Decreased circulating T regulatory lymphocytes in obese patients undergoing bariatric surgery.

Objective: It has been previously demonstrated that T lymphocytes may be involved in the development of hypertension and microvascular remodeling, and that circulating T effector lymphocytes may be increased in hypertension. In particular, Th1 and Th 17 lymphocytes may contribute to the progression of hypertension and microvascular damage while T-regulatory (Treg) lymphocytes seem to be protective in this regard. However, no data is available about patients with severe obesity, in which pronounced microvascular alterations were observed.

Predictive Factors of Secondary Normocalcemic Hyperparathyroidism after Roux-en-Y Gastric Bypass.

Objective: Aim of this study is to evaluate determinants of secondary normocalcemic hyperparathyroidism (SNHPT) persistence in patients who have undergone Roux-en-Y gastric bypass on vertical-banded gastroplasty.

Methods: 226 consecutive patients submitted to bariatric surgery were prospectively enrolled and divided in two groups on the basis of preoperative presence of SNHPT. For each patient, we evaluated anthropometric and laboratory parameters.

Comparison between invasive and noninvasive techniques of evaluation of microvascular structural alterations.

Background: The evaluation of the morphological characteristics of small resistance arteries in humans is challenging. The gold standard method is generally considered to be the measurement by wire or pressure micromyography of the media-to-lumen ratio of subcutaneous small vessels obtained by local biopsies. However, noninvasive techniques for the evaluation of retinal arterioles were recently proposed; in particular, two approaches, scanning laser Doppler flowmetry (SLDF) and adaptive optics, seem to provide useful information; both of them provide an estimation of the wall-to-lumen ratio (WLR) of retinal arterioles.

Near-zero difficult tracheal intubation and tracheal intubation failure rate with the "Besta Airway Algorithm" and "Glidescope® in morbidly obese" (GLOBE).

Background: Unpredicted Difficult Tracheal Intubation (DTI) with Macintosh occurs frequently in obese patients. We investigated the incidence of DTI using an algorithm based on preoperative assessment with the El-Ganzouri Risk Index (EGRI) and Glidescope® routine use.

Methods: We prospectively enrolled morbidly obese patients undergoing abdominal surgery.

Oral liquid L-thyroxine (L-t4) may be better absorbed compared to L-T4 tablets following bariatric surgery.

Drug malabsorption is a potential concern after bariatric surgery. We present four case reports of hypothyroid patients who were well replaced with thyroxine tablets to euthyroid thyrotropin (TSH) levels prior to Roux-en-Y gastric bypass surgery. These patients developed elevated TSH levels after the surgery, the TSH responded reversibly to switching from treatment with oral tablets to a liquid formulation.

Circulating endothelial progenitor cells, microvascular density and fibrosis in obesity before and after bariatric surgery.

It is not known whether, in obesity, the capillary density or the number of circulating endothelial progenitor cells (EPCs) are reduced, or whether fibrosis of small vessels is also present. In addition, possible effects of weight reduction on these parameters have never been evaluated. Therefore, we investigated EPCs and capillary density in 25 patients with severe obesity, all submitted to bariatric surgery, and in 18 normotensive lean subjects and 12 hypertensive lean patients as controls.

Preoperative prediction of growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis modification and postoperative changes in candidates for bariatric surgery.

Background: Several factors alter the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis in obese patients, but GH/IGF-1 correlation with anthropometric parameters and lipid metabolism is still unclear. We evaluated this relationship and the postoperative axis modifications in candidates for bariatric surgery.

Methods: Eighty-eight patients (males/females (M/F), 34/54) scheduled for bariatric surgery (biliopancreatic diversion or laparoscopic-adjustable gastric banding) between 2008 and 2010 were included in this observational, open, prospective study.

Biliopancreatic diversion with transient gastroplasty and duodenal switch: long-term results of a multicentric study.

Background: Over the years, several modifications of the Scopinaro biliopancreatic diversion (BPD) have been proposed. This retrospective study reported the results of 15 years of follow-up after open BPD coupled with a type of transient gastroplasty (TG) and duodenal switch (DS), termed BPD-TG with DS.

Methods: Data were analyzed for 874 patients operated on between January 1993 and May 2010 in 3 different surgical departments.

Effects of weight loss on structural and functional alterations of subcutaneous small arteries in obese patients.

Structural alterations of subcutaneous small resistance arteries, as indicated by an increased media:lumen ratio, are frequently present in hypertensive and/or diabetic patients and may represent the earliest alteration observed. In addition, media:lumen ratios of small arteries have a strong prognostic significance. However, no data are available about the structure of small resistance arteries of obese patients, particularly after weight loss.

Morbid obesity in women is associated to a lower prevalence of thyroid nodules.

Background: Few studies have recently showed functional and morphological changes of the thyroid gland in relation to obesity. To our knowledge, no data are available about the prevalence of thyroid nodules in female obese patients. The aim of this study was to investigate the prevalence of thyroid nodules in morbidly obese women.

Loupe magnification reduces postoperative hypocalcemia after total thyroidectomy.

We aimed to evaluate the impact of loupe magnification (LM) on incidental parathyroid gland removal (from pathology reports), hypocalcemia, and recurrent laryngeal nerve (RLN) injury after total thyroidectomy and answer the question of whether this tool should be always recommended for patient's safety. Between January 2005 and December 2008, 126 patients underwent total thyroidectomy with routine use of 2.5 x galilean loupes; their charts were compared with data on 118 patients operated on between January 1997 and December 2000 without LM (two different equally skilled surgical teams operating in the two periods).

