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1.
Audrey Auclair Julie Martin Marjorie Bastien Nadine Bonneville Laurent Biertho Simon Marceau Frédéric-Simon Hould Simon Biron Stéfane Lebel Odette Lescelleur Jean-Pierre Després Paul Poirier 《Obesity surgery》2016,26(8):1717-1727
Background
Severe obesity is often characterized by ectopic fat deposition, which is related to development of type 2 diabetes (T2D). Thus, resolution of T2D may not be linearly associated with weight loss. The importance of ectopic fat reduction after bariatric surgery and T2D resolution is uncertain.Objective
The aim of this pilot study is to compare body composition and body fat distribution in severely obese patients with or without T2D after biliopancreatic diversion with duodenal switch (BPD-DS) surgery in relation to diabetes resolution.Methods
Sixty-two severely obese patients were evaluated at baseline, 6, and 12 months. Of these, 40 patients underwent BPD-DS surgery. Anthropometric measurements and abdominal and mid-thigh computed tomography scans were performed at each visit.Results
Before BPD-DS surgery, obese patients with T2D had higher weight as well as greater ectopic fat deposition in the abdomen and mid-thigh level than obese patients without T2D (p?<?0.05). Resolution of T2D was 65 and 90 % at 6 and 12 months, respectively. No difference in body composition changes at 6 and 12 months could be found between patients without T2D, patients with T2D resolution, and patients who remained T2D. Resolution of T2D was associated with a greater absolute loss of visceral adipose tissue (VAT) in comparison to patients without T2D (?1175?±?570 cm3 vs. ?729?±?394 cm3 at 6 months and ?1647?±?816 cm3 vs. ?1103?±?422 cm3 at 12 months; all p?≤?0.05).Conclusion
Ectopic fat mobilization, particularly the absolute loss of VAT, may play a major role in T2D resolution following BPD-DS surgery, regardless of the amount of weight loss.2.
Stephanie C. Hart B.S.E. Bao Lien Nguyen-Tu M.D. Frederic-Simon Hould M.D. Russell B. Hanson B.S. Keith A. Kelly M.D. 《Journal of gastrointestinal surgery》1999,3(5):524-532
The aim of this study was to determine whether microsurgical anastomosis can restore propagation of jejunal pacesetter potentials
(PPs) across a site of canine jejunal transection and preserve motility and transit in bowel distal to the transection. A
complete jejunal transection with exact microsurgical anastomosis was performed in five dogs, while five dogs with intact
jejunum and five dogs with complete transection and end-to-end conventional macrosurgical anastomosis were used as controls.
Long-term recording electrodes and intraluminal, open-tipped pressure catheters were implanted in all dogs. The mean frequency
of PPs decreased distal to the transection in both groups of transected dogs. However, aborad propagation of PPs across the
anastomosis occurred episodically by 3 months in each dog that had a microsurgical anastomosis, but never occurred in any
dog with a conventional macroanastomosis. Moreover, the motility and transit in bowel distal to the transection were unaltered
in the dogs with a microsurgical anastomosis, whereas they decreased in the dogs with a macroanastomosis. The conclusion was
that microsurgical anastomosis of transected canine jejunum restored episodic propagation of PPs across the anastomosis, and
preserved motility and maintained transit in bowel distal to the anastomosis. The conventional macroanastomosis did none of
these.
Supported by the Mayo Foundation and the Nigrn Grant.
Presented in part at the Thirty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, May 19–22, 1996,
San Francisco, Calif. 相似文献
3.
