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Use of intragastric baloon for obesity: Technique and preliminary results
AGAAI065
April 2000
patients and 6 orthopedic patients (p
stimulates leptin secretion in experimental models. Aim of this study was to investigate the relationship of REE and anorexia to leptin and TNF-a serum concentration in patients with liver cirrhosis. Thirty patients (21 males, 9 females mean age 52 years, range 32-68)were studies. The degree of liver disease was assessed using the Child-Pugh classification: 6 patients were Child A, 17 Child Band 7 class C. Anorexia was measured using a 100 mm visual analog scale. REE was determined using indirect calorimetry. Fat mass was assessed by dual energy-x-absorptiometry (DEXA). Serum leptin and TNF-a concentrations were determined by immunoassays. Results: leptin showed a significant correlation with fat mass (r= 0.74, p
4940
PROLONGED PARENTERAL NUTRITION DUE TO NEONATAL SHORT BOWEL SYNDROME, A DANISH EXPERIENCE. Anne E. Christensen, Niels Qvist, Steffen Husby, Odense Univ Hosp, Odense, Denmark. Long-term treatment with parenteral nutrition (TPN) is essential for survival of children with short bowel syndrome acquired in infancy. Aims: To estimate the incidence of short bowel syndrome and to characterize the clinical course of long term TPN in infants and children from a geographically well-defined area. Design: Review of the clinical course of infants with a TPN requirement for more than two months due to gastrointestinal disease in western Denmark and over a period of 11.5 years. Results: A total of 23 patients were registered with a cumulative hospital stay of 4462 days. The study showed a low incidence of long-term TPN with a yearly incidence of approx. 3.8 per 105 births per year or 2.5 per 106 inhabitants below 16 years of age. Two groups of patients were identified: seven patients with resection or atresia of the small intestine and a larger group (n= 16) with signs of bowel dysmotility. The former group had a significantly higher incidence of sepsis, longer hospital stay and a longer need of TPN. As shown in other studies the length of residual small intestine and the percent of daily energy intake tolerated by the enteral route at 12 weeks of age were variables of prognostic importance. Conclusions: Neonatal short gut syndrome is registered at a low frequency in Denmark most commonly caused by gastroschisis and intestinal atresia.
4943 MODIFIED SUBJECTIVE GLOBAL ASSESSMENT (SGA), AN EFFECTIVE TOOL FOR IMPLEMENTING NUTRITION SUPPORT IN ONCOLOGY PATIENTS. Kala Bailey, Heather Gabbert, Carolyn Lammersfeld, Ivy Marsh, JaneAnn Megna, Valerie Revemont, Pankaj Vashi, Midwestern Regional Med Ctr, Zion,IL. The purpose of this study was to determine if implementation of nutrition support based on objective evaluation of the SGA is effective in improving or maintaining nutritional status in oncology patients. Modified SGA was administered to 69 prospective oncology patients. All patients had an initial evaluation followed by a minimum of three consecutive monthly reevaluations. The patients were objectively categorized into well nourished (A), moderately nourished (B), and severely malnourished (C), based on their modified SGA scoring. Aggressive intervention for patients in categories B & C included oral supplementation, appetite stimulants, and enteral and/or parenteral nutrition. As a result of this intervention, 83% of all patients demonstrated either improvement or maintenance of their nutritional status. Our results indicate that implementation of nutrition support based on objective interpretation of the SGA is effective in improving or maintaining nutritional status in oncology patients. This objective modification of SGA is an inexpensive and effective modality of nutritional assessment and may be useful as an alternative to other standard methods. 