Impact of bariatric surgery on the oral health of patients with morbid obesity.

BACKGROUND: The present study assessed the impact of bariatric surgery on the oral health. METHODS: All of the patients who underwent Roux-en-Y gastric bypass at Nossa Senhora da Conceição Hospital between October 2009 and January 2011 were invited to participate. In this longitudinal study, oral examinations and interviews were conducted in two stages. A descriptive analysis, McNemar's test, Student's t test for paired samples, and the Wilcoxon test were performed. RESULTS: Thirty-nine patients completed the protocol. There was a statistically significant reduction in the number of medications taken daily, sensation of dry mouth, and increased stimulated salivary flow rate. CONCLUSIONS: The oral health of patients who underwent bariatric surgery improved; moreover, the sensation of dry mouth decreased.

Prevalence of upper digestive endoscopy and gastric histopathology findings in morbidly obese patients.

CONTEXT: The prevalence of obesity has been increasing in modern society. Roux-en-y gastric bypass is a bariatric surgery that involves the exclusion of significant part of the stomach. Atrophy, intestinal metaplasia and gastric cancer have been associated with infection by Helicobacter pylori. OBJECTIVES: To evaluate the presence of endoscopy findings and histological changes in morbid obese patients for the presence of inflammatory cells, inflammatory activity, lymphoid hyperplasia, H. pylori infection, atrophy and intestinal metaplasia in the gastric mucosa. METHODS: Upper digestive endoscopy and gastric histopathological were studied in 126 obese patients in the preoperative evaluation for bariatric surgery. RESULTS: Upper digestive endoscopy abnormalities were diagnosed in 73/126 (57.9%) patients. In three patients (2.4%) the upper gastrointestinal endoscopy diagnosed gastric ulcer and one patient (0.8%) had duodenal ulcer. The histopathological from gastric biopsies of these obese patients showed 65.1% of mucosa inflammation, inflammatory activity in 50.0%, infection by H. pylori in 53.2%, lymphoid hyperplasia in 50.0% and atrophy and/or intestinal metaplasia in 16.7%. CONCLUSIONS: In present study, with routine preoperative upper gastrointestinal endoscopy and histopathological examination, were detected 57.9% patients with endoscopy abnormalities, high prevalence of infection by H. pylori (53%) and 16.7% of gastric atrophy and/or intestinal metaplasia.

Prevalence of upper digestive endoscopy and gastric histopathology findings in morbidly obese patients / Prevalência de achados gástricos endoscópicos e histopatológicos em pacientes obesos

CONTEXT: The prevalence of obesity has been increasing in modern society. Roux-en-y gastric bypass is a bariatric surgery that involves the exclusion of significant part of the stomach. Atrophy, intestinal metaplasia and gastric cancer have been associated with infection by Helicobacter pylori. OBJECTIVES: To evaluate the presence of endoscopy findings and histological changes in morbid obese patients for the presence of inflammatory cells, inflammatory activity, lymphoid hyperplasia, H. pylori infection, atrophy and intestinal metaplasia in the gastric mucosa. METHODS: Upper digestive endoscopy and gastric histopathological were studied in 126 obese patients in the preoperative evaluation for bariatric surgery. RESULTS: Upper digestive endoscopy abnormalities were diagnosed in 73/126 (57.9%) patients. In three patients (2.4%) the upper gastrointestinal endoscopy diagnosed gastric ulcer and one patient (0.8%) had duodenal ulcer. The histopathological from gastric biopsies of these obese patients showed 65.1% of mucosa inflammation, inflammatory activity in 50.0%, infection by H. pylori in 53.2%, lymphoid hyperplasia in 50.0% and atrophy and/or intestinal metaplasia in 16.7%. CONCLUSIONS: In present study, with routine preoperative upper gastrointestinal endoscopy and histopathological examination, were detected 57.9% patients with endoscopy abnormalities, high prevalence of infection by H. pylori (53%) and 16.7% of gastric atrophy and/or intestinal metaplasia.