Biron S Hould FS Lebel S Marceau S Lescelleur O Simard S Marceau P 《Obesity surgery》2004,14(2):160-164
Background: Comparative evaluation of weight loss after bariatric surgery is difficult without definition of success and without
a norm for presenting results. We explored the pertinence of defining success: a residual BMI <40 or <35 kg/m2, and the need for reporting results with stratification by initial obesity and length of follow-up. Methods: Results of 1,271
consecutive biliopancreatic diversion (BPD) patients were compared when presented with or without stratification, and we searched
for landmarks of success which would be shared by patients themselves. Results: Presented globally, after a mean follow-up
of 7.9 ± 4.2 years, BMI decreased from 48.4 ± 9.4 to 31.3 ± 6.5, and only 10% and 26% of patients would have been considered
failures with a residual BMI ≥ 40 or ≥ 35 respectively. Because heavier patients were losing less in terms of percentage (
P <0.0001) and regained weight faster ( P <0.0001), global and cumulative results failed to show a failure-rate doubling every
5 years and a very high failure-rate in heavier patients. The landmarks of BMI 40 and 35 were the same unconsciously used
by patients to express their own perception of failure. For patients with an initial BMI <50, a residual BMI of 35 caused
a significant drop in the degree of satisfaction from 90 to 40%. For super-obese, the same critical point was found at a BMI
of 40 where satisfaction dropped from 91 to 57%. Conclusion: Landmarks of success at BMI 40 and 35 were realistic, reasonable
and coincided with patients' own expectations. Since initial obesity and duration after surgery made so much difference in
results, a comparison of different surgical approaches was useless without stratification for both factors together. 相似文献
4.
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
5.
6.
Duval K Marceau P Lescelleur O Hould FS Marceau S Biron S Lebel S Pérusse L Lacasse Y 《Obesity surgery》2006,16(5):574-579
Background: In order to evaluate the impact of severe obesity and its treatment on quality of life (QoL), it would be important
to first identify the areas of QoL most likely to be affected by the disease. Methods: We first constructed a list of 187
items potentially related to QoL of patients with morbid obesity. From this list, consecutive candidates for bariatric surgery
were asked to identify what they felt were the most significant items and to grade their importance. The item impact was determined
from the proportion of patients who identified it as important, and the mean importance score attributed to this item (impact
score = frequency X importance). Results: 100 patients (68 female; mean body mass index 51.5 kg/m2; mean age 42) were interviewed. Overall, the impact of morbid obesity was more important in women than in men. The areas
of impairment were very similar in both groups, with the important difference that women ranked their dissatisfaction with
physical appearance higher than men. The items having the most important impact on QoL clustered into 7 domains: 1) activity/mobility;
2) symptoms; 3) personal hygiene/clothing; 4) emotions; 5) social interactions; 6) sexual life; and 7) eating behavior. Conclusion:
The impact of morbid obesity on QoL is not limited to the activity/mobility domain. Morbid obesity contributes to the impairment
of all domains of what is usually referred to as "health-related quality of life". 相似文献
7.
Bouchard L Faucher G Tchernof A Deshaies Y Lebel S Hould FS Marceau P Vohl MC 《Acta diabetologica》2009,46(1):13-21
The incretin system has been shown to stimulate insulin secretion in a glucose dependent manner and currently fosters considerable
hope for the treatment of diabetes. Recently, we have shown that the dipeptidylpeptidase-4 (DPP4) gene, which is responsible for incretin inactivation, was overexpressed in omental adipose tissue of obese men with the
metabolic syndrome, compared to men not characterized by this condition. Since the cardiovascular disease (CVD) risk profile
shows substantial inter-individual variability in obesity, this study aimed at verifying whether DPP4 polymorphisms contribute to explain such a difference. In the first step of this multi-stage study, seven tagging SNPs were
genotyped in a sample of 576 obese (BMI > 40 kg/m2) individuals and tested for their association with blood pressure and lipids, as well as diabetes-related phenotypes. Then,
in an additional sample of 572 obese individuals (stage 2), SNPs showing trends (P < 0.10) for an association in the first sample were genotyped and reanalyzed. Logistic regressions were used to compute odds
ratio for obesity-related metabolic complications. In sample 1, homozygotes for rs17848915 and rs7608798 minor alleles were
at lower risk of hyperglycemia/diabetes (P = 0.002) and elevated plasma triglyceride levels (P = 0.030) respectively, whereas rs1558957 heterozygotes were at higher risk to have high plasma triglyceride (P = 0.040), HDL- (P = 0.021), LDL- (P = 0.001) and total-cholesterol (P = 0.003) levels. However, none of these associations was consistently replicated in stage 2. This first comprehensive genetic
analysis does not support the notion that DPP4 polymorphisms could modulate the CVD risk profile among obese patients. 相似文献
8.
