Randomized controlled trial comparing three methods of liver retraction in laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: This study aimed to evaluate differences between three methods of liver retraction during laparoscopic Roux-en-Y Gastric bypass (LRYGB) and to compare novel liver retraction techniques with the traditional mechanical liver retractor in a randomized controlled trial. METHODS: In this study, 60 obese patients (26 males and 34 females) who underwent LRYGB between January and July 2010 were randomized to one of three groups (20 in each): group 1 (Nathanson liver retractor), group 2 (liver suspension tape), and group 3 (V-shaped liver suspension technique [V-LIST]). Data regarding demographics (age, sex, body mass index); liver function test (LFT) just before surgery; postoperative results immediately, then 18 h, 1 week, and 1 month after surgery; operative data, and visual analog scale (VAS) for pain on postoperative days (PODs) 1 and 2 were calculated and analyzed. RESULTS: The groups did not differ significantly in terms of preoperative LFT or operative data except that group 3 took significantly longer time for liver suspension than group 1 (p = 0.01) or group 2 (p = 0.03). The VAS score in group 2 was significantly lower on POD 1 than in group 1 (p = 0.04). Group 1 showed a significant rise in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at 18 h compared with group 2 (p < 0.01 and p = 0.02, respectively) and group 3 (p < 0.01 and p = 0.01), at 1 week compared with group 2 (p = 0.04 and 0.04), and in AST levels alone during the immediate postoperative compared with group 3 (p = 0.04). CONCLUSION: The Nathanson liver retractor causes more liver dysfunction than V-LIST or the liver suspension technique and causes more postoperative pain than the liver suspension technique. Both V-LIST and liver suspension tape have a short learning curve and implications for single-port surgery.

Psychiatric disorders of patients seeking obesity treatment.

BACKGROUND: Obese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment. METHODS: Subjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment. RESULTS: Of the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group. CONCLUSION: A high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.

Low dose gonadotropin-releasing hormone agonist treatments with early discontinuation for controlled ovarian hyperstimulation in an in vitro fertilization program.

Aim: The purpose of the present study was to investigate the applicability of a protocol for controlled ovarian hyperstimulation (COH) featuring early discontinuation of low dose gonadotropin-releasing hormone agonist (GnRHa) for ovulation induction for in vitro fertilization (IVF). Methods: Four hundred and eighty-seven women undergoing 555 IVF cycles were recruited into the study. Controlled ovarian hyperstimulation was achieved by using either a short protocol of low dose GnRHa (for 5 days only; groups 1 and 2) or a modified long protocol with early discontinuation of GnRHa (groups 3 and 4). Groups 1 and 3 received urinary follicle-stimulating hormone (FSH) and groups 2 and 4 received recombinant FSH. Oocyte retrieval was performed 34 to 36 h after human chorionic gonadotropin (hCG) injection, followed by embryo transfer 3 days later. Results: Luteinizing hormone (LH) levels on the hCG injection day were lower with the modified long protocol (groups 3 and 4) than with the short 5-day treatment (groups 1 and 2). There were higher LH levels in group 1 than in groups 2, 3 and 4, resulting in a worse fertilization rate and clinical pregnancy rate. There were no statistically significant differences between groups 2, 3 and 4 in the rates of fertilization, clinical pregnancy and delivery. A higher estradiol (E2) level in group 3 than in groups 1, 2 and 4 resulted in a worse implantation rate. Conclusion: Early cessation of GnRHa may not induce a premature LH surge in controlled ovarian hyperstimulation, while a low dose also offers a useful alternative to a long protocol of IVF. Ovarian stimulation with recombinant follicle-stimulating hormone (rFSH) is considered to be favorable in this low dose GnRHa treatment. (Reprod Med Biol 2003; 2: 25-30).

Low blood lead concentration in association with infertility in women.

This study investigated the relationship between low-level lead exposure and risk of infertility in women. Study participants consisted of 64 cases recruited at a private infertility clinic and 83 control women from the postpartum clinic unit at a medical center in Kaohsiung, Taiwan. With informed consent, venous blood samples were obtained from subjects, during their early follicular phases (the 1st to 5th days of the menstrual cycle), for measuring concentrations of lead and hormones. Information on other potential risk factors associated with infertility, including reproductive history, Chinese herbal Medicine use, dairy product consumption, residential environment, and sociodemographic status, was obtained during an in-person interview. The mean blood lead level (BLL) in infertile women was significantly higher than that in controls (3.55 vs 2.78 microg/dL, P=0.007). Compared to women with BLL < or = 2.5 microg/dL, women with BLL>2.5 microg/dL were associated with a threefold increased risk for infertility (adjusted odds ratio=2.94, 95% confidence interval 1.18-7.34), after controlling for age, body mass index, smoking, Chinese herbal Medicine use, and irregular menstruation. Women's BLL was a significant predictor of the serum estradiol concentration also. These findings suggest an important role of very low BLL in the risk of infertility in women.