[Not Available]. / Evaluación de la composición corporal en niños y adolescentes: directrices y recomendaciones.

El índice de masa corporal (IMC) otorga uno de los índices más usados para determinar el estado nutricional de la población a nivel mundial, donde a pesar de existir recomendaciones claras y definidas para su interpretación como el sexo, edad, raza, entre otros, normalmente se estandariza su clasificación, independiente de las variables, aumentando el error en el resultado y en la clasificación del estado nutricional.El uso de la composición corporal a través de la antropometría entrega mayor información que el IMC, siendo la masa grasa y la masa muscular los principales resultados útiles.Este artículo presenta una revisión de las ecuaciones existentes y propone aquellas más simples y con menor error de estimación para ser usadas como una herramienta que reemplace o complemente al IMC, favoreciendo una mejor comprensión e interpretación del estado nutricional y nivelde actividad física en niños y adolescentes.

Evaluación de la composición corporal en niños y adolescentes: directrices y recomendaciones / Assessment body composition in children and teens: guidelines and recommendations

El índice de masa corporal (IMC) otorga uno de los índices más usados para determinar el estado nutricional de la población a nivel mundial, donde a pesar de existir recomendaciones claras y definidas para su interpretación como el sexo, edad, raza, entre otros, normalmente se estandariza su clasificación, independiente de las variables, aumentando el error en el resultado y en la clasificación del estado nutricional. El uso de la composición corporal a través de la antropometría entrega mayor información que el IMC, siendo la masa grasa y la masa muscular los principales resultados útiles. Este artículo presenta una revisión de las ecuaciones existentes y propone aquellas más simples y con menor error de estimación para ser usadas como una herramienta que reemplace o complemente al IMC, favoreciendo una mejor comprensión e interpretación del estado nutricional y nivel de actividad física en niños y adolescentes (AU)

The body mass index (BMI) provides one of the indices used to determine the nutritional status of the population worldwide, where despite the existence of clear recommendations for interpretation and defi ned as gender, age, race, etc. usually their classifi cation, independent of the variables is standardized, increasing the error in the result and classifi cation of nutritional status. The use of body composition through anthropometry, delivers more information than BMI, being fat mass and muscle mass leading useful results. This article presents a review of existing and proposed those equations simpler and less error estimate to be used as a tool to replace or supplement to BMI, promoting a better understanding and interpretation of nutritional status and level of physical activity in children and adolescents (AU)

Laparoscopic surgical treatment for patients with short- and long-segment Barrett's esophagus: which technique in which patient?

Laparoscopic antireflux surgery is very successful in patients with short-segment Barrett's esophagus (BE), but in patients with long-segment BE, the results remain in discussion. In these patients, during the open era of surgery, we performed acid suppression + duodenal diversion procedures added to the antireflux procedure (fundoplication + vagotomy + antrectomy + Roux-en-Y gastrojejunostomy) to obtain better results at long-term follow-up. The aim of this prospective study is to present the results of 3 to 5 years' follow-up in patients with short-segment and long-segment or complicated BE (ulcer or stricture) who underwent fundoplication or the acid suppression-duodenal diversion technique, both performed by a laparoscopic approach. One hundred eight patients with histologically confirmed BE were included: 58 patients with short-segment BE, and 50 with long-segment BE, 28 of whom had complications associated with severe erosive esophagitis, ulcer, or stricture. After surgery, among patients treated with fundoplication with cardia calibration, endoscopic erosive esophagitis was observed in 6.9% of patients with short-segment BE, while 50% of patients with long-segment BE presented with positive acid reflux, persistence of endoscopic esophagitis with intestinal metaplasia, and progression to dysplasia (in 5% of cases; P = 0.000). On the contrary, after acid suppression-duodenal diversion surgery in patients with long-segment BE, more than 95.6% presented with successful results regarding recurrent symptoms and endoscopic regression of esophagitis. Regression of intestinal metaplasia to the cardiac mucosa was observed in 56.9% of patients with short-segment BE who underwent fundoplication and in 61% of those with long-segment BE treated with the acid suppression-duodenal diversion procedure. Patients with long-segment BE who experienced fundoplication alone presented no regression of intestinal metaplasia; on the contrary, progression to dysplasia was observed in 1 case (P = 0.049). Patients with short-segment BE can be successfully treated with fundoplication, but for patients with long-segment BE, we suggest performance of fundoplication plus an acid suppression-duodenal diversion procedure.

