Personalna historia otyłości ma znaczenie. Otyłość wieku młodzieńczego może wpływać na wyniki odległe operacji ominięcia żołądka u dorosłych

Introduction: The influence of adolescent obesity on weight loss following bariatric surgery in adults has not been evaluated. The purpose of this study was to determine the impact of prior adolescent obesity on long-term weight changes following Roux-en-Y gastric bypass (RYGB) in adulthood. Material and methods: This single centre retrospective cohort study evaluated changes in body mass index (BMI) after RYGB within 9–13 years. Questionnaires were sent by post to patients (n = 147) operated on between January 1999 and December 2003 in the Department of General and Transplant Surgery of Medical University, Lodz, Poland. Long-term data was obtained from 33.33% (n = 49, mean age 46.1 ± 10.7 years). Preoperative, nadir and actual BMI and differences between these values were calculated. Data was analysed with a cut-off BMI at 18 years old of 30 and 35 units (U). Results: Patients with a BMI of more than 30 and 35 U in adulthood regained more weight after initial achievement of nadir total weight loss compared to their only adult obese counterparts. Preoperative BMI varied by weight at 18 years old (p = 0.02), while value and time to nadir postoperative BMI and actual BMI were comparable. Conclusion: Adolescent obesity may be a risk factor for long-term RYGB failure. Surgery cannot be definitively curative in this group of patients, and continued active conservative treatment is required.Wstęp: Dotychczas nie oceniano wpływu otyłości wieku młodzieńczego na utratę masy ciała po operacjach bariatrycznych. Celem badania było określenie odległych zmian masy ciała po operacji ominięcia żołądka (RYGB) wykonywanych u dorosłych, którzy byli otyli w wieku młodzieńczym. Materiały i metody: W jednoośrodkowym badaniu kohortowym poddano ocenie zmiany wskaźnika masy ciała (BMI) w okresie 9–13 lat po RYGB. Do chorych operowanych w Klinice Chirurgii Ogólnej i Transplantacyjnej Uniwersytetu Medycznego w Łodzi w latach 1999–2003 (n = 147) wysłano kwestionariusze drogą pocztową. Wyniki odległe leczenia uzyskano w 33,33% przypadków (n = 49, średnia wieku 46,1 ± 10,7 roku). Wyliczono przedoperacyjne, minimalne oraz aktualne BMI oraz różnice pomiędzy nimi. Dane analizowano przy punkcie odcięcia dla BMI w 18. roku życia wynoszącym 30 i 35 jednostek. Wyniki: Przyrost masy ciała po wcześniejszym osiągnięciu jej minimalnej wartości był większy u chorych z BMI wyższym od 30 i 35 j. w wieku młodzieńczym, w porównaniu do osób otyłych jedynie w wieku dorosłym. Wykazano różnice w przedoperacyjnym BMI w zależności od masy ciała w 18 roku życia (p = 0,02), podczas gdy wartość i czas do osiągnięcia minimalnego pooperacyjnego oraz aktualnego BMI były porównywalne dla analizowanych grup. Wnioski: Otyłość wieku młodzieńczego może być czynnikiem ryzyka nawrotu otyłości po RYGB. W tej grupie chorych odległe wyniki operacji mogą być niezadowalające, dlatego konieczne jest dalsze aktywne leczenie zachowawcze tych chorych

Sudden onset of sarcoidosis after successful surgical treatment of Cushing’s syndrome

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The influence of liver and pancreas surgery on the thyroid function

