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1.
David Gutierrez Blanco David Romero Funes Giulio Giambartolomei Emanuele Lo Menzo Samuel Szomstein Raul J. Rosenthal 《Surgery for obesity and related diseases》2019,15(1):14-20
Background
There is a paucity of studies comparing risk reduction of the atherosclerotic cardiovascular disease (ASCVD) and Framingham-body mass index (BMI) Coronary Heart risk score after a laparoscopic Roux-en-Y gastric bypass (RYGB), and few studies have assessed the efficacy of laparoscopic sleeve gastrectomy (SG) in reducing cardiovascular risk.Objective
Our goal in this study was to compare the impact of SG and RYGB on cardiovascular risk reduction.Setting
U.S. university hospital.Methods
We retrospectively reviewed the records of all SG or RYGB cases at our institution between 2010 and 2015. Patients who met the criteria for calculating the ASCVD 10-year and Framingham-BMI score were included in the study. Propensity score matching was used to match SG and RYGB on demographic characteristics and co-morbidities.Results
Of the 1330 bariatric patients reviewed in the study period, 219 (19.3%) patients met the criteria for risk score calculation. SG was the most prevalent surgery in 72.6% (N?=?159) of cases compared with RYGB in 27.4% (N?=?60) of cases. At 12-month follow-up, ASCVD 10-year score had an absolute risk reduction of 3.9 ± 6.5% in SG patients and 2.9 ± 5.8% in RYGB patients (P?=?.3). Framingham-BMI score absolute risk reduction was 11.0 ± 12.0% in SG and 9.0 ± 11.0% in RYGB patients (P?=?.4), and the decrease in estimated heart age was 12.1 ± 15.6 years in SG versus 9.2 ± 9.6 years in RYGB (P?=?.1). The percentage of estimated BMI loss at 1 year was 68.1 ± 23.3% in SG versus 74.2 ± 24.8% in RYGB (P?=?.1).Conclusion
Our results suggest that SG and RYGB are equally effective in improving cardiovascular risk and decreasing the estimated vascular/heart age at 12-month follow-up. 相似文献2.
Séverine Ledoux Ouidad Sami Daniela Calabrese Maud Le Gall Martin Flamant Muriel Coupaye 《Surgery for obesity and related diseases》2019,15(2):220-226
Background
Numerous studies have shown that Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differently affect metabolic disorders associated with obesity. While bariatric surgery has been shown to improve nonalcoholic fatty liver disease, very few studies have compared liver parameters after both procedures.Objectives
To compare the evolution of liver parameters after SG and RYGB and their relationships with improvement of metabolic disorders.Methods
Metabolic parameters and abdominal ultrasonography were recorded before and 1 year after bariatric surgery in all patients who underwent SG or RYGB between 2004 and 2016 in our institution.Setting
University hospital, Colombes, France.Results
Five hundred thirty-three patients (15% men, age 43 ± 11 yr) were analyzed, including 326 who underwent RYGB and 207 who underwent SG. Before surgery, body mass index (44.7 ± 5.7 versus 44.4 ± 7.4 kg/m²) and metabolic parameters were not significantly different. One year after surgery, RYGB induced greater weight loss (31.9 ± 7.7 versus 28.6 ± 8.3 %, P < .001). Metabolic parameters improved in both groups, but fasting insulin, low-density lipoprotein cholesterol, C-reactive protein, and ferritin were lower after RYGB (P < .001). In contrast, transaminases were higher after RYGB compared with SG (alanine aminotransferase: 31.6 ± 18.7 versus 22.6 ± 7.7 IU/L; P < .001). The persistence of alanine aminotransferase >34 IU/L (27% versus 7% of patients, P < .001) was independent of the persistence of steatosis on ultrasonography (39% versus 37% of patients) 1 year after RYGB and SG, respectively.Conclusion
Despite a greater improvement of metabolic disorders, RYGB has less beneficial effect on liver parameters compared with SG. Further studies are required to define the mechanisms explaining these differences between both procedures. 相似文献3.
