ABSTRACT
Bone loss is a potential adverse consequence of rapid and sustained weight loss after bariatric surgery. The aim of the present study was to evaluate the bone mass, body fat distribution, and metabolic parameters in women submitted to Roux-en-Y gastric bypass (RYGB). The study included the following three groups: one group of lean women (control [C] group) and two groups of obese women, one evaluated one year (B1) and the other five years (B5) after RYGB. Dual-energy X-ray absorptiometry and magnetic resonance imaging were used to determine bone mineral density (BMD; lumbar spine, total hip, and femoral neck) and abdominal fat content (subcutaneous [SAT] and visceral [VAT] adipose tissues, and intrahepatic lipids [IHL]). The BMD/body mass index ratio was lower in the B5 compared with the C group at all sites. Serum C-terminal telopeptide of type I collagen (CTX) levels were higher in the B1 and B5 groups compared with the C group. Individuals submitted to RYGB showed greater SAT but similar VAT and IHL values compared with those in the C group. However, the B5 group had higher mean parathyroid hormone levels compared with the other two groups. Individuals submitted to RYGB presented increased levels of CTX and low BMD for body weight than those in the C group, suggesting that bone catabolism is a persistent alteration associated with RYGB. In conclusion, the long-lasting metabolic benefits obtained with RYGB in obesity are counterbalanced by a persistent catabolic effect of the procedure on bone and mineral metabolism.
ABSTRACT
Introduction: The use of videolaparoscopy in the treatment of digestive diseases, associated with generalized peritonitis, is controverted. Objective: To develop a model of bacterial peritonitis for the evaluation of the treatments through laparotomy and through videolaparoscopy. Methods: Male Wistar rats were submitted to occlusion of the ceacum (CLP) on a rigid mold of 3mm diameter, followed by 14 punctures of the ceacum with a 15 x 10 needle. Six hours after the induction of peritonitis, the animals were treated by laparotomy or videolaparoscopy, while analysing blood cultures and the mortality rates. The treatment involved typhlectomy followed or no by peritoneal lavage with saline solution. Results: The mortality rate in one week, after CLP without treatment, was 90%. The blood cultures were positive in 80 to 100% of the animals after 3 hours, and in 60 to 80% after 24 hours, in the animals when treated with laparotomy without peritoneal lavage and in the animals treated through videolaparoscopy with or without peritoneal lavage. The mortality rate after laparotomy was 20%, whereas after videolaparoscopy it was 80%. Conclusion: The experimental model induced severe peritonitis, and the bactereamia associated with videolaparoscopy has a high mortality rate.
Introdução: O emprego do acesso videolaparoscópico no tratamento das afecções digestivas que cursam com peritonite generalizada é motivo de controvérsia. Objetivo: Desenvolver um modelo de peritonite bacteriana para avaliação do tratamento mediante acesso laparotômico e videolaparoscópico. Métodos: Ratos machos Wistar foram submetidos à ligadura de ceco (CLP) sob molde rígido de 3mm de diâmetro; na seqüência foram feitas 14 punções no ceco com agulha 15X10. Após 6 horas de indução da peritonite, os animais foram tratados mediante laparotomia ou videolaparoscopia e avaliados com base nas hemoculturas e na taxa de mortalidade. O tratamento consistiu de tiflectomia seguida ou não de lavagem da cavidade peritoneal com solução fisiológica. Resultado: A mortalidade após CLP sem tratamento foi de 90% em uma semana. As hemoculturas positivas para bactérias após 3 horas variaram de 80 a 100% e após 24 horas de 60 a 80%, nos animais tratados com laparotomia sem lavagem do peritôneo e com videolaparoscopia seguida ou não de lavagem peritoneal. Todavia, a mortalidade após laparotomia foi de 20% e após videolaparoscopia foi de 80%. Conclusão: O modelo experimental desenvolvido induz a peritonite grave, e a bacteremia associada ao tratamento videolaparoscópico tem alta letalidade.