Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases.

BACKGROUND: No bariatric operation has been documented to effect adequate weight loss in all patients. Patients with inadequate weight loss or significant weight regain with an anatomically intact short-limb gastric bypass, of which the Fobi pouch operation (FPO) for obesity is a modification, are usually revised to a distal Roux-en-Y gastric bypass (DRYGBP) to enhance weight loss. METHOD: A retrospective review of the charts of all patients who had a revision to a DRYGBP at our Center during an 8-year period was carried out and the findings analyzed. RESULTS: 65 patients who had the FPO had a revision to the DRYGBP. Most were super obese patients who, even though they had lost significant weight, were still morbidly obese. Some were patients who had not lost adequate weight or <40% excess weight, and a small number were patients who requested more weight loss even though they had a BMI of < 35. 15 patients developed protein malnutrition requiring supplemental feeding. 6 required rerevision to short-limb gastric bypass. CONCLUSION: Revision of short-limb gastric bypass to DRYGBP usually enhances weight loss but at a cost of an increased incidence of protein malnutrition.

Laparoscopic gastric bypass as a reoperative bariatric surgery for failed open restrictive procedures.

An estimated 2% of men and 6% of women in the United States are morbidly obese. These patients have a mortality rate that is six to twelve times greater than their normal-weight peers. In these extreme cases of overweight, only surgical intervention can produce substantial and sustained weight loss. However, up to 20% of these patients will require reoperation for failure to achieve or maintain an adequate weight loss. Reoperative bariatric surgery can be challenging and has traditionally been performed as an open procedure. We present seven female patients who underwent a laparoscopic Roux-en-Y gastric bypass after failing to achieve their weight-loss goals with prior open restrictive procedures. Their average BMI before surgical revision was 42.2 kg/m2. Mean operative time was 4 h 20 min, and length of hospital stay was 4.1 days. There were three complications in two patients and no deaths. Our initial experience suggests that laparoscopic gastric bypass is a safe and feasible reoperative bariatric procedure. Confirmation awaits a larger series of patients with follow-up data.

Evaluation of thyroid function in obese dogs and in dogs undergoing a weight loss protocol.

Obesity and weight loss have been shown to alter thyroid hormone homeostasis in humans. In dogs, obesity is the most common nutritional problem encountered and weight loss is the cornerstone of its treatment. Therefore, it is important to clarify how obesity and weight loss can affect thyroid function test results in that species. The objectives of this study were to compare thyroid function in obese dogs and in lean dogs and to explore the effects of caloric restriction and weight loss on thyroid hormone serum concentrations in obese dogs. In the first experiment, 12 healthy lean beagles and 12 obese beagles were compared. Thyroid function was evaluated by measuring serum concentrations of total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), thyrotropin (TSH), and reverse triiodothyronine (rT3) as well as a TSH stimulation test using 75 microg i.v. of recombinant human TSH. In the second experiment, eight obese beagles were fed an energy-restricted diet [average 63% maintenance energy requirement (MER)] until optimal weight was obtained. Blood samples for determination of TT4, FT4, TT3, TSH and rT3, were taken at the start and then weekly during weight loss. Only TT3 and TT4 serum concentrations were significantly higher in obese dogs as compared to lean dogs. In the second experiment, weight loss resulted in a significant decrease in TT3 and TSH serum concentrations. Thus obesity and energy restriction significantly alter thyroid homeostasis in dogs, but the observed changes are unlikely to affect interpretation of thyroid function test results in clinics.

Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes.

CONTEXT: The benefit of weight reduction for cardiovascular disease (CVD) outcomes remains uncertain. OBJECTIVE: To examine the effects of baseline body mass index on major CVD outcomes and diabetes over a 20 year follow up, and of weight change in the first five years over the subsequent 15 years. DESIGN AND SETTING: A prospective study of British men followed up for 20 years. PARTICIPANTS: Men aged 40-59 years with no diagnosis of CVD or diabetes (n = 7176) of whom 6798 provided full information on weight change five years later. OUTCOME MEASURES: Major CVD events (fatal and non-fatal myocardial infarction and stroke, angina, "other" CVD deaths) and diabetes. RESULTS: During the 20 year follow up there were 1989 major CVD events and 449 incident cases of diabetes in the 7176 men. Risk of major CVD and diabetes increased significantly with increasing overweight and obesity. During the 15 year follow up, weight gain was associated with increased risk of CVD and diabetes. weight loss was associated with lower risk of diabetes than the stable group irrespective of initial weight. No significant cardiovascular benefit was seen for weight loss in any men, except possibly in considerably overweight (BMI 27.5-29.9 kg/m(2)) younger middle aged men (RR = 0.42; 95% CI 0.22 to 0.81). CONCLUSION: Long term risk of CVD and diabetes increased significantly with increasing overweight and obesity. weight loss was associated with significant reduction in risk of diabetes but not CVD, except possibly in considerably overweight younger men. Duration and severity of obesity seem to limit the cardiovascular benefits of weight reduction in older men.

Decomposition analysis of binary polyfunctional urethane monomer mixtures.

