Bypass Intestinal Lazzarotto & Souza (BILS): cirurgia restritiva / Bypass Intestinal Lazzarotto and Souza (Bils): restrictive surgery

Objetivo: Demonstrar que a cirurgia bypass intestinal Lazzarotto & Souza (BILS) é tratamento cirúrgico eficaz para a cura da obesidade e da obesidade mórbida, desencadeando emagrecimento duradouro, sem diarreia persistente e sem nenhum tipo de distúrbio nutricional e metabólico. Método: 1.200 pacientes foram submetidos à cirurgia bariátrica por esta técnica, de 1986 a 2005. A idade variou de 14 a 70 anos (média:36,9), sendo 196 (16,3%) homens e 1.004 (83,7%) mulheres, com altura variando de 1m a 1,98m (média: 1,64m), peso de 79,80kg a 265kg (média: 125kg), índice de massa corpórea (IMC) oscilando de 35,2 a 83,6kg/m² (média: 46,6kg/m²) e ritmo de defecação variando de cinco vezes/dia até de 25 em 25 dias, sem uso de laxativos. Utilizou-se anestesia peridural e raquidiana. Procedeu-se abdominoplastia acessional não estética. O procedimento visou operar o intestino delgado efetuando anastomose látero-lateral, formando dois trajetos no trânsito intestinal: o primeiro com anastomose jejunoileal criando um trajeto mais encurtado e o segundo, o restante do jejuno-íleo, permitindo o aporte de menor quantidade de quimo por estreitamento no início da alça do jejuno, após a anastomose e, consequentemente, tornando-se hipoabsortivo. Em pacientes com constipação crônica efetuou-se valvuloplastia de íleo terminal, similar às piloroplastias no estômago. Não se extirpa nada do intestino delgado. Calculam-se as áreas para o bypass com a fórmula: 2πr.h.3.10.20cm2. Calcula-se a área de intestino delgado que o paciente necessita para ter uma vida normal com base em hábitos de vida, tipo de alimentação, idade, sexo, altura, ritmo intestinal e outros hábitos. Mede-se comprimento e largura do intestino com dinamômetro em 2 dinas de força. Calcula-se o raio da entrada do intestino hipofuncionante com a fórmula 2πr = C, de tal forma que somando as áreas do duodeno, jejuno-íleo e a porcentagem do segmento hipofuncionante são obrigadas a equivaler à absorção para cada paciente...

Objective: Demonstrate that the hypofunctioning reversible intestinal bypass surgery Lazzarotto & Souza is efficient surgical treatment in the cure for obesity and morbid obesity unleashing lasting weight loss, without any persistent diarrhea, any type of nutritional or metabolic disturbances. Method: Twelve hundred patients were submitted to bariatric surgery by the hypofunctioning reversible intestinal bypass surgery Lazzarotto & Souza technique (HRIBLS) in the period of 1986 to 2005. The patients’ age varied from 14 to 70 years (mean of 36.9), 196 of them (16.3%) were male and 1,004 (83.7%) were female, with height averaging from 1 to 1.98 meters (mean of 1.64m), with body weight from 79.80 to 265kg (mean of 125.00kg), index of body mass (IBM) oscillating from 35.2 to 110kg/m²(mean of 46.6kg/m²) and rhythm of defecation varying from five times a day and 25 in 25 days without the use of laxatives. Peridural and the rachidian anesthesia were performed. The non esthetic accessional abdominoplasty was made. The procedure aimed on operating the small intestines performing a laterolateral anastomosis, forming two routes in the intestinal transit: The first, with jejunoileal anastomosis creating a shorter route and the second, the rest of the jejunoileum, allowing the arriving of lesser quantity of chyme by the narrowing of the beginning of the jejuno’s sleeve, after the anastomosis and, therefore, becoming hypoabsorptive. In patients with chronic constipation an ileoterminal valvuloplasty was performed, similar to the pyloroplasties in the stomach. Nothing is ripped from the small intestine. The areas for the bypass are calculated with the formula: 2πr.h.3.10.20cm2. The area of the small intestine which the patient needs in order to have a normal life is calculated based on life habits, type of nourishment, age, gender, height, intestinal rhythm and other habits...

Antibody response after immunization of Brazilian children with serogroup C meningococcal polysaccharide noncovalently complexed with outer membrane proteins

We have studied the antibody response of Brazilian vaccines to C meningococcal polysaccharide (C-PS) after one or two doses of a vaccine composed of C-PS, outer membrane proteins of B meningococci and aluminum hydroxide. Total IgG, IgG1 and IgG2 as well as bactericidal activity mediated by complement were measured in serum samples from children 3 to 83 months of age (post-vaccination IgG, IgG1 and IgG2 levels of 2.4 to 13.4 µg/ml; less than 18 to 67.8 U/ml and less than 8 to 106.8U/ml, respectively) and from individuals 10 to 14 years of age (post-vaccination IgG, IgG1 and IgG2 levels of 14.6 µg/ml, 23,7 U/ml and 112.0 U/ml, respectively). The antibody response, measured as IgG levels, was age-dependent. Although high antibody levels were demonstrableby enzyme-linked immunosorbent assay (ELISA), bactericidal activity was not demonstrable (less than 1:4) in serum from children aged less than 24 months. A significant bactericidal activity was detected in serum of children older than 49 months of age and in individuals 10 to 14 years of age. A predominance of IgG2 was observed in post-vaccination serum samples from children belonging to those two age groups. The antibody concentration sufficient to confer protection as well as the possible causes of the poor correlation observed between ELISA and bactericidal activity results are discussed