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Íîâîñòè áàðèàòðè÷åñêîé ìåäèöèíû
Ñîîòíîøåíèå "îáúåì òàëèè/ðîñò" (WHR) ëó÷øå ïðåäñêàçûâàåò ñìåðòíîñòü ïðè îæèðåíèè, ÷åì èíäåêñ ìàññû òåëà (BMI). Îá ýòîì ãîâîðèò ïðåçåíòàöèÿ, ñäåëàííàÿ íà Åâðîïåéñêîì êîíãðåññå ïî îæèðåíèþ â Ëèâåðïóëå, êîòîðûé ïðîõîäèë â ýòè äíè (13-15 ìàÿ 2013). Àâòîðû äîêëàäà - Dr Margaret Ashwell è ñîàâò.
Êàê èçâåñòíî, èíäåêñ ìàññû òåëà ÿâëÿåòñÿ ïîêàçàòåëåì îáùåãî îæèðåíèÿ, â òî âðåìÿ êàê WHR ÿâëÿåòñÿ ïîêàçàòåëåì öåíòðàëüíîãî îæèðåíèÿ. |
#2
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Ñîííîå àïíîå: ýôôåêòèâíîñòü áàðèàòðè÷åñêîé õèðóðãèè è èçìåíåíèÿ ñòèëÿ æèçíè
Èññëåäîâàòåëè èç Íîðâåãèè ñðàâíèëè ýôôåêòèâíîñòü áàðèàòðè÷åñêîé õèðóðãèè (â âèäå æåëóäî÷íîãî øóíòèðîâàíèÿ) è èíòåíñèâíîé ìîäèôèêàöèè îáðàçà æèçíè â ëå÷åíèè ñîííîãî àïíîå.
Îêàçàëîñü, ÷òî áàðèàòðè÷åñêàÿ õèðóðãèÿ çíà÷èòåëüíî ýôôåêòèâíåå ìîäèôèêàöèè îáðàçà æèçíè â îòíîøåíèè ñîííîãî àïíîå. Êîëè÷åñòâî ýïèçîäîâ àïíîå/ãèïîïíîå óìåíüøèëîñü íà øåñòü â ÷àñ íà ôîíå ìîäèôèêàöèè îáðàçà æèçíè (÷åðåç ãîä ëå÷åíèÿ), â òî âðåìÿ êàê ïîñëå áàðèàòðè÷åñêîé îïåðàöèè (÷åðåç ãîä) êîëè÷åñòâî ñëó÷àåâ àïíîå óìåíüøèëîñü íà 13 ýïèçîäîâ â ÷àñ. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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Ã.À. Ìåëüíè÷åíêî |
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#5
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Ôóíêöèÿ êîñòíî-ìûøå÷íîé ñèñòåìû ïîñëå áàðèàòðè÷åñêèõ îïåðàöèé
Àìåðèêàíñêèå îðòîïåäû è ñïåöèàëèñòû ïî ðåàáèëèòàöèè èçó÷èëè ðåçóëüòàòû ïàöèåíòîâ ïîñëå áàðèàòðè÷åñêîé õèðóðãèè â àñïåêòå ôóíêöèîíèðîâàíèÿ êîñòíî-ìûøå÷íîé ñèñòåìû. Áûëà èçó÷åíà ãðóïïà èç 50 ïàöèåíòîê â âîçðàñòå îò 24-70 ëåò, êîòîðûì â êà÷åñòâå áàðèàòðè÷åñêîé îïåðàöèè áûëî ñäåëàíî æåëóäî÷íîå øóíòèðîâàíèå ïî Ðó.