Thermal decomposition in three binary monomer mixture systems containing an experimentally synthesized monomer (EXP3) and a commercial polyfunctional urethane monomer (U-4TXA) was examined in terms of differential thermal analysis (DTA) and simultaneous thermogravimetry (TG) analysis when a sample was heated to 800 degrees C. The binary EXP3/U-4TXA monomer mixtures were visible light-cured (VLC) resins which included CQ (camphorquinone=0.5 wt%) and DMAEMA (dimethylaminoethyl methacrylate=0.5 wt%) as the photoinitiator. Their DTA curves showed that thermal decomposition initiated at around 300 degrees C and finished at around 500 degrees C. TG curves showed complete weight loss at 800 degrees C during thermally induced decomposition: the decomposition reaction at weight losses of 5 to 50% was calculated from the slope of the (1/T) versus log10(Hr) diagram, because the exothermic decomposition temperature shown on DTA curves increased with increasing heating rate from 2 to 20 degrees C/min. Thermal decomposition analysis showed that a decomposition with weight change had exothermic heats ranging from 0.38 to 1.07 kJ/g for the EXP U1 mixture, 1.06 to 1.76 kJ/g for EXP U2 and 1.74 to 2.02 kJ/g for EXP U3. Activation energy ranged from 1.42 to 1.89 kJ/mol at weight losses of 5 to 50% in the three binary EXP3/U-4TXA monomer mixture systems.

Weight Loss maintenance in African-American women.

The purpose of this study was to identify factors associated with weight loss and weight loss maintenance in 23 African American women participating in a 32-week lifestyle enhancement awareness program (LEAP), 16 weekly sessions on weight loss and 16 weekly sessions on weight loss maintenance. A pre-test, post-test one group design was used. Measures included dietary readiness to lose weight, bioelectrical impedance analysis, lipid levels, blood pressure, waist/hip ratio, weight, height, and activity level. Women who completed the weight loss phase of the program showed a reduction in weight; body mass index; percentage body fat; and waist/hip ratio; and an increase in physical activity and dietary readiness to control over-eating. weight loss was significantly correlated with attendance and dietary readiness to decrease emotional eating. Women who continued on to complete the weight loss maintenance classes maintained a significant loss in body mass index, and increased their high-density lipoproteins and dietary readiness to monitor hunger and eating cues. African-American women who sustain weight loss and weight loss maintenance regimens reduce their risks for developing chronic diseases.

Audit of successful weight maintenance in adult and paediatric survivors of thermal injury at a UK regional burn centre.

BACKGROUND: Thermal injury is associated with significant weight loss, particularly of lean body mass. weight loss increases the risk of morbidity and increased length of stay (LOS). Appropriate nutrition support can improve these outcomes. The aim of this audit was to evaluate the success of nutrition intervention in minimizing weight loss in adults and children with thermal injury. METHOD: Patients referred for nutrition support were monitored for weight change during their inpatient care episode. Sixty cases met the study criteria. Admission and discharge weight profiles were identified. The degree of weight loss was calculated. Comparison was made to a recognized standard of acceptable weight loss. RESULTS: On admission five (13.2%) adults were found to be clinically underweight. All children were within the acceptable weight percentile range. Adults demonstrated higher (mean +/- SD) percentage weight loss (8.1 +/- 6.0%) than children (4.7 +/- 4.5%). About 76.7% of all cases met the standard used. More children (95.5%) met the standard than adults (65.8%). CONCLUSIONS: Most subjects maintained weight within an acceptable limit during the inpatient episode. Children appeared particularly successful at weight maintenance. Reasons are multifactorial and warrant further investigation.

Comparison of efficacy of Sibutramine ( Meridia ) or Orlistat ( Xenical ) versus their combination in obese women.

OBJECTIVE: Sibutramine ( Meridia ) and Orlistat ( Xenical ) are currently used for weight loss. We aimed to investigate the effect of Orlistat ( Xenical ) and Sibutramine ( Meridia ) combination therapy in treatment of obese women. SUBJECTS AND DESIGN: Study population consisted of 89 obese women who had a body mass index > or = 30 kg/m2, were normotensive, and had normal glucose tolerance. All patients were placed on a diet which contained fat approximately 30% of total calorie intake and the diet was designed to cause an energy deficit of approximately 2.51-3.56 megajoule/day. At the first month of diet (baseline), all patients were randomly divided into three therapy groups: Diet + Orlistat ( Xenical ) (group 1; n = 30 patients), Diet + Sibutramine ( Meridia ) (group 2; n = 29 patients), Diet + Orlistat ( Xenical ) + Sibutramine ( Meridia ) (group 3; n = 30 patients). Body weight, body fat distribution and serum lipid levels were evaluated baseline and after six months in all subjects. RESULTS: Mean weight loss was 5.5 +/- 4.9 kg (p = 0.024) in group 1, 10.1 +/- 3.6 kg (p < 0.001) in group 2, 10.8 +/- 6.6 kg (p < 0.001) in group 3 after the six months. weight loss was significantly greater in group 2 (p = 0.003) and group 3 (p = 0.002) when compared with group 1. Percentage of mean weight loss was 5.5 +/- 3.1% in group 1, 10.2 +/- 4.8% in group 2, 10.6 +/- 5.7% in group 3. Percentage of weight loss was higher in group 2 (p = 0.01) and group 3 (p = 0.009) when compared with group 1. weight loss and percentage of weight loss were not different between group 2 and group 3. CONCLUSION: These three regimens had different results on weight loss in obese women. Combination drug therapy and Sibutramine ( Meridia ) therapy were both more effective than Orlistat ( Xenical ) therapy alone. However, no significant difference was noted between combination drug therapy and Sibutramine ( Meridia ) treatment groups.