Effects Of Various Surgical Procedures Research Articles

Quality of life after surgical treatments for facial palsy: A systematic review and meta-analysis.

Facial palsy profoundly affects patients' quality of life (QoL). We evaluated the effect of various surgical procedures on QoL using patient-reported outcome measures (PROMs) to provide evidence-based recommendations for improved care. Embase, Medline, Web of Science, Cochrane, and CINAHL were searched for studies on QoL in patients with facial palsy who had undergone reconstructive surgery with preoperative and postoperative data from validated PROMs. After conducting the quality assessment, data were subtracted from the articles. Meta-analyses of subgroups were performed when study outcomes where compatible. Incorporating 24 studies (522 patients), our systematic review revealed consistent and significant QoL improvements following diverse reconstructive surgical procedures. Our systematic review and meta-analysis showed the positive effects of different reconstructive surgical procedures on QoL of patients with facial palsy. These results support clinicians to better inform patients about their potential outcomes, optimizing informed and shared decision-making and ultimately improving overall QoL in patients with facial palsy.

Clinical Effectiveness of Various Surgical Procedures Addressing Long Head of Biceps Pathology: Protocol for a Systematic Review and Meta-Analysis.

Introduction:The long head of biceps tendon is a common source of anterior shoulder pain and impaired function. Multiple surgical procedures are available as treatment options, but the optimal procedure is not known. The aim of this systematic review and meta-analysis is to review the literature to assess the clinical effectiveness of various surgical procedures to treat pain arising from the long head of biceps.Methods:The study protocol was designed and registered prospectively on PROSPERO (International prospective register for systematic reviews). Electronic databases used for the literature search will include MEDLINE, EMBASE, PsycINFO, and The Cochrane Library. Randomised controlled trials (RCTs) evaluating surgical procedures on the long head of biceps will be included. Our primary outcome is any functional patient-reported outcome measure related to the shoulder. Secondary outcomes will include the rate of ‘Popeye’ deformity, the rate of biceps cramping pain, the rate of complications, objective measurements of strength testing such as dynamometer, and other patient-reported outcome measures not specific to the shoulder such as the Visual-Analog Scale (VAS) for pain. Methodological quality of included studies will be assessed using The Cochrane Risk of Bias Tool 2.0 and the Jadad score. Inconsistency and bias across included studies will be assessed statistically. Comparable outcome data will be pooled and analysed quantitatively or qualitatively as appropriate.Ethics and dissemination:No ethical clearances required for this study. We plan to publish this systematic review and meta-analysis in a peer-reviewed journal. It will also be presented at various national and international conferences.HighlightsEvaluating the clinical effectiveness of surgical procedures for long head of biceps pathology.Randomised controlled trials.Biceps tenodesis and biceps tenotomy.Systematic review compliant with the PRISMA guideline.

Surgical Impacts of Metastatic Non-small Cell Lung Cancer to the Thoracic and Lumbar Spine.

BackgroundSurgery for spinal metastasis is rapidly increasing in frequency with procedures ranging from laminectomy to spondylectomy combined with stabilization. This study investigated the effect of various surgical procedures for spinal metastasis of non-small cell lung cancer (NSCLC).MethodsA single-center consecutive series of patients who underwent surgery for spinal metastasis of NSCLC were retrospectively reviewed. Patients' characteristics, radiographic parameters, operative data, clinical outcomes, and complications were analyzed. Surgical outcomes were assessed according to pain and performance status before and after surgery. Overall survival (OS) rate was estimated using the Kaplan-Meier method. Multivariate analysis was performed to detect factors independently associated with OS using a Cox proportional hazards model.ResultsTwenty-one patients were treated with laminectomy, 24 with corpectomy, 13 with spondylectomy (piecemeal or total en bloc fashion), and all procedures were combined with stabilization. Back pain and performance status improved significantly after surgical treatment among the three groups. Revision surgery due to tumor progression at the index level or spinal metastasis at another level were four patients (19.0%) in the laminectomy group, six patients (25.0%) in the corpectomy group, and one patient (7.7%) in the spondylectomy group. A Charlson comorbidity index and the number of spinal metastasis negatively affected OS (hazard ratio [HR], 19.613 and 2.244). Postoperative chemotherapy, time to metastasis, spondylectomy, and corpectomy had favorable associations with OS (HR, 0.455, 0.487, 0.619, and 0.715, respectively).ConclusionPostoperative chemotherapy was the most critical factor in OS of patients with metastatic NSCLC to the spine. An extensive surgical procedure (corpectomy/spondylectomy) with stabilization also could be beneficial for limited patients with spinal metastasis of NSCLC.

