The prevalence of overweight and obesity in a breast clinic population: Consideration for weight loss as a therapeutic intervention

BackgroundObesity is an important risk factor for breast cancer and weight loss may be associated with a decreased risk for breast cancer and its recurrence. We evaluated the prevalence of overweight, obesity, and obesity-related co-morbidities in a breast health clinic population to determine the potential need for weight loss intervention.MethodsA retrospective review was conducted of sequential patients seen at a breast health clinic from July 1 to December 31, 2011. Body mass index (BMI), reason for visit (breast cancer diagnosis, high risk for breast cancer, or benign condition), and presence of obesity-related co-morbidities were recorded.ResultsThe 302 patients who met inclusion criteria had a median age of 52 years (10–91) and median BMI of 26 kg/m² (15.4–56.5). Overall, 36.8% of patients had a BMI between 18.5–24.9 kg/m²; 32.1%, 25–29.9 kg/m²; 14.2%, 30–34.9 kg/m²; 8.3%, 35–39.9 kg/m²; and 4.3%,≥40 kg/m². Overweight or obesity (BMI≥25 kg/m²) occurred in 64.2% of breast cancer, 65.0% of high-risk, and 57.1% of benign patients (P value not significant). Criteria for bariatric surgery (BMI 35–39.9 kg/m² with≥1 obesity-related co-morbidity or BMI≥40 kg/m²) were met in 8.2% of breast cancer, 16.7% of high-risk, and 11.5% of benign patients (P value not significant).ConclusionsRegardless of diagnosis, a significant proportion of patients visiting the breast health clinic meet criteria for weight loss intervention, including bariatric surgery. Weight management represents an underutilized therapeutic modality that could potentially decrease the risk of breast cancer and its recurrence, and improve overall prognosis.     

Bariatric surgery decreased the serum level of an endotoxin-associated marker: lipopolysaccharide-binding protein

BackgroundRecent studies have shown serum lipopolysaccharide binding protein (LBP) is associated with obesity and related metabolic disorder. Bariatric surgery can significantly reduce weight, but reports about the change of LBP after bariatric surgery are limited. We investigated LBP concentration and its associations with clinical variables.MethodsWe enrolled 178 obese patients receiving different bariatric surgeries and 38 normal weight individuals. Fasting blood samples were collected at baseline in all and 1 year after surgery in obese individuals. The serum LBP concentration was measured.ResultsThe percentage of excess weight loss of mini-gastric bypass, Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric band were 72.0±20.0%, 65.5±23.0%, 67.2±18.4%, and 16.1±14.3%, respectively. Serum LBP levels were higher in the obese participants than in the normal weight participants (49.9±15.7 versus 25.2±7.5 μg/mL; P<.001) at baseline and significantly decreased to 35.1±22.6 μg/mL after bariatric surgery (P<.001) in the obese group. In the bariatric participants, after multivariate analyses, preoperative LBP and the change of LBP with surgery were independently associated only with high sensitive C-reactive protein (hs-CRP) (P<.001) and the change of hs-CRP (P = .012), respectively, while none of the postoperative variables was independently associated with LBP.ConclusionLBP is associated with body mass index and hs-CRP. Bariatric surgery significantly decreased the serum level of LBP. The relationship between LBP and hs-CRP disappeared after bariatric surgery. (Surg Obes Relat Dis 2014;0:000–000.) © 2014 American Society for Metabolic and Bariatric Surgery. All rights reserved.     

The effect of bariatric surgery on gout: a comparative study

BackgroundObesity is a risk factor for the development of gout. An increased incidence of early gouty attacks after bariatric surgery has been reported, but the data is sparse. The effect of weight loss surgery on the behavior of gout beyond the immediate postoperative phase remains unclear. The objective of this study was to evaluate the pre- and postoperative frequency and features of gouty attacks in bariatric surgery patients.MethodsCharts were reviewed to identify patients who had gout before bariatric surgery. Demographic and gout-related parameters were recorded. The comparison group consisted of obese individuals with gout who underwent nonbariatric upper abdominal procedures.ResultsNinety-nine morbidly obese patients who underwent bariatric surgery had gout. The comparison group consisted of 56 patients. The incidence of early gouty attack in the first month after surgery was significantly higher in the bariatric group than the nonbariatric group (17.5% versus 1.8%, P = .003). In the bariatric group, 23.8% of patients had at least one gouty attack during the 12-month period before surgery, which dropped to 8.0% during postoperative months 1–13 (P = .005). There was no significant difference in the number of gouty attacks in the comparison group before and after surgery (18.2% versus 11.1%, P = .33). There was a significant reduction in uric acid levels 13-months after bariatric surgery compared with baseline values (9.1±2.0 versus 5.6±2.5 mg/dL, P = .007).ConclusionThe frequency of early postoperative gout attacks after bariatric surgery is significantly higher than that of patients undergoing other procedures. However, the incidence decreases significantly after the first postoperative month up to 1 year.     