Äëÿ èíòåãðàëüíîé îöåíêè ôóíêöèè êîñòíî-ìûøå÷íîé ñèñòåìû áûë èñïîëüçîâàí òåñò TGUG*, à òàêæå êðàòêèé îïðîñíèê ôóíêöèè êîñòíî-ìûøå÷íîé ñèñòåìû (SMFA) è êðàòêèé îïðîñíèê êà÷åñòâà çäîðîâüÿ (SF-36). Îöåíêè ïðîâîäèëèñü äî îïåðàöèè è ÷åðåç ãîä ïîñëå îïåðàöèè.  ñðåäíåì ïàöèåíòêè ïîõóäåëè íà 48.5 êã. Ðåçóëüòàòû îáîèõ îïðîñíèêîâ ïîêàçàëè ñóùåñòâåííîå óëó÷øåíèå. Òåñò TGUG óëó÷øèëñÿ â ñðåäíåì íà 3.1 ñåêóíäû. Àâòîðû äåëàþò âûâîä î ñóùåñòâåííîì óëó÷øåíèè ôóíêöèîíàëüíîãî ñîñòîÿíèÿ êîñòíî-ìûøå÷íîé ñèñòåìû ïîñëå áàðèàòðè÷åñêèõ îïåðàöèé. ------------------------------------ * Òåñò TGUG (timed-get-up-and-go) ïðîâîäèòñÿ ñëåäóþùèì îáðàçîì: ïàöèåíò ïî êîìàíäå âñòàåò ñ êðåñëà, äîõîäèò äî ëèíèè íà ðàññòîÿíèè òðåõ ìåòðîâ îò êðåñëà, âîçâðàùàåòñÿ îáðàòíî è ñàäèòñÿ. Íîðìàëüíîå âðåìÿ âûïîëíåíèÿ çàäà÷è – 10 ñåêóíä è ìåíåå. |
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Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient — 2013 Update : Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery
Endocr Pract. 2013 Mar-Apr;19(2):337-72. Àìåðèêàíñêèå ðåêîìåíäàöèè ïî ïèòàíèþ, îáìåíó âåùåñòâ è íå-õèðóðãè÷åñêîìó âåäåíèþ áàðèàòðè÷åñêèõ ïàöèåíòîâ - êàê âûÿâèòü/ñêîððåêòèðîâàòü/ïðåäîòâðàòèòü äåôèöèò æèçíåííîâàæíûõ âèòàìèíîâ è ìàêðî/ìèêðî-ýëåìåíòîâ è ìíîãîå äðóãîå â ïîëíîì òåêñòå ïî ññûëêå: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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Äëÿ òîãî, ÷òîáû äèåòà ðàáîòàëà, åå íàäî ñîáëþäàòü 25 äíåé â ìåñÿö
Äëÿ òîãî, ÷òîáû äèåòà ðàáîòàëà, åå íàäî ñîáëþäàòü 25 äíåé â ìåñÿö. È òîëüêî 5 äíåé â ìåñÿö ìîæíî ðàññëàáèòüñÿ. Ê òàêîìó âûâîäó ïðèøëè ó÷åíûå èç Ôèíëÿíäèè è ÑØÀ â ñâîåé ñîâìåñòíîé ðàáîòå:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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Ðàíåå áûëî ïðàâèëî "íèêîãäà íå òðè ðàçà ïîäðÿä"- òå íåëüçÿ ïðïóñòèòü òåòüþ òðåíèðîâêó, íåëüçÿ òðè äíÿ îòñòóïàòü îò ïèòàíèÿ è òä
Âèäàòü, ïîðà óæåñòî÷àòü
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Ã.À. Ìåëüíè÷åíêî |
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Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes a systematic review bariatric surgery for weight loss and glycemic control
JAMA, 06/13/2013 Evidence Based Medicine Clinical Article Maggard–Gibbons M et al. – Bariatric surgery is beneficial in persons with a body mass index (BMI) of 35 or greater with obesity–related comorbidities. There is interest in using these procedures in persons with lower BMI and diabetes. To assess the association between bariatric surgery vs nonsurgical treatments and weight loss and glycemic control among patients with diabetes or impaired glucose tolerance and BMI of 30 to 35. Current evidence suggests that, when compared with nonsurgical treatments, bariatric surgical procedures in patients with a BMI of 30 to 35 and diabetes are associated with greater short–term weight loss and better intermediate glucose outcomes. Evidence is insufficient to reach conclusions about the appropriate use of bariatric surgery in this population until more data are available about long–term outcomes and complications of surgery. Methods PubMed, EMBASE, and Cochrane Library databases were searched from January 1985 through September 2012. Of 1291 screened articles, authors included 32 surgical studies, 11 systematic reviews on nonsurgical treatments, and 11 large nonsurgical studies published after those reviews. Weight loss, metabolic outcomes, and adverse events were ed by 2 independent reviewers. Results Three randomized clinical trials (RCTs) (N = 290; including 1 trial of 150 patients with type 2 diabetes and mean BMI of 37, 1 trial of 80 patients without diabetes [38% with metabolic syndrome] and BMI of 30 to 35, and 1 trial of 60 patients with diabetes and BMI of 30 to 40 [13 patients with BMI <35]) found that surgery was associated with greater weight loss (range, 14.4–24 kg) and glycemic control (range, 0.9–1.43 point improvements in hemoglobin A1c levels) during 1 to 2 years of follow–up than nonsurgical treatment. Indirect comparisons of evidence from observational studies of bariatric procedures (n ~ 600 patients) and meta–analyses of nonsurgical therapies (containing more than 300 RCTs) support this finding at 1 or 2 years of follow–up. However, there are no robust surgical data beyond 5 years of follow–up on outcomes of diabetes, glucose control, or macrovascular and microvascular outcomes. In contrast, some RCT data of nonsurgical therapies show benefits at 10 years of follow–up or more. Surgeon–reported adverse events were low (eg, hospital deaths of 0.3%–1.0%), but data were from select centers and surgeons. Long–term adverse events are unknown.
