Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic biliopancreatic diversion with duodenal switch (LDS) are surgical options for superobesity. A randomized trial was conducted to evaluate perioperative (30-day) safety and 1-year results. METHODS: Sixty patients with a body mass index (BMI) of 50-60 kg/m(2) were randomized to LRYGB or LDS. BMI, percentage of excess BMI lost, complications and readmissions were compared between groups. RESULTS: Patient characteristics were similar in the two groups. Mean operating time was 91 min for LRYGB and 206 min for LDS (P < 0.001). One LDS was converted to open surgery. Early complications occurred in four patients undergoing LRYGB and seven having LDS (P = 0.327), with no deaths. Median stay was 2 days after LRYGB and 4 days after LDS (P < 0.001). Four and nine patients respectively had late complications (P = 0.121). Mean BMI at 1 year decreased from 54.8 to 38.5 kg/m(2) after LRYGB and from 55.2 to 32.5 kg/m(2) after LDS; percentage of excess BMI lost was greater after LDS (74.8 versus 54.4 per cent; P < 0.001). CONCLUSION: LRYGB and LDS can be performed with comparable perioperative safety in superobese patients. LDS provides greater weight loss in the first year.

Linkage analysis of IL4 and other chromosome 5q31.1 markers and total serum immunoglobulin E concentrations.

Sib-pair analysis of 170 individuals from 11 Amish families revealed evidence for linkage of five markers in chromosome 5q31.1 with a gene controlling total serum immunoglobulin E (IgE) concentration. No linkage was found between these markers and specific IgE antibody concentrations. Analysis of total IgE within a subset of 128 IgE antibody-negative sib pairs confirmed evidence for linkage to 5q31.1, especially to the interleukin-4 gene (IL4). A combination of segregation and maximum likelihood analyses provided further evidence for this linkage. These analyses suggest that IL4 or a nearby gene in 5q31.1 regulates IgE production in a nonantigen-specific (noncognate) fashion.

Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: Gastric bipartition, a novel metabolic surgery procedure: A retrospective cohort study.

INTRODUCTION: The single anastomosis sleeve ileal (SASI) bypass is a Novel Metabolic/Bariatric Surgery operation based on mini gastric bypass operation and Santoro's operation in which a sleeve gastrectomy is followed by a side to side gastro-ileal anastomosis. The purpose of this Study is to report the clinical results of the outcomes of SASI bypass as a therapeutic option for obese T2DM patients. METHODS: We conducted a retrospective cohort study of type 2 diabetic obese patients who underwent SASI bypass at one hospital from March 1, 2013 to December 31, 2014. Patients with previous bariatric surgery, history of upper laparotomy, and with less than one year follow up, were excluded. Sleeve gastrectomy was performed over a 36-Fr bougie, 6 cm from the pylorus, and 250 cm from the ileocecal valve the ileum brought to be anastomosis side to side with the antrum. Data collected included comorbidity resolution, percent excess weight loss (% EWL), and one-year morbidity and mortality. RESULTS: During the study period, 61 underwent laparoscopic SASI bypass. Ultimately, 50 patients with a mean BMI of 48.7 ± 7.6 kg/m2 met inclusion criteria and were evaluated. %EWL reached 90% at one year and all patients have normal glucose level in the first 3 months after surgery. Hypertension remitted in 86%, hypercholesterolemia in 100% and hypertriglyceridemia in 97% of patients. There were 6 postoperative complications. One pulmonary embolism, one postoperative bleeding, one leak from biliary limb and one complete obstruction at the gastro-ileal anastomosis. Six months postoperative, one patient was diagnosed with marginal ulcer, 12 months after surgery, another patient was re-operated for fear of more excessive weight loss. CONCLUSION: SASI bypass is a promising operation that offers excellent weight loss and diabetic resolution.

Bone disorder in men with chronic alcoholism: a reversible disease?

Disturbances in bone metabolism and histology have been recognized in chronic alcoholism. It has not been established whether they are reversible and the cause remains unclear. We studied various serum and urine variables (including serum PTH, calcium, D-vitamins, and osteocalcin concentrations), bone mineral content, and bone histomorphometrics in men who at present abused alcohol and compared the results to those from men who previously had abused alcohol but who had abstained from alcohol for at least 2 yr and from normal men. No significant differences were found in bone mineral content at the two measuring sites (distal forearm, lumbar spine) between drinkers, abstainers, and controls though a considerable proportion of both current drinkers and abstainers had subnormal values. Bone formation rate and turnover (expressed by the activation frequency) was significantly reduced in the current drinkers who also had lower serum PTH, 1,25-dihydroxycholecalciferol, and osteocalcin concentrations. Men who had abstained from alcohol consumption for at least 2 yr had results similar to those from normal men, suggesting that the disturbances in bone metabolism in men abusing alcohol are reversible. The decrease in bone turnover in the drinkers may be explained by the observed reduction in plasma PTH concentration or a direct toxic effect of ethanol on bone tissue leading to a deficient recruitment of osteogenic cells.

