Dare to Challenge Obesity

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Washington, Sep 18 (IANS) Shedding pounds can help patients of kidney diseases protect their health, says a new study led by an Indian American.

More than a third of US adults are either obese or overweight. Weight loss can improve a number of health problems. For example, it can improve control of diabetes, lower blood pressure and cholesterol levels, and reduce the effects of heart disease.

Sankar Navaneethan of the Cleveland Clinic, who did his MBBS from Madras Medical College, and his colleagues analysed data from 13 studies that assessed the impact of diet, exercise, and surgical procedures on kidney function.

The analysis revealed that weight loss attained through diet and exercise reduces proteinuria (excess excretion of protein in the urine, a hallmark of kidney damage) and may prevent additional decline in kidney function in obese patients with kidney disease.

Studies also showed that surgical interventions normalise the filtration rate of the kidneys in obese patients with high filtration rates (a risk factor for the development of kidney disease).

While the findings imply that weight reduction may prevent the progression of kidney disease in obese patients, the authors noted that there were only a small number of studies available for analysis.

Additional high-quality long-term studies on this topic are needed, they said.

These findings will appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

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One Danger of Liposuction -- Death

Liposuction is now the most common cosmetic surgery in the U. S. with over 400,000 of these procedures done annually. Liposuction involves the surgical suctioning of fat deposits from specific parts of the body. The most common target areas are the abdomen, buttocks, hips, thighs, knees, chin, upper arms, back, and calves.

Liposuction breaks up and "sucks" fat out of the body through a hollow instrument (a cannula) inserted under the skin (subdermally). A strong vacuum is applied to the cannula.

In ultrasonic-assisted liposuction (UAL), the cannula is energized with ultrasonic energy which causes the fat to melt away on contact. This method offers an advantage in treating scar tissue in areas such as the male breast, back, and in areas of prior liposuction. The disadvantages of UAL include the need for longer incisions in the skin, the potential for skin or internal burns, greater cost, and longer time.

The technique of tumescent liposuction has become especially popular, in part because of its purported safety. This procedure involves pumping several quarts/liters of a solution below the skin (subcutaneously) in the area to be suctioned. The solution consists of salt water (saline) to which is added the local anesthetic lidocaine to numb the surgical site and the vessel-constrictor epinephrine (adrenaline) to help minimize bleeding. The fat is then suctioned out through small tubes. Tumescent liposuction is now the most common form of liposuction.

Five deaths after tumescent liposuction were found among 48,527 deaths referred to the Office of Chief Medical Examiner of the City of New York from 1993 to 1998, according to a report published in The New England Journal of Medicine.

The 5 victims ranged from ages 33 to 54. Four of the 5 patients were women. All 5 had received lidocaine. Three died because their heart rate became too slow (bradycardia) and their blood pressure dropped dangerously (hypotension). It is well known that lidocaine lowers the heart rate. In fact, lidocaine is sometimes used as an emergency measure to slow dangerously rapid heart rates.

One patient died of a fluid overload. She had been given more than 13 quarts of fluid, 7 intravenously and 6 pumped into the surgical sites which included the breasts (for enlargement), chest, arms, back, abdomen, thighs, buttocks and knees. The excess fluid collected in her lungs (pulmonary edema) and she essentially drowned to death.

The fifth patient died of a blood clot in the lungs. During a tumescent liposuction procedure of the legs, the patient developed a clot (thrombosis) in her calf veins, which broke loose (embolized) and wedged in her lungs (pulmonary thromboembolism).

Tumescent liposuction can be fatal, conclude the authors of the report, Drs. Rama B. Rao and Robert S. Hoffman of New York University Medical Center and Bellevue Hospital and Dr. Susan F. Ely, forensic pathologist in the Office of the Chief Medical Examiner of New York City.

The danger of tumescent liposuction appears to be due, at least in part, to the lidocaine -- the toxicity of lidocaine and unfavorable interactions of lidocaine with other medications the patient may be taking.

No matter which technique is used, liposuction is considered completely cosmetic and therefore entirely optional (elective). The central question now looming with liposuction would seem to be: "Are any deaths justifiable with a completely cosmetic procedure?"

(Source: N Engl J Med 1999;340:1471-5.)

 

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