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Intestinal malrotation usually presents in the pediatric population with midgut volvulus requiring emergency Ladd’s procedure. Rarely, it remains asymptomatic and is discovered incidentally only during adulthood when it seldom causes intestinal complications. The scenario of a cirrhotic adult being diagnosed with asymptomatic intestinal malrotation with subsequent intestinal complications is thus extremely rare and to our knowledge has not been previously reported. We describe a 56-year-old man with decompensated alcoholic cirrhosis (Child-Pugh class C, MELD score 22) who was initially observed after an incidental diagnosis of intestinal malrotation on computed tomography. Observation continued as his liver disease improved with alcohol cessation (Child-Pugh class A, MELD score 8). He later presented with a closed loop bowel obstruction secondary to midgut volvulus at the time of alcohol relapse and liver redecompensation (Child-Pugh class C, MELD score 22-29). He underwent emergency Ladd’s procedure during which his midjejunum was volvulized into an internal hernia space created by a thick Ladd’s band containing large varices. The postoperative course was complicated by ileus and loculated bacterial peritonitis. Based on our experience, we discuss special considerations with regard to the surgical technique and timing of Ladd’s procedure when encountering intestinal malrotation in a cirrhotic adult with portal hypertension.

Background Parathyroid gland (PG) identification during thyroid and parathyroid surgery is challenging. Accidental parathyroidectomy increases the rate of postoperative hypocalcaemia. Recently, autofluorescence with near infrared light (NIRL) has been described for PG visualization. The aim of this study is to analyze the increased rate of visualization of PGs with the use of NIRL compared to white light (WL). Materials and methods All patients undergoing thyroid and parathyroid surgery were included in this study. PGs were identified with both NIRL and WL by experienced head and neck surgeons. The number of PGs identified with NIRL and WL were compared. The identification of PGs was correlated to age, sex, and histopathological diagnosis. Results Seventy-four patients were included in the study. The mean age was 48.4 (SD ±13.5) years old. Mean PG fluorescence intensity (47.60) was significantly higher compared to the thyroid gland (22.32) and background (9.27) ( p  < 0.0001). The mean number of PGs identified with NIRL and WL were 3.7 and 2.5 PG, respectively ( p  < 0.001). The difference in the number of PGs identified with NIRL and WL and fluorescence intensity was not related to age, sex, or histopathological diagnosis, with the exception of the diagnosis of thyroiditis, in which there was a significant increase in the number of PGs visualized with NIRL ( p  = 0.026). Conclusion The use of NIRL for PG visualization significantly increased the number of PGs identified during thyroid and parathyroid surgery, and the differences in fluorescent intensity among PGs, thyroid glands, and background were not affected by age, sex, and histopathological diagnosis.

Background Laparoscopic adjustable gastric banding (LAGB) was a popular procedure in the USA and Europe in the past decade. However, its use has currently declined. Band erosion (BE) is a rare complication after LAGB with a reported incidence rate of 1.46 %. Controversies exist regarding the management, approach and timing for the band removal. The aim of this study is to describe the rate, clinical presentation and perioperative outcomes of BEs at our institution and provide overall recommendations regarding the diagnosis and management of BE. Materials and methods This study is a single-center, retrospective review of a prospectively maintained database. Data were collected from all consecutive patients who underwent a LAGB and band revisional surgeries at the University of Illinois Hospital and Health Sciences System from December 2008 to September 2015. We identified patients who underwent gastric band removal due to a BE and analyzed their outcomes. Results A total of 576 LAGBs were performed at our institution. Nine patients underwent surgery for BE at our hospital. The average time between the primary surgery and the removal of the band was 68.5 (42.9) months. Abdominal pain, nausea and/or vomiting were the most frequently mentioned symptoms. In all patients, a minimally invasive approach was used to remove the band. The mean length of hospitalization was 2.6 (1.1) days. The only complication was a pneumonia ( n  = 1). Conclusions BE is one of the most severe complications of LAGB. The minimally invasive approach provided us with the opportunity to repair the fistula, and it was associated with a prompt recovery with very little morbidity. In general, it is recommended that the band be removed at the time of the diagnosis of the BE. Endoscopic band removal can be utilized with patients who have a more advanced BE and migration into the gastric lumen.

The purpose of this study was to conduct a literature review to examine micronutrient deficiencies in laparoscopic sleeve gastrectomy. We conducted a literature review using PubMed and Cochrane databases to examine micronutrient deficiencies in SG patients in order to identify trends and find consistency in recommendations. Seventeen articles were identified that met the defined criteria. Iron, vitamin B12 and vitamin D were the primary micronutrients evaluated. Results demonstrate the need for consistent iron and B12 supplementation, in addition to a multivitamin, while vitamin D supplementation may not be necessary. Additional prospective studies to establish a clearer picture of micronutrient deficiencies post-SG are needed.

