Bariatric surgery: is it a safe treatment modality?

Introduction: Bariatric surgery is currently the most effective treatment for morbid obesity with proven benefits in terms of improvement of the quality of life, obesity related morbidity and obesity related mortality. Safety of bariatric surgery is widely documented in the literature. In this review, we discuss types of bariatric surgeries and their safety and complications

Methods: A review of the current literature concerning bariatric surgery and its complications and safety was undertaken

Conclusion: Bariatric surgery is very safe with safety profile comparable to commonly performed abdominal surgeries

Superoxide dismutase activities in plasma of patients with breast cancer

Superoxide radicals are produced during oxidative metabolic processes, and removed by superoxide dismutase [SOD] enzymes. Controversial results have been reported regarding the tissue and plasma concentration of SOD in patients with breast cancer. Venous blood was obtained from study participants and activity of SOD enzyme was determined in 100 women. Comparison was made between 50 patients with breast cancer and 50 individuals in control group. The activities of SOD in patients with malignancy and control group were 553.56 +/- 53.67 U/gr Hb and 1218.60 +/- 98.55 U/gr Hb, respectively [P <0.001]. Patients with higher stage and nuclear grade had lower SOD activity. lower levels of SOD activity was observed in women with breast cancer compared to healthy individuals. Considering the existing controversy regarding the SOD level in breast cancer patients, further studies to explore the reason of these differences are warranted

Hem-o-Lok clip is safe in minimally invasive general surgery: a single center experience and review of data from food and drug administration

There are several methods for the ligation of structures during minimally invasive operations. The hem-o-lok clip is a nonabsorbable polymer clip with a lock engagement feature. There are few reports about its use in minimally invasive general surgical procedures. In this report, we describe our experience with the hem-o-lok clip during basic, minimally invasive, general surgery procedures and the adverse events during application of the hem-o-lok. We retrospectively reviewed all laparoscopic appendectomies [LAs], cholecystectomies [LCs], and splenectomies [LSs], performed by 6 general surgeons at a university-affiliated hospital over 4 years. Clip failure was defined as intraoperative or postoperative bleeding due to clip malfunction that necessitated placement of another clip, conversion to an open procedure, or postoperative re-exploration. Leakage from the cystic duct and appendiceal stump was also considered clip failure. A search of the US Food and Drug Administration Manufacturer and User Facility Device Experience [MAUDE] database using the appropriate keywords was performed on July 7, 2011. This online resource contains reports of adverse events involving medical devices. Over a 4-year period, 856 laparoscopic operations, comprising 770 LC, 55 LS, and 31 LA, were performed. We did not observe any incidence of clip failure. There were 22 reports of hem-o-lok clip failure in the MAUDA database. Eighty-two percent [n=18] of clip failures were reported during laparoscopic nephrectomy. There was no report of failure after LA. There were 2 reported clip failures after LC [with bile leakage] and 1 after LS [tearing of splenic vessels with intraoperative bleeding]. There was also a report of migration of the hem-o-lok clip into the common bile duct, which occurred 4 years after a complicated LC. Hem-o-lok clips that are properly applied during basic laparoscopic procedures are a secure option for the ligation of the structures. Surgeons must be educated regarding the proper application technique

[ prevalence of abdominal aortic aneurysm in Iranian male population over 65 years old]

Prevalence of Abdominal Aortic Aneurysm [AAA], estimated by various studies, ranged from 4.1% to 14.2% in men older than 60 years. Most cases of AAA are asymptomatic and often discovered incidentally. Approximately the initial presentation in 12% of cases of AAA is sudden rupture with subsequent high mortality. This study was performed to evaluate the prevalence and screening necessity of AAA among Iranian men older than 65 years old. In this cross-sectional study, men older than 65 years, who referred for ultrasound examination to three different centers in Tehran, Iran at the year 2008 were included for evaluation of size of the abdominal aorta and presence of AAA. A total of 240 men older than 65 years enrolled in this study. AAA was found in 24 of the participants with prevalence rate of 10% in the studied population. Mean diameter of detected aneurysms was 3.93-1.435 cm. In 4 [1.7%] subjects, aneurysms greater than 5.5 cm in diameter were detected. One of these four subjects had the history of coronary artery disease and one was cigarette smoker. Three out of four had history of hypertension. Considering the estimated prevalence rate of AAA by the current study and the population of Iranian men older than 65, implementing of mass screening for AAA in this group would detect 986 asymptomatic cases each year. Therefore, the authors recommend further studies about the cost-effectiveness of mass screening for AAA among Iranian men above 65 years

