Laparoscopic SASI bypass has been shown to be an effective, safe, and simple procedure for the treatment of morbid obesity and its associated metabolic consequences. Moreover, it results in minimal postoperative nutritional complications in comparison to other bariatric procedures.

We studied the effects of cortisol and triiodothyronine (T3) on 20-day fetal rat lung cell cultures. Cortisol -enhanced the production of surfactant-associated saturated phosphatidylcholine while T3 did not. However, T3 potentiated the cortisoleffect. We observed that T3 enhanced the response of cultures enriched-with alveolar type 11 cells to fibroblast-pneumonocyte factor (FPF). Intracellular cAMP was increased by exposure of these cultures to FPF, and T3 potentiated this increase. Unlike cortisol, T3 had no effect on production of FPF by fetal lung fibroblasts, as determined by bioassay of fractions of fibroblastconditioned medium partially purified by column chromatography. The time. course of cortisol action on mixed (fibroblast/epithelial) cultures was in keeping with the proposed mechanism: glucocorticoid induction of FPF in fibroblasts, followed by FPF induction of cAMP 'in epithelia and, 'finally, by enhanced production of saturated phosphatidylcholine. Thus, glucocorticoid acting on mesenchyme and thyroid hormone acting on epithelium have a synergistic effect on expression of differentiated epithelial function.In late fetal life, maturation of the mammalian lung is heralded by the ability of alveolar epithelial type II cells to synthesize and secrete the pulmonary surfactant, which is necessary for successful postnatal gas exchange (1). Extensive evidence suggests that both glucocorticoids and thyroid hormones regulate surfactant synthesis in late fetal life. Glucocorticoids enhance surfactant-associated phospholipid synthesis by fetal lung in organ culture (2-4) or in mixed monolayer culture (5, 6), but their effect on clonally derived alveolar type II cells is very much attenuated (7). It is now evident that a major glucocorticoid effect on the alveolar epithelium is indirect: glucocorticoid (cortisol) induces production by fetal lung fibroblasts of fibroblastpneumonocyte factor (FPF), which, in turn, increases phospholipid synthesis by alveolar epithelial type II cells in vitro (7) and in vivo (8). We here report that triiodothyronine (T3) acts directly on alveolar type II cells to enhance responsiveness to FPF.MATERIALS AND METHODS Cell Cultures. All cultures were prepared from 20-day fetal rat lungs. Mixed monolayer cultures were prepared as described (5), modified as follows: mixed cell suspensions were prepared by incubating finely minced lung in Ca2"-, Mg2+-free Hanks' balanced salt solution containing 0.05% trypsin (Worthington), DNase (10 pg/ml; Sigma), and 1% chicken serum (GIBCO) (9). They were plated in 24-well plates (10) at high cell density (4 x 106 cells.per cm2) and maintained in 2 ml of minimal essential medium/10% newborn calf serum for 3 days with daily medium changes.Cultures enriched with respect to alveolar type II cells were prepared as described above, except that 2 hr after initial plating, -at which time a majority of the fibroblasts had attached to the flask (11), the supernatant media were aspirated with unattached cells. The cells were pelleted at 50 x g and the ...

Background Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS. Methods A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus. ResultsThe experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient's situation and surgeon's experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively. Conclusion Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.

Background. Long-term studies have reported that the rate of conversion surgeries after open VBG ranged from 49.7 to 56%. This study is aiming to compare between LMGB and LRYGB as conversion surgeries after failed open VBG with respect to indications and operative and postoperative outcomes. Methods. Sixty patients (48 females and 12 males) presenting with failed VBG, with an average BMI of 39.7 kg/m2 ranging between 26.5 kg/m2 and 53 kg/m2, and a mean age of 38.7 ranging between 24 and 51 years were enrolled in this study. Operative and postoperative data was recorded up to one year after the operation. Results. MGB is a simple procedure that is associated with short operative time and low rate of complications. However, MGB may not be applicable in all cases with failed VBG and therefore RYGB may be needed in such cases. Conclusion. LMGB is a safe and feasible revisional bariatric surgery after failed VBG and can achieve early good weight loss results similar to that of LRYGP. However, the decision to convert to lap RYGB or MGB should be taken intraoperatively depending mainly on the actual intraoperative pouch length.

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