RESUMO
INTRODUCTION: Sleeve gastrectomy is one of the main techniques used to treat severe obesity. The study of the immunohistochemical expression of ghrelin in the gastric mucosa has already been related to weight loss and can be a promising method to predict the surgical outcome. PURPOSE: To analyze the immunohistochemical expression of ghrelin in the gastric mucosa and its correlation with weight loss, comorbidities, and inflammatory changes after sleeve gastrectomy. METHODS: Thirty-five patients submitted to sleeve gastrectomy were evaluated, 29 of whom were female (82.9%), with a mean age of 35.2 years and an average body mass index of 38.1 kg/m2. Endoscopic samples of the mucosa were collected, whose ghrelin expression was evaluated in a semi-quantitative way through the stained antibody area. These data were correlated with weight loss at 3, 6, and 12 months and with the control of comorbidities, and inflammatory alterations. RESULTS: The average total weight loss (TWL%) was 17.7, 26.4, and 32.1%, respectively, at 3, 6, and 12 months. A negative correlation was found between the immunohistochemical expression of ghrelin in the endoscopic biopsy of the fundus and weight loss at 3 (s = - 0.536; p = 0.001) and 6 months (s = - 0.339; p = 0.047). CONCLUSION: The immunohistochemical expression of ghrelin in the mucosa of the gastric fundus was negatively correlated with early weight loss after sleeve gastrectomy.
Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Adulto , Feminino , Humanos , Masculino , Gastrectomia/métodos , Mucosa Gástrica/metabolismo , Grelina/metabolismo , Obesidade Mórbida/cirurgia , Redução de Peso , Imuno-HistoquímicaRESUMO
OBJECTIVE: To compare the intratumoral T2 signal intensity on MRI and histopathological and molecular expression of biomarkers of aggressiveness (histological grade, hormonal status, HER2, and Ki-67). METHODS: This retrospective study included all women with invasive breast cancer undergoing MRI from January 2014 to October 2016. The intratumoral T2 signal as interpreted at consensus by two radiologists was compared to histopathological and molecular prognostic factors from the surgical specimen. Statistical analyses used Pearson χâ2 test with a confidence level of 95% (P ≤ 0.05). RESULTS: Fifty patients with 50 lesions met study criteria (mean age 65.8 ± 13.5 years). Mean lesion size was 28 mm ± 15.7 mm (range, 15 to 76 mm). Cancer types were invasive ductal (35/50, 70%), invasive lobular (10/50, 20%), and mixed (5/50, 10%). Most lesions were histological grade 1 or 2 (41/50, 82%) and luminal type (45/50, 90%). On T2 images, lesions were hypointense in 62% (31/50), isointense in 20% (10/50), and hyperintense in 18% (9/50) of cases. Among hypointense lesions, 94% (29/31) were low or intermediate grade tumors (P = 0.02), low HER2 overexpression (30/31, 97%) (P = 0.005), and high ER status (30/31, 97%) (P = 0.006), high PR (26/31, 84%) (P = 0.02), and low incidence of necrosis (2/31, 6%). The difference in Ki-67 tumoral expression between groups was not significant. CONCLUSION: Intratumoral T2 hypointensity in invasive breast cancer is associated with better prognostic tumors, such as histological low-grade high hormone receptor status.
RESUMO
PURPOSE: To evaluate of postoperative adhesion prevention and inflammatory response to polypropylene mesh, coated with reabsorbable hydrogel of polyethylene glycol (Coseal®) in contact with small bowel in an experimental model in rabbits. METHODS: Twenty female rabbits underwent laparotomy to implant two polypropylene meshes, 2 x 1 cm, in the right and left flanks. The right mesh was protected with Coseal® spray (Group 1) and the left mesh received no treatment after implantation (Group 2). Thirty days after implantation, the rabbits underwent laparoscopy for adhesion analysis; the prosthesis were removed en bloc with the adjacent tissue for microscopic analysis of inflammation. Statistical analysis used the Mann-Whitney test. RESULTS: There was adhesion formation in five meshes (36%) from Group 1 and in 14 meshes (100%) from Group 2, with statistical significance (p<0.01). There were no differences in the inflammatory response, fibrosis, foreign body reaction, presence of collagen and type of inflammatory cells between the two groups. CONCLUSION: Polypropylene mesh coated with Coseal® showed a significantly lower rate of adhesion formation when compared with uncoated meshes, without interfering with inflammatory response.
