Micronutrient Deficiencies After Roux-en-Y Gastric Bypass: Long-Term Results.

BACKGROUND: Patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) are under risk of micronutrient deficiencies. We aimed to assess the preoperative and postoperative micronutrient deficiencies in a sample of patients with obesity who underwent LRYGB. METHODS: We evaluated 169 patients-satisfying the National Institute of Health criteria for bariatric surgery-who underwent a LRYGB from January 2014 to July 2017. Before surgery, we recorded a detailed medical history for every patient, and after surgery, we instructed them to return at 1, 6, 12, 24, 36, and 48 months after surgery. RESULTS: Preoperatively, anemia was present in 4.24% of patients, iron deficiency in 5.33%, vitamin B12 deficiency in 12.3%, and vitamin D deficiency in 74.35%. Postoperatively, the deficiency rates of calcium, magnesium, folate, and vitamins A, B1, and B6 were markedly low at 1, 2, and 3 years after surgery. In regard to anemia, iron, and vitamin B12, rates of deficiency were higher at 2 and 3 years postoperatively versus preoperatively, but only anemia (4% vs 14% and 4% vs 27%, at 2 and 3 years) and iron (5% vs 23% at 3 years) reached statistical significance. Compared with the preoperative assessment, the rates of vitamin D deficiency decreased over time (74% vs 50% at 1 year [p < 0.001], 74% vs 45% at 2 years [p < 0.002] and 74% vs 41% at 3 years [p < 0.04]). CONCLUSIONS: Vitamin D deficiency remains the most common preoperative deficiency. Anemia and deficiencies of iron and vitamin B12 are common before and after surgery. Deficiencies of calcium, magnesium, folate, and vitamins A, B1, and B6 are markedly low in the postoperative period.

Edema pulmonar de reexpansión en avenamiento pleural por neumotórax / Re-expansion pulmonary edema afer pleural drainage of pneumothorax

Se trata de un paciente masculino de 28 años que consultó por dolor torácico izquierdo, acompañado de disnea de 4 días de evolución. La radiografia de tórax confirmó la sospecha de neumotórax izquierdo. Cuarenta minutos después de realizado el avenamiento pleural izquierdo, el paciente comenzó con tos productiva y disnea. La radiografia de tórax evidenció infltrados en el pulmón izquierdo. La tomografia computarizada de tórax confirmó el edema pulmonar de reexpansión. El paciente cursó la internación en terapia intensiva con tratamiento de soporte. Se retró el tubo de tórax al sexto día y se otorgó el alta hospitalaria.

A 28 year old man presented with lef thoracic pain and dyspnea for the four previous days. Chest X-ray evidenced a lef pneumothorax. Forty minutes afer inserton of a pleural drainage, the patent complained of dyspnea and productive cough. A new chest X-ray showed pulmonary infltrates in the lef lung. A computed tomographic scan was consistent with re-expansion pulmonary edema. The patent spent a postoperative course in the intensive care unit with suportive therapy. The pleural drain was withdrawn on the sixth day, and was discharged home.