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1.
Indian J Med Res ; 149(4): 544-547, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31411179

RESUMO

Background & objectives: Ghrelin is an orexigenic gut hormone expressed by the gastric fundus. Laparoscopic sleeve gastrectomy (LSG) procedure involves resection of the gastric fundus leading to a decreased appetite and weight loss. This study was undertaken to determine the levels of plasma ghrelin after sleeve gastrectomy in obese patients. Methods: The study was conducted on 90 morbidly obese patients [body mass index (BMI) >40 kg/m[2]] and severely obese patients (BMI >35/kg/m[2]) who underwent sleeve gastrectomy. The patients were followed up for six months. Weight loss parameters and plasma ghrelin levels were assessed pre- and postoperatively. Results: A significant weight loss and decrease in BMI were observed at three and six months postoperatively. A significant decrease in plasma ghrelin levels over six months of follow up postoperatively was also seen. Interpretation & conclusions: These preliminary findings indicated inhibition of ghrelin production after LSG leading to a decrease in the plasma ghrelin levels within a few days of surgery and sustainable weight loss in obese patients.


Assuntos
Biomarcadores/sangue , Grelina/sangue , Obesidade Mórbida/sangue , Perda de Peso , Adulto , Idoso , Índice de Massa Corporal , Feminino , Gastrectomia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Período Pós-Operatório
2.
Gynecol Oncol ; 155(1): 27-33, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31349997

RESUMO

OBJECTIVE: To assess risk factors for lymph node involvement in patients with endometrial cancer and a body-mass index (BMI) ≥30 kg/m2. MATERIALS AND METHODS: A retrospective analysis was performed of obese patients diagnosed with endometrial carcinoma between 2007 and 2015, treated in a single center in Montreal. Preoperative variables evaluated were age, BMI, parity, and preoperative ASA score, grade, CA-125 and histology. Odds ratios (OR) and hazard ratios (HR) and their respective 95% confidence intervals (95%CI) were calculated using multivariable logistic regression and Cox proportional hazard models. RESULTS: The study included 230 women with BMI ≥30, 223 (97.0%) had complete staging. Pelvic lymph node involvement was detected in 26 patients (11.3%). Sentinel node detection and pelvic lymph node dissection decreased with increasing BMI (adjusted OR 0.86, 95%CI 0.76-0.97 and 0.76, 95%CI 0.59-0.96, respectively, per 1 kg/m2 increment). Pelvic lymph node involvement was inversely correlated with BMI (adjusted OR 0.88, 95%CI 0.79-0.99) and present in 16/85 (18.8%), 6/56 (10.7%), and 4/82 (4.9%) of patients with a BMI of 30.0-34.9, 35.0-39.9, and ≥40.0 kg/m2, respectively. Preoperative CA-125 was associated with lymph node involvement (adjusted OR 2.77, 95%CI 1.62-4.73, per quartile increment). CONCLUSION: Pelvic lymph node dissection might be omitted in selected cases of morbidly obese patients with failed sentinel nodes mapping and a low CA-125.


Assuntos
Neoplasias do Endométrio/patologia , Linfonodos/patologia , Obesidade Mórbida/patologia , Idoso , Índice de Massa Corporal , Antígeno Ca-125/metabolismo , Neoplasias do Endométrio/metabolismo , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/metabolismo , Linfonodos/cirurgia , Metástase Linfática , Proteínas de Membrana/metabolismo , Pessoa de Meia-Idade , Obesidade Mórbida/metabolismo , Estudos Retrospectivos , Fatores de Risco
3.
Diabetes Metab Syndr ; 13(3): 2142-2147, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31235148

RESUMO

AIM OF THE STUDY: Bariatric surgery causes profound improvement in metabolic parameters by increasing plasma glucagon like peptide - 1 (GLP-1) level even few weeks after surgery. GLP-1 analogues can cause calcitonin secreting medullary thyroid carcinoma in animals. The studies relating to the mechanisms that underlie these changes are few. The objectives of the study were to measure the change in insulin resistance, beta cell function, GLP-1 and calcitonin levels before and 2 weeks after bariatric surgery. METHODS: Patients above 18 years of age who underwent either laparoscopic sleeve gastrectomy or Roux-en Y gastric bypass were recruited into the study. Measured indices were homeostatic model assessment 2 for insulin resistance (HOMA2-IR), an index for hepatic insulin resistance; Matsuda index, an index of whole body insulin sensitivity; and insulin secretion and sensitivity index (ISSI-2), a marker of beta cell secretion. RESULTS: Twenty eight patients completed the study. HOMA2-IR was lower (2.72 ±â€¯1.28 vs. 2.04 ±â€¯0.9; P = 0.001) and ISSI-2 was higher (0.80 (0.51-1.26) vs. 1.04 (0.56-1.38); P = 0.019) at 2 weeks after surgery compared to baseline. Matsuda index also improved after surgery but was not statistically significant (2.02 (1.1-2.94) vs. 2.84 (1.56-4.12); P = 0.078). Fasting GLP-1 and calcitonin levels did not change while both peak GLP-1, and area under curve for GLP-1 were higher after surgery. CONCLUSIONS: At 2 weeks following bariatric surgery, hepatic insulin resistance decreased while beta cell function improved due to increase in postprandial GLP-1 level without any change in fasting calcitonin levels.


