WorldWideScience

Sample records for bariatric medicine

  1. Lipids and bariatric procedures part 1 of 2: Scientific statement from the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and Obesity Medicine Association: EXECUTIVE SUMMARY.

    Science.gov (United States)

    Bays, Harold E; Jones, Peter H; Jacobson, Terry A; Cohen, David E; Orringer, Carl E; Kothari, Shanu; Azagury, Dan E; Morton, John; Nguyen, Ninh T; Westman, Eric C; Horn, Deborah B; Scinta, Wendy; Primack, Craig

    2016-01-01

    Bariatric procedures often improve lipid levels in patients with obesity. This 2-part scientific statement examines the potential lipid benefits of bariatric procedures and represents contributions from authors representing the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and the Obesity Medicine Association. The foundation for this scientific statement was based on data published through June 2015. Part 1 of this 2-part scientific statement provides an overview of: (1) adipose tissue, cholesterol metabolism, and lipids; (2) bariatric procedures, cholesterol metabolism, and lipids; (3) endocrine factors relevant to lipid influx, synthesis, metabolism, and efflux; (4) immune factors relevant to lipid influx, synthesis, metabolism, and efflux; (5) bariatric procedures, bile acid metabolism, and lipids; and (6) bariatric procedures, intestinal microbiota, and lipids, with specific emphasis on how the alterations in the microbiome by bariatric procedures influence obesity, bile acids, and inflammation, which in turn, may all affect lipid levels. Included in part 2 of this comprehensive scientific statement will be a review of: (1) the importance of nutrients (fats, carbohydrates, and proteins) and their absorption on lipid levels; (2) the effects of bariatric procedures on gut hormones and lipid levels; (3) the effects of bariatric procedures on nonlipid cardiovascular disease risk factors; (4) the effects of bariatric procedures on lipid levels; (5) effects of bariatric procedures on cardiovascular disease; and finally (6) the potential lipid effects of vitamin, mineral, and trace element deficiencies that may occur after bariatric procedures. This document represents the executive summary of part 1.

  2. Lipids and bariatric procedures part 1 of 2: Scientific statement from the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and Obesity Medicine Association: FULL REPORT.

    Science.gov (United States)

    Bays, Harold E; Jones, Peter H; Jacobson, Terry A; Cohen, David E; Orringer, Carl E; Kothari, Shanu; Azagury, Dan E; Morton, John; Nguyen, Ninh T; Westman, Eric C; Horn, Deborah B; Scinta, Wendy; Primack, Craig

    2016-01-01

    Bariatric procedures often improve lipid levels in patients with obesity. This 2 part scientific statement examines the potential lipid benefits of bariatric procedures and represents the contributions from authors representing the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and the Obesity Medicine Association. The foundation for this scientific statement was based on published data through June 2015. Part 1 of this 2 part scientific statement provides an overview of: (1) adipose tissue, cholesterol metabolism, and lipids; (2) bariatric procedures, cholesterol metabolism, and lipids; (3) endocrine factors relevant to lipid influx, synthesis, metabolism, and efflux; (4) immune factors relevant to lipid influx, synthesis, metabolism, and efflux; (5) bariatric procedures, bile acid metabolism, and lipids; and (6) bariatric procedures, intestinal microbiota, and lipids, with specific emphasis on how the alterations in the microbiome by bariatric procedures influence obesity, bile acids, and inflammation, which in turn, may all affect lipid levels. Included in part 2 of this comprehensive scientific statement will be a review of (1) the importance of nutrients (fats, carbohydrates, and proteins) and their absorption on lipid levels; (2) the effects of bariatric procedures on gut hormones and lipid levels; (3) the effects of bariatric procedures on nonlipid cardiovascular disease (CVD) risk factors; (4) the effects of bariatric procedures on lipid levels; (5) effects of bariatric procedures on CVD; and finally, (6) the potential lipid effects of vitamin, mineral, and trace element deficiencies that may occur after bariatric procedures. This document represents the full report of part 1.

  3. Lipids and bariatric procedures part 1 of 2: Scientific statement from the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and Obesity Medicine Association: EXECUTIVE SUMMARY.

    Science.gov (United States)

    Bays, Harold E; Jones, Peter H; Jacobson, Terry A; Cohen, David E; Orringer, Carl E; Kothari, Shanu; Azagury, Dan E; Morton, John; Nguyen, Ninh T; Westman, Eric C; Horn, Deborah B; Scinta, Wendy; Primack, Craig

    2016-01-01

    Bariatric procedures often improve lipid levels in patients with obesity. This 2-part scientific statement examines the potential lipid benefits of bariatric procedures and represents contributions from authors representing the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and the Obesity Medicine Association. The foundation for this scientific statement was based on data published through June 2015. Part 1 of this 2-part scientific statement provides an overview of: (1) adipose tissue, cholesterol metabolism, and lipids; (2) bariatric procedures, cholesterol metabolism, and lipids; (3) endocrine factors relevant to lipid influx, synthesis, metabolism, and efflux; (4) immune factors relevant to lipid influx, synthesis, metabolism, and efflux; (5) bariatric procedures, bile acid metabolism, and lipids; and (6) bariatric procedures, intestinal microbiota, and lipids, with specific emphasis on how the alterations in the microbiome by bariatric procedures influence obesity, bile acids, and inflammation, which in turn, may all affect lipid levels. Included in part 2 of this comprehensive scientific statement will be a review of: (1) the importance of nutrients (fats, carbohydrates, and proteins) and their absorption on lipid levels; (2) the effects of bariatric procedures on gut hormones and lipid levels; (3) the effects of bariatric procedures on nonlipid cardiovascular disease risk factors; (4) the effects of bariatric procedures on lipid levels; (5) effects of bariatric procedures on cardiovascular disease; and finally (6) the potential lipid effects of vitamin, mineral, and trace element deficiencies that may occur after bariatric procedures. This document represents the executive summary of part 1. PMID:26892119

  4. Lipids and bariatric procedures part 1 of 2: Scientific statement from the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and Obesity Medicine Association: FULL REPORT.

    Science.gov (United States)

    Bays, Harold E; Jones, Peter H; Jacobson, Terry A; Cohen, David E; Orringer, Carl E; Kothari, Shanu; Azagury, Dan E; Morton, John; Nguyen, Ninh T; Westman, Eric C; Horn, Deborah B; Scinta, Wendy; Primack, Craig

    2016-01-01

    Bariatric procedures often improve lipid levels in patients with obesity. This 2 part scientific statement examines the potential lipid benefits of bariatric procedures and represents the contributions from authors representing the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and the Obesity Medicine Association. The foundation for this scientific statement was based on published data through June 2015. Part 1 of this 2 part scientific statement provides an overview of: (1) adipose tissue, cholesterol metabolism, and lipids; (2) bariatric procedures, cholesterol metabolism, and lipids; (3) endocrine factors relevant to lipid influx, synthesis, metabolism, and efflux; (4) immune factors relevant to lipid influx, synthesis, metabolism, and efflux; (5) bariatric procedures, bile acid metabolism, and lipids; and (6) bariatric procedures, intestinal microbiota, and lipids, with specific emphasis on how the alterations in the microbiome by bariatric procedures influence obesity, bile acids, and inflammation, which in turn, may all affect lipid levels. Included in part 2 of this comprehensive scientific statement will be a review of (1) the importance of nutrients (fats, carbohydrates, and proteins) and their absorption on lipid levels; (2) the effects of bariatric procedures on gut hormones and lipid levels; (3) the effects of bariatric procedures on nonlipid cardiovascular disease (CVD) risk factors; (4) the effects of bariatric procedures on lipid levels; (5) effects of bariatric procedures on CVD; and finally, (6) the potential lipid effects of vitamin, mineral, and trace element deficiencies that may occur after bariatric procedures. This document represents the full report of part 1. PMID:26892120

  5. Bariatric Surgery Misconceptions

    Science.gov (United States)

    ... from depression or anxiety and to have lower self-esteem and overall quality of life than someone who ... is a Candidate for Bariatric Surgery? Childhood and Adolescent Obesity Find a Provider Benefits of Bariatric Surgery ...

  6. Hyperoxaluria and Bariatric Surgery

    Science.gov (United States)

    Asplin, John R.

    2007-04-01

    Bariatric surgery as a means to treat obesity is becoming increasingly common in the United States. An early form of bariatric surgery, the jejunoileal bypass, had to be abandoned in 1980 due to numerous complications, including hyperoxaluria and kidney stones. Current bariatric procedures have not been systematically evaluated to determine if they cause hyperoxaluria. Presented here are data showing that hyperoxaluria is the major metabolic abnormality in patients with bariatric surgery who form kidney stones. Further studies are needed to assess the prevalence of hyperoxaluria in all patients with bariatric surgery.

  7. [Bariatric surgery in Denmark.

    DEFF Research Database (Denmark)

    Funch-Jensen, P.; Iversen, M.G.; Kehlet, H.

    2008-01-01

    INTRODUCTION: In 2005 the National Board of Health (NBH) published guidelines on bariatric surgery in Denmark. The aim of the present study was to shed light on the national bariatric effort in relation to these guidelines. MATERIAL AND METHODS: The analysis is based on extraction of the following......, a tendency which was attributable to the activities of one of the private clinics. CONCLUSION: The frequency with which bariatric surgery is performed follows a strongly increasing trend and the procedures are only performed at the public departments selected by the National Board of Health...... and at the private centres that have entered into an agreement with Danish Regions. Since the operative access and selection of procedures varies between departments we conclude that research should be a firm requirement for all centres, and that research efforts should comprise cooperation concerning the database...

  8. American Society for Metabolic and Bariatric Surgery

    Science.gov (United States)

    ... Op Weight Loss, Intra-Gastric Balloon, and Revisional Surgery... Certified Bariatric Nurses Be a part of the ASMBS Certified ... Online Education Directory Search Patient Learning Center Bariatric Surgery FAQs Bariatric Surgery Procedures BMI Calculator Childhood and Adolescent Obesity ...

  9. Depo-Provera (depot medroxyprogesterone acetate use after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Lam C

    2016-09-01

    Full Text Available Clarissa Lam,1 Amitasrigowri S Murthy2,3 1New York University School of Medicine, 2Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York University School of Medicine, 3New York University Langone Medical Center, New York, NY, USA Abstract: In the US, obesity rates are increasing greatly. The Centers for Disease Control and Prevention estimates that 68.5% of Americans, including 63.9% of adult women older than 20 years, are overweight (body mass index between 25 kg/m2 and 29.9 kg/m2 or obese (body mass index >30 kg/m2. In light of this, it is not surprising that the rates of bariatric surgery have also been increasing. When considering the metabolic changes associated with both bariatric surgery and contraceptive use, in combination with the unique medical considerations of obese women, it is indisputable that clear guidelines are needed when counseling obese patients of reproductive age after bariatric surgery. In this literature review, we focus on depot medroxyprogesterone acetate (DMPA and the implications of its use in obese women, preweight and postweight loss following bariatric surgery. Both DMPA use and bariatric surgery are known to cause bone loss, but it is still unclear whether there is an additive effect of the two factors on bone loss and whether either of these factors directly leads to an increased risk of bone fracture. The current consensus guidelines do not impose a restriction on the use of DMPA after bariatric surgery. DMPA use is associated with weight gain, and it is unclear whether weight loss blunting occurs with the use of DMPA after bariatric surgery. Prior studies had demonstrated an association with weight gain in adolescents, and therefore, those prescribing DMPA use after bariatric surgery in adolescents should proceed with caution. Adult women do not have a similar response to the use of DMPA. DMPA use has rarely been associated with increased risk of venous thromboembolism (VTE. The

  10. Pregnancy management following bariatric surgery.

    Science.gov (United States)

    Uzoma, A; Keriakos, R

    2013-02-01

    Bariatric surgery is gaining in popularity, due to globally increasing rates of obesity. In the UK, this has manifested as a 14-fold increase in bariatric surgery between 2004 and 2010, making it necessary to develop strategies to manage women who become pregnant following bariatric surgery. This review paper has explored all the current evidence in the literature and provided a comprehensive management strategy for pregnant women following bariatric surgery. The emphasis is on a multidisciplinary team approach to all aspects of care. Adequate pre-conception and antenatal and postnatal care is essential to good pregnancy outcomes with emphasis on appropriate nutritional supplementation. This is especially important following malabsorptive procedures. There is no evidence to suggest that pregnancy outcome is worse after bariatric surgery, though women who remain obese are prone to obesity-related risks in pregnancy. Neonatal outcome post-bariatric surgery is no different from the general population. PMID:23445128

  11. Bariatric Surgery for Severe Obesity

    Science.gov (United States)

    ... switch, less often. Each type of surgery has advantages and disadvantages. ​ ​​​​ Bariatric Surgery Benefits Bariatric surgery can ... basic and clinical research into many disorders. ​ Additional Reading Active at Any Size! Binge Eating Disorder Dieting ...

  12. A Prior History of Substance Abuse in Veterans Undergoing Bariatric Surgery

    OpenAIRE

    Maureen Tedesco; William Q. Hua; Lohnberg, Jessica A.; Nina Bellatorre; Dan Eisenberg

    2013-01-01

    Background. The rates of obesity and substance abuse are high among US veterans. Objective. To examine weight loss and substance abuse rates following bariatric surgery in veterans with a history of substance abuse (SA). Methods. A prospective database of consecutive bariatric operations was reviewed. Data for SA patients were compared to patients without a substance abuse history (NA). Behavioral medicine staff followed patients throughout the pre- and postoperative courses. Results. Of 205 ...

  13. Innovations in Bariatric Surgery.

    Science.gov (United States)

    Zhu, Catherine; Pryor, Aurora D

    2015-11-01

    Surgery has consistently been demonstrated to be the most effective long-term therapy for the treatment of obesity. However, despite excellent outcomes with current procedures, most patients with obesity- and weight-related comorbidities who meet criteria for surgical treatment choose not to pursue surgery out of fear of operative risks and complications or concerns about high costs. Novel minimally invasive procedures and devices may offer alternative solutions for patients who are hesitant to pursue standard surgical approaches. These procedures may be used for primary treatment of obesity, early intervention for patients approaching morbid obesity, temporary management prior to bariatric surgery, or revision of bypass surgery associated with weight regain. Novel bariatric procedures can in general be divided into four categories: endoluminal space-occupying devices, gastric suturing and restrictive devices, absorption-limiting devices, and neural-hormonal modulating devices. Many of these are only approved as short-term interventions, but these devices may be effective for patients desiring low-risk procedures or a transient effect. We will see the expansion of indications and alternatives for metabolic surgery as these techniques gain approval.

  14. Bariatric Surgery and Stone Disease

    Science.gov (United States)

    Lieske, John C.; Kumar, Rajiv

    2008-09-01

    Bariatric surgery is an effective treatment strategy for patients with morbid obesity that can result in effective weight loss, resolution of diabetes mellitus and other weight related complications, and even improved mortality. However, it also appears that hyperoxaluria is common after modern bariatric surgery, perhaps occurring in up to 50% of patients after Rouxen-Y gastric bypass. Although increasing numbers of patients are being seen with calcium oxalate kidney stones after bariatric surgery, and even a few with oxalosis and renal failure, the true risk of these outcomes remains unknown. The mechanisms that contribute to this enteric hyperoxaluria are also incompletely defined, although fat malabsorption may be an important component. Since increasing numbers of these procedures are likely to be performed in the coming years, further study regarding the prevalence and mechanisms of hyperoxaluria and kidney stones after bariatric surgery is needed to devise effective methods of treatment in order to prevent such complications.

  15. Bariatric surgery in hypothalamic obesity

    Directory of Open Access Journals (Sweden)

    Nathan eBingham

    2012-02-01

    Full Text Available Craniopharyngiomas (CP are epithelial neoplasms generally found in the area of the pituitary and hypothalamus. Despite benign histology, these tumors and/or their treatment often result in significant, debilitating disorders of endocrine, neurological, behavioral, and metabolic systems. Severe obesity is observed in a high percentage of patients with CP resulting in significant comorbidities and negatively impacting quality of life. Obesity occurs as a result of hypothalamic damage and disruption of normal homeostatic mechanisms regulating energy balance. Such pathological weight gain, termed hypothalamic obesity (HyOb, is often severe and refractory to therapy.Unfortunately, neither lifestyle intervention nor pharmacotherapy has proven truly effective in the treatment of CP-HyOb. Given the limited choices and poor results of these treatments, several groups have examined bariatric surgery as a treatment alternative for patients with CP-HyOb. While a large body of evidence exists supporting the use of bariatric surgery in the treatment of exogenous obesity and its comorbidities, its role in the treatment of HyOb has yet to be well defined. To date, the existing literature on bariatric surgery in CP-HyOb is largely limited to case reports and series with short term follow-up. Here we review the current reports on the use of bariatric surgery in the treatment of CP-HyOb. We also compare these results to those reported for other populations of HyOb, including Prader-Willi Syndrome and patients with melanocortin signaling defects. While initial reports of bariatric surgery in CP-HyOb are promising, their limited scope makes it difficult to draw any substantial conclusions as to the long term safety and efficacy of bariatric surgery in CP-HyOb. There continues to be a need for more robust, controlled, prospective trials with long term follow-up in order to better define the role of bariatric surgery in the treatment of all types of hypothalamic

  16. Update on Adolescent Bariatric Surgery.

    Science.gov (United States)

    Desai, Nirav K; Wulkan, Mark L; Inge, Thomas H

    2016-09-01

    Childhood obesity remains a significant public health issue. Approximately 8% of adolescent girls and 7% of adolescent boys have severe (≥class 2) obesity. Adolescent severe obesity is associated with numerous comorbidities, and persists into adulthood. Bariatric surgery is the most effective treatment available, resulting in major weight loss and resolution of important comorbid conditions. Clinical practice guidelines for pediatric obesity treatment recommend consideration of surgery after failure of behavioral approaches. Careful screening and postoperative management of patients by a multidisciplinary team is required. Long-term studies are needed to assess the impact of adolescent bariatric surgery. PMID:27519138

  17. Pregnancy after Bariatric Surgery: A Review

    Directory of Open Access Journals (Sweden)

    N. L. Hezelgrave

    2011-01-01

    Full Text Available Maternal obesity is a major cause of obstetric morbidity and mortality. With surgical procedures to facilitate weight loss becoming more widely available and demanded and increasing number of women becoming pregnant after undergoing bariatric surgery, it is important and timely to consider the outcome of pregnancy following bariatric surgery. This paper aims to synthesize the current evidence regarding pregnancy outcomes after bariatric surgery. It concludes that bariatric surgery appears to have positive effects on fertility and reduces the risk of gestational diabetes and preeclampsia. Moreover, there appears to be a reduced incidence of fetal macrosomia post-bariatric procedure, although there remains uncertainty about the increased rates of small-for-gestational age and intrauterine growth restricted infants, as well as premature rupture of membranes in this group. A number of case reports highlight that pregnancy following bariatric surgery is not without complications and it must be managed as high risk by the multidisciplinary team.

  18. Parkinsonism as a Complication of Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Walaa A. Kamel

    2015-11-01

    CONCLUSION: We conclude that with the increasing popularity of bariatric surgery, clinicians will need to recognize and manage neurologic complications that may appear soon after or years to decades later. Thorough evaluation is essential for any patient who has undergone bariatric surgery and develops neurologic symptoms.

  19. Kidney stone risk following modern bariatric surgery.

    Science.gov (United States)

    Gonzalez, Ricardo D; Canales, Benjamin K

    2014-05-01

    Over the past 10 years, a variety of reports have linked bariatric surgery to metabolic changes that alter kidney stone risk. Most of these studies were retrospective, lacked appropriate controls, or involved bariatric patients with a variety of inclusion criteria. Despite these limitations, recent clinical and experimental research has contributed to our understanding of the pathophysiology of stone disease in this high-risk population. This review summarizes the urinary chemistry profiles that may be responsible for the increased kidney stone incidence seen in contemporary epidemiological bariatric studies, outlines the mechanisms of hyperoxaluria and potential therapies through a newly described experimental bariatric animal model, and provides a focused appraisal of recommendations for reducing stone risk in bariatric stone formers.

  20. A Bariatric Surgery Primer for Orthopedic Surgeons.

    Science.gov (United States)

    Kingsberg, Jessica G; Halpern, Alan A; Hill, Brian C

    2016-01-01

    Increasing numbers of patients who have undergone bariatric surgery are now presenting to orthopedic surgeons for elective arthroplasties. In addition, orthopedic surgeons themselves are referring more patients for consideration of bariatric surgery in anticipation of future elective procedures. Although the full effects of bariatric surgery on metabolism are not yet known, the altered digestion associated with these surgeries poses several issues for orthopedic surgeons. In this article, we address 3 aspects of care of this class of patient: review of the most commonly performed procedures and their metabolic consequences; suggested preoperative assessment of bariatric patients for any conditions that should be corrected before surgery; and evaluation of outcomes of elective procedures performed after bariatric surgery. Awareness of the unique characteristics of this group of patients helps minimize the potential for complications of planned orthopedic surgeries.

  1. Perioperative Optimization of Patients Undergoing Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    C. E. Owers

    2012-01-01

    Full Text Available Bariatric surgery is fast becoming an efficient and safe method of weight reduction, especially for patients in whom conservative measures have failed. As the obese population of the world increases, so will the number of patients requesting or requiring surgical weight loss methods. Bariatric patients however have numerous co-morbidities that make their operative course more difficult, and therefore is important to have a good understanding of the important issues surrounding their pre, peri and post operative management. This article aims to educate the reader about optimal management of the bariatric surgical patient.

  2. Endocrine and metabolic complications after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Anwar A Jammah

    2015-01-01

    Full Text Available Bariatric surgery is the most effective therapeutic option for obese patients; however, it carries substantial risks, including procedure-related complications, malabsorption, and hormonal disturbance. Recent years have seen an increase in the bariatric surgeries performed utilizing either an independent or a combination of restrictive and malabsorptive procedures. We review some complications of bariatric procedures more specifically, hypoglycemia and osteoporosis, the recommended preoperative assessment and then regular follow up, and the therapeutic options. Surgeon, internist, and the patient must be aware of the multiple risks of this kind of surgery and the needed assessment and follow up.

  3. American Board of Obesity Medicine (ABOM)

    Science.gov (United States)

    ... Medical Specialties (ABMS) member board or osteopathic medicine equivalent. Successful completion of an on-site clinical ... American Society for Metabolic and Bariatric Surgery Canadian Obesity Network Cleveland Clinic ...

  4. [Assessment of bariatric surgery results].

    Science.gov (United States)

    Barros, Lívia Moreira; Frota, Natasha Marques; Moreira, Rosa Aparecida Nogueira; de Araújo, Thiago Moura; Caetano, Joselany Áfio

    2015-03-01

    The objective was to evaluate the results of bariatric surgery in patients in the late postoperative period using the Bariatric Analysis and Reporting Outcome System (BAROS). This cross-sectional study was conducted from November 2011 to June 2012 at a hospital in the state of Ceará, Brazil. Data were collected from 92 patients using the BAROS protocol, which analyzes weight loss, improved comorbidities, complications, reoperations and Quality of Life (QoL). Data were analysed using the chi-squared test, Fischer's exact test and the Mann-Whitney test. There was a reduction in the Body Mass Index (47.2±6.8 kg/m2 in the pre-operatory and 31.3±5.0 kg/m2 after surgery, p<0.001). The comorbidity with the highest resolution was arterial hypertension (p<0.001), and QV improved in 94.6% of patients. The main complications were hair loss, incisional hernia and cholelithiasis. The surgery provided satisfactory weight loss and improvements in the comorbidities associated to a better QL. Use of the BAROS protocol allows nurses to plan interventions and maintain the good results. PMID:26098798

  5. Kidney Stone Risk Following Modern Bariatric Surgery

    OpenAIRE

    Gonzalez, Ricardo D.; Canales, Benjamin K.

    2014-01-01

    Over the past 10 years, a variety of reports have linked bariatric surgery to metabolic changes that alter kidney stone risk. Most of these studies were retrospective, lacked appropriate controls, or involved bariatric patients with a variety of inclusion criteria. Despite these limitations, recent clinical and experimental research has contributed to our understanding of the pathophysiology of stone disease in this high-risk population. This review summarizes the urinary chemistry profiles t...

  6. Pregnancy following bariatric requires special attention

    DEFF Research Database (Denmark)

    Renault, Kristina; Andersen, Lise Lotte Fischer; Kjær, Mette Karie Mandrup;

    2012-01-01

    In the latest years the number of pregnant women having undergone bariatric surgery before pregnancy has increased rapidly. In pregnancy, they seem to have a reduced risk of obesity-related complications but an increased risk of mechanical complications causing small bowel obstruction...... and complications due to malabsorption. This article reviews the effect of bariatric surgery before pregnancy on obstetric and neonatal outcomes and provides, based on the limited available evidence, recommendations for the management of pregnancy in these women....

  7. Aortic rupture during reoperative bariatric surgery

    Directory of Open Access Journals (Sweden)

    Sorin Hostiuc

    2015-08-01

    Full Text Available Abstract Morbid obesity has become a very common problem worldwide, causing severe health-related consequences including cardiovascular or metabolic diseases, arthritis, sleep apnea, or an increased risk of cancer. Bariatric surgery was shown to be the only way to achieve sustainable weight loss and to decrease the frequency and severity of metabolic and cardiovascular comorbidities. The purpose of this article is to present a case of bariatric surgery complicated with lesion of the aorta with a lethal outcome.

  8. The risk of adverse pregnancy outcome after bariatric surgery

    DEFF Research Database (Denmark)

    Kjær, Mette Karie Mandrup; Lauenborg, Jeannet; Breum, Birger Michael;

    2013-01-01

    The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery.......The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery....

  9. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    Science.gov (United States)

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  10. Nursing care in the perioperative period for patients undergoing bariatric surgery

    OpenAIRE

    Maria Beatriz Guimarães Ferreira; Márcia Marques dos Santos Felix; Cristina Maria Galvão

    2014-01-01

    This integrative review aimed to analyze the available evidence in the literature regarding nursing care in the perioperative period for patients who underwent bariatric surgery. The search for primary studies was carried out in the US National Library of Medicine National Institutes of Health, Cumulative Index to Nursing and Allied Health Literature and Latin American and Caribbean Health Sciences Literature databases. The sample was comprised of 11 primary studies, published between January...

  11. Bariatric surgery: assessing opportunities for value innovation.

    Science.gov (United States)

    Tarantino, David P; Smith, Darlene B

    2005-03-01

    Obesity has been increasing over the past two decades, and the amount of medical and media attention given to bariatric surgery as a promising option for morbidly obese individuals is growing. The growth of bariatric surgery also has been attributed to improved surgical technique, the increase in surgeons trained in laparoscopic procedures, as well increased public awareness with celebrities having successfully undergone surgery. The number of surgeons and hospitals offering bariatric services is increasing. How then does a surgeon or a hospital develop a competitive strategy? The first step is to understand the health-care industry. The key forces are rivalry among present competitors, and the bargaining power of suppliers and buyers. While bariatric surgery currently is in a growth phase, time and competition will force practitioners to compete on the basis of price, unless they find true competitive advantage. Value innovation, is a means of creating new marketing space by looking across the conventionally defined boundaries of business--across substitute industries, across strategic groups, across buyer groups, across complementary product and service offerings, and across the functional-emotional orientation of an industry. One can compete by offering similar services focusing primarily on cost efficiencies as the key to profitability. Alternatively, one can break free from the pack by innovating and focusing on delivering superior value to the customer. As the market for bariatric surgery becomes increasingly overcrowded, profitable growth is not sustainable without developing a clear differential advantage in the market. Value innovation allows you to develop that advantage. PMID:15846452

  12. Stone formation and management after bariatric surgery.

    Science.gov (United States)

    Tarplin, Sarah; Ganesan, Vishnu; Monga, Manoj

    2015-05-01

    Obesity is a significant health concern and is associated with an increased risk of nephrolithiasis, particularly in women. The underlying pathophysiology of stone formation in obese patients is thought to be related to insulin resistance, dietary factors, and a lithogenic urinary profile. Uric acid stones and calcium oxalate stones are common in these patients. Use of surgical procedures for obesity (bariatric surgery) has risen over the past two decades. Although such procedures effectively manage obesity-dependent comorbidities, several large, controlled studies have revealed that modern bariatric surgeries increase the risk of nephrolithiasis by approximately twofold. In patients who have undergone bariatric surgery, fat malabsorption leads to hyperabsorption of oxalate, which is exacerbated by an increased permeability of the gut to oxalate. Patients who have undergone bariatric surgery show characteristic 24 h urine parameters including low urine volume, low urinary pH, hypocitraturia, hyperoxaluria and hyperuricosuria. Prevention of stones with dietary limitation of oxalate and sodium and a high intake of fluids is critical, and calcium supplementation with calcium citrate is typically required. Potassium citrate is valuable for treating the common metabolic derangements as it raises urinary pH, enhances the activity of stone inhibitors, reduces the supersaturation of calcium oxalate, and corrects hypokalaemia. Both pyridoxine and probiotics have been shown in small studies to reduce hyperoxaluria, but further study is necessary to clarify their effects on stone morbidity in the bariatric surgery population. PMID:25850790

  13. Bariatric surgery: assessing opportunities for value innovation.

    Science.gov (United States)

    Tarantino, David P; Smith, Darlene B

    2005-03-01

    Obesity has been increasing over the past two decades, and the amount of medical and media attention given to bariatric surgery as a promising option for morbidly obese individuals is growing. The growth of bariatric surgery also has been attributed to improved surgical technique, the increase in surgeons trained in laparoscopic procedures, as well increased public awareness with celebrities having successfully undergone surgery. The number of surgeons and hospitals offering bariatric services is increasing. How then does a surgeon or a hospital develop a competitive strategy? The first step is to understand the health-care industry. The key forces are rivalry among present competitors, and the bargaining power of suppliers and buyers. While bariatric surgery currently is in a growth phase, time and competition will force practitioners to compete on the basis of price, unless they find true competitive advantage. Value innovation, is a means of creating new marketing space by looking across the conventionally defined boundaries of business--across substitute industries, across strategic groups, across buyer groups, across complementary product and service offerings, and across the functional-emotional orientation of an industry. One can compete by offering similar services focusing primarily on cost efficiencies as the key to profitability. Alternatively, one can break free from the pack by innovating and focusing on delivering superior value to the customer. As the market for bariatric surgery becomes increasingly overcrowded, profitable growth is not sustainable without developing a clear differential advantage in the market. Value innovation allows you to develop that advantage.

  14. Single-incision laparoscopic bariatric surgery

    Directory of Open Access Journals (Sweden)

    Huang Chih-Kun

    2011-01-01

    Full Text Available Background: Bariatric surgery has been established as the best option of treatment for morbid obesity. In recent years single-incision laparoscopic surgery (SILS has emerged as another modality of carrying out the bariatric procedures. While SILS represents an advance, its application in morbid obesity at present is limited. In this article, we review the technique and results of SILS in bariatric surgery. Methods: The PubMed database was searched and totally 11 series reporting SILS in bariatric surgery were identified and analyzed. The case reports were excluded. Since 2008, 114 morbidly obese patients receiving SILS bariatric surgeries were reported. Results: The procedures performed included SILS gastric banding, sleeve gastrectomy and gastric bypass. No mortality was reported in the literatures. Sixteen patients (14.05% needed an additional incision for a liver retractor, a trocar or for conversion. Only one complication of wound infection was reported in these series. All the surgeons reported that the patients were highly satisfied with the scar. Conclusion: Because of abundant visceral and subcutaneous fat and multiple comorbidities in morbid obesity, it is more challenging for surgeons to perform the procedures with SILS. It is clear that extensive development of new instruments and technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential before these procedures can be utilized in day-to-day clinical practice.

  15. Difficulties of Bariatric Surgery after Abdominoplasty

    Directory of Open Access Journals (Sweden)

    Bora Karip

    2014-01-01

    Full Text Available During laparoscopy, the main problems of patients who have undergone previous abdominoplasty are inadequate pneumoperitoneum secondary to fibrosis and reconstructed anatomic landmarks for trocar placement. In this study, we present our laparoscopic bariatric experience in two patients with previous abdominoplasty. The procedures were a laparoscopic sleeve gastrectomy and a robotic Roux-en-Y gastric bypass. Both operations were done successfully by an abdominal wall traction technique, cutting fibrotic tissue and choosing new landmarks. We conclude that after abdominoplasty bariatric surgery can be performed safely either using conventional laparoscopic technique or robotically.

  16. Treatment of Adult Obesity with Bariatric Surgery.

    Science.gov (United States)

    Schroeder, Robin; Harrison, T Daniel; McGraw, Shaniqua L

    2016-01-01

    In 2013, approximately 179,000 bariatric surgery procedures were performed in the United States, including the laparoscopic sleeve gastrectomy (42.1%), Roux-en-Y gastric bypass (34.2%), and laparoscopic adjustable gastric banding (14.0%). Choice of procedure depends on the medical conditions of the patient, patient preference, and expertise of the surgeon. On average, weight loss of 60% to 70% of excess body weight is achieved in the short term, and up to 50% at 10 years. Remission of type 2 diabetes mellitus occurs in 60% to 80% of patients two years after surgery and persists in about 30% of patients 15 years after Roux-en-Y gastric bypass. Other obesity-related comorbidities are greatly reduced, and health-related quality of life improves. The Roux-en-Y procedure carries an increased risk of malabsorption sequelae, which can be minimized with nutritional supplementation and surveillance. Overall, these procedures have a mortality risk of less than 0.5%. Cohort studies show that bariatric surgery reduces all-cause mortality by 30% to 50% at seven to 15 years postsurgery compared with patients with obesity who did not have surgery. Dietary changes, such as consuming protein first at every meal, and regular physical activity are critical for patient success after bariatric surgery. The family physician is well positioned to counsel patients about bariatric surgical options, the risks and benefits of surgery, and to provide long-term support and medical management postsurgery. PMID:26760838

  17. [Bariatric surgery and patient therapeutic education].

    Science.gov (United States)

    Mével, Katell

    2015-11-01

    Weight loss surgery or "bariatric surgery", used in cases of severe obesity, is a complex procedure aiming to reduce food intake. An increasingly accessible technique, it requires a long postoperative follow-up and a change in eating habits. Patient therapeutic education encourages the patient to become a player in their care.

  18. How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?

    Science.gov (United States)

    Bächler, Thomas; le Roux, Carel W; Bueter, Marco

    2016-01-01

    Bariatric surgery is currently the most effective option for the treatment of morbid obesity and its associated comorbidities. Recent clinical and experimental findings have challenged the role of mechanical restriction and caloric malabsorption as the main mechanisms for weight loss and health benefits. Instead, other mechanisms including increased levels of satiety gut hormones, altered gut microbiota, changes in bile acid metabolism, and/or energy expenditure have been proposed as explanations for benefits of bariatric surgery. Beside the standard proximal Roux-en-Y gastric bypass and the biliopancreatic diversion with or without duodenal switch, where parts of the small intestine are excluded from contact with nutrients, resectional techniques like the sleeve gastrectomy (SG) have recently been added to the armory of bariatric surgeons. The variation of weight loss and glycemic control is vast between but also within different bariatric operations. We surveyed members of the Swiss Society for the Study of Morbid Obesity and Metabolic Disorders to assess the extent to which the phenotype of patients influences the choice of bariatric procedure. Swiss bariatric surgeons preferred Roux-en-Y gastric bypass and SG for patients with type 2 diabetes mellitus and patients with a body mass index >50 kg/m(2), which is consistent with the literature. An SG was preferred in patients with a high anesthetic risk or previous laparotomy. The surgeons' own experience was a major determinant as there is little evidence in the literature for this approach. Although trends will come and go, evidence-based medicine requires a rigorous examination of the proof to inform clinical practice. PMID:27524917

  19. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients.

    Science.gov (United States)

    Sogg, Stephanie; Lauretti, Jennifer; West-Smith, Lisa

    2016-05-01

    Psychosocial factors have significant potential to affect long-term outcomes of bariatric surgery, including emotional adjustment, adherence to the recommended postoperative lifestyle regimen, weight loss outcomes, and co-morbidity improvement and or resolution. Thus, it is recommended that bariatric behavioral health clinicians with specialized knowledge and experience be involved in the evaluation and care of patients both before and after surgery. The evaluating clinician plays a number of important roles in the multidisciplinary treatment of the bariatric patient. Central among these is the role of identifying factors that may pose challenges to optimal surgical outcome and providing recommendations to the patient and bariatric team on how to address these issues. This document outlines recommendations for the psychosocial evaluation of bariatric surgery patients, appropriate qualifications of those conducting these evaluations, communication of evaluation results and suggested treatment plan, and the extension of behavioral healthcare of the bariatric patient to the entire span of the surgical and postsurgical process.

  20. Bariatric surgery for obesity and metabolic conditions in adults

    OpenAIRE

    Arterburn, David E; Courcoulas, Anita P.

    2014-01-01

    This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and q...

  1. Developing criteria for pediatric/adolescent bariatric surgery programs.

    Science.gov (United States)

    Michalsky, Marc; Kramer, Robert E; Fullmer, Michelle A; Polfuss, Michele; Porter, Renee; Ward-Begnoche, Wendy; Getzoff, Elizabeth A; Dreyer, Meredith; Stolzman, Stacy; Reichard, Kirk W

    2011-09-01

    The prevalence of morbid obesity in adolescents is rising at an alarming rate. Comorbidities known to predispose to cardiovascular disease are increasingly being diagnosed in these children. Bariatric surgery has become an acceptable treatment alternative for morbidly obese adults, and criteria have been developed to establish center-of-excellence designation for adult bariatric surgery programs. Evidence suggests that bariatric surgical procedures are being performed with increasing numbers in adolescents. We have examined and compiled the current expert recommendations for guidelines and criteria that are needed to deliver safe and effective bariatric surgical care to adolescents.

  2. Bariatric surgery outcomes: a single-center study in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Abusnana S

    2015-09-01

    Full Text Available Salah Abusnana,1 Sarah Abdi,1 Brigette Tagure,1 Murtada Elbagir,1 Almantas Maleckas2 1Rashid Center for Diabetes and Research, Ministry of Health, Ajman, United Arab Emirates; 2Kaunas University of Medicine, Kaunas, LithuaniaBackground: Bariatric surgery has become an attractive treatment for severe obesity over the last decade, due to its impacts on weight loss and remission of type 2 diabetes and metabolic syndrome. In the United Arab Emirates, a country where the rate of obesity is dramatically increasing bariatric surgery has gained popularity in recent years; however, published data on its outcomes in the Emirati population are lacking.Methods: We retrospectively reviewed the medical records of 95 patients who underwent bariatric surgery (ie, laparoscopic Roux-en-Y gastric bypass [RYGB] or laparoscopic sleeve gastrectomy at the Rashid Center for Diabetes and Research in Ajman, United Arab Emirates. Weight outcomes and metabolic marker data were abstracted at baseline and at 3, 6, and 12 months postoperatively.Results: Laparoscopic RYGB was the main procedure performed by our bariatric unit. All variables demonstrated postoperative improvement. An average excess weight loss of 68% was observed at 12 months. Fat mass was the body component that decreased the most, with an average reduction of 46%. Additionally, lipid profiles were significantly different (P<0.01 at 12 months, with triglyceride levels improving by 27% and low-density lipoprotein levels improving by 21%. Similarly, glycated hemoglobin (HbA1c levels decreased significantly (P<0.001 in patients with type 2 diabetes, with an average reduction of 73%.Conclusion: Our results show that a substantial short-term reduction in weight and significant improvements in metabolic markers followed bariatric surgery in severely obese Emirati patients. Our results are consistent with the outcomes of other internationally published studies. Additional studies are warranted to determine whether

  3. Difficulties of Bariatric Surgery after Abdominoplasty

    OpenAIRE

    Bora Karip; Hasan Altun; Yalın İşcan; Martin Bazan; Kafkas Çelik; Yetkin Özcabı; Birol Ağca; Kemal Memişoğlu

    2014-01-01

    During laparoscopy, the main problems of patients who have undergone previous abdominoplasty are inadequate pneumoperitoneum secondary to fibrosis and reconstructed anatomic landmarks for trocar placement. In this study, we present our laparoscopic bariatric experience in two patients with previous abdominoplasty. The procedures were a laparoscopic sleeve gastrectomy and a robotic Roux-en-Y gastric bypass. Both operations were done successfully by an abdominal wall traction technique, cutting...

  4. Mineral Malnutrition Following Bariatric Surgery12

    OpenAIRE

    Gletsu-Miller, Nana; Wright, Breanne N.

    2013-01-01

    Moderate/severe obesity is on the rise in the United States. Weight management includes bariatric surgery, which is effective and can alleviate morbidity and mortality from obesity-associated diseases. However, many individuals are dealing with nutritional complications. Risk factors include: 1) preoperative malnutrition (e.g., vitamin D, iron); 2) decreased food intake (due to reduced hunger and increased satiety, food intolerances, frequent vomiting); 3) inadequate nutrient supplementation ...

  5. COMPLICATIONS REQUIRING HOSPITAL MANAGEMENT AFTER BARIATRIC SURGERY

    OpenAIRE

    WRZESINSKI, Aline; CORRÊA, Jéssica Moraes; FERNANDES, Tainiely Müller Barbosa; MONTEIRO, Letícia Fernandes; TREVISOL, Fabiana Schuelter; do NASCIMENTO, Ricardo Reis

    2015-01-01

    Background: The actual gold standard technique for obesity treatment is the Roux-en-Y gastric bypass. However, complications may occur and the surgeon must be prepared for them. Aim: To evaluate retrospectively the complications occurrence and associated factors in patients who underwent bariatric surgery. Methods: In this study, 469 medical charts were considered, from patients and from data collected during outpatient consultations. The variables considered were gender, age, height, pre-ope...

  6. Does bariatric surgery improve adipose tissue function?

    Science.gov (United States)

    Frikke-Schmidt, H; O'Rourke, R W; Lumeng, C N; Sandoval, D A; Seeley, R J

    2016-09-01

    Bariatric surgery is currently the most effective treatment for obesity. Not only do these types of surgeries produce significant weight loss but also they improve insulin sensitivity and whole body metabolic function. The aim of this review is to explore how altered physiology of adipose tissue may contribute to the potent metabolic effects of some of these procedures. This includes specific effects on various fat depots, the function of individual adipocytes and the interaction between adipose tissue and other key metabolic tissues. Besides a dramatic loss of fat mass, bariatric surgery shifts the distribution of fat from visceral to the subcutaneous compartment favoring metabolic improvement. The sensitivity towards lipolysis controlled by insulin and catecholamines is improved, adipokine secretion is altered and local adipose inflammation as well as systemic inflammatory markers decreases. Some of these changes have been shown to be weight loss independent, and novel hypothesis for these effects includes include changes in bile acid metabolism, gut microbiota and central regulation of metabolism. In conclusion bariatric surgery is capable of improving aspects of adipose tissue function and do so in some cases in ways that are not entirely explained by the potent effect of surgery. © 2016 World Obesity.

  7. Post-bariatric abdominoplasty: our experience.

    Science.gov (United States)

    Grignaffini, Eugenio; Grieco, Michele P; Bertozzi, Nicolo'; Gandolfi, Marco; Palli, Dante; Cinieri, Francesco Giovanni; Gardani, Marco; Raposio, Edoardo

    2015-01-01

    The fast increase in obesity has been followed by the growth in the demand for plastic surgery in formerly obese patients. The weight loss is accompanied by new dysfunctions and disorders of the outline of the body that affects the quality of life of the patient. Abdominoplasty is a cosmetic surgery procedure that aims to remove the excess of skin and the redundant fat. The aim of this paper was to analyze our experience in this field and to test how functional abdominoplasty improved quality of life in the operated patients. In our Unit from January 2012 to December 2014, 25 patients (18 women and 7 men, age: 24 - 79 years, mean: 51 years) underwent abdominoplastic surgery. Only at least six months after bariatric surgery the patients were eligible for functional abdominoplasty. Average weight of the patients before surgery was 83.5 kg (range 58 - 163 Kg); averege BMI was 31 (range 24.77 - 57). The average quantity of tissue removed was 1.765 Kg (range 250 g - 11,5 Kg). Minor complications rate was in agreement with the percentages reported in literature. No mortality and major complications have occurred in our series. The majority of patients undergoing post-bariatric abdominoplasty reported an improvement in the quality of life and psychological well-being. In our opinion, however, only a multidisciplinary (surgical, psychological, dietological) approach of the post-bariatric patient allows to maintain long-term aesthetic and functional results. PMID:26694156

  8. The effect of the Ontario Bariatric Network on health services utilization after bariatric surgery: a retrospective cohort study

    Science.gov (United States)

    Elnahas, Ahmad; Jackson, Timothy D.; Okrainec, Allan; Austin, Peter C.; Bell, Chaim M.; Urbach, David R.

    2016-01-01

    Background: In 2009, the Ontario Bariatric Network was established to address the exploding demand by Ontario residents for bariatric surgery services outside Canada. We compared the use of postoperative hospital services between out-of-country surgery recipients and patients within the Ontario Bariatric Network. Methods: We conducted a population-based, comparative study using administrative data held at the Institute for Clinical Evaluative Sciences. We included Ontario residents who underwent bariatric surgery between 2007 and 2012 either outside the country or at one of the Ontario Bariatric Network's designated centres of excellence. The primary outcome was use of hospital services in Ontario within 1 year after surgery. Results: A total of 4852 patients received bariatric surgery out of country, and 5179 patients underwent surgery through the Ontario Bariatric Network. After adjustment, surgery at a network centre was associated with a significantly lower utilization rate of postoperative hospital services than surgery out of country (rate ratio 0.90, 95% confidence interval [CI] 0.84 to 0.97). No statistically significant differences were found with respect to time in critical care or mortality. However, the physician assessment and reoperation rates were significantly higher among patients who received surgery at a network centre than among those who had bariatric surgery out of country (rate ratio 4.10, 95% CI 3.69 to 4.56, and rate ratio 1.84, 95% CI 1.34 to 2.53, respectively). Interpretation: The implementation of a comprehensive, multidisciplinary provincial program to replace outsourcing of bariatric surgical services was associated with less use of postoperative hospital services by Ontario residents undergoing bariatric surgery. Future research should include an economic evaluation to determine the costs and benefits of the Ontario Bariatric Network. PMID:27730113

  9. Adherence to vitamin supplementation following adolescent bariatric surgery

    OpenAIRE

    Modi, Avani C.; Zeller, Meg H.; Xanthakos, Stavra A.; Jenkins, Todd M.; Inge, Thomas H.

    2013-01-01

    Adolescents with extreme obesity, who have undergone bariatric surgery, must adhere to many lifestyle and nutritional recommendations, including multivitamin therapy. Little is know about multivitamin adherence following adolescent bariatric surgery. The present study aims to document self-reported and electronically-monitored adherence to multivitamins, determine convergence between self-report and electronic monitoring adherence for multivitamins, and identify barriers to multivitamin adher...

  10. Pregnancy after bariatric surgery - a review of benefits and risks

    DEFF Research Database (Denmark)

    Kjær, Mette Karie Mandrup; Nilas, Lisbeth

    2013-01-01

    Background. When other weight loss attempts have failed, bariatric surgery offers a successful alternative against obesity. Since operations are performed during women´s reproductive years, the number of pregnant women with prior bariatric surgery is increasing. Bariatric surgery results in restr......Background. When other weight loss attempts have failed, bariatric surgery offers a successful alternative against obesity. Since operations are performed during women´s reproductive years, the number of pregnant women with prior bariatric surgery is increasing. Bariatric surgery results...... in restriction of food intake and/or malabsorption leading to weight loss, but may induce a risk for malnutrition and pregnancy complications. Method. Systematically conducted review addressing pregnancy after bariatric surgery using the PubMed and Cochrane databases. Main Outcome Measures. Birthweight......, gestational age, birth defects, preeclampsia, gestational diabetes mellitus, and mode of delivery. Results. We included 17 articles in English, comparing pregnancies in women with prior bariatric surgery to pregnancies in a control group without this. There was considerable heterogeneity in study design...

  11. Influence of obesity and bariatric surgery on gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Anna Carolina Batista Dantas; Marco Aurelio Santo; Roberto de Cleva; Rubens Antônio Aissar Sallum; Ivan Cecconello

    2016-01-01

    Esophageal and gastric cancer (GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population. After surgery, GC reports are anecdotal and treatment is not standardized. This review aims to discuss GC related to obesity before and after bariatric surgery.

  12. Development of a Pilot Telehealth Bariatric Surgery Support Group

    Science.gov (United States)

    Schofield, Carin K.

    2013-01-01

    The prevalence of obesity in the United States continues to grow. Bariatric surgery is becoming more common and accepted in the treatment of obesity. Clinical candidates for bariatric surgery should have a BMI > 40 kg/m[superscript 2] alone, or a BMI > 35 kg/m[superscript 2] plus one comorbidity. A trend is emerging in the literature showing…

  13. Gonadal status and outcome of bariatric surgery in obese men

    NARCIS (Netherlands)

    Aarts, E.O.; Wageningen, B. van; Loves, S.C.; Janssen, I.; Berends, F.; Sweep, F.C.; Boer, H. de

    2014-01-01

    BACKGROUND: Obesity-related hypogonadotrophic hypogonadism (OrHH) occurs in over 40% of morbidly obese men. Obesity-related hypogonadotrophic hypogonadism may reduce the beneficial effects of bariatric surgery. OBJECTIVE: To assess the impact of OrHH on the outcome of bariatric surgery in men. PATIE

  14. Bariatric surgery: A review of normal postoperative anatomy and complications

    Energy Technology Data Exchange (ETDEWEB)

    Quigley, S., E-mail: shaun.quigley@bartsandthelondon.nhs.uk [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Colledge, J. [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Mukherjee, S. [Bariatric Surgery Unit, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Patel, K. [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom)

    2011-10-15

    The number of bariatric surgery procedures performed is increasing every year. Patients may be referred for radiological investigations to exclude complications not only in the early postoperative period but many months later. Radiologists who do not work in bariatric centres are therefore required to have an understanding of the complex normal anatomy and complications associated with bariatric surgery to interpret imaging studies correctly. The purpose of this article is to describe the surgical techniques and normal anatomy of the four bariatric operations performed today, review the most common problems encountered in this patient group, and to describe the imaging findings that allow the accurate diagnosis of complications. In particular, we focus on identification of the internal hernia, a grave complication of bariatric surgery often missed by radiologists.

  15. How do patients’ clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?

    Directory of Open Access Journals (Sweden)

    Bächler T

    2016-07-01

    the literature for this approach. Although trends will come and go, evidence-based medicine requires a rigorous examination of the proof to inform clinical practice. Keywords: bariatric procedures, underlying physiology, choice of type of surgery

  16. Bariatric Surgery: Bad to the Bone, Part 1.

    Science.gov (United States)

    Pizzorno, Lara

    2016-03-01

    Obesity is now a global epidemic affecting a significant and rapidly increasing number of adults, adolescents, and children. As the incidence of obesity has increased, so has the use of bariatric surgery as a medical solution. A growing number of studies now report that, despite calcium and vitamin D supplementation, the most frequently performed types of bariatric surgery, the Roux-en-Y gastric bypass and the sleeve gastrectomy, cause significant ongoing bone loss. In resources available to the general public and to physicians, this adverse outcome is rarely mentioned or is attributed solely to reduced calcium absorption. Recent studies investigating micronutrient malabsorption and changes in a wide range of hormones induced by bariatric surgery now indicate that calcium malabsorption is the tip of a formidable iceberg. The current article, part 1 of a 2-part series, reviews the latest research findings confirming that obesity prevalence is skyrocketing and that bariatric surgery causes ongoing, accelerated bone loss. Part 1 also discusses the mechanisms through which the bariatric surgery-induced malabsorption of key nutrients adversely affects bone homeostasis. Part 2 discusses the specific changes seen in bone metabolism after bariatric surgery and reviews current data on the underlying mechanisms, in addition to nutrient malabsorption, which are thought to contribute to bariatric surgery-induced ongoing accelerated bone loss. These processes include mechanical unloading and changes in a wide variety of hormones (eg, leptin, adiponectin, testosterone, estradiol, serotonin, ghrelin, glucagon-like peptide 1, and gastric inhibitory peptide). Also, part 2 covers interventions that may help lessen bariatric surgery-induced bone loss, which are now beginning to appear in the medical literature. Bariatric surgery's adverse effects on bone must be widely recognized and protocols developed to prevent early onset osteoporosis in the recipients of an increasingly utilized

  17. Ethical issues in the psychosocial assessment of bariatric surgery candidates.

    Science.gov (United States)

    Rouleau, Codie R; Rash, Joshua A; Mothersill, Kerry J

    2016-07-01

    Psychosocial evaluation is recommended prior to bariatric surgery. Practice guidelines have been published on assessment methods for bariatric surgery candidates, but they have not emphasized ethical issues with this population. This review outlines ethical and professional considerations for behavioral healthcare providers who conduct pre-surgical assessments of bariatric surgery candidates by merging ethical principles for mental health professionals with current practices in pre-surgical assessments. Issues discussed include the following: (a) establishing and maintaining competence, (b) obtaining informed consent, (c) respecting confidentiality, (d) avoiding bias and discrimination, (e) avoiding and addressing dual roles, (f) selecting and using psychological tests, and (g) acknowledging limitations of psychosocial assessments. PMID:25411197

  18. Bariatric surgery - effects on obesity and related co-morbidities

    DEFF Research Database (Denmark)

    Svane, Maria Saur; Madsbad, Sten

    2014-01-01

    Laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG) are the three most commonly performed bariatric procedures. Obesity responds well to bariatric surgery, with major long-lasting weight loss that is most pronounced...... hormone responses, especially a 10-fold increase in glucagon-like peptide-1 (GLP-1), which improves insulin secretion. After gastric banding, the remission of diabetes depends more on weight loss. Bariatric surgery reduces cardiovascular risk factors including hypertension, lipid disturbances, non...

  19. Bariatric diagnostic CT scanning: A radiotherapy perspective

    International Nuclear Information System (INIS)

    Obesity is increasing in the United Kingdom. Equipment available for this patient group including wheelchairs, beds and hoists is becoming more common in the hospital environment; diagnostic imaging equipment that can accommodate bariatric patients has not increased at the same rate. Subsequently these service-users are often unable to receive “gold-standard” cross-sectional imaging within their patient-pathway. This paper highlights how a diagnostic imaging department has utilised wide-bore CT scanning equipment within the radiotherapy setting to ensure an equitable service for all service users. Through literature review and local experience, a standard operating procedure and scanning service has been developed. Areas explored include technical consideration of scanner design; patient positioning; image artefacts and intravenous contrast administration. Also investigated is patient wellbeing incorporating manual handling, respiration and psycho-social needs. Additionally, demonstration of how interprofessional collaboration by diagnostic and radiotherapy radiographers can ensure the best imaging experience and outcome for this patient group. - Highlights: • Rising obesity in the UK has highlighted a shortage of diagnostic imaging facilities. • Large bore CT scanners are the scanner of choice for radiotherapy planning. • Technical capability, manual handling and psycho-social issues have been explored. • Bariatric diagnostic imaging facilitated by inter-professional collaboration

  20. Bariatric Endocrinology: Principles of Medical Practice

    Directory of Open Access Journals (Sweden)

    J. Michael Gonzalez-Campoy

    2014-01-01

    Full Text Available Obesity, is a chronic, biological, preventable, and treatable disease. The accumulation of fat mass causes physical changes (adiposity, metabolic and hormonal changes due to adipose tissue dysfunction (adiposopathy, and psychological changes. Bariatric endocrinology was conceived from the need to address the neuro-endocrinological derangements that are associated with adiposopathy, and from the need to broaden the scope of the management of its complications. In addition to the well-established metabolic complications of overweight and obesity, adiposopathy leads to hyperinsulinemia, hyperleptinemia, hypoadiponectinemia, dysregulation of gut peptides including GLP-1 and ghrelin, the development of an inflammatory milieu, and the strong risk of vascular disease. Therapy for adiposopathy hinges on effectively lowering the ratio of orexigenic to anorexigenic signals reaching the the hypothalamus and other relevant brain regions, favoring a lower caloric intake. Adiposopathy, overweight and obesity should be treated indefinitely with the specific aims to reduce fat mass for the adiposity complications, and to normalize adipose tissue function for the adiposopathic complications. This paper defines the principles of medical practice in bariatric endocrinology—the treatment of overweight and obesity as means to treat adiposopathy and its accompanying metabolic and hormonal derangements.

  1. Imaging of patients treated with bariatric surgery

    International Nuclear Information System (INIS)

    Over the past few years, obesity has become a major clinical and population concern in the majority of developed countries. Obesity leads to significant systemic disorders, such as hypertension, hypercholesterolemia, hypertriglyceridemia and insulin resistance, and also increases the risk of developing cardiovascular diseases (ischemic heart disease, ischemic stroke), metabolic diseases (type 2 diabetes), certain types of cancer, and degenerative bone disorders (osteoarthritis). Health hazards associated with epidemic of obesity and potential benefits of weight loss have spurred interest in new treatment methods. Bariatric surgical procedures constitute a recognized alternative in cases where conservative management of obesity fails. Several bariatric operations can be distinguished: restrictive procedures, such as adjustable gastric band (AGB) and vertical banded gastroplasty (VBG); predominantly malabsorptive procedures, such as biliopancreatic diversion (BPD), and a combination of both methods, such as Roux-en-Y gastric bypass. The adverse consequences of surgical treatment of obesity include i.a.: intestinal anastomotic leakage, impaired intestinal permeability and internal hernia, dilatation of the stomach, gastrointestinal anastomotic stenosis, marginal ulceration, incisional hernia. Basic knowledge of procedures in the surgical treatment of obesity is of vital importance for the radiologist during evaluation of upper gastrointestinal tract in the early and late postoperative period, allowing correct interpretation of acquired images as well as recognition of typical complications

  2. [Beginnings of bariatric and metabolic surgery in Spain].

    Science.gov (United States)

    Baltasar, Aniceto; Domínguez-Adame, Eduardo

    2013-01-01

    When bariatric and metabolic surgery initially began in Spain, it was a subject of debate, due to not knowing exactly who were the first surgeons to perform it. A study has revealed the authors of the first interventions.

  3. Bariatric Surgery in Type 1 Diabetes Mellitus: A Systematic Review.

    Science.gov (United States)

    Mahawar, Kamal K; De Alwis, Nimantha; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Small, Peter K

    2016-01-01

    Bariatric surgery is recognised as an effective treatment strategy for obese patients with type 2 diabetes mellitus. An increasing number of patients with type 1 diabetes mellitus also suffer with obesity and obesity-associated comorbidities but the role of bariatric and metabolic surgery in this group of patients is unclear. This systematic review investigates published English language scientific literature to understand the results of bariatric surgery in obese patients with type 1 diabetes mellitus. We found that these patients can experience significant weight loss and comorbidity resolution with bariatric surgery. Though most patients also see a decline in total insulin requirement, glycaemic control remains difficult. Most of the patients reported in literature have undergone gastric bypass but data is insufficient to recommend any particular procedure.

  4. Metabolic Bone Disease in the Bariatric Surgery Patient

    Directory of Open Access Journals (Sweden)

    Susan E. Williams

    2011-01-01

    Full Text Available Bariatric surgery has proven to be a life-saving measure for some, but for others it has precipitated a plethora of metabolic complications ranging from mild to life-threatening, sometimes to the point of requiring surgical revision. Obesity was previously thought to be bone protective, but this is indeed not the case. Morbidly obese individuals are at risk for metabolic bone disease (MBD due to chronic vitamin D deficiency, inadequate calcium intake, sedentary lifestyle, chronic dieting, underlying chronic diseases, and the use of certain medications used to treat those diseases. After bariatric surgery, the risk for bone-related problems is even greater, owing to severely restricted intake, malabsorption, poor compliance with prescribed supplements, and dramatic weight loss. Patients presenting for bariatric surgery should be evaluated for MBD and receive appropriate presurgical interventions. Furthermore, every patient who has undergone bariatric surgery should receive meticulous lifetime monitoring, as the risk for developing MBD remains ever present.

