Early Effect of Metabolic Surgery on Erectile Function and Ejaculation: a Pilot Study of Obese Men with Type 2 Diabetes Mellitus.

PURPOSE: Majority of men with type 2 diabetes mellitus (T2DM) have been reported to experience erectile dysfunction (ED) in a lifetime. The aim of our study was to prospectively evaluate the postoperative condition of ED and premature ejaculation (PE) in men who underwent metabolic surgery for the treatment of T2DM. MATERIALS AND METHODS: A total of 36 sexually active male individuals with T2DM who were applied for metabolic surgery were given two different questionnaire forms prior to and 6 months after the surgery. Patients filled the International Index of Erectile Function (IIEF) and the Premature Ejaculation Profile (PEP) questionnaires before and 6 months after the surgery. The BMI, fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) concentrations were also measured prior to the surgery and on follow-up points of postoperative first, third, and sixth months. RESULTS: Erectile function (EF) and overall satisfaction domains of the IIEF questionnaire increased significantly after the surgery in the patient groups irrespective of the previous ED severity (p < 0.001). There were significant improvements of the PEP interpersonal difficulty related to ejaculation score and HbA1c levels in the severe/moderate EF group and IIEF EF, PEP interpersonal difficulty related to ejaculation domains, and HbA1c levels of mild to moderate/mild/no ED group after the metabolic surgery. CONCLUSION: Metabolic surgery could improve erectile and ejaculatory function scores of obese patients with T2DM.

Effects of Sleeve Gastrectomy with Transit Bipartition on Glycemic Variables, Lipid Profile, Liver Enzymes, and Nutritional Status in Type 2 Diabetes Mellitus Patients.

BACKGROUND: Sleeve gastrectomy with transit bipartition (SG + TB) surgery is an effective treatment modality for the patients with type 2 diabetes mellitus (T2DM). Here, we aimed to present the 1-year follow-up data of our patients with T2DM who underwent SG + TB. METHODS: We evaluated the follow-up results of 45 patients and evaluated the remission status of T2DM. Additionally, biochemical variables including lipid status, liver function and nutritional status were presented. RESULTS: A total of 40 T2DM remissions occurred among the 45 patients (88.8%). The complete remission was present in 35 of the patients at the end of the postoperative first year. The lipid profile markers improved following the first postoperative month. The levels of the liver enzyme alanine aminotransferase (ALT) decreased after the first postoperative month, while aspartate aminotransferase (AST) levels did not alter significantly during the follow-up period. We did not observe a change regarding albumin and vitamin B12 levels following the surgery. CONCLUSION: SG + TB is a convenient and therapeutic method for the treatment of T2DM, along with the improvement in lipid profile and liver enzyme levels.

Neurological Complication After Laparoscopic Sleeve Gastrectomy: Foot Drop.

BACKGROUND: The relationship between rapid weight loss and peroneal nerve entrapment neuropathy (PNEN) was shown in various series following bariatric surgery. Thus, we aimed to determine the occurrence of PNEN in our patients who underwent laparoscopic sleeve gastrectomy (LSG) and to reveal the factors contributing to this complication. METHODS: We evaluated our series of 635 patients in terms of neurological symptoms following laparoscopic sleeve gastrectomy, retrospectively. We recorded the preoperative data, laboratory vitamin and nutrient levels, weight loss, electromyography (EMG) findings, and treatment modalities of these patients. RESULTS: Seven out of 635 patients developed foot drop as a result of PNEN after bariatric surgery. The mean total weight loss for these patients was 50.6 kg in 6 months, and 63 kg in 12 months. In the laboratory analyses, we did not detect any signs of vitamin deficiency. EMG findings confirmed the diagnosis. CONCLUSION: We demonstrate that rapid weight loss is correlated with the risk of foot drop incidence as a result of PNEN.

Time to Glycemic Control - an Observational Study of 3 Different Operations.

