Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Severe malnutrition is an uncommon, sometimes life-threatening complication following bariatric procedures. In this article, the authors reported data from a retrospective series of patients cared for in a single institution over a 12-year interval (n=53). All included patients required revisional surgery in addition to nutritional support to remedy a malnourished state that was perceived to be life-threatening. Roux-Y gastric bypass was the primary bariatric operation performed, at 75% of patients; the authors noted that the most likely etiology of the malnutrition was bypass of more than 70% of the small bowel.
The need for enteral and/or parenteral nutritional supplementation was reduced from 90% to 13% following the revisional procedure. Postoperative morbidity was significant, however, with surgical site infection occurring in 28% of patients. Reoperation for small bowel obstruction or wound complications was necessary in 13% of patients. No early mortality occurred, but two patients died more than 1 year following the revisional procedure (one following multiple reoperations for intestinal obstruction and one from persistent severe malnutrition). The authors concluded that revisional surgery is an effective therapeutic option for patients with severe malnutrition following bariatric procedures and that the risk of morbidity, though significant, is outweighed by the benefit that results from the revisional procedure.
Data cited in this excellent review article showed that more than 50% of women will have an abnormality of the ovary or Fallopian tube diagnosed during their lifetimes. The authors emphasized that the three goals leading to successful management of these lesions are:
First, to determine whether urgent or emergent surgical intervention is required
Second, to confirm whether the discovered lesion is benign or malignant
Third, to make certain that the strategy chosen for diagnosis and management incorporates patient preferences for maintenance of fertility and hormonal preservation
The article provided a clear description of the anatomy and physiology of the ovaries and Fallopian tubes. The authors noted that neoplastic lesions can arise from any germ layer of the ovaries but most lesions that are diagnosed as ovarian cancers begin in the epithelium of the fimbriated end of the Fallopian tube where the ovary and Fallopian tube are in contact. Ultrasound imaging is the most useful diagnostic test for discovering and characterizing the features of lesions arising in these structures; more complex lesions visualized on ultrasonography have a higher risk of malignancy. When increased risk of malignancy is present, cancer antigen (CA)-125 testing is indicated and is abnormal in 80% of patients with malignant lesions. Although most lesions of the ovaries and Fallopian tubes are benign and can be managed with observation, suspicion of malignancy requires immediate surgical consultation.
Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients
Data cited in this article confirmed previously published evidence that surgical treatment of displaced distal radius fractures in elderly patients is not superior to nonsurgical treatment at 12 months following injury. The purpose of the study reported by the authors was to determine outcomes at 24 months following injury using a secondary analysis of data gathered for a randomized prospective trial that included 300 patients treated at 19 centers in Australia and New Zealand.
Surgical treatment consisted of open reduction and fixation using a volar locking plate; patients in the nonsurgical arm of the study were treated with cast immobilization. Wrist function was assessed with a standard questionnaire at 6 months, 1 year, and 2 years following the initial injury. Complete data was available at 24 months for 151 patients treated surgically and 108 patients treated nonsurgically. There were no significant differences in any outcomes except patient-reported treatment success; patient perception of treatment success was reported in 75% of patients treated surgically compared with 45% of patients treated nonsurgically.
The authors concluded that, overall, the evidence supports no superiority of surgical treatment over nonsurgical treatment, but additional investigation is needed to determine the reasons for increased perceptions of treatment success in the surgically treated group.
