Early Improvement in Glycemic Metabolism after Laparoscopic Sleeve Gastrectomy in Obese Patients - A Prospective Study.

BACKGROUND: according to W.H.O. in 2014 more than 600 million adults were obese, (more than doubled since 1980), and face a major risk for the onset of metabolic syndrome, including T2DM. Due to the poor control of glycemic imbalance for the conservative treatment of T2DM, the metabolic surgery was able to gain an important role in modern management of T2DM, with significant reported improvements or remissions for these patients. OBJECTIVE: to study the effects of laparoscopic sleeve gastrectomy (LSG) on glycemic metabolism in obese patients, with or without T2DM. METHODS: 60 consecutive patients were included in a prospective study and were submitted to laparoscopic sleeve gastrectomy in Ponderas Hospital between February - March 2013. BMI, waist circumference and glycemic parameters were studied at the moment of entering the study, 10 days after surgery and at 6 months follow up. RESULTS: the glycemic control was significantly improved starting with postoperative day 10. Statistically significant improvements were noticed after six months postoperatively in BMI values (p 0,0001), waist circumference (p 0,0001), glycemic levels (p 0,0001), insulin (p 0,0001), C-peptide (p 0,0001) and HOMA. CONCLUSIONS: a rapid induced improvement of glucose metabolism in both diabetic and non-diabetic patients occurs before a significant weight loss (POD 10). At 6 months, when associated with an important weight loss, both diabetic and non-diabetic patients present a furthermore improvement in glycemic metabolism, that enables us to consider that sleeve gastrectomy is an efficient method for a sustained improvement in the metabolic status of patients with obesity. These beneficial changes that can explain the remission of T2DM can also explain the prevention of T2DM after metabolic surgery.

[Video-assisted thoracoscopic extended thymectomy (VATET) with cervical approach for myasthenia gravis--initial experience]. / Timectomia extinsa prin abord toracoscopic bilateral si timp cervical pentru miastenia gravis--experienta initiala.

Complete thymectomy plays an important role in the myasthenia gravis (MG) pacient's treatment. Many different surgical techniques have been developed to achieve thymectomy. Of these, thoracoscopic technique is the most recent. There still are many controversies about the most suitable approach for thymectomy. The paper presents in detail the video-assisted thoracoscopic extended thymectomy--VATET-technique, and initial results with this procedure. Prospective data was obtain according to the Myasthenia Gravis Foundation of America (MGFA) recommendations. From Mai 2007 to December 2009, 15 patients with MG underwent the VATET procedure with cervical access. There was no conversion to sternotomic approach. Mean operating time for complete VATET was 215 min (150-280 min), with the cervical procedure requiring 44 min (25-60 min). There was no mortality or intraoperative complications. It was a single case with a thoracoscopic second look for hemothorax from intercostals bleeding. At this time, due to the reduced number of cases, we can't evaluate the therapeutic effectiveness of the VATET. We consider VATET as a valuable surgical option to treat myasthenic patients, with an optimal report between radicality and invasiveness.