Assuntos
Cirurgia Bariátrica/métodos , Biomarcadores/análise , Calcitonina/sangue , Peptídeo 1 Semelhante ao Glucagon/sangue , Resistência à Insulina , Células Secretoras de Insulina/citologia , Obesidade Mórbida/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/metabolismo , Obesidade Mórbida/patologia , Prognóstico , Adulto Jovem
4.
PLoS One ; 14(5): e0217093, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31125357

RESUMO

BACKGROUND AND AIM: The controlled attenuation parameter (CAP) using FibroScan (Echosens, Paris, France) M or XL probe has been developed for liver steatosis assessment. However, CAP performs poorly in patients with high body mass index. The aim of our study was to assess whether CAP is overestimated using the standard XL probe in patients with morbid obesity, and in the case of an overestimation, to reprocess the data at a greater depth to obtain the appropriate CAP (CAPa). PATIENTS AND METHODS: We conducted an observational prospective cohort study on a total of 249 severely obese patients admitted to our institution to undergo sleeve gastrectomy. Patients had a liver biopsy performed during the surgery and a CAP measurement during the 15 days preceding biopsy. Patient files were reprocessed retrospectively by an algorithm, blinded to the patients' clinical data. The algorithm automatically assessed the probe-to-capsula distance (PCD) by analysing the echogenicity of ultrasound signals on the time-motion mode. In the case of a distance >35 mm, the algorithm automatically selected a deeper measurement for CAP (CAPa). When PCD was less than 35 mm, the measured CAP was considered as appropriated (CAPa) and no further reprocessing was performed. RESULTS: CAP recording was not performed at a sufficient depth in 130 patients. In these patients, the CAPa obtained at the adapted depth was significantly lower than CAP (298±3.9 versus 340±4.2 dB/m; p< 0.0001) measured at the standard depth (35 to 75 mm). Multiple linear regression analysis revealed that both body mass index and hepatic steatosis were independently correlated with CAP values. After reprocessing the CAP in patients with PCD > 35 mm, steatosis stage was the only parameter independently correlated with CAP values. For the diagnosis of steatosis (S≥1), moderate to severe steatosis (S≥2) and severe steatosis (S = 3), the AUROC curves of CAPa (measured CAP in patients with PCD<35 mm and reprocessed CAP in those with PCD>35 mm) were 0.86, 0.83 and 0.79, respectively. The Obuchowski measure for the diagnosis of steatosis was 0.90±0.013. CONCLUSION: CAP was overestimated in a half of morbidly obese patients using an XL probe, but CAP can be performed correctly in these patients after adapting the measurement depth.


Assuntos
Cirurgia Bariátrica/métodos , Técnicas de Imagem por Elasticidade/métodos , Hepatopatia Gordurosa não Alcoólica/patologia , Obesidade Mórbida/patologia , Adulto , Feminino , Humanos , Masculino , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/cirurgia , Obesidade Mórbida/complicações , Obesidade Mórbida/diagnóstico por imagem , Obesidade Mórbida/cirurgia , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos
5.
Lancet Haematol ; 6(7): e359-e365, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31133411

RESUMO

BACKGROUND: Because studies of direct oral anticoagulants in patients with venous thromboembolism and non-valvular atrial fibrillation have had minimal representation of morbidly obese patients (ie, body-mass index [BMI] ≥40 kg/m2), their efficacy and safety in this population are unclear. We investigated whether apixaban and rivaroxaban are as effective and safe as warfarin in morbidly obese patients. METHODS: We did a single-centre, retrospective analysis of chart data for all adult patients aged at least 18 years at Montefiore Medical Center (Bronx, NY, USA) with a BMI of at least 40 kg/m2 who were prescribed apixaban, rivaroxaban, or warfarin for either venous thromboembolism or atrial fibrillation between March 1, 2013, and March 1, 2017. Patients who had both venous thromboembolism and atrial fibrillation were excluded, as were patients with indications other than atrial fibrillation and venous thromboembolism. Outcomes of recurrent venous thromboembolism, stroke, and bleeding were measured from the first prescription date to the earliest of a thrombotic event, medication discontinuation, death, or end of study on June 30, 2017. Analyses were stratified by anticoagulation indication and adjusted for comorbidities, CHA2DS2-VASc score, and age where appropriate. Outcome rates were compared using Pearson's χ2 or Fisher's exact test. Time-to-event analyses accounting for length of follow-up were used to compare risks of outcomes. FINDINGS: We obtained data for 795 patients: 150 prescribed apixaban, 326 rivaroxaban, and 319 warfarin. In 366 patients prescribed an anticoagulant for venous thromboembolism, the incidence of recurrent venous thromboembolism was similar between the apixaban, rivaroxaban, and warfarin cohorts (1/47 [2·1%, 95% CI 0·0-6·3], 3/152 [2·0%, 0·0-4·2], and 2/167 [1·2%, 0·0-2·9], respectively; p=0·74). Incidence of major bleeding in this patient group was also similar between the treatment cohorts (1/47 patients on apixaban [2·1%, 95% CI 0·0-6·3], 2/152 on rivaroxaban [1·3%, 0·0-3·1], and 4/167 on warfarin [2·4%, 0·1-4·7]; p=0·77). In 429 patients prescribed an anticoagulant for atrial fibrillation, incidence of stroke was similar between the treatment cohorts (1/103 patients on apixaban [1·0%, 95% CI 0·0-2·9], 4/174 on rivaroxaban [2·3%, 0·1-4·5], and 2/152 on warfarin [1·3%, 0·0-3·1], p=0·71). In this patient group, major bleeding occurred in 3/103 patients on apixaban (2·9%, 95% CI 0·0-6·2), 5/174 on rivaroxaban (2·9%, 0·4-5·4), and 12/152 on warfarin (7·9%, 3·6-12·2); p=0·063. Time-to-event analyses showed that risk of all outcomes in patients with venous thromboembolism, and stroke and composite bleeding in patients with atrial fibrillation, were similar between the anticoagulant cohorts. INTERPRETATION: Our retrospective study provides further evidence of similar efficacy and safety between the direct oral anticoagulants apixaban and rivaroxaban, and warfarin in morbidly obese patients with atrial fibrillation and venous thromboembolism. These data, if confirmed in prospective studies, might enable patients with a BMI of at least 40 kg/m2 to benefit from more convenient, and possibly safer, anticoagulants. FUNDING: None.


