Body size perception, knowledge about obesity and factors associated with lifestyle change among patients, health care professionals and public health experts.

BACKGROUND: The attitudes towards obesity may have an important role on healthier behavior. The goal of the present study was to explore the attitudes towards obesity and to investigate how these attitudes were associated with lifestyle-changing behavior among the patients attending primary care centers, health care professionals and public health experts. METHODS: This cross-sectional survey study was performed in 10 primary care offices in different regions in Lithuania and in 2 public health institutions. Nine hundred thirty-four patients, 97 nurses, 65 physicians and 30 public health experts have filled the questionnaire about attitudes towards obesity and presented data about lifestyle-changing activities during last 12 months. The attitudes were compared between different respondent groups and factors associated with healthier behaviors were analyzed among overweight/obese individuals in our study population. RESULTS: Participants failed to visually recognize correct figure corresponding to male and female with obesity. Majority of respondents' perceived obesity as a risk factor for heart diseases and diabetes but had less knowledge about other diseases associated with weight. About one third of respondents changed their lifestyle during last 12 months. Overweight individuals with age < 45 years (OR 1.64, 1.06-2.55; p = 0.025) were more likely and those who overestimated current weight (OR 0.44, 0.20-0.96; p = 0.036) less likely to change their lifestyle. Disappointment with their current weight (OR 2.57, 1.36-4.84; p = 0.003) was associated with healthier behavior among participants with obesity. CONCLUSION: Participants had similar body size perception and knowledge about obesity. Younger age had significant association with lifestyle changing behavior among overweight individuals and disappointment with current weight among obese participants.

The choice of optimal antireflux procedure after laparoscopic cardiomyotomy: two decades of clinical experience in one center.

INTRODUCTION: Two types of partial wrap are commonly performed in achalasia patients after Heller myotomy: the posterior 270° fundoplication (Toupet) and the anterior 180° fundoplication (Dor). The optimal type of fundoplication (posterior vs. anterior) is still debated. AIM: To compare the long-term rates of dysphagia, reflux symptoms and patient satisfaction with current postoperative condition between two fundoplication groups in achalasia treatment. MATERIAL AND METHODS: Our retrospective study included 97 consecutive patients with achalasia: 37 patients underwent laparoscopic posterior Toupet (270°) fundoplication followed by Heller myotomy (group I); 60 patients underwent laparoscopic anterior partial Dor fundoplication followed by Heller myotomy (group II). Long-term follow-up results included evaluation of dysphagia symptoms, intensity of heartburn and patient satisfaction with current condition. RESULTS: Patients in these two groups did not differ according to age, weight, height, postoperative stay or follow-up period. Laparoscopic myotomy with posterior Toupet fundoplication was effective in 89% of patients, while laparoscopic myotomy with anterior Dor was effective in 93% of patients (p > 0.05). 11% of patients after posterior Toupet fundoplication had clinically significant heartburn vs. 35% of patients after anterior Dor fundoplication (p < 0.05). Overall patient satisfaction with current condition was 88%, with no significant difference between the groups. CONCLUSIONS: According to our study results, the two laparoscopic techniques were similarly effective in reducing achalasia symptoms, but postoperative clinical manifestation of heartburn is significantly more frequent after anterior Dor fundoplication (35% vs. 11%). The majority of patients (88%) were satisfied with operation outcomes.

Trends and results in treatment of gastric cancer over last two decades at single East European centre: a cohort study.

