As rates of obesity have increased this disease has become a common problem that physicians are faced with treating. This paper aims to review the different options for patients and determine the best treatments for obesity. Modalities that are considered include dietary treatment, exercise, pharmacologic treatment, and weight loss surgery. This study compares reduced calorie diets, low fat diets, low glycemic index/load diets, the Mediterranean diet, and low carbohydrate diets. The validity of exercise as an effective prescription for obesity is evaluated and debunked. Pharmacologic treatments that are contrasted include those drug therapies that are currently approved by the United States Food and Drug Administration for the long-term treatment of obesity. Those are orlistat, lorcaserin and phentermine/topiramate. The surgical treatments reviewed include vertical banded gastroplasty, adjustable gastric banding, Roux-en Y gastric bypass, biliopancreatic diversion, and biliopancreatic diversion with duodenal switch. After a comprehensive review of the literature the conclusion reached was that treatment for obesity should begin with the least invasive options and those that have the least potential for harm. That is, diet should be a first course of action. Among diets a Mediterranean diet or another culturally adapted low glycemic index/load diet is best. However, more studies are needed to determine how to translate the diets for different cultures and individual tastes. When diets are unable to produce enough weight loss, pharmacologic treatments are considered. Among them, lorcaserin and phentermine/topiramate do not have enough long-term studies to warrant a strong recommendation as of the publishing of this paper. The only other option available, orlistat, comes with many uncomfortable gastrointestinal side effects, so it is also not an ideal option. In addition, orlistat does not produce the amount of weight loss that is seen with surgical procedures. Patients and physicians considering surgical treatment for obesity will find that the best option is laparoscopic adjustable gastric banding.

No description available.

Background: In Hirschsprung's disease, the trend has been for earlier performance of definitive surgery. In our institution, primary Swenson pull- through has become the preferred procedure. Methods: Retrospective review of the patients treated for Hirschsprung's disease from January 1988 through March 1998 was performed. Sixty-five patients were identified. Median values, analysis of variance and χ2 were used for comparisons. Results: The multiple-stage group (M, n = 47) was similar to the primary group (P, n = 18) for gestational age (40 v 39 weeks), time to meconium passage (37.9 v 35.5 hours), and age at diagnosis (median, M 27 v P 3.5 days). Age (median, M 268 v P 5 days) and weight (mean, M 9.4 v P 3.7 kg; P < .001) at pull-through were lower in the primary group. Length of stay (LOS) was lower in the primary group (mean, M 40,8 v P 20.3 days; P < .05). Operating time for pull- through was decreased in P (mean, M 305.2 v P 272.2 minutes; P = .02). Total complications were lower in the primary group (P = .03), with no differences in mortality or enterocolitis rates. Conclusions: At our institution there were no increases in total complications or enterocolitis in the group undergoing primary Swenson. Primary pull-through is a viable option for the treatment of Hirschsprung's disease.

