This study was aimed at investigating adverse and beneficial long-term effects of jejunoileal bypass (JIB) sugery in obese patients. The JIB was the first widly used surgical procedure for treatment of morbid obesity. The weight loss was remarkable, but the procedure was declared not appropiate for obesity surgery in the late 1970's. Serious late adverse effects such as liver cirrhosis and malignancies, have been postulated. Unexpectedly few studies have adressed these problems. In the long-term follow-up of 87 uniformly operated patients, several persisting beneficial effects were found. The mean Body Mass Index was 41.5 kg/m2 at the time of operation and 29.7 kg/m2 sixteen years after the operation. Diabetes type II and hyperlipidemia, common in an obese population, was not found in this group. Reversals were performed in 3% of the patients in contrast to 20-30% in many earlier studies. Revisions performed in 8% of the patients due to excessive weight loss could have contributed to the good long-term outcome. Percutaneous liver biopsies from 44 patients taken 14-20 (mean 17) years after JIB revealed normal or fatty liver, a lower degree of histological abnormalities than in 11 biopsies taken at the time of operations 1-14 (mean 6) years postoperatively. Liver cirrhosis seen early in one patient could not be found in the late biopsies. Reduced activity of the fibrinolytic system has been shown to be a new cardiovacular risk factor. In 45 patients studied 14-20 years after JIB, the levels of both plasminogen activator inhibitor type 1 (PAI-1) and tissue plasminogen activator (tPA) were significantly lower than in a control group of 10 morbidly obese patients ( PAI-1: 8.4 vs 32 U/mL, tPA: 7.2 vs 12 pg/L). Bile acids are regarded as cofactors in the carcinogenesis in the colon and experimentally an increased frequency of malignant tumors has been demonstated after JIB in carcinogen-induced rats. In 30 of the operated patients, colonoscopy with biopsy was performed 11-17 yeras after the operation. No evidence for malignant transformation was found as reflected by an abscense of polyp formation, histologic dysplasia or aneuploidia in flow cytometric DNA analysis. Eight hundred and thirty patients from 10 hospitals subjected to JIB were compared to 1660 controls with respect to malignant diagnosis over a 20 years period. No significantly increased risk for colorectal carcinoma could be demonstrated. However the overall risk for malignant disease was increased in the operated patients. The frequency of endometrial carcinoma was significantly elevated up to five years after the operation but was normal after that time. In conclusion the postulated progress of serious adverse effects of JIB such as liver cirrhosis and malignant disease has not been possible to demonstrate. Several beneficial effects such as weight loss and reduction of cardiovascular risk factors have been found a long time after the operation. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 5 uppsatser.</p> / digitalisering@umu

Orientador: Nelson Adami Andreollo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T10:20:03Z (GMT). No. of bitstreams: 1 Santos_ElisvaniaFreitasdos_D.pdf: 6112433 bytes, checksum: 5a08970ce3277a59590bf80d3a093158 (MD5) Previous issue date: 2011 / Resumo: A derivação jejuno-ileal é um dos procedimentos cirúrgicos considerados disabsortivos no tratamento da obesidade mórbida, além de levar a deficiência na absorção de alguns minerais como o ferro, causando anemia, alterações hepáticas e proporcionando quantidade maior de ácidos biliares e outros nutrientes ao intestino grosso sem serem devidamente metabolizados, os quais podem ser considerados como co-fatores na carcinogênese. Por outro lado, alguns componentes ou ingredientes funcionais dos alimentos denominados prebióticos podem influenciar positivamente na absorção dos minerais e na supressão da produção de metabólitos carcinogênicos, sendo a polidextrose um desses compostos. O objetivo desta pesquisa foi avaliar o efeito da suplementação de polidextrose no metabolismo de ferro, na morfologia do intestino e alterações hepáticas em ratos Wistar submetidos à derivação jejunoileal. Foram utilizados 59 animais machos divididos em 3 grupos: Grupo Controle- Sham (C1); Grupo Controle (C2). Os animais do grupo