BACKGROUND: A steady decline in gastric cancer mortality rate over the last few decades is observed in Western Europe. However it is still not clear if this trend applies to Eastern Europe where high incidence rate of gastric cancer is observed. METHODS: This was a retrospective non-randomized, single center, cohort study. During the study period 557 consecutive patients diagnosed with gastric cancer in which curative operation was performed met the inclusion criteria. The study population was divided into two groups according to two equal time periods: 01-01-1994 - 31-12-2000 (Group I - 273 patients) and 01-01-2001 - 31-12-2007 (Group II - 284 patients). Primary (five-year survival rate) and secondary (postoperative complications, 30-day mortality rate and length of hospital stay) endpoints were evaluated and compared. RESULTS: Rate of postoperative complications was similar between the groups, except for Grade III (Clavien-Dindo grading system for the classification of surgical complications) complications that were observed at significantly lower rates in Group II (26 (9.5%) vs. 11 (3.9%), p = 0.02). Length of hospital stay was significantly (p = 0.001) shorter (22.6 ± 28.9 vs. 16.2 ± 17.01 days) and 30-day mortality was significantly (p = 0.02) lower (15 (5.5%) vs. 4 (1.4%)) in Group II. Similar rates of gastric cancer related mortality were observed in both groups (92.3% vs. 90.7%). However survival analysis revealed significantly (p = 0.02) better overall 5-year survival rate in Group II (35.6%, 101 of 284) than in Group I (23.4%, 64 of 273). There was no difference in 5-year survival rate when comparing different TNM stages. CONCLUSIONS: Gastric cancer treatment results remain poor despite decreasing early postoperative mortality rates, shortening hospital stay and improved overall survival over the time. Prognosis of treatment of gastric cancer depends mainly on the stage of the disease. Absence of screening programs and lack of clinical symptoms in early stages of gastric cancer lead to circumstances when most of the patients presenting with advanced stage of the disease can expect a median survival of less than 30 months even after surgery with curative intent.

DNA methylation at selected CpG sites in peripheral blood leukocytes is predictive of gastric cancer.

BACKGROUND/AIM: Recently, a set of studies addressed the question of the prevalence of aberrant methylation in surrogate tissues, such as peripheral blood leukocytes. Toward this aim, we conducted a case-control pilot study to investigate aberrant methylation in leukocytes of gastric cancer patients. MATERIALS AND METHODS: The SNuPE combined with ion pair reverse phase HPLC (SIRPH method) was used to examine site-specific methylation status at selected CpG sites of the promoter regions of APC, ACIN1, BCL2, CD44, DAPK1, CDKN2A, RARB, TNFRSF10C HS3ST2 and of LINE-1, Alu repeats. RESULTS: We observed that in the patients, tumor suppressor genes were slightly but significantly higher methylated at several CpG sites, while DNA repetitive elements were slightly less methylated compared to controls. This was found to be significantly associated with higher prevalence for gastric cancer. CONCLUSION: These results suggest that larger studies must be carried-out to explore the biological significance and clinical usefulness of leukocyte DNA as non-invasive detection tool for gastric cancer.

The influence of operation technique on long-term results of achalasia treatment.

UNLABELLED: Currently, the most effective therapy for achalasia is laparoscopic Heller myotomy with partial fundoplication. The aim of this study was to compare the long-term results between 2 different laparoscopic operation techniques in achalasia treatment. MATERIAL AND METHODS: This was a retrospective study, where 46 achalasia patients were examined: 23 patients underwent laparoscopic Heller myotomy followed by the full gastric fundus mobilization, total hiatal dissection, and posterior Toupet (270°) fundoplication (group 1); other 23 patients underwent laparoscopic Heller myotomy with limited surgical cardia region dissection, not dividing the short gastric vessels and performing anterior partial Dor fundoplication (group 2). Long-term findings included the evaluation of postoperative dysphagia according Vantrappen and Hellemans and intensity of heartburn according the standard grading system. RESULTS: The patients in these 2 groups were similar in terms of age, weight, height, and postoperative hospital stay. The median follow-up was 66 months in the group 1 and 39 months in the group 2 (P<0.05). Laparoscopic operation was effective in 82.6% of patients (excellent and good results) in the group 1; treatment was effective in 78.3% of patients in the group 2 (P>0.05). Clinically significant heartburn was documented in 39% of patients in the group 1 and only in 13% of patients in the group 2 (P<0.05). CONCLUSIONS: According our study results, both laparoscopic techniques were similarly effective (82.6% vs. 78.3%) in achalasia treatment. Postoperative heartburn was significantly more common (39% vs. 13%) after laparoscopic myotomy, followed by the full gastric fundus mobilization, total hiatal dissection, and posterior Toupet (270°) fundoplication.

Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study.

