Cardiac Myxomas: A Single?Center Case Series of 145 Patients Over a 32?Year Period Study

Background:Myxomas are the most common primary cardiac tumors that develop mostly at the atrial chambers of the heart and represent 0,25% of all cardiac diseases. Methods: This is a retrospective study aiming to analyze epidemiological and intraoperative data from cardiac myxoma cases in the hospital of the last 32 years. The study population was 145 cardiac surgical patients and was divided into 4 certain 8?year periods. 87,6% of cases had the myxoma located at left atrium and 97,2% of all patients fully recovered. 4,1% of patients relapsed and underwent a redo operation. Results: Mean CPB time and mean ICU length of stay increased during the 8?year periods (p < 0,001, P < 0,001, P = 0,002 and P = 0,003 respectively). In-hospital length of stay decreased to 5 days in the most recent period (p < 0,001). Cases significantly increased to 54 in the last 8?year period (p = 0,009). Conclusion: Improvement on cardiac imaging and a better accessibility may drive patients to earlier and safer diagnosis of myxomas preventing any deterioration of their condition. Improvement on postoperative care can also reduce in-hospital length of stay. Surgical excision is the treatment of choice and guaranteed survival at 97,2% of patients.

Resolución laparoscópica de un caso de "candy cane" en un postoperatorio de by pass gástrico / Laparoscopic resolution of a case of "candy cane" in a postoperative period of gastric bypass / Resolução laparoscópica de um caso de "candy cane" em pós-operatório de bypass gástrico

El by pass gástrico (BPG) es una técnica de cirugía bariátrica de probada eficacia en el control de la obesidad y la resolución de enfermedades asociadas, como diabetes e hipertensión. El dolor abdominal en el postoperatorio alejado del BPG es un verdadero desafío, y exige para su diagnóstico etiológico comprender la técnica quirúrgica y las posibles causas que originan el dolor. Las principales causas de dolor son la úlcera de neoboca, las hernias internas (por el espacio de Petersen o la brecha mesentérica), la litiasis vesicular sintomática y el síndrome del "bastón de caramelo" (o "Candy Cane syndrome" por su nombre anglosajón). El mismo resulta de una excesiva longitud del cabo yeyunal ciego del asa alimentaria, luego de la anastomosis gastro yeyunal. Cuando mide más de 4 cm puede llenarse de alimentos, actuando como una bolsa o reservorio, generando dolor, náuseas o vómitos. El diagnóstico surge de la clínica y un estudio contrastado que demuestre la longitud excesiva del extremo del asa alimentaria. El tratamiento es quirúrgico y la desaparición de los síntomas confirma el diagnóstico.

Analysis of the cardiopulmonary endurance response of women to aerobic exercise / Análise da resposta de resistência cardiopulmonar de mulheres ao exercício aeróbico / Análisis de la respuesta de resistencia cardiopulmonar de las mujeres al ejercicio aeróbico

ABSTRACT Introduction: The main purpose of aerobic exercise is to enhance cardiopulmonary endurance, so it is necessary to build cardiopulmonary endurance response models based on different frequencies of aerobic exercise. Objective: To study the cardiopulmonary endurance response of women to different frequencies of aerobic exercise. Methods: Twenty young female desk workers (female teachers and civil servants) who worked out at a fitness club were randomly divided into two groups. Cardiopulmonary function, both before and after 16 weeks of aerobic exercise at different exercise loads, was studied and analyzed. Results: After 16 weeks of aerobic exercise at different exercise loads, all the young women had significantly improved their vital capacity (VC), and their maximum oxygen uptake ability was improved to a certain extent. Compared with the 45-minute aerobic exercise group, the vital capacity (VC)of 90-minute aerobic exercise group was significantly increased (P>0.05). Conclusions: When performed at a consistent frequency level, aerobic exercise with a relatively high exercise load can better develop the body's respiratory system function. This may be due to deep stimulation of the respiratory system from high-load aerobic exercise, and ultimately to the intensive exercising of lung function. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: O principal objetivo do exercício aeróbico é aumentar a resistência cardiopulmonar, por isso é necessário construir modelos de resposta de resistência cardiopulmonar baseados em diferentes frequências de exercício aeróbico. Objetivo: Estudar a resposta de resistência cardiopulmonar de mulheres em diferentes frequências de exercício aeróbio. Métodos: Vinte jovens profissionais de escritório (professoras e funcionárias públicas) que frequentavam uma academia foram divididas randomicamente em dois grupos. A função cardiopulmonar foi estudada e analisada antes e depois de 16 semanas de exercício aeróbico com diferentes cargas de exercício. Resultados: Depois de 16 semanas de exercícios aeróbicos com diferentes cargas, todas as jovens tiveram melhora significativa da capacidade vital (CV), sendo que a capacidade máxima de captação de oxigênio melhorou até certo ponto. Comparada com o grupo de exercícios aeróbicos de 45 minutos, a capacidade vital (CV) do grupo de exercícios aeróbicos de 90 minutos foi significativamente maior (P > 0,05). Conclusões: Quando praticado com frequência regular, o exercício aeróbico com carga relativamente alta pode melhorar o desenvolvimento da função respiratória. Isso pode dever-se à estimulação profunda do sistema respiratório a partir de exercícios aeróbicos de alta carga e, em última instância,é devidoao exercício intensivo da função pulmonar. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Introducción: El principal objetivo del ejercicio aeróbico es aumentar la resistencia cardiopulmonar, por lo que es necesario desarrollar modelos de respuesta de resistencia cardiopulmonar basados en diferentes frecuencias de ejercicio aeróbico. Objetivo: Estudiar la respuesta de resistencia cardiopulmonar de mujeres a diferentes frecuencias de ejercicio aeróbico. Métodos: Veinte jóvenes profesionales de oficina (profesoras y funcionarias públicas) que asistían a un gimnasio fueron divididas aleatoriamente en dos grupos. Se estudió y analizó la función cardiopulmonar antes y después de 16 semanas de ejercicio aeróbico con diferentes cargas de ejercicio. Resultados: Después de 16 semanas de ejercicio aeróbico con diferentes cargas, todas las mujeres jóvenes presentaron una mejora significativa de la capacidad vital (CV), siendo que la capacidad máxima de captación de oxígeno mejoró en cierta medida. En comparación con el grupo de ejercicio aeróbico de 45 minutos, la capacidad vital (CV) del grupo de ejercicio aeróbico de 90 minutos fue significativamente mayor (P > 0,05). Conclusiones: Cuando se practica con una frecuencia regular, el ejercicio aeróbico con una carga relativamente alta puede mejorar el desarrollo de la función respiratoria. Ello puede deberse a la profunda estimulación del sistema respiratorio por el ejercicio aeróbico de alta carga y, en última instancia, al ejercicio intensivo de la función pulmonar. Nivel de Evidencia II; Estudios terapéuticos - Investigación de los resultados del tratamiento.