C1 foram submetidos à laparotomia mediana com exposição das alças intestinais e Grupo (G) também submetidos a laparotomia e o intestino foi seccionado a 5 cm da junção duodenojejunal e a derivação jejuno-ileal foi realizada mediante anastomose látero-lateral no íleo terminal a 2 cm da válvula íleo-cecal. Após 15 dias os animais foram subdivididos em: C1- Grupo controle-Sham, composto de 6 animais que receberam a dieta AIN-93M formulada com ferro; C2 - Grupo controle, composto de 6 animais (ração comercial). G: Grupo operado que foi subdividido em 4 subgrupos: G3 - Grupo operado composto de 12 animais que receberam a dieta AIN-93M formulada com ferro; G4 - Grupo operado, composto de 12 animais que receberam a dieta AIN-93M formulada com ferro e com polidextrose 7,5%; G5 - Grupo operado, composto de 11 animais que receberam a dieta AIN-93M formulada com polidextrose 7,5%; G6 - Grupo operado composto de 12 animais que receberam dieta AIN-93M formulada sem ferro e sem polidextrose. Após 90 dias de observação, os animais foram eutanasiados. Foram coletados sangue, fígado e intestino para análises séricas e histológicas. Para a análise histopatológica o intestino foi dividido em cinco segmentos (S1, S2, S3, S4 e S5) correspondentes ao íleo terminal, cólon ascendente, transverso, descendente e reto. Os animais operados apresentaram menor ganho de peso e menor consumo de ração. As dosagens séricas de ferro sérico, ferritina, capacidade total de ligação de ferro, capacidade de ligação de ferro insaturada, índice de saturação de transferrina e a análise de absorção aparente do ferro não apresentaram diferença estatisticamente significante entre os grupos. A análise da dosagem de hemoglobina mostrou diferença estatisticamente significante entre os grupos no intervalo final de 90 dias e para o hematócrito nos intervalos de 45 dias e 90 dias. O exame histopatológico do fígado mostrou fígados normais e diversos graus de esteatose hepática. Considerando presença ou não de esteatose, foi observado diferença estatisticamente significante entre os grupos estudados. Nas análises histopatológicas dos segmentos do intestino não foram observadas alterações. Portanto, os resultados da presente pesquisa permitem concluir que a suplementação de polidextrose na concentração 7,5% não teve efeito na absorção de ferro, nos parâmetros de ferro sérico e hematológicos após 90 dias da cirurgia de derivação jejuno-ileal. As alterações histológicas encontradas no fígado foram caracterizadas como esteatose e foram mais acentuadas nos animais submetidos à derivação jejuno-ileal. Não foram observadas alterações histológicas na mucosa intestinal dos segmentos estudados no período do estudo / Abstract: The jejunoileal bypass is considered one of the disabsorptive surgical procedures in the treatment of morbid obesity, and lead to deficiency in the absorption of some minerals like iron, causing anemia, liver and providing greater amount of bile acids and other nutrients to the intestine not properly metabolized, which can be considered as cofactors in carcinogenesis. On the other hand, some components or functional food ingredients called prebiotics can positively influence the absorption of minerals and suppressing the production of carcinogenic metabolites, and the polydextrose it is one of these compounds. The objective of this research was to evaluate the effect of iron supplementation and / or polydextrose in iron metabolism and morphology of the intestine in rats submitted to jejunoileal bypass. Were employed 59 males rats divided into 3 groups: control-Sham group (C1), control group (C2). The animals of group C1 who underwent laparotomy with exposure of the bowel and Group (G) also underwent laparotomy and the small bowel was transected 5 cm from the duodenal-jejunal junction and a latero-lateral jejunoileal anastomosis was performed in the ileum 2 cm from the ileocecal valve. After 15 days the animals were divided into: C1-sham-control group, consisting of 6 animals received the AIN-93M diet formulated with iron; C2 - control group, consisting of 6 animals (commercial diet). G: Group operated which was subdivided into four subgroups: G3 - Group composed of 12 operated animals that received the AIN-93M diet formulated with iron; G4 - operated group, consisting of 12 animals that