Weight regain and the metabolic profile of women in the postoperative period of bariatric surgery: a multivariate analysis / Reganho de peso e perfil metabólico de mulheres no pós-operatório de cirurgia bariátrica: análise multiariada

ABSTRACT BACKGROUND: Weight regain in the postoperative period after bariatric surgery is directly related to the relapse of preoperative comorbidities and a negative impact on the patients' biochemical profile. AIMS: To assess the metabolic impact of weight regain on preoperative comorbidities and on patients' biochemical profiles, in order to show the impact of the complications on the metabolic outcomes of bariatric surgery. METHODS: A retrospective study was carried out with 75 women in the late postoperative period of bariatric surgery who presented pathological weight regain (≥20% of the maximum weight loss). Data of interest consisted of glycemic, lipid, and inflammatory profile measurements at three different moments of evaluation: preoperative period, at the weight nadir (minimum weight), and after weight regain. A multivariate analysis was performed. RESULTS: The mean age was 46.39±12.09 years. Preoperative body mass index was 40.10±4.11 kg/m2. There was an overall increase of 3.36 points in the mean body mass index between the nadir and after regain: from 26.30±3.9 kg/m2 to 29.66±4.66 kg/m2. The mean time to reach the nadir was 18±7.6 months, with an average percentage of excess weight loss of 91.08±11.8%. The median time for pathological weight regain was 48 months, and the mean regain amongst the sample was 8.85±5.65 kg. There was a significant correlation between pathological weight regain and levels of insulin (r=0.351; p<0.011), C-peptide (r=0.303; p<0.011), C-reactive protein (r=0.402; p<0.001), and vitamin D (r=-0.435; p<0.001), the last two being the most influenced by the percentage of weight regained. CONCLUSIONS: The pathological weight regain in the postoperative period of bariatric surgery results in losses in the patients' metabolic and inflammatory profiles. However, the biochemical benefits are sustained up to the preoperative levels of the parameters analyzed.

RESUMO RACIONAL: Reganho de peso no pós-operatório de cirurgia bariátrica está diretamente relacionado à recidiva das comorbidades pré-operatórias e a um impacto negativo no perfil bioquímico desses pacientes. OBJETIVOS: avaliar o impacto metabólico do reganho de peso nas comorbidades pré-operatórias e no perfil bioquímico desses pacientes, a fim de mostrar o impacto das complicações nos desfechos metabólicos finais da cirurgia bariátrica. MÉTODOS: Estudo retrospectivo que analisou 75 mulheres no pós-operatório tardio de cirurgia bariátrica que apresentaram reganho patológico de peso (=20% do máximo de peso perdido). Foram coletados dados referentes às medidas dos perfis glicêmico, lipídico e inflamatório em três momentos distintos de avaliação: no pré-operatório, no nadir de peso (menor peso) e após o reganho ponderal. Foi realizada uma análise multivariada. RESULTADOS: A idade média foi 46.39±12.09 anos. IMC médio pré-operatório foi 40.10±4.11 kg/m2. Houve um aumento de 3,36 pontos no IMC médio entre o nadir e após reganho: de 26.30±3.9 Kg/m2 para 29.66±4.66 Kg/m2. O tempo médio para atingir o nadir foi de 18±7.6 meses, com uma %PEP de 91.08±11.8%. O tempo médio para o reganho patológico foi de 48 meses, e a média de reganho foi 8.85±5.65 kg. Houve correlação significativa entre o reganho patológico e os níveis de insulina (r=0.351; p<0.011), peptídeo C (r=0.303; p<0.011), proteína C reativa (r=0.402; p<0.001) e vitamina D (r=-0.435; p<0.001), sendo os dois últimos os mais influenciados pela porcentagem de reganho de peso. CONCLUSÕES: O reganho de peso patológico no pós-operatório de cirurgia bariátrica resulta em prejuízos ao perfil metabólico e inflamatório dos pacientes. No entanto, os benefícios bioquímicos perduram em relação aos níveis pré-operatórios dos parâmetros analisados