4941 USE OF INTRAGASTRIC BALOON FOR OBESITY: TECHNIQUE AND PRELIMINARY RESULTS. Salomon Benchetrit, Bertrand Napoleon, Roger Michel Bory, Philippe Guyot, Clin Jeanne D' Are, Lyon, France. The use of intragastric baloon was recently introduce in France by our team. We use a silicon baloon(BIOENTERICS)inflated in the stomach with 500 ml of physiologic serum. The patient is under neuroleptalgesia and the baloon in introduced under endoscopic view into the stomach and inflated. Between April 1998 and Septembre 1999 we report 105 patients who have an Intragastric baloon for obesity.All the patient have a BMI (Body mass Index) between 30 and 35.They where no major complication, and 100 patient where discharged the same day. The weight loss was significant in 85 patients between 12 kg to 26 kg in 4 to 6 month. Two patients have there baloon retires 15 days after the operation for no tolerance after 8 kg of weight loss. We retired the baloon after 6 month in all the patients.7 patients have eliminated there baloon. 1 patient present a small bowel obstruction by migration of the baloon. The indication are represented by patients with BMI>30 and super obese patient to prepare them to a gastroplasty. The inconvenient is the time of life of the baloon (6 month) that in some cases is to short to have in this time a nutritional reeducation of the patient. 4942 RESTING ENERGY-EXPENDITURE (REE) IN CIRRHOTIC PATIENTS:ROLE OF PLASMA CONCENTRATIONS OF LEPTIN AND TUMOR NECROSIS FACTOR-A (TNF-A). Andrea Buda, Maurizio Vamier, Carla Venturi, Patrizia Burra, Stefano Fagiuoli, Sara Pevere, Fabio Farinati, Piera Englaro, Remo Naccarato, Diego Martines, Gastroenterological and Surg Sci Dept, Padova, Italy; Med and Surg Sci Dept, Padova, Italy; Gastroenterological and Surg Sci, Padova, Italy. Malnutrition is common among patients with liver cirrhosis and it is frequently associated with anorexia and increased REE. Leptin is a newly discovered hormone secreted by adipocytes involved in the regulation of food intake and long term energy metabolism. TNF-a is a cytokine that induces anorexia and weight loss by suppression of food intake and
4944 RETINOIC ACID DECREASES EXPRESSION OF INSULIN-LIKE GROWTH FACTOR (IGF)·II BY HT-29 CELLS. Mark R. Corkins, Beverly S. Schaffer, Richard G. MacDonald, Indiana Univ, Indianapolis, IN; Univ of Nebraska Med Ctr, Omaha, NE. Retinoic acid is a cell differentiation agent that experimentally mediates some of its effects by altering the IGF-axis. The IGF-axis consists of two classic IGFs and six classic IGF binding proteins (IGFBPs), which modulate their actions. The IGF-axis is an important regulator of both proliferation and differentiation for gastrointestinal cell lines. We have investigated the effect of retinoic acid on HT-29 cells. HT-29 cells are a heterogenous, pluripotent human colonic cell line that has been utilized as a model of enterocyte differentiation and proliferation. HT·29 cells produce IGF-II and three isoforms of IGFBP-4. We have previously reported that treatment with retinoic acid results in an increase in IGFBP-4 production. This increased IGFBP-4 production was dose dependent although the higher concentrations resulted in a decrease in overall cell numbers. The HT-29 cells were plated equally and grown to confluence. The experimental cells were then exposed to 1 /LM retinoic acid in seum-free media for 48h. This concentration was selected, as previous experiments had demonstrated no change in cell number or protein concentration at this retinoic acid concentration. The conditioned media was stored at -20°C until analysis. The radiolabeled western and ligand blots were analyzed by a Phosphorimager with results expressed as arbitrary intensity units (AIU). Ligand blotting of the media confirmed a 39% increase in IGFBP-4 production (496,100 versus 689,740 AID). These findings are consistant with our previous studies. Equal volumes of the conditioned media were concentrated by lyophilization. The residual materials were reconstituted in equal volumes of water and under went western blotting for IGF-II. HT-29 cells treated with l/LM retinoic acid demontrated a 36% decrease in IGF-II production (205,200 versus 151,200 AIU). Retinoic acid stimulates IGFBP-4 production that has been associated with differentiation, while it suppresses the proproliferative IGF-II production. These findings support a role for the enterocyte IGF-axis in the enterocyte response to the prodifferentiation agent retinoic acid.
