Laparoscopic sleeve gastrectomy: an Indian experience-surgical technique and early results.

BACKGROUND: Obesity has been observed to be on the rise in the Indian subcontinent. We report our early experience with the laparoscopic sleeve gastrectomy (LSG) for treating morbid obesity in the Indian population along with description of the surgical technique. METHODS: The data of 75 patients who underwent LSG for the treatment of morbid obesity at the Minimal Access, Metabolic and Bariatric Surgery Centre, Sir Ganga Ram Hospital, Delhi, from November 2006 to February 2009, were retrospectively reviewed from prospective database. The gastric sleeve is created laparoscopically using sequential firings of a linear stapling device applied alongside a 36-Fr calibrating bougie. The data collected included age, gender, initial body mass index (BMI) and excess weight, the co-morbidity status, and preoperative investigations. Perioperative parameters and follow-up details [weight, BMI, excess weight loss (%EWL), resolution of co-morbidities, and postoperative investigations] were noted. RESULTS: All procedures were completed laparoscopically. There was no major procedure-related morbidity. Hemorrhage requiring blood transfusion was observed in four patients. One patient died at 2 weeks postoperatively due to pulmonary embolism. There was a steady rise in %EWL from 31.2% at 3 months to 52.3% at 6 months, 59.13% at 1 year, and 65% at 2 years. Type II diabetes was resolved in 81.2%, hypertension in 93.75%, and dyslipidemia in 85% at 1 year. CONCLUSION: Although long-term results are necessary to determine the benefits of the procedure, early results indicate that LSG may be a safe and feasible option for treating the morbidly obese patients.

Anxiolytic activity of aerial and underground parts of Passiflora incarnata.

The petroleum ether, chloroform, methanol, and water extracts of Passiflora incarnata whole plant and sorted out plant parts have been evaluated for their anxiolytic activity using the elevated plus-maze model in mice. The methanol extracts of leaves, stems, flowers, and whole plant exhibited anxiolytic effects at 100, 125, 200 and 300 mg/kg, respectively. The roots were practically devoid of anxiolytic effects. These results show that roots and flowers of P. incarnata act as natural adulterants by causing a significant increase in the anxiolytic dose. Therefore, separation of these parts is recommended prior to any pharmacological, phytochemical and standardization studies on P. incarnata.

Anti-anxiety studies on extracts of Passiflora incarnata Linneaus.

Passiflora incarnata Linn. has been used to cure anxiety and insomnia since time immemorial. Despite the worldwide use of P. incarnata, the pharmacological work on this plant had been inadequate, inconclusive and wage as the earlier reports were unable to infer the mode of action of the plant as well as the phytoconstituents responsible for the much acclaimed anxiolytic and sedative effects of P. incarnata. An attempt has been made to isolate and identify the bioactive phytomoiety of P. incarnata by resorting to bioactivity directed fractionation and chromatographic procedures. A fraction derived from the methanol extract of P. incarnata has been observed to exhibit significant anxiolytic activity at a dose of 10 mg/kg in mice using elevated plus-maze model of anxiety. This fraction comprises mainly two components which are visible as blue and turquoise colored fluorescent spots at 366 nm of the UV light. The possibility of a phytoconstituent having benzoflavone nucleus as the basic moiety being responsible for the bioactivity of P. incarnata is highly anticipated.

Comparative biological activity study on Passiflora incarnata and P. edulis.

The correct identity of Passiflora incarnata and P. edulis was recently established using various parameters. To strengthen these findings, the anxiolytic activity of these two controversial plants has been comparatively investigated. The methanol extract of P. incarnata exhibited significant anxiolytic activity at an oral dose of 125 mg/kg, whereas P. edulis was devoid of any significant activity.

Herbal medicines: current trends in anesthesiology practice--a hospital survey.

STUDY OBJECTIVES: To develop a simple survey to determine the patient population actively utilizing dietary supplements and/or herbs, during the preoperative period. DESIGN: Prospective study, with survey instrument. SETTING: University medical center. PATIENTS: 1,017 patients presenting for preanesthetic evaluation prior to outpatient surgery. INTERVENTIONS: After undergoing preanesthetic evaluation, patients were asked to complete a survey listing which of the nine most popular nutraceuticals currently available on the market they were using. MEASUREMENTS AND MAIN RESULTS: A total of 1017 surveys were submitted over a period of five months, with 32% being poorly completed and thus discarded. Of the remaining 755 valid surveys, 482 patients used at least one nutraceutical agent. 90% of these patients were using vitamins, 43% garlic extracts, 32% Gingko Biloba, 30% St. John's Wort, 18% Ma Huang, 12% Ecchinaceae, 10% Aloe, 8% Cascare, 3% licorice. CONCLUSION: A significant population of patients scheduled for an elective surgical procedure are self-administering nutraceutical agents. Some of these agents have the potential to cause serious drug interactions and hemodynamic instability during surgery. Hence, it may be important to identify patients self-administering these medications, during the preoperative period.

