Rol de la cirugía bariátrica/metabólica en el manejo de la diabetes mellitus 2. Consenso SOCHED/SCCBM / Consensus statement of the Chilean endocrinological society on the role of bariatric surgery in type 2 diabetes

Diabetes Mellitus (DM) and obesity are a public health problem in Chile. Bariatric surgery is the most effective treatment alternative to achieve a significant and sustained weight reduction in patients with morbid obesity. The results of controlled clinical trials indicate that, compared to medical treatment, surgery for obese patients with DM2 allows a better control of blood glucose and cardiovascular risk factors, reduces the need for medications and increases the likelihood for remission. Consensus conferences and clinical practice guidelines support bariatric surgery as an option to treat DM2 in Class III Obesity (Body Mass Index (BMI) > 40) regardless of the glycemic control and the complexity of pharmacological treatment and in Class II Obesity (BMI 35-39,9) with inadequate glycemic control despite optimal pharmacological treatment and lifestyle. However, surgical indication for patients with DM2 and BMI between 30-34.9, the most prevalent sub-group, is only suggested. The Chilean Societies of Endocrinology and Diabetes and of Bariatric and Metabolic Surgery decided to generate a consensus regarding the importance of other factors related to DM2 that would allow a better selection of candidates for surgery, particularly when weight does not constitute an indication. Considering the national reality, we also need a statement regarding the selection and characteristics of the surgical procedure as well as the role of the diabetologist in the multidisciplinary team.

[Consensus statement of the Chilean endocrinological society on the role of bariatric surgery in type 2 diabetes]. / Rol de la cirugía bariátrica/metabólica en el manejo de la diabetes mellitus 2. Consenso SOCHED/SCCBM.

Diabetes Mellitus (DM) and obesity are a public health problem in Chile. Bariatric surgery is the most effective treatment alternative to achieve a significant and sustained weight reduction in patients with morbid obesity. The results of controlled clinical trials indicate that, compared to medical treatment, surgery for obese patients with DM2 allows a better control of blood glucose and cardiovascular risk factors, reduces the need for medications and increases the likelihood for remission. Consensus conferences and clinical practice guidelines support bariatric surgery as an option to treat DM2 in Class III Obesity (Body Mass Index (BMI) > 40) regardless of the glycemic control and the complexity of pharmacological treatment and in Class II Obesity (BMI 35-39,9) with inadequate glycemic control despite optimal pharmacological treatment and lifestyle. However, surgical indication for patients with DM2 and BMI between 30-34.9, the most prevalent sub-group, is only suggested. The Chilean Societies of Endocrinology and Diabetes and of Bariatric and Metabolic Surgery decided to generate a consensus regarding the importance of other factors related to DM2 that would allow a better selection of candidates for surgery, particularly when weight does not constitute an indication. Considering the national reality, we also need a statement regarding the selection and characteristics of the surgical procedure as well as the role of the diabetologist in the multidisciplinary team.

Is laparoscopic sleeve gastrectomy an acceptable primary bariatric procedure in obese patients? Early and 5-year postoperative results.

In this paper, we analyze and discuss the possibility of Laparoscopic sleeve gastrectomy being accepted as a primary and definitive procedure for obese patients with comorbidities. This is based on our postoperative and 5 years of follow-up result and comparing them with the data reported in the international literature. For comparison of the results, a narrative revision of the literature was performed, using the Medline, Pubmed, and data base publications (Medline, Lilacs, and Cochrane Library), looking for the term "Sleeve gastrectomy," "Obesity," "Bariatric surgery," "Laparoscopic surgery" including "Review" articles and also other 42 selected papers. The current results demonstrate very low morbidity (<10%), nil mortality (<1%), mean % weight loss after 5 years of follow-up of 57%, very satisfactory results regarding comorbidities or improvement. However, gastroesophageal reflux manifestation after the operation (20% to 31%) and the possibility of regaining weight after 5 years (15% to 75%) appear as points for analysis.

[Solid-pseudopapillary tumor of the pancreas. Presentation of 3 clinical cases]. / Tumor sólido-pseudopapilar del páncreas presentación de 3 casos clínicos.

The solid-pseudopapillary tumors of the pancreas (TSPP) are a uncommon neoplasm (1- 2% of exocrine tumors). Are more frequent in young women and presents a low malignant potential (15% develop metastases). Its preoperative diagnosis is very difficult, because these tumors haven`t radiological features that makes distinguish from the other pancreatic cysts tumors. Usually are a histopathological finding. Surgical therapy provides good survival, even in the presence of metastases. We present 3 cases with clinical, imaging, treatment and histopathology to provide more information about this rare disease.