Aneurisma gigante de Arteria Cerebral Media: Trapping y By-Pass / Giant Aneurysm of the Middle Cerebral Artery: Trapping and By-Pass

Objetivo: Presentar la resolución quirúrgica de un aneurisma gigante de arteria cerebral media mediante técnica de Trapping y By-Pass. Introducción: La tasa de mortalidad a 5 años de pacientes con aneurismas gigantes es del 80%. Debido a su cuello ancho en ocasiones el clipado directo no es posible, requiriendo realizar Trapping del aneurisma seguido de revascularización mediante By-Pass. Material y Método: Se analizaron datos de historia clínica, imágenes complementarias pre y postquirúrgicas, así como imágenes de video intraoperatorias de un paciente portador de aneurisma gigante de arteria cerebral media intervenido en nuestro centro. Resultados: Mediante abordaje Pterional se localizó arteria temporal superficial y sus ramos. Luego de una cuidadosa disección del saco aneurismático se intentó el clipado primario, debido a su cuello ancho, aterosclerosis asociada y trombo intrasacular, el flujo en la rama temporal de arteria cerebral media era comprometido por el clip. Se decidió la oclusión del aneurisma mediante técnica de trapping y, en mismo tiempo quirúrgico, realización de By Pass extra-intracraneano de arteria temporal superficial a rama temporal de arteria cerebral media. A su vez se secciono el aneurisma y se removió el trombo contenido en su interior, logrando disminuir el efecto de masa ejercido por el mismo. Se corroboro permeabilidad intraquirurgica mediante Doppler y en el postoperatorio alejado mediante angiotomografía con reconstrucción 3D. El paciente evoluciono sin complicaciones asociadas con un Rankin modificado de 1. Conclusión: Se presentó resolución quirúrgica de aneurisma gigante de arteria cerebral media mediante técnica de Trapping seguida de By-Pass extra-intra craneano temporo-silviano

Objective: To present the surgical resolution of a giant aneurysm of the middle cerebral artery using Trapping and By-Pass technique. Introduction: The 5-year mortality rate of patients with giant aneurysms is 80%. Due to its wide neck, sometimes-direct clipping is not possible, requiring trapping of the aneu-rysm followed by bypass revascularization. Material and Method: Clinical history data and intraoperative video images of a pa-tient with a giant aneurysm of the middle cerebral artery were analyzed. Results: The superficial temporal artery and its branches were identified through a Pterional approach. After careful aneurysm dissection, primary clipping was attempted, but the flow in the temporal branch of the middle cerebral artery was compromised. Due to its wide neck, associated atherosclerosis and intrasaccular thrombus, an Extra-intracranial bypass was performed from superficial temporal artery to temporal branch of middle cerebral artery, followed by trapping technique of the aneurysm. Then the aneu-rysm was sectioned and the thrombus contained inside was removed, decreasing the mass effect exerted by it. A Doppler probe was used to corroborate bypass permeability, as well as 3D reconstruction angiotomography during the postoperative period. The pa-tient was discharged without associated complications and a modified Rankin scale of 1. Conclusion: Surgical resolution of a giant middle cerebral artery aneurysm was present-ed by Trapping technique followed by extra-intra-cranial temporo-Silvian bypass

Efeitos precoces do bypass gástrico de anastomose única com e sem anel sobre a perda de peso e o metabolismo glicêmico: um estudo prospectivo randomizado / Early weight loss outcomes and glucose metabolism parameters after banded versus non-banded one anastomosis gastric bypass: a prospective randomized trial

ABSTRACT BACKGROUND: The influence of the placement of a band on the outcomes of one anastomosis gastric bypass (OAGB) has not been appropriately studied yet. OBJECTIVE: To compare early weight loss and glucose metabolism parameters following banded versus non-banded OAGB. METHODS: A prospective randomized study, which evaluated 20 morbidly obese individuals who underwent banded and non-banded OAGB and were followed-up for three months. Weight loss (percentage of excess weight loss - %EWL and percentage of body mass index loss - %BMIL) and glucose metabolism outcomes (glucose, insulin and homeostasis model assessment - HOMA) were compared. RESULTS: The banded group presented a significantly higher %EWL at one month (29.6±5.5% vs 17.2±3.4%; P<0.0001) and two months post-surgery (46±7% vs 34.2±9%; P=0.004544), as well as a significantly higher %BMIL at one month (9.7±1.1% vs 5.8±0.8%; P<0.0001), two months (15±1.4% vs 11.5±2.1; P=0.000248), and three months (18.8±1.8% vs 15.7±3.2%; P=0.016637). At three months, banded OAGB led to significant decreases of insulin (14.4±4.3 vs 7.6±1.9; P=0.00044) and HOMA (3.1±1.1 vs 1.5±0.4; P=0.00044), whereas non-banded OAGB also led to significant decreases of insulin (14.8±7.6 vs 7.8±3.1; P=0.006) and HOMA (3.2±1.9 vs 1.6±0.8; P=0.0041). The percent variation of HOMA did not significantly differ between banded and non-banded OAGB (P=0.62414); overall, the percent variation of HOMA was not correlated with %EWL (P=0.96988) or %BMIL (P=0.82299). CONCLUSION: Banded OAGB led to a higher early weight loss than the standard technique. Banded and non-banded OAGB led to improvements in insulin resistance regardless of weight loss.

