Introdução: Os mecanismos responsáveis pela evolução do diabetes associado à obesidade entre pacientes bariátricos são alvos de muitos estudos atualmente. As principais linhas de pensamento envolvem alterações no índice de massa corporal (IMC), hormônios gastrointestinais, inflamação sistêmica e a reformatação ou reeducação alimentar. A maioria destes quesitos foi examinada sob a ótica do curto prazo, sendo que informações concernentes a casos com 10 anos de pós-operatório ainda são escassos. Objetivos: Avaliar o desfecho da homeostase glicídica tardio após a DGYR, em pacientes com e sem diabetes prévio, e documentar os parâmetros clínicos e nutricionais que diferenciem estes grupos. Metodologia: Estudo observacional controlado retrospectivo e prospectivo de 100 pacientes submetidos à derivação gástrica em Y de Roux. Estes pacientes foram divididos em dois grupos iniciais, um com diabetes no pré-operatório e outro sem diabetes. Em seguida, os dois foram subdivididos em quatro subgrupos conforme a evolução do diabetes, sendo eles refratário, responsivo, estáveis e não estáveis, respectivamente. Dados demográficos, laboratoriais, nutricionais, prescrições medicamentosas e evolução clínica do diabetes no pós-operatório a longo prazo foram coletados. Resultados: Dos 96 pacientes efetivamente avaliados, a idade situou-se em 50,39 (± 10,98) no grupo refratário, 56,63 (± 8,29) no grupo responsivo, 47,62 (± 10,72) no grupo estável e 48,17 (± 10,45) no grupo não estável. O sexo feminino prevaleceu em todos os grupos. Uma taxa de 66,7% dos pacientes com diabetes alcançaram a remissão da doença após a DGYR, o tempo de diagnóstico de diabetes pré-operatório se relacionou com o grupo refratário, e uma população de novos diabéticos se configurou tardiamente em pacientes sem a doença no período pré-operatório. Conclusão: 1) A derivação gástrica em Y de Roux induziu remissão em 66,7% dos pacientes com diabetes prévio; 2) O tempo de diagnóstico de diabetes tipo 2 esteve associado com ausência da resposta cirúrgica; 3) Pacientes euglicêmicos desenvolveram diabetes após a intervenção na proporção de 17,7%, comprovando que a proteção do procedimento bariátrico contra a instalação do diabetes tipo 2 se atenua com o passar dos anos; 4) Tanto os pacientes com a glicemia anormal quanto os euglicêmicos submetidos à DGYR, necessitam de um seguimento a longo prazo do homeostase glicídica / Introduction: The mechanisms responsible for the development of diabetes associated with obesity among bariatric patients are targets of many ongoing studies. The main lines of thought involve changes in body mass index (BMI), gastrointestinal hormones, systemic inflammation and reformatting nutritional education. Most of these issues were examined from a short term perspective, with information concerning cases after 10 years still scarce. Objectives: Evaluate the outcome of long term of glucose homeostasis after DGYR in patients with and without previous diabetes, and document the clinical and nutritional parameters that differentiate these groups. Methods: An observational retrospective and prospective controlled study with 100 patients undergoing Roux-en-Y gastric bypass. These patients were divided into two initial groups, one with diabetes preoperatively and another without. Then the two groups were subdivided into four subgroups according to the evolution of diabetes, namely refractory, responsive, stable and unstable respectively. Demographic, laboratory, nutritional, and clinical information along with drug prescriptions were collected Results: Among the 96 patients effectively studied, age was 50.39 (± 10.98) in the refractory group, 56.63 (± 8.29) in the responsive group, 47.62 (± 10.72) in the stable group and 48 , 17 (± 10.45) in the unstable group. Females were the majority in all groups. About 66,7% of patients with diabetes achieved disease remission after DGYR, and duration of diabetes was associated with the refractory group. A population of new-onset diabetes was identified in patients without disease in the preoperative period. Conclusion: 1) Roux-en-Y gastric bypass induced remission in 66,7% of patients with previous diabetes; 2) Duration of diagnosis of type 2 diabetes was associated with surgical response, 3) Euglycemic patients developed diabetes after the intervention in the proportion of 17,7%, proving that the protection of bariatric procedure against type 2 diabetes is attenuated over the years; 4) Both patients with abnormal glucose profile as well as those euglycemic undergoing DGYR, require long follow-up of glucose homeostasis

