Obese Female Patients Research Articles

Morbid Obesity in Women is Associated to a Lower Prevalence of Thyroid Nodules

Few studies have recently showed functional and morphological changes of the thyroid gland in relation to obesity. To our knowledge, no data are available about the prevalence of thyroid nodules in female obese patients. The aim of this study was to investigate the prevalence of thyroid nodules in morbidly obese women. One hundred eight consecutive female obese patients were selected from those referred to our medical and surgery outpatients providing that following criteria were satisfied: (1) affected by morbid obesity (body mass index (BMI) >40kg/m(2)); (2) no previous diagnosis of thyroid disease; (3) biochemically proven euthyroid state at the time of recruitment. Ninety-seven control subjects, constituted by normo-weight and/or slightly overweight (BMI ≤ 30kg/m(2)) women, should satisfy the above criteria 2 and 3. All the subjects were submitted to ultrasound investigation. The two groups of patients displayed no differences for age and fT4 levels. Obese patients clearly showed a lower prevalence of thyroid nodules [odds ratio 0.294, 95% confidence interval 0.206-0.382]. A single nodule was found in 23% of obese patients as compared to 65% of control subjects (p < 0.0001). No difference for age (year) was found between obese and non-obese subjects with nodules (40.5 ± 8.2 vs. 44.2 ± 8.9, respectively, p = 0.07). Our data clearly show a significantly lower prevalence of thyroid nodules in morbidly obese patients. Further studies are needed to confirm and to understand this first observation.

P02-115 - Bariatric surgery is associated with reduced psychological distress and improved sexual function in obese female patients

IntroductionObesity is a serious health issue, associated with significant medical and psychosocial co-morbidity. Bariatric surgery is a promising treatment modality however, few studies have so far investigated its impact on patients’ sexuality.AimsThe present study's aim was to determine bariatric surgery's effect on female patients’ Body Mass Index (BMI), psychological and sexual functioning.Methods59 obese female patients, scheduled to undergo weight loss operation, completed the study. Psychological functioning was measured by the Hospital Anxiety and Depression Scale (HADS), while sexual functioning was assessed by the Female Sexual Functioning Index (FSFI). All participants were evaluated in two consecutive time intervals, one week before surgery (T1) and one year after (T2).ResultsStatistical analysis revealed a significant reduction in BMI (p &lt; 0.001) and depression (p &lt; 0.001) scores, a significant improvement in sexual desire (p = 0.005), arousal (p = 0.001), lubrication (p = 0.003), satisfaction (p = 0.012) and total sexual function (p = 0.003) and a decrease in the levels of pain during intercourse (p = 0.014) postoperatively.Postoperative total sexual functioning was correlated with baseline BMI (p = 0.030) and BMI decrease (p = 0.037).ConclusionsBariatric surgery appears as an effective way to control weight and improve psychological and sexual functioning in female obese patients. Patients, who ceased to be obese postoperatively, reported the greatest level of sexual improvement, indicating that obesity treatment should focus on BMI normalization.

Radiographs and low field MRI (0.2T) as predictors of efficacy in a weight loss trial in obese women with knee osteoarthritis

BackgroundTo study the predictive value of baseline radiographs and low-field (0.2T) MRI scans for the symptomatic outcome of clinically significant weight loss in obese patients with knee osteoarthritis.MethodsIn this study we hypothesize that imaging variables assessed with radiographs and MRI scans pre-treatment can predict the symptomatic changes following a recommended clinically significant weight reduction Patients were recruited from the Department of Rheumatology, Frederiksberg Hospital, Denmark. Eligibility criteria were: age >18 years; primary osteoarthritis according to ACR; BMI > 28 kg/m2; motivation for weight loss. Subjects were randomly assigned to either intervention by low-energy diet (LED) for 8 weeks followed by another 24 weeks of dietary instruction or control-group. MRI scans and radiographs were scored for structural changes and these parameters were examined as independent predictors of changes in osteoarthritis symptoms after 32 weeks. The outcome assessor and statistician were blinded to group allocation.ResultsNo significant correlations were found between imaging variables and changes in Western Ontario and McMaster Universities Index of Osteoarthritis (Spearman's test, r < 0.33 and P > 0.07).Only the LED group achieved a weight loss, with a mean difference of 16.3 kg (95%CI: 13.4-19.2;P < 0.0001) compared to the control group. The total WOMAC index showed a significant difference favouring LED, with a group mean difference of - 321.3 mm (95%CI: -577.5 to -65.1 mm; P = 0.01). No significant adverse events were reported.ConclusionStage of joint destruction, assessed on either radiographs or low-field MRI (0.2T), does not preclude a symptoms relief following a clinically relevant weight loss in elderly obese female patients with knee osteoarthritis.