RESUMO CONTEXTO: A influência da colocação de bandas sobre os resultados do bypass gástrico de anastomose única (BGAU) não foi profundamente estudada. OBJETIVO: Comparar a perda precoce de peso e os parâmetros do metabolismo da glicose após bypass gástrico de anastomose única (BGAU) com e sem anel. MÉTODOS: Estudo prospectivo randomizado que avaliou 20 obesos mórbidos submetidos ao BGAU com e sem anel e acompanhados por três meses. A perda de peso (percentual de perda do excesso de peso - %PEP e percentual de perda de peso - %PP) e parâmetros do metabolismo da glicose (glicemia, insulina e modelo homeostático de avaliação - HOMA) foram comparados. RESULTADOS: O grupo com anel apresentou %PEP significativamente maior em um mês (29,6±5,5% vs 17,2±3,4%; P<0,0001) e dois meses após a cirurgia (46±7% vs 34,2±9%; P=0,004544), bem como %PP significativamente maior em um mês (9,7±1,1% vs 5,8±0,8%; P<0,0001), dois meses (15±1,4% vs 11,5±2,1; P=0,000248) e três meses (18,8±1,8% vs 15,7±3,2%; P=0,016637). Aos três meses, o BGAU com anel resultou em reduções significativas de insulina (14,4±4,3 vs 7,6±1,9; P=0,00044) e HOMA (3,1±1,1 vs 1,5±0,4; P=0,00044), enquanto o BGAU sem anel também levou a reduções significativas de insulina (14,8±7,6 vs 7,8±3,1; P=0,006) e HOMA (3,2±1,9 vs 1,6±0,8; P=0,0041). A variação percentual de HOMA não diferiu significativamente entre BGAU com bandas ou sem anel (P=0,62414); no geral, a variação percentual do HOMA não foi correlacionada com %PEP (P=0,96988) ou %PP (P=0,82299). CONCLUSÃO: O BGAU com anel levou a uma maior perda de peso precoce do que a técnica padrão. O BGAU com ou sem anel levou à melhora precoce na resistência à insulina, independentemente da perda de peso.

Follow-up study on improvement of vascular patency rate of vein bypass graft after coronary artery bypass grafting with medical chemical external stent / 中华胸心血管外科杂志

Objective To evaluate the efficacy and clinical significance of medical chemical glue as an external stent in improving the fluency rate of venous bypass graft after coronary artery bypass grafting .Methods Randomly selected 200 pa-tients from April 2010 to December 2016 included who were underwent coronary artery bypass grafting in Beijing Anzhen Hospi-tal.All patients had different degrees of angina , and coronary angiography showed multi-branches artery lesion.They were ran-domly divided into two groups, 100 in each group.Spray gel group: coronary artery bypass grafting simultaneously spraying medical chemical glue on the surface of the bridge vessel.Unsprayed gel group:simple coronary artery bypass grafting.All 200 patients were followed up in June 2018.The follow-up content mainly included: recent recurrence of angina pectoris, recent echocardiography and electrocardiogram report, coronary CTA or coronary angiography results, and current living conditions. The data obtained were collectively summarized and compared .Results The follow-up rate was 96％ in the sprayed group, and 92％ in the unsprayed group.Compared with the unsprayed group , the incidence of chest pain and angina pectoris was significantly lower in the sprayed group(23.96％ vs.40.22％, P<0.05), the venous occlusion rate of the vein bypass graft in the sprayed group was significantly lower(29.17％ vs.55.43％, P<0.01), the probability of death due to cardiac causes in the sprayed group was significant decrease(1.04％ vs.6.52％, P<0.05), the number of patients with the main adverse cardiac and cerebral events(MACCE) in the sprayed group was significantly lower(9.38％ vs.21.74％, P<0.01), all with statistically significant differences .The number of patients with heart failure and recurrent myocardial infarction was lower in the sprayed group, but there were no statistically significant differences .Conclusion Medical chemical glue as an external stent does play a role in improving the venous patency rate after coronary artery bypass grafting , and it is reliable for the preven-tion and treatment of vein bypass vascular stenosis after coronary artery bypass grafting .

Hipoglucemia post cirugía bariátrica. Presentación de un caso con buena respuesta a octreótide / HYPOGLYCEMIA COMPLICATING BARIATRIC SURGERY. CASE REPORT WITH SUCCESSFUL RESPONSE TO OCTROTIDE

El Bypass Gástrico (BPG) representa la herramienta terapéutica más efectiva para el manejo de la obesidad. Sin embargo, la hipoglucemia con neuroglucopenia post BPG es una complicación que se describe cada vez con mayor frecuencia. Se presenta el caso de una paciente con hipoglucemia hiperinsulinémica (HH) post BPG y los distintos esquemas terapéuticos utilizados, pudiendo controlar finalmente los valores de glucemia con octreótide y evitando así, la realización de una pancreatectomía para el tratamiento de las hipoglucemias

Gastric Bypass (GBP) is the most effective treatment for patients with severe obesity. Hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly late complication of GBP. A case of a post GBP hyperinsulinemic hypoglycemia is reported, and the different drugs used for its treatment, being able to control the glycemia with octreotide and avoiding a pancreatectomy surgery as hypoglycemia treatment

By pass extra anatomico como tratamiento de la arteritis actinica / Extra anatomical by pass as treatment of actinal arteritis

La arteritis actínica es la lesión producida a las arterias por la exposición a radiaciones ionizantes utilizadas previamente para el tratamiento radioterápico por diagnóstico de una neoplasia maligna y se presenta tras años de la exposición. Presentamos el caso de una paciente con antecedentes de Cáncer del canal anal con exposición a radioterapia en zona pélvica 21 años atrás que presento síntomas 8 años antes con signos de isquemia progresiva recibiendo tratamiento médico hasta llegar a isquemia critica en el miembro inferior izquierdo 7 meses antes con dolor en reposo y presentar lesión en hallux izquierdo 15 días antes de su internación, por lo que tras el fallo del tratamiento médico se optó por la revascularización con la realización de un By Pass extra anatómico.

