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1.
Johansson Hans-Erik Haenni Arvo Öhrvall Margareta Sundbom Magnus Zethelius Björn 《Obesity surgery》2009,19(5):601-607
Background Roux-en-Y gastric bypass (RYGBP) powerfully reduces type 2 diabetes (T2DM) incidence. Proinsulin predicts development of T2DM.
Adjustable gastric banding is associated with lowered proinsulin but after RYGBP information is scant.
Methods Twenty-one non-diabetic morbidly obese patients who underwent RYGBP surgery were evaluated before (baseline), at 12 months
(first follow-up), and at 42 months, range 36–50 (second follow-up), after surgery and compared to a control group, matched
at baseline regarding fasting glucose, insulin, proinsulin, alanine aminotransferase (ALT), high-density lipoprotein (HDL)
cholesterol, and body mass index (BMI).
Results In the RYGBP group, fasting serum proinsulin concentrations were markedly lowered from 13.5 to 3.5 pmol/l at first follow-up
and to 4.9 pmol/l at second follow-up (p < 0.001, respectively). Fasting insulin concentrations were reduced from 83.4 to 24.6 pmol/l at first follow-up (p < 0.001) and to 36.4 pmol/l at second follow-up (p < 0.01). ALT was lowered from 0.62 to 0.34 μkatal/l at first follow-up and continued to lower to 0.24 μkatal/l at second
follow-up (p < 0.001, respectively). The further decrease between first and second follow-up was also significant (p = 0.002). HDL cholesterol increased from 1.16 to 1.45 mmol/l at the first follow-up and continued to increase at second follow-up
to 1.58 mmol/l (p < 0.001, respectively). The further increase between first and second follow-up was also significant (p = 0.006). The differences between groups at first follow-up were significant for BMI, proinsulin, insulin, ALT, and HDL cholesterol
(p = 0.04–0.001).
Conclusion RYGBP surgery in morbidly obese patients is not only characterized by markedly and sustained lowered BMI but also lowered
concentrations of proinsulin, insulin, and ALT and increased HDL cholesterol.
An erratum to this article can be found at 相似文献
2.
Roth CL Reinehr T Schernthaner GH Kopp HP Kriwanek S Schernthaner G 《Obesity surgery》2009,19(1):29-35
Background Ghrelin and obestatin are derived from the same gene but have different effects: Ghrelin stimulates appetite, and previous—albeit
inconsistent—data show that obestatin may be involved in satiety. The present study was designed to test the hypothesis that
Roux-en-Y gastric bypass (RYGB) surgery and/or the weight loss that reliably results from this procedure would alter levels
of ghrelin and obestatin and ghrelin/obestatin ratios in a cohort of morbidly obese women.
Methods This is a longitudinal follow-up study in 18 morbidly obese women (mean weight 131.2 kg, mean body mass index [BMI] 47.4).
Clinical parameters and fasting serum concentrations of ghrelin, obestatin, triglycerides, low-density lipoprotein cholesterol,
glucose, and insulin were measured before and 2 years after RYGB surgery, which was associated with body weight reductions
of 41.5 ± 11.6 kg (mean 62.5% excess weight loss).
Results Ghrelin concentrations (−12%, p = 0.022) and ghrelin/obestatin ratios (−14%, p = 0.017) were lower after surgery than before, while obestatin levels did not change. Changes in ghrelin concentrations correlated
with changes in insulin levels (r = 0.45, p = 0.011). Most cardiovascular risk factors studied improved postsurgically (p < 0.01).
Conclusion In contrast to previous weight loss studies involving gastric banding, ghrelin levels decreased and obestatin levels remained
stable after massive weight loss in long-term follow-up. The favorable gastrointestinal hormone profiles observed are likely
to contribute to the long-term weight loss success rate attributed to RYGB.
C.L. Roth and T. Reinehr contributed equally to this work. 相似文献
3.
Gastro-Esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients before and after Bariatric Surgery 总被引:6,自引:6,他引:0
Merrouche M Sabaté JM Jouet P Harnois F Scaringi S Coffin B Msika S 《Obesity surgery》2007,17(7):894-900
Background Obesity is a predisposing factor to gastro- esophageal reflux disease (GERD), but esophageal function remains poorly studied
in morbidly obese patients and could be modified by bariatric surgery.
