Effect of Roux-en Y gastric bypass on bone metabolism in patients with morbid obesity: [Mansoura experiences]

Roux-en-Y gastric bypass [RYGBP] has been found to be the most efficient way to lose weight and maintain the weight loss in morbid obesity. However, with the formation of a new stomach and the modification of intestinal anatomy, there are significant changes on bone metabolism .The objectives of this study were to evaluate effects of weight loss on bone metabolism after Roux-en Y gastric bypass in patients with morbid obesity. Our study included 70 patients with morbid obesity, RYGBP was done for all patients. Daily postoperative oral supplementation with 1000 mg of calcium and 800 IU of vitamin D was done for each patient Body weight, BMJ, also Total body fat, Total lean tissue mass, Bone Mineral content [BMC], Bone Mineral density [BMD], Total bone area [TBA] [using DEXA], also, serum calcium, parathyroid hormone [PTH], 25-OH vitamin D, 24 hours urinary calcium and bone specific Alkaline phos-phatase [BSAP] were assessed preoperatively and one year after surgery. In our study: females comprised 70% of cases. The mean age was 35 +/- 8.8 years. One year after RYGB: Body weight [BW] decreased significantly from 132.8 +/- 26.5 to 90.3 +/- 17.3 kg [P=0.001]. Body Mass Index [BMI] decreased significantly from 48 +/- 7.3 to 32.6 +/- 4.1 kg/m2 [P= 0.001]. BMC decreased significantly from 2968.6 +/- 71.4 to 2700.8 +/- 45.4 gm [p = 0.001] BMD decreased significantly from 1.026 +/- 0.03 to 1.22 +/- 0.015 gm/cm[2] [P=0.001]. TBA decreased significantly from 2356.2 +/- 35.4 to 2216.3 +/- 43.5 cm2 [P=0.001]. Serum calcium, 24 hours urinary calcium and BSAP were non significantly decreased while 25 OH-vitamin D and PTH were non significantly increased after surgery. From this study, it is shown that Roux-en-Y gastric bypass operation gives very good results as regards reduction of body weight in morbidly obese patients. Postoperative supplementation with calcium and vitamin D partially correct osteoporosis. So, These patients need periodic follow up for Bone Mineral Density [BMD], PTH, calcium, serum vitamin D and markers of bone resorption and formation specially postmenopausal female

Thyroid surgery: use of ligasure vessel sealing system versus conventional knot tying method

The aim of this study was to compare the use of conventional knot tying vs. LigaSure Vessel Sealing System [Valley lab, Boulder, Colorado] in patients undergoing thyroid surgery. We hypothesized that the use of LigaSure would reduce the time of operation without more complications. This study was conducted in Endocrine Surgery Unit, Mansoura University Hospital on patients who underwent thyroid surgery from January 1, 2006 to December 31, 2006. 110 patients were operated upon by the same team of surgeons using conventional knot tying in 55 and LigaSure in 55 patients for hemostasis. The medical records of patients enrolled regarding age, sex, histopathological diagnosis, type of operation performed [lobectomy vs. subtotal thyroidectomy vs. total thyroidectomy]; the operation time, intraoperative blood loss, postoperative complications, length of incision, hospital stay and cost, as well as the postoperative pain and outcome were reviewed and compared. The two groups had nearly similar demographic data. We have noticed that patients in the LigaSure[TM] group had significant lower operating times [P = 0.000], lower intraoperative blood loss [P = 0.000], less postoperative pain and early pain-free return to normal activity and return to work [P = 0.0001]. LigaSure Vessel Sealing System was as safe as conventional knot tying method for thyroidectomy, with the benefit of a reduced operating time, decreased postoperative pain and early pain-free return to normal activity and return to work

Study of endocrinal, biochemical and radiological changes after roux-en Y gastric bypass in patients with clinically severe obesity