CONTEXT: A prevalência de obesidade tem aumentado significativamente nos últimos anos. Bypass gástrico em Y-de-Roux, uma das técnicas cirúrgicas realizadas no tratamento da obesidade, envolve exclusão de parte do estômago. Atrofia, metaplasia intestinal e câncer gástrico têm sido associados com infecção pelo Helicobacter pylori. OBJETIVOS: Avaliar a prevalência de achados endoscópicos e alterações histopatológicas em pacientes obesos mórbidos em relação à presença de células inflamatórias, atividade inflamatória, hiperplasia linfóide, infecção pelo H. pylori, atrofia e metaplasia intestinal na mucosa gástrica. MÉTODOS: Achados na endoscopia digestiva alta e histopatologia gástrica foram analisados em 126 pacientes obesos na avaliação pré-operatória de cirurgia bariátrica. RESULTADOS: Anormalidades endoscópicas do trato digestivo superior foram diagnosticadas em 73/126 pacientes, com três pacientes (2,4%) apresentando úlcera gástrica e um paciente (0,8%) com úlcera duodenal. A histopatologia das biopsias gástricas dos obesos estudados revelou 65,1% de processo inflamatório na mucosa, atividade inflamatória em 50,0%; infecção pelo H. pylori em 53,2%, hiperplasia linfóide em 50,0%, atrofia e/ou metaplasia intestinal em 16,7%. CONCLUSÕES: No presente estudo, através de endoscopia digestiva alta e histopatologia de biopsias gástricas, foram detectados 57,9% de pacientes com anormalidades endoscópicas, prevalência de infecção pelo H. pylori em 53% e atrofia e/ou metaplasia intestinal em 16,7%.

Inferior vena cava syndrome and morbid obesity.

A case is reported of inferior vena cava syndrome in a patient with extreme obesity (BMI: >70 kg/m(2)), treated at a public hospital. The inferior vena cava obstruction was diagnosed during an attempt at inferior vena cava filter percutaneous insertion, in prebariatric surgery period. The diagnosis occurred after a hepatic scintillography, and was confirmed with a femoral venography and celiac trunk arteriography. The patient underwent a biliopancreatic diversion-duodenal switch and has lost weight. A venography 7 months after the surgery did not show any inferior vena cava rechanneling evidence.

Flutuação de peso nos pacientes em tratamento de obesidade atendidos no ambulatório de endocrinologia do Hospital Nossa Senhora da Conceição entre 2002 e 2005 / Cycling weight in patients submitted to obesity treatment in the endocrinology ambulatory of Nossa Senhora da Conceição Hospital between 2002 and 2005

Introdução: A obesidade é um problema de saúde em ascensão. Seu tratamento constitui um desafio ao médico assistente e, principalmente, ao próprio paciente. Poucas pessoas obtêm bons resultados e os mantêm ao longo do tempo. Peso flutuante é um ciclo de perda e ganho (ou ganho e perda) de peso superior a 5% a partir do peso inicial. Objetivo: Determinar a incidência de peso flutuante em pacientes em tratamento de obesidade em um ambulatório de referência, além de descrever as características desses pacientes, na tentativa de estabelecer os fatores associados a este fenômeno. Metodologia: Estudo de coorte retrospectivo, analisando dados das carteiras de atendimento de 145 pacientes atendidos no ambulatório de endocrinologia do Hospital Nossa Senhora da Conceição no período de maio a julho de 2006, os quais haviam consultado pela primeira vez no mesmo ambulatório entre janeiro de 2002 e junho de 2005. Resultados: A incidência de peso flutuante nos pacientes em estudo foi de 13,10%. A história familiar positiva para obesidade foi mais prevalente no grupo dos pacientes sem peso flutuante, quando comparado ao grupo dos pacientes com peso flutuante (p = 0,011). Ainda, pacientes sem peso flutuante apresentaram diabete melito com menor freqüência do que os com peso flutuante (p = 0,038). Conclusão: Foi verificada uma baixa incidência de peso flutuante. Isso, provavelmente, se deveu ao fato de esses pacientes terem sido acompanhados por uma equipe multidisciplinar. Pacientes com história familiar positiva para obesidade e pacientes com diabete melito têm menores riscos de apresentar peso flutuante

