Body image and quality of life in post massive weight loss body contouring patients

Objective: Because post‐bariatric surgery patients undergo massive weight loss, the resulting skin excess can lead to both functional problems and profound dissatisfaction with appearance. Correcting skin excess could improve all these corollaries, including body image. Presently, few data are available documenting body image and weight‐related quality of life in this population. Research Methods and Procedures: Eighteen patients who underwent both bariatric surgery and body contouring completed our study. Both established surveys and new surveys designed specifically for the study were used to assess body perception and ideals, quality of life, and mood. Patients were surveyed at the following time‐points: pre‐body contouring (after massive weight loss) and both 3 and 6 month post‐body contouring. Statistical testing was performed using Student's t test and ANOVA. Results: The mean age of the patients was 46 ± 10 years (standard deviation). Quality of life improved after obesity surgery and was significantly enhanced after body contouring. Three months after body contouring, subjects ascribed thinner silhouettes to both current appearance and ideal body image. Body image also improved with body contouring surgery. Mood remained stable over 6 months. Discussion: Body contouring after surgical weight loss improved both quality‐of‐life measurements and body image. Initial body dissatisfaction did not correlate with mood. Body contouring improved body image but produced dissatisfaction with other parts of the body, suggesting that as patients become closer to their ideal, these ideals may shift. We further developed several new assessment methods that may prove useful in understanding these post‐surgical weight loss patients.     

Outcome study in liposuction breast reduction

Liposuction as a primary modality of treating breast hypertrophy has been reported in the literature; however, many of these reports are small series and personal experiences. This report is the first outcome study to attempt to validate the effectiveness of liposuction as a primary method of breast reduction surgery. Questionnaires were sent to 117 patients who had undergone liposuction breast reduction surgery in our office during a 4-year period. Seventy-eight questionnaires were returned (67 percent response rate). The patients were asked about their complaints, their surgical results, and their satisfaction with the operation. Complaints such as neck and back pain, shoulder ruts, and intertrigo were improved or eliminated in the vast majority of patients. Women returned to work in 5 days on average and resumed full exercise in 2 weeks. Eighty percent of patients were either very or completely satisfied with their outcomes, 87 percent would choose the liposuction method again, and 92 percent would recommend the liposuction method to a friend. This study demonstrates that liposuction breast reduction is an effective method of breast reduction surgery.     

Comparative lipoplasty analysis of in vivo-treated adipose tissue

A comparative histologic and chemical analysis was undertaken of adipose tissue treated in vivo with traditional, ultrasound-assisted, and external ultrasound-assisted lipoplasty. A series of six healthy women undergoing elective liposuction according to the superwet technique using a 1:1 infiltration ratio with the estimated quantity of fat to be removed was included in the study. Four separate regions on each patient were treated independently in vivo with traditional liposuction, internal ultrasound-assisted liposuction, or external ultrasound-assisted liposuction for 7 minutes. External massage was used as a control. Four separate specimens of adipose tissue from each patient were assessed for cellular disruption using blinded histologic evaluation. The remainder of tissue was centrifuged to separate the aqueous phase from the cellular components and then spectrophotometrically analyzed for creatinine kinase and glycerol 3-phosphate dehydrogenase activity as markers of cellular disruption. Histologic analysis confirmed 70 to 90 percent cellular disruption with internal ultrasound-assisted liposuction. Suction-assisted and external ultrasound-assisted liposuction showed 5 to 25 percent disruption, whereas massage controls showed only 5 percent. Only internal ultrasound-assisted liposuction showed 5 to 20 percent thermal liquefaction. Absorbance analysis showed creatine kinase activity (sigma units) greatest in ultrasound-exposed tissue. Both external and internal ultrasound-assisted liposuction gave creatine kinase levels 28 to 33 percent greater than suction-assisted liposuction, which varied only 10 percent from controls. Glycerol 3-phosphate dehydrogenase activity was 44 percent greater for internal ultrasound-assisted liposuction than that detected with suction-assisted liposuction. Glycerol 3-phosphate dehydrogenase activity with external ultrasound-assisted liposuction and massage did not vary much from each other, at only 14 percent and 11 percent activity compared with internal ultrasound-assisted liposuction, respectively. Histologic and enzyme analysis of the different types of liposuction and their effect on adipocyte cellular disruption revealed no significant effect of external ultrasound or massage on the adipocytes. Further experimental studies are necessary to evaluate the role and efficacy of alternative techniques for body contouring.     