April 2000
patients and 6 orthopedic patients (p
stimulates leptin secretion in experimental models. Aim of this study was to investigate the relationship of REE and anorexia to leptin and TNF-a serum concentration in patients with liver cirrhosis. Thirty patients (21 males, 9 females mean age 52 years, range 32-68)were studies. The degree of liver disease was assessed using the Child-Pugh classification: 6 patients were Child A, 17 Child Band 7 class C. Anorexia was measured using a 100 mm visual analog scale. REE was determined using indirect calorimetry. Fat mass was assessed by dual energy-x-absorptiometry (DEXA). Serum leptin and TNF-a concentrations were determined by immunoassays. Results: leptin showed a significant correlation with fat mass (r= 0.74, p
4940
PROLONGED PARENTERAL NUTRITION DUE TO NEONATAL SHORT BOWEL SYNDROME, A DANISH EXPERIENCE. Anne E. Christensen, Niels Qvist, Steffen Husby, Odense Univ Hosp, Odense, Denmark. Long-term treatment with parenteral nutrition (TPN) is essential for survival of children with short bowel syndrome acquired in infancy. Aims: To estimate the incidence of short bowel syndrome and to characterize the clinical course of long term TPN in infants and children from a geographically well-defined area. Design: Review of the clinical course of infants with a TPN requirement for more than two months due to gastrointestinal disease in western Denmark and over a period of 11.5 years. Results: A total of 23 patients were registered with a cumulative hospital stay of 4462 days. The study showed a low incidence of long-term TPN with a yearly incidence of approx. 3.8 per 105 births per year or 2.5 per 106 inhabitants below 16 years of age. Two groups of patients were identified: seven patients with resection or atresia of the small intestine and a larger group (n= 16) with signs of bowel dysmotility. The former group had a significantly higher incidence of sepsis, longer hospital stay and a longer need of TPN. As shown in other studies the length of residual small intestine and the percent of daily energy intake tolerated by the enteral route at 12 weeks of age were variables of prognostic importance. Conclusions: Neonatal short gut syndrome is registered at a low frequency in Denmark most commonly caused by gastroschisis and intestinal atresia.
4943 MODIFIED SUBJECTIVE GLOBAL ASSESSMENT (SGA), AN EFFECTIVE TOOL FOR IMPLEMENTING NUTRITION SUPPORT IN ONCOLOGY PATIENTS. Kala Bailey, Heather Gabbert, Carolyn Lammersfeld, Ivy Marsh, JaneAnn Megna, Valerie Revemont, Pankaj Vashi, Midwestern Regional Med Ctr, Zion,IL. The purpose of this study was to determine if implementation of nutrition support based on objective evaluation of the SGA is effective in improving or maintaining nutritional status in oncology patients. Modified SGA was administered to 69 prospective oncology patients. All patients had an initial evaluation followed by a minimum of three consecutive monthly reevaluations. The patients were objectively categorized into well nourished (A), moderately nourished (B), and severely malnourished (C), based on their modified SGA scoring. Aggressive intervention for patients in categories B & C included oral supplementation, appetite stimulants, and enteral and/or parenteral nutrition. As a result of this intervention, 83% of all patients demonstrated either improvement or maintenance of their nutritional status. Our results indicate that implementation of nutrition support based on objective interpretation of the SGA is effective in improving or maintaining nutritional status in oncology patients. This objective modification of SGA is an inexpensive and effective modality of nutritional assessment and may be useful as an alternative to other standard methods. 