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

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

Antibiotic prophylaxis in elective laparoscopic cholecystectomy: a prospective study

Aim: laparoscopic cholecystectomy gives rise to a very complicated issue concerning the use of antimicrobial prophylaxis. The role of antibiotic prophylaxis in elective laparoscopic cholecystectomy and the relation between post-operative septic complication and bile microbiology will be assessed in this study

Patients and methods: 64 patients were included in the study and divided into two groups; group A: [29 patients] received antibiotic prophylaxis [cefotaxime] and group B [35 patients] received 100m1 isotonic saline [placebo]. Bile sampling and culture was taken for all cases and the patients' were followed up for incidence of sepsis where the wounds were swapped and cultured

Results: bile sampling and culture revealed no growth in 41 cases [64.1%] [19 in-group A and 22 in-group B]. Postoperative infection developed in two cases of group A and in three cases of group, B. Incidence of wound infection was significantly related to incidence of GB perforation [p < 0.0001]. Swabbing of infected wounds and collections revealed infecting organisms other than that detected in bile culture except in one case of group B

Conclusion: there is no relation between bile microbiology and postoperative infection, so, antibiotic prophylaxis is to be used in high-risk patients and in patients suspected to have difficult operation and GB perforation

Peripheral vascular malformations: favorable outcome

In the period from May 1999 and January 2003, 45 patients were presented with arteriovenous malformations. All patients were subjected to thorough history taking, clinical examination and investigation with recent modalities techniques. A surgical excision was done in all cases; wide surgical excision of hemangioma and preliminary ligation of the feeding vessels was done in case of arteriovenous communication. Residual lesions were subjected to a further excision or injection sclerotherapy with ethanol. An excellent outcome was obtained in most of the patients, with only residual lesions in seven patients who were treated by a further excision or injection sclerotherapy with ethanol. There was no major complication in the postoperative period, e.g. DVT and PE. There was no recurrence in the study

Peripheral aneurysms in Behcet's disease

Behcet's disease is a multisystem inflammatory disorder which may involve the vascular system. In this report, 14 patients with Behcet's disease with a total of 16 periphral aneurysms are presented. All patients were male, ranging in age from 23-50 years. The most common site of aneurysm formation was the femoral artery in 10 patients [71%]. Others include: 2 brachial, 1 popliteal, 1 external iliac, 1 peroneal, 1 posterior tibial. Only two patients with known previous history of venous thrombosis and under treatment of Behcet's disease In the other patients [86%] the first presentation was peripheral aneurysm and recurrent scrotal ulceration +/- oral ulceration. Synchronous multiple presentation in one patient and dis-synchronous presentation in other patient We performed interposition vein grafts for11 [8 femoral, 2 brachial and 1 popliteal] and 3 interposition PTFE graft [2 femoral and 1 external iliac]. Simple ligation as initial procedure was done for two [1 peroneal and 1 posterior tibial]. Anastomotic aneurysm developed in 2 patients [14%], secondary haemorrhage ended with A.k amputation in one patient [7%]. Relapse as new aneurysm formation in the aorta in 3 patients [21%] with mortality in two of them [14%]. Behcet's .disease should be considered in the differential diagnosis of periphral arterial aneurysm in young person in our population. A combination of corticosteroids and immune-suppression should be considered to control relapses responsible for new aneurysm formation especially in patients presented with multiple aneurysms