Impact of Laparoscopic Banded Gastric Bypass on Weight Loss Surgery Outcomes: 5 Years' Experience

OBJECTIVE

Evaluate 5-year outcomes of banded gastric bypass (BRYGB) as a primary and conversion bariatric procedure.

METHODS

Retrospective review of BRYGB between January 2011and March 2013. Outcomes included percentage of total weight loss (%TWL), weight loss maintenance, and band-related complications.

RESULTS

One hundred forty-two patients underwent BRYGB, 106 primary and 36 conversions. Indications for conversion to BRYGB were complications of the primary procedure (n = 19), insufficient weight loss (n = 5), and weight regain (n = 12). In the primary group, mean preoperative BMI was 44.8 kg/m² (± 6.9 kg/m²). Compared with preoperative weight, mean %TWL was 33.9% (n = 95), 34.1% (n = 82), 34.0% (n = 70), 33.9% (n = 62), and 31.8% (n = 75) after 1, 2, 3, 4, and 5 years, respectively. In conversions secondary to failed primary procedure (insufficient WL and weight regain), mean preoperative BMI was 40.8 kg/m² (± 6.01 kg/m²). Despite one patient gaining weight, mean %TWL was 25.7% (n = 13), 28% (n = 11), 23.9% (n = 8), 18.3% (n = 8), and 15.1% (n = 12) after 1, 2, 3, 4, and 5 years, respectively. In conversions secondary to primary procedure complications (n = 19), mean preoperative BMI was 28.4 kg/m² (± 3.5 kg/m²). After 1, 2, 3, 4, and 5 years, mean BMI was 28.1 (n = 15), 29 (n = 10), 29.8 (n = 9), 30.6 (n = 10), and 30.9 (n = 12) kg/m², respectively. Band-related complications after 5 years: three erosion and five patients complained of persistent dysphagia. One band needed reposition. Perioperative surgical complications: two bleeding, one leakage, one port-site hernia, and one food impaction.

CONCLUSION

Banded gastric bypass has good results in terms of weight loss and weight loss maintenance in both primary and conversional bariatric procedures with acceptable incidence of band-related complications.

Glutathione S-transferase Mu-1 gene polymorphism in Egyptian patients with idiopathic male infertility

The aim of this study was to examine whether an association exists between glutathione S-transferase Mu-1 (GSTM1) gene polymorphism and idiopathic male infertility. Sixty men with primary idiopathic infertility and 60 fertile men, serving as controls, were recruited for the study. The polymorphism was analysed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The frequency of GSTM1 null genotype was observed to be higher in infertile men 40% in comparison with 33.3% in the fertile men, but this difference was not statistically significant. There was statistically significant difference between cases and controls as regards GSTM1 genotype distribution ((MC) P = 0.006*) in GSTM1-positive men. Patients with the GSTM1 null genotype had significantly lower sperm concentrations and total sperm count when compared with patients with GSTM1-positive genotype. In the control group, men with GSTM1 null genotype had significantly lower sperm concentrations but not total sperm count when compared with men with GSTM1-positive genotype. The results of this study suggest a possible negative effect of GSTM1 null genotype on the spermatogenic potential of the testis.

Is serum cystatin C an accurate endogenous marker of glomerular filteration rate for detection of early renal impairment in patients with type 2 diabetes mellitus?

BACKGROUND

Researches have recently reported that serum cystatin C is a more sensitive marker of changes in glomerular filtration rate (GFR) than serum creatinine. We conducted this study to evaluate the significance of serum cystatin C as a more sensitive marker of GFR for early detection of renal impairment in special groups of patients with type 2 diabetes mellitus (DM).

METHODS

The present study included 40 patients with type 2 DM divided into four equal groups based on their urinary albumin excretion and renal function: group 1 was normoalbuminuric, group 2 was microalbuminuric, group 3 was macroalbuminuric, and group 4 was macroalbuminuric with renal dysfunction. All patients underwent a thorough history, full clinical examination, fasting, and renal function tests. Post-prandial blood glucose levels, glycosylated hemoglobin A1c (HbA1c), proteins, albumin in 24 hr urine, and serum cystatin C were collected.

RESULTS

Serum cystatin C and creatinine were significantly higher in macrolbuminuric type 2 diabetic patients with renal dysfunction (group 4: 2.26 +/- 1.28, 4.21 +/- 2.38 mg/dl, respectively; p < 0.001) than macrolbuminuric type 2 diabetic patients with normal renal function (group 3: 1.04 +/- 0.24, 0.96 +/- 0.20 mg/dl, respectively), the microalbuminuric group (0.87 +/- 0.28, 0.71 +/- 0.12 mg/dl, respectively), as well as the normoalbuminuric group (0.55 +/- 0.41, 0.60 +/- 0.18 mg/dl, respectively). ROC plots demonstrated that area under the curve (AUC) of cystatin C (0.74) was greater than that for creatinine clearance (cr.cl) (0.67) and serum creatinine (s-cr) (0.74); therefore, the sensitivity and diagnostic accuracy of cystatin c was better than cr. cl., and both were better than s-cr. Serum cystatin C showed significant correlation in groups 2-4 with s-cr, cr.cl, and 24 hr urine albumin, but no correlation was found in group 1.

CONCLUSION

Serum cystatin C is a reliable and easily performed marker for GFR to detect renal impairment in patients with type 2 DM.