Assuntos
Hérnia Abdominal/cirurgia , Polietilenoglicóis/efeitos adversos , Polipropilenos/uso terapêutico , Telas Cirúrgicas/efeitos adversos , Animais , Colágeno/análise , Modelos Animais de Doenças , Feminino , Fibrose/patologia , Fibrose/prevenção & controle , Reação a Corpo Estranho/patologia , Reação a Corpo Estranho/prevenção & controle , Herniorrafia/métodos , Laparoscopia , Teste de Materiais , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Coelhos , Reprodutibilidade dos Testes , Fatores de Tempo , Aderências Teciduais/patologia , Aderências Teciduais/prevenção & controle , Resultado do TratamentoRESUMO
PURPOSE: To evaluate of postoperative adhesion prevention and inflammatory response to polypropylene mesh, coated with reabsorbable hydrogel of polyethylene glycol (Coseal®) in contact with small bowel in an experimental model in rabbits. METHODS: Twenty female rabbits underwent laparotomy to implant two polypropylene meshes, 2x1cm, in the right and left flanks. The right mesh was protected with Coseal® spray (Group 1) and the left mesh received no treatment after implantation (Group 2). Thirty days after implantation, the rabbits underwent laparoscopy for adhesion analysis; the prosthesis were removed en bloc with the adjacent tissue for microscopic analysis of inflammation. Statistical analysis used the Mann-Whitney test. RESULTS: There was adhesion formation in five meshes (36%) from Group 1 and in 14 meshes (100%) from Group 2, with statistical significance (p<0.01). There were no differences in the inflammatory response, fibrosis, foreign body reaction, presence of collagen and type of inflammatory cells between the two groups. CONCLUSION: Polypropylene mesh coated with Coseal® showed a significantly lower rate of adhesion formation when compared with uncoated meshes, without interfering with inflammatory response.
Assuntos
Animais , Feminino , Coelhos , Hérnia Abdominal/cirurgia , Polietilenoglicóis/efeitos adversos , Polipropilenos/uso terapêutico , Telas Cirúrgicas/efeitos adversos , Colágeno/análise , Modelos Animais de Doenças , Fibrose/patologia , Fibrose/prevenção & controle , Reação a Corpo Estranho/patologia , Reação a Corpo Estranho/prevenção & controle , Herniorrafia/métodos , Laparoscopia , Teste de Materiais , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Aderências Teciduais/patologia , Aderências Teciduais/prevenção & controleRESUMO
PURPOSE: To evaluate of postoperative adhesion prevention and inflammatory response to polypropylene mesh, coated with reabsorbable hydrogel of polyethylene glycol (Coseal®) in contact with small bowel in an experimental model in rabbits. METHODS: Twenty female rabbits underwent laparotomy to implant two polypropylene meshes, 2x1cm, in the right and left flanks. The right mesh was protected with Coseal® spray (Group 1) and the left mesh received no treatment after implantation (Group 2). Thirty days after implantation, the rabbits underwent laparoscopy for adhesion analysis; the prosthesis were removed en bloc with the adjacent tissue for microscopic analysis of inflammation. Statistical analysis used the Mann-Whitney test. RESULTS: There was adhesion formation in five meshes (36%) from Group 1 and in 14 meshes (100%) from Group 2, with statistical significance (p<0.01). There were no differences in the inflammatory response, fibrosis, foreign body reaction, presence of collagen and type of inflammatory cells between the two groups. CONCLUSION: Polypropylene mesh coated with Coseal® showed a significantly lower rate of adhesion formation when compared with uncoated meshes, without interfering with inflammatory response.(AU)
Assuntos
Animais , Coelhos , Hidrogéis/análise , Aderências Teciduais/complicações , Polipropilenos/análise , Coelhos/classificação , InflamaçãoRESUMO
BACKGROUND: Under the restrictive component, patients undergoing gastric bypass may have food intolerance with or without complications. METHODS: This study used quantitative, analytical, observational methodology with patients submitted to Roux-en-Y gastric bypass without the placement of a ring at Hospital Universitário do Rio Grande do Norte in the city of Natal, Brazil between July 2005 and August 2010. Out of 176 patients monitored after surgery by the interdisciplinary team, 47 took part in the study. Two questionnaires were applied to participants: one elaborated by Suter et al. and previously validated for assessment of food tolerance and another to characterize schooling and socioeconomic status. Evaluation of food tolerance considered patient satisfaction with eating, most accepted food types, and frequency of vomiting and/or regurgitation. After application of the first questionnaire, a score was generated, characterizing food intolerance. RESULTS: Of the 47 patients evaluated, 85.1% classified their degree of food satisfaction as good or excellent. Red meat was the most cited as being difficult to ingest (38.3%), representing a significant impact on overall tolerance level (P < 0.001); 48.9% of participants exhibited rare episodes of vomiting, which resulted in a mean food tolerance score of 23.02 (2.87 ± SD). Moreover, socioeconomic status showed a significant correlation with tolerance level (P = 0.032). CONCLUSIONS: The degree of food tolerance observed in the study sample was better than that obtained in other investigations using similar methodology. The questionnaire proved to be useful in evaluating food quality and comparing postoperative results. Socioeconomic status was correlated with food tolerance level.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Derivação Gástrica/efeitos adversos , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Vômito/etiologia , Adulto , Brasil/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Seguimentos , Derivação Gástrica/estatística & dados numéricos , Humanos , Masculino , Obesidade Mórbida/epidemiologia , Satisfação do Paciente , Qualidade de Vida , Fatores Socioeconômicos , Inquéritos e Questionários , Resultado do Tratamento , Vômito/epidemiologiaRESUMO
Superior mesenteric artery syndrome is a duodenal obstructive complication, which has been reported after Roux-en-Y gastric bypass. We report a patient who presented a fistula at the angle of His after a laparoscopic sleeve gastrectomy, which was treated with endoscopic procedures and laparoscopic drainage. During this period, there was excessive, rapid weight loss to BMI 22 kg/m2. At 3 months after the fistula had closed, metrorrhagia was treated by blood transfusion and urgent hysterectomy. Following this, diarrhea occurred and worsened the malnutrition, and the BMI was 18. Duodenal obstruction occurred, confirmed by radiological studies and endoscopy. Duodenojejunostomy and choleystectomy were done, and there has been no recurrence of duodenal obstruction in the 14 follow-up months.