Morphine-induced straub tail response: mediated by central mu2-opioid receptor.

The opioid receptor mechanism involved in the morphine induced straub tail response was investigated in mice. Morphine (2.5, 5, 10 and 20 mg/kg s.c.) produced a dose dependent straub tail response and analgesia (hot plate test). Naloxone (5 mg/kg s.c.) and the mu-opioid receptor antagonist beta-funaltrexamine (10 micrograms i.c.v.) blocked both the straub tail response and analgesia while the mu 1-opioid receptor selective antagonist naloxonazine (35 mg/kg s.c.) blocked only analgesia and did not affect the straub tail response. Morphine (20 micrograms) administered by the i.c.v. route also produced the straub tail response as well as analgesia. Pretreatment with naloxonazine (35 mg/kg s.c.) antagonised i.c.v. administered morphine induced analgesia while the straub tail response was not affected. The results indicate that the morphine induced straub analgesia while the straub tail response was not affected. The results indicate that the morphine induced straub tail response is mediated by central mu 2-opioid receptors.

Hepato protective effect of Liv-52 against CCl4 induced lipid peroxidation in liver of rats.

Effect of oral feeding of Liv-52, on lipid peroxidation in normal liver and damaged liver induced by CCl4 of albino rats was studied. While Liv-52 did not show any effect on normal healthy liver cells, it had a significant protective effect against damage by CCl4 as shown by significant decrease in malonaldialdehyde content.

Modification of reserpine-induced emetic response in pigeons by alpha 2-adrenoceptors.

In the present study, an attempt has been made to elucidate the role of alpha 2-adrenoceptors in reserpine-induced emesis in pigeons. Reserpine was found to induce dose-dependent emesis and a 500 micrograms kg-1 dose was found to be the 100% emetic dose. alpha 2-adrenoceptor agonists clonidine and alpha-methylnoradrenaline inhibited the reserpine induced emesis. Out of the two selective alpha 2-adrenoceptor antagonists idazoxan and yohimbine, only the latter induced a dose-dependent emesis. However, both the drugs potentiated reserpine-induced emesis and antagonised its inhibition by clonidine. Prior depletion of monoamines by reserpine also blocked the emetic response of reserpine. These observations indicate that release of monoamines is responsible for its emetic response in pigeons which is modulated by presynaptic alpha 2-adrenoceptors in a predictable manner.

Nutrient composition and electrophoretic pattern of protein in two distinct types of phalsa (Grewia subinequalis DC).

Two distinct types, i.e. tall and dwarf types of phalsa, were studied for the differences in their physical parameters, chemical compositions and electrophoretic patterns of seed proteins by SDS-PAGE. The two types did not show any remarkable variation in their fruit weight, edible portion, seed weight and juice yield. Tall type had higher content of reducing sugars whereas total and non-reducing sugars were higher in drawf one. Qualitative analysis revealed the presence of sucrose and fructose in both the types whereas glucose was present only in tall one. Observed marked variations in the protein content of the fruit could be due to the differences in protein content of the seed rather than that of the pulp. Electrophoretic pattern of seed proteins revealed the complete absence of two protein bands of molecular weight 37, and 59 kD from the dwarf type.

Seed protein fractions and amino acid composition in gram (Cicer arietinum).

Six chickpea strains were analysed for their protein content and various protein fractions. The protein content ranged from 20.9-25.27%. Albumin, globulin, prolamin and glutelin contents ranged from 8.39-12.31%; 53.44-60.29%; 3.12-6.89% and 19.38-24.40% respectively. Salt soluble proteins (albumin + globulin) and globulins resolved into 19-23 bands whereas albumin proteins resolved into 30-34 bands. The molecular weights of various polypeptides ranged from 10-91 kD. Amino acid analysis of total proteins revealed that glutamic acid was present in maximum concentration followed by aspartic acid and arginine. Just like other pulse proteins, chick pea proteins were also found deficient in sulphur containing amino acids.

Evidence for a central component in the cardiovascular effects of calcium channel blockers.

The possibility of a central component in the cardiovascular effects of peripherally administered calcium channel blockers has been explored through a comparison of the effects observed after intravenous (i.v.) and intracisternal (i.c.) administration of verapamil and diltiazem in chloralose-anesthetized and artificially ventilated cats. Both agents produced relatively greater effects after i.c. than after i.v. administration. The bradycardiac effect following i.c. as well as i.v. administration was totally abolished by bilateral cervical vagotomy, and the hypotensive effect was attenuated by this procedure. The results strongly suggest the existence of a central component in the cardiovascular effects of both agents.