Methods Every morbidly obese patient (BMI ≥40 kg/m2 or ≥35 in association with co-morbidity) was prospectively included with an evaluation of GERD symptoms, endoscopy, 24-hour
pH monitoring and esophageal manometry before and after adjustable gastric banding (AGB) or Roux-en-Y gastric bypass (RYGBP).
Results Before surgery, 100 patients were included (84 F, age 38.4 ± 10.9 years, BMI 45.1 ± 6.02 kg/m2), of whom 73% reported GERD
symptoms. Endoscopy evidenced hiatus hernia in 39.4% and esophagitis in 6.4%. The DeMeester score was pathological in 53.3%;
69% of patients had lower esophageal sphincter (LES) pressure <15 mmHg and 7 had esophageal dyskinesia. BMI was significantly
related to the DeMeester score (P = 0.018) but not to LES tone or esophageal dyskinesia. Postoperative data were available in 27 patients (AGB n = 12/60, RYGBP
n = 15/36). The DeMeester score (normal <14.72) was significantly decreased after RYGBP (24.8 ± 13.7 before vs 5.8 ± 4.9 after;
P < 0.001) but tended to increase after AGB (11.5 ± 5.1 before vs 51.7 ± 70.7 after; P = 0.09), with severe dyskinesia in 2 cases. Conclusion: GERD and LES incompetence are highly prevalent in morbidly obese
patients. Preliminary postoperative data show different effects of RYGBP and AGB on esophageal function, with worsening of
pH-metric data with occasional severe dyskinesia after AGB. 相似文献
4.
Reinehr T Roth CL Schernthaner GH Kopp HP Kriwanek S Schernthaner G 《Obesity surgery》2007,17(12):1571-1577
Background Peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) are cosecreted in the same enteroendocrine L-cells of the gut and reported
to inhibit food intake additively. However, findings in human studies regarding these peptides are controversial. The aim
of this study was to analyze the relationships between fasting PYY, GLP-1, and weight status in morbidly obese patients before
and after surgically induced weight loss.
Methods Fasting GLP-1, PYY, glucose, and insulin concentrations; blood pressure; and body-mass index (BMI) were determined in 30 morbidly
obese adults (mean BMI 45.8, mean age 40 years) before bariatric surgery [Roux-en-Y gastric bypass (RYGB): n = 19; gastric banding (GB): n = 11] and after weight loss (mean 50% excess weight loss) in the course of mean 2 years.
Results GLP-1 concentrations decreased (mean −20 pg/ml; mean −38%; p = 0.001) and PYY concentrations increased (mean +19 pg/ml; mean +19%, p = 0.036) after bariatric surgery. The weight loss and changes of GLP-1 were significantly (p < 0.05) more pronounced after RYGB as compared to GB, whereas the changes of PYY did not differ significantly between the
patients who had undergone RYGB or GB.
Conclusions In morbidly obese adults reducing their weight by bariatric surgery, fasting PYY levels increased and GLP-1 concentrations
decreased independently of each other. Therefore, the relationship between PYY and GLP-1 seems more complicated than might
be anticipated from animal and in vitro studies.
T. Reinehr and C. L. Roth contributed equally to this work. 相似文献
5.
Background Roux-en-Y gastric bypass (RYGBP) has been found to be the most efficient way to lose weight and maintain the weight loss in
morbid obesity. However, with the formation of a new stomach and the modification of intestinal anatomy, there are significant
changes on bone metabolism. The objectives of this study were to evaluate effects of weight loss on bone metabolism after
Roux-en Y gastric bypass in patients with morbid obesity.
Methods Our study included 70 patients with morbid obesity; RYGB was done for all patients. Daily postoperative oral supplementation
with 1,000 mg of calcium and 800 IU of vitamin D was done for each patient. Body weight (BW), body mass index (BMI), total
body fat, total lean tissue mass, bone mineral content (BMC), bone mineral density (BMD), total bone area (TBA; using dual
energy X-ray absorptiometry), serum calcium, parathyroid hormone (PTH), 25-OH vitamin D, 24-h urinary calcium, and bone-specific
alkaline phosphatase (BSAP) were assessed preoperatively and 1 year after surgery.
