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Histoplasmosis is an increasing infection that mainly affects immunocompromised individuals such as patients with HIV/AIDS, with the disseminated form, especially gastrointestinal, being common in this population. The clinical presentation ranges from asymptomatic to symptoms that mimic other abdominal diseases. Jejunal perforation due to histoplasmosis, although rare, has been reported in a few cases, typically in men living with HIV in their fourth decade of life. We present the case of a 34-year-old male, with a history of HIV and colonic histoplasmosis who presented with acute abdominal pain requiring exploratory laparotomy and intestinal resection due to jejunal perforation, with histological confirmation of histoplasmosis in the resected intestinal segment.
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Introduction: Sleeve gastrectomy with jejunal bypass (SGJB) has been used as a bariatric/metabolic procedure since 2003, in the search for a simpler than other standard techniques and as effective as them. The jejunal-ileal anastomosis can deliver food directly to the hindgut where incretins are secreted. This procedure has gained popularity around the globe and has been studied in rat models as in humans, especially in South America and Asia. In this review, we present the details of the original surgical technique SGJB, summarized all the publications of the procedure, discuss possible advantages and disadvantages, and provide scientific information to look for the real place between bariatric/metabolic procedures. Methods: With 20 years of experience performing the original SGJB, the authors present the details of the procedure. Results: The SGJB consists of a traditional sleeve with the addition of a jejunal bypass. The jejunum is transected 20-30 cm distally to the ligament of Treitz. Then, the biliopancreatic limb is anastomosed to restore transit 250-300 cm distal to the jejunum transection. This way, the ileum gets in contact with partially digested food with the subsequent production of incretins. Conclusion: In this article, we describe the original Alamo technique of SGJB. It is important to clarify the technical details since many publications have presented different lengths of the defunctionalized jejunal limb. Also, the SGJB has been categorized in the "sleeve plus" procedures and its promising outcomes should rapidly position it as an alternative metabolic surgery.
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Cirurgia Bariátrica , Derivação Gástrica , Obesidade Mórbida , Humanos , Animais , Ratos , Jejuno/cirurgia , Obesidade Mórbida/cirurgia , Incretinas , Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Derivação Gástrica/métodosRESUMO
Diverticula at the jejuno-ileum are rare. They correspond mostly to pseudo diverticula and usually go unnoticed. Among symptomatic patients the clinical presentation is heterogeneous. We present 3 cases of it most frequent complication: acute jejunal diverticulitis
La presencia de divertículos a nivel de yeyuno-íleon es infrecuente. Ellos corresponden mayormente a pseudo divertículos y suelen pasar desapercibidos. Entre los casos sintomáticos, la presentación clínica es heterogénea. Presentamos 3 casos de diverticulitis aguda yeyunal que es la complicación más frecuente.
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Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Doença Aguda , Diverticulite/complicações , Diverticulite/terapia , Doenças do Jejuno/complicações , Doenças do Jejuno/terapia , Dor Abdominal/etiologia , Tomógrafos Computadorizados , Antibacterianos/uso terapêuticoRESUMO
Surgical conversion of Roux-en-Y gastric bypass (RYGB) to one anastomosis duodenal switch with sleeve gastrectomy (SADI-S), can be effective, when there is obesity recidivism, but surgically challenging. This case report video aims to detail the technical modifications that simplifies this conversion, in one stage. This video article demonstrates the conversion of RYGB to SADI-S using a jejunal bridge to facilitating the gastro-gastric reconnection. Surgical conversion was done laparoscopically, firstly removing the fundus, gastric body and the proximal part of the antrum. The gastrojejunal (GJ) anastomosis from the previous RYGB was preserved and the jejunal alimentary limb that follows was transected, 8cm distal to the GJ anastomosis, and anastomosed, at this level, with the antrum. The remaining alimentary limb was removed, until the jejuno-jejuno anastomosis, from the previous RYGB. The interposition of a segment of jejunal alimentary limb between the gastric bypass pouch and the antrum, has shown to be safe and feasible in RYGB conversion to SADI-S, without complications. Not reconnecting the remnant jejunal alimentary limb to the intestinal transit, but removing it, makes the procedure shorter and safer.
