Novel application assigned to toluquinol: inhibition of lymphangiogenesis by interfering with VEGF-C/VEGFR-3 signalling pathway.

BACKGROUND AND PURPOSE: Lymphangiogenesis is an important biological process associated with the pathogenesis of several diseases, including metastatic dissemination, graft rejection, lymphoedema and other inflammatory disorders. The development of new drugs that block lymphangiogenesis has become a promising therapeutic strategy. In this study, we investigated the ability of toluquinol, a 2-methyl-hydroquinone isolated from the culture broth of the marine fungus Penicillium sp. HL-85-ALS5-R004, to inhibit lymphangiogenesis in vitro, ex vivo and in vivo. EXPERIMENTAL APPROACH: We used human lymphatic endothelial cells (LECs) to analyse the effect of toluquinol in 2D and 3D in vitro cultures and in the ex vivo mouse lymphatic ring assay. For in vivo approaches, the transgenic Fli1:eGFPy1 zebrafish, mouse ear sponges and cornea models were used. Western blotting and apoptosis analyses were carried out to search for drug targets. KEY RESULTS: Toluquinol inhibited LEC proliferation, migration, tubulogenesis and sprouting of new lymphatic vessels. Furthermore, toluquinol induced apoptosis of LECs after 14 h of treatment in vitro, blocked the development of the thoracic duct in zebrafish and reduced the VEGF-C-induced lymphatic vessel formation and corneal neovascularization in mice. Mechanistically, we demonstrated that this drug attenuates VEGF-C-induced VEGFR-3 phosphorylation in a dose-dependent manner and suppresses the phosphorylation of Akt and ERK1/2. CONCLUSIONS AND IMPLICATIONS: Based on these findings, we propose toluquinol as a new candidate with pharmacological potential for the treatment of lymphangiogenesis-related pathologies. Notably, its ability to suppress corneal neovascularization paves the way for applications in vascular ocular pathologies.

Pupila Argyll-Robertson / Argyll-Robertson pupil

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Development of type 2 diabetes mellitus thirty-one years after Billroth II in a patient asking for diabetes surgery / Desarrollo de diabetes mellitus tipo 2 treinta y un años después de Billroth II en un paciente que solicita cirugía de diabetes

Introduction: Diabetes surgery in obese and slim patients seems to be a superior alternative to the current medical treatment. Gastric bypass is an alternative treatment for diabetes. Nevertheless, there are still doubts whether diabetes can recur if you gain weight or if the effects are maintained over time. Other questions refer to the type of surgery to make the bypass limb length or reservoir size for the resolution of the Diabetes Mellitus. Presentation of case: Male patient 69-year-old came to us in order to perform tailored One Anastomosis Gastric Bypass (BAGUA) to treat his type 2 diabetes mellitus and metabolic syndrome. He has a history of peptic ulcer treated with subtotal gastrectomy and Billroth II reconstruction 49 years ago. He currently is not obese and developed diabetes 31 years after surgery. Discussion: Globally there are no reports of patients with normal BMI that after performing gastric bypass developed diabetes mellitus. There are cases where obese diabetic patients after gastric bypass improve or remits the T2DM, but it relapses due to insufficient weight loss or gain it. The patient with gastric bypass Billroth II type, should not developed diabetes. He is normal weight and not had weight gain that could be linked to the development of diabetes. Conclusions: The results generated by bariatric surgery are encouraging, but still do not clarify the precise way how surgery produces rapid improvement of systemic metabolism as in diabetes, but in our patient, the effect was quite different because the gastric bypass had no protective effect against diabetes (AU)