Actinic arteritis is the lesion produced in the arteries by exposure to ionizing radiation previously used for radiotherapy treatment by diagnosis of a malignant neoplasm and occurs after years of exposure. We present the case of a patient with a history of anal canal cancer with exposure to pelvic radiotherapy 21 years ago who presented symptoms 8 years earlier with signs of progressive ischemia receiving medical treatment until critical ischemia in the left lower limb 7 months before With pain at rest and present lesion in the left hallux 15 days before their hospitalization, so that after the failure of the medical treatment was revascularization with the realization of an extra anatomical By Pass.

Psychological variables: determinants of the body image adjustment of obese subject to gastric bypass / Variables psicológicas: determinantes de la adaptación a la imagen corporal del obeso sometido a by-pass gástrico

Morbid obesity as an entity that is associated to numerous clinical complications, an increased mortality and a deterioration of the quality of life, the World Health Organization (WHO) recommends surgical treatments as an alternative. In this sense, the physical and psychological benefits associated with bariatric surgery are well documented. However, the surgery can generate negative effects. The structural changes in the digestive system, coupled with the disruption of the body image especially patients who undergo bypass gastric, reinforce the idea that everything is not positive. Given this reality, this theoretical review is to emphasize the importance of studying the role that psychological variables in adapting to the new body image in these patients.

Al ser la obesidad mórbida una entidad que se asocia a numerosas complicaciones clínicas, a un aumento de la mortalidad y a un deterioro de la calidad de vida de quien la sufre; la Organización Mundial de la Salud (OMS), recomienda considerar como alternativa los tratamientos quirúrgicos. En este sentido, los beneficios físicos y psicológicos vinculados a la cirugía bariátrica están bien documentados. No obstante, la cirugía conlleva efectos negativos en un alto porcentaje de individuos. Los cambios estructurales que produce en el circuito digestivo, sumado a la desorganización de la imagen corporal que sufren los pacientes que se someten especialmente al By-Pass Gástrico, refuerzan la idea de que no todo es positivo. Ante esta realidad, la presente revisión teórica trata de debe de subrayar la importancia de estudiar el papel que tienen las variables psicológicas en la adaptación a la nueva imagen corporal en estos pacientes.

La hepaticoyeyunostomía en el tratamiento de las afecciones hepatobiliopancreáticas / Hepaticojejunostomy in the treatment of affections

Introducción: el tratamiento de las afecciones del sistema hepatobiliopancreático dista mucho de ser el óptimo a pesar de los avances conseguidos con la incorporación de nuevos procedimientos diagnósticos y terapéuticos; sin embargo, las derivaciones bilioentéricas son consideradas una alternativa valiosa en el tratamiento. Objetivo: caracterizar el tratamiento de las afecciones del sistema hepatobiliopancreático con el uso de la hepaticoyeyunostomía, en el servicio de cirugía general del hospital Dr. Salvador Allende, desde enero de 2000 hasta diciembre de 2013. Métodos: estudio de corte transversal, retrospectivo-prospectivo y descriptivo. La muestra estuvo constituida por 77 pacientes. Resultados: las enfermedades del sistema hepatobiliopancreático malignas representaron el principal diagnóstico entre nuestros pacientes, con 31 por ciento de complicaciones posoperatoria y cuatro (5,19 por ciento) muertes asociadas al proceder. Conclusiones: la hepaticoyeyunostomía es una opción terapéutica segura en aquellos pacientes con enfermedad hepatobiliopancreática cuando no exista la adecuada factibilidad de métodos endoscópicos derivativos, ante el fallo de estos o el fracaso de la descompresión percutánea(AU)

Introduction: the treatment of disorders of the hepatobiliopancreatic system is far from being despite the progress made with the incorporation of new diagnostic and therapeutic procedures; however, biliary-enteric by-passes are considered a valuable alternative in the treatment. Objective: to characterize the treatment of hepatobiliopancreatic system affections using hepaticojejunostomy, in the Department of General Surgery Dr. of Salvador Allende Hospital, from January 2000 to December 2013. Methods: a cross-sectional, retrospective-prospective and descriptive study was carried out. The sample consisted of 77 patients. Results: the malignant disease of the hepatobiliopancreatic system were the main diagnosis among our patients, with 31 percent of postoperative complications and four (5.19 percent) deaths associated with the procedure. Conclusions: hepaticojejunostomy is a safe therapeutic option for patients with hepatobiliopancreatic disease, when there is no adequate feasibility of endoscopic derivative methods, in face of the failure of these or that of percutaneous decompression(AU)

Medium-term glycemic control in diabetics before coronary bypass surgery

The aim of this study was to determine the association between preoperative medium-term (60-90 days) glycemic control, as reflected by glycosylated hemoglobin levels (HbA1c), and the incidence of major complications (mediastinitis, perioperative infarction, heart failure, stroke and kidney failure dialysis) and mortality in diabetic patients undergoing elective coronary artery by-pass graft surgery (CABG). This study suggests that aggressive glycemic control three months before surgery, achieving HbA1c ≤ 7% improvement results with less postoperative morbidity and mortality.

