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Background: Few studies have examined weight loss sustainability after sleeve gastrectomy (SG). The purpose of this study was to determine long-term outcome after SG and gastric bypass (GBP) and learn whether preoperative weight loss and binge eating behavior can be used to predict outcome., Materials and Methods: Together, 257 patients (64 % women) were operated, 163 by GBP and 94 by SG. Binge eating was assessed by binge eating scale (BES) and preoperative weight loss was advised to all, including very low-calorie diet for 5 weeks. Postoperative visits took place at 1 and 2 years, and long-term outcome was at median 5 years (range 2.29-6.85). Multivariate linear regression analysis was used to predict outcome at 2-year and long-term control., Results: Median age was 48 years, weight 141.1 kg, and BMI 48.2 kg/m(2). Preoperative weight loss was median 4.9 % before GBP and 3.8 % before SG, P = 0.04. Total weight loss at year one was 24.1 % in GBP and 23.7 % in SG (P = 0.40), at year two 24.4 and 23.4 % (P = 0.26), and at long-term control 23.0 and 20.2 % (P = 0.006), respectively. Weight was analyzed in 93, 88, and 89 % of those alive, respectively. BES did not predict weight outcome, but larger preoperative weight loss predicted less postoperative weight loss at 2 years., Conclusion: On long term, weight loss was better maintained after GBP compared with SG. Binge eating behavior was not a significant predictor, but larger preoperative weight loss predicted less postoperative weight loss for the next 2 years.

Background & Aims: Non-alcoholic steatohepatitis (NASH) is a leading cause of chronic liver disease in Western countries. Diagnosis of NASH requires a liver biopsy. We estimated the prevalence of NASH non-invasively in a population-based study using scores validated against liver histology., Methods: Clinical characteristics, PNPLA3 genotype at rs738409, and serum cytokeratin 18 fragments were measured in 296 consecutive bariatric surgery patients who underwent a liver biopsy to discover and validate a NASH score ('NASH score'). We also defined the cut-off for NASH for a previously validated NAFLD liver fat score to diagnose NASH in the same cohort ('NASH liver fat score'). Both scores were validated in an Italian cohort comprising of 380, mainly non-bariatric surgery patients, who had undergone a liver biopsy for NASH. The cut-offs were utilized in the Finnish population-based D2D-study involving 2849 subjects (age 45-74 years) to estimate the population prevalence of NASH., Results: The final 'NASH Score' model included PNPLA3 genotype, AST and fasting insulin. It predicted NASH with an AUROC 0.774 (0.709, 0.839) in Finns and 0.759 (0.711, 0.807) in Italians (NS). The AUROCs for 'NASH liver fat score' were 0.734 (0.664, 0.805) and 0.737 (0.687, 0.787), respectively. Using 'NASH liver fat score' and 'NASH Score', the prevalences of NASH in the D2D study were 4.2% (95% CI: 3.4, 5.0) and 6.0% (5.0, 6.9%). Sensitivity analysis was performed by taking into account stochastic false-positivity and false-negativity rates in a Bayesian model. This analysis yielded population prevalences of NASH of 3.1% (95% stimulation limits 0.2-6.8%) using 'NASH liver fat score' and 3.6% (0.2-7.7%) using 'NASH Score'., Conclusions: The population prevalence of NASH in 45-74 year old Finnish subjects is ∼ 5%., (Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

We examined whether relative concentrations of circulating triacylglycerols (TAGs) between carriers compared with noncarriers of PNPLA3(I148M) gene variant display deficiency of TAGs, which accumulate in the liver because of defective lipase activity. We also analyzed the effects of obesity-associated nonalcoholic fatty liver disease (NAFLD) independent of genotype, and of NAFLD due to either PNPLA3(I148M) gene variant or obesity on circulating TAGs. A total of 372 subjects were divided into groups based on PNPLA3 genotype or obesity. Absolute and relative deficiency of distinct circulating TAGs was observed in the PNPLA3(148MM/148MI) compared with the PNPLA3(148II) group. Obese and 'nonobese' groups had similar PNPLA3 genotypes, but the obese subjects were insulin-resistant. Liver fat was similarly increased in obese and PNPLA3(148MM/148MI) groups. Relative concentrations of TAGs in the obese subjects versus nonobese displayed multiple changes. These closely resembled those between obese subjects with NAFLD but without PNPLA3(I148M) versus those with the I148M variant and NAFLD. The etiology of NAFLD influences circulating TAG profiles. 'PNPLA3 NAFLD' is associated with a relative deficiency of TAGs, supporting the idea that the I148M variant impedes intrahepatocellular lipolysis rather than stimulates TAG synthesis. 'Obese NAFLD' is associated with multiple changes in TAGs, which can be attributed to obesity/insulin resistance rather than increased liver fat content per se.

