Concentraciones séricas de marcadores bioquímicos en pacientes intervenidos de derivación biliopancreática / Serum biochemical markers in patients with biliopancreatic diversion

Introducción. La derivación biliopancreática (DBP) es una intervención malabsortiva por lo que es muy frecuente la aparición de deficiencias nutricionales, además suele ser necesaria la suplementación tras la cirugía. Material y Métodos. Se compararon las concentraciones de marcadores bioquímicos que reflejan el estado nutricional de 53 controles y 28 pacientes sometidos a DBP en distintos tiempos tras la intervención (seis meses, al año, cinco y siete años). Además, se evaluaron las principales comorbilidades asociadas a la obesidad. Resultados. La distribución por sexos del estudio fue del 86% y 72% de mujeres, para el grupo estudiado y controles, respectivamente. La edad media, para el grupo de sujetos intervenidos fue de 41±10 años, y de 57±16 años para el grupo control. Se observó el mayor porcentaje de pérdida de peso a los 6 primeros meses, la pérdida se estabilizó a los 5 años de la intervención. Las comorbilidades asociadas más frecuentes fueron hipertensión y diabetes. Se obtuvieron diferencias inter- e intragrupos para vitaminas A y E, ácido fólico, vitamina D y paratohotmona, zinc y calcio, prealbúmina, hierro y hemoglobina, y para colesterol y fibrinógeno. Sin embargo, no se encontraron para vitamina B12, magnesio, proteínas totales y albúmina, ferritina, transferrina y hematocrito, ni para homocisteina. Conclusión. Los pacientes intervenidos de DBP presentan déficits notables de nutrientes y estas carencias suelen persistir a lo largo del tiempo por lo que la suplementación y el seguimiento exhaustivo deberían realizarse a largo plazo (AU)

Introduction. Biliopancreatic diversion (BPD) is a malabsorptive procedure which often leads to nutritional deficiencies and supplements should be given after surgery. Material and methods. We compared the concentrations of biochemical markers that reflect the nutritional status of 53 controls and 28 patients submitted to BPD at different times after the intervention (six months, one year, five, and seven years). Results. There were 86% and 72% women in the study and control groups, respectively. The mean age of the study subjects was 41±10 years, and 57±16 years for the control group. We observed the highest percentage of weight loss in the 6 first months. The weight loss became stable 5 years after the intervention. The most frequent associated comorbidities were hypertension and diabetes. Within and between group differences were obtained for vitamins A and E, folic acid, vitamin D and parathormone, zinc and calcium, prealbumin, iron and haemoglobin, and for total cholesterol and fibrinogen. Nevertheless, we did not found any differences for vitamin B12, magnesium, total proteins and albumin, ferritin, transferrin and haematocrit or for homocysteine. Conclusion. The patients operated on by BPD showed notable deficiencies of nutrients and these deficiencies often persist over time; for this reason the supplementation and the exhaustive follow-up should be long-term (AU)

Concentraciones séricas de vitaminas liposolubles y de zinc en pacientes sometidos a cirugía bariátrica / Serum concentrations of fat-soluble vitamins, zinc and other biochemical markers in patients after gastric or biliopancreatic bypass

Las vitaminas liposolubles y el zinc son micronutrientes que deben ser aportados con la dieta. Los bypass gástricos y biliopancreáticos son considerados intervenciones malabsortivas, pudiendo provocar importantes déficits carenciales. Material y métodos. Se compararon las concentraciones de vitaminas A y E, zinc y otros marcadores bioquímicos de 35 controles y 32 pacientes sometidos a cirugía bariátrica en distintos tiempos tras la intervención (tras seis meses, al año y transcurridos más de cinco años). Las determinaciones de las vitaminas y del zinc se realizaron mediante HPLC y por espectroscopia de absorción atómica por llama de aire-acetileno, respectivamente. Resultados. Para la vitamina A se obtuvieron medias de 2,15μmol/L en los controles. Los pacientes en los distintos tiempos tras la intervención mostraron valores decrecientes de vitamina A hasta alcanzar concentraciones de 0,63μmol/L tras más de cinco años de la cirugía (p<0,002). En el caso de la vitamina E se encontraron medias de 28,6 nmol/L para los controles y valores entre 11,7-15,6 nmol/L para los pacientes en las distintas etapas (p<0,001). En el caso del zinc se observaron medias de 11,6, 10,7 y 9,94μmol/L para los pacientes en los distintos tiempos, encontrándose diferencias significativas con los controles (p<0,001). Además, se observó significación estadística en las concentraciones de calcio, hierro y folato. Conclusiones. Los pacientes intervenidos de cirugía bariátrica presentan problemas absortivos con déficits notables de nutrientes por lo que este hecho debería ser considerado a efectos de evitar posibles patologías derivadas de estas carencias (AU)

