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PubMed2000

Panniculectomy in morbidly obese gynecologic oncology patients.

BACKGROUND: It is clear that morbid obesity presents a serious risk to women undergoing major intra-abdominal gynecologic surgery. Unfortunately, many gynecologic malignancies and benign conditions are best treated surgically. Thus, the gynecologic surgeon must choose an incision that permits adequate exposure with acceptables rates of complications. Panniculectomy as an approach to the peritoneal cavity is becoming increasingly popular. Recent reports suggest that panniculectomy is reasonably straightforward to perform, provides adequate exposure and is associated with an acceptable rate of manageable complications. In these circumstances, panniculectomy is not a cosmetic procedure, but medically necessary to perform indicated major gynecologic intra-abdominal surgery. AIMS: To present our experience with panniculectomy in morbidly obese women undergoing major intra-abdominal surgery on a gynecologic oncology service. METHODS: The medical records of 48 morbidly obese women (Quetelet Index > 40 kg/m2) with a large dependent pannus who underwent major intra-abdominal surgery via a panniculectomy between May 1990 and October 1999 were reviewed. Data regarding demographics, concomitant medical conditions, operative indications and results, and postoperative outcomes were abstracted for analysis. RESULTS: The mean age was 54.9 years, the mean body mass was 130.2 kg, the mean height was 1.63 m and the mean Quetelet Index was 49.3 kg/m2. The mean operating time was 188 min and the mean estimated blood loss was 615 ml. Two patients suffered intraoperative urologic injuries which were repaired without sequelae; there were no bowel, vascular or neurologic injuries. Eighteen patients had a suprafascial wound breakdown (3 complete and 15 superficial) and 15 patients developed an infection. There were no documented deep venous thromboses, pulmonary emboli or fascial dehiscences. Two patients died in the postoperative period; one from a myocardial infarction on Day 2 and one from overwhelming sepsis on Day 76. CONCLUSIONS: Morbid obesity is associated with substantial operative and postoperative risks. Panniculectomy provides operative exposure with acceptable risks of complications.

Abdominal Wall↗
PubMed2003

The frequency of respiratory failure in patients with morbid obesity undergoing gastric bypass.

Morbid obesity is associated with multiple metabolic and mechanical abnormalities that increase morbidity and mortality after major abdominal surgery. It is unclear whether patients undergoing bariatric surgery have increased pulmonary complications postoperatively. We performed a retrospective chart review of 207 patients who underwent elective gastric bypass surgery during a recent 2-year period. Body mass index (BMI = kg/m2) of more than 35 was used to define morbid obesity. The purpose of this study was to determine the frequency of respiratory failure, defined as intubation for 24 hours or more and/or reintubation, in these patients. We also evaluated differences in the frequency of respiratory failure between patients with a BMI of 43 or less and those with a BMI of more than 43. Patients with morbid obesity undergoing elective weight loss surgery had few respiratory or other perioperative complications with our experienced team. The rates of respiratory failure and total postoperative complications were 8% in the group with a BMI of 43 or less and 14% in the group with a BMI of more than 43. Skillful anesthetic care allows patients with significant comorbid conditions to benefit from bariatric surgery with reasonable risk in terms of postoperative complications.

Female↗
PubMed2003

Dynamics of transitory morbidity in children aged 0 to 6 years from the town of Varna.

Transitory chronic morbidity of children aged 0-6 years from the town of Varna was retrospectively studied for a five-year period (1997-2001) based on the results obtained during the annual prophylactic examinations. A total of 54,068 children (24,204 being 0-3 year-old and the rest of 29,864 aged between 4-6 years) is involved in the study. Based on data from the documentation records the frequency of cases per 1000 examined is given. The structure and the dynamics of transitory morbidity is determined. The total chronic transitory morbidity for the whole period is 36 per 1000 examined children. The prevalence of chronic diseases in children aged 0-3 years is 23%@1000, while in children aged 4-6 years it is twice as high (47%@1000) (p < 0.01). In the nosologic structure of chronic morbidity in children aged 0-3 years diseases of the blood and haemopoiesis dominate (52.2%) followed by congenital anomalies (7.5%), and bronchial asthma (4.1%). For the age group of 4-6 years, diseases of the blood and haemopoietic organs occupy the first place (14.3%). Second come disorders in refraction, accommodation and vision (12.8%) followed by bronchial asthma (11.8%) and scoliosis (11.2%). The results obtained in this study define the priority guidelines of the work of general practitioners and medical specialists for disease prevention and health promotion in children aged up to 6 years. They are offered to the municipal authorities of public health.