Ultrasound-assisted lipoplasty treatment for axillary bromidrosis: clinical experience of 375 cases

Bromidrosis is a condition of abnormal offensive body odor caused mostly by apocrine gland secretion from the axilla. Although no morbid sequelae are known, the odor can be disturbing enough to cause social impairment and psychological distress. Medical care is available but is temporary and yields limited clinical benefit. Surgical treatment may provide a more definite remedy through reduction of the apocrine gland. However, there are risks for complication following surgical treatment such as subdermal excision, subcutaneous shaving, en bloc excision, and liposuction. The search for a less invasive but still effective procedure has led the authors to use ultrasound-assisted liposuction, which has reduced the risk of complication and recurrence. The purpose of this article was to evaluate the long-term outcome of ultrasound-assisted liposuction for the treatment of bromidrosis. From August 1998 to September 2002, 375 consecutive patients underwent ultrasound-assisted liposuction for bromidrosis of the axilla. The average age of the patients was 25.7 years (range, 15 to 55 years) and the average follow-up period was 18.8 months (range, 7 to 56 months). Subjective complaints of recurrences were noted in 22 patients (5.9 percent) and secondary ultrasound-assisted liposuction was performed, resulting in no further complaints. Complications other than recurrences were mild skin sloughing (3.2 percent), hematoma (1.3 percent), subcutaneous band (0.3 percent), and hypesthesia of the hand (0.3 percent), all of which healed spontaneously. Through a questionnaire that was answered by 264 patients, a subjective satisfaction rate was measured. Among the completed questionnaires, 91.7 percent reported satisfactory reduction of odor. Ultrasound-assisted liposuction to treat bromidrosis of the axilla provides advantages such as rapid recovery, less restriction of movement, unnoticeable scars, and a low rate of recurrence. The long-term outcome supports the benefits of this procedure. The authors recommend the use of ultrasound-assisted liposuction as first-line treatment for bromidrosis of the axilla.     

Patients Lacking Sustainable Long-Term Weight Loss after Gastric Bypass Surgery Show Signs of Decreased Inhibitory Control of Prepotent Responses

Background

A considerable number of bariatric patients report poor long-term weight loss after Roux-en-Y gastric bypass (RYGB) surgery. One possibility for an underlying cause is an impairment of cognitive control that impedes this patient group’s dietary efforts.

Objective

To investigate if patients having either poor or good weight loss response, ~12 years after RYGB-surgery, differ in their ability to inhibit prepotent responses when processing food cues during attentional operations—as measure of cognitive control.

Methods

In terms of weight loss following RYGB-surgery, 15 ‘poor responders’ and 15 ‘good responders’, matched for gender, age, education, preoperative body mass index, and years since surgery, were administered two tasks that measure sustained attention and response control: a go/no-go task and a Stroop interference task; both of which are associated with maladaptive eating behaviours.

Results

The poor responders (vs. good responders) needed significantly more time when conducting a go/no-go task (603±134 vs. 519±44 msec, p = 0.03), but the number of errors did not differ between groups. When conducting a Stroop interference task, poor responders read fewer inks than good responders (68±16 vs. 85±10 words, p = 0.002).

Conclusion

Patients lacking sustainable weight loss after RYGB-surgery showed poorer inhibitory control than patients that successfully lost weight. In the authors’ view, these results suggest that cognitive behavioral therapies post-RYGB-surgery may represent a promising behavioral adjuvant to achieve sustainable weight loss in patients undergoing this procedure. Future studies should examine whether these control deficits in poor responders are food-specific or not.     

Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study

In this study, the authors investigated the physiologic effects of the altered body composition that results from surgical removal of large amounts of subcutaneous adipose tissue. Fourteen women with body mass indexes of greater than > 27 kg/m2 underwent measurements of fasting plasma insulin, triglycerides, cholesterol, body composition by dual-energy x-ray absorptiometry (DXA), resting energy expenditure, and blood pressure before and after undergoing large-volume ultrasound-assisted liposuction.There were no significant intraoperative complications. Body weight had decreased by 5.1 kg (p < 0.0001) by 6 weeks after liposuction, with an additional 1.3-kg weight loss (p < 0.05) observed between 6 weeks and 4 months after surgery, for a total weight loss of 6.5 kg (p < 0.00006). Body mass index decreased from (mean +/- SEM) 28.8 +/- 2.3 to 26.8 +/- 1.5 kg/m2 (p < 0.0001). This change in body weight was primarily the result of decreases in body fat mass: as assessed by DXA, lean body mass did not change (43.8 +/- 3.1 kg to 43.4 +/- 3.6 kg, p = 0.80), whereas DXA total body fat mass decreased from 35.7 +/- 6.3 to 30.1 +/- 6.5 kg (p < 0.0001). There were significant decreases in fasting plasma insulin levels (14.9 +/- 6.5 mIU/ml before liposuction versus 7.2 +/- 3.2 mIU/ml 4 months after liposuction, p < 0.007), and systolic blood pressure (132.1 +/- 7.2 versus 120.5 +/- 7.8 mmHg, p < 0.0002). Total cholesterol, high-density lipoprotein cholesterol, plasma triglycerides, and resting energy expenditure values were not significantly altered after liposuction.In conclusion, over a 4-month period, large-volume liposuction decreased weight, body fat mass, systolic blood pressure, and fasting insulin levels without detrimental effects on lean body mass, bone mass, resting energy expenditure, or lipid profiles. Should these improvements be maintained over time, liposuction may prove to be a valuable tool for reducing the comorbid conditions associated with obesity.     

Influence of diet form on the hyperphagia-promoting effect of polysaccharide in rats

Adult female rats were fed chow only, or chow plus the polysaccharide Polycose presented as a solution (32% w/v), as a powder, or as a powder mixed into the chow diet. The rats fed the Polycose solution overate and gained three times as much weight as did the control rats in the 30-day test period. The rats fed the Polycose powder or mixed diet, on the other hand, did not differ from controls in food intake or weight gain. The solution-fed rats consumed more Polycose than did the powder-fed rats, but the two groups were equivalent in their chow intake. The absolute and percent body fat of the solution-fed rats exceeded that of control rats, as well as that of powder and mixed-diet animals. The percent body fat of the powder and mixed diet groups exceeded that of the control animals. The findings demonstrate that the form of diet presentation has a major impact on the rat's feeding and body weight responses to polysaccharide diets.     

Role of adipokines in the obesity-inflammation relationship: the effect of fat removal

During the past 10 years, there has been a dramatic increase in the prevalence of obesity in the United States and other developed nations. Recent studies indicate that adipose tissue is an endocrine organ producing numerous proteins, collectively referred to as adipokines, with broad biological activity, that play an important autocrine role in obesity-associated complications. Adipose tissue in general and visceral fat in particular are thought to be key regulators of inflammation. Inflammation is heavily involved in the onset and development of atherothrombotic disease. Moreover, chronic inflammation may also represent a triggering factor in the origin of the metabolic syndrome and type 2 diabetes mellitus. According to a hypothesis, stimuli such as overnutrition, physical inactivity, and aging would result in cytokine hypersecretion and eventually lead to insulin resistance and diabetes in genetically or metabolically predisposed individuals. This article discusses the current understanding of important adipokines thought to be involved in the metabolic and cardiovascular risk associated with obesity. Available evidence linking fat removal by liposuction to modification of cardiovascular risk and vascular inflammatory markers in the obese patient is also presented. Most studies have shown that liposuction produces beneficial effects on insulin resistance and vascular inflammation in the obese patient, reducing its cardiovascular risk. Besides having a significant role in body contouring of the obese patient at the end of the lengthy process of bariatric surgery and massive weight loss, plastic surgery should be incorporated into a multifaceted program of lifestyle changes that allows the obese patient to obtain weight loss and, more importantly, to maintain the reduced weight in the long term.     

