Effects of Two Preoperatory Weight Loss Diets on Hepatic Volume, Metabolic Parameters, and Surgical Complications in Morbid Obese Bariatric Surgery Candidates: a Randomized Clinical Trial.

OBJECTIVE: To assess which type of preoperative dietary strategy is most effective in reducing liver volume and assessing its influence on different biochemical parameters and on surgical complications in individuals undergoing bariatric surgery. METHODS: Parallel randomized trial comparing the effect of a very low calorie diet (VLCD) and a low calorie diet (LCD) for a period of 21 days before surgery on hepatic volume, anthropometric and biochemical parameters. Compliance and tolerance to the diets, surgical complications, and hospital stay were also determined. RESULTS: Eighty-six morbid obese participants undergoing bariatric surgery were randomized. The hepatic volume was significantly reduced in both intervention groups, but no differences in changes between groups were detected. The reduction in the hepatic volume was higher in those patients with a baseline hepatic volume > 3 L compared to those with < 3 L (adjusted P value < 0.001). The percentages of total weight lost were 5.8 and 4.2% (adjusted P value = 0.004) for participants on the VLCD and LCD, respectively. There were no differences between groups for any of the biochemical parameters analyzed, nor in the number of surgical complications nor the length of hospital stay. Adherence to the diet was good; nevertheless, participants in the VLCD intervention showed worse tolerance. CONCLUSIONS: In subjects with morbid obesity undergoing bariatric surgery, compared to a LCD, a preoperative 21-day intervention with VLCD is more effective in terms of reducing total body weight but not in terms of reducing the liver volume. Both types of preoperative diets have similar effects on clinical biochemical parameters, rate of surgical complications, and hospital length stay.

Morbid obesity: postsurgical predictive factors and prioritization of the waiting list.

AIM: To study a sample of patients with morbid obesity who are on the waiting list for a surgical intervention, to establish various scores of surgical risk (Possum and severity score), and to assess potential criteria for list prioritization. DESIGN: We calculated physiological and surgical Possum scores for every patient, and analysed comorbidities and other associated factors to calculate the severity score. Likewise, we calculated the predictive rates of morbimortality. Differences between associated comorbidities in body mass index (BMI) were also analyzed. The correlation between Possum score, prediction rates, and severity score were analyzed. PATIENTS: Fifty-two patients on the surgical waiting list in our institution (San Juan University Hospital, Reus) from 26/4/02 to 5/03/04. RESULTS: The mean qualitative score is significantly higher in the female sex. Invalidating arthropathy and socio-occupational and/or psychiatric criteria are significantly higher in women. There is a significant correlation between the severity score and Possum score. Age does not correlate with any of the variables studied. CONCLUSIONS: Possum scores are significantly related to BMI, particularly in terms of morbidity rates. The degree of correlation between the Possum score and the qualitative score tells how useful the latter is to cover other determinant factors in the severity of this condition. Socio-occupational and psychiatric criteria, and invalidating arthropathy are the main variables to be taken into account for postsurgical prediction, and are directly related to BMI degree.

[Relationship between microalbuminuria and diabetic retinopathy in type 1 diabetes mellitus]. / Estudio de relación entre microalbuminuria y retinopatía diabética en la diabetes mellitus tipo 1.

Prospective studies focusing on the relationship between diabetic retinopathy and the presence of microalbuminuria are lacking. The objective of the present study was to determine the potential relationship between both forms of diabetic microangiopathy by means of a five-year long prospective study in which 104 patients with type 1 diabetes mellitus and with no retinal involvement at the beginning of the study were included. At the end of the study four groups of patients emerged: group 1, made up of 63 patients without both retinal involvement and microalbuminuria; group 2, made up of 17 patients with both retinopathy and microalbuminuria; group 3, with 16 patients with retinopathy but without microalbuminuria, and group 4, with eight patients with microalbuminuria only. In the statistical study, a direct significance was observed for both increased levels of HbA1c and total cholesterol; and a reverse significance for increased levels of HDL-cholesterol as well as the presence of diastolic arterial hypertension, for group 2 (patients with both retinopathy and microalbuminuria). For group 3, increased levels of triglycerides and evolution time (patients with retinopathy but without microalbuminuria) were significant. In the present study we conclude that microalbuminuria is not a good marker for diabetic microangiopathy defined as renal and retinal involvement, although its presence prompt us to watch more frequently the ocular fundus in diabetic patients.

[Epidemiologic study of diabetic retinopathy in a primary care unit]. / Estudio epidemiológico de retinopatía diabética, en un área básica de salud.

PURPOSE: To determine the prevalence of diabetic retinopathy and associated risk factors in the Riudoms population. METHODS: Transversal study of prevalence of diabetic retinopathy in 283 patients of 305 identified with type II diabetic mellitus patients, in the primary care unit of Riudoms. RESULTS: The prevalence of diabetic retinopathy is 24,4%, the significant risk factors are diabetes duration, insulin treatment, HbA1c high levels, microalbuminury association, and in inverse mode high cholesterol-HDL levels. The microalbuminury is associated with diabetic retinopathy but not the inverse. CONCLUSION: The prevalence of diabetic retinopathy in the type II diabetes patients of the present study is 24,4%. The significative risk factors are diabetic time evolution, insulin treatment, HbA1c high levels, microalbuminury association, and in inverse mode high cholesterol-HDL levels.

[Long-term survival in rhino-mucormycosis after conservative treatment]. / Rinomucormicosis supervivencia a largo plazo tras tratamiento conservador.

OBJECTIVE/METHODS: We describe a case of rhino-mucormycosis, in a 52-year-old male, with diabetes mellitus type 2, III cranial nerve palsy and blindness due to obliteration of central retinal artery and vein of the right eye The patient was treated with anfotericin B and necrotic tissues exeresis of nasal and paranasal (ethmoidal, maxillar and esfenoidal) sinuses, without orbital exenteration. RESULTS/CONCLUSIONS: After a follow up of five years, no type of relapse was detected, but neovascular glaucoma developed.

[Macroamylasemia in the differential diagnosis of acute pancreatitis]. / La macroamilasemia en el diagnóstico diferencial de la pancreatitis aguda.

The presence of macroamylasemia should be considered in the differential diagnosis of hyperamylasemia associated with acute abdominal pain, with suspect of pancreatitis. This uncommon and poorly known abnormality is defined as a blinding of serum amylase to certain proteins forming a circulating macrocomplex which prevents renal clearance of serum amylase. Two clinical cases as well as a review of this rare entity are here reported.