Atrial lipomatous hypertrophy causing reduction in systemic venous return

Lipomatous hypertrophy of the interatrial septum (LHIAS) is a benign condition characterized by an abnormal deposition of adipose tissue in the interatrial septum which appears as a pseudomass with a bilobed shape. We present the case of a 68-year-old obese female patient. LHIAS is an infrequent finding, but with recent improvements in imaging it is increasingly recognized. Cardiac MRI may prove useful in its diagnosis in terms of tissue characterization, as well as for the evaluation of disease extension and haemodynamic compromise.

Effects of a whey protein supplementation on intrahepatocellular lipids in obese female patients

High protein diets have been shown to improve hepatic steatosis in rodent models and in high-fat fed humans. We therefore evaluated the effects of a protein supplementation on intrahepatocellular lipids (IHCL), and fasting plasma triglycerides in obese non diabetic women. Eleven obese women received a 60g/day whey protein supplement (WPS) for 4-weeks, while otherwise nourished on a spontaneous diet, IHCL concentrations, visceral body fat, total liver volume (MR), fasting total-triglyceride and cholesterol concentrations, glucose tolerance (standard 75g OGTT), insulin sensitivity (HOMA IS index), creatinine clearance, blood pressure and body composition (bio-impedance analysis) were assessed before and after 4-week WPS. IHCL were positively correlated with visceral fat and total liver volume at inclusion. WPS decreased significantly IHCL by 20.8±7.7%, fasting total TG by 15±6.9%, and total cholesterol by 7.3±2.7%. WPS slightly increased fat free mass from 54.8±2.2kg to 56.7±2.5kg, p=0.005). Visceral fat, total liver volume, glucose tolerance, creatinine clearance and insulin sensitivity were not changed. WPS improves hepatic steatosis and plasma lipid profiles in obese non diabetic patients, without adverse effects on glucose tolerance or creatinine clearance. NCT00870077, ClinicalTrials.gov.

Evaluation of serum leptin levels in obese local Libyan female subjects at Benghazi- Is cluster analysis a better evaluator method for such a study

Obesity related diseases like diabetes and coronary artery disease (CAD) are very much prevalent in local Libyan population at Benghazi. Leptin is one of the adipocytokines implicated in fuel balance as well as a marker of obesity. Leptin resistance is considered to be one of the risk factors associated with CAD. Therefore the present study was undertaken to evaluate the presence of leptin resistance in obese females in local population. The study was undertaken in female obese (measured by Body Mass Index) and non-obese patients. The patients were grouped into two groups of patients; one with BMI 30(G2). The results obtained were analyzed according to groups classified as obese and non-obese subjects as well as by cluster analyses. Cluster analysis is an important technique in many research areas such as data mining, information science agriculture technology, and biomedicine. One of the most important issues in cluster analysis is the evaluation of clustering results to find the partitioning that best fits the underlying data. The data obtained was subjected to cluster analysis using Silhouette index: The assumption made was obese people will have more leptin levels or leptin resistance. This assumption generalizes and assumes obesity is the cause or effect of leptin resistance. But when the results are used in adopting cluster analyses there was no assumption or classification of patients based BMI. Rather the results obtained were correlated to bring out the relationship between obesity and leptin resistance. In the present study cluster analyses did bring about similar observations made in the independent variables (biochemical parameters) as observed in groups classified based on BMI. Cluster analyses seem a better approach to say that BMI or obesity could be a risk factor for leptin resistance and will help undertake a prospective cohort studies extended more to patients with obesity, leptin resistance and future coronary artery disease (CAD). Key words: Leptin, body mass index (BMI), obesity, cluster analyses, Silhouette index.

