A Spanish Society joint SECO and SEEDO approach to the Post-operative management of the patients undergoing surgery for obesity.

PURPOSE: Bariatric surgery is the method of choice for the management or treatment of obesity. Bariatric surgery brings about several physiological changes in the body and is associated with set of complications. The aim of this study is to provide guidelines on post bariatric surgery management based on consensus by the Spanish society for Obesity Surgery (Sociedad Española de Cirugía de la Obesidad) (SECO) and the Spanish Society for the Study of Obesity (Sociedad Española para el Estudio de la Obesidad) (SEEDO). METHOD: The boards proposed seven experts from each society. The experts provided the evidence and a grade of recommendation on the selected topics based on systematic reviews/meta-analysis. A list of clinical practical recommendations levels of evidence and grades of these recommendations was derived from the consensus statements from the members of these societies. RESULTS: Seventeen topics related to post-operative management were reviewed after bariatric surgery. The experts came with 47 recommendations and statements. The mean number of persons voting at each statement was 54 (range 36-76). CONCLUSION: In this consensus, we have designed a set of guidelines to be followed while managing patients after bariatric surgery. Expertise and knowledge of the clinicians are required to convey suitable considerations to the post-bariatric patients. There should also be extensive follow-up plans for the bariatric surgery patients.

Tratamiento quirúrgico de la obesidad mediante “banda gástrica ajustable” por vía la paroscópica. Una técnica posible en los programas de CMA / No disponible

Objetivo: Exponer nuestra experiencia en el tratamiento quirúrgico de la obesidad mediante banda gástrica ajustable por la paroscopia (BGAL) dentro de un programa de cirugía de corta estancia. Pacientes y método: Entre junio de 2006 y diciembre de2007 fueron intervenidos de forma consecutiva 57 pacientes obesos mediante la técnica de BGAL. Los criterios de selección utilizados para establecer la indicación quirúrgica se basan en los establecidos por el Instituto Nacional de Salud americano y en la declaración de Salamanca de la Sociedad Española de Cirugía de la Obesidad (SECO). Las variables analizadas son: tiempo quirúrgico, tiempo de cumplimiento de criterios de alta en CMA, tiempo de estancia postoperatoria, tiempo de estancia total (desde el ingreso hasta el alta) y complicaciones. Resultados: Todos los pacientes fueron dados de alta dentro de las 24 horas postoperatorias. La estancia hospitalaria postoperatoria fue de 13 horas (11-20). La estancia media total fue de 20 horas (con una noche). El tiempo medio de cumplimiento de los criterios de alta fue de 6 horas. El tiempo quirúrgico medio fue de 118 minutos (80-164). No se registró ninguna complicación intraoperatoria. No hubo reconversiones, reintervenciones, reingresos o complicaciones en los 30 primeros días postoperatorios. Hubo un caso de rotación del reservorio subcutáneo, que obligó a reposición amiento bajo anestesia local, así como tres disfunciones esofágicas. Conclusiones: La intervención de BGAL, realizada por equipos multidisciplinares dedicados específicamente a la obesidad mórbida, puede desarrollarse dentro de programas de cirugía de corta estancia y CMA. La mayoría de pacientes cumplen los criterios de alta en las 6 primeras horas postoperatorias (AU)

Objective: To show our experience in the laparoscopic surgical treatment of obesity using the adjustable gastric band (AGBL) included in a program for day surgery .Patients and method: Between June 2006 and December 2007 we performed the procedure on 57 obese patients, consecutively, using the AGBL technique. The selection criteria used to establish the surgical indications is based on the American National Institute of Health and the SECO. The variables analyzed were: surgical time, time until discharge criteria are met, time spent in hospital post surgery, the overall time of hospital stay (from admittance until leaving) and complications. Results: All patients were discharged within 24 hours postsurgery. The hospital postoperative stay was 13 hours (r:11-20 h). The total average period of time spent in the hospital was 20 hours (with one night). Average time before reaching discharge criteria was 6 hours. Average surgical time was 118 min (r:80-164 m). We have not registered any intra-operative complications. No reconversions. No re-operations No re-admissions to hospital. No complications during the first 30 day spost surgery. 1 case of subcutaneous port rotation of reservoir that required a repositioning under local anesthesia. 3 esophageal disfuntions. Conclusions: The AGBL procedure performed by multidisciplinary teams dedicated specifically to the treatment of morbid obesity can be included in a program for ambulatory surgery. Most patients recover and are discharged before the anticipated 6 postsurgical hours (AU)

The uptake inhibitors cocaine and benztropine differentially alter the conformation of the human dopamine transporter.