Association between quantitative traits underlying asthma and the HLA-DRB1 locus in a family-based population sample.

The region of human chromosome 6 containing the MHC has been identified as influencing asthma and atopy (allergy) by several genome-wide searches. The MHC contains many genes with potential effects on innate and specific immunity. As a first step in dissecting MHC influences on asthma and its underlying quantitative phenotypes, we have examined the HLA-DRB1 locus in a population sample consisting of 1004 individuals from 230 families from the rural Australian town of Busselton. The locus was strongly associated with the (log(e)) total serum IgE concentration, accounting for 4.0% of the sigma(2) (variance) in that trait (multi-allelic test, P=0.00001). The locus also influenced specific IgE titres to common allergens (multi-allelic tests, 2.8% sigma(2) for the house dust mite allergen Der p I, P=0.0013; 3.0% of sigma(2) for Der p II, P=0.0007; and 2.1% of sigma(2) for the cat allergen Fel d I, P=0.014). No associations were found to the categorical phenotype of asthma, or to the quantitative traits of peripheral blood eosinophil counts and bronchial hyper-responsiveness. Transmission disequilibrium tests excluded genetic admixture as a cause of false-positive findings. The results indicate that HLA-DRB1 alleles modulate the total serum IgE concentration and IgE responses to allergens, but do not account for the previous observations of linkage of asthma to the MHC.

Assay for the specificity of monoclonal antibodies in crossed immunoelectrophoresis.

A method is described based on crossed immunoelectrophoresis of a complex antigen mixture in agarose gel followed by incubation of the gel with the monoclonal antibody. The bound monoclonal antibody is detected by the use of a secondary enzyme-labelled antibody. Using this technique we have been able to identify the precipitate arc in crossed immunoelectrophoresis of major histocompatibility complex (MHC) class I molecules in a mixture of all detergent solubilized cell membrane molecules by means of a monoclonal antibody, the specificity of which was known independently to be against MHC class I molecules. In other experiments using the same technique we demonstrated the reaction of a monoclonal antibody specific for chicken Ig light chains.

Association between HLA-DRB3*0101 and immunoglobulin-E responsiveness to Bet v I.

The relationship between HLA-DRB3 antigens and specific IgE responsiveness to highly purified major allergen from white birch (Betula verrucosa), Bet v I, was studied in 43 patients, who were skin-prick test positive to birch pollen extract. Specific IgE to Bet v I was measured using an assay based on the principle of the Magic Lite method. HLA-DR and -DQ typings were performed by standard restriction fragment-length polymorphism techniques and HLA-DRB3 typing by the use of polymerase chain reaction and sequence-specific oligonucleotide. Of the 43 patients, 41 (95%) exhibited Bet v I-specific IgE. The data showed a significant association between HLA-DRB3*0101 and specific IgE to Bet v I (pc = 0.02). Furthermore, it was shown that this association was linked to the overall IgE responsiveness and not to a limited area of IgE sensitivity. The present study confirms and further identifies the association of DRB3*0101/0301 earlier described in an Austrian population to be present also in a Danish study group. This underlines the importance of this particular allele in the allergic immune response to birch pollen and emphasizes the importance of investigating the molecular basis of human allergic immune responsiveness.

Early stimulation of acidification rate by novel cytotoxic pyridyl cyanoguanidines in human tumor cells: comparison with m-iodobenzylguanidine.

CHS 828, a newly recognized pyridyl cyanoguanidine, has shown promising antitumor activity both in vitro and in vivo and is presently in early phase I clinical trial in collaboration with EORTC. In this study, the effects of CHS 828 and a series of analogues on extracellular acidification and cytotoxicity were compared with those of m-iodobenzylguanidine (MIBG) in human tumor cells. The extracellular acidification rate was measured using the Cytosensor microphysiometer, and determination of cytotoxicity and proliferation was [(14)C] performed by the fluorometric microculture cytotoxicity assay (FMCA) and measurement of [(14)C]thymidine and leucine uptake. CHS 828 significantly increased the acidification rate during the first 15-24 hr in a concentration-dependent manner. This effect was abolished by removal of glucose from the medium, substituted with 10 mM of pyruvate, indicating stimulated glycolysis as the source of the increased acidification rate. However, CHS 828 induced cytotoxicity at concentrations well below those that affected the rate of acidification; when a series of closely related pyridylguanidine analogues were tested and compared, no apparent relationship between cytotoxicity and acidification could be discerned. Furthermore, comparable increases in the acidification rate were evident in one subline with high-grade resistance to the cytotoxic actions of CHS 828. The results indicate that CHS 828 may share the inhibitory actions of MIBG on mitochondrial respiration with a subsequent increase in glycolysis and acidification rate. However, this mechanism of action appears neither necessary nor sufficient to fully explain the cytotoxic actions of CHS 828 in human tumor cells, actions which remain to be mechanistically clarified.