Bulgaria↗
PubMed1992

[The effect of breast feeding on morbidity in children].

The authors investigated in a group of 4210 children from birth to three years from Southern Moravia the morbidity from respiratory infections, diarrhoea and other infections. There were bisexual differences in morbidity, girls were less frequently ill. Children from child communities had a two old morbidity. Birth order was also important. The influence of natural nutrition was apparent in particular during the first year when infants breastfed for more than 4 months had significantly fewer spells of illness. These results were influenced by sex and birth order. At the age of two and three years the differences between children breastfed for a short and long time disappeared. Similar results were found also in other morbidity indicators such as administration of antibiotics, number of hospital admissions and mean number of days spent in hospital.

Breast Feeding↗
PubMed2003

Morbidity in children born to women infected with human immunodeficiency virus in South Africa: does mode of feeding matter?

AIM: To examine infant morbidity risks associated with refraining from breastfeeding where it is used in an attempt to prevent mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). METHODS: The population consisted of infants born to HIV-infected women in South Africa who were participating in a vitamin A intervention trial to prevent MTCT of HIV. Women chose to breastfeed or formula feed their infants according to UNAIDS guidelines. Actual feeding practices and morbidity were recorded at clinic follow-up visits at I wk, 6 wk, 3 mo and every 3 mo thereafter until 15 mo of age or cessation of breastfeeding. The infant's HIV status was assessed according to a predetermined algorithm. RESULTS: HIV-infected infants who were never breastfed had a poorer outcome than those who were breastfed; 9 (60%) of those who were never breastfed had 3 or more morbidity episodes compared with 15 (32%) of breastfed children [odds ratio (OR) 4.05, 95% confidence interval (95% CI) 0.91-20.63, p = 0.05]. During the first 2 mo of life, never-breastfed infants (regardless of HIV status) were nearly twice as likely to have had an illness episode than breastfed infants (OR 1.91, 95% CI 1. 17-3.13, p = 0.006). CONCLUSION: The significant extra morbidity experienced in the first few months by all never-breastfed infants and at all times by HIV-infected infants who are not breastfed needs to be considered in all decisions by mothers, health workers and policy makers so as not to offset any gains achieved by decreasing HIV transmission through avoiding breastfeeding.

Adult↗
PubMed1992

Laparoscopy: the preferred method of cholecystectomy in the morbidly obese.

BACKGROUND: Morbid obesity has been considered a contraindication to laparoscopic cholecystectomy (LC). METHODS: To evaluate this we reviewed our first 201 patients undergoing LC and compared the operative procedure and outcome in morbidly obese (greater than or equal to 100 pounds over ideal body weight [IBW]) and nonobese patients. We also compared a group of morbidly obese patients who underwent standard open cholecystectomy (n = 11) with the obese group undergoing LC (n = 21). All groups were comparable in terms of age, sex, and symptoms (acute vs chronic). The obese groups undergoing LC and open cholecystectomy had similar weights (134.0 +/- 9.4 pounds over IBW [range, 100 to 286 pounds] and 133.8 +/- 6.0 pounds over IBW [range, 108 to 170 pounds], respectively) and were significantly different from the nonobese group undergoing LC (28.3 +/- 2.0 pounds over IBW [range, 23 to 98 pounds]). Parameters evaluated included operative time, resumption of normal diet, length of postoperative hospitalization, complications, conversion to open procedure, and ability to perform cholangiography. RESULTS: There were no statistically significant differences between the obese and nonobese groups undergoing LC in any parameters studied (operative time, 151.7 +/- 4.0 minutes vs 160.7 +/- 9.9 minutes; tolerance of diet, 1.2 +/- 0.1 days vs 1.1 +/- 0.1 days; time to discharge, 2.0 +/- 0.1 days vs 1.8 +/- 0.2 days; complications, 7.0% vs 0.0%). Operative time (117.6 +/- 11.6 minutes) was shorter (p = 0.45) in obese patients undergoing open cholecystectomy. However, time to normal diet and length of postoperative hospitalization were significantly longer (3.1 and 4.6 days, respectively; p less than 0.01), and there were more complications (18.2%). CONCLUSIONS: Rather than being contraindicated in the morbidly obese, LC appears to be the preferred method of cholecystectomy.