Assuntos
Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Obesidade Mórbida/tratamento farmacológico , Varfarina/uso terapêutico , Adulto , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Índice de Massa Corporal , Inibidores do Fator Xa/efeitos adversos , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Modelos de Riscos Proporcionais , Pirazóis/efeitos adversos , Pirazóis/uso terapêutico , Piridonas/efeitos adversos , Piridonas/uso terapêutico , Recidiva , Estudos Retrospectivos , Rivaroxabana/efeitos adversos , Rivaroxabana/uso terapêutico , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/epidemiologia , Varfarina/efeitos adversos
6.
Endocr J ; 66(7): 605-613, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31019152

RESUMO

In this study, we investigated the relationships between body weight (BW), computed tomography (CT)-assessed abdominal adipose tissue, and the glycemic metabolic profile in obese Japanese patients following laparoscopic sleeve gastrectomy (LSG). This study analyzed adipose tissue compartments using CT methods before and 1 year after LSG. Thirty obese patients were studied, and variables measured included visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), density of VAT (VAT-D), and density of SAT (SAT-D). We also examined the parameters in patients according to whether they had type-2 diabetes (T2DM). LSG induced significant losses in BW, SAT, and VAT after LSG. Additionally, SAT-D and VAT-D both increased and fasting plasma glucose (FPG) and HbA1c, but not C-peptide, decreased after surgery. ΔSAT and ΔVAT were positively related, and ΔSAT-D and ΔVAT-D were negatively related to ΔBW and/or FPG. Furthermore, a multivariate regression model showed that total BW loss (TBWL) was closely related to ΔSAT (ß = 0.84; p < 0.001) and ΔVAT-D (ß = -0.45; p < 0.05) and improvement of FPG was related to ΔVAT (ß = 0.61; p < 0.05) after LSG. Finally, ΔFPG was correlated with ΔVAT in 16 T2DM patients (r = 0.58; p < 0.05) but not in non-T2DM patients. TBWL was related to ΔSAT and ΔVAT-D, and improvement of FPG was related to ΔVAT in obese Japanese patients after LSG.


Assuntos
Gordura Abdominal/diagnóstico por imagem , Gordura Abdominal/patologia , Glicemia/metabolismo , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/patologia , Obesidade Mórbida/cirurgia , Gordura Abdominal/metabolismo , Adulto , Metabolismo Energético/fisiologia , Feminino , Gastrectomia/métodos , Humanos , Gordura Intra-Abdominal/metabolismo , Japão , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/metabolismo , Obesidade Mórbida/patologia , Tamanho do Órgão , Estudos Retrospectivos , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/metabolismo , Gordura Subcutânea/patologia , Tomografia Computadorizada por Raios X
8.
Hormones (Athens) ; 18(2): 237-240, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30778850

RESUMO

There are numerous causes, such as environmental factors, medications, endocrine disorders, and genetic factors, that can lead to obesity. However, severe early-onset obesity with abnormal feeding behavior, mental retardation, dysmorphic features, organ-specific developmental abnormalities, and endocrine disorders suggest a genetic etiology. Mutations in genes related to the leptin-melanocortin pathway play a key role in genetic obesity. This pathway controls hypothalamic regulation of food intake. A few cases have been reported to have mutations in leptin (LEP) or leptin receptor (LEPR) genes. The cases had severe early-onset obesity, hyperphagia, and additional features, such as altered immune function, hypogonadism, and hypothyroidism. We present a 3-year-old male patient with severe early-onset obesity whose genetic analysis revealed a homozygous, novel, and pathogenic variant (c.1603+2T>C) in LEPR.