  5. Bariatric surgery and pregnancy: literature review

    Directory of Open Access Journals (Sweden)

    Pedro Ferrand Miranda

    2014-01-01

    Full Text Available Obesity has currently reached epidemic proportions, both in Chile and in the world. This condition is associated to a variety of maternal complications in all stages of the vital cycle and during pregnancy. Medical treatment has not proved successful thus resulting in an increase in bariatric surgery in recent years, even when it is not first line treatment. This literature review aims to report updated results of surgical treatment for obesity before and during pregnancy with respect to fertility, gestational diabetes, pre-eclampsia and pregnancy-induced hypertension. It also looks into the possible effects of surgery on fetal development, and its relation to premature delivery, fetal macrosomy, low birth weight and neural tube defects, as well as effects on maternal and fetal outcomes, mainly in nutrition. Lastly, we suggest some recommendations that arise from this review on the role of contraception, nutrition and time between surgery and pregnancy.

  6. The use of contraception for patients after bariatric surgery.

    Science.gov (United States)

    Ostrowska, Lucyna; Lech, Medard; Stefańska, Ewa; Jastrzębska-Mierzyńska, Marta; Smarkusz, Joanna

    2016-01-01

    Obesity in women of reproductive age is a serious concern regarding reproductive health. In many cases of infertility in obese women, reduction of body weight may lead to spontaneous pregnancy, without the need for more specific methods of treatment. Bariatric surgery is safe and is the most effective method for body weight reduction in obese and very obese patients. In practice there are two bariatric techniques; gastric banding, which leads to weight loss through intake restriction, and gastric bypass, leads to weight loss through food malabsorption. Gastric bypass surgery (the more frequently performed procedure), in most cases, leads to changes in eating habits and may result in vomiting, diarrhea and rapid body mass reduction. There are reliable data describing the continuous increase in the number of women who are trying to conceive, or are already pregnant, following bariatric surgery. Most medical specialists advise women to avoid pregnancy within 12-18 months after bariatric surgery. This allows for time to recover sufficiency from the decreased absorption of nutrients caused by the bariatric surgery. During this period there is a need for the use of reliable contraception. As there is a risk for malabsorption of hormones taken orally, the combined and progestogen-only pills are contraindicated, and displaced by non-oral hormonal contraception or non-hormonal methods, including intrauterine devices and condoms. PMID:27629135

  7. A psychiatric perspective view of bariatric surgery patients

    Directory of Open Access Journals (Sweden)

    Isabel Brandão

    2015-10-01

    Full Text Available Abstract Background Bariatric surgery is the only procedure that has significant results in weight loss and improvements in medical comorbidities in morbid obese patients. Severely obese patients are also associated with a higher prevalence of psychiatric disorders and poor quality of life. Objective To evaluate specific areas of psychopathology in individuals undergoing bariatric surgery. Methods A review of the literature was conducted from January 2002 to March 2014 by researching PubMed database using the following query: “morbid AND obesity AND bariatric AND surgery AND (psychiatry OR psychology”. Results Overall improvements in eating behaviors, mood disorders and body image are reported after bariatric surgery, and the mechanism is not enlightened. Risk of suicide and consumption of substances of abuse, especially alcohol, after gastric bypass surgery are problems that clinicians must be aware. Discussion Bariatric patients should be monitored after surgery to identify who did not show the expected benefits postoperatively and the ones who develop psychiatric symptoms after an initial positive response.

  8. Food quality in the late postoperative period of bariatric surgery: an evaluation using the bariatric food pyramid.

    Science.gov (United States)

    Soares, Fernando Lucas; Bissoni de Sousa, Larissa; Corradi-Perini, Carla; Ramos da Cruz, Magda Rosa; Nunes, Mario Gilberto Jesus; Branco-Filho, Alcides José

    2014-09-01

    Bariatric surgery is an effective intervention in the treatment of obesity, but lifestyle and diet should be monitored after this procedure to ensure success. The Bariatric Food Pyramid was created basing on long-term nutritional care that proposes a standard of healthy living and eating habits considering gastric capacity and specific nutritional needs. The purpose of the current study is to evaluate the life habits and diet quality of patients who have undergone bariatric surgery (who have been recovering for at least 6 months) based on the specific food pyramid. Retrospective data analysis was performed using medical records of patients who had been followed for at least 6 months after bariatric surgery. The following data were collected from patient records: age, gender, education level (years), BMI (preoperative and postoperative), percentage of excess weight loss (EWL) relative to the time of surgery, frequency of physical activity, use of nutritional supplements, usual dietary intake history, and fluid intake. Results were analyzed using descriptive statistics. We evaluated 172 patient records. In this study, there was a low prevalence of physical activity, use of vitamin-mineral supplements, and water intake. There also was low consumption of protein, fruit, vegetables, and vegetable oils. In addition, intake of carbohydrates, sugars, and fats were higher than the recommendations established by the pyramid. The results indicate that patients who have undergone bariatric surgery have an inadequate diet according to food evaluation with the specific pyramid. In the long term, this may lead to weight gain and vitamin and mineral deficiencies.

  9. Endoscopic management of post-bariatric surgery complications.

    Science.gov (United States)

    Boules, Mena; Chang, Julietta; Haskins, Ivy N; Sharma, Gautam; Froylich, Dvir; El-Hayek, Kevin; Rodriguez, John; Kroh, Matthew

    2016-09-16

    Understanding the technical constructs of bariatric surgery is important to the treating endoscopist to maximize effective endoluminal therapy. Post-operative complication rates vary widely based on the complication of interest, and have been reported to be as high as 68% following adjustable gastric banding. Similarly, there is a wide range of presenting symptoms for post-operative bariatric complications, including abdominal pain, nausea and vomiting, dysphagia, gastrointestinal hemorrhage, and weight regain, all of which may provoke an endoscopic assessment. Bleeding and anastomotic leak are considered to be early ( 30 d) complications. Treatment of complications in the immediate post-operative period may require unique considerations. Endoluminal therapies serve as adjuncts to surgical and radiographic procedures. This review aims to summarize the spectrum and efficacy of endoscopic management of post-operative bariatric complications. PMID:27668069

  10. Nutrition Care for Patients with Weight Regain after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Carlene Johnson Stoklossa

    2013-01-01

    Full Text Available Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.

  11. Enhanced recovery after bariatric surgery – a modern approach

    Directory of Open Access Journals (Sweden)

    Bekkhan Bayalovich Khatsiev

    2014-06-01

    Full Text Available Guidelines for enhanced recovery after surgery (ERAS are widely used and their efficiency was clearly demonstrated by numerous studies. Number of publications on this topic in bariatric surgery is significantly lower compared with other fields of surgery. However, the data accumulated allow to compose recommendations based on studies with high level of evidence. Authors review existing methods of enhanced recovery in their implementation into bariatric surgery. Enhanced recovery methods can be used to optimize all stages of perioperative care and include data on preoperative preparation, maintenance of electrolyte balance, prevention of postoperative nausea and vomiting, sufficient analgesia and safe discharge form hospital. Suggested guidelines for bariatric surgery are implied to be used by a multidisciplinary team.

  12. Endoscopic management of post-bariatric surgery complications.

    Science.gov (United States)

    Boules, Mena; Chang, Julietta; Haskins, Ivy N; Sharma, Gautam; Froylich, Dvir; El-Hayek, Kevin; Rodriguez, John; Kroh, Matthew

    2016-09-16

    Understanding the technical constructs of bariatric surgery is important to the treating endoscopist to maximize effective endoluminal therapy. Post-operative complication rates vary widely based on the complication of interest, and have been reported to be as high as 68% following adjustable gastric banding. Similarly, there is a wide range of presenting symptoms for post-operative bariatric complications, including abdominal pain, nausea and vomiting, dysphagia, gastrointestinal hemorrhage, and weight regain, all of which may provoke an endoscopic assessment. Bleeding and anastomotic leak are considered to be early ( 30 d) complications. Treatment of complications in the immediate post-operative period may require unique considerations. Endoluminal therapies serve as adjuncts to surgical and radiographic procedures. This review aims to summarize the spectrum and efficacy of endoscopic management of post-operative bariatric complications.

  13. Bariatric surgery, gut morphology and enteroendocrine cells

    DEFF Research Database (Denmark)

    Hansen, Carl Frederik

    Considering that obesity and diabetes are some of the most important health problems in the world today, a lot studies have investigated the powerful effects of bariatric surgery on weight loss and diabetes remission during the past decade. An increased release of gut hormones is believed to cont...... 40 hormones. In this PhD study, gut morphology and the population of endocrine cells have been examined in three rodent animal models using stereological techniques. First, in a rodent model of type-2 diabetes (T2DM), the Zucker diabetic fatty rat (ZDF), the population of endocrine L......-cells and the gut morphology were quantified. The number of Lcells was 4.8 million in the normal rat and the L-cells were found to double in number in the diabetic ZDF rat model. Second, the L-cell population, gut morphology and endocrine cell gene expression were examined in a rodent model of Roux-en-Y gastric....... Finally, we investigated several endocrine subtypes, including the L-cell, together with gut morphology in a rodent model of Ileal Transposition (IT) 1.5 month post-surgery. In this study a 60% increase in the number of endocrine cells was found, and all four subtypes (neurotensin-, GLP-1...

  14. Bariatric surgery and implications for stoma care.

    Science.gov (United States)

    Swash, Carolyn

    In the UK, 62% of the population are now described as being either overweight or obese. People with weight-management issues are more likely to suffer from cardiovascular disease and diabetes, as well as having an increased risk of cancer, including bowel cancer. Following the initial National Institute for Health and Care Excellence guidance in 2006, revised in 2014, health professionals have a more proactive role in identifying people with weight-management issues and supporting them to achieve a weight that helps reduce their health risks. This includes referrals to bariatric surgeons for consideration for surgery if appropriate. One particular surgical procedure, the Roux-en-Y, is not reversible and alters the capacity of the stomach and function of the small bowel in order to achieve weight loss. Using a case study, this article will highlight the role of the stoma nurse in managing a patient, who previously had a Roux-en-Y procedure for weight loss and subsequently needed formation of a loop ileostomy after surgery for bowel cancer. PMID:26973009

  15. Influence of Bariatric Surgery on Remission of Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Paweł Nalepa

    2011-12-01

    Full Text Available The plague of obesity afflicts an increasing group of people. Moreover type 2 diabetes, which is the most serious illness accompanying excessive weight, is becoming more and more common. Traditional methods of obesity treatment, such as diet and physical exercise, fail. This applies especially to people with class III obesity. The only successful way of treating obesity in their case is bariatric surgery. There are three types of bariatric surgery: restrictive procedures (reducing stomach volume, malabsorptive procedures, and mixed procedures, which combine both methods. In spite of the risk connected with the surgery and complications after it, bariatric procedures are advised to patients with class III obesity and class II with an accompanying illness which increases the probability of death. It has been proved that bariatric surgery not only eliminates obesity but also very frequently (in 90�0of cases leads to the remission of type 2 diabetes. Moreover, the remission occurs very fast – it takes place a long time before the patients reduce their weight, even within a few days after surgery. Detailed studies have shown that the remission of diabetes is caused mostly by the change of the gastro-intestinal hormones’ profile, resulting from the surgery. These hormones include GLP-1, GIP, peptide YY, ghrelin and oxyntomodulin. Additionally, the change of the amount of adipose tissue after the surgery influences the level of adipokines, i.e. the hormones of the adipose tissue, among which the most important are leptin, adiponectin and resistin. Thus, bariatric surgery not only changes the shape of the gastrointestinal tract but it also modulates the hormonal activity. Bariatric surgery is considered as therapy not only for the obese but also for diabetic patients.

  16. Early metabolic improvement following bariatric surgery in morbidly obese adolescents.

    Science.gov (United States)

    Teeple, E A; Teich, S; Schuster, D P; Michalsky, M P

    2012-01-01

    Bariatric surgery results in durable weight loss and improved comorbidities. The objectives of this study were to examine the efficacy of gastric bypass in reducing comorbid burden and improving metabolic status among morbidly obese adolescents. The medical records of 15 gastric bypass patients were retrospectively reviewed. Changes in metabolic markers were determined at baseline, 1 and 2 years post-operatively. Comparative analysis demonstrated significant improvement in weight, BMI, insulin, HbA1C, C-peptide, %B, %S, IR, cholesterol, percentile cholesterol, TG, percentile TG, HDL, percentile HDL, LDL, percentile LDL, and VLDL. Results support bariatric surgery as a treatment for morbidly obese adolescents with comorbidities.

  17. [Strategy and critical analysis of bariatric surgery].

    Science.gov (United States)

    Houben, J J; Barea, M; Maroquin, L; Isabo, O; Desmarets, A

    2007-09-01

    Bariatric surgery has considerably developed during the last 20 years in Belgium. The increase of prevalence of the morbid obesity and the development of multiple surgical procedures widened the spectrum of treatment. If a rigorous selection and a multidisciplinary approach of the patients are inescapable, the various decision-making algorithms plunge the practitioner into a certain confusion. The purpose of this paper is to clarify the advantages and the inconveniences of the different surgical treatments in light of the evolution of the principles and the objective results of the literature. Among the techniques proven and validated in the long run, one can mention the Silastic Ring Vertical Gastroplasty according to Mac Lean by minilaparotomy, the laparoscopic adjustable ring and the more recent gastric by pass. The evaluation of laparoscopic sleeve gastrectomy, and of duodenal switch is on course. The bilio-pancreatic by-pass according to Scopinaro remains strongly controversed. A meta-analysis of the literature confirms the success of the gastric bypass. Regarding to the long term follow-up, the adjustable gastric banding deceives. The sleeve gastrectomy should be analyzed in the long term. The preliminary results of a epidemiologic and financial study within a private hospital of Brussels reveals that the cost effective ratio is in favor the Silastic Ring Vertical Gastroplasty and the laparoscopic adjustable banding, as well in terms of public health support than the charge for the private insurance and the patient. The projection beyond 5 years reverses the tendency to plead in favor of the gastric by-pass. First with the hit-parade of comfort, food diversification, tolerance, gastro-esophageal reflux, and undoubtedly of the rate of recurrence, it supplants the others techniques for sweet eaters. The volume eaters can profit from a sleeve gastrectomy which undoubtedly supplants the Silastic Ring Vertical Gastroplasty responsible for late annular stenoses and

  18. Energetic adaptations persist after bariatric surgery in severely obese adolescents

    Science.gov (United States)

    Energetic adaptations induced by bariatric surgery have not been studied in adolescents or for extended periods postsurgery. Energetic, metabolic, and neuroendocrine responses to Roux-en-Y gastric bypass (RYGB) surgery were investigated in extremely obese adolescents. At baseline and at 1.5, 6, and...

  19. NSAID Use after Bariatric Surgery : a Randomized Controlled Intervention Study

    NARCIS (Netherlands)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N

    2016-01-01

    BACKGROUND: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. AIM: To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAI

  20. Pregnancy Following Bariatric Surgery-Medical Complications and Management.

    Science.gov (United States)

    Narayanan, Ram Prakash; Syed, Akheel A

    2016-10-01

    Bariatric surgery is most commonly carried out in women of childbearing age. Whilst fertility rates are improved, pregnancy following bariatric surgery poses several challenges. Whilst rates of many adverse maternal and foetal outcomes in obese women are reduced after bariatric surgery, pregnancy is best avoided for 12-24 months to reduce the potential risk of intrauterine growth retardation. Dumping syndromes are common after bariatric surgery and can present diagnostic and therapeutic challenges in pregnancy. Early dumping occurs due to osmotic fluid shifts resulting from rapid gastrointestinal food transit, whilst late dumping is characterized by a hyperinsulinemic response to rapid absorption of simple carbohydrates. Dietary measures are the mainstay of management of dumping syndromes but pharmacotherapy may sometimes become necessary. Acarbose is the least hazardous pharmacological option for the management of postprandial hypoglycemia in pregnancy. Nutrient deficiencies may vary depending on the type of surgery; it is important to optimize the nutritional status of women prior to and during pregnancy. Dietary management should include adequate protein and calorie intake and supplementation of vitamins and micronutrients. A high clinical index of suspicion is required for early diagnosis of surgical complications of prior weight loss procedures during pregnancy, including small bowel obstruction, internal hernias, gastric band erosion or migration and cholelithiasis. PMID:27488114

  1. Medical management of patients after bariatric surgery: Principles and guidelines.

    Science.gov (United States)

    Elrazek, Abd Elrazek Mohammad Ali Abd; Elbanna, Abduh Elsayed Mohamed; Bilasy, Shymaa E

    2014-11-27

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m(2)) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m(2) and those with BMI > 35 kg/m(2) with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

  2. Medical management of patients after bariatric surgery: Principles and guidelines

    Institute of Scientific and Technical Information of China (English)

    Abd; Elrazek; Mohammad; Ali; Abd; Elrazek; Abduh; Elsayed; Mohamed; Elbanna; Shymaa; E; Bilasy

    2014-01-01

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index(BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients(BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

  3. Bariatric Surgery in Women: A Boon Needs Special Care During Pregnancy

    OpenAIRE

    Kumari, Archana; Nigam, Aruna

    2015-01-01

    Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional statu...

  4. Bariatric Surgery in Women: A Boon Needs Special Care During Pregnancy.

    Science.gov (United States)

    Kumari, Archana; Nigam, Aruna

    2015-11-01

    Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional status and the importance of regular check-ups must be explained. Nutritional supplementation should be tailored to the patient's status and the type of bariatric surgery performed. PMID:26672514

  5. Psychological predictors of weight loss after bariatric surgery

    DEFF Research Database (Denmark)

    Wimmelmann, Cathrine Lawaetz; Dela, Flemming; Mortensen, Erik Lykke

    2014-01-01

    Background: Morbid obesity is the fastest growing BMI group in the U.S. and the prevalence of morbid obesity worldwide has never been higher. Bariatric surgery is the most effective treatment for severe forms of obesity especially with regardto a sustained long-term weight loss. Psychological...... factors are thought to play animportant role for maintaining the surgical weight loss. However, results from priorresearch examining preoperative psychological predictors of weight loss outcomeare inconsistent. The aim of this article was to review more recent literature onpsychological predictors...... of surgical weight loss.Methods: We searched PubMed, PsycInfo and Web of Science, for original prospectivestudies with a sample size >30 and at least one year follow-up, using a combina-tion of search terms such as ‘bariatric surgery’, ‘morbid obesity’, ‘psychologicalpredictors’, and ‘weight loss’. Only...

  6. Young adult women's experiences of body image after bariatric surgery

    DEFF Research Database (Denmark)

    Froulund Jensen, Janet; Petersen, Mette H; Larsen, Tine B;

    2014-01-01

    AIM: To understand the lived experience of body image in young women after obesity surgery. BACKGROUND: Quantitative studies have documented that health-related quality of life and body image are improved after bariatric surgery, probably due to significant weight loss. Female obesity surgery...... candidates are likely to be motivated by dissatisfaction regarding physical appearance. However, little is known about the experience of the individual woman, leaving little understanding of the association between bariatric surgery and changes in health-related quality of life and body image. DESIGN...... synthesized into one major theme: on the edge of control, that is describing these women's feelings of being on the edge of balance between control and loss of control. CONCLUSION: Perception of control may be an essential aspect of body image and the key to understanding these young women's feelings...

  7. Benefits of Bariatric Surgery and Perioperative Surgical Safety

    Directory of Open Access Journals (Sweden)

    Ji Chung Tham

    2015-11-01

    Full Text Available Obesity is a worldwide problem with numerous associated health problems. The number of patients eligible for surgery outnumber surgical capacity and so patients need to be prioritised based on their obesity- related health burden and comorbidities. Weight loss as a result of bariatric surgery is significant and maintained in the long term. In addition to weight loss, patient health improves in terms of metabolic, macrovascular, and microvascular disease. As a result, quality of life is better, along with psychosocial wellbeing. Bariatric surgery is associated with a relatively low number of complications and appears to result in a reduction in mortality risk due to the resolution of comorbidities. Hence, surgery can now be routinely considered as an adjunct to medical therapy in the management of obesity.

  8. Post-operative bariatric surgery complications: Deficiency of nutrients

    Directory of Open Access Journals (Sweden)

    Syed Abdul Majid Mufaqam1, Soni Dhwani Satishkumar2, Patel Palak Arvindkumar2

    2013-08-01

    Full Text Available Since more than half of the population in America falls under the category of obesity, scientists have discovered a surgical technique to reduce the weight of the obese patients. Bariatric surgery or gastric bypass surgery is a procedure that has been successful in reducing the weight for obese people. This technique requires a permanent gastric bypass (Roux-en-Y where part of the stomach and duodenum is removed. Since the size of the stomach is reduced to 20% of its original size along with the removal of duodenum – this may lead to improper absorption of several vitamins and minerals. This review showed that several vitamins and mineral deficiencies are observed in patients, post-operative bariatric surgery. Thiamin, folate, and B12 deficiencies were most commonly observed, and Vitamin A, D, C and B6 deficiencies were also seen in some cases. Iron and calcium deficiencies were also reported by some of the studies.

  9. Communication between the obese patient and bariatric surgeon.

    Science.gov (United States)

    Ruiz de Angulo, David; Munitiz, Vicente; Ortiz, M Ángeles; Martínez de Haro, Luisa F; Frutos, M Dolores; Hernández, Antonio; Parrilla, Pascual

    2015-10-01

    Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important. PMID:25912163

  10. Bile Acids, FXR, and Metabolic Effects of Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Olivier F. Noel

    2016-01-01

    Full Text Available Overweight and obesity represent major risk factors for diabetes and related metabolic diseases. Obesity is associated with a chronic and progressive inflammatory response leading to the development of insulin resistance and type 2 diabetes (T2D mellitus, although the precise mechanism mediating this inflammatory process remains poorly understood. The most effective intervention for the treatment of obesity, bariatric surgery, leads to glucose normalization and remission of T2D. Recent work in both clinical studies and animal models supports bile acids (BAs as key mediators of these effects. BAs are involved in lipid and glucose homeostasis primarily via the farnesoid X receptor (FXR transcription factor. BAs are also involved in regulating genes involved in inflammation, obesity, and lipid metabolism. Here, we review the novel role of BAs in bariatric surgery and the intersection between BAs and immune, obesity, weight loss, and lipid metabolism genes.

  11. The Night Eating Syndrome (NES) in Bariatric Surgery Patients.

    Science.gov (United States)

    de Zwaan, Martina; Marschollek, Michael; Allison, Kelly C

    2015-11-01

    The night eating syndrome (NES) has been included into the Diagnostic and Statistical Manual of Mental Disorders 5 as an example of an 'other-specified feeding or eating disorder'. The prevalence of NES has found to be higher in obese populations than in the general population and seems to rise with increasing body mass index. Recent studies suggest a prevalence of 2%-20% in bariatric surgery samples. Given that the core feature of this eating disorder may involve a shift in the circadian pattern of eating that disrupts sleep, and not the ingestion of objectively large amounts of food, it is a pattern that can continue after bariatric surgery. Nonetheless, symptoms of NES appear to decrease after weight loss surgery, and there is no evidence that pre-surgery NES negatively impacts weight loss following surgery. Prospective and longitudinal studies of the course of night eating symptoms are warranted using clear criteria and standardized assessment instruments.

  12. Economic considerations for bariatric surgery and morbid obesity.

    Science.gov (United States)

    Frezza, Eldo E; Wacthell, Mitchell; Ewing, Bradley

    2009-01-01

    The obesity epidemic is also an economic tragedy. This analysis evaluates the economic effects and the potential to improve the well-being of both individual and societal wealth. Econometric techniques should carefully assess the degree to which obesity affects declines in business output, employment, income, and tax revenues at the regional and national levels. Microeconomics assesses lost productivity and associated wages and profit. Macroeconomics assesses trends associated with employment, inflation, interest rates, money supply, and output. To decrease the adverse economic consequences of the obesity epidemic, policy makers must emphasize bariatric surgery as a cost-effective option for qualified patients. Early intervention, education, and tax rebates for obese individuals who undergo bariatric surgery and for medical centers and doctors would likely have positive economic effects on the whole economy in a few years. PMID:21935309

  13. Effects of Bariatric Surgery on Human Small Artery Function

    OpenAIRE

    Aghamohammadzadeh, Reza; Greenstein, Adam S.; Yadav, Rahul; Jeziorska, Maria; Hama, Salam; Soltani, Fardad; Pemberton, Phil W.; Ammori, Basil; Malik, Rayaz A; Soran, Handrean; Heagerty, Anthony M

    2013-01-01

    Objectives The aim of this study was to investigate the effects of bariatric surgery on small artery function and the mechanisms underlying this. Background In lean healthy humans, perivascular adipose tissue (PVAT) exerts an anticontractile effect on adjacent small arteries, but this is lost in obesity-associated conditions such as the metabolic syndrome and type II diabetes where there is evidence of adipocyte inflammation and increased oxidative stress. Methods Segments of small subcutaneo...

  14. Effects of Bariatric Surgery on Human Small Artery Function

    Science.gov (United States)

    Aghamohammadzadeh, Reza; Greenstein, Adam S.; Yadav, Rahul; Jeziorska, Maria; Hama, Salam; Soltani, Fardad; Pemberton, Phil W.; Ammori, Basil; Malik, Rayaz A.; Soran, Handrean; Heagerty, Anthony M.

    2013-01-01

    Objectives The aim of this study was to investigate the effects of bariatric surgery on small artery function and the mechanisms underlying this. Background In lean healthy humans, perivascular adipose tissue (PVAT) exerts an anticontractile effect on adjacent small arteries, but this is lost in obesity-associated conditions such as the metabolic syndrome and type II diabetes where there is evidence of adipocyte inflammation and increased oxidative stress. Methods Segments of small subcutaneous artery and perivascular fat were harvested from severely obese individuals before (n = 20) and 6 months after bariatric surgery (n = 15). Small artery contractile function was examined in vitro with wire myography, and perivascular adipose tissue (PVAT) morphology was assessed with immunohistochemistry. Results The anticontractile activity of PVAT was lost in obese patients before surgery when compared with healthy volunteers and was restored 6 months after bariatric surgery. In vitro protocols with superoxide dismutase and catalase rescued PVAT anticontractile function in tissue from obese individuals before surgery. The improvement in anticontractile function after surgery was accompanied by improvements in insulin sensitivity, serum glycemic indexes, inflammatory cytokines, adipokine profile, and systolic blood pressure together with increased PVAT adiponectin and nitric oxide bioavailability and reduced macrophage infiltration and inflammation. These changes were observed despite the patients remaining severely obese. Conclusions Bariatric surgery and its attendant improvements in weight, blood pressure, inflammation, and metabolism collectively reverse the obesity-induced alteration to PVAT anticontractile function. This reversal is attributable to reductions in local adipose inflammation and oxidative stress with improved adiponectin and nitric oxide bioavailability. PMID:23665100

  15. Metabolic Hormones in bariatric surgery and reward behaviour

    OpenAIRE

    Emmanuel, J. J.

    2015-01-01

    The World Health Organization (WHO) defines obesity as a condition in which body fat is increased to the extent that health and well-being are impaired. Obesity and type-2 diabetes are two of the leading healthcare challenges facing this generation. Bariatric surgery is the most effective therapeutic option for morbid obesity. A systematic review has concluded that surgery is superior to conventional treatment in reducing weight. However, the review failed to show the superiority of one surgi...

  16. Bariatric surgery is associated with improvement in kidney outcomes.

    Science.gov (United States)

    Chang, Alex R; Chen, Yuan; Still, Christopher; Wood, G Craig; Kirchner, H Lester; Lewis, Meredith; Kramer, Holly; Hartle, James E; Carey, David; Appel, Lawrence J; Grams, Morgan E

    2016-07-01

    Severe obesity is associated with increased risk of kidney disease. Whether bariatric surgery reduces the risk of adverse kidney outcomes is uncertain. To resolve this we compared the risk of estimated glomerular filtration rate (eGFR) decline of ≥30% and doubling of serum creatinine or end-stage renal disease (ESRD) in 985 patients who underwent bariatric surgery with 985 patients who did not undergo such surgery. Patients were matched on demographics, baseline body mass index, eGFR, comorbidities, and previous nutrition clinic use. Mean age was 45 years, 97% were white, 80% were female, and 33% had baseline eGFR surgery group compared with 1.4 kg in the matched cohort. Over a median follow-up of 4.4 years, 85 surgery patients had an eGFR decline of ≥30% (22 had doubling of serum creatinine/ESRD). Over a median follow-up of 3.8 years, 177 patients in the matched cohort had an eGFR decline of ≥30% (50 had doubling of serum creatinine/ESRD). In adjusted analysis, bariatric surgery patients had a significant 58% lower risk for an eGFR decline of ≥30% (hazard ratio 0.42, 95% confidence interval 0.32-0.55) and 57% lower risk of doubling of serum creatinine or ESRD (hazard ratio 0.43, 95% confidence interval: 0.26-0.71) compared with the matched cohort. Results were generally consistent among subgroups of patients with and without eGFR bariatric surgery may be an option to prevent kidney function decline in severely obese individuals.

  17. Peroneal palsy after bariatric surgery: is nerve decompresion always necessary?

    Directory of Open Access Journals (Sweden)

    Ana M. Ramos-Leví

    2013-08-01

    Full Text Available We present two patients who underwent successful bariatric surgery and developed peroneal nerve palsy six months after the procedure. This is an unusual complication which determines a significant functional limitation, mainly because of foot drop, and its presence may be a hallmark of excessive and rapid weight loss. We discuss possible pathogenic mechanisms and therapeutic options, and we emphasize the important role of an adequate nutritional management, in order to avoid the need for a surgical nerve decompression.

  18. The Impact of Bariatric Surgery on Psychological Health

    Directory of Open Access Journals (Sweden)

    Jeremy F. Kubik

    2013-01-01

    Full Text Available Obesity is associated with a relatively high prevalence of psychopathological conditions, which may have a significant negative impact on the quality of life. Bariatric surgery is an effective intervention in the morbidly obese to achieve marked weight loss and improve physical comorbidities, yet its impact on psychological health has yet to be determined. A review of the literature identified a trend suggesting improvements in psychological health after bariatric surgery. Majority of mental health gain is likely attributed to weight loss and resultant gains in body image, self-esteem, and self-concept; however, other important factors contributing to postoperative mental health include a patient’s sense of taking control of his/her life and support from health care staff. Preoperative psychological health also plays an important role. In addition, the literature suggests similar benefit in the obese pediatric population. However, not all patients report psychological benefits after bariatric surgery. Some patients continue to struggle with weight loss, maintenance and regain, and resulting body image dissatisfaction. Severe preoperative psychopathology and patient expectation that life will dramatically change after surgery can also negatively impact psychological health after surgery. The health care team must address these issues in the perioperative period to maximize mental health gains after surgery.

  19. [Bariatric and plastic surgery in obese adolescents: an alternative treatment].

    Science.gov (United States)

    Dubern, Béatrice; Tounian, Patrice

    2014-06-01

    The increased frequency of extreme forms of obesity in adolescents and the disappointing results of conventional treatments are now leading pediatricians to consider bariatric or cosmetic surgery as the only real long-term effective therapeutic alternative. The two main techniques currently used for bariatric surgery in adolescents are gastric bypass and adjustable gastric banding. Whatever the technique, weight loss is significant with improvement of comorbidities and quality of life. In addition, the complications are identical to those in adults and equally frequent. However, because of the particularities of this age, caution is still required. Adolescence is indeed characterized by specific nutritional needs, but also changes in body image in which surgery could have a negative effect. Currently, all obese teenagers making a request for bariatric surgery should have a comprehensive assessment with global care for at least 6 months. The indication is then discussed on a case-by-case basis by multidisciplinary teams and experts. To date, the type of surgery (gastric banding, gastric sleeve, or bypass) is still widely discussed. Based on experience with adults, we believe that gastric sleeve and bypass should be preferred. In addition, obesity in adolescents almost always involves psychosocial consequences, while somatic complications are rare. Thus, the care of adipo- or gynecomastia, abdominal fat excess, and concealed penis is essential and therefore justifies cosmetic surgery.

  20. Economic considerations for bariatric surgery and morbid obesity

    Directory of Open Access Journals (Sweden)

    Eldo E Frezza

    2009-12-01

    Full Text Available Eldo E Frezza, Mitchell Wacthell1, Bradley Ewing21Center for Metabolic Disease and Texas Tech University, Department of Pathology, 2Rawls Business School, Texas Tech University, Lubbock, TX, USAAbstract: The obesity epidemic is also an economic tragedy. This analysis evaluates the economic effects and the potential to improve the well-being of both individual and societal wealth. Econometric techniques should carefully assess the degree to which obesity affects declines in business output, employment, income, and tax revenues at the regional and national levels. Microeconomics assesses lost productivity and associated wages and profit. Macroeconomics assesses trends associated with employment, inflation, interest rates, money supply, and output. To decrease the adverse economic consequences of the obesity epidemic, policy makers must emphasize bariatric surgery as a cost-effective option for qualified patients. Early intervention, education, and tax rebates for obese individuals who undergo bariatric surgery and for medical centers and doctors would likely have positive economic effects on the whole economy in a few years.Keywords: bariatric surgery, morbid obesity, economics

  1. Complications of bariatric surgery: Presentation and emergency management.

    Science.gov (United States)

    Kassir, Radwan; Debs, Tarek; Blanc, Pierre; Gugenheim, Jean; Ben Amor, Imed; Boutet, Claire; Tiffet, Olivier

    2016-03-01

    The epidemic in obesity has led to an increase in number of so called bariatric procedures. Doctors are less comfortable managing an obese patient after bariatric surgery. Peri-operative mortality is less than 1%. The specific feature in the obese patient is that the classical signs of peritoneal irritation are never present as there is no abdominal wall and therefore no guarding or rigidity. Simple post-operative tachycardia in obese patients should be taken seriously as it is a WARNING SIGNAL. The most common complication after surgery is peritonitis due to anastomotic fistula formation. This occurs typically as an early complication within the first 10 days post-operatively and has an incidence of 1-6% after gastric bypass and 3-7% after sleeve gastrectomy. Post-operative malnutrition is extremely rare after restrictive surgery (ring, sleeve gastrectomy) although may occur after malabsorbative surgery (bypass, biliary pancreatic shunt) and is due to the restriction and change in absorption. Prophylactic cholecystectomy is not routinely carried out during the same procedure as the bypass. Superior mesenteric vein thrombosis after bariatric surgery is a diagnosis which should be considered in the presence of any postoperative abdominal pain. Initially a first etiological assessment is performed (measurement of antithrombin III and of protein C and protein S, testing for activated protein C resistance). If the least doubt is present, a medical or surgical consultation should be requested with a specialist practitioner in the management of obese patients as death rates increase with delayed diagnosis. PMID:26808323

  2. Revisional Bariatric/Metabolic Surgery: What Dictates Its Indications?

    Science.gov (United States)

    Ma, Pearl; Reddy, Subhash; Higa, Kelvin D

    2016-07-01

    Bariatric/metabolic surgery is currently the only effective long-term treatment for morbid obesity- and obesity-related diseases such as diabetes, heart disease, hypertension, obstructive sleep apnea, and dyslipidemia. In addition, bariatric/metabolic surgery has been shown to significantly reduce the incidence of diabetes and cancer and prolong life when compared to non-surgical therapies. However, as obesity is a chronic disease, recidivism of weight and comorbid conditions can occur. In addition, the surgical construct can lead to long-term consequences such as marginal ulceration, bowel obstruction, reflux, and nutritional deficiencies. Despite these drawbacks, prospective randomized controlled studies and long-term longitudinal population-based comparative studies greatly favor surgical intervention as opposed to traditional lifestyle, diet, and exercise programs. Revisional surgery can be quite complex and technically challenging and may offer the patient a wide variety of solutions for treatment of weight recidivism and complications after primary operations. Given the paucity of high quality published data, we have endeavored to provide indications for revisions after bariatric surgery. PMID:27221504

  3. Complications of bariatric surgery: Presentation and emergency management.

    Science.gov (United States)

    Kassir, Radwan; Debs, Tarek; Blanc, Pierre; Gugenheim, Jean; Ben Amor, Imed; Boutet, Claire; Tiffet, Olivier

    2016-03-01

    The epidemic in obesity has led to an increase in number of so called bariatric procedures. Doctors are less comfortable managing an obese patient after bariatric surgery. Peri-operative mortality is less than 1%. The specific feature in the obese patient is that the classical signs of peritoneal irritation are never present as there is no abdominal wall and therefore no guarding or rigidity. Simple post-operative tachycardia in obese patients should be taken seriously as it is a WARNING SIGNAL. The most common complication after surgery is peritonitis due to anastomotic fistula formation. This occurs typically as an early complication within the first 10 days post-operatively and has an incidence of 1-6% after gastric bypass and 3-7% after sleeve gastrectomy. Post-operative malnutrition is extremely rare after restrictive surgery (ring, sleeve gastrectomy) although may occur after malabsorbative surgery (bypass, biliary pancreatic shunt) and is due to the restriction and change in absorption. Prophylactic cholecystectomy is not routinely carried out during the same procedure as the bypass. Superior mesenteric vein thrombosis after bariatric surgery is a diagnosis which should be considered in the presence of any postoperative abdominal pain. Initially a first etiological assessment is performed (measurement of antithrombin III and of protein C and protein S, testing for activated protein C resistance). If the least doubt is present, a medical or surgical consultation should be requested with a specialist practitioner in the management of obese patients as death rates increase with delayed diagnosis.

  4. Country of origin and bariatric surgery in Sweden during 2001-2010.

    OpenAIRE

    Memarian, Ensieh; Sundquist, Kristina; Calling, Susanna; Sundquist, Jan; Li, Xinjun

    2015-01-01

    The prevalence of obesity, as well as use of bariatric surgery, has increased worldwide. The aim of the present study was to investigate the potential differences in the use of bariatric surgery among Swedes and immigrants in Sweden and whether the hypothesized differences remain after adjustment for socioeconomic factors.

  5. Results of Implementing an Enhanced Recovery After Bariatric Surgery (ERABS) Protocol

    NARCIS (Netherlands)

    G.H.H. Mannaerts (Guido); S. van Mil (Stefanie); P.S. Stepaniak (Pieter); M. Dunkelgrun (Martin); M. de Quelerij (Marcel); S.J.C. Verbrugge (Serge); H. Zengerink (Hans); L.U. Biter (L. Ulas)

    2015-01-01

    textabstractBackground: With the increasing prevalence of morbid obesity and healthcare costs in general, interest is shown in safe, efficient, and cost-effective bariatric care. This study describes an Enhanced Recovery After Bariatric Surgery (ERABS) protocol and the results of implementing such p

  6. Confirmatory Factor Analysis of the Beck Depression Inventory-II in Bariatric Surgery Candidates

    Science.gov (United States)

    Hall, Brian J.; Hood, Megan M.; Nackers, Lisa M.; Azarbad, Leila; Ivan, Iulia; Corsica, Joyce

    2013-01-01

    Screening for depression is an integral part of psychological evaluations conducted prior to bariatric surgery. The Beck Depression Inventory-II (BDI-II) is the most commonly used measure of depression in these treatment evaluations. The reliability and validity of the BDI-II has not yet been evaluated within bariatric surgery-seeking samples,…

  7. Influence of Bariatric Surgery on the Use and Pharmacokinetics of Some Major Drug Classes

    NARCIS (Netherlands)

    Yska, Jan Peter; van der Linde, Susanne; Tapper, Veronique V.; Apers, Jan A.; Emous, Marloes; Totte, Erik R.; Wilffert, Bob; van Roon, Eric N.

    2013-01-01

    The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes t

  8. The prevalence of iron deficiency anaemia in patients undergoing bariatric surgery.

    Science.gov (United States)

    Khanbhai, M; Dubb, S; Patel, K; Ahmed, A; Richards, T

    2015-01-01

    As bariatric surgery rates continue to climb, anaemia will become an increasing concern. We assessed the prevalence of anaemia and length of hospital stay in patients undergoing bariatric surgery. Prospective data (anaemia [haemoglobin bariatric surgery. Results from a prospective database of 1530 patients undergoing elective general surgery were used as a baseline. Fifty-seven patients (14%) were anaemic pre-operatively, of which 98% were females. Median MCV (fL) and overall median ferritin (μg/L) was lower in anaemic patients (83 vs. 86, p=0.001) and (28 vs. 61, psurgery patients, prevalence of anaemia was similar (14% vs. 16%) but absolute iron deficiency was more common in those undergoing bariatric surgery; microcytosis pbariatric surgery. In bariatric patients with anaemia there was an overall increased length of hospital stay.

  9. Implementing enhanced recovery after bariatric surgery protocol: a retrospective study.

    Science.gov (United States)

    Proczko, Monika; Kaska, Lukasz; Twardowski, Pawel; Stepaniak, Pieter

    2016-02-01

    While the demand for bariatric surgery is increasing, hospital capacity remains limited. The ERABS (Enhanced Recovery After Bariatric Surgery) protocol has been implemented in a number of bariatric centers. We retrospectively compared the operating room logistics and postoperative complications between pre-ERABS and ERABS periods in an academic hospital. The primary endpoint was the length of stay in hospital. The secondary endpoints were turnover times-the time required for preparing the operating room for the next case, induction time (from induction of anesthesia until a patient is ready for surgery), surgical time (duration of surgery), procedure time (duration of stay in the operating room), and the incidence of re-admissions, re-operations and complications during admission and within 30 days after surgery. Of a total of 374 patients, 228 and 146 received surgery following the pre-ERABS and ERABS protocols, respectively. The length of hospital stay was significantly shortened from 3.7 (95 % confidence interval [CI] 3.1-4.7) days to 2.1 (95 % CI 1.6-2.6) days (P surgery, respectively (P < 0.001 for both), by introducing the ERABS protocol. Induction times were reduced from 15.2 (95 % CI 14.3-16.1) min to 12.5 (95 % CI 11.7-13.3) min (P < 0.001).Turnover times were shortened significantly from 38 (95 % CI 44-32) min to 11 (95 % CI 8-14) min. The incidence of re-operations, re-admissions and complications did not change.

  10. Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis

    Science.gov (United States)

    Ye, Zhibin; Di, Jianzhong; Han, Xiaodong; Zhang, Hongwei; Liu, Weijie; Ren, Qinggui; Zhang, Pin

    2016-01-01

    Background Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting. Objective To explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery. Methods We comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale. Results 32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery. Limitations The main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up. Conclusions Bariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed. PMID:27701452

  11. The impact of bariatric surgery on quality of life: a systematic review and meta-analysis.

    Science.gov (United States)

    Lindekilde, N; Gladstone, B P; Lübeck, M; Nielsen, J; Clausen, L; Vach, W; Jones, A

    2015-08-01

    This study aims to review the obesity literature in order to assess the impact of bariatric surgery on quality of life and the between-study variation by examining the standardized mean magnitude of effect in change in the levels of quality of life. The following databases EMBASE, PubMed, PsycINFO, CINAHL, the Cochrane Library and Web of Science were systematically searched for studies examining change in quality of life in adults receiving bariatric surgery for obesity. Seventy-two studies were included with a total of 9,433 participants treated for obesity with bariatric surgery. The average impact of bariatric surgery on quality of life corresponded to an effect size of 0.88 (95% CI: 0.80-0.96), indicating that bariatric surgery has a significant positive influence on quality of life in general. The impact varied considerably across studies with bariatric surgery showing a significantly greater positive influence on physical quality of life compared to mental quality of life. Bariatric surgery is effective in improving quality of life, especially when looking at physical well-being. Greater focus on the psychological well-being of the person undergoing surgery for obesity may lead to a better post-surgery prognosis for more people.

  12. FUNCTIONAL ASSESSMENT OF OLDER OBESE PATIENTS CANDIDATES FOR BARIATRIC SURGERY

    Directory of Open Access Journals (Sweden)

    Denis PAJECKI

    2014-03-01

    Full Text Available Context Obesity in the elderly is associated with exacerbation of functional decline (dependency, that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined. Objective To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods Patients with age ≥60 and BMI ≥35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the “Timedupandgo” test to evaluate mobility, whose cut-off point was ≤10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years. Results Forty subjects have completed evaluation. The mean age was 64.1 years (60-72 and 75% were women. They had an average weight of 121.1 kg (72.7-204 and a mean BMI of 47.2 kg/m2 (35.8-68.9. 16 patients (40% have shown dependency for activities of daily living, 19 (47,5% for instrumental activities of daily living and 20 patients (50% had a “Timedupandgo” test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression has shown

  13. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

    Directory of Open Access Journals (Sweden)

    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  14. Temperament and Personality in Bariatric Surgery-Resisting Temptations?

    Science.gov (United States)

    Claes, Laurence; Müller, Astrid

    2015-11-01

    Temperament and personality traits can serve as both risk factors as well as protective factors in the development of morbid obesity. In the present review, we present an overview of studies focusing on the relationship between temperament/personality and morbid obesity in pre-operative and postoperative bariatric surgery patients. We consider studies that focus on both a categorical and dimensional point of view on temperament/personality, as well as studies based on cross-sectional and longitudinal designs. Finally, we will integrate the research findings, discuss the implications for assessment and treatment and formulate suggestions for future research.

  15. The use of drugs in patients who have undergone bariatric surgery

    Directory of Open Access Journals (Sweden)

    Geraldo MSP

    2014-05-01

    Full Text Available Mariana de Sousa Prado Geraldo,1 Fernando Luiz Affonso Fonseca,2,3 Marisa Regina de Fatima Veiga Gouveia,4 David Feder41Department of Medicine, Faculdade de Medicina do ABC, 2Department of Pharmacy and Biochemistry, Universidade Federal de Sao Paulo, 3Department of Hematology, Faculdade de Medicina do ABC, 4Department of Pharmacology, Faculdade de Medicina do ABC, Santo Andre, SP, Brazil Abstract: According to the World Health Organization, obesity has become an epidemic in the 21st century affecting around 300 million people of all ages worldwide. Clinical treatment modalities for this disease are limited and ineffective when it comes to morbidly obese patients (body mass index – the weight in kilograms divided by height in meters squared – surpasses 40 kg/m2. Therefore, the alternative, surgical treatment, is the best option for these patients, namely gastric restrictive procedures or an intestinal bypass culminating in a malabsorptive syndrome. In the past 20 years, there has been a 70% increase in the number of bariatric procedures all over the world. The main pharmacokinetic consequence observed in the postoperative period of these individuals is a higher or lower absorption of orally administered drugs.Keywords: anatomophysiological alterations, pharmacokinetic, obesity

  16. Changes in Weight and Comorbidities among Adolescents Undergoing Bariatric Surgery: 1-Year Results from the Bariatric Outcomes Longitudinal Database

    Science.gov (United States)

    Messiah, Sarah E.; Lopez-Mitnik, Gabriela; Winegar, Deborah; Sherif, Bintu; Arheart, Kristopher L.; Reichard, Kirk W.; Michalsky, Marc P.; Lipshultz, Steven E.; Miller, Tracie L.; Livingstone, Alan S.; De La Cruz-Muñoz, Nestor

    2012-01-01

    Background Bariatric surgery is one of the few effective treatments for morbid obesity but the weight loss and other health related outcomes for this procedure in large, diverse adolescent patient populations are not well characterized. Objective To analyze the prospective Bariatric Outcomes Longitudinal Database (BOLD) to determine the weight loss and health related outcomes in adolescents. Setting BOLD data is collected from 423 surgeons at 360 facilities in the United States. Methods Main outcome measures included anthropometric and comorbidity status at baseline (n=890) and at 3 (n=786), 6 (n=541), and 12 (n=259) months after surgery. Adolescents (75% female; 68% non-Hispanic white, 14% Hispanic, 11% non-Hispanic black, and 6% other) age 11-to-19 years were included in the analyses. Results The overall one year mean weight loss for those who underwent gastric bypass surgery was more than twice that of those who underwent adjustable gastric band surgery (48.6 kg versus 20 kg, P<0.001). Similar results were found for all other anthropometric changes and comparisons over one year between surgery types (P<0.001). In general, gastric bypass patients reported more improvement versus adjustable gastric band patients in comorbidities one year after surgery. There were a total of 45 readmissions among gastric bypass patients and 10 among adjustable gastric band patients with 29 and 8 reoperations required, respectively. Conclusions Weight loss at 3-, 6-, and 12-months after surgery is approximately double in adolescent males and females who underwent gastric bypass surgery versus those who underwent adjustable gastric band surgery. Bariatric surgery can safely and substantially reduce weight and related comorbidities in morbidly obese adolescents for at least 1 year. PMID:22542199

  17. Bariatric surgery: the challenges with candidate selection, individualizing treatment and clinical outcomes

    Directory of Open Access Journals (Sweden)

    Neff KJ

    2013-01-01

    Full Text Available Abstract Obesity is recognized as a global health crisis. Bariatric surgery offers a treatment that can reduce weight, induce remission of obesity-related diseases, and improve the quality of life. In this article, we outline the different options in bariatric surgery and summarize the recommendations for selecting and assessing potential candidates before proceeding to surgery. We present current data on post-surgical outcomes and evaluate the psychosocial and economic effects of bariatric surgery. Finally, we evaluate the complication rates and present recommendations for post-operative care.

  18. [Bariatric surgery is more efficient than medical treatment in achieving remission in diabetes mellitus type 2].

    Science.gov (United States)

    Klein, Mads; Rosenberg, Jacob; Gögenur, Ismail

    2013-04-01

    Observational studies have shown that bariatric surgery can lead to remission of diabetes mellitus type 2 (DMII), but randomized controlled trials have been lacking. Recently, randomized controlled trials comparing bariatric surgery with optimal medical treatment in patients suffering from poorly controlled DMII, have been performed. These trials show that bariatric surgery in general, and the malabsorptive procedures in particular, are more effective than medical treatment in achieving remission of DMII. These procedures should therefore be considered in the treatment of patients with DMII and obesity.

  19. Cardiac dual-source CT for the preoperative assessment of patients undergoing bariatric surgery

    International Nuclear Information System (INIS)

    Aim: To assess the diagnostic value of coronary dual-source computed tomography (DSCT) as a comprehensive, non-invasive tool in the preoperative cardiac evaluation of patients undergoing bariatric surgery. Materials and methods: Thirty consecutive obese [average body mass index (BMI): 45 ± 7.6, range: 35–59] patients (24 women; six men; median age: 52 ± 15 years) were enrolled in this institutional review board (IRB)-approved, Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant prospective study. Calcium scoring (CaS) and electrocardiography (ECG)-gated images of the coronary arteries were obtained with a large body habitus protocol (120 kV; 430 mAs; 100 ml iodinated contrast medium at 7 ml/s injection rate) on a DSCT machine. Qualitative (four-point: 1 = excellent to 4 = not delineable) coronary segmental analysis, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) measurements were performed. The presence and degree of vascular disease (four-grade scale: mild to severe) was correlated with CaS and cardiovascular (CV) risk stratification blood tests. In patients with severe stenosis (>70%), findings were compared with cardiac nuclear medicine imaging (single photon-emission computed tomography; SPECT) imaging. Results: The average HR, enhancement, and quality score were 64 ± 7 beats/min, 288 ± 66 HU and 1.8 ± .5, respectively. Ninety-three percent (417/450) of the coronary segments were rated diagnostic. The SNRs and CNRs were 17 ± 9 and 12 ± 7 for the right coronary artery; 17 ± 8 and 12 ± 7 for the left main coronary artery; 16 ± 9 and 11 ± 7 for the left anterior descending coronary artery; and 15 ± 7 and 10 ± 6 for the left circumflex coronary artery. Ten of the 30 patients (33%) demonstrated coronary artery disease (CAD) of which two (6%) showed three-vessel disease. Four (13%) patients showed severe disease: in three of which the presence of significant stenosis was confirmed by SPECT and by catheter

  20. The psychological profile of bariatric patients with and without type 2 diabetes

    DEFF Research Database (Denmark)

    Wimmelmann, Cathrine L; Smith, Evelyn; Lund, Michael T;

    2015-01-01

    BACKGROUND: Some bariatric patients are referred for surgery with a diagnosis of type 2 diabetes while others are referred without co-morbid diabetes, but psychological differences between patients with and without type 2 diabetes undergoing bariatric surgery have not yet been investigated....... The objective of this study was to present the baseline results of the longitudinal GASMITO-PSYC study, and to evaluate the psychological differences between bariatric patients with and without type 2 diabetes. METHODS: A total of 129 Roux-en- Y gastric bypass patients were recruited from the bariatric clinic...... at a hospital in the suburban Copenhagen area. Participants answered questionnaires concerning personality, mental symptoms, health-related quality of life (HRQOL), body image, lifestyle, and physical health including diabetes status on average 11 weeks before surgery. Questionnaires were either sent...

  1. Recent advances in the modification of taste and food preferences following bariatric surgery.

    Science.gov (United States)

    Primeaux, Stefany D; de Silva, Taniya; Tzeng, Tony H; Chiang, Monica C; Hsia, Daniel S

    2016-06-01

    There is a large body of evidence indicating that bariatric surgery provides durable weight loss and health benefits to patients who are obese and have comorbidities such as type 2 diabetes (T2D). However, there are still many questions related to mechanisms of metabolic improvement, predictors of success/failure, and long term consequences, which need to be answered. More recently, there has been a particular interest in the modulation of taste and food preferences that occurs after bariatric surgery and how this affects weight loss in different individuals. Animal models as well as human studies have shed some light on the role of taste in changing food preferences and how these changes may affect weight loss after surgery. The goal of this review is to discuss the physiological and behavioral consequences of bariatric surgery as a treatment for obesity and T2D, with particular emphasis on recent studies describing bariatric surgery-induced modifications in taste perception and food preferences.

  2. Recent advances in bariatric/metabolic surgery: appraisal of clinical evidence

    Institute of Scientific and Technical Information of China (English)

    Wei-Jei Lee; Abdullah Almulaifi

    2015-01-01

    Obesity and associated type 2 diabetes mellitus (T2DM) are becoming a serious medical issue worldwide.Bariatric surgery has been shown to be the most effective and durable therapy for the treatment of morbid obese patients.Increasing data indicates bariatric surgery as metabolic surgery is an effective and novel therapy for not well controlled obese T2DM patients.The review of recent developments in bariatric/metabolic surgery covers 4 major fields.1) Improvement of safety:recent advances in laparoscopic/metabolic surgery has made this minimal invasive surgery more than ten times safer than a decade ago.The safety profile of laparoscopic/metabolic surgery is compatible with that of laparoscopic cholecystectomy now.2) New bariatric/metabolic surgery:laparoscopic sleeve gastrectomy (LSG) is becoming the leading bariatric surgery because of its simplicity and efficacy.Other new procedures,such as gastric plication,banded plication,single anastomosis (mini) gastric bypass and Duodeno-jejunal bypass with sleeve gastrectomy have all been accepted as treatment modalities for bariatric/metabolic surgery.3)Mechanism of bariatric/metabolic surgery:Restriction is the most important mechanism for bariatric surgery.Weight regain after bariatric surgery is usually associated with loss of restriction.Recent studies demonstrated that gut hormone,microbiota and bile acid changes after bariatric surgery may play an important role in durable weight loss as well as in T2DM remission.However,weight loss is still the cornerstone of T2DM remission after metabolic surgery.4) Patient selection:patients who may benefit most from bariatric surgery was found to be patients with insulin resistance.For Asian T2DM patients,the indication of metabolic surgery has been set to those with not well controlled (HbA1c > 7.5%) disease and with their BMI > 27.5 Kg/m2.A novel diabetes surgical score,ABCD score,is a simple system for predicting the success of surgical therapy for T2DM.

  3. Metabolic bariatric surgery and type 2 diabetes mellitus: an endocrinologist's perspective

    Institute of Scientific and Technical Information of China (English)

    Sonali Ganguly; Hong Chang Tan; Phong Ching Lee; Kwang Wei Tham

    2015-01-01

    Traditional treatment of T2DM consisting of modification of diet,an exercise regimen,and pharmacotherapy has problems of poor lifestyle modifications and fail tend of treatment over time,now bariatric surgery is recommended for treatment of obese patients with T2DM because its great improvements on weight loss and metabolic.In this article,effects of bariatric surgery on diabetes and diabetes-related complications are reviewed.

  4. Bariatric surgery: studies on its consequences with emphasis on thrombotic and bleeding complications

    OpenAIRE

    Brandjes, D.P.M.; Gerdes, V.E.A.; Çelik, F.

    2014-01-01

    Obesity is a steadily growing problem that is associated with several diseases such as diabetes type 2, hypertension and dyslipidemia. For morbidly obese persons who have failed to achieve weight loss after several weight loss interventions, bariatric surgery is at this moment the only long-lasting, effective treatment. Bariatric surgery is not only an effective option to lose weight. It is also associated with significant improvement or remission of diabetes, cardiovascular risk factors and ...

  5. Equal ratio ventilation (1:1) improves arterial oxygenation during laparoscopic bariatric surgery: A crossover study

    OpenAIRE

    Wesam Farid Mousa

    2013-01-01

    Background: Hypoxaemia and high peak airway pressure (Ppeak) are common anesthetic problems during laparoscopic bariatric surgery. Several publications have reported the successful improvement in arterial oxygenation using positive end expiratory pressure and alveolar recruitment maneuver, however, high peak airway pressure during laparoscopic bariatric surgery may limit the use of both techniques. This study was designed to determine whether equal I:E (inspiratory-to-expiratory) ratio ventil...

  6. Dietary intake in the postoperative bariatric surgery at a university hospital in Rio de Janeiro

    OpenAIRE

    Louise Crovesy-de-Oliveira; Gigliane Cosendey-Menegati; Eliane Lopes-Rosado

    2014-01-01

    Introduction: bariatric surgery is a treatment for morbid obesity that besides result in high weight loss promotes improvements in laboratory tests and in the pressure reduction. However the surgery can cause bad effects as deficiency some nutrients. This fact become more important evaluates the adequacy of dietary intake of these patients. The objective this study was evaluates the adequacy dietetic of patients after bariatric surgery.Material and methods: we select forty women who underwent...

  7. Krukenberg tumor after gastric bypass for morbid obesity: Bariatric surgery and gastric cancer

    Directory of Open Access Journals (Sweden)

    Pablo Menéndez

    2013-06-01

    Full Text Available Gastric by-pass is one of the most performed surgical procedure in bariatric surgery. Neoplasm within gastric remnant is a slightly frequent complication (only six cases have been described but with important survival consequences. We present a case of a patient who developed an adenocarcinoma in excluded stomach, after three years of bariatric surgery; the tumor was incidentally discovered after a gynecological surgery for uterine myomas. Different diagnostic modalities for the excluded stomach were analyzed.

  8. KIDNEY STONE INCIDENCE AND METABOLIC URINARY CHANGES AFTER MODERN BARIATRIC SURGERY: REVIEW OF CLINICAL STUDIES, EXPERIMENTAL MODELS, AND PREVENTION STRATEGIES

    OpenAIRE

    Canales, Benjamin K.; Hatch, Marguerite

    2014-01-01

    Bariatric surgery has been associated with increased metabolic kidney stone risk and post-operative stone formation. A MEDLINE search, performed for articles published between January 2005 and November 2013, identified 24 pertinent studies containing 683 bariatric patients with 24-hour urine profiles, 6,777 bariatric patients with kidney stone incidence, and 7,089 non-stone forming controls. Of all procedures reviewed, only Roux-en-Y gastric bypass (RYGB) was linked to post-...

  9. Obesity and co-morbid psychiatric disorders as contraindications for bariatric surgery?—A case study

    OpenAIRE

    Peterhänsel, C; Wagner, B.; Dietrich, A; A. Kersting

    2014-01-01

    INTRODUCTION: Many patients undergoing bariatric surgery report current or past psychiatric disorders and controversy exists regarding their outcome after bariatric surgery. PRESENTATION OF CASE: We present a case of an obese patient with a borderline personality disorder, a recurrent depressive disorder, post-traumatic stress symptoms and binge eating episodes who underwent bariatric surgery. DISCUSSION: Although the psychiatric disorders remained, the procedure contributed to an impro...