Orientador: Ana Elizabete Silva / Banca: Maria Inês Moura Pardini / Banca: Fátima Pereira de Souza / Resumo: O câncer gástrico é a segunda causa de morte por câncer no mundo e o quinto tipo com maior prevalência no Brasil, sendo previstos 21.800 casos novos em 2008. Esta neoplasia apresenta etiologia bastante complexa, envolvendo fatores genéticos e ambientais. Os fatores etiológicos de maiores destaques incluem a infecção pela bactéria Helicobacter pylori, a ingestão de determinados alimentos, como defumados, enlatados e com elevada quantidade de sal, além do estilo de vida dos indivíduos, associado ao consumo de cigarro e álcool. Uma lesão pré-cancerosa importante no desenvolvimento da neoplasia gástrica é a metaplasia intestinal, podendo aumentar o seu risco em até 10 vezes. Atualmente é reconhecida a participação de alterações epigenéticas como metilação aberrante do DNA, que atua de forma igualmente relevante e complementar no processo de desenvolvimento e progressão do câncer. Vários genes com papel importante no controle do ciclo celular, reparo do DNA, apoptose, angiogênese e adesão celular podem apresentar expressão alterada devido metilação aberrante de sua região promotora, assim a investigação do padrão de metilação de genes envolvidos com o processo neoplásico pode ser uma estratégia interessante para a indicação de marcadores moleculares que possam auxiliar no diagnóstico precoce do câncer. Desta forma, no presente trabalho foi investigado o padrão de metilação dos genes WT1 e RARß em metaplasia intestinal (35 amostras) e suas respectivas mucosas gástricas normais, em comparação com o câncer gástrico (8 amostras) também com suas respectivas mucosas normais, através da técnica MS-PCR (Methylation Specific PCR). Devido à participação da infecção pela H. pylori na carcinogênese gástrica, foi investigada molecularmente a presença dessa bactéria nas amostras...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Worldwide, the gastric cancer is the second cause of death by cancer. In Brazil, it is the fifth type with more abundant, foreseen 21.800 new cases in 2008. This neoplasia presents very complex etiology involving genetic and environmental factors. The main etiologic factors include: infection by H. pylori, intake of specific foods such as curing food, canned food, and high consumption of salt wealthy food, besides people life style associated to alcohol and cigarette consumptions. An important previous-cankered lesion in development of gastric neoplasia is the intestinal metaplasia, what can increase your risk in ten times. At this moment, it is recognized the participation of epigenetic alterations like ADN aberrant methylation, which actuate in a same way considerable and complementary in development process and cancer evolution. Many genes with important role in control of cellular cycle, ADN repair, apoptosis, angiogenesis and cellular adhesion can present changed expression due aberrant metthylation of your promoter region. In this manner, the investigation of metithyation pattern of genes involved with the neoplasic process can be an interesting strategy for the indication of molecular markers that can help in cancer precocious diagnosis. Thus, in this present study were investigated the metthylation pattern of RARß and WT1genes (35 samples) and their respective normal mucous gastrics by technic MSPCR (Methylation Specific PCR). Due to participation of infection by H. pylori in gastric carcinogenesis, it was too molecular investigated the presence of this bacterium in the studied samples and the possible association with the metthylation pattern presented by both genes. The results showed high pattern of methylation in both valued lesions, that is, 97% and 100%, respectively of methylated samples in metaplasia group ...(Complete abstract click electronic access below) / Mestre

<p>Patienter med morbid obesitas har en ökad risk för atelektasbildning och postoperativarespiratoriska komplikationer efter generell anestesi på grund av sänkt vitalkapacitet (VC),funktionel residualkapacitet (FRC) och total lungkapacitet (TLC). Tidigare forskning har visat attPostoperativ Bi-level Positiv Airway Pressure (BIPAP) ventilations behandling minskar denna risk.Denna studie avsåg att utvärdera om postoperativ BIPAP-behandling förbättrar patienternas SpO2,paO2 , paCO2 och pH i arteriellt blod efter genomgången elektiv gastric bypass kirurgi jämfört medtraditionell postoperativ behandling. Insamlat material från 18 patienter huvudsakligen bestående avarteriella blodgaser och bakgrundsdata analyserades med analytisk statistisk. För att kunna beskrivahur patienterna upplevde BIPAP-behandlingen ställdes två öppna frågor ställdes till patienterna,.Resultatet visar att postoperativ behandling med BIPAP under 3 timmar ger högre SpO2 och lägrepaCO2 än traditionell postoperativ behandling efter elektiv gastric bypass kirurgi. Vid bådabehandlingarna sjunker paO2 och pH är oförändrat. Flera av patienterna upplevde besvär av BIPAPbehandlingen.