Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery

BACKGROUND: Abnormalities in calcium and vitamin D metabolism have been reported after bariatric surgery. The purpose of this study was to evaluate vitamin D nutritional status among morbidly obese patients before gastric bypass surgery. METHODS: We prospectively studied 279 morbidly obese patients seeking gastric bypass surgery for vitamin D nutritional status as assessed by serum 25-hydroxyvitamin D level. In addition, serum samples were analyzed for calcium, alkaline phosphatase (AP), intact parathyroid hormone (PTH), and 1,25-dihydroxyvitamin D. RESULTS: Mean patient age was 43 +/- 9 years; 87% of the study patients were women, and 72% were white. Serum calcium and AP levels were normal in 88% and 89% of the patients, respectively. Vitamin D depletion, defined as serum 25-hydroxyvitamin D level 相似文献   

Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity

BACKGROUND: Preoperative dietary counseling (PDC) before bariatric surgery is mandated by a growing number of insurance payers. Their claim is that PDC improves outcomes and postoperative compliance. We compared outcomes of GBP patients undergoing a mandatory 13 weeks of PDC (n = 72) to a contemporaneous group of patients with no such requirement (no-PDC; n = 252) who underwent operation between January 2000 and December 2002. METHODS: The PDC and no-PDC groups were characterized by similar male:female ratios (1:4 vs 1:4.6), mean age (42 years), mean body weight (324 lb vs 309 lb), and mean body mass index (BMI) (52 kg/m2 vs 50 kg/m2). The PDC group had a higher incidence of obstructive sleep apnea compared with the no-PDC group (41% vs 28%; P < .04) but otherwise the two groups had similar incidences of obesity-related comorbidities. The presurgery dropout rate was 50% higher in the PDC group than in the no-PDC group (28% vs 19%; P < .05). RESULTS: At 1 year follow-up, the no-PDC patients had a statistically greater percentage excess weight loss (67% vs 60%; P < .0001), lower BMI (32 vs 35; P < .015), and lower body weight (197 vs 218; P < .01). Resolution of major comorbidities, complication rates, 30-day postoperative mortality, and postoperative compliance with follow-up were similar in the two groups. CONCLUSIONS: The data demonstrate that insurance-mandated PDC is an obstacle to patient access for surgical treatment of severe obesity and has no impact on weight loss outcome or postsurgical compliance. PDC should be abandoned by the insurance industry.     

Prevalence of H pylori associated 'high risk gastritis' for development of gastric cancer in patients with normal endoscopic findings

INTRODUCTION H pylori infection is an established risk factor for development of gastric cancer[1,2]. According to the model of carcinogenesis of the intestinal type adenocarcinoma proposed by Correa, the multi-step development starts from the condition o…     

胃癌穿孔24例治疗分析

目的 :探讨胃癌穿孔的临床特点 ,指导临床诊治和提高疗效。方法 :对本院 2 4例胃癌穿孔病人采用不同手术方式治疗。其中 8例行单纯修补术 ,2例在穿孔修补术后 3周早期施行二期根治性手术 ,3例行穿孔修补加胃空肠吻合术 ,7例行姑息性胃大部切除术 ,4例行胃癌根治术。结果 :本组死亡 4例 ,其余病例中位生存期分别为 7,13 .2 ,2 5 .1个月。结论 :采取积极的治疗措施 ,可望延长患者的生存时间和提高生存质量     

电针对狗血浆与胃黏膜组织中NO和NOS的影响及其意义

目的　观察电针对狗幽门压力、胃黏膜血流量的调控作用及其与血浆、胃黏膜组织中一氧化氮 (NO) ,一氧化氮合酶 (NOS)水平变化的关系 ,以探讨电针对胃黏膜保护作用的机制。方法　将 2 0只狗随机分为 4组 :空白对照组、非经非穴组、上巨虚组、足三里组 (每组 5只 )。采用胃压测量仪、激光多普勒血流仪监测幽门压力、频率及胃黏膜血流量的变化 ,同步测定血浆及胃黏膜组织中NO ,NOS含量 ,并观察变化规律。结果　电针后足三里组幽门括约肌总压力、基础压下降、频率下降 (P <0 .0 5 ) ,胃黏膜血流量显著升高 (4 .5 1± 0 .73→ 6.90± 1.0 1,P <0 .0 1) ,血浆及胃黏膜组织中NO ,NOS含量显著升高 (P <0 .0 5 ) ,上巨虚组仅幽门括约肌总压力下降 ,血浆NO含量上升。但足三里组各项监测指标变化趋势更明显 ,其他组变化无显著性。结论　电针可使狗幽门压力、频率下降 ,使胃黏膜血流量增加 ,与影响幽门压力、胃黏膜血流量的某些活性物质的含量改变有关 ,并具有一定的经络和穴位特异性。     