Effectiveness of Various Surgical Procedures for Correction of Monocular Elevation Deficit

Monocular Elevation Deficit (MED) is a frequent cause of hypotropia and is associated with ptosis/pseudoptosis. The primary aim of surgery in these cases is to improve Bell's phenomenon and correct misalignment. Various surgical procedures have been described to correct this defect and the choice of procedure depends upon the numerous associated factors. In this retrospective case series we have analyzed the effect of various surgical procedures used to correct MED.

Observations on the Tear Trough.

The tear trough is a prominent structure of the midface. Many surgical and nonsurgical techniques have been devised to efface this feature. The aim of this study was to define an aesthetically pleasing tear trough and understand the effect of various surgical procedures on its appearance. We undertook a retrospective review of "ideal" subjects (ie, young men and women as well as male and female models) as well as surgical patients undergoing lower blepharoplasty with fat excision, fat transposition, erbium laser resurfacing of the eyelids and midface, or endoscopic midface lifting. Marginal reflex distance-2, lower eyelid length, and nasojugal fold depth were measured and analyzed for all patients. The nasojugal fold was significantly less prominent in ideal female models than in all other groups (P < 0.0001). Lower eyelid length was significantly shorter after fat excisional lower blepharoplasty, laser resurfacing, and midface lift (P < 0.0001), and did not change after fat transpositional lower blepharoplasty. Postsurgical reduction in lower eyelid length was significantly less with fat transpositional lower blepharoplasty than in all other groups (P < 0.0001). The nasojugal fold was significantly effaced after all types of procedures (P < 0.0001), but was significantly more effaced after fat transpositional lower blepharoplasty (P < 0.01) than after all other procedures. A slight, medial tear trough is present in youth in many patients. The clinical tear trough is a virtual topographic structure distinct from the anatomic tear trough ligament and can be altered in a variety of ways.

Effects of various surgical procedures on biochemical parameters of Nigerian dogs and their clinical implications.

Aim:The importance of physical and psychological stress caused by pain during surgery cannot be overemphasized. The aim of this study was to assess the effects of ovariohysterectomy (OVH), gastrotomy (GST), and intestinal resection and anastomosis (IRA) on biochemical parameters of Nigerian dogs anesthetized with the xylazine-propofol combination.Materials and Methods:A total of 12 dogs were randomly divided into three groups of four each. The animals were treated with xylazine and propofol anesthetics for OVH, GST, and IRA in Groups 1-3, respectively. Blood samples were collected at 0 h, 2, 24, 48, 72, 96, 120, and 144 h postsurgery for determination of cortisol (CORT), glucose (GLU), total protein (TP), albumin (ALB), globulin (GL), and ALB/GL ratio.Results:There were significant increases (p<0.05) in mean CORT concentrations 2 h postsurgery in the three groups and at 24 h in Group 3 and 96 h in Groups 1 and 3, respectively. GLU concentrations increased significantly (p<0.05) in the three groups at 2 h postsurgery. The mean protein concentrations in Groups 2 and 3 decreased significantly (p<0.05) at 2h and 24 h and 72 h, 96 h, 120 h, and 144 h in Group 3, respectively. There was significant decrease (p<0.05) in the mean ALB concentrations at 2 h, 24 h, 72 h, 96 h, 120 h, and 144 h postsurgery. There was a significant difference (p<0.05) in the mean GL concentrations in Group 3 at 24 h, 72 h, 96 h, and 144 h. All other parameters were not significantly different (p>0.05) in comparison with the control.Conclusion:Xylazine-propofol combination could decrease humoral immune status and increase serum GLU level invariably portending a high risk of diabetes in the vulnerable dogs.

