ABSTRACT
INTRODUCTION: Internal hernias (IH) are late complications of bariatric surgery, specifically gastric bypass and manifest with diffuse abdominal pain and/or intestinal obstruction. They have a low incidence, however, are increasingly common in patients undergoing laparoscopic gastric bypass (LGBP). Petersen's internal hernia is one of the most frequent internal hernias following Bariatric surgery. METHODS: We describe our experience at a third-level surgical center using a prophylactic Petersen's space herniorrhaphy immediately following LGBP as a preventative strategy for post-bariatric internal hernias. In addition, we perform a retrospective descriptive study with 667 patients undergoing LGBP under which we divided into two groups. In the first group, the Petersen's space was not closed, and in the second group, the Petersen´s space closure was performed using non-absorbable polypropylene non-interrupted sutures. RESULTS AND CONCLUSIONS: 667 patients were taken to LGBP, and of which 5 presented internal hernias. From the 346 patients who had Petersen´s herniorrhaphy performed, one developed signs of an internal hernia at 22 months follow-up and was subsequently confirmed later with laparoscopy (0.02%). Of the 321 patients not having had Petersen's space closure, 4 developed Petersen's internal hernia at an average of 22-month post-op, incidence of 0.1%. We analyzed and compared our results with those reported in the literature. Petersen's space closure immediately after a LGBP with an alimentary loop in the anterior colic position (prophylactic herniorrhaphy) with non-interrupted non-absorbable suture is a useful, safe, and effective technique to prevent the development of Petersen's IH during the post-operative period following LGBP.
Subject(s)
Gastric Bypass/adverse effects , Gastric Bypass/methods , Hernia, Abdominal/prevention & control , Herniorrhaphy/methods , Bariatric Surgery/adverse effects , Bariatric Surgery/methods , Hernia, Abdominal/etiology , Humans , Incidence , Laparoscopy/adverse effects , Mesentery/surgery , Retrospective Studies , Suture TechniquesABSTRACT
Objetivo. Analizar los efectos de un programa multidisciplinar de tratamiento de la obesidad (PMTO) sobre los factores de riesgo del Síndrome Metabólico (SM) en niños prepúberes, púberes y adolescentes de acuerdo con el género. Método. Participaron en el estudio 69 niños y adolescentes obesos entre 10 y 18 años de edad divididos en dos grupos: grupo de intervención (GI) (n = 37) y grupo control (GC) (n = 32). En el GI había 23 niñas, en el GC 14. El GI fue sometido a intervención multidisciplinar, con duración de 16 semanas. Se evaluaron parámetros antropométricos, aptitud cardiorrespiratoria y factores de riesgo para SM. Resultados. Se observó que el GI obtuvo reducción en la prevalencia de SM (- 35,8 % para género masculino y - 8,7 % para femenino), entre tanto se mantuvo el valor en las niñas del grupo GC y aumentó en los niños del GC (+ 11,1 %). En relación a dislipidemias, hubo una reducción en el GI para ambos géneros (- 7,2 % para el masculino; - 17,4 % para el femenino), y para el GC se observó aumento para el masculino (+ 22,2 %) y femenino (14,3 %). Las niñas del GI tuvieron mejoras significativas para las variables índice de masa corporal, circunferencia de cintura y cadera, y sensibilidad a la insulina, que no fueron observadas en el género masculino del GI, que presentaron aumento de masa magra. Conclusión. Los resultados del estudio muestran que 16 semanas de intervención multidisciplinar, basada en una terapia cognitivo-conductual, son suficientes para promover reducción de la prevalencia de SM y dislipidemias en niños y adolescentes obesos (AU)
Objetive. To analyze the effects of a multidisciplinary program of obesity treatment (PMTO) on risk factors for metabolic syndrome (MS) in children and adolescents at prepubertal, pubertal and adolescents stages according to gender. Method. he study included 69 obese children and adolescents aged 10 to 18 years. They were allocated to the intervention group (GI) (n = 37) and control group (GC) (n = 32). There were 23 girls in GI and 14 in GC. The GI was submitted to the multidisciplinary intervention, lasting 16 weeks. It was assessed anthropometric parameters, cardiorespiratory fitness and risk factor for MS. Results. We found that the GI achieved a reduction in the prevalence of MS (7.1 % for boys and 8.7 % for girls), and in GC a maintenance for girls and increasing for boys. For dyslipidemia, a reduction in GI for both genders (boys 78.6 % to 71.4 %; girls 82.6 % to 65.2 %), and increasing in GC for both genders. GI Girls had significant improvements for the variables, body mass index, waist circumference, hip circumference and insulin sensibility which was not observed in GI boys who increased lean body mass. Conclusion. The findings show that 16 weeks of multidisciplinary intervention based on cognitive behavioral therapy are sufficient to promote decreasing in the prevalence of MS and dyslipidemia in obese children and adolescents (AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Obesity/complications , Obesity/diagnosis , Obesity/therapy , Metabolic Syndrome/complications , Metabolic Syndrome/diagnosis , Gender and Health , Risk Factors , Behavior Therapy/methods , Cognitive Behavioral Therapy/methods , Obesity/diet therapy , Obesity/physiopathology , Sexual and Gender Disorders/complications , Sexual and Gender Disorders/diagnosis , Outcome and Process Assessment, Health Care , Evaluation of Results of Preventive ActionsABSTRACT
El carcinoma papilar del tiroides, variante de celulas altas, fue descrito en 1976 como un tumor agresivo, con una incidencia de recurrencia y mortalidad mayor que la variante usual. Ocurre entre el 7 y el 9.1 por ciento del total de los carcinomas papilares, pero no es frecuentemente descrito en los estudios de carcinomas tiroideos bien diferenciados. Presentamos 1 caso en una mujer de 55 años, con un tumor de esta variante con un comportamiento agresivo y hacemos una revision de la literatura reciente sobre esta neoplasia.
