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Chan DL, Talbot ML. Robotic Vagus-Sparing Total Gastrectomy for CDH1 Gene Mutation Treatment. J Vis Exp 2023. [PMID: 38145373 DOI: 10.3791/65303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
Hereditary diffuse gastric cancer (HDGC) caused by the CDH1 gene mutation is an inherited cancer syndrome that increases the risk of diffuse gastric cancer and is nearly impossible to detect by screening gastroscopy. The recommended preventative treatment is a total gastrectomy. Robotic surgery facilitates the use of minimally invasive surgical (MIS) techniques for anastomoses and posterior vagus preservation to potentially reduce adverse functional outcomes. An asymptomatic 24 year old male with the CDH1 gene mutation proven by genetic testing and a family history of a brother having a total gastrectomy for HDGC was treated with this technique. This video case report demonstrates the techniques and pitfalls of robotic surgery in terms of the patient positioning and port placement, posterior vagus-preserving dissection, sutured esophagojejunostomy, jejunal pouch formation, and Roux-en-Y reconstruction with a staple-stapled jejunojejunostomy. While these techniques are demonstrated in the case of prophylactic gastrectomy, many of them can be applied to other benign and bariatric foregut and general surgery types.Robotic surgery can facilitate the foregut MIS technique, as described in this case of a vagus-sparing total gastrectomy.
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Affiliation(s)
- Daniel L Chan
- Saint George and Sutherland Clinical School, Faculty of Medicine, The University of New South Wales;
| | - Michael L Talbot
- Saint George and Sutherland Clinical School, Faculty of Medicine, The University of New South Wales
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2
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Zarshenas N, Tapsell LC, Batterham M, Neale EP, Talbot ML. Investigating the Prevalence of Copper and Zinc Abnormalities in Patients Pre and Post bariatric Surgery-an Australian Experience. Obes Surg 2023; 33:3437-3446. [PMID: 37773088 PMCID: PMC10602995 DOI: 10.1007/s11695-023-06822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/19/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Bariatric surgery predisposes patients to nutritional deficiencies. There are limited studies on zinc and copper abnormalities in this cohort. PURPOSE The aim of this study was to identify the prevalence of these abnormalities in a cohort of Australian bariatric patients. Inflammatory markers, adherence to multivitamin supplementation (MVS) and the presence of gastrointestinal (GI) symptoms were also investigated. MATERIAL AND METHODS Data was collected on all patients who attended a single clinic in Sydney, Australia, from August 2020 to August 2021. RESULTS The study cohort consisted of 231 patients (76.2% female; mean pre-operative body mass index of 43.4 ± 7.1 kg/m2), most of whom underwent sleeve gastrectomy (78.8%). Data were collected preoperatively and then at ≤ 6 months, 1 and > 2 years postoperatively. Prior to surgery, low levels of zinc (2.1%) and copper (0.7%) were rare, but elevated copper levels were common (16.7%) and potentially related to an elevated C-reactive protein (CRP) (47.7%). Following surgery at > 2 years, the mean total weight loss (TWL) was 33.5 ± 12.4. CRP levels improved over time. Post operatively, low zinc (2.7-3.6%) and copper (1.5%) levels were rare. Patients with low levels in zinc and copper were a higher-risk group and generally exhibited GI symptoms, despite taking MVS. CONCLUSION In the initial post-operative stages and with good adherence to MVS containing copper and zinc, abnormalities may not be a concern. Patients with GI symptoms appear to be at higher risk of abnormalities; increasing awareness, thorough screening, and more comprehensive supplementation are recommended.
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Affiliation(s)
- Nazy Zarshenas
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- Shore Surgical, 156-158 Pacific Highway, Greenwhich, Sydney, NSW, 2065, Australia.
| | - Linda C Tapsell
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Elizabeth P Neale
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Michael L Talbot
- St George and Sutherland Clinical School, St George Private Hospital, Suite 3 Level 5 1 South St, Kogarah, Sydney, NSW, 2217, Australia
- University of New South Wales, Sydney, Australia
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3
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Chiu TR, Waller JH, Meslin SMM, Talbot ML, Jorgensen JJ, Fisher OM. A case of life-threatening, early postoperative refeeding syndrome in an obese young female undergoing laparoscopic sleeve gastrectomy. J Surg Case Rep 2023; 2023:rjad516. [PMID: 37724063 PMCID: PMC10505510 DOI: 10.1093/jscr/rjad516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
Early complications after a laparoscopic sleeve gastrectomy (LSG) include bleeding, leaks, strictures and bowel obstructions. Patients post-LSG experience rapid but intended weight loss and may be on a restricted diet before and following surgery. Thus, many of these patients are in a malnourished state, placing them at a risk of developing potentially life-threatening refeeding syndrome (RFS). We describe the case of an 18-year-old female who developed RFS 2 weeks after LSG. We examine potential causes, review literature and discuss RFS pathophysiology as well as the guidelines that could help prevent RFS in bariatric surgery. Currently, not much is known about the risk of RFS in bariatric surgery and to our knowledge, this is the first report of RFS occurring in the early postoperative phase after LSG. A globally accepted definition of RFS should be established for guidelines to encompass wider patient groups.