The binding affinity of the cocaine analog [(3)H]2 beta-carbomethoxy-3beta-(4-fluorophenyl) tropane (WIN) for the dopamine transporter (DAT) is increased by the reaction of Cys-90, at the extracellular end of the first transmembrane segment, with methanethiosulfonate (MTS) reagents. Cocaine enhances the reaction of Cys-90 with the sulfhydryl reagents, thereby augmenting the increase in binding. In contrast, cocaine decreases the reaction of Cys-135 and Cys-342, endogenous cysteines in cytoplasmic loops, with MTS reagents. Because this reaction inhibits [(3)H]WIN binding, cocaine protects against the loss of binding caused by reaction of these cysteines. In the present work, we compare the abilities of DAT inhibitors and substrates to affect the reaction of Cys-90, Cys-135, and Cys-342 with MTS ethyltrimethylammonium (MTSET). The results indicate that the different abilities of compounds to protect against the MTSET-induced inhibition of binding are attributable to differences in their abilities to attenuate the inhibitory effects of modification of Cys-135 and Cys-342 as well as to enhance the reaction with Cys-90 and the resulting potentiation of binding. The inhibitor benztropine was unique in its inability to protect Cys-135. Moreover, whereas cocaine, WIN, mazindol, and dopamine enhanced the reaction of Cys-90 with MTSET, benztropine had no effect on this reaction. These two features combine to give benztropine its weak potency in protecting ligand binding to wild-type DAT from MTSET. These results indicate that different inhibitors of DAT, such as cocaine and benztropine, produce different conformational changes in the transporter. There are differences in the psychomotor stimulant-like effects of these compounds, and it is possible that the different behavioral effects of these DAT inhibitors stem from their different molecular actions on DAT.

[3H]MFZ 2-12: a novel radioligand for the dopamine transporter.

In an effort to develop a tritiated dopamine transporter radioligand with higher affinity than the widely used [(3)H]WIN 35,428, we have synthesized [(3)H]2beta-carbomethoxy-3beta-(3',4'-dichlorophenyl)tropane ([(3)H]MFZ 2-12). Unlabeled MFZ 2-12 and the N-demethylated intermediate (MFZ 2-13) inhibited dopamine uptake by the human dopamine transporter with IC(50)'s of 1.1 and 1.4nM, respectively. The N-nor-intermediate (MFZ 2-13) was treated with CT(3)I resulting in [(3)H]MFZ 2-12; S.A.=80 Ci/mmol). [(3)H]MFZ 2-12 reversibly bound with a K(D) of 2.8nM to human dopamine transporter expressed heterologously in EM4 cells.

Reaction of oxidized dopamine with endogenous cysteine residues in the human dopamine transporter.

There is evidence to suggest that dopamine (DA) oxidizes to form dopamine ortho-quinone (DAQ), which binds covalently to nucleophilic sulfhydryl groups on protein cysteinyl residues. This reaction has been shown to inhibit dopamine uptake, as well as other biological processes. We have identified specific cysteine residues in the human dopamine transporter (hDAT) that are modified by this electron-deficient substrate analog. DAQ reactivity was inferred from its effects on the binding of [(3)H]2-beta-carbomethoxy-3-beta-(4-fluorophenyl)tropane (beta-CFT) to hDAT cysteine mutant constructs. One construct, X5C, had four cysteines mutated to alanine and one to phenylalanine (Cys(90)A, Cys(135)A, C306A, C319F and Cys(342)A). In membrane preparations 1 mM DAQ did not affect [(3)H]beta-CFT binding to X5C hDAT, in contrast to its effect in wild-type hDAT in which it reduced the B:(max) value by more than half. Wild-type cysteines were substituted back into X5C, one at a time, and the ability of DAQ to inhibit [(3)H]beta-CFT binding was assessed. Reactivity of DAQ with Cys(90) increased the affinity of [(3)H]beta-CFT for the transporter, whereas reactivity with Cys(135) decreased the affinity of [(3)H]beta-CFT. DAQ did not change the K:(D) for [(3)H]beta-CFT binding to wild-type. The reactivity of DAQ at Cys(342) decreased B:(max) to the same degree as wild-type. The latter result suggests that Cys(342) is the wild-type residue most responsible for DAQ-induced inhibition of [(3)H]beta-CFT binding.

