Roux-en-Y gastric bypass and sleeve gastrectomy: mechanisms of diabetes remission and role of gut hormones.

CONTEXT: In obese patients with type 2 diabetes (T2DM), Roux-en-Y-gastric-bypass (RYGB) and sleeve gastrectomy (SLG) improve glycemic control. OBJECTIVE: The objective of this study was to investigate the mechanisms of surgery-induced T2DM improvement and role of gastrointestinal hormones. PATIENTS, SETTING, AND INTERVENTION: In 35 patients with T2DM, we performed a mixed-meal test before and 15 days and 1 year after surgery (23 RYGB and 12 SLG). MAIN OUTCOME MEASURES: Insulin sensitivity, ß-cell function, and amylin, ghrelin, PYY, pancreatic polypeptide (PP), glucagon, and glucagon-like peptide-1 (GLP-1) responses to the meal were measured. RESULTS: T2DM remission occurred in 13 patients undergoing RYGB and in 7 patients undergoing SLG. Similarly in the RYGB and SLG groups, ß-cell glucose sensitivity improved both early and long term (P < .005), whereas insulin sensitivity improved long term only (P < .006), in proportion to body mass index changes (P < .001). Early after RYGB, glucagon and GLP-1 responses to the meal increased, whereas the PP response decreased. At 1 year, PYY was increased, and PP, amylin, ghrelin, and GLP-1 were reduced. After SLG, hormonal responses were similar to those with RYGB except that PP was increased, whereas amylin was unchanged. In remitters, fasting GLP-1 was higher (P = .04), but its meal response was flat compared with that of nonremitters; postsurgery, however, the GLP-1 response was higher. Other hormone responses were similar between the 2 groups. In logistic regression, presurgery ß-cell glucose sensitivity (positive, P < .0001) and meal-stimulated GLP-1 response (negative, P = .004) were the only predictors of remission. CONCLUSIONS: RYGB and SLG have a similar impact on diabetes remission, of which baseline ß-cell glucose sensitivity and a restored GLP-1 response are the chief determinants. Other hormonal responses are the consequences of the altered gastrointestinal anatomy.

The role of perfectionism in postpartum depression and symptomatology.

The role of perfectionism as a correlate and as a predictor of perinatal depressive symptomatology and disorder was examined. Three-hundred and eighty-six pregnant women (mean age = 30.08 years; SD = 4.205; range = 19-44) completed the Portuguese versions of the Multidimensional Perfectionism Scale, Beck Depression Inventory-II/BDI-II and three questions evaluating anxiety trait, life stress and social support perception. Diagnoses of depression were obtained using the Portuguese version of the Diagnostic Interview for Genetic Studies/OPCRIT system. Women who were depressed in pregnancy (ICD-10/DSM-IV) were excluded from the analyses. Self-Oriented Perfectionism and Socially Prescribed Perfectionism subcomponents (Conditional Acceptance and Others' High Standards) were significant correlates of depressive symptomatology/BDI-II in pregnancy. Others' High Standards was a significant predictor of postpartum depressive symptomatology/BDI-II, after controlling the other independent variables (depressive symptomatology and trait anxiety in pregnancy, life stress and social support perception in postpartum). None of the perfectionism subscales predicted postpartum depressive disorder (ICD-10/DSM-IV). Self-Oriented Perfectionism was an important correlate of depressive symptomatology in pregnancy and Others' High Standards and Conditional Acceptance were significant correlates of perinatal depressive symptomatology. Others' High Standards accounted for 0.8 % of the depressive symptomatology variance in postpartum after controlling the effect for other depressive symptomatology correlates. Perfectionism was not a risk factor for postpartum depressive disorder. Our findings improve the knowledge regarding the risk factors implicated in the development of postpartum depressive symptomatology/disorder, which is of utmost importance to develop adequate prevention and intervention strategies.

Affective state dependence and relative trait stability of perfectionism in sleep disturbances.

