ABSTRACT
BACKGROUND: Obesity is associated with autonomic imbalance. With respect to cardiovascular autonomic dysfunction, this is characterized by reduced heart rate variability (HRV). Our objective was to determine the effect of surgically induced weight loss on cardiovascular autonomic nerve fiber function in subjects with severe obesity and examine whether an association with reduced insulin resistance exists. The setting was a hospital and private practice in the United States. METHODS: A total of 32 morbidly obese patients (body mass index 51 ± 11 kg/m(2)) underwent laparoscopic Roux-en-Y gastric bypass. Measures of HRV (e.g., power spectral analysis, RR variation during deep breathing) were used to evaluate autonomic function before and 6 months after surgery. The homeostasis model assessment of insulin resistance index (HOMA-IR) was used to assess insulin resistance. RESULTS: At 6 months after bariatric surgery, the patients had lost 58% excess body mass index with improvement in the HOMA-IR (3.0 ± 1.4 versus 1.1 ± .7; P < .001). Measures of RR variation during deep breathing and total spectral power, low frequency (LF) power (influenced by sympathetic and parasympathetic activity), and high frequency (HF) power (parasympathetic activity) increased with weight loss. The LF/HF ratio was lower (1.5 ± 1.5 versus .9 ± .7, P < .05) with a reduction in weight. Spectral analysis of HRV combined with spectral analysis of respiratory activity generated the respiration frequency area (RFA) and low frequency area. The RFA was increased, and the LFA/RFA ratio was reduced with weight loss. HOMA-IR and HRV did not correlate. CONCLUSION: Surgically induced weight loss has a favorable effect on autonomic function, but it does not appear to be directly attributable to reduced insulin resistance.
Subject(s)
Arrhythmias, Cardiac/surgery , Autonomic Nervous System Diseases/surgery , Gastric Bypass , Laparoscopy , Obesity, Morbid/surgery , Weight Loss/physiology , Adult , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , Autonomic Nervous System Diseases/etiology , Autonomic Nervous System Diseases/physiopathology , Female , Heart Rate/physiology , Homeostasis/physiology , Humans , Insulin Resistance/physiology , Male , Obesity, Morbid/physiopathology , Prospective Studies , Respiratory Rate/physiologyABSTRACT
BACKGROUND: Osteocalcin (OC), a protein synthesized by osteoblasts, is a marker of bone turnover with undercarboxylated OC (ucOC) being involved in glucose homeostasis. Although laparoscopic Roux-en-Y gastric bypass (LRYGB)-induced weight loss likely alters bone turnover, data on markers of bone turnover remain less clear. The aim of this study was to examine the effect of surgically induced weight loss on OC and ucOC. METHODS: A total of 32 individuals with a body mass index 50.2±10.2 kg/m(2) underwent LRYGB. Osteocalcin, ucOC, other blood analytes (e.g., vitamin D, leptin, total and high-molecular-weight adiponectin), and homeostasis model assessment for insulin resistance were measured before and after weight loss. The effect of an acute nutrient load on OC parameters after a mixed meal tolerance test also was assessed. RESULTS: Six months after surgery, there was an increase in OC (17.8±7.4 [mean±SD] [baseline] versus 31.5±9.8 ng/mL [follow-up]; P<.001) and ucOC (7.3±6.2 versus 18.5±8.9 ng/mL; P<.001). Although adiponectin increased, only the magnitude of change in OC and leptin was correlated (r =-.43; P = .017). After weight loss, an acute nutrient load reduced OC (31.5±9.8 [0-hour] versus 29.6±8.2 [2-hour] ng/mL; P = .024), whereas ucOC was higher (18.8±9.3 [0-hour] versus 21.1±8.6 [2-hour] ng/mL; P< .001). CONCLUSION: Surgically induced weight loss was associated with increases in OC and ucOC. Underlying mechanisms are unclear, but change in OC may be related to change in leptin. After a nutrient load, the increase in ucOC suggests a potential role as a short-term compensatory regulator of glucose homeostasis.