Body Weight↗
PubMed2003

[Maternal and fetal morbidity in patients with premature rupture of the membrane after 27-week gestation. Causes and costs].

Premature rupture of the membranes (PROM) occurs in a third of the childbirths preterm, this represents 8% of all pregnancies, with same morbidity and mortality in developing and developed countries, PROM is the more common cause of neonatal morbidity and mortality, making this obstetric complication a worldwide problem of health, since it contributes to the economic problem for the cost risen in medical attention for both, mothers and live birth. PROM is considered a mutifactorial entity. This study was carried out in the Hospital de Ginecología y Obstetricia of the Centro Médico "La Raza" in Mexico City, where women entered in serial form with pregnancies from 27 to 34 weeks of gestation and spontaneous PROM, without any other pathology. 120 patients were included, with 26.8 +/- 5.9 year-old age. The gestational age with more frequency of PROM were from 30 to 33 weeks, 22.5% of the patients had 4 days with PROM, 6 of this cases arrived up to 13 days with this complication at delivery. 2.5% of the patients presented deciduitis, with adequated response to the use of antibiotics. When analyzing the hospital stay, a stay was observed from 4 to 7 days (5.26 +/- 1.96 M +/- SD), with a total cost for maternal stay of 2 millions 445,650 pesos. Those babies born had an average of 23 days of hospital stay and the total cot of the days of stay was 4 millions 963,978 pesos. Other costs were the attention of maternal and pediatrics specialty, the obstetric resolution of the pregnancy, obstetric ultrasonography and crystallographies. Thus, the total costs of the attention of this complication in these patients with PROM was of 10 millions 296,988 pesos. The international reference is the American dollar that was in 10 pesos for dollar to the moment of this study. The maternal morbidity is low to that described in previous studies, but in spite of the exhaustive efforts on the prevention, prediction, diagnosis and treatment, the premature rate due to PROM has not diminished, however the rate of neonatal survival has been increased and the morbidity has diminished.

Adult↗
PubMed2003

Morbidity and mortality of a failed attempt at mitral valve repair converted to replacement at the same operation.

BACKGROUND AND AIM OF THE STUDY: Although mitral valve repair (MVRpr) is the preferred operation for mitral disease worldwide, some surgeons are reluctant to attempt this, believing that excess morbidity and mortality will result if the attempt fails and conversion to mitral valve replacement (MVR) is necessary during surgery. METHODS: Typical preoperative, operative and postoperative parameters were reviewed retrospectively on 2,017 consecutive adults undergoing mitral valve operations (MVO), with and without additional cardiac surgery, between 1986 and 1999. Morbidity and mortality were compared for all MVRpr, MVR and attempted repairs, which failed and were converted to replacement at the same operation (FRpr). RESULTS: Although cross-clamp and extracorporeal pump times were longer for FRpr than for MVRpr and MVR, neither blood product use, morbidity, nor length of ICU or hospital stay was increased. Perioperative myocardial infarction was higher in FRpr, but less than 5%. Although operative mortality was lower for successful MVRpr compared with MVR, there was no difference between FRpr and either MVRpr or MVR, whether as an isolated or combined procedure. The addition of other cardiac procedures to a specific MVO appeared to be the important variable in mortality in all the groups, rather than the length of cross-clamp or extracorporeal pump times. CONCLUSION: An attempted MVRpr which fails and is converted to replacement at the same operation does not appear to be associated with excess morbidity or mortality, despite longer cross-clamp and pump times. Accordingly, MVRpr can be safely undertaken when indicated, even with additional cardiac procedures.

Aged↗
PubMed1992

A comparison of pre-discharge survival and morbidity in singleton and twin very low birth weight infants.

