Laparoskooppinen lihavuusleikkaus

Teema : lihavuuskirurgia. English summar

Partial restoration of normal intestinal microbiota in morbidly obese women six months after bariatric surgery

We studied the impact of bariatric surgery on the intestinal microbiota of morbidly obese study subjects. A total of 13 morbidly obese women (five of which had type 2 diabetes) and 14 healthy age- and gender-matched controls were recruited and the microbiota composition of fecal samples were determined by using a phylogenetic microarray. Sampling of the patients took place just one month before and 6 months after the operation. Within six months after bariatric surgery, the obese subjects had lost on average a quarter of their weight whereas four of the five of the diabetic subjects were in remission. Bariatric surgery was associated with an increased microbial community richness and Bacteroidetes/Firmicutes ratio. In addition, we observed an increased relative abundance of facultative anaerobes, such as Streptococcus spp., and a reduction in specific butyrate-producing Firmicutes. The observed postoperative alterations in intestinal microbiota reflect adaptation to the changing conditions in the gastrointestinal tract, such as energy restriction and the inability to process fiber-rich foods after bariatric surgery.Peer reviewe

Miksi Suomessa tehdään liian vähän lihavuuskirurgisia leikkauksia

Teema : lihavuuskirurgi

Onko lihavuuskirurgia kustannusvaikuttavaa?

Teema : lihavuuskirurgi

Herd-Level and Individual Differences in Fecal Lactobacilli Dynamics of Growing Pigs

We studied the fecal lactobacilli count and species diversity of growing pigs along with immune parameters associated with intestinal lactobacilli. Thirty pigs categorized as small (S, n = 12) or large (L, n = 18) at birth were followed from birth to slaughter in two commercial herds, H1 and H2. Herds differed in terms of their general management. We determined sow colostrum quality, colostrum intake, piglet serum immunoglobulins, and pig growth. We took individual fecal samples from pigs in the weaning and finishing units. We studied lactobacilli count and identified their diversity with 16S PCR. Total lactobacilli count increased in H1 and decreased in H2 between samplings. Lactobacilli species diversity was higher in H1 in both fecal sampling points, whereas diversity decreased over time in both herds. We identified altogether seven lactobacilli species with a maximum of five (one to five) species in one herd. However, a relatively large proportion of lactobacilli remained unidentified with the used sequencing technique. Small pigs had higher lactobacilli counts in both herds but the difference was significant only in H2 (p = 0.01). Colostrum quality was numerically better in H1 than in H2, where colostrum intake tended to be associated with total lactobacilli count (p = 0.05)

Herd-Level and Individual Differences in Fecal Lactobacilli Dynamics of Growing Pigs

We studied the fecal lactobacilli count and species diversity of growing pigs along with immune parameters associated with intestinal lactobacilli. Thirty pigs categorized as small (S, n = 12) or large (L, n = 18) at birth were followed from birth to slaughter in two commercial herds, H1 and H2. Herds differed in terms of their general management. We determined sow colostrum quality, colostrum intake, piglet serum immunoglobulins, and pig growth. We took individual fecal samples from pigs in the weaning and finishing units. We studied lactobacilli count and identified their diversity with 16S PCR. Total lactobacilli count increased in H1 and decreased in H2 between samplings. Lactobacilli species diversity was higher in H1 in both fecal sampling points, whereas diversity decreased over time in both herds. We identified altogether seven lactobacilli species with a maximum of five (one to five) species in one herd. However, a relatively large proportion of lactobacilli remained unidentified with the used sequencing technique. Small pigs had higher lactobacilli counts in both herds but the difference was significant only in H2 (p = 0.01). Colostrum quality was numerically better in H1 than in H2, where colostrum intake tended to be associated with total lactobacilli count (p = 0.05)

Low-Dose Abdominal CT for Evaluating Suspected Appendicitis in Adolescents and Young Adults Review of Evidence

Due to its excellent diagnostic performance, CT is the mainstay of diagnostic test in adults with suspected acute appendicitis in many countries. Although debatable, extensive epidemiological studies have suggested that CT radiation is carcinogenic, at least in children and adolescents. Setting aside the debate over the carcinogenic risk of CT radiation, the value of judicious use of CT radiation cannot be overstated for the diagnosis of appendicitis, considering that appendicitis is a very common disease, and that the vast majority of patients with suspected acute appendicitis are adolescents and young adults with average life expectancies. Given the accumulated evidence justifying the use of low-dose CT (LDCT) of only 2 mSv, there is no reasonable basis to insist on using radiation dose of multi-purpose abdominal CT for the diagnosis of appendicitis, particularly in adolescents and young adults. Published data strongly suggest that LDCT is comparable to conventional dose CT in terms of clinical outcomes and diagnostic performance. In this narrative review, we will discuss such evidence for reducing CT radiation in adolescents and young adults with suspected appendicitis.</p

Lihavuusleikkauksen vaikutukset lääkkeiden farmakokinetiikkaan

Lihavuusleikkaus muuttaa ruoansulatuselimistön anatomiaa ja potilaan kehon koostumusta, mikä vaikuttaa lääkkeiden farmakokinetiikkaan. Leikkauksen välittömiä seurauksia ovat lääkkeiden imeytymisen ja ensikierron aineenvaihdunnan muutokset. Lääkkeen jakautumistilavuus, aineenvaihdunta ja eliminaatio saattavat muuttua rasvakudoksen ja maksan rasvoittumisen vähenemisen sekä munuaistoiminnan parantumisen myötä. Lääkepitoisuuksien suurentuminen tai pienentyminen voivat vaikuttaa lääkehoidon tehoon ja haittavaikutusriskiin. Yksittäisten lääkkeiden osalta näyttö on puutteellista, eikä selkeitä yleissuosituksia lääkkeiden lihavuusleikkauksen jälkeisistä annoksista ole saatavilla. Leikkaustekniikka ja yksilölliset potilaskohtaiset tekijät vaikuttavat farmakokinetiikan muutoksiin. Muutosten vaikean ennakoitavuuden takia on tärkeää seurata lääkehoidon kliinistä vastetta, haittavaikutuksia ja tarvittaessa lääkepitoisuuksia 1-2 vuoden ajan leikkauksesta, jolloin paino vähenee eniten

Preoperative brain μ-opioid receptor availability predicts weight development following bariatric surgery in women

Bariatric surgery is the most effective method for weight loss in morbid obesity. There is significant individual variability in the weight loss outcomes, yet factors leading to postoperative weight loss or weight regain remain elusive. Alterations in the mu-opioid receptor (MOR) and dopamine D2 receptor (D2R) systems are associated with obesity and appetite control, and the magnitude of initial brain receptor system perturbation may predict long-term surgical weight loss outcomes. We tested this hypothesis by studying 19 morbidly obese women (mean BMI 40) scheduled to undergo bariatric surgery. We measured their preoperative MOR and D2R availabilities using positron emission tomography with [11C]carfentanil and [11C]raclopride, respectively, and then assessed their weight development association with regional MOR and D2R availabilities at 24-month follow-up. MOR availability in the amygdala consistently predicted weight development throughout the follow-up period, but no associations were found for D2R. This is the first study to our knowledge to demonstrate that neuroreceptor markers prior to bariatric surgery are associated with postoperative weight development. Postoperative weight regain may derive from dysfunction in the opioid system, and weight loss outcomes after bariatric surgery may be partially predicted based on preoperative brain receptor availability, opening up new potential for treatment possibilities