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1.
Ann Surg ; 259(1): 117-22, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23314274

RESUMO

OBJECTIVE: This study investigated the practical clinical consequences of offering surgery for metabolic disease and diabetes as opposed to weight loss. BACKGROUND: The terms "metabolic" and "diabetes surgery" indicate a surgical approach whose primary intent is the control of metabolic alterations/hyperglycemia in contrast to "bariatric surgery," conceived as a mere weight-reduction therapy. METHODS: A "metabolic surgery" program distinct from the "bariatric surgery" program was recently established at a tertiary US academic medical center. The 2 programs differ in their stated goals but offer the same procedures and use identical eligibility criteria for patients with morbid obesity. Demographics, clinical characteristics, and 30-day postoperative morbidity and mortality were assessed from a prospective database of 200 consecutive patients who underwent surgery at these units. RESULTS: Metabolic surgery patients were older (45.8±13.4 v 41.8±11.7, P<0.05), had a lower body mass index (42.4±7.1 vs 48.6±9.5 kg/m; P<0.01), and a higher prevalence of being of the male sex (42% vs 26%, P<0.05), having diabetes (62% vs 35%; P<0.01), hypertension (68% vs 52%; P<0.05), dyslipidemia (48% vs 31%; P<0.05), and cardiovascular disease (14% vs 5%; P<0.05). Diabetes was more severe among metabolic surgery patients (higher glycated hemoglobin levels; greater percentage of insulin use). There was no mortality, and there were no differences in perioperative complications. CONCLUSIONS: Offering surgery to treat metabolic disease or diabetes rather than as a mere weight-reduction therapy changes demographical and clinical characteristics of surgical candidates. This has important and practical ramifications for clinical care and support consideration of metabolic/diabetes surgery as a novel practice distinct from traditional bariatric surgery.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus/cirurgia , Doenças Metabólicas/cirurgia , Obesidade/cirurgia , Adulto , Idoso , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Doenças Metabólicas/epidemiologia , Pessoa de Meia-Idade , Nomes , Obesidade/epidemiologia
2.
Obesity (Silver Spring) ; 22(1): 159-69, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23512969

RESUMO

OBJECTIVE: To elucidate the specific role of gastric vs. intestinal manipulations in the regulation of body weight and glucose homeostasis. DESIGN AND METHODS: The effects of intestinal bypass alone (duodenal-jejunal bypass -DJB) and gastric resection alone (SG) in Zucker Diabetic Fatty (ZDF) rats were compared. Additional animals underwent a combination procedure (SG + DJB). Outcome measures included changes in weight, food intake (FI), oral glucose tolerance (GT) and gut hormones. RESULTS: DJB did not substantially affect weight and FI, whereas SG significantly reduced weight gain and food consumption. DJB rats showed weight-independent improvement in GT, which improved less after SG. Furthermore, SG significantly suppressed plasma ghrelin and increased insulin, glucagon like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide and peptide YY response to oral glucose whereas DJB had no effects on postprandial levels of these hormones. DJB restored postprandial glucagon suppression in diabetic rats whereas SG did not affect glucagon response. The combination procedure (SG + DJB) induced greater weight loss and better GT than SG alone without reducing food intake further. CONCLUSIONS: These findings reveal a dominant role of the stomach in the regulation of body weight and incretin response to oral glucose whereas intestinal bypass primarily affects glucose homeostasis by a weight-, insulin- and incretin-independent mechanism.


