Changes in ghrelin levels following bariatric surgery: review of the literature.

Obesity is a severe health issue that is a global epidemic. Bariatric surgery is an accepted, popular, and effective therapy for weight loss. Ghrelin, a peptide secreted primarily by the fundus cells of the stomach, has been found to impact body weight by its influence on appetite. Although numerous studies have investigated serum ghrelin levels following bariatric surgery, there is no solid agreement yet as to the direction or magnitude of its change, or even its impact on weight loss. Some studies have found an increase in ghrelin, some have found a decrease, and others have found no change in ghrelin following bariatric surgery. The purpose of this review was to establish the impact of ghrelin changes following bariatric surgery.

Influence of sex on lung cancer histology, stage, and survival in a midwestern United States tumor registry.

BACKGROUND: A study was performed to identify differences between men and women with regard to lung cancer type, stage at diagnosis, and survival in a single hospital system cancer registry. PATIENTS AND METHODS: A retrospective cohort study was designed based on a study population drawn from the lung cancer tumor registry at a single hospital system composed of 2 independent hospitals in the Midwestern United States. This database included all patients from 1996 to 2002 with known lung cancer or abnormal findings on chest radiography or computed tomography (N=2618). Patients with adenocarcinoma or squamous cell, small-cell, or large-cell carcinoma were included in the study. Data were collected on patient sex, age, cancer type, stage at diagnosis, and survival status. RESULTS: A total of 1216 men and 997 women met inclusion criteria for the study. There was no significant difference in age between sexes at diagnosis. Women were significantly more likely to have adenocarcinoma or small-cell carcinoma but less likely to have squamous cell carcinoma compared with men. There were no significant differences between sexes in the incidence of large-cell carcinoma. No significant differences were found between men and women in terms of cancer stage at diagnosis. There were significant differences in survival between the histologic types at years 3, 4, and 5. Only patients with stage I disease showed a difference between sexes and only for years 2, 3, 4, and 5. CONCLUSION: Overall differences in lung cancer histology and survival were found between men and women. Because a high mortality rate of lung cancer exists in both sexes, it is important to understand its occurrence and survival rates in both sexes.

Cardiac surgery in octogenarians: does age alone influence outcomes?

HYPOTHESIS: Outcome differences in octogenarians vs patients younger than 80 years undergoing coronary artery bypass grafting or valve surgery can be analyzed to isolate the effect of age alone on morbidity and mortality. DESIGN: Eight-year hospitalization cohort study. Physicians, nurses, and perfusionists prospectively collected data on 225 variables. SETTING: Community hospital. PATIENTS: A consecutive sample of 7726 patients undergoing coronary artery bypass grafting or valve surgery between October 1, 1993, and February 28, 2001. MAIN OUTCOME MEASURES: There were 9 main outcomes of interest: mortality, length of hospital stay, gastrointestinal tract complications, neurologic complications, pulmonary complications, renal complications, return to intensive care unit, intraoperative complications, and reoperation to treat bleeding. We controlled for 16 potential confounding variables to isolate outcome differences according to age. RESULTS: Of 7726 patients who fit the inclusion criteria, 522 were octogenarians. Compared with nonoctogenarians, octogenarians had a significantly higher New York Heart Association functional classification, higher incidence of hypertension, and underwent a greater number of coronary artery bypass grafting plus valve surgical procedures (P<.05). They also had significantly lower body surface area, fewer total number of grafts used, less history of tobacco use, and less abnormal left ventricular hypertrophy, and there were fewer nonwhite patients and fewer men. At multivariate analysis, octogenarians had a higher risk for death (relative risk [RR], 1.72; 95% confidence interval [CI], 1.52-1.83), longer hospital stay (RR, 1.03; 95% CI, 1.01-1.04), more neurologic complications (RR, 1.51; 95% CI, 1.26-1.67), and were more likely to undergo a reoperation to treat bleeding (RR, 1.49; 95% CI, 1.09-1.72). Univariate analyses revealed no difference between octogenarians and nonoctogenarians for diabetes mellitus, urgency of procedure, prior myocardial infarction, time since last myocardial infarction, cerebrovascular history, chronic obstructive pulmonary disease, or pump time. CONCLUSIONS: Age alone has been shown to influence outcomes after cardiac bypass or valve surgery. Octogenarians undergoing cardiac surgery have more comorbidities and higher mortality even after controlling for 16 potential confounding variables, compared with nonoctogenarians.

