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1.
Int J Med Sci ; 16(5): 665-674, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31217734

RESUMO

BACKGROUNDː Dysglycemia is associated with adverse outcome including increased morbidity and mortality in surgical patients. Acute insulin resistance due to the surgical stress response is seen as a major cause of so-called stress hyperglycemia. However, understanding of factors determining blood glucose (BG) during surgery is limited. Therefore, we investigated risk factors contributing to intraoperative dysglycemia. METHODSː In this subgroup investigation of the BIOCOG study, we analyzed 87 patients of ≥ 65 years with tight intraoperative BG measurement every 20 min during elective surgery. Dysglycemia was defined as at least one intraoperative BG measurement outside the recommended target range of 80-150 mg/dL. Additionally, all postoperative BG measurements in the ICU were obtained. Multivariable logistic regression analysis adjusted for age, sex, American Society of Anesthesiologists (ASA) status, diabetes, type and duration of surgery, minimum Hemoglobin (Hb) and mean intraoperative norepinephrine use was performed to identify risk factors of intraoperative dysglycemia. RESULTSː 46 (52.9%) out of 87 patients developed intraoperative dysglycemia. 31.8% of all intraoperative BG measurements were detected outside the target range. Diabetes [OR 9.263 (95% CI 2.492, 34.433); p=0.001] and duration of surgery [OR 1.005 (1.000, 1.010); p=0.036] were independently associated with the development of intraoperative dysglycemia. Patients who experienced intraoperative dysglycemia had significantly elevated postoperative mean (p<0.001) and maximum BG levels (p=0.001). Length of ICU (p=0.007) as well as hospital stay (p=0.012) were longer in patients with dysglycemia. CONCLUSIONSː Diabetes and duration of surgery were confirmed as independent risk factors for intraoperative dysglycemia, which was associated with adverse outcome. These patients, therefore, might require intensified glycemic control. Increased awareness and management of intraoperative dysglycemia is warranted.


Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus/cirurgia , Hiperglicemia/epidemiologia , Complicações Intraoperatórias/epidemiologia , Idoso , Glicemia/metabolismo , Complicações do Diabetes/patologia , Complicações do Diabetes/cirurgia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/patologia , Feminino , Humanos , Hiperglicemia/etiologia , Hiperglicemia/patologia , Hiperglicemia/cirurgia , Insulina/metabolismo , Resistência à Insulina/genética , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/patologia , Complicações Intraoperatórias/cirurgia , Masculino , Fatores de Risco
2.
Curr Gastroenterol Rep ; 21(6): 26, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31025126

RESUMO

PURPOSE OF REVIEW: Transplantation of the islets of Langerhans or the pancreas aims to restore blood sugar control. We review both forms of transplantation in children. RECENT FINDINGS: Allogenic islet transplantation typically in to the liver via the portal vein may be a potential alternative to pancreas transplantation in the future. Autologous islet transplantation after total pancreatectomy is effective for debilitating symptoms of recurrent and chronic pancreatitis. Chronic pancreatitis in children is most often related to genetic mutations but is otherwise similar to adults with eventual exocrine and endocrine failure. Removal of the pancreas ameliorates pain, and islet transplantation preserves endocrine function to the extent allowed by the damage sustained by the pancreas from chronic inflammation. Despite the complexity of the operative procedure, the outcome of total pancreatectomy and autologous islet transplantation in children has been excellent including quality of life.


Assuntos
Complicações do Diabetes/cirurgia , Hiperglicemia/cirurgia , Transplante das Ilhotas Pancreáticas , Transplante de Pâncreas , Pancreatopatias/cirurgia , Criança , Complicações do Diabetes/etiologia , Humanos , Hiperglicemia/etiologia , Transplante das Ilhotas Pancreáticas/métodos , Pancreatectomia , Pancreatopatias/complicações , Pancreatite Crônica/etiologia , Pancreatite Crônica/cirurgia
3.
Obes Surg ; 29(4): 1164-1168, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30645722

RESUMO

OBJECTIVES: To explore the risk factors for relapse of hyperglycemia in obese patients with type II diabetes mellitus (T2DM) who received laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. METHODS: A retrospective analysis was performed on all obese patients with T2DM who underwent a LRYGB during the period 2011-2013. Demographics, preoperative body mass index (BMI), preoperative glycated hemoglobin A1c (HbA1c), adherence to lifestyle intervention, preoperative medication of insulin, and the time interval between surgery and diagnosis of T2DM were investigated and compared. RESULTS: A total of 24 patients were included in our study. The median age was 45.5 years, the median BMI was 29.9 kg/m2, and the median HbA1c was 7.9%. Out of 24 patients, 54.2% (13/24) experienced a relapse of hyperglycemia. The 1-year, 3-year, and 5-year relapse rates were 4.2%, 12.5%, and 50.0%, respectively. The preoperative HbA1c level, C-peptide (2 h) level, and C-peptide (3 h) level were identified as independent variables for the relapse of hyperglycemia (8.11 ± 0.48 vs 7.72 ± 0.37 kg/m2, p = 0.036; 4.35 ± 1.46 vs 7.13 ± 4.10 ng/ml, p = 0.032; 3.76 ± 0.61 vs 5.99 ± 3.39 ng/ml, p = 0.029). Lifestyle intervention could reduce the hyperglycemia relapse rate (66.7 vs 41.7%) after LRYGB surgery. CONCLUSIONS: The preoperative HbA1c level and C-peptide level at surgery have an important significance in predicting the relapse of hyperglycemia after LRYGB surgery; lifestyle intervention is crucial for these patients.


Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Derivação Gástrica/métodos , Hiperglicemia/etiologia , Obesidade/cirurgia , Adulto , Idoso , Índice de Massa Corporal , Peptídeo C/sangue , Doença Crônica , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/cirurgia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Laparoscopia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade Mórbida/sangue , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Cooperação do Paciente , Período Pré-Operatório , Recidiva , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Perda de Peso
4.
Georgian Med News ; (283): 10-15, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30516482

RESUMO

Object study carbohydrate metabolism state in patient with GC during the surgical treatment period, and the detection of factors that influence these kind of disorders. The results of investigations of 270 patients with GC were analyzed. The rest of patients were males - 193 (71.48%). 239 patients underwent different surgical involvements. The state of carbohydrate metabolism was evaluated based on the study of the level of glucose in blood serum and urine at various stages of surgical treatment. The results of carbohydrate metabolism in 270 patients with gastric cancer in the perioperative period are analyzed. Factors that have an effect on the changes in glucose and insulin levels in the blood and its appearance in the urine before the specific treatment, as well as at various periods of staying patients in the surgical department, was the duration of the anamnesis, advanced stages of the oncological process, complicated clinical course of the underlying disease.. It was established that surgical intervention itself, its extension, and also postoperative period have a direct negative effect on the disorders in carbohydrate metabolism. In 65.3% of cases operations were accompanied by hyperglycemia, and in 25.9% of cases glucosuria was detected. The duration of a surgical operation for more than two hours lead to an almost twofold increase in the incidence of cases of hyperglycemia, and tripled increase in glucosuria. Intensive correction of blood glucose level along with enteral feeding led to a decrease in levels of hyperglycemia and glucosuria. Complicated postoperative period did not lead to an increase in the incidence of carbohydrate metabolism disorders, but had an effect on the longer retention of elevated levels of glucose in the blood and urine.


Assuntos
Glicemia/fisiologia , Metabolismo dos Carboidratos/fisiologia , Hiperglicemia/etiologia , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/cirurgia , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Período Pós-Operatório , Neoplasias Gástricas/complicações
5.
Obes Surg ; 28(12): 3997-4005, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30112599

RESUMO

PURPOSE: We aimed to compare the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on postprandial glucose and lipid metabolism in addition to weight loss and fasting metabolic profile, in non-diabetic patients undergoing bariatric surgery. METHODS: Seventy-one patients were consecutively recruited and studied preoperatively, 3 and 6 months after surgery. Of these, 28 underwent RYGB (7 males, age 38 ± 9 years, BMI 46.9 ± 5.0 kg/m2), and 43 SG (9 males, age 38 ± 9 years, BMI 50.2 ± 7.0 kg/m2). A semi-liquid mixed meal was consumed, and blood samples were taken before, and every 30 min after meal ingestion up to 180 min postprandially, for measurement of glucose, insulin, and lipids. The overall postprandial response was assessed as area under the concentration-time curve (AUC). RESULTS: Baseline metabolic parameters were similar between RYGB and SG. Both groups experienced comparable weight loss, and a similar improvement in fasting glucose, insulin, and insulin resistance. Total and LDL cholesterol levels were lower at 6 months after RYGB compared to SG, while there was no difference in HDL cholesterol or triglycerides. Glucose AUC was lower after RYGB compared to SG at both 3 (p = 0.008) and 6 months (p = 0.016), without any difference in postprandial insulin response. Triglyceride AUC was also lower in RYGB vs. SG at 3 and 6 months (p ≤ 0.001). CONCLUSIONS: RYGB is superior to SG in improving postprandial glycaemia and lipaemia and cholesterol profile 6 months postoperatively in non-diabetic, severely obese patients. These findings imply procedure-specific effects, such as the malabsorptive nature of RYGB, and less likely a different incretin postoperative response.


Assuntos
Gastrectomia , Derivação Gástrica , Hiperglicemia/cirurgia , Hiperlipidemias/cirurgia , Obesidade Mórbida/cirurgia , Adulto , Glicemia/metabolismo , Colesterol/sangue , Feminino , Seguimentos , Gastrectomia/métodos , Derivação Gástrica/métodos , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hiperglicemia/etiologia , Hiperlipidemias/sangue , Hiperlipidemias/diagnóstico , Hiperlipidemias/etiologia , Insulina/sangue , Resistência à Insulina , Metabolismo dos Lipídeos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Obesidade Mórbida/complicações , Período Pós-Prandial , Estudos Prospectivos , Triglicerídeos/sangue , Perda de Peso
6.
J Diabetes Complications ; 32(8): 764-769, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29937139

