Mid-term quality of life after gastric band removal and single-stage conversion to gastric bypass: a single-center cohort study.

BACKGROUND: Revision surgeries in patients with failed gastric banding including band removal are increasingly necessary. However, long-term outcomes after band removal alone are unsatisfactory due to weight regain and limited improvement in quality of life. This study aimed to report mid-term quality of life outcomes after gastric band removal and single-stage conversion to Roux-en-Y gastric bypass. METHODS: Data of 108 patients who underwent conversion surgery from 2011 to 2017 were extracted from a prospective database and retrospectively analyzed. During follow-up visits, physical and laboratory data as well as quality of life questionnaires were obtained. RESULTS: Postoperative mean Moorehead score increased significantly after 1 year (1.62 ± 0.86, p < 0.001) and after 5 years (1.55 ± 0.84, p < 0.001) compared to baseline values (0.72 ± 1.1). The mean follow-up time was 53 months. Moorehead scores at 1, 2, and 5 years postoperative were available in 75% (n = 81), 71% (n = 77), and 42% (n = 45) of cases, respectively. Mixed ANOVA analysis showed a significantly superior increase in Moorehead score in males (p = 0.024). No other significant predictors were identified. Lasting BMI reduction (- 4.6 to 33.0 ± 6.7 kg/m2, p < 0.001) and weight loss (- 12.9% (- 13.6 kg), p < 0.001) 5 years after conversion surgery were seen. Postoperative complications occurred in 35% (n = 38) of patients with a re-operation rate of 30.5% (n = 33). CONCLUSION: The current study shows that band removal with single-stage gastric bypass in patients with failed gastric banding leads to a lasting improvement in quality of life and may be the rescue procedure of choice in this setting.

The invariance of sentence performance structures across language modality.

Native users of American Sign Language were asked to manipulate sentences in four different ways: sign them at slow rate, parse them, make relatedness judgments of pairs of signs taken from each sentence, and recall the sentences. The data obtained from these four tasks (pause durations, parsing values, indices of relatedness and probe latencies) were used to construct hierarchical performance structures for each of the sentences. The resulting structures were highly similar across tasks; that is, performance structures are not task specific. The four measures at each sign boundary in each sentence were well predicted by a performance model, elaborated by Grosjean, Grosjean, and Lane for speech, that combines a parsing measure with a symmetry measure. Thus performance structures appear to be founded in the processing of language, be it visual or oral, and not in the properties of any particular communication modality.

Mirror movements after childhood hemiparesis.

Mirror movements are normal in childhood and may persist to a later age following early brain lesions. We studied these movements in patients with childhood hemiparesis at different ages. The earlier the lesions, the more the mirror movements persisted. More mirror movement persisted in the nonparetic hand than in the paretic one. Complete paralysis of either hand tended to abolish all mirror movements in both hands. The task eliciting the most mirror movement was one that may come under ipsilateral control following contralateral damage. The greater persistence of mirror movements after earlier lesions appears to be an indicator of more extensive compensatory motor system reorganization that takes place after damage to a less mature nervous system.

[Flavonol glycosides of leaves and fruits of dill (Anethum graveolens L.). II. Phenolics of spices (author's transl)]. / Flavonolglykoside der Blätter und Früchte des Dills (Anethum graveolens L.). II. Uber Gewürzphenole.

From the leaves of dill (Anethum graveolens L.) ten flavonol glycosides have been isolated by means of polyamide, paper and thin-layer chromatography and could be identified by the usual procedures. The two major flavonoids, quercetin 3-O-beta-D-glucuronide and isorhamnetin 3-O-beta-D-glucuronide, were obtained crystalline. The minor components were found to be the 3-glucosides, 3-galactosides and 3-rhamnoglucosides of quercetin and isorhamnetin. Two other 3-glycosides of quercetin and isorhamnetin occur with the component sugars galactose, xylose, and arabinose. Besides these there are probably other two flavonoids present in trace amounts. In addition, the fruits of dill contain kaempferol 3-glucuronide as main component thought this component is completely absent in leaves.--This is probably the first time that isorhamnetin 3-O-beta-D-glucuronide has been obtained crystalline from a plant.

