RESUMEN
OBJECTIVE: The aim of this study was to examine echocardiographic parameters of left ventricle (LV) mechanics in obese patients before and after sleeve gastrectomy (SG). DESIGN AND METHODS: Twenty-five obese individuals submitted to laparoscopic SG were enrolled in this study. Echocardiography was performed before and after the procedure, and left ventricle mechanics were evaluated by speckle tracking imaging. RESULTS: Before surgery, altered global longitudinal strain (GLS) values were present in 56% of the patients. In a mean follow-up of 3.6 ± 0.5 months after surgery, there was an increase in GLS values (from 17.4 ± 3.2 to 19.3 ± 2.7%, P = 0.01). There was an inverse correlation between the absolute values of GLS in the preoperative period and the variation in the GLS at follow-up (r = 0.577, P = 0.002). Measurements of global circumferential strain (GCS), global radial strain (GRS), and LV twist were normal preoperatively and did not change after surgery. CONCLUSIONS: Altered global longitudinal strain values were common in young obese patients. Sleeve gastrectomy increased global longitudinal strain even in the early postoperative phase without promoting changes in global radial strain, global circumferential strain, and left ventricle twist measurements.
Asunto(s)
Gastrectomía/efectos adversos , Obesidad Mórbida/fisiopatología , Obesidad Mórbida/cirugía , Función Ventricular Izquierda/fisiología , Adulto , Estudios Controlados Antes y Después , Ecocardiografía/métodos , Femenino , Gastrectomía/métodos , Gastrectomía/rehabilitación , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Contracción Miocárdica/fisiología , Obesidad Mórbida/diagnóstico , Obesidad Mórbida/epidemiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Preoperatorio , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
We determined the effects of enhanced recovery after surgery (ERAS) in patients undergoing radical surgery for gastric carcinoma. Sixty patients undergoing radical gastrectomy for gastric carcinoma in Lishui Hospital between March and October 2016 were randomized to receive either ERAS (30 patients) or conventional care (30 patients, controls). Clinical, economic, and laboratory indices were analyzed. ERAS patients showed faster recovery and shorter postoperative hospital stays than the controls (P<0.05). Some clinical indices (i.e., time to first flatus and defecation, time to removal of drainage tubes, time to resumption of oral feeding, time to postoperative mobilization, and postoperative complications) were significantly better in ERAS patients than in controls. Duration of postoperative infusion was lower in ERAS patients than in controls (P<0.05). In ERAS patients, serum albumin and prealbumin were higher on postoperative day 7, C-reactive protein was lower on postoperative days 3 and 7, and neutrophil count was lower on postoperative day 3 compared to the values in controls (P<0.05 for all). IgM levels were higher in ERAS patients on postoperative days 3 and 7 (P<0.05), while IgG levels were higher on postoperative day 3 (P<0.05). Total T lymphocytes were higher in ERAS patients on postoperative day 3, while helper T cells and CD4+/CD8+ ratio were higher on postoperative days 3 and 7 (P<0.05 for all). In gastric carcinoma patients, ERAS may reduce perioperative inflammation, improve immunity and postoperative nutrition, shorten hospitalization, and enhance rehabilitation.
Asunto(s)
Gastrectomía/rehabilitación , Neoplasias Gástricas/cirugía , Estudios de Casos y Controles , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Recuperación de la Función , Factores de Tiempo , Resultado del TratamientoRESUMEN
We determined the effects of enhanced recovery after surgery (ERAS) in patients undergoing radical surgery for gastric carcinoma. Sixty patients undergoing radical gastrectomy for gastric carcinoma in Lishui Hospital between March and October 2016 were randomized to receive either ERAS (30 patients) or conventional care (30 patients, controls). Clinical, economic, and laboratory indices were analyzed. ERAS patients showed faster recovery and shorter postoperative hospital stays than the controls (P<0.05). Some clinical indices (i.e., time to first flatus and defecation, time to removal of drainage tubes, time to resumption of oral feeding, time to postoperative mobilization, and postoperative complications) were significantly better in ERAS patients than in controls. Duration of postoperative infusion was lower in ERAS patients than in controls (P<0.05). In ERAS patients, serum albumin and prealbumin were higher on postoperative day 7, C-reactive protein was lower on postoperative days 3 and 7, and neutrophil count was lower on postoperative day 3 compared to the values in controls (P<0.05 for all). IgM levels were higher in ERAS patients on postoperative days 3 and 7 (P<0.05), while IgG levels were higher on postoperative day 3 (P<0.05). Total T lymphocytes were higher in ERAS patients on postoperative day 3, while helper T cells and CD4+/CD8+ ratio were higher on postoperative days 3 and 7 (P<0.05 for all). In gastric carcinoma patients, ERAS may reduce perioperative inflammation, improve immunity and postoperative nutrition, shorten hospitalization, and enhance rehabilitation.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Neoplasias Gástricas/cirugía , Gastrectomía/rehabilitación , Factores de Tiempo , Estudios de Casos y Controles , Resultado del Tratamiento , Recuperación de la Función , Tiempo de Internación , Estadificación de NeoplasiasRESUMEN
