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Biomedical subjects

I Charuzi

Publications and source records attributed to I Charuzi.

At least 19 recordsLinked to original sources
PubMed1998

Obstructive sleep apnea in the obese.

Obstructive sleep apnea (OSA) syndrome occurs in 4% to 9% of middle-aged men and in 1% to 2% of middle-aged women. The incidence of OSA among morbidly obese patients is 12- to 30-fold higher. The pathophysiology of OSA is complex and incompletely understood. The important clinical symptoms of OSA include snoring, daytime sleepiness, restless sleep, morning fatigue, and headaches. The diagnosis is made by polysomnography. The possible sequelae of OSA are hypertension, left and right ventricular hypertrophy, sudden cardiovascular death, and increased risk for brain infarction. Nasal continuous positive airway pressure (nCPAP) appears to be the recommended treatment for OSA. Morbidly obese patients may also benefit from weight reduction gastric surgery.

Humans↗
PubMed1995

Glucose utilization in morbidly obese subjects before and after weight loss by gastric bypass operation.

OBJECTIVE: To investigate the effect of weight reduction induced by gastric bypass operation (GBO), on the peripheral resistance to insulin in extremely obese subjects. DESIGN: A three-stage euglycemic clamp was applied to assess the metabolic clearance rate of glucose (g-MCR) in lean controls and in obese subjects, prior to and 6-12 months post operation. SUBJECTS: Six obese subjects (four obese normoglycemics-ON and two obese non-insulin dependent diabetics-OD) before and after GBO and six healthy, lean controls (LC) were compared. MAIN OUTCOME MEASURES: Body mass index after GBO, metabolic clearance rate of glucose under increasing insulin concentrations. RESULTS: GBO resulted in a significant change in body mass index from a pre-operation value (mean +/- s.d.) of 45.0 +/- 8.5 to 30.4 +/- 5.9 kg m-2 and remained significantly greater than controls (23.3 +/- 2.3 kg m-2). Glucose MCR increased from a mean baseline value of 3.0 +/- 1.6 to 6.7 +/- 3.9 ml kg-1 min-1 at post GBO (P) (P < 0.02). Similar effects were obtained under the two higher insulin concentration. CONCLUSIONS: GBO resulted in a massive reduction in BMI, that still remained above normal controls. This could explain the effect of weight reduction to decrease, but not completely reverse, peripheral resistance to insulin associated with obesity.

Adolescent↗
PubMed1994

[Laparoscopic and thoracoscopic surgery in children and adolescents].

Initial experience with laparoscopic and thoracoscopic surgery in children during the year Sept. 1992-Sept. 1993 is presented. The 36 procedures included 20 appendectomies, 3 cholecystectomies, 10 upper thoracic sympathectomies, 1 bilateral oophorectomy and 2 diagnostic laparoscopies. Indications were appendicitis, symptomatic gallstones, idiopathic primary palmar hyperhidrosis, and gonadal dysgenesis (xo/xy mosaicism) in a 13-year-old girl. 2 diagnostic laparoscopies were performed for chronic abdominal pain and for a possible retroperitoneal lesion, respectively. All procedures were successfully managed without complications. In 2 cases of acute appendicitis it was necessary to change to the open conventional technique because of technical difficulties. Duration of hospitalization for cholecystectomy and sympathectomy was significantly shorter than with the conventional surgical approach and convalescence was excellent, with less postoperative pain. As for the surgical approach in acute appendicitis, we cannot as yet decide whether or not laparoscopy is superior to the conventional technique.

Abdominal Pain↗
PubMed1994

[Laparoscopic-assisted colectomy].

After gaining experience in laparoscopic cholecystectomy, laparoscopic appendectomy and other laparoscopic procedures, we decided to perform laparoscopic-assisted colectomy. During July 1992 to February 1993 we performed 14 such procedures. Ages ranged from 46-83 years (mean, 68). In all cases the indication for surgery was neoplasm of the colon. 8 of the tumors were located in the right colon and 6 in the sigmoid. Procedures performed were laparoscopic-assisted right hemicolectomy with a biofragmentable anastomotic ring or laparoscopic-assisted sigmoidectomy with end-to-end anastomosis. In 1 operation we combined laparoscopic cholecystectomy with laparoscopic right hemicolectomy. Operation time varied from 90-130 min (mean, 100 min). In our opinion the procedure is as radical as standard laparotomy with the number of lymph nodes per specimen ranging from 4-10 (mean, 7); the surgical margins were free of tumor in all cases. There was less pain in the postoperative period than with the standard procedure and the average time from operation to discharge was 7 days (range, 5-9). Complications included 1 fatality due to postoperative myocardial infarction, and 1 case of duodenal perforation which was sutured during the operation. We conclude that laparoscopic-assisted right hemicolectomy and laparoscopic sigmoidectomy are feasible for carcinoma, and that recovery is quicker and with less pain. However, we need a larger series and long-term follow-up to conclude whether the laparoscopic assisted technic is an adequate operation in cases of cancer.

