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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Salient features of an operative technique designed to reduce to a minimum the iatrogenic trauma of cholecystectomy include a limited incision, muscle retraction (instead of division), specific packing and retraction, and distant manipulations by long instruments. Eighty two unselected consecutive patients with primary gallbladder disease underwent operation by this technique. Two permanently bed-confined patients were excluded from study. Acute cholecystitis was documented by histopathology review in 23 cases and chronic cholecystitis in 57 cases. Case material included usual pre-existing concomitant medical problems; five patients meeting formal criteria for the diagnosis of morbid obesity; 15 patients exceeding 199 pounds and one weighing 315 pounds; ambulatory (outpatient) cholecystectomy; 17 patients over 70 and four patients over 80 years of age; five gangrenous and one perforated gallbladders, and perigallbladder abscesses without gangrene in one case; and conspicuous absence of respiratory complications. Median and average incision length was 5.5 cm. There were no major and five minor complications. Recent experience demonstrated safe performance of elective cholecystectomy for chronic disease, regardless of degree of patient obesity, with median incision length 5 cm, median operative time 65 minutes and median post-operative hospital stay 2 days.
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PMID:Minimal trauma cholecystectomy (a "no-touch" procedure in a "well"). 336 59

In a six-month period, 157 obstructive sleep apnea syndrome (OSAS) patients seen consecutively in clinic had standardized cephalometric roentgenograms and underwent polygraphic monitoring during sleep. Different variables, including cephalometric landmarks, body mass index (BMI), and polygraphic results (particularly degree of O2 saturation and number of abnormal breathing events), were statistically analyzed. As a rule, OSAS patients had upper airway anatomic abnormalities and an elevated BMI: massive obesity was associated with less anatomic abnormality, less nocturnal sleep disruption, and longer total sleep time (TST). Patients having a high respiratory disturbance index (RDI) were more likely to have upper airway anatomic abnormalities; they slept for a shorter time and had increased stage 1 non-rapid eye movement (NREM) sleep but decreased stage 3 and 4 and REM sleep. Long mandibular plane to hyoid bone (MP-H) distance and width of the posterior airway space (PAS) (space behind the base of the tongue) were statistically significant predictors of elevated RDI. The cephalometric variables were much less useful for predicting frequency of O2 saturation drops below 80 percent. The patient population can be subdivided into (a) patients with clear anatomic abnormalities and low BMI, (b) patients with morbid obesity with few abnormal cephalometric measurements, and (c) patients who have variably increased BMI and abnormal cephalometric measurements. This is the largest group. We concluded that standardized cephalometric roentgenograms can be useful in determining the appropriate treatment for OSAS patients.
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PMID:Obstructive sleep apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. 337 Oct 99

Although the risk of developing congestive heart failure increases in parallel with the degree of obesity, load-dependent indexes of left ventricular function are found to be reduced in patients with morbid obesity only. We used the ratio of end-systolic wall stress to end-systolic volume index, which is load-independent, to assess myocardial contractility in 23 nonobese, 28 mildly obese and 26 moderately obese patients with mild to moderate essential hypertension. Although load-dependent indexes (i.e., ejection fraction, fractional fiber shortening and velocity of circumferential fiber shortening) were similar in the 3 groups, end-systolic wall stress to end-systolic volume index was lower in the moderately obese group (2.63 +/- 0.4, p less than 0.002) and even in the mildly obese group (2.88 +/- 0.8, p less than 0.05) than in the nonobese group (3.27 +/- 0.7). Further, there was a significant inverse relation between end-systolic wall stress to end-systolic volume index and body mass index (r = -0.34, p less than 0.005), diastolic diameter (r = -0.56, p less than 0.001) and left ventricular mass index (r = -0.55, p less than 0.001). Some obese patients have depressed myocardial contractility when compared with lean patients despite well-preserved pump function.
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PMID:Myocardial contractility and left ventricular function in obese patients with essential hypertension. 341 51

Linear brain parameters were measured by CT in 19 patients with morbid obesity (mean weight 126.4 +/- 20.5 kg) and 20 age and sex matched normal weight subjects (mean weight 62.6 +/- 14.9 kg). Ventricular parameters were slightly smaller and cortical parameters were slightly larger in the preoperative obese than in control subjects. However, only the four cortical sulci ratio was significantly different in the two groups (P = 0.02). After gastric restriction surgery and drastic weight loss (mean postoperative weight 82.9 +/- 27.4 kg), all the ventricular and cortical parameters increased, with significant change in the frontal interhemispheric fissure ratio (P less than 0.05). Obese patients followed for 23 months after surgery had less striking changes than those followed for 6 months. Morbidly obese subjects have altered brain CT dimensions which are partly reversible after weight correction.
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PMID:Brain computed tomography in morbid obesity before and after gastric restriction surgery: a prospective quantitative study. 343 99