El propósito de este estudio fue determinar la asociación entre el control glucémico a mediano plazo, 2-3 meses previos a la cirugía cardiaca, evaluado mediante el dosaje de hemoglobina glicosilada (HbA1c), y la incidencia de muerte y complicaciones mayores (mediastinitis, infarto perioperatorio, insuficiencia cardíaca, accidente cerebrovascular e insuficiencia renal dialítica) en pacientes diabéticos tipo 2. Este estudio sugiere que el control glucémico 3 meses antes de la cirugía en pacientes con diabetes mellitus tipo 2, logrando HbA1c ≤ 7%, mejora los resultados en el posoperatorio observándose menor morbilidad y mortalidad.

Efeitos da cirurgia metabólica no portador de diabetes mellitus tipo 2 / Effects of metabolic surgery in diabetes mellitus type 2 patients

JUSTIFICATIVA E OBJETIVOS: O diabetes mellitus tipo 2) é a principal causa de doença renal terminal. O tratamento inicial da progressão da nefropatia diabética engloba o controle estrito da hiperglicemia, hiperfiltração e hipertensão. Algumas cirurgias envolvendo derivações intestinais melhoram a homeostase da glicose.Os objetivos deste estudo são avaliar os efeitos da cirurgia metabólica em pacientes com diabetes mellitus tipo 2. MÉTODOS:Estudo retrospectivo. Foram revisados prontuários de 17 pacientes diabéticos que foram submetidos à cirurgia de derivação do intestino proximal. Para comparar as variáveis foram utilizados os testes t de Student e Wilcoxon. Um valor de p<0,05 foi considerado estatisticamente significativo. RESULTADOS:A média da idade dos pacientes foi de 52,1 ± 3,5 anos e houve predomínio do sexo masculino (59%). Ocorreu redução estatisticamente significativa no peso, índice de massa corpórea, colesterol total, glicemia de jejum e hemoglobina glicada (p<0,05). Entretanto, não houve diferença estatisticamente significativa nos níveis de colesterol-HDL, colesterol-LDL, triglicerídeos, creatinina,depuração de creatinina, microalbuminúria e proteinúria de 24h (p>0,05). CONCLUSÃO: Os presentes dados sugerem que a cirurgia de derivação do intestino proximal, além da perda de peso, favorece o controle do diabetes mellitus tipo 2. Estudos com maior seguimento e número de pacientes são necessários para melhor definição do papel da cirurgia metabólica no tratamento do diabetes.

BACKGROUND AND OBJECTIVES: Type 2 diabetes mellitus is the leading cause of end-stage renal disease worldwide. Initial treatment in the progression of diabetic nephropathy includes strict control of hyperglycemia, hyperfiltration and arterial hypertension. Certain operations involving intestinal diversions improve glucose homeostasis. The objective of this study is to evaluate the effects of metabolic surgery in diabetes mellitus type 2 patients. METHODS: This is a retrospective study. We reviewed medical records of 17 diabetic patients who had undergone laparoscopic duodenal-jejunal exclusion. To compare the variables Student t and Wilcoxon tests were used. A p value < 0.05 was considered statistically significant. RESULTS: Patients mean age was 52.1 ± 3.5 years and 59% of them were male. There was a statistical significant decrease in weight, body mass index, total cholesterol, fasting glucose and glycosylated hemoglobin (p< 0.05). However, there was no statistical significant difference in levels of HDL-cholesterol, LDL-cholesterol, triglycerides, creatinine, creatinine clearance, microalbuminuria and proteinuria (p > 0.05). CONCLUSION: Our data suggest that laparoscopic duodenal-jejunal exclusion, in addition to weight loss, favors glycemic control in type 2 diabetes. Studies with longer follow-up and a larger number of patients are necessary to better define the role of metabolic surgery in the treatment of diabetes.

Feasibility analysis on the prevention of edaravone on myocardial ischemia after beating coronary artery bypass grafting / 重庆医学

Objective To explore and analysis feasibility of the prevention of edaravone on myocardial ischemia after beating cor-onary artery bypass grafting .Methods From June 2011 to December 2012 ,78 patients which accepted beating heart coronary artery bypass grafting were randomly divided into treatment group (39 cases) and control group(39 cases) .After induction of anesthesia , the treatment group were continued to intravenous edaravone 60 mg ,while the control group were continued infusion of equivalent saline .The serum superoxide dismutase(SOD) ,malondialdehyde(MDA) levels were compared between the two groups at different times which were before surgery (T1) ,after incision 1 h(T2) ,surgery (T3) ,and after 24 h(T4) ,plasma brain natriuretic peptide (BNP) ,troponin I(cTnI) levels were compared at T1 and T4 .Left ventricular ejection fraction(LVEF) were also be compared .Re-sults The two groups of patients before treatment ,there were not statistically significant difference between the two groups on SOD ,MDA ,CK-MB ,BNP and cTnI(P> 0 .05) .At T2 ,T3 ,T4 point ,the SOD activity of the treatment group was significantly higher than that of control group(P<0 .05) .The MDA ,CK-MB value were significantly lower than that of control group (P<0 . 05) .At T4 ,the BNP and cTnI in the treatment group were less than that of control group (P<0 .05) .The postoperative LVEF% in treatment group were significantly higher than that of control group (P<0 .05) .Postoperative ventilator treatment time and ICU stay time and total hospitalization time of the treatment group were all significantly less than that of control group (P<0 .05) .Con-clusion For the beating heart coronary artery bypass surgery patients ,edaravone can effectively scavenge oxygen free radicals and reduce the release of enzymes ,reduce injury caused by myocardial ischemia-reperfusion and protect myocardial cells .

