Effect of lipectomy on growth and development of hyperinsulinemia and hyperlipidemia in the Zucker rat.

The Zucker fat rat inherits obesity and hyperinsulinemia, exhibits insulin resistance, and is, therefore, a model of adult onset, or type II, diabetes. The purpose of this study was to determine if excision of fat depots from the infant Zucker (fa+/fa+) rat would affect growth, fat cell number, hyperinsulinism, and hyperlipidemia. In the experimental design, 10 percent of the total body weight (inguinal and interscapular depots) was excised at 6 weeks of age from 18 fat and 18 lean (fa+/fa-) litter mates, with 18 fat and 18 lean rats serving as nonoperated controls. At intervals, serum glucose, insulin, cholesterol, and triglycerides were measured. Initially, the operated fat group was significantly (p < 0.01) lighter than the nonoperated group. By 9 weeks postoperatively, the operated fat rat group had regained weight and continued to grow at the same rate as the nonoperated fat rats because of intra-abdominal fat depots. Lipectomy had no effect on growth rate of the lean rat group. Although lipectomy caused no consistent change in serum glucose or insulin levels, it caused a significant decrease in lipid levels. For example, the operated fat rats had a reduction in cholesterol from 876 to 171 mg/dl by 15 weeks postoperatively, and serum cholesterol persisted at about 50 percent of the nonoperated group throughout the rest of the study (38 weeks postoperatively). Even a greater reduction in triglyceride levels occurred, for example, from 7415 to 1082 mg/dl at 24 weeks postoperatively. Lipectomy did not cause a change in lipid levels in the lean group. It is concluded that the lipectomy in the Zucker fat group is an excellent model to evaluate the effects of changes in fat cell number on lipid metabolism.

Complications of breast reconstruction.

The discovery of modern techniques of breast reconstruction paralleled two major advancements in plastic and reconstructive surgery. The first was the identification of areas of cutaneous perfusion through underlying muscles, and the recognition that entire muscles could be rotated into new positions on a vascular pedicle of one dominant artery and vein. The use of the latissimus dorsi musculocutaneous flap and a silicone breast implant to simulate the breast mound was the first truly elegant solution to a problem that had perplexed reconstructive surgeons for centuries. The second discovery was the Radovan tissue expander. The placement of the tissue expander underneath the chest wall muscles and its gradual expansion with stretching of the overlying tissues also provided a theoretically simple technique for breast mound reconstruction.

Iliohypogastric nerve entrapment following abdominoplasty.

This is a case report of iliohypogastric nerve entrapment following abdominoplasty with plication of the anterior rectus sheath. Persistent lower abdominal pain postoperatively following abdominal surgery despite a negative gastrointestinal and/or gynecologic workup should alert the surgeon to the possibility of iliohypogastric or ilioinguinal nerve entrapment. Diagnosis is confirmed when there are pain and sensory impairment in the distribution of the nerve with relief of pain following nerve block. Treatment consists of neurectomy with proximal resection into the retroperitoneum to avoid painful recurrent neuroma within the ventral abdominal wall. Prevention of injury is best accomplished with thorough understanding of the course of the nerve in the lower abdomen.

Weight loss with vertical banded gastroplasty and Roux-Y gastric bypass for morbid obesity with selective versus random assignment.

In a previous study, Roux-Y gastric bypass was found to be significantly more effective than vertical banded gastroplasty for weight loss in morbid obesity, especially for patients addicted to sweets, probably as a result of dumping syndrome symptoms. This study evaluated the ability to selectively assign nonsweet eaters to vertical banded gastroplasty and sweet eaters to gastric bypass. Compared with random assignment, the percentage excess weight lost at 2 years improved significantly with both groups combined. In the vertical banded gastroplasty group, the percentage increased from 41 +/- 19 to 55 +/- 19 percent. With selective assignment, the percentage excess weight lost with gastric bypass was still better than that with vertical banded gastroplasty. Weight loss with gastric bypass was still superior to that of vertical banded gastroplasty but at the expense of more complications. Gastric bypass was ineffective in 19 percent of the super obese patients. A combined restrictive, malabsorptive procedure may be necessary in such persons.