RESUMO
BACKGROUND: Psychological Clearance level (PCL) for patients undergoing metabolic and bariatric surgery (MBS) is a critical step for successful postoperative outcomes. This study aims to assess the relationship between the level of psychologic fitness and postoperative outcomes in patients undergoing MBS. METHODS: We retrospectively analyzed the data of patients who underwent MBS (laparoscopic sleeve gastrectomy [LSG] and laparoscopic Roux-en-Y Gastric Bypass [LRYGB]) and completed two years follow-up, between 2012 and 2019, in a single medical center. The patients were divided into four groups based on PCL, suggesting level of readiness for surgery: Group A (PCL-0: guarded), group B (PCL-1: Fair/reasonable), group C (PCL-2: Good/appropriate), and group D (PCL-3: Strong/excellent). Primary outcome was the percent of total body weight loss (%TWL), and the absolute change in BMI units. Secondary outcomes were missed postoperative visits and patient compliance. Differences between the groups were analyzed using a generalized linear model (GLM), chi-squared and exact Fisher tests, as appropriate. RESULTS: Of 1411 total patients, 607 (43.20%) had complete data at two years follow-up. 512 (84.34%) were females. LSG was performed in 361 (59.5%). No difference was found in %TWL between the four groups (22.14% vs. 28.0% vs. 26.0% vs. 24.8%, p = 0.118). We found a small difference in the mean (SD) of absolute change in BMI between the groups, and on post-hoc analysis it was found between groups B (PCL-1) and D (PCL-3). Overall, no difference between the groups in number of follow-up visits, or compliance issues. However, patients who attended more follow-up visits had less compliance issues (p < 0.001). PCL is inversely correlated with number of psychologic diagnoses (r = - 0.41, p < 0.001) and medical comorbidities (r = - 0.20, p < 0.001). CONCLUSION: We found no difference in the percent of TWL in patients who underwent MBS based on PCL at two -years follow-up. Medical comorbidities and psychiatric diagnoses impact the PCL.
Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Feminino , Humanos , Masculino , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Redução de Peso , Resultado do Tratamento , Derivação Gástrica/efeitos adversos , Laparoscopia/efeitos adversos , Gastrectomia/efeitos adversosRESUMO
Os campos visuais de 15 pacientes portadores de traumas mecânicos de nervo óptico foram estudados. 93//apresentavam quadros unilaterais sem percepçäo luminosa ou com resíduos de campo visual. O homem jovem, ferido na área fronto-orbitária e envolvido em acidentes de veículos auto-motores ou atingido por pancada é o paciente padräo deste grupo. Há envolvimentos orbitários, otorrino e neurológicos frequentes. A grande variedade de achados anótomo-patológicos já descritos talvez permita compreender o comportamento evolutivo e as respostas às vezes contraditórias às condutas classicamente adotadas. A angiografia fluoresceínica e a angiografia carotídea, se feitas de rotina, provavelmente contribuiräo na escolha e julgamento de propostas terapêuticas, para estes casos. Uso de capacete e cinto de segurança, melhoria da sinalizaçäo e estado das vias públicas e maior disciplina no tráfego reduziriam a incidência deste tipo de traumatismo
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Traumatismos Oculares/patologia , Nervo Óptico/lesões , Acuidade Visual/fisiologiaRESUMO
Descrevem-se as características dos pacientes, dos traumas, dos achados clínicos e radiológicos e as evoluçöes neuroftalmológicas em 4 pacientes portadores de trauma presumível ao quiasma óptico. Apesar de todos terem tido danos severos aos campos visuais, o prognótico foi eventualmente bom. Suscinta revisäo bibliográfica geral sobre o assunto éacrescentada nos comentários e sugestöes para a profilaxia de tais lesöes