Introduction: Fat-soluble vitamins and zinc are substances not synthesized in the body. Consequently intake of those micronutrients is required. Gastric and biliopancreatic bypass considered malabsorption interventions that can lead to nutritional deficiencies. Material and methods: We compared levels of vitamins A and E, zinc and others biochemical markers of 35 controls and 32 patients submitted to bariatric surgery at different times after the operation (after six months, after one year and after more than five years). Vitamins and zinc were determined by HPLC and air-acetylene flame atomic absorption, respectively. Results: A mean of 2.15 mol/L was obtained for controls. In the different times after the surgery, the patients showed decreasing values of vitamin A up to concentrations of 0.63 mol/L after more than five years after the intervention (P < .002). For vitamin E, a mean 28.6 nmol/L was obtained for controls, and values between 11.7-15.6 nmol/L for patients at the different times after the surgery (P < -001). Means of 11.6, 10.7 and 9.9 mol/L of zinc were observed in patients at the different times, being significantly different from the control group (P < .001). In addition, we found statistical significance in the concentration of calcium, iron and folic acid. Conclusions: Patients after bariatric surgery show absorption problems with a marked lack of nutrients. This fact should be taken into consideration to reduce effects of possible pathologies derived from these deficiencies (AU)

Estimation of precision and inaccuracy for serum magnesium determination on the basis of interlaboratory comparison data Accreditation ISO 15189.

Serum Mg is an important biochemical parameter in the context of clinical medicine for monitoring patients and for helping to diagnose some pathologies. The clinical laboratories must offer analytical results of quality in all parameters determined, demonstrating this way the laboratory "skill competence". The aim of this study was to revalidate (ISO 15189 standard) some different colorimetric methods for Mg determination in serum used in clinical and/or biochemical laboratories in four hospitals in Spain, on the basis of results of interlaboratory comparison programmes: Bio-Rad EQAS and external quality control SEQC. Precision and inaccuracy were estimated by analysis of records of an external quality control programme for Mg. The precision and inaccuracy values obtained were both less than 10%, except in one hospital in which the precision was less than 15%. These values of precision and inaccuracy obtained may be considered highly satisfactory taking into account the validation requirement for these ones: less than 10%. These findings demonstrate the effectiveness of the new revalidation methodology for diagnostic methods in medicine, which does not require any disruption of the laboratory's routine activity and which can be used even if the method in question has not been validated previously. It is also suggested that the ideas and requirements of ISO 15189 should be followed by the research laboratories.

Pancreatic fibrosis in rats and its response to antioxidant treatment.

CONTEXT: Oxidative stress plays a role in the development of pancreatic fibrosis. OBJECTIVES: In the present study, we hypothesized that the administration of an antioxidant complex could ameliorate cerulein and cyclosporin A pancreatic fibrosis, assessed by changes in oxidative stress and a histopathological study in an experimental rat model. ANIMALS: Four groups of ten rats each. In Group A, the rats served as controls and were treated with intraperitoneal saline solution. In Group B, six courses of cerulein pancreatitis were induced at weekly intervals. In Group C, the rats received cyclosporin A the day before and the day on which pancreatitis was induced in Group B. In Group D, the rats were treated as in Group C but also received antioxidants. All rats were sacrificed at the seventh week. MAIN OUTCOME MEASURES: The presence of fibrosis was evaluated according to a scoring system. Glutathione peroxidase was utilized as an indicator of oxidative stress and total antioxidant status as an indicator of total antioxidant tissue capacity. RESULTS: The rats in Groups B and C showed more pancreatic fibrosis than those in Groups A and D (90%, 70%, 0%, and 20%, respectively). The glutathione peroxidase increased in Group B (455+/-196 mU/g protein) and Group C (243+/-206 mU/g protein) with respect to those in Group A (137+/-80 mU/g protein) and Group D (135+/-105 mU/g protein). Total antioxidant status was significantly higher in Groups B (1.41+/-0.96 mmol/g protein) and D (1.28+/-0.09 mmol/g protein) with respect to Groups A (0.10+/-0.06 mmol/g protein) and C (0.15+/-0.09 mmoL/g protein). CONCLUSION: The administration of cerulein and cyclosporin A caused fibrosis, whereas antioxidant administration showed preventive effects regarding cerulein and cyclosporin A-induced pancreatic fibrosis.