Michael G. Sarr

Prospective evaluation of vertical banded gastroplasty as the primary operation for morbid obesity

Our previous experience with vertical (nonbanded) gastroplasty proved disappointing because of unsatisfactory maintenance of weight loss. Vertical banded gastroplasty seemed to be an attractive alternative operation because it provided an externally reinforced (banded) stoma that would not enlarge over time. In this study, our aim was to determine prospectively the results of vertical banded gastroplasty used as a primary, weight-reducing procedure in patients with morbid obesity. Seventy consecutive patients with morbid obesity (mean weight, 139 kg), all of whom had obesity-related complications, underwent vertical banded gastroplasty and prospective follow-up. The hospital mortality was nil, and substantial morbidity occurred in 3% (two patients). Long-term achievement and maintenance of satisfactory weight loss, however, were variable. The median weight loss at 1 year after operation was 36.7 kg or 48% of excess body weight. At 3 years postoperatively, however, weight loss was only 32.4 kg or 40% of excess body weight, and only 38% of patients had achieved and maintained a weight loss of 50% or more of their preoperative excess body weight. Vertical banded gastroplasty caused major changes in eating habits, and many patients were unable to eat red meat or untoasted bread; moreover, approximately 30 to 50% of patients continued to vomit once or more per week. Despite theoretically attractive advantages as a weight-reduction operation, vertical banded gastroplasty does not seem to be the optimal procedure for most patients with morbid obesity.

Extrinsic innervation modulates canine jejunal transport of glutamine, alanine, leucine, and glucose

BACKGROUNDnWe previously showed a decrease in ileal glutamine transport in vitro and net absorption in vivo after extrinsic denervation of the canine jejunoileum. The aim was to determine whether extrinsic innervation modulates in vivo net absorption and in vitro transport of glutamine and other nutrients in canine jejunum.nnnMETHODSnIn vivo net jejunal uptakes of glutamine, alanine, leucine, and glucose were measured in five dogs before and 2 and 8 weeks after a model neurally isolating in situ the jejunoileum (extrinsic denervation, intestinal transection). To assess mechanisms, carrier-mediated uptakes were quantitated in jejunal brush border membrane vesicles from six dogs before and at 2 and 8 weeks after neural isolation of the jejunoileum and compared with six control dogs with fully intact extrinsic innervation.nnnRESULTSnIn vivo net absorption of glutamine decreased at 2 weeks (p < 0.05) and returned to normal values at 8 weeks; net absorptions of leucine, alanine, and glucose were decreased at both 2 and 8 weeks. In vitro brush border membrane vesicles transport of glutamine, leucine, and alanine followed the patterns of in vivo absorption, but glucose transport did not differ at any time point. Decreased glutamine uptake at 2 weeks resulted from a decrease in Vmax rather than a change in K(m) in sodium-dependent carrier-mediated transport.nnnCONCLUSIONSnExtrinsic denervation down-regulated carrier-mediated transport of amino acids but not glucose. Decreased in vitro glutamine transport was mediated in part by a decrease in number rather than affinity of sodium-dependent transporters.

Social media in surgical education and practice

At a recent meeting of the Editorial Board of Surgery, a surprising number of this somewhat senior group of academic surgeons indicted that they did not use the ‘‘new’’ social media for professional communication and learning---a few used Facebook, YouTube, and Twitter for personal purposes. As the essays in this section indicate, medical students, residents, program directors, teachers, and surgical organizations like the American College of Surgeons have discovered innovative applications of social media mechanisms that quite frankly were a revelation to the Editors. Clearly the means of teaching, learning, and connectivity are evolving rapidly and usefully. At the same time, there are dangers inherent in the inappropriate use of social networking---breach of patient health information, public display of aberrant behavior of caregivers, and unwanted invasion of their own privacy. Used well, the social media provide expanded and expedited access to worlds of information, but we must beware of the converse---too much information of the wrong kind. Our students and residents---major users of these media--- must understand the personal and professional limits of social networks.

Pancreatic Cancer, Cystic Neoplasms and Endocrine Tumors: Diagnosis and Management

Inevitably, reading is one of the requirements to be undergone. To improve the performance and quality, someone needs to have something new every day. It will suggest you to have more inspirations, then. However, the needs of inspirations will make you searching for some sources. Even from the other people experience, internet, and many books. Books and internet are the recommended media to help you improving your quality and performance.

International practices in pancreatic surgery

International practices in pancreatic surgery / , International practices in pancreatic surgery / , کتابخانه دیجیتال جندی شاپور اهواز

Andrew L. Warshaw, MD: modern pioneer of pancreatic surgery.

Fig 1. Andy Warshaw’s high school graduation photo. ANDREW LOUIS WARSHAW was born in the Bronx during World War II. His father, the son of Ukrainian immigrants (who had come from a town called Warsawski), put himself through medical school and eventually became a surgeon. His mother was a schoolteacher, and interestingly her mother (Andy’s grandmother), was hit by a car in the 1920s and spent many months in the hospital with a fractured pancreas while her daughter dutifully stood by her. Back then, very little was known about the pancreas, and, as fate would have it, the grandson one day would become ultimately a worldfamous pancreatic surgeon and uncover some of the mysteries of this ‘‘secret organ.’’ Andy must have been some kind of wunderkid, because he entered Harvard College at age 16 (Fig 1). In addition to being an excellent student, he was also part of the shooting team and proved to be an accomplished marksman. After graduating cum laude from college, he entered Harvard Medical School, where he graduated summa cum laude. He then entered the surgical residency at Massachusetts General Hospital (MGH), and thus fulfilled the 3 steps needed for what is fondly known in the Boston circles as ‘‘preparation triple H.’’ After completing his residency and a 2-year research fellowship at the National Institutes of Health, he joined the staff at the MGH in 1972 and began what by any measure can only be called an incredible clinical and academic career. In his own words, he took the pancreas as his organ of interest ‘‘because it was the only one that was left.’’ At that time, pancreatic surgery was a dangerous enterprise, performed infrequently even in prestigious medical centers. The paper