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1.
Nutrition ; 54: 94-99, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29778908

RESUMO

OBJECTIVES: After bariatric surgery, modifications to signaling pathway networks including those of the metabolic regulator called mammalian or mechanistic target of rapamycin (mTOR) may lead to molecular alterations related to energy source availability, systemic nutrients, and catabolic and anabolic cellular processes. This study aimed to identify gene expression changes with regard to the mTOR complex 2 subunit signaling pathway in obese patients before and after bariatric surgery. METHODS: The experimental group included 13 obese women who were examined before (preoperative) and 6 mo after (postoperative) Roux-en-Y gastric bypass (RYGB) surgery. The control group included nine apparently eutrophic women matched by age and without any other metabolic diseases (i.e., no diabetes and no liver or kidney diseases). Peripheral blood mononuclear cell samples were collected for RNA extraction and subsequent microarray analysis. RESULTS: After this methodological procedure, we identified 47 000 differentially expressed genes. A subsequent bioinformatic analysis showed that three diferentially expressed genes (rapamycin-insensitive companion of mTOR [RICTOR], phosphoinositide-3-kinase regulatory subunit 1 [PIK3 R1], and hypoxia inducible factor 1 alpha subunit 1A [HIF1 A]) participated in the mTOR signaling pathway. Real-time quantitative polymerase chain reaction revealed that RICTOR, PIK3 R1, and HIF1 A were upregulated 6 mo after RYGB surgery (P <0.05). In addition, patients in the experimental group lost weight significantly and presented significant improvement in biochemical/metabolic variables. CONCLUSIONS: The weight loss that was induced by RYGB surgery alters the mTOR signaling pathway and specifically the mTOR complex 2 subunit. The increased expression of genes that act in this pathway such as RICTOR, PIK3 R1, and HIF1 A reflects the induced weight loss and improved metabolic indicators (e.g., insulin resistance and lipolysis) that are evidenced in this study.


Assuntos
Derivação Gástrica , Alvo Mecanístico do Complexo 2 de Rapamicina/metabolismo , Obesidade/genética , Transdução de Sinais/genética , Perda de Peso/genética , Adulto , Feminino , Humanos , Leucócitos Mononucleares/metabolismo , Estudos Longitudinais , Pessoa de Meia-Idade , Obesidade/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Resultado do Tratamento
2.
Obes Surg ; 27(12): 3351, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29047048

RESUMO

Larissa Alves dos Reis Dias wasmistakenly included in the 13 acknowledgment section of this article, and was mistakenly.

4.
Obes Surg ; 27(9): 2303-2307, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28397104

RESUMO

PURPOSE: Roux-en-Y gastric bypass (RYGB) is one of the bariatric surgeries most frequently performed worldwide. Since this operation may predispose to the formation of peptic ulcer of the gastrojejunal anastomosis, the use of proton pump inhibitors (PPI) is recommended during the first postoperative year. However, so far, there is no detailed knowledge about the absorption of this medication during the immediate postoperative period and consequently about its effectiveness in blocking acid secretion. The objective was to assess the possible endoscopic peptic changes, the absorption of omeprazole (OME), and the status of fasting gastrinemia before and after RYGB operation. MATERIALS AND METHODS: OME absorption, the production of its metabolites omeprazole sulfone (OMES) and 5-hydroxyomeprazole (HOME), and basal (fasting) gastrinemia were determined in patients submitted to RYGB before and 2 months after the operation. Upper digestive endoscopy (UDE) was also performed before and 6 months after the operation. RESULTS: Twenty patients were studied. Preoperatively, all these patients had some peptic changes and 55% tested positive for Helicobacter pylori. Six months after surgery, ten patients still showed endoscopic changes and one patient tested positive for H. pylori. During the postoperative period, there was a reduction of OME absorption and of the production of its metabolites 90 min after administration of the drug, and reduction of serum gastrin levels. CONCLUSION: The standard OME dose (40 mg) administered after bariatric surgery is insufficient to achieve serum levels that can effectively block the production of hydrochloric acid, permitting the formation of peptic injuries in many patients.


