Jeff Evans

BOSTON — Live births occurred in 70% of heart transplant recipients who became pregnant after surgery, according to a review of 36 patients with 60 singleton pregnancies reported to the National Transplantation Pregnancy Registry.

Of 42 live-born children, 36 were healthy and developing well at the time of follow-up. Three children were receiving medical management for cardiomyopathy, the same diagnosis for which their mothers received transplants. In the other three, one underwent a hypospadias repair, one was treated for attention-deficit hyperactivity disorder, and one died from a traumatic injury, Lisa A. Coscia said during a poster session at the 2006 World Transplant Congress.

These 42 children were born at a mean gestational age of 37 weeks (5 were premature) and with a mean birth weight of 2.67 kg. A cesarean section was performed in 14 deliveries. Neonatal complications developed in 11 cases.

In the 18 unsuccessful pregnancies, 11 fetuses were aborted spontaneously and 5 for therapeutic reasons. One woman had an ectopic pregnancy and another had a stillborn delivery, according to Ms. Coscia, a registered nurse in the department of surgery at Temple University, Philadelphia.

The 36 patients conceived their pregnancies a mean of 5 years after their transplants, although this ranged from as little as 2 months to as much as 15 years. They had an average age of 28 years at conception, ranging from 18 to 39 years.

During pregnancy, hypertension was the most common comorbidity (43%) in the women, followed by infections (14%), preeclampsia (11%), and gestational diabetes (3%). Nine of the mothers (25%) died after pregnancy, although all of the deaths occurred more than 2 years post partum. These deaths were attributed to cardiac arrest (2), acute rejection (2), and in one patient each, vasculopathy, atherosclerosis, sepsis, lymphoma, and noncompliance. The other 27 mothers (75%) had adequate graft function at follow-up.

The congress was sponsored by the American Society of Transplant Surgeons, the American Society of Transplantation, and the Transplantation Society.

BOSTON — Live births occurred in 70% of heart transplant recipients who became pregnant after surgery, according to a review of 36 patients with 60 singleton pregnancies reported to the National Transplantation Pregnancy Registry.

Of 42 live-born children, 36 were healthy and developing well at the time of follow-up. Three children were receiving medical management for cardiomyopathy, the same diagnosis for which their mothers received transplants. In the other three, one underwent a hypospadias repair, one was treated for attention-deficit hyperactivity disorder, and one died from a traumatic injury, Lisa A. Coscia said during a poster session at the 2006 World Transplant Congress.

These 42 children were born at a mean gestational age of 37 weeks (5 were premature) and with a mean birth weight of 2.67 kg. A cesarean section was performed in 14 deliveries. Neonatal complications developed in 11 cases.

In the 18 unsuccessful pregnancies, 11 fetuses were aborted spontaneously and 5 for therapeutic reasons. One woman had an ectopic pregnancy and another had a stillborn delivery, according to Ms. Coscia, a registered nurse in the department of surgery at Temple University, Philadelphia.

The 36 patients conceived their pregnancies a mean of 5 years after their transplants, although this ranged from as little as 2 months to as much as 15 years. They had an average age of 28 years at conception, ranging from 18 to 39 years.

During pregnancy, hypertension was the most common comorbidity (43%) in the women, followed by infections (14%), preeclampsia (11%), and gestational diabetes (3%). Nine of the mothers (25%) died after pregnancy, although all of the deaths occurred more than 2 years post partum. These deaths were attributed to cardiac arrest (2), acute rejection (2), and in one patient each, vasculopathy, atherosclerosis, sepsis, lymphoma, and noncompliance. The other 27 mothers (75%) had adequate graft function at follow-up.

The congress was sponsored by the American Society of Transplant Surgeons, the American Society of Transplantation, and the Transplantation Society.

BOSTON — Live births occurred in 70% of heart transplant recipients who became pregnant after surgery, according to a review of 36 patients with 60 singleton pregnancies reported to the National Transplantation Pregnancy Registry.

Of 42 live-born children, 36 were healthy and developing well at the time of follow-up. Three children were receiving medical management for cardiomyopathy, the same diagnosis for which their mothers received transplants. In the other three, one underwent a hypospadias repair, one was treated for attention-deficit hyperactivity disorder, and one died from a traumatic injury, Lisa A. Coscia said during a poster session at the 2006 World Transplant Congress.

These 42 children were born at a mean gestational age of 37 weeks (5 were premature) and with a mean birth weight of 2.67 kg. A cesarean section was performed in 14 deliveries. Neonatal complications developed in 11 cases.

In the 18 unsuccessful pregnancies, 11 fetuses were aborted spontaneously and 5 for therapeutic reasons. One woman had an ectopic pregnancy and another had a stillborn delivery, according to Ms. Coscia, a registered nurse in the department of surgery at Temple University, Philadelphia.

The 36 patients conceived their pregnancies a mean of 5 years after their transplants, although this ranged from as little as 2 months to as much as 15 years. They had an average age of 28 years at conception, ranging from 18 to 39 years.

During pregnancy, hypertension was the most common comorbidity (43%) in the women, followed by infections (14%), preeclampsia (11%), and gestational diabetes (3%). Nine of the mothers (25%) died after pregnancy, although all of the deaths occurred more than 2 years post partum. These deaths were attributed to cardiac arrest (2), acute rejection (2), and in one patient each, vasculopathy, atherosclerosis, sepsis, lymphoma, and noncompliance. The other 27 mothers (75%) had adequate graft function at follow-up.

The congress was sponsored by the American Society of Transplant Surgeons, the American Society of Transplantation, and the Transplantation Society.

The most extensive analysis of genetic variations more common in people with alcohol dependence than in healthy controls has identified 51 small chromosomal regions spread across the genome that hold genes with various important functions, reported Catherine Johnson of the National Institute on Drug Abuse and her associates.

“This identification provides the first genome-wide, association-based assessment for genomic loci likely to contain variants that contribute to dependence on alcohol,” wrote Ms. Johnson of the intramural research program in the molecular neurobiology branch at the institute in Baltimore, and her associates.

Previous research has shown that a substantial portion of the regions where these genes are located have been associated with alcoholic and other addictive phenotypes, according to Ms. Johnson and her colleagues.

The researchers identified and pooled together samples from 120 unrelated alcohol-dependent individuals and then pooled a separate group of samples from 160 unrelated, unaffected controls who self-reported European American ethnicities. Most of the healthy control participants had married into the pedigrees, which were collected as part of the Collaborative Study on the Genetics of Alcoholism (Am. J. Med. Genet. B Neuropsychiatr. Genet. Epub ahead of print 2006;DOI:10.1002/ajmg.b.30346).

Instead of conducting association and linkage studies with whole family pedigrees, the investigators performed association genome scanning to assess the location and significance of the relationships among many more single nucleotide polymorphisms (SNPs) than would be possible with these other techniques, the investigators said.

Using a new kind of SNP microarray chip, the investigators assessed a set of 104,268 SNPs that were localized to the autosomal chromosomes. In each of the sample pools, alleles with frequencies of 2% or higher could be identified, allowing the study of many more SNP markers for more unrelated individuals than were previously available.

From these 104,268 SNPs, the investigators narrowed their analysis down to 188 SNPs that lay in 51 clusters in people with alcohol dependency. These clusters had to contain at least 3 SNPs that were close to one another and have an allele frequency that was significantly different from that of the controls.

Of the 26 candidate genes that were identified within these clusters, 10 also had been identified in the results of other association and linkage studies of addictions in European American, African American, and Japanese individuals who were dependent on at least one substance. “This level of replication is especially remarkable, since these convergences were sought for samples from different ethnic backgrounds and different addictions,” Ms. Johnson and her associates said.

The candidate genes that were identified in the study involve a potassium channel, intra- and intercell-signaling molecules, enzymes that convert propeptides to biologically active peptides, phospholipid-signaling pathways, regulatory and developmental genes that could alter brain development and/or adult form and function, cell adhesion molecules and their possible ligands, as well as those that encode proteins with unknown function, they noted.

“While these data nominate interesting genes, it is only confirmation in multiple data sets in ongoing and future studies that will link each of them securely to addiction vulnerability,” the researchers cautioned.

However, this investigation represents a step forward in the area of identifying genetic pathways to addiction. “As we identify more and more of the allelic variants that contribute to vulnerability to abuse of alcohol and other substances, we will be better able to understand addictions themselves,” they said.

The most extensive analysis of genetic variations more common in people with alcohol dependence than in healthy controls has identified 51 small chromosomal regions spread across the genome that hold genes with various important functions, reported Catherine Johnson of the National Institute on Drug Abuse and her associates.

“This identification provides the first genome-wide, association-based assessment for genomic loci likely to contain variants that contribute to dependence on alcohol,” wrote Ms. Johnson of the intramural research program in the molecular neurobiology branch at the institute in Baltimore, and her associates.

Previous research has shown that a substantial portion of the regions where these genes are located have been associated with alcoholic and other addictive phenotypes, according to Ms. Johnson and her colleagues.

The researchers identified and pooled together samples from 120 unrelated alcohol-dependent individuals and then pooled a separate group of samples from 160 unrelated, unaffected controls who self-reported European American ethnicities. Most of the healthy control participants had married into the pedigrees, which were collected as part of the Collaborative Study on the Genetics of Alcoholism (Am. J. Med. Genet. B Neuropsychiatr. Genet. Epub ahead of print 2006;DOI:10.1002/ajmg.b.30346).

Instead of conducting association and linkage studies with whole family pedigrees, the investigators performed association genome scanning to assess the location and significance of the relationships among many more single nucleotide polymorphisms (SNPs) than would be possible with these other techniques, the investigators said.

Using a new kind of SNP microarray chip, the investigators assessed a set of 104,268 SNPs that were localized to the autosomal chromosomes. In each of the sample pools, alleles with frequencies of 2% or higher could be identified, allowing the study of many more SNP markers for more unrelated individuals than were previously available.

From these 104,268 SNPs, the investigators narrowed their analysis down to 188 SNPs that lay in 51 clusters in people with alcohol dependency. These clusters had to contain at least 3 SNPs that were close to one another and have an allele frequency that was significantly different from that of the controls.

Of the 26 candidate genes that were identified within these clusters, 10 also had been identified in the results of other association and linkage studies of addictions in European American, African American, and Japanese individuals who were dependent on at least one substance. “This level of replication is especially remarkable, since these convergences were sought for samples from different ethnic backgrounds and different addictions,” Ms. Johnson and her associates said.

The candidate genes that were identified in the study involve a potassium channel, intra- and intercell-signaling molecules, enzymes that convert propeptides to biologically active peptides, phospholipid-signaling pathways, regulatory and developmental genes that could alter brain development and/or adult form and function, cell adhesion molecules and their possible ligands, as well as those that encode proteins with unknown function, they noted.

“While these data nominate interesting genes, it is only confirmation in multiple data sets in ongoing and future studies that will link each of them securely to addiction vulnerability,” the researchers cautioned.

However, this investigation represents a step forward in the area of identifying genetic pathways to addiction. “As we identify more and more of the allelic variants that contribute to vulnerability to abuse of alcohol and other substances, we will be better able to understand addictions themselves,” they said.

The most extensive analysis of genetic variations more common in people with alcohol dependence than in healthy controls has identified 51 small chromosomal regions spread across the genome that hold genes with various important functions, reported Catherine Johnson of the National Institute on Drug Abuse and her associates.

“This identification provides the first genome-wide, association-based assessment for genomic loci likely to contain variants that contribute to dependence on alcohol,” wrote Ms. Johnson of the intramural research program in the molecular neurobiology branch at the institute in Baltimore, and her associates.

Previous research has shown that a substantial portion of the regions where these genes are located have been associated with alcoholic and other addictive phenotypes, according to Ms. Johnson and her colleagues.

The researchers identified and pooled together samples from 120 unrelated alcohol-dependent individuals and then pooled a separate group of samples from 160 unrelated, unaffected controls who self-reported European American ethnicities. Most of the healthy control participants had married into the pedigrees, which were collected as part of the Collaborative Study on the Genetics of Alcoholism (Am. J. Med. Genet. B Neuropsychiatr. Genet. Epub ahead of print 2006;DOI:10.1002/ajmg.b.30346).

Instead of conducting association and linkage studies with whole family pedigrees, the investigators performed association genome scanning to assess the location and significance of the relationships among many more single nucleotide polymorphisms (SNPs) than would be possible with these other techniques, the investigators said.

Using a new kind of SNP microarray chip, the investigators assessed a set of 104,268 SNPs that were localized to the autosomal chromosomes. In each of the sample pools, alleles with frequencies of 2% or higher could be identified, allowing the study of many more SNP markers for more unrelated individuals than were previously available.

From these 104,268 SNPs, the investigators narrowed their analysis down to 188 SNPs that lay in 51 clusters in people with alcohol dependency. These clusters had to contain at least 3 SNPs that were close to one another and have an allele frequency that was significantly different from that of the controls.

