Syncope Secondary to Obesity?

The frequency of obesity is increasing worldwide. The relationship between obesity and mortality is known. Bariatric surgery is well established in the treatment of morbid obesity to reduce weight permanently. Bariatric procedures are effective and influencing associated comorbidities. Adjustable gastric banding is a popular and effective bariatric operation in Europe for more than 10 years. Classic complications of gastric banding are known, but here we describe one more example. In this study, we report the case of a patient with gastric banding who presented with syncope after a meal.     

Comparative effectiveness of bariatric surgeries in patients with obesity and type 2 diabetes mellitus: A network meta‐analysis of randomized controlled trials

A network meta‐analysis of randomized controlled trials (RCTs) was performed to determine the hierarchies of different bariatric surgeries in patients with obesity and type 2 diabetes mellitus (T2DM), in terms of diabetes remission and cardiometabolic outcomes. Seventeen RCTs and six bariatric surgeries, including single anastomosis (mini) gastric bypass (mini‐GBP), biliopancreatic diversion without duodenal switch (BPD), laparoscopic‐adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), Roux‐en‐Y gastric bypass (RYGBP), greater curvature plication (GCP) and nonsurgical treatments (NST) were included. Mini‐GBP, BPD, LSG, RYGBP and LAGB (from best to worst), as compared with NST, were all significantly associated with the remission of T2DM. For the follow‐up period > 3 years, BPD, mini‐GBP, RYGBP and LSG (from best to worst) were significantly superior to NST in achieving the remission of T2DM. For secondary outcomes, the overall ranking for bariatric surgeries was RYGBP > BPD > LSG > LAGB after comprehensively weighting glucose, weight, systolic and diastolic pressure, total cholesterol, triglycerides, high‐density lipoprotein cholesterol (HDL‐C) and low‐density lipoprotein cholesterol (LDL‐C). Mini‐GBP has the greatest probability of achieving diabetes remission in adults with obesity and T2DM, yet BPD was the most effective in long‐term diabetes remission. RYGBP appears to be the most favourable alternative treatment to manage patients with cardiometabolic conditions.     

Endoscopic full-thickness plication for the treatment of GERD: 12-month follow-up for the North American open-label trial

BACKGROUND: The aim of this study was to assess the intermediate-term (12-month) safety and efficacy of endoscopic full-thickness plication in patients with symptomatic GERD. METHODS: Sixty-four patients with chronic heartburn that required maintenance antisecretory therapy received a single, endoscopically placed, full-thickness plication in the gastric cardia 1 cm distal to the gastroesophageal junction. At baseline and 12 months after plication, patients completed the GERD Health Related Quality of Life questionnaire, Gastrointestinal Symptom Rating Scale, and SF-36 Health Survey, as well as a medication use diary. Ambulatory 24-hour pH monitoring and esophageal manometry were obtained at baseline and 3 months after plication. At 6 months after plication, the 24-hour pH study was repeated. RESULTS: Of the 57 patients who completed the 12-month follow-up, 40 (70%) were no longer taking a proton pump inhibitor. Median GERD Health Related Quality of Life scores were improved compared with baseline while taking medication (19.0 vs. 5.0; p < 0.0001) and while not taking medication (13.0 vs. 5.0; p < 0.002). At 6 months after the procedure, an improvement in distal esophageal acid exposure was demonstrated in 40 of 51 patients (80%), with a decrease of 39% in the median percentage of time the pH was less than 4 (p < 0.0001). Normal pH scores were observed in 30% of patients. All procedure-related adverse events occurred acutely, as previously reported, and no new adverse event was observed during extended follow-up. CONCLUSIONS: Full-thickness plication at the gastroesophageal junction is an effective endoscopic procedure for treatment of patients with symptoms caused by GERD. It reduces reflux symptoms and antisecretory medication use over at least a 1-year period.     

Adipositaschirurgie

Every fifth German is obese, which means that 20% of male and 21.1% of female adults have a BMI of more than 30. In total 1.02 million adults in Germany are morbidly obese (BMI>40). This pandemic situation of obesity and morbid obesity is similar to the incidence of obesity in North America. In consideration of the increasing incidence of obesity the long-term success rate of conservative obesity treatment of 1?C2% does not ease this situation. Widespread prevention programs are not planned. The current only, as well long-term, effective therapy against morbid obesity is bariatric surgery. There is an arsenal of restrictive (e.g. gastric band, gastric sleeve) and combinations of restrictive and malabsorptive procedures (Roux-en-Y gastric bypass, biliopancreatic diversion) available to treat morbid obesity. Bariatric surgery can not only induce excess weight loss of 75?C80% but also a remission of co-morbidities, such as type 2 diabetes mellitus or metabolic syndrome. Even the tremendously reduced life expectancy of morbidly obese patients could be adapted to normal weight subjects by bariatric surgery.     

