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61.
Schuster R Alami RS Curet MJ Paulraj N Morton JM Brodsky JB Brock-Utne JG Lemmens HJ 《Obesity surgery》2006,16(7):848-851
Background: Laparoscopic Roux-en-Y gastric bypass (RYGBP) is a commonly performed operation for morbid obesity. A significant
number of patients experience postoperative nausea and vomiting (PONV) following this procedure. The aim of this study was
to determine the effect, if any, of intra-operative fluid replacement on PONV. Methods: Patients who underwent laparoscopic
(RYGBP) for morbid obesity during a 12-month period were included in this retrospective analysis. Demographic data including
age, gender, and body mass index (BMI) were collected. Perioperative data also included total volume of intra-operative fluids
administered, rate of administration, urine output, length of surgery, and incidence of PONV as determined by nursing or anesthesia
records in the postanesthesia care unit (PACU). Data were analyzed by t-test. Results: The table below depicts demographic and perioperative data, comparing patients who experienced PONV (n=125)
in the PACU with those who did not (n=55). Values are mean ± standard deviation. Conclusions: PONV is a common complication
after laparoscopic RYGB. Patient who did not experience PONV received a larger volume of intravenous fluid at a faster rate
than similar patients who complained of PONV. 相似文献
62.
Liver Involvement in Obese Children (Ultrasonography and Liver Enzyme Levels at Diagnosis and During Follow-up in an Italian Population) 总被引:26,自引:0,他引:26
Maria Carmela Saviano Francesco Brunetti Armido Rubino Adriana Franzese Pietro Vajro Alessandro Argenziano Alessandro Puzziello Maria Pina Iannucci 《Digestive diseases and sciences》1997,42(7):1428-1432
Our aim was to evaluate incidence and riskfactors of liver involvement in obese Italian childrenas assessed by both ultrasonographic and biochemicalparameters. In seventy-five consecutive obese children (age 9.5 ± 2.9 years, males/females41/34), serum levels of enzymes and ultrasonography ofthe liver were evaluated. Tests were repeated one,three, and six months after starting a moderatehypocaloric diet and an exercise program. Three obese childrenwho were found to have chronic viral hepatitis wereexcluded from the study. Thirty-eight of 72 (53%) obesechildren had an ultrasonographic image of bright liver consistent with liver steatosis. Thelatter was severe in nine children, moderate in 16, andmild in 13. Eighteen obese children (25%) had elevatedtransaminase levels. Bright liver andhypertransaminasemia were not due to any of the most common causesof liver disease. Both were rapidly responsive to lossof weight, confirming that liver involvement wassecondary to obesity and that steatosis orsteatohepatitis rather than fibrosis were involved. Obesityduration not more than three years (odds ratio = 4.77),a higher degree of obesity (odds ratio = 2.09), andhypertransaminasemia (odds ratio = 2.15) appeared asimportant predictive factors of liver involvement atultrasonography. Incidence of liver involvement assessedby means of ultrasonography is significantly higher thanthat revealed by measurement of serum liver enzymes. A short duration of obesity emerged as apotentially new risk factor of liver involvement in thepediatric obese population and needs to be confirmed infuture studies. 相似文献
63.
Valencia-Flores M Orea A Herrera M Santiago V Rebollar V Castaño VA Oseguera J Pedroza J Sumano J Resendiz M García-Ramos G 《Obesity surgery》2004,14(6):755-762
Background: We evaluated the impact of surgically-induced weight loss on Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS),
electrocardiographic changes, pulmonary arterial pressure and daytime sleepiness in morbidly obese patients. Methods: 16 women
and 13 men (n=29) underwent bariatric surgery in a 3-year period. The following tests were performed before and 1 year after
surgery: nocturnal polysomnography, daytime Multiple Sleep Latency Test (MSLT), and echocardiogram. Results: Mean age was
37.9±11 years (range 20-56). Preoperative body mass index was 56.5±12.3 kg/m2 and it was 39.2±8.5 kg/m2 at 13.7±6.6 months follow-up. Performed surgical procedures included: vertical banded gastroplasty in 6, Roux-en-Y gastric
bypass in 12, and Distal Roux-en-Y gastric bypass in 11. Weight loss induced by surgery eliminated OSAHS in 46% of obese patients
with an important improvement in oxygen saturation. Neck, thorax, waist and hip circumferences decreased significantly after
surgical intervention but only neck circumference correlated significantly with the apnea/hypopnea index (Spearman rho=0.63, P <0.0001). Electrocardiographic abnormalities were present in 9 patients (31%) before surgery (sinus arrhythmia, ventricular
arrhythmias, and sinus arrest). The number of electrocardiographic abnormalities decreased after surgery but new abnormalities
appeared in some patients. Systolic pulmonary arterial pressure significantly decreased in the group of patients in whom OSAHS
disappeared after surgery. Daytime sleepiness persisted after surgery in most patients. Conclusion: Bariatric surgery effectively
reduces respiratory disturbances during sleep and improves pulmonary hypertension. Electro cardiographic abnormalities change
after surgery. Daytime sleepiness appeared not to be related to respiratory disturbances during sleep. 相似文献
64.
