Quality of Life in Children with Neurofibromatosis Type 1: Agreement between Parents and Patients, and the Role of Disease Severity and Visibility.

BACKGROUND: Neurofibromatosis type 1 (NF1) is a genetic disorder that affects multiple systems in the body, often leading to physical disfigurements and a wide range of clinical symptoms. This study aims to investigate the relationship between NF1 severity and visibility and the quality of life (QoL) in children. METHODS: The Pediatric Quality of Life Inventory (PedsQL) and a modified version of the Ablon scale were used to assess QoL and NF1 severity and visibility, respectively. Self-reported and parent-reported QoL scores were compared, and the associations between NF1 severity/visibility and QoL were explored. RESULTS: Thirty-eight pediatric NF1 patients and their parents were enrolled. QoL scores did not differ significantly between patient self-reports and parent reports. However, correlational analyses revealed that higher NF1 severity was associated with lower physical QoL in patients, and greater NF1 visibility was linked to lower physical and social QoL. For parents, higher NF1 severity correlated with lower school functioning, whereas NF1 visibility did not show a significant correlation with QoL. CONCLUSION: The severity and visibility of NF1 have distinct impacts on various aspects of QoL in children, highlighting the need for tailored interventions that address both physical and psychological challenges. These findings underscore the importance of comprehensive care approaches in managing NF1 in pediatric populations.

Acute complications following endoscopic intragastric balloon insertion for treatment of morbid obesity in elderly patients. A single center experience.

BACKGROUND: Obesity is a serious disease, with an increasing incidence also among subjects over 60 years old; surgical management has proven to be the most effective in the production of significant and durable weight loss. Intragastric balloon (IGB) treatment promotes a reduction of five to nine Body Mass Index (BMI) units in 6 months with an impressive improvement of obesity-associated comorbidities. METHODS: Two hundred and twenty-five patients, 106 men (47.1%) and 119 women (52.9%), were evaluated at our institution to be submitted to a IGB positioning. Of these, 12 patients (8 women and 4 men) were more than 60 years old. For all patients BMI, comorbidities, weight loss and complications were recorded. χ2 test was used to evaluate differences in complications rate between elderly and other patients. RESULTS: For the 12 elderly patients, we recorded a mean excess weight loss rate (EWL%) of 31.4. About complications, we recorded 2 severe esophagitis requiring IGB removal and 1 late gastric perforation. A higher complications rate was found in elderly population and the comparison with other patients revealed a significant difference (P<0.001). CONCLUSIONS: Our results underline that IGB treatment in elderly patients is safe and effective in terms of weight loss and improvement in comorbidities. IGB can cause complications which, sometimes, can be severe such as esophageal damage and gastric perforation. For the management of complications, we highly recommend a close follow-up in all patients and a deepened instrumental study in every suspect case.

Results following laparoscopic sleeve gastrectomy in elderly obese patients: a single center experience with follow-up at three years.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) represents the most performed bariatric surgical procedure worldwide. Morbid Overweight in elderly patients is becoming a significant health problem even in Italy. As well as in younger age groups, bariatric surgery could be indicated even in this subset of patients. However the advantages and results of LSG in patients over 60 years old have received minimal attention. METHODS: The records of 375 patients underwent LSG between 2008 and 2016 were reviewed. In the entire series 18 patients were aged 60 years or older at the time of surgery. Since a 3 years follow-up was available for 12 patients out of the 18 aged over 60 we included in the study only these. General epidemiologic data, clinical findings, BMI and comorbidities surgical treatment and follow-up data were collected; postoperative measurements such as operative time, intraoperative complications, mortality rate, length of stay, incidence of early and late complications, Body mass Index (BMI), excess weight loss rate (EWL%) and comorbidities resolution were also recorded. RESULTS: LSG was successfully performed for all geriatric patients. Global complications rate was 16.6% At 3 years mean BMI was 34.4±3.8 with a mean EWL% 66.1±31.9. Postoperative resolution of obesity comorbidities was observed; Hypertension (71.4%), type 2 Diabetes Mellitus (T2DM) (50.0%), obstructive sleep apnea syndrome (OSAS) (66.6%) respectively. No intraoperative complications or mortality were recorded. CONCLUSIONS: LSG offered cure in geriatric patients affected by morbid obesity for weight loss and comorbidities resolution. Larger studies are necessary to analyze and minimize the incidence of postoperative complications associated to this surgical procedure in elderly patients.