PURPOSE: To investigate whether polydextrose stimulates iron absorption in rats submitted to partial gastrectomy and sham operated. METHODS: The rats were submitted to partial gastrectomy (Billroth II) or laparotomy (sham-operated control), in groups of 20 and 20 each respectively. The animals were fed with a control diet (AIN-93M) without polydextrose or a diet containing polydextrose (50g/Kg of diet) for eight weeks. They were divided into four subgroups: sham-operated and Billroth II gastrectomy and with or without polydextrose. Two animals died during the experiment. All rats submitted to gastrectomy received B-12 vitamin (intramuscular) each two weeks. The hematocrit and hemoglobin concentration were measured at the start and on day 30 and 56 after the beginning of the experimental period. At the end of the study, the blood was collected for determination of serum iron concentration. RESULTS: The diet with polydextrose reduced the excretion of iron. Apparent iron absorption was higher in the polydextrose fed groups than in the control group. The haematocrit and haemoglobin concentration were lower after Billroth II gastrectomy rats fed the control diet as compared to the polydextrose diet groups. CONCLUSION: Polydextrose increase iron absorption and prevents postgastrectomy anemia.(AU)
OBJETIVO: Investigar se a polidextrose estimula a absorção de ferro em ratos submetidos à gastrectomia parcial e sham operados. MÉTODOS: Os ratos foram submetidos à gastrectomia parcial (Billroth II) e à laparotomia (controle sham-operados) em grupos de 20 e 20 cada, respectivamente. Os animais foram alimentados com uma dieta controle (AIN-93M), sem polidextrose ou uma dieta contendo polidextrose (50g/kg de dieta) durante oito semanas. Foram divididos em quatro grupos: sham-operados e com gastrectomia BII e com ou sem polidextrose. Dois animais morreram durante o experimento. Todos os ratos com gastrectomia receberam vitamina B-12 (intramuscular) a cada duas semanas. O hematócrito e a hemoglobina foram dosados no início e nos dias 30 e 56 após o início do período experimental. No final do estudo, o sangue foi coletado para determinação da concentração de ferro sérico. RESULTADOS: A dieta com polidextrose reduziu a excreção de ferro e a absorção de ferro aparente foi maior nos grupos alimentados com polidextrose do que no grupo controle. As dosagens de hematócrito e hemoglobina foram menores em ratos com gastrectomia alimentados com a dieta controle em relação aos grupos de dieta com polidextrose. CONCLUSÃO: A polidextrose aumenta a absorção do ferro e previne a anemia pós-gastrectomia.(AU)
Asunto(s)
Animales , Ratas , Deficiencias de Hierro/prevención & control , Hierro de la Dieta/efectos adversos , Gastrectomía/rehabilitación , Factores Bióticos/efectos adversosRESUMEN
Enteral nutrition (EN) is an effective method to meet the nutritional requirements in patients who have a deteriorated nutritional status. Objectives: To compare clinical and nutritional performance of two groups: Early Enteral Nutrition (EEN) versus Late Enteral Nutrition (LEN) of patients undergoing to total gastrectomy for gastric cancer. Material and Methods: 18 patients with resectable gastric cancer were studied with anthropometric, functional and biochemical parameters to assess nutritional status in the preoperative and postoperative period. They received a polimeric enteral formula (1 kcal/ml) in the postoperative period. They were randomly assigned to the type of nutrition (early or late). Results: The group with EEN had a significant improvement in the bicipital fold adequacy percentage and dynamometry. The LEN group had a significant decrease of albumin. The bloating was more frequent in the group with EEN. Conclusion: Early enteral nutrition is a safe nutritional support, effective and that brings nutritional benefits compared with late enteral nutrition in patients undergoing to total gastrectomy for gastric cancer.
La nutrición enteral (NE) es un método efectivo para cubrir los requerimientos nutricionales en pacientes que presentan un estado nutricional deteriorado. Objetivos: Comparar la Nutrición Enteral Precoz (NEP) versus Nutrición Enteral Tardía (NET) en la evolución clínica y nutricional de pacientes sometidos a gastrectomía total por Cáncer Gástrico. Material y Método: 18 pacientes con cáncer gástrico resecable, fueron estudiados con parámetros antropométricos, funcionales y bioquímicos que evalúan el estado nutricional, en el período preoperatorio y postoperatorio. Recibieron una fórmula enteral polimérica (1 kcal/ml) en el período postoperatorio. De manera aleatoria fueron asignados al tipo de nutrición (precoz o tardía). Resultados: El grupo con NEP presentó mejoría significativa del porcentaje de adecuación del pliegue bicipital y dinamometría. El grupo con NET presentó disminución significativa de la albuminemia. La distensión abdominal fue más frecuente en grupo con NEP. Conclusión: La Nutrición Enteral Precoz es un soporte nutricional seguro, eficaz y que trae consigo ventajas nutricionales en comparación con la Nutrición Enteral Tardía en el grupo de pacientes gastrectomizados totales por presentar cáncer gástrico.
