RESUMO
BACKGROUND: Bariatric surgery promotes changes in body composition, that can include the loss of bone mineral density (BMD). There is a lack of studies on the evolution of bone health of elderly people who underwent bariatric surgery, in general, and when comparing the gastric bypass (GB) and sleeve gastrectomy (SG) techniques. OBJECTIVE: To evaluate the bone health of elderly patients with obesity undergoing bariatric surgery. METHODS: This is a prospective randomized clinical study, that was carried out with individuals of both sexes, ≥65 years, undergoing GB or SG and who met the inclusion criteria. Age, gender and comorbidities (type 2 diabetes mellitus, arterial hypertension, dyslipidemia and osteoarthrosis) were collected and analyzed at baseline. Anthropometric data (weight, body mass index, percentage of weight loss, percentage of excess weight loss), laboratory tests related to bone health and bone mineral density were analyzed before and 24 months after surgery. RESULTS: A total of 36 patients (GB, n=18; SG, n=18) were evaluated. At baseline, except for sex and preoperative body mass index, which was higher in GB, groups were similar. After 24 months, GB was superior for weight loss (%WL) and excess weight loss (%EWL). Regarding bone health, a significant decrease of BMD was observed in the spine, total proximal femur and femoral neck in all groups, with an average decrease of 5.1%, 10.5% and 15.1%, respectively. In addition, the observed decrease in BMD was up to 25% in the total femur after 24 months, six patients went from normal BMD to osteopenia and one from osteopenia to osteoporosis. There was no difference in parathormone values. However, there was an association between the increase in parathormone and the decrease in BMD in the spine, mainly in the GB group. There was no association between %WL and %EWL with the reduction in BMD. CONCLUSION: Bariatric surgery was related to the reduction of BMD in elderly patients, but there was no statistical difference between the two surgical techniques.
Assuntos
Cirurgia Bariátrica , Doenças Ósseas Metabólicas , Diabetes Mellitus Tipo 2 , Derivação Gástrica , Obesidade Mórbida , Masculino , Feminino , Humanos , Idoso , Obesidade Mórbida/cirurgia , Densidade Óssea , Estudos Prospectivos , Derivação Gástrica/métodos , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Redução de Peso , Índice de Massa Corporal , Hormônio Paratireóideo , Doenças Ósseas Metabólicas/etiologia , Doenças Ósseas Metabólicas/cirurgiaRESUMO
Abstract Secondary osteoma cutis is a phenomenon that may occur in several conditions. When it occurs in a melanocytic nevus it is named osteonevus of Nanta, an event considered uncommon and characterized by the presence of bone formation adjacent or interposed with melanocytic cells. There are reports of its occurrence in various melanocytic lesions, being more frequently associated with intradermal nevus. We report a case of osteonevus of Nanta in combined nevus, possibly the first description of this association.
Assuntos
Humanos , Feminino , Adulto , Dermatoses do Couro Cabeludo/patologia , Dermatopatias Genéticas/patologia , Neoplasias Cutâneas/patologia , Doenças Ósseas Metabólicas/patologia , Ossificação Heterotópica/patologia , Nevo Intradérmico/patologia , Nevo Pigmentado/patologia , Dermatoses do Couro Cabeludo/cirurgia , Dermatopatias Genéticas/cirurgia , Neoplasias Cutâneas/cirurgia , Doenças Ósseas Metabólicas/cirurgia , Imuno-Histoquímica , Ossificação Heterotópica/cirurgia , Nevo Intradérmico/cirurgia , Melanócitos/patologia , Nevo Pigmentado/cirurgiaRESUMO
Secondary osteoma cutis is a phenomenon that may occur in several conditions. When it occurs in a melanocytic nevus it is named osteonevus of Nanta, an event considered uncommon and characterized by the presence of bone formation adjacent or interposed with melanocytic cells. There are reports of its occurrence in various melanocytic lesions, being more frequently associated with intradermal nevus. We report a case of osteonevus of Nanta in combined nevus, possibly the first description of this association.
