Re-sleeve gastrectomy is a safe and sensible intervention in selected patients: retrospective cohort study

INTRODUCTION

Sleeve gastrectomy is a good treatment intervention to control the metabolic syndrome in patients with obesity worldwide. However, weight regain is of great concern and would usually necessitate a reintervention. In recent years, re-sleeve gastrectomy (ReSG) has been proposed to treat weight regain in the context of a large residual stomach. Our objective was to analyze the long-term results and safety profile of this intervention in a large case series.

METHODS

From September 2010 to March 2021, a retrospective cohort study in a tertiary nonuniversity hospital was performed. Seventy-nine patients received a ReSG by laparoscopy. Preoperative radiologic imaging showed a dilation of the gastric pouch exceeding 250 cc in all cases.

RESULTS

A total of 79 patients (87% females) with a mean age of 44.8 years old and a mean BMI of 40.0 kg/m 2 were enrolled in the study. The mean follow-up was 44.8 months. The ReSG indication was insufficient weight loss in 37 patients (46.8%) and weight regain in 39 patients (53.2%). The authors noticed a 10.1% complications rate: gastric stenosis (5.1%), bleeding (2.5%), and incisional site hernia in 2.5%, with no death. There was no gastric fistula detected. The mean BMI decreased to 33.1 kg/m 2 after ReSG (a decrease of 6.9 kg/m 2 ).

CONCLUSION

After insufficient weight loss or weight regain following sleeve gastrectomy and in the presence of localized or global gastric tube dilation, ReSG seems to be a good treatment choice and a safe procedure.

Long-term endoscopic follow-up after sleeve gastrectomy

BACKGROUND

Endoscopic follow-up after sleeve gastrectomy (SG) sometime reveals worrisome findings as the presence of major digestive lesions such as esophagitis, Barrett's esophagus (BE), and also esophageal cancer.

OBJECTIVES

The aim of this study was to investigate the frequency and severity of esophageal and gastric lesions after SG.

METHODS

Our team collected the results of esogastric endoscopies performed on patients who underwent SG up to five years before in our hospital, from April 2010 to August 2014. Summons were sent by mail to all patients operated on between those dates. The results were collected from January 2018 to June 2019.

RESULTS

Of the 765 patients who underwent SG up to five years before, only 78 (10.2%) agreed to undergo an upper digestive endoscopy. The average age before surgery was 51 years (range: 25-70 years). The mean preoperative body mass index (BMI) was 44.2±4.6kg/m². For 12 out of these 78 patients (15.4%) it was revisional surgery: 9 SG after gastric banding, and 3 revisional SG (Re-SG). With an average follow-up of 6.3±0.8 years, the endoscopic results of the 78 patients were found to be normal in 31 cases (39.7%): gastritis was found in 28 patients (35.9%), severe grade C or D esophagitis was found in 15 cases (19.2%), hiatal hernia in 18 cases (23.1%), a benign gastric polyp in 2 cases (2.6%). Of the 28 patients with gastritis, HelicobacterPylori was detected in 8 cases (28.6%). No cancer was diagnosed, and BE after SG was found in only one case (1.3%) (normal before surgery). Six of 15 patients with esophagitis (40%) had reflux symptoms. Fourteen of these patients (93.3%) developed de novo esophagitis.

CONCLUSION

Only 10.2% of operated patients agreed to a long-term esogastric endoscopy. The frequency and severity of endoscopic anomalies observed with an average follow-up of more than 6 years pleads for a policy of systematic upper endoscopies of long-term control after SG.

Fetal spina bifida in a pregnant woman following omega gastric bypass: Case report and literature review

•

Nutritional status in a pregnant woman is crucial. It determines the fetal outcome.

•

We added a case of spina bifida after Omega Gastric Bypass.

•

Biochemical and ultrasound monitoring should be performed regularly in pregnant women with a history of bariatric surgery.

•

Vitamins, minerals and trace metals deficiencies after bypass bariatric surgery could be prevented by adequate supplementation administered before and during pregnancy.