The perinatal mortality rate of twins is four to 11 times higher than that of singletons, and twins are widely reported to have more morbidity than singletons, mainly because of a higher preterm birth rate. However, it is not clear that live-born preterm birth rate. However, it is not clear that live-born preterm twins suffer greater morbidity than comparable singletons. In fact, twins have been reported to develop pulmonary maturity earlier than singletons, which might result in decreased morbidity relative to comparable preterm singletons. We conducted this retrospective review of 496 consecutive singleton and 104 twin infants weighing 500-1499 g and born alive at 24-31 weeks' gestation to determine whether pre-discharge survival and morbidity in very low birth weight (VLBW) twin infants were greater than those of comparable singletons. The mean (+/- standard deviation) gestational age of the singletons was 27.5 +/- 2.0 weeks and of the twins 27.6 +/- 2.0 weeks. There were no differences in mean gestational age, gestational age distribution, mean birth weight, birth weight distribution, gender, or maternal race between the two groups. The pre-discharge survival rate for twins (77%) was not significantly different than that of singletons (82%). There were no differences between twins and singletons in the incidences of neonatal respiratory distress syndrome (63 versus 71%), pulmonary interstitial emphysema (14 versus 16%), patent ductus arteriosus (28 versus 29%), necrotizing enterocolitis (3 versus 5%), intraventricular hemorrhage (11 versus 16%), and retinopathy of prematurity (11 versus 18%). The incidence of bronchopulmonary dysplasia was significantly less in twins (27 versus 46%; P = .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMedDate not supplied

Intragastric balloon: another option for treatment of obesity and morbid obesity.

BACKGROUND/AIMS: The BioEnterics Intragrastric Balloon (BIB, BioEnterics, Santa Barbara, CA) in association with restricted diet has been used for the treatment of obesity and morbid obesity. METHODOLOGY: Since March 1998, 349 BIB were placed in 303 obese and morbidly obese patients; 95 patients were male and 208 female; mean age was 41.5 years (19-70); mean weight was 118.8 Kg (67-229); mean BMI was 42 Kg/m2, % excess weight was 62.3% (4.6-216.3). The balloon was inserted and removed endoscopically under general anesthesia. Patients were given a balanced diet of 1000 Kcal/day. RESULTS: After 4 months of balloon treatment, the mean weight loss was 13.9 Kg and the mean reduction in BMI was 4.8 Kg/m2. Weight loss was greater in male patients. Weight loss was accompanied by an improvement of the diseases associated with obesity, in particular diabetes. CONCLUSIONS: The best indications for BIB were: morbidly obese (BMI >40) and super-obese patients (BMI >50) in preparation for bariatric operations; obese patients with BMI 35-40 with co-morbidity in preparation for bariatric surgery; obese patients with BMI 30-35 with a chronic disease otherwise unresolved; patients with BMI <30 only in a multidisciplinary approach.

Adult↗
PubMed2005

Morbid obesity: a surgical perspective.

Morbid obesity is a chronic illness of multifactorial aetiology which is defined as Body Mass Index (BMI) greater than 40 kg/sq.m. Non-surgical treatments for this condition have been shown to be ineffective. Surgery is the only effective treatment and obtains the best long-term outcomes. Surgery is indicated when BMI is greater than 40, or BMI is greater than 35 with significant associated co-morbidities. Four types of operations are currently performed: restrictive, malabsorptive, combined procedures (malabsorptive-restrictive) and motility-reducing pro-cedures. With restrictive procedures (adjustable gastric banding and vertical banded gastroplasty), patients can expect a long-term excess weight loss of 44-68%; for combined procedures (Roux-en-Y gastric by-pass) this is 60-70%, whereas for malabsorptive procedures (bilio-pancreatic diversion with or without duodenal switch), this is 75-80%. Intra-gastric stimulation is the least invasive treatment, but induces the lowest excess weight loss (32%) in the first two years after the operation. Gastric banding offers the best results when balancing risks and benefits. All procedures are now performed laparoscopically with comparable results to open surgery. The overall mortality rate in specialized centers is less than 0.3%. Different techniques are indicated according to BMI and the patient's eating habits. Surgery for morbid obesity has proved to improve quality of life and significantly reduce associated co-morbidities.

Decision Making↗
PubMed2005

The nasal airway evaluation in morbid obesity.