Introduction: Obesity is a health problem increasing. The treatment is a challenge to the assistant physician and, mainly, to the own patient. Few people get good results and keep them along the time. Cycling weight is a cycle of loss and gain (or gain and loss) of weight over 5% from the initial weight. Objective: Determining the incidence of cycling weight in patients submitted to obesity treatment in a reference ambulatory, besides describing the characteristics of these patients, in order to establish the factors associated to this phenomenon. Methodology: A retrospective cohort study, analyzing data of attendment cards of 145 patients attended in the endocrinology ambulatory of Nossa Senhora da Conceição Hospital in the period of May to July of 2006, who had consulted for the first time in the same ambulatory between January 2002 and July 2005. Results: The incidence of cycling weight was 13,10%. The positive family history of obesity was more prevalent in the group of patients without cycling weight, when compared to the group of patients with cycling weight (p = 0,011). About the comorbities, only the prevalence ofdiabetes mellitus was different in the two groups in a significant way. No-cycler patients had diabetes mellitus in a minor frequency than cyclers (p = 0,038). Conclusion: It was observed a low incidence of cycling weight. It probably happened because these patients were monitored by a multidisciplinary staff. Patients with a positive family history of obesity and diabetic patients have lower risks of developing cycling weight

Hepatic outcomes after jejunoileal bypass: is there a publication bias?

BACKGROUND: One of the reasons why jejunoileal bypass (JIB) was abandoned were reports of liver failure. The aim of this study was to describe histological findings in the intraoperative and follow-up liver biopsies of a cohort of super-obese patients who had undergone JIB. METHODS: 50 consecutive patients underwent JIB. Samples of liver biopsies performed intraoperatively (41 patients) and in the follow-up (31 patients) were evaluated. Brunt's scale was used. RESULTS: Mean age at operation was 37.9 +/- 7.6 years, and 15 patients (30.6%) had diabetes type 2, 20 (40.8%) had dyslipidemia, 29 (59.2%) had high blood pressure, and one (0.5%) had hepatitis C. Mean BMI preoperatively was 52.8 +/- 7.5 kg/m(2). Mean follow-up time was 67.0 +/- 42.8 months. At the time of the latest liver biopsy, the mean BMI was 35.7 +/- 7.5 kg/m(2). The % excess weight loss (%EWL) was 62.4 +/- 20.0%. 8 deaths (16%) have occurred, none from liver-related complications. At liver biopsy during the JIB operation, NAFLD was confirmed in 36 patients (86.7%) and NASH in 13 (31.7%). In 25 patients with mean follow-up of 4.8 +/- 4.0 years, there was no statistically significant change in the liver histology regarding the extent of steatosis (P=0.20), steatohepatitis (P=0.74) and fibrosis (P=0.71). CONCLUSIONS: There was a significant metabolic improvement, maintenance of the %EWL, and no worsening of liver histology. There has possibly been a publication bias concerning liver outcomes, where the type of JIB and the concomitance of hepatitis C were not taken into account.

The -106CC genotype of the aldose reductase gene is associated with an increased risk of proliferative diabetic retinopathy in Caucasian-Brazilians with type 2 diabetes.

Diabetic retinopathy is a sight-threatening chronic complication of diabetes mellitus and is the leading cause of acquired blindness in adults. The -106C>T polymorphism in the promoter region of the aldose reductase (AR) gene has been shown to be associated with the susceptibility to diabetic nephropathy in type 2 diabetes, but the findings regarding the occurrence of diabetic retinopathy are conflicting. In this case-control study, we investigated whether the -106C>T polymorphism in the AR gene is involved in the development and progression of diabetic retinopathy in 579 Brazilians with type 2 diabetes (424 Caucasian- and 155 African-Brazilians). Patients underwent a clinical and laboratory evaluation consisting of a questionnaire, physical examination, assessment of diabetic complications and laboratory tests. Genotype analysis was performed using the polymerase chain reaction followed by digestion with restriction enzyme. Logistic regression analysis was used to control for independent risk factors associated with diabetic retinopathy. There were no differences in either genotype or allele frequencies for the -106C>T polymorphism between type 2 diabetic patients with or without diabetic retinopathy, in both ethnic groups. However, the CC genotype was associated with an increased risk of having proliferative diabetic retinopathy in Caucasian-Brazilians with type 2 diabetes (odds ratio (OR)=2.04; 95% confidence interval (CI)=1.21-3.45; P=0.007), independently of other risk factors associated with this complication. Thus, our results show that the -106CC genotype (-106C>T polymorphism) in the AR gene is related to the progression of diabetic retinopathy in Caucasian-Brazilians with type 2 diabetes.