Protection against gastric ulcer by verapamil.

The effect of verapamil, a calcium channel blocker, was studied against stress (cold restraint), aspirin and pylorus ligation induced gastric ulcers in rats. Verapamil inhibited ulcerogenic response and ulcer index in all the three types of ulcers. Verapamil also decreased total and free gastric acidity without changing gastric secretory volume.

Role of central histaminergic mechanism in behavioural depression (swimming despair) in mice.

The role of the central histaminergic system in depression was studied by using swimming despair test in mice - a behavioural model of depression. In this test, immobility of mice reflects a state of depression. Intracerebral (ic) injection of histamine (50-200 micrograms) increased significantly the immobility. The H1-receptor blocker mepyramine (2.5-20 mg/kg ip) had no effect while H2-receptor blocker cimetidine (100-200 micrograms ic) caused a significant decrease in immobility. The histamine induced facilitation was blocked completely by cimetidine and antidepressant drugs-imipramine and desipramine, but remained unaffected in mice pretreated with mepyramine or atropine. The H2 agonist impromidine (20-40 micrograms ic) also enhanced significantly, the immobility which was blocked by cimetidine and antidepressant drugs. It has been concluded that central H2-receptors facilitate depression and antidepressant drugs block central H2-receptors.

On the mechanism of potentiation of apomorphine-induced stereotypy due to electroconvulsive shock.

Electroconvulsive shock-induced changes in the intensity of stereotype induced by apomorphine, the binding of [3H]spiroperidol in the corpus striatum, the accumulation of [3H]dopamine in brain and the permeability of the blood-brain barrier, were monitored in rats 30 min after single, or 24 hr after chronic (once daily for 7 days) electroconvulsive shock. There was significant potentiation in stereotypy induced by apomorphine after chronic electroconvulsive shock. The binding of [3H]spiroperidol did not show any change in the affinity (Kd) or density (Bmax) of receptors in the striatum after acute or chronic electroconvulsive shock. The accumulation of dopamine increased significantly in the hypothalamus after acute electroconvulsive shock and in the corpus striatum and hypothalamus after chronic electroconvulsive shock. A significant increase in the entry of sodium fluorescein into the hypothalamus occurred after acute electroconvulsive shock; it increased in all the regions of the brain after chronic electroconvulsive shock. Alteration in the blood-brain barrier (BBB) by electroconvulsive shock leading to increased accumulation of dopamine in the corpus striatum may be responsible for the potentiation of stereotypy.

Evidence for the involvement of histamine in the regulation of blood-brain barrier permeability.

Role of histaminergic mechanisms in the regulation of blood-brain barrier (BBB) was assessed in dog. Histamine increased the entry of sodium fluorescein from the blood to the cerebrospinal fluid (CSF) in a dose-dependent manner. Histamine receptor antagonists, mepyramine (H1) and metiamide (H2) per se did not affect the entry of dye in the CSF. Mepyramine failed to affect the change induced by histamine whereas metiamide completely blocked the histamine-induced entry of sodium fluorescein in CSF. 2-Methyl histamine, a specific H1-agonist, did not affect the barrier permeability. However, 4-methyl histamine, a specific H2 receptor agonist significantly increased the permeability of BBB. This increase was blocked by metiamide. Forskolin, a stimulant of adenylate cyclase, also increased the entry of dye in the CSF which could be significantly blocked by metiamide. It is concluded that histamine increases the permeability of BBB by affecting H2-receptors linked to adenylate cyclase.

Effect of alcohols on the permeability of blood-brain barrier.

Effect of alcohols on the permeability of blood-brain barrier was studied in anaesthetised dogs using sodium fluorescein as circulant. Entry of sodium fluorescein in the cerebrospinal fluid (CSF) was measured spectrophotofluorometrically. Methyl, ethyl, propyl and butyl alcohols were used in the study. Methyl alcohol did not increase the entry of sodium fluorescein in CSF compared to control. However, ethyl, propyl and butyl alcohols significantly increased the entry of sodium fluorescein. The increase was dependent upon the length of alkyl chain of alcohols. Longer was the aliphatic chain more marked was the effect. The increase in permeability was also dependent upon the concentration of the alcohol. Thus 90% ethyl alcohol was more effective than 30% and this effect was concentration-dependent. The increase in permeability of blood-brain barrier could be correlated to the lipid solubility of alcohols.