BACKGROUND: Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment. METHODS: A total of 153 patients were randomized to Nissen or Toupet 1.5- or 3-cm wrap laparoscopic fundoplication. The primary endpoint--treatment failure rate was defined as a recurrent GERD or persistent dysphagia. Intensity of heartburn, dysphagia, gas-bloating, presence of esophagitis were assessed as a secondary outcome at 1-year and 5-year follow-up. RESULTS: At 5-year follow-up, data were collected from 129 (85 %) patients. At 1-year follow-up, 17 (11 %) treatment failures were detected. At the end of the fifth year, the numbers reached 23 (15 %). The failures were more common in the 1.5-cm Toupet (25 %) and the 3-cm Nissen group (18.2 %). The significant difference in failure rates was found between 1.5-cm and 3-cm Toupet groups (P < 0.05). Dysphagia remained low during the follow-up in all of the groups. The prevalence of higher scores of heartburn after 5 years was detected in Nissen 1.5-cm group (20.8 %). The lowest scores were observed in Toupet 3-cm group. Bloating symptoms were more prevalent among Nissen and Toupet 3-cm group patients at 5-year follow-up. At the end of the fifth year, the prevalence of esophagitis was lower in Nissen 1.5-cm (19.3 %) and Toupet 3-cm (13.3 %) groups. The highest prevalence of esophagitis-32.4 %-was found in Toupet 1.5-cm group. CONCLUSIONS: Nissen and Toupet fundoplication achieved sufficient control of reflux with success rate of 85 % at 5-year follow-up. There were no significant differences in the postoperative dysphagia, esophagitis, and bloating rates. However, the distribution of treatment failures leads us to conclude that 1.5-cm wrap length is insufficient in cases of posterior partial fundoplication.

[Early postoperative intraperitoneal chemotherapy for the treatment of advanced gastric cancer]. / Skrandzio vezio gydymas ankstyvaja pooperacine intraperitonine chemoterapija.

UNLABELLED: Surgery remains the main treatment modality for gastric cancer. Adjuvant radiochemotherapy and adjuvant chemotherapy are becoming more and more popular in the treatment of advanced gastric cancer. Early postoperative intraperitoneal chemotherapy as one of the methods of adjuvant chemotherapy is currently being extensively investigated. The aim of the present study was to evaluate the toxicity of early postoperative intraperitoneal chemotherapy and its impact on postoperative complications as well as long-term survival. MATERIAL AND METHODS: A prospective study including 46 patients with gastric cancer who underwent radical resection was carried out during 2004-2005. Fourteen patients who received early postoperative intraperitoneal chemotherapy with 5-FU (EPIC group) were compared with 32 patients not receiving intraperitoneal chemotherapy (control group). All patient, except one patient in the EPIC group, received adjuvant radiochemotherapy or adjuvant chemotherapy. The toxicity of early postoperative intraperitoneal chemotherapy was evaluated using the WHO scale, and survival was estimated by the Kaplan-Meier method. RESULTS: The rate of postoperative complications was similar in both the groups (14.3% in the EPIC group vs. 12.5% in the control group). Four patients (28.6%) in the EPIC group developed grade III toxicity. There was no difference in survival comparing the EPIC group with the control group (median survival, 30 months and 34 months, respectively; P=0.500). CONCLUSIONS: Early postoperative intraperitoneal chemotherapy with 5-fluorouracile demonstrated acceptable toxicity and was relatively simple to perform. No survival benefit was documented combining early postoperative intraperitoneal chemotherapy with adjuvant radiochemotherapy or adjuvant chemotherapy.

A combinative effect of low-molecular-weight heparin and intermittent pneumatic compression device for thrombosis prevention during laparoscopic fundoplication.

