Assessment of Changes in Body Composition During the First Postoperative Year After Bariatric Surgery.

BACKGROUND: The potential effect of bariatric surgery on weight reduction and improvement of associated comorbidities is known, but the ratio obtained between the components of body weight, including lean body mass, body fat mass, and bone mass, is still not determined. This study aims to verify the changes in body composition during the first year after bariatric surgery. METHODS: We conducted a prospective observational cohort study. Fifty patients who underwent bariatric surgery and maintained follow-ups were selected. Patients were assessed preoperatively and postoperatively for periods of 1, 3, 6, and 12 months using tetrapolar bioelectrical impedance analysis and laboratory testing of lipids and serum albumin levels. Data were statistically analyzed. RESULTS: Statistically significant differences (p < 0.001) were obtained between the preoperative and 12-month evaluation respectively, for body mass index (BMI) (45.8 ± 7.5 to 30.0 ± 4.8 kg/m2), FM (64.7 ± 15.5 to 30.6 ± 9.8 kg), PFM (51.6 ± 4.17 to 37.3 ± 7.6%), and total cholesterol levels (197.1 ± 49.8 to 169.8 ± 31.0 mg/dL). The decrease in PFM shows a better proportion between the body components. PFM showed significantly higher decrease in males than in females (p = 0.012). Lean body mass (p = 0.000) reduction was highest for patients operated by the Unified Health System (SUS, Government of Brazil) probably because of its few financial resources to maintain postoperative care. CONCLUSION: The change in body composition of patients who underwent Roux-en-Y gastric bypass was statistically significant for all variables examined during the first year postoperatively. This shows the effectiveness of the surgical procedure and clinical protocol set, which tends to favor a better health prognosis and weight maintenance in the long term.

Surgical treatment of tongue lymphangioma in a pediatric patient: a case report.

Lymphangiomas are benign tumors that occur predominantly in the head and neck regions. They are very common in children and are usually diagnosed at birth or during the first years of life. Understanding their clinical features is crucial to an early diagnosis. The purpose of this paper was to report the case of a 3-year-old patient with a nodular lesion that evolved for 2 years on the tongue's dorsal surface, highlight the surgical treatment and characteristics of this kind of pathology, and explore the differential diagnosis.

Applied mechanics of the Puricelli osteotomy: a linear elastic analysis with the finite element method.

BACKGROUND: Surgical orthopedic treatment of the mandible depends on the development of techniques resulting in adequate healing processes. In a new technical and conceptual alternative recently introduced by Puricelli, osteotomy is performed in a more distal region, next to the mental foramen. The method results in an increased area of bone contact, resulting in larger sliding rates among bone segments. This work aimed to investigate the mechanical stability of the Puricelli osteotomy design. METHODS: Laboratory tests complied with an Applied Mechanics protocol, in which results from the Control group (without osteotomy) were compared with those from Test I (Obwegeser-Dal Pont osteotomy) and Test II (Puricelli osteotomy) groups. Mandible edentulous prototypes were scanned using computerized tomography, and digitalized images were used to build voxel-based finite element models. A new code was developed for solving the voxel-based finite elements equations, using a reconditioned conjugate gradients iterative solver. The Magnitude of Displacement and von Mises equivalent stress fields were compared among the three groups. RESULTS: In Test Group I, maximum stress was seen in the region of the rigid internal fixation plate, with value greater than those of Test II and Control groups. In Test Group II, maximum stress was in the same region as in Control group, but was lower. The results of this comparative study using the Finite Element Analysis suggest that Puricelli osteotomy presents better mechanical stability than the original Obwegeser-Dal Pont technique. The increased area of the proximal segment and consequent decrease of the size of lever arm applied to the mandible in the modified technique yielded lower stress values, and consequently greater stability of the bone segments. CONCLUSION: This work showed that Puricelli osteotomy of the mandible results in greater mechanical stability when compared to the original technique introduced by Obwegeser-Dal Pont. The increased area of the proximal segment and consequent decrease of the size of lever arm applied to the mandible in the modified technique yield lower stress values and displacements, and consequently greater stability of the bone segments.

Mandibular avascular osteonecrosis caused by bisphosphonate - a case report and brief review / Osteonecrose avascular de mandíbula por uso de bisfosfonato - relato de caso e breve revisão

Purpose: To present a case of total bilateral jaw necrosis in a patient with primary breast cancer and bone metastases treated with zeledronic acid and discuss the adverse effects of biphosphonates and the best moment to perform dental procedures. Case description: A female patient, 62 years old, with primary breast adenocarcinoma underwent chemotherapy and zoledronic acid because of bone metastases on the right hip. After 7 months, she was submitted to debridement of exposed bone on the anterior mandible, which resulted in skin fistulae and severe pain. Computerized tomography showed bone sequestration hypodensity at the right and left mandibular body and mentum with excessive uptake of the labeled drug as seen by bone scintigraphy. The patient received amoxicillin, gluconate and chlorhexidine mouthrinse and hydrogen peroxide; partial closure of skin fistulae was achieved. After 4 months, the patient returned with submandibular tissue necrosis, intra- and extra-orally exposed mandible with active discharge. After 5 days of palliative treatment, the patient died from sepsis. Conclusion: Local infection/inflammation should be treated before the use of biphosphonates, and topic and systemic pharmacologic treatment should be combined with a strict follow-up. For selected cases, the osteonecrosis treatment may include conservative debridement, pain control, topic and systemic antimicrobial control, and, in extremely severe cases, radical surgery.

Objetivo: Apresentar um caso de necrose total de mandíbula, bilateral, em uma paciente com neoplasia primária de mama e metástases ósseas tratadas com ácido zoledrônico endovenoso, e discutir os efeitos adversos de bisfosfonatos e o momento adequado para realização de procedimentos odontológicos. Descrição do caso: Paciente do sexo feminino, 62 anos, com adenocarcinoma de mama primário foi submetida a quimioterapia e uso de ácido zoledrônico devido a metástases ósseas no quadril direito. Após 7 meses, realizou-se debridamento de osso exposto na região anterior da mandíbula, resultando em fístulas e dor severa. Os exames de tomografia computadorizada e de cintilografia óssea revelaram hipodensidade do sequestro ósseo no corpo mandibular e no mento com presença excessiva da droga nestes sítios. Após antibioticoterapia e uso de enxaguatórios bucais houve fechamento parcial das fístulas. Após 4 meses, a paciente retornou com necrose submandibular e osso mandibular exposto intra e extraoralmente com drenagem. Após 5 dias de tratamento paliativo a paciente morreu de sepsis. Conclusão: Focos de infecção e/ou processos inflamatórios locais devem ser tratados previamente ao uso de bisfosfonatos. Indica-se o tratamento farmacológico tópico e sistêmico, e a proservação do caso. Terapias para osteonecrose, em determinados casos, envolvem debridamento conservador, controle da dor, manejo antimicrobiano tópico e sistêmico e, em casos extremos, cirurgia radical.