Improved growth of lipoprotein lipase deficient kittens by feeding a low-fat, highly digestible diet small star, filled

Adult domestic cats homozygous with a naturally occurring Gly412Arg LPL gene mutation are good models for the study of LPL deficiency. Previous studies report that homozygous LPL deficient kittens have reduced growth rates and develop subnormal body fat mass. It was hypothesized in the present study that homozygote kittens would have normal growth if provided a standard low fat, highly digestible diet at weaning and that their body fat would be increased by provision of a diet high in protein. When fed a nutritionally complete, 10% fat, purified or commercial extruded diet, the body weights of homozygous (n = 24), heterozygous (n = 25) and normal (n = 16) kittens were determined at birth, 2, 3, 4, 6, 12 and 18 weeks of age. Male homozygote kittens from homozygote dams had reduced weight gains (p < 0.05) compared to normal males at 2, 3 and 4 weeks. Female heterozygotes and homozygotes from homozygote and heterozygote dams had reduced weight gains (p < 0.05) compared to normal females at 2, 3, 4 and 6 weeks. By 6 weeks for males and 18 weeks for females, genotype related differences in weight gain were not observed. At 30 weeks, homozygotes and heterozygotes were given either a 60 or 30% (dry matter) protein diet for two months. As indicated by deuterium dilution estimation of body composition, cats eating the 30% protein diet (n = 12) tended to have a lower increase in lean body mass (p = 0.057) and a greater increase in fat mass (p = 0.092) compared to cats eating the 60% protein diet (n = 12). Increase in lean body mass among homozygotes tended to be not as great as that observed in heterozygotes (p = 0.057). Poor postweaning gains previously reported in homozygotes probably reflected inappropriate selection of diet for this genotype. The high protein diet increased the rate of lean body mass development but not body fat mass.     

Large-volume liposuction: a review of 631 consecutive cases over 12 years.

Since the advent of epinephrine-containing wetting solutions and sophisticated fluid management techniques, increasingly larger and larger volumes of liposuction aspirations have been reported. Unfortunately, with these larger volumes of liposuction being routinely performed, greater rates of complications have also been reported, with the worst of these resulting in deaths. In a response to the increasing concerns over the safety of large-volume liposuction, a critical review of the senior author's own series has been performed to evaluate risks and benefits and to recommend guidelines for safe and effective large-volume liposuction. A retrospective chart review was performed on 631 consecutive patients who underwent liposuction procedures of at least 3000 cc total aspirate. All procedures were performed by the same senior surgeon between January of 1986 and March of 1998. Before September of 1996, traditional liposuction techniques were used. After September of 1996, ultrasound-assisted liposuction was performed. The superwet technique of fluid management was employed for all procedures performed after 1991. The particulars of the surgical and anesthetic techniques used are reviewed in the article. Data collection included preoperative patient demographics, preoperative and postoperative weights and measurements, and preoperative and postoperative photographs. Total aspirate volumes, fluid intakes, and fluid outputs were measured, and all complications were tallied. Average follow-up was 1 year.Results showed the majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal chart weight. Total aspirate volumes ranged from 3 to 17 liters, with 94.5 percent of these under 10 liters. Fluid balance measurements showed an average of 120 cc/kg positive fluid balance at the end of the procedure, with none of these patients experiencing any significant fluid balance abnormalities. Cosmetic results were good, with a 2- to 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients experienced minor skin contour irregularities, with most of these patients not requiring any additional surgical procedures. One year after surgery, 80 percent of patients maintained stable postoperative weights. No serious complications were experienced in this series. The majority of the complications consisted of minor skin injuries and burns, allergic reactions to garments, and postoperative seromas. The more serious complications included four patients who developed mild pulmonary edema and one patient who developed pneumonia postoperatively. These patients were treated appropriately and went on to have uneventful recoveries. The results show that large-volume liposuction can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly performed. Meticulous fluid balance calculations are necessary to avoid volume abnormalities, and experience is mandatory when performing the largest aspirations. Cosmetic benefits are excellent, and overall complication rates are low.     