  10. The Effect of Bariatric Surgery on Diabetic Retinopathy: Good, Bad, or Both?

    Science.gov (United States)

    Gorman, Dora M.; le Roux, Carel W.

    2016-01-01

    Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes. This review aims to collate the recent data on retinal outcomes after bariatric surgery. This comprehensive evaluation revealed that the majority of DR cases remain stable after surgery. However, risk of progression of pre-existing DR and the development of new DR is not eliminated by surgery. Instances of regression of DR are also noted. Potential risk factors for deterioration include severity of DR at the time of surgery and the magnitude of glycated hemoglobin reduction. Concerns also exist over the detrimental effects of postprandial hypoglycemia after surgery. In vivo studies evaluating the chronology of DR development and the impact of bariatric surgery could provide clarity on the situation. For now, however, the effect of bariatric surgery on DR remains inconclusive.

  11. Bariatric surgery and nonalcoholic fatty liver disease: current and potential future treatments

    Directory of Open Access Journals (Sweden)

    Akira eSasaki

    2014-10-01

    Full Text Available Nonalcoholic fatty liver disease (NAFLD and nonalcoholic steatohepatitis (NASH are increasingly common cause of chronic liver disease worldwide. The diagnosis of NASH is challenging as most affected patients are symptom-free and the role of routine screening is not clearly established. Most patients with severe obesity who undergo bariatric surgery have NAFLD, which is associated insulin resistance, type 2 diabetes mellitus (T2DM, hypertension, and obesity-related dyslipidemia. The effective treatment for NAFLD is weight reduction through lifestyle modifications, antiobesity medication, or bariatric surgery. Among these treatments, bariatric surgery is the most reliable method for achieving substantial, sustained weight loss. This procedure is safe when performed by a skilled surgeon, and the benefits include reduced weight, improved quality of life, decreased obesity-related comorbidities, and increased life expectancy. Further research is urgently needed to determine the best use of bariatric surgery with NAFLD patients at high risk of developing liver cirrhosis and its role in modulating complications of NAFLD, such as T2DM and cardiovascular disease. The current evidence suggests that bariatric surgery for patients with severe obesity decreases the grade of steatosis, hepatic inflammation, and fibrosis. However, further long-term studies are required to confirm the true effects before recommending bariatric surgery as a potential treatment for nonalcoholic steatohepatitis.

  12. CO - RELATION OF SIX MINUTE WALK TEST WITH PULMONARY FUNCTION TESTS IN OBESE INDIVIDUALS ADMITTED FOR BARIATRIC SURGERY

    Directory of Open Access Journals (Sweden)

    Monti Kumar

    2015-05-01

    Full Text Available AIMS AND OBJECTIVES : To evaluate Pulmonary Function Tests and 6MWT in obese individuals and to correlate 6MWT with FEV1 and MMEF 75 - 25 and establish the individual significance in evaluating bariatric subjects. MATERIAL AND METHOD: Prospective observational study carried out on 50 obese patients r eferred to PFT Lab for pre - operative investigations (admitted for planned Bariatric Surgery after the informed consent in Department of Respiratory Medicine, Sri Aurobindo Medical College and Post Graduate Institute, Indore (MP. Biometric data (age, sex, height and weight, Pulmonary Function Tests (PFT and Six minute walk test (6MWT data was collected. Exclusion criteria for study is those who were not willing, unable to perform PFT/6MWT acceptably, recent cardiac event, patients with osteoarthritis or neuromuscular disorder and patients with known pre - existing respiratory illness. STATISTICAL ANALYSIS : Statistical analysis was performed using Graphpad Quick Calcs: t test calculator software. The data were reported as mean ± standard deviation (SD. The absolute (6MWD in meters was used. The correlation between 6MWD and the patient’s pulmonary function test were evaluated by applying unpaired ‘t’ test. 6MWT shows extremely significant correlation with FEV1and MMEF 75 - 25 . RESULT: There is high correlatio n between 6MWT and PFT in obese individuals. All the patients above normal BMI have ventilatory defect which may be due to restriction imposed by abdominal wall and chemical mediators released by adipocytes. Predicted values are calculated by Udwadia Index . CONCLUSION : 6MWT is a good prognostic tool to study ventilatory mechanism in obese individuals.

  13. Remission of Ulcerated Necrobiosis Lipoidica Diabeticorum after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Suleyman Bozkurt

    2013-01-01

    Full Text Available A 32-year-old woman with type 2 diabetes mellitus suffering from morbid obesity with BMI 45,14 kg/m2 was operated on. Not only the type 2DM but also one of its complication known as necrobiosis lipoidica diabeticorum remitted postoperatively. Obesity should no longer be regarded simply as a cosmetic problem affecting certain individuals but an epidemic that threatens global well-being. It causes or exacerbates many health problems, and in particular, it is associated with the type 2 diabetes. Necrobiosis lipoidica is a granulomatous skin disease of unknown etiology, associated mainly with diabetes mellitus. We presented in this paper a morbid obese case of necrobiosis lipoidica diabeticorum with dramatic good response to bariatric surgery.

  14. Nutritional Optic Neuropathy Caused by Copper Deficiency After Bariatric Surgery.

    Science.gov (United States)

    Rapoport, Yuna; Lavin, Patrick J M

    2016-06-01

    A 47-year-old woman developed severe bilateral visual loss 4 years after a Roux-en-Y gastric bypass and 24 years after vertical banded gastroplasty. Her serum copper level was 35 μg/dL (normal, 80-155 μg/dL). She was prescribed elemental copper tablets. Because her methylmalonic acid was slightly elevated, she received vitamin B12 injections as well. Five weeks later, she reported that her vision had improved and, at 10 months, her vision had recovered from 20/400 bilaterally to 20/25 in each eye. This case highlights the importance of checking copper levels in addition to the "more routine" vitamin levels, such as B1, B6, B12, E, and serum folate in patients with suspected nutritional optic neuropathy after bariatric surgery, particularly if it involved a bypass procedure. PMID:26828841

  15. Tissue-Specific Effects of Bariatric Surgery Including Mitochondrial Function

    Directory of Open Access Journals (Sweden)

    Simon N. Dankel

    2011-01-01

    Full Text Available A better understanding of the molecular links between obesity and disease is potentially of great benefit for society. In this paper we discuss proposed mechanisms whereby bariatric surgery improves metabolic health, including acute effects on glucose metabolism and long-term effects on metabolic tissues (adipose tissue, skeletal muscle, and liver and mitochondrial function. More short-term randomized controlled trials should be performed that include simultaneous measurement of metabolic parameters in different tissues, such as tissue gene expression, protein profile, and lipid content. By directly comparing different surgical procedures using a wider array of metabolic parameters, one may further unravel the mechanisms of aberrant metabolic regulation in obesity and related disorders.

  16. Lithium toxicity after Roux-en-Y bariatric surgery.

    Science.gov (United States)

    Musfeldt, Deanna; Levinson, Andrew; Nykiel, Jennifer; Carino, Gerardo

    2016-01-01

    A 61-year-old woman with medical history significant for morbid obesity, type II diabetes mellitus, nephrogenic diabetes insipidus and bipolar disorder, had been stable on lithium carbonate therapy for several years. She had undergone a Roux-en-Y bypass surgery and, at the time of her surgery, her lithium level was found to be 0.61 mEq/L on a maintenance dose of 600 mg orally twice per day. She was discharged 8 days postoperatively on the same lithium dose, but presented to the emergency department 12 days postoperatively with signs of lithium toxicity. Her lithium level was elevated to 1.51 mEq/L and she was treated for lithium toxicity with supportive care and, ultimately, reduction of her lithium dose. Clinicians should be aware that dramatic and poorly understood changes in drug absorption may occur after bariatric surgery. PMID:26994048

  17. Wishing for deburdening through a sustainable control after bariatric surgery

    Directory of Open Access Journals (Sweden)

    My Engström

    2011-02-01

    Full Text Available The aim of this study was an in-depth investigation of the change process experienced by patients undergoing bariatric surgery. A prospective interview study was performed prior to as well as 1 and 2 years after surgery. Data analyses of the transcribed interviews were performed by means of the Grounded Theory method. A core category was identified: Wishing for deburdening through a sustainable control over eating and weight, comprising three related categories: hoping for deburdening and control through surgery, feeling deburdened and practising control through physical restriction, and feeling deburdened and trying to maintain control by own willpower. Before surgery, the participants experienced little or no control in relation to food and eating and hoped that the bariatric procedure would be the first brick in the building of a foundation that would lead to control in this area. The control thus achieved in turn affected the participants’ relationship to themselves, their roles in society, and the family as well as to health care. One year after surgery they reported established routines regarding eating as well as higher self-esteem due to weight loss. In family and society they set limits and in relation to health care staff they felt their concern and reported satisfaction with the surgery. After 2 years, fear of weight gain resurfaced and their self-image was modified to be more realistic. They were no longer totally self-confident about their condition, but realised that maintaining control was a matter of struggle to obtaining a foundation of sustainable control. Between 1 and 2 years after surgery, the physical control mechanism over eating habits started to more or less fade for all participants. An implication is that when this occurs, health care professionals need to provide interventions that help to maintain the weight loss in order to achieve a good long-term outcome.

  18. IMPACT OF DEFICIENT NUTRITION IN BONE MASS AFTER BARIATRIC SURGERY

    Science.gov (United States)

    COSTA, Tatiana Munhoz da Rocha Lemos; PAGANOTO, Mariana; RADOMINSKI, Rosana Bento; BORBA, Victoria Zeghbi Cochenski

    2016-01-01

    Background: Essential nutrients are considered for the prevention of the bone loss that occurs after bariatric surgery. Aim: Evaluate nutrients involved in bone metabolism, and relate to serum concentrations of calcium, vitamin D, and parathyroid hormone, and the use of supplements and sun exposure on the bone mass of patients who had undergone gastric bypass surgery. Methods: An observational study, with patients who had undergone the surgery 12 or more months previously, operated group (OG), compared to a control group (CG). Results: Were included 56 in OG and 27 in the CG. The mean age was 36.4±8.5 years. The individuals in the OG, compared to CG, consumed inadequate amounts of protein and daily calcium. The OG had a higher prevalence of low sun exposure, lower levels of 25OH Vitamin D (21.3±10.9 vs. 32.1±11.8 ng/dl), and increased serum levels of parathyroid hormone (68.1±32.9 vs. 39.9±11.9 pg/ml, p<0.001). Secondary hyperparathyroidism was present only in the OG (41.7%). The mean lumbar spine bone mineral density was lower in the OG. Four individuals from the OG had low bone mineral density for chronological age, and no one from the CG. Conclusion: The dietary components that affect bone mass in patients undergoing bariatric surgery were inadequate. The supplementation was insufficient and the sun exposure was low. These changes were accompanied by secondary hyperparathyroidism and a high prevalence of low bone mass in lumbar spine in these subjects. PMID:27120738

  19. Binge Eating Disorder and Medical Comorbidities in Bariatric Surgery Candidates

    Science.gov (United States)

    Mitchell, James E.; King, Wendy C.; Pories, Walter; Wolfe, Bruce; Flum, David R.; Spaniolas, Konstatinos; Bessler, Mark; Devlin, Michael; Marcus, Marsha D.; Kalarchian, Melissa; Engel, Scott; Khandelwal, Saurobh; Yanovski, Susan

    2016-01-01

    Objective To determine whether binge eating disorder (BED) status is associated with medical comorbidities in obese adults scheduled for bariatric surgery. Method The study utilized Longitudinal Assessment of Bariatric Surgery-2 data obtained from 6 clinical centers around the United States. This is a well-phenotyped cohort of individuals who were evaluated within 30 days prior to their scheduled surgery using standardized protocols. In the cohort, 350 participants were classified as having BED and 1875 as not having BED (non-BED). Multivariable logistic regression was used to determine whether BED status was independently related to medical comorbidities. As an exploratory analysis, significance was based on nominal P-values (p<.05). Holm-adjusted P-values were also reported. Results After adjusting for age, sex, education and body mass index, BED status was independently associated with 4 of 15 comorbidities (i.e., impaired glucose levels (odds ratio [OR]=1.45 (95%CI: 1.12–1.87), high triglycerides (OR=1.28 (95%CI: 1.002–1.63) and urinary incontinence (OR=1.30 (95%CI: 1.02,1.66) all being more common among the BED sample, and severe walking limitations being less common in the BED sample (OR=0.53 (95%CI: 0.29–0.96)). With further adjustment for psychiatric/emotional health indicators, BED status was independently associated with 3 comorbidities (impaired glucose levels (OR=1.36 (95%CI: 1.04–1.79), cardiovascular disease (OR=0.50 (95%CI: 0.30–0.86) and severe walking limitations (OR=0.38 (95%CI: 0.19–0.77)). However, Holm’s adjusted P-values for all variables were greater than .05. Discussion The results suggest the possibility of a contribution of BED to risk of specific medical comorbidities in severely obese adults. PMID:25778499

  20. Use of alcohol before and after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ana Carolina Ribeiro de Amorim

    2015-02-01

    Full Text Available OBJECTIVE: to assess alcohol intake in the bariatric surgery pre and postoperative periods. METHODS: Patients were interviewed atSurgery Clinic of the Hospital das Clínicas da Universidade Federal de Pernambuco - HC/UFPE (Brazil from July 2011 to March 2012. We analyzed socioeconomic, anthropometric and clinical variables. We used the Alcohol Use Disorders Identification Test (AUDIT C. RESULTS: One hundred nineteen patients were enrolled (mean age: 41.23+11.30 years, with a predominance of the female gender (83.2%, non-Caucasian race (55%, married individuals or in a stable union (65.5%, with a high school education (40.3%and active in the job market (37%. Weight and body mass index (BMI were 128.77+25.28Kg and 49.09+9.26Kg/m2,respectively in the preoperative period (class II obesity and 87.19+19.16Kg and 33.04+6.21Kg/m2, respectively in the postoperative period (class I obesity (p<0.001. Hypertension was the most frequent disease in the pre (66.6% and postoperative (36.5% periods. The prevalence of alcohol use was 26.6% in the preoperative period, of which 2.2% of high risk, and 35.1% in the postoperative period, of which 1.4% of probable dependence; this difference did not achieve statistical significance (p=0.337. CONCLUSION: The prevalence of abusive alcohol intake and/or probable dependence was low in both the pre and postoperative periods, with little evidence of risky consumption among the patients submitted to bariatric surgery.

  1. INSTANT REMEDY OR TOTAL SALVATION? MERITS AND DEMERITS OF BARIATRIC SURGERY

    Directory of Open Access Journals (Sweden)

    Randhawa

    2014-12-01

    Full Text Available Bariatric surgery as it is called now is not a new thing. First bariatric surgery was performed in 1954. Later the surgical remedy for bariatric surgery remained dormant till the popularity of laparoscopic surgery. Past decade has seen a tremendous increase in the number of bariatric or metabolic surgical procedures. This trend may continue because of the epidemic of obesity throughout globe and its rising prevalence among children. Advocates of bariatric surgery consider it the most effective and only treatment for morbid obesity and its co morbidities. To simplify; two types of procedures are performed. 1. Restrictive- where the intake of calories are prevented by restricting food intake. 2. The other one is malabsorptive- where food rich in calories is prevented to get absorbed. Operations based on these principles are-Laparoscopic adjustable gastric band and Vertical sleeve resection of stomach; for restrictive surgery and Laparoscopic biliopancreatic diversion with or without duodenal switch; for malabsorptive procedures. Both types have their own merits and demerits, many of which are almost unacceptable. To counter each other’s’ demerits certain combinations of both types are evolved like Roux-en-Y gastric bypass; it combines both restrictive and malabsorptive components. Each operation has its own merits and demerits. Important points for the patient and surgeon alike in the decision to proceed with bariatric operation include – the technical aspects of operation, post-operative complications including long term nutritional problems, Magnitude of initial and later steady weight loss over the period and correction of obesity related comorbidities. Here, the merits and demerits of present day laparoscopic bariatric surgical procedures are reviewed and related controversial aspects related to them are discussed. Right patient selection; right selection of operative procedure for an individual patient and more importantly right

  2. Country of origin and bariatric surgery in Sweden during 2001–2010

    Science.gov (United States)

    Memarian, Ensieh; Sundquist, Kristina; Calling, Susanna; Sundquist, Jan; Li, Xinjun

    2016-01-01

    Background The prevalence of obesity, as well as use of bariatric surgery, has increased worldwide. The aim of the present study was to investigate the potential differences in the use of bariatric surgery among Swedes and immigrants in Sweden and whether the hypothesized differences remain after adjustment for socioeconomic factors. Methods A closed cohort of all individuals aged 20–64 years was followed during 2001–2010. Further analyses were performed in 2 periods separately (2001–2005 and 2006–2010). Age-standardized cumulative incidence rates (CR) of bariatric surgery were compared between Swedes and immigrants considering individual variables. Cox proportional hazards models were used in univariate and multivariate models for males and females. Results A total of 12,791 Swedes and 2060 immigrants underwent bariatric surgery. The lowest rates of bariatric surgery were found in immigrant men. The largest difference in CR between Swedes and immigrants was observed among low-income individuals (3.4 and 2.3 per 1000 individuals, respectively). Adjusted hazard ratios (HRs) were lower for all immigrants compared with Swedes in the second period. The highest HRs were observed among immigrants from Chile and Lebanon and the lowest among immigrants from Bosnia. Except for Nordic countries, immigrants from all other European countries had a lower HR compared with Swedes. Conclusions Men in general and some immigrant groups had a lower HR of bariatric surgery. Moreover, the difference between Swedes and immigrants was more pronounced in individuals with low socioeconomic status (income). It is unclear if underlying barriers to receive bariatric surgery are due to patients’ preferences/lack of knowledge or healthcare structures. Future studies are needed to examine potential causes behind these differences. PMID:25979207

  3. Psychologists' Evaluation of Bariatric Surgery Candidates Influenced by Patients' Attachment Representations and Symptoms of Depression and Anxiety

    NARCIS (Netherlands)

    Aarts, Floor; Hinnen, Chris; Gerdes, Victor E. A.; Acherman, Yair; Brandjes, Dees P. M.

    2014-01-01

    This study examines whether patients self-reported attachment representations and levels of depression and anxiety influenced psychologists' evaluations of morbidly obese patients applying for bariatric surgery. A sample of 250 patients (mean age 44, 84 % female) who were referred for bariatric surg

  4. A review of psychological assessment instruments for use in bariatric surgery evaluations.

    Science.gov (United States)

    Marek, Ryan J; Heinberg, Leslie J; Lavery, Megan; Merrell Rish, Julie; Ashton, Kathleen

    2016-09-01

    Bariatric surgery is a viable treatment option for patients with extreme obesity and associated medical comorbidities; however, optimal surgical outcomes are not universal. Surgical societies, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), recommend that patients undergo a presurgical psychological evaluation that includes reviewing patients' medical charts, conducting a comprehensive clinical interview, and employing some form of objective psychometric testing. Despite numerous societies recommending the inclusion of self-report assessments, only about 2/3 of clinics actively use psychological testing-some of which have limited empirical support to justify their use. This review aims to critically evaluate the psychometric properties of self-report measures when used in bariatric surgery settings and provide recommendations to help guide clinicians in selecting instruments to use in bariatric surgery evaluations. Recommended assessment batteries include use of a broadband instrument along with a narrowband eating measure. Suggestions for self-report measures to include in a presurgical psychological evaluation in bariatric surgery settings are also provided. (PsycINFO Database Record PMID:27537008

  5. Micronutrient levels and supplement intake in pregnancy after bariatric surgery: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Roland Devlieger

    Full Text Available Studies report frequent micronutrient deficiencies after bariatric surgery, but less is known about micronutrient levels of pregnant women after bariatric surgery.To prospectively evaluate micronutrient levels and supplement intake in pregnancy following bariatric surgery.A multicenter prospective cohort study including women with restrictive or malabsorptive types of bariatric surgery. Nutritional deficiencies, together with supplement intake, were screened during pregnancy.The total population included 18 women in the restrictive and 31 in the malabsorptive group. Most micronutrients were depleted and declined significantly during pregnancy. The proportion of women with low vitamin A and B-1 levels increased to respectively 58 and 17% at delivery (P = 0.005 and 0.002. The proportion of women with vitamin D deficiency decreased from 14% at trimester 1 to 6% at delivery (P = 0.030. Mild anemia was found in respectively 22 and 40% of the women at trimester 1 and delivery. In the first trimester, most women took a multivitamin (57.1%. In the second and third trimester, the majority took additional supplements (69.4 and 73.5%. No associations were found between supplement intake and micronutrient deficiencies.Pregnant women with bariatric surgery show frequent low micronutrient levels. Supplementation partially normalizes low levels of micronutrients.

  6. The Anatomy of a Weight Recidivism and Revision Bariatric Surgical Clinic

    Directory of Open Access Journals (Sweden)

    C. J. de Gara

    2014-01-01

    Full Text Available Abstract. Weight recidivism in bariatric surgery failure is multifactorial. It ranges from inappropriate patient selection for primary surgery to technical/anatomic issues related to the original surgery. Most bariatric surgeons and centers focus on primary bariatric surgery while weight recidivism and its complications are very much secondary concerns. Methods. We report on our initial experience having established a dedicated weight recidivism and revisional bariatric surgery clinic. A single surgeon, dedicated nursing, dieticians, and psychologist developed care maps, goals of care, nonsurgical candidate rules, and discharge planning strategies. Results. A single year audit (2012 of clinical activity revealed 137 patients, with a mean age 49 ± 10.1 years (6 years older on average than in our primary clinic, 75% of whom were women with BMI 47 ± 11.5. Over three quarters had undergone a vertical band gastroplasty while 15% had had a laparoscopic adjustable gastric band. Only 27% of those attending clinic required further surgery. As for primary surgery, the role of the obesity expert clinical psychologist was a key component to achieving successful revision outcomes. Conclusion. With an exponential rise in obesity and a concomitant major increase in bariatric surgery, an inevitable increase in revisional surgery is becoming a reality. Anticipating this increase in activity, Alberta Health Services, Alberta, Canada, has established a unique and dedicated clinic whose early results are promising.

  7. Psychological and health comorbidities before and after bariatric surgery: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Susana Sofia Pereira da Silva

    2013-12-01

    Full Text Available INTRODUCTION: Morbid obesity has multiple implications for psychological and physical health. Bariatric surgery has been selected as the treatment of choice for this chronic disease, despite the controversial impact of the surgery on psychosocial health. The objective of this study was to describe candidates for bariatric surgery and analyze changes in weight, psychopathology, personality, and health problems and complaints at 6- and 12- month follow-up assessments. METHODS: Thirty obese patients (20 women and 10 men with a mean age of 39.17±8.81 years were evaluated in different dimensions before surgery and 6 and 12 months after the procedure. RESULTS: Six and 12 months after bariatric surgery, patients reported significant weight loss and a significant reduction in the number of health problems and complaints. The rates of self-reported psychopathology were low before surgery, and there were no statistically significant changes over time. The conscientiousness, extraversion, and agreeableness dimensions increased, but neuroticism and openness remained unchanged. All changes had a medium effect size. CONCLUSIONS: Our results suggest that patients experience significant health improvements and some positive personality changes after bariatric surgery. Even though these findings underscore the role of bariatric surgery as a relevant treatment for morbid obesity, more in-depth longitudinal studies are needed to elucidate the evolution of patients after the procedure.

  8. Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity.

    Science.gov (United States)

    Wharton, S; Serodio, K J; Kuk, J L; Sivapalan, N; Craik, A; Aarts, M-A

    2016-04-01

    The objective of the study was to assess the interest, views and patient-perceived barriers to bariatric surgery among surgery-eligible patients. Surveys were completed at a weight management clinic and local hospital in Ontario, Canada. Patients were ≥18 years of age with a body mass index (BMI) >40 kg m(-2) or BMI > 35 kg m(-2) with ≥1 comorbidity. The sample included 105 participants, 73.3% female, with a mean BMI of 46.6 ± 7.1 kg m(-2) . Only 33.3% of participants were interested in surgery; 50.5% of participants were not interested and 16.2% had mixed feelings. Participants identified risks (69.5%) and side effects (57.1%) as significant surgical barriers. Interested participants were more likely to perceive themselves as obese, were unhappy with their current weight loss method and were less likely to fear surgery (P bariatric surgery, the majority of qualified patients are not interested in surgery mainly due to the perceived risk of surgery in general and satisfaction with current non-surgical weight loss efforts. The self-perception of obesity, as opposed to medical comorbidities, may be a stronger driver of the decision to have bariatric surgery. It is unclear if patients are aware of the effectiveness of bariatric surgery to help improve comorbidities or if bariatric surgery is perceived as being more cosmetic in nature.

  9. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report

    Directory of Open Access Journals (Sweden)

    Patel Pranav H

    2012-03-01

    Full Text Available Abstract Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.

  10. Quality of Life, Body Image and Sexual Functioning in Bariatric Surgery Patients.

    Science.gov (United States)

    Sarwer, David B; Steffen, Kristine J

    2015-11-01

    This article provides an overview of the literature on quality of life, body image and sexual behaviour in individuals with extreme obesity and who undergo bariatric surgery. Quality of life is a psychosocial construct that includes multiple domains, including health-related quality of life, weight-related quality of life, as well as other psychological constructs such as body image and sexual functioning. A large literature has documented the impairments in quality of life and these other domains in persons with obesity and extreme obesity in particular. These impairments are believed to play an influential role in the decision to undergo bariatric surgery. Individuals who undergo bariatric surgery typically report significant improvements in these and other areas of psychosocial functioning, often before they reach their maximum weight loss. The durability of these changes as patients maintain or regain weight, however, is largely unknown. PMID:26608946

  11. Bariatric surgery in type 1 diabetes mellitus: long-term experience in two cases

    Directory of Open Access Journals (Sweden)

    Nuria Fuertes-Zamorano

    2013-08-01

    Full Text Available In patients with obesity and type 2 diabetes, recommendations for bariatric surgery are well established. However, no consensus exists regarding its role for the management of patients with type 1 diabetes and morbid obesity. We present the long-term follow-up of two women with type 1 diabetes, morbid obesity and associated comorbidities, who underwent malabsorptive bariatric surgery. More than four years after the procedure, both have a body mass index (BMI within the normal range and HbA1c levels below 7%. Also, they have been able to reduce their insulin requirements in more than 50%, their associated comorbidities have disappeared, and their overall quality of life has significantly improved. We compare our results with other recently published ones, emphasizing potential indications of bariatric surgery for patients with type 1 diabetes.

  12. The effects of bariatric surgeries on type 2 diabetes mellitus

    Science.gov (United States)

    Lerd Ng, Jia; Ortiz, Roberto; Hughes, Tyler; Abou Ghantous, Michel; Bouhali, Othmane; Arredouani, Abdelilah; Allen, Roland

    2012-10-01

    We consider a scientific mystery which is of central importance in treating the most rapidly emerging national and global health threat: type 2 diabetes mellitus. The mystery involves a surprising effect of certain bariatric surgeries, and specifically Roux-en-Y gastric bypass (RYGB), a procedure which bypasses most of the stomach and upper intestine. An unanticipated result is that RYGB is usually found to contribute within only a few days to glucose homeostasis. This means the surgery can immediately cure patients even before they start losing weight. We are investigating this wondrous biochemical response with a quantitative model which includes the most important mechanisms. One of the major contributors is glucagon-like peptide 1 (GLP-1), an incretin whose concentration is found to increase by a large amount right after the RYGB surgical procedure. However, our results, in conjunction with the experimental and medical data, indicate that other substances must also contribute. If these substances can be definitively identified, it may be possible to replace the surgery with pharmaceuticals as the preferred treatment for type 2 diabetes.

  13. Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Martin Fried

    2013-10-01

    Full Text Available In 2012, an outstanding expert panel derived from IFSO-EC (International Federation for the Surgery of Obesity - European Chapter and EASO (European Association for the Study of Obesity, composed by key representatives of both Societies including past and present presidents together with EASO's OMTF (Obesity Management Task Force chair, agreed to devote the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery as a pre-satellite of the 2013 European Congress on Obesity (ECO to be held in Liverpool given the extraordinarily advancement made specifically in this field during the past years. It was further agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced in cooperation of both Societies by focusing in particular on the evidence gathered in relation to the effects on diabetes during this lustrum and the subsequent changes that have taken place in patient eligibility criteria. The expert panel composition allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.

  14. Endoscopic management of bariatric complications: Areview and update

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    With over a third of Americans being considered obese,bariatric procedures have now become the mostperformed operation be general surgeons in theUnited States. The most common operations are theLaparoscopic Roux-en-Y Gastric Bypass, the LaparoscopicSleeve Gastrectomy, and the LaparoscopicAdjustable Gastric Band. With over 340000 bariatricprocedures preformed worldwide in 2011, the absolutenumber of complications related to these operationsis also increasing. Complications, although few, canbe life threatening. One of the most dreaded acutecomplication is the anastomotic/staple line leak. If leftundiagnosed or untreated they can lead to sepsis, multiorgan failure, and death. Smaller or contained leaks candevelop into fistulas. Although most patients with anacute anastomotic leak return to the operating room,there has been a trend to manage the stable patientwith an endoscopic stent. They offer an advantageby creating a barrier between enteric content and theleak, and will allow the patients to resume enteralfeeding much earlier. Fistulas are a complex andchronic complication with high morbidity and mortality.Postoperative bleeding although rare may also betreated locally with endoscopy. Stenosis is a morefrequent late complication and is best-managed withendoscopic therapy. Stents may not heal every fistula orstenosis, however they may prevent certain patients theneed for additional revisional surgery.

  15. FROM COMPLEX EVOLVING TO SIMPLE: CURRENT REVISIONAL AND ENDOSCOPIC PROCEDURES FOLLOWING BARIATRIC SURGERY

    Science.gov (United States)

    ZORRON, Ricardo; GALVÃO-NETO, Manoel Passos; CAMPOS, Josemberg; BRANCO, Alcides José; SAMPAIO, José; JUNGHANS, Tido; BOTHE, Claudia; BENZING, Christian; KRENZIEN, Felix

    2016-01-01

    ABSTRACT Background: Roux-en-Y gastric bypass (RYGB) is a standard therapy in bariatric surgery. Sleeve gastrectomy and gastric banding, although with good results in the literature, are showing higher rates of treatment failure to reduce obesity-associated morbidity and body weight. Other problems after bariatric may occur, as band erosion, gastroesophageal reflux disease and might be refractory to medication. Therefore, a laparoscopic conversion to a RYGB can be an effective alternative, as long as specific indications for revision are fulfilled. Objective: The objective of this study was to analyse own and literature data on revisional bariatric procedures to evaluate best alternatives to current practice. Methods: Institutional experience and systematic review from the literature on revisional bariatric surgery. Results: Endoscopic procedures are recently applied to ameliorate failure and complications of bariatric procedures. Therapy failure following RYGB occurs in up to 20%. Transoral outlet reduction is currently an alternative method to reduce the gastrojejunal anastomosis. The diameter and volume of sleeve gastrectomy can enlarge as well, which can be reduced by endoscopic full-thickness sutures longitudinally. Dumping syndrome and severe hypoglycemic episodes (neuroglycopenia) can be present in patients following RYGB. The hypoglycemic episodes have to be evaluated and usually can be treated conventionally. To avoid partial pancreatectomy or conversion to normal anatomy, a new laparoscopic approach with remnant gastric resection and jejunal interposition can be applied in non-responders alternatively. Hypoglycemic episodes are ameliorated while weight loss is sustained. Conclusion: Revisional and endoscopic procedures following bariatric surgery in patients with collateral symptomatic or treatment failure can be applied. Conventional non-surgical approaches should have been applied intensively before a revisional surgery will be indicated. Former complex

  16. The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol

    Directory of Open Access Journals (Sweden)

    Hollywood Amelia

    2012-04-01

    Full Text Available Abstract Background Bariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 (or 35 with co morbidities. A minority of patients, however, either do not show the desired loss of excess weight or show weight regain by follow up. Research highlights some of the reasons for this variability, most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body, psychological issues relating to dietary control, self esteem, coping and emotional eating remain neglected. The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service (BRS on patient health outcomes. The bariatric rehabilitation service will provide information, support and mentoring pre and post surgery and will address psychological issues such as dietary control, self esteem, coping and emotional eating. The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes. Methods/Design The study is a randomised control trial and patients will be allocated to receive either usual care or the bariatric rehabilitation service pre and post bariatric surgery. Follow up measures of weight loss and psychological issues will be taken at baseline (2 weeks preoperatively, 3, 6 and 12 months postoperatively. The contents of the bariatric service and the follow up measures are based on previous pilot work and have been developed further by the research team working closely with two patient support groups (BOSPA & WLSinfo. This study will take place in St Richard's Hospital in Chichester in the UK. Discussion It is predicted that a bariatric rehabilitation service will improve weight loss following surgery and will also facilitate changes in other psychological variables such as quality of life, dietary control, self esteem, coping and

  17. Could the mechanisms of bariatric surgery hold the key for novel therapies?

    DEFF Research Database (Denmark)

    Tam, C S; Berthoud, H-R; Bueter, M;

    2011-01-01

    Bariatric surgery is the most effective method for promoting dramatic and durable weight loss in morbidly obese subjects. Furthermore, type 2 diabetes is resolved in over 80% of patients. The mechanisms behind the amelioration in metabolic abnormalities are largely unknown but may be due to changes...... in energy metabolism, gut peptides and food preference. The goal of this meeting was to review the latest research to better understand the mechanisms behind the 'magic' of bariatric surgery. Replication of these effects in a non-surgical manner remains one of the ultimate challenges for the treatment...

  18. Dissociated incretin response to oral glucose at 1 year after restrictive vs. malabsorptive bariatric surgery

    DEFF Research Database (Denmark)

    Guldstrand, M; Ahrén, B; Näslund, E;

    2009-01-01

    AIM: Compare the response to oral glucose of the two incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) at 1 year after restrictive vs. malabsorptive bariatric surgery. METHODS: Vertical banded gastroplasty (VBG, n = 7) or jejunoileal bypass...... = 0.007). CONCLUSIONS: We conclude that at 1 year after bariatric surgery, the two incretins show dissociated responses in that the GIP secretion is higher after VBG whereas GLP-1 secretion is higher after JIB. This dissociated incretin response is independent from reduction in body weight, glucose...

  19. Adolescent bariatric surgery program characteristics: the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study experience.

    Science.gov (United States)

    Michalsky, Marc P; Inge, Thomas H; Teich, Steven; Eneli, Ihuoma; Miller, Rosemary; Brandt, Mary L; Helmrath, Michael; Harmon, Carroll M; Zeller, Meg H; Jenkins, Todd M; Courcoulas, Anita; Buncher, Ralph C

    2014-02-01

    The number of adolescents undergoing weight loss surgery (WLS) has increased in response to the increasing prevalence of severe childhood obesity. Adolescents undergoing WLS require unique support, which may differ from adult programs. The aim of this study was to describe institutional and programmatic characteristics of centers participating in Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a prospective study investigating safety and efficacy of adolescent WLS. Data were obtained from the Teen-LABS database, and site survey completed by Teen-LABS investigators. The survey queried (1) institutional characteristics, (2) multidisciplinary team composition, (3) clinical program characteristics, and (4) clinical research infrastructure. All centers had extensive multidisciplinary involvement in the assessment, pre-operative education, and post-operative management of adolescents undergoing WLS. Eligibility criteria and pre-operative clinical and diagnostic evaluations were similar between programs. All programs have well-developed clinical research infrastructure, use adolescent-specific educational resources, and maintain specialty equipment, including high weight capacity diagnostic imaging equipment. The composition of clinical team and institutional resources is consistent with current clinical practice guidelines. These characteristics, coupled with dedicated research staff, have facilitated enrollment of 242 participants into Teen-LABS.

  20. Nuclear Medicine

    Science.gov (United States)

    ... Parents/Teachers Resource Links for Students Glossary Nuclear Medicine What is nuclear medicine? What are radioactive tracers? ... funded researchers advancing nuclear medicine? What is nuclear medicine? Nuclear medicine is a medical specialty that uses ...

  1. Answers to Clinical Questions in the Primary Care Management of People with Obesity: Bariatric Surgery.

    Science.gov (United States)

    Braverman-Panza, Jill; Horn, Deborah Bade

    2016-07-01

    The role of bariatric surgery in the management of patients with obesity is expanding owing to the amount of data that are accumulating; these data demonstrate significant short- and long-term health benefits, including control or remission of obesity-related complications, as well as acceptable long-term safety. PMID:27565108

  2. Effective Ventilation Strategies for Obese Patients Undergoing Bariatric Surgery: A Literature Review.

    Science.gov (United States)

    Hu, Xin Yan

    2016-02-01

    Obesity causes major alterations in pulmonary mechanics. Obese patients undergoing bariatric surgery present mechanical ventilation-related challenges that may lead to perioperative complications. Databases were systematically searched for clinical trials of ventilation maneuvers for obese patients and bariatric surgery. Thirteen randomized controlled trials were selected. The quality of the studies was evaluated with the Critical Appraisal Skills Programme tool, and a matrix was developed to present the essential components of the studies. Eight strategies of ventilation maneuvers were identified. Recruitment maneuvers followed by positive end-expiratory pressure (PEEP) consistently demonstrated effectiveness in obese patients undergoing bariatric surgery. Pressure-controlled ventilation and volume-controlled ventilation did not differ significantly in their efficacy. Noninvasive positive pressure ventilation (NIPPV) during induction was effective in preventing atelectasis and increasing the duration of safe apnea. Equal ratio ventilation can be a useful ventilation strategy. Recruitment maneuvers followed by PEEP are effective ventilation strategies for obese patients undergoing bariatric surgery. During induction, NIPPV provides further benefit. Future studies are needed to examine the postoperative effects of recruitment maneuvers with PEEP as well as the efficacy and safety of equal ratio ventilation. PMID:26939387

  3. Splitting, impulsivity, and intimate partnerships in young obese women seeking bariatric treatment

    Science.gov (United States)

    Zmolikova, Jana; Pichlerova, Dita; Bob, Petr; Schückova, Denisa; Herlesova, Jitka; Weiss, Petr

    2016-01-01

    Background Splitting represents a defense mechanism that describes fragmentation of conscious experience that may occur in various psychopathological conditions. The purpose of this study was to examine the relationship of splitting with disturbed cognitive and affective functions related to impulsivity and intimate partnerships in a group of obese patients indicated for bariatric treatment and compare the results with other obese patients and patients with bulimia nervosa. Methods In this clinical study, we assessed 102 young women. The sample was divided into three subgroups: obese women (N=30), obese women indicated for bariatric treatment (N=48), and patients with bulimia nervosa (N=24). The patients were assessed using Splitting Index and Barratt Impulsivity Scale, and selected information about their intimate partnership was documented for all the participants. Results The main results of this study indicate significant differences in the relationship of splitting and impulsivity with difficulties in intimate partnerships. These differences discriminate obese patients indicated for bariatric treatment from other obese patients and patients with bulimia nervosa. Conclusion These findings may have significant implications for treatment of the obese patients indicated for bariatric treatment and their presurgery psychological evaluations. PMID:27703353

  4. Bariatric surgery: studies on its consequences with emphasis on thrombotic and bleeding complications

    NARCIS (Netherlands)

    F. Çelik

    2014-01-01

    Obesity is a steadily growing problem that is associated with several diseases such as diabetes type 2, hypertension and dyslipidemia. For morbidly obese persons who have failed to achieve weight loss after several weight loss interventions, bariatric surgery is at this moment the only long-lasting,

  5. Guidelines for the follow-up of patients undergoing bariatric surgery.

    Science.gov (United States)

    O'Kane, Mary; Parretti, Helen M; Hughes, Carly A; Sharma, Manisha; Woodcock, Sean; Puplampu, Tamara; Blakemore, Alexandra I; Clare, Kenneth; MacMillan, Iris; Joyce, Jacqueline; Sethi, Su; Barth, Julian H

    2016-06-01

    Bariatric surgery can facilitate weight loss and improvement in medical comorbidities. It has a profound impact on nutrition, and patients need access to follow-up and aftercare. NICE CG189 Obesity emphasized the importance of a minimum of 2 years follow-up in the bariatric surgical service and recommended that following discharge from the surgical service, there should be annual monitoring as part of a shared care model of chronic disease management. NHS England Obesity Clinical Reference Group commissioned a multi-professional subgroup, which included patient representatives, to develop bariatric surgery follow-up guidelines. Terms of reference and scope were agreed upon. The group members took responsibility for different sections of the guidelines depending on their areas of expertise and experience. The quality of the evidence was rated and strength graded. Four different shared care models were proposed, taking into account the variation in access to bariatric surgical services and specialist teams across the country. The common features include annual review, ability for a GP to refer back to specialist centre, submission of follow-up data to the national data base to NBSR. Clinical commissioning groups need to ensure that a shared care model is implemented as patient safety and long-term follow-up are important. PMID:27166136

  6. Complications of bariatric surgery--What the general surgeon needs to know.

    Science.gov (United States)

    Healy, Paul; Clarke, Christopher; Reynolds, Ian; Arumugasamy, Mayilone; McNamara, Deborah

    2016-04-01

    Obesity is an important cause of physical and psychosocial morbidity and it places a significant burden on health system costs and resources. Worldwide an estimated 200 million people over 20 years are obese and in the U.K. the Department of Health report that 61.3% of people in the U.K. are either overweight or obese. Surgery for obesity (bariatric surgery) is being performed with increasing frequency in specialist centres both in the U.K. and Ireland and abroad due to the phenomenon of health tourism. Its role and success in treating medical conditions such as diabetes mellitus and hypertension in obese patients will likely lead to an even greater number of bariatric surgery procedures being performed. Patients with early postoperative complications may be managed in specialist centres but patients with later complications, occurring months or years after surgery, may present to local surgical units for assessment and management. This review will highlight the late complications of the 3 most commonly performed bariatric surgery procedures that the emergency general surgeon may encounter. It will also highlight the complications that require urgent intervention by the emergency general surgeon and those that can be safely referred to a bariatric surgeon for further management after initial assessment and investigations.

  7. A Qualitative Assessment of the My True Body Bariatric Surgery Preparation Program

    Science.gov (United States)

    Nakamura, Tracy; Mamary, Edward

    2013-01-01

    Background: The My True Body (MTB) group intervention incorporates cognitive restructuring and social support into bariatric surgery preparation. Purpose: To identify and describe program components that support long-term behavioral modifications and influence confidence in healthy weight maintenance. Methods: Semistructured telephone interviews…

  8. All-Cause and Cause-Specific Mortality Associated with Bariatric Surgery: A Review.

    Science.gov (United States)

    Adams, Ted D; Mehta, Tapan S; Davidson, Lance E; Hunt, Steven C

    2015-12-01

    The question of whether or not nonsurgical intentional or voluntary weight loss results in reduced mortality has been equivocal, with long-term mortality following weight loss being reported as increased, decreased, and not changed. In part, inconsistent results have been attributed to the uncertainty of whether the intentionality of weight loss is accurately reported in large population studies and also that achieving significant and sustained voluntary weight loss in large intervention trials is extremely difficult. Bariatric surgery has generally been free of these conflicts. Patients voluntarily undergo surgery and the resulting weight is typically significant and sustained. These elements, combined with possible non-weight loss-related mechanisms, have resulted in improved comorbidities, which likely contribute to a reduction in long-term mortality. This paper reviews the association between bariatric surgery and long-term mortality. From these studies, the general consensus is that bariatric surgical patients have: 1) significantly reduced long-term all-cause mortality when compared to severely obese non-bariatric surgical control groups; 2) greater mortality when compared to the general population, with the exception of one study; 3) reduced cardiovascular-, stroke-, and cancer-caused mortality when compared to severely obese non-operated controls; and 4) increased risk for externally caused death such as suicide.

  9. Factors Associated with Suicide Ideation in Severely Obese Bariatric Surgery-Seeking Individuals

    Science.gov (United States)

    Chen, Eunice Y.; Fettich, Karla C.; Tierney, Megan; Cummings, Hakeemah; Berona, Johnny; Weissman, Jessica; Ward, Amanda; Christensen, Kara; Southward, Matthew; Gordon, Kathryn H.; Mitchell, James; Coccaro, Emil

    2012-01-01

    There are high rates of suicide ideation and/or behavior in severely obese individuals. The potential contributors to suicide ideation in a sample of 334 severely obese bariatric surgery candidates was explored. Lack of college education, a history of suicide ideation and/or behavior, psychological distress, hopelessness, loneliness, history of…

  10. Competence assessment in minors, illustrated by the case of bariatric surgery for morbidly obese children

    NARCIS (Netherlands)

    Bolt, L.L.E.; Summeren van, M

    2014-01-01

    Clinicians have to assess children's competence frequently. In order to do justice to children who are competent to make decisions and to protect incompetent children, valid assessment is essential. We address this issue by using bariatric surgery for morbidly obese minors as a case study. Our previ

  11. Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery

    NARCIS (Netherlands)

    Zijlstra, H.; Middendorp, H. van; Devaere, L.; Larsen, J.K.; Ramshorst, B. van; Geenen, M.J.M.

    2012-01-01

    Emotional eating, the tendency to eat when experiencing negative affect, is prevalent in morbid obesity and may indicate that ways to deal with emotions are disturbed. Our aim was to compare emotion processing and regulation between 102 women with morbid obesity who apply for bariatric surgery and 1

  12. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  13. Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis.

    Science.gov (United States)

    Black, J A; White, B; Viner, R M; Simmons, R K

    2013-08-01

    The number of obese young people continues to rise, with a corresponding increase in extreme obesity and paediatric-adolescent bariatric surgery. We aimed to (i) systematically review the literature on bariatric surgery in children and adolescents; (ii) meta-analyse change in body mass index (BMI) 1-year post-surgery and (iii) report complications, co-morbidity resolution and health-related quality of life (HRQoL). A systematic literature search (1955-2013) was performed to examine adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass or biliopancreatic diversions operations among obese children and adolescents. Change in BMI a year after surgery was meta-analysed using a random effects model. In total, 637 patients from 23 studies were included in the meta-analysis. There were significant decreases in BMI at 1 year (average weighted mean BMI difference: -13.5 kg m(-2) ; 95% confidence interval [CI] -14.1 to -11.9). Complications were inconsistently reported. There was some evidence of co-morbidity resolution and improvements in HRQol post-surgery. Bariatric surgery leads to significant short-term weight loss in obese children and adolescents. However, the risks of complications are not well defined in the literature. Long-term, prospectively designed studies, with clear reporting of complications and co-morbidity resolution, alongside measures of HRQol, are needed to firmly establish the harms and benefits of bariatric surgery in children and adolescents.

  14. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study

    Science.gov (United States)

    Rousseau, Catherine; Jean, Sonia; Gamache, Philippe; Lebel, Stéfane; Mac-Way, Fabrice; Biertho, Laurent; Michou, Laëtitia

    2016-01-01

    Objective To investigate whether bariatric surgery increases the risk of fracture. Design Retrospective nested case-control study. Setting Patients who underwent bariatric surgery in the province of Quebec, Canada, between 2001 and 2014, selected using healthcare administrative databases. Participants 12 676 patients who underwent bariatric surgery, age and sex matched with 38 028 obese and 126 760 non-obese controls. Main outcome measures Incidence and sites of fracture in patients who had undergone bariatric surgery compared with obese and non-obese controls. Fracture risk was also compared before and after surgery (index date) within each group and by type of surgery from 2006 to 2014. Multivariate conditional Poisson regression models were adjusted for fracture history, number of comorbidities, sociomaterial deprivation, and area of residence. Results Before surgery, patients undergoing bariatric surgery (9169 (72.3%) women; mean age 42 (SD 11) years) were more likely to fracture (1326; 10.5%) than were obese (3065; 8.1%) or non-obese (8329; 6.6%) controls. A mean of 4.4 years after surgery, bariatric patients were more susceptible to fracture (514; 4.1%) than were obese (1013; 2.7%) and non-obese (3008; 2.4%) controls. Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (relative risk 1.38, 95% confidence interval 1.23 to 1.55) and non-obese (1.44, 1.29 to 1.59) groups. Before surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. After surgery, risk of distal lower limb fracture decreased (relative risk 0.66, 0.56 to 0.78), whereas risk of upper limb (1.64, 1.40 to 1.93), clinical spine (1.78, 1.08 to 2.93), pelvic, hip, or femur (2.52, 1.78 to 3.59) fractures increased. The increase in risk of fracture reached significance only for

  15. Weight loss by calorie restriction versus bariatric surgery differentially regulates the HPA axis in male rats

    Science.gov (United States)

    Grayson, Bernadette E.; Hakala-Finch, Andrew P.; Kekulawala, Melani; Laub, Holly; Egan, Ann E.; Ressler, Ilana B.; Woods, Stephen C.; Herman, James P.; Seeley, Randy J.; Benoit, Stephen C.; Ulrich-Lai, Yvonne M.

    2015-01-01

    Behavioral modifications for the treatment of obesity, including caloric restriction, have notoriously low long-term success rates relative to bariatric weight-loss surgery. The reasons for the difference in sustained weight loss are not clear. One possibility is that caloric restriction alone activates the stress-responsive hypothalamo-pituitary-adrenocortical (HPA) axis, undermining the long-term maintenance of weight loss, and that this is abrogated after bariatric surgery. Accordingly, we compared the HPA response to weight loss in 5 groups of male rats: (1) high-fat diet-induced obese (DIO) rats treated with Roux-en-Y gastric bypass surgery (RYGB, n=7), (2) DIO rats treated with vertical sleeve gastrectomy (VSG, n=11), (3) DIO rats given sham surgery and subsequently restricted to the food intake of the VSG/RYGB groups (Pair-fed, n=11), (4) ad libitum-fed DIO rats given sham surgery (Obese, n=11) and (5) ad libitum chow-fed rats given sham surgery (Lean, n=12). Compared to Lean controls, food-restricted rats exhibited elevated morning (nadir) non-stress plasma corticosterone concentrations and increased hypothalamic corticotropin releasing hormone and vasopressin mRNA expression, indicative of basal HPA activation. This was largely prevented when weight loss was achieved by bariatric surgery. DIO increased HPA activation by acute (novel environment) stress and this was diminished by bariatric surgery-, but not pair-feeding-, induced weight loss. These results suggest that the HPA axis is differentially affected by weight loss from caloric restriction versus bariatric surgery, and this may contribute to the differing long-term effectiveness of these two weight-loss approaches. PMID:25238021

  16. Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity.

    Science.gov (United States)

    Wharton, S; Serodio, K J; Kuk, J L; Sivapalan, N; Craik, A; Aarts, M-A

    2016-04-01

    The objective of the study was to assess the interest, views and patient-perceived barriers to bariatric surgery among surgery-eligible patients. Surveys were completed at a weight management clinic and local hospital in Ontario, Canada. Patients were ≥18 years of age with a body mass index (BMI) >40 kg m(-2) or BMI > 35 kg m(-2) with ≥1 comorbidity. The sample included 105 participants, 73.3% female, with a mean BMI of 46.6 ± 7.1 kg m(-2) . Only 33.3% of participants were interested in surgery; 50.5% of participants were not interested and 16.2% had mixed feelings. Participants identified risks (69.5%) and side effects (57.1%) as significant surgical barriers. Interested participants were more likely to perceive themselves as obese, were unhappy with their current weight loss method and were less likely to fear surgery (P effectiveness of bariatric surgery, the majority of qualified patients are not interested in surgery mainly due to the perceived risk of surgery in general and satisfaction with current non-surgical weight loss efforts. The self-perception of obesity, as opposed to medical comorbidities, may be a stronger driver of the decision to have bariatric surgery. It is unclear if patients are aware of the effectiveness of bariatric surgery to help improve comorbidities or if bariatric surgery is perceived as being more cosmetic in nature. PMID:26910303

  17. Reduced Survival in Bariatric Surgery Candidates Delayed or Denied by Lack of Insurance Approval.

    Science.gov (United States)

    Flanagan, Eleisha; Ghaderi, Iman; Overby, D Wayne; Farrell, Timothy M

    2016-02-01

    Bariatric surgery reduces mortality for Americans who meet candidacy criteria and have insurance coverage. Unfortunately, some medically suitable candidates are denied or delayed during insurance approval processes. The long-term impact of such care delays on survival is unknown. Using a prospectively maintained bariatric intake database, we identified consecutive applicants who were evaluated and medically cleared by our multidisciplinary care team and for whom insurance approval was requested. We compared survival in those who were initially approved by their insurance carriers (controls) and those who were initially denied coverage (subjects). Mortality was determined using the Social Security Death Index. Kaplan-Meier survival curves were plotted and the log-rank test for significance was applied. From August 2003 to December 2008, 463 patients (391 females, mean age 45 ± 10 years, mean body mass index 52.5 ± 9.4 kg/m(2)) were medically cleared for a bariatric procedure. Of these, 363 were approved by insurance on initial request, whereas 100 were denied. Given the study's intention to measure the aggregate impact of delays and denials, nine patients who later came to operation after appeal or coverage change were maintained in the subject cohort. During 0- to 113-month follow-up, six subjects (6%) died compared with seven controls (1.9%), corresponding to a statistically significant survival benefit for patients initially approved for bariatric surgery without delay or denial (P insurance certification processes in 22 per cent of medically acceptable candidates. Processes that delay or restrict efficient access to bariatric surgery are associated with a 3-fold mortality increase. PMID:26874141

  18. Prevalence and Predictors of Self-Reported Sexual Abuse in Severely Obese Patients in a Population-Based Bariatric Program

    OpenAIRE

    Gabert, Danielle L.; Majumdar, Sumit R; Sharma, Arya M; Rueda-Clausen, Christian F; Klarenbach, Scott W.; Birch, Daniel W; Shahzeer Karmali; Linda McCargar; Konrad Fassbender; Padwal, Raj S

    2013-01-01

    Background. Sexual abuse may be associated with poorer weight loss outcomes following bariatric treatment. Identifying predictors of abuse would enable focused screening and may increase weight management success. Methods. We analyzed data from 500 consecutively recruited obese subjects from a population-based, regional bariatric program. The prevalence of self-reported sexual abuse was ascertained using a single interview question. Health status was measured using a visual analogue scale (VA...

  19. The Impact of Bariatric Surgery on Obesity related Metabolic Traits with Specific Emphasis on Glucose, Insulin and Proinsulin

    OpenAIRE

    Johansson, Hans-Erik

    2010-01-01

    Hyperproinsulinemia is associated with type 2 diabetes (T2DM) and obesity and is a predictor for future coronary heart disease. This thesis examines the effect of bariatric surgery on glucometabolic status including insulin and proinsulin responses after meal. Further we explored longitudinally the effects of bariatric surgery on glucose, insulin and proinsulin secretion as well as lipids, liver enzymes and magnesium concentrations. We explored by a standardised meal test the postprandial dyn...

  20. The growing role of bariatric surgery in the management of type 2 diabetes: evidences and open questions.

    Science.gov (United States)

    Busetto, Luca; Sbraccia, Paolo; Frittitta, Lucia; Pontiroli, Antonio E

    2011-09-01

    The use of bariatric surgery in the clinical management of type 2 diabetes has been recently endorsed in the clinical practice recommendations released by the most influential diabetologic associations. However, authoritative critic voices about the application of metabolic surgery in type 2 diabetes continue to appear in diabetologic literature. In this review, we will try therefore to understand what the reasons for this apparent dichotomy. In this paper, we revised what we believe are now clear evidences about the role of bariatric surgery in the treatment of type 2 diabetes in patients with morbid obesity: the efficacy of bariatric surgery in metabolic control, the existence of plausible weight-independent metabolic mechanisms at least in some bariatric procedure, and the importance of the early referral to surgery in patients with firm indications. However, we stressed also the lack of clear high-quality long-term data about the effects of bariatric surgery in the prevention of both macro- and micro-vascular hard endpoints in patients with type 2 diabetes. The accrual of these results will be critical to completely clarify the risk/benefit ratio of bariatric surgery in diabetes, as compared to current pharmacologic therapies. This may be particularly important in patients in which data on long-term efficacy are still not completed, such as in patients with lower BMI levels. PMID:21717182

  1. EARLY COMPLICATIONS IN BARIATRIC SURGERY: incidence, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Marco Aurelio SANTO

    2013-03-01

    Full Text Available Context Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control. Method The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery were reviewed. Ninety-three (17.2% patients were male and 445 (82.8% were female. The ages of the patients ranged from 18 to 70 years (average = 46, and their body mass indices ranged from 34.6 to 77 kg/m2. Results Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5% patients experienced pulmonary thromboembolism. The mortality rate was 0,55%. Conclusion The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years. Contexto A cirurgia bariátrica tem mostrado ser o método mais eficaz de tratamento da obesidade grave. No entanto, sua aceitação como terapia padrão-ouro ainda é questionada. As complicações cirúrgicas observadas no início do período p

  2. Perioperative Outcome of Adolescents Undergoing Bariatric Surgery: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study

    Science.gov (United States)

    Inge, T.H.; Zeller, M.H.; Jenkins, T.M.; Helmrath, M.; Brandt, M.L.; Michalsky, M.P.; Harmon, C.M.; Courcoulas, A.; Horlick, M.; Xanthakos, S.A.; Dolan, L.; Mitsnefes, M.; Barnett, S.J.; Buncher, C.R.

    2014-01-01

    -term complication profile, supporting the early postoperative safety of WLS in select adolescents. Further longitudinal study of this cohort will permit accurate assessment of long-term outcomes for adolescents undergoing bariatric surgery. PMID:24189578

  3. Bariatric surgery: a cutting-edge cure for Type 2 diabetes?

    Science.gov (United States)

    Coleman, James; Phillips, Simon

    2010-03-19

    Type 2 diabetes is rapidly becoming a global health crisis. It is associated with multiple comorbidities and is placing an ever increasing financial burden on society. There is now a need to explore new methods of tackling this problem. A growing pool of evidence suggests that bariatric surgery has the potential to cure Type 2 diabetes in a select population and provide additional benefits for many of its associated comorbidities. Whilst there are various proposals that explain these phenomena, current research suggests the cause is mainly due to increased post surgical release of insulin promoting gut hormones. The aim of this paper is to introduce some of the complex issues surrounding the use of bariatric surgery in Type 2 diabetes and highlight the controversial aspects encompassing this topic. PMID:20360798

  4. The Bariatric Patient in the Intensive Care Unit: Pitfalls and Management.

    Science.gov (United States)

    Pompilio, Carlos E; Pelosi, Paolo; Castro, Melina G

    2016-09-01

    The increasing number of bariatric/metabolic operations as important alternatives for the treatment of obesity and type 2 diabetes brought several concerns about the intensive care of patients undergoing those procedures. Intensive Care Unit admission criteria are needed in order to better allocate resources and avoid unnecessary interventions. Furthermore, well-established protocols, helpful in many clinical situations, are not directly applicable to obese patients. Indeed, difficult airway management, mechanical ventilation, fluid therapy protocols, prophylaxis, and treatment of venous thromboembolic events have unique aspects that should be taken into consideration. Finally, new data related to planning nutrition therapy of the critically obese have been highlighted and deserve consideration. In this review, we provide an outline of recent studies related to those important aspects of the care of the bariatric/metabolic patients in critical conditions. PMID:27464648

  5. Anesthesia management in laparoscopic bariatric surgery: Perioperative complications and outcomes in the third year of practice

    Directory of Open Access Journals (Sweden)

    Serkan Karaman

    2014-06-01

    Full Text Available Objective: In this study, we aimed to assess the perioperative and postoperative results of the patients who underwent bariatric surgery. Methods: After obtaining approval, a retrospectively designed observational study was conducted. All adult patients who underwent laparoscopic gastric plication, sleeve gastrectomy, or roux-en-Y anastomosis between January 2011 and May 2013 were included. Results: A total of 104 patients were included in the study period: 49 (47.1% underwent laparoscopic roux-en-Y anastomosis, 44 (42.3% underwent laparoscopic sleeve gastrectomy, and 11 (10.6% underwent laparoscopic gastric plication. The present study showed a mortality rate of 1.9% (n = 2, one after Roux-en-Y anastomosis operation, and the other one after gastric plication. Conclusion: The anesthesia methods and approaches have no association with morbidity and mortality in such procedures of bariatric surgery indicated in the present study. J Clin Exp Invest 2014; 5 (2: 200-205

  6. Cushing's Syndrome in a Morbidly Obese Patient Undergoing Evaluation before Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Livia Borsoi

    2014-06-01

    Full Text Available Objective: Cushing's syndrome (CS is extremely rare in morbidly obese patients. To date, no occurrences in obese patients with BMI above 60 kg/m2 have been reported in the literature. Case Report: This case report describes a patient who was admitted to the ward of the Clinical Division of Endocrinology and Metabolism of the Medical University of Vienna in preparation for bariatric surgery. The patient was a 49-year-old female who showed morbid obesity (BMI 61.6 kg/m2, hypertension, and substituted hypothyroidism. Preoperative work-up revealed CS due to an adrenal adenoma. Therefore, the patient underwent unilateral adrenalectomy followed by bariatric surgery 6 months later. Conclusion: Since undiagnosed CS might result in severe perioperative complications in a population already at increased risk, this case report underlines the importance of careful endocrine evaluation of morbidly obese patients. After all, even rare endocrine causes should be excluded.

