RESUMO
BACKGROUND AND AIM: Although nonalcoholic fatty liver disease (NAFLD) is very common among morbidly obese patients, the effect of weight loss after bariatric surgery on inflammation and fibrosis related to NAFLD is still a matter of debate. The aim of this study was to evaluate the impact of Roux-en-Y gastric bypass (RYGB) surgery on NAFLD with a follow up of 2 years. METHODS: Eighteen consecutive NAFLD patients with body mass index >40 kg/m(2) undergoing gastroplasty with RYGB were enrolled, and wedge liver biopsy was obtained at the operation. After 2 years, these patients underwent percutaneous liver biopsy. RESULTS: At baseline, 67% of patients had nonalcoholic steatohepatitis (NASH) and 33% had steatosis, according to the NASH Clinical Research Network Scoring System (NAS) for biopsy. Cirrhosis was present in 5.5% of the patients with NASH. After a mean excess weight loss of 60%, steatosis disappeared in 84% and fibrosis disappeared in 75% of the patients. Hepatocellular ballooning disappeared in 50%. A slight lobular inflammatory infiltrate remained in 81%, apparently unrelated to fatty degeneration. As liver biochemical variables had been found within normal limits in 92.3% of patients at initial biopsy, no difference was found 2 years later. Lipid profile and blood sugar plasma concentration were closer to normal in all patients after 2 years (P < 0.05). CONCLUSIONS: Aspects of NAFLD including steatohepatitis improved significantly with massive weight loss at 2 years after RYGB surgery. No patient in this series had progression of hepatic fibrosis.
Assuntos
Cirurgia Bariátrica , Fígado Gorduroso/cirurgia , Obesidade Mórbida/cirurgia , Adulto , Biópsia , Índice de Massa Corporal , Comorbidade , Fígado Gorduroso/sangue , Fígado Gorduroso/etiologia , Fígado Gorduroso/patologia , Feminino , Seguimentos , Humanos , Lipídeos/sangue , Fígado/patologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , gama-Glutamiltransferase/sangueRESUMO
Prader-Willi Syndrome (PWS) is a genetic disorder characterized by hypotonia, mental retardation or learning disability, hyperphagia and compulsive eating due to hypothalamic dysfunction. Obesity is a major cause of increased morbidity and mortality among patients with PWS. Gastric restrictive surgery has been associated with partial breakdown of the staple-line in PWS. We report two patients with PWS associated with morbid obesity and obstructive sleep apnea who underwent biliopancreatic diversion (BPD). A 27-year-old male with BMI 52 kg/m(2) and a 20 year-old female with BMI 64 kg/m(2) underwent BPD. No perioperative complications were observed. After BPD, the male's BMI was 36.7 kg/m(2) at 12 months and the female's BMI was 48.4 kg/m(2) at 28 months, with excess weight loss 58% and 48%, respectively. They developed loose stools associated with eating. These patients have shown a considerable improvement in hypersomnia and respiratory difficulties. BPD proved to be an effective approach to weight loss in PWS, resulting in improvement of sleep apnea, behavior problems and quality of life.
Assuntos
Obesidade Mórbida/epidemiologia , Síndrome de Prader-Willi/epidemiologia , Adulto , Desvio Biliopancreático , Comorbidade , Feminino , Humanos , Masculino , Obesidade Mórbida/sangue , Síndrome de Prader-Willi/sangueRESUMO
BACKGROUND: Pathogenesis of nonalcoholic fatty liver disease (NAFLD) remains incompletely known, and oxidative stress is one of the mechanisms incriminated. The aim of this study was to evaluate the role of liver oxidative stress in NAFLD affecting morbidly obese patients. METHODS: 39 consecutive patients with BMI >40 kg/m2 submitted to Roux-en-Y gastric bypass were enrolled, and wedge liver biopsy was obtained during operation. Oxidative stress was measured by concentration of hydroperoxides (CEOOH) in liver tissue. RESULTS: Female gender was dominant (89.7%) and median age was 43.6 +/- 11.1 years. Histology showed fatty liver in 92.3%, including 43.6% with nonalcoholic steatohepatitis (NASH), 48.7% with isolated steatosis and just 7.7% with normal liver. Liver cirrhosis was present in 11.7% of those with nonalcoholic steatohepatitis. Concentration of CEOOH was increased in the liver of patients with NASH when compared to isolated steatosis and normal liver (0.26+/- 0.17, 0.20+/- 0.01 and 0.14+/- 0.00 nmol/mg protein, respectively) (P < 0.01). Liver biochemical variables were normal in 92.3% of all cases, and no difference between NASH and isolated steatosis could be demonstrated. CONCLUSIONS: 1) Nonalcoholic steatosis, steatohepatitis and cirrhosis were identified in substantial numbers of morbidly obese patients; 2) Concentration of hydroperoxides was increased in steatohepatitis, consistent with a pathogenetic role for oxidative stress in this condition.
