Should obese, smoking and alcohol consuming women receive assisted reproduction treatment?

The European Society of Human Reproduction and Embryology (ESHRE) has published a position statement on the impact of the life style factors obesity, smoking and alcohol consumption on natural and medically assisted reproduction.

In a literature study the ESHRE Task Force on Ethics and Law summarised the negative effects of obesity, smoking and drinking on the natural reproductive potential of patients, on IVF results, pregnancy complications and outcomes and finally on the health of the future child. The paper was published online on 19 January 2010 in Europe’s leading reproductive medicine journal Human Reproduction. The group made five recommendations.

1) In view of the risks for the future child, fertility doctors should refuse treatment to women used to more than moderate drinking and who are not willing or able to minimize their alcohol consumption.

2) Treating women with severe or morbid obesity required special justification. The available data suggested that weight loss would incur in a positive reproductive effect, although more data was needed to establish whether assisted reproduction should be made conditional upon prior life-style changes for obese and smoking females.

3) Assisted reproduction should only be conditional upon life style changes, if there was strong evidence that without behavioural modifications there was a risk of serious harm to the child or that the treatment became disproportional in terms of cost-effectiveness or obstetric risks.

4) When making assisted reproduction conditional upon life style modifications, fertility doctors should help patients to achieve the necessary results.

5) More data on obesity, smoking and alcohol consumption as well as other life style factors were necessary to assess reproductive effects. Fertility doctors should continue research in this area.

ESHRE acknowledged that this was a complex issue due to personal, patient, professional and societal responsibilities and also in terms of what these responsibilities meant with regard to safety of mother and child and fair and equitable access to treatment. The respect for patient autonomy needed to be balanced with the moral weight of the interests of society and the future child.

Obesity

According to the group obesity negatively affected reproductive potential through interference with hormonal and metabolic mechanisms leading to lower ovulation frequency and reduced chances of conception. The risk of gestational diabetes increased from twofold in overweight women to eightfold for morbidly obese women. The infants of obese mothers were at risk of perinatal death, congenital abnormalities such as neural tube defects (80% increase) and cardiovascular anomalies (30% increase).

Smoking

The risk of infertility was thought to be twice as high in smokers compared to non-smokers. Female smokers needed more time to become pregnant, were less likely to do so spontaneously and had a higher risk of miscarriage. Having an accelerating effect on oocyte depletion, smoking was suggested to lead to an increase in 10 years with regards to IVF outcome. Lower birth weight, a higher risk of oral facial clefts and Sudden Infant Death Syndrome were associated with maternal smoking. Male smokers were at risk of producing sperm of reduced quality and concentration.

Alcohol Consumption

Reduced conception, lower pregnancy rates and higher miscarriage rates were suggested as adverse effects of alcohol consumption. The known effects of alcohol consumption were summarised under Foetal Alcohol Spectrum Disorders (FASD) such as physical anomalies and behavioural and cognitive deficits. Other risks associated with prenatal alcohol consumption were foetal death, preterm labour and compromised foetal growth.

Please feel free to contact Sublimis for information about assisted reproduction treatments and weight loss surgery in Argentina.

Obesity linked to common form of kidney cancer and each extra BMI point increases risk

Being obese could lead to a greater risk of developing the most common form of renal cell cancer, according to research in the January issue of the UK-based urology journal BJUI.

US researchers found that obese patients with kidney tumours have 48 per cent higher odds of developing a clear-cell renal cell cancer (RCC) than patients with a body mass index (BMI) of less than 30. And the odds increase by four per cent for every extra BMI point.

The team at the Memorial Sloan-Kettering Cancer Center in New York, USA, studied 1,640 patients with kidney tumours. They found that 88 per cent had malignant tumours and 61 per cent of these were clear-cell RCCs. The remaining 12 per cent had benign tumours.

When they factored in the patient’s weight, they discovered that there was a significant association between obesity and clear-cell RCC, which accounts for up to 80 per cent of RCC cases and is one of the more lethal variants.