Endoscopic full-thickness plication for the treatment of GERD: a multicenter trial

BACKGROUND: A novel endoscopic full-thickness plication device has been designed to inhibit gastroesophageal reflux by placing a transmural plication near the gastroesophageal junction under direct endoscopic visualization. This study assessed the safety and efficacy of endoscopic full-thickness plication in the treatment of patients with symptoms caused by GERD. METHODS: Patients with chronic heartburn requiring maintenance therapy with antisecretory medication were recruited. Exclusion criteria were the following: hiatal hernia (>2 cm), grade III and IV esophagitis, and Barrett's esophagus. The following were assessed over a follow-up period of 6 months: GERD-Health-Related Quality of Life, Gastrointestinal Symptom Rating Scale, and SF-36 Health Survey, medication use, 24-hour esophageal pH monitoring and esophageal manometry. Patients underwent a single, full-thickness plication in the gastric cardia just distal to the gastroesophageal junction. Re-treatment was not permitted. RESULTS: A total of 64 patients (mean age 46.3 years, range 23-71 years) underwent endoscopic full-thickness plication (mean procedure time 17.2 minutes). At 6 months after plication, proton pump inhibitor therapy had been eliminated in 74% of previously medication-dependent patients. Median GERD-Health-Related Quality of Life scores improved 67% (19.0 vs. 5.0; p<0.001). Improvements also were observed in median Gastrointestinal Symptom Rating Scale and SF-36 Health Survey mental and physical composite scores. Median esophageal acid exposure improved significantly (10 vs. 8; p<0.008) with normalization of pH noted in 30% of patients. No significant change in esophageal manometry was noted. One gastric perforation occurred and was managed conservatively without sequelae. CONCLUSIONS: In this study, a single full-thickness plication placed at the gastroesophageal junction reduced symptoms, medication use, and esophageal acid exposure associated with GERD.     

A Controlled Study of the Influence of Continuous Subcutaneous Insulin Infusion Treatment on Diabetic Retinopathy during Pregnancy

ABSTRACT. Laatikainen L, Teramo K, Hieta-Heikurainen H, Koivisto V, Pelkonen R (Department of Ophthalmology, I and II Departments of Obstetrics and Gynaecology, III Department of Medicine, Helsinki University Hospital, Helsinki, Finland). A controlled study of the influence of continuous subcutaneous insulin infusion treatment on diabetic retinopathy during pregnancy. Forty consecutive pregnant patients with insulin-dependent (Type I) diabetes mellitus were randomized at the end of the first trimester for treatment with conventional insulin therapy (CIT) or continuous subcutaneous insulin infusion therapy (CSII). Nine patients randomized into the CSII group declined the pump treatment. The mean glycosylated haemoglobin (Hb A_1c) decreased (p<0.001) both in the CIT and the CSII groups with no difference between the groups. Some deterioration in retinopathy was found in 2/18 patients in the CIT group, in 5/13 in the CSII group, and in 3/9 of those who declined the pump treatment. The proportion of patients whose retinopathy progressed did not differ significantly between the groups, and in the majority the deterioration was mild. However, two patients in the CSII group developed acute ischaemic retinopathy, which progressed to proliferative stage in spite of laser treatment. In these two cases the decrease in the Hb A_lc level was among the greatest and fastest in the study. These data suggest that a rapid near normalization of glycaemic control by CSII during pregnancy can accelerate the progress of retinopathy in poorly controlled diabetic patients.     

