Mediating factors explain anxiety experienced by women with obesity during the Covid-19 pandemic

The Covid-19 pandemic could be a source of great anxiety, especially for those at higher risk, such as women experiencing obesity. The aim of this study was to measure how some personal characteristics such as BMI (from underweight to class 3 obesity), bariatric surgery (yes or no), comorbidities, or age (as antecedent variables), and mediating factors impacted state anxiety during the Covid-19 Pandemic. Mediating factors were related to subjective knowledge or attitudes (e.g. interest or beliefs and practices around Covid-19, subjective health perception, and confidence in the government). French women (N = 532) were invited to take part in a voluntary online health survey during lockdown in Paris and its suburbs. Results showed that women with higher BMI had higher anxiety scores, primarily because they feel less healthy than other people. Secondly, the larger the body size of the participants was (BMI), the less they reported that information about Covid-19 held their attention. This lack of interest resulted in feelings of anxiety not being generated. Thirdly, the larger their body size was, the less confidence they had in the effectiveness of the proposed measures by the government and therefore, the more anxious they were. Finally, older age predicted higher interest in the pandemic, higher subjective health, and higher confidence in the government. Identifying obesity as a potential risk factor for anxiety disorders is crucial, but measuring the relationship between state anxiety and personal characteristics (e.g. BMI) requires considering mediating variables (e.g. subjective health perception). To reduce anxiety in women with obesity, it appears necessary to focus on psychological programs that can help them improve their perception of their health, as well as the confidence they may have in institutions, especially for younger women

Women with obesity are not as curvy as they think: consequences on their everyday life behavior

Two studies explore the impact of body size on daily life activities of women with obesity. In the first study, ethnographic techniques (first-person perspective video recordings) and subsequent interviews based on the video recordings were used. Results showed atypical behavior of women with obesity and ex-obese women related to memories of embarrassing experiences regarding personal body size (sitting, passing doors sideways, over-careful navigation in public space, and choosing clothes sizes too large.) Women with obesity seem to behave as if they thought they had a larger body than it actually was. These atypical behaviors are related to memories of embarrassing experiences regarding personal body size and stigma. Overweight women exhibit the same behavior but to a lesser and less systematic degree. In the second study, the represented (imagined) body size was compared to the perceived (in a mirror) body size with digital morphing techniques. In the mirror condition, the perceived image is accurate, while in the absence of a mirror women with obesity overestimate their body size by about 30%. Moreover, overestimation of imagined body size increased according to the weight status. Finally, women who had bariatric surgery had poorer estimates than women who had not. This would result of being continuously reminded of obesity and its stigma by daily embarrassing experiences, by being confronted with an environment designed for normal weight (e.g., narrow seats, turnstiles etc.) that makes obesity salient. We suggest that body size overestimation is a case of accentuation where things that matter are perceived bigger. These results could also been explained by the allocentric lock theory

Gallbladder duplication with Gallstone migration. A case report and literature review

Congenital gallbladder anomalies and variations in their anatomical position are associated with an increased risk of complications after laparoscopic cholecystectomy. A 28-year-old female patient with no previous medical history, presented to the emergency department with complaints of epigastric pain, radiating to the back, associated with constipation, and progressively increasing in intensity over 5 days. No gallstones were visualized in the distal CBD. Neither any pancreatic mass, nor dilation of the main pancreatic duct was identified. A voluminous gallstone of 20 mm in the gallbladder and multiple microlithiasis in the gallbladder neck were identified. The diagnosis of symptomatic cholelithiasis with gallstone migration was retained, and the decision was taken to hospitalize the patient in order to institute symptomatic treatment and to carry out further investigations to explore the etiology of the CBD dilatation. On MRCP the presence of a congenitally folded gallbladder, containing gallstones was confirmed. The decision was made to operate on the patient one month later by laparoscopy. A laparoscopic cholecystectomy was performed one month later, on an outpatient basis. The surgery was carried out without any difficulty, and Calot’s triangle was dissected relatively easily.Wrodzone anomalie i odmiany anatomiczne pęcherzyka żółciowego są elementem ryzyka powikłań podczas cholecystektomii laparoskopowej. Do SOR została przyjęta 28-letnia pacjentka bez wcześniejszego wywiadu, skarżąca się na bóle w nadbrzuszu promieniujące do pleców połączone z zaparciami, nasilające się w ciągu 5 dni. Nie stwierdzono kamicy w dystalnej części przewodu żółciowego wspólnego (PŻW). Nie stwierdzono również zmian guzowatych w trzustce ani poszerzenia przewodu trzustkowego. Stwierdzono natomiast duży, 20 mm kamień w pęcherzyku oraz drobną kamicę w szyi pęcherzyka. Postawiono rozpoznanie objawowej kamicy pęcherzyka żółciowego z migracją kamienia i podjęto decyzję o hospitalizacji i leczeniu objawowym w celu poszerzenia diagnostyki poszerzenia PŻW. W badaniu MRI dróg żółciowych stwierdzono wrodzoną duplikację pęcherzyka żółciowego. Chora została zakwalifikowana do planowej laparoskopowej cholecystektomii miesiąc póżniej w ramach pobytu jednodniowego. Zabieg przebiegł bez powikłań ze względnie prostym preparowaniem struktur trójkąta Calota

