1) A randomized controlled trial compared gastric bypass (GB) and sleeve gastrectomy (SG) for treating type 2 diabetes mellitus (T2DM) in 60 moderately obese patients.
2) At 12 months, remission of T2DM was achieved by 93% in the GB group and 47% in the SG group, indicating GB was more effective at treating T2DM.
3) Participants who received GB had greater weight loss and better control of glucose, HbA1c, and blood lipid levels compared to those who received SG. No serious complications occurred in either group.
The Mini-Gastric Bypass:Best Treatment Type 2 Diabetes MellitusDr. Robert Rutledge
The Mini-Gastric Bypass:Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Hirschsprung’s disease in adults: Clinical and therapeutic featuresPremier Publishers
Hirschsprung’s disease (HD) is rare in adults and it is thus often undiagnosed or misdiagnosed. Through this series of 12 patients we try to study the clinical characteristics of this pathology, to define its diagnostic clues and to assess the different therapeutic approaches.
Definitive diagnosis is established on histology of specimens from the rectum and colon. The disease involved the rectum and the sigmoid colon in 2 patients and was confined to the rectum, in the 10 others.
Treatment was in all cases surgical consisting of recto-colic resection associated with coloanal anastomosis and a protective right lateral ileostomy.
We conclude that Hirschsprung’s disease is rare in adults but by no means exceptional. It should be considered in young adults with a history of chronic constipation. Diagnosis is first of all clinical. When barium enema appearances are pathognomonic we needn’t resort to histology to confirm the diagnosis. Anorectal manometry does not usually show RAIR. Current primary treatment of HD diagnosed in adults consists mainly of surgical resection.
Endoscopic and surgical treatment of obesityDrShivaraj SA
The document discusses several endoscopic and surgical treatments for obesity, including space occupying devices, gastric restrictive measures, malabsorptive procedures, and measures regulating gastric emptying. It provides details on several intragastric balloons (e.g. ORBERA, ReShape, Obalon, Spatz), transoral endoscopic procedures (e.g. gastroplasty, DJBL), and describes results from studies on weight loss and safety outcomes. Endoscopic sleeve gastroplasty is highlighted as a minimally invasive procedure for weight loss that can reduce comorbidities like diabetes up to 24 months after the procedure.
This document summarizes a study on using an endoluminal device called the StomaphyX to reduce gastric pouches after Roux-en-Y gastric bypass surgery in patients experiencing weight regain. Thirty-nine patients underwent the procedure, with an average excess weight loss of 7.4% at 2 weeks, 10.6% at 1 month, and 19.5% at 1 year. Minor complications included sore throat and epigastric pain. The procedure may offer an alternative to open or laparoscopic revisional surgery for weight regain with no major complications observed.
Laparoscopy-assisted distal gastrectomy with D1+β compared with D1+α lymph no...Goto Pablo
This study compared outcomes of laparoscopy-assisted distal gastrectomy (LADG) with D1+a lymph node dissection versus D1+b lymph node dissection for early gastric cancer. D1+b dissection removed more lymph nodes along the common hepatic artery and celiac artery compared to D1+a. However, there were no significant differences in short-term outcomes such as complications, recovery times, or length of stay between the two procedures. The study concluded that LADG with D1+b dissection is as minimally invasive as D1+a dissection while providing the oncological benefits of more extensive lymph node removal.
This 12-month study evaluated the safety and efficacy of the transoral incisionless fundoplication (TIF) procedure using the EsophyX system. 86 patients with gastroesophageal reflux disease underwent the TIF procedure. At 12 months, 73% of patients reported at least a 50% improvement in quality of life scores, 85% discontinued daily PPI use, and 81% had complete cessation of PPIs. The TIF procedure was found to be safe and effective in improving symptoms for most patients with GERD.
This case report describes a 14-year-old female who presented with abdominal pain and weight loss. She was found to have both biliary dyskinesia and superior mesenteric artery syndrome (SMA syndrome). Biliary dyskinesia was confirmed by a HIDA scan showing poor gallbladder function. An upper GI series showed duodenal obstruction consistent with SMA syndrome due to rapid weight loss. She underwent open cholecystectomy and duodenojejunostomy to address both conditions simultaneously. Postoperatively, she continued to experience gastric symptoms requiring nutritional support. She was eventually discharged tolerating full feeds.
Dr.NAGARJUNA JOURNAL - GUM CHEWING REDUCES POST OPERATIVE ILEUS?Butkuri Nagarjuna
This document summarizes a systematic review and meta-analysis on the effect of gum chewing in reducing postoperative ileus. The review included 9 randomized controlled trials with a total of 437 patients who underwent elective intestinal surgery. The meta-analysis found that gum chewing was associated with a shorter time to passing flatus (reduced by 14 hours) and stool (reduced by 23 hours), as well as a shorter hospital stay (reduced by 1.1 days). However, the evidence was limited by the small sample sizes of the included studies and lack of details on randomization and blinding methods. While gum chewing appears to be a low-cost intervention, more rigorous studies are still needed to confirm its benefits.
