Effect of Roux-en-Y gastric bypass surgery on ventricular function and cardiac risk factors in obese patients: a systematic review

Introduction: Weight gain and obesity are two important public health problems, which are associated with many diseases such as cardiovascular disorders. Various policies such as bariatric surgery have been proposed for the treatment of morbid obesity

Methods: PubMed and Scopus were searched thoroughly with the following search terms [roux-en-y gastric bypass surgery] AND [ventricular function, OR cardiac risk factors OR heart]] AND [BMI OR body mass index] to find the articles in which the effect of roux-en-Y gastric bypass [RYGB] surgery had been evaluated in severely obese patients

Result: Out of 120 articles which were found in PubMed, and 28 records which were found in Scopus, only 18 articles fully met the inclusion criteria. Out of 2740 participants in the included studied, 1706 were patients with body mass index [BMI] over 40 kg/m2 who had undergone RYGB surgery, and 1034 were control participants. Results of the studies showed that RYGB surgery could reduce BMI, and cardiac risk factors, and improve diastolic function, systolic and diastolic blood pressures, and aortic function, postoperatively

Discussion: Obesity is associated with increased risk of cardiovascular diseases, impaired cardiac function, and hypertension. It is shown that RYGB surgery reduces the serum level of biochemical markers of cardiac diseases. Cardiac structure, parasympathetic indices of autonomic function, coronary circulatory function, hypertension, epicardial fat thickness, and ventricular performance improve after bariatric surgery

Conclusions: It is concluded that RYGB surgery is an effective strategy to improve ventricular function and cardiac risk factors in morbid obese patients

Pre-operative rectal indomethacin for reduction of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double-blind randomized clinical trial

To evaluate the effect of pre-operative indomethacin suppository on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. A double blind placebo-controlled randomized clinical trial. Hazrat Rasoul Akram Hospital, Tehran, Iran, from February 2010 to September 2012. One hundred and thirty patients, scheduled for laparoscopic cholecystectomy, were randomly divided into case and control groups. Sixty-five patients received indomethacin suppository and 70 patients received rectal placebo in the case and control groups respectively. All patients underwent the same protocol in laparoscopic surgery and anesthesia, then nausea and vomiting was recorded after 1, 6, 12 and 24 hours postoperatively and compared between the two groups. Independent-sample t test or Mann-Whitney tests were used for statistical analysis. Level of statistical significance was set at P

Sentinel node mapping for early breast cancer patients using[99m]Tc-phytate: Single center experience on 165 patients

Several radiotracers are being used for sentinel node mapping in patients with breast cancer. In the current study, we reported our experience with 99m-Tc Phytate for sentinel node mapping in Mashhad University of Medical Sciences. All breast cancer patients who underwent sentinel node mapping using 99m-Tc Phytate were included. All patients received intradermal peri-areolar injection of 0.5 mCi/0.lcc 99m-Tc Phytate. Lymphoscintiraphy was performed for 145 patients 5-10 minutes post-injection. The sentinel nodes were found during surgery using a hand-held gamma probe as well as blue dye technique. In total 165 patients were evaluated. Lymphoscintigraphy showed axillary sentinel nodes in 135 out of 145 patients [93%] following imaging. At least one sentinel node could be detected in all these 135 patients during surgery. In the remaining 10 patients with sentinel node non-visualization, 5 had sentinel node harvesting failure during surgery. Median number of sentinel nodes on the lymphoscintigraphy images was 1. Sentinel node detection rate was 95% [157/165]. In the 8 patients with sentinel node harvesting failure, 7 had pathologically involved axilla. Median number of harvested sentinel nodes was 1. Mean sentinel node to background count ratio was 10 +/- 2. 99m-Tc Phytate is an effective and highly successful radiotracer for sentinel node mapping. Sentinel node can be visualized in a short time after 99m-Tc Phytate injection on the lymphoscintigraphy images. The sentinel to background count during surgery is high which results in more convenient sentinel node harvesting and high detection rate

Can gallbladder ejection fraction measured by fatty meal cholescitigraphy diagnose chronic cholecystitis?

