Biomedical subjects
EE Mason
Publications and source records attributed to EE Mason.
Impact of Vertical Banded Gastroplasty on Respiratory Insufficiency of Severe Obesity.
BACKGROUND: Respiratory insufficiency associated with morbid obesity can include sleep apnea syndrome (SAS), obesity hypoventilation syndrome (OHS), or a combination of both. The aim of our study was to determine the safety and effectiveness of vertical banded gastroplasty (VBG) in the treatment of severely obese patients with respiratory insufficiency. METHODS: From 1983 to 1994, 35 patients (25 males, ten females) who met the criteria for either SAS and OHS (1 9 patients) or SAS alone (1 6 patients) underwent VBG. RESULTS: Six patients (17%) died of subsequent pulmonary-cardiac disease despite significant weight loss. Need for nasal continuous positive airway pressure (CPAP) decreased after VBG from 68% of patients preoperatively to 22% postoperatively. Of the ten patients with sleep studies, the apnea/hyponea index decreased from 45 +/- 11 events per h preoperatively to 12 +/- 6 events per h postoperatively, while per cent ideal body weight (%IBW) also decreased (pre-VBG: 268 +/- 12, post-VBG: 204 +/- 12). Of the seven patients with arterial blood gases, PaCO&inf2; decreased from 55 +/- 4 torr preoperatively to 41 +/- 3 torr postoperatively, and PaO&inf2; increased from 50 +/- 4 torr preoperatively to 73 +/- 6 torr postoperatively, while %IBW decreased (pre-VBG: 263 +/- 16, post-VBG: 193 +/- 14). CONCLUSION: Respiratory insufficiency is a life-threatening complication of morbid obesity. In morbidly obese patients with respiratory insufficiency, VBG offers improvement in both SAS and OHS. Respiratory insufficiency due to obesity should be considered a strong indication for VBG.
Acceptance of Surgery for Obesity by Academic Surgeons in North America.
BACKGROUND: Have surgeons in North America accepted operations for the treatment of severe obesity? This question was posed by organizers of the Ninth International Symposium on Obesity Surgery that met in Stockholm in September, 1995. Study design: In order to obtain opinions which might help to answer the question posed, a 1-page questionnaire was sent to 151 chairmen of academic departments of surgery in North America in December 1994 asking about the acceptance and use of surgical operations for the treatment of severe obesity. RESULTS: Answers, received from 112 or 74%, indicated that operative treatment should be used (74%), was effective (77%) and safe (71 %). However, only 65% of departments provided such operations. Operative treatment for obesity was available outside the department in 53%. The operations most frequently used were Roux-en-Y gastric bypass (RGB) and vertical banded gastroplasty (VBG). A single operation was offered by 44 departments and a choice of two or more operations in 30 departments. RGB and VBG were equally in use. Gastric banding was used as an alternative to VBG in six departments. Other operations were in use in six departments either alone (three) or as alternatives to RGB and VBG (three). CONCLUSIONS: It appears that surgical treatment of obesity is accepted and available in the majority of academic departments of surgery.
Pay Status as a Predictor of Outcome in Surgical Treatment of Obesity.
BACKGROUND: Higher complication rates and lower success in surgery for severe obesity have been reported for patients with government pay status. We examined the effect of pay status upon outcome in surgical treatment of obesity. METHODS: This was an observational study from an aggregate data set of individual patient information. Government pay status (G) was defined as full or partial medical care payment through Medicare, Medicaid, or Veterans Administration. Payment entirely by private insurance was defined as private (P). Operations were classified as either simple (S, gastric restriction) or complex (C, gastric restriction with small bowel bypass). Two measures of outcome, perioperative complication rate and weight loss success (</= 50% excess weight), were examined to determine pay status effect. RESULTS: More G than P patients were treated with simple procedures (79% vs 51%, p < 0.05). Perioperative complication rates were more common for G than P patients (14.4% vs 9.1%, p < 0.05). One-year weight loss success was higher for P than G, regardless of operation type. CONCLUSION: Pay status should be included in characterization of patient groups and in the analysis of results when effectiveness of surgical treatment for severe obesity is reported.
Ulcerogenesis in Surgery for Obesity.
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The Effect of Follow-up on Reporting Success for Obesity Surgery.
BACKGROUND: Much is written about the importance of follow-up in determining the effect of surgical treatment for obesity upon weight loss. When patients are lost to follow-up, it has been suggested that these patients should be considered as failures. This study was undertaken to determine the effect of incorporating patients not followed in a definition of success for weight loss at one year. METHODS: Data from 34 surgical practices were used to study the effect of using two different denominators, patients followed (Df) or patients eligible (De), to define success. The numerator used in both methods was the number of patients with </= 50% EW at 1 year. RESULTS: One-year follow-up was 61% (5091/8356). Success was 67% (3423/5091) when calculated using the denominator patients followed (Df). No correlation was found between success and follow-up when data within each surgical practice were averaged and used in a correlation analysis. CONCLUSIONS: This study does not support the thesis that patients who fall to return for follow-up should be considered as having failed in weight control.
Diagnosis and Treatment of Rapid Pulse.
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Vertical Banded Gastroplasty in the Severely Obese under Age Twenty-One.