Correction to: Acute acalculous cholecystitis determining Mirizzi syndrome: case report and literature review.

Following publication of the original article [1], the authors reported that one of the authors' names is spelled incorrectly.

Efficacy of Postoperative Upper Gastrointestinal Series (UGI) and Computed Tomography (CT) Scan in Bariatric Surgery: a Meta-analysis on 7516 Patients.

BACKGROUND: To demonstrate the lack of utility and efficacy of routine early postoperative upper gastrointestinal study (UGI) in obese patients undergoing bariatric surgery and to show the higher efficacy of CT scan in cases of clinical suspicion of a leakage, a meta-analysis was performed. MATERIALS AND METHODS: A literature search including articles published in last 18 years was performed. For both UGI and CT scan, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A first analysis considered overall patients, and a second analysis considered only symptomatic patients. RESULTS: Starting from 1233 eligible citations, 18 articles, including 7516 patients, were left. The pooled sensitivity was 54% for UGI (95% CI 34-74) with a high heterogeneity (I2 = 99.8%, p < .001), whereas CT scan showed a pooled sensitivity of 91% (95% CI 89-93) significantly higher than sensitivity of UGI series (p < 0.01), with a high heterogeneity (I2 = 98.9%, p < .001). In symptomatic patients the pooled sensitivity of UGI series was significantly lower than sensitivity of CT scan [49% (95% CI 31-68) vs 94% (95% CI 92-96), p < 0.01]. PPV showed a significant difference between UGI series and CT scan (54 vs 100%, p < 0.01). Specificity for UGI series was 98.6%, and specificity for CT scan was 99.7% (p = ns); the mean NPV was 96 and 98% for UGI series and CT scan (p = ns). CONCLUSIONS: According to our results, a CT scan triggered by clinical suspicion must be considered the first-line procedure to detect a postoperative leak following primary sleeve gastrectomy or Roux-en-Y gastric bypass.

Acute Leaks Following Laparoscopic Sleeve Gastrectomy: Early Surgical Repair According to a Management Algorithm.

INTRODUCTION: Despite leakages remaining a worrisome complication, laparoscopic sleeve gastrectomy (LSG) has become the preferred choice for most bariatric surgeons in Italy. In light of the emerging trend to discharge patients on postoperative day (POD) 1 or to consider LSG as an outpatient procedure, we felt it useful in selected cases to define a treatment protocol aimed to manage patients presenting with an acute postoperative leakage. PATIENTS AND METHODS: Starting from 2007, 295 LSGs have been performed at our institution. Six patients, including 5 from our series (1.6%), were treated for a leak. The first patient presented a leak on POD 3, whereas the next 2 patients were re-admitted on POD 11 and 12, respectively. They all underwent a conservative treatment. The last 3 patients, according to a suggested algorithm, underwent a prompt surgical repair. RESULTS: The conservatively treated patients were discharged following 22 ± 7.7 days, whereas patients treated by surgery were discharged following 10 ± 0.8 days (P = .09). By not considering the cost of primary LSG, which is about 5600 € in our region, the expense for every patient treated by re-intervention was about 2500 €. The cost for each patient treated by stenting was about 4700 €. The cost for each patient treated conservatively was about 5700 €. CONCLUSIONS: According to our series and in agreement with published data, it is reasonable in selected cases to consider a wider role for early surgery. A timely surgical approach following an appropriate algorithm may offer a resolutive and cost-effective answer to the management of acute leaks following LSG.

Role of colonoscopy in the diagnostic work-up of bowel endometriosis.