received the AIN-93M diet formulated with iron and with 7.5% polydextrose; G5 - operated group, consisting of 11 animals that received the AIN- 93M diet formulated with polydextrose 7.5% G6 - operated group composed of 12 animals received AIN-93M diet formulated without iron and without polydextrose. After 90 days of observation, the animals were sacrificed. We collected blood, liver and intestine for analysis and histological studies. For histopathological analysis the intestine was divided into five segments (S1, S2, S3, S4 and S5) corresponding to the terminal ileum, ascending colon, transverse, descending and rectum. Operated animals showed lower weight gain and lower feed intake. The serum levels of serum iron, ferritin, total iron- binding capacity, unsaturated iron binding capacity, transferrin saturation index and iron apparent absorption analysis showed no statistically significant difference between groups. The analysis of hemoglobin showed a statistically significant difference between groups in the final interval of 90 days and the hematocrit in intervals of 45 days and 90 days. Histopathology of the liver showed normal livers and various degrees of hepatic steatosis. Considering the presence or absence of steatosis, a statistically significant difference was observed between the groups. In the histopathological analysis of the segments of the intestine was not observed any change. Therefore, the results of this research showed that the supplementation of 7.5% polydextrose had no effect on iron absorption, serum iron and hematological levels after 90 days of jejunoileal bypass. The histological changes found in the liver were characterized as steatosis and were more pronounced in animals subjected to jejunoileal bypass. There were no histological changes in the intestinal mucosa of the segments during the study period / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

Orientador: Nelson Adami Andreollo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-15T23:47:26Z (GMT). No. of bitstreams: 1 Braoios_MariaCristinaCostaResck_D.pdf: 3388857 bytes, checksum: 58550a8a6d4c3f121c9a3aa9185d24ae (MD5) Previous issue date: 2010 / Resumo: As gastroplastias e as derivações intestinais revolucionaram o tratamento da obesidade mórbida, pela sua viabilidade e resposta sustentada. Porém, estudos experimentais, sugerem após as derivações jejunoileais um aumento do risco de câncer de cólon devido ao aumento do tamanho e da proliferação das criptas intestinais. Evidências sugerem os possíveis efeitos antioxidantes na prevenção da carcinogênese que demonstram sua capacidade de neutralizar ou eliminar os radicais livres. O ácido ascórbico participa do processo de oxirredução das células, como também é importante na biossíntese de catecolaminas. Os compostos de nitrito e nitrato são sais empregados como conservantes de alimentos, que neste contexto do aumento de população mundial e escassez de alimentos, será cada vez mais empregado. Estes sais têm ação danosa ao organismo em situações específicas, como demonstram vários experimentos. O objetivo dessa pesquisa foi analisar as alterações histopatológicas caracterizadas pelo índice de mitoses produzidas no intestino grosso de ratos Wistar submetidos à derivação jejunoileal após administração continuada de vitamina C e nitrito de sódio, em diferentes grupos. Oitenta ratos machos Wistar pesando entre 450-550g foram divididos em doze grupos, com vinte animais controles não operados (5 animais ingeriram somente água, 5 animais ingeriram somente vitamina C, 5 animais ingeriram somente nitrito de sódio e 5 animais ingeriram vitamina C+nitrito de sódio). Sessenta animais foram anestesiados e submetidos à laparotomia mediana com exposição das alças intestinais. Em vinte animais apenas manipulação intestinal foi realizada, este servindo como sham. Nos restantes (grupo denominado operado), o intestino foi seccionado a 3cm da junção duodeno-jejunal, e a derivação jejunoileal foi realizada através da anastomose látero-lateral no íleo terminal a 2cm da válvula íleo-cecal. Os animais foram acondicionados em gaiolas com cinco animais cada de acordo com a droga que receberam. Após 180 dias de observação, os animais eram pesados semanalmente, e para análise foram divididos em segmentos (S1, S2, S3, S4 e S5) correspondentes