Obesity surgery
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This paper focuses on the Greco-Roman views on obesity with certain extensions to the Byzantine era. The writers reported hereby are Aulus Cornelius Celsus (circa 25 BC), Dioscorides Pedanius (40-90 AD), Soranus of Ephesus (98-138 AD) whose writings on the subject survived through Caelius Aurelianus (5th c. AD), Claudius Aelianus (3rd C. ⋯ All of the authors treat the subject of etiology, clinical manifestations and treatment, while the Hippocratic and Galenic views seem to be taken into consideration. The most important observation made on the basis of the studied texts is the emersion of the notion of the "Mediterranean diet" that was advised as an extremely successful conservative way to treat obesity. The Greco-Roman and Byzantine writers continue the long tradition of treating obesity and set the foundations for modern methods of treatment.
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Comparative Study
The value of pulmonary function testing prior to bariatric surgery.
Pulmonary function tests (PFTs) are often abnormal in the morbidly obese and improve after bariatric surgery. Our aim was to determine the utility of obtaining preoperative PFTs in assessing postoperative risk. ⋯ PFTs help to predict complications after bariatric surgery. The greatest reduction in VC may occur in patients with central obesity, reflecting increased intrabdominal pressure and diminished chest wall compliance.
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Obesity is a chronic inflammatory condition, with related steatohepatitis and liver fibrosis. The authors analyzed the hepatic histopathology in morbidly obese patients and predictors of concurrence of clinical and/ or histopathologic findings of steatohepatitis with other forms of chronic liver disease. ⋯ Hepatic steatosis, features of metabolic syndrome and liver cell injuries were common in morbidly obese patients. Abnormal liver function and portal inflammation were related to hepatic fibrosis. The coexistance of clinical and histologic features of steatohepatitis with another chronic liver disease may reflect the biological significance of the chronic inflammatory condition in the obese population, which requires further investigation.
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Although the implications for the anesthetic and perioperative care of severely obese patients undergoing weight loss operations are considerable, current anesthetic management of super-obese (SO) patients (BMI > or =50 kg/m(2)), including super-super-obese (BMI > or =60) derives from experience with morbidly obese (MO) patients (BMI 40-49.9 kg/m(2)). We compared anesthetic and perioperative data of SO patients and MO patients undergoing weight loss operations to evaluate if anesthetic management influenced outcome. ⋯ No differences in outcome occurred between MO and SO patients undergoing bariatric operations under similar anesthetic management. Anesthesia for weight loss surgery can be safely performed on SO patients with the understanding that these patients are not at risk per se due to their higher BMI. The degree of obesity influenced only the incidence of intraoperative surgical complications.
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Serum amyloid A (SAA) is an inflammatory marker associated with cardiovascular disease (CVD) and found to be increased in obesity. Obstructive sleep apnea (OSA) syndrome, a frequent complication of obesity also associated with CVD risk, is improved after surgically-induced weight loss. To explore the potential role of SAA in the relation between OSA and CVD, we investigated relationships between changes in SAA concentrations and nocturnal respiratory events in obese subjects undergoing bariatric surgery. ⋯ The improvement of OSA after bariatric surgery is associated with a decrease in SAA, independent of the change in BMI. SAA may represent a marker of the improvement in CVD risk profile after surgically-induced weight loss in patients with OSA.