Sleeve gastrectomy in a 10-year-old child.

Adolescents bariatric surgery (ABS) in morbid obesity (MO), with or without comorbid conditions, is and will be more and more indicated. Restrictive operations have the advantage of no influence on absorption. Laparoscopic sleeve gastrectomy (LSG) can be an excellent alternative. A LSG was done in a 10-year-old boy, body mass index (BMI) 42, who has Blount's disease (tibia vara) with severe pain at the knee joints that made him a wheelchair-bound person. He had a LSG and gallbladder removal without incidents. Eight months later, he has a BMI 28 and almost all his knees pain is gone. No side effects have been detected. A LSG may be the ideal bariatric operation for ABS with MO.

Ultraflex precision colonic stent placement as a bridge to surgery in patients with malignant colon obstruction.

BACKGROUND: Emergency surgery for malignant colon obstruction entails relatively high morbidity and mortality rates and typically necessitates a 2-step resection. These problems might be potentially mitigated by placement of a self-expanding metal stent (SEMS) as a bridge to surgery. A nitinol colorectal SEMS may offer several advantages, but available evidence on the utility of this SEMS type remains highly limited. OBJECTIVE: Our purpose was to evaluate the effectiveness and safety as a bridge to surgery of a nitinol SEMS designed for colorectal use. DESIGN: Prospective and retrospective multicenter clinical study. SETTING: Sixteen European study centers. PATIENTS: Thirty-six patients with malignant colonic obstruction. INTERVENTIONS: Nitinol colorectal SEMS placement. MAIN OUTCOME MEASURES: Technical success in accurate SEMS placement with coverage of the entire stricture length, clinical success in alleviating colonic obstructive symptoms, and bridging to elective surgery. RESULTS: Technical success was achieved in 97% of patients with a 95% CI of 85% to 100% and clinical success in 81% (95% CI, 64%-92%). Elective surgery was performed in 94% (95% CI, 81%-99%) of patients at a median of 11 days (95% CI, 7-15 days) after SEMS placement. SEMS-related perforation occurred in 3 patients. LIMITATIONS: No control group was included in this nonrandomized cohort study. CONCLUSIONS: In this first comparatively large clinical study of a nitinol colorectal SEMS as a bridge to surgery, a high proportion of patients successfully proceeded to elective surgery after prior decompression by SEMS placement.

Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy.

BACKGROUND: Duodenal switch (DS) is one of the most effective techniques for the treatment of morbid obesity and its co-morbidities, with mortality rate <1%, but with 9.4% morbidity rates (6.5% due to leaks). In our experience, leaks of the staple-line after sleeve gastrectomy (SG) are the most frequent sites of fistula formation and conservative treatment usually takes a long time. We present our experience in the treatment of gastric leaks with coated self-expandable stents (CSES). METHODS: 6 patients had gastric leaks at the gastroesophageal (GE) junction after SG or DS. One patient had a symptomatic gastro-bronchial fistula. Stents were placed by the interventional radiologist under fluoroscopic control and removed endoscopically. In one case, we used an uncoated Wallstent. In two patients, percutaneous microcoil embolization of the fistula was added. RESULTS: The patient treated with the Wallstent required a total gastrectomy 6 months after placement of the uncovered stent. In the other 5 patients, coated stents were successfully removed and the gastric leaks completely sealed. CONCLUSIONS: CSES are proposed as an alternative therapeutic option for the management of GE junction leaks in bariatric surgery with good results in terms of morbidity and survival.

Análisis de lecturas 'falso negativo' en un programa de screening de mama / Analysis of 'false negative' readings in a breast screening program

Objetivo: Revisar los carcinomas incidentes (CI), analizando las lecturas que en una vuelta anterior habían sido consideradas negativas.Describir el tipo de imágenes radiológicas más frecuentemente desapercibidas. Comparar tamaño y estadios tumorales entre falsos negativos (FN) y verdaderos negativos (VN). Valorar la influencia de la densidad mamaria, la edad y otros factores en la aparición de FN.Material y método: Seleccionamos 267 CI, y sometemos las mamografías previas a una lectura triple ciego. Ciento diecisiete de estos casos fueron mezclados para su lectura con mamografías normales, elegidas al azar, en relación 1/3.Resultados: Se detectaron un total de 77 casos (28,8 por ciento): 25 por los tres lectores, 21 por dos y 31 por uno. Los 190 estudios restantes (71,16 por ciento) fueron considerados VN. El grado de detección fue mayor en los 150 casos leídos directamente (32 por ciento) que en los 117 casos mezclados con otros normales (24,7 por ciento). La imagen radiológica que más frecuentemente pasó inadvertida fue la asimetría, aunque varió según la unidad de origen. Entre los factores que indujeron al error de lectura destacamos diez casos que estudiados con proyecciones adicionales fueron considerados normales, y 11 casos tras dos años de seguimiento sin cambios. La densidad mamaria y la edad influyen pero no nos parecen determinantes. Respecto al estadio, tamaño y afectación ganglionar, no encontramos diferencias estadísticamente significativas entre los FN y VN, si bien la proporción de in situ es algo menor en el grupo de los FN Conclusiones: El estudio de FN es un parámetro necesario de control de calidad y autoevaluación de las lecturas. La incidencia de FN va a estar en función de las características del programa. Los objetivos de estadio y tamaño tumoral siguen cumpliéndose a pesar del diagnóstico más tardío en el grupo de los FN (AU)