RESUMEN
BACKGROUND: Nutritional status during pregnancy and the effects of nutritional deficiencies on pregnancy outcomes after bariatric surgery is an important issue that warrants further study. The objective of this study was to investigate pregnancy outcomes and nutritional indices after restrictive and malabsorptive procedures. METHODS: We investigated pregnancy outcomes of 113 women who gave birth to 150 children after biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) between June 1994 and December 2011. Biochemical indices and pregnancy outcomes were compared among the different types of surgery and to overall 20-year hospital data, as well as to 56 presurgery pregnancies in 36 women of the same group. RESULTS: Anemia was observed in 24.2% and 15.6% of pregnancies after BPD and RYGB, respectively. Vitamin B12 levels decreased postoperatively in all groups, with no further decrease during pregnancy; however, low levels were observed not only after BPD (11.7%) and RYGB (15.6%), but also after SG (13.3%). Folic acid levels increased. Serum albumin levels decreased in all groups during pregnancy, but hypoproteinemia was seen only after BPD. Neonates after BPD had significantly lower average birth weight without a higher frequency of low birth weight defined as<2500 g. A comparison of neonatal data between babies born before surgery and siblings born after surgery (AS) showed that AS newborns had lower average birth weight with no significant differences in body length or head circumference and no cases of macrosomia. CONCLUSION: Our study showed reasonably good pregnancy outcomes in this sample population after all types of bariatric surgery provided nutritional supplement guidelines are followed. Closer monitoring is required in pregnancies after malabsorptive procedures especially regarding protein nutrition.
Asunto(s)
Desviación Biliopancreática/efectos adversos , Gastrectomía/efectos adversos , Derivación Gástrica/efectos adversos , Estado Nutricional , Obesidad Mórbida/cirugía , Resultado del Embarazo , Adulto , Análisis de Varianza , Desviación Biliopancreática/métodos , Peso al Nacer , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Gastrectomía/métodos , Derivación Gástrica/métodos , Edad Gestacional , Humanos , Recién Nacido , Laparoscopía/métodos , Desnutrición/etiología , Desnutrición/fisiopatología , Edad Materna , Obesidad Mórbida/diagnóstico , Embarazo , Atención Prenatal/métodos , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Deficiencia de Vitamina B 12/etiología , Deficiencia de Vitamina B 12/fisiopatología , Pérdida de PesoRESUMEN
Aromatase inhibitors (AIs) provide an alternative to tamoxifen as an adjuvant therapy for post-menopausal, hormone-receptor positive breast cancer patients. The aim of the present study was to evaluate the effect of PvuII and XbaI polymorphisms of the ERα gene at ΑΙs treatment's adverse effects in post-menopausal women with breast cancer. The study included 87 post-menopausal women with ER-positive breast cancer treated with AIs and 80 healthy controls. The overall presence of ERα polymorphisms in all women with breast cancer was not different from the healthy controls. Endometrial thickness under AIs treatment was reduced from (mean value ± SD) 6,404 ± 2,901 mm to 3,666 ± 1,4656 mm. Moreover, the AA XbaI genotype was associated with greater reduction in endometrial thickness during therapy with AIs (p = 0.005). The presence of the CC PvuII and the AA XbaI genotypes were associated with elevated LDL levels and elevated triglycerides. In conclusion, the results of the present study showed that the genotype of women with breast cancer under AIs treatment might influence treatment's adverse effects, as, the presence of the CC PvuII and the AA XbaI genotypes of the ERα were associated with elevated LDL and triglycerides serum levels, while the AA XbaI genotype was associated with a greater reduction in endometrial thickness.
Asunto(s)
Inhibidores de la Aromatasa/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Endometrio/efectos de los fármacos , Receptor alfa de Estrógeno/genética , Lípidos/sangre , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Persona de Mediana Edad , Polimorfismo GenéticoRESUMEN
PURPOSE: The aim of the present study was to determine the prevalence and association of the G972S polymorphism of the insulin receptor substrate-1 gene (IRS-1 G972S SNP) with polycystic ovary syndrome (PCOS) and insulin resistance-related traits in a distinct phenotypic group of lean PCOS women with biochemical hyperandrogenemia, excluding obesity, which is considered to be an aggravating parameter of insulin resistance. METHODS: The study included 162 women with PCOS and 122 regularly menstruating, ovulatory women as controls. Physical measurements included weight, height, fat-free mass, fat mass, systolic and diastolic blood pressure and resting heart rate. Biochemical parameters included the serum testosterone, free testosterone, androstenedione, total cholesterol, triglycerides, HDL and LDL cholesterol and glucose levels. Insulin resistance was assessed by determining fasting insulin levels, fasting glucose levels, the fasting glucose/insulin ratio, as well as the HOMA and QUICKI indexes. All DNA samples were genotyped by a PCR-restriction fragment length polymorphism (RLFP) assay. RESULTS: No association of the genotype frequencies of the G972S polymorphism in insulin receptor substrate-1 gene (IRS-1 G972S SNP) with PCOS phenotype and insulin resistance was detected. CONCLUSION: The G972S polymorphism of the IRS-1 gene should not be viewed as major contributor to the development of PCOS or as a causative variant for insulin resistance.
