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在 polycystic 定义 bariatric 外科的角色卵巢的症候群病人

World Journal of Diabetes 2012年第4期3卷 71-79页

作者： Shaveta M Malik Michael L Traub Michael L Traub Department of Obstetrics and GynecologyStaten Island University Hospital Island Reproductive Services Staten IslandNY 10314United States

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women.To meet PCOS criteria,women must have a combination of hyperandrogenism,anovulation and ultrasound findings.Almost 10% of all reproductive age women worldwide show signs of PCOS.Although women often seek care for gynecological or body image concerns,many PCOS women are at risk for metabolic syndrome (MS).Many of the metabolic consequences are overlooked and un-dertreated by physicians because these patients tend to be young,reproductive age women.MS and obesity coexist commonly with PCOS.These young women are predisposed to glucose abnormalities and ulti-mately diabetes mellitus,dyslipidemia and eventually cardiovascular disease.bariatric surgery can be an ef-fective means of weight loss in PCOS women.Surgical techniques have become safer and less invasive over time and have been found to be effective in achieving significant weight loss.Surgical options have also in-creased,giving patients more choices.bariatric surgery may prevent or reverse metabolic syndrome.bariatric surgery may also have reproductive benefits in PCOS patients.Although bariatric surgery has historically been performed in older,reproductive aged women,it has recently gained favor in adolescents as well.This is of particular importance due to the prevalence of both PCOS and MS in adolescents.Treatment of PCOS and MS certainly requires a combination of medical therapy,psychological support and lifestyle modifications.These treatments are difficult and often frustrating for pa-tients and physicians.bariatric surgery can be effective in achieving significant weight loss,restoration of the hypothalamic pituitary axis,reduction of cardiovascular risk and even in improving pregnancy outcomes.Ulti-mately,bariatric surgery should be considered part of the treatment in PCOS women,especially in those with MS.

关键词： Polycystic ovarian syndrome Metabolic syn-drome bariatric surgery Obesity Pregnancy Infertility

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Psychiatric Complications of Obesity and Its Treatment: A Brief Review

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Open Journal of Psychiatry 2019年第4期9卷 267-280页

作者： Ghanem Al Hassani Amir A. Mufaddel Al Ain Hospital Al Ain UAE Department of Internal Medicine Division of Psychiatry Tawam Hospital Al Ain UAE.

Obesity—defined as a body mass index (BMI) of 30 kg/m2 or more—is associated with a wide range of medical and psychiatric complications. Physical co-morbidities include: insulin resistance, type 2 diabetes mellitus, dyslipidemia, asthma, hypertension, coronary heart disease, osteoarthritis of the knee and polycystic ovary syndrome. Mental health problems are particularly more common among individuals presenting for treatment of obesity than those in the community. They have higher rates of depression, anxiety, increased substance abuse and an increased prevalence in eating disorders. It has been estimated that up to 60% of extremely obese individuals have been suffering from an Axis I psychiatric disorder;most commonly mood and anxiety disorders. Obstructive sleep apnea (OSA) can occur with obesity and can also lead to sleep disorders and psychiatric complications. Up to 40% of patients with sleep apnea were found to have affective disorder or alcohol abuse. Weight loss medications and surgery may add to the problem of psychological complications of obesity. For example, in 2008, rimonabant development was discontinued by manufacturer as it has been associated with an increased risk of adverse psychiatric events including suicidal ideation and suicidal behavior. On the other hand, the prevalence of obesity is also high among patents with psychiatric illness, which can be caused by the effects of psychotropic medications which can lead to increased appetite, weight gain, sedation and psychomotor retardation. Obesity is reported in more than 60% of patients with schizophrenia and bipolar disorder. Food intake is regulated by several neurotransmitters, peptides and amino acids. Antipsychotics which block dopamine D2 receptors increase appetite and result in significant weight gain, while drugs that increase brain dopamine concentration are anorexigenic.