Ácidos graxos voláteis no rúmen de vacas alimentadas com diferentes teores de concentrado na dieta / Volatile fatty acids in rumen of cows fed different concentrate level diets

Avaliou-se o efeito de teores de concentrado na dieta sobre a concentração de ácidos graxos voláteis no líquido ruminal de bovinos. Foram utilizadas quatro vacas mestiças, fistuladas no rúmen, com peso médio de 442,15kg, distribuídas em quadrado latino 4x4, divididos em quatro períodos de 14 dias, sendo 11 de adaptação e três para coleta de dados. Foi utilizada a silagem de milho, como volumoso, e milho, sorgo, farelo de soja, casca de soja, ureia e gordura protegida, como concentrado. As dietas foram formuladas para 13 por cento de proteína bruta (PB), utilizando-se proporções de 30; 40; 50 e 60 por cento de concentrado. Não houve influência do tratamento para concentrações de ácido acético, isobutírico, butírico, isovalérico e valérico. O ácido propiônico e a proporção acetato:propionato apresentaram concentrações máximas em 8,44 e 8,14 horas após a alimentação, respectivamente. Os ácidos graxos totais não foram influenciados pelos tratamentos, com concentração máxima em 7,68 horas após a alimentação, juntamente com valores mínimos de pH entre seis e nove horas. Dietas com até 60 por cento de concentrado na matéria seca total não influenciaram as concentrações de ácidos graxos voláteis do rúmen.

The influence of concentrate levels from the diet on the content of volatile fatty acids in rumen fluid of cattle was evaluated. Four rumen fistulated crossbred cows, weighting around 442.15kg, were distributed in 4x4 Latin square schedule, divided into four periods of 14 days, 11 for adaptation and three for data collection. Corn silage was used as roughage, and corn, sorghum, soybean meal, soybean hulls, protected fat and urea, as concentrate. Diets were formulated with 13 percent crude protein (CP), using the proportions of 30, 40, 50 and 60 percent concentrate. There was no influence of treatment for the following acid concentrations: acetic, isobutyric, butyric, isovaleric and valeric. The propionic acid content and the ratio acetate: propionate showed values of 8.44 and 8.14 hours after feeding, respectively. The total fatty acids were not affected by treatments, with maximum concentration at 7.68 hours after feeding, with minimum pH values between six and nine hours. Diets containing up to 60 percent of concentrate in dry matter did not influence the concentrations of rumen volatile fatty acids.

Cirugía de revascularización miocárdica con apoyo de un sistema de circulación extracorpórea mínima / Coronary artery bypass grafting surgery with minimal extracorporeal circulation system

Introducción: Para realizar revascularización miocárdica, en la mayoría de los casos se requiere el apoyo de circulación extracorpórea, no exenta de riesgos. El objetivo de esta investigación fue probar la hipótesis de que la circulación extracorpórea mínima ofrece mayores ventajas sobre la circulación extracorpórea convencional en la cirugía de revascularización cardiaca. Material y métodos: Se incluyeron 17 pacientes sometidos a revascularización miocárdica entre el 1 de abril de 2006 y el 31 de agosto de 2009, que se dividieron en dos grupos: uno en el que se utilizó circulación extracorpórea mínima (n = 8) y otro con circulación extracorpórea convencional (n = 9), se comparó la hemorragia perioperatoria, uso de hemoderivados y evolución clínica. Resultados: Se observó diferencia estadísticamente significativa en el conteo de leucocitos en el posoperatorio (p < 0.05). En cuanto a los requerimientos de hemoderivados, diuresis transoperatoria, creatinina prequirúrgica y creatinina a las 24 horas posoperatorio, no se observó diferencia estadísticamente significativa entre los grupos. El sangrado transoperatorio fue menor en el grupo en el que se utilizó circulación extracorpórea mínima (p < 0.05). Las complicaciones cardiovasculares mayores ocurrieron con más frecuencia en los pacientes en los que se utilizó circulación extracorpórea convencional (p < 0.05). Conclusiones: La circulación extracorpórea mínima en revascularización miocárdica reduce la frecuencia de eventos adversos cardiovasculares mayores, el sangrado intraoperatorio y tiende a producir menor respuesta inflamatoria comparada con la circulación extracorpórea convencional.

BACKGROUND: For coronary artery bypass graft (CABG) surgery, cardiopulmonary bypass (CPB) is required for many patients. However, this procedure has several risks. Our objective was to test the hypothesis that the minimal extracorporeal circulation circuit (MECC) is more advantageous than CPB for CABG surgery. METHODS: We analyzed 17 patients submitted to CABG surgery between April 1, 2006 and August 31, 2009. Patients were divided into two groups. In one group, MECC (n = 8) was used and in the other group the conventional CPB circuit (n = 9). Perioperative bleeding, blood requirements and clinical evolution were compared. RESULTS: We observed a statistically significant difference for postoperative leukocyte count (p <0.05). However, for blood requirements, intraoperative urinary output, and pre- and postsurgical levels of creatinine, we did not find differences. Intraoperative bleeding was lower in the MECC group (p <0.05). Major cardiovascular complications were also lower in this group (p <0.05). CONCLUSIONS: MECC reduces the frequency of major cardiovascular complications, intraoperative bleeding and probably a lower inflammatory systemic response compared with conventional CPB.