Assuntos
Gastrectomia/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade/cirurgia , Síndrome da Artéria Mesentérica Superior/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome da Artéria Mesentérica Superior/diagnóstico , Síndrome da Artéria Mesentérica Superior/cirurgiaRESUMO
O objetivo deste artigo é rever a literatura, buscando estabelecer as possíveis causas das complicações macânicas e biológicas nas reabilitações com implantes, dedescrevendo algumas estratégias preventivas no planejamento, tratamento e no período de manutenção, objetivando maior logevidade nos implantes orais.
Assuntos
Humanos , Fenômenos Biomecânicos , Planejamento de Prótese Dentária , Falha de Restauração Dentária , Doenças da Gengiva , Implantes Dentários , Higiene Bucal , Doenças Periodontais , TabagismoRESUMO
A case of intestinal spirochetosis in a 62-year-old white male is reported. The condition was characterized by chronic flatulence and episodes of intestinal hemorrhage, in addition to the evidence of hypotonic diverticular disease, with a large number of slender organisms in the colon epithelium and cryptae. Spirochetes were demonstrated by Whartin-Starry stain. The serologic tests for syphilis and HIV were positive. Spirochetosis was treated with penicillin G, and the patient remains free of intestinal complaints 20 months later.
Assuntos
Diverticulose Cólica/complicações , Hemorragia Gastrointestinal/etiologia , Infecções por Spirochaetales/complicações , Antibacterianos/uso terapêutico , Diverticulose Cólica/diagnóstico , Diverticulose Cólica/tratamento farmacológico , Infecções por HIV/complicações , Humanos , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Penicilina G/uso terapêutico , Spirochaetales/isolamento & purificação , Infecções por Spirochaetales/diagnóstico , Infecções por Spirochaetales/tratamento farmacológicoRESUMO
Um caso de espiroquetose intestinal é relatado em um homem branco de 62 anos. A condição foi caracterizada por flatulência crônica e episódios de hemorragia intestinal, além da evidência de doença diverticular hipotônica dos cólons, com numerosos organismos filamentosos no epitélio e nas criptas do cólon. Os espiroquetas foram demonstrados pela coloração de Whartin-Starry. Os testes sorológicos para sífilis e HIV foram positivos. A espiroquetose foi tratada com penicilina G e o paciente permanece sem queixas intestinais após 20 meses.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Diverticulose Cólica/complicações , Hemorragia Gastrointestinal/etiologia , Infecções por Spirochaetales/complicações , Antibacterianos/uso terapêutico , Diverticulose Cólica/diagnóstico , Diverticulose Cólica/tratamento farmacológico , Infecções por HIV/complicações , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Penicilina G/uso terapêutico , Infecções por Spirochaetales/diagnóstico , Infecções por Spirochaetales/tratamento farmacológico , Spirochaetales/isolamento & purificaçãoRESUMO
Os tricobezoares ocasionam raramente obstruçäo intestinal. Como os localizados no estômago, ocorrem em mulheres jovens com hábito de tricofagia. Uma jovem de 22 anos foi admitida com história de dor epigástrica em crises há duas semanas, acompanhada de vômitos nos últimos três dias. Ao exame físico mostrava-se desidratada, discretamente ictérica, com o abdomen distendido, sem irritaçäo peritoneal. Ao nível do epigástrico palpava-se massa móvel, indolor. Os exames laboratoriais revelaram 12.490 leucócitos com desvio à esquerda, hipopotassemia (K: 2,9 mEq/l) e discreta icterícia (Bilirrubinas totais: 2,3 mg porcento). A gastroscopia mostrou corpo estranho sólido, compatível com tricobezoar, ocupando o estômsgo e duodeno. As radiografias simples do abdome evidenciaram sinais clássicos de oclusäo do intestino delgado. A laparotomia exploradora encontrou-se massa impactada no íleo distal e confirmou-se a presença do tricobezoar gastroduodenal. A conduta cirúrgica constou de ressecçäo ileal e retirada do tricobezoar por gastrotomia. O pós-operatório foi sem intercorrências