Prevalence and degree of sexual dysfunction in a sample of women seeking bariatric surgery

BackgroundSexual functioning has been shown to be impaired in women who are obese, particularly those seeking bariatric surgery. However, most previous studies evaluating sexual function in these populations have not used validated measures. We used the validated Female Sexual Function Index (FSFI) to assess the prevalence of female sexual dysfunction (FSD) in a sample of >100 women evaluated for bariatric surgery.MethodsThe FSFI was administered to reportedly sexually active women during their preoperative evaluation. The scores for the individual FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) ranging from 0 (or 1.2) to 6 were summed to produce a FSFI total score (range 2–36). A FSFI total cutoff score of ≤26.55 was used to identify participants with FSD. The participants' FSFI total and domain scores were compared with previously published norms available for women diagnosed with female sexual arousal disorder and healthy controls.ResultsOf the 102 women, 61 (59.8%) had FSFI total scores of ≤26.55, indicative of FSD. Older age and menopause were associated with FSD. Compared with published norms, bariatric surgery candidates had FSFI domain scores that were lower than those of the control group (all P values < 0.0001) but greater than those of the female sexual arousal disorder group (all P values < 0.0001), except for desire, for which the scores were similar.ConclusionWomen seeking bariatric surgery are clearly a population with substantial sexual function impairment, with 60% of participants reporting FSD. These findings highlight the need to initiate routine assessment of sexual functioning in this population and examine whether the weight loss after bariatric surgery contributes to a reversal of FSD.     

Expressions of vaginal endothelial nitric oxide synthase and phosphodiesterase 5 in female sexual dysfunction: a pilot study

Introduction and hypothesis

The objective was to investigate the expression of endothelial nitric oxide synthase (eNOS) and phosphodiesterase (PDE) 5 in vaginal tissue of premenopausal women experiencing stress urinary incontinence (SUI) with and without sexual dysfunction.

Methods

Women presenting for treatment of SUI were screened using the Female Sexual Function Index (FSFI) and 10 were selected who met the criteria for female sexual dysfunction (FSD) and 10 asymptomatic controls. Vaginal tissue specimens were obtained from those premenopausal women aged ≥40 years who had had sexual activity ≥2 times every month for the last 6 months and who were scheduled to undergo surgery for SUI. FSD criteria was FSFI scores <18 and arousal domain scores <3. The control group had FSFI scores ≥26 and individual domain scores ≥4. The expressions of eNOS and PDE 5 were compared in the two groups using immunofluorescence staining and western blotting.

Results

The mean total FSFI scores were 30.4?±?2.6 and 15.3?±?2.3 in the control and FSD groups respectively. In immunofluorescence staining, eNOS and PDE5 were localized in the vaginal epithelium. In western blotting, the expressions of eNOS and PDE5 were significantly lower in the FSD group than in the control group (p?=?0.003 and p?=?0.038 respectively).

Conclusions

eNOS and PDE5 in the vagina may play important roles in the pathophysiology of FSD.

     

Changes in fat-free mass and muscle mass at 6 and 12 months after biliopancreatic diversion with duodenal switch surgery

BackgroundBariatric surgery is associated with concomitant loss in both fat and muscle masses. Literature on muscle composition/quality after bariatric surgery is limited.ObjectivesTo measure and compare the changes in fat-free mass with the changes in muscle composition after biliopancreatic diversion with duodenal switch surgery (BPD/DS).SettingBariatric surgery is associated with concomitant loss in both fat and muscle masses. Literature on muscle composition/quality after bariatric surgery is limited.MethodsForty patients underwent BPD/DS and 22 patients are considered as controls. Bioelectrical impedance analysis (body composition) and computed tomography scan at the midthigh and abdominal levels (muscle composition) were performed at baseline, 6, and 12 months.ResultsAt 6 and 12 months, the BPD/DS group displayed significant reduction in weight (12 months: −46.6 ± 13.5 kg) and fat-free mass (12 months: −8.2 ± 4.4 kg; both P < .001). A significant reduction in abdominal (−15 ± 8%, P < .001) and midthigh muscle areas (−18 ± 7%, P < .001) was observed during the first postoperative 6 months, followed by a plateau after 6 months (abdominal: −1 ± 5%, midthigh: −1 ± 4%, both P > .05). At 6 months, both midthigh fat-infiltrated muscle (−22 ± 10%, P < .001) and normal-density muscle (−16 ± 9%, P < .001) areas decreased. Further reduction at 12 months was only observed in the fat-infiltrated muscle (−11 ± 8%, P < .001) in comparison with an increase in the normal-density muscle area (5 ± 8%, P = .001). There was no significant change for the control group.ConclusionsReduction in muscle, assessed with computed tomography scans, occurs mostly during the first 6 months postoperatively after BPD/DS. Focus on muscle quantity as well as quality, using precise imaging methods, instead of quantifying total body lean mass, is likely to provide better assessment in body content modulation after BPD/DS.     

