Meralgia paresthetica following bariatric surgery.

BACKGROUND: Two papers in the literature have described meralgia paresthetica following bariatric surgery. One author ascribed the cause of the condition to pressure from an abdominal retractor. We encountered 11 similar cases in our bariatric surgery practice, but do not use the retractor previously invoked as the cause of the problem. It seems likely that some other factor is involved. METHODS: Retrospective chart review. RESULTS: 11 patients were identified whose symptoms and clinical findings were consistent with meralgia paresthetica. There were 6 men and 5 women. Symptoms developed immediately following surgery in 8 cases, and resolved spontaneously within 3 months in 6 of these. CONCLUSIONS: Multiple causes have been described for meralgia paresthetica. It appears to be more common in obese patients. While extrinsic pressure from an abdominal retractor may play a role in some cases, other factors are clearly involved in the cases reported here.

A comparison of body size evaluations of obesity surgery patients and general population adults.

OBJECTIVE: To compare post-operative obesity surgery patients and general population adults in their assessments of a wide range of body sizes. RESEARCH METHODS AND PROCEDURES: Obesity surgery patients (n = 274) and general population adults (n = 326) rated ideal and socially acceptable body sizes in separate arrays of babies, children, young adults, and middle-aged and older adults. Nine line figure drawings ranging from very thin to very obese were rated for each array. RESULTS: Both groups selected the same ideal body size for all arrays except for babies. Both groups rejected obese and very thin body sizes as socially acceptable. However, the obesity surgery patients were more restrictive than general population adults in their ratings of socially acceptable body sizes. Current obesity status did not impact ratings for the patient or general population subjects. In the patient sample, time since surgery did not influence body size evaluations. DISCUSSION: The study of body size ratings limited only to the "ideal" size may be misleading because it may mask subtle but meaningful differences between groups. The consistent difference in more restrictive ratings of obesity surgery patients compared to general population adults may be due to patients' greater psychological investment in endorsing the societal ideal body size. It may also be due to patients' status as peripheral group members of the normal weight community. The inability of some patients to maintain their post-operative weight loss may be particularly problematic for those who have defined "socially acceptable" body size most narrowly.

Perforated peptic ulcer following gastric bypass for obesity.

Peptic ulcer in the excluded segment of a gastric bypass performed in the management of morbid obesity has only rarely been reported in the literature. The purpose of this study is to review our experience with the condition in a series of 4300 patients who underwent gastric-restrictive surgery between 1978 and 1997. Eleven patients presented with acute perforation of a peptic ulcer in the excluded gastric segment. Nine ulcers were duodenal, one was gastric, and one patient had both gastric and duodenal perforations. The time between primary gastric-restrictive surgery and ulcer perforation varied from 20 days to 12 years. All patients presented with upper abdominal pain. The classical radiological sign of perforated peptic ulcer, free air under the diaphragm, did not occur in any patient. Nine patients were initially treated by primary closure of the perforation with subsequent definitive ulcer therapy by vagotomy, pyloroplasty, or gastrectomy. One case, initially treated elsewhere, was managed by placement of a Malecot catheter through the duodenal perforation, gastrostomy, and peritoneal drainage. One recent case remains symptom-free on H2 blockers after simple closure. There was no mortality. Six cases were previously reported in the literature with a 33 per cent mortality rate.

The night eating syndrome in the general population and among postoperative obesity surgery patients.

OBJECTIVE: To determine the prevalence of night-eating syndrome in the general population and among a new sample of obesity surgery patients. METHODS: Night-eating syndrome was defined by presence of morning anorexia, excessive evening eating, evening tension and/or feeling upset, and insomnia. A randomly selected sample of 2,097 adults (survey sample) answered structured interview questions on night-eating syndrome. A self-report form was completed by 111 patients who had received gastric restriction surgery for obesity at a patient reunion (patient sample). RESULTS: Prevalence of night-eating syndrome in the survey sample was 1.5% (31 of 2,097). Prevalence in the patient sample was 27% (30 of 111). Weights for subjects in each sample, with and without the syndrome, were comparable. DISCUSSION: Prevalence of night-eating syndrome was higher in the patient sample than in the survey sample. Within each sample, presence of the syndrome was not related to weight. Prevalence in the survey sample was within the range reported for binge-eating disorder. Night-eating syndrome may warrant consideration as a distinct eating disorder.

