778 research outputs found
Six Months of Balloon Treatment does Not Predict the Success of Gastric Banding
BACKGROUND: We studied whether weight loss by intragastric balloon would predict the outcome of subsequent gastric banding with regard to weight loss and BMI reduction. METHODS: A prospective cohort of patients with a body mass index (BMI)>40 kg/m(2) received an intragastric balloon for 6 months followed by laparoscopic adjustable gastric banding (LAGB). Successful balloon-induced weight loss was defined as > or =10% weight loss after 6 months. Successful surgical weight loss was defined as an additional 15% weight loss in the following 12 months. Patients were divided in group A, losing > or =10% of their initial weight with 6 months' balloon treatment, and group B, losing <10% of their initial weight. RESULTS: In 40 patients (32 female, 8 male; age 36.6 yr, range 26-54), the mean BMI decreased from 46.5 to 40.5 kg/m(2) (P <0.001) after 6 months of balloon treatment and to 35.2 kg/m(2) (P <0.001) 12 months after LAGB. Group A (25 patients) and group B (15 patients) had a significant difference in BMI decrease, 12.4 vs 9.0 kg/m(2) (P <0.05), after the total study duration of 18 months. However, there was no difference in BMI reduction (4.7 kg/m(2) vs 5.8 kg/m(2)) in the 12 months after LAGB. 6 patients in group A lost > or =10% of their starting weight during 6 months balloon treatment as well as > or =15% 12 months following LAGB. 6 patients in group B lost <10% of their starting weight after 6 months of BIB, but also lost > or =15% 12 months following LAGB. CONCLUSION: Intragastric balloon did not predict the success of subsequent LAG
Daily enteral feeding practice on the ICU: attainment of goals and interfering factors
BACKGROUND: The purpose of this study was to evaluate the daily feeding practice of enterally fed patients in an intensive care unit (ICU) and to study the impact of preset factors in reaching predefined optimal nutritional goals. METHODS: The feeding practice of all ICU patients receiving enteral nutrition for at least 48 hours was recorded during a 1-year period. Actual intake was expressed as the percentage of the prescribed volume of formula (a success is defined as 90% or more). Prescribed volume (optimal intake) was guided by protocol but adjusted to individual patient conditions by the intensivist. The potential barriers to the success of feeding were assessed by multivariate analysis. RESULTS: Four-hundred-and-three eligible patients had a total of 3,526 records of feeding days. The desired intake was successful in 52% (1,842 of 3,526) of feeding days. The percentage of successful feeding days increased from 39% (124 of 316) on day 1 to 51% (112 of 218) on day 5. Average ideal protein intake was 54% (95% confidence interval (CI) 52 to 55), energy intake was 66% (95% CI 65 to 68) and volume 75% (95% CI 74 to 76). Factors impeding successful nutrition were the use of the feeding tube to deliver contrast, the need for prokinetic drugs, a high Therapeutic Intervention Score System category and elective admissions. CONCLUSION: The records revealed an unsatisfactory feeding process. A better use of relative successful volume intake, namely increasing the energy and protein density, could enhance the nutritional yield. Factors such as an improper use of tubes and feeding intolerance were related to failure. Meticulous recording of intake and interfering factors helps to uncover inadequacies in ICU feeding practice
Enteral Nutrition and Acute Pancreatitis: A Review
Introduction. In patients with acute pancreatitis (AP), nutritional support is required if normal food cannot be tolerated within several days. Enteral nutrition is preferred over parenteral nutrition. We reviewed the literature about enteral nutrition in AP. Methods. A MEDLINE search of the English language literature between 1999–2009. Results. Nasogastric tube feeding appears to be safe and well tolerated in the majority of patients with severe AP, rendering the concept of pancreatic rest less probable. Enteral nutrition has a beneficial influence on the outcome of AP and should probably be initiated as early as possible (within 48 hours). Supplementation of enteral formulas with glutamine or prebiotics and probiotics cannot routinely be recommended. Conclusions. Nutrition therapy in patients with AP emerged from supportive adjunctive therapy to a proactive primary intervention. Large multicentre studies are needed to confirm the safety and effectiveness of nasogastric feeding and to investigate the role of early nutrition support
The influence of body composition on therapeutic hypothermia: a prospective observational study of patients after cardiac arrest