Laparoscopic ultrasound of the liver

Objective: despite recent advances in medical imaging, pre-operative evaluation of liver tumors, whether benign or malignant, is often lacking in accuracy and precision. With the development of surgical laparoscopy, the benefits of diagnostic laparoscopy have been combined with those of operative ultrasound. This article aims to describe the technique of laparoscopic ultrasound of the liver, and to define its applications and the role of its association with diagnostic laparoscopy in the localization and assessment for resectability of liver tumors. Methods: after an initial visual inspection with the laparoscope, laparoscopic ultrasound is utilized to further examine the liver. This relies largely on recognition of branches of the portal vein and tributaries of the hepatic veins. During this procedure, the hepatic parenchyma is also examined. Minimal displacement of the transducer, using clockwise and anti-clockwise rotatory movements, allows a full exploration of the liver. Results: the combination of visual with sonographic laparoscopy allows accurate localization of benign and malignant hepatic tumors, as well as ultrasound-guided biopsies of these. Laparoscopic ultrasound can detect small lesions previously unseen by pre-operative imaging techniques. The relationship of tumors to adjacent blood vessels can be defined. Portal vein thrombosis can be diagnosed. Conclusion: curability and liver tumor resectability can be determined and the appropriate surgical treatment thus planned

Outcome of Leaks After Sleeve Gastrectomy Based on a New Algorithm Addressing Leak Size and Gastric Stenosis

Text We welcomed with great interest the masterpiece of Nedelcu et al. Moreover, we believe in the importance of introducing a well-defined algorithm in order to standardize the endoscopic treatment modality for leak following bariatric surgery. However, according to our experience, we have some remarks to do. Here, we report a case of a 59-year-old woman, presenting an early fistula [3] following laparoscopic sleeve gastrectomy. At day 12 after surgery, she underwent reoperation for peritonitis with lavage and drainage of peritoneal cavity, and two peri-gastric surgical drainage were left in place. No primary repair was attempted due to severe local tissue inflammation. Endoscopy showed a 2-cm-long dehiscence, of the last staple fire line, allowing passing through with the scope. Swallow study through the scope showed the persistence of intra-abdominal collection in the left hypochondrium and the presence of a left bronchial tree fistula Electronic supplementary material The online version of this articl

Comparaison de l'echolaparoscopie et de la cholangiographie lors des cholecystectomies laparoscopiques

Aim - Prospective evaluation of the results of laparoscopic ultrasound and cholangiography to investigate choledocholithiasis and detect variations in biliary anatomy during laparoscopic cholecystectomies. Methods - The biliary trees of 600 patients who underwent laparoscopic cholecystectomy were routinely explored by laparoscopic ultrasound and cholangiography. Results - Laparoscopic ultrasound was performed in all 600 cases. Cholangiography was perFormed in 498 (83%). Laparoscopic ultrasound required less time than cholangiography: 10.2 minutes versus 17. 9 minutes (p=0.0001). Common bile duct stones were detected intraoperatively in 40 cases (7%). Both methods were equally effective. The sensitivity of laparoscopic ultrasound was 80% and its specificity 99%. For cholangiography these values were 75% and 98%; respectively. For laparoscopic ultrasound, false positives and False negatives were noted in the First 45 cases of individual trainees. Nevertheless, cholangiography showed 30 anatomical anomalies and laparoscopic ultrasound only 15. Conclusion - Laparoscopic ultrasound can be performed rapidly and in all cases. Results are comparable to cholangiography in the detection of common duct stones. Individual training is necessary to optimize efficacy. Anatomical anomalies are often missed

Comparaison de l'echolaparoscopie et de la cholangiographie\ud lors des cholecystectomies laparoscopiques

Aim - Prospective evaluation of the results of laparoscopic ultrasound and cholangiography to investigate choledocholithiasis and detect variations in biliary anatomy during laparoscopic cholecystectomies.\ud \ud Methods - The biliary trees of 600 patients who underwent laparoscopic cholecystectomy were routinely explored by laparoscopic ultrasound and cholangiography.\ud \ud Results - Laparoscopic ultrasound was performed in all 600 cases. Cholangiography was perFormed in 498 (83%). Laparoscopic ultrasound required less time than cholangiography: 10.2 minutes versus 17. 9 minutes (p=0.0001). Common bile duct stones were detected intraoperatively in 40 cases (7%). Both methods were equally effective. The sensitivity of laparoscopic ultrasound was 80% and its specificity 99%. For cholangiography these values were 75% and 98%; respectively. For laparoscopic ultrasound, false positives\ud and False negatives were noted in the First 45 cases of individual trainees. Nevertheless, cholangiography showed 30 anatomical anomalies and laparoscopic ultrasound only 15.\ud Conclusion - Laparoscopic ultrasound can be performed rapidly and in all cases. Results are comparable to cholangiography in the detection of common duct stones. Individual training is necessary to optimize efficacy. Anatomical anomalies are often missed