The Mini-Gastric Bypass:Best Treatment Type 2 Diabetes MellitusDr. Robert Rutledge
The Mini-Gastric Bypass:Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Hirschsprung’s disease in adults: Clinical and therapeutic featuresPremier Publishers
Hirschsprung’s disease (HD) is rare in adults and it is thus often undiagnosed or misdiagnosed. Through this series of 12 patients we try to study the clinical characteristics of this pathology, to define its diagnostic clues and to assess the different therapeutic approaches.
Definitive diagnosis is established on histology of specimens from the rectum and colon. The disease involved the rectum and the sigmoid colon in 2 patients and was confined to the rectum, in the 10 others.
Treatment was in all cases surgical consisting of recto-colic resection associated with coloanal anastomosis and a protective right lateral ileostomy.
We conclude that Hirschsprung’s disease is rare in adults but by no means exceptional. It should be considered in young adults with a history of chronic constipation. Diagnosis is first of all clinical. When barium enema appearances are pathognomonic we needn’t resort to histology to confirm the diagnosis. Anorectal manometry does not usually show RAIR. Current primary treatment of HD diagnosed in adults consists mainly of surgical resection.
Endoscopic and surgical treatment of obesityDrShivaraj SA
The document discusses several endoscopic and surgical treatments for obesity, including space occupying devices, gastric restrictive measures, malabsorptive procedures, and measures regulating gastric emptying. It provides details on several intragastric balloons (e.g. ORBERA, ReShape, Obalon, Spatz), transoral endoscopic procedures (e.g. gastroplasty, DJBL), and describes results from studies on weight loss and safety outcomes. Endoscopic sleeve gastroplasty is highlighted as a minimally invasive procedure for weight loss that can reduce comorbidities like diabetes up to 24 months after the procedure.
This document summarizes a study on using an endoluminal device called the StomaphyX to reduce gastric pouches after Roux-en-Y gastric bypass surgery in patients experiencing weight regain. Thirty-nine patients underwent the procedure, with an average excess weight loss of 7.4% at 2 weeks, 10.6% at 1 month, and 19.5% at 1 year. Minor complications included sore throat and epigastric pain. The procedure may offer an alternative to open or laparoscopic revisional surgery for weight regain with no major complications observed.
Laparoscopy-assisted distal gastrectomy with D1+β compared with D1+α lymph no...Goto Pablo
This study compared outcomes of laparoscopy-assisted distal gastrectomy (LADG) with D1+a lymph node dissection versus D1+b lymph node dissection for early gastric cancer. D1+b dissection removed more lymph nodes along the common hepatic artery and celiac artery compared to D1+a. However, there were no significant differences in short-term outcomes such as complications, recovery times, or length of stay between the two procedures. The study concluded that LADG with D1+b dissection is as minimally invasive as D1+a dissection while providing the oncological benefits of more extensive lymph node removal.
This 12-month study evaluated the safety and efficacy of the transoral incisionless fundoplication (TIF) procedure using the EsophyX system. 86 patients with gastroesophageal reflux disease underwent the TIF procedure. At 12 months, 73% of patients reported at least a 50% improvement in quality of life scores, 85% discontinued daily PPI use, and 81% had complete cessation of PPIs. The TIF procedure was found to be safe and effective in improving symptoms for most patients with GERD.
This case report describes a 14-year-old female who presented with abdominal pain and weight loss. She was found to have both biliary dyskinesia and superior mesenteric artery syndrome (SMA syndrome). Biliary dyskinesia was confirmed by a HIDA scan showing poor gallbladder function. An upper GI series showed duodenal obstruction consistent with SMA syndrome due to rapid weight loss. She underwent open cholecystectomy and duodenojejunostomy to address both conditions simultaneously. Postoperatively, she continued to experience gastric symptoms requiring nutritional support. She was eventually discharged tolerating full feeds.
Dr.NAGARJUNA JOURNAL - GUM CHEWING REDUCES POST OPERATIVE ILEUS?Butkuri Nagarjuna
This document summarizes a systematic review and meta-analysis on the effect of gum chewing in reducing postoperative ileus. The review included 9 randomized controlled trials with a total of 437 patients who underwent elective intestinal surgery. The meta-analysis found that gum chewing was associated with a shorter time to passing flatus (reduced by 14 hours) and stool (reduced by 23 hours), as well as a shorter hospital stay (reduced by 1.1 days). However, the evidence was limited by the small sample sizes of the included studies and lack of details on randomization and blinding methods. While gum chewing appears to be a low-cost intervention, more rigorous studies are still needed to confirm its benefits.
This document discusses endoscopic management of obesity, known as endobariatrics. It can be used as primary therapy, bridging therapy before surgery, or revisional therapy after surgery. Primary endoscopic therapies include intragastric balloons, tissue apposition techniques, and nutrient diverting therapies. Secondary endoscopic therapies include transoral outlet reduction, revision obesity surgery procedures, and argon plasma coagulation. Several studies on intragastric balloons and other primary therapies show promising results with 20-50% excess weight loss. Endobariatrics aims to bridge the gap between medical and surgical obesity treatment.