As doenças perimplantares (DPi) vêm sendo consideradas umas das maiores causas de perdas tardias de implantes dentários e nenhum dos tratamentos já propostos na literatura mostrou ser eficiente a ponto de se tornar a primeira escolha terapêutica. Considerando que a definição correta do tratamento depende invariavelmente do entendimento da etiopatogenia, ocorrências e diagnóstico das DPi, o objetivo da presente tese foi abordar as DPi através de uma ampla revisão dos seus conceitos e da apresentação de dados clínicos preliminares de três meses de um ensaio clínico controlado randomizado comparando os resultados dos tratamentos cirúrgico (C) e não cirúrgico (NC) da perimplantite. Foram incluídos implantes apresentando um ou mais sítios com profundidade de sondagem perimplantar (PSi) ≥ 5mm, com presença de sangramento submucoso (SSi) e/ou supuração e apresentando perda óssea radiográfica (PO) ≥ 3mm. O tratamento não cirúrgico incluiu debridamento mecânico com curetas de teflon e irrigação com solução salina, assim como o tratamento cirúrgico, com acesso por retalho mucoperiostal. Não foram utilizadas técnicas ressectivas e nem implantoplastia. A amostra foi randomizada de maneira estratificada para o hábito de fumar e a presente análise, de 3 meses de acompanhamento após o tratamento, se refere à amostra de 22 indivíduos (29 implantes), sendo 12 (17 implantes) no grupo C e 10 (12 implantes) no NC. No início do estudo não foram observadas diferenças significativas entre os grupos para variáveis demográficas e clínicas, exceto nas condições periodontais de índice de placa visível (IPV) (NC 22,3±14,08 / C 40,2±19,9) e sangramento a sondagem (NC 15,9±10,2 / C 31,8±15,9). Após três meses de tratamento, não houve desistências e, considerando o pior sítio do implante, os dois tratamentos reduziram significativamente as medidas de PSi (NC 5,8±0,27 para 4,3±0,55mm / C 5,9±0,29 para 5,0±0,28mm), os dois grupos apresentaram redução de SSi mas apenas no grupo C foi significativa, diminuindo de 100% para 53%. Não houve diferenças entre os níveis de perda de inserção clínica (PIi). Em uma análise multivariada para identificar os preditores de sucesso dos tratamentos, implantes com PSi basal > 6 mm apresentaram piores reduções de PSi, SSi e PIi, o histórico de periodontite dificultou a redução de PSi enquanto indivíduos com 5 ou mais implantes e reabilitados com próteses cimentadas apresentaram piores reduções de SSi. A taxa de sucesso dos tratamentos foi de 33% no grupo NC e 17% para o grupo C sem diferenças estatísticas. Conclui-se que ambos os tratamentos diminuíram sinais inflamatórios embora sem a demonstração de diferenças entre eles, e que preditores de risco ao sucesso do tratamento devem ser investigados. / Peri-implant diseases (PiD) have been considered the major causes of late loss of dental implants, and none of the proposed treatments in the literature demonstrated to be efficient to become the first therapeutic choice. Considering that the correct definition of treatment depends invariably on the understanding of the etiopathogenesis, occurrence and diagnosis of PiD, the aim of the present theses was to approach PiD through a 9oné99ono f its concepts and presenting preliminary clinical data of 3 months from a randomized controlled 9oné9 comparing surgical (ST) and non-surgical (NST) treatments of peri-implantitis. Implants presenting pocket depth (PD) ≥5mm and bleeding on probing (Bosshardt et al.) with radiographic bone loss ≥3 mm were included in the study. NST included mechanical debridement of the implant with Teflon curets and irrigation with saline solution, whereas ST included the debridement with mucoperiostal flap. Ressective surgery and implantoplasty were not applied. The sample was randomized by stratification according to smoking habit, and the present 3-months analysis after treatment referes to 22 individuals (29 implants), 12 (17 implants) in ST and 10 (12 implants) in the NST group. At basliene, no significant differences were observed between groups for demographic and clinical variables, except for periodontal conditions of teeth in regards to visible plaque (NST 22.3±14.08% and ST 40.2±19.9%) and BOP (NST 15.9±10.2% and ST 31.8±15.9%). After 3 months, there were no drop-outs and, considering the worst site of each implant, the two treatments reduced significantly mean PD (NST 5.8±0.27mm to 4.3±0.55mm and ST 5.9±0.29mm to 5.0±0.28mm. Both groups presented reduction in BOP, but only in the ST the reduction was significant, decreasing from 100% to 53%. There were no significant differences in clinical attachment loss after 3 months in the two groups. In a multivariable analysis to identify predictors of treatment success, implants with baseline PD >6mm presented lower reduction in PD over 3 months, as well as BOP and CAL. Previous history of periodontitis lead to higher PD and individuals with more then 5 implants and rehabilitated with bonded prosthesis had higher BOP over time. It can be concluded that both treatments reduced signs of inflammation although without significant differences between them, and baseline PD, number of implants, history of periodontitis and type of prosthetic fixation may be used as predictors of clinical outcomes of peri-implantitis treatment.

