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1.
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
2.
Julien Paccou Niels Martignène Eric Lespessailles Evgéniya Babykina François Pattou Bernard Cortet Grégoire Ficheur 《Journal of bone and mineral research》2020,35(8):1415-1423
The objective of this work was to investigate the risk of major osteoporotic fracture (MOF; hip, proximal humerus, wrist and distal forearm, and clinical spine) in bariatric surgery patients versus matched controls. Bariatric surgery is associated with an increase in fracture risk. However, it remains unclear whether the same degree of fracture risk is associated with sleeve gastrectomy, which has recently surpassed gastric bypass. Records from the French National Inpatient database were used from 2008 to 2018. Bariatric surgery patients, aged 40 to 65 years, with BMI ≥40 kg/m2, hospitalized between January 1, 2010 and December 31, 2014, were matched to one control (1:1) by age, sex, Charlson comorbidity index, year of inclusion, and class of obesity (40 to 49.9 kg/m2 versus ≥50 kg/m2). We performed a Cox regression analysis to assess the association between the risk of any MOF and, respectively, (i) bariatric surgery (yes/no) and (ii) type of surgical procedure (gastric bypass, gastric banding, vertical banded gastroplasty, and sleeve gastrectomy) versus no surgery. A total of 81,984 patients were included in the study (40,992 in the bariatric surgery group, and 40,992 matched controls). There were 585 MOFs in the surgical group (2.30 cases per 1000 patient-year [PY]) and 416 MOFs in the matched controls (1.93 cases per 1000 PY). The risk of MOF was significantly higher in the surgical group (hazard ratio [HR] 1.22; 95% CI, 1.08–1.39). We observed an increase in risk of MOF for gastric bypass only (HR 1.70; 95% CI, 1.46–1.98) compared with the matched controls. In patients aged 40 to 65 years, gastric bypass but not sleeve gastrectomy or the other procedures increased risk of major osteoporotic fractures. © 2020 American Society for Bone and Mineral Research. 相似文献
3.
Helena Johansson John A Kanis Anders Odén Eugene McCloskey Roland D Chapurlat Claus Christiansen Steve R Cummings Adolfo Diez‐Perez John A Eisman Saeko Fujiwara Claus‐C Glüer David Goltzman Didier Hans Kay‐Tee Khaw Marc‐Antoine Krieg Heikki Kröger Andrea Z LaCroix Edith Lau William D Leslie Dan Mellström L Joseph Melton III Terence W O'Neill Julie A Pasco Jerilynn C Prior David M Reid Fernando Rivadeneira Tjerd van Staa Noriko Yoshimura M Carola Zillikens 《Journal of bone and mineral research》2014,29(1):223-233
Several recent studies suggest that obesity may be a risk factor for fracture. The aim of this study was to investigate the association between body mass index (BMI) and future fracture risk at different skeletal sites. In prospective cohorts from more than 25 countries, baseline data on BMI were available in 398,610 women with an average age of 63 (range, 20–105) years and follow up of 2.2 million person‐years during which 30,280 osteoporotic fractures (6457 hip fractures) occurred. Femoral neck BMD was measured in 108,267 of these women. Obesity (BMI ≥ 30 kg/m2) was present in 22%. A majority of osteoporotic fractures (81%) and hip fractures (87%) arose in non‐obese women. Compared to a BMI of 25 kg/m2, the hazard ratio (HR) for osteoporotic fracture at a BMI of 35 kg/m2 was 0.87 (95% confidence interval [CI], 0.85–0.90). When adjusted for bone mineral density (BMD), however, the same comparison showed that the HR for osteoporotic fracture was increased (HR, 1.16; 95% CI, 1.09–1.23). Low BMI is a risk factor for hip and all osteoporotic fracture, but is a protective factor for lower leg fracture, whereas high BMI is a risk factor for upper arm (humerus and elbow) fracture. When adjusted for BMD, low BMI remained a risk factor for hip fracture but was protective for osteoporotic fracture, tibia and fibula fracture, distal forearm fracture, and upper arm fracture. When adjusted for BMD, high BMI remained a risk factor for upper arm fracture but was also a risk factor for all osteoporotic fractures. The association between BMI and fracture risk is complex, differs across skeletal sites, and is modified by the interaction between BMI and BMD. At a population level, high BMI remains a protective factor for most sites of fragility fracture. The contribution of increasing population rates of obesity to apparent decreases in fracture rates should be explored. © 2014 American Society for Bone and Mineral Research. 相似文献
4.