Introducción: La cirugía de la diabetes en pacientes obesos y delgados parece ser una alternativa superior al tratamiento médico actual. El bypass gástrico es un tratamiento alternativo al tratamiento médico actual. Sin embargo, todavía hay dudas sobre si la diabetes puede reaparecer si hay aumento de peso o si se mantienen los efectos en el tiempo. Otras preguntas se refieren al tipo de cirugía para hacer la longitud del remanente gástrico o el tamaño del reservorio para la resolución de la Diabetes Mellitus. Presentación del caso: Paciente masculino de 69 años de edad, vino a nosotros con el fin de realizar el bypass gástrico de una anastomosis a medida (BAGUA) para tratar su diabetes mellitus tipo 2 y el síndrome metabólico. Tiene antecedentes de úlcera péptica tratado con gastrectomía subtotal y reconstrucción tipo Billroth II hace 49 años. Actualmente él no es obeso y desarrolló diabetes 31 años después de la cirugía. Discusión: A nivel mundial no hay reportes de pacientes con IMC normal que después de realizar un bypass gástrico desarrollaron diabetes mellitus. Hay casos en que los pacientes diabéticos obesos después del bypass gástrico mejoran o remite la DMT2, pero reaparece debido a la pérdida de peso insuficiente o reganancia de él. El paciente con un bypass gástrico tipo Billroth II, no debió desarrollar diabetes. Él tiene peso normal y no ha aumentado de peso que podría estar relacionado con el desarrollo de diabetes. Conclusión: Los resultados generados por la cirugía bariátrica son alentadores, pero aún no aclaran la forma precisa cómo la cirugía produce una rápida mejoría del metabolismo sistémico como la diabetes, pero en nuestro paciente, el efecto fue muy diferente debido a que el bypass gástrico no tuvo un efecto protector contra la diabetes (AU)

Super obese behave different from simple and morbid obese patients in the changes of body composition after tailored one anastomosis gastric bypass (BAGUA).

INTRODUCTION: Super obese patients behave different from simple and morbid obese patients when they reach final changes of body composition (BC) after bariatric surgery. This has led us to tailor One Anastomosis Gastric Bypass (BAGUA) to achieve better results in this group of patients. PATIENTS AND METHODS: We studied 83 (37 diabetic and 46 nondiabetic BMI 30 and up) patients who completed all evaluation appointment (preoperative, 10 days, 1, 3, 6 and 12 months) after tailored BAGUA for diabesity. We used the Tanita body composition analyzer BC-420 MA by the method of single frequency impedance to analyze the evolution of BC in patients classified by BMI 30 - 34,9, 35 - 50, and >50. RESULTS: While preoperative excess weight presented dramatic decreases after tailored BAGUA in all the groups, super obese have different final BC. Diabetics retained more fat mass and visceral fat, where super obese have double (14 kg) that simple obese patients (6 kg), they lost more muscle mass, and have higher basal metabolism. The final BC is altered in all parameters if diabetes is added. CONCLUSIONS: The reduction of the preoperative excess weight is motivated largely by the tailored effect of BAGUA. Patients BMI 30-50 behaved homogeneous in BC after surgery while patients BMI >50 behave different. Super obese lose less weight, retained more fat mass, visceral fat, bone mass, and total water. This effect should be treated by more aggressive surgery by measuring the entire small intestine to make a proper exclusion (tailored) to achieve homogeneous effects.

Introducción: Los pacientes súper obesos se comportan de manera distinta a los pacientes con obesidad simple y obesidad mórbida cuando alcanzan los cambios finales de la composición corporal (CC) tras la cirugía bariátrica. Esto nos condujo a individualizar la anastomosis única de derivación gástrica (BAGUA) para conseguir mejores resultados en estos pacientes. Pacientes y métodos: Estudiamos a 83 pacientes (37 diabéticos y 46 no diabéticos, con IMC ≥30) que completaron todos las visitas de evaluación (preoperatorio, 10 días, 1, 3, 6 y 12 meses) tras la cirugía personalizada BAGUA para la obesidad. Empleamos el analizador de la composición corporal Tanita CC-420 MA mediante el método de impedancia de un única frecuencia para analizar la evolución de la CC en pacientes clasificados por el IMC 30 - 34,9, 35 - 50, y > 50. Resultados: Mientras que el exceso de peso preoperatorio mostró unas reducciones drásticas tras la cirugía BAGUA personalizada en todos los grupos, los súper obesos tuvieron una CC final diferente. Los diabéticos retuvieron más masa grasa y grasa visceral, mientras que los súper obesos mostraban el doble (14 kg) que los pacientes con obesidad simple (6 kg), perdieron más masa muscular y tuvieron un mayor metabolismo basal. La CC final se altera en todos sus parámetros si se añade la diabetes. Conclusiones: La reducción del exceso de peso preoperatorio está motivada en gran medida por el efecto de la cirugía BAGUA personalizada. Los pacientes con un IMC entre 30-50 se comportan de forma homogénea en la CC tras la cirugía mientras que los pacientes con un IMC > 50 se comportan diferentemente. Los súper obsesos pierden menos peso, retienen más masa grasa, grasa visceral, masa ósea y agua total. Este efecto debería tratarse con una cirugía más agresiva midiendo todo el intestino delgado para realizar una exclusión adecuada (personalizada) para conseguir unos efectos homogéneos.