Results In our study, females comprised 70% of cases. The mean age was 35 ± 8.8 years. One year after RYGB, BW decreased significantly
from 132.8 ± 26.5 to 90.3 ± 17.3 kg (p = 0.001). BMI decreased significantly from 48 ± 7.3 to 32.6 ± 4.1 kg/m2 (p = 0.001). BMC decreased significantly from 2,968.6 ± 71.4 to 2,700.8 ± 45.4 g (p = 0.001). BMD decreased significantly from 1.026 ± 0.03 to 1.22 ± 0.015 g/cm2 (p = 0.001). TBA decreased significantly from 2,356.2 ± 35.4 to 2,216.3 ± 43.5 cm2 (p = 0.001). Serum calcium, 24-h urinary calcium, and BSAP were not significantly decreased while 25-OH vitamin D and PTH were
not significantly increased after surgery.
Conclusions From this study, it is shown that RYGBP operation gives very good results as regards reduction of body weight in morbidly
obese patients. Postoperative supplementation with calcium and vitamin D partially corrects osteoporosis. Thus, these patients
need periodic follow-up for BMD, PTH, calcium, serum vitamin D, and markers of bone resorption and formation specially postmenopausal
female. 相似文献
6.
E. Pardina A. Lecube R. Llamas R. Catalán R. Galard J. M. Fort H. Allende V. Vargas J. A. Baena-Fustegueras J. Peinado-Onsurbe 《Obesity surgery》2009,19(8):1150-1158
Background Although bariatric surgery is currently the most common practice for inducing weight loss in morbidly obese patients (BMI > 40 kg/m2), its effect on the lipid content of adipose tissue and its lipases (lipoprotein lipase [LPL] and hormone-sensitive lipase
[HSL]) are controversial.
Methods We analyzed LPL and HSL activities and lipid content from plasma as well as subcutaneous (SAT) and visceral (VAT) adipose
tissue of 34 morbidly obese patients (MO) before and after (6 and 12 months) Roux-en-Y gastric bypass surgery and compare
the values with those of normal weight (control) patients.
Results LPL activity was significantly higher in MO (SAT = 32.9 ± 1.0 vs VAT = 36.4 ± 3.3 mU/g tissue; p < 0.001) than in control subjects (SAT = 8.2 ± 1.4 vs VAT = 6.8 ± 1.0 mU/g tissue) in both adipose depots. HSL activity had
similar values in both types of tissue (SAT = 32.8 ± 1.6 and VAT = 32.9 ± 1.6 mU/g) of MO. In the control group, we found
similar results but with lower values (SAT = 11.9 ± 1.4 vs VAT = 12.1 ± 1.4 mU/g tissue). Twelve months after surgery, SAT
LPL activity diminished (9.8 ± 1.4 mU/g tissue, p < 0.001 vs morbidly obese), while HSL (46.6 ± 3.7 mU/g tissue) remained high. All lipids in tissue and plasma diminished
after bariatric surgery except plasma nonesterified fatty acids, which maintained higher levels than controls (16 ± 3 vs 9 ± 0 mg/dL;
p < 0.001, respectively).
Conclusions When obese patients lose weight, they lose not only part of the lipid content of the cells but also the capacity to store
triacylglycerides in SAT depots.
E. Pardina and A. Lecube contributed equally to this study.
J.A. Baena-Fustegueras and J. Peinado-Onsurbe share senior authorship. 相似文献
7.
Garcia-Fuentes E Garrido-Sanchez L Garcia-Almeida JM Garcia-Arnes J Gallego-Perales JL Rivas-Marin J Morcillo S Cardona I Soriguer F 《Obesity surgery》2008,18(11):1424-1429
Background The impact of bariatric surgery on levels of peptide YY (PYY) and ghrelin is still under discussion. We undertook a simultaneous
evaluation of the serum changes in PYY and ghrelin depending on the specific type of bariatric surgery.
Methods Total PYY and ghrelin were analyzed in 29 healthy persons and in morbidly obese persons undergoing open biliopancreatic diversion
(BPD) of Scopinaro (n = 38) or laparoscopic Roux-en-Y gastric bypass (RYGB; n = 13).
Results RYGB resulted in a significantly greater loss of weight and body mass index than BPD. Both RYGB and BPD were associated with
a significant increase in PYY, significantly greater for BDP (p = 0.001). Ghrelin rose significantly after RYGB (p = 0.022) but not after BPD. After surgery, PYY correlated positively with weight (r = 0.416, p = 0.009). Ghrelin did not correlate significantly with any of the variables studied. Analysis of variance showed that only
the type of surgery contributed significantly to explain the variances in the PYY (p = 0.002) and ghrelin (p = 0.018).