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INTRODUCTION: The duodenal-jejunal bypass liner (DJBL) is a less-invasive treatment of obesity and type 2 diabetes mellitus (T2DM). METHODS: This is a systematic review and meta-analysis including randomized clinical trials (RCTs) comparing DJBL versus sham or pharmacotherapies aiming to evaluate the effectiveness and safety of DJBL. RESULTS: Ten RCTs (681 patients) were included. The DJBL group showed superior excess weight loss (+ 11.4% [+ 7.75 to + 15.03%], p < 0.00001) and higher decrease in HbA1c compared to the control group (- 2.73 ± 0.5 vs. - 1.73 ± 0.4, p = 0.0001). Severe adverse events (SAEs) occurred in 19.7%. CONCLUSION: The DJBL did not reach the ASGE/ASMBS thresholds for the treatment of obesity. However, it is important to state that many SAEs were not really severe. Therefore, we believe this therapy plays an important role in the management obesity and T2DM.
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Cirurgia Bariátrica , Diabetes Mellitus Tipo 2 , Obesidade Mórbida , Humanos , Obesidade Mórbida/cirurgia , Duodeno/cirurgia , Jejuno/cirurgia , Cirurgia Bariátrica/efeitos adversos , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto , Obesidade/cirurgia , Obesidade/etiologia , Diabetes Mellitus Tipo 2/etiologiaRESUMO
Objectives: To report the case of a patient with a prenatal diagnosis of jejunal atresia and to review the literature regarding the results and prenatal diagnosis of this entity, implementing the use of non-conventional methods (3D ultrasound or magnetic resonance imaging). Material and methods: Report of a case of an 18-year-old pregnant woman referred to the Maternal-Fetal Medicine, Genetics and Reproduction Unit of the Virgen del Rocío Hospital in Seville due to fetus with abdominal peristaltic cystic image, consistent with jejunal atresia, confirmed with 3D HDLive mode ultrasound. A bibliographic search was carried out in Medline/PubMed, Google Scholar and LILACS, restricting by type of language (English and Spanish) and date of publication (January 1995 to June 2020). Primary studies of reports and case series relating to the outcome and prenatal diagnosis of this pathology were included. Results: The search identified 1,033 titles, of which four studies met the inclusion criteria, these being reports or case series. A total of twelve fetuses with a prenatal diagnosis of jejunal atresia detected with unconventional methods were reported. In all cases, the prenatal diagnosis was confirmed during the neonatal period, which required resection of the compromised segment; one of them died and two neonates developed short bowel syndrome because of a wide bowel resection. The postoperative course in the remaining cases was favorable. Conclusion: The available literature on the prenatal diagnosis of jejunal atresia using non-conventional methods is scarce and is limited to case reports or case series. The literature reviewed suggests that, in the presence of intestinal dilation, 3D ultrasound and magnetic resonance imaging could be of some use in characterizing the atretic portion and establishing the differential diagnosis. More studies are required to evaluate the diagnostic utility of these two alternatives.