  7. A Gut Feeling to Cure Diabetes: Potential Mechanisms of Diabetes Remission after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Young Min Cho

    2014-12-01

    Full Text Available A cure for type 2 diabetes was once a mere dream but has now become a tangible and achievable goal with the unforeseen success of bariatric surgery in the treatment of both obesity and type 2 diabetes. Popular bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy exhibit high rates of diabetes remission or marked improvement in glycemic control. However, the mechanism of diabetes remission following these procedures is still elusive and appears to be very complex and encompasses multiple anatomical and physiological changes. In this article, calorie restriction, improved β-cell function, improved insulin sensitivity, and alterations in gut physiology, bile acid metabolism, and gut microbiota are reviewed as potential mechanisms of diabetes remission after Roux-en-Y gastric bypass and sleeve gastrectomy.

  8. Financial costs and patients’ perceptions of medical tourism in bariatric surgery

    Science.gov (United States)

    Kim, David H.; Sheppard, Caroline E.; de Gara, Christopher J.; Karmali, Shahzeer; Birch, Daniel W.

    2016-01-01

    Summary Many Canadians pursue surgical treatment for severe obesity outside of their province or country — so-called “medical tourism.” We have managed many complications related to this evolving phenomenon. The costs associated with this care seem substantial but have not been previously quantified. We surveyed Alberta general surgeons and postoperative medical tourists to estimate costs of treating complications related to medical tourism in bariatric surgery and to understand patients’ motivations for pursuing medical tourism. Our analysis suggests more than $560 000 was spent treating 59 bariatric medical tourists by 25 surgeons between 2012 and 2013. Responses from medical tourists suggest that they believe their surgeries were successful despite some having postoperative complications and lacking support from medical or surgical teams. We believe that the financial cost of treating complications related to medical tourism in Alberta is substantial and impacts existing limited resources. PMID:26574702

  9. Ménage-à-trois of bariatric surgery, bile acids and the gutmicrobiome

    Institute of Scientific and Technical Information of China (English)

    Rajendra Raghow

    2015-01-01

    Bariatric surgeries have emerged as highly effectivetreatments for obesity associated type-2 diabetesmellitus. Evidently, the desired therapeutic endpointssuch as rates of weight loss, lower levels of glycatedhemoglobin and remission of diabetes are achievedmore rapidly and last longer following bariatric surgery,as opposed to drug therapies alone. In light of thesefindings, it has been suspected that in addition tocausing weight loss dependent glucose intolerance,bariatric surgery induces other physiological changesthat contribute to the alleviation of diabetes. However,the putative post-surgical neuro-hormonal pathwaysthat underpin the therapeutic benefits of bariatricsurgery remain undefined. In a recent report, Ryan andcolleagues shed new light on the potential mechanismsthat determine the salutary effects of bariatric surgeryin mice. The authors demonstrated that the improvedglucose tolerance and weight loss in mice after verticalsleeve gastrectomy (VSG) surgery were likely to becaused by post-surgical changes in circulating bileacids and farnesoid-X receptor (FXR) signaling, both ofwhich were also mechanistically linked to changes inthe microbial ecology of the gut. The authors arrivedat this conclusion from a comparison of genome-wide,metabolic consequences of VSG surgery in obese wildtype (WT) and FXR knockout mice. Gene expressionin the distal small intestines of WT and FXR knockoutmice revealed that the pathways regulating bile acidcomposition, nutrient metabolism and anti-oxidantdefense were differentially altered by VSG surgeryin WT and FXR-/- mice. Based on these data Ryanet al , hypothesized that bile acid homeostasis andFXR signaling were mechanistically linked to the gutmicrobiota that played a role in modulating post-surgicalchanges in total body mass and glucose tolerance.The authors' data provide a plausible explanation forputative weight loss-independent benefits of bariatricsurgery and its relationship with metabolism of bileacids.

  10. Effect of ethnicity on weight loss among adolescents 1 year after bariatric surgery

    Institute of Scientific and Technical Information of China (English)

    Sarah; E; Messiah; Gabriela; Lopez-Mitnik; Deborah; Winegar; Bintu; Sherif; Kristopher; L; Arheart; Kirk; W; Reichard; Marc; P; Michalsky; Steven; E; Lipshultz; Tracie; L; Miller; Alan; S; Livingstone; Nestor; de; la; Cruz-Muoz

    2013-01-01

    AIM:To investigate whether or not bariatric surgeryweight outcomes vary by ethnicity in a large,nationally representative sample of adolescents.METHODS:The Bariatric Outcomes Longitudinal Database was used for analysis and contains data on surgeries performed on adolescents from 2004 to 2010from 423 surgeons at 360 facilities across the United States Adolescents(n=827)between 11 and 19 years old who underwent either gastric bypass or adjustable gastric banding surgery were included in the analysis.Outcome measures included changes in anthropometric measurements[weight(kg)and body mass index]from baseline to 3(n=739),6(n=512),and 12(n=247)mo after surgery.RESULTS:A year after patients underwent either gastric bypass(51%)or adjustable gastric banding(49%)surgery,mean estimated weight loss for all ethnic groups differed by a maximum of only 1.5 kg,being34.3 kg(95%CI:30.0-38.5 kg)for Hispanics,33.8 kg(95%CI:27.3-40.3 kg)for non-Hispanic blacks,and32.8 kg(95%CI:30.9-34.7 kg)for non-Hispanic whites.No overall pairwise group comparisons were significant,indicating that no ethnic group had better weight loss outcomes than did another.CONCLUSION:Bariatric surgery substantially reduces the weight of severely obese adolescents at 1 year post-procedure with little variation by ethnicity and/or gender.These results suggest that bariatric surgery is a safe and reasonable treatment for all severely obese adolescents with the appropriate indications.

  11. Chronic Renin-Angiotensin System (RAS) Blockade May Not Induce Hypotension During Anaesthesia for Bariatric Surgery.

    Science.gov (United States)

    Salvetti, Guido; Di Salvo, Claudio; Ceccarini, Giovanni; Abramo, Antonio; Fierabracci, Paola; Magno, Silvia; Piaggi, Paolo; Vitti, Paolo; Santini, Ferruccio

    2016-06-01

    The use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) for the treatment of hypertensive obese patients is steadily increasing. Some studies have reported that the use of these drugs was associated with an increased risk of hypotensive episodes, during general anaesthesia. The number of bariatric procedures is also increasing worldwide, but there is a lack of studies investigating the hypotensive effect of renin-angiotensin system (RAS) blockers in severely obese patients during general anaesthesia for bariatric surgery. The aim of this pilot study was to evaluate hemodynamic changes induced by general anaesthesia in obese patients chronically treated with ACE-I or ARB compared to a control group not treated with antihypertensive therapy. Fourteen obese subjects (mean body mass index (BMI) 47.5 kg/m(2)) treated with ACE-I or ARB and twelve obese (mean BMI 45.7 kg/m2) controls not treated with antihypertensive therapy underwent general anaesthesia to perform laparoscopic bariatric surgery. Systolic blood pressure, diastolic blood pressure, and heart rate were monitored continuously and registered at different time points: T0 before induction, then at 2, 5, 7, 10, 15, 20, 30, 60, 90, 120, and 150 min after induction, and the last time point taken following recovery from anaesthesia. A progressive reduction of both systolic and diastolic blood pressure values was observed without significant differences between the two groups. A similar trend of heart rate values was observed. In conclusion, our pilot study suggests that RAS blockers may be continued during the perioperative period in patients undergoing bariatric surgery, without increasing the risk of hypotensive episodes. PMID:26328531

  12. Post-Bariatric Surgery Satisfaction and Body-Contouring Consideration after Massive Weight Loss

    OpenAIRE

    Saleh M Aldaqal; Ahmad M Makhdoum; Ali M Turki; Awan, Basim A; Osama A Samargandi; Hytham Jamjom

    2013-01-01

    Background: Following a bariatric surgery and massive weight-loss, the outcome is usually sullied by consequences on the body′s contour and redundant skin. Aims: We aimed to record the frequency of contour irregularities and quantify patients′ satisfaction with appearance and anticipations from body contouring surgery. Materials and Methods: The ethical committee at King Abdulaziz University Hospital approved the study, and patients were consented. A cross-sectional study targeting the post-b...

  13. Bariatric surgery decreases carotid intima-media thickness in obese subjects

    Directory of Open Access Journals (Sweden)

    Gonzalo García

    2013-08-01

    Full Text Available Background: Obesity has long been associated with an increased risk of cardiovascular disease (CVD. The aim of this study was to evaluate the impact of substantial weight loss induced by bariatric surgery on carotid intima media thickness (C-IMT (surrogate marker of early atherosclerosis and classic factors of cardiovascular risk (CVRFs. Methods: thirty-one obesity patients were evaluated for bariatric surgery. Twenty-seven were undergone surgery, 14 Roux-en-Y gastric bypass surgery (GBS and 13 sleeve gastrectomy. The four obese patients who did not undergo surgery, were performed the same evaluations. Measurements: Body weight, BMI, blood pressure, total cholesterol, TC levels, LDL-C, HDL-C, TG, fasting plasma glucose and insulin, HOMA IR, and US B-mode C-IMT was measured. Results: After 354 ± 92 days follow up, 27 patients that underwent bariatric surgery evidenced a mean body mass index decrease from 38 to 27 k/m² (p < 0.001, simultaneously was observed improvement in CVRFs, 10 years Framingham risk and a significant reduction of therapeutic requirements. C-IMT diminished from a mean of 0.58 ± 0.14 mm to 0.49 ± 0.09 mm (p = 0.0001. Four patients that did not undergo surgery increased C-IMT from 0.52 ± 0.12 to 0.58 ± 0.13 mm (p = 0.03 with no significant changes in CVRFs. Conclusion: Weight loss, one year after bariatric surgery, GBS and sleeve gastrectomy, decreases C-IMT; improve CVRFs and 10 years Framingham risk.

  14. Equal ratio ventilation (1:1 improves arterial oxygenation during laparoscopic bariatric surgery: A crossover study

    Directory of Open Access Journals (Sweden)

    Wesam Farid Mousa

    2013-01-01

    Full Text Available Background: Hypoxaemia and high peak airway pressure (Ppeak are common anesthetic problems during laparoscopic bariatric surgery. Several publications have reported the successful improvement in arterial oxygenation using positive end expiratory pressure and alveolar recruitment maneuver, however, high peak airway pressure during laparoscopic bariatric surgery may limit the use of both techniques. This study was designed to determine whether equal I:E (inspiratory-to-expiratory ratio ventilation (1:1 improves arterial oxygenation with parallel decrease in the Ppeak values. Methods: Thirty patients with a body mass index ≥40 kg/m 2 scheduled for laparoscopic bariatric surgery were randomized, after creation of pneumoperitoneum, to receive I:E ratio either 1:1 (group 1, 15 patients or 1:2 (group 2, 15 patients. After a stabilization period of 30 min, patients were crossed over to the other studied I:E ratio. Ppeak, mean airway pressure (Pmean, dynamic compliance (Cdyn, arterial blood gases and hemodynamic data were collected at the end of each stabilization period. Results: Ventilation with I: E ratio of 1:1 significantly increased partial pressure of O 2 in the arterial blood (PaO 2 , Pmean and Cdyn with concomitant significant decrease in Ppeak compared to ventilation with I: E ratio of 1:2. There were no statistical differences between the two groups regarding the mean arterial pressure, heart rate, respiratory rate, end tidal CO 2 or partial pressure of CO 2 in the arterial blood. Conclusion: Equal ratio ventilation (1:1 is an effective technique in increase PaO 2 during laparoscopic bariatric surgery. It increases Pmean and Cdyn while decreasing Ppeak without adverse respiratory or hemodynamic effects.

  15. Cognitive function and nonfood-related impulsivity in post-bariatric surgery patients.

    Science.gov (United States)

    Georgiadou, Ekaterini; Gruner-Labitzke, Kerstin; Köhler, Hinrich; de Zwaan, Martina; Müller, Astrid

    2014-01-01

    Initial evidence that cognitive function improves after bariatric surgery exists. The post-surgery increase in cognitive control might correspond with a decrease of impulsive symptoms after surgery. The present study investigated cognitive function and nonfood-related impulsivity in patients with substantial weight loss due to bariatric surgery by using a comparative cross-sectional design. Fifty post-bariatric surgery patients (postBS group) who had significant percent weight loss (M = 75.94, SD = 18.09) after Roux-en-Y gastric bypass (body mass index, BMI M post = 30.54 kg/m(2), SDpost = 5.14) were compared with 50 age and gender matched bariatric surgery candidates (preBS group; BMI M pre = 48.01 kg/m(2), SDpre = 6.56). To measure cognitive function the following computer-assisted behavioral tasks were utilized: Iowa Gambling Task, Tower of Hanoi, Stroop Test, Trail Making Test-Part B, and Corsi Block Tapping Test. Impulsive symptoms and behaviors were assessed using impulsivity questionnaires and a structured interview for impulse control disorders (ICDs). No group differences were found with regard to performance-based cognitive control, self-reported impulsive symptoms, and ICDs. The results indicate that the general tendency to react impulsively does not differ between pre-surgery and post-surgery patients. The question of whether nonfood-related impulsivity in morbidly obese patients changes post-surgery should be addressed in longitudinal studies given that impulsive symptoms can be considered potential targets for pre- as well post-surgery interventions. PMID:25566164

  16. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...... minimal invasive and fully reversible endoscopic treatment modality approved for treatment of obesity with or without concomitant type 2 diabetes. Here we review present data for the efficacy and safety of this treatment modality....

  17. Diagnosis and treatment of atypical presentations of hiatal hernia following bariatric surgery.

    Science.gov (United States)

    Flanagin, Brody A; Mitchell, Myrosia T; Thistlethwaite, William A; Alverdy, John C

    2010-03-01

    Bariatric surgery dramatically alters the normal stomach anatomy resulting in a significant incidence of hiatal hernia and gastroesophageal reflux disease. Although the majority of patients remain asymptomatic, many complain of severe heartburn refractory to medical management and additional highly atypical symptoms. Here, we describe the diagnosis and treatment regarding four cases of symptomatic hiatal hernia following bariatric surgery presenting with atypical symptoms in the University Hospital, USA. Four patients presented following laparoscopic Roux-en-Y gastric bypass or duodenal switch/pancreaticobiliary bypass (DS) with disabling and intractable midepigastric abdominal pain characterized as severe and radiating to the jaw, left shoulder, and midscapular area. The pain in all cases was described as paroxysmal and not necessarily associated with eating. All four patients also experienced nausea, vomiting, and failure to thrive at various intervals following laparoscopic bariatric surgery. Routine workup failed to produce any clear mechanical cause of these symptoms. However, complimentary use of multidetector CT and upper gastrointestinal contrast studies eventually revealed the diagnosis of hiatal hernia. Exploration identified the presence of a type I hiatal hernia in all four patients, with the stomach staple lines densely adherent to the diaphragm and parietal peritoneum. Operative intervention led to immediate and complete resolution of symptoms. The presence of a hiatal hernia following bariatric surgery can present with highly atypical symptoms that do not resolve without operative intervention. Recognition of this problem should lead to the consideration of surgery in cases where patients are dependent on artificial nutritional support and whose symptoms are poorly controlled with medication alone.

  18. Can Flaxseed Help Satisfy Appetite in Women Subjected to Bariatric Surgery?

    Directory of Open Access Journals (Sweden)

    Gigliane Cosendey-Menegati

    2014-05-01

    Full Text Available Background: Bariatric surgery is considered the most effective immediate weight loss method for the morbidly obese, despite widely reported weight regain after a few years. Appetite, satiety and satiation control are essential to maintaining a long-term result post-surgery. Dietary fatty acids composition may be implicated in the satiety. As flaxseed is a food high in linolenic acid, we aimed to verify the influence of flaxseed fat on appetite and satiety of women after bariatric surgery.Material and methods: Six women who underwent bariatric surgery at least 2 years before participated in a single-blind crossover trial that compared the effect of two isocaloric meals on satiety, one containing whole golden flaxseed (high in polyunsaturated fatty acids and fiber (G1 and another withdefatted flaxseed (high in fiber (G2, with one week of washout period. This variable was estimated by visual analogue scales in both meals at baseline (T0, immediately after ingestion (T1 and 60, 120, and 180 minutes after the meal (T60, T120 and T180. Fasting anthropometric, body composition, laboratory tests (glucose and lipids and dietary variables, were evaluated while fasting.Results: The volunteers were obese and had excess central adiposity, even after two years of surgery and still showed habitual fibre intake below recommended levels. G1 had reduced hunger after 180 minutes compared to G2 (P=.046. Other parameters related to appetite and satiety did not differ between groups.Conclusions: Less hunger was observed after 180 minutes in whole golden flaxseed meal compared with the defatted flaxseed meal, indicating that the whole golden flaxseed meal, possibly, supports obesity treatment in the long-term after bariatric surgery by controlling appetite and satiety sensations.

  19. Chronic Renin-Angiotensin System (RAS) Blockade May Not Induce Hypotension During Anaesthesia for Bariatric Surgery.

    Science.gov (United States)

    Salvetti, Guido; Di Salvo, Claudio; Ceccarini, Giovanni; Abramo, Antonio; Fierabracci, Paola; Magno, Silvia; Piaggi, Paolo; Vitti, Paolo; Santini, Ferruccio

    2016-06-01

    The use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) for the treatment of hypertensive obese patients is steadily increasing. Some studies have reported that the use of these drugs was associated with an increased risk of hypotensive episodes, during general anaesthesia. The number of bariatric procedures is also increasing worldwide, but there is a lack of studies investigating the hypotensive effect of renin-angiotensin system (RAS) blockers in severely obese patients during general anaesthesia for bariatric surgery. The aim of this pilot study was to evaluate hemodynamic changes induced by general anaesthesia in obese patients chronically treated with ACE-I or ARB compared to a control group not treated with antihypertensive therapy. Fourteen obese subjects (mean body mass index (BMI) 47.5 kg/m(2)) treated with ACE-I or ARB and twelve obese (mean BMI 45.7 kg/m2) controls not treated with antihypertensive therapy underwent general anaesthesia to perform laparoscopic bariatric surgery. Systolic blood pressure, diastolic blood pressure, and heart rate were monitored continuously and registered at different time points: T0 before induction, then at 2, 5, 7, 10, 15, 20, 30, 60, 90, 120, and 150 min after induction, and the last time point taken following recovery from anaesthesia. A progressive reduction of both systolic and diastolic blood pressure values was observed without significant differences between the two groups. A similar trend of heart rate values was observed. In conclusion, our pilot study suggests that RAS blockers may be continued during the perioperative period in patients undergoing bariatric surgery, without increasing the risk of hypotensive episodes.

  20. From bariatric to metabolic surgery: Looking for a "diseasemodifier" surgery for type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    In this review the recent evolution of the comprehensionof clinical and metabolic consequences of bariatricsurgery is depicted. At the beginning bariatric surgeryaim was a significant and durable weight loss. Later on,it became evident that bariatric surgery was associatedwith metabolic changes, activated by unknown pathways,partially or totally independent of weight loss. Paradigmof this "metabolic" surgery is its effects on type 2diabetes mellitus (T2DM). In morbid obese subjects itwas observed a dramatic metabolic response leadingto decrease blood glucose, till diabetesremission,before the achievement of clinically significant weightloss, opening the avenue to search for putative antidiabetic"intestinal" factors. Both proximal duodenal(still unknown) and distal (GLP1) signals have beensuggested as hormonal effectors of surgery on bloodglucose decrease. Despite these findings T2DMremission was never considered a primary indicationfor bariatric surgery but only a secondary one. RecentlyT2DM remission in obese subjects with body massindex (BMI) greater than 35 has become a primaryaim for surgery. This change supports the idea that"metabolic surgery" definition could more appropriatethan bariatric, allowing to explore the possibility thatmetabolic surgery could represent a "disease modifier"for T2DM. Therefore, several patients have undergonesurgery with a primary aim of a definitive cure of T2DMand today this surgery can be proposed as an alternativetherapy. How much surgery can be considered trulymetabolic is still unknown. To be truly "metabolic" itshould be demonstrated that surgery could cause T2DMremission not only in subjects with BMI 〉 35 but alsowith BMI 〈 35 or even 〈 30. Available evidence on thistopic is discussed in this mini-review.

  1. Cognitive function and nonfood-related impulsivity in post-bariatric surgery patients

    Directory of Open Access Journals (Sweden)

    Ekaterini eGeorgiadou

    2014-12-01

    Full Text Available Initial evidence that cognitive function improves after bariatric surgery exists. The post-surgery increase in cognitive control might correspond with a decrease of impulsive symptoms after surgery. The present study investigated cognitive function and nonfood-related impulsivity in patients with substantial weight loss due to bariatric surgery by using a comparative cross-sectional design. Fifty post-bariatric surgery patients (postBS group who had significant percent weight loss (M = 75.94, SD = 18.09 after Roux-en-Y gastric bypass (body mass index, BMI Mpost = 30.54 kg/m2, SDpost = 5.14 were compared with 50 age and gender matched bariatric surgery candidates (preBS group (BMI Mpre = 48.01 kg/m2, SDpre = 6.56. To measure cognitive function the following computer-assisted behavioral tasks were utilized: Iowa Gambling Task, Tower of Hanoi, Stroop Test, Trail Making Test-Part B, and Corsi Block Tapping Test. Impulsive symptoms and behaviors were assessed using impulsivity questionnaires and a structured interview for impulse control disorders. No group differences were found with regard to performance-based cognitive control, self-reported impulsive symptoms and impulse control disorders. The results indicate that the general tendency to react impulsively does not differ between pre-surgery and post-surgery patients. The question of whether nonfood-related impulsivity in morbidly obese patients changes post-surgery should be addressed in longitudinal studies given that impulsive symptoms should be considered potential targets for pre- as well post-surgery interventions.

  2. Salt taste after bariatric surgery and weight loss in obese persons.

    Science.gov (United States)

    Ekmekcioglu, Cem; Maedge, Julia; Lam, Linda; Blasche, Gerhard; Shakeri-Leidenmühler, Soheila; Kundi, Michael; Ludvik, Bernhard; Langer, Felix B; Prager, Gerhard; Schindler, Karin; Dürrschmid, Klaus

    2016-01-01

    Background. Little is known about the perception of salty taste in obese patients, especially after bariatric surgery. Therefore, the aim of this study was to analyse possible differences in salt detection thresholds and preferences for foods differing in salt content in obese persons before and after bariatric surgery with weight loss compared to non-obese individuals. Methods. Sodium chloride detection thresholds and liking for cream soups with different salt concentrations were studied with established tests. Moreover, a brief salt food questionnaire was assessed to identify the usage and awareness of salt in food. Results. The results showed similar mean sodium chloride detection thresholds between non-obese and obese participants. After bariatric surgery a non-significant increase in the salt detection threshold was observed in the obese patients (mean ± SD: 0.44 ± 0.24 g NaCl/L before OP vs. 0.64 ± 0.47 g NaCl/L after OP, p = 0.069). Cream soup liking between controls and obese patients were not significantly different. However, significant sex specific differences were detected with the tested women not liking the soups (p < 0.001). Results from the food questionnaire were similar between the groups. Conclusion. No differences between non-obese persons and obese patients were shown regarding the salt detection threshold. However, due to highly significant differences in soup liking, sex should be taken into consideration when conducting similar sensory studies. PMID:27330856

  3. Effects of Bariatric Surgery on Adipokine-Induced Inflammation and Insulin Resistance

    Directory of Open Access Journals (Sweden)

    Zeynep eGoktas

    2013-06-01

    Full Text Available Over a third of the US population is obese and at high risk for developing type 2 diabetes, insulin resistance and other metabolic disorders. Obesity is considered a chronic low grade inflammatory condition that is primarily attributed to expansion and inflammation of adipose tissues. Indeed, adipocytes produce and secrete numerous proinflammatory and anti-inflammatory cytokines known as adipokines. When the balance of these adipokines is shifted towards higher production of proinflammatory factors, local inflammation within adipose tissues and subsequently systemic inflammation occur. These adipokines including leptin, visfatin, resistin, apelin, vaspin, and retinol binding protein-4 can regulate inflammatory responses and contribute to the pathogenesis of diabetes. These effects are mediated by key inflammatory signaling molecules including activated serine kinases such as c-Jun N-terminal kinase (JNK and serine kinases inhibitor κB kinase (IKK and insulin signaling molecules including insulin receptor substrates, protein kinase B (PKB, also known as Akt, and nuclear factor kappa B (NF-kB. Bariatric surgery can decrease body weight and improve insulin resistance in morbidly obese subjects. However, despite reports suggesting reduced inflammation and weight-independent effects of bariatric surgery on glucose metabolism, mechanisms behind such improvements are not yet well understood. This review article focuses on some of these novel adipokines and discusses their changes after bariatric surgery and their relationship to insulin resistance, fat mass, inflammation, and glucose homeostasis.

  4. Mechanisms of changes in glucose metabolism and bodyweight after bariatric surgery

    DEFF Research Database (Denmark)

    Madsbad, Sten; Dirksen, Carsten; Holst, Jens Juul

    2014-01-01

    Bariatric surgery is the most effective treatment for obesity and also greatly improves glycaemic control, often within days after surgery, independently of weight loss. Laparoscopic adjustable gastric banding (LAGB) was designed as a purely restrictive procedure, whereas vertical sleeve gastrect......Bariatric surgery is the most effective treatment for obesity and also greatly improves glycaemic control, often within days after surgery, independently of weight loss. Laparoscopic adjustable gastric banding (LAGB) was designed as a purely restrictive procedure, whereas vertical sleeve...... gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) induce changes in appetite through regulation of gut hormones, resulting in decreased hunger and increased satiation. Thus, VSG and RYBG more frequently result in remission of type 2 diabetes than does LAGB. With all three of these procedures, remission...... regulatory pathways that control appetite and glucose metabolism after bariatric surgery. Recent research suggests that changes in bile acid concentrations in the blood and altered intestinal microbiota might contribute to metabolic changes after surgery, but the mechanisms are unclear. In this Series paper...

  5. Metabolic Mechanisms in Obesity and Type 2 Diabetes: Insights from Bariatric/Metabolic Surgery

    Directory of Open Access Journals (Sweden)

    Adriana Florinela Cătoi

    2015-11-01

    Full Text Available Obesity and the related diabetes epidemics represent a real concern worldwide. Bariatric/metabolic surgery emerged in last years as a valuable therapeutic option for obesity and related diseases, including type 2 diabetes mellitus (T2DM. The complicated network of mechanisms involved in obesity and T2DM have not completely defined yet. There is still a debate on which would be the first metabolic defect leading to metabolic deterioration: insulin resistance or hyperinsulinemia? Insight into the metabolic effects of bariatric/metabolic surgery has revealed that, beyond weight loss and food restriction, other mechanisms can be activated by the rearrangements of the gastrointestinal tract, such as the incretinic/anti-incretinic system, changes in bile acid composition and flow, and modifications of gut microbiota; all of them possibly involved in the remission of T2DM. The complete elucidation of these mechanisms will lead to a better understanding of the pathogenesis of this disease. Our aim was to review some of the metabolic mechanisms involved in the development of T2DM in obese patients as well as in the remission of this condition in patients submitted to bariatric/metabolic surgery.

  6. Experimental Bariatric Surgery in Rats Generates a Cytotoxic Chemical Environment in the Gut Contents.

    Directory of Open Access Journals (Sweden)

    Jia eLi

    2011-09-01

    Full Text Available Bariatric surgery, also known as metabolic surgery, is an effective treatment for morbid obesity which also offers pronounced metabolic effects including the resolution of type 2 diabetes and a decrease in cardiovascular disease and long-term cancer risk. However, the mechanisms of surgical weight loss and the long term consequences of bariatric surgery remain unclear. Bariatric surgery has been demonstrated to alter the composition of both the microbiome and the metabolic phenotype. We observed a marked shift towards Gammaproteobacteria, particularly Enterobacter hormaechei, following Roux-en-Y gastric bypass (RYGB surgery in a rat model compared with sham operated controls. Fecal water from RYGB surgery rats was highly cytotoxic to rodent cells (mouse lymphoma cell line, although In contrast, fecal water from sham operated animals showed no/very low cytotoxicity. This shift in the gross structure of the microbiome correlated with greatly increased cytotoxicity in a regulatory acceptable mouse lymphoma assay. Urinary phenylacetylglycine and indoxyl sulfate and fecal GABA, putrescine, tyramine and uracil were found to be inversely correlated with cell survival rate. This profound co-dependent response of mammalian and microbial metabolism to RYGB surgery and the impact on the cytotoxicity of the gut luminal environment suggests that RYGB exerts local and global metabolic effects which may have an influence on long term cancer risk and cytotoxic load.

  7. Does bariatric surgery improve the patient´s quality of life?

    Directory of Open Access Journals (Sweden)

    Y. Martínez

    2010-12-01

    Full Text Available Objective: The aim of this investigation was to assess the effect of malabsorptive bariatric surgery (BS on the quality of life (QoL, applying the Nottingham Health Profile (NHP and the bariatric analysis and reporting outcome system (BAROS. Design: A prospective cohort study was performed in 100 adult patients (> 18 years undergoing bariatric surgery by malabsorptive technique for one year. Research methods and procedures: Patients were monitored from the beginning of the BS program until a year after the intervention, applying the NHP and the BAROS test. At baseline, the mean weight of the women was 132 ± 22 kg and the Body Mass Index (BMI was 50.7 kg/m². Results: The values obtained from different areas applying the NHP questionnaire showed statistical significant differences (p < 0.001 with respect to baseline values. According to the BAROS test, 48% of patients lost 25-49% of weight excess and 80.8% had resolved major comorbidities at 1 yr. According to the Moorehead-Ardelt QoL score, there were major improvements in employment and self-esteem in 89% and 87% of patients, respectively, and improvements in physical activity, sexual and social relationships. According to the total mean BAROS score, the outcome was considered "very good". Conclusion: NHP and BAROS questionnaires appear to be useful and easily applicable tools to assess the QoL of obese patients.

  8. Becoming a normal guy: Men making sense of long-term bodily changes following bariatric surgery

    Directory of Open Access Journals (Sweden)

    Karen Synne Groven

    2015-12-01

    Full Text Available Background: To date, research on bodily changes following bariatric surgery has focused predominantly on women, leaving the long-term experience of men relatively unexplored. In this paper, we draw on interviews with men who have undergone an irreversible gastric bypass procedure to explore their bodily changes more than 4 years post-surgery. We apply a phenomenological framework that draws on Leder's perspectives on the “disappearing” and “dys-appearing” body, combined with a gender-sensitive lens that draws on Connell's theory of hegemonic masculinity and Robertson's conceptions of embodied masculinity. Findings: Our principal finding was that the men negotiated their bodily changes following bariatric surgery in profoundly ambivalent ways. Although they enthusiastically praised the surgery for improving their health, self-esteem, and social functioning, they also emphasized their efforts to cope with post-surgical side effects and life-threatening complications. Our analysis elaborates on their efforts to adjust to and come to terms with these changes, focusing on episodes of hypoglycemia, severe pain and internal herniation, and the significance of physical activity and exercise. Conclusions: Our findings point to the need to acknowledge men's ways of making sense of profound and ongoing bodily changes following bariatric surgery and how these negotiations are closely intertwined with masculine ideals of embodiment and social value.

  9. Effect of Bariatric Weight Loss on the Adipose Lipolytic Transcriptome in Obese Humans

    Directory of Open Access Journals (Sweden)

    Shakun Karki

    2015-01-01

    Full Text Available Background. Dysregulated lipolysis has been implicated in mechanisms of cardiometabolic disease and inflammation in obesity. Purpose. We sought to examine the effect of bariatric weight loss on adipose tissue lipolytic gene expression and their relationship to systemic metabolic parameters in obese subjects. Methods/Results. We biopsied subcutaneous adipose tissue in 19 obese individuals (BMI 42 ± 5 kg/m2, 79% female at baseline and after a mean period of 8 ± 5 months (range 3–15 months following bariatric surgery. We performed adipose tissue mRNA expression of proteins involved in triglyceride hydrolysis and correlated their weight loss induced alterations with systemic parameters associated with cardiovascular disease risk. mRNA transcripts of adipose triglyceride lipase (ATGL, hormone-sensitive lipase (HSL, and lipid droplet proteins comparative gene identification 58 (CGI-58 and perilipin increased significantly after weight loss (p<0.05 for all. ATGL expression correlated inversely with plasma triglyceride (TG, hemoglobin A1C (HbA1C, and glucose, and HSL expression correlated negatively with glucose, while CGI-58 was inversely associated with HbA1C. Conclusion. We observed increased expression of adipose tissue lipolytic genes following bariatric weight loss which correlated inversely with systemic markers of lipid and glucose metabolism. Functional alterations in lipolysis in human adipose tissue may play a role in shaping cardiometabolic phenotypes in human obesity.

  10. Bariatric Surgery in University Clinic Center Tuzla - Results After 30 Operations

    Science.gov (United States)

    Ahmetasevic, Emir; Pasic, Fuad; Beslin, Miroslav Bekavac; Ilic, Miroslav; Ahmetasevic, Dzenita; Mesic, Mirza

    2016-01-01

    Introduction: Project of Bariatric surgery in University clinic center (UCC) Tuzla has been initiated in 2009 as an idea of professor Dešo Mešić and soon after that Bariatric surgical team led by doctor Fuad Pasic has been created. Material and methods: Practical team education was realized in Croatia in hospital „Sisters of Mercy” under supervision of professor Miroslav-Bekavac Beslin. First bariatric operations in UCC Tuzla has been done in 2011 and it was biliopancreatic diversion (BPD) Scopinaro. Results and discussion: So far there has been done 30 operations and among them there have been used almost all operative modalities - restrictive, malabsorptive and combined (laparoscopic gastric banding-LAPGB, Roux-y mini gastric bypass, open and laparoscopic gastric sleeve resection, and over mentioned Scopinaro’s BPD). Beginning results are very promising according to the fact that almost all operated patients after one year stopped using antihypertensive, antidiabetic and antidepressant therapy, that average year’s weight loss is 35-100 kilograms and total satisfactions of patients after surgeries is obvious. PMID:27147808

  11. Weight regain among women after metabolic and bariatric surgery: a qualitative study in Brazil

    Directory of Open Access Journals (Sweden)

    Ataliba de Carvalho Jr.

    2014-09-01

    Full Text Available INTRODUCTION: Due to the increased number of bariatric surgeries over the years, aspects contributing or hindering the achievement of outcomes, among them weight regain, have acquired increased significance. Psychological factors directly influence on this unwanted situation, but there are few studies and controversies about the degree of participation of these factors. We propose a qualitative investigation to analyze the meanings of weight regain after surgery among women and how these factors influence this outcome.METHOD: This study uses the clinical-qualitative method, by means of a semi-structured interview with open questions in an intentional sample, closed by saturation, with eight women who underwent surgery at the Bariatric Surgery Outpatient Clinic of Hospital das Clínicas, Universidade Estadual de Campinas (UNICAMP, in the state of São Paulo, Brazil.RESULTS: A feeling of defeat and failure emerges with weight regain, which contributes to social isolation; there is no regret, but gratitude for the surgery; among patients, there is a sense of feeling rejected greater than a rejection that actually exists.CONCLUSION: We found out the need for further qualitative studies that help the health team to better understand the dynamic psychological factors involved in the meaning of weight regain after bariatric surgery among women, in order to adopt appropriate conducts to deal with this problem.

  12. Bariatric surgery for obesity%肥胖症的外科治疗

    Institute of Scientific and Technical Information of China (English)

    颜晓捷; 姚琪远; 张延龄

    2010-01-01

    Obesity and related comorbidities have become serious health threats all over the world. Bariatric surgery has been shown to be an effective method for severe obesity in both the short and long term. Patients experience significant and sustained weight loss after bariatric surgery. Moreover, the preexist obesity associated comorbidities have been improved or resolved in most patients. A series of clinical researches have demonstrated the safety and validity of bariatric surgery. The clinical applications of surgery therapy provide an alternative for obesity and related comorbidities.%肥胖及其并发疾病已成为全球主要健康问题.对于严重肥胖的患者而言,手术治疗是长期有效的.在减轻体重的同时,患者原有的肥胖相关疾病也得到了缓解和控制,远期病死率大大降低.大量临床资料已经证明了减肥手术的安全性及有效性.减肥手术为解决肥胖问题及其并发疾病打开了一扇新窗口.

  13. Can medical therapy mimic the clinical efficacy or physiological effects of bariatric surgery?

    Science.gov (United States)

    Miras, A D; le Roux, C W

    2014-03-01

    The number of bariatric surgical procedures performed has increased dramatically. This review discusses the clinical and physiological changes, and in particular, the mechanisms behind weight loss and glycaemic improvements, observed following the gastric bypass, sleeve gastrectomy and gastric banding bariatric procedures. The review then examines how close we are to mimicking the clinical or physiological effects of surgery through less invasive and safer modern interventions that are currently available for clinical use. These include dietary interventions, orlistat, lorcaserin, phentermine/topiramate, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, pramlintide, dapagliflozin, the duodenal-jejunal bypass liner, gastric pacemakers and gastric balloons. We conclude that, based on the most recent trials, we cannot fully mimic the clinical or physiological effects of surgery; however, we are getting closer. A 'medical bypass' may not be as far in the future as we previously thought, as the physician's armamentarium against obesity and type 2 diabetes has recently got stronger through the use of specific dietary modifications, novel medical devices and pharmacotherapy. Novel therapeutic targets include not only appetite but also taste/food preferences, energy expenditure, gut microbiota, bile acid signalling, inflammation, preservation of β-cell function and hepatic glucose output, among others. Although there are no magic bullets, an integrated multimodal approach may yield success. Non-surgical interventions that mimic the metabolic benefits of bariatric surgery, with a reduced morbidity and mortality burden, remain tenable alternatives for patients and health-care professionals.

  14. Initial Weight Loss after Restrictive Bariatric Procedures May Predict Mid-Term Weight Maintenance: Results From a 12-Month Pilot Trial

    OpenAIRE

    Nikolić, Marko; Kruljac, Ivan; Kirigin, Lora; Mirošević, Gorana; Ljubičić, Neven; Nikolić, Borka Pezo; Bekavac-Bešlin, Miroslav; Budimir, Ivan; Vrkljan, Milan

    2015-01-01

    Background: Bariatric procedures are effective options for weight loss (WL) in the morbidly obese. However, some patients fail to lose any weight after bariatric surgery, and mid-term weight maintenance is variable. The aim of this study was to investigate whether initial WL could predict mid-term weight maintenance.

  15. Remission of Type 2 Diabetes Mellitus in Patients After Different Types of Bariatric Surgery : A Population-Based Cohort Study in the United Kingdom

    NARCIS (Netherlands)

    Yska, Jan Peter; van Roon, Eric N; de Boer, Anthonius; Leufkens, Hubert G M; Wilffert, Bob; de Heide, Loek J M; de Vries, Frank; Lalmohamed, Arief

    2015-01-01

    Importance: To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. Objective: To assess the effect of different types of bariatric surgery in patients with T

  16. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery : A population-based cohort study in the United Kingdom

    NARCIS (Netherlands)

    Yska, Jan Peter; Van Roon, Eric N.; De Boer, Anthonius; Leufkens, Hubert G M; Wilffert, Bob; De Heide, Loek J M; De Vries, Frank; Lalmohamed, Arief

    2015-01-01

    IMPORTANCE: To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. OBJECTIVE: To assess the effect of different types of bariatric surgery in patients with T

  17. Aerospace Medicine

    Science.gov (United States)

    Michaud, Vince

    2015-01-01

    NASA Aerospace Medicine overview - Aerospace Medicine is that specialty area of medicine concerned with the determination and maintenance of the health, safety, and performance of those who fly in the air or in space.

  18. Timing of food intake is associated with weight loss evolution in severe obese patients after bariatric surgery

    OpenAIRE

    Ruíz-Lozano, T.; Vidal i Cortada, Josep; de Hollanda, A.; Scheer, F.A.J.L.; Garaulet, M.; Izquierdo Pulido, María Luz

    2016-01-01

    Background Recent research has demonstrated a relationship between the timing of food intake and weight loss in humans. However, whether the meal timing can be associated with weight loss in patients treated with bariatric surgery is unknown. Objective To evaluate the role of food-timing in the evolution of weight loss in a sample of 270 patients that underwent bariatric surgery with a follow-up of 6 years. Methods Participants (79% women; age [mean ± SD]: 52 ± 11 years; BMI: 46.5 ± 6.0 kg/m2...

  19. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care.

    Directory of Open Access Journals (Sweden)

    Ian J Douglas

    2015-12-01

    Full Text Available Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities.This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM, hypertension, angina, myocardial infarction (MI, stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88-5.08. Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo and sleeve gastrectomy (6.29 kg/mo were associated with greater initial weight reduction than gastric banding (2.77 kg/mo. Protective hazard ratios (HRs were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55-0.83; hypertension, 0.35 (95% CI 0.27-0.45; angina, 0.59 (95% CI 0.40-0.87;MI, 0.28 (95% CI 0.10-0.74; and obstructive sleep apnoea, 0.55 (95% CI 0.40-0.87. Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84-12.62, and between bariatric surgery and the resolution of hypertension, with a HR of 5.64 (95% CI

  20. 减重外科的发展历程及前景%History and prospect of bariatric surgery

    Institute of Scientific and Technical Information of China (English)

    李威杰

    2013-01-01

    With the coming of obesity epidemic and the development of mini-invasive bariatric surgery,we have entered an era where bariatric surgery growing in an exponential way and becoming an independent surgical division.Bariatric surgery is not only the single effective treatment for morbid obese patients (BMI > 35 kg/m2),but also transforming into metabolic surgery for the treatment of not well controlled type 2 diabetes in obese patients with BMI < 35 kg/m2.The type of bariatric procedure had changed a lot in the past decades.Current bariatric surgery is not only very safe but also very effective.Many new metabolic surgeries and procedures have also been developed and a great break-through in diabetes treatment is expected in the future.Bariatric/Metabolic surgical division is a consequence of the rapid growing bariatric surgeries.An independent Bariatric/Metabolic surgical division may focus on a high quality bariatric surgical service,provide the education and training of bariatric surgeons,and help in research and development of this field.As obesity and associated diabete is becoming the most important health issue in the modern world,a continuing development of Bariatric/Metabolic surgery is expecting.%随着肥胖问题的日益严重以及微创减重手术的发展,减重手术在近年来呈现跳跃式的发展,也发展出独立的减重外科分支.减重手术不但是病态性肥胖患者目前唯一有效的治疗方法,而且逐渐发展为代谢性手术,为难治性的肥胖合并糖尿病患者提供了一种新的治疗方法.减重手术的术式数十年发生了很大的变化,目前的减重手术经过不断的改进及发展,已成为一种相对安全和有效的外科治疗方法.新的代谢性手术仍在不断地发展,预期对未来糖尿病的治疗会有很大的突破.减重外科的专科化发展则是减重手术蓬勃发展后的必然趋势,独立的减重外科可以专注于减重手术的服务以及质量提升,对减

  1. Place of upper endoscopy before and after bariatric surgery: A multicenter experience with 3219 patients

    Science.gov (United States)

    Abd Ellatif, Mohamed E; Alfalah, Haitham; Asker, Walid A; El Nakeeb, Ayman E; Magdy, Alaa; Thabet, Waleed; Ghaith, Mohamed A; Abdallah, Emad; Shahin, Rania; Shoma, Asharf; Dawoud, Ibraheim E; Abbas, Ashraf; Salama, Asaad F; Ali Gamal, Maged

    2016-01-01

    AIM: To study the preoperative and postoperative role of upper esophagogastroduodenoscopy (EGD) in morbidly obese patients. METHODS: This is a multicenter retrospective study by reviewing the database of patients who underwent bariatric surgery (laparoscopic sleeve gastrectomy, laparoscopic Roux en Y gastric bypass, or laparoscopic minigastric bypass) in the period between 2001 June and 2015 August (Jahra Hospital-Kuwait, Hafr Elbatin Hospital and King Saud Medical City-KSA, and Mansoura University Hospital - Egypt). Patients with age 18-65 years, body mass index (BMI) > 40, or > 35 with comorbidities after failure of many dietetic regimen and acceptable levels of surgical risk were included in the study after having an informed signed consent. We retrospectively reviewed the medical charts of all morbidly obese patients. The patients’ preoperative data included clinical history including upper digestive symptoms and preoperative full workup including EGD. Only patients whose charts revealed weather they were symptomatic or not were studied. We categorized patients accordingly into two groups; with (group A) or without (group B) upper digestive symptoms. The endoscopic findings were categorized into 4 groups based on predetermined criteria. The medical record of patients who developed stricture, leak or bleeding after bariatric surgery was reviewed. Logestic regression analysis was used to identify preoperative predictors that might be associated with abnormal endoscopic findings. RESULTS: Three thousand, two hundred and nineteen patients in the study period underwent bariatric surgery (75% LSG, 10% LRYDB, and 15% MGB). Mean BMI was 43 ± 13, mean age 37 ± 9 years, 79% were female. Twenty eight percent had presented with upper digestive symptoms (group A). EGD was considered normal in 2414 (75%) patients (9% group A vs 66% group B, P = 0.001). The abnormal endoscopic findings were found high in those patients with upper digestive symptoms. Abnormal findings (one

  2. Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups

    Science.gov (United States)

    de Zwaan, Martina; Georgiadou, Ekaterini; Stroh, Christine E.; Teufel, Martin; Köhler, Hinrich; Tengler, Maxi; Müller, Astrid

    2014-01-01

    Background: Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning. Methods: In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7). Results: Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole. PMID:25477839

  3. Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups

    Directory of Open Access Journals (Sweden)

    Martina eDe Zwaan

    2014-11-01

    Full Text Available Background: Massive weight loss (MWL following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image and physical functioning.Methods: In this cross-sectional study 3 groups were compared: 1 patients prior to bariatric surgery (n=79, 2 patients after bariatric surgery who had not undergone BCS (n=252, and 3 patients after bariatric surgery who underwent subsequent body contouring surgery (BCS (n=62. All participants completed self-report questionnaires assessing body image (MBSRQ, quality of life (IWQOL-Lite, symptoms of depression (PHQ-9 and anxiety (GAD-7.Results: Overall, 62 patients (19.2% reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%, thigh lifts (24.2%, and breast lifts (16.1%. Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients; however, there were fewer differences between patients with and without BCS. Patients after BCS reported better appearance evaluation, body area satisfaction, and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better appearance evaluation and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.

  4. Protocolo eletrônico multiprofissional em cirurgia bariátrica Multiprofessional electronic protocol in bariatric surgery

    Directory of Open Access Journals (Sweden)

    Denise Serpa Bopp Nassif

    2011-09-01

    protocolo eletrônico e suas coletas foram disponibilizados para visualização via internet utilizando SINPE WEB©.BACKGROUND: Obesity is a multi factorial disease. Data collection plays a fundamental role for conducting papers with high level of quality and obesity surgery lacks the means to carry out prospective studies with high reliability. Data from electronic protocols are more complete, have fewer errors, are more consistent and have a low percentage of violations in relation to paper charts. AIM: 1 To create a theoretical basis of clinical data regarding the multiprofessionalism on metabolic and bariatric surgery; 2 to computerize this basis by transforming it into electronic multi professional protocol; 3 to incorporate it into the SINPE©; 4 to provide the protocol address and their collections for viewing via the Internet using SINPE WEB©. METHOD: The creation of the theoretical background was done in Word© - later transformed into digital form to be used as electronic protocol - based on literature review of nine textbooks in morbid obesity, bariatric surgery and metabolic multi professionalism books, special books in psychology and nutrition applied to the subject. Was added systematic review of the literature based on scientific articles published over the last five years in Medline/Pubmed, Lilacs and Scielo and in theses and dissertations done with electronic protocols. Thus, 10,306 items were computerized in a hierarchical and branched containing data related to medicine, physiotherapy, psychology and nutrition applied to the subject. RESULTS: The complete protocol can be accessed to view in site www.sinpe.com.br CONCLUSIONS: 1 It was possible to create electronic database regarding the clinical multi professionalism on bariatric and metabolic surgery to collect standardized information; 2 it was possible to computerized the database; 3 it is incorporated into the SINPE©; 4 the electronic protocol and its collections were made available for viewing via

  5. A Cognitive-Behavioral Mindfulness Group Therapy Intervention for the Treatment of Binge Eating in Bariatric Surgery Patients

    Science.gov (United States)

    Leahey, Tricia M.; Crowther, Janis H.; Irwin, Sharon R.

    2008-01-01

    Binge eating is a negative indicator of post-surgical weight loss and health outcome in bariatric surgery patients (Hsu, Bentancourt, Sullivan, 1996). Cognitive-behavioral techniques and mindfulness-based practices have been shown to successfully treat binge eating (Agras, Telch, Arnow, Eldredge, & Marnell, 1997; Kristeller & Hallett, 1999). This…

  6. Fatty acid composition of adipose tissue triglycerides in obese diabetic women after bariatric surgery: a 2-year follow up.

    Science.gov (United States)

    Kunešová, M; Sedláčková, B; Bradnová, O; Tvrzická, E; Staňková, B; Šrámková, P; DoleŽalová, K; Kalousková, P; Hlavatý, P; Hill, M; Bendlová, B; Fried, M; Hainer, V; Vrbíková, J

    2015-01-01

    Bariatric surgery is the most effective method in the treatment of obesity and type 2 diabetes (T2DM). The aim of this study was to evaluate the effects of different types of bariatric procedures on remission of T2DM and on the fatty acid composition in subcutaneous adipose tissue. Patients included obese diabetic women who underwent bariatric surgery: biliopancreatic diversion (BPD), n=8, laparoscopic gastric banding (LAGB), n=9 or laparoscopic greater curvature plication (LGCP), n=12. Anthropometric characteristics and fatty acid composition of adipose tissue (FA AT) were analyzed before surgery, then 6 months and 2 years after surgery. FA AT was analyzed by gas chromatography. Diabetes remission was estimated. BPD was most efficient in inducing a remission of diabetes (p=0.004). Significantly higher increases in lauric (12:0), myristoleic (14:1n-5) and palmitoleic (16:1n-7) acids and delta-9 desaturase were found two years after BPD, suggesting higher lipogenesis in adipose tissue. Docosatetraenoic acid (22:4n-6) increased significantly after BPD, while docosapentaenoic acid (22:5n-3) decreased 6 months after BPD and increased after 2 years. No changes were found after LAGB and LGCP after 2 years. Bariatric surgery led to significant changes in the fatty acid composition of subcutaneous adipose tissue in severely obese diabetic women after six months and two years, and was partly influenced by the type of surgery used. PMID:26680476

  7. Cognitive and emotional processes that promote and obstruct a successful outcome after bariatric surgery for morbid obesity

    NARCIS (Netherlands)

    Zijlstra, H.

    2011-01-01

    The studies in this thesis were aimed at examining cognitive and emotional factors that predict or obstruct a successful weight outcome after bariatric surgery (weight loss surgery) for morbid obesity. The thesis includes two studies with a cross-sectional and four studies with a prospective design.

  8. Relevance of Adipose Tissue Stiffness Evaluated by Transient Elastography (AdipoScan™) in Morbidly Obese Patients before Bariatric Surgery

    Science.gov (United States)

    Sasso, Magali; Abdennour, Meriem; Liu, Yuejun; Hazrak, Hecham; Aron-Wisnewsky, Judith; Bouillot, Jean-Luc; Le Naour, Gilles; Bedossa, Pierre; Torjman, Joan; Clément, Karine; Miette, Véronique

    Subcutaneous adipose tissue (scAT) in human obesity undergoes severe alteration such as fibrosis which is related to metabolic alterations and to less efficiency in losing weight after bariatric surgery. There is currently no non-invasive tool to assess fibrosis in scAT. Vibration Controlled Transient Elastography (VCTE) using FibroScan® is widely used to assess liver fibrosis in clinical practice. A novel device named AdipoScan™ which is based on VCTE has been developed by Echosens (Paris) so as to assess scAT. The objective of this study is to show the first AdipoScan clinical results. AdipoScan™ was assessed in vivo on 73 morbidly obese patients candidate for bariatric surgery who were enrolled in the Pitié Salpêtrière hospital. scAT shear wave speed measured by AdipoScan™ is significantly associated with scAT fibrosis, gender, hypertension status, total body fat mass assessed by DXA, hypertension status, glycemic, lipid, hepatic parameters and adiponectin. Results suggest that scAT evaluation before bariatric surgery can be useful in clinical practice since it is related to scAT fibrosis -who plays in role in weight loss resistance after bariatric surgery- and to obesity induced co-morbidities such as diabetes, hypertension liver dysfunction.

  9. Restoration of Glycemic Control in Patients with Type 2 Diabetes Following Bariatric Surgery is Associated with Reduction in Microparticles

    Science.gov (United States)

    Cheng, V.; Kashyap, S.R.; Schauer, P.R.; Kirwan, J.P.; McCrae, K.R.

    2011-01-01

    Background Microparticles bud from cellular elements during inflammation and are associated with vascular dysfunction related to type 2 diabetes. Although weight loss is known to reduce inflammation, the metabolic effects of bariatric surgery on microparticle concentration and composition are not known. Objectives To determine the effect of bariatric surgery on microparticle concentration and correlate these changes with clinical parameters. Setting Multispecialty group practice Methods We studied 14 obese subjects with type 2 diabetes two weeks before and at one and 12 months following bariatric surgery. Nine of the patients underwent Roux-en-Y gastric bypass and 5 received gastric restrictive surgery. Results One month following surgery, body mass index was reduced by ~10%, glycemic control improved dramatically (P 60% reduction in endothelial, platelet microparticles and CRP levels (P 50% reduction in monocyte microparticles compared to pre-surgery. The reduction in monocyte microparticles one month after surgery was strongly associated with the reduction in hemoglobin A1c (P < 0.05). The reduction in monocyte microparticles 12 months following surgery correlated strongly with the reduction in body mass index (P < 0.05). Conclusion The reduction in microparticles after bariatric surgery in patients with type 2 diabetes reflects an attenuation of inflammation and this mechanism may contribute to normalization of glycemic control. PMID:22093380

  10. Self-determination and motivation for bariatric surgery: a qualitative study.

    Science.gov (United States)

    Park, Juyeon

    2016-10-01

    This study examined how obese individuals acquire their motivation to undergo weight loss surgery and characterized the motivations within the framework of the self-determination theory (SDT). Participants expecting to have bariatric surgery were recruited and participated in semi-structured interviews. Interview accounts characterized different types of motivation for individuals seeking surgical weight loss treatments on the SDT continuum of relative autonomy. This study demonstrated that the more one's motivation was internally regulated, related to one's personal life and supported for competency, the more personal and hopeful were the anecdotes participants mentioned in accounts, thus the more positive the surgical outcomes were anticipated. Study limitations and future research were discussed as was the need for a systematic scheme to categorize types of motivation within the SDT, a longitudinal approach to measure actual weight loss outcomes based on the patient's pre-surgical motivation, and a further investigation with a larger sample size and balanced gender ratio. Practical implications of the study findings were also discussed as a novel strategy to internalize bariatric patients' motivation, further helping to improve their long-term quality of life post-surgery. PMID:26708344

  11. Impact of a CBT psychotherapy group on post-operative bariatric patients.

    Science.gov (United States)

    Beaulac, Julie; Sandre, Daniella

    2015-01-01

    Psychological difficulties for patients seeking bariatric surgery are greater and in the post-operative phase, a significant minority go on to experience significant psychosocial difficulties, increasing their risk of poorer post-operative adjustment and associated weight regain. 17 post-operative patients participated in an eight-week cognitive behavioral therapy (CBT) based psychotherapy group at the Ottawa Hospital. A pre-post design with a 3-month follow-up investigated the impact of the group on emotional eating, general as well as obesity-specific adjustment, psychological distress, and attachment. There were significant and meaningful improvements in patients' level of psychological distress, perceived difficulties in their lives, and weight-related adjustment that were maintained at a 3-month follow-up period. Although statistical change was not significant, there were also meaningful improvements in emotional overeating and relationship anxiety and avoidance. The intervention also appeared to be acceptable to patients in that attendance and satisfaction were good. Findings suggest that a short-term CBT psychotherapy group led to significant and meaningful benefits in psychological wellbeing for post-surgical bariatric patients.

  12. Self-determination and motivation for bariatric surgery: a qualitative study.

    Science.gov (United States)

    Park, Juyeon

    2016-10-01

    This study examined how obese individuals acquire their motivation to undergo weight loss surgery and characterized the motivations within the framework of the self-determination theory (SDT). Participants expecting to have bariatric surgery were recruited and participated in semi-structured interviews. Interview accounts characterized different types of motivation for individuals seeking surgical weight loss treatments on the SDT continuum of relative autonomy. This study demonstrated that the more one's motivation was internally regulated, related to one's personal life and supported for competency, the more personal and hopeful were the anecdotes participants mentioned in accounts, thus the more positive the surgical outcomes were anticipated. Study limitations and future research were discussed as was the need for a systematic scheme to categorize types of motivation within the SDT, a longitudinal approach to measure actual weight loss outcomes based on the patient's pre-surgical motivation, and a further investigation with a larger sample size and balanced gender ratio. Practical implications of the study findings were also discussed as a novel strategy to internalize bariatric patients' motivation, further helping to improve their long-term quality of life post-surgery.

  13. Psychological Correlates to Dysfunctional Eating Patterns among Morbidly Obese Patients Accepted for Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Hege Gade

    2014-03-01

    Full Text Available Objective: To examine the relationships between dysfunctional eating patterns, personality, anxiety and depression in morbidly obese patients accepted for bariatric surgery. Design: The study used cross-sectional data collected by running a randomized controlled trial (http://clinicaltrials.gov/ct2/show/NCT01403558. Subjects: A total of 102 patients (69 women, 33 men with a mean (SD age of 42.6 (9.8 years and a mean BMI of 43.5 (4.4 kg/m2 participated. Measurements: Measurements included the NEO-PI-R (personality: neuroticism, extroversion, openness, conscientiousness and agreeableness, the TFEQ-R-21 (dysfunctional eating: emotional eating (EE, uncontrolled eating (UE and cognitive restraint of eating (CR and the HADS (anxiety and depression. Results: The personality traits neuroticism and conscientiousness were more strongly correlated with dysfunctional eating than anxiety and depression. These differences were most pronounced for emotional and cognitive restraint of eating. Emotional eating occurred more often in female than in male patients, a finding that was partially mediated by neuroticism but not by anxiety and depression. Conclusion: Personality traits may be important to address in the clinical management of morbidly obese patients seeking bariatric surgery as neuroticism is particularly salient in female patients displaying an emotional eating behaviour.