The Effect of Acute Exercise on Undercarboxylated Osteocalcin and Insulin Sensitivity in Obese Men
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Itamar Levinger George Jerums Nigel K Stepto Lewan Parker Fabio R Serpiello Glenn K McConell Mitchell Anderson David L Hare Elizabeth Byrnes Peter R Ebeling Ego Seeman 《Journal of bone and mineral research》2014,29(12):2571-2576
Acute exercise improves insulin sensitivity for hours after the exercise is ceased. The skeleton contributes to glucose metabolism and insulin sensitivity via osteocalcin (OC) in its undercarboxylated (ucOC) form in mice. We tested the hypothesis that insulin sensitivity over the hours after exercise is associated with circulating levels of ucOC. Eleven middle‐aged (58.1 ± 2.2 years mean ± SEM), obese (body mass index [BMI] = 33.1 ± 1.4 kg/m2) nondiabetic men completed a euglycemic‐hyperinsulinemic clamp at rest (rest‐control) and at 60 minutes after exercise (4 × 4 minutes of cycling at 95% of HRpeak). Insulin sensitivity was determined by glucose infusion rate relative to body mass (GIR, mL/kg/min) as well as GIR per unit of insulin (M‐value). Blood samples and five muscle biopsies were obtained; two at the resting‐control session, one before and one after clamping, and three in the exercise session, at rest, 60 minutes after exercise, and after the clamp. Exercise increased serum ucOC (6.4 ± 2.1%, p = 0.013) but not total OC (p > 0.05). Blood glucose was ~6% lower and insulin sensitivity was ~35% higher after exercise compared with control (both p < 0.05). Phosphorylated (P)‐AKT (Ak thymoma) was higher after exercise and insulin compared with exercise alone (no insulin) and insulin alone (no exercise, all p < 0.05). In a multiple‐linear regression including BMI, age, and aerobic fitness, ucOC was associated with whole‐body insulin sensitivity at rest (β = 0.59, p = 0.023) and after exercise (β = 0.66, p = 0.005). Insulin sensitivity, after acute exercise, is associated with circulating levels of ucOC in obese men. Whether ucOC has a direct effect on skeletal muscle insulin sensitivity after exercise is yet to be determined. © 2014 American Society for Bone and Mineral Research. 相似文献
5.
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
6.
Virtual Gastroduodenoscopy: A New Look at the Bypassed Stomach and Duodenum After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity 总被引:2,自引:4,他引:2
Silecchia G Catalano C Gentileschi P Elmore U Restuccia A Gagner M Basso N 《Obesity surgery》2002,12(1):39-48
Background: After open or laparoscopic Roux-en-Y gastric bypass (RYGBP) for morbid obesity, the bypassed stomach and duodenum
are not readily available for radiological and endoscopic evaluation. Furthermore, little is known about the long-term physiologic
and histologic changes that occur in the bypassed GI segments following these procedures. Many alternative radiological and
endoscopic techniques have been described to access the distal gastric pouch and the duodenum after RYGBP. Apart from percutaneous
gastrografin? studies, all these techniques require the insertion of a gastrostomy tube in the distal stomach. Methods: a
new diagnostic method to access the bypassed segments by virtual CT gastroscopy (VG) was used in 5 morbidly obese patients
who underwent laparoscopic RYGBP (LRYGBP). Results: All patients tolerated the procedure well, which appears safe and suitable
for an outpatient setting.The virtual images offered an excellent intraluminal view of the stomach and duodenum. Conclusions:
VG holds promise as the method of choice in the follow-up of LRYGB patients, having the potential to detect inflammatory changes
and cancer in the excluded segments early. 相似文献
7.
Background: We evaluated the safety and feasibility of performing a laparoscopic intracorporeal end-toside small bowel anastomosis
using a stapling technique as part of a Roux-en-Y gastric bypass operation (RYGBP). Methods: 80 consecutive patients who underwent
RYGBP with laparoscopic jejunojejunostomy were evaluated. Operative time and intraoperative and postoperative complications
directly related to the jejunojejunostomy anastomosis were recorded. Results: All 80 laparoscopic jejunojejunostomy procedures
were successfully performed without conversion to laparotomy. Mean operative time was longer for the first 40 laparoscopic
RYGBP than for the last 40 RYGBP (32±18 min vs 21±14 min, respectively, p<0.05). Intraoperative complications were staple-line
bleeding (2 patients) and narrowing of the anastomosis (1 patient). Postoperative complications were four small bowel obstructions:
technical narrowing at jejunojejunostomy site (2 patients), angulation of the afferent limb (1 patient), and food impaction
at the jejunojejunostomy anastomosis (1 patient). These four patients underwent successful laparoscopic re-exploration and
creation of another jejunojejunostomy proximal to the original anastomosis. There were no small bowel anastomotic leaks. The
median time to resuming oral diet was 2 days. Conclusions: Laparoscopic jejunojejunostomy as part of the RYGBP operation is
a safe and technically feasible procedure. Postoperative small bowel obstruction is a potential complication, which can be
prevented by avoiding technical narrowing of the afferent limb. 相似文献
8.