RESUMO

AIMS: Hyperglycemia is frequent in patients with ST elevation myocardial infarction (STEMI) and is associated with adverse outcome. Aim of our study was to evaluate the correlation between admission plasma glucose level (PGL) and coronary arteries flow velocity. METHODS: We enrolled 149 STEMI patients successfully treated with primary percutaneous coronary intervention (pPCI). The study population was divided into two groups based on PGL (< or >140 mg/dl) and on history of diabetes, and the groups compared in terms of corrected TIMI frame count (cTFC). RESULTS: Hyperglycemic patients had a significantly higher cTFC in both the culprit (p < 0.0001) and non-culprit vessel (p: 0.0002); diabetes history impairs as well cTFC of the culprit (p < 0.0001) and non-culprit vessel (p: 0.0001). Within the subpopulation of diabetic patients hyperglycemic ones showed higher cTFC in both the culprit (p 0.0013) and non-culprit vessel (p: 0.0006). Moreover in the whole population cTFC values of both arteries increase linearly with the increment of admission PGL. CONCLUSIONS: Admission PGL affects coronary flow of both culprit and non-culprit vessel. The impairment of coronary flow is also demonstrated in known diabetic patients, suggesting to consider hyperglycemia an additional risk factor. We finally demonstrated for the first time a positive linear relationship between PGL and cTFC.


Assuntos
Glicemia/fisiologia , Circulação Coronária/fisiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Idoso , Velocidade do Fluxo Sanguíneo , Estudos de Coortes , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiologia , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/complicações , Hiperglicemia/fisiopatologia , Hiperglicemia/cirurgia , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Prognóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Resultado do Tratamento
7.
J Neurointerv Surg ; 10(2): 112-117, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28289148

RESUMO

BACKGROUND AND PURPOSE: Higher admission serum glucose levels have been associated with poor outcomes in patients with acute ischemic stroke (AIS) treated with IV thrombolysis. We sought to evaluate the association of admission serum glucose with early outcomes of patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). METHODS: Consecutive AIS patients due to ELVO treated with MT in three tertiary stroke centers were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), complete reperfusion, mortality, functional independence (modified Rankin Scale (mRS) score of 0-2), and functional improvement (shift in mRS score) at 3 months. The association of admission serum glucose and admission hyperglycemia (>140 mg/dL) with outcomes was evaluated using univariable and multivariable binary and ordinal logistic regression models. RESULTS: 231 AIS patients with ELVO (mean age 62±14 years, 51% men, median admission National Institute of Health Stroke Scale score 16 points (IQR 12-21), median admission serum glucose 125 mg/dL (IQR 104-162)) were treated with MT. Admission hyperglycemia was associated with a lower likelihood of functional improvement (common OR 0.53; 95% CI 0.31 to 0.97; p=0.027) and higher odds of 3 month mortality (OR 2.76; 95% CI 1.40 to 5.44; p=0.004) in multivariable analyses adjusting for potential confounders. A 10 mg/dL increase in admission blood glucose was associated with a higher likelihood of sICH (OR 1.07; 95% CI 1.01 to 1.13; p=0.033) and 3 month mortality (OR 1.07; 95% CI 1.02 to 1.12; p=0.004) in multivariable models. There was no association between admission serum glucose or hyperglycemia and complete reperfusion. CONCLUSIONS: Higher admission serum glucose and admission hyperglycemia are independent predictors of adverse outcomes in ELVO patients treated with MT.


Assuntos
Hiperglicemia/sangue , Hiperglicemia/cirurgia , Admissão do Paciente/tendências , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/cirurgia , Trombectomia/tendências , Idoso , Glicemia/metabolismo , Isquemia Encefálica/sangue , Isquemia Encefálica/mortalidade , Isquemia Encefálica/cirurgia , Feminino , Humanos , Hiperglicemia/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reperfusão/efeitos adversos , Reperfusão/tendências , Estudos Retrospectivos , Acidente Vascular Cerebral/mortalidade , Trombectomia/efeitos adversos , Resultado do Tratamento
8.
Endocrinology ; 159(1): 83-102, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29029025

RESUMO

Insulin receptor (IR) insufficiency in ß-cells leads to impaired insulin secretion and reduced ß-cell hyperplasia in response to hyperglycemia. Selective IR deficiency in ß-cells in later embryological development may lead to compensatory ß-cell hyperplasia. Although these findings suggest insulin signaling on the ß-cell is important for ß-cell function, they are confounded by loss of signaling by the insulinlike growth factors through the IR. To determine whether insulin itself is necessary for ß-cell development and maturation, we performed a characterization of pancreatic islets in mice with deletions of both nonallelic insulin genes (Ins1-/-Ins2-/-). We immunostained neonatal Ins1-/-Ins2-/- and Ins1+/+Ins2+/+ pancreata and performed quantitative polymerase chain reaction on isolated neonatal islets. Insulin-deficient islets had reduced expression of factors normally expressed in maturing ß-cells, including muscoloaponeurotic fibrosarcoma oncogene homolog A, homeodomain transcription factor 6.1, and glucose transporter 2. Ins1-/-Ins2-/-ß-cells expressed progenitor factors associated with stem cells or dedifferentiated ß-cells, including v-myc avian myolocytomatosis viral oncogene lung carcinoma derived and homeobox protein NANOG. We replaced insulin by injection or islet transplantation to keep mice alive into adulthood to determine whether insulin replacement was sufficient for the completed maturation of insulin-deficient ß-cells. Short-term insulin glargine (Lantus®) injections partially rescued the ß-cell phenotype, whereas long-term replacement of insulin by isogenic islet transplantation supported the formation of more mature ß-cells. Our findings suggest that tightly regulated glycemia, insulin species, or other islet factors are necessary for ß-cell maturation.