Aged↗
PubMed1994

Superoxide production by neutrophils from trauma patients: regulation of NADPH oxidase activity.

The production of free oxygen radicals by polymorphonuclear cells (PMNs) was studied in 25 patients after blunt trauma. Superoxide generation significantly increased immediately after trauma and returned to normal soon after the event. Patients were subsequently divided into two groups: those who developed sepsis and those who did not develop infectious complications. Superoxide production by intact PMNs following stimulation by three different stimulants was initially not different in trauma patients who developed sepsis. Follow-up showed an increase in superoxide production when infection complicated the course of trauma patients. Further studies were performed in a cell-free system containing cell membranes and cytosol from patients or healthy controls. No difference in the production of superoxide was found when membranes from trauma patients or controls were mixed with cytosols from controls. When cytosols from patients were mixed with membranes from controls, a significant increase in superoxide production was observed in the group that developed sepsis. Immunoblotting analysis of two protein components of the cytosolic portion of the NADPH oxidase, p47 and p67, were done. The increase in quantity of p47 correlated with the increase in superoxide production during sepsis, and thus may be the major contributor to the high activity.

Adolescent↗
PubMed1994

Laparoscopic cholecystectomy for empyema of gallbladder during pregnancy.

Laparoscopic cholecystectomy has gained great popularity during the last few years. This procedure has advantages over the traditional open operation, thus making it the standard method for removal of the gallbladder at present. Only a few cases of laparoscopic cholecystectomy during pregnancy have been reported. On the other hand, some authors classify pregnancy as one of the contraindications for this procedure.

Acute Disease↗
PubMed1993

[Experience with biofragmentable anastomotic rings].

During 1991-92 we performed 50 bowel anastomoses using the biofragmentable anastomotic ring (BAR). The indications were malignancy (35 cases), Crohn's disease (3), dolichosigma (4), diverticulitis (2), gastric outlet obstruction (2), and 1 each for abdominal trauma, postoperative stricture, and stricture caused by ischemic colitis. The average age was 61; 28 were women and 22 men. The anastomoses were between colon and rectum (21 cases), ileum and colon (18), colon and colon (8), stomach and jejunum (2) and ileum and ileum (1). First stools were passed after an average of 4.7 +/- 2.5 (SD) days and a low-residue diet was well-tolerated after an average of 7 +/- 3.9 days. There were complications in 12 (24%). In 3 others leaks necessitated reoperation. Incomplete small bowel obstruction developed in 6, 4-18 days after operation and lasted 3-11 days. In 2 a perianastomotic inflammation appeared 1-3 weeks after operation and was treated successfully with IV antibiotics and bowel rest. In 1 case a stricture appeared 3 months after surgery and was treated successfully with balloon dilatation. No complications were seen after anastomosing bowel segments proximal to the ileocecal valve. The average time for expelling the BAR in 19 of the 45 patients was 2.5 +/- 0.6 weeks, assessed by weekly X-raying of the abdomen. Although the group of patients was small, our impression is that the method of anastomosis is easy to learn, easy to perform and relatively safe.

Anastomosis, Surgical↗
PubMed1993

[Experience with laparoscopic appendectomy].

