These results confirm threshold-decreasing effects of intra-MRN 8-OH-DPAT and extend this to the DRN and to VTA thresholds. Monophasic dose dependent increases in VTA thresholds following systemic 8-OH-DPAT are not equivalent to reports for hypothalamic self-stimulation. Differences between studies may be attributable to stimulation site and/or differences in threshold measurement procedures. Effects of WAY 100635 in this study indicate 5-HT(1A) receptor mediation of these 8-OH-DPAT effects.

There was significant cognitive improvement in older adults after surgical hospitalization. HRQL improved back to age-matched population norms. These results suggest that elderly adults admitted for emergency surgery have good cognitive, functional, and HRQL outcomes.

Background. There is limited literature assessing the outcomes of bariatric surgery in a publically funded, North American, multidisciplinary bariatric program. Our objective was to assess outcomes of roux-en-Y gastric bypass (RYGB) in a publically funded bariatric program through a retrospective review of patient records. Methods. 293 patients spent a median of 13 months attending a multidisciplinary obesity clinic prior to undergoing laparoscopic RYGB surgery. The hospital was a Canadian, publically funded, level 2 trauma center with university teaching services. Results. 79% of the patients were female and the average BMI at first visit to clinic was 55.3 kg/m2. The average decrease in BMI was 19.2 ± 0.9 kg/m2. This was an average absolute weight loss of 56.1 kg or 35.5% of initial weight. The average excess weight loss was 63.4 ± 20.4%. Improvement or resolution of obesity related comorbidities occurred in 65.9% of type 2 diabetics and in 50% of hypertensive patients. Conclusion. Despite this being an unconventional setting of a publically funded program in a large Canadian teaching hospital, early outcomes following RYGB were appropriate in severely obese patients. Ongoing work will identify areas of improvement for enhanced efficiencies within this system.

Bariatric patients are difficult to assess clinically for signs of postoperative complication. Diagnostic laparoscopy (DL) is used to investigate patients suspicious for complications such as anastomotic leak (AL) and intra-abdominal hemorrhage (IH). Most bariatric surgeons use DL in the presence of sustained tachycardia; however, the rate of this procedure and its clinical value have not been sufficiently investigated.A retrospective review of patients undergoing bariatric surgery from January 2010 to December 2011 was performed. Data from 4 collaborative bariatric centres of excellence were included in this analysis. From among all elective bariatric procedures, cases that required early reoperation were selected for further evaluation.A total of 1001 elective bariatric procedures were identified. Of these, 952 (95%) were primary bariatric procedures, including 866 (91%) Roux-en-Y gastric bypasses and 86 (9%) sleeve gastrectomies. The remaining 48 cases represented revisional proced ures. Of these, 11 patients (1.1%) returned to the operating room within 72 hours for DL: 64% were primary cases (n = 7) and 36% revisional cases (n = 4). Intraoperative findings included AL (45%, n = 5), IH (27%, n = 3), no pathology identified (18%, n = 2) and small bowel obstruction (9%, n = 1). Of the 9 patients with complications, all were tachycardic (heart rate > 100 beats/min), and 4 of the 5 patients with AL were febrile (t > 37.5). There were no reported adverse events directly related to the use of DL.Diagnostic laparoscopy is a useful and safe option for both the diagnosis and treatment of suspected complications after bariatric surgery. The majority of patients returning to operating room had significant findings, and all were treated laparoscopically. Persistent postoperative tachycardia or fever were highly predictive of positive findings during DL. An emphasis on early decisionmaking and expeditious return to the operating room for laparoscopy should be the standard for bariatric patients on clinical suspicion of a postoperative complication. 4Changes of active and total ghrelin, GLP-1 and PYY following restrictive bariatric surgery and their impact on satiety: comparison of sleeve gastrectomy and adjustable gastric banding. A