Influence of Large-Volume Liposuction on Metabolic and Cardiovascular Health: A Systematic Review.

BACKGROUND: Evidence suggesting that adipose tissue is a metabolically active tissue has generated debate on the effects of large-volume liposuction (LVL) on metabolic and cardiovascular health. Given the inconsistency in the literature, the authors performed a systematic review to identify available evidence in order to elucidate the potential impact of LVL on metabolic markers and cardiovascular risk factors. METHODS: A PubMed search using relevant keywords was conducted. Articles were screened using predetermined inclusion and exclusion criteria. Large-volume liposuction was defined as greater than 3.5 L of lipoaspirate. All studies included evaluation of patients' preoperative and postoperative cardiovascular risk factors, inflammatory cytokines, and/or insulin resistance/sensitivity. Relevant studies were evaluated and assigned a level of evidence. RESULTS: A total of 12 studies that met the inclusion criteria were reviewed, of which 1 was a continuation of a previous study. All reports were prospective studies, 2 were randomized control trials, and 3 included a control group. A total of 364 patients were pooled for analysis. The mean volume of lipoaspirate was 7440 ± 1934.9 mL. The mean body mass index at baseline and postliposuction was 30.7 and 28.4, respectively. Seven studies reported a trend toward decrease in total cholesterol levels with an overall mean reduction of 0.21 ± 0.05 mmol/L from 4.6 ± 0.79 mmol/L to 4.4 ± 0.74 mmol/L. After LVL, leptin was reported to significantly decrease in 4 studies, and TNF-α was reported to significantly decrease in 2. Adiponectin was reported to significantly increase in 2 studies. IL-6 decreased significantly in 2 studies. Two studies included participants with type II diabetes mellitus, whereas 10 studies evaluated insulin sensitivity. Of these, 6 studies reported improvement in insulin sensitivity. Six studies represented level IV and 6 represented level II evidence. CONCLUSIONS: Liposuction is among the most common aesthetic procedures performed with advances that make it possible to remove considerable amount of adipose tissue within a short period. Current data, although conflicting, appear to support the notion that LVL can affect cardiovascular risk factors, metabolic balance, and insulin resistance in positive ways. Future research with prospective studies is needed to clarify the role of LVL in improving overall health.

Long term speech outcomes following late cleft palate repair using the modified Furlow technique.

OBJECTIVES: Published reports and previous studies from our institution have reported worse overall speech results, including significantly higher rates of persistent articulation errors, in patients undergoing palatoplasty at age >18 months. This study further investigates the effects of late repair on long term speech outcomes. METHODS: A retrospective review was performed of non-syndromic patients undergoing primary palatoplasty at age >18 months between 1980 and 2006 at our institution. Longitudinal speech results were compared based on reason for late repair and age at repair. RESULTS: Forty-one patients were greater than 18 months of age at the time of palatoplasty, and 24 fit criteria for longitudinal data analysis. There was a statistically significant improvement in nasality scores at Time Point 1 for international adoptees compared to the non-adopted population (p=0.04). Patients with submucosal clefts were found to have significantly less severe nasal emission scores at Time Point 1 compared to those with overt clefts (p=0.04), but not at Time Point 2. There were no significant differences between scores if repair was performed between 18 and 36 months or >36 months, nor any difference in incidence of articulation errors between subgroups of patients with late repair at either Time Point. CONCLUSION: Our experience demonstrates that cleft palate repair after 18 months of age is associated with a significantly increased incidence of articulation errors associated with VPI, irrespective of reason for late repair, highlighting the persistence of learned compensatory behaviors in speech and the importance of proceeding with early repair.