Patient dose during radiological examination in the follow-up of bariatric surgery.

A patient dose survey was carried out measuring the kerma-area product (KAP) values during radiological evaluation in the follow-up of bariatric surgery. The procedures were performed by three radiologists to adjust laparoscopic gastric bands and to detect postoperative complications after Roux-en-Y gastric bypass procedures to treat morbid obesity. Total fluoroscopy time, exposure factors and the overall contribution of fluoroscopy to the accumulated KAP value were recorded. The median KAP values were used to estimate organ doses and effective dose to a standard patient; the radiation risk associated with the procedures was also evaluated. The doses were smaller for one of the three radiologists, owing to a more appropriate beam collimation and a reduction of the screening time. The KAP values ranged from 1.6 to 7.1 Gy cm(2) for the laparoscopic adjustable gastric banding management, and from 3.0 and 8.3 Gy cm(2) for the radiological examinations after gastric bypass. As a whole, the effective doses associated to these procedures were between 0.5 and 2.7 mSv. The organs receiving the highest doses were not only breast, stomach, pancreas and liver, but also lungs, owing to of their high radiosensitivity, significantly contributed to the effective dose.

Efficacy of the SF-36 questionnaire in identifying obese patients with psychological discomfort.

BACKGROUND: The primary endpoint of this study was to assess the association of health-related quality of life (QoL) and the presence of psychopathology. The association of other patients' characteristics and of Cognitive Behavioral Assessment (CBA) scales with quality of life (QoL) was also evaluated. METHODS: 100 consecutive obese patients (WHO grade 2 and 3 obesity), addressed for psychological advice before either invasive or non-invasive treatment of obesity, were investigated. The instruments used were the SF-36 questionnaire (physical and mental component summaries, PCS and MCS), the CBA scales and psychological counselling. The association of PCS and MCS with the presence of psychopathology (Marked or DSM IV discomfort) was assessed by means of logistic regression. RESULTS: SF-36 PCS was 39.5 (95% CI 37.7-41.3) and MCS 49.8 (95% CI 47.7-51.9). PCS only was significantly lower than the average for the reference normal population. The mean PCS score was similar in the No-Moderate (39.6 (SD 7.6)) and Marked-DSM IV (39.1 (SD 7.6)) groups, with an adjusted odds ratios (OR) of 1.07 (95% CI 0.74-1.55), P=0.706, for 5 points increase in PCS. The mean MCS score was 51.7 (SD 10.3) in the No-Moderate group and 42 (SD 8.1) in the Marked-DSM IV group, with an adjusted OR for 5 points increase in score of 0.63 (95% CI 0.43-0.95), P=0.003. CONCLUSIONS: SF-36, and particularly the MCS component, is a simple tool of easy use that could be utilized for identifying patients needing a specific psychological intervention in severely obese subjects applying for a weight reduction program.

Retrorectal tumours: a case report.

The authors describe a case of retrorectal tumour in a 48-year-old female. Retrorectal tumours are rare, and their diagnosis is notoriously difficult and late. In this case the first-step diagnosis was made on the basis of clinical findings and radiological investigations such as abdominal ultrasonography. The second step included pelvic CT scans and MR imaging which yielded more precise anatomical details and information for the best surgical approach. We opted for a posterior approach with complete, easy removal of the tumour mass which, after pathological examination, turned out to be an epidermoid cyst. The postoperative course was uneventful and, one year after operation, the patient complains only of mild, irregular perineal pain with completely negative radiological investigations (US and CT scan).

Weight loss after Swedish Adjustable Gastric Banding: relationships to insulin resistance and metabolic syndrome.

BACKGROUND: The metabolic syndrome is a cluster of cardiovascular risk factors (central obesity, hypertension, dyslipidemia, disturbance in glucose metabolism) associated with insulin-resistance. The cluster of risk factors defining the metabolic syndrome increases cardiovascular risk more than each single component. The aim of the present longitudinal study was to evaluate the relationship between weight loss and changes in insulin-resistance and in the prevalence of the metabolic syndrome 1-year after SAGB implantation. METHODS: 51 premenopausal severely obese women (mean age 35.2 +/- 8.8 years, BMI 43.3 +/- 6.9) were enrolled. As a control group, 51 premenopausal non-obese women (BMI < 30) were enrolled. All obese subjects underwent successful implantation of the SAGB via videolaparoscopy. In all subjects insulin-resistance was estimated by HOMA index and metabolic syndrome was defined according to the criteria of the European Group for the Study of Insulin Resistance. RESULTS: HOMA (4.2 +/- 2.0 vs 1.9 +/- 0.8, P < 0.001) and the prevalence of the metabolic syndrome (58.8% vs 7.8%, P < 0.001) were significantly higher in obese than non-obese women. 1 year after SAGB, BMI significantly decreased from 43.3 +/- 6.9 to 34.5 +/- 7.4 (P < 0.001). HOMA index showed a significant dramatic breakdown (4.2 +/- 2.0 vs 2.4 +/- 1.0, P < 0.001). The prevalence of the metabolic syndrome declined significantly (58.8% vs 21.6%, P < 0.001). CONCLUSION: Our study shows that in severely obese women, insulin-resistance and the prevalence of the metabolic syndrome significantly decrease 1 year after SAGB. Our findings indicate that SAGB could be a useful tool to reduce the global cardiovascular risk in severely obese people and to improve their long-term prognosis.