Objetivos: reportar el caso de una paciente con diagnóstico prenatal de atresia de yeyuno y hacer una revisión de la literatura en torno al resultado y al diagnóstico de esta entidad, implementando el uso de métodos no convencionales: ecografía tridimensional (3D) o resonancia magnética fetal (RM). Materiales y métodos: se reporta el caso de una gestante de 18 años, remitida a la Unidad de Medicina Materno-Fetal, Genética y Reproducción del Hospital Virgen del Rocío de Sevilla (España), por feto con imagen quística abdominal, peristáltica, compatible con atresia de yeyuno, la cual se confirmó con ecografía 3D modo HDlive. Se realizó una búsqueda bibliográfica en Medline/PubMed, LILACS y Google Scholar, restringiendo por tipo de idioma (inglés y español) y fecha de publicación (enero de 1995 a junio de 2020). Se incluyeron estudios primarios de reportes y series de caso, que abordaran el resultado y el diagnóstico prenatal de esta patología. Resultados: la búsqueda identificó 1.033 títulos, de los cuales cuatro estudios cumplieron con los criterios de inclusión, estos fueron reporte o series de casos. En total se reportaron doce fetos con diagnóstico prenatal de atresia de yeyuno detectada con métodos no convencionales. Una gestación finalizó con óbito a la semana 26 de gestación y en todos los demás casos, el diagnóstico se ratificó durante el periodo neonatal, requiriendo la resección del segmento comprometido. Dos neonatos desarrollaron síndrome de intestino corto como consecuencia de una resección intestinal amplia. El resto experimentó una evolución posoperatoria favorable. Conclusión: la literatura disponible en torno al diagnóstico prenatal de atresia de yeyuno utilizando métodos no convencionales es escasa y se limita a reporte o series de casos. La literatura revisada sugiere que, en presencia de dilatación intestinal, la ecografía 3D y la resonancia magnética fetal podrían tener cierta utilidad a la hora de caracterizar la porción atrésica y establecer el diagnóstico diferencial. Se requieren más estudios que evalúen la utilidad diagnóstica de estas dos alternativas.
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Atresia Intestinal , Adolescente , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/diagnóstico por imagem , Atresia Intestinal/cirurgia , Imageamento por Ressonância Magnética , Gravidez , Diagnóstico Pré-Natal , Ultrassonografia , Ultrassonografia Pré-NatalRESUMO
PURPOSE OF REVIEW: To provide updated evidence on the endoscopic procedures for weight loss and to bring personal insights on the future of endobariatrics. RECENT FINDINGS: Intragastric balloons promote significant improvement in histologic and radiologic aspects of non-alcoholic steatohepatitis; the endoscopic sleeve gastroplasty is effective up to 5 years and seems particularly beneficial to patients with BMI≤40kg/m2; distal POSE is a promising technique but still lacks adequate clinical data; aspiration therapy triggers remarkable weight loss, but data on weight trends after removal of the device are still lacking; the satiety-inducing device, the sleeveballoon, the gastric mucosal devitalization, and the endoscopic magnetic partial jejunal diversion are promising procedures still under study and refinements. Several therapeutic options are necessary during obesity's natural history. Therefore, endobariatrics should act in harmony with lifestyle interventions, diet modification, psychological treatment, pharmacotherapy, and bariatric surgery seeking the best outcome in the long term.
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Cirurgia Bariátrica , Hepatopatia Gordurosa não Alcoólica , Endoscopia , Humanos , Resultado do Tratamento , Redução de PesoRESUMO
Abstract Jejunal adenocarcinoma is a rare type of primary small bowelmalignancy. It is generally diagnosed at late stages and as a surgical finding, with abdominal pain or discomfort being the main associated symptom. Cases presenting with perforation are even rarer, especially without disseminated disease. The relationship between cancer and coronavirus disease 2019 (COVID-19) is still being studied, as well as the postsurgical evolution of COVID-19 patients and its possible causality of intestinal perforation. We present the case of a perforated jejunal adenocarcinoma in a COVID-19-positive patient, in whom the symptomatology secondary to the perforation led to an early diagnosis, treatment and adequate postsurgical evolution, despite the concomitant condition.
Resumo O adenocarcinoma jejunal é um tipo raro de malignidade primária do intestino delgado, o qual geralmente é diagnosticado em estágios tardios e como achado cirúrgico, sendo a dor ou o desconforto abdominal o principal sintoma associado. Casos que apresentam perfuração são ainda mais raros, principalmente sem doença disseminada. A relação entre câncer e a cornonavirus disease 2019 (covid-19) ainda está sendo estudada, assim como a evolução pós-cirúrgica de pacientes com covid-19 e sua possível causalidade de perfuração intestinal. Apresentamos o caso de um adenocarcinoma jejunal perfurado em um paciente positivo para covid-19, em que a sintomatologia secundária à perfuração levou a um diagnóstico precoce, tratamento e evolução pós-cirúrgica adequada, apesar da condição concomitante.
