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H Nehoda

Publications and source records attributed to H Nehoda.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic gastric re-banding versus laparoscopic gastric bypass as a rescue operation for patients with pouch dilatation.

BACKGROUND: The authors assessed whether laparoscopic rebanding or laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the best approach for failed gastric banding after pouch dilatation. METHODS: Between January 2000 and June 2005, 489 patients underwent laparoscopic gastric banding, and of these, 33 (6.7%) required rescue procedures for pouch dilatation. Each reoperated patient was contacted to obtain information about their postoperative course. Additionally, preoperative weight and BMI, weight loss at 1 year postoperatively, weight at time of pouch dilatation and the time-period between the primary operation and pouch dilatation were analyzed. RESULTS: The most common operation for pouch dilatation was band repositioning or rebanding (16 patients). Band removal without replacement was performed in 7 patients. 8 patients underwent conversion to a LRYGBP. 1 patient underwent laparoscopic gastric sleeve resection and 1 patient received an intragastric balloon. Patients who underwent conversion to LRYGBP are very content and, although weight loss has been nearly the same as after gastric banding, they would prefer the gastric bypass operation to the gastric banding. CONCLUSION: Conversion to LRYGBP appears to offer significant advantages, and appears to be the rescue therapy of choice after failed laparoscopic gastric banding.

Dilatation, Pathologic↗
PubMed2004

Surgical revision after failure of laparoscopic adjustable gastric banding.

BACKGROUND: This paper reports the outcome of surgical revision for complications following laparoscopic placement of an adjustable silicone gastric band (AGB) to treat morbid obesity. METHODS: Seventy-three (19.1 per cent) of 382 patients who underwent laparoscopic AGB placement between January 1996 and March 2001 presented with complications within 6 years after operation. Revision was carried out with the intention of reinstating the functional device in all patients. RESULTS: Successful surgical revision or gradual balloon deflation was performed in 53 patients (29 port-related complications, 14 pouch dilatations, 12 band leakages, three oesophageal dilatations, two symptomatic hernias, one late migration, one intracerebral bleed). Of these patients, 51 (96.2 per cent) had a successful outcome according to the Bariatric Analysis and Reporting Outcome System following significant additional postinterventional weight loss. AGB removal was carried out in 20 patients (13 early or late migrations, five pouch dilatations, three port-related complications, two psychiatric disorders, one band leakage). The final failure rate for complicated AGB procedures was 30.1 per cent. CONCLUSION: AGB placement is associated with a variety of complications. In most cases surgical complications can be treated with minimally invasive surgery, which should allow further weight loss and improvement of quality of life during long-term follow-up. Alternative bariatric procedures should be reserved for patients with poor outcome after surgical revision of the AGB.

Adolescent↗
PubMed2004

Videobronchoscopic guidance makes percutaneous dilational tracheostomy safer.

BACKGROUND: Percutaneous dilational tracheostomy (PDT) can be performed under either conventional bronchoscopic or videobronchoscopic guidance. Only the latter procedure provides the surgeon with direct visual information. This study prospectively assessed procedural parameters and complications of PDT guided by conventional bronchoscopy (CB) or videobronchoscopy (VB). METHODS: Consecutive intensive care unit (ICU) patients who underwent PDT were enrolled in this study. Videobronchoscopy was available in two ICUs, whereas CB was available in three ICUs. Demographic data, procedural variables, and complications were recorded. RESULTS: In this study, 36 patients underwent PDT guided by VB (group V), and 38 patients underwent PDT guided by CB (group C). The two groups were well matched in terms of gender, anatomic aspects, and positioning of the patient. Operating time, procedural difficulty, and extent of tracheal bleeding were not different between the two groups. Group V showed a tendency to younger age (p = 0.055). Surgeons significantly more often considered PTD to be "completely safe" in group V (92% vs 61% in group C). The skin incisions were smaller (p = 0.003), and the extent of stomal bleeding was less (p = 0.001). Complications were tendentiously less frequent in group V (5.5%) than in group C (23.7%; p = 0.062). CONCLUSIONS: The surgeon performing PDT guided by VB has a higher degree of safety, resulting in less bleeding than with PDT guided by CB.

Adult↗
PubMed2004

Mechanical resistance of gastric bands - comparison between new bands and bands within the patient for at least two years.