Assuntos
Derivação Gástrica/reabilitação , Gastrinas/sangue , Obesidade Mórbida/metabolismo , Obesidade Mórbida/cirurgia , Omeprazol/farmacocinética , Inibidores da Bomba de Prótons/farmacocinética , Adulto , Anastomose em-Y de Roux , Jejum/sangue , Feminino , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Omeprazol/uso terapêutico , Úlcera Péptica/metabolismo , Úlcera Péptica/prevenção & controle , Inibidores da Bomba de Prótons/uso terapêutico
5.
Nutrition ; 33: 326-330, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27743836

RESUMO

OBJECTIVE: The aim of this study was to investigate whether the Ala55Val and -866G>A polymorphisms of the UCP2 gene are related to weight loss and changes in body composition after bariatric surgery performed by Roux-en-Y gastric bypass (RYGB). METHODS: This longitudinal study enrolled obese patients submitted to RYGB. Data regarding weight (kg), body mass index (kg/m2), fat-free mass (FFM; kg), fat mass (kg), weight loss (kg and %), and percent excess weight loss were collected from both preoperative and 1-y postoperative medical records. Polymorphisms were genotyped by allelic discrimination using real-time polymerase chain reaction and TaqMan-predesigned single nucleotide polymorphism Genotyping Assay kits (Applied Biosystems, Foster City, CA, USA). The t test was used to compare variables between genotypes of each polymorphism to analyze the dominant and recessive models. Linear regression models were used to adjust the effects of initial weight, age, and sex on the variation of weight and body composition (P < 0.05). RESULTS: We analyzed 150 severely obese individuals (age 47.2 ± 10.5 y; 80% women). Genotype analysis showed a greater prevalence of heterozygous GA (41.3%) for -866G>A polymorphism and CT (39.3%) for Ala55Val polymorphism. Individuals who carried the T (CT+TT) and A (GA+AA) mutated alleles for Ala55Val and -866G>A, respectively, showed a higher weight and FFM loss. CONCLUSION: The mutated alleles T for Ala55Val and A for -866G>A polymorphism could be biomarkers of weight loss 1 y after RYGB.


Assuntos
Derivação Gástrica , Mutação de Sentido Incorreto , Obesidade Mórbida/cirurgia , Polimorfismo de Nucleotídeo Único , Proteína Desacopladora 2/genética , Adulto , Alelos , Substituição de Aminoácidos , Biomarcadores , Composição Corporal , Índice de Massa Corporal , Brasil , Terapia Combinada , Feminino , Frequência do Gene , Estudos de Associação Genética , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/genética , Obesidade Mórbida/metabolismo , Obesidade Mórbida/terapia , Proteína Desacopladora 2/metabolismo , Perda de Peso
6.
PLoS One ; 9(4): e93512, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24690978

RESUMO

Obesity is a multifactorial disease, with epigenetic alterations. Have been described modifications in the expression of some microRNAs, and some proteins related to obesity. The objective was to determine and correlate, in obese patients, the gene expression of LEP, LEPR, IGF1, IL10 and of miR-27a, miR-27b, miR-143 and miR-145. RNA was extracted from biopsies of subcutaneous fat, liver and visceral fat of 15 obese subjects submitted to bariatric surgery and of 15 non-obese subjects submitted to cholecystectomy for cDNA synthesis and for RT-PCR. The microRNAs were chosen using the TargetScan software. An increased expression of LEP and IGF1 was detected in the subcutaneous fat of the obese group compared to control, while the expression of IGF1 was higher in the control group than in the obese one. MiRNA-27a had a higher expression in the omentum of the obese patients and there was also a correlation in the expression of miRNA-145 and LEPR in the omentum of this group.