4941 USE OF INTRAGASTRIC BALOON FOR OBESITY: TECHNIQUE AND PRELIMINARY RESULTS. Salomon Benchetrit, Bertrand Napoleon, Roger Michel Bory, Philippe Guyot, Clin Jeanne D' Are, Lyon, France. The use of intragastric baloon was recently introduce in France by our team. We use a silicon baloon(BIOENTERICS)inflated in the stomach with 500 ml of physiologic serum. The patient is under neuroleptalgesia and the baloon in introduced under endoscopic view into the stomach and inflated. Between April 1998 and Septembre 1999 we report 105 patients who have an Intragastric baloon for obesity.All the patient have a BMI (Body mass Index) between 30 and 35.They where no major complication, and 100 patient where discharged the same day. The weight loss was significant in 85 patients between 12 kg to 26 kg in 4 to 6 month. Two patients have there baloon retires 15 days after the operation for no tolerance after 8 kg of weight loss. We retired the baloon after 6 month in all the patients.7 patients have eliminated there baloon. 1 patient present a small bowel obstruction by migration of the baloon. The indication are represented by patients with BMI>30 and super obese patient to prepare them to a gastroplasty. The inconvenient is the time of life of the baloon (6 month) that in some cases is to short to have in this time a nutritional reeducation of the patient. 4942 RESTING ENERGY-EXPENDITURE (REE) IN CIRRHOTIC PATIENTS:ROLE OF PLASMA CONCENTRATIONS OF LEPTIN AND TUMOR NECROSIS FACTOR-A (TNF-A). Andrea Buda, Maurizio Vamier, Carla Venturi, Patrizia Burra, Stefano Fagiuoli, Sara Pevere, Fabio Farinati, Piera Englaro, Remo Naccarato, Diego Martines, Gastroenterological and Surg Sci Dept, Padova, Italy; Med and Surg Sci Dept, Padova, Italy; Gastroenterological and Surg Sci, Padova, Italy. Malnutrition is common among patients with liver cirrhosis and it is frequently associated with anorexia and increased REE. Leptin is a newly discovered hormone secreted by adipocytes involved in the regulation of food intake and long term energy metabolism. TNF-a is a cytokine that induces anorexia and weight loss by suppression of food intake and
4944 RETINOIC ACID DECREASES EXPRESSION OF INSULIN-LIKE GROWTH FACTOR (IGF)·II BY HT-29 CELLS. Mark R. Corkins, Beverly S. Schaffer, Richard G. MacDonald, Indiana Univ, Indianapolis, IN; Univ of Nebraska Med Ctr, Omaha, NE. Retinoic acid is a cell differentiation agent that experimentally mediates some of its effects by altering the IGF-axis. The IGF-axis consists of two classic IGFs and six classic IGF binding proteins (IGFBPs), which modulate their actions. The IGF-axis is an important regulator of both proliferation and differentiation for gastrointestinal cell lines. We have investigated the effect of retinoic acid on HT-29 cells. HT-29 cells are a heterogenous, pluripotent human colonic cell line that has been utilized as a model of enterocyte differentiation and proliferation. HT·29 cells produce IGF-II and three isoforms of IGFBP-4. We have previously reported that treatment with retinoic acid results in an increase in IGFBP-4 production. This increased IGFBP-4 production was dose dependent although the higher concentrations resulted in a decrease in overall cell numbers. The HT-29 cells were plated equally and grown to confluence. The experimental cells were then exposed to 1 /LM retinoic acid in seum-free media for 48h. This concentration was selected, as previous experiments had demonstrated no change in cell number or protein concentration at this retinoic acid concentration. The conditioned media was stored at -20°C until analysis. The radiolabeled western and ligand blots were analyzed by a Phosphorimager with results expressed as arbitrary intensity units (AIU). Ligand blotting of the media confirmed a 39% increase in IGFBP-4 production (496,100 versus 689,740 AID). These findings are consistant with our previous studies. Equal volumes of the conditioned media were concentrated by lyophilization. The residual materials were reconstituted in equal volumes of water and under went western blotting for IGF-II. HT-29 cells treated with l/LM retinoic acid demontrated a 36% decrease in IGF-II production (205,200 versus 151,200 AIU). Retinoic acid stimulates IGFBP-4 production that has been associated with differentiation, while it suppresses the proproliferative IGF-II production. These findings support a role for the enterocyte IGF-axis in the enterocyte response to the prodifferentiation agent retinoic acid.