Despite presence of a body of evidence in support of high accuracy of cholecystokinin cholescintigraphy [CCK-CS], for diagnosis of chronic cholecystitis[CC], some authors have claimed that gallbladder ejection fraction [GBEF] has poor predictive diagnostic values. The purpose of this study was to determine if there is any difference in GBEF between normal individuals and patients with CC. In a prospective case-control study, we studied 36 subjects as control group who did not have any abdominal symptoms, or history of abdominal disease or gallstone. Patients group were 42 with established choronic calcalous cholecystitis[CCC] who complaining of chronic biliary-like pain and had gallstone on ultrasonography. All subjects underwent gallbladder scintigraphy and GBEF was calculated at 30 and 60 minutes after fatty meal [FM] ingestion. In control group GBEF at 30-minute and at 60-minute after FM ingestion were 69.54% +/- 21.04% and 84.26% +/- 11.41% respectively while in patients group GBEF at 30-minute was 61.21% +/- 16.01% and at 60-minute was 80.22% +/- 12.57%. No significant difference was noticed between control and patient groups. GBEF didn't show significant difference between different groups based on the number of gallbladder stone, severity of chronic inflammatory [lymphoplasma] cell infiltration, wall thickness and evidence of fibrosis in the gallbladder wall. Our data are against the diagnostic value of the GBEF as measured by FM-CS in the workup of patients with CC. Thus, interpretation of GBEF should take the proper clinical context into consideration

Sentinel lymph node biopsy in melanoma patients: an experience with Tc-99m antimony sulfide colloid

Sentinel lymph node biopsy is the standard procedure for lymph node staging in intermediate thickness melanoma. In Iran, this procedure has not been addressed sufficiently. In this study, we report our experience in this area. Ten consecutive patients with intermediate thickness melanoma where included in our study. 1.5 mCi of Tc-99m antimony sulfide colloid in two divided dose was injected around the tumor. All patients underwent surgery 2-4 hours after injection of the tracer. Patent blue V dye was also used for 8 patients. Using a hand-held gamma probe, the sentinel nodes were harvested and sent to the pathologist for frozen section and H and E review. For patients with positive sentinel nodes, lymph node dissection was performed. At least one sentinel node could be harvested in all patients. The mean number of sentinel nodes was 1.66. Detection rate with radiotracer and blue dye was 100% and 75% respectively. 30% of the patients had positive sentinel nodes. One patient in the pediatric age range and one head and neck melanoma were included in our study with successful sentinel node mapping. Sentinel lymph node biopsy using Tc-99m antimony sulfide colloid is a reliable and safe method in melanoma patients which can help in treatment planning and patient's ultimate prognosis

Minimally invasive radio-guided surgery for hyperparathyroidism: an experience with Tc-99m sestamibi

Radio-guided parathyroid surgery along with other minimally invasive surgeries constitutes the main surgical treatment procedures for different kinds of hyperparathyroidism. In this article we have reported our experience of radio-guided parathyroid surgery using Tc-99m sestamibi. Ten patients with hyperparathyroidism included in our study. Twenty mCi of Tc-99m sestamibi was injected intravenously to the patients in the day of surgery. All patients underwent surgery 4 hours after injection of the tracer. Abnormal parathyroid glands were localized by surgical gamma probe during surgery and were removed. Eight out of 10 patients had single adenoma. One patient had parathyroid hyperplasia secondary to chronic renal failure. The one remaining patient had persistent hyperparathyroidism with previous unsuccessful parathyroid surgeries. Except for the patient with parathyroid hyperplasia, parathyroid hormone [PTH] level of all other patients decreased after surgery including the patient with persistent hyperparathyroidism. Minimally invasive radio-guided parathyroid surgery is an easy and safe method for surgical treatment of hyperparathyroidism. With the increasing availability of surgical gamma probes and nuclear medicine facilities in Iran considering this kind of approach for surgical treatment of hyperparathyroidism seems rational

[Traumatic obstruction of duodenum [report of 2 cases]]