Gastroparesis is delayed gastric emptying without mechanical obstruction. It is commonly caused by autonomic neuropathy like in diabetes. Symptoms include nausea, vomiting, bloating and weight loss. Diagnosis involves ruling out obstruction and scintigraphy showing retained food after meals. Treatments include prokinetic medications, botulinum toxin injections, enteral feeding tubes, and gastric pacemakers which use electrical stimulation to increase motility. While many can live normally with treatment, diabetes-related gastroparesis often requires more intensive intervention.
Complications Following Antireflux Surgery: Recognition and ManagementGeorge S. Ferzli
Re-operative antireflux surgery requires extensive pre-operative evaluation to determine the cause of failure and appropriate surgical approach. Common causes of failure include inadequate crus closure, fundoplication disruption, and esophageal shortening. The surgical approach should be tailored to the suspected mechanism of failure but often involves dismantling prior operations andredoing the fundoplication. Re-operation has a higher failure rate than initial surgery due to surgical challenges and patient factors.
This study retrospectively reviewed 29 patients over 10 years with penetrating duodenal or pancreaticoduodenal injuries to compare outcomes of repairs with or without pyloric exclusion. It found that the two groups were similar in demographics and injury severity. There was a non-significant trend toward higher complication rates, pancreatic fistulas, and longer hospital stays with pyloric exclusion. Neither group experienced duodenal fistulas. The study concludes pyloric exclusion did not improve outcomes for these injuries and simple repair may be adequate and safer.
Gastroesophageal Reflux Disease Pathophysiology and TreatmentGeorge S. Ferzli
This document discusses gastroesophageal reflux disease (GERD), including its pathophysiology, symptoms, diagnosis, and treatment options. It provides details on the medical and surgical management of GERD, highlighting the importance of a thorough pre-operative workup including pH testing, manometry, and other diagnostic evaluations to determine the appropriate treatment and ensure good postoperative outcomes. Both medical therapies like proton pump inhibitors and surgical procedures like Nissen fundoplication are discussed as options for treating GERD, with surgery reserved for cases that are refractory to medical management or that involve complications.
Bouveret's syndrome as an unusual cause of gastric outletFerstman Duran
This case report describes an 83-year-old man who presented with vomiting and abdominal pain and was found to have Bouveret's syndrome. Endoscopy revealed a large mass obstructing the duodenum, which was discovered to be a gallstone during surgery. The gallstone had caused a cholecysto-duodenal fistula. Initial surgery removed the fistula but the gallstone remained, requiring a second surgery to remove it from the duodenum. Bouveret's syndrome is a rare complication of gallstones that can cause gastric outlet obstruction.
Background: The transanal one-stage endorectal pull-through (TOSEPT) procedure sometimes requires assistance by an abdominal approach to complete the operation. This study aims to rectify this by evaluating the impact of an assisted abdominal approach in the outcomes of the TOSEPT in children with HD.
Methods: A retrospective study was conducted at surgical pediatric department of Hue central hospital. All consecutive medical records of patients operated on for HD in our department between June 2010 and June 2018 were retrieved and analysed.
The document discusses transoral incisionless fundoplication (TIF), a minimally invasive surgical procedure for treating gastroesophageal reflux disease (GERD). It provides details on the causes and symptoms of GERD, limitations of current treatment options like PPI medications, and how TIF aims to anatomically reconstruct the gastroesophageal junction in a minimally invasive manner to effectively treat GERD. Clinical trial results show TIF significantly improves outcomes for patients with GERD, allowing many to discontinue daily PPI use with no serious side effects reported.
This document summarizes recent advances in the diagnosis and treatment of gastroesophageal reflux disease (GERD). It discusses new diagnostic tests such as the Bravo capsule and multichannel intraluminal impedance that allow for improved detection of acid and non-acid reflux. It also reviews therapeutic advances for GERD including new drugs that target transient lower esophageal sphincter relaxations, combination therapies, and endoscopic procedures like Stretta and Enteryx that aim to strengthen the lower esophageal sphincter. Finally, it discusses ongoing issues around Barrett's esophagus screening and surveillance.
Morbid obesity is diagnosed using body mass index, body fat percentage, and waist circumference measurements. Treatment involves lifestyle changes including diet, exercise, and behavior therapy as well as medications or surgery. Surgical options include restrictive procedures like gastric banding and sleeve gastrectomy, or combined restrictive and malabsorptive procedures like Roux-en-Y gastric bypass. Complications can include leaks, infections, nutritional deficiencies, and weight regain, so patients require long-term management. Bariatric surgery is effective for treating obesity-related medical conditions and promoting significant and sustainable weight loss for eligible patients.
Morbid obesity and surgical managementGaurav Gupta
The document discusses morbid obesity and surgical management options. It defines morbid obesity as being 100 pounds or more overweight, or having a BMI over 40 kg/m2. Surgical procedures like gastric bypass, sleeve gastrectomy, and gastric banding are recommended when lifestyle changes fail to achieve weight loss. These procedures work by restricting food intake, slowing stomach emptying, or reducing nutrient absorption. Complications can include leaks, strictures, nutritional deficiencies, and infection, but bariatric surgery is generally effective for achieving long-term weight loss and resolving obesity-related health conditions.
The Skinny on he Role of Endoscopy in Bariatric SurgeryPatricia Raymond
Obesity epidemic; so where does endoscopy fit in with current bariatric surgery in preoperative assessment and management of complications, and what's under development for primary endoscopic bariatric techniques-- get the skinny here!
Metabolic Surgery Mechanisms of Actions the Foregut TheoryGeorge S. Ferzli
The document discusses metabolic surgery and its mechanisms for treating type 2 diabetes. It presents findings that duodenal-jejunal bypass surgery leads to remission of diabetes in non-obese diabetic rats, controlling blood sugar independently of weight loss or nutrient malabsorption. Exclusion of the duodenum from nutrient passage may offset an abnormality in gastrointestinal physiology responsible for insulin resistance. The findings support the hypothesis that a dysfunction of the duodenum contributes to the pathophysiology of type 2 diabetes.
Bouveret’s syndrome case report and review of the literatureFerstman Duran
This case report describes a patient with Bouveret's syndrome who presented with nausea, vomiting, abdominal pain and melena. Imaging revealed a gallstone obstructing the duodenum. The stone was successfully removed during an endoscopy using various extraction devices and mechanical lithotripsy. Bouveret's syndrome is a rare complication of gallstones that occurs when a gallstone passes through a cholecystoduodenal fistula and becomes lodged in the duodenum, causing gastric outlet obstruction. Endoscopic extraction is recommended as first-line treatment when possible due to its lower risk compared to surgery. The literature on Bouveret's syndrome and approaches to treatment, including endoscopic, lithotripsy and surgical
Comparison of Bariatric to Metabolic surgery- DR PRAVIN JOHNAlisha Prince
This document summarizes metabolic surgery compared to bariatric surgery. It defines metabolic surgery as operations intended to treat diabetes and metabolic dysfunctions like obesity. The primary procedures discussed are sleeve gastrectomy, gastric bypass, and gastric banding. Metabolic surgery is shown to have high rates of resolving type 2 diabetes and improving other comorbidities like hypertension. Complications and outcomes of the different procedures are compared.
This document summarizes a seminar on bariatric surgery presented by several professors and doctors. It defines obesity and bariatric surgery. It discusses the prevalence of obesity, causes, medical risks, guidelines for treatment, and various bariatric procedures such as gastric bypass and gastric banding. The seminar provided an overview of obesity as a disease and the role of bariatric surgery as an effective treatment option.
Este documento resume varias micosis cutáneas y ectoparásitosis comunes. Describe las candidiasis, pitiriasis versicolor, escabiosis, pediculosis y larva migrans, incluyendo sus agentes causales, factores de riesgo, cuadros clínicos y tratamientos. Proporciona detalles sobre cada enfermedad como su presentación, síntomas y opciones terapéuticas para combatir las infecciones causadas por hongos, bacterias y parásitos descritos.
This document discusses key aspects of project management including application areas, project environments, management and interpersonal skills, the project management context involving programs, portfolios, subprojects and project management offices (PMOs). It notes that PMOs centralize resources, methodology, documentation and more to coordinate project management across an organization at the enterprise level. The roles of a project manager and PMO are compared, with the project manager focusing on a specific project and the PMO taking a broader enterprise perspective.
Ainoa is a cheerful and friendly girl from Cartagena, Spain who has green eyes and blonde hair. She enjoys music, spending time with friends both online and going out, and shopping for clothes. Ainoa would like to meet boys aged 14 to 16 to practice her English.
This document discusses endoscopic management of obesity, known as endobariatrics. It can be used as primary therapy, bridging therapy before surgery, or revisional therapy after surgery. Primary endoscopic therapies include intragastric balloons, tissue apposition techniques, and nutrient diverting therapies. Secondary endoscopic therapies include transoral outlet reduction, revision obesity surgery procedures, and argon plasma coagulation. Several studies on intragastric balloons and other primary therapies show promising results with 20-50% excess weight loss. Endobariatrics aims to bridge the gap between medical and surgical obesity treatment.
Gastroparesis is delayed gastric emptying without mechanical obstruction. It is commonly caused by autonomic neuropathy like in diabetes. Symptoms include nausea, vomiting, bloating and weight loss. Diagnosis involves ruling out obstruction and scintigraphy showing retained food after meals. Treatments include prokinetic medications, botulinum toxin injections, enteral feeding tubes, and gastric pacemakers which use electrical stimulation to increase motility. While many can live normally with treatment, diabetes-related gastroparesis often requires more intensive intervention.
Complications Following Antireflux Surgery: Recognition and ManagementGeorge S. Ferzli
Re-operative antireflux surgery requires extensive pre-operative evaluation to determine the cause of failure and appropriate surgical approach. Common causes of failure include inadequate crus closure, fundoplication disruption, and esophageal shortening. The surgical approach should be tailored to the suspected mechanism of failure but often involves dismantling prior operations andredoing the fundoplication. Re-operation has a higher failure rate than initial surgery due to surgical challenges and patient factors.
This study retrospectively reviewed 29 patients over 10 years with penetrating duodenal or pancreaticoduodenal injuries to compare outcomes of repairs with or without pyloric exclusion. It found that the two groups were similar in demographics and injury severity. There was a non-significant trend toward higher complication rates, pancreatic fistulas, and longer hospital stays with pyloric exclusion. Neither group experienced duodenal fistulas. The study concludes pyloric exclusion did not improve outcomes for these injuries and simple repair may be adequate and safer.
Gastroesophageal Reflux Disease Pathophysiology and TreatmentGeorge S. Ferzli
This document discusses gastroesophageal reflux disease (GERD), including its pathophysiology, symptoms, diagnosis, and treatment options. It provides details on the medical and surgical management of GERD, highlighting the importance of a thorough pre-operative workup including pH testing, manometry, and other diagnostic evaluations to determine the appropriate treatment and ensure good postoperative outcomes. Both medical therapies like proton pump inhibitors and surgical procedures like Nissen fundoplication are discussed as options for treating GERD, with surgery reserved for cases that are refractory to medical management or that involve complications.
Bouveret's syndrome as an unusual cause of gastric outletFerstman Duran
This case report describes an 83-year-old man who presented with vomiting and abdominal pain and was found to have Bouveret's syndrome. Endoscopy revealed a large mass obstructing the duodenum, which was discovered to be a gallstone during surgery. The gallstone had caused a cholecysto-duodenal fistula. Initial surgery removed the fistula but the gallstone remained, requiring a second surgery to remove it from the duodenum. Bouveret's syndrome is a rare complication of gallstones that can cause gastric outlet obstruction.
Background: The transanal one-stage endorectal pull-through (TOSEPT) procedure sometimes requires assistance by an abdominal approach to complete the operation. This study aims to rectify this by evaluating the impact of an assisted abdominal approach in the outcomes of the TOSEPT in children with HD.
Methods: A retrospective study was conducted at surgical pediatric department of Hue central hospital. All consecutive medical records of patients operated on for HD in our department between June 2010 and June 2018 were retrieved and analysed.
The document discusses transoral incisionless fundoplication (TIF), a minimally invasive surgical procedure for treating gastroesophageal reflux disease (GERD). It provides details on the causes and symptoms of GERD, limitations of current treatment options like PPI medications, and how TIF aims to anatomically reconstruct the gastroesophageal junction in a minimally invasive manner to effectively treat GERD. Clinical trial results show TIF significantly improves outcomes for patients with GERD, allowing many to discontinue daily PPI use with no serious side effects reported.
This document summarizes recent advances in the diagnosis and treatment of gastroesophageal reflux disease (GERD). It discusses new diagnostic tests such as the Bravo capsule and multichannel intraluminal impedance that allow for improved detection of acid and non-acid reflux. It also reviews therapeutic advances for GERD including new drugs that target transient lower esophageal sphincter relaxations, combination therapies, and endoscopic procedures like Stretta and Enteryx that aim to strengthen the lower esophageal sphincter. Finally, it discusses ongoing issues around Barrett's esophagus screening and surveillance.
Morbid obesity is diagnosed using body mass index, body fat percentage, and waist circumference measurements. Treatment involves lifestyle changes including diet, exercise, and behavior therapy as well as medications or surgery. Surgical options include restrictive procedures like gastric banding and sleeve gastrectomy, or combined restrictive and malabsorptive procedures like Roux-en-Y gastric bypass. Complications can include leaks, infections, nutritional deficiencies, and weight regain, so patients require long-term management. Bariatric surgery is effective for treating obesity-related medical conditions and promoting significant and sustainable weight loss for eligible patients.
Morbid obesity and surgical managementGaurav Gupta
The document discusses morbid obesity and surgical management options. It defines morbid obesity as being 100 pounds or more overweight, or having a BMI over 40 kg/m2. Surgical procedures like gastric bypass, sleeve gastrectomy, and gastric banding are recommended when lifestyle changes fail to achieve weight loss. These procedures work by restricting food intake, slowing stomach emptying, or reducing nutrient absorption. Complications can include leaks, strictures, nutritional deficiencies, and infection, but bariatric surgery is generally effective for achieving long-term weight loss and resolving obesity-related health conditions.
The Skinny on he Role of Endoscopy in Bariatric SurgeryPatricia Raymond
Obesity epidemic; so where does endoscopy fit in with current bariatric surgery in preoperative assessment and management of complications, and what's under development for primary endoscopic bariatric techniques-- get the skinny here!
Metabolic Surgery Mechanisms of Actions the Foregut TheoryGeorge S. Ferzli
The document discusses metabolic surgery and its mechanisms for treating type 2 diabetes. It presents findings that duodenal-jejunal bypass surgery leads to remission of diabetes in non-obese diabetic rats, controlling blood sugar independently of weight loss or nutrient malabsorption. Exclusion of the duodenum from nutrient passage may offset an abnormality in gastrointestinal physiology responsible for insulin resistance. The findings support the hypothesis that a dysfunction of the duodenum contributes to the pathophysiology of type 2 diabetes.