During April to August 1992, laparoscopies were performed in this department in 35 of 100 cases of appendicitis. The average patient age was 29 years; 18 of the 35 (51%) were women; 3 patients were operated on electively, and the rest as emergencies. Appendectomy was performed in 33 (94%), but not in 2 women with sepsis due to tubo-ovarian abscess; In 1 of these 2 we had to convert to laparotomy. Acute appendicitis was found in 20 (57%). In 7 women (20%) gynecologic disease was diagnosed. In 1 case (3%) a carcinoid tumor of the tip of the appendix was found and in another primary peritonitis. In the remaining 6 (17%) no lesions were found. In 33 (94%) a regular diet was resumed 25 hours postoperatively and 25 (71%) were discharged the day after operation. The only complication was an abdominal wall hematoma in a single case, which resolved spontaneously. It is our impression that laparoscopy is a useful diagnostic tool in acute appendicitis, that it is a safe route for appendectomy, and that recovery is quick with minimal complications.

Acute Disease↗
PubMed1993

[Long-term weight changes after Roux-en-Y gastric bypass for morbid obesity].

100 patients were followed for 6-9 years after Roux-en-Y gastric bypass for morbid obesity. They were randomly selected from 600 patients operated on between 1980-85. Their initial weight averaged 118 +/- 16 kg, which was 196 +/- 25% of their ideal body weight. They reached their lowest weight during an average of 15.5 months after surgery, at which time 37% were at their ideal weight, 42% were 110-130% of their ideal weight and 21% were 131-192% of their ideal weight. 90% had lost more than 50% of their excess weight. 24% had lost all their excess weight or even more, which could jeopardize nutritional status. Longer follow-up of 6-9 years showed weight gain, with 24% having become morbidly obese again, 74% having lost more than 50% of their excess weight and only 7% having lost all their excess weight. We conclude that Roux-en-Y gastric bypass induces long term weight loss and largely prevents return of morbid obesity, as long as 6-9 years after surgery.

Adult↗
PubMed1992

[Nutritional disturbances after Roux-en-Y gastric bypass].

200 patients after Roux-en-Y gastric bypass were nutritionally followed for an average of 6.7 years. They were randomly selected out of 450 patients operated on during 1980-1985. They had lost a mean of 56 +/- 22% of their excess weight and had remained stable in weight for the preceding 5 years with limited nutritional caloric restriction. Iron saturation, hemoglobin and mean corpuscular volume declined gradually and significantly (p less than 0.0001, p less than 0.0001 and p less than 0.001, respectively). However, mean serum concentration of vitamin B12, which also had decreased significantly during the preceding 5 years (p less than 0.0004), increased during recent years, but still was lower than before the bypass. Albumin and transferrin levels remained normal. There was no correlation between weight change and serum concentration of iron or vitamin B12. We conclude that 6.7 years after surgery, while there is no caloric or protein deficiency, there has been gradual development of iron deficiency, but not correlated with weight loss.

Adolescent↗
PubMed1992

[Nutritional habits after Roux-en-Y gastric bypass for morbid obesity].

The nutrition of 200 patients after Roux-en-Y gastric bypass for morbid obesity was followed for 6.7 years. During the first 2 years their food intake was severely restricted, resulting in an excess weight loss of 69 +/- 14%. At an average of 3 years after surgery they began to regain weight significantly (p less than 0.04) due to nutritional adaptation. In the following years caloric consumption stabilized at an excess weight loss of 48-56%. However, they had continuing meat intolerance with 51.0, 60.3, 59.5 and 55.1% of them avoiding meat during 0-12 months, 13-24 months, 25-72 months and 73-96 months after surgery, respectively. We conclude that after Roux-en-Y gastric bypass there is nutritional adaptation lasting as long as 2 years, when a characteristic nutritional behavior is adopted which persists for years.

Adaptation, Physiological↗
PubMed1992

Bariatric surgery in morbidly obese sleep-apnea patients: short- and long-term follow-up.

Forty-seven obese sleep-apnea patients were investigated in the sleep laboratory before and after a massive weight reduction achieved by bariatric surgery. The first postoperative sleep investigations were performed approximately 1 y after surgery and revealed a highly significant decrease in the number of apneic episodes per hour of sleep and a significant improvement in all sleep-quality-related measures. A second postoperative sleep study was performed approximately 7 y postoperatively and revealed that regaining of weight was associated with the reappearance of sleep apnea syndrome, although the great majority of the patients still felt, subjectively, that they were well and did not suffer from recurrence of the sleep apnea syndrome.

Adult↗
PubMed1992

Nutritional status seven years after Roux-en-Y gastric bypass surgery.