Operative and early results of coronary artery bypass grafting in female patients in different body mass indexes.

BackgroundFemale gender has been reported to be an independent risk factor for coronary artery bypass grafting (CABG) in European System for Cardiac Risk Evaluation. The effect of the body size on the CABG outcome is less clear. There is ongoing debate about obesity as a risk factor for adverse outcomes after cardiovascular procedures. The goal of this retrospective study is to evaluate the in hospital and early postoperative outcomes in severe obese, obese and normal-slightly obese female patients after CABG.MethodsIn a four year period a total of 427 female patients underwent isolated CABG under cardiopulmonary bypass. The patients were allocated into three groups according to the Body Mass Index (BMI) as follows; group 1: severe obese patients; BMI > 35, group 2: obese patients; 30≤BMI≤35, group 3: normal-slightly obese patients; BMI < 30ResultsThe patients in group 3 were older than the group1 and group 2 (65,6 ± 8,3 year vs 63,01 ± 8,0 and 63,57 ± 8,4 year p < 0,05). In group 1 diabetic patients were more than in group 2 and group 3 respectively (54,4% vs 43,4% and 40%, p < 0,05). Urgent operation was more in group 1 than in group 2 and 3 respectively (37,6% vs 17,2% and 21,2% p < 0,05). The patients in group 3 had significantly greater postoperative drainage at 24 h compared with values in group 1 and group 2 (647 ± 142 ml vs. 539 ± 169 ml and 582 ± 133 ml, p < 0,05). Mortality rate in group 1 was 0,8%, 0% in group 2 and 1,2% in group 3 respectively. Wound problem has occured in 41 patients (9,6%).The percentage of postoperative wound problems was higher in group 1 but did not show statiscially difference. Following discharge a total of 43 (10,1%) patients re-hospitalized within 30 days. Re-hospitalization rate was 16,1% in group1, 9,8% in group 2 and 6,5% in group 3 (p < 0,05).ConclusionThis study may give an aspect for evaluations of the inhospital-early mortality and morbidity after CABG in female patients in different BMI. Severe obesity is not a risk factor in-hospital mortality in female patients. However, severe obese female patients appear to have more wound problems and re-hospitalization rate after CABG compared to obese and normal-slightly obese patients.

Bariatric Surgery is Associated with Reduced Depressive Symptoms and Better Sexual Function in Obese Female Patients: A One-Year Follow-Up Study

Bariatric surgery is an effective treatment for obesity; few studies, however, have investigated its impact on patients' sexuality. We aimed to determine bariatric surgery's effect on female patients' body mass index (BMI), anxiety and depressive symptoms, and sexual function and delineate predictors of treatment outcomes. Fifty-nine obese female bariatric candidates were administered the Hospital Anxiety and Depression Scale and the Female Sexual Function Index 1week before surgery (T1) and 1year after (T2). Statistical analysis revealed significant reductions in BMI (p < 0.001), depression (p < 0.001), and sexual pain levels (p = 0.014) and significant improvements in sexual desire (p = 0.005), arousal (p = 0.001), lubrication (p = 0.003), satisfaction (p = 0.012), and total sexual function (p = 0.003) postoperatively. Postoperative total sexual function was independently predicted by baseline sexual function and low baseline BMI. Bariatric surgery is an effective way to reduce weight, manage depression, and improve sexual function in female obese patients.

