The Super-Magenstrasse and Mill operation with pyloroplasty: preliminary results.

BACKGROUND: Our strategy for performing various types of bariatric operations in order to make them suitable for the individual morbidly obese patient, has led us to take into account the original Magenstrasse and Mill (M&M) operation and modify it. This resulted in the so-called Super-Magenstrasse and Mill with pyloroplasty (SM&M-P). METHODS: In the past 3 years, 34 patients with mean BMI 48 and mean age 43 years underwent the SM&MP operation for morbid obesity. A digitoclasic pyloroplasty was performed and a 36-Fr bougie was used to calibrate the Magenstrasse. A 21-mm circular stapler was used to create a gastric window 10 cm proximal to the pylorus. The stapled division of the stomach to 3-4 cm from the pylorus and to the angle of His was performed first distally via the gastric window and then proximally from the window. RESULTS: 2 patients have reached 3 years since the operation: one could not be assessed due to the development of rectal cancer 1 year after surgery, and the other one has had an excellent outcome with 3-year BMI 26 kg/m2. 8 patients who underwent the surgery 2 years ago have a mean percent excess BMI loss (%EBL) of 69, and 19 patients who have reached 1 year have %EBL 64. All patients have experienced a clear reduction of appetite, with vomiting absent or rare. CONCLUSIONS: The SM&M-P procedure confers to this restrictive intervention some characteristics similar to gastric bypass, including rapid transit of the alimentary contents in the prepyloric "mill", scarse reflux into the gastric fundus, possible entero-endocrine effects and loss of interest in food.

A spatial memory task appropriate for electrophysiological recordings.

We developed a novel method for assessing spatial learning that is compatible with the requirements of electrophysiological recording of multiple single neurons. The behavioral task utilized a rectangular track with 8 reward boxes of which a subset contained available food (bait). Errors were scored whenever the rat investigated a non-baited box location (commission), failed to investigate a baited box location (omission), or hesitated in front of a non-baited box location (hesitation). Several controls encouraged the animal to solve the task through allocentric cues rather than through procedural strategies or simple local cue pairing. The learning curve for this task (3-5 d to criterion) was comparable to that of other spatial learning tasks when adequately motivated. The types of errors varied as the animal learned the task. Unlike other spatial learning tasks, the multi-box track allows many repeated samples of the same spatial coordinates within a short period of time to allow, for example, reliable determination of place fields while recording from hippocampal cells. Multiple trials per session also allow for high intensity training important for many learning assessments such as the timing and type of sleep involved in learning and memory.

Do electroweak precision data and Higgs-mass constraints rule out a scalar bottom quark with mass of order 5 GeV?

We study the implications of a scalar bottom quark, with a mass of O (5 GeV), within the minimal supersymmetric standard model. Light sbottoms may naturally appear for large tan(beta) and, depending on the decay modes, may have escaped experimental detection. We show that a light sbottom cannot be ruled out by electroweak precision data and the bound on the lightest CP-even Higgs-boson mass. We infer that a light b scenario requires a relatively light scalar top quark whose mass is typically about the top-quark mass. In this scenario the lightest Higgs boson decays predominantly into b pairs and obeys the mass bound m(h) less, similar 123 GeV.

Automatic centering of the microscope image for vitreoretinal surgery.

PURPOSE: The authors report on their device, the surgical image tracker, which provides automatic compensation for movements of the surgical image within the microscope field of view, during vitreoretinal procedures. METHODS: The authors developed a compact device acting as an automatic image tracker, based on video monitoring of the surgical image and translation of the operating microscope. Basic components are a standard color charge-coupled device camera and a specifically designed frame grabber for discrimination and tracking of the target image. Operation of the device is fully compatible with the usual pedal adjustments. RESULTS: Ready, fast, and correct automatic centering of the microscope field of view has been achieved successfully in all typical operating conditions. Video recording always is equally well centered. System operation also is effective with panoramic optics and diffuse illumination. CONCLUSION: The surgical image tracker appears to be a valuable tool to obtain well auto-centered surgical images, eliminating a bothersome task during vitreoretinal surgery.

Automatic eye tracker for excimer laser photorefractive keratectomy.