BACKGROUND: Nutritional deficiencies in patients after Roux-en-Y gastric bypass operations have been mainly attributed to dietary restriction. However, most of these studies have been performed during the period of greatest caloric restriction. METHODS: Two hundred patients who were morbidly obese were followed for 6 to 8 years (mean, 6.7 years) after Roux-en-Y gastric bypass surgery. Each underwent a thorough physical examination and behavioral and nutritional assessments, including hemoglobin, red blood cell indices, serum iron content, iron binding capacity, and serum vitamin B12 and folic acid concentrations. RESULTS: Data obtained from blood tests disclosed a significant gradual decrease of the mean serum hemoglobin (p less than or equal to 0.0000), mean corpuscular volume (p less than 0.001), and iron saturation (p less than or equal to 0.0000). Mean vitamin B12 concentration improved during the last 3 years of follow-up. The mean values of iron saturation and vitamin B12 were not correlated with the patients' weight loss. Meat intolerance was observed in 51%, 60.3%, 59.5%, and 55.1% of the patients during the 0 to 12 months, 13 to 24 months, 25 to 72 months, and 73 to 96 months after surgery, respectively. A significant correlation was found between the eating habits and the laboratory values. The mean serum iron saturation, vitamin B12, and folic acid were significantly higher in patients who eat meat than in patients who do not eat meat (piron less than 0.0046, pB12 less than 0.0052, folate less than 0.01). In addition, oral vitamin and mineral supplements significantly improved the nutritional status of the patients. The patients had no caloric malnutrition or protein deficiency. CONCLUSIONS: Roux-en-Y gastric bypass induces long-term changes in eating habits, independent of caloric intake. Iron continuously declines 6 to 8 years after surgery, depending (significantly) on the eating behavior, but not on the caloric intake.

Anastomosis, Roux-en-Y↗
PubMed1990

Effect of an acute bout of exercise on glucose disposal in human obesity.

The effect of acute exercise on insulin action has been studied in six obese (150-250% ideal body weight) non-insulin-dependent diabetics (OD), seven obese normoglycemics (ON), and six lean healthy controls (LC). Using a three-stage euglycemic clamp, the metabolic clearance rate (MCR) of glucose under increasing insulin concentrations was measured. The insulin dose-response curve was assessed on two separate occasions: 1) a base-line test and 2) 1 h after aerobic treadmill exercise at a steady-state heart rate of 150-160 beats/min. In the base-line test, under all insulin levels, glucose MCR was significantly lower in obese compared with lean individuals (P less than 0.01). Exercise increased glucose MCR at the highest hormonal concentrations applied to 124 and 134% of base line in OD and in ON, respectively (P less than 0.05); the insulin concentration required for one-half of the maximal clearance rate of glucose achieved in this study decreased from 200 to 130 and from 160 to 95 microU/ml in OD and ON, respectively (P less than 0.05). The changes in these parameters were insignificant in LC. It is suggested that acute exercise affected the insulin dose-response curve in OD and in ON but not in LC; although enhanced by exercise, glucose MCR remained significantly lower in both obese groups compared with control subjects. We concluded that insulin resistance, which accompanies extreme obesity, could be markedly decreased but not completely reversed by one bout of exercise.

Adult↗
PubMed1989

Liver histology abnormalities in the morbidly obese.

A prospective study was undertaken in order to investigate the association between clinical and biochemical parameters and the histopathological findings in liver biopsies in the morbidly obese. Wedge liver biopsy specimens were taken at the beginning of the surgical procedure from 100 consecutive morbidly obese patients undergoing Roux-en-Y gastric bypass. Histological abnormalities were found in almost all of the examined material (98 of 100), which ranged from mild fatty infiltration through inflammatory change and alcoholic hepatitis-like change to fibrosis and cirrhosis. The patients with abnormalities were divided into two groups: those with a single abnormality (n = 56) and those with two or more histopathological findings (n = 42). Age, excess body weight, total cholesterol and triglyceride levels were significantly higher in the group with more than one histopathological finding. In a discriminant function analysis, it was found that the preoperatively available measures of age, sex and excess body weight, as well as ALT and triglyceride levels, could discriminate between the two patient groups. A model which uses these variables has been described which correctly assigns the patients to their histology groups in 73% of the cases. This model could provide a useful noninvasive clinical tool for the preoperative evaluation of possible hepatic damage in morbidly obese patients in whom there is no other known cause of possible liver disease.

Adult↗