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Humanos , Feminino , Adenocarcinoma/diagnóstico , COVID-19 , Perfuração Intestinal , Adenocarcinoma/cirurgia , Neoplasias IntestinaisRESUMO
Resumen Objetivos: Reportar el caso de una paciente con diagnóstico prenatal de atresia de yeyuno y hacer una revisión de la literatura en torno al resultado y al diagnóstico de esta entidad, implementando el uso de métodos no convencionales: ecografía tridimensional (3D) o resonancia magnética fetal (RM). Materiales y métodos: Se reporta el caso de una gestante de 18 años, remitida a la Unidad de Medicina Materno-Fetal, Genética y Reproducción del Hospital Virgen del Rocío de Sevilla (España), por feto con imagen quística abdominal, peristáltica, compatible con atresia de yeyuno, la cual se confirmó con ecografía 3D modo HDlive. Se realizó una búsqueda bibliográfica en Medline/PubMed, LILACS y Google Scholar, restringiendo por tipo de idioma (inglés y español) y fecha de publicación (enero de 1995 a junio de 2020). Se incluyeron estudios primarios de reportes y series de caso, que abordaran el resultado y el diagnóstico prenatal de esta patología. Resultados: La búsqueda identificó 1.033 títulos, de los cuales cuatro estudios cumplieron con los criterios de inclusión, estos fueron reporte o series de casos. En total se reportaron doce fetos con diagnóstico prenatal de atresia de yeyuno detectada con métodos no convencionales. Una gestación finalizó con óbito a la semana 26 de gestación y en todos los demás casos, el diagnóstico se ratificó durante el periodo neonatal, requiriendo la resección del segmento comprometido. Dos neonatos desarrollaron síndrome de intestino corto como consecuencia de una resección intestinal amplia. El resto experimentó una evolución posoperatoria favorable. Conclusión: La literatura disponible en torno al diagnóstico prenatal de atresia de yeyuno utilizando métodos no convencionales es escasa y se limita a reporte o series de casos. La literatura revisada sugiere que, en presencia de dilatación intestinal, la ecografía 3D y la resonancia magnética fetal podrían tener cierta utilidad a la hora de caracterizar la porción atrésica y establecer el diagnóstico diferencial. Se requieren más estudios que evalúen la utilidad diagnóstica de estas dos alternativas.
Abstract Objectives: To report the case of a patient with a prenatal diagnosis of jejunal atresia and to review the literature regarding the results and prenatal diagnosis of this entity, implementing the use of non-conventional methods (3D ultrasound or magnetic resonance imaging). Material and methods: Report of a case of an 18-year-old pregnant woman referred to the Maternal-Fetal Medicine, Genetics and Reproduction Unit of the Virgen del Rocío Hospital in Seville due to fetus with abdominal peristaltic cystic image, consistent with jejunal atresia, confirmed with 3D HDLive mode ultrasound. A bibliographic search was carried out in Medline/PubMed, Google Scholar and LILACS, restricting by type of language (English and Spanish) and date of publication (January 1995 to June 2020). Primary studies of reports and case series relating to the outcome and prenatal diagnosis of this pathology were included. Results: The search identified 1,033 titles, of which four studies met the inclusion criteria, these being reports or case series. A total of twelve fetuses with a prenatal diagnosis of jejunal atresia detected with unconventional methods were reported. In all cases, the prenatal diagnosis was confirmed during the neonatal period, which required resection of the compromised segment; one of them died and two neonates developed short bowel syndrome because of a wide bowel resection. The postoperative course in the remaining cases was favorable. Conclusion: The available literature on the prenatal diagnosis of jejunal atresia using non-conventional methods is scarce and is limited to case reports or case series. The literature reviewed suggests that, in the presence of intestinal dilation, 3D ultrasound and magnetic resonance imaging could be of some use in characterizing the atretic portion and establishing the differential diagnosis. More studies are required to evaluate the diagnostic utility of these two alternatives.
