Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment.

Background: Clinically significant morbid obesity is associated with an increased risk of gastroesophageal reflux disease. Vertical Roux-en-Y gastric bypass (RYGBP) is known to eliminate acid (and bile) in the pouch of cardia, which would provide control of reflux symptoms. The aim of our study was to assess the technical considerations, morbidity, and safety of RYGBP after previous antireflux surgery and evaluate postoperative reflux symptoms.

Transcranial Doppler ultrasonography in adults with sickle cell disease.

Background: Transcranial Doppler (TCD) is used to select children with sickle cell disease (SCD) for primary stroke prevention using regular blood transfusion. Whether it can also identify high stroke risk in adults with SCD is not known.

Methods: The authors examined 112 adult patients from two convenience population samples with SCD and 53 healthy control subjects to compare velocities in adults to those reported in children with SCD and to evaluate the influence of age and hematocrit on TCD.

Percutaneous endoscopic gastrostomy risks rendering the gastric conduit unusable for esophagectomy.

Surgical treatment for cancer of the esophagus most often involves replacement of the esophagus with a gastric conduit. This gastric tube relies upon the continuity of the gastroepiploic artery for its blood supply. This case report involves a patient whose gastroepiploic artery became thrombosed by a percutaneous endoscopic gastrostomy, rendering his gastric conduit unusable.

Lymphadenectomy in metastasectomy.

Although surgery for pulmonary metastases does not benefit a significant number of patients, PM should continue to be offered to patients whose primary tumor is controlled and who have acceptable operative risks. For a survival benefit to be achieved, all extrathoracic and pulmonary metastases must be amenable to complete surgical resection. We have shown that the presence of metastatically involved lymph nodes discovered during PM adversely effects survival in patients undergoing curative PM.

Postpneumonectomy empyema: results after the Clagett procedure.

Background: The purpose of this study was to analyze our experience with the management of patients with postpneumonectomy empyema treated by the Clagett procedure.

Methods: Data were analyzed from our prospective database on 84 consecutive patients with postpneumonectomy empyema from July 1988 to June 2004.

Results: There were 73 men and 11 women.

Failed antireflux surgery: results after reoperation.

Background: Since laparoscopy has become a common surgical approach for antireflux surgery, little is known regarding reoperation for failed antireflux surgery.

Methods: Records of all patients who underwent reoperation without esophageal resection for symptoms of recurrent gastroesophageal reflux disease or hiatal hernia between July 1, 1995 and April 1, 2004 were reviewed. There were 126 patients.

Gynecologic cancers: factors affecting survival after pulmonary metastasectomy.

Background: Little information is available regarding long-term survival after pulmonary metastasectomy for gynecologic malignancies.

Methods: All patients who underwent pulmonary resection for gynecologic malignancies at our institution between January 1985 and June 2001 were reviewed. Factors affecting long-term survival were analyzed.

Pathophysiology and treatment of stroke in sickle-cell disease: present and future.

Sickle-cell anaemia is the most common cause of stroke in children, and stroke is one of the most devastating complications of sickle-cell disease. Overt strokes are typically due to large-artery vasculopathy affecting the intracranial internal carotid arteries and proximal middle cerebral arteries, whereas silent strokes typically occur in the territory of penetrating arteries. The sickled red blood cell can contribute to the pathogenesis of stroke via abnormal adherence to the vascular endothelium and by haemolysis, which results in endothelial cell activation, a hypercoaguable state, and alterations in vasomotor tone.

The role of pulmonary resection in small cell lung cancer.

Objective: To analyze the outcome of surgical resection for patients with small cell lung cancer (SCLC).

Patients And Methods: We identified all patients who underwent thoracotomy for SCLC at our institution from January 1985 to July 2002. All patients were staged using the American Joint Committee on Cancer TNM system.

Predicting postrecurrence survival among completely resected nonsmall-cell lung cancer patients.

Background: Survival after recurrence subsequent to complete resection of nonsmall-cell lung cancer (NSCLC) has been considered a multifactorial process dependent on demographic, clinical, biological, and treatment characteristics. This study sought to quantify the prognostic effects of these characteristics on postrecurrence survival.

Methods: Three hundred ninety NSCLC patients who underwent complete resection and subsequently had recurrent cancer were studied.

Telestroke: extending stroke expertise into underserved areas.

Telestroke systems offer the opportunity to extend stroke-care expertise into rural and underserved areas. These systems are being used to give alteplase to patients with stroke in previously underserved areas safely, effectively, and rapidly. Telestroke will probably play a large part in improving the quality of stroke care and in enrolling patients into clinical trials in rural and community hospitals.

Porphyromonas gingivalis lipids and diseased dental tissues.

Background/aim: Porphyromonas gingivalis synthesizes several classes of dihydroceramides and at least one of these lipid classes promotes proinflammatory secretory reactions in gingival fibroblasts as well as alters fibroblast morphology in culture. The purpose of this investigation was to determine whether the dihydroceramide lipids of P. gingivalis are recovered in lipid extracts of subgingival plaque, diseased teeth, and diseased gingival tissue samples.

