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1.
Medicine (Baltimore) ; 99(19): e19823, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384427

RESUMEN

BACKGROUND/AIM: Obesity is associated with increased incidence of gastroesophageal reflux disease (GERD), and it has been suggested that GERD symptoms may be improved by weight reduction. However, various patterns of bariatric surgery may affect symptoms of GERD due to the changed anatomy of stomach and esophagus. The aim of this systematic review and meta-analysis is to analyze the effect of bariatric surgery on GERD. MATERIALS AND METHODS: A systematic literature search was performed using PubMed, EMBASE, and the Cochrane Library from January 2005 to January 2019, combining the words obesity, gastroesophageal reflux with different types of bariatric surgery and weight loss. The methodological quality of randomized controlled trials and non-randomized controlled trials published in English and have at least 1-year follow-up data were included and assessed by Cochrane Collaboration's tool for assessing risk bias and Newcastle-Ottawa scale. Only clinical trials were included, and case series or case reports were excluded. RESULTS: We anticipate that our review will provide the exact estimates of the burden and phenotype of GERD among patients that have undergone bariatric surgery. CONCLUSION: GERD may improve in obese patients who underwent laparoscopic sleeve gastrectomy (LSG); however, the most favorable effect is likely to be found after Roux-en-Y gastric bypass surgery. PROSPERO REGISTRATION NUMBER: CRD42018090074.


Asunto(s)
Cirugía Bariátrica , Reflujo Gastroesofágico/cirugía , Obesidad Mórbida/cirugía , Reflujo Gastroesofágico/etiología , Reflujo Gastroesofágico/fisiopatología , Humanos , Metaanálisis como Asunto , Obesidad Mórbida/complicaciones , Obesidad Mórbida/fisiopatología , Periodo Posoperatorio , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento , Pérdida de Peso/fisiología
4.
Transplant Proc ; 52(1): 276-283, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31889539

RESUMEN

BACKGROUND: Obesity is a major public health burden that affects the transplant community because of its key role in fatty liver disease and transplantation outcomes. OBJECTIVES: To evaluate the role of sleeve gastrectomy in treating recurrent and de novo nonalcoholic fatty liver disease (NAFLD) in liver transplant recipients. SETTING: A university hospital. METHODS: We describe 2 obese liver transplant recipients with recurrent and de novo NAFLD who underwent minimally invasive metabolic and bariatric surgery. RESULTS: The surgery was performed successfully, with much of the operative time consumed by enterolysis. There were no intraoperative or postoperative complications. At last follow-up appointment (16 months postoperatively), there was a mean reduction in weight (31.98 kg), body mass index (10.2 kg/m2), glycosylated hemoglobin (1.05%), alanine aminotransferase (38 IU/L), steatosis score (0.34), and fibrosis score (0.05). The mean decrease in 6-month postoperative hepatic fat quantification was 6%. CONCLUSIONS: These cases show that metabolic and bariatric surgery in obese, posttransplant recipients with recurrent and de novo nonalcoholic steatohepatitis lead to improved steatosis and reduced obesity and obesity-associated comorbidities.


Asunto(s)
Cirugía Bariátrica/métodos , Gastrectomía/métodos , Trasplante de Hígado , Enfermedad del Hígado Graso no Alcohólico/cirugía , Obesidad Mórbida/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Obesidad Mórbida/complicaciones , Complicaciones Posoperatorias/cirugía , Receptores de Trasplantes
5.
Ann R Coll Surg Engl ; 102(1): e7-e11, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31530171