Assuntos
Hiperglicemia/cirurgia , Células Secretoras de Insulina/metabolismo , Insulina/deficiência , Transplante das Ilhotas Pancreáticas , Animais , Animais Recém-Nascidos , Biomarcadores/metabolismo , Diferenciação Celular/efeitos dos fármacos , Tamanho Celular/efeitos dos fármacos , Feminino , Fibrose , Regulação da Expressão Gênica no Desenvolvimento/efeitos dos fármacos , Terapia de Reposição Hormonal/efeitos adversos , Hiperglicemia/tratamento farmacológico , Hiperglicemia/etiologia , Hiperglicemia/patologia , Injeções Subcutâneas , Insulina/genética , Insulina/metabolismo , Insulina Glargina/administração & dosagem , Insulina Glargina/efeitos adversos , Insulina Glargina/uso terapêutico , Secreção de Insulina , Células Secretoras de Insulina/efeitos dos fármacos , Células Secretoras de Insulina/patologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , Técnicas de Cultura de Tecidos
9.
Clin Neurol Neurosurg ; 163: 128-132, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29101862

RESUMO

OBJECTIVES: Elevated blood glucose is frequently detected early after aneurysmal subarachnoid hemorrhage (aSAH) and is considered a risk factor for poor neurological outcome. However it remains unclear whether hyperglycemia is caused by the SAH ictus or reflects a pre-existing hyperglycemic metabolism. In a prospective register we analysed glycated haemoglobin levels (HbA1c) in patients with aSAH and its influence on outcome. PATIENTS AND METHODS: Between July 2012 and July 2014, 87 patients with confirmed aSAH were included (NCT02081820). Within 72h HbA1c levels were assessed as a measure for hyperglycemic metabolism preceding aSAH. Blood glucose levels were recorded upon admission. Patient outcome was recorded after 6 months using modified Rankin scale (mRS). RESULTS: HbA1c levels did not correlate with initial neurological status (p=0.338, r=0.104). On the contrary, initial blood glucose levels correlated significantly with neurological status at admission (p=0.001, r=0.341). Additionally, HbA1c levels failed to show a significant influence on the occurrence of delayed cerebral ischemia (DCI) (p=0.400) or outcome after 6 months (p=0.790). CONCLUSION: A pre-existing hyperglycemic metabolism does not contribute to the severity of aSAH or influences the quality of neurological recovery. Hyperglycemia after aSAH correlates with initial neurological status and patient outcome and is potentially attributable to the metabolic changes induced by the brain injury after the hemorrhage.


Assuntos
Isquemia Encefálica/cirurgia , Hemoglobina A Glicada/metabolismo , Hiperglicemia/cirurgia , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Isquemia Encefálica/complicações , Feminino , Humanos , Hiperglicemia/complicações , Hiperglicemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico
10.
J Vis Exp ; (125)2017 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-28784962

RESUMO

Islet transplantation has been clinically proven to be effective at treating type 1 diabetes. However, the current intrahepatic transplantation strategy may incur acute whole blood reactions and result in poor islet engraftment. Here, we report a robust protocol for the transplantation of islets at the extrahepatic transplantation site-the epididymal fat pad (EFP)-in a diabetic mouse model. A protocol to isolate and purify islets at high yields from C57BL/6J mice is described, as well as a transplantation method performed by seeding islets onto a decellularized scaffold (DCS) and implanting them at the EFP site in syngeneic C57BL/6J mice rendered diabetic by streptozotocin. The DCS graft containing 500 islets reversed the hyperglycemic condition within 10 days, while the free islets without DCS required at least 30 days. The normoglycemia was maintained for up to 3 months until the graft was explanted. In conclusion, DCS enhanced the engraftment of islets into the extrahepatic site of the EFP, which could easily be retrieved and might provide a reproducible and useful platform for investigating the scaffold materials, as well as other transplantation parameters required for a successful islet engraftment.


Assuntos
Tecido Adiposo/cirurgia , Diabetes Mellitus Experimental/cirurgia , Diabetes Mellitus Tipo 1/cirurgia , Epididimo/cirurgia , Transplante das Ilhotas Pancreáticas/métodos , Animais , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Tipo 1/induzido quimicamente , Modelos Animais de Doenças , Hiperglicemia/cirurgia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Estreptozocina/toxicidade , Resultado do Tratamento
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 20(4): 372-377, 2017 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-28440515

