Ligasure impact™ might reduce blood loss, complications, and re-operation occurrence after abdominoplasty in massive-weight-loss patients: A Comparative Study.

BACKGROUND AND AIMS: The most effective dissection technique for raising the flap in abdominoplasty is still controversial, particularly in high-risk massive-weight-loss patients. LigaSure Impact™ vessel-sealing system (Medtronic, Dublin, Ireland) is an energy device commonly used among different surgical specialties to reduce morbidity and implement outcomes. The aim of this study was to investigate the effectiveness of LigaSure Impact in abdominoplasty compared with the conventional techniques, diathermia. MATERIAL AND METHODS: Patients underwent primary abdominoplasty after massive weight loss at a single center from 1 January 2008 to 31 May 2015 and were retrospectively reviewed. A total of 94 patients eligible for the study were divided into two groups on basis of the dissection technique: LigaSure Impact group (29 patients) and the conventional technique group (65 patients). Total intraoperative blood loss was the primary endpoint. Duration of the operation, perioperative complications and re-operation were recorded as secondary endpoints. RESULTS: Baseline characteristics were well balanced between the groups. Significant differences were found in intraoperative blood loss favoring LigaSure Impact group (259.6 ± 198.8 mL vs 377.9 ± 190.0 mL, p = 0.004) and blood transfusion rates (13.8% vs 35.4%, p = 0.047). In contrast, operative time was significantly longer in LigaSure Impact group (168.6 ± 121.2 vs 179.7 ± 57.6 min, p = 0.005), while a tendency to shorter hospital stay was found in LigaSure Impact group (3.6 ± 1.1 days vs 4.6 ± 3.2 days, p = 0.081). Overall complications occurrence, Clavien-Dindo grade II (24.1% vs 55.4%) and grade III (13.8% vs 30.8%) complications were significantly lower in LigaSure Impact group (respectively, p = 0.005, p = 0.007, p = 0.016). Late (>30 days) re-operation rate was significantly lower in the LigaSure Impact group (6.9% vs 27.70%, p = 0.0028). Specific wound complications showed no significant difference. CONCLUSION: LigaSure Impact vessel-sealing system may be beneficial in improving abdominoplasty outcomes in massive-weight-loss patients because it might reduce blood loss, need for transfusions, complications, and re-operations.

Drinking and unemployment: contrasting patterns among men and women.

Research on unemployment has paid only little attention to drinking and drinking problems. From the 1970s onwards the association of drinking and unemployment has come under systematic study. Contrasting tendencies emerge from this research. This paper distinguishes three instances of drinking and drinking problems and examines their association with employment status, i.e., (i) frequency of drinking, (ii) frequency of intoxication, and (iii) frequency of health problems due to drinking. A panel survey was conducted in 1983-1984, consisting of a sample of Finnish men and women, originally jobseekers in industry. Prevalence data and results of logistic regression analyses on the association of the three instances of drinking and drinking problems with employment status are presented. The frequency of drinking was unassociated with employment status for men and women at either of the two measurement points. Neither did the frequency of intoxication show any clear association with employment status. In contrast, the frequency of health problems due to drinking was associated in a statistically significant way with unemployment among men. Among women the association was rather the opposite, but it was not statistically significant. The paper concludes that it is important to distinguish between overall drinking and drinking problems, and between the determinants of male and female drinking problems. It is likely that selective processes at the labour market as well as social causation during unemployment lie behind the observed association of male unemployment and drinking problems.

Serum lipid concentrations in subjects with phenylketonuria and their families.

To determine if subjects with phenylketonuria receiving diets significantly lower in cholesterol and saturated fat had serum lipid concentrations different from those of their family members, we measured serum concentrations of total cholesterol, high-density lipoprotein cholesterol, and total triglycerides in the probands with phenylketonuria, their parents, and their siblings. Eleven adults (seven women and four men) and 16 children (eight girls and eight boys) were studied. Ten subjects (four girls and six boys) had phenylketonuria. Subjects with phenylketonuria consumed less cholesterol (0.02 vs 0.41 mmol/d) and fat (median, 21% vs 39.5% of total calories), and their diets had a higher ratio of polyunsaturated to saturated fatty acids (median, 2.0 vs 0.2) than did their siblings without phenylketonuria. The diet of the parents was similar to that of their offspring without phenylketonuria. No differences were noted between the subjects with phenylketonuria (consuming a diet lower in saturated fat and cholesterol) and their siblings without phenylketonuria in serum concentrations of total cholesterol (median, 3.34 vs 3.07 mmol/L); high-density lipoprotein cholesterol (median, 1.44 vs 1.37 mmol/L); low-density lipoprotein cholesterol (median, 1.44 vs 1.09 mmol/L); or triglycerides (median, 0.89 vs 0.54 mmol/L). We conclude that previously reported lipoprotein abnormalities noted between unrelated subjects with and without phenylketonuria may not be due to differences in dietary intake, but rather due to a (genetic) predisposition of the population with phenylketonuria toward lower serum lipid concentrations.