OBJECTIVE: To evaluate the degree of absolute change, relative stability and state dependence of trait perfectionism in sleep disturbances in a sample of university students. METHOD: Participants completed the Multidimensional Perfectionism Scale and two items concerning sleep difficulties. The mean age at T0 (baseline) was 19.59 years (SD = 1.61, range = 17-25) and 62.5% of the sample were female. RESULTS: Absolute changes in self-oriented and socially-prescribed perfectionism were found. Relative stability was found for all perfectionism dimensions. Prior and concurrent sleep disturbances explained a significant amount of variance in perfectionism. Controlling for the effects of sleep measures, prior self-oriented perfectionism and other-oriented perfectionism were the only significant predictors of subsequent self-oriented perfectionism and other-oriented perfectionism, at T1 and T2. Difficulties falling asleep at T1 and socially-prescribed perfectionism at T0 were significant predictors of socially-prescribed perfectionism at T1. CONCLUSION: Despite significant changes in perfectionism mean scores over the follow-up, the correlation analyses demonstrated that participants remained quite stable in regard to their relative levels of perfectionism. As concurrent difficulties initiating sleep also predicted concurrent socially-prescribed perfectionism, this seems to be one dimension of perfectionism with trait-state characteristics.

Affective state dependence and relative trait stability of perfectionism in sleep disturbances / Dependência do estado afetivo e estabilidade relativa do traço do perfeccionismo nas perturbações de sono

OBJECTIVE: To evaluate the degree of absolute change, relative stability and state dependence of trait perfectionism in sleep disturbances in a sample of university students. METHOD: Participants completed the Multidimensional Perfectionism Scale and two items concerning sleep difficulties. The mean age at T0 (baseline) was 19.59 years (SD = 1.61, range = 17-25) and 62.5 percent of the sample were female. RESULTS: Absolute changes in self-oriented and socially-prescribed perfectionism were found. Relative stability was found for all perfectionism dimensions. Prior and concurrent sleep disturbances explained a significant amount of variance in perfectionism. Controlling for the effects of sleep measures, prior self-oriented perfectionism and other-oriented perfectionism were the only significant predictors of subsequent self-oriented perfectionism and other-oriented perfectionism, at T1 and T2. Difficulties falling asleep at T1 and socially-prescribed perfectionism at T0 were significant predictors of socially-prescribed perfectionism at T1. CONCLUSION: Despite significant changes in perfectionism mean scores over the follow-up, the correlation analyses demonstrated that participants remained quite stable in regard to their relative levels of perfectionism. As concurrent difficulties initiating sleep also predicted concurrent socially-prescribed perfectionism, this seems to be one dimension of perfectionism with trait-state characteristics.

OBJETIVOS: Avaliar o grau de mudança absoluta, de estabilidade relativa e dependência do estado do perfeccionismo nas perturbações de sono numa amostra de estudantes universitários. MÉTODO: Os sujeitos completaram a Escala Multidimensional do Perfeccionismo e dois itens sobre dificuldades em dormir. Os dados foram recolhidos em três momentos de avaliação, separados por um intervalo de um ano acadêmico. A idade média dos sujeitos no T0 era de 19,59 anos (DP = 1,61, variação = 17-25); 62,5 por cento eram mulheres. RESULTADOS: Foram encontradas ao longo do follow-up mudanças absolutas para o perfeccionismo auto-orientado e para o perfeccionismo socialmente prescrito. Foi encontrada estabilidade relativa para todas as dimensões do perfeccionismo. As dificuldades de sono prévias e concorrentes explicaram significativamente a variância do perfeccionismo. Controlando o efeito das dificuldades em dormir, o perfeccionismo auto-orientado e o perfeccionismo orientado para o outro prévios foram os únicos preditores significativos de perfeccionismo auto-orientado e perfeccionismo orientado para o outro (T1 e T2). As dificuldades em iniciar o sono no T1 e o perfeccionismo socialmente prescrito prévio (T0) revelaram-se preditores significativos de perfeccionismo socialmente prescrito no T1. CONCLUSÃO: Apesar das mudanças significativas nas pontuações médias de perfeccionismo ao longo do follow-up, as análises de correlação demonstraram que os participantes permaneceram relativamente estáveis nos seus níveis de perfeccionismo. Uma vez que as dificuldades em iniciar o sono concorrentes se revelaram um preditor significativo de perfeccionismo socialmente prescrito, esta é a dimensão do perfeccionismo que possui características traço-estado.

