Gastroplastia redutora com bypass gastrojejunal em Y-de-Roux: conversão para bypass gastrointestinal distal por perda insuficiente de peso - experiência em 41 pacientes

RACIONAL: O tratamento cirúrgico é a única modalidade efetiva de tratamento da obesidade mórbida. O insucesso do bypass gastrointestinal (percentagem de perda de excesso de peso inferior a 50%) pode chegar a 10% dos pacientes operados a longo prazo (acima de 5, num ideal de 10 anos). OBJETIVOS: Avaliar os resultados, em termos de perda de peso, dos pacientes submetidos a reoperação com a finalidade de aumentar o componente disabsortivo. CASUÍSTICA E MÉTODOS: Estudaram-se 41 doentes, sendo 32 submetidos a reoperação por uma de três técnicas cirúrgicas (Fobi, Brolin e bypass gastrojejunoileal distal) nas quais foi realizada diminuição da área absortiva do intestino delgado. RESULTADOS: Os doentes submetidos a bypass gastrojejunoileal distal apresentaram resultados superiores aos demais (69,7%). CONCLUSÃO: O emprego do bypass distal pode ser utilizado em casos selecionados com o intuito de melhorar os resultados em termos de perda de peso. É aconselhável a centralização desses procedimentos em serviços de referência com experiência na área específica de cirurgia bariátrica, para acompanhamento rigoroso desses doentes

The Incapacity of the Surgeon to Identify NASH in Bariatric Surgery Makes Biopsy Mandatory

Nonalcoholic steatohepatitis (NASH) is a morbid condition highly related to obesity. It is unclear if the macroscopic liver appearance correlates with the histopathologic findings. The goal of this prospective study was to determine the relationship between the intraoperative liver appearance and the histopathologic diagnosis of NASH in morbidly obese subjects undergoing bariatric surgery. We also aimed to determine variables that could predict NASH preoperatively. Consecutive 51 subjects undergoing bariatric surgery without evidence of other liver disease underwent intraoperative liver biopsy. An intraoperative liver visual (macroscopic and tactile examination) was recorded. The liver aspect was compared with the liver histologic findings. Histological assessment was categorized into two groups: NASH and non-NASH (including normal histology and simple steatosis). Clinical and biochemical parameters were obtained from the patient databases and were compared between groups to identify preoperatively predictive factors of NASH. From 51 patients, only one presented totally normal histology. Forty-three (86.2%) presented simple steatosis, and seven (13.7%) were classified as NASH. Clinical parameters were not different between groups. At biochemical analysis, only VLDL cholesterol level was significantly higher in the NASH group (p = 0.037) but yet within the normal range. Association between macroscopic liver appearance and the presence of histological NASH is poor (sensitivity of 14%, specificity of 56%, positive predictive value of 5%, and negative predictive value of 80%). No predictor of NASH was found. Surgeons` evaluation could not identify NASH individuals. Routine liver biopsy during bariatric operations is mandatory to differentiate NASH and nonalcoholic fatty liver disease.19121678168

[gastric Bypass Roux-en-y Gastrojejunostomy--conversion To Distal Gastrojejunoileostomy For Weight Loss Failure--experience In 41 Patients].

Surgery is the only effective treatment for morbid obesity. Gastric bypass could fail in up to 10% of the patients (excess weight loss under 50%). To evaluate the weight loss determined by reoperation performing disabsortive variation of gastric bypass. The records of 41 patients, in whom 32 were submitted to reoperation by one of three surgical techniques (Fobi, Brolin, distal gastrojejunoileal bypass) which consisted in increasing the disabsortive length of intestinal limb. The patients submitted to distal gastrojejunoileal bypass showed the best results (69.7%). The distal gastric bypass as a revisional procedure could be done in selected cases with the aim to improve the weight loss. It is advisable to refer these patients to selected centers (known as center of excellence) with experience in this area of bariatric surgery, in order to perform a very close follow-up.42196-20

Gastric bypass Roux-en-Y gastrojejunostomy: conversion to distal gastrojejunoileostomy for weight loss failure - experience in 41 patients

