Hormonal Changes in Women Undergoing Bariatric Surgery: A Comparative Study with a Control Group.

Bariatric surgery is an effective treatment option for obesity, but its effects on reproductive hormones are not well understood. This study aimed to investigate the impact of bariatric surgery on estrogen and progesterone levels in women with obesity. This was a prospective study that included 87 women with obesity who underwent bariatric surgery and 87 control women with obesity who did not. Blood samples were collected at baseline and at 3-month and 6-month follow-up periods to measure reproductive hormones and Adiponectin as well as medical history and physical examination for endometriosis and polycystic ovary syndrome (PCOS). The study found that sleeve gastrectomy significantly increased follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in the bariatric surgery group compared to the control group at 3 and 6-month follow-up. There was no significant difference in the mean levels of estrogen and progesterone between the two groups at the 3-month follow-up period. Bariatric surgery leads to significant weight loss in women with obesity, but it does not seem to have a significant impact on estrogen and progesterone levels in the short-term. Future studies with longer follow-up periods are needed to investigate the long-term effects of bariatric surgery on reproductive hormones.

Bariatric surgery outcomes following organ transplantation: A review study.

Weight gain is a frequent postoperative complication following a solid organ transplant which can be solved by bariatric surgery. The outcomes of bariatric surgery among patients with an organ transplant history are always a challengeable subject for surgeons and surgery candidates. In this review article, we aim to investigate the existence literature about the rates of morbidity and mortality, frequent complications in terms of graft function, remission in diabetes, hypertension, pulmonary and cardiovascular disorders, hepatic and renal functions, and immunosuppressive stability, as well as the safety of bariatric surgery among patients.

Surgical technique of congenital diaphragmatic hernia following sleeve gastrectomy; a case report study.

INTRODUCTION AND IMPORTANCE: Congenital diaphragmatic hernia (CDH) is caused by a defect of diaphragm. The incidence of CDH is 1/3600 in new births in the US, causing pulmonary hypoplasia and pulmonary hypertension. In rare cases, the late presentation in adulthood is reported. CASE PRESENTATION: We report a 31-year-old female with respiratory distress and gastrointestinal disease, diagnosed on X-ray chest and abdomen CT scan as CDH case, which was in left-sided diaphragm. CLINICAL DISCUSSION: Left posterolateral thoracotomy was performed for this patient. The patient with late diaphragmatic hernias presentation had a variety of symptoms, but diagnosis was very difficult. CONCLUSION: In this super rare case, the patient had a mix of bariatric surgery complications such as excessive weight loss. Additional investigation and research are necessary to better detect this type of disease.

The changes in cognitive function following bariatric surgery considering the function of gut microbiome.

Background: There is a correlation between gut microbiota and cognitive function. The mechanisms and pathways explain why the incidence of Alzheimer's disease in subjects undergoing bariatric surgery is lower than in other people with obesity. Methods: In this review article, we aim to discuss the association of obesity, cognitive impairment, and physiological changes after bariatric surgery. Results: Bariatric surgery has a series of physiological benefits which may lead to an improvement in cognitive functions in individuals who are prone to later developing Alzheimer's disease. Also, taxonomical change in the gut microbiome profile provides a healthy condition for living with better levels of cognition without neuropathological damages in older ages. Conclusion: It can be concluded that there is a possible correlation between cognitive dysfunction and increased risk of cognitive dysfunction in people with a BMI higher than 40 kg/m2. Bariatric surgery may increase neurotransmitters and improve the gut bacteria, leading to a significant reduction in the risk of Alzheimer's disease.

Changes in clinical depression following Sleeve Gastrectomy.

INTRODUCTION: Bariatric surgery is safe and efficient surgical method for weight loss, but it is not free from complications. We aim to evaluate the prevalence of depression after Sleeve Gastrectomy (SG) in a narrow period of time on Iranian ethnicity. METHODS: 307 cases that underwent SG in Erfan Niayesh hospital were included. The questionnaire was based on International Classification of Diseases, Ninth Revision (ICD-9) codes to define diagnoses. Screening follow-up period was 20 to 24 months. The level of statistical significance was set at p < .05. RESULTS: Of 307 subjects, preoperative depression was 30.2% and post-operative depression was 37.7% (p = .025). Besides, BMI, dyslipidaemia, good feelings about body size and weight loss were statistically significant at p < .05.There was an increased risk of depression following the procedure mainly in divorced cases. CONCLUSION: The prevalence of clinical depression after sleeve gastrectomy was statistically significant and dependent on other variables. We provided guidance for people considering SG and their clinicians in terms of evaluating potential risks and benefits of surgery.