Assuntos
Expressão Gênica , Fator de Crescimento Insulin-Like I/genética , Interleucina-10/genética , Leptina/genética , MicroRNAs/genética , Obesidade/genética , Receptores para Leptina/genética , Adulto , Estudos de Casos e Controles , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Nutrition ; 30(5): 569-74, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24698348

RESUMO

OBJECTIVE: Because of the inefficacy of standard methods for the evaluation of body composition of grade III obese individuals, it is difficult to analyze the quality of weight loss after bariatric surgery in these patients. Electrical bioimpedance vector analysis and the RXc graph uses crude resistance (R) and reactance (Xc) values, like components of the Z vector, to monitor variations in body fluid and the nutritional status of obese individuals. Using bioelectrical impedance vector analysis (BIVA) and the RXc graph, the objective of the present study was to evaluate long-term changes in weight and body composition of obese women after Roux-en-Y bariatric surgery. METHODS: A study was conducted on 43 grade III obese women submitted to bariatric surgery. Anthropometric and bioimpedance (800 mA-50 kHz) data were obtained during the preoperative period and 1, 2, 3, and 4 y after surgery. BIVA was performed by plotting resistance and reactance values corrected for body height (R/H and Xc/H, Ohm/m) as bivariates on the RXc graph. BIVA software was used to plot the vectors of the RXc plane. RESULTS: Surgery promoted changes in body composition, with a reduction of fat mass and of fat-free mass. During the postoperative period, the vectors demonstrated migration to the right lower quadrant of the graph, corresponding to the classification of cachexia and water retention. CONCLUSION: Weight loss due to surgery results in an important reduction of fat-free mass characterized by the position of most individuals in the cachexia quadrant throughout the postoperative period.


Assuntos
Tecido Adiposo/metabolismo , Cirurgia Bariátrica , Composição Corporal/fisiologia , Compartimentos de Líquidos Corporais/metabolismo , Impedância Elétrica , Obesidade Mórbida/cirurgia , Perda de Peso/fisiologia , Tecido Adiposo/fisiologia , Compartimentos de Líquidos Corporais/fisiologia , Índice de Massa Corporal , Água Corporal/fisiologia , Peso Corporal , Caquexia , Feminino , Humanos , Estado Nutricional , Obesidade Mórbida/metabolismo , Período Pós-Operatório
8.
Surg Obes Relat Dis ; 10(1): 49-54, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24071485

RESUMO

BACKGROUND: Iron deficiency and anemia are changes often associated with obesity. Bariatric surgery is responsible for increasing the iron loss and reducing its absorption. The objective of this study was to evaluate anemia and iron deficiency before and after bariatric surgery and to relate them to possible predisposing factors. METHODS: A retrospective study was conducted on obese patients submitted to open Roux-en-Y gastric bypass, in which clinical and laboratory data were obtained up to 48 months postoperatively. Patients were divided into groups according to the presence or absence of anemia and to the presence or absence of iron deficiency (even without anemia), and all data were compared between these groups. RESULTS: Preoperatively, 21.5% of patients had anemia and 20% had iron deficiency. The number of patients with anemia did not vary through the 4 years of the study, but ferritin levels significantly decreased with time (P<.01). Younger patients and patients with greater weight loss had a higher incidence of anemia. Female gender was a variable associated with a greater incidence of iron deficiency. CONCLUSIONS: Anemia and iron deficiency are frequent in obese patients and must be treated before surgery. Medical and nutritional surveillance is important in the postoperative period of bariatric surgery. Management of each condition must be directed at correcting the 2 major sources of iron deficiency and anemia: food intolerance (mostly meat intolerance) and losses (frequently due to menstruation). These are the factors more related to iron deficient anemia.