Bouveret’s syndrome case report and review of the literatureFerstman Duran
This case report describes a patient with Bouveret's syndrome who presented with nausea, vomiting, abdominal pain and melena. Imaging revealed a gallstone obstructing the duodenum. The stone was successfully removed during an endoscopy using various extraction devices and mechanical lithotripsy. Bouveret's syndrome is a rare complication of gallstones that occurs when a gallstone passes through a cholecystoduodenal fistula and becomes lodged in the duodenum, causing gastric outlet obstruction. Endoscopic extraction is recommended as first-line treatment when possible due to its lower risk compared to surgery. The literature on Bouveret's syndrome and approaches to treatment, including endoscopic, lithotripsy and surgical
Comparison of Bariatric to Metabolic surgery- DR PRAVIN JOHNAlisha Prince
This document summarizes metabolic surgery compared to bariatric surgery. It defines metabolic surgery as operations intended to treat diabetes and metabolic dysfunctions like obesity. The primary procedures discussed are sleeve gastrectomy, gastric bypass, and gastric banding. Metabolic surgery is shown to have high rates of resolving type 2 diabetes and improving other comorbidities like hypertension. Complications and outcomes of the different procedures are compared.
This document summarizes a seminar on bariatric surgery presented by several professors and doctors. It defines obesity and bariatric surgery. It discusses the prevalence of obesity, causes, medical risks, guidelines for treatment, and various bariatric procedures such as gastric bypass and gastric banding. The seminar provided an overview of obesity as a disease and the role of bariatric surgery as an effective treatment option.
Este documento resume varias micosis cutáneas y ectoparásitosis comunes. Describe las candidiasis, pitiriasis versicolor, escabiosis, pediculosis y larva migrans, incluyendo sus agentes causales, factores de riesgo, cuadros clínicos y tratamientos. Proporciona detalles sobre cada enfermedad como su presentación, síntomas y opciones terapéuticas para combatir las infecciones causadas por hongos, bacterias y parásitos descritos.
This document discusses key aspects of project management including application areas, project environments, management and interpersonal skills, the project management context involving programs, portfolios, subprojects and project management offices (PMOs). It notes that PMOs centralize resources, methodology, documentation and more to coordinate project management across an organization at the enterprise level. The roles of a project manager and PMO are compared, with the project manager focusing on a specific project and the PMO taking a broader enterprise perspective.
Ainoa is a cheerful and friendly girl from Cartagena, Spain who has green eyes and blonde hair. She enjoys music, spending time with friends both online and going out, and shopping for clothes. Ainoa would like to meet boys aged 14 to 16 to practice her English.
The document is an excerpt from a textbook on introductory chemistry. It covers several key topics:
1) It defines chemistry as the science dealing with the composition and changes of matter, as well as energy changes. 2) It explains that matter is composed of discrete particles called atoms. 3) It describes the three physical states of matter - solids, liquids, and gases - and how they differ in terms of shape, volume, compressibility, and intermolecular forces. 4) It defines pure substances, mixtures, homogeneous mixtures, and heterogeneous mixtures.
El documento describe una excursión de estudiantes de una escuela primaria al Museo del Niño en Carolina, Puerto Rico. Los estudiantes participaron en numerosas actividades interactivas en diferentes secciones del museo, incluyendo secciones sobre agua, volcanes, aviación, construcción, magnetismo, televisión y sistemas planetarios. Los estudiantes aprendieron de manera divertida a través de experimentos prácticos y juegos.
The document provides instructions for registering an application with the GSMA OneAPI Gateway and using various APIs to send SMS, retrieve location data, and process payments. It outlines the registration process, creating an application, and calling APIs to send SMS, get location with user authorization, and charge payments to phone bills by adding users to a payments sandbox. It provides JSON request examples and response formats.
This document describes a wedding celebration through a series of images. Photos show the bride and groom's cousins, guests throwing rice, people having dinner and dancing, the wedding cake, and guests drinking. The images capture the key moments and people at the wedding.
My ideal home is a large, modern house in Paris with three bedrooms, two bathrooms, a kitchen, and living room. It has a balcony with a view of the cathedral and a pool in the garden for summer, along with an indoor heated pool. I live there with my boyfriend and cat, and our favorite room is the large, comfortable living room with its sofa, tea table, and big TV.
The Mini-Gastric Bypass: Best Treatment Type 2 Diabetes Mellitus
Dr K S Kular
Kular Medical Education & Research Society ,
Kular Group of Institutes ,
drkskular@gmail.com
www.kularhospital.com
Why Consider the MGB?
With the Band/Sleeve/RNY available
Why even consider the Mini-Gastric Bypass?
6 yr study 29,820 BCBS plan members.
"Laparoscopic RNY and Lap Band both Fail to reduce overall health care costs in the long term."
Impact of Bariatric Surgery on Health Care Costs of Obese Persons, A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, et al. JAMA Surg. 2013;148(6)
Metabolic effects of bariatric surgery in patients with moderate obesity and ...Apollo Hospitals
Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: Analysis of a randomized control trial comparing surgery with intensive medical treatment
Sleeve vs Mini-Gastric Bypass
IN EVERY STUDY, by every measure, the Mini-Gastric Bypass is equal to or better than every other form of bariatric surgery
Duodenal-jejeunal Bypass in Non-obese Adults with Type 2 DiabetesGeorge S. Ferzli
This document summarizes several studies on duodenal-jejunal bypass surgery for type 2 diabetes:
1) A study on 10 non-obese adults with type 2 diabetes who underwent duodenal-jejunal bypass surgery found that it significantly improved blood glucose control and insulin sensitivity within days of the procedure.