RESUMEN

Ehlers-Danlos syndrome is a hereditary connective tissue disorder that has gastrointestinal manifestations in over 50% of its cases. We present the first case of bariatric surgery in a patient with Ehlers-Danlos syndrome and outline management challenges in the context of the relevant literature. A 56-year-old man with type IV Ehlers-Danlos syndrome and a body mass index of 41.8 kg/m2 was referred to the bariatric centre of the Churchill Hospital, Oxford, for consideration of surgery for morbid obesity. His comorbidity included type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea. He underwent a laparoscopic Roux-en-Y gastric bypass. His initial recovery was uneventful and he was discharged on the first postoperative day. Six weeks later, he presented with 43.9% excess weight loss and improved glycaemic control. Three months postoperatively, however, he complained of dysphagia, regurgitation and postprandial pain. A barium meal and gastroscopy suggested the presence of a gastric diverticulum. A surgical exploration was planned. Intraoperative gastroscopy demonstrated an asymmetrical gastric pouch dilatation and the pouch was therefore refashioned laparoscopically. Despite the initial symptomatic relief, two months later he experienced retrosternal pain with progressive dysphagia. Since then, multiple endoscopic dilatations of the gastro-oesophageal junction have been performed for recurrence of symptoms. Finally, a laparoscopic hiatus hernia repair and adhesiolysis was performed resulting in complete relief of patient's symptoms. Bariatric management of patients with Ehlers-Danlos syndrome can prove challenging. The bariatric team must implement a careful management plan including a detailed consent process, a tailored surgical intervention and a follow-up focused on potential gastrointestinal manifestations.


Asunto(s)
Síndrome de Ehlers-Danlos/complicaciones , Obesidad Mórbida/cirugía , Trastornos de Deglución/etiología , Diabetes Mellitus Tipo 2/complicaciones , Endoscopía del Sistema Digestivo/métodos , Derivación Gástrica/métodos , Hernia Hiatal/diagnóstico , Hernia Hiatal/etiología , Hernia Hiatal/cirugía , Herniorrafia/métodos , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación
6.
J Laparoendosc Adv Surg Tech A ; 30(1): 12-19, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31855106

RESUMEN

Background and Aims: Laparoscopic sleeve gastrectomy (LSG) among older obese subjects (>60 years of age) has recently gained popularity because of the population aging. We performed a meta-analysis to clarify whether elderly patients undergoing this procedure have an increased complications risk. Methods: A literature search aiming at outcomes of LSG in elderly patients throughout Cochrane Library, Embase, Google Scholar, Medline, and Scopus databases was performed from inception until June 2019. Primary endpoints consisted of mortality and overall complications. Secondary endpoints comprised excess weight loss percentage (%EWL), remission, or postoperative improvement of several comorbidities (type-2 diabetes [T2DM], hypertension, dyslipidemia, and obstructive sleep apnea [OSA]). Heterogeneity between the studies was assessed by I2 test and random effects model for the comparative analysis. Mean difference (MD) and relative risk (RR) were used to report the results. Results: Eleven studies involving 2259 patients were scrutinized for this study. Overall complications rates did not significantly differ among younger and elderly patients undergoing LSG (RR: 1.71; 95% CI [confidence interval]: 0.76-3.83; P = .19). %EWL was superior among younger patients (MD: -7.63; 95% CI: -13.19 - 2.08; P = .007) while there were no significant differences in remission of T2DM, hypertension, and hyperlipidemia between the age groups (RR: 1.04; 95% CI: 0.83-1.31; P = .72; RR: 1.00; 95% CI: 0.84-1.18; P = .96; RR: 1.05; 95% CI: 0.79-1.38; P = .76). Younger patients exhibited a significantly higher OSA remission/improvement rate (RR: 0.81; 95% CI: 0.69-0.95; P = .001). Conclusion: LSG is a reliable bariatric method that is also safe in elderly patients with similar overall morbidity and similar obesity-related comorbidity resolution rates than younger ones, although weight loss outcomes were inferior.


Asunto(s)
Gastrectomía/efectos adversos , Obesidad Mórbida/cirugía , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Gastrectomía/métodos , Gastrectomía/mortalidad , Humanos , Hiperlipidemias/complicaciones , Hipertensión/complicaciones , Laparoscopía/métodos , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Apnea Obstructiva del Sueño/complicaciones , Pérdida de Peso
7.
Arq Bras Cir Dig ; 32(3): e1458, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31826085