Assuntos
Anemia/etiologia , Derivação Gástrica , Ferro/deficiência , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Índice de Massa Corporal , Suplementos Nutricionais , Feminino , Compostos Ferrosos/administração & dosagem , Humanos , Masculino , Obesidade Mórbida/complicações , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Retrospectivos , Oligoelementos/administração & dosagem , Perda de Peso/fisiologia
9.
Surg Obes Relat Dis ; 9(6): 1008-12, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24321570

RESUMO

BACKGROUND: Patients with obesity submitted to bariatric surgery present altered ingestion of macronutrient and micronutrient levels and nutrients deficiency. The objective of this study was to evaluate the protein and amino acid nutritional status of obese adults before and after bariatric surgery, with emphasis on plasma free amino acids. METHODS: Thirty obese women were submitted to Roux-en-Y gastric shunt (bariatric surgery). Food and protein intake, anthropometric and bioimpedance data (body composition analysis), and serum total protein, albumin, and plasma amino acids levels were collected before the surgery (preoperative) and 3, 6, and 12 months after the surgical procedure. RESULTS: The mean protein intake was 47±2 g/day. The total weight loss during the study period was 39±8 kg; the fat-free mass decreased 7±5 kg. The amino acid profile showed increased concentrations of most amino acids 3 months after surgery; at 6 months, glutamic acid, serine, arginine, alanine, methionine, valine, phenylalanine, isoleucine, and tyrosine concentrations decreased. The total protein and albumin concentrations dropped along the 12-month follow-up. CONCLUSION: The amino acid profile changes after RYGB are evidence that total protein and albumin levels may not be good indicators of protein profile after the surgery.


Assuntos
Aminoácidos/metabolismo , Derivação Gástrica/métodos , Estado Nutricional , Obesidade Mórbida/cirurgia , Proteínas/metabolismo , Adulto , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Estudos de Coortes , Ingestão de Energia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Necessidades Nutricionais , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/metabolismo , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios/métodos , Fatores de Tempo
11.
Surg Obes Relat Dis ; 9(4): 520-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-21978750

RESUMO

BACKGROUND: The combination of preoperative deficiencies and the restrictions and malabsorption possibly induced by bariatric surgery could lead patients to experience important nutritional deficits during the late postoperative period. Our objective was to characterize the eating, anthropometric, and biochemical profiles of obese candidates for bariatric surgery at a bariatric surgery center of a university hospital. METHODS: A retrospective study with the analysis of medical records of candidates for bariatric surgery from 2007 to 2008 was performed. A total of 80 adult patients, aged 45 ± 11 years, were included in the present study. RESULTS: The mean patient weight was 145 ± 24 kg, and the mean body mass index was 54 ± 8 kg/m(2). Of the 80 patients, 78% had ≥1 co-morbidities related to obesity. The reported daily energy intake before surgery was 1981 ± 882 kcal, with 48% ± 11% consisting of carbohydrate, 29% ± 8% of lipids, and 23% ± 8% of protein. The mean number of daily meals was 4 ± 1. Patients with a greater body mass index ingested a smaller amount of calories per kilogram of current weight. The occurrence of hyperglycemia, hyperuricemia, and dyslipidemia and of nutritional deficiencies, among them magnesium (19%), vitamin A (15%), vitamin C (16%), iron (9%), ß-carotene (3%), and vitamin B12 (3%), was high. CONCLUSION: The high occurrence of micronutrient deficiency detected by biochemical analysis in morbidly obese candidates for bariatric surgery, representing a disabsorptive process, might involve a poorer prognosis during the late postoperative period. A preoperative evaluation of the nutritional parameters and the food intake pattern is recommended for these patients, together with the necessary interventions.


