This longitudinal study was aimed to evaluate the electromyographic activity (EMG) of the masticatory muscles during mandibular tasks in women with grade II and III obesity, who were eligible for bariatric surgery. Twenty-one patients were followed up for 3 and 6 months after the Roux-en-Y gastric bypass. The EMG included analyses of the masseter and temporalis muscles during rest, right and left laterality, protrusion, and dental clenching at maximal voluntary contraction with and without parafilm. Data were tabulated and submitted for statistical analysis using the repeated measures test (P<0.05) with the Bonferroni post-test. Significant differences were observed between the right temporal muscle during maximal voluntary contraction (P=0.003) and maximal voluntary contraction with Parafilm M for the right masseter (P=0.01), left masseter (P=0.03), right temporal (P=0.002), and left temporal (P=0.03) muscles. There was gradual decrease in the resting EMG of the masticatory muscles 6 months after surgery. There was an increase in the EMG of the muscles that are the most active in the neuroanatomical movements of laterality and protrusion 6 months after surgery. There was an increase in EMG in maximal voluntary contraction with and without parafilm, 3 and 6 months after surgery. This study suggests that women with severe obesity who underwent bariatric surgery had better functional results of the masticatory muscles 3 and 6 months after the procedure, which is an important parameter in surgical planning, functional recovery, and nutritional status.
- Klíčová slova
- Bariatric surgery, Electromyography, Masseter muscle, Obesity, Temporal muscles,
- MeSH
- bariatrická chirurgie metody MeSH
- dospělí MeSH
- elektromyografie * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- longitudinální studie MeSH
- morbidní obezita chirurgie patofyziologie MeSH
- musculus masseter * patofyziologie MeSH
- musculus temporalis * patofyziologie MeSH
- obezita patofyziologie chirurgie MeSH
- svalová kontrakce fyziologie MeSH
- žaludeční bypass metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The endoscopically implanted duodenal-jejunal bypass liner (DJBL) is an attractive alternative to bariatric surgery for obese diabetic patients. This article aims to study dynamical aspects of the glycaemic profile that may influence DJBL effects. METHODS: Thirty patients underwent DJBL implantation and were followed for 10 months. Continuous glucose monitoring (CGM) was performed before implantation and at month 10. Dynamical variables from CGM were measured: coefficient of variation of glycaemia, mean amplitude of glycaemic excursions (MAGE), detrended fluctuation analysis (DFA), % of time with glycaemia under 6.1 mmol/L (TU6.1), area over 7.8 mmol/L (AO7.8) and time in range. We analysed the correlation between changes in both anthropometric (body mass index, BMI and waist circumference) and metabolic (fasting blood glucose, FBG and HbA1c) variables and dynamical CGM-derived metrics and searched for variables in the basal CGM that could predict successful outcomes. RESULTS: There was a poor correlation between anthropometric and metabolic outcomes. There was a strong correlation between anthropometric changes and changes in glycaemic tonic control (∆BMI-∆TU6.1: rho = - 0.67, P < .01) and between metabolic outcomes and glycaemic phasic control (∆FBG-∆AO7.8: r = .60, P < .01). Basal AO7.8 was a powerful predictor of successful metabolic outcome (0.85 in patients with AO7.8 above the median vs 0.31 in patients with AO7.8 below the median: Chi-squared = 5.67, P = .02). CONCLUSIONS: In our population, anthropometric outcomes of DJBL correlate with improvement in tonic control of glycaemia, while metabolic outcomes correlate preferentially with improvement in phasic control. Assessment of basal phasic control may help in candidate profiling for DJBL implantation.
