Suction-assisted lipectomy fails to improve cardiovascular metabolic markers of disease: a meta-analysis.

BACKGROUND: The purpose of this study was to determine whether suction-assisted lipectomy (SAL) decreases the incidence of early cardiovascular disease risk factors or its biochemical and clinical risk indicators. METHODS: A systematic review of the literature was performed by conducting a predefined, sensitive search in MEDLINE without limiting the year of publication or language. The extracted data included the basal characteristics of the patients, the surgical technique, the amount of fat extracted, the cardiovascular risk factors and the biochemical and clinical markers monitored over time. The data were analysed using pooled curves, risk ratios and standardised means with meta-analytical techniques. RESULTS: Fifteen studies were identified involving 357 patients. In all of the studies, measurements of predefined variables were recorded before and after the SAL procedure. The median follow-up was 3 months (interquartile range (IQR) 1-6, range 0.5-10.5). The mean amount of extracted fat ranged from 2063 to 16,300 ml, with a mean ± standard deviation (SD) of 6138 ± 4735 ml. After adjusting for time and body mass index (BMI), leptin and fasting insulin were the only markers that were significantly associated with the amount of aspirated fat. No associations were observed for high sensitive C-reactive protein (hCRP), interleukin-6 (IL-6), adiponectin, resistin, tumour necrosis factor-α (TNF-α), Homeostasis Model of Assessment (HOMA), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, free fatty acids or systolic blood pressure. CONCLUSIONS: Based on the results of our analysis, we conclude that there is no evidence to support the hypothesis that subcutaneous fat removal reduces early cardiovascular or metabolic disease, its markers or its risk factors.

Near-optimal glycemic control in Chilean women with pregestational type-2 diabetes: persistent macrosomia relates to maternal pre-pregnancy overweight.

UNLABELLED: After a 10-year program intending to improve glycemic control in diabetic pregnancies, we evaluated whether factors underlying macrosomia are similar for type-1 and -2 pregestational diabetic women. PATIENTS AND METHODS: Twenty-three pregnancies in type-1 diabetics (PDM1, age 28.3+/-1.1 years) and 51 pregnancies in type-2 diabetics (PDM2, age 32.8+/-0.6 years) were followed and treated with intensified insulin therapy. Several factors potentially influencing macrosomia were evaluated. STATISTICS: chi-square, Fisher's exact, Student's "t" and Mann-Whitney "U" tests, and ROC analysis. RESULTS: In PDM1 and PDM2, respectively, large-for-gestational-age (LGA) frequencies were 26.08% and 37.25% (NS), antepartum HbA1c values were 6.5+/-0.32 and 6.1+/-0.16 (NS), and pre-pregnancy body mass indexes (BMI) were 23.03+/-0.66 and 30.01+/-0.89 (p<0.0001). In PDM1 the main predictor of LGA was an antepartum HbA1c> or =6.8% (p=0.046), whereas in PDM2 pregestational BMI> or =24 the variable associated (p=0.032) with LGA newborns. CONCLUSIONS: PDM1 and PDM2 differ in the underlying factors related to macrosomia. Whereas in PDM1 the antepartum HbA1c emerged as the most significant variable, suggesting that glycemic control largely determines macrosomia, in PDM2 with near-optimal glycemic control, macrosomia related to pregestational BMI.

Evaluación de la terapia de reemplazo hormonal en usuarias del programa climaterio a nivel de atención primaria, Antofagasta, 2002 / Evaluation of hormone replacement therapy in users of the climacteric program at the basic treatment level, Antofagasta, 2002

The benefits of hormone replacement therapy (HRT) have been widely demonstrated, and in theory, all climacteric women should receive it, except for those who demonstrate absolute contraindications. A study was made of 83 active users of HRT in the Climacteric Subprogram at a primary Treatment Clinic at Antofagasta. The average age of this group was 56 years, with an average age at menopause of 47 years and initiation of HRT treatment of 50 years. The range of time of therapy was from 3 to 5 years. Farlupost (37 percent) and Killios (24 percent) were the types of hormonal treatment most utilized. A rate of 92 percent of physiological menopause was observed, and predominant pretherapy symptoms included fluhing (42 percent), bone pain (18 percent), and headache (18 percent). With development of therapy, 72.3 percent reported being asymptomatic, and the remainig individuals had bone pain (35 percent), flushing (31 percent), headache (13 percent), sweating (13 percent), and insomnia (8 percent). A total of 94 percent would not elect to suspend the HRT for fear of reappearance of symptoms, with the only cause for abandoning the treatment being bleeding. During the study, 67.4 percent took supplementary calcium and 39 percent carried out physical exercise, primmarily walking. Improvement in family relations was cited by 43.4 percent, improved self esteem in 54.2 percent and sexual improvement in 37.3 percent.

Están ampliamente demostrados los beneficios de la terapia de reemplazo hormonal (TRH) y, en teoría, todas las mujeres climatéricas deberían recibirla, a menos que presenten contraindicaciones absolutas. Se estudió a 83 usuarias activas con terapia de reemplazo hormonal (TRH) del Subprograma Climaterio en un Consultorio de Atención Primaria de Antofagasta. El promedio de edad actual en este grupo de 56 años, con edad media de menopausia de 47 años e inicio de TRH de 50 años. El rango de tiempo de terapia fue de 3 a 5 años. Farlupost (37 percent) y Killios (24 por ciento) fueron los tipos de terapia hormonal más utilizados. Se constató un 92 por ciento de menopausia fisiológica y la sintomatología predominante preterapia fue bochornos (42 por ciento), dolor óseo (18 por ciento) y cefalea (18 por ciento). En la evolución con terapia el 72,3 por ciento refirió encontrarse asintomática, mientras que persistieron dolor óseo (35 por ciento), bochornos (31 por ciento), cefalea (13 por ciento), sudoración (13 por ciento) e insomnio (8 por ciento). Un 94 por ciento no suspendería la TRH temiendo la reaparición de síntomas y la única causal de abandono aludida fue el sangramiento. Al momento del estudio el 67,4 por ciento toma suplemento de calcio y un 39,7 por ciento realiza actividad física, principalmente caminata. Se asoció mejoría en el ámbito familiar en un 43,4 por ciento, autoestima en 54,2 por ciento y sexual en 37,3 por ciento.