Assuntos
Derivação Gástrica/métodos , Estado Nutricional , Obesidade Mórbida/cirurgia , Cuidados Pré-Operatórios/métodos , Ingestão de Alimentos/fisiologia , Ingestão de Energia/fisiologia , Metabolismo Energético/fisiologia , Feminino , Humanos , Masculino , Micronutrientes/deficiência , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Nutrition ; 28(4): 391-6, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22055480

RESUMO

OBJECTIVE: The objective of this study was to determine whether constant daily vitamin supplementation would be sufficient to prevent possible vitamin deficiencies in obese patients undergoing bariatric surgery. METHODS: The study was conducted on 58 men and women (mean age 41 ± 10 y) who underwent Roux-en-Y gastric bypass RYGB and were assessed preoperatively and at 3, 6, and 12 mo after surgery. During the postoperative period, the patients received a multivitamin-mineral supplement on a daily basis. RESULTS: Serum ß-carotene and vitamin C were lower starting from the third postoperative month and continued to be low after 12 mo, and vitamin A was decreased by the sixth month and increased by 12 mo. Vitamin B12 levels were stable up to 6 mo but were decreased by 12 mo. Folic acid levels increased from the third month and remained higher throughout follow-up. One year after surgery there were 19% and 21% increases in the number of patients with vitamin A and vitamin C deficiency, respectively, and a 4% decreased of patients with folic acid deficiency. CONCLUSION: Weight loss and improvement in patients' general condition followed surgery, but serum levels of some vitamins were decreased despite the use of a vitamin-mineral supplement. These patients need continuous follow-up and individualized prescription of supplementation after the surgical procedure to prevent and treat vitamin deficiencies.


Assuntos
Deficiência de Vitaminas/prevenção & controle , Suplementos Nutricionais , Derivação Gástrica , Obesidade/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Vitaminas/uso terapêutico , Adulto , Deficiência de Vitaminas/epidemiologia , Deficiência de Vitaminas/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Complicações Pós-Operatórias/epidemiologia , Prevalência , Vitaminas/sangue , Vitaminas/farmacologia
13.
Nutr Metab Insights ; 5: 71-6, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23882150

RESUMO

OBJECTIVE: The objective of the present study was to identify new risk factors associated with longer hospitalization following bariatric surgery. METHODS: Patient clinical, social, and biochemical data in addition to multidisciplinary team experience were analyzed in a cohort that included all patients undergoing bariatric surgery at our hospital. The primary outcome was length of hospital stay (LOS). Mortality was recorded to validate the obesity surgery mortality risk score (OS-MRS). RESULTS: This study included 299 sequential patients, 41 ± 10 years of age, and BMI of 50 ± 8 kg/m(2) who underwent bariatric surgery. Two thirds (196) of patients were hypertensive, a third (86) were diabetic and a third (91) were current or former smokers. Overall, LOS was 8 ± 5 days. The predictors of a longer LOS were smoking (P < 0.05) and less multidisciplinary team experience (P < 0.05). Looking at only the last three years of data, LOS was 6 ± 5 days, and the predictors of a longer LOS were low educational attainment (P < 0.02) and smoking (P < 0.01) but not team experience. The global mortality was 2.6%, with the OS-MRS identifying a high-risk group. CONCLUSION: Excluding the initial learning phase, longer LOS independent predictors were patient low educational attainment and smoking. These predictors can help guide care to reduce complications.

14.
J Laparoendosc Adv Surg Tech A ; 21(7): 579-82, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21657939

RESUMO

AIMS: Surgical staple line dehiscence usually leads to severe complications. Several techniques and materials have been used to reinforce this stapling and thus reduce the related complications. The objective was to compare safety of two types of anastomotic reinforcement in open gastric bypass. METHODS: A prospective, randomized study comparing an extraluminal suture, fibrin glue, and a nonpermanent buttressing material, Seamguard®, for staple line reinforcement. Fibrin glue was excluded from the study and analysis after two leaks, requiring surgical reintervention, antibiotic therapy, and prolonged patient hospitalization. RESULTS: Twenty patients were assigned to the suture and Seamguard reinforcement groups. The groups were similar in terms of preoperative characteristics. No staple line dehiscence occurred in the two groups, whereas two cases of dehiscence occurred in the fibrin glue group. No mortality occurred and surgical time was statistically similar for both techniques. Seamguard made the surgery more expensive. CONCLUSION: In our service, staple line reinforcement in open bariatric surgery with oversewing or Seamguard was considered to be safe. Seamguard application was considered to be easier than oversewing, but more expensive.