No association between non-steroidal anti-inflammatory drugs and acute appendicitis in a case-control study.

BACKGROUND: A recent case-control study reported an association between non-steroidal anti-inflammatory drug (NSAID) use and acute appendicitis. This association was investigated in a case-control study of patients, aged 30 years and over, admitted as an emergency to hospitals in Tayside between 1989 and 1992, who had appendicectomy for acute appendicitis. METHODS: A record-linkage database containing records of dispensed prescriptions and hospital admissions was used. A total of 223 patients were identified. The medical records of 161 were checked, of which 138 were valid cases, and information on white cell count and NSAID exposure was recorded. Community and hospital controls were generated. RESULTS: Some 9.0 per cent of patients were prescribed NSAIDs within 90 days of hospitalization, compared with 7.6 per cent of community controls and 11.5 per cent of hospital controls. The odds ratio was 1.21 (95 per cent confidence interval 0.73-2.01) and 0.75 (0.43-1.32) respectively. There was no significant difference in white cell count between exposed and non-exposed cases. No increased risk of appendicectomy was associated with aspirin use: odds ratio 1.67 (0.52-5.30) and 0.37 (0.12-1.13) using community and hospital controls respectively. CONCLUSION: Appendicectomy for acute appendicitis is not associated with increased prior use of NSAIDs.

Body size preferences and desired weight of patients who have received obesity surgery and of comparison adults.

Patients who had received obesity surgery (n = 144) and comparison adults (n = 72) selected the most attractive male and female size and the same-sex size they most wanted to look like from an array of 15 outline drawings. Subjects also reported their height, and current and desired weights (transformed into body mass index units [BMI]). There was a remarkable consensus on the sizes considered most attractive: Two male sizes were chosen by 78% of all subjects, and two female sizes by 83%. The hypothesis that adults who had obesity surgery would idealize thin sizes and, therefore, select thinner sizes and lower weights than comparison adults was not supported. Not only did patients and comparison adults select the same desired size, but women patients desired significantly larger BMIs than comparison women. There was a large range of desired BMIs associated with each desired size; the correlation between desired BMI and desired size was significant for women but not for men. It was speculated that subjects' desired size reflected cultural norms while subjects' desired BMI was a function of their current weight. Health professionals working in weight loss and/or physical fitness areas need to help clients understand weight-size relationships so that clients can have both realistic weight and realistic size goals.

A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss.

BACKGROUND: Previous studies have documented a high incidence of gallstone formation following gastric-bypass (GBP)-induced rapid weight loss in morbidly obese patients. This study was designed to determine if a 6-month regimen of prophylactic ursodiol might prevent the development of gallstones. METHODS: A multicenter, randomized, double-blind, prospective trial evaluated 3 oral doses of ursodiol: 300, 600, and 1,200 mg versus placebo beginning within 10 days after surgery and continuing for 6 months or until gallstone development, for patients with a body mass index (BMI) > or = 40 kg/m2. All patients had normal intraoperative gallbladder sonography. Transabdominal sonography was obtained at 2, 4, and 6 months following surgery, or until gallstone formation. RESULTS: Of 233 patients with at least one postoperative sonogram, 56 were randomized to placebo, 53 to 300 mg ursodiol, 61 to 600 mg ursodiol, and 63 to 1,200 mg ursodiol. Preoperative age, sex, race, weight, BMI, and postoperative weight loss were not significantly different between groups. Gallstone formation occurred at 6 months in 32%, 13%, 2%, and 6% of the patients on the respective doses. Gallstones were significantly (P < 0.001) less frequent with ursodiol 600 and 1,200 mg than with placebo. CONCLUSION: A daily dose of 600 mg ursodiol is effective prophylaxis for gallstone formation following GBP-induced rapid weight loss.

Adolescents having obesity surgery: a 6-year follow-up.