The role of beta-cell function and insulin sensitivity in the remission of type 2 diabetes after gastric bypass surgery.

CONTEXT: Bariatric surgery can induce remission in a high proportion of severely obese patients with type 2 diabetes mellitus (T2DM). OBJECTIVE: Our objective was to investigate predictors and mechanisms of surgery-induced diabetes remission. PATIENTS AND SETTING: Forty-three morbidly obese subjects (body mass index = 45.6 ± 5.0 kg/m(2)), 32 with T2DM and 11 nondiabetic [normal glucose tolerance (NGT)], participated at a clinical research center. INTERVENTION: Patients underwent Roux-en-Y gastric bypass. MAIN OUTCOME MEASURES: Diabetes remission and ß-cell function were evaluated. RESULTS: Subjects were tested before and 45 d and 1 yr after surgery. Weight decreased similarly in T2DM and NGT (-39 kg at 1 yr, P < 0.0001). Insulin sensitivity improved in both groups in proportion to the changes in body mass index but remained lower in T2DM than NGT (386 ± 91 vs. 479 ± 89 ml/min · m(2), P < 0.01). Based on glycosylated hemoglobin and oral glucose testing, diabetes had remitted in nine patients at 45 d and in an additional 16 at 1 yr. In T2DM, ß-cell glucose sensitivity increased early after surgery but was no further improved and still abnormal at 1 yr [median, 48 (coefficient interval, 53) pmol/min · m(2) · mm vs. median, 100 (coefficient interval, 68) of NGT, P < 0.001]. Baseline ß-cell glucose sensitivity was progressively worse in early remitters, late remitters, and nonremitters (median, 54[coefficient interval, 50] vs. median, 22[coefficient interval, 26] vs. median, 4[coefficient interval, 10] pmol/min · m(2) · mm) and, by logistic regression, was the only predictor of failure [odds ratio for bottom tertile = 7.9 (95% confidence interval = 1.2-51.9); P = 0.03]. CONCLUSIONS: In morbid obesity, Roux-en-Y gastric bypass causes rapid and profound metabolic adaptations; insulin sensitivity improves in proportion to the weight loss, and ß-cell glucose sensitivity increases independently of weight loss. Over a period of 1 yr after surgery, diabetes remission depends on the starting degree of ß-cell dysfunction.

The postpartum depression screening scale: is it valid to screen for antenatal depression?

The purpose of the study was to analyse for the first time the validity of a slightly modified version of the Portuguese Postpartum Depression Screening Scale (PDSS), to be used as a screening instrument for antenatal depression. Specifically, the aims were to analyse its psychometric properties, to determine PDSS cutoff points and associated conditional probabilities to screen for depression according to DSM-IV and ICD-10 criteria and to compare its screening performance with that of the Beck Depression Inventory-II (BDI-II). Five hundred and three pregnant women in the third trimester of pregnancy completed both questionnaires and were interviewed face-to-face with the Portuguese version of the Diagnostic Interview for Genetic Studies. The Portuguese version of the Operational Criteria Checklist for Psychotic Illness was used to obtain DSM-IV and ICD-10 diagnoses of depression, our gold standards for caseness. PDSS reliability and validity were very good and comparable to those obtained in the postpartum validation studies developed in Portugal and in other countries, showing satisfactory sensitivity and specificity combinations (≅80%). Compared with BDI-II, it has the advantage of being more specific for the motherhood context. Although developed for postpartum depression, PDSS is accurate to screen for antenatal depression, and it could be very useful for clinical and epidemiologic purposes.

