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101.
Severe Protein-Calorie Malnutrition after Bariatric Procedures 总被引:1,自引:0,他引:1
Faintuch J Matsuda M Cruz ME Silva MM Teivelis MP Garrido AB Gama-Rodrigues JJ 《Obesity surgery》2004,14(2):175-181
Background: Serious nutritional complications after Roux-en-Y gastric bypass (RYGBP) are infrequent. In a retrospective study
of patients operated during a 68-month period, malnutrition was investigated to analyze circumstances associated with nutritional
failure. Methods: In 236 consecutive RYGBPs, 11 patients with severe malnutrition were identified (4.7%) with age 45.1 ± 10.6
years (10 females/1 male) and initial BMI 54.6 ± 8.4 kg/m2. Results: In these 11 patients, the derangement was diagnosed 17.9 ± 15.8 months after RYGBP, following defined events in
63.6% (gastric stenosis, associated diseases ) or mostly exaggeration of expected symptoms in 36.4% (vomiting without endoscopic
abnormalities). BMI then was 31.4 ± 8.6 kg/m2 (42.5 ± 9.9% total reduction, or 2.4 ± 2.1% decrease/month), and serum albumin and hemoglobin were 24.0 ± 8.2 g/L and 97.0
± 23.0 g/L respectively. Edema was present in 45.4% (5/11), hospitalization was required in 54.5% (6/11), and 18.2% (2/11)
eventually died. Conclusions: Serious malnutrition was unusual but not exceedingly rare in this series. Exogenous precipitating
factors were clearly identified in 63.6% of the patients. Careful clinical and nutritional follow-up is recommended to prevent
these uncommon but potentially dangerous complications. 相似文献
102.
Outcome of Pregnancies after Biliopancreatic Diversion 总被引:4,自引:0,他引:4
Background: Severe obesity has deleterious effects on fertility and pregnancy outcomes. Although surgery is the best long-term treatment
for severe obesity, there is a risk of gestational undernutrition in operated mothers because bariatric surgery reduces nutrient
availability. This is a follow-up report of our initial findings regarding pregnancy and neonatal outcomes in biliopancreatic
diversion (BPD) patients, with addition of a new cohort of children born to mothers after BPD. Methods: All women (n = 916) who had successfully undergone BPD in our hospital were mailed a questionnaire containing multiple-choice
and essay questions concerning gynecologic and obstetric history, and pregnancy and neonatal outcomes in both preoperative
and postoperative pregnancies. Patients operated between 1984 and 1995 (n = 568) were mailed an additional questionnaire regarding
children's weight and height progress, and school performance. Perinatal records from our patients' obstetric clinics were
also reviewed. Results: The questionnaire was completed by 783 women (85.5%). 251 postoperative pregnancies in 132 women resulted in 166 infants
by 109 mothers. 47.0% of patients who were unable to become pregnant preoperatively were successful postoperatively. 90 out
of 109 women (82.6%) reported an appropriate weight gain (9.1 ± 5.9 kg) during postoperative pregnancies. The incidence of
fetal macrosomia decreased from 34.8 to 7.7%, with a concomitant increase in normalweight babies from 62.1 to 82.7%. The elevated
miscarriage rate (26.0%) in these obese women persisted after surgery. Conclusion: Major weight loss following BPD improves the reproductive function of severely obese women. BPD provides major beneficial
effects for both mother and child, including normalization of gestational weight changes, reduction of fetal macrosomia, and
normalization of the infant's birth-weight. Our results speak in favor of delaying pregnancy in obese women until after the
substantial surgical weight loss has occurred. 相似文献
103.
Silvestre V Ruano M Domínguez Y Castro R García-Lescun MC Rodríguez A Marco A García-Blanch G 《Obesity surgery》2004,14(9):1227-1232
Background: Morbid obesity (MO) and the pathologies associated with it constitute an important public health problem, accounting
for 7% of the health expenditure in industrialized countries. An important percentage of this expense is attributed to the
different biochemical tests performed in these patients, who suffer from several metabolic derangements. We evaluated the
basic biochemical abnormalities in MO patients and their reversibility by weight loss after gastric bypass, to standardize
the surveillance of the different metabolic abnormalities in obese patients. Methods: By a retrospective analysis on 125 patients
operated in our hospital, we evaluated anthropometric and biochemical data before and 1, 3, 6, 12 and 24 months after gastric
bypass. Results: Preoperatively hyperinsulinemia, hyperglycemia, dyslipidemia and hypertensive disease were present, and began
to improve 1 and 3 months after surgery (although not significantly) and significantly at 6, 12 and 24 months after it. We
also observed deficient protein nutrition and a deficiency of micronutrients both before bypass and during the follow-up.
Conclusion: After gastric bypass, a marked decrease in insulin occurred, with normalization of blood pressure and the biochemical
parameters associated with the metabolic syndrome. We propose a biochemical follow-up protocol for MO patients. 相似文献
104.