Assuntos
Glicemia/metabolismo , Peso Corporal , Diabetes Mellitus Tipo 2/cirurgia , Homeostase , Obesidade/cirurgia , Animais , Diabetes Mellitus Experimental/sangue , Diabetes Mellitus Tipo 2/sangue , Duodeno/cirurgia , Gastrectomia , Polipeptídeo Inibidor Gástrico/sangue , Grelina/sangue , Peptídeo 1 Semelhante ao Glucagon/sangue , Teste de Tolerância a Glucose , Insulina/sangue , Derivação Jejunoileal , Jejuno/cirurgia , Masculino , Obesidade/sangue , Peptídeo YY/sangue , Cuidados Pós-Operatórios , Ratos
3.
Surg Obes Relat Dis ; 8(4): 476-82, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22551575

RESUMO

Data from observational and nonrandomized comparative studies have shown a dramatic effect of bariatric surgery on type 2 diabetes mellitus (T2DM), including in nonobese patients. However, a relative paucity of level 1 evidence is available to define the exact role of surgery as a treatment modality for T2DM, especially in less obese subjects. Performing randomized clinical trials in this field, however, poses significant and specific challenges for the study design. We have addressed such challenges in a carefully designed randomized controlled trial comparing glycemic control with optimal medical management versus Roux-en-Y gastric bypass in overweight to mildly obese patients with T2DM mellitus (body mass index 26-35 kg/m(2)). The present report describes the rationale and design of the Weill Cornell Medical College study. In addition to glycemic endpoints, however, clinical trials should also investigate the effect of surgery on cardiovascular risk or T2DM-specific morbidity. Addressing these endpoints would entail large, randomized clinical trials with prolonged period of observation and ideally a multicenter study design. Such a multisite trial poses substantial logistical and financial challenges, which would predictably delay rather than accelerate progress of research in this field. A consortium of centers performing independent small and medium size randomized clinical trials may provide a more realistic and feasible approach. In this paper, we present an overview of on-going randomized clinical trials in this field and propose a worldwide consortium of randomized controlled trials (WORLDCoRDS) using the Weill Cornell Medical College protocol. The aim of this consortium is to standardize research in T2DM surgery and timely accumulate homogeneous data that can help assess the effects of GI surgery on cardiovascular risk and T2DM-related mortality and morbidity.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/cirurgia , Hipoglicemiantes/uso terapêutico , Medicina Baseada em Evidências , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Rev Col Bras Cir ; 38(4): 260-5, 2011.
Artigo em Inglês, Português | MEDLINE | ID: mdl-21971860

RESUMO

OBJECTIVE: To determine whether tacrolimus administered to rats, in the presence of pancreatitis induced by L-Arginine, interferes with the serum levels of amylase and glucose and the histological pattern of the pancreatic parenchyma. METHODS: Forty Wistar rats were divided into four groups with 10 rats each: control group (C), tacrolimus group (T), pancreatitis group (P) and pancreatitis-tacrolimus group (PT). We evaluated serum levels of amylase, glucose, and tacrolimus and made histological assessments of the pancreas. Induction of pancreatitis was made by inoculation of L-Arginine at a dose of 500 mg/100g body weight intraperitoneally, and tacrolimus treatment at a dose of 1ìg/kg subcutaneously for four days. RESULTS: Serum amylase was higher (p = 0.0000) in groups PT, P and T than in the control group. The PT group mean was higher (p = 0.0009) than in the T group, but did not differ (p = 0.6802) from the average of the P group. There was no difference between groups P and T (p = 0.2568). Neither in mean blood glucose between the groups (p = 0.4920); serum levels of tacrolimus were similar in PT and T groups (p = 0.7112). There were no histological changes in groups T and C and no hemorrhage in the pancreas of rats in groups P and PT. In group P, there was no edema in 30%, mild edema in 20% and in 50%, moderate; as for inflammatory infiltration, it was moderate in 80% and absent in 20%, and atrophy of the parenchyma was moderate in 60% and severe in 40%. In the PT group, there was edema, inflammatory infiltration or atrophy in the pancreas in all rats. CONCLUSION: Treatment with Tacrolimus induced an increase in serum amylase in normal mice, but did not affect blood glucose or the histological pattern of the pancreatic parenchyma. In the presence of pancreatitis induced by L-Arginine tacrolimus induced edema, inflammatory infiltration and more severe atrophy in the pancreatic parenchyma.


Assuntos
Amilases/sangue , Glicemia/análise , Pancreatite/sangue , Pancreatite/patologia , Tacrolimo/farmacologia , Doença Aguda , Animais , Arginina/administração & dosagem , Camundongos , Pancreatite/induzido quimicamente , Ratos , Ratos Wistar
5.
Rev. Col. Bras. Cir ; 38(4): 260-265, jul.-ago. 2011. ilus
Artigo em Português | LILACS | ID: lil-601068

RESUMO

OBJETIVO: verificar se o tacrolimus administrado em ratos, em vigência de pancreatite induzida pela L-Arginina, interfere nos níveis séricos da amilase e glicose e no padrão histológico do parênquima pancreático. MÉTODOS: quarenta ratos Wistar foram distribuídos em quatro grupos com 10 ratos cada. Grupo controle (C), grupo tacrolimus (T), grupo pancreatite (P) e grupo pancreatite-tacrolimus (PT). Foram avaliados os níveis séricos de amilase, glicose e tacrolimus e feitas avaliações histológicas do pâncreas, A indução de pancreatite foi feita pela inoculação de L-Arginina na dose de 500mg/100g de peso corporal por via intraperitoneal e o tratamento com tacrolimus na dose de 1ìg/kg por via subcutânea durante quatro dias. RESULTADOS: a amilasemia estava mais elevada (p=0,0000) nos grupos PT, T e P do que no grupo controle. A média do grupo PT foi maior (p=0,0009) que a do grupo T, mas não diferiu (p=0,6802) da média do grupo P. Entre os grupos P e T não houve diferença (p=0,2568). Não houve diferença nas médias de glicemia entre os grupos (p=0,4920) e os níveis séricos de tacrolimus foram similares nos grupos PT e T (p=0,7112). Não ocorreram alterações histológicas nos grupos T e C e não ocorreu hemorragia no pâncreas dos ratos dos grupos P e PT. No grupo P, em 30 por cento não se observou edema, em 20 por cento observou-se a forma leve e em 50 por cento, a moderada; quanto à infiltração inflamatória, em 80 por cento moderada e em 20 por cento não ocorreu, e a atrofia do parênquima foi de 60 por cento moderada e 40 por cento acentuada. No grupo PT, houve ocorrência de edema, infiltração inflamatória e atrofia do pâncreas em todos os ratos. CONCLUSÃO: o tratamento pelo tacrolimus induziu aumento nos níveis séricos de amilase em ratos normais, não alterou a glicemia nem o padrão histológico do parênquima pancreático. Na vigência de pancreatite induzida pela L-Arginina o tacrolimus induziu edema, infiltração inflamatória e atrofia com maior gravidade no parênquima pancreático.


OBJECTIVE: To determine whether tacrolimus administered to rats, in the presence of pancreatitis induced by L-Arginine, interferes with the serum levels of amylase and glucose and the histological pattern of the pancreatic parenchyma. METHODS: Forty Wistar rats were divided into four groups with 10 rats each: control group (C), tacrolimus group (T), pancreatitis group (P) and pancreatitis-tacrolimus group (PT). We evaluated serum levels of amylase, glucose, and tacrolimus and made histological assessments of the pancreas. Induction of pancreatitis was made by inoculation of L-Arginine at a dose of 500mg/100g body weight intraperitoneally, and tacrolimus treatment at a dose of 1ìg/kg subcutaneously for four days. RESULTS: Serum amylase was higher (p = 0.0000) in groups PT, P and T than in the control group. The PT group mean was higher (p = 0.0009) than in the T group, but did not differ (p = 0.6802) from the average of the P group. There was no difference between groups P and T (p = 0.2568). Neither in mean blood glucose between the groups (p = 0.4920); serum levels of tacrolimus were similar in PT and T groups (p = 0.7112). There were no histological changes in groups T and C and no hemorrhage in the pancreas of rats in groups P and PT. In group P, there was no edema in 30 percent, mild edema in 20 percent and in 50 percent, moderate; as for inflammatory infiltration, it was moderate in 80 percent and absent in 20 percent, and atrophy of the parenchyma was moderate in 60 percent and severe in 40 percent. In the PT group, there was edema, inflammatory infiltration or atrophy in the pancreas in all rats. CONCLUSION: Treatment with Tacrolimus induced an increase in serum amylase in normal mice, but did not affect blood glucose or the histological pattern of the pancreatic parenchyma. In the presence of pancreatitis induced by L-Arginine tacrolimus induced edema, inflammatory infiltration and more severe atrophy in the pancreatic parenchyma.


