Genetic Correlates as a Predictor of Bariatric Surgery Outcomes after 1 Year.

This study analyzed genetic risk assessments in patients undergoing bariatric surgery to serve as a predictive factor for weight loss parameters 1 year after the operation. Thirty (30) patients were assessed for Genetic Addiction Risk Severity (GARS), which analyzes neurogenetic polymorphisms involved in addiction and reward deficiency. Genetic and psychosocial data collected before the operation were correlated with weight loss data, including changes in weight, body mass index (BMI), and percent of expected weight loss (%EWL). Results examined correlations between individual gene risk alleles, 1-year body weight data, and psychosocial trait scores. Spearman's correlations revealed that the OPRM1 (rs1799971) gene polymorphism had significant negative correlation with 1-year weight (rs = -0.4477, p < 0.01) and BMI (rs = -0.4477, p < 0.05). In addition, the DRD2 risk allele (rs1800497) was correlated negatively with BMI at 1 year (rs = -0.4927, p < 0.05), indicating that one risk allele copy was associated with lower BMI. However, this allele was positively correlated with both ∆Weight (rs = 0.4077, p < 0.05) and %EWL (rs = 0.5521, p < 0.05) at 1 year post-surgery. Moreover, the overall GARS score was correlated with %EWL (rs = 0.4236, p < 0.05), ∆Weight (rs = 0.3971, p < 0.05) and ∆BMI (rs = 0.3778, p < 0.05). Lastly, Food Cravings Questionnaire (FCQ) scores were negatively correlated with %EWL (rs = -0.4320, p < 0.05) and ∆Weight at 1 year post-surgery (rs = -0.4294, p < 0.05). This suggests that individuals with a higher genetic addiction risk are more responsive to weight loss treatment, especially in the case of the DRD2 polymorphism. These results should translate clinically to improve positivity and attitude related to weight management by those individuals born with the risk alleles (rs1800497; rs1799971).

Laparoscopy in the early diagnosis and management of sclerosing encapsulating peritonitis.

Sclerosing encapsulating peritonitis (SEP) is a rare and dreaded complication that can occur in patients undergoing peritoneal dialysis (PD). Although risk factors have been identified, the diagnosis is difficult and is usually made late in the disease after extensive fibrosis of the peritoneal membrane has occurred, at which point therapy is often fruitless. The high mortality rate of SEP is due to complications resulting from recurrent bowel obstruction, malnutrition, and sepsis. We report three patients with signs and symptoms suggestive of SEP all of whom had normal abdominal CT scans. Nevertheless, each patient underwent diagnostic laparoscopy, which confirmed the clinical suspicion of SEP. In each case, the diagnosis was made before extensive peritoneal fibrosis had occurred allowing therapeutic intervention at an early stage. All three patients subsequently became asymptomatic and thrived. This clinical improvement was supported by the lack of progression to overt peritoneal fibrosis on repeat laparoscopy. We conclude that a high index of suspicion in conjunction with a low threshold for diagnostic laparoscopy may be an effective strategy to establish an early diagnosis and treatment regimen for SEP. Additionally, repeat laparoscopy can be used to guide the length of therapy. These interventions may ultimately improve the long-term morbidity and mortality of SEP.

Nutrition support in the critically ill: a physician survey.

BACKGROUND: Current clinical practice guidelines delineate optimal nutrition management in the intensive care unit (ICU) patient. In light of these existing data, the authors identify current physician perceptions of nutrition in critical illness, preferences relating to initiation of feeding, and management practices specific to nutrition after initiation of feeding in the ICU patient. METHODS: The authors electronically distributed a 12-question survey to attending physicians, fellows, and residents who routinely admit patients to medical and surgical ICUs. RESULTS: On a scale ranging from 1 to 5 (1 = low, 5 = high), the attending physician's mean rating for importance of nutrition in the ICU was 4.60, the rating for comfort level with the nutrition support at the authors' institution was 3.70, and the rating for the physician's own understanding of nutrition support in critically ill patients was 3.33. Attending physicians, fellows, and residents reported waiting an average of 2.43, 1.79, and 2.63 days, respectively, before addressing nutrition status in an ICU patient. Fifty-two percent of attending physicians chose parenteral nutrition as the preferred route of nutrition support in a patient with necrotizing pancreatitis. If a patient experiences enteral feeding intolerance, physicians most commonly would stop tube feeds. There was no significant difference in responses to any of the survey questions between attending physicians, fellows, and residents. CONCLUSIONS: This study demonstrates a substantial discordance in physician perceptions and practice patterns regarding initiation and management of nutrition in ICU patients, indicating an urgent need for nutrition-related education at all levels of training.

Invasive candidal enterocolitis followed shortly by fatal cerebral hemorrhage in immunocompromised patients.

Two immunocompromised adult patients (male, 43 years of age; female, 50 years of age) are described who developed unusual and similarly unique complications. After chemotherapy, both presented with abdominal pain and severe bloody diarrhea. Initial blood cultures were negative, and abdominal CT showed pneumatosis and thickening of colonic wall. Colonoscopy showed severe right-sided colitis. Relentless bloody diarrhea necessitated emergency right hemicolectomy in both cases. Pathologic examination of the specimens showed extensive and severe hematogenous Candida enterocolitis. Both patients died of acute cerebral hemorrhage within 3 days of hemicolectomy. Autopsy, performed on 1 of the 2 cases, showed diffuse severe cerebritis and cerebral hemorrhage secondary to hematogenous invasive candidiasis. This sequence of events is not documented in the English literature on candidal enterocolitis, which is reviewed.