Aims/hypothesis: We examined whether analysis of lipids by ultra-performance liquid chromatography (UPLC) coupled to MS allows the development of a laboratory test for non-alcoholic fatty-liver disease (NAFLD), and how a lipid-profile biomarker compares with the prediction of NAFLD and liver-fat content based on routinely available clinical and laboratory data., Methods: We analysed the concentrations of molecular lipids by UPLC-MS in blood samples of 679 well-characterised individuals in whom liver-fat content was measured using proton magnetic resonance spectroscopy ((1)H-MRS) or liver biopsy. The participants were divided into biomarker-discovery (n = 287) and validation (n = 392) groups to build and validate the diagnostic models, respectively., Results: Individuals with NAFLD had increased triacylglycerols with low carbon number and double-bond content while lysophosphatidylcholines and ether phospholipids were diminished in those with NAFLD. A serum-lipid signature comprising three molecular lipids ('lipid triplet') was developed to estimate the percentage of liver fat. It had a sensitivity of 69.1% and specificity of 73.8% when applied for diagnosis of NAFLD in the validation series. The usefulness of the lipid triplet was demonstrated in a weight-loss intervention study., Conclusions/interpretation: The liver-fat-biomarker signature based on molecular lipids may provide a non-invasive tool to diagnose NAFLD, in addition to highlighting lipid molecular pathways involved in the disease.

The study group consisted of 96 patients who had used a medication for type 2 diabetes; of them, 33 had undergone gastric sleeve surgery and 63 bypass surgery. Both surgical methods resulted in a similar weight loss among the patients. In follow-up 39 out of 88 patients were able to manage without antidiabetic drugs two years after surgery. The costs of antidiabetic drugs two years after surgery were 79% lower than before the operation. Weight reduction surgery decreases the need for antidiabetic drugs. The greatest cost-efficiency is achieved by targeting weight-loss operations to patients using insulin therapy.

Background: The long-term efficacy of laparoscopic Roux-en-Y gastric bypass (RYGB) in the treatment of morbid obesity has been demonstrated. Laparoscopic sleeve gastrectomy (SG) as a single procedure has shown promising short-term results, but the long-term efficacy of SG has not yet been demonstrated. The aim of this study was to determine the preliminary 30-day morbidity and mortality of RYGB and SG in a prospective multicenter randomized setting., Methods: A total of 240 morbidly obese (BMI = 35-66 kg/m²) patients evaluated by a multidisciplinary team were randomized to undergo either RYGB or SG. There were 117 patients in the RYGB group and 121 in the SG group; two patients had to be excluded after randomization. Both study groups were comparable regarding age, gender, BMI, and comorbidities., Results: There was no 30-day mortality. The median operating time was significantly shorter in the SG group (66 min vs. 94 min, p < 0.001). All complications were recorded thoroughly. There were 7 (5.8 %) major complications following SG and 11 (9.4 %) after RYGB (p = 0.292). Nine (7.4 %) SG patients and 20 (17.1 %) RYGB patients had minor complications (p = 0.023). The overall morbidity was 13.2 % after SG and 26.5 % after RYGB (p = 0.010). There were three (2.5 %) early reoperations after SG and four (3.3 %) after RYGB (p = 0.719)., Conclusions: At 30-day analysis SG is associated with a shorter operating time and fewer early minor complications compared to RYGB. There were no significant differences in major complications or early reoperations. Long-term follow-up is required to determine the effect on weight loss, resolution of obesity-related comorbidities, and improvement of quality of life.