Impact of deficient nutrition in bone mass after bariatric surgery / Impacto da deficiência nutricional na massa óssea após cirurgia bariátrica

Background : Essential nutrients are considered for the prevention of the bone loss that occurs after bariatric surgery. Aim : Evaluate nutrients involved in bone metabolism, and relate to serum concentrations of calcium, vitamin D, and parathyroid hormone, and the use of supplements and sun exposure on the bone mass of patients who had undergone gastric bypass surgery. Methods : An observational study, with patients who had undergone the surgery 12 or more months previously, operated group (OG), compared to a control group (CG). Results : Were included 56 in OG and 27 in the CG. The mean age was 36.4±8.5 years. The individuals in the OG, compared to CG, consumed inadequate amounts of protein and daily calcium. The OG had a higher prevalence of low sun exposure, lower levels of 25OH Vitamin D (21.3±10.9 vs. 32.1±11.8 ng/dl), and increased serum levels of parathyroid hormone (68.1±32.9 vs. 39.9±11.9 pg/ml, p<0.001). Secondary hyperparathyroidism was present only in the OG (41.7%). The mean lumbar spine bone mineral density was lower in the OG. Four individuals from the OG had low bone mineral density for chronological age, and no one from the CG. Conclusion : The dietary components that affect bone mass in patients undergoing bariatric surgery were inadequate. The supplementation was insufficient and the sun exposure was low. These changes were accompanied by secondary hyperparathyroidism and a high prevalence of low bone mass in lumbar spine in these subjects.

Racional : Alguns nutrientes são essenciais para a prevenção da perda de massa óssea que ocorre após a cirurgia bariátrica. Objetivo : Avaliar nos pacientes que foram submetidos à cirurgia bariárica pela técnica de bypass gástrico os nutrientes envolvidos no metabolismo ósseo e sua relação com: a concentração sérica de cálcio; a vitamina D e paratormônio; o uso de suplementos alimentares e a exposição solar. Métodos : Estudo observacional com pacientes que foram previamente submetidos à cirurgia, 12 meses ou mais que compuseram o grupo operado (OG), em comparação a um grupo controle (GC). Resultados : Foram avaliados 56 pacientes no OG e 27 no GC. A média de idade foi de 36,4±8,5 anos. Os indivíduos do OG, em comparação com o CG, consumiram diariamente quantidades insuficientes de proteína e cálcio. O OG apresentou maior prevalência de baixa exposição solar, níveis mais baixos de 25OH vitamina D (21,3±10,9 vs 32,1±11,8 ng/ dL) e aumento dos níveis séricos de paratormônio (68,1±32,9 vs 39,9±11,9 pg/ml, p<0,001). Hiperparatiroidismo secundário foi presente apenas no OG (41,7%). A densidade mineral óssea da coluna lombar foi significativamente menor no OG. Quatro indivíduos do OG tiveram baixa densidade mineral óssea comparado com a idade cronológica, e nenhum do CG. Conclusão : Os componentes da dieta que afetam a massa óssea em pacientes submetidos à cirurgia bariátrica estavam inadequados. A suplementação alimentar foi insuficiente e a exposição solar baixa. Estas alterações foram acompanhadas de hiperparatireoidismo secundário e alta prevalência de baixa massa óssea em coluna lombar nestes pacientes.

role of nitric oxide synthase in post-operative hyperglycaemia

Post-operative hyperglycaemia is important with regard to outcomes of surgical operations. It affects postoperative morbidity, length of hospital stay, and mortality. Poor peri-operative blood glucose control leads to a higher risk of post-operative complication. Insulin resistance as a cause of post-operative hyperglycaemia has been blamed for some time. Nitric Oxide [NO] is produced by nitric oxide synthase [NOS] isoenzymes. Inducible nitric oxide synthase [iNOS] is not a normal cellular constitute. It is expressed by cytokines and non-cytokines e.g. fasting, trauma, intravenous glucose, and lipid infusion, which are encountered in surgical operations. Review of current published data on postoperative hyperglycaemia was completed. Our studies and others were explored for the possible role of NO in this scenario. Induction and expression of iNOS enzyme in pancreatic islet cells is included in the chaotic postoperative blood glucose control. The high concentrations of iNOS derived NO are toxic to pancreatic p-cells and may inhibit insulin secretion postoperatively. Hence, current peri-operative management is questionable regarding post-operative hyperglycaemia and necessitates development of a new strategy

