Dihydrosphingolipids are associated with steatosis and increased fibrosis damage in non-alcoholic fatty liver disease.

Dihydrosphingolipids are lipids biosynthetically related to ceramides. An increase in ceramides is associated with enhanced fat storage in the liver, and inhibition of their synthesis is reported to prevent the appearance of steatosis in animal models. However, the precise association of dihydrosphingolipids with non-alcoholic fatty liver disease (NAFLD) is yet to be established. We employed a diet induced NAFLD mouse model to study the association between this class of compounds and disease progression. Mice fed a high-fat diet were sacrificed at 22, 30 and 40 weeks to reproduce the full spectrum of histological damage found in human disease, steatosis (NAFL) and steatohepatitis (NASH) with and without significant fibrosis. Blood and liver tissue samples were obtained from patients whose NAFLD severity was assessed histologically. To demonstrate the effect of dihydroceramides over NAFLD progression we treated mice with fenretinide an inhibitor of dihydroceramide desaturase-1 (DEGS1). Lipidomic analyses were performed using liquid chromatography-tandem mass spectrometry. Triglycerides, cholesteryl esters and dihydrosphingolipids were increased in the liver of model mice in association with the degree of steatosis and fibrosis. Dihydroceramides increased with the histological severity observed in liver samples of mice (0.024 ± 0.003 nmol/mg vs 0.049 ± 0.005 nmol/mg, non-NAFLD vs NASH-fibrosis, p < 0.0001) and patients (0.105 ± 0.011 nmol/mg vs 0.165 ± 0.021 nmol/mg, p = 0.0221). Inhibition of DEGS1 induce a four-fold increase in dihydroceramides improving steatosis but increasing the inflammatory activity and fibrosis. In conclusion, the degree of histological damage in NAFLD correlate with dihydroceramide and dihydrosphingolipid accumulation. LAY SUMMARY: Accumulation of triglyceride and cholesteryl ester lipids is the hallmark of non-alcoholic fatty liver disease. Using lipidomics, we examined the role of dihydrosphingolipids in NAFLD progression. Our results demonstrate that de novo dihydrosphingolipid synthesis is an early event in NAFLD and the concentrations of these lipids are correlated with histological severity in both mouse and human disease.

La comunicación entre el paciente obeso y el cirujano bariátrico / Communication between the obese patient and bariatric surgeon

La comunicación entre el cirujano bariátrico y el paciente obeso es muy importante, ya que influye en las expectativas de los pacientes respecto a la cirugía, sus objetivos y la comprensión de los mecanismos por los que esta puede fallar. Además, la incidencia de determinadas condiciones psicopatológicas en este grupo de población exige a los cirujanos poseer unas habilidades psicológicas que les permitan una comunicación destinada a conseguir el compromiso del paciente y el mantenimiento de unos hábitos de vida saludables. A pesar de la subjetividad del tema, en este artículo se exponen ciertas recomendaciones útiles para optimizar dicha comunicación antes y después de la intervención quirúrgica. Por último, destacamos la necesidad de crear talleres destinados a la formación del cirujano bariátrico en esta faceta que consideramos tan importante

Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important

Communication between the obese patient and bariatric surgeon.

Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important.

Rabdomiolisis tras intervención de angiofibroma de cavum de larga duración / Rhabdomyolysis following lengthy surgery on a nasopharyngeal angiofibroma

No disponible

[Long-term results of laparoscopic gastric bypass in patients with morbid obesity. a prospective study of 508 cases]. / Resultados a largo plazo del bypass gástrico laparoscópico en pacientes con obesidad mórbida. Estudio prospectivo de 508 casos.

INTRODUCTION: Although there are publications on the short-medium term results of gastric bypass, publications of long-term results are very limited and the results are less documented. PATIENTS AND METHOD: In this article we present the experience of the same surgical team with laparoscopic gastric bypass over 7 years, with a follow-up of 97% of the patients. From March 2000 until May 2007, 508 laparoscopic gastric bypasses were performed by the same surgical team. RESULTS: Of the 508 patients who were subjected to laparoscopic gastric bypass, 353 were women (69.5%) and 155 were men (30.5%), with a mean age of 40 years (16-71), a mean pre-operative weight of 131.3 +/- 24.5 kg (80-230) and a mean BMI of 48.3 +/- 7 (34-78). There were early complications (< 30 days) in 14.7% of the patients and delayed complications (> 30 days) in 7.3%. The mean operation time was 125.8 +/- 35.6 minutes (60-300). The mean hospital stay was 3 +/- 2.6 days (1-40). The mortality of the series was 0.8%. The EWL and BMI loss at 3 and 5 years was 77.8% and 75.1% and 82.7% and 79.8%, respectively. CONCLUSIONS: Laparoscopic gastric bypass is an effective technique for the long-term treatment of morbid obesity, with a low number of complications, low mortality, excellent weight loss and recovery or improvement of the comorbidities associated with these patients.

Resultados a largo plazo del bypass gástrico laparoscópico en pacientes con obesidad mórbida. Estudio prospectivo de 508 casos / Long-term results of laparoscopic gastric bypass in patients with morbid obesity. A prospective study of 508 cases

Introducción. En la actualidad hay publicaciones de los resultados del bypass gástrico a corto-medio plazo, pero a largo plazo las publicaciones son escasas y los resultados están menos documentados. Pacientes y método. En este artículo presentamos la experiencia con el bypass gástrico laparoscópico de un mismo equipo quirúrgico a lo largo de 7 años, con un seguimiento del 97% de los pacientes. Desde marzo de 2000 hasta mayo de 2007, en nuestro hospital, un mismo equipo quirúrgico realizó 508 bypass gástricos por vía laparoscópica. Resultados. De los 508 pacientes sometidos a bypass gástrico laparoscópico, 353 (69,5%) eran mujeres y 155 (30,5%), varones, con una media de edad de 40 (16-71) años, un peso medio preoperatorio de 131,3 ± 24,5 (80-230) kg y un índice de masa corporal (IMC) medio de 48,3 ± 7 (34-78). Ocurrieron complicaciones precoces ( 30 días) en el 7,3% de los pacientes. El tiempo operatorio medio fue de 125,8 ± 35,6 (60-300) min. La estancia hospitalaria media fue de 3 ± 2,6 (1-40) días. La mortalidad de la serie fue del 0,8%. El porcentaje de peso perdido y el de exceso de IMC perdido a los 3 y 5 años ha sido del 77,8 y el 75,1% y del 82,7 y el 79,8%, respectivamente. Conclusiones. El bypass gástrico por laparoscopia es una técnica eficaz para el tratamiento a largo plazo de la obesidad mórbida, con escaso número de complicaciones, baja mortalidad, excelente pérdida de peso y curación o mejora de las comorbilidades asociadas en estos pacientes (AU)

Introduction. Although there are publications on the short-medium term results of gastric bypass, publications of long-term results are very limited and the results are less documented. Patients and method. In this article we present the experience of the same surgical team with laparoscopic gastric bypass over 7 years, with a follow-up of 97% of the patients. From March 2000 until May 2007, 508 laparoscopic gastric bypasses were performed by the same surgical team. Results. Of the 508 patients who were subjected to laparoscopic gastric bypass, 353 were women (69.5%) and 155 were men (30.5%), with a mean age of 40 years (16-71), a mean pre-operative weight of 131.3 ± 24.5 kg (80-230) and a mean BMI of 48.3 ± 7 (34-78). There were early complications ( 30 days) in 7.3%. The mean operation time was 125.8 ± 35.6 minutes (60-300). The mean hospital stay was 3 ± 2.6 days (1-40). The mortality of the series was 0.8%. The EWL and BMI loss at 3 and 5 years was 77.8% and 75.1% and 82.7% and 79.8%, respectively. Conclusions. Laparoscopic gastric bypass is an effective technique for the long-term treatment of morbid obesity, with a low number of complications, low mortality, excellent weight loss and recovery or improvement of the comorbidities associated with these patients (AU)

Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study.

OBJECTIVE: The objective of the study was to compare the results of open versus laparoscopic gastric bypass in the treatment of morbid obesity. SUMMARY BACKGROUND DATA: Gastric bypass is one of the most commonly acknowledged surgical techniques for the management of morbid obesity. It is usually performed as an open surgery procedure, although now some groups perform it via the laparoscopic approach. PATIENTS AND METHODS: Between June 1999 and January 2002 we conducted a randomized prospective study in 104 patients diagnosed with morbid obesity. The patients were divided into 2 groups: 1 group with gastric bypass via the open approach (OGBP) comprising 51 patients, and 1 group with gastric bypass via the laparoscopic approach (LGBP) comprising 53 patients. The parameters compared were as follows: operating time, intraoperative complications, early (<30 days) and late (>30 days) postoperative complications, hospital stay, and short-term evolution of body mass index. RESULTS: Mean operating time was 186.4 minutes (125-290) in the LGBP group and 201.7 minutes (129-310) in the OGBP group (P < 0.05). Conversion to laparotomy was necessary in 8% of the LGBP patients. Early postoperative complications (<30 days) occurred in 22.6% of the LGBP group compared with 29.4% of the OGBP group, with no significant differences. Late complications (>30 days) occurred in 11% of the LGBP group compared with 24% of the OGBP group (P < 0.05). The differences observed between the 2 groups are the result of a high incidence of abdominal wall hernias in the OGBP group. Mean hospital stay was 5.2 days (1-13) in the LGBP group and 7.9 days (2-28) in the OGBP group (P < 0.05). Evolution of body mass index during a mean follow-up of 23 months was similar in both groups. CONCLUSIONS: LGBP is a good surgical technique for the management of morbid obesity and has clear advantages over OGBP, such as a reduction in abdominal wall complications and a shorter hospital stay. The midterm weight loss is similar with both techniques. One inconvenience is that LGBP has a more complex learning curve than other advanced laparoscopic techniques, which may be associated with an increase in postoperative complications.