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Affiliation(s)
- Tricia R Chiu
- Department of Medicine, UNSW Medicine, UNSW, Sydney, NSW 2052, Australia
- Upper GI Surgery Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
| | - Jake H Waller
- Upper GI Surgery Unit, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Sylvain M M Meslin
- Department of Medicine, UNSW Medicine, UNSW, Sydney, NSW 2052, Australia
- Upper GI Surgery Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
| | - Michael L Talbot
- Upper GI Surgery Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
| | - John J Jorgensen
- Upper GI & Bariatric Surgery Unit, St George Private Hospital, Kogarah, NSW 2217, Australia
| | - Oliver M Fisher
- Upper GI Surgery Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia
- Upper GI Surgery Unit, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- St George & Sutherland Clinical School, UNSW Australia, Sydney, NSW 2052, Australia
- Department of Surgery, Notre Dame University School of Medicine, Sydney, NSW 2010, Australia
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4
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Huang BW, Shahul SS, Ong MKH, Fisher OM, Chan DL, Talbot ML. Medium Term Outcomes of Revision Laparoscopic Sleeve Gastrectomy after Gastric Banding: A Propensity Score Matched Study. Obes Surg 2023; 33:2005-2015. [PMID: 37212965 PMCID: PMC10289990 DOI: 10.1007/s11695-023-06629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Revision bariatric surgery may be undertaken after weight loss failure and/or complications following primary bariatric surgery. This study aims to compare the efficacy and safety of revision laparoscopic sleeve gastrectomy (RLSG) after gastric banding (GB) to those of primary laparoscopic sleeve gastrectomy (PLSG). MATERIALS AND METHODS A retrospective, propensity-score matched study was conducted to compare between PLSG (control) patients and RLSG after GB (treatment) patients. Patients were matched using 2:1 nearest neighbor propensity score matching without replacement. Patients were compared on weight loss outcomes and postoperative complications for up to five years. RESULTS 144 PLSG patients were compared against 72 RLSG patients. At 36 months, PLSG patients had significantly higher mean %TWL than RLSG patients (27.4 ± 8.6 [9.3-48.9]% vs. 17.9 ± 10.2 [1.7-36.3]%, p < 0.01). At 60 months, both groups had similar mean %TWL (16.6 ± 8.1 [4.6-31.3]% vs. 16.2 ± 6.0 [8.8-22.4)]%, p > 0.05). Early functional complication rates were slightly higher with PLSG (13.9% vs. 9.7%), but late functional complication rates were comparatively higher with RLSG (50.0% vs. 37.5%). The differences were not statistically significant (p > 0.05). Both early (0.7% vs 4.2%) and late (3.5% vs 8.3%) surgical complication rates were lower in PLSG patients compared to RLSG patients but did not reach statistical significance (p > 0.05). CONCLUSION RLSG after GB has poorer weight loss outcomes than PLSG in the short-term. Although RLSG may carry higher risks of functional complications, the safety of RLSG and PLSG are overall comparable.
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Affiliation(s)
- Brenda W Huang
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia.
| | - Sarfraz S Shahul
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
| | - Marcus K H Ong
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
| | - Oliver M Fisher
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
- Upper Gastrointestinal Surgery Unit, Department of Surgery, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
| | - Daniel L Chan
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
- Upper Gastrointestinal Surgery Unit, Department of Surgery, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
- School of Medicine, Western Sydney University, Narellan Rd & Gilchrist Dr, Campbelltown, NSW, 2560, Australia
| | - Michael L Talbot
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
- Upper Gastrointestinal Surgery Unit, Department of Surgery, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
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5
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Colbourne JRM, Fisher OM, Mo S, Rigas GS, Talbot ML. The role of adjuvant pharmacotherapy with liraglutide for patients with inadequate weight loss following bariatric surgery. Langenbecks Arch Surg 2023; 408:115. [PMID: 36867261 PMCID: PMC9984502 DOI: 10.1007/s00423-023-02805-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/30/2022] [Indexed: 03/04/2023]
Abstract
PURPOSE Despite the benefits of bariatric surgery for many patients, there are a proportion of patients who do not achieve adequate weight loss. We evaluate the role of liraglutide as adjuvant pharmacotherapy in those who respond poorly to weight loss surgery. MATERIALS AND METHODS A non-controlled, prospective, open-label cohort study in which participants are prescribed liraglutide following inadequate response to weight loss surgery. The efficacy and tolerability of liraglutide was measured through measurement of BMI and monitoring of side effect profile. RESULTS A total of 68 partial responders to bariatric surgery were included in the study, 2 participants were lost to follow-up. Overall 89.7% lost weight on liraglutide, with 22.1% showing a good response (>10% total body weight loss). There were 41 patients who discontinued liraglutide mainly due to cost. CONCLUSION Liraglutide is efficacious in achieving weight loss and reasonably well tolerated in patients who have inadequate weight loss post-bariatric surgery.