Totally double laparoscopic colon resection with intracorporeal anastomosis and transvaginal specimens extraction

Dear Editor: Laparoscopic colorectal resection is equivalent to open resection in terms of oncologic outcomes, with superior perioperative results. Usually, an abdominal incision is required for anastomosis and specimen extraction. Recently, natural orifice specimen extraction (NOSE) and intracorporeal anastomosis have been proposed to improve the quality of laparoscopic colon resections. Transvaginal and transanal specimen extraction have been reported in association with right and left colic intracorporeal anastomosis and these two technical innovations may maximize the advantages of laparoscopic surgery. We present a case of double colon resection with intracorporeal anastomosis and transvaginal specimens extraction. A 73-year-old female obese patient was admitted for rectal bleeding and hypochromic microcytic anemia. Past medical history was significant for hypertension, COPD, myocardial infarction, treated with double stenting 4 years before, and sigmoid diverticular disease with several episodes of diverticulitis in the last 6 years. Her BMI was 36 kg/m. She denied any change in bowel habits, neither constipation nor diarrhea. She underwent colonoscopy revealing a gradually narrowing stenosis of the sigmoid with intact mucosa. Multiple biopsies were negative for cancer and confirmed the inflammatory disease. Due to the stenosing lesion, the procedure was incomplete and a virtual colonoscopy was performed. A right-colon mass, highly suspected for cancer but apparently not involving the lymph nodes, was found. Metastatic disease was excluded with contrast-enhanced total body CT scan. Preoperative carcinoembryonic antigen (CEA) level was normal (<5 ng/ml). Because of the patient’s general conditions and to reduce the risks related to anesthesia, we decided to treat both lesions at the same surgical time. In the aim to minimize complications and according to the patient willingness, we choose a minimally invasive approach with totally laparoscopic right colectomy and sigmoidectomy. Her low-dose aspirin therapy was stopped 7 days before surgery and therapeutic-dose of lowmolecular-weight heparin was administered. Mechanical bowel preparation was avoided, a single enema was given the night before. Broad-spectrum intravenous antibiotics were administered 30 min before the skin incision and postoperatively for 24 h. The patient underwent general endotracheal anesthesia and was positioned in the lithotomic position; nasogastric tube and urinary catheter were placed. The surgeon stood at the left side of the patient for the right colectomy and on the right for the sigmoidectomy. A medial to lateral right colectomy followed by a side to side ileocolic anastomosis with linear stapler was first performed. Subsequently, a sigmoidectomy with inferior mesenteric artery preservation and side to end colorectal anastomosis, using a circular stapler, was carried out. A colotomy was made just proximal to the transection site. The anvil was introduced inside the abdomen through one of the trocar incisions, and inserted in the proximal colon through the colotomy. The proximal colon was closed with a linear stapler, and an end to side anastomosis was established using a transrectal circular stapler. A 12-mm trocar was inserted through the posterior fornix under laparoscopic vision. The culdotomy F. Stipa :V. Giaccaglia : E. Santini : L. Tammaro Department of Surgery, San Giovanni Hospital, Rome, Italy

Elephantiasis nostras verrucosa on the abdomen of a Turkish female patient caused by morbid obesity

Elephantiasis Nostras Verrucosa is a rare disorder of an extremity or a body region, which is associated with chronic lymphedema. There are 7 reported cases of abdominal elephantiasis in the medical literature. Here we report a morbidly obese female patient with elephantiasis nostras verrucosa on the abdominal wall.

Body Perception and Satisfaction in Obese, Severely Obese, and Normal Weight Female Patients

The objective of this study was to investigate body perception and the associated level of dissatisfaction among obese patients. Twenty patients from each category of obese, severely obese, and normal weight individuals had their pictures enlarged or thinned using a computer program to manipulate photographs taken from the front, profile angle, and back. The pictures were shown to patients to represent both the way they thought they appeared and the way they would like to appear. Our results show that severely obese patients correctly perceived themselves as being more corpulent than obese patients, who in turn correctly perceived themselves as being more corpulent than normal weight females. These results remained stable regardless of whether the pictures were taken from the front, profile angle, or back. These results are discussed in terms of clinical and therapeutic interventions.