Pairing of Schistosoma mansoni males in infected Syrian hamsters

Pairing of male schistosomes in the liver of infected hamsters was recorded with Egyptians S. mansoni strain. The homospecific male pairs never carried each other in the gynaecophoric duct, but they being closed in either central or hepatic veins. Other perfused males and females en copula showed normal mating behaviour. The paired males were more or less in the same size. The random sexed miracidia used resulted in obtaining 1:2.1 female/male ratio. It is concluded that the random increase of male schistosomes may create the male pairing behaviour. Also, the migration of female against the blood stream to the mesenteric plexus of the host and the failure of male to catch them may lead to this homosexual pairing. The black haemozoin-like substance seen in mature females was also observed in the pairing males and this probably reflects the effect of scarcity or migration of females to the mesenteric plexus.

The histopathological effect of metacercariae of the genus Brachylaima on the land snail, Monacha obstructa

The histopathological changes in the kidney of the land snail Monacha obstructa and the histochemistry of the body wall of the parasite were studied. The histological pictures of the infected kidney showed extensive degree of degeneration in the renal tissue with multiple necrotic foci. Due to the mechanical and feeding effects of the parasite, the renal lamellae were disintegrated. Also, suckers increased the renal damage. In some levels of the kidney, the renal tissue was completely disappeared except the connective tissue of kidney capsule. Also, it was observed that there was a clear space between the parasites and renal tissue probably as a trial of evasion from the Host's reaction. The histochemical study on the metacercarial body wall revealed that it is consisting of three layers arranged as outer, middle and inner layers. Staining with Periodic Acid Schiff proved that the body wall is rich in mucopolysaccharide content. The idea that this parasite can be used as a biocontrol agent is also discussed.

Profile of portal hypertension in hepatosplenic schistosomiasis

Intrasplenic pressure changes versus ova count in stool of schistosomal portal hypertension in cases of bilharzial hepatic fibrosis were studied before and after 40 mg/kg body weight praziquantel therapy. Praziquantel acts on the vascular level in which it decreases the portal hypertension caused by bilharziasis as detected by decreased size of portal and splenic veins diameter as well as a significant decrease of portal pressure by the decrease of intrasplenic pressure (P less than 0.05). On the other hand, praziquantel decrease bilharzial stool egg count after 3 months of therapy (P less than 0.05).

Study of C-reactive protein in bilharziasis and malignancy as causes of ascites

C-reactive protein titre was estimated in serum and ascitic fluid in 23 patients, 12 with cancer stomach accompanied by liver metastatases and 11 with bilharzial liver fibrosis. The results showed no statistically significant differences between the titre in serum and ascitic fluid in the group of cancer with mean of serum/ascitic level ratio 1.3, while in bilharzial group there was significant difference with ratio mean 6.3.

Causes of lymphadenopathy in Egyptian children other than malignancy

Fifty children aged 3 to 12 years presented with cervical or inguinal lymph nodes enlargement were selected from Zagazig University Hospitals. They were subjected to routine laboratory examination as well as histopathological & immunopathological studies. The results revealed eosinophilia and intestinal parasites in 80 percent. Besides, pediculosis and flea dermatitis were also demonstrated in 30 and 12 percent respectively. Histopathological studies of the nodal tissues revealed sinus hyperplasia (ten cases), reactive paracortical hyperplasia (30 cases) and necrosis and caseition (ten cases). Infiltration with eosinophils was demonstrated in the nodal tissues of 40 cases. Immunopathologyical studies revealed cytotoxic T-cells in all the cases, and helper T lymphocytes in only 15 cases. It is concluded that this may give an explanation of some causes of lymphadenopathy in Egyptian children other than malignancy.

Treatment of primary nocturnal enuresis by oral androgen mesterolone. A clinical and cystometric study

A double-blind clinical study of 30 boys, six to ten years of age, with primary nocturnal enuresis was undertaken to assess the role of androgens in treating enuresis. The oral synthetic androgen mesterolone was selected because of its minimal potential toxic effects. Twenty boys were treated with mesterolone and 10 received placebo. Fourteen boys (70%) became dry during treatment (20 mg daily for 14 days), and 5 (25%) remained dry for a follow-up period of four months. Increased cystometric bladder capacity and disappearance of uninhibited detrusor contractions were noticed in a significant number of cases after treatment. No side effects were recorded. Mesterolone has probably modulated the autonomic innervation of the vesical musculature with correction of the defective neural mechanism which is believed to be implicated in the pathogenesis of nocturnal enuresis.

Mechanism of continence after transpubic urethroplasty

Urethral profilmetry was performed in seven continent patients with transpubic urethroplasty. The studies were repeated in the supine and upright positions, both at rest and under the stresses of cough, bearing down, and hold maneuvers. The urethral pressure tracing of these patients is characteristically bihumped in shape. The proximal hump with a mean height of 18 cm water at rest corresponds to the prostatic plateau of normal subjects. The distal hump with a mean height of 32 cm water represents the pressure inside that segment of the bulbar urethra which had been brought into the abdomen by the transpubic operation. The average functional urethral length is 4.6 cm and on standing increased to 6.7 cm, mainly due to elongation of the distal hump. Changes in intra-abdominal pressure by cough or bearing down are transmitted along the whole functional urethral length with augmented urethral closure pressure of 57 to 61 cm water in the proximal hump and 44 to 48 cm water in the distal hump. However, contraction of the perineal musculature by hold maneuvers has no effect on the urethra of these patients. We conclude that after transpubic urethroplasty, although the distal urethral mechanism is destroyed and excluded, the new intra-abdominal position of the transposed bulbar urethra provides a new factor that supplements the bladder neck in maintaining urinary continence.