Assuntos
Doenças Ósseas Metabólicas/patologia , Nevo Intradérmico/patologia , Nevo Pigmentado/patologia , Ossificação Heterotópica/patologia , Dermatoses do Couro Cabeludo/patologia , Dermatopatias Genéticas/patologia , Neoplasias Cutâneas/patologia , Adulto , Doenças Ósseas Metabólicas/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Melanócitos/patologia , Nevo Intradérmico/cirurgia , Nevo Pigmentado/cirurgia , Ossificação Heterotópica/cirurgia , Dermatoses do Couro Cabeludo/cirurgia , Dermatopatias Genéticas/cirurgia , Neoplasias Cutâneas/cirurgiaRESUMO
BACKGROUND: One of the most challenging aspects of a revision knee arthroplasty is the management of bone loss. The OBJECTIVE of the study is to show the capability to augment bone mineral density in areas with bone loss with platelet-derived growth factors. METHODS: Randomized, prospective, blinded study in patients who underwent a total knee replacement revision with tibial-damaged metaphyseal bone were randomly allocated to have a revision total knee arthroplasty and to fill the bone defects with lyophilized bone allograft mixed with platelet growth factors (experimental group, n= 9) or with lyophilized bone allograft alone (control group, n= 7). To evaluate bone mineral density between groups, dual-energy X-ray absorptiometry (DEXA) was performed preoperatively, at 1 month, 6 months and 1 year after surgery. RESULTS: The study was comprised of a total of 16 patients. We found no significant differences observed during the follow-up between groups in mineral bone density. CONCLUSIONS: Use of platelet-derived growth factors does not improve bone mineral density in patients with revision knee arthroplasty.
ANTECEDENTES: uno de los aspectos más desafiantes de la artroplastia de revisión de rodilla es el manejo de la pérdida ósea. OBJETIVO: demostrar la capacidad de incrementar la densidad mineral ósea en áreas con pérdida ósea, mediante el uso de plasma rico en plaquetas. MATERIAL Y MÉTODOS: estudio prospectivo, aleatorizado, cegado; efectuado con pacientes a quienes se realizó artroplastia de revisión de rodilla con pérdida ósea metafisiaria de tibia. Los pacientes se asignaron al azar a dos grupos para rellenar los defectos con aloinjerto óseo liofilizado con plasma rico en plaquetas (grupo experimental, n= 9), y otro grupo que sólo recibió el injerto óseo liofilizado (grupo control, n= 7). En ambos grupos la evaluación de la densidad mineral ósea se hizo con absorciometría de rayos X de energía dual (DXA) antes de la operación, al mes, seis meses, y un año después de la cirugía. RESULTADOS: se estudiaron 16 pacientes sin diferencias significativas entre ambos grupos en la densidad mineral ósea durante el periodo de seguimiento. CONCLUSIONES: el plasma rico en plaquetas no demostró incrementar la densidad mineral ósea en pacientes con defectos óseos por artroplastia de revisión de rodilla.
Assuntos
Artroplastia do Joelho/métodos , Transplante Ósseo , Fator de Crescimento Derivado de Plaquetas/uso terapêutico , Plasma Rico em Plaquetas , Tíbia/patologia , Absorciometria de Fóton , Idoso , Aloenxertos , Densidade Óssea , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/tratamento farmacológico , Doenças Ósseas Metabólicas/etiologia , Doenças Ósseas Metabólicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Fator de Crescimento Derivado de Plaquetas/administração & dosagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Reoperação , Método Simples-Cego , Tíbia/diagnóstico por imagem , Tíbia/cirurgiaRESUMO
The purpose of this study was to analyze histologically the effect of low-level laser therapy (LLLT) in combination with bisphosphonate on bone healing in surgically created critical size defects (CSD) in rat calvaria. One hundred Wistar female rats sham operated (sham) and ovariectomized (Ovx) were maintained untreated for 1 month to allow for the development of osteopenia in the Ovx animals. A CSD was made in the calvarium of each rat, and the animals were divided into five groups according to following treatments: (1) sham rats (control), (2) Ovx rats, (3) Ovx rats treated with LLLT, (4) Ovx rats treated with bisphosphonate, and (5) Ovx rats treated with bisphosphonate and LLLT. Groups 4 and 5 were irrigated with 1 ml of bisphosphonate, and groups 3 and 5 were submitted to LLLT (GaAlAs), 660 nm, 24 J, and 0.4285 W/cm(2) on the CSD. Ten animals of each treatment were killed at 30 and 60 days. Histomorphometric assessments, using image analysis software, and histological analyses were performed. No defect was completely regenerated with the bone. Histometrically, it can be observed that groups 3 (37.49 ± 1.94%, 43.11 ± 2.39%) and 5 (35.05 ± 1.57%, 41.07 ± 1.89%) showed a significant bone neoformation when compared to groups 1 (16.81 ± 1.57%, 27.54 ± 1.49%), 2 (11.68 ± 0.98%, 22.51 ± 1.05%), and 4 (14.62 ± 1.70%, 25.67 ± 1.41%) in all experimental periods (P < 0.05). It was possible to conclude that the LLLT associated or not with bisphosphonate treatment was effective for stimulating bone formation in CSD in the calvaria of rats submitted to ovariectomy.
