. We conclude that current evidence suggests that staple-line reinforcement reduces the incidence of leakage and postoperative complications than non-reinforcement but does not significantly reduce bleeding complications. However, we cannot as yet recommend staple-line reinforcement as the strength of the presented evidence is limited by the variable quality of the published studies. The full-length publication of several abstracts of randomised, controlled trials presented at various recent conferences is awaited. This may provide more data on the effect of staple-line reinforcement on other outcomes largely neglected by currently available studies. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  18. Laparoscopic sleeve gastrectomy: an innovative new tool in the battle against the obesity epidemic in Canada

    Science.gov (United States)

    Karmali, Shahzeer; Schauer, Philip; Birch, Daniel; Sharma, Arya M.; Sherman, Vadim

    2010-01-01

    Obesity can be considered to be one of the most important chronic diseases facing Canadians of all ages. Whereas patients with a very high body mass index may have the most to gain from procedures such as Roux-en-Y gastric bypass or biliopancreatic diversion/duodenal switch, the increased risk of postoperative complications often makes them poor surgical candidates. As a result, several “bridging” procedures have been proposed to impart clinically effective weight loss and reduce the risk of complications and improve outcomes in the definitive weight-loss procedure. In this article, we provide a review of the evidence in support of laparoscopic sleeve gastrectomy as an innovative new surgical procedure used as a bridging procedure in patients with severe obesity and discuss new findings for its possible role as a definitive procedure for some individuals with less severe obesity. Finally, we comment on a possible approach to introduce this innovative new procedure to Canadian bariatric centres. PMID:20334745

  19. Randomized, Prospective Comparison of Ursodeoxycholic Acid for the Prevention of Gallstones after Sleeve Gastrectomy.

    Science.gov (United States)

    Adams, Lindsay B; Chang, Craig; Pope, Janet; Kim, Yeonsoo; Liu, Pei; Yates, Amy

    2016-05-01

    Several studies have examined the role of ursodeoxycholic acid (UDCA) for the prevention of cholelithiasis (gallstones) following rapid weight loss from restrictive diets, vertical band gastroplasty, and Roux-en-Y gastric bypass. However, to date, there have been no prospective, controlled studies examining the role of UDCA for the prevention of gallstones following sleeve gastrectomy (SG). This study was conducted to identify the effectiveness of UDCA for prevention of gallstones after SG. Following SG, eligible patients were randomized to a control group who did not receive UDCA treatment or to a group who were prescribed 300 mg UDCA twice daily for 6 months. Gallbladder ultrasounds were performed preoperatively and at 6 and 12 months postoperatively. Patients with positive findings preoperatively were excluded from the study. Compliance with UDCA was assessed. Between December 2011 and April 2013, 37 patients were randomized to the UDCA treatment arm and 38 patients were randomized to no treatment. At baseline, the two groups were similar. At 6 months, the UDCA group had a statistically significant lower incidence of gallstones (p = 0.032). Analysis revealed no significant difference in gallstones between the two groups at 1 year (p = 0.553 and p = 0.962, respectively). The overall gallstone formation rate was 29.8%. The incidence of gallstones is higher than previously estimated in SG patients. UDCA significantly lowers the gallstone formation rate at 6 months postoperatively.

  20. Symptoms suggestive of dumping syndrome after provocation in patients after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Tzovaras, George; Papamargaritis, Dimitris; Sioka, Eleni; Zachari, Eleni; Baloyiannis, Ioannis; Zacharoulis, Dimitris; Koukoulis, George

    2012-01-01

    Dumping syndrome is a well-known complication after upper gastrointestinal (GI) surgery. There are scarce data in the literature about the incidence of dumping after bariatric operations but, certainly no relation between this syndrome and laparoscopic sleeve gastrectomy (LSG) has been attempted. We conducted a prospective clinical study in order to evaluate the potential presence, incidence and severity of Dumping syndrome after LSG. Thirty one non-diabetic morbidly obese patients (eight male, 23 female) eligible for LSG were evaluated. Median age was 38 (22-58 years) and mean body mass index (BMI) was 45.55 (± 5.37). The diagnosis of dumping syndrome was based on clinical provocation of signs and symptoms using an oral glucose challenge before and 6 weeks after the operation. The Sigstad's dumping score was estimated in order to separate dumpers from non-dumpers, and the Arts questionnaire was completed to distinguish between early and late dumping. Moreover, blood glucose levels during the oral glucose challenge were measured. No patient had symptoms of dumping after provocation preoperatively, whereas after LSG 9 patients (29%) experienced definite dumping and other 5 patients (16%) symptoms suggestive of dumping syndrome. Arts' questionnaire demonstrated that dumping occurrence after LSG was associated with early symptoms. Late hypoglycaemia occurred in one patient. A significant proportion of patients after LSG experienced dumping syndrome upon provocation. It seems that LSG should no longer be considered as a pure restrictive procedure, and it might be an option for heavy sweeters by changing their food tolerance patterns.

  1. Morbid obesity and subsequent pancreatic cancer: pylorus-preserving pancreatoduodenectomy after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Küper, Markus A; Königsrainer, Ingmar; Schmidt, Diethard; Kramer, K Michael; Granderath, Frank A; Schneider, Joachim; Löb, Stefan; Zieker, Derek; Hartmann, Jörg T; Zdichavsky, Marty; Königsrainer, Alfred; Brücher, Björn L D M

    2009-03-01

    Morbid obesity is a recognized risk factor for gastrointestinal cancer. Little is known about pancreatic cancer developing after gastric bypass surgery or about surgery for this type of tumor following bariatric surgery. This report describes a case of pancreatic head cancer identified 3 months after laparoscopic sleeve gastrectomy for morbid obesity. During routine follow-up, mild abdominal pain and elevated pancreatic enzymes prompted computed tomography, which revealed mild edematous pancreatitis. Hyperbilirubinemia developed, and magnetic resonance imaging showed a pancreatic head tumor. CA19-9 was elevated. After a pylorus-preserving pancreatic head resection, the postoperative course was uneventful. The patient received adjuvant chemotherapy. Unfortunately, at the time of writing (9 months postoperatively), a local recurrence and hepatic metastases were diagnosed. Patients treated with bariatric surgery who develop new symptoms or report constant mild symptoms should be evaluated using endoscopy and radiomorphological imaging. Interdisciplinary obesity treatment can then offer significant benefits for the patient, particularly in the case of pancreatic cancer, which is still difficult to diagnose. In addition, there is a need for epidemiological studies of patients who undergo bariatric surgery and subsequently develop cancer.

  2. A single-operator learning curve analysis for the endoscopic sleeve gastroplasty.

    Science.gov (United States)

    Saumoy, Monica; Schneider, Yecheskel; Zhou, Xi Kathy; Shukla, Alpana; Kahaleh, Michel; Aronne, Louis; Sharaiha, Reem Z

    2018-02-01

    Endoscopic sleeve gastroplasty (ESG) is a novel, incisionless technique for gastric volume reduction to promote weight loss. Our aim was to describe the learning curve for performing ESG using a prospective case series. Using a prospective case series design, we analyzed the first 128 consecutive patients at a tertiary care academic medical center who underwent ESG performed by a single operator from August 2013 to December 2016. Efficiency (refining performance to decrease procedure time) and mastery (absence of outliers) for performing ESG was evaluated by using a penalized basis-spline regression and cumulative sum analysis. Efficiency for ESG was attained after 38 ESGs, with mastery after 55 procedures. At 12 months, the mean percent total body weight loss was 15.8% (standard deviation, 9.47%). A total of 71.7% of patients achieved successful weight loss. When using multiple linear regression analysis, both number of sutures and baseline weight were significantly associated with procedure time. Other patient characteristics, such as age, sex, and race, did not significantly affect procedure time. In addition, number of sutures, baseline weight, and endoscopist achieving efficiency were not correlated with successful weight loss at 12 months. Mastery of ESG by a single operator is suggested after sufficient endoscopic experience and may help guide widespread clinical adaptability. Copyright © 2018. Published by Elsevier Inc.

