Long-term hypovitaminosis D and secondary hyperparathyroidism outcomes of the Roux-en-Y gastric bypass: a systematic review.

INTRODUCTION: Pre-operative Vitamin D deficiency is markedly prevalent in prospective bariatric surgery patients. While bariatric surgery leads to significant weight loss, it can exacerbate or prolong Vitamin D deficiency. We systematically reviewed the literature to assess whether secondary hyperparathyroidism is maintained in the medium to long term in patients following the Roux-en-Y gastric bypass. METHODS: A comprehensive literature search was conducted through Medline, Embase, Scopus, Web of Science, Dare, Cochrane library and HTA database. The search terms used were bariatric surgery, gastric bypass and hyperparathyroidism. RESULTS: Fourteen studies were included (n = 2688 subjects). Parathyroid hormone levels rose gradually from a mean pre-operative level of 5.69 ± 1.2 pmol/L to 6.36 ± 0.77 pmol/L, 7.59 ± 0.73 pmol/L and 8.29 ± 1.41 pmol/L at 2 years, between 2 and 5 years, and beyond 5 years, respectively. Vitamin D levels slowly fell to a mean of 20.50 ± 4.37 ng/mL and 20.76 ± 3.80 ng/mL between follow-up intervals 2-5 years and beyond 5, respectively. CONCLUSION: It appears that hyperparathyroidism persists at 5-year follow-up after gastric bypass, despite most patients being supplemented with calcium and Vitamin D.

The penetration of oral ciprofloxacin into the aqueous humor, vitreous, and subretinal fluid of humans.

We examined ciprofloxacin levels in the aqueous humor, vitreous, or subretinal fluid in 40 patients undergoing cataract extraction, vitrectomy, or scleral buckling. Ciprofloxacin, 750 mg, was administered orally an average of 17 1/2 and 5 1/2 hours preoperatively. We obtained mean ciprofloxacin levels of 0.53 microgram/ml in aqueous humor, 0.51 microgram/ml in vitreous, and 0.71 microgram/ml in subretinal fluid. These vitreous levels exceed the minimum inhibitory concentration (MIC)90 of Staphylococcus epidermidis, Propionibacterium species, Pseudomonas aeruginosa, Proteus mirabilis, and Haemophilus influenzae, as well as the MIC70 of S. aureus and Bacillus cereus. Therefore, ciprofloxacin may have a role in the management and prevention of endophthalmitis.

[Course of retinopathy in premature infants treated by cryopexy]. / Evolution de la rétinopathie du prématuré traitée par cryopexie.

Beneficial effect of cryopexy on 180 degrees to 360 degrees of avascular retina was demonstrated in 7 prematurely born infants (14 eyes) affected with advanced retinopathy of prematurity. Intravitreous new vessels were present in all eyes before treatment. The treatment of one eye was supplemented with scleral indentation. Only one of the treated eyes went on unfavourably with retrolental fibroplasia and consecutive loss of visual acuity. We believe that cryopexy, when administered promptly, when limited to the avascular zone, and when supplemented with scleral indentation in cases with important vitreous traction, is a valuable treatment with fewer risks than unchecked evolution for advanced cases of retinopathy of prematurity.

[Study of the visual field using automated static perimetry following panretinal photocoagulation in the diabetic]. / Etude du champ visuel en périmétrie statique automatisée après photocoagulation panrétinienne chez le diabétique.

Twelve diabetic patients presenting a preproliferative or proliferative retinopathy were the subjects of our study. We studied the modifications of the visual fields, analyzed by computerized perimetry, after panretinal photocoagulation (PRP). For every patient, two techniques of PRP were applied, one on each eye: C: conventional scattered treatment, G: cluster technique. Computerized perimetry was done within 10 days prior to PRP, and 4 to 8 weeks following it. We used the Octopus 500, programs 36 (0 to 30 degrees) and 44 (30 to 60 degrees). It appears that, before any treatment, there is a loss of retinal sensitivity excepted the more central zone. Concerning the loss of sensitivity, although the number of laser burns, is greater in group G, there is no statistical significative difference between the 2 groups. Nevertheless, it seems to be more heterogeneous in group G. However, we have not studied the visual field modifications after confluent PRP using up to 5,000 500 micron laser burns. Although there is a loss of retinal sensitivity after PRP, none of our patients complained of it. PRP seems to us to be the only treatment able to prevent the natural evolution of preproliferative or proliferative diabetic retinopathies.

Field dependence in alcoholics: relation to years of drinking, severity of alcohol dependence and emotional distress.

A number of factors were evaluated as predictors of field dependence (Embedded-Figures Test score) in alcoholics. In our sample, duration of excessive drinking and symptomatology of alcohol dependence were significantly related to the level of field dependence. These results fail to corroborate earlier findings and suggest that heightened field dependence in alcoholics is, at least partly, a consequence of alcohol misuse. In addition, a strong relationship was detected between the alcoholics' degree of anxiety and their degree of alcohol dependence. Possible bases for such a relationship are discussed.