Bacterial binding to extracellular matrix proteins -- in vitro adhesion.

A binding assay was developed and used to study the binding of oral streptococcus to immobilized human fibronectin, laminin, vitronectin, fibrinogen, heparin, and collagen IV. The protein binding was dependent on the broth used for bacterial growth. The binding after growth in brain heart infusion broth, trypticase soy broth, Todd-Hewitt broth, and Dulbecco's modified Eagle's medium was examined. Most of the strains were able to bind to immobilized fibronectin and laminin, and to a minor extent vitronectin. Binding was not observed on immobilized fibrinogen, collagen IV, or heparin. Measured surface hydrophobicity correlated well with the bacterial binding strength to the proteins. Streptococcal incubation with putative inhibitors indicates multiple binding mechanisms of a lectin-like and protein nature, possibly involving protein receptors.

[Access to case records in department for child and adolescent psychiatry]. / Aktindsigt p børne- og ungdomspsykiatriske afdelinger.

The object of this investigation was registration of all requests for access to case records in 1987 in all departments for child and adolescent psychiatry in Denmark. A total of 34 requests were made concerning child psychiatric departments and 55 concerning departments for adolescent psychiatry. This corresponds to requests for access to case records in 0.8% of all patients admitted to departments of child psychiatry, and also 0.8% of the outpatients. In the departments for adolescent psychiatry, access to the case records was desired concerning 16.5% of the hospitalized adolescents. No complaints have been made concerning access to the case records and it is concluded that the new Danish law functions satisfactorily also where parents were concerned, where the possibility of providing limited insight for adolescents or parents may be of value. The significance of introduction of a period of limitation for access to case records in departments for child and adolescent psychiatry is emphasized.

[Fractionated P-bilirubins]. / P-bilirubiner, fraktioneret.

A diazo-based dry film technique for the estimation of different bilirubins in plasma is now available. This procedure separates bilirubins from icteric sera into three separate fractions: bilirubin (unconjugated), bilirubin-glucuronides (mono + diglucuronide) and bilirubin-albumin. In newborns with prolonged jaundice classification of hyperbilirubinemia is of importance for choice of treatment. While binding of bilirubin and bilirubin-glucuronides to albumin is non covalent, reversible, bilirubin-albumin appears to be firmly associated with albumin by covalent bonds. This causes delayed clearance of this bilirubin fraction from plasma as the half-life of albumin is approximately 18 days. Hence the substance concentration of bilirubin-albumin will decrease at a slower rate than will bilirubin and bilirubin-glucuronide, despite hepatobiliary recovery. Bilirubin-albumin may therefore prove of value in the differentiation between different clinical entities with hyperbilirubinemia.

[Fractionated P-bilirubins. Clinical use]. / P-bilirubiner, fraktioneret. Klinisk anvendelse.

Development of new assays for accurate quantification of bile pigments in plasma have facilitated their clinical application. Hyperbilirubinemia and jaundice occur frequently in the neonatal period. The purpose of the present study was to determine reference intervals for bilirubins in 60 fullterm healthy infants during the first four days of life. For comparison the bilirubin fractions were analyzed in an infant with biliary atresia and six adults with hepatobiliary disorders.

Variations in blood constituents of healthy full term infants as related to body weight in the new-born period.

In 59 full term new-born infants an increase in the mean value for (blood, (B] B-haemoglobin, (plasma, (P] P-potassium and (plasma, (P] P-bilirubins was seen during the first three days of life. The erythrocyte volume fraction, P-sodium and P-albumin varied in parallel with the B-haemoglobin concentration. The variation in these blood constituents indicated that an initial destruction of erythrocytes occurred and that a haemoconcentration took place as well. This was further substantiated by the observation of a weight loss in the infants of about 6.4% of the estimated total body water content during the first three days after delivery. An increase in P-sodium of 5% in the same period indicated that the weight loss consisted mainly of water. These results show that new-born infants are prone to be hypovolaemic during the first three days of life.

Mucinous adenocarcinoma of the sublingual gland.