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Affiliation(s)
- James R M Colbourne
- Upper GI Surgery Unit, St George Hospital, Sydney, Australia.
- Faculty of Medicine, University of Sydney, Sydney, Australia.
- School of Surgery, University of Western Australia, Perth, Australia.
| | - Oliver M Fisher
- Upper GI Surgery Unit, St George Hospital, Sydney, Australia
| | - Shirley Mo
- Upper GI Surgery Unit, St George Hospital, Sydney, Australia
| | - Georgia S Rigas
- Upper GI Surgery Unit, St George Hospital, Sydney, Australia
- St George and Sutherland Clinical School - UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Michael L Talbot
- Upper GI Surgery Unit, St George Hospital, Sydney, Australia
- St George and Sutherland Clinical School - UNSW Medicine, University of New South Wales, Sydney, Australia
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6
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Indja B, Chan DL, Talbot ML. Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy. BMC Surg 2022; 22:347. [PMID: 36131312 PMCID: PMC9490990 DOI: 10.1186/s12893-022-01800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Gastroesophageal reflux is a known complication following laparoscopic sleeve gastrectomy (LSG) as anatomical changes predispose to reduced lower esophageal sphincter pressure and development of hiatus hernia. The mainstay of surgical management has been Roux-en-Y gastric bypass (RYGB) which is not without risk. Hiatus hernia repair (HHR) with surgical reattachment of the oesophagus to the crura, recreating the phreno-esophageal ligament is a simple procedure specifically targeting a number of anatomical changes responsible for reflux in this population. Methods We conducted a single centre retrospective analysis of adult patients with post-sleeve reflux refractory to medical treatment, managed with either HHR, RYGB or One-anastomosis Duodenal switch (OADS). PPI use and symptoms of reflux were assessed at early and mid-term time points via validated questionnaires.
Results 99 patients were included, of these the surgical procedure was HHR alone in 58, RYGB in 29 and OADS in 12. At early follow-up control of reflux symptoms was achieved in 72.4% after HHR, 82.1% after RYGB and 100% after OADS with no significant difference between groups (p = 0.09). At mid-term followup (median 10 months IQR 7–21) there was no significant difference in the presence of symptomatic reflux as determined by post-op Visick score nor a difference in PPI use. The GerdQ score was significantly lower after OADS as compared to HHR and RYGB (4.6 ± 2.3 vs 7.7 ± 2.2 vs 8.7 ± 3.5, p = 0.006). Conclusion HHR with reconstruction of the phreno-esophageal ligament is a safe and effective procedure for patients with reflux after LSG, that avoids more complex operations such as RYGB and OADS and their associated long-term sequelae.
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Affiliation(s)
- Ben Indja
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,Department of Surgery, St George Hospital, Sydney, NSW, Australia. .,Upper GI Surgery, St George Private Hospital, Suite 3, Level 5, 1 South, Sydney, NSW, 2217, Australia.
| | - Daniel L Chan
- Department of Surgery, St George Hospital, Sydney, NSW, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Sydney, NSW, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.,Upper GI Surgery, St George Private Hospital, Suite 3, Level 5, 1 South, Sydney, NSW, 2217, Australia
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7
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Aly A, Talbot ML, Brown WA. Bariatric surgery: a call for greater access to coordinated surgical and specialist care in the public health system. Med J Aust 2022; 217:228-231. [PMID: 35964266 PMCID: PMC9539896 DOI: 10.5694/mja2.51673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Ahmad Aly
- Austin Hospital Melbourne VIC
- University Of Melbourne Melbourne VIC
| | | | - Wendy A Brown
- Monash University Melbourne VIC
- The Alfred Hospital Melbourne VIC
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8
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Cheah S, Gao Y, Mo S, Rigas G, Fisher O, Chan DL, Chapman MG, Talbot ML. Fertility, pregnancy and post partum management after bariatric surgery: a narrative review. Med J Aust 2022; 216:96-102. [PMID: 35034365 PMCID: PMC9306879 DOI: 10.5694/mja2.51373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
Of the women who gave birth in Australia in 2018, 47% had overweight or obesity, with obesity being associated with both maternal and fetal complications. Bariatric surgery improves fertility and some pregnancy‐related outcomes. Following bariatric surgery, pregnancy should be delayed by at least 12–18 months due to adverse pregnancy outcomes associated with rapid weight loss. Contraception should be prescribed after bariatric surgery, although the effectiveness of the oral contraceptive pill may be reduced due to malabsorption and contraceptive devices such as intrauterine devices should be considered as first line therapy. After bariatric surgery, women should undergo close monitoring for nutritional insufficiencies before, during and after pregnancy. Expert opinion recommends these women undergo dietary assessment and supplementation to prevent micronutrient deficiencies. Bariatric surgeons, bariatric medical practitioners, bariatric dieticians, the patient’s usual general practitioner, obstetricians, and maternity specialists should be involved to assist in the multidisciplinary management of these complex patients.