Assuntos
Implantes Absorvíveis , Adesivo Tecidual de Fibrina , Derivação Gástrica/métodos , Grampeamento Cirúrgico/métodos , Adesivos Teciduais , Adulto , Feminino , Humanos , Masculino , Estudos Prospectivos
15.
Obes Surg ; 21(5): 569-73, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21213066

RESUMO

BACKGROUND: The risk of developing cardiovascular disease is higher in obese than in non-obese individuals. Surgery for obesity is effective in reducing weight and resolution of diabetes, hypertension, and dyslipidemia. Our aim was to assess the estimated 10-year cardiovascular risk of obese patients before and after treatment of obesity with a gastric bypass. METHODS: Weight, body mass index systolic and diastolic blood pressure, lipid profile, glycemia, and history of cardiovascular disease were obtained for obese patients before and 2 years after Roux-en-Y gastric bypass surgery. Ten-year cardiovascular risk was calculated using the Framingham score. RESULTS: Forty-two patients were included in the study. We observed a significant reduction (p < 0.05) of 10-year cardiovascular risk mainly associated with weight reduction and improvement of comorbidities associated with obesity. The benefits were greater among patients who already presented known risk factors such as diabetes and hypertension. Superobese patients benefited as early as 2 years after surgery, when weight loss was greater. CONCLUSIONS: Weight loss secondary to surgery was sustained after 2 years and promoted improvement of comorbidities, with an important reduction of 10-year cardiovascular risk especially among patients with previous risk factors.


Assuntos
Doenças Cardiovasculares/epidemiologia , Derivação Gástrica , Obesidade Mórbida/epidemiologia , Comorbidade , Humanos , Estado Nutricional , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Medição de Risco , Perda de Peso/fisiologia
16.
Obes Surg ; 20(6): 716-21, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18931884

RESUMO

BACKGROUND: Surgical treatment has proved to be effective for weight loss, improving the quality of life of obese individuals. However, metabolic and nutritional deficiencies may occur during the late postoperative period. The objective of the present study was to assess the metabolic and nutritional profile of grade III obese individuals for 12 months after Roux-en-Y gastric bypass (RYGBP). METHODS: Forty-eight patients with mean body mass index (BMI) of 51.9 +/- 7.8 kg/m(2) were submitted to RYGBP. Anthropometric, food intake, and biochemical data were obtained before and for 12 months after surgery. RESULTS: There was an average weight and body fat reduction of 35% and 46%, respectively. Calorie intake was reduced, ranging from 773 +/- 206 to 1035 +/- 345 kcal during the study. Protein intake remained below recommended values throughout follow-up, corresponding to 0.5 +/- 0.3 g/kg/current body weight/day during the 12th month. Iron and fiber intake was significantly reduced, remaining below recommended levels throughout the study. Serum cholesterol, low-density lipoprotein cholesterol, and glycemia were reduced. Albumin deficiency was present in 15.6% of subjects at the beginning of the study vs 8.9% at the end, calcium deficiency was present in 3.4% vs 16.7%, and iron deficiency was present in 12.2% vs 14.6%. CONCLUSIONS: RYGBP was effective for weight loss and for the reduction of obesity rates and risk factors for comorbidities. The diet of these patients, who frequently present inadequate intake of macronutrients and micronutrients, should receive special attention. Patient follow-up and assessment at short intervals are necessary for an early correction of nutritional deficiencies.