Assuntos
Regeneração Óssea/efeitos dos fármacos , Regeneração Óssea/efeitos da radiação , Difosfonatos/farmacologia , Terapia com Luz de Baixa Intensidade/métodos , Crânio/efeitos da radiação , Animais , Conservadores da Densidade Óssea/farmacologia , Doenças Ósseas Metabólicas/cirurgia , Interpretação Estatística de Dados , Feminino , Processamento de Imagem Assistida por Computador , Ovariectomia , Ratos , Ratos Wistar , Crânio/efeitos dos fármacos , Crânio/patologia , Crânio/cirurgiaRESUMO
O objetivo foi comparar a consolidação óssea em tíbias de ratas normais e osteopênicas. 49 ratas albinas fêmeas, linhagem Wistar, peso médio de 160 (± 20g) e 100 dias foram distribuídas em 2 grupos: Ooforectomizado (OOF) e Pseudo-ooforectomizado (Grupo controle - SHAM). 30 dias após a ooforectomia e/ou cirurgia simulada, todas foram submetidas à produção de lesão óssea cortical. Foram sacrificadas na 2ª, 4ª, 6ª e 8ª semanas. Os osteoblastos foram contados. O peso aumentou progressivamente, porém as OOF apresentaram maior peso (p<0,05) quando comparadas as SHAM, à época da segunda cirurgia. 15 dias pós-lesão óssea, as OOF apresentaram maior número de osteoblastos (p<0,05) quando comparados as SHAM. 30 dias pós-lesão óssea houve diminuição no número de osteoblastos, porém os valores foram equivalentes entre os dois grupos OOF e SHAM. 45 dias pós-lesão, apesar da diminuição constante de osteoblastos, o grupo OOF permaneceu elevado quando comparado ao grupo controle (p<0,05). Aos 60 dias o grupo SHAM apresentou menos osteoblastos, sugerindo processo avançado de reparo ósseo. Os animais osteopênicos apresentaram resposta inicial acelerada à lesão óssea, possibilitando a equivalência entre os grupos 30 dias pós-lesão. Mas, após este período apresentaram retardo na mineralização do osteóide, sugerindo atraso tardio no processo de reparo ósseo.
The purpose was to compare tibial bone union in normal and osteopenic female rats. Forty-nine Wistar albino female rats weighing 160 g (±20g) and 100 days were distributed into 2 groups: Oophorectomized (OOF) and Pseudo-oophorectomized (SHAM). Thirty days later, a cortical injury was produced in all the animals. They were sacrificed in the 2nd, 4th, 6th and 8th weeks. Osteoblasts count was performed. Progressive weight increase was observed, but the OOF group was shown to have gained more weight (p£0.05) than the SHAM group, at the time of the second surgery. After 15 days post-injury, the animals in the OOF group presented a higher number of osteoblasts (p£0.05) compared to the SHAM group. Thirty days after injury, the number of osteoblasts was reduced, but both groups showed similar amounts. Forty-five days after injury, despite a constant reduction, the number of osteoblasts in the OOF group remained high when compared to SHAM (p£0.05) group. After 60 days, we found less osteoblasts in the SHAM group, suggesting an advanced bone repair process. The osteopenic animals showed an early accelerated response, which became equivalent between both groups 30 days after injury. However, after that period, they showed a delayed osteoid mineralization, suggesting delayed late bone repair process.