Laparoscopic resectional gastric bypass in patients with morbid obesity: experience on 112 consecutive patients.

INTRODUCTION: Gastric bypass, without gastric resection of the distal excluded stomach, is the surgical treatment more frequently performed for morbid obesity. Several postoperative complications related to the "in situ" distal stomach have been described, and few cases of undetected gastric carcinoma located in this segment of stomach have been published. In this paper, we present our early postoperative results in patients submitted to laparoscopic gastric bypass with resection of distal stomach in patients with morbid obesity. METHODS: One hundred twelve consecutive patients were included in this study. The mean body weight was 112.15±5.1 (range 78­145), and BMI was 40.5±6.9 kg/m2 (32.9­50.3). Patients were submitted to resectional gastric bypass by laparoscopic approach. The operative time was 133.7±29.1 min (range 120­240). RESULTS: Postoperative complications occurred in 12 patients (10.7%) without any mortality. Early complications were observed in 11 patients while one patient presented a late complication, four patients were re-hospitalized, three of them without operation and other four of them were re-operated due to early (three patients) or late complication (one patient). One hundred patients (89.2%) were discharged at fourth postoperative day, seven patients remained in hospital between 5 and 10 days, and four patients after the tenth day due to complications. Leaks were observed in three patients. The histological study of the resected specimen was normal in only 8.9%. CONCLUSIONS: Laparoscopic resectional gastric bypass presents very similar results compared to classic gastric bypass, without significant increase of morbidity, mortality, early and late postoperative results, and therefore, it is an option for the surgical treatment of morbid obesity in countries with high risk of gastric carcinoma.

Postoperative results after laparoscopic approach for treatment of large hiatal hernias: is mesh always needed? Is the addition of an antireflux procedure necessary?

Laparoscopic approach has been suggested as the definitive treatment for large hiatal hernias. Reinforcement of the hiatoplasty and the need to perform antireflux surgery is still undergoing discussion. The purpose of this study was to evaluate the postoperative results, with special emphasis on the recurrence rate and reflux after surgery comparing the use or not of mesh reinforcement. This prospective study included 81 patients with a complete evaluation through a clinical questionnaire, barium sulfate radiologic evaluation, endoscopy, manometry, and 24-hour intraesophageal pH monitoring before and after a hiatoplasty with an antireflux procedure. Mesh reinforcement was used in 23 patients. Postoperative complications occurred in 11 patients (13.6%), without mortality. Recurrent hernia was observed in 10 patients without mesh reinforcement (12.3%), whereas those with mesh reinforcement showed no hiatal hernia recurrence (P = 0.33). Normal resting lower esophageal sphincter pressure was obtained after fundoplication in 87.2% of patients, and abnormal acid reflux was observed in 12.8% of patients after surgery. In conclusion, mesh reinforcement in patients with large Type IV could prevent recurrent hiatal hernias, and an antireflux procedure must be performed in order to avoid postoperative acid reflux.

Laparoscopic anterior cardiomyotomy plus anterior Dor fundoplication without division of lateral and posterior periesophageal anatomic structures for treatment of achalasia of the esophagus.

Laparoscopic cardiomyotomy is the treatment of choice for patients with achalasia of the esophagus. Several different techniques and modifications have been reported concerning the approach (thoracoscopic or laparoscopic), type and length of the myotomy, with or without fundoplication, type of fundoplication, etc. In this prospective study, we report our simplified technique for anterior cardiomyotomy with Dor fundoplication and the results obtained using this procedure. Only the anterior wall of the esophagus was exposed without dissection of the lateral or posterior periesophageal anatomic structures for the technique. Twenty-five patients were operated by a single surgeon. The diagnosis was based on the clinical, radiologic, endoscopic, and functional esophageal tests. Achalasia was classified into 3 types: achalasia type I was diagnosed in 5 patients, type II in 6 patients, and type III in 14 patients. Manometry demonstrated a mean resting pressure of 33.5 mm Hg (range, 18 to 55), associated with incomplete relaxation. The hospital stay was 3 days; the median operative time was 115 minutes (range, 90 to 150), 2 small mucosal perforations occurred which were immediately sutured during surgery without conversion into open technique and no postoperative complications occurred. After operation, lower esophageal sphincter pressure returned to normal values and complete relaxation in all patients. In type II and III achalasia, the esophageal body diameter decreased more than 50% (P=0.001) compared with the preoperative diameter, and the internal diameter of the esophagogastric junction increased significantly (P=0.001). Only 2 patients presented occasional heartburn and 2 patients received 1 session of hydrostatic dilatation due to mild residual dysphagia. No late recurrence of dysphagia has been observed to the present time (1 to 5 y of follow-up). In conclusion, the goals of the surgery for achalasia are obtained with this simplified technique.