Background: Obesity and anovulation are common medical problems in the United States. Anovulation in obese patients primarily
manifests with irregular, sporadic or absent menstrual bleeding. Weight loss of at least 5% has been shown to reverse obesity-related
anovulation. The aim of this study was to assess the impact of bariatric surgery on infertility in morbidly obese women and
to identify factors associated with return of normal menses following bariatric surgery. Methods: A survey of patients was
collected from the bariatric surgery data-base at the Hospital of the University of Pennsylvania. 410 women under the age
of 40 were sent questionnaires. 195 patients completed the questionnaire, and 29 patients had incorrect addresses without
a forwarding address, resulting in a 51.2% response rate. Patients who reported menstrual cycle lengths >35 days were considered
abnormal. 92 of the 195 responders were considered anovulatory preoperatively, based on menstrual history. Results: There
was no significant difference in postoperative BMI, BMI decrease or age at surgery between the survey responders and non-responders.
There was a significant difference between these 2 groups in time since surgery (P=.01). Both groups had a decrease in BMI of >18 kg/m2. The mean menstrual cycle length preoperatively among those categorized as ovulatory and anovulatory was 27.3 and 127.5 days,
respectively. Of the 98 patients who were anovulatory preoperatively, 70 patients (71.4%) regained normal menstrual cycles
after surgery. Those patients who regained ovulation had greater weight loss than those who remained anovulatory (61.4 kg
vs 49.9 kg, P=0.02). Conclusions: Anovulation resulting in abnormal menses is a common problem in morbidly obese premenopausal women. The
menstrual cycle disorders may completely resolve after bariatric surgery. Thus, infertility due to anovulation among morbidly
obese women could potentially be viewed as an additional indication for bariatric surgery. 相似文献
9.
This report represents the first known case of a gastric schwannoma in a patient subsequent to a gastric stapling and partitioning
procedure for morbid obesity. The submucosal tumor found in the collapsed distal portion of the stomach was merely an incidental
finding and it appeared that all of the patient's ongoing symptomatology (nausea and vomiting after meals) was a reflection
of the chronic obstruction that was present at the gastric partitioning staple-line. No correlation between gastric stapling
and partitioning and the development of gastric schwannoma is known or is suggested in this report. 相似文献
10.
Angrisani L Furbetta F Doldi SB Basso N Lucchese M Giacomelli M Zappa M Di Cosmo L Veneziani A Turicchia GU Alkilani M Forestieri P Lesti G Puglisi F Toppino M Campanile F Capizzi FD D'Atri C Scipioni L Giardiello C Di Lorenzo N Lacitignola S Belvederesi M Marzano B Bernante P Iuppa A Borrelli V Lorenzo M;Italian Collaborative Study Group for the Lap-Band System 《Obesity surgery》2002,12(6):846-850
Background: Laparoscopic adjustable gastric banding (LAGB) is the most common bariatric operation. This study is a retrospective
analysis of the multicenter Italian experience in patients with BMI >50 over the last 4 years. Methods: An electronic data
sheet made for LAGBoperated patients since January 1996, was mailed and e-mailed to all surgeons involved in this kind of
procedure in Italy. Items regarding patients with BMI >50 were selected. Analysis used Fisher's exact test and logarithmic
regression analysis (P<0.05 significant). Data were expressed as mean ± SD. Results: 239 patients (13.3%), out of 1,797 LapBand? operated patients entered the study (179F / 60M), with mean age 37.6±11.3 years (19-69) and mean BMI 54.6±4.8 (50.1-83.6).
Laparotomic conversion rate was 5.4% (44/239). Postoperative complications occurred in 24 / 239 patients (9.0%). Follow-up
was obtained in 218 / 218, 198 / 198, 121 / 147, 75 / 93, 30 / 38 LAGB patients at 6, 12, 24, 36, and 48 months respectively.
At these time periods, mean BMI was 46.7, 43.9, 42.2, 41.9, and 39.3 kg/m2. At the same intervals, mean %EWL was 24.1, 34.1, 38.8, 38.9, and 52.9%.The number of patients with <25% EWL at 12, 24, 36,
and 48 months follow-up were 34, 10, 4, and 0. Serious co-morbidities (189 in 124 of 239, 57%) had completely resolved 1 year
postoperatively in 74 / 124 of the patients (59.6%). Conclusion: Although super-obese patients following the LAGB remain obese
with BMI >35, in the short-term most lose their co-morbidities, with a very low morbidity and mortality rate. 相似文献