Relationship Between Inflammation and Sex Hormone Profile in Female Patients Receiving Different Types of Renal Replacement Therapy

Background

Patients with end-stage renal disease (ESRD) experience female sexual dysfunction (FSD). The purpose of this study was to compare FSD in different types of renal replacement therapy and control patients.

Methods

The study was consisted of 47 renal transplantation (RT), 46 hemodialysis (HD), and 28 continuous ambulatory peritoneal dialysis (CAPD) patients and 36 healthy control subjects. All groups were evaluated with the following scales: Female Sexual Function Index (FSFI) questionnaire, Short Form (SF)–36 questionnaires, and Beck Depression Inventory (BDI). Demographic data, laboratory values, and hormone levels were obtained. The patients with FSFI score <26.55 were accepted as experiencing sexual dysfunction.

Results

Overall, total FSFI scores in RT, HD, CAPD, and control were 22 (range, 2–35), 22.4 (4–34), 18.35 (2–34), and 29.6 (2–35), respectively. The mean total FSFI score was not different in patients receiving different kinds of renal replacement therapy (P > .05) although they were significantly worse then the control group (P < .001). On regression analysis, age was significantly associated with FSD (β = −0.14; P = .001). In addition, the physiologic health domain of SF-36 was significantly better in control groups (P < .001). The difference in terms of mean of BDI score did not reach statistical significance among patient groups (P > .05). Female sexual dysfunction score was negatively correlated with BDI (r = −0.371; P < .001) and positively correlated with the mental-physical components score of SF-36 (r = 0.423 [P < .001] and r = 0.494 [P < .001], respectively) in all patients groups. Regarding the hormones of the patients, there was a significant difference between RT and the HD and CAPD groups in dihydroepiandrosterone sulfate (DHEAS; P < .001), RT and HD in prolactin (P < .001), and RT and CAPD in free testesterone (P < .001).

Conclusions

Renal transplantation, hemodialysis, and peritoneal dialysis patients were at more risk of developing sexual dysfunction and lower quality of life scores than healthy subjects. Notably, the mode of renal replacement therapy had no impact on female sexual function.     

Assessment of female sexual function and quality of life in predialysis,peritoneal dialysis,hemodialysis, and renal transplant patients

Introduction  Chronic renal failure (CRF) and renal replacement treatments have a negative effect on sexual function and quality of life (QoL). The literature on female sexual dysfunction (FSD) in patients with CRF is limited. The aim of this study is to compare the sexual function and QoL in predialysis (PreD), dialysis, and transplant patients. Materials and methods  A total of 106 women including 21 PreD, 45 dialysis, 20 renal transplantation (Tx), and 20 control patients were enrolled in the study. The Female Sexual Function Index (FSFI) and SF-36 scales were used to assess all patients, and demographic and clinical variables were documented. The FSFI and QoL scale scores were compared among the groups. Results  The rates of FSD were 50, 81, 66.7, 75, and 50% in the control, PreD, peritoneal dialysis (PD), hemodialysis (HD) and Tx patients respectively. Total FSFI scores for desire, arousal and orgasm scores in the PreD group were significantly lower than those in Tx and control patients (P < 0.05). Physical components of QoL in CRF patients were significantly worse than in the control group (P < 0.0001). On logistic regression analysis, age, glucose and creatinine were significantly associated with FSD. Conclusion  This preliminary study documented that Tx is the most effective way to retain good sexual function in women, and a diagnosis of FSD should be made routinely in CRF patients.     