  3. Laparoscopic Roux En Y Esophago-Jejunostomy for Chronic Leak/Fistula After Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Mahmoud, Maysoon; Maasher, Ahmed; Al Hadad, Mohamed; Salim, Elnazeer; Nimeri, Abdelrahman A

    2016-03-01

    Leak following laparoscopic sleeve gastrectomy (LSG) is one of the most serious and devastating complications. Endoscopic stents can treat most early LSG leaks, but is not as effective for chronic LSG leaks/fistulae. The surgical options to treat a chronic leak/fistula after LSG are laparoscopic Roux en Y esophago-jejunostomy (LRYEJ) or laparoscopic Roux en Y fistulo-jejunostomy. We reviewed our prospective database for all patients with leak after LSG treated with LRYEJ. We have described our algorithm for managing LSG previously. We prefer to optimize the nutritional status of patients with enteral rather than parenteral nutrition and drain all collections prior to LRYEJ. We have treated four patients utilizing our technique of LRYEJ. Initial endoscopic stent placement was attempted in all four patients (two failed to resolve (50 %) and two had distal stenosis at the incisura not amenable to endoscopic stenting). We utilized enteral feeding through either naso-jejunal (NJ) or jejunostomy tube feeding in 3/4 (75 %) of patients, and in one patient with stenosis, we could not introduce a NJ tube endoscopically due to tight stricture. This patient was placed on total parenteral nutrition (TPN) and went on to develop pulmonary embolism. None of the patient developed leak after LRYEJ. The only patient with stenosis (25 %) had antecolic LRYEJ. In contrast, all patients who had retrocolic LRYGB laparoscopically did not develop stenosis. Laparoscopic Roux en Y esophago-jejunostomy for chronic leak/fistula after is safe and effective. Preoperative enteral nutrition is important.

  4. Health-Related Fitness Improvements in Morbid Obese Patients After Laparoscopic Sleeve Gastrectomy: a Cohort Study.

    Science.gov (United States)

    Gallart-Aragón, Tania; Fernández-Lao, Carolina; Castro-Martín, Eduardo; Cantarero-Villanueva, Irene; Cózar-Ibáñez, Antonio; Arroyo-Morales, Manuel

    2017-05-01

    Laparoscopic sleeve gastrectomy (LSG) has demonstrated high long-term effectiveness and major advantages over other techniques. The objective of this study was to analyze changes in physical fitness parameters in morbidly obese patients during 6 months after LSG. We conducted a descriptive observational study with 6-month follow-up in 72 LSG patients, evaluating changes in body mass index (BMI), functional capacity (6-min walking test), hand grip strength (manual dynamometry), flexibility (fingertip-to-floor test), balance (Flamingo test), physical activity level (International Physical Activity Questionnaire, IPAQ), and perception of general physical fitness (International Fitness Scale [IFIS] questionnaire). The ANOVA revealed significant improvements in BMI, functional capacity, flexibility, balance, and physical activity level (P fitness in most cases. No significant changes were found in dominant hand (P = 0.676) or non-dominant hand (P = 0.222) dynamometry. General physical fitness was positively correlated with BMI and distance in the 6-min test, and was negatively correlated with fingertip-to-floor distance. Morbidly obese patients showed major improvements at 6 months after LSG in functional capacity, balance, mobility, and physical activity, with no change in grip strength. These improvements were related to a better self-perception of general physical fitness.

  5. Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Alter the Gut-Brain Communication

    Directory of Open Access Journals (Sweden)

    L. A. Ballsmider

    2015-01-01

    Full Text Available This study investigated the anatomical integrity of vagal innervation of the gastrointestinal tract following vertical sleeve gastrectomy (VSG and Roux-en-Y gastric bypass (RYGB operations. The retrograde tracer fast blue (FB was injected into the stomach to label vagal neurons originating from nodose ganglion (NG and dorsal motor nucleus of the vagus (DMV. Microglia activation was determined by quantifying changes in the fluorescent staining of hindbrain sections against an ionizing calcium adapter binding molecule 1 (Iba1. Reorganization of vagal afferents in the hindbrain was studied by fluorescent staining against isolectin 4 (IB4. The density of Iba1- and IB4-immunoreactivity was analyzed using Nikon Elements software. There was no difference in the number of FB-labeled neurons located in NG and DMV between VSG and VSG-sham rats. RYGB, but not RYGB-sham rats, showed a dramatic reduction in number of FB-labeled neurons located in the NG and DMV. VSG increased, while the RYGB operation decreased, the density of vagal afferents in the nucleus tractus solitarius (NTS. The RYGB operation, but not the VSG procedure, significantly activated microglia in the NTS and DMV. Results of this study show that the RYGB, but not the VSG procedure, triggers microglia activation in vagal structures and remodels gut-brain communication.

  6. Hiatoplasty with Crura Buttressing versus Hiatoplasty Alone during Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Andrea Balla

    2017-01-01

    Full Text Available Introduction. In obese patients with hiatal hernia (HH, laparoscopic sleeve gastrectomy (LSG with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD was assessed by the Health-Related Quality of Life (GERD-HRQL questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12 underwent simple cruroplasty, whereas in group B patients (17, absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p=0.006, the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p=0.837 postoperatively became 9.5 and 2.4 (p=0.071. In group A, there was no difference between pre- and postoperative scores (p=0.279, whereas in group B, a highly significant difference was observed (p=0.002. The difference (Δ comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p=0.0058. Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG.

  7. Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Mauro Montuori

    2017-01-01

    Full Text Available Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years’ experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%. All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6–34 days, SD ± 11.85. We recorded one death (16.67% due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26–83 days; SD ± 25.44. Conclusion. Choosing the proper treatment depends on clinical stability and on the presence or not of collected abscess. Our treatment protocol showed being associated with low complication rate and minor discomfort to the patients, reducing the need for more invasive procedures.

  8. Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration

    Science.gov (United States)

    Kumar, Nitin

    2015-01-01

    A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, space-occupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo OverStitch, TransOral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoBarrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons (Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and SatiSphere. The AspireAssist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo OverStitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery. PMID:26240686

  9. Initial experience with endoscopic sleeve gastroplasty: technical success and reproducibility in the bariatric population.

    Science.gov (United States)

    Sharaiha, Reem Z; Kedia, Prashant; Kumta, Nikhil; DeFilippis, Ersilia M; Gaidhane, Monica; Shukla, Alpana; Aronne, Louis J; Kahaleh, Michel

    2015-02-01

    Novel endoscopic techniques have been developed as effective treatments for obesity. Recently, reduction of gastric volume via endoscopic placement of full-thickness sutures, termed endoscopic sleeve gastroplasty (ESG), has been described. Our aim was to evaluate the safety, technical feasibility, and clinical outcomes for ESG. Between August 2013 and May 2014, ESG was performed on 10 patients using an endoscopic suturing device. Their weight loss, waist circumference, and clinical outcomes were assessed. Mean patient age was 43.7 years and mean body mass index (BMI) was 45.2 kg/m(2). There were no significant adverse events noted. After 1 month, 3 months, and 6 months, excess weight loss of 18 %, 26 %, and 30 %, and mean weight loss of 11.5 kg, 19.4 kg, and 33.0 kg, respectively, were observed. The differences observed in mean BMI and waist circumference were 4.9 kg/m(2) (P = 0.0004) and 21.7 cm (P = 0.003), respectively. ESG is effective in achieving weight loss with minimal adverse events. This approach may provide a cost-effective outpatient procedure to add to the steadily growing armamentarium available for treatment of this significant epidemic. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration.

