Chronic and Sustained High-Dose Opioid Use in an Integrated Health System.

Introduction: The Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain released in 2016 had led to decreases in opioid prescribing. This study sought to examine chronic and sustained high-dose prescription opioid use in an integrated health system.

Methods: A serial cross-sectional study was conducted in 2021 to estimate the annual age-adjusted prevalence and incidence of chronic and high-dose opioid use among demographically diverse noncancer adults in an integrated health system in Southern California during 2013-2020.

Laparoscopic Hiatal Hernia Repair in 221 Patients: Outcomes and Experience.

Background And Objectives: Hiatal hernia is a common condition often associated with symptomatic gastroesophageal reflux disease (GERD). The objectives of this study were to examine the efficacy and safety of laparoscopic hiatal hernia repair (LHHR) with biologic mesh to reduce and/or alleviate GERD symptoms and associated hiatal hernia recurrence.

Methods: We retrospectively reviewed consecutive LHHR procedures with biologic mesh performed by a single surgeon from July 2009 to October 2014.

Randomized, Prospective Comparison of Ursodeoxycholic Acid for the Prevention of Gallstones after Sleeve Gastrectomy.

Background: Several studies have examined the role of ursodeoxycholic acid (UDCA) for the prevention of cholelithiasis (gallstones) following rapid weight loss from restrictive diets, vertical band gastroplasty, and Roux-en-Y gastric bypass. However, to date, there have been no prospective, controlled studies examining the role of UDCA for the prevention of gallstones following sleeve gastrectomy (SG). This study was conducted to identify the effectiveness of UDCA for prevention of gallstones after SG.

Case reports--resolution of Barrett's disease and esophageal epithelial atypia after gastric bypass and LAP-BAND.

Gastroesophageal reflux is a well-recognized complication of obesity. Long-term reflux is associated with the progression from esophageal injury to Barrett's esophagus then to carcinoma. Bariatric surgery may prevent reflux and the progression of esophageal injury.

Metabolic syndrome phenotype in very obese women.

Severe obesity is increasingly common in the United States. Very obese persons are at increased risk for the metabolic consequences of obesity. A common multidimensional risk condition associated with obesity is the metabolic syndrome.

Laparoscopic choledochojejunostomy via PTFE-covered stent successfully achieves internal drainage of common bile duct obstruction.

The purpose of this study was to develop a method of laparoscopic biliary bypass utilizing a PTFE-covered biliary stent. An animal model of common bile duct obstruction was developed. Three days before the planned choledochojejunostomy, the common duct in 10 female pigs was ligated using mini-laparoscopy instrumentation (2 mm) to create an obstruction model.

Focal motor seizures induced by alerting stimuli in critically ill patients.

Purpose: We have previously demonstrated that it is common for alerting stimuli to induce electrographic seizures and other periodic or rhythmic patterns in the critically ill; however, only 1 of the first 33 patients we reported with this phenomenon had a detectable clinical correlate.

Methods: Review of charts and video EEG findings in critically ill patients in a neurological ICU at a tertiary care medical center in Manhattan.

Results: We identified nine patients who had focal motor seizures repeatedly induced by alerting stimuli.

Pit viper envenomation in pregnancy: a case report and literature review.

Pit viper bites are very rare in pregnant patients and there is no consensus for treatment. This case report describes the treatment of a 28-year-old woman at 26 weeks gestation who suffered a pit viper envenomation.

Abdominal wall neurofibroma presenting as an inguinal hernia.

Inguinal hernias are a common cause of abdominal wall pain and are the most common abdominal wall abnormality. They can usually be differentiated from other abnormalities by history and physical examination. Occasionally, the diagnosis may be difficult with very small or very large lesions.

Is routine cholecystectomy required during laparoscopic gastric bypass?

Background: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of our study was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric bypass (LRYGBP).

Methods: 289 LRYGBP were performed between November 1999 and May 2002.

Acute post-gastric reduction surgery (APGARS) neuropathy.

Background: A variety of neurologic complications have been reported after weight loss surgery. Recently, a new term was introduced to describe cases of postoperative polyneuropathy - acute post-gastric reduction surgery (APGARS) neuropathy, a polynutritional, multisystem disorder characterized by protracted postoperative vomiting, hyporeflexia, and muscular weakness. The incidence, associations, and prognosis of this disorder have not been precisely defined.

Gastro-clip gastroplasty: a very long-term complication.

For most surgeons, the gastro-clip gastroplasty is an unfamiliar operation. It was performed during the mid 1980s as an alternative to more complex bariatric operations. However, the device had problems.

Is routine cholecystectomy required during laparoscopic gastric bypass?

Background: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of this study was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric bypass (LRYGBP).

Methods: 289 LRYGBP were performed between November 1999 and May 2002.

Gastric bypass: it pays to keep military hospitals busy.

This study was performed to review the surgical treatment of obesity at a community military hospital and compare costs to TRICARE reimbursement rates (the cost of sending a patient to a civilian surgeon for obesity surgery). The preoperative, operative, and postoperative phases are described in detail. The expenses of five consecutive patients were calculated and averaged.

Weakness after gastric bypass.

Two patients underwent gastric bypasses and had uneventful hospital courses. In the early postoperative periods, both developed severe, protracted vomiting, weakness, and hyporeflexia. After thorough laboratory and clinical evaluations by neurologists, the patients were diagnosed with Guillain-Barré syndrome, although there were many atypical features.