ao ceco, colon ascendente, transverso, descendente e reto. No grupo controle, observando os segmentos em comparação ao tratamento (p< .0001) e comparando a média entre todos os segmentos (p=0,0323) indica que o nitrito+vitamina C obtiveram o menor índice de mitoses em relação aos outros tratamentos. No grupo operado os segmentos S1 e S2 houve diferença estatística com o tratamento vitamina C, o qual apresentou um maior índice de mitose e melhor preservação do epitélio. No grupo sham houve diferença apenas entre tratamento (p< .0001), não havendo diferença entre segmentos (p=0,0849) e nem interação entre segmento e tratamento (p=0.7135). A principal diferença estatística ficou apenas no grupo nitrito+vitamina C entre a média dos segmentos. Concluem que, comparando todos os segmentos colônicos avaliados dos vários grupos estudados, foi observado que os animais que receberam nitrito de sódio associado à vitamina C apresentaram menor índice de mitoses. Além disso, foi verificado que a vitamina C não apresentou um efeito inibidor, estatisticamente significativo, na preservação da mucosa e no índice de mitos / Abstract: Gastroplasty and intestinal bypass revolutionized the treatment of morbid obesity, the viability and sustained response. However, experimental studies suggest following the jejunoileal bypass increased risk of colon cancer due to the increased size and proliferation of intestinal crypts. Evidence suggests the possible effects of antioxidants in the prevention of carcinogenesis that demonstrate their ability to neutralize or eliminate free radicals. The ascorbic acid redox process of the cells, it is also important in the biosynthesis of catecholamines. The compounds of nitrite and nitrate salts are used as food preservatives, which in this context of increasing world population and food shortages, will be increasingly employed. These salts have a harmful action to the body in specific situations, as demonstrated by several experiments. The aim of this study was to evaluate the histopathological changes characterized by the index of mitosis produced in the intestine of rats subjected to jejunum-ileum bypass after continuous administration of vitamin C and sodium nitrite in different groups. Eighty male Wistar rats weighing 450-550g were divided into twelve groups, with twenty non-operated control animals (5 animals ingested only water, only 5 animals ate vitamin C, only 5 animals ingested sodium nitrite and 5 animals ate vitamin C + nitrite sodium). Sixty animals were anesthetized and underwent laparotomy with exposure of the bowel. In twenty animals only intestinal manipulation was performed, this serving as a sham. In the other (called the operated group), the intestine was cut to 3 cm from the duodenum-jejunal junction, and jejunum-ileum bypass was performed through the side-to-side anastomosis in the ileum 2 cm from the ileocecal valve. The animals were placed in cages with five animals each according to the drug they received. After 180 days of observation, the animals were weighed weekly, and for analysis were divided into segments (S1, S2, S3, S4 and S5) corresponding to the cecum, ascending colon, transverse, descending and rectum. In the control group, noting the segments in comparison to treatment (p <.0001) and comparing the average of all segments (p = 0.0323) indicates that nitrite + vitamin C obtained the lowest rate of mitosis in relation to other treatments. In the group operated the segments S1 and S2 was no statistical difference in treatment vitamin C, which showed a higher rate of mitosis and better preservation of the epithelium. In the sham group only showed a difference between treatment (p <.0001), with no difference between segments (p = 0.0849) nor interaction between segment and treatment (p = 0.7135). The main difference was statistically only for the nitrite + vitamin C between the average of the segments. They conclude that, comparing all colonic segments evaluated the various groups, it was observed that the animals that received sodium nitrite plus vitamin C had a lower rate of mitosis. Furthermore, it was found that vitamin C did not show an inhibitory effect was statistically significant to the preservation of the mucosa and the index of mitos / Doutorado / Pesquisa Experimental / Doutor em Cirurgia