Weight-Loss Surgery Can Break a Family’s Cycle of Obesity

New study finds the intrauterine environment may determine whether a child is destined to become obese

Adolescent and young children of obese mothers who underwent weight-loss surgery prior to pregnancy have been found to have a lower prevalence of obesity and significantly improved cardio-metabolic markers when compared to siblings born before the same obese mothers had weight-loss surgery. This new study has been accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

Obesity can lead to insulin resistance, cardiovascular disease and pregnancy complications and is a major contributor to causes of death in industrialized nations. Previous studies of obese pregnant women have shown that obesity and its co-morbidities can be transmitted to their children, which indicates that the intrauterine environment may determine whether a child at birth is already destined to become obese.

“Our study confirms previous research showing that the intrauterine environment may be more important than genes and the post-natal environment when it comes to the association between maternal obesity and childhood obesity,” said John Kral, MD, PhD, of SUNY Downstate Medical Center in Brooklyn, N.Y. and co-author of the study. “Any medical or surgical treatment to reduce obesity and existing metabolic disorders before pregnancy can be an investment in the life of future offspring.”

Weight-loss surgery limits the amount of food a person can consume. Some of these operations also restrict the amount of food that can be digested. This particular study focused on women who had undergone biliopancreatic diversion (BPD) prior to becoming pregnant. BPD changes the normal process of digestion by making the stomach smaller and directing food to bypass part of the small intestine resulting in fewer calorie absorption.

Specifically, researchers studied 49 mothers who had undergone BPD surgery and their 111 children (between the ages of 2.5 and 25 years). All mothers in this study had children born before and then after their weight-loss surgery. The research found that children who were born after their mother underwent weight-loss surgery had reduced birth weight and waist circumference and were three times less likely to become severely obese. Furthermore, children born after their mother’s weight-loss surgery had improved cardiovascular markers including reduced insulin resistance and lower cholesterol.

“To our knowledge, our paper is the first to demonstrate that dramatic maternal weight loss causes metabolic improvements in their children,” said Kral. “Our findings show that obese women should be encouraged to lose weight before becoming pregnant, and then, once pregnant, should limit their weight gain. For those women interested in both surgical treatment and having children, we believe surgery should come first. Preventing obesity and treating it effectively in young women could prevent further transmission to future generations.”

Other researchers working on the study include J. Smith, K. Cianflone, S. Simard and Picard Marceau of the Centre de Recherche Institut Universitaire de Cardiologie et Pneumologie de Quebec in Canada; S. Biron, S. Lebel, S. Marceau, O. Lescelleur and L. Biertho of Laval University in Quebec, Canada; and J.G. Kral of SUNY Downstate Medical Center in Brooklyn, N.Y.

The article, “Effects of maternal surgical weight loss on intergenerational transmission of obesity,” will appear in the November 2009 issue of JCEM.

For information about weight loss surgery in Argentina feel free to contact our surgeon Norman Jalil.

Source: The Endocrine Society

A quick and accurate way of diagnosing endometriosis

A quick and accurate test for endometriosis that does not require surgery has been developed by researchers from Australia, Jordan and Belgium, according to new research published online in Europe’s leading reproductive medicine journal Human Reproduction .

Until now there has been no way of accurately diagnosing endometriosis apart from laparoscopy – an invasive surgical procedure – and this often leads to women waiting for years in pain and discomfort before their condition is identified correctly and treated.

Now researchers at the University of Sydney and Mu’tah University in Karak, Jordan, have discovered that if they take a small sample of the endometrium (the lining of the uterus), which can be done by inserting the device for taking the biopsy via the vagina, and then test for the presence of nerve fibres in the sample, they can diagnose whether or not endometriosis is present with nearly 100% accuracy.

Endometriosis, which has been estimated to affect 10-15% of women of reproductive age, is a chronic gynaecological disease in which cells from the endometrium establish themselves outside the uterus, within a woman’s pelvic area. Symptoms associated with it include infertility, painful periods, pelvic pain and pain during sexual intercourse. Once laparoscopy has identified endometriosis as the cause of these symptoms, treatment involves surgical removal (usually via laparoscopy) of the abnormally sited endometrial cells. However, laparoscopy itself can be associated with complications and can adversely affect fertility in women who do not have endometriosis.