    Science.gov (United States)

    Kumar, Nitin

    2015-07-25

    A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, space-occupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo OverStitch, TransOral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoBarrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons (Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and SatiSphere. The AspireAssist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo OverStitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.

  11. The effects of a prophylactic knee brace and two neoprene knee sleeves on the performance of healthy athletes: a crossover randomized controlled trial.

    Science.gov (United States)

    Mortaza, Niyousha; Ebrahimi, Ismail; Jamshidi, Ali Ashraf; Abdollah, Vahid; Kamali, Mohammad; Abas, Wan Abu Bakar Wan; Osman, Noor Azuan Abu

    2012-01-01

    Knee injury is one of the major problems in sports medicine, and the use of prophylactic knee braces is an attempt to reduce the occurrence and/or severity of injuries to the knee joint ligament(s) without inhibiting knee mobility. The aim of the present study was to examine the effect of one recently designed prophylactic knee brace and two neoprene knee sleeves upon performance of healthy athletes. Thirty-one healthy male athletes (age = 21.2 ± 1.5) volunteered as participants to examine the effect of prophylactic knee brace/sleeves on performance using isokinetic and functional tests. All subjects were tested in four conditions in a random order: 1. nonbraced (control) 2. using a neoprene knee sleeve 3. using a knee sleeve with four bilateral metal supports and 4. using a prophylactic knee brace. The study design was a crossover, randomized, controlled trial. Subjects completed single leg vertical jump, cross-over hop, and the isokinetic knee flexion and extension (at 60, 180, 300°/sec). Data were collected from the above tests and analyzed for jump height, cross-over hop distance, peak torque to body weight ratio and average power, respectively. Comparisons of these variables in the four testing conditions revealed no statistically significant difference (p>0.05). The selected prophylactic brace/sleeves did not significantly inhibit athletic performance which might verify that their structure and design have caused no complication in the normal function of the knee joint. Moreover, it could be speculated that, if the brace or the sleeves had any limiting effect, our young healthy athletic subjects were well able to generate a mean peak torque large enough to overcome this possible restriction. Further studies are suggested to investigate the long term effect of these prophylactic knee brace and sleeves as well as their possible effect on the adjacent joints to the knee.

  12. The effects of a prophylactic knee brace and two neoprene knee sleeves on the performance of healthy athletes: a crossover randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Niyousha Mortaza

    Full Text Available Knee injury is one of the major problems in sports medicine, and the use of prophylactic knee braces is an attempt to reduce the occurrence and/or severity of injuries to the knee joint ligament(s without inhibiting knee mobility. The aim of the present study was to examine the effect of one recently designed prophylactic knee brace and two neoprene knee sleeves upon performance of healthy athletes. Thirty-one healthy male athletes (age = 21.2 ± 1.5 volunteered as participants to examine the effect of prophylactic knee brace/sleeves on performance using isokinetic and functional tests. All subjects were tested in four conditions in a random order: 1. nonbraced (control 2. using a neoprene knee sleeve 3. using a knee sleeve with four bilateral metal supports and 4. using a prophylactic knee brace. The study design was a crossover, randomized, controlled trial. Subjects completed single leg vertical jump, cross-over hop, and the isokinetic knee flexion and extension (at 60, 180, 300°/sec. Data were collected from the above tests and analyzed for jump height, cross-over hop distance, peak torque to body weight ratio and average power, respectively. Comparisons of these variables in the four testing conditions revealed no statistically significant difference (p>0.05. The selected prophylactic brace/sleeves did not significantly inhibit athletic performance which might verify that their structure and design have caused no complication in the normal function of the knee joint. Moreover, it could be speculated that, if the brace or the sleeves had any limiting effect, our young healthy athletic subjects were well able to generate a mean peak torque large enough to overcome this possible restriction. Further studies are suggested to investigate the long term effect of these prophylactic knee brace and sleeves as well as their possible effect on the adjacent joints to the knee.

  13. Preventing intimal thickening of vein grafts in vein artery bypass using STAT-3 siRNA

    Directory of Open Access Journals (Sweden)

    Sun Jiangbin

    2012-01-01

    Full Text Available Abstract Background Proliferation and migration of vascular smooth muscle cells (VSMCs play a key role in neointimal formation which leads to restenosis of vein graft in venous bypass. STAT-3 is a transcription factor associated with cell proliferation. We hypothesized that silencing of STAT-3 by siRNA will inhibit proliferation of VSMCs and attenuate intimal thickening. Methods Rat VSMCs were isolated and cultured in vitro by applying tissue piece inoculation methods. VSMCs were transfected with STAT 3 siRNA using lipofectamine 2000. In vitro proliferation of VSMC was quantified by the MTT assay, while in vivo assessment was performed in a venous transplantation model. In vivo delivery of STAT-3 siRNA plasmid or scramble plasmid was performed by admixing with liposomes 2000 and transfected into the vein graft by bioprotein gel applied onto the adventitia. Rat jugular vein-carotid artery bypass was performed. On day 3 and7 after grafting, the vein grafts were extracted, and analyzed morphologically by haematoxylin eosin (H&E, and assessed by immunohistochemistry for expression of Ki-67 and proliferating cell nuclear antigen (PCNA. Western-blot and reverse transcriptase polymerase chain reaction (RT-PCR were used to detect the protein and mRNA expression in vivo and in vitro. Cell apoptosis in vein grafts was detected by TUNEL assay. Results MTT assay shows that the proliferation of VSMCs in the STAT-3 siRNA treated group was inhibited. On day 7 after operation, a reduced number of Ki-67 and PCNA positive cells were observed in the neointima of the vein graft in the STAT-3 siRNA treated group as compared to the scramble control. The PCNA index in the control group (31.3 ± 4.7 was higher than that in the STAT-3 siRNA treated group (23.3 ± 2.8 (P Conclusions The STAT-3 siRNA can inhibit the proliferation of VSMCs in vivo and in vitro and attenuate neointimal formation.

  14. Dynamic CT myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Caruso, Damiano [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome “Sapienza”, Latina (Italy); Eid, Marwen [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Jin, Kwang Nam [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul (Korea, Republic of); Varga-Szemes, Akos [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Tesche, Christian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich (Germany); Mangold, Stefanie [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen (Germany); and others

    2016-10-15

    Highlights: • CT myocardial perfusion provides functional assessment of the myocardium. • CCTA is limited in determining the hemodynamic significance of coronary stenosis. • CT-MPI can accurately detect hemodynamically significant coronary artery stenosis. - Abstract: Non-invasive cardiac imaging has rapidly evolved during the last decade due to advancements in CT based technologies. Coronary CT angiography has been shown to reliably assess coronary anatomy and detect high risk coronary artery disease. However, this technique is limited to anatomical assessment, thus non-invasive techniques for functional assessment of the heart are necessary. CT myocardial perfusion is a new CT based technique that provides functional assessment of the myocardium and allows for a comprehensive assessment of coronary artery disease with a single modality when combined with CTA. This review aims to discuss dynamic CT myocardial perfusion as a new technique in the assessment of CAD.

  15. Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Infants

    OpenAIRE

    Wen-Hsien Lu; Mei-Ling Yao; Kai-Sheng Hsieh; Pao-Chin Chiu; Ying-Yao Chen; Chu-Chuan Lin; Ta-Cheng Huang; Chu-Chin Chen

    2006-01-01

    Central venous catheterization is an important procedure for infant patients for a number of different purposes, including nutritional support, surgical operation, hemodynamic monitoring, and multiple lines for critical care medications. Subclavian vein catheterization (SVC) is one of the central vein catheterization techniques. SVC can be performed from 4 different locations: right supraclavicular (RSC), left supraclavicular (LSC), right infraclavicular (RIC), and left infraclavicular (LIC)....

