Effect of Phentermine on Hepatic Steatosis in Bariatric Surgery: A Pilot Study.

OBJECTIVE: Hepatic steatosis is associated with increased surgical complications in bariatric surgery patients. We aimed to evaluate the effect of phentermine in reducing hepatic steatosis, adipose tissue, and surgical complications in patients undergoing bariatric surgery. METHODS: This was a two-arm, double-blind, randomized, controlled pilot trial of 64 adult subjects with BMI >35 kg/m2 selected for bariatric surgery randomized into phentermine group (15 mg once daily) or placebo group for 8 weeks. Both groups adhered to a hypocaloric diet (500 calories/day) and an individualized exercise program. The primary endpoint was reducing the frequency of hepatic steatosis measured by ultrasound and reducing adipose tissue through fat mass in total kilograms or percentage. Key secondary points were the prevalence of surgical complications. Baseline and final biochemical parameters and blood pressure too were assessments. RESULTS: In the phentermine group, the frequency of hepatic steatosis decreased by 19%, and the percentage of patients with a normal ultrasound increased from 9% to 28% (p = 0.05). Likewise, the decrease in fat mass in kilograms was more significant in the phentermine group (56.1 kg vs. 51.8 kg, p = 0.02). A significant reduction in the HOMA-IR index was observed regardless of weight loss. No differences in surgical complications were observed between groups. Phentermine was well-tolerated; no differences were observed in the frequency of adverse events between the groups. CONCLUSIONS: Phentermine decreased the proportion of individuals with hepatic steatosis by 19% and promoted a more significant fat mass loss in kilograms among candidates for bariatric surgery.

Usefulness of serum amylase and lipase as predictors of the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis.

BACKGROUND: Post-ERCP pancreatitis (PEP) is the most common complication of Post-endoscopic retrograde cholangiopancreatography. OBJECTIVE: to demonstrate whether serum amylase and lipase values correlate with the presence and severity of PEP. METHOD: We conducted a retrospective, observational and analytical study of patients who underwent ERCP, those who developed pancreatitis were classified by severity according to the 2012 revised Atlanta criteria and their serum enzyme levels were analyzed. We used ROC (Receiver Operating Characteristics) curves to know the best enzyme cutoff points and analyzed their diagnostic yields. Chi-square, t-distribution and Mann-Whitney U test were used in the variable analysis and it was considered statistically significant when p < 0.05. RESULTS: A total 621 patients, 54 presented pancreatitis. For moderately severe and severe forms: lipase level of 1500 U/L had an area under the curve (AUC) = 0.827, 95% CI (0.67-0.98), sensitivity = 72.7%, specificity = 86%, negative predictive value = 92.5%, p < 0.05. Amylase level of 920 U/L presented AUC = 0.65, 95% CI (0.43-0.86), sensitivity = 63%, specificity = 67%, p > 0.05. CONCLUSIONS: Serum lipase shows correlation with the presence and severity of PEP. Amylase shows no significant correlation with PEP.

ANTECEDENTES: La pancreatitis poscolangiopancreatografía retrógrada endoscópica (PPCPRE) es la complicación más frecuente de este procedimiento. OBJETIVO: Demostrar si la amilasa y la lipasa séricas se correlacionan con la presencia y la gravedad de la PPCPRE. MÉTODO: Realizamos un estudio retrospectivo, observacional y analítico de pacientes a quienes se realizó CPRE. Los que desarrollaron pancreatitis se clasificaron por gravedad de acuerdo con la revisión de Atlanta de 2012 y se analizaron sus concentraciones séricas de enzimas. Empleamos curvas ROC (Receiver Operating Characteristics) para conocer los mejores puntos de corte enzimáticos y analizamos sus rendimientos diagnósticos. Usamos las pruebas de ji al cuadrado, t de Student y U de Mann Whitney para el análisis de las variables, y se consideró estadísticamente significativo un valor de p < 0.05. RESULTADOS: De un total de 621 pacientes, 54 presentaron pancreatitis. Para pancreatitis moderadamente grave y grave, unas cifras de lipasa de 1500 U/l presentaron un área bajo la curva (AUC) = 0.827 (intervalo de confianza del 95% [IC 95%]: 0.67-0.98), con una sensibilidad del 72.7%, una especificidad del 86% y un valor predictivo negativo del 92.5% (p < 0.05); y unas cifras de amilasa de 920 U/l presentaron un AUC = 0.65 (IC 95%: 0.43-0.86), con una sensibilidad del 63% y una especificidad del 67% (p > 0.05). CONCLUSIONES: La lipasa muestra correlación con la presencia y la gravedad de la PPCPRE. La amilasa muestra correlación no significativa con la PPCPRE.

Gallstone ileus presenting as obstructive gangrenous appendicitis.

We present the very unusual case of a 38-year-old woman with acute appendicitis and intestinal obstruction. During surgery, a 2.5 cm gallstone impacted at the base of the cecal appendix was found as the cause of a gangrenous appendicitis and obstruction; a choledochal-duodenal fistula was found during the same surgery with no gallstones remaining in the gallbladder or elsewhere. The case was managed by appendectomy with retrieval of the gallstones and no other procedure was performed for the gallbladder or the fistula, since no other gallstone was found on examination. Previously, she was found to have a round, radio-opaque image on the right iliac fossa on imaging, initially identified as an appendicolith, but after pathological examination it turned out to contain cholesterol and calcium bilirubinate. Gallstone ileus as the cause of an obstructive gangrenous appendicitis is a very unusual disease presentation that should be kept in mind when finding an unusual appendicolith presentation in or out the appendix.

Gallstone ileus presenting as obstructive gangrenous appendicitis

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