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Biomedical subjects

N Scopinaro

Publications and source records attributed to N Scopinaro.

At least 37 records · Page 2Linked to original sources
PubMed1998

Radiology of adjustable silicone gastric banding for morbid obesity.

We reviewed the radiological findings in 45 morbidly obese patients (weight range 80-129 kg; mean 95.7 kg) after gastric restriction surgery with adjustable silicone gastric banding (ASBG) according to the Kuzmak technique. Radiographic studies of the stomach were performed before, and at 4 and 12 months after surgery; symptomatic patients underwent additional studies when needed. Patients were evaluated using both liquid barium and a solid opaque meal to assess post-operative gastric morphology as well as emptying time of the proximal gastric pouch. 27 patients had a normal clinical course. Variation of the calibre of the silicone band under radiographic guidance was required in 12 of these patients, based on dilatation of the proximal pouch, variation of the stomal calibre from operative values, or an emptying time longer than 30 min. All these problems disappeared after the adjustment manoeuvres. 18 patients had complications, of which five had stomal stenosis which could not be managed through simple deflation of the band; two had posterior bending and dilatation of the proximal pouch; four had gastritis and oesophagitis; six had infection of the inflatable reservoir; one had cranial displacement of the band, and two had migration of the band into the stomach. Removal of the gastric band was necessary in 11 cases, and removal of the reservoir alone had to be performed in three additional patients. Radiology plays an important role in evaluating complications after gastric restriction surgery. Knowing the variety of findings enables accurate treatment planning and follow-up of these patients.

Adolescent↗
PubMed1998

Body image in binge eating disorder.

BACKGROUND: The purpose of this study was to evaluate the impairment of body image in patients with binge eating disorder (BED). MATERIALS AND METHODS: A 3-year longitudinal study was undertaken in 25 BED obese patients and 26 non-BED obese patients who had undergone biliopancreatic diversion (BPD) for obesity. The body image was evaluated by the Eating Disorder Inventory body dissatisfaction scale. RESULTS: Within the third postoperative year, 95% of patients had stopped binge eating. After the first postoperative year, the BED patients showed body dissatisfaction scores higher than those of the non-BED group, whereas the longer-term results were closely similar. CONCLUSIONS: Over the long term following BPD, binge eating disappears, which suggests that the loss of control over food intake is mainly dependent on dieting and on the preoccupation with food and body shape. The derangement of body image in obese patients with BED is only partly dependent on inner feelings. In fact, the stable weight normalization after BPD is accompanied by a sharp improvement in body image in all cases. It appears that the complete normalization requires more time in BED patients than in their non-BED counterparts.

Adult↗
PubMed1997

Body image in early-onset obese patients.

In a group of early-onset-obesity obese patients eating behaviour, body image and psychological condition were assessed by the Eating Disorder Inventory, the Three Factor Eating Questionnaire, the Body Shape Questionnaire and the Body Attitude Questionnaire. These evaluations were carried out prior to and at long-term follow-up after biliopancreatic diversion when body weight had steadily fallen towards normal values. The aim was to establish the influence of actual body weight and shape over body image. A notable improvement in eating behaviour and overall psychological conditions was observed, while the parameters assessing body image remained substantially unchanged, indicating that early-onset-obesity postobese subjects, despite having obtained normal or nearly normal weight conditions, are still much more dissatisfied with their body weight and somatic morphology than never-obese subjects with very similar actual body weights.

Adult↗
PubMed1997

Night eating syndrome in individuals with Mediterranean eating-style.

Night eating syndrome is identified with no appetite for breakfast, 50% or more of food intake after 7 p.m. and trouble getting to sleep and/or staying asleep. In a population with a Mediterranean eating style more than 25% of lean healthy subjects should be considered as affected by night eating syndrome, thus making the definition criteria and even the syndrome itself clinically meaningless. Therefore, to assess the presence of night eating syndrome in a population with Mediterranean eating and lifestyle, the following definition criteria were employed: no food or only a little food for breakfast, sleep disturbances and usual consumption of some food just before going to sleep or waking up during sleeptime. According to these criteria, 3.5% of lean subjects should be considered as affected by night eating syndrome, without any relationship between reported psychological distress or tendency to lose control over food intake. Further studies in populations with Mediterranean eating style are mandatory to assess the true clinical significance of night eating syndrome.

