Considerações nutricionais para cirurgia plástica em paciente após cirurgia bariátrica / Nutritional considerations for plastic surgery in post-bariatric surgery patients

A cirurgia bariátrica continua a ser o tratamento mais efetivo para obesidade mórbida e a mais associada a outras condições metabólicas tais como diabetes tipo 2, doença refluxo gastroesofágico, e apneia do sono obstrutiva. Na população obesa, deficiências nutricionais comuns incluem vitaminas A, C, D, e B12, folato, tiamina, ferro, ferritina, zinco e selênio. Com a perda de peso ponderal, muitos pacientes podem utilizar o contorno corporal para deformidades. Após perda de peso ponderal seguida de cirurgia bariátrica, os pacientes geralmente desenvolvem deficiência nutricional significante que aumenta o risco de morbidade e mortalidade pós-operatória com quaisquer cirurgias subsequentes. Alguns pacientes requererem avaliação adicional durante a doença, ou quando candidatos eletivos pré-cirurgia, devido a alterações no trato alimentar com objetivo de melhorar os resultados e prevenir complicações devido a deficiências nutricionais.

Bariatric surgery continues to be the most effective treatment for morbid obesity and most other associated metabolic conditions such as type 2 diabetes mellitus, gastroesophageal reflux disease, and obstructive sleep apnea. In the obese population, common nutritional deficiencies include vitamins A, C, D, and B12, folate, thiamine, iron, ferritin, zinc, and selenium. With massive weight loss, many patients may utilize body contouring for deformities. After massive weight loss following bariatric surgery, patients often develop significant nutritional deficiencies that increase the risk of postoperative morbidity and mortality with any subsequent surgeries. Some unique patients will require additional evaluation during illness or when considering elective surgery due to alterations to the alimentary tract, in order to optimize outcomes and prevent complications from nutritional deficiencies.

Influence of obesity and surgical weight loss on thyroid hormone levels.

BACKGROUND: The pathophysiologic relationship between morbid obesity and thyroid hormones is not well understood. The goal of this study was to evaluate the influence of obesity and weight reduction after bariatric surgery on thyroid hormone levels. METHODS: Patients who underwent gastric bypass or adjustable gastric banding at our institution, had no previous diagnosis of thyroid disorder, were not taking medication that could affect the thyroid function evaluation, and who were nonsmokers were included in this retrospective evaluation. The association between the thyroid-stimulating hormone (TSH) and free thyroxine (T(4)) levels and body mass index (BMI), and the influence of weight loss after bariatric surgery on these hormones were investigated at different points (preoperatively and 6 and 12 months after bariatric surgery). RESULTS: A total of 86 patients met the study criteria. The TSH levels correlated positively with BMI (P <.001, r = .91) within the BMI range of 30-67 kg/m(2). The mean BMI change from 49 to 32 kg/m(2) after bariatric surgery was associated with a mean reduction in the TSH level from 4.5 to 1.9 microU/mL. Free T(4) showed no association with BMI and was not significantly influenced by weight loss. Before bariatric surgery, 10.5% of the subjects had laboratory values consistent with subclinical hypothyroidism. After bariatric surgery, 100% of these patients experienced significant weight reduction with simultaneous resolution of their subclinical hypothyroidism. CONCLUSION: The results of our study have demonstrated a statistically significant positive association between serum TSH within the normal range and BMI. No association was found between BMI and free T(4) serum levels. The prevalence of subclinical hypothyroidism in study group was 10.5%. Weight loss after bariatric surgery improved or normalized thyroid hormone levels.

Intermittent pneumatic compression as an adjuvant therapy in venous ulcer disease.

Despite improvements in healing rates venous ulcer disease still carries significant morbidity and cost. Any therapy that further improves healing rates is worthy of consideration. The recognised effects of intermittent pneumatic compression (IPC) on both arterial and venous circulation suggest that its use may confer significant benefits to venous ulcer healing. This study investigates the potential additive effects of adjuvant IPC on the healing and subsequent prevention of venous ulcers. Some improvement in the rate of healing in venous ulcers is noted. These findings are set against a background of very high healing rates in both treatment and control groups. No benefit is seen to accrue if IPC is used as an adjuvant therapy to help prevent recurrence of ulcers although the study period is very short.