The effects of metformin therapy on BMI and biochemical markers among overweight children and adolescents [abstract]

Introduction: In the United States, overweight adolescents are likely to continue to gain weight over time and are more likely to become overweight adults. High rates of child and adolescent obesity leave physicians searching for ways to stop this trend. Methods: A retrospective study design was implemented to describe trends of obese adolescent patients who are prescribed metformin as part of treatment in the multidisciplinary adolescent obesity specialty clinic at the University of Missouri. Results: Of the 156 participants in this study, 55 (35%) were prescribed a variable dose of metformin, a drug commonly used for elevated insulin levels, at least once during their clinic visits. The majority of patients in this study (61%) had insulin levels that above 20, which defines hyperinsulinemia. In a chi-square analysis of the data, patients who were in higher BMI categories were more likely to have higher serum insulin levels (p=0.0285). In the analysis of the patients in the study over time, it was found that of the 131 patients who were seen for more than one visit, 111 (85%) of these patients had no increase in BMI. Discussion: The adolescent obesity clinic has shown to halt or reverse weight gain in most of the patients who came for more than one visit. While many factors, including counseling on lifestyle modification (diet and exercise), medication, and routine follow-up can be attributed to the patients' ability to stop weight gain, metformin appears to be a satisfactory adjuvant therapy in the clinical management of adolescent obesity, especially in patients with hyperinsulinemia

Use of preoperative embolization prior to Transplant nephrectomy

ABSTRACT Introduction After a failed transplant, management of a non-functional graft with pain or recurrent infections can be challenging. Transplant nephrectomy (TN) can be a morbid procedure with the potential for significant blood loss. Embolization of the renal artery alone has been proposed as a method of reducing complications from an in vivo failed kidney transplant. While this does yield less morbidity, it may not address an infected graft or refractory hematuria or rejection. We elected to begin preoperative embolization to assess if this would help decrease the blood loss and transfusion rate associated with TN. Materials and Methods We performed a retrospective analysis of all patients who underwent non-emergent TN at our institution. Patients who had functioning grafts that later failed were included in analysis. TN was performed for recurrent infections, pain or hematuria. We evaluated for blood loss (EBL) during TN, transfusion rate and length of hospital stay. Results A total of 16 patients were identified. Nine had preoperative embolization or no blood flow to the graft prior to TN. The remaining 7 did not have preoperative embolization. The shortest time from transplant to TN was 8 months and the longest 18 years with an average of 6.3 years. Average EBL for the embolized patients (ETN) was 143.9cc compared to 621.4cc in the non-embolized (NETN) group (p=0.041). Average number of units of blood transfused was 0.44 in the ETN with only 3/9 patients requiring transfusion. The NETN patients had average of 1.29 units transfused with 5/7 requiring transfusion. The length of stay was longer for the ETN (5.4 days) compared to 3.9 in the NETN. No intraoperative complications were seen in either group and only one patient had a postoperative ileus in the NETN. Conclusion Embolization prior to TN significantly decreases the EBL but does not significantly decrease transfusion rate. However, patients do require a significantly longer hospitalization with embolization due to the time needed for embolization. Larger studies are needed to determine if embolization before transplant nephrectomy reduces the transfusion rates and overall complications