The catalase -262C/T promoter polymorphism and diabetic complications in Caucasians with type 2 diabetes.

Catalase is a central antioxidant enzyme constituting the primary defense against oxidative stress. In this study, we investigated whether the functional -262C/T polymorphism in the promoter of catalase gene is associated with the presence of diabetic retinopathy (DR), diabetic nephropathy (DN) and ischemic heart disease (IHD) in 520 Caucasian-Brazilians with type 2 diabetes. The -262C/T polymorphism was also examined in 100 Caucasian blood donors. Patients underwent a clinical and laboratory evaluation consisting of a questionnaire, physical examination, assessment of diabetic complications and laboratory tests. Genotype analysis was performed using the polymerase chain reaction followed by digestion with restriction enzyme. The genotype and allele frequencies of the -262C/T polymorphism in patients with type 2 diabetes were very similar to those of blood donors (T allele frequency=0.20 and 0.18, respectively). Likewise, there were no differences in either genotype or allele frequencies between type 2 diabetic patients with or without DR, DN or IHD. Thus, our results do not support the hypothesis that the -262C/T polymorphism is related to the development of DR, DN or IHD in patients with type 2 diabetes. Further studies are necessary to elucidate the role of catalase gene polymorphisms in the pathogenesis of diabetic complications.

Análise crítica dos desfechos de pacientes morbidamente obesos operados pela técnica Bypass Jejuno-lleal

A doença gordurosa do figado não alcoólica ( na lingua inglesa Non Alcoholic Fatty Liver Disease -NAFLD) é um problema clínico reconhecido em pacientes obesos. Entre os problemas pós-operatórios, alterações hepáticas clínicas têm sido relatadas, especialmente após procedimentos malabsortivos. Cirurgia bariátrica é o tratamento de escolha para obesidade mórbida quando o tratamento clínico não obteve sucesso. Várias técnicas cirúrgicas foram descritas desde o primeiros procedimento chamado Bypass Jejuno-lleal( do inglês Jejuno lleal Bypass- JIB) proposto por Kremen e Linner, em 1954. Desde 1970, o Bypass Jejuno-lleal deixou um legado ao redor do mundo que deve ser seguido. Uma das razões pelas quais o JIB foi abandonado, foram os relatos de insuficiência hepática. O objetivo deste estudo foi descrever o seguimento a longo prazo de pacientes submetidos ao JIB no sul do Brasil

Evaluation of quality of life and metabolic improvement after jejunoileal bypass in a community of low socioeconomic status.

BACKGROUND: Bariatric operations are currently the only effective treatment for morbid obesity The first operation, jejunoileal bypass (JIB), has been superceded. However, JIB has left a heritage which must be followed. We report the long-term follow-up of a series of patients who had undergone JIB in south Brazil. METHODS: 49 super-obese patients (85% female) from a poor community were submitted to JIB from 1987 to 2001. 5 deaths occurred and 4 patients were lost during follow-up. Quality of life was evaluated by means of the Bariatric Analysis and Reporting Outcome System (BAROS) applied to 40 patients. RESULTS: Preoperatively, 11 patients (22.4%) were diabetic,13 (26.5%) were dyslipidemic, and 23 (46.9%) had high blood pressure. After a mean postoperative period of 64.3 +/- 40.0 months, there was complete resolution of co-morbidites in all patients. Mean preoperative BMI was 52.8 +/- 10.3 kg/m(2), and the postoperative mean excess weight loss was 58.9% +/- 18.9%. CONCLUSION: JIB was adequate in reduction of weight, resolution of co-morbidites, and improvement in the quality of life as measured by BAROS. Since February 2001, we perform biliopancreatic diversion with duodenal switch, but we continue to follow our patients with JIB.