Asian consensus on the relationship between obesity and gastrointestinal and liver diseases

The incidence of obesity is increasing in Asia, with implications on gastrointestinal (GI) and liver diseases. The Gut and Obesity in Asia Workgroup comprises regional experts with the aim of studying relationship between obesity and the GI and liver diseases in Asia. Through literature review and the modified Delphi process, consensus statements examining the impact of obesity on esophageal, gastric, pancreatic, colorectal, and liver diseases, exploring relationship between gut microbiome and obesity, and assessing obesity therapies have been produced by the Gut and Obesity in Asia Workgroup. Sixteen experts participated with 9/15 statements having strong consensus (>80% agreement). The prevalence of obesity in Asia is increasing (100% percentage agreement in brackets), and this increased prevalence of obesity will result in a greater burden of obesity‐related GI and liver diseases (93.8%). There was consensus that obesity increases the risk of gastric cancer (75%) and colorectal neoplasia (87.5%). Obesity was also associated with Barrett's esophagus and esophageal adenocarcinoma (66.7%) and pancreatic cancer (66.7%) in Asia. The prevalence of non‐alcoholic fatty liver disease (NAFLD) in Asia is on the rise (100%), and the risk of NAFLD in Asia (100%) is increased by obesity. Obesity is a risk factor for the development of hepatocellular carcinoma (93.8%). Regarding therapy, it was agreed that bariatric surgery was an effective treatment modality for obesity (93.8%) but there was less agreement on its benefit for NAFLD (62.5%). These experts' consensus on obesity and GI diseases in Asia forms the basis for further research, and its translation into addressing this emerging issue.     

Size at birth, childhood growth and obesity in adult life

BACKGROUND: Several studies have shown tracking of obesity from childhood to adult life. People who develop obesity in adult life may therefore have had a particular path of growth from birth through childhood. OBJECTIVE: To examine the relationship of obesity to size at birth and childhood growth. DESIGN: Birth cohort study. PARTICIPANTS: A total of 5210 individuals alive and living in Finland in 1997, who were born at the Helsinki University Central Hospital between 1924 and 1933 and who went to school in Helsinki were sent a questionnaire in order to get information about adult weight and height. Detailed birth and school health records were available for all subjects. In all, 3847 responded and 3659 (1552 men and 2107 women) with adequate data are included in the present study. MEASUREMENTS: Incidence of obesity based upon lifetime maximum body mass index (BMI) ascertained from a postal questionnaire and defined as a BMI>30 kg/m(2). The main explanatory measurements were size at birth and childhood growth in height, weight and BMI. RESULTS: The cumulative incidence of obesity was 34.2% in men and 33.9% in women. The incidence rose with increasing birth weight and ponderal index (birthweight/length(3); P=0.01 and P=0.04, respectively). These associations were statistically significant only among males. By the age of 7 y the mean weights, heights and BMI of people who later became obese exceeded the average and remained above average at all ages from 7 to 15 y. In both men and women there was a 3-fold increase in obesity associated with a BMI>16 kg/m(2) at age 7 compared with a BMI<14.5 kg/m(2) (P<0.0001). Boys and girls whose mothers had a high BMI in pregnancy had more rapid childhood growth and an increased risk of becoming obese. This effect was stronger among boys (P=0.008). CONCLUSIONS: Obesity is initiated early in life. These results emphasise the importance of early preventive measures for its treatment.     

2型糖尿病胃促生长素受体的表达与胃排空关系

目的 探讨2型糖尿病大鼠下丘脑和胃组织中胃促生长素(ghrelin)受体(GHSR)表达变化与胃排空的关系.方法 将大鼠分为糖尿病组、单纯肥胖组和对照组.糖尿病组和单纯肥胖组大鼠给予高糖和高脂饮食,糖尿病组8周后注射小剂量链脲佐菌素(STZ).检测各组大鼠体重、空腹血糖和胰岛素水平,并计算胰岛素抵抗指数.酚红灌胃法检测胃排空,实时定量荧光RT-PCR测定下丘脑和胃组织中GHSR mRNA表达.结果 糖尿病组和单纯肥胖组饲养8周后,体重和胰岛素水平较对照组明显升高(P＜0.01),血糖较对照组增高,但差异无统计学意义(P＞0.05).注射STZ后,糖尿病组胰岛素水平显著下降,血糖水平明显升高(P＜0.05).糖尿病组和单纯肥胖组液体胃排空低于对照组(P＜0.05),下丘脑和胃组织GHSR mRNA表达均明显下降(P＜0.05),并与胃排空下降呈正相关(P＜0.05).结论 2型糖尿病大鼠下丘脑和胃组织中GHSR mRNA的表达下降,降低了胃促生长素的促胃肠动力作用,从而有可能参与了糖尿病胃排空的延迟.可能与糖尿病胃排空障碍有关.     