Quality of life after different surgical procedures for the treatment of spinal metastases: results of a single-center prospective case series.

OBJECTIVE The performance of surgery for spinal metastases is rapidly increasing. Different surgical procedures, ranging from stabilization alone to stabilization combined with corpectomy, are thereby performed for various indications. Little is known about the impact of these different procedures on patient quality of life (QOL), but this factor is crucial when discussing the various therapeutic options with patients and their families. Thus, the authors of this study investigated the effect of various surgical procedures for spinal metastases on patient QOL. METHODS The authors prospectively followed a cohort of 113 patients with spinal metastases who were referred to their clinic for surgical evaluation between July 2012 and July 2014. Quality of life was assessed using the EQ-5D at intake and at 3, 6, 9, and 12 months after treatment. RESULTS Nineteen patients were treated conservatively, 41 underwent decompressive surgery with or without stabilization, 47 underwent a piecemeal corpectomy procedure with stabilization and expandable cage reconstruction, and 6 had a stabilization procedure without decompression. Among all surgical patients, the mean EQ-5D score was significantly increased from 0.44 pretreatment to 0.59 at 3 months after treatment (p < 0.001). Mean EQ-5D scores at 1 year after surgery further increased to 0.84 following decompression with stabilization, 0.74 after corpectomy with stabilization, and 0.94 after stabilization without decompression. Frankel scores also improved after surgery. There were no significant differences in improvements in EQ-5D scores and Frankel grades among the different surgical procedures. In addition, mortality and complication rates were similar. CONCLUSIONS Quality of life can improve significantly after various extensive and less extensive surgical procedures in patients with spinal metastases. The relatively invasive corpectomy procedure, as compared with alternative less invasive techniques, does not negatively affect outcome.

Changes In Leptin Level After Different Bariatric Procedures: Gastric Balloon And Sleeve Gastrectomy, And Its Relation To The Effectiveness Of Weight Loss.

Background: Obesity can affect the neuroendocrine system in various ways, either by hormonal elevation as in ghrelin and growth hormone or by depression as in the case of leptin and insulin. Leptin has been previously researched in its relation t o the energy homeostasis in obesity, however the effect of various surgical procedures are far from being fully understood. Methods: A prospective multicenter case control study was done including twenty non morbidly obese ( ≤ 40 kg/m 2 ) and morbidly obese (> 40 kg/m 2 )patients treated with IGB (control) or SG with base line and follow up after six months leptin level determination and weight loss assessment. Results: Leptin showed a highly significant (P<0.001) decrease six months after the insertion of the balloon. The mean decline of leptin hormone level was 8 ug/l (+/- 5.06). In the group of sleeve gastrectomy (SG), leptin showed a significant (P<0.05) decrease six months after the operation. The mean decline of leptin hormone level was 17.6 ug/l (+/ - 17.06). There was a statistically significant differe nce between the two groups as regard the weight loss (P<0.05). Conclusion: The effect of different intervention procedures on the neuroendocrine system can give us an important clue to the future of individualized therapy either in the further selection of patients to undertake the most beneficial cost effective procedure or to add adjuvant hormonal therapy to the treatment.