BACKGROUND: Morbid obesity is a rapidly increasing health risk in industrialized countries, and is associated with serious co-morbidities. Since conservative medical therapies fail to sustain significant weight loss, adjustable gastric banding (AGB) has become an established therapy for morbid obesity. To our knowledge there have been no trials assessing whether gastric bands implanted in the patient for some time can withstand the same mechanical stress as a new band. METHODS: The mechanical resistance of unused and used gastric bands was tested through the Tensile Test, to evaluate if a material is strong and rigid enough to withstand the loads experienced in use. 9 bands were tested, 2 of which were unused. RESULTS: The tested new Swedish AGB (SAGB) resisted 361 Newtons (N, 36.8 kg) until tearing, and the new LAGB (Inamed) 157 N (16 kg). The 7 SAGB which had been in a patient for at least 2 years, pulled apart at a mechanical stress of 250.6 N (25.54 kg). CONCLUSION: The new SAGB had a higher mechanical tensile strength than any of the used bands placed in the body for 2 years.

Female↗
PubMed2003

Mediastinalemphysema after laparoscopic gastric banding.

From January 1996 to July 2001, 530 patients underwent a laparoscopic gastric banding operation at the University Hospital of Innsbruck. In one of these patients, a pneumomediastinum developed 17 months after surgery. Unable to swallow, the 28-year-old patient suddenly felt sick and reported left chest pain. Additionally, recurrent vomiting and later hematemesis were reported. A band migration was excluded via endoscopy. After the diagnosis of a mediastinalemphysema was established, the patient was treated conservatively. The causes of mediastinalemphysema are heterogeneous and sometimes not exactly clear. In our patient it is a question whether vomiting led to an esophageal tear, which in turn was responsible for the mediastinalemphysema.

Adult↗
PubMed2003

Plasma amine oxidase: a postulated cardiovascular risk factor in nondiabetic obese patients.

Increased activity of semicarbazide-sensitive plasma amine oxidase (SSAO), an enzyme converting various amines, has been implicated in the generation of endothelial damage through formation of cytotoxic reaction products. We investigated if SSAO activity is elevated in morbidly obese patients, which might contribute to the increased cardiovascular risk associated with obesity. SSAO activity was determined in 74 nondiabetic, obese patients (median body mass index [BMI]: 42.9 kg/m(2)) and in 32 healthy, non-obese controls (median BMI: 23.3 kg/m(2)) using a radiometric assay based on the conversion of [(14)C]benzylamine. SSAO and parameters of glucose and lipid metabolism were compared for subgroups of obese patients with normal (n = 49) and impaired (n = 25) glucose tolerance using nonparametric statistical tests. Median SSAO activity was 434 microU/mL in obese patients, which was significantly higher than in healthy, non-obese controls (median SSAO activity: 361 microU/mL). Median SSAO activity in patients with normal and impaired glucose tolerance was 423 and 464 microU/mL, respectively. SSAO activity was not correlated with any other clinical or laboratory parameters characteristic of the metabolic alterations associated with obesity. Elevated SSAO activity is found in nondiabetic, morbidly obese patients and might be an interesting independent risk factor for obesity-related cardiovascular morbidity. Long-term follow-up of SSAO and its possible role in pathogenic events is warranted since intervention with specific SSAO inhibitors is available.

Adult↗
PubMed2002

Markers of chronic inflammation and obesity: a prospective study on the reversibility of this association in middle-aged women undergoing weight loss by surgical intervention.

BACKGROUND: Human adipose tissue expresses and releases proinflammatory cytokines and these measures of chronic inflammation have recently been associated with obesity. HYPOTHESIS: To test whether the proinflammatory state is reversible in subjects undergoing weight loss by surgical measures. SUBJECTS AND METHODS: Twenty morbidly obese women participated in this prospective study. Subjects were examined for fat mass, high-sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) before and 1 y after Swedish adjustable gastric banding. RESULTS: Anthropometric measures displayed a significant reduction of the body mass index (BMI) from 41.6+/-5.4 to 30.8+/-6.1 kg/m(2) and the fat mass from 53.9+/-10.3 to 29.8+/-12.1 kg (mean+/-s.d.). Hs-CRP levels decreased significantly from 1.33+/-1.21 mg/dl in pre-gastric banding subjects to 0.40+/-0.61 mg/dl in post-gastric banding subjects, respectively. IL-6 and TNF-alpha levels did not differ significantly between pre- and post-gastric banding subjects. CONCLUSIONS: We speculate that in these patients the marked reduction in C-reactive protein might be beneficial in reducing their cardiovascular risk and is not solely mediated by IL-6 and TNF-alpha.