AIM: To evaluate the accuracy of colonoscopy for the prediction of intestinal involvement in deep pelvic endometriosis. METHODS: This prospective observational study was performed between September 2011 and July 2014. Only women with both a clinical and imaging diagnosis of deep pelvic endometriosis were included. The study was approved by the local ethics committee and written informed consent was obtained in all cases. Both colonoscopy and laparoscopy were performed by expert surgeons with a high level of expertise with these techniques. Laparoscopy was performed within 4 wk of colonoscopic examination. All hypothetical colonoscopy findings (eccentric wall thickening with or without surface nodularities and polypoid lesions with or without surface nodularities of endometriosis) were compared with laparoscopic and histological findings. We calculated the sensitivity, specificity, positive predictive value and negative predictive value for the presence of colonoscopic findings of intestinal endometriosis. RESULTS: A total of 174 consecutive women aged between 21-42 years with a diagnosis of deep pelvic endometriosis who underwent colonoscopy and surgical intervention were included in our analysis. In 76 of the women (43.6%), intestinal endometrial implants were found at surgery and histopathological examination. Specifically, 38 of the 76 lesions (50%) were characterized by the presence of serosal bowel nodules; 28 of the 76 lesions (36.8%) reached the muscularis layer; 8 of the 76 lesions (10.5%) reached the submucosa; and 2 of the 76 lesions (2.6%) reached the mucosa. Colonoscopic findings suggestive of intestinal endometriosis were detected in 7 of the 174 (4%) examinations. Colonoscopy failed to diagnose intestinal endometriosis in 70 of the 76 women (92.1%). A colonoscopic diagnosis of endometriosis was obtained in all cases of mucosal involvement, in 3 of 8 cases (37.5%) of submucosal involvement, in no cases of muscularis layer involvement and in 1 of 38 cases (2.6%) of serosa involvement. The sensitivity, specificity, positive predictive and negative predictive values of colonoscopy for the diagnosis of intestinal endometriosis were 7%, 98%, 85% and 58%, respectively. CONCLUSION: Being an invasive procedure, colonoscopy should not be routinely performed in the diagnostic work-up of bowel endometriosis.

Lipid profile changes in patients undergoing bariatric surgery: a comparative study between sleeve gastrectomy and mini-gastric bypass.

OBJECTIVE: To prospectively evaluate the effect of different types of bariatric surgery on lipid profile. METHODS: Total cholesterol (TC), High-Density-Lipoprotein cholesterol (HDLc), Low-Density-Lipoprotein cholesterol (LDLc) and triglycerides (TG) levels were evaluated before surgery and at 3 different post-operative time-points (3, 6 and 12 months) in consecutive obese subjects undergoing mini-gastric bypass (MGB) or sleeve gastrectomy (SG). RESULTS: At baseline, 74 MGB and 86 SG subjects were comparable for lipid profile and prevalence of hypercholesterolemia/hypertriglyceridemia. During the post-operative follow-up, both MGB and SG subjects showed significant changes in lipid profile. However, at 3 months, MGB patients showed higher changes in TC (ß = 0.179, p = 0.022) and TG (ß = 0.265, p = 0.001) than those undergoing SG. At 6-month post-operative follow-up, these differences were confirmed only for TC. After a 12-month follow-up, MGB and SG were entirely comparable for changes in lipid profile with the exception of HDLc, whose changes were higher in SG group (ß = 0.130, p = 0.039). Overall, the probability to normalize lipid profile during the 12-month follow-up was similar in MGB and in SG patients (OR:1.24, 95%CI:0.41-3.76, p = 0.689). CONCLUSION: Despites some differences at 3-6 post-operative months, during a 12-month follow-up, SG and MGB showed a similar efficacy in the improvement of lipid profile of obese patients.

Haemostatic and fibrinolytic changes in obese subjects undergoing bariatric surgery: the effect of different surgical procedures.