Introduction Patients after out-of-hospital cardiac arrest (OHCA) benefit from therapeutic hypothermia for 24 hours. The time needed to reach hypothermia (target temperature of 32 degrees C to 34 degrees C) varies widely. In this study, we explore the relation between measures of body composition and the time needed to reach target temperature with hypothermia. Method We conducted a prospective observational study in patients treated with hypothermia after OHCA. Data collected included weight and height, body composition by anthropometric measures and by single-frequency body impedance, and waist-to-hip ratio. Analysis of concordance between impedance and anthropometric measures and hazard ratios of achieving target temperature (event) corrected for different body composition measures. Results Twenty-seven patients were included. The median (interquartile range) time to reach target temperature after admission to the intensive care unit was 191 (105 to 382) minutes. Intraclass correlation for total body fat (TBF) measures was 0.94 (95% confidence interval [CI] 0.89 to 0.97). Only TBF percentage (anthropometrics by the Durnin's table) appeared to be associated with time to reach target temperature: 0.93 (95% CI 0.87 to 0.99; P = 0.03). Conclusion The body composition measures from single-frequency impedance and anthropometrics appear to be very concordant. Only TBF percentage (anthropometrics) showed a significant but clinically irrelevant influence on time needed to achieve target temperature with hypothermia. We conclude that there are no indications to adjust current cooling practice toward the body composition of patient
Adjustable Intragastric Balloons: A 12-Month Pilot Trial in Endoscopic Weight Loss Management
Intragastric balloons are associated with (1) early period intolerance, (2) diminished effect within 3–4 months, and (3) bowel obstruction risk mandating removal at 6 months. The introduction of an adjustable balloon could improve comfort and offer greater efficacy. A migration prevention function, safely enabling prolonged implantation, could improve efficacy and weight maintenance post-extraction. The first implantations of an adjustable balloon with an attached migration prevention anchor are reported. The primary endpoint was the absence of bowel perforation, obstruction, or hemorrhage. Eighteen patients with mean BMI of 37.3 were implanted with the Spatz Adjustable Balloon system (ABS) for 12 months. Balloon volumes were adjusted for intolerance or weight loss plateau. Mean weight loss at 24 weeks was 15.6 kg with 26.4% EWL (percent of excess weight loss) and 24.4 kg with 48.8% EWL at 52 weeks. Sixteen adjustments were successfully performed. Six downward adjustments alleviated intolerance, yielding additional mean weight loss of 4.6 kg. Ten upward adjustments for weight loss plateau yielded a mean additional weight loss of 7 kg. Seven balloons were removed prematurely. Complications necessitating early removal included valve malfunction (1), gastritis (1), Mallory–Weiss tear (1), NSAID (2× dose/2 weeks) perforating ulcer (1), and balloon deflation (1). Two incidents of catheter shear from the chain: one passed uneventfully and one caused an esophageal laceration without perforation during extraction. The Spatz ABS has been successfully implanted in 18 patients. (1) Upward adjustments yielded additional weight loss. (2) Downward adjustments alleviated intolerance, with continued weight loss. (3) Preliminary 1-year implantation results are encouraging
Polyp measurement based on CT colonography and colonoscopy: variability and systematic differences
Influence of Reoperations on Long-Term Quality of Life After Restrictive Procedures: A Prospective Study
Quality of life improves after bariatric surgery. However, long-term results and the influence of reoperations are not well known. A prospective quality of life assessment before, 1 and 7 years after laparoscopic adjustable gastric banding (LAGB) and vertical banded gastroplasty (VBG) was performed in order to determine the influence of reoperations during follow-up. One hundred patients were included in the study. Fifty patients underwent VBG and 50 LAGB. Patients completed the quality of life questionnaires prior to surgery and two times during follow-up. Health-related quality of life (HRQoL) questionnaires included the Nottingham Health Profile I and II and the Sickness Impact Profile 68. Follow-up was 84% with a mean duration of 84 months (7 years). During follow-up, 65% of VBG patients underwent conversion to Roux-en-Y gastric bypass while 44% of LAGB patients underwent a reoperation or conversion. One year after the procedure, nearly all quality-of-life parameters significantly improved. After 7 years, the Nottingham Health Profile (NHP)-I domain “physical ability”, the NHP-II and the SIP-68 domains “mobility control”, “social behavior”, and “mobility range” were still significantly improved in both groups. The domains “emotional reaction”, “social isolation” (NHP-I), and “emotional stability” (SIP-68) remained significantly improved in the VBG group while this was true for the domain “energy level” (NHP-I) in the LAGB group. Both the type of procedure and reoperations during follow-up were not of significant influence on the HRQoL results. Weight loss and decrease in comorbidities were the only significant factors influencing quality of life. Restrictive bariatric surgery improves quality of life. Although results are most impressive 1 year after surgery, the improvement remains significant after long-term follow-up. Postoperative quality of life is mainly dependent on weight loss and decrease in comorbidities and not on the type of procedure or surgical complications
Ursodeoxycholic acid counteracts celecoxib in reduction of duodenal polyps in patients with familial adenomatous polyposis: A multicentre, randomized controlled trial