RESUMEN

BACKGROUND: Obesity and its surgical treatment have been related with oral diseases. Aim: To evaluate and compare dental wear and dental loss in eutrophic and morbidly obese patients submitted to Roux-en-Y gastric bypass. METHOD: Observational and analytical study with gender and age matching. The sample consisted of 240 patients, divided into four groups: eutrophic (GC=60), morbidly obese (GO=60), operated with up to 24 months (G24=60) and operated on for more than 36 months (G36=60). The following variables were analyzed: race, schooling, economic class, hypertension, diabetes, triglycerides, cholesterol, BMI, weight loss, waist-hip ratio, smoking, alcoholism, tooth loss and tooth wear. RESULTS: GO presented lower economic class (p=0.012), hypertension (p<0.001), diabetes (p<0.001), cholesterol (p=0.001), BMI (p<0.001), waist-hip ratio (p<0.001) and percentage of weight loss percent (p<0.001) than groups G24 and G36. Dental wear was higher among the II and V sextants. CONCLUSION: Individuals submitted to Roux-en-Y gastric bypass, regardless of the surgery period, presented more dental wear on the incisal/occlusal surfaces, and the anterior teeth were the most affected. Dental wear was associated with age and number of missing teeth.


Asunto(s)
Derivación Gástrica/efectos adversos , Obesidad Mórbida/complicaciones , Obesidad Mórbida/cirugía , Pérdida de Diente/etiología , Estudios Transversales , Femenino , Humanos , Masculino
8.
Arq Bras Cir Dig ; 32(4): e1482, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31859934

RESUMEN

BACKGROUND: Obesity represents a growing threat to population health all over the world. Laparoscopic sleeve gastrectomy induces alteration of the esophagogastric angle due to surgery itself, hypotony of the lower esophageal sphincter after division of muscular sling fibers, decrease of the gastric volume and, consequently, increase of intragastric pressure; that's why some patients have reflux after sleeve. AIM: To describe a technique and preliminary results of sleeve gastrectomy with a Nissen fundoplication, in order to decrease reflux after sleeve. METHOD: In the current article we describe the technique step by step mostly focused on the creation of the wrap and it care. RESULTS: This procedure was applied in a case of 45 BMI female of 53 years old, with GERD. An endoscopy was done demonstrating a hiatal hernia, and five benign polyps. A Nissen sleeve was performed due to its GERD, hiatal hernia and multiple polyps on the stomach. She tolerated well the procedure and was discharged home uneventfully 48 h after. CONCLUSION: N-sleeve is a feasible and safe alternative in obese patients with reflux and hiatal hernia when Roux-en-Y gastric bypass it is not indicated.


Asunto(s)
Gastrectomía/métodos , Reflujo Gastroesofágico/cirugía , Hernia Hiatal/cirugía , Obesidad Mórbida/cirugía , Femenino , Fundoplicación , Reflujo Gastroesofágico/etiología , Hernia Hiatal/etiología , Humanos , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
10.
Am J Case Rep ; 20: 1492-1496, 2019 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-31597909

RESUMEN

BACKGROUND First described in 1863 by French surgeon Victor-Auguste-François Morel-Lavallee, the Morel-Lavallee lesion (MLL) is a closed traumatic soft-tissue degloving injury. These lesions most commonly occur following motor vehicle collisions (MVCs). The pathophysiology stems from a shearing force that causes separation of the soft tissue from the fascia underneath, which disrupts the vasculature and lymphatic vessels that perforate between the tissue layers. Timely diagnosis and treatment are imperative, as a delayed diagnosis can lead to complications. However, at present there is no universally accepted treatment algorithm. CASE REPORT A 60-year-old morbidly obese woman presented after being involved in an MVC. She complained of abdominal tenderness in the right lower quadrant, with no evidence of peritonitis. Cross-sectional imaging revealed hemoperitoneum and a traumatic posterior abdominal wall/lumbar hernia on the right, with multiple contusions in the subcutaneous abdomen. The patient was taken to the operating room and underwent an exploratory laparotomy that revealed a large abdominal Morel-Lavallee lesion (MLL) along with a traumatic abdominal wall hernia (TAWH). There was also a mesenteric avulsion injury with an associated ileocecal injury. The patient underwent resection of the involved bowel, with primary anastomosis, debridement of the abdominal wall degloving injury, and expectant management for the hernia defect. She recovered from the injuries and was doing well when followed up in the clinic, with follow-up to repair the hernia in the near future. CONCLUSIONS More research is needed to provide surgeons with evidence-based standardized therapies for dealing with these rare pathologies to ensure optimal patient outcomes.