Is the treatment of axillary osmidrosis with liposuction better than open surgery?

Axillary osmidrosis is an annoying, although not life-threatening, problem that includes unpleasant odor and the occasional staining of clothing. Suction-assisted lipectomy has been tested as a treatment for axillary osmidrosis with variable success. The authors retrospectively reviewed 134 patients who underwent superficial liposuction for bilateral axillary osmidrosis in their division between June of 1998 and June of 2002. The surgical complications and results were compared with those reported in their previous report of 343 patients (102 available for postoperative result evaluation) who received open surgical treatment with partial excision of axillary skin and subcutaneous tissue. The overall complication rate was 3.73 percent, significantly lower than the 11.08 percent complication rate seen with open surgical treatment. Of their 134 patients, 114 were available for long-term follow-up. Thirteen patients (11.40 percent) had very good results, 79 patients (69.30 percent) had good results, and 22 patients (19.30 percent) had poor results. Significant differences were found between those who underwent superficial liposuction and those who underwent open surgery. The number of patients with very good and good results decreased significantly from 91.18 percent (open surgery) to 80.70 percent (liposuction), and those with little or no improvement increased from 8.82 percent (open surgery) to 19.29 percent (liposuction). Compared with open surgery for the treatment of osmidrosis, liposuction produces significantly fewer complications but is less effective. Of the patients who underwent liposuction for osmidrosis, 80 percent were satisfied with the result. Further study is needed to determine whether liposuction for osmidrosis can be improved.     

Gender differences in predictors of body weight and body weight change in healthy adults

Background: Overweight and obesity are important predictors of a wide variety of health problems. Analysis of naturally occurring changes in body weight can provide valuable insights in improving our understanding of the influence of demographic, lifestyle, and psychosocial factors on weight gain in middle‐age adults. Objective: To identify gender‐specific predictors of body weight using cross‐sectional and longitudinal analyses. Methods and Procedures: Anthropometric, lifestyle and psychosocial factors were measured at baseline and then quarterly for 1 year in 572 healthy adult volunteers from Central Massachusetts who were recruited between 1994 and 1998. Linear mixed models were used to analyze the relationship between body weight and potential predictors, including demographic (e.g., age, educational level), lifestyle (e.g., diet, physical activity, smoking), and psychosocial (e.g., anxiety, depression) factors. Results: Over the 1‐year study period, on average, men gained 0.3 kg and women lost 0.2 kg. Predictors of lower body weight at baseline in both men and women included current cigarette smoking, greater leisure‐time physical activity, and lower depression and anxiety scores. Lower body weights were associated with a lower percentage of caloric intake from protein and greater occupational physical activity levels only among men; and with higher education level only among women. Longitudinal predictors of 1‐year weight gain among women included increased total caloric intake and decreased leisure‐time physical activity, and among men, greater anxiety scores. Discussion: Demographic, lifestyle and psychosocial factors are independently related to naturally occurring changes in body weight and have marked differential gender effects. These effects should be taken into consideration when designing interventions for weight‐loss and maintenance at the individual and population levels.     