Of the 26 candidate genes that were identified within these clusters, 10 also had been identified in the results of other association and linkage studies of addictions in European American, African American, and Japanese individuals who were dependent on at least one substance. “This level of replication is especially remarkable, since these convergences were sought for samples from different ethnic backgrounds and different addictions,” Ms. Johnson and her associates said.

The candidate genes that were identified in the study involve a potassium channel, intra- and intercell-signaling molecules, enzymes that convert propeptides to biologically active peptides, phospholipid-signaling pathways, regulatory and developmental genes that could alter brain development and/or adult form and function, cell adhesion molecules and their possible ligands, as well as those that encode proteins with unknown function, they noted.

“While these data nominate interesting genes, it is only confirmation in multiple data sets in ongoing and future studies that will link each of them securely to addiction vulnerability,” the researchers cautioned.

However, this investigation represents a step forward in the area of identifying genetic pathways to addiction. “As we identify more and more of the allelic variants that contribute to vulnerability to abuse of alcohol and other substances, we will be better able to understand addictions themselves,” they said.

BALTIMORE – Motor stereotypies can affect otherwise normal children at an early age and persist at least through adolescence, but may be amenable to behavioral therapy and some medications, Dr. Harvey S. Singer said at a meeting on developmental disabilities sponsored by Johns Hopkins University.

The presence of motor stereotypies is more commonly known in children with developmental disorders than in healthy children, but research has not yet pinpointed any specific differences in the biology or types of movements that occur in patients with these repetitive movements, said Dr. Singer, professor of pediatric neurology at the university.

Stereotypies seem to fall into two major groups, according to Dr. Singer. One group is repetitive movements with a pathologic basis, commonly found in people with autism, mental retardation, and sensory deprivations (for example, blind or deaf individuals). Behaviors with a physiologic underpinning are commonly found in healthy people–rocking, pencil tapping, biting/chewing–and can involve head (nodding) or complex movements.

Dr. Singer and his colleagues recently finished updating a report on the characteristics of repetitive arm and hand movements that they had previously published on 40 children (J. Pediatr. 2004;145:391–5). The updated study, now with 81 children total, included 56 (69%) patients with stereotypy onset at younger than age 24 months, 19 (23%) at age 24–35 months, and 6 (8%) at age 36 months or older. None of the children had mental retardation or pervasive developmental disorders.

The stereotypies seen in these children were associated especially with periods of engrossment such as when playing a game or participating in an activity, but also at times of excitement, stress, fatigue, and boredom. They usually lasted in the range of seconds to minutes (but could go on for hours in some cases) and appeared many times per day. In practically all cases, the stereotypies could be suppressed by sensory stimuli or distraction. Most children–but not parents–reported that these behaviors were of little concern and were not bothersome.

Most of the parents whose children were referred to Dr. Singer said that they had been told by other physicians that their child would stop doing their stereotypy, but these repetitive movements continue for most children into adolescence and beyond, he said.

In follow-up averaging about 6.5 years after onset of the stereotypy, the movements remained unchanged in 44 children (54%), grew worse in 7 (9%), improved in 26 (32%), and completely resolved in 4 (5%). Most (60%) patients had follow-up of more than 5 years.

It is possible for a child with a stereotypy to subsequently develop a tic at a later age, Dr. Singer pointed out.

Stereotypies usually develop in early life, mostly before 2 years of age, whereas tics begin to occur in children at age 6–7 years. Unlike tics, which rapidly change from one thing to another (blinks, grimaces, twists, shrugs), stereotypies are prolonged episodes of the same iterated movement. Some people with tic disorders feel a premonitory urge, but this does not happen with stereotypies. People with a tic disorder often will stop their tics during engrossing activities, but individuals with stereotypies will start their repetitive movements during such periods. Distraction usually interrupts stereotypies but not tics.

Many of the children in the study had a comorbidity, including ADHD (15%), obsessive-compulsive disorder or obsessive-compulsive behavior (20%), tics (13%), learning disability (4%), or had an early language or motor developmental delay that resolved itself (12%).

Overall, 20% of the children had a family history of stereotypies. A substantial percentage of the children had a family history of ADHD (12%), tic disorders (27%), mood-anxiety disorders (27%), and/or other neurologic disorders (22%).

The biologic basis for stereotypies remains unclear, although some evidence suggest that there is a dysfunction in the circuitry between the cortex and the striatum, he said (Pediatr. Neurol. 2005;32:109–12).

If a child's stereotypy doesn't interfere with his activity, Dr. Singer said that he doesn't recommend any particular therapy. The autistic literature has a long list of drugs to try, including benzodiazepines, β-adrenergic agonists, antipsychotics, and SSRIs. About half of autistic children with self-injurious behaviors, including some with stereotypic movements, respond better with neuroleptics than with SSRIs, although the difference is not large, he said.

Dr. Singer and his colleagues recently reported improvement in the frequency, intensity, and number of stereotypies in an open trial of 12 nonautistic children with physiologic motor stereotypies who received habit reversal training. They taught the children to be aware of their stereotypy by learning to exhibit the movement voluntarily and then to learn to inhibit the behavior through the reinforcement of a competing behavior (J. Child Neurol. 2006;21:119–25).

BALTIMORE – Motor stereotypies can affect otherwise normal children at an early age and persist at least through adolescence, but may be amenable to behavioral therapy and some medications, Dr. Harvey S. Singer said at a meeting on developmental disabilities sponsored by Johns Hopkins University.

The presence of motor stereotypies is more commonly known in children with developmental disorders than in healthy children, but research has not yet pinpointed any specific differences in the biology or types of movements that occur in patients with these repetitive movements, said Dr. Singer, professor of pediatric neurology at the university.

Stereotypies seem to fall into two major groups, according to Dr. Singer. One group is repetitive movements with a pathologic basis, commonly found in people with autism, mental retardation, and sensory deprivations (for example, blind or deaf individuals). Behaviors with a physiologic underpinning are commonly found in healthy people–rocking, pencil tapping, biting/chewing–and can involve head (nodding) or complex movements.

Dr. Singer and his colleagues recently finished updating a report on the characteristics of repetitive arm and hand movements that they had previously published on 40 children (J. Pediatr. 2004;145:391–5). The updated study, now with 81 children total, included 56 (69%) patients with stereotypy onset at younger than age 24 months, 19 (23%) at age 24–35 months, and 6 (8%) at age 36 months or older. None of the children had mental retardation or pervasive developmental disorders.

The stereotypies seen in these children were associated especially with periods of engrossment such as when playing a game or participating in an activity, but also at times of excitement, stress, fatigue, and boredom. They usually lasted in the range of seconds to minutes (but could go on for hours in some cases) and appeared many times per day. In practically all cases, the stereotypies could be suppressed by sensory stimuli or distraction. Most children–but not parents–reported that these behaviors were of little concern and were not bothersome.

Most of the parents whose children were referred to Dr. Singer said that they had been told by other physicians that their child would stop doing their stereotypy, but these repetitive movements continue for most children into adolescence and beyond, he said.

In follow-up averaging about 6.5 years after onset of the stereotypy, the movements remained unchanged in 44 children (54%), grew worse in 7 (9%), improved in 26 (32%), and completely resolved in 4 (5%). Most (60%) patients had follow-up of more than 5 years.

It is possible for a child with a stereotypy to subsequently develop a tic at a later age, Dr. Singer pointed out.

Stereotypies usually develop in early life, mostly before 2 years of age, whereas tics begin to occur in children at age 6–7 years. Unlike tics, which rapidly change from one thing to another (blinks, grimaces, twists, shrugs), stereotypies are prolonged episodes of the same iterated movement. Some people with tic disorders feel a premonitory urge, but this does not happen with stereotypies. People with a tic disorder often will stop their tics during engrossing activities, but individuals with stereotypies will start their repetitive movements during such periods. Distraction usually interrupts stereotypies but not tics.

Many of the children in the study had a comorbidity, including ADHD (15%), obsessive-compulsive disorder or obsessive-compulsive behavior (20%), tics (13%), learning disability (4%), or had an early language or motor developmental delay that resolved itself (12%).

Overall, 20% of the children had a family history of stereotypies. A substantial percentage of the children had a family history of ADHD (12%), tic disorders (27%), mood-anxiety disorders (27%), and/or other neurologic disorders (22%).

The biologic basis for stereotypies remains unclear, although some evidence suggest that there is a dysfunction in the circuitry between the cortex and the striatum, he said (Pediatr. Neurol. 2005;32:109–12).

If a child's stereotypy doesn't interfere with his activity, Dr. Singer said that he doesn't recommend any particular therapy. The autistic literature has a long list of drugs to try, including benzodiazepines, β-adrenergic agonists, antipsychotics, and SSRIs. About half of autistic children with self-injurious behaviors, including some with stereotypic movements, respond better with neuroleptics than with SSRIs, although the difference is not large, he said.

Dr. Singer and his colleagues recently reported improvement in the frequency, intensity, and number of stereotypies in an open trial of 12 nonautistic children with physiologic motor stereotypies who received habit reversal training. They taught the children to be aware of their stereotypy by learning to exhibit the movement voluntarily and then to learn to inhibit the behavior through the reinforcement of a competing behavior (J. Child Neurol. 2006;21:119–25).

BALTIMORE – Motor stereotypies can affect otherwise normal children at an early age and persist at least through adolescence, but may be amenable to behavioral therapy and some medications, Dr. Harvey S. Singer said at a meeting on developmental disabilities sponsored by Johns Hopkins University.

The presence of motor stereotypies is more commonly known in children with developmental disorders than in healthy children, but research has not yet pinpointed any specific differences in the biology or types of movements that occur in patients with these repetitive movements, said Dr. Singer, professor of pediatric neurology at the university.

Stereotypies seem to fall into two major groups, according to Dr. Singer. One group is repetitive movements with a pathologic basis, commonly found in people with autism, mental retardation, and sensory deprivations (for example, blind or deaf individuals). Behaviors with a physiologic underpinning are commonly found in healthy people–rocking, pencil tapping, biting/chewing–and can involve head (nodding) or complex movements.

Dr. Singer and his colleagues recently finished updating a report on the characteristics of repetitive arm and hand movements that they had previously published on 40 children (J. Pediatr. 2004;145:391–5). The updated study, now with 81 children total, included 56 (69%) patients with stereotypy onset at younger than age 24 months, 19 (23%) at age 24–35 months, and 6 (8%) at age 36 months or older. None of the children had mental retardation or pervasive developmental disorders.

The stereotypies seen in these children were associated especially with periods of engrossment such as when playing a game or participating in an activity, but also at times of excitement, stress, fatigue, and boredom. They usually lasted in the range of seconds to minutes (but could go on for hours in some cases) and appeared many times per day. In practically all cases, the stereotypies could be suppressed by sensory stimuli or distraction. Most children–but not parents–reported that these behaviors were of little concern and were not bothersome.

Most of the parents whose children were referred to Dr. Singer said that they had been told by other physicians that their child would stop doing their stereotypy, but these repetitive movements continue for most children into adolescence and beyond, he said.

In follow-up averaging about 6.5 years after onset of the stereotypy, the movements remained unchanged in 44 children (54%), grew worse in 7 (9%), improved in 26 (32%), and completely resolved in 4 (5%). Most (60%) patients had follow-up of more than 5 years.

It is possible for a child with a stereotypy to subsequently develop a tic at a later age, Dr. Singer pointed out.

Stereotypies usually develop in early life, mostly before 2 years of age, whereas tics begin to occur in children at age 6–7 years. Unlike tics, which rapidly change from one thing to another (blinks, grimaces, twists, shrugs), stereotypies are prolonged episodes of the same iterated movement. Some people with tic disorders feel a premonitory urge, but this does not happen with stereotypies. People with a tic disorder often will stop their tics during engrossing activities, but individuals with stereotypies will start their repetitive movements during such periods. Distraction usually interrupts stereotypies but not tics.

Many of the children in the study had a comorbidity, including ADHD (15%), obsessive-compulsive disorder or obsessive-compulsive behavior (20%), tics (13%), learning disability (4%), or had an early language or motor developmental delay that resolved itself (12%).

Overall, 20% of the children had a family history of stereotypies. A substantial percentage of the children had a family history of ADHD (12%), tic disorders (27%), mood-anxiety disorders (27%), and/or other neurologic disorders (22%).

The biologic basis for stereotypies remains unclear, although some evidence suggest that there is a dysfunction in the circuitry between the cortex and the striatum, he said (Pediatr. Neurol. 2005;32:109–12).

If a child's stereotypy doesn't interfere with his activity, Dr. Singer said that he doesn't recommend any particular therapy. The autistic literature has a long list of drugs to try, including benzodiazepines, β-adrenergic agonists, antipsychotics, and SSRIs. About half of autistic children with self-injurious behaviors, including some with stereotypic movements, respond better with neuroleptics than with SSRIs, although the difference is not large, he said.