Thirty-four adolescents aged 11 to 19 at the time of gastric surgery for obesity were interviewed an average of 6 years postoperatively. Patients' preoperative body mass index averaged 47; at follow-up, their body mass index averaged 32. Two thirds of the patients weighed within 9 kg of their lowest postsurgical weight at the time of follow-up; three had had additional obesity surgery. Patients reported excellent psychosocial adjustment, including improved self-esteem, social relationships, and appearance. No patient was unemployed. Patients reported poor compliance with exercise and dietary instructions. More seriously, only four patients reported taking vitamin B12, multivitamin supplements, and calcium as directed. The need for long-term patient commitment and monitoring is discussed.

Gastric surgery in morbid obesity. Outcome in patients aged 55 years and older.

OBJECTIVE: To evaluate long-term outcome of gastric restrictive surgery in morbidly obese patients aged 55 years and older. DESIGN: Retrospective review with 3- to 13-year postoperative follow-up. Average follow-up 6 years. SETTING: Private surgical practice with bariatric surgery specialty. STUDY PARTICIPANTS: Eighty-eight morbidity obese patients, 73 women and 15 men, aged 55 years and older. INTERVENTION: Between 1977 and 1989, 77 patients had Roux-en-Y gastric bypass, four had vertical banded gastroplasty, and seven had silicone ring vertical gastroplasty. MAIN OUTCOME MEASURES: Weight loss, change in incidence of comorbidity, and reduction in medication use. RESULTS: Patients had an average of 57% excess body weight loss, lost 31 kg, and decreased their body mass index by 12 kg/m2. There was a 20% to 48% reduction in the number of patients requiring medication for obesity-related disorders (eg, diabetes mellitus and hypertension). Body mass index of less than 30 kg/m2 was achieved and maintained by 42% of patients. CONCLUSION: This form of therapy is appropriate for selected patients in the older age groups.

Characterization of glucose-6-phosphatase in hepatocytes. Effects of amiloride and pentamidine.

The hepatic microsomal glucose-6-phosphatase enzyme is situated inside the lumen of the endoplasmic reticulum and, for normal enzyme activity in vivo, three transport systems are needed for the substrate glucose-6-phosphate and the products phosphate and glucose. Previous studies using isolated microsomes showed that the drugs amiloride and pentamidine do not affect the glucose-6-phosphatase enzyme but can activate the glucose-6-phosphate transport system. Here we demonstrate that, very surprisingly, the addition of pentamidine (and to a lesser extent amiloride) to isolated hepatocytes results in an inhibition of the catalytic subunit of glucose-6-phosphatase.

Successful weight loss following obesity surgery and the perceived liability of morbid obesity.

Patients (n = 47) who lost 45 kg (100 lb) or more and who successfully maintained weight loss for at least three years following gastric restrictive surgery for morbid obesity viewed their previous morbidly obese state as having been extremely distressful. In spite of the strong proclivity for people to evaluate their own worst handicap as less disabling than other handicaps, patients said they would prefer to be normal weight with a major handicap (deaf, dyslexic, diabetic, legally blind, very bad acne, heart disease, one leg amputated) than to be morbidly obese. All patients said they would rather be normal weight than a morbidly obese multi-millionaire.

Morbidly obese patients' perceptions of social discrimination before and after surgery for obesity.

Morbidly obese patients' perceptions of obesity-related prejudice and discrimination were assessed before and 14 months after operation for obesity. Preoperatively, the 57 consecutive patients perceived overwhelming prejudice and discrimination at work, within the family, and in public places. After a weight loss of more than 45.5 kg (100 lb), these patients perceived little or no prejudice or discrimination. We examine factors contributing to the change in patients' perceptions and comment upon patients' perceptions of the negative attitudes held by health professionals toward obese patients.

Eating behavior after gastric bypass surgery for obesity.

We studied eating behavior in two non-overlapping cohorts of consecutive patients electing gastric bypass surgery for obesity: 100 patients one year after operation and 60 patients three years afterward. Information was obtained through structured interviews and from office charts. Eating behavior was compared with previously collected data on 232 morbidly obese adults and 174 adults of normal weight. Despite an average weight loss of 100 lb (45 kg), there was little evidence of disturbed eating patterns among gastric bypass patients. Significantly fewer gastric bypass patients than morbidly obese comparison subjects reported frequent hunger, overeating, guilt about eating, or food preoccupation. Gastric bypass patients reported less preoccupation with food than did the normal-weight comparison subjects.