BACKGROUND: Little is known about effects of different bariatric surgery procedures on haemostatic and fibrinolytic parameters. MATERIAL AND METHODS: Consecutive obese subjects undergoing gastric bypass (GBP) or sleeve gastrectomy (SG) were enrolled. In all patients, levels of haemostatic factors (FII, FVII, FVIII, FIX, FX, vWF, fibrinogen), fibrinolytic variables (PAI-1, t-PA and D-dimer) and natural anticoagulants (AT, protein C and protein S) were evaluated before and 2 months after surgery. RESULTS: A total of 77 GBP and 79 SG subjects completed the study. At baseline no difference in coagulation parameters was found between the two groups. After both GBP and SG, subjects showed significant changes in haemostatic and fibrinolytic variables and in natural anticoagulant levels. The Δ% changes in FVII, FVIII, FIX, vWF, fibrinogen, D-dimer, protein C and protein S levels were significantly higher in subjects who underwent GBP than in those who underwent SG. Multivariate analysis confirmed that GBP was a predictor of higher Δ% changes in FVII (ß=0.268, p=0.010), protein C (ß=0.274, p=0.003) and protein S (ß=0.297, p<0.001), but not in all the other variables. Following coagulation factor reduction, 31 subjects (25.9% of GBP and 13.9% of SG; p=0.044) showed overt FVII deficiency; protein C deficiency was reported by 34 subjects (32.5% of GBP vs 11.4% of SG, p=0.033) and protein S deficiency by 39 (37.6% of GBP vs 12.6% of SG, p=0.009). Multivariate analyses showed that GBP was associated with an increased risk of deficiency of FVII (OR: 3.64; 95% CI: 1.73-7.64, p=0.001), protein C (OR: 4.319; 95% CI: 1.33-13.9, p=0.015) and protein S (OR: 5.50; 95% CI: 1.71-17.7, p=0.004). DISCUSSION: GBP is associated with an increased risk of post-operative deficiency in some vitamin K-dependent coagulation factors. Whereas such deficiency is too weak to cause bleeding, it is significant enough to increase the risk of thrombosis.

Acute acalculous cholecystitis determining Mirizzi syndrome: case report and literature review.

BACKGROUND: Although Mirizzi syndrome is widely reported in literature, little is known about acute acalcholous cholecystitis determinig the findings of a Mirizzi syndrome. CASE PRESENTATION: We report a case of MRCP-confirmed Mirizzi syndrome in acute acalculous cholecystitis resolved by surgery. CONCLUSION: Acute acalcholosus cholecystitis determinig a Mirizzi Syndrome should be included in the Mirizzi classification as a type 1. Thus it could be useful to divide the type 1 in two entity (compression by stone and compression by enlarged gallbladder). Magnetic Resonance should be considered the preferred diagnostic tool in any case of Mirizzi syndrome suspicious.

Bariatric surgery is not contraindicated in obese patients suffering from glycogen storage disease type IXa. A case report with follow-up at three years.

INTRODUCTION: Glucose storage disease type IXa (GSD IXa) is an uncommon condition presenting with childhood onset hepatomegaly, growth retardation, and often, fasting ketosis and hypoglycemia. Despite its benign course, the lack of dietary counseling may favor uncontrolled weight gain. We investigated the efficacy of bariatric surgery in one 17 years old female suffering from GSD IXa and morbid obesity. PRESENTATION OF CASE: The diagnosis was GSD type IXa in a patient with a body mass index (BMI) of 45.5kg/m(2). Onset of hypoglycemia was reported twice each month. She was treated her implanting an adjustable gastric banding through laparoscopy. Three years after surgery the patient presents a BMI of 30.1kg/m(2) and an excess of weight loss (EWL) of 71.1%. Only once, following surgery, she had to deflate her band to allow a faster transit of food through her stomach, thus reaching a prompt euglycemic condition, due to an incoming hypoglycemic crisis. DISCUSSION: Laparoscopic adjustable gastric banding (LAGB) is one of the most used approaches to treat morbid obesity. It is a restrictive procedure unable to affect the absorption of any nutrient, presenting a very low intra and perioperative complication rate. In our GSD IXa patient, it offered a prompt modification of food intake restriction whenever requested, thus avoiding hypoglycemia. CONCLUSION: LAGB is effective in determining weight loss without inducing significant side effects or worsening hypoglycemia, in this morbid obese patient, suffering from GSD type IXa.