Adult↗
PubMed1997

Achievement of near-normal body weight as the prerequisite to normalize sex hormone-binding globulin concentrations in massively obese men.

OBJECTIVE: To investigate the effects of weight loss on sex hormone-binding globulin (SHBG) in massively obese males and whether normal SHBG concentrations could be obtained regardless or not of the achievement of normal body weight values. DESIGN AND SUBJECTS: Sera were collected for SHBG determination from 63 massively obese men, partly before they underwent biliopancreatic diversion (pre-op group = 11) and partly during the post-surgical follow up (post-op group = 52), and twenty normal weight healthy control men. MEASUREMENTS: Serum SHBG was measured using a noncompetitive liquid-phase immunoradiometric assay. RESULTS: Baseline general characteristics were similar in both obese groups. Obese patients in the post-op group had lost 46.4 +/- 2.9 kg since they had undergone operation, namely during a mean period of 14.9 +/- 13.8 (range 1-58) months follow up. Obese groups had significantly lower SHBG than normal weight controls (66.2 +/- 18.6 nmol/l). However, pre-op obese (19.9 +/- 5.5 nmol/l) had significantly lower values than post-op obese subjects (45.5 +/- 24.8 nmol/l; P < 0.001). There were a highly significant correlation between SHBG and individual BMI values (r = -0.629; P < 0.001). Moreover, the post-op obese with BMI values lower or equal to 28 had significantly higher SHBG concentrations than those with BMI greater than 28 (62.8 +/- 22.2 nmol/l vs 32.1 +/- 19.6 nmol/l; P < 0.001), but not significantly different with respect to normal weight controls. CONCLUSIONS: Massively obese men weight loss can completely reverse SHBG abnormalities, which can be restored to the normal range when near-normal body weight is achieved. Since reduced SHBG concentrations can be an independent risk factor for the development of diabetes and cardiovascular disease, this represents an additional benefit of weight loss program in massively obese individuals.

Adult↗
PubMed1996

Binge eating in obesity: a longitudinal study following biliopancreatic diversion.

OBJECTIVE: Evaluating the influence of dieting and of being overweight on binge-eating episodes and on psychological traits in severely obese patients. METHODS: Clinical interviews and self-report questionnaires prior to and 2 years following biliopancreatic diversion (BPD) when subjects adopt a completely free eating style and achieve in maintaining a normal or nearly normal body weight. RESULTS: At two years following the operation, the prevalence of binge-eating episodes sharply fell and the subjects' overall psychological conditions improved; only a few patients started binging. DISCUSSION: These results point out the importance of dieting and of overweight itself in determining eating behavior disturbances or psychopathology. The fact that only a very small number of patients continue or start binging following BDP suggests that a minority of obese bingers should be considered as true eating-disordered patients.

Adult↗
PubMed1996

Food- and weight-related attitudes in obese persons: a longitudinal study over two years following biliopancreatic diversion.

Food- and weight-related attitudes were assessed in obese subjects prior to biliopancreatic diversion (BPD) and at 1 and 2 years after BPD, when any preoccupation with dieting and body weight and shape should have been abandoned. A decrease in the number of subjects whose food attitudes suggested some loss of control over food consumption, such as snacking, nibbling, getting hungry and eating in response to non-alimentary stimuli or arousal conditions was observed, confirming the role of dieting in leading to loss of control over food intake. The stable weight loss correlated with changes in the body attitudes and in the overall psychological status. The changes observed in obese persons after BPD suggest that 1) the food-related attitudes are influenced by the preoccupation with food and with dieting; 2) the weight-related attitudes are accounted for more by dissatisfaction with a body shape that is very different from the socially accepted one than by an individual's psychological traits.

Adult↗
PubMed1996

Biliopancreatic diversion for obesity at eighteen years.