Effect of new criteria on the diagnosis of gestational diabetes in women submitted to gastric bypass

BackgroundBariatric surgery has been shown to improve many obesity related co-morbidities, including gestational diabetes mellitus (GDM). Recently, new diagnostic criteria for GDM following the International Association of Diabetes and Pregnancy Study Group recommendations were implemented. The objective of this study was to compare the use of 2 different GDM criteria in diagnostic and pregnancy outcome after Roux-en-Y gastric bypass (RYGB).MethodsPregnant women who had previously undergone RYGB (n = 30) were screened for GDM with Carpenter and Coustan (C&C) criteria (n = 18) or the new diagnostic criteria (n = 12).ResultsNone of the patients screened using C&C criteria where diagnosed with GDM, while 50% of the patients screened with the new criteria had GDM. Among women that underwent oral glucose tolerance tests (OGTT) (n = 19) as required for the new diagnostic criteria, 57.9% developed reactive hypoglycemia. All women diagnosed with GDM had excellent metabolic control during pregnancy and comparing the outcome of these pregnancies and those of women without GDM, there were no significant differences regarding the age at time of surgery or at pregnancy, body mass index before surgery and pregnancy, parity, previous history of GDM, time from surgery to conception, weight lost until pregnancy, weight gain during pregnancy, gestational age at delivery, and birth weight adjusted for gestational age.ConclusionNew GDM diagnostic criteria in post-RYGB pregnant women increased the prevalence of GDM diagnostic without changing pregnancy outcomes. In addition, OGTTs were associated with a high rate of reactive hypoglycemia. These data suggest that alternative GDM diagnostic criteria are needed for these postbariatric patients.     

Pituitary disease and anaesthesia

Patients with pituitary gland tumours comprise a significant proportion of the neurosurgical population, making transsphenoidal pituitary surgery a relatively common procedure. Such patients present anaesthetists with unique challenges resulting from hormone hypersecretion, pituitary hypofunction or tumour mass effect. To understand this pathophysiology requires a good working knowledge of normal pituitary anatomy and physiology. An appreciation of the respiratory and cardiovascular comorbidities associated with pituitary tumours is also essential to the anaesthetist. We aim to review the key principles involved in the preoperative assessment, intraoperative management and postoperative care of these patients.     

退变性腰椎疾患后路减压术后脑脊液漏的相关因素分析及处理

目的:分析退变性腰椎疾患后路减压术后脑脊液漏的相关因素,探讨其处理方法.方法:收集2011年1月～2012年12月在北京大学第三医院骨科腰椎组手术治疗患者的病历资料,纳入因腰椎间盘突出症(LDH)、腰椎管狭窄症(LSS)、腰椎滑脱(LS)、腰椎退变性侧(后)凸(LDS)行腰椎后路减压术的患者,记录患者的性别、年龄、体重指数、诊断、是否翻修手术、手术方法、减压节段数、融合方式、术后引流量、引流管留置时间、脑脊液漏的诊断、术中及术后处理方法.按1:3配比选择对照组,观察脑脊液漏组术后引流特点和引流管留置时间.结果:共纳入因退变性腰椎疾患行后路减压手术治疗的患者1425例,其中男675例,女750例,年龄16～80岁,平均54.6±13.1岁.LDH 378例,LSS 647例,LS 304例,LDS 96例;初次手术1351例,翻修手术74例;1节段减压635例,2节段减压491例,3节段减压204例,4节段及以上减压95例.术后57例发生脑脊液漏,发生率为4.0％,其中LDH 7例,发生率为1.9％;LSS 30例,发生率为4.6％;LS 13例,发生率为4.3％;LDS 7例,发生率为7.3％.4种疾病脑脊液漏的发生率无显著性差异(P＞0.05).翻修手术发生脑脊液漏9例,发生率为12.2％;初次手术发生脑脊漏48例,发生率为3.6％,差异有显著性(P＜0.05).减压节段数4节段及以上者脑脊液漏的发生率为13.7％,高于1节段(1.9％)、2节段(3.7％)和3节段(6.9％)者.多因素Logistic回归分析结果显示翻修手术和减压节段数≥4是术后并发脑脊液漏的危险因素.脑脊液漏患者采用预防感染、体位调节、引流管留置平均5.6d,卧床休息6～7d,无一例出现伤口不愈合或感染,无一例形成脑脊液囊肿或瘘管,但引流量较对照组大.结论:翻修手术与减压节段数≥4是退变性腰椎疾患后路减压术后脑脊液漏发生的危险因素;发生脑脊液漏患者术后引流管留置5～6d是安全的.     