Dr. Singer and his colleagues recently reported improvement in the frequency, intensity, and number of stereotypies in an open trial of 12 nonautistic children with physiologic motor stereotypies who received habit reversal training. They taught the children to be aware of their stereotypy by learning to exhibit the movement voluntarily and then to learn to inhibit the behavior through the reinforcement of a competing behavior (J. Child Neurol. 2006;21:119–25).

SAN FRANCISCO — Pregnancy soon after bariatric surgery does not appear to pose safety concerns for the mother or newborn, Dr. Tuoc N. Dao reported at the annual meeting of the American Society for Bariatric Surgery.

Surgeons have generally recommended that bariatric surgery patients should not become pregnant until 12–18 months after the procedure because of a perceived risk to the fetus or the woman during the period of large weight loss and limited calorie and nutrient intake following the surgery, said Dr. Dao, a surgical resident at Baylor University Medical Center at Dallas.

Although her review of 24 patients indicated that “the desire for pregnancy should not be a deterrent for Roux-en-Y gastric bypass as a weight-loss procedure,” Dr. Dao and her colleagues continue to recommend that most bariatric surgery patients wait 12–18 months before becoming pregnant “due to the psychological component of trying to undergo all of these changes at one time. Trying to lose weight and deal with a pregnancy at the same time, I think, would be too much for people.”

Several previous studies have not reported any major adverse events or outcomes in women who became pregnant after bariatric surgery.

In a study of 298 deliveries, no adverse perinatal outcomes were reported in women who had restrictive or malabsorptive surgery, although Roux-en-Y gastric bypass (RYGB) was associated with an increased risk of premature rupture of membranes, labor induction, and fetal macrosomia (Am. J. Obstet. Gynecol. 2004;190:1335–40).

A separate review of 18 pregnancies after gastric bypass showed few metabolic problems or deficiencies in vitamin B₁₂ or iron (South. Med. J. 1989;82:1319–20).

In another group of 46 deliveries, four of seven preterm infants were born to mothers who became pregnant within 16 months of their surgery. Pregnancy was safe outside of that time period (Am. Surg. 1982;48:363–5).

Pregnancy during the period of rapid weight loss immediately after surgery can cause deficiencies in iron, folate, calcium, and vitamin B₁₂.

It also has been questioned whether women will be able to lose additional weight post partum during the early postoperative phase.

Fetal and maternal deaths have been reported in a few cases of postoperative small bowel herniations and ischemia, but other reports have recorded good outcomes with early detection and treatment of this complication, Dr. Dao said.

In her review of 2,532 patients who underwent RYGB at Baylor during 2001–2005, 24 became pregnant within 1 year after the surgery.

These patients were 32 years old with a body mass index of 49 kg/m

At the time of delivery, the women were 34 years old and had gained a mean of 0.3 pounds during pregnancy, although this varied widely from losing 70 pounds to gaining 45 pounds.

The patients' mean body mass index dropped from 34 kg/m

Only one patient failed to sustain their excess weight loss.

The 24 women had 26 pregnancies, 2 of which were early miscarriages in women who soon became pregnant again and carried to term. Of three other miscarriages, two occurred in the first trimester and one at a gestational age of 20 weeks.

Another patient had an ectopic pregnancy.

One patient had mild iron deficiency during pregnancy that resolved with iron supplementation.

One patient had symptomatic cholelithiasis and underwent laparoscopic cholecystectomy after the delivery of her baby.

An internal hernia in one patient was detected early and repaired without any incident.

Another patient with a gastrogastric fistula was treated conservatively until her delivery.

Two patients had preterm labor. One patient had preeclampsia and one had mild hypertension that was much improved since her last pregnancy before bariatric surgery.

The 21 babies (including one set of twins) had an average birth weight of 2,874 g. Three neonates, including the twins, had a low birth weight (less than 2,500 g). One infant had intrauterine growth restriction (born to the mother with an internal hernia).

Another infant had intrauterine growth restriction plus a low birth weight (born to the mother with a gastrogastric fistula).

No infants had any congenital or developmental defects.

In five of the women who had pregnancies before their RYGB surgery, there were fewer instances of diabetes, hypertension, and complications during postsurgery pregnancies than in those that occurred before the operation.

Dr. Dao did not know how many of the other patients who received RYGB in the cohort were lost to follow-up, but she said that patients who report pregnancy at clinical visits or on follow-up surveys are interviewed to gather information.

SAN FRANCISCO — Pregnancy soon after bariatric surgery does not appear to pose safety concerns for the mother or newborn, Dr. Tuoc N. Dao reported at the annual meeting of the American Society for Bariatric Surgery.

Surgeons have generally recommended that bariatric surgery patients should not become pregnant until 12–18 months after the procedure because of a perceived risk to the fetus or the woman during the period of large weight loss and limited calorie and nutrient intake following the surgery, said Dr. Dao, a surgical resident at Baylor University Medical Center at Dallas.

Although her review of 24 patients indicated that “the desire for pregnancy should not be a deterrent for Roux-en-Y gastric bypass as a weight-loss procedure,” Dr. Dao and her colleagues continue to recommend that most bariatric surgery patients wait 12–18 months before becoming pregnant “due to the psychological component of trying to undergo all of these changes at one time. Trying to lose weight and deal with a pregnancy at the same time, I think, would be too much for people.”

Several previous studies have not reported any major adverse events or outcomes in women who became pregnant after bariatric surgery.

In a study of 298 deliveries, no adverse perinatal outcomes were reported in women who had restrictive or malabsorptive surgery, although Roux-en-Y gastric bypass (RYGB) was associated with an increased risk of premature rupture of membranes, labor induction, and fetal macrosomia (Am. J. Obstet. Gynecol. 2004;190:1335–40).

A separate review of 18 pregnancies after gastric bypass showed few metabolic problems or deficiencies in vitamin B₁₂ or iron (South. Med. J. 1989;82:1319–20).

In another group of 46 deliveries, four of seven preterm infants were born to mothers who became pregnant within 16 months of their surgery. Pregnancy was safe outside of that time period (Am. Surg. 1982;48:363–5).

Pregnancy during the period of rapid weight loss immediately after surgery can cause deficiencies in iron, folate, calcium, and vitamin B₁₂.

It also has been questioned whether women will be able to lose additional weight post partum during the early postoperative phase.

Fetal and maternal deaths have been reported in a few cases of postoperative small bowel herniations and ischemia, but other reports have recorded good outcomes with early detection and treatment of this complication, Dr. Dao said.

In her review of 2,532 patients who underwent RYGB at Baylor during 2001–2005, 24 became pregnant within 1 year after the surgery.

These patients were 32 years old with a body mass index of 49 kg/m

At the time of delivery, the women were 34 years old and had gained a mean of 0.3 pounds during pregnancy, although this varied widely from losing 70 pounds to gaining 45 pounds.

The patients' mean body mass index dropped from 34 kg/m

Only one patient failed to sustain their excess weight loss.

The 24 women had 26 pregnancies, 2 of which were early miscarriages in women who soon became pregnant again and carried to term. Of three other miscarriages, two occurred in the first trimester and one at a gestational age of 20 weeks.

Another patient had an ectopic pregnancy.

One patient had mild iron deficiency during pregnancy that resolved with iron supplementation.

One patient had symptomatic cholelithiasis and underwent laparoscopic cholecystectomy after the delivery of her baby.

An internal hernia in one patient was detected early and repaired without any incident.

Another patient with a gastrogastric fistula was treated conservatively until her delivery.

Two patients had preterm labor. One patient had preeclampsia and one had mild hypertension that was much improved since her last pregnancy before bariatric surgery.

The 21 babies (including one set of twins) had an average birth weight of 2,874 g. Three neonates, including the twins, had a low birth weight (less than 2,500 g). One infant had intrauterine growth restriction (born to the mother with an internal hernia).

Another infant had intrauterine growth restriction plus a low birth weight (born to the mother with a gastrogastric fistula).

No infants had any congenital or developmental defects.

In five of the women who had pregnancies before their RYGB surgery, there were fewer instances of diabetes, hypertension, and complications during postsurgery pregnancies than in those that occurred before the operation.

Dr. Dao did not know how many of the other patients who received RYGB in the cohort were lost to follow-up, but she said that patients who report pregnancy at clinical visits or on follow-up surveys are interviewed to gather information.

SAN FRANCISCO — Pregnancy soon after bariatric surgery does not appear to pose safety concerns for the mother or newborn, Dr. Tuoc N. Dao reported at the annual meeting of the American Society for Bariatric Surgery.

Surgeons have generally recommended that bariatric surgery patients should not become pregnant until 12–18 months after the procedure because of a perceived risk to the fetus or the woman during the period of large weight loss and limited calorie and nutrient intake following the surgery, said Dr. Dao, a surgical resident at Baylor University Medical Center at Dallas.

Although her review of 24 patients indicated that “the desire for pregnancy should not be a deterrent for Roux-en-Y gastric bypass as a weight-loss procedure,” Dr. Dao and her colleagues continue to recommend that most bariatric surgery patients wait 12–18 months before becoming pregnant “due to the psychological component of trying to undergo all of these changes at one time. Trying to lose weight and deal with a pregnancy at the same time, I think, would be too much for people.”

Several previous studies have not reported any major adverse events or outcomes in women who became pregnant after bariatric surgery.

In a study of 298 deliveries, no adverse perinatal outcomes were reported in women who had restrictive or malabsorptive surgery, although Roux-en-Y gastric bypass (RYGB) was associated with an increased risk of premature rupture of membranes, labor induction, and fetal macrosomia (Am. J. Obstet. Gynecol. 2004;190:1335–40).

A separate review of 18 pregnancies after gastric bypass showed few metabolic problems or deficiencies in vitamin B₁₂ or iron (South. Med. J. 1989;82:1319–20).

In another group of 46 deliveries, four of seven preterm infants were born to mothers who became pregnant within 16 months of their surgery. Pregnancy was safe outside of that time period (Am. Surg. 1982;48:363–5).

Pregnancy during the period of rapid weight loss immediately after surgery can cause deficiencies in iron, folate, calcium, and vitamin B₁₂.

It also has been questioned whether women will be able to lose additional weight post partum during the early postoperative phase.

Fetal and maternal deaths have been reported in a few cases of postoperative small bowel herniations and ischemia, but other reports have recorded good outcomes with early detection and treatment of this complication, Dr. Dao said.

In her review of 2,532 patients who underwent RYGB at Baylor during 2001–2005, 24 became pregnant within 1 year after the surgery.

These patients were 32 years old with a body mass index of 49 kg/m

At the time of delivery, the women were 34 years old and had gained a mean of 0.3 pounds during pregnancy, although this varied widely from losing 70 pounds to gaining 45 pounds.

The patients' mean body mass index dropped from 34 kg/m

Only one patient failed to sustain their excess weight loss.

The 24 women had 26 pregnancies, 2 of which were early miscarriages in women who soon became pregnant again and carried to term. Of three other miscarriages, two occurred in the first trimester and one at a gestational age of 20 weeks.

Another patient had an ectopic pregnancy.

One patient had mild iron deficiency during pregnancy that resolved with iron supplementation.

One patient had symptomatic cholelithiasis and underwent laparoscopic cholecystectomy after the delivery of her baby.

An internal hernia in one patient was detected early and repaired without any incident.

Another patient with a gastrogastric fistula was treated conservatively until her delivery.

Two patients had preterm labor. One patient had preeclampsia and one had mild hypertension that was much improved since her last pregnancy before bariatric surgery.

The 21 babies (including one set of twins) had an average birth weight of 2,874 g. Three neonates, including the twins, had a low birth weight (less than 2,500 g). One infant had intrauterine growth restriction (born to the mother with an internal hernia).

Another infant had intrauterine growth restriction plus a low birth weight (born to the mother with a gastrogastric fistula).

No infants had any congenital or developmental defects.

In five of the women who had pregnancies before their RYGB surgery, there were fewer instances of diabetes, hypertension, and complications during postsurgery pregnancies than in those that occurred before the operation.

Dr. Dao did not know how many of the other patients who received RYGB in the cohort were lost to follow-up, but she said that patients who report pregnancy at clinical visits or on follow-up surveys are interviewed to gather information.

WASHINGTON — Diabetic patients have lower lung function than would otherwise be predicted, but the actual trajectory of their lung function parallels that of normal, healthy individuals as they age, Dr. Naresh M. Punjabi said at the annual scientific sessions of the American Diabetes Association.

Studies have shown that type 1 and 2 diabetic patients have reduced forced expiratory volumes, total lung volumes, and diffusion capacities. But because most of these studies have been cross-sectional, it has been hard to “tease out” whether diabetes or reduced lung function came first, said Dr. Punjabi of the division of pulmonary and critical care medicine at Johns Hopkins University, Baltimore.

