Quality of life in morbid obesity.

INTRODUCTION: Morbid obesity (MO) is a chronic disease that is reaching epidemic proportions and becoming an increasing health problem in developed countries. Obesity-related comorbidities reduce both the quality and expectancy of life. OBJECTIVES: To validate the GIQLI (Gastrointestinal Quality of Life Index) test as a reliable and effective tool for the evaluation of quality of life in morbidly obese patients. PATIENTS AND METHODS: The GIQLI test is made up of 36 individually scored items, the addition of which give up a final score. A higher score correlates with a better quality of life. Items can be separated into five groups or dimensions: digestive symptoms, emotional status, effects of treatment, and physical as well as social dysfunction. The GIQLI test was administered to a randomized sample of 1990 morbidly obese patients who fulfilled the indication criteria for bariatric surgery, and to a control group of 100 healthy individuals with no known medical, functional or psychiatric disease. Overall test and specific dimension scores were evaluated for each group. RESULTS: Overall test and specific dimension scores were significantly lower in patients with MO when compared to the control group. The overall GIQLI score decreased as age increased, as did the number of associated comorbidities. CONCLUSIONS: The GIQLI test proved to be a rather useful tool to evaluate quality of life in morbidly obese patients. These patients present a poorer quality of life not only because of the presence of digestive symptoms but also because of their emotional, physical, and social status.

Calidad de vida en la obesidad mórbida / Quality of life in morbid obesity

Introducción: la obesidad mórbida (OM) es una enfermedadcrónica que alcanza dimensiones epidémicas en los países desarrollados.La OM suele acompañarse de enfermedades graves asociadasque provocan una menor expectativa y peor calidad de vida.Objetivos: validar el cuestionario GIQLI (GastrointestinalQuality of Life Index) como herramienta fiable y eficaz en la evaluaciónde la calidad de vida en el paciente obeso mórbido.Pacientes y métodos: el cuestionario GIQLI consta de 36ítems cuya suma de cada puntuación individual otorga un valor final.A mayor puntuación, mejor calidad de vida. Dichos ítems seagrupan en 5 apartados: sintomatología digestiva, emocional,efectos sobre el tratamiento, disfunción física y social. Se ha aplicadoel GIQLI a una muestra aleatoria de 190 pacientes afectosde OM que cumplían los requisitos necesarios para someterse a cirugíabariátrica, y a un grupo control de 100 individuos sanos sinenfermedades orgánicas, funcionales, ni psíquicas conocidas. Seevaluó, en cada grupo, tanto la puntuación global del cuestionariocomo aquellas que hacían referencia a sus apartados específicos.Resultados: las puntuaciones fueron significativamente inferioresen los pacientes con OM frente al grupo control, tanto en lapuntuación global del cuestionario como en todas sus dimensiones.La puntuación global GIQLI disminuyó en función de la edady del número de enfermedades comórbidas asociadas.Conclusiones: el cuestionario GICLI se ha mostrado comouna herramienta útil en la valoración de la calidad de vida en elpaciente obeso mórbido. Los pacientes con OM tienen una peorpercepción en su calidad de vida que los pacientes no obesos, nosólo en cuanto a la presencia de síntomas digestivos, sino tambiénen la dimensión emocional, estado físico y vida de relación social

Introduction: morbid obesity (MO) is a chronic disease that isreaching epidemic proportions and becoming an increasing healthproblem in developed countries. Obesity-related comorbidities reduceboth the quality and expectancy of life.Objectives: to validate the GIQLI (Gastrointestinal Quality ofLife Index) test as a reliable and effective tool for the evaluation ofquality of life in morbidly obese patients.Patients and methods: the GIQLI test is made up of 36 individuallyscored items, the addition of which give up a final score.A higher score correlates with a better quality of life. Items can beseparated into five groups or dimensions: digestive symptoms,emotional status, effects of treatment, and physical as well as socialdysfunction. The GIQLI test was administered to a randomizedsample of 1990 morbidly obese patients who fulfilled the indicationcriteria for bariatric surgery, and to a control group of100 healthy individuals with no known medical, functional or psychiatricdisease. Overall test and specific dimension scores wereevaluated for each group.Results: overall test and specific dimension scores were significantlylower in patients with MO when compared to the controlgroup. The overall GIQLI score decreased as age increased, as didthe number of associated comorbidities.Conclusions: the GIQLI test proved to be a rather useful toolto evaluate quality of life in morbidly obese patients. These patientspresent a poorer quality of life not only because of the presenceof digestive symptoms but also because of their emotional,physical, and social status

Early onset of organ failure is the best predictor of mortality in acute pancreatitis.