  14. New obesity classification criteria as a tool for bariatric surgery indication.

    Science.gov (United States)

    De Lorenzo, Antonino; Soldati, Laura; Sarlo, Francesca; Calvani, Menotti; Di Lorenzo, Nicola; Di Renzo, Laura

    2016-01-14

    Obesity plays relevant pathophysiological role in the development of health problems, arising as result of complex interaction of genetic, nutritional, and metabolic factors. Due to the role of adipose tissue in lipid and glucose metabolism, and low grade inflammation, it is necessary to classify obesity on the basis of body fat composition and distribution, rather than the simply increase of body weight, and the Body Mass Index. The new term of adiposopathy (''sick fat'') clearly defines the pathogenic role of adipose tissue. Four phenotypes of obese individuals have been described: (1) normal weight obese (NWO); (2) metabolically obese normal weight; (3) metabolically healthy obese; and (4) metabolically unhealthy obese or "at risk" obese. Moreover, sarcopenic obesity has been related to all the phenotypes. The category of normal weight lean, represented by metabolically healthy normal weight has been classified to distinguish from NWO. It is crucial to recommend a bariatric surgery taking into account adiposopathy and sick fat that occurs with the expansion of fat mass, changing the inflammatory and metabolic profile of the patient. Body fat percentage and genetic polymorphism have to be evaluated to personalize the best bariatric surgery intervention. PMID:26811617

  15. Weight loss after bariatric surgery normalizes brain opioid receptors in morbid obesity.

    Science.gov (United States)

    Karlsson, H K; Tuulari, J J; Tuominen, L; Hirvonen, J; Honka, H; Parkkola, R; Helin, S; Salminen, P; Nuutila, P; Nummenmaa, L

    2016-08-01

    Positron emission tomography (PET) studies suggest opioidergic system dysfunction in morbid obesity, while evidence for the role of the dopaminergic system is less consistent. Whether opioid dysfunction represents a state or trait in obesity remains unresolved, but could be assessed in obese subjects undergoing weight loss. Here we measured brain μ-opioid receptor (MOR) and dopamine D2 receptor (D2R) availability in 16 morbidly obese women twice-before and 6 months after bariatric surgery-using PET with [(11)C]carfentanil and [(11)C]raclopride. Data were compared with those from 14 lean control subjects. Receptor-binding potentials (BPND) were compared between the groups and between the pre- and postoperative scans among the obese subjects. Brain MOR availability was initially lower among obese subjects, but weight loss (mean=26.1 kg, s.d.=7.6 kg) reversed this and resulted in ~23% higher MOR availability in the postoperative versus preoperative scan. Changes were observed in areas implicated in reward processing, including ventral striatum, insula, amygdala and thalamus (P'ssystem plays an important role in the pathophysiology of human obesity. Because bariatric surgery and concomitant weight loss recover downregulated MOR availability, lowered MOR availability is associated with an obese phenotype and may mediate excessive energy uptake. Our results highlight that understanding the opioidergic contribution to overeating is critical for developing new treatments for obesity. PMID:26460230

  16. Fatal Nonhepatic Hyperammonemia in ICU Setting: A Rare but Serious Complication following Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Gyanendra Acharya

    2016-01-01

    Full Text Available Bariatric surgery is well established in reducing weight and improving the obesity-associated morbidity and mortality. Hyperammonemic encephalopathy following bariatric surgery is rare but highly fatal if not diagnosed in time and managed aggressively. Both macro- and micronutrients deficiencies play a role. A 42-year-old Hispanic female with a history of Roux-en-Y Gastric Bypass Procedure was brought to ED for progressive altered mental status. Physical exam was remarkable for drowsiness with Glasgow Coma Scale 11, ascites, and bilateral pedal edema. Labs showed elevated ammonia, low hemoglobin, low serum prealbumin, albumin, HDL, and positive toxicology. She remained obtunded despite the treatment with Narcan and flumazenil and the serum ammonia level fluctuated despite standard treatment with lactulose and rifaximin. Laboratory investigations helped to elucidate the etiology of the hyperammonemia most likely secondary to unmasking the functional deficiency of the urea cycle enzymes. Hyperammonemia in the context of normal liver function tests becomes diagnostically challenging for physicians. Severe hyperammonemia is highly fatal. Early diagnosis and aggressive treatment can alter the prognosis favorably.

  17. Fatal Nonhepatic Hyperammonemia in ICU Setting: A Rare but Serious Complication following Bariatric Surgery

    Science.gov (United States)

    Mehra, Sunil; Patel, Ronakkumar; Frunza-Stefan, Simona; Kaur, Harmanjot

    2016-01-01

    Bariatric surgery is well established in reducing weight and improving the obesity-associated morbidity and mortality. Hyperammonemic encephalopathy following bariatric surgery is rare but highly fatal if not diagnosed in time and managed aggressively. Both macro- and micronutrients deficiencies play a role. A 42-year-old Hispanic female with a history of Roux-en-Y Gastric Bypass Procedure was brought to ED for progressive altered mental status. Physical exam was remarkable for drowsiness with Glasgow Coma Scale 11, ascites, and bilateral pedal edema. Labs showed elevated ammonia, low hemoglobin, low serum prealbumin, albumin, HDL, and positive toxicology. She remained obtunded despite the treatment with Narcan and flumazenil and the serum ammonia level fluctuated despite standard treatment with lactulose and rifaximin. Laboratory investigations helped to elucidate the etiology of the hyperammonemia most likely secondary to unmasking the functional deficiency of the urea cycle enzymes. Hyperammonemia in the context of normal liver function tests becomes diagnostically challenging for physicians. Severe hyperammonemia is highly fatal. Early diagnosis and aggressive treatment can alter the prognosis favorably. PMID:27144037

  18. Bile acids and bariatric surgery%胆汁酸与减重手术

    Institute of Scientific and Technical Information of China (English)

    刘光耀; 王群伟; 刘威

    2015-01-01

    As an essential metabolic molecule, bile acids regulate triglyceride, cholesterol, energy metabolism. Bariatric surgery offers a treatment that can reduce weight and induce metabolic syndrome, but the mechanism is still unclear. New researches reveal that serum bile acids are elevated after surgery, as well as the improvement of metabolic disease. The surgery changes gastrointestinal tract, resulting in a short circuiting of the enterohepatic circulation of bile acids. Here we review the bile acids metabolism and their effect after bariatric surgery.%胆汁酸作为机体的重要代谢信号分子,参与了糖类、脂肪及能量的代谢。减重手术目前是治疗治疗肥胖症和代谢综合征有效途径之一,但其机制尚不明确。研究发现,减重手术后胆汁酸水平明显升高,并且与代谢综合征改善正相关。由于减重手术后胃肠道生理结构发生变化,必然会对胆汁酸代谢产生影响。本文对胆汁酸对代谢和对减重手术的影响作一综述。

  19. Persistently High Hip Circumference after Bariatric Surgery Is a Major Hurdle to Successful Hip Replacement

    Directory of Open Access Journals (Sweden)

    Menachem M. Meller

    2014-01-01

    Full Text Available The prevalence of class III obesity (BMI≥40 kg/m2 in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was successful as her BMI declined from 52.0 kg/m2 to 33.7 kg/m2. However, her hip circumference after weight loss remained persistently high. Therefore, at surgery the soft tissue tunnel geometry presented major challenges. Tunnel depth and immobility of the soft tissue interfered with retractor placement, tissue reflection, and surgical access to the acetabulum. Therefore a traditional cup placement could not be achieved. Instead, a hemiarthroplasty was performed. After surgery her pain and reliance on external support decreased. But her functional independence never improved. This case demonstrates that a lower BMI after bariatric surgery may improve the metabolic profile and decrease anesthesia risk, but the success of total hip arthroplasties remains problematic if fat mass in the operative field (i.e., high hip circumference remains high.

  20. Herbal Medicine

    Science.gov (United States)

    ... for its scent, flavor, or therapeutic properties. Herbal medicines are one type of dietary supplement. They are ... and fresh or dried plants. People use herbal medicines to try to maintain or improve their health. ...

  1. Diabetes Medicines

    Science.gov (United States)

    Diabetes means your blood glucose, or blood sugar, levels are too high. If you can't control your diabetes with wise food choices and physical activity, you may need diabetes medicines. The kind of medicine you take depends ...

  2. Weight loss by calorie restriction versus bariatric surgery differentially regulates the hypothalamo-pituitary-adrenocortical axis in male rats.

    Science.gov (United States)

    Grayson, Bernadette E; Hakala-Finch, Andrew P; Kekulawala, Melani; Laub, Holly; Egan, Ann E; Ressler, Ilana B; Woods, Stephen C; Herman, James P; Seeley, Randy J; Benoit, Stephen C; Ulrich-Lai, Yvonne M

    2014-12-01

    Behavioral modifications for the treatment of obesity, including caloric restriction, have notoriously low long-term success rates relative to bariatric weight-loss surgery. The reasons for the difference in sustained weight loss are not clear. One possibility is that caloric restriction alone activates the stress-responsive hypothalamo-pituitary-adrenocortical (HPA) axis, undermining the long-term maintenance of weight loss, and that this is abrogated after bariatric surgery. Accordingly, we compared the HPA response to weight loss in five groups of male rats: (1) high-fat diet-induced obese (DIO) rats treated with Roux-en-Y gastric bypass surgery (RYGB, n = 7), (2) DIO rats treated with vertical sleeve gastrectomy (VSG, n = 11), (3) DIO rats given sham surgery and subsequently restricted to the food intake of the VSG/RYGB groups (Pair-fed, n = 11), (4) ad libitum-fed DIO rats given sham surgery (Obese, n = 11) and (5) ad libitum chow-fed rats given sham surgery (Lean, n = 12). Compared with Lean controls, food-restricted rats exhibited elevated morning (nadir) non-stress plasma corticosterone concentration and increased hypothalamic corticotropin-releasing hormone and vasopressin mRNA expression, indicative of basal HPA activation. This was largely prevented when weight loss was achieved by bariatric surgery. DIO increased HPA activation by acute (novel environment) stress and this was diminished by bariatric surgery-, but not pair-feeding-, induced weight loss. These results indicate that the HPA axis is differentially affected by weight loss from caloric restriction versus bariatric surgery, and this may contribute to the differing long-term effectiveness of these two weight-loss approaches. PMID:25238021

  3. An Untargeted Metabolomics Approach to Characterize Short-Term and Long-Term Metabolic Changes after Bariatric Surgery

    Science.gov (United States)

    Narath, Sophie H.; Mautner, Selma I.; Svehlikova, Eva; Schultes, Bernd; Pieber, Thomas R.; Sinner, Frank M.; Gander, Edgar; Libiseller, Gunnar; Schimek, Michael G.; Sourij, Harald; Magnes, Christoph

    2016-01-01

    Bariatric surgery is currently one of the most effective treatments for obesity and leads to significant weight reduction, improved cardiovascular risk factors and overall survival in treated patients. To date, most studies focused on short-term effects of bariatric surgery on the metabolic profile and found high variation in the individual responses to surgery. The aim of this study was to identify relevant metabolic changes not only shortly after bariatric surgery (Roux-en-Y gastric bypass) but also up to one year after the intervention by using untargeted metabolomics. 132 serum samples taken from 44 patients before surgery, after hospital discharge (1–3 weeks after surgery) and at a 1-year follow-up during a prospective study (NCT01271062) performed at two study centers (Austria and Switzerland). The samples included 24 patients with type 2 diabetes at baseline, thereof 9 with diabetes remission after one year. The samples were analyzed by using liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS, HILIC-QExactive). Raw data was processed with XCMS and drift-corrected through quantile regression based on quality controls. 177 relevant metabolic features were selected through Random Forests and univariate testing and 36 metabolites were identified. Identified metabolites included trimethylamine-N-oxide, alanine, phenylalanine and indoxyl-sulfate which are known markers for cardiovascular risk. In addition we found a significant decrease in alanine after one year in the group of patients with diabetes remission relative to non-remission. Our analysis highlights the importance of assessing multiple points in time in subjects undergoing bariatric surgery to enable the identification of biomarkers for treatment response, cardiovascular benefit and diabetes remission. Key-findings include different trend pattern over time for various metabolites and demonstrated that short term changes should not necessarily be used to identify important long

  4. An Untargeted Metabolomics Approach to Characterize Short-Term and Long-Term Metabolic Changes after Bariatric Surgery.

    Science.gov (United States)

    Narath, Sophie H; Mautner, Selma I; Svehlikova, Eva; Schultes, Bernd; Pieber, Thomas R; Sinner, Frank M; Gander, Edgar; Libiseller, Gunnar; Schimek, Michael G; Sourij, Harald; Magnes, Christoph

    2016-01-01

    Bariatric surgery is currently one of the most effective treatments for obesity and leads to significant weight reduction, improved cardiovascular risk factors and overall survival in treated patients. To date, most studies focused on short-term effects of bariatric surgery on the metabolic profile and found high variation in the individual responses to surgery. The aim of this study was to identify relevant metabolic changes not only shortly after bariatric surgery (Roux-en-Y gastric bypass) but also up to one year after the intervention by using untargeted metabolomics. 132 serum samples taken from 44 patients before surgery, after hospital discharge (1-3 weeks after surgery) and at a 1-year follow-up during a prospective study (NCT01271062) performed at two study centers (Austria and Switzerland). The samples included 24 patients with type 2 diabetes at baseline, thereof 9 with diabetes remission after one year. The samples were analyzed by using liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS, HILIC-QExactive). Raw data was processed with XCMS and drift-corrected through quantile regression based on quality controls. 177 relevant metabolic features were selected through Random Forests and univariate testing and 36 metabolites were identified. Identified metabolites included trimethylamine-N-oxide, alanine, phenylalanine and indoxyl-sulfate which are known markers for cardiovascular risk. In addition we found a significant decrease in alanine after one year in the group of patients with diabetes remission relative to non-remission. Our analysis highlights the importance of assessing multiple points in time in subjects undergoing bariatric surgery to enable the identification of biomarkers for treatment response, cardiovascular benefit and diabetes remission. Key-findings include different trend pattern over time for various metabolites and demonstrated that short term changes should not necessarily be used to identify important long

  5. Usefulness of an accelerated transoesophageal stress echocardiography in the preoperative evaluation of high risk severely obese subjects awaiting bariatric surgery

    Directory of Open Access Journals (Sweden)

    Tessier Michel

    2010-07-01

    Full Text Available Abstract Background Severe obesity is associated with an increased risk of coronary artery disease (CAD. Bariatric surgery is an effective procedure for long term weight management as well as reduction of comorbidities. Preoperative evaluation of cardiac operative risk may often be necessary but unfortunately standard imaging techniques are often suboptimal in these subjects. The purpose of this study was to demonstrate the feasibility, safety and utility of transesophageal dobutamine stress echocardiography (TE-DSE using an adapted accelerated dobutamine infusion protocol in severely obese subjects with comorbidities being evaluated for bariatric surgery for assessing the presence of myocardial ischemia. Methods Subjects with severe obesity [body mass index (BMI >40 kg/m2] with known or suspected CAD and being evaluated for bariatric surgery were recruited. Results Twenty subjects (9M/11F, aged 50 ± 8 years (mean ± SD, weighing 141 ± 21 kg and with a BMI of 50 ± 5 kg/m2 were enrolled in the study and underwent a TE-DSE. The accelerated dobutamine infusion protocol used was well tolerated. Eighteen (90% subjects reached their target heart rate with a mean intubation time of 13 ± 4 minutes. Mean dobutamine dose was 31.5 ± 9.9 ug/kg/min while mean atropine dose was 0.5 ± 0.3 mg. TE-DSE was well tolerated by all subjects without complications including no significant arrhythmia, hypotension or reduction in blood arterial saturation. Two subjects had abnormal TE-DSE suggestive of myocardial ischemia. All patients underwent bariatric surgery with no documented cardiovascular complications. Conclusions TE-DSE using an accelerated infusion protocol is a safe and well tolerated imaging technique for the evaluation of suspected myocardial ischemia and cardiac operative risk in severely obese patients awaiting bariatric surgery. Moreover, the absence of myocardial ischemia on TE-DSE correlates well with a low operative risk of cardiac event.

  6. Medicine Women.

    Science.gov (United States)

    Beiswenger, James N., Ed.; Jeanotte, Holly, Ed.

    Described as a survival manual for Indian women in medicine, this collected work contains diverse pieces offering inspiration and practical advice for Indian women pursuing or considering careers in medicine. Introductory material includes two legends symbolizing the Medicine or Spirit Woman's role in Indian culture and an overview of Indians Into…

  7. [SPORT MEDICINE].

    Science.gov (United States)

    Constantini, Naama; Mann, Gideon

    2016-06-01

    Sports Medicine is a relatively new subject in medicine and includes a variety of medical and paramedical fields. Although sports medicine is mistakenly thought to be mainly for sports professionals/athletes, it actually encompasses the entire population, including the active and non-active healthy populations, as well as the sick. Sports medicine also engages amateur sportsmen and strives to promote physical activity and quality of life in the general population. Hence, the field involves all ages from childhood to old age, aiming to preserve and support every person at every age. Sports medicine, which started developing in the 19th century, is today a specialty, primary or secondary, in many countries, while in others it is a fellowship or under the jurisdiction of local or sports authorities. In Israel, the field exists since the 1950's and is advanced. The Sports Medicine Society founded a 3-year course of continued education in sport medicine as part of the Tel-Aviv University Faculty of Medicine. Later on, a fellowship in general Sports Medicine and in Orthopedic Sports Medicine were developed within the Israel Medical Association. A year ago, Israel formally became a member of the global "Exercise is Medicine" foundation, and under this title promotes education for health care providers on exercise prescription. The understanding of the importance of physical activity and fitness as part of a healthy lifestyle is increasing in Israel, as well as the number of amateur athletes, and the profession of sports medicine takes a big part in this process.

  8. Interfaces between bariatric surgery and oral health: a longitudinal survey Interface entre cirurgia bariátrica e saúde bucal: estudo longitudinal

    OpenAIRE

    Juliane Avansini Marsicano; Patrícia Garcia de Moura Grec; Lídia Barbieri Belarmino; Reginaldo Ceneviva; Sílvia Helena de Carvalho Sales Peres

    2011-01-01

    PURPOSE: To evaluate oral changes, such as dental caries, periodontal disease, dental wear and salivary flow in bariatric patients. Fifty four obese patients who underwent bariatric surgery were studied before (n=54), up after 3 months (n=24) and 6 months (n=16). METHODS: Indices for evaluating oral conditions were: DMFT, CPI, DWI and salivary flow. OIDP questionnaire was used to assess the impact of oral health on quality of life. ANOVA and Spearman correlation were used (p0.05), presence of...

  9. Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial

    OpenAIRE

    Patrícia Brigatto; Carbinatto, Jéssica C.; Costa, Carolina M.; Montebelo, Maria I. L.; Irineu Rasera-Júnior; Pazzianotto-Forti, Eli M.

    2014-01-01

    Objective: To evaluate whether the application of bilevel positive airway pressure in the postoperative period of bariatric surgery might be more effective in restoring lung volume and capacity and thoracic mobility than the separate application of expiratory and inspiratory positive pressure. Method: Sixty morbidly obese adult subjects who were hospitalized for bariatric surgery and met the predefined inclusion criteria were evaluated. The pulmonary function and thoracic mobility were preope...

  10. Peroral endoscopic reduction of dilated gastrojejunalanastomosis after bariatric surgery: Techniques andefficacy

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    AIM To investigate the techniques and efficacy ofperoral endoscopic reduction of dilated gastrojejunalanastomosis after bariatric surgery.METHODS: An extensive English language literaturesearch was conducted using PubMed, MEDLINE,Medscape and Google to identify peer-reviewed originaland review articles using the keywords "bariatricendoscopic suturing", "overstitch bariatric surgery","endoscopic anastomotic reduction", "bariatric surgery","gastric bypass", "obesity", "weight loss". We identifiedarticles describing technical feasibility, safety, efficacy,and adverse outcomes of overstitch endoscopic suturingsystem for transoral outlet reduction in patients withweight regain following Roux-en-Y gastric bypass (RYGB).All studies that contained material applicable to the topicwere considered. Retrieved peer-reviewed original andreview articles were reviewed by the authors and thedata extracted using a standardized collection tool. Datawere analyzed using statistical analysis as percentages ofthe event.RESULTS: Four original published articles which met oursearch criteria were pooled. The total number cases werefifty-nine with a mean age of 46.75 years (34-63 years).Eight of the patients included in those studies weremales (13.6%) and fifty-one were females (86.4%). Themean time elapsed since the primary bypass surgerywas 5.75 years. The average pre-endoscopic procedurebody mass index (BMI) was 38.68 (27.5-48.5). Meanbody weight regained post-RYGB surgery was 13.4 kgfrom their post-RYGB nadir. The average pouch length atthe initial upper endoscopy was 5.75 cm (2-14 cm). Thepre-intervention anastomotic diameter was averagedat 24.85 mm (8-40 mm). Average procedure time was74 min (50-164 min). Mean post endoscopic interventionanastomotic diameter was 8 mm (3-15 mm). Weightreduction at 3 to 4 mo post revision noted to be an average of 10.1 kg. Average overall post revision BMIwas recorded at 37.7. The

  11. Anemia pós-cirurgia bariátrica: as causas nem sempre são relacionadas à cirurgia Anemia after bariatric surgery: the causes sometimes are not related to the surgery

    Directory of Open Access Journals (Sweden)

    Giorgio Alfredo Pedroso Baretta

    2008-06-01

    Full Text Available RACIONAL: As anemias ferropriva, perniciosa e megaloblástica são comuns após procedimentos bariátricos como o bypass e as derivações biliopancreáticas. As principais causas devem-se ao desvio duodenal e do jejuno proximal do trânsito alimentar e, em menor grau, às úlceras anastomóticas. Entretanto a dieta pobre em nutrientes, a suplementação vitamínica inadequada, medicamentos, uso de álcool e neoplasias devem ser lembrados. RELATO DOS CASOS: Os autores relatam dois casos de pacientes pós-procedimentos bariátricos com anemia severa sem controle clínico e cuja investigação identificou melanoma metastático em um caso e neoplasia colônica no segundo, ambos tratados cirurgicamente com bons resultados. CONCLUSÃO: Anemias são comuns após procedimentos bariátricos, porém causas atípicas como neoplasias devem ser suspeitadas nos pacientes mais idosos e principalmente naqueles refratários ao controle clínico.BACKGROUND: Iron deficiency anemia, pernicious and megaloblastic are common after gastric bypass and biliopancreatic diversion. The main causes are due to duodenal exclusion and anastomotic ulcers. However, low protein diet, vitaminic supplementation, medicines, alcohol and tumors must be remembered. CASES REPORT: The authors relate two cases of severe anemia after bariatric procedures that were diagnosed as metastatic melanoma in small bowel and a colorectal cancer treated surgically with good results. CONCLUSION: Anemias are common after bariatric surgery, however unusual causes like tumors must be suspected in the elderly and in those patients that clinical treatment didn't have good results.

  12. Contribution of 32 GWAS-identified common variants to severe obesity in European adults referred for bariatric surgery.

    Directory of Open Access Journals (Sweden)

    Reedik Mägi

    Full Text Available The prevalence of severe obesity, defined as body mass index (BMI ≥ 35.0 kg/m(2, is rising rapidly. Given the disproportionately high health burden and healthcare costs associated with this condition, understanding the underlying aetiology, including predisposing genetic factors, is a biomedical research priority. Previous studies have suggested that severe obesity represents an extreme tail of the population BMI variation, reflecting shared genetic factors operating across the spectrum. Here, we sought to determine whether a panel of 32 known common obesity-susceptibility variants contribute to severe obesity in patients (n = 1,003, mean BMI 48.4 ± 8.1 kg/m(2 attending bariatric surgery clinics in two European centres. We examined the effects of these 32 common variants on obesity risk and BMI, both as individual markers and in combination as a genetic risk score, in a comparison with normal-weight controls (n = 1,809, BMI 18.0-24.9 kg/m(2; an approach which, to our knowledge, has not been previously undertaken in the setting of a bariatric clinic. We found strong associations with severe obesity for SNP rs9939609 within the FTO gene (P = 9.3 × 10(-8 and SNP rs2815752 near the NEGR1 gene (P = 3.6 × 10(-4, and directionally consistent nominal associations (P<0.05 for 12 other SNPs. The genetic risk score associated with severe obesity (P = 8.3 × 10(-11 but, within the bariatric cohort, this score did not associate with BMI itself (P = 0.264. Our results show significant effects of individual BMI-associated common variants within a relatively small sample size of bariatric patients. Furthermore, the burden of such low-penetrant risk alleles contributes to severe obesity in this population. Our findings support that severe obesity observed in bariatric patients represents an extreme tail of the population BMI variation. Moreover, future genetic studies focused on bariatric patients may provide valuable insights into the pathogenesis of

  13. Body image in obese patients before and after stable weight reduction following bariatric surgery.

    Science.gov (United States)

    Adami, G F; Meneghelli, A; Bressani, A; Scopinaro, N

    1999-03-01

    The role of possessing an abnormal body weight in the body image alterations of obese patients was evaluated in bariatric surgery subjects prior to and at long term after operation, when body weight and shape had become steadily normalized. Body image was assessed by the body dissatisfaction scale of the Eating Disorders Inventory, the Body Shape Questionnaire, and the Body Attitude Questionnaire. When the individuals were obese, a sharply impaired body image was observed; following operation, weight loss corresponded to normalization of body dissatisfaction, feeling of fatness, and physical attractiveness, whereas body disparagement and salience of shape, although improved in comparison to preoperative data, remained significantly different from that of controls. In the obese patients, some aspects of body image alterations are substantially accounted for by overweight status; other aspects reflect inner feelings, which are partially independent of the actual body weight and shape. PMID:10193918

  14. Positive peritoneal fluid fungal cultures in postoperative peritonitis after bariatric surgery.

    Science.gov (United States)

    Zappella, N; Desmard, M; Chochillon, C; Ribeiro-Parenti, L; Houze, S; Marmuse, J-P; Montravers, P

    2015-09-01

    Postoperative peritonitis (POP) is a common surgical complication after bariatric surgery (BS). We assessed the importance of positive fungal cultures in these cases of POP admitted to the intensive care unit. Clinical features and outcome were compared in 25 (41%) Candida-positive patients (6 (22%) fluconazole-resistant Candida glabrata) and 36 patients without Candida infection. Candida infections were more commonly isolated in late-onset peritonitis and were often associated with multidrug-resistant bacteria. Risk factors for intensive care unit mortality (19.6%) were diabetes and superobesity. Candida infections, including fluconazole-resistant strains, are common in POP after BS. These data encourage the empirical use of a broad-spectrum antifungal agent.

  15. Type 2 diabetes, bariatric surgery and the risk of subsequent gestational diabetes

    Science.gov (United States)

    Steven, S; Woodcock, S; Small, P K; Taylor, R

    2011-01-01

    Women with pre-existing abnormal glucose regulation are certain to develop gestational diabetes in pregnancy and pre-gestational type 2 diabetes will become more difficult to control. However, an increasing number of women with type 2 diabetes have had bariatric surgery. In this group, the effect of pregnancy on glucose metabolism is unknown. We report two women with type 2 diabetes who underwent laparoscopic gastric bypass surgery with normalization of plasma glucose levels. During subsequent pregnancy, maternal blood glucose levels remained completely normal throughout. This is remarkable given the predisposition to abnormal glucose tolerance and the ongoing obesity, in the face of the insulin resistance of pregnancy. Women with prior type 2 diabetes reversed by gastric bypass surgery are not at high risk for gestational diabetes.

  16. A comparative analysis of Type 2 diabetes and binge eating disorder in a bariatric sample.

    Science.gov (United States)

    Webb, Jennifer B; Applegate, Katherine L; Grant, John P

    2011-08-01

    An emerging literature has illuminated an important link between Type 2 diabetes mellitus (DM) and binge eating disorder (BED) within obese cohorts. However, prior work has not examined this relationship specifically in a weight loss surgery (WLS) sample or fully explored potential psychosocial factors associated with this co-occurrence. Therefore, the present investigation sought to identify socio-demographic (i.e. age, education, BMI, ethnicity, gender, age of obesity onset) and psychological (i.e. depressive symptoms, hedonic hunger/food locus of control beliefs, severity of binge eating-related cognitions) correlates of the co-occurrence of Type 2 DM and BED among bariatric surgery candidates. An archival sample of 488 patients seeking surgical treatment for clinical obesity completed a standard battery of pre-operative psychosocial measures. The presence of BED was evaluated using a semi-structured clinical interview based on the DSM-IV TR (APA, 2000) and was further corroborated by responses on the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R; Spitzer, Yanovski, & Marcus, 1993). Results indicated that 8.2% of the sample was classified as having both Type 2 DM and BED concurrently. A multivariate logistic regression model revealed that in addition to other psychological (e.g., binge eating-related cognitions, hedonic hunger) and demographic variables (i.e. male gender), African American ethnicity (OR=3.3: 1.41-7.73) was a particularly robust indicator of comorbid status. Findings support and extend previous health disparity research urging greater attention to the needs of traditionally underserved, at-risk populations seeking treatment for obesity complicated by dysregulated eating and metabolism. Additionally, these preliminary results underscore the relevance of considering the potential benefits of providing quality comprehensive pre- and post-operative psychological care among bariatric patients towards optimizing both short- and long

  17. News media reports of patient deaths following 'medical tourism' for cosmetic surgery and bariatric surgery.

    Science.gov (United States)

    Turner, Leigh

    2012-04-01

    Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer-reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from 1993 to 2011, this article identifies and describes twenty-six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. Over half of the reported deaths occurred in two countries. Analysis of these news reports cannot be used to make causal claims about why the patients died. In addition, cases identified in news media accounts do not provide a basis for establishing the relative risk of traveling abroad for care instead of seeking elective cosmetic surgery at domestic health care facilities. Acknowledging these limitations, the case reports suggest the possibility that contemporary peer-reviewed scholarship is underreporting patient mortality in medical travel. The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of 'medical tourism' will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel. PMID:22420449

  18. ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem

    Directory of Open Access Journals (Sweden)

    Álvaro Antônio Bandeira FERRAZ

    2015-06-01

    Full Text Available Background The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The study compared three groups of patients according to the perioperative antibiotic prophylaxis administered intravenously and beginning at anesthesia induction: Group I consisting of 194 patients treated with two 3-g doses of ampicillin/sulbactam; Group II with 303 patients treated with a single 1-g dose of ertapenem; and Group III with 399 patients treated with a 2-g dose of cefazolin at anesthesia induction followed by a continuous infusion of cefazolin 1g throughout the surgical procedure. The rate of surgical site infection was analyzed, as well as its association with age, sex, preoperative weight, body mass index and comorbidities. Results The rates of surgical site infection were 4.16% in the group treated prophylactically with ampicillin/sulbactam, 1.98% in the ertapenem group and 1.55% in the continuous cefazolin group. Conclusion The prophylactic use of continuous cefazolin in surgeries for morbid obesity shows very promising results. These findings suggest that some prophylactic regimens need to be reconsidered and even substituted by more effective therapies for the prevention of surgical site infections in bariatric patients.

  19. Other aspects of bariatric surgery: liver steatosis, ferritin and cholesterol metabolism

    Directory of Open Access Journals (Sweden)

    A. E. Pontiroli

    2013-01-01

    Full Text Available Bariatric surgery developed in the late 1970 to treat severe hyperlipidemias in overweight individuals, not necessarily obese. Several techniques have been developed, and the concept has come first of a surgery for morbid obesity, then of a cure for diabetes in morbid obesity. There are other aspects of bariatric surgery that deserve attention, beyond BMI and diabetes, such as hypertension, poor life expectancy, increased prevalence of cancer, congestive heart failure, social inadequacy. The aim of this presentation is to review some recent development in clinical research, in the fields of liver steatosis, ferritin metabolism, and cholesterol metabolism. Liver steatosis, also called fatty liver encompasses a graduation of diseases with different clinical relevance and prognosis. NAFLD correlates with atherosclerosis, insulin resistance and diabetes mellitus. There is now evidence that weight loss, obtained through diet or restrictive surgery, reduces the prevalence (and the severity of NAFLD. An other issue is represented by serum ferritin concentrations, that are strongly associated with fibrosis, portal and lobular inflammation in NAFLD patients, especially in the presence of obesity. Body iron contributes to excess oxidative stress already at non iron overload concentrations. Moreover, serum ferritin is an important and independent predictor of the development of diabetes. Weight loss is accompanied by reduction of ferritin, more after restrictive than malabsorptive surgery. Metabolic changes are greater after malabsorptive or mixed surgery than after purely restrictive surgery, and this has been ascribed to a greater weight loss. Studies comparing the two kinds of surgery indicate that, for the same amount of weight loss, decrease of cholesterol is greater with the former than with the latter techniques, and this difference is mainly due to a greater reduction of intestinal absorption of cholesterol. In the choice of surgery for the single

  20. COPD Medicine

    Science.gov (United States)

    ... AerobiKa® Cardiology Medications Anticoagulant Medicine Anticoagulants and Drug-Food Interactions COPD Medications Bronchodilators Anti-Inflammatories Antibiotics Managing Your Medications Devices ...

  1. Employment and Professional Outcomes in 803 Patients Undergoing Bariatric Surgery in a French Reference Center for Obesity

    Directory of Open Access Journals (Sweden)

    Q Durand-Moreau

    2015-03-01

    Full Text Available Background: Very few studies have been performed on small populations about the links between employment and bariatric surgery.Objective: To determine if rates of employment are increased among patients who have undergone bariatric surgery, to assess their post-operative health consequences (post-prandial weakness, diarrhea, and patients' ability to maintain post-operative advice (ie, 30 minutes of daily physical activity, 6 small meals daily compared to non-employed post-surgical patients.Methods: This cross-sectional study was performed in the Regional Reference Centre for Obesity, which is a partnership between the University Hospital and a clinic in Angers, France during 2012 using a self-administrated questionnaire completed by patients hospitalized for post-operative follow-ups after bariatric surgery. Issues investigated were their professional situation before and after the surgery, compliancy to post-operative advice, and any postoperative side effects.Results: Employment rates were 64.4% before and 64.7% after the surgery (p=0.94. Of these, 30.6% maintained 30 minutes of daily physical activity vs. 41.0% of non-workers (p=0.02. 50.5% of employed patients and 57.3% of non-workers maintained 6 small meals a day after surgery (p=0.09. 8% of working patients reported post-prandial weaknesses and 8% reported diarrhea that caused problems at work.Conclusion: Employment rate remained stable after surgery. Having a job seemed to be an obstacle to managing 30 minutes of daily exercise, especially among women, but not maintaining 6 small meals a day. Therefore, working environment needs to be assessed to improve job quality and retention for patients who have undergone bariatric surgery.

  2. Weight Loss After Bariatric Surgery Reverses Insulin-Induced Increases in Brain Glucose Metabolism of the Morbidly Obese

    OpenAIRE

    Tuulari, Jetro J.; Henry K Karlsson; Hirvonen, Jussi; Hannukainen, Jarna C.; Bucci, Marco; Helmiö, Mika; Ovaska, Jari; Soinio, Minna; Salminen, Paulina; Savisto, Nina; Nummenmaa, Lauri; Nuutila, Pirjo

    2013-01-01

    Obesity and insulin resistance are associated with altered brain glucose metabolism. Here, we studied brain glucose metabolism in 22 morbidly obese patients before and 6 months after bariatric surgery. Seven healthy subjects served as control subjects. Brain glucose metabolism was measured twice per imaging session: with and without insulin stimulation (hyperinsulinemic-euglycemic clamp) using [18F]fluorodeoxyglucose scanning. We found that during fasting, brain glucose metabolism was not dif...

  3. Bariatric surgery for the treatment of metabolic diseases%减重手术治疗代谢性疾病

    Institute of Scientific and Technical Information of China (English)

    高铭; 殷浩

    2013-01-01

    减重手术兴起于20世纪50年代,90年代后肥胖患者人数的迅猛增加和腹腔镜手术的引入,减重手术在全世界逐渐流行.目前减重手术方式主要有可调节胃束带减容术、胃袖状切除术、胃旁路术、十二指肠转流术等.各种减重手术各有优缺点,涉及减重效果、手术死亡率和术后并发症发生率等,应重视减重手术对高血糖、高血脂、高胆固醇血症等代谢紊乱疾病的疗效,提倡个体化治疗,多学科协作综合治疗.%Bariatric surgery began in 1950s.The rapid increase of obese patients and development of laparoseopic techniques lead to popularity of bariatric surgery all over the world in 1990s.Current mainstream of bariatric surgeries include laparoscopic adjustable gastric banding,sleeve gastrectomy,Roux-en-Y gastric bypass and biliopancreatic diversion.In this review,the efficacy of different surgical procedures was compared in the aspects of metabolic disorder remission and incidence of operation complications and mortality.Efficacy of bariatric surgery on the alleviation of metabolic disorders (including hypergycemia,hyperlipidemia,hypercholesterolemia),individual treatment and interdisciplinary cooperation should be emphasized.

  4. Frequency of periodontal pathogens and Helicobacter pylori in the mouths and stomachs of obese individuals submitted to bariatric surgery: a cross-sectional study

    Science.gov (United States)

    PATARO, André Luiz; CORTELLI, Sheila Cavalca; ABREU, Mauro Henrique Nogueira Guimarães; CORTELLI, José Roberto; FRANCO, Gilson Cesar Nobre; AQUINO, Davi Romeiro; COTA, Luis Otavio Miranda; COSTA, Fernando Oliveira

    2016-01-01

    ABSTRACT Objectives This cross-sectional study compared the frequency of oral periodontopathogens and H. pylori in the mouths and stomachs of obese individuals with or without periodontitis submitted to bariatric surgery. Material and Methods One hundred and fifty-four men and women aged 18-65 were conveniently distributed into four groups. Two groups were composed of individuals who underwent bariatric surgery with (BP) (n=40) and without (BNP) (n=39) periodontitis and two obese control groups with (CP) (n=35) and without (CNP) (n=40) periodontitis. The oral pathogens Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Parvimonas micra, Treponema denticola, Tannerella forsythia, Campylobacter rectus, and Helicobacter pylori were detected by a polymerase chain reaction technique using saliva, tongue and stomach biopsy samples. Results Statistical analysis demonstrated that periodontopathogens were highly frequent in the mouth (up to 91.4%). In the bariatric surgically treated group, orally, P. gingivalis, T. denticola and T. forsythia were more frequent in periodontitis, while C. rectus was more frequent in non-periodontitis subjects. Stomach biopsies also revealed the high frequency of five oral species in both candidates for bariatric surgery (91.6%) and the bariatric (83.3%) groups. H. pylori was frequently detected in the mouth (50.0%) and stomach (83.3%). In the stomach, oral species and H. pylori appeared in lower frequency in the bariatric group. Conclusions Obese individuals showed high frequencies of periodontopathogens and H. pylori in their mouths and stomachs. Bariatric surgery showed an inverse microbial effect on oral and stomach environments by revealing higher oral and lower stomach bacterial frequencies. PMID:27383704

  5. Impact of minimally invasive/bariatric surgery fellowship on perioperative complications and outcomes in the first year of practice

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2013-01-01

    Full Text Available Background: Several reports have described worse perioperative outcomes of laparoscopic gastric bypass procedure during learning curve, which improved after completion of one-year fellowship training. Aims: The aim of this study was to evaluate the immediate impact of fellowship training on perioperative complications and outcomes of various bariatric procedures. Materials and Methods: One hundred initial patients who underwent laparoscopic gastric banding, laparoscopic Roux-en-Y gastric bypass, laparoscopic vertical sleeve gastrectomy, and robotically-assisted laparoscopic biliopancreatic diversion with duodenal switch by a single fellowship trained surgeon were analyzed. Results: Overall average Body Mass Index (BMI of the patients was 45.9 kg/m 2 , age was 47.5 years, and the American Society of Anesthesiologist Score was 2.89. There were no intraoperative, major 30-day complications, or open conversions. Average operative time was 62 minutes in gastric banding, 160 minutes in gastric bypass, 119 minutes in vertical sleeve gastrectomy, and 320 minutes in biliopancreatic diversion. Length of stay ranged from 0.5 day after gastric banding to 3.9 days after biliopancreatic diversion. The perioperative complications and outcomes are comparable with those reported by experienced surgeons. No mortality occurred in this series. Conclusions: Bariatric fellowship ensured skills acquisition for new surgeons to safely and effectively perform various types of bariatric operations, with minimal perioperative complications and excellent outcomes.

  6. Use of positive pressure in preoperative and intraoperative of bariatric surgery and its effect on the time of extubation

    Directory of Open Access Journals (Sweden)

    Letícia Baltieri

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVE: To investigate the influence of intraoperative and preoperative positive pressure in the time of extubation in patients undergoing bariatric surgery. METHOD: Randomized clinical trial, in which 40 individuals with a body mass index between 40 and 55 kg/m2, age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n = 10: individuals who received treatment with noninvasive positive pressure before surgery for 1 h; G-intra (n = 10: individuals who received positive end-expiratory pressure of 10 cm H2O throughout the surgical procedure; and G-control (n = 20: not received any preoperative or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the post-anesthetic recovery. RESULTS: There was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of positive end-expiratory pressure of 10 cm H2O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect. CONCLUSION: The use of positive end-expiratory pressure of 10 cm H2O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery.

  7. Changes in Testosterone Levels and Sex Hormone-Binding Globulin Levels in Extremely Obese Men after Bariatric Surgery

    Science.gov (United States)

    Laichuthai, Nitchakarn; Suwannasrisuk, Preaw; Houngngam, Natnicha; Udomsawaengsup, Suthep; Snabboon, Thiti

    2016-01-01

    Objective. Obesity is a risk factor for hypogonadotropic hypogonadism in men. Weight loss has been shown to improve hypogonadism in obese men. This study evaluated the early changes in sex hormones profile after bariatric surgery. Methods. This is a prospective study including 29 morbidly obese men. Main outcomes were changes in serum levels of total testosterone (TT), free testosterone (cFT), SHBG, estradiol, adiponectin, and leptin at 1 and 6 months after surgery. Results. The mean age of patients was 31 ± 8 years and the mean BMI was 56.8 ± 11.7 kg/m2. Fifteen patients underwent Roux-en-Y gastric bypass and 14 patients underwent sleeve gastrectomy. At baseline, 22 patients (75.9%) had either low TT levels (<10.4 nmol/L) or low cFT levels (<225 pmol/L). Total testosterone and SHBG levels increased significantly at 1 month after surgery (p ≤ 0.001). At 6 months after surgery, TT and cFT increased significantly (p ≤ 0.001) and 22 patients (75.9%) had normalized TT and cFT levels. There were no changes in estradiol levels at either 1 month or 6 months after surgery. Conclusions. Increases in TT and SHBG levels occurred early at 1 month after bariatric surgery while improvements in cFT levels were observed at 6 months after bariatric surgery.

  8. 腹腔镜减肥手术的编码探讨%Discussion of Classification of Laparoscope Bariatric Surgery

    Institute of Scientific and Technical Information of China (English)

    范炜然; 柏朝青; 林海丽

    2011-01-01

    Objective To know the w ays of laparoscope bariatric surgery,and discuss the classification of the surgery.M ethods D iscussing the classification of the surgery according to different w ays and coding principle of laparoscope bariatric surgery.R esults L aparoscope bariatric surgery have different coding according to different surgical m ethods and w ays.C onclusion C oders should grasp correct code of new clinicalsurgeries to m eet the needs of clinical m edicine,education,research and statistics.%目的 了解腹腔镜减肥手术术式,探讨手术编码.方法 依据腹腔镜减肥手术的不同术式及编码原则,探讨手术的正确编码.结果 腹腔镜减肥手术采取的手术方法、术式不同,编码亦不同.结论 编码员应随时掌握临床新开展的业务正确编码,以满足临床医教研统计的需要.

  9. Bariatric Surgery

    Science.gov (United States)

    ... disorders. ​ Additional Reading Active at Any Size! Binge Eating Disorder Dieting and Gallstones ​ Related Conditions and Diseases Obesity ... Follow Us Contact Us Get Email Updates Twitter Facebook Follow ... Institute of Diabetes and Digestive and Kidney Diseases, Health Information Center, Telephone: 1-800-860-8747 ...

  10. Nuclear medicine

    International Nuclear Information System (INIS)

    The task of the Expert Committee was to review the technical development and efficacy of nuclear medicine methods and to recommend the best possible means of establishing nuclear medicine services at various levels of medical care in different countries. After reviewing the contributions which nuclear medicine can make, the various types of medical institutions and hospitals in existence, the requirements, organization and funding of nuclear medicine services, and the cost/effectiveness of nuclear medicine, a number of recommendations were made. IAEA and WHO should make information on existing methods of cost/effectiveness analysis widely available; invite governments to include a description of such analysis methods in training programmes of their health officers; assist in the acquisition of the necessary data; and encourage and eventually support actual applications of such analyses to carefully selected nuclear medicine procedures in varying medicosocial environments. They were further recommended to study possible ways of improving reliability and ease of servicing nuclear medicine equipment, and extent of possible local construction; the possibility of making available supplies of matched characterized reagents for radioimmunoassay and related techniques; and to study the advantages of establishing a network of collaborating centres on an international basis

  11. Folk Medicine

    Science.gov (United States)

    ... CLPPP CAP Healthy Homes Assessment Tools Lead Health Literacy Initiative Refugee Tool Kit Resources Healthy Homes and ... As blood lead levels increase, so does lead’s effects on health. How to tell if herbal medicines ...

  12. Network medicine

    DEFF Research Database (Denmark)

    Pawson, Tony; Linding, Rune

    2008-01-01

    for new therapeutic intervention. We argue that by targeting the architecture of aberrant signaling networks associated with cancer and other diseases new therapeutic strategies can be implemented. Transforming medicine into a network driven endeavour will require quantitative measurements of cell...... signaling processes; we will describe how this may be performed and combined with new algorithms to predict the trajectories taken by a cellular system either in time or through disease states. We term this approach, network medicine....

  13. Medicinal Moves

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Traditional Chinese medicine is becoming a new source of growth in China-Africa trade LIU Tao never expected that his traditional Chinese medicine (TCM) products would be so warmly welcomed at the annual Canton Fair last year.His surprise came after a large number of African businessmen expressed a keen interest in importing the products.That knowledge left a broad smile on his face.

  14. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Resources Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small ... of Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical ...

  15. General Nuclear Medicine

    Science.gov (United States)

    ... Resources Professions Site Index A-Z General Nuclear Medicine Nuclear medicine imaging uses small amounts of radioactive ... of General Nuclear Medicine? What is General Nuclear Medicine? Nuclear medicine is a branch of medical imaging ...

  16. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small amounts ... Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical imaging ...

  17. Children's (Pediatric) Nuclear Medicine

    Science.gov (United States)

    ... Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small amounts ... Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical imaging ...

  18. Do Postoperative Psychotherapeutic Interventions and Support Groups Influence Weight Loss Following Bariatric Surgery? A Systematic Review and Meta-analysis of Randomized and Nonrandomized Trials

    DEFF Research Database (Denmark)

    Beck, Nina N.; Johannsen, Maja; Støvring, René K.;

    2012-01-01

    Bariatric surgery is currently considered the most effective treatment of severe obesity, but considerable individual variations in weight loss results have been reported. We therefore conducted a systematic review and meta-analysis of studies investigating the effect of psychotherapeutic...... interventions and support groups on weight loss following bariatric surgery. A literature search was conducted in the databases PubMed and PsycINFO, identifying nine eligible studies reporting results of the effect of psychotherapeutic interventions and support groups on weight loss following bariatric surgery....... The results revealed a statistically significant overall effect of both psychotherapeutic interventions and support groups on weight loss (pooled effect size correlation (ESr) = 0.18; p ...

  19. The decision of an obese woman to have bariatric surgery: the social phenomenology

    Directory of Open Access Journals (Sweden)

    Deíse Moura de Oliveira

    2014-12-01

    Full Text Available Objective To understand the process by which an obese woman decides to have bariatric surgery. Method A qualitative survey with a social phenomenology approach, carried out in 2012, with 12 women, using the phenomenological interview. Results A woman bases the decision to have the surgery on: the inappropriateness of her eating habits; a physical appearance that is incompatible with an appearance that is standardized by society; the social prejudice that she has to live with; the limitations imposed by obesity; and her lack of success with previous attempts to lose weight. Outcomes that she hopes for from the decision to have the surgery include: restoring her health; achieving social inclusion; and entering the labor market. Conclusion This study allows one to reflect that prescriptive actions do not give a satisfactory response to a complexity of the subjective questions involved in the decision to have surgery for obesity. For this, what is called for is a program of work based on an interdisciplinary approach, and training that gives value to the bio-psycho-social aspects involved in a decision in favor of surgical treatment.

  20. Maintaining weight loss after bariatric surgery: when the spectator role is no longer enough.

    Science.gov (United States)

    Jones, L; Cleator, J; Yorke, J

    2016-08-01

    Bariatric (weight loss) surgery is the gold standard treatment for severe obesity. Concern exists that patients are regaining weight in the longer term. Success and cost-effectiveness of surgery are threatened due to the re-emergence of related conditions such as diabetes. This exploratory qualitative study investigates patients' expectations and experiences of weight regain (WR) 2 years or more after Roux-en-Y gastric bypass (RYGB). Ten participants (two men and eight women) who experienced WR were interviewed between 2 and 6 years following surgery. Findings highlight that participants reacted to initial weight loss as passive spectators and were unprepared for subsequent WR. Their tolerability of WR reduced as the amount of regain increased, suggesting a 'line of tolerance' for WR. WR was influenced by a new vulnerability arising from weight loss over time, and participants struggled to manage their own weight actively as surgical effects waned. They considered self-management skills, and carer and professional support to be limited at the time when WR was most likely to occur. Degrees of tolerability are noted in individuals regaining weight after RYGB. More studies are needed to further understand these problems. Pre- and post-operative support and teaching patients self-management skills may be helpful to minimize WR. PMID:27273813

  1. Methylation and Expression of Immune and Inflammatory Genes in the Offspring of Bariatric Bypass Surgery Patients

    Directory of Open Access Journals (Sweden)

    Frédéric Guénard

    2013-01-01

    Full Text Available Background. Maternal obesity, excess weight gain and overnutrition during pregnancy increase risks of obesity, type 2 diabetes mellitus, and cardiovascular disease in the offspring. Maternal biliopancreatic diversion is an effective treatment for severe obesity and is beneficial for offspring born after maternal surgery (AMS. These offspring exhibit lower severe obesity prevalence and improved cardiometabolic risk factors including inflammatory marker compared to siblings born before maternal surgery (BMS. Objective. To assess relationships between maternal bariatric surgery and the methylation/expression of genes involved in the immune and inflammatory pathways. Methods. A differential gene methylation analysis was conducted in a sibling cohort of 25 BMS and 25 AMS offspring from 20 mothers. Following differential gene expression analysis (23 BMS and 23 AMS, pathway analysis was conducted. Correlations between gene methylation/expression and circulating inflammatory markers were computed. Results. Five immune and inflammatory pathways with significant overrepresentation of both differential gene methylation and expression were identified. In the IL-8 pathway, gene methylation correlated with both gene expression and plasma C-reactive protein levels. Conclusion. These results suggest that improvements in cardiometabolic risk markers in AMS compared to BMS offspring may be mediated through differential methylation of genes involved in immune and inflammatory pathways.

  2. Obesity, bariatric surgery and nutritional implications - doi:10.5020/18061230.2007.p259

    Directory of Open Access Journals (Sweden)

    Michele Novaes Ravelli

    2012-01-01

    Full Text Available Obesity is an important nutritional deviation that is exponentially increasing in Brazil and in the world, becoming a public health problem. The World Health Organization verified in 2005 that 1.6 billion people above 15 years old were overweight and 400 million were obese. Among children, 20 million were overweight. Amongst the different treatments for the obesity the bariatric surgery has been used very often nowadays, for being effective against weight excess and associated co-morbidities, both for the adult and youngster populations. The surgical techniques are divided in restrictive, disabsorptive and mixed procedures. Each technique promotes digestive and absorptive distinct alterations, needing, therefore, an exclusive multidisciplinary educational program, directed both to pre and postsurgery periods, emphasizing the habits of physical activity and the necessity to adhere to the restricted dietary recommendations. The surgeries promote a severe reduction in the consumption, which induces to the ingestion of diets that are hypocaloric and deficient in micronutrients, with consequent nutritional complications.

  3. Impact of bariatric surgery on carotid artery inflammation and the metabolic activity in different adipose tissues.

    Science.gov (United States)

    Bucerius, Jan; Vijgen, Guy H E J; Brans, Boudewijn; Bouvy, Nicole D; Bauwens, Matthias; Rudd, James H F; Havekes, Bas; Fayad, Zahi A; van Marken Lichtenbelt, Wouter D; Mottaghy, Felix M

    2015-05-01

    In this study, we unravel a molecular imaging marker correlated with the known reduction of cardiovascular events (most commonly related to vulnerable plaques) in morbidly obese patients after bariatric surgery (BaS).We prospectively imaged 10 morbidly obese subjects with F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography before and 1 year after BaS. F-FDG uptake-which is enhanced in inflamed, atherosclerotic vessels and in metabolically active adipose tissues-was quantified in the carotids, pericardial adipose tissue (PAT), visceral adipose tissue (VAT), as well as brown adipose tissue (BAT). The degree of carotid inflammation was compared to lean and overweight controls.Carotid inflammation significantly declined leading to an F-FDG uptake comparable to the 2 control groups. Metabolic activity significantly decreased in PAT and VAT and increased in BAT.BaS leads to a normalization of carotid artery inflammation and a beneficial impact on the metabolic activity in PAT, VAT, and BAT that is related to the metabolic syndrome observed in this patient group.

  4. BINGE EATING DISORDER AND QUALITY OF LIFE OF CANDIDATES TO BARIATRIC SURGERY

    Science.gov (United States)

    COSTA, Ana Júlia Rosa Barcelos; PINTO, Sônia Lopes

    2015-01-01

    Background : Obesity decreases the quality of life, which is aggravated by the association of comorbidities, and the binge eating disorder is directly related to body image and predisposes to overweight. Aim: Evaluate association between the presence and the level of binge eating disorder and the quality of life of the obese candidates for bariatric surgery. Methods : Cross-sectional study analyzing anthropometric data (weight and height) and socioeconomics (age, sex, marital status, education and income). The application of Binge Eating Scale was held for diagnosis of Binge Eating Disorder and the Medical Outcomes Study 36-item Short-From Health Survey to assess the quality of life. Results : Total sample studied was 96 patients, mean age 38.15±9.6 years, 80.2% female, 67.7% married, 41% with complete and incomplete higher education, 77.1% with lower income or equal to four the minimum salary, 59.3% with grade III obesity. Binge eating disorder was observed in 44.2% of patients (29.9% moderate and 14.3% severe), and these had the worst scores in all domains of quality of life SF36 scale; however, this difference was not statistically significant. Only the nutritional status presented significant statistically association with the presence of binge eating disorder. Conclusion : High prevalence of patients with binge eating disorder was found and they presented the worst scores in all domains of quality of life. PMID:26537275

  5. Lung function and left ventricular hypertrophy in morbidly obese candidates for bariatric surgery

    Science.gov (United States)

    Müller, Paulo de Tarso; Domingos, Hamilton; Patusco, Luiz Armando Pereira; Rapello, Gabriel Victor Guimarães

    2015-01-01

    Objective: To look for correlations between lung function and cardiac dimension variables in morbidly obese patients, in order to test the hypothesis that the relative size of the small airways is independently correlated with left ventricular hypertrophy. Methods: This was a retrospective study involving 192 medical records containing a clinical protocol employed in candidates for bariatric surgery between January of 2006 and December of 2010. Results: Of the 192 patients evaluated, 39 (10 males and 29 females) met the inclusion criteria. The mean BMI of the patients was 49.2 ± 7.6 kg/m2, and the mean age was 35.5 ± 7.7 years. The FEF25-75/FVC, % correlated significantly with left ventricular posterior wall thickness and relative left ventricular posterior wall thickness, those correlations remaining statistically significant (r = −0.355 and r = −0.349, respectively) after adjustment for weight, gender, and history of systemic arterial hypertension. Stepwise multivariate linear regression analysis showed that FVC and FEV1 were the major determinants of left ventricular mass (in grams or indexed to body surface area). Conclusions: A reduction in the relative size of the small airways appears to be independently correlated with obesity-related cardiac hypertrophy, regardless of factors affecting respiratory mechanics (BMI and weight), gender, or history of systemic arterial hypertension. However, FEV1 and FVC might be important predictors of left ventricular mass in morbidly obese individuals. PMID:26578134

  6. Study of the patency of different peritoneal drains used prophylactically in bariatric surgery

    Institute of Scientific and Technical Information of China (English)

    Wilson Salgado Júnior; Marcelo Martins Macedo Neto; José Sebastiao dos Santos; Ajith Kumar Sakarankutty; Reginaldo Ceneviva; Orlando de Castro e Silva Jr

    2009-01-01

    AIM: To compare the performance of different types of abdominal drains used in bariatric surgery. METHODS: A vertical banded Roux-en-Y gastric bypass was performed in 33 morbidly obese patients. Drainage of the peritoneal cavity was performed in each case using three different types of drain selected in a randomized manner: a latex tubular drain, a Watterman tubulolaminar drain, and a silicone channeled drain. Drain permeability, contamination of the drained fluid, ease of handling, and patient discomfort were evaluated postoperatively over a period of 7 d. RESULTS: The patients with the silicone channeled drain had larger volumes of drainage compared to patients with tubular and tubulolaminar drains between the third and seventh postoperative days. In addition, a lower incidence of discomfort and of contamination with bacteria of a more pathogenic profile was observed in the patients with the silicone channeled drain.CONCLUSION: The silicone channeled drain was more comfortable and had less chance of occlusion, which is important in the detection of delayed dehiscence.

  7. Mesopotamian medicine.

    Science.gov (United States)

    Retief, F P; Cilliers, L

    2007-01-01

    Although the Mesopotamian civilisation is as old as that of Egypt and might even have predated it, we know much less about Mesopotamian medicine, mainly because the cuneiform source material is less well researched. Medical healers existed from the middle of the 3rd millennium. In line with the strong theocratic state culture, healers were closely integrated with the powerful priestly fraternity, and were essentially of three main kinds: barû (seers) who were experts in divination, âshipu (exorcists), and asû (healing priests) who tended directly to the sick. All illness was accepted as sent by gods, demons and other evil spirits, either as retribution for sins or as malevolent visitations. Treatment revolved around identification of the offending supernatural power, appeasement of the angry gods, for example by offering amulets or incantations, exorcism of evil spirits, as well as a measure of empirical therapy aimed against certain recognised symptom complexes. Medical practice was rigidly codified, starting with Hammurabi's Code in the 18th century BC and persisting to the late 1st millennium BC. Works like the so-called Diagnostic Handbook, the Assyrian Herbal and Prescription Texts describe the rationale of Mesopotamian medicine, based predominantly on supernatural concepts, although rudimentary traces of empirical medicine are discernible. There is evidence that Egyptian medicine might have been influenced by Mesopotamian practices, but Greek rational medicine as it evolved in the 5th/4th centuries BC almost certainly had no significant Mesopotamian roots. PMID:17378276

  8. Travel medicine

    Science.gov (United States)

    Aw, Brian; Boraston, Suni; Botten, David; Cherniwchan, Darin; Fazal, Hyder; Kelton, Timothy; Libman, Michael; Saldanha, Colin; Scappatura, Philip; Stowe, Brian

    2014-01-01

    Abstract Objective To define the practice of travel medicine, provide the basics of a comprehensive pretravel consultation for international travelers, and assist in identifying patients who might require referral to travel medicine professionals. Sources of information Guidelines and recommendations on travel medicine and travel-related illnesses by national and international travel health authorities were reviewed. MEDLINE and EMBASE searches for related literature were also performed. Main message Travel medicine is a highly dynamic specialty that focuses on pretravel preventive care. A comprehensive risk assessment for each individual traveler is essential in order to accurately evaluate traveler-, itinerary-, and destination-specific risks, and to advise on the most appropriate risk management interventions to promote health and prevent adverse health outcomes during travel. Vaccinations might also be required and should be personalized according to the individual traveler’s immunization history, travel itinerary, and the amount of time available before departure. Conclusion A traveler’s health and safety depends on a practitioner’s level of expertise in providing pretravel counseling and vaccinations, if required. Those who advise travelers are encouraged to be aware of the extent of this responsibility and to refer all high-risk travelers to travel medicine professionals whenever possible. PMID:25500599

  9. Prophylaxis of Venous Thromboembolism with Low Molecular Weight Heparin in Bariatric Surgery: a Prospective, Randomised Pilot Study Evaluating Two Doses of Parnaparin (BAFLUX Study)

    OpenAIRE

    Imberti, Davide; Baldini, Edoardo; Pierfranceschi, Matteo Giorgi; Nicolini, Alberto; Cartelli, Concetto; De Paoli, Marco; Boni, Marcello; Filippucci, Esmeralda; Cariani, Stefano; Bottani, Giorgio

    2013-01-01

    Background The optimal dose of low molecular weight heparin (LMWH) to prevent venous thromboembolism (VTE) after bariatric surgery remains controversial. The aim of this multicentre, open-label, pilot study was to evaluate the efficacy and safety of two different doses of the LMWH parnaparin administered to patients undergoing bariatric surgery. Methods Patients were randomised to receive 4,250 IU/day (group A) or 6,400 IU/day (group B) of parnaparin s.c. for 7–11 days. Bilateral colour Doppl...