As doenças perimplantares (DPi) vêm sendo consideradas umas das maiores causas de perdas tardias de implantes dentários e nenhum dos tratamentos já propostos na literatura mostrou ser eficiente a ponto de se tornar a primeira escolha terapêutica. Considerando que a definição correta do tratamento depende invariavelmente do entendimento da etiopatogenia, ocorrências e diagnóstico das DPi, o objetivo da presente tese foi abordar as DPi através de uma ampla revisão dos seus conceitos e da apresentação de dados clínicos preliminares de três meses de um ensaio clínico controlado randomizado comparando os resultados dos tratamentos cirúrgico (C) e não cirúrgico (NC) da perimplantite. Foram incluídos implantes apresentando um ou mais sítios com profundidade de sondagem perimplantar (PSi) ≥ 5mm, com presença de sangramento submucoso (SSi) e/ou supuração e apresentando perda óssea radiográfica (PO) ≥ 3mm. O tratamento não cirúrgico incluiu debridamento mecânico com curetas de teflon e irrigação com solução salina, assim como o tratamento cirúrgico, com acesso por retalho mucoperiostal. Não foram utilizadas técnicas ressectivas e nem implantoplastia. A amostra foi randomizada de maneira estratificada para o hábito de fumar e a presente análise, de 3 meses de acompanhamento após o tratamento, se refere à amostra de 22 indivíduos (29 implantes), sendo 12 (17 implantes) no grupo C e 10 (12 implantes) no NC. No início do estudo não foram observadas diferenças significativas entre os grupos para variáveis demográficas e clínicas, exceto nas condições periodontais de índice de placa visível (IPV) (NC 22,3±14,08 / C 40,2±19,9) e sangramento a sondagem (NC 15,9±10,2 / C 31,8±15,9). Após três meses de tratamento, não houve desistências e, considerando o pior sítio do implante, os dois tratamentos reduziram significativamente as medidas de PSi (NC 5,8±0,27 para 4,3±0,55mm / C 5,9±0,29 para 5,0±0,28mm), os dois grupos apresentaram redução de SSi mas apenas no grupo C foi significativa, diminuindo de 100% para 53%. Não houve diferenças entre os níveis de perda de inserção clínica (PIi). Em uma análise multivariada para identificar os preditores de sucesso dos tratamentos, implantes com PSi basal > 6 mm apresentaram piores reduções de PSi, SSi e PIi, o histórico de periodontite dificultou a redução de PSi enquanto indivíduos com 5 ou mais implantes e reabilitados com próteses cimentadas apresentaram piores reduções de SSi. A taxa de sucesso dos tratamentos foi de 33% no grupo NC e 17% para o grupo C sem diferenças estatísticas. Conclui-se que ambos os tratamentos diminuíram sinais inflamatórios embora sem a demonstração de diferenças entre eles, e que preditores de risco ao sucesso do tratamento devem ser investigados. / Peri-implant diseases (PiD) have been considered the major causes of late loss of dental implants, and none of the proposed treatments in the literature demonstrated to be efficient to become the first therapeutic choice. Considering that the correct definition of treatment depends invariably on the understanding of the etiopathogenesis, occurrence and diagnosis of PiD, the aim of the present theses was to approach PiD through a 9oné99ono f its concepts and presenting preliminary clinical data of 3 months from a randomized controlled 9oné9 comparing surgical (ST) and non-surgical (NST) treatments of peri-implantitis. Implants presenting pocket depth (PD) ≥5mm and bleeding on probing (Bosshardt et al.) with radiographic bone loss ≥3 mm were included in the study. NST included mechanical debridement of the implant with Teflon curets and irrigation with saline solution, whereas ST included the debridement with mucoperiostal flap. Ressective surgery and implantoplasty were not applied. The sample was randomized by stratification according to smoking habit, and the present 3-months analysis after treatment referes to 22 individuals (29 implants), 12 (17 implants) in ST and 10 (12 implants) in the NST group. At basliene, no significant differences were observed between groups for demographic and clinical variables, except for periodontal conditions of teeth in regards to visible plaque (NST 22.3±14.08% and ST 40.2±19.9%) and BOP (NST 15.9±10.2% and ST 31.8±15.9%). After 3 months, there were no drop-outs and, considering the worst site of each implant, the two treatments reduced significantly mean PD (NST 5.8±0.27mm to 4.3±0.55mm and ST 5.9±0.29mm to 5.0±0.28mm. Both groups presented reduction in BOP, but only in the ST the reduction was significant, decreasing from 100% to 53%. There were no significant differences in clinical attachment loss after 3 months in the two groups. In a multivariable analysis to identify predictors of treatment success, implants with baseline PD >6mm presented lower reduction in PD over 3 months, as well as BOP and CAL. Previous history of periodontitis lead to higher PD and individuals with more then 5 implants and rehabilitated with bonded prosthesis had higher BOP over time. It can be concluded that both treatments reduced signs of inflammation although without significant differences between them, and baseline PD, number of implants, history of periodontitis and type of prosthetic fixation may be used as predictors of clinical outcomes of peri-implantitis treatment.