Acute overlapping of successive laser pulses onto the cornea during photorefractive keratectomy (PRK) is important to avoid refractive distortions. Most excimer laser systems performing corneal ablation lack control of the patient's eye movements and they cannot track the target corneal zone. We developed an eye-tracker based on television monitoring of the pupil and on automatic electro-mechanical deflection of the laser turning mirror, and we applied it to the ExciMed UV200 ArF work station (Summit Technology, Inc., Waltham, Mass.). Basic components are a black and white CCD camera and two fast stepping motors. The circuitry for target discrimination and tracking, and the optical imaging system are designed specifically. The tracker assembly does not interfere with the laser beam path nor with the operator's observation. Tracking of the pupil has been successfully achieved on different color irides, with an accuracy better than 0.1 mm in a 6 x 6 mm2 tracking field. Response time is less than 100 ms. Recordings of eye movements during PRK are presented. Tracking ablations have been performed on moving test eye-balls with plastic corneas. The proposed automatic system appears to be a reliable and effective method for the compensation of patient eye movements appears to be a reliable and effective method during PRK procedures.

Radioimmunolocalization of pelvic recurrences from rectosigmoid cancer employing 111In anti-CEA F(ab')2.

Thirty-two immunoscintigraphic studies have been performed in 26 patients previously operated upon for rectosigmoid cancer, for an early detection of pelvic recurrence, employing 111In anti-CEA, F(ab')2. The sensitivity was 1, specificity 0.76 and accuracy 0.84, leading to a positive predictive value of 0.69 and a negative value of 1. The combined use of a non-imaging surgical probe in 6 of the 10 patients who underwent second look surgery, detecting the 111In radioactivity used for RIS, improved diagnostic accuracy, ruling out the presence of tumors in 3 patients with false positive RIS.

Quantitative lymphoscintigraphy.

A radioisotopic method was used to evaluate the state and dynamics of the lymphatic system in 92 patients affected by chronic oedema of the limbs and in 12 control subjects. After interstitial injections of 99mTc-sulphur microcolloid, scans were obtained using a LFOV camera linked to a data processor. The quantitative indices of clearance and lymph node uptake obtained showed good correlation with lymphoedema etiology, controls and ostensibly healthy limbs of patients affected by monolateral disease. In conclusion, quantitative lymphoscintigraphy appears to be a feasible indicator of early changes in the lymph pathophysiology and supports the hypothesis that lymphoedema generally arises from a predisposing congenital pathology.

[Lymphoscintigraphy in the study of lymphedema of the arms]. / La linfoscintigrafia nello studio dei linfedemi degli arti superiori.

The aim of this work has been the study of the mechanism of lymph formation and drainage in the upper limb in patients with monolateral lymphoedema (15 limbs, L) in comparison with the apparently healthy limb (S) as well as with a control group (8 limbs, C). After interstitial injection of 99mTc sulphur micro-colloid, scans were obtained employing a LFOV camera linked to a data processor. Results were expressed as percentage of the id removed from the injection site 1 and 6 hr pi, mean T6%/h it is (T6-T1)/5 and percentage lymph nodes uptake at the same times. Mean T6%/h is significantly different between C and L, but not between L and S, while lymph node uptake at 6 hr shows a significant difference even between C and S. Quantitative lymphoscintigraphy appears to be a feasible indicator of early changes in the lymph pathophysiology and supports the hypothesis that lymphoedema generally arises from a predisposing congenital pathology.

[Cutaneo-systemic necrotizing vasculitis occurring during desensitization]. / Vascularite nécrosante cutanéo-systémique survenue en cours de désensibilisation.

The authors report a case of cutaneo-systemic necrotizing vasculitis, predominantly affecting the skin and digestive tract, observed in an asthmatic patient undergoing desensitization with Graminaceae pollen extract and mite-enriched house dust. Vasculitis developed 22 months after the first injections, became autonomous after the end of treatment and responded well to systemic corticosteroid therapy in daily doses of 1 mg/kg. The patient was followed up for 8 months during which the vasculitis did not recur, despite reduction in steroid dosage. Reports of necrotizing vasculitis occurring during desensitization seem to be very rare. They raise the problem of whether specific immunotherapy plays a role in the pathogenesis of vasculitis. Most of the characteristics that emerged from the cases previously published are concordant with those found in our patient: the interval between the first injections and the initial symptoms varied from 45 days to 8 years; in every case the condition followed its own course after the injections were discontinued; most patients were being desensitized to several allergens; the cutaneous symptoms were pronounced, eosinophilia was moderate and hepatitis B serology was constantly negative. The few prospective studies aimed at determining, by different methods, the levels of circulating immune complexes (CIC) have given conflicting results. Atopic subjects have high CIC levels, but these do not seem to be influenced by desensitization. The nature of the CIC remains unknown, and the various suggestions put forward (cross-reaction between blocking IgG and auto-antibodies, CIC [blocking IgG, anti-idiotype antibodies]) require confirmation, although the hypothesis of pathogenic CIC (allergen, blocking IgG) is unlikely to be correct.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of split renal function with 99mTc-aprotinin.