Comparative evaluation of two methods of chemotherapy dose calculation according to body surface area and body mass index in obese females with breast cancer.

678 Background: Obese patients experience planned or unplanned reduction in chemotherapy dose. There seems to be a consistent tendency to underdose obese patients. Methods: In Alexandria Clinical Oncology Department, from October 2004 to June 2005, 120 obese female breast cancer patients were prospectively recruited, signed IRB approved informed consent and randomized. A woman was classified as obese if her body surface area (BSA) > 2 and/or body mass index >/= 27.3 kg/m2. They received adjuvant FAC chemotherapy calculated according to either the actual (group I) or ideal (group II) BSA. Ideal BSA was calculated according to ideal body weight. The patients were followed prospectively during chemotherapy and for 60 months. Results: Both groups were comparable regarding age (mean 47.5 years), weight (mean 85.5 kg), height (mean 157 cm), menopausal status, hormonal receptors' status, PS, grade, and stage without any statistical difference. The most common acute lab toxicity was the hematological toxicity that was statistically significant on comparing the hemoglobin level (HB) between the first cycle and sixth cycle (p > 0.002) in group I but of no significance in group II. There was an overall statistical significant difference between group I and II as regard the HB level (p < 0.0001), WBCs counts (p > 0.002) and liver function test -ALT level- (p < 0.0001). The same pattern was also noted between the 2 groups as regards renal toxicity, gastrointestinal toxicity, nail discoloration, and hair loss. After 60 months of follow up, there was no statistical significant difference as regards the disease-free survival (mean 46.48 months in group I versus 49.3 months in group II) or treatment failure (19 patients -31.7%- in group I versus 18 patients -30%- in group II with p > 0.843). Conclusions: There was a trend towards a higher toxicity profile in the obese females who received FAC chemotherapy for early stage breast cancer dosed according to the actual BSA. However, no significant differences as regard the treatment failure or disease free survival after 60 months of follow up. We believe that this innovative method used in calculating the chemotherapy dose is less toxic, safer and relatively effective. No significant financial relationships to disclose.

Progrediente Erblindung einer jungen Patientin mit extremer Adipositas

We report on a 40-year-old, extremely obese female patient with severe headaches and transitory visual obscurations due to idiopathic intracranial hypertension, which still remains a dangerous and potentially blinding disease. An immediate and consistent, stage adjusted therapy with medical and/or surgical options is needed to prevent patients from going blind. Lacking compliance is a high risk factor for a severe course of the disease. In case of the occurrence of the typical symptoms and predisposing factors, an idiopathic intracranial hypertension should be considered in the differential diagnosis.

T1132 The Impact of the Speed of Food Intake on Intraesophageal Reflux Events in Obese Female Patients

T1132 The Impact of the Speed of Food Intake on Intraesophageal Reflux Events in Obese Female Patients

Chemerin Correlates with Markers for Fatty Liver in Morbidly Obese Patients and Strongly Decreases after Weight Loss Induced by Bariatric Surgery

Chemerin is a new adipokine involved in in vitro adipogenesis and insulin resistance and associates with body mass index (BMI) in vivo. We investigated the role of chemerin in morbid obesity, associated metabolic diseases (insulin resistance, hepatic diseases), and postsurgery-induced weight loss. This was a prospective study performed at a university hospital. Subjects included 60 obese female patients (BMI 50.0 +/- 1.0 kg/m(-2)) being candidates for gastric bypass. Patients were examined before and 3, 6, and 12 months after surgery. In 27 patients, chemerin was measured after 2 yr. Outcomes included chemerin, anthropometric parameters, homeostasis model assessment for insulin resistance index (HOMA-IR), cholesterol, high-density lipoprotein, triglycerides, C-reactive protein, adipokines at all time points; and liver histology and macrophage content in fat at baseline. Chemerin was substantially elevated in obese patients compared with nonobese persons (353.8 +/- 18.0 vs. 191 +/- 14 ng/ml, P < 0.001). Preoperatively, chemerin concentrations correlated positively with BMI, C-reactive protein, IL-6, HOMA-IR, and the amount of omental macrophages and negatively with high-density lipoprotein levels. Baseline chemerin was elevated in patients with a significant activity score for nonalcoholic fatty liver disease, portal inflammation, fibrosis, and fibroinflammation. After surgery, chemerin decreased significantly to 253.0 +/- 14.9 ng/ml after 1 yr and pursued its decrease in patients studied for 2 yr. After surgery, chemerin concentrations positively correlated with triglycerides. The strong decrease of chemerin in the 3 months after surgery was associated with the decrease in HOMA-IR and blood glucose. Chemerin concentrations are elevated in morbidly obese patients and correlated with insulin resistance and markers of liver pathology. Chemerin plasma concentrations decreased after bariatric surgery. This study suggests that chemerin might mediate metabolic alterations in obesity, drastically improving after gastric bypass.

