Evolution of lipid profiles after bariatric surgery.

BACKGROUND: The most commonly encountered dyslipidemia in obese individuals is characterized by a cluster of interrelated plasma lipid and lipoprotein abnormalities including hypertriglyceridemia, low HDL cholesterol values, and increased small, dense LDL cholesterol particles. The aim of this study was to assess the changes in lipid profiles at baseline (pre-operatively) and at follow-up (6, 12, and 18 months) after a laparoscopic Roux-en-Y gastric bypass (LRYGBP). A retrospective observational study was performed involving all patients who consecutively underwent a LRYGBP between January 1, 2007 and December 31, 2009. Fasting lipids sub-fractions (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides) were measured and HOMA-IR calculated pre-operatively and at follow-up post-LRYGBP. Pearson's correlation coefficients were used to assess the relationship between excess weight loss (EWL) and lipid sub-fractions. ANOVA was used to assess the differences between each lipid sub-fraction at various time-points. METHODS: One hundred twenty eight (N = 128) medical charts were reviewed, and those containing data on lipid fractions at the three follow-up time-points were analyzed. One hundred fourteen patients (N = 114), 84 of whom were women (73.7%), were finally included in the study. RESULTS: Total cholesterol, LDL cholesterol, triglycerides, and HOMA-IR were significantly reduced after LRYGBP (P < 0.0005 for all). Inversely, HDL cholesterol disclosed a significant rise (P < 0.0005). Noteworthy significant associations between lipid subfractions and EWL were detected overall (P < 0.0005 for all). A gender effect was found since female patients displayed a milder association than male patients (P < 0.0005). CONCLUSIONS: LRYGBP-induced weight loss improves the lipid profile while reducing insulin resistance, with male patients showing a better profile than female patients.

Biopsia guiada por laparoscopia de tumoraciones intraabdominales no digestivas / Laparoscopic biopsy of non-digestive intra-abdominal masses

Introducción. La laparoscopia es un recurso diagnóstico de múltiples enfermedades que requieren biopsia de masas intraabdominales no abordables mediante punciones guiadas por imagen. Evita la morbimortalidad asociada a la laparotomía favoreciendo el tratamiento precoz de los procesos malignos. Pacientes y método. Análisis descriptivo, retrospectivo de los resultados de una serie de pacientes de nuestro hospital, que presentan nódulo intraabdominal de etiología desconocida biopsiados mediante cirugía laparoscópica desde enero de 2001 hasta mayo de 2006. Ninguno de los pacientes es candidato a punción percutánea guiada por imagen. Resultados. Realizamos 23 biopsias: 8 retroperitoneales (34,7%), 5 mesentéricas (21,7%), 5 en hilio hepático, 4 pelvianas y 1 en cadena de vena ilíaca y asociamos 5 biopsias complementarias. Se obtuvo un 100% de material suficiente para diagnóstico anatomopatológico. La duración media de la intervención fue de 71 min. El 61% tuvo un ingreso menor de 24 h. La estancia hospitalaria (mediana) fue de 1,5 días. Conclusiones. El abordaje laparoscópico permite una exposición y una revisión completa de la cavidad peritoneal. La biopsia laparoscópica es segura y efectiva con excelente recuperación del paciente permitiendo iniciar precozmente el tratamiento definitivo (AU)

Introduction. Laparoscopic surgery offers an alternative diagnostic technique in multiple diseases requiring biopsy of non-digestive intra-abdominal masses in which image-guided biopsy cannot be performed. Laparoscopic biopsy aims to reduce the surgical aggression and complications associated with laparotomy and favors the early treatment of malignancies. Patients and method. We performed a retrospective descriptive study of our results in a series of patients in our hospital with intra-abdominal masses of unknown etiology who underwent laparoscopic surgery between January 2001 and April 2006. None of the patients were candidates for image-guided percutaneous biopsy. Results. We carried out 23 biopsies: 8 retroperitoneal (34.7%), 5 mesenteric (21.7%), 5 hepatic, 4 pelvic, and 1 in the iliac chain, as well as 5 complementary biopsies. In all patients, sufficient material for histologic diagnosis was obtained. The mean operating time was 71 minutes. Length of hospital stay was less than 24 hours in 61% of the patients. The median length of hospital stay was 1.5 days. Conclusions. The laparoscopic approach allows complete visualization and examination of the entire peritoneal cavity. Laparoscopic biopsy is a safe and effective procedure with excellent patient recovery and allows early definitive treatment (AU)

Actividad sanitaria durante la operación Alfa-Charlie en Centroamérica

En el presente artículo se expone la actividad sanitaria desarrollada por el Servicio de Sanidad del Buque "Pizarro" en diferentes países de Centroamérica en enero de 1999, afectados por el huracán "Mitch" (AU)