Efficacy and effects of bariatric surgery in the treatment of obesity: Network meta-analysis of randomized controlled trials

AimsBariatric surgery (BS) is recommended for subjects with a Body Mass Index (BMI) over of 40 kg/m² or with a BMI between 35 and 40 kg/m² with obesity-related comorbidities. Aim of the study was to compare different types of BS with medical therapy (MT) for the treatment of obesity.Data synthesisWe conducted a network-meta-analysis (NMA) including randomized clinical trials comparing different BS techniques versus MT in people with obesity, with a duration ≥24 weeks (PROSPERO, #CRD42020160359). Primary endpoint was BMI. Indirect comparisons of different types of surgery were performed by NMA. Types of BS included: laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass, sleeve gastrectomy (SG), bilio-pancreatic diversion (BPD); greater curvature plication (GCP); one-anastomosis gastric bypass (OAGB); Laparoscopic Vertical Banded Gastroplasty (LVBG) and duodenal switch (DS). 43 trials were retrieved in this metanalysis. BS was associated with a significant reduction in BMI, systolic blood pressure, triglyceride and fasting glucose, and with a significant increase of HDL cholesterol when compared to MT. In direct comparisons, RYGB was more effective than LAGB, LVBG, and GCP, but less effective than DS, whereas LAGB was less effective than LVBG and SG. In the NMA, DS and BPD appeared to be more effective than other procedures.ConclusionsBS produces a greater weight loss than MT in morbidly obese patients, inducing a greater improvement of obesity-associated metabolic parameters. Available data are insufficient to assess the effect of BS on mortality. Different surgical procedures are heterogeneous for efficacy and safety.     

Risk factors for end‐stage renal disease in a community‐based population: 26‐year follow‐up of 25 821 men and women in eastern Finland

Abstract. Kastarinen M, Juutilainen A, Kastarinen H, Salomaa V, Karhapää P, Tuomilehto J, Grönhagen‐Riska C, Jousilahti P, Finne P. (Kuopio University Hospital, Kuopio; National Institute for Health and Welfare, Helsinki; University of Helsinki, Helsinki; South Ostrobotnia Central Hospital, Seinäjoki; Finnish Registry for Kidney Diseases, Helsinki; Helsinki University Central Hospital, Helsinki; and University of Tampere, Tampere; Finland). Risk factors for end‐stage renal disease in a community‐based population: 26‐year follow‐up of 25 821 men and women in eastern Finland. J Intern Med 2010; 267 :612–620. Background and objective. There are very few European cohort studies assessing the risk factors of end‐stage renal disease (ESRD) in a community‐based population. This study investigated the predictors of ESRD in Finland. Design. Prospective cohort study. Setting. Eastern Finland. Subjects. A random sample of 25 821 men and women aged 25–64 years from the national population register participating in three independent cross‐sectional population surveys in 1972, 1977 and 1982. Only the subjects without diagnosis of ESRD or chronic kidney disease based on the national register data were included in the study. Main outcome measure. Initiation of renal replacement therapy (dialysis or kidney transplantation) identified from the Finnish Registry for Kidney Diseases through December 31, 2006. Results. A total of 94 cases with ESRD were identified during a mean follow‐up period of 26.5 years. In a multivariate proportional subdistribution hazard regression analysis, taking into account death as a competing risk event, diabetes (hazard ratio [HR] 4.76, 95% confidence interval [CI] 2.32–9.79), hypertension (HR 2.21, 95% CI 1.19–4.12), obesity defined as body mass index ≥30 kg m^?2 (HR 2.02, 95 %CI 1.10–3.71) and male gender (HR 1.68, 95% CI 1.19–4.12) were independent risk factors for ESRD. Conclusion. The findings of the present study confirm that modifiable risk factors play a major role in the development of ESRD in the North‐European population. People with diabetes, hypertension or obesity should be considered as the target groups when planning preventive measures to control the future epidemic of ESRD.     

Updates on gastric electrical stimulation to treat obesity: Systematic review and future perspectives

AIM: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric electrical stimulation(GES) on obesity.RESULTS: Thirty-one studies consisting of a total of 33 different trials were included in the systematic review for data analysis. Weight loss was achieved in most studies, especially during the first 12 mo, but only very few studies had a follow-up period longer than 1 year. Among those that had a longer follow-up period, many were from the Transcend(Implantable Gastric Stimulation) device group and maintained significant weight loss. Other significant results included changes in appetite/satiety, gastric emptying rate, blood pressure and neurohormone levels or biochemical markers such as ghrelin or HbA1 c respectively. CONCLUSION: GES holds great promises to be an effective obesity treatment. However, stronger evidence is required through more studies with a standardized way of carrying out trials and reporting outcomes, to determine the long-term effect of GES on obesity.     