BACKGROUND
The pattern of linear graph schematized by visual analogue scale (VAS) score displaying pain worsening between 2 days and 2 weeks after selective nerve root block (SNRB) is called rebound pain.PURPOSE
The purpose of this study was to determine if sodium hyaluronate and carboxymethyl cellulose solution (HA-CMC sol) injection could reduce the occurrence of rebound pain at 3 days to 2 weeks after SNRB in patients with radiculopathy compared with injection with corticosteroids and local anesthetics alone.STUDY DESIGN/SETTING
Double blinded randomized controlled clinical trial.PATIENT SAMPLE
A total of 44 patients (23 of 24 patients in the Guardix group and 21 of 24 patients in the control group) who finished the follow-up session were subjects of this study.OUTCOME MEASUREMENT
Patients were asked to write down their average VAS pain scores daily for 12 weeks. Functional outcomes were assessed by Oswestry Disability Index, Roland Morris Disability Questionnaire , and Short Form-36.METHOD
A cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of normal saline was used for the control group whereas a cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of HA-CMC solution was used for the G group. Study participants were randomized into one of two treatment regimens. They were followed up for 3 months.RESULTS
VAS score at 2 weeks after the procedure was 4.19±1.32 in the control group, which was significantly (p<.05) higher than that (2.43±1.24) in the G group. VAS score at 6 weeks after the procedure was 4.00±1.23 in the control group and 3.22±1.45 in the G group, showing no significant (p=.077) difference between the two groups. There were no significant differences in functional outcomes at 6 or 12 weeks after the procedure.CONCLUSIONS
Compared with conventional cocktail used for SNRB, addition of HA-CMC sol showed effective control of rebound pain at 3 days to 2 weeks after the procedure. 相似文献4.
Marie-Maëlle Chandeze David Moszkowicz Alain Beauchet Karina Vychnevskaia Frédérique Peschaud Jean-Luc Bouillot 《Surgery for obesity and related diseases》2019,15(1):83-88
Background
Obesity is a risk factor for the development of ventral hernia and increases the risk of recurrence and surgical site infection after hernia repair (HR).Objectives
We tested the hypothesis that bariatric surgery (BS) before HR would decrease these risks in patients with morbid obesity.Setting
University hospital, France.Methods
We retrospectively compared 2 groups of patients with morbid obesity in a case-matched study; 1 underwent immediate HR surgery (control), and the other initially underwent BS and then HR after weight loss (case). Patients were individually matched at a 2:1 ratio according to defect size (<7 or ≥7 cm), obesity grade (<40 or ≥40 kg/m²), American Society of Anesthesiologists score, sex, smoker status, and presence of chronic obstructive pulmonary disease.Results
From 2000 to 2017, 41 patients underwent BS, in association with herniorrhaphy in 14 cases (34%). Initial body mass index was higher in the BS group (46.7 ± 6.4 versus 42.4 ± 7.2, P < .0001) but had decreased by the time of HR (34.1 ± 6.5 versus 42.3 ± 7.2, P < .0001). Prosthetic HR was performed after 21.5 months (range, 7–87); however, 7 patients did not receive HR at this time due to insufficient weight loss. Postoperative morbidity was similar in the 2 groups. Hospital stay was shorter in the BS group (6.2 ± 2.6 versus 10.7 ± 9.3 d, P?=?.002). After a median follow-up of 4.6 ± 4.1 years, the recurrence rate was lower in the BS group (2/30, 6.7%) than in the control group (12/50, 24%; P?=?.048).Conclusion
For morbidly obese patients with ventral hernia, BS before HR surgery can decrease recurrence without increasing morbidity. 相似文献5.
Daniel Gärtner Christine Stroh Martin Hukauf Frank Benedix Thomas Manger 《Surgery for obesity and related diseases》2019,15(2):187-193
Background
Recently, sleeve gastrectomy (SG) has become one of the most important procedures in bariatric surgery. Short-term results show that SG is a feasible, safe, and effective operation treating obesity and its related co-morbidities. Now, the main focus is on long-term data after SG.Objectives
The aim of this study was to analyze perioperative and long-term results after SG in the German Bariatric Surgery Registry.Setting
National database, Germany.Methods
Perioperative data of primary SG (n?=?21525) and follow-up data for 5 years ± 6 months (n?=?435, 18.3% of 2375 SG performed between 2005 and 2011) were analyzed. After a review of the literature long-term results were compared with international data.Results
Mean baseline body mass index (BMI) was 51.1 kg/m2. Two hundred ninety-eight (68.5%) patients were female and 137 (31.5%) were male. Of patients, 90% had ≥1 co-morbidities. Mean operation time was 86 minutes. General postoperative complications occurred in 4.1% and special complications in 4.6% (staple-line leaks 1.6%). Mean maximum BMI loss was 18.0 ± 6.8 kg/m2 and BMI loss after 5 years was 14.3 ± 7.4 kg/m2 (P < .001). Co-morbidities, such as type 2 diabetes, hypertension, and sleep apnea, were significantly improved (P < .001). Gastroesophageal reflux was significantly impaired (P < .001).Conclusions
The current results showed that SG is a safe and effective procedure in bariatric surgery. BMI loss was significant 5 years after SG. Most co-morbidities were significantly improved, but gastroesophageal reflux has often worsened. The follow-up rate was very low, which is a persistent problem in German bariatric surgery. 相似文献6.
