Management of pancreaticopleural fistulas secondary to chronic pancreatitis

sem informaçãoPancreaticopleural fistula is a rare complication of chronic pancreatitis. To describe pancreaticopleural fistula due to chronic pancreatitis and perform an extensive review of literature on this topic. Comprehensive narrative review through online rese303225228sem informaçãosem informaçãosem informaçã

Cirurgia bariátrica em indivíduos com déficits cognitivos graves: relato de dois casos

sem informaçãoBariatric surgery has become the gold-standard treatment for refractory morbid obesity. Obesity is frequently associated with certain syndromes that include coexisting cognitive deficits. However, the outcomes from bariatric surgery in this group of indiv13618488sem informaçãosem informaçãosem informaçã

Programa multidisciplinar de assistência pré-operatória para cirurgia bariátrica: uma proposta para o Sistema Público de Saúde do Brasil

Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.5417074sem informaçãosem informaçã

Control of hypertension after roux-en-y gastric bypass among obese diabetic patients [controle da hipertensão arterial após bypass gástrico em y-de-roux em obesos diabéticos

Context - Hypertension is a common disorder in general practice and has a widely known association with type 2 diabetes mellitus. Low adhesion to clinical treatment may lead to poor results. Obesity surgery can bring early and relevant resolution rates of both morbidities. Objective - To describe hypertension evolution after Roux-en-Y gastric bypass in patients with type 2 diabetes mellitus. Method - Descriptive observational study designed as a historical cohort of 90 subjects with hypertension and diabetes who underwent Roux-en-Y gastric bypass and were evaluated before and after surgery. Results - It was observed a hypertension resolution rate of 85.6% along with markedly decrease in anti-hypertensive usage. Mean resolution time was 3.2 months. Resolution was associated with homeostasis model assessment - insulin resistance, preoperative fasting insulin, anti-hypertensive usage, hypertension time, body mass index and percentage of weight loss. Resolution of hypertension was not statistically associated with diabetes remission within this sample. Conclusion - Roux-en-Y gastric bypass was a safe and effective therapeutic tool to achieve hypertension resolution in patients who also had diabetes mellitus.Hypertension is a common disorder in general practice and has a widely known association with type 2 diabetes mellitus. Low adhesion to clinical treatment may lead to poor results. Obesity surgery can bring early and relevant resolution rates of both morb5112124sem informaçãosem informaçãoAdams, T.D., Gress, R.E., Smith, S.C., Halverson, R.C., Simper, S.C., Rosamond, W.D., Lamonte, M.J., Hunt, S.C., Long-term mortality after gastric bypass surgery (2007) N Engl J Med., 357, pp. 753-761Standards of medical care in diabetes (position statement) (2005) Diabetes Care., 28, pp. S4-S36. , American Diabetes AssociationAnwer, Z., Sharma, R.K., Garg, V.K., Kumar, N., Kumari, A., Hypertension management in diabetic patients (2011) Eur Rev Med Pharmacol Sci., 15, pp. 1256-1263Arcucci, O., de Simone, G., Izzo, R., Rozza, F., Chinali, M., Rao, M.A., Bodenizza, C., Trimarco, B., Association of suboptimal blood pressure control with body size and metabolic abnormalities (2007) J Hypertens., 25, pp. 2296-2300Bacchetti, P., Current sample size conventions: Flaws, harms, and alternatives (2010) BMC Med., 8, p. 17Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M.D., Pories, W., Fahrbach, K., Schoelles, K., Bariatric surgery: A systematic review and meta-analysis (2004) JAMA., 292, pp. 1724-1737Cooper-DeHoff, R.M., Gong, Y., Handberg, E.M., Bavry, A.A., Denardo, S.J., Bakris, G.L., Pepine, C.J., Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease (2010) JAMA., 304, pp. 61-68Curb, J.D., Pressel, S.L., Cutler, J.A., Savage, P.J., Applegate, W.B., Black, H., Camel, G., Stamler, J., Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension (1996) JAMA., 276, pp. 1886-1892. , Systolic Hypertension in the Elderly Program Cooperative Research GroupDonadelli, S.P., Salgado Jr., W., Marchini, J.S., Schmidt, A., Amato, C.A., Ceneviva, R., Dos Santos, J.E., Nonino, C.B., Change in predicted 10-year cardiovascular risk following Roux-en-Y gastric bypass surgery: Who benefits? (2011) Obes Surg., 21, pp. 