Hypothalamic obesity is an intractable form of obesity syndrome that was initially described in patients with hypothalamic tumours and surgical damage. However, this definition is now expanded to include obesity developing after a variety of insults, including intracranial infections, infiltrations, trauma, vascular problems and hydrocephalus, in addition to acquired or congenital functional defects in central energy homeostasis in children with the so-called common obesity. The pathogenetic mechanisms underlying hypothalamic obesity are complex and multifactorial. Weight gain results from damage to the ventromedial hypothalamus, which leads, variously, to hyperphagia, a low-resting metabolic rate; autonomic imbalance; growth hormone-, gonadotropins and thyroid-stimulating hormone deficiency; hypomobility; and insomnia. Hypothalamic obesity did not receive enough attention, as evidenced by rarity of studies in this group of patients. A satellite symposium was held during the European Congress of Obesity in May 2011, in Istanbul, Turkey, to discuss recent developments and concepts regarding pathophysiology and management of hypothalamic obesity in children. An international group of leading researchers presented certain aspects of the problem. This paper summarizes the highlights of this symposium. Understanding the central role of the hypothalamus in the regulation of feeding and energy metabolism will help us gain insights into the pathogenesis and management of common obesity.
Two experiments aiming at comparing palpation with gloved fingers, conventional laparoscopic instruments, and a laparoscopic instrument with a sensor array attached to its end effector are described. The sensor array provides the surgeon with visually presented tactile information. Fifteen subjects were asked to discriminate hardness and size of objects (rubber balls hidden in pig's intestine) with the 3 palpation methods. The experiments showed that the gloved fingers are better at differentiating hardness and size compared with conventional laparoscopic instruments and the instrument with sensor. There was no significant difference between conventional instruments and the instrument with sensor, although the results showed a higher average score with the instrument with sensor. This indicates that visual presentation may not be an ideal way of presenting tactile information. It also indicates that the presence of the array does not make the task more difficult.
Direct contact of the tip of the scope with small bowel may cause functional and cytologic injury even after short durations of exposure. Therefore, we do not recommend direct contact of scopes with the intra-abdominal organs to avoid heat injuries. In addition, this study also emphasizes the variation in heat generation at the tip of the scopes when used with a mismatching light source and fiber optic cable.
The level of IAP used in current practice (10-12 mmHg) appears to be safe with regard to hemodynamic variables and tissues blood flow; however, higher levels may induce a decrease in cardiac output and tissue blood flow.
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