Changing patterns of childhood aphasia.

Acquired aphasia in children has been generally characterized as nonfluent, transient, and frequently due to right hemisphere lesions. We studied 65 children with unilateral hemispheric brain lesions occurring after speech acquisition any time from the second through the fourteenth year. Of 34 patients with a left hemisphere lesion, 25 had an initial aphasic speech disturbance, while of 31 patients with a right hemisphere lesion, only 4 (including 2 left-handers) showed any initial aphasia. All those who became aphasic before the age of 8 years eventually regained speech, but recovery time required ranged from less than a month to more than two years. One 5-year-old boy who recovered had initial jargon aphasia. Our review of the literature indicated that the conflict between our results and the traditional claim of frequent aphasia with right hemisphere lesions only apparent; the great majority of crossed aphasias are concentrated in reports written before antibiotics were used, and many cases were assoicated with systemic bacterial infections.

[Flavonol glycosides of apples (Malus silvestris Mill.). 10. Phenolics of fruits (author's transl)]. / Flavonolglykoside der Apfel (Malus silvestris Mill.). 10. Phenolische Inhaltsstoffe des Obstes.

The flavonol glycosides of apple skin (Malus silvestris Mill. cv. Golden Delicious) were separated by means of cellulose column chromatography and paper chromatography, and the following compounds were obtained crystalline and identified by usual procedures: quercetin 3-O-alpha-D-galactoside, quercetin 3-O-xyloside, quercetin 3-O-alpha-L-arabinofuranoside, quercetin 3-O-rhamnoside and rutin. Quercetin 3-O-beta-D-glucoside also was identified, but could not be obtained crystallin. A comparison by TLC of 10 very different varieties of apples namely Golden Delicious, Cox Orange, Roter Berlepsch, Cortland, Ingrid Marie, Jonathan, Boskoop, Laxtons Superb, Gloster, and James Grieve demonstrated the same flavonol glycosides and thus showed no distinctions in glycosid pattern between the different varieties of these apples.

Recovery of function after brain injury in man.

Late after-effects of cerebral trauma are difficult to study because patients tend to be seen for persisting symptoms, and not simply for their lesions. We have tried to avoid this bias by recalling periodically, over the years, 520 men with known brain injuries incurred in World War II or in Korea or Vietnam. These men are seen irrespective of clinical need and all undergo intensive behavioural and neurological assessment, which still continues. For such groups, recovery is impressive, though one third shows persistent intellectual loss. In addition, some tasks reveal specific deficits enduring unchanged, after th first 2-3 yr, for the 20-30 yr of follow-up (e.g. visual field defects, certain auditory discrimination losses, trouble on various complex perceptual tasks). These lasting deficits are linked to the site and size of focal injury, often representing remnants of more severe initially-present disorders. The extent of recovery is correlated with age at the time of trauma, the youngest faring best. Extension of such studies to cases of early brain damage (birth to five years), as indicated by hemiparesis, shows the familiar 'escape' of language after early left-hemisphere lesions but this is achieved at a price, the price being borne by non-verbal functions that normally depend on the integrity of the right hemisphere.

Unity and diversity of frontal lobe functions.

In attempting to summarize recent work on functions of granular prefrontal cortex in primates, including man, and possible homologues of these structures in rodents and carnivores, four question need to be asked, the questions of 'where', 'when', 'what' and 'how'. Progress since the Pennsylvania Symposium has been considerable for questions of 'where' and 'when': localization of symptoms ('where') fields a double gradient (up-down and back-to-front) in monkeys, and a right-left difference in man; analysis of time factors ('when') distinguishes early and late lesions, single and serial removals, or succeeds in recording and stimulating at critical moments during performance. However, problems of 'what' and 'how' are still largely unsolved: we do not yet know what various prefrontal symptoms sigify, in terms of normal function, and are only beginning to see how individual prefrontal neurons act and interact. Advances on these questions are likely if one exploits an extended version of those hypotheses about prefrontal physiology that attribute to these structures neither purely sensory nor purely motor functions but consider them instead as sources of 'corollary discharges' whereby the organism presets its sensory systems for the anticipated consequences of its own action.