- Klíčová slova
- continuous glucose monitoring, detrended fluctuation analysis (DFA), diabesity, duodenal-jejunal bypass liner (DJBL), metabolic surgery, type 2 diabetes mellitus,
- MeSH
- biologické markery analýza MeSH
- diabetes mellitus 2. typu komplikace chirurgie MeSH
- dospělí MeSH
- duodenum chirurgie MeSH
- glykovaný hemoglobin analýza MeSH
- hmotnostní úbytek MeSH
- jejunum chirurgie MeSH
- krevní glukóza analýza MeSH
- lidé středního věku MeSH
- lidé MeSH
- metabolický syndrom etiologie prevence a kontrola MeSH
- morbidní obezita patofyziologie chirurgie MeSH
- následné studie MeSH
- prognóza MeSH
- senioři MeSH
- žaludeční bypass metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- biologické markery MeSH
- glykovaný hemoglobin MeSH
- hemoglobin A1c protein, human MeSH Prohlížeč
- krevní glukóza MeSH
BACKGROUND Obesity and associated comorbidities increase the probability of sexual disorders. The present study evaluated sexual satisfaction levels in obese women prior to and following bariatric surgery, utilizing the validated Female Sexual Function Index (FSFI) to also evaluate the sexual satisfaction in obese and non-obese women. MATERIAL AND METHODS 60 obese women (mean initial BMI of 43.7±5.9 kg/m²; mean age of 41.7±10.8 years) were administered the questionnaire on sexual function (FSFI) preceding bariatric surgery (laparoscopic adjustable gastric banding, 22 women; gastric plication, 33 women; and biliopancreatic diversion, 5 women), 6 months and 12 months after the procedure, i.e., following substantial weight reduction (final mean BMI of 35.5±5.5 kg/m²). The control group comprised 60 non-obese women (mean BMI of 22.2±1.9kg/m²; mean age of 36.4±10.7 years). RESULTS Our findings indicate that baseline sexual function in the preoperative obese females was significantly lower than in non-obese women, with p<0.01 in each domain. Data gathered at the 6- and 12-month points following the procedure indicated no significant difference. Before the procedure, 31 obese subjects (51.6%) exceeded the cutoff for FSD, at the 6-month evaluation point, 17 women (39.5%) exceeded the cutoff, and at 12 months postoperatively, 18 subjects (41.9%) exceeded the cutoff, indicative of FSD. Among the non-obese controls, only 9 subjects (15%) exceeded the cutoff threshold. CONCLUSIONS These findings show that substantive weight reduction resulting from bariatric surgery results in reduced sexual dysfunction in female subjects.
- MeSH
- bariatrická chirurgie * MeSH
- dospělí MeSH
- hmotnostní úbytek MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- morbidní obezita patofyziologie chirurgie MeSH
- obezita patofyziologie chirurgie MeSH
- orgasmus fyziologie MeSH
- průzkumy a dotazníky MeSH
- sexuální dysfunkce fyziologická patofyziologie chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The surgical technique of laparoscopic sleeve gastrectomy (LSG) has not been fully standardized yet and there is the unresolved question of what is the optimum size of retained pyloric antrum. The aim of our research was to prove that even after a radical resection of the pyloric antrum the physiological stomach evacuation function can still be preserved. METHODS: Our study was based on 12 patients, who were randomly divided into two groups. Patients undergoing radical antrum resection (RA group) underwent gastric emptying scintigraphy to determine the evacuation half-time (T1/2) and food retention in the 90th minute of the test (%GE) both before the operation and 3 months afterward. Patients in whom the antrum was preserved (PA group) served as a control group for comparison of postoperative weight loss (in kilogram), decrease in body mass index (BMI), and decline in excess weight (%EWL). The resulting changes were statistically processed. RESULTS: In the RA group, the average time T1/2 declined from 57.5 to 32.25 min (p = 0.016) and average retention %GE dropped from 20.5 to 9.5% (p = 0.073). Differences in the average values of weight, BMI, or %EWL between both groups were of no statistical significance (p > 0.8). CONCLUSIONS: In the RA group, an increase in gastric emptying postoperatively was noted. Complications such as failure of stomach evacuation were not observed in the RA group. Our results suggest that even more radical resection of the pyloric antrum performed by LSG is possible without concerns of postoperative disorder of the stomach evacuation function.
- MeSH
- analýza rozptylu MeSH
- antrum pyloricum diagnostické zobrazování patofyziologie chirurgie MeSH
- dospělí MeSH
- gastroplastika metody MeSH
- hmotnostní úbytek MeSH
- index tělesné hmotnosti MeSH
- laparoskopie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- morbidní obezita patofyziologie chirurgie MeSH
- následné studie MeSH
- pilotní projekty MeSH
- radioisotopová scintigrafie MeSH
- tělesná hmotnost MeSH
- vyprazdňování žaludku * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: Laparoscopic greater curvature plication (LGCP) is a new metabolic/bariatric surgical procedure that requires no resection, bypass, or implantable device. We report LGCP outcomes in 244 morbidly obese patients. METHODS: Between 2010 and 2011, patients underwent LGCP. Body mass index (BMI, kilogram per square meter) evolution, excess BMI loss (%EBMIL), excess weight loss (%EWL), complications, and type 2 diabetes mellitus (T2DM) changes were recorded. Repeated-measures analysis of variance (ANOVA) was used to assess weight change at 6, 12, and 18 months. Subgroup analyses were conducted to provide benchmark outcomes at 6 months. Logistic regression was used to identify characteristics predictive of suboptimal weight loss. RESULTS: Mean baseline BMI (±SD) was 41.4 ± 5.5 (80.7 % women, mean age 46.1 ± 11.0 years, 68 [27.9 %] patients had T2DM). Mean operative time was 70.6 min; mean hospitalization, 36 h (24-72). Sixty-eight patients (27.9 %) experienced postoperative nausea and/or vomiting that was controlled within 36 h. There was no mortality. Major complication rate was 1.2 % (n = 3). Repeated-measures ANOVA indicated significant weight loss across time points (p < 0.001). At 6 months (n = 105), BMI, %EBMIL, and %EWL were 36.1 ± 4.7, 34.8 ± 17.3, and 31.8 ± 15.9. Preoperative BMI was the only predictor of weight loss. Patients with BMI <40 lost more weight than those ≥40, although by 9 months, differences were no longer significant. In patients with preoperative BMI <40, 18-month %EWL approached 50 % and %EBMIL exceeded 50 %. At 6 months, 96.9 % of patients' T2DM was significantly improved/resolved. CONCLUSIONS: Over the short term, LGCP results in effective weight loss and significant T2DM reduction with a very low rate of complications.