In one cross-sectional study of 3,254 individuals in the Framingham offspring cohort, both residual forced expiratory volume in 1 second (FEV₁) and residual forced vital capacity (FVC) declined significantly, whereas the fasting blood glucose levels of nondiabetic individuals increased. FEV₁ and FVC also were lower than predicted levels in diabetic participants. The pattern was even stronger in diabetic and nondiabetic former or current smokers, compared with those who never smoked. The ratio of FEV₁ to FVC, which is a measure of expiratory airflow obstruction, was not related to fasting blood glucose levels in former smokers and in those who had never smoked (Am. J. Respir. Crit. Care Med. 2003;167:911–6).

Another cross-sectional study of 3,911 women aged 60–79 years reported that FEV₁ and FVC were significantly and negatively correlated with insulin resistance and the prevalence of type 2 diabetes after adjustments were made for confounding variables (Diabetologia 2004;47:195–203).

“These are two large studies that show a cross-sectional relationship between spirometric measures and metabolic measures,” he said. “The question then becomes, can we prove causality?”

In a longitudinal study of 17,506 patients, 266 patients already had diabetes at the beginning of the study and another 451 developed diabetes during the study's 15-year follow-up. In spirometric testing performed at baseline and during at least one round of additional testing, both FEV₁ and FVC were 8% lower than their predicted values in patients with diabetes, compared with those who did not have diabetes (Eur. Respir. J. 2002;20:1406–12).

“This is a pretty substantial difference between those that have diabetes and those that don't,” Dr. Punjabi said. But the longitudinal decline in lung function of diabetic patients was similar to that of nondiabetic patients for both men and women.

It is possible to speculate how diabetes could lead to impaired lung function, Dr. Punjabi said. There are data from postmortem studies of diabetic individuals to suggest that the lung is a target organ for diabetic microangiopathy, as well as indirect data showing that diabetes may contribute to lower diffusion capacity.

There are fewer data to suggest that impaired lung function predicts future diabetes, but some evidence is beginning to show that such an association might exist, even though plausible biologic mechanisms are “shaky,” Dr. Punjabi said.

Spirometric data on 4,830 men and women in the National Health and Nutrition Examination Survey showed that obstructive lung disease (represented by the FEV₁/FVC ratio) was not significantly associated with the development of diabetes, but restrictive lung disease (signifying a lower FVC) was. The men and women were followed from their first interview and examination in 1971–1975 through 1992–1993. Only 68 patients had restrictive lung disease, but those who had the disease were 45% more likely to develop diabetes than were those who did not have the lung condition. The associations did not differ according to smoking status (Diabetes Care 2004;27:2966–70).

Another study that addressed the effect of baseline pulmonary function on incident diabetes prospectively showed that over the course of a 9-year follow-up in 11,479 patients, both the absolute values of FEV₁ and FVC and the percentage of predicted FEV₁ and FVC were associated with incident diabetes. No relationship was found with the FEV₁/FVC ratio (Diabetes Care 2005;28:1472–9).

Investigators in both studies adjusted the analyses for numerous confounding variables.

“The decrease in lung function that we're talking about here is insufficient to cause any degree of hypoxemia,” thus eliminating it as a possible mechanism to explain how impaired lung function could lead to diabetes, he said.

But low lung function and diabetes risk may be determined by another underlying cause. It is possible that reduced lung function is a “not a precursor of diabetes but just a marker of what's going to happen eventually anyway,” Dr. Punjabi speculated.

WASHINGTON — Diabetic patients have lower lung function than would otherwise be predicted, but the actual trajectory of their lung function parallels that of normal, healthy individuals as they age, Dr. Naresh M. Punjabi said at the annual scientific sessions of the American Diabetes Association.

Studies have shown that type 1 and 2 diabetic patients have reduced forced expiratory volumes, total lung volumes, and diffusion capacities. But because most of these studies have been cross-sectional, it has been hard to “tease out” whether diabetes or reduced lung function came first, said Dr. Punjabi of the division of pulmonary and critical care medicine at Johns Hopkins University, Baltimore.

In one cross-sectional study of 3,254 individuals in the Framingham offspring cohort, both residual forced expiratory volume in 1 second (FEV₁) and residual forced vital capacity (FVC) declined significantly, whereas the fasting blood glucose levels of nondiabetic individuals increased. FEV₁ and FVC also were lower than predicted levels in diabetic participants. The pattern was even stronger in diabetic and nondiabetic former or current smokers, compared with those who never smoked. The ratio of FEV₁ to FVC, which is a measure of expiratory airflow obstruction, was not related to fasting blood glucose levels in former smokers and in those who had never smoked (Am. J. Respir. Crit. Care Med. 2003;167:911–6).

Another cross-sectional study of 3,911 women aged 60–79 years reported that FEV₁ and FVC were significantly and negatively correlated with insulin resistance and the prevalence of type 2 diabetes after adjustments were made for confounding variables (Diabetologia 2004;47:195–203).

“These are two large studies that show a cross-sectional relationship between spirometric measures and metabolic measures,” he said. “The question then becomes, can we prove causality?”

In a longitudinal study of 17,506 patients, 266 patients already had diabetes at the beginning of the study and another 451 developed diabetes during the study's 15-year follow-up. In spirometric testing performed at baseline and during at least one round of additional testing, both FEV₁ and FVC were 8% lower than their predicted values in patients with diabetes, compared with those who did not have diabetes (Eur. Respir. J. 2002;20:1406–12).

“This is a pretty substantial difference between those that have diabetes and those that don't,” Dr. Punjabi said. But the longitudinal decline in lung function of diabetic patients was similar to that of nondiabetic patients for both men and women.

It is possible to speculate how diabetes could lead to impaired lung function, Dr. Punjabi said. There are data from postmortem studies of diabetic individuals to suggest that the lung is a target organ for diabetic microangiopathy, as well as indirect data showing that diabetes may contribute to lower diffusion capacity.

There are fewer data to suggest that impaired lung function predicts future diabetes, but some evidence is beginning to show that such an association might exist, even though plausible biologic mechanisms are “shaky,” Dr. Punjabi said.

Spirometric data on 4,830 men and women in the National Health and Nutrition Examination Survey showed that obstructive lung disease (represented by the FEV₁/FVC ratio) was not significantly associated with the development of diabetes, but restrictive lung disease (signifying a lower FVC) was. The men and women were followed from their first interview and examination in 1971–1975 through 1992–1993. Only 68 patients had restrictive lung disease, but those who had the disease were 45% more likely to develop diabetes than were those who did not have the lung condition. The associations did not differ according to smoking status (Diabetes Care 2004;27:2966–70).

Another study that addressed the effect of baseline pulmonary function on incident diabetes prospectively showed that over the course of a 9-year follow-up in 11,479 patients, both the absolute values of FEV₁ and FVC and the percentage of predicted FEV₁ and FVC were associated with incident diabetes. No relationship was found with the FEV₁/FVC ratio (Diabetes Care 2005;28:1472–9).

Investigators in both studies adjusted the analyses for numerous confounding variables.

“The decrease in lung function that we're talking about here is insufficient to cause any degree of hypoxemia,” thus eliminating it as a possible mechanism to explain how impaired lung function could lead to diabetes, he said.

But low lung function and diabetes risk may be determined by another underlying cause. It is possible that reduced lung function is a “not a precursor of diabetes but just a marker of what's going to happen eventually anyway,” Dr. Punjabi speculated.

WASHINGTON — Diabetic patients have lower lung function than would otherwise be predicted, but the actual trajectory of their lung function parallels that of normal, healthy individuals as they age, Dr. Naresh M. Punjabi said at the annual scientific sessions of the American Diabetes Association.

Studies have shown that type 1 and 2 diabetic patients have reduced forced expiratory volumes, total lung volumes, and diffusion capacities. But because most of these studies have been cross-sectional, it has been hard to “tease out” whether diabetes or reduced lung function came first, said Dr. Punjabi of the division of pulmonary and critical care medicine at Johns Hopkins University, Baltimore.

In one cross-sectional study of 3,254 individuals in the Framingham offspring cohort, both residual forced expiratory volume in 1 second (FEV₁) and residual forced vital capacity (FVC) declined significantly, whereas the fasting blood glucose levels of nondiabetic individuals increased. FEV₁ and FVC also were lower than predicted levels in diabetic participants. The pattern was even stronger in diabetic and nondiabetic former or current smokers, compared with those who never smoked. The ratio of FEV₁ to FVC, which is a measure of expiratory airflow obstruction, was not related to fasting blood glucose levels in former smokers and in those who had never smoked (Am. J. Respir. Crit. Care Med. 2003;167:911–6).

Another cross-sectional study of 3,911 women aged 60–79 years reported that FEV₁ and FVC were significantly and negatively correlated with insulin resistance and the prevalence of type 2 diabetes after adjustments were made for confounding variables (Diabetologia 2004;47:195–203).

“These are two large studies that show a cross-sectional relationship between spirometric measures and metabolic measures,” he said. “The question then becomes, can we prove causality?”

In a longitudinal study of 17,506 patients, 266 patients already had diabetes at the beginning of the study and another 451 developed diabetes during the study's 15-year follow-up. In spirometric testing performed at baseline and during at least one round of additional testing, both FEV₁ and FVC were 8% lower than their predicted values in patients with diabetes, compared with those who did not have diabetes (Eur. Respir. J. 2002;20:1406–12).

“This is a pretty substantial difference between those that have diabetes and those that don't,” Dr. Punjabi said. But the longitudinal decline in lung function of diabetic patients was similar to that of nondiabetic patients for both men and women.

It is possible to speculate how diabetes could lead to impaired lung function, Dr. Punjabi said. There are data from postmortem studies of diabetic individuals to suggest that the lung is a target organ for diabetic microangiopathy, as well as indirect data showing that diabetes may contribute to lower diffusion capacity.

There are fewer data to suggest that impaired lung function predicts future diabetes, but some evidence is beginning to show that such an association might exist, even though plausible biologic mechanisms are “shaky,” Dr. Punjabi said.

Spirometric data on 4,830 men and women in the National Health and Nutrition Examination Survey showed that obstructive lung disease (represented by the FEV₁/FVC ratio) was not significantly associated with the development of diabetes, but restrictive lung disease (signifying a lower FVC) was. The men and women were followed from their first interview and examination in 1971–1975 through 1992–1993. Only 68 patients had restrictive lung disease, but those who had the disease were 45% more likely to develop diabetes than were those who did not have the lung condition. The associations did not differ according to smoking status (Diabetes Care 2004;27:2966–70).

Another study that addressed the effect of baseline pulmonary function on incident diabetes prospectively showed that over the course of a 9-year follow-up in 11,479 patients, both the absolute values of FEV₁ and FVC and the percentage of predicted FEV₁ and FVC were associated with incident diabetes. No relationship was found with the FEV₁/FVC ratio (Diabetes Care 2005;28:1472–9).

Investigators in both studies adjusted the analyses for numerous confounding variables.

“The decrease in lung function that we're talking about here is insufficient to cause any degree of hypoxemia,” thus eliminating it as a possible mechanism to explain how impaired lung function could lead to diabetes, he said.

But low lung function and diabetes risk may be determined by another underlying cause. It is possible that reduced lung function is a “not a precursor of diabetes but just a marker of what's going to happen eventually anyway,” Dr. Punjabi speculated.

BOSTON — Obese living kidney donors may have an increased risk of hypertension, but not renal insufficiency or proteinuria, many years after donation, Dr. Mehdi Tavakol said at the 2006 World Transplant Congress.

In some reports, a high body mass index has been strongly associated with an increased risk of developing end-stage renal disease, whereas other studies have found that obese patients who underwent a unilateral nephrectomy for reasons other than donation had a higher risk of proteinuria and renal disease, said Dr. Tavakol of the division of transplant surgery at the University of California, San Francisco.

Dr. Tavakol and his associates located individuals who had donated a kidney at the university during 1969–2002 to determine if obesity at the time of the donation (BMI higher than 30 kg/m

When the patients were broken into subgroups based on quartiles of BMI (less than 25, 25–29.9, 30–34.9, and 35 or higher), the investigators found no significant differences in the incidence of renal insufficiency (glomerular filtration rate less than 60 mL/min), proteinuria (greater than 150 mg/day), or microalbuminuria (greater than 30 mg/day). All of the BMI subgroups had a 70%–75% lower glomerular filtration rate at the time of follow-up than at the time of their predonation measurement.

But almost 50% of obese donors had hypertension at follow-up, compared with 30% of nonobese donors. The incidence of hypertension also rose significantly with increasing obesity. Univariate and multivariate analyses confirmed that obesity was a significant risk factor for developing hypertension.

These results “should be taken into consideration in the preoperative evaluation, counseling, and postoperative follow-up of these patients,” he said.

BOSTON — Obese living kidney donors may have an increased risk of hypertension, but not renal insufficiency or proteinuria, many years after donation, Dr. Mehdi Tavakol said at the 2006 World Transplant Congress.

