Long-term complications after gastric bypass and sleeve gastrectomy: What information to give to patients and practitioners, and why?

Bariatric surgery is now recognized as the most effective treatment of morbid obesity, leading to durable weight loss and resolution of associated co-morbidities. Roux-en-Y gastric bypass and sleeve gastrectomy are the two most widely used operations today. However, potentially serious medical, surgical, and/or psychiatric complications can occur that raise questions regarding the benefits of this type of surgery. These complications can lead to surgical re-operations, iterative hospitalizations, severe nutritional deficiencies and psychological disorders. Indeed, death from suicide is said to be three times higher than in non-operated obese patients. These results are of concern, all the more because of the high prevalence of patients lost to follow-up (for various and multifactorial reasons) after bariatric surgery. However, better knowledge of post-surgical sequelae could improve the information provided to patients, the preoperative evaluation of the benefit/risk ratio, and, for patients undergoing surgery, the completeness and quality of follow-up as well as the detection and management of complications. The development of new strategies for postoperative follow-up such as telemedicine but also the mobilization of all the actors along the healthcare pathway can make inroads and warrant further study.

Bariatric revisional surgery: What are the challenges for the patient and the practitioner?

Bariatric revisional surgery represents an important new issue for obese patients because of the considerable rate of failure and complications following bariatric surgery. As the frequency of bariatric procedures increases, so too does the incidence of revisional surgery, which has become becoming increasingly important. The surgeon must know the indications and the results of the various revisional procedures in order to best guide the therapeutic decision. The current challenge is to correctly select the patients for revisional surgery and to choose the appropriate procedure in each case. Multidisciplinary management is essential to patient re-assessment and to prepare the patient for a re- intervention. The objective of this update, based on data from all the most recent studies concerning revisional surgery, is to guide the surgeon in the choice of the revisional procedure, depending on patient characteristics, co-morbidities, the previously performed procedure, the type of failure or complication observed, but also on the surgeon's own habits and the center's expertise. The collected results show that revisional surgery is difficult, with higher complication rates and weight-loss results that are often lower than those of first-intent surgery. For these reasons, patient selection must be rigorous and multidisciplinary and the management in expert centers of these difficult situations must be encouraged.

[Toxicological study of emissions resulting from a diesel and a gazoline engine using an organotypic culture of lung slice]. / Etude toxicologique des gaz d'échappement issus de moteurs diesel et essence sur une culture organotypique de tissu pulmonaire.

INTRODUCTION: Many studies were carried out in vivo and/or in vitro for better understanding toxic effects of exhausts or particles emitted by Diesel vehicles. Few studies were interested in Gazoline engines when progress of metrology made it possible to highlight the presence of small particles with a strong capacity of penetration within pulmonary tissue. The aim of this study is to compare the toxic impact of the emissions of Diesel and Gasoline engines of recent technology. MATERIALS AND METHODS: Biological material was constituted by an organotypic rat lung precision slice. It was exposed to a continuous flow exhausts thanks to a preparation and dilutions system of these emissions placed on the line of exhaust. A measurement of the biological markers involved in the process of the lung tissue reaction to the air-contaminants was carried out. RESULTS: With Diesel exhausts, the results showed a stability of the rate of ATP and an increase in enzymatic activities of the antioxydant system (GPx and catalase). Gazoline emissions, as for them, were responsible for a cytotoxic attack of the pulmonary tissue defined by a reduction in the rate of ATP as well as a deterioration of the system of detoxication with reduction in the antioxydant enzymatic activities. CONCLUSION: These results show that toxicological profiles obtained with this system of exposure depends on the engine technology used, highlighting thus the specific response of the model in relation with the type of atmospheres which it is exposed.

Toxicity of diesel engine exhausts in an in vitro model of lung slices in biphasic organotypic culture: induction of a proinflammatory and apoptotic response.

Precision-cut rat lung slices in organotypic culture placed in a biphasic air/liquid system were used for this study. This model allowed pathological as well as cellular and molecular biology investigations to be carried out. Slices were exposed to a continuous flow of diluted diesel exhaust, with a pO2 adjusted to 20% to avoid hypoxia-induced effects. The exposure system allowed five exhaust concentrations from the same diesel engine to be studied concomitantly, and also allowed the impact of removing the particulate matter using a filter cap on the exposure vials to be evaluated. Lung slices were exposed for 3 or 6 h to whole or filtered diesel exhaust. DNA integrity was characterized by two different techniques: (1) an ELISA for the determination of nucleosomes, and (2) the histochemical TUNEL method. By the TUNEL method, apoptotic cells were detected after a 6-h exposure followed by an incubation period of 18 h in a controlled atmosphere comprising 5% CO2/95% O2. Under these conditions, apoptotic nuclei were more frequent in slices exposed to diesel exhaust than in control slices. Cytokine production (tumor necrosis factor alpha, interleukin-1beta) in the culture medium was measured using an ELISA technique. After a 3-h exposure only TNF-alpha was detected and increased in the culture medium of lung slices exposed to diesel exhaust. Under the same conditions, nucleosome levels in the slices increases in a dose-dependent way. In conclusion, whole diesel exhaust induced an inflammatory response and DNA alterations which were reduced by filtration, thus indicating the important role of the particulate matter in diesel exhaust.

Synthesis of interleukin 1beta and interleukin 6 by stimulated rat peritoneal macrophages: modulation by glutamine.

Synthesis and secretion of IL-1beta and IL-6 were compared in LPS-stimulated rat peritoneal macrophages, and the effect of glutamine studied. LPS induced a parallel increase in mRNA and synthesis of IL-1beta and IL-6. IL-1beta accumulated mainly in the cytosol and IL-6 in the culture medium. Glutamine addition increased the synthesis of both cytokines, but the overall production (intra-+extracellular) of IL-1beta increased two-fold, although that of IL-6 increased only 1.3-fold. The influence of glutamine is discussed.

Glutamine accelerates interleukin-6 production by rat peritoneal macrophages in culture.

The effect of glutamine on the production of interleukin-6 (IL-6) was studied in rat peritoneal macrophages in culture. A maximal production of IL-6 was measured at 4 h in lipopolysaccharide (LPS)-stimulated macrophages, and addition of glutamine (5 mM) anticipated this increase by 1 h without any increase in the IL-6 mRNA level. The effect of glutamine required the presence of LPS. Thus, glutamine accelerates IL-6 production from the pre-existing mRNA. The effect of glutamine was not mediated by cell swelling since culture of macrophages in hypoosmotic condition decreased the production of IL-6 in the culture medium with a corresponding decrease in the IL-6 mRNA level.