Introduction

Bariatric surgery has been increasingly popular during the last years because of its proven efficacy on obesity and related complications. However, nutrient deficiency is common after surgery, in particular after Roux-en-Y gastric bypass (RYGB) or omega gastric bypass (OGB), due to iatrogenic malabsorption. All vitamins and minerals could be involved, including vitamin B9 which plays an important role in the prevention of neural tube defects during pregnancy. We present a case of a spina bifida in the fetus of a pregnant woman following OGB.

Case presentation

A twenty-six years old young woman underwent OGB five years after weight loss failure post sleeve gastrectomy. Her initial body mass index (BMI) was 42.7 kg/m². Two years after OGB, she became pregnant. On her gynecologist’s advice, the patient discontinued daily vitamin intake before the end of the first trimester, as obstetrical follow-up had been considered appropriate. Regrettably, second trimester ultrasound showed myelomeningocele and surgical abortion was decided during the 25^th week of pregnancy.

Discussion

Nutritional status in a pregnant woman is crucial, since it determines the fetal outcome. Biochemical and ultrasound monitoring should be performed regularly, especially in pregnant women with a history of bariatric surgery.

Conclusion

Vitamins, minerals and trace metals deficiencies after bypass bariatric surgery could be prevented by adequate supplementation administered before and during pregnancy.

Phase II trial of extrapleural pneumonectomy followed by adjuvant radiotherapy in malignant pleural mesothelioma

7579

Background: This phase II clinical study was conducted to evaluate the effectiveness of the association of extrapleural pneumonectomy followed by radiation therapy in patients with potentially resectable malignant pleural mesothelioma (MPM). Methods: Eligible patients had histologically proven epithelial or mixed MPM with clinical stage T1–3, N0–2, M0 disease considered to be completely resectable and a WHO performance status of 0 or 1. Surgery had to consist of a complete extrapleural pneumonectomy including resection of pericardium and diaphragm. Postoperative radiotherapy (40 Gy) was delivered through anterior and posterior fields, with a 10 to 20 Gy boost dose if necessary. Results: Thirty seven patients were included in this study. Extrapleural pneumonectomy was completed in 35 patients. Overall hospital mortality was 5,7 %. Major post operative complications were: 3 acute lung injury, 1 bronchopleural fistula, 1 stroke, 1 chylothorax and one diaphragmatic patch dehiscence. IMIG post-operative staging was: stage II = 5 patients; stage III = 25 patients; stage IV = 5 patients. Adjuvant radiation was administered to 29 patients. Survival for the 35 patients with complete resection was 47 ± 8 % at 2 years. Median overall survival time was 22 months. Survival without recurrence was 37 ± 8 % at 2 years. Median time to progression was 15 months. Locoregional recurrence is the most common form of relapse. Conclusions: In the era of surgical neoadjuvant therapy in MPM treatment, extrapleural pneumonectomy followed by radiation therapy in patients with resectable epithelial or mixed MPM can achieve acceptable results.

No significant financial relationships to disclose.

The epidemiology and virology of hepatitis C virus genotype 5 in central France

BACKGROUND

We previously reported high prevalence of hepatitis C virus genotype 5a (HCV 5) (14%) in Central France.

AIM

To identify the risk factors associated with HCV5 infection and to characterize local HCV5 lineages.

METHOD

A case-control study and phylogenetic analysis were conducted.

RESULTS

In all, 131 HCV5 and 343 HCV non 5 infected patients were enrolled. No HCV5 patient was born in sub-Saharan Africa and only two were injection drug user. HCV5 contamination was associated with living in a rural area called Vic le Comte (VLC) in non-transfused patients (OR = 17.7), with transfusion in patients living outside VLC (OR = 3.8) and with receiving injections in patients from VLC (OR = 3.1). More than 80% of the patients from outside VLC were contaminated by transfusion and those from VLC mainly by an iatrogenic factor - injections performed before 1972 by the local physician. Phylogenetic analysis of HCV5 isolates evidenced no distinct genetic cluster, but close relationships between the isolates of spouse pairs and between blood donors and recipients.

CONCLUSIONS

Our results suggest that HCV5 spread in our district by iatrogenic route before 1972 and then via transfusion to the whole district. Collaborative studies are underway to study viral sequences from different parts of Africa and Europe to estimate the origin of our HCV 5a strains.