Asunto(s)
Traumatismos Abdominales/etiología , Accidentes de Tránsito , Lesiones por Desenguantamiento/etiología , Hernia Ventral/etiología , Traumatismos Abdominales/diagnóstico por imagen , Lesiones por Desenguantamiento/diagnóstico por imagen , Femenino , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/etiología , Hernia Ventral/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Tomografía Computarizada por Rayos X
11.
Thorac Surg Clin ; 29(4): 379-386, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31564394

RESUMEN

Gastroesophageal reflux disease (GERD) is common in the morbidly obese population, and hiatal hernias are encountered in 20% to 52% of patients. Primary surgical repair of hiatal hernias, in particular the paraesophageal type, is associated with a higher recurrence rate in obese patients. Concomitant weight loss surgery may be advisable. Combined sleeve gastrectomy and paraesophageal hiatal hernia repair is feasible but can induce or worsen preexisting GERD. A Roux-en-Y gastric bypass offers advantages of more pronounced excess weight loss and better symptom control, albeit with a potentially higher rate of morbidity compared with paraesophageal hernia repair alone or sleeve gastrectomy.


Asunto(s)
Cirugía Bariátrica/métodos , Reflujo Gastroesofágico/cirugía , Hernia Hiatal/cirugía , Herniorrafia/métodos , Obesidad Mórbida/cirugía , Gastrectomía/efectos adversos , Derivación Gástrica , Hernia Hiatal/complicaciones , Humanos , Laparoscopía , Obesidad Mórbida/complicaciones , Recurrencia , Estudios Retrospectivos , Pérdida de Peso
12.
Anesth Analg ; 129(4): 1130-1136, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31584919

RESUMEN

BACKGROUND: Morbidly obese patients undergoing general anesthesia are at risk of hypoxemia during anesthesia induction. High-flow nasal oxygenation use during anesthesia induction prolongs safe apnea time in nonobese surgical patients. The primary objective of our study was to compare safe apnea time, between patients given high-flow nasal oxygenation or conventional facemask oxygenation during anesthesia induction, in morbidly obese surgical patients. METHODS: Research ethics board approval was obtained. Elective surgical patients ≥18 years with body mass index ≥40 kg·m were included. Patients with severe comorbidity, gastric reflux disease, known difficult airway, or nasal obstruction were excluded. After obtaining informed consent patients were randomized. In the intervention (high-flow nasal oxygenation) group, preoxygenation was provided by 100% nasal oxygen for 3 minutes at 40 L·minute; in the control group, preoxygenation was delivered using a facemask with 100% oxygen, targeting end-tidal O2 >85%. Anesthesia was induced with propofol, remifentanil, and rocuronium. Bag-mask ventilation was not performed. At 2 minutes after rocuronium, videolaryngoscopy was performed. If the laryngoscopy grade was I or II, laryngoscope was left in place and the study was continued; if grade III or IV was observed, the patient was excluded from the study. During the apnea period, high-flow nasal oxygenation patients received nasal oxygen at 60 L·minute; control group patients received no supplemental oxygen. The primary outcome, safe apnea time, was reached when oxygen saturation measured by pulse oximetry (SpO2) fell to 95% or maximum 6 minutes of apnea. The patient was then intubated. T tests and χ analyses were used to compare groups. P < .05 was considered significant. RESULTS: Forty patients completed the study. Baseline parameters were comparable between groups. Safe apnea time was significantly longer (261.4 ± 77.7 vs 185.5 ± 52.9 seconds; mean difference [95% CI], 75.9 [33.3-118.5]; P = .001) and the minimum peri-intubation SpO2 was higher (91.0 ± 3.5 vs 88.0 ± 4.8; mean difference [95% CI], 3.1 [0.4-5.7]; P = .026) in the high-flow nasal oxygenation group compared to the control group. CONCLUSIONS: High-flow nasal oxygenation, compared to conventional oxygenation, provided a longer safe apnea time by 76 seconds (40%) and higher minimum SpO2 in morbidly obese patients during anesthesia induction. High-flow oxygenation use should be considered in morbidly obese surgical patients.


