Biomedical subjects

Madelyn H Fernstrom

Publications and source records attributed to Madelyn H Fernstrom.

6 recordsLinked to original sources

PubMed2006

Long-term changes in blood pressure in extremely obese patients who have undergone bariatric surgery.

HYPOTHESIS: Systolic and diastolic pressure and the incidence of hypertension in very obese patients decline after bariatric surgery and do not rebound. DESIGN: Chart review. SETTING: Surgical practice in a university medical center. PATIENTS: Women and men, 18 years or older, with a body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) of 40 or greater, having no previous surgical intervention for extreme obesity. INTERVENTION: Vertical-banded gastroplasty or Roux-en-Y gastric bypass. MAIN OUTCOME MEASURES: Systolic and diastolic blood pressure, BMI, and antihypertensive medications. RESULTS: Patients underwent Roux-en-Y gastric bypass (n = 285; mean initial BMI, 55.7) or vertical banded gastroplasty (n = 62; mean initial BMI, 48.5); half of each group was hypertensive at evaluation. The BMI dropped in both groups after surgery and stabilized at about 35 within 18 months. Systolic pressure changes were generally modest, although diastolic pressure declined significantly after surgery. In patients with untreated stage 1 hypertension, marked reductions in systolic and diastolic pressures occurred after surgery. Many patients taking antihypertensive medications before surgery discontinued them after surgery and remained normotensive. CONCLUSIONS: Blood pressure reductions that occur after bariatric surgery and substantial weight loss depend on the blood pressure status of patients before surgery: normotensive patients and hypertensive patients taking antihypertensive medications show small postsurgical pressure reductions, while patients with elevated blood pressure before surgery show notable postsurgical pressure drops. The overall incidence of hypertension after bariatric surgery declines substantially and remains low.

Adult↗

PubMed2006

Body image and quality of life in post massive weight loss body contouring patients.

OBJECTIVE: Because post-bariatric surgery patients undergo massive weight loss, the resulting skin excess can lead to both functional problems and profound dissatisfaction with appearance. Correcting skin excess could improve all these corollaries, including body image. Presently, few data are available documenting body image and weight-related quality of life in this population. RESEARCH METHODS AND PROCEDURES: Eighteen patients who underwent both bariatric surgery and body contouring completed our study. Both established surveys and new surveys designed specifically for the study were used to assess body perception and ideals, quality of life, and mood. Patients were surveyed at the following time-points: pre-body contouring (after massive weight loss) and both 3 and 6 month post-body contouring. Statistical testing was performed using Student's t test and ANOVA. RESULTS: The mean age of the patients was 46 +/- 10 years (standard deviation). Quality of life improved after obesity surgery and was significantly enhanced after body contouring. Three months after body contouring, subjects ascribed thinner silhouettes to both current appearance and ideal body image. Body image also improved with body contouring surgery. Mood remained stable over 6 months. DISCUSSION: Body contouring after surgical weight loss improved both quality-of-life measurements and body image. Initial body dissatisfaction did not correlate with mood. Body contouring improved body image but produced dissatisfaction with other parts of the body, suggesting that as patients become closer to their ideal, these ideals may shift. We further developed several new assessment methods that may prove useful in understanding these post-surgical weight loss patients.

Analysis of Variance↗

PubMed2006

Exercise, serum free tryptophan, and central fatigue.

Brain tryptophan (TRP) concentrations and serotonin (5HT) synthesis and release increase during running. This increase in 5HT function may promote central fatigue and contribute to suboptimal physical performance. The rise in brain TRP is reputed to result from exercise-induced elevations in serum nonesterified fatty acid (NEFA) concentrations, which dissociate TRP from albumin in blood and increase the serum free TRP pool. But, as discussed in this article, ample evidence exists that the serum free TRP pool does not control brain TRP uptake. The clearest data are dietary, but pharmacologic data in exercising rats also support this conclusion. Changes in the serum levels of amino acids that compete with TRP for brain uptake appear also not to explain the rise in brain TRP. The mechanism is therefore not presently known. The link between the rise in brain TRP and 5HT synthesis/release is not simple: a rise in brain TRP stimulates 5HT synthesis/release in actively firing neurons. Hence, during exercise, only 5HT neurons that are firing should increase 5HT production/release when brain TRP rises. It is not known which 5HT neurons fire during exercise; the 5HT neurons that respond to exercise-induced increases in brain TRP are therefore not known. Hence, it is not possible to conclude which 5HT neurons contribute to the generation of central fatigue. Because some 5HT neurons control specific functions important to physical performance (e.g., respiration), the current understanding of 5HT neuronal function in central fatigue might benefit from the study of specific 5HT pathways during exercise.