TST加直肠黏膜下柱状药物注射术治疗直肠前突并发直肠黏膜内脱垂(附118例报告)

目的探讨TST加直肠黏膜下柱状药物注射术治疗直肠前突并发直肠黏膜内脱垂的临床疗效。方法分析总结118例直肠前突并发直肠黏膜内脱垂患者的临床资料,均行TST加直肠黏膜下柱状药物注射术治疗。结果 118例患者治愈97例(82.2%),显效17例(14.4%),好转4例(3.4%)。无1例切口出血、感染、直肠阴道瘘等并发症发生。结论 TST加直肠黏膜下柱状药物注射术治疗直肠前突并发直肠黏膜内脱垂,操作简便,创伤小,疗效满意,并发症少,住院时间和手术时间短,术后恢复快,值得推广使用。     

加速康复外科和传统外科在肋骨骨折围手术期的应用比较

目的：比较加速康复外科（fast track surgery,FTS）理念和传统外科方法在肋骨骨折围手术期的应用。方法选择肋骨骨折患者84例,围手术期应用加速康复理念42例（FTS组）,应用传统外科手术42例（传统组）,将两组手术后疼痛VAS评分、血清白蛋白检测结果、肠鸣音恢复时间、首次通气时间、术后并发症（消化道症状、消化性溃疡、胸腔出血、肺不张、肺部感染、胸腔积液、心脏并发症、泌尿系统并发症、切口感染、深静脉血栓）发生率、住院时间及住院总费用、患者满意度等进行比较。结果 FTS组术后疼痛VAS评分较传统组低,血清白蛋白较传统组高,肠鸣音恢复时间及首次通气时间提前,术后并发症发生率较低,住院时间缩短,住院费用降低,患者满意度提高,两组比较差异有统计学意义（P＜0．05）。结论 FTS应用于肋骨骨折围手术期患者的术后疼痛VAS评分低,营养状况较好,肠道恢复较早,术后并发症发生率较低,住院时间缩短,治疗费用降低,患者满意度提高,值得进一步推广。     

经脐单一切口腹腔镜阑尾切除术131例分析

目的 探讨经脐单一切口腹腔镜阑尾切除术（transumbilical single-incision laparoscopic appendectomy,TUSILA）的可行性和应用价值.方法 我院2008年2月～2011年6月行131例TUSILA,在脐环下缘沿脐缘做弧形切口,长1.5~1.8 cm,于弧形切口置入1个10 mm trocar和2个3 mm trocar,trocar内置入10 mm 30°腹腔镜和腹腔镜器械,完成腹腔镜下阑尾切除术.结果 129例成功施行TUSILA,2例因阑尾周围粘连严重和阑尾后位中转开腹（中转率1.5%）.129例TUSILA手术时间25～130 min,平均40 min.无切口感染,术后1~3 d出院,平均2.6 d.129例TUSILA电话或门诊随访6个月,脐部切口瘢痕不明显,无脐疝出现,美容效果好.结论 TUSILA微创、美观、安全可行,值得推广.     

腹腔镜下卵巢浆液性腺癌直肠转移癌根治术1例报告

本文报道2013年5月对1例Ⅳ期卵巢浆液性腺癌施行腹腔镜下卵巢癌细胞减灭术和直肠癌根治术（Dixion术）,术后行顺铂及紫杉醇静脉化疗6次。随访5个月复查,直肠吻合口愈合良好,盆腔无转移病灶,肝转移灶消失。