BACKGROUND. Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery. For instance, 20-30% of patients develop this problem after general surgical operations, while 5.5% of patients have this complication when laparoscopic fundoplications are performed without any prophylaxis. The aim of our study was to evaluate the hypocoagulation effect of the following treatments during and after laparoscopic fundoplication: a) intermittent pneumatic compression (IPC) and b) combination of low-molecular-weight heparin (LMWH) and IPC. MATERIAL AND METHODS. The study was performed on 20 consecutive patients who were randomized into two groups. The first group received IPC during operation, the second group received IPC during operation and LMWH before operation. Plasma prothrombin fragment F1+2 (F1+2), thrombin-antithrombin complex (TAT) - markers of thrombogenesis - and plasma free tissue factor pathway inhibitor (fTFPI) - a marker of hypocoagulation effect - were measured 1 h before, during, and after the laparoscopic operation. RESULTS. In the IPC group, plasma F1+2 and TAT levels increased significantly during and after laparoscopic gastrofundoplication. In the IPC+LMWH group, F1+2 and plasma TAT levels did not change during or after the operation. fTFPI levels significantly increased during and after the operation in the IPC+LMWH group; however, fTFPI levels did not change during or after the laparoscopic operation in the IPC group. CONCLUSIONS. A combination of low-molecular-weight heparin and intermittent pneumatic compression during laparoscopic fundoplication caused hypocoagulation effect in the patients, which was not observed in the patients who were treated with intermittent pneumatic compression alone.

[Adjuvant therapy after curative resection with D2 lymphadenectomy for gastric cancer: results of a prospective clinical trial]. / Skrandzio vezio adjuvantinis gydymas po radikaliu operaciju su D2 limfadenektomija (perspektyviojo klinikinio tyrimo duomenys).

OBJECTIVE: Adjuvant chemoradiation for gastric cancer is used more frequently, but there is no general opinion about the effect of this treatment. The aim of this study was to compare adjuvant chemoradiation with adjuvant chemotherapy after radical operation for stomach cancer. MATERIAL AND METHODS: A total of 133 patients were included in this prospective study. Sixty-three patients after curative gastrectomy and D2 lymphadenectomy for gastric cancer were assigned to the chemoradiotherapy group and 70 to the chemotherapy group. The groups were identical by age, sex, and cancer stages. Toxicity was evaluated by the WHO scale, and survival was evaluated by the Kaplan-Meier method. RESULTS: Grade III and IV toxicity was found more frequently in the chemoradiation group than in the chemotherapy group (44.4% and 7.1%, respectively; P<0.0001). Treatment was not finished in 27% of patients in the chemoradiation group and 11.4% in the chemotherapy group (P=0.03). Overall survival was better in the chemotherapy group as compared with the chemoradiation group (P=0.039). Median survival for patients with stage III and IV cancer was 41 months in the chemotherapy group and 18 months in the chemoradiation group (P=0.085). Survival of patients with stage IIIA cancer in the chemotherapy group was significantly better (P=0.005). CONCLUSIONS: Median survival is shorter in the adjuvant chemoradiation group after curative gastrectomy for gastric cancer as compared with the adjuvant chemotherapy group. Adjuvant chemoradiation is more toxic and should be recommended only for patients with advanced-stage cancer.

Influence of wrap length on the effectiveness of Nissen and Toupet fundoplication: a prospective randomized study.

BACKGROUND: Incontinence or hypercontinence of the fundic wrap depends primarily on the length of the valve or the type of procedure. Much less attention has been paid to the fundic wrap length. This study aimed to compare the effectiveness of two different wrap lengths among the patients undergoing partial or total fundoplication. METHODS: For this study, 153 patients were randomized to either Nissen (1.5- or 3-cm wrap) or Toupet (1.5- or 3-cm wrap) laparoscopic fundoplication. The groups were compared according to intensity of dysphagia, esophageal manometry data, ambulatory 24-h pH monitoring data, postoperative esophagitis rate, and overall treatment failure rate. RESULTS: In all the groups, the tone of the lower esophageal sphincter was significantly increased and the DeMeester score significantly decreased, reaching normal levels. At 6 months after surgery, the Toupet 1.5-cm group had significantly more cases of esophagitis than the 3-cm wrap group (24.2% vs 3.3%; p<0.05). At 12 months after surgery, only one patient in the Nissen 3-cm group had moderate to severe dysphagia. In all cases, failures were associated with persistent erosive esophagitis. At the 12-month follow-up assessment, treatment failures were significantly more common in Toupet 1.5-cm group than in the Toupet 3-cm group (17.5% vs 2.7%; p<0.05). However, such differences were not observed in the Nissen groups (7.8% for 1.5 cm and 15.6% for 3 cm; p>0.05). CONCLUSIONS: Evaluation of the treatment results suggests that the wrap length is important in partial Toupet fundoplication to avoid treatment failures. The 3-cm wrap is superior to the 1.5-cm wrap in cases of partial posterior Toupet fundoplication. The influence of wrap length on treatment failure remains unconfirmed for the Nissen procedure.