Cirugía Bariátrica en el Hospital de San José, Bogotá D. C.: experiencia y resultados / Bariatric surgery at Hospital de San José Bogotá DC: expertise an results

En los últimos años se ha dado gran importancia al tratamiento de la obesidad por el incremento de la incidencia a nivel mundial y a la falla del tratamiento médico en algunos tipos. Por eso hoy se practican con mayor frecuencia procedimientos de tipo bariátrico. Objetivo: describir la experiencia y resultados en el Hospital de San José de Bogotá D.C. entre enero 2006 y abril 2009. Métodos: cohorte de 146 pacientes con indicación de cirugía bariátrica en el período mencionado. Resultados: 54 hombres (37%) con edad promedio de 54 años (DE: 10,5) y 92 mujeres (37%) con 43 años (DE: 11). El promedio de índice de masa corporal de cirugía fue 43 k/m2 (DE: 5.1); veinte (13,7%) se catalogaron superobesos. Las comorbilidades fueron hipertensión arterial (43,1%), hipercolesterolemia (40,4%) y diabetes mellitus (34,9%). Hubo antecedente de cirugía abdominal en 34,2%. Todos los procedimientos corresponden a by pass gástrico, excepto uno de manga gástrica. El promedio de pérdida de peso entre el octavo y décimo mes fue 55% (DE: 9:9.1), con reducción de glicemia en ayunas y del perfil lipídico. No se obtuvieron datos en la totalidad de la población. La complicación más frecuente fue la ISO presente en doce (8,2%), de los cuales ocho (5,5%) tuvieron infección de cavidad. La fuga anastomótica se documentó en siete (4,8%), hernia interna en tres (2,1%), estenosis anastomótica y peritonitis secundaria en dos (1,4%). No se reportaron hemoperitoneo, úlcera marginal ni hernia incisional. El tiempo quirúrgico promedio fue 106 minutos (DE: 22) y en 25 (17,1%) se prolongó (mayor o igual a 120 minutos). El tiempo mediano de estancia hospitalaria fue cuatro días. La mortalidad global intrahospitalaria fue de siete (4,7%), distribuida así: ningún caso en 2006 (35 cirugías), cuatro en 2007 (59 cirugías, 6,7%), uno en 2008 (29 cirugías, 3,4%) y dos en 2009 (22 cirugías, 9%). Conclusiones: los pacientes llevados a cirugía bariátrica en el Hospital de San José...

Treatment for obesity has gained importance over the last few years as a result of increased global incidence and lack of medical therapeutic options for some types of overweight. Thus bariatric procedures are more frequently practiced nowadays. Objective: to describe expertise and results at Hospital de San José, Bogotá DC between January 2006 and April 2009. Methods: cohort of 146 patients with an indication for bariatric surgery during named period. Results: 54 males (37%), mean age 54 years (SD: 10.5) and 92 females (37%), mean age 43 years (SD: 11). The mean body mass index of candidates to bariatric surgery was 43 k/m2 (SD: 5.1); 20 (13.7%) were classified as extremely obese. Comorbid conditions included arterial hypertension (43.1%), hyperlipidemia (40.4%) and diabetes mellitus (34.9%). There was an abdominal surgery history in 34.2%. All the procedures corresponded to a gastric bypass surgery except for one sleeve gastrectomy. Mean weight loss between an 8-month and 10.month post-surgical follow-up period was 55% (SD: 9:9.1) with reduction of serum fasting glucose and lipid profile. Data from the total study population were not obtained. The most common complication was surgical site infection in 12 patients (8.2%), of which 8 (5.5%) had infection of the abdominal cavity. Anastomotic complications such as intestinal leaks was documented in 7 cases (4.8%), internal hernia in 3 (2.1%), strictures with peritonitis in 2 (1.4%). No cases of hemoperitoneum, marginal ulcers or incisional hernias were reported. Mean operating time was 106 minutes (SD: 22) and was greater in 25 (17.1%) cases (= 120 minutes). Mean hospital stay was four days. The overall mortality rate in hospitalized patients was 7 (4.7%), as follows: zero in 2006 (35 surgeries), 4 in 2007 (59 surgeries, 6.7%), 1 in 2008 (29 surgeries, 3.4%) and 2 in 2009 (22 surgeries, 9%). Conclusions: Those who underwent bariatric surgery at Hospital de San José...

Obesidad y cirugía bariátrica: Complicaciones clinicometabólicas / Obesity and bariatric surgery: Clinical and metabolic complications

Con el notable aumento en los últimos años a nivel mundial de la prevalencia de la obesidad, se ha generado un vasto número de alternativas para su tratamiento. Las intervenciones quirúrgicas han mostrado ser muy efectivas para lograr una disminución importante y sostenida de peso. Se han descrito complicaciones secundarias a la realización de los procedimientos quirúrgicos entre los que se incluyen los que derivan directamente del acto quirúrgico, alteraciones nutricionales como desnutrición y carencias de micro y macronutrientes, alteraciones metabólicas como anomalías en el metabolismo del calcio, formación de cálculos biliares e inclusive entidades más raras como la nesidioblastosis, son frecuentes los efectos secundarios que alteran la calidad de vida como el vómito y el síndrome de Dumping y los trastornos adaptativos relacionados con la necesidad de modificar hábitos alimentarios. La mortalidad se relaciona directamente con la experiencia del grupo quirúrgico y ha mostrado ser muy baja en sitios de gran experiencia y con un equipo interdisciplinario. En esta publicación se revisan los efectos adversos metabólicos de la cirugía bariátrica en particular del bypass gástrico así como su diagnóstico y manejo médico o quirúrgico, para lo cual se realizó una búsqueda sistemática en www.pubmed.com de los artículos publicados en los últimos siete años, en inglés, español y portugués, que estuvieran incluidos en las bases de datos Hinari, Ovid y Cochrane, seleccionando 28 artículos que cumplieron con los criterios de inclusión.

With the notable increases at a global scale of the prevalence of obesity, a huge number of alternatives for its treatment have been developed. The surgical interventions have demonstrated to be effective in obtaining a significant and sustained weight loss. Complications have been described after the surgical procedures, which include those derived directly from surgery, nutritional abnormalities like malnutrition and deficiencies in micro and macro nutrients, metabolic abnormalities such as modifications in the calcium metabolism, formation of gallbladder stones and also some rare entities like nesidioblastosis; these adverse effects frequently affect the quality of life including vomit and Dumping syndrome, and the adaptive upheaval related to the need of modifying eating habits. Mortality is directly related to the surgeon’s expertise, and it has shown to be very low at places with important experience and an interdisciplinary group. In this publication we will review the adverse effects of the bariatric surgery, particularly the gastric bypass, and so their diagnosis and treatment, after a systematic search in www.pubmed.com of the articles published on the lost seven years, in english, spanish or portuguese language and who where included in the following data bases: Hinary, Ovid and Cochrane. There were selected 28 papers which met the inclusion criteria.

