Efeitos Das Hormonas Do Apetite Na Gastrectomia Sleeve

Obesity is an extremely prevalent condition worldwide and is associated with significant morbidity and mortality. In order to avoid or delay its evolution and consequent complications, in more severe cases, bariatric surgery should be performed as primary therapy, especially Sleeve Gastrectomy, the most commonly performed surgical technique. This therapeutic option is the most effective in the treatment of obesity and chronic complications, by promoting greater and sustained weight-loss. Also, there are significant changes in glucose homeostasis and even in some cases a remission of diabetes mellitus. It is known that there are numerous gastrointestinal hormones, namely ghrelin, glucagon-like peptide 1 and peptide tyrosine-tyrosine, which have been suggested as important mediators of metabolic changes in the postoperative period, in terms of appetite regulation, weight loss and even glucose homeostasis. In this review, highlighting the changes in the concentrations of these 3 hormones resulting from sleeve gastrectomy surgery is of paramount importance and thus, clarifying the role and impact of these hormones on the postoperative metabolic effects and consequently on the effectiveness of surgery. This review concludes that, after surgery, there is a significant decrease in fasting and postprandial ghrelin levels and a significant increase in postprandial levels of glucagon-like peptide 1 and peptide tyrosine-tyrosine, thus contributing to the success of sleeve gastrectomy.  A obesidade é uma condição extremamente prevalente na população mundial associada a uma importante morbimortalidade. De modo a evitar ou atrasar a sua evolução e consequentemente complicações, em casos mais severos, deve-se proceder à cirurgia bariátrica como terapêutica de eleição, destacando-se a gastrectomia sleeve, técnica cirúrgica mais comumente realizada. Esta opção terapêutica é a mais eficaz no tratamento da obesidade e complicações a longo prazo, ao promover uma maior e sustentada perda de peso. Como efeito da cirurgia verificam-se alterações significativas na homeostasia da glicose e até mesmo em alguns casos uma remissão da diabetes mellitus. Sabe-se que existem inúmeras hormonas gastrointestinais, nomeadamente a grelina, o glucagon-like peptide 1 e o péptido tirosina-tirosina, que têm sido sugeridas como importantes mediadores das alterações metabólicas no pós-operatório, a nível da regulação do apetite, da perda de peso e até da homeostasia da glicose. Torna-se então fulcral evidenciar as alterações das concentrações destas 3 hormonas resultantes da realização da gastrectomia sleeve, e assim esclarecer o papel e o impacto destas nos efeitos metabólicos pós-operatórios e consequentemente na eficácia da cirurgia. Nesta revisão conclui-se que, após a realização da cirurgia, ocorre uma diminuição dos níveis séricos em jejum e pós-prandiais de grelina e um aumento dos níveis pós-prandiais do glucagon-like peptide 1 e do péptido tirosina-tirosina, de forma significativa, contribuindo assim para o sucesso da gastrectomia sleeve

CATÁSTROFE DA PAREDE ABDOMINAL, ESTRATÉGIA TERAPÊUTICA – RELATO DE UM CASO CLÍNICO E REVISÃO DA LITERATURA

A complete abdominal wall defect (AWD) is life-threatening, has a functional and cosmetic impact on patients’ quality of life and represents a significant challenge for surgeons, requiring a multidisciplinary treatment strategy. The goals of the reconstructive surgery in the management of these defects are to provide stable coverage of the abdominal contents, restore function and achieve complete wound closure. We present a case that shows that the use of a biological mesh (porcine dermis), negative wound pressure therapy (NPWT) and split skin grafting is suitable to manage such defects when visceral exposure is present. A biological mesh is a good and less aggressive alternative to the use of free flaps, closing the AWD in a tension-free manner in an infected field or in one that is suspected of being infected and it has been shown to be better tolerated than synthetic meshes in open abdomens, with the ability to provide vascular ingrowth and incorporate itself into the native tissue. On the other hand, NPWT showed to provide a firm bandage for the patient and a closed, moist environment, protected from the invasion of bacteria, while eliminating excessive exudation, stimulating angiogenesis and reducing the wound surface area. Um defeito completo da parede abdominal (AWD) ameaça a vida, tem um impacto funcional e cosmético na vida dos doentes e representa um grande desafio para os cirurgiões, exigindo uma estratégia de tratamento multidisciplinar. Os objetivos da cirurgia reconstrutiva no tratamento destes defeitos são fornecer uma cobertura estável do conteúdo abdominal, restaurar a função da parede abdominal e atingir um encerramento completo da ferida. Apresentamos um caso clínico que mostra que o uso de uma prótese biológica (derme suína), terapia de pressão negativa (NPWT) e enxertos cutâneos é adequado para tratar estes defeitos quando o doente tem exposição visceral. O uso de uma prótese biológica é uma alternativa boa e menos agressiva em comparação com o uso de retalhos livres, encerrando o AWD sem tensão num terreno infetado, e mostrou ser melhor tolerado do que o uso de próteses sintéticas num abdómen aberto, com a capacidade de fornecer um meio para crescimento vascular e de se incorporar aos tecidos do doente. Por outro lado, a NPWT mostrou fornecer um ambiente firme, fechado e húmido, protegido da invasão de bactérias, ao mesmo tempo que elimina a exsudação excessiva, estimula a angiogénese e reduz a área de superfície da ferida.&nbsp