Effects of C358A missense polymorphism of the endocannabinoid degrading enzyme fatty acid amide hydrolase on weight loss and cardiovascular risk factors 1 year after biliopancreatic diversion surgery

BackgroundBariatric surgery is the most effective long-term treatment of morbid obesity and also results in a reduction of obesity-associated co-morbidities. We investigated the role of the polymorphism (C358A) of the fatty acid amide hydrolase gene on the clinical outcomes 1 year after biliopancreatic diversion in morbidly obese patients.MethodsA total of 67 morbidly obese patients (body mass index >40 kg/m²) underwent biliopancreatic diversion. Their weight, blood pressure, basal glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at the baseline visit and at each follow-up visit. The frequency of the metabolic co-morbidities was recorded at each visit.ResultsOf the 67 patients, 46 (68.7%) had genotype C358C (wild-type group) and 21 (10.3%) had genotype C358A (mutant-type group). In the wild- and mutant-type groups, the body mass index, weight, waist circumference, systolic blood pressure, and glucose, total cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations decreased, without statistical significance between the 2 groups. The initial percentage of weight loss at 9 months and 1 year of follow-up was greater in the mutant-type group (9 months, 22.1% versus 28.8%, P <.05; and 1 year, 28.3% versus 36.4%, P <.05).ConclusionThe allele A358 of fatty acid amide hydrolase was associated with a better initial percentage of excess weight loss 9 and 12 months after biliopancreatic diversion.     

Need for parenteral iron therapy after bariatric surgery

BackgroundMalabsorptive bariatric procedures such as Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch expose the patient to malnutrition and commonly cause iron deficiency. The optimal replacement and monitoring method remain undetermined. To identify high-risk patients who might need intravenous iron supplementation after bariatric surgery, we evaluated bariatric surgery patients who received parenteral iron at a university hospital-affiliated hematology center.MethodsWe performed a retrospective analysis and reviewed the records of 165 patients who had received parenteral iron from May 2004 to June 2007. Of the 165 patients, 42 bariatric surgery patients were identified. The type of bariatric procedure and menstrual status of the patients were compared.ResultsThe average patient age was 40 years. Of the 42 patients, 2 were men and 40 were women. Of the 40 women, 32 were premenopausal and 8 were postmenopausal. The patients in the biliopancreatic diversion/duodenal switch group had a significantly lower hemoglobin at presentation (P = .02), relatively lower ferritin levels, and required more additional parenteral iron treatment after the initial resolution of anemia (P = .001). The premenopausal women required earlier parenteral replacement (P = .008) and were at a greater risk of anemia-related hospitalization (P = .00033).ConclusionThe available published studies lack any data regarding parenteral iron replacement needs after bariatric surgery. Our results have identified the need for long-term parenteral iron replacement therapy after malabsorptive bariatric procedures, especially in premenopausal women. Patients who do not respond to oral iron therapy should be referred early for parenteral iron replacement therapy to prevent anemia-related complications and to maintain patients' quality of life. Iron monitoring should continue indefinitely even after the initial repletion of iron stores and the resolution of anemia.     