  10. Tibetan traditional medicine

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Tibetan medicine companies in T.A.R can manufacture more than 360 Tibetan patent medicines. There are 18 Tibetan medicine factories in Tibet, and total out value exceeds 3 billion yuan. 24 kinds of Tibetan patent medicines have been incorporated into State Fundamental Medicine List, in which 14 Tibetan patent medicines are listed in national protected traditional medicine category.

  11. Carbon dioxide monitoring during laparoscopic-assisted bariatric surgery in severely obese patients: transcutaneous versus end-tidal techniques.

    Science.gov (United States)

    Dion, Joanna M; McKee, Chris; Tobias, Joseph D; Herz, Daniel; Sohner, Paul; Teich, Steven; Michalsky, Marc

    2015-02-01

    Various factors including severe obesity or increases in intra-abdominal pressure during laparoscopy can lead to inaccuracies in end-tidal carbon dioxide (PETCO2) monitoring. The current study prospectively compares ET and transcutaneous (TC) CO2 monitoring in severely obese adolescents and young adults during laparoscopic-assisted bariatric surgery. Carbon dioxide was measured with both ET and TC devices during insufflation and laparoscopic bariatric surgery. The differences between each measure (PETCO2 and TC-CO2) and the PaCO2 were compared using a non-paired t test, Fisher's exact test, and a Bland-Altman analysis. The study cohort included 25 adolescents with a mean body mass index of 50.2 kg/m2 undergoing laparoscopic bariatric surgery. There was no difference in the absolute difference between the TC-CO2 and PaCO2 (3.2±3.0 mmHg) and the absolute difference between the PETCO2 and PaCO2 (3.7±2.5 mmHg). The bias and precision were 0.3 and 4.3 mmHg for TC monitoring versus PaCO2 and 3.2 and 3.2 mmHg for ET monitoring versus PaCO2. In the young severely obese population both TC and PETCO2 monitoring can be used to effectively estimate PaCO2. The correlation of PaCO2 to TC-CO2 is good, and similar to the correlation of PaCO2 to PETCO2. In this population, both of these non-invasive measures of PaCO2 can be used to monitor ventilation and minimize arterial blood gas sampling.

  12. Prevalence of Helicobacter pylori infection in a group of morbidly obese Saudi patients undergoing bariatric surgery: A preliminary report

    Directory of Open Access Journals (Sweden)

    Al-Akwaa Ahmad

    2010-01-01

    Full Text Available Background/Aim: Earlier reports from Saudi Arabia have shown high prevalence of Helicobacter pylori infection. However, recent studies have documented a reduction in the infection prevalence. No prior study has assessed the prevalence in morbidly obese Saudi patients. We aimed to study the prevalence of H. pylori infection in a group morbidly obese Saudi patients referred for endoscopy prior to bariatric surgery. Materials and Methods: We retrospectively reviewed the medical records of all patients who were referred for upper endoscopy prior to bariatric surgery from June 2006 to September 2008. All data were recorded including patient′s demographics, comorbid conditions, endoscopic and histological findings. Results: There were 62 patients included, 20 males and 42 females. The mean age was 34 years (range 18 - 51 with a mean BMI of 55 Kg/m 2 (range 35 -92. H. pylori were present in 53 patients (85.5% with chronic active gastritis. All patients with positive H. pylori had chronic gastritis of variable severity. Intestinal metaplasia was present in 5%. The prevalence of H. pylori infection was similar in patients with and without co-morbid conditions. Main endoscopic findings were gastritis in 67.7%, hiatus hernia in 13%, and gastric erosions in 13%. No patient had duodenal or gastric ulcer. Conclusions: There is a high prevalence of H. pylori infection in morbidly obese Saudi patients undergoing bariatric surgery being referred for upper GI endoscopy. Further prospective studies are needed to evaluate the clinical implication and benefit of eradication treatment of infection in these patients.

  13. Prevalence and Predictors of Self-Reported Sexual Abuse in Severely Obese Patients in a Population-Based Bariatric Program

    Directory of Open Access Journals (Sweden)

    Danielle L. Gabert

    2013-01-01

    Full Text Available Background. Sexual abuse may be associated with poorer weight loss outcomes following bariatric treatment. Identifying predictors of abuse would enable focused screening and may increase weight management success. Methods. We analyzed data from 500 consecutively recruited obese subjects from a population-based, regional bariatric program. The prevalence of self-reported sexual abuse was ascertained using a single interview question. Health status was measured using a visual analogue scale (VAS. Multivariable logistic regression was performed to identify sexual abuse predictors. Results. The mean age was 43.7 y (SD 9.6, 441 (88.2% were females, 458 (91.8% were white, and the mean body mass index (BMI was 47.9 kg/m2 (SD 8.1. The self-reported prevalence of past abuse was 21.8% (95% CI 18.4–25.4%. Abused subjects had worse health status (VAS score 53.1 (SD 21.2 versus 58.0 (SD 20.1, P=0.03. BMI was not associated with abuse (P>0.5. Age, sex, BMI, and covariate-adjusted independent predictors of abuse included alcohol addiction (adjusted odds ratio 15.8; 95% CI 4.0–62.8, posttraumatic stress disorder (4.9; 2.5–9.5, borderline personality (3.8; 1.0–13.8, depression (2.4; 1.3–4.3, and lower household income (3.4; 1.6–7.0. Conclusions. Abuse was common amongst obese patients managed in a population-based bariatric program; alcohol addiction, psychiatric comorbidities, and low-income status were highly associated with sexual abuse.

  14. Reconstruction of short bowel syndrome after internal hernia in a pregnant woman with previous bariatric surgery ☆

    OpenAIRE

    Borghede, Märta Kristina; Vinter-Jensen, Lars; Andersen, Jens Christian; Mortensen, Peter Brøndum; Rasmussen, Henrik Højgaard

    2013-01-01

    INTRODUCTION Bariatric surgery is most often performed with the laparoscopic Roux-en-Y gastric bypass. A complication to the laparoscopic Roux-en-Y gastric bypass is internal hernia, which occurs in up to 16% of the patients. Since the laparoscopic Roux-en-Y gastric bypass is performed in women of fertile age, internal hernia may occur during pregnancy. PRESENTATION OF CASE A 22-year old woman with a history of laparoscopic Roux-en-Y gastric bypass suffered from massive internal hernia during...

  15. Medicinal Mushrooms

    NARCIS (Netherlands)

    Lindequist, U.; Won Kim, H.; Tiralongo, E.; Griensven, van L.J.L.D.

    2014-01-01

    Since beginning of mankind nature is the most important source of medicines. Bioactive compounds produced by living organisms can be used directly as drugs or as lead compounds for drug development. Besides, the natural material can be used as crude drug for preparation of powder or extracts. Plants

  16. [Osteopathic medicine].

    Science.gov (United States)

    Klein, P; Lepers, Y; Salem, W

    2011-09-01

    Osteopathy is originated in the 19th century in the United States. Andrew Taylor Still seek for an alternative medical system to the orthodox medicine largely empirical and advocating bloodletting, calomel, etc., all of which was resumed with terms like" heroic medicine". Osteopathy as other alternative medical practices (homeopathy, eclecticism, etc.) based on rational and metaphysical postulates as vitalism or the fact that man is a divinely ordained machine. Still's approach was essentially manual and based on manipulation of the joints. Today osteopaths challenge these dogmas and seek to agree their practice within scientific biomedical standards. Even if strong randomized clinical trials are lacking, several surveys report how osteopathy gained public notoriety. Several recent meta-analyses pinpoint the benefit of the spinal manipulative treatment and even if there is no evidence that such an approach is superior to other advocated therapies there is no evidence that these therapies are more effective than the first one. The major indications for such a treatment are cervical and low back pain, either chronic or acute. The quality of the relationship between the practitioner and patient together with the placebo effect are important components of a treatment effect. Osteopathic education is an important aspect and only higher education institutions, i.e. universities can achieve and maintain adequate standards. Materia medica and surgery represent the two major therapeutic mainstreams in medicine; osteopathy considered as manual medicine could be the third one. PMID:22034767

  17. Medicinal Plants.

    Science.gov (United States)

    Phillipson, J. David

    1997-01-01

    Highlights the demand for medicinal plants as pharmaceuticals and the demand for health care treatments worldwide and the issues that arise from this. Discusses new drugs from plants, anticancer drugs, antiviral drugs, antimalarial drugs, herbal remedies, quality, safety, efficacy, and conservation of plants. Contains 30 references. (JRH)

  18. NONALCOHOLIC FATTY LIVER DISEASE IN SEVERE OBESE PATIENTS, SUBJECTED TO BARIATRIC SURGERY

    Directory of Open Access Journals (Sweden)

    Alexandre LOSEKANN

    2013-12-01

    Full Text Available Context Nonalcoholic fatty liver disease encompasses a spectrum of histopathological changes that range from simple steatosis to nonalcoholic steatohepatitis. Works suggest that iron (Fe deposits in the liver are involved in the physiopathology of nonalcoholic steatohepatitis. Objective The aim of this study was to determine the prevalence of simple steatosis and nonalcoholic steatohepatitis in patients with morbid obesity, subjected to bariatric surgery and to establish a correlation of the anatomopathological findings with the presence of liver fibrosis. Methods A total of 250 liver biopsies were conducted in the transoperation of the surgeries. Results Steatosis was present in 226 (90.4% of the samples, 76 (30.4% being classified as mild; 71 (28.4% as moderate and 79 (31.6% as intense. Nonalcoholic steatohepatitis was diagnosed in 176 (70.4% cases, where 120 (48.4% were mild; 50 (20% were moderate, and 6 (2.4% cases were intense. Fibrosis was referred to in 108 (43.2% biopsies, 95 of which (38% were mild; 2 (0.8% were moderate; 7 (2.8% were intense, and cirrhosis was diagnosed in 4 (1.6% cases. There was a correlation between the degree of steatosis and the level of inflammatory activity (rs = 0.460; P<0.001 and between the degree of this activity and the degree of fibrosis (rs = 0.583; P<0.001. Only 13 (5.2% samples showed Fe deposits. Conclusion There is a high prevalence of nonalcoholic steatohepatitis in these patients and a positive correlation of the degrees of nonalcoholic steatohepatitis with the intensity of fibrosis. The low prevalence of Fe deposits found makes it questionable that the presence of this ion has any participation in the physiopathogeny of nonalcoholic fatty liver disease.

  19. Early detection of changes in lung mechanics with oscillometry following bariatric surgery in severe obesity.

    Science.gov (United States)

    Peters, Ubong; Hernandez, Paul; Dechman, Gail; Ellsmere, James; Maksym, Geoffrey

    2016-05-01

    Obesity is associated with respiratory symptoms that are reported to improve with weight loss, but this is poorly reflected in spirometry, and few studies have measured respiratory mechanics with oscillometry. We investigated whether early changes in lung mechanics following weight loss are detectable with oscillometry. Furthermore, we investigated whether the changes in lung mechanics measured in the supine position following weight loss are associated with changes in sleep quality. Nineteen severely obese female subjects (mean body mass index, 47.2 ± 6.6 kg/m(2)) were evaluated using spirometry, oscillometry, plethysmography, and the Pittsburgh Sleep Quality Index before and 5 weeks after bariatric surgery. These tests were conducted in both the upright and the supine position, and pre- and postbronchodilation with 200 μg of salbutamol. Five weeks after surgery, weight loss of 11.5 ± 2.5 kg was not associated with changes in spirometry and plethysmography, with the exception of functional residual capacity. There were also no changes in upright respiratory system resistance (Rrs) or reactance following weight loss. Importantly, however, in the supine position, weight loss caused a substantial reduction in Rrs. In addition, sleep quality improved significantly and was highly correlated with the reduction in supine Rrs. Prior to weight loss, subjects did not respond to the bronchodilator when assessed in the upright position with either spirometry or oscillometry; however, with modest weight loss, bronchodilator responsiveness returned to the normal range. Improvements in lung mechanics occur very early after weight loss, mostly in the supine position, resulting in improved sleep quality. These improvements are detectable with oscillometry but not with spirometry.

  20. Early detection of changes in lung mechanics with oscillometry following bariatric surgery in severe obesity.

    Science.gov (United States)

    Peters, Ubong; Hernandez, Paul; Dechman, Gail; Ellsmere, James; Maksym, Geoffrey

    2016-05-01

    Obesity is associated with respiratory symptoms that are reported to improve with weight loss, but this is poorly reflected in spirometry, and few studies have measured respiratory mechanics with oscillometry. We investigated whether early changes in lung mechanics following weight loss are detectable with oscillometry. Furthermore, we investigated whether the changes in lung mechanics measured in the supine position following weight loss are associated with changes in sleep quality. Nineteen severely obese female subjects (mean body mass index, 47.2 ± 6.6 kg/m(2)) were evaluated using spirometry, oscillometry, plethysmography, and the Pittsburgh Sleep Quality Index before and 5 weeks after bariatric surgery. These tests were conducted in both the upright and the supine position, and pre- and postbronchodilation with 200 μg of salbutamol. Five weeks after surgery, weight loss of 11.5 ± 2.5 kg was not associated with changes in spirometry and plethysmography, with the exception of functional residual capacity. There were also no changes in upright respiratory system resistance (Rrs) or reactance following weight loss. Importantly, however, in the supine position, weight loss caused a substantial reduction in Rrs. In addition, sleep quality improved significantly and was highly correlated with the reduction in supine Rrs. Prior to weight loss, subjects did not respond to the bronchodilator when assessed in the upright position with either spirometry or oscillometry; however, with modest weight loss, bronchodilator responsiveness returned to the normal range. Improvements in lung mechanics occur very early after weight loss, mostly in the supine position, resulting in improved sleep quality. These improvements are detectable with oscillometry but not with spirometry. PMID:27109263

  1. Healthcare utilization and costs in severely obese subjects before bariatric surgery.

    Science.gov (United States)

    Keating, Catherine L; Moodie, Marj L; Bulfone, Liliana; Swinburn, Boyd A; Stevenson, Christopher E; Peeters, Anna

    2012-12-01

    This study examined healthcare utilization and associated costs for a severely obese population before receiving bariatric surgery relative to an age- and sex-matched sample from the Australian general population. Severely obese subjects receiving laparoscopic adjustable gastric banding (LAGB) surgery in 2009 (n = 11,769) were identified. Utilization of medical services and pharmaceuticals in the 3.5 years before surgery were ascertained for each severely obese subject through linkage with Medicare, Australia's universal health insurance scheme. Equivalent data were retrieved for each subject from the matched general population sample (n = 140,000). Severely obese subjects utilized significantly more medical services annually compared to the general population (mean: 22.8 vs. 12.1/person, standardized incidence ratio (SIR): 1.89 (95% confidence interval (CI) 1.88-1.89)), translating to twofold higher mean annual costs (Australian $1,140 vs. $567/person). The greatest excess costs in the obese related to consultations with general practitioners, psychiatrists/psychologists and other specialists, investigations for obstructive sleep apnea, and in vitro fertilization. Severely obese subjects also utilized significantly more pharmaceutical prescriptions annually (mean: 11.4 vs. 5.3/person, SIR 2.18 (95% CI: 2.17-2.19)), translating to 2.2-fold higher mean annual costs ($595/person vs. $270/person). The greatest excess costs in the obese related to diabetes drugs, lipid-modifying agents, psychoanaleptics, acid-related disorder drugs, agents acting on the rennin-angiotensin system, immunosuppressants, and obstructive airway disease drugs. Overall, healthcare costs in the severely obese population were more than double those incurred by the general population. PMID:22627914

  2. Changes in the distance between carina and orotracheal tube during open or videolaparoscopic bariatric surgery

    Directory of Open Access Journals (Sweden)

    Giovani de Figueiredo Locks

    2015-10-01

    Full Text Available ABSTRACTOBJECTIVE: To examine whether there are changes in the distance between the orotracheal tube and carina induced by orthostatic retractor placement or by pneumoperitoneum insufflation in obese patients undergoing gastroplasty.METHODS: 60 patients undergoing bariatric surgery by two techniques: open (G1 or videolaparoscopic (G2 gastroplasty were studied. After tracheal intubation, adequate ventilation of both hemitoraxes was confirmed by lung auscultation. The distance orotracheal tube-carina was estimated with the use of a fiber bronchoscope before and after installation of orthostatic retractors in G1 or before and after insufflation of pneumoperitoneum in patients in G2.RESULTS: G1 was composed of 22 and G2 of 38 patients. No cases of endobronchial intubation were detected in either group. The mean orotracheal tube-carina distance variation was estimated in -0.03 cm (95% CI 0.06 to -0.13 in the group of patients undergoing open gastroplasty and in -0.42 cm (95% CI -0.56 to -1.4 in the group of patients undergoing videolaparoscopic gastroplasty. The extremes of variation in each group were: 0.5 cm to -1.6 cm in patients undergoing open surgery and 0.1 cm to -2.2 cm in patients undergoing videolaparoscopic surgery.CONCLUSIONS: There was no significant change in orotracheal tube-CA distance after placement of orthostatic retractors in patients undergoing open gastroplasty. There was a reduction in orotracheal tube-CA distance after insufflation of pneumoperitoneum in patients undergoing videolaparoscopic gastroplasty. We recommend attention to lung auscultation and to signals of ventilation monitoring and reevaluation of orotracheal tube placement after peritoneal insufflation.

  3. Pregnancy and Medicines

    Science.gov (United States)

    Not all medicines are safe to take when you are pregnant. Some medicines can harm your baby. That includes over-the- ... care provider before you start or stop any medicine. Not using medicine that you need may be ...

  4. Complementary and Alternative Medicine

    Science.gov (United States)

    ... Help a Friend Who Cuts? Complementary and Alternative Medicine KidsHealth > For Teens > Complementary and Alternative Medicine Print ... replacement. continue How Is CAM Different From Conventional Medicine? Conventional medicine is based on scientific knowledge of ...

  5. Prediction of Exercise in Patients across Various Stages of Bariatric Surgery: A Comparison of the Merits of the Theory of Reasoned Action versus the Theory of Planned Behavior

    Science.gov (United States)

    Hunt, Hillary R.; Gross, Alan M.

    2009-01-01

    Obesity is a world-wide health concern approaching epidemic proportions. Successful long-term treatment involves a combination of bariatric surgery, diet, and exercise. Social cognitive models, such as the Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TPB), are among the most commonly tested theories utilized in the…

  6. Post-bariatric abdominoplasty resulting in wound infection and dehiscence—Conservative treatment with medical grade honey: A case report and review of literature

    Science.gov (United States)

    Dina Jarjis, Reem; Thomas Crewe, Bjørn; Henrik Matzen, Steen

    2016-01-01

    Introduction Wound complications in post-bariatric patients undergoing body-contouring surgery after massive weight loss are not uncommon and often, surgical debridement or conservative management is necessary. Honey is one of the most ancient remedies for wound care and it is also considered to possess debriding effects. Current research has demonstrated promising results showing that honey can improve wound granulation and epithelialization, reduce exudate and shorten healing times. Methods This case report has been reported in line with the CARE criteria. Presentation of case A 40 year-old female suffered wound infection and dehiscence after undergoing post-bariatric abdominoplasty. The patient was not interested in surgical revision and split skin grafting. Therefore, conservative wound treatment with topical Manuka honey was instituted resulting in significant clinical improvement and effective healing concurrently with good patient satisfaction. Discussion Surgical wound complications in post-bariatric patients undergoing abdominoplasty are common and often require surgical revision or conservative wound treatment. No previous publication has addressed outpatient treatment of post-bariatric abdominoplasty wound complications with medical grade honey. Conclusion Although more research is needed for definitive conclusions of honey’s efficacy, it is safe and as presented in our case, it may under certain circumstances reduce the need of surgical wound debridement and serve as a remedy for conservative treatment. PMID:26773204

  7. Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study

    NARCIS (Netherlands)

    Paul, Linda; van Rongen, Sofie; van Hoeken, Daphne; Deen, Mathijs; Klaassen, Rene; Biter, L. Ulas; Hoek, Hans W.; van der Heiden, Colin

    2015-01-01

    Background: (Extreme) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences. Bariatric surgery is an effective intervention for obesity, but approximately 20 to 30% of the patients experience adverse outcomes after surgery and t

  8. Current status of bariatric surgery for type 2 diabetes management%减肥手术治疗2型糖尿病近况

    Institute of Scientific and Technical Information of China (English)

    江兆涛; 邹一平

    2010-01-01

    Although weight loss is beneficial for obese patients with diabetes, current medical treatment for obesity is difficult. Bariatric surgery leads to substantial and durable weight reduction.Nearly 30% of patients who undergo bariatric surgery have type 2 diabetes.For many of them, diabetes resolves following bariatric surgery (83% to 93% for bypass procedures and 55% to 84% for restrictive procedures).This review discusses the effects of various bariatric procedures on type 2 diabetes mellitus and their possible mechanisms.%减肥有助于治疗肥胖伴发2型糖尿病,但目前尚无有效的药物治疗肥胖症.减肥外科手术能达到明显有效且持续的减重效果.约30%接受减肥手术的患者伴发2型糖尿病,减肥手术后多数患者的2型糖尿病得到缓解(胃肠Bypass手术的有效率为84%~98%,限制食物摄人型手术的有效率为55%~84%).本综述重点讨论各种类型的减肥手术治疗2型糖尿病的疗效及其可能的发生机制.

  9. From bariatric surgery history to select operation procedure%从减重手术的历史看减重术式的选择

    Institute of Scientific and Technical Information of China (English)

    梁辉; 吴鸿浩

    2012-01-01

    Bariatric surgery has developed in western countries for more than 50 years.With the increase of obese patients in China,the surgical treatment of obesity and diabetes become acceptable.It is important to review the history of bariatric surgery and summarize suitable procedures for Chinese bariatric surgery including Roux-en-Y gastric bypass,sleeve gastrectomy,and adjustable gastric band.Appropriate procedure selection is made according to the condition of patients and their desire.It is very important to follow up all the patients postoperatively,and achieve the best bariatric outcomes.%减重手术在西方发展了50年以上.随着我国肥胖人口的增加,肥胖及2型糖尿病的手术治疗逐渐受到重视.通过回顾减重手术的历史,总结出目前适合中国国情的减重术式,包括胃旁路术、袖状胃切除术以及可调节胃绑带术等.根据患者的意愿和病情,综合考虑患者的承受能力以及支持随访等条件,选择最适合的术式,方能达到最佳的减重降糖效果.

  10. Bariatric Surgery and Multidisciplinary Treatment for Obesity%减重手术与多学科综合治疗肥胖症

    Institute of Scientific and Technical Information of China (English)

    于健春

    2011-01-01

    减重手术是治疗肥胖症最有效并可明显减重的治疗选择之一.与腹腔镜下可调节胃束带术相比,腹腔镜下Roux-en-Y胃旁路术具有更多的获益及手术风险.减重手术后可出现多种胃肠激素水平的变化,能部分解释减重手术后的体重下降及糖尿病缓解机制.减重手术后的治疗管理应是多学科综合治疗,包括调整饮食结构、增加身体活动量、纠正行为和药物治疗.%Bariatric surgery is one of the most effective treatment options for obesity. Compared with laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery has demonstrated more benefits and surgical risks. Bariatric surgery can result in the decreases in multiple gastrointestinal hormone levels, which can partially explain the mechanisms behind weight loss and resolution of diabetes after bariatric surgery. The management after bariatric surgery should be multidisciplinary and comprehensive, including dietary adjustment, physical exercise, behavioral intervention, and drug therapy.

  11. Transfusion Medicine

    Directory of Open Access Journals (Sweden)

    Smit Sibinga CT

    2013-07-01

    Full Text Available Cees Th. Smit Sibinga ID Consulting, Zuidhorn, The NetherlandsTransfusion Medicine is a bridging science, spanning the evidence-based practice at the bedside with the social sciences in the community.     Transfusion Medicine starts at the bedside. Surprisingly, only recently that has become rediscovered with the development of ‘patient blood management’ and ‘patient centered’ approaches to allow the growth of an optimal and rational patient care through supportive hemotherapy – safe and effective, affordable and accessible.1    Where transfusion of blood found its origin in the need of a patient, it has drifted away for a long period of time from the bedside and has been dominated for almost a century by laboratory sciences. At least the first ten editions of the famous and well reputed textbook Mollison’s Blood Transfusion in Clinical Medicine contained only a fraction on the actual bedside practice of transfusion medicine and did not focus at all on patient blood management.2    This journal will focus on all aspects of the transfusion chain that immediately relate to the bedside practice and clinical use of blood and its components, and plasma derivatives as integral elements of a human transplant tissue. That includes legal and regulatory aspects, medical, ethical and cultural aspects, pure science and pathophysiology of disease and the impact of transfusion of blood, as well as aspects of the epidemiology of blood transfusion and clinical indications, and cost-effectiveness. Education through timely and continued transfer of up to date knowledge and the application of knowledge in clinical practice to develop and maintain clinical skills and competence, with the extension of current educational approaches through e-learning and accessible ‘apps’ will be given a prominent place.

  12. Personcentreret medicin

    DEFF Research Database (Denmark)

    Hvas, Lotte

    2015-01-01

    Personcentreret medicin tager udgangspunkt i den person, lægen møder, hvad enten vedkommende er rask eller syg, og bygger på værdier som fortrolighed, kontinuitet, nærvær, tillid og tilgængelighed. Det er patientens dagsorden, der gælder, og lægen kan i fællesskab med patienten (baseret på en...

  13. Medicine partnerships

    OpenAIRE

    Cramer, J.

    2003-01-01

    Partial medication compliance, where patients do not take enough of their prescribed medicine to achieve adequate outcomes, is common. Research using electronic monitoring to assess compliance has shown that people take approximately 75% of doses as prescribed, irrespective of the condition being treated or its severity. Erratic compliance often leads to discontinuation of therapy, as treatment is perceived to be ineffective. Compliance decreases as frequency of dosing increases. Inadequate c...

  14. The Role of Obesity Training in Medical School and Residency on Bariatric Surgery Knowledge in Primary Care Physicians.

    Science.gov (United States)

    Stanford, Fatima Cody; Johnson, Erica D; Claridy, Mechelle D; Earle, Rebecca L; Kaplan, Lee M

    2015-01-01

    Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH). We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20-39) were more likely to have received some obesity training than those aged 40-49 (OR: 0.08, 95% CI: 0.008-0.822) or those 50+ (OR: 0.03, 95% CI: 0.004-0.321). Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight. PMID:26339506

  15. The Role of Obesity Training in Medical School and Residency on Bariatric Surgery Knowledge in Primary Care Physicians

    Directory of Open Access Journals (Sweden)

    Fatima Cody Stanford

    2015-01-01

    Full Text Available Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH. We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20–39 were more likely to have received some obesity training than those aged 40–49 (OR: 0.08, 95% CI: 0.008–0.822 or those 50+ (OR: 0.03, 95% CI: 0.004–0.321. Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight.

  16. Measurement and Intervention on Physical Activity and Sedentary Behaviours in Bariatric Surgery Patients: Emphasis on Mobile Technology.

    Science.gov (United States)

    Bond, Dale S; Thomas, J Graham

    2015-11-01

    Physical activity (PA) and sedentary behaviours (SB-i.e. activities involving low-energy expenditure and a sitting/reclining posture) may each have significant implications for weight loss and other bariatric surgery outcomes. While early studies suggested that patients typically comply with clinical recommendations to adopt habitual PA, these data were based on retrospective questionnaires. Conversely, recent studies incorporating mobile health (mHealth) technologies (e.g. objective monitors), which assess PA and SB in real time and in the natural environment, show that most patients are inactive and highly sedentary pre-operatively and only make modest changes in these behaviours postoperatively. In addition to using mHealth technologies for obtaining accurate and detailed information on PA and SB, they are increasingly being employed to intervene on patients' PA and SB and/or evaluate intervention outcomes. Researchers and clinicians are encouraged to consider the benefits of using mHealth technology when studying and treating PA and SB in bariatric surgery patients.

  17. Effectiveness of a Cognitive Behavioral Therapy for Dysfunctional Eating among Patients Admitted for Bariatric Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Hege Gade

    2014-01-01

    Full Text Available Objective. To examine whether cognitive behavioral therapy (CBT alleviates dysfunctional eating (DE patterns and symptoms of anxiety and depression in morbidly obese patients planned for bariatric surgery. Design and Methods. A total of 98 (68 females patients with a mean (SD age of 43 (10 years and BMI 43.5 (4.9 kg/m2 were randomly assigned to a CBT-group or a control group receiving usual care (i.e., nutritional support and education. The CBT-group received ten weekly intervention sessions. DE, anxiety, and depression were assessed by the TFEQ R-21 and HADS, respectively. Results. Compared with controls, the CBT-patients showed significantly less DE, affective symptoms, and a larger weight loss at follow-up. The effect sizes were large (DE-cognitive restraint, g=-.92, P≤.001; DE-uncontrolled eating, g=-.90, P≤.001, moderate (HADS-depression, g=-.73, P≤.001; DE-emotional eating, g=-.67, P≤.001; HADS-anxiety, g=-.62, P=.003, and low (BMI, g=-.24, P=.004. Conclusion. This study supports the use of CBT in helping patients preparing for bariatric surgery to reduce DE and to improve mental health. This clinical trial is registered with NCT01403558.

  18. Perioperative management of bariatric surgery%胃肠减肥术围手术期管理要点

    Institute of Scientific and Technical Information of China (English)

    刘兴振; 邹大进

    2012-01-01

    There has been a globally ever-increasing incidence rate of obesity and obesity-related comorbidities (i. e. type 2 diabetes mellitus). Bariatric surgery has increasingly been applied in patients with severe obesity and has obtained preferable outcomes. However,as compared with general surgical procedures,comprehensive assessment and management for bariatric surgery is required. In the current review,preoperative assessment and preparation,management of surgical procedures, postoperative nutritional care and endocrinologic management were delineated.%肥胖及肥胖相关疾病(如2型糖尿病)在全球的发病率逐年增加.胃肠减肥术已应用于重度肥胖的治疗,并对肥胖及相关疾病起到了较好的治疗效果.但是,与普通的外科手术相比,减重手术需要全面的评估及管理.文章主要阐述术前评估和准备、手术过程中的管理以及术后营养和内分泌的管理.

  19. Feasibility and Impact of a Combined Supervised Exercise and Nutritional-Behavioral Intervention following Bariatric Surgery: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Friedrich C. Jassil

    2015-01-01

    Full Text Available Background. Lifestyle intervention programs after bariatric surgery have been suggested to maximise health outcomes. This pilot study aimed to investigate the feasibility and impact of an 8-week combined supervised exercise with nutritional-behavioral intervention following Roux-en-Y gastric bypass and sleeve gastrectomy. Methods. Eight female patients (44 ± 8 years old, BMI = 38.5 ± 7.2 kgm−2 completed the program. Before and after intervention, anthropometric measures, six-minute walk test (6MWT, physical activity level, eating behavior, and quality of life (QoL were assessed. Percentage weight loss (%WL outcomes were compared with a historical matched control group. Results. The program significantly improved functional capacity (mean increment in 6MWT was 127 ± 107 meters, p=0.043, increased strenuous intensity exercise (44 ± 49 min/week, p=0.043, increased consumption of fruits and vegetables (p=0.034, reduced consumption of ready meals (p=0.034, and improved “Change in Health” in QoL domain (p=0.039. The intervention group exhibited greater %WL in the 3–12-month postsurgery period compared to historical controls, 12.2 ± 7.5% versus 5.1 ± 5.4%, respectively (p=0.027. Conclusions. Lifestyle intervention program following bariatric surgery is feasible and resulted in several beneficial outcomes. A large randomised control trial is now warranted.

  20. Haptic medicine.

    Science.gov (United States)

    Mason, Cindy; Mason, Earl

    2009-01-01

    The paper introduces haptic medicine--healthcare based on loving touch for healing and preventing disease. We describe the effects of loving touch (a square inch of our skin has over 1000 nerves) on the body, brain and mind. We describe two web-based health education and media projects. The first, HYPERLINK "http://www.21stcenturymed.org" www.21stcenturymed.org is a place for health practitioners to start learning about touch and resources. The second project, Humans Without Borders, is a multi-lingual self help education website for everyday people. Teaching materials for these projects are based on our previous work with a form of haptic medicine known as psychophysiophilosophy with patients at Stanford Hospital, Kaiser Permanente and Lucille Packard Children's Hospital. We describe psychophysiophilosophy, relate motherly love to recent discoveries in neurosciences and give hints on ways to increase motherly love in each of us. We present a plan for moving into the future by re-introducing haptic medicine into our daily lives through self-help and as an adjunct for current physician practice. There is an exercise in self-help for the reader and an appendix of recent clinical research with profound benefits on the use of human touch for over 40 conditions. PMID:19745495

  1. Physical activity and quality of life in severely obese individuals seeking bariatric surgery or lifestyle intervention

    Directory of Open Access Journals (Sweden)

    Bond Dale S

    2012-07-01

    Full Text Available Abstract Background Given that bariatric surgery (BS and lifestyle intervention (LI represent two vastly different approaches to treating severe obesity, there is growing interest in whether individuals who seek BS versus LI also differ on weight-related behaviors. In the present study, we compared BS- and LI-seekers on physical activity (PA and sedentary behaviors (SB, and examined between-group differences in health-related quality of life (HRQoL, while controlling for PA. Findings A sample of 34 LI-seekers were matched with 34 BS-seekers on gender, age, BMI, and PA monitor-daily wear time (age: 42.1±10.0 years; BMI: 45.6±6.5 kg/m2. PA and SB were assessed over a 7-day period via the SenseWear Armband (SWA. HRQoL was measured using the SF-36, with scores standardized to a population normal distribution (M=50, SD=10. Participants wore the SWA for 13.7±1.6 h/day. BS-seekers did not differ from LI-seekers on average min/d over the wear period spent in SB (641±117.1 vs. 638.4±133.4, p=0.62 or light (136.4±76.1 vs. 145.5±72.5, p=0.59 and moderate-to-vigorous (>1-min bouts=36.4±26.2 vs. 40.2±31.3, p=0.59; ≥10-min bouts=5.7±8.3 vs. 10.2±17.0, p=0.17 PA. BS-seekers reported significantly lower SF-36 physical functioning (42.4±10.9 vs. 49.0±6.8, p=0.004 and physical component summary (43.9±10.1 vs. 48.9±7.0 scores versus LI-seekers. BS-seeker group status was related to lower physical functioning (β=0.30, p=0.009, independent of gender, age, BMI, and daily PA. Conclusions Findings suggest that seeking BS versus LI is not related to patterns of PA or SB, and that lower subjective physical functioning is not associated with lower overall PA levels in BS-seekers.

  2. Evolutionary medicine.

    Science.gov (United States)

    Swynghedauw, B

    2004-04-01

    Nothing in biology makes sense except in the light of evolution. Evolutionary, or darwinian, medicine takes the view that contemporary diseases result from incompatibility between the conditions under which the evolutionary pressure had modified our genetic endowment and the lifestyle and dietary habits in which we are currently living, including the enhanced lifespan, the changes in dietary habits and the lack of physical activity. An evolutionary trait express a genetic polymorphism which finally improve fitness, it needs million years to become functional. A limited genetic diversity is a necessary prerequisite for evolutionary medicine. Nevertheless, search for a genetic endowment would become nearly impossible if the human races were genetically different. From a genetic point of view, homo sapiens, is homogeneous, and the so-called human races have only a socio-economic definition. Historically, Heart Failure, HF, had an infectious origin and resulted from mechanical overload which triggered mechanoconversion by using phylogenically ancient pleiotropic pathways. Adaptation was mainly caused by negative inotropism. Recently, HF was caused by a complex remodelling caused by the trophic effects of mechanics, ischemia, senescence, diabetes and, neurohormones. The generally admitted hypothesis is that cancers were largely caused by a combination of modern reproductive and dietary lifestyles mismatched with genotypic traits, plus the longer time available for a confrontation. Such a concept is illustrated for skin and breast cancers, and also for the link between cancer risk and dietary habits.

  3. GENOMIC MEDICINE

    Directory of Open Access Journals (Sweden)

    Ignacio Briceño Balcázar

    2011-03-01

    Full Text Available Until the twilight of the 20th century, genetics was a branch of medicine applied to diseases of rare occurrence. The advent of the human genome sequence and the possibility of studying it at affordable costs for patients and healthcare institutions, has permitted its application in high-priority diseases like cancer, cardiovascular disease, diabetes, and Alzheimer’s, among others.There is great potential in predictive and preventive medicine, through studying polymorphic genetic variants associated to risks for different diseases. Currently, clinical laboratories offer studies of over 30,000 variants associated with susceptibilities, to which individuals can access without much difficulty because a medical prescription is not required. These exams permit conducting a specific plan of preventive medicine. For example, upon the possibility of finding a deleterious mutation in the BRCA1 and BRCA2 genes, the patient can prevent the breast cancer by mastectomy or chemoprophylaxis and in the presence of polymorphisms associated to cardiovascular risk preventive action may be undertaken through changes in life style (diet, exercise, etc..Legal aspects are also present in this new conception of medicine. For example, currently there is legislation for medications to indicate on their labels the different responses such medication can offer regarding the genetic variants of the patients, given that similar doses may provoke adverse reactions in an individual, while for another such dosage may be insufficient. This scenario would allow verifying the polymorphisms of drug response prior to administering medications like anticoagulants, hyperlipidemia treatments, or chemotherapy, among others.We must specially mention recessive diseases, produced by the presence of two alleles of a mutated gene, which are inherited from the mother, as well as the father. By studying the mutations, we may learn if a couple is at risk of bearing children with the disease

  4. Genomic Medicine

    Directory of Open Access Journals (Sweden)

    Ignacio Briceño Balcázar

    2011-04-01

    Full Text Available Until the twilight of the 20th century, genetics was a branch of medicine applied to diseases of rare occurrence.  The advent of the human genome sequence and the possibility of studying it at affordable costs for patients and healthcare institutions, has permitted its application in high-priority diseases like cancer, cardiovascular disease, diabetes, and Alzheimer’s, among others. There is great potential in predictive and preventive medicine, through studying polymorphic genetic variants associated to risks for different diseases. Currently, clinical laboratories offer studies of over 30,000 variants associated with susceptibilities, to which individuals can access without much difficulty because a medical prescription is not required. These exams permit conducting a specific plan of preventive medicine.  For example, upon the possibility of finding a deleterious mutation in the BRCA1 and BRCA2 genes, the patient can prevent the breast cancer by mastectomy or chemoprophylaxis and in the presence of polymorphisms associated to cardiovascular risk preventive action may be undertaken through changes in life style (diet, exercise, etc.. Legal aspects are also present in this new conception of medicine.  For example, currently there is legislation for medications to indicate on their labels the different responses such medication can offer regarding the genetic variants of the patients, given that similar doses may provoke adverse reactions in an individual, while for another such dosage may be insufficient. This scenario would allow verifying the polymorphisms of drug response prior to administering medications like anticoagulants, hyperlipidemia treatments, or chemotherapy, among others. We must specially mention recessive diseases, produced by the presence of two alleles of a mutated gene, which are inherited from the mother, as well as the father. By studying the mutations, we may learn if a couple is at risk of bearing children with the

  5. The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES study: background, design and rationale

    Directory of Open Access Journals (Sweden)

    McCargar Linda

    2010-10-01

    Full Text Available Abstract Background Extreme obesity affects nearly 8% of Canadians, and is debilitating, costly and ultimately lethal. Bariatric surgery is currently the most effective treatment available; is associated with reductions in morbidity/mortality, improvements in quality of life; and appears cost-effective. However, current demand for surgery in Canada outstrips capacity by at least 1000-fold, causing exponential increases in already protracted, multi-year wait-times. The objectives and hypotheses of this study were as follows: 1. To serially assess the clinical, economic and humanistic outcomes in patients wait-listed for bariatric care over a 2-year period. We hypothesize deterioration in these outcomes over time; 2. To determine the clinical effectiveness and changes in quality of life associated with modern bariatric procedures compared with medically treated and wait-listed controls over 2 years. We hypothesize that surgery will markedly reduce weight, decrease the need for unplanned medical care, and increase quality of life; 3. To conduct a 3-year (1 year retrospective and 2 year prospective economic assessment of bariatric surgery compared to medical and wait-listed controls from the societal, public payor, and health-care payor perspectives. We hypothesize that lower indirect, out of pocket and productivity costs will offset increased direct health-care costs resulting in lower total costs for bariatric surgery. Methods/design Population-based prospective cohort study of 500 consecutive, consenting adults, including 150 surgically treated patients, 200 medically treated patients and 150 wait-listed patients. Subjects will be enrolled from the Edmonton Weight Wise Regional Obesity Program (Edmonton, Alberta, Canada, with prospective bi-annual follow-up for 2 years. Mixed methods data collection, linking primary data to provincial administrative databases will be employed. Major outcomes include generic, obesity-specific and preference

  6. Plasma Medicine

    Science.gov (United States)

    Laroussi, M.; Kong, M. G.; Morfill, G.; Stolz, W.

    2012-05-01

    Foreword R. Satava and R. J. Barker; Part I. Introduction to Non-equilibrium Plasma, Cell Biology, and Contamination: 1. Introduction M. Laroussi; 2. Fundamentals of non-equilibrium plasmas M. Kushner and M. Kong; 3. Non-equilibrium plasma sources M. Laroussi and M. Kong; 4. Basic cell biology L. Greene and G. Shama; 5. Contamination G. Shama and B. Ahlfeld; Part II. Plasma Biology and Plasma Medicine: 6. Common healthcare challenges G. Isbary and W. Stolz; 7. Plasma decontamination of surfaces M. Kong and M. Laroussi; 8. Plasma decontamination of gases and liquids A. Fridman; 9. Plasma-cell interaction: prokaryotes M. Laroussi and M. Kong; 10. Plasma-cell interaction: eukaryotes G. Isbary, G. Morfill and W. Stolz; 11. Plasma based wound healing G. Isbary, G. Morfill and W. Stolz; 12. Plasma ablation, surgery, and dental applications K. Stalder, J. Woloszko, S. Kalghatgi, G. McCombs, M. Darby and M. Laroussi; Index.

  7. Narrativ medicin

    DEFF Research Database (Denmark)

    Hvas, Lotte; Getz, Linn

    2015-01-01

    Dagens allmänmedicin påverkas av ett växande managementtänkandetillsammans med fragmenterande ekonomiska incitament.Vårdens kvaliteter evalueras med nya metoder som ”värdebaseradvård” där värde räknas i kronor och ören. Produktion går före etik,och det intersubjektiva mötet mellan patient och läk...... läkare håller påatt nedvärderas. Perspektiven från narrativ medicin kan bidra tillatt visa vad som står på spel. Vilken blir annars berättelsen omallmänmedicinen?...

  8. Efficacy of a liquid low-energy formula diet in achieving preoperative target weight loss before bariatric surgery

    DEFF Research Database (Denmark)

    Nielsen, Lone Vestergaard; Nielsen, Mette Søndergaard; Schmidt, Julie Berg;

    2016-01-01

    A preoperative weight loss of 8 % is a prerequisite to undergo bariatric surgery (BS) in Denmark. The aim of the present study was to evaluate the efficacy of a 7- or an 11-week low-energy diet (LCD) for achieving preoperative target weight before BS. A total of thirty obese patients (BMI 46·0 (sd...... 4·4) kg/m2) followed an LCD (Cambridge Weight Plan®, 4184 kJ/d (1000 kcal/d)) for 7 or 11 weeks as preparation for BS. Anthropometric measurements including body composition (dual-energy X-ray absorptiometry), blood parameters and blood pressure were assessed at weeks 0, 7 and 11. At week 7...... in TAG (P LCD within 7 weeks as part of preparation for BS...

  9. Update on bariatric surgical procedures and an introduction to the implantable weight loss device: the Maestro Rechargeable System

    Directory of Open Access Journals (Sweden)

    Hwang SS

    2016-08-01

    Full Text Available Stephanie S Hwang,1 Mark C Takata,1 Ken Fujioka,2 William Fuller1 1Division of General/Bariatric Surgery, Scripps Clinic Weight Management, 2Division of Diabetes and Endocrinology, Scripps Clinic, La Jolla, CA, USA Abstract: There are many different methods of treating obesity, ranging from various medical options to several surgical therapies. This paper briefly summarizes current surgical options for weight loss with a focus on one of the newest US Food and Drug Administration-approved devices for surgical weight loss therapy, the Maestro Rechargeable System. Also known as the vagal blocking for obesity control implantable device, this tool blocks vagal nerve activity to induce weight loss. Keywords: VBLOC device, vagal, vagus, obesity

  10. Macrophage activation marker soluble CD163 and non-alcoholic fatty liver disease in morbidly obese patients undergoing bariatric surgery

    DEFF Research Database (Denmark)

    Kazankov, Konstantin; Tordjman, Joan; Møller, Holger Jon;

    2015-01-01

    ). METHODS: Demographic, clinical, and biochemical data, and plasma sCD163 measured by enzyme-linked immunosorbent assay, of 196 patients were collected preoperatively and 3, 6, and 12 months after BS leading to significant weight loss. Peroperative liver biopsies were assessed for the NAFLD Activity Score......BACKGROUND AND AIMS: Macrophages play an important role in non-alcoholic fatty liver disease (NAFLD). Soluble CD163 (sCD163) is a specific marker of macrophage activation. We aimed to measure sCD163 in morbidly obese patients with varying degrees of NAFLD before and after bariatric surgery (BS...... (NAS), Kleiner fibrosis score, and the fatty liver inhibition of progression (FLIP) algorithm. In a subset, CD163 immunohistochemistry and real-time quantitative polymerase chain reaction for CD163 mRNA were performed. RESULTS: sCD163 was higher in patients with NAS ≥ 5 compared with those with NAS 

  11. Postoperative nursing and education for bariatric surgery%肥胖外科手术后病人的护理

    Institute of Scientific and Technical Information of China (English)

    张爱珍; 马圣君; 李静; 周承孝

    2009-01-01

    The patients treated with bariatric surgery often were combined with complications such as hypertension, corcnary artery disease and diabetic, etc. Because of the effects of anesthesia and operation, the patients were often combined with postoperative anastomosis leakage, local infection, dumping syndrome. This article reviewed the postoperative nursing and education problems.%由于肥胖外科手术病人术前伴发病多,加之麻醉、手术的影响,常合并吻合口瘘、局部感染、胃倾倒综合症等.本文对术后护理、出院后护理指导相关问题进行综述.

  12. Endoscopic extraction of adjustable gastric bands after intragastric migration as a complication of bariatric surgery: technique and advice

    Science.gov (United States)

    Collado-Pacheco, David; Rábago-Torre, Luis Ramon; Arias-Rivera, Maria; Ortega-Carbonel, Alejandro; Olivares-Valles, Ana; Alonso-Prada, Alicia; Vázquez-Echarri, Jaime; Herrera-Merino, Norberto

    2016-01-01

    Background: Surgery has been the method most widely used to manage the extraction of gastric bands with inclusion as a late complication of bariatric surgery; however, surgical extraction entails morbidity and limits future surgical procedures. The development of endoscopic techniques has provided an important means of improving the treatment of this complication, enabling minimally invasive and safe procedures that have a high success rate. Methods: A retrospective analysis was conducted of patients who had laparoscopic gastric banding complicated by intragastric migration and were treated endoscopically. A technique already described for managing this complication was employed. An MTW Endoskopie Dormia basket for mechanical lithotripsy or a standard 0.0035-in guidewire was placed around the band, and an MTW Endoskopie emergency lithotripter was used to section it, after which the band was extracted with a standard polypectomy snare. Also analyzed were the initial symptoms of patients with this complication, the mean time from surgery to development of the event, the success rate of endoscopic treatment, and complications, Results: A total of 127 patients had undergone gastric banding surgery in our Bariatric Surgery Center; of these, 12 patients (9.4 %) developed a complication such as intragastric migration of the band. Weight gain and pain were the main symptoms in 11 patients (92 %), and the mean time to the development of symptoms was 51.3 months. A single endoscopic treatment was successful in 7 of 9 patients (78 %). Only 1 complication, involving ventilation during anesthesia, occurred; no other adverse events were recorded. Conclusions: The endoscopic extraction of bands with inclusion is feasible and can be performed easily and successfully. The procedure is available in all hospitals and has a low incidence of related complications, so that unnecessary surgical procedures can be avoided.

  13. Contribution of the distal small intestine to metabolic improvement after bariatric/metabolic surgery: Lessons from ileal transposition surgery.

    Science.gov (United States)

    Oh, Tae Jung; Ahn, Chang Ho; Cho, Young Min

    2016-04-01

    Roux-en Y gastric bypass is a highly effective bariatric/metabolic surgical procedure that can induce robust weight loss and even remission of type 2 diabetes. One of the characteristic consequences of Roux-en Y gastric bypass is the expedited nutrient delivery to the distal small intestine, where L-cells are abundant and bile acid reabsorption occurs. To examine the role of the distal small intestine in isolation from other components of Roux-en Y gastric bypass, the ileal transposition (IT) surgery has been used in various rat models. IT relocates the distal ileal segment to the upper jejunum distal to the ligament of Treitz without any other alterations in the gastrointestinal anatomy. Therefore, IT exposes the distal ileal tissue to ingested nutrients after a meal faster than the normal condition. Although there is some inconsistency in the effect of IT according to different types of rat models and different types of surgical protocols, IT typically improved glucose tolerance, increased insulin sensitivity and induced weight loss, and the findings were more prominent in obese diabetic rats. Suggested mechanisms for the metabolic improvements after IT include increased L-cell secretion (e.g., glucagon-like peptides and peptide YY), altered bile acid metabolism, altered host-microbial interaction, attenuated metabolic endotoxemia and many others. Based on the effect of IT, we can conclude that the contribution of the distal small intestine to the metabolic benefits of bariatric/metabolic surgery is quite considerable. By unveiling the mechanism of action of IT, we might revolutionize the treatment for obesity and type 2 diabetes.

  14. Striatal dopamine D2/3 receptor availability increases after long-term bariatric surgery-induced weight loss.

    Science.gov (United States)

    van der Zwaal, Esther M; de Weijer, Barbara A; van de Giessen, Elsmarieke M; Janssen, Ignace; Berends, Frits J; van de Laar, Arnold; Ackermans, Mariette T; Fliers, Eric; la Fleur, Susanne E; Booij, Jan; Serlie, Mireille J

    2016-07-01

    In several studies reduced striatal dopamine D2/3 receptor (D2/3R) availability was reported in obese subjects compared to lean controls. Whether this is a reversible phenomenon remained uncertain. We previously determined the short-term effect of Roux-en-Y gastric bypass surgery (RYGB) on striatal D2/3R availability (using [(123)I]IBZM SPECT) in 20 morbidly obese women. Striatal D2/3R availability was lower compared to controls at baseline, and remained unaltered after 6 weeks, despite significant weight loss. To determine whether long-term bariatric surgery-induced weight loss normalizes striatal D2/3R binding, we repeated striatal D2/3R binding measurements at least 2 years after RYGB in 14 subjects of the original cohort. In addition, we assessed long-term changes in body composition, eating behavior and fasting plasma levels of leptin, ghrelin, insulin and glucose. Mean body mass index declined from 46±7kg/m(2) to 32±6kg/m(2), which was accompanied by a significant increase in striatal D2/3R availability (p=0.031). Striatal D2/3R availability remained significantly reduced compared to the age-matched controls (BMI 22±2kg/m(2); p=0.01). Changes in striatal D2/3R availability did not correlate with changes in body weight/fat, insulin sensitivity, ghrelin or leptin levels. Scores on eating behavior questionnaires improved and changes in the General Food Craving Questionnaire-State showed a borderline significant correlation with changes in striatal D2/3R availability. These findings show that striatal D2/3R availability increases after long-term bariatric-surgery induced weight loss, suggesting that reduced D2/3R availability in obesity is a reversible phenomenon. PMID:27184782

  15. Complementary and Integrative Medicine

    Science.gov (United States)

    ... medical treatments that are not part of mainstream medicine. When you are using these types of care, it may be called complementary, integrative, or alternative medicine. Complementary medicine is used together with mainstream medical ...

  16. Preventing HIV with Medicine

    Science.gov (United States)

    ... HIV/AIDS This information in Spanish ( en español ) Preventing HIV with medicine Get medicine right after you ... during sex. Return to top More information on Preventing HIV with medicine Explore other publications and websites ...

  17. Traveling Safely with Medicines

    Science.gov (United States)

    ... Medications Safely My Medicine List How to Administer Traveling Safely with Medicines Planes, trains, cars – even boats ... your trip, ask your pharmacist about how to travel safely with your medicines. Make sure that you ...

  18. Depression - stopping your medicines

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000570.htm Depression - stopping your medicines To use the sharing features ... prescription medicines you may take to help with depression, anxiety, or pain. Like any medicine, there are ...

  19. Medicines by Design

    Science.gov (United States)

    ... Order Search the NIGMS Website Search the NIGMS Website NIGMS Home Research Funding Research Training News & Meetings Science Education About NIGMS NIGMS Home > Science Education > Medicines By Design Medicines By Design Spotlight Nature's Medicine Cabinet A ...

  20. What Is Nuclear Medicine?

    Science.gov (United States)

    What is nuclear medicine? Nuclear medicine is a medical specialty that is used to diagnose and treat diseases in a safe and painless way. Nuclear medicine procedures permit the determination of medical information ...

  1. Medicines for sleep

    Science.gov (United States)

    Benzodiazepines; Sedatives; Hypnotics; Sleeping pills; Insomnia - medicines; Sleep disorder - medicines ... are commonly used to treat allergies. While these sleep aids are not addictive, your body becomes used ...

  2. Medicines for osteoporosis

    Science.gov (United States)

    ... Teriparatide (Forteo); Denosumab (Prolia); Low bone density - medicines; Osteoporosis - medicines ... when: A bone density test shows you have osteoporosis, even if you have not had a fracture ...

  3. Profilaxia antimicrobiana na cirurgia bariátrica Antibiotic prophylaxis in bariatric surgery

    Directory of Open Access Journals (Sweden)

    Álvaro Antonio Bandeira Ferraz

    2007-04-01

    Full Text Available OBJETIVO: Analisar os resultados da incidência de infecção do sítio cirúrgico com três diferentes esquemas antimicrobianos. MÉTODO: No período de Janeiro de 1999 a Dezembro de 2004 foram realizadas 716 cirurgias para o tratamento da Obesidade mórbida, seguindo a técnica proposta por Fobi/Capella. Foram estudados comparativamente três grupos de pacientes: Grupo I - (185 em que foi realizada a profilaxia antimicrobiana com ampicilina/sulbactam, na dose de 3g em duas doses; Grupo II (280 em que a profilaxia foi com ceftriaxona na dose de 1g (dose única; e Grupo III (251 em que a profilaxia foi com ertapenem, na dose de 1 g (dose única. RESULTADOS: O resultado do presente estudo demonstra taxas de infecção do sítio cirúrgico de 3,78% no grupo de profilaxia com ampicilina-sulbactam, 6,81% no grupo de profilaxia com ceftriaxona e de 1,99% no grupo de ertapenem. Não houve diferença estatisticamente significativa entre o uso da associação ampicilina/sulbactam ou ceftriaxona com relação à incidência de infecção do sítio cirúrgico. No entanto, quando comparados os resultados do Grupo II (Ceftriaxona com o Grupo III (Ertapenem, houve uma diferença estatisticamente sisgnificante. CONCLUSÃO: A utilização do ertapenem, de maneira profilática, no tratamento cirúrgico da obesidade mórbida, determinou taxas de infecção do sítio cirúrgico estatisticamente inferiores ao grupo de ceftriaxona e similar ao de ampicilina-sulbactam.BACKGROUND:To analyze the results of the incidence of wound infection under 3 different antibiotics regiments. METHODS: Between January, 1999 and December, 2004, 716 bariatric surgeries had been performed using the technique proposed by Fobi/Capella. Three groups of patients had been compared, according to the antibiotic prophylaxys regimen: Group I: (n=185 ampicillin/sulbactam, 3g in two doses; Group II (n=280: ceftriaxone, 1g (single dose; and Group III: (n=251 ertapenem, 1 g (single dose. RESULTS

  4. 减肥手术治疗2型糖尿病的进展%The Progress of Bariatric Surgery in the Treatment of Type 2 Diabetes

    Institute of Scientific and Technical Information of China (English)

    覃新干

    2014-01-01

    全球糖尿病发病率逐年增高,但其治疗效果并不理想,近年来的研究表明,减肥手术可以缓解或改善糖尿病,给糖尿病患者带来希望。本文拟对减肥手术治疗2型糖尿病的进展作一综述。%The global incidence of diabetes increased year by year, but the treatment is not satisfactory. In recent years, studies have shown that bariatric surgery can alleviate or ameliorate diabetes, bring hope to patients with diabetes. This paper intends to review the progress of bariatric surgery in the treatment of type 2 diabetes.

  5. 减重手术改善代谢的机制%Research progress in mechanisms by which bariatric surgery improves metabolism

    Institute of Scientific and Technical Information of China (English)

    邵怡凯; 姚琪远

    2014-01-01

    Bariatric surgery is the most effective treatment for obesity and its comorbidities,but mechanisms of bariatric surgery remain unknown.In addition to volume restriction and malabsorption,gut hormones,bile acids,adipokines,intestinal microbiome and central nervous system may be the potential mechanisms.%减重手术是治疗肥胖及其合并症最有效的方法,但其机制目前仍未完全明确.除了手术的限容和促吸收不良作用以外,胃肠激素、胆汁酸、脂肪因子、肠道菌群和中枢神经系统的作用都可能是减重手术改善代谢的潜在机制.本文对此进行综述.

  6. [Disaster medicine].

    Science.gov (United States)

    Carli, Pierre; Telionri, Caroline

    2015-01-01

    For over 30 years, the French hospital and pre-hospital medical teams are trained in disaster medicine. In fact, they are regularly confronted with the management of multiple casualties in accidents or even terrorist attacks, and more rarely to large-scale disasters. The intervention of physicians of the EMS system (SAMU-SMUR) in the field allows an original healthcare organization: in an advanced medical post, the victims are triaged according to their severity and benefit if needed of initial resuscitation. SAMU medical regulating center then organize their transport and repartition in several hospitals put on alert. To cope with a mass casualty situation, the hospital also has a specific organization, the White Plan. This plan, initiated by the director, assisted by a medico-administrative cell crisis can mobilize all the resources of the institution. Personnel are recalled and the ability of emergency units is increased. Care, less urgent, other patients are postponed. There are many plans for responding to disasters. ORSEC plans of the ministry of Interior articulate with the ORSAN plans of the ministry of Health. This complementarity allows a global mobilization of public services in disasters or exceptional medical situations.