“Recent scientific breakthroughs about what causes clear-cell RCC have led to the development of new targeted therapies” says lead author Dr William T Lowrance.

“This makes it more important than ever to identify those people who face an increased risk of developing this variant, which is on the rise in the USA.

“The widespread use of abdominal imaging has definitely contributed to increased detection of RCC, but fails to account for it entirely.

“A number of studies have suggested that obesity could be a risk factor for RCC, but the exact reason is unknown. Researchers suggest it might be secondary to hormonal changes, decreased immune function, hypertension or diabetes in obese patients.”

The study looked at all patients who had undergone surgery at the Center between January 2000 and December 2007. Patients with hereditary renal cancer syndrome were excluded and BMI data was missing for a further 64, giving a study size of 1,640.

Key findings included:

* Patients had an average age of 62 years, 63 per cent were male and 88 per cent were white.
* 38 per cent of patients had a BMI of 30 or more, which is classified as obese, and this figure rose to 42 per cent in the patients with clear-cell RCC. By contrast, only 31 per cent of the patients with benign tumours were obese.
* 67 per cent of the obese patients had malignant tumours with clear-cell RCC, compared with 57 per cent of the non-obese patients.
* The rates for the other kinds of malignant tumours – including papillary, chromophobe and collecting duct – were similar between the obese and non-obese patients.

“We also looked at other health and lifestyle factors, like diabetes, hypertension and smoking” adds Dr Lowrance. “This showed that the only other factors that were independent predictors of clear-cell RCC were male gender and tumour size.”

The researchers conclude that BMI is an independent predictor of clear-cell RCC and that as BMI increases, the odds of having a clear-cell RCC also increases.

“Although we still need to find out more about the pathology of clear-cell RCC, this study is useful as it provides individual predictors of the chance of developing this form of cancer” concludes Dr Lowrance. “Of these, obesity provides the strongest association.”

Source: Wiley.com

For information about obesity treatments don’t hesitate to contact us

Obesity Now Poses As Great a Threat to Quality of Life As Smoking

San Diego, CA – As the US population becomes increasingly obese while smoking rates continue to decline, obesity has become an equal, if not greater, contributor to the burden of disease and shortening of healthy life in comparison to smoking. In an article published in the February 2010 issue of the American Journal of Preventive Medicine, researchers from Columbia University and The City College of New York calculate that the Quality-Adjusted Life Years (QALYs) lost due to obesity is now equal to, if not greater than, those lost due to smoking, both modifiable risk factors.

QALYs use preference-based measurements of Health-Related Quality of Life (HRQOL) which allow a person to state a relative preference for a given health outcome. Since one person may value a particular outcome differently than another person, these measures capture how each respondent views his or her own quality of life.

The 1993–2008 Behavioral Risk Factor Surveillance System (BRFSS), the largest ongoing state-based health survey of US adults, has conducted interviews of more than 3,500,000 individuals; annual interviews started with 102,263 in 1993 and culminated with 406,749 in 2008. This survey includes a set of questions that measures HRQOL, asking about recent poor health days and tracking overall physical and mental health of the population. The authors analyzed these data and converted the measures to QALYs lost due to smoking and obesity.

From 1993 to 2008, when the proportion of smokers among US adults declined 18.5%, smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. During the same period, the proportion of obese people increased 85% and this resulted in 0.0464 QALYs lost. Smoking had a bigger impact on deaths while obesity had a bigger impact on illness.

Investigators Haomiao Jia, PhD and Erica I. Lubetkin, MD, MPH, state, “Although life expectancy and QALE have increased over time, the increase in the contribution of mortality to QALYs lost from obesity may result in a decline in future life expectancy. Such data are essential in setting targets for reducing modifiable health risks and eliminating health disparities.”

The article is “Trends in Quality-Adjusted Life-Years Lost Contributed by Smoking and Obesity” by Haomiao Jia, PhD, and Erica I. Lubetkin, MD, MPH. The article appears in the American Journal of Preventive Medicine, Volume 38, Issue 2 (February 2010) published by Elsevier.