569-573Estacio, R.O., Jeffers, B.W., Gifford, N., Schrier, R.W., Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes (2000) Diabetes Care., 23, pp. S54-S64Fernstrom, J.D., Courcoulas, A.P., Houck, P.R., Fernstrom, M.H., Long-term changes in blood pressure in extremely obese patients who have undergone bariatric surgery (2006) Arch Surg., 141, pp. 276-283Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement (1992) Am J Clin Nutr., 55, pp. 615S-619SHansson, L., Zanchetti, A., Carruthers, S.G., Dahlof, B., Elmfeldt, D., Julius, S., Ménard, J., Westerling, S., Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial (1998) Lancet., 351, pp. 1755-1762Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: Results of the HOPE study and MICROHOPE substudy (2000) Lancet., 355, pp. 253-259. , Heart Outcomes Prevention Evaluation (HOPE) Study investigatorsHinojosa, M.W., Varela, J.E., Smith, B.R., Che, F., Nguyen, N.T., Resolution of systemic hypertension after laparoscopic gastric bypass (2009) J Gastrointest Surg., 13, pp. 793-797Ikramuddin, S., Korner, J., Lee, W.J., Connett, J.E., Inabnet, W.B., Billington, C.J., Thomas, A.J., Bantle, J.P., Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: The Diabetes Surgery Study randomized clinical trial (2013) JAMA., 309, pp. 2240-2249Le Roux, C.W., Aylwin, S.J., Batterham, R.L., Borg, C.M., Coyle, F., Prasad, V., Shurey, S., Bloom, S.R., Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters (2006) Ann Surg., 243, pp. 108-114López-Jaramillo, P., Sánchez, R.A., Diaz, M., Cobos, L., Bryce, A., Parra Carrillo, J.Z., Lizcano, F., Zanchetti, A., Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome (2013) J Hypertens., 31, pp. 223-238Maggard, M.A., Shugarman, L.R., Suttorp, M., Maglione, M., Sugerman, H.J., Livingston, E.H., Nguyen, N.T., Shekelle, P.G., Meta-analysis: Surgical treatment of obesity (2005) Ann Intern Med., 142, pp. 547-559Nursalin, A., Siregar, P., A comprehensive management of hypertension among patients with metabolic syndrome: An evidence-based update (2013) Med J Indones., 22, pp. 189-194Pajecki, D., Dalcanalle, L., de Souza Oliveira, C.P., Zilberstein, B., Halpern, A., Garrido Jr., A.B., Cecconello, I., Follow-up of Roux-en-Y gastric bypass patients at 5 or more years postoperatively (2007) Obes Surg., 17, pp. 601-607Pimenta, G.P., Saruwatari, R.T., Corrêa, M.R., Genaro, P.L., Aguilar-Nascimento, J.E., Mortality, weight loss and quality of life of patients with morbid obesity: Evaluation of the surgical and medical treatment after 2 years (2010) Arq Gastr., 47, pp. 263-269Reis, C.E., Alvarez-Leite, J.I., Bressan, J., Alfenas, R.C., Role of bariatric-metabolic surgery in the treatment of obese type 2 diabetes with body mass index <35 kg/m2: A literature review (2012) Diabetes Technol Ther., 14, pp. 365-372Schauer, P.R., Kashyap, S.R., Wolski, K., Brethauer, S.A., Kirwan, J.P., Pothier, C.E., Thomas, S., Bhatt, D.L., Bariatric surgery versus intensive medical therapy in obese patients with diabetes (2012) N Engl J Med., 366, pp. 1567-1576VI Brazilian Guidelines on Hypertension (2010) Arq Bras Cardiol., 95, pp. 1-51. , Sociedade Brasileira de CardiologiaSociedade Brasileira de HipertensãoSociedade Brasileira de NefrologiaStaessen, J.A., Asmar, R., De Buyzere, M., Imai, Y., Parati, G., Shimada, K., Stergiou, G., Verdecchia, P., Participants of the 2001 Consensus Conference on Ambulatory Blood Pressure Monitoring. Task Force II. Blood pressure measurement and cardiovascular outcome (2001) Blood Press Monit., 6, pp. 355-370. , Participants of the 2001 Consensus Conference on Ambulatory Blood Pressure MonitoringSugerman, H.J., Wolfe, L.G., Sica, D.A., Clore, J.N., Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss (2003) Ann Surg., 237, pp. 751-756Suzuki, S., Ramos, E.J., Gonçalves, C.G., Chen, C., Meguid, M.M., Changes in GI hormones and their effect on gastric emptying and transit times after Roux-en-Y gastric bypass in rat model (2005) Surgery., 138, pp. 283-290Tuomilehto, J., Rastenyte, D., Birkenhäger, W.H., Thijs, L., Antikainen, R., Bulpitt, C.J., Fletcher, A.E., Fagard, R., Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators (1999) N Engl J Med., 340, pp. 677-684Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 (1998) BMJ., 317, pp. 703-713. , UK Prospective Diabetes Study Group(2003) Adherence to long term therapies: Evidence for action, pp. 1-211. , World Health Organization. Genebra: WH