Haemostatic Parameters in Cushing's Syndrome

ABSTRACT. Ikkala E, MyllylÄ G, Pelkonen R, Rasi V, Viinikka L, Ylikorkala O. (Finnish Red Cross Blood Transfusion Service and Helsinki University Central Hospital, Helsinki, Finland.) Haemostatic parameters in Cushing's syndrome. We have studied haemostatic parameters in 12 patients with Cushing's syndrome. Three patients had prolonged bleeding times, and in all seven patients whose bleeding times were measured 3–6 months after surgical treatment the postoperative bleeding times were shorter (mean 7.5 min) than the pretreatment times (mean 12.3 min). In ADP- or adrenaline-induced aggregation the second wave was lacking in six and the degree of aggregation was borderline or subnormal in five patients. One patient had, in addition, a severe defect in collagen-induced aggregation. However, thromboxane B₂ production of the platelets from both endogenous and exogenous arachidonic acid was unaffected. Factor VIII:C, RAg and Rcof activities were all elevated, and in patients with severe disease F VIIIR:Ag and F VIII:Rcof activities were markedly more elevated than F VIII:C activity. The changes in both primary haemostasis and in factor VIII activities correlated clearly with the clinical severity of the disease.     

Esophageal adenocarcinoma after laparoscopic gastric band placement for obesity

Obesity is a risk factor for the development of esophageal malignancy. We report a case of the development of esophageal adenocarcinoma after placement of an adjustable gastric band for obesity. A 66‐year‐old male was referred to our clinic for findings of an obstructing mass at the gastroesophageal junction after previously undergoing a laparoscopic adjustable gastric band placement. Investigations confirmed a locally advanced poorly differentiated esophageal adenocarcinoma. The patient underwent chemotherapy and gastric band removal with improvement of his dysphagia. However, his disease progressed and he died of metastatic disease. We discuss the diagnosis of esophageal carcinoma after gastric banding procedure.     

Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidence of bariatric operations and coherently possible complications after such procedures, which modify patient’s anatomy and physiology.     

Ob/ob mice as a model of delayed gastric emptying

Diabetic gastroparesis is a well-recognized delay of gastric emptying in diabetic patients. We assessed the gastric emptying rate in ob/ob mice, a genetic model of obesity and diabetes. The basal gastric emptying rate in 22- to 27-week-old ob/ob mice was significantly lower than that in 10- to 11-week-old ob/ob mice (P<.01). Our results indicate that the ob/ob mice are a useful model not only of glucose intolerance but also of delayed gastric emptying as a diabetic complication.     

Parental factors associated with obesity in children with disability: a systematic review

The current literature on obesity in typically developing children shows that the family context, and specifically the way parents parent their children are major determinants of childhood obesity. The influence of these factors on obesity in children with disability, however, remains unclear. A systematic review of the literature was undertaken to identify the parental and parenting risk factors associated with obesity in children and adolescents with disability. Articles were identified through Medline, Academic Search Complete, PsycINFO, ProQuest, ISI, CINAHL, Cochrane and Scopus databases. There was no restriction on publication dates. The inclusion criteria were empirical papers that tested associations between parental and parenting risk factors and obesity in children and adolescents with intellectual and other developmental disabilities. Only 11 studies met the selection criteria and subsequently included in this review. Results suggest that obesity in children and adolescents with disability may be associated with socioeconomic status; parents' body mass index, perception and attitude towards their children's weight and physical activity; and levels of activity in both parents and children. Firm conclusions about these associations cannot be reached, however, due to mixed findings and methodological limitations of the studies. Recommendations for future research are provided.     

