The Influence of Obesity on Perioperative Morbidity: Retrospective Study of 502 Aortocoronary Bypass Operations

Fasol, Roland; Schindler, M; Schumacher, Burghard; Schlaudraff, Kai-Uwe; Hannes, Waltraud; Seitelberger, R.; Schlosser, V.

doi:10.1055/s-2007-1020129

Cited by 101 publications

(51 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Data analysis showed a benefit in survival of euthrophic and overweight patients; similar to findings published by Brikmeyer et al [17], Gurm et al [18] and Fasol et al [30], in which a BMI superior to 30 kg/m² was not associated with increased mortality [31].…”

Section: Discussionsupporting

confidence: 76%

O efeito do índice de massa corporal sobre as complicações no pós-operatório de cirurgia de revascularização do miocárdio em idosos

Reis

Barbiero²,

Ribas³

2008

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

O efeito do índice de massa corporal sobre as complicações no pós-operatório de cirurgia de revascularização do miocárdio em idososThe effect of the body mass index on postoperative complications of coronary artery bypass grafting in elderly Abstract Objectives: To evaluate the effect of BMI (body mass index) in the postoperative period of elderly patients undergoing CABG.Methods: Cross-sectional retrospective study, carried out in academic hospital, with all patients (n=290), aged or above 60 years, undergone CABG, from August 2006 to July 2007. The patients were divided into tertiles of BMI (<22, 22-27,> 27kg /m²). The variables included in the study were collected from medical records of patients and analyzed by logistic regression in association with the categories of BMI.Results: In the group with malnutrition were found larger percentage of impaired lung, kidney, hospital stay and immediate surgical mortality; but without statistical significance. Among female patients, the group malnutrition and eutrophy, 61.5% had hospital stay for a period longer than seven postoperative days compared to 42.5% male patients (p=0.003). In the group with malnutrition was found association between the CPB time and renal dysfunction with p<0.001 and, in eutrophic group with p=0.04. Obesity obtained protective association for lung dysfunction (RR=0.99), readmissions (RR=0.45) and mortality (RR = 0.77), and risk factor for renal dysfunction (RR=1.12). Conclusions 525REIS, C ET AL -The effect of the body mass index on postoperative complications of coronary artery bypass grafting in elderly Bras Cir Cardiovasc 2008; 23(4): 524-529 Rev

show abstract

Section: Discussionsupporting

confidence: 76%

O efeito do índice de massa corporal sobre as complicações no pós-operatório de cirurgia de revascularização do miocárdio em idosos

Reis

Barbiero²,

Ribas³

2008

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

show abstract

“…Obese patients often have many medical conditions, such as cardiovascular disease, diabetes mellitus, and high blood pressure [ 25,26 ] , factors which may affect surgical outcomes [ 27,28 ] . Many studies in the literature have used BMI as an indicator of the degree to which a patient is overweight, and BMI is often used as an indicator of physical frame; however, BMI does not always accurately refl ect the various types of obesity because the distribution of adipose tissue differs greatly among individuals.…”

Section: Discussionmentioning

confidence: 99%

Visceral obesity is a strong predictor of perioperative outcome in patients undergoing laparoscopic radical nephrectomy

Hagiwara¹,

Miyajima²,

Hasegawa³

et al. 2012

BJU International

View full text Add to dashboard Cite

What ' s known on the subject? and What does the study add? Obesity is a common and growing problem in industrialized countries, and metabolic syndrome has been the focus of much attention recently, particularly with respect to obesity. Obesity is thought to be a major factor infl uencing surgical complexity during abdominal surgery, including laparoscopic surgery.In this study, we focused on visceral obesity which has been recognized as the most important pathogenic factor in metabolic syndrome. We found that a high visceral fat area was a signifi cant risk factor for a prolonged operating time. We believe that visceral obesity may greatly affect surgical complexity and may be a suitable index for predicting the degree of operating diffi culty associated with laparoscopic nephrectomy. OBJECTIVE• To examine the impact of visceral fat on surgical complexity in patients undergoing laparoscopic nephrectomy. PATIENTS AND METHODS• We reviewed the medical records of 121 patients who underwent laparoscopic nephrectomy from 2006 to 2010 at our institution.• The total fat area, visceral fat area (VFA) and subcutaneous fat area were measured at the level of the umbilicus using computed tomography (CT).• To identify the type of obesity, we divided VFA into ≥ 100 cm 2 and < 100 cm 2 . A VFA ≥ 100 cm 2 was used as the defi nition of visceral obesity.• We evaluated the impact of the VFA on technical diffi culties encountered during laparoscopic nephrectomy by measuring operating time. RESULTS• A signifi cant correlation was observed between body mass index (BMI) and operating time ( P < 0.001, r = 0.316) in the patients undergoing laparoscopic nephrectomy.• VFA was also signifi cantly correlated with operating time ( P < 0.001, r = 0.348), and the correlation coeffi cient of VFA was higher than that of BMI.• Multivariate analysis showed that a high VFA was an independent risk factor for prolonged operating time ( P = 0.009, odds ratio; 3.70), whereas BMI was not found to be a risk factor. CONCLUSIONS• The present data indicate that measurement of VFA by CT is of benefi t for predicting the technical diffi culty associated with laparoscopic radical nephrectomy.• Visceral obesity, which is one factor involved in metabolic syndrome, has a greater impact than BMI on the complexity of laparoscopic radical nephrectomy. KEYWORDSnephrectomy , laparoscopy , visceral obesity , metabolic syndrome , visceral fat area , renal cell carcinoma , BMI Study Type -Therapy (case series) Level of Evidence 4