</p> / <p>Obese patients have a higher risk for respiratory complications after general anesthesia related toreduced vital capacity (VC), functional residual capacity (FRC) and total lung capacity (TLC).Earlier studies have shown that postoperative treatment with Bi-level Positive Airway Pressureimproved forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1.0) andsaturation (SpO2) after elective gastric bypass surgery. Present study evaluates whether or not thesame postoperative treatment also shows differences in arterial blood gases, if compared with usualpostoperative treatment with nasal administered oxygen. A second aim was to describe how patientsexperienced the BIPAP treatment. Arterial blood gases from 18 patients were analyzed withanalytical statistics. The study showed that postoperative treatment whit BIPAP during 3 hoursresults in higher SpO2 and lower paCO2 than traditional postoperative treatment after electivegastric bypass surgery. Both treatments results in lower paO2 and unchanged pH. Several patientsexperienced discomfort during the BIPAP treatment.</p>

This work has tried to provide better insight in some pathophysiological factors involved in functional dyspepsia. We have identified several experimental evidences supporting the hypothesis that activation of transducers of wall tension at the level the proximal stomach might be the key to the genesis of at least some of the symptoms. One of the mechanisms by which this activation may be enhanced in patients is the presence of defective accommodation of the proximal stomach in response to a meal. This abnormality was present in a large subgroup of patients and was associated to the presence of early satiety. Pharmacological modulation of the gastric wall tension resulted in concomitant changes in symptom severity, both in health and in functional dyspepsia patients. Special attention has been given to provide the clinician with better tools to investigate his patient, in the perspective of the prescription of a treatment aimed at restoring a defective mechanism. / Ce travail a tenté d'améliorer la compréhension de certains mécanismes physiopathologiques de la dyspepsie fonctionnelle. Nous avons identifié plusieurs arguments expérimentaux soutenant l'hypothèse disant que c'est l'activation de mécanorécepteurs sensibles à la tension pariétale qui est reponsable d'au moins un des symptômes de l'affection. Un des mécanismes par lesquels cette activation peut accrue chez les patients est la présence d'un défaut de l'accommodation gastrique post-prandiale. Cette anomalie a été retrouvée dans une large proportion des patients et est associée à la présence de satiété précoce. Les modifications du tonus gastrique ont résulté dans de modifications concomitantes des symptômes aussi bien chez les volontaires que chez les patients atteints de dyspepsie fonctionnelle.Une attention particulière a été portée sur le développement de nouveaux outils permettant de caractériser les patients dans la perspective de la prescription d'un traitement visant à corriger un mécanisme défectueux.

This work has tried to provide better insight in some pathophysiological factors involved in functional dyspepsia. We have identified several experimental evidences supporting the hypothesis that activation of transducers of wall tension at the level the proximal stomach might be the key to the genesis of at least some of the symptoms. One of the mechanisms by which this activation may be enhanced in patients is the presence of defective accommodation of the proximal stomach in response to a meal. This abnormality was present in a large subgroup of patients and was associated to the presence of early satiety. Pharmacological modulation of the gastric wall tension resulted in concomitant changes in symptom severity, both in health and in functional dyspepsia patients. Special attention has been given to provide the clinician with better tools to investigate his patient, in the perspective of the prescription of a treatment aimed at restoring a defective mechanism. / Ce travail a tenté d'améliorer la compréhension de certains mécanismes physiopathologiques de la dyspepsie fonctionnelle. Nous avons identifié plusieurs arguments expérimentaux soutenant l'hypothèse disant que c'est l'activation de mécanorécepteurs sensibles à la tension pariétale qui est reponsable d'au moins un des symptômes de l'affection. Un des mécanismes par lesquels cette activation peut accrue chez les patients est la présence d'un défaut de l'accommodation gastrique post-prandiale. Cette anomalie a été retrouvée dans une large proportion des patients et est associée à la présence de satiété précoce. Les modifications du tonus gastrique ont résulté dans de modifications concomitantes des symptômes aussi bien chez les volontaires que chez les patients atteints de dyspepsie fonctionnelle.Une attention particulière a été portée sur le développement de nouveaux outils permettant de caractériser les patients dans la perspective de la prescription d'un traitement visant à corriger un mécanisme défectueux.

