Variation in blood levels of hormones in obese patients following weight reduction induced by endoscopic and surgical bariatric therapies

BACKGROUND

Beneficial clinical effects of weight reduction following bariatric therapies is not fully understood and maybe related to the complex interactions between leptin, adiponectin, visfatin, omentin, and ghrelin. The aim of study was to investigate their timeline changes associated with weight reduction and their profile in relation to the type of treatment and its efficacy.

METHODS

Circulating hormones levels were analyzed before and after endoscopic and surgical procedures in 67 obese patients and compared to non-obese healthy controls.

RESULTS

Obese patients had higher leptin levels and lower levels of adiponectin, visfatin, omentin, and ghrelin than non-obese controls. During the consecutive follow-up visits after treatment, there was a gradual decrease in leptin levels and an increase in adiponectin levels to the levels observed in non-obese. At 50-54weeks, the ghrelin levels were lower and the levels of adiponectin and visfatin, but not omentin, were higher compared to their baseline values. BMI correlated with ghrelin and leptin levels. The percentage of total weight loss correlated positively with adiponectin levels and negatively with leptin levels. Patients with adequate weight loss had a significantly lower leptin concentration than those with treatment failure. There were timeline variations in hormone levels between endoscopic and bariatric therapies, however there were no significant differences in the median their concentration at 50-54weeks after therapy.

CONCLUSION

Our study supports observations that weight loss itself, rather than the procedure type, is responsible for hormonal variation. The leptin levels reflect the best the body weight changes after bariatric therapies.

Surgical treatment of malignant and benign colorectal neoplasms based on authors' clinical data

BACKGROUND

Colorectal cancer remains a huge diagnostic and therapeutic issue in Poland and worldwide. World epidemiological data indicates a constant increase in morbidity in recent decades.

OBJECTIVES

The aim of this research was to present surgical procedures in malignant and benign colorectal neoplasms based on authors' clinical data.

MATERIAL AND METHODS

Between 2001 and 2010, in the 1st Department of General and Endocrinological Surgery in Bialystok, 754 patients with malignant colorectal cancer were hospitalized. Precancerous conditions which included polyps and non-specific bowel inflammations were observed in 491 and 52 patients, respectively.

RESULTS

The most frequent location of a malignant colorectal tumor was the rectum - 271 (35%) cases and sigmoid colon - 235 (31%) cases. In 8 cases (1%), a multifocal location of colorectal neoplasm was observed. Similar locations were observed in the case of polyps. They were observed the most frequently in the sigmoid colon - 144 (29.3%) cases and rectum - 122 (24.8%) cases. In the cases of colorectal cancer located in the rectum (271), the most frequently applied procedure was abdomino-perineal amputation - 102 (37.6%) patients (T1-3 N1-2 M0). In sigmoid colon cancer (235 cases), sigmoid colon resection was performed most frequently - in 175 patients (74.5%) (T1-3 N0-2 M0-1). Right hemicolectomy was performed in 120 (T1-4 N0-2 M0-1) patients and left hemicolectomy in 52 (T1-4 N02 M0-1) patients. In 482 cases, endoscopic resection of polyps was performed and in 9 patients resection through laparotomy. The majority of operations were performed according to plan, however, many of them were performed in emergency.

CONCLUSIONS

Colorectal cancers, irrespectively to their location, develop secretly without any symptoms in the early stages which is the reason why patients contact a doctor in the late stadium of the disease. It is also the cause for a majority of the procedures performed in emergency. The best prognosis and long-term results are obtained with treatment combined with radio- and chemotherapy.

The influence of laparoscopic sleeve gastrectomy on metabolic syndrome parameters in obese patients in own material

Popularity of laparoscopic sleeve gastrectomy (LSG) has been growing gradually. The aim of this study was to determine changes in metabolic syndrome parameters as well as insulin, total cholesterol, and LDL cholesterol, and to describe the influence of body weight loss on co-morbidities in obese patients after LSG with 1-year follow-up. The material consists of 130 patients who underwent LSG (2007–2010) in order to treat morbid obesity and who had met before the surgery at least three criteria necessary for the diagnosis of metabolic syndrome according to the International Diabetes Federation. The influence of LSG on co-morbidities was also analyzed. During 1-year follow-up after LSG, we obtained a statistically significant decrease in BMI (from 53.18 ± 7.5 kg/m² to 31.4 ± 3.75 kg/m², p < 0.00001) and a reduction in waist circumference. Twelve months after the surgery, excess weight loss (EWL) was 59.42 ± 7.21% and excess body mass index loss (EBL) was 61.03 ± 6.50%. One year after LSG, the amount of patients with diagnosed metabolic syndrome decreased in 61 patients (53.08%). After 1 year, none of the patients met five criteria of metabolic syndrome. According to efficiency in body mass loss presented by %EWL and %EBL, LSG is gaining approval as a method of obesity and metabolic syndrome treatment, although it is a relatively new procedure. LSG is rather an easy procedure; the time of performance and hospitalization are shorter which entails normalization in all parameters of metabolic syndrome and decreases the percentage of obese patients with metabolic syndrome.