BACKGROUND: Surgery is the only effective treatment for morbid obesity. Gastric bypass could fail in up to 10% of the patients (excess weight loss under 50%). AIMS: To evaluate the weight loss determined by reoperation performing disabsortive variation of gastric bypass. PATIENTS AND METHODS: The records of 41 patients, in whom 32 were submitted to reoperation by one of three surgical techniques (Fobi, Brolin, distal gastrojejunoileal bypass) which consisted in increasing the disabsortive length of intestinal limb. RESULTS: The patients submitted to distal gastrojejunoileal bypass showed the best results (69,7%). CONCLUSION: The distal gastric bypass as a revisional procedure could be done in selected cases with the aim to improve the weight loss. It is advisable to refer these patients to selected centers (known as center of excellence) with experience in this area of bariatric surgery, in order to perform a very close follow-up.RACIONAL: O tratamento cirúrgico é a única modalidade efetiva de tratamento da obesidade mórbida. O insucesso do bypass gastrointestinal (percentagem de perda de excesso de peso inferior a 50%) pode chegar a 10% dos pacientes operados a longo prazo (acima de 5, num ideal de 10 anos). OBJETIVOS: Avaliar os resultados, em termos de perda de peso, dos pacientes submetidos a reoperação com a finalidade de aumentar o componente disabsortivo. CASUÍSTICA E MÉTODOS: Estudaram-se 41 doentes, sendo 32 submetidos a reoperação por uma de três técnicas cirúrgicas (Fobi, Brolin e bypass gastrojejunoileal distal) nas quais foi realizada diminuição da área absortiva do intestino delgado. RESULTADOS: Os doentes submetidos a bypass gastrojejunoileal distal apresentaram resultados superiores aos demais (69,7%). CONCLUSÃO: O emprego do bypass distal pode ser utilizado em casos selecionados com o intuito de melhorar os resultados em termos de perda de peso. É aconselhável a centralização desses procedimentos em serviços de referência com experiência na área específica de cirurgia bariátrica, para acompanhamento rigoroso desses doentes.19620

The Incapacity of the Surgeon to Identify NASH in Bariatric Surgery Makes Biopsy Mandatory

Nonalcoholic steatohepatitis (NASH) is a morbid condition highly related to obesity. It is unclear if the macroscopic liver appearance correlates with the histopathologic findings. The goal of this prospective study was to determine the relationship between the intraoperative liver appearance and the histopathologic diagnosis of NASH in morbidly obese subjects undergoing bariatric surgery. We also aimed to determine variables that could predict NASH preoperatively. Consecutive 51 subjects undergoing bariatric surgery without evidence of other liver disease underwent intraoperative liver biopsy. An intraoperative liver visual (macroscopic and tactile examination) was recorded. The liver aspect was compared with the liver histologic findings. Histological assessment was categorized into two groups: NASH and non-NASH (including normal histology and simple steatosis). Clinical and biochemical parameters were obtained from the patient databases and were compared between groups to identify preoperatively predictive factors of NASH. From 51 patients, only one presented totally normal histology. Forty-three (86.2%) presented simple steatosis, and seven (13.7%) were classified as NASH. Clinical parameters were not different between groups. At biochemical analysis, only VLDL cholesterol level was significantly higher in the NASH group (p = 0.037) but yet within the normal range. Association between macroscopic liver appearance and the presence of histological NASH is poor (sensitivity of 14%, specificity of 56%, positive predictive value of 5%, and negative predictive value of 80%). No predictor of NASH was found. Surgeons` evaluation could not identify NASH individuals. Routine liver biopsy during bariatric operations is mandatory to differentiate NASH and nonalcoholic fatty liver disease

Improvement of antimalarial activity of a 3-alkylpiridine alkaloid analog by replacing the pyridine ring to a thiazole-containing heterocycle : mode of action, mutagenicity profile, and Caco-2 cell-based permeability.

The development of new antimalarial drugs is urgent to overcome the spread of resistance to the current treatment. Herein we synthesized the compound 3, a hit-to?lead optimization of a thiazole based on the most promising 3-alkylpyridine marine alkaloid analog. Compound 3 was tested against Plasmodium falciparum and has shown to be more potent than its precursor (IC50 values of 1.55 and 14.7??M, respectively), with higher selectivity index (74.7) for noncancerous human cell line. This compound was not mutagenic and showed genotoxicity only at concentrations four-fold higher than its IC50. Compound 3 was tested in vivo against Plasmodium berghei NK65 strain and inhibited the development of parasite at 50?mg/kg. In silico and UV?vis approaches determined that compound 3 acts impairing hemozoin crystallization and confocal microscopy experiments corroborate these findings as the compound was capable of diminishing food vacuole acidity. The assay of uptake using human intestinal Caco-2 cell line showed that compound 3 is absorbed similarly to chloroquine, a standard antimalarial agent. Therefore, we present here compound 3 as a potent new lead antimalarial compound