Surgical treatment of Chiari I malformation complicated with syringomyelia

The aim of this study was to evaluate the curative effects of various surgical procedures on Chiari I malformation (CMI) complicated with syringomyelia. A total of 185 patients with CMI complicated with syringomyelia who received treatment between January 1997 and December 2011 were recruited. All patients underwent posterior fossa decompression in which the lamina of the first cervical vertebra was removed, with the removal of the second or third depending on the severity of the cerebellar tonsil herniation. Of the patients, 76 underwent large-bone-window decompression and duraplasty, while 109 underwent small-bone-window decompression, displaced cerebellar tonsil resection and duraplasty. The curative effects of the different surgical procedures were analyzed retrospectively. Clinical symptoms were eliminated or improved in 156 patients (84.3%) by the time of discharge from hospital. A total of 148 patients were evaluated using magnetic resonance imaging (MRI) which revealed that the cisterna magna was reconstructed in 92 patients and spinal syrinx was reduced in 75. Follow-up was performed on 147 patients (79.5%) for between 3 months and 12 years. During the follow-up, symptoms were eliminated or improved in 110 patients (74.8%), not improved in 26 (17.7%) and deteriorated in 11 (7.5%). MRI was performed on 95 patients during follow-up examinations and the cisterna magna was reconstructed in 87 patients and spinal syrinx was reduced in 79. Small-bone-window decompression plus duraplasty is an effective surgical procedure for treating CMI complicated with syringomyelia and intraoperative cerebellar tonsillectomy significantly aids patient recovery.

Assessment of intra-operative techniques to prevent visual axis opacification in congenital cataract surgery

ObjectiveTo evaluate the effectiveness of various surgical procedures in the management of posterior capsule and anterior vitreous for the prevention of visual axis opacification. Subjects, material and methodsWe retrospectively reviewed 120 eyes operated for unilateral congenital cataracts, with a median age at the time of cataract surgery of 21 months (interquartile range, 6–52 months). The eyes were divided into 3 groups: group 1 (eyes with intact posterior capsule, n=39), group 2 (eyes with posterior continuous curvilinear capsulorhexis, n=38), group 3 (eyes with posterior continuous curvilinear capsulorhexis and anterior vitrectomy, n=43). ResultsTo determine the effect of posterior continuous curvilinear capsulorhexis on visual axis opacification we compared group 2 with group 1 (chi-square Pearson test, P=.281), therefore in this study the implementation of the posterior continuous curvilinear capsulorhexis did not show any decrease in the incidence of visual axis opacification. To study the effect of posterior continuous curvilinear capsulorhexis associated anterior vitrectomy, we compared group 3 with group 1 (chi-square Pearson test, P=.014), demonstrating that the combination of both techniques (posterior continuous curvilinear capsulorhexis and anterior vitrectomy) decreases the incidence of visual axis opacification. ConclusionPosterior continuous curvilinear capsulorhexis as a single technique did not show any decrease in the incidence of visual axis opacification. Posterior continuous curvilinear capsulorhexis together with anterior vitrectomy is required to prevent visual axis opacification and to decrease reoperation rate.

Valoración de técnicas intraoperatorias para la prevención de la opacificación del eje visual en la cirugía de cataratas congénitas

ObjectiveTo evaluate the effectiveness of various surgical procedures in the management of posterior capsule and anterior vitreous on the prevention of visual axis opacification. Subjects, material and methodsWe retrospectively reviewed 120 eyes operated for unilateral congenital cataracts, with a median age at the time of cataract surgery of 21 months (interquartile range, 6-52 months). The eyes were divided into 3 groups: group 1 (eyes with intact posterior capsule, n=39), group 2 (eyes with posterior continuous curvilinear capsulorhexis, n=38), group 3 (eyes with posterior continuous curvilinear capsulorhexis and anterior vitrectomy, n=43). ResultsTo determine the effect of posterior continuous curvilinear capsulorhexis on visual axis opacification we compared group 2 with group 1 (chi-square Pearson test, P=.281), therefore in this study the implementation of the posterior continuous curvilinear capsulorhexis did not show any decreases in the incidence of visual axis opacification. To study the effect of posterior continuous curvilinear capsulorhexis associated anterior vitrectomy, we compared group 3 with group 1 (chi-square Pearson test, P=.014), demonstrating that the combination of both techniques (posterior continuous curvilinear capsulorhexis and anterior vitrectomy) decreases the incidence of visual axis opacification. ConclusionPosterior continuous curvilinear capsulorhexis as a single technique did not show any decrease in the incidence of visual axis opacification. Posterior continuous curvilinear capsulorhexis together with anterior vitrectomy are required to prevent visual axis opacification and to decrease reoperation rate.