Assuntos
Mutação , Obesidade Mórbida/genética , Obesidade Pediátrica/genética , Receptores para Leptina/genética , Análise Mutacional de DNA , Homozigoto , Humanos , Hiperfagia/complicações , Hiperfagia/diagnóstico , Hiperfagia/genética , Lactente , Masculino , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/patologia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/patologia , Linhagem
9.
J Assist Reprod Genet ; 36(4): 777-786, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30659447

RESUMO

OBJECTIVE: To study the location and expression of receptors (SR-BI/CLA-1, SR-BII, and LDLr) and transporter (ABCA1) involved in uptake and efflux of cholesterol in human spermatozoa and assess whether obesity alters its location/expression and whether this could be related to infertility. DESIGN: Observational study. SETTING: None PATIENT(S): Ten controls and 20 obese patients. INTERVENTION(S): Anthropometric parameters. Serum and semen samples were collected. MAIN OUTCOME MEASURE(S): Spermatozoon concentration, immunolocalization, and protein expression in semen. RESULTS: Spermatozoon concentration and motility was decreased in morbidly obese patients. SR-BI/CLA-1, SR-BII, LDLr, and ABCA1 are located in the spermatozoon cell membrane and the localization does not change between obese patients and controls. Control spermatozoa showed high SR-BI expression, and less expression for the rest of the receptors analyzed, indicating that SR-BI/CLA-1 is relevant in human spermatozoon cholesterol uptake/efflux. On the contrary, spermatozoa of obese patients showed less SR-BI/CLA-1 expression than controls, and more intense positive staining for SR-BII, LDLr, and ABCA1. Finally, human sperm expresses the 130- and 82-kDa hormone-sensitive lipase (HSL) isoforms. The 130-kDa isoform is expressed in the control sperm, and the expression disappears in the obese patients. CONCLUSION(S): The presence of lipid receptors/transporters and HSL in human spermatozoa suggests their role in the process of maturation/capacitation. The changes in the expression of lipid receptors/transporters and the lack of the 130-kDa HSL isoform in obese patients prevent the hydrolysis of cholesterol esters internalized by these receptors, and favor their accumulation in the cytoplasm of the spermatozoa that could contribute to lipotoxicity and infertility.


Assuntos
Infertilidade Masculina/genética , Obesidade Mórbida/genética , Sêmen/metabolismo , Espermatozoides/metabolismo , Transportador 1 de Cassete de Ligação de ATP/genética , Adulto , Antígenos CD36/genética , Membrana Celular/genética , Colesterol/genética , Colesterol/metabolismo , Regulação da Expressão Gênica/genética , Humanos , Infertilidade Masculina/complicações , Infertilidade Masculina/patologia , Glicoproteínas de Membrana Associadas ao Lisossomo/genética , Masculino , Obesidade Mórbida/complicações , Obesidade Mórbida/patologia , Isoformas de Proteínas/genética , Receptores de LDL/genética , Receptores Depuradores/genética , Capacitação Espermática/genética , Espermatozoides/patologia , Esterol Esterase/genética
10.
J Matern Fetal Neonatal Med ; 32(21): 3600-3605, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29681190

RESUMO

Objective: The gestation-adjusted projection (GAP) is a method to predict birthweight using population birth data and third trimester ultrasound fetal weight. This method usually utilizes population birth weight data from almost 40 years ago. In 2011, a large cohort of racially diverse infants across the US was included to validate updated birth curves. Our objective was to determine if the updated data would improve the accuracy of the GAP method during the third trimester among obese women. Methods: This secondary analysis of a cohort study included singleton pregnancies of obese women who had fetal growth assessment(s) in the third trimester. The first subgroup (N = 235) included women with a BMI >40 kg/m2 who had ultrasounds during 30 + 0-35 + 0 weeks (EARLY) and greater than 35 + 0 weeks (LATE). The second subgroup (N = 431) included women with a BMI 30-35, 40-50, or >50 kg/m2 who had an ultrasound during 34 + 0-36 + 6 weeks. Mean absolute percent error was calculated for all GAP methods and compared using paired t-tests. Sensitivity, specificity, and area under the curve for diagnosis of birth weight >4000 grams were also estimated for each GAP method. Results: The mean absolute percent error for the first subgroup (N = 235) using historical population birth weights was 7.4-7.9%. After using updated population birth weight curves using all neonates, the mean absolute percent error for the first subgroup ranged between 7.6 and 9.4%. GAP predictions using all neonates, as well as male and female-specific birth data compared to the historical population data during both the EARLY and LATE periods were significantly worse (p < .01). The mean absolute percent error for the second subgroup (N = 431) using historical population birth weights ranged from 7.2 to 7.9%. The absolute percent error using gender-specific compared to historical data was significant in the BMI 30-35 group (male 8.1% versus historical 7.6%, p < .01, female 8.1% versus historical 7.6%, p < .01). The differences in absolute percent error between historical and updated population data became less evident in the BMI 40-50 and >50-kg/m2 groups (p = .05 and p = .15, respectively) though still overall performed worse with the updated data. Conclusions: Prediction of birth weight using the GAP method does not seem to be improved among obese women after using updated population data. Alternatively, modeling techniques may need to be applied to improve the accuracy of the GAP method.