Conclusions BPD results in a greater increase in PYY and a lower weight loss than RYGB. However, only RYGB was associated with a significant
increase in ghrelin. The differing weight loss according to the type of bariatric surgery does not seem to be explained by
changes arising in PYY and ghrelin. 相似文献
8.
Background Obesity has been widely recognized as a chronic inflammatory condition and associated with elevated inflammatory indicators
including C-reactive protein (CRP) and white blood cell count (WBC). Recent studies have shown elevated CRP or WBC is a significant
risk factor for cardiac events and stroke but the clinical significance of CRP and WBC has not been clearly studied in morbidly
obese patients. This study is aimed at the clinical significance of WBC and CRP in morbidly obese patients and the change
after bariatric surgery.
Methods The study was a prospectively controlled clinical study. From December 1, 2001 to January 31, 2006, of 640 (442 females and
198 males) consecutive morbid obese patients enrolled in a surgically supervised weight loss program with at least 1 year’s
follow-up were examined.
Results Of the patients, 476 (74.4%) had elevated CRP and 100 (15.6%) had elevated WBC at preoperative study. CRP and WBC were significantly
related and both increased with increasing body mass index (BMI). CRP is also increased with increasing waist, glucose level,
hemoglobin, albumin, Ca, insulin, C-peptide, and metabolic syndrome while WBC is increased with metabolic syndrome but decreased
with increasing age. Multivariate analysis confirmed fasting glucose level and hemoglobin are independent predictors of the
elevation of CRP while age is the only independent predictor for elevated WBC. Both WBC and CRP levels decreased rapidly after
obesity surgery. These improvements resulted in a 69.8% reduction of CRP and 26.4% reduction of WBC 1 year after surgery.
Although individuals who underwent laparoscopic gastric bypass lost significantly more weight (36.8 ± 11.7 kg vs. 17.3 ± 10.8 kg;
p = 0.000) and achieved a lower BMI (27.8 ± 4.6 vs. 35.0 ± 5.5; p = 0.000) than individuals who underwent laparoscopic gastric banding, there was no difference in the resolution of elevated
CRP 1 year after surgery (95.9% vs. 84.5%; p = 0.169) and WBC (99.4% vs. 98.3%; p = 0.323).
Conclusions Both baseline WBC and CRP are elevated in morbid obese patients but CRP has a better clinical significance. Significant weight
reduction 1 year after surgery markedly reduced CRP and WBC with a resolution rate of 93.9% and 98.2% separately. Obesity
surgery performed by laparoscopic surgery is recommended for obese patients with elevated CRP or WBC. 相似文献
9.
10.
Jean J. Bao Vikas Desai Katherine Kaufer Christoffel Patrick Smith-Ray Alex P. Nagle 《Obesity surgery》2009,19(7):833-839
Background Clinical experience suggests that some adults who undergo bariatric surgery have children who are obese. Childhood obesity
is associated with increased morbidity and mortality in later life. This study examined the prevalence of obesity among children
and grandchildren (≤12 years of age) of adult bariatric surgery patients.
Methods Patients in a prospective database of morbidly obese patients who underwent bariatric surgery between January 2004 and May
2007 were recruited by phone and in clinic. Patient demographics, body mass index (BMI) at surgery, and survey data were collected.
The survey included questions regarding their child/grandchild's body habitus, weight, and height. Child obesity was defined
as BMI percentile ≥95. Statistical significance was set at p < 0.05.
Results One hundred twenty-two patients were enrolled in this study (77% women, mean BMI 49 kg/m2). One hundred thirty-four out of 233 children/grandchildren identified had complete data; 41% had a BMI percentile ≥95. Only
29% of these obese children were so identified by the adult respondents. Significantly more biological children/grandchildren
were obese than nonbiological (p = 0.013), and significantly more biological children were obese than biological grandchildren (p = 0.027).
Conclusions This sample of bariatric surgery patients had a high proportion of obese preteen children/grandchildren. Obesity was most
prevalent among biological children (vs. biological grandchildren and nonbiological children). Patients often did not recognize
the degree of overweight in their children/grandchildren. Because families of bariatric surgery patients often include obese
children, interventions aimed at all family members merit consideration. 相似文献
11.
Background Early postoperative hemorrhage is an infrequent complication of both laparoscopic and open Roux-en-Y gastric bypass (RYGBP).