Utilização dos níveis de amilase no dreno abdominal para diagnóstico de fístulas anastomóticas após o bypass gástrico em Y de Roux

sem informaçãoAlthough the incidence of leaks after Roux-en-Y gastric bypass (RYGB) significantly decreased over time, their detection still remains challenging. This study aimed to determine the usefulness of drain amylase levels to detect leaks after RYGB. This is5516672sem informaçãosem informaçãosem informaçã

Impact of roux-en-y gastric bypass on metabolic syndrome and insulin resistance parameters

Background: Metabolic syndrome (MetS) is a complex association of clustering metabolic factors that increase risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease. Surgical treatment has become an important tool to achieve its control. The aim of this study was to evaluate the impact of Roux-en-Y gastric bypass (RYGB) on MetS and its individual components, clinical characteristics, and biochemical features. Subjects and Methods: The study is a retrospective cohort of 96 subjects with MetS who underwent RYGB and were evaluated at baseline and after surgery. Clinical and biochemical features were analyzed. Results: After surgery, significant rates of resolution for MetS (88.5%), T2DM (90.6%), hypertension (85.6%), and dyslipidemias (54.2%) were found. Significant decreases in levels of fasting glucose, fasting insulin, hemoglobin A1c, low-density lipoprotein, and triglycerides and an increase in high-density lipoprotein level were also shown. The decrease in insulin resistance evaluated by homeostasis model assessment (HOMA-IR) was consistent. MetS resolution was associated with postoperative glycemic control, decreases in levels of fasting glucose, hemoglobin A1c, HOMA-IR, and triglycerides and in antihypertensive usage, and percentage weight loss. Conclusions: This study found high rates of resolution for MetS, T2DM, hypertension, and dyslipidemias after RYGB in obese patients. This finding was consistent with current literature. Hence RYGB should be largely indicated for this group of subjects as it is a safe and powerful tool to achieve MetS control.Metabolic syndrome (MetS) is a complex association of clustering metabolic factors that increase risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease. Surgical treatment has become an important tool to achieve its control. The aim of this sto TEXTO COMPLETO DESTE ARTIGO, ESTARÁ DISPONÍVEL À PARTIR DE AGOSTO DE 2015.164262265sem informaçãosem informaçã

Cirurgia bariátrica em indivíduos com cirrose hepática: uma revisão narrativa

Bariatric surgery has become the gold standard treatment for morbid obesity, but there is no consensus regarding its safety and efficacy among individuals with chronic liver diseases. To critically evaluate the existing evidence on literature about baria632190194sem informaçãosem informaçã

Influence of insulin resistance status on the development of gallstones following roux-en-Y gastric bypass: a prospective cohort study

The occurrence of gallstones following Roux-en-Y gastric bypass (RYGB) has been extensively reported. As RYGB promotes improvement in insulin resistance (IR), which is one of the factors enrolled in the pathophysiology of gallstones, this study aims to determine the influence of IR and its post-RYGB course on the development of gallstones. This is a prospective cohort study that enrolled 108 morbidly obese subjects free of gallstones which underwent RYGB and were followed up for 24 months, through clinical, laboratory, and ultrasound examinations. IR was assessed through the surrogate marker homeostasis model assessment (HOMA). Of the individuals evaluated, 29 (26.8 %) developed gallstones following RYGB. In the univariate analysis, postsurgical gallstones were associated with preoperative HOMA (p < 0.0001), preoperative fasting glucose (p = 0.0019), preoperative fasting insulin (p = 0.0001), and preoperative triglycerides (p = 0.0001). Multivariate analysis revealed that preoperative HOMA was the only factor independently associated with gallstones (p < 0.0001). The incidence of gallstones among individuals with IR was 46.8 %; in the non-IR subjects, the incidence was 7.4 % (p < 0.0001). Preoperative IR led to a relative risk of 6.02 (95 % CI = 2.1-17.3; p = 0.0009) of gallstones. As gallstones often occur following RYGB, there is controversy regarding their management. Some authors propose systematic cholecystectomy along with RYGB, while others suggest that the aggregate risk of the concomitant approach is significantly higher. As IR was a significant risk factor in this study, an individualized approach for this population may be proposed. Further research is needed to confirm these findings.The occurrence of gallstones following Roux-en-Y gastric bypass (RYGB) has been extensively reported. As RYGB promotes improvement in insulin resistance (IR), which is one of the factors enrolled in the pathophysiology of gallstones, this study to determ264769775sem informaçãosem informaçã