A modified laparoscopic sleeve gastrectomy for the treatment of diabetes mellitus type 2 and metabolic syndrome in obesity.

BACKGROUND: Ghrelin is a gastrointestinal peptide hormone (a 28-amino acid peptide) produced primarily by X/A cells in the oxyntic glands of the stomach fundus and cells lining the duodenum cavern. It suppresses insulin secretion and action and commands a significant role in regulating food intake. The aim of the present study was to show that modified laparoscopic sleeve gastrectomy (MLSG), in which a significant part of the gastric fundus and body of the stomach is removed up to 1 inch from the pylorus vein, may contribute to decreasing circulating ghrelin levels. METHODS: A study population consisting of 150 individuals was monitored after undergoing a MLSG, with individuals chosen based on a documented history of diabetes mellitus type 2 and metabolic syndrome, clinical results determining a body mass index (BMI) of 35 to 60 kg/m(2), peptide C level greater than 1, negative anti-glutamic acid decarboxylase, negative anti-insulin, and confirmed stability of drug/insulin treatment and glycosylated hemoglobin greater than 6.5% for at least 24 and 3 months, respectively, before enrollment. RESULTS: Twenty-four months after surgery, 150 patients (86.6%) presented with normal glycemic levels between 77 and 99 mg/dL. All patients improved average serum insulin levels by 9 mU/L and average glycosylated hemoglobin levels by 5.1% (normal range, 4%-6%). All patients tested negative for Helicobacter pylori and stopped using insulin, with 3 patients prescribed twice-daily use of an oral hypoglycemiant. In 14% of cases, patients experienced partial hair loss with low serum zinc levels and were prescribed oral zinc reposition and topical hair stimulants. The average weight loss recorded was 44.6% for patients with a BMI less than 45 kg/m(2) and 58% for patients with a BMI greater than 50 kg/m(2). CONCLUSIONS: The MLSG is a safe procedure with a low morbidity rate (2.7%) (4 cases of fistula and 2 of bleeding) and no surgical mortality in this study. This surgery can promote control of diabetes mellitus type 2 and aid the treatment of exogenous overweight and morbidly obese individuals. The results of this study show that only through resection of the ghrelin-producing gastric area can most obesity cases and diabetes type II conditions be reverted to nonobese and controlled diabetes.

Tratamento da síndrome do QT longo com a técnica de autotransplante cardíaco com preservaçäo do sistema de conduçäo / Treatment of long QT syndrome with the technique of heart transplantation with the conduction system preservation

A síndrome do QT longo é caracterizada por prolongaçao intermitente ou permanente do intervalo QT, taquicardias paroxísticas ventriculares (TVR) e morte súbita. Existem três casos publicados na literatura tratados cirurgicamente com a técnica do autotransplante cardíaco, com l paciente sobrevivente. Nos 3 casos foi necessária, após a operaçao, a utilizaçao de marcapasso átrio-atrial ou atrioventricular. No InCór, entre outubro de 1993 e maio de 1994, 3 pacientes portadores desta síndrome, l do sexo feminino e 2 do masculino, com idades, respectivamente, de lO, ll e 13 anos, foram submetidos a desnervaçao por autotransplante. No pré-operatório, apesar de dose máxima de beta-bloqueadores, os freqüentes episódios de taquicardia ventricular nao foram evitados. Com carga mínima o teste ergométrico provocava TVR. A retirada do órgao foi feita seccionando-se as veias cavas, aorta, tronco pulmonar e as veias pulmonares, com remanescente de átrio esquerdo. Assim, o sistema de conduçao permaneceu íntegro e o ritmo, sinusal. No pós-operatório os testes ergométricos realizados mostraram ausência de taquicardia ventricular. Considerando os resultados imediatos, julgamos que a técnica relatada de autotransplante cardíaco como método de completa desnervaçao pode ser empregada em pacientes portadores da síndrome do QT longo, com baixo risco cirúrgico e preservaçao do sistema de conduçao.