Assuntos
Peso ao Nascer/fisiologia , Desenvolvimento Fetal/fisiologia , Previsões/métodos , Idade Gestacional , Obesidade Mórbida/patologia , Adulto , Índice de Massa Corporal , Estudos de Coortes , Feminino , Peso Fetal/fisiologia , Gráficos de Crescimento , Humanos , Recém-Nascido , Obesidade Mórbida/complicações , Obesidade Mórbida/diagnóstico , Valor Preditivo dos Testes , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/patologia , Prognóstico , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estados Unidos
11.
Crit Care Med ; 47(2): 247-253, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30395555

RESUMO

OBJECTIVES: Although one third or more of critically ill patients in the United States are obese, obesity is not incorporated as a contributing factor in any of the commonly used severity of illness scores. We hypothesize that selected severity of illness scores would perform differently if body mass index categorization was incorporated and that the performance of these score models would improve after consideration of body mass index as an additional model feature. DESIGN: Retrospective cohort analysis from a multicenter ICU database which contains deidentified data for more than 200,000 ICU admissions from 208 distinct ICUs across the United States between 2014 and 2015. SETTING: First ICU admission of patients with documented height and weight. PATIENTS: One-hundred eight-thousand four-hundred two patients from 189 different ICUs across United States were included in the analyses, of whom 4,661 (4%) were classified as underweight, 32,134 (30%) as normal weight, 32,278 (30%) as overweight, 30,259 (28%) as obese, and 9,070 (8%) as morbidly obese. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: To assess the effect of adding body mass index as a risk adjustment element to the Acute Physiology and Chronic Health Evaluation IV and Oxford Acute Severity of Illness scoring systems, we examined the impact of this addition on both discrimination and calibration. We performed three assessments based upon 1) the original scoring systems, 2) a recalibrated version of the systems, and 3) a recalibrated version incorporating body mass index as a covariate. We also performed a subgroup analysis in groups defined using World Health Organization guidelines for obesity. Incorporating body mass index into the models provided a minor improvement in both discrimination and calibration. In a subgroup analysis, model discrimination was higher in groups with higher body mass index, but calibration worsened. CONCLUSIONS: The performance of ICU prognostic models utilizing body mass index category as a scoring element was inconsistent across body mass index categories. Overall, adding body mass index as a risk adjustment variable led only to a minor improvement in scoring system performance.


Assuntos
APACHE , Índice de Massa Corporal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade/patologia , Obesidade Mórbida/patologia , Sobrepeso/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Magreza/patologia , Estados Unidos
12.
Obes Surg ; 29(2): 401-405, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30411224

RESUMO

BACKGROUND: Laparoscopic staplers are integral to bariatric surgery. Their pricing significantly impacts the overall cost of procedures. An independent device company has designed a stapler handle and single-use reloads for cross-compatibility and equivalency with existing manufacturers, at a lower cost. OBJECTIVES: We aim to demonstrate non-inferior function and cross-compatibility of a newly introduced stapler handle and reloads compared to our institution's current stapling system in a large animal survival study. SETTING: University-affiliated animal research facility, USA. METHODS: Matched small bowel anastomoses were created in four pigs, one with each stapler (a total of two per animal). After 14 days, investigators blinded to stapler type evaluated the anastomoses grossly and microscopically. Each anastomosis was scored on multiple measures of healing. Individual parameters were added for a global "healing score." RESULTS: Clinical stapler function and gross quality of anastomoses were similar between stapler groups. Individual scores for anastomotic ulceration, reepithelialization, granulation tissue, mural healing, eosinophilic infiltration, serosal inflammation, and microscopic adherences were also statistically similar. The mean "healing scores" were equal. While this study was underpowered for subtle differences, safe and reliable performance in large animals still supports the feasibility of introducing new devices into human use. CONCLUSIONS: The new stapler system delivers a similar technical performance and is cross-compatible with currently marketed stapling devices. An equivalent quality device at a lower price point should enable case cost reduction, helping to maintain hospital case margin and procedure value in the face of potentially declining reimbursement. This device may provide a safe and functional alternative to currently used laparoscopic surgical staplers.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Grampeadores Cirúrgicos/economia , Grampeamento Cirúrgico/economia , Grampeamento Cirúrgico/instrumentação , Anastomose Cirúrgica/economia , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Animais , Cirurgia Bariátrica/economia , Cirurgia Bariátrica/instrumentação , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/mortalidade , Custos e Análise de Custo , Modelos Animais de Doenças , Estudos de Viabilidade , Humanos , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Laparoscopia/economia , Laparoscopia/instrumentação , Laparoscopia/métodos , Laparoscopia/mortalidade , Obesidade Mórbida/economia , Obesidade Mórbida/mortalidade , Obesidade Mórbida/patologia , Grampeamento Cirúrgico/métodos , Grampeamento Cirúrgico/mortalidade , Suínos
13.
Obes Surg ; 29(1): 350-352, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30382462

RESUMO

Sleeve gastrectomy (SG) is currently the most popular bariatric procedure. Portomesenteric venous thrombosis (PVT) is a feared and increasingly reported complication. Herein, we describe the history of a patient who developed a post-operative PVT after SG, aggravated with refractory ascites, and finally required orthotopic liver transplantation (LT). Acquired thrombophilia-anti-cardiolipin syndrome was present. As SG expands worldwide, this first case of LT for PVT following SG may warrant a systematic screening for prothrombotic condition and information on the possible consequences of PVT prior to bariatric surgery.