Asunto(s)
Proteínas Sustrato del Receptor de Insulina/genética , Resistencia a la Insulina/genética , Síndrome del Ovario Poliquístico/genética , Adolescente , Adulto , Femenino , Genotipo , Grecia , Humanos , Hiperandrogenismo/sangre , Fenotipo , Síndrome del Ovario Poliquístico/sangre , Polimorfismo Genético , Delgadez , Adulto JovenRESUMEN
Hemangiomas of the umbilical cord are extremely rare benign vascular tumors, not always detected prenatally. They have been associated with increased alpha-fetoprotein (AFP), hydramnios, congenital anomalies, and increased perinatal mortality. Impaired umbilical circulation has been proposed as the predisposing factor for fetal compromise. We report a case of an antenatally detected umbilical cord hemangioma with one artery crossing the tumor, and we reviewed the literature. Close surveillance with Doppler flow studies of the umbilical vessels were carried out throughout the pregnancy. All indices were normal, except from the intra-tumoral part of the umbilical artery under discussion that showed increasing resistance from 32 weeks onwards. Our review confirmed the reported association with increased AFP and hydramnios. The placental end of the cord was the preferred site of location, and the umbilical artery the commonest vessel of origin. Association with cutaneous vascular malformations, and single umbilical artery were assessed.
Asunto(s)
Hemangioma/diagnóstico por imagen , Cordón Umbilical , Neoplasias Vasculares/diagnóstico por imagen , Adulto , Anomalías Congénitas/etiología , Femenino , Hemangioma/complicaciones , Humanos , Polihidramnios/etiología , Embarazo , Ultrasonografía Doppler , Arterias Umbilicales/diagnóstico por imagen , Neoplasias Vasculares/complicaciones , alfa-Fetoproteínas/metabolismoRESUMEN
In postmenopausal women with estrogen receptor (ER)-positive breast cancer, long-term tamoxifen administration has proved beneficial after surgical treatment and subsequent chemotherapy. One of the major adverse effects of tamoxifen is the development of endometrial pathology (polyps, endometrial hyperplasia and endometrial cancer). PvuII and XbaI polymorphisms of the estrogen receptor-alpha gene (ERalpha) and RsaI and AluI polymorphisms of the estrogen receptor-beta gene (ERbeta) have been associated with breast cancer. Thus the present study aimed to identify whether ER gene polymorphisms are associated with breast cancer stage or endometrial responsiveness to long-term tamoxifen treatment in 87 postmenopausal, tamoxifen-treated women with ER-positive breast cancer. The mean age of the patients was 58.7 +/- 4.7 years and the mean duration of tamoxifen treatment was 3.9 +/- 1.1 years. At diagnosis, the stage of breast cancer was determined as follows: 29 women (32%) at Stage I, 49 (58%) at Stage II and 9 (10%) at Stage III. The frequency distributions of the estrogen receptor polymorphisms in all women with breast cancer were not different from those predicted by the Hardy-Weinberg equilibrium hypothesis (p > 0.10). None of the ER polymorphisms studied was linked to either the presence of endometrial pathology or the stage of breast cancer.
Asunto(s)
Neoplasias de la Mama/genética , Endometrio/patología , Receptor alfa de Estrógeno/genética , Receptor beta de Estrógeno/genética , Polimorfismo Genético/genética , Moduladores Selectivos de los Receptores de Estrógeno/efectos adversos , Tamoxifeno/efectos adversos , Neoplasias de la Mama/patología , Neoplasias Endometriales/etiología , Neoplasias Endometriales/patología , Femenino , Predisposición Genética a la Enfermedad , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias/efectos adversosRESUMEN
Our objective was to evaluate the effectiveness of a late or emergency (salvage) cerclage after tissue reinforcement with Pelvicol natural implant, in preventing premature rupture of the fetal membranes and advancing pregnancy prolongation. A flat sheet of Pelvicol, a sterile acellular natural (porcine) implant was used in an emergency cerclage to reinforce the thin tissues of a widely dilated cervix in a 24 weeks' twin gestation with prolapsed unruptured membranes, without contractions, placental abruption, or intrauterine infection. The gestation was extended to 38 weeks without any complications. Two live healthy newborns were delivered by elective cesarean section due to a nonvertex/vertex presentation. The implant was found to be attached almost unaltered firmly on the outer surface of the membrane sac just opposite to the internal os. It seems that Pelvicol is safe and apparently protects by clothing the thinned, soft, and weak wall of a significantly dilated uterine cervix and the bulging or protruding gestational membranes. It also reinforces and strengthens the tissue thickness and resistance, rendering more accurate and safe the otherwise delicate and risky late cerclage. The technique gives hopes that it can help in pregnancy prolongation.