ABSTRACT
BACKGROUND: Sleeve gastrectomy (SG) is the most common bariatric procedure performed worldwide. It accounts for more than 50% of primary bariatric surgeries performed each year. Recent long-term data has shown an alarming trend of weight recidivism. Some authors have proposed the concurrent use of a non-adjustable gastric band to decrease long-term sleeve failure. OBJECTIVE: To compare the outcomes (weight loss) and safety (rate of complication and presence of upper GI symptoms) between SG and BSG. METHODS: A systematic search with no language or time restrictions was performed to identify relevant observational studies and randomized controlled trials (RCT) evaluating people with morbid obesity undergoing SG or SGB for weight loss. An inverse-of-the-variance meta-analysis was performed by random effects model. Heterogeneity was assessed using Cochrane X2 and I2 analysis. RESULTS: A total of 7 observational studies and 3 RCT were included in the final analysis. There were 911 participants pooled from observational studies and 194 from RCT. BSG showed a significant higher excess of weight loss (% EWL). The difference among groups was clinically relevant after the third year where the weighted mean difference (SMD) was 16.8 (CI 95% 12.45, 21.15, p < 0.0001), while at 5 years, a SMD of 25.59 (16.31, 34.87, p < 0.0001) was noticed. No differences related to overall complications were noticed. Upper GI symptoms were up to three times more frequent in the BSG group (OR 3.26. CI 95% 1.96, 5.42, p < 0.0001). CONCLUSIONS: According to the results, BSG is superior to SG in weight loss at 5 years but is associated with a higher incidence of upper GI symptoms. However, these conclusions are based mainly on data obtained from observational studies. Further RCT are needed to evaluate the effect and safety of BSG.
Subject(s)
Bariatric Surgery , Gastric Bypass , Obesity, Morbid , Bariatric Surgery/adverse effects , Bariatric Surgery/methods , Gastrectomy/adverse effects , Gastrectomy/methods , Gastric Bypass/methods , Humans , Obesity, Morbid/surgery , Postoperative Complications/etiology , Treatment Outcome , Weight LossABSTRACT
Fundoplication has been commonly performed in neurologically impaired and normal children with complicated gastroesophageal reflux disease. The relationship between gastroesophageal reflux disease and respiratory diseases is still unclear. We aimed to compare results of open and laparoscopic procedures, as well as the impact of fundoplication over digestive and respiratory symptoms. From January 2000 to June 2007, 151 children underwent Nissen fundoplication. Data were prospectively collected regarding age at surgery, presence of neurologic handicap, symptoms related to reflux (digestive or respiratory, including recurrent lung infections and reactive airways disease), surgical approach, concomitant procedures, complications, and results. Mean age was 6 years and 9 months. Eighty-two children (54.3%) had neurological handicaps. The surgical approach was laparoscopy in 118 cases and laparotomy in 33. Dysphagia occurred in 23 patients submitted to laparoscopic and none to open procedure (P = 0.01). A total of 86.6% of patients with digestive symptoms had complete resolution or significant improvement of the problems after the surgery. A total of 62.2% of children with recurrent lung infections showed any reduction in the frequency of pneumonias. Only 45.2% of patients with reactive airway disease had any relief from bronchospasm episodes after fundoplication. The comparisons demonstrated that Nissen fundoplication was more effective for the resolution of digestive symptoms than to respiratory manifestations (P = 0.04). Open or laparoscopic fundoplication are safe procedures with acceptable complication indices and the results of the surgery are better for digestive than for respiratory symptoms.
Subject(s)
Digestive System Diseases/prevention & control , Fundoplication , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/surgery , Laparoscopy , Respiratory Tract Diseases/prevention & control , Adolescent , Child , Child, Preschool , Digestive System Diseases/etiology , Follow-Up Studies , Fundoplication/adverse effects , Fundoplication/methods , Humans , Infant , Laparoscopy/adverse effects , Laparotomy/adverse effects , Prospective Studies , Respiratory Tract Diseases/etiology , Treatment OutcomeABSTRACT
The lignin component found in both water insoluble (WI) and water and alkali insoluble (WIA) fractions derived from SO(2)-impregnated steam-exploded eucalyptus chips (SEE) was isolated and characterized. Dioxane lignins with a sugar content lower than 2% (w/w) were obtained after each material was treated with commercial cellulases. The C9 formulas of both SEE-WI and SEE-WIA dioxane lignins were C(9)H(6.83)N(0.04)O(2.24)(OCH(3))(1.21)(OH(aro))(0.56)(OH(ali))(0. 77) and C(9)H(8.65)N(0.29)O(1.97)(OCH(3))(0.90)(OH(aro))(0. 46)(OH(ali))(1.02), respectively. The weight-average molecular weight (M(w)) of the SEE-WI lignin corresponded to 3.85 kDa, whereas the SEE-WIA lignin had an M(w) of 3.66 kDa for the same polydispersity of 2.4. The SEE-WIA lignin was shown to be more thermally stable than the SEE-WI lignin, requiring temperatures in the range of 520 degrees C for complete degradation. FTIR and (1)H NMR analyses of both untreated and peracetylated lignin fractions showed that (a) the alkali insoluble lignin contained a relatively higher degree of substitution in aromatic rings per C9 unit and that (b) alkaline extraction removed lignin fragments containing appreciable amounts of phenolic hydroxyl groups.
Subject(s)
Eucalyptus , Lignin/chemistry , Plants, Medicinal , Wood , Cellulase , Hot Temperature , Hydrolysis , Lignin/analysis , Solubility , Spectroscopy, Fourier Transform Infrared , Sulfur DioxideSubject(s)
Cysts/congenital , Cysts/therapy , Endoscopy, Digestive System , Splenic Diseases/congenital , Splenic Diseases/therapy , Child , Child, Preschool , Female , Humans , Male , SplenectomyABSTRACT
The pathway for L-arabinose metabolism in Herbaspirillum seropedicae was shown to involve nonphosphorylated intermediates and to produce alpha-ketoglutarate. The activities of the enzymes and the natures of several intermediates were determined. The pathway was inducible by L-arabinose, and two key enzymes, L-arabinose dehydrogenase and 2-keto-glutarate semialdehyde dehydrogenase, were present in all strains of H. seropedicae tested.
Subject(s)
Arabinose/metabolism , Bacteria, Aerobic/metabolism , Isomerism , Kinetics , Species SpecificityABSTRACT
Uma crianca do sexo feminino com dois anos e nove meses de idade, foi admitida com o diagnostico de crises recidivantes de pancreatite aguda. A pancreatografia endoscopica nada revelou de anormal. Um estudo radiologico do aparelho digestivo alto demonstrou a existencia de compressao extrinseca do antro gastrico cujas pregas mucosas se apresentavam finas e regulares.Fez-se suspeita diagnostica de duplicacao gastrica confirmada a cirurgia. O estudo radiologico intra-operatorio mostrou comunicacao com o ducto pancreatico. Optou-se por cistojejunostomia em Y de Roux com cura dos sintomas do doente
Subject(s)
Child , Humans , Female , Pancreatic Ducts , Pancreatitis , StomachABSTRACT
Os autores relatam a experiencia de uma equipe multiprofissional (pediatra, cirurgiao pediatra, assistente social, enfermeira e nutricionista) no atendimento a 17 criancas com incontinencia fecal pos-cirurgia colo-proctologica (9 por megacolo e 8 por anomalia anorretal). Foram realizados estudos morfofuncionais que revelaram somente alteracoes de absorcao de lactose e sacarose, o que motivou emprego de dietas especiais. O esquema basico de tratamento foi: a) diminuir o numero de evacuacoes e/ou aumentar a consistencia das fezes; b) promover disciplina da exoneracao intestinal; c) fortalecer a musculatura abdominoperineal; d) proporcionar apoio a crianca e e) orientar os familiares. Os resultados foram considerados muito satisfatorios