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Gastric Bypass

Gastric bypass procedures are any of a group of similar operations used to treat morbid obesity—the severe accumulation of excess weight as fatty tissue—and the health problems it causes. Bariatric surgery is the term encompassing all of the surgical treatments for morbid obesity, not just gastric bypasses, which make up only one class of such operations. A gastric bypass first divides the stomach into a small upper pouch and a much larger, lower remnant pouch and then re-arranges the small intestine to allow both pouches to stay connected to it. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different bypass names. Any bypass leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and psychological response to food. The resulting weight loss, typically dramatic, markedly reduces comorbidities. The long-term mortality rate of gastric bypass patients has reduction of up to 40 percent. The gastric bypass, in its various forms, accounts for a large majority of the bariatric surgical procedures performed. An increasing number of these operations are by limited access techniques, termed laparoscopy. Laparoscopic surgery uses several small incisions, or ports, one of which conveys a surgical telescope connected to a video camera, and others permit access of specialized operating instruments. The surgeon actually views his operation on a video screen. The method is limited access surgery, reflecting both the limitation on handling and feeling tissues, and also the limited resolution and two-dimensionality of the video image. With experience, a skilled laparoscopic surgeon can perform most procedures as expeditiously as with an open incision—with the option of using an incision should the need arise. The gastric bypass reduces the size of the stomach by well over 90 percent. A normal stomach can stretch, sometimes to over 1000 ml, while the pouch of the gastric bypass may be 15 ml in size. The gastric bypass pouch is formed from the part of the stomach, which is least susceptible to stretching. That, and its small original size, prevents any significant long-term change in pouch volume. What does change, over time, is the size of the connection between stomach and bowel, and the ability of the small bowel to hold a greater volume of food. Over time, the functional capacity of the pouch increases, and by that time, weight loss has occurred, and the increased capacity serves to allow maintenance of a lower body weight. When the patient ingests just a small amount of food, the first response is a stretching of the wall of the stomach pouch, stimulating nerves, which tell the brain that the stomach is full. The patient feels a sensation of fullness, as if they had just eaten a large meal—but with just a thumbful of food.

How does an erection occur?

Two chambers called the corpora cavernosa run the length of the penis (see Figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.

An erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in through the arteries and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining the erection. The erection ends when muscles in the penis contract to stop the inflow of blood and open the veins for blood outflow.

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Arteries (top) and veins (bottom) penetrate the corpora cavernosa and the corpus spongiosum. An erection occurs when relaxed muscles allow the corpora cavernosa to fill with excess blood fed by the arteries, while drainage of blood through the veins is blocked by the tunica albuginea.

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Audition

Auditions are held by producers and casting directors. They choose whom to cast after an audition has been held. Always bring a headshot and resume to an audition. Auditioning is a very important part of any actor's career; be sure you're well informed. Go to audition audition and find out what you need to know to ace any audition. An audition is the process of trying out for a role in a performance, as in a demonstration of acting, dancing or singing ability.

Casting means selecting the actors, dancers, singers or other talent for a live or recorded performance. It typically involves auditions before a panel that may include the production's producer, director, and choreographer. In the early stages of casting auditions, the performers may present prepared audition pieces such as monologues or songs. Major productions that need to fill many roles may use a casting director and a specialized staff. Casting calls of celebrity performers may follow strictly personal channels; e.g. direct contact with the director.

Sexuality in Later Life

Many people want and need to be close to others as they grow older. This includes the desire to continue an active, satisfying sex life as they grow older. But, with aging, there may be changes that can cause problems.

What Are Normal Changes?

Normal aging brings physical changes in both men and women. These changes sometimes affect the ability to have and enjoy sex. A woman may notice changes in her vagina. As a woman ages, her vagina can shorten and narrow. Her vaginal walls can become thinner and also a little stiffer. Most women will have less vaginal lubrication. These changes could affect sexual function and/or pleasure. Talk with your doctor about these problems.

As men get older, impotence (also called erectile dysfunction—ED) becomes more common. ED is the loss of ability to have and keep an erection for sexual intercourse. ED may cause a man to take longer to have an erection. His erection may not be as firm or as large as it used to be. The loss of erection after orgasm may happen more quickly, or it may take longer before another erection is possible. ED is not a problem if it happens every now and then, but if it occurs often, talk with your doctor.