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Affiliation(s)
| | | | | | | | - Oliver Fisher
- St George Hospital Sydney NSW
- University of New South Wales Sydney NSW
| | - Daniel L Chan
- St George Hospital Sydney NSW
- University of New South Wales Sydney NSW
| | | | - Michael L Talbot
- St George Hospital Sydney NSW
- University of New South Wales Sydney NSW
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9
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Chan DL, Chern TY, Iliopoulos J, Hennessy A, Wong SKH, Ng EKW, Talbot ML. Accuracy of High-Resolution Manometry in Hiatal Hernia Diagnosis in Primary and Revision Bariatric Surgery. Obes Surg 2021; 31:2906-2912. [PMID: 33852151 DOI: 10.1007/s11695-021-05335-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE There is a complex association between obesity, hiatal hernia (HH), and reflux. There is a deficiency of literature on the accuracy of preoperative high-resolution manometry (HRM) in detecting HH before both primary and revision bariatric surgery. MATERIALS AND METHODS A retrospective analysis of a prospective database of all HRM performed before bariatric surgery from 2014 to 2019. An electronic medical records review was conducted. Sensitivity, specificity, and global diagnostic test accuracy were calculated. RESULTS Sixty-seven patients with HRM (mean age of 44.0 ± 11.3 years, body mass index 40.8 ± 6.9 kg/m2) were eligible. Intraoperative diagnosis of HH was made in 37 patients (55.2% prevalence). The HRM sensitivity was 48.7% (95% confidence interval (CI) 31.9-65.6%), specificity 90.0% (95% CI 73.5-97.9%), and accuracy was 67.2% (95% CI 54.6-78.2%). Comparing primary (28) and revision (39) surgery, the sensitivity (37.5% vs 57.1%), specificity (75.0% vs 100%), and diagnostic accuracy (54.3% vs 76.3%) were comparable, with overlapping 95% CI. Endoscopy performed in 30 patients had a sensitivity of 25.5% (95% CI 6.8-49.9%), specificity of 100% (95% CI 75.3-100%), and accuracy of 57.8% (95% CI 38.5-75.5%) and was comparable to HRM. CONCLUSION High-resolution manometry for the detection of HH before bariatric surgery has a high specificity and maintains a high accuracy in both primary and revision bariatric surgery.
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Affiliation(s)
- Daniel L Chan
- Department of Surgery, St George Hospital, Gray St, Sydney, NSW, 2217, Australia. .,School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia. .,Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia. .,Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Tien Y Chern
- Department of Surgery, St George Hospital, Gray St, Sydney, NSW, 2217, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jim Iliopoulos
- Department of Surgery, St George Hospital, Gray St, Sydney, NSW, 2217, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Annemarie Hennessy
- School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia
| | - Simon K H Wong
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Enders K W Ng
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Gray St, Sydney, NSW, 2217, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, 2751, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
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10
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Fisher OM, Chan DL, Talbot ML, Ramos A, Bashir A, Herrera MF, Himpens J, Shikora S, Higa KD, Kow L, Brown WA. Barrett's Oesophagus and Bariatric/Metabolic Surgery-IFSO 2020 Position Statement. Obes Surg 2021; 31:915-934. [PMID: 33460005 DOI: 10.1007/s11695-020-05143-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/07/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022]
Abstract
The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has been playing an integral role in educating both the metabolic surgical and the medical community at large about the importance of surgical and/or endoscopic interventions in treating adiposity-based chronic diseases. The occurrence of chronic conditions following bariatric/metabolic surgery (BMS), such as gastro-oesophageal reflux disease (GERD) and columnar (intestinal) epithelial metaplasia of the distal oesophagus (also known as Barrett's oesophagus (BE)), has long been discussed in the metabolic surgical and medical community. Equally, the risk of neoplastic progression of Barrett's oesophagus to oesophageal adenocarcinoma (EAC) and the resulting requirement for surgery are the source of some concern for many involved in the care of these patients, as the surgical alteration of the gastrointestinal tract may lead to impaired reconstructive options. As such, there is a requirement for guidance of the community.The IFSO commissioned a task force to elucidate three aspects of the presenting problem: First, to determine what the estimated incidence of Barrett's oesophagus is in patients presenting for BMS; second, to determine the frequency at which Barrett's oesophagus may develop following BMS (with a particular focus on the laparoscopic sleeve gastrectomy (LSG)); and third, to determine if regression of Barrett's oesophagus may occur following BMS given the close relationship of obesity and the development of BE/EAC. Based on these findings, a position statement regarding the management of this pathology in the context of BMS was developed. The following position statement is issued by the IFSO Barrett's Oesophagus task force andapproved by the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion and published peer-reviewed scientific evidence. It will be reviewed regularly.