Complicaciones crónicas del trasplante cardiaco: Implicaciones clínicas y estrategias futuras / Chronic complications in cardiac transplantation: Clinical implications and future strategies

Chronic complications are situations which limit the long-term utility of cardiac transplantation. The allograft vasculopathy is the most important cause of death at 5 years alter transplantation. Another conditions are systemic arterial hypertension, nephropathies, diabetes mellitus, dyslipidemies and malignant neoplasies. The present manuscript summarizes the characteristics, clinical presentation and therapeutic strategies for this conditions.

Las complicaciones crónicas asociadas al trasplante cardiaco son situaciones que limitan la utilidad a largo plazo de este procedimiento. Dentro de ellas destaca la vasculopatía del injerto que constituye la primera causa de muerte a cinco años del trasplante. Otras situaciones incluyen la hipertensión arterial sistémica, la enfermedad renal, la diabetes mellitus de novo, las dislipidemias y las neoplasias. En el presente trabajo se resumen algunas de las características, causas, presentación clínica y estrategias de manejo de estas situaciones.

Metabolic and stress responses of the body to trauma: produced by the laparoscopic and open cholecystectomy.

Laparoscopic cholecystectomy is regarded as gold standard therapy for symptomatic gall stone disease. This study was done to compare the metabolic and stress responses between open and lapraroscopic cholecystectomy and to evaluate their significance in postoperative recovery. Thirty patients with symptomatic gall stone disease were treated with open and laparoscopic cholecystectomy on elective basis (14 versus 16). Three samples of blood were collected from each patient to investigate serum cortisol, adrenaline, nor-adrenaline, C-reactive protein and blood glucose level. The mean age of patients was 41.86+/-10.13 blood glucose and stress hormones (cortisol, adrenaline, nor adrenaline) and C-reactive protein all were found significantly raised in the postoperative period in open cholecystectomy than laparoscopic cholecystectomy group. The postoperative recovery was also prolonged in the open group. The obvious clinical advantages of laparoscopic cholecystectomy over open cholecystectomy is mainly because of less metabolic and stress response.

Infeccion de la herida operatoria / Infection of postoperative wounds

Se realiza un estudio prospectivo desde enero hasta el 31 de agosto de 1995. En este periodo se realizaron 152 intervenciones quirurgicas de las cuales el 55.9 por ciento fueron electivas, 39.5 por ciento urgencias y en el 4.6 por ciento reoperaciones. El procedimiento quirurgico mas frecuentemente realizado fue la colecistectomia (20.4 por ciento). Se detectaron 31 casos positivos con infeccion de la herida operatoria (IHO). La mayor parte de ellos fueron casos de cirugias de urgencia. El diagnostico de IHO se realizo antes de los 3 dias en 23 casos (74.2 por ciento) durante el posoperatorio. El germen aislado con mas frecuencia fue la E. Coli (63.2 por ciento). El antibiotico mas comunmente utilizado es la ampicilina. El antibiograma demostro resistencia a la ampicilina en el 92.2 por ciento de los casos

Resposta metabólica ao trauma / Metabolic response to trauma

Através deste trabalho de revisäo da literatura, objetiva-se sistematizar e caracterizar as diversas fases da convalescença pós-trauma, enfatizando as respostas do paciente cirúrgico e correlacionando-as com as manifestaçöes clínicas, bem como identificar os fatores que podem interferir na mesma