Long-Term Outcome in a Phase II Study of Regional Hyperthermia Added to Preoperative Radiochemotherapy in Locally Advanced and Recurrent Rectal Adenocarcinomas.

Hyperthermia was added to standard preoperative chemoradiation for rectal adenocarcinomas in a phase II study. Patients with T3-4 N0-2 M0 rectal cancer or local recurrences were included. Radiation dose was 54 Gy combined with capecitabine 825 mg/m2 × 2 daily and once weekly oxaliplatin 55 mg/m2. Regional hyperthermia aimed at 41.5-42.5 °C for 60 min combined with oxaliplatin infusion. Radical surgery with total or extended TME technique, was scheduled at 6-8 weeks after radiation. From April 2003 to April 2008, a total of 49 eligible patients were recruited. Median number of hyperthermia sessions were 5.4. A total of 47 out of 49 patients (96%) had the scheduled surgery, which was clinically radical in 44 patients. Complete tumour regression occurred in 29.8% of the patients who also exhibited statistically significantly better RFS and CSS. Rate of local recurrence alone at 10 years was 9.1%, distant metastases alone occurred in 25.6%, including local recurrences 40.4%. RFS for all patients was 54.8% after 5 years and CSS was 73.5%. Patients with T50 temperatures in tumours above median 39.9 °C had better RFS, 66.7% vs. 31.3%, p = 0.047, indicating a role of hyperthermia. Toxicity was acceptable.

Predictors for remission of major components of the metabolic syndrome after biliopancreatic diversion with duodenal switch (BPDDS).

BACKGROUND: Metabolic surgery causes the remission of type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia to varying degrees, depending on the patient characteristics and the surgical procedure. The aim of this study was to find predictors for the remission of T2DM and hypertension after biliopancreatic diversion with duodenal switch (BPDDS). METHODS: Eighty patients with T2DM were followed up for 2 years or more after BPDDS, and changes in body weight and metabolic status were noted. Remission was defined as fasting glucose <7 mmol/l with HbA1C <6.5 %, blood pressure <140/90 mmHg, and low-density lipoprotein (LDL) <2.6 mmol without the use of medication. RESULTS: Preoperatively, the mean age was 44 years, body mass index (BMI) was 48 kg/m(2), and duration of diabetes was 5 years. Of the 80 patients, 38 patients were using insulin, 48 patients were using antihypertensives, and 38 patients were using a lipid-lowering drug. Five percent of the patients had recommended levels for HbA1C, blood pressure, and LDL prior to the operation. The remission rate at 2 years was 94 % for T2DM, 54 % for hypertension, and 86 % for LDL hyperlipidemia. Preoperative predictors for nonremission of T2DM were a higher BMI, insulin usage, and low insulin C-peptide, and for hypertension, older age and more severe hypertension. Postoperative weight loss was important for both. CONCLUSIONS: Surgical intervention with BPDDS is an effective treatment of T2DM, hypertension, and hyperlipidemia. The duration of T2DM and age of the patient are the most important preoperative predictors for the remission of T2DM and hypertension, respectively.

The biliopancreatic diversion with a duodenal switch (BPDDS): how is it optimally performed?

BACKGROUND: The biliopancreatic diversion with duodenal switch can be performed by different combinations of restriction and malabsorption. The aim of this study was to evaluate weight loss and potential side effects for two variants of the procedure. METHODS: All patients eligible for a 2-year follow-up (n = 182) was included in the study. Thirty-five patients (group A) had a gastric remnant with a volume of approximately 200 ml, an alimentary limb (AL) of 250 cm, and a common channel (CC) of 100 cm, while 147 patients (group B) had a gastric remnant of 100-120 ml, an AL of 40%, and a CC of 10% of the small bowel length. Preoperative variables, such as body mass index (BMI), sex, age, and factors that might influence weight loss, and postoperative weight loss and side effects were registered and compared. RESULTS: Preoperatively, the BMI was 50.6 in group A and 52.1 in group B (ns), with no difference in age, sex, or variables that might influence weight loss. At 2 years, the BMI was 33.1 in group A (n = 34) and 28.5 in group B (n = 119) with an adjusted difference in weight loss of 5.6 BMI units between the groups (p < 0.001). Vitamin D status was also better in group B than in group A at follow-up, while there was no difference in side effects. CONCLUSIONS: Patients with a remnant stomach of 100-120 ml, and AL and CC with individually adapted lengths had a larger weight loss and better vitamin D status postoperatively without an increase in side effects.

Anxiety and depression in association with morbid obesity: changes with improved physical health after duodenal switch.

BACKGROUND: Patients with morbid obesity have an increased risk for anxiety and depression. The "duodenal switch" is perhaps the most effective obesity surgery procedure for inducing weight loss. However, to our knowledge, data on symptoms of anxiety and depression after the duodenal switch are lacking. Furthermore, it has been hypothesized that self-reported physical health is the major predictor of symptoms of depression in patients with morbid obesity. We therefore investigated the symptoms of anxiety and depression before and after the duodenal switch procedure and whether post-operative changes in self-reported physical health were predictive of changes in these symptoms. METHODS: Data were assessed before surgery (n = 50), and one (n = 47) and two (n = 44) years afterwards. Symptoms of anxiety and depression were assessed by the "Hospital Anxiety and Depression Scale", and self-reported physical health was assessed by the "Short-Form 36" questionnaire. Linear mixed effect models were used to investigate changes in the symptoms of anxiety and depression. Correlation and linear multiple regression analyses were used to study whether changes in self-reported physical health were predictive of post-operative changes in the symptoms of anxiety and depression. RESULTS: The symptom burden of anxiety and depression were high before surgery but were normalized one and two years afterwards (P < 0.001). The degree of improvement in self-reported physical health was associated with statistically significant reductions in the symptoms of anxiety (P = 0.003) and depression (P = 0.004). CONCLUSIONS: The novelty of this study is the large and sustained reductions in the symptoms of anxiety and depression after the duodenal switch procedure, and that these changes were closely associated with improvements in self-reported physical health.