Asunto(s)
Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Gastrectomía/rehabilitación , Nutrición Enteral/métodos , Índice de Masa Corporal , Cuidados Posoperatorios/métodos , Necesidades Nutricionales , Estado Nutricional , Interpretación Estadística de Datos , Factores de TiempoRESUMEN
El presente trabajo constituye una recopilación de las principales alteraciones, tanto fisiológicas como mecánicas, que se pueden presentar en los pacientes sometidos a intervenciones quirúrgicas sobre el estómago o su inervación. En general, esto se conoce con el nombre de síndromes posgastrectomía. Se hace énfasis en su fisiopatología, diagnóstico, tratamiento médico y quirúrgico.
Asunto(s)
Humanos , Gastrectomía , Gastrectomía/efectos adversos , Gastrectomía/instrumentación , Gastrectomía/rehabilitación , Gastrectomía/normas , Gastrectomía/tendenciasRESUMEN
Pacientes submetidos a radioterapia pélvica poderäo necessitar de derivaçöes urinárias, seja por recidiva local, estenose ureteral ou cistite actínica grave. A maioria das técnicas descritas para a confecçäo de reservatórios continentes exigem o emprego de segmentos íleocolônicos que sofrem igualmente os efeitos deletérios da irradiaçäo. Nesta situaçäo, o estômago tem sido nova opçäo primária. Os autores relatam dois casos em que houve falha no uso de tecido gástrico na reconstruçäo urinária pós-radioterapia, discutem uma proposta alternativa para resoluçäo desta situaçäo, aspectos técnicos envolvidos e os resultados iniciais
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Muñón Gástrico/cirugía , Derivación Urinaria/rehabilitación , Pelvis/efectos de la radiación , Procedimientos de Cirugía Plástica , Colectomía/rehabilitación , Gastrectomía/rehabilitaciónRESUMEN
Em publicaçäo anterior foram analisados 266 pacientes operados na Disciplina de Cirurgia de Aparelho Digestivo do HC da UFPA, dos quais nenhum caso de câncer gástrico precoce foi registrado. Os dois primeiros autores reuniram, de suas clínicas privadas, 158 casos de adenocarcinoma gástrico dos quais 12 eram precoce. Os sintomas mais frequentes foram: epigastralgia, emagrecimento e síndrome ulcerosa de longa evoluçäo. A duraçäo dos sintomas, exceto os da síndrome ulcerosa, foi, em média, de sete meses. O exame físico era normal em todos os pacientes. Para o diagnóstico, realizaram-se endoscopias digestivas altas em todos os pacientes e sete seriografias. Todos os pacientes foram submetidos ao tratamento cirúrgico: nove gastrectomias subtotais tipo B-II, duas gastrectomias totais em Y de Roux e uma gastrectomia subtotal tipo B-I. Só um paciente apresentou complicaçöes pós-operatórias (deiscência de anastomose esofagojejunal), indo a óbito. Nenhum paciente submeteu-se a tratamento rádio ou quimioterápico. O seguimento desses pacientes foi em média de 7 anos (1 mês a 12 anos). Säo tecidas consideraçöes sobre o diagnóstico do câncer gástrico precoce e comparada a presente com a literatura médica
Asunto(s)
Humanos , Femenino , Masculino , Persona de Mediana Edad , Diagnóstico , Gastrectomía/rehabilitación , Neoplasias Gástricas/análisis , BrasilRESUMEN
A 28 pacientes sin patología esosfágica se les efectuó una electromanometría esofágica 7 días antes y otra 30 días después de una gastrectomía subtotal con gastroyeyunoanastomosis según técnica de Polya. En 8 de estos enfermos se analizó un nuevo trazado entre los 3 y 9 meses del postoperatorio. La comprobación estadística de los resultados reveló ausencia de cambios significativos en los parámetros estudiados, tanto en los trazados realizados en período temprano como en los alejados. La resección gástrica, que incluye las células G productoras de gastrina antral, no altera la función del esfínter ni del cuerpo esofágico (AU)
Asunto(s)
Persona de Mediana Edad , Humanos , Masculino , Femenino , Gastrectomía/rehabilitación , Esófago/fisiopatología , Cuidados Posoperatorios , Reflujo Gastroesofágico/fisiopatología , Manometría , PresiónRESUMEN
A 28 pacientes sin patología esosfágica se les efectuó una electromanometría esofágica 7 días antes y otra 30 días después de una gastrectomía subtotal con gastroyeyunoanastomosis según técnica de Polya. En 8 de estos enfermos se analizó un nuevo trazado entre los 3 y 9 meses del postoperatorio. La comprobación estadística de los resultados reveló ausencia de cambios significativos en los parámetros estudiados, tanto en los trazados realizados en período temprano como en los alejados. La resección gástrica, que incluye las células G productoras de gastrina antral, no altera la función del esfínter ni del cuerpo esofágico