The aim of the present study was to evaluate objectively the nasal patency in the obese patients. A total of 18 morbidly obese patients were recruited for the study. All of them were surgically treated because of morbid obesity using Bilo-Pancreatic Diversion (BPD) or Laparoscopic Gastric Banding (LGB) methods. The patients were free of nasal abnormalities, such as septum deviation, polyps, nasal concha hypertrophy and paranasal sinus diseases. This group comprised 10 men and 8 women aged from 17 to 54. The mean Body Mass Index (BMI) was 51.6 kg/m(2), ranged from 34.7 to 61.8 kg/m(2). In all of the patients the nasal patency was examined by active anterior rhinomanometry according International Standardization Rhinomanometric Committee using air pressure 75, 100 and 150 dPa. The results were compared to the healthy control group. The correlation between BMI and nasal airflow pressure was also examined. We found that inspiration values for 75, 100 and 150 dPa as well as the expiration values for 100 and 150 dPa in standard method and expiration values for 100 and 150 dPa in Broms method using anterior rhinomanometry in morbidly obese patients were statistically significant higher in comparison with the healthy controls. No statistical significant correlation between BMI of obese patients and the airflow pressure values was found. We conclude that in the morbid obesity the nasal patency is reduced as compared to the healthy controls.

Adolescent↗
PubMed2006

Morbidity surveillance after Hurricane Katrina--Arkansas, Louisiana, Mississippi, and Texas, September 2005.

Hurricane Katrina made landfall on the U.S. Gulf Coast on August 29, 2005. Thousands of Gulf Coast residents evacuated and dispersed across the country, moving into hotels, private homes, and evacuation centers (ECs) in 30 states and the District of Columbia (DC). One goal of public health responders was to identify and prevent hurricane-related morbidity and mortality among affected populations, especially among those with limited access to health care and those who were living in crowded conditions. This report summarizes the challenges of conducting national surveillance after Hurricane Katrina, focusing on the role of CDC in coordinating surveillance and consolidating and interpreting morbidity data from jurisdictions that used diverse surveillance approaches. Aggregate morbidity data that were reported through Arkansas, Louisiana, Mississippi, and Texas to CDC during September 1-22, 2005 (before the Gulf Coast landfall of Hurricane Rita on September 24) are presented from ECs and health-care facilities (HCFs) that served affected populations in these states. Chronic diseases and injuries were the most common conditions reported by ECs and HCFs, respectively. To better prepare for future large-scale disasters with widespread impact, public health agencies and other partners are actively working to establish standardized guidelines and tools for morbidity surveillance. These guidelines will facilitate the interpretation and exchange of health information among multiple jurisdictions and public and private agencies during a disaster response to identify outbreaks and monitor health concerns.

Arkansas↗
PubMed2006

[Clinical effect of mivacurium in morbidly obese patients].

OBJECTIVES: To compare the clinical effect of mivacurium in morbidly obese and normal-weight patients. PATIENTS AND METHODS: Ten morbidly obese patients (body mass index >40) and 10 normal-weight patients (body mass index, 21-24) with normal plasma cholinesterase levels. Anesthesia was provided with propofol and remifentanil in continuous infusion and a mixture of oxygen and nitrous oxide. Mivacurium was administered at a dose based on the patient's weight (0.15 mg x kg(-1)). The neuromuscular block was monitored by train-of-four (TOF) acceleromyography after stimulation of the cubital nerve at the forearm. We measured the onset time (time from administration of the muscle relaxant to 95% twitch depression), duration of block (times from dosing to 5% recovery after the first twitch [T1] of a TOF stimulus and to a TOF ratio of 80%), and the recovery indices (time between 25% and 75% recovery after T1 and between recovery of TOF ratios of 25% and 80%). Groups were compared with the Student t test. RESULTS: Mean (SD) onset time was similar in the 2 groups (normal weight 2.73 [1] minutes vs morbidly obese 1.91 [0.6] minutes). Other measures of duration and recovery were also similar in the 2 groups, respectively: duration of dose-T1 5%, 12.23 (2.1) vs 11.45 (3) minutes; dose-TOF ratio 80%, 24.71 (4.6) vs 24.81 (5) minutes); recovery index T1 25%-75%, 6.45 (2) vs 5.56 (1) minutes; recovery of TOF ratio T1 25%-80%, 9 (2) vs 10.11 (2) minutes. CONCLUSION: We found no differences in the clinical effect of mivacurium between morbidly obese and normal-weight patients when doses were based on real weight.