Bariatric surgery in elderly patients. A comparison between gastric banding and sleeve gastrectomy with five years of follow up.

INTRODUCTION: The prevalence of obesity is rising progressively, even among elderly patients. Many studies investigated about safety and efficacy of bariatric surgery among aged obese patients. The objective of this review is to assess the benefits relative to risks of weight loss that may be obtained by performing two common bariatric procedures in obese elderly patient. MATERIALS AND METHODS: We retrospectively evaluated 10 morbid obese patients older than 60 years reaching 5 years of follow up who respectively underwent Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Adjustable Gastric Banding (LAGB). Eventual changes in comorbidities, weight loss, EWL% were investigated. RESULTS: Although LSG patients required a longer postoperative hospital stay than LAGB patients (p < 0.001), both procedures have shown to be safe and equally effective for weight loss achievement in elderly patients. Whereas all patients showed comorbidities resolution, no significant difference in weight loss between LAGB group and LSG group was found at 1 year (EWL% p = 0.87; BMI p = 0.32), 3 years (EWL% p = 0.62; BMI p = 0.79) and 5 years (EWL% p = 0.52; BMI p = 0.46) of follow up. CONCLUSIONS: Bariatric surgery is safe and effective to reach obesity related comorbidities resolution among elderly obese patients. Both LAGB and LSG determine a weight loss lesser than observed in a standard bariatric population. In this study LSG is significantly less cost effective than LAGB. Larger studies with longer follow up are however needed to evaluate the real impact of bariatric surgery on weight loss, resolution of comorbidities and improvement of quality of life in elderly obese patients.

Laparoscopic sleeve gastrectomy: efficacy of fibrin sealant in reducing postoperative bleeding. A randomized controlled trial.

Staple line leakage and bleeding are worrisome complications of laparoscopic sleeve gastrectomy (LSG). Solutions such as buttressing, oversewing or roofing the staple line with gelatin matrix have been proposed with controversial results. Because the use of fibrin sealant has shown a possible benefit in reducing the reoperation rate due to early complication in patients (pts) undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP), this solution has been tested in 100 consecutive pts undergoing LSG. A clinical trial has been performed on 100 consecutive pts. Exclusion criteria from the study were considered ASA IV pts, treated or untreated malignancies at any stage, steroids or FANS assumption, previous sovramesocolic surgery and conversion to open surgery. All pts were randomized to receive (group A, 50 pts) or to not receive (group B, 50 pts) 4 ml of human fibrin sealant (Tisseel™, Baxter(®) Deerfield, IL, USA) sprayed along the suture line. Primary endpoint was the incidence of postoperative complications: leaks, bleeding of the staple line or stenosis of the gastric remnant. Significance was assigned at a p level <0.05. By considering pts in group A vs. pts in group B our results shown no significant difference in fistulas or strictures occurrence (p = 0.2). Bleeding was significantly higher in patients not sprayed with sealant (group A vs. group B, 1/7, p = 0.03). This randomized trial has so far shown the use of fibrin sealant in LSG to significantly reduce postoperative bleeding. Although a trend in reducing leak occurrence emerges, it does not reach statistical significance.

Wernicke encephalopathy in subjects undergoing restrictive weight loss surgery: a systematic review of literature data.

The use of weight loss surgery is progressively increasing, and in recent years, restrictive bariatric surgery procedures have been more often used. Although thought to be associated with a lower incidence of post-operative side effects than malabsorpitive surgery, some cases of micronutrients deficiency have been reported because of an acquired thiamine deficiency; in this clinical setting, some cases of Wernicke encephalopathy (WE) have been described. Major determinants and predictors of this major neurological complication are currently unknown. The aim of this systematic review was to analyse literature data in order to address this issue. The main result of our systematic review was that persistent vomiting is the major determinant of WE in patients undergoing restrictive weight loss surgery. In addition, early thiamine supplementation can rapidly improve the clinical conditions, avoiding permanent deficiencies. On the other hand, given the wide variability of clinical and demographic characteristics, definite prognostic factors of WE occurrence and of clinical outcome cannot be identified. In conclusion, although our results are suggestive, further ad hoc prospective studies evaluating changes in micronutrients levels according to different types of surgery are needed.