Animals↗

PubMed2006

Assessment of TRAM aesthetics: the importance of subunit integration.

BACKGROUND: Characterization of optimal aesthetics in transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction is a challenge that even the most experienced breast surgeon faces. Aesthetic assessment in breast surgery has attempted to evaluate the reconstructed breast either as one cohesive entity or as a sum of its parts. The authors propose that the most advantageous assessment involves looking at the reconstructions in terms of aesthetic components, not necessarily in visual subunits. METHODS: The authors investigated the responses of five physicians and 12 nonphysician evaluators using various methods of aesthetic assessment, including, most importantly, a visual analogue scale survey. Pearson's correlation and intraclass correlation analyses were performed using SAS software. RESULTS: Their analysis determined that while all components of TRAM reconstruction were important, symmetry, contour, and breast positioning were consistently named the most important components of breast reconstruction. When the breast reconstruction was divided into aesthetic subunits, there was a high degree of correlation between the overall score and the subunit scores (r = 0.81: r > 0.6 for good correlation). CONCLUSIONS: From these assessments, the authors derived a set of aesthetic rules for TRAM flap reconstruction. They believe that methodical application of these rules on a consistent basis can lead to the production of maximal aesthetic outcomes in TRAM breast reconstruction.

Esthetics↗

PubMed2005

A classification of contour deformities after bariatric weight loss: the Pittsburgh Rating Scale.

BACKGROUND: Contour deformities after massive weight loss are diverse and often severe in nature. Current progress has necessitated a valid, accessible, and comprehensive rating system that correlates appearance and appropriate surgical treatment. Presently, no existing rating system addresses the breadth and variety of deformities that can occur or allows for adequate postsurgical evaluation. METHODS: The authors reviewed full-body photographs of over 300 female patients seen between October of 2002 and May of 2004. The authors targeted body areas most frequently demonstrating skin and soft-tissue laxity and ptosis. A 10-region, four-point grading system was designed to describe the common deformities found in each region of the body. To validate the scale, 12 trained observers applied the rating scale to photographs of 25 patients who showed the 10 regions. Each grading scale ranged from 0, indicating normal, to 3, indicating the most severe deformity. Repeat testing was performed at 2 weeks. Interobserver validity and test-retest reliability were determined using weighted kappa analysis. RESULTS: In all 10 categories, the kappa value was 0.6 or higher (0.6 = threshold for good validity), with a mean kappa value of 0.68 (range, 0.61 to 0.78) and an overall agreement of 69 percent over two sessions. All 12 observers scored an individual mean kappa value of greater than 0.6, indicating good interobserver validity. A given observer had a mean 67 percent agreement, indicating reasonable test-retest reliability. CONCLUSIONS: The Pittsburgh Rating Scale is a validated measure of contour deformities after bariatric weight loss. This scale may have applications in preoperative planning and evaluating surgical outcomes.

Abdomen↗

PubMed2004

Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass.

Little is known about the effects on the skeleton of laparoscopic Roux-en-Y gastric bypass (LRGB) surgery for morbid obesity and subsequent weight loss. We compared 25 patients who had undergone LRGB 11 +/- 3 months previously with 30 obese controls matched for age, gender, and menopausal status. Compared with obese controls, patients post LRGB had significantly lower weight (92 +/- 16 vs. 133 +/- 20 kg; P < 0.001) and body mass index (31 +/- 5 vs. 48 +/- 7 kg/m(2); P < 0.001). Markers of bone turnover were significantly elevated in patients post LRGB compared with controls (urinary N-telopeptide cross-linked collagen type 1, 93 +/- 38 vs. 24 +/- 11 nmol bone collagen equivalents per mmol creatinine; and osteocalcin, 11.6 +/- 3.4 vs. 7.6 +/- 3.6 ng/ml; both P < 0.001). Fifteen patients were studied prospectively for an average of 9 months after LRGB. They lost 37 +/- 9 kg and had a 29 +/- 8% fall in body mass index (both P < 0.001). Urinary N-telopeptide cross-linked collagen type 1 increased by 174 +/- 168% at 3 months (P < 0.01) and 319 +/- 187% at 9 months (P < 0.01). Bone mineral density decreased significantly at the total hip (7.8 +/- 4.8%; P < 0.001), trochanter (9.3 +/- 5.7%; P < 0.001), and total body (1.6 +/- 2.0%; P < 0.05), with significant decreases in bone mineral content at these sites. In summary, within 3 to 9 months after LRGB, morbidly obese patients have an increase in bone resorption associated with a decrease in bone mass. Additional studies are needed to examine these findings over the longer term.

Adult↗