La nutrición: un aspecto importante en la calidad de vida de la mujer / Nutrition: an important aspect in women's quality of life

La 53ª sesión de la Comisión de Derechos Humanos, incluía en su preámbulo el derecho a un nivel de vida adecuado, incluyendo la alimentación. Desde hace años existe una gran preocupación por los organismos internacionales en relación con la producción de alimentos, por la gravedad y extensión del problema y su impacto económico. La accesibilidad de los alimentos está determinada por la existencia de los mismos y las posibilidades de adquisición. Algunos malos resultados perinatales son producto de una dieta insuficiente y desequilibrada, que puede corregirse utilizando la educación nutricional y la promoción social, analizando los hábitos alimentarios, los alimentos disponibles y su accesibilidad. Los esfuerzos para la solución de este problema están relacionados con la seguridad alimentaria y la presión social que se ejerza para lograr la posibilidad de un desarrollo armónico a escala mundial.

A clinical comparison of two calculus-inhibiting dentifrices.

The objective of this double-blind clinical study, conducted in harmony with the Volpe-Manhold design for studies of dental calculus, was to compare the effect on supragingival calculus formation of a dentifrice containing pyrophosphate, tripolyphosphate and a copolymer in a 0.243% sodium fluoride/silica base (Test Dentifrice), to that of a commercially available calculus-inhibiting dentifrice containing tetrapotassium pyrophosphate, disodium pyrophosphate and tetrasodium pyrophosphate in a 0.243% sodium fluoride/silica base (Positive Control Dentifrice). Adult male and female subjects from the Buffalo, New York area were entered into the study, provided a full oral prophylaxis, and assigned the use of a placebo (non-calculus-inhibiting) dentifrice for fourteen weeks. At the completion of this initial period, subjects were assessed for baseline Volpe-Manhold Calculus Index scores, provided another full prophylaxis, and stratified into two treatment groups which were balanced for age, sex and baseline calculus. Subjects were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned dentifrice, using a soft-bristled toothbrush. Examinations for dental calculus were again performed after twelve weeks' use of the study dentifrices. Ninety-one (91) subjects complied with the protocol and completed the entire study. At the three-month examination, the Test Dentifrice group exhibited a statistically significant 27.3% reduction in mean Volpe-Manhold Calculus Index score as compared to the Positive Control Dentifrice group. The results of this clinical study support the conclusion that a new calculus-inhibiting dentifrice, containing pyrophosphate, tripolyphosphate and a copolymer in a 0.243% sodium fluoride/silica base, is efficacious for the control of the development of supragingival calculus, and provides a level of benefit greater than that provided by a commercially available calculus-inhibiting dentifrice containing tetrapotassium pyrophosphate, disodium pyrophosphate and tetrasodium pyrophosphate in a 0.243% sodium fluoride/silica base.

[Hernia surgery with short hospitalization]. / La chirurgia dell'ernia in regime di ricovero breve.

The hospital stay of 55 patients, 47 males and 8 females, admitted to hospital for surgical repair of inguinal (53 procedures) and crural (4 procedures) hernias was analyzed. The mean age was 60.7 years (range from 25 to 82 years), local anesthesia was the method of choice (55 procedures), it has suppressed post-anesthetic respiratory and urinary troubles. The mean hospital stay was 1.18 days. One superficial skin hematoma and 1 wound infection were found, local anesthetic intolerance occurred in 1 case, and low fever in three cases. Over 90 percent of patients were favourable to short stay surgery for hernia repair at 30 days follow-up. The authors conclude on the feasibility, acceptability, social benefits and usefulness of short stay and day care surgery for hernia repair.

Microbial alterations in supragingival dental plaque in response to a triclosan-containing dentifrice.

A total of 325 subjects were entered into a double-blind, stratified 2-treatment clinical study that examined the effects of a dentifrice containing 0.3% triclosan, 2% Gantrez copolymer and 0.243% sodium fluoride on supragingival dental plaque and gingivitis. A subset of 159 subjects including 72 men and 87 women participated in the microbiological component of this study, which was designed to detect shifts in supragingival bacterial species in response to triclosan. Subjects were divided into two groups: one performed normal oral hygiene with the triclosan/copolymer dentifrice and a control group used a placebo dentifrice without triclosan. At baseline, 3 and 6 months during treatment and at 6, 12, 18 and 24 weeks post-treatment, supragingival dental plaque was collected from the buccal and lingual surfaces of the 4 first molar teeth and assayed for: 1) bacterial morphotypes by phase-contrast microscopy; 2) select bacterial groups and bacterial species by culture; and 3) target periodontal pathogens including Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis and Prevotella intermedia by immunofluorescence microscopy. There were few statistically significant differences between treatment groups in any of the 90 microbiological parameters measured at the 7 different time points. The control group demonstrated significantly higher levels of cultivable Neisseria and higher proportions at the 3-month treatment period of P. gingivalis-infected subjects and mean cells. After 6 months of treatment, the triclosan group demonstrated higher levels of fusiforms. Analysis of triclosan resistance data failed to detect a shift towards increased proportions of bacteria resistant to triclosan, and both treatment groups demonstrated triclosan-resistant strains, predominantly Veillonella dispar. This study confirms the microbiological safety of triclosan-containing dentifrices and suggests that continued use can be associated with beneficial alterations in the bacterial composition of supragingival dental plaque.

