ABSTRACT
Background: Obesity is a chronic condition that affects millions globally; consequently, bariatric surgery is the key to this serious issue. Bariatric procedures are rapidly expanding in number and methods to address the recognized problems. So, it would make a sense for surgeons and patients if there is a more physiological bypass surgery technique in Morbid obesity. This study aims to evaluate the outcome proposed technique. Patients and methods: The present study is a retrospective analysis on 256 participants subjected to the proposed bypass procedure from December 1999 to January 2017, the participants were followed up for an interval of 3years. Results: The findings of the present study revealed a significant Excess Weight Loss (EWL). In addition, patients experienced decreased calcium, iron, vitamin B12, Hemoglobin, zinc, and Prothrombin Concentration. However, three to six months after surgery, they experienced a significant improvement until they reached normal levels without any supplement by the end of 12,18 months, with a three-year follow-up. Conclusion: This proposed Bypass Operation aims to adequate digestions as well as selective absorption without inducing any vital deficit. Most of study's population showed no elements inadequacies, although few percentages emerged during the interval of maximal weight reduction, and it were transient and minimal. No minerals or vitamins were needed.
ABSTRACT
BACKGROUND: The optimum target in surgery for Parkinson's disease (PD) is still controversial, especially in patients with tremor-dominant PD. We aim to compare results in tremor-dominant patients undergoing pallidotomy vs. those undergoing simultaneous posteroventral pallidotomy (PVP) and ventral intermediate nucleus (VIM) thalamotomy. METHODS: Twenty-four patients with tremor-dominant PD were included in this study. Twelve patients received unilateral PVP contralateral to the most affected side. The other 12 patients received simultaneous unilateral PVP and VIM thalamotomy contralateral to the most affected side. Assessment of results in both groups was achieved using both UPDRS "off" motor scores and UPDRS rest tremor subscores. RESULTS: The mean UPDRS off motor score improved in the pallidotomy group from 61.3 preoperatively to 36.8 at 12 months. In the combined group, it improved from 59.6 to 35.2 at 12 months, with no statistically significant difference between both groups. On the other hand, while the mean tremor subscore in the pallidotomy group improved from a mean of 2.3-0.8, the tremors were abolished in all of the patients in the combined group except for 1 patient who showed slight infrequent tremors at 12 months. CONCLUSION: Patients with tremor-dominant PD achieve more improvement in tremor control after combined PVP and VIM thalamotomy.
Subject(s)
Globus Pallidus/surgery , Pallidotomy/methods , Parkinson Disease/surgery , Thalamus/surgery , Tremor/surgery , Adult , Female , Humans , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
This study compared the effect of general anesthesia or regional vertebral analgesia (subarachnoid or epidural) on postoperative cognitive function in 60 young adult (group A) and 60 elderly (group E) patients undergoing orthopedic and urologic surgery. Wechsler Adult Intelligence Scale-Revised for cognitive functions assessment was done preoperatively, and postoperatively; one day and three days after surgery. Variations in heart rate, blood pressure, arterial oxygen and carbon dioxide tensions, and pH as well as serum bicarbonate, sodium and potassium levels, were assessed at the same time intervals. They did not show any significant change from the preoperative levels. Cognitive functions, one and three days after surgery, did not change significantly in young adult patients after either general or regional vertebral nor in elderly patients who received regional regional vertebral, as compared with the preoperative levels. Only elderly patients who received general anesthesia had significant decline in cognitive function one day after surgery. It significantly improved on the third postoperative day but still was significantly less than the preoperative level. Moreover, significantly better WAIS-R Scores were found in the elderly group one and three days after spinal anesthesia than after general anesthesia. The results indicate that general anesthesia poses a significant risk for the occurrence of early postoperative cognitive dysfunction in elderly patients that can persist for 3 day after surgery. Regional vertebral analgesia is advantageous over general anesthesia for elderly patients in terms of a better postoperative neuropsychological functioning.