Adipose Tissue↗
PubMed2001

Adjustable gastric banding in a patient with sarcoidosis.

The use of silicone in patients with immune-compromising diseases is controversial because of fears that there may be inflammatory reactions against the material. We report the case of a patient who suffered from cutaneous sarcoidosis with bihilar lymphadenopathy and obesity (110 kg; BMI, 38 kg/m2) that was exaggerated by cortisone therapy. The patient underwent adjustable gastric banding because of aggravating comorbid hypertension and hyperlipidemia. Six months postoperatively, she had achieved an excess weight loss of 33%. During this period, she had a relapse of scar sarcoidosis of the right elbow and bilateral hilar lyphadenopathy. Although she was treated with a double dose of cortisone (8 mg daily), the scars from the laparoscopy as well as those in the gastric region adjacent to the band remained unaffected. We therefore believe that preexisting immune-compromising diseases are not an absolute contraindication against gastric banding, particularly since our patient experienced a notable improvement in her quality of life.

Adult↗
PubMed2001

Laparoscopic gastric banding in older patients.

HYPOTHESIS: Older patients experience the same benefits from a laparoscopic gastric banding (LGB) operation as younger patients. DESIGN: A case series of 320 morbidly obese and superobese patients who underwent LGB within a 46-month period. SETTING: University Hospital Innsbruck, General Surgical Department, Innsbruck, Austria. PATIENTS: A consecutive sample of 320 patients who met the criteria for a bariatric procedure and were aged 18 years or older. Patients were divided into the following 2 age groups: younger patients (group A, 18-49 years) and older patients (group B, > or =50 years). INTERVENTION: Laparoscopic gastric banding with an adjustable gastric band. MAIN OUTCOME MEASURES: Clinicopathologic features, including weight loss, complications, length of hospital stay, and operative times, were reviewed retrospectively, and a multivariate analysis was carried out. RESULTS: Of 320 patients, we identified 68 older patients (21.5%, group B). The mean postoperative follow-up period was 12 months (range, 6-28 months). The average preoperative weight was 127.8 kg (body mass index [calculated as weight in kilograms divided by the square of height in meters], 44.29). The average total weight loss was 4.3 kg per month for the first 3 months, reaching an average total of 31.0 kg after 1 year. The excess weight loss after 12 months was 68%. Complications requiring reoperation occurred in 10.3% of patients. Ninety-seven percent of the patients reported an improvement in their comorbid conditions. CONCLUSIONS: Older patients receive the same benefits from LGB as younger patients, with an acceptable postoperative complication rate. Presently, our upper age limit is 70 years.

Adolescent↗
PubMed2001

Increased tacrolimus levels during diarrhea.

While it is well known that diarrhea results in decreased trough levels of cyclosporin A, experience with levels of tacrolimus (FK506) and diarrhea is limited. We have therefore measured the tacrolimus trough levels of four male and two female recipients of solid organs before, during, and after gastroenteritis. The average age of these six patients was 31 (1-60) years. Four patients had received a kidney transplant, one patient had undergone simultaneous kidney-pancreas transplantation, and another patient had received a liver transplant. Rotavirus was identified in the feces specimen of a 1-year-old child that had undergone liver transplantation. All patients showed an elevated tacrolimus trough level (peak 20-60 ng/ml) after onset of gastroenteritis. Under symptomatic therapy and adequate adjustment of tacrolimus dose, the gastroenteritis stopped and tacrolimus levels returned to the therapeutic range. We recommend that FK506 levels be carefully monitored during diarrhea in order to prevent intoxication.

Adolescent↗
PubMed2001

Results and complications after adjustable gastric banding in a series of 250 patients.

BACKGROUND: Morbid obesity contributes to many health risks including physical, emotional, and social problems. The increasing prevalence of obesity is a major public health concern since obesity is associated with several chronic diseases. Morbid obesity is the biggest independent risk factor for early mortality. Various options for the surgical treatment of morbid obesity have been developed with varying results. METHODS: Between January 1996 and December 1999, we operated on a series of 250 patients (200 women and 50 men) at the General Surgical Department of the University Hospital in Innsbruck. The parameters that were evaluated included age, preoperative and postoperative body mass index (BMI), type of surgery, and intraoperative and postoperative complications. RESULTS: The mean follow-up period was 12 months (range 3 to 18). The average preoperative weight was 135.5 kg (BMI 46.69 kg/m(2)). The average total weight-loss was 5.5 kg per month, reaching an average total of 35 kg after one year. The excess weight loss (EWL) after 12 months was 72%. Complications requiring reoperation occurred in 8.8%. CONCLUSIONS: In the first year after laparoscopic adjustable gastric banding, weight reduction of the study population was excellent. Additionally, the complication rate was reasonable with no mortalities.