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Humanos , Feminino , Gravidez , Atresia Intestinal , Jejuno/diagnóstico por imagem , Diagnóstico Pré-Natal , UltrassonografiaRESUMO
PURPOSE: Define factors for proper diagnosis and treatment of small intestinal injury during procedures with percutaneous renal access, thus optimizing favorable outcomes and avoiding complications and death during conservative or surgical approaches. MATERIALS AND METHODS: Bibliographic review of case reports available in the literature and presentation of data from an additional case have been carried out. RESULTS: Percutaneous nephrolithotripsy was the procedure that most frequently caused injury of the small intestine. Time for diagnosis of the lesion took up to 5 days after the intraoperative phase. When occurring in the intraoperative phase, perforation was identified by direct endoscopic visualization; a catheter was then placed inside the intestinal lumen and a conservative approach to the derived fistula was adopted, which led to successful outcomes in all cases. Abdominal pain was the most common symptom in cases diagnosed during the postoperative phase (75%). In the presence of signs of peritonitis, surgical intervention was performed, with favorable evolution in all cases. CONCLUSIONS: Conservative management of small intestine injuries is possible when there is no peritoneal contamination. Its success factors include intraoperative diagnosis and non-transfixing lesions, which is more common in duodenal involvement. Laparotomy to clean the cavity associated with a corrective approach (enterorrhaphy or enterectomy with primary anastomosis) was successfully indicated in cases of late diagnosis with signs of peritonitis, a situation that is most commonly found in transfixing lesions of ileum and jejunum.
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Intestino Delgado/lesões , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/terapia , Rim/cirurgia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Humanos , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
Percutaneous access for treatment of renal pathologies is a minimally invasive modality, although it can present complications. Small bowel lesions are rare but correct diagnosis and management are essential to prevent major complications. A patient submitted to an uncomplicated percutaneous nephrolithotomy presented jejunal transfixing perforation with a stable clinical progression. It was first managed conservatively unsuccessfully. Therefore, a laparotomy with enterectomy was necessary, with a favorable outcome. In transfixing lesions of the small bowel, diagnosis may be difficult and delayed. This contributes to conservative management failures and the requirement of laparotomy with enterectomy in order to reduce further complications.
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Intestinal malformations are common disorders in newborn and favorable outcomes have been reported for such conditions. Although, if the patient is treated in a not experienced center, misinterpretation of the clinical and radiological findings may lead to errors in treatment and possible complications in adulthood. We report a case of a congenital megaduodenum which was misinterpreted as an intestinal malrotation resulting in late complications. The patient underwent a successful surgical resection of the duodenum with improvement of his clinical symptoms and nutritional status. This case report emphasizes the importance of considering megaduodenum in the differential diagnosis of patients with feeding impairment, even during adulthood. Early diagnosis and treatment may improve patients' outcome and reduce morbidity.
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BACKGROUND: Obesity and rapid weight loss after bariatric surgery (BS) are independent risk factors for development of cholelithiasis (CL), a prevalent disease in the Chilean population. This study aimed to determine the incidence of CL in obese Chilean patients 12 months after BS and identify risk factors for development of gallstones. METHODS: Retrospective study of patients who underwent BS in 2014. Patients with preoperative negative abdominal ultrasound (US) for CL and follow-up for at least than 12 months were included. Patients underwent US at 6 months and 12 months. We analyzed sex, age, hypertension, dyslipidemia, type 2 diabetes mellitus, body mass index (BMI), surgical procedure, percentage of excess BMI loss (%EBMIL) at 6 months, and BMI at 6 months. RESULTS: Of 279 patients who underwent bariatric surgery during 2014, 66 had previous gallbladder disease and 176 met the inclusion criteria (82.6%), while 54.6% were female. The mean age was 37.8 ± 10.5 years and preoperative BMI was 37.5 kg/m2. BMI and %EBMIL at 6 months were 27.8 ± 3.3 kg/m2 and 77.9 ± 33.6%, respectively. At 12 months after BS, CL was found in 65 patients (36.9%). Hypertension turned out to be protective against occurrence of gallstones at 1 year with an OR 0.241. CONCLUSIONS: Incidence of CL was up to one-third of the patients followed up for 12 months after BS. Excessive weight loss and other variables studied did not increase risk. Hypertension seems to be protective against gallstone formation, but this result needs further analysis.
