[Biliopancreatic bypass in the treatment of severe obesity: long-term clinical, nutritional and metabolic evaluation]. / Diversione bilio-pancreatica per la terapia della grave obesità: valutazioni clinico-nutrizionali e metaboliche a lungo termine.

Biliopancreatic bypass surgery leads to considerable weight loss and the stabilisation over time of the newly acquired body weight. The aim of this study was to evaluate the long-term clinical and nutritional conditions of patients undergoing this operation. Thirty subjects who had undergone biliopancreatic bypass surgery (7 males and 23 females) aged between 20 and 55 years old, with body mass indexes between 35 and 80, were examined at yearly intervals (maximum follow-up 5 years). Tha following parameters were evaluated at each control: body weight, presence of collateral effects, support therapy, main hematochemical parameters, nutritional behavior and calorie intake. All patients recorded a significant reduction in body weight with a mean weight loss of 28% during the first year; these values were confirmed during the second year, whereas body weight tended to stabilise in the long-term. Laboratory data showed a significant reduction in triglycerides, cholesterol, glycemia in all patients; sideropenic anemia appeared in 50% of patients. Mean daily calorie intake was 2,200 kcal/day, broken down as follows: glucides 50%, lipids 33%, proteins 17%. The main collateral effects reported were: diarrhea, vomit, flatulence, onset of food intolerances. The following support therapies were used: iron in 90% of cases, calcium in 60% and 30% of patients also underwent surgery. In conclusion, biliopancreatic bypass surgery enables a significant weight loss to be achieved together with an improved glycolipid status without leading to nutritional deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Antioxidant vitamins or lactulose for the prevention of the recurrence of colorectal adenomas. Colorectal Cancer Study Group of the University of Modena and the Health Care District 16.

Colonic adenomas represent the natural precursor lesions of most colorectal cancers. The treatment of choice is endoscopic polypectomy. However, after endoscopic removal, polyps recur in a large fraction of cases. Thus, we evaluated the effect of antioxidant vitamins or lactulose on the recurrence rate of adenomatous polyps. After polypectomy, 255 individuals were randomized into three groups. Group 1 was given vitamin A (30,000 IU/day), vitamin C (1 g/day), and vitamin E (70 mg/day); Group 2 was given lactulose (20 g/day); Group 3 received no treatment. Forty-six subjects had to be excluded because the histologic diagnosis was not consistent with adenoma. The remaining 209 individuals were included in the analysis according to the "intention to treat" criterion, though 34 did not adhere to the scheduled treatment or were lost during the follow-up. Subjects were followed at regular intervals for an average of 18 months. Polyps recurring before one year from index colonoscopy were considered missed by the endoscopist. In the 209 evaluable subjects, the percentages of recurrence of adenomas were 5.7 percent, 14.7 percent, and 35.9 percent in the vitamins, lactulose, and untreated groups, respectively. The fraction of subjects remaining free of adenomas, estimated by Kaplan-Meier survival curves, was significantly different among the three groups (log-rank chi-squared = 17.138; P < 0.001). Using Cox's regression analysis, treatment was the only variable that significantly contributed to the model (regression coefficient = 0.905; P < 0.001). In conclusion, either antioxidant vitamins or, to a lesser extent, lactulose lower the recurrence rate of adenomas of the large bowel and can be proposed as chemopreventive agents, at least in high-risk individuals.