RESUMO

Along with the soaring prevalence of obesity and type 2 diabetes mellitus (T2DM) globally, metabolic and bariatric surgery (MBS) has been rapidly developing into a major surgical subspecialty. However, the indications, benefits and potential risks of MBS are still controversial so far. In September 2015, the 2nd Diabetes Surgery Summit (DSS-II() was successfully convened, and later on an international joint statement on metabolic surgery in the treatment algorithm for T2DM was released based upon the consensus reached in DSS-II(, aiming to serve as a new global clinical guideline. The DSS-II( joint statement was initiated and endorsed by 5 leading international diabetes organizations, including American Diabetes Association (ADA), International Diabetes Federation (IDF), Chinese Diabetes Society (CDS), Diabetes India, as well as Diabetes UK, and was developed by an expert committee comprised of 48 international authorities as voting delegates. Up to the date of publication, the DSS-II( statement has been officially endorsed by 45 international professional associations/societies, including 30 non-surgical and 15 surgical organizations. In this statement, the following six aspects were recommended to differentiate MBS from traditional bariatric surgery: 1)The primary goal of MBS is to treat T2DM and to reduce the risk of T2DM complications; 2) In addition to a 50% or more of excess weight loss and normalization of glycemia, outcomes of diabetes complications should also be considered as clinical endpoints of MBS; 3) For patient selection, body mass index (BMI), T2DM treatment, as well as long-term risks versus benefits, including its effects on cardiovascular events (CVD), should all be considered; 4) T2DM and its complications, as well as pancreatic function reserve should be assessed pre-operatively; 5) Major surgical options include laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric banding (LAGB), and bilio-pancreatic diversion with duodenal switch(BPD-DS). BPD-DS has the best outcome in T2DM remission followed by LRYGB, LSG and LAGB; 6) Glycemic variation should be intensively monitored, and if needed, managed following surgery. Clinical follow-up should be conducted at least once every six months within two years after surgery. For patients achieving complete remission from T2DM, diabetes complications should still be monitored within five years after surgery with the same frequency and protocols as pre-operatively.


Assuntos
Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/normas , Diabetes Mellitus Tipo 2/cirurgia , Gerenciamento Clínico , Obesidade/cirurgia , Planejamento de Assistência ao Paciente/normas , Resultado do Tratamento , Assistência ao Convalescente/normas , Desvio Biliopancreático , Glicemia/fisiologia , Índice de Massa Corporal , Gastrectomia , Derivação Gástrica , Gastroplastia , Humanos , Hiperglicemia/cirurgia , Laparoscopia , Guias de Prática Clínica como Assunto/normas , Indução de Remissão/métodos , Perda de Peso
12.
J Arthroplasty ; 32(9S): S251-S253, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28343827

RESUMO

BACKGROUND: It is unknown to what extent diabetes mellitus modifies the long-term risk of aseptic loosening in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We examined the association between diabetes mellitus, perioperative hyperglycemia, and the likelihood of revisions for aseptic loosening. METHODS: We studied 16,085 primary THA and TKA procedures performed at a large tertiary care hospital between 2002 and 2009. All blood glucose values around the time of surgery (within 1 week) were retrieved. Subsequent revision surgeries and the reasons for revision were ascertained through the institutional joint registry. Multivariate Cox models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for aseptic loosening associated with diabetes mellitus and hyperglycemia adjusting for age, gender, body mass index, and surgery type. RESULTS: A total of 2911 (18%) surgeries had a diagnosis of diabetes mellitus at the time of surgery. Glucose testing was performed at least once in 7055 (44%) procedures within ±1 week of surgery. Although diabetic patients did not experience a higher risk of revision for aseptic loosening (HR, 0.87; 95% CI, 0.55-1.38), higher preoperative glucose values on the day before surgery were significantly associated with both the overall risk of revisions (HR, 2.80; 95% CI, 1.00-7.85) and revisions for aseptic loosening (HR, 4.95; 95% CI, 1.26-19.54). CONCLUSION: High preoperative hyperglycemia is a potential risk factor for aseptic loosening in THA and TKA.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Complicações do Diabetes/complicações , Hiperglicemia/complicações , Falha de Prótese , Adulto , Idoso , Glicemia , Índice de Massa Corporal , Complicações do Diabetes/sangue , Diabetes Mellitus/sangue , Diabetes Mellitus/cirurgia , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Modelos de Riscos Proporcionais , Sistema de Registros , Análise de Regressão , Reoperação , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária
13.
Int J Cardiol ; 241: 57-63, 2017 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-28256326

RESUMO

BACKGROUND: We aimed to investigate the outcome-predicting value of a novel index of stress hyperglycemia in coronary artery disease (CAD) patients who underwent percutaneous coronary intervention (PCI). METHODS: This was a retrospective observational study. Four-thousand-three-hundred-sixty-two subjects from the COACT registry were used to estimate the risk of major adverse cardiovascular and cerebrovascular events (MACCE), which are defined as composites of all-cause death, non-fatal myocardial infarction (MI) and non-fatal stroke. The stress hyperglycemia ratio (SHR) was calculated by dividing the random serum glucose at admission with the estimated average glucose derived from HbA1c. RESULTS: Over a median follow-up of 2.5years, 344 (7.9%), 43 (1.0%), and 89 (2.0%) cases of death, non-fatal MI, and non-fatal stroke occurred, respectively. Compared with the subjects in the lower three quartiles of SHR, the HR (95% CI) for the highest SHR quartile (Q4) group for MACCE was 1.31 (1.05, 1.64) in the total population and 1.45 (1.02, 2.06) in the non-diabetic population after adjusting for potential covariables. The risk of MACCE in the SHR Q4 group was significantly higher in patients presenting with ST-elevation MI (STEMI), which was not the case for patients presenting with other CAD types. The prognostic impact of SHR was more prominent for the 30-day MACCE. Similar results were observed in another cohort consisting of patients who only presented with acute MI. CONCLUSIONS: SHR is a useful predictive marker of MACCE after PCI, especially in non-diabetic patients with STEMI, which could be utilized to identify high-risk patients for adverse outcomes.