Perfil de pacientes dependentes químicos atendidos no Hospital Psiquiátrico São Pedro - RS / Profile of drug addicted patients assisted at Hospital Psiquiátrico São Pedro Rio Grande do Sul - Brazil

A dependência química é um diagnóstico muito frequente na clínica psiquiátrica, sendo fundamental que se façam pesquisas nesta área. Este trabalho objetiva caracterizar o perfil sócio-demográfico dos pacientes dependentes químicos atendidos no Hospital Psiquiátrico São Pedro (Porto Alegre/RS). Este é um estudo de corte transversal, descritivo, retrospectivo e que utiliza uma metodologia quantitativa, utilizando para tal um levantamento, em prontuários, do perfil dos pacientes dependentes químicos atendidos na Unidade de Desintoxicação (UD) e no Ambulatório. A amostra foi composta por 80 sujeitos da UD e 80 pacientes ambulatoriais, selecionados de forma não aleatória. NA UD, a média de idade foi de 35, 16 anos, e de anos de estudo de 5,18, havendo um grande número de desempregados, alcoolistas de comorbidades psiquiátricas. A forma de encaminhamento e a procedência eram variadas. No Ambulatório, a média de idades e anos de estudo correspondem a 43,66 e 6,05 respectivamente; 46,2 por cento são desempregados e 45 por cento é a taxa de comorbidades. Todos os pacientes buscaram o serviço voluntariamente e são precedentes de Porto Alegre. Existem pontos de semelhança entre os dois serviços, como o predomínio de pacientes alcoolistas, de desempregados, o pouco grau de escolaridade e a alta taxa de comorbidades psiquiátricas, bem como diferenças referentes à média de idade, à procedência e à forma de encaminhamento. Conclui-se que é importante que os serviços de atendimento tenham claro o perfil de seus pacientes, pois a partir disto, podem reavaliar os seus métodos, podendo, da mesma forma, identificar susceptibilidades que orientem trabalhos preventivos.

Hiperceratose palmoplantar adquirida e associada a carcinoma de esôfago: relato de um caso / Acquired hyperkeratosis of the palms and soles associated with esophageal carcinoma: a case report

A hiperqueratose palmoplantar adquirida tem sido correlacionada com várias neoplasias viscerais. O artigo descreve um caso de hiperqueratose palmoplantar adquirida do tipo estriado, associado a carcinoma epidermóide de esôfago. O aspecto linear e estriado é uma peculiaridade no presente caso, que o diferencia de outros já relacionados. O carcinoma esofágico foi tratado através de resseçäo cirúrgica total, que levou a regressäo completa das lesöes dermatológicas. Realiza-se uma revisäo bibliográfica a respeito da correlaçäo entre neoplasias e essa manifestaçäo cutânea, sendo também salientado o diagnóstico diferencial das várias hiperqueratose adquiridas de extremidade. Os autores salientam a importância de investigaçäo completa na presença dessas lesöes dermatológicas

Actinomicetose torácica: relato de um caso / Thoracic actinomycosis: report of a case

É apresentado um caso de actinomicetose torácica com lesäo pulmonar, pleural, em arcos costais e na parede do tórax, onde se formou abscesso que fistulizou para o exterior. O tempo entre o ínicio do quadro e o estabelecimento do diagnóstico foi de cinco meses, com suspeita prévia indevida de tuberculose pleural e indicaçäo de tratamento de prova. Propöem-se meios de diagnosticar a doença em etapas mais precoces, a partir da revisäo de publicaçöes pertinentes

Tireotoxicose devido a carcinoma folicular de tireóide metastático / Thyrotoxicosis caused by follicular carcinoma of metastatic thyroid

Os autores relatam um raro caso de tireotoxicose devido a carcinoma folicular de tireóide com metástases funcionantes