《Gynecological endocrinology》2013,29(1):14-22
The aim of this study was to determine the influence of body weight on circulating plasma levels of β-endorphin and insulin in women with polycystic ovary disease (PCOD) ,as well as the correlation between the plasma levels of β-endorphin and insulin. One-hundred and sixty-seven consecutive subjects with PCOD were recruited ,117 of whom had normal weight (body mass index (BMI) < 25) while 50 were obese (BMI > 25). A venous blood sample was taken and plasma concentrations of β-endorphin ,insulin ,gonadotropins ,prolactin ,progesterone ,17β-estradiol ,estrone ,androgens ,dehydroepiandrosterone sulfate and sex hormone-binding globulin (SHBG) were measured. Mean β-endorphin and insulin plasma levels were significantly higher (p < 0.05) in obese PCOD women than in non-obese ones. Correlation analysis showed a positive association between insulin and β-endorphin ,β-endorphin and BMI (and weight) ,insulin and BMI (and weight) ,and a negative correlation was found between insulin and SHBG. A weak association was found between-endorphin and luteinizing hormone (LH) in peripheral plasma. Stratified and linear regression analysis showed that plasma-endorphin concentrations correlate more with BMI than with insulinemia. 相似文献
65.
Early Experience with Two-Stage Laparoscopic Roux-en-Y Gastric Bypass as an Alternative in the Super-Super Obese Patient 总被引:6,自引:16,他引:6
Background: Surgical management of the supersuper obese patient (BMI >60 kg/m2) has been a challenging problem associated with higher morbidity, mortality, and long-term weight loss failure. Current limited
experience exists with a two-stage biliopancreatic diversion and duodenal switch in the supersuper obese patient, and we now
present our early experience with a two-stage gastric bypass for these patients. Methods: We completed a retrospective bariatric
database and chart review of super-super obese patients who underwent laparoscopic sleeve gastrectomy as a first-stage procedure
followed by laparoscopic Roux-en-Y gastric bypass as a second-stage for more definitive treatment of obesity. Results: During
a two-year period, 7 patients with BMI 58-71 kg/m2 underwent a two-stage laparoscopic Roux-en-Y gastric bypass by two surgeons at the Mount Sinai Medical Center. 3 patients
were female, 4 patients were male, and the average age was 43. Prior to the sleeve gastrectomy, the mean weight was 181 kg
with a BMI of 63. Average time between procedures was 11 months. Prior to the second-stage procedure, the mean weight was
145 kg with a BMI of 50 and average excess weight loss of 37 kg (33% EWL). Six patients have had follow-up after the second-stage
procedure with an average of 2.5 months. At follow-up the mean weight was 126 kg with a BMI of 44 and average excess weight
loss of 51 kg (46% EWL). The mean operative times for the two procedures were 124 and 158 minutes respectively. The average
length of stay for all procedures was 2.7 days. 4 patients had 5 complications, which included splenic injury, proximal anastomotic
stricture, left arm nerve praxia, trocar site hernia, and urinary tract infection.There were no mortalities in the series.
Conclusions: Laparoscopic sleeve gastrectomy with second-stage Roux-en-Y gastric bypass are feasible and effective procedures
based on short-term results. This two-stage approach is a reasonable alternative for surgical treatment of the high-risk supersuper
obese patient. 相似文献
66.