Hong D Khajanchee YS Pereira N Lockhart B Patterson EJ Swanstrom LL 《Obesity surgery》2004,14(6):744-749
Background: Obesity is an epidemic in the USA. Many disorders are associated with obesity including gastroesophageal reflux
disease (GERD). However, the prevalence of GERD and esophageal motility disorders in the morbidly obese population is unclear.
Methods: During evaluation for bariatric surgery, 61 morbidly obese patients underwent preoperative 24-hr pH and esophageal
manometry. A single reviewer evaluated all 24-hr pH and manometric tracings. Johnson-DeMeester score >14.7 was considered
diagnostic of GERD. Manometric criteria for motility disorders were from published values. All values are given as mean ±
SD. Results: Mean age was 44.4 + 10.3 years. 55 of the patients (90%) were female. Mean BMI was 50.1 ± 7.2 kg/m2. 23 patients (38%) complained of GERD symptoms (reflux and/or heartburn). 1 patient (2%) complained of noncardiac chest pain.
Mean Johnson-DeMeester score was 19.6 ± 17.8. Mean intragastric and intrabolus pressures were both elevated (8.3 ± 1.6 mmHg
and 15 ± 9 mmHg). 33 patients (54%) had abnormal manometric findings: 10 had a mechanically defective LES, 11 had a hypertensive
LES, 2 had diffuse esophageal spasm, 3 had nutcracker esopha gus,1 had ineffective esophageal disorder and 14 had nonspecific
esophageal motility disorder. Some patients had more than one disorder. 20 patients (33%) had significantly elevated (>180
mmHg) contraction amplitudes at the most distal channel (210.0 ± 28.7 mmHg). Conclusions: Prevalence of manometric abnormalities
in the morbidly obese is high. Presence of a nut cracker-like distal esophagus in the morbidly obese is significant and warrants
further evaluation. 相似文献
105.
Despite the current opinion that leptin can no longer be seen as a hormone which could be used therapeutically to prevent
an energy surplus (it rather protects the organism for an energy deficit), leptin may still have an impact in clinical medicine.
Leptin was shown to have several important functions. The pleiotropic properties of leptin include a regulatory function in
the immune system. Reviewing the effects of leptin on different parts of the immune system reveals that the immune system
is deregulated in an environment low in leptin. A strong reduction in leptin levels occurs in situations of starvation as
seen after bariatric surgery. We postulate the hypothesis that the starvation-induced postoperative decrease of leptin is
causative of the more serious course of complications observed after bariatric surgery. 相似文献
106.
The Decrease in Plasma Ghrelin Concentrations following Bariatric Surgery Depends on the Functional Integrity of the Fundus 总被引:7,自引:3,他引:4
Frühbeck G Diez-Caballero A Gil MJ Montero I Gómez-Ambrosi J Salvador J Cienfuegos JA 《Obesity surgery》2004,14(5):606-612
Background: Gastric bypass surgery, which involves the production of a reduced stomach pouch,has been shown to markedly suppress
circulating ghrelin concentrations. Since bypassing the ghrelin-producing cell population may be relevant to the disruption
of fundic-derived factors participating in food intake signaling, the effect of weight loss induced by either adjustable gastric
banding (AGB), Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion (BPD) was studied. Methods: 16 matched obese
patients [35.0 + 2.4 years; initial body weight 124.8 ± 5.7 kg; body mass index (BMI) 47.1 ± 2.2 kg/m2] in whom similar weight loss had been achieved by either AGB (n=7), RYGBP (n=6) or BPD (n=3) were studied. Blood was obtained
for biochemical and hormonal analyses. Body composition was assessed by air-displacement-plethysmography. Results: Comparable
weight loss (AGB: 26.1 ± 5.1 kg; RYGBP: 32.1 ± 5.0; BPD: 31.7 ± 6.1; P=NS) and decrease in percentage body fat (AGB: 10.0 ± 1.5%; RYGBP: 14.2 ± 2.8; BPD: 10.3 ± 1.0; P=NS) induced by bariatric surgery exerted significantly different (P=0.004) effects on plasma ghrelin concentrations, depending on the surgical procedure applied (AGB: 480 ± 78 pg/ml; RYGBP:
117 ± 34; BPD: 406 ± 86). Without significant differences in BMI, body fat, glucose, triglycerides, cholesterol, insulin and
leptin levels, patients who had undergone the RYGBP exhibited statistically significant diminished circulating fasting plasma
ghrelin concentrations compared with the other two bariatric techniques which conserve direct contact of the fundus with ingested
food (P=0.003 vs AGB and P=0.020 vs BPD). Conclusion: Fasting circulating ghrelin concentrations in patients undergoing diverse bariatric operations
depend on the degree of dysfunctionality of the fundus. 相似文献
107.