Diabetes surgery: minimum information on diabetic patients sample BMI 24-29 or BMI 30-34 for doing studies comparable / Cirugía diabetes: Información mínima sobre la muestra de pacientes IMC 24-29 ó IMC 30-34 para hacer estudios compatibles

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Improvement of C peptide zero BMI 24-34 diabetic patients after tailored one anastomosis gastric bypass (BAGUA) / Mejoría de pacientes diabéticos péptido C cero IMC 24-34 tras bypass gástrico una anastomosis (BAGUA) tallado

Background: Although bariatric surgery proved to be a very effective method in the treatment of patients in whose pancreas still produce insulin (type 2 diabetes), the accompanied metabolic syndrome and their diabetes complications, there is no information on the effect of this type of surgery in BMI24-34 patients when pancreas do not produce insulin at all (type 1, LADA and long term evolution type 2 diabetes among others). Patients and methods: We report preliminary data of a serie of 11 patients all with a C-peptide values below 0.0 ng/ml. They were followed for 6 to 60 months (mean 19 months) after surgery. We studied the changes in glycemic control, evolution of the metabolic syndrome and diabetes complications after one anastomosis gastric bypass (BAGUA). Results: All values relative to glycemic control were improved HbA1c (from 8.9 ± 0.6 to 6.7 ± 0.2%), FPG (Fasting Plasma Glucose) [from 222.36 ± 16.87 to 94 ± 5 (mg/dl)] as well as the daily insulin requirement of rapid (from 40.6 ± 12.8 to 0 (U/d) and long-lasting insulin (from 41.27 ± 7.3 U/day to 15.2 ± 3.3 U/day). It resolved 100% of the metabolic syndrome diseases as well as severe hypoglycaemia episodes present before surgery and improved some serious complications from diabetes like retinopathy, nephropathy, neuropathy, peripheral vasculopathy and cardiopathy. Conclusions: Tailored one anastomosis gastric bypass in BMI 24-34 C peptide zero diabetic patients eliminated the use of rapid insulin, reduced to only one injection per day long-lasting insulin and improved the glycemic control. After surgery disappear metabolic syndrome and severe hypoglycaemia episodes and improves significantly retinopathy, neuropathy, nephropathy, peripheral vasculopathy and cardiopathy (AU)