The mouse pancreas is a mixed exocrine and endocrine glandconsisting of three lobular compartments: the splenic, duodenal and gastric lobes. During embryogenesis, the pancreas forms from two progenitor populations located on the dorsal and ventral side of the primitive gut tube. These anlagen are brought in close proximity as the gut elongates and rotates, and fuse to form a single organ. The splenic and duodenal lobes develop from the dorsal and ventral anlagen, respectively. In the adult pancreas, exocrine tissue secretes digestive enzymes intothe gut lumen to support nutrient uptake. The endocrine Islets of Langerhans are scattered throughout the exocrine tissue and aid in regulation of energy homeostasis through the secretion of hormones. One of the key players in energy homeostasis is the pancreatic ß-cell, which is the most abundant cell type of the islets. The β-cells regulates blood glucose levels through the action of insulin. Conditions where this regulation does not function properly are gathered under the common name of Diabetes mellitus. Type 1 diabetes (T1D) is characterized by insulin deficiency due to autoimmune destruction of the ß-cells. Using recently developed protocols for optical projection tomography (OPT) whole-organ imaging, we have revealed new spatial and quantitative aspects on ß-cell mass dynamics and immune infiltration during the course of T1D development in the non-obese diabetic (NOD) mouse model. We show that although immune infiltration appears to occur asynchronously throughout the organ, smaller islets, mainly located in the periphery of the organ, preferentially loose their ß-cells during early stages of disease progression. Larger islets appear more resistant to the autoimmune attack and our data indicate the existence of a compensatory proliferative capacity within these islets. We also report the appearance of structures resembling tertiary lymphoid organs (TLOs) in association with the remaining islets during later phases of T1D progression. OPT has already proven to be a useful tool for assessments of ß-cellmass in the adult mouse pancreas. However, as with other techniques, previous protocols have relied on a tedious degree of manual postivacquisition editing. To further refine OPT-based assessment of pancreatic ß-cell mass distribution in the murine pancreas, we implemented a computational statistical approach, Contrast-Limited Adaptive Histogram Normalisation (CLAHE), to the OPT projection data of pancreata from C57Bl/6 mice. This methodology provided increased islet detection sensitivity, improved islet morphology and diminished subjectivity in thresholding for reconstruction and quantification. Using this approach, we could report a substantially higher number of islets than previously described for this strain and provide evidence of significant differences in islet mass distribution between the pancreatic lobes. The gastric lobe stood out in particular and contained a 75% higher islet density as compared to the splenic lobe. Although the development of the early pancreatic buds has been relatively well studied, later morphogenetic events are less clear and information regarding the formation of the gastric lobe has largely been missing. Using OPT we have generated a quantitative three-dimensional road map of pancreatic morphogenesis in the mouse. We show that the gastric lobe forms as a perpendicular outgrowth fromthe stem of the dorsal pancreas at around embryonic day (e) 13.5, which grows into a mesenchymal domain overlaying the pyloric sphincter and proximal part of the glandular stomach. By analyzing mutant mice with aberrant spleen development, we further demonstrate that proper formation of the gastric lobe is dependent on the initial formation of the closely positioned spleen, indicating a close interplay between pancreatic and splenic mesenchyme during development. Additionally, we show that the expression profile of markers for pancreatic multipotent progenitors within the pancreas is heterogenous with regards to lobular origin. Altogether, our studies regarding the morphogenesis and adult constitution of the mouse pancreas recognize lobular heterogeneities that add important information for future interpretations of this organ.