Imad S Nahle Hubert Labelle Stefan Parent Julie Joncas Jean-Marc Mac-Thiong 《The spine journal》2019,19(4):670-676
BACKGOUND CONTEXT
Abnormal proximal femoral angle (PFA) was recently found to be associated with deteriorating sagittal balance and quality of life (QoL) in high-grade spondylolisthesis (HGS). However, the influence of PFA on the QoL of patients undergoing surgery remains unknown.PURPOSE
This study compares the pre- and postoperative measurements of sagittal balance including PFA in patients with lumbosacral HGS after surgery. It also determines if PFA is a radiographic parameter that is associated with QoL in patients undergoing surgery.STUDY DESIGN
Retrospective cohort study.PATIENT SAMPLE
Thirty-three patients (mean age 15.6 ± 3.0 years) operated for L5-S1 HGS between July 2002 and April 2015. Thirteen had in situ fusion and 20 had reduction to a low-grade slip.OUTCOME MEASURES
The outcome measures included PFA and QoL scores measured from the Scoliosis Research Society SRS-30 QoL questionnaire.METHODS
The minimum follow-up was 2 years. PFA and QoL were compared pre- and postoperatively. Statistical analysis used nonparametric Mann-Whitney and Wilcoxon Signed Rank tests, Chi-square tests to compare proportions, and bivariate correlations with Spearman's coefficients.RESULTS
A decreasing PFA correlated with less pain (r = ?0.56, p?=?.010), improved function (r = ?0.51, p?=?.022) and better self-image (r = ?0.46, p?=?.044) postreduction. Reduction decreased PFA by 5.1° (p?=?.002), whereas in situ fusion did not alter PFA significantly. Patients with normal preoperative PFA had similar postoperative QoL regardless of the type of surgery, except for self-image, which improved further with reduction (3.73 ± 0.49 to 4.26 ± 0.58, p?=?.015). Patients with abnormal preoperative PFA tended to have a higher QoL in all domains after reduction.CONCLUSION
Decreasing PFA correlates with less pain, better function and self-image. Reduction of HGS decreases PFA. Reduction also relates to a better postoperative QoL when the preoperative PFA is abnormal. When the preoperative PFA is normal, in situ fusion is equivalent to reduction except for self-image, which is better improved after reduction. 相似文献7.
María Belén Acevedo Ramiro Ferrando Bruce W. Patterson J. Christopher Eagon Samuel Klein Marta Yanina Pepino 《Surgery for obesity and related diseases》2019,15(1):36-42
Background
Roux-en-Y gastric bypass surgery (RYGB) increases the rate of alcohol absorption so that peak blood alcohol concentration is 2-fold higher after surgery compared with concentrations reached after consuming the same amount presurgery. Because high doses of alcohol can lead to hypoglycemia, patients may be at increased risk of developing hypoglycemia after alcohol ingestion.Objectives
We conducted 2 studies to test the hypothesis that the consumption of approximately 2 standard drinks of alcohol would decrease glycemia more after RYGB than before surgery.Setting
Single-center prospective randomized trial.Methods
We evaluated plasma glucose concentrations and glucose kinetics (assessed by infusing a stable isotopically labelled glucose tracer) after ingestion of a nonalcoholic drink (placebo) or an alcoholic drink in the following groups: (1) 5 women before RYGB (body mass index?=?43 ± 5 kg/m2) and 10 ± 2 months after RYGB (body mass index?=?31 ± 7 kg/m2; study 1), and (2) 8 women who had undergone RYGB surgery 2.2 ± 1.2 years earlier (body mass index?=?30 ± 5 kg/m2; study 2)Results
Compared with the placebo drink, alcohol ingestion decreased plasma glucose both before and after surgery, but the reduction was greater before (glucose nadir placebo?=??.4 ± 1.0 mg/dL versus alcohol?=??9.6 ± 1.5 mg/dL) than after (glucose nadir placebo?=??1.0 ± 1.6 mg/dL versus alcohol?=??5.5 ± 2.6 mg/dL; P < .001) surgery. This difference was primarily due to an alcohol-induced early increase followed by a subsequent decrease in the rate of glucose appearance into systemic circulation.Conclusion
RYGB does not increase the risk of hypoglycemia after consumption of a moderate dose of alcohol. 相似文献8.
