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1.
Jouët P Sabaté JM Maillard D Msika S Mechler C Ledoux S Harnois F Coffin B 《Obesity surgery》2007,17(4):478-485
Background Morbid obesity is a risk factor of nonalcoholic steatohepatitis (NASH). Obstructive sleep apnea (OSA) could also be an independent
risk factor for elevated liver enzymes and NASH. The relationships between liver injuries and OSA in morbidly obese patients
requiring bariatric surgery were studied prospectively.
Methods Every consecutive morbidly obese patient (BMI ≥40 kg/m2 or ≥35 kg/m2 with severe comorbidities) requiring bariatric surgery was included between January 2003 and October 2004. Polygraphic recording,
serum aminotransferases (ALT, AST), γ-glutamyltransferase (GGT) and liver biopsy were systematically performed. OSA was present
when the apnea–hypopnea index (AHI) was >10/h.
Results 62 patients (54 F; age 38.5 ± 11.0 (SD) yrs; BMI 47.8 ± 8.4 kg/m2) were included. Liver enzymes (AST, ALT or GGT) were increased in 46.6%. NASH was present in 34.4% and OSA in 84.7%. Patients
with OSA were significantly older (P = 0.015) and had a higher BMI (P = 0.003). In multivariate analysis, risk factors for elevated liver enzymes were the presence of OSA and male sex.The presence
of NASH was similar in patients with or without OSA (32.7% vs 44.4% of patients, P = 0.76).
Conclusion In this cohort of morbidly obese patients requiring bariatric surgery, one-third of patients had NASH, a prevalence similar
to previous studies. OSA was found to be a risk factor for elevated liver enzymes but not for NASH. 相似文献
2.
High Prevalence of Asymptomatic Esophageal Motility Disorders among Morbidly Obese Patients 总被引:4,自引:1,他引:3
Background: Morbid obesity is becoming more prevalent in the industrialized world. Few data exist regarding the resting lower
esophageal sphincter pressure (LESP) and esophageal motility in relationship to body mass index (BMI). Methods: During a 3-year
period, 111 of 152 morbidly obese patients seeking bariatric surgery completed esophageal manometric testing and questionnaire
regarding esophageal symptoms. Manometric parameters included wave amplitude and duration of esophageal contractions, percentage
of peristaltic function, and resting LESP. Questionnaire data included age, sex, medications, prior medical conditions, and
esophageal symptoms. Results: 88 (79%) of the patients were female; 23 (21%) were male. The mean age was 39.8 years (± 9.9),
the mean BMI was 50.7 kg/m2 (± 9.4). There was a lack of correlation between BMI and LESP (r = 0.04). Abnormal manometric
findings were observed in 68/111 (61%) patients: 28 (25%) had only hypotensive lower esophageal sphincter (LESP < 10 mm Hg);
16 (14%) had nutcracker esophagus (amplitude >180 mm Hg), 15 (14%) had nonspecific esophageal motility disorders, 8 (7%) had
diffuse esophageal spasm (DES), and 1 (1%) had achalasia. Patients with DES had a significantly higher BMI than those with
other motility disorders (P < 0.05). Dysphagia was reported in 7 (6%) patients and chest pain in 1 patient. Heartburn and/or
regurgitation (gastroesophageal reflux disease, GERD) was noted in 35 patients (32%), of whom 18 (51%) had a hypotensive resting
LES. 40 of 68 patients (59%) with abnormal motility tracings did not report any esophageal symptoms. Conclusion: Morbid obesity
per se does not imply an abnormality of LESP. In addition, a majority of morbidly obese patients who were considering bariatric
surgery had no esophageal symptoms but were found to have abnormal esophageal manometric patterns. These findings add support
to the suggestion that morbidly obese patients may have abnormal visceral sensation. 相似文献
3.