关键词： Obesity Psychiatric Complications Anxiety Depression Mood Disorder Sleep Apnea bariatric Surgery Antipsychotics

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Relationships between Emotional Well-Being, Patient Activation and Social Support among Adults with Severe Obesity Who Have Undergone Gastric Bypass Surgery

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Open Journal of Nursing 2015年第7期5卷 596-604页

作者： Hege Solberg Morten Aarflot Liv Heidi Skotnes Marit Graue Department of Medicine North-Tr&oslashndelag Health Trust Namsos Hospital Namsos Norway Faculty of Health and Social Sciences Centre for Evidence-Based Practice Bergen University College Bergen Norway Department of Pediatrics Haukeland University Hospital Bergen Norway

Objective: To examine the relationship between emotional well-being, patient activation and social support in a cohort of adults with severe obesity who underwent gastric bypass surgery from January to December 2012. Design: Cross-sectional survey. Subjects: Of a total population of 129 people, aged 18 - 68 years, at a local hospital in central Norway, 64 (50%) responding to the questionnaire, 52 (81%) being women. Main Outcome Measures: The World Health Organization—Five Well-Being Index (WHO-5), the 13-item Patient Activation Measure (PAM-13), a 16-item instrument on the frequency and content of social support, and demographic and clinical data. Results: A significant positive association was found between higher level of patient activation and better emotional well-being (P = 0.02) in linear regression analysis. A higher level of family support was significantly associated with better emotional well-being (practical social support from the family (P = 0.04), emotional social support from family (P = 0.01) and from friends (P = 0.005)). Conclusion: Screening tools for emotional well-being should be used systematically in postoperative consultations to recognize those who need a more individually tailored post-surgery follow-up care after gastric bypass surgery. In addition, health care providers in both specialist and primary health care settings should consider assessing the level of social support as part of regular follow-up routines.

关键词： Emotional Well-Being Social Support Obesity Diabetes bariatric Surgery

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Complications, Mineral and Vitamin Deficiencies: Comparison between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

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Surgical Science 2013年第12期4卷 547-553页

作者： Nina Sauer Jan Wienecke Clarissa Schulze zur Wiesfch Stefan Wolter Oliver Mann Jens Aberle Department for Endocrinology and Diabetology University Hospital Hamburg Eppendorf (UKE) Hamburg Germany Department for Visceral and Abdominal Surgery University Hospital Hamburg Eppendorf (UKE) Hamburg Germany

Objective: Nutritional deficiencies are known side-effects of bariatric surgeries, specifically in those that bypass the proximal intestine. Therefore, in clinical practice, vitamin and mineral supplementations are often necessary after such operations. It was our intention to evaluate, whether alimentary deficiencies occur with the same frequency in patients following Sleeve-Gastrectomy (SG) compared to Roux-en-Y Gastric Bypass (RYGB) surgeries. Methods: We conducted a retrospective data analysis of 171 patients (121 RYGB, 50 SG). Vitamin levels were compared between SG and RYGB patients over the first post-operative year. Furthermore, regression analysis was performed with regard to vitamin and iron supplementations and their recommended dosages. Complications occurring within the first post-surgical year were documented as well. Results: Other than vitamin B6 deficiency, which was found to be more frequent in SG patients, there was no other significant difference regarding the type of operation and the number of patients who had these deficiencies. There was no significant difference in average vitamin and iron levels between RYGB and SG. A minimum dose of 1000 IU vitamin D per day was necessary to affect vitamin D levels. The intramuscular administration of vitamin B12 was the only route found to be effective. Complications within the first year were rare. Conclusions: Against common assumptions, vitamin and iron deficiencies in SG patients are not less frequent in the first post-surgical year?in comparison to RYGB patients. Standard supplementations should include iron in premenopausal women: Vitamin D at least 1000 IU per day and vitamin B12 i.m. administration in case of a deficiency.

关键词： Nutritional Deficiencies Vitamin Supplementation bariatric Surgery

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Roux-en-Y gastric bypass remains as the reference technique for morbid obesity

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中华肥胖与代谢病电子杂志 2017年第1期3卷 1-6页

作者： Almino C Ramos Eduardo L. S. Bastos Gastro-Obeso-Center Advanced Institute Sao Paulo Brazil

Overweight and obesity has more than doubled in the last 30 years, affecting people worldwide and bringing a high morbidity, mortality, and cost of treatment of obesity-related diseases[1-2]. bariatric surgery has been the most effective way for morbidly obese patients, with a longstanding weight loss and improvement or resolution of comorbidities, which is clearly better in comparison with clinical management[3-6]. Over the last decades, there have been several technical options to treat morbid obesity surgically, and the Roux-en-Y gastric bypass (RYGB) has survived the time sieve and be considered as referral procedure.