The objective of our study is to review the incidence and management of this complication and identify contributing clinical
and technical risk factors.
Methods Over a 3-year period, 1,025 patients underwent RYGBP at our institution. The medical records of patients who required postoperative
blood transfusions were reviewed for clinical presentation, diagnostic evaluation and management. These patients were matched
for surgical approach (open vs. laparoscopic) in a 1:3 ratio and compared to a random group of patients who underwent RYGBP
during the same time period.
Results Thirty-three patients (3.2%) were diagnosed with postoperative hemorrhage, 17 (51.5%) of which were intraluminal. The incidence
of hemorrhage was higher in the laparoscopic group (5.1% vs. 2.4%, p = 0.02). Comparing bleeders to nonbleeders, the average BMI, gender distribution, gastro-jejunostomy anastomotic technique
(stapled vs. hand sewn) and the postoperative administration of ketorolac were not significantly different. The bleeding group
was older (47.5 vs. 42.8, p = 0.02), had a longer hospital stay (4.9 vs. 3 days, p = 0.0001) and was more likely to have received low molecular weight heparin (LMWH) preoperatively (p = 0.03). Hemorrhage occurred earlier (13.8 vs. 25.9 h, p = 0.039) and was more severe (4.1 vs. 2.3 transfused blood units, p = 0.007) in the patients who required surgical reexploration (n = 9).
Conclusions A laparoscopic approach and the preoperative administration of LMWH may increase the incidence of early hemorrhage after RYGBP.
This complication frequently requires surgical reexploration and significantly prolongs the hospital stay.
Oral presentation and 1st prize winner, Bariatric surgery competition, CTACS meeting, November 2006.
Poster presentation at the New England Surgical Society meeting, September 2007. 相似文献
12.
Mejía-Rivas MA Herrera-López A Hernández-Calleros J Herrera MF Valdovinos MA 《Obesity surgery》2008,18(10):1217-1224
Background Gastroesophageal reflux disease (GERD) is a common condition in obesity. The impact of Roux-en-Y gastric bypass (RYGBP) on
GERD is poorly known. We studied the effect of the RYGBP on GERD in patients with morbid obesity (MO).
Methods Twenty consecutive patients with MO (BMI > 40 kg/m2) were studied before and 6 months after RYGBP. GERD symptoms were evaluated with Carlsson–Dent questionnaire (CDQ). All the
patients underwent esophageal manometry and ambulatory 24-h pH-metry. Chi-square test was used to compare categorical variables,
and Wilcoxon test was used for numerical variables. A p value under 0.05 was considered significant.
Results There were 16 women (80%) and 4 men (20%) with mean age 38.9 ± 6.9 years included in this study. BMI was 48.5 ± 6.2 kg/m2 and 33.2 ± 4.5 kg/m2 before and after RYGBP, respectively. Mean weight reduction was 42.5 ± 9.7 kg (p < 0.001). Reflux symptoms measured by CDQ and esophageal acid exposure improved significantly after RYGBP. The percentage
of time of pH < 4 was 10.7 ± 6.7 before and 1.6 ± 1.2 after the surgical procedure (p < 0.001). LES basal pressure before and after the RYGBP was 18 ± 11 and 20.1 ± 5.6 mmHg (p = 0.372), and the esophageal body amplitude was 104.2 ± 47.2 and 75.1 ± 36.2 mmHg, respectively (p = 0.005).
Conclusion RYGBP improves GERD symptoms and reduces esophageal acid exposure in patients with MO. 相似文献
13.
Santiago-Recuerda A Gómez-Terreros FJ Caballero P Martin-Duce A Soleto MJ Vesperinas G Pérez-Fernández E Villamor J Alvarez-Sala R 《Obesity surgery》2007,17(5):689-697
Background The authors studied changes in the upper airway in morbidly obese women and the relationship to sleep apnea-hypopnea syndrome
(OSAS).
Methods Patients underwent a cardiorespiratory polygraphic study, respiratory function test (spirometry, plethysmography, maximum
inspiratory pressures and arterial blood gas analysis), and computed tomographic studies of the upper airway.