Abdominal dermolipectomy in an abdomen with pre-existing scars: a different concept

Although abdominal dermolipectomy is a frequently performed procedure, few publications have reported on the safety of the procedure in the scarred abdomen. The aim of this study was to stress the possibility of performing a natural-looking abdominoplasty with no complication such as skin necrosis or liponecrosis in the presence of abdominal scars and to clarify that the scarred abdomen is not a great limitation for full abdominoplasty as reported in the literature. Seventy-six abdominoplasties were performed on scarred patients from July of 1997 to June of 2003. Twenty-five patients had oblique subcostal scars, six patients had median supraumbilical scars, three patients had median infraumbilical scars, 10 patients had appendectomy scars, nine patients had paramedian supraumbilical scars, eight patients had paramedian infraumbilical scars, seven patients had long transverse scars of repaired ventral hernias, and eight patients had multiple small scars after laparoscopy. In addition, there were concomitant transverse cesarean delivery scars in 40 patients. All patients underwent full abdominoplasties, plication of the musculoaponeurotic system, and liposuction assistance if required (45 patients). Of 76 subjects, three patients had very limited liponecrosis at the watershed area. Eleven patients (14.5 percent) were morbidly obese and heavy smokers. In comparisons of postabdominoplasty complications, such as liponecrosis, wound infection, and dehiscence with and without liposuction in scarred abdomen, no significant differences were found. Secondary revision was more common among abdominoplasties without liposuction [seven of 45 (15.6 percent) versus 12 of 31 (38.7 percent); p = 0.02]. In conclusion, there is no limitation or contraindication for abdominal dermolipectomy with or without liposuction assistance on the previously scarred abdomen as long as the vascular zones of the abdomen are respected. The abdominal wall dissection is limited to allow only the plication of the musculoaponeurotic system, and aggressive liposuction is avoided.     

Factors Related to Body Weight Changes During and After Pregnancy: The Stockholm Pregnancy and Weight Development Study

The Stockholm Pregnancy and Weight Development Study is a prospective study of body weight changes in women, whose maternity unit charts were reviewed and who were then invited for a 1-year follow-up, including weigh-in sessions and questionnaires on dietary habits, physical activity and socio-demographic factors. Total weight gain during pregnancy was related to weight gain already during the first trimester. Women reporting previous weight cycling had slightly higher weight gain during pregnancy. Successful return towards pre-pregnancy weight was found more often in women with regular breakfast and lunch habits. Lactation had only a small effect on weight loss after delivery, independent of eating habits. Lack of physical activity was more common in women who had low lactation scores. Twenty-eight percent reported an increased interest in sweets during pregnancy; these women increased 1 to 2 kg more than others in weight during pregnancy. Postpartum weight retention was more affected by lifestyle changes during and after pregnancy than by factors before pregnancy.     

Effects of Weight Cycling Induced by Diet Cycling in Rats Differing in Susceptibility to Dietary Obesity

LAUER, JOAN B., GEORGE W. REED, AND JAMES O. HILL. Effects of weight cycling induced by diet cycling in rats differing in susceptibility to dietary obesity. Obes Res. Objective Although the majority of evidence in rodents does not support the view that weight cycling (consisting of bouts of food restriction and refeeding) promotes obesity, the effects of weight cycling on body weight regulation remain controversial. We have previously demonstrated that some rats within a strain are more susceptible to develop obesity than others when given free access to a high-fat diet. In this study, we tested the hypothesis that rats most susceptible to weight gain on a high-fat diet would also be most susceptible to weight gain as a consequence of weight cycling. Research Methods and Procedures Rats were provided a low-fat diet (12% corn oil) for 2 weeks, then given a high-fat diet (45% corn oil) for 2 weeks to identify those most (obesity prone) and least (obesity resistant) susceptible to weight gain. Half of each group was then subjected to three 30-day cycles of food restriction (10 days) and refeeding (20 days) [weight cycler (WC) rats]. The other half were allowed free access to the high-fat diet [control (CO) rats]. All rats were then followed for an additional 10 weeks, with free access to the high-fat diet. Results When considering the entire 160 days of the study, we found no evidence that WC rats relative to CO rats had increased body weight, increased body fat content, or elevated energy efficiency. We found no evidence that rats most prone to dietary obesity were also prone to weight gain after weight cycling. During the weight cycling phase (days 1 to 90), weight cycled groups consumed less energy and gained less weight than controls. During the follow-up phase, WC and CO rats did not differ significantly in weight gain or energy intake. Discussion In this study, weight cycling did not exacerbate the obesity produced by high-fat diet feeding.     