Assuntos
Fígado Gorduroso/patologia , Derivação Gástrica/métodos , Peroxidação de Lipídeos/fisiologia , Obesidade Mórbida/cirurgia , Estresse Oxidativo/fisiologia , Análise de Variância , Anastomose em-Y de Roux , Biópsia por Agulha , Índice de Massa Corporal , Distribuição de Qui-Quadrado , Estudos Transversais , Fígado Gorduroso/complicações , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Período Intraoperatório , Masculino , Obesidade Mórbida/complicações , Obesidade Mórbida/diagnóstico , Probabilidade , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
BACKGROUND: Serious nutritional complications after Roux-en-Y gastric bypass (RYGBP) are infrequent. In a retrospective study of patients operated during a 68-month period, malnutrition was investigated to analyze circumstances associated with nutritional failure. METHODS: In 236 consecutive RYGBPs, 11 patients with severe malnutrition were identified (4.7%) with age 45.1 +/- 10.6 years (10 females/1 male) and initial BMI 54.6 +/- 8.4 kg/m(2). RESULTS: In these 11 patients, the derangement was diagnosed 17.9 +/- 15.8 months after RYGBP, following defined events in 63.6% (gastric stenosis, associated diseases ) or mostly exaggeration of expected symptoms in 36.4% (vomiting without endoscopic abnormalities). BMI then was 31.4 +/- 8.6 kg/m(2) (42.5 +/- 9.9% total reduction, or 2.4 +/- 2.1% decrease/month), and serum albumin and hemoglobin were 24.0 +/- 8.2 g/L and 97.0 +/- 23.0 g/L respectively. Edema was present in 45.4% (5/11), hospitalization was required in 54.5% (6/11), and 18.2% (2/11) eventually died. CONCLUSIONS: Serious malnutrition was unusual but not exceedingly rare in this series. Exogenous precipitating factors were clearly identified in 63.6% of the patients. Careful clinical and nutritional follow-up is recommended to prevent these uncommon but potentially dangerous complications.
Assuntos
Derivação Gástrica/efeitos adversos , Obesidade Mórbida/cirurgia , Desnutrição Proteico-Calórica/etiologia , Estômago/cirurgia , Adulto , Anastomose em-Y de Roux/efeitos adversos , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desnutrição Proteico-Calórica/mortalidade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Several drugs and their associations are being used for adjuvant or complementary chemotherapy with the aim of improving results of gastric cancer treatment. The objective of this study was to verify the impact of these drugs on nutrition and on survival rate after radical treatment of 53 patients with gastric cancer in stage III of the TNM classification. A control group including 28 patients who had only undergone radical resection was compared to a group of 25 patients who underwent the same operative technique followed by adjuvant polychemotherapy with FAM (5-fluorouracil, Adriamycin, and mitomycin C). In this latter group, chemotherapy toxicity in relation to hepatic, renal, cardiologic, neurological, hematologic, gastrointestinal, and dermatological functions was also studied. There was no significant difference on admission between both groups in relation to gender, race, macroscopic tumoral type of tumor according to the Borrmann classification, location of the tumor in the stomach, length of the gastric resection, or response to cutaneous tests on delayed sensitivity. Chemotherapy was started on average, 2.3 months following surgical treatment. Clinical and laboratory follow-up of all patients continued for 5 years. The following conclusions were reached: 1) The nutritional status and incidence of gastrointestinal manifestation were similar in both groups; 2) There was no occurrence of cardiac, renal, neurological, or hepatic toxicity or death due to the chemotherapeutic method per se; 3) Dermatological alterations and hematological toxicity occurred exclusively in patients who underwent polychemotherapy; 4) There was no significant difference between the rate and site of tumoral recurrence, the disease-free interval, or the survival rate of both study groups; 5) Therefore, we concluded, after a 5-year follow-up, chemotherapy with the FAM regimen did not increase the survival rate