Results 40 morbidly obese women being evaluated for bariatric surgery (mean age 39.6 ± 9.6 years old, BMI 48.7 ± 5.6 kg/m2) were studied. 37 women had OSAS, and 14 had severe OSAS. Results on respiratory function tests were normal. BMI and weight
had a positive correlation with apnea-hypopnea index (AHI), apnea index (AI), desaturation index (DI), lowest oxygen saturation
and CT90. Uvula diameter had a negative correlation with FEV1, FVC, VC IN and a positive correlation with TLC. Retropharynx soft tissue at the retropalatal level had a negative correlation
with FEV1, FVC and VC IN. The oropharynx area at maximal inspiration (total lung capacity) obtained a negative correlation with the
AHI (r = −0.423, P = 0.044), AI (r = −0.484, P = 0.042) and DI (r = −0.484, P = 0.019).
Conclusions Prevalence of OSAS in morbidly obese women is very high. Our results show the significant correlation between BMI and AHI
in morbidly obese women. Uvula diameter and retropharynx soft tissue are the upper airway parameters with higher relationship
with pulmonary function. A reduction in the cross-sectional area of the airway at the level of the oropharynx could be related
to the severity of OSAS in morbidly obese women. 相似文献
14.
Genevieve B. Melton Kimberley E. Steele Michael A. Schweitzer Anne O. Lidor Thomas H. Magnuson 《Journal of gastrointestinal surgery》2008,12(2):250-255
Although Roux-en-Y gastric bypass surgery (RYGBP) is safe and effective at achieving weight loss in the majority of severely
obese patients, a subset fails to achieve expected weight loss outcomes. Factors associated with poor weight loss are not
well defined. Patients undergoing open RYGBP using a standardized surgical technique and clinical pathway by a single surgeon
at a dedicated bariatric center were reviewed. Suboptimal weight loss was defined as failure to lose at least 40% excess body
weight by 12 months postoperatively. Of 555 consecutive patients who underwent RYGBP from 1999 to 2004, a 12-month follow-up
was available for the 495 (89%). Suboptimal weight loss occurred in 55 (11%) and was associated on unadjusted bivariate analysis
with increased body mass index (BMI; p = 0.0002), diabetes mellitus (p = 0.0002), Medicaid insurance (p = 0.04), and male sex (p = 0.01). On adjusted multivariate analysis, increased BMI (p = 0.003), diabetes (p = 0.002), and male gender (p = 0.04) were associated with suboptimal weight loss, but type of insurance (p = 0.11) was not. Medicaid patients were younger (p = 0.01) and had higher BMI (p = 0.0002). Suboptimal weight loss after RYGBP appears to be associated with greater BMI, male sex, and diabetes but not type
of insurance. This study may help identify patients who could benefit from increased perioperative education and counseling
or selection of procedures with greater malabsorption.
Presented at the 48th Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington DC, May 19–24, 2007. 相似文献
15.
Pardina E Baena-Fustegueras JA Catalán R Galard R Lecube A Fort JM Allende H Vargas V Peinado-Onsurbe J 《Obesity surgery》2009,19(7):894-904
Background The types and sources of lipid deposition in the liver of most patients with morbid obesity, as well as the effects of bariatric
surgery, are discussed.
Methods In 26 patients with morbid obesity who underwent bariatric surgery, we analyzed different kinds of lipids and hepatic lipase
(HL) from both plasma and liver biopsies performed 12–18 months after surgery.
Results The HL activity and HL-mRNA in morbidly obese (MO) livers were high (258 ± 17 mU/g, and 4.5-fold, respectively); after surgery,
the activity decreased (137 ± 15 mU/g, p < 0.001) but not the levels of HL-mRNA (4.3-fold). Plasma HL activity was also high (4.31 ± 0.94 mU/mL plasma), and it decreased
during weight loss (2.01 ± 0.29 mU/mL, p < 0.01); moreover, it correlated (r = 0.3694, p < 0.05) with decreased liver HL activity. Adrenocorticotropic hormone in MO was higher (27 ± 3 pg/mL) than after surgery
(13 ± 1 pg/mL, p < 0.001). All hepatic and plasma lipids were significantly increased in MO patients, but, after bariatric surgery, most of
those parameters recovered or normalized. Liver HL activity correlated with total and esterified cholesterol (r = 0.4399, p < 0.001 and r = 0.4395, p < 0.01, respectively).
Conclusion High HL in MO patients could allow for liver intake of cholesterol that could be re-exported to steroidogenic organs to synthesize
steroidal hormones. A decrease of plasma HL during weight loss could be a good index for improvement of liver disease. 相似文献
16.
