Obesity and gastro-esophageal reflux disease: a 2009 update.

The reports describing that obesity per se predisposes to gastroesophageal reflux disease (GERD) have brought conflicting results. Establishing a causal link between these two conditions would be of major public health importance, because of their present epidemic proportions. To date, some large studies examining the relationship between obesity and GERD found a strongly positively relationship while others did not. The main cause of this discordance is the vast heterogeneity of such studies: sufficiently powerful design is found only in few investigations, GERD is defined with a low degree of homogeneity, biases are obvious in the choice of diagnostic methods, thus giving room for large variations in the adjustment of potential confounding factors. Future research should take three directions: 1) prospective population-based studies in which the incidence or recurrence of GERD should be evaluated in correlation with body mass index; 2) intervention trials, focusing on the benefit of weight loss in the prevention of GERD and its recurrence; 3) studies of physiopathology (both in the animal models and humans) to understand the potential biological plausibility.

[Endoscopic gastrostomy in patients with complicated heart diseases]. / Gastrostomia endoscópica em pacientes com cardiopatia complicada.

Complicated cardiologic patients with brain ischemia and heart failure need long term enteral nutrition. Long term nasoenteral tube feeding may cause complications that could be avoided with percutaneous endoscopic gastrostomy. The aim of this study was to evaluate the indications for percutaneous endoscopic gastrostomy and its main complications. Twelve patients were submitted to percutaneous endoscopic gastrostomy (eight male) with main age of 62.42 +/- 22.10 years old. Brain ischemia was the main indication of percutaneous endoscopic gastrostomy and occurred after 35.58 +/- 26.79 days, after initiated enteral nutrition. There were no complications during procedure. On late post operatory period there were local infection in one cases, treated with local care. In conclusion, percutaneous endoscopic gastrostomy is a secure technique with low incidence of complications and its indication should be earlier.

[Effect of total++ time of extracorporeal circulation in in myocardial revascularization surgery on urinary urea nitrogen loss]. / Efeito do tempo total de circulação extracorpórea em cirurgia de revascularização miocárdica sobre a perda urinária de nitrogênio na forma de uréia.

Cardiopulmonary bypass probably should be an important factor increasing surgical stress when heart surgery is focused. This study was undertaken in order to evaluate the role of cardiopulmonary bypass in proteic catabolism. Study group consisted of patients who underwent cardiac aortic bypass graft as an isolated procedure. Inclusion criteria were elective surgery and absence of comorbidities after a rigorous preoperatory evaluation. One hundred and five patients were studied prospectively and urinary nitrogen loss was measured in the first 24 hour postoperative period. Operations performed were standard cardiopulmonary bypass procedures, under cardiopulmonary bypass, moderate hypothermia and hemodilution. Saphenous veins and mammary artery grafts were performed in all cases. Correlation and multiple linear regression were used. There was found no correlation between urinary nitrogen loss and age, gender and time under cardiopulmonary bypass. A positive correlation was found between number of grafts and increased urinary nitrogen loss. Further studies comparing cardiac aortic bypass graft with and without cardiopulmonary bypass are suggested.

Terapia nutricional em transplante cardíaco / Nutritional therapy in heart transplantation

Os casos graves de miocardiopatias com indicaçäo cirúrgica de transplante cardíaco necessitam de rigoroso cuidado nutricional. A avaliaçäo desses pacientes, baseada em parâmetros clínicos, laboratoriais e exames especializados, constitui a base do sucesso da dietoterapia aplicada. Na formulaçäo dietética, configura-se a necessidade de rigoroso aporte protéico, controle glicídio baseado nos parâmetros clínicos e laboratoriais e restriçäo lipídica relativa. O acompanhamento requer a interaçäo multiprissional que atua nas decisöes e orientaçöes no pós-transplante imediato e ambulatorial.