Assuntos
Gastrectomia/efeitos adversos , Falência Hepática Aguda/diagnóstico , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Anticorpos Anticardiolipina/sangue , Gastrectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Falência Hepática Aguda/sangue , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/terapia , Transplante de Fígado , Veias Mesentéricas/patologia , Obesidade Mórbida/patologia , Veia Porta/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Síndrome , Trombofilia/sangue , Trombofilia/complicações , Trombofilia/etiologia , Trombose Venosa/etiologia , Trombose Venosa/terapia
14.
Obes Surg ; 29(2): 369-375, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30293133

RESUMO

INTRODUCTION: Some traditional bariatric surgery procedures may lead to functional gut shortening, which may unsettle the fine-tuned gastrointestinal physiology and affect gut microbiota balance. PURPOSE: Evaluate the gut microbiota behavior in rat models facing gut shortening due to intestinal bypass. MATERIALS AND METHODS: Wistar rats (n = 17) were randomly distributed in three groups: (1) sham group (n = 5); (2) blind loop group (n = 6); and (3) resection group (n = 6). Intestinal samples and feces were analyzed to measure bacterial concentrations (small intestinal bacterial overgrowth-SIBO) 12 weeks after the experimental procedures. Bacterial translocation (BT) was investigated in the mesenteric lymph node (MLN), liver, spleen, and lung of the animals. In addition, inflammatory aspects were investigated in their liver and small bowel through histological analysis. RESULTS: Regardless of blind loop, gut shortening groups recorded similar high level of bacterial concentrations in intestine compartments, greater than that of the sham group (p ≤ 0.05). BT was only observed in the MLN of gut shortening models, with higher percentage in the blind loop group (p ≤ 0.05). The gut and liver histopathological analysis showed similar low-grade chronic inflammation in both gut shortening groups, likely associated with SIBO/BT events. CONCLUSION: Sustained SIBO/BT was associated with proximal gut shortening in half regardless of blind loop, whereas the GI tract's ability to restore gut microbiota balance after a surgical challenge on the small bowel appears to be linked to the functional remaining gut.


Assuntos
Cirurgia Bariátrica , Disbiose/etiologia , Intestino Delgado/cirurgia , Síndromes de Malabsorção/etiologia , Obesidade Mórbida/cirurgia , Animais , Translocação Bacteriana/fisiologia , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Disbiose/patologia , Fezes/microbiologia , Microbioma Gastrointestinal/fisiologia , Intestino Delgado/microbiologia , Intestino Delgado/patologia , Síndromes de Malabsorção/patologia , Masculino , Obesidade Mórbida/microbiologia , Obesidade Mórbida/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/microbiologia , Distribuição Aleatória , Ratos , Ratos Wistar
15.
Obes Surg ; 29(2): 420-425, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30293135

RESUMO

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is associated with high long-term failure rates, often requiring conversion to an alternative bariatric procedure. The most efficacious procedure after failed LAGB is subject to debate. Our objective was to compare 12-month weight loss following laparoscopic sleeve gastrectomy (LSG) vs. laparoscopic Roux-en-Y gastric bypass (LRYGB) performed for insufficient weight loss or weight regain after LAGB. METHODS: A systematic search was conducted in PubMed and Medline for English language studies comparing weight loss after a conversion surgery for failed gastric banding. We examined studies with patients who had at least 1-year follow-up and included conversions to both LSG and LRYGB. A fixed effects model was created, and variance measures were calculated to measure heterogeneity. Both were analyzed for significance. All statistical analyses were conducted with the "meta" package in R 3.3.2. RESULTS: The initial search produced 17 studies. Six studies, consisting of 205 LSG and 232 LRYGB patients, met our inclusion criteria and were included in the review. Heterogeneity among studies was high (Q = 23.1; p < 0.001). There was no statistically significant difference in weight loss after 12 months between the groups (p = 0.14). CONCLUSIONS: It remains unknown which conversion procedure is more appropriate to perform after a failed gastric band in order to achieve the highest weight loss potential. In our meta-analysis, there was no difference in weight loss after 12 months in patients who were converted to LSG or LRYGB. Further studies and longer follow-up comparisons are required before firm conclusions can be drawn.


Assuntos
Gastrectomia , Derivação Gástrica , Gastroplastia/efeitos adversos , Obesidade Mórbida/cirurgia , Reoperação , Adulto , Cirurgia Bariátrica , Feminino , Gastrectomia/métodos , Derivação Gástrica/métodos , Gastroplastia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Período Pós-Operatório , Reoperação/efeitos adversos , Reoperação/métodos , Resultado do Tratamento , Perda de Peso
16.
Obes Surg ; 29(1): 281-291, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30251091