As doenças perimplantares (DPi) vêm sendo consideradas umas das maiores causas de perdas tardias de implantes dentários e nenhum dos tratamentos já propostos na literatura mostrou ser eficiente a ponto de se tornar a primeira escolha terapêutica. Considerando que a definição correta do tratamento depende invariavelmente do entendimento da etiopatogenia, ocorrências e diagnóstico das DPi, o objetivo da presente tese foi abordar as DPi através de uma ampla revisão dos seus conceitos e da apresentação de dados clínicos preliminares de três meses de um ensaio clínico controlado randomizado comparando os resultados dos tratamentos cirúrgico (C) e não cirúrgico (NC) da perimplantite. Foram incluídos implantes apresentando um ou mais sítios com profundidade de sondagem perimplantar (PSi) ≥ 5mm, com presença de sangramento submucoso (SSi) e/ou supuração e apresentando perda óssea radiográfica (PO) ≥ 3mm. O tratamento não cirúrgico incluiu debridamento mecânico com curetas de teflon e irrigação com solução salina, assim como o tratamento cirúrgico, com acesso por retalho mucoperiostal. Não foram utilizadas técnicas ressectivas e nem implantoplastia. A amostra foi randomizada de maneira estratificada para o hábito de fumar e a presente análise, de 3 meses de acompanhamento após o tratamento, se refere à amostra de 22 indivíduos (29 implantes), sendo 12 (17 implantes) no grupo C e 10 (12 implantes) no NC. No início do estudo não foram observadas diferenças significativas entre os grupos para variáveis demográficas e clínicas, exceto nas condições periodontais de índice de placa visível (IPV) (NC 22,3±14,08 / C 40,2±19,9) e sangramento a sondagem (NC 15,9±10,2 / C 31,8±15,9). Após três meses de tratamento, não houve desistências e, considerando o pior sítio do implante, os dois tratamentos reduziram significativamente as medidas de PSi (NC 5,8±0,27 para 4,3±0,55mm / C 5,9±0,29 para 5,0±0,28mm), os dois grupos apresentaram redução de SSi mas apenas no grupo C foi significativa, diminuindo de 100% para 53%. Não houve diferenças entre os níveis de perda de inserção clínica (PIi). Em uma análise multivariada para identificar os preditores de sucesso dos tratamentos, implantes com PSi basal > 6 mm apresentaram piores reduções de PSi, SSi e PIi, o histórico de periodontite dificultou a redução de PSi enquanto indivíduos com 5 ou mais implantes e reabilitados com próteses cimentadas apresentaram piores reduções de SSi. A taxa de sucesso dos tratamentos foi de 33% no grupo NC e 17% para o grupo C sem diferenças estatísticas. Conclui-se que ambos os tratamentos diminuíram sinais inflamatórios embora sem a demonstração de diferenças entre eles, e que preditores de risco ao sucesso do tratamento devem ser investigados. / Peri-implant diseases (PiD) have been considered the major causes of late loss of dental implants, and none of the proposed treatments in the literature demonstrated to be efficient to become the first therapeutic choice. Considering that the correct definition of treatment depends invariably on the understanding of the etiopathogenesis, occurrence and diagnosis of PiD, the aim of the present theses was to approach PiD through a 9oné99ono f its concepts and presenting preliminary clinical data of 3 months from a randomized controlled 9oné9 comparing surgical (ST) and non-surgical (NST) treatments of peri-implantitis. Implants presenting pocket depth (PD) ≥5mm and bleeding on probing (Bosshardt et al.) with radiographic bone loss ≥3 mm were included in the study. NST included mechanical debridement of the implant with Teflon curets and irrigation with saline solution, whereas ST included the debridement with mucoperiostal flap. Ressective surgery and implantoplasty were not applied. The sample was randomized by stratification according to smoking habit, and the present 3-months analysis after treatment referes to 22 individuals (29 implants), 12 (17 implants) in ST and 10 (12 implants) in the NST group. At basliene, no significant differences were observed between groups for demographic and clinical