Low-Fat Diets May Prevent Weight Gain in Sedentary Women: Prospective Observations From the Population Study of Women in Gothenburg,Sweden

The Population Study of Women in Gothenburg, Sweden is an ongoing prospective study of female residents who were recruited from the local registry in 1968–1969 when they were 38–60 years old. The data presented here were collected from 361 healthy women who underwent a baseline physical examination including a supplementary dietary history interview and returned for a second general health examination 6 years later. This report identifies a subgroup of 57 women who were sedentary during their leisure time and appear to have been particularly susceptible to gaining weight as a function of the fat content of their diets. Specifically, longitudinal analysis of body weights in the whole sample revealed a statistical interaction between leisure-time physical activity and habitual dietary fat intake (energy-%), as reported at the baseline examination, in the prediction of subsequent weight change. Further stratified analysis suggested that weight changes were significantly dependent on dietary fat intake among the sedentary women only. High energy intake also predicted weight gain in the sedentary group, although the predictive value for a high-fat diet was of marginal significance after adjusting for total energy consumption. These results suggest that sedentary recreational activity plus a low-fat diet may have a combined contribution to weight change that is not equivalent to the sum of the separate effects. Such a synergy between two modifiable lifestyle factors seems highly relevant for prevention of obesity.     

Effects of covert subject actions on percent body fat by air-displacement plethsymography

Air-displacement plethysmography (ADP) is used for estimation of body composition, however, some individuals, such as athletes in weight classification sports, may use covert methods during ADP testing to alter their apparent percent body fat. The purpose of this study was to examine the effect of covert subject actions on percent body fat measured by ADP. Subjects underwent body composition analysis in the Bod Pod following the standard procedure using the manufacturer's guidelines. The subjects then underwent 8 more measurements while performing the following intentional manipulations: 4 breathing patterns altering lung volume, foot movement to disrupt air, hand cupping to trap air, and heat and cold exposure before entering the chamber. Increasing and decreasing lung volume during thoracic volume measurement and during body density measurement altered the percent body fat assessment (p < 0.001). High lung volume during thoracic gas measures overestimated fat by 3.7 ± 2.1 percentage points. Lowered lung volume during body volume measures overestimated body fat by an additional 2.2 ± 2.1 percentage points. The heat and cold exposure, tapping, and cupping treatments provided similar estimates of percent body fat when compared with the standard condition. These results demonstrate the subjects were able to covertly change their estimated ADP body composition value by altering breathing when compared with the standard condition. We recommend that sports conditioning coaches, athletic trainers, and technicians administering ADP should be aware of the potential effects of these covert actions. The individual responsible for administering ADP should remain vigilant during testing to detect deliberate altered breathing patterns by athletes in an effort to gain a competitive advantage by manipulating their body composition assessment.     