Asunto(s)
Anestesia General , Apnea/fisiopatología , Hipoxia/prevención & control , Obesidad Mórbida/fisiopatología , Terapia por Inhalación de Oxígeno , Oxígeno/sangre , Administración Intranasal , Adulto , Anestesia General/efectos adversos , Apnea/sangre , Biomarcadores/sangre , Índice de Masa Corporal , Femenino , Humanos , Hipoxia/sangre , Hipoxia/etiología , Hipoxia/fisiopatología , Intubación Intratraqueal/efectos adversos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/sangre , Obesidad Mórbida/complicaciones , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
13.
Am Surg ; 85(10): 1108-1112, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657304

RESUMEN

In patients undergoing bariatric surgery, the presence of metabolic syndrome (MetS) contributes to perioperative morbidity. We aimed to evaluate the utilization and outcome of severely obese patients with MetS who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB). Using the 2015 and 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, data were obtained for patients with MetS undergoing LSG or LRYGB. There were 29,588 MetS patients (LSG: 58.7% vs LRYGB: 41.3%). There was no significant difference in 30-day mortality (0.1% for LSG vs 0.2% for LRYGB, adjusted odds ratio (AOR) 0.58, confidence interval (CI) 0.32-1.05, P = 0.07) or length of stay between groups (2 ± 2 for LSG vs 2.2 ± 2 days for LRYGB, P = 0.40). Compared with LRYGB, LSG was associated with significantly shorter operative time (78 ± 39 vs 122 ± 54 minutes, P < 0.01), lower overall morbidity (2.3% vs 4.4%, AOR 0.53, CI 0.46-0.60, P < 0.01), lower serious morbidity (1.5% vs 2.3%, AOR 0.64, CI 0.53-0.76, P < 0.01), lower 30-day reoperation (1.2% vs 2.3%, AOR 0.52, CI 0.43-0.63, P < 0.01), and lower 30-day readmission (4.2% vs 6.6%, AOR 0.62, CI 0.55-0.69, P < 0.01). In conclusion, LSG is the predominant operation being performed for severely obese patients with MetS, and its popularity may in part be related to its improved perioperative safety profile.


Asunto(s)
Gastrectomía/métodos , Derivación Gástrica/métodos , Síndrome Metabólico/cirugía , Obesidad Mórbida/cirugía , Intervalos de Confianza , Bases de Datos Factuales , Femenino , Gastrectomía/efectos adversos , Gastrectomía/mortalidad , Derivación Gástrica/efectos adversos , Derivación Gástrica/mortalidad , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Oportunidad Relativa , Tempo Operativo , Complicaciones Posoperatorias , Análisis de Regresión , Reoperación/estadística & datos numéricos
14.
BMC Health Serv Res ; 19(1): 748, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31651309

RESUMEN

BACKGROUND: Despite the growing evidence base supporting intensive lifestyle and medical treatments for severe obesity, patient engagement in specialist obesity services is difficult to achieve and poorly understood. To address this knowledge gap, we aimed to develop a model for predicting non-completion of a specialist multidisciplinary service for clinically severe obesity, termed the Metabolic Rehabilitation Programme (MRP). METHOD: Using a case-control study design in a public hospital setting, we extracted data from medical records for all eligible patients with a body mass index (BMI) of ≥35 kg/m2 with either type 2 diabetes or fatty liver disease referred to the MRP from 2010 through 2015. Non-completion status (case definition) was coded for patients whom started but dropped-out of the MRP within 12 months. Using multivariable logistic regression, we tested the following baseline predictors hypothesised in previous research: age, gender, BMI, waist circumference, residential distance from the clinic, blood pressure, obstructive sleep apnoea (OSA), current continuous positive airway pressure (CPAP) therapy, current depression/anxiety, diabetes status, and medications. We used receiver operating characteristics and area under the curve to test the performance of models. RESULTS: Out of the 219 eligible patient records, 78 (35.6%) non-completion cases were identified. Significant differences between non-completers versus completers were: age (47.1 versus 54.5 years, p < 0.001); residential distance from the clinic (21.8 versus 17.1 km, p = 0.018); obstructive sleep apnoea (OSA) (42.9% versus 56.7%, p = 0.050) and CPAP therapy (11.7% versus 28.4%, p = 0.005). The probability of non-completion could be independently associated with age, residential distance, and either OSA or CPAP. There was no statistically significant difference in performance between the alternate models (69.5% versus 66.4%, p = 0.57). CONCLUSIONS: Non-completion of intensive specialist obesity management services is most common among younger patients, with fewer complex care needs, and those living further away from the clinic. Clinicians should be aware of these potential risk factors for dropping out early when managing outpatients with severe obesity, whereas policy makers might consider strategies for increasing access to specialist obesity management services.


