Patients With Diabetes May Need Fewer Medications After Bariatric Surgery

Chicago — Bariatric surgery appears to be associated with reduced use of medications and lower health care costs among patients with type 2 diabetes, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.

“The rapidly growing epidemics of obesity and diabetes threaten to overburden the world’s health care systems,” the authors write as background information in the article. “From an epidemiological standpoint, once these diseases develop they are rarely reversed. Dietary, pharmaceutical and behavior treatments for obesity are associated with high failure rates, and medical management of diabetes is also often unsuccessful. Despite many efforts to improve the control of glucose levels in diabetes, including clinical guidelines and patient and provider education, less than half of all patients with type 2 diabetes mellitus achieve the American Diabetes Association recommendation of a hemoglobin A1C level of less than 7 percent.”

The use of bariatric surgery—that results in long-term weight loss, improved lifestyle and decreased risk of death—has tripled in the past five years, the authors note. Martin A. Makary, M.D., M.P.H., and colleagues at the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University School of Medicine, Baltimore, studied 2,235 U.S. adults (average age 48.4) with type 2 diabetes who underwent bariatric surgery during a four-year period, from 2002 to 2005. They used claims data to measure the use of diabetes medications before and after surgery, along with health care costs per year.

Of the 2,235 patients, 1,918 (85.8 percent) were taking at least one diabetes medication before surgery, with an average of 4.4 medications per patient. Six months after surgery, 1,669 of 2,235 patients (74.7 percent) had eliminated their diabetes medications. Of the 1,847 patients with available data one year after surgery, 1,489 (80.6 percent) had eliminated medications; after two years, 906 of 1,072 (84.5 percent) had done so. This reduction was observed in all classes of diabetes medications.

Before and after bypass gastric surgery

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Do Gender Knee Implants Provide Better Outcomes?

- Study finds gender-specific total knee prostheses provide no clinical benefits compared to standard prostheses in women

- For information about knee replacement surgery in Argentina please don’t hesitate to contact Sublimis.

Rosemont, IL – A gender-specific total knee prosthesis was developed to more closely match the anatomy of the female knee, aiming to be a better fit resulting in better outcomes for women. However, a recent study in the Journal of Bone and Joint Surgery (JBJS) found that 85 women who received a gender-specific implant in one knee and a standard prosthesis in the other knee found no clinical benefits of the gender-specific knee.

“We conducted this study to investigate whether women derive less benefit, or perhaps less predictable benefit, from total knee replacement using a standard conventional total knee implant,” said Young-Hoo Kim, M.D., orthopaedic surgeon and lead author of the study.

After receiving knee implants – one gender-specific and one standard prosthesis – the women were assessed for at least two years after surgery. The knees with the gender-specific implant and the knees with the standard implant had similar knee scores and similar range of motion while lying down (125° for the knees with standard implants and 126° for the knees with gender-specific implants). All patients except three were able to bend their knees at least 90°.

Additionally, patient satisfaction with the implants was similar (8.3 points for the standard implants and 8.1 points for the gender-specific implants). A rating of 6 to 8 meant “satisfied,” and a rating of 9 to 10 meant “fully satisfied.”

Important findings included:

* The majority of women in the study (71 females or 84 percent) had no preference between the two implants,
* eight women (9 percent) preferred the standard prosthesis, and
* six (7 percent) preferred the gender-specific prosthesis.

Knee Implant. Source: AAOS.org

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Argentina, among the most important centers for plastic surgery

- Worldwide Plastic Surgery Statistics Available for the First Time
- Non Surgical Procedures Outpace Surgical Procedures

New York – The International Society of Aesthetic Plastic Surgery (ISAPS) is a world leader in plastic surgery. After a year-long process, the Society has produced the “ISAPS Biennial Global Survey(TM)” of plastic surgeons and procedures in the top 25 countries and regions – representing 75% of all procedures in 2009. The ISAPS Survey marks the first time reliable international plastic surgery data has been obtained and analyzed by independent statistical specialists.

“This year marks the 40th anniversary of the founding of ISAPS,” noted Foad Nahai, MD of the United States and current President of ISAPS. “The Society was founded at the United Nations by a group of concerned and proactive plastic surgeons. We could think of no better way of commemorating this important milestone than by commissioning and releasing this breakthrough Survey.”

Geographic Trends

The ISAPS Global Survey revealed a new hierarchy of countries with the most surgical and non surgical cosmetic procedures. While the United States continues its dominance in the field, countries not always associated with plastic surgery are emerging as major centers.

The top 25 countries and regions are:

1. United States
2. China
3. Brazil
4. India
5. Mexico
6. Japan
7. South Korea
8. Germany
9. Turkey
10. Spain
11. Argentina
12. Russia
13. Italy
14. France
15. Canada
16. Taiwan
17. United Kingdom
18. Colombia
19. Greece
20. Thailand
21. Australia
22. Venezuela
23. Saudi Arabia
24. Netherlands
25. Portugal

Before and after tummy tuck & breast implants

Most Popular Surgical and Non Surgical Procedures

For the last ten years, the consensus has been that breast augmentation was the most popular plastic surgery procedure. The ISAPS Global Survey reveals a new trend with liposuction representing 18.8% of all surgical procedures, followed by breast augmentation at 17%, and blepharoplasty (upper or lower eyelid lift) at 13.5%, rhinoplasty (nose reshaping) at 9.4% and abdominoplasty (“Tummy Tuck”) at 7.3%.

The popularity of surgical procedures varied by country with Brazil, the United States, China, Mexico, India and Japan the dominant countries for the top five procedures.

Reflecting both advances in cosmetic surgery innovation and the desirability of less expensive treatments, the number of non surgical procedures performed by plastic surgeons actually topped surgical procedures. While there is no previous baseline of information against which to compare these figures, there can be no doubt that this is a dramatic turn of events.

The top five non surgical procedures are: toxins or neuromodulators injections (Botox, Dysport) (32.7%), hyaluronic acid injections (20.1%), laser hair removal (13.1%), autologous fat injections (taking a patient’s fat from one location and transferring it in the same patient in another location) (5.9%) and IP Laser treatment (4.4%).

The countries where non surgical procedures were performed were dominated by the United States, Brazil, Mexico and China and to a lesser extent by Japan, Hungary, South Korea, India and Germany.

Obesity in Early Adulthood Associated With Increased Risk of Psoriatic Arthritis

For information about bariatric surgery abroad please do not hesitate to contact Sublimis Argentina.

Chicago — Among persons with psoriasis, those who reported being obese at age 18 had an increased risk of developing psoriatic arthritis, according to a report in the July 19 issue of Archives of Dermatology, one of the JAMA/Archives journals.

Psoriatic arthritis is a specific type of arthritis that develops in the joints of some patients who have psoriasis. According to background information in the article, “obesity has emerged as a significant risk factor for psoriasis,” and “psoriatic arthritis affects 6 percent to 42 percent of people with psoriasis.” Additionally, “psoriatic arthritis shares some clinical features with rheumatoid arthritis, both leading to joint destruction and significant morbidity.”

Razieh Soltani-Arabshahi, M.D., of the University of Utah School of Medicine, Salt Lake City, and colleagues studied a volunteer sample of patients with dermatologist-diagnosed psoriasis enrolled in the Utah Psoriasis Initiative from November 2002 to October 2008. Of the 943 participants, 50.2 percent were women and psoriatic arthritis was present in 26.5 percent of participants with psoriasis (250 persons).

The study found that body mass index (BMI) at age 18 was predictive of psoriatic arthritis. Other predictors included younger age at psoriasis onset, being female and having larger body surface areas affected with psoriasis. Additionally, the findings show “the obese group having an earlier onset of psoriatic arthritis, followed by the overweight group and finally the normal BMI group.” Twenty percent of the overweight or obese group developed psoriatic arthritis by age 35 years while 20 percent of those individuals in the normal BMI group developed psoriatic arthritis by age 48.

The authors conclude that their findings, “support a growing concept that patients more prone to psoriatic arthritis might benefit from more frequent and meticulous screening measures for early detection and treatment of psoriatic arthritis, i.e., before the development of irreversible joint destruction.”

Genetic Basis of Alopecia Areata Established

Among the Most Common Forms of Hair Loss, Alopecia Areata Affects 5.3 Million in U.S.

New York – A team of investigators led by Columbia University Medical Center has uncovered eight genes that underpin alopecia areata, one of the most common causes of hair loss, as reported in a paper in the July 1, 2010 issue of Nature. Since many of the genes are also implicated in other autoimmune diseases, including rheumatoid arthritis and type 1 diabetes – and treatments have already been developed that target these genes – this discovery may soon lead to new treatments for the 5.3 million Americans suffering from hair loss caused by alopecia areata.

According to the National Alopecia Areata Foundation, alopecia areata is a common autoimmune skin disease resulting in the loss of hair on the scalp and elsewhere. It affects approximately two percent of the population overall. While it affects both men and women equally, it is diagnosed more often in women, since they are more likely to seek treatment.

Among the eight genes, one stands out for its potential role in the onset of alopecia areata. The gene, called ULBP3, is known to act as a homing beacon for cytotoxic cells that can invade and quickly destroy an organ. Normally, ULBP3 is not present in hair follicles, but the ULBP3 proteins are abundant in hair follicles affected by alopecia areata. The proteins attract cells marked by a killer cell receptor, known as NKG2D. In addition to ULBP3, two other genes are expressed in the hair follicle, while the five remaining genes are involved in the immune response.

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Studies show Women’s attitudes to social egg freezing

Studies of women’s attitudes to ‘social egg freezing’ find that young professionals put career ahead of motherhood, while older women are still waiting for Mr. Right

Rome, Italy – Women of different ages differ in their reasons for wishing to undergo egg freezing, show two studies presented to the 26th annual meeting of the European Society of Human Reproduction and Embryology today (Monday). A large number of female university students would be prepared to undertake egg freezing in an attempt to combine career success and motherhood, said Dr. Srilatha Gorthi, a research fellow at the Leeds Centre for Reproductive Medicine, Leeds, UK, adding that her team’s research emphasised the importance of educating young women about their biological clocks in order that they could take informed decisions about future reproduction.

Dr. Gorthi surveyed 98 medical students (group A) and 97 students of education and sports studies (group B) from the University of Leeds. Information regarding egg freezing was provided, including the fact that they would have to finance their own egg freezing. The average age was 21 with age range from 18-30 years in both the groups; 63.3% of the medical students were not in a relationship, as opposed to 25.8% in group B, probably reflecting the level of commitment and time needed for their courses.

While 85.7% in group A said that they would be prepared to delay starting a family, only 49.5% in group B said they would consider this. Eight out of ten from group A said they would undergo egg collection and freezing, compared with only half as many (four out of ten) from group B. In group A, 85.3% were prepared to undergo up to three cycles of egg collection to bank enough eggs to give them a realistic chance of pregnancy. In contrast, the majority (79%) of those who would bank their eggs from group B said they would be prepared to undergo only one cycle of egg collection.

“Career considerations were given as the commonest reason to delay starting a family in group A, followed by financial stability and marriage or a stable relationship,” said Dr. Gorthi. “However, in group B, financial stability came first, followed by a stable relationship and then career reasons. We think that this is the first time that young women’s attitudes to egg freezing have been studied in this way.”

Egg freezing is still a relatively new technology; a woman has to go through an IVF treatment cycle, which takes two to four weeks and carries certain risks: ovarian hyperstimulation, haemorrhage, infection and a possible, albeit small, effect on future natural fertility. Read the rest of this entry »

Bariatric Surgery in Diabetic Adults Improves Insulin Sensitivity Better than Diet

San Diego, CA — Gastric bypass surgery improves Type 2 diabetes by other mechanisms in addition to weight loss and does so better than a low-calorie diet despite achieving equal weight loss, a new study finds. The results will be presented Monday at The Endocrine Society’s 92nd Annual Meeting in San Diego.

“Our study shows that in the short term, weight loss by diet alone does not achieve the same improvements in diabetes as gastric bypass surgery,” said the presenting author, Judith Korner, MD, PhD, assistant professor of medicine at Columbia University College of Physicians and Surgeons, New York.

Korner and her colleagues found that gastric bypass surgery better improved insulin sensitivity, the body’s ability to successfully clear glucose sugar from the bloodstream into the cells. Insulin sensitivity is impaired in people with Type 2 diabetes, and obesity adds to this problem. The result is a buildup of sugar in the blood.

The study compared the effects on diabetic adults of a low-calorie diet versus Roux-en-Y gastric bypass, the most common gastric bypass procedure. Roux-en-Y gastric bypass decreases the size of the stomach and reroutes the digestive tract to bypass most of the stomach and part of the small intestine. After gastric bypass, many diabetic patients achieve normal blood glucose control or vastly improved control, and some may no longer require diabetes medications.

In the study, seven obese patients with Type 2 diabetes received a daily 800-calorie liquid diet and no surgery, while seven other obese diabetic adults underwent gastric bypass surgery. The study ended when both groups lost the same amount of weight: an average of 8 percent of body weight. However, the surgery-treated patients lost the weight faster: in about 3.5 weeks compared with 8 weeks for the dieters.

Surgical patients were able to discontinue all of their diabetes medications by the study’s end, but the dieters reduced their medication use by 55 percent, Korner reported.

The researchers found significant improvements in the surgery group in measures of insulin sensitivity and function of beta cells, the insulin-producing cells in the pancreas. Improvements in insulin sensitivity in the low-calorie diet group were not statistically significant and beta cell function improved to a lesser extent.

Korner speculated that hormonal changes may be responsible for the improvements resulting from Roux-en-Y surgery in individuals with Type 2 diabetes.

“It will be important to understand how surgery works to produce these results so that we can develop medical therapies of equivalent efficacy,” she said.

The National Institute of Diabetes and Digestive and Kidney Diseases funded this study.

For information about bariatric surgery abroad please do not hesitate to contact Sublimis Argentina.

Prompt Gallbladder Removal in Elderly Associated with Increased Survival, Lower Costs

New Research Findings in Journal of the American College of Surgeons Show Patients Not Treated during Initial Hospitalization Required Re-admission within Two Years

Chicago – New research findings published in the May issue of the Journal of the American College of Surgeons indicate that delaying cholecystectomy, the surgical removal of the gallbladder, in elderly patients with sudden inflammation of the organ often results in increased costs, morbidity and mortality.

Gallstone disease is the most costly digestive disease in the United States, with approximately 20 million people having the disorder.  Annually, gallstone disease leads to more than one million hospitalizations, 700,000 operative procedures, and a cost of $5 billion. Furthermore, the prevalence of gallstones increases with age: 15 percent of men and 24 percent of women will have gallstones by age 70. As well, complications related to gallstones are more common in elderly patients, with the most common being acute cholecystitis, a sudden inflammation of the gallbladder, which can cause abdominal pain, nausea, vomiting, and fever.

Between 1996 and 2005, 29,818 Medicare beneficiaries were admitted to acute care facilities for a first episode of acute cholecystitis. Of these patients, 75 percent (n=22,367) underwent cholecystectomy. The inpatient mortality rate was 2.7 percent in patients who did not undergo cholecystectomy, and 2.1 percent in patients who did (p = 0.001).

For the 25 percent of patients (n=7,451) who did not undergo cholecystectomy upon first hospitalization, 38 percent required gallstone related re-admission over the subsequent two years, compared to only four percent in patients who did undergo the surgery (P<0.0001). Twenty-seven percent of patients who did not undergo definitive therapy (gallbladder removal) required subsequent cholecystectomy, often not performed electively, but associated with acute care re-admission. The gallstone-related readmissions were expensive for Medicare, leading to approximately $14,000 in total charges and greater than $7,000 in Medicare payments per readmission.

Additionally, patients who did not undergo cholecystectomy during initial hospitalization were 56 percent more likely to die two years after hospitalization discharge versus those who received immediate treatment (HR 1.56, 95 percent CI 1.47 to 1.65), even after controlling for patient demographics and comorbidities.

Source: American College of Surgeons

If you are interested in having a cholecystectomy abroad please don’t hesitate to contact Sublimis.