Venous Thromboembolism (VTE) Prophylaxis After Abdominoplasty and Liposuction: A Review of the Literature.

BACKGROUND: The aim of this review article was to study recent articles and summarise the guidelines, indications, risks and benefits of using VTE prophylaxis in patients undergoing abdominoplasty and liposuction. METHODS: A search of PubMed was performed using selected keywords related to the topic. Based on the inclusion and exclusion criteria, a total of 25 articles were included in the review. RESULTS: Abdominoplasty has the highest occurrence of VTE among aesthetic procedures. A higher incidence of VTE was noted when abdominoplasty was combined with liposuction. Circumferential procedures, obesity and HRT (hormone replacement therapy) were found to be independent risk factors for VTE. The 2005 Caprini/Davison risk assessment model is the most appropriate model for risk stratification in plastic surgery patients. Newer oral anticoagulants hold promise. CONCLUSIONS: Preoperative risk stratification should be performed for all patients. Chemoprophylaxis should be considered in cases with a Caprini RAM score > 7 or in those with independent risk factors. Administering regional blocks for anaesthesia and avoiding full muscle paralysis help reduce the risk of VTE. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Association between gamma glutamyl transferase and insulin resistance markers in healthy obese children.

OBJECTIVE: To study the relationship of gamma glutamyl transferase (GGT) with insulin resistance markers [fasting insulin and Homeostasis Model Assessment of-insulin resistance (HOMA-IR)] and to assess the role of GGT as a determinant of insulin resistance in healthy obese children. MATERIAL AND METHODS: Fifty healthy obese children (boys and girls with mean age 9.2 +/- 0.73 and 8.8 +/- 0.74 years) born to diabetic mothers were studied. In all the subjects, anthropometric measurements viz, BMI and body weight were studied. The biochemical parameters analysed in fasting samples of subjects were plasma glucose, plasma insulin, serum GGT and calculation of HOMA-IR. RESULTS: The fifty studied subjects belonged to age group 8 to12 years. The difference in mean age of boys and girls was not significant (p = 0.09). Body weight values in all subjects ranged from 20 to 78 kgs and BMI values ranged from 14.5 to 42.1 Kg/m2. No significant difference was observed between body weight and BMI values when compared between boys and girls. A similar trend was observed in the values of biochemical parameters viz, fasting glucose, fasting insulin and HOMA-IR levels when compared between boys and girls (p = 0.72, p = 0.80, p = 0.59). Serum GGT correlated significantly with age, body weight, BMI, fasting insulin and HOMA-IR levels. HOMA-IR values also showed significant correlation with body weight, BMI, fasting glucose and fasting insulin levels. The association of GGT with fasting insulin and HOMA-IR levels was considerably significant compared to its association with other variables. The serum activity of GGT remained correlated with HOMA-IR even after removing the effect of BMI, weight and age on GGT values. The results showed that GGT is a determinant of HOMA-IR independently of age, BMI and weight. CONCLUSION: A correlation exists between GGT and insulin resistance markers. The observed correlation indicates that monitoring GGT and fasting insulin levels in obese children might serve to help prevent the development of diabetes in these children.