Revisional bariatric surgery.

BACKGROUND: Revisional surgery is required in a significant number of patients because of failure to lose weight, loss of quality of life, weight regain, or complications of the previous procedure. It has traditionally been associated with higher complication rates, and there appears to be no standardized surgical approach to revisional surgery. The aim of the study was to review the revisional procedures performed at St George Private Hospital and analyze the outcomes of the different types of revisional surgery. METHODS: We performed a retrospective review of 75 patients who underwent revisional surgery between December 2003 and October 2007. Demographic, anthropometric, perioperative, and clinical follow-up data were collected, and statistical analyses were performed using SPSS version 14.0. RESULTS: Sixty-six of the 75 patients were female. The mean age at the time of revision was 46.32 (22-68) years. Mean initial weight was 119.08 kg, and body mass index (BMI) was 43.42 kg/m(2). The lowest BMI and excess weight loss (EWL) recorded after primary surgery was 36.9% and 53.5%, respectively. At the time of revision, the mean EWL was 24.79. The EWL at 3 months and 6 months were 41.7% and 47.8%, respectively. Revision was performed laparoscopically in 51 patients and via laparotomy in 24 patients. There was no mortality in the cohort, but there were 17.3% minor and 4.0% major perioperative morbidities. CONCLUSION: Our study suggests that revision can be performed safely. Weight loss is satisfactory, and complications of the previous operations were all reversed. Furthermore, revisions may be done laparoscopically, including those who had previous open procedures.

Total dorsal pancreatectomy for intraductal papillary mucinous neoplasm in a patient with pancreas divisum.

We report a case of intraductal papillary mucinous neoplasm confined to the dorsal (Santorini) pancreatic duct. A 51-year-old woman presented with a cystic lesion in the head of her pancreas and pancreas divisum. A biopsy taken during cyst-enteric drainage revealed dysplastic epithelium so the patient was scheduled for resection. At operation, excision of the entire dorsal pancreas was performed with preservation of the unaffected ventral pancreas and the spleen and its vessels. Over 6 years later she remains well with stable weight and a good quality of life. This case illustrates the benefits of anatomical preservation in pancreatic resection, and was performed some years prior to the only other reported similar case.

Hepatic portal vein gas as a complication of cryotherapy.

BACKGROUND: Hepatic portal vein gas (HPVG) is a radiological finding normally associated with life-threatening conditions such as mesenteric ischaemia and necrotising enterocolitis in infants. Its presence has previously been associated with a high mortality rate. As a result of more sensitive imaging modalities the spectrum of conditions for which portal vein gas is detected has broadened. We present a patient who developed HPVG as a complication of cryotherapy. The association between portal vein gas and cryotherapy has not previously been described in well over one thousand patients with hepatic cryotherapy reported in the literature.

Gastroduodenal ulceration following hepatic arterial chemotherapy: the role of methylene blue endoscopy in the investigation of pain.

BACKGROUND: Unintended perfusion of the gastroduodenum may complicate hepatic arterial chemotherapy leading to mucosal ulceration. PATIENTS AND METHODS: In a review of 233 consecutive hepatic artery catheters placed, 61 patients were investigated for chemotherapy-related epigastric pain. Investigations included catheter imaging, upper gastrointestinal endoscopy with methylene blue injection via the hepatic artery catheter and angiography. RESULTS: Twenty patients (33%) demonstrated blue staining of the gastroduodenum. Angiography performed in 15 of these patients confirmed a misperfusing vessel in 13.The aberrant artery was successfully embolised and infusional chemotherapy recommenced in 11 patients. Forty-one patients had a negative dye test, of whom three had gastroduodenal ulcers, 14 had oesophagitis or gastroduodenitis, ten had catheter complications (leak n=2, arteritis n=5, pseudoaneurysm n=1, sepsis n=1), three had liver collections, five had floxuridine cholangitis and one had myocardial ischaemia. No cause could be found in 8 patients. No patient with a negative dye test developed unintended perfusion on repeat investigation.

Cognitive styles of students with cerebral palsy.

Cognitive style is frequently described in terms of performance on the Matching Familiar Figures Test. Because this test has a heavy visual perceptual loading its usefulness as a measure of cognitive style with cerebral palsied students, a population frequently characterized by ocular anomalies and visual perceptual deficits, may be questioned. The test and standardized tests of visual perception and motor accuracy were administered to 46 cerebral palsied students of normal intelligence. Chronological age was the major determiner of visual perceptual and matching performance. The matching data generally suggested that the cerebral palsied students' cognitive styles were qualitatively similar to those of nonhandicapped students, although the extraocular movements of some students appeared to affect the classifications of cognitive style to which they were assigned by the data.

Association of Epstein-Barr virus with nasopharyngeal carcinoma in Alaskan native patients: serum antibodies and tissue EBNA and DNA.

Biopsy specimens from Alaskan Native patients with nasopharyngeal carcinoma (NPC) and from other patients seen on the otolaryngology service were tested for Epstein-Barr virus-specific DNA and nuclear antigen (EBNA). Serum samples from both groups were tested for various EBV-related antibodies. EBV DNA and EBNA results were in agreement in 29 of 31 tissue specimens tested by the two methods. Ten of 11 biopsies containing NPC cells were positive for EBV DNA. Two NPC patients had biopsies that showed only atypical epithelium but were also positive for EBV DNA or EBNA. The other tissue specimens were negative except for biopsies from two patients: one with a parotid gland lymphoepithelial lesion; another with undifferentiated carcinoma of salivary gland origin.

The effects of auditorally augmented feedback on the eye-hand coordination of students with cerebral palsy.

To explore the question of whether auditorally augmented feedback can improve the eye-hand coordination of individuals with cerebral palsy, 59 (cerebral-palsied) students (mean chronological age 14 years, 3 months) were pretested with the Southern California Motor Accuracy Test and then randomly assigned to three groups. Group 1 performed training exercises-tracing line drawings-while simultaneously receiving auditorally augmented feedback about their efforts. Group 2 performed the same training exercises without the augmented feedback. Group 3 served as controls. All subjects were post-tested with the Southern California Motor Accuracy Test, followed by a second post-test after a 3-month interval. At the first post-test, the performance of the feedback group was significantly superior to that of the other groups. At the second post-test, the performance patterns among the groups were essentially the same as the time of the first post-test, but between-group differences were no longer significant. The results of this study are discussed in both empirical and theoretical terms.

Epstein-Barr virus-specific antibody titers in seven Alaskan natives before and after diagnosis of nasopharyngeal carcinoma.

Results are presented of Epstein-Barr virus-specific serologic tests for seven Alaskan Native patients with nasopharyngeal carcinoma (NPC) from whom serum had been collected 2-10 years before diagnosis and up to 6 years after diagnosis. The pre-illness antibody spectra and titers of the NPC patients did not differ from those of controls. However, broadened antibody spectra and elevated titers were associated with the emergence of NPC disease, which in one case was present as early as 22 months before actual diagnosis. Increasing or continuously high antibody titers were associated with progression of the disease and death, whereas patients who maintained relatively low, stable antibody titers after treatment have remained well.