Calibrated Gastrojejunostomy in Gastric Bypass: It Is a Myth.

BACKGROUND: Many surgeons prefer a narrow gastrojejunostomy in gastric bypass believing that this provides greater weight loss. The question is whether the anastomosis remains at its initial diameter, whether it narrows or widens over time. This study tests the hypothesis that the initial diameter of the anastomosis varies over time. MATERIALS AND METHODS: One hundred obese had undergone surgery. Group A with anastomosis 1.5 cm wide and group B with anastomosis 3 cm wide. One-year follow-up was done for 83 patients. The size of the anastomosis diameter was evaluated using a balloon for cardia dilation. RESULTS: Comparing the results of surgery with the values presented 1 year after the procedure, (i) BMI decreased from 43.3 ± 6.6 to 28.7 ± 7.0 kg/m2 for group A and 44.6 ± 5.9 to 29.1 ± 6.3 kg/m2 for group B, (ii) the total weight loss was 30.6 ± 4.7% for group A and 31.9 ± 5.2% for group B, and (iii) the initial 1.5-cm anastomosis in group A measured 2.3 ± 1.0 cm while the initial 3-cm anastomosis in group B measured 2.7 ± 1.0 cm 1 year after surgery. No statistically significant difference was found for any of the variables evaluated before and after the surgical procedure. CONCLUSION: Calibrated anastomosis has no utility in increasing weight loss in gastric bypass.

A molecular insight into the role of inflammation in the behavior and pathogenesis of odontogenic cysts.

BACKGROUND: Although, odontogenickeratocyst (OKC) and dentigerous cyst (DC) are considered asdevelopmental cysts inflammation has been seen in its connective tissue wall. Inflammation is seen to alter the epithelial lining of both OKC and DC butwhether it plays in altering the behavior of these cysts is not fully understood. AIM: The present study is conducted with the help of molecular marker proliferating cellular nuclear antigen (PCNA) to assess the proliferative activity of OKC and DC and to further evaluate and correlate the effect of inflammation on the proliferative activity and hence on biological behavior of these cysts. MATERIALS AND METHODS: Immunohistochemicalstaining was performed using anti-PCNA antibody in 10 cases each of classical OKC, inflamed OKC, classical DC, and inflamed DC. The resulting data was tabulated on Microsoft excel and subjected to statistical analysis using two-way analysis of variance test, t test and post-hoc test followed by Bonferroni test with the application of statistical package for social sciences (SPSS) (SPSS, Chicago, IL, USA) and Epi-Info 6.04 d, Atlanta, Georgia (USA). RESULTS: Total mean PCNA expression is statistically higher in inflamed OKC than classical OKC and inflamed DC also showed significantly higher PCNA expression than classical DC (P < 0.001). Correlation between inflammation and PCNA expression was not statistically significant (P ≥ 0.05). CONCLUSION: Inflammation is responsible for change in behavior of neoplastic epithelium of OKC, whereas in dentigerous it is responsible for changes in epithelial lining and hence should be treated meticulously.

Analysis of cranial 133-Xenon clearance in the newborn infant by the two-compartment model.

Cranial and chest clearance curves after intravenous administration of 133-Xenon was obtained on 112 occasions in 62 newborn infants admitted to our neonatal intensive care unit. The mean postnatal age was 5.1 days. The cranial clearance curves were submitted to two-compartment analysis. The compartmental clearance rate constants were 1.49 +/- 0.61/min and 0.099 +/- 0.033/min respectively while the fractional flow to the fast compartment was 0.51 +/- 0.14. Possible artefacts, particularly relevant to newborns, were analysed by computer simulation. It is concluded that the cranial 133-Xenon clearance curves varied considerably within the group of ill newborns and that the mean two-compartment parameter values differed considerably from those of healthy premature infants or adults, with or without cerebral illness. But the computer simulations demonstrated that the two-compartment parameters had high coefficients of variation and were significantly biased by right-to-left shunting of blood through the foramen ovale, by heterogeneity of the flow to the fastest compartment and by contamination of the cranial clearance curves by 133-Xenon in the airways. The radiation dose was 1.3 mGy to the lungs and 0.2 mGy to other tissues.

Cerebral blood flow in the newborn infant: comparison of Doppler ultrasound and 133xenon clearance.

Two techniques of Doppler ultrasound examination, continuous-wave and range-gated, applied to the anterior cerebral artery and to the internal carotid artery, were compared with 133xenon clearance after intravenous injection. Thirty-two sets of measurements were obtained in 16 newborn infants. The pulsatility index, the mean flow velocity, and the end-diastolic flow velocity were read from the Doppler recordings. Mean cerebral blood flow was estimated from the 133Xe clearance curves. The correlation coefficients between the Doppler and the 133Xe measurements ranged from 0.41 to 0.82. In the subset of 16 first measurements in each infant, there were no statistically significant differences between the correlation coefficients of the various Doppler ultrasound variables, but the correlation coefficients were consistently lower for the pulsatility index than for mean flow velocity or end-diastolic flow velocity, and they were consistently higher for the range-gated than for the continuous-wave Doppler technique.

Methotrexate maintenance following Ingram therapy in 'difficult' psoriasis.

A retrospective analysis is presented summarizing 9 years' experience using a combined regime of Ingram therapy followed by methotrexate maintenance in the management of especially difficult psoriatic patients. The lesion-free period was extended from about 1 month (controls) to 1 year, and the period before re-admission was extended from 5 months to more than 3 years.

Low-dose PUVA maintenance in psoriasis following Ingram therapy.

Following the initial treatment of severe psoriasis with conventional Ingram therapy, it is shown that PUVA maintenance at a mean dose-rate of 28.6 J/cm2/month increases the average period of remission from 7 weeks to more than a year. Surprisingly, the patients who withdrew from maintenance therapy whilst still in remission have so far continued (10 months) to show an extremely low relapse rate.

Deafness, ichthyosiform erythroderma, corneal involvement, photophobia and dental dysplasia.

Early childhood deafness, congenital non-bullous ichthyosiform erythroderma, corneal involvement, photophobia, chronic blepharoconjunctivitis, hypotrichosis, anhidrosis, hyperkeratosis of the nails and dental dysplasia were the symptoms observed in the 19-year-old girl described in this paper. The literature comprises reports on 8 patients with this syndrome, which McKusick (1975) listed as no. 24215.

A lysosomal storage disorder of the epidermis characterized by a deficiency of alpha-mannosidase and an accumulation of mannose-rich materials.

Laboratory investigation of a patient diagnosed as ichthyosiform erythroderma bullosa revealed the following abnormalities: (1) alpha- and beta-galactosidases were elevated in the lesion. (2) alpha-mannosidase activity was extremely low both in the lesion and in relatively normal epidermis. (3) The mannose:glucose ratio of water-soluble hexose-containing material in the scales was very high. (4) Membrane-limited vacuoles, apparently enlarged secondary lysosomes, were observed. We conclude that this patients is the first documented example of a lysosomal storage disease in which overt clinical lesions are confined to the epidermis.

An evaluation of betamethasone dipropionate (Diprosone) versus Locacorten 0.02% cream.

A double-blind randomized evaluation of betamethasone dipropionate cream (Diprosone) compared with Locacorten 0.02% cream flumethason privalate in 60 patients over 3 consecutive weeks showed the betamethasone dipropionate cream to be significantly more effective in the treatment of psoriasis and other steroid-responsive dermatoses.