Introducción: Aunque la cirugía bariátrica ha demostrado ser un método muy eficaz en el tratamiento de pacientes diabéticos cuyo páncreas aún es capaz de producir insulina (diabetes tipo 2), así como del síndrome metabólico y las complicaciones relacionadas con la diabetes, no hay información sobre el efecto de este tipo de cirugía en pacientes IMC 24-34 cuando el páncreas no produce insulina en absoluto (tipo 1, tipo LADA y diabetes tipo 2 de larga evolución, entre otros). Métodos: Presentamos datos preliminares de una serie de 11 pacientes todos con valores de Péptido C < 0,0 ng/ml. El seguimiento postoperatorio varia de 6 y 60 meses (media 19 meses). Estudiamos los cambios en el control de la glucemia, evolución del síndrome metabólico y complicaciones relacionadas con la diabetes tras bypass de una anastomosis (BAGUA). Resultados: Mejoraron todos los valores relativos al control glucémico HbA1c (de 8,9 ± 0,6 a 6,7 ± 0,2%), FPG (Glucosa Plasmática Ayunas) (de 222,36 ± 16,87 a 94 ± 5 (mg/dl)) así como el requerimiento diario de insulina, tanto de insulina rápida (de 40,6 ± 12,8 a 0 U/día) como de insulina retardada (41,27 ± 7,3 U/día a 15,2 ± 3,3 U/día). Se resolvieron el 100% de las comorbilidades estudiadas y se mejoraron algunas complicaciones graves derivadas de la diabetes como retinopatía o nefropatía. Conclusiones: El bypass gástrico de una anastomosis adaptado a pacientes diabéticos IMC24-34 con péptido C cero elimina el uso de insulina de acción rápida, reduce a una sola inyección diaria la insulina retardada y mejora el control glucémico. Tras la cirugía desaparecen el síndrome metabólico y los episodios severos de hipoglucemia, y mejora significativamente la retinopatía, neuropatía, nefropatía, vasculopatía periférica y cardiopatía (AU)

Influences of the diabetes surgery on pancreatic Beta-cells mass / Influencia de la cirugía de diabetes sobre la masa de células beta pancreáticas

In diabetes mellitus type 2 (DMT2), malfunction and apoptosis of β-cell provoke a deficient insulin secretion. Generally, has been sustained that β-cell function is severely compromised in type 2 diabetes before the disease appears and then continues to decrease linearly with time. Diversionary bariatric procedures such as gastric bypass, biliopancreatic diversion, one anastomosis gastric by-pass (BAGUA) and others that bypasses the foregut, induce a rapid non-weight-loss-associated improvement in glycemic control, especially if treated early before irreparable β-cell damage has occurred. The antidiabetic effect of bariatric operations is likely due to the improvement in the hormonal dysregulation associated with the development of diabetes. Now we know that the bariatric surgery through the reorganization of the gastrointestinal tract can affect to β-cells mass homeostasis, stopped apoptosis and stimulate the replication and neogenesis. These effects are caused mainly by three stimuli: caloric restriction, rapid transit of food to the ileum and the exclusion of an intestinal portion including the stomach, duodenum and part of the jejunum. Several mechanisms have been proposed for this exciting effect that may provide key insights into the pathogenesis of type-2 diabetes. All of these mechanisms include from gut hormones such as ghrelin to second messengers such as AKT system or protein kinase B. Although not all the processes involved in the homeostasis of β-cells are clear, we can explain some of the effects of bariatric surgery exerted on this important set of endocrine cells, which are essential in diabetes control (AU)

En la diabetes mellitus tipo 2 (DMT2) se puede observar una disfunción de las células así como un alto índice de apoptosis, este hecho, da lugar a una deficiente secreción de insulina. La función de este tipo celular se ve gravemente comprometida incluso antes de que aparezcan los primeros síntomas de la enfermedad y luego continúa disminuyendo linealmente con el tiempo. Los procedimientos bariátricos derivativos como el bypass gástrico, la derivación biliopancreática, el bypass gástrico de una anastomosis (BAGUA) y otras técnicas quirúrgicas donde se puentea el intestino proximal, inducen una rápida mejora del control glucémico no asociada a la pérdida de peso, sobre todo si se trata a tiempo, antes de que la enfermedad provoque un daño irreparable en el conjunto de las células pancreáticas. El efecto antidiabético de las operaciones bariátricas se debe, probablemente, a la mejora en la desregulación hormonal asociada con el desarrollo de la diabetes. Ahora sabemos que la cirugía bariátrica mediante la reorganización del tracto gastrointestinal puede afectar a la homeostasis de la masa de células-β, deteniendo la apoptosis y estimulando la replicación y la neogénesis. Estos efectos son causados principalmente por tres estímulos: la restricción calórica, el tránsito rápido de alimentos a través del íleon y la exclusión de una porción intestinal que incluye parte del estómago, el duodeno y una gran porción del yeyuno. Se han propuesto varios mecanismos para explicar este interesante efecto que pueden proporcionar información clave en la patogénesis de la diabetes tipo 2. Estos mecanismos incluyen desde hormonas intestinales tales como la grelina a segundos mensajeros tales como el sistema AKT o la proteína quinasa B. Aunque aun no conocemos todos los procesos implicados en la homeostasis de las células, sí se pueden explicar algunos de los efectos que ejerce la cirugía bariátrica sobre este importante conjunto de células endocrinas, que son esenciales en el control de la diabetes (AU)