Assuntos
Ingestão de Alimentos/fisiologia , Ingestão de Energia/fisiologia , Derivação Gástrica/métodos , Desnutrição/etiologia , Perda de Peso , Tecido Adiposo/metabolismo , Adulto , Algoritmos , Composição Corporal , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Masculino , Resultado do Tratamento
17.
Surg Obes Relat Dis ; 6(6): 648-52, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-19926526

RESUMO

BACKGROUND: Despite the extensive published data regarding the use of drains in surgery, it is still controversial. Most bariatric surgeons use drains as routinely. However, drains have sometimes have been shown to be unhelpful and even to increase the anastomotic leak rates. The purpose of the present study was to evaluate the peritoneal inflammatory response in the presence of a drain left in place until the seventh postoperative day after bariatric surgery. METHODS: All patients who underwent open Roux-en-Y gastric bypass from February 2007 to August 2008 were prospectively evaluated. A 24F Blake drain was left in place for 7 days. The peritoneal effluent from the drain was collected for the determination of cytokine levels and for microbiologic analysis. RESULTS: A total of 107 obese patients were studied. A marked increase in the levels of tumor necrosis factor-α and interleukin-1ß was observed by the seventh postoperative day, even in patients without any abdominal complications. Bacterial contamination of the peritoneal effluent was also demonstrated. CONCLUSION: The results of our study have shown that at 7 days after surgery, a marked peritoneal inflammatory response and bacterial contamination are present. These findings could have resulted from the use of the drain for 7 postoperative days.


Assuntos
Drenagem/estatística & dados numéricos , Derivação Gástrica/estatística & dados numéricos , Peritonite/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Cavidade Abdominal/microbiologia , Cavidade Abdominal/patologia , Adulto , Bactérias/isolamento & purificação , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/metabolismo , Infecções Bacterianas/microbiologia , Feminino , Humanos , Interleucina-1beta/metabolismo , Masculino , Pessoa de Meia-Idade , Peritonite/metabolismo , Peritonite/microbiologia , Complicações Pós-Operatórias/metabolismo , Complicações Pós-Operatórias/microbiologia , Estudos Prospectivos , Fator de Necrose Tumoral alfa/metabolismo
18.
Obes Surg ; 19(7): 867-72, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19434466

RESUMO

BACKGROUND: Obesity has become a global epidemic and bariatric surgery is one of the therapeutic tools to deal with it. Postoperative complications can occur, such as staple line dehiscence and anastomotic leaks, leading to increased patient mortality. The diagnosis of these complications is frequently difficult. The objective of the present study was to determine whether peritoneal and systemic cytokines could early detect those complications. METHODS: All patients who underwent open Roux-en-Y gastric bypass from February 2007 to August 2008 were prospectively evaluated. Blood and peritoneal effluent from the drain were collected for the determination of cytokine levels. We also evaluated the clinical signs and the leukograms of the patients. RESULTS: A total of 107 obese patients were studied. Ninety patients had no complications; 17 had at least one infectious complication which include five cases of staple line dehiscence. Until the third postoperative day, the vital signs and the leukogram did not predict the onset of infectious complications, but the cytokines (interleukin-1beta and interleukin-6) were early markers of these complications. CONCLUSION: Cytokines are good predictors of poor postoperative evolution in bariatric surgery since peritoneal cytokines diagnose better these infectious complications even before changes in blood count and before the occurrence of clinical manifestations.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Deiscência da Ferida Operatória/etiologia , Infecção da Ferida Cirúrgica/diagnóstico , Adulto , Biomarcadores/sangue , Feminino , Humanos , Interleucina-1/sangue , Interleucina-6/sangue , Masculino , Peritonite/imunologia , Complicações Pós-Operatórias/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de Tempo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/sangue
19.
Acta Cir Bras ; 23 Suppl 1: 47-52; discussion 52, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18516448