Sexual Dysfunction in Postmenopausal Women with Breast Cancer on Adjuvant Aromatase Inhibitor Therapy

IntroductionThe aim of this study was to investigate whether postmenopausal women with breast cancer (BC) on adjuvant aromatase inhibitor (AI) therapy have a higher prevalence of female sexual dysfunction (FSD). Second, the aim was to determine the quality of life (QoL) and level of anxiety depending on whether or not they are AI users.MethodsA prospective cross-sectional study involving 168 patients was performed. Three questionnaires were carried out: sexual functioning was evaluated with the Female Sexual Function Index (FSFI), while the EORTC QLQ-BR23 measures to study QoL in patients with BC and the State-Trait Anxiety Inventory (STAI) questionnaire (trait and status) were used to assess anxiety status in patients under treatment with AIs or not.Results47.6% (80/168) of the postmenopausal BC survivors were not sexually active (mean time after surgery: 48.6 months) despite a relatively low mean age (56.43 years). Postmenopausal AI-treated women had significantly worse sexual function as measured by the FSFI (23.40 ± 5.26 vs. 30.16 ± 2.24; p = 0.000). There were significant differences between both groups in all domains, except orgasm. The QoL score was 37.67 ± 7.38 in AI users versus 39.00 ± 1.44 among nonusers (p = 0.053). Patients under endocrine treatment also presented STAI scores significantly higher (25.83 ± 4.99 vs. 19.00 ± 7.12; p = 0.000). Trait anxiety was high in both groups, but this was not statistically significant.ConclusionsWe observed a high prevalence of sexual inactivity among BC survivors regardless of AI use. Patients with AI use presented significantly higher prevalence of FSD, worse QoL, and greater anxiety.     

Duodenal switch improved standard biliopancreatic diversion: a retrospective study

BackgroundThis was a retrospective study, performed 10 years after surgery, to compare the results between biliopancreatic diversion (BPD) with distal gastrectomy (DG) versus BPD with duodenal switch (DS).MethodsComplete follow-up data were available for 96% of patients, allowing a comparison of weight loss, revision, side effects, and complications at 10 years.ResultsAfter BPD-DS, weight loss was 25% greater than after BPD-DG (46.8 ± 21.7 kg versus 37.5 ± 22 kg, respectively; P <.0001). The need for revision decreased from 18.5% to 2.7% (P <.0001), and the prevalence of vomiting during the previous month was 50% less (23.7–50.6%, P <.0001) after BPD-DS compared with after BPD-DG. Late complications were the same for both procedures. Blood analysis showed that, after BPD-DS, the levels of calcium, iron, and hemoglobin were significantly greater and the parathyroid hormone level was lower than after BPD-DG (71.3 ± 44.2 versus 103.0 ± 64.0 ng/L, respectively; P <.0001).ConclusionThe DS greatly improved the BPD, as it was initially proposed. The use of the DS increased weight loss, decreased the need for revision, resulted in fewer side effects, and improved the absorption of nutrients.     

The relationship between female sexual function index domains and premature ejaculation

Purpose

The aim of this prospective, observational study was to investigate the relationship between premature ejaculation (PE) and female sexual response cycle, using the female sexual function index (FSFI). The FSFI evaluates female sexual function in six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.

Methods

All men were considered to have PE if they fulfilled the criteria of the second Ad Hoc International Society for Sexual Medicine (ISSM) Committee. All men were also assessed by the Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculatory latency time (IELT) using stopwatch which was held by the partner. All women completed the FSFI.

Results

A total of 181 couples who had regular sexual intercourse with one partner for the past 6 months were enrolled the study. By the definition of ISSM Committee, there were 117 men with PE and 64 men without PE. Partners of men with PE had significantly lower total FSFI scores than did partners of men without PE (21.8?±?3.5 for PE and 26.4?±?3.1 for non-PE, p?<?0.001). Moreover, all the domains of the FSFI scoring system were separately associated with PE. According to the mean FSFI scores, the 48.43% of women had sexual dysfunction in the non-PE group, and all women had sexual dysfunction in PE group.

Conclusion

PE is associated with female sexual dysfunction and all of the female sexual dysfunction domains, as determined by FSFI scores.