Alcalde OL Duce AM Bustos FA Torres RF Huarte MG González JG Pérez CG 《Obesity surgery》2011,21(2):173-178
To study the evolution of the bone mass by ultrasonic transmission after biliopancreatic diversion. Forty eight morbid obese
patients were prospectively studied during 36 months following the Larrad biliopancreatic diversion. The bone metabolism was
studied by PTHi and the urinary pirydinolines. The bone mass by echography and bone densitometry, which correlate to the levels
of PTHi and pyridinolines. After 3 years the bone mass decreased from 50.15 +/− 7.31 kg/m2, preoperatively, to 34.03 +/− 4.53 kg/m2 (p < 0.001). There was an increase of the PTHi value (from 71.4 +/− 79.6 to 91.65 +/− 43.06 pg/ml) (p = 0.01), and the urinary pirydinolines (from 7.93 +/− 4.06 an 11.4 +/− 10.12 nM/mM) (p < 0.05). The ultrasonic transmission speed increased (from 1,990.93 +/− 62.38 to 2,035.25 +/− 53.98 m/s). However, the bone
mineral content (BMC) did not show changes (from 3,016.5 +/− 562.8 to 2,909.6 +/− 304.2 g), as well as the Bone Mineral Density
(BMD) (of 1,174.2 +/− 98.8 g/cm2). Neither correlation was found between the BMD (r = 0.212; p = 0.6), the BMC (r =−0.125; p = 0.768), and the T-score (r = 0.592, p = 0.093). The study of the bone mass through ultrasonic transmission speed revealed low sensitivity during the assessment
of the morbid obese patients. A percentage of cases of osteopenia were observed despite the fact that they are not reflected
in the bone content or in the bone mass. Ultrasonic evaluation of bone mass has no value in the morbidly obese, by the clear
negative correlation between ultrasound velocity and thickness of soft tissue. 相似文献
17.
Background The metabolic syndrome is associated with significant cardiovascular morbidity and mortality. We assessed the in-hospital
outcomes of bariatric surgery in morbidly obese patients with the metabolic syndrome in comparison to a control group without
the metabolic syndrome.
Methods Using ICD-9-CM diagnosis and procedure codes, clinical data for 20,242 patients with and without the metabolic syndrome who
underwent bariatric surgery over a 5-year period were obtained from the University HealthSystem Consortium database.
Results The prevalence of the metabolic syndrome among bariatric surgery patients was 27.4%. Patients with the metabolic syndrome
presented significantly higher overall morbidity as compared to morbidly obese patients without the metabolic syndrome (8.6%
vs. 5.8%; p < 0.01), and similar mortality (0.04% vs. 0.01%; p = 0.2) after bariatric surgery. Hispanics with the metabolic syndrome had the highest morbidity rates, and men had the uppermost
mortality. In-hospital bariatric surgery outcomes were significantly improved among patients who underwent laparoscopic adjustable
gastric banding.
Conclusions The data suggest that the presence of the metabolic syndrome affects inter-ethnic and gender-specific short-term outcomes
after bariatric surgery. 相似文献
18.
Ulderico Freo Michele Carron Federico Innocente Mirto Foletto Donato Nitti Carlo Ori 《Obesity surgery》2011,21(7):850-857
Monitoring depth of anesthesia may improve anesthetic dosing and postanesthetic recovery in obese patients. Sixty morbidly
obese patients undergoing laparoscopic adjustable gastric bandage (LAGB) were randomly assigned to receive anesthesia with
sevoflurane titrated by either standard clinical parameters (SCP) (target = baseline hemodynamic parameters ± 20%) or by A-line
ARX index (AAI) (target = 20 ± 5). Heart rate, arterial blood pressure, inspiratory and expiratory gas concentrations, and
AAI were recorded in all patients at 5-min intervals, but AAI was made available only to the anesthesiologist assigned to
AAI-monitored patients. Emergence times in surgery room and recovery times in postanesthesia care unit (PACU) were recorded
at 1- and 30-min intervals. Mean intraoperative values of AAI were higher in AAI-monitored than in SCP-monitored patients
(22.5 vs 15.0, p = 0.001). Compared to SCP monitoring, AAI monitoring reduced consumption of sevoflurane by 20% (p = 0.014), times to eye opening by 2.4 min (p = 0.001) and to extubation by 2.5 min (p = 0.009) and to achieve SpO2 92% in room air by 17 min (p = 0.001). Aldrete scores were higher in AAI- than in SCP-monitored patients at arrival in PACU (p = 0.035), but Aldrete scores ≥9 were attained in similar times. AAI monitoring can improve titration of and recovery from
sevoflurane for LAGB. 相似文献
19.