A new locus for autosomal dominant intracranial aneurysm, ANIB4, maps to chromosome 5p15.2-14.3

BACKGROUND

Intracranial aneurysms (IA) are dilatations of intracranial arteries that occur most commonly at arterial bifurcations. Unruptured IA are present in approximately 1-2% of the population aged over 30 years of age. Aneurysms are only rarely symptomatic unless they rupture, which typically results in a subarachnoid haemorrhage associated with high morbidity and mortality.

METHODS

A large French Canadian (FC) family (Aneu60) was identified which contained 12 affected individuals with intracranial aneurysms. Nine of the affected patients and three unaffected individuals were sent for an 8 cM genome-wide scan. Multipoint and two-point methods were used to analyse the scan data by using a dominant parametric model.

RESULTS

We identified an IA susceptibility locus (ANIB4) located on chromosome 5p15.2-14.3. The locus was found by genome-wide linkage analysis and follow up analyses provided a maximum multipoint LOD score of 3.57 over the region. An identical haplotype segment of 7.2 Mb was found in a second FC pedigree and contributes to the refinement of the candidate gene interval.

CONCLUSIONS

Our results indicate that there is a major gene locus on chromosome 5p.

CCM3 mutations are uncommon in cerebral cavernous malformations

Cerebral cavernous malformations (CCMs) are characterized by abnormally enlarged capillary cavities without intervening brain parenchyma. Mutations in the gene PDCD10 have been found in CCM families linked to the CCM3 locus. The authors screened this gene in 15 families that did not have a CCM1 or CCM2 mutation. Only two novel mutations were found, suggesting that mutations in this gene may only account for a small percentage of CCM familial cases.

[Granulocytic sarcoma (chloroma) of small bowel: an unfrequent cause of intestinal obstruction]

Granulocytic sarcoma or chloroma is a malignant extra medullar tumor, based on inmature myeloid cells. It usually emerges as a secondary manifestation of acute myeloid leukemia. Chloromas are scarcely diagnosed in patiens without hematological malignances, either peripheral or medullar, and are thus frequently misdiagnosed for other tumors. In these patients, further development of acute leukemia seems to stand as a rule. Small bowel location of these tumors has hardly been reported. A case of granulocytic sarcoma in a non-leukemic at time of diagnosis patient is reported therein. Medical literature is briefly reviewed.

A novel vascular endothelial growth factor-directed therapy that selectively activates cytotoxic prodrugs

We have generated fusion proteins between vascular endothelial growth factor (VEGF) and the bacterial enzyme carboxypeptidase G2 (CPG2) that can activate the prodrug 4-[(2-chloroethyl)(2-mesyloxyethyl)amino]benzoyl-L-glutamic acid (CMDA). Three asparagine residues of CPG2 were mutated to glutamine (CPG2(Q)3) to prevent glycosylation during secretion, and truncations of VEGF(165) were fused to either the C- or N-terminal of CPG2. The K(m) of the fusion proteins (37.5 microM) was similar to that of secreted CPG2(Q)3 (29.5 microM) but greater than that of wild-type CPG2 (8 microM). The affinity of the fusion proteins for VEGF receptor-2 (VEGFR2) (K(d)=0.5-1.1 nM) was similar to that of [(125)I]VEGF (K(d)=0.5 nM) (ELISA) or slightly higher (K(d)=1.3-9.6 nM) (competitive RIA). One protein, VEGF(115)-CPG2(Q)3-H(6), possessed 140% of the enzymic activity of secreted CPG2(Q)3, and had a faster half-maximal binding time for VEGFR2 (77 s), than the other candidates (330 s). In vitro, VEGF(115)-CPG2(Q)3-H(6) targeted CMDA cytotoxicity only towards VEGFR-expressing cells. The plasma half-life of VEGF(115)-CPG2(Q)3-H(6) in vivo was 3 h, comparable to equivalent values observed in ADEPT. We conclude that enzyme prodrug therapy using VEGF as a targeting moiety represents a promising novel antitumour therapy, with VEGF(115)-CPG2(Q)3-H(6) being a lead candidate.