关键词： bariatric surgery Roux-en-Y gastric bypass Obesity

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Morbid Obesity: A Review on the Reasons for Impediments to Physical Exercises and Social Activities

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Modern Plastic Surgery 2020年第3期10卷 93-100页

作者： José Humberto Cardoso Resende Mattheus Duarte da Veiga Jardim Brena Thamyres de Andrade Irineu Leydeane Rosa Gomes Gontijo Lucas Radi Cruvinel Zeno Augusto de Sousa Neto Rodrigo Gonç alves de Oliveira Daniel Soares de Araújo Emídio Silva Falcã o Brasileiro UNIFAN Work Coordinator Aparecida de Goi&#226 nia Brazil UNIFAN Academics of Medicine Aparecida de Goi&#226 nia Brazil UNIFAN Research Coordinator Aparecida de Goi&#226 nia Brazil

Morbid obesity is regarded as a disease due to excess body weight, causing a silence of life as a whole and entailing the most varied disabilities for the person, such as: physical, social, psychological, affective, etc. It represents cases of “public health”, thereby involving competent bodies in the development of solutions that encompass various medical specialties and other health fields, in addition to influencing the mind of these people, causing depression that, due to metabolic involvement, can evolve to the death of the individual. The participation of multidisciplinary health focuses on weight loss, freely and spontaneously, or on the indication of bariatric surgery. We know how difficult it is to lose weight. In order to achieve successful procedures, we recommend the “Obese Workshop” or pre- and post-surgical follow-ups close to the patients, with a view to avoiding recurrences or the “accordion effect” (very common), which can interfere with the Body Mass Index (BMI). Everyone, males and females, complained of tiredness and the impossibility of any physical exercise, even the lightest and simplest to be performed, in addition to the fact that they cannot attend gyms and are unable to open a simple door handle.

关键词： Obesity Hypertension Diabetes bariatric Illness Physical Exercise

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Obesity research: Status quo and future outlooks

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World Journal of Translational Medicine 2014年第3期3卷 119-132页

作者： Alexander T El Gammal Anna Dupree Stefan Wolter Jens Aberle Jakob R Izbicki Cenap Güngr Oliver Mann Department of General Visceral and Thoracic Surgery University Medical Center Hamburg-Eppendorf Department of Endocrinology and Diabetology University Medical Center Hamburg-Eppendorf

Obesity is a multifactorial disease showing a pandemic increase within the last decades in developing, and developed countries. It is associated with several severe comorbidities such as type Ⅱ diabetes, hypertension, sleep apnea, non-alcoholic steatosis hepatis and cancer. Due to the increasing number of overweight individuals worldwide, research in the field of obesity has become more vital than ever. Currently, great efforts are spend to understand this complex disease from a biological, psychological and sociological angle. Further insights of obesity research come from bariatric surgery that provides new information regarding hormonal changes during weight loss. The initiation of programs for obesity treatment, both interventional and pharmaceutical, are being pursued with the fullest intensity. Currently, bariatric surgery is the most effective therapy for weight loss and resolution of comorbidities in morbid obese patients. Reasons for weight loss and remission of comorbidities following Roux-en-Y-Gastric Bypass,Sleeve Gastrectomy, and other bariatric procedures are therefore under intense investigation. In this review, however, we will focus on obesity treatment, highlighting new insights and future trends of gut hormone research, the relation of obesity and cancer development via the obesity induced chronic state of inflammation, and new potential concepts of interventional and conservative obesity treatment.

关键词： Obesity Cancer Gut hormones bariatric surgery

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What makes a gastric bypass a good gastric bypass? Opinion and hypothesis

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World Journal of Surgical Procedures 2014年第2期4卷 48-54页

作者： Richard S Stubbs Rohit Sarvepalli The Wakefield Clinic for Gastrointestinal Diseases Wakefield HospitalWellington 6242New Zealand

Gastric bypass is widely accepted as the gold standard bariatric operation.It was first reported 1967 and has been the subject of many technical alterations and variations since that time.Each of these variations has the potential to confer different outcomes,in terms of such things as weight loss,ease of surgery,risk,complications and durability of weight loss.All variations being performed these days should be accomplished with high levels of safety,in which case the primary interest of those undergoing surgery is the degree of weight loss that can be expected and the durability of that weight loss.Broadly speaking these two features will also determine the degree to which all co-morbidities are improved,which is also a goal of those undergoing surgery.In this article the authors describe the features of the Fobi Pouch gastric bypass which make it the most predictable and reliable variant of gastric bypass and report such evidence in the literature as exists for their contentions.