Assuntos
Glicemia/metabolismo , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/cirurgia , Hiperglicemia/sangue , Hiperglicemia/cirurgia , Intervenção Coronária Percutânea/tendências , Idoso , Doença da Artéria Coronariana/diagnóstico , Feminino , Seguimentos , Humanos , Hiperglicemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento
14.
Cell Transplant ; 26(11): 1755-1762, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29338381

RESUMO

In islet transplantation, in addition to immunologic and ischemic factors, the diabetic/hyperglycemic state of the recipient has been proposed, although not yet validated, as a possible cause of islet toxicity, contributing to islet loss during the engraftment period. Using a miniature swine model of islet transplantation, we have now assessed the effect of a persistent state of hyperglycemia on islet engraftment and subsequent function. An islet-kidney (IK) model previously described by our laboratory was utilized. Three experimental donor animals underwent total pancreatectomy and autologous islet transplantation underneath the renal capsule to prepare an IK at a load of ≤1,000 islet equivalents (IE)/kg donor weight, leading to a chronic diabetic state during the engraftment period (fasting blood glucose >250 mg/dL). Three control donor animals underwent partial pancreatectomy (sufficient to maintain normoglycemia during islet engraftment period) and IK preparation. As in vivo functional readout for islet engraftment, the IKs were transplanted across an immunologic minor or class I mismatch barrier into diabetic, nephrectomized recipients at an islet load of ∼4,500 IE/kg recipient weight. A 12-d course of cyclosporine was administered for tolerance induction. All experimental donors became diabetic and showed signs of end organ injury, while control donors maintained normoglycemia. All recipients of IK from both experimental and control donors achieved glycemic control over long-term follow-up, with reversal of diabetic nephropathy and with similar glucose tolerance tests. In this preclinical, large animal model, neither islet engraftment nor subsequent long-term islet function after transplantation appear to be affected by the diabetic state.


Assuntos
Hiperglicemia/cirurgia , Transplante das Ilhotas Pancreáticas/métodos , Transplante de Rim/métodos , Animais , Glicemia/metabolismo , Teste de Tolerância a Glucose , Pancreatectomia , Suínos , Porco Miniatura
15.
J. physiol. biochem ; 72(4): 625-633, dic. 2016. tab, graf
Artigo em Inglês | IBECS | ID: ibc-168370

RESUMO

Herein, we investigated whether subdiaphragmatic vagotomy has benefits on obesity, body glucose homeostasis, and insulin secretion in cafeteria (CAF)-obese rats. Wistar rats were fed a standard or CAF diet for 12 weeks. Subsequently, CAF rats were randomly submitted to truncal vagotomy (CAF Vag) or sham operation (CAF Sham). CAF Sham rats were hyperphagic, obese, and presented metabolic disturbances, including hyperinsulinemia, glucose intolerance, insulin resistance, hyperglycemia, and hypertriglyceridemia. Twelve weeks after vagotomy, CAF Vag rats presented reductions in body weight and perigonadal fat stores. Vagotomy did not modify glucose tolerance but normalized fed glycemia, insulinemia, and insulin sensitivity. Isolated islets from CAF Sham rats secreted more insulin in response to the cholinergic agent, carbachol, and when intracellular cyclic adenine monophosphate (cAMP) is enhanced by forskolin or 3-isobutyl-1-methylxanthine. Vagotomy decreased glucose-induced insulin release due to a reduction in the cholinergic action on β-cells. This effect also normalized islet secretion in response to cAMP. Therefore, vagotomy in rats fed on a CAF-style diet effectively decreases adiposity and restores insulin sensitivity. These effects were mainly associated with the lack of cholinergic action on the endocrine pancreas, which decreases insulinemia and may gradually reduce fat storage and improve insulin sensitivity (AU)


No disponible


Assuntos
Animais , Masculino , Ratos , Hiperglicemia/cirurgia , Hiperinsulinismo/cirurgia , Hipertrigliceridemia/cirurgia , Obesidade/cirurgia , Vagotomia , Modelos Animais de Doenças , Ratos Wistar , Resistência à Insulina , Peso Corporal , Técnicas de Cultura de Células , 1-Metil-3-Isobutilxantina/farmacologia , AMP Cíclico/metabolismo , Dieta Hiperlipídica
16.
J Neurosci ; 36(36): 9313-25, 2016 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-27605608

RESUMO

UNLABELLED: Hyperglycemia is common in patients with acute stroke, even in those without preexisting diabetes, and denotes a bad outcome. However, the mechanisms underlying the detrimental effects of hyperglycemia are largely unclear. In a mouse model of ischemic stroke, we found that hyperglycemia increased the infarct volume and decreased the number of protective noninflammatory monocytes/macrophages in the ischemic brain. Ablation of peripheral monocytes blocked the detrimental effect of hyperglycemia, suggesting that monocytes are required. In hyperglycemic mice, α-dicarbonyl glucose metabolites, the precursors for advanced glycation end products, were significantly elevated in plasma and ischemic brain tissue. The receptor of advanced glycation end products, AGER (previously known as RAGE), interfered with polarization of macrophages to a noninflammatory phenotype. When Ager was deleted, hyperglycemia did not aggravate ischemic brain damage any longer. Independently of AGER, methylglyoxal reduced the release of endothelial CSF-1 (M-CSF), which stimulates polarization of macrophages to a noninflammatory phenotype in the microenvironment of the ischemic brain. In summary, our study identified α-dicarbonyls and AGER as mediators by which hyperglycemia lowers the number of protective noninflammatory macrophages and consequently increases ischemic brain damage. Modulating the metabolism of α-dicarbonyls or blocking AGER may improve the treatment of stroke patients with hyperglycemia. SIGNIFICANCE STATEMENT: Although glucose is the main energy substrate of the brain, hyperglycemia aggravates ischemic brain damage in acute stroke. So far, clinical trials have indicated that insulin treatment provides no solution to this common clinical problem. This study shows, in an experimental stroke model, that hyperglycemia interferes with the polarization of monocytes/macrophages to a protective cell type. Key players are α-dicarbonyls and the receptor for advanced glycation end products (AGER). Deletion of AGER normalized monocyte/macrophage polarization and reversed the detrimental effects of hyperglycemia, suggesting new avenues to treat stroke patients.