Evidence Summary

There is a growing body of literature on surgical treatments for elderly patients with a hip fracture and the effects of various surgical procedures on complications and postoperative outcomes. No single review has previously summarized the literature on the effects of surgical procedures on outcomes after treatment across all types of hip fractures. We conducted a comprehensive systematic literature review to organize the clinical evidence for patient-centered outcomes across all types of geriatric hip fractures. We searched MEDLINE, the Cochrane Database of Systematic Reviews, Scirus, and ClinicalTrials.gov for randomized clinical trials and observational studies published between 1985 and 2008. We also manually searched reference lists from relevant systematic reviews. We found eighty-four [corrected] articles representing seventy-four [corrected] unique, randomized, controlled trials, including thirty-three [corrected] on femoral neck fractures, forty on intertrochanteric fractures, and one on subtrochanteric fractures. Nine observational studies addressed the link between patient characteristics and outcome variables by fracture type. Age, sex, prefracture functioning, and cognitive impairment are related to mortality and functional outcomes. Fracture type does not appear to be independently related to patient outcomes. Mortality, pain, function, and quality of life did not differ by surgical implant class, or by implants within a class. Neither the randomized controlled trials nor the observational literature include the full complement of potential covariates that can impact treatment outcomes after treatment. The broader questions about the relationship of patient factors, fracture type, and specific treatments to the outcomes of mortality, functional status, and quality of life cannot be addressed with the existing literature. Research should include comprehensive conceptual models that capture complete sets of important independent variables. Studies of musculoskeletal outcomes, including hip fracture, require well-defined patient groups and consistent use of validated outcome measures.

Parameters that effect spine biomechanics following cervical disc replacement.

Total disc replacement (TDR) is expected to provide a more physiologic alternative to fusion. However, long-term clinical data proving the efficacy of the implants is lacking. Limited clinical data suggest somewhat of a disagreement between the in vitro biomechanical studies and in vivo assessments. This conceptual paper presents the potential biomechanical challenges affecting the TDR that should be addressed with a hope to improve the clinical outcomes and our understanding of the devices. Appropriate literature and our own research findings comparing the biomechanics of different disc designs are presented to highlight the need for additional investigations. The biomechanical effects of various surgical procedures are analyzed, reiterating the importance of parameters like preserving uncinate processes, disc placement and its orientation within the cervical spine. Moreover, the need for a 360° dynamic system for disc recipients who may experience whiplash injuries is explored. Probabilistic studies as performed already in the lumbar spine may explore high risk combinations of different parameters and explain the differences between "standard" biomechanical investigations and clinical studies. Development of a patient specific optimized finite element model that takes muscle forces into consideration may help resolve the discrepancies between biomechanics of TDR and the clinical studies. Factors affecting long-term performance such as bone remodeling, subsidence, and wear are elaborated. In vivo assessment of segmental spine motion has been, and continues to be, a challenge. In general, clinical studies while reporting the data have placed lesser emphasis on kinematics following intervertebral disc replacements. Evaluation of in vivo kinematics following TDR to analyze the quality and quantity of motion using stereoradiogrammetric technique may be needed.

CLINICOPATHOLOGICAL PROFILE AND SURGICAL MANAGEMENT OUTCOMES IN PATIENTS SUFFERING FROM INTESTINAL TUBERCULOSIS

OBJECTIVES: To determine the mode of presentation in intestinal tuberculosis and effectiveness of various surgical procedures adopted in our set up. DESIGN: A descriptive study.