- MeSH
- analýza rozptylu MeSH
- diabetes mellitus 2. typu krev komplikace patofyziologie MeSH
- gastroplastika škodlivé účinky metody MeSH
- hmotnostní úbytek MeSH
- index tělesné hmotnosti MeSH
- laparoskopie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- morbidní obezita krev komplikace patofyziologie chirurgie MeSH
- následné studie MeSH
- prospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Intraband pressure (IBP) measurement may be a less invasive method to assess esophageal motility response to band adjustment and restrictive integrity of the device in Swedish adjustable gastric band (SAGB) patients. However, the relationship between IBP and esophageal function is not yet established. Our aim was to characterize in vivo IBP-peristalsis associations in SAGB patients. Ten patients in their second postoperative year were prospectively recruited. IBP was measured via percutaneous port, and concurrent esophageal manometry was performed using an 8-channel catheter. Contraction length and amplitude were measured with both methods. The IBP-peristalsis correlation was computed using the R-square of the regression analysis (R (2)) for band volumes ranging from 4 to 9 mL. One hundred ten swallows were studied. Excellent IBP-peristalsis correlation was observed in 6 of 10 patients (267 contractions): contraction length R (2) = 0.8537 and amplitude R (2) = 0.7365 (p-value of slope < 0.001). Mean contraction length was 17 +/- 7 (4-42) s for manometry and 18 +/- 7 (5-43) s for IBP. Mean amplitude was 55 +/- 55 (9-209) mm Hg for manometry and 67 +/- 47 (7-190) mm Hg for IBP. A weak IBP-peristalsis correlation was observed in the remaining four patients: two had impaired lower sphincter relaxation, one had band slippage, and one had disruption of the port needle connection. In vivo IBP measurement may be reliable in the assessment of esophageal peristalsis in response to band adjustments and the restrictive integrity of the device in patients with intact esophageal function. More studies are warranted to completely assess the potential for IBP to be indicative of the presence of band-related complications.
- MeSH
- dolní jícnový svěrač fyziologie MeSH
- dospělí MeSH
- ezofágus fyziologie MeSH
- gastrointestinální motilita MeSH
- gastroplastika * MeSH
- lidé středního věku MeSH
- lidé MeSH
- manometrie MeSH
- morbidní obezita patofyziologie chirurgie MeSH
- peristaltika fyziologie MeSH
- polykání fyziologie MeSH
- poruchy motility jícnu diagnóza etiologie MeSH
- prospektivní studie MeSH
- tlak MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
INTRODUCTION: Gastric banding for morbid obesity is among the least mutilating of procedures used in bariatric surgery and is classified as a restrictive surgical method. Although it is widespread, so far, however the mechanism responsible has not been fully explained. METHODS AND RESULTS: The authors present the preliminary results from scintigraphic examination of the evacuation ability of the stomach using food labeled with (99m)Tc-colloid in six obese patients with a gastric bandage. This initial study showed that the functionality of the bandage demonstrated as a significant drop in body weight, is connected with slower evacuation of the stomach. However, the use of adjustable bandages would have significantly slowed and restricted the passage of food through the cardia of the stomach. CONCLUSIONS: Since it can be extremely difficult to adequately objectively determine the functionality of gastric bandages, evaluating the gastric emptying scintigraphy may be useful in fulfilling this purpose.
- MeSH
- dospělí MeSH
- gastroplastika * MeSH
- hmotnostní úbytek MeSH
- lidé středního věku MeSH
- lidé MeSH
- morbidní obezita diagnostické zobrazování patofyziologie chirurgie MeSH
- radioisotopová scintigrafie MeSH
- vyprazdňování žaludku * MeSH
- žaludek diagnostické zobrazování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Overweight and obesity are connected with increased risk of obesity related co-morbidities, such as T2DM, hypertension, cardiovascular diseases, dyslipidaemia and others, as well as in higher risk of some malignant diseases. In obese population there is 2.5-3.3 fold increased risk of renal cell carcinoma in comparison with non-obese population of similar age. It has been proven in many studies that for severely obese patients there is no other more effective treatment of their obesity and co-morbidities than bariatric. Bariatric surgery decreases mortality risks, treat existing, obesity related co-morbidities, and can act as prevention of onset of new obesity related co-morbidities. Moreover at the end bariatric surgery lowers economic burden of health care systems. Nowadays, bariatric surgery is considered to be standard treatment option and pathway in complex management of morbidly obese patients.