<p>Abstract</p> <p>Background</p> <p>Nowadays, the increasing number of oncologic patients with liver or pancreatic tumours are subjected to surgical treatment, as it can provide a long-term survival or sometimes cure. As a result, numerous new clinical questions regarding metabolic disturbances in these patients have been arisen. Among others, the impact of the pancreas and liver surgery extent in relation to the thyroid function remains to be elucidated.</p> <p>Materials and methods</p> <p>The study comprised 51 patients (25 men and 26 women, mean age ± SD 61.6 ± 10.4 yrs, mean ± SD) with pancreatic or liver tumours, qualified for abdominal operation. Serum levels of FT3, FT4 and TSH were measured on the day before (time “0”) and on the 1^st, 3^rd and 5^th day after surgery in two (2) subgroups reflecting the extent of surgery: twenty seven (27) patients (14 men and 13 women, mean age ± SD 61.5 ± 11.8 yrs) after major surgery (Whipple’s surgery, right and left hemihepatectomy, segmentectomy of the liver, distal pancreatectomy, total duodenopancreatectomy) and twenty four (24) patients (11 men and 13 women, mean age ± SD 61.8 ± 8.9 yrs) after minor, palliative surgery (exploratory laparotomy, gastroenterostomy, triple by-pass, liver tumour embolization, hepaticojejunostomy). Additionally, the obtained results were analyzed in relation to the type of the disease (pancreatic surgery vs liver surgery).</p> <p>Results</p> <p>Mean serum FT3 level decreased significantly during the study in major and minor surgery subgroups (p<0.001, in both) in comparison to the baseline values, accompanied by stable serum concentrations of TSH (NS) and FT4 (NS). The above decreasing tendency in FT3 concentrations was similar in both subgroups (NS), the same as were unchanged levels of TSH (NS) and FT4 (NS). Mean FT4 concentration on the 3^rd and 5^th day after major surgery was lower in pancreatic tumour patients in comparison to liver tumour patients (p=0.002, p=0.032, respectively). Similarly, mean FT3 concentration on the 3^rd day in minor surgery subgroup was lower in pancreatic tumour patients in comparison to liver tumour patients (p=0.015).</p> <p>Discussion</p> <p>Our findings have confirmed essential reduction of FT3 values after abdominal surgery, independently of surgery extent. Additionally, pancreatic tumour patients are more likely to have lower FT3 and FT4 levels after surgery when compared to liver tumour patients.</p

Percentage of Myeloid Dendritic Cells in Peripheral Venous Blood Is Negatively Related to Incidence of Graves’ Orbitopathy

The aim of the study was to evaluate the distribution of blood dendritic cells (DCs) in patients with Graves’ orbitopathy (GO) and to assess the influence of methylprednisolone therapy on subsets of peripheral blood mononuclear cells (PBMCs). Peripheral blood DC subsets were analyzed by flow cytometry in patients with active GO (n=17), inactive GO (n=8), and Graves’ disease (GD) without GO (n=8) and controls (n=15); additionally, in patients with active GO (n=17), analyses were done at three time points, i.e., before methylprednisolone treatment and after 6 weeks and after 12 weeks of the treatment. Percentage of myeloid DCs (mDCs) in PBMC fraction was significantly lower in patients with both active and inactive GO, compared to patients with GD without GO and controls (p0.05). In the present study, we have succeeded to firstly demonstrate—according to our knowledge—that blood mDCs are negatively related to GO incidence

The role of phosphoinositide 3-kinase subunits in chronic thyroiditis

<p>Abstract</p> <p>Background</p> <p>The risk of neoplastic transformation in patients with chronic thyroiditis (Hashimoto’s thyroiditis – HT) is slightly increased. Genetic background of this observation is still unclear. PI3K isoforms are linked with inflammatory and neoplastic processes, thus they appear to be interesting subjects of a research in this respect. The aim of our study was to assess the <it>PIK3CA</it>, <it>PIK3CB</it>, <it>PIK3CD</it> and <it>PIK3CG</it> genes expression levels in HT.</p> <p>Methods</p> <p>Following conventional cytological examination, 67 thyroid FNAB specimens, received from patients with HT, were quantitatively evaluated regarding <it>PIK3CA</it>, <it>PIK3CB</it>, <it>PIK3CD</it> and <it>PIK3CG</it> expression levels by real-time PCR in the ABI PRISM ^®7500 Sequence Detection System.</p> <p>Results</p> <p>The performed analysis has revealed significantly higher expression levels (RQ) of <it>PIK3CD</it>, <it>PIK3CG</it> and <it>PIK3CA</it> genes in comparison with <it>PIK3CB</it> gene (p<0.05) and significantly higher gene expression level of <it>PIK3CD</it> in comparison with <it>PIK3CA</it> (p<0.05).</p> <p>Conclusion</p> <p>The observed increased <it>PIK3CD</it>, <it>PIK3CG</it> genes expression in HT is probably related to lymphocyte infiltration commonly seen in this condition, however, the role of increased <it>PIK3CA</it> gene expression in the multi-step carcinogenesis process cannot be excluded.</p