Coronary artery bypass grafting in patients with dialysis-dependent end stage renal disease: a prospective, nested case-control study.

OBJECTIVE: To assess if coronary artery bypass grafting (CABG) patients with dialysis-dependent end stage renal disease (ESRD) experience greater intraoperative and postoperative morbidity and mortality compared to CABG patients without ESRD. METHODS: We conducted a nested case-control study from an 8-year hospitalization cohort in which data were collected prospectively. Inclusion criteria included CABG surgery and age greater than 18 years. Cases were patients with dialysis dependent ESRD (N = 28) and controls were patients without ESRD (N = 84). Cases were matched to controls 1:3 on age, gender, tobacco history, and New York Heart Association Functional Class. The outcomes of interest were mortality, intensive care unit length of stay, total length of hospitalization, time on the ventilator, wound complications, pulmonary complications, neurological complications, gastrointestinal complications, arrhythmia, and intraoperative complications. Using logistic regression we controlled for 13 potential confounding variables. RESULTS: There were no significant differences between the groups with the exception of total length of hospitalization. Patients with dialysis-dependent ESRD had a significantly longer total hospitalization stay (21%) than patients without ESRD. There were no significant differences for the remaining nine outcomes of interest, including perioperative morbidity or mortality. CONCLUSION: Intraoperative and postoperative morbidity and mortality for CABG were not increased for patients with dialysis-dependent ESRD compared to patients without ESRD. However, patients on dialysis undergoing CABG experienced a greater length of hospitalization than patients undergoing CABG who were not on dialysis.

Radiofrequency ablation of the porcine liver with complete hepatic vascular occlusion.

BACKGROUND: We studied the effects of radiofrequency ablation, relative to hepatic blood flow, on the volume and shape of the resulting tissue necrosis. The extent of necrosis is directly proportional to the size of the electrode and inversely related to blood flow, which dissipates the heat generated. METHODS: Two areas of necrosis were created in each of eight porcine livers, which were assigned to four groups according to blood flow occlusion: no occlusion, occlusion of the hepatic artery and portal vein, occlusion of the hepatic veins, and complete hepatic vascular occlusion. After 25 minutes of liver reperfusion, the animals were euthanized, and the livers were examined. RESULTS: Complete vascular occlusion resulted in the greatest area of necrosis (28.6 +/- 3.4 cm(3)), followed by occlusion of the hepatic artery and portal vein (19.2 +/- 5.9 cm(3)), occlusion of hepatic veins (14.4 +/- 2.6 cm(3)), and no occlusion (4.9 +/- 1.5 cm(3)). The volume of the necrotic areas created during complete vascular occlusion were significantly greater than those created with no occlusion, as well as those created with only the hepatic artery and portal vein occluded (P <.05). CONCLUSIONS: Complete vascular occlusion, combined with radiofrequency ablation, increases the volume of necrosis and creates a more spherical ablative area.

The influence of gender of the surgeon on surgical procedure preference for breast cancer.

There are few data in the literature with regard to the influence of surgeon gender and the treatment of breast cancer. In this retrospective review we propose to test the hypothesis that male surgeons are just as likely as female surgeons to provide breast-conservative treatment. From 1990 through 1997 2271 women with breast cancer in Cincinnati, Ohio were operated on by surgeons within the TriHealth Corporation. We compared the performance rate of breast conservation therapy (BCT) with the rate of mastectomy in early-stage breast cancer patients between male and female surgeons. Male surgeons were significantly more likely to provide their patients with breast-conserving treatment than their female colleagues for stages 0 and IIb (P < 0.05). Although male surgeons performed more BCT than female surgeons for stages I and IIa the difference was not statistically significant. For the three stages combined there was a 30 per cent greater chance of a patient receiving breast-conserving treatment if she went to a male surgeon (P < 0.05). We conclude that in our institution male surgeons are no more likely to select mastectomy than their female colleagues and there appears to be an increased use of BCT by male surgeons.