Endoscopic plication of massively bleeding peptic ulcer by using the Eagle Claw VII device: a feasibility study in a porcine model

BACKGROUND AND OBJECTIVE: We examined the efficacy of endoscopic plication when using Eagle Claw VII in a porcine bleeding ulcer model. ANIMAL MODEL PREPARATION: The right gastroepiploic artery (diameter 1.5-2 mm) was isolated and was tunneled to small gastrotomies at either the lesser or greater curvature of the stomach. INTERVENTIONS: We applied the Eagle Claw VII to achieve hemostasis. MAIN OUTCOME MEASUREMENTS: The survival of the pigs after endoscopic plication for hemostasis, time to achieve hemostasis with Eagle Claw VII, recurrent bleeding, number of successful plication, and number of suture remained. RESULTS: Endoscopic plication was performed on bleeding gastric ulcers in 6 pigs. The time to achieve hemostasis was 6 minutes 56 seconds +/- 3 minutes 50 seconds. There was no complication. A total of 14 plications were performed. All animals survived for 1 week without recurrent bleeding. At the postmortem, 10 of the plication sutures remained. LIMITATION: Our model cannot simulate the chronicity of peptic ulcer. CONCLUSIONS: In this porcine model, the Eagle Claw VII effectively stopped bleeding from arteries 2 mm in size.     

Elevated serum TNF-alpha level as a link between endothelial dysfunction and insulin resistance in normotensive obese patients.

AIMS: The aim of the study was to analyse the role of tumour necrosis factor-alpha (TNF-alpha) in insulin resistance and endothelial dysfunction in patients with different types of obesity. PATIENTS AND METHODS: Fasting serum TNF-alpha immunoreactive concentration (enzyme-linked immunosorbent assay, ELISA) and bioactivity (L929 cell cytotoxicity assay), endothelin-1 and C-peptide levels (radioimmunoassay, RIA) were measured in 15 patients with android- and 13 patients with gynoid-type obesity and 15 lean healthy controls with normal glucose tolerance and blood pressure. RESULTS: Significantly (P<0.01) higher TNF-alpha concentration (8.92 +/- 0.44 pg/ml) and bioactivity (3.12 +/- 0.48 U/ml) were found in patients with android obesity as compared to patients with gynoid obesity (7.01 +/- 0.30 pg/ml, 0.97 +/- 0.11 U/ml) and to the lean controls (6.88 +/- 0.26 pg/ml, 0.88 +/- 0.08 U/ml). Serum endothelin-1 (5.38 +/- 0.30 pg/ml) and C-peptide levels (4.82 +/- 0.71 ng/ml) were also significantly higher (P < 0.01) in patients with android-type obesity than in controls (3.89 +/- 0.43 pg/ml, 1.46 +/- 0.25 ng/ml, respectively). In patients with gynoid-type obesity, only the C-peptide levels proved to be significantly higher (2.84 +/- 0.29 ng/ ml). Endothelin-1 levels, although were found to be slightly higher, did not differ statistically from in controls (4.56 +/- 0.31 pg/ml). There were significant positive linear correlations only in patients with android-type obesity between TNF-alpha, body mass index (BMI), serum endothelin-1 and C-peptide levels. CONCLUSIONS: TNF-alpha may be one of the factors contributing to insulin resistance and vascular dysfunction in patients with android obesity.     

Significant renoprotective effect of telbivudine during preemptive antiviral therapy in advanced liver cancer patients receiving cisplatin-based chemotherapy: a case–control study

Objective. To assess the frequency of gastric cancer patients having received eradication treatment of Helicobacter pylori, and whether this treatment has any influence on the delay in the diagnosis or the stage of the tumours at the time of the operation. Material and methods. A total of 119 consecutive patients with gastric cancer were interviewed preoperatively between 2001 and 2003 at the Department of Surgery, Helsinki University Central Hospital. Abdominal symptoms, previous endoscopies, previous H. pylori testing and eradication therapies were recorded. Results. Of these patients, 112 (94%) had abdominal symptoms before the cancer diagnosis, and in 110 patients (92%) these symptoms were alarming or had changed before the cancer diagnosis. Thirty-five patients (29%) had received H. pylori eradication therapy prior to the diagnosis of gastric cancer (15 after onset or change in symptoms, 10 more than 5 years prior to the cancer diagnosis). The median duration of alarm, new or changed symptoms was longer among patients with H. pylori eradication therapy after the onset or change in their symptoms as compared to other patients (12.0 versus 4.5 months, p=0.001). However, there was no difference in the tumour stages at time of the operation between the eradication and no eradication groups. A previous gastroscopy within 2 years prior to the cancer diagnosis was performed in 17 (14%) patients. Diffuse-type cancers were missed significantly more often in endoscopies than cancers of intestinal type. Conclusion. Previous H. pylori eradication may delay the detection of gastric cancer if it is given during symptoms caused by tumour.