L Dumont MD M Mattys MD C Mardirosoff MD V Picard MD J L Allé MD J Massaut MD 《Obesity surgery》1997,7(4):326-331
Background: In nonobese patients, peritoneal insufflation has consistently been shown to influence parameters of preload and
afterload as well as cardiac output. Obese patients have an abnormal and particular cardiovascular status. The aim of this
study was to investigate the hemodynamic changes induced by an increase of intra-abdominal pressure in morbidly obese patients
(MOP). Methods: Standard general anesthetia was administered to 15 informed MOP (body mass index > 40 kg/m2) scheduled for laparoscopic gastroplasty. Hemodynamic parameters were measured by thermodilution through a pulmonary artery
catheter and through invasive blood pressure monitoring. Results: CO2 insufflation with an intra-abdominal pressure of 17 mmHg caused a significant increase of mean arterial pressure (MAP) (33%,
P = 0.005), mean pulmonary arterial pressure (MPAP) (40%, P = 0.001), pulmonary capillary wedge pressure (PCWP) (41%, P = 0.001), and central venous pressure (CVP) (55%, P = 0.001). The increase in diastolic filling pressures could be due to an increase in the filling volume or to a decrease
in diastolic compliance. Ventricular volumes were not measured but we speculate that the rise in CVP, PCWP and MPAP is due
to an increase in intrathoracic pressure as judged by the increase of pulmonary airway pressure. Stroke volume fell slightly
(11%, P = 0.008), because of a reduction in transmural pressure and a fall ineffective preload. Cardiac output rose slightly (16%,
P = 0.005) because of an increase in heart rate (15%, P = 0.014) probably induced by sympathetic stimulation, which only became fully operative after 15 minutes. Conclusions: When
compared to nonobese patients our obese patients tolerated the pneumoperitoneum surprisingly well, without experiencing fall
in cardiac output. The hemodynamic consequences of peritoneal insufflation seem to be different in obese and nonobese patients. 相似文献
4.
Case reports are presented on three patients treated for morbid obesity by vertical gastroplasty. Prior to surgery the patients
had diabetes which required insulin, up to 200 units per day, or oral hypoglycaemics for its control. Six months after surgery
the diabetes had been resolved in all three patients, and they were no longer dependent on medication. Subjective reports
from the patients suggests that their quality of life improved significantly. 相似文献
5.
Lutrzykowski M 《Obesity surgery》2008,18(12):1647-1648
Two morbidly obese patients are presented. The first patient is a 38-year-old superobese female with BMI 56.2 in a wheelchair
secondary to multiple sclerosis. The second patient is a 49-year-old female with BMI 47.7 confined to a wheelchair secondary
to spinal cord transection due to a motor vehicle accident. Both patients underwent an open duodenal switch procedure, which
provided significant weight loss and improved quality of life primarily for mobility with a wheelchair, as well as controlling
comorbidities. 相似文献
6.
Background The authors evaluated body image attitudes in post-obese persons following bariatric surgery who require cosmetic and body
contouring operations.
Methods We studied 20 morbidly obese women prior to biliopancreatic diversion (BPD) (OB group), 20 post-obese women at >2 years following
BPD (POST group), 10 post-obese women following BPD who required cosmetic procedures (POST-A group), 10 post-obese women after
BPD and subsequent cosmetic surgery (POST-B group), and 20 healthy lean controls. Attitudes to weight and shape were evaluated
by means of the Body Uneasiness Test (BUT).
Results In comparison with the obese patients in the POST group, lower BUT scores were observed, while in the POST-A group the values
were very similar to those observed in the non-operated obese individuals. In the individuals having received cosmetic surgery,
the BUT findings were similar to those recorded in the POST group patients, the values approaching data found in the controls.
Conclusion Despite a fully satisfactory weight loss and maintenance, the post-BPD individuals requiring aesthetic surgery showed some
disparagement of body image; in these subjects, cosmetic and body contouring procedures may actually improve body weight and
shape attitudes towards normality. 相似文献
7.
Cardiac weight was determined at autopsy in 27 morbidly obese, but otherwise healthy men (mean weight 168 kg) and women (mean
weight 138 kg) who died suddenly, prior to, or shortly after gastric restriction operations for relief of obesity. They had
lost no weight. Post-mortem examination revealed no cardiac or other pathology explaining the cause of death. Cardiac weight
was also measured in 25 men and women of equivalent baseline weight and body mass index who, after operation, subsisted on
a hypocaloric diet for 3-4 months after operation, but then died suddenly. Mean weight losses of this latter group were 45.8
kg in men and 32.9 kg in women. No cardiac abnormalities and no organic causes of death were found at autopsy. Decreases in
heart weight were calculated. The baseline measurements demonstrated that cardiac weight in the healthy obese rose with increasingly
severe obesity in both sexes, but the increase tended to lessen with more extreme obesity. The generally quoted figures of
cardiac weight as a fraction of body weight are 0.043 and 0.040% for men and women, respectively. In the group of morbidly
obese men, cardiac weight was 0.035% of body weight or 16% lower than predicted. In morbidly obese women, cardiac weight was
0.030% of body weight or 25% lower than predicted. In men, a 28% body weight reduction due to dietary restriction resulted
in a proportionately similar 20% decrease in cardiac weight. In contrast, in women after a 27% loss of body weight, cardiac
weight decreased only 5%. Severe dietary restriction with a drastic body weight loss did not result in a disproportionate
decrease of cardiac weight in either sex, when final body weight had remained above or in the normal range. 相似文献
8.