Tumor sólido-pseudopapilar del páncreas: presentación de 3 casos clínicos / Solid-pseudopapillary tumor of the pancreas: presentation of 3 clinical cases

El tumor sólido-pseudopapilar del páncreas (TSPP) es una neoplasia infrecuente (1-2 por ciento de los tumores exocrinos), que afecta predominantemente a mujeres jóvenes, con bajo potencial de malignidad (15 por ciento da metástasis). Su diagnóstico preoperatorio es difícil, principalmente debido a que a la imagenología no tiene una característica que la pueda diferenciar de otros quistes pancreáticos, por lo que generalmente es un hallazgo histopatológico. El tratamiento quirúrgico presenta buena sobrevida, incluso en presencia de metástasis. Presentamos 3 casos con cuadro clínico, imagenología, tratamiento e histopatología, con el fin de aportar más información, sobre esta infrecuente patología.

Distribution of urocanic acid isomers between aqueous solutions and n-octanol, liposomes or bovine serum albumin.

The distribution of urocanic acid (UCA) isomers between aqueous solutions and n-octanol, egg yolk phosphatidylcholine (eggPC) liposomes or bovine serum albumin (BSA) has been evaluated. Regarding its partitioning between water and n-octanol, the behaviour of both isomers is very similar, and the amount incorporated to the organic solvent is mostly determined by the fraction of the compound that, in the aqueous phase, is present as uncharged species. This implies that the highest hydrophobicity occurs near the isoelectric point. cis- and trans-UCA are readily incorporated into eggPC unilamellar liposomes. A simple pseudophase treatment of ultrafiltration data renders a binding constant of 0.20+/-0.04mL/mg for the trans isomer at pH 7.4. The binding constant decreases, by a factor two, at pH 5.0, suggesting that the negatively charged species is more favourably bound to the liposomes than the neutral species, which is mostly present as zwitterions. The cis-isomer, at both pHs, is less incorporated to the bilayers. trans-UCA and cis-UCA readily bind to BSA at pH 7.4, with binding constants of 3400M(-1) and 6900M(-1), respectively. This result suggests that, as in the octanol/water partitioning, hydrophobic interactions predominate and the degree of binding is determined by the fraction present as uncharged species. A smaller binding constant at pH 5.0 indicates that the charge of the protein is also plying a relevant role.

[Nutcracker esophagus. Analysis of 80 patients]. / Características clínicas, endoscópicas, manométricas y magnitud de reflujo gastroesofágico ácido patológico en pacientes con esófago en cascanueces. Análisis prospectivo de 80 pacientes.

BACKGROUND: The nutcracker esophagus, a primary motor disorder, is frequently associated with noncardiac chest pain. AIM: To study the clinical, endoscopic, manometric, and pathological features and 24 h acid reflux in patients with nutcracker esophagus. PATIENTS AND METHODS: Eighty patients (63 females, aged 26 to 70 years) with nutcracker esophagus, defined as the presence of contraction waves of more than 180 mmHg in the esophageal manometry, were studied. All were subjected to an upper gastrointestinal endoscopy, 24 h esophageal pH monitoring and a new manometric study. RESULTS: Eighty percent of patients had symptoms suggestive of gastroesophageal reflux, 31% had retrosternal pain and 25% had dysphagia. Upper endoscopy was normal in 41% and showed erosive esophagitis or Barrett esophagus in 27%. Fifty percent of patients had an abnormal acid reflux. There were no significant differences in manometric parameters between patients with and without acid reflux. CONCLUSIONS: Symptoms of gastroesophageal reflux not necessarily mean that a pathological reflux is present. Primary motor disorders of the esophagus may cause similar symptoms.

Caracteristicas clínicas, endoscópicas, manomÚtricas y magnitud de reflujo gastroesofágico ácido patológico en pacientes con esófago en cascanueces: análisis prospectivo de 80 pacientes / Nutcracker esophagus: analysis of 80 patients

Background: The nutcracker esophagus, a primary motor disorder, is frequently associated with noncardic chest pain. Aim: To study the clinical, endoscopic, manometric, and pathological features and 24 h acid reflux in patients with nutcracker esophagus. Patients and methods: Eighty patients (63 females, aged 26 to 70 years) with nutcracker esophagus, defined as the presence of contraction waves of more than 180 mmHg in the esophageal manometry, were studied. All were subjected to an upper gastrointestinal endoscopy, 24 h esophageal pH monitoring and a new manometric study. Results: Eighty percent of patients had symptoms suggestive of gastroesophageal reflux, 31 percent had retrosternal pain and 25 percent had dysphagia. Upper endoscopy was normal in 41 percent and showed erosive esophagitis or Barrett esophagus in 27 percent. Fifty percent of patients had an abnormal acid reflux. There were no significant differences in manometric parameters between patients with and without acid reflux. Conclusions: Symptoms of gastroesophageal reflux not necessarily mean that a pathological reflux is present. Primary motor disorders of the esophagus may cause similar symptoms.