Assuntos
Polaridade Celular/fisiologia , Hiperglicemia/etiologia , Hiperglicemia/patologia , Macrófagos/patologia , Monócitos/patologia , Acidente Vascular Cerebral/complicações , Animais , Transplante de Medula Óssea , Encéfalo/citologia , Antígeno CD11b/genética , Antígeno CD11b/metabolismo , Receptor 1 de Quimiocina CX3C , Polaridade Celular/genética , Células Cultivadas , Citocinas/metabolismo , Modelos Animais de Doenças , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/fisiologia , Regulação da Expressão Gênica/genética , Hiperglicemia/cirurgia , Lipopolissacarídeos/farmacologia , Macrófagos/efeitos dos fármacos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Monócitos/efeitos dos fármacos , Receptor para Produtos Finais de Glicação Avançada/genética , Receptor para Produtos Finais de Glicação Avançada/metabolismo , Receptores de Quimiocinas/genética , Receptores de Quimiocinas/metabolismo , Acidente Vascular Cerebral/cirurgia
17.
Diabetes Care ; 39(12): 2254-2261, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27519448

RESUMO

OBJECTIVE: To assess procedural safety and glycemic indices at 6 months in a first-in-human study of duodenal mucosal resurfacing (DMR), a novel, minimally invasive, upper endoscopic procedure involving hydrothermal ablation of the duodenal mucosa, in patients with type 2 diabetes and HbA1c ≥7.5% (58 mmol/mol) on one or more oral antidiabetic agents. RESEARCH DESIGN AND METHODS: Using novel balloon catheters, DMR was conducted on varying lengths of duodenum in anesthetized patients at a single medical center. RESULTS: A total of 39 patients with type 2 diabetes (screening HbA1c 9.5% [80 mmol/mol]; BMI 31 kg/m2) were treated and included in the interim efficacy analysis: 28 had a long duodenal segment ablated (LS; ∼9.3 cm treated) and 11 had a short segment ablated (SS; ∼3.4 cm treated). Overall, DMR was well tolerated with minimal gastrointestinal symptoms postprocedure. Three patients experienced duodenal stenosis treated successfully by balloon dilation. HbA1c was reduced by 1.2% at 6 months in the full cohort (P < 0.001). More potent glycemic effects were observed among the LS cohort, who experienced a 2.5% reduction in mean HbA1c at 3 months postprocedure vs. 1.2% in the SS group (P < 0.05) and a 1.4% reduction at 6 months vs. 0.7% in the SS group (P = 0.3). This occurred despite net medication reductions in the LS cohort between 0 and 6 months. Among LS patients with a screening HbA1c of 7.5-10% (58-86 mmol/mol) and on stable antidiabetic medications postprocedure, HbA1c was reduced by 1.8% at 6 months (P < 0.01). CONCLUSIONS: Single-procedure DMR elicits a clinically significant improvement in hyperglycemia in patients with type 2 diabetes in the short-term, with acceptable safety and tolerability. Long-term safety, efficacy, and durability and possible mechanisms of action require further investigation.


Assuntos
Cirurgia Bariátrica/métodos , Diabetes Mellitus Tipo 2/cirurgia , Duodeno/cirurgia , Endoscopia Gastrointestinal/métodos , Adulto , Idoso , Glicemia/metabolismo , Terapia Combinada , Quimioterapia Combinada , Feminino , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/tratamento farmacológico , Hiperglicemia/cirurgia , Hipoglicemiantes/uso terapêutico , Mucosa Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Projetos Piloto
18.
J Physiol Biochem ; 72(4): 625-633, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27351887

RESUMO

Herein, we investigated whether subdiaphragmatic vagotomy has benefits on obesity, body glucose homeostasis, and insulin secretion in cafeteria (CAF)-obese rats. Wistar rats were fed a standard or CAF diet for 12 weeks. Subsequently, CAF rats were randomly submitted to truncal vagotomy (CAF Vag) or sham operation (CAF Sham). CAF Sham rats were hyperphagic, obese, and presented metabolic disturbances, including hyperinsulinemia, glucose intolerance, insulin resistance, hyperglycemia, and hypertriglyceridemia. Twelve weeks after vagotomy, CAF Vag rats presented reductions in body weight and perigonadal fat stores. Vagotomy did not modify glucose tolerance but normalized fed glycemia, insulinemia, and insulin sensitivity. Isolated islets from CAF Sham rats secreted more insulin in response to the cholinergic agent, carbachol, and when intracellular cyclic adenine monophosphate (cAMP) is enhanced by forskolin or 3-isobutyl-1-methylxanthine. Vagotomy decreased glucose-induced insulin release due to a reduction in the cholinergic action on ß-cells. This effect also normalized islet secretion in response to cAMP. Therefore, vagotomy in rats fed on a CAF-style diet effectively decreases adiposity and restores insulin sensitivity. These effects were mainly associated with the lack of cholinergic action on the endocrine pancreas, which decreases insulinemia and may gradually reduce fat storage and improve insulin sensitivity.