9.
Debra S Mason RN BA CNOR RNFA James A Sapala MD FACS Michael H Wood MD FACS M Andrew Sapala MD FACS 《Obesity surgery》1998,8(4):453-460
Background: Hypothermia during and after major abdominal surgery decreases host defenses, increases the incidence of coagulopathy
and may alter blood pressure, cardiac contractility and myocardial stability. Methods: We designed a prospective randomized
study to compare the benefits of a forced air warming system with warm blanket treatments in minimizing the effects of hypothermia
on 64 morbidly obese patients undergoing Roux-en-Y gastric bypass. Results: Patients in the forced air warming group (n = 32) had significantly higher perioperative body core temperature, lower central venous pressure and blood pressure readings,
lower incidence of shivering, less blood loss intraoperatively and achieved a higher post anesthesia Aldrete Score than those
patients in the warmed blanket group (n = 32). Conclusion: The forced air warming system is safe, cost effective and beneficial in minimizing the undesirable consequences
of hypothermia in morbidly obese patients undergoing Roux-en-Y gastric bypass. 相似文献
10.
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
11.
De Panfilis C Cero S Torre M Salvatore P Dall'Aglio E Adorni A Maggini C 《Obesity surgery》2007,17(6):792-799
Background The effectiveness of post-surgical weight loss in improving body image disturbance (BID) in morbidly obese patients is still
unclear. Providing multidimensional measures of BID and controlling for the effect of co-morbid eating psychopathology may
help to clarify this issue. This preliminary study explores whether 1) BID improves 1 year after laparoscopic adjustable gastric
banding (LAGB), and whether 2) such improvement is related to post-surgical BMI and/or eating disorder reduction. BID was
multidimensionally assessed by means of the Body Uneasiness Test(BUT).
Methods 35 obese subjects (mean BMI 45.5) were evaluated prior to and 1 year after LAGB using the BUT, and a standardized interview
and questionnaire to assess eating psychopathology. BID and eating habit changes during follow-up were also investigated.
Postoperative BUT values were entered as outcome measures (dependent variables) in a series of stepwise multiple regression
analyses; BMI and binge eating reduction, baseline BUT scores, gender, age, and age of onset of obesity were tested as independent
variables.
Results Some aspects of BID (body image overconcern and related avoidance behaviors, compulsive self-monitoring, and overall severity
of BID) improved following LAGB, while others (weight phobia, depersonalization, and uneasiness toward body parts) did not.
The post-surgical lower levels of the former were predicted by the overall decrease in binge eating symptoms, irrespective
of BMI reduction, age, gender, and age of onset of obesity.
Conclusions LAGB may ameliorate some BID aspects in morbidly obese patients, and an improvement in eating behaviors may contribute to
this effect. 相似文献
12.
Forty morbidly obese asthmatic patients who underwent gastric restrictive surgery more than 2 years earlier were evaluated
to determine the influence of weight loss on asthma outcome. Mean percentage excess weight loss in this group was 68% and
body mass index (BMI) fell from a mean of 46 to 30. Following surgery, 90% showed improvement in asthma symptoms. Complete
remission of asthma occurred in 48% and a further 12.5% became asthma free on reduced medications dosage. Of those taking
daily medications for asthma before surgery, 42% were completely off medication following weight loss surgery, and another
18.5% experienced fewer asthma attacks on reduced medication dosage. Of the 22 patients with severe asthma (> 10 attacks per
year) on routine daily medications for asthma preoperatively, 8(36%) required no medication after surgery, 7(32%) used medication
only on an ‘as-needed’ basis, and 7(32%) controlled their asthma on reduced medication dosage. Five patients gained weight
during the follow-up period. All developed an increased incidence of asthma attacks, which again abated after successfully
losing weight following revisional surgery. Coexistent factors of smoking and clinically apparent esophageal reflux were evaluated,
but no statistically significant correlation was shown with either smoking or reflux and improvement in asthma. Possible etiologies
of the improvement in asthma with weight loss are discussed. 相似文献
13.
