RESUMEN
PURPOSE: In patients with moderate to severe thyroid-associated orbitopathy (TAO), orbital radiation therapy (ORT) can prevent disease progression. In the sequelae stage, orbital decompression surgery can be useful in case of functional discomfort. The aim of this study was to evaluate the effect of orbital ORT on the outcomes of decompression surgery. METHODS: In this retrospective study, we included 136 patients who had had bilateral orbital decompression between 1995 and 2016. Before surgery, 38 patients received Radiation Therapy (RT+) while 98 did not (RT-). All RT+ patients and 20 RT- patients had systemic corticosteroid treatment. In both groups surgical outcome was evaluated by exophthalmos reduction (mm), palpebral fissure (mm), distance between the lid margin and the corneo-scleral limbus (mm), existence of conjunctival hyperemia and diplopia. RESULTS: In both RT+ and RT- groups, surgery improved the proptosis, significantly greater in RT+(3.66 ± 1.79 mm) than in RT- group (2.85 ± 1.80 mm) (p < 0.019). No significant differences were noted in the palpebral fissure, the distance from the lid margin to the corneo-scleral limbus. After surgery, only one patient (5%) in the RT+ group presented with new-onset diplopia, whereas in the RT- group there were 14 (36%) patients (p < 0.007). After orbital decompression, the number of conjunctival hyperemia decreased by 6 (21%) in the RT+ group versus 21 (60%) in the RT- group (p < 0.006). CONCLUSION: Orbital radiotherapy during the inflammatory phase enhances the outcomes after orbital decompression in TAO. After surgery we observed a greater improvement in proptosis and in diplopia for RT+ versus RT- patients.
Asunto(s)
Oftalmopatía de Graves , Descompresión Quirúrgica , Oftalmopatía de Graves/radioterapia , Oftalmopatía de Graves/cirugía , Humanos , Órbita/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Non stabilized severe eating disorder is a contra-indication for bariatric surgery. Specific cares can stabilize this disorder, and therefore a surgery can be undertaken. In this respect, more and more attention is paid to the concept of food addiction even if its definition is still debated. Some authors, according to neurobiological data, consider food addiction as independent from eating disorder, but others see food addiction as a severe sub-type of eating disorder. To contribute to this debate, we performed a study in our department including 23 subjects candidates for a bariatric surgery and found a significant association between food addiction and eating disorder, independently of the body mass index. Clarification of the food addiction concept should permit to reconsider the specific cares needed by these obese patients.
Les troubles du comportement alimentaire (TCA) sévères non stabilisés sont une contre-indication à la chirurgie bariatrique. Une prise en charge spécifique peut permettre de stabiliser ces troubles et d'autoriser ainsi une chirurgie. Le concept d'addiction à la nourriture émerge de plus en plus même s'il reste encore débattu. Certains auteurs, en s'appuyant sur des bases neurobiologiques, le considèrent comme un trouble indépendant des TCA et d'autres l'envisagent plutôt comme un sous-type sévère. Une étude réalisée dans notre service chez 23 sujets candidats à la chirurgie bariatrique a montré une association significative entre les TCA et l'addiction à la nourriture, et ce indépendamment de l'indice de masse corporelle. Préciser le concept d'addiction à la nourriture permettrait de pouvoir repenser la prise en charge de ces patients.
Asunto(s)
Cirugía Bariátrica/métodos , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Adicción a la Comida/epidemiología , Obesidad/psicología , Índice de Masa Corporal , Humanos , Obesidad/cirugíaRESUMEN
Obesity and mental disorders are frequent diseases in our society and do not always receive the appropriate care. Moreover, it has been proved that obese people suffer more from mental disorders than the general population. This article reviews mental illnesses commonly found in obese people to raise awareness about their screening and treatment in order to improve both weight loss and the quality of life of people who are suffering from it.
L'obésité et les troubles mentaux sont des maladies fréquentes dans notre société et ne reçoivent pas toujours les soins appropriés. De plus, il est maintenant prouvé que les personnes obèses souffrent davantage de troubles mentaux que la population générale. Cet article passe en revue les maladies mentales fréquemment retrouvées chez les personnes obèses pour sensibiliser à leur dépistage et à leur traitement afin d'améliorer à la fois la perte de poids et la qualité de vie de personnes qui en souffrent.