IntroductionThe causal relationship between obesity and high blood pressure is established; however, the detailed pathways for such association are still under research. This work aims to assess the changes in neprilysin, vasoconstrictor and vasodilatory molecules in obese hypertensive patients undergoing laparoscopic sleeve gastrectomy (LSG).PatientsThe present prospective study was done on 59 hypertensive obese patients in whom LGS was performed. Blood pressure, as well as blood samples for neprilysin, angiotensinogen, angiotensin II, renin, endothelin‐1 "ET‐1", aldosterone, atrial natriuretic peptide "ANP" and B‐type natriuretic peptide "BNP", were assessed before and 15 months after surgery. Patients were divided into two groups according to the remission of hypertension (HTN).ResultsAfter 15 months, remission of hypertension was seen in 42 patients (71%). The declines in the following measurements were significantly higher in patients with remission than those with persistent HTN: aldosterone (p = .029567), angiotensin II (p < .000001), angiotensinogen (p = .000021), neprilysin (p = .000601), renin (p = .000454) and endothelin‐1(p = .000030). There was a significantly higher increment in ANP (p = .000002) and a non‐significant increment in BNP (p = .081740). Angiotensin II 15 months after LSG and Δ ANP % were significant independent predictors of persistent HTN.ConclusionIn the setting of LSG, aldosterone, angiotensinogen, angiotensin II, renin and neprilysin were significantly lower in patients with remission of HTN after 15 months than those with persistent HTN, and natriuretic peptides were significantly higher. A lower postoperative level of angiotensin II and a larger percentage increment of ANP are independently associated with hypertension remission after LSG.
Background and Aims:The palatal defect and abnormal dentition in cleft palate make mask ventilation and laryngoscopy difficult. This study aimed to assess the effect of feeding obturator on laryngeal view in unilateral complete cleft palate.Methods:Ninety non-syndromic infants scheduled for the first stage correction of complete unilateral cleft palate were randomised to Group A (no feeding obturator) or Group B (obturator used for induction and intubation). The primary objective was to assess effect of the feeding obturator on the Cormack–Lehane grade on laryngoscopy. Effects on face mask ventilation, easiness of laryngoscopy and intubation and the side effects were also measured.Results:Ninety patients completed the study. There was no statistically significant difference between the two groups regarding the CL grade (P < 0.1). However duration for intubation was significantly longer in Group A than Group B (31.4 ± 12.8 vs. 23.4 ± 40.7 sec, P < 0.001). The degree of difficulty of face mask ventilation was significantly greater in Group A than Group B (P < 0.008). Attempts for successful intubation and manoeuvres for successful intubation were significantly more in Group A than B (P < 0.05). Trauma occurred in ten patients in Group A relative to no patients in Group B.Conclusion:Use of a pre-sized obturator in infants with complete unilateral cleft palate does not improve the laryngoscopic view. However, it results in better face mask ventilation and easier and faster laryngoscopy and intubation.
Introduction: Reconstruction of defects in the maxillofacial region can be challenging. Anatomy, location and size of the defect are major determinants of type of flap that could be used whether local, regional or distant. Nasolabial flap is one of the local flaps that can be used for reconstructing small to moderate size soft tissue defects, especially when microsurgical free flaps are less feasible due to lack of infrastructure, expertise or financial constraints. Aims and Objectives:To study the effectiveness of the nasolabial flaps in reconstruction of orofacial defects of various origins. Materials and Methods: A prospective study was conducted on 37 patients (49 nasolabial flaps) 25 unilateral flaps & 12 bilateral flaps. Of these, 30 patients had reconstruction following oncological resection. All flaps were inferiorly based, and 36 flaps required a second stage for separation after 3 weeks. Patients were evaluated for postoperative complications, flap uptake, donor site morbidity, postoperative extraoral scarring and patient's satisfaction.Results: Good results in form of function and cosmesis were obtained in most of patients. Postoperative complications were relatively minor as tip of flap necrosis, and oro-cutaneous fistula. The average time taken for flap harvesting was 43 minutes for bilateral nasolabial flaps and 27 minutes for unilateral ones. Conclusion:The nasolabial flap is a simple and reliable flap that can be used in reconstruction of small to moderate sized defects in orofacial region with good cosmetics and functional outcomes.
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