In some reports, a high body mass index has been strongly associated with an increased risk of developing end-stage renal disease, whereas other studies have found that obese patients who underwent a unilateral nephrectomy for reasons other than donation had a higher risk of proteinuria and renal disease, said Dr. Tavakol of the division of transplant surgery at the University of California, San Francisco.

Dr. Tavakol and his associates located individuals who had donated a kidney at the university during 1969–2002 to determine if obesity at the time of the donation (BMI higher than 30 kg/m

When the patients were broken into subgroups based on quartiles of BMI (less than 25, 25–29.9, 30–34.9, and 35 or higher), the investigators found no significant differences in the incidence of renal insufficiency (glomerular filtration rate less than 60 mL/min), proteinuria (greater than 150 mg/day), or microalbuminuria (greater than 30 mg/day). All of the BMI subgroups had a 70%–75% lower glomerular filtration rate at the time of follow-up than at the time of their predonation measurement.

But almost 50% of obese donors had hypertension at follow-up, compared with 30% of nonobese donors. The incidence of hypertension also rose significantly with increasing obesity. Univariate and multivariate analyses confirmed that obesity was a significant risk factor for developing hypertension.

These results “should be taken into consideration in the preoperative evaluation, counseling, and postoperative follow-up of these patients,” he said.

BOSTON — Obese living kidney donors may have an increased risk of hypertension, but not renal insufficiency or proteinuria, many years after donation, Dr. Mehdi Tavakol said at the 2006 World Transplant Congress.

In some reports, a high body mass index has been strongly associated with an increased risk of developing end-stage renal disease, whereas other studies have found that obese patients who underwent a unilateral nephrectomy for reasons other than donation had a higher risk of proteinuria and renal disease, said Dr. Tavakol of the division of transplant surgery at the University of California, San Francisco.

Dr. Tavakol and his associates located individuals who had donated a kidney at the university during 1969–2002 to determine if obesity at the time of the donation (BMI higher than 30 kg/m

When the patients were broken into subgroups based on quartiles of BMI (less than 25, 25–29.9, 30–34.9, and 35 or higher), the investigators found no significant differences in the incidence of renal insufficiency (glomerular filtration rate less than 60 mL/min), proteinuria (greater than 150 mg/day), or microalbuminuria (greater than 30 mg/day). All of the BMI subgroups had a 70%–75% lower glomerular filtration rate at the time of follow-up than at the time of their predonation measurement.

But almost 50% of obese donors had hypertension at follow-up, compared with 30% of nonobese donors. The incidence of hypertension also rose significantly with increasing obesity. Univariate and multivariate analyses confirmed that obesity was a significant risk factor for developing hypertension.

These results “should be taken into consideration in the preoperative evaluation, counseling, and postoperative follow-up of these patients,” he said.

BOSTON — Obese patients remain much longer on waiting lists for kidneys and livers from deceased donors and have higher mortality than do nonobese individuals, Dr. Dorry L. Segev reported at the 2006 World Transplant Congress.

The increasing rate of obesity in the general population is mirrored by high rates of obese patients on waiting lists for kidney and liver transplants, said Dr. Segev of the department of surgery at Johns Hopkins University, Baltimore.

About 8% of patients on the United Network for Organ Sharing (UNOS) waiting list for a deceased donor liver and 7% of those waiting for a kidney have a body mass index (kg/m

In his study of 166,063 patients on the UNOS waiting list for a primary deceased-donor kidney transplant during 1995–2005, patients in BMI categories ranging from normal to morbidly obese benefited equally from transplantation, compared with patients in each BMI category who remained on the waiting list. These results suggested there might be a bias against renal transplantation in obese patients, he said.

The percentage of patients who received a deceased-donor kidney transplant during the study period declined significantly in a stepwise manner from a high of 44% in patients with the lowest BMI (18.5–25) to a low of 31% in those with the highest BMI (40 or greater). Those in the highest BMI category were 40% less likely to receive a kidney transplant than were patients in the lowest BMI range.

The mean waiting time to receipt of transplant similarly rose, from a low of 41 months in the lowest BMI group to a high of 65 months in the highest BMI group.

As BMI increased, patients had significantly higher rates of delayed graft function. But kidney transplant recipients with a BMI of 40 or greater had only modestly lower rates of graft survival at 5 years (75%) and patient survival at 5 years (78%) than did normal BMI patients (80% and 83%, respectively).

The obese patients who were called in for a kidney transplant may have been a selected group that had better outcomes than an unselected group would have had. But if the obese patients who “were not called in were not appropriate for transplantation, perhaps we should never have listed them in the first place,” Dr. Segev said at the congress, which was sponsored by the American Society of Transplant Surgeons, the American Society of Transplantation, and the Transplantation Society.

In the time since the Model for End-Stage Liver Disease (MELD) score was introduced in 2002 to allocate deceased donor livers to patients on the UNOS waiting list, obese patients with a MELD score less than 20 have been less likely than nonobese patients to be listed, to be transplanted once listed, or to receive a transplant in exception to their MELD score, Dr. Segev reported in a separate presentation.

In a review of the 30,968 patients placed on the UNOS waiting list for a deceased-donor liver since 2002, Dr. Segev and his associates found that as BMI increased, patients were less likely to be listed and transplanted at centers. Of patients with a BMI of 18.5–34.9, 100% were listed and 100% were transplanted. But among those with a BMI of 35–39.9, 83% were listed and 78% were transplanted. In patients with a BMI of 40 or greater, 74% were listed and 53% were transplanted. This trend nearly disappeared, however, when the analysis was limited to high-volume centers.

A BMI of 40 or greater was an independent risk factor for a longer wait for a liver transplant, but not for graft loss or for patient death after transplantation.

In patients with a MELD score of less than 15, those with a BMI of 40 or greater spent significantly more time on the waiting list than did those with a BMI of 35–39.9. The same trend was true for recipients with a MELD score of 15–20, though all of the BMI subgroups with this severity of liver disease got transplanted faster than those with a MELD score of less than 15. Among all the BMI categories, there was no difference in the time to transplantation in patients with a MELD score greater than 20.

A significantly smaller percentage of patients in the highest BMI category received an exception to their MELD score than did patients in the lowest BMI category. This left those with a BMI of 40 or greater 35% less likely to receive an exception to their MELD score.

ELSEVIER GLOBAL MEDICAL NEWS

BOSTON — Obese patients remain much longer on waiting lists for kidneys and livers from deceased donors and have higher mortality than do nonobese individuals, Dr. Dorry L. Segev reported at the 2006 World Transplant Congress.

The increasing rate of obesity in the general population is mirrored by high rates of obese patients on waiting lists for kidney and liver transplants, said Dr. Segev of the department of surgery at Johns Hopkins University, Baltimore.

About 8% of patients on the United Network for Organ Sharing (UNOS) waiting list for a deceased donor liver and 7% of those waiting for a kidney have a body mass index (kg/m

In his study of 166,063 patients on the UNOS waiting list for a primary deceased-donor kidney transplant during 1995–2005, patients in BMI categories ranging from normal to morbidly obese benefited equally from transplantation, compared with patients in each BMI category who remained on the waiting list. These results suggested there might be a bias against renal transplantation in obese patients, he said.

The percentage of patients who received a deceased-donor kidney transplant during the study period declined significantly in a stepwise manner from a high of 44% in patients with the lowest BMI (18.5–25) to a low of 31% in those with the highest BMI (40 or greater). Those in the highest BMI category were 40% less likely to receive a kidney transplant than were patients in the lowest BMI range.

The mean waiting time to receipt of transplant similarly rose, from a low of 41 months in the lowest BMI group to a high of 65 months in the highest BMI group.

As BMI increased, patients had significantly higher rates of delayed graft function. But kidney transplant recipients with a BMI of 40 or greater had only modestly lower rates of graft survival at 5 years (75%) and patient survival at 5 years (78%) than did normal BMI patients (80% and 83%, respectively).

The obese patients who were called in for a kidney transplant may have been a selected group that had better outcomes than an unselected group would have had. But if the obese patients who “were not called in were not appropriate for transplantation, perhaps we should never have listed them in the first place,” Dr. Segev said at the congress, which was sponsored by the American Society of Transplant Surgeons, the American Society of Transplantation, and the Transplantation Society.

In the time since the Model for End-Stage Liver Disease (MELD) score was introduced in 2002 to allocate deceased donor livers to patients on the UNOS waiting list, obese patients with a MELD score less than 20 have been less likely than nonobese patients to be listed, to be transplanted once listed, or to receive a transplant in exception to their MELD score, Dr. Segev reported in a separate presentation.

In a review of the 30,968 patients placed on the UNOS waiting list for a deceased-donor liver since 2002, Dr. Segev and his associates found that as BMI increased, patients were less likely to be listed and transplanted at centers. Of patients with a BMI of 18.5–34.9, 100% were listed and 100% were transplanted. But among those with a BMI of 35–39.9, 83% were listed and 78% were transplanted. In patients with a BMI of 40 or greater, 74% were listed and 53% were transplanted. This trend nearly disappeared, however, when the analysis was limited to high-volume centers.

A BMI of 40 or greater was an independent risk factor for a longer wait for a liver transplant, but not for graft loss or for patient death after transplantation.

In patients with a MELD score of less than 15, those with a BMI of 40 or greater spent significantly more time on the waiting list than did those with a BMI of 35–39.9. The same trend was true for recipients with a MELD score of 15–20, though all of the BMI subgroups with this severity of liver disease got transplanted faster than those with a MELD score of less than 15. Among all the BMI categories, there was no difference in the time to transplantation in patients with a MELD score greater than 20.

A significantly smaller percentage of patients in the highest BMI category received an exception to their MELD score than did patients in the lowest BMI category. This left those with a BMI of 40 or greater 35% less likely to receive an exception to their MELD score.

ELSEVIER GLOBAL MEDICAL NEWS

BOSTON — Obese patients remain much longer on waiting lists for kidneys and livers from deceased donors and have higher mortality than do nonobese individuals, Dr. Dorry L. Segev reported at the 2006 World Transplant Congress.

The increasing rate of obesity in the general population is mirrored by high rates of obese patients on waiting lists for kidney and liver transplants, said Dr. Segev of the department of surgery at Johns Hopkins University, Baltimore.

About 8% of patients on the United Network for Organ Sharing (UNOS) waiting list for a deceased donor liver and 7% of those waiting for a kidney have a body mass index (kg/m

In his study of 166,063 patients on the UNOS waiting list for a primary deceased-donor kidney transplant during 1995–2005, patients in BMI categories ranging from normal to morbidly obese benefited equally from transplantation, compared with patients in each BMI category who remained on the waiting list. These results suggested there might be a bias against renal transplantation in obese patients, he said.

The percentage of patients who received a deceased-donor kidney transplant during the study period declined significantly in a stepwise manner from a high of 44% in patients with the lowest BMI (18.5–25) to a low of 31% in those with the highest BMI (40 or greater). Those in the highest BMI category were 40% less likely to receive a kidney transplant than were patients in the lowest BMI range.

The mean waiting time to receipt of transplant similarly rose, from a low of 41 months in the lowest BMI group to a high of 65 months in the highest BMI group.

As BMI increased, patients had significantly higher rates of delayed graft function. But kidney transplant recipients with a BMI of 40 or greater had only modestly lower rates of graft survival at 5 years (75%) and patient survival at 5 years (78%) than did normal BMI patients (80% and 83%, respectively).

The obese patients who were called in for a kidney transplant may have been a selected group that had better outcomes than an unselected group would have had. But if the obese patients who “were not called in were not appropriate for transplantation, perhaps we should never have listed them in the first place,” Dr. Segev said at the congress, which was sponsored by the American Society of Transplant Surgeons, the American Society of Transplantation, and the Transplantation Society.

In the time since the Model for End-Stage Liver Disease (MELD) score was introduced in 2002 to allocate deceased donor livers to patients on the UNOS waiting list, obese patients with a MELD score less than 20 have been less likely than nonobese patients to be listed, to be transplanted once listed, or to receive a transplant in exception to their MELD score, Dr. Segev reported in a separate presentation.

In a review of the 30,968 patients placed on the UNOS waiting list for a deceased-donor liver since 2002, Dr. Segev and his associates found that as BMI increased, patients were less likely to be listed and transplanted at centers. Of patients with a BMI of 18.5–34.9, 100% were listed and 100% were transplanted. But among those with a BMI of 35–39.9, 83% were listed and 78% were transplanted. In patients with a BMI of 40 or greater, 74% were listed and 53% were transplanted. This trend nearly disappeared, however, when the analysis was limited to high-volume centers.

A BMI of 40 or greater was an independent risk factor for a longer wait for a liver transplant, but not for graft loss or for patient death after transplantation.

