Browsing Scholarly Projects 2021 by Subjects
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Resolution of Diabetes Mellitus with Laparoscopic Sleeve GastrectomyBackground: Laparoscopic sleeve gastrectomy (LSG) is a proven intervention to induce weight loss. Its applications as a surgical procedure may extend beyond body weight control to the realm of metabolic therapy in chronic conditions such as diabetes mellitus (DM), which results from the dysregulation of blood glucose levels. Objective: The aim of this study is to evaluate the improvement and resolution of diabetes following sleeve gastrectomy at our facilities. Setting: Two affiliated non-profit surgery centers, United States Methods: Eighty-two adult diabetic patients were treated with sleeve gastrectomy. We conducted a single point analysis of our existing longitudinal data for that calendar year through a retrospective chart review. Statistical outcomes were determined for anthropometric data unique to patients with DM including prescribed medications, Hemoglobin A1C, excessive weight loss (EWL), and body mass index (BMI). Results: Time was a significant predictor of diabetic resolution after six months post-op in patients who originally presented with Type 1 DM and change in hemoglobin A1C values held a significant association to improvement of Type 1 diabetes. BMI and EWL displayed a positive correlation to resolution at all time points of interest. Conclusions: There are differences between the post-operative improvements in diabetic status following sleeve gastrectomy depending on the initial diagnosis of insulin-dependent or insulinindependent DM. Pathophysiological mechanism of a patient’s diabetic condition, specifically auto-immune destruction of pancreatic beta cells, may contribute to the variable metabolic response following sleeve gastrectomy.
Shift in electrocorticography electrode locations after surgical implantation in childrenInterpreting electrocorticography (ECoG) in the context of neuroimaging requires that multimodal information be integrated accurately. However, the implantation of ECoG electrodes can shift the brain impacting the spatial interpretation of electrode locations in the context of pre-implant imaging. We characterized the amount of shift in ECoG electrode locations immediately after implant in a pediatric population. Electrode-shift was quantified as the difference in the electrode locations immediately after surgery (via post-operation CT) compared to the brain surface before the operation (preimplant T1 MRI). A total of 1140 ECoG contracts were assessed across 18 patients ranging from 3 to 19 (12.1 ± 4.8) years of age who underwent intracranial monitoring in preparation for epilepsy resection surgery. Patients had an average of 63 channels assessed with an average of 5.64 ± 3.27 mm shift from the pre-implant brain surface within 24 h of implant. This shift significantly increased with estimated intracranial volume, but not age. Shift also varied significantly depending of the lobe the contact was over; where contacts on the temporal and frontal lobe had less shift than the parietal. Furthermore, contacts on strips had significantly less shift than those on grids. The shift in the brain surface due to ECoG implantation could lead to a misinterpretation of contact location particularly in patients with larger intracranial volume and for grid contacts over the parietal lobes.