[Roux-en-Y gastric bypass for treatment of patients with DM type 2 and BMI of 30 to 35 Kg/m²]. / Bypass gástrico en Y de Roux para el tratamiento de pacientes con diabetes mellitus tipo II con IMC de 30 a 35 kg/m²

BACKGROUND: The incidence of obesity and its most feared comorbidity, diabetes mellitus type 2, is increasing and there would not seem to be any medical treatment to help control these pandemics. However, there is a bariatric surgery technique, the Roux-en-Y Gastric Bypass (RYGB), which is safe and not only helps control excess weight, but produces encouraging results in the control and remission of diabetes. METHODS: We present 15 selected patients with a BMI between 30 and 35 kg/mt² and diabetes type 2 who underwent a laparoscopic RYGB with of one-year follow-up. RESULTS: A total of 14 women and one man were operated with the following average values: age: 37 years, weight: 88.3 kg, BMI: 32.8 kg/mt², blood glucose: 120 ± 38.8 mg%, HbA1c: 7.6 ± 0.73. Forty percent (40%) suffered from high blood pressure and 33.3% were dyslipidemic. Average surgical time was 75 minutes, hospital length of stay was two days, and there was a low rate of complications and no mortality. Diabetes remission was achieved in 93% of cases with significant drops in blood glucose and HbA1c (p ≤ 0.05 and p ≤ 0.001 respectively), dyslipidemia was 100% controlled and hypertension was 83.3% controlled. CONCLUSIONS: RYGB in selected patients with obesity type 1 and diabetes mellitus type 2 is a safe and effective technique for metabolic control and obesity control.

Is diabetes a surgical disease? / ¿Es la diabetes una enfermedad quirúrgica?

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Bypass gástrico en Y de Roux para el tratamiento de pacientes con diabetes mellitus tipo II con IMC de 30 a 35 kg/m2 / Roux-en-Y gastric bypass for treatment of patients with DM type 2 and BMI of 30 to 35 Kg/m2

La incidencia de obesidad y una de sus comorbilidades más temida la diabetes mellitus tipo II está en aumento y no pareciera haber tratamiento médico que ayude a controlar estas pandemias. Existe una técnica quirúrgica bariátrica, el Bypass Gástrico en Y de Roux (BGYR) que es segura y no sólo ayuda a controlar el exceso de peso sino también produce resultados alentadores en el control y remisión de la diabetes. Métodos: Se presentan 15 pacientes con IMC entre 30 y 35 kg/mt2 diabéticos tipo II seleccionados sometidos a BGYR por laparoscopia con seguimiento de un año. Resultados: Se operaron 14 mujeres y un hombre con los siguientes valores promedios: Edad: 37 años, Peso: 88,3 kg, IMC: 32,8 kg/mt2, Glicemia: 120 ± 38,8 mg%, HbA1c: 7,6% ± 0,73. 40% de hipertensión arterial y 33,3% dislipidémicos. El tiempo quirúrgico promedio fue de 75 minutos, dos días de hospitalización bajo índice de complicaciones y sin mortalidad. Se logró una remisión de la diabetes en el 93%, de los casos, con descensos de la glicemia y HbA1c significativos (p ≤ 0,05 y p ≤ 0,001 respectivamente) con un control de la dislipidemia del 100% y 83,3% de la HTA. Conclusiones: El BGYR en obesos tipo I diabéticos seleccionados es una técnica segura y eficaz en el control metabólico y de la obesidad (AU)