Subject(s)
Bone Remodeling/physiology , Gastric Bypass/methods , Obesity, Morbid/surgery , Osteocalcin/blood , Weight Loss/physiology , Adult , Anastomosis, Roux-en-Y/methods , Biomarkers/blood , Blood Glucose/analysis , Body Mass Index , Cohort Studies , Female , Follow-Up Studies , Gastric Bypass/adverse effects , Humans , Laparoscopy/methods , Male , Middle Aged , Obesity, Morbid/metabolism , Osteocalcin/metabolism , Postoperative Care , Preoperative Care , Sensitivity and Specificity , Time Factors , Treatment OutcomeABSTRACT
Colonic lipomas are infrequent lesions, yet they are the second most common benign lesions of the colon after benign adenomatous polyps. Their treatment ranges from observation to segmental colectomy and has been a matter of debate since Bauer first reported them in 1757. With the advent of new technologies, therapeutic options now include observation, endoscopic removal, laparoscopic removal, and traditional open surgery. We present a case of colonic lipoma presenting with indeterminate symptomatology, its workup, treatment outcome, and a review of the current literature.
Subject(s)
Colonic Neoplasms/surgery , Laparoscopy , Lipoma/surgery , Female , Humans , Middle Aged , Treatment OutcomeABSTRACT
BACKGROUND: The current study was undertaken to define the learning curve for laparoscopic splenectomy (LS) in patients with immune thrombocytopenic purpura (ITP). METHODS: The data of 50 patients who underwent LS for ITP between March 1996 and February 2003 were reviewed. Patients were divided into sequential groups of 10. Operative time, estimated blood loss, conversion to open procedure, length of stay (LOS), time to oral intake, complications, and mortality rates were analyzed. RESULTS: The mean OR time in the 3rd, 4th, and 5th groups of 10 were significantly shorter than the 1st and 2nd groups of 10. There were no significant differences in estimated blood loss, LOS, or time to oral intake between the groups. Three conversions to open splenectomy occurred; one each in the 2nd, 3rd, and 4th groups of 10. Complications were evenly distributed between groups. There were no deaths. CONCLUSION: The learning curve for LS in patients with ITP is a minimum of 20 cases.
Subject(s)
Laparoscopy/methods , Purpura, Thrombocytopenic/surgery , Splenectomy/methods , Adult , Aged , Blood Loss, Surgical , Clinical Competence , Female , Follow-Up Studies , Humans , Laparoscopy/adverse effects , Length of Stay , Male , Middle Aged , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/methods , Postoperative Complications/epidemiology , Purpura, Thrombocytopenic/diagnosis , Retrospective Studies , Risk Assessment , Sampling Studies , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: We hypothesized that intravenous methylene blue will facilitate adrenal gland identification and resection during laparoscopic adrenalectomy. METHODS: Five mini-Hanford pigs were anesthetized and monitored per an approved Internal Review Board protocol. Timing of color changes in the adrenals was recorded after administering methylene blue at three different doses: 2.5 mg/kg, 5.0 mg/kg, and 7.5 mg/kg. The time required for laparoscopic adrenalectomy with and without methylene blue was recorded. RESULTS: No color change occurred after the 2.5 mg/kg dose. For the 7.5 mg/kg versus the 5.0 mg/kg dose there was a more rapid bluish color change (mean time, 1.89 minutes versus 3.45 minutes; P = 0.03) and a longer duration of bluish color change (mean time, 12.20 minutes versus 6.19 minutes; P = 0.01). Laparoscopic adrenalectomy using methylene blue resulted in a 34.5% faster median resection time (10.13 minutes versus 15.47 minutes). CONCLUSIONS: Methylene blue concentrates in the adrenal glands and facilitates identification and resection of the adrenal glands by a laparoscopic approach.
