RESUMEN
BACKGROUND: While a cause and effect relationship is traditionally thought to exist between thigh surgery and postoperative lymphedema, the link between obesity-related lymphatic and/or venous disease and post-body contouring lower extremity edema has not been investigated. We hypothesize that patients who experience prolonged lower extremity edema following thigh surgery are predisposed to developing this complication due to unrecognized preoperative lymphovascular disease. METHODS: Fifty-five patients who had undergone body contouring surgery were identified from our prospective registry. Twenty-eight patients completed the Venous Clinical Severity Score (VCSS), a validated outcome measure of venous disease. Three time points were assessed: pre-weight loss (T1), post-weight loss but pre-body contouring (T2), and post-body contouring (T3). Based on T3 VCSS, patients were divided into 2 groups-a T3 VCSS ≤3 (group 1; N = 13) and a T3 VCSS ≥4 (group 2; N = 15). RESULTS: VCSS for group 1 at T1, T2, and T3 were 3.31 ± 0.55, 1.85 ± 0.27, and 1.54 ± 0.35 (mean ± SEM), respectively, versus 6.3 ± 1.10, 4.33 ± 0.8, and 6.8 ± 0.63 for group 2 (P < 0.05, P < 0.05, and P < 0.0001). Pain scores at T1 was 0.46 ± 0.21 for group 1 versus 1.1 ± 0.24 for group 2 (P < 0.05). Edema scores for group 1 at T1, T2, and T3 were 0.69 ± 0.29, 0.08 ± 0.08, and 0.15 ± 0.10 versus 1.87 ± 0.35, 1.13 ± 0.31, and 2.13 ± 0.24 for group 2 (P < 0.05, P < 0.001, and P < 0.0001, respectively). CONCLUSIONS: Using VCSS, post-bariatric patients with prolonged lower extremity edema experienced clinically identifiable signs of disease prior to weight loss and body contouring surgery. Thus, careful preoperative evaluation may help identify at-risk patients and aid in managing postoperative expectations.
Asunto(s)
Técnicas Cosméticas , Edema/etiología , Linfedema/complicaciones , Obesidad/complicaciones , Complicaciones Posoperatorias/etiología , Muslo/cirugía , Insuficiencia Venosa/complicaciones , Adulto , Femenino , Humanos , Extremidad Inferior , Linfedema/diagnóstico , Masculino , Persona de Mediana Edad , Obesidad/terapia , Evaluación de Resultado en la Atención de Salud , Periodo Preoperatorio , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Insuficiencia Venosa/diagnóstico , Pérdida de PesoRESUMEN
Multilevel categorization is investigated within the context of analog activity patterns on the output layer of an ART 2 network. The ART 2 network parameters are analyzed in terms of stable category formation and in terms of the number of nodes in the output layer that can become most active. The resulting activity patterns on the output layer demonstrate a multilevel category structure based on the relative differences between patterns that exist for many different values of the vigilance parameter. We have shown that the information contained in the output analog patterns can be interpreted in several different ways, which is not possible when the category is represented by a single winning node. Also, favorable comparisons are also demonstrated between the category structure emerging from the set of category patterns and principles of categorization in psychology and neurobiology.