BACKGROUND: Medical treatment fails to provide adequate control for many obese patients with type 2 diabetes mellitus (T2DM). A comparative observational study of bariatric procedures was performed to investigate the time at which patients achieve glycemic control within the first 30 postoperative days following sleeve gastrectomy (SG), mini-gastric bypass (MGB), and diverted sleeve gastrectomy with ileal transposition (DSIT). METHODS: Included patients had a body mass index (BMI) ≥30 kg/m2; T2DM for ≥3 years, HbA1C > 7 % for ≥3 months, and no significant weight change (>3 %) within the prior 3 months. Surgical procedures performed were SG (n = 49), MGB (n = 93), and DSIT (n = 109). The primary endpoint was the day within the first postoperative month on which mean fasting capillary glucose levels reached <126 mg/dL. Multivariate logistic regression analysis was used to identify predictors of glycemic control. RESULTS: The cohort included 251 patients with a mean BMI of 36.04 ± 5.76 kg/m2; age, 52.84 ± 8.52 years; T2DM duration, 13.09 ± 7.54 years; HbA1C, 8.82 ± 1.58 %. On the morning of surgery, mean fasting plasma glucose was 177.63 ± 51.3 mg/dL; on day 30, 131.35 ± 28.7 mg/dL (p < 0.05). Mean fasting plasma glucose of <126 mg/dL was reached in the DSIT group (124.36 ± 20.21 mg/dL) on day 29, and in the MGB group (123.61 ± 22.51 mg/dL), on day 30. The SG group did not achieve target mean capillary glucose level within postoperative 30 days. CONCLUSION: During the first postoperative month, glycemic control (<126 mg/dL) was achieved following DSIT and MGB, but not SG. Preoperative BMI and postprandial C-peptide levels were independent predictors of early glycemic control following DSIT.

Effects of different metabolic states and surgical models on glucose metabolism and secretion of ileal L-cell peptides: protocol for a cross-sectional study.

INTRODUCTION: Obesity and type 2 diabetes mellitus are increasing worldwide, reaching pandemic proportions. The understanding of the role of functional restriction and gut hormones can be a beneficial tool in treating obesity and diabetes. However, the exact hormonal profiles in different metabolic states and surgical models are not known. METHODS AND ANALYSIS: The HIPER-1 Study is a single-centre cross-sectional study in which 240 patients (in different metabolic states and surgical models) will receive an oral mixed-meal tolerance test (OMTT). At baseline and after 30, 60 and 120 min, peptide YY and glucagon-like peptide 1 levels and glucose and insulin sensitivity will be measured. The primary end point of the study will be the area under the glucagon-like peptide 1 and peptide YY curves after the OMTT. Secondary study end points will include examination of the difference in plasma levels of the distal ileal hormones in subjects with various health statuses and in patients who have been treated with different surgical techniques. ETHICS AND DISSEMINATION: An independent ethics committee, the Institutional Review Board of Istanbul Sisli Kolan International Hospital, Turkey, has approved the study protocol. Dissemination will occur via publication, national and international conference presentations, and exchanges with regional, provincial and national stakeholders. TRIAL REGISTRATION NUMBER: NCT02532829; Pre-results.

Nodular Fasciitis of the Breast Previously Misdiagnosed as Breast Carcinoma.

BACKGROUND: Nodular fasciitis of the breast is a rare benign pathology that can mimic breast cancer clinically, radiologically, and histopathologically. CASE REPORT: An 18-year-old female patient had first visited a physician in a different center with the complaint of a lump in her left breast. Breast examination had revealed a palpable mass located in the left upper outer quadrant. Ultrasonography had demonstrated a hypoechoic lesion. Excisional biopsy of the lump had been performed and histopathologic examination misdiagnosed this lump as a mesenchymal tumor. The patient was then referred to our clinic for further investigations. Pathologic revision was performed and the diagnosis of nodular fasciitis of the breast was established. CONCLUSION: Awareness of this rare clinical entity, nodular fasciitis, in the breast eliminates the misdiagnosis of breast cancer.