     

Hormone changes and diabetes resolution after biliopancreatic diversion and laparoscopic sleeve gastrectomy: a comparative prospective study

BackgroundBiliopancreatic diversion (BPD) is the most effective bariatric procedure in terms of weight loss and remission of diabetes type 2 (T2DM), but it is accompanied by nutrient deficiencies. Sleeve gastrectomy (SG) is a relatively new operation that has shown promising results concerning T2DM resolution and weight loss. The objective of this study was to evaluate and compare prospectively the effects of BPD long limb (BPD) and laparoscopic SG on fasting, and glucose-stimulated insulin, glucagon, ghrelin, peptide YY (PYY), and glucagon-like peptide-1 (GLP-1) secretion and also on remission of T2DM, hypertension, and dyslipidemia in morbidly obese patients with T2DM.MethodsTwelve patients (body mass index [BMI] 57.6±9.9 kg/m²) underwent BPD and 12 (BMI 43.7±2.1 kg/m²) underwent SG. All patients had T2DM and underwent an oral glucose tolerance test (OGTT) before and 1, 3, and 12 months after surgery.ResultsBMI decreased more after BPD, but percent excess weight loss (%EWL) was similar in both groups (P = .8) and T2DM resolved in all patients at 12 months. Insulin sensitivity improved more after BPD than after SG (P = .003). Blood pressure, total and LDL cholesterol decreased only after BPD (P<.001). Triglycerides decreased after either operation, but HDL increased only after SG (P<.001). Fasting ghrelin did not change after BPD (P = .2), but decreased markedly after SG (P<.001). GLP-1 and PYY responses during OGTT were dramatically enhanced after either procedure (P = .001).ConclusionsSG was comparable to BPD in T2DM resolution but inferior in improving dyslipidemia and blood pressure. SG and BPD enhanced markedly PYY and GLP-1 responses but only SG suppressed ghrelin levels.     

Minimally Invasive Kidney Transplantation Had Better Cosmetic Effect and Comparable Safety: A Randomized Controlled Trial

PurposeTo prospectively evaluate short-term outcomes between a novel minimally invasive kidney transplantation (MIKT) technique and conventional kidney transplantation (CKT).Materials and MethodsFrom March 2018 to February 29, 2019, 148 patients were randomized into MIKT and CKT groups. All patients were followed up for 12 months.ResultsThe MIKT group had a significantly shorter incision length (5.6 ± 0.4 vs 11.4 ± 0.4 cm, P < .001). There was no difference in operation time, blood loss, acute rejection, infection, and wound dehiscence between MIKT and CKT groups. Both groups had comparable pain scores and analgesic requirements in the first 3 days after transplantation and comparable renal function at 12 months. The MIKT group had higher satisfaction than the CKT group during follow-up (9.3 ± 0.3 vs 8.1 ± 0.5, P < .001; 9.5 ± 0.2 vs 8.5 ± 0.3, P < .001; 9.4 ± 0.3 vs 8.5 ± 0.3, P < .001; 9.2 ± 0.3 vs 8.5 ± 0.4, P = .003 for posttransplant months 1, 3, 6, and 12, respectively). The MIKT group had a significantly lower Vancouver Scar Scale score (4.1 ± 0.4 vs 5.2 ± 0.5, P < .001; 4.3 ± 0.4 vs 6.1 ± 0.4, P < .001; 5.2 ± 0.6 vs 6.7 ± 0.5, P < .001; 7.7 ± 0.7 vs 8.9 ± 0.5, P = .009 for posttransplant months 1, 3, 6, and 12, respectively).ConclusionsMIKT has demonstrated equivalent safety and improved patient satisfaction compared to CKT. This technique may be an appropriate choice for selected patients.     

Can stronger pelvic muscle floor improve sexual function?

Introduction and hypothesis

This study aims to evaluate the association between pelvic floor muscle (PFM) strength and sexual functioning.

Methods

Retrospective chart review of consecutive all women who were referred with a primary complaint of sexual dysfunction. Women underwent standardized clinical evaluation including pelvic muscle strength which was ranked from 0 (weak) to 2 (strong). The duration of pelvic muscle contraction was also recorded in seconds. Sexual function was evaluated by using a validated questionnaire, the Female Sexual Function Index (FSFI).