In patients with a MELD score of less than 15, those with a BMI of 40 or greater spent significantly more time on the waiting list than did those with a BMI of 35–39.9. The same trend was true for recipients with a MELD score of 15–20, though all of the BMI subgroups with this severity of liver disease got transplanted faster than those with a MELD score of less than 15. Among all the BMI categories, there was no difference in the time to transplantation in patients with a MELD score greater than 20.

A significantly smaller percentage of patients in the highest BMI category received an exception to their MELD score than did patients in the lowest BMI category. This left those with a BMI of 40 or greater 35% less likely to receive an exception to their MELD score.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Tight glycemic control early in the course of type 1 diabetes does not result in later cognitive decline, according to new findings from two studies with an average of 18 years of follow-up data.

“Because of the length of follow-up and extent of cognitive testing, this study strongly supports the safety of intensive diabetes therapy,” Dr. Alan M. Jacobson said at the annual scientific sessions of the American Diabetes Association.

The results should allay the serious concerns about whether tight glycemic control might lead to more severe hypoglycemic episodes and subsequent decreased cognitive ability, said Dr. Jacobson, head of the behavioral and mental health research section at the Joslin Diabetes Center, Boston.

But the recurrent, severe hypoglycemic events that are more likely to occur with tight glycemic control could still possibly have a negative cognitive effect on older adults, very young children, or those with a longer disease duration, he added.

The results from the multicenter, randomized Diabetes Control and Complications Trial (DCCT) and its continuation in the long-term observational Epidemiology of Diabetes Interventions and Complications (EDIC) study showed that patients receiving intensive glycemic control during the DCCT did not have any differences in cognition, compared with conventional treatment, as measured by an extensive test battery involving eight cognitive domains (problem solving, learning, immediate memory, delayed recall, spatial information, attention, psychomotor efficiency, and motor speed), Dr. Jacobson said.

Among patients in either group, there were no differences in cognitive functioning in those who had no hypoglycemic episodes, one to five episodes, or more than five episodes. Control of HbA_1c (glycosylated hemoglobin) values to less than 7.9% similarly showed no significant effects, except in sparing patients from small reductions in psychomotor efficiency and in improving motor speed. The “very modest” declines in psychomotor efficiency and motor speed that were associated with higher HbA_1c values (7.9% or greater) were “consistent with emerging literature on the effects of persistent hyperglycemia on mental and motor slowing,” Dr. Jacobson said.

All of the analyses were adjusted to account for the confounding variables of baseline age, gender, years of education, length of follow-up, and the number of cognitive tests taken.

The initial results at the end of the DCCT showed that maintenance of near normal glycemic control reduced the risk of developing—or the progression of—microvascular complications.

After 10 years of additional follow-up in the EDIC study, the patients who had prior intensive treatment still had reduced progression of retinopathy, nephropathy, neuropathy, and cardiovascular events.

As patients in the intensive treatment arm of the DCCT finished the trial and entered the EDIC study, they did not maintain the same level of glycemic control during the ensuing years, whereas individuals who were in the conventional treatment arm of the DCCT received training on how to maintain tight glycemic control and soon began doing so on their own. Both groups had a mean HbA_1c value of 7.8% at the end of 12 years of follow-up in the EDIC study, which includes data on more than 90% of the original DCCT patients.

At the end of the 12 years, a significantly greater percentage of the 583 patients who were in the intensive treatment arm of the DCCT had one or more severe hypoglycemic events leading to coma or seizures than did the 553 patients who received conventional treatment (44%, or 258 patients with 880 events, vs. 34%, or 187 patients with 452 events).

Most (97%) of the participants were white and were 27 years old on average when they entered the DCCT, where they received a mean of 6.5 years of intervention; they were 45 years old on average after 12 years of follow-up in the EDIC trial. At the last follow-up, all of the participants were adults and about 50% were employed as professionals.

WASHINGTON — Tight glycemic control early in the course of type 1 diabetes does not result in later cognitive decline, according to new findings from two studies with an average of 18 years of follow-up data.

“Because of the length of follow-up and extent of cognitive testing, this study strongly supports the safety of intensive diabetes therapy,” Dr. Alan M. Jacobson said at the annual scientific sessions of the American Diabetes Association.

The results should allay the serious concerns about whether tight glycemic control might lead to more severe hypoglycemic episodes and subsequent decreased cognitive ability, said Dr. Jacobson, head of the behavioral and mental health research section at the Joslin Diabetes Center, Boston.

But the recurrent, severe hypoglycemic events that are more likely to occur with tight glycemic control could still possibly have a negative cognitive effect on older adults, very young children, or those with a longer disease duration, he added.

The results from the multicenter, randomized Diabetes Control and Complications Trial (DCCT) and its continuation in the long-term observational Epidemiology of Diabetes Interventions and Complications (EDIC) study showed that patients receiving intensive glycemic control during the DCCT did not have any differences in cognition, compared with conventional treatment, as measured by an extensive test battery involving eight cognitive domains (problem solving, learning, immediate memory, delayed recall, spatial information, attention, psychomotor efficiency, and motor speed), Dr. Jacobson said.

Among patients in either group, there were no differences in cognitive functioning in those who had no hypoglycemic episodes, one to five episodes, or more than five episodes. Control of HbA_1c (glycosylated hemoglobin) values to less than 7.9% similarly showed no significant effects, except in sparing patients from small reductions in psychomotor efficiency and in improving motor speed. The “very modest” declines in psychomotor efficiency and motor speed that were associated with higher HbA_1c values (7.9% or greater) were “consistent with emerging literature on the effects of persistent hyperglycemia on mental and motor slowing,” Dr. Jacobson said.

All of the analyses were adjusted to account for the confounding variables of baseline age, gender, years of education, length of follow-up, and the number of cognitive tests taken.

The initial results at the end of the DCCT showed that maintenance of near normal glycemic control reduced the risk of developing—or the progression of—microvascular complications.

After 10 years of additional follow-up in the EDIC study, the patients who had prior intensive treatment still had reduced progression of retinopathy, nephropathy, neuropathy, and cardiovascular events.

As patients in the intensive treatment arm of the DCCT finished the trial and entered the EDIC study, they did not maintain the same level of glycemic control during the ensuing years, whereas individuals who were in the conventional treatment arm of the DCCT received training on how to maintain tight glycemic control and soon began doing so on their own. Both groups had a mean HbA_1c value of 7.8% at the end of 12 years of follow-up in the EDIC study, which includes data on more than 90% of the original DCCT patients.

At the end of the 12 years, a significantly greater percentage of the 583 patients who were in the intensive treatment arm of the DCCT had one or more severe hypoglycemic events leading to coma or seizures than did the 553 patients who received conventional treatment (44%, or 258 patients with 880 events, vs. 34%, or 187 patients with 452 events).

Most (97%) of the participants were white and were 27 years old on average when they entered the DCCT, where they received a mean of 6.5 years of intervention; they were 45 years old on average after 12 years of follow-up in the EDIC trial. At the last follow-up, all of the participants were adults and about 50% were employed as professionals.

WASHINGTON — Tight glycemic control early in the course of type 1 diabetes does not result in later cognitive decline, according to new findings from two studies with an average of 18 years of follow-up data.

“Because of the length of follow-up and extent of cognitive testing, this study strongly supports the safety of intensive diabetes therapy,” Dr. Alan M. Jacobson said at the annual scientific sessions of the American Diabetes Association.

The results should allay the serious concerns about whether tight glycemic control might lead to more severe hypoglycemic episodes and subsequent decreased cognitive ability, said Dr. Jacobson, head of the behavioral and mental health research section at the Joslin Diabetes Center, Boston.

But the recurrent, severe hypoglycemic events that are more likely to occur with tight glycemic control could still possibly have a negative cognitive effect on older adults, very young children, or those with a longer disease duration, he added.

The results from the multicenter, randomized Diabetes Control and Complications Trial (DCCT) and its continuation in the long-term observational Epidemiology of Diabetes Interventions and Complications (EDIC) study showed that patients receiving intensive glycemic control during the DCCT did not have any differences in cognition, compared with conventional treatment, as measured by an extensive test battery involving eight cognitive domains (problem solving, learning, immediate memory, delayed recall, spatial information, attention, psychomotor efficiency, and motor speed), Dr. Jacobson said.

Among patients in either group, there were no differences in cognitive functioning in those who had no hypoglycemic episodes, one to five episodes, or more than five episodes. Control of HbA_1c (glycosylated hemoglobin) values to less than 7.9% similarly showed no significant effects, except in sparing patients from small reductions in psychomotor efficiency and in improving motor speed. The “very modest” declines in psychomotor efficiency and motor speed that were associated with higher HbA_1c values (7.9% or greater) were “consistent with emerging literature on the effects of persistent hyperglycemia on mental and motor slowing,” Dr. Jacobson said.

All of the analyses were adjusted to account for the confounding variables of baseline age, gender, years of education, length of follow-up, and the number of cognitive tests taken.

The initial results at the end of the DCCT showed that maintenance of near normal glycemic control reduced the risk of developing—or the progression of—microvascular complications.

After 10 years of additional follow-up in the EDIC study, the patients who had prior intensive treatment still had reduced progression of retinopathy, nephropathy, neuropathy, and cardiovascular events.

As patients in the intensive treatment arm of the DCCT finished the trial and entered the EDIC study, they did not maintain the same level of glycemic control during the ensuing years, whereas individuals who were in the conventional treatment arm of the DCCT received training on how to maintain tight glycemic control and soon began doing so on their own. Both groups had a mean HbA_1c value of 7.8% at the end of 12 years of follow-up in the EDIC study, which includes data on more than 90% of the original DCCT patients.

At the end of the 12 years, a significantly greater percentage of the 583 patients who were in the intensive treatment arm of the DCCT had one or more severe hypoglycemic events leading to coma or seizures than did the 553 patients who received conventional treatment (44%, or 258 patients with 880 events, vs. 34%, or 187 patients with 452 events).

Most (97%) of the participants were white and were 27 years old on average when they entered the DCCT, where they received a mean of 6.5 years of intervention; they were 45 years old on average after 12 years of follow-up in the EDIC trial. At the last follow-up, all of the participants were adults and about 50% were employed as professionals.

SAN FRANCISCO — Relatively few patients benefit from routine cholecystectomy during laparoscopic or open gastric bypass surgery, according to results of two studies presented at the annual meeting of the American Society for Bariatric Surgery.

The new studies indicate that 10% or less of asymptomatic patients with negative findings during preoperative work-up will develop gallstones and even those with positive findings on ultrasound and CT scans or liver function tests have a low incidence of delayed cholecystectomy.

“We agree that any patient with acute or chronic cholecystitis would best benefit from a cholecystectomy, but our data [do] not support routine ultrasound or routine cholecystectomy in asymptomatic, morbidly obese patients considering weight loss surgery,” said Dr. Dana D. Portenier of Duke University, Durham, N.C.

Routine cholecystectomy during open Roux-en-Y gastric bypass (RYGB) surgery was first recommended in 1985, and it is commonly done because 10%–25% of patients undergoing this procedure develop gallstones.

Although ursodeoxycholic acid is sometimes used to decrease the incidence of post-RYGB cholelithiasis, this practice has been criticized because of poor compliance and increased costs, Dr. Portenier said.

Cholecystectomy during laparoscopic RYGB has been performed safely, but the additional procedure increases operative time and nearly doubles the length of hospital stay (Obes. Surg. 2003;13:76–81).

Dr. Portenier and his colleagues reviewed the use of pre- or intraoperative ultrasound in 1,391 consecutive patients with abdominal complaints or elevated liver function tests who received RYGB during 2000–2005. Cholecystectomy was performed only in patients with biliary symptoms and positive findings on ultrasound. No patients received ursodeoxycholic acid postoperatively. Most patients (1,228) had laparoscopic operations.

The investigators excluded 334 patients (24%) from the study because they previously had a cholecystectomy.

The gallbladder was removed during RYGB in 17 of 541 patients who did not receive an ultrasound and in 27 of 406 patients who had a normal ultrasound. Most of these gallbladders were removed early in the series of patients during open RYGB, when it was the center's policy to perform routine cholecystectomy.

The gallbladder was removed at a later date in 29 (6%) of the remaining 524 patients who did not receive an ultrasound and in 37 (10%) of the remaining 379 patients who had a normal ultrasound.

Of the 110 patients with positive findings on ultrasound, 29 had their gallbladders removed during RYGB. Among the remaining 81 patients with positive findings on ultrasound, just 14 (17%) required a delayed cholecystectomy when they developed biliary symptoms.

All of the delayed cholecystectomies were performed between 1 and 30 months after RYGB, at an average of 11 months. The increased incidence of cholelithiasis mainly occurs in the first 2 years after surgery and thereafter returns to baseline, Dr. Portenier said.

“Proponents of prophylactic cholecystectomy at the time of gastric bypass worry about gallstone pancreatitis, choledocholithiasis, and the unique problems they present in the Roux-en-Y gastric bypass,” he said.