Amphetamine-induced loss of human dopamine transporter activity: an internalization-dependent and cocaine-sensitive mechanism.

The dopamine transporter (DAT) is a target of amphetamine (AMPH) and cocaine. These psychostimulants attenuate DAT clearance efficiency, thereby increasing synaptic dopamine (DA) levels. Re-uptake rate is determined by the number of functional transporters at the cell surface as well as by their turnover rate. Here, we present evidence that DAT substrates, including AMPH and DA, cause internalization of human DAT, thereby reducing transport capacity. Acute treatment with AMPH reduced the maximal rate of [(3)H]DA uptake, decreased AMPH-induced currents, and significantly redistributed the immunofluorescence of an epitope-tagged DAT from the plasma membrane to the cytosol in human embryonic kidney 293 cells. Conversely, DAT inhibitors, such as cocaine, mazindol, and nomifensine, when administered with AMPH, blocked the reduction in [(3)H]DA uptake and the redistribution of DAT immunofluorescence to the cytosol. The reductions of [(3)H]DA uptake and AMPH-induced DAT internalization also were inhibited by coexpression of a dominant negative mutant of dynamin I (K44A), indicating that endocytosis modulates transport capacity, likely through a clathrin-mediated pathway. With this mechanism of regulation, acute application of AMPH would reduce DA uptake not only by direct competition for uptake, but also by reducing the available cell-surface DAT. Moreover, AMPH-induced internalization might diminish the amount of DAT available for DA efflux, thereby modulating the cytotoxic effects of elevated extracellular DA.

Tratamiento quirúrgico de la obstrucción intestinal aguda por cáncer colorrectal. experiencia reciente en 1994-1998 / Surgical treatment of acute intestinal obstruction due to colorectal cancer: recent experience occurring between 1994 and 1998

Introducción. Estudiamos prospectivamente la morbimortalidad de la cirugía urgente por obstrucción intestinal secundaria a cáncer colorrectal en 5 años (1994-1998).Pacientes y método. Incluimos a todos los pacientes tratados en este período, seleccionando la técnica de acuerdo con el riesgo del paciente y el estado del colon. Resultados. Fueron intervenidos de urgencia por obstrucción completa 60 pacientes (un 17 por ciento de todos los cánceres colorrectales intervenidos en el servicio) de los que 12 fueron de colon derecho, 45 de colon transverso e izquierdo y tres de recto. Se realizaron 50 resecciones de colon: 44 con anastomosis primaria (colectomía derecha, izquierda, segmentaria, resección anterior de recto, y colectomía subtotal) y 6 intervenciones de Hartmann, así como 9 colostomías de descarga o derivación ileocólica y una tumorectomía. Se realizó lavado anterógrado del colon en 11 de 25 pacientes candidatos a ello por resección de tumores de colon izquierdo sin colostomía. La mortalidad operatoria fue de 3 pacientes (5 por ciento) y la morbilidad del 45 por ciento, con una estancia media de 17 días. Se produjeron 2 fístulas anastomóticas que no precisaron reintervención. Conclusiones. Seleccionando la técnica quirúrgica según el estado del paciente se pueden obtener buenos resultados de morbimortalidad en estos enfermos, a pesar de realizar resección y anastomosis, sin colostomía, en la mayoría de los casos (AU)

Transport-dependent accessibility of a cytoplasmic loop cysteine in the human dopamine transporter.

The effect of covalent sulfhydryl modification on dopamine uptake by the human dopamine transporter was determined by rotating disc electrode voltammetry. A transporter construct, X5C, with five mutated cysteines (C90A, C135A, C306A, C319F, and C342A) and the constructs into which the wild-type cysteines were substituted back into X5C, one at a time, all showed nearly normal binding affinity for [(3)H]CFT and for cocaine, but they displayed significant reductions in K(m) and V(max) for DA uptake. Reaction of Cys-90 or Cys-306 with impermeant methanethiosulfonate derivatives enhanced dopamine uptake to a similar extent as the previously observed enhancement of [(3)H]CFT binding caused by the same reaction, suggesting that cocaine may bind preferentially to a conformation in the transport cycle. m-Tyramine increased the rate of reaction of (2-aminoethyl)methanethiosulfonate (MTSEA) with X-A342C, the construct with a cytoplasmic loop residue Cys-342 restored. This m-tyramine-induced increase in reactivity appeared to require the inward transport rather than the outward transport or external binding of m-tyramine, and it was prevented by cocaine. Thus, inward translocation of substrates may involve structural rearrangement of hDAT, which likely exposes Cys-342 to reaction with MTSEA, and Cys-342 may be located on a part of the transporter associated with cytoplasmic gating.

