The risk and benefit of revisional vs. primary metabolic- bariatric surgery and drug therapy - A narrative review.

Metabolic and bariatric surgery (MBS) leads to long-term weight loss, reduced risk of cardiovascular events and cancer, and reduced mortality. Sleeve gastrectomy and Roux-en-Y gastric bypass are currently the most common surgical techniques. Weight loss after MBS was previously believed to work through restriction and malabsorption, however, mechanistic studies show that MBS techniques with long term efficacy instead alter physiological signaling between the gut and the brain. In revisional MBS, the initial surgical technique is corrected, modified, or converted to a new one. The indication for revisional MBS can be to achieve further weight loss or improvement in obesity comorbidity, but it may be necessary due to complications (e.g., gastroesophageal reflux or obstruction). Revisional MBS is associated with an increased risk of surgical complications and often less weight loss compared to the results following primary surgery. This narrative review summarizes data from revisional MBS where information is often presented with inconsistent definitions for indications and outcomes, making comparison between strategies difficult. In summary, we suggest careful weighing of potential benefits and risks with revisional MBS, bearing in mind the option of add-on therapy with new anti-obesity drugs.

High prevalence of gastroesophageal reflux in vocal opera students. A case-control type study.

BACKGROUND: Opera singers are at risk to develop gastroesophageal reflux, because of the vocational challenges during singing. The singers are reluctant to be submitted to pH-metry fearing throat injuries. We evaluated the gastroesophageal reflux in vocal opera students using a non-invasive salivary test. DESIGN AND SETTING: A prospective, case-control study was carried out in 30 vocal opera students from the Music Academy of the city Cluj-Napoca, Romania, enrolled in the "canto" section. METHODS: For control, 20 medical students and residents were enrolled. Each subject filled in a questionnaire and gave saliva samples for the salivary test Peptest™ (RD Biomed). The statistical analysis was made using program R version 3.2.1 (2015-06-18). RESULTS: According to salivary Peptest, vocal opera students had a higher prevalence of gastro-esophageal reflux than the control group (96.67% versus 30%; 29 from 30 vs 14 from 20), P<0.001. Only 50% (15 of 30) of the vocal opera students reported reflux symptoms. CONCLUSIONS: Salivary Peptest confirmed a higher prevalence of gastroesophageal reflux in vocal opera students, although not all of them reported reflux symptoms.

Re-operations for early postoperative complications after CRS and HIPEC: indication, timing, procedure, and outcome.

PURPOSE: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have become standard of care for many peritoneal malignancies in selected patients. Nevertheless, this aggressive treatment strategy is associated with significant major morbidity. The aim of the present study is to analyze the re-operation rate and clinical outcome following CRS and HIPEC. PATIENTS AND METHODS: In the present study, prospectively documented data of 474 consecutive patients treated with CRS and HIPEC between February 2011 and December 2015 in a high-volume certified reference center for peritoneal malignancies in Germany have been retrospectively analyzed. RESULTS: The re-operation rate was 14.5%. The most frequent reasons for revisional surgery were fascial dehiscence, intraabdominal hemorrhage, and anastomotic leak. Most complications occurred between postoperative day 7 and 9. However, postoperative bleeding was more common within the first 5 days after surgery. The overall in-hospital mortality rate was 2.1% for all patients and 10% after revisional surgery. CONCLUSIONS: CRS and HIPEC are associated with an acceptable re-operation rate and low mortality rate. Most frequently, re-operations are performed on 7-9 days after initial surgery due to fascial dehiscence, pancreatitis, or anastomotic leak. Postoperative bleedings are more common within the first 5 days after surgery.

Morbidity and Mortality Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Data from the DGAV StuDoQ Registry with 2149 Consecutive Patients.

BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are performed for well-selected patients with peritoneal surface malignancies. This combined treatment is potentially associated with an increased rate of complications. OBJECTIVE: The aim of this paper was to analyze the morbidity and mortality of CRS and HIPEC in the German national registry. METHODS: We present a retrospective analysis of 2149 consecutive patients from 52 hospitals. The data were prospectively documented in the DGAV StuDoQ Registry between February 2011 and December 2016. RESULTS: Almost two-thirds of all patients had a colorectal malignancy; therefore, the most frequently performed resections were colectomies (54%) and rectal resections (30%). Only 36.2% of all patients had no anastomosis, and fewer than 20% of all patients were older than 70 years of age (16.4%). Enteric fistula and anastomotic leaks occurred in 10.5% of all cases. The reoperation rate was 14.6% (95% confidence interval [CI] 11.51-18.1). Major grade 3 and 4 complications (Clavien-Dindo classification) occurred in 19.3% of all patients, half of which were due to surgical complications. The overall 30-day postoperative hospital mortality was 2.3% (95% CI 1.02-3.85). Multivariate analysis showed an increased risk for morbidity associated with pancreatic resections (odds ratio [OR] 2.4), rectal resection (OR 1.5), or at least one anastomosis (OR 1.35), and mortality with reoperation (OR 8.7) or age > 70 years (OR 3.35). CONCLUSIONS: CRS and HIPEC are associated with acceptable morbidity and low mortality. These results show that CRS and HIPEC can be safely performed nationwide when close mentoring by experienced centers is provided.

Lifestyle and psychosocial factors in musicians.