Hiatal hernia recurrence after laparoscopic fundoplication.

OBJECTIVES: To determine the influence of hiatal hernia size and the laparoscopic fundoplication technique on the rate of hernia recurrence. PATIENTS AND METHODS: The preoperative, operative, and postoperative observational data of 381 patients operated on at the Department of Surgery of Kaunas University of Medicine during the period of 1998-2004 for hiatal hernia complicated with gastroesophageal reflux were analyzed. The surgery technique (Nissen or Toupet operation) was chosen independently of the hernia size. The radiological investigation of the esophagus-stomach using barium contrast as well as esophagogastroduodenoscopy and biopsy was performed for all patients before the surgery. The subjective and objective assessment of the patients' health status was investigated before and no less than 12 months after surgery. If the disease symptoms remained or new ones (i.e. pain behind the sternum, dysphagia, etc.) occurred after surgery, the hernia recurrence was suspected. The radiological investigation of the esophagus-stomach using barium contrast, as well as esophagogastroduodenoscopy and biopsy were performed at the consultative outpatient clinic. The hernia recurrence was confirmed after performing these two investigations. When analyzing the results, the patients were divided into two groups: Group 1--patients with small hiatal hernia (grade 1 and 2 hernia according to radiological classification), Group 2--patients with large hiatal hernia (grade 3 and 4 hernia according to radiological classification). RESULTS: A total of 272 (71.4%) patients had small hiatal hernia, and 109 (28.6%) patients had large ones. Hernia recurrence was diagnosed in 7 (2.58%) patients in Group 1, while in Group 2, 11 (10.1%) patients had hernia recurrence (P<0.05). Laparoscopic Nissen fundoplication was performed in 287 (75.4%) patients, after which 14 (4.98%) patients had hernia recurrence, while Toupet fundoplication was performed in 94 (24.6%) patients, after which 4 (4.3%) patients had hernia recurrence (P>0.05). CONCLUSIONS: The recurrence rate of hiatal hernia after laparoscopic fundoplications is significantly higher in patients with large hernias (grade 3 and 4 according to radiological classification). The surgery technique (Nissen or Toupet fundoplication) was not a significant factor affecting the recurrence rate of hiatal hernia.

The effectiveness of caloric value of enteral nutrition in patients with major burns.

UNLABELLED: Enteral nutrition as an important component of modern treatment is mandatory for patients suffering from major burns. Regardless of the initial estimation of caloric requirements, actual daily volume of energy consumption may vary depending on the general condition of the patient and the side effects of enteral nutrition. The aim of our study was to investigate the relation between caloric value of enteral nutrition and treatment course. METHODS: The prospective study involved 103 adult patients treated in the Hospital of Kaunas University of Medicine for 2 degrees -3 degrees burns of 10-80% body surface area from 1 January 2001 till 31 December 2003. All patients received enteral nutrition during the acute phase. After the completion of the treatment, caloric value of enteral nutrition was estimated, and patients were divided into two groups: group A received more than 30 kcal/(kg 24 h); and group B, received less than 30 kcal/(kg 24 h). We compared patients' mortality, complication rate, and hospital stay time. RESULTS: The mortality of patients, who enterally received less than 30 kcal/(kg 24 h), was 32.6%, comparing to 5.3% mortality in patients who received 30 or more kcal/(kg 24 h) (p < 0.01). The caloric value of less than 30 kcal/(kg 24 h) increased the frequency of pneumonia by 2.0 times, and the frequency of sepsis by 1.8 times (p < 0.05). The duration of the treatment of survivors in this group was by 12.6 days longer (p = 0.01). CONCLUSIONS: The caloric value of enteral nutrition seems to be associated with patient mortality, complication rate, and treatment duration. The results of the treatment of patients who received more or 30 kcal/(kg 24 h) were much better. Because determined relationship may not be directly causal, further study is needed to determine whether active intervention to improve nutrition could improve outcomes.

