RESUMEN
Esophagoscopy in pediatric surgery represents about 70% of examinations of upper digestive tract. The authors present their experience with pediatric surgical endoscopy. They show the importance of this procedure in pediatric population, which provides clear diagnostic answers and represents a good alternative to traditional surgical procedures.
Asunto(s)
Enfermedades del Esófago/cirugía , Esofagoscopía , Adolescente , Factores de Edad , Quemaduras Químicas/cirugía , Cáusticos/efectos adversos , Niño , Preescolar , Dilatación , Acalasia del Esófago/cirugía , Atresia Esofágica/cirugía , Estenosis Esofágica/inducido químicamente , Estenosis Esofágica/cirugía , Várices Esofágicas y Gástricas/cirugía , Esófago/cirugía , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/cirugía , Reflujo Gastroesofágico/cirugía , Humanos , Lactante , Recién Nacido , RadiografíaRESUMEN
Videourodynamic investigation was carried on 62 patients with enuresis (34 females, 28 males). Patients were all grouped in four different clinical types according to the International Continence Society: (Type I) monosymptomatic enuresis nocturnal (24 cases); (Type II) nocturnal and diurnal enuresis without daytime frequency (8 cases); Type III) nocturnal enuresis with daytime frequency (22 cases); (Type IV) nocturnal and diurnal enuresis with daytime frequency and/or urgency (8 cases). In children with monosymptomatic enuresis nocturnal the videourodynamic study revealed, in 85% of cases, a normal bladder; in only 17% of cases was observed a detrusor instability. In patients with Type II enuresis a normal bladder was observed in 6 cases, whereas in two a detrusor instability was present. Among the 22 patients with Type III enuresis, 13 cases (59%) had a detrusor instability, 3 cases (14%) had a vesicosfinteric dyssinergia and 6 (27%) had a normal activity. In this group of patients it was documented in 10 cases a trabeculated bladder together with a vesicoureteral reflux in 4 patients, meatal stenosis and bladder diverticula in other two cases. All patients with Type IV enuresis documented pathological data: detrusor instability in 4 patients, vesico-sfinteric dyssinergia in two and neurogenic non-neurogenic bladder in the other two cases. A severe trabeculated bladder was present in all this cases, with vesico-ureteral reflux in two patient. Maximum cystometric capacity was low in 41 cases (66%), normal in 20 (32%), high in 1 (2%), independently of the types of enuresis.
Asunto(s)
Enuresis/fisiopatología , Vejiga Urinaria/fisiopatología , Adolescente , Niño , Preescolar , Enuresis/clasificación , Femenino , Humanos , Masculino , Urodinámica/fisiologíaRESUMEN
Two groups of 25 severely obese patients underwent 3 months of hypocaloric diet therapy either alone or associated with a glucomannan-based fibrous diet supplement (approx. 4 g/die in 3 doses). The comparative analysis of the results obtained in both groups showed that the diet + glucomannan group had a more significant weight loss in relation to the fatty mass alone, an overall improvement in lipid status and carbohydrate tolerance, and a greater adherence to the diet in the absence of any relevant side effects. Due to the marked ability to satiate patients and the positive metabolic effects, glucomannan diet supplements have been found to be particularly efficacious and well tolerated even in the long-term treatment of severe obesity.
Asunto(s)
Catárticos/uso terapéutico , Fibras de la Dieta/uso terapéutico , Mananos/uso terapéutico , Obesidad/dietoterapia , Adulto , Glucemia/análisis , Catárticos/administración & dosificación , Colesterol/sangre , Fibras de la Dieta/administración & dosificación , Femenino , Humanos , Masculino , Mananos/administración & dosificación , Persona de Mediana Edad , Obesidad/sangre , Obesidad/tratamiento farmacológico , Saciedad , Factores de Tiempo , Triglicéridos/sangre , Pérdida de PesoRESUMEN
Since 1954 the aim of surgical treatment of severe obesity has been to perfect a specific treatment capable of obtaining a massive, long-lasting and well tolerated loss of weight in severely obese subjects in which different and repeated attempts using conservative medicine have proved inefficacious or non-resolutive. During the course of almost 40 years, bariatric surgery has gradually evolved in the search for the "ideal" surgical treatment: for this purpose, operative methodologies and techniques have been proposed and experimented using differing physiopathological concepts and means of application. After a brief analysis of the history of bariatric surgery, there is a short summary of the most internationally widespread surgical methods and the most recent techniques now used for the surgical treatment of severe obesity based on the Authors' ten year experience of 321 intestinal bypasses (jejuno-ileal and biliointestinal), 110 horizontal gastroplasties and 23 vertical gastroplasties with a silastic ring. Intestinal bypass almost always allows sufficient weight loss to be achieved (85% of operated patients lose 80% of excess body weight) and the various postoperative problems of differing degrees of severity can be prevented by adequate replacement therapy and regular outpatient monitoring. Gastroplasties lead to a slightly smaller loss of weight (73% of excess body weight) within a shorter period of time, with fewer postoperative problems, but at the expense of a drastic and continual reduction in food intake. All patients operated require intense and long-term postoperative follow-up carried out by experts in order to achieve the desired results.
Asunto(s)
Obesidad Mórbida/cirugía , Anastomosis Quirúrgica/métodos , Desviación Biliopancreática/métodos , Derivación Gástrica/métodos , Gastroplastia/métodos , Gastrostomía/métodos , Humanos , Derivación Yeyunoileal/métodosAsunto(s)
Obesidad Mórbida/clasificación , Obesidad/clasificación , Tejido Adiposo/fisiología , Tejido Adiposo Pardo/fisiología , Regulación de la Temperatura Corporal/fisiología , Peso Corporal , Causas de Muerte , Humanos , Obesidad/diagnóstico , Obesidad/etiología , Obesidad/mortalidad , Obesidad Mórbida/diagnóstico , Obesidad Mórbida/etiología , Obesidad Mórbida/mortalidadRESUMEN
The use of inflatable intragastric balloons is a new non-intensive approach in the treatment of obesity when poor results are obtained by more conservative treatment. The intragastric balloons are certainly less hazardous than bariatric surgery but their long term effect on body-weight reduction it is not still proved. Several types of balloons are currently in use. The two used most widely are the Garren-Edwards Gastric Bubble and the Ballobes Balloon. The Authors report their experience with these two types of anti-obesity gastric-balloon in 60 grossly obese patients.
Asunto(s)
Balón Gástrico , Obesidad/terapia , Estudios de Evaluación como Asunto , Balón Gástrico/efectos adversos , HumanosRESUMEN
Horizontal gastroplasty has been performed on 100 pathologically obese patients over the last nine years. In our series, the mean age was 39.3 +/- 8.2 years and the mean body weight was 120.8 +/- 19.6 kg. One year after surgery the average weight loss was 29.7 kg which corresponds to a reduction of 24.6% of the preoperative weight (BMI:-24%). After three years, the body weight stabilised, reaching a total weight reduction of 30.5% (BMI:-28.7%), corresponding to 36.8 kg. The incidence of complications directly related to surgery was generally acceptable. The absence of specific malabsorption problems, the low incidence of severe complications and the satisfactory weight loss induced and maintained make, in our opinion, horizontal gastroplasty one of the most suitable and effective interventions in the long-term management of morbid obesity.
Asunto(s)
Gastroplastia/métodos , Obesidad Mórbida/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Triglicéridos/sangre , Pérdida de PesoRESUMEN
Jejuno-ileal bypass has been widely used for the surgical treatment of morbid obesity since 1954, but from 1978 onwards the operation has met with increasing disfavor, especially in the USA as a result of its unacceptably high complication rate. From 1982 onwards, 235 morbidly obese patients had a side-to-side jejuno-ileal bypass in our Department. Our data concerning weight loss and the overall incidence of complications show that jejuno-ileal bypass can still play a role in the surgical treatment of morbid obesity.
Asunto(s)
Derivación Yeyunoileal/métodos , Obesidad Mórbida/cirugía , Adolescente , Adulto , Colesterol/sangre , Diarrea/etiología , Femenino , Estudios de Seguimiento , Humanos , Derivación Yeyunoileal/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Pérdida de PesoAsunto(s)
Derivación Yeyunoileal , Estómago/cirugía , Adolescente , Adulto , Peso Corporal , Estudios de Evaluación como Asunto , Femenino , Hospitalización , Humanos , Derivación Yeyunoileal/efectos adversos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/metabolismo , Complicaciones Posoperatorias/epidemiologíaAsunto(s)
Atención Ambulatoria , Íleon/cirugía , Yeyuno/cirugía , Obesidad/terapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados PosoperatoriosAsunto(s)
Íleon/cirugía , Obesidad/terapia , Nutrición Parenteral , Humanos , Yeyuno/cirugía , Complicaciones PosoperatoriasAsunto(s)
Prueba de Tolerancia a la Glucosa , Nutrición Parenteral Total , Nutrición Parenteral , Adulto , Anciano , Ingestión de Energía , Femenino , Neoplasias Gastrointestinales/terapia , Glucosa/administración & dosificación , Prueba de Tolerancia a la Glucosa/métodos , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana EdadRESUMEN
IVGTT was performed in 16 extra-obese patients in order to evaluate the validity of the test in the functional biochemical study of massive obesity. Various glucose doses were used in order to identify the amount providing a constant glycaemic trend and therefore a reliable KG.
Asunto(s)
Glucemia/análisis , Prueba de Tolerancia a la Glucosa/métodos , Obesidad/metabolismo , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OGTT (75 g glucose) and IVGTT (25 g glucose) were compared in 20 extra-obese patients, both glycaemia and insulin levels being calculated. In only 2 out of 7 cases was the glucose intolerance revealed by OGTT confirmed by IGVTT and IVGTT was never able to identify the excessive insulin output revealed by OGTT. It can therefore be confirmed that in the extra-obese even more than in normal patients, IVGTT and OGTT investigate different functions of glucose tolerance and acute insulin output.
Asunto(s)
Prueba de Tolerancia a la Glucosa/métodos , Obesidad/metabolismo , Administración Oral , Adulto , Femenino , Glucosa/administración & dosificación , Humanos , Inyecciones Intravenosas , Insulina/metabolismo , Secreción de Insulina , Masculino , Persona de Mediana EdadRESUMEN
In 15 subjects affected by "severe" obesity, some functional parameters were measured: glycemia, insulinemia, lacticidemia, uricemia, triglyceridemia, following oral load of fructose (100 gms), and separately, of glucose (100 gms). The analysis of the results obtained revealed a trend significantly different in the two cases in the glycemic and insulinemic profiles, whereas no statistically significant variations were observed with reference to the trend of the other parameters taken into consideration.