Serum Ferritin and NAFLD in Patients Undergoing Bariatric Surgery.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has become a challenge in public health, as the prevalence of obesity and overweight has been increasing. It has been observed that serum ferritin (SF) levels are commonly elevated in NAFLD patients. PURPOSE: To assess the relationship between SF levels and NAFLD, exploring the role of SF as a non-invasive marker of NAFLD. METHODS: Clinical, anthropometric, laboratory, and histological data of patients with obesity who underwent bariatric surgery in a reference center in Brazil were retrospectively evaluated. Data were collected in the preoperative period up to the first year postoperatively. RESULTS: A total of 431 patients were analyzed. The prevalence of hyperferritinemia was 18% in the preoperative period and 14% 1 year after the surgery. After multiple regression analysis, elevated SF was not an independent predictor of steatosis, non-alcoholic steatohepatitis (NASH), or liver fibrosis. CONCLUSIONS: Increased SF levels are common in patients with NAFLD; however, SF was not considered an independent predictor of steatosis, NASH, or fibrosis.

Role of micronutrients in staging of nonalcoholic fatty liver disease: A retrospective cross-sectional study.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) presents high incidence throughout the world and has been progressively increasing in prevalence. This disease has a heterogeneous natural history, including simple steatosis, nonalcoholic steatohepatitis (NASH), and cirrhosis. The factors that determine its evolution to more severe forms of the disease are still poorly understood, and micronutrients with antioxidant potential may be involved in the pathophysiology of the disease. AIM: To evaluate the relationship between serum levels of micronutrients and the severity of NAFLD. METHODS: A retrospective, observational and cross-sectional study was conducted. This study included all patients undergoing bariatric surgery who experienced liver biopsy during the procedure, and had serum levels of micronutrients (vitamin D, vitamin B12, zinc, iron, and magnesium), which was assessed in a preoperative evaluation conducted at a reference center in southern Brazil. RESULTS: A total of 614 patients were analyzed, of which 93% had steatosis, 70.7% had NASH, and 49.3% had some degree of fibrosis. Serum levels of vitamin D were negatively correlated with the severity of steatosis and NASH, and serum levels of vitamin B12 were positively correlated with the severity of steatosis and fibrosis. The other micronutrients showed no association with NAFLD staging. CONCLUSION: Serum levels of vitamin D are inversely related to the severity of steatosis and NASH, and serum levels of vitamin B12 are higher in more advanced stages of simple steatosis and liver fibrosis. Serum levels of zinc, iron, and magnesium were not associated with NAFLD severity.

Petit lumbar hernia--a double-layer technique for tension-free repair.

This report describes an alternative technique for Petit hernia repair. The treatment of lumbar hernias should follow the concept of tension-free surgery, and the preperitoneal space can be the best place for prosthesis placement. An obese patient had a bulge in the right lumbar region, which gradually grew and became symptomatic, limiting her daily activities and jeopardizing her quality of life. She had previously undergone 2 surgical procedures with different incisions. We created a preperitoneal space and attached a mesh in this position. Another prosthesis was placed on the muscles, with a suitable edge beyond the limits of the defect. There were no complications. It has been described as a safe and tension-free repair for Petit hernia. In larger defects, a second mesh can be used to prevent further enlargement of the triangle and also to provide additional protection beyond the bone limits.

Cistoadenoma mucinoso de pâncreas durante a gravidez / Mucinous cystadenoma of the pancreas developing during pregnancy

Cistoadenoma mucinoso de pâncreas durante a gravidez é extremamente raro e relatado somente cinco vezes na literatura. Nós descrevemos caso de uma mulher de 26 anos, na sua segunda gestação, com um acentuado aumento de volume intra-abdominal por massa cística, cuja gestação foi interrompida durante a trigésima primeira semana por severa pré-eclâmpsia. A cirurgia de retirada do cisto ocorreu 26 dias após o parto, com enucleação total da lesão. O exame anatomopatológico evidenciou o cisto como cistoadenoma mucinoso, que mediu 23x20x15 cm e pesou 9070 g. Até onde é do nosso conhecimento, é um dos maiores cistoadenomas mucinosos pancreáticos relatados durante a gestação