Gastroesophageal Reflux in Patients with Morbid Obesity: A Role of Obstructive Sleep Apnea Syndrome?
Sabaté JM Jouët P Merrouche M Pouzoulet J Maillard D Harnois F Msika S Coffin B 《Obesity surgery》2008,18(11):1479-1484
Background Obesity is a risk factor for gastroesophageal reflux disease (GERD) and for obstructive sleep apnea (OSA). Our aim was to
evaluate in morbidly obese patients the prevalence of OSA and GERD and their possible relationship.
Methods Morbidly obese patients [body mass index (BMI) >40 or >35 kg/m2 in association with comorbidities] selected for bariatric surgery were prospectively included. Every patient underwent a
24-h pH monitoring, esophageal manometry, and nocturnal polysomnographic recording.
Results Sixty-eight patients [59 women and 9 men, age 39.1 ± 11.1 years; BMI 46.5 ± 6.4 kg/m2 (mean ± SD)] were included. Fifty-six percent of patients had an abnormal Demester score, 44% had abnormal time spent at
pH <4, and 80.9% had OSA [apnea hypopnea index (AHI) >10] and 39.7% had both conditions. The lower esophageal sphincter (LES)
pressure was lower in patients with GERD (11.6 ± 3.4 vs 13.4 ± 3.6 mm Hg, respectively; P = 0.039). There was a relationship between AHI and BMI (r = 0.337; P = 0.005). Patients with OSA were older (40.5 ± 10.9 vs 33.5 ± 10.4 years; P = 0.039). GERD tended to be more frequent in patients with OSA (49.1% vs 23.1%, respectively; P = 0.089). There was no significant relationship between pH-metric data and AHI in either the 24-h total recording time or
the nocturnal recording time. In multivariate analysis, GERD was significantly associated with a low LES pressure (P = 0.031) and with OSA (P = 0.045) but not with gender, age, and BMI.
Conclusion In this population of morbidly obese patients, OSA and GERD were frequent, associated in about 40% of patients. GERD was significantly
associated with LES hypotonia and OSA independently of BMI. 相似文献
20.
Gómez-Ambrosi J Pastor C Salvador J Silva C Rotellar F Gil MJ Catalán V Rodríguez A Cienfuegos JA Frühbeck G 《Obesity surgery》2007,17(5):585-591
Background Impaired fasting glucose (IFG) is a prediabetic state defined as a fasting plasma glucose (FPG) between 100 and 125 mg/dl.
However, individuals in this group do not exhibit the same atherogenic risk.
Methods The atherogenic profile of subjects with IFG >110 mg/dl (IFG110, n = 96) or <110 mg/dl (IFG100, n = 131) were compared and
the potential differential impact of the waist circumference analyzed. In addition, the same clinical variables were measured
in 18 morbidly obese patients (8 males, 10 females; BMI 45.3 ± 1.9 kg/m2) before and after weight loss following Roux-en-Y gastric bypass (RYGBP), in order to analyze the influence of the reduction
in waist circumference on the improvement of the metabolic risk factors.
Results Individuals in the IFG110 group showed decreased HDL-cholesterol levels together with an increased total cholesterol to HDL
ratio (TC/HDL), accompanied by elevated homocysteine concentrations and white blood cell (WBC) count, and higher waist circumference
(P < 0.05 for all). Significant correlations between waist circumference and HDL-cholesterol (r = −0.200, P < 0.05), TC/HDL (r = 0.190, P < 0.05), WBC count (r = 0.299, P < 0.05), and QUICKI (r = −0.375, P < 0.0001) were observed. An almost 3-fold increase in the prevalence of T2DM in subjects in the IFG110 group as compared
to IFG100 was observed. In the group of patients who underwent RYGBP, the reduction in waist circumference was significantly
associated with the improvement in insulin sensitivity as evidenced by the QUICKI index (r = −0.582, P < 0.05) and the reduction in TC/HDL (r = 0.595, P < 0.05).
Conclusion Waist circumference is related to metabolic risk factors associated with increased levels of IFG. Our data support that individuals
with IFG >110 mg/dl and a high waist circumference should undergo an OGTT to exclude the presence of diabetes. 相似文献