Study of endocrinal, biochemical and radiological changes after Roux-en Y gastric bypass in patients with clinically severe obesity. Our study included 30 patients with clinically severe obesity, RYGB was done for all patients. Daily postoperative oral supplementation with 1000 mg of calcium and 800 IU of vitamin D was done for each patient. Body weight, BMI, also Total body fat, Total lean tissue mass, Bone Mineral content [BMD], Bone Mineral density [BMD], Total bone area [TBA] [using DEXA], also, serum calcium, parathyroid hormone [PTH], 25-OH vitamin D, 24 hours urinary calcium and bone specific Alkaline phosphatase [BSAP] were assessed preoperatively and one year after surgery. In our study: females comprised 73% of cases. The mean age was 35 +/- 8.8 years. One year after RYGB: Body weight [BW] decreased significantly from 132.8 +/- 26.5 to 90.3 +/- 17.3 kg [p = 0.000]. Body Mass Index [BMI] decreased significantly from 48 +/- 7.3 to 32.6 +/- 4.1 kg/m[2] [p= 0.000]. Also, parameters of skeletal health changes were determined after one year. BMC decreased significantly from 2968.6 +/- 71.4 to 2700.8 +/- 45.4 gm [p = 0.000] BMD decreased significantly from 1.2600 + 0.03 to 1.2197 +/- 0.015 gm/cm[2] [p= 0.000]. TBA decreased significantly from 2356.2 +/- 35.4 to 2216.3 +/- 43.5 cm[2] [p= 0.000]. Serum calcium, 24 hours urinary calcium and BSAP were non significantly decreased while OH-vitamin D and PTH were non significantly increased after surgery. From this study, RYGB gives very good results as regards reduction of body weight. Postoperative supplementation with calcium and vitamin D partially correct osteoporosis. Further studies are needed to determine the exact dose of calcium and vitamin D that may abort bone resorption. From this study, it is shown that Roux-en-Y gastric bypass operation gives very good results as regards reduction of body weight in morbidly obese patients. Postoperative supplementation with calcium and vitamin D partially correct osteoporosis. So, These patients need periodic follow up for Bone Mineral Density [BMD], PTH, calcium, serum vitamin D and markers of bone resorption and formation specially postmenopausal female

Laparoscopic intraperitonealmesh repair of ventral hernia :prospective comparison toconventional mesh repair

The recurrence rate after standard repair of ventral hernias may behigh and the wide surgical dissection required often results in wound complications. Use of laparoscopic approach may decrease rates of complications and recurrence after ventral hernia repair. The laparoscopic repair of ventral hernias is still a controversial therapeutic op-tion. To evaluate the efficacy and safety of laparoscopic repair we compared the results of open and laparoscopic repair of ventral her-nias. Fifty three patients were randomized prospectively to undergo laparoscopic or open repair of ventral hernias. Thirty-eight patients presented with incisional hernias [12 upper midline, 15 lower midline, and 10 transverse abdominal], 8 had epigastric hernias, 8 had periumbilical hernias. All defects were estimated to be larger than 5 cm in diameter. Twenty six patients underwent attempted laparoscopic ventral hernia repair [LVHR] with mesh and twenty seven patients underwent open ventral hernia repair [OVHR] with mesh. Two of the 26 attempts of LVHR were converted to OVHR for a conversion rate of 7.6 percent The mean duration of surgery was significantly longer in the open group. The analgesic requirement was lower in the laparoscopic group. Time to oral solid food intake was longer in the open group. Post-operative stay was shorter in the laparoscopic group. Also, we noticed that there were significant early pain free return to activity and work in LVHR. In LVHR, postoperative complications occurred in 8 patients inthe form of seroma, and ileus in one patient. Whereas, in OVHR, 10 patients had postoperative complications that included wound seroma in 4patients, wound infection in 4 patients [one required removal of mesh],postoperative ileus in one patient, and wound dehiscence in one patient. There was a significant less recurrence rate in LVHR in comparison with OVHR [0 vs. 3 patients]. In conclusion, laparoscopic incisional hernia re-pair, is a safe, feasible alternative to open techniques. However, largerstudies and long-term follow-up are required to further evaluate the true effectiveness of this operation

Prognostic value of sentinel lymph node and local thyroid lymphocyte infiltration in differentiated thyroid carcinoma