Mucinous cystadenoma of the pancreas during pregnancy is an extremely rare condition and was reported only five times in the literature. We report the case of a 26-year-old female who, in her second pregnancy, had a sharp intra-abdominal volume increase due to cystic mass, whose pregnancy was interrupted at the thirty-first week of gestation because of severe pre-eclampsia. The surgery to remove the cyst was performed 26 days after delivery, with total enucleation of the lesion. The anatomico-pathological examination showed a mucinous cystadenoma that measured 23x20x15 cm and weighed 9,070 g. To the best of our knowledge this is one of the largest pancreatic mucinous cystadenomas reported during pregnancy

Hepatojejunostomia periférica: uma alternativa técnica no tratamento paliativo das neoplasias malignas do hilo hepático / Peripheral hepatojejunostoy: a technic option for paliative treatment of hilar cancer

OBJETIVO: Relatar a experiência do nosso Serviço com a descompressão cirúrgica da árvore biliar através de uma hepatojejunostomia periférica. MÉTODO: Entre julho de 2000 a julho de 2005, 11 pacientes foram à laparotomia para ressecção de tumores do hilo hepático e, durante o trans-operatório, apresentavam lesões irressecáveis. Os dados analisados foram: idade, sexo, morbidade, mortalidade, dosagem de bilirrubinas séricas pré-operatórias e no 7ºdia de pós-operatório, prurido pré e pós-operatório e sobrevida. RESULTADOS: A idade média dos pacientes foi de 67 anos, seis eram mulheres e cinco eram homens. Icterícia estava presente em 100 por cento dos casos e prurido em 80 por cento. Seis pacientes tiveram o diagnóstico de neoplasia de vesícula biliar e cinco de colangiocarcinoma. Ocorreram três óbitos intra-hospitalares. A dosagem média no pré-operatório de bilirrubina total foi 19,33mg/dl e bilirrubina direta 16,81mg/dl e no pós-operatório 4,88mg/dl e 3,64mg/dl, respectivamente. Oito pacientes que receberam alta hospitalar tiveram sobrevida média de oito meses, evoluindo sem icterícia e prurido. CONCLUSÃO: A hepatojejunostomia periférica pode ser considerada uma boa opção como tratamento paliativo . Ela demonstrou ser segura, com sangramento mínimo, rápida execução e mortalidade aceitável, melhorando significativamente a icterícia, o prurido e fornecendo uma sobrevida satisfatória.

BACKGROUND: This study shows the experience of our service with peripheral hepatojejunostomy. METHODS: Between 2000 and 2005, eleven patients were submitted to peripheral hepatojejunostomy. Laparotomy in all patients had been performed as an attempt for curative resection. We analyzed age, gender, morbimortality, pre and post-operatory dosage of bilirubin, pre and post-operatory pruritus and survival. RESULTS: The mean age of the patients was 67 years, six were female and five were male. Jaundice was present in 100 percent of cases, and pruritus in 80 percent. Gallbladder neoplasm was diagnosed in six patients and cholangiocarcinoma in five. There were three intrahospital deaths. In preoperatory, mean values of total bilirubin was 19.33mg/dl and of direct bilirubin was 16.81mg/dl, and in the post-operatory, 4.88mg/dl and 3.64mg/dl, respectively. The eight discharged patients did not referred pruritus anymore, and their mean survival was eight months. All patients evoluted without jaundice and pruritus. CONCLUSIONS: Peripheral Hepatojejunostomy can be considered as capable to improve quality of life of the icteric patients. Surgery was demonstrated to be safe, with minimal blooding, rapid execution, and acceptable mortality rates. It was possible to improve significatively jaundice, pruritus, and to give a satisfactory survival.