The advantages and disadvantages of sleeve gastrectomy; clinical laboratory to bedside review.

Sleeve gastrectomy is a surgical technique and a leading method in metabolic surgery. Sleeve gastrectomy gained ever-increasing popularity among laparoscopic surgeons involved in bariatric surgery and has proved to be a successful method in achieving considerable weight loss in a short time. There are some disparate effects that patients may experience after sleeve gastrectomy including a reduction in BMI, weight, blood pressure, stroke, and cancer and also a significant remission in obesity-related diseases including type 2 diabetes (T2D), Non-alcoholic fatty liver (NAFLD), cardiovascular disease, obstructive sleep apnea, and craniopharyngioma-related hypothalamic obesity as well as non-obesity-related diseases such as gout, musculoskeletal problems, ovarian disorders and urinary incontinence. The most common complications of sleeve gastrectomy are bleeding, nutrient deficiencies, and leakage. There are several studies on the impact of gender and ethnic disparities on post-operative complications. This study collects state of the art of reports on sleeve gastrectomy. The aim of this study was to analyze recent studies and review the advantages and disadvantages of sleeve gastrectomy.

Socio-demographic Characteristics, Biochemical and Cytokine Levels in Bulimia Nervosa Candidates for Sleeve Gastrectomy.

BACKGROUND: Eating disorders (EDs) are widely known by abnormal eating behaviors associated with significant medical complications. Bulimia nervosa (BN) is an eating disorder characterized by uncontrolled episodes of overeating typically followed by some form of compensatory behaviors. We aimed to determine the relationships between socio-demographic characteristics, biochemical markers, and cytokine levels in BN candidates for laparoscopic sleeve gastrectomy (LSG). METHODS: A case-control study was designed among 76 BN participants of Iranian descent who were candidates for LSG based on defined criteria for Bulimia by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The healthy control subjects (n = 42) were selected at random from academic staff in the college. Moreover, levels of biochemical parameters and serum cytokines were measured in serum samples. RESULTS: Routine consumption of caffeine (odds ratio [OR] = 3.1, 95% CI: 1.23-6.41, P = 0.013), tobacco (OR = 1.8, 95% CI: 0.67-3.57, P = 0.03), and alcohol (OR = 3.6, 95% CI: 0.84-7.18, P = 0.048), and depression history (OR = 2.8, 95% CI: 0.76- 5.79, P = 0.037) were substantially more common among patients with bulimia. Also, the serum levels of fasting blood sugar (P < 0.001), HbA1c (P = 0.04), cholesterol (P = 0.03), triglycerides (P = 0.01), blood urea nitrogen (P = 0.03), and pro-inflammatory cytokines including IL-1ß, IL-6, and TNF-α were significantly higher in BN candidates for LSG (P ≤ 0.001). CONCLUSION: Our findings reveal that lifestyle-related risk factors and a depression history were both related with a significantly increased risk of BN among the candidates for LSG. Furthermore, there is a relationship between clinical characteristics as well as levels of various biochemical and cytokines parameters in serum of BN patients.

Endothelial to Mesenchymal Transition in the Cardiogenesis and Cardiovascular Diseases.