Background: The incidence of obesity and its most feared comorbidity, diabetes mellitus type 2, is increasing and there would not seem to be any medical treatment to help control these pandemics. However, there is a bariatric surgery technique, the Roux-en-Y Gastric Bypass (RYGB), which is safe and not only helps control excess weight, but produces encouraging results in the control and remission of diabetes. Methods: We present 15 selected patients with a BMI between 30 and 35 kg/mt2 and diabetes type 2 who underwent a laparoscopic RYGB with of one-year follow-up. Results: A total of 14 women and one man were operated with the following average values: age: 37 years, weight: 88.3 kg, BMI: 32.8 kg/mt2, blood glucose: 120 ± 38.8 mg%, HbA1c: 7.6 ± 0.73. Forty percent (40%) suffered from high blood pressure and 33.3% were dyslipidemic. Average surgical time was 75 minutes, hospital length of stay was two days, and there was a low rate of complications and no mortality. Diabetes remission was achieved in 93% of cases with significant drops in blood glucose and HbA1c (p ≤ 0.05 and p ≤ 0.001 respectively), dyslipidemia was 100% controlled and hypertension was 83.3% controlled. Conclusions: RYGB in selected patients with obesity type 1 and diabetes mellitus type 2 is a safe and effective technique for metabolic control and obesity control (AU)

Resolution of diabetes mellitus and metabolic syndrome in normal weight 24-29 BMI patients with One Anastomosis Gastric Bypass.

INTRODUCTION: Diabetes mellitus type 2 (DMT2) is a major cause of death in the world. The medical therapy for this disease has had enormous progress, but it still leaves many patients exposed to the complications developed from the disease. It is well known the beneficial effects of bariatric surgery in obese diabetic patients, however it is important to investigate if the same principles of bariatric surgery that improve diabetes in obese patients, could be applied to non obese normal weight diabetics. MATERIAL AND METHODS: Thirteen diabetic patients operated by One Anastomosis Gastric Bypass (BAGUA), were evaluated in the preoperative period and 1,3 and 6 months after surgery. Body weight and composition, Fasting Plasma Glucose, HbA1c levels, blood pressure and serum lipids levels were analyzed, as well as the monitoring of the immediate postoperative treatment necessities for Diabetes and other metabolic syndrome comorbidities. RESULTS: After the surgery the 77% of the patients resolves its T2DM, 46% from surgery, and rest noted an significant improvement of the disease in spite of having a C peptide level near to zero some of the patients. The comorbidities, mainly hypertension and lipid abnormalities experience improvement early. All patients reduce their weight and the amount of fat mass until values consistent with their age and height. CONCLUSIONS: The One Anastomosis Gastric Bypass leads to resolution or improvement of T2DM in non obese normal weight patients. The best results are obtained in patients with few years of diabetes, without or short term use of insulin treatment and high C-peptide levels.

Resolution of diabetes mellitus and metabolic syndrome in normal weight 24-29 BMI patients with one anastomosis gastric bypass / Resolución de la diabetes mellitus y del síndrome metabólico

Introduction: Diabetes mellitus type 2 (DMT2) is a major cause of death in the world. The medical therapy for this disease has had enormous progress, but it still leaves many patients exposed to the complications developed from the disease. It is well known the beneficial effects of bariatric surgery in obese diabetic patients, however it is important to investigate if the same principles of bariatric surgery that improve diabetes in obese patients, could be applied to non obese normal weight diabetics. Material and methods: Thirteen diabetic patients operated by One Anastomosis Gastric Bypass (BAGUA), were evaluated in the preoperative period and 1,3 and 6 months after surgery. Body weight and composition, Fasting Plasma Glucose, HbA1c levels, blood pressure and serum lipids levels were analyzed, as well as the monitoring of the immediate postoperative treatment necessities for Diabetes and other metabolic syndrome comorbidities. Results: After the surgery the 77% of the patients resolves its T2DM, 46% from surgery, and rest noted an significant improvement of the disease in spite of having a C peptide level near to zero some of the patients. The comorbidities, mainly hypertension and lipid abnormalities experience improvement early. All patients reduce their weight and the amount of fat mass until values consistent with their age and height. Conclusions: The One Anastomosis Gastric Bypass leads to resolution or improvement of T2DM in non obese normal weight patients. The best results are obtained in patients with few years of diabetes, without or short term use of insulin treatment and high C-peptide levels (AU)