RESUMO

BACKGROUND: Super obesity (BMI ≥ 50 kg/m2) is associated with significant morbidity and mortality. The best procedure to treat super obesity is not completely established. Our aim was to compare the effectiveness of bariatric procedures (adjustable gastric band [AGB], Roux-en-Y gastric bypass [RYGB], sleeve gastrectomy [SG]) in super obesity. METHODS: Retrospective observational study of super obese patients who underwent bariatric surgery. Data was assessed preoperatively and in the 1st and 2nd years of follow-up. RESULTS: We evaluated 213 individuals, 77.9% female, age of 43.38 ± 11.49 years, and preoperative BMI of 54.53 ± 4.54 kg/m2; 19 submitted to AGB, 127 to RYGB, and 67 to SG. In the pre-surgical assessment, there were no significant differences in age, anthropometric parameters, blood pressure, glycemic profile, and lipid profile between the three surgical groups. The percentage of excess weight loss (%EWL) in the 1st year was 67.58% in RYGB, 58.74% in SG, and 38.71% in AGB (p < 0.001), and the percentage of total weight loss (%TWL) was 36.29%, 31.59%, and 21.07%, respectively (p < 0.001). Two years after surgery (n = 147; follow-up rate of 69%), the %EWL and %TWL were significantly higher in the RYGB group (p < 0.001). RYGB had a higher success rate (%EWL ≥ 50% and %TWL ≥ 20%) in both years of follow-up (p < 0.001). In multiple linear regression, after adjusting for other covariates, RYGB was the only strong predictive factor of %EWL and %TWL (p < 0.001). CONCLUSION: RYGB proved to be more effective in super obesity. The beneficial effects in weight loss were evident both 1 and 2 years after the procedure, regardless of pre-surgical anthropometric characteristics.


Assuntos
Cirurgia Bariátrica/métodos , Índice de Massa Corporal , Peso Corporal/fisiologia , Obesidade Mórbida/cirurgia , Adulto , Cirurgia Bariátrica/efeitos adversos , Feminino , Gastrectomia/métodos , Derivação Gástrica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Estudos Retrospectivos , Resultado do Tratamento , Perda de Peso/fisiologia
17.
Obes Surg ; 29(1): 277-280, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30251093

RESUMO

OBJECTIVE: For treatment of obesity, which is one of the important health problems of the present time, lifestyle modification, pharmacotherapy, behavioral treatment methods, and surgical procedures are commonly used. Sleeve gastrectomy is widely used among surgical procedures. We aimed to investigate the relationship between histopathologic findings and body mass indices (BMIs) of cases with sleeve gastrectomy in our study. METHODS: Thirty-seven patients were included in our study who underwent sleeve gastrectomy and whose operation materials were examined histopathologically in our hospital. Two pathologists re-evaluated all gastrectomy materials. The relationship between BMI and the presence of gastritis, atrophy, intestinal metaplasia (IM), Helicobacter pylori (HPL), and other histopathological findings was investigated. RESULTS: The mean age of patients included in the study was 34.7 + 9.3 years. Of patients, 70.3% were female and 29.7% were male. There was a statistically significant difference between BMI and IM among the evaluated histopathologic parameters. Moreover, IM was significantly more present in patients with type 2 diabetes. CONCLUSIONS: There is no previous study investigating the relationship between gastric histopathological findings and BMI in sleeve gastrectomy patients. We think that the statistically significant difference between BMI and IM that we found in our study may shed light on studies to be performed in the future.


Assuntos
Índice de Massa Corporal , Gastrectomia , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Adulto , Biópsia , Comorbidade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/cirurgia , Feminino , Gastrectomia/métodos , Gastrectomia/estatística & dados numéricos , Gastrite/epidemiologia , Gastrite/patologia , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Humanos , Intestinos/patologia , Laparoscopia/métodos , Masculino , Metaplasia/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/patologia , Obesidade/cirurgia , Obesidade Mórbida/complicações , Obesidade Mórbida/epidemiologia , Estudos Retrospectivos , Estômago/patologia , Adulto Jovem
18.
J Matern Fetal Neonatal Med ; 32(5): 781-785, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29020834

RESUMO

OBJECTIVE: Women having cesarean section have a high risk of wound complications. Our objective was to determine whether high transverse skin incisions are associated with a reduced risk of cesarean wound complications in women with BMI greater than 40. METHODS: A retrospective cohort study was undertaken of parturients ages 18-45 with BMI greater than 40 having high transverse skin incisions from January 2010 to April 2015 at a tertiary maternity hospital. Temporally matched controls had low transverse skin incisions along with a BMI greater than 40. The primary outcome, wound complication, was defined as any seroma, hematoma, dehiscence, or infection requiring opening and evacuating/debriding the wound. Secondary outcomes included rates of endometritis, number of hospital days, NICU admission, Apgar scores, birth weight, and gestational age at delivery. Analysis of outcomes was performed using two-sample t-test or Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical variables. RESULTS: Thirty-two women had high transverse incisions and were temporally matched with 96 controls (low transverse incisions). The mean BMI was 49 for both groups. There was a trend toward reduced wound complications in those having high transverse skin incisions, but this did not reach statistical significance (15.63% versus 27.08%, p = .2379). Those having high transverse skin incisions had lower five minute median Apgar scores (8.0 versus 9.0, p = .0021), but no difference in umbilical artery pH values. The high transverse group also had increased NICU admissions (28.13% versus 5.21%, p = .0011), and early gestational age at delivery (36.8 versus 38.0, p = .0272). CONCLUSION: High transverse skin incisions may reduce the risk of wound complications in parturients with obesity. A study with more power should be considered.