ABORDAGEM LOCO-REGIONAL NA TERAPÊUTICA DO CARCINOMA HEPATOCELULAR

Hepatocellular carcinoma ranks 5th in terms of the most frequent neoplasms, currently constituting one of the main causes of death from cancer. The vast investigation and growing knowledge on the mechanisms of this neoplasia, allowed the development of a set of therapies, which can be used alone or combined, thus contributing to a change in the treatment paradigm for these patients. Liver resection is the method of choice for approaching this carcinoma, however transplantation remains a curative option used when hepatectomy is contraindicated. The development of loco-regional ablation and embolization techniques has shown great efficacy and a growing interest in tumor combat, either alone or in conjunction with surgery, as they often allow tumor regression so that hepatocellular carcinoma meets the criteria for resectability and / or transplantation. Systemic targeted therapy, immunotherapy and the combination of loco-regional techniques have contributed to the possibility of curing this neoplasia. The author reviewed the various therapeutic options for approaching hepatocellular carcinoma currently used.O carcinoma hepatocelular ocupa a 5a posição no que diz respeito às neoplasias mais frequentes, constituindo atualmente uma das principais causas de morte por cancro. A vasta investigação e crescente conhecimento nos mecanismos desta neoplasia, permitiu o desenvolvimento de um conjunto de terapêuticas, que podem ser utilizadas isoladamente ou combinadas, contribuindo deste modo para uma mudança no paradigma do tratamento destes doentes. A resseção hepática constitui o método de eleição para a abordagem deste carcinoma, porém o transplante continua a ser uma opção curativa utilizada quando a hepatectomia está contra-indicada. O desenvolvimento de técnicas loco-regionais de ablação e embolização têm mostrado grande eficácia e um interesse crescente no combate tumoral, quer isoladamente quer em conjunto com a cirurgia por permitirem muitas vezes fazer uma regressão tumoral de modo que o carcinoma hepatocelular se enquadre nos critérios de ressecabilidade e/ou transplante. A terapêutica sistémica dirigida, a imunoterapia e a combinação de técnicas loco-regionais tem contribuído para a possibilidade de cura desta neoplasia. O autor fez uma revisão das várias opções terapêuticas de abordagem do carcinoma hepatocelular atualmente utilizadas

Approach to synchronous liver metastases from colorectal carcinoma - results from a Portuguese reference center

About 15%-25% of patients with colorectal cancer, have synchronous liver metastases. The best surgical approach for the patients with asymptomatic primary colorectal tumor and synchronous liver metastases is still the subject of much debate. We aimed to evaluate the perioperative and long-term results as well as to identify possible prognostic factors of the two strategies:  liver- first and synchronous resection. Observational, retrospective study, which included patients with synchronous liver metastases from colorectal cancer, who underwent liver surgery between January 2016 and December 2021, in a Portuguese reference center. Patients were divided into two groups according to the therapeutic approach (synchronous resections vs Liver First) and into three groups according to the hepatic tumor burden (single liver lesion versus more than three liver lesions versus bilobar lesions). To determine the overall and disease-free survival, Kaplan-Meier curves and the log-rank test were performed and, to identify factors with an impact on the prognosis, a univariate and multivariate analysis were performed with the application of Cox regression (significance of 5%). Among the 46 patients included, 54,4% underwent the liver-first approach and 21 patients (45.7%) underwent simultaneous resection. The liver-first group had a greater number of patients with primary rectal tumor (84% vs.14.3%; p<0.001), with more than 3 hepatic lesions (56% vs.14%; p=0.004) and with more extensive hepatic resection. As for postoperative morbimortality, no statistically significant difference was observed between the two approaches (p=0.514). The median overall survival was similar even when considering the hepatic tumor burden (35.0 months (95%CI 15.91- 54.09) in the liver-first group vs. 48.0 months (95%CI 21.69-74.96) in the synchronous resection group; p=0.145). The same was observed for the median disease-free survival (16.0 months (95% CI 0-32.7) vs. 23.0 months (95% CI 16.3-29.7) p=0.651, respectively). The two strategies showed similar morbidity. No statistically significant difference was observed with regard to overall and disease-free survival even when the hepatic tumor burden was considered. One-year and three-year survival were also similar. However, it should be stressed that, the choice of the surgical approach for each group did not took into account the hepatic tumor burden, which we believe it is essential in choosing the best surgical approach.The existence of a multidisciplinary team is fundamental for the therapeutic success of these patients