Long-term results of biliopancreatic diversion with or without gastric preservation for morbid obesity.

We aimed at comparing our long-term results after biliopancreatic diversion (BPD) with or without gastric preservation for morbid obesity. Between 1999 and 2009, we performed 540 BPD: 287 patients (group A) underwent BPD with distal gastric resection (BPD-AHS) and 253 (group B) underwent BPD associated with transitory vertical gastroplasty (TGR) with duodenal switch (DS). The results have been analyzed in terms of weight loss, improvement of comorbidities, and quality of life (Bariatric Analysis and Reporting Outcome System).

Clinical appraisal of 99m technetium-sestamibi SPECT/CT compared to conventional SPECT in patients with primary hyperparathyroidism and concomitant nodular goiter.

Background: Although 99m Technetium-sestamibi scintigraphy with single-photon emission computed tomography (SPECT) and, recently, hybrid SPECT/computed tomography (CT) have been claimed to be the preoperative methods of choice for parathyroid localization in patients with primary hyperparathyroidism (PHPT) and concomitant nodular goiter (NG), they have never been compared in this setting. We aimed at testing the hypothesis that SPECT/CT may be superior to SPECT for parathyroid localization in patients with PHPT and NG.

Methods: Thirty-three patients with PHPT and NG (one or more nodular lesions based on cervical ultrasound) who underwent open parathyroidectomy during 2004-2009 were reviewed.

High incidence of appendix carcinoid tumors among candidates for bariatric surgery: diagnostic and therapeutic implications.

Although the appendix has been recognized as a preferential site for carcinoid tumors in obese patients, no definitive guidelines are so far available regarding the management of these patients when candidates for bariatric surgery. This study was designed to fill that gap. Between 2000-2008, 558 patients underwent bariatric procedures.

Improvement of metabolic syndrome following intragastric balloon: 1 year follow-up analysis.

Objective: This study aimed to assess the impact of intragastric balloon (IGB)-induced body weight loss on metabolic syndrome in obese patients and evaluate what happens during 1-year follow-up.

Methods: To this end, data were collected on 143 obese patients (body mass index (BMI) 36.2+/-5.

[Comparision between a bilio-pacreatic diversion with or without gastroresection after 2 years of follow-up in the treatment of the pathological obesity].

Malabsorptive bariatric procedures have a long history beginning with jejunoileal bypass, which was first performed in 1950s. The biliopancreatic diversion (BPD) has gained more prominence in Europe since its introduction by Scopinaro in 1976 The BPD has been modified and popularized by Hess in the United States and Marceau in Canada to include a sleeve gastrectomy and duodenal switch in order to decrease the incidence of marginal ulceration and iron deficiency anemia. Moreover the common channel was lengthened to 100 cm to decrease the incidence of long-term malnutrition.

Does extralaryngeal branching have an impact on the rate of postoperative transient or permanent recurrent laryngeal nerve palsy?

Background: This prospective study assessed the prevalence of the extralaryngeal branching of the recurrent laryngeal nerve (RLN) and its impact on the incidence of postoperative transient or permanent RLN palsy.

Methods: Total or hemithyroidectomy was performed in 115 patients, with a total of 195 RLNs displayed. The RLN extralaryngeal branches were routinely identified and preserved.

Outcome of duodenal switch with a transitory vertical gastroplasty, in super-super-obese patients in an 8-year series.

Background: In super-super obese (SSO) patients [body mass index (BMI) superior of 60 kg/m2] results of bariatric surgery are still controversial. This study evaluated safety and efficacy of open duodenal switch associated with transitory vertical gastroplasty (DS-TVG) after 8 years of follow-up.

Methods: A prospective observational study of 32 SSO patients who underwent an open DS-TVG from January 1999 till March 2006 was performed.

[Severe obesity and insulin resistance. Result obtained by the bilio-pancreatic diversion independentely for an associated gastroresection or gastropreservation].

Introduction: Type 2 diabetes is the paradigm of an obesity-related disease. In most cases it exists because of the obesity and will disappear with weight loss.

Aim Of This Study: To evaluate the glicemic control in obese patients after two malabsorbitive procedure, the bilio-pancreatic diversion with ad hoc stomach resection (BPD-AHS) and the bilio-pancreatic diversion with transitory gastric restriction (BPD-TGR).

[Giant intrathyroidal parathyroid cyst with hyperparathyroidism: a case report].

Parathyroid cysts are rare lesions. A correct pre-operative diagnosis is rarely formulated. The Authors report a case of young woman with hyperparathyroidism do to a giant intrathyroidal parathyroid cyst.

Duodenal switch without gastric resection after failed gastric restrictive surgery for morbid obesity.

Background: Several surgical treatments have been proposed for patients in whom gastric restrictive operations have failed. The aim of this study was to analyze the effectiveness and safety of duodenal switch (DS) with restoration of normal gastric capacity in such patients.

Methods: Between May 2001 and May 2003, 11 DS with restoration of normal gastric capacity were performed without other gastric procedures in patients who had had previous gastric restrictive operations which had failed because of inadequate weight loss or weight regain.