For any inquiry about bariatric surgery procedures please do not hesitate to contact us.

Timing of surgery for knee injuries may not affect outcomes

Rosemont, Ill – Multiple-ligament knee injuries resulting from traumatic knee dislocations – such as high impact car accidents or certain sports are uncommon, and the optimal timing of surgical repair or reconstruction has not been definitively established.

According to a new study published in the December 2009 issue of The Journal of Bone and Joint Surgery (JBJS), patients who undergo surgery more than three weeks after a multiple ligament knee injury (called chronic intervention treatment) may have comparable outcomes to those who undergo surgery within three weeks of injury (called acute intervention treatment) with regard to knee stability. Additionally, researchers found that early mobility is associated with better outcomes than immobilization in those patients who are treated within that three week time period.

“After a review of the available literature, we found that chronic intervention provides results that are at least as good as acute intervention, despite some recent studies showing that acute intervention may be better,” said lead author of the study William R. Mook, MD, who conducted the study with colleagues from the Department of Orthopaedic Surgery at the University of Virginia in Charlottesville.

Dr. Mook and his colleagues surveyed 24 retrospective studies that included 396 knees treated surgically for the most severe multiple-ligament knee injuries. Patients were managed either acutely, chronically, or with a combination of both interventions, which is called staged treatment. The researchers also studied whether the patient’s leg should or should not be mobile or immobilized after surgery.

The study found that:

* patients receiving acute intervention had less stable knees and were not able to bend their knees as far as those who were treated with chronic intervention; and
* patients who underwent staged procedures (treatment from both the acute and chronic intervention stages) reported better outcomes than those treated just early or late.

“The reasons for this are not clear. The patient population is heterogeneous, and surgery can be delayed for a variety of reasons. It is difficult to tell which procedures were delayed intentionally and which were delayed due to other medical reasons occurring as a result of their initial injury,” Dr. Mook said.

This literature review suggests the following:

* Surgical reconstructions within three weeks of the injury and those performed later provide comparable knee stability.
* In patients treated within three weeks of injury, early mobility (compared with immobilization) is associated with better outcomes. However, early surgery is highly associated with range-of-motion limitations.
* Patients reported better outcomes and fewer range-of-motion limitations with a combination of acute and chronic procedures. However, additional treatment for joint stiffness may be required in these patients.
* In patients treated within three weeks of their injury, more aggressive rehabilitation may prevent the need for additional treatment for joint stiffness.

Previous studies have indicated that early treatment provides better outcomes, but that may not be the case. “Although recent evidence suggests that acute intervention is superior to chronic interventions in all outcomes, we found that chronic intervention may provide knees with equal stability as those managed acutely,” Dr. Mook concluded.

Source: American Academy of Orthopaedic Surgeons

For more information about Orthopedics and Traumatology Treatments in Argentina don’t hesitate to contact us.

’Tis the season for gifting cosmetic surgery

However, discuss procedure with recipient beforehand

Chicago – Maybe you’ve received eye-opening holiday gifts in the past such as new electronics, an exciting vacation or that car you have always craved. The gift of cosmetic surgery is not a new phenomenon, but many are going that route this holiday season as husbands and wives yearn for that perfect present to their loved one.

“It’s the season of giving and cosmetic surgery can fit into that category just as easily as some of the more traditional gifts out there,” said Dr. Patrick McMenamin, MD, President of the American Academy of Cosmetic Surgery. “What better way to ring in the New Year than to get that procedure that you’ve always wanted? And if it’s a present to or from a loved one, that makes it all the better.”

According to a consumer survey by the American Academy of Cosmetic Surgery, 46 percent of consumers say they would forego an expensive vacation or luxury car to pay for cosmetic surgery.

Surgery gift-giving does take some planning, as the procedures are often done before Christmas, so patients are either recovering or showing off their improved looks in time for their holiday gatherings. But make sure this is something you talk over with the surgery recipient beforehand, because surprising someone with cosmetic surgery is not recommended.

