Serum beta-endorphin levels in morbidly obese patients: the effect of vertical banded gastroplasty.

The associations between serum beta-endorphin levels and clinical and metabolic variables as well as beta-endorphin changes after surgically induced weight loss were investigated in 43 morbidly obese patients. A significant positive correlation between beta-endorphin and body weight, degree of body weight increase and ACTH was found preoperatively. Only body weight was independently associated with beta-endorphin levels. Twelve months following vertical banded gastroplasty, there was an extensive weight loss in all patients and improvement in their metabolic profile. A significant reduction in beta-endorphin levels which was proportional to the extent of weight loss was also observed.

Sex hormone changes in morbidly obese patients after vertical banded gastroplasty.

Serum sex hormone levels were measured preoperatively in 57 morbidly obese patients (19 men and 38 premenopausal women) and 12 months after vertical banded gastroplasty. In the male group, there was a significant decrease in estradiol and an increase in follicle-stimulating hormone (FSH), total testosterone and sex-hormone-binding globulin (SHBG). Among female patients, a significant decrease in estradiol, total and free testosterone and an increase in FSH and SHBG was found. Irregular menses present preoperatively in 5 women were corrected after successful weight loss. In conclusion, altered sex hormonal levels and gynecologic abnormalities associated with morbid obesity are corrected with adequate weight loss following vertical banded gastroplasty.

The effect of vertical banded gastroplasty on glucose-induced beta-endorphin response.

BACKGROUND: beta-Endorphin is an endogenous opioid involved in the regulation of food intake and obesity as well as in insulin metabolism. In this study, we investigated glucose-induced beta-endorphin, insulin, and glucose responsiveness in morbidly obese patients and the effect of surgically induced weight loss. METHODS: Thirty-two healthy, nondiabetic, morbidly obese patients (body mass index over 40 kg/m2) and 32 normal-weight controls were studied. Serum levels of beta-endorphin, insulin, and glucose were measured under basal conditions and during an oral glucose tolerance test (OGTT) before and 12 months following vertical banded gastroplasty. RESULTS: Preoperative basal levels of beta-endorphin, insulin, and glucose and their responses during OGTT in obese patients were significantly higher compared with those of controls. After surgery, basal beta-endorphin, insulin, and glucose levels decreased significantly compared with preoperative values. Postoperative basal insulin and glucose levels were similar to those in controls, while beta-endorphin levels remained significantly higher than those of controls. A significant reduction in total responses of beta-endorphin, insulin, and glucose during OGTT was also observed; however, postoperative beta-endorphin and insulin responses remained significantly higher than in controls. CONCLUSION: Morbidly obese patients have an increased glucose-stimulated response of beta-endorphin, insulin, and glucose which is partially corrected with weight loss following vertical banded gastroplasty.

Systemic stress response after laparoscopic or open cholecystectomy: a randomized trial.

BACKGROUND: Surgical injury induces a systemic endocrine-metabolic response which is proportional to the severity of surgical stress. Laparoscopic cholecystectomy is associated with a favourable clinical outcome compared with open cholecystectomy suggesting that surgical injury is reduced. METHODS: In a randomized clinical trial of 41 patients undergoing laparoscopic cholecystectomy and 42 patients undergoing open cholecystectomy, the neuroendocrine and metabolic stress responses were compared. Plasma levels of cortisol, adrenaline, noradrenaline, glucose, interleukin (IL) 6 and C-reactive protein (CRP) were measured before, during and at 4, 8 and 24 h after operation. RESULTS: Plasma levels of cortisol and catecholamines increased during and after both laparoscopic and open cholecystectomy; however, their postoperative responses during and after both laparoscopic and open cholecystectomy; however, their postoperative responses were significantly higher (P < 0.05) after open cholecystectomy. Glucose, IL-6 and CRP levels also increased after operation and were significantly higher (P < 0.05) in the open cholecystectomy group. CONCLUSION: The neuroendocrine stress response and inflammatory response following laparoscopic cholecystectomy were significantly reduced compared with those after open cholecystectomy.

Incidentalomas of the adrenal gland: diagnostic and therapeutic implications.

Incidentally discovered adrenal masses are common since the advent and application of sensitive noninvasive imaging methods. The significance of these so-called "incidentalomas" and the question of further evaluation or treatment remains elusive. This report describes a retrospective study of 86 patients with incidentaloma. Adrenalectomy was performed on 26 patients during initial admission. Histologically, two cortisol-producing adenomas, an adenoma with subclinical cortisol production, and two pheochromocytomas (all of the preceding detected during the preoperative hormonal evaluation), three cystic lesions, one myelolipoma, and one hematoma were found. One primary and two metastatic adrenal carcinomas were also found in this series. Sixty patients with a nonfunctioning incidentaloma smaller than 6 cm were observed in an average of 43 months with serial CT scans performed at 3, 9, and 18 months after the initial diagnosis. Enlargement of the mass was detected in two patients; both proved to be nonfunctioning adenomas. Based on these observations, it is concluded that the initial laboratory evaluation is mandatory in cases of incidentalomas, including parameters of adrenocortical and medullar function. Hormonally active incidentalomas and those suspected for malignancy should be treated surgically. Masses greater than 6 cm should also be removed. Smaller incidentalomas without endocrine activity or signs of malignancy should be followed by CT scan at 3, 9, and 18 months after the initial diagnosis.

