Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass.

BACKGROUND: The failure of approximately 20 % of obese patients who undergo Roux-en-Y gastric bypass (RYGB) to maintain weight loss over the following 18-24 months is related to the surgical procedure, to the patient, or both. Although the underlying mechanisms are uncertain, one factor that has been postulated is the dilation of the gastrojejunal anastomosis. The objective was to evaluate the safety and efficacy of the serial use of argon plasma coagulation (APC) in reducing the diameter of the dilated gastrojejunal anastomosis and post-RYGB weight regain. METHODS: We carried out a prospective, nonrandomized study of 30 patients, with no control or sham group, monitoring RYGB weight regain associated with dilation of the gastrojejunal anastomosis over a postoperative period of 18 months. Each patient underwent three sessions of APC in the anastomosis separated by 8 weeks, with a final endoscopic examination 8 weeks after the last session. RESULTS: There was a loss of 15.48 kg (range = 8.0-16.0 kg) of the 19.6 kg (range = 7.0-39.0 kg) of regained weight after RYGB and a reduction of 66.89 % in the final anastomotic diameter, with statistically significant reductions between each APC session. Previous body mass index significantly decreased up to the final examination, and the final weight was close to but not at the same level as the nadir. CONCLUSIONS: Our study indicates that the use of APC to treat weight regain after RYGB is a safe and effective procedure and promotes a reduction in gastrojejunal anastomosis, final weight, and BMI, with a low rate of complications.

Leiomiossarcoma de estômago / Leiomyosarcoma of the stomach

The gastrointestinal tract musculature tumors are uncommon, this is the reason why we considered important to describe an occurence of stomach leiomyosarcoma in a 56 year-old male patient who presented abdominal pain and weight loss. The endoscopic biopsy did not define the tumor hsitologic type, but permitted a malignant neoplasm diagnosis. In the exploratory laparotomy a large ulcerated gastric tumor was noticed. It was infiltrated and with areas of necrosis. A total gastrectomy and transit reconstruction with a Roux-in-Y limb was acomplished. The histopathological study detected a stomach leiomyosarcoma

Insulinoma na gravidez: apresentaçäo de um caso / Insulinoma in the pregnancy

Relata-se o caso de uma paciente de 22 anos, sofrendo de hipoglicemia devido a um insulinoma durante o primeiro trimestre de gravidez. O diagnóstico foi estabelecido somente 9 meses após o parto. Durante a gestaçäo, o nível de glicose foi mantido através do aumento de ingestäo de açucares e, quando necessário, infusäo intravenosa de glicose. Após o retorno da paciente ao hospital, o diagnóstico foi estabelecido clinicamente e através da demonstraçäo de hipoglicemia, hiperinsulinismo inapropriado, CT, USG e arteriografia. Um tumor de 2cm foi removido da cabeça do pâncreas e os níveis sanguíneos de açucar e secreçäo de insulina voltaram ao normal

Servico de emergencia hospitalar e assistencia ao politraumatizado / Hospital emergency service and care for the severily injured patient

A assistencia ao politraumatizado ocorre em tres etapas: no local do acidente, durante o transporte e no hospital. No entanto , em nosso pais, as duas primeiras fases somente acontecem de modo eventual ou entao em situacoes regionais da excecao, que se revestem de carater pioneiro. Assim, na quase totalidade dos casos, o atendimento inicial e feito no Servico de Emergencia, cuja organizacao e funcionamento sao analisados pelos autores. A fisiopatologia do trauma e delineada e os principios basicos assistenciais sao descritos em tres etapas: avaliacao secundaria e diagnostico definitivo...

Diverticulose de jejuno associada a tumor de ceco / Jejunal diverticulosis associated with cecal neoplasm

É apresentado o caso de um paciente portador de diverticulose jejunal adquirida associada a um adenocarcinoma de ceco. Säo discutidas as formas de divertículos, os aspectos clínicos e radiológicos, além das complicaçöes. Sua baixa incidência relaciona-se com as dificuldades diagnósticas e ao quadro clínico habitualmente inespecífico ou ausente