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Cirurgia Bariátrica/efeitos adversos , Colelitíase/epidemiologia , Colelitíase/etiologia , Obesidade Mórbida/cirurgia , Adulto , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Índice de Massa Corporal , Chile/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/cirurgia , Feminino , Cálculos Biliares/epidemiologia , Cálculos Biliares/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Redução de Peso/fisiologiaRESUMO
RESUMEN Fundamento: los tumores del estroma gastrointestinal, conocidos en inglés como gastrointestinal stromal tumors, son tumores mesenquimales que aparecen en cualquier sitio del tracto gastrointestinal. Muchos de los cuales suelen ser pediculados y de difícil diagnóstico preoperatorio. Objetivo: exponer un caso de un tumor del estroma gastrointestinal de localización poco frecuente en duodeno, más raro aún su ubicación en yeyuno. Caso clínico: paciente masculino de 77 años de edad que presenta un tumor del estroma gastrointestinal de localización en yeyuno fue atendido en el Hospital Universitario Amalia Simoni, por el servicio de urgencia en el periodo 2016-2017. Conclusiones: los tumores mesenquimales son pocos frecuentes y los del estroma gastrointestinal lo son aún más, donde la localización yeyunal los menos encontrados y en su mayoría el diagnóstico se realiza durante el acto quirúrgico.
ABSTRACT Background: the gastrointestinal stromal tumors, are mesenchymal tumors that appear in any place of gastrointestinal tract. Many of them can be pediculate and difficult pre-operatory diagnosis. Objective: to explain a case of gastrointestinal stromal tumor of difficult localization in duodenum but it is even stranger to find it in jejune. Clinical case: a 77-year-old male patient who presents a gastrointestinal stromal tumor located in jejune, he was attended in Amalia Simoni University Hospital, by the emergency services, in the period of 2016-2017. Conclusions: the mesenchymal tumors are not frequent and those of gastrointestinal stroma are even rarer but, being the localization jejunal less found and in its majority the diagnosis is made during the surgical act.
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BACKGROUND: In recent years, studies indicate gut microbiota as an important modulator in the pathophysiology of type 2 diabetes. Environmental and genetic factors interact to control the host's intestinal microbiota, triggering metabolic disorders such as obesity and insulin resistance. OBJECTIVES: The objective of this study was to identify the fecal microbiota in adult type 2 diabetes patients and to assess changes in composition after metabolic surgery. SETTING: University Hospital of the University of São Paulo. METHODS: Twenty-one patients were enrolled in a randomized controlled study divided into 2 arms. One group underwent duodenal-jejunal bypass surgery with minimal gastric resection, and fecal samples were collected before the operation and after 6 and 12 months. The other group received medical care (standard care group) and was followed for 12 months. Fecal samples were collected at baseline and after 6 and 12 months. Fecal microbiota was analyzed using high-throughput sequencing with V4 16 S rRNA primers. RESULTS: The fecal microbiota in duodenal-jejunal bypass surgery with minimal gastric resection group (Bacteroides, Akkermansia, and Dialister) exhibited increased abundance and diversity compared with that in the standard care group; however, the increase in A. muciniphila was only statistically significant in the surgical group, probably due to the study's small sample size. CONCLUSIONS: The data presented suggest that duodenal-jejunal bypass surgery with minimal gastric resection increases microbial richness and abundancy, mainly for those bacteria related to weight loss and metabolic control (Akkermansia), providing a better understanding of the role of microbiota in type 2 diabetes regulation and its changes after metabolic surgery.