Introducción: La diabetes mellitus de tipo 2 (DMT2) es una causa principal de muerte a escala mundial. El tratamiento médico de esta enfermedad ha progresado tremendamente pero sigue dejando a muchos pacientes expuestos a las complicaciones derivadas de la enfermedad. Son bien conocidos los efectos beneficiosos de la cirugía bariátrica en los pacientes diabéticos obesos, sin embargo es importante investigar si se podrían aplicar los mismos principios de la cirugía bariátrica que mejoran la diabetes en los pacientes obesos podrían aplicarse a los pacientes diabéticos no obsesos, con un peso normal. Material y métodos: Se evaluó a 13 pacientes operados mediante una derivación gástrica de un sola anastomosis (BAGUA) durante el período preoperatorio y a los 1, 3 y 6 meses después de la cirugía. Se analizó el peso corporal y su composición, la glucemia en ayunas, las concentraciones de HbA1c, la presión sanguínea y las concentraciones séricas de lípidos, así como las necesidades de tratamiento en el posoperatorio inmediato para la diabetes y otros comorbilidades del síndrome metabólico. Resultados: Después de la cirugía, el 77% de los pacientes resuelve su DMT2, el 46% desde la cirugía, y en el resto se vio una mejoría significativa de la enfermedad a pesar de que algunos pacientes tenían una concentración del péptido C cercana a cero. Las comorbilidades, principalmente la hipertensión y las anomalías lipídicas, mostraron una mejoría de forma temprana. En todos los pacientes se redujo el peso y la cantidad de grasa hasta cifras correspondientes con su edad y talla. Conclusiones: la derivación gástrica con una única anastomosis conlleva una resolución o una mejoría de la DMT2 en los pacientes no obesos con peso normal. Los mejores resultados se obtienen en los pacientes con una corta evolución de la diabetes, sin uso de insulina, o por poco tiempo, y con concentraciones elevadas del péptido C (AU)

Cirugía de la diabetes mellitus tipo 2: el gran descubrimiento de la cirugía bariátrica / Surgery of type 2 diabetes mellitus: the great discovery of bariatric surgery

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Nutrition and the surgical patient: triumphs and challenges.

The understanding of the role of nutrition in the surgical patient has lead to major developments in the nutritional support of patients undergoing surgery. Reductions in morbidity by ensuring that patients receive optimal nutritional support can be achieved. Furthermore, the use of nutrients to modify immune, inflammatory and metabolic processes also offers new possibilities for reducing morbidity following major surgery. However, we are only at an embryonic stage in our understanding of how nutrients and nutrition affect the genome and this knowledge offers exciting possibilities in the future for modulating many key intracellular processes, particularly in the patient with cancer.

Surgery to modify nutritional behaviour.

The main aim of obesity surgery is to change the dietary habits of morbidly obese patients. These are patients whose dietary habits nutritionists and psychologists have not been able to change during previous decades. The history of this surgery can teach us many important lessons. For example, procedures that have focused on effecting a malabsorptive state, but without addressing any behavioural mechanism for weight control, such as jejunoileal bypass, have failed. On the other hand, those that have centered on only addressing behavioural issues, the purely restrictive, are also difficult for patients to comply with and also have a high failure rate. To facilitate a change in the nutritional behaviour of morbidly obese patients which can lead to the loss of an adequate amount of weight, and which could be maintained in the long term is difficult. We need to stimulate changes that can be easily followed by the patient, and at the same time, provoke minimal medium and long term alterations in their nutritional state. To achieve and maintain this aim efficiently, it is necessary that the patients have confidence in and respect the physician, so that they can follow strictly their medical advice.