Duodenal hematoma occurs rarely due to blunt or penetrating trauma and it may cause intestinal obstruction. Half of the patients with duodenal hematoma show symptoms of obstruction 48 hours after trauma. After ruling out other visceral injuries, treatment is essentially conservative and laparoscopic or surgical drainage is rarely necessary. First case was a 16-year-old man who referred to the hospital with abdominal pain, vomiting and tenderness of upper abdominal quadrant, 2 days after blunt abdominal trauma. Diagnosis was made with CT scan and upper GI radiography. After 10 days of conservative treatment, patient was discharged from hospital in a good condition. The second case was a 25-year-old man who referred to the hospital 3 days after blunt abdominal trauma. Patient symptoms were; vomiting, pain and tenderness in upper abdominal regions. Diagnosis was made with ultrasonography, CT scan and upper GI contrast radiography. After 6 days of conservative therapy he tolerated oral diet and was discharged from hospital with good condition. Trauma is not a common cause of alimentary tract occlusion. If obstructive symptoms appear after trauma, the hematoma of intestine particularly duodenum must be considered. The protocol for conservative therapy of hematoma includes: 1] Early diagnosis and ruling out any duodenal leakage through upper GI radiography at admission and 5-7 days later, 2] On time diagnosis of associated injuries like pancreatic injuries, 3] Parenteral nutrition and intravenous hyperalimentation if needed

need for skin pen marking for sentinel lymph node biopsy: a comparative study

There is a consensus in the literature that sentinel lymph node biopsy is the standard procedure for axillary staging in early stage [I and II] breast cancer patients. Usually during lymphoscintigraphy, the location of the sentinel lymph node is marked on the skin by an indelible ink. In this study we evaluated this issue in our patients. 40 patients with the clinical diagnosis of early stage breast cancer [stage I or II] were included into the study. All patients received periareolar intradermal injections of 18.5 MBq Tc-99m antimony sulfide colloid 2-4 hours before the surgery and 2 ml patent blue V dye in a subdermal and periareolar fashion during surgery. The patients were divided randomly into two groups [20 patients in each group]. In group I, the anterior and lateral locations of the sentinel lymph node were marked on the skin with an indelible ink. In group II, no skin marking was used. A sentinel node was defined as any blue node or any node with an ex vivo radioisotope count of twofold or greater than the axillary background. All patients underwent standard axillary lymph node dissection after sentinel node biopsy. Mean age and tumor size were not significantly different between groups. SLN detection rate and number of detected SLNs were not significantly different either [P > 0.05]. Number of detected lymph nodes was 1.24 +/- 0.43 and 1.28 +/- 0.61 in group I and II of the patients, respectively. False negative rate [negative SLN and positive axillary nodes] for both groups were 0%. Although marking the location of the sentinel lymph node on the skin with an indelible ink can guide the surgeon during surgery, it can not increase the sentinel lymph node detection rate or improve the results of sentinel lymph node biopsy

[ comparison of early excision and grafting V.S conventional therapy in patients with less than 20% burns]

For many years superficial partial thickness burns were treated conservatively. In full thickness burns, skin grafts were applied usually 3 to 8 weeks after injury. The goal of this study is to accomplish a comparison of early excision and grafting versus conventional therapy in small full thickness burns. This Clinical trial study enrold in 2004-2006 at Emam Reza Hospital of Mashhad University of Medical Sciences on 65 Female burned patients with total body surface less than 20%, This study was approved by the local committee of Medical Ethics. 28 patients were treated by early excision of second and third degree burned wounds to the level of fascia within first week of admission and wound immediately covered with autografts of partial thickness meshed 2:1. In 37 Patients of the conservative treatment group the burned wound was dressed daily and full thickness burns grafted after 3-4 weeks of injury. Individual characteristics was collected in questionnaire and analyzed by descrptive statistics. The mean age of patients was 33.4 Length of hospital stay in early excision and graft was 10 +/- 4 days and in conventional therapy 37 +/- 7 days, with significant difference. Mean number of produres in early excison and graft was one stage and in the other group was 1.24. Mortality in the two groups was similar. Small full-thickness burns, if treated by an experienced surgeon. can be safely early excised and grafted with a decrease in hospital stay, costs, and number of painful debridments and will have fewer infectious wound complications