Anna Elander Christina Biörserud Trude Staalesen Jonas Ockell Monika Fagevik Olsén 《Surgery for obesity and related diseases》2019,15(2):305-311
Background
Excess skin is well known after massive weight loss but, there is missing knowledge from various groups.Objectives
To describe and compare excess skin in a reference population during obesity, after obesity surgery, and after reconstructive abdominoplasty.Setting
University hospital, Sweden.Methods
The following 6 groups were included: the reference population, obese adults before obesity surgery, obese adults after obesity surgery, adolescents after obesity surgery, super-obese adults after obesity surgery, and adults after abdominoplasty. All groups filled in the Sahlgrenska Excess Skin Questionnaire (SESQ). Some groups also underwent measurements of ptosis/excess skin on 4 body parts.Results
All groups scored significantly higher experience of and discomfort from excess skin compared with the reference population. SESQ scores were significantly higher for obese adults (10.5 ± 8.5) and even higher for adults and adolescents (12.3 ± 8.1 versus 14.4 ± 7.7) after obesity surgery compared with the reference population (1.5 ± 3.5). Abdominoplasty resulted in significantly reduced scores (2.9 ± 5.2). Those undergoing obesity surgery and weight loss had significantly less excess skin measured on arms, breasts, and abdomen compared with before surgery, except for the upper arms on the adolescents. Excess skin increased on inner thighs in both age groups after weight loss. Correlations between objectively measured ptosis/excess skin and the patients’ experience of and discomfort were .16 to .71, and the highest correlations were found among adolescents.Conclusion
Excess skin is not a problem for the vast majority of the normal population but is linked to obesity and massive weight loss. The SESQ score illustrates major problems related to excess skin both for obese adults and after obesity surgery for adults and for adolescents, who have problems similar to or worse than adults. Abdominoplasty markedly decreases symptoms. 相似文献9.
David Gutierrez-Blanco David Romero Funes Marco Castillo Emanuele Lo Menzo Samuel Szomstein Raul J. Rosenthal 《Surgery for obesity and related diseases》2019,15(2):168-172
Background
Obesity is a major independent risk factor for developing type 2 diabetes (T2D).Objectives
Our goal in this study was to analyze the impact of laparoscopic sleeve gastrectomy in the risk reduction of developing T2D in middle-aged, severely obese nondiabetes patients.Setting
University Hospital, United States.Methods
We retrospectively reviewed our prospectively collected database from 2010 to 2016. All severely obese patients between 45 and 64 years of age without diabetes at baseline that underwent sleeve gastrectomy were included in our study. The T2D risk score for predicting the incidence of diabetes was measured preoperatively and at 12 months postoperatively and was based on the Framingham Offspring Study that calculates an 8-year risk of developing T2D.Results
Of the 1330 patients included in this study, 6.5% (n?=?86) met the criteria for the T2D risk score calculation. The population was predominantly composed of females (68.9%; n?=?59) with a mean age of 52.8 ± 5.3 years. Preoperative body mass index was 43.1 ± 6.9 kg/m2 with a percentage of estimated body mass index loss and percentages of total weight loss were 72.2 ± 26.3% and 26.39 ± 18.15%, respectively, with fasting plasma glucose of 103.3 ± 14.9 mg/dL. The preoperative risk for T2D was 13.9 ± 11.6%, with an absolute risk reduction 12 months after surgery of 10.3%, corresponding to a 74.2% relative risk reduction. When comparing between sexes, risk reduction in females was slightly better than in males; however, this was not statistically significant. At 12-month follow-up, all measured variables were significantly improved, except for diastolic blood pressure.Conclusions
Laparoscopic sleeve gastrectomy significantly decreases the risk of developing T2D in middle-aged severely obese patients. Prospective studies are needed to further understand these findings. 相似文献10.
Carlos Aurelio Schiavon Renato Nakagawa Santos Eliana Vieira Santucci Patricia Malvina Noujaim Alexandre Biasi Cavalcanti Luciano Ferreira Drager 《Surgery for obesity and related diseases》2019,15(2):211-217
Background
Although Roux-en-Y gastric bypass (RYGB) results in significant weight loss and cardiometabolic risk factors improvements; there is no consensus whether limb lengths may influence these results.Objective
To evaluate the correlations between the common limb length (CLL) and hypertension remission rate, cardiometabolic risk factors, and nutritional parameters after RYGB.Settings
Private Hospital, Brazil.Methods
GATEWAY is a randomized trial designed to evaluate the efficacy of RYGB on hypertension improvement and other cardiometabolic risk factors in patients with grade I and II obesity compared with medical therapy. The follow-up was 1 year. We measured the entire bowel in all patients and used a 150-cm alimentary limb and a 100-cm biliopancreatic limb. Univariate logistic regression was used to estimate the relationship between CLL and hypertension remission. Pearson and Spearman correlation were used to evaluate the correlation between the CLL and the percentage changes of cardiometabolic risk factors and nutritional parameters.Results
From 100 randomized patients, 45 were submitted to RYGB and completed the follow-up. Mean CLL was 466.3 ± 86.4 cm. Of patients, 55.6% from the RYGB group showed remission of hypertension. CLL length was not significantly associated with hypertension remission (odds ratio [95% confidence interval] for 50 units increase in CLL: .97 [.68; 1.38], P?=?.88). Consistently, we found no correlations between CLL and all changes in cardiometabolic risk factors and nutritional parameters.Conclusions
In a proximal RYGB, CLL does not influence hypertension remission, cardiometabolic risk factors, and nutritional parameters. 相似文献11.