Adult↗
PubMedDate not supplied

Microlaparoscopic-assisted lumboperitoneal shunt in the lateral position for pseudotumor cerebri in a morbidly obese adolescent.

BACKGROUND: Pseudotumor cerebri or idiopathic intracranial hypertension is a known complication of morbid obesity that often requires neurosurgical intervention for worsening symptoms. Placement of a lumboperitoneal shunt (LPS) is one of the treatment options, but in a morbidly obese patient it can be technically challenging. We describe the use of 3-mm instrumentation for assistance in placing the peritoneal end of the shunt. CASE REPORT: A 16-year-old morbidly obese girl with a diagnosis of pseudotumor cerebri and decreasing visual acuity and contraction of her visual fields underwent lumboperitoneal shunt placement. Due to her body habitus secondary to her morbid obesity a microlaparoscopic-assisted approach was utilized for placement of the peritoneal end of the lumboperitoneal shunt. RESULTS: No operative or postoperative problems occurred, and she was discharged home with resolution of symptoms. Her visual acuity and fields had normalized at 3-month follow-up. CONCLUSION: Microlaparoscopic-assisted lumboperitoneal shunt placement in the lateral position is an efficient and safe method for the treatment of pseudotumor cerebri. It is a minimally invasive, simple, effective tool for placing the peritoneal catheter for LPS.

Adolescent↗
PubMed1991

Successful weight loss following obesity surgery and the perceived liability of morbid obesity.

Patients (n = 47) who lost 45 kg (100 lb) or more and who successfully maintained weight loss for at least three years following gastric restrictive surgery for morbid obesity viewed their previous morbidly obese state as having been extremely distressful. In spite of the strong proclivity for people to evaluate their own worst handicap as less disabling than other handicaps, patients said they would prefer to be normal weight with a major handicap (deaf, dyslexic, diabetic, legally blind, very bad acne, heart disease, one leg amputated) than to be morbidly obese. All patients said they would rather be normal weight than a morbidly obese multi-millionaire.

Adult↗
PubMed1991

Knee replacement in morbidly obese women.

Sixty-six total knee replacements in 50 morbidly obese women with osteoarthritis were performed. The results in these patients were compared with 64 knee replacements in 50 nonobese women and with 50 obese women who did not have knee replacement operations. All obese patients were advised by a physician to lose weight and were counseled by a dietician. Five obese patients with six replaced knees and four nonobese patients were lost prior to follow-up study. Follow-up examinations were performed after 24 to 60 months, with mean of 33 months, in the remaining patients. No significant sustained weight loss occurred in the obese patients who had knee replacement operations or in obese patients who did not have surgical treatment. Eighty-six per cent of nonobese patients had excellent or good results from knee replacement surgical treatment. Fifty-seven per cent of morbidity obese patients had excellent or good results. There were two infections and two revision operations in morbidly obese patients and no infections and one revision in nonobese patients. Total knee replacement is safe and reasonably effective in the morbidly obese. However, the results are not comparable with those achieved in nonobese patients, and knee replacement should not be expected to facilitate weight loss.

Aged↗
PubMed1991

Psychiatric morbidity and referral rate among medical in-patients at Kenyatta National Hospital.

Psychiatric morbidity among 200 medical in-patients at Kenyatta National Hospital was determined by a two-stage screening procedure, using the Self Reporting Questionnaire (SRQ) and standardized psychiatric interview (SPI). 44 (22%) of the total sample of 200 patients who were interviewed met the pre-established criteria for psychiatric morbidity; of these 59% comprised affective disorders. 4 (9%) of the psychiatric morbidity cases were referred for psychiatric evaluation. Referral seemed to be related to severity of illness and a previous history of psychiatric illness. There was no evidence in the notes that the psychiatric problems had been detected, treated or dealt with in any other way by the medical team in 34 patients out of 44 with psychiatric morbidity. Increase in the mental health input in the training of all health workers with emphasis on recognition and management of some of the commoner psychological problems is recommended.

Adult↗