Asunto(s)
Manejo de la Obesidad/estadística & datos numéricos , Obesidad Mórbida/terapia , Cooperación del Paciente/estadística & datos numéricos , Ansiedad/etiología , Presión Sanguínea/fisiología , Índice de Masa Corporal , Estudios de Casos y Controles , Presión de las Vías Aéreas Positiva Contínua , Depresión/etiología , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Hospitalización/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Obesidad Mórbida/psicología , Factores de Riesgo , Apnea Obstructiva del Sueño/complicaciones
15.
Am Surg ; 85(8): 923-926, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31560313

RESUMEN

The extended focused assessment with sonography for trauma (eFAST) ultrasound examination is an essential step in the initial assessment of trauma patients. Its accuracy depends on the ability to acquire high-quality ultrasound images, and we hypothesized that increasing BMI was associated with increased odds for incorrect eFAST. All adult blunt trauma activations at a high-volume urban trauma center in 2016 that underwent eFAST and CT chest, abdomen, and pelvis were included (n = 446). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the eFAST were calculated with CT results as reference. The association of BMI and eFAST accuracy was determined using univariate analyses. Sensitivity and specificity of the eFAST examination were 27.1 per cent and 91.7 per cent, respectively, with an overall 76.2 per cent accuracy. At BMI 36 kg/m², the odds of having incorrect eFAST results increased to odds ratio (OR) = 1.85 (95% confidence interval, 1.03-3.32; P = 0.05). For those with BMI > 40 kg/m², the OR increased to OR = 3.12 (95% confidence interval, 1.45-6.69; P = 0.01). One-third of patients in this study were obese or morbidly obese. The latter was associated with increased odds for incorrect eFAST results, particularly the abdominal examination component.


Asunto(s)
Traumatismos Abdominales/diagnóstico por imagen , Obesidad Mórbida/complicaciones , Traumatismos Torácicos/diagnóstico por imagen , Heridas no Penetrantes/diagnóstico por imagen , Accidentes por Caídas , Accidentes de Tránsito , Adulto , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Sensibilidad y Especificidad , Centros Traumatológicos
16.
Ther Umsch ; 76(3): 133-137, 2019 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-31498050

RESUMEN

Metabolic surgery in patients with poorly controlled type 2 diabetes and low BMI Abstract. Bariatric surgery has been established as an efficient therapy for morbid obesity. Metabolic surgery represents the operative treatment of type 2 diabetes and other metabolic disorders. Metabolic surgery does not focus on weight loss, as many mechanisms, which are responsible for the improvement of the glycemic control are independent from weight loss. There are many studies, which show the efficient effect of metabolic surgery in diabetic patients with class II obesity. Furthermore, there is growing evidence, that metabolic surgery does also work in patients with a BMI below 35 kg / m2. Multiple surgical and endocrinological associations have endorsed these facts and adopted their guidelines. In obese type 2 diabetics with a BMI below 35 kg / m2 and a poor glycemic control metabolic surgery should be considered as a therapeutic option.


Asunto(s)
Cirugía Bariátrica , Diabetes Mellitus Tipo 2 , Obesidad Mórbida , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/cirugía , Humanos , Obesidad Mórbida/complicaciones , Obesidad Mórbida/cirugía , Pérdida de Peso
17.
J Bone Joint Surg Am ; 101(16): 1440-1450, 2019 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-31436651