The G3057A LEPR polymorphism is associated with obesity in Tunisian women

Objectives The aim of this study was to evaluate the effect of the G3057A (rs62589000) LEPR polymorphism on obesity risk and plasma leptin, insulin, and lipid levels in a sample of the Tunisian population. Design and methods Three hundred and ninety-three obese patients and 317 controls participated in this study. The G3057A genotype was determined by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) analysis. Results In the entire study sample, no significant differences in genotype frequencies were observed between obese patients and controls. However, stratified analysis by gender revealed a quantitative increase in the variant allele (33.3% vs. 25.8%; χ 2 = 4.90, p = 0.026) in obese women (but not men) compared to controls. When a dominant model of inheritance was assumed, the GA + AA genotypes were more prevalent in these obese female patients than in controls (58.3% vs. 47.8%; χ 2 = 4.08, p = 0.044). Unconditional logistic regression showed that in women only, obesity risk was significantly higher for homozygotes for the variant allele (OR = 2.73, 95% CI 1.03–7.21) and for carriers of GA + AA genotypes (OR = 1.53, 95% CI 1.01–2.31) compared with homozygotes for the normal allele. The association between the G3057A LEPR variant and obesity remained statistically significant even after adjustment for age. No relationship was found between the G3057A LEPR polymorphism and leptin and insulin levels. Additionally, this LEPR gene variant had no effect on plasma lipid concentrations. Conclusion There is evidence in this study that the G3057A LEPR polymorphism is associated with obesity in Tunisian women.

An obesity drug sibutramine reduces brain natriuretic peptide (BNP) levels in severely obese patients

Sibutramine is a selective inhibitor of the reuptake of monoamines. Plasma levels of brain natriuretic peptide (BNP) appear to be inversely associated with body mass index (BMI) in subjects with and without heart failure for reasons that remain unexplained. The aim of this study was to investigate the possible influence of sibutramine treatment on BNP levels in severely obese patients. Fifty-two severely obese female patients with BMI > 40 kg/m(2) were included to this study. The women were recommended to follow a weight-reducing daily diet of 25 kcal/kg of ideal body weight. During the treatment period, all patients were to receive 15 mg of sibutramine once a day. Blood chemistry tests were performed before the onset of the medication and after 12 weeks of treatment. None of the subjects was withdrawn from the study because of the adverse effects of sibutramine. Body weight (108.8 +/- 13.3 kg vs. 101.7 +/- 15.6 kg, p < 0.001), BMI (44.6 +/- 4.6 kg/m(2) vs. 41.8 +/- 5.7 kg/m(2), p < 0.001) and BNP [8.6 (0.5-49.5) ng/l vs. 3.1 (0.2-28.6) ng/l, p = 0.018] levels were significantly decreased after 12 weeks of sibutramine treatment. Total cholesterol (5.19 +/- 0.90 mmol/l vs. 4.82 +/- 1.05 mmol/l respectively; p < 0.001), low-density lipoprotein-cholesterol (3.26 +/- 0.86 mmol/l vs. 2.99 +/- 0.40 mmol/l respectively; p = 0.008), levels were significantly decreased; however, there was no significant alteration in high-density lipoprotein-cholesterol and triglyceride levels. This study has shown a decrease in BNP levels which may lead to improvement in cardiac outcome after sibutramine treatment. Further randomised studies are needed to be conducted to clarify the relationship between sibutramine and BNP.