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Ã.À. Ìåëüíè÷åíêî |
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Áàðèàòðè÷åñêàÿ õèðóðãèÿ ýôôåêòèâíà ó ïàöèåíòîâ ñ ãåíåòè÷åñêèì îæèðåíèåì
Áàðèàòðè÷åñêàÿ õèðóðãèÿ îêàçàëàñü ýôôåêòèâíîé ó ïàöèåíòîâ ñ ìóòàöèåé ãåíà MC4R (ãåí ðåöåïòîðà ìåëàíîêîðòèíà4). Èçâåñòíî, ÷òî òàêàÿ ìóòàöèÿ àññîöèèðîâàíà ñ îæèðåíèåì, èíñóëèíîðåçèñòåíòíîñòüþ è ÑÄ2.
Îêàçàëîñü, ÷òî áàðèàòðè÷åñêàÿ îïåðàöèÿ ó ïîäðîñòêîâ, èìåþùèõ ýòó ìóòàöèþ, ñòîëü æå ýôôåêòèâíà, êàê è ó ïàöèåíòîâ áåç ìóòàöèè ([Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]). |
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Êëèíè÷åñêè ýòî ÐÛÆÈÅ äåòè ñ îæèðåíèåì .
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Ã.À. Ìåëüíè÷åíêî |
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Îòäàëåííûå ðåçóëüòàòû áàíäàæèðîâàíèÿ æåëóäêà
Îïóáëèêîâàíû ðåçóëüòàòû 10-ëåòíåãî èññëåäîâàíèÿ çà ïàöèåíòàìè ïîñëå áàíäàæèðîâàíèÿ æåëóäêà â ñðàâíåíèè íåõèðóðãè÷åñêèì ëå÷åíèåì çà òîò æå ïåðèîä âðåìåíè.
Ãðóïïà ïàöèåíòîâ ñ íåáîëüøèì îæèðåíèåì (ÈÌÒ 30-35) áûëà ðàíäîìèçèðîâàíà íà ïðîâåäåíèå áàíäàæèðîâàíèÿ æåëóäêà èëè íà ïðîâåäåíèå èíòåíñèâíîé ìåäèêàìåíòîçíîé òåðàïèè. Îêàçàëîñü, ÷òî â ãðóïïå áàíäàæèðîâàíèÿ æåëóäêà ñðåäíÿÿ ïîòåðÿ ìàññû òåëà ñîñòàâèëà 14,1 êã çà 10 ëåò íàáëþäåíèÿ.  ãðóïïå èíòåíñèâíîãî ìåäèêàìåíòîçíîãî ëå÷åíèÿ ïîòåðÿ ìàññû òåëà ñîñòàâèëà â ñðåäíåì 0.4 êã çà 10 ëåò íàáëþäåíèÿ. Àâòîðû äåëàþò âûâîä î äîëãîâðåìåííîé ýôôåêòèâíîñòè áàíäàæèðîâàíèÿ æåëóäêà ïî ñðàâíåíèþ ñ ìåäèêàìåíòîçíûì ëå÷åíèåì. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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Èíòåðåñíîå èññëåäîâàíèå âûïîëíåíî ó÷åíûìè èç Johns Hopkins University, Baltimore. Âñåãäà ñóùåñòâîâàëî ïîäîçðåíèå, ÷òî ãîëîâíûå áîëè è âåñ ÷åëîâåêà âçàèìîñâÿçàíû. Äîêòîð Peterlin è ñîàâòîðû, ïðîâåäÿ ðåàëüíî áîëüøîå èññëåäîâàíèå íà 3700 ïàöèåíòàõ, ïîëó÷èëè ïðÿìóþ è ïî÷òè ëèíåéíóþ çàâèñèìîñòü ðåãóëÿðíîé ãîëîâíîé áîëè (â òîì ÷èñëå ìèãðåíè) îò èíäåêñà ìàññû òåëà. Ñèëüíåå ýòà çàâèñèìîñòü áûëà ó æåíùèí, áåëûõ, è ëþäåé ìëàäøå 50 ëåò.