BACKGROUND: Surgical attempts to treat obesity began because of the discouraging results of conservative medical treatment, which successfully achieved initial weight loss but failed to maintain it. Gastric restrictive procedures, currently the most popular surgical methods for obesity therapy, have proved to be effective in initiating weight loss, but some concerns regarding their long-term efficacy in weight maintenance have arisen. METHODS: Of a total of 1968 obese patients who underwent biliopancreatic diversion since 1976, the last consecutive 1217 underwent the "ad hoc stomach" type of diversion with a 200 cm alimentary limb, a 50 cm common limb, and a gastric volume varying between 200 and 500 ml. Mean age was 37 years old (11 to 69 years), and mean excess weight was 117%. Maximum follow-up was 115 months with nearly 100% participation. RESULTS: In the last half of the series, operative mortality was 0.4% with no general complications and with early surgical complications of wound dehiscence and infection (total, 1.2%) and late complications of incisional hernia (8.7%) and intestinal obstruction (1.2%). Mean percent loss initial excess weight (IEW) at 2, 4, 6, and 8 years was 78 +/- 16, 75 +/- 16, 78 +/- 18, and 77 +/- 16 in the patients with IEW up to 120% and 74 +/- 12, 73 +/- 13, 73 +/- 12, and 72 +/- 10 in those with IEW more than 120%. A group of 40 patients who underwent the original "half-half" biliopancreatic diversion maintained a mean 70% reduction of IEW during a 15-year follow-up period. Specific late complications included anemia (less than 5%), stomal ulcer (2.8%), protein malnutrition (7% with 1.7% requiring surgical revision by common limb elongation or by restoration). Clinical problems from bone demineralization were minimal in the short term and almost absent in the long term. CONCLUSIONS: Biliopancreatic diversion is a very effective procedure but is potentially dangerous if used incorrectly.

Adolescent↗
PubMed1996

Imaging of patients with pancreaticobiliary diversion for obesity: post-operative anatomy and findings in small bowel obstruction.

Pancreaticobiliary diversion is a surgical procedure undertaken for obesity. It consists of a distal gastrectomy with a long Roux-en-Y reconstruction, the enteroenterostomy being placed 200 cm distal to the gastroenterostomy and 50 cm proximal to the ileocaecal valve. Three intestinal limbs are recognized: (a) the alimentary loop from the gastroenterostomy to the enteroenterostomy; (b) common loop from the enteroenterostomy to the ileocaecal valve and (c) pancreaticobiliary loop from the duodenum to the enteroenterostomy. The radiological findings in 15 pancreaticobiliary diversion patients with small bowel obstruction were reviewed (15 plain abdominal radiographs, 13 ultrasound (US), 8 CT) and compared with 20 plain abdominal radiographs, 10 US, and 10 CT studies performed for other causes in patients with pancreaticobiliary diversion and 15 CT scans from non-operated patients. After pancreaticobiliary diversion the pancreaticobiliary loop was completely air-free. In the patients operated on more than 1 year previously, alimentary and common loops were significantly larger than the pancreaticobiliary loop and small bowel loops of non-operated subjects. Obstruction of the pancreaticobiliary loop arrests only the flow of pancreaticobiliary secretions with non-specific clinical findings. Plain abdominal radiographs were not diagnostic in all but two cases with radiographically detectable dilated fluid filled loops. Air-fluid levels were never apparent. US and CT showed markedly dilatated intestinal loops and duodenum. Obstruction of the alimentary and common loops presented with symptoms, clinical signs, and radiological findings more typical for bowel obstruction in intact subjects.

Adolescent↗
PubMed1996

Preoperative Eating Behavior and Weight-loss Following Gastric Banding for Obesity.

BACKGROUND AND METHODS: The relationships between cognitive restraint and the tendency to disinhibition, as assessed by the Three Factor Eating Questionnaire (TFEQ), and the weight loss at 1 year following gastric banding are evaluated. RESULTS: A significant predictability of the TFEQ Disinhibition score on the postoperative weight reduction was observed, while the amount of weight lost was negatively related to the preoperative TFEQ Cognitive Restraint score. CONCLUSION: It must then be hypothesized that the operated subjects feel a strong aversive stimulus and then they are led to reduce their food consumption only when they lose control and tend to overeat. The discomfort due to proximal gastric pouch distention facilitates the development of food aversion and then both the decrease of food intake and a change in eating behavior. The subjects must therefore be encouraged to adopt an eating style that cannot allow them to avoid such a feeling.

Journal Article↗
PubMed1996

[Preoperative eating behavior and weight loss after gastric banding for obesity].

