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A Decade of Change in Obesity Surgery 总被引:4,自引:0,他引:4
Edward E Mason MD PhD Shenghui Tang MS Kathleen E Renquist BS Dwight T Barnes Joseph J Cullen MD Cornelius Doherty MD James W Maher MD 《Obesity surgery》1997,7(3):189-197
Background: The International (formerly National) Bariatric Surgery Registry began collecting data in January 1986. The aim
of this study was to examine changes in the practice of surgical treatment of severe obesity that occurred during the decade
of 1986 through 1995, as observed in the IBSR data. Methods: All data submitted to the IBSR during the decade were transferred
to the IBM mainframe computer for analysis. Characteristics of operative type populations were compared over time using analysis
of variance (ANOVA) for age, body mass index (BMI), operative weight and Chi-square (χ2) test for gender. Results: There has been a steady increase over the decade in mean patient weight. The operations used have
changed from predominantly ‘simple’ operations to more frequent use of ‘complex’ operations. Within the categories of ‘simple’
and ‘complex’, an increase in the variety of operations occurred. As a group, patients with ‘simple’ operations have been
heavier, more often male and public pay patients than those who have undergone ‘complex’ operations. One year weight loss
was greater for Roux-en-Y gastric bypass (RGB) than vertical banded gastroplasty (VBG), but follow-up rates were too low to
study the relative merits of the operations used. The reported incidence of operative mortality and serious complications
(leak with peritonitis, abscess and pulmonary embolism) remained low. Conclusions: These observations and their implications
can be summarized in three statements which relate to action for improved patient care in the beginning of the new century:
(1) increasing weight of candidates for surgical treatment during this decade indicates the need for earlier use of operative
treatment before irreversible complications of obesity can develop; (2) low risk of obesity surgery, decreasing postoperative
hospital stay, and early weight control support the continued and increased use of surgical treatment; (3) continued widespread
use of both ‘simple’ and ‘complex’ operations with increased modifications of standard RGB and VBG procedures emphasizes the
need for standardized long-term data and analyses regarding both weight control and postoperative side-effects. 相似文献
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Lungiswa L Nkonki Tanya M Doherty Zelee Hill Mickey Chopra Nikki Schaay Carl Kendall 《AIDS research and therapy》2007,4(1):27
Background
The objective of this study was to examine missed opportunities for participation in a prevention of mother-to-child transmission (PMTCT) programme in three sites in South Africa. A rapid anthropological assessment was used to collect in-depth data from 58 HIV-positive women who were enrolled in a larger cohort study to assess mother-to-child HIV transmission. Semi-structured interviews were conducted with the women in order to gain an understanding of their experiences of antenatal care and to identify missed opportunities for participation in PMTCT. 相似文献5.
We used a quantitative immunoassay to examine the effects of human serum and immunoglobulins on neurofilament protein expression in cultures of chick spinal neurons. Compared with cultures grown in the presence of serum from healthy controls or patients with other neurologic disorders, ALS serum lowered the level of neurofilament proteins. Effects were similar with or without muscle-derived neurotrophic factors; there was no specificity for motor neurons. No neurotoxic activity was found in immunoglobulin fractions, and there was no evidence of circulating antibodies that might neutralize muscle-derived neurotrophic factors or induce cytolysis of spinal neurons. 相似文献
6.
