ABSTRACT
Background. Nonalcoholic fatty liver disease is present in up to 85% of adipose patients and may proceed to nonalcoholic steatohepatitis (NASH). With insulin resistance and obesity being the main risk factors for NASH, the effect of isolated sleeve gastrectomy (ISG) on these parameters was examined. Methods. 236 patients underwent ISG with intraoperative liver biopsy from December 2002 to September 2009. Besides demographic data, pre-operative weight/BMI, HbA1c, AST, ALT, triglycerides, HDL and LDL levels were determined. Results. A significant correlation of NASH with higher HbA1c, AST and ALT and lower levels for HDL was observed (P < .05, <.0001, <.0001, <.01, resp.). Overall BMI decreased from 45.0 ± 6.8 to 29.7 ± 6.5 and 31.6 ± 4.4 kg/m(2) at 1 and 3 years. An impaired weight loss was demonstrated for patients with NASH and patients with elevated HbA1c (plateau 28.08 kg/m(2) versus 29.79 kg/m(2) and 32.30 kg/m(2) versus 28.79 kg/m(2), resp.). Regarding NASH, a significant improvement of AST, ALT, triglyceride and HDL levels was shown (P < .0001 for all). A resolution of elevated HbA1c was observed in 21 of 23 patients. Summary. NASH patients showed a significant loss of body weight and amelioration of NASH status. ISG can be successfully performed in these patients and should be recommended for this subgroup.
ABSTRACT
A study was made of 76 patients with subclavian vessel injury. The mechanism of trauma was stabbing in 40 patients (53 per cent) and gunshot in 36 (47 per cent). There were marked differences between the two groups in clinical presentation, operative management and outcome. The group with gunshot injury was characterized by a more immediate threat to life, and a greater need for a median sternotomy and use of interposition grafts. The mortality rate in patients with gunshot wounds was more than twice that in the group with stab injury.
Subject(s)
Subclavian Artery/injuries , Subclavian Vein/injuries , Wounds, Gunshot/surgery , Wounds, Stab/surgery , Adult , Female , Humans , Male , Retrospective Studies , Treatment Outcome , Wounds, Gunshot/mortality , Wounds, Stab/mortalityABSTRACT
This study comprises 74 patients with penetrating injuries of the duodenum. Sixty-three of these had sustained gunshot wounds, many of which were high velocity. The change in the incidence and the severity of the gunshot injuries within the last few years resulted in changes in the operative management of the duodenal wound with gradually improving results. When pyloric exclusion was added to the operative management of grade III duodenal injuries, the postoperative leakage rate was 12%. When only primary repair was done, the leakage rate was 43%. We suggest that pyloric exclusion be added to the treatment of most severe grade II and all grade III gunshot duodenal injuries. The adequacy of primary repair and pyloric exclusion in grade IV injuries requires further study.
Subject(s)
Duodenum/injuries , Duodenum/surgery , Pylorus/surgery , Wounds, Penetrating/surgery , Adult , Female , Humans , Male , Methods , Retrospective Studies , Wounds, Gunshot/surgeryABSTRACT
Authors relate their experience of six cases of acute acalculous cholecystitis (4 postoperative, 2 posttraumatic and postoperative). Five cases were correctly diagnosed preoperatively and another case was operated on the basis of a high index of suspicion. Acute acalculous cholecystitis is often misdiagnosed and its frequency is probably higher than suspected. Associated diseases, the natural history of the disease as well as delayed diagnosis explain its poor prognosis. The diagnosis of acute acalculous cholecystitis should be routinely ruled out in high risk patients (polyoperated, polytraumatised) in order to improve the mortality rate. Ultrasonography and biliary scintigraphy are useful for the diagnosis in high risk patients. Emergency cholecystectomy is still the best long term treatment.