“There are a large number of people who really want cosmetic surgery, and they just need that little nudge or incentive to get it done,” said Dr. Mark Berman, AACS President- Elect. “Well, if you’re that spouse or significant other, just make sure you’ve discussed the idea in the past so it doesn’t come as a surprise.”

Source: cosmeticsurgery.org

For more information about cosmetic surgery please don’t hesitate to contact us.

American Academy Of Cosmetic Surgery Opposes Cosmetic Surgery Tax

Chicago, IL – As negotiators on Capitol Hill try to find ways to fund a health care overhaul, a 5% tax on cosmetic surgery has been introduced on Nov. 18 as part of the Senate’s proposed health reform bill, introduced by US Senator Harry Reid (D-NV). The American Academy of Cosmetic Surgery strongly opposes such taxes and urges legislators to consider the following points:

• A tax on elective cosmetic procedures is an unreliable, risky revenue source that has no proven record of raising projected revenues.
• The difficulty of defining elective vs. medically-necessary cosmetic surgery. There is a blurry line between what procedures are considered medically-necessary and those that are elective.
• Retention of highly-skilled physicians is at risk. Physicians face many challenges in operating their practices on a day-to-day basis. Turning them into tax-collectors is an additional burden on these doctors.
• Cosmetic surgery is not a specialty for only the wealthy or the vain. In fact, the median income for those electing to have cosmetic surgery is dropping.
• Despite the fact that more men are seeking cosmetic procedures than ever, the largest portion of patients are still working women, who would be unfairly targeted by such taxes.
• A large portion of those being taxed would be the baby-boomer generation. And as this age group continues to age, the more interest will be generated in cosmetic procedures. It is important to note that the age bracket are most likely to vote in elections is the same as those who are electing to have cosmetic procedures.

Read the rest of this entry »

Cosmetic eyelid surgery can boost quality of life for patients

New research released at world’s largest ENT meeting

San Diego, CA – Cosmetic surgery that repairs droopy eyelids, also known as blepharoplasty, has an overall positive impact on patients’ quality of life (QOL).

In a paper presented at the 2009 American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO in San Diego, researchers administered a retrospective questionnaire survey of 26 adult patients undergoing bilateral upper and lower lid cosmetic blepharoplasty. The authors used the Glasgow Benefit Inventory (GBI), which is a validated QOL questionnaire that aims to assess the impact of an otolaryngologic intervention on a patient. Patients undergoing surgery for non-cosmetic indications, or those who had additional cosmetic procedures performed, were excluded.

Before and After Blepharoplasty Procedure

Blepharoplasty (BLEF-uh-ro-plas-te) is surgery to repair droopy eyelids by removing excess skin, muscle and fat. Eyelids stretch and lose elasticity as people age. As a result, excess fat may gather above and below the eyelids, causing sagging eyebrows, drooping upper lids and bags under your eyes. Besides making patients look older, severely sagging skin around the eyes can also impair vision.

Results of the questionnaire indicated that the procedure had a positive impact on QOL for almost all the outcome measures used in the GBI. The authors noted that most patients who undergo a blepharoplasty procedure do so to feel better about their appearance and improve their self esteem. They note that this study is the first to confirm that patients do receive the QOL benefits that they are hoping to achieve with the plastic surgery.

For more information about having a blepharoplasty abroad do not hesitate to contact us.

Reconstructive Plastic Surgery Patients Honored for Giving Back

Ceremony at American Society of Plastic Surgeons Annual Meeting

Seattle – An injured Iraqi citizen, a port wine stain patient, a breast reconstruction patient and a skin cancer patient will be named honorees of the Patients of Courage: Triumph Over Adversity awards by the American Society of Plastic Surgeons (ASPS) at Plastic Surgery 2009, October 24, 4:30 p.m., at the Washington State Convention & Trade Center in Seattle.  These unselfish individuals endured numerous reconstructive plastic surgeries and use their experiences, strength and determination to help others in need.