  16. Ovarian vein thrombosis | Jenayah | Pan African Medical Journal

    African Journals Online (AJOL)

    Ovarian vein thrombosis (OVT) is a rare cause of abdominal pain that may mimic a surgical abdomen. It is most often diagnosed during the postpartum period. In this report, we present four cases of postoperative ovarian vein thrombosis .The complications of OVT can be significant, and the diagnosis relies on a careful ...

  17. Portal Vein Stenting for Portal Biliopathy with Jaundice.

    Science.gov (United States)

    Hyun, Dongho; Park, Kwang Bo; Lim, Seong Joo; Hwang, Jin Ho; Sinn, Dong Hyun

    2016-04-01

    Portal biliopathy refers to obstruction of the bile duct by dilated peri- or para-ductal collateral channels following the main portal vein occlusion from various causes. Surgical shunt operation or endoscopic treatment has been reported. Herein, we report a case of portal biliopathy that was successfully treated by interventional portal vein recanalization.

  18. Endovascular management for significant iatrogenic portal vein bleeding.

    Science.gov (United States)

    Kim, Jong Woo; Shin, Ji Hoon; Park, Jonathan K; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu-Bo

    2017-11-01

    Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.

  19. Portal Vein Stenting for Portal Biliopathy with Jaundice

    Energy Technology Data Exchange (ETDEWEB)

    Hyun, Dongho, E-mail: mesentery@naver.com; Park, Kwang Bo, E-mail: kbjh.park@samsung.com [Sungkyunkwan University School of Medicine, Department of Radiology, Samsung Medical Center (Korea, Republic of); Lim, Seong Joo [Konyang University, Department of Radiology, College of Medicine, Konyang University Hospital (Korea, Republic of); Hwang, Jin Ho [Hallym University Sacred Heart Hospital, Department of Radiology (Korea, Republic of); Sinn, Dong Hyun [Sungkyunkwan University School of Medicine, Department of Medicine, Samsung Medical Center (Korea, Republic of)

    2016-04-15

    Portal biliopathy refers to obstruction of the bile duct by dilated peri- or para-ductal collateral channels following the main portal vein occlusion from various causes. Surgical shunt operation or endoscopic treatment has been reported. Herein, we report a case of portal biliopathy that was successfully treated by interventional portal vein recanalization.

  20. unilateral idiopathic dilated episcleral vein with secondary open ...

    African Journals Online (AJOL)

    TAIBAT OTULANA

    intraocular pressure (IOP) is a function of: production of aqueous humour, resistance to aqueous outflow at the anterior chamber angles, and episcleral venous pressure. When the episcleral veins are dilated, the pressure in these veins becomes elevated. Prolonged elevation of episcleral venous pressure often causes ...

  1. Foam treatment for varicose veins; efficacy and safety | Kotb ...

    African Journals Online (AJOL)

    Introduction: Lower extremity varicose vein is a common disease. Sclerotherapy can be used to treat truncal varices of the superficial venous system. This involves injecting a sclerosant intraluminally in order to cause fibrosis and eventual obliteration of the vein. Objective: To demonstrate the efficacy and safety of foam ...

  2. Foam treatment for varicose veins; efficacy and safety

    African Journals Online (AJOL)

    Mamdouh Mohamed Kotb

    2013-04-08

    Apr 8, 2013 ... Abstract Introduction: Lower extremity varicose vein is a common disease. Sclerotherapy can be used to treat truncal varices of the superficial venous system. This involves injecting a sclerosant intraluminally in order to cause fibrosis and eventual obliteration of the vein. Objective: To demonstrate the ...

  3. HIV Associated Deep Vein Thrombosis: Case Reports from Jos ...

    African Journals Online (AJOL)

    Deep vein thrombosis (DVT) has been reported to be 2-10 times commoner in HIV infected patients than in the general population. We report two cases of extensive unilateral deep vein thrombosis involving the lower limb in HIV infected patients on highly active antiretroviral therapy (HAART). Doppler ultrasound in the two ...

  4. Early Diagnosis of Posttraumatic Deep Vein Thrombosis - A Review ...

    African Journals Online (AJOL)

    OBJECTIVE: The importance of early diagnosis and treatment of deep vein thrombosis in patients with fractures of long bones. INTRODUCTION: Associated injury to deep-veins in limb fractures presents a serious pathology. It results not only to localized venous occlusion but also to death from pulmonary embolism.

  5. Upper extremity deep vein thrombosis after elbow trauma: a case ...

    African Journals Online (AJOL)

    Treatment by low molecular weight heparin (LMWH) then by vitamin K antagonists was conducted and evaluation by Doppler ultrasonography realized 18 months after trauma showed recanalization of basilica and humeral veins and thrombosis of axillary and subclavian veins. Management of occupational activity was ...

  6. A Tight Spot After Pulmonary Vein Catheter Ablation

    NARCIS (Netherlands)

    Amir, Rabia; Yeh, Lu; Montealegre-Gallegos, Mario; Saraf, Rabya; Matyal, Robina; Mahmood, Feroze

    2016-01-01

    A 52-YEAR-OLD woman with a history of embolic stroke due to paroxysmal atrial fibrillation was referred to the authors’ institution for epicardial surgical pulmonary vein isolation with left atrial appendage resection. The patient had 2 previous failed pulmonary vein catheter ablations. Dense

  7. Geology and geochemistry of giant quartz veins from the ...

    Indian Academy of Sciences (India)

    They show imprints of strong brittle to ductile–brittle deformation, and in places are associated with base metal and gold incidences, and pyrophyllite-diaspore mineralization. The geochemistry of giant quartz veins were studied. Apart from presenting new data on the geology and geochemistry of these veins, an attempt has ...

  8. Renal Vein Leiomyoma: A Rare Entity with Review of Literature

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    2014-01-01

    Full Text Available Tumors of vascular origin are unusual. These tumors are predominantly malignant and commonly arise from the inferior vena cava. Benign smooth muscle tumors arising from renal vein are very rare. We present a case of leiomyoma of renal vein in a post-menopausal woman that clinically resembled a retroperitoneal paraganglioma.

  9. The fifth pulmonary vein | Kinfemichael | Anatomy Journal of Africa

    African Journals Online (AJOL)

    A cadaver in Myungsung Medical College (MMC) had a 3rd pulmonary vein originating from the middle lobe of the right lung. Such anatomical variations are very rare. People with this variation have a total of five pulmonary veins entering left atrium. It has clinical implications especially for thoracic surgeons and radiologists ...

  10. Cardiac metabolism in myocardial ischemia.

    Science.gov (United States)

    Rosano, Giuseppe M C; Fini, Massimo; Caminiti, Giuseppe; Barbaro, Giuseppe

    2008-01-01

    Myocardial ischemia occurs for a mismatch between blood flow and metabolic requirements, when the rate of oxygen and metabolic substrates delivery to the myocardium is insufficient to meet the myocardial energy requirements for a given myocardial workload. During ischemia, substantial changes occur in cardiac energy metabolism, as a consequence of the reduced oxygen availability. Some of these metabolic changes are beneficial and may help the heart adapt to the ischemic condition. However, most of the changes are maladaptive and contribute to the severity of the ischemic injury leading stunned or hibernating myocardium, cell death and ultimately to contractile disfunction. Dramatic changes in cardiac metabolism and contractile function, also occur during myocardial reperfusion as a consequence of the generation of oxygen free radicals, loss of cation homeostasis, depletion of energy stores, and changes in subcellular activities. The reperfusion injury may cause in the death of cardiac myocytes that were still viable immediately before myocardial reperfusion. This form of myocardial injury, by itself can induce cardiomyocyte death and increase infarct size. During acute ischemia the relative substrate concentration is the prime factor defining preference and utilization rate. Allosteric enzyme regulation and protein phosphorylation cascades, partially controlled by hormones such as insulin, modulate the concentration effect; together they provide short-term adjustments of cardiac energy metabolism. The expression of metabolic genes is also dynamically regulated in response to developmental and (patho)physiological conditions, leading to long-term adjustments. Specific nuclear receptor transcription factors and co-activators regulate the expression of these genes. Understanding the functional role of these changes is critical for developing the concept of metabolic intervention for heart disease. The paper will review the alterations in energy metabolism that occur

  11. Morphological aspects of myocardial bridges

    Directory of Open Access Journals (Sweden)

    Almira Lujinović

    2013-11-01

    Full Text Available Although some myocardial bridges can be asymptomatic, their presence often causes coronary disease either through direct compression of the “tunnel” segment or through stimulation and accelerated development of atherosclerosis in the segment proximally to the myocardial bridge. The studied material contained 30 human hearts received from the Department of Anatomy. The hearts were preserved 3 to 5 days in 10% formalin solution. Thereafter, the fatty tissue was removed and arterial blood vessels prepared by careful dissection with special reference to the presence of the myocardial bridges. Length and thickness of the bridges were measured by the precise electronic caliper. The angle between the myocardial bridge fibre axis and other axis of the crossed blood vessel was measured by a goniometer. The presence of the bridges was confirmed in 53.33% of the researched material, most frequently (43.33% above the anterior interventricular branch. The mean length of the bridges was 14.64±9.03 mm and the mean thickness was 1.23±1.32 mm. Myocardial bridge fibres pass over the descending blood vessel at the angle of 10-90 degrees. The results obtained on a limited sample suggest that the muscular index of myocardial bridge is the highest for bridges located on RIA, but that the difference is not significant in relation to bridges located on other branches. The results obtained suggest that bridges located on other branches, not only those on RIA, could have a great contractive power and, consequently, a great compressive force, which would be exerted on the wall of a crossed blood vessel.

  12. Leiomyosarcoma of the great saphenous vein

    Directory of Open Access Journals (Sweden)

    Alexandre Campos Moraes Amato

    2015-06-01

    Full Text Available A 56-year-old male patient presented with a complaint of two painful, hard, palpable nodules in the right lower limb. A Doppler ultrasound scan revealed the presence of nodules, likely to be neoplastic. Computed angiography showed two solid hypervascular nodules in the right great saphenous vein, fed by branches of the posterior tibial artery. Embolization of the nodules using surgical cyanoacrylate was performed, followed by an excisional biopsy. Anatomical pathology and immunohistochemical analysis identified the nodule as a high-grade leiomyosarcoma, characterized by ten mitotic figures per ten high-power fields, necrosis and cell pleomorphism. Immunohistochemical analysis results were positive for caldesmon and desmin labeling. A second surgical procedure was performed to enlarge the free margins.

  13. Doppler spectral characteristics of infrainguinal vein bypasses

    DEFF Research Database (Denmark)

    Nielsen, Tina G; von Jessen, F; Sillesen, H

    1993-01-01

    of arteriovenous fistulas the initially antegrade diastolic velocity was replaced by a retrograde flow within 3 months, whereas a forward flow in diastole was sustained in grafts with patent fistulas. Abnormal Duplex findings in 31 patients led to angiography and revision in 13 cases. Four revised grafts failed......, while nine remained patent at follow-up 1-12 months later. Ten (56%) of 18 non-revised bypasses with abnormal Duplex findings failed within 9 months compared to 1 (1%) of 76 bypasses with a normal velocity profile (p ... valuable information concerning haemodynamics of infrainguinal vein bypasses and identifies grafts at risk of thrombosis. Inclusion of low resistance index (detection of stenoses appears to improve the sensitivity of Duplex scanning....

  14. Experimental Approaches to Acute Myocardial Infarction

    NARCIS (Netherlands)

    D.B. Uitterdijk (André)

    2015-01-01

    markdownabstractAbstract This thesis is dedicated to i) novel methods and optimization studies to improve the diagnosis of myocardial ischemia and myocardial infarction as well as fundamental studies that precede novel therapies for myocardial infarction. In part ii) 2 novel, adjunctive therapies

  15. Climate drives vein anatomy in Proteaceae.

    Science.gov (United States)

    Jordan, Gregory J; Brodribb, Timothy J; Blackman, Christopher J; Weston, Peter H

    2013-08-01

    The mechanisms by which plants tolerate water deficit are only just becoming clear. One key factor in drought tolerance is the ability to maintain the capacity to conduct water through the leaves in conditions of water stress. Recent work has shown that a simple feature of the leaf xylem cells, the cube of the thickness of cell walls divided by the lumen width (t/b)(3), is strongly correlated with this ability. Using ecologically, phylogenetically, and anatomically diverse members of Proteaceae, we tested the relationships between (t/b)(3) and climate, leaf mass per unit area, leaf area, and vein density. To test relationships at high phylogenetic levels (mostly genus), we used phylogenetic and nonphylogenetic single and multiple regressions based on data from 50 species. We also used 14 within-genus species pairs to test for relationships at lower phylogenetic levels. All analyses revealed that climate, especially mean annual precipitation, was the best predictor of (t/b)(3). The variation in (t/b)(3) was driven by variation in both lumen diameter and wall thickness, implying active control of these dimensions. Total vein density was weakly related to (t/b)(3) but unrelated to either leaf area or climate. We conclude that xylem reinforcement is a fundamental adaptation for water stress tolerance and, among evergreen woody plants, drives a strong association between rainfall and xylem anatomy. The strong association between (t/b)(3) and climate cannot be explained by autocorrelation with other aspects of leaf form and anatomy that vary along precipitation gradients.

  16. Mineral vein dynamics modelling (FRACS II)

    Energy Technology Data Exchange (ETDEWEB)

    Urai, J.; Virgo, S.; Arndt, M. [RWTH Aachen (Germany); and others

    2016-08-15

    The Mineral Vein Dynamics Modeling group ''FRACS'' started out as a team of 7 research groups in its first phase and continued with a team of 5 research groups at the Universities of Aachen, Tuebingen, Karlsruhe, Mainz and Glasgow during its second phase ''FRACS 11''. The aim of the group was to develop an advanced understanding of the interplay between fracturing, fluid flow and fracture healing with a special emphasis on the comparison of field data and numerical models. Field areas comprised the Oman mountains in Oman (which where already studied in detail in the first phase), a siliciclastic sequence in the Internal Ligurian Units in Italy (closed to Sestri Levante) and cores of Zechstein carbonates from a Lean Gas reservoir in Northern Germany. Numerical models of fracturing, sealing and interaction with fluid that were developed in phase I where expanded in phase 11. They were used to model small scale fracture healing by crystal growth and the resulting influence on flow, medium scale fracture healing and its influence on successive fracturing and healing, as well as large scale dynamic fluid flow through opening and closing fractures and channels as a function of fluid overpressure. The numerical models were compared with structures in the field and we were able to identify first proxies for mechanical vein-hostrock properties and fluid overpressures versus tectonic stresses. Finally we propose a new classification of stylolites based on numerical models and observations in the Zechstein cores and continued to develop a new stress inversion tool to use stylolites to estimate depth of their formation.

  17. Asymptomatic portal vein aneurysms: To treat, or not to treat?

    Science.gov (United States)

    Hirji, Sameer A; Robertson, Faith C; Casillas, Sergio; McPhee, James T; Gupta, Naren; Martin, Michelle C; Raffetto, Joseph D

    2017-01-01

    Background Portal vein aneurysms are rare dilations in the portal venous system, for which the etiology and pathophysiological consequences are poorly understood. Method We reviewed the existing literature as well as present a unique anecdotal case of a patient presenting with a very large portal vein aneurysm that was successfully managed conservatively and non-operatively without anticoagulation, with close follow-up and routine surveillance. Result The rising prevalence of abdominal imaging in clinical practice has increased rates of portal vein aneurysm detection. While asymptomatic aneurysms less than 3 cm can be clinically observed, surgical intervention may be necessary in large asymptomatic aneurysms (>3 cm) with or without thrombus, or small aneurysms with evidence of evolving mural thrombus formation on imaging. Conclusion Portal vein aneurysms present a diagnostic challenge for any surgeon, and the goal for surgical therapy is based on repairing the portal vein aneurysm, and if portal hypertension is present decompressing via surgically constructed shunts.

  18. Three superficial veins coursing over the clavicles: a case report.

    Science.gov (United States)

    Anastasopoulos, Nikolaos; Paraskevas, George; Apostolidis, Stylianos; Natsis, Konstantinos

    2015-11-01

    We report a unique bilateral combination of multiple variations in the superficial venous system of the neck of a 77-year-old male cadaver. On the right side of the neck, the external jugular vein (EJV) crossed superficial to the lateral third of the clavicle constituting a common trunk with the cephalic vein (CV) that drained into the subclavian vein (SCV). On the left side the EJV descended distally, passed over the anterior surface of the medial third of the clavicle and drained into the SCV. The posterior external jugular vein (PEJV) crossed superficial to the lateral third of the clavicle and terminated into the CV, providing an additional communicating branch to the EJV. Knowledge of both normal and abnormal anatomy of the veins of the neck plays an important role for anesthesiologists or cardiologists doing catheterization, orthopedic surgeons treating clavicle fractures and general surgeons performing head and neck surgery, to avoid inadvertent injury to these vascular structures.

  19. Thrombolysis for acute upper extremity deep vein thrombosis

    DEFF Research Database (Denmark)

    Feinberg, Joshua; Nielsen, Emil Eik; Jakobsen, Janus C

    2017-01-01

    BACKGROUND: About 5% to 10% of all deep vein thromboses occur in the upper extremities. Serious complications of upper extremity deep vein thrombosis, such as post-thrombotic syndrome and pulmonary embolism, may in theory be avoided using thrombolysis. No systematic review has assessed the effects...... of thrombolysis for the treatment of individuals with acute upper extremity deep vein thrombosis. OBJECTIVES: To assess the beneficial and harmful effects of thrombolysis for the treatment of individuals with acute upper extremity deep vein thrombosis. SEARCH METHODS: The Cochrane Vascular Information Specialist...... of thrombolytics added to anticoagulation, thrombolysis versus anticoagulation, or thrombolysis versus any other type of medical intervention for the treatment of acute upper extremity deep vein thrombosis. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all records to identify those...

  20. Persistent right umbilical vein: sonographic detection and subsequent neonatal outcome.

    Science.gov (United States)

    Hill, L M; Mills, A; Peterson, C; Boyles, D

    1994-12-01

    To review our experience with antenatal detection and subsequent neonatal outcome of fetuses with a persistent right umbilical vein. In a prospective observational study, 33 cases of persistent right umbilical vein were detected during 15,237 obstetric ultrasound examinations performed after 15 weeks' gestation. Persistent right umbilical vein was detected at a rate of one per 476 obstetric ultrasound examinations. Six of 33 (18.2%) fetuses with a persistent right umbilical vein had additional important congenital malformations. Careful second- and third-trimester ultrasound examinations can detect a persistent right umbilical vein. When this particular anomaly is detected, a thorough fetal anatomic survey, including echocardiography, should be performed to rule out more serious congenital malformations.

  1. Catheter entrapment in a pulmonary vein: a unique complication of pulmonary vein isolation.

    Science.gov (United States)

    Monney, Pierre; Pascale, Patrizio; Fromer, Martin; Pruvot, Etienne

    2010-08-01

    Ablation strategies for the treatment of atrial fibrillation (AF) are associated with several potential complications. During electro-anatomic mapping of the left atrium (LA) before ablation, the ablation catheter was entrapped in the right inferior pulmonary vein (RIPV). After multiple unsuccessful gentle tractions, stronger maneuvers with rotation of the catheter slowly allowed its retrieval. Examination of the catheter showed a thin, translucent membrane covering its tip, suggesting complete stripping of a vein branch. Occlusion of the superior branch of the RIPV was confirmed by LA angiogram. During the following days, no pericardial effusion was noted, but the patient complained of light chest pain and mild hemoptysis, spontaneously resolving within 48 h. This case shows that catheter entrapment and mechanical disruption of a PV branch can be a rare potential complication of AF ablation. In this case, the outcome was spontaneously favorable and symptoms only included transient mild hemoptysis.

  2. Scintigraphic findings in myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Schuemichen, C.; Krause, T.

    1988-09-01

    Radioisotope studies are currently used mainly to assess the individual risk before and after myocardial infarction (MI). Scintigraphy will be used increasingly to diagnose and localize acute myocardial infarction (AMI), to measure the infarct size and to detect reperfusion, whether spontaneous or after lysis, in the infarct area. High sensitivity and specificity are obtained by using tomographic imaging modalities and by the combined and simultaneous use of markers for perfusion and necrosis. This technique allows recognition even of nontransmural infarctions, involvement of the right ventricle, subendocardial necroses, and ischemic injuries in unstable angina pectoris.

  3. Evaluation of endoscopic vein extraction on structural and functional viability of saphenous vein endothelium

    OpenAIRE

    Hussaini, Bader E; Lu, Xiu-Gui; Wolfe, J Alan; Thatte, Hemant S

    2011-01-01

    Abstract Objectives Endothelial injury during harvest influences graft patency post CABG. We have previously shown that endoscopic harvest causes structural and functional damage to the saphenous vein (SV) endothelium. However, causes of such injury may depend on the extraction technique. In order to assess this supposition, we evaluated the effect of VirtuoSaph endoscopic SV harvesting technique (VsEVH) on structural and functional viability of SV endothelium using multiphoton imaging, bioch...

  4. Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt Creation for Chronic Portal Vein Thrombosis: Technical Considerations.

    Science.gov (United States)

    Thornburg, Bartley; Desai, Kush; Hickey, Ryan; Kulik, Laura; Ganger, Daniel; Baker, Talia; Abecassis, Michael; Lewandowski, Robert J; Salem, Riad

    2016-03-01

    Portal vein thrombosis (PVT) is common in cirrhotic patients and presents a challenge at the time of transplant. Owing to the increased posttransplant morbidity and mortality associated with complete PVT, the presence of PVT is a relative contraindication to liver transplantation at many centers. Our group began performing portal vein (PV) recanalization and transjugular intrahepatic portostystemic shunt placement (PVR-TIPS) several years ago to optimize the transplant candidacy of patients with PVT. The procedure has evolved to include transsplenic access to assist with recanalization, which is now our preferred method due to its technical success without significant added morbidity. Here, we describe in detail our approach to PVR-TIPS with a focus on the transsplenic method. The procedure was attempted in 61 patients and was technically successful in 60 patients (98%). After transitioning to transsplenic access to assist with recanalization, the technical success rate has improved to 100%. The recanalized portal vein and TIPS have maintained patency during follow-up, or to the time of transplant, in 55 patients (92%) with a mean follow-up of 16.7 months. In total, 23 patients (38%) have undergone transplant, all of whom received a physiologic anastomosis (end-to-end anastomosis in 22 of 23 patients, 96%). PVR-TIPS placement should be considered as an option for patients with chronic PVT in need of transplantation. Transsplenic access makes the procedure technically straightforward and should be considered as the primary method for recanalization. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Total anomalous connection of pulmonary veins to the portal vein. Value of multislice angiotomography. Report on three cases

    Directory of Open Access Journals (Sweden)

    Sara Alejandra Solórzano-Morales

    2014-07-01

    15 and 26% if all its varieties. Multislice angiotomography allows us to view the blood vessels and adjacent organs under consideration and obtain high-definition anatomic information. In the patients in this study, total anomalous connection of pulmonary veins to the portal vein was viewed with three-dimensional volumetric tomographic reconstructions and their correlation with ultrasonography studies.