Assuntos
Humanos , Masculino , Feminino , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Gástricas/cirurgia , Estudos de Casos e Controles , Quimioterapia Adjuvante , Intervalo Livre de Doença , Doxorrubicina/uso terapêutico , Fluoruracila/uso terapêutico , Seguimentos , Mitomicina/uso terapêutico , Estadiamento de Neoplasias , Estado Nutricional/efeitos dos fármacos , Recidiva , Neoplasias Gástricas/tratamento farmacológico , Taxa de SobrevidaRESUMO
Os autores apresentam análise de 22 doentes portadores de gastrite de refluxo alcalino observada após operaçäo de gastrectomia parcial com reconstruçäo à Billroth II. Todos os doentes apresentavam sintomas de dor epigástrica, vômito e perda de peso. O exame endoscópico evidenciava presença de gastrite superficial do coto gástrico, mais intensa ao nível da boca anastomótica. O exame anatomopatológico de fragmentos de mucosa obtidos a esse nível mostrou gastrite crônica superficial em 94,0% dos casos e gastrite atrófica em 6,0%. Em 59,0% dos casos ocorreu associaçäo com a síndrome de "dumping". Os doentes foram submetidos a tratamento pela operaçäo de Henley-Soupault, associando-se vagotomia em 15 casos (68%). No pós-operatório hospitalar ocorreram três complicaçöes: hemoperitônio por escape de ligadura na curvatura gástrica menor, em um caso, e obstruçäo intestinal por compressäo jejunal, em dois casos. No pós operatório tardio observou-se a cura clínica da gastrite de refluxo alcalino em 90,5% dos casos e melhora em 9,5%; a cura do "dumping" em 53,8% dos casos, a melhora em 23,0% e a persistência dos sintomas em 23,0%. Os exames de controle indicaram ainda presença de gastrite em 35,0% dos casos, pelo exame endoscópico, e em 94,0% dos casos, pelo exame anatomopatológico de biópsia da mucosa gástrica. Embora a operaçäo de Henley-Soupault näo determine normalizaçäo histológica da mucosa gástrica, concluem os autores que ele é eficiente, suprimindo ou aliviando os sintomas da gastrite de refluxo alcalino e, na maioria dos casos, também do "dumping"
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Síndrome de Esvaziamento Rápido , Gastrectomia , Gastrite/cirurgia , Refluxo Gastroesofágico/cirurgia , Úlcera Péptica/cirurgia , Vagotomia , Complicações Pós-Operatórias , Vagotomia Gástrica ProximalRESUMO
A ressecçäo radical é o único tratamento possível para a obtençäo de cura do câncer do estômago. Como procedimento cirúrgico oncológico submete-se às regras de margem adequada de ressecçäo, linfadenectomia extensa, ressecçäo em monobloco e ressecçäo das metásfases. É mister a análise em separado da conduta cirúrgica no câncer gástrico avançado e na neoplasia precoce, sendo esta última limitada em sua profundidade até a camada submucosa gástrica. Em relaçäo ao câncer gástrico avançado, verificou-se que a ressecçäo de segmento gástrico livre de tumor da ordem de 5 a 6 cm proporciona margem de segurança adequada. Tal limite baliza a indicaçäo da gastrectomia total para os tumores localizados nos terços médio e proximal do estômago. Quando a neoplasia maligna estiver junto à grande curvatura do corpo ou fundo gástrico ou na cárdia, recomenda-se à gastrectomia total associar-se a esplenectomia e a pancreatectomia corpo-caudal. No entanto, deve ser bem aquilatada a associaçäo da ressecçäo explênico-pancreática à gastrectomia total, pois estes procedimentos, longe de inócuos, trazem elevaçäo de morbidade e mortalidade cirúrgicas. Contudo, ao se buscar uma intervençäo radical a operaçäo ampliada é recomendável, desde que haja efetivo comprometimento neoplásico dos linfonodos ao longo da cadeia esplênica. A extensäo da ressecçäo gástrica na vigência de tumor localizado no terço distal do estômago ainda constitui assunto näo definido, chegando a ser polêmico. Tratando-se de tumor nesta localizaçäo, alguns autores advogam a "Gastrectomie de Principe" (independente do tamanho e estadiamento do tumor), que teria melhores condiçöes técnicas para obtençäo de margem de segurança efetiva e dissecçäo linfonodal ampla. Embora se tenha reduzido nos últimos anos, a taxa de morbidade e mortalidade da ressecçäo gástrica...