Obese patients with type 2 diabetes submitted to banded gastric bypass: greater incidence of dumping syndrome.

BACKGROUND: Dumping syndrome is one of ten most common complications in morbidly obese patients operated. Recent studies in relation to type 2 diabetes mellitus (DM2) in patients submitted to gastric bypass led us to examine the different outcomes in this group of patients. Our objective was to determine the difference in the prevalence of dumping syndrome in patients with DM2 submitted to gastric bypass. METHODS: In this retrospective study, 49 diabetic and 54 non-diabetic morbidly obese patients were submitted to gastric bypass and followed up at 3, 6, and 12 months after surgery. The occurrence of dumping was determined by the patient's medical chart, where it was considered positive if recorded in at least one of three evaluations. RESULTS: The 103 patients evaluated had a mean BMI of 49.5 +/- 9.3 kg/m(2) and mean age of 38 +/- 9.7 years, with 75.7% being women. The prevalence of dumping syndrome in this population was 24.3%. The prevalence of dumping was greater in patients with DM2 (44.9%) when compared to the control group (5.6%; p < 0.001). Multivariate logistic regression analysis indicated the diagnosis of DM2 as the only variable associated with dumping syndrome. CONCLUSIONS: Dumping syndrome is a common postoperative complication in gastric bypass. Patients with DM2 show a greater postoperative prevalence of dumping.

Behavior of type 2 diabetes mellitus in morbid obese patients submitted to gastric bypass.

INTRODUCTION: Surgical treatment of obesity has not only resulted in weight loss, but also the control of associated diseases in the postoperative period. The aim of this study was to determine the post-op response of type 2 diabetes mellitus (DM2) to gastric bypass. METHODS: A historical cohort study was performed involving all the diabetic, morbid obese patients who underwent gastric bypass during the period of May 2000 to October 2006 at the Centro da Obesidade Mórbida. Patient records were reviewed with regard to sex, age, anthropometric measurements, glycemia, glycosylated hemoglobin, pre-op insulin, and DM2 outcome. RESULTS: A total of 125 diabetic, morbid obese patients were operated; they had a mean age of 42.6 +/- 9.7 years and body mass index of 49 +/- 8.3 kg/m2. Of these patients, 63 (50.4%) required medication for control of DM2, and the rest managed only with diet. Of these 63 patients, 43 (68.2%) achieved control of DM2 and were discharged without the need for antidiabetic medication, and 20 (31.7%) were discharged still on medication. One month after surgery, seven more patients discontinued medication for DM2, and 18 months after surgery, 97.6% of the patients showed control of DM2. CONCLUSION: Gastric bypass is effective in controlling DM2 in morbid obese patients.

Miomas uterinos / uterine myoma

Os leiomiomas uterinos, ou miomas, são neoplasias benignas do músculo liso uterino, sendo os tumores benignos mais comuns do trato genital feminino, correspondente a 95% deles. Eles contêm uma grande quantidade de matriz extracelular (colágeno, proteoglicanos, fibronectina), cercados por um afina pseudocápsula de tecido areolar e fibras de músculo liso. Podem ser únicos ou múltiplos, pequenos ou gigantes. Histologicamente pode-se encontrar até duas mitoses por dez campos de grande aumento, independente da atipia celular, pleomorfismos ou presença de células gigantes. Caso estas alterações não estejam presentes, são aceitas até cinco mitoses por dez campos.

Crescimento intra-uterino restrito / Restricted intrauterine growth

O crescimento intra-uterino restrito (CIUR) é definido quando o peso do recém-nascido situa-se abaixo do percentil 10 da curva de crescimento. Um número de fetos ou neonatos considerados pequenos para a idade gestacional (IG) podem ser constitucionalmente pequenos, sem os estigmas do CIUR, os chamados CIUR constitucionais (40%). Podem derivar de processos patológicos de origem materna (40%) e/ ou fetal (20%), os quais prejudicam o desenvolvimento do feto.