A case of mucinous (colloid) adenocarcinoma of the sublingual gland is reported. Adenocarcinomas associated with large pools of extracellular mucin are extremely rare in the major salivary glands. Analysis of the tumor for cytokeratin expression, estrogen and progesterone receptors was performed. Predominantly, the tumor expressed cytokeratins 7, 8, 18 and 19 that are commonly found in simple epithelia, and to a lesser degree cytokeratins 4 and 13 which are usually found in complex epithelia. Staining for estrogen and progesterone receptors was negative. No other cancer has been detected for three years after the first examination. The tumor is considered to be a primary mucinous adenocarcinoma of the sublingual gland.

Diagnostic significance of in vitro T-cell proliferative responses to house-dust mite Der p 1 in children with dust-mite allergy.

The study aimed to investigate the possible diagnostic significance of T-cell proliferative responses to purified Der p 1 antigen in allergic children with and without allergic sensitization to house-dust-mite (HDM) allergens. T-cell reactivity to purified Der p 1 antigen was analyzed in 24 children with allergic sensitization to HDM demonstrated by RAST and/or positive skin prick tests. Twelve healthy young adults and 11 children with allergic sensitizations other than HDM served as controls. Of 25 HDM-allergic patients, 16 displayed strong T-cell reactivity to Der p 1 (stimulation indices > 3): nine patients showed no T-cell proliferation despite the presence of specific IgE, and five showed no responses despite positive skin prick test. In two patients, a weak T-cell response to Der p 1 could be demonstrated in the absence of specific IgE and negative skin test result. The two affected subjects did not show evidence of mite allergy. No T-cell responses were observed in adult controls (stimulation indices < 3). We conclude that the assessment of T-cell reactivity to Der p 1 is of little value for the diagnosis of HDM allergy. The importance of T-cell proliferative responses for the study of the pathogenesis of HDM allergy remains unchallenged.

Modification of the ELISA for the estimation of tetanus antitoxin in human sera.

The use of indirect ELISA for the quantitation of tetanus toxin neutralizing antibodies in human sera is limited by marked overestimations in low titered sera. The reasons for the discrepancy between the results obtained by ELISA and by in vivo assay and modifications of the ELISA to overcome the problem were investigated. Catching ELISA and indirect ELISA using trays coated with the contaminant proteins in toxoid preparations indicated that antibodies to contaminants were only partly responsible for the discrepancy and the introduction of these modifications did not solve the problem. In ELISA competition experiments with toxin neutralizing monoclonal antibodies, the human immunoglobulins irrelevant in toxin neutralization, but detectable in indirect ELISA, were found to be difficult to inhibit in their binding to the solid antigen phase. These might represent antitoxins bound bivalently to the solid phase but with affinities in monovalent binding insufficient for toxin neutralization or other coupled antibodies due to conformational changes of the antigen. A competition ELISA with toxin in solution was therefore developed to assess selectively the antitoxin capable of binding the antigen in solution and by this approach the in vivo activities of even low titered sera were accurately predicted. This antigen competition ELISA may be easily introduced into routine tetanus serology and the principle may also be of value for the in vitro detection of functional antibodies to other antigens.

Determination of tetanus and diphtheria antitoxin content in dried samples of capillary blood: a convenient method applied to infants.

To assess the effect of vaccination of infants against tetanus and diphtheria capillary blood was drawn from 51 randomly selected healthy infants 2 years of age. The blood was applied directly to filter paper. In the laboratory the blood dots were eluted in phosphate buffered saline for 2 h at room temperature yielding 100% recovery of antitoxin activity. Serum volume in the blood dots was determined by calculation of dot area or by measuring albumin content in the eluted samples by means of rocket immunoelectrophoresis. These approaches were found to be equally applicable. Concentration of antitoxin to tetanus and diphtheria was assessed with ELISA and in vitro toxin neutralization assay respectively. Mean diphtheria antitoxin concentration was 0.53 IU/ml, and mean tetanus antitoxin concentration 4.1 IU/ml. Low initial immune response to diphtheria vaccination may be responsible for the risk among school children to have antitoxin concentration below protective level (reported elsewhere). In environments where diphtheria is disappearing a lowered vaccination response may be expected.

Does guanine concentration in house-dust samples reflect house-dust mite exposure?

Using specific ELISA extracts, we analyzed samples of pure mite cultures and house dust for group I allergens from Dermatophagoides pteronyssinus, D. farinae, and D. microceras. Correspondingly, we measured the concentration of guanine and xanthine by rigorous chemical methods. The pure mite cultures were used to correlate allergen levels with guanine levels. The house-dust samples one-sidedly contained more guanine than expected. This suggests that considerable amounts of guanine originate from non-house-dust mite sources and implies that guanine quantifications are of limited clinical value.