Background: Preoperative ultrasonography (US) prior to laparoscopic Roux-en-Y gastric bypass (LRYGBP) aimed to find possible gallstones. The aim of this study was to evaluate the reliability of the US in evaluating the size and consistency of the left lobe of the liver., Methods: One hundred LRYGBP and LSG were performed in our new bariatric surgery unit by two surgeons. All patients underwent preoperative US to evaluate the size and consistency of the left lobe of the liver. A consultant radiologist reviewed the US findings, which were then compared to the intraoperative findings., Results: The mean preoperative body mass index was 49. All patients had co-morbidities. The intraoperative evaluation showed an enlarged left lobe of the liver in 23 patients, whereas the US found enlargement only in eight patients, but revealed eight false positives. In the intraoperative evaluation, fatty liver was observed in five patients, only four of whom were shown in the US, but US revealed 77 false positives. In evaluating the size of the left lobe, US had 35% sensitivity, 90% specificity, 65% false negative rate (FNR) and 10% false positive rate (FPR). In evaluating the consistency, US had 80% sensitivity, 18% specificity, 20% FNR and 82% FPR., Conclusion: Preoperative US is unreliable in evaluating the size and consistency of the left lobe of the liver prior to LRYGBP and LSG and has limited prognostic value for surgical complications and complexity of surgery.

Background: Bariatric surgery has shown to be safe for patients over 60 years with good results especially considering resolving of comorbidities. Sleeve gastrectomy is considered to be safer than gastric bypass (GBP) and more effective than gastric banding with less adverse symptoms. Weight loss may be more modest than after GBP, but the effect on vitamins may also be milder., Methods: Since 2007, we collected prospectively 12-month follow-up data from 55 sleeve gastrectomy patients of whom 12 were over 59 years of age. Vitamin and calcium supplements were used postoperatively. The recovery from the operation was recorded during hospital stay, at 1- and 12-month follow-up visits using a standard protocol including laboratory tests. The results between patients over and under 59 years were compared., Results: The preoperative weight and weight loss were comparable between the groups. Operation time was shorter and hospital stay was longer for older patients, p = ns. There was no operative mortality. Early major complications were seen more often in the older age group, 42% vs 9% (p = 0.02), but late complications were more common in younger patients, 17% vs 44%, p = ns. Early complications were mostly bleedings, which did not lengthen the hospital stay, neither were re-operations nor endoscopic procedures needed. Excess weight loss and resolving of comorbidities after 12 months was comparable between the groups. However, vitamin deficiencies and hypoalbuminemia were more common in the older age group, 42% and 23% for vitamins and 44% and 29% for proteins, p = ns. The older patients had more adverse effects related to surgery, 25% vs 9%, and younger had more adverse psychiatric effects, p = ns., Conclusions: Sleeve gastrectomy is effective and safe for older bariatric patients. Weight loss is comparable to younger patients and enough to resolve the comorbidities in most of the patients. With standardized nutritional supplementation, the older patients had more often vitamin deficiencies and hypoalbuminemia. Although operative treatment of older bariatric patients is safe, their postoperative care is demanding considering vitamins and protein.

The objective of the current study was to determine the incidence of common types of parasites encountered in the Central Region of Saudi Arabia. The current study is a retrospective study which includes the results of 10427 stool sample and occult blood sample. The results obtained during last two years (2005-2007), were compared to the earlier reports on parasites in the Central as well as other regions of Saudi Arabia. Attempts were made to find out the cases of increasing and/or decreasing trend of parasite incidence and to locate any differences between the current study results and the earlier reports.

All cases of gastrointestinal (GI) non-Hodgkin's lymphoma diagnosed in Finland between 1972 and 1977 were histologically reexamined and immunostained in order to study the value of histological classification. One hundred and eleven cases were found. The crude annual incidence was 0.51/10(5) and the age-adjusted (world standard population) incidence 0.23/10(5). The male-to-female ratio of age-adjusted incidence rates was 2.7. The most common histological type was large B-cell lymphoma comprising 61% of all classifiable cases. Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma comprised 12%, centrocytic lymphoma 9%, peripheral T-cell lymphoma 9%, Burkitt's lymphoma 7% and large-cell anaplastic lymphoma 3% of the total. In the jejunum, almost one half of the cases were T-cell lymphomas and there were no lymphomas with definite MALT features. Gastric lymphomas had higher survival rates than intestinal lymphomas, B-cell lymphomas slightly higher survival rates than T-cell lymphomas, and low-grade MALT lymphomas higher survival rates than other B-cell lymphomas. The other types of lymphomas differed only slightly from each other in prognosis. The histological grade according to the Working Formulation correlated with survival rates, but a great majority of cases were classified as intermediate grade. Classification of GI lymphomas into the types mentioned above appears to correlate with several clinical and pathological parameters.