Structures and biological activities of novel phosphatidylethanolamine lipids of Porphyromonas gingivalis.

The Gram-negative periodontal pathogen Porphyromonas gingivalis synthesizes several classes of novel phosphorylated complex lipids, including the recently characterized phosphorylated dihydroceramides. These sphingolipids promote the interleukin-1 (IL-1)-mediated secretion of inflammatory mediators from fibroblasts, including prostaglandin E2 and 6-keto prostaglandin F2alpha, and alter gingival fibroblast morphology in culture. This report demonstrates that one additional class of phosphorylated complex lipids of P.

Esophagogastrectomy: the influence of stapled versus hand-sewn anastomosis on outcome.

Successful anastomosis is essential for favorable esophagogastrectomy outcomes. Before July 2002, almost all esophagogastric anastomoses at our institution were hand-sewn. We then began using linear stapled anastomotic techniques.

Pulmonary resection for metastatic malignant fibrous histiocytoma: an analysis of prognostic factors.

Background: Factors affecting recurrence and survival after pulmonary resection for metastatic malignant fibrous histiocytoma (MFH) are not well known.

Methods: Records of patients undergoing pulmonary metastasectomy for MFH between January 1976 and January 2000 were analyzed.

Results: There were 103 patients (46 men and 57 women).

Laparoscopic esophageal myotomy for achalasia: factors affecting functional results.

Background: We reviewed our experience and analyzed factors affecting functional results after laparoscopic esophageal myotomy (LEM) for achalasia.

Methods: From January 1996 through October 2003, the records of 211 patients (110 men and 101 women) who had LEM for achalasia were reviewed, and factors affecting morbidity and functional results were analyzed.

Results: Median age was 47 years (range, 12 to 85).

Locally recurrent esophageal carcinoma: when is re-resection indicated?

Background: Limited locally recurrent esophageal carcinoma is rare, and little is known regarding effectiveness of re-resection.

Methods: Medical records of 27 consecutive patients with locally recurrent esophageal carcinoma who underwent reoperation at our institution between February 1974 and January 2003 were analyzed.

Results: The original and recurrent cancer cell types were identical in all patients.

REACH: clinical feasibility of a rural telestroke network.

Background And Purpose: Development of stroke networks is critical to bringing guideline-driven stroke care to rural, underserved areas.

Methods: A Web-based telestroke tool, REACH, was developed to provide a foundation for a rural stroke network that delivered acute stroke consults 24 hours per day 7 days per week to 8 rural community hospitals in Georgia.

Results: There were 194 acute stroke consults delivered.

Etiology of chylothorax in 203 patients.

Objectives: To characterize the etiology of chylothorax in patients encountered at a single tertiary referral center and to compare the findings with those from previous studies.

Patients And Methods: The medical records of all patients with chylothorax seen at the Mayo Clinic in Rochester, Minn, over a 21-year period, from January 1, 1980, to December 31, 2000, were retrospectively reviewed to ascertain the underlying cause of their condition.

Results: We identified 203 patients with chylothorax; 92 were females (male-female ratio, 1.

Is voluntary vitamin and mineral supplementation associated with better outcome in non-small cell lung cancer patients? Results from the Mayo Clinic lung cancer cohort.

Background: Some previous studies report that 80% of cancer patients take multivitamin and/or mineral supplements. To our knowledge, the consequences of such self-directed supplementation have not been examined previously in non-small cell lung cancer (NSCLC) patients. The goal of this study was to determine whether vitamin/mineral supplementation is associated with improved survival and quality of life in a cohort of NSCLC patients.

Long-term function and quality of life after esophageal resection for cancer and Barrett's.

Esophagectomy is the treatment of choice for cancer or high-grade dysplasia. Although the patients frequently experience symptoms postoperatively, their quality of life is most often comparable to that of a control population. This article provides details of post-esophagectomy symptomatology and examines how quality of life can be measured in these patients.

Ivor Lewis esophagogastrectomy.

In conclusion, an Ivor Lewis esophagogastrectomy is a safe surgical approach for esophageal cancer. The technique allows direct visualization and resection of most of the lymph node stations at risk. Survival is stage-dependent and, unfortunately, is low in advanced stages.

Diverticula of the esophagus.

Esophageal diverticula can cause disabling symptoms. The authors describe here our preferred surgical approach for Zenker's and epi-phrenic diverticula. For most patients, excision of the diverticulum and addition of a myotomy will result in a favorable functional outcome and a low recurrence rate.

Pulmonary carcinoid tumors with Cushing's syndrome: an aggressive variant or not?

Background: Adrenocorticotropic hormone (ACTH)-secreting pulmonary carcinoid is considered an aggressive variant of carcinoid tumors. Current knowledge is based upon a limited number of reports with few patients.

Methods: All patients with Cushing's syndrome (CS) resulting from pulmonary carcinoid (PC) who underwent pulmonary resection at our institution from November 1966 through April 1998 were reviewed.