Malabsorptive obesity surgery 总被引:5,自引:0,他引:5
Marceau P Hould FS Lebel S Marceau S Biron S 《The Surgical clinics of North America》2001,81(5):1113-1127
Biliopancreatic diversion is the only valuable surgical approach for changing intestinal absorption. It is efficient in producing appropriate permanent weight loss and has a considerable psychological advantage because it does not impose abnormal food restriction. It not only decreases caloric absorption, but it also directly improves insulin and lipid metabolism. The ideal technique for the construction of BPD is not yet established, but our current preference is for the duodenal switch type. BPD must be seen as a means to change an intolerable and untreatable disease to a tolerable and treatable one, with substantial improvement in quality of life. 相似文献
9.
Progesterone receptors regulate gallbladder motility 总被引:1,自引:0,他引:1
F S Hould G M Fried A G Fazekas S Tremblay W A Mersereau 《The Journal of surgical research》1988,45(6):505-512
The increased incidence of gallstones in multiparous women may be related to hormonal effects on the gallbladder and its contractility. The occurrence of estrogen and progesterone receptors were studied in the gallbladders of three groups of female guinea pigs (normals, oophorectomized, and oophorectomized treated with estrogen + progesterone for 14 days). Gallbladder contractile response in vivo to cholecystokinin (CCK) was related to the presence of these receptors. The gallbladders from normal females showed low progesterone and estrogen binding activity (4.9 +/- 2.0 and 2.4 +/- 0.8 fmoles/mg cytosol protein). Oophorectomized females had no detectable progesterone or estrogen receptors, but after treating oophorectomized females for 14 days with estrogen + progesterone, gallbladder concentrations of progesterone receptors increased significantly to 14.7 +/- 5.9 fmoles/mg and estrogen binding activity was minimally detectable at 1.4 +/- 0.8 fmoles/mg. The gallbladder contractile response to CCK was inversely related to the concentration of progesterone receptors in the gallbladder wall. These data suggest that the gallbladder contains progesterone receptors which are susceptible to circulating hormonal conditions and which have a regulatory effect on gallbladder contractility. 相似文献
10.
Picard Marceau Simon Biron Frédéric-Simon Hould Stéfane Lebel Simon Marceau Odette Lescelleur Laurent Biertho Serge Simard 《Surgery for obesity and related diseases》2009,5(1):43-47
BackgroundThis was a retrospective study, performed 10 years after surgery, to compare the results between biliopancreatic diversion (BPD) with distal gastrectomy (DG) versus BPD with duodenal switch (DS).MethodsComplete follow-up data were available for 96% of patients, allowing a comparison of weight loss, revision, side effects, and complications at 10 years.ResultsAfter BPD-DS, weight loss was 25% greater than after BPD-DG (46.8 ± 21.7 kg versus 37.5 ± 22 kg, respectively; P <.0001). The need for revision decreased from 18.5% to 2.7% (P <.0001), and the prevalence of vomiting during the previous month was 50% less (23.7–50.6%, P <.0001) after BPD-DS compared with after BPD-DG. Late complications were the same for both procedures. Blood analysis showed that, after BPD-DS, the levels of calcium, iron, and hemoglobin were significantly greater and the parathyroid hormone level was lower than after BPD-DG (71.3 ± 44.2 versus 103.0 ± 64.0 ng/L, respectively; P <.0001).ConclusionThe DS greatly improved the BPD, as it was initially proposed. The use of the DS increased weight loss, decreased the need for revision, resulted in fewer side effects, and improved the absorption of nutrients. 相似文献