RESUMEN

BACKGROUND: Many surgeons require or request weight loss among morbidly obese patients (those with a body mass index [BMI] of ≥40 kg/m) before undergoing total knee arthroplasty. We sought to determine how much weight reduction was necessary to improve operative time, length of stay, discharge to a facility, and physical function improvement. METHODS: Using a retrospective review of cohort data that were prospectively collected from 2011 to 2016 at 1 tertiary institution, we identified 203 patients who were morbidly obese at least 90 days before the surgical procedure and had their BMI measured again at the immediate preoperative visit. All heights and weights were clinically measured. We used logistic and linear regression models that adjusted for preoperative age, sex, year of the surgical procedure, bilateral status, physical function (Patient-Reported Outcomes Measurement Information System [PROMIS]-10 physical component score [PCS]), mental function (PROMIS-10 mental component score [MCS]), and the Charlson Comorbidity Index. RESULTS: Of the 203 patients in the study, 41% lost at least 5 pounds (2.27 kg) before the surgical procedure, 29% lost at least 10 pounds (4.54 kg), and 14% lost at least 20 pounds (9.07 kg). Among morbidly obese patients, losing 20 pounds before a total knee arthroplasty was associated with lower adjusted odds of discharge to a facility (odds ratio [OR], 0.28 [95% confidence interval (CI), 0.09 to 0.94]; p = 0.039), lower odds of extended length of stay of at least 4 days (OR, 0.24 [95% CI, 0.07 to 0.88]; p = 0.031), and an absolute shorter length of stay (mean difference, -0.87 day [95% CI, -1.39 to -0.36 days]; p = 0.001). There were no differences in operative time or PCS improvement. Losing 5 or 10 pounds was not associated with differences in any outcome. CONCLUSIONS: Losing at least 20 pounds before total knee arthroplasty was associated with shorter length of stay and lower odds of facility discharge for morbidly obese patients, even while most patients remained morbidly or severely obese. Although there were no differences in operative time or physical function improvement, this has considerable implications for patient burden and cost reduction. Patients and providers may want to focus on larger preoperative weight loss targets. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Índice de Masa Corporal , Obesidad Mórbida/complicaciones , Obesidad Mórbida/terapia , Aptitud Física , Pérdida de Peso , Anciano , Artroplastia de Reemplazo de Rodilla/efectos adversos , Estudios de Cohortes , Bases de Datos Factuales , Dieta Reductora/métodos , Ejercicio Físico/fisiología , Femenino , Humanos , Tiempo de Internación , Modelos Lineales , Masculino , Persona de Mediana Edad , Obesidad Mórbida/diagnóstico , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/métodos , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Centros de Atención Terciaria , Resultado del Tratamiento
18.
Nutr Metab Cardiovasc Dis ; 29(12): 1368-1381, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31383503

RESUMEN

BACKGROUND AND AIMS: Resistant training (RT) improves health markers in obesity, but its effects in morbid obesity are unknown. We aimed to determine the effects of a RT-program in preventing/attenuating the metabolic syndrome (MetS) in patients with morbid obesity. A second aim was to report the interindividual variability in terms of improvements in MetS markers and other related co-variables. METHODS AND RESULTS: Twenty-one adults with obesity or morbid obesity were divided into two groups based on body mass index (BMI): a control obesity (CO, n = 7, BMI ≥35 < 40.0 kg/m2) and a morbid obese group (MO, n = 14, BMI ≥40 kg/m2). Participants completed a 20-week RT-program (3 sessions/week, 4-8 exercise) using free weights. Participants were assessed for MetS markers (waist circumference, systolic and diastolic blood pressure [BP], fasting glucose, high-density lipoproteins, and triglycerides) and other co-variables (total cholesterol, low-density lipoprotein, one-maximum repetition of biceps curl, and handgrip strength, 6 min walking test). Significant reductions in MetS markers were observed in both CO and MO groups (P < 0.05 to P < 0.0001), but significant reductions in diastolic BP and increases in HDL-C were noted only in the MO group (P < 0.0001). Changes in waist circumference, and systolic and diastolic BP were significantly greater only in the MO group (P < 0.001), but the CO group presented a greater fasting glucose decreases (P < 0.0001). The prevalence of non-responders between CO and MO groups was similar in the MetS outcomes. CONCLUSIONS: RT promotes greater improvements in overall MetS outcomes waist circumference, BP, and plasma triglycerides in patients with morbid obesity than in obese peers, with no overall differences in the prevalence of non-responders. CLINICAL TRIAL NUMBER: NCT03921853 at www.clinicaltrials.gov.


