Gastric band erosion into the lumen of the stomach or the esophagus is a fairly common but often underreported complication of laparoscopic adjustable gastric banding surgery. It occurs in as many as 3-11% of patients who undergo the procedure. We present here the case of a 56-year-old morbidly obese female who developed the sudden onset of hematemesis and dysphagia more than 3 years after laparoscopic gastric band placement. Endoscopy was performed at presentation and revealed erosion into the proximal gastric lumen. The patient was stabilized with medical management of her anemia and abdominal pain. Both the band and subcutaneous reservoir were subsequently removed laparoscopically. A perforation of the gastric wall was identified and treated with a falciform ligament patch and naso-gastric decompression. Five days after surgical band removal, the patient had an episode of hematemesis productive of over 750 cc of blood, accompanied by tachycardia and hypotension. Mesenteric (celiac artery) angiography revealed an actively bleeding pseudoaneurysm of the left gastric artery that was successfully thrombosed with coils. The patient was kept nil per os (NPO) on total parenteral nutrition (TPN) for 1 week postoperatively and remained stable. A follow-up gastrograffin upper gastrointestinal (GI) study showed no leak from the perforation site. To our knowledge, this is the first reported case in which an erosion from an adjustable laparoscopic gastric band was associated with massive upper GI bleeding from a left gastric artery pseudoaneurysm. The case demonstrates the importance of monitoring a patient with hematemesis post lap band surgery, as life-threatening bleeding may persist after removal of the gastric band.
Gene-flow between intensively and extensively farmed grass populations is an ongoing feature of agroecological landscapes, especially in Atlantic northwestern Europe. Adjoining population boundaries and in-field admixture of grass types via winter forage dispersal facilitates both in-field hybridisation and recruitment of immigrant seedlings. Here we examine the paternal hybridisation of one grass species (Lolium multiflorum, pollen donor) into the population of a second, fully interfertile, grass species (L. perenne, pollen receptor) via pollen-mediated gene-flow in an experimental field plot. Using weekly counts of successful pollination in 470 individual receptor plants based on paternity analysis in 4281 germinated F 1 seedlings, we determined the extent of evident hybridisation (hybrid progeny that show some paternal morphology) and silent hybridisation (hybrid progeny that show no paternal morphology) over the course of floral anthesis. Co-dominant morphological traits in F 1 progeny underestimated microsatellite-validated genetic hybridisation by approximately 30%, while background pollen competition dampened the overall rate of successful pollen donor pollination. Overall pollination from the donor plot followed a composite decline model. However over the course of floral anthesis the successful pollination pattern was changeable, and showed varying levels of affinity to three tested decline distribution models.
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