Immunohistochemical detection of oestrogen receptors in ductal carcinoma in situ of the breast.

The expression of oestrogen receptor (ER) protein in invasive carcinoma of the breast and its clinical significance has been extensively evaluated. Little information is available regarding ER expression in ductal carcinoma in situ (DCIS). In this study, 46 formalin-fixed, paraffin-embedded tissue specimens of mammographically detected DCIS were evaluated immunohistochemically for the presence of ER using specific monoclonal antibodies against ER (ER-ICA Abbott Lab). The associations between ER expression and histological type, degree of differentiation and patient menopausal status were evaluated. Positive ER staining was present in 72% of cases. Non-comedo types of DCIS were more frequently ER-positive than comedocarcinoma. ER-positive tumours were inversely correlated with the presence of nuclear pleomorphism. The incidence of ER in pre-menopausal and post-menopausal women was similar. In conclusion, ER expression is present in a considerable percentage of DCIS, and ER-positivity is associated with the degree of differentiation and non-comedo carcinoma variants.

Postoperative pulmonary function after laparoscopic and open cholecystectomy.

In this prospective, randomized study, we compared 42 patients undergoing laparoscopic cholecystectomy and 40 undergoing open cholecystectomy to determine if laparoscopic cholecystectomy results in less respiratory impairment and fewer respiratory complications. Pulmonary function tests, arterial blood-gas analysis and chest radiographs were obtained in both groups before operation and on the second day after operation. Postoperative pain scores and analgesic requirements were also recorded. After operation, a significant reduction in total lung capacity, functional residual capacity (FRC), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and mid-expiratory flow (FEF25-75%) occurred after both laparoscopic and open cholecystectomy. The reductions in FRC, FEV1, FVC and FEF25-75% were smaller after laparoscopic (7%, 22%, 19% and 23%, respectively) than after open (21%, 38%, 32% and 34%, respectively) cholecystectomy. Laparoscopic cholecystectomy was also associated with a significantly lower incidence (28.6% vs 62.5%) and less severe atelectasis, better oxygenation and reduced postoperative pain and analgesia use compared with open cholecystectomy. We conclude that postoperative pulmonary function was impaired less after laparoscopic than after open cholecystectomy.

The incidence of occult cancer in patients with deep venous thrombosis: a prospective study.

OBJECTIVE: This study was undertaken to assess a potential relationship between idiopathic deep venous thrombosis (DVT) and occult cancer. DESIGN: Prospective study with a 2-year follow-up. SETTING: The Angiology Unit of the First Department of Surgery, University of Athens, Greece, a tertiary referral centre. SUBJECTS: Two hundred and ninety-three patients with a first episode of venographically or Doppler-proved DVT were included in the study, of whom 264 were followed up for 2 years. INTERVENTIONS: After an initial extensive diagnostic workup, including routine blood counts and chemistries, erythrocyte sedimentation rate, CEA levels, chest X-ray and abdominopelvic CT scan, all patients were closely followed up and periodically examined. MAIN OUTCOME MEASURES: The incidence of cancer amongst patients with idiopathic and secondary DVT, and the validity of our screening programme. RESULTS: Cancer was diagnosed in 21 out of 84 patients with idiopathic DVT (25%) as compared with eight out of 202 patients with secondary DVT (4%). In 22 out of the 29 cases, cancer was detected during the initial admission, and the remaining seven cases were detected during follow-up. Cancer was diagnosed in 15 asymptomatic, healthy individuals, but only in seven of them was the diagnosis made by CT scan. CONCLUSION: Occult cancer is fairly common in patients with idiopathic DVT, but the routine use of extensive diagnostic studies for its detection remains to be validated by further prospective studies.

Somatostatin as adjuvant therapy in the management of obstructive ileus.

The adjuvant use of somatostatin in the clinical management of obstructive ileus was studied prospectively. Fifty-four consecutive patients suffering from total obstructive ileus were managed over a period of one year. A double-blind clinical trial involving the administration of somatostatin for two days was carried out. Twenty-seven non-selected patients received somatostatin, while the other twenty-seven did not. Of the 27 patients who did not receive somatostatin, 12 (44%) were operated on, while only 6 (22%) of those who had received the agent required surgery. As little as 16% of the patients who received somatostatin pre-operatively exhibited severe dilatation and necrosis of the intestine proximal to the area of destruction as compared with 83% of those patients who did not receive somatostatin before the operation. It was concluded that while the administration of somatostatin to patients suffering from obstructive ileus may not be directly related to a reduction in surgery, it does reduce the effects of intestinal dilatation on the healthy gut proximal to the area of destruction.