Reoperative bariatric surgery is a complex and growing field in bariatric surgery. The indications for surgical reoperation can vary depending on the procedure and reason for intervention. Laparoscopy appears to be a feasible approach. Though safe, morbidity and mortality are significantly higher than in primary bariatric procedures.

Limited information is available regarding reversal of gastric bypass. While reversal will lead to weight regain and return of comorbid conditions, procedure reversal is sometimes necessary due to complications. The decision to reverse versus revise is difficult; currently, there are no established guidelines. The objective was to review one center's experience with reversals of gastric bypass and jejunoileal bypass procedures and identify potential indications as well as technical feasibility and short-term outcomes. A retrospective review of a prospectively collected database from 1999 to 2010 was conducted; 12 patients who underwent reversal of non-banding bariatric procedures were included. There was no major perioperative morbidity in elective patients; one patient whose reversal was part of a second-look operation had massive intestinal necrosis. There was one (8.3 %) non-procedure-related postoperative death. No leaks were identified in any of the reversals. Leak rates were compared with other revisional procedures such as reversals, revisions, and conversions, with no statistical significance regarding leak rates between all three groups; however, revisions and conversions were performed via open or laparoscopic approach, while reversals were performed exclusively via open approach. Reversals of bariatric (non-banding) procedures, either combined or purely malabsorptive, are technically challenging. Indications remain poorly defined. In our experience, short gut syndrome, renal failure, marginal ulceration, and malnutrition were the most common indications for reversal, differing from previously published data. Indications can depend on patient and surgeon preferences, but primarily on surgeon experience and type of complications. Based on this initial experience, these operations can be performed using the open approach with good outcomes.

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Objective. To provide a virtual environment for pharmacy students to learn United States Pharmacopeia Chapter 797 (USP 797) requirements, while recognizing the role of pharmacists in the safe use of intravenous (IV) medications. Design. A virtual laboratory was created that included stations for IV medications, product verification, medication safety, and patient cases pertaining to high-alert medications. Pharmacy students used 3-D glasses and a wireless controller to navigate through the session and identify violations of USP 797 regulations. Assessment. Preassessments and postassessments were administered to students who completed the session in each of the 2 years it was offered. In the first year, 88% of students strongly agreed or agreed that the sessions met their expectation. Following their APPE clerkship, 92% of these students felt the virtual IV room prepared them for the IV clean room experience. In the second year, 88% of students felt the experience enhanced their understanding of clean room procedures. After session completion, 75% of participants perceived medication errors to be more significant. Written examinations also were administered and students' mean scores improved significantly compared to those of students' prior to implementation of the session (89.6% in year 0; 91.2% in year 1; and 96.1% in year 2). Conclusion. The immersive virtual environment is a contemporary and effective way to teach USP 797 requirements and enhance the awareness of medication errors.

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Polyhydroxyalkanoates are water-insoluble, hydrophobic polymers and can be degraded by microorganisms that produce extracellular PHA depolymerase. The present work was aimed to evaluate the degradability of Polyhydroxyalkanoate film produced by Halomonas hydrothermalis using Jatropha biodiesel byproduct as a substrate. PHB films were subjected to degradation in soil and compared with the synthetic polymer (acrylate) and blend prepared using the synthetic polymer (acrylate) and PHB. After 50 days, 60% of weight loss in PHB film and after 180 days 10% of blended film was degraded while no degradation was found in the synthetic film. Scanning electron microscopy and confocal microscopy revealed that after 50 days the PHB film and the blended film became more porous after degradation while synthetic film was not porous.The degradative process was biologically mediated which was evident by the control in which the PHB films were kept in sterile soil and the films showed inherent integrity over time. The TGA and DSC analysis shows that the melting temperatures were changed after degradation indicating physical changes in the polymer during degradation.

Laparoscopic duodenojejunal bypass seems to be a feasible and safe treatment option for superior mesenteric artery syndrome.

A true chylous effusion is defined as the presence of ascitic fluid with high fat (triglyceride) content, usually higher than 110 mg/dl. We report a case of chyloperitoneum following laparoscopic Roux-en-Y gastric bypass (LRYGB) in a 40-year-old patient who was admitted for surgery on May 31, 2007. On August 2008 an abdominal CT with contrast was ordered for chronic abdominal pain showing diffuse ascites as well as mesenteric adenitis. On September 2008, the patient was admitted to the hospital. An elective diagnostic laparoscopy was scheduled. A large amount of chylous fluid was found. Microscopic analysis came back negative. The patient made an uneventful recovery after surgery. To our knowledge, this is the first reported case of chylous ascites following LRYGB. Chyloperitoneum should be considered as a possible cause of ascites in patients with chronic small bowel obstruction following a LRYGB.