Effects of acute administration of d-amphetamine and haloperidol on procedural learning in man

The effects of an indirect dopamine-agonist, d-amphetamine, and a non-selective dopamine receptor antagonist, haloperidol, were investigated in normal male volunteers using a between-subjects double-blind design in a procedural learning task, thought mainly to involve unconscious/automatic learning. The results showed: (1) d-amphetamine facilitated response speed, whereas haloperidol inhibited it, in comparison to placebo; (2) the linear increase in procedural learning corresponded with pharmacological manipulation of degree of dopaminergic activity, i.e. subjects given haloperidol showed the least, and subjects given d-amphetamine the greatest, procedural learning. The implications of these findings are discussed in relation to investigation of abnormalities of procedural learning processes in schizophrenia. Received: 28 June 1996/Final version: 2 October 1996     

Stoma Adjustable Silicone Gastric Banding versus Vertical Banded Gastroplasty for the Treatment of Morbid Obesity

Background: Among gastric restrictive operations, the procedure of choice is still controversial. The aim of this study is to compare the results of two different gastric restrictive procedures: vertical banded gastroplasty (VBG) and stoma adjustable silicone gastric banding (ASGB). Methods: Between 1991 and 1996, 51 patients were treated surgically for morbid obesity: 27 underwent VBG and 24 underwent ASGB. Preoperative body weight (BW), body mass index (BMI) and percentage of ideal body weight (% IBW) were (mean ± SD): 145.7 ± 45.3 kg; 53.9 ± 15.9 kg/m²; 249.1 ± 73.5% respectively in the VBG group. Corresponding figures for the ASBG group were 132.5 ± 22.7 kg; 46.9 ± 7.8 kg/m² and 207.2 ± 35.0%. Results: In the VBG group, the median follow-up period was 26 months (range: 7-47). Eighteen months after the operation BW, BMI, % IBW and percentage of excess weight loss (% EWL) were 85.5 ± 26.8 kg, 31.9 ± 9.8 kg/m², 145.4 ± 43.9% and 74 ± 1% respectively. Complications included incisional hernia (n = 1), and bowel obstruction (n = 1). One patient died of acute myocardial infarction on the third postoperative day. In the ASGB group, median follow-up time was 19.7 months (range: 18-26). At 18 months postoperation BW, BMI, % IBW and % EWL values were 86.6 ± 20.6 kg 30.6 ± 6.6 kg/m2 140.6 ± 29.3% and 64 ± 1% respectively. Gastric wall erosion occurred in two patients and the bands had to be removed. These patients underwent VBG 6 months later. Complications encountered in this group were incisional hernia (n = 1), outlet stenosis and reflux esophagitis (n = 1), reservoir leakage (n = 1) and gastrointestinal bleeding (n = 1). Two patients died of pulmonary embolism and acute gastrointestinal bleeding. Conclusions: Weight reduction was not statistically significant between the two groups. ASGB was easier to perform and less invasive than VBG.     

Proposed new bladder volume monitoring device based on impedance measurement

A new implantable bladder volume-monitoring device based on the impedance measurement of the detrusor muscle is described. The system is completely autonomous and forms a mixed-signal (analogue/digital) feedback loop with a neuro-stimulator to rectify bladder dysfunctions (incontinence and retention) through neuromuscular stimulation techniques. A programmable instrumentation amplifier and a signal processing block, to eliminate the artefacts caused by the patient’s movements, have been designed and tested. The layout for the signal processing block has been realised in 0.8 μm BiCMOS technology.     

460例胃癌纤维胃镜活检标本的病理观察

本文分析了460例胃癌胃粘膜活检资料,结果:男:女为2.36:1:51～60岁年龄组发病率最岛(37.17％);发生部位以胃窦部最多见,占46.74％;组织学分类以低分化腺癌最多,占51 52％;在伴随病变中,畅化生的检出率为21.74％,胃腺囊为35％,胃粘膜上皮异型增生为32.61％。本组材料提示,不完全性大肠型肠化生、异型胃腺囊及胃粘膜中度以上异型增生与胃癌有密切关系。     

贲门癌术中留置金属导芯硅胶鼻肠管的临床研究

目的探讨贲门癌术后早期肠内营养的可行性、安全性及临床效果.方法贲门癌患者术中留置金属导芯硅胶鼻饲管,术后第1天开始肠内营养支持,术前及术后第10天,分别测量体重,检测血红蛋白浓度及肝肾功能,观察肠内营养的副作用.结果全组鼻饲管留置时间平均15.2 d;术后早期肠内营养明显增加了营养物质的摄入量,术后无明显的体重丢失,未见需要终止治疗的并发症.结论早期肠内营养治疗具有符合生理、减少医药费用等优点,该置管方法安全、简便,达到了加强术后患者营养支持的目的,可列入术后常规应用.