Percutaneous electrogastrography (EGG) is a non-invasive measuring method of gastric myoelectrical activity. We measured myoelectrical activity patients after laparoscopic cholecystectomy (16 patients), after laparotomic cholecystectomy (9 patients) and after gastric bandage (14 patients). We used a Microdigitrapper (Medtronic) and data were analysed with a spectral analysis and Fournier's transformation. We measured 24 hours and 5 hours before operation procedure and 24 and 48 hours after operation. After operative procedure we compared results with healthy voluntaries. Bradygastria was found in most frequent cases in early postoperative period. Physiologic conditions were renewed in laparoscopic operative procedure in first day, after laparotomic operation in second day after operation.
- MeSH
- cholecystektomie laparoskopická * MeSH
- cholecystektomie * MeSH
- dospělí MeSH
- elektrofyziologie MeSH
- gastrointestinální motilita MeSH
- gastroplastika * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- migrující myoelektrický komplex MeSH
- morbidní obezita patofyziologie chirurgie MeSH
- prospektivní studie MeSH
- žaludek patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- práce podpořená grantem MeSH
AIM: To evaluate response of cardiovascular system in laparoscopic surgery. The main aim was: 1--comparison of healthy subjects and morbid obese population, 2--comparison of healthy subjects and cohort of patients with organic cardiopathy. Secondly we compared the influence of the operation position. PATIENTS AND METHODS: Patients (n = 17) were divided into 3 subgroups:--Control group of "normal" subjects: mean age 36.8 +/- 11.2 years; BMI 25.33 +/- 3.62; BSA 1.84 +/- 0.21 m2; two men and four women; op. diagnosis: 3x cholecystectomy, 1x appendectomy, 1x inguinal herniotomy, 1x hiatal hernia operation. --Group of patients with morbid obesity: mean age 38 +/- 8.1 years; BMI 45.82 +/- 7.54!; BSA 2.66 +/- 0.32 m2; one man and five women; all of them were operated for obesity (laparoscopic gastric banding).--Group of patients with severe cardiopathy: mean age 64.0 +/- 11.55; BMI 26.4 +/- 4.09; BSA 1.89 +/- 0.23; three men and two women; card. diagnosis: 2x aortic stenosis, 1x combined aortic valvulopathy, 1x aortic stenosis with secondary mitral regurgitation, 1x secondary mitral regurgitation (both caused by coronary artery disease); op. diagnosis: 4x cholecystectomy; 1x extraction of catheter for peritoneal dialysis. The method of our examination was transesophageal echocardiography with use of omni planar sond with continual monitoring of each patient. Our data are based on repeated measurements (3x minimal for each state and each patient) before and after peritoneal cavity insufflation and third after positioning of patient (in Trendelenburg or Fowler position). Examinations were recorded and data analysed off-line. Following parameters were analysed: mean age, BMI, BSA, heart rate, mean arterial pressure (MAP), ejection fraction of left ventricle (EF), E/A ratio of transmitral flow, cardiac output (CO), cardiac index (CI), systemic (peripheral) vascular resistance (SVR) and pressure-rate-product (PRP). For statistical analysis were used: ANOVA tests, t-tests with Benforroni correction and Friedman's tests. RESULTS AND DISCUSSION: In comparison of normal and obese patients statistically significant differences were found (after exclusion of BMI and BSA) in cardiac output values, after recalculation on body surface (cardiac index) remained only non-significant trend to fall. Differences between control group and group of cardiacs were also non significant with exclusion of E/A ratio of transmitral flow. This result we explain by pseudonormalization. All 17 operations were successfully done without any complication. CONCLUSIONS: Our data were obtained on relatively small cohort of patients but the number of patients was respected by statistics and results might be borderline but significant. Laparoscopic gastric band (operation is done in semi-sitting position) in morbid obese patients is well tolerated without any differences in comparison to healthy population. The population of patients with severe organic cardiopathy needs careful approach. Our data are favourable but significant change in the left ventricle filling together with non-significant hemodynamic disadvantageous trends in EF, CI and MAP requires care. Further investigations are needed and with intraoperative monitoring (transesophageal echocardiography is preferred) can be considered as safe.
- MeSH
- dospělí MeSH
- echokardiografie transezofageální MeSH
- hemodynamika * MeSH
- index tělesné hmotnosti MeSH
- laparoskopie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- morbidní obezita patofyziologie chirurgie MeSH
- nemoci srdce patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