Varicocele repair in severe oligozoospermia: A case report of post-operative azoospermia.

Varicocele has been implicated as a cause in 35%-50% of patients with primary infertility and up to 81% of men with secondary infertility. Although a large number of reports have shown improvement in the semen parameters after correction of varicocele, other studies have suggested no benefit. We report the first case of azoospermia after surgery in a young infertile male patient with left-sided varicocele and severe oligozoospermia undergoing laparoscopic varicocelectomy. A pregnancy was only achieved with assisted reproductive technology because semen cryopreservation was performed before surgery. In the light of the above, the deterioration of sperm count after varicocele repair in patients with severe oligozoospermia could be due to irreversible impairment of spermatogenesis of such patients, together with the possible temporary damage of the surgical repair. This possible complication could therefore turn the severe oligozoospermia into an indication to perform cryopreservation before surgery, on both clinical and medico-legal grounds. Further research is needed before drawing definitive conclusions regarding the management of varicocele-related severe oligozoospermia.

The mini-gastric bypass in the management of morbid obesity in Prader-Willi syndrome: a viable option?

AIMS: To test the efficacy of the mini-gastric bypass (MGB) in the treatment of morbid obesity related to the Prader-Willi Syndrome (PWS). PATIENTS AND METHODS: Three young male patients (mean age 15.6 years) complaining with PWS were treated by MGB with the aim to improve morbid obesity associated with the syndrome. Preoperative body mass index was 51 ± 4.13 kg/m(2). Two patients suffered from both hypertension and frequent sleep apnea crises. The mean preoperative level of fasting plasma acyl ghrelin was 1417.26 ± 289.37 pg/ml. All patients underwent a laparoscopic MGB. RESULTS: The postoperative period was uneventful and all patients were discharged on the fifth postoperative day. The patients suffering from both hypertension and respiratory crises are now free from receiving any therapeutic support. When measured, the postoperative level of fasting plasma acyl ghrelin decreased to 675.5, 524.6, and 353.1 pg/ml, respectively. An excess weight loss of 79% has been recorded at two years so far. To date, no nutritional impairment, weight regain, or need for revision surgery has been recorded. CONCLUSION: MGB appears to provide an effective weight reduction in patients suffering from PWS without determining significant nutritional impairment or weight regain. Larger studies are however required.

Intradermal absorbable sutures to close pilonidal sinus wounds: a safe closure method?

PURPOSE: The aim of this study was to demonstrate the safety of using intradermal absorbable sutures for pilonidal sinus skin closure. METHODS: The study was prospectively carried out in 203 patients randomized into two groups of patients. In the first group (103 patients), interrupted sutures were used; in the second group (100 patients), a continuous intradermal suture was used. We have analyzed the time off work, time to walk without pain, time to sit on the toilet without pain, wound infections, satisfaction rate and esthetic results. RESULTS: There were no significant differences between the groups with regard to the time off work, time to walk without pain and time to sit on a toilet without pain. There was also no significant difference between the groups with regard to the wound infection rates (p = 0.64). The study suggested that the patients' satisfaction was higher when an intradermal suture was used (p = 0.001). Similarly, a better cosmetic appearance of the scar was obtained with an intradermal suture (p = 0.01). CONCLUSIONS: Our results suggest that using intradermal sutures after excision and primary closure of the pilonidal sinus is safe and has advantages in terms of the cosmetic results and patient satisfaction.

A vaginal drain of a pelvic abscess due to colonic diverticulitis.

Although well recognized for tubo-ovarian abscesses, we report, in our best knowledge, the first case of a vaginal drain of a pelvic abscess due to colonic diverticulitis. A 78-year-old patient presented with abdominal and pelvic pain, fever (39.3 °C) and an elevated white blood cell count (18500/mL). After abdominopelvic computed tomography the patient was presumed to have a pelvic abscess, which developed as a complication of the sigmoid diverticulitis. Due to the numerous intervening structures that create obstacles to safe percutaneous access, we planned a trans-vaginal drain. A rapid recovery was obtained within 2 d from the procedure and, at present, the follow-up was uneventful after 18 mo. We believe that transvaginal drain of pelvic abscess could be a useful alternative, when percutaneous approach is not feasible.