BACKGROUND AND AIM: Musicians face professional challenges that may lead them to adopt unhealthy lifestyles. They also may present performance-related anxiety. We investigated anxiety and lifestyle patterns in musicians, both professional and trainees. METHODS: A prospective controlled protocol was developed. Musicians (employed or students) and matched controls (also employed and students) were surveyed with several questionnaires on lifestyle and some psychological factors: anxiety and music performance anxiety. RESULTS: General anxiety and music performance anxiety are higher in music students compared with trained musicians. Musicians have also higher anxiety scores than their matched controls. Soloists have higher scores of anxiety, also percussion and keyboard students. Musicians smoke less than controls, but sleep also less, a factor perceived as an index for stress. BMI was also higher in musicians. CONCLUSIONS: Performing music is associated with anxiety levels that are higher than in control population. Trainees have higher scores than the employed musicians.

Overlapping of functional esophageal disorders and irritable bowel syndrome, in musicians and athletes / Sobreposição de distúrbios esofágicos funcionais e síndrome do intestino irritável em músicos e esportistas / Sobreposición de trastornos esofágicos funcionales y síndrome del intestino irritable en músicos y deportistas

ABSTRACT Introduction: Functional gastrointestinal disorders (FGIDs) are the most common disorders in the general population. These disorders can overlap, decreasing the quality of life. Objective: We analyzed the prevalence of functional esophageal disorders (FED) and irritable bowel disease (IBS), and their overlapping and associated factors in musicians and athletes. Methods: A cross-sectional study was conducted using FGID and associated factors questionnaires administered to four groups: instrumentalists, singers, athletes, and a control group of healthy volunteers. Results: Of the 161 subjects, 62 (38.51%) had only FED, 76 (47.2%) had only IBS, and 23 (14.29%) had FED-IBS overlap. Subjects with FED-IBS overlap had more severe symptoms of IBS, especially hard and lumpy stools and constipation, compared to those with IBS alone. IBS subtype was more frequent in the overlap group, while not specified IBS type was less frequent. Regarding FED, we found that subjects with FED-IBS overlap had more functional heartburn and less functional dysphagia symptoms. There was a higher risk of overlap in instrumentalists and smokers. Conclusions: FED and IBS are frequently encountered in musicians and athletes. Subjects with FED-IBS overlap presented more frequent and severe symptoms. Instrumentalists and smokers are at higher risk of overlap. Level of Evidence IV; Case series.

RESUMO Introdução: Os distúrbios gastrintestinais funcionais (DGIF) são os mais comuns na população em geral. Esses distúrbios podem se sobrepor, diminuindo a qualidade de vida. Objetivo: Analisamos a prevalência dos distúrbios funcionais esofágicos (DFE) e da síndrome do intestino irritável (SII), sua sobreposição e os fatores associados em músicos e esportistas. Métodos: Realizou-se um estudo transversal por meio de questionários sobre DGIF e fatores associados, administrados a quatro grupos: instrumentistas, cantores, esportistas e um grupo controle de voluntários saudáveis. Resultados: Dos 161 indivíduos, 62 (38,51%) tinham só DFE, 76 (47,2%) tinham só SII e 23 (14,29%) tinham sobreposição de DFE e SII. Os indivíduos com sobreposição de DFE e SII tinham sintomas mais intensos de SII, especialmente fezes duras e encaroçadas e constipação em comparação com os que tinham só SII. O subtipo SII foi mais frequente no grupo de sobreposição, enquanto o tipo SII indefinido foi menos frequente. Quanto ao DFE, verificamos que os indivíduos com sobreposição DFE-SII tinham mais sintomas de azia funcional e menos de disfagia funcional. Houve maior risco de sobreposição em instrumentistas e fumantes. Conclusões: DFE e SII são frequentes em músicos e esportistas. Os indivíduos com sobreposição de DFE e SII apresentaram sintomas mais frequentes e mais severos. Os instrumentistas e os fumantes têm maior risco de sobreposição. Nível de Evidência IV; Série de casos.

RESUMEN Introducción: Los trastornos gastrointestinales funcionales (TGIF) son los más comunes en la población en general. Estos trastornos pueden sobreponerse, disminuyendo la calidad de vida. Objetivo: Analizamos la prevalencia de los trastornos funcionales esofágicos (TFE) y del síndrome del colon irritable (SCI), su superposición y los factores asociados en músicos y deportistas. Métodos: Se realizó un estudio transversal por medio de cuestionarios sobre TGIF y factores asociados, administrados a cuatro grupos: instrumentistas, cantantes, deportistas y un grupo control de voluntarios sanos. Resultados: De los 161 sujetos, 62 (38,51%) tenían sólo TFE, 76 (47,2%) tenían sólo SCI y 23 (14,29%) tenían superposición de TFE e SCI. Los individuos con superposición de TFE y SCI tenían síntomas más intensos de SCI, especialmente heces duras y grumosas y estreñimiento en comparación con los que tenían sólo SCI.. El subtipo SCI fue más frecuente en el grupo de superposición, mientras que el tipo de SCI no especificado resultó menos frecuente. En cuanto al TFE, verificamos que los sujetos con superposición TFE-SCI tenían más síntomas de pirosis funcional y menos de disfagia funcional. Hubo mayor riesgo de superposición en instrumentistas y fumadores. Conclusiones: TFE y SCI son frecuentes en músicos y deportistas. Los sujetos con superposición de TFE y SCI presentaron síntomas más frecuentes y más severos. Los instrumentistas y los fumadores tienen mayor riesgo de superposición. Nivel de Evidencia IV; Serie de casos.