Results

One hundred seventy-six women with a mean age of 37?±?11 years were included. Women with strong or moderate PFM scored significantly higher on the FSFI orgasmic and arousal domains than women with weak PFM (5.4?±?0.8 vs. 2.8?±?0.8, and 3.9?±?0.5 vs. 1.7?±?0.24, respectively; P?<?0.001). The duration of PFM contraction was correlated with FSFI orgasmic domain and sexual arousal (r?=?0.26, P?<?0.001; r?=?0.32, P?<?0.0001, respectively).

Conclusions

Our findings suggest that both the orgasm and arousal function are related to better PFM function.     

Effect of laparoscopic gastric bypass surgery on urinary incontinence in morbidly obese women

BackgroundMorbid obesity is an independent risk factor for urinary incontinence (UI) that tends to be underreported. A validated, reliable, self-administered, easy-to-use questionnaire was used to determine the effect of laparoscopic gastric bypass (LGB) surgery on UI in morbidly obese women.MethodsWe prospectively evaluated 470 morbidly obese women seeking bariatric surgery with the International Consultation on Incontinence Questionnaire Short Form. The International Consultation on Incontinence Questionnaire Short Form was given to female patients at their initial consultation and at 3 and 12 months after LGB to assess both UI symptoms and quality of life. Data are expressed as the mean ± standard deviation.ResultsThe preoperative prevalence of UI was 66% (n = 309) and included 21% urge, 33% stress, and 46% mixed UI. For the 58 patients with UI who underwent LGB and completed a follow-up International Consultation on Incontinence Questionnaire Short Form, a reduction occurred in the total symptom score from 7.6 ± 4 preoperatively to 3.0 ± 4 and 1.8 ± 4 (P < .001) at 3 and 12 months after LGB, respectively. The corresponding quality-of-life scores improved from 3.2 ± 3 to 1.0 ± 2 and 0.4 ± 2 (P < .001). The UI had resolved in 64% and improved overall in 92% of patients at 1 year after LGB. An improvement in UI was found within 3 months after LGB with as little as 30 lb of weight loss.ConclusionUI is a common co-morbidity in the morbidly obese and was prevalent in two thirds of female patients presenting for bariatric surgery evaluation. LGB with resultant weight loss significantly improved the UI symptoms and quality of life.     

Weight loss is more sustained after biliopancreatic diversion with duodenal switch than Roux-en-Y gastric bypass in superobese patients

BackgroundAlthough biliopancreatic diversion with duodenal switch (BPD-DS) is not the most performed procedure, Roux-en-Y gastric bypass (RYGB) is challenged by weight regain and insufficient weight loss, especially in patients with a body mass index >50 kg/m². The aim of our retrospective study was to compare the weight loss after 2 types of primary bariatric surgery. A total of 83 BPD-DS and 97 RYGB procedures were performed from March 2002 to October 2009 for an initial mean body mass index of 55 kg/m².MethodsAll RYGB patients underwent surgery at a private practice hospital and BPD-DS patients underwent surgery at a university hospital before February 2007 and at the same private hospital thereafter. The patients were seen in follow-up every 4 months the first year, every 6 months the second, and yearly thereafter. The maximum weight loss was assessed, as well as the weight regain beyond the first postoperative year. Weight loss success was defined as a percentage of excess weight loss (%EWL) of ≥50%.ResultsThe patients did not differ by age, gender, or length of follow-up (mean 46 mo, range .5–102 for RYGB and 44.3 mo, range 9–111 for BPD-DS). Of the patients, 17 RYGB and 7 BPD-DS patients were lost to follow-up within 3 years postoperatively. At 3 years of follow-up, the mean %EWL was 63.7% ± 17.0% after RYGB and 84.0% ± 14.5% after BPD-DS (P < .0001). Weight loss success was achieved by 83.5% of the RYGB and 98.7% of the BPD-DS patients (P = .0005).ConclusionAfter 12 months postoperatively, the number of patients regaining 10% of the weight lost during the first postoperative year was significantly greater after RYGB than after BPD-DS.     