The relationships between the cognitive restraint and the tendency to disinhibition prior to gastric banding for obesity, as assessed by the Three Factor Eating Questionnaire, and the weight loss at one year following the operation were investigated. The amount of overall weight loss was correlated positively to the disinhibition and negatively to the cognitive restraint score. When the food consumption overtakes the proximal gastric pouch capacity, the patient feels a strong aversive stimulus, thus stopping eating. Therefore, more is the patient's tendency to lose the control on food intake more is the postoperative weight loss. On the contrary, the high restraint patient only seldom feels such an aversive stimulus, and only seldom stops eating, thus the weight loss is smaller. Except for the overeating due to the disinhibition, the aversive stimulus arising from the gastric restriction cannot influence by itself any other aspect of eating behavior.

Adolescent↗
PubMed1996

Binge eating in obesity.

OBJECTIVE: To investigate the influence of dieting and of body shape dissatisfaction on binge eating. DESIGN: Longitudinal study following billiopancreatic diversion (BPD), when the body shape has become normal or nearly normal, and any worries over weight, dieting and food have probably been abandoned completely. SUBJECTS: 65 severely obese patients, evaluated by clinical semistructured interview for occurrence of binge eating episodes prior to, and at one and at two years following BPD. RESULTS: Whereas preoperative binge eating had been reported by 65% of the obese individuals, at two years following BPD binge eating occurred only in 9.2% of them. CONCLUSIONS: Weight stabilisation following BPD is associated with a sharp improvement in control over food intake, and this suggests the central role of dieting and/or of body dissatisfaction in causing binge eating episodes.

Adult↗
PubMed1996

[Pregnancy after surgical therapy of obesity. Bibliographic review and our experience with biliopancreatic diversion].

BACKGROUND: An increasing number of women in childbearing age are submitted to surgical treatment of obesity; for this reason pregnancy represents a frequent event in operated patients. METHODS: In this study pregnancy in patients with morbid obesity submitted to jejunoileal bypass (JIB) and gastric bypass (GB) are reviewed from the literature and the analysis of our experience with biliopancreatic diversion (BPD) is reported. RESULTS: In 113 pregnancies after JIB reviewed from the literature, the results seem to be debated either about the course of pregnancy or about maternal and neonatal status. The data of literature concerning the pregnancies following GB are less debated but rather slight. One hundred and fifty-two pregnancies after BPD have a complete documentation concerning maternal conditions, modality of outcome and neonatal situation. CONCLUSIONS: Pregnancy occurred in the obese women represents an increased maternal-fetal risk. The excess weight loss, the weight maintenance and the reduced weight changes during pregnancy are an advantage in the operate women who, in any case, need accurate controls of the nutritional status during the whole gestational period. Keeping these cautions pregnancy following surgical treatment of obesity represents an event not only possible but even with less problems than in pregnancy in obese women.

Adult↗
PubMed1995

Binge eating in massively obese patients undergoing bariatric surgery.

Data on the prevalence of binge eating in a series of 92 massively obese patients undergoing bariatric surgery are presented. A semistructured clinical interview demonstrated that 63 individuals had problems with binge eating, 43 of these reporting episodes of binge eating more than twice a week and then meeting the diagnostic criteria for binge eating disorder. By comparison with their nonbinge eating counterparts, binge eaters demonstrated higher body weight, greater weight fluctuation due to reducing diets in their past lifetime, higher Three-Factor Eating Questionnaire Disinhibition and Hunger score, and an overall higher psychopathology as assessed by the Eating Disorder Inventory. The great prevalence of binge eating in these patients could be accounted for by the high body weight, by the characteristics of the patients, or by the context in which the eating behavior assessment was carried out.

Adolescent↗
PubMed1995

Binge eating following biliopancreatic diversion for obesity.

The prevalence of binge eating disorder (BED) was assessed in 68 massively obese patients prior to and following biliopancreatic diversion (BPD) for obesity. The eating behavior and the psychological traits were evaluated by the Three Factor Eating Questionnaire and the Eating Disorder Inventory. Since after BPD the body weight regulation is substantially dependent on intestinal absorption, the individuals operated on have to be considered as absolutely free eaters. In this population, 30 patients were affected by BED and in 24 of them binge eating disappeared spontaneously following BPD, highlighting the main role of preoccupation with food, diet and overweight in causing or in maintaining BED.

Adolescent↗