Tratamiento quirúrgico de la obesidad mediante “banda gástrica ajustable” por vía la paroscópica. Una técnica posible en los programas de CMA / No disponible

Objetivo: Exponer nuestra experiencia en el tratamiento quirúrgico de la obesidad mediante banda gástrica ajustable por la paroscopia (BGAL) dentro de un programa de cirugía de corta estancia. Pacientes y método: Entre junio de 2006 y diciembre de2007 fueron intervenidos de forma consecutiva 57 pacientes obesos mediante la técnica de BGAL. Los criterios de selección utilizados para establecer la indicación quirúrgica se basan en los establecidos por el Instituto Nacional de Salud americano y en la declaración de Salamanca de la Sociedad Española de Cirugía de la Obesidad (SECO). Las variables analizadas son: tiempo quirúrgico, tiempo de cumplimiento de criterios de alta en CMA, tiempo de estancia postoperatoria, tiempo de estancia total (desde el ingreso hasta el alta) y complicaciones. Resultados: Todos los pacientes fueron dados de alta dentro de las 24 horas postoperatorias. La estancia hospitalaria postoperatoria fue de 13 horas (11-20). La estancia media total fue de 20 horas (con una noche). El tiempo medio de cumplimiento de los criterios de alta fue de 6 horas. El tiempo quirúrgico medio fue de 118 minutos (80-164). No se registró ninguna complicación intraoperatoria. No hubo reconversiones, reintervenciones, reingresos o complicaciones en los 30 primeros días postoperatorios. Hubo un caso de rotación del reservorio subcutáneo, que obligó a reposición amiento bajo anestesia local, así como tres disfunciones esofágicas. Conclusiones: La intervención de BGAL, realizada por equipos multidisciplinares dedicados específicamente a la obesidad mórbida, puede desarrollarse dentro de programas de cirugía de corta estancia y CMA. La mayoría de pacientes cumplen los criterios de alta en las 6 primeras horas postoperatorias (AU)

Objective: To show our experience in the laparoscopic surgical treatment of obesity using the adjustable gastric band (AGBL) included in a program for day surgery .Patients and method: Between June 2006 and December 2007 we performed the procedure on 57 obese patients, consecutively, using the AGBL technique. The selection criteria used to establish the surgical indications is based on the American National Institute of Health and the SECO. The variables analyzed were: surgical time, time until discharge criteria are met, time spent in hospital post surgery, the overall time of hospital stay (from admittance until leaving) and complications. Results: All patients were discharged within 24 hours postsurgery. The hospital postoperative stay was 13 hours (r:11-20 h). The total average period of time spent in the hospital was 20 hours (with one night). Average time before reaching discharge criteria was 6 hours. Average surgical time was 118 min (r:80-164 m). We have not registered any intra-operative complications. No reconversions. No re-operations No re-admissions to hospital. No complications during the first 30 day spost surgery. 1 case of subcutaneous port rotation of reservoir that required a repositioning under local anesthesia. 3 esophageal disfuntions. Conclusions: The AGBL procedure performed by multidisciplinary teams dedicated specifically to the treatment of morbid obesity can be included in a program for ambulatory surgery. Most patients recover and are discharged before the anticipated 6 postsurgical hours (AU)

Effects of rolipram, pimobendan and zaprinast on ischaemia-induced dysrhythmias and on ventricular cyclic nucleotide content in the anaesthetized rat.

BACKGROUND AND OBJECTIVE: This study was designed to compare the haemodynamic, electrophysiological and pharmacodynamic effects of three selective inhibitors of the different isoenzyme forms of phosphodiesterase (PDE) on ischaemia-induced dysrhythmias in the anaesthetized rat. The drugs used were pimobendan, a selective PDE III inhibitor, rolipram, a selective PDE IV inhibitor, and zaprinast, a selective PDE V inhibitor. METHODS: The coronary artery was occluded 15 min after commencing drug administration, and myocardial ischaemia was maintained for 30 min during which the heart rate and mean arterial pressure were recorded. cAMP and cGMP were determined by radioimmunoassay. RESULTS: Pretreatment with rolipram decreased the duration of ventricular tachycardia without any change in the incidences of dysrhythmias or the mortality rate. This drug did not modify ventricular content of adenosine 3',5'-cyclic monophosphate (cAMP) or guanosine 3',5'-cyclic monophosphate (cGMP). Pimobendan (1 mg kg(-1) + 0.1 mg kg(-1) min) decreased the duration of ventricular tachycardia. This dose of pimobendan and zaprinast (1 mg kg(-1) + 0.1 mg kg(-1) min(-1)) increased the incidence rate of ventricular fibrillation following coronary artery ligation and the mortality rate. Moreover, both drugs increased cGMP in the ventricle. CONCLUSIONS: The results demonstrated that pimobendan and zaprinast increased the incidence of dysrhythmias and the mortality rate, which was accompanied by an increase in the ventricular content of cGMP. Rolipram decreased the duration of ventricular tachycardia without a change in the cyclic nucleotide content or in the mortality rate.

Combined phosphodiesterase inhibition and beta-blockade in the GI104313, decreases ischemia-induced arrhythmias in the rat.

PURPOSE: The purpose of the present study was to evaluate the effects of GI104313, a chimeric molecule containing a phosphodiesterase inhibiting pyradazinone and a blocking phenoxpropanolamine, on ischemia-induced arrhythmias in anesthetized rats. METHOD: The coronary artery was occluded 15 min after commencing drug administration and myocardial ischemia was maintained for 30 min during which the heart rate and mean blood pressure were recorded. Cyclic AMP and GMP were determined by radio-immunoassay. RESULTS: GI104313 (0.1 micromol x kg(-1) plus 0.01 micromol x kg(-1) x min(-1) or 1 micromol x kg(-1) plus 0.1 micromol x kg(-1) x min(-1)) decreased the incidence of ventricular tachycardia (86% and 75%), ventricular fibrillation (28%, P <0.01 and 12%, P <0.001) and premature ventricular beats (164 +/- 27.0 and 114 +/- 28.5, P <0.05) following coronary artery ligation, resulting in a decrease in mortality (29% and 12%, P <0.05). Changes in cyclic nucleotide concentrations have been implicated in the genesis of ischemia-induced arrhythmias. However, in the present study GI104313 did not change the concentrations of adenosine 3':5'-cyclic monophosphate (cyclic AMP) (1.0 +/- 0.07 pmol x mg(-1), 1.0 +/- 0.05 pmol x mg(-1)) or guanosine 3':5'-cyclic monophosphate (cyclic GMP) (0.025 +/- 0.008 pmol x mg(-1) protein, 0.017 +/- 0.004 pmol x mg(-1) protein) in the left ventricle during ischemia-induced arrhythmias in anesthetized rats compared to saline (0.9 +/- 0.1 pmol x mg(-1) and 0.013 +/- 0.002 pmol x m(-1), respectively). CONCLUSION: Our results demonstrate that, in rats, GI104313 induced a decrease in both incidence of arrhythmias and mortality which was not associated with changes in ventricular cyclic nucleotide content.