Pia Henfridsson Anna Laurenius Ola Wallengren Eva Gronowitz Jovanna Dahlgren Carl-Erik Flodmark Claude Marcus Torsten Olbers Lars Ellegård 《Surgery for obesity and related diseases》2019,15(1):51-58
Background
Information is scarce on long-term changes in energy intake (EI), dietary energy density (DED), and body composition in adolescents undergoing laparoscopic Roux-en-Y gastric bypass (RYGB).Objectives
To investigate long-term changes in EI, DED, and body composition in adolescents after LRYGB.Setting
University hospitals, multicenter study, Sweden.Methods
Eighty-five adolescents (67% girls; mean ± standard deviation, age 16.0 ± 1.2 yr, body mass index 45.5 ± 6.1 kg/m2) were assessed preoperatively (baseline) and 1, 2, and 5 years after LRYGB with diet history interviews and dual-energy x-ray absorptiometry. Matched obese adolescent controls receiving nonsurgical treatment were assessed only at 5 years.Results
Weight decreased 31%, 33%, and 28% at 1, 2, and 5 years after LRYGB (P < .001) while controls gained 13% over 5 years (P < .001). Dietary assessments were completed in 98%, 93%, 87%, and 75% at baseline and 1, 2, and 5 years, respectively, and in 65% of controls. Baseline EI (2558 kcal/d), decreased by 34%, 22%, and 10% after 1, 2, and 5 years (P < .05). DED decreased at 1 year (P?=?.03). Macronutrient distribution was not different from controls at 5 years, but EI and DED were 31% and 14% lower (P < .015). Fat, fat-free, and muscle mass decreased through 5 years after LRYGB (P < .001). Boys preserved muscle mass more than girls (P < .01). Adequate protein intake was associated with preservation of muscle mass (P?=?.003).Conclusions
In adolescents undergoing LRYGB EI remained 10% lower 5 years after surgery. Decreased EI and DED, rather than macronutrient distribution, are important factors in weight loss after surgery. Higher protein intake may facilitate preservation of muscle mass. 相似文献12.
José Miguel Spirig Reto Sutter Tobias Götschi Nadja A. Farshad-Amacker Mazda Farshad 《The spine journal》2019,19(3):461-468
BACKGROUND CONTEXT
Pedicle screw loosening is common after spinal fusion and can be associated with pseudoarthrosis and pain. With suspicion of screw loosening on standard radiographs, CT is currently considered the advanced imaging modality of choice. MRI with new metal artifact reduction techniques holds potential to be sensitive in detection of screw loosening. The sensitivity and specificity of either of the imaging modalities are yet clear.PURPOSE
To evaluate the sensitivity and specificity of three different image modalities (standard radiographs, CT, and MRI) for detection of pedicle screw loosening.STUDY DESIGN/SETTING
Cross-sectional diagnostic study.PATIENT SAMPLE
Forty-one patients (159 pedicle screws) undergoing revision surgeries after lumbar spinal fusion between August 2014 and April 2017 with preoperative radiographs, CT, and MRI with spinal metal artifact reduction (STIR WARP and TSE high bandwidth sequences).OUTCOME MEASURES
Sensitivity and specificity in detection of screw loosening for each imaging modality.METHODS
Screw torque force was measured intraoperatively and compared with preoperative screw loosening signs such as peri-screw edema in MRI and peri-screw osteolysis in CT and radiographs. A torque force of less than 60 Ncm was used to define a screw as loosened.RESULTS
Sensitivity and specificity in detection of screw loosening was 43.9% and 92.1% for MRI, 64.8% and 96.7% for CT, and 54.2% and 83.5% for standard radiographs, respectively.CONCLUSIONS
Despite improvement of MRI with metal artifact reduction MRI technique, CT remains the modality of choice. Even so, CT fails to detect all loosened pedicle screws. 相似文献13.