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Affiliation(s)
- Oliver M Fisher
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Daniel L Chan
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Michael L Talbot
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Almino Ramos
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Ahmad Bashir
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Miguel F Herrera
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Jacques Himpens
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Scott Shikora
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Kelvin D Higa
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Lilian Kow
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Wendy A Brown
- International Federation for the Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy. .,Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia.
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11
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Chan DL, Wong SKH, Lok HT, Iliopoulos J, Talbot ML, Hennessy A, Ng EKW. Accuracy of hiatal hernia diagnosis in bariatric patients: Preoperative endoscopy versus intraoperative reference. JGH Open 2020; 4:1074-1078. [PMID: 33319039 PMCID: PMC7731797 DOI: 10.1002/jgh3.12388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/18/2022]
Abstract
Background and Aim Obesity is becoming increasingly prevalent in Asia. Bariatric surgery in the region is growing in popularity to reflect increasing demand. Hiatal hernia (HH) is common among the obese population. There is a lack of evidence comparing preoperative endoscopy against intraoperative findings as a standard of reference for HH diagnosis. Methods This was a retrospective analysis of a bariatric procedure database from a single tertiary teaching hospital and high‐volume endoscopy center. Electronic medical records were reviewed. Endoscopy results were compared to intraoperative findings, and subgroup analysis of >2 cm hernias was performed. Sensitivity, specificity, predictive values, likelihood ratios, and global diagnostic test accuracy were calculated. Results A total of 434 patients were eligible for this study, of which HH was detected in 37 patients (prevalence rate 8.55%). Mean age was 41.51 ± 11.07 years, and body mass index was 39.37 ± 5.67 kg/m2. Endoscopy sensitivity was 75.68% (95% confidence interval, 58.80–88.23%) and specificity 91.44% (88.24–94.00%). Positive likelihood ratio was 8.53 (6.11–12.79) and negative likelihood ratio 0.27 (0.15–0.47). Positive predictive value was 45.16% (36.27–54.38%) and negative predictive value 97.58% (95.80–98.62%). Accuracy of endoscopy for preoperative HH diagnosis was 90.09% (86.89–92.74%). Conclusion Endoscopy can have a high diagnostic accuracy of preoperative HH diagnosis in obese Asian patients using intraoperative diagnosis as the reference standard.
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Affiliation(s)
- Daniel L Chan
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China.,School of Medicine Western Sydney University Sydney New South Wales Australia.,Faculty of Medicine The University of New South Wales Sydney New South Wales Australia
| | - Simon K-H Wong
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China
| | - Hon Ting Lok
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China
| | - Jim Iliopoulos
- School of Medicine Western Sydney University Sydney New South Wales Australia
| | - Michael L Talbot
- School of Medicine Western Sydney University Sydney New South Wales Australia.,Faculty of Medicine The University of New South Wales Sydney New South Wales Australia
| | - Annemarie Hennessy
- School of Medicine Western Sydney University Sydney New South Wales Australia
| | - Enders K-W Ng
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine The Chinese University of Hong Kong Hong Kong SAR China
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12
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Chan DL, Ravindran P, Fan HS, Elstner KE, Jacombs ASW, Ibrahim N, Talbot ML. Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation. ANZ J Surg 2019; 90:67-71. [PMID: 31566297 DOI: 10.1111/ans.15438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/02/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic ventral repair is safe, with lower wound infection rates compared with open repair. 'Venetian blinds' technique of plication in combination with mesh reinforcement, is totally intra-corporeal, with hernia defect and sac plication to reduce seroma formation. While laparoscopic suturing of the abdominal wall can represent a technical challenge, pre-operative botulinum toxin A (BTA) injections as an adjunct can assist. This study aims to demonstrate feasibility and efficacy of this technique in abdominal wall hernia repair, with BTA adjunct in midline hernias. METHODS A single-centre case series was conducted using minimally invasive 'Venetian blinds' technique for repair of complex ventral abdominal hernias. Twelve patients (seven midline, five non-midline) underwent repair (11 laparoscopic; one robotic). Midline hernias received BTA (200-300 units Botox) 4-6 weeks prior to surgery. Repairs were mesh-reinforced following fascial closure. RESULTS Twelve (10 female, two male) patients, with a median age 72 years (range 31-83) and body mass index of 27.3 kg/m2 (range 22.8-61.7) were included. The median length of operation was 133 min (range 45-290) and length of hospital stay 3 days (range 1-28). To date there has been no recurrence of hernia. A single symptomatic seroma was treated with antibiotics and did not require mesh removal. One patient developed hospital-acquired pneumonia and pseudomembranous colitis. CONCLUSION Minimally invasive 'Venetian blinds' technique has promising early results with both midline and non-midline ventral hernias. The addition of BTA is a novel and feasible combination for repair of midline ventral hernias.