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Bactérias , Glicemia/fisiologia , Duodeno/cirurgia , Derivação Gástrica , Microbioma Gastrointestinal/fisiologia , Redução de Peso/fisiologia , Bactérias/classificação , Bactérias/isolamento & purificação , Diabetes Mellitus Tipo 2/cirurgia , Fezes/microbiologia , Humanos , Obesidade Mórbida/cirurgiaRESUMO
INTRODUCTION: Sleeve gastrectomy with jejunal bypass (SGJB) and Roux-en-Y gastric bypass (RYGB) has shown good results with respect to type 2 diabetes mellitus (T2D) remission in our institution. In this study, we compared the efficacy and safety of SGJB versus RYGB in terms of T2D remission up to 3 years postoperatively. MATERIALS AND METHODS: A retrospective cohort study of two groups of patients with T2D who underwent SGJB or RYGB. All patients were matched by age, presurgical body mass index (BMI), glycated hemoglobin (HbA1c), and diabetes duration. Complete remission was defined as HbA1c of < 6%, fasting plasma glucose (FPG) of < 100 mg/dL, and no antidiabetic drugs. RESULTS: In total, 57 and 55 patients in the SGJB and RYGB groups, respectively, met the inclusion criteria. The diabetes remission rate was similar between the SGJB and RYGB groups at 1 year postoperatively (69.2 vs. 64.7%) and 3 years postoperatively (56.1 vs. 58.8%). There were no significant differences in HbA1c or FPG at 1 or 3 years between the two groups. Additionally, weight loss and other metabolic parameters were similar between the groups. Clinical chemistry values were similar at 12 months except for hematocrit and calcium, which were significantly lower in the RYGB group. There were no differences in surgical complications. CONCLUSIONS: Both procedures showed similar results in terms of T2D remission and other metabolic markers at 3 years. Hematocrit and calcium were significantly higher in the SGJB than RYGB group. SGJB is as effective and safe as RYGB in obese patients with T2D.
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Diabetes Mellitus Tipo 2 , Gastrectomia/estatística & dados numéricos , Derivação Gástrica/estatística & dados numéricos , Obesidade Mórbida , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/cirurgia , Hemoglobinas Glicadas/análise , Humanos , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Estudos RetrospectivosRESUMO
The accuracy of the provisional estimation of the Biopharmaceutics Classification System (BCS) is heavily influenced by the permeability measurement. In this study, several theoretical and experimental models currently employed for BCS permeability classification have been analysed. The experimental models included the in situ rat intestinal perfusion, the ex vivo rat intestinal tissue in an Ussing chamber, the MDCK and Caco-2 cell monolayers, and the parallel artificial membrane (PAMPA). The theoretical models included the octanol-water partition coefficient and the QSPeR (Quantitative Structure-Permeability Relationship) model recently developed. For model validation, a dataset of 43 compounds has been recompiled and analysed for the suitability for BCS permeability classification in comparison with the use of human intestinal absorption and oral bioavailability values. The application of the final model, based on a majority voting system showed a 95.3% accuracy for predicting human permeability. Finally, the present approach was applied to the 186 orally administered drugs in immediate-release dosage forms of the WHO Model List of Essential Medicines. The percentages of the drugs that were provisionally classified as BCS Class I and Class III was 62.4%, suggesting that in vivo bioequivalence (BE) may potentially be assured with a less expensive and more easily implemented in vitro dissolution test, ensuring the efficiency and quality of pharmaceutical products. The results of the current study improve the accuracy of provisional BCS classification by combining different permeability models.
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Medicamentos Essenciais/classificação , Medicamentos Essenciais/metabolismo , Mucosa Intestinal/metabolismo , Modelos Biológicos , Animais , Biofarmácia , Células CACO-2 , Cães , Humanos , Técnicas In Vitro , Células Madin Darby de Rim Canino , Permeabilidade , Ratos , Organização Mundial da SaúdeRESUMO
Jejunal diverticular disease is a very uncommon pathology often asymptomatic. Associated complications appear in less than 30% of patients and they can present as diverticulitis, refractary inflammation, obstruction, hemorrhage, perforation or intraabdominal abscess formation. Clinical manifestations are usually unspecific and high suspicion index is required to reach the diagnosis. Treatment of complications includes volume replacement, transfusions, antibiotic therapy, percutaneous drainage or surgical intervention. We present a retrospective observational study of the cases treated in our hospital between 2007 and 2016.