Aislamiento de amebas de vida libre en piscinas públicas de Santiago de Chile / Isolation of free living amoebae from public swimming pool in Santiago, Chile

La presencia de amebas de vida libre (AVL) se estudio en muestras de agua obtenidas de 8 piscinas públicas. La recolección de la superficie, fondo, canales y filtros. Ocho muestras de cada piscina, con un total de 64. La amebas fueron encontradas en 5 piscinas (62 por ciento). En 22 de las muestras cepas de amebas se identificaron (34, 5 por ciento). De estas Hartmannella vermiformes constituyo el 12,5 por ciento; Vannella sp., 9,4 por ciento; Naegleria, 7,8 por ciento y Acanthamoeba un 4,7 por ciento. Considerando la capacidad patógena para el hombre, el 36,6 por ciento de las cepas aisladas resultarían ser que tienen probado peligro (Naegleria y Acanthamoeba). En consecuencia, este trabajo recomienda hacer un mantenimiento más prolijo de las piscinas públicas de Santiago, incluyendo los sistemas de filtración o recirculación de las aguas utilizadas, dado que los cuadros clínicos que pueden provocar estas AVL son realmente severos llegando incluso a causar la muerte.

Gastrectomía casi total abierta o laparoscópica en obesidad refractaria a tratamiento médico: fundamentos y resultados / Total open gastrectomy or laparoscopy in refractory obesity to medical treatment

Se presenta la experiencia protocolizada de 375 pacientes con obesidad grave refractaria a tratamiento médico, que han sido sometidos a gastrectomía casi total de 98 por ciento con reservorio de 20 ml. y asa yeyunal desfuncionalizada en Y de Roux de 150 cm. ya sea por abordaje abierto o por laparoscopía, basados en la experiencia publicada de los riesgos que representa dejar un estómago ciego abandonado. Los resultados muestran que el método es muy eficaz para manejar en forma definitiva la obesidad y que puede ser realizado por vía laparoscópica. Sin embargo, dado que tiene riesgos de morbilidad relacionados con la técnica quirúrgica, debe ser realizado por grupos con experiencia en cirugía gastro-esofágica, que sepan manejar oportuna y adecuadamente las complicaciones, bajo protocolos de estudio, con pacientes debidamente informados y en el marco de un trabajo trans-disciplinario que involucre a otros profesionales de la salud, tanto para el manejo inmediato del paciente operado como para su seguimiento y control alejado.

Inoculación experimental en ratas con amebas de vida libre potencialmente patógenas (AVLPP) aisladas de piscinas públicas de Santiago de Chile / Experimental inoculation in rats with isolated potentially pathogens amoebas of free life (PPAFL) from public swimmings pools of Santiago of Chile

Las amebas de vida libre (AVL) han sido descritas en numerosas publicaciones por la propiedad patogénica que ellas tienen. La AVL Naegleria fowleri, ha sido identificada como el principal agente causal de meningo-encefalitis amebiana primaria (MAP). En nuestro medio se dio a conocer la presencia de amebas de vida libre en fuentes acuáticas de algunas zonas de Chile. El primer hallazgo de Acanthamoeba en muestras de pacientes con queratitis en nuestro país, también fue reportado. Por estos antecedentes se decidió investigar la patogenicidad de AVLPP, aisladas en piscinas públicas de Santiago, mediante la inoculación experimental en ratas. Se utilizaron 32 ratas variedad suiza albina. A 24 de ellas, se les instiló 0.04 ml de suspensión de AVLPP en la nariz. Se hizo el mismo procedimiento de instilación con solución de Page y con solución de E. coli a 8 ratas control. Se mantuvieron todas en iguales condiciones ambientales. De las 32 ratas inoculadas, 6 fallecieron antes de los 30 días. A éstas se les extrajo el cerebro y se practicó estudio histopatológico y de cultivo del macerado. 3 de ellas dieron examen directo (-) y cultivo (+) a Naegleria sp. Las otras 3 dieron cultivo y examen directo (-). Las 26 ratas sobrevivientes fueron sacrificadas a los 30 días. Se les realizó el mismo procedimiento de estudio histopatológico y cultivo, los que dieron resultados negativos. Lo anterior indicaría que la patogenicidad de Acanthamoeba sp. y Naegleria sp. inoculadas, en concordancia con estudios previos, es de sólo algunas cepas y no de todas las especies