Casos Clínicos en Cirugía. Manejo multidisciplinar del pie diabético

La organización asistencial a la atención del paciente con Pie Diabético está avocada de manera inequívoca a una asistencia multidisciplinar, necesaria y demostrada por múltiples estudios y publicaciones. El objetivo es una atención integral, equilibrada y personalizada, cumpliendo con uno de los objetivos más importante pero no por ello el único: disminución de las tasas de amputaciones. El libro “Casos clínicos en Cirugía. Manejo multidisciplinar del Pie Diabético”, recopila treinta y siete capítulos en el que participan las distintas especialidades médico-quirúrgicas que abordan estos pacientes en el Hospital Universitario de Puerto Real (Cádiz). Pretende mostrar la actividad asistencial en el día a día de este problema sanitario que va en aumento debido al envejecimiento de la población. Colaboran el Servicio de Angiología y Cirugia Vascular (H.U. Puerta del Mar), referente vascular de nuestro Hospital. También se incluyen casos clínicos del Servicio de Angiología y Cirugia Vascular del H.U. Virgen de la Victoria-Málaga y del Servicio de Cirugia General del H.U. Rio Tinto-Huelva. Por último comentar que hemos creído interesante la inclusión de dos capítulos de anatomía, junto a los treinta y siete casos clínicos, pudiéndose usar estos de recuerdo para el lector. Este sencillo libro de casos clínicos puede aportar una perspectiva, quizás, distinta a como muchos sanitarios la entienden (médicos especialistas y de atención primaria así como personal de enfermería). Somos conscientes de los posibles desacuerdos que puedan generar la lectura de algún capítulo o apartado. No obstante, estas discrepancias deben servir de aliciente científico adicional para continuar progresando, tanto a los autores como al propio lector. Sirva este libro como una herramienta adicional a las ya existentes para los profesionales que abordan esta entidad

Una experiencia de formación integral a través del fútbol

Soccer’s current social impact makes it a very powerful tool for the comprehensive training of those minors who come to practice it. It is especially valuable among young people of school age, who may otherwise lose motivation and begin to frequent places that lead them away from their studies. For young people with their dreams, soccer can focus their attention and contribute to their overall education. In this work, we present the results of a program carried out with three soccer teams in the city of Cádiz, Spain. For each team, we analyzed six aspects of interest from the comprehensive training program of the players: academic training; fair play; health, hygiene and nutrition; training for coaching staff; training for parents and social responsibility. The experience was relevant and positive for players, parents, and teams. The results were very encouraging. The interest on the part of the team officials, players, and parents was clear.El impacto social que produce el fútbol constituye una herramienta muy potente para la formación integral de los menores que lo practican. Es especialmente valioso entre la juventud en edad escolar, que podrían de otra manera perder la motivación y comenzar a frecuentar lugares que les alejen de sus estudios. Para la juventud, con sus sueños, el futbol puede enfocar su atención y contribuir a su educación general. En este trabajo, presentamos los resultados de un programa llevado a cabo con tres equipos de fútbol en la ciudad de Cádiz, España. Para cada equipo, se han analizado seis aspectos de interés desde este programa de formación integral de los jugadores: formación académica; juego limpio; salud, higiene y nutrición; entrenamiento del cuerpo técnico; entrenamiento de los padres y madres y responsabilidad social. La experiencia fue relevante y positiva para jugadores, familiares y equipos. Los resultados fueron muy alentadores. El interés por parte de los equipos, jugadores, padres y madres fue claro

Enseñanza de Anatomía de Superficie Mediante la Pintura Corporal

The present project on learning surface anatomy through the body painting method was undertaken because anatomical knowledge supports medical practice. The appropriate anatomical training of the doctor depends on surface anatomy. We considered the renovation of teaching strategies and didactic resources to optimize the overall teaching- learning process. 189 first-year medical students, enrolled in the Trunk and Splanchnology course at the University of Cádiz (Spain) participated in this study. Students were divided into 5 groups each of 38-41 students. The students were asked to complete a satisfaction questionnaire supplied to each participant through an on-line platform. On the basis of the results, we recommend the body painting method as an alternative tool for learning surface and clinical anatomy

A surgical model of short bowel syndrome induces a long-lasting increase in pancreatic beta-cell mass

Several surgical techniques are used nowadays as a severe treatment for obesity and diabetes mellitus type 2. These techniques are aggressive due to drastic changes in the nutrient flow and non-reversible modifications on the digestive tube. In this paper we present the effects of a massive intestinal resection on the pancreas. Results have shown that short bowel technique is less aggressive to normal anatomy and physiology of the intestinal tract than Gastric bypass or biliopancreatic diversion (e.g.). In this paper we reproduce a model of short bowel syndrome (SIC), with similar surgical conditions and clinical complications as seen in human cases. This work was conducted on normal Wistar rats, with no other concurrent factors, in order to determine the effects on normal pancreas islets. We measured pancreatic implications by histomorphometric studies, which included beta-cell mass by immunocytochemistry, and apoptosis/proliferation test with TUNEL technique and Ki-67. Briefly, we reported on an increased relative area of the islets of the pancreas, as well as an increase in the average size of islets in the SIC versus the control group. Furthermore we stated that this increase in size of the pancreatic islets is due to the mechanisms of proliferation of beta cells in animals undergoing SIC. These goals could reveal a direct influence of surgical modification of the digestive tract over the pancreatic beta cell homeostasis. In this sense, there are many potential stimulators of intestinal adaptation, including peptide hormones and growth components which are associated or involved as effectors of the endocrine pancreas