Cocaine alters the accessibility of endogenous cysteines in putative extracellular and intracellular loops of the human dopamine transporter.

Cocaine and other psychostimulants act by blocking the dopamine transporter. Binding of the cocaine analog, [3H]2-beta-carbomethoxy-3-beta-(4-fluorophenyl) tropane (CFT) to the dopamine transporter is sensitive to polar sulfhydryl-specific derivatives of methanethiosulfonate (MTS). These reagents preferentially react with water-accessible, reduced cysteines. The human dopamine transporter has 13 cysteines. Their topology is not completely determined. We sought to identify those cysteine residues the modification of which affects CFT binding and to determine the topology of these reactive cysteines. We mutated each of the cysteines, one at a time and in various combinations, to residues that preserved binding and transport, and we tested the sensitivity of each of the mutant transporters to the reagents. One construct, X5C, had five mutated cysteines (C90A, C135A, C306A, C319F, and C342A). Using a membrane preparation in which both extracellular and intracellular cysteines could be accessible, we found that CFT binding in X5C, as compared with wild-type transporter, was two orders of magnitude less sensitive to MTS ethylammonium (MTSEA). The wild-type cysteines were substituted back into X5C, one at a time, and these constructs were tested in cells and in membranes. Cys-90 and Cys-306 appear to be extracellular, and Cys-135 and Cys-342 appear to be intracellular. Each of these residues is predicted to be in extramembranous loops. The binding of cocaine increases the rate of reaction of MTSEA and MTS ethyltrimethylammonium with the extracellular Cys-90 and therefore acts by inducing a conformational change. Cocaine decreases the rate of reaction of MTSEA with Cys-135 and Cys-342, acting either directly or indirectly on these intracellular residues.

The fission yeast UVDR DNA repair pathway is inducible.

In addition to nucleotide excision repair (NER), the fission yeast Schizosaccharomyces pombe possesses a UV damage endonuclease (UVDE) for the excision of cyclobutane pyrimidine dimers and 6-4 pyrimidine pyrimidones. We have previously described UVDE as part of an alternative excision repair pathway, UVDR, for UV damage repair. The existence of two excision repair processes has long been postulated to exist in S.pombe, as NER-deficient mutants are still proficient in the excision of UV photoproducts. UVDE recognizes the phosphodiester bond immediately 5'of the UV photoproducts as the initiating event in this process. We show here that UVDE activity is inducible at both the level of uve1+ mRNA and UVDE enzyme activity. Further, we show that UVDE activity is regulated by the product of the rad12 gene.

[Utilisation of organs proceeding from donors with heart failure: review of the pathogenesis of organic damage and the possible mechanisms of prevention]. / Utilización de órganos procedentes de donantes en parada cardíaca: revisión de la patogenia del daño orgánico y los posibles mecanismos de prevención.

There is an evident imbalance between the number of patients awaiting a kidney transplant and the availability of organs proceeding from donors with brain death. A high number of patients die each day from heart failure, whose organs could be used for transplants if specific care is employed. Although centres do exist where these methods of extraction are established, the problems of organic damage have yet to be resolved, since one third of the organs are still lost, besides the increase in the need for early dialysis, and the number of dysfunctioning grafts two years after the transplant, when this type or organ is employed. There is increasingly detailed knowledge of the pathogenesis of organic damage following heart failure and reanimation, as well as of the damage following the conservation and reimplantation of the kidney. Knowledge of the maximum time of hot ischemic that an organ can withstand is of crucial importance if organs are not to be unduly discarded. Besides, the increasing understanding of the physiopathology of oxidative stress could make it possible for us, through the use of antioxidants, to attempt to improve the utilisation of the organs and diminish the incidence of dysfunctions and rejections.