Adult↗
PubMed2001

Central liver hematomas caused by mountain-bike crashes.

BACKGROUND: Mountain biking, one of the most popular sports in recent years with more than 10 million riders, is implicated more and more in severe bike accidents with complicated injuries. In addition to head injuries, which are common and account for most of the fatalities, we have observed an increase in liver trauma over the years. METHOD: Approximately 19000 bike associated accidents were reported in 1998 in Austria. A total of 52 patients were admitted to our trauma ward between 1995 and 1997 with mountain-bike associated injuries. Of the 52, eight presented with subcapsular hematoma of the liver sustained by falling while riding. In all patients, nonoperative management was successful. These injuries were associated with a special form of bar-ends used on the mountain-bikes. After a broad response from the industry, facilitated by many articles in newspapers, life-style magazines, radio and television stations, this type of bar end has nearly vanished from the market. RESULTS: As a result, in 1998, only one case of liver injury was observed, and from 1999 to August 2000, no such injuries have been reported thus far.

Adolescent↗
PubMed2001

Improved scintigraphic assessment of occult leakages in adjustable gastric bands using 99mTc-labelled human albumin colloid.

BACKGROUND: Adjustable gastric banding has become the preferred procedure in Europe for the treatment of morbid obesity. A complication of this treatment is the presence of leakage in the system. The knowledge of the localization of the leak is essential for planning the reoperation procedure. PATIENTS AND METHODS: In a series of 325 adjustable gastric bandings, we observed 10 band leakages. In 3 cases, fluoroscopy failed to detect fluid extravasation. We present a sensitive and simple scintigraphic method for the detection of gastric band leakage in these patients using 37 MBq of a 99mTc-human albumin colloid suspension. Imaging was started immediately after the dose application. During the first minute, images were acquired dynamically with 1 frame every 2 seconds. Afterwards, a static image was obtained every 10 minutes, up to 60 minutes post-injection. Then the system was emptied completely to detect tracer extravasation and consecutive reabsorption during 60 minutes. The study was analyzed by using the regions of interest (ROI) technique drawn on the following points: injection reservoir, tube, anterior band, posterior band, and an adjacent region which was taken as background. RESULTS: During the first hour, ROI analysis showed a clear diminution in the number of counts contained in the defect parts of the band, whereas it remained constant in the other locations. After system emptying, detection of tracer extravasation further strengthened the diagnosis of band leakage in all patients. CONCLUSION: This new approach using the 99mTc-human albumin colloid suspension with ROI analysis is an effective and simple method to detect occult leakages in adjustable gastric bands which escaped detection by fluoroscopy. In contrast to previously described scintigraphic methods, this investigation is able to demonstrate the exact site of leakage.

Adult↗
PubMed2001

Pregnancies after adjustable gastric banding.

BACKGROUND: We evaluated outcome of pregnancies of morbidly obese women who are within the first 2 years after laparoscopic adjustable gastric banding. METHODS: 215 morbidly obese women of reproductive potential (age 18-45 years), who had agreed to remain on reliable contraceptives for 2 years after surgery, were retrospectively analyzed following bariatric surgery. RESULTS: 7 unexpected pregnancies were observed. 5 pregnancies were full-term (3 vaginal and 2 cesarean deliveries). The birth weights ranged from 2110 g to 3860 g. 2 women had first trimester miscarriages. All gastric bands were completely decompressed due to nausea and vomiting, resulting in further weight gain. 2 serious band complications were observed (1 intragastric band migration and 1 balloon defect), which required re-operation. CONCLUSIONS: Pregnancy in morbidly obese women soon after adjustable gastric banding may occur unexpectedly during a period of weight loss. Prophylactic fluid removal from the band eliminates the efficacy of the obesity treatment. Moreover, this cohort shows an increased incidence of spontaneous abortions and band-related complications.

Adolescent↗