A prospective study of anal symptoms and continence among obese patients before and after bariatric surgery.

BACKGROUND: The effects of bariatric surgery on anal continence are not known. Data about proctologic lesions are very rare and do not include clinical data. The aim of this prospective study was to evaluate anal continence and anal lesions before and after sleeve gastrectomy (SG). METHODS: We prospectively included all patients presenting for bariatric surgery consultation at Bichat-Claude Bernard University Hospital, Paris, France, between 20 April 2015 and 16 December 2017. The patients were evaluated with questionnaires, anorectal manometry and clinical examination before SG (at enrollment) and between 12 and 24 months after (SG). Anal incontinence was defined as a Vaizey score above 4. RESULTS: Of 118 enrolled patients, 98 had SG. The patients were mostly women (n = 99, 84.6%). Median patient age was 45 years (IQR 34-54 years). The median follow-up period after surgery among the 86 patients who completed follow-up was 15 months (IQR 12.5-17.3 months). There was no significant change in the prevalence of anal incontinence after SG (12.8% preoperatively vs 24.4% postoperatively, p = 0.06). The median Vaizey score was 4 (IQR 4-4) both before and after SG (p = 0.1). No patient had de novo anal incontinence but worsening of anal incontinence was noted in 10 patients. Manometry revealed significantly lower median resting pressure (29 mmHg [IQR 22-68 mmHg] vs 22 mmHg [IQR 15-30 mmHg], p = 0.0015) and maximal squeeze pressure (IQR 29-74 mmHg vs IQR 30-60 mmHg, p = 0.0008) after SG. Anismus was more frequent after SG and was associated with constipation and Bristol type 1-2 stool consistency. Quality of life was unchanged. Proctologic lesions were rare and were present in 11 patients (12%) at enrollment and in 2 (2.4%) at follow-up. CONCLUSIONS: SG affected clinical anal continence but not significantly, and manometric measurements for anal pressures were lower postoperatively. Proctologic lesions were rare in this study population.

Remediation of distilleries wastewater using chitosan immobilized Bentonite and Bentonite based organoclays.

Organic-inorganic nanocomposite, namely chitosan immobilized Bentonite (CIB) with chitosan content of 5% was synthesized in an acetic acid solution (2%). Organically modified CIB and Bentonite (mbent.) were prepared by intercalating cetyl trimethylammonium bromide (CTAB) as a cationic surfactant at doses equivalent to 1.5 and 3 times the cation exchange capacity (CEC) of clay. The prepared samples were characterized using FTIR, XRD and SEM to explore the interlayer structure and morphology of the resultant nanocomposites. The remediation of distilleries (vinasse) wastewater process was carried out using different adsorbents including CIB, modified CIB (mCIB), Bentonite (bent.), modified Bentonite (mbent.) and chitosan at different contact time. The results showed that the packing density of surfactant used in the synthesis of organoclays strongly affects the sorption capacity of the clay mineral and also showed that (mCIB)3 was found to be the most effective sorbent in the purification of distilleries wastewater with 83% chemical oxygen demand (COD) reduction and 78% color removal.

Prospective evaluation of renal artery resistance and pulsatility indices in normal pregnant women.

OBJECTIVES: To establish normal values for renal artery resistance index (RI) and pulsatility index (PI) during gestation and, by comparison with non-pregnant controls, to determine if pregnancy affects these indices. METHODS: This was a prospective longitudinal study involving 36 normal pregnant women who underwent a total of 280 examinations at 4-week intervals from the 6th gestational week to the end of pregnancy. High-resolution ultrasound equipment with 'triplex' Doppler facilities was used. RI and PI were obtained for the main arteries of both kidneys. The same evaluation was performed in 15 non-pregnant women as controls. RESULTS: The mean RI in pregnant and non-pregnant women was the same (0.65 +/- 0.03 for controls and 0.65 +/- 0.02 for the pregnant women). For PI, the values were 1.25 +/- 0.12 for non-pregnant women and 1.18 +/- 0.09 for pregnant women. The only statistical difference (P < 0.05) was found between the PI of the left renal artery in the control group (1.29 +/- 0.20) and that in the pregnant group at the 8-12-week interval of gestational age (1.08 +/- 0.14). CONCLUSIONS: No significant alterations in renal artery RI and PI occur during normal pregnancy, except for in a subgroup of patients between 8 and 12 weeks of gestation.

[The significance of gastric helicobacteriosis in the genesis hemorrhage from duodenal peptic ulcer]. / Znachenie khelikobakterioza zheludka v geneze krovotecheniia iz iazvy dvenadtsatiperstnoi kishki.

Based on a comprehensive analysis of findings from examination and surgical treatment of 196 patients with bleeding pyloroduodenal ulcers, it was found out that patients with concurrent helicobacteriosis of the stomach are prone to more unfavourable course of their illness, which fact is evidenced by a greater loss of blood and higher risk for bleeding recurrences. A classification is proposed by the authors, taking advantage of the data from endoscopic, microscopic and immunoenzymatic techniques, with the purpose of providing an assessment of degree of severity of helicobacteriosis of the stomach.

[Organ-conserving operations in the treatment of peptic ulcer complicated by hemorrhage and stenosis of the pyloroduodenal canal]. / Organosokhraniaiushchie operatsii v lechenii iazvennoi bolezni, oslozhnennoi krovotecheniem i stenozom piloroduodenal'nogo kanala.

Surgical tactics and the peculiarities of operative procedure choice in stenosing duodenal ulcer, complicated with bleeding, were generalized on the base of analysis of surgical treatment results in 134 patients. Clinical application of organ preserving operations in combination with adequate vagotomy permitted to expel the origin of bleeding and pyloroduodenal zone stenosis recurrence and also the severe postoperative gastric stasis occurrence.

[Surgical treatment of patients with gastrointestinal ulcer hemorrhage and concomitant diabetes mellitus]. / Khirurgicheskoe lechenie bol'nykh s iazvennym zheludochno-kishechnym krovotecheniem i soputstvuiushchim sakharnym diabetom.

The results of surgical treatment of 800 patients with ulcer gastroduodenal bleeding, in 122 of whom diabetes mellitus was diagnosed, were analyzed. Organpreserving operations combined with vagotomy were conducted to the whole of the patients, the elaborated in clinic individualized approach to the diabetes mellitus prophylaxis was used. The glucose-correcting therapy methods were depicted with the respect to diabetes mellitus form, hemorrhage severity and indications for the operation.