Comparison of physician weight loss goals for obese male and female patients

Objective The aim of this study was to compare physicians' weight loss goals for obese male and female patients. Method This study was conducted in 2008–2009 in Florida, USA. Physicians ( N = 108; 79.6% primary care specialty) reviewed two hypothetical clinical scenarios that were identical with respect to health status and obesity (BMI = 33 kg/m 2) but differed in the gender of the patient. Physicians then completed a survey about the need for weight loss, intentions to provide weight loss counseling, and weight loss goals (i.e., ideal, successful, and acceptable goal weights) for each hypothetical patient. Results Physicians strongly agreed that both patients should lose weight and physician counseling and/or treatment referrals would be appropriate; however, physician weight loss goals for male and female patients differed. BMI values calculated from the suggested ideal, successful, and acceptable weight goals were significantly lower for female patients than male patients, 22.0 vs. 25. 2 kg/m 2; 25.4 vs. 27. 8 kg/m 2; and 27.0 vs. 29. 2 kg/m 2, respectively, P values < .001. Conclusions Physicians endorsed significantly more stringent weight loss goals for obese female patients than obese male patients. Regardless of patient gender, physician goals exceeded the 5–10% losses currently recommended. Additional research is needed to better understand this gender discrepancy in physician expectations for obese patients.

Failure of volar locking plate fixation of an extraarticular distal radius fracture: A case report

BackgroundVolar locking plates provide significant structural stability to the distal radius. Failure of a volar locked plating is a rarely reported complication in the literature.Case PresentationA 40 year-old, obese female patient who presented with a displaced extraarticular distal radius fracture, underwent open reduction and internal fixation of the fracture using a volar locking plate. Radiographs taken at 10 weeks postoperatively showed failure of fixation with breakage of the four distal locking screws. A hardware removal was performed at 6 months, and the patient was then lost to follow-up. She presented again at 18 months after the first surgery, with significant pain, and radiographic signs of a radial collapse and a fracture-nonunion. A total wrist fusion was performed as the method of choice at that point in time.ConclusionVolar locked plating represents the new "gold standard" of distal radius fracture fixation. However, despite the stability provided by locking plates, hardware failure may occur and lead to a cascade of complications which will ultimately require a wrist fusion, as outlined in this case report. Additional structural support by bone grafting may be needed in selected cases of volar locked plating, particularly in patients with a high risk of developing a fracture-nonunion.

Sex-dependent differences in rheological properties and the relation of blood viscosity to erythrocyte aggregation indices among morbidly obese patients

Some studies indicate that obesity is associated with rheological disturbances. Because there are usually sex differences in the type of obesity we decided to evaluate rheological differences between male and female obese patients. We studied 18 morbidly obese men, mean age 43.66 +/- 11.32 years, mean body mass index (BMI) 49.82 +/- 6.03 kg/m2 and 20 obese females, mean age 40.6 +/- 11.86 years, mean BMI 47.41 +/- 8.81 kg/m2. Blood and plasma viscosity measurements were performed using a cone-plate viscometer (Brookfield DV-II). Erythrocyte elongation and red blood cell (RBC) aggregation were measured using the Laser-assisted Optical Rotational Cell Analyser (LORCA). Whole blood viscosity and RBC deformability expressed by the elongation index were significantly higher in obese men. We did not observe differences in plasma viscosity, corrected blood viscosity and aggregation parameters among the obese population. Blood viscosity correlated with selected RBC aggregation indices. We conclude that morbidly obese patients presented sex-dependent differences in some rheological properties. This study indicates a relation between erythrocyte aggregation indices and blood viscosity in obese populations.