In a separate study also published online in Human Reproduction, another research group from Belgium and Hungary has found that the density of nerve fibres in the endometrium was about 14 times higher in women with endometriosis than in healthy women, and that using specific markers to identify the presence of nerve fibres could predict with nearly 100% accuracy the presence of minimal to mild endometriosis.

In the first study, led by Professor Ian S. Fraser, head of the Queen Elizabeth II Research Institute for Mothers and Infants at the University of Sydney and Dr Moamar Al-Jefout, assistant professor in reproductive medicine at Mu’tah University, researchers took endometrial biopsies from 99 women who had consulted doctors about pelvic pain, infertility or both and who were undergoing laparoscopy for the condition.

The results from the endometrial biopsies were compared with the results of the laparoscopies, and the researchers found that in 64 women who had endometriosis confirmed by laparoscopy, all but one tested positive for the presence of nerve fibres in the endometrial biopsy. In the 35 women who were found not to have endometriosis by laparoscopy, no nerve fibres were found in 29 of the endometrial biopsies. In the other six cases, the biopsy found there were nerve fibres present; three of these women had severely painful periods and painful sex, and also a history of infertility, and of the other three, one had adhesions that were considered too slight to be endometriosis, while the other had a previous history of endometriosis.

Women with endometriosis and painful symptoms had significantly higher nerve fibre density in comparison with women with infertility but no pain (2.3 nerve fibres per mm2 compared to 0.8 per mm2 respectively). The mean average of nerve fibre density in the women with a laparoscopic diagnosis of endometriosis was 2.7 per mm2.

The study showed that testing endometrial biopsies for the presence of nerve fibres was able to diagnose endometriosis with 83% specificity (the proportion of negative cases of endometriosis correctly identified) and 98% sensitivity (proportion of positive cases correctly identified). This double blind study confirmed the results of a pilot study published in 2007 by the same group.

Dr Al-Jefout said: “This study has shown that testing for nerve fibres in endometrial biopsies is a valid and highly accurate diagnostic test for endometriosis. This test is probably as accurate as assessment via laparoscopy, the current gold standard, especially as it is unclear how often endometriosis is overlooked, even by experienced gynaecologists. Endometrial biopsy is clearly less invasive than laparoscopy, and this test could help to reduce the current lengthy delay in diagnosis of the condition, as well as allowing more effective planning for formal surgical or long-term medical management. It may be particularly helpful in cases of infertility.”

Currently, diagnosing endometriosis via laparoscopy involves the woman being booked into hospital for the surgical procedure, an anaesthetic, and the presence of doctors, nurses and expensive equipment. In some countries there are long waiting lists for operations. In contrast, taking an endometrial biopsy is relatively quick and easy to organise and perform, and results are available within about three days. However, Dr Al-Jefout said: “It needs to be emphasised that this test requires a carefully collected endometrial biopsy and an experienced immunohistochemical pathology laboratory to confirm or exclude the presence of nerve fibres.”

He continued: “Our results indicate that a negative endometrial biopsy result would miss endometriosis in only one percent of women. Performing a planned laparoscopy only on a woman with a positive endometrial biopsy result would result in endometriosis being confirmed in eighty to ninety percent of these women. Thus, using this diagnostic test in an infertility workup would significantly reduce the number of laparoscopies performed without reducing the number of women whose endometriosis is diagnosed and surgically treated.”

In addition, he said it could be particularly useful in teenagers with spasmodic symptoms but a family history of endometriosis. “The usual diagnostic delay in this special group is greater than in older women. An endometrial biopsy to confirm or exclude the diagnosis of endometriosis will help initiating earlier treatment and possibly preventing the progress of endometriosis, thus improving life style and protecting their future fertility.”

The researchers plan to continue using the test in patients and to search for other markers to help refine the test further. “Ideally, we would like to develop a blood test as an even simpler means of providing early information on the presence or absence of endometriosis in order to assist doctors in early diagnosis. However, this endometrial biopsy test has proven so effective that it is currently the only test which appears to have equivalent efficacy to a diagnostic laparoscopy carried out by an experienced gynaecologist,” he concluded.