  6. Leaf hydraulic conductance varies with vein anatomy across Arabidopsis thaliana wild-type and leaf vein mutants.

    Science.gov (United States)

    Caringella, Marissa A; Bongers, Franca J; Sack, Lawren

    2015-12-01

    Leaf venation is diverse across plant species and has practical applications from paleobotany to modern agriculture. However, the impact of vein traits on plant performance has not yet been tested in a model system such as Arabidopsis thaliana. Previous studies analysed cotyledons of A. thaliana vein mutants and identified visible differences in their vein systems from the wild type (WT). We measured leaf hydraulic conductance (Kleaf ), vein traits, and xylem and mesophyll anatomy for A. thaliana WT (Col-0) and four vein mutants (dot3-111 and dot3-134, and cvp1-3 and cvp2-1). Mutant true leaves did not possess the qualitative venation anomalies previously shown in the cotyledons, but varied quantitatively in vein traits and leaf anatomy across genotypes. The WT had significantly higher mean Kleaf . Across all genotypes, there was a strong correlation of Kleaf with traits related to hydraulic conductance across the bundle sheath, as influenced by the number and radial diameter of bundle sheath cells and vein length per area. These findings support the hypothesis that vein traits influence Kleaf , indicating the usefulness of this mutant system for testing theory that was primarily established comparatively across species, and supports a strong role for the bundle sheath in influencing Kleaf . © 2015 John Wiley & Sons Ltd.

  7. Factors Associated with Recurrence of Varicose Veins after Thermal Ablation: Results of The Recurrent Veins after Thermal Ablation Study

    Directory of Open Access Journals (Sweden)

    R. G. Bush

    2014-01-01

    Full Text Available Background. The goal of this retrospective cohort study (REVATA was to determine the site, source, and contributory factors of varicose vein recurrence after radiofrequency (RF and laser ablation. Methods. Seven centers enrolled patients into the study over a 1-year period. All patients underwent previous thermal ablation of the great saphenous vein (GSV, small saphenous vein (SSV, or anterior accessory great saphenous vein (AAGSV. From a specific designed study tool, the etiology of recurrence was identified. Results. 2,380 patients were evaluated during this time frame. A total of 164 patients had varicose vein recurrence at a median of 3 years. GSV ablation was the initial treatment in 159 patients (RF: 33, laser: 126, 52 of these patients had either SSV or AAGSV ablation concurrently. Total or partial GSV recanalization occurred in 47 patients. New AAGSV reflux occurred in 40 patients, and new SSV reflux occurred in 24 patients. Perforator pathology was present in 64% of patients. Conclusion. Recurrence of varicose veins occurred at a median of 3 years after procedure. The four most important factors associated with recurrent veins included perforating veins, recanalized GSV, new AAGSV reflux, and new SSV reflux in decreasing frequency. Patients who underwent RF treatment had a statistically higher rate of recanalization than those treated with laser.

  8. Conversion of Vertical Sleeve Gastrectomy to a Functional Single-Anastomosis Gastric Bypass: Technique and Preliminary Results Using a Non-Adjustable Ring Instead of Stapled Division.

    Science.gov (United States)

    Greco, Francesco

    2017-04-01

    Recent data show that some patients will have insufficient weight loss or experience weight regain after sleeve gastrectomy. Dilation of the sleeve over time or use of an inadequate technique may contribute to relapse of morbid obesity. Repeat sleeve gastrectomy is the most obvious option but requires stapling of scarred tissue, has a higher risk of leakage, and is prone to re-enlargement with time. We herein describe a simple and innovative technique with which to revise vertical sleeve gastrectomy (VSG) into functional single-anastomosis gastric bypass (f-SAGB). Twelve VSGs were converted to f-SAGB by placing a GaBP Ring (Bariatec Corp., Palos Verdes Peninsula, CA, USA) at the base of the "sleeve" and performing the anastomosis above the ring. The length of the biliopancreatic loop was chosen according to the volume of the pouch and the patient's residual eating capability. All procedures were completed by laparoscopy and were uneventful. The average decrease in the body mass index was from 41.0 to 29.5 kg/m2 at the 12-month follow-up. No ring-related complications were reported. f-SAGB is a low-risk and effective option with which to revise VSG in patients with inadequate weight loss. Avoiding detachment of the pouch from the antrum assures full reversibility of the procedure and preserves the chance to explore the remnant stomach and biliary tree.

  9. Wear Resistance of Piston Sleeve Made of Layered Material Structure: MMC A356R, Anti-Abrasion Layer and FGM Interface

    Directory of Open Access Journals (Sweden)

    Hernik Szymon

    2016-09-01

    Full Text Available The aim of this paper is the numerical analysis of the one of main part of car engine – piston sleeve. The first example is for piston sleeve made of metal matrix composite (MMC A356R. The second improved material structure is layered. Both of them are comparison to the classical structure of piston sleeve made of Cr-Ni stainless steel. The layered material structure contains the anti-abrasion layer at the inner surface of piston sleeve, where the contact and friction is highest, FGM (functionally graded material interface and the layer of virgin material on the outer surface made of A356R. The complex thermo-elastic model with Archard's condition as a wear law is proposed. The piston sleeve is modelling as a thin walled cylindrical axisymmetric shell. The coupled between the formulation of thermo-elasticity of cylindrical axisymmetric shell and the Archard’s law with functionally changes of local hardness is proposed.

  10. Compared to Sleeve Gastrectomy, Duodenal-Jejunal Bypass with Sleeve Gastrectomy Gives Better Glycemic Control in T2DM Patients, with a Lower β-Cell Response and Similar Appetite Sensations: Mixed-Meal Study.

    Science.gov (United States)

    Zachariah, Pulimuttil James; Chen, Chih-Yen; Lee, Wei-Jei; Chen, Shu-Chu; Ser, Kong-Han; Chen, Jung-Chien; Lee, Yi-Chih

    2016-12-01

    Functional studies of how duodenal-jejunal exclusion (DJE) brings a superior glycemic control when added to sleeve gastrectomy in duodenal-jejunal bypass with sleeve gastrectomy (DJB-SG) patients, are lacking. To study this, we compared the appetite sensations and the β-cell response following a standard mixed meal in patients with DJB-SG, versus those with sleeve gastrectomy (SG) alone. Twenty one patients who underwent DJB-SG and 25 with SG, who participated in mixed-meal tests (MMTT) preoperatively and at 1 year, with complete data were included and compared. Blood glucose, C-peptide, and insulin levels were estimated, along with the visual analogue scale (VAS) scoring of the six appetite sensations, as a part of the MMTT. At 1 year following surgery, compared to SG group, DJB-SG group had greater complete remission rates (HbA1C <6.0 %) of 62 versus 32 % (p < 0.05), with similar total body weight loss (25.7 vs. 22 %). There were significantly lower post-prandial blood glucose and lower C-peptide levels during the MMTT in the patients with DJB-SG compared to SG group. There were no significant differences in the appetite sensations (mean VAS) scores between the groups. The addition of DJE component to SG, as in DJB-SG, was associated with higher diabetes remission rates, lower glycemic fluctuations, and lower C-peptide levels. This may point to a β-cell preserving glucose control which could result in longer remission of type 2 diabetes mellitus (T2DM). This effect also may be unrelated to food intake as there were no significant differences in the appetite sensations.