Laparoscopic Cholecystectomy in Obese and Nonobese Patients 总被引:2,自引:1,他引:1
Gatsoulis N Koulas S Kiparos G Tzafestas N Pangratis K Pandis K Mavrakis G 《Obesity surgery》1999,9(5):459-461
Background: From November 1997 to November 1998, 145 cases of laparoscopic cholecystectomy (LC) have been attempted at the
District General Hospital of Corfu. Methods: 23 (15.8%) were obese (Group I, BMI >30) and 122 (84.2%) were nonobese patients
(Group II, BMI ≤30). One-fifth of these patients suffered from acute cholecystitis. Results: Operative time averaged 95 minutes
in Group 1 and 78 minutes in Group II. There were no deaths. There were no significant differences between the obese and nonobese
groups in conversion to open procedure (Group1: 0%, Group II: 2.4%), intraoperative and postoperative complications (Group
I: 4.3%, Group II: 4.0%), operating time, and length of postoperative hospitalization. Conclusion: LC was a safe and effective
treatment for obese patients with symptomatic cholelithiasis. 相似文献
14.
Fraccalvieri M Datta G Bogetti P Verna G Pedrale R Bocchiotti MA Boriani F Obbialero FD Kefalas N Bruschi S 《Obesity surgery》2007,17(10):1319-1324
Background Morbid obesity is associated with various co-morbidities. With the significant weight loss, new dysfunctions arise, and prior
body contour disorders start to severely affect the patient’s quality of life. The abdominal apron is generally the greater
and the first disturbance faced by the post-bariatric patient.
Methods The authors retrospectively reviewed their clinical experience in the treatment of those disorders through abdominoplasty.
The benefits in terms of relief of said disorders and drawbacks in terms of surgical complications are described.
Results 117 abdominoplasties were performed from January 2002 to December 2005 on patients who had lost significant weight.The tissue
removed ranged from 400 g to 10,500 g of adipose-cutaneous tissue (mean 2,276.5 g). Mean duration of the procedure was 4 hours
and 25 minutes, with a maximum of 7 and a minimum of 2 and 40. Complication rate was 50.43%.
Conclusion Abdominoplasty in the post-obese patient is an apparently simple procedure, which in fact causes a high rate of surgical complications.
The complication rate is higher than that of cosmetic abdominoplasties. Nevertheless, the improvement in quality of life following
such a procedure renders it a fundamental step in the rehabilitation of the formerly obese patient. 相似文献
15.
Relationship among Adiponectin, Adiponectin Gene Expression and Fatty Acids Composition in Morbidly Obese Patients 总被引:1,自引:0,他引:1
Hernandez-Morante JJ Milagro FI Larque E Lujan J Martinez JA Zamora S Garaulet M 《Obesity surgery》2007,17(4):516-524
Background he aim of this study was to examine the relationship between adiponectin plasma circulating levels and its gene expression
in two abdominal fat depots (subcutaneous and visceral) with the fatty acid composition of plasma and adipose tissue in morbidly
obese subjects.
Methods 20 patients (10 women and 10 men) were selected. All were morbidly obese (BMI ≥40 kg/m2) and admitted for gastric surgery. Plasma samples and adipose tissue from both subcutaneous and visceral regions were obtained.
Plasma adiponectin and adipose adiponectin expression were analyzed.
Results Adiponectin mRNA expression in the subcutaneous tissue was significantly higher (P = 0.048) than in visceral tissue. Circulating adiponectin values, were positively associated with the proportion of n-3 polyunsaturated fatty acids in plasma (r = 0.62, P = 0.002). The visceral depot showed greater statistical associations between adiponectin gene expression and fatty acids
profile, being saturated fatty acids associated with a decrease (r = −0.68, P = 0.015), whereas monounsaturated were related to an increase in this adipose region (r = 0.67, P = 0.017).
Conclusions e demonstrated significant associations between adipose tissue adiponectin gene expression and fatty acid composition. These
associations were more evident in relation to the visceral depot, an adipose tissue region highly implicated in the metabolic
syndrome. 相似文献
16.
17.
Fox SR 《Obesity surgery》1991,1(1):89-93
The dilemma with which every bariatric surgeon is confronted is: What to do with the inevitable failures? In vertical gastric partitioning, revising the gastroplasty results in a high second failure rate. In an effort to improve the Success rate in failed gastroplasty patients who request revisionary surgery, the biliopancreatic bypass (classic Scopinaro procedure) was carried out on 57 patients. They have been followed for up to 10 years. The long-term weight loss has averaged 69.4 lb, which is 87% of the pregastroplasty excess weight. The price paid by these patients, in terms of complications, has been significant. Twenty-two Percent have developed hypoalbuminemia with its accompanying peripheral edema; 24% have required i.v. hyperalimintation because Of malnutrition. Sixteen percent of the patients developed a late post-op bowel obstruction, one resulting in death. Osteomalacia, spontaneous fractures have occurred. The biliopancreatic diversion procedure (BPD) is an effective weight-loss operation in the failed gastroplasty patients, but a significant price must be paid in terms of careful follow-up, nutritional deficiencies, and rehospitalizations. 相似文献
18.