Fris RJ 《Obesity surgery》2004,14(9):1165-1170
Background: A limited view of the gastro-esophageal area in obese patients is often aggravated by an enlarged liver due to
fatty infiltration. Preoperative decrease in liver size would help surgeons, particularly those not used to working with morbidly
obese patients. Methods: 50 morbidly obese patients booked for laparoscopic gastric banding undertook a 2-week, preoperative
low energy liquid diet. Ultrasound measurements of the left lobe of the liver and body analysis were undertaken at the start
of the diet, and again at the conclusion of the diet (preoperatively). Changes in liver size were compared to body analysis
changes. Results: There was a highly significant decrease in liver size in the 2 weeks, which correlated with BMI and weight
loss. There was no correlation with fat loss. No large left lobe of the liver was encountered at surgery nor caused any problem
in any patients with successful preoperative weight loss. Conclusions: Preoperative restriction of dietary energy will reduce
liver size, and is accurately predicted by associated weight loss. 相似文献
108.
Associated or rare diseases, such as myasthenia gravis, introduce a challenge to the perioperative management of severely
obese patients undergoing bariatric surgery. We report the surgical management and unique anesthetic approach to a 55-year-old
morbidly obese woman with a complex past medical history that included myasthenia gravis, who underwent laparoscopic gastric
bypass. Her myasthenia was controlled on pyridostigmine and her greatest concern was the potential need for postoperative
mechanical ventilation. While the laparoscopic surgical approach was ideal to reduce pain and the adverse effects on ventilatory
mechanics associated with open upper abdominal surgery, a combined inhalational and intravenous anesthetic without muscle
relaxants resulted in satisfactory surgical conditions, and allowed for immediate postoperative extubation followed by an
uneventful postoperative course. Continued perioperative anticholinesterase administration may have facilitated this successful
outcome. We conclude that a diagnosis of myasthenia gravis does not mandate postoperative mechanical ventilation following
laparoscopic gastric bypass. 相似文献
109.
Pellis T Leykin Y Albano G Zannier G Di Capua G Marzano B Gullo A 《Obesity surgery》2004,14(10):1423-1427
Anesthetic management of super-obese patients is inferred from evidence which has been based on obese or morbidly obese patients.
We present the perioperative management and monitoring of a 44-year-old 232-kg patient (BMI 70) admitted for laparoscopic
gastric bypass surgery. Awake fiberoptic endotracheal intubation preceded induction with propofol and rocuronium. Anesthesia
was maintained with desflurane and remifentanil. Desflurane was titrated on BIS values, whereas remifentanil was based on
hemodynamic monitoring (invasive arterial pressure and HemoSonic™). Rocuronium was administered based on ideal body weight
and recovery of twitch tension. Safe and rapid extubation in the operating theatre was made possible by the use of short-acting
agents coupled with continuous intraoperative monitoring. Recovery in the post-anesthesia care unit was uneventful, pain was
managed with meperidine, and after 5 hours the patient was discharged to the surgical ward. Oxygen therapy and SpO2 monitoring
were continued overnight. No desaturation episodes were recorded. Pain was managed with I.V. drip of ketorolac and tramadole. 相似文献
110.
Fatal Pulmonary Embolism after Bariatric Operations for Morbid Obesity: A 24-Year Retrospective Analysis 总被引:2,自引:0,他引:2
Background: Pulmonary embolism (PE) is a leading cause of death following gastric bypass operations for morbid obesity. Although
its incidence appears to be stable, the number of bariatric operations performed annually is increasing considerably; hence,
the isolated fatal PE is no longer a rare occurrence. The records of patients undergoing bariatric surgical operations since
1979 were reviewed to determine specific factors that increased the risk of developing a fatal PE. Both recommended and optional
indications for prophylactic inferior vena cava (IVC) filter placement in patients considered at high risk were also examined.
Materials and Methods: Between September, 1979 and March, 2003, 5,554 operations were performed for clinically severe obesity.
These operations included jejuno-ileal bypass, horizontal gastroplasty, Roux-en-Y gastric bypass with a 30-cc pouch, modified
biliopancreatic diversion, the Sapala-Wood Micropouch? gastric bypass (MicropouchSM), Lap-Band?, and revisions. 12 fatal pulmonary emboli (0.21 %) were identified. All but 1 embolus occurred within 30 days
following surgery. Results: In 11 of 12 patients, at least 1 co-morbidity known to increase the risk of postoperative venous
thromboembolism (VTE) was identified. 4 co-morbidites were common to 4 patients (33%): venous stasis disease (VSD), BMI ≥
60, truncal obesity, and obesity hypoventilation syndrome/sleep apnea syndrome (OHS/SAS). 6 of 12 patients (50%) had a BMI
≥ 60. Another 6 had chronic leg swelling with stasis dermatitis. 2 patients experienced a previous PE, and 1 patient reported
a history of deep vein thrombosis (DVT). Conclusion: 4 patients (33%) demonstrated a combination of risk factors (VSD, BMI
≥ 60, truncal obesity, OHS/SAS) recognized as significant for the development of postoperative VTE. In such patients, prophylactic
IVC filter placement is highly recommended. Filter placement for other factors, such as age, body build, hypercoagulable state,
etc., should be considered on an individual basis. 相似文献