La enfermedad diverticular yeyunal es una condición clínica muy poco frecuente y habitualmente asintomática. Las complicaciones asociadas aparecen en menos del 30% de los pacientes y pueden manifestarse como inflamación de los divertículos, obstrucción intestinal, hemorragia digestiva, malabsorción intestinal, formación de abscesos intraabdominales y perforación. La clínica de los pacientes es muchas veces inespecífica, requiriendo un alto grado de sospecha para llegar al diagnóstico. El tratamiento de las complicaciones de la enfermedad diverticular es variado, incluyendo reposición de volumen o transfusiones, antibioticoterapia, drenaje percutáneo o intervención quirúrgica. Presentamos un estudio observacional retrospectivo de los casos tratados en nuestro hospital entre 2007 y 2016.
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Diverticulite/diagnóstico , Diverticulite/terapia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
Los tumores de intestino delgado son infrecuentes, generalmente se presentan con cuadros clínicos inespecíficos y la mayoría de los diagnósticos se hacen en etapas avanzadas de la enfermedad. Se presenta un paciente de sexo masculino de 58 años de edad, con dolor abdominal generalizado, intermitente, vómitos ocasionales, pérdida de peso y llenura posprandial, de dos meses de evolución. Ingresó con manifestaciones clínicas de obstrucción intestinal, y en una tomografía abdómino-pélvica se observó disminución abrupta del calibre en el yeyuno proximal. Se le practicó una laparotomía en la que se evidenció una lesión obstructiva del yeyuno que se resecó y se anastomosó el segmento. En la histopatología se reportó adenocarcinoma de yeyuno moderadamente diferenciado T3N0M0. Presentó una evolución favorable
Small bowel tumors are infrequent. Adenocarcinoma of the jejunum constitutes a rare diagnosis. It usually presents with nonspecific clinical symptoms and most patients are diagnosed in advanced stages of the disease. We present the case of a 58-year-old man with a diagnosis of jejunal adenocarcinoma, intermittent generalized abdominal pain, occasional vomiting, weight loss and postprandial fullness of two months of evolution. The patient was admitted with intestinal obstruction, with an abdominopelvic tomography showing abrupt caliber reduction at the level of the proximal jejunum. A laparotomy was performed, where an obstructive lesion was evidenced in the jejunum; resection was performed primary anastomosis. Histopathology reported moderately differentiated adenocarcinoma T3N0M0. The patient has had a favorable evolution
Assuntos
Humanos , Adenocarcinoma , Dor Abdominal , Obstrução Intestinal , Neoplasias do JejunoRESUMO
AIM: To evaluate the mucosal tunic and submucosal plexus of the jejunum of rats infected with different inoculum doses of Toxoplasma gondii. MAIN METHODS: Rats were infected with different inoculum doses (50, 500, 1000 and 5000 oocysts) of the T. gondii for 30days, while a control group (CG) received saline solution. Blood and feces were collected before euthanasia for analysis of blood and fecal leukocytes (LEs). Histological analysis of the mucosa, submucosa, villi, crypts and enterocytes were performed. Goblet cells, intraepithelial lymphocytes (IELs) and Paneth cells were quantified. Immunohistochemistry was used to assess enteroendocrine serotonergic (5HT-IR) cells, proliferative cells (PCNA+) and mast cells. Whole mounts were obtained to determine the total submucosal neurons by Giemsa staining and metabolically active neurons (NADH-d+), nitrergic neurons (NADPH-d+) and glial cells (S100). KEY FINDINGS: An increase in blood LEs was observed 30days post-infection (dpi). Fecal LEs were more abundant in the feces in all infected groups at 21 dpi when compared to the CG. The number of IELs, sulfomucin-producing goblet cells, Paneth cells, PCNA+ cells and mast cells increased, whereas the number of 5HT-IR cells decreased. The jejunal architecture was altered, with atrophy of the mucosa, submucosa, villi and crypts. The number of total submucosal neurons decreased, but the NADPH-d+ subpopulation increased. SIGNIFICANCE: The results show how chronic toxoplasmic infection affects the tissue and cellular composition of the rat jejunum. These structural changes tend to intensify with the inoculum dose, demonstrating the importance of the parasitic load on intestinal alterations.