Duodenal-jejunal bypass normalizes pancreatic islet proliferation rate and function but not hepatic steatosis in hypothalamic obese rats.

Modifications in life-style and/or pharmacotherapies contribute to weight loss and ameliorate the metabolic profile of diet-induced obese humans and rodents. Since these strategies fail to treat hypothalamic obesity, we have assessed the possible mechanisms by which duodenal-jejunal bypass (DJB) surgery regulates hepatic lipid metabolism and the morphophysiology of pancreatic islets, in hypothalamic obese (HyO) rats. During the first 5 days of life, male Wistar rats received subcutaneous injections of monosodium glutamate (4 g/kg body weight, HyO group), or saline (CTL). At 90 days of age, HyO rats were randomly subjected to DJB (HyO DJB group) or sham surgery (HyO Sham group). HyO Sham rats were morbidly obese, insulin resistant, hypertriglyceridemic and displayed higher serum concentrations of non-esterified fatty acids (NEFA) and hepatic triglyceride (TG). These effects were associated with higher expressions of the lipogenic genes and fatty acid synthase (FASN) protein content in the liver. Furthermore, hepatic genes involved in ß-oxidation and TG export were down-regulated in HyO rats. In addition, these rats exhibited hyperinsulinemia, ß-cell hypersecretion, a higher percentage of islets and ß-cell area/pancreas section, and enhanced nuclear content of Ki67 protein in islet-cells. At 2 months after DJB surgery, serum concentrations of TG and NEFA, but not hepatic TG accumulation and gene and protein expressions, were normalized in HyO rats. Insulin release and Ki67 positive cells were also normalized in HyO DJB islets. In conclusion, DJB decreased islet-cell proliferation, normalized insulinemia, and ameliorated insulin sensitivity and plasma lipid profile, independently of changes in hepatic metabolism.

[Terminolateral esophagojejunostomy after gastrectomy with the biofragmentable anastomosis ring in the dog model]. / End-zu-Seit Osophagojejunostomie mit dem biofragmentierbaren Anastomosenring nach Gastrektomie am Hundemodell.

INTRODUCTION: Esophagojejunostomy after total gastrectomy still remains a high risk anastomosis with a considerable morbidity and mortality. The majority of these anastomoses are performed by the intraluminal stapler technique, yet stenoses are a known late complication even after an uneventful postoperative course. In the present study, the osophagojejunostomy with the biofragmentable anastomosis ring (BAR) was examined in dogs. METHODS: 28 dogs were randomized into a group of manual suture (n = 14) and a BAR-group (n = 14). After gastrectomy, the esophagojejunostomy was performed by hand-suture with polypropylene 4-0 in the manual suture group, and with the 25/1.5 mm BAR in the BAR-group. In both groups the Roux-en-Y jejunojejunostomy was performed by hand-suture. The dogs were evaluated on postoperative days 4, 7 and 14 with regard to macroscopy, bursting strength, tissue hydroxyproline and histology. RESULTS: There was one leakage without clinical effect in the hand-sewn group on postoperative day 4; there was no leak in the BAR-group. In observing fibre-free enteral feeding, neither functional disorders nor obstruction of the BAR were observed. The general anastomosis parameters were matchable between the groups. CONCLUSION: The infracarinal BAR-esophagojejunostomy is comparable to the hand-sewn anastomosis in the dog-model.

Ventriculectomia parcial: um novo conceito no tratamento cirúrgico de cardiopatias em fase final / Partial ventriculectomy: a new concept in the surgical treatment of end stage cardiopathies

A melhora clínica da funçao cardíaca pós aneurismectomia de ventrículo esquerdo e/ou cardiomioplastia com o músculo grande dorsal parece ser, ao menos parcialmente, devida ao remodelamento do ventrículo esquerdo. Através de pesquisa em nosso laboratório experimental com carneiros, demonstramos que o aumento do diâmetro do ventrículo é mais importante que a perda de massa muscular para a deterioraçao da funçao ventricular. Sabendo-se que em miocardiopatia dilatada nao ocorre aumento de massa muscular, reduzimos o diâmetro do ventrículo para o normal, em uma série consecutiva de pacientes com esta lesao. No período de 1984 a 1995, foram operados com esta nova técnica, denominada, entao, "Ventriculectomia Parcial", lO3 pacientes portadores de miocardiopatias complexas e insuficiência cardíaca congestiva (NYHA IV). A operaçao é baseada na lei de Laplace (T=P.1l.D) e consistiu na remoçao de uma fatia de músculo da parede lateral do ventrículo esquerdo, iniciando-se na ponta deste, estendendo-se entre os músculos papilares e terminando próximo ao anel mitral. A cirurgia é realizada sob circulaçao extracorpórea normotérmica e nao se utiliza cardioplegia. Todos os pacientes foram avaliados pré-operatoriamente com ecodopplercardiografia e ventriculografia digital, os quais revelaram fraçao de ejeçao < 20 por cento, confirmando estes pacientes como candidatos ao transplante cardíaco. A maioria era do sexo masculino (n=73) e a idade variou de l9 a 74 anos. As doenças foram: miocardite a virus (n=l2); pós miocardioplastia (n=l); doença de Chagas (n=l5); doença valvar (n=38); doença isquêmica (n=l6); idiopática (n=21). Obitos hospitalares (ocorridos nos primeiros 30 dias da cirurgia) (n=l3): embolia pulmonar (n=4); insuficiência renal (n=5); sangramento (n=4). Obitos tardios (ocorridos depois do 30( dia de cirurgia) (n=lO): arritmia (n=6); "insuficiência cardíaca" (n=2); causa desconhecida (n=2); 8 pacientes precisaram ser reoperados por sangramento. Nao houve infecçao e nenhum paciente precisou balao intra-aórtico. Todos saíram com nitroprussiato e 19 pacientes, com inotrópicos. A ventriculografia e a ecocardiografia pós-op mostraram melhora acentuada da FE (de 100 por cento a 300 por cento). Em conclusao, a nova técnica "Ventriculectomia Parcial", com o objetivo de reduzir o diâmetro do ventrículo esquerdo, pode beneficiar pacientes em estágio final de cardiopatia dilatada. Este novo conceito pode, na nossa experiência, proporcionar ao paciente melhora clínica significativa e prolongamento de sua vida.