ABSTRACT
Abstract Purpose: To evaluate the contribution of ursodeoxycholic acid (UDCA) in the first 12 months after Roux-en-Y gastric bypass in the prevention of gallstone formation. Methods: A community-based clinical trial was conducted. A total of 137 patients were included in the study; 69 were treated with UDCA, starting 30 days after the surgery, at a dose of 150 mg twice daily (300 mg/day) over a period of 5 consecutive months (GROUP A), and 68 were control patients (GROUP B). The patients were followed-up, and ultrasonography was performed to determine the presence of gallstones at various times during follow-up. Demographic, anthropometric and comorbid indicators were obtained. The data were subjected to normality tests and evaluated using appropriate tests. Results: Patients did not differ in their baseline characteristics. Of the 69 patients who used UDCA, only one patient developed cholelithiasis (1%), whereas 18 controls (26%) formed gallstones (OR = 24.4, p <0.001). Also, other factors were found not to influence the formation of calculi, such as pre-operative or postoperative hepatic steatosis or diabetes (p = 0.759, 0.468, 0.956). Conclusion: The results demonstrated that patients who did not use UDCA showed a 24.4-fold greater probability of developing cholelithiasis.
Subject(s)
Humans , Male , Female , Adult , Postoperative Complications/prevention & control , Ursodeoxycholic Acid/therapeutic use , Obesity, Morbid/surgery , Cholagogues and Choleretics/therapeutic use , Gastric Bypass/adverse effects , Gallstones/prevention & control , Postoperative Complications/etiology , Postoperative Complications/drug therapy , Postoperative Period , Stomach/surgery , Gallstones/etiology , Gallstones/drug therapy , Comorbidity , Anthropometry , Prospective StudiesABSTRACT
BACKGROUND/AIMS: Cholecystectomy is necessary for the treatment of symptomatic or complicated gallbladder (GB) stones, but oral litholysis with bile acids is an attractive alternative therapeutic option for asymptomatic or mildly symptomatic patients. This study was conducted to evaluate the efficacy of magnesium trihydrate of ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) on gallstone dissolution and to investigate improvements in gallstone-related symptoms. METHODS: A prospective, multicenter, phase 4 clinical study to determine the efficacy of orally administered magnesium trihydrate of UDCA and CDCA was performed from January 2011 to June 2013. The inclusion criteria were GB stone diameter or =50%, radiolucency on plain X-ray, and asymptomatic/mildly symptomatic patients. The patients were prescribed one capsule of magnesium trihydrate of UDCA and CDCA at breakfast and two capsules at bedtime for 6 months. The dissolution rate, response rate, and change in symptom score were evaluated. RESULTS: A total of 237 subjects were enrolled, and 195 subjects completed the treatment. The dissolution rate was 45.1% and the response rate was 47.2% (92/195) after 6 months of administration of magnesium trihydrate of UDCA and CDCA. Only the stone diameter was significantly associated with the response rate. Both the symptom score and the number of patients with symptoms significantly decreased regardless of stone dissolution. Adverse events necessitating discontinuation of the drug, surgery, or endoscopic management occurred in 2.5% (6/237) of patients. CONCLUSIONS: Magnesium trihydrate of UDCA and CDCA is a well-tolerated bile acid that showed similar efficacy for gallstone dissolution and improvement of gallstone-related symptoms as that shown in previous studies.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Antacids/administration & dosage , Chenodeoxycholic Acid/administration & dosage , Cholagogues and Choleretics/administration & dosage , Drug Administration Schedule , Drug Combinations , Gallstones/drug therapy , Magnesium Hydroxide/administration & dosage , Prospective Studies , Severity of Illness Index , Solubility/drug effects , Ursodeoxycholic Acid/administration & dosageABSTRACT
En este trabajo los autores estudian la naturaleza del acto del cuidado, destacan la importancia de la ética en las profesiones vinculadas con la salud de las personas y desarrollan, a la luz de la tradición central de la filosofía moral occidental, un conjunto de principios que deben guiar la actividad de la enfermería.
In this paper the authors study the nature of the act of care, emphasize the importance of ethics in the professions related to the health of people and develop, in the light of the central tradition of Western moral philosophy, a set of principles that should guide nursing activity.
Neste trabalho, os autores refletem sobre a natureza do ato de cuidar, enfatizam a importância da ética nas profissões relacionadas com a saúde das pessoas e desenvolvem, à luz da tradição central da filosofia moral ocidental, um conjunto de princípios que deve orientar o trabalho de enfermagem.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Cholelithiasis/drug therapy , Glycerides/administration & dosage , Solvents/administration & dosage , Caprylates , Cholecystectomy , Cholelithiasis/surgery , Drainage , Gallstones/drug therapy , Gallstones/surgeryABSTRACT
Os autores relatam dois casos de calculos residuais no coledoco tratados com exito com solucao fisiologica heparinizada (50.000u de heparina em cada 500 ml de soro fisiologico isotonico - 3x/dia, por periodo de seis horas. O metodo e simples e nao ha alteracoes na coagulacao. Sugerem ser uma opcao de tratamento para os cirurgioes que nao tem acesso a terapeutica endoscopica contemporanea.