BACKGROUND: APACHE II is a multifactorial scoring system for predicting severity in acute pancreatitis (AP). Organ failure (OF) has been correlated with mortality in AP. OBJECTIVE: To evaluate the usefulness of APACHE II as an early predictor of severity in AP, its correlation with OF, and the relevance of an early establishment of OF during the course of AP. PATIENTS AND METHODS: From January 1999 to November 2001, 447 consecutive cases of AP were studied. APACHE II scores and Atlanta criteria were used for defining severity and OF. RESULTS: Twenty-five percent of patients had severe acute pancreatitis (SAP). APACHE II at 24 h after admission showed a sensitivity, specificity, and positive and negative predictive value of 52, 77, 46, and 84%, respectively, for predicting severity. Mortality for SAP was 20.5%. Seventy percent of patients who developed OF did so within the first 24 hours of admission, and their mortality was 52%. Mortality was statistically significant (p< 0.01) if OF was established within the first 24 hours after admission. CONCLUSIONS: APACHE II is not reliable for predicting outcome within the first 24 hours after admission and should therefore be used together with other methods. OF mostly develops within the first days after admission, if ever. The time of onset of OF is the most accurate and reliable method for predicting death risk in AP.

Apendagitis epiploica primaria / Primary epiploic appendix inflammation

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[Results of cephalic pancreaticoduodenectomy in patients with chronic pancreatitis]. / Resultados de la duodenopancreatectomía cefálica en los pacientes con pancreatitis crónica.

OBJECTIVE: To analyse the results obtained after cephalic pancreatoduodenectomy in patients with severe chronic pancreatitis. DESIGN: Retrospective study of indications and results of the intervention.Patients. The inclusion criteria were severe anatomic alteration of the head of the pancreas associated with refractory pain. Pancreatoduodenectomy was performed in 19 patients. RESULTS: Four patients had postoperative morbidity, and the mean hospital stay was 15 days. One patient died in the postoperative period. The pain evolution after surgery was: total control in 72% and satisfactory control in the remaining patients. During follow-up, de novo diabetes was detected in two patients, difficulty in maintaining weight in one patient, and de novo steatorrhea in four patients. CONCLUSIONS: Cephalic pancreatoduodenectomy is a good therapeutic alternative for the treatment of patients with chronic pancreatitis, refractory pain, and severe involvement of the pancreas head. Pain control is excellent and sequelae, such as diabetes or steatorrhea, are easily amenable to medical treatment.

Resultados de la duodenopancreatectomía cefálica en los pacientes con pancreatitis crónica / Results of cephalic pancreatoduodenectomy in patients with chronic pancreatitis

Objetivo. Análisis de los resultados obtenidos tras la realización de una duodenopancreatectomía cefálica en pacientes con pancreatitis crónica grave. Diseño. Estudio retrospectivo de las indicaciones y resultados de la intervención. Pacientes. Los criterios de inclusión fueron la alteración anatómica grave de la cabeza pancreática asociada a dolor intratable. Se efectuó duodenopancreatectomía en 19 pacientes. Resultados. Cuatro pacientes presentaron morbilidad postoperatoria, siendo la estancia postoperatoria media de 15 días. Un paciente falleció en el postoperatorio. La evolución del dolor tras la intervención fue: de control total en el 72 por ciento y satisfactorio en el resto. Durante el seguimiento se detectó diabetes de novo en 2 pacientes, dificultad para mantener el peso en un caso y esteatorrea de novo en 4. Conclusiones. La duodenopancreatectomía cefálica es una buena alternativa terapéutica para el tratamiento de los pacientes con pancreatitis crónica, dolor intratable y afectación grave de la cabeza pancreática. El control del dolor es excelente y las secuelas como la diabetes o la esteatorrea son fácilmente controlables con tratamiento médico. (AU)