  11. Myocardial Fibrosis in Congenital Heart Disease.

    Science.gov (United States)

    Rathod, Rahul H; Powell, Andrew J; Geva, Tal

    2016-05-25

    Myocardial fibrosis is common in patients with congenital heart disease (CHD) and has been associated with arrhythmias, decreased functional status, and adverse ventricular mechanics. There are multiple types of myocardial fibrosis that occur in response to different pathophysiologic stimuli. Recent advances in imaging technology have made detection and quantification of the types of myocardial fibrosis possible. In this review, we describe the pathophysiology of myocardial fibrosis, examine the imaging techniques used to evaluate fibrosis, and discuss the relationship between myocardial fibrosis and clinical outcomes in CHD. (Circ J 2016; 80: 1300-1307).

  12. Perceived stress in myocardial infarction

    NARCIS (Netherlands)

    Arnold, Suzanne V.; Smolderen, K.G.E.; Buchanan, Donna M.; Li, Yan; Spertus, John A.

    2012-01-01

    Objectives This study sought to determine the association of chronic stress with long-term adverse outcomes after acute myocardial infarction (AMI).BackgroundChronic stress has been shown to be associated with the development of cardiovascular disease and, in the case of particular types of stress

  13. Neonatal Myocardial Infarction or Myocarditis?

    NARCIS (Netherlands)

    de Vetten, Leanne; Bergman, Klasien A.; Elzenga, Nynke J.; van Melle, Joost P.; Timmer, Albertus; Bartelds, Beatrijs

    We report a 29 week-gestation preterm infant who presented during his second week of life with cardiogenic shock. Clinical presentation and first diagnostics suggested myocardial infarction, but echocardiographic features during follow-up pointed to a diagnosis of enteroviral myocarditis. The child

  14. Myocardial perfusion at fatal infarction

    DEFF Research Database (Denmark)

    Hvid-Jacobsen, K; Møller, J T; Kjøller, E

    1992-01-01

    In a consecutive study of myocardial scintigraphy in acute ischemic syndrome, four patients had 99mTc-hexamibi injected intravenously before they developed fatal cardiogenic shock. Planar scintigraphy was performed after death. Slices of the hearts after autopsy were analyzed for scintigraphic...

  15. Dosimetry in myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Toledo, Janine M.; Trindade, Bruno; Ribeiro, Tarcisio P.C. [Universidade Federal de Minas Gerais (DEN/UFMG), Belo Horizonte (Brazil). Dept. de Engenharia Nuclear. Programa de Pos-Graduacao em Ciencias e Tecnicas Nucleares

    2011-07-01

    This paper conducts a dosimetric investigation on the myocardial perfusion image protocol, together with a literature reviewing, motivated by the significant statistic increasing on mortality, morbidity and disability associated with cardiovascular disease, surpassing infectious diseases. Nuclear Cardiology plays a role n the diagnostic functional evaluation of the heart and in the prognostic of patients with suspected or known cardiac ischemia. In the context of unstable myocardial ischemic syndrome, myocardial perfusion scintigraphy is a non-invasive procedure performed by administering a radiopharmaceutical targeted to the heart. As tool for this study are that the images obtained by thoracic angiotomography and abdominal aorta as a anatomic and functional information for model reproduction in SISCODES - System of Codes for Absorbed Dose Calculations based on Stochastic Methods. Data were manipulated in order to create a voxel computational model of the heart to be running in MCNP - Monte Carlo Neutron Particle Code. . It was assumed a homogeneous distribution of Tl-201 in cardiac muscle. Simulations of the transport of particles through the voxel and the interaction with the heart tissue were performed. As a result, the isodose curves in the heart model are displayed as well as the dose versus volume histogram of the heart muscle. We conclude that the present computational tools can generate doses distributed in myocardial perfusion. (author)

  16. The Orchestra of Myocardial Regeneration

    NARCIS (Netherlands)

    Siddiqi, S.

    2014-01-01

    A glimpse on previous and current literature ignites the recognition of the luxurious era that cardiac science has reached. In particular, the past fifteen years have provided tremendous advancements in the field of myocardial biology with the characterization of cardiac stem cells, reprogramming of

  17. Pregnancy-related myocardial infarction

    NARCIS (Netherlands)

    Lameijer, H.; Lont, M. C.; Buter, H.; van Boven, A. J.; Boonstra, P. W.; Pieper, P. G.

    Introduction The risk of acute myocardial infarction in young women is low, but increases during pregnancy due to the physiological changes in pregnancy, including hypercoagulability. Ischaemic heart disease during pregnancy is not only associated with increased maternal morbidity and mortality, but

  18. Spousal Adjustment to Myocardial Infarction.

    Science.gov (United States)

    Ziglar, Elisa J.

    This paper reviews the literature on the stresses and coping strategies of spouses of patients with myocardial infarction (MI). It attempts to identify specific problem areas of adjustment for the spouse and to explore the effects of spousal adjustment on patient recovery. Chapter one provides an overview of the importance in examining the…

  19. Biomarkers in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Ng Leong L

    2010-06-01

    Full Text Available Abstract Myocardial infarction causes significant mortality and morbidity. Timely diagnosis allows clinicians to risk stratify their patients and select appropriate treatment. Biomarkers have been used to assist with timely diagnosis, while an increasing number of novel markers have been identified to predict outcome following an acute myocardial infarction or acute coronary syndrome. This may facilitate tailoring of appropriate therapy to high-risk patients. This review focuses on a variety of promising biomarkers which provide diagnostic and prognostic information. Heart-type Fatty Acid Binding Protein and copeptin in combination with cardiac troponin help diagnose myocardial infarction or acute coronary syndrome in the early hours following symptoms. An elevated N-Terminal Pro-B-type Natriuretic Peptide has been well validated to predict death and heart failure following a myocardial infarction. Similarly other biomarkers such as Mid-regional pro-Atrial Natriuretic Peptide, ST2, C-Terminal pro-endothelin 1, Mid-regional pro-Adrenomedullin and copeptin all provide incremental information in predicting death and heart failure. Growth differentiation factor-15 and high-sensitivity C-reactive protein predict death following an acute coronary syndrome. Pregnancy associated plasma protein A levels following chest pain predicts risk of myocardial infarction and revascularisation. Some biomarkers such as myeloperoxidase and high-sensitivity C-reactive protein in an apparently healthy population predicts risk of coronary disease and allows clinicians to initiate early preventative treatment. In addition to biomarkers, various well-validated scoring systems based on clinical characteristics are available to help clinicians predict mortality risk, such as the Thrombolysis In Myocardial Infarction score and Global Registry of Acute Coronary Events score. A multimarker approach incorporating biomarkers and clinical scores will increase the prognostic

  20. Mortality rate in type 2 myocardial infarction

    DEFF Research Database (Denmark)

    Saaby, Lotte; Poulsen, Tina Svenstrup; Diederichsen, Axel Cosmus Pyndt

    2014-01-01

    2 myocardial infarction. CONCLUSIONS: Mortality in patients with type 2 myocardial infarction is high, reaching approximately 50% after 2 years. Further descriptive and survival studies are needed to improve the scientific evidence on which treatment of type 2 myocardial infarction is based.......BACKGROUND: The classification of myocardial infarction into 5 types was introduced in 2007. The prognostic impact of this universal definition, with particular focus on type 2 myocardial infarction, has not been studied prospectively in unselected hospital patients. METHODS: During a 1-year period......, all hospitalized patients having cardiac troponin I measured were considered. The diagnosis of a myocardial infarction was according to the universal definition, and specified criteria were used in the classification of type 2 myocardial infarction. Follow-up was at least 1 year, with mortality...