BackgroundAlterations in gastrointestinal, pancreatic, and adipose hormone levels may have a greater role in weight loss than initially appreciated. The laparoscopic sleeve gastrectomy (LSG) operation is now the most frequently performed bariatric operation in many countries, but there are relatively few data regarding its molecular effects. We sought to characterize the effect of LSG on fasting plasma levels of selected hormones and on non-esterified fatty acids (NEFA), and to compare these to levels in non-obese control individuals.Materials and MethodsThe levels of nine plasma hormones were measured using a multiplex bead-based assay at baseline and at 3 months after operation in 11 obese patients undergoing LSG. NEFA levels were also measured. The levels were compared to those for 22 age- and sex-matched non-obese individuals.ResultsAt baseline, obese patients showed significantly higher expression of C-peptide, insulin, and leptin and significantly lower ghrelin, glucose-dependent insulinotropic peptide (GIP), and resistin compared to non-obese controls (p < 0.05). LSG resulted in a reduction in BMI from 42.5 ± 6.47 kg/m2 at operation to 35.2 ± 5.14 kg/m2 at 3 months (42 % mean excess weight loss, p < 0.001). LSG led to a significant decrease in ghrelin, glucagon-like peptide-1 (GLP-1), glucagon, leptin, plasminogen activator inhibitor-1 (PAI-1), and NEFA.ConclusionLSG induces marked early changes in the fasting levels of factors thought to be important regulators of obesity and metabolic health. These changes differ somewhat from the findings for operations with a malabsorptive component, suggesting that subtle differences exist in the mechanisms of weight loss between LSG and other bariatric operations.

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BackgroundThe primary objective was evaluation of axillary ultrasound (AxUS) in preoperative staging of patients with invasive carcinoma undergoing breast‐conserving surgery.MethodsThis is a retrospective, observational cohort study of patients with clinically node‐negative (cN0) biopsy‐proven invasive breast carcinoma undergoing breast‐conserving surgery between January 2011 and December 2014 who underwent AxUS with fine needle aspiration (FNA) biopsy of sonographically abnormal lymph nodes. Patient records were reviewed.ResultsA total of 713 cases were analysed. Four hundred and thirty‐three patients underwent formal preoperative AxUS; 100 underwent biopsy for abnormal findings. Of these, 32 had positive FNA biopsy result and underwent level II axillary dissection (axillary lymph node dissection (ALND)). Thirty were T1–2 tumours with AxUS scan/FNA demonstrating sensitivity of 25.2%, specificity of 100%, positive predictive value of 100% and negative predictive value of 76.6%. Forty‐six patients had a positive sentinel lymph node (SLN) biopsy and axillary dissection. 34.8% of T1 tumours, 47.8% of T2 tumours and 100% of T3 tumours had further positive nodes. The average number of nodes involved per axilla was 1.8 for the T1 group, 4.1 for the T2 group and 4.6 in the T3 group. Macrometastases were a more common finding than micrometastases for all T stages undergoing ALND. A suspicious preoperative AxUS result was significantly associated with positive SLN. Other risk factors for positive SLN biopsy were oestrogen receptor positivity and lymphovascular invasion.ConclusionAxUS identifies patients with high nodal burdens justifying immediate ALND. AxUS did not adversely affect women with histologically negative sentinel nodes. Three percent may have been overtreated.