Of the 80 patients who required a delayed cholecystectomy, only 1 developed mild gallstone pancreatitis and none developed choledocholithiasis. One patient had a bile duct injury.

In a separate presentation, Dr. Scott J. Ellner reported on his center's experience with the use of a preoperative work-up to determine the need for a concomitant cholecystectomy during either RYGB or laparoscopic adjustable gastric banding (LAGB). The work-up includes abdominal ultrasound scanning, liver function tests, and a health history.

“Many patients are asymptomatic at the time of preoperative work-up, despite having findings on ultrasound or abdominal CT scanning, and these patients also continue to be asymptomatic even after their weight loss surgery,” said Dr. Ellner of the Center for Bariatric Surgery at St. Francis Hospital, Hartford, Conn.

Of 621 patients who underwent RYGB or LAGB at the center during 2003–2005, 451 had not undergone a previous cholecystectomy. After 4–25 months of follow-up, 29 (9%) of 332 patients who were originally asymptomatic and had a negative ultrasound scan at the time of the preoperative work-up developed symptoms of biliary disease. Similarly, of 102 patients who were originally asymptomatic but had positive findings on ultrasound during the preoperative work-up, 9 (9%) later developed symptoms of biliary disease. A total of 17 patients who were symptomatic during the preoperative work-up had their gallbladders removed during bariatric surgery; most of these patients had open procedures, Dr. Ellner said.

None of the patients received ursodeoxycholic acid after surgery.

The percentage of patients who later required a delayed cholecystectomy changed to 10%–11% if the 98 patients who received LAGB were removed from the analysis. LAGB typically causes slower and less weight loss than RYGB and would be expected to have a lower incidence of cholelithiasis than RYGB.

The patients who received LAGB had a shorter median time to cholecystectomy (4 months) than did those who received open (14 months) or laparoscopic RYGB (9 months), “which was somewhat perplexing and we're still trying to figure out why this is the case,” Dr. Ellner said.

Nearly all of the delayed cholecystectomies (37 of 38) in Dr. Ellner's study were performed laparoscopically. Four patients had choledocholithiasis, and one had gallstone pancreatitis.

In both studies, the patients who participated because they did not have a previous cholecystectomy may represent a preselected population with a lower risk for gallbladder pathology, the speakers noted.

The incidence of symptomatic biliary disease “will grow considerably” during the following decades from the 9% that was detected in the “very, very short follow-up” of Dr. Ellner's study, cautioned audience member Dr. Michael G. Sarr of the Mayo Clinic, Rochester, Minn. “That doesn't mean that we should be taking everyone's gallbladder out if you do [bariatric surgery] laparoscopically, but if you do [open surgery], I don't see any reason not to” take the gallbladder out.

SAN FRANCISCO — Relatively few patients benefit from routine cholecystectomy during laparoscopic or open gastric bypass surgery, according to results of two studies presented at the annual meeting of the American Society for Bariatric Surgery.

The new studies indicate that 10% or less of asymptomatic patients with negative findings during preoperative work-up will develop gallstones and even those with positive findings on ultrasound and CT scans or liver function tests have a low incidence of delayed cholecystectomy.

“We agree that any patient with acute or chronic cholecystitis would best benefit from a cholecystectomy, but our data [do] not support routine ultrasound or routine cholecystectomy in asymptomatic, morbidly obese patients considering weight loss surgery,” said Dr. Dana D. Portenier of Duke University, Durham, N.C.

Routine cholecystectomy during open Roux-en-Y gastric bypass (RYGB) surgery was first recommended in 1985, and it is commonly done because 10%–25% of patients undergoing this procedure develop gallstones.

Although ursodeoxycholic acid is sometimes used to decrease the incidence of post-RYGB cholelithiasis, this practice has been criticized because of poor compliance and increased costs, Dr. Portenier said.

Cholecystectomy during laparoscopic RYGB has been performed safely, but the additional procedure increases operative time and nearly doubles the length of hospital stay (Obes. Surg. 2003;13:76–81).

Dr. Portenier and his colleagues reviewed the use of pre- or intraoperative ultrasound in 1,391 consecutive patients with abdominal complaints or elevated liver function tests who received RYGB during 2000–2005. Cholecystectomy was performed only in patients with biliary symptoms and positive findings on ultrasound. No patients received ursodeoxycholic acid postoperatively. Most patients (1,228) had laparoscopic operations.

The investigators excluded 334 patients (24%) from the study because they previously had a cholecystectomy.

The gallbladder was removed during RYGB in 17 of 541 patients who did not receive an ultrasound and in 27 of 406 patients who had a normal ultrasound. Most of these gallbladders were removed early in the series of patients during open RYGB, when it was the center's policy to perform routine cholecystectomy.

The gallbladder was removed at a later date in 29 (6%) of the remaining 524 patients who did not receive an ultrasound and in 37 (10%) of the remaining 379 patients who had a normal ultrasound.

Of the 110 patients with positive findings on ultrasound, 29 had their gallbladders removed during RYGB. Among the remaining 81 patients with positive findings on ultrasound, just 14 (17%) required a delayed cholecystectomy when they developed biliary symptoms.

All of the delayed cholecystectomies were performed between 1 and 30 months after RYGB, at an average of 11 months. The increased incidence of cholelithiasis mainly occurs in the first 2 years after surgery and thereafter returns to baseline, Dr. Portenier said.

“Proponents of prophylactic cholecystectomy at the time of gastric bypass worry about gallstone pancreatitis, choledocholithiasis, and the unique problems they present in the Roux-en-Y gastric bypass,” he said.

Of the 80 patients who required a delayed cholecystectomy, only 1 developed mild gallstone pancreatitis and none developed choledocholithiasis. One patient had a bile duct injury.

In a separate presentation, Dr. Scott J. Ellner reported on his center's experience with the use of a preoperative work-up to determine the need for a concomitant cholecystectomy during either RYGB or laparoscopic adjustable gastric banding (LAGB). The work-up includes abdominal ultrasound scanning, liver function tests, and a health history.

“Many patients are asymptomatic at the time of preoperative work-up, despite having findings on ultrasound or abdominal CT scanning, and these patients also continue to be asymptomatic even after their weight loss surgery,” said Dr. Ellner of the Center for Bariatric Surgery at St. Francis Hospital, Hartford, Conn.

Of 621 patients who underwent RYGB or LAGB at the center during 2003–2005, 451 had not undergone a previous cholecystectomy. After 4–25 months of follow-up, 29 (9%) of 332 patients who were originally asymptomatic and had a negative ultrasound scan at the time of the preoperative work-up developed symptoms of biliary disease. Similarly, of 102 patients who were originally asymptomatic but had positive findings on ultrasound during the preoperative work-up, 9 (9%) later developed symptoms of biliary disease. A total of 17 patients who were symptomatic during the preoperative work-up had their gallbladders removed during bariatric surgery; most of these patients had open procedures, Dr. Ellner said.

None of the patients received ursodeoxycholic acid after surgery.

The percentage of patients who later required a delayed cholecystectomy changed to 10%–11% if the 98 patients who received LAGB were removed from the analysis. LAGB typically causes slower and less weight loss than RYGB and would be expected to have a lower incidence of cholelithiasis than RYGB.

The patients who received LAGB had a shorter median time to cholecystectomy (4 months) than did those who received open (14 months) or laparoscopic RYGB (9 months), “which was somewhat perplexing and we're still trying to figure out why this is the case,” Dr. Ellner said.

Nearly all of the delayed cholecystectomies (37 of 38) in Dr. Ellner's study were performed laparoscopically. Four patients had choledocholithiasis, and one had gallstone pancreatitis.

In both studies, the patients who participated because they did not have a previous cholecystectomy may represent a preselected population with a lower risk for gallbladder pathology, the speakers noted.

The incidence of symptomatic biliary disease “will grow considerably” during the following decades from the 9% that was detected in the “very, very short follow-up” of Dr. Ellner's study, cautioned audience member Dr. Michael G. Sarr of the Mayo Clinic, Rochester, Minn. “That doesn't mean that we should be taking everyone's gallbladder out if you do [bariatric surgery] laparoscopically, but if you do [open surgery], I don't see any reason not to” take the gallbladder out.

SAN FRANCISCO — Relatively few patients benefit from routine cholecystectomy during laparoscopic or open gastric bypass surgery, according to results of two studies presented at the annual meeting of the American Society for Bariatric Surgery.

The new studies indicate that 10% or less of asymptomatic patients with negative findings during preoperative work-up will develop gallstones and even those with positive findings on ultrasound and CT scans or liver function tests have a low incidence of delayed cholecystectomy.

“We agree that any patient with acute or chronic cholecystitis would best benefit from a cholecystectomy, but our data [do] not support routine ultrasound or routine cholecystectomy in asymptomatic, morbidly obese patients considering weight loss surgery,” said Dr. Dana D. Portenier of Duke University, Durham, N.C.

Routine cholecystectomy during open Roux-en-Y gastric bypass (RYGB) surgery was first recommended in 1985, and it is commonly done because 10%–25% of patients undergoing this procedure develop gallstones.

Although ursodeoxycholic acid is sometimes used to decrease the incidence of post-RYGB cholelithiasis, this practice has been criticized because of poor compliance and increased costs, Dr. Portenier said.

Cholecystectomy during laparoscopic RYGB has been performed safely, but the additional procedure increases operative time and nearly doubles the length of hospital stay (Obes. Surg. 2003;13:76–81).

Dr. Portenier and his colleagues reviewed the use of pre- or intraoperative ultrasound in 1,391 consecutive patients with abdominal complaints or elevated liver function tests who received RYGB during 2000–2005. Cholecystectomy was performed only in patients with biliary symptoms and positive findings on ultrasound. No patients received ursodeoxycholic acid postoperatively. Most patients (1,228) had laparoscopic operations.

The investigators excluded 334 patients (24%) from the study because they previously had a cholecystectomy.

The gallbladder was removed during RYGB in 17 of 541 patients who did not receive an ultrasound and in 27 of 406 patients who had a normal ultrasound. Most of these gallbladders were removed early in the series of patients during open RYGB, when it was the center's policy to perform routine cholecystectomy.

The gallbladder was removed at a later date in 29 (6%) of the remaining 524 patients who did not receive an ultrasound and in 37 (10%) of the remaining 379 patients who had a normal ultrasound.

Of the 110 patients with positive findings on ultrasound, 29 had their gallbladders removed during RYGB. Among the remaining 81 patients with positive findings on ultrasound, just 14 (17%) required a delayed cholecystectomy when they developed biliary symptoms.

All of the delayed cholecystectomies were performed between 1 and 30 months after RYGB, at an average of 11 months. The increased incidence of cholelithiasis mainly occurs in the first 2 years after surgery and thereafter returns to baseline, Dr. Portenier said.

“Proponents of prophylactic cholecystectomy at the time of gastric bypass worry about gallstone pancreatitis, choledocholithiasis, and the unique problems they present in the Roux-en-Y gastric bypass,” he said.

Of the 80 patients who required a delayed cholecystectomy, only 1 developed mild gallstone pancreatitis and none developed choledocholithiasis. One patient had a bile duct injury.

In a separate presentation, Dr. Scott J. Ellner reported on his center's experience with the use of a preoperative work-up to determine the need for a concomitant cholecystectomy during either RYGB or laparoscopic adjustable gastric banding (LAGB). The work-up includes abdominal ultrasound scanning, liver function tests, and a health history.

“Many patients are asymptomatic at the time of preoperative work-up, despite having findings on ultrasound or abdominal CT scanning, and these patients also continue to be asymptomatic even after their weight loss surgery,” said Dr. Ellner of the Center for Bariatric Surgery at St. Francis Hospital, Hartford, Conn.

Of 621 patients who underwent RYGB or LAGB at the center during 2003–2005, 451 had not undergone a previous cholecystectomy. After 4–25 months of follow-up, 29 (9%) of 332 patients who were originally asymptomatic and had a negative ultrasound scan at the time of the preoperative work-up developed symptoms of biliary disease. Similarly, of 102 patients who were originally asymptomatic but had positive findings on ultrasound during the preoperative work-up, 9 (9%) later developed symptoms of biliary disease. A total of 17 patients who were symptomatic during the preoperative work-up had their gallbladders removed during bariatric surgery; most of these patients had open procedures, Dr. Ellner said.

None of the patients received ursodeoxycholic acid after surgery.

The percentage of patients who later required a delayed cholecystectomy changed to 10%–11% if the 98 patients who received LAGB were removed from the analysis. LAGB typically causes slower and less weight loss than RYGB and would be expected to have a lower incidence of cholelithiasis than RYGB.

The patients who received LAGB had a shorter median time to cholecystectomy (4 months) than did those who received open (14 months) or laparoscopic RYGB (9 months), “which was somewhat perplexing and we're still trying to figure out why this is the case,” Dr. Ellner said.