A classical model of educational cooperation in Human Anatomy: the Table Leaders

This project has been developed for many years in the Human Anatomy courses. Its good outcomes have been confirmed by years of evidence of excellent results obtained through the learning of Human Anatomy. This method of teaching and learning as one allows students who are taking Human Anatomy classes to receive practical training in small groups and transmit it to their colleagues in the practical training established in the Medical degree. Table Leaders feel rewarded as they learn to speak in public, regularly transmitting the knowledge obtained, and by having to be up to date with their studies. These are all aspects that help, not only the Table Leaders process of learning, but also that of their colleagues, who see closely and carefully anatomical details that help them understand the subject. This method of supporting practical training is always under the supervision of the teacher who develops the practical classes. These Leaders used to pass the test without additional problems. Thus the note was significantly increased versus the class colleagues

Bariatric Surgery Influences beta-Cell Turnover in Non Obese Rats.

Manuscrito en proceso de revisión editorialThe aim of this study was to investigate the different bariatric surgeries relationship with pancreatic beta-cell turnover. We used healthy adult male Wistar rats to undergo the different techniques. We developed three surgical techniques (malabsorptive, Sleeve gastrectomy and Roux-Y Gastric Bypass-), and two control groups (Sham and fasting control). Pancreatic beta-cell mass was measured, as well as apoptosis, proliferation and neogenesis related to cellular turnover. Otherwise, we measured the functional issues to elucidate the physiological role that these surgical techniques trigger in the carbohydrate metabolism (e.g. food intake, weight gain, intraperitoneal glucose tolerance test, and basal glycaemia). Results included the differences that these parameters underwent in each surgical model. The -cell mass presented modifications that were related with proliferation processes. We reported significant increase of -cell mass in the malabsorptive technique. Other while the peripheral resistance to insulin trended to reduce in rats underwent with malabsorptive and mixed techniques. The goal of the present study was to present how different bariatric surgical techniques affected on pancreatic beta-cell turnover. We considered that these implications of surgery over the endocrine pancreas must be one of the mechanisms related to the improvement of type 2 Diabetes mellitus afterward the bariatric surgery.41 paginas, que recogen toda la documentación enviada a consideración editoria

Somatostatin: From a supporting actor to the protagonist to explain the long-term effect of sleeve gastrectomy on glucose metabolism.

BACKGROUND: Bariatric/metabolic surgery has become the most effective treatment against type 2 Diabetes mellitus (T2DM). The role of many gastrointestinal hormones in T2DM has been proposed, but the pathophysiological models described vary greatly depending on the anatomical rearrangements after surgery. We focus on somatostatin as a common factor in two of the most commonly performed surgical procedures in a healthy rodent model. We performed sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) and also an experimental surgery without gastric involvement (intestinal resection of 50 % jejunum-ileum portion -IR50 %). METHODS: We used five groups of Wistar rats: fasting control, sham-operated, SG-operated, RYGB-operated and IR50-operated. We analysed several parameters 4 and 23 weeks after surgery: plasma SST-14/28 fractions, plasma glucose, insulin release and SST-producing cell expression in the duodenum and pancreatic islets. RESULTS: Numerous SST-producing cells in the duodenum but a low number in the pancreas and a long-term loss of glucose tolerance were observed in SG and RYGB animals. Additionally, a high plasma SST-28 fraction was found in animals after SG but not after RYGB. Finally, IR50 animals showed no differences versus controls. CONCLUSIONS: In our SG model the amplitude of insulin response after metabolic surgeries, is mediated by SST-28 plasma levels derived from the proportional compensatory effect of gastric SST-producing tissue ablation. In addition, a strong compensatory response to the surgical loss of gastric SST-producing cells, leads to long-term loss of insulin production after SG but not in the others. Copyright © 2022 The Author(s). Published by Elsevier GmbH.. All rights reserved

Dual effect of RYGB on the entero-insular axis: How GLP-1 is enhanced by surgical duodenal exclusion