Portal venous pressure variation during hepatectomy: a prospective study

Excessive portal venous pressure in the liver remnant is an independent factor in the occurrence of posthepatectomy liver failure and small-for-size syndrome. The baseline portal pressure prior to hepatectomy was not considered previously. The aim of this study is to assess the impact of portal pressure change during hepatectomy on the patient outcome.info:eu-repo/semantics/publishedVersio

Plasmatic Oxidative and Metabonomic Profile of Patients with Different Degrees of Biliary Acute Pancreatitis Severity

Acute pancreatitis (AP) is an inflammatory process of the pancreas with variable involvement of the pancreatic and peripancreatic tissues and remote organ systems. The main goal of this study was to evaluate the inflammatory biomarkers, oxidative stress (OS), and plasma metabolome of patients with different degrees of biliary AP severity to improve its prognosis. Twenty-nine patients with biliary AP and 11 healthy controls were enrolled in this study. We analyzed several inflammatory biomarkers, multifactorial scores, reactive oxygen species (ROS), antioxidants defenses, and the plasma metabolome of biliary AP and healthy controls. Hepcidin (1.00), CRP (0.94), and SIRI (0.87) were the most accurate serological biomarkers of AP severity. OS played a pivotal role in the initial phase of AP, with significant changes in ROS and antioxidant defenses relating to AP severity. Phenylalanine (p < 0.05), threonine (p < 0.05), and lipids (p < 0.01) showed significant changes in AP severity. The role of hepcidin and SIRI were confirmed as new prognostic biomarkers of biliary AP. OS appears to have a role in the onset and progression of the AP process. Overall, this study identified several metabolites that may predict the onset and progression of biliary AP severity, constituting the first metabonomic study in the field of biliary AP

De novo colorectal cancer after liver and kidney transplantation–Microenvironment disturbance

Colorectal cancer (CRC) is a major health burden and may arise as a complication of solid organ transplantation. Our study aimed to assess the incidence of the CRC in kidney and liver transplanted patients at a tertiary and reference center and to describe their clinical and pathological features. Twelve patients, 10 men and two women, with a mean age of 60 years, composed our cohort, ten of them submitted to CRC resection. Transplanted organ was liver in five patients and kidney in seven. Regarding overall survival, patients submitted to renal transplantation were all deceased 5 years after CRC diagnosis, while those subjected to hepatic transplantation had a survival of 60% at the fifth year. Pathology examination showed seven patients with advanced disease (stage III/IV) and high amount of necrosis. Tumor microenvironment was disturbed, with low inflammatory infiltrate, absence of natural killer cells and no PD-L1 expression. CRC exhibited microsatellite instability in 40%, with expression of cancer stem cell markers (CD133, CD44 and ALDH1), as well as P53 (50%) and KRAS mutations (41.7%). CRC cancer after kidney and hepatic transplantation is a rare, but aggressive and deadly event. Regular follow-up should be instituted in these patients

Liver Metastases and Histological Growth Patterns: Biological Behavior and Potential Clinical Implications-Another Path to Individualized Medicine?

Colorectal cancer is a major health burden and despite the recent advances in healthcare and screening programs, a great percentage of patients already present metastases once their disease is found. In those cases, liver surgery has an essential role, but even with neoadjuvant chemotherapy there is a high rate of intrahepatic recurrence. New prognostic factors are needed in order to decide the best surgical approach considering the biological behavior of the tumors in order to tailor the used therapies, moving towards individualized medicine/treatment. However, the majority of the factors described in literature are expensive, time consuming, and difficult to apply on a daily basis. Histological growth patterns have emerged over the past few years as a reproducible characteristic, an easy to apply one, and with very low costs since it only needs the standard Haematoxylin and Eosin stained slides of observation. In this article, we provide a review of the histological growth patterns of liver metastases and their prognostic significance, biological meaning, and therapeutic importance