Hemodynamic physiology and thermoregulation in liposuction

Little is known about the physiology of large-volume liposuction. Patients are exposed to prolonged procedures, general anesthesia, fluid shifts, and infusion of high doses of epinephrine and lidocaine. Consequently, the authors examined the thermoregulatory and cardiovascular responses to liposuction by assessing multiple physiologic factors. The aims of their study were to serially determine hemodynamic parameters perioperatively, to quantify perioperative and postoperative plasma epinephrine levels, and to chronologically document fluctuations in core body temperature. Five female volunteers with American Society of Anesthesiologists' physical status I and II underwent moderate- to large-volume liposuction. Heart rate, blood pressure, mean pulmonary arterial pressure, cardiac index, and central venous pressure were monitored. Serum epinephrine levels and core body temperature were assessed perioperatively. The hemodynamic responses to liposuction were characterized by an increase in cardiac index (57 percent), heart rate (47 percent), and mean pulmonary arterial pressure (44 percent) (p < 0.05). Central venous pressure was not significantly altered. Maximum epinephrine levels were observed 5 to 6 hours after induction. Significant correlations between cardiac index and epinephrine concentrations were shown intraoperatively (r = 0.75). All patients developed intraoperative low body temperatures (mean 35.5 degrees C). An overall enhanced cardiac function was observed in patients subsequent to large-volume liposuction. The etiology of the altered cardiac parameters was multifactorial but may have been attributable in part to the administration of epinephrine, which counters the effects of general anesthesia and operative hypothermia. Additional explanations for raised cardiac output may be hemodilution or emergence from general anesthesia. Elevated mean pulmonary arterial pressure may be a result of subclinical fat embolism demonstrated in previous porcine studies, although fat was not observed in urine. The unchanged central venous pressure levels indicate that young healthy patients with compliant right ventricles can accommodate the fluid loads of large-volume liposuction. Overall hemodynamic parameters remained within safe limits. Within these surgical parameters, patients should be clinically screened for cardiovascular and blood pressure disorders before liposuction is undertaken, and preventative measures should be taken to limit intraoperative hypothermia.     

The effect of diet and feeding level on survival and weight gain of hand-raised harbor seal pups (Phoca vitulina)

Hundreds of stranded harbor seals pups (Phoca vitulina) are brought to wildlife rescue centers every year. Typical hand-rearing diets include artificial milk-replacers and diets based on macerated fish fed via gavage, but weight gains are often low and mortality rates can be high. This study compared survival and weight gain of orphaned seal pups fed either artificial milk-replacer or fish-formula. Pups admitted to the facility in summer 2007 (n=145) and 2008 (n=98) were randomly assigned to one of two diets and fed by gavage until weaning. In 2007, pups fed milk-replacer gained more (43 ± 12 g/d) than those fed fish-formula (loss of 13 ± 6 g/d; P<0.002). In 2008, when intake was increased from 8 to 11% of body weight daily, weight gain improved for both diets but remained higher in pups fed milk-replacer (123 ± 12 g/d, vs. loss of 6 ± 8 g/day; P<0.001). Pup survival to weaning was significantly higher in 2008 than 2007 (P<0.001) and was higher for pups on milk-replacer compared with those on fish-formula (P<0.05). Survival was also correlated with body weight at admittance (P<0.001). Although neither diet achieved the weight gains recorded in mother-raised pups (400-800 g/d), the artificial milk-replacer was clearly more successful, and pups fared better in the second year of the study when intake was higher.     

The effects of ultrasonic energy on peripheral nerves: implications for ultrasound-assisted liposuction

The integration of ultrasound-assisted liposuction with traditional suction-assisted lipoplasty has extended the role of liposuction in body contouring. Although there are ample data regarding the effects of ultrasound on peripheral nerves from studies with the Cavitron ultrasound surgical aspirator, there is little information concerning the effects of modern ultrasound body contouring equipment on neural tissue. This study was designed to evaluate the functional and histologic effects of ultrasound energy on rat peripheral nerves (sciatic nerves) using a commonly-used ultrasound-assisted liposuction generator. After the application of ultrasound to exposed rat sciatic nerves, operative magnification was used to assess any visible injury. The sciatic function index was serially measured to quantify immediate and long-term functional effects on the nerves. Our results showed immediate visible injury using low amplitude settings (level 6), but no functional evidence of injury until much higher settings were used (level 9). All animals in the groups with initial functional impairment had returned to normal or near-normal function at completion of the study (51 days). Histologic examination revealed no evidence of damage in the low amplitude groups. Histologic analysis of the high amplitude groups displayed diffuse infiltration of the nerve, with foamy histiocytes and an increased number of mast cells, consistent with remote neural injury followed by myelin breakdown and repair.