To conclude, we report here that DJB induces dramatic loss of fecal matter in obese mice fed a HF-HS diet. This does not take place in lean mice fed a control starch diet. In obese mice, this could be sufﬁcient to explain the lasting weight loss and associated improvements in glucose control associated with DJB. Since this could dominate the metabolic features linked to the mouse genotype/phenotype, we conclude that fecal energy loss should no longer be underestimated in bypasssurgery studies in the mouse and should even be considered as a key integral component of the mechanism underlying the metabolic
A. DROCHON et al. Surgetica 2019 Rennes, France – 17 – 18 June
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W e present here a simulating tool developed to compute pressure and flow rate values everywhere in the coronary network. The patients included in the study (n = 22) have very severe stenoses or even thromboses on the main coronary arteries. The model is based on the electric-hydraulic analogy, and the simulations are performed with MatLab-Simulink. Collateral pathways and bypass grafts may be included in order to see their influence on blood delivery to ischemic territories. The results obtained for the 22 patients already studied constitute a data- bank of typical cases to which the surgeons can refer. It is hoped that this can help their surgical decision for the next patients because the simulations provide some data that cannot be clinically measured.
In this work, we investigated the impact of CPB on the kinetic of endocan concentrations. We therefore selected inclusion criteria to obtain a homogeneous population with low perioperative risk of complications, as illustrated with Euroscore 2 less than 1.0%. In preoperative period of CABG surgery, the baseline endocan concentration was 4 fold increased in comparison to concentrations usually assessed in healthy volunteers in previous studies [10,11]. This difference may be explained because all patients included in this study had severe coronary stenosis. Endocan is a well-known biomarker of the endothelial dysfunction involved in the physiologic mechanism of atherosclerosis . In the specific case of cardio-vascular surgery, 3 studies investigated already the kinetic of endocan concentrations. The first, performed by Stoppelkamp et al., investigated the kinetic of biomarkers, including endocan, in sterile SIRS conditions after cardio-vascular surgery . Endocan was measured at admission, before and in the postoperative period until Day 8. Baseline values of endocan were measured at 2 to 5 ng.mL -1 . Postoperative endocan
15 improve by much more. This has been attributed to the fact that early after surgery, caloric restriction plays a major role in improving insulin sensitivity. Months to years after surgery, once weight loss has stabilised, then a quantitative relationship between the changes in BMI and insulin sensitivity is evident. It is not clear whether there is a greater insulin sensitising power of GBP than SG, although biliopancreatic diversions have been shown to be the most effective in this regard . While HOMA- IR did not significantly alter acutely after any of the three interventions, this may have been masked by the withdrawal of metformin therapy, an insulin sensitising medication.
cardiac dysfunction, CPB and aortic clamp durations, and quality of myocardial protection during bypass), which cannot be controlled for. Thus, we deliberately choose to make the comparisons between baseline and the time when LCOS was considered over in each pa- tient (dobutamine weaning). This pragmatic approach allowed us to minimize the administration of study drug, which was important from a safety point of view, and to compare patients when they had reached a similar hemodynamic situation. However, it can be noted that changes between H0 and H2 (common to all patients) were similar to changes between H0 and the time of study drug cessation. Finally, because investigators were not always available when eligible patients underwent surgery, those who were included in this cohort are not strictly consecutive patients.
Blood samples were collected for platelet function testing on admittance before the operation, repeated 4 –6 days after surgery before hospital discharge, and at follow-up after one and three to four months. Blood was obtained from an antecubital vein using vacutainer tubes containing EDTA for hematological analyses and sodium citrate for flow cytometry. Complete blood cell counts and mean platelet volume were assessed in samples anticoagu- lated with EDTA, within 20 min of sampling to minimize platelet swelling, using a MICROS 60 cell counter (ABX Diagnostics, Montpellier, France).
TITRE DE LA THESE EN ANGLAIS :
Screening urolithiasis risk after gastric bypass : assessment by a questionnaire
RESUME DE LA THESE EN ANGLAIS :
Introduction - Gastric bypass operations have significantly increased in recent years. The surgery raises the risk of kidney stone formation versus persons who have not undergone the surgery. Our study aims to set up a screening questionnaire in order to assess the lithiasis risk among operated patients. Material and method – Our report consist of a monocentric clinical study with a screening questionnaire destinated to people who have undergone gastric bypasssurgery between 2014 and 2015. Patients were asked to answer 22 questions divided into 4 parts : history, episodes of renal colic before and after bypasssurgery and eating habits.
Hernia surgery , edited by Volker Schumpelick, Georg Arlt, Joachim Conze, Karsten Junge and Georg Thieme Verlag KG, Germany, Thieme Publishers Stuttgart, 2019, 329 pp
Abdominal wall and hernia surgery constitute the most frequent surgical procedures performed by abdominal and general surgeons. Despite that fact, complications are not rare and sometimes impair the quality of life of the patients for decades. Recurrence can also be the consequence of inadequate surgical technique. It is, therefore, of great importance to improve the results of our abdominal wall surgery for the best of the Belgian population.