Computed tomography findings of pneumatosis and portomesenteric venous gas in acute bowel ischemia.

AIM: To use more representative sample size to evaluate whether computed tomography (CT) scan evidence of the concomitant presence of pneumatosis and portomesenteric venous gas is a predictor of transmural bowel necrosis. METHODS: Data from 208 patients who were referred for a diagnosis of bowel ischemia were retrospectively reviewed. Only patients who underwent a surgical intervention following a diagnosis of bowel ischemia who also had a post-operative histological confirmation of such a diagnosis were included. Patients were split into two groups according to the presence of histological evidence of transmural bowel ischemia (case group) or partial bowel ischemia (control group). CT images were reviewed for findings of ischemia, including mural thickening, pneumatosis, bowel distension, portomesenteric venous gas and arterial or venous thrombi. RESULTS: A total of 248 subjects who underwent surgery for bowel ischemia were identified. Among the 208 subjects enrolled in our study, transmural bowel necrosis was identified in 121 subjects (case group), and partial bowel necrosis was identified in 87 subjects (control group). Based on CT findings, including mural thickening, bowel distension, pneumatosis, pneumatosis plus portomesenteric venous gas and presence of thrombi or emboli, there were no significant differences between the case and control groups. The concomitant presence of pneumatosis and porto-mesenteric venous gas showed an odds ratio of 1.95 (95%CI: 0.491-7.775, P = 0.342) for the presence of transmural necrosis. The presence of pneumatosis plus porto-mesenteric venous gas exhibited good specificity (83%) but low sensitivity (17%) in the identification of transmural bowel infarction. Accordingly, the positive and negative predictive values were 60% and 17%, respectively. CONCLUSION: Although pneumatosis plus porto-mesenteric venous gas is associated with bowel ischemia, we have demonstrated that their co-occurrence cannot be used as diagnostic signs of transmural necrosis.

Bariatric surgery and diabetes remission: sleeve gastrectomy or mini-gastric bypass?

AIM: To investigate the weight loss and glycemic control status [blood glucose, hemoglobin A1c (HbA1c) and hypoglycaemic treatment]. METHODS: The primary risk factor for type 2 diabetes is obesity, and 90% of all patients with type 2 diabetes are overweight or obese. Although a remarkable effect of bariatric surgery is the profound and durable resolution of type 2 diabetes clinical manifestations, little is known about the difference among various weight loss surgical procedures on diabetes remission. Data from patients referred during a 3-year period (from January 2009 to December 2011) to the University of Naples "Federico II" diagnosed with obesity and diabetes were retrieved from a prospective database. The patients were split into two groups according to the surgical intervention performed [sleeve gastrectomy (SG) and mini-gastric bypass (MGB)]. Weight loss and glycemic control status (blood glucose, HbA1c and hypoglycaemic treatment) were evaluated. RESULTS: A total of 53 subjects who underwent sleeve gastrectomy or mini-gastric bypass for obesity and diabetes were screened for the inclusion in this study. Of these, 4 subjects were excluded because of surgical complications, 7 subjects were omitted because young surgeons conducted the operations and 11 subjects were removed because of the lack of follow-up. Thirty-one obese patients were recruited for this study. A total of 15 subjects underwent SG (48.4%), and 16 underwent MGB (51.6%). After adjusting for various clinical and demographic characteristics in a multivariate logistic regression analysis, high hemoglobin A1c was determined to be a negative predictor of diabetes remission at 12 mo (OR = 0.366, 95%CI: 0.152-0.884). Using the same regression model, MGB showed a clear trend toward higher diabetes remission rates relative to SG (OR = 3.780, 95%CI: 0.961-14.872). CONCLUSION: Although our results are encouraging regarding the effectiveness of mini-gastric bypass on diabetes remission, further studies are needed to provide definitive conclusions in selecting the ideal procedure for diabetes remission.