  7. Post-bariatric abdominoplasty resulting in wound infection and dehiscence—Conservative treatment with medical grade honey: A case report and review of literature

    OpenAIRE

    Reem Dina Jarjis; Bjørn Thomas Crewe; Steen Henrik Matzen

    2016-01-01

    Introduction: Wound complications in post-bariatric patients undergoing body-contouring surgery after massive weight loss are not uncommon and often, surgical debridement or conservative management is necessary. Honey is one of the most ancient remedies for wound care and it is also considered to possess debriding effects. Current research has demonstrated promising results showing that honey can improve wound granulation and epithelialization, reduce exudate and shorten healing times. Met...

  8. Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Patrícia Brigatto

    2014-12-01

    Full Text Available Objective: To evaluate whether the application of bilevel positive airway pressure in the postoperative period of bariatric surgery might be more effective in restoring lung volume and capacity and thoracic mobility than the separate application of expiratory and inspiratory positive pressure. Method: Sixty morbidly obese adult subjects who were hospitalized for bariatric surgery and met the predefined inclusion criteria were evaluated. The pulmonary function and thoracic mobility were preoperatively assessed by spirometry and cirtometry and reevaluated on the 1st postoperative day. After preoperative evaluation, the subjects were randomized and allocated into groups: EPAP Group (n=20, IPPB Group (n=20 and BIPAP Group (n=20, then received the corresponding intervention: positive expiratory pressure (EPAP, inspiratory positive pressure breathing (IPPB or bilevel inspiratory positive airway pressure (BIPAP, in 6 sets of 15 breaths or 30 minutes twice a day in the immediate postoperative period and on the 1st postoperative day, in addition to conventional physical therapy. Results: There was a significant postoperative reduction in spirometric variables (p0.05. Thoracic mobility was preserved only in group BIPAP (p>0.05, but no significant difference was found in the comparison among groups (p>0.05. Conclusion: The application of positive pressure does not seem to be effective in restoring lung function after bariatric surgery, but the use of bilevel positive pressure can preserve thoracic mobility, although this technique was not superior to the other techniques.

  9. Changes in Plasma Levels of N-Arachidonoyl Ethanolamine and N-Palmitoylethanolamine following Bariatric Surgery in Morbidly Obese Females with Impaired Glucose Homeostasis

    Directory of Open Access Journals (Sweden)

    Akhila Mallipedhi

    2015-01-01

    Full Text Available Aim. We examined endocannabinoids (ECs in relation to bariatric surgery and the association between plasma ECs and markers of insulin resistance. Methods. A study of 20 participants undergoing bariatric surgery. Fasting and 2-hour plasma glucose, lipids, insulin, and C-peptide were recorded preoperatively and 6 months postoperatively with plasma ECs (AEA, 2-AG and endocannabinoid-related lipids (PEA, OEA. Results. Gender-specific analysis showed differences in AEA, OEA, and PEA preoperatively with reductions in AEA and PEA in females postoperatively. Preoperatively, AEA was correlated with 2-hour glucose (r=0.55, P=0.01, HOMA-IR (r=0.61, P=0.009, and HOMA %S (r=-0.71, P=0.002. OEA was correlated with weight (r=0.49, P=0.03, waist circumference (r=0.52, P=0.02, fasting insulin (r=0.49, P=0.04, and HOMA-IR (r=0.48, P=0.05. PEA was correlated with fasting insulin (r=0.49, P=0.04. 2-AG had a negative correlation with fasting glucose (r=-0.59, P=0.04. Conclusion. Gender differences exist in circulating ECs in obese subjects. Females show changes in AEA and PEA after bariatric surgery. Specific correlations exist between different ECs and markers of obesity and insulin and glucose homeostasis.

  10. To eat or not to eat; is that really the question? An evaluation of problematic eating behaviors and mental health among bariatric surgery candidates.

    Science.gov (United States)

    Miller-Matero, Lisa Renee; Armstrong, Rachel; McCulloch, Katherine; Hyde-Nolan, Maren; Eshelman, Anne; Genaw, Jeffrey

    2014-01-01

    Problematic eating behaviors, such as emotional eating, and food addiction, may affect weight; however, little is known about these eating behaviors, especially among those seeking bariatric surgery. Therefore, the purpose of this study was to estimate the prevalence of problematic eating behaviors and to investigate their relationship with other eating behaviors, body mass index (BMI), and psychiatric symptoms. There were 142 patients who completed a required psychiatric evaluation prior to bariatric surgery. Of these, 16.9 % met criteria for a food addiction and 25.4-40.7 % endorsed emotional eating, depending on type of emotional eating. The number of food addiction symptoms endorsed was related to emotional eating. Both food addiction and emotional eating were related to anxiety and depressive symptoms. However, surprisingly, BMI was not related to a food addiction diagnosis, emotional eating scores, or psychiatric symptoms. Results from this study suggest that problematic eating behaviors are occurring among bariatric surgery candidates. Furthermore, this study may help to address the conflicting research regarding the effects of psychiatric symptoms on weight-loss outcomes. Perhaps it is the problematic eating behaviors (e.g., food addiction and emotional eating) that are associated with psychiatric symptoms that could be influencing outcomes. Future research should evaluate treatments for problematic eating behaviors and whether treatments improve weight-loss success. PMID:24878835

  11. 减肥手术对骨骼健康的影响及其机制%Effects of bariatric surgery on skeletal health and its possible mechanism

    Institute of Scientific and Technical Information of China (English)

    李梅

    2014-01-01

    肥胖症发病率的显著提高已成为严重的公众健康问题。胃减容或旁路手术是治疗重度肥胖症切实有效的方法。新近研究发现减肥手术不仅可能引起骨密度降低,而且远期可能导致骨折率上升。本文就减肥手术对骨骼的影响、机制及防治措施进行综述。%As dramatic increase of the prevalence , obesity has become a severe public health issue .Restrictive and gastric by-pass bariatric surgery remains the most effective treatment for morbid obese patients .However , recent re-search indicates that bariatric surgery not only leads to reduce of bone mineral density , but also increases bone fracture risk.This review aims to present the impact of bariatric surgery on skeleton , to elucidate its possible mechanism and pre-vention protocol .

  12. Obstetric medicine

    Directory of Open Access Journals (Sweden)

    L. Balbi

    2013-05-01

    Full Text Available BACKGROUND Obstetric assistance made major advances in the last 20 years: improved surgical technique allows quicker caesarean sections, anaesthesiology procedures such as peripheral anaesthesia and epidural analgesia made safer operative assistance, remarkably reducing perioperative morbidity and mortality, neonatology greatly improved the results of assistance to low birth weight newborns. A new branch of medicine called “obstetric medicine” gained interest and experience after the lessons of distinguished physicians like Michael De Swiet in England. All together these advances are making successful pregnancies that 20 years ago would have been discouraged or even interrupted: that’s what we call high risk pregnancy. High risk of what? Either complications of pregnancy on pre-existing disease or complications of pre-existing disease on pregnancy. Nowadays, mortality in pregnancy has a medical cause in 80% of cases in Western countries (Confidential Enquiry on Maternal Deaths, UK, 2004. DISCUSSION The background is always changing and we have to take in account of: increase of maternal age; widespread use of assisted fertilization techniques for treatment of infertility; social feelings about maternity desire with increasing expectations from medical assistance; immigration of medically “naive” patients who don’t know to have a chronic disease, but apt and ready to conceive; limited knowledge of feasibility of drug use in pregnancy which may induce both patients and doctors to stopping appropriate drug therapy in condition of severe disease. Preconception counseling, planning the pregnancy, wise use of drugs, regular follow-up throughout the pregnancy and, in selected cases, preterm elective termination of pregnancy may result in excellent outcome both for mother and foetus. CONCLUSIONS Highly committed and specifically trained physicians are required to counsel these patients and to plan their treatment before and during pregnancy.

  13. TRADITIONAL CHINESE HERBAL MEDICINE

    NARCIS (Netherlands)

    ZHU, YP; WOERDENBAG, HJ

    1995-01-01

    Herbal medicine, acupuncture and moxibustion, and massage and the three major constituent parts of traditional Chinese medicine. Although acupuncture is well known in many Western countries, Chinese herbal medicine, the mos important part of traditional Chinese medicine, is less well known in the We

  14. Personalized laboratory medicine

    DEFF Research Database (Denmark)

    Pazzagli, M.; Malentacchi, F.; Mancini, I.;

    2015-01-01

    diagnostic tools and expertise and commands proper state-of-the-art knowledge about Personalized Medicine and Laboratory Medicine in Europe, the joint Working Group "Personalized Laboratory Medicine" of the EFLM and ESPT societies compiled and conducted the Questionnaire "Is Laboratory Medicine ready...... for the era of Personalized Medicine?". 48 laboratories from 18 European countries participated at this survey. The answers of the participating Laboratory Medicine professionals indicate that they are aware that Personalized Medicine can represent a new and promising health model. Whereas they are aware...... that Laboratory Medicine should play a key role to support the implementation of Personalized Medicine in the clinical settings, the participants of this survey think that the current organization of the Laboratory Medicine needs additional/relevant implementations such as: 1. New technological Facilities...

  15. Comparative effectiveness and safety of gastric bypass, sleeve gastrectomy and adjustable gastric banding in a population-based bariatric program: prospective cohort study

    Science.gov (United States)

    Gill, Richdeep S.; Majumdar, Sumit R.; Rueda-Clausen, Christian F.; Apte, Sameer; Birch, Daniel W.; Karmali, Shahzeer; Sharma, Arya M.; Klarenbach, Scott; Padwal, Raj S.

    2016-01-01

    Background Bariatric surgery in Canada is primarily delivered within publicly funded specialty clinics. Previous studies have demonstrated that bariatric surgery is superior to intensive medical management for reduction of weight and obesity-related comorbidities. Our objective was to compare the effectiveness and safety of laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (LSG) and adjustable gastric banding (LAGB) in a publicly funded, population-based bariatric treatment program. Methods We followed consecutive bariatric surgery patients for 2 years. The primary outcome was weight change (in kilograms). Between-group changes were analyzed using multivariable regression. Last-observation-carried-forward imputation was used for missing data. Results We included 150 consecutive patients (51 RYGB; 51 LSG; 48 LAGB) in our study. At baseline, mean age was 43.5 ± 9.5 years, 87.3% of patients were women, and preoperative body mass index (BMI) was 46.2 ± 7.4. Absolute and relative (% of baseline) weight loss at 2 years were 36.6 ± 19.5 kg (26.1 ± 12.2%) for RYGB, 21.4 ± 16.0 kg (16.4 ± 11.6%) for LSG and 7.0 ± 9.7 kg (5.8 ± 7.9%) for LAGB (p < 0.001). Change in BMI was greater for the RYGB (−13.0 ± 6.6) than both the LSG (−7.6 ± 5.7) and the LAGB (−2.6 ± 3.5) groups (p < 0.001). The reduction in diabetes, hypertension and dyslipidemia was greater after RYGB than after LAGB (all p < 0.05). There were no deaths. The anastomotic and staple leakage rate was 1.3%. Conclusion In a publicly funded, population-based bariatric surgery program, RYGB and LSG demonstrated greater weight loss than the LAGB procedure. Bypass resulted in the greatest reduction in obesity-related comorbidities. All procedures were safe. PMID:27240132

  16. Sleep Medicine Textbook

    OpenAIRE

    Bassetti, Claudio; Dogas, Zoran; Peigneux, Philippe

    2014-01-01

    The Sleep Medicine Textbook provides comprehensive, all-in-one educational material (550 pages) structured around the Catalogue of knowledge and skills for sleep medicine (Penzel et al. 2014, Journal of Sleep Research). Written by experts in the field and published by the ESRS, it provides an European approach to sleep medicine education, and represents the knowledge-base for the ESRS-endorsed sleep medicine examinations.The book is available at http://www.esrs.eu/esrs/sleep-medicine-textbook...

  17. The application of transcutaneous CO2 pressure monitoring in the anesthesia of obese patients undergoing laparoscopic bariatric surgery.

    Directory of Open Access Journals (Sweden)

    Shijiang Liu

    Full Text Available To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2 with regard to arterial carbon dioxide partial pressure (PaCO2 in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m(2 were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2, as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2-PaCO2 and. (PTCCO2-PaCO2 were calculated. Bland-Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19-54 yr, mean 29, SD 9 yr; weight 86-160 kg, mean 119.3, SD 22.1 kg; BMI 35.3-51.1 kg/m(2, mean 42.1,SD 5.4 kg/m(2 were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2-PTCCO2 difference was 0.9 ± 1.3 mmHg (mean ± SD. And the average PaCO2-PetCO2 difference was 10.3 ± 2.3 mmHg (mean ± SD. The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57 × PaCO2 (r(2 = 0.64, P<0.01, whereas the one of PaCO2-PTCCO2 is PTCCO2 = 0.60 + 0.97 × PaCO2 (r(2 = 0.89. The LOA (limits of agreement of 95% average PaCO2-PetCO2 difference is 10.3 ± 4.6 mmHg (mean ± 1.96 SD, while the LOA of 95% average PaCO2-PTCCO2 difference is 0.9 ± 2.6 mmHg (mean ± 1.96 SD. In conclusion, transcutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery.

  18. Preoperative and Postoperative (1st and 3rd Month Metabolic Data of Patients Who Underwent Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Nilüfer Özdemir Kutbay

    2015-03-01

    Full Text Available Purpose: The growing prevalence of obesity has become a major concern. The efficacy of medical treatment, diet and behavior therapy in morbidly obese patients is limited. Obesity surgery is a treatment option for selected morbidly obese patients. Material and Method: Data of 47 patients (n=39 women, 8 men who underwent bariatric surgery were investigated. Results: Out of 47 patients, 20 underwent Roux-en-Y gastric bypass (RYGB (43% and 27 had sleeve gastrectomy (SG (57%. The mean age of the patients was 37±9.5 (19-59 years. 17% of patients were men and 83% were women. In the analysis of data on weight that could be found for 31 out of 47 patients, we detected preoperative and postoperative (1st and 3rd month mean weight values as 125.4±15.9 kg, 112.7±13.2 kg (p<0.001 and 100.9±17.5 kg (p<0.001, respectively. In addition, the analysis of the data on mean fasting plasma glucose (FPG levels which could be found for 23 out of 47 patients, showed us that preoperative and postoperative (1st and 3rd month FPG levels were 100.9±17.5 mg/dL, 91.6±10.9 mg/dL (p=0.03 and 87.3±2.0 mg/dL, respectively. Only 1 patient had diabetes before the surgery. In the RYGB group, the mean change in weight was 12.4±5.5 kg in the 1st month and 22.2±8.6 kg in the 3rd month (compared to the weights in the preoperative period. Moreover, in the SG group, the mean change in weight was 13.7±4.5 kg in the 1st month and 23.4±5.8 kg in the 3rd month. No statistically significant difference was found between the weight changes in the 1st and the 3rd month as for surgery types. Discussion: After bariatric surgery, significant loss in weight and reduction in FPG occurred in short-term.

  19. Mecanismos cirúrgicos de controle do diabetes mellitus tipo 2 após cirurgia bariátrica Mechanisms of surgical control for type 2 diabetes mellitus after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Dantas de Campos Martins

    2007-10-01

    Full Text Available Type 2 diabetes mellitus is an epidemic health problem. Approximately, 90% of diabetic patients are overweight or are obese. The current increase in the prevalence of obesity has been associated with an increase in the prevalence of type 2 diabetes. Bariatric surgery is the most effective treatment for morbid obese patients in terms of controlling weight and co-morbidities. Sustained normal plasma concentration of glucose has been reported in most diabetic morbid obese patients, which has been managed surgically. Available data show a significant alteration in the production of some gastrointestinal hormones, which might explain the improvement of glucose metabolism following these procedures. Diabetic patient improvements following some bariatric surgeries seems to be an independent factor unrelated to the amount of weight loss. The authors reviewed data published on the effects of bariatric surgery in diabetic patient improvements and the possible mechanisms responsible for this control.

  20. DNA methylation analysis in nonalcoholic fatty liver disease suggests distinct disease-specific and remodeling signatures after bariatric surgery.

    Science.gov (United States)

    Ahrens, Markus; Ammerpohl, Ole; von Schönfels, Witigo; Kolarova, Julia; Bens, Susanne; Itzel, Timo; Teufel, Andreas; Herrmann, Alexander; Brosch, Mario; Hinrichsen, Holger; Erhart, Wiebke; Egberts, Jan; Sipos, Bence; Schreiber, Stefan; Häsler, Robert; Stickel, Felix; Becker, Thomas; Krawczak, Michael; Röcken, Christoph; Siebert, Reiner; Schafmayer, Clemens; Hampe, Jochen

    2013-08-01

    Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in industrialized countries. Liver samples from morbidly obese patients (n = 45) with all stages of NAFLD and controls (n = 18) were analyzed by array-based DNA methylation and mRNA expression profiling. NAFLD-specific expression and methylation differences were seen for nine genes coding for key enzymes in intermediate metabolism (including PC, ACLY, and PLCG1) and insulin/insulin-like signaling (including IGF1, IGFBP2, and PRKCE) and replicated by bisulfite pyrosequening (independent n = 39). Transcription factor binding sites at NAFLD-specific CpG sites were >1,000-fold enriched for ZNF274, PGC1A, and SREBP2. Intraindividual comparison of liver biopsies before and after bariatric surgery showed NAFLD-associated methylation changes to be partially reversible. Postbariatric and NAFLD-specific methylation signatures were clearly distinct both in gene ontology and transcription factor binding site analyses, with >400-fold enrichment of NRF1, HSF1, and ESRRA sites. Our findings provide an example of treatment-induced epigenetic organ remodeling in humans. PMID:23931760

  1. Effectiveness of cognitive-behavioral therapy in morbidity obese candidates for bariatric surgery with and without binge eating disorder

    Directory of Open Access Journals (Sweden)

    V. Abilés

    2013-10-01

    Full Text Available Aims: To analyze changes in the general and specific psychopathology of morbidly obese bariatric surgery (BS candidates after cognitive behavioral therapy (CBT and assess differences between patients with and without binge eating disorder (BED and between patients with obesity grades III and IV, studying their influence on weight loss. Methods: 110 consecutive morbidly obese BS candidates [77 females; aged 41 ± 9 yrs; body mass index 49.1 ± 9.0 kg/m²] entered a three-month CBT program (12 two-hour sessions before BS. Participants were assessed with general and specific psychopathology tests pre-and post-CBT. Data were analyzed according to the degree of obesity and presence/absence of BED. Results: At baseline, BED patients were more anxious and depressive with lower self-esteem and quality of life versus non-BED patients (p 10% in 61%, with no intergroup differences. Conclusions: CBT is effective to treat psychological comorbidity in BS candidates, regardless of the presence of BED and degree of obesity.

  2. DNA methylation analysis in nonalcoholic fatty liver disease suggests distinct disease-specific and remodeling signatures after bariatric surgery.

    Science.gov (United States)

    Ahrens, Markus; Ammerpohl, Ole; von Schönfels, Witigo; Kolarova, Julia; Bens, Susanne; Itzel, Timo; Teufel, Andreas; Herrmann, Alexander; Brosch, Mario; Hinrichsen, Holger; Erhart, Wiebke; Egberts, Jan; Sipos, Bence; Schreiber, Stefan; Häsler, Robert; Stickel, Felix; Becker, Thomas; Krawczak, Michael; Röcken, Christoph; Siebert, Reiner; Schafmayer, Clemens; Hampe, Jochen

    2013-08-01

    Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in industrialized countries. Liver samples from morbidly obese patients (n = 45) with all stages of NAFLD and controls (n = 18) were analyzed by array-based DNA methylation and mRNA expression profiling. NAFLD-specific expression and methylation differences were seen for nine genes coding for key enzymes in intermediate metabolism (including PC, ACLY, and PLCG1) and insulin/insulin-like signaling (including IGF1, IGFBP2, and PRKCE) and replicated by bisulfite pyrosequening (independent n = 39). Transcription factor binding sites at NAFLD-specific CpG sites were >1,000-fold enriched for ZNF274, PGC1A, and SREBP2. Intraindividual comparison of liver biopsies before and after bariatric surgery showed NAFLD-associated methylation changes to be partially reversible. Postbariatric and NAFLD-specific methylation signatures were clearly distinct both in gene ontology and transcription factor binding site analyses, with >400-fold enrichment of NRF1, HSF1, and ESRRA sites. Our findings provide an example of treatment-induced epigenetic organ remodeling in humans.

  3. Effect of Weight Reduction Following Bariatric Surgery on Serum Visfatin and Adiponectin Levels in Morbidly Obese Subjects

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Hosseinzadeh-Attar

    2013-04-01

    Full Text Available Objective: Adipokines are signaling and mediator proteins secreted from adipose tissue. A novel adipokine, visfatin, was reported as a protein which was mainly expressed in visceral adipose tissue. Controversial results have been shown regarding the changes of adipokines following weight reduction. So we investigated the effects of weight reduction on serum concentrations of adiponectin and visfatin in morbidly obese subjects. Methods: 35 severely obese patients (26 females and 9 males, aged 15-58 years, were studied. Anthropometric parameters and biochemical parameters as well as adiponectin and visfatin were analyzed before and 6 weeks after weight reduction. Results: Anthropometric indices decreased significantly. Blood levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride were reduced significantly. The reduction of visfatin and the elevation of adiponectin were significant as well. However, other parameters like fasting glucose and insulin did not change. Moreover, we could not find any significant correlation between the change of serum visfatin and that of adiponectin. Conclusions: 6-week weight reduction after bariatric surgery resulted in decreased serum visfatin and increased adiponectin levels. However, we cannot find any significant correlation between changes of adiponectin, visfatin, BMI, waist circumference, and insulin resistance. Further studies with different design are suggested to clarify these associations.

  4. An improved dual approach to post bariatric contouring - Staged liposuction and modified medial thigh lift: A case series

    Directory of Open Access Journals (Sweden)

    Zaher Jandali

    2014-01-01

    Full Text Available Objective: Following massive weight loss (MWL medial contouring of the thigh is frequently requested to improve appearance and function. Thigh lifting can be associated with significant complications. We present a case series of post bariatric patients undergoing thigh lift using staged the liposuction, a modified T incision and a buried de-epithelialised dermal flap. Materials and Methods: From January to December 2012, 21 consecutive patients underwent a modified medial thigh lift. A retrospective review of the case notes was performed to assess complications that occurred. Results: There were no major post-operative complications in terms of reoperation, hematoma, thromboembolism and no seromas. Seven patients, all of which were smokers had minor superficial wound healing complications. Aesthetic outcomes were satisfactory for all patients at a minimum follow-up of 6 months. Conclusions: The modified ′T′ incision with staged liposuction is described. We have found the technique to be useful for a variety of different thighs. It is a reproducible method for contouring the medial thigh in MWL patients. In this series, our overall complications were low, and no seromas occurred.

  5. Defining the Role of Bariatric Surgery in Polycystic Ovarian Syndrome Patients%减重手术在多囊卵巢综合征治疗中的作用

    Institute of Scientific and Technical Information of China (English)

    Shaveta M. Malik; Michael L. Traub; 王恺京; 徐安安

    2013-01-01

    Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women. To meet PCOS criteria, women must have a combination of hyperandrogenism, anovulation and ultrasound findings. Almost 10% of all reproductive age women worldwide show signs of PCOS. Although women often seek care for gynecological or body image concerns, many PCOS women are at risk for metabolic syndrome (MS). Many of the metabolic consequences are overlooked and undertreated by physicians because these patients tend to be young, reproductive age women. MS and obesity coexist commonly with PCOS. These young women are predisposed to glucose abnormalities and ultimately diabetes mellitus, dyslipidemia and eventually cardiovascular disease. Bariatric surgery can be an effective means of weight loss in PCOS women. Surgical techniques have become safer and less invasive over time and have been found to be effective in achieving significant weight loss. Surgical options have also increased, giving patients more choices. Bariatric surgery may prevent or reverse metabolic syndrome. Bariatric surgery may also have reproductive benefits in PCOS patients. Although bariatric surgery has historically been performed in older, reproductive aged women, it has recently gained favor in adolescents as well. This is of particular importance due to the prevalence of both PCOS and MS in adolescents. Treatment of PCOS and MS certainly requires a combination of medical therapy, psychological support and lifestyle modifications. These treatments are difficult and often frustrating for patients and physicians. Bariatric surgery can be effective in achieving significant weight loss, restoration of the hypothalamic pituitary axis, reduction of cardiovascular risk and even in improving pregnancy outcomes. Ultimately, bariatric surgery should be considered part of the treatment in PCOS women, especially in those with MS.

  6. National Farm Medicine Center

    Science.gov (United States)

    Research Areas Applied Sciences Biomedical Informatics Clinical Research Epidemiology Farm Medicine Human Genetics Oral-Systemic Health Clinical ... Consulting Agritourism Farm MAPPER Lyme Disease ROPS Rebate Zika Virus National Farm Medicine Center The National Farm ...

  7. Cold and Cough Medicines

    Science.gov (United States)

    ... What can you do for your cold or cough symptoms? Besides drinking lots of fluids and getting ... medicines. There are lots of different cold and cough medicines, and they do different things. Nasal decongestants - ...

  8. Society for Vascular Medicine

    Science.gov (United States)

    ... 2017 Learn more Patient Information Pages from Vascular Medicine August 2016 The Vascular Laboratory More info for ... Learn more. Trending Now: Hot Topics in Vascular Medicine Video Series Fibromuscular Dysplasia (FMD) with Drs. Jeffrey ...

  9. HIV/AIDS Medicines

    Science.gov (United States)

    ... few years. But today, there are many effective medicines to fight the infection, and people with HIV ... healthier lives. There are five major types of medicines: Reverse transcriptase (RT) inhibitors - interfere with a critical ...

  10. Depression - stopping your medicines

    Science.gov (United States)

    ... prescription medicines you may take to help with depression, anxiety, or pain. Like any medicine, there are ... at risk for: Returning symptoms, such as severe depression Increased risk of suicide (for some people) Withdrawal ...

  11. Medicine safety and children

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000619.htm Medicine safety and children To use the sharing features ... especially careful if you have toddlers around. Keep Medicines out of Reach and Sight Safety tips: DO ...

  12. Future of Personalized Medicine

    Science.gov (United States)

    ... please turn Javascript on. The Future of Personalized Medicine, From NIH Director Dr. Francis S. Collins Past Issues / ... five priorities for NIH is to advance personalized medicine. What does this mean for the average American? ...

  13. Nuclear energy and medicine

    International Nuclear Information System (INIS)

    The applications of nuclear energy on medicine, as well as the basic principles of these applications, are presented. The radiological diagnosis, the radiotherapy, the nuclear medicine, the radiological protection and the production of radioisotopes are studied. (M.A.C.)

  14. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Tell your doctor about your child’s recent illnesses, medical conditions, medications and allergies. Depending on the type ... Nuclear Medicine? Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material ...

  15. ADHD Medicines (for Kids)

    Science.gov (United States)

    ... Dictionary of Medical Words En Español What Other Kids Are Reading Movie: Digestive System Winter Sports: Sledding, ... Crushes What's a Booger? ADHD Medicines KidsHealth > For Kids > ADHD Medicines Print A A A Text Size ...

  16. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... referring physician. top of page What are the benefits vs. risks? Benefits The information provided by nuclear medicine examinations is ... risk is very low compared with the potential benefits. Nuclear medicine diagnostic procedures have been used for ...

  17. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... is approximately $75 billion spent annually on prescription medicine. All too often, however, we overlook the vital ... between prescription and over-the-counter remedies. Prescription medicine is prescribed by a doctor for a specific ...

  18. Mind-Body Medicine Practices in Complementary and Alternative Medicine

    Science.gov (United States)

    ... Education Visitor Information RePORT NIH Fact Sheets Home > Mind-Body Medicine Practices in Complementary and Alternative Medicine Small Text Medium Text Large Text Mind-Body Medicine Practices in Complementary and Alternative Medicine ...

  19. Performing Narrative Medicine

    Science.gov (United States)

    Langellier, Kristin M.

    2009-01-01

    In this article, the author weaves narrative medicine and performance together to consider what might it mean to call narrative medicine a performance. To name narrative medicine as performance is to recognize the texts and bodies, the stories and selves, that participate in its practice--patients' and physicians' embodied stories as well as the…

  20. Medicines to Treat Allergies

    Science.gov (United States)

    ... it costs. Ask if they have a drug discount program that can help you pay less for your medicine. Buy your medicine from the pharmacy that gives you the cheapest price.  Sign up for patient assistance programs: Most companies that make medicines have programs that help people ...

  1. Is Marijuana Medicine?

    Science.gov (United States)

    ... Publications » DrugFacts » Is Marijuana Medicine? DrugFacts: Is Marijuana Medicine? Email Facebook Twitter Revised July 2015 What is ... isn’t the marijuana plant an FDA-approved medicine? The FDA requires carefully conducted studies (clinical trials) ...

  2. Evaluation of medical and health economic effectiveness of bariatric surgery (obesity surgery versus conservative strategies in adult patients with morbid obesity

    Directory of Open Access Journals (Sweden)

    von der Schulenburg, Johann-Matthias

    2008-07-01

    Full Text Available Background: Obesity with its associated medical, psychological, social, and economic complications is considered a chronic, multifactorial disorder. Given the magnitude of the challenge obesity, there is a clear need for preventive as well as therapeutic measures and strategies on an individual and a public health level. Objectives: The goal of this health technology assessment (HTA-report is to summarise the current literature on bariatric surgery, to evaluate their medical effectiveness/efficacy and cost-effectiveness as well as the ethical, social and legal implications of these procedures in comparison to conventional therapies and compared to each other. Methods: Relevant publications are identified by means of a structured search of databases accessed on 13.11.2006 and an update conducted on 12.11.2007. In addition, a manual search of identified reference lists is conducted. The present report includes German and English literature published since 2001 and targeting adult subjects with morbid obesity (body mass index (BMI >=40 kg/m² or BMI >=35 kg/m² with severe comorbidities. The methodological quality of studies included is assessed according to pre-defined quality criteria by two independent scientists. Results: Among 5910 retrieved publications, 25 medical articles, as well as seven health economic studies meet the inclusion criteria. The medical studies show a superior weight loss following bariatric surgery compared to conventional therapy. Malabsorptive procedures lead to a more profound weight loss than purely restrictive procedures. Weight reduction in general is accompanied by a reduced frequency of comorbidities (mostly diabetes type 2. The evidence is not sufficient to quantify these effects for individual procedures or to assess long-term outcomes. However, recent studies show a profound survival benefit for surgically treated patients up to a period of eleven years. The economic studies illustrate that bariatric surgery is

  3. 减肥手术后营养代谢紊乱及预防%Prevention of Nutrition Deficiencies After Bariatric Surgery

    Institute of Scientific and Technical Information of China (English)

    邹大进

    2012-01-01

    肥胖已成为全球普遍关注的健康问题.减重手术已广泛应用于重度肥胖患者,不仅可以显著减轻体重,而且还对肥胖相关的内分泌代谢紊乱(特别是2型糖尿病)产生有利影响.然而,也有一些患者出现了较严重的并发症,包括围手术期及长期随访的营养代谢相关并发症,其中多数并发症的病因为宏量及微量营养素摄人不足或不均衡.因此,应警惕减重手术术后患者可能发生的营养缺乏及其症状.早期给予预防性治疗以有效避免代谢并发症的发生,最终获得良好的临床结局.%Obesity is an increasing health concern in the world. Bariatric surgery has increasingly been applied for patients with severe obesity. Not only can bariatric surgery dramatically reduce body weight but also can produce favorable effects on disorders in endocrine metabolism (especially type 2 diabetes), However, this intervention involves a profound change in digestive physiology and may cause nutrition metabolism-related severe complications, which mainly result from the deficiency or unbalance of macronutrients and micronutrients. Therefore, bariatric patients need to be aware of possible nutritional deficiencies and their symptoms. It is also necessary to give early preventive nutritional support, so as to prevent metabolic complications and achieve better outcomes.

  4. SurgiCal Obesity Treatment Study (SCOTS): protocol for a national prospective cohort study of patients undergoing bariatric surgery in Scotland

    Science.gov (United States)

    Logue, Jennifer; Stewart, Sally; Munro, Jane; Grieve, Eleanor; Lean, Mike; Lindsay, Robert S; Bruce, Duff; Ali, Abdulmajid; Briggs, Andrew; Sattar, Naveed; Ford, Ian

    2015-01-01

    Introduction The efficacy of bariatric surgery for large-scale, long-term weight loss is well established. However, many questions remain over the continual benefits and cost-effectiveness of that weight loss for overall health, particularly when accounting for potential complications and adverse events of surgery. Health research institutes in the UK and the USA have called for high-quality longitudinal cohort studies of patients undergoing bariatric surgery, assessing outcomes such as surgical complications, mortality, diabetes remission, microvascular complications, cardiovascular events, mental health, cost and healthcare use. Methods and analysis SurgiCal Obesity Treatment Study (SCOTS) is a national, prospective, observational, cohort study of patients undergoing primary bariatric surgical procedures in Scotland. This study aims to recruit 2000 patients and conduct a follow-up for 10 years postbariatric surgery using multiple data collection methods: surgeon-recorded data, electronic health record linkage, and patient-reported outcome measures. Outcomes measured will include: mortality, weight change, diabetes, surgical, cardiovascular, cancer, behavioural, reproductive/urological and nutritional variables. Healthcare utilisation and economic productivity will be collected to inform cost-effectiveness analysis. Ethics and dissemination The study has received a favourable ethical opinion from the West of Scotland Research Ethics committee. All publications arising from this cohort study will be published in open-access peer-reviewed journals. All SCOTS investigators (all members of the research team at every recruiting site) will have the ability to propose research suggestions and potential publications using SCOTS data; a publications committee will approve all requests for use of SCOTS data and propose writing committees and timelines. Lay-person summaries of all research findings will be published simultaneously on the SCOTS website (http

  5. Cough and Cold Medicine Abuse

    Science.gov (United States)

    ... and Cold Medicine Abuse DrugFacts: Cough and Cold Medicine Abuse Email Facebook Twitter Revised May 2014 Some ... diverted for abuse. How Are Cough and Cold Medicines Abused? Cough and cold medicines are usually consumed ...

  6. Takotsubo Syndrome as a Cause of False Acute Abdomen in the Early Postoperative Period After Bariatric Surgery-a Report of Two Cases.

    Science.gov (United States)

    Viegas, Fabio; Viegas, Carla; França, Enio; Kleuser, Klaus; de Barros, Fernando

    2016-10-01

    Takotsubo syndrome, also known as broken-heart syndrome, stress-induced cardiomyopathy or transient apical ballooning syndrome, is a transient disorder characterized by segmental left ventricular failure in the absence of obstructive coronary artery disease. Most cases of Takotsubo syndrome are caused by acute stress that leads to a sudden, temporary weakening of the cardiac musculature. This stress triggers a rise in circulating catecholamine levels that results in acute ventricular dysfunction. In this report, we describe two cases of Takotsubo syndrome in the early postoperative period after bariatric surgery.

  7. Cirugía Bariátrica, Cirugía Colorrectal e Internet: ¿Pacientes (desinformados? Bariatric surgery, colorectal surgery and the internet: (Uninformed patients?

    Directory of Open Access Journals (Sweden)

    M. Elisa De Castro Peraza

    2009-12-01

    Full Text Available Introducción: El uso de Internet por los pacientes se incrementa buscando información. Evaluamos una cohorte de pacientes de cirugía bariátrica y otra de colorrectal. Objetivo: Conocer patrones de uso de Internet de pacientes bariátricos y colorrectales. Método: Preguntas a 60 pacientes de bariátrica recogiendo edad, género, nivel académico y patrones de uso de Internet comparados con 61 pacientes de colorrecto. Resultados principales: Los pacientes de bariátrica usan más Internet para informarse, destacando universitarios y mujeres. Los pacientes afirman que la información encontrada les resulta útil para el conocimiento y la toma de decisiones aunque refieran como dudosa y hasta peligrosa alguna información encontrada. Conclusiones: El uso incrementado de Internet favorece a la comunidad quirúrgica permitiendo llegar a más pacientes pero puede ser una fuente de desinformación, creando perspectivas erróneas. Un mejor entendimiento del uso que el paciente hace de Internet y de la información que encuentra permitirá mejorar el cuidado.Introduction: Internet use by patients seeking information increases. We evaluated a cohort of patients for bariatric surgery and another of colorectal. Aim: Knowing patterns of Internet use in colorectal and bariatric patients. Method: 60 questions to gather bariatric patients age, gender, educational level and patterns of Internet use compared with 61 patients of colorectum. Main results: Bariatric patients used the Internet to learn more, leading academics and women. Patients say that they found the information useful for understanding and decision making as suspect and even relate to any dangerous information found. Conclusions: The increased use of the Internet favors the surgical community to reach more patients but can be a source of misinformation, creating prospects wrong. A better understanding of the patient makes use of the Internet and found information that will improve care.

  8. Changes in uric acid levels following bariatric surgery are not associated with SLC2A9 variants in the Swedish Obese Subjects Study.

    Directory of Open Access Journals (Sweden)

    Mark A Sarzynski

    Full Text Available CONTEXT AND OBJECTIVE: Obesity and SLC2A9 genotype are strong determinants of uric acid levels. However, data on SLC2A9 variants and weight loss induced changes in uric acid levels are missing. We examined whether the changes in uric acid levels two- and ten-years after weight loss induced by bariatric surgery were associated with SLC2A9 single nucleotide polymorphisms (SNPs in the Swedish Obese Subjects study. METHODS: SNPs (N = 14 identified by genome-wide association studies and exonic SNPs in the SLC2A9 gene locus were genotyped. Cross-sectional associations were tested before (N = 1806, two (N = 1664 and ten years (N = 1201 after bariatric surgery. Changes in uric acid were compared between baseline and Year 2 (N = 1660 and years 2 and 10 (N = 1172. A multiple testing corrected threshold of P = 0.007 was used for statistical significance. RESULTS: Overall, 11 of the 14 tested SLC2A9 SNPs were significantly associated with cross-sectional uric acid levels at all three time points, with rs13113918 showing the strongest association at each time point (R(2 = 3.7-5.2%, 3.9×10(-22≤p≤7.7×10(-11. One SNP (rs737267 showed a significant association (R(2 = 0.60%, P = 0.002 with change in uric acid levels from baseline to Year 2, as common allele homozygotes (C/C, N = 957 showed a larger decrease in uric acid (-61.4 µmol/L compared to minor allele carriers (A/X: -51.7 µmol/L, N = 702. No SNPs were associated with changes in uric acid from years 2 to 10. CONCLUSIONS: SNPs in the SLC2A9 locus contribute significantly to uric acid levels in obese individuals, and the associations persist even after considerable weight loss due to bariatric surgery. However, we found little evidence for an interaction between genotype and weight change on the response of uric acid to bariatric surgery over ten years. Thus, the fluctuations in uric acid levels among the surgery group appear to be driven by the weight

  9. The Genomic Medicine Game.

    Science.gov (United States)

    Tran, Elvis; de Andrés-Galiana, Enrique J; Benitez, Sonia; Martin-Sanchez, Fernando; Lopez-Campos, Guillermo H

    2016-01-01

    With advancements in genomics technology, health care has been improving and new paradigms of medicine such as genomic medicine have evolved. The education of clinicians, researchers and students to face the challenges posed by these new approaches, however, has been often lagging behind. From this the Genomic Medicine Game, an educational tool, was created for the purpose of conceptualizing the key components of Genomic Medicine. A number of phenotype-genotype associations were found through a literature review, which was used to be a base for the concepts the Genomic Medicine Game would focus on. Built in Java, the game was successfully tested with promising results. PMID:27577486

  10. Nuclear medicine physics

    CERN Document Server

    De Lima, Joao Jose

    2011-01-01

    Edited by a renowned international expert in the field, Nuclear Medicine Physics offers an up-to-date, state-of-the-art account of the physics behind the theoretical foundation and applications of nuclear medicine. It covers important physical aspects of the methods and instruments involved in modern nuclear medicine, along with related biological topics. The book first discusses the physics of and machines for producing radioisotopes suitable for use in conventional nuclear medicine and PET. After focusing on positron physics and the applications of positrons in medicine and biology, it descr

  11. Fundamentals of nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Alazraki, N.P.; Mishkin, F.S.

    1984-01-01

    This guidebook for clinical nuclear medicine is written as a description of how nuclear medicine procedures should be used by clinicians in evaluating their patients. It is designed to assist medical students and physicians in becoming acquainted with nuclear medicine techniques for detecting and evaluating most common disorders. The material provides an introduction to, not a textbook of, nuclear medicine. Each chapter is devoted to a particular organ system or topic relevant to the risks and benefits involved in nuclear medicine studies. The emphasis is on presenting the rationales for ordering the various clinical imaging procedures performed in most nuclear medicine departments. Where appropriate, alternative imaging modalities including ultrasound, computed tomography imaging, and radiographic special procedures are discussed. Comparative data between nuclear medicine imaging and other modalities are presented to help guide the practicing clinician in the selection of the most appropriate procedure for a given problem.

  12. [Interaction between medicines and medicinal plants].

    Science.gov (United States)

    Tres, J C

    2006-01-01

    In recent years there has been a notable increase in the consumption of medicinal plants in Spanish society. This might be due to the fact that in some cases they have shown themselves to be efficient in treating certain pathologies and to the erroneous perception that these products are innocuous. Medicinal plants behave as authentic medicines since the chemical substances of which they are formed can have a biological activity in humans. For this reason, their joint administration with "conventional medicines" can produce variations in the magnitude of the effect. This type of interaction, just like those produced between two or more medicines, can produce pharmacokinetic mechanisms if they affect the processes of absorption, distribution, metabolism and excretion, or pharmacodynamic mechanisms if they affect the result of the pharmacological action. In the medical literature there are few articles and notifications of cases concerning the adverse effects and interactions that affect medicinal plants, which probably reflects an under-notification of these phenomena. If we add to this the lack of experimental data and controlled studies, perception of their prevalence is difficult or nearly impossible. This article sets out, in an order that will be explained later, the findings of an exhaustive review of the medical literature with the aim of making its existence known to the reader, without going into other considerations, such as the degree of evidence for example, which will be the subject of forthcoming articles.

  13. Changes in the salivary protein profile of morbidly obese women either previously subjected to bariatric surgery or not.

    Science.gov (United States)

    Lamy, Elsa; Simões, Carla; Rodrigues, Lénia; Costa, Ana Rodrigues; Vitorino, Rui; Amado, Francisco; Antunes, Célia; do Carmo, Isabel

    2015-12-01

    Saliva is a non-invasive source of biomarkers useful in the study of physiological mechanisms. Moreover, this fluid has diverse functions, among which food perception and ingestion, making it particularly suitable for the study of obesity. The aims of this study were to assess changes in salivary proteome among morbidly obese women, with a view to provide information about mechanisms potentially related to the development of obesity, and to evaluate whether these changes persist after weight loss. Mixed saliva samples from morbidly obese women (N = 18) who had been either subjected (group O-BS) or not (group O) to bariatric surgery and women with normal weight (N = 14; group C) were compared for protein profiles, alpha-amylase abundance and enzymatic activity, and carbonic anhydrase (CA) VI abundance. Differences in salivary obese profiles were observed for 23 different spots. Zinc-alpha-2 glycoprotein-containing spots showed higher abundance in group O only, whereas cystatin S-containing spots presented higher abundance in the two groups of obese subjects. Most of the spots identified as salivary amylase were present at lower levels in group O-BS. With regard to the amylase enzymatic activity, increases were observed for group O and decreases for group O-BS. One interesting finding was the high correlation between levels of CA VI and body mass index in group O, which was not observed for groups O-BS or C. The differences between groups, mainly regarding salivary proteins involved in taste sensitivity and metabolism, point to the potential of using saliva in the study of obesity development. PMID:26399515

  14. ‘For the cases we've had… I don't think anybody has had enormous confidence’: exploring ‘uncertainty’ in adolescent bariatric teams: an interpretative phenomenological analysis

    NARCIS (Netherlands)

    J. Doyle; S. Colville; P. Brown; D. Christie

    2014-01-01

    Evidence suggests that bariatric surgery is increasingly being offered to adolescents with severe obesity despite the lack of long-term outcome data or research to guide patient selection. This is a qualitative study in which nine clinicians were interviewed to investigate the process of decision-ma

  15. Detection of non-alcoholic steatohepatitis in patients with morbid obesity before bariatric surgery: preliminary evaluation with acoustic radiation force impulse imaging

    Energy Technology Data Exchange (ETDEWEB)

    Guzman-Aroca, F.; Reus, M.; Dios Berna-Serna, Juan de [Virgen de la Arrixaca University Hospital, Department of of Radiology, El Palmar, Murcia (Spain); Frutos-Bernal, M.D.; Lujan-Mompean, J.A.; Parrilla, P. [Virgen de la Arrixaca University Hospital, Department of Surgery, El Palmar, Murcia (Spain); Bas, A. [Virgen de la Arrixaca University Hospital, Department of Pathology, El Palmar, Murcia (Spain)

    2012-11-15

    To investigate the utility of acoustic radiation force impulse (ARFI) imaging, with the determination of shear wave velocity (SWV), to differentiate non-alcoholic fatty liver disease (NAFLD) from non-alcoholic steatohepatitis (NASH) in patients with morbid obesity before bariatric surgery. Thirty-two patients with morbid obesity were evaluated with ARFI and conventional ultrasound before bariatric surgery. The ARFI and ultrasound results were compared with liver biopsy findings, which is the reference standard. The patients were classed according to their histological findings into three groups: group A, simple steatosis; group B, inflammation; and group C, fibrosis. The median SWV was 1.57 {+-} 0.79 m/s. Hepatic alterations were observed in the histopathological findings for all the patients in the study (100 %), with the results of the laboratory tests proving normal. Differences in SWV were also observed between groups A, B and C: 1.34 {+-} 0.90 m/s, 1.55 {+-} 0.79 m/s and 1.86 {+-} 0.75 m/s (P < 0.001), respectively. The Az for differentiating NAFLD from NASH or fibrosis was 0.899 (optimal cut-off value 1.3 m/s; sensitivity 85 %; specificity 83.3 %). The ARFI technique is a useful diagnostic tool for differentiating NAFLD from NASH in asymptomatic patients with morbid obesity. (orig.)

  16. Detection of non-alcoholic steatohepatitis in patients with morbid obesity before bariatric surgery: preliminary evaluation with acoustic radiation force impulse imaging

    International Nuclear Information System (INIS)

    To investigate the utility of acoustic radiation force impulse (ARFI) imaging, with the determination of shear wave velocity (SWV), to differentiate non-alcoholic fatty liver disease (NAFLD) from non-alcoholic steatohepatitis (NASH) in patients with morbid obesity before bariatric surgery. Thirty-two patients with morbid obesity were evaluated with ARFI and conventional ultrasound before bariatric surgery. The ARFI and ultrasound results were compared with liver biopsy findings, which is the reference standard. The patients were classed according to their histological findings into three groups: group A, simple steatosis; group B, inflammation; and group C, fibrosis. The median SWV was 1.57 ± 0.79 m/s. Hepatic alterations were observed in the histopathological findings for all the patients in the study (100 %), with the results of the laboratory tests proving normal. Differences in SWV were also observed between groups A, B and C: 1.34 ± 0.90 m/s, 1.55 ± 0.79 m/s and 1.86 ± 0.75 m/s (P < 0.001), respectively. The Az for differentiating NAFLD from NASH or fibrosis was 0.899 (optimal cut-off value 1.3 m/s; sensitivity 85 %; specificity 83.3 %). The ARFI technique is a useful diagnostic tool for differentiating NAFLD from NASH in asymptomatic patients with morbid obesity. (orig.)

  17. Bariatric Surgery in the Treatment of Essential Hypertension%减重手术治疗原发性高血压

    Institute of Scientific and Technical Information of China (English)

    陆佳军(综述); 朱江帆(审校)

    2015-01-01

    [Summary] Obesity is the most important risk factor of essential hypertension.Obesity-related hypertention has become a worldwide problem.Many clinical studies show that bariatric surgery has significant therapeutic effect on essential hypertension, but the specific mechanism of the condition remains to be fully understood.This paper tried to explain the mechanism of the treatment of bariatric surgery for essential hypertension from the following two aspects: the reversal of the sympathetic disorder and the decline of plasma leptin.%肥胖是原发性高血压第一危险因素,肥胖性高血压已成为一个不容忽视的全球性问题。许多临床研究证实,减重手术对原发性高血压有明显的治疗效果,但机制尚未完全阐明。本文着重从交感神经紊乱逆转和血浆瘦素的下降阐述减重手术治疗原发性高血压可能的机制。

  18. Fundamentals of nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Alazraki, N.P.; Mishkin, F.S.

    1988-01-01

    The book begins with basic science and statistics relevant to nuclear medicine, and specific organ systems are addressed in separate chapters. A section of the text also covers imaging of groups of disease processes (eg, trauma, cancer). The authors present a comparison between nuclear medicine techniques and other diagnostic imaging studies. A table is given which comments on sensitivities and specificities of common nuclear medicine studies. The sensitivities and specificities are categorized as very high, high, moderate, and so forth.

  19. Children's access to medicines

    OpenAIRE

    Alkahtani, Saad Ahmed

    2013-01-01

    Access to health care for children is important. It is dependent on access to health professionals and also parental attitudes towards illness. Children have the right to receive medicines that are scientifically evaluated for both efficacy and safety. Counterfeit and substandard medicines unfortunately result in the death of many children worldwide. There have been particular problems with diethylene glycol which has been used as a solvent in counterfeit medicines. It has also been foun...

  20. Music and medicine

    OpenAIRE

    Donatella Lippi; Paolo Roberti di Sarsina; John Patrick D’Elios

    2010-01-01

    Donatella Lippi1, Paolo Roberti di Sarsina2, John Patrick D’Elios11History of Medicine, Department of Anatomy, Histology, and Forensic Medicine, University of Florence, Florence, Italy; 2Health Local Unit, Department of Mental Health, Bologna, ItalyAbstract: Healing sounds have always been considered in the past an important aid in medical practice, and nowadays, medicine has confirmed the efficacy of music therapy in many diseases. The aim of this study is to assess the curative po...

  1. Veterinary nuclear medicine

    International Nuclear Information System (INIS)

    A brief review is presented of the expanding horizons of nuclear medicine, the equipment necessary for a nuclear medicine laboratory is listed, and the value of this relatively new field to the veterinary clinician is indicated. Although clinical applications to veterinary medicine have not kept pace with those of human medicine, many advances have been made, particularly in the use of in vitro techniques. Areas for expanded applications should include competitive protein binding and other in vitro procedures, particularly in connection with metabolic profile studies. Indicated also is more intensive application by the veterinarian of imaging procedures, which have been found to be of such great value to the physician. (U.S.)

  2. Music and medicine

    Directory of Open Access Journals (Sweden)

    Donatella Lippi

    2010-08-01

    Full Text Available Donatella Lippi1, Paolo Roberti di Sarsina2, John Patrick D’Elios11History of Medicine, Department of Anatomy, Histology, and Forensic Medicine, University of Florence, Florence, Italy; 2Health Local Unit, Department of Mental Health, Bologna, ItalyAbstract: Healing sounds have always been considered in the past an important aid in medical practice, and nowadays, medicine has confirmed the efficacy of music therapy in many diseases. The aim of this study is to assess the curative power of music, in the frame of the current clinical relationship.Keywords: history of medicine, medical humanities, healing music

  3. Glimpses of Islamic medicine.

    Science.gov (United States)

    Majumdar, S K

    1997-07-01

    The fall of the Roman Empire during the fifth century A.D. Ushered in the beginning of the Dark Ages. After this, in Europe further progress of Greco-Roman medicine originated from Hippocrates was halted. The ideas about medicine and hygiene were kept alive in monasteries only. The Arabs made advances in medicine at a time when the rest of Europe was in the Dark Ages. Islamic system or the rulers of the day actively encouraged scholarship and growth of knowledge. The Islamic gift of the day to the world of medicine was simply unique. PMID:12572570

  4. Teaching evidence based medicine in family medicine

    Directory of Open Access Journals (Sweden)

    Davorka Vrdoljak

    2012-05-01

    Full Text Available The concept of evidence based medicine (EBM as the integrationof clinical expertise, patient values and the best evidence was introduced by David Sackett in the 1980’s. Scientific literature in medicine is often marked by expansion, acummulation and quick expiration. Reading all important articles to keep in touch with relevant information is impossible. Finding the best evidence that answers a clinical question in general practice (GP in a short time is not easy. Five useful steps are described –represented by the acronym “5A+E”: assess, ask, acquire, appraise, apply and evaluate.The habit of conducting an evidence search “on the spot’’ is proposed. Although students of medicine at University of Split School of Medicine are taught EBM from the first day of their study and in all courses, their experience of evidence-searching and critical appraisal of the evidence, in real time with real patient is inadequate. Teaching the final-year students the practical use of EBM in a GP’s office is different and can have an important role in their professional development. It can positively impact on quality of their future work in family practice (or some other medical specialty by acquiring this habit of constant evidence-checking to ensure that best practice becomes a mechanism for life-long learning. Conclusion. EBM is a foundation stone of every branch of medicine and important part of Family Medicine as scientific and professional discipline. To have an EB answer resulting from GP’s everyday work is becoming a part of everyday practice.

  5. Implementation of an Integrative Medicine Curriculum for Preventive Medicine Residents.

    Science.gov (United States)

    Chiaramonte, Delia R; D'Adamo, Christopher; Amr, Sania

    2015-11-01

    The University of Maryland Department of Epidemiology and Public Health collaborated with the Center for Integrative Medicine at the same institution to develop and implement a unique integrative medicine curriculum within a preventive medicine residency program. Between October 2012 and July 2014, Center for Integrative Medicine faculty provided preventive medicine residents and faculty, and occasionally other Department of Epidemiology and Public Health faculty, with comprehensive exposure to the field of integrative medicine, including topics such as mind-body medicine, nutrition and nutritional supplements, Traditional Chinese Medicine, massage, biofield therapies, manual medicine, stress management, creative arts, and the use of integrative medicine in the inpatient setting. Preventive medicine residents, under the supervision of Department of Epidemiology and Public Health faculty, led integrative medicine-themed journal clubs. Resident assessments included a case-based knowledge evaluation, the Integrative Medicine Attitudes Questionnaire, and a qualitative evaluation of the program. Residents received more than 60 hours of integrative medicine instruction, including didactic sessions, experiential workshops, and wellness retreats in addition to clinical experiences and individual wellness mentoring. Residents rated the program positively and recommended that integrative medicine be included in preventive medicine residency curricula. The inclusion of a wellness-focused didactic, experiential, and skill-based integrative medicine program within a preventive medicine residency was feasible and well received by all six preventive medicine residents.

  6. Implementation of an Integrative Medicine Curriculum for Preventive Medicine Residents.

    Science.gov (United States)

    Chiaramonte, Delia R; D'Adamo, Christopher; Amr, Sania

    2015-11-01

    The University of Maryland Department of Epidemiology and Public Health collaborated with the Center for Integrative Medicine at the same institution to develop and implement a unique integrative medicine curriculum within a preventive medicine residency program. Between October 2012 and July 2014, Center for Integrative Medicine faculty provided preventive medicine residents and faculty, and occasionally other Department of Epidemiology and Public Health faculty, with comprehensive exposure to the field of integrative medicine, including topics such as mind-body medicine, nutrition and nutritional supplements, Traditional Chinese Medicine, massage, biofield therapies, manual medicine, stress management, creative arts, and the use of integrative medicine in the inpatient setting. Preventive medicine residents, under the supervision of Department of Epidemiology and Public Health faculty, led integrative medicine-themed journal clubs. Resident assessments included a case-based knowledge evaluation, the Integrative Medicine Attitudes Questionnaire, and a qualitative evaluation of the program. Residents received more than 60 hours of integrative medicine instruction, including didactic sessions, experiential workshops, and wellness retreats in addition to clinical experiences and individual wellness mentoring. Residents rated the program positively and recommended that integrative medicine be included in preventive medicine residency curricula. The inclusion of a wellness-focused didactic, experiential, and skill-based integrative medicine program within a preventive medicine residency was feasible and well received by all six preventive medicine residents. PMID:26477900

  7. HIV Medicines and Side Effects

    Science.gov (United States)

    Side Effects of HIV Medicines HIV Medicines and Side Effects (Last updated 1/7/2016; last reviewed 1/7/2016) Key Points HIV medicines help people with ... will depend on a person’s individual needs. Can HIV medicines cause side effects? HIV medicines help people ...

  8. MEDICINAL PLANTS OF RAJASTHAN IN INDIAN SYSTEM OF MEDICINE

    OpenAIRE

    Tripathi, Y.C.; Prabhu, V V; R S Pal; R N Mishra

    1996-01-01

    Medicinal plants used in Indian system of medicine from Rajasthan state have been surveyed and catagorised systematically. The paper deals with 205 medicinal plants, thoroughly indexed along with their important traditional application for the cure of various ailments.

  9. Alternative and Integrative Medicine

    Science.gov (United States)

    ... are the healthcare rituals practiced by a given culture (eg, Asian, Indian, African). Homeopathic Medicine: This alternative medicine system is based on the principle that “like cures like.” In other words, the same substance ... American Brain Tumor Association 8550 W. Bryn Mawr Ave. ...

  10. [Opening medicine containers].

    Science.gov (United States)

    Glerup, E; Dengsø, H

    1990-07-01

    In connection with self-administration of medicine for patients with rheumatoid arthritis, patients with weak hands and elderly patients in general, the design of many medicine containers makes them awkward to handle for the patients. In this investigation 12 different medicine containers were tested. The 12 containers represent the antirheumatic medicine containers available on the market in Denmark in 1988. Sixty patients participated in the investigation. Thirty had rheumatoid arthritis and 30 had normal hand function. The age range was 40-85 years The patients had the choice between five possible answers concerning each container. In all patients, grip strength was measured. The patients with rheumatoid arthritis were classified in four functional classes, and pulpa-vola distance end thumb--5th MCP point distance were measured. The opening mechanisms of 29% of the antirheumatic medicine containers are unacceptable; these are plastic containers with a "push-off" top and suppository packs. 46%--(containers with screw cap or pressure dispensing) are considered acceptable. For 25% (tablet and capsule blister packs) the patients' estimate varied. It is important that medicine containers can be opened by the patients without difficulty, so that they do not present a hindrance to a correct intake of medicine or result in an unnecessary admission to hospital. The results of this investigation show that it is of continuous importance to encourage the production of medicine containers that comply with the requirements of the patients. PMID:2142351

  11. Children's Knowledge about Medicines.

    Science.gov (United States)

    Almarsdottir, Anna B.; Zimmer, Catherine

    1998-01-01

    Examined knowledge about medicines and perceived benefit among 101 children, ages 7 and 10. Found that medicine knowledge was explained using age, educational environment, and degree of internal locus of control as significant predictors. The negative effect of internal locus of control predicted perceived benefit. Retention of drug advertising…

  12. Prehistoric Iroquois Medicine

    Science.gov (United States)

    Hosbach, Richard E.; Doyle, Robert E.

    1976-01-01

    Study of pre-1750 medicine reveals that Iroquois diagnosis and treatment of disease was more advanced than the medicine of their European counterparts. The Iroquois developed a cure for scurvy, treated hypertension, and head lice, and even designed sauna baths. Indian psychiatry also included modern day techniques such as dream analysis. (MR)

  13. Foucault and modern medicine.

    Science.gov (United States)

    Peerson, A

    1995-06-01

    Modernity as a concept or ideal, resulting from the age of Enlightenment and the French Revolution gave hope of a better future and new possibilities. To be modern means an 'enlightened' individual and society, welcoming change and development. In this paper, I will discuss Foucault's analysis (1973) of problematics in medicine in eighteenth century France. Three themes prominent in the text are: 'the birth of the clinic', 'the clinical gaze' and the power-knowledge relationship. Three problematics identified in modern medicine by Foucault and which are particularly relevant to twentieth century medicine are: (i) the extension of the clinical gaze from the individual body to the wider population; (ii) the increasing medical intervention and use of technology in fundamental life processes; and (iii) the relationship between society and medicine. I will argue that Foucault's analysis is fraught with ambiguities. It is useful, however, for establishing an explanation for medicine today and for presenting a particular interpretation of modernity.