RESUMO

PURPOSE: The aim of this study was to investigate alterations compatible with hepatic ischemia-reperfusion after bilioduodenal shunt (BD) in rats with obstructive jaundice (OB) . METHODS: Thirty six animals were divided into 6 experimental groups: CO1 and CO2--control groups, sham-operated (SO) and evaluated 6 and 24 hours after, respectively; OB1 and OB2,--obstructive jaundice groups, sham-operated 15 days after bile duct ligature and evaluated 6 and 24 hours after SO, respectively; DBD1 and DBD2--obstructive jaundice groups evaluated ,respectively, 6 and 24 hours after BD performed 15 days after bile duct ligature. The parameters evaluated were serum total bilirubin, aminotransferase activity (AST, ALT), TNFalpha, liver mitochondrial functions and parenchymatous injury. RESULTS: Bilirubin decreased while aminotransferase activity increased 6 hours after BD (p<0.01); TNFalpha determination at the 6th hour after BD was higher than the one at the 24th hour (p<0.05); oxygen consumption in states 3 and 4 remained elevated in the BD initial phase , and liver cell damage worsened 24 hours after BD. CONCLUSION: The results demonstrated that surgical biliary decompression in obstructive jaundice is followed by alterations related to hepatic ischemia- reperfusion.


Assuntos
Colestase Extra-Hepática/cirurgia , Icterícia Obstrutiva/cirurgia , Fígado/irrigação sanguínea , Traumatismo por Reperfusão/complicações , Anastomose Cirúrgica/efeitos adversos , Animais , Ductos Biliares/cirurgia , Bilirrubina/sangue , Biomarcadores/sangue , Modelos Animais de Doenças , Duodeno/cirurgia , Icterícia Obstrutiva/etiologia , Fígado/metabolismo , Fígado/patologia , Masculino , Consumo de Oxigênio/fisiologia , Ratos , Ratos Wistar , Fatores de Tempo , Transaminases/sangue , Fator de Necrose Tumoral alfa/sangue
20.
J Laparoendosc Adv Surg Tech A ; 18(1): 5-12, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18266567

RESUMO

INTRODUCTION: Treatment of severe bacterial peritonitis, especially by videolaparoscopy, is still a matter of investigation. The aim of the present study was to evaluate the effect of videolaparoscopy and laparotomy access with or without antibiotics on the outcome of severe bacterial peritonitis in rats. MATERIALS AND METHODS: Sixty-four male Wistar rats were equally assigned to 8 groups: Sham surgery (SHAM), SHAM+antibiotics (SHAM+AB), cecal ligation and puncture (CLP), CLP+AB, CLP+videolaparoscopy (VLAP), CLP+laparotomy (LAP), VLAP+AB, and LAP+AB. All treated animals were submitted to an evaluation of bacteremia, white cell counts, and cytokine determinations: interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha (TNF-alpha). The groups treated with antibiotics received gentamicin and metronidazole. Survival was monitored over a period of 7 days. RESULTS: Peritonitis induced by CLP was severe, with IL-1, IL-6, and TNF-alpha levels and lethality being significantly higher compared to the SHAM group. The IL-6 levels in the VLAP group were significantly higher compared to the CLP and VLAP+AB groups, and the TNF-alpha levels in the VLAP and LAP+AB groups were significantly higher compared to the LAP group. The survival time was significantly higher in the CLP+AB and VLAP+AB groups, when compared to the CLP group. There was no significant difference in bacteremia and lethality rates between the resources employed for treatment of peritonitis. CONCLUSIONS: Although the use of laparoscopic access itself exacerbates the inflammatory response, the combination with antibiotics minimizes this effect and increases the survival time. However, all of the resources used for treating severe peritonitis, when applied alone or in combination, have an equivalent influence on bacteremia and lethality rates.


Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/terapia , Laparoscopia , Peritonite/terapia , Animais , Bacteriemia/terapia , Interleucina-1/sangue , Interleucina-6/sangue , Laparotomia , Contagem de Leucócitos , Masculino , Ratos , Ratos Wistar , Resultado do Tratamento , Fator de Necrose Tumoral alfa/sangue , Gravação de Videoteipe
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