Unfortunately none of those substances can give a solution to the big problem that is obesity either because of the induced risks, or of their inefficacy.
d) Surgical treatment of obesity, so-called - bariatric surgery
Because current treatments, as we have seen, are usually ineffective in patients with morbid obesity, surgical methods (especially Roux-en-Y gastric by-pass) have been assessed. The success rate in achieving and maintaining long term weight loss is 80% or greater, significantly higher than with any other treatment (16).
Les hypoglycémies hyperinsulinémiques postprandiales (PHH) sont souvent rapportées après Roux-en-Y gastric bypass (RYGB). En l'absence d'étude prospective, les déterminants cliniques et biologiques de la PHH restent peu clairs. L’objectif de cette étude est de déterminer l'incidence et les facteurs prédictifs de PHH après RYGB. Pour cela, nous avons inclus dans une étude de cohorte longitudinale, 957 patients opérés d’un RYGB. Nous avons analysé les résultats des tests de tolérance orale au glucose (OGTT) effectués habituellement avant la chirurgie, puis répétés à 1 et / ou 5 ans après la chirurgie. La PHH était définie comme une glycémie inférieure à 50 mg / dL et une insulinémie plasmatique> 3 mU / L à 120 minutes au cours de l’OGTT. Nous avons calculé les indices validés pour la sensibilité à l'insuline (indice de Matsuda), la fonction des cellules β (insulinogenic index) et de la masse de cellules β (rapport C-peptide sur glucose) à partir des concentrations de glucose, d'insuline et de c peptide, mesurées pendant l'OGTT.
Goncalves et al. 2014 Bile bioavailability and gastric bypass Bile diversions down-regulate hepatic glucose production and induce intestinal gluconeogenesis. A decrease in HGP and an increase in IGN are key features associated with the improvements in metabolic control in rodents 13–15 and humans. 16–18 Thus, we analyzed gluconeogenesis gene expression in the liver and the intestine of bile-diverted rats fed a standard diet. First, both mRNA and protein levels of the catalytic subunit of glucose-6-phosphatase (G6PC) were markedly decreased in the liver of bile-diverted rats (Fig. 3a). Likewise, bile-diverted rats exhibited a substantial reduction of hepatic glucose-6-phosphatase (G6Pase) activity (Fig. 3b). Relatively to the mid-jejunum diversion, G6Pase activity was increased in the duodenum and in the proximal jejunum, i.e. the portion of gut devoid of bile. On the contrary, G6Pase activity was markedly decreased in the distal jejunum and in the ileum, i.e. the gut section where the bile bioavailability was restored (Fig. 3c). For the bile diversion in the mid-ileum, we obtained comparable results with an increase in G6Pase activity upstream of the site of bile re-insertion and a decrease downstream (Fig. 3d).
The risk of cancer in the excluded distal stomach after RYGBP is unknown. The distal gastric segment is excluded from the alimentary channel and thus from contact with exogenous carcinogens, but could theoretically suffer from prolonged contact with stagnant bile, shown to promote carcinogenesis experimentally. 1,2 The distal stomach after gastric bypass appears to be exposed to pancreaticobiliary reflux with pooled bile found in the excluded stomach. 2,3 Superficial gastritis of this segment is common. While Sinar et al 2 reported that biopsies from the distal stomach in 4 of 33 patients showed intestinal dysplasia at 3-24 months after RYGBP, this was not observed in a later study with a 2 years follow-up by the same group. 3
For several decades, the number of humanitarian organizations has been grawing, in the health field and also education, engineer ing, agriculture, etc.
"Humanitarian aid" has become a watchword, and perhaps a buzz-word. Although the term is well suited to situations of natu ral disasters or war. in pediatric orthopedic surgery the concept of cooperation missions with emerging countries seems more appra priate. However, we shall stick to the term "humanitarian aid", which is anchored in the public imagination.
that they are directly related to the mail volume distributed by the incumbent. Hence, it is when the entrant remains a monopolist in the delivery activity that the direct incentives are the strongest.
There is also a strategic motive for investment. In regions of the parameters for which the incumbent optimally deters bypass, a reduction of the delivery cost reduces the price distortion between the optimal price of the incumbent and its actual price. Hence, investing ex ante in a cost reducing investment makes it cheaper for the incumbent to deter bypass. This suggests that the incentives to invest in cost-reducing technologies may not be highest when the incumbent and the entrant are engaged in facility-based competition (accommodated bypass), but when the incumbent strategically distorts its delivery and access prices in order to deter bypass (deterred bypass). Hence, PO may be compelled to invest massively in cost- reducing technologies before FMO, in order to induce their competitors to choose access over bypass. In order to better understand the strategic effects of cost-reducing investments, it would be necessary to study in detail the actual patterns of investment by postal operators in Europe in anticipation of the full opening of the postal market.
SUMMARY : We report the case of a patient operated of an aorto-bifemoral bypass for aorto-iliac aneurysm who presented a metachronous iliac aneurysm rupture, six years later, because of aneurysmal degeneration. We performed bipolar ligation of the external iliac artery and an end-to-end anastomosis of the prosthetic limb to the common femoral artery. We discuss aneu- rysms of the external iliac artery, characterised by their rarity, their specific morbidity and mortality.