Tone Nygaard Flølo Grethe S. Tell Ronette L. Kolotkin Anny Aasprang Tone M. Norekvål Villy Våge John R. Andersen 《Surgery for obesity and related diseases》2019,15(2):161-167
Background
A person's confidence to control eating, eating self-efficacy (ESE), has been identified as a target for long-term weight management in nonsurgical weight loss interventions, but has to a limited extent been studied after bariatric surgery.Objective
We investigated the association between ESE, weight loss, and obesity-specific quality of life (QOL) after sleeve gastrectomy (SG).Setting
A single-center longitudinal study.Methods
Data from adult patients were collected before SG, and at mean 16 months (±standard deviation 4 mo) and 55 (±4) months postoperatively. ESE was measured by the Weight Efficacy Lifestyle Questionnaire Short-Form. Multiple regression analyses were performed with excess body mass index loss (%EBMIL) and obesity-specific QOL as dependent variables. Age, sex, and other preoperative values were covariates in all models.Results
Of 114 preoperative patients, 91 (80%) and 84 (74%) were available for follow-up 16 and 55 months after SG, respectively. Mean %EBMIL from baseline to 16 and 55 months was 76% (95% confidence interval: 71.9, 79.6) and 67% (95% confidence interval: 61.9, 72.2), respectively. Preoperative ESE scores improved significantly at both 16 and 55 months (P?=?.002) but did not predict postoperative %EBMIL or QOL at 55 months (β?=??.08, P?=?.485). Greater change in ESE from 0 to 16 months predicted higher %EBMIL (β?=?.34, P?=?.013) at 55 months, and improvements in ESE from 0 to 55 months were significantly associated with higher %EBMIL (β?=?.46, P?=?.001) and obesity-specific QOL (β?=?.50, P < .001) 55 months after SG.Conclusion
Significant improvements in ESE were seen at 16 months, and remained high at 55 months after SG in this cohort. Patients who improved their ESE the most also experienced the highest weight loss and obesity-specific QOL 5 years postoperatively. Future research should address whether enhancement of ESE corresponds to sustained improvements in eating behavior after bariatric surgery. 相似文献14.
Kevin T. Lynch J. Hunter Mehaffey Robert B. Hawkins Taryn E. Hassinger Peter T. Hallowell Jennifer L. Kirby 《Surgery for obesity and related diseases》2019,15(2):279-285
Background
Obesity is associated with an increased risk of atrial fibrillation (AF). Bariatric surgery results insubstantial long-term weight loss and the amelioration of several chronic comorbidities. We hypothesized that weightreduction with bariatric surgery would reduce the long-term incidence of AF.Objectives
To assess the association between bariatric surgery and AF prevention.Setting
University Hospital, United States.Methods
All patients who underwent bariatric surgery at a single institution from 1985–2015 (n?=?3,572) were propensity score matched 1:1 to a control population of obese patients with outpatient appointments (n?=?45,750) in our clinical data repository. Patients with a prior diagnosis of AF were excluded. Demographics, relevant comorbidities, and insurance status were collected and a chart review was performed for all patients with AF. Paired univariate analyses were used to compare the two groups.Results
After propensity score matching, 5,044 total patients were included (2,522 surgical, 2,522 non-surgical). There were no differences in preoperative body mass index (BMI) (47.1 vs 47.7 kg/m2, P?=?0.76) or medical comorbidities between groups. The incidence of AF was lower among surgical patients (0.8% vs 2.9%, P?=?0.0001). In patients ultimately diagnosed with AF, time from enrollment to development of AF did not differ between groups; however, surgical patients with AF experienced a significantly higher reduction in excess BMI compared to non-surgical patients with AF (57.9% vs ?3.8%, P<0.001).Conclusion
The incidence of AF was lower among patients who underwent bariatric surgery compared to their medically managed counterparts. Weight reduction with bariatric surgery may reduce the long-term incidence of AF. 相似文献15.