Introduction: Revisional bariatric surgery is sometimes required due to inadequate weight loss, reoccurrence of comorbidities, or long-term complications following a previous bariatric procedure. However, the use of revisional surgery, based on the status of medical comorbidities, warrants further investigation. As such, the aim of this study was to examine medication usage for hypertension (HTN), type 2 diabetes mellitus (T2DM), and dyslipidemia (DLP) pre and postrobot-assisted Roux-en-Y gastric bypass (RRYGB) surgery as a revisional bariatric procedure. Materials and Methods: This is a retrospective review of a prospectively maintained database that included patients who underwent a RRYGB as a revisional procedure due to inadequate weight loss between January 2008 and January 2016 at the University of Illinois Hospital and Health Sciences System. In this study, medication use was a proxy measure of whether the medical comorbidity was improved/resolved. Results: A total of 39 patients (100% female) underwent revisional RRYGB surgery following either a laparoscopic adjustable gastric band (LAGB) (n = 29, 74.4%) or sleeve gastrectomy (SG) (n = 10, 25.6%). The mean time between the revisional RRYGB and the previous bariatric procedure was 5.4 years (standard deviation [SD] = 2.3) for LAGB and 2.4 years (SD = 1.3) for SG (p < 0.001). Before the revisional procedure, 41% of the sample were taking medication for HTN, 30.8% were taking medication for T2DM, and 23.1% were taking medication for DLP. Results revealed that there was a significant reduction in the use of medication pre- and post-revisional Roux-en-Y gastric bypass for HTN (p < 0.01), T2DM (p < 0.01), and DLP (p < 0.05). Conclusion: RRYGB as a revisional bariatric procedure after LAGB or SG was associated with significant reduction or elimination in the use of medications for HTN, T2DM, and DLP. Larger studies with a longer follow-up period are warranted to examine long-term improvement in various medical comorbidities.

Introduction: There are few publications regarding the surgical treatment of obesity among super-super obese (SSO) patients undergoing sleeve gastrectomy (SG).The aim of this study is to examine weight outcomes (6, 12, and 24 months), presurgical comorbidities, and perioperative outcomes in SSO men and women patients undergoing SG. Material and Methods: This is a retrospective study with 109 SSO patients who underwent SG at the University of Illinois Hospital and Health Sciences System between January 2008 and June 2015. Results: Out of 674 patients who underwent SG, 109 (16.2%) were SSO. There were no significant differences in perioperative outcomes (operative time, length of hospitalization, and complication rates). Women had a greater percent excess weight loss (%EWL) (p = 0.039) and percent total weight loss (%TWL) (p = 0.026) than men at 6 months. Whereas at 12 and 24 months follow-up, there were no significant differences in %EWL and %TWL between SSO men and women. Conclusions: There were no significant differences in perioperative outcomes between SSO women and men. Percent EWL and %TWL during the 6-month follow-up was significantly greater in women versus men, but by 12 and 24 months, there were no significant differences in %EWL and %TWL between the two groups.

Mercury (Hg) is a great concern for marine environments. Bird feathers have been widely used to assess Hg pollution. In this study, we determine mercury concentrations in body feathers of juvenile Magellanic penguins ( Spheniscus magellanicus ) from the southeastern sector of Buenos Aires province, Argentina, during a non-breeding season, considering both sexes. Hg levels, considering both females and males together, ranged between 265.5 and 1515.52 ng/g. These levels are well below the concentrations in feathers suggested for taking actions focused on the protection of seabirds. Non-significant differences between sexes regarding Hg levels were found, probably because juveniles were sexually immature and females did not excrete Hg by egg laying yet. Hg concentrations found in this study were an order of magnitude higher than those reported 10 years ago for the species in breeding areas on the Argentine coast. Thus, the present study provides relevant information indicating a possible increase of Hg pollution in the southwestern region of the Atlantic Ocean and thus trigger for the development of monitoring programs and regional strategies to improve the conservation status of this species.

PDS 110 is a young disk-hosting star in the Orion OB1A association. Two dimming events of similar depth and duration were seen in 2008 (WASP) and 2011 (KELT), consistent with an object in a closed periodic orbit. In this paper we present data from a ground-based observing campaign designed to measure the star both photometrically and spectroscopically during the time of predicted eclipse in September 2017. Despite high-quality photometry, the predicted eclipse did not occur, although coherent structure is present suggesting variable amounts of stellar flux or dust obscuration. We also searched for RV oscillations caused by any hypothetical companion and can rule out close binaries to 0.1 \\(M_\\odot\\). A search of Sonneberg plate archive data also enabled us to extend the photometric baseline of this star back more than 50 years, and similarly does not re-detect any deep eclipses. Taken together, they suggest that the eclipses seen in WASP and KELT photometry were due to aperiodic events. It would seem that PDS 110 undergoes stochastic dimmings that are shallower and shorter-duration than those of UX Ori variables, but may have a similar mechanism.