Assuntos
Hiperglicemia/cirurgia , Hiperinsulinismo/cirurgia , Hipertrigliceridemia/cirurgia , Obesidade/cirurgia , Vagotomia , Nervo Vago/cirurgia , 1-Metil-3-Isobutilxantina/farmacologia , Tecido Adiposo/efeitos dos fármacos , Tecido Adiposo/metabolismo , Animais , Peso Corporal/efeitos dos fármacos , Carbacol/farmacologia , Colforsina/farmacologia , AMP Cíclico/metabolismo , Dieta Hiperlipídica , Modelos Animais de Doenças , Glucose/metabolismo , Glucose/farmacologia , Hiperglicemia/etiologia , Hiperglicemia/metabolismo , Hiperglicemia/patologia , Hiperinsulinismo/etiologia , Hiperinsulinismo/metabolismo , Hiperinsulinismo/patologia , Hipertrigliceridemia/etiologia , Hipertrigliceridemia/metabolismo , Hipertrigliceridemia/patologia , Insulina/metabolismo , Resistência à Insulina , Secreção de Insulina , Ilhotas Pancreáticas/efeitos dos fármacos , Ilhotas Pancreáticas/metabolismo , Masculino , Obesidade/etiologia , Obesidade/metabolismo , Obesidade/patologia , Ratos , Ratos Wistar , Técnicas de Cultura de Tecidos , Nervo Vago/metabolismo
19.
BMC Res Notes ; 9: 140, 2016 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-26939866

RESUMO

BACKGROUND: Neonatal hyperglycaemia is a rare metabolic disorder. There are no reports of an association between neonatal hyperglycaemia and gastroschisis. CASE PRESENTATION: This report presents preoperative and intraoperative management of blood sugar in a low birth weight Thai preterm neonate with gastroschisis and a diagnosis of neonatal hyperglycaemia. The patient underwent an emergency, multi-staged, surgical repair under general anaesthesia. CONCLUSION: Anaesthesiologists should be aware of possible perioperative dysglycaemic conditions in these patients. Proper timing of surgery and appropriate preanaesthetic preparation are necessary to reduce the morbidity and mortality related to hyperglycaemia and gastroschisis. CONSENT: The patient's guardian has given consent for the case report to be published.


Assuntos
Gastrosquise/tratamento farmacológico , Gastrosquise/cirurgia , Hiperglicemia/tratamento farmacológico , Hiperglicemia/cirurgia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Parede Abdominal/anormalidades , Parede Abdominal/cirurgia , Doença Aguda , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Gastrosquise/complicações , Gastrosquise/patologia , Humanos , Hiperglicemia/complicações , Hiperglicemia/patologia , Recém-Nascido , Doenças do Recém-Nascido , Recém-Nascido Prematuro , Masculino , Resultado do Tratamento
20.
Curr Opin Anaesthesiol ; 29(3): 430-7, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26910050

RESUMO

PURPOSE OF REVIEW: Diabetes is the most prevalent long-term metabolic condition and its incidence continues to increase unabated. Patients with diabetes are overrepresented in the surgical population. It has been well recognized that poor perioperative diabetes control is associated with poor surgical outcomes. The outcomes are worst for those people who were not recognized as having hyperglycaemia. RECENT FINDINGS: Recent work has shown that preoperative recognition of diabetes and good communication between the clinical teams at all stages of the patient pathway help to minimize the potential for errors, and improve glycaemic control. The stages of the patient journey start in primary care and end when the patient goes home. The early involvement of the diabetes specialist team is important if the glycated haemoglobin is more than 8.5%, and advice sought if the preoperative assessment team is not familiar with the drug regimens. To date the glycaemic targets for the perioperative period have remained uncertain, but recently a consensus is being reached to ensure glucose levels remain between 108 and180 mg/dl (6.0 and 10.0 mmol/l). There have been a number of ways to achieve these - primarily by manipulating the patients' usual diabetes medications, to also allow day of surgery admission. SUMMARY: glycaemic control remains an important consideration in the surgical patient.


Assuntos
Diabetes Mellitus/sangue , Hemoglobina A Glicada/análise , Hiperglicemia/sangue , Hipoglicemia/sangue , Assistência Perioperatória/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Glicemia/análise , Glicemia/efeitos dos fármacos , Estado Terminal , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/cirurgia , Glucose/uso terapêutico , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/tratamento farmacológico , Hiperglicemia/cirurgia , Hipoglicemia/diagnóstico , Hipoglicemia/tratamento farmacológico , Hipoglicemia/cirurgia , Hipoglicemiantes/uso terapêutico , Bombas de Infusão Implantáveis , Insulina/uso terapêutico , Náusea e Vômito Pós-Operatórios/sangue , Náusea e Vômito Pós-Operatórios/complicações , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Cloreto de Potássio/uso terapêutico , Estresse Psicológico/sangue , Resultado do Tratamento
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