Neosaxitoxin as a local anesthetic: preliminary observations from a first human trial.

BACKGROUND: Neosaxitoxin is a phycotoxin that reversibly blocks the voltage-gated sodium channels at the neuronal level. Its activity results in blocking the axonal conduction, stopping the propagation of the nerve impulse. The objective of the present work was to evaluate neosaxitoxin as a local anesthetic in a human trial. METHODS: The authors conducted a randomized, double-blind, placebo-controlled trial with 10 healthy volunteers. Subcutaneous injections were made in the middle posterior skin of the calf: one leg received 50 microg neosaxitoxin, and the contra-lateral leg received placebo. The anesthetic effect was evaluated using a standardized human sensory and pain model. TSA II Neurosensory Analyzer (Medoc Ltd, Minneapolis, MN) and von Frey technique were used to evaluate five parameters: sensory threshold for warm and cold, pain thresholds for heat and cold, and mechanical touch perception threshold. Measurements were made 0, 1, 3, 6, 9, 12, 16, 24, and 48 h after the injections. RESULTS: For all the patients, effective and complete blocking of the evaluated parameters was obtained. As the blocking began to revert gradually, heat pain was the first to return to normal values after 3 h. Cold pain was the longest sensation abolished, achieving 24 h of blockade. The toxin was undetected in blood and urine samples. No adverse reactions to neosaxitoxin were detected. CONCLUSIONS: Neosaxitoxin showed an effective local anesthetic effect when injected in the subcutaneous plane. The efficacy of a 50-microg dose of neosaxitoxin was shown. This is the first report of neosaxitoxin as a local anesthetic in a human trial.

Laparoscopic sleeve gastrectomy: surgical technique, indications and clinical results.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has been introduced as a multipurpose restrictive procedure for obese patients. Variations of the surgical technique may be important for the late results. METHODS: 50 patients submitted to LSG from January 2005 to December 2006 were studied. Mean age was 38.2 years, preoperative weight was 103.4 +/- 14.1 kg (78 to 146 kg), and preoperative BMI was 37.9 +/- 3.4 (32.9 to 46.8). Important co-morbidities were present in 39 patients (78%). RESULTS: Operative time was 110 +/- 15 min. Intraoperative difficulties were observed in 7 patients. Volume of the resected specimen was 760 +/- 55 ml and capacity of the gastric remnant was 108.5 +/- 25 ml. There was no conversion to open surgery. Histology of the resected stomach was normal in 8 patients, while chronic gastritis was found in 42 patients. At 6 and 12 months postoperatively, weight loss was 28.0 +/- 6.4 kg and 32.6 +/- 6.8 kg respectively. In the 18 patients who have reached 1 year follow-up, % excess BMI loss reached 85 +/- 0.7%. Most of the medical diseases associated with the obesity resolved after 6 to 12 months. CONCLUSION: LSG may be an acceptable operation. It is easy to perform, safe, and has a lower complication rate than other bariatric operations. Further studies are necessary for the clinical results at long-term follow-up.

[Prader-Willi Syndrome (PWS) associated to morbid obesity: surgical treatment]. / Síndrome Prader-Willi asociado a obesidad mórbida: tratamiento quirúrgico.

Prader-Willi Syndrome (PWS) is a multisystemic genetic disease characterized by hypothalamic hypogonadism, mental retardation and compulsive hyperphagia associated with early and severe obesity. Complications of overweight, such as type-2 diabetes Mellitus, dyslipidemia and diffuse atheromatosis are common. We report a 15 years old morbid obese male with PWS, with a body mass index of 57.7 kg/m2, refractory to weight-lowering treatments. He underwent preoperative evaluation and treatment by a multidisciplinary team, and subjected to a 95% gastrectomy, leaving a 50 ml remnant pouch and a long limb (120 cm) Y-Roux gastro-jejuno anastomosis. There were no surgical complications, oral feeding was initiated at the 5th day with an hypocaloric diet. During the first postoperative year, the patient lost 70 kg, achieving a body mass index of 30 kg/m2. Surgical treatment can become a therapeutic choice for obesity in PWS patients.