Ghalia N. Abdeen Alexander D. Miras Aayed R. Alqahtani Carel W. le Roux 《Surgery for obesity and related diseases》2019,15(2):194-199
Background
Adolescent obesity is challenging to treat even if good multidisciplinary approaches are started early. Vertical sleeve gastrectomy (VSG) is an effective intervention for long-term weight loss, but the underlying mechanisms that result in reduced calorie intake are controversial. Anecdotal evidence from the clinic and evidence in rodents after VSG suggest a decrease in the reward value of high-calorie dense foods.Objectives
To determine changes in appetitive behavior of candies (high in sugar and fat) after VSG in adolescents with obesity.Setting
University hospital.Methods
Sixteen adolescents with obesity (age 15.3 ± .5 yr) who had VSG and 10 control patients (age 13.8 ± .6 yr) who had not undergone surgery were studied. Both groups completed a progressive ratio task by clicking a computer mouse on a progressive ratio schedule to receive a candy high in sugar and fat. In the task, patients were required to expend an increasing amount of effort to obtain the reinforcer until they reach a breakpoint (measure of the reward value of the reinforcer). The task was performed before VSG and 12 and 52 weeks after VSG.Results
The VSG group's bodyweight decreased from the baseline 136.6 ± 5.1 to 110.9 ± 5.2 to 87.4 ± 3.7 kg after 12 and 52 weeks, respectively (P < .001). The median breakpoint for candies decreased after VSG from the baseline 320 (160–640) to 80 (50–320) to 160 (80–560) after 12 and 52 weeks, respectively (P?=?.01). Breakpoints for the control patients did not change (480 [160–640] versus 640 [280–640], P?=?.17).Conclusion
VSG resulted in a reduction in the reward value of a candy, as suggested by the reduced amount of effort adolescents were prepared to expend to obtain the high-sugar and high-fat candy. The effect was most pronounced 12 weeks after surgery but was largely maintained at 1 year. Long-term attenuation of appetitive behavior may be the key to weight loss and weight loss maintenance after VSG in adolescents. 相似文献16.
Molly Orcutt Wendy C. King Melissa A. Kalarchian Michael J. Devlin Marsha D. Marcus Luis Garcia Kristine J. Steffen James E. Mitchell 《Surgery for obesity and related diseases》2019,15(2):295-303
Background
A history of childhood maltreatment and psychopathology are common in adults with obesity.Objectives
To report childhood maltreatment and to evaluate associations between severity and type of childhood maltreatment and lifetime history of psychopathology among adults with severe obesity awaiting bariatric surgery.Setting
Four clinical centers of the Longitudinal Assessment of Bariatric Surgery Research Consortium.Methods
The Childhood Trauma Questionnaire, which assesses presence/severity (i.e., none, mild, moderate, severe) of physical abuse, mental abuse, physical neglect, mental neglect, and sexual abuse, was completed by 302 female and 66 male bariatric surgery patients. Presurgery lifetime history of psychopathology and suicidal ideation/behavior were assessed with the Structured Clinical Interview for DSM-IV and the Suicidal Behavioral Questionnaire-Revised, respectively. Presurgery lifetime history of antidepressant use was self-reported.Results
Two thirds (66.6%) of females and 47.0% of males reported at least 1 form of childhood trauma; 42.4% and 24.2%, respectively, at greater than or equal to moderate severity. Among women, presence/greater severity of childhood mental or physical abuse or neglect was associated with a higher risk of history of psychopathology (i.e., major depressive disorder, posttraumatic stress disorder, other anxiety disorder, alcohol use disorder, binge eating disorder), suicidal ideation/behavior and antidepressant use (P for all ≤ .02). These associations were independent of age, race, education, body mass index, and childhood sexual abuse. Childhood sexual abuse was independently associated with a history of suicidal ideation/behavior and antidepressant use only (P for both ≤ .05). Statistical power was limited to evaluate these associations among men.Conclusion
Among women with obesity, presence/severity of childhood trauma was positively associated with relatively common psychiatric disorders. 相似文献17.
Carlo Ammendolia Y. Raja Rampersaud Danielle Southerst Aksa Ahmed Michael Schneider Gillian Hawker Claire Bombardier Pierre Côté 《The spine journal》2019,19(3):386-394
BACKGROUND CONTEXT
Lumbar spinal stenosis (LSS) can impair blood flow to the spinal nerves giving rise to neurogenic claudication and limited walking ability. Reducing lumbar lordosis can increases the volume of the spinal canal and reduce neuroischemia. We developed a prototype LSS belt aimed at reducing lumbar lordosis while walking.PURPOSE
The aim of this study was to assess the short-term effectiveness of a prototype LSS belt compared to a lumbar support in improving walking ability in patients with degenerative LSS.STUDY DESIGN
This was a two-arm, double-blinded (participant and assessor) randomized controlled trial.PATIENT SAMPLE
We recruited 104 participants aged 50 years or older with neurogenic claudication, imaging confirmed degenerative LSS, and limited walking ability.OUTCOME MEASURES
The primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals.METHODS
Within 1 week of a baseline SPWT, participants randomized to the prototype LSS belt group (n=52) and those randomized to the lumbar support group (n=52) performed a SPWT that was conducted by a blinded assessor. The Arthritis Society funded this study ($365,000 CAN) with salary support for principal investigator funded by the Canadian Chiropractic Research Foundation ($500,000 CAN for 5 years).RESULTS
Both groups showed significant improvement in walking distance, but there was no significant difference between groups. The mean group difference in walking distance was ?74 m (95% CI: ?282.8 to 134.8, p=.49). In total, 62% of participants wearing the prototype LSS belt and 82% of participants wearing the lumbar support achieved at least 30% improvement in walking distance (relative risk, 0.7; 95% CI: 0.5–1.3, p=.43).CONCLUSIONS
A prototype LSS belt demonstrated significant improvement in walking ability in degenerative LSS but was no better than a lumbar support. 相似文献18.