variables, except for periodontal conditions of teeth in regards to visible plaque (NST 22.3±14.08% and ST 40.2±19.9%) and BOP (NST 15.9±10.2% and ST 31.8±15.9%). After 3 months, there were no drop-outs and, considering the worst site of each implant, the two treatments reduced significantly mean PD (NST 5.8±0.27mm to 4.3±0.55mm and ST 5.9±0.29mm to 5.0±0.28mm. Both groups presented reduction in BOP, but only in the ST the reduction was significant, decreasing from 100% to 53%. There were no significant differences in clinical attachment loss after 3 months in the two groups. In a multivariable analysis to identify predictors of treatment success, implants with baseline PD >6mm presented lower reduction in PD over 3 months, as well as BOP and CAL. Previous history of periodontitis lead to higher PD and individuals with more then 5 implants and rehabilitated with bonded prosthesis had higher BOP over time. It can be concluded that both treatments reduced signs of inflammation although without significant differences between them, and baseline PD, number of implants, history of periodontitis and type of prosthetic fixation may be used as predictors of clinical outcomes of peri-implantitis treatment.

<p>Syftet med denna studie var att beskriva personers erfarenheter av sina kost- och motionsvanor före respektive efter en kirurgisk behandling mot fetma. Vidare var syftet att beskriva om personerna ansåg att operationen påverkat deras psykiska och fysiska hälsa. Kirurgiska behandlingar mot fetma har ökat under de senaste åren och forskning visar att det är den metod som ger bäst effekt för att behålla en långvarig viktnedgång i jämförelse med diverse dieter och fysisk aktivitet. En kvalitativ metod med innehållsanalyser användes där fem kvinnor som genomgått en operation mot fetma intervjuades. Kategorier har skapats utifrån hur det har sett ut före och efter operationen när det gäller kost- och motionsvanor samt psykisk och fysisk hälsa. Resultatet visade att kostvanorna hos alla deltagare före operation var oregelbundna där det mesta av maten intogs på kvällarna. Motion utövades i regel inte alls av de flesta deltagarna. Efter operation har samtliga regelbundna kostvanor och äter små portioner. Motionsvanorna har förändrats i den mån att fler promenader utförs men i övrigt ingen ökad fysisk aktivitet. Den psykiska hälsan har förbättrats för de flesta genom bättre självförtroende och ökad livskvalitet. Även den fysiska hälsan har förbättrats då deltagarna upplever mer ork och färre besvär med bland annat värk och högt blodtryck. Slutsatserna från studien är att kost- och motionsvanor förändrats men endast i viss utsträckning, däremot har den fysiska och psykiska hälsan förändrats till det bättre.</p> / <p>The purpose of this study is to describe how people who have undergone surgical treatment for obesity experience their diet and exercise habits before and after surgery. Furthermore, it intends to describe if the participants believe that the operation affected their mental and physical health. Surgical treatments for obesity has become more popular in recent years and research shows that it is the method most effective for maintaining weight loss in comparison with various diets and physical activities. A qualitative method with content analysis was used and five women who had surgery for obesity participated. The results showed that the dietary habits of all participants before surgery was irregular and the participants all ate large meals in the evenings. Exercising in general did not exist among the participants. After surgery, all participants had a regular diet and ate smaller portions. Exercise habits have changed to the extent that all take more walks but otherwise they have not increased their physical activity. Mental health has improved for most through better self-esteem and quality of life. Physical health has improved and the participants feel more strength and fewer symptoms, such as pain and high blood pressure. The conclusion from this study is that diet and exercise habits have changed but only to a certain extent, however, the physical and mental health has changed for the better.</p>

