Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications.

INTRODUCTION: The aim of this study is to retrospectively analyze the incidence of complications after two-stage laparoscopic biliopancreatic diversion with duodenal switch (Lap BPD-DS) in high-risk super-obese patients and explore the possible predictive factors of specific complications after laparoscopic sleeve gastrectomy (SG). METHODS: High-risk patients--body mass index (BMI) > 50 kg/m(2) with at least two major comorbidities: type 2 diabetes, obstructive sleep apnea syndrome (OSAS), hypertension--undergoing two-stage laparoscopic BPD-DS were retrospectively analysed. The SG pouch volume was 100-150 ml; in the second stage, the common channel and the alimentary loop were 100 cm and 150 cm, respectively. RESULTS: Eighty-seven patients (50 female, 57.5%) underwent SG (two open). The mean age was 41.8 +/- 10.22 years with BMI of 55.2 +/- 6.69 kg/m(2). Four patients had Prader-Willy syndrome. Fourteen (16.46%) patients (6 female, 42.8%) had postoperative complications such as bleeding, fistula, pulmonary embolism, transitory acute renal failure, and abdominal abscess. One patient died at postoperative day 5 of pulmonary embolism. One patient was reoperated for hemoperitoneum by laparoscopy. The risk of complications after SG was lower in patients where reinforcement of the suture line was used (0.492), while it was higher in men (1.780). Neither difference was statistically significant [p = not significant (NS)]. After 9-24 months, 27 patients (BMI 43 +/- 8 kg/m(2)) underwent a second stage of BPD-DS (two open). Major postoperative complications were registered in eight patients (29.6%): three bleeding, four duodeno-ileal stenosis and one rhabdomyolysis. Two cases of internal hernia required laparoscopic reoperation. The reoperation rate was 1/85 (1.2%) after SG and 2/27 (7.4%) after second stage. CONCLUSIONS: Complications after SG greatly decrease after the learning curve period and can be successfully managed without need of reoperation. Suture-line reinforcement, at least selectively in the middle-upper portion of the staple line and in super-super-obese patients, is recommended to decrease the incidence of specific complications.

[Work related sensitization risk in hotel school students, the role of garlic]. / Rischio di sensibilizzazione "professionale" in studenti di scuola alberghiera, il ruolo dell'aglio.

We want to evaluate the incidence of allergic problems in a population of catering students at the beginning and after 3 and 5 years of their course. We enrolled in the study 601 students of a professional catering school: 412 in the first year and 189 in the fifth years. We used two questionnaires to investigate respiratory problems and dermatological ones. All the subjects were also patch tested with 10 aptens. The incidence of reported symptoms of allergy was higher in fifth year than in first one. We can observe a rising in positive reaction between the two group of students to Balsam Perù, Nickel, Fragrance mix and Garlic. In particular we found an higher incidence of positive patch reaction in female population. On the contrary the rising in positive reaction to Garlic is higher in male. About two third of the subjects positive to garlic present a sensitization to diallyl disulphide. The rising of positive patch test reactions to Garlic and Balsam Perù should be caused by the contact with cooking spices. The higher incidence of allergic pathology between students during fifth year of school and students at first year is probably due to scholastic practical activity.

[Longitudinal study for assessing the efficacy of preventive measures in a population of health workers exposed to the risk of patient lifting]. / Studio longitudinale per la valutazione dell'efficacia di misure preventive in una popolazione di operatori sanitari esposta al rischio di movimentazione manuale di pazienti.

Preliminary data of a follow-up study on effectiveness of mechanical devices for patients handling are shown. Main study results highlight a statistical significant decrease for subjective referred episodes of acute low back pain during the previous 12 months, a decrease in perceived effort and Borg scale score in the subgroup who received any sort of mechanical devices. However no difference was found regarding to proportion of subjects positive at symptom questionnaire for low back pain and mean length of absenteeism for disease was similar even after the introduction of mechanical devices.

[Osteoarthritis caused by Brucella melitensis: isolation of the microorganism from the synovial fluid]. / Osteoartrite da Brucella melitensis: isolamento del germe nel liquido sinoviale.

Brucellosis is an unusual disease in childhood but the organ manifestations are even more unusual. The Authors describe an osteoarthritis caused by Brucella melitensis, localized at the tarsal scaphoid in a three years old Calabrian child.

[A case of solitary myeloma of the glenoid cavity. Notes on glenoidectomy]. / Su un caso di mieloma solitario della glenoide. Note sulla glenoidectomia.

A case of solitary myeloma of the glenoid cavity is presented; the case was operated 6 years after the onset of symptoms; there was no recurrence of the disease or hematologic pathology. Total glenoidectomy is described.

The ilizarov apparatus in the treatment of thalamic fractures of the calcaneus.

The authors present a new method for the treatment of severe thalamic fractures of the calcaneus by the Ilizarov apparatus. The versatility of this apparatus makes it possible to restore the anatomy of the area, in particular, the total height of the talo-calcaneal complex and correction of varus or valgus deviation while leaving the ankle joint free. This method was used to treat 10 cases of severe thalamic fracture. If the apparatus is maintained for at least 3 months there is no subsequent loss of correction and the results are very good.

A new guide in the surgical reconstruction of the cruciate ligaments.

The authors present a guide for the perforation of the transskeletal tibial and femoral tunnels during reconstruction of the anterior and posterior cruciate ligaments, by both arthroscopy and arthrotomy. This guide is accurate, maneuverable, light and has the advantage of being able to be oriented at different planes.

[Pathological fractures and prefracture osteolytic lesions due to metastases located in the femoral diaphysis: a clinico-radiographic study, a case history review and considerations of treatment evolution]. / Le fratture patologiche e le lesioni osteolitiche pre-fratturative da metastasi localizzate alla diafisi femorale: studio clinico-radiografico, revisione della casistica e considerazioni sull'evoluzione del trattamento.

The authors reviewed the clinical and radiographic documentation of 44 cases of metastatic lesion in the femoral diaphysis, all treated during a 15-year period at the Centro Traumatologico e Ortopedico of Florence. The results obtained with both initial nonoperative treatment (casts) as well as subsequent intramedullary fixation are evaluated with great care. The evaluation of the results in terms of survival was not possible for several reasons, not least of which the recent progress made in radiation-chemo-hormonal therapy for tumors. Despite the precarious general condition of most of the patients surgical treatment did not cause intraoperative or immediate postoperative mortality. Overall, the postoperative complications were not serious and were compensated for by good progress in systemic therapy, good nursing, and in some cases recovery of autonomy.

Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle.

Fourteen children affected by juvenile osteochondritis dissecans of the medial femoral condyle (16 knees) were treated by arthroscopic drilling of the lesion. The average age at operation was 12.8 years, and all the knees had open physes. Conservative treatment including restriction of activities had been unsuccessfully attempted in all cases for a period of > 1 year on average. At surgery each lesion was shown to have intact articular cartilage. All the lesions progressed to healing, and the patients were asymptomatic at an average of 56 months after the operation. Radiographic examination showed reconstitution of a normal or minimally flattened profile of the medial condyle. Arthroscopic drilling of the lesion in knees with juvenile osteochondritis dissecans and intact articular cartilage was effective to promote healing. The low morbidity and easy rehabilitation justify the procedure for these young patients when conservative measures fail.