BACKGROUND: The severely obese under 21 years of age are at high risk of missing normal development during a crucial period of life and should be considered for surgical treatment. Vertical banded gastroplasty allows patients to be treated effectively while continuing to have normal digestion and absorption without the risks of complex operations. METHODS: This was a retrospective outcome review of 47 severely obese who were under age 21 when surgically treated with VBG. RESULTS: There were no operative mortalities, leaks, or wound infections. Body mass index in 25 patients followed 5 years decreased from an average operative 48.1 to 36.2 kg m(2). Equally for 14 patients followed 10 years, BMI decreased from an average operative 49.6 to 39.2 kg m (2). Both patient groups had 74% follow-up. CONCLUSIONS: Sustained weight reduction improved general health and allowed participation in life activities that would otherwise not have been possible. Adherence to recommended operative technique and intraoperative measurement of pouch volume is necessary to avoid excessive enlargement of the pouch, with resulting weight gain, reflux, and need for revision.
The Use of Pneumoperitoneum in the Repair of Giant Hernias.
Preoperative pneumoperitoneum is used to re-establish the right of domain for abdominal viscera before repair of otherwise inoperable giant abdominal hernias. The aim of this study was to evaluate the use and safety of preoperative pneumoperitoneum in the repair of giant hernias in relation to surgical treatment of obesity. The medical records of patients who underwent preoperative pneumoperitoneum in the treatment of giant hernias between 1953-1993 were reviewed. There were 27 patients (11 males, 16 females; mean age: 56 years) whose mean preoperative weight was 99 kg (range: 69-183). Hernias were predominantly in the midline (17). Other locations were right lower quadrant (5), right upper quadrant (3) and groin (2). The mean duration of preoperative pneumoperitoneum was 28 days (3-100). Subcutaneous emphysema developed in three patients with no sequelae. Primary repair of the giant hernia without Marlex mesh was possible in 19 patients (70%). Marlex mesh was used in seven (26%). One patient had a fascia late graft. Operative complications were one pulmonary embolus and one hematoma. There were no deaths. We conclude that preoperative pneumoperitoneum is a useful adjunct to giant hernia repair. Severe obesity should be corrected before preoperative pneumoperitoneum and hernia repair. Some patients may need mesh to replace insufficient abdominal wall or to reinforce repair.
A Study on Predicting Weight Loss Following Surgical Treatment for Obesity.
To date, longitudinal weight loss analyses (curve-fitting) have been complicated by non-linear weight patterns, incomplete follow-up, and varied follow-up times. Therefore, the cross-sectional design (one time point survey) was chosen to study predictors of weight loss at yearly postoperative time intervals (+/- 6 months). Mean values for the initial cohort of 7,540 patients were: age 37.4 years (+/- 9.4), weight 124.0 kg (+/- 25.5), height 165.4 cm (+/- 8.5). Females comprised 87.7% of the data set. Follow-up was 62.5% at year one, 32.0% at year 2, 20.6% at year 3, and 15.4% at year 4. The multiple regression model used included 20 explanatory variables and was performed separately for four yearly time points. Only operative weight, initial visit height, age, and operative type were consistent predictors of weight loss (p < 0.05) at all time points examined and accounted for 40-50% of weight loss variation.
Standards for Reporting Results.
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Surgery for Severe Obesity: Information for Patients.
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Guidelines for Selection of Patients for Surgical Treatment of Obesity.
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Calculating Follow-up Rates.
Follow-up rates are presented as a percentage but the method of calculation is seldom discussed. Determining a follow-up rate begins with identifying the numerator and denominator used in the calculation. Four methods of calculating follow-up rate after surgical treatment for weight reduction were studied. Method 1 follow-up rate, 91.2%, was calculated using patients with at least one follow-up contact as the numerator (6169) and the number of primary operations performed as the denominator (6764). Method 2 calculated patient contact on or beyond a specific time point: 65.9% for >/= 6 months (4232/6424), >/= 1 year (y) = 52.1% (3111/5977), >/= 2 y = 29.8% (1455/ 4890), >/=3y=18.8% (710/3784), >/=4y=12.5% (331/ 2643). Follow-up calculated using method 3 determined patient contact within specific time points: 0-1 y = 89.7% (6064/6764), 1-2 y = 45.8% (2739/5977), 2-3 y = 23.0% (1124/4890), 3-4 y=13.9% (526/3784), 4-5y=11.3% (298/2643). Method 4 studied patient contact within time points according to ASBS guidelines. Rates for method 4 were: 0-6 months = 58.8% (11,938/20,292), 6-12 months = 36.7% (4717/12,848), 1-2 y = 45.8% (2739/5977), 2-3 y = 23.0% (1124/4890), 3-4 y = 13.9% (52613784). Results using these four methods of calculation emphasize the need to standardize follow-up rate before operative comparisons can be made.
Predictors of Two Obesity Complications: diabetes and hypertension.
Gender, age, waist-hip ratio (WHR) and body mass index (BMI) have been reported to herald two complications of obesity: diabetes or hypertension. Most literature is based on patient populations with mean BMIs ranging from 22 to 35 kg/m(2). This study population of severely obese patients selected for surgical treatment of obesity had a mean age of 37 +/- 9.4 years, median WHR of 0.9 (0.4-2.1) and median BMI of 44.0 (29-89) kg/m(2). It was found that age, WHR and BMI were significant predictors for diabetes or hypertension. Gender was not found to be a significant predictor for either diabetes or hypertension. A mathematical model was used to calculate the predictive probability of developing diabetes or hypertension using age, BMI and WHR.
Methods for Voluntary Weight Loss and Control.
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