Duodenal diverticulization as treatment of complex duodeno-pancreatic lesions: Case report.

INTRODUCTION: Duodenal and pancreatic lesions are uncommon, but severe and responsible for high incidence in morbidity and mortality. Differences between the mechanisms of trauma, the severity of lesions and the time between trauma, diagnosis and treatment influence the evolution of the case. PRESENTATION OF CASE: We report a case of a 20-year-old patient with several lesions in stomach, duodenum, pancreas and jejunum due to three gunshots treated at our service. Duodenal diverticulalization was used on treatment of complex duodeno-pancreatic lesions. The patient presented good evolution, with discharge conditions in the 10th PO. DISCUSSION: We discussed the positives and negatives of this technique, with the approval of the Ethics Committee number 13736519.8.0000.5479. CONCLUSION: The duodenal diverticulization leads to an irreversible change to the food transit. However, this is a feasible bypass option in cases of high chances of fistula and scar stenosis complex duodenal injury, particularly in the context of associated gastric injury.

Assessment of the body composition and the loss of fat-free mass through bioelectric impedance analysis in patients who underwent open gastric bypass.

BACKGROUND: Bariatric surgery is considered an effective option for the management of morbid obesity. The incidence of obesity has been gradually increasing all over the world reaching epidemic proportions in some regions of the world. Obesity can cause a reduction of up to 22% in the life expectancy of morbidly obese patients. OBJECTIVE: The objective of this paper is to assess the weight loss associated with the first 6 months after bariatric surgery using bioelectric impedance analysis (BIA) for the evaluation of fat mass and fat-free mass. METHOD: A total of 36 morbidly obese patients were subjected to open gastric bypass surgery. The patients weight was monitored before and after the procedure using the bioelectric impedance analysis. RESULTS: Bariatric surgery resulted in an average percentage of weight loss of 28.6% (40 kg) as determined 6 months after the procedure was performed. Analysis of the different components of body weight indicated an undesirable loss of fat-free mass along with the reduction of total body weight. CONCLUSION: Open gastric bypass induced a significant loss of total weight and loss of fat-free mass in patients six months after the surgery. The use of bioelectric impedance analysis resulted in an appropriate estimation of the total weight components in individuals subjected to bariatric surgery allowing a more real analysis of the variation of weight after the surgery.

Improvement of atherosclerotic markers in non-diabetic patients after bariatric surgery.

BACKGROUND: The objective of this study was to assess the impact of bariatric surgery performed in extremely obese non-diabetic subjects on the following parameters: endothelial function, inflammatory processes (assessed by high-sensitivity C-reactive protein [hs-CRP]), carotid artery intima-media thickness (CIMT), and glucose and lipid profiles. METHODS: Forty-seven obese individuals with body mass index >40 kg/m(2) underwent bariatric surgery and returned for post-procedure assessment between 6 and 19 months after surgery. Ninety-three percent of patients were female. Their age ranged from 18 to 65 (mean 41) years old at baseline. Baseline was defined as the maximum of 30 days before surgery. Before and after surgery, all patients were subjected to a brachial artery ultrasound examination to evaluate endothelial-dependent dilation, CIMT by ultrasound, and laboratory analyses including glucose, lipid and inflammatory profiles were performed. RESULTS: Subjects lost an average of 33 % of their original weight (p < 0.001). Flow-mediated dilation showed significant improvement after surgery from 7.4 % to 18.9 % (p < 0.001) on average. There was regression of CIMT, with the median being reduced from 0.8 to 0.5 mm (p < 0.001). The median Hs-CRP reduced from 0.83 to 0.18 mg/dl (p < 0.001), while glucose and lipid profiles were also improved after surgery. CONCLUSIONS: This study shows that severely obese, non-diabetic patients who had pronounced weight loss after bariatric surgery had an overall improvement in brachial flow-mediated dilation, CIMT, high-sensitivity CRP, and glucose and lipid metabolism. The best responses of the brachial flow-mediated dilation after surgery were observed in non-smokers and in younger subjects.

Improvement of atherosclerotic markers in non-diabetic patients after bariatric surgery

Background The objective of this study was to assess the impact of bariatric surgery performed in extremely obesenon-diabetic subjects on the following parameters: endothelial function, inflammatory processes (assessed by highsensitivity C-reactive protein [hs-CRP]), carotid arteryintima-media thickness (CIMT), and glucose and lipid profiles. Methods Forty-seven obese individuals with body mass index >40 kg/m2 underwent bariatric surgery and returned for post-procedure assessment between 6 and 19 months after surgery. Ninety-three percent of patients were female.Their age ranged from 18 to 65 (mean 41) years old at baseline. Baseline was defined as the maximum of 30 days before surgery. Before and after surgery, all patients were subjected to a brachial artery ultrasound examination to evaluate endothelial-dependent dilation, CIMT by ultrasound, and laboratory analyses including glucose, lipidand inflammatory profiles were performed. Results Subjects lost an average of 33 % of their original weight (p<0.001). Flow-mediated dilation showed significant improvement after surgery from 7.4 % to 18.9 % (p<0.001)on average. There was regression of CIMT, with the median being reduced from 0.8 to 0.5mm(p<0.001). The median Hs-CRP reduced from 0.83 to 0.18 mg/dl (p<0.001), while glucose and lipid profiles were also improved after surgery. Conclusions This study shows that severely obese, non diabetic patients who had pronounced weight loss after bariatric surgery had an overall improvement in brachial flow-mediated dilation, CIMT, high-sensitivity CRP, and glucose and lipid metabolism. The best responses of the brachial flow-mediated dilation after surgery were observed in non-smokers and in younger subjects.

Uso do adesivo butilcianoacrilato no controle da hemorragia após punções hepáticas em ratos / Use of tissue adhesive butylcyanocrylate for hemorrhage control after hepatic puncture in rats

OBJETIVO: Avaliar o uso do adesivo butilcianoacrilato no controle da hemorragia em punções hepáticas de ratos. MÉTODO: Foram utilizados 40 ratos distribuídos em dois grupos, um deles heparinizado e o outro não, submetidos à punção hepática com jelco 14. Metade dos animais de cada grupo foi tratado com o adesivo butilcianoacrilato e a outra metade não recebeu nenhum tipo de tratamento. RESULTADOS: Os animais heparinizados e tratados com adesivo mantiveram os níveis de hematócrito e hemoglobina e uma mínima quantidade de sangue livre na cavidade. Já os animais heparinizados e sem tratamento apresentaram queda significativa dos níveis hematimétricos com moderada quantidade de sangue livre na cavidade (p < 0.005). CONCLUSÃO: O adesivo tecidual butilcianoacrilato mostrou ser eficiente como agente hemostático no controle de sangramento de punções hepáticas em ratos heparinizados.

BACKGROUND: The objective of this study was to assess the effectiveness of tissue adhesive butylcyanocrylate in liver biopsy. METHOD: Forty rats were divided in two groups: one group included heparin-injected rats; the second group was not injected with heparin. Liver punction was performed with a 14-gauge needle. Half of the animals in each group was treated with tissue adhesive butylcyanocrylate and the other half had no treatment. RESULTS: The heparin-injected rats treated with adhesive kept their initial hemoglobin and hematocrit levels and had minimal amount of blood in the abdominal cavity. On the other hand, non treated heparin-injected rats presented a significant drop in hemoglobin and hematocrit levels and had a moderate volume of blood in the cavity. CONCLUSIONS: The tissue adhesive butylcyanocrylate showed be efficient as a hemostatic agent.