Evaluación de factores predisponentes para el sangrado mediastinal en cirugía de revascularización miocárdica: Papel del ácido acetilsalicílico, otros antiagregantes plaquetarios, y anticoagulantes / Evaluation of Predisposing Factors for Mediastinal Bleeding in Myocardial Revascularization Surgery: Role of Acetylsalicylic Acid, Other Platelet Adhesion Inhibitors, and Anticoagulants

Propósito del trabajo: Determinar los factores predisponentes para sangrados perioperatorios en cirugía de revascularización miocárdica y establecer el papel de ácido acetilsalicílico, otros antiagregantes plaquetarios, y anticoagulantes, en la ocurrencia de estos sangrados. Método: Se realizó un análisis multivariado de 251 pacientes sometidos a cirugía de revascularización miocárdica en el año 2002. Resultados: En la administración prequirúrgica de ácido acetilsalicílico no se encontró diferencia significativa para la ocurrencia de sangrado perioperatorio importante. No existió incremento significativo en la transfusión de unidades de paquetes globulares, plaquetas, crioprecipitados. Los pacientes con administración de heparina no fraccionada y de bajo peso molecular, tuvieron un sangrado transoperatorio significativamente mayor (p < 0.001) que los pacientes sin este fármaco. El empleo del resto de los fármacos estudiados, no incrementó la cantidad de sangrado ni la administración de hemoderivados. Conclusiones: No existe evidencia estadística que justifique suspender la administración de antiagregantes plaquetarios en los pacientes con síndromes coronarios urgentes o electivos, a quienes se les someta a cirugía de revascularización miocárdica. Sin embargo, resultaría conveniente suspender la administración de heparina no fraccionada y de bajo peso molecular, a pacientes sometidos a cirugía de revascularización miocárdica en forma electiva.

Objective: To determine the main factors for perioperative mediastinal bleeding during coronary artery by-pass grafting and to establish the role of acetylsalicylic acid, other inhibitors of platelet adhesion, and anticoagulants in its occurrence. Methods: A multivariate analysis was performed to the data obtained from 251 patients subjected to coronary artery by-pass grafting in the year 2002. Results: There were no significant differences for the occurrence of perioperative bleeding induced by the preoperative administration of acetylsalicylic acid. No significant increment in the need for blood, platelet, or cryoprecipitates transfusion existed. Patients receiving non-fractionated or low molecular weight heparin had a significantly greater (p < 0.001) transoperative bleeding than patients without this drug. Administration of the other studied drugs did not increase either mediastinal bleeding or the need for blood derivatives. Conclusions: No statistical evidence was found to suspend administration of inhibitors of platelet adhesion in patients with coronary syndromes, subjected to coronary artery by-pass grafting. However, data obtained suggest the convenience of suspending administration of low molecular weight or non-fractionated heparin to patients subjected electively to coronary artery by-pass grafting.

Off-pump coronary artery bypass grafting (A report of 23 cases) / 中国微创外科杂志

Objective To study a minimally invasive surgical procedure for coronary artery bypass grafting (GABG). Methods 23 patients, aged from 45 to 73 years old, undervent off-pump coronary artery bypass grafting (OPCABG) according to Octopus procedure from December 1999 to Auguest 2001. In the present study , more than 3 vessels were involved in 19 patients; 2 vessels involved in 3 cases and 1 vessel involved in one case. The grafted arteries included left anterior descending branch (LAD)(23); circumflex(CX)(15); right coronary artery(RCA)(14); ramus intermedius(RUM)(8); and posterior descending artery(PDA) (8). The types of grafts were left internal mammary artery (LIMA)(20) and saphenous vein grafts(SVG)(48). Results None of the patients was managed by means of cardiopulmonary bypass. All survived without angina pectoris. MRI showed that all the conduits were patent postoperatively. Conclusions OPCABG by Octopus procedure can be used in multiple vessel coronary bypass including CX and PDA. The patency rate is similar to that of the conventional technique. The mortality rate and occurrence of complications is low compared with those of the conventional technique . In addition, medical cost is lower. So This procedure is both safe and cost-effective, and is of value in clinical practice.

Cirurgia de revascularização miocárdica na lesão do tronco da coronária esquerda em pacientes acima de 65 anos de idade / Coronary Artery Bypass Surgery in Patients Aged 65 Years and Older With Left Main Coronary Artery Disease

PURPOSE--To study the short and long-term follow-up of patients with left main coronary artery disease (LMCAD) and age over 65 years, by comparing the results with patients under 65 years-old. METHODS--Twenty-two patients with LMCAD and mean age of 69 +/- 3.5 years (group I) were underwent isolated coronary artery bypass grafting (CABG) and compared to 31 patients with LMCAD, mean age of 54 +/- 7 years (group II), who also underwent isolated CABG. The life-table Kaplan-Meyer method was used to estimate the post-operative survival. The chi-square and Student "t" test were used when necessary. RESULTS--Despite higher operative mortality in group I (9.1 x 3.2), the difference was statistically not significant. The operative morbidity was similar in both groups. Actuarial survival at 4 years was 85 in group I and 95 in group II. Actuarial survival free of cardiac events was 69 in group II and 75 in group II. CONCLUSION--The CABG is well tolerated and had low morbidity and acceptable mortality in old patients with LMCAD. The long-term survival in these patients was very similar to the younger patients.