2) A follow-up study using a non-obese diabetic rat model also found that duodenal-jejunal exclusion directly improved blood glucose control, independently of any weight loss effects.
3) A subsequent study on these rats further showed that bypassing the duodenum was responsible for the blood glucose benefits, not other surgical factors, as reversing the bypass procedure reversed
Initial human experience with restrictive duodenal jejunal bypass liner for t...Ricardo Yanez
This study evaluated the use of a duodenal-jejunal bypass liner (DJBL) with a restrictor orifice for weight loss in 10 obese patients over 12 weeks. Key results:
1) Patients experienced a mean excess weight loss of 40% and total weight loss of 16.7 kg by the end of the study.
2) Gastric emptying was delayed with the DJBL in place, returning to normal levels after its removal in most patients.
3) Episodes of nausea and abdominal pain required dilation of the restrictor orifice in most patients, but there were no clinically significant adverse events.
4) The DJBL with restrictor orifice promoted substantial weight loss
This study compared outcomes of 61 gastric cancer patients treated with postoperative chemoradiotherapy using either intensity-modulated radiotherapy (IMRT) or 3-dimensional conformal radiotherapy (3D CRT). The 2-year overall survival rates were 51% for 3D CRT and 65% for IMRT, with no significant difference. Locoregional failure occurred in 15% of 3D CRT patients and 13% of IMRT patients. Both the 2-year disease-free survival and local control rates were similar between the two groups. Overall, the study found no significant differences in outcomes between IMRT and 3D CRT for adjuvant therapy of gastric cancer.
Surgery for Obesity Duodeno-Jejunal Bypass forType 2 Diabetes in Non-Obese - ...George S. Ferzli
This document summarizes research on the effects of bariatric surgery procedures like gastric bypass and duodenal switch on type 2 diabetes. It finds that these procedures often dramatically improve blood sugar control and can even cure diabetes in many patients. This is believed to be due both to weight loss effects and hormonal changes from rerouting digestion, which increase levels of gut hormones like GLP-1 that stimulate insulin secretion and improve insulin sensitivity. The document reviews long-term studies finding high rates of diabetes remission following various bariatric procedures.
Proximal Gastrectomy for Early Gastric Cancerjim kuok
Proximal gastrectomy (PG) is an alternative to total gastrectomy for early gastric cancers located in the upper third of the stomach. PG aims to preserve gastric function while achieving adequate cancer resection. PG is oncologically appropriate for cT1a/bN0 stage I gastric cancers. Lymph node dissection for PG typically involves D1 or D1+ lymphadenectomy. Various reconstruction techniques after PG aim to reduce postoperative complications like reflux esophagitis. Larger studies comparing PG to total gastrectomy find similar long-term survival but PG may better preserve nutritional parameters and quality of life. Prospective randomized trials are still needed to further establish the role of PG.
Common Complication, Errors & Misunderstandings in the MGBDr. Robert Rutledge
This document provides information on common complications, errors, and misunderstandings related to the Mini-Gastric Bypass (MGB) procedure, as well as guidelines for prevention and treatment. It discusses topics like anemia, staple line complications, leaks and bleeding, protein-calorie malnutrition from excessive weight loss, and management of these issues. The document emphasizes that widespread misunderstanding of the MGB procedure often leads to complications and errors in patient management, highlighting the need for standardization and recognition of surgeons with expertise in MGB.
The document describes a study investigating the use of an endoscopic procedure called StomaphyX to reduce the size of the gastric pouch and decrease the diameter of the gastrojejunostomy in patients who had previously undergone gastric bypass surgery but regained significant weight. The procedure involves using an endoscopic device to apply fasteners to plicate and reduce the size of the gastric pouch transorally without external incisions. The study aims to evaluate if this endoscopic approach can help promote further weight loss without the risks of traditional revisional surgery. Preliminary results of the first 5 patients are not yet reported.
The document describes a study investigating the use of an endoscopic procedure called StomaphyX to reduce the size of the gastric pouch and decrease the diameter of the gastrojejunostomy in patients who had previously undergone gastric bypass surgery but regained significant weight. The procedure involves using an endoscopic device to apply fasteners to plicate and reduce the size of the gastric pouch transorally without external incisions. The study aims to evaluate if this endoscopic approach can help promote further weight loss without the risks of traditional revisional surgeries. Preliminary results of the procedure in the first few patients are promising for restoring the pouch size and decreasing complications compared to other revisional surgery options.
Anti Diabetes Operations: The Foundation for New ProceduresGeorge S. Ferzli
- Bariatric surgery may provide a "cure" for type 2 diabetes by inducing significant weight loss and resolution of comorbid diseases like diabetes. Procedures like Roux-en-Y gastric bypass and biliopancreatic diversion have been shown to control diabetes in 80-100% of patients.