We should ask about any therapy: (1) is it safe? and (2) is it effective? The best therapy is that which has the greatest chance to do good with the least chance to cause harm. Medical treatment is certainly safer than surgery, since (by my definition) surgery always involves a general anaesthetic, and morbidly obese patients are bad anaesthetic risks. Obesity also increases other surgical risks, so all published series of surgically-treated obese patients report some mortality. Surgeons will claim that surgery is much more effective than medical treatment, which has negligible success in morbid obesity. However all surgical bypass or banding procedures cause weight loss by restricting food intake, so if food intake can be equally restricted without surgery the results are just as good. In our experience jaw-wiring (which does not require a general anaesthetic) produces similar weight loss to gastroplasty. However the most difficult problem in morbid obesity is the maintenance of reduced weight many years after treatment. We have too few good long-term follow-up data after either medical or surgical treatment, but about half our patients treated with jaw-wiring and a waist cord maintain their weight loss on 3 years follow-up, zero mortality from the procedure. The results of surgical and medical treatments depend on the skill and care with which they are applied, and the way in which patients are selected. If patients are given treatment B if they are considered unsuitable for treatment A then the results from treatment A will be better.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Morbid obesity: medical or surgical treatment? The case for medical treatment. 344 Jun 85

One hundred and fifty-three consecutive patients referred to the Royal Prince Alfred Hospital for consideration of gastric bariatric surgery (surgery for obesity) were assessed pre-operatively by the one psychiatrist, with regard to social, psychological and psychiatric factors. Fifty-one patients (33%) were considered to be uncomplicated from a psychiatric point of view. Eighty-eight patients (58%) had identifiable psychopathology and 14 patients (9%) were of doubtful motivation. Thirty patients (20%) were rejected from the treatment programme after the initial assessment because of overt psychiatric illness, severe situational stress, insufficient motivation or lack of significant support. Six of these patients after further assessment or after responding to psychiatric treatment were reviewed and found suitable for a bariatric operation. Of the 113 patients who had a bariatric procedure performed, 17 patients (15%) required postoperative psychiatric management. while the need for psychiatric assessment of patients presenting for bariatric surgery is disputed by some, our experience would indicate that careful pre-operative screening by a liaison psychiatrist, familiar with morbid obesity and its surgical management, is useful in any bariatric surgical programme. Such screening should identify and enable exclusion of the small number of patients who for psychiatric reasons, are poor risk candidates. A number of other patients in whom identifiable psychopathology will be discerned, will require pre-operative psychiatric management. While such a programme will decrease postoperative psychiatric problems, these will not be eliminated in the morbidly obese, and the assessing liaison psychiatrist will have a valuable role to play in the collaborative postoperative management of such patients.
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PMID:Pre-operative psychiatric assessment of patients presenting for gastric bariatric surgery (surgical control of morbid obesity). 346 May 50

Vertical banded gastroplasty is currently closest to the ideal gastric restrictive procedure for the surgical treatment of obesity. A modification of the technique of vertical banded gastroplasty can be successfully used to revise a failed high gastric reduction for morbid obesity.
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PMID:Modified vertical banded gastroplasty as revision of failed high gastric reduction for morbid obesity. 346 72

This article defines obesity, ideal body weight, morbid obesity, and indexes of overweight, pointing out some of the difficulties in studies of the epidemiology of morbid obesity.
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PMID:Morbid obesity: definitions, epidemiology, and methodological problems. 350 Sep 20

New surgical procedures have revolutionized the treatment of morbid obesity (more than 100% overweight), a condition associated with serious medical complications and for which conservative treatment has been largely ineffective. These procedures, which are surprisingly safe, produce large weight losses and marked improvement in hypertension, diabetes, and other disorders influenced by obesity. Striking changes also occur in vocational and psychosocial functioning, including marital and sexual relations, in eating behavior, in food preferences, and in body image. The emotional state of patients during weight loss following surgery is far superior to that during attempts at weight reduction by other methods. The surgical procedures appear to produce a major biological change, perhaps lowering a body weight set point.
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PMID:Psychological and social aspects of the surgical treatment of obesity. 351 32

Between 1980 and 1985, three types of horizontal and one of vertical gastroplasty were employed in an attempt to find the best alternative to jejunoileal bypass in morbid obesity. Operations were tried successively, one being abandoned in favour of the next whenever unsatisfactory results were too frequent. Thus survey pertains to 93 consecutive, but previously untreated patients. The four groups were comparable with regard to inclusion criteria, preoperative degree of obesity and postoperative care. Weight losses were significantly greater in the vertical type, while there were no significant differences among the horizontal types of gastroplasty. There were few and only minor differences with regard to complications. Evidence to date seems to point to vertical gastroplasty as the best surgical treatment in morbid obesity.
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PMID:Comparison of different types of gastroplasty in the treatment of 93 morbid obese patients. 358 24


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