Randomized, double-blind comparison of once-weekly dalbavancin versus twice-daily linezolid therapy for the treatment of complicated skin and skin structure infections.

BACKGROUND: Dalbavancin, a novel lipoglycopeptide with a pharmacokinetic profile that allows weekly dosing, is active against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). The efficacy of dalbavancin for treatment of skin and skin structure infections (SSSIs) was demonstrated in a phase 2 study. METHODS: In a phase 3 noninferiority study, patients with complicated SSSIs, including infections known or suspected to involve MRSA, were randomized (ratio, 2 : 1) in a double-blind manner to receive dalbavancin (1000 mg given intravenously on day 1 and 500 mg given intravenously on day 8) or linezolid (600 mg given intravenously or intravenously/orally every 12 h for 14 days). Efficacy was assessed by determining clinical and microbiological responses at the end of therapy and at the test-of-cure visit. Relapses were identified by additional follow-up approximately 1 month later. RESULTS: MRSA was identified in 51% of patients from whom a pathogen was isolated at baseline. Dalbavancin and linezolid demonstrated comparable clinical efficacy in the clinically evaluable population at the test-of-cure visit (88.9% and 91.2% success, respectively). The rate of clinical success at the end of therapy was >90% in both arms. Less than 1.0% of patients in either treatment arm experienced relapse after the test-of-cure visit. Both treatments yielded successful microbiological response in excess of 85% among microbiologically evaluable patients at end of therapy and at the test-of-cure visit for all pathogens combined, for all S. aureus strains, and for MRSA. Gastrointestinal symptoms were among the most common adverse events in both arms. A higher proportion of patients in the linezolid arm reported adverse events that were judged by the investigator to be probably/possibly related to treatment (dalbavancin arm, 25.4% of subjects; linezolid arm, 32.2% of subjects). CONCLUSIONS: Two doses of dalbavancin (1000 mg given on day 1 followed by 500 mg given on day 8) were as well tolerated and as effective as linezolid given twice daily for 14 days for the treatment of patients with complicated SSSI, including those infected with MRSA.

[Hiatal hernia and gastroesophageal reflux: possibilities and results of surgical treatment]. / Stemplines angos isvarza ir gastroezofaginis refliuksas. Chirurginio gydymo galimybes ir rezultatai.

In this article we analyze our experience of surgical treatment of hiatal hernia, complicated with gastroesophageal reflux. We operated 134 patients with hernia hiatus esophagi, complicated with gastroesophageal reflux, from 03.1998 till 10.2001. One hundred twenty-six Nissen and 8 Toupet laparoscopic gastrofundoplications were performed. We evaluated clinical signs of gastroesophageal reflux, performed endoscopy and esophageal biopsy with histological examination and stomach X-ray examination with barium meal before the operation. Esophagus and stomach X-ray examination with water contrast on the first day after operation were performed in order to evaluate the position and function of created wrap. We also analyzed intraoperative and postoperative complications. Long-term follow-up (12 months) was obtained by using a structured questionnaire. We evaluated heartburn, dysphagia, regurgitation and patient's satisfaction of surgery. RESULTS. Postoperative complications rate was 8.96%. Eighty-two percent of our patients completed our questionnaire. Ninety-one percent of patients had no heartburn signs, 95.5% any signs of regurgitation. Eighty-three percent of our patients were satisfied with our performed laparoscopic gastrofundoplication. We performed 6 refundoplications, when gastroesophageal reflux clinical signs renewed shortly after operation. CONCLUSIONS. Laparoscopic gastrofundoplication is a safe and effective treatment of hernia hiatus esophagi, complicated with gastroesophageal reflux. Operation success was about 90% in our study. Recurrences are more frequent in elderly patients or those with long disease anamnesis. Refundoplications can be successfully done laparoscopicaly as well.