Assuntos
Cesárea/métodos , Obesidade Mórbida/cirurgia , Complicações na Gravidez/cirurgia , Deiscência da Ferida Operatória/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Índice de Massa Corporal , Cesárea/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Projetos Piloto , Complicações Pós-Operatórias/prevenção & controle , Gravidez , Estudos Retrospectivos , Ferida Cirúrgica/complicações , Ferida Cirúrgica/terapia , Adulto Jovem
19.
J Clin Endocrinol Metab ; 104(1): 21-37, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30137403

RESUMO

Context: Human obesity is associated with increased circulating TNF-α, a proinflammatory cytokine that induces hepatocyte cell death. Objective: The potential beneficial effects of acylated and desacyl ghrelin in the progression of nonalcoholic fatty liver disease (NAFLD) to nonalcoholic steatohepatitis in obesity via the inhibition of TNF-α-induced hepatocyte apoptosis, autophagic cell death, and pyroptosis were investigated. Design, Settings, and Participants: Plasma ghrelin isoforms and TNF-α were measured in 158 participants, and hepatocyte cell death was evaluated in liver biopsies from 76 patients with morbid obesity undergoing bariatric surgery with available liver echography and pathology analysis. The effect of acylated and desacyl ghrelin on basal and TNF-α-induced cell death was determined in vitro in human HepG2 hepatocytes. Results: Circulating TNF-α and the acylated/desacyl ghrelin ratio were increased, whereas desacyl ghrelin levels were decreased in patients with obesity and NAFLD. Six months after bariatric surgery, decreased acylated/desacyl ghrelin levels, and improved hepatic function were found. Patients with obesity and type 2 diabetes showed increased hepatic ghrelin O-acyltransferase transcripts as well as an increased hepatic apoptosis, pyroptosis, and compromised autophagy. In HepG2 hepatocytes, acylated and desacyl ghrelin treatment reduced TNF-α-induced apoptosis, evidenced by lower caspase-8 and caspase-3 cleavage, as well as TUNEL-positive cells and pyroptosis, revealed by decreased caspase-1 activation and lower high-mobility group box 1 expression. Moreover, acylated ghrelin suppressed TNF-α-activated hepatocyte autophagy, as evidenced by a decreased LC3B-II/I ratio and increased p62 accumulation via AMPK/mTOR. Conclusions: Ghrelin constitutes a protective factor against hepatocyte cell death. The increased acylated/desacyl ghrelin ratio in patients with obesity and NAFLD might constitute a compensatory mechanism to overcome TNF-α-induced hepatocyte apoptosis, autophagy, and pyroptosis.


Assuntos
Apoptose/efeitos dos fármacos , Autofagia/efeitos dos fármacos , Grelina/farmacologia , Hepatócitos/efeitos dos fármacos , Hepatopatia Gordurosa não Alcoólica/patologia , Obesidade Mórbida/patologia , Piroptose/efeitos dos fármacos , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/farmacologia , Adulto , Cirurgia Bariátrica , Estudos Transversais , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Grelina/metabolismo , Humanos , Fígado/patologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/etiologia , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Resultado do Tratamento
20.
PLoS One ; 13(11): e0206617, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30408116

RESUMO

METHODS: Data from women (n = 305, aged 43 [34; 53] years-old, BMI 44.2 [40.8; 48.2] kg/m2) included in the Severe Obesity Outcome Network (SOON) cohort were analyzed (i) to evaluate collinearity between the different anthropometric markers, (ii) to compare the association of markers with hypertension, type 2 diabetes, obstructive sleep apnea syndrome (OSAS) and other cardiometabolic risks. RESULTS: Hip, waist and neck circumferences correlated with BMI with respectively less collinearity (r = 0.70, r = 0.59 and r = 0.37, respectively, p<0.001) whereas waist-to-hip ratio was not correlated (r = 0.11, p = 0.072). Waist and neck circumferences were significantly associated with hypertension, type 2 diabetes and OSAS in univariate logistic regressions, waist-to-hip ratio with hypertension and type 2 diabetes. Hip circumference was inversely correlated with type 2 diabetes (OR 0.970 (95CI: 0.948; 0.991) p = 0.006). BMI was only linked to OSAS (OR 1.092 (95CI: 1.043; 1.143) p<0.001). Neck circumference was the only marker significantly associated with all cardiometabolic risk markers (HOMA-IR, apnea-hypopnea index, Log Triglycerides/HDL-c, alanin-aminotransferase, aspartate-aminotransferase, gammaglutamyl transpeptidase). CONCLUSIONS: Neck circumference appears the most appropriate anthropometric marker to identify the fat distribution associated with high cardiometabolic risk in women with severe obesity.


Assuntos
Pesos e Medidas Corporais/métodos , Doenças Cardiovasculares/etiologia , Doenças Metabólicas/etiologia , Obesidade Mórbida/complicações , Obesidade Mórbida/patologia , Adiposidade , Adulto , Índice de Massa Corporal , Estudos de Coortes , Diabetes Mellitus Tipo 2/etiologia , Feminino , Humanos , Hipertensão/etiologia , Pessoa de Meia-Idade , Pescoço/patologia , Fatores de Risco , Apneia Obstrutiva do Sono/etiologia , Circunferência da Cintura , Relação Cintura-Quadril
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