Symptomatic Vitamin A Deficiency following Biliopancreatic Diversion

Background: Biliopancreatic diversion (BPD) is an effective operation for morbid obesity. Fat-soluble vitamin deficiencies are known complications of this procedure, with incidence rates reported as high as 6%. Case Report: A-36-year old morbidly obese female with BMI 60.6 kg/m² underwent laparoscopic adjustable gastric banding, followed 2 years later by BPD in an attempt to control her weight. Following BPD, she failed to attend outpatient appointments and was poorly compliant with daily multivitamins and monitoring of serum vitamin and mineral levels. She developed symptomatic vitamin A deficiency, with vitamin A levels <0.1 umol/L, and night blindness, as well as deficiencies of vitamins D, E and K, zinc and selenium. Her vitamin deficiencies were corrected with appropriate supplements and her night blindness resolved. Discussion: This case raises the issues of preoperative screening of patients and compliance, as well as life-long postoperative monitoring of serum vitamin and mineral levels. With better compliance with outpatient appointments, prescribed multivitamins and oral vitamin A tablets, as well as regular monitoring of serum vitamin and mineral levels, vitamin deficiencies and their consequences, such as night blindness, may be avoided.     

Low-dose intravaginal estradiol delivery using a Silastic vaginal ring for estrogen replacement therapy in postmenopausal women: a review

Objective: The aim of this study was to review the potential of the intravaginal ring to be an effective low-dose estrogen delivery system for the treatment of postmenopausal women. Methods The data were extracted from the literature using the computerized MEDLINE system. The soft and flexible ring (Estring®) is made of silicone rubber with a 55-mm outer diameter and 9.5-mm cross-sectional diameter, contains 2 mg 17β-estradiol in the core section with the release specification limit of 6.5-9.5 μg/24 h and maintains a continuous plasma estradiol concentration of 20-30 pmol/l for 3 months when inserted in women. Results: Comparative clinical trials have demonstrated that treatment with the intravaginal ring is excellent at alleviating subjective and objective symptoms of estrogen deficiency, restores vaginal mucosa, induces a high maturation index of mucosal cells and reduces vaginal pH to < 5.5 in postmenopausal women. No major side-effects or endometrial proliferation have been observed during treatment. The majority of patients prefer using the vaginal ring to other currently available vaginal steroid delivery systems. The sustained low-dose estrogen therapy is also found to improve the serum lipid profile in elderly women. Conclusion: It is suggested that the low-dose estradiol intravaginal ring is safe, effective and well accepted for the treatment of estrogen deficiency symptoms in postmenopausal women.     

Night Eating Syndrome: Impact on Bariatric Surgery

Individuals with night eating syndrome (NES) display a time-delayed pattern of food intake, outside the natural circadian rhythm. High prevalence estimates have been reported among bariatric surgery candidates, and some evidence suggests that NES is positively associated with obesity, negatively associated with weight loss efficacy, and follows a chronic course. In order to evaluate current NES theory, and the association between NES and bariatric surgery, literature searches were conducted to identify relevant literature published in English up to 2005. Because of inconsistencies in NES characterization, and significant heterogeneity in study design and methods, a qualitative assessment of NES and its relation to bariatric surgery was then undertaken. Within the literature, variable NES definitions highlight the distinct lack of clarity as to which behavioral features constitute a clinically meaningful entity. Prevalence estimates appear high among persons seeking bariatric surgery; however, no consistent pre- or postoperative demographic, clinical, or psychological factors reliably differentiate NES from non-NES. Further examination of the clinical significance, correlates, and course of NES in general and surgical samples is important, given the link with obesity. The ways in which NES departs from "normal" eating behavior must be clarified. Behavioral and psychological traits of NES need elucidation, and the establishment of agreed diagnostic criteria is essential for research to move forward. Therapy options should focus on aspects of the syndrome that cause greatest impairment, distress, or health risk.