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Affiliation(s)
- Daniel L Chan
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Praveen Ravindran
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Howard S Fan
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Kristen E Elstner
- Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Anita S W Jacombs
- Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Nabeel Ibrahim
- Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
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13
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Tran S, Choi V, Hepburn K, Hewitt N, Zhou J, Chan DL, Talbot ML. Subspecialty approach for the management of acute cholecystitis: an alternative to acute surgical unit model of care. ANZ J Surg 2017; 87:560-564. [PMID: 28512772 DOI: 10.1111/ans.13986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute cholecystitis is a common condition. Recent studies have shown an association between creation of an acute surgical unit (ASU) and improved outcomes. This study aimed to evaluate the outcomes of a subspecialty based approach to the management of acute cholecystitis as an alternative to the traditional 'generalist' general surgery approach or the ASU model. METHOD A 6-year retrospective analysis of outcomes in patients admitted under a dedicated upper gastrointestinal service for acute cholecystitis undergoing emergency laparoscopic cholecystectomy. RESULTS Seven hundred emergency laparoscopic cholecystectomies were performed over this time. A total of 486 patients were available for analysis. The median time to operation was 2 days and median length of operation was 80 min. A total of 86.9% were performed during daylight hours. Eight cases were converted to open surgery (1.6%). Intra-operative cholangiography was performed in 408 patients. The major complication rate was 8.2%, including retained common bile duct stones (2.3%), sepsis (0.2%), post-operative bleeding (0.4%), readmission (0.6%), bile leak (2.1%), AMI (0.4%), unscheduled return to theatre (0.6%) and pneumonia (0.8%). There were no mortalities and no common bile duct injuries. CONCLUSION Over a time period that encompasses the current publications on the ASU model, a subspecialty model of care has shown consistent results that exceed established benchmarks. Subspecialty management of complex elective pathologies has become the norm in general surgery and this study generates the hypothesis that subspecialty management of patients with complex emergency pathologies should be considered a valid alternative to ASU. Access block to emergency theatres delays treatment and prolongs hospital stay.
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Affiliation(s)
- Sonia Tran
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Vincent Choi
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Kirsten Hepburn
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Nathan Hewitt
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia
| | - Joel Zhou
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia.,UNSW Department of Surgery, St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel L Chan
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia.,UNSW Department of Surgery, St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael L Talbot
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia.,UNSW Department of Surgery, St George Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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14
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Fan HS, Rahman AA, Talbot ML. Laparoscopic Enucleation of Schwannoma Masquerading as a Leiomyoma. J Med Cases 2017. [DOI: 10.14740/jmc2823w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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15
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Affiliation(s)
- Howard S Fan
- Department of Surgery, University of New South Wales, St George Hospital, Kogarah, New South Wales, Australia
| | - Michael L Talbot
- Department of Surgery, University of New South Wales, St George Hospital, Kogarah, New South Wales, Australia
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16
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Affiliation(s)
- Michael Edye
- Blacktown/Mt Druitt Clinical School, University of Western Sydney, Sydney, NSW, Australia.
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Sydney, NSW, Australia
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17
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Talbot ML. Revision LAGB to RYGBP in patients with BMI<35: not yet ready for prime time. Surg Obes Relat Dis 2014; 10:1109. [PMID: 25393048 DOI: 10.1016/j.soard.2014.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Revisional surgery is required in a significant number of patients because of failure to lose weight, loss of quality of life, weight regain, or complications of the previous procedure. It has traditionally been associated with higher complication rates, and there appears to be no standardized surgical approach to revisional surgery. The aim of the study was to review the revisional procedures performed at St George Private Hospital and analyze the outcomes of the different types of revisional surgery. METHODS We performed a retrospective review of 75 patients who underwent revisional surgery between December 2003 and October 2007. Demographic, anthropometric, perioperative, and clinical follow-up data were collected, and statistical analyses were performed using SPSS version 14.0. RESULTS Sixty-six of the 75 patients were female. The mean age at the time of revision was 46.32 (22-68) years. Mean initial weight was 119.08 kg, and body mass index (BMI) was 43.42 kg/m(2). The lowest BMI and excess weight loss (EWL) recorded after primary surgery was 36.9% and 53.5%, respectively. At the time of revision, the mean EWL was 24.79. The EWL at 3 months and 6 months were 41.7% and 47.8%, respectively. Revision was performed laparoscopically in 51 patients and via laparotomy in 24 patients. There was no mortality in the cohort, but there were 17.3% minor and 4.0% major perioperative morbidities. CONCLUSION Our study suggests that revision can be performed safely. Weight loss is satisfactory, and complications of the previous operations were all reversed. Furthermore, revisions may be done laparoscopically, including those who had previous open procedures.