The aim of this work is to investigate the prevalence, significance and prognostic value of lymphocytic infiltration and SLN associated to differentiated thyroid carcinoma. Our study included 50 patients with preoperative diagnosis of differentiated thyroid carcinoma by FNAC and Trucut needle biopsy, there age ranged from 17 to 55 years with mean age [36 year]. They were 35 females and 15 males. Absence of clinically palpable draining cervical lymph node was the main exclusion criterion in selection of our patients.Our patients were subjected to peroperative injection of patent blue dye intra tumoral, detection and resection of SLN and stained lymphatic channels, resection of samples from jugular lymph nodes [non stained] as NSLNs. Then total thyroidectomy was done. In our study, SLNs staining occurred in 37/50 patients with DTC [74%], 28 of which in patients with PTC 28/33 [84.8%], 5 in patients with FTC 5/13 [38.4%] and 4 in patients with follicular variants of PTC 4/4 [100%] mapping failure occurred in 13/50 patients [26%].22 patients revealed the SLN biopsy from which 18 patients show -ve NSLN and 4 patients with +ve NSLNs [false +ve]. 15 patients revealed -ve SLN biopsy from them 10 patients show -ve NSLNs and 5 patients show +ve NSLN [false -ve SLNI. The accuracy of SLN biopsy needs further investigation before it can be recommended in the routine management of the thyroid neoplasia. The onus must fall on the endocrine surgeon to define clearly the direct therapeutic relevance of occult nodal disease if SLN biopsy is to become a standard of care in thyroid cancer

Testosterone, dihydrotestosterone, interleukin-6 and serotonin in varicocele fertile and infertile patients: a controlled study

The objective of this study was to determine the changes in the concentration of testosterone [T], dihydrotestosterone [DHT], serotonin and interleukin-6 [IL-6] in peripheral venous and internal spermatic vein [ISV] blood and also in seminal plasma in infertile and fertile patients with varicocele as well as in the control fertile subjects without varicocele and to correlate these changes with the autosperm parameters. Thirty-six infertile and five fertile varicocele patients as well as five control fertile non-varicocele subjects were included in the study. Autosperm was used for an objective semi-computerized semen analysis. ELISA kits were used to determine testosterone, dihydrotestosterone, serotonin and interleukin-6 aspiration of internal spermatic vein [ISV] blood was done intra-operatively during varicocelectomy in varicocele patients and during herniorrhaphy in the control subjects. The study concluded that since there was a significant deviation in T, DHT, serotonin and IL-6 in infertile patients with varicocele in comparison with both fertile varicocele and control subjects as well as since these deviations were accompanied by nearly similar changes in the autosperm parameters, it was concluded that no single deviation is solely responsible for such semen alteration but additive effect is most appropriate

Effect of varicocelectomy on sperm count, motility and morphology: comparative randomized study of different approaches

This prospective study was undertaken to estimate the effect of varicocelectomy on the count, motility and sperm morphology and how the morphological criteria predict outcome in patient population. Also, to estimate which approach can improve this outcome in a comparative randomized study. Between June 1996 and June 2000, a total number of 346/425 patients suffering from varicocele with primary infertility passed the exclusion criteria and agreed randomization. Their mean age was 33.4 years. All patients were clinically examined and fully investigated using semen analyses, testicular ultrasound and color doppler flow imaging. Bilateral high ligation, bilateral laparoscopic approach and subinguinal varicocelectomy with 5.5X magnification were carried out in 119, 112 and 115 patients respectively. Postoperatively, patients were followed up at 1, 3, 6 and 12 months intervals. Surgical correction of varicocele was associated with significant overall improvement in sperm count and motility in all-surgical groups. According to WHO classification, the percentage of sperms with normal morphology was significantly increased with a significant decrease in percentage of amorphous forms. Also, according to Kruger classification, there was a significant improvement in the overall percentage of normal forms after varicocelectomy. Moreover, the pregnancy rate was significantly higher in the subinguinal approach with magnification [53%] when compared with high ligation and laparoscopic groups [21.8% and 29.4% respectively]. On the other hand, postoperative hydrocele formation occurred more frequently in the high ligation approach [24.3%] when compared with laparoscopic [5.3%] and subinguinal [0%] approaches. Also the postoperative recurrence was significantly higher in the high ligation group [23.5%] when compared with the laparoscopic [14.2%] and the sabinguinal with magnification groups [0.8%]. From this study, we conclude that varicocelectomy has a positive effect on sperm count, motility and morphology and the subinguinal varicocelectomy with magnification is a safe, and a minimal invasive approach to varicocelectomy that lessens the incidence of hydrocele formation and varicocele recurrence, and assures preservation of testicular artery. Moreover, it has a higher positive effect on the sperm motility and morphology, which are the predictors of pregnancy