A prospective study comparing vertical banded gastroplasty versus laparoscopic adjustable gastric banding in the treatment of morbid and super-obesity.

We present our prospective comparative study on 60 patients subjected to two types of gastric restrictive procedures, i.e. Vertical Banded Gastroplasty (VBG) and Laparoscopic Adjustable Gastric Banding (LAGB) at King Abdul Aziz University Hospital, Jeddah, Saudi Arabia. The aim of our study was to compare weight reduction after both procedures. Thirty patients had VBG and thirty had LAGB based upon informed consents. The age, sex and preoperative weight and BMI were comparable in both groups. Excess weight loss of 87% was achieved in the VBG group while only 50% was noticed in the LAGB group at 6 months postoperatively.

Laparoscopic adjustable silicone gastric banding in the treatment of super obesity in the Jeddah area, Saudi Arabia. A preliminary report.

Eighteen morbid and super-obese patients were subjected to laparoscopic adjustable silicone gastric banding (LASGB) of the new prototype which is currently used in Europe. This prospective study was done during a short period of time between October 26, 1995 and January 29, 1996 by one team and in the same hospital. Eleven patients were males, while seven were females. The mean age was 32 years (range 19-55 years), while the mean weight was 138 kg (range 98-191 kg), and the mean Body Mass Index (BMI) was 49.8 kg/m2 (range 36.3-65 kg/m2). Although most of the patients were super obese, no major operative difficulties were encountered and the patients made a good postoperative recovery after this technique. The weight loss during this short period was encouraging. The literatures are reviewed.

The value of nutritional assessment methods in surgical patients living in Saudi Arabia.

Several methods have been propsed to assess nutritional status of patients in relation to post-operative complications including instant nutritional assessment (INA) and prognostic nutritional index (PNI). Weight loss (WL) has also been related to post-operative morbidity. A prospective study was conducted to evaluate the prognostic ability of INA, PNI and WL in 300 patients affected by major and semi-major surgeries. Post-operative sepsis occurred in 28 (9.3%) patients. Of the 300 patients studied, 91 (30.2%) had WL 10%; 12 patients were septic. Of the 28 septic patients indentified, 24 (85.7%) were within the high-risk group as identified by PNI characterisation. When both serum albumin and total lymphocyte count were abnormal, sepsis rate was 100%. All methods had a Youden index greater than one. Therefore, WL should be the first parameter assessed, and if WL is > 10%, then INA can be used to assess the patient further.

Glucose and glutamine metabolism in the small intestine of septic rats.

The intestinal metabolism of glucose and glutamine was studied in rats made septic by cecal ligation and puncture technique. Sepsis resulted in negative nitrogen balance and produced increases in the concentrations of blood pyruvate, lactate, alanine, and glutamine, and decreases in those of 3-hydroxybutyrate and acetoacetate. Both plasma insulin and glucagon concentrations were increased by 2.2- and 3.2-fold in septic rats, respectively. Portal-drained visceral blood flow increased in septic rats, and was accompanied by a decrease in the rates of utilization of glutamine and production of lactate, glutamate, and ammonia compared with those rates in sham-operated animals. Enterocytes isolated from septic rats showed decreased rates of glucose and glutamine utilization compared with cells isolated from corresponding controls. The maximal activities of hexokinase, 6-phosphofructokinase, pyruvate kinase, and glutaminase were decreased in intestinal mucosal scrapings of septic rats. It is concluded that a moderate form of sepsis decreases the rates of glucose and glutamine utilization (both in vivo and in vitro) by the epithelial cells of the small intestine. This may be caused by changes in the maximal activities of key enzymes in the pathways of glucose and glutamine metabolism in these cells as a metabolic adaptation to spare glucose and glutamine for use by other tissues.

Paediatric burn injuries in the Jeddah area of Saudi Arabia: a study of 197 patients.

A prospective study was conducted on paediatric thermal injury patients admitted to the Burns Unit at King Fahd Hospital, Jeddah, Saudi Arabia over a 2-year period (December 1985 to December 1987). A total of 197 patients (out of 319) were paediatric, aged up to 18 years. Infants and toddlers accounted for 59.4 per cent and adolescents for 14.2 per cent. Scalding and flame injuries accounted for 98 per cent with most injuries occurring at home (97.5 per cent) and the overall paediatric mortality rate was 4.4 per cent.

Detection of new epitopes formed upon oxidation of low-density lipoprotein, lipoprotein (a) and very-low-density lipoprotein. Use of an antiserum against 4-hydroxynonenal-modified low-density lipoprotein.

4-Hydroxynonenal (HNE) is a major aldehydic propagation product formed during peroxidation of unsaturated fatty acids. The aldehyde was used to modify freshly prepared human low-density lipoprotein (LDL). A polyclonal antiserum was raised in the rabbit and absorbed with freshly prepared LDL. The antiserum did not react with human LDL, but reacted with CuCl2-oxidized LDL and in a dose-dependent manner with LDL, modified with 1, 2 and 3 mM-HNE, in the double-diffusion analysis. LDL treated with 4 mM of hexanal or hepta-2,4-dienal or 4-hydroxyhexenal or malonaldehyde (4 or 20 mM) did not react with the antiserum. However, LDL modified with 4 mM-4-hydroxyoctenal showed a very weak reaction. Lipoprotein (a) and very-low-density lipoprotein were revealed for the first time to undergo oxidative modification initiated by CuCl2. This was evidenced by the generation of lipid hydroperoxides and thiobarbituric acid-reactive substances, as well as by a marked increase in the electrophoretic mobility. After oxidation these two lipoproteins also reacted positively with the antiserum against HNE-modified LDL.

Metabolic control of hepatic gluconeogenesis in response to sepsis.

The regulation of hepatic gluconeogenesis was studied in rats made septic by cecal-ligation and puncture technique. Blood glucose was not significantly different in septic rats, but lactate, pyruvate, and alanine were markedly increased. Conversely, blood ketone body concentrations were markedly decreased in septic rats. Both plasma insulin and glucagon were markedly elevated in septic rats. The maximal activities of glucose 6-phosphatase, fructose 1,6-biphosphatase, pyruvate carboxylase, and phosphenolpyruvate carboxykinase were decreased in livers obtained from septic rats suggesting a diminished hepatic gluconeogenesis. Hepatic concentrations of lactate, pyruvate, and other gluconeogenic intermediates were markedly increased in septic rats, whereas those of fructose 2,6-bisphosphate and acetyl-CoA were decreased. The rate of gluconeogenesis from added lactate, pyruvate, alanine, and glutamine was decreased in isolated incubated hepatocytes from septic rats. It is concluded that the diminished capacity of hepatic gluconeogenesis of septic rats could be the result of changes in the maximal activities or regulation of key nonequilibrium gluconeogenic enzymes or both but do not exclude other factors (e.g., toxins).

Burn injuries in the Jeddah area of Saudi Arabia: a study of 319 cases.

Three hundred and nineteen patients with different types of burns were studied at King Fahd Hospital, Jeddah, Saudi Arabia over a 2-year period (December, 1985 to December, 1987). Scalding was the most common cause (56.4 per cent) of burn injuries compared with 41.4 per cent of patients who sustained flame injury; 84.6 per cent of the thermal injuries occurred at home, with children (less than or equal to 18 years of age) being affected most frequently (61.8 per cent). The overall mortality was 9.4 per cent.

Glucose, glutamine, and ketone-body metabolism in human enterocytes.

Suspensions of metabolically viable human small-intestinal epithelial cells (enterocytes) were used to assess the metabolism of substrate(s) normally derived from the blood circulation to the intestinal mucosa (glucose, glutamine, and ketone bodies). Glutamine, glutamate, and glucose were the only substrates that caused major increases in oxygen consumption by isolated human enterocytes. In human enterocytes 72% of glucose could be accounted for as lactate. Human enterocytes utilized glutamine at about 14.90 mumol/min/g dry wt, with glutamate, alanine, aspartate, and ammonia as the major end-products. Human enterocytes utilized 3-hydroxybutyrate and acetoacetate at similar rates. Under the experimental condition employed, the respiratory fuels of human enterocytes include glutamine, glucose, and to a lesser extent, ketone bodies as indicated in the proportion of oxygen consumption attributed to these fuels and to the extent of utilization.

Comparison of fluorescence polarization immunoassay and high performance liquid chromatography for the quantitative determination of phenytoin, phenobarbitone and carbamazepine in serum.

The Abbott TDx fluorescence polarization immunoassay (FPIA) system has been evaluated and compared with well-established high performance liquid chromatography (HPLC) for the determination of three anticonvulsant drugs: phenytoin, phenobarbitone and carbamazepine. These assays were evaluated for precision, calibration curve stability, specificity and accuracy. Within-run precision studies using control samples (n = 15) in the subtherapeutic, therapeutic, and toxic concentrations, resulted in coefficients of variation in the range of 1.79-3.99% (FPIA) and 1.16-2.52% (HPLC), respectively. Between-run precision ranged from 2.32-6.34% for FPIA and from 2.04-3.38% for HPLC. Comparison of 122 patient samples assayed with both methods indicated an extremely good analytical correlation (r = 0.96) for all three comparisons. The FPIA method offers significant advantages in calibration curve stability while maintaining accuracy and precision comparable with those of established HPLC procedures.