Abstract. Background: Due to prophylactic colectomy, mortality in patients with familial adenomatous polyposis (FAP) has changed, with duodenal cancer currently being the main cause of death. Although celecoxib reduces duodenal polyp density in patients with FAP, its long-term use may increase the risk of cardiovas
Interdisciplinary European guidelines on surgery of severe obesity
W 2005 roku, dzięki wspólnemu wysiłkowi głównych europejskich
towarzystw naukowych aktywnych na polu leczenia otyłości został
powołany zespół ekspertów nazwany Bariatryczno-Naukową
Grupą Badawczą (BSCG). Towarzystwami, które stworzyły ten
zespół i oddelegowały swoich przedstawicieli do prac w opracowaniu
wytycznych były: Międzynarodowe Towarzystwo Chirurgicznego
Leczenia Otyłości (IFSO), Oddział Europejski Międzynarodowego
Towarzystwa Chirurgicznego Leczenia Otyłości
(IFSO-EC), Europejskie Towarzystwo Badań nad Otyłością
(EASO), Europejska Grupa ds. Otyłości u Dzieci (ECOG) (razem
z Międzynarodową Grupą Zwalczania Otyłości). Bariatryczno-Naukowa
Grupa Badawcza składała się z władz reprezentujących
powyższe towarzystwa (czterech czynnych przewodniczących,
dwóch byłych, jeden honorowy, dwóch dyrektorów wykonawczych),
a także najwybitniejszych ekspertów w tej dziedzinie. Skład BSCG pozwolił na całościowe objęcie zagadnienia leczenia
otyłości olbrzymiej z uwzględnieniem różnorodności geograficznej
i etnicznej Europy. Członkowie BSCG odbyli wiele spotkań
poświęconych stworzeniu wytycznych, które odzwierciedlałyby
współczesną wiedzę i doświadczenie w zakresie leczenia
otyłości olbrzymiej.In 2005, for the first time in European history, an extraordinary expert
panel named BSCG (Bariatric Scientific Collaborative Group),
was appointed through joint effort of the major European scientific
societies which are active in the field of obesity management. Societies
that constituted this panel were: IFSO - International Federation
for the Surgery of Obesity, IFSO-EC - International Federation
for the Surgery of Obesity - European Chapter, EASO - European Association for Study of Obesity, ECOG - European
Childhood Obesity Group, together with the IOTF (International
Obesity Task Force) which was represented during the completion
process by its representative. The BSCG was composed not
only of the top officers representing the respective scientific societies
(four acting presidents, two past presidents, one honorary president,
two executive directors), but was balanced with the presence
of many other key opinion leaders in the field of obesity. The
BSCG composition allowed the coverage of key disciplines in comprehensive
obesity management, as well as reflecting European
geographical and ethnic diversity. This joint BSCG expert panel
convened several meetings which were entirely focused on guidelines
creation, during the past 2 years. There was a specific effort
to develop clinical guidelines, which will reflect current knowledge,
expertise and evidence based data on morbid obesity treatment
Management of obesity in adults: European clinical practice guidelines
Stworzenie jednolitych wytycznych postępowania w otyłości jest
złożone. Obejmują one zarówno zalecenia diagnostyczne, lecznicze,
jak i działania w zakresie prewencji. Wobec wielu publikacji
i różnic poglądów oraz świadomości krótkotrwałości efektu odchudzającego
u poszczególnych osób wielu uważa, że trudno jest
ustalić właściwe postępowanie w otyłości. Różnorodność zasad
postępowania w kraju oraz pomiędzy regionami Europy utrudnia
ustalenie i wprowadzenie standardów. W ustalaniu obecnych wytycznych
za podstawę brano wiedzę opartą na dowodach (EBM), a w razie wątpliwości uzupełniano na podstawie doświadczenia
klinicznego i różnorodności regionalnej oraz uzgodnionego stanowiska
zespołu.
W podsumowaniu stwierdzono, że: 1) lekarz jest odpowiedzialny
za rozpoznanie otyłości jako choroby oraz pomoc w odpowiedniej
prewencji i leczeniu; 2) leczenie powinno być oparte na dobrej
praktyce klinicznej i EBM; 3) leczenie otyłości powinno wyznaczać
indywidualne realne cele i dożywotnie postępowanie.The development of consensus guidelines for obesity is complex. It
involves recommending both treatment interventions and interventions
related to screening and prevention. With so many publications
and claims, and with the awareness that success for the individual
is short-lived, many find it difficult to know what action is appropriate
in the management of obesity. Furthermore, the significant
variation in existing service provision both within countries as well
as across the regions of Europe makes a standardised approach,
even if evidence-based, difficult to implement. In formulating these
guidelines, we have attempted to use an evidence based approach
while allowing flexibility for the practicing clinician in domains where
evidence is currently lacking and ensuring that in treatment there
is recognition of clinical judgment and of regional diversity as well
as the necessity of an agreed approach by the individual and family.
We conclude that 1) physicians have a responsibility to recognise
obesity as a disease and help obese patients with appropriate
prevention and treatment, 2) treatment should be based on good
clinical care and evidence- based interventions and 3) obesity treatment
should focus on realistic goals and lifelong management
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