Syftet med denna studie var att beskriva personers erfarenheter av sina kost- och motionsvanor före respektive efter en kirurgisk behandling mot fetma. Vidare var syftet att beskriva om personerna ansåg att operationen påverkat deras psykiska och fysiska hälsa. Kirurgiska behandlingar mot fetma har ökat under de senaste åren och forskning visar att det är den metod som ger bäst effekt för att behålla en långvarig viktnedgång i jämförelse med diverse dieter och fysisk aktivitet. En kvalitativ metod med innehållsanalyser användes där fem kvinnor som genomgått en operation mot fetma intervjuades. Kategorier har skapats utifrån hur det har sett ut före och efter operationen när det gäller kost- och motionsvanor samt psykisk och fysisk hälsa. Resultatet visade att kostvanorna hos alla deltagare före operation var oregelbundna där det mesta av maten intogs på kvällarna. Motion utövades i regel inte alls av de flesta deltagarna. Efter operation har samtliga regelbundna kostvanor och äter små portioner. Motionsvanorna har förändrats i den mån att fler promenader utförs men i övrigt ingen ökad fysisk aktivitet. Den psykiska hälsan har förbättrats för de flesta genom bättre självförtroende och ökad livskvalitet. Även den fysiska hälsan har förbättrats då deltagarna upplever mer ork och färre besvär med bland annat värk och högt blodtryck. Slutsatserna från studien är att kost- och motionsvanor förändrats men endast i viss utsträckning, däremot har den fysiska och psykiska hälsan förändrats till det bättre. / The purpose of this study is to describe how people who have undergone surgical treatment for obesity experience their diet and exercise habits before and after surgery. Furthermore, it intends to describe if the participants believe that the operation affected their mental and physical health. Surgical treatments for obesity has become more popular in recent years and research shows that it is the method most effective for maintaining weight loss in comparison with various diets and physical activities. A qualitative method with content analysis was used and five women who had surgery for obesity participated. The results showed that the dietary habits of all participants before surgery was irregular and the participants all ate large meals in the evenings. Exercising in general did not exist among the participants. After surgery, all participants had a regular diet and ate smaller portions. Exercise habits have changed to the extent that all take more walks but otherwise they have not increased their physical activity. Mental health has improved for most through better self-esteem and quality of life. Physical health has improved and the participants feel more strength and fewer symptoms, such as pain and high blood pressure. The conclusion from this study is that diet and exercise habits have changed but only to a certain extent, however, the physical and mental health has changed for the better.

No description available.

The aim of this thesis was to evaluate the benefits and complications of surgical treatment of refractory epilepsy. The criterion for the selection of patients was undergoing preoperative long-term monitoring. Information were obtained from six patients after 2-3 years r of surgery using the narrative interview and questionnaire QOLIE 89, which evaluates the quality of life. The interview was analyzed using grounded theory while the information obtained from questionnaire were used only as supplement and comparison of the results. Overall evaluation of questionnaire QOLIE 89 was in standard in five of six patients which is against the results obtained in interviews. Comparing risks and complications with benefits of surgical treatment of refractory epilepsy in the observed group was evaluate as problematic. Patients expected more positive benefit of the treatment and improving the quality of life. Keyword: epilepsy, surgical treatment, nursing care, quality of live