In the second study, led by Professor Thomas D’Hooghe, coordinator of the University of Leuven Fertility Centre (Belgium), researchers looked at 40 endometrial samples, half taken from women with minimal to mild endometriosis diagnosed by laparoscopy and histology (microscopic examination of tissue), and half from women without the condition. They analysed the tissues for several markers indicating the presence of four types of nerve fibres (sensory C, A?, adrenergic and cholinergic nerve fibres).

Dr Attila Bokor, a doctoral fellow at the University of Leuven, who did the study as part of his PhD project said: “We observed nerve fibres in the endometrial samples of ninety percent (18 out of 20) of the women with endometriosis. The density varied throughout the samples, with few specimens showing counts above 30 per mm2, and with most between 0 and 10 per mm2. None, or very few, nerve fibres, were detected in any of the samples from women without endometriosis. The density of the small nerve fibres was about 14 times higher in endometrium from patients with minimal to mild endometriosis when compared with women with a normal pelvis.”

Prof D’Hooghe said: “Our data show that the combination of three different neural markers increases the sensitivity, specificity and diagnostic accuracy of this method of testing for endometriosis. The test diagnosed endometriosis with 95% sensitivity and 100% specificity.”

Dr Bokor and the team of Prof D’Hooghe will do a blinded validation study in September 2009 to confirm the results of their research. “If this confirms our findings, we believe our research can be a solid base for a simple, reliable and relatively cheap method for non-invasive diagnosis of minimal and mild endometriosis, since trans-cervical endometrium sampling and immunohistochemical analysis are routine gynaecological and pathological procedures. Our research programme is also aimed at discovering new biomarkers that can enable a blood test for endometriosis to be developed,” said Prof D’Hooghe.

For more information about Assisted Fertilization Treatments don’t hesitate to contact us.

Source: eshre.com

El Dr. Juan Sánchez Pulgar se une al equipo de Sublimis

Sublimis, organización dedicada a  servicios y tratamientos médicos de alto nivel, les informa que el Doctor Juan Sánchez Pulgar, especialista en Cirugía Traumatológica y Ortopédica, se ha incorporado a nuestro equipo médico.

El Dr. Sánchez Pulgar se egresó de la Universidad Católica de Córdoba y  ejerce su profesión desde 1980. Es Miembro Titular de la Sociedad de Ortopedia y Traumatología de Córdoba desde Agosto 1985 y Miembro Titular designado por la Asociación Argentina de Ortopedia y Traumatología desde el 2001.

Además ha sido reconocido como especialista en Ortopedia y Traumatología por la Facultad de Medicina de la Universidad Nacional de Córdoba,  la Asociación Argentina de Ortopedia y Traumatología Infantil y por la Sociedad Argentina de Ortopedia y Traumatología.  También fue ganador del “Premio Anual SAMECIPP” otorgado por la Sociedad Argentina de Medicina y Cirugía del Pie y Pierna en el año 2006.

Sánchez Pulgar  participo como panelista/relator especialista en Cirugía Traumatológica y Ortopédica en conferencias en Argentina, Brasil, Chile, Colombia, Costa Rica, México, Panamá, Perú, Uruguay, Venezuela, entre otros países.

In the field of health and medical care, Argentina compares favorably with other Latin American countries. (From: National Encyclopedia, US)

COSTS OF MEDICAL TREATMENTS IN ARGENTINA
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Some information on Argentinian Health Situation

National health policy is determined by the Department of Public Health, an agency of the Ministry of Social Welfare. In 1998 Argentina had an estimated 108,800 physicians, 28,900 dentists, 15,300 pharmacists, 29,000 nurses, and 11,100 medical technicians. There were an estimated 2.7 doctors per 1,000 people as of 1999. Nutritional requirements are comfortably met and, in 2000, 79% of the population had access to safe drinking water and 85% had adequate sanitation. Health and medical services for workers are provided by clinics of unions, and employers are usually required to provide free medical and pharmaceutical care for injured workers. In Argentina the private sector plays a role in the provision of health services, ensuring social security through organizations called Obras Sociales. Funding for health services comes from employee payroll taxes and contributions.