  14. Maimonides’ Appreciation for Medicine

    Directory of Open Access Journals (Sweden)

    Benjamin Gesundheit

    2011-01-01

    Full Text Available Moses Maimonides, the illustrious medieval rabbi and philosopher, dedicated the last decade of his life primarily to medicine. His strong interest in medicine was an integral component of his religious-philosophical teachings and world view. In this paper various sources from his rabbinic writings are presented that explain Maimonides’ motivation regarding and deep appreciation for medicine: (A The physician fulfills the basic biblical obligation to return lost objects to their owner, for with his knowledge and experience the physician can restore good health to his sick fellow human being; (B medicine provides a unique opportunity to practice imitatio dei, as it reflects the religious duty to maintain a healthy life-style; (C as an important natural science, medicine offers tools to recognize, love, and fear God. These three aspects address man’s relationship and obligation towards his fellow-man, himself and God. Biographical insights supported by additional sources from Maimonides’ writings are discussed.

  15. Hipoglicemia por nesidioblastose: uma complicação rara da cirurgia bariátrica? Nesidioblastosis hypoglycemia: is it a rare complication of bariatric surgery?

    Directory of Open Access Journals (Sweden)

    Daniele Gehlen Klaus

    2007-12-01

    mórbidos com diabetes do tipo II, porém em alguns casos raros esse fenômeno benéfico gera malefícios, ou seja, a nesidioblastose, que deve ser corrigida pela ressecção parcial do pâncreas, sob pena de ameaçar a vida desses pacientes.BACKGROUND: Bariatric surgery has shown to be the most effective method in diabetes mellitus (DM type II resolution, reaching up to 80% of cure. However, some studies have shown the development of a hyperinsulinemic hypoglycemia state in certain morbidly obese patients after bariatric surgery, so called nesidioblastosis corresponding to pathological disseminated proliferation of pancreatic beta-cells. The purpose of this study is to review bibliographical data on nesidioblastosis after bariatric surgery, researching scientific articles published since 2000 over the subject. METHODS: A literature review was made over scientific articles published since 2000. Researching data based on PubMed (www.pubmed.gov, crossing the following headings: nesidioblastosis, hyperinsulinism, hypoglycemia and bariatric surgery complications. LITERATURE REVIEW: Fourteen publications related to the subject were reviewed. Among them, Cummings defends alterations in the functional activity of the intestinal tract after bariatric surgery promoting stimulation and excessive growth of pancreatic beta-cells and greater activity of pancreatic hormones, suggesting a possible cause for nesidioblastosis. Corroborating in order to elucidate the cause for this disease, authors suggest that the rapid intestinal transit after gastric bypass surgery elevates the serum level of glucagon-like peptide 1, thereby stimulating hyperinsulinemic hypoglycemia in these patients. Similarly, other authors defend the idea that the weight lost after bariatric surgery decrease intensively insulin-resistance due to hypertrophy and hyperfunctional state of pancreatic beta-cells, which is very common in obesity, promoting the development of nesidioblastosis. CONCLUSION

  16. TRIBAL MEDICINAL PLANTS OF CHITTOOR

    OpenAIRE

    Vedavathy, S.; Sudhakar, A; Mrdula, V.

    1997-01-01

    Medicinal plants used in tribal medicine from chittoor district have been surveyed and documented systematically. The paper deals with 202 medicinal plants, indexed along with important tribal applications for the cure of various ailments.

  17. Your Radiologist Explains Nuclear Medicine

    Medline Plus

    Full Text Available ... produced by: Image/Video Gallery Your Radiologist Explains Nuclear Medicine Transcript Welcome to Radiology Info dot org ... I’d like to talk to you about nuclear medicine. Nuclear medicine offers the potential to identify ...

  18. Alternative Medicine and Your Child

    Science.gov (United States)

    ... to Know About Zika & Pregnancy Complementary and Alternative Medicine KidsHealth > For Parents > Complementary and Alternative Medicine Print ... works. previous continue How CAM Differs From Traditional Medicine CAM is frequently distinguished by its holistic methods, ...

  19. Women and Diabetes -- Diabetes Medicines

    Science.gov (United States)

    ... Audience For Women Women's Health Topics Women and Diabetes - Diabetes Medicines Share Tweet Linkedin Pin it More sharing ... 1-800-332-1088 to request a form. Diabetes Medicines The different kinds of diabetes medicines are ...

  20. American Academy of Oral Medicine

    Science.gov (United States)

    ... Meeting Orlando, FL AAOM: Representing the Discipline of Oral Medicine Oral Medicine is the discipline of dentistry concerned with the ... AAOM offers credentialing, resources and professional community for oral medicine practitioners. Our membership provides care to thousands We ...

  1. Your Radiologist Explains Nuclear Medicine

    Medline Plus

    Full Text Available ... by: Image/Video Gallery Your Radiologist Explains Nuclear Medicine Transcript Welcome to Radiology Info dot org Hello! ... d like to talk to you about nuclear medicine. Nuclear medicine offers the potential to identify disease ...

  2. 减重手术228例术后并发症分析%Postoperative complications of bariatric surgery:An analysis of 228 cases

    Institute of Scientific and Technical Information of China (English)

    于一凡; 王勇; 刘金钢

    2015-01-01

    Objective To explore the clinical complications of bariatric surgery and treatment methods. Methods The clinical data of 228 patients with obesity and type 2 diabetes underwent bariatric surgeries between January 2010 and January 2015 in Shengjing Hospital of China Medical University including laparoscopic gastric bypass,sleeve gastrectomy and banding surgery were analyzed retrospectively. The complications were summarized. Results One hundred and forty three cases of laparoscopic gastric bypass included 2 cases of anastomotic ulcer and bleeding,1 case of anastomotic stenosis,2 cases of malnutrition,1 case of pleural effusion,1 case of intestinal twist. In 77 cases of laparoscopic sleeve gastrectomy,there were 2 cases of postoperative continuous reflux vomiting,1 case of fistula. In 8 cases of laparoscopic banding surgery,there was 1 case of gastric banding withdrawn. Conclusion Postoperative complication rate of bariatric surgeries is relatively low, and the prognosis was good after active treatment.%目的:探讨减重手术的并发症及其处理方法。方法回顾分析中国医科大学附属盛京医院2010年1月至2015年1月行减重手术治疗单纯肥胖或肥胖合并2型糖尿病病人228例临床资料,术式包括腹腔镜胃旁路术、袖状胃切除术、胃束带术,总结并分析其并发症情况。结果腹腔镜胃旁路术143例,其中发生吻合口溃疡并出血2例,吻合口狭窄1例,营养不良2例,胸腔积液1例,腹腔小肠扭转1例;腹腔镜袖状胃切除术77例,术后发生持续反流呕吐2例,残留漏1例;腹腔镜胃束带术8例,取出胃束带1例。结论减重手术术后并发症发生率相对较低,且经积极处理后预后均较好。

  3. Practical nuclear medicine

    CERN Document Server

    Gemmell, Howard G; Sharp, Peter F

    2006-01-01

    Nuclear medicine plays a crucial role in patient care, and this book is an essential guide for all practitioners to the many techniques that inform clinical management. The first part covers the scientific basis of nuclear medicine, the rest of the book deals with clinical applications. Diagnostic imaging has an increasingly important role in patient management and, despite advances in other modalities (functional MRI and spiral CT), nuclear medicine continues to make its unique contribution by its ability to demonstrate physiological function. This book is also expanded by covering areas of d

  4. Resultados materno-fetales de la gestación tras cirugía bariátrica Maternal and fetal outcomes in pregnancy following bariatric surgery

    Directory of Open Access Journals (Sweden)

    I. González Navarro

    2011-04-01

    Full Text Available Introducción: La obesidad es la enfermedad metabòlica más frecuente en el mundo y conlleva múltiples co-morbilidades, siendo la cirugía bariátrica (CB una opción terapéutica cuando fallan las medidas clásicas. La mitad de los pacientes intervenidos son mujeres en edad fértil y está demostrado que la obesidad se asocia a peores resultados obstétricos y fetales. Dado que el estado nutricional se ve afectado por la CB y es un factor esencial para el adecuado desarrollo del embarazo, el objetivo de nuestro trabajo es valorar los efectos de la CB sobre la gestación en mujeres obesas intervenidas. Material y métodos: Seguimiento de 10 mujeres y 15 gestaciones tras CB durante el periodo 2003-2009. Se realizaron visitas trimestrales en consultas de Nutrición y Obstetricia, con evaluación clínica y de laboratorio en cada una. Resultados: Se evidenció deficiencia de hierro en el 80% de las gestaciones, de vitamina D en el 46,7%, de vitamina A en el 20%, de vitamina E en el 13,3% y de vitamina B12 en el 26,7%. No hubo complicaciones durante la gestación salvo un caso de hiperemesis gravidica. Hubo 9 partos de recién nacidos vivos sin malformaciones de los cuales 3 fueron recién nacidos pequeños para la edad gestacional (RNPEG y uno presentó neumonía por aspiración de meconio. Hubo 3 abortos y un parto prematuro con feto muerto. Conclusiones: En nuestro grupo de estudio hubo menos complicaciones durante la gestación comparado con lo descrito en obesas no operadas y similares a la población general.Background: Obesity is the most frecuent metabolic disease in the World, and is associated with several comorbidities. Bariatric procedures arise as a promising treatment when classical approach is ineffective. Half of the operated patients are reproductive-aged women and there is evidence that obesity is related to worse maternal and fetal outcomes. Because nutritional status is affected by bariatric surgery and is a vital component

  5. Design and results of preoperative questionnaire in bariatric surgery%减重手术术前调查问卷的设计及结果分析

    Institute of Scientific and Technical Information of China (English)

    杨宁琍; 戴晓冬; 梁辉; 管蔚; 汤娟

    2014-01-01

    目的 设计适合中国国情的减重手术术前问卷调查表.方法 我中心2010年1月起为接受减重手术的患者提供术前问卷调查表,至2014年1月共应用于401例患者,调查表的设计经历3个阶段:引进SCL-90量表,翻译后用于30例患者;根据中国的国情修改阶段用于90例患者;再次完善后应用于281例患者.对医生和患者满意度进行问卷后调查.结果 3个问卷版本医生满意度分别为73.3%、86.7%和96.8%;患者满意度分别是30.0%、40.0%、76.9%,不满意度分别为20.0%、11.1%、2.8%.结论 医生和患者对第三版问卷调查表满意度较高,适于临床推广应用.%Objective To design an appropriate preoperative questionnaire in Chinese bariatric surgery.Methods Bariatric surgery center carried out laparoscopic bariatric operation from January 2010,preoperative questionnaire before the operation were supplied.Till January 2014,a total of 401 patients replied to the survey.The questionnaires were designed through three stages:translated from the Cleveland Clinic (USA) and applied in 30 patients for the first survey; adjustments and changes to the contents of the questionnaire for 90 patients according to Chinese conditions in the second phase; in the third stage,the third edition questionnaire was used in 281 patients.The satisfaction degree of the doctors and patients about the content of the questionnaire was evaluated.Results For the three versions of the questionnaire,the doctor satisfaction rate was 73.3%,86.7% and 96.8%.Patients' satisfaction rate of three versions were 30.0%,40.0%,76.9%,not satisfactory rate was 20.0%,11.1%,2.8%.Conclusions The current preoperative questionnaire includes 11 categories with 101 items of the third edition,doctors and patients satisfaction rate is higher,and it is suitable for Chinese bariatric surgery.

  6. Does bariatric surgery improve the patient´s quality of life? ¿La cirugía bariatrica mejora sensiblemente la calidad de vida del paciente?

    Directory of Open Access Journals (Sweden)

    Y. Martínez

    2010-12-01

    Full Text Available Objective: The aim of this investigation was to assess the effect of malabsorptive bariatric surgery (BS on the quality of life (QoL, applying the Nottingham Health Profile (NHP and the bariatric analysis and reporting outcome system (BAROS. Design: A prospective cohort study was performed in 100 adult patients (> 18 years undergoing bariatric surgery by malabsorptive technique for one year. Research methods and procedures: Patients were monitored from the beginning of the BS program until a year after the intervention, applying the NHP and the BAROS test. At baseline, the mean weight of the women was 132 ± 22 kg and the Body Mass Index (BMI was 50.7 kg/m². Results: The values obtained from different areas applying the NHP questionnaire showed statistical significant differences (p Introducción: La obesidad mórbida suele acompañarse de enfermedades graves asociadas que provocan una menor expectativa y peor calidad de vida (CV. Objetivos: evaluar el efecto de la cirugía bariátrica (CB por técnicas malabsortivas sobre la CV, utilizado (Perfil de Salud del Nottingham (PSN y el Bariatric analysis and reporting outcome system (BAROS. Material y métodos: Estudio prospectivo, descriptivo, desde Octubre del 2002 hasta Mayo de 2006, seguimiento a los pacientes desde el inicio al protocolo de CB hasta el año post-intervención., donde se incluyeron 100 pacientes. El 86% mujeres, el peso inicial medio 132±22 kg y IMC de 50,7 kg/m². Se aplicaron 2 cuestionarios: PSN y el BAROS. Resultado: Los valores obtenidos de las diferentes áreas aplicando el cuestionario PSN al año de la intervención muestran diferencias estadísticamente significativas (p < 0,001 con los valores iniciales. Según BAROS: Porcentaje de sobrepeso perdido (%SP. El 48% de los pacientes perdió entre el 25 y el 49% de su exceso de peso. Condiciones médicas. El 80,8% habían resuelto todas las comorbilidades mayores. CV de Moorehead Ardelt. El aspecto más mejorado fue el

  7. Interfaces between bariatric surgery and oral health: a longitudinal survey Interface entre cirurgia bariátrica e saúde bucal: estudo longitudinal

    Directory of Open Access Journals (Sweden)

    Juliane Avansini Marsicano

    2011-01-01

    Full Text Available PURPOSE: To evaluate oral changes, such as dental caries, periodontal disease, dental wear and salivary flow in bariatric patients. Fifty four obese patients who underwent bariatric surgery were studied before (n=54, up after 3 months (n=24 and 6 months (n=16. METHODS: Indices for evaluating oral conditions were: DMFT, CPI, DWI and salivary flow. OIDP questionnaire was used to assess the impact of oral health on quality of life. ANOVA and Spearman correlation were used (p0.05, presence of periodontal pockets in 50%, 58% and 50% of patients (p>0.05, tooth wear in dentin present in 81.5%, 87.5% and 87.5% before, 3 and 6 months after surgical treatment respectively. There were differences between the three periods for prevalence and severity of dental wear (p = 0.012. Salivary flow was 0.8±0.5 ml/min before surgery, 0.9±0.5 ml/min for 3 months and 1.1±0.5m/min for 6 months (p>0.05. The impact of oral health on quality of life decreased with time after bariatric surgery (p= 0.029. CONCLUSION: The lifestyle changes after bariatric surgery and these changes may increase the severity of pre-existing dental problems. However, these alterations in oral health did not influence the quality of life.OBJETIVO: Avaliar alterações bucais, como cárie dentária, doença periodontal, desgaste dentário e fluxo salivar, em pacientes bariátricos. MÉTODOS: Cinquenta e quatro pacientes obesos, submetidos à cirurgia bariátrica, tiveram suas condições bucais avaliadas antes (n=54, aos 3 meses (n=24 e aos 6 meses (n=16 após a cirurgia bariátrica. Os índices para avaliação das condições bucais foram: CPOD, IPC, IDD e o volume de fluxo salivar. O questionário OIDP foi utilizado para verificar o impacto da saúde bucal na qualidade de vida. ANOVA e correlação de Spearman foram utilizados para análise estatística (p0,05, bolsa periodontal foi encontrada em 50%, 58% e 50% dos pacientes (p>0,05 e o desgaste dentário em dentina em 81,5%, 87,5% e 87

  8. [Overdiagnosis and defensive medicine in occupational medicine].

    Science.gov (United States)

    Berral, Alessandro; Pira, Enrico; Romano, Canzio

    2014-01-01

    In clinical medicine since some years overdiagnosis is giving rise to growing attention and concern. Overdiagnosis is the diagnosis of a "disease" that will never cause symptoms or death during a patient's lifetime. It is a side effect of testing for early forms of disease which may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm. Overdiagnosis occurs when a disease is diagnosed correctly, but the diagnosis is irrelevant. A correct diagnosis may be irrelevant because treatment for the disease is not available, not needed, or not wanted. Four drivers engender overdiagnosis: 1) screening in non symptomatic subjects; 2) raised sensitivity of diagnostic tests; 3) incidental overdiagnosis; 4) broadening of diagnostic criteria for diseases. "Defensive medicine" can play a role. It begs the question of whether even in the context of Occupational Medicine overdiagnosis is possible. In relation to the double diagnostic evaluation peculiar to Occupational Medicine, the clinical and the causal, a dual phenomenon is possible: that of overdiagnosis properly said and what we could define the overattribution, in relation to the assessment of a causal relationship with work. Examples of occupational "diseases" that can represent cases of overdiagnosis, with the possible consequences of overtreatment, consisting of unnecessary and socially harmful limitations to fitness for work, are taken into consideration: pleural plaques, alterations of the intervertebral discs, "small airways disease", sub-clinical hearing impairment. In Italy the National Insurance for occupational diseases (INAIL) regularly recognizes less than 50% of the notified diseases; this might suggest overdiagnosis and possibly overattribution in reporting. Physicians dealing with the diagnosis of occupational diseases are obviously requested to perform a careful, up-to-date and active investigation. When applying to the diagnosis of occupational diseases, proper

  9. [Herbal medicines alternative to synthetical medicines].

    Science.gov (United States)

    Beer, A M; Schilcher, H; Loew, D

    2013-12-16

    Herbal pharmaceuticals in medical practice are similarly used as chemically well defined drugs. Like other synthetical drugs, they are subject to pharmaceutical legislature (AMG) and EU directives. It is to differentiate between phytopharmaceuticals with effectiveness of proven indications and traditional registered herbal medicine. Through the Health Reform Act January 2004 and the policy of the Common Federal Committee (G-BA)on the contractual medical care from March 2009--with four exceptions--Non-prescription Phytopharmaka of the legal Health insurance is no longer (SHI) refundable and must be paid by the patients. The result is that more and more well-established preparations disappear from the market. This article gives an overview of practical relevant indications for herbal medicines, which according to its licensing status, the scientific assessment by the Cochrane Collaboration and the Institute for Quality and Efficiency in Health Care (IQWiG) and evidence-based Medicine (EBM)/ meta-analyzes as an alternative to synthetics can be used. PMID:24934061

  10. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... nuclear medicine images can be superimposed with computed tomography (CT) or magnetic resonance imaging (MRI) to produce ... manufacturers are now making single photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography/ ...

  11. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... variety of diseases, including many types of cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities ... and bladder. bones. liver and gallbladder. gastrointestinal tract. heart. lungs. brain. thyroid. Nuclear medicine scans are typically ...

  12. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... take medicine safely, people can vastly lower the quality of their lives and in some extreme cases, ... the other one standing on my head, you know, it really gets to be difficult. Announcer: Some ...

  13. Terpenoids for medicine

    NARCIS (Netherlands)

    Fischedick, Justin

    2013-01-01

    This thesis is concerns research on monoterpenoids, sesquiterpenoids, and diterpenoids with medicinal properties. Terpenoids from commond herbs as well as Cannabis sativa, Inula britannica, Tanacetum parthenium, and Salvia officinalis were investigated

  14. Challenges in sexual medicine

    DEFF Research Database (Denmark)

    Cellek, Selim; Giraldi, Annamaria

    2012-01-01

    The sexual medicine field has been in mode of revolution until recently. Like all other fields of biomedical research, the economic situation around the world has had a negative impact on the field's momentum-research funding bodies, regulatory bodies and pharmaceutical companies seem to have...... placed sexual medicine in their low-priority list. But this is not the only challenge the field is facing. The successful development of phosphodiesterase type 5 (PDE5) inhibitors for treatment of erectile dysfunction (ED) means that research in this area seems to have slowed. However, there remain...... several unmet medical needs within sexual medicine such as premature ejaculation, severe ED and hypoactive sexual desire disorder, which await novel therapeutic approaches. Despite these challenges, research into finding and developing such therapies is likely to continue in the sexual medicine field...

  15. Occupational Space Medicine

    Science.gov (United States)

    Tarver, William J.

    2012-01-01

    Learning Objectives are: (1) Understand the unique work environment of astronauts. (2) Understand the effect microgravity has on human physiology (3) Understand how NASA Space Medicine Division is mitigating the health risks of space missions.

  16. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... after leaving the nuclear medicine facility. Through the natural process of radioactive decay, the small amount of radiotracer in your child’s body will lose its radioactivity over time. In many cases, the radioactivity will ...

  17. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Videos related to Children's (Pediatric) Nuclear Medicine About this Site RadiologyInfo.org is produced by: Please note ... you can search the ACR-accredited facilities database . This website does not provide cost information. The costs ...

  18. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... in the United States, most of us, our culture, is that we take antibiotics for seven to ... I take it and for how long? What foods, drinks, other medicines or activities should I avoid ...

  19. Occupational medicine and toxicology

    Directory of Open Access Journals (Sweden)

    Fischer Axel

    2006-02-01

    Full Text Available Abstract This editorial is to announce the Journal of Occupational Medicine and Toxicology, a new Open Access, peer-reviewed, online journal published by BioMed Central. Occupational medicine and toxicology belong to the most wide ranging disciplines of all medical specialties. The field is devoted to the diagnosis, prevention, management and scientific analysis of diseases from the fields of occupational and environmental medicine and toxicology. It also covers the promotion of occupational and environmental health. The complexity of modern industrial processes has dramatically changed over the past years and today's areas include effects of atmospheric pollution, carcinogenesis, biological monitoring, ergonomics, epidemiology, product safety and health promotion. We hope that the launch of the Journal of Occupational Medicine and Toxicology will aid in the advance of these important areas of research bringing together multi-disciplinary research findings.

  20. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... after the procedure? Except for intravenous injections, most nuclear medicine procedures are painless and are rarely associated with significant discomfort or side effects. If the radiotracer is given intravenously, your child ...

  1. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... the bacteria, but it might not completely give what they call a "bactericidal effect." That means taking ... be sure to ask the following six questions-- What is the name of the medicine? What is ...

  2. Storing your medicines

    Science.gov (United States)

    ... in your carry-on luggage. To help with security at the airport: Keep medicine in the original ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...

  3. Emergency medicine in space.

    Science.gov (United States)

    Stewart, Lowan H; Trunkey, Donald; Rebagliati, G Steve

    2007-01-01

    Recent events, including the development of space tourism and commercial spaceflight, have increased the need for specialists in space medicine. With increased duration of missions and distance from Earth, medical and surgical events will become inevitable. Ground-based medical support will no longer be adequate when return to Earth is not an option. Pending the inclusion of sub-specialists, clinical skills and medical expertise will be required that go beyond those of current physician-astronauts, yet are well within the scope of Emergency Medicine. Emergency physicians have the necessary broad knowledge base as well as proficiency in basic surgical skills and management of the critically ill and injured. Space medicine shares many attributes with extreme conditions and environments that many emergency physicians already specialize in. This article is an introduction to space medicine, and a review of current issues in the emergent management of medical and surgical disease during spaceflight. PMID:17239732

  4. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... top of page What are the benefits vs. risks? Benefits The information provided by nuclear medicine examinations ... diagnosis or to determine appropriate treatment, if any. Risks Because the doses of radiotracer administered are small, ...

  5. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... means taking the bacteria completely out of the system. It might be just putting it to rest ... if they occur? And, is there any written information available about the medicine? There are many reasons ...

  6. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... leaving the nuclear medicine facility. Through the natural process of radioactive decay, the small amount of radiotracer ... possible charges you will incur. Web page review process: This Web page is reviewed regularly by a ...

  7. [Homeopathic medicine and magic].

    Science.gov (United States)

    Angutek, Dorota

    2007-01-01

    The article compares homeopathic medicine and primitive magic. The author realises formal similarities beetwen these two fields of knowledge. The primitive homeopathic magic characterised by J. G. Frazer in his The Golden Bought announces that "similar courses similar". M. Mauss and H. Hubert added to this "low" an another formula: "similar acts on similar that courses a contrary phenomenon". The last formula is an identic one with the "low" of homeopathic medicine. Moreover there is a similarity between pantheistic religion of Hahnemann and magician beliefs in the power named mana in Melanesia and Polinesia or orenda, wakan, manitou and so on, by the Indians from The North America. The amazing thing is that homeopathic chemists belive that kinetic power transforms itself into esoteric one, during preparation of homeopathic medicines.In the end of this article the author ascertains that homeopathic medicine and magic has certain paradigm in common what is opposit to racionalism of official European paradigm of thinking. PMID:19244731

  8. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... nearly 2/3 of all visits to the doctor's office end with a prescription for medication. There ... counter remedies. Prescription medicine is prescribed by a doctor for a specific ailment, using his or her ...

  9. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... referring physician. top of page What are the benefits vs. risks? Benefits The information provided by nuclear medicine examinations is ... the possible charges you will incur. Web page review process: This Web page is reviewed regularly by ...

  10. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... annually on prescription medicine. All too often, however, we overlook the vital role medication plays in our ... have switched to the non-prescription status so we have a lot of potent medications available for ...

  11. Take Your Medicines Safely

    Medline Plus

    Full Text Available Announcer: Recent studies show that nearly 2/3 of all visits to the doctor's office end with a prescription for medication. There is approximately $75 billion spent annually on prescription medicine. ...

  12. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... nuclear medicine imaging uses small amounts of radioactive materials called radiotracers, a special camera and a computer ... medical imaging that uses small amounts of radioactive material to diagnose and determine the severity of or ...

  13. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... not experience any discomfort. When swallowed, the radiotracer has little or no taste. If inhaled, your child ... after the nuclear medicine scan. If the child has been sedated, you will receive specific instructions to ...

  14. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... teeth or eating breakfast. By communicating with our health care providers and by accepting a greater responsibility in our own health care, we can learn to take our medicines safely.

  15. Darwin, medicine and cancer.

    Science.gov (United States)

    Purushotham, A D; Sullivan, R

    2010-02-01

    'Nothing in biology makes sense except in the light of evolution'! So said Theodore Dobzhansky. It is extraordinary how little Darwinism and post-Darwinian evolutionary science has penetrated medicine despite the fact that all biology is built upon its foundations. Randy Nesse, one of the fathers of Darwinian medicine, recently observed that doctors 'know the facts but not the origins'. Clearly, then, in this auspicious year-200 years since Charles Darwin's birth and 150 years since the first edition of the Origin of Species-it is time to reconsider Darwin's legacy to medicine and to invite evolution back into the biomedical fold. Here, we consider the legacy of Darwin and the contribution of the other great evolutionists such as Ernst Mayr to cancer and medicine.

  16. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... or eating breakfast. By communicating with our health care providers and by accepting a greater responsibility in our own health care, we can learn to take our medicines safely.

  17. Folk medicine and horticulture

    OpenAIRE

    1995-01-01

    The article discusses the uses of marine organisms in folk medicine and in horticulture in the Philippines. Commonly used marine organisms are the different varieties of seaweeds, sea urchin, sea cucumber, turtle, crocodile and fishes such as grouper and rabbitfish.

  18. OTC Medicines and Pregnancy

    Science.gov (United States)

    ... with other active ingredients, such as decongestants or antihistamines. Drug Recall Information View information on recent drug ... in nursing babies. Limit long-term use of antihistamines. Just like other medicines you take, antihistamines will ...

  19. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... teeth or eating breakfast. By communicating with our health care providers and by accepting a greater responsibility in our own health care, we can learn to take our medicines ...

  20. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... I take it and for how long? What foods, drinks, other medicines or activities should I avoid ... twice a day and one of them with food and the other one standing on my head, ...

  1. Take Your Medicines Safely

    Medline Plus

    Full Text Available ... if they occur? And, is there any written information available about the medicine? There are many reasons ... seven days of the week. Announcer: Regardless of age or economic status, taking medication can be as ...

  2. Alternative medicine - pain relief

    Science.gov (United States)

    Alternative medicine refers to treatments that are used instead of conventional (standard) ones. If you use an alternative ... considered complementary therapy. There are many forms of ... Acupuncture involves stimulating certain acupoints on the body ...

  3. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... medicine will interpret the images and forward a report to your referring physician. top of page What ... by: Please note RadiologyInfo.org is not a medical facility. Please contact your physician with specific medical ...

  4. Nanotechnology: The future medicine

    Directory of Open Access Journals (Sweden)

    Rajiv Saini

    2010-01-01

    Full Text Available Nanotechnology is an exciting new area in science, with many possible applications in medicine. This article seeks to outline the role of different areas such as diagnosis of diseases, drug delivery, imaging, and so on.

  5. Astronomy, Astrology, and Medicine

    Science.gov (United States)

    Greenbaum, Dorian Gieseler

    Astronomy and astrology were combined with medicine for thousands of years. Beginning in Mesopotamia in the second millennium BCE and continuing into the eighteenth century, medical practitioners used astronomy/astrology as an important part of diagnosis and prescription. Throughout this time frame, scientists cited the similarities between medicine and astrology, in addition to combining the two in practice. Hippocrates and Galen based medical theories on the relationship between heavenly bodies and human bodies. In an enduring cultural phenomenon, parts of the body as well as diseases were linked to zodiac signs and planets. In Renaissance universities, astronomy and astrology were studied by students of medicine. History records a long tradition of astrologer-physicians. This chapter covers the topic of astronomy, astrology, and medicine from the Old Babylonian period to the Enlightenment.

  6. 减肥手术对妊娠结局影响的研究进展%The Impact of Bariatric Surgery on Pregnancy Outcomes

    Institute of Scientific and Technical Information of China (English)

    段力园; 李东浩; 康军聪(综述); 宋光耀(审校)

    2015-01-01

    The prevalence of obesity worldwide has been increasing over the last several decades.Despite attempted intervention,1 in 5 women of reproductive age are obese when they conceive.Obesity during preg-nancy increases the risk of almost every obstetric complication ,and also puts the developing fetus at risk for congenital abnormalities and abnormal intrauterine growth .Due to the limited success of medical therapy and life-style change,bariatric surgery has become increasingly important in managing obesity.Regarding certain complications,pregnancy after bariatric surgery appears to be safer than pregnancy with obesity.%全球肥胖的发病率在近几十年中持续增长,尽管人们试图采取各种方式进行干预,育龄女性在孕期肥胖者仍占20%,肥胖女性妊娠几乎可以导致所有产科并发症的增加,并且造成胎儿的先天异常和宫内异常生长。由于药物治疗和生活方式改变的局限性,减肥手术已经成为治疗肥胖和减少孕期肥胖相关并发症最有效的方式。对于特定类型的并发症,减肥手术后的怀孕似乎比孕期肥胖更安全。

  7. The Impact of Bariatric Surgery on Pregnancy Outcomes%减肥手术对妊娠结局影响的研究进展

    Institute of Scientific and Technical Information of China (English)

    段力园; 李东浩; 康军聪(综述); 宋光耀(审校)

    2015-01-01

    全球肥胖的发病率在近几十年中持续增长,尽管人们试图采取各种方式进行干预,育龄女性在孕期肥胖者仍占20%,肥胖女性妊娠几乎可以导致所有产科并发症的增加,并且造成胎儿的先天异常和宫内异常生长。由于药物治疗和生活方式改变的局限性,减肥手术已经成为治疗肥胖和减少孕期肥胖相关并发症最有效的方式。对于特定类型的并发症,减肥手术后的怀孕似乎比孕期肥胖更安全。%The prevalence of obesity worldwide has been increasing over the last several decades.Despite attempted intervention,1 in 5 women of reproductive age are obese when they conceive.Obesity during preg-nancy increases the risk of almost every obstetric complication ,and also puts the developing fetus at risk for congenital abnormalities and abnormal intrauterine growth .Due to the limited success of medical therapy and life-style change,bariatric surgery has become increasingly important in managing obesity.Regarding certain complications,pregnancy after bariatric surgery appears to be safer than pregnancy with obesity.

  8. 减重手术治疗2型糖尿病机制研究进展%Recent advances in bariatric surgery for type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    郎敏; 张宏斌; 吴良平; 黄宗海

    2015-01-01

    糖尿病是目前威胁全人类健康的重大疾病之一,其中90%以上均为2型糖尿病。近年来,我国糖尿病发病率快速增长,且年龄呈年轻化趋势。研究表明,与传统内科治疗相比,减重手术在减轻体重、维持血糖平衡方面有着更好的治疗效果,不仅可以有效的治疗肥胖及2型糖尿病,还可显著改善相关的心血管并发症风险。但手术治疗2型糖尿病的机制尚未完全明确,国内外研究提出了各种可能,本文现对目前的研究进展作一综述。%Diabetes mellitus is one of the most serious medical issues which threaten the health of humen being ’ s in worldwide , and more then 90% is type 2 diabetes mellitus .Increasing data indicates , compare with medical therapy , bariatric surgery is more effective on reducing weight and maintaining blood glucose balance ,it not only has effective treatment of obesity and type 2 diabetes ,but also significantly reduce the risk of the related cardiaovascular compliacations .Howerber,the mechanism of bariatric surgery for type 2 diabetes mellitus is not yet fully clear ,the domestic and foreign research has proposed various possibilities , this article is a review of the current research progress .

  9. Assessment of Surgical Complications in Morbid Obese Patients, The Candidates for 2 Methods of Laparoscopic Bariatric Surgery (Laparoscopic Gastric Bypass, Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Pazouki

    2015-11-01

    Full Text Available Background In 2005, obesity rate was declared 396 million worldwide, which has been doubled in the last 20 years (compared with 1985. Obesity has a strong correlation with a pool of comorbidities and consequences. Although many modules, including behavioural approach and medications have presented particular short-term unreliable methods to reduce and control the body weight in morbid obesity, only 5 - 10% of weight loss was achieved, which is usually regained overtime, compared with 50 - 75% success rate in bariatric surgery. Objectives This retrospective study tried to monitor weight loss after LRYGB and LSG in morbid obese patients referred to a known center in Tehran through a one-year follow up. Materials and Methods Participants were selected regarding the U.S. National Institute of Health (NIH guidelines, which indicates BMI > 40 kg/m2 alone, or BMI > 35 kg/m2 in addition to comorbidities and failure of non-surgical attempts to control their weight. They were visited at points of one, three, six, and 12 months postoperatively to collect information about weight loss, BMI, and complications in addition to percent excess weight loss (EWL%. The percentage of failure was computed to the proportion of patients who had EWL% < 25 to the total number of operated patients in a year. Results Significant decrease in BMI and weight were achieved in all postoperative visits (for all of them, P value < 0.0001, while no significant difference was found in which the parameters between two studied procedures were in this regard. Conclusions To sum up, LRYGB and LSG deserve an overall preference not only in current study, but also in the majority of performances up to now. Nevertheless it is urgent the relevant studies to confirm the preference or improve this kind of bariatric surgery in order to diminish complications as far as possible.

  10. Nuclear tele medicine

    International Nuclear Information System (INIS)

    The great majority of the digital images of nuclear medicine are susceptible of being sent through internet. This has allowed that the work in diagnosis cabinets by image it can benefit of this modern technology. We have presented in previous congresses works related with tele medicine, however, due to the speed in the evolution of the computer programs and the internet, becomes necessary to make a current position in this modality of work. (Author)

  11. Complementary medicine: common misconceptions.

    OpenAIRE

    Ernst, E

    1995-01-01

    Complementary medicine (CM), defined as health care which lies for the most part outside the mainstream of conventional medicine, is gaining popularity in Britain and elsewhere. In the UK the most prevalent therapies are manipulation (used by 36% of the population), herbalism (24%) homoeopathy (16%) and acupuncture (16%). Due to the heterogeneity of CM, it is often problematic to generalize. The debate about the usefulness of CM is often regrettably emotional, and thus unproductive. In the pu...

  12. The family medicine cabinet *

    OpenAIRE

    Edwards, G. P. L.

    1982-01-01

    Medicine selection and storage was examined in 130 families. Over 50 per cent were found to be less than adequate. Health education advice helped half the inadequate group to change to adequate. Age and social class were not related to hoarding of prescribed drugs, to initial standards of storage or selection, nor to the likelihood of a response to advice. Those who hoarded medicines but stored them well were highly likely to change. Those who stored and selected poorly were unlikely to make ...

  13. Robotics in medicine

    Science.gov (United States)

    Kuznetsov, D. N.; Syryamkin, V. I.

    2015-11-01

    Modern technologies play a very important role in our lives. It is hard to imagine how people can get along without personal computers, and companies - without powerful computer centers. Nowadays, many devices make modern medicine more effective. Medicine is developing constantly, so introduction of robots in this sector is a very promising activity. Advances in technology have influenced medicine greatly. Robotic surgery is now actively developing worldwide. Scientists have been carrying out research and practical attempts to create robotic surgeons for more than 20 years, since the mid-80s of the last century. Robotic assistants play an important role in modern medicine. This industry is new enough and is at the early stage of development; despite this, some developments already have worldwide application; they function successfully and bring invaluable help to employees of medical institutions. Today, doctors can perform operations that seemed impossible a few years ago. Such progress in medicine is due to many factors. First, modern operating rooms are equipped with up-to-date equipment, allowing doctors to make operations more accurately and with less risk to the patient. Second, technology has enabled to improve the quality of doctors' training. Various types of robots exist now: assistants, military robots, space, household and medical, of course. Further, we should make a detailed analysis of existing types of robots and their application. The purpose of the article is to illustrate the most popular types of robots used in medicine.

  14. Integration of Traditional Chinese Medicine and modern medicine promotes the unification of human medicine

    Directory of Open Access Journals (Sweden)

    Peng Zhang

    2010-10-01

    Full Text Available "nThere are two mutually supportive systems in medical profession: modern medicines and traditional medicine. The current status is that although the modern medicine occupies the major position in healthcare system, the therapeutic effect of traditional medicines should not be omitted. If all of them merged and unified as one, it will be beneficial to the development of human medicine. In this paper, the integration of Traditional Chinese Medicine (TCM and modern medicine was exemplified to elucidate the mutual complements, mutual benefits of traditional medicines and modern medicine to maintain the unification of human medicine via the development of molecular biology, cytology etc. We believed that TCM theory may share the same mechanism with western medicine at some extent which need to be explored in the future research. In our point of view, although the road may twist and turn, the results are promising.

  15. IBD and Complementary and Alternative Medicine (CAM)

    Science.gov (United States)

    ... Alternative Medicine (CAM) Go Back Complementary and Alternative Medicine (CAM) Email Print + Share Crohn’s disease and ulcerative ... Energy Medicine, and Biologically-Based Practices. Mind-Body Medicine Mind-body medicine is a set of interventions ...

  16. Quality of generic medicines in South Africa

    DEFF Research Database (Denmark)

    Patel, Aarti; Gauld, Robin; Norris, Pauline;

    2012-01-01

    Generic Medicines are an important policy option allowing for access to affordable, essential medicines. Quality of generic medicines must be guaranteed through the activities of national medicines regulatory authorities. Existing negative perceptions surrounding the quality of generic medicines...

  17. 重视减重手术治疗肥胖伴2型糖尿病机制研究%Focus attention on potential mechanisms of remission after bariatric surgery in diabetes

    Institute of Scientific and Technical Information of China (English)

    梁佩雯; 洪洁

    2016-01-01

    肥胖及2型糖尿病的患病率在全球范围呈现上升趋势,相较于传统保守治疗,外科减重手术能更持久有效地减低体重并且改善糖代谢。其潜在机制包括食欲下降,胃肠激素的变化,胆汁酸以及肠道菌群的变化等。%[Summary] The incidences of obesity and its associated diseases are increasing worldwide.Bariatric surgery leads to more sustainable weight loss and better glycemic control compared with conservative medical treatment. Potential mechanisms mediating the improvement in glycemic control after bariatric surgery include changes in the levels of food intake, gastrointestinal hormones, bile acids as well as intestinal bacterial flora.

  18. Nuclear medicine resources manual

    International Nuclear Information System (INIS)

    Over the past decade many IAEA programmes have significantly enhanced the capabilities of numerous Member States in the field of nuclear medicine. Functional imaging using nuclear medicine procedures has become an indispensable tool for the diagnosis, treatment planning and management of patients. However, due to the heterogeneous growth and development of nuclear medicine in the IAEA's Member States, the operating standards of practice vary considerably from country to country and region to region. This publication is the result of the work of over 30 international professionals who have assisted the IAEA in the process of standardization and harmonization. This manual sets out the prerequisites for the establishment of a nuclear medicine service, including basic infrastructure, suitable premises, reliable supply of electricity, maintenance of a steady temperature, dust exclusion for gamma cameras and radiopharmacy dispensaries. It offers clear guidance on human resources and training needs for medical doctors, technologists, radiopharmaceutical scientists, physicists and specialist nurses in the practice of nuclear medicine. The manual describes the requirements for safe preparation and quality control of radiopharmaceuticals. In addition, it contains essential requirements for maintenance of facilities and instruments, for radiation hygiene and for optimization of nuclear medicine operational performance with the use of working clinical protocols. The result is a comprehensive guide at an international level that contains practical suggestions based on the experience of professionals around the globe. This publication will be of interest to nuclear medicine physicians, radiologists, medical educationalists, diagnostic centre managers, medical physicists, medical technologists, radiopharmacists, specialist nurses, clinical scientists and those engaged in quality assurance and control systems in public health in both developed and developing countries

  19. Medicinal plants of Kermanshah province

    OpenAIRE

    Mostafa Nemati Paykani; Nastaran Jalilian

    2012-01-01

    In order to collect and determine medicinal plants of Kermanshah province, at first a list of medicinal plants and their localities was prepared based on the floristic list of the Kermanshah province mentioned as medicinal plants in the related references. Then, stands of the mentioned medicinal plants were referred according to the topographic maps and the extracted localities and after collecting medicinal plant specimens, herbarium specimens were prepared based on the traditional taxonomic...

  20. Imaging and development of medicines

    International Nuclear Information System (INIS)

    The last developments in medical imaging allow visualization of medicines in organism. Today, these techniques: positron emission tomography (PET) and single photon emission computed tomography (SPECT) play an essential role in the production and the development of new medicines. The medicinal substances labelled with radioisotopes permit to improve the understanding of medicines' action mode. The spectacular advances were observed in the field of medicines acting on the brain (F.M.)

  1. Genomic medicine, precision medicine, personalized medicine: what's in a name?

    Science.gov (United States)

    Roden, D M; Tyndale, R F

    2013-08-01

    This issue of Clinical Pharmacology & Therapeutics is devoted to genomic medicine, and a reader may reasonably ask what we mean when we use those words. In the initial issue of the journal Genomics in 1987, McKusick and Ruddle pointed out that the descriptor "genome" had been coined in 1920 as a hybrid of "gene" and "chromosome," and that their new journal would focus on the "newly-developing discipline of mapping/sequencing (including analysis of the information)." A key milestone in the field was the generation of the first draft of a human genome in 2000, but this success really represents only one of many milestones in the journey from Mendel to MiSeq.

  2. Differences in gestational weight gain between pregnancies before and after maternal bariatric surgery correlate with differences in birth weight but not with scores on the body mass index in early childhood

    DEFF Research Database (Denmark)

    Berglind, D; Willmer, M; Näslund, E;

    2013-01-01

    Large maternal gestational weight gain (GWG) is associated with increased birth weight and increased risk of obesity in offspring, but these associations may be confounded by genetic and environmental factors. The aim was to investigate the effects of differences in GWG in all three trimesters on...... on differences in birth weight and in body mass index (BMI) scores at 4 and 6 years of age, within siblings born before and after bariatric surgery....

  3. Complementary Therapies and Medicines and Reproductive Medicine.

    Science.gov (United States)

    Smith, Caroline A; Armour, Mike; Ee, Carolyn

    2016-03-01

    Complementary therapies and medicines are a broad and diverse range of treatments, and are frequently used by women and their partners during the preconception period to assist with infertility, and to address pregnancy-related conditions. Despite frequent use, the evidence examining the efficacy, effectiveness, and safety for many modalities is lacking, with variable study quality. In this article, we provide an overview of research evidence with the aim of examining the evidence to inform clinical practice. During the preconception period, there is mixed evidence for acupuncture to improve ovulation, or increase pregnancy rates. Acupuncture may improve sperm quality, but there is insufficient evidence to determine whether this results in improved pregnancy and live birth rates. Acupuncture can be described as a low-risk intervention. Chinese and Western herbal medicines may increase pregnancy rates; however, study quality is low. The evaluation of efficacy, effectiveness, and safety during the first trimester of pregnancy has most commonly reported on herbs, supplements, and practices such as acupuncture. There is high-quality evidence reporting the benefits of herbal medicines and acupuncture to treat nausea in pregnancy. The benefit from ginger to manage symptoms of nausea in early pregnancy is incorporated in national clinical guidelines, and vitamin B6 is recommended as a first-line treatment for nausea and vomiting in pregnancy. The safety of ginger and vitamin B6 is considered to be well established, and is based on epidemiological studies. Acupuncture has been shown to reduce back pain and improve function for women in early pregnancy. There is little evidence to support the use of cranberries in pregnancy for prevention of urinary tract infections, and chiropractic treatment for back pain. Overall the numbers of studies are small and of low quality, although the modalities appear to be low risk of harm. PMID:26866600

  4. The research progress on bariatric surgery in the treatment of type 2 diabetes%减肥手术治疗2型糖尿病的研究进展

    Institute of Scientific and Technical Information of China (English)

    张思敏; 纪立农

    2012-01-01

    面对日益严峻的糖尿病发病形势,医务人员应提供更加积极有效的治疗干预措施.除生活方式和药物干预外,减肥手术成为肥胖T2DM患者的选择之一.手术治疗糖尿病的机制和术后肠促胰素的分泌密切相关.本文就手术治疗糖尿病的发展历史、研究机制等方面进行文献综述.%Facing to the increasing global diabetes crisis, health care providers should provide potent therapeutic interventions as more as possible. In addition to behavioural and medical approaches, the bariatric surgery becomes a powerful option to relieve diabetes in obese type 2 diabetic patients. The mechanism of bariatric surgery in the treatment of diabetes is considered to be associated with incretin. This paper is a literature review on the history and mechanism of bariatric surgery.

  5. Relationship between the changes of related factors after bariatric surgery and the function of pancreatic beta cells%减重手术后相关因素变化与胰岛β细胞功能的关系

    Institute of Scientific and Technical Information of China (English)

    杨健; 王勇

    2013-01-01

    胰岛β细胞功能与2型糖尿病息息相关.国内外专家一致认为:减重手术是治疗2型糖尿病及其并发症的最有效手段,但其机制尚不清楚,可能与胰岛β细胞功能的改善有关.本文主要就减重手术后各相关因素变化与胰岛β细胞功能的关系进行综述.%The function of β-cells is closely correlated with the onset of type 2 diabetes mellitus.Currently the bariatric surgery has been considered to be the most effective therapy for ameliorating the complications and improving the prognosis of type 2 diabetes mellitus,while the mechanism remains unknown.The improvement of β-cells function following bariatric surgery might play important roles in the remission of type 2 diabetes mellitus.In this article,the relationship between the changes of related factors after bariatric surgery and the function of pancreatic β-cells is reviewed.

  6. 减重手术治疗2型糖尿病机制研究进展%Mechanism research progress of bariatric surgery for type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    李鹏洲; 朱利勇; 朱晒红

    2012-01-01

    Patients with type 2 diabetes mellitus experienced a complete and comfirm diabetic remission after bariatric surgery.Although weight loss,reduction of food intake and other factors may play important roles in diabetic resolution after bariatric surgery,the major mechanism is the change of gastrointestinal hormones.Further research is essential to better understand these mechanisms and bariatric surgery may ultimately become a major tool in the treatment of type 2 diabetes mellitus.%2型糖尿病患者接受减重手术后糖尿病症状显著缓解并能长期维持,主要是因为术后胃肠道激素的改变,此外体质量下降、饮食减少以及其他的因素也起着一定作用.随着其治疗机制研究的不断深入,减重手术有望成为治疗2型糖尿病的一种主要手段.

  7. Progress of bariatric surgery on treatment of obesity and type 2 diabetes%手术治疗肥胖2型糖尿病的研究进展

    Institute of Scientific and Technical Information of China (English)

    颜朝阳; 张忠涛; 孟化

    2014-01-01

    肥胖及2型糖尿病是严重威胁人类健康的常见慢性疾病,除生活方式和内科治疗外,代谢手术以其疗效确切、并发症少等优点日益被广大医务人员所重视.代谢手术种类繁多,但目前袖状胃切除术和Roux-en-Y胃转流术应用较广,其内在机制与胃肠激素、脂肪代谢等多方面有关,尚存在诸多假说.本文就代谢手术的疗效作用、研究机制等方面进行综述.%Obesity and type 2 diabetes are common chronic diseases which severely threatens human's health and lives.In addition to behavioural and medical approaches,the bariatric surgery is increasingly being valued by medical workers.There are many kinds of surgical method of the bariatric surgery,but by far the most popular ones are Laparoscopic sleeve gastrectomy and Laparoscopic sleeve gastrectomy.The mechanism of the surgery may related to gastrointestinal hormones and fat metabolism,but no final conclusion has yet been reached on this matter.This paper is a literature review on the effect and mechanism of bariatric surgery.

  8. Transmitting Chinese Medicine

    Science.gov (United States)

    Scheid, Volker

    2015-01-01

    Historians of Chinese medicine acknowledge the plurality of Chinese medicine along both synchronic and diachronic dimensions. Yet, there remains a tendency to think of tradition as being defined by some unchanging features. The Chinese medical body is a case in point. This is assumed to have been formalised by the late Han dynasty around a system of internal organs, conduits, collaterals, and associated body structures. Although criticism was voiced from time to time, this body and the micro/macrocosmic cosmological resonances that underpin it are seen to persist until the present day. I challenge this view by attending to attempts by physicians in China and Japan in the period from the mid 16th to the late 18th century to reimagine this body. Working within the domain of cold damage therapeutics and combining philological scholarship, empirical observations, and new hermeneutic strategies these physicians worked their way towards a new territorial understanding of the body and of medicine as warfare that required an intimate familiarity with the body’s topography. In late imperial China this new view of the body and medicine was gradually re-absorbed into the mainstream. In Japan, however, it led to a break with this orthodoxy that in the Republican era became influential in China once more. I argue that attending further to the innovations of this period from a transnational perspective - commonly portrayed as one of decline - may help to go beyond the modern insistence to frame East Asian medicines as traditional. PMID:26869864

  9. Bariatric surgery and diabetes

    Directory of Open Access Journals (Sweden)

    Andrew Collier

    2012-01-01

    Full Text Available Obesity is a relatively new and serious world-wide epidemic. Obesity is a stronger predictor in mortality than either poverty or smoking, and obesity is also now more prevalent than malnutrition. The prevalence of obesity continues to increase, ironically, the rate of increase of obesity is highest amongst the morbidly obesity. Obesity is the result of many factors resulting in concert, including poor dietary habits, reduced physical activity and genetic predisposition. With the rapid increase in obesity there has been a pronounced increase in obesity-related metabolic disorders including type 2 diabetes, hyperlipidemia, hypertension and many others. These co-morbidities are responsible for more than 2.5 million deaths, worldwide. The loss of life expectancy due to obesity is profound. In comparison to a normal weight individual Caucasian, a 25-year-old morbidly obese man has a 22% reduction in the expected remaining life span, representing an approximate loss of 12 years of life.

  10. Bariatric Surgery Procedures

    Science.gov (United States)

    ... mechanisms by which obesity induces type 2 diabetes. Advantages Produces significant long-term weight loss (60 to ... band and the roux-en-y gastric bypass. Advantages Restricts the amount of food the stomach can ...

  11. Engineering in translational medicine

    CERN Document Server

    2014-01-01

    This book covers a broad area of engineering research in translational medicine. Leaders in academic institutions around the world contributed focused chapters on a broad array of topics such as: cell and tissue engineering (6 chapters), genetic and protein engineering (10 chapters), nanoengineering (10 chapters), biomedical instrumentation (4 chapters), and theranostics and other novel approaches (4 chapters). Each chapter is a stand-alone review that summarizes the state-of-the-art of the specific research area. Engineering in Translational Medicine gives readers a comprehensive and in-depth overview of a broad array of related research areas, making this an excellent reference book for scientists and students both new to engineering/translational medicine and currently working in this area.

  12. Traceability in nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Zimmerman, B.E. [National Institute of Standards and Technology, Ionizing Radiation Div., Gaithersburg MD (United States); Judge, St. [National Physical Laboratory, Hampton Road, Teddington, Middlesex (United Kingdom)

    2007-08-15

    Accurate, reproducible measurement of radioactivity in nuclear medicine applications is vital to ensure the safety and effectiveness of disease diagnosis and treatment using unsealed radioactive sources. The need to maintain a high degree of confidence in those measurements requires that they be carried out so as to be traceable to national and international standards. In addition, measurement traceability for radioactivity in medicine helps ensure international consistency in measurement at all levels of practice (national measurement laboratories, research institutions, isotope producers, radiopharmaceutical manufacturers and clinics). This paper explores the importance of radioactivity measurement in nuclear medicine and demonstrates how traceability can be extended from international standards to the quantity of the drug administered to the patient. (authors)

  13. Pediatric nuclear medicine

    International Nuclear Information System (INIS)

    This symposium presented the latest techniques and approaches to the proper medical application of radionuclides in pediatrics. An expert faculty, comprised of specialists in the field of pediatric nuclear medicine, discussed the major indications as well as the advantages and potential hazards of nuclear medicine procedures compared to other diagnostic modalities. In recent years, newer radiopharmaceuticals labeled with technetium-99m and other short-lived radionuclides with relatively favorable radiation characteristics have permitted a variety of diagnostic studies that are very useful clinically and carry a substantially lower radiation burden then many comparable X-ray studies. This new battery of nuclear medicine procedures is now widely available for diagnosis and management of pediatric patients. Many recent research studies in children have yielded data concerning the effacacy of these procedures, and current recommendations will be presented by those involved in conducting such studies. Individual papers are processed separately for the Energy Data Base

  14. Medicinal chemistry for 2020.

    Science.gov (United States)

    Satyanarayanajois, Seetharama D; Hill, Ronald A

    2011-10-01

    Rapid advances in our collective understanding of biomolecular structure and, in concert, of biochemical systems, coupled with developments in computational methods, have massively impacted the field of medicinal chemistry over the past two decades, with even greater changes appearing on the horizon. In this perspective, we endeavor to profile some of the most prominent determinants of change and speculate as to further evolution that may consequently occur during the next decade. The five main angles to be addressed are: protein-protein interactions; peptides and peptidomimetics; molecular diversity and pharmacological space; molecular pharmacodynamics (significance, potential and challenges); and early-stage clinical efficacy and safety. We then consider, in light of these, the future of medicinal chemistry and the educational preparation that will be required for future medicinal chemists. PMID:22004084

  15. Pediatric nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    1986-01-01

    This symposium presented the latest techniques and approaches to the proper medical application of radionuclides in pediatrics. An expert faculty, comprised of specialists in the field of pediatric nuclear medicine, discussed the major indications as well as the advantages and potential hazards of nuclear medicine procedures compared to other diagnostic modalities. In recent years, newer radiopharmaceuticals labeled with technetium-99m and other short-lived radionuclides with relatively favorable radiation characteristics have permitted a variety of diagnostic studies that are very useful clinically and carry a substantially lower radiation burden then many comparable X-ray studies. This new battery of nuclear medicine procedures is now widely available for diagnosis and management of pediatric patients. Many recent research studies in children have yielded data concerning the effacacy of these procedures, and current recommendations will be presented by those involved in conducting such studies. Individual papers are processed separately for the Energy Data Base.

  16. Nuclear medicine tomorrow

    International Nuclear Information System (INIS)

    The purpose of this Workshop was to discuss and promote future nuclear medicine applications. Atomic Energy of Canada Limited (AECL) is determined to assist in this role. A major aim of this gathering was to form an interface that was meaningful, representative of the two entities, and above all, on-going. In the opening address, given by Mr. J. Donnelly, President of AECL, this strong commitment was emphasized. In the individual sessions, AECL participants outlined R and D programs and unique expertise that promised to be of interest to members of the nuclear medicine community. The latter group, in turn, described what they saw as some problems and needs of nuclear medicine, especially in the near future. These Proceedings comprise the record of the formal presentations. Additionally, a system of reporting by rapporteurs insured a summary of informal discussions at the sessions and brought to focus pertinent conclusions of the workshop attendees

  17. Traceability in nuclear medicine

    Science.gov (United States)

    Zimmerman, Brian E.; Judge, Steven

    2007-08-01

    Accurate, reproducible measurement of radioactivity in nuclear medicine applications is vital to ensure the safety and effectiveness of disease diagnosis and treatment using unsealed radioactive sources. The need to maintain a high degree of confidence in those measurements requires that they be carried out so as to be traceable to national and international standards. In addition, measurement traceability for radioactivity in medicine helps ensure international consistency in measurement at all levels of practice (national measurement laboratories, research institutions, isotope producers, radiopharmaceutical manufacturers and clinics). This paper explores the importance of radioactivity measurement in nuclear medicine and demonstrates how traceability can be extended from international standards to the quantity of the drug administered to the patient.

  18. Personalized medicine in psychiatry

    DEFF Research Database (Denmark)

    Wium-Andersen, Ida Kim; Vinberg, Maj; Kessing, Lars Vedel;

    2016-01-01

    BACKGROUND: Personalized medicine is a model in which a patient's unique clinical, genetic, and environmental characteristics are the basis for treatment and prevention. Aim, method, and results: This review aims to describe the current tools, phenomenological features, clinical risk factors......, and biomarkers used to provide personalized medicine. Furthermore, this study describes the target areas in which they can be applied including diagnostics, treatment selection and response, assessment of risk of side-effects, and prevention. DISCUSSION AND CONCLUSION: Personalized medicine in psychiatry...... is challenged by the current taxonomy, where the diagnostic categories are broad and great biological heterogeneity exists within each category. There is, thus, a gap between the current advanced research prospects and clinical practice, and the current taxonomy is, thus, a poor basis for biological research...

  19. Hvad er evidensbaseret medicin?

    DEFF Research Database (Denmark)

    Pedersen, T.; Gluud, Christian Nyfeldt; Gøtzsche, Peter C.;

    2001-01-01

    of a diagnostic method is a randomised trial. Evidence-based medicine will provide the best basis for evaluations of which interventions should be abandoned and which are effective and economically feasible. The use of evidence-based clinical guidelines will lead to more cost-effective treatments. It should......Evidence-based medicine is based on the best results from clinical and epidemiological research, which is combined with clinical experience and patient preferences. Questions of prognosis and harm are often best elucidated in large cohort studies. For other clinical questions the best evidence...... be a national strategy that health care should be evidence-based....

  20. Benjamin Franklin and medicine.

    Science.gov (United States)

    Hirschmann, J V

    2005-12-01

    Benjamin Franklin, called Dr. Franklin after receiving an honorary degree in 1759 for his contributions to understanding electricity, was not formally trained as a physician. Nevertheless, he had numerous interests in medicine, including experimentation, shrewd observations about health and disease in himself and others, civic activities, and inventions of medical devices. These achievements show his capacity for detailed, perceptive insights; his fastidiousness in recording his observations; and his thoughtful analyses of scientific phenomena and human conduct. In medicine, perhaps uniquely in his life, his major interests intersected: scientific pursuits, civic activities, amused scrutiny of human behavior, and the desire to improve the lot of his fellow man.