scholarly journals Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery

2006 ◽  
Vol 64 (3a) ◽  
pp. 609-612 ◽  
Author(s):  
Flavia Costa Nunes Machado ◽  
Berenice Cataldo Oliveira Valério ◽  
Roberto Naun Franco Morgulis ◽  
Karlo Faria Nunes ◽  
Sílvia Mazzali-Verst
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Gastric Surgery ◽  
Lower Limbs ◽  
Vitamin Supplementation ◽  
Axonal Polyneuropathy ◽  
Peripheral Polyneuropathy

Bariatric surgery is frequently indicated in the treatment of morbid obesity. Previously unreported complications have been associated to this surgery; among them, neurological complications have gained attention. We report the case of a 25-year-old man submitted to gastric surgery for treatment of morbid obesity who developed, two months after surgery, acute proximal weakness in lower limbs. The electroneuromyography revealed axonal peripheral polyneuropathy with predominant proximal involvement. After treatment with immunoglobulin and vitamin supplementation, rapid clinical and neurophysiologic recovery was observed. We describe the clinical and electroneuromyographic features of this case, stressing the difficulty of initial diagnosis, particularly in the differential diagnosis with Guillain-Barré syndrome. We discuss the importance of nutritional follow-up and the eventual indication of routine vitamin supplementation in these patients.

Nutritional Deficiencies and Bariatric Surgery

2018 ◽  
Author(s):  
Anthony B. Mozer ◽  
Konstantinos Spaniolas ◽  
Walter J. Pories
Keyword(s):  
Bariatric Surgery ◽  
Oral Intake ◽  
Emergency Department Visits ◽  
Nutritional Deficiencies ◽  
Vitamin Supplementation ◽  
Behavioral Modification ◽  
Poor Oral Intake ◽  
Preoperative Counseling ◽  
Disproportionate Number

Dietary intolerance and poor oral intake account for a disproportionate number of emergency department visits and readmissions after bariatric surgery. Micronutrient, vitamin, and protein deficiencies can occur after both malabsorptive and restrictive weight-loss operations, and they are best mitigated against by conscientious preoperative counseling and vigilance in follow-up. Routine vitamin supplementation can prevent the need for unnecessary laboratory testing, while symptoms of dumping syndrome can frequently be managed with dietary and behavioral modification alone. Alternative enteral feeding access for alimentary supplementation can be safely performed surgically or with assistance by interventional radiology, and should be considered in the management of perforation, early anastomotic leak, surgical revision, or patients with refractory malnourishment.

scholarly journals Neurological complications and pathogenetic therapy for chronic nitrous oxide intoxication (“laughing gas”) in nightclub visitors

2020 ◽  
Vol 10 (3) ◽  
pp. 49-62
Author(s):  
N. А. Suponeva ◽  
D. А. Grishina ◽  
D. А. Grozova ◽  
N. V. Belova ◽  
М. А. Ginzberg ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Vitamin B ◽  
Aged People ◽  
Laughing Gas ◽  
Pathogenetic Therapy ◽  
Vitamin Level ◽  
Sensory Polyneuropathy

Background. Nitrous oxide abuse (“laughing gas”, N2O) is common among young people attending nightclubs. Contrary to popular belief about the safety of N2O, in some cases neurological complications develop due to a deficiency of vitamin B12, the activity of which is blocked by N2O. Purpose of the study – to determine the typology and course of neurological disorders in a group of patients who regularly use “laughing gas”. To note the key diagnostic markers that allow verification of vitamin B12 deficiency induced by nitrous oxide consumption. To describe pathogenetic therapy features and follow-up. Materials and methods. The study included 12 patients (10 men and 2 women) aged 18 to 45 years (average age 29 years) with a diagnosis of B12-deficient myelopolyneuropathy induced by regular use of nitrous oxide. Results. The most common neurological complication of nitrous oxide abuse for more than 1 month was a generalized lesion of the peripheral nerves with acute or subacute distal symmetric sensory or sensorimotor axonal polyneuropathy. In the clinical picture, sensory complaints and disorders prevailed. Paresis developed in half of the cases. A typical neuroimaging symptom characteristic of funicular myelosis was rarely detected (16.7 %). A decrease in B12 vitamin level could most reliably be diagnosed only indirectly, by the presence of hyperhomocysteinemia (91.7 % of cases). In all cases that were followed-up, prolonged therapy with cyanocobalamin led to partial (n = 5; 62.5 %) or complete (n = 3; 37.5 %) regression of neurological symptoms. Conclusion. Caution regarding the use of nitrous oxide should be in all cases of predominantly sensory polyneuropathy with acute or subacute development in young and middle-aged people. A thorough history taking (targeted survey on the fact of nitrous oxide consumption) and diagnostics (testing the level of homocysteine, if possible methylmalonic acid) allow you to not miss a deficiency of vitamin B12, the treatment of the consequences of which with timely verification and adequate correction is quite effective. It is recommended that the level of homocysteine in the blood to be regularly monitored during the treatment (in order to achieve its normalization).

scholarly journals An immediate post op and follow up assessment of circulating adipo-cytokines after bariatric surgery in morbid obesity

2021 ◽  
pp. 100147
Author(s):  
Astha Sachan ◽  
Archna Singh ◽  
Sakshi Shukla ◽  
Sandeep Aggarwal ◽  
Ishfaq Mir ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity

scholarly journals VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

2013 ◽  
Vol 50 (3) ◽  
pp. 191-195 ◽  
Author(s):  
Bonno van BELLEN ◽  
Ivan de Barros GODOY ◽  
Andrea Almeida REIS ◽  
Pedro BERTEVELLO
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Venous Thrombosis ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Thromboembolic Disease ◽  
Lower Limbs ◽  
Abdominal Circumference ◽  
Morbidly Obese ◽  
Ceap Classification

Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI) and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings), type of surgery (open or laparoscopic), abdominal circumference, body mass index (BMI) and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%), the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%), but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although prophylaxis was used in all patients, the incidence of post-operative distal venous thrombosis was considerably high.

scholarly journals The Bariatric Surgery Patient: Lost to Follow-Up; from Morbid Obesity to Severe Malnutrition

2012 ◽  
Vol 18 (2) ◽  
pp. e21-e25 ◽  
Author(s):  
Gregory Dodell ◽  
Jeanine Albu ◽  
Lawrence Attia ◽  
James McGinty ◽  
F. Pi-Sunyer ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Severe Malnutrition ◽  
Surgery Patient ◽  
Bariatric Surgery Patient ◽  
Lost To Follow Up

O53 Long-term follow-up after gastric surgery for morbid obesity

2003 ◽  
Vol 14 ◽  
pp. S16
Author(s):  
J.W.F. Elte ◽  
T.M.H. Neumann-Dezaire ◽  
A. van der Wild-de Ruigh ◽  
J.W. Janssen ◽  
R.T. van Domburg ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Gastric Surgery ◽  
Long Term Follow Up

scholarly journals Treatment of posterior circulation fusiform aneurysms

2020 ◽  
pp. 1-7
Author(s):  
Ephraim W. Church ◽  
Mark G. Bigder ◽  
Eric S. Sussman ◽  
Santosh E. Gummidipundi ◽  
Summer S. Han ◽  
...  
Keyword(s):  
Neurological Complication ◽  
Posterior Inferior Cerebellar Artery ◽  
Retrospective Chart Review ◽  
Neurological Complications ◽  
Posterior Circulation ◽  
Flow Diversion ◽  
Interdisciplinary Treatment ◽  
Complication Rates ◽  
The Difference

OBJECTIVEPerforator arteries, the absence of an aneurysm discrete neck, and the often-extensive nature of posterior circulation fusiform aneurysms present treatment challenges. There have been advances in microsurgical and endovascular approaches, including flow diversion, and the authors sought to review these treatments in a long-term series at their neurovascular referral center.METHODSThe authors performed a retrospective chart review from 1990 to 2018. Primary outcomes were modified Rankin Scale (mRS) scores and Glasgow Outcome Scale (GOS) scores at follow-up. The authors also examined neurological complication rates. Using regression techniques, they reviewed independent and dependent variables, including presenting features, aneurysm location and size, surgical approach, and pretreatment and posttreatment thrombosis.RESULTSEighty-four patients met the inclusion criteria. Their mean age was 53 years, and 49 (58%) were female. Forty-one (49%) patients presented with subarachnoid hemorrhage. Aneurysms were located on the vertebral artery (VA) or posterior inferior cerebellar artery (PICA) in 50 (60%) patients, basilar artery (BA) or vertebrobasilar junction (VBJ) in 22 (26%), and posterior cerebral artery (PCA) in 12 (14%). Thirty-one (37%) patients were treated with microsurgical and 53 (63%) with endovascular approaches. Six aneurysms were treated with endovascular flow diversion. The authors found moderate disability or better (mRS score ≤ 3) in 85% of the patients at a mean 14-month follow-up. The GOS score was ≥ 4 in 82% of the patients. The overall neurological complication rate was 12%. In the regression analysis, patients with VA or PICA aneurysms had better functional outcomes than the other groups (p < 0.001). Endovascular strategies were associated with better outcomes for BA-VBJ aneurysms (p < 0.01), but microsurgery was associated with better outcomes for VA-PICA and PCA aneurysms (p < 0.05). There were no other significant associations between patient, aneurysm characteristics, or treatment features and neurological complications (p > 0.05). Patients treated with flow diversion had more complications than those who underwent other endovascular and microsurgical strategies, but the difference was not significant in regression models.CONCLUSIONSPosterior circulation fusiform aneurysms remain a challenging aneurysm subtype, but an interdisciplinary treatment approach can result in good outcomes. While flow diversion is a useful addition to the armamentarium, traditional endovascular and microsurgical techniques continue to offer effective options.

scholarly journals Timing and Spectrum of Neurological Complications After Flow Diverter Implantation for Intracranial Aneurysms

2021 ◽  
Vol 12 ◽  
Author(s):  
Guillaume Charbonnier ◽  
Jean-Philippe Desilles ◽  
Simon Escalard ◽  
Benjamin Maier ◽  
Gabriele Ciccio ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Flow Diverter ◽  
Factors Associated ◽  
Long Term Follow Up ◽  
Ischemic Complications ◽  
Ischemic Events

Background and Purpose: The aim of this study was to characterize neurological complications after flow diverter (FD) treatment on a long follow-up cohort and identify predictive factors associated with these complications.Methods: This study was conducted on a monocentric cohort of patients treated for intracranial aneurysms by FD.Results: Between September 2008 and July 2018, 413 patients were treated for 514 aneurysms: 18% of the patients presented with at least one neurological complication during a median follow-up of 446 days (IQR 186–1,210). Sixty-one patients presented with ischemic complications, 13 with hemorrhagic ones and 10 with compressive processes. Among 89 neurological complications 64.5% were peri-operative (occurring within the 30 days following the procedure) and 35.5% were delayed after 1 month.Conclusions: Overall, neurological complications after FD implantation were overrepresented by cerebrovascular ischemic events occurring during the peri-operative period, but also in a delayed manner after 1 year. Long-term follow-up is relevant after aneurysm intervention using FD.

Sign in / Sign up

Export Citation Format

Share Document