Nearly all of the delayed cholecystectomies (37 of 38) in Dr. Ellner's study were performed laparoscopically. Four patients had choledocholithiasis, and one had gallstone pancreatitis.

In both studies, the patients who participated because they did not have a previous cholecystectomy may represent a preselected population with a lower risk for gallbladder pathology, the speakers noted.

The incidence of symptomatic biliary disease “will grow considerably” during the following decades from the 9% that was detected in the “very, very short follow-up” of Dr. Ellner's study, cautioned audience member Dr. Michael G. Sarr of the Mayo Clinic, Rochester, Minn. “That doesn't mean that we should be taking everyone's gallbladder out if you do [bariatric surgery] laparoscopically, but if you do [open surgery], I don't see any reason not to” take the gallbladder out.

SAN FRANCISCO — Bariatric surgery may be safe for older patients and provide weight loss benefits and improved comorbidities similar to those achieved by younger patients, according to four new studies presented at the annual meeting of the American Society for Bariatric Surgery.

In February, the Centers for Medicare and Medicaid Services extended coverage for bariatric surgery to beneficiaries of all ages, provided that the surgery was performed at certified facilities.

And although a recent review of Medicare beneficiaries reported significantly higher mortality in patients aged 65 years and older than in younger patients (JAMA 2005;294:1903–8), the new studies do not support that finding.

In a study of 340 Medicare patients who underwent bariatric surgery, individuals aged 65 years and older had similar rates of major and minor complications but lower mortality after surgery than did those younger than 65 years, reported Dr. David A. Provost of the University of Texas Southwestern Medical Center, Dallas.

No deaths occurred in 65 older adult patients who received either laparoscopic adjustable gastric banding (LAGB) or open or laparoscopic Roux-en-Y gastric bypass (RYGB), but 3 (0.1%) of 275 younger patients died. The overall complication rate for patients aged 65 years and older was similar to that observed for patients under 65 years of age.

In a separate retrospective study of 55 patients aged at least 60 years, laparoscopic bariatric procedures caused no deaths and few complications, reported Dr. David Hazzan of the division of minimally invasive surgery at Mount Sinai School of Medicine, New York.

The procedures, performed during 1999–2005, included laparoscopic RYGB (33), LAGB (9), biliopancreatic diversion with duodenal switch (7), sleeve gastrectomy (3), and a revision of previous bariatric surgery (3).

In the first 30 days after surgery, 4 (7%) patients developed complications: upper GI bleeding, an empyema, a urinary tract infection, and a wound infection. No patients had died at 90 days after surgery.

All patients underwent a contrast swallow study on the first day after surgery, and more than 70% were monitored in the surgical or postanesthesia ICU for the first 24 hours after surgery, based on their comorbidities and cardiovascular status.

Another study found that RYGB surgery in patients aged 60 years and older could be safe and effective in resolving comorbidities, even though the older patients lost less excess weight and had more comorbidities than their younger counterparts.

Of 1,002 patients who received bariatric surgery at the Geisinger Medical Center, Danville, Pa., during 2001–2005, 61 patients aged at least 60 years (mean, 62 years old) and 941 younger patients (mean, 43 years old) received laparoscopic or open RYGB surgery, said Dr. Stephanie E. Dunkle-Blatter, of the center.

Surgeons performed laparoscopic RYGB surgery in 32% of the older patients and in 53% of the younger patients. All patients received a preoperative weight management intervention for a minimum of 6 months; patients aimed for a 10% reduction in excess body weight. The intervention included supervised diet and exercise programs, psychological evaluations, counseling, and medical treatment of comorbidities.

Postoperative body mass index was similar between the two groups (about 36 kg/m

At a mean follow-up of nearly 14 months in older patients and almost 17 months in younger patients, a significantly greater percentage of older patients resolved or improved their type 2 diabetes than did younger patients (98% vs. 91%), but a significantly larger percentage of younger patients had improvement or resolution of hypertension than did older patients (83% vs. 76%). The number of prescription medications decreased from about 10 to 5 in older adults and from about 5 to 3 in younger patients.

Rates of major complications were 13% in older adults and 12% in younger patients, while rates of minor complications were 27% and 21%, respectively. However, 90-day mortality rates were similar in the two groups (1.6% vs. 0.53%, respectively).

A similar study presented by Dr. Peter T. Hallowell at a poster session during the meeting also showed that patients older than 60 years can have rates of complication and death similar to those of younger patients.

In a review of 43 older patients (62 years old on average) and 794 younger patients (43 years old on average) who received a primary RYGB, Dr. Hallowell and his associates at the University Hospitals of Cleveland found that the two groups did not differ in their rate of postoperative pulmonary embolism, leak, fistula, bleeding, pneumonia, or bowel obstruction. No older patients died, but 3 (0.4%) younger adults did.

More bariatric surgery is likely to be performed in older adults in the future, given the aging population and climbing rate of obesity, several speakers noted.

SAN FRANCISCO — Bariatric surgery may be safe for older patients and provide weight loss benefits and improved comorbidities similar to those achieved by younger patients, according to four new studies presented at the annual meeting of the American Society for Bariatric Surgery.

In February, the Centers for Medicare and Medicaid Services extended coverage for bariatric surgery to beneficiaries of all ages, provided that the surgery was performed at certified facilities.

And although a recent review of Medicare beneficiaries reported significantly higher mortality in patients aged 65 years and older than in younger patients (JAMA 2005;294:1903–8), the new studies do not support that finding.

In a study of 340 Medicare patients who underwent bariatric surgery, individuals aged 65 years and older had similar rates of major and minor complications but lower mortality after surgery than did those younger than 65 years, reported Dr. David A. Provost of the University of Texas Southwestern Medical Center, Dallas.

No deaths occurred in 65 older adult patients who received either laparoscopic adjustable gastric banding (LAGB) or open or laparoscopic Roux-en-Y gastric bypass (RYGB), but 3 (0.1%) of 275 younger patients died. The overall complication rate for patients aged 65 years and older was similar to that observed for patients under 65 years of age.

In a separate retrospective study of 55 patients aged at least 60 years, laparoscopic bariatric procedures caused no deaths and few complications, reported Dr. David Hazzan of the division of minimally invasive surgery at Mount Sinai School of Medicine, New York.

The procedures, performed during 1999–2005, included laparoscopic RYGB (33), LAGB (9), biliopancreatic diversion with duodenal switch (7), sleeve gastrectomy (3), and a revision of previous bariatric surgery (3).

In the first 30 days after surgery, 4 (7%) patients developed complications: upper GI bleeding, an empyema, a urinary tract infection, and a wound infection. No patients had died at 90 days after surgery.

All patients underwent a contrast swallow study on the first day after surgery, and more than 70% were monitored in the surgical or postanesthesia ICU for the first 24 hours after surgery, based on their comorbidities and cardiovascular status.

Another study found that RYGB surgery in patients aged 60 years and older could be safe and effective in resolving comorbidities, even though the older patients lost less excess weight and had more comorbidities than their younger counterparts.

Of 1,002 patients who received bariatric surgery at the Geisinger Medical Center, Danville, Pa., during 2001–2005, 61 patients aged at least 60 years (mean, 62 years old) and 941 younger patients (mean, 43 years old) received laparoscopic or open RYGB surgery, said Dr. Stephanie E. Dunkle-Blatter, of the center.

Surgeons performed laparoscopic RYGB surgery in 32% of the older patients and in 53% of the younger patients. All patients received a preoperative weight management intervention for a minimum of 6 months; patients aimed for a 10% reduction in excess body weight. The intervention included supervised diet and exercise programs, psychological evaluations, counseling, and medical treatment of comorbidities.

Postoperative body mass index was similar between the two groups (about 36 kg/m

At a mean follow-up of nearly 14 months in older patients and almost 17 months in younger patients, a significantly greater percentage of older patients resolved or improved their type 2 diabetes than did younger patients (98% vs. 91%), but a significantly larger percentage of younger patients had improvement or resolution of hypertension than did older patients (83% vs. 76%). The number of prescription medications decreased from about 10 to 5 in older adults and from about 5 to 3 in younger patients.

Rates of major complications were 13% in older adults and 12% in younger patients, while rates of minor complications were 27% and 21%, respectively. However, 90-day mortality rates were similar in the two groups (1.6% vs. 0.53%, respectively).

A similar study presented by Dr. Peter T. Hallowell at a poster session during the meeting also showed that patients older than 60 years can have rates of complication and death similar to those of younger patients.

In a review of 43 older patients (62 years old on average) and 794 younger patients (43 years old on average) who received a primary RYGB, Dr. Hallowell and his associates at the University Hospitals of Cleveland found that the two groups did not differ in their rate of postoperative pulmonary embolism, leak, fistula, bleeding, pneumonia, or bowel obstruction. No older patients died, but 3 (0.4%) younger adults did.

More bariatric surgery is likely to be performed in older adults in the future, given the aging population and climbing rate of obesity, several speakers noted.

SAN FRANCISCO — Bariatric surgery may be safe for older patients and provide weight loss benefits and improved comorbidities similar to those achieved by younger patients, according to four new studies presented at the annual meeting of the American Society for Bariatric Surgery.

In February, the Centers for Medicare and Medicaid Services extended coverage for bariatric surgery to beneficiaries of all ages, provided that the surgery was performed at certified facilities.

And although a recent review of Medicare beneficiaries reported significantly higher mortality in patients aged 65 years and older than in younger patients (JAMA 2005;294:1903–8), the new studies do not support that finding.

In a study of 340 Medicare patients who underwent bariatric surgery, individuals aged 65 years and older had similar rates of major and minor complications but lower mortality after surgery than did those younger than 65 years, reported Dr. David A. Provost of the University of Texas Southwestern Medical Center, Dallas.

No deaths occurred in 65 older adult patients who received either laparoscopic adjustable gastric banding (LAGB) or open or laparoscopic Roux-en-Y gastric bypass (RYGB), but 3 (0.1%) of 275 younger patients died. The overall complication rate for patients aged 65 years and older was similar to that observed for patients under 65 years of age.

In a separate retrospective study of 55 patients aged at least 60 years, laparoscopic bariatric procedures caused no deaths and few complications, reported Dr. David Hazzan of the division of minimally invasive surgery at Mount Sinai School of Medicine, New York.

The procedures, performed during 1999–2005, included laparoscopic RYGB (33), LAGB (9), biliopancreatic diversion with duodenal switch (7), sleeve gastrectomy (3), and a revision of previous bariatric surgery (3).

In the first 30 days after surgery, 4 (7%) patients developed complications: upper GI bleeding, an empyema, a urinary tract infection, and a wound infection. No patients had died at 90 days after surgery.

All patients underwent a contrast swallow study on the first day after surgery, and more than 70% were monitored in the surgical or postanesthesia ICU for the first 24 hours after surgery, based on their comorbidities and cardiovascular status.

Another study found that RYGB surgery in patients aged 60 years and older could be safe and effective in resolving comorbidities, even though the older patients lost less excess weight and had more comorbidities than their younger counterparts.

Of 1,002 patients who received bariatric surgery at the Geisinger Medical Center, Danville, Pa., during 2001–2005, 61 patients aged at least 60 years (mean, 62 years old) and 941 younger patients (mean, 43 years old) received laparoscopic or open RYGB surgery, said Dr. Stephanie E. Dunkle-Blatter, of the center.

Surgeons performed laparoscopic RYGB surgery in 32% of the older patients and in 53% of the younger patients. All patients received a preoperative weight management intervention for a minimum of 6 months; patients aimed for a 10% reduction in excess body weight. The intervention included supervised diet and exercise programs, psychological evaluations, counseling, and medical treatment of comorbidities.

Postoperative body mass index was similar between the two groups (about 36 kg/m

At a mean follow-up of nearly 14 months in older patients and almost 17 months in younger patients, a significantly greater percentage of older patients resolved or improved their type 2 diabetes than did younger patients (98% vs. 91%), but a significantly larger percentage of younger patients had improvement or resolution of hypertension than did older patients (83% vs. 76%). The number of prescription medications decreased from about 10 to 5 in older adults and from about 5 to 3 in younger patients.

Rates of major complications were 13% in older adults and 12% in younger patients, while rates of minor complications were 27% and 21%, respectively. However, 90-day mortality rates were similar in the two groups (1.6% vs. 0.53%, respectively).

A similar study presented by Dr. Peter T. Hallowell at a poster session during the meeting also showed that patients older than 60 years can have rates of complication and death similar to those of younger patients.

In a review of 43 older patients (62 years old on average) and 794 younger patients (43 years old on average) who received a primary RYGB, Dr. Hallowell and his associates at the University Hospitals of Cleveland found that the two groups did not differ in their rate of postoperative pulmonary embolism, leak, fistula, bleeding, pneumonia, or bowel obstruction. No older patients died, but 3 (0.4%) younger adults did.

More bariatric surgery is likely to be performed in older adults in the future, given the aging population and climbing rate of obesity, several speakers noted.