Today, cardiovascular diseases remain a leading cause of morbidity and mortality worldwide. Endothelial to mesenchymal transition (EndMT) does not only play a major role in the course of development but also contributes to several cardiovascular diseases in adulthood. EndMT is characterized by down-regulation of the endothelial proteins and highly up-regulated fibrotic specific genes and extracellular matrix-forming proteins. EndMT is also a transforming growth factor- ß-driven (TGF-ß) process in which endothelial cells lose their endothelial characteristics and acquire a mesenchymal phenotype with expression of α-smooth muscle actin (α-SMA), fibroblastspecific protein 1, etc. EndMT is a vital process during cardiac development, thus disrupted EndMT gives rise to the congenital heart diseases, namely septal defects and valve abnormalities. In this review, we have discussed the main signaling pathways and mechanisms participating in the process of EndMT such as TGF-ß and Bone morphogenetic protein (BMP), Wnt#, and Notch signaling pathway and also studied the role of EndMT in physiological cardiovascular development and pathological conditions including myocardial infarction, pulmonary arterial hypertension, congenital heart defects, cardiac fibrosis, and atherosclerosis. As a perspective view, having a clear understanding of involving cellular and molecular mechanisms in EndMT and conducting Randomized controlled trials (RCTs) with a large number of samples for involving pharmacological agents may guide us into novel therapeutic approaches of congenital disorders and heart diseases.

A randomized clinical trial comparing 4-port, 3-port, and single-incision laparoscopic cholecystectomy.

BACKGROUNDS: Despite increasing trend in single incision laparoscopic cholecystectomy (SILC), there is still controversy regarding its global acceptance as a routine practice. Our study aimed to compare surgical events, early in-hospital and later outcomes of SILC with conventional multiport laparoscopic cholecystectomy (LC). METHODS: Through a randomized controlled trial (RCT) between June and December 2011, 90 consecutive patients with documented biliary diseases waiting for LC were equally allocated to 3-port, 4-port, and single incision LC group. Operative time, surgical adverse events, postoperative pain according to visual analogue scale (VAS), total morphine administration, length of hospital stay, and cosmetic outcomes were compared between these three groups. RESULTS: A total of 27 males (30%) and 63 females (70%) were enrolled in this study. The average patients' age and BMI were 42.6 ± 12.1 years and 26.2 ± 2.7 kg/m(2), respectively. Operative time in SILC group was significantly longer than other groups. Total intraoperative adverse events and postoperative complications did not differ significantly between the three groups. Mean ± SD VAS score at rest was significantly lower (p < 0.05) in SILC group. The average VAS at coughing was significantly lower in SILC group in all time intervals except the first 6 hr (p < 0.05). In addition, total morphine dose showed significantly lower amount in SILC group (p = 0.02). 12-month follow-up did not reveal significant difference between the study groups (p > 0.05). CONCLUSION: SILC is associated with less postoperative pain in later hours, reduces in-hospital analgesic dosages, has longer procedure time, but does not increase intraoperative and postoperative adverse events It seems that SILC has no obvious advantages in terms of later outcomes.

Giant adrenal pseudocyst.

Adrenal cysts are rare lesions which are usually nonfunctional and asymptomatic. Adrenal pseudocysts do not have epithelial linings and account for about 40% of adrenal cysts. We report a case of giant adrenal pseudocyst in a 32 year old woman presenting with flank pain who had undergone surgical excision.

Thyroid synovial sarcoma: a case report.

Sarcomas are rare tumors account for about 1% of cancers in adult. Soft tissue sarcomas are the most common one. Synovial sarcoma's incident is about 10% of all sarcomas and most commonly rise from para-articular regions in young adults. Based on our knowledge there have been only two reports of thyroid synovial sarcoma in medical literature. We report a 44-year old woman presented with a rapid growing neck mass. The pathology report revealed sarcoma and the immunohistochemistry (IHC) was compatible with synovial sarcoma. It could be understood that synovial sarcoma can be found in various tissues even if there is no synovial cells.

A rare case report of appendix and cecum in the sac of left inguinal hernia (left Amyand's hernia).

This case is a rare aspect of left inguinal hernia. The patient was a 60-years old man with left scrotal mass since childhood. In the operating room, the hernia sac was opened which included cecum and appendix that is called left Amyand's hernia. The patient underwent herniorrhaphy with Lichtenstein repair.

Case report of a perforated appendix in the sac of inguinal hernia (Amyand's hernia).

This case is a rare aspect of inguinal hernia. The patient was admitted with a 10-day pain of right groin and a past history of an inguinal hernia which was irreducible at the time of admission. In the operating room, the hernia sac was opened which included a perforated and gangrenous appendix that is called Amyand's hernia. The patient underwent appendectomy and herniorrhaphy at the same operation.