Percutaneous transhepatic placement of biliary endoprostheses: results in 100 consecutive patients. 总被引:4,自引:0,他引:4
B W Dick R L Gordon J M LaBerge M M Doherty E J Ring 《Journal of vascular and interventional radiology : JVIR》1990,1(1):97-100
One hundred patients with malignant biliary obstruction underwent palliative therapy by means of percutaneous transhepatic placement of 114 biliary endoprostheses. All patients were then followed up for at least 18 months or until death. Retrospective evaluation of the 95 patients who died showed an average survival time of 5.0 months. The five remaining patients have survived an average of 29.8 months. During the 1st week after stent insertion, a second manipulation was performed to improve stent function in nine patients. Overall, 14 (12.3%) of the stents became obstructed and six (5.2%) migrated; 86 patients required no further therapy for biliary obstruction or stent malfunction. The 30-day mortality rate was 12%; none of the deaths were directly attributable to a complication of the stent placement procedure. 相似文献
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INTRODUCTION: Levetiracetam (LEV) is approved for use as add-on therapy in adult patients with partial epilepsy. It is apparent from clinical trials that up to 8% of previously drug-resistant patients may be rendered seizure-free by adding-on levetiracetam. As yet there is no way of predicting these unexpectedly responsive patients. We set out to identify our previously refractory patients who had demonstrated unexpected responsiveness to add-on therapy with levetiracetam, and compared these to patients who had not responded to the drug. We then attempted to characterise any clinical features that differentiated these groups of patients. METHODS: We included all patients with a history of present or previous exposure to levetiracetam who had been unresponsive to at least two other prior anti-epileptic drugs (AEDs) and recorded their demographic and clinical data. We divided response into (a) 'seizure-free' (seizure-free for a minimum of 6 months after commencing LEV); (b) 'partial > 50%' (greater than 50% reduction in seizures for a minimum of 6 months after commencing LEV); (c) 'honeymoon' (seizure-free for less than 6 months after commencing LEV and then returned towards baseline frequency); and (d) 'no-response'. For the purpose of analysis we considered the 'seizure-free' and 'partial > 50%' groups as 'responders', and the 'no response' group as 'non responders'. RESULTS: 344 patients were included in the analysis. Fifty-six patients (16.3%) were rendered seizure-free on levetiracetam. Idiopathic generalised epilepsy and post-traumatic partial epilepsy were more common in the responder than the non-responder group (p = 0.005 and 0.05 respectively). Lamotrigine was used significantly more often in combination with levetiracetam in responders than non-responders (p = 0.003). The mean daily dose of levetiracetam was lower in responders than non-responders. DISCUSSION: A higher than expected number of previously drug resistant patients was rendered seizure-free by add-on therapy with levetiracetam. Those who respond best appear to do so at relatively low doses and our data suggest the possibility of a beneficial pharmacodynamic interaction between levetiracetam and lamotrigine. We were unable to identify any clinical factors that clearly predicted which patients would become seizure-free and we hypothesise that response may be determined by genetic or molecular factors. All drug-resistant patients, including those being assessed for surgery, should be considered for a trial of levetiracetam, regardless of their epilepsy classification. 相似文献
9.
The roles of gamma-interferon and tumor necrosis factor alpha in an experimental rat model of cancer cachexia 总被引:3,自引:0,他引:3
Administration of repetitive sublethal doses of either recombinant human tumor necrosis factor (TNF) or recombinant murine gamma-interferon (IFN) to non-tumor-bearing (NTB) rats caused a significant decline in food intake and body weight. After 3 days rats became resistant to the anorectic and weight loss effects of TNF but maintained persistent diminished food intake and diminished body weight gain while receiving recombinant murine IFN. Passive immunization against recombinant rat gamma-interferon allowed cachectic tumor-bearing (TB) rats to eat more food, have a lesser decline in body weight, live longer, and tolerate larger tumors than similar TB rats given nonspecific control antibody. TB rats treated with an antisera to recombinant murine TNF, which was 100% protective when given to NTB rats 6 h before a lethal endotoxin challenge, did not differ significantly from TB rats treated with control antibody with respect to food intake, body weight, survival, or tumor size. Serum levels of TNF or IFN were not detectable in cachectic tumor-bearing rats. The data indicate that the administration of exogenous IFN can simulate cachexia in NTB rats and that passive immunization against it can partially reverse the cachectic changes associated with cancer and prolong survival. These findings suggest that gamma-interferon may be an important mediator of cachexia in this rat tumor model. 相似文献
10.
Current emphasis on reducing length of hospital stay has stimulated a review of the philosophical, clinical, and administrative approaches to brief psychiatric hospitalization of children. A model of time-limited hospitalization on an eight-bed children's unit was designed to stabilize the patients and triage them back to appropriate levels of community aftercare within 28 days. Clinical and administrative strategies used to facilitate this process included a community-based case manager for each patient, focused clinical intervention, and strong parent involvement. The treatment model was generally successful in meeting the goals of hospitalization. Of 212 admissions over three years, 37 percent of the patients at discharge continued to need complex, multi-modal treatments, and 63 percent were referred for less intensive outpatient care. 相似文献