Abel Boerboom Jens Homan Edo Aarts Theo Aufenacker Ignace Janssen Frits Berends 《Surgery for obesity and related diseases》2019,15(1):60-69
Background
For a number of years the laparoscopic adjustable gastric band has been one of the leading bariatric procedures with good short-term outcomes. However, inadequate weight loss, weight regain, and other band-related complications in the long term led to an increase in revisional Roux-en-Y gastric bypass (RYGB) procedures. Lengthening the biliopancreatic limb, a relatively simple and safe adjustment of the standard technique, could improve the results of the revisional procedure.Objectives
The aim of this randomized controlled trial was to evaluate the effect of a long biliopancreatic limb RYGB (LBP-GB) and standard RYGB (S-GB) as revisional procedure after laparoscopic adjustable gastric band.Setting
General hospital specialized in bariatric surgeryMethods
One hundred forty-six patients were randomized in 2 groups; 73 patients underwent an S-GB (alimentary/biliopancreatic limb 150/75 cm), and 73 patients underwent LBP-GB (alimentary/biliopancreatic limb 75/150). Weight loss, remission of co-morbidities, quality of life, and complications were assessed during a period of 4 years.Results
Baseline characteristics between the groups were comparable. At 48 months the follow-up rate was 95%. Mean total weight loss after 24 months was 27% for LBP-GB versus 22% S-GB (P?=?.015); mean total weight loss after 48 months was 23% and 18%, respectively (P?=?.036). No significant differences in other parameters were found between the groups.Conclusions
A LBP-GB as revisional procedure after a failing laparoscopic adjustable gastric band improves short- and long-term total weight loss compared with an S-GB. Together with future modifications this technically simple adjustment of the RYGB could significantly improve disappointing results after revisional surgery. 相似文献19.
BACKGROUND CONTEXT
Patients with pyogenic vertebral osteomyelitis (PVO) are expected to have an increased risk of bone loss. Therefore, early bisphosphonate therapy would be clinically effective for PVO patients with osteoporosis.PURPOSE
This study aimed to investigate the effect of bisphosphonate on clinical outcomes of PVO patients with osteoporosis.STUDY DESIGN/SETTING
A retrospective comparative study.PATIENT SAMPLE
PVO patients with osteoporosis.OUTCOME MEASURES
Four events of interest for Cox proportional hazard model included surgical treatment, recurrence of infection, subsequent fracture of adjacent vertebral bodies, and death.METHODS
PVO patients were divided into three groups: group A (initiation of bisphosphonate within 6 weeks after PVO diagnosis), group B (initiation of bisphosphonate between 6 weeks and 3 months after PVO diagnosis), and group C (no treatment for osteoporosis). Cox proportional hazard model was used for the four events of interest.RESULTS
A total of 360 PVO patients with osteoporosis were investigated for the four events of interest. Group A had significantly lower hazard ratios for undergoing later (>6 weeks after diagnosis) surgery than group C (p?=?.014) despite similar occurrences of overall surgery. A significant difference was also observed in the occurrence of subsequent fractures at adjacent vertebral bodies (p?=?.001 for model 1 and p?=?.002 for model 2). Groups A and B had significantly lower hazard ratios for subsequent fracture than group C. No significant differences were observed in the hazard ratios of recurrence and death among the three groups.CONCLUSIONS
Early bisphosphonate treatment in PVO patients with osteoporosis was associated with a significantly lower occurrence of subsequent vertebral fracture at adjacent vertebral bodies and lower occurrence of subsequent surgery. 相似文献20.
Alisson R. Teles Don Daniel Ocay Abdulaziz Bin Shebreen Andrew Tice Neil Saran Jean A. Ouellet Catherine E. Ferland 《The spine journal》2019,19(4):677-686