Micronutrient and physiologic parameters before and 6 months after RYGB

BackgroundBariatric surgery is considered an effective method for sustained weight loss, but may cause various nutritional complications. The aim of this study was to evaluate the nutritional status of minerals and vitamins, food consumption, and to monitor physiologic parameters in patients with obesity before and 6 months after Roux-en-Y gastric bypass surgery (RYGB).MethodsThirty-six patients who had undergone RYGB were prospectively evaluated before and 6 months after surgery. At each phase their weight, height, body mass index (BMI), Electro Sensor Complex (ES Complex) data, food consumption, and total protein serum levels, albumin, prealbumin, parathyroid hormone (PTH), zinc (Zn), B12 vitamin (VitB12), iron (Fe), ferritin, copper (Cu), ionic calcium (CaI), magnesium (Mg), and folic acid were assessed.ResultsThe mean weight loss from baseline to 6 months after surgery was 35.34±4.82%. Markers of autonomic nervous system balance (P<.01), stiffness index (P<.01), standard deviation of normal-to-normal R-R intervals (SDNN) (P<.01), and insulin resistance (P<.001) were also improved. With regard to the micronutrients measured, 34 patients demonstrated some kind of deficiency. There was a high percentage of Zn deficiency in both pre- (55.55%) and postoperative (61.11%) patients, and 33.33% of the patients were deficient in prealbumin postoperatively. The protein intake after 6 months of surgery was below the recommended intake (<70 g/d) for 88.88% of the patients. Laboratory analyses demonstrated an average decrease in total protein (P<.05), prealbumin (P = .002), and PTH (P = .008) between pre- and postsurgery, and a decrease in the percentage of deficiencies for Mg (P<.05), CaI (P<.05), and Fe (P = .021).ConclusionDespite improvements in the autonomic nervous system balance, stiffness index markers and insulin resistance, we found a high prevalence of hypozincemia at 6 months post-RYGB. Furthermore, protein supplements were needed to maintain an adequate protein intake up to 6 months postsurgery.     

Preinductive use of clonidine and ketamine improves recovery and reduces postoperative pain after bariatric surgery

BackgroundIn obese patients, concomitant use of clonidine and ketamine might be suitable to reduce the doses and minimize the undesired side effects of anesthetic and analgesic drugs. In this study, we evaluated the perioperative effects of administration of clonidine and ketamine in morbidly obese patients undergoing weight loss surgery at a university hospital in Rome, Italy.MethodsA total of 50 morbidly obese patients undergoing open biliopancreatic diversion for weight loss surgery were enrolled. The patients were randomly allocated into a study group (n = 23) receiving a slow infusion of ketamine-clonidine before anesthesia induction and a control group (n = 27) who received standard anesthesia. The hemodynamic profile, intraoperative end-tidal sevoflurane and opioid consumption, tracheal extubation time, Aldrete score, postoperative pain assessment by visual analog scale, and analgesic requirements were recorded.ResultsThe patients in the study group required less end-tidal sevoflurane, lower total doses of fentanyl (3.8 ± 0.3 γ/kg actual body weight versus 5.0 ± 0.2 γ/kg actual body weight, respectively; P <.05) and had a shorter time to extubation (15.1 ± 5 min versus 28.2 ± 6 min, P <.05). The Aldrete score was significantly better in the postanesthesia care unit in the study group. The study group consumed less tramadol than did the control group (138 ± 57 mg versus 252 ± 78 mg, P <.05) and had a lower visual analog scale score postoperatively during the first 6 hours.ConclusionThe preoperative administration of low doses of ketamine and clonidine at induction appears to provide early extubation and diminished postoperative analgesic requirements in morbidly obese patients undergoing open bariatric surgery.     