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïðè÷èíû òàêîé âçàèìîñâÿçè ìåæäó ãîëîâíûìè áîëÿìè è ÈÌÒ íåÿñíû. Õîòÿ ãèïîòåòè÷åñêè ýòè ãîëîâíûå áîëè ìîæíî îáúÿñíèòü íàëè÷èåì öèðêóëèðóþùèõ ìåäèàòîðîâ âîñïàëåíèÿ ó ëþäåé ñ îæèðåíèåì, à òàêæå ïîâûøåíèåì âíóòðè÷åðåïíîãî äàâëåíèÿ ó ëþäåé ñ áîëüøèì ÈÌÒ. Ýòî èññëåäîâàíèå ïîäòâåðæäàåò ðàíåå îïóáëèêîâàííûå ôàêòû î ïîçèòèâíîì âëèÿíèè áàðèàòðè÷åñêîé õèðóðãèè íà òå÷åíèå ìèãðåíè: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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À âîò è òåñòû óæå äëÿ âðà÷åé îáùåé ïðàêòèêè ïî âîïðîñàì áàðèàòðè÷åñêîé õèðóðãèè
Remission of diabetes is usually permanent 50% of participants selected this Remissionof diabetes is temporary in about 30% of patients 50% of participants selected this Remission of diabetes is temporary in about 70% of patients Answer: The correct answer is remission is temporary in about 30% of patients. Data was collected in a retrospective cohort study of 4,434 adults with type 2 diabetes who underwent gastric bypass from 1995 to 2008. Diabetes remission and relapse events were recorded. Overall, 2,254 patients or 68.2% (95% CI, 66 and 70%) experienced an initial complete diabetes remission within 5 years after surgery. Among these patients, 35.1% (95% CI, 32 and 38%) redeveloped diabetes within 5 years. The median duration of remission was 8.3 years. Arterburn D, et al. A Multisite Study of Long-term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass. Obesity Surgery 2012
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Ã.À. Ìåëüíè÷åíêî |
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Ïñèõèàòðè÷åñêèå íàðóøåíèÿ äî è ïîñëå áàðèàòðè÷åñêèõ îïåðàöèé
Íîðâåæñêèå èññëåäîâàòåëè îöåíèëè óðîâåíü ïñèõèàòðè÷åñêèõ íàðóøåíèé äî áàðèàòðè÷åñêèõ îïåðàöèé è ïîñëå íèõ.  èññëåäîâàíèå áûëè âêëþ÷åíû 127 ïàöèåíòîâ îáîåãî ïîëà ñî ñðåäíèì óðîâíåì ÈÌÒ 45 è ñðåäíèì âîçðàñòîì 41 ãîä.
Óðîâåíü äåïðåññèè, áåñïîêîéñòâà è ñòûäëèâîñòè èçó÷àëñÿ ïðè ïîìîùè ñòðóêòóðèðîâàííîãî êëèíè÷åñêîãî èíòåðâüþ è òðåõ ñòàíäàðòíûõ îïðîñíèêîâ (Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) è Internalized Shame Scale (ISS)). Îêàçàëîñü, ÷òî ïñèõèàòðè÷åñêèå íàðóøåíèÿ äî îïåðàöèè èìåëèñü ó 48% ïàöèåíòîâ, â òî âðåìÿ êàê ÷åðåç ãîä ïîñëå îïåðàöèè ýòà öèôðà ñíèçèëàñü äî 18%. Óðîâåíü ñòûäëèâîñòè áîëåå 50 ïóíêòîâ ïî øêàëå ISS äî îïåðàöèè áûë ñèëüíûì ïðîãíîñòè÷åñêèì ôàêòîðîì â îòíîøåíèè ñîõðàíåíèÿ ïñèõèàòðè÷åñêèõ ïðîáëåì è ïîñëå îïåðàöèè. Àâòîðû äåëàþò âûâîä î ñóùåñòâåííîì ñíèæåíèè óðîâíÿ ïñèõèàòðè÷åñêèõ íàðóøåíèé ïîñëå áàðèàòðè÷åñêèõ îïåðàöèé. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |