- Sublimis Argentina offers affordable bariatric surgery abroad

Chicago — Among obese individuals, having bariatric surgery was associated with a reduced long-term incidence of cardiovascular deaths and events such as heart attack and stroke, according to a study in the January 4 issue of JAMA.

Most epidemiological studies have shown that obesity is associated with increased cardiovascular events and death. “Weight loss might protect against cardiovascular events, but solid evidence is lacking,” according to background information in the article.

Lars Sjostrom, M.D., Ph.D., of the University of Gothenburg, Sweden, and colleagues conducted a study to test the hypothesis that bariatric surgery is associated with a reduced incidence of cardiovascular events and examined the relationship between weight change and cardiovascular events. The study (Swedish Obese Subjects [SOS]) is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden, and includes 2,010 obese participants who underwent bariatric surgery and 2,037 matched obese controls who received usual care.

Patients were recruited between September 1987 and January 2001. Date of analysis was December 31, 2009, with median (midpoint) follow-up of 14.7 years. Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Surgery patients underwent gastric bypass (13.2 percent), banding (18.7 percent), or vertical banded gastroplasty (68.1 percent), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals. The average changes in body weight after 2, 10,15, and 20 years were -23 percent, -17 percent, -16 percent, and -18 percent in the surgery group and 0 percent, 1 percent, -1 percent, and -1 percent in the control group, respectively.

- Before and after bariatric surgery in Argentina

During follow-up, there were 49 cardiovascular deaths among the patients in the control group and 28 cardiovascular deaths among the patients in the surgery group. In total (fatal and nonfatal), there were 234 cardiovascular events among patients in the control group and 199 cardiovascular events among patients in the surgery group. After adjustment for a number of variables, bariatric surgery was associated with a reduced number of fatal cardiovascular deaths and a lower incidence of total cardiovascular events.

Bariatric surgery was associated with reduced number of fatal heart attack deaths (22 in the surgery group vs. 37 in the control group), with analysis indicating that bariatric surgery was related both to reduced fatal heart attack incidence and total heart attack incidence. Also, bariatric surgery was associated both with reduced number of fatal stroke events and total stroke events.

However, the researchers found no significant relationship between weight change and cardiovascular events in the surgery or control group. The authors suggest that the lack of association between weight loss and reduction of cardiovascular events could be related to inadequate statistical power to detect this relationship. “Alternatively, following relatively modest weight loss induced by bariatric surgery, there is no further risk reduction attributable to greater, subsequent weight loss. Our negative findings also emphasize the need to explore weight loss independent of effects of bariatric surgery.”

“In conclusion, this is the first prospective, controlled intervention to our knowledge reporting that bariatric surgery is associated with reduced incidence of cardiovascular deaths and cardiovascular events. These results– together with our previously reported associations between bariatric surgery and favorable outcomes regarding long-term changes of body weight, cardiovascular risk factors, quality of life, diabetes, cancer, and mortality– demonstrate that there are many benefits to bariatric surgery and that some of these benefits are independent of the degree of the surgically induced weight loss.”

Undergoing Bariatric Surgery Associated With Obese Family Members Adopting Healthier Lifestyles

Having an obese family member undergo gastric bypass surgery for weight loss appears to be associated with additional benefits of weight loss and improved healthy behaviors of obese family members, according to a report of Archives of Surgery, one of the JAMA/Archives journals.

One of the biggest risks for becoming an obese child is having an obese parent, and data show that childhood obesity is strongly associated with obesity in adulthood, according to background information in the article. “The obesity rate in children of mothers who have had Roux-en-Y gastric bypass is 52 percent lower after surgery compared with the obesity rate in children born to the same mothers before surgery,” the authors write. “If one member of the family makes drastic lifestyle changes following surgery, it is possible that other family members will adopt similar healthy habits.”

- Before and after bariatric surgery in Argentina

Gavitt A. Woodard, M.D., and colleagues from Stanford University School of Medicine, Stanford, Calif., observed the weight and lifestyle changes of patients who underwent Roux-en-Y gastric bypass surgery and their family members. The study was conducted between January 2007 and December 2009, and included 85 participants; 35 bariatric surgery patients, 35 adult family members and 15 children under 18 years of age. Obese adult family members were define as having a BMI greater than 30 and obese children were defined as having a BMI at the 95th percentile or higher, using the BMI for sex and age growth charts of the Centers for Disease Control and Prevention (CDC).

The weight loss in patients observed by the authors one year following surgery was typical for patients undergoing gastric bypass surgery at the study institution. The mean (average) weight loss of all adult family members decreased from 220 pounds to 198 pounds but was not statistically significant. However, among obese family members, the weight decreased from 234 to 226 pounds, a difference that did reach statistical significance. The same results were observed for waist circumference, as the results among all adult family members did not change significantly (from 108 cm to 105 cm; 42.5 inches to 41.3 inches), but did significantly decrease among obese adult family members (from 119 to 111 cm; 46.9 inches to 43.7 inches).

In obese children only, the authors observed a lower BMI than was expected for their growth curve at the one-year follow-up, however this finding did not reach statistical significance.

One year following surgery, both patients and adult family members had significant changes in their eating habits, with patients significantly increasing cognitive control of eating while decreasing uncontrolled and emotional eating. Adult family members showed no significant changes in cognitive control of eating, but did significantly decrease uncontrolled eating and emotional eating. Additionally, children of bariatric patients were twice as likely to report being on a diet to lose weight one year post-surgery. Children also benefited from fewer daily hours of television watching and increased hours of physical activity after a parent underwent bariatric surgery.

For more information about Bariatric Surgery in Argentina please do not hesitate to contact us.

Tests That Use DNA From Mother’s Blood to Determine Sex of Fetus Often Effective

As a noninvasive method of determining the sex of a fetus, tests using cell-free fetal DNA obtained from the mother’s blood after 7 weeks gestation performed well, while urine-based tests appear to be unreliable, according to a review and analysis of previous studies, reported in the August 10 issue of JAMA.

Noninvasive prenatal determination of fetal sex could provide an important alternative to invasive cytogenetic determination, which is currently the gold standard for determining sex and single-gene disorders. Amniocentesis has small but measurable rates of procedure-related pregnancy loss; and sonography can be performed as early as 11 weeks’ gestation to determine fetal sex, although not reliably, according to background information in the article. “The availability of a reliable noninvasive alternative to determine fetal sex would reduce unintended fetal losses and would presumably be welcomed by pregnant women carrying fetuses at risk for disorders,” the authors write.

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New approach to Thyroid Surgery eliminates neck scar

- Minimally invasive approach allows surgeons to remove thyroid tumors by way of the armpit
- Note: Sublimis Argentina offers affordable thyroid surgery abroad. Feel free to contact us for further information

As the rate of thyroid cancer continues to climb, doctors are urging patients to be more cautious about thyroid nodules, a common disorder that is responsible for a small but growing number of thyroid cancer cases. Thyroid nodules affect nearly 13 million Americans and are a result of abnormal cell growth on the gland. Until recently, the only way to remove nodules and rule out cancer was through surgery that required a five centimeter incision across the front of the neck. The procedure, and the large scar that resulted, was a deterrent for many patients who feared altering their appearance for something that may not be life threatening. Today however, a new option exists that allows surgeons to access the neck through the armpit, allowing for a biopsy of tissue with no visible scar.

“We now have a minimally invasive way of determining if a thyroid nodule is cancerous,” said Jose Dutra, MD, head and neck surgical oncologist and director of the Thyroid Surgical Clinic at Northwestern Memorial Hospital. “It’s an approach that more patients are comfortable pursuing. If we can identify cancerous cells earlier we increase the chance of removing the cancer before it spreads.”

The procedure, transaxillary robotic thyroid surgery, utilizes 3D cameras and specially designed robotic arms to create a small incision within the armpit, the mechanical arms work just like hands allowing the specialized surgeon to operate remotely with precise control and movements to remove suspicious nodules.

“The underarm area has fewer nerve endings than the anterior neck area, so there’s less pain, no scarring on the neck, and with good care, the incision will heal faster,” said Dutra who is also an associate professor at the department of otolaryngology/head and neck surgery at Northwestern University Feinberg School of Medicine.

This summer, Socorro Delaluz became one of the first patients at Northwestern Memorial to undergo transaxillary thyroid robotic surgery. The mother of two was impressed to have the option that left no visible scar and the quick recovery associated with the technique.

“I didn’t want to be reminded constantly, every morning when I get dressed that I had a scar across my neck. I would have to explain to everyone what happened all the time,” expressed Delaluz.

Another benefit of the minimally invasive approach is that the precision of the robot allows physicians to remove all of the potentially cancerous tissue while sparing more of the structure surrounding the gland.

“The thyroid gland controls how the body uses energy. Changes to the gland can cause a myriad of health issues,” explained Dutra, member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Thyroid nodules are six-times more common in women than men and can be difficult to diagnose because they often do not present signs or symptoms. Most nodules are small and are often found incidentally during a routine physical or imaging for an unrelated condition. Conditions that can cause one or more nodules to develop in the thyroid gland range from overgrowth of normal thyroid tissue, tumors, a cyst, inflammation and goiters. Individuals should routinely check their neck and should talk with their doctor if they notice any lumps or experience symptoms such as swelling, trouble swallowing, and pain in the throat or hoarseness of the voice.

Robotic surgery is currently widely used for minimally invasive heart and lower abdominal procedures, only recently have the robotic arms been applied to the confined space involved in neck and head surgery. The benefits for robotic thyroid surgery include shorter recovery period, less pain in neck following surgery and better preservation of the laryngeal nerves and the parathyroid glands.

Jennifer Panaro recently had a large nodule removed from her thyroid gland by way of transaxillary thyroid robotic surgery and was back on the tennis court just six weeks after her surgery. The 28 year old was impressed with the speedy recovery and was pleased her voice was protected. “I was thrilled to not experience any changes in my voice or to have deal with a large scar on my neck. As an accountant, I talk to clients all day and I would be self conscious about having a foreign mark across my throat,” said Panaro, patient at Northwestern Memorial.

While the new technology has great advantages, Dutra stresses this option is not the best for all patients and not all tumors can be removed with this approach.

Botox Receives A Positive Opinion for Urinary Incontinence

- Botox injections can provide long-lasting bladder control for patients with neurogenic bladder
- Note: Sublimis offers different treatments with Botox in Argentina

Marlow, United Kingdom – Allergan is pleased to announce that BOTOX® (botulinum toxin type A) has received a positive opinion from the Irish Medicines Board for the management of urinary incontinence in adults with neurogenic detrusor overactivity (NDO) resulting from neurogenic bladder due to stable sub-cervical spinal cord injury, or multiple sclerosis. This is an important step towards securing national licences in the 14 European countries involved in the Mutual Recognition Procedure and marks a key milestone in bringing this innovative treatment to patients suffering from urinary incontinence due to neurogenic detrusor overactivity. The positive opinion is specific for BOTOX® and is based on Allergan’s successful global phase III programme.

Between 60-80% of people with multiple sclerosis (MS) and 75-80% of people with spinal cord injury (SCI) will suffer from some degree of bladder dysfunction including urinary incontinence which can be distressing. Urinary incontinence in patients with MS or SCI is frequently caused by a condition called neurogenic detrusor overactivity (NDO), which results in involuntary contractions of the bladder during the filling stage when the bladder should be relaxed. This overactivity can lead to urinary incontinence (uncontrolled urinary leaking). Targeted injections of BOTOX® into the bladder muscle have been shown to reduce the involuntary contractions and increase bladder capacity. In turn, this reduces the number of urinary leaking episodes and may even stop leaking altogether in some patients.

In Europe, approximately 656,000 people live with MS and, on average, nearly 11,000 people are diagnosed with SCI per year. Many of these people face long-term mobility issues, yet remain professionally and socially active. Urinary incontinence can be a disabling and socially isolating condition. It is also associated with significant quality of life and emotional well-being implications such as embarrassment, low self esteem, depression and loss of independence. Other health implications of urinary incontinence in people living with MS or spinal cord injury include skin irritation and ulcers, kidney failure and recurrent urinary tract infections, which may lead to serious health consequences, if the overactivity of the detrusor muscle is not treated.

“We are pleased that BOTOX® has received a positive opinion following the Mutual Recognition Procedure for the treatment of urinary incontinence in people living with multiple sclerosis or spinal cord injury,” said Douglas Ingram, President of Allergan in Europe, Africa and the Middle East. “For many people with spinal cord injury or multiple sclerosis, gaining effective control over their bladder and staying dry can be a significant step towards improving daily functioning and overall quality of life. Our task now is to work closely with the national health authorities to secure the relevant national licences so that we can bring this valuable treatment option to patients, as quickly as possible.”

Diabetes and Obesity Combo a Major Red Flag in Pregnancy

Type 2 diabetes and obesity in pregnancy is a daunting duo, according to new research published this month in The Journal of Maternal-Fetal and Neonatal Medicine. The study shows that both conditions independently contribute to higher risks, opening the door to a wide range of pregnancy, delivery and newborn complications.

Study authors say the findings are important because obesity and type 2 diabetes are skyrocketing in women of childbearing age. A study in The Journal of the American Medical Association reports that between 2007 and 2008 the prevalence of obesity among adult women in the United States was more than 35 percent. A report from the Centers for Disease Control and Prevention states that approximately 11 percent of women above the age of 20 had diabetes in 2010.

Loralei Thornburg, M.D., senior study author and a high-risk pregnancy expert at the University of Rochester Medical Center, emphasizes that the research is needed now more than ever. “We’ve never seen the degree of obesity and type 2 diabetes in women that we are seeing right now, because for a very long time diabetes was a disease of an older population, so we rarely dealt with it in prenatal care. We hope this new knowledge will help physicians better understand and care for this rapidly expanding group of high-risk women.”

While numerous studies have established that obesity, in the absence of diabetes, is associated with problems in pregnancy – preterm birth, birth trauma, blood loss and a prolonged hospital stay, to name a few – less is known about type 2 diabetes and what causes difficulties when the two conditions coexist. Researchers from Rochester wanted to determine if obesity alone accounts for the increased risks in this “dual-diagnosis” group, or if diabetes plays a role as well.

To determine the influence of obesity and type 2 diabetes when the conditions coexist in pregnancy, Thornburg and lead study author Kristin Knight, M.D., used clinical records and the hospital’s birth certificate database to identify 213 pairs of women who delivered babies at the Medical Center between 2000 and 2008. Each pair included a diabetic and a non-diabetic patient with approximately the same pre-pregnancy body mass index (BMI). The majority of women in the study were overweight, obese or morbidly obese.

“We matched the pairs pound for pound, because if obesity was the main problem, we’d see similar outcomes between women, whether they had diabetes or not. But if we saw different outcomes between pairs, we’d know the diabetes was impacting outcomes as well,” said Thornburg.

Using mathematical models and controlling for outside factors, such as age and tobacco use, researchers found that the patients with type 2 diabetes had overall worse pregnancy, delivery and newborn outcomes than their BMI-matched counterparts. Specifically, diabetic patients had higher rates of preeclampsia, cesarean delivery, shoulder dystocia, preterm delivery, large for gestational age infant, fetal anomaly and admission to the neonatal intensive care unit.

“Women and their physicians need to be aware that each condition on its own increases risk in pregnancy, so when they coexist the situation is even more worrisome,” said Knight, a maternal fetal medicine fellow at Rochester. “Pregnancy is a time of great change, and fortunately many women are very open to making modifications during this period in their life. Anything a woman can do to improve her condition, from controlling blood sugar and exercising, to eating nutritious foods and maintaining an optimal weight, will help her deliver a healthier baby.”

Knight originally focused her research on the effects of type 1 and type 2 diabetes on pregnancy. In a previous study, she found that women with type 2 diabetes, most of whom were also obese, had poorer outcomes. Consequently, her research turned to obese, type 2 diabetics and their experiences in pregnancy.

“If a woman enters pregnancy obese, but hasn’t developed type 2 diabetes, she is in a better place than if she had both,” concluded Thornburg.

In addition to Knight and Thornburg, Eva K. Pressman, M.D., and David N. Hackney, M.D., from the Medical Center, also participated in the research.

Note: Sublimis offers fertility treatments abroad and weight loss surgery in Argentina

New Body Sculpting Technique uses High-Intensity Ultrasound

- Noninvasive Technique Reduces Waist Size in Nonobese Patients, Study Finds

- Note: Sublimis offers affordable Vaser Liposuction and non-surgical body sculpting in Argentina. Feel free to contact us for more information.

Arlington Heights, Ill. – A “body sculpting” technique using high-intensity focused ultrasound to eliminate unwanted abdominal fat effectively reduces waist circumference, with only minor pain and side effects, reports a study in the July issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Body sculpting is defined as “the optimization of the smoothness, definition, or silhouette of the human physique, particularly the torso.” The most common medical procedure for body sculpting is liposuction, which can remove relatively large volumes of fat. High-intensity ultrasound provides a nonsurgical alternative to liposuction for removing unwanted fat in nonobese patients, according to the study led by ASPS Member Mark L. Jewell, MD of Oregon Health Science University, Eugene.

Body Sculpting Technique Eliminates Fat with Few Side Effects

The researchers evaluated the outcomes of high-intensity focused ultrasound for body sculpting of the abdomen and flanks in 180 patients. All patients sought treatment to eliminate excess abdominal fat; only patients who were not obese (body mass index less than 30) were eligible for the study. The average age was 42 years, and 85 percent of the patients were women.

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Study Shows Gastric Bypass May Reverse Infertility

- New hope for women with morbid obesity trying to get pregnant

- Sublimis Argentina offers affordable bariatric surgery abroad and fertility treatments abroad

Orlando, FL – Obesity has been linked to infertility and now a new study shows bariatric surgery may treat its most common cause, polycystic ovarian syndrome (PCOS), a hormonal imbalance that affects up to 10 percent of women of child-bearing age — 33 to 50 percent of whom are overweight or obese. The findings were presented here at the 28th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).

“Not many patients come to a bariatric surgeon to treat infertility problems,” said Mohammad Jamal, MD, FACS, study co-author and Clinical Assistant Professor of Surgery at the University of Iowa Hospitals and Clinics in Iowa City. “But this study suggests that women with morbid obesity, who are infertile secondary to PCOS, may have a new surgical option. Many other studies have shown bariatric surgery can improve or resolve a multitude of diseases and conditions. It appears that infertility now joins that list.”

In the study, researchers from the University of Iowa Hospitals and Clinics report that 100 percent of the morbidly obese women who were diagnosed with PCOS related infertility, and desired children, became pregnant within three years following gastric bypass surgery.

A review of medical records of 566 morbidly obese women who had gastric bypass surgery over a period of nine years revealed 31 patients between the ages of 22 and 42 who had PCOS before surgery. Six post-menopausal patients, and five patients lost to follow-up, were excluded. The remaining 20 patients, average age 32, were contacted by telephone. Fourteen of them were fertile prior to surgery or did not desire to become pregnant after surgery.

The remaining six women, who had been diagnosed with infertility before surgery, and still desired pregnancy, became pregnant within three years of gastric bypass surgery. Doctors advise women not to try to conceive until at least 18 months after bariatric surgery due to surgery-related changes that could affect fetal development.
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