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Affiliation(s)
- C S H Lim
- Department of Upper Gastrointestinal, Advanced Laparoscopic and Bariatric Surgery, St George Hospital, New South Wales, 2217, Australia.
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Abstract
BACKGROUND It is estimated that up to 80% of persons with diabetes mellitus type 2 are overweight and in these patients it is recognized that effective weight control can lead to improvement or even resolution of their diabetes (Colagiuri et al.). All currently carried out operations for morbid obesity have been shown to improve diabetes, but there appears to be a variable response to surgery depending on several surgical and patient factors. METHODS In this prospective review, we analysed the change in the diabetic status in 72 patients undergoing three different bariatric procedures in a single institution over 30 months. A review of the published work comparing the efficacy of the various procedures in achieving improvement or resolution of diabetes was also carried out and correlated to our findings. RESULTS At an average follow up of 13 months, 50% of patients who had placement of laparoscopic adjustable gastric band had an improvement or resolution of their diabetes, compared with 95% of patients who had had laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass. Two of 12 (17%) laparoscopic adjustable gastric band patients had normal blood glucose levels off all diabetic medications compared with 7 of 21 (33%) laparoscopic sleeve gastrectomy and 27 of 39 (69%) Roux-en-Y gastric bypass patients. There was no significant association between the amount of weight lost and the return to euglycaemia. CONCLUSION Direct comparison has shown a significant difference in the effects of different forms of bariatric surgery on type 2 diabetes, this is in keeping with evidence that surgery can lead to improvement in diabetes additional to that obtained by weight loss alone.
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Affiliation(s)
- Susan S H Gan
- Department of Surgery, Birmingham Heartlands Hospital, Birmingham, West Midlands, UK.
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Abstract
Acquired tracheo-oesophageal fistula is a devastating condition, usually occurring as a late manifestation of oesophageal or other thoracic malignancies. In these cases palliation by placement of an oesophageal stent is the preferred option, but management of a large non-malignant fistula is more complex. In many patients in whom primary repair of the defects is not possible oesophagectomy may be seen as the best treatment. We present a case of a large tracheo-oesophageal fistula repaired with a gastric antral patch oesophagoplasty and intercostal muscle flap.
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Affiliation(s)
- Michael L Talbot
- Department of Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia.
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21
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Abstract
Morbid obesity (defined as having a body mass index [BMI] > 40 kg/m(2), or BMI > 35 kg/m(2) with obesity-related comorbidities) is a medical disorder associated with increased morbidity and mortality. Management guidelines published by the National Health and Medical Research Council and by similar US and UK bodies have recommended surgery as the most effective treatment available for selected patients with morbid obesity. A recent meta-analysis of obesity surgery has documented its safety and effectiveness in resolving some of the major medical comorbidities that occur in obese patients. To date, no intervention other than surgery has proven either effective or cost-effective in treating severe obesity and its associated medical conditions. Targeting patients with metabolic complications of obesity (eg, type 2 diabetes) could lead to substantial cost savings for the public health system. Currently, Medicare pays for privately insured patients to undergo obesity surgery, while uninsured patients are denied access to surgery in public hospitals. This raises significant equity issues that should be addressed.
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Affiliation(s)
- Michael L Talbot
- Department of Surgery, University of New South Wales, St George Hospital, Kogarah, Australia.
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Abstract
We report a case of intraductal papillary mucinous neoplasm confined to the dorsal (Santorini) pancreatic duct. A 51-year-old woman presented with a cystic lesion in the head of her pancreas and pancreas divisum. A biopsy taken during cyst-enteric drainage revealed dysplastic epithelium so the patient was scheduled for resection. At operation, excision of the entire dorsal pancreas was performed with preservation of the unaffected ventral pancreas and the spleen and its vessels. Over 6 years later she remains well with stable weight and a good quality of life. This case illustrates the benefits of anatomical preservation in pancreatic resection, and was performed some years prior to the only other reported similar case.
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Affiliation(s)
- M L Talbot
- Department of Surgery, The Glasgow Royal Infirmary, Glasgow, Scotland
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23
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Talbot ML, Clark JR, Clingan PC, Morris DL. Gastroduodenal ulceration following hepatic arterial chemotherapy: the role of methylene blue endoscopy in the investigation of pain. HPB (Oxford) 2002; 4:29-34. [PMID: 18333149 PMCID: PMC2023909 DOI: 10.1080/136518202753598708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Unintended perfusion of the gastroduodenum may complicate hepatic arterial chemotherapy leading to mucosal ulceration. PATIENTS AND METHODS In a review of 233 consecutive hepatic artery catheters placed, 61 patients were investigated for chemotherapy-related epigastric pain. Investigations included catheter imaging, upper gastrointestinal endoscopy with methylene blue injection via the hepatic artery catheter and angiography. RESULTS Twenty patients (33%) demonstrated blue staining of the gastroduodenum. Angiography performed in 15 of these patients confirmed a misperfusing vessel in 13.The aberrant artery was successfully embolised and infusional chemotherapy recommenced in 11 patients. Forty-one patients had a negative dye test, of whom three had gastroduodenal ulcers, 14 had oesophagitis or gastroduodenitis, ten had catheter complications (leak n=2, arteritis n=5, pseudoaneurysm n=1, sepsis n=1), three had liver collections, five had floxuridine cholangitis and one had myocardial ischaemia. No cause could be found in 8 patients. No patient with a negative dye test developed unintended perfusion on repeat investigation.