The Patients of Courage: Triumph Over Adversity program is supported by Ethicon, Inc., a Johnson & Johnson company. Continuing in the spirit of giving, Ethicon will donate, on behalf of each of the honorees, $5,000 to four non-profit organizations providing reconstructive plastic surgery services to people in need.

“ASPS Member Surgeons are humbled by the achievements of their patients,” said ASPS President John Canady, MD. “It is so impressive to see our patients doing such good things for so many people.”

Uday Hattem, New York – As a citizen of Baghdad, Iraq, Hattem signed on as a translator for the U.S. Army during Operation Iraqi Freedom. In May, 2003, Hattem ventured out for supplies for the troops when he encountered a group of insurgents who shot him at close range in the face, neck, and arm and left him for dead. He suffered facial deformities losing his right eye, cheek, palate, and partial mandible. In a twist of fate, the founder of Global Medical Relief Fund (GMRF) met Hattem in an Iraqi hospital and sought aid from doctors in the United States. Hattem arrived in New York after receiving a Certificate of Honor for his heroism. He underwent microsurgical reconstruction of the cheek and orbit followed by facial flap rotation for soft tissue coverage. He also required bone grafts, nasal reconstruction, as well as numerous skin, cartilage, and fat grafts to improve the color and contour mismatch on his face. Grateful for all he’s been given, Hattem gives back to those in need by actively participating in the GMRF efforts to bring Iraqi children injured during war to the United States.

Abigail Hardin, Clinton, Miss. – Hardin, currently a student at the University of Alabama, was born with a right cheek capillary vascular malformation – port wine stain.  She received several laser treatments throughout her childhood to try to alleviate the malformation. Based on her life experiences, she recently published a children’s book entitled “Look at me; I’m just like you” about a hippopotamus named Lucy who has a port wine stain on her cheek. Lucy is the subject of peer ridicule and teaches her classmates to accept and respect other children with facial and functional deformities. Hardin travels to schools to read her book to school children, giving both teachers and students the opportunity to increase their awareness of the self-esteem and emotional issues facing children perceived as “different.” Hardin also started a foundation called Open My Eyes whose sole purpose is to fund projects that promote character-development in children. A percentage of the sales of her book will go to support the ongoing mission of her foundation.

Janet Smith, Canton, Ohio – Smith was diagnosed with infiltrating ductal carcinoma of her left breast and underwent lumpectomy. After chemo and radiation therapy, she developed inflammatory carcinoma invading the skin and lymph nodes. This was followed by 10 cycles of chemo, and she was given a poor prognosis. A latissimus dorsi flap was unsuccessful, and she was left with an extensive chest wall wound which had to be covered with skin grafts. She recently developed inflammatory disease in the right breast and underwent a right mastectomy with advancement flap for closure. Her spirits remain high throughout her numerous surgical procedures and therapies. Next to her family, music is her joy. She volunteers with the music program at McKinley Senior High School teaching children the gift of music. Smith leads the FACES of Stark County, an agency of parents who have been successful navigating the various systems for their own children and now help other parents find appropriate services for their children.

Jane Escher, Easton, Md. – Escher was diagnosed, at age 82, with an aggressive basal cell carcinoma on her nose, a cancer she successfully fought twice before. She sought the expertise of a MOHS’ surgeon, but the cancer was more widespread than initially believed, and she was left with a large nasal defect that ended up requiring a forehead flap reconstruction.  Not wanting to miss work, Escher returned to work within a week, even though her reconstruction was not completely finished.  She is an outreach nurse for the Shore Regional Breast Center giving uninsured women access to life-saving cancer screenings. Escher is an inspiration to everyone around her, especially her young cancer patients, as they are inspired seeing an elder woman tackle the difficulties of skin cancer and reconstructive surgeries. She is a senior citizen who never let cancer slow her down in her quest to care for others as a nurse at the underserved Shore Regional Breast Center.

For more information about reconstructive plastic surgery do not hesitate to contact us.