Neuron-specific expression of mutant superoxide dismutase 1 in transgenic mice does not lead to motor impairment

Mutations were identified in the Cu/Zn superoxide dismutase gene (SOD1) in approximately 15% of patients with familial amyotrophic lateral sclerosis. Transgenic animals expressing mutant SOD1 in all tissues develop an ALS-like phenotype. To determine whether neuron-specific expression of mutant SOD1 is sufficient to produce such a phenotype, we generated transgenic animals carrying the G37R mutation that is associated with the familial form of ALS (FALS), which is driven by the neurofilament light chain promoter. The transgenic animals express high levels of the human SOD1 protein in neuronal tissues, especially in the large motor neurons of the spinal cord, but they show no apparent motor deficit at up to 1.5 years of age. Our animal model suggests that neuron-specific expression of ALS-associated mutant human SOD1 may not be sufficient for the development of the disease in mice.

TNF receptor family member BCMA (B cell maturation) associates with TNF receptor-associated factor (TRAF) 1, TRAF2, and TRAF3 and activates NF-kappa B, elk-1, c-Jun N-terminal kinase, and p38 mitogen-activated protein kinase

BCMA (B cell maturation) is a nonglycosylated integral membrane type I protein that is preferentially expressed in mature B lymphocytes. Previously, we reported in a human malignant myeloma cell line that BCMA is not primarily present on the cell surface but lies in a perinuclear structure that partially overlaps the Golgi apparatus. We now show that in transiently or stably transfected cells, BCMA is located on the cell surface, as well as in a perinulear Golgi-like structure. We also show that overexpression of BCMA in 293 cells activates NF-kappa B, Elk-1, the c-Jun N-terminal kinase, and the p38 mitogen-activated protein kinase. Coimmunoprecipitation experiments performed in transfected cells showed that BCMA associates with TNFR-associated factor (TRAF) 1, TRAF2, and TRAF3 adaptor proteins. Analysis of deletion mutants of the intracytoplasmic tail of BCMA showed that the 25-aa protein segment, from position 119 to 143, conserved between mouse and human BCMA, is essential for its association with the TRAFs and the activation of NF-kappa B, Elk-1, and c-Jun N-terminal kinase. BCMA belongs structurally to the TNFR family. Its unique TNFR motif corresponds to a variant motif present in the fourth repeat of the TNFRI molecule. This study confirms that BCMA is a functional member of the TNFR superfamily. Furthermore, as BCMA is lacking a "death domain" and its overexpression activates NF-kappa B and c-Jun N-terminal kinase, we can reasonably hypothesize that upon binding of its corresponding ligand BCMA transduces signals for cell survival and proliferation.

The characterization of murine BCMA gene defines it as a new member of the tumor necrosis factor receptor superfamily

The BCMA gene is a new gene discovered by the molecular analysis of a t(4;16) translocation, characteristic of a human T cell lymphoma. It has no significant similarity with any known protein or motif, so that its function was unknown. This report describes the cloning of murine BCMA cDNA and its genomic counterpart. The mouse gene is organized into three exons, like the human gene, and lies in murine chromosome 16, in the 16B3 band, the counterpart of the human chromosome 16p13 band, where the human gene lies. Murine BCMA cDNA encodes a 185 amino acids protein (184 residues for the human), has a potential central transmembrane segment like the human protein and is 62% identical to it. The murine BCMA mRNA is found mainly in lymphoid tissues, as is human BCMA mRNA. Alignment of the murine and human BCMA protein sequences revealed a conserved motif of six cysteines in the N-terminal part, which strongly suggests that the BCMA protein belongs to the tumor necrosis factor receptor (TNFR) superfamily. Human BCMA is the first member of the TNFR family to be implicated in a chromosomal translocation.

High heterogeneity of the exopolysaccharides of Pseudomonas solanacearum strain GMI 1000 and the complete structure of the major polysaccharide

The exopolysaccharide of Pseudomonas solanacearum, which is believed to play an important role in bacterial virulence, was considered by most authors as a homogeneous entity essentially composed of N-acetylgalactosamine. The present work demonstrates the high degree of heterogeneity of this exopolysaccharidic material, which consists of a high molecular weight acidic polysaccharide and a mainly noncarbohydrate structure as major subfractions. Rhamnose-rich polyoside and glucan fractions are also present as minor components. We report the complete structure of the acidic heteropolymer involving, in addition to N-acetylgalactosamine, equimolar ratios of two rare amino sugars, 2-N-acetyl-2-deoxy-L-galacturonic acid and 2-N-acetyl-4-N-(3-hydroxybutanoyl)-2,4,6-trideoxy-D-glucose. The structure of this acidic exopolysaccharide provides the first precise basis for the analysis of the correlation exopolysaccharide structure with pathogenicity in P. solanacearum.