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Affiliation(s)
- ML Talbot
- Liver Unit, UNSW Department of Surgery, St George HospitalSydneyAustralia
| | - JR Clark
- Liver Unit, UNSW Department of Surgery, St George HospitalSydneyAustralia
| | - PC Clingan
- Liver Unit, UNSW Department of Surgery, St George HospitalSydneyAustralia
| | - DL Morris
- Liver Unit, UNSW Department of Surgery, St George HospitalSydneyAustralia
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Abstract
Cognitive style is frequently described in terms of performance on the Matching Familiar Figures Test. Because this test has a heavy visual perceptual loading its usefulness as a measure of cognitive style with cerebral palsied students, a population frequently characterized by ocular anomalies and visual perceptual deficits, may be questioned. The test and standardized tests of visual perception and motor accuracy were administered to 46 cerebral palsied students of normal intelligence. Chronological age was the major determiner of visual perceptual and matching performance. The matching data generally suggested that the cerebral palsied students' cognitive styles were qualitatively similar to those of nonhandicapped students, although the extraocular movements of some students appeared to affect the classifications of cognitive style to which they were assigned by the data.
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Lanier AP, Bornkamm GW, Henle W, Henle G, Bender TR, Talbot ML, Dohan PH. Association of Epstein-Barr virus with nasopharyngeal carcinoma in Alaskan native patients: serum antibodies and tissue EBNA and DNA. Int J Cancer 1981; 28:301-5. [PMID: 6274814 DOI: 10.1002/ijc.2910280308] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Biopsy specimens from Alaskan Native patients with nasopharyngeal carcinoma (NPC) and from other patients seen on the otolaryngology service were tested for Epstein-Barr virus-specific DNA and nuclear antigen (EBNA). Serum samples from both groups were tested for various EBV-related antibodies. EBV DNA and EBNA results were in agreement in 29 of 31 tissue specimens tested by the two methods. Ten of 11 biopsies containing NPC cells were positive for EBV DNA. Two NPC patients had biopsies that showed only atypical epithelium but were also positive for EBV DNA or EBNA. The other tissue specimens were negative except for biopsies from two patients: one with a parotid gland lymphoepithelial lesion; another with undifferentiated carcinoma of salivary gland origin.
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Talbot ML, Junkala J. The effects of auditorally augmented feedback on the eye-hand coordination of students with cerebral palsy. Am J Occup Ther 1981; 35:525-8. [PMID: 7025642 DOI: 10.5014/ajot.35.8.525] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
To explore the question of whether auditorally augmented feedback can improve the eye-hand coordination of individuals with cerebral palsy, 59 (cerebral-palsied) students (mean chronological age 14 years, 3 months) were pretested with the Southern California Motor Accuracy Test and then randomly assigned to three groups. Group 1 performed training exercises-tracing line drawings-while simultaneously receiving auditorally augmented feedback about their efforts. Group 2 performed the same training exercises without the augmented feedback. Group 3 served as controls. All subjects were post-tested with the Southern California Motor Accuracy Test, followed by a second post-test after a 3-month interval. At the first post-test, the performance of the feedback group was significantly superior to that of the other groups. At the second post-test, the performance patterns among the groups were essentially the same as the time of the first post-test, but between-group differences were no longer significant. The results of this study are discussed in both empirical and theoretical terms.
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Lanier AP, Henle W, Bender TR, Henle G, Talbot ML. Epstein-Barr virus-specific antibody titers in seven Alaskan natives before and after diagnosis of nasopharyngeal carcinoma. Int J Cancer 1980; 26:133-7. [PMID: 6259065 DOI: 10.1002/ijc.2910260203] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Results are presented of Epstein-Barr virus-specific serologic tests for seven Alaskan Native patients with nasopharyngeal carcinoma (NPC) from whom serum had been collected 2-10 years before diagnosis and up to 6 years after diagnosis. The pre-illness antibody spectra and titers of the NPC patients did not differ from those of controls. However, broadened antibody spectra and elevated titers were associated with the emergence of NPC disease, which in one case was present as early as 22 months before actual diagnosis. Increasing or continuously high antibody titers were associated with progression of the disease and death, whereas patients who maintained relatively low, stable antibody titers after treatment have remained well.
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Talbot ML. Histiocytosis X. Am Surg 1974; 40:89-96. [PMID: 4810636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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