The aim of this work is to correlate the net kidney uptake of 99mTc-aprotinin (TcA) in 103 subjects with separate effective renal plasma flow (ERPF) and some blood chemistry parameters at 90, 180, and 360 min postinjection both in the normal and diseased kidney. Correlations found with separate ERPFs are highly significant at any time (P less than 0.001). However, although the slope of the regression line is steeper at 180 min, r tends to deteriorate slightly with time postinjection and a higher intercept on the y axis; this pattern is more pronounced if diseased kidneys are considered separately. The following are probably related to the renal handling of TcA: Early scans better reflect blood flow to the kidney, while later scans are more related to the metabolism/excretion tubular mechanisms; correlations found with urea, creatinine, urea clearance, and creatinine clearance are highly significant at any time; in 20 additional patients with diseased kidneys, renal uptake measurements done 360 min postinjection first with TcA and then with DMSA showed better correlations with ERPF employing TcA. Our results indicate that TcA is a feasible indicator of split renal function even at 90 min postinjection when a scan is easily carried out on an outpatient basis.

The role of meta-iodo [131I]benzylguanidine (MIBG) in the diagnosis and follow-up of neuroblastoma.

Fourteen scans employing the adrenergic blocking agent [131I]MIBG were performed on 10 children with neuroblastoma (NB) or ganglioneuroblastoma (GNB). The scans were negative in 5 cases, and 1 further case produced doubtful results in both the MIBG and CT scan tests. In 4 cases, very positive results were obtained with clear vision of the primary tumor and its metastases. In 1 case, which demonstrated partial differentiation of the outer part of the tumor mass toward GNB, a differentiated tumor specimen did not reveal significant uptake of the tracer. Half-lives of the tracer as measured by external detection in the period 24-48 h after injection were reduced after successful therapy. MIBG scanning appears to be a feasible indicator of NB adrenergic activity, and it can assume a primary role in the staging and follow-up of NB. Higher tumor uptake of the [131 I]MIBG and low background offer new perspectives in the radiometabolic treatment of MIBG.

Evaluation of separate renal function by means of 99mTc-aprotinin uptake test.

The possibility that relative kidney uptake of technetium-99m aprotinin (TcA) might be indicative of separate renal function was investigated in 89 patients who underwent both effective renal plasma flow (ERPFs) and glomerular filtration rate (GFR) determination. A reference group consisted of 27 healthy volunteers, studied only with TcA. The correlation with ERPFs (r = .73) was similar to that previously reported and confirmed. The correlation with GFR (r = .68) was better if a subgroup of renal units with TcA uptake lower than 16% (lower normal limit) was considered. Most likely, glomerular filtration is a limiting factor of the tubular uptake of TcA, and when GFR is reduced, both parameters decrease in the same manner, while if GFR is normal the two parameters are relatively independent. The correlation between TcA and GFR in 32 children was very similar to that found in adults. TcA uptake test seems to be a useful indicator of separate renal function, providing morphological information at, the same time.

[Intestinal absorption of iron observed in 2 cases of porphyria cutanea tarda]. / L'assorbimento intestinale del ferro osservato in due casi di porfiria cutanea tarda.

Two cases of porphyria cutanea tarda (PCT) are reported. Iron absorbtion has been studied by a radioisotopic method in these two patients. Our findings confirm the hypothesis of possible genetic association between PCT and hemochromatosis.

Accumulation of 99m Tc-Sn-pyrophosphate in pleural effusions.

Accumulation of 99m Tc-Sn-pyrophosphate in pleural effusions has been evaluated in 56 patients grouped as follows: 8 with bacterial effusion (Group A), 27 with malignant effusion treated by local and/or parenteral antitumor chemotherapy (Group B), 21 with malignant effusion treated only by supportive therapy (Group C). Results, expressed as effusion to plasma PPi ratio, ranged from 0.1 to 0.28 in group A, from 0.04 to 0.64 in group B and from 0.60 to 1.73 in group C, with significant differences among the three groups. In no case was uptake found in cells of the sediment. Chemical analysis (including total and ionized calcium, total protein, acid and alkaline phosphatase) of plasma and exudate in neoplastic patients showed a slight, but significant, difference between groups B and C as regards plasma-effusion gradient for total calcium and acid phosphatase. Negative correlation also exists between effusion to plasma PPi ratio and plasma-exudate gradient for ionized calcium in neoplastic patients. The data support the hypothesis that acid phosphatase content and calcium gradient are among the factors involved in the mechanism of PPi accumulation in pleural effusions.