[Analysis of serum levels of ghrelin and obestatin in children and adolescents with autoimmune thyroid diseases]

INTRODUCTION

Thyroid disease is leading to a change of weight - in hyperthyroidism body mass is reduced, but in hypothyroidism it is increased. Recently researches suggest that many new bioactive substances, like ghrelin and obestatin, play a role in regulation of body mass. These closely related hormones have different effects- ghrelin increases, but obestatin decreases the appetite. The aim of the study was to evaluate ghrelin and obestatin levels in young patients with untreated Graves' disease, subclinical Hashimoto' thyroiditis and in children with nodular goiter in the euthyroid clinical state.

MATERIAL AND METHODS

The study group formed 78 patients of the Outpatient Endocrinology of the 2nd Department of Children's Disease (Medical University in Bialystok) and Outpatient Endocrinology IHC in Warsaw suffering from Graves' disease (29 girls and 2 boys; aged from 6 to 21 - mean 15,2 yrs) and Hashimoto's thyroiditis (29 girls and 3 boys; aged from 9 to 18 - mean 14,5 yrs). The control group consisted of children with nodular goiter (euthyroid) - 13 girls and 2 boys; aged from 9 to 18 - mean 14,8 yrs. In all patients, ghrelin and obestatin levels were analyzed by RIA's method (Phoenix Pharmaceuticals, USA).

RESULTS

In children and adolescents with hyperthyroidism in Graves' disease we found lower levels of ghrelin compared to the group of children with nodular goiter and with subclinical hypothyroidism in Hashimoto's thyroiditis (123+/-23 vs. 151+/-45; vs. 140+/-36 pg/ml, p<0,02, ns). On the other hand obestatin levels were lower in children with untreated subclinical hypothyroidism in Hashimoto's thyroiditis compared to a group with nodular goiter or Hashimoto's thyroiditis in euthyroidism (203,28+/-59 vs. 222.49+/-49; 267.24+/-70 pg/ml, p<0.03, p<0.02). In a group of untreated hyperthyroidism in Graves' disease we found correlations between ghrelin and fT3 (r=-0.36, p<0,4) and fT4 levels (r=- 0.45, p<0.01).

CONCLUSIONS

In conclusion, we suggested that disturbances in thyroid hormones in thyroid diseases have an essential effect on changes of hormones controlled appetite: ghrelin (in hyperthyroidism) and obestatin (in hypothyroidism).

[Precocious puberty due to hypothalamic hamartoma]

INTRODUCTION

Central precocious puberty is usually idiopathic. Appearance of the precocious puberty symptoms in early childhood or pre-school period indicate that also it could be caused by organic disorder of the central nervous system. The aim of this work is to present the case of the 4-year-old girl, diagnosed with precocious puberty.

THE CASE REPORT

The first clinical symptoms of precocious puberty such as increased growth rate and breast enlargement were observed when the girl was 4 years old. The height (above the 97 centile) and weight (90-97 centile) were measured during the physical examination. The advancement of sexual features was determined as follows: thelarche III degrees , pubarche II degrees , axillarche II degrees . The LHRH test used in this differential diagnosis revealed the pubertal level of gonadotropins, when plasma levels of dehydroepiandrosterone, prolactin, thyroid-stimulating hormone and alpha-fetoprotein levels were correct. The advanced bone age was 8 years and 10 months, while the height age was 7 years. The final diagnosis was based on MRI scan. The patient is currently treated with an analog of gonadoliberine (Diphereline). In conclusion, we aspired to notice that the pharmacological treatment of hypothalamic hamartoma may be safe and effective. Suppression of puberty to the normal time of pubescence gives a child the chance to reduce health discomforts as well as further emotional and social problems.

Forecasting models for human resources in health care

This article is a review of the approaches published between 1996 and 1999 that have been used to forecast human resource requirements for nursing. Much of the work to date generally does not consider the complex factors that influence health human resources (HHR). They also do not consider the effect of HHR decisions on population health, provider outcomes such as stress, and the cost of a decision made. Supply and demand approaches have dominated. Forecasting is limited, too, by the availability of reliable and valid data bases for examining supply and use of nursing personnel across sectors. Three models--needs based, utilization based, and effective demand based--provide substantially different estimates of future HHR need. The methods of analysis employed for forecasting range from descriptive to predictive and are borrowed from demography, epidemiology, economics, and industrial engineering. Simulation models offer the most promise for the future. The forecasting methods described have demonstrated their accuracy and usefulness for specific situations, but none has proven accurate for long-term forecasting or for estimating needs for large geographical areas or populations.

An evaluation of WHA resolution 45.5: health human resource implications

The World Health Assembly approved resolution WHA45.5 in 1992. This paper reports the findings of an evaluation of the implementation of this resolution using a survey technique. A total of 150 WHO Member States responded, for a 79% response rate. Findings suggest that the greatest strides worldwide have been made in education. While the data show that progress has been made at the country level, far more action is needed to strengthen nursing and midwifery if these cost-effective resources are to play a decisive role in improving the extent and quality of services, especially as delivered to people in the greatest need.