Clark MM Balsiger BM Sletten CD Dahlman KL Ames G Williams DE Abu-Lebdeh HS Sarr MG 《Obesity surgery》2003,13(5):739-745
Background: How psychosocial factors may impact on weight loss after bariatric surgery is not well understood. This lack of
knowledge is problematic, because there is a high prevalence of psychosocial distress in patients seeking treatment for obesity
in hospital-based programs. The purpose of this study was to examine the relationship between preoperative psychosocial factors
and eventual weight loss. Method: Between 1987 and 1998, all individuals undergoing Roux-en-Y gastric bypass for weight loss
in our institution had psychologic preoperative evaluations. Patients who were followed prospectively were studied. The relation
of having received mental health treatment to percentage of excess weight loss at 2 years is examined using t-tests. Results:
62 women and 18 men completed a 2-year follow-up. Patients who had received treatment for either substance abuse (n=10) or
psychiatric co-morbidity (n=39) lost more weight compared with those without such histories (P<0.05, P <0.001 respectively). Conclusion: Given these results, it is plausible that a history of having received either psychiatric
treatment for a disorder or counseling for substance abuse should not be a contraindication to bariatric surgery, and, in
fact, may be prognostic of favorable outcome. Further research examining psychosocial factors and outcome from bariatric surgery
is clearly warranted. 相似文献
67.
Background: Laparoscopic implantation of an adjustable gastric band is being performed widely. One potential complication
is the transgastric migration of the band, that should be extracted. Methods: The authors report a series of 182 patients,
followed prospectively, October 1996 - April 2002, who had undergone insertion of the Swedish adjustable gastric band. All
implantations had been completed by laparoscopy alone. Results: There were no deaths. 15 complications were detected, of which
7 were intragastric migrations of the band (3.8%) at an average follow-up of 40 months. 6 were treated successfully by gastroscopy
only, with a new cutter device and without complications. Conclusion: The endoscopic technique is beneficial even when the
intraluminal migration is partial. 相似文献
68.
Ballantyne GH 《Obesity surgery》2003,13(6):954-964
Restrictive and particularly malabsorptive bariatric operations achieve significant sustained weight loss. Results from different
operations have been difficult to compare.The aims of this review are: 1) to indicate the limitations of outcomes reported
as weight-related parameters; 2) to document some of the patient characteristics that impact weight loss; 3) to assess the
literature documenting improvement in obesity-related medical conditions; and 4) to review studies that quantitate changes
in health-related quality of life (QoL). Weight-related parameters such as body mass index and % excess weight inconsistently
correlate with body fat. Direct determination of body fat with bioelectric impedance may offer more reliable outcome parameters.
Patient characteristics such as gender, age, weight, body mass index, ethnicity, race and socioeconomic status affect weight
loss following bariatric operations. Improvements in co-morbid conditions are poorly documented in many studies. Standardized
instruments that assess health-related QoL have shown differing values. SF-36 has given inconsistent results following bariatric
operations. Both BAROS and IWQoL-Lite have demonstrated significant improvements after surgery. Bariatric surgeons have rarely
used patient satisfaction as an outcome parameter. This review suggests that bariatric operations should be judged by change
in fat mass or fat mass index, improvement in obesity-related medical conditions, change in health-related QoL as judged by
standardized instruments, and level of patient satisfaction. In addition, surgeons should characterize their study population
and report outcomes for sub-populations. 相似文献
69.
An Approach to Venous Thromboembolism Prophylaxis in Laparoscopic Roux-en-Y Gastric Bypass Surgery 总被引:3,自引:0,他引:3
Background: Venous thromboembolism (VTE) prophylaxis regimens for laparoscopic Roux-en-Y gastric bypass (LRYGBP) have not
been adequately addressed in the literature. This study presents the results of our prophylactic regimen in LRYGBP at a tertiary
care hospital. Methods: A retrospective review of 255 morbidly obese patients undergoing LRYGBP between March 2000 and February
2003 was conducted. Patients received preoperative subcutaneous heparin (SQH) (5000u or 7500u) and every 8 hours thereafter
during hospitalization. Sequential compression devices (SCD) were utilized during and after surgery unless ambulating. Early
ambulation was enforced. Results: 255 patients underwent LRYGBP, with 5 (1.9%) converted to open.Average preoperative weight
and body mass index (BMI) were 138 kg and 50, respectively. Operative time averaged 174 minutes. Average length of stay was
2.2 days. 9 patients (3.6%) had a prior history of deep venous thrombosis/pulmonary embolism (DVT/PE), one of whom had a DVT/PE
postoperatively. 2 patients developed DVT/PE within 30 days. Overall DVT/PE incidence was 1.2%. There were 6 postoperative
bleeding episodes (2.4%). Conclusion: This regimen provides excellent prophylaxis against VTE in the hospital setting. 相似文献
70.
The Decrease in Plasma Ghrelin Concentrations following Bariatric Surgery Depends on the Functional Integrity of the Fundus 总被引:4,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