During the period of 1978-1988, 36 patients were treated for primary gastrointestinal non-Hodgkin's lymphoma (PGIL) at the Second Department of Surgery, Helsinki University Central Hospital. There were 16 gastric, 15 small intestinal, four large bowel lymphomas, and one case of diffuse multiple lymphomatous polyposis (MLP) of the gastrointestinal tract. Most frequently the disease occurred in middle-aged patients equally in both sexes. Symptoms were non-specific. Abdominal pain was the most common symptom occurring in 30 patients (83%), followed by nausea in 17 patients (47%). Fever occurred in seven patients (20%). Bleeding occurred in ten patients (28%), obstruction in five (14%), and perforation in three patients (8%). An abdominal mass was felt in ten patients (28%). Radiological findings were mostly non-specific but suggested malignant tumour. A definitive diagnosis was difficult to confirm by endoscopic examination. Thirty-five patients underwent surgery, curative in 19 (12 gastric, five small intestine lymphomas (SIL), two large intestine lymphomas (LIL)), and palliative in 12 patients (two gastric, eight SIL, one LIL, and one case of MLP). One patient (gastric) underwent exploration and three had other procedures (two SIL, one LIL). 89% of the patients who had a curative resection survived five years, compared with 28% of those who had palliative resection. The stage of the disease was a very important prognostic factor: the five-year survival was 92% for patients with Stage I disease, while none of the patients with Stage IV disease survived five years. Also, adjuvant therapy was a statistically significant variable affecting survival, and the site of the tumour. Patients with gastric lymphoma had better survival than those with small and large intestinal lymphoma.

During the period of 1972-1977, 29 patients were treated for primary non-Hodgkin's small intestinal lymphoma (PSIL) in different hospitals in Finland. Most frequently the disease occurred in patients in middle age and there was a male predominance. Clinical symptoms were non-specific. An abdominal mass was felt in 31% of the patients. Radiological findings were mostly non-specific, and often a stricture was revealed. All patients underwent surgery, ten patients curative resection, 15 patients palliative resection and 4 patients exploration and biopsy only. Sixty per cent of the patients who underwent curative resection survived five years compared with ten per cent who underwent palliative resection. The stage of the disease was an important prognostic factor. The five-year survival was 60% for patients with stage I disease, while all the patients with stage IV disease died during the first two years.

During the period of 1972-1977 nine patients were treated for primary non-Hodgkin's ileocaecal and colorectal lymphoma in different hospitals in Finland. Most frequently the disease occurred in patients in the sixth or seventh decade. The clinical symptoms indicated non-specific intestinal disorder. An abdominal mass was felt in 44% of the patients. Radiological findings were mostly non-specific and often revealed a tumour. All patients underwent surgery, six curative resection, and three palliative resection. Two of the patients who underwent curative resection survived 10-13 years, while all the patients who underwent palliative resection died within two years. The stage of the disease was an important prognostic factor. Three of the five patients with stage I disease died of lymphoma, while all three patients with stage IV disease died of lymphoma.

Myxomas of the skeletal muscle are uncommon mesenchymal tumours. About one hundred such tumours have been reported in the world literature so far. In the present paper, we report a case of myxoma which occurred in the thigh muscles, with brief review of pertinent literature.

A 41-year-old female with intermittent abdominal pain and diarrhea for a period of three years was found to have eosinophilic enteritis. The patient has had neither a history of atopy nor peripheral eosinophilia, commonly reported in association with eosinophilic enteritis. The patient made a rapid clinical response to steroid therapy. The literature on eosinophilic gastroenteritis is reviewed.