Ten years experience of banded gastric bypass: does it make a difference?

Many surgeons support some sort of restriction of the gastric pouch outlet by placing a ring around the gastric reservoir. Previous studies have shown positive results of banded gastric bypass (BGBP); however, there are not many comparative long-term studies to assess the real advantage of placing a ring during gastric bypass (GBP) surgery. This study aims to evaluate the long-term outcome of patients subjected to BGBP and nonbanded GBP procedures. We studied 260 retrospective, nonrandomized obese patients who underwent BGBP and 218 patients without the ring (i.e., GBP). They were followed up for 10 years, and the following parameters were evaluated: excess weight loss (EWL), quality of life (QOL), food tolerance, and correction of comorbidities. The study was approved by the Committee on Ethics, and all the patients gave their informed consent. There is a significant difference in %EWL from the third year until the tenth year of observation, with the proportion being 82% in BGBP versus 63% in nonbanded GBP patients at the end of the study. Although there was some increased intolerance to food intake in the BGBP patients, this was not felt to reduce the QOL. The outcome in terms of comorbidities was not conclusive. There is a clear advantage in terms of %EWL in the BGBP patients. No differences in QOL were found in both groups. Further, selecting the right type of material and the right size of the ring is important to improve results and avoid complications.

Perspective: PhD scientists completing medical school in two years: looking at the Miami PhD-to-MD program alumni twenty years later.

Producing and retaining physician-scientists remains a major challenge in advancing innovation, knowledge, and patient care across all medical disciplines. Various programs during medical school, including MD-PhD programs, have been instituted to address the need for continued production of physician-scientists. From 1971 through 1989, 508 students with a prior PhD in the sciences, mathematics, or engineering graduated in two years from an accelerated MD program at the University of Miami School of Medicine. The program, designed to address potential clinical physician shortages rather than physician-scientist shortages, quickly attracted many top-notch scientists to medicine. Many program graduates went to top-tier residencies, pursued research careers in academic medicine, and became academic leaders in their respective fields. A retrospective examination of graduates conducted in 2008-2009 demonstrated that approximately 59% took positions in academic university medical departments, 3% worked for governmental agencies, 5% entered industry as researchers or executives, and 33% opted for private practice. Graduates' positions included 85 full professors, 11 university directors or division heads, 14 academic chairs, 2 medical school deans, and 1 astronaut. Overall, 30% of graduates had obtained National Institutes of Health funding after completing the program. These results suggest that accelerated medical training for accomplished scientists can produce a large number of successful physician-scientists and other leaders in medicine. Furthermore, these results suggest that shortening the medical portion of combined MD-PhD programs might also be considered.

Vagotomia supraselectiva laparoscopica en el tratamiento de la ulcera duodenal y del reflujo gastroesofagico / Laparoscopic supraselective vagotomy in the treatment of the duodenal ulcer and gastric reflux

La V.S.S fue ideada para el tratamiento de la U.D. Actualmente esta indicacion es poco frecuente. Tiene mayor importancia en el tratamiento del reflujo gastroesofagico por la reduccion de acidez y por la excelente presentacion de la union gastroesofagica y hiato esofagico. Este estudio prospectivo analiza la tecnica quirurgica y los resultados de la V.S.S. laparoscopica en U.D. y de V.S.S. mas fundoplicatura en R.G.E. Se operaron entre marzo de 1992 y agosto de 1996, 150 pacientes: 36 con U.D., 80 con R.G.E. y 34 con asociacion de ambas afecciones. En la U.D. hay cicatrizacion en todos los casos y sin recidivas. En el R.G.E los resultados de manometria y ph 24 hs. indican normalizacion de los indices y la endoscopia desaparicion de la esofagitis. Hay dos recidivas que corresponden a dos casos de esofagos gastrificados en que la valvula creada quedo baja, sobre estomago. Estos casos mas avanzados requieren probablemente de otras tecnicas terapeuticas.