When CHIVA treatment could be video guided.

BACKGROUND: Hemodynamic correction (CHIVA) is a conservative, ambulatory, and controversial varicose vein treatment. It consists of selected ligatures of the superficial venous system decided by means of preoperative duplex mapping. OBJECTIVE: Prospective evaluation of 80 patients, operated on according to the CHIVA technique described by Claude Franceschi. Mean follow-up length was 30 months. METHODS: Fifty-five consecutive patients were operated on after clinical, ultrasonographic, ambulatory venous pressure and light reflection rheography evaluations. After a 3-year follow-up, another 25 consecutive patients were selected applying some exclusion criteria that emerged in the first part of the study. This second series was operated on by means of intraoperative angioscopy. The same preoperative evaluations have been used to study the outcome in all patients. RESULTS: CHIVA failed in the short saphenous vein territory varices and when the long saphenous vein and the insufficient perforating veins had a preoperative diameter greater than 10 and 4 mm, respectively. The procedure showed a long saphenous vein patency of 90.4% and registered a total recurrence rate of 18.7%. CONCLUSIONS: CHIVA seems to be a more effective varicose vein treatment than high ligation and distal stab avulsion. It also preserves a higher rate of long saphenous veins, suitable for bypass surgery.

[Laparoscopic treatment of Mirizzi's syndrome]. / Trattamento laparoscopico della sindrome di Mirizzi.

The Mirizzi syndrome is an unusual benign obstructive jaundice due to extrinsic mechanical compression of the common hepatic duct by gallstone impacted within the neck or cystic duct of the gallbladder. This syndrome is described either as an acute form due only to extrinsic compression of the common bile duct (type I) or as a chronic form resulting in an erosive cholecysto-choledochal fistula (type II). Up to date, the syndrome remains a clinically and surgically challenging problem. The anatomic basic of the syndrome (an anomalous relationship between the cystic duct and the common hepatic duct) when associated with inflammation and interbiliary fistula predisposes to a critical situation to be clearly detected and contributes to technical difficulties when surgical management is performed. The operative diagnosis of Mirizzi syndrome remains elusive and requires careful scrutiny of the biliary tract imaging to recognize the diseased duct system and to facilitate the following operative procedures. The surgical treatment requires a skill and careful operative dissection of the duct system, cholecystectomy and a safe biliary exploration and stone clearance, avoiding any iatrogenic damage to common hepatic duct. Laparotomy is commonly advocated as the safer approach to the diseased biliary tract and it is still employed by most authors. The laparoscopic surgery has not yet entered as the first-choice procedure for this syndrome due to jaundice and acute inflammation considered by some as contraindication to mini-invasive treatment. This paper describes successful surgical management by laparoscopic techniques in two patients affected by Mirizzi type I and type II syndrome treated by cholecystectomy alone and cholecystectomy with choledochal fistula flap repair, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[A new technique in positioning of Kehr's tube in laparoscopy]. / Metodica originale per il posizionamento del tubo di Kehr in laparoscopia.

The enlargement of the indications in the use of the laparoscopic technique puts the surgeon in front of the need to project new techniques and to improve new instruments daily. On one hand, the technique and instruments used to perform a video-laparoscopic cholecystectomy are codified. However, there is still a lot of work to do for the laparoscopic treatment of the common bile duct stones. The aim of the present scientific contribution is the exposition of an original methodology for the positioning of the T-tube in laparoscopy which would be a difficult manoeuvre otherwise.

