6 mmol per liter] and a glycated hemoglobin level of <6.5% in the absence of pharmacologic therapy).
Results
At 2 years, diabetes remission had occurred in no patients in the medical-therapy group versus 75% in the gastric-bypass group and 95% in the biliopancreatic-diversion selleck group (P<0.001 for both comparisons). Age, sex, baseline BMI, duration of diabetes, and weight changes were not significant predictors of diabetes remission at 2 years or of improvement in glycemia at 1 and 3 months. At 2 years, the average baseline glycated hemoglobin level (8.65 +/- 1.45%) had decreased in all groups, but patients in the two surgical
groups had the greatest degree of improvement (average glycated hemoglobin levels, 7.69 +/- 0.57% in the medical-therapy group, 6.35 +/- 1.42% in the gastric-bypass group, and 4.95 +/- 0.49% in the biliopancreatic-diversion group).
Conclusions
In severely obese patients with type 2 diabetes, bariatric surgery resulted in better glucose control than did medical therapy. Preoperative BMI and weight loss did not predict the improvement in hyperglycemia after these procedures. (Funded by Catholic University of Rome; ClinicalTrials.gov number, NCT00888836.)”
“Objective: Although mortality after direct aortic reimplantation for anomalous LCL161 research buy origin of the left coronary artery from the pulmonary artery (ALCAPA) has significantly decreased, many questions
remain unanswered.
Methods: Between 1986 and June 2010, we operated on 27
consecutive pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). All patients underwent reestablishment of a dual coronary system with direct aortic reimplantation of the left coronary artery into the aorta. Postoperative extracorporeal mechanical circulatory support was necessary in 7 cases. In all 7 patients, hemodynamic stability was achieved after 4 to 10 days of support. Mitral valve repair was performed in 9 patients with severe mitral valve incompetence Glutathione peroxidase and resulted in stable mitral valve function during follow-up as long as 19 years.
Results: There were no early or late deaths. During follow-up (3 months-17.5 years), both early and late improvement of myocardial function was observed in all patients. Reduced left ventricular regional function late after successful surgical correction of ALCAPA was related to the presence of left ventricular myocardial scar tissue, as detected by magnetic resonance imaging.
Conclusions: Despite the absence of early and late mortality, the long-term prognosis for patients after reimplantation of ALCAPA into the aorta is not clear. Scars and perfusion deficits of the left ventricle may not be detected by standard echocardiographic evaluation of global left ventricular function and therefore may be underestimated. We therefore recommend lifelong surveillance of these patients, including magnetic resonance imaging.