Asunto(s)
Variación Biológica Individual , Síndrome Metabólico/prevención & control , Obesidad Mórbida/terapia , Entrenamiento de Resistencia , Pérdida de Peso , Adulto , Biomarcadores/sangre , Glucemia/metabolismo , Presión Sanguínea , Índice de Masa Corporal , Capacidad Cardiovascular , Chile , Tolerancia al Ejercicio , Femenino , Fuerza de la Mano , Humanos , Lípidos/sangre , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/etiología , Síndrome Metabólico/fisiopatología , Persona de Mediana Edad , Obesidad Mórbida/sangre , Obesidad Mórbida/complicaciones , Obesidad Mórbida/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Circunferencia de la Cintura
19.
BMJ Case Rep ; 12(8)2019 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-31444260

RESUMEN

A 57-year-old obese, diabetic woman, presented with 1 day history of purulent umbilical discharge. She was vitally stable and afebrile. Abdominal examination revealed a full abdomen with purulent discharge from the umbilicus, swelling with erythema and induration surrounding the umbilicus. Lab tests were normal. Initial impression was abdominal wall abscess. Ultrasound showed subcutaneous fluid collection. Non-contrast CT showed collection and abdominal wall defect at the umbilicus. On exploration of the abscess cavity, there were two defects (umbilical and supraumbilical) with appendix protruding through the umbilical defect and a part of a small bowel and omentum adherent to the other defect. Wash was given, bowel and omentum were released and appendectomy was performed. Histopathology showed mucinous cystadenoma with periappendicitis. We would like to highlight the rare occurrence of an appendiceal mucinous cystadenoma in such a clinical presentation.


Asunto(s)
Absceso Abdominal/diagnóstico , Neoplasias del Apéndice/diagnóstico , Cistoadenoma Mucinoso/diagnóstico , Hernia Umbilical/diagnóstico , Infecciones por Klebsiella/diagnóstico , Klebsiella pneumoniae/aislamiento & purificación , Absceso Abdominal/complicaciones , Absceso Abdominal/cirugía , Neoplasias del Apéndice/complicaciones , Neoplasias del Apéndice/cirugía , Cistoadenoma Mucinoso/complicaciones , Cistoadenoma Mucinoso/cirugía , Diabetes Mellitus Tipo 2/complicaciones , Diagnóstico Diferencial , Femenino , Hernia Umbilical/complicaciones , Hernia Umbilical/cirugía , Humanos , Infecciones por Klebsiella/complicaciones , Infecciones por Klebsiella/cirugía , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Ombligo/patología
20.
Bone Joint J ; 101-B(7_Supple_C): 28-32, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31256642

RESUMEN

AIMS: The aim of this study was to observe the implications of withholding total joint arthroplasty (TJA) in morbidly obese patients. PATIENTS AND METHODS: A total of 289 morbidly obese patients with end-stage osteoarthritis were prospectively followed. There were 218 women and 71 men, with a mean age of 56.3 years (26.7 to 79.1). At initial visit, patients were given information about the risks of TJA in the morbidly obese and were given referral information to a bariatric clinic. Patients were contacted at six, 12, 18, and 24 months from initial visit. RESULTS: The median body mass index (BMI) at initial visit was 46.9 kg/m2 (interquartile range (IQR) 44.6 to 51.3). A total of 82 patients (28.4%) refused to follow-up or answer phone surveys, and 149 of the remaining 207 (72.0%) did not have surgery. Initial median BMI of those 149 was 47.5 kg/m2 (IQR 44.6 to 52.5) and at last follow-up was 46.7 kg/m2 (IQR 43.4 to 51.2). Only 67 patients (23.2%) went to the bariatric clinic, of whom 14 (20.9%) had bariatric surgery. A total of 58 patients (20.1%) underwent TJA. For those 58, BMI at initial visit was 45.3 kg/m2 (IQR 43.7 to 47.2), and at surgery was 42.3 kg/m2 (IQR 38.1 to 46.5). Only 23 patients (39.7%) of those who had TJA successfully achieved BMI < 40 kg/m2 at surgery. CONCLUSION: Restricting TJA for morbidly obese patients does not incentivize weight loss prior to arthroplasty. Only 20.1% of patients ultimately underwent TJA and the majority of those remained morbidly obese. Better resources and coordinated care are required to optimize patients prior to surgery. Cite this article: Bone Joint J 2019;101-B(7 Supple C):28-32.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Obesidad Mórbida/complicaciones , Osteoartritis/cirugía , Pérdida de Peso/fisiología , Privación de Tratamiento , Adulto , Anciano , Cirugía Bariátrica , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Obesidad Mórbida/cirugía , Osteoartritis/complicaciones , Estudios Prospectivos
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