关键词： Gastric Bypass Roux Y gastric bypass bariatric surgery Weight loss surgery

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The Long Magenstrasse with pyloroplasty as functional gastric bypass: 6-years experience, 308 operations

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Health 2010年第8期2卷 935-940页

作者： Carlo Vassallo Giovanni Berbiglia Matteo Carena 不详

Background: The Long Magenstrasse with py-loroplasty as functional Gastric Bypass (briefly LMGBP) procedure for morbid obesity may re- duce the incidence of side effects associated with gastric restrictive and malabsorptive sur- gery, particularly on quality of life and long-term nutritional insufficiency. In follow-up to pre- liminary findings in 34 patients, we report the results of an additional 274 LMGBPs performed over the past 3 years. Methods: Between October 2003 and 2009, 308 patients were treated with the LMGBP. 149 patients underwent open procedures;74, hand-assisted laparoscopic surgery (HALS);and 85 were operated laparo-scopically. 17% had ≥ 125 mg/dl glycemia, 43% sleep apnea, 38% hyperlipidemia, 12% hyperuricemia, and 58% arterial hypertension under treatment. Results: The mean BMI of 256 pre-operatively normoglycemic patients at 1 year was 29 (range 26-31);27 (25-30) in 45 patients at 3 years;and 27.5 (26-30) in 12 patients at 5 years. Mean BMI of 53 preoperatively hyperglycemic patients (≥ 125 mg/dl) at 1 year (21 patients) was 32 (29-34), and at 3 years (9 patients), 32.5 (30- 33). 15 patients with preoperative type 2 diabetes under oral treatment required no therapy 3-6 months after surgery. Patients reported considerable appetite reduction with rapid satiety but maintained good nutrition with no supplementation. There was no mortality. Conclusions: Safe and effective sustained weight loss, positive metabolic changes, and appetite diminution with rapid satiety were seen after LMGBP.

关键词： Morbid Obesity bariatric Surgery Partial Vagotomy Pyloroplasty Magenstrasse and Mill Gastric Bypass

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The Long Magenstrasse in the Treatment of Super Obese Patients (Results over 5 Years after Surgery)

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Surgical Science 2013年第10期4卷 469-473页

作者： Giovanni Berbiglia Mario Martinotti Gian Matteo Carena Elena Palamarciuc Marina Fariseo Carlo Vassallo Chirurgia II Istituto Clinico “Città di Pavia” Pavia Italy Dipartimento di Chirurgia Generale “Istituti Ospitalieri” Cremona Italy

Background: The considerable increase in Obesity and especially the increase in super obese patients (Body Mass Index—BMI ≥ 50 Kg/m2) who require surgery lead doctors to search for surgery techniques which give good results in terms of a consistent and stable weight loss associated with low morbidity and good quality of life. The Long Magenstrasse (LM) intervention, born from combining two properly modified surgical procedures (Selective Vagotomy with pyloric divulsion and Mangestrasse & Mill by Johnston) seems to have these characteristics according to our experience after operating on 660 patients. Methods: From October 2003 to October 2008 we treated 186 patients with LM. One hundred and sixty-two patients were regularly present to the annual follow-up, but 24 patients didn’t turn up, therefore, they were contacted by phone. On average, surgery lasted approximately 80 minutes (range: 50 - 90 minutes). Thirty patients were super obese with an average BMI of 57.4 Kg/m2;156 patients were grade II and III obese with an average BMI of 40.7 Kg/m2. Results: The average BMI of the 30 super obese patients decreased from 57.4 Kg/m2 to 35.9 Kg/m2 one year after surgery, to 35.6, 5 years after surgery and it has remained stable until now. In the 156 patients suffering from II and III grade obesity, the average BMI decreased from 40.7 Kg/m2 to 27.8 Kg/m2 one year after surgery and it has remained stable until now. Out of all super obese diabetic patients, only one has partially maintained his/her therapy. Patients have reported a decreased appetite since the very first days of post-operative period with an early sense of satiety which is unchanged until today. Conclusions: A consistent and stable weight loss over 5 years after surgery even in Super Obese patients, a decrease in appetite with an early sense of satiety, a re-equilibrium of the metabolic syndrome in particular of Diabetes Mellitus, allow to classify LM among those surgical treatments with a mixed mechanism of action: both restrictive and functional, in partic

关键词： Super Obesity bariatric Surgery Magenstrasse and Mill Sleeve Gastrectomy Gastric Partition Gastric Bypass

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