Effect on plaque removal and gingivitis of a triclosan-copolymer pre-brush rinse: a six-month clinical study in Canada.

The effect on plaque removal and gingivitis of using a pre-brush rinse containing 0.03 per cent triclosan (Irgacare MP, Ciba-Geigy Corp.) and 0.125 per cent of a copolymer of polyvinylmethyl ether and maleic acid over a six-month period, versus using a matching placebo pre-brush rinse, was assessed in this clinical study. Subjects were instructed to rinse their mouths for one minute, twice daily (morning and evening), with 15 mL of their assigned pre-brush rinse. Immediately after rinsing, subjects brushed their teeth for 30 seconds using the dentifrice and toothbrush supplied to them at the outset. Subjects were instructed to refrain from any other oral hygiene procedures throughout the duration of the study. Plaque and gingivitis examinations were conducted after three months and again after six months. At the conclusion of the study (six months), the triclosan/copolymer pre-brush rinse demonstrated an advantage of 24.8 per cent for plaque removal and a 22.1 per cent reduction in gingivitis, when compared to the matching placebo pre-brush rinse. These advantages in plaque removal and gingivitis reduction were statistically significant. The six-month effect of the triclosan/copolymer pre-brush rinse was even greater on "the more difficult to brush" surfaces of the teeth, as determined by the use of the Plaque Severity Index and the Gingivitis Severity Index.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative efficacy of two dentifrices containing 5% potassium nitrate on dentinal sensitivity: a twelve-week clinical study.

The effect of a dentifrice containing 5.0% potassium nitrate, 1.3% soluble pyrophosphate, 1.5% PVM/MA copolymer, and 0.243% sodium fluoride in a silica base (Sensitive/Tartar Control) on dentinal hypersensitivity over a twelve-week period was compared to a commercially available dentifrice containing 5% potassium nitrate and 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base (Sensodyne-F). A total of ninety-seven subjects were entered into the study, and stratified into two balanced groups according to their baseline mean air sensitivity score and baseline mean tactile (Yeaple Probe) sensitivity score. The two groups were randomly assigned to use either the Sensitive/Tartar Control dentifrice or the commercially available hypersensitivity control dentifrice with potassium nitrate. The two groups were balanced with regard to their mean baseline air and tactile sensitivity scores, sex and age. Subjects were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned dentifrice and a commercially available soft-bristled toothbrush. Dentinal hypersensitivity examinations, which included tactile sensitivity, cold air blast, and a visual analog scale were conducted at baseline, six weeks, and twelve weeks. All examinations were conducted by the same dental examiner. After six weeks' use of the assigned dentifrices, there were no statistically significant differences between dentifrice groups in any of the parameters assessed (tactile, cold air blast and visual analog scale). After twelve weeks' use of the assigned products, there were no statistically significant differences between dentifrice groups in any of the parameters assessed (tactile, cold air blast and visual analog scale). Thus it can be concluded from this study that the use of a dentifrice containing 5.0% potassium nitrate, 1.3% soluble pyrophosphate, 1.5% PVM/MA copolymer, and 0.243% sodium fluoride in a silica base provides a clinically effective method of reducing dentinal hypersensitivity which is comparable in efficacy to a commercially available hypersensitivity control dentifrice containing 5% potassium nitrate and 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base.

Isolated true atherosclerotic aneurysms of the superficial femoral artery. Case report and literature review.

Isolated true atherosclerotic aneurysms of the superficial femoral artery are rare. We report an original case of superficial femoral artery aneurysm (SFAA) not associated with dilatation of the common femoral or popliteal artery. The review of the literature emphasizes the great latency of the disease and the high incidence of complication at presentation, as well as, echosonographic diagnostical advantages over angiography. After surgical treatment the prognosis is favourable. Early recognition and surgical repair are recommended for patients with aneurysms of the superficial femoral artery greater at least twice the normal vessel size. Elective surgical treatment is associated with little risk to the patients and avoids the need for operation in the setting of limb-threatening ischemia.