show abstract

“…Our current study uniquely studied proliferation and migration of adult mature aortic endothelial cells, and endothelial outgrowth from adult mouse aortic discs to examine the angiogenic effects of netrin-1. Compared to umbilical vein or developing vessels, aorta shares the closest physiology with large adult coronary arteries where therapeutic angiogenesis is beneficial for patients with ischemic coronary artery diseases (9,10). More importantly, the signaling mechanisms underlying netrin-1 modulation of angiogenesis were identified.…”

mentioning

confidence: 99%

Netrin-1 induces angiogenesis via a DCC-dependent ERK1/2-eNOS feed-forward mechanism

Nguyen

Cai

2006

Proc. Natl. Acad. Sci. U.S.A.

152

View full text Add to dashboard Cite

Netrin-1 is critical for axonal pathfinding which shares similarities with formation of vascular network. Here we report that netrin-1 induction of angiogenesis is mediated by an increase in endothelial nitric oxide (NO ⅐ ) production, which occurs via a DCC-dependent, ERK1͞2-eNOS feed-forward mechanism. Exposure of mature aortic endothelial cells to netrin-1 resulted in a potent, dose-dependent increase in NO ⅐ production, detected by electron spin resonance. Scavenging NO ⅐ with 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (PTIO) abolished netrin-1 stimulated angiogenesis. Netrin-1-stimulated NO ⅐ production or angiogenesis was inhibited by DCC antibody, DCC small interfering RNA (siRNA), specific inhibitors (PD98059, U0126), or siRNAs for MEK1͞2. PTIO attenuated ERK1͞2 phosphorylation, indicating a feed-forward mechanism. Netrin-1 induced a time-dependent phosphorylation of eNOS s1179, s116 and a rapid dephosphorylation of eNOSt497. Only eNOS s1179 was sensitive to U0126 or PTIO. These data characterized a mechanism whereby netrin-1 promotes angiogenesis, which may broadly relate to cardiovascular, neuronal and cancer physiology.nitric oxide N etrin-1 is one of the first discovered axon-guiding molecules that are critical for neuronal development (1, 2). It is a secreted protein that is released to circulation after being produced by a variety of cells (3). Upon activation of its attraction-selective receptor deleted in colorectal cancer (DCC) or neogenin, netrin-1 induces axonal outgrowth and crossover through the midline (2, 4); this is at least partially mediated by activation of the mitogen activated protein kinase ERK1͞2 (5).Formation of vascular network shares many similarities with neuronal pathfinding (6). A number of mitogens including VEGF and EGF have been shown to regulate endothelial cell growth and proliferation. Interestingly, netrin-1 is structurally homologous to the endothelial mitogens. It has an N-terminal type IV laminin repeat, followed by three cystein-rich EGF modules and a positively charged C-terminal domain. A recent study demonstrated that netrin-1 stimulates growth of umbilical vein endothelial cells and vascular smooth muscle (7). However, in the presence of the repulsive receptor UNC5B in developing capillaries, netrin-1 induces endothelial filopodial retraction (8). Our current study uniquely studied proliferation and migration of adult mature aortic endothelial cells, and endothelial outgrowth from adult mouse aortic discs to examine the angiogenic effects of netrin-1. Compared to umbilical vein or developing vessels, aorta shares the closest physiology with large adult coronary arteries where therapeutic angiogenesis is beneficial for patients with ischemic coronary artery diseases (9, 10). More importantly, the signaling mechanisms underlying netrin-1 modulation of angiogenesis were identified.Using the highly specific and sensitive electron spin resonance technology for direct and characteristic measurement of nitric oxide gas radical (NO ⅐ ), we examined a potent...

show abstract

The Influence of Obesity on Perioperative Morbidity: Retrospective Study of 502 Aortocoronary Bypass Operations

Cited by 101 publications

References 2 publications

O efeito do índice de massa corporal sobre as complicações no pós-operatório de cirurgia de revascularização do miocárdio em idosos

O efeito do índice de massa corporal sobre as complicações no pós-operatório de cirurgia de revascularização do miocárdio em idosos

Visceral obesity is a strong predictor of perioperative outcome in patients undergoing laparoscopic radical nephrectomy

Netrin-1 induces angiogenesis via a DCC-dependent ERK1/2-eNOS feed-forward mechanism

Contact Info

Product

Resources

About