Clinicopathologic Findings after Nasolacrimal Polyurethane Stent Implantations

To evaluate the results of nasolacrimal polyurethane stent implantations for the treatment of primary acquired nasolacrimal duct obstruction, and to determine the effects of various surgical procedures, including stent removal, in subsequent nasolacrimal duct obstruction. This study included 15 patients who had nasolacrimal polyurethane implantations for the treatment of primary acquired nasolacrimal duct obstruction. Occluded stents were removed either by nasal endoscopy or during dacryocystorhinostomy (DCR). Cultures and biopsies were performed on the removed stents, and the results of the secondary DCR were analyzed for a 6-month follow-up period. During stent removal surgery, various degrees of chronic inflammatory reaction and fibrous tissue formation were detected in the lacrimal sac and nasolacrimal duct. Formations of granuloma and fibrous tissue were found in 15 eyes, and culture-positive reaction were found in nine of the 15 eyes. Conventional dacryocystorhinostomy surgery was performed in nine of the 15 eyes and a silicone tube was located at the canaliculi. Subjective and objective outcome were favorable in 13 of the 15 eyes. The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low. This may result from a chronic inflammatory reaction. Despite the low success rate of nasolacrimal polyurethane stent implantation, the success rate of endonasal DCR as a subsequent surgery is favorable.

Surgery for deep venous incompetence.

Chronic deep venous incompetence (DVI) is caused by incompetent vein valves and/or the blockage of large calibre leg veins, with a range of symptoms including recurrent ulcers, pain and swelling. To establish the effectiveness of various surgical procedures for treating DVI. Trials were identified through the Cochrane Peripheral Vascular Diseases Group's trials register, reference lists of relevant studies, and contact with principal investigators of identified trials and world experts in deep venous surgery. Randomised controlled trials of surgical treatment for patients with DVI. Reviewers extracted data independently. Outcome measures included ambulatory venous pressure (AVP) and venous refill time (VRT). Three trials were included, one trial was excluded. Two trials compared external valvuloplasty using limited anterior plication (LAP) in combination with ligation (L) of incompetent superficial veins (L+LAP) against ligation only (L). The other trial compared external valvuloplasty and ligation (V+L) of incompetent superficial veins against ligation only (L). Trial participants had primary valvular incompetence with mild to moderate symptoms but no venous ulcers.L+LAP produced significant improvement in AVP: the mean difference between L+LAP and L groups was -15 mm Hg (95% confidence interval (CI) -20.9 to -9.0) at one year and -15 mm Hg (95% CI -21 to -8.9) at ten years.AVP values after surgery remained relatively high. Nine of eleven valves repaired remained competent after two years of follow up. No complications occurred. The overall mean score for clinical outcome was +2 (moderate improvement) in the L+LAP group compared with +1 (mild improvement) in the L group. Patients with deteriorating clinical dynamics over the five years preceding surgery had a significantly higher rate of improvement in clinical condition in V+L compared to L (81% versus 51%; p < 0.05) after seven years follow-up. Patients with stable preoperative clinical dynamics demonstrated a similar rate of improvement in both groups (96% versus 90%; p> 0.1). AVPs were not performed. These results indicate that ligation and valvuloplasty may have produced a moderate and sustained improvement for seven to ten years after surgery, in patients with mild to moderate DVI caused by primary valvular incompetence. However, there is insufficient evidence to recommend the treatment to this subgroup of patients, as the trials were small, used different methods of valvuloplasty and different methods of assessment.

Theoretical analysis of the pathophysiology of syringomyelia associated with adhesive arachnoiditis

Objective: To apply a theoretical model to analyse the derangement of cerebrospinal fluid (CSF) dynamics in syringomyelia associated with adhesive arachnoiditis. Methods: An electrical circuit model of CSF dynamics in...

Surgery for deep venous incompetence.