- The anti-diabetic effects of bariatric surgery are not solely due to weight loss and must also have direct impacts on glucose homeostasis, possibly due to changes in gut hormone secretion and levels of GLP-1.
- Emerging evidence suggests bariatric surgery could be a treatment option for non-obese patients with type 2 diabetes, though current guidelines only approve the procedure
The document discusses various bariatric surgeries and their effectiveness, complications, and long-term outcomes. It finds that while restrictive procedures like bands and sleeves can initially cause weight loss, they often fail long-term as patients develop increased hunger and turn to unhealthy high-calorie foods and drinks. The mini-gastric bypass is presented as a more effective alternative, blocking the neuro-hormonal hunger system, inducing more durable weight loss and diabetes remission over 10-15 years with low complication rates according to studies of over 1000 and 1322 patients. A controlled trial also found the mini-gastric bypass was twice as effective at controlling diabetes as sleeve gastrectomy.
Research Comparing Gastric Bypass Surgery and Intensive Medical Therapy in Ty...Yunji Kim
Gastric bypass surgery results in better glycemic control and diabetes remission compared to intensive medical therapy alone in obese patients with type 2 diabetes according to several randomized controlled trials and cohort studies. Studies found greater reductions in HbA1c and BMI levels in patients who underwent gastric bypass surgery versus those receiving intensive medical therapy. Remission rates of type 2 diabetes were higher, ranging from 40-75%, in patients undergoing gastric bypass surgery compared to 0% of those receiving intensive medical therapy alone. However, larger and longer term studies are still needed to further evaluate safety and long term outcomes of gastric bypass surgery.
This document summarizes information on gallbladder removal surgery (cholecystectomy). It discusses the history and types of cholecystectomy procedures, including open and laparoscopic techniques. Key points include that laparoscopic cholecystectomy has become the gold standard treatment for gallstone disease since the 1990s as it is associated with less pain, smaller incisions, shorter hospital stays and faster recovery compared to open cholecystectomy. However, laparoscopic approaches may be more technically challenging and carry a higher risk of bile duct injuries.
Acs0533 The Surgical Management Of Ulcerative Colitis 2004medbookonline
This document discusses procedures for ulcerative colitis. It outlines indications for both emergency and elective surgery to treat ulcerative colitis. Emergency operations are needed for fulminant colitis, toxic megacolon, massive hemorrhage, or perforation. Elective operations are considered for chronic symptoms, steroid dependency or refractoriness, dysplasia or cancer risk, or strictures. The goal of emergency surgery is to remove diseased colon to improve the patient's condition, while elective operations can cure intestinal manifestations through removal of the entire large intestine.
Bariatric surgery is the most effective treatment for obesity, resulting in greater weight loss than diet and exercise alone. The three most common bariatric surgery procedures are sleeve gastrectomy, Roux-en-Y gastric bypass, and adjustable gastric banding. Sleeve gastrectomy and Roux-en-Y gastric bypass typically result in 60-70% excess weight loss, while gastric banding results in less weight loss of around 50%. Bariatric surgery significantly improves or resolves obesity-related conditions like type 2 diabetes, hypertension, and sleep apnea. Complications can include leaks, strictures, nutritional deficiencies, and gallstones, but can often be managed endoscopically.
A clinical study on medical cupping for metabolic syndrome with abdominal obe...LucyPi1
Abstract Objective: To observe the clinical effects of medical cupping for metabolic syndrome (MetS) with abdominal obesity. Methods: In total, 75 patients with MetS with abdominal obesity were randomly divided into three groups: medical cupping, acupuncture, and waiting. Patients in the medical cupping group received smearing of Chinese medicine and cupping twice a week for 8 weeks. Patients in the acupuncture group received acupuncture on regulating the Dai meridian three times a week for 8 weeks. The waiting group was observed without any intervention. Changes in metabolic indices, including waist circumference (WC), blood pressure, fasting triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), 2-h blood glucose (2hBG), and subcutaneous fat thickness were observed and compared before and after treatment among the three groups. Results: After the treatment, the WC, TG, FBG, and 2hBG in the medical cupping and acupuncture groups were lower than those in the waiting group. No difference was observed between the medical cupping and acupuncture groups. The subcutaneous fat thickness at the upper umbilicus, right side of the umbilicus, and waist in the medical cupping and acupuncture groups were lower than those in the waiting group. The subcutaneous fat thickness at the upper umbilicus and waist in the medical cupping group was lower than that in the acupuncture group. The MetS prevalence in the medical cupping and acupuncture groups was lower than that in the waiting group. Conclusion: medical cupping treatment can effectively alleviate metabolic indices and subcutaneous fat thickness at the abdomen in patients with MetS and abdominal obesity and decrease the MetS prevalence. Its efficacy was better than that of waiting and similar to that of acupuncture. The frequency of medical cupping is lower than that of the acupuncture. Meanwhile, it circumvents some patients’ fear of acupuncture. medical cupping should be clinically promoted.
Similar to Ebm上課 arch surg. 2011 feb;146(2)143 8. (20)
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.