Background: The role of the ileum and Glucagon Like Peptide-1 (GLP-1) secretion in the pathophysiological processes underlying the effects of Roux-en-Y gastric bypass (RYGB) on type 2 Diabetes mellitus (T2DM) improvement has been previously determined. However, the roles of duodenal exclusion and Glucose Insulinotropic Peptide (GIP) secretion change is not clear. To clarify this aspect, we compared the pathophysiological mechanisms triggered by RYGB, which implies the early arrival of food to the ileum with duodenal exclusion, and through pre-duodenal ileal transposition (PdIT), with early arrival of food to the ileum but without duodenal exclusion, in a nondiabetic rodent model. Methods: We compared plasma and insulin, glucose (OGTT), GIP and GLP-1 plasma levels, ileal and duodenal GIP and GLP-1 tissue expression and beta-cell mass for n = 12 Sham-operated, n = 6 RYGB-operated, and n = 6 PdIT-operated Wistar rats. Results: No surgery induced changes in blood glucose levels after the OGTT. However, RYGB induced a significant and strong insulin response that increased less in PdIT animals. Increased beta-cell mass was found in RYGB and PdIT animals as well as similar GLP-1 secretion and GLP-1 intestinal expression. However, differential GIP secretion and GIP duodenal expression were found between RYGB and PdIT. Conclusion: The RYGB effect on glucose metabolism is mostly due to early ileal stimulation; however, duodenal exclusion potentiates the ileal response within RYGB effects through enhanced GIP secretio

La influencia de las resecciones masivas intestinales sobre el páncreas endocrino de ratas diabéticas Goto-Kakizaki

Objective: Several bariatric surgeries have been related to the T2DM improvement in obese patients. Despite the different mechanism invoked for this improvement, many evidences showed that the pancreas cellularity is conditioned for the homeostatic physiological changes after these surgeries. Many authors reported the changes in beta-cell mass after some surgeries in healthy rats. We purpose to analyze the changes in b-cell cellularity and b-cell-mass after a severe malabsorptive surgical method. Thus, we studied several parameters of the islet morphometric composition after a massive jejunal resection. Materials and methods: We employed Goto-Kakizaki diabetic non-obese rats, which underwent the 50% resection of middle portion of the jejunum versus a control group. After 3 months, rats were sacrificed and pancreas was immunohistochemicaly studied. Results: The b-cell mass was analyzed and several parameters about the endocrine islet size distribution were studied. We report an increase of b-cell mass in massive resection surgical group versus controls. The islet distribution was significant different between both groups. Endocrine islets of surgical group were bigger with a different cellular distribution. Conclusion: According to the enteroendocrine changes related to surgeries in jejunum, as in other gastrointestinal portions, the cellularity of islets changes as an adaptive process to glycemic demands.Objetivo: Varias técnicas quirúrgicas bariátricas han sido relacionadas con el mejoramiento de la T2DM en pacientes obesos. Se han invocado distintos mecanismos de porqué se da este mejoramiento y muchas evidencias apuntan a que la celularidad del páncreas cambia por las condiciones fisiológicas tras estas cirugías. Se han publicado cambios en la celularidad beta en ratas sanas sometidas a estos procesos. Y nos proponemos observar dichos cambios en ratas diabéticas tras una resección jejunal masiva. Estudiamos varios parámetros sobre la masa beta y la morfometría de los islotes, que indiquen los procesos celulares que han tenido lugar. Material y metodo: Empleamos Goto-Kakizaki, un modelo de rata diabética no obesa, a la que se sometió a una resección del 50%de la poción media del yeyuno. Tras tres meses de supervivencia, las ratas se estudiaron los páncreas mediante inmunocitoquímica. Resultados: Mostramos un incremento de la masa beta en las ratas resecadas frente a los controles. La distribución de islotes fue significativamente distinta entre los grupos, donde los islotes eran mayores en las ratas diabéticas. Conclusión: Los cambios glucémicos tras las resecciones masivas yeyunales cambian la celularidad del páncreas como una muestra de la capacidad adaptativa del mismo a las modificaciones.6 página

The long-term failure of RYGB surgery in improving T2DM is related to hyperinsulinism.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is the gold standard method for bariatric surgery and leads to substantial improvements in Type 2 Diabetes mellitus. However, many patients experience relapses in diabetes five years after undergoing this aggressive surgical procedure. We focus on beta-cell population changes and absorptive intestinal consequences after RYGB in a healthy nonobese animal model after a long survival period. METHODS: For our purpose, we use three groups of Wistar rats: RYGB-operated, surgical control (Sham) and fasting control. We measure alpha-, beta-cell mass; transcription (Arx, and Pdx-1) and proliferation (Ki67) factors; glucose tolerance and insulin release after oral glucose tests; histological adaptive changes in the jejunum; and intestinal glucose transporters. RESULTS: Our results showed an early increase in insulin secretion after surgery, that decrease at the end of the study. The beta-cell mass reduces twenty-four weeks after RYGB, which coincides with decrease of Pdx-1 transcription promoter factor. These was coincident with an increase in alpha-mass and a high expression of Arx in RYGB group. CONCLUSIONS: The analysis of all data showed beta-cell mass transdifferentiation into alpha-cell mass in RYGB rats. Due to long-term exhaustion of the beta-cell population by hyperinsulinism derived from digestive tract adaptation to surgery. Copyright © 2021 The Author(s). Published by Elsevier GmbH.. All rights reserved