Health-related quality of life and paid work participation after duodenal switch.

BACKGROUND: Morbid obesity can reduce the health-related quality of life (HRQL) and paid work participation, and the duodenal switch (DS) can induce large weight loss in patients suffering from this disease. However, data about HRQL combined with paid work participation after duodenal switch are lacking. The aim of this study was to provide longitudinal data of these issues. METHODS: Fifty-one consecutive morbidly obese patients accepted for DS gave their informed consent to participate in the study. Mean age was 37.7 years (SD, 8.0), and 54.9% were women. HRQL was assessed using the "Short-Form 36 Health Status Survey". Eight subscores, the physical component summary (PCS), and the mental component summary (MCS) were calculated. Paid-work participation was assessed as performing or not performing paid work. Data were assessed before DS (T0), 1 year after DS (T1), and 2 years after DS (T2). RESULTS: All the SF-36 scores improved significantly from T0 to T1 and T2 (p < 0.001), when they were in the normal range compared to the population norm. The number of patients performing paid work increased from 28 (54.9%) at T0 to 34 (66.7%) at T2, p = 0.031. The patients who performed paid work had significantly better PCS and MCS scores than those who did not before, but not after, DS. CONCLUSION: Our data indicate that the SF-36 scores of the patients were normalized after DS. A marked improvement in the paid work participation was also observed.

Predictors for health-related quality of life in patients accepted for bariatric surgery.

BACKGROUND: The relationship among musculoskeletal pain, depression, and health-related quality of life in patients with severe obesity who are accepted for bariatric surgery should be explored further. METHODS: In this cross-sectional study, we measured the health-related quality of life using the generic questionnaire "Short-Form 36 Health Status Survey." Multiple regression analysis was used to explore associations between the predictors (musculoskeletal pain and depression) and the physical cumulative summary (PCS) and mental cumulative summary (MCS). Age, gender, body mass index, and the number of co-morbidities were entered as covariates. RESULTS: The study subjects included 28 women and 23 men, with a mean age of 37.7 years and a mean body mass index of 51.9 kg/m(2). The PCS and MCS scores were very poor compared with the age- and gender-adjusted population norm (P <.001). The presence of musculoskeletal pain was associated with a score that was 10.97 points lower on the PCS (P <.001) and 7.05 points lower on the MCS (P = .031). The presence of depression was associated with a score that was 20.89 points lower on the MCS (P <.001); no significant association was found between depression and the PCS. CONCLUSION: The results of this study have shown that musculoskeletal pain was strongly associated with lower scores on the PCS and MCS, and depression was strongly associated with a lower score on the MCS.

[Health-related quality of life before and one year after operation for morbid obesity]. / Helserelatert livskvalitet før og eit år etter operasjon for sjukleg overvekt.

BACKGROUND: Several studies have shown that morbid obese patients have poor health-related quality of life. The aim of this study was to investigate the effect of bariatric surgery (biliopancreatic diversion with duodenal switch) on health-related quality of life for morbidly obese patients. METHODS: 48 patients (26 women and 22 men, mean age 37.4, mean BMI 51.5) completed the Short Form 36 (SF-36) before and one year after surgery. Paired t-tests were used to analyze differences in SF-36 scores before and one year after surgery. RESULTS: Morbidly obese patients had very poor health-related quality of life (SF-36) before surgery compared with norms (p < 0.001). One year after surgery, all SF-36 dimensions had improved significantly (p < 0.001). CONCLUSIONS: The morbidly obese patients in this study had very poor health-related quality of life compared to norms, but they experienced considerable improvement after bariatric surgery.

[Boerhaave's syndrome--an unusual cause of acute retrosternal pain]. / Boerhaaves syndrom--uvanleg årsak til akutte retrosternale smerter.

BACKGROUND: Boerhaave's syndrome or spontaneous perforation of the oesophagus is a rare condition with a severe prognosis. Adequate treatment is often delayed because of misdiagnosis of the condition as cardial, pulmonary or other gastrointestinal disease, with a concomitant rise in mortality. MATERIAL AND METHODS: A case of Boerhaave's syndrome is described. An 88-year-old male presented with acute retrosternal pain, initially believed to be caused by cardiac disease. After a delay of more than 24 hours, laparotomy revealed a perforation of the oesophagus. RESULTS: The patient was treated with laparotomy, drainage, antibiotics, antifungal and medical supportive therapy. Surgical closure of the lesion was not performed because of the debilitated state of the patient and the delay in diagnosis. He left the hospital in his habitual state after 33 days of hospitalization. INTERPRETATION: Boerhaave's syndrome is a serious condition that is often misdiagnosed. The preferred treatment is prompt surgical closure of the oesophageal defect.