Chronic deep venous incompetence (DVI) is a troublesome condition with a range of symptoms in the legs including recurrent ulcers, pain and swelling. It is caused by incompetent vein valves and/or the blockage of large-calibre leg veins. To establish the effectiveness of various surgical procedures for treating DVI. Trials were identified from the Cochrane Peripheral Vascular Diseases Group's Specialised Trials Register, reference lists of relevant studies, and through contact with principal investigators of identified trials and world experts in deep venous surgery. Randomised controlled trials of surgical treatment for patients with DVI. Trials were selected by AA and checked by SCH. The reviewers extracted the data independently. A variety of outcome measures were reported including ambulatory venous pressure (AVP) and venous refill time (VRT). Only one trial met the inclusion criteria, none was excluded. The trial compared external valvuloplasty using limited anterior plication (LAP) in combination with ligature of incompetent superficial veins (ligation and LAP) against ligation only. The trial participants had primary valvular incompetence with mild to moderate symptoms but no venous ulcers. Ligation and LAP produced significant improvement in AVP: the mean difference between the Ligation and LAP group and the Ligation only group was -15 torr (weighted mean difference [WMD] -20.9, -9.0, confidence interval [CI] 95% fixed) at one year and -15 torr (WMD -21, -8.9, 95% CI fixed) at two years. However, there was no statistically significant improvement in VRT, the mean difference between the groups at one year was 2 seconds (WMD -2.7, 6.7; 95% CI fixed) and at two years was 4 seconds (WMD -0.7, 8.7; 95% CI fixed). AVP values after surgery remained relatively high. Nine out of eleven valves repaired remained competent after two years of follow up. No complications occurred. The overall mean score for clinical outcome was +2 (moderate improvement) in the Ligation and LAP group. This compared with +1 (mild improvement) in the Ligation only group. The results of one small trial showed that ligation and LAP produced a moderate improvement for two years after surgery, in patients with mild to moderate DVI caused by primary valvular incompetence. However, there is not sufficient evidence to recommend the treatment to this subgroup of patients with DVI.

Experimental and clinical studies on lower esophageal sphincter motor function with special reference to the influence of vagal denervation

Dysmotility of lower esophageal sphincter (LES) is common following gastric surgery. This may result in gastroesophageal reflux which frequently seen following gastric surgery. The aim of this study was to determine the effect of various surgical procedures on esophagogastric motility in dog and human. Esophago-gastric motility was investigated by strain gauge transducers during fasted and fed state in conscious dogs. Motility recordings were performed in three groups of dogs; 1) control dogs, 2) with truncal vagotomized dogs (TV), 3) with selective proximal vagotomized dogs (SPV). In human, manometric recordings were performed before and after gastric surgery (SPV or distal partial gastrectomy). In control animals, lower esophagus and LES contracted simultaneously with each contractions of the stomach during interdigestive motor contractions in fasted state. In fed state, LES showed tonic contractions, while gastric body showed receptive relaxation. These motility pattern of LES was considered to prevent gastroesophageal reflux in both fasted and fed states. These coordinated LES contractions disappeared following SPV or TV. In human, the amplitude and velocity of esophageal propagating contractions deceased after SPV or distal partial gastrectomy. In conclusion, gastric surgeries such as SPV, TV and/or distal partial gastrectomy caused LES dysmotility. These phenomena explain frequent gastroesophageal reflux following gastric surgery. Supplementation of anti-reflux procedure for gastric surgery should be required in the prevention of gastroesophageal reflux following gastric surgery.

Cognitive function--victim of disease or hostage to treatment?

In persons suffering from epilepsy, cognitive functioning may be compromised for various reasons, including--first and foremost--the learning and behavioral effects of the conditions causing the epilepsy. In addition, the epilepsy itself may cause changes in the nervous system through the metabolic and excitotoxic effects of the seizures and the neurotransmitter elements involved at the membrane level. The effect of the treatment modality, be it pharmacologic or surgical, may also play havoc with cognitive function. The neurobehavioral effects of antiepileptic drugs, although probably less important with the newer agents than in the past, must be considered, especially in polypharmacy, as recent reports have indicated. With increasing data, the effects of various surgical procedures on the cognitive elements of human behavior are becoming better recognized.