Surgery to modify nutritional behaviour / Cirugía para modificar el comportamiento nutritivo

The main aim of obesity surgery is to change the dietary habits of morbidly obese patients. These are patients whose dietary habits nutritionists and psychologists have not been able to change during previous decades. The history of this surgery can teach us many important lessons. For example, procedures that have focused on effecting a malabsorptive state, but without addressing any behavioural mechanism for weight control, such as jejunoileal bypass, have failed. On the other hand, those that have centered on only addressing behavioural issues, the purely restrictive, are also difficult for patients to comply with and also have a high failure rate. To facilitate a change in the nutritional behaviour of morbidly obese patients which can lead to the loss of an adequate amount of weight, and which could be maintained in the long term is difficult. We need to stimulate changes that can be easily followed by the patient, and at the same time, provoke minimal medium and long term alterations in their nutritional state. To achieve and maintain this aim efficiently, it is necessary that the patients have confidence in and respect the physician, so that they can follow strictly their medical advice (AU)

El principal objetivo de la cirugía de la obesidad es cambiar los hábitos dietéticos de los pacientes con obesidad mórbida. Nutricionistas y psicólogos no han podido cambiarlos durante décadas. La historia de esta cirugía nos enseña lecciones importantes. Por ejemplo, que los procedimientos centrados en provocar una malabsorción sin ningún mecanismo de cambio de conducta dietética, como el bypass yeyuno-ileal, han fracasado. Por otro lado, los procedimientos bariátricos centrados sólo en mecanismos conductuales, los restrictivos puros, son difíciles de seguir para los pacientes y también tienen una alta tasa de fracasos. Facilitar un cambio en la conducta nutricional de los pacientes obesos mórbidos que les permita perder la cantidad de peso adecuada y mantenerla a largo plazo, es difícil. Debemos provocar cambios fáciles de seguir por los pacientes y que, al mismo tiempo, provoquen mínimas alteraciones de su estado nutritivo. Para conseguir y mantener este objetivo de forma eficiente es necesario conseguir la confianza y el respeto del paciente, de manera que éste siga estrictamente nuestras indicaciones (AU)

Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES).

BACKGROUND: The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectiveness and surrounding circumstances of the various types of obesity surgery. METHODS: A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. RECOMMENDATIONS: After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life.

One anastomosis gastric bypass: a simple, safe and efficient surgical procedure for treating morbid obesity / El bypass gástrico de una anastómosis: un procedimiento simple, seguro y eficaz para tratar la obesidad mórbida

The One Anastomosis Gastric Bypass has been developed from the Mini Gastric Bypass procedure as originally described by Robert Rutledge. The modification of the original procedure consists of making a latero-lateral gastro-jejunal anastomosis instead of a termino-lateral anastomosis, as is carried out as described in the original procedure. The rationale for these changes is to try to reduce exposure of the gastric mucosa to biliopancreatic secretions because of their potentially carcinogenic effects with longer term exposure, which is the major criticism of the original technique. If we fix the jejunal loop to the gastric pouch some centimetres up to the gastro-jejunal anastomosis the biliopancreatic secretions have less possibility of coming into the gastric cavity (gravity force). Furthermore, if the anastomosis is latero-lateral this possibility is reduced even more. In addition, the intestinal loop reinforces the staple line against disruption, and also the gastric pouch against dilatation (AU)

El Bypass Gástrico de Una Anastomosis se ha desarrollado a partir del Mini Bypass Gástrico descrito por Robert Rutledge. La modificación del procedimiento original consiste en hacer una anastomosis latero-lateral en lugar de termino-lateral como se hace en la técnica original. Este cambio intenta reducir la exposición de la mucosa gástrica a la secreción bilio-pancreática, evitando así el posible efecto carcinogénico de la exposición crónica que constituye la más importante crítica del procedimiento original. Al fijar el asa de yeyuno a la nueva bolsa gástrica unos centímetros por encima de la anastomosis gastro-yeyunal, la secreción bilio-pancreática tiene menos posibilidades de entrar en la cavidad gástrica (fuerza de gravedad). Al ser la anastomosis latero-lateral esta posibilidad se reduce aún más. Además, el asa de yeyuno refuerza la línea de grapas contra su disrupción y previene la posible dilatación de la bolsa gástrica (AU)