A novel mycolic acid in a Mycobacterium sp. from the environment

A fast-growing, non-photochromogenic mycobacterium isolated from the environment exhibited, on thin-layer chromatograms, a characteristic pattern of mycolates composed of unsaturated mycolates and also an unknown more polar component. Spectroscopic analysis and chemical degradation showed that this latter component was a novel mycolic acid containing a methoxy group at the omega-1 position (instead of omega-17 and omega-18 in known methoxymycolates), and two double bonds in the long mero aldehyde chain (instead of one as in known mycolates with additional oxygenated groups).

[Chemotaxonomy of gram-positive bacteria metabolizing beta-caryophyllene]

Chemotaxonomic identification of coryneform bacteria metabolizing b-caryophyllene was attempted. The following phospholipids were identified as main components of the bacterial extracts: cardiolipids, phosphatidylethanolamine, phosphatidylinositol and mannosides of phosphatidylinositol. Saponification of the lipid extracts gave a mixture of hydroxylated and nonhydroxylated fatty acids. Among the latter, oleic and tuberculostearic acids were identified. The hydroxylated fatty acids were analysed by thin-layer chromatography and mass spectrometry (as methyl esters). From the results thus obtained, the strains appeared to be more closely related to the genus Rhodococcus than to the genus Nocardia.

[Parostal lipoma of the axilla. Apropos of a case and review of the literature]

The authors report a case of soft tissue tumor discovered fortuitously in a 52 year old woman. This lesion was in the axilla and on standard films was seen as a well-defined radiotransparent zone, accompanied by a typical spiculated bone reaction of the lateral edge of the scapula. CT and MRI confirmed the fatty and noninvasive nature of the lesion. Histopathological examination of the operative specimen showed it to be a parostal lipoma.

[Specific lipids from Mycobacterium ulcerans]

The main lipids synthesized by Mycobacterium ulcerans are specific for the species. Three products were isolated by chromatography. Their structures were determined by means of spectrographic methods performed on the natural substances or on their split products. The most abundant products were phthiodiolone diphthioceranate and phenolphthiodiolone diphthioceranate . These structures have some analogies with those of phthiocerol dimycocerosate synthesized by M. tuberculosis and M. bovis, and with those of phenolphthiocerol mycocerosate synthesized by M. bovis. The reverse configuration of the polymethyl-branched-chain fatty acids isolated from the substances, according to their origin, remains to be pointed out. Little attention has generally been paid to the stereochemistry of such molecules. We verified that the branched-chain fatty acids found in diacyl phthiocerol and in the mycoside of M. leprae have the same configuration as in the analogous molecules isolated from M. tuberculosis or M. bovis, contrary to M. ulcerans. Another peculiarity of phenolphthiodiolone isolated from M. ulcerans is the occurrence of the phenol group in free form.

Fatty acid composition of the lipids of Pseudomonas mildenbergii. Presence of a fatty acid containing two conjugated double bonds

The whole cell fatty acids of Pseudomonas mildenbergii were extracted and separated, as methyl esters, into non-hydroxylated (60.6%) and hydroxylated (39.4%) esters. The main component of the hydroxy-ester fraction was methyl 3D-hydroxydecanoate. The non-hydroxylated fraction mainly consisted of methyl 2-decenoate, the methyl ester of a C-12 acid having two conjugated double bonds, methyl palmitate, methyl methylene-hexadecanoate and methyl vaccenate.

[Distal fixation of the intima after endarterectomy. Technical variation]

Oblique termination in a "bevel" of the distal endartery and its fixation by a circumferential continuous suture which provides a surface which is as stable and regular as possible, after endarterectomy. This may favourise improuved distal flow and influence immediate and late local permeability.