Significance of platelet count in esophageal carcinomas

Thrombocytosis is found to be associated with unfavorable prognosis in esophageal carcinoma. Platelets produce thymidine phosphorylase which is a platelet-derived endothelial cell growth factor with angiogenic activity. Increased platelet count may be translated into enhanced tumor growth. We examined the relation between platelet count and several prognostic variables in patients with esophageal cancer. Patients and Three hundred and eighty-one cases with esophageal cancer that underwent esophagectomy in a referral cancer institute during a 5-year period were studied retrospectively. The relation between preoperative platelet count and patient age, gender, site of tumor, presence of multiple cancers and clinicopathological characteristics including histological type, tumor size, depth of penetration [T], lymph node involvement [N], distant metastasis [M], degree of differentiation, presence of vascular, lymphatic and perineural invasion was examined. Squamous cell carcinoma [SCC] constituted 93% and adenocarcinoma 7% of cases. Most of patients were in stage III, followed by stage II. The mean platelet count was 245 +/- 76 [10[9]/L]. There was no statistically significant correlation between platelet counts with prognostic factors except a weak linear correlation between platelet count and and tumor size [P= 0.03, Pearson correlation coefficient: 0.16]. Patients with adenocarcinoma had a higher platelet count than those with SCC [P= 0.003]. Platelet count does not correlate with prognostic factors in esophageal cancer. However, it is significantly different between SCC and adenocarcinoma of esophagus

effect of age on the outcome of esophageal cancer surgery

Surgery is still the best way for treatment of esophageal cancer. The increase in life expectancy and the rising incidence of esophageal tumors have led to a great number of elderly candidates for complex surgery. The purpose of this study was to evaluate the effects of advanced age [70 years or more] on the surgical outcome of esophagectomy for esophageal cancer at a single high-volume center. Between January 2000 and April 2006, 480 cases with esophageal cancer underwent esophagectomy in the referral cancer institute. One hundred sixty-five patients in the elderly group [70 years old or more] were compared with 315 patients in the younger group [<70 years]. All in-hospital morbidity and mortality were studied. The range of age was 38-84 years, with a mean of 58.7. The mean age of the elderly and younger groups was 74 and 53.2, respectively. In the younger group, 70 patients [22.2%] and in the elderly group, 39 patients [23.6%] were complicated [P 0.72].The most common complications in the two groups were pulmonary complications [9.8% in younger and 10.3% in elderly] [P 0.87]. Rates of anastomotic leakage and cardiac complications were also similar between the two groups. Hospital mortality rates in younger and elderly patients were 2.8% and 3%, respectively. There was no significant difference between the two groups in morbidities and mortality [P -value > 0.05]. With increased experience and care, the outcomes of esophagectomy in elderly patients are comparable to young patients. Advanced age alone is not a contraindication for esophagectomy

Two lung ventilation through single lumen tracheal tube in thoracoscopic thymectomy: a randomized clinical trial of efficacy and safety

Video assisted thoracoscopic surgery [VATS] has been successfully used for thymectomy in myasthenia gravis [MG]. Thoracoscopic thymectomy [TT] is usually done under general anesthesia with double lumen tubes [DLT]. The aim of this study is evaluation of two lung ventilation through single lumen tubes [SLT] during TT. In this prospective randomized study, TT was done in 30 patients with MG from January 2004 to December 2007. Patients were randomly intubated with either a DLT or SLT, 15 patients in each group. All patients were evaluated for hemodynamie stability, oxygen saturation of hemoglobin [Spo[2]], end-tidal Pco[2] [ETPco[2]], times required for intubation and surgery, satisfaction of surgeon about exposure and postoperative complications. in the SLT group, all patients had stable hemodynamic, Spo[2] and ETPco[2]. In the DLT group, hemodynamic instability occurred in one, decrease in Spo[2] in one and increase in ETPco[2] in another patient. One patient in DLT group developed vocal cord granuloma two months later. Time required for surgery and surgeon's opinion about exposure were similar in the two groups. SLT is safe in TT. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT