Suture pattern does not influence outcomes of endoscopic sleeve gastroplasty in obese patients.

Background and study aims ESG is an effective and safe medium-term procedure for obesity treatment. A variety of suture patterns have been reported. We aimed to compare whether there are differences in efficacy depending on suture pattern used. Patients and methods Retrospective and comparative review of 5 years of prospectively collected data, including consecutive obese patients undergoing ESG at two collaborative centers. Primary outcomes included weight loss (mainly % total body weight loss [TBWL] and % exces weight loss [EWL]) at 12 months and safety profile. We compared them according to three suture patterns (transverse bilinear [TBp], longitudinal [Lp] and transverse monolinear [TMp]), and number of sutures (4 - 7) and stitches (< 25, 25 to 30 and > 30) applied. Evolution of major obesity-associated morbidities (hypertension, dyslipidemia, Type 2 diabetes mellitus (T2DM), sleep obstructive apnea syndrome, and arthropathy) were also described. Results 88 patients (mean age 46.1±12.3 years, 69.3 % female) underwent ESG. Mean body mass index (BMI) at baseline was 39.40 ±â€Š4.69 kg/m². At 1 year, %TBWL was 17.36 ±â€Š6.09 % (%EWL 46.41±20.6 %) with TBWL > 10 % in 95.5 % of patients (EWL > 25 % in 94.3 % of patients). According to pattern, there were no differences in %TBWL but there were in %EWL (43.7 ±â€Š20.4 %, 59.8 ±â€Š18.9 % and 45.4 ±â€Š14.9 % in TBp, Lp and TMp patterns, respectively) ( P  = 0.034). No differences were found related to number of sutures (mean 5.2 ±â€Š0.73, r = 4 - 7) or stitches (mean 27.4 ±â€Š6.50, r = 18 - 50) applied. Forty-three of 72 (59.7 %) major comorbidities were resolved. No serious adverse events were observed with any pattern. Conclusions ESG is an effective procedure at 12-month follow-up for weight loss and comorbidity resolution. All three analyzed patterns are safe and effective without differences in %TBWL, but there was a slight increase in %EWL in Lp, regardless of the number of sutures or stitches applied.

Propofol infusion syndrome; are high doses always required? / Síndrome por infusión de propofol; ¿realmente se requieren altas dosis?

Propofol infusion syndrome is a rare condition that mainly affects critically ill patients who receive high doses of this hypnotic for a long time. We describe the case of a patient who presented hepatotoxicity in the immediate postoperative period of two surgeries in which she had received conventional doses of propofol for a short period of time. After studying the patient and monitoring her evolution, we arrived at a differential diagnosis of propofol infusion syndrome due to increased susceptibility. This syndrome should be considered in patients presenting hepatotoxicity in the immediate postoperative period, even when low doses of propofol have been administered.

Síndrome por infusión de propofol; ¿realmente se requieren altas dosis? / Propofol infusion syndrome; are high doses always required?

El síndrome por infusión de propofol es una entidad poco frecuente que afecta principalmente a pacientes críticos que reciben dosis elevadas de este hipnótico durante un tiempo prolongado. Describimos el caso de una paciente que presentó en dos ocasiones hepatotoxicidad en el periodo postoperatorio inmediato de dos cirugías en las que había recibido dosis convencionales de propofol en un periodo corto de tiempo. Después de su estudio, evolución y diagnóstico diferencial, se orienta como posible síndrome por infusión de propofol a causa de una susceptibilidad aumentada. Ante la aparición de una hepatotoxicidad en el postoperatorio inmediato debería tenerse presente esta entidad como posible causa aunque las dosis administradas sean bajas

Propofol infusion syndrome is a rare condition that mainly affects critically ill patients who receive high doses of this hypnotic for a long time. We describe the case of a patient who presented hepatotoxicity in the immediate postoperative period of two surgeries in which she had received conventional doses of propofol for a short period of time. After studying the patient and monitoring her evolution, we arrived at a differential diagnosis of propofol infusion syndrome due to increased susceptibility. This syndrome should be considered in patients presenting hepatotoxicity in the immediate postoperative period, even when low doses of propofol have been administered

[Bacteremia in patients with chronic hepatopathy: a study of 54 cases]. / Bacteriemia en pacientes con hepatopatía crónica: estudio de 54 casos.

The authors reviewed 54 cases of bacteremia in 48 patients with chronic liver disease over a period of two years. Thirty-three were outpatients and 21 were hospitalized. Fifty-eight microorganisms were detected, which represented 10.3% of the total number of germs isolated in all the cases of bacteremia in the hospital during that same period of time. Gram-negative bacilli were predominant, especially Escherichia coli (19 cases); among the gram-positive ones, the most frequent was Staphylococcus aureus (8 cases). There was ascites in 62.9% of the patients, but the predominant symptom was fever. The most frequent sources of infection were: unknown (29.6%), urinary (22.2%), catheter (16.6%) and lung (14.8%). All the in-hospital cases were preceded by an aggressive diagnostic or therapeutic technique. The rate of mortality was 29.6%, and it was highest among patients with gram-negative bacteremia, ascites, Child C (p less than 0.05), complications (hepatic encephalopathy, hemorrhage and/or septic shock) (p less than 0.03), unknown origin or originating from catheter and in-hospital episodes.