Pontiroli AE Fossati A Vedani P Fiorilli M Folli F Paganelli M Marchi M Maffei C 《Obesity surgery》2007,17(11):1492-1497
BACKGROUND: With bariatric restrictive procedures a major issue is predictors of clinical outcome; non-surgical (compliance) and psychological factors might play a role in long term-results of bariatric surgery. We evaluated a set of predictors of short-term and long-term clinical outcome including psychiatric and psychological variables, as well as measures of post-surgery compliance. METHODS: 172 consecutive patients undergoing laparoscopic adjustable gastric banding (LAGB) with a minimum of 12 months follow-up, were studied; before surgery they were administered the NIMH Diagnostic Interview Schedule (Version III-R, DIS III-R) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (Version 2.0, SCID-II). After surgery, patients were scheduled for visits at 2-week intervals for the first 2 months, at monthly intervals up to 1 year and 3-monthly intervals for 2 years; compliance with diet, rules, physical exercise, plus integrated compliance (sum of scores), and percentage of attendance at scheduled visits were recorded. Patients were contacted again at 36 and at 48 months. RESULTS: BMI, compliance, percentage of attendance at scheduled visits (positively), and narcissistic personality (negatively) were all associated with weight loss at 12, 24 (and 36 months). Percentage of attendance was also associated at 48 months. At stepwise regression analysis, BMI and integrated compliance predicted weight loss at 12, 24, and 36 months, while percentage of attendance at scheduled visits predicted weight loss at 48 months. Narcissistic personality predicted weight loss only at 12 months. CONCLUSION: Adherence to scheduled visits and compliance to recommended rules, more than personality disorders, predict success of LAGB, at least during the first 4 years. 相似文献
19.
Central blood flow and cardiac output are increased in most morbidly obese patients. This may be reflected in abnormal vessel
sizes. Other influences such as smoking, age, weight, vertebral size, hypertension and age at onset of obesity may also be
operative. Abdominal aorta and common iliac artery diameters were retrospectively measured on abdominal computer-assisted
axial tomography scans of 44 morbidly obese, vascular disease-free females prior to their bariatric surgery. They were compared
at standardized aortic and illiac levels with normal weight, similar age, control patients. There was no correlation between
patient body weight, body mass index, per cent excess body weight or age at onset of obesity versus any of the aortic or iliac
diameters. Pearson's correlation analysis of smoking, age and hypertension each showed a significant positive relationship
with aorto-iliac diameters (p<0.05). Vertebral coronal body widths revealed a significant correlation with age (p<0.05) but
not with body weight, aortic or iliac diameters at any level. We conclude that the aortic and iliac arterial diameters of
morbidly obese patients are significantly enlarged relative to normal weight controls. Smoking, age and hypertension also
appear to have some degree of influence on aorto-iliac diameters in morbidly obese middle-aged women. 相似文献
20.
Psychosocial Correlates of Psychopathology in a National Sample of the Morbidly Obese 总被引:3,自引:3,他引:0
Salvatore R Maddi PhD Deborah M Khoshaba PsyD Michelle Persico BA Felicia Bleecker BA Gregory VanArsdall BA 《Obesity surgery》1997,7(5):397-404
Background: Although several studies have documented the existence of psychopathology in the morbidly obese, there is disagreement
as to its extent and nature. The disagreement has been difficult to resolve because earlier studies have tended to use small,
regional samples, and diverse, unstandardized approaches to measuring psychopathology. Methods: To add clarity, the present
study utilized an unusually large, national sample, all subjects of which were administered a standardized, comprehensive
test of psychopathology (the MMPI-2), an intensive interview concerning psychosocial history, and a medical examination. Subjects'
scores on the MMPI-2 were compared to available norms. The psychosocial interview yielded information about families of both
origin and reference. Information about comorbidities, medications, and body mass index (BMI) were available from the medical
examinations. Multiple regression analyses were performed to determine the variables that best predicted psychopathology and
BMI. Results: The percentage of subjects whose MMPI-2 scores exceeded and approached psychopathological levels was in excess
of normative expectations. The 1,3,2 pattern of scale scores on this test expresses depressive disorder, with anxiety and
somatization features. Regression analyses showed that abuse of the subject and of substances in the family of origin positively
predicted, while education and number of children negatively predicted both psychopathology and BMI. Conclusions: Dysfunctionality
in the family of origin may lead to obesity through such regressive coping styles as stress eating, but this can be offset
by personal development and nurturance responsibilities. 相似文献