Biomedical subjects

Odette Lescelleur

Publications and source records attributed to Odette Lescelleur.

4 recordsLinked to original sources

PubMed2006

Health-related quality of life in morbid obesity.

BACKGROUND: In order to evaluate the impact of severe obesity and its treatment on quality of life (QoL), it would be important to first identify the areas of QoL most likely to be affected by the disease. METHODS: We first constructed a list of 187 items potentially related to QoL of patients with morbid obesity. From this list, consecutive candidates for bariatric surgery were asked to identify what they felt were the most significant items and to grade their importance. The item impact was determined from the proportion of patients who identified it as important, and the mean importance score attributed to this item (impact score = frequency X importance). RESULTS: 100 patients (68 female; mean body mass index 51.5 kg/m(2); mean age 42) were interviewed. Overall, the impact of morbid obesity was more important in women than in men. The areas of impairment were very similar in both groups, with the important difference that women ranked their dissatisfaction with physical appearance higher than men. The items having the most important impact on QoL clustered into 7 domains: 1) activity/mobility; 2) symptoms; 3) personal hygiene/clothing; 4) emotions; 5) social interactions; 6) sexual life; and 7) eating behavior. CONCLUSION: The impact of morbid obesity on QoL is not limited to the activity/mobility domain. Morbid obesity contributes to the impairment of all domains of what is usually referred to as "health-related quality of life".

Adult↗

PubMed2005

Accelerated satiation after duodenal switch.

BACKGROUND: This is to introduce a new test "negative alliesthesia" for measuring satiation after bariatric surgery. It is a test that is well known by physiologists but has never been used clinically. It is based on the observation that repeated pleasant gustatory stimuli turn into unpleasantness in the process of satiation. METHODS: We measured the time it took for a repeatedly ingested sweet stimulus to become first unpleasant (negative alliesthesia) and then intolerable (satiety). At the same time, we measured the degree of pleasure aroused by the sweet stimulus (hedonic rating). The test was given to 9 patients before and 3 and 6 months after the duodenal switch procedure and in 10 morbidly obese patients, three times, 3 months apart. RESULTS: The test showed that negative alliesthesia and satiety were three times faster after surgery. The negative alliesthesia time decreased from 16.0 +/- 3.9 minutes to 5.7 +/- 1.4 minutes (P < 0.0004). The satiety time decreased from 26.7 +/- 5.0 minutes to 10.7 +/- 1.3 minutes (P <0.001). Finally, the hedonic rating for the sweet stimulus decreased from 78.8% +/- 15.7% to 49.9% +/- 13.0% at 3 months and 39.3% +/- 20.6% at 6 months after surgery, without, however, reaching statistical significance. CONCLUSION: The duodenal switch modified negative alliesthesia. It is too soon to say what place this test may have in bariatric surgery, but its simplicity and ingenuity are attractive.

Adult↗

PubMed2004

Metabolic and cardiovascular improvements after biliopancreatic diversion in a severely obese patient.

BACKGROUND: Severe obesity is associated with important morbidity and increased mortality. The successes of lifestyle modifications and drug therapy have been partial and mostly unsustained in reducing obesity and its comorbidities. Bariatric surgery, particularly biliopancreatic diversion with duodenal switch reduces efficiently excess body weight and improves metabolic and cardiovascular functions. CASE PRESENTATION: A 56-year-old man with severe clinical obesity underwent a biliopancreatic diversion with a duodenal switch after unsuccessful treatment with weight loss pharmacotherapy. He had diabetes, hypertension and sleep apnea syndrome and was on three medications for hypertension and two hypoglycemic agents in addition to > 200 insulin units daily. Eleven months after the surgery, he had lost 40% of his body weight. The lipid profile showed great improvement and the hypertension and diabetes were more easily controlled with no more insulin needed. The pseudonormalized pattern of left ventricular diastolic function improved and ventricular walls showed decreased thickness. CONCLUSION: Biliopancreatic diversion may bring metabolic and cardiovascular benefits in severely obese patients from a cardiovascular perspective.

Journal Article↗

PubMed2004

Twenty years of biliopancreatic diversion: what is the goal of the surgery?

BACKGROUND: Comparative evaluation of weight loss after bariatric surgery is difficult without definition of success and without a norm for presenting results. We explored the pertinence of defining success: a residual BMI <40 or <35 kg/m(2), and the need for reporting results with stratification by initial obesity and length of follow-up. METHODS: Results of 1,271 consecutive biliopancreatic diversion (BPD) patients were compared when presented with or without stratification, and we searched for landmarks of success which would be shared by patients themselves. RESULTS: Presented globally, after a mean follow-up of 7.9 +/- 4.2 years, BMI decreased from 48.4 +/- 9.4 to 31.3 +/- 6.5, and only 10% and 26% of patients would have been considered failures with a residual BMI >or= 40 or >or= 35 respectively. Because heavier patients were losing less in terms of percentage ( P <0.0001) and regained weight faster ( P <0.0001), global and cumulative results failed to show a failure-rate doubling every 5 years and a very high failure-rate in heavier patients. The landmarks of BMI 40 and 35 were the same unconsciously used by patients to express their own perception of failure. For patients with an initial BMI <50, a residual BMI of 35 caused a significant drop in the degree of satisfaction from 90 to 40%. For super-obese, the same critical point was found at a BMI of 40 where satisfaction dropped from 91 to 57%. CONCLUSION: Landmarks of success at BMI 40 and 35 were realistic, reasonable and coincided with patients' own expectations. Since initial obesity and duration after surgery made so much difference in results, a comparison of different surgical approaches was useless without stratification for both factors together.

Adult↗