Sexual function in women with coronary artery disease: a preliminary study

We investigated sexual function in female patients with coronary artery disease (CAD). A total of 20 consecutive female patients (38.2+/-3.8 years) with CAD diagnosed by coronary angiography and 15 healthy subjects (37.9+/-5.4 years) were enrolled in this study. The Female Sexual Function Index (FSFI) was used to assess sexual function in all the participants. Women with psychiatric disorders, gynecologic and systemic diseases that may affect sexual function were excluded from the study. The other exclusion criteria were usage of antidepressants and drugs affecting sexual function. Patients with CAD and healthy women were comparable in age, body mass index and education level. Female sexual dysfunction (FSD) was diagnosed in 12 of 20 women with CAD (60%), whereas five of 15 healthy women (33.3%) were found to have FSD (P<0.05). Patients with CAD had a significantly lower number of sexual intercourse episodes per month than healthy women volunteers (2.24 versus 5.2, respectively; P<0.05). The FSFI total score was clearly significantly decreased in the CAD group compared with that in healthy controls (17.8+/-2.9 and 26.0+/-4.8, P=0.001). When the subscores of each domain of FSFI were evaluated, all the subscores of FSFI, except the satisfaction domain, in patients with CAD were significantly lower than those of healthy subjects (P<0.05). This preliminary study demonstrates that female patients with CAD have distinct sexual dysfunction compared with healthy controls. Women with CAD should be evaluated also in terms of sexual function to provide better quality of life.     

Effects of Modified Biliopancreatic Diversion on Glucose Tolerance of GK Rats

Background

The purpose of this study was to investigate the hypoglycemic effect of new biliopancreatic diversion and duodenal–jejunal bypass in Goto–Kakizaki rats and observe effects of the new surgical procedure on the glucose tolerance of GK rats.

Methods

Twenty-four 10-week-old rats (SPF grade) were randomly divided into groups A, B, and C, each with eight rats. Group A underwent duodenal–jejunal bypass, group B underwent modified biliopancreatic diversion, and group C underwent a sham operation. Median rat body weight, fasting blood glucose, OGTT, and blood lipids were measured in fasting 1 week before surgery and 1, 2, 4, and 8 weeks after surgery. Changes in gastric inhibitory polypeptide, glucagon P-like peptide-1, and insulin levels were measured by ELISA 1 week before surgery and 8 weeks after surgery.

Results

Rats’ mean body weight in groups A and B decreased significantly from 368.025?±?11.726 and 373.100?±?9.859 g preoperatively to 345.750?±?11.403 and 343.260?±?12.399 g at the early postoperative stage (P?<?0.05), and with statistically significant differences compared to the weight of rats in group C (P?<?0.05). Comparisons between fasting blood glucose before surgery and 8 weeks after surgery revealed no significant differences between all three groups (P?>?0.05). Glucose tolerance in groups A and B decreased from preoperative 21.175?±?3.684 and 20.820?±?1.671 mmol/L to postoperative 8.950?±?0.580 and 10.500?±?1.509 mmol/L, and both were better than that of group C (P?<?0.001).

Conclusions

Both new biliopancreatic diversion and duodenal–jejunal bypass improve glucose tolerance of Goto–Kakizaki rats.     

Prospective observational study of the impact of vaginal surgery (pelvic organ prolapse with or without urinary incontinence) on female sexual function

Introduction and hypothesis

There is a difference of opinion in the literature as to whether pelvic organ prolapse (POP) is a direct cause of female sexual dysfunction (FSD). Sexual function in women is negatively impacted by the presence of urinary symptoms. Thus, sexual dysfunction (SD) might be improved, unchanged, or worsened by pelvic floor surgery.

Methods

In this study, we observed SD and impact of surgical intervention on female sexual function (FSF) using a validated Prolapse/Urinary Incontinence Sexual Questionnaire Short Form (PISQ-12) in women undergoing surgery for POP with or without urinary incontinence. Two hundred women were recruited and followed up at 6 and 12 months postoperatively.

Results

Sexual function (SF) as measured by the PISQ-12 improved after surgery irrespective of the nature of surgery or the patient’s past gynaecology history. Improvement in SF was seen by 6 months (97 patients) postsurgery (P < 0.05), after which (at 12 months; 80 patients) no further change was observed. Improved SF was associated with better patient satisfaction postoperatively.

Conclusions

Sexual function improved in women following surgery for POP with or withour urinary incontinence, irrespective of the nature of surgery and the patient’s past gynecologic history. Results of this study will assist when counselling women with POP with or without urinary incontinence regarding treatment options.