Assuntos
Animais , Camundongos , Ratos , Amilases/sangue , Glicemia/análise , Pancreatite/sangue , Pancreatite/patologia , Tacrolimo/farmacologia , Doença Aguda , Arginina/administração & dosagem , Pancreatite/induzido quimicamente , Ratos Wistar
6.
Acta Cir Bras ; 21 Suppl 3: 16-25, 2006.
Artigo em Português | MEDLINE | ID: mdl-17293933

RESUMO

INTRODUCTION: Investigation of new substances with therapeutic effects have been done trying to isolate, extract or purify new compounds of vegetable origin. The Passiflora edulis (maracujá) species from the Plassifloracia family, originated from the tropical and subtropical regions of the american continent, is found all over Brazil. It is commonly used as a sedative, painkiller and anti-inflammatory drug and also for the treatment of skin wounds, lesions and Erisipelae. PURPOSE: To evaluate the wound healing in colonic anastomosis in rats that received an hydro-alcoholic extract of Passiflora edulis peri-operatively. METHOD: 40 wistar rats were used distributed into two groups of 20 rats each, named: Passiflora edulis group (GP) and control group (GC). The rats of each group were separated into two subgroups of 10 animals each and were evaluated on the 3rd and 7th postoperative days. The surgical procedure consisted of a section of the left colon, 5 cm above the peritoneal reflexion with preservation of the vascular elements. Intestinal continuity was restored by an end-to-end single layer anastomosis. The Passiflora edulis group received an intraperitoneal application of the hydro-alcoholic extract in the dosage of 250 mg/kg. The control-group received one intraperitoneal dose of a saline with the same volume of the GP. The parameters evaluated were: macroscopic aspects of the wall and abdominal cavity, perianastomotic (adherences), bursting pressure, inflammatory tissue reaction on the anastomotic wound. RESULTS: The macroscopic aspects did not differ between the groups. No rupture in the anastomotic wound was seen in any rat. Regarding the bursting pressure, it was noticed that the average pressure was significantly higher in the subgroup that received the Passiflora edulis extract on the 3rd day (P3) (42.6 +/- 17.8 mmHg vs. 25.4 +/- 14.1 mmHg, p=0.028), as compared to the control sub-group (C3). However, on the 7th day, bursting pressure was similar in both groups (p=0.447). Rats from the C7 sub-group had a mean bursting pressure of 203.0 +/- 50.0 mmHg vs. 187.3 +/- 39.5 mmHg in the C7 sub-group. In the histologic analysis the polymorphic nuclear cells were more frequent in the C3 group, with significant differences (p=0.034). The monomorphic nuclear cells (MMN) and the fibroblastic proliferation were more frequent in the P3 sub-group with a significant difference, p=0.02 to MMN, and p=0.001 to the fibroblastic proliferation. On the 7th day there was a significant difference in all histologic criteria stained by hematoxin-eosin and Masson Trichomic (p<0.05) in the sub-group that received the Passiflora edulis extracts. CONCLUSION: The peri-operative administration of the hydro-alcoholic extract of Passiflora edulis has a positive influence on the healing of colonic anastomosis in rats.


Assuntos
Anti-Inflamatórios/uso terapêutico , Colo/cirurgia , Passiflora/química , Fitoterapia , Cicatrização/efeitos dos fármacos , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Anastomose Cirúrgica , Animais , Anti-Inflamatórios/farmacologia , Colágeno/efeitos dos fármacos , Colo/patologia , Corantes/química , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Injeções Intraperitoneais , Masculino , Extratos Vegetais/farmacologia , Extratos Vegetais/uso terapêutico , Distribuição Aleatória , Ratos , Ratos Wistar , Estatísticas não Paramétricas , Resistência à Tração/efeitos dos fármacos , Cicatrização/fisiologia
7.
Acta cir. bras ; 21(supl.3): 14-25, 2006. ilus, tab, graf
Artigo em Português | LILACS | ID: lil-473906

RESUMO

INTRODUÇÃO: Pesquisas de novas substâncias com finalidades terapêuticas têm sido realizadas procurando isolar, extrair ou purificar novos compostos de origem vegetal. A Passiflora edulis (maracujá), espécie pertencente à família Passifloracea, originária das regiões tropicais e subtropicais do continente americano, é popularmente usada como sedativo, analgésico e antinflamatório e no tratamento de lesões cutâneas, feridas e erisipelas. OBJETIVO: Avaliar a cicatrização de anastomoses colônicas em ratos, que receberam extrato hidroalcoólico de Passiflora edulis no trans-operatório. MÉTODOS: Foram utilizados 40 ratos Wistar, distribuídos em dois grupos de 20 animais cada, denominados: grupo Passiflora (GP) e grupo controle (GC). Os ratos de cada grupo foram separados em dois subgrupos de 10 animais cada, avaliados no 3º e 7º dia do pós-operatório. O procedimento cirúrgico constou de secção da alça colônica esquerda, 5cm acima da reflexão peritoneal com preservação da arcada vascular e anastomose término-terminal em plano único. O grupo Passiflora recebeu dose única intraperitoneal do extrato hidroalcoólico de Passiflora edulis na dose de 250 mg/Kg. O grupo controle recebeu dose única de solução salina intraperitoneal em volume igual ao GP. Os parâmetros avaliados foram: aspectos macroscópicos da parede e cavidade abdominal, aderências perianastomóticas, pressão de ruptura à insuflação de ar, reação inflamatória tecidual da anastomose que constou de polimorfonucleares, monomorfonucleares e proliferação fibroblástica. RESULTADOS: Os aspectos macroscópicos não apresentaram diferenças significantes entre os grupos. Não ocorreu nenhuma deiscência de anastomose nos grupos estudados. Com relação à pressão de ruptura à insuflação de ar, observou-se que a média foi significantemente maior no subgrupo que recebeu o extrato de Passiflora no 3º dia (P3), cuja pressão foi 42,6 ± 17,8 mmHg em comparação ao subgrupo controle (C3), cuja pressão foi 25,4 ± 14,1 mmHg, p=0,028. O mesmo não ocorreu no 7º dia, onde o subgrupo C7 apresentou pressão de ruptura de 187,3 ± 39,5 mmHg, enquanto o subgrupo P7, apresentou pressão de ruptura de 203,0 ± 50,0 mmHg, p=0,447. Na análise histológica, os polimorfonucleares foram mais freqüentes no subgrupo C3, em comparação ao subgrupo P3, com diferença significante (p=0,034). Os monomorfonucleares (MMN) e proliferação fibroblástica foram mais freqüentes no subgrupo P3, com diferença significante, onde p=0,02 para MMN, e p=0,001 para proliferação fibroblástica. No 7º dia, houve diferença significante em todas as variáveis histológicas coradas pela hematoxilina-eosina e Tricômico de Masson (p<0,05) no subgrupo que recebeu o extrato de Passiflora. CONCLUSÃO: A administração peroperatória do extrato hidroalcoólico de Passiflora edulis influencia de forma significante na cicatrização das anastomoses colônicas em ratos.


INTRODUCTION: Investigation of new substances with therapeutic effects have been done trying to isolate, extract or purify new compounds of vegetable origin. The Passiflora edulis (maracujá) species from the Plassifloracia family, originated from the tropical and subtropical regions of the american continent, is found all over Brazil. It is commonly used as a sedative, painkiller and anti-inflammatory drug and also for the treatment of skin wounds, lesions and Erisipelae. PURPOSE: To evaluate the wound healing in colonic anastomosis in rats that received an hydro-alcoholic extract of Passiflora edulis peri-operatively. METHOD: 40 wistar rats were used distributed into two groups of 20 rats each, named: Passiflora edulis group (GP) and control group (GC). The rats of each group were separated into two subgroups of 10 animals each and were evaluated on the 3rd and 7th postoperative days. The surgical procedure consisted of a section of the left colon, 5 cm above the peritoneal reflexion with preservation of the vascular elements. Intestinal continuity was restored by an end-to-end single layer anastomosis. The Passiflora edulis group received an intraperitoneal application of the hydro-alcoholic extract in the dosage of 250 mg/kg. The control-group received one intraperitoneal dose of a saline with the same volume of the GP. The parameters evaluated were: macroscopic aspects of the wall and abdominal cavity, perianastomotic (adherences), bursting pressure, inflammatory tissue reaction on the anastomotic wound. RESULTS: The macroscopic aspects did not differ between the groups. No rupture in the anastomotic wound was seen in any rat. Regarding the bursting pressure, it was noticed that the average pressure was significantly higher in the subgroup that received the Passiflora edulis extract on the 3rd day (P3) (42,6 ± 17,8 mmHg vs. 25,4 ± 14,1 mmHg, p=0,028), as compared to the control sub-group (C3). However, on the 7th day, bursting pressure was similar in both groups (p=0.447). Rats from the C7 sub-group had a mean bursting pressure of 203,0 ± 50,0 mmHg vs. 187,3 ± 39,5 mmHg in the C7 sub-group. In the histologic analysis the polimorphic nuclear cells were more frequent in the C3 group, with significant differences (p=0,034). The monomorphic nuclear cells (MMN) and the fibrobastic proliferation were more frequent in the P3 sub-group with a significant difference, p=0,02 to MMN, and p=0,001 to the fibroblastic proliferation. On the 7th day there was a significant difference in all histologic criteria stained by hematoxin-eosin and Masson Trichomic (p<0,05) in the sub-group that received the Passiflora edulis extracts. CONCLUSION: The peri-operative administration of the hydro-alcoholic extract of Passiflora edulis has a positive influence on the healing of colonic anastomosis in rats.


Assuntos
Animais , Masculino , Ratos , Anti-Inflamatórios/uso terapêutico , Colo/cirurgia , Fitoterapia , Passiflora/química , Cicatrização/efeitos dos fármacos , Anastomose Cirúrgica , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Anti-Inflamatórios/farmacologia , Colágeno/efeitos dos fármacos , Colo/patologia , Corantes/síntese química , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Injeções Intraperitoneais , Extratos Vegetais/farmacologia , Extratos Vegetais/uso terapêutico , Distribuição Aleatória , Ratos Wistar , Estatísticas não Paramétricas , Resistência à Tração/efeitos dos fármacos , Cicatrização/fisiologia
8.
Rev. Col. Bras. Cir ; 32(4): 220-222, jul.-ago. 2005. tab
Artigo em Português | LILACS | ID: lil-418007

RESUMO

Orthotopic liver transplantation (OLT) usually requires large amounts of blood transfusion. Reports of OLT without transfusion are scarce and often associated to religious reasons. Herein we report two cases of OLT successfully managed without blood transfusion and not related to religious beliefs.

9.
Rev. Col. Bras. Cir ; 32(2): 104-105, mar.-abr. 2005. ilus
Artigo em Português | LILACS | ID: lil-451108

RESUMO

Fibrolamellar carcinoma of the liver is a distinct variant of hepatocellular carcinoma characterized by the lack of association with cirrhosis or other underlying liver diseases, as hepatitis B virus. The serum alpha-fetoprotein level is often not elevated, occuring typically in young patients. Distinction from conventional hepatocellular carcinoma is of clinical significance, because prognosis is far better due to higher ressecability and more indolent growth. We describe a case of a 26-year-old woman free of other liver diseases presenting with a large abdominal palpable mass. After ressection by vascular exclusion technique, the pathologic examination revealed fibrolamellar carcinoma. The former should not be confused with the hepatocellular carcinoma, since it is related with a more favorable prognosis.

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