Longitudinal follow-up of nutritional status and its influencing factors in adults undergoing allogeneic hematopoietic cell transplantation.

There are few longitudinal data on nutritional status and body composition of patients undergoing allogeneic hematopoietic cell transplantation (alloHCT). We assessed nutritional status of 105 patients before alloHCT and its course during the early post-transplant period to day +30 and day +100 via weight history, body mass index (BMI) normalized for gender and age, Subjective Global Assessment, phase angle normalized for gender, age, and BMI, and fat-free and body fat masses. Furthermore, we present a multivariate regression model investigating the impact of factors on body weight. At admission, 23.8% reported significant weight losses (>5%) in the previous 6 months, and we noted 31.5% with abnormal age- and sex-adjusted BMI values (10th, 90th percentiles). BMI decreased significantly (P<0.0001) in both periods by 11% in total, meaning a weight loss of 8.6±5.7 kg. Simultaneously, the patients experienced significant losses (P<0.0001) of both fat-free and body fat masses. Multivariate regression model revealed clinically relevant acute GVHD (parameter estimate 1.43; P=0.02) and moderate/severe anorexia (parameter estimate 1.07; P=0.058) as independent factors influencing early weight loss. In conclusion, our results show a significant deterioration in nutritional status during the early post-transplant period. Predominant alloHCT-associated complications such as anorexia and acute GVHD became evident as significant factors influencing nutritional status.

Bioavailability of vitamin D2 from UV-B-irradiated button mushrooms in healthy adults deficient in serum 25-hydroxyvitamin D: a randomized controlled trial.

BACKGROUND/OBJECTIVES: Mushrooms contain very little or any vitamin D(2) but are abundant in ergosterol, which can be converted into vitamin D(2) by ultraviolet (UV) irradiation. Our objective was to investigate the bioavailability of vitamin D(2) from vitamin D(2)-enhanced mushrooms by UV-B in humans, and comparing it with a vitamin D(2) supplement. SUBJECTS/METHODS: Fresh mushrooms were irradiated with an UV-B dose of 1.5 J/cm(2), increasing vitamin D(2) content from <1 to 491 µg/100 g and made to an experimental soup. In this 5-week, single-blinded, randomized, placebo-controlled trial, 26 young subjects with serum 25-hydroxyvitamin D (25OHD) ≤ 50 nmol/l were randomly assigned into three groups ((a) mushroom, (b) supplement and (c) placebo). They received during winter (a) 28,000 IU (700 µg) vitamin D(2) via the experimental soup, or (b) 28,000 IU vitamin D(2) via a supplement or (c) placebo, respectively. RESULTS: After 2 weeks, serum 25OHD was significantly higher in the mushroom than in the placebo group (P=0.001). The serum 25OHD concentrations in the mushroom and supplement groups rose significantly and similarly over the study period by 3.9 nmol/l (95% confidence interval (95% CI): 2.9, 4.8) and by 4.7 nmol/l per week (95% CI: 3.8, 5.7), respectively. CONCLUSIONS: We are the first to demonstrate in humans that the bioavailability of vitamin D(2) from vitamin D(2)-enhanced button mushrooms via UV-B irradiation was effective in improving vitamin D status and not different to a vitamin D(2) supplement. This trial was registered at http://germanctr.de as DRKS00000195.

Small intestine gastric balloon impaction treated by laparoscopic surgery.

BACKGROUND: The BioEnterics intragastric balloon device (BIB) is being used as an adjunct for treatment of obesity. This procedure may have complications, mainly related to the migration of the balloon in the bowel, with abdominal cramping before anal extrusion. METHODS: We report a case of migration of a deflated BIB in the small bowel with obstruction. This device had been implanted 7 months earlier. RESULTS: The plain radiograph and the CT scan confirmed the diagnosis, and the patient was operated with opening of the bowel for removal of the device and the impacted food. The whole procedure was done via laparoscopy. The patient left the hospital on the 7th postoperative day. CONCLUSION: We report a small bowel obstruction by migration of a deflated BIB.

Six years experience with minilaparotomy silastic ring vertical gastroplasty.

BACKGROUND: In 1994, we modified the silastic ring vertical gastroplasty (SRVG) procedure to be able to perform it through a small incision. We expected this MiniSRVG to reduce postoperative pain and discomfort, shorten hospital stay and cost, and reduce scars and overall morbidities. METHODS: From October 1991 to December 1999, 893 patients were operated for morbid obesity. From October 1991 to December 1993, 111 patients underwent the classic Eckhout SRVG. From January 1994 to February 1999, 782 patients underwent the MiniSRVG, in which the dissection is limited to the lesser curvature of the stomach and is done partly blindly. Certain technical maneuvers were done to facilitate the procedure and to shorten the incision. RESULTS: Immediate postoperative complications and overall morbidities were similar in both series. Long-term follow-up showed no significant differences in weight and BMI loss. The small incision in the MiniSRVG, however, shortened the median operating time (32.1 vs 38.1 minutes) and reduced greatly the incision size (6.5 vs 18 cm), the postoperative pain (1.2 vs 2.6 days), the hospital stay (3.0 vs 5.1 days), the evisceration rate (0.1 vs 2.7%) and incisional hernia rate (5.4 vs 15.8%). The only side-effect was an increase in seroma formation (11.8 vs 4.50%). CONCLUSIONS: The MiniSRVG was as safe and efficient as the classic SRVG, obtaining the same BMI reduction and satisfaction.

Multicentric experience of the Belgian Group for Endoscopic Surgery (BGES) with endoscopic adrenalectomy.

BACKGROUND: Adrenalectomy is not a frequent operation. Therefore the newly developed laparoscopic approach is sporadically performed by surgeons dealing with endocrine disorders. METHODS: Some 54 videoendoscopic adrenalectomies performed on 52 patients by five surgical teams between October 1993 and December 1996 were prospectively evaluated. RESULTS: Indications for endoscopic adrenalectomy were pheochromocytoma (n = 17), primary hyperaldosteronism (n = 15), Cushing's adenoma or disease (n = 7), nonsecreting adenoma (n = 7), single metastasis from adenocarcinoma (n = 2), adenoma with dehydroepiandrostenedione (DHEAS) hypersecretion (n = 3), and ACTH-secreting metastases from a thymoma (n = 1). Of the 54 adrenalectomies performed, 31 were of the left gland, 19 of the right and two bilateral. Laparoscopic adrenalectomy was successful in 50 patients (96%). Median tumor size was 4 cm (range 1.5-12), median operation duration was 80 min (range 59-360), and median postoperative stay was 4 days (range 2-13). One patient required blood transfusion. CONCLUSIONS: Endoscopic adrenalectomy can safely be performed-even sporadically-by surgeons well versed in adrenalectomy techniques for endocrine disorders and trained in endoscopic surgery.

[Exploratory laparotomy under local anesthesia]. / Laparoscopie exploratrice sous anesthésie locale.

Diagnostic laparoscopy under local anaesthesia for acute pain in the right iliac fossa in an old man is reported. Exploring the abdominal cavity under local anaesthesia is an excellent method for establishing a diagnosis in doubtful abdominal pain presentation. This technically easy procedure may avoid up to 45% of unnecessary laparotomies and related complications.

Silastic ring vertical gastroplasty as treatment for morbid obesity: technique and results for 337 patients.

SRVG is an easy and efficient treatment for morbid obesity. It allows spectacular weight loss and by this increases notably the life expectancy. In our series of 337 patients, we have no operative mortality and a morbidity of 5.6%. A permanent multidisciplinary approach is necessary to obtain good results. A more important follow-up has to confirm these encouraging results.