Metabolic Outcomes of Laparoscopic Diverted Sleeve Gastrectomy with Ileal Transposition (DSIT) in Obese Type 2 Diabetic Patients.

BACKGROUND: Bariatric surgical techniques are based on mechanical restriction rather than functional restriction. Our purpose is to analyze the outcomes of diverted sleeve gastrectomy with ileal transposition (DSIT) as a mode of functional restrictive therapeutic option for class II and class III obese type 2 diabetes mellitus patients. METHODS: A retrospective analysis was performed on data derived from 159 patients with type 2 diabetes mellitus who underwent DSIT between October 2011 and January 2014. Postoperative changes in body mass index (BMI), HbA1c, cholesterol indexes, and triglycerides, as well as complications and mortality rates, were noted and analyzed. RESULTS: The study group consisted of 88 females and 73 males, with a mean age of 51.8 years. Mean duration of hospital stay was 6.4 (range, 4 to 42) days; mean follow-up was 18.3 months, and no mortality was detected. Mean BMI decreased from 39.33 to 25.51 kg/m(2) (excess BMI loss rate was 75.4 %, p < 0.001). Mean fasting glucose level decreased from 189.8 to 123.5 mg/dl (p < 0.001), and mean postprandial glucose level decreased from 246.1 to 179.4 mg/dl (p < 0.01). Mean HbA1c decreased from 9.24 to 6.14 % 1 year after surgery (p < 0.001). Overall, 88.68 % of patients were off antidiabetic medications at the end of 1 year. Hypertension was diagnosed in 121 of 161 patients preoperatively and resolved in 114 cases (94.2 %, p < 0.001). Triglycerides decreased from a mean of 210.07 to 125.24 mg/dl, and cholesterol decreased from a mean of 208.34 to 163.23 mg/dl (p < 0.001 for each). CONCLUSION: Our results demonstrate that DSIT provided effective remission rates in all components of metabolic syndrome in obese type 2 diabetic patients with acceptable complication and mortality rates.

Metabolic syndrome and glucose tolerance status.

AIM: To determine justifiability of oral glucose tolerance test (OGTT) in non diabetic patients with metabolic syndrome (MetS). METHODS: It was included 398 patients attended to Outpatient Clinics of Sisli Etfal Training and Research Hospital. Eligible patients were assigned as patients with MetS according to International Diabetes Federation (IDF) criteria. RESULTS: After OGTT, there were 7 (2%) diabetic patients, 119 (30%) patients had impaired glucose tolerance (IGT) and 272 (68%) were normal. Height, weight, waist circumference, fasting glycemia, high density cholesterol were not different between IGT and non IGT group. CONCLUSION: OGTT is necessary in MetS non diabetic situation for detection early prediabetic patients.

A geriatric patient with diffuse idiopathic skeletal hyperostosis.

The most frequent health problems seen in senility are chronic and degenerative diseases. A 75-year-old male patient with the complaints of weight loss and difficulty in swallowing was admitted to our hospital from a nursing home. Upper system fiber-optic gastrointestinal endoscopy was performed and a mass at the junction of the hypopharynx and esophagus just below recessus piriformis obstructing almost the whole of the lumen and blocking the distal passage was detected. Computed tomography revealed marked narrowing secondary to osseous hypertrophy in the air column of the hypopharynx and proximal esophagus. Diffuse idiopathic skeletal hyperostosis or Forestier's disease is an idiopathic disease characterized by the ossification of the anterior longitudinal ligament of vertebra and some of the extraspinal ligaments. In the present case we aim to discuss an elderly patient who suffered from dysphagia and weight loss and the diagnostic stages.

Cyclosporin treatment of anal and perianal lesions associated with Crohn's disease.

BACKGROUND/AIMS: To analyse the long-term effect of cyclosporin on anal-perianal lesions associated with Crohn's disease. METHODS: Twenty patients (15 females and 5 males); having Crohn's disease with anal-perianal involvement and resistant to conventional treatment were evaluated. The following criteria of diagnosis and evaluation were applied to all patients: onset of Crohn's disease, description of anal-perianal lesions according to Cardiff classification after proctological examination, onset of symptoms and their aggravation, and previous agents and surgical interventions. Cyclosporin was administered orally following intravenous treatment for 7 days (4 mg/kg/day). Dose adjustments' target was to achieve a cyclosporin level of 100/200 ng/mL. The efficacy of treatment was assessed by proctologists on days; 15 and 30, so-called acute period, and at 3, 6, 7, and 20 months, so-called chronic period. Patients were also seen between these two periods as needed, based on the condition of patients and their symptoms. At each examination, patients were scored according to Cardiff classification and the anatomical localisation of lesions, with the scores recorded subsequently. RESULTS: Symptomatic improvements were seen in 80-85% of patients while proceeding from acute to chronic period. Oral treatment was continued for 3-7 months. In acute period (in the follow-up assessments: on days 15 and 30), 16/20 (80%) patients had symptomatic improvements, 5/20 (25%) had improvements in all anal-perianal lesions, 11/20 (55%) had regression of lesions, and 4/20 (20%) had worsening of lesions. In chronic period (range, 1-20 months; mean, 5 months), no complication occurred and no patient showed reactivation. In chronic period, the observation was that; 45% of fistulae were closed and 70% of ulcers healed. During treatment, 3 (15%) patients underwent a definitive ileostomy and 4 patients underwent surgical drainage of abscess of ano-vaginal and ano-perianal fistula. CONCLUSIONS: In treatment of anal-perianal lesions associated with Crohn's disease, cyclosporin is an important agent in providing regression and healing of lesions in cases refractory to standard treatment. It should be considered an alternative treatment particularly in restorative surgical interventions. Comparisons are needed versus newer agents and cyclosporin for efficacy and superiority.