Patienter med morbid obesitas har en ökad risk för atelektasbildning och postoperativarespiratoriska komplikationer efter generell anestesi på grund av sänkt vitalkapacitet (VC),funktionel residualkapacitet (FRC) och total lungkapacitet (TLC). Tidigare forskning har visat attPostoperativ Bi-level Positiv Airway Pressure (BIPAP) ventilations behandling minskar denna risk.Denna studie avsåg att utvärdera om postoperativ BIPAP-behandling förbättrar patienternas SpO2,paO2 , paCO2 och pH i arteriellt blod efter genomgången elektiv gastric bypass kirurgi jämfört medtraditionell postoperativ behandling. Insamlat material från 18 patienter huvudsakligen bestående avarteriella blodgaser och bakgrundsdata analyserades med analytisk statistisk. För att kunna beskrivahur patienterna upplevde BIPAP-behandlingen ställdes två öppna frågor ställdes till patienterna,.Resultatet visar att postoperativ behandling med BIPAP under 3 timmar ger högre SpO2 och lägrepaCO2 än traditionell postoperativ behandling efter elektiv gastric bypass kirurgi. Vid bådabehandlingarna sjunker paO2 och pH är oförändrat. Flera av patienterna upplevde besvär av BIPAPbehandlingen. / Obese patients have a higher risk for respiratory complications after general anesthesia related toreduced vital capacity (VC), functional residual capacity (FRC) and total lung capacity (TLC).Earlier studies have shown that postoperative treatment with Bi-level Positive Airway Pressureimproved forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1.0) andsaturation (SpO2) after elective gastric bypass surgery. Present study evaluates whether or not thesame postoperative treatment also shows differences in arterial blood gases, if compared with usualpostoperative treatment with nasal administered oxygen. A second aim was to describe how patientsexperienced the BIPAP treatment. Arterial blood gases from 18 patients were analyzed withanalytical statistics. The study showed that postoperative treatment whit BIPAP during 3 hoursresults in higher SpO2 and lower paCO2 than traditional postoperative treatment after electivegastric bypass surgery. Both treatments results in lower paO2 and unchanged pH. Several patientsexperienced discomfort during the BIPAP treatment.

Background Transthyretin amyloid (ATTR) amyloidosis is a systemic disorder caused by amyloid deposits formed by misfolded transthyretin (TTR) monomers. Two main forms exist – wild-type and hereditary ATTR amyloidosis, the latter associated with TTR gene mutations. Wild-type ATTR amyloidosis has a late onset and primarily cardiac manifestations, whereas hereditary ATTR amyloidosis is a rare autosomal dominant condition with a considerable phenotypic diversity. Both disorders are present all over the world, but endemic areas of the hereditary form are found in Sweden, Portugal, Brazil and Japan. Gastrointestinal (GI) complications are common in hereditary ATTR amyloidosis and play an important role in the patients’ morbidity and mortality. Malfunction of the autonomic and enteric nervous systems has been proposed to contribute to the GI disturbances, but the underlying mechanisms have not been fully elucidated. The aims of this thesis were to assess the prevalence of GI disturbances for different subtypes of ATTR amyloidosis, to further explore the mechanisms behind these disturbances, and to evaluate the outcome of the patients’ GI function after liver transplantation, which currently is the standard treatment for hereditary ATTR amyloidosis. Methods The Transthyretin Amyloidosis Outcomes Survey (THAOS) is the first global, multicenter, longitudinal, observational survey that collects data on patients with ATTR amyloidosis. THAOS enrollment data were used to assess the prevalence of GI symptoms and to evaluate their impact on nutritional status (mBMI) and health-related quality of life (EQ-5D Index Score). Data from routine investigations of heart-rate variability and cardio-vascular response to tilt tests were utilized to evaluate the impact of autonomic neuropathy on the scintigraphically measured gastric emptying half-times in Swedish patients with hereditary ATTR amyloidosis. Gastric wall autopsy specimens from Japanese patients with hereditary ATTR amyloidosis and Japanese non-amyloidosis controls were analyzed with immunohistochemistry and computerized image analysis to assess the densities of interstitial cells of Cajal (ICC) and nervous tissue. Data from gastric emptying scintigraphies and validated questionnaires were used to evaluate the outcome of Swedish patients’ GI function after liver transplantation for hereditary ATTR amyloidosis. Results Sixty-three percent of the patients with TTR mutations and 15 % of those with wild-type ATTR amyloidosis reported GI symptoms at enrollment into THAOS. Subsequent analyses focused on patients with TTR mutations and, among them, unintentional weight loss was the most frequent symptom (32 %) followed by early satiety (26 %). Early-onset patients (&lt;50 years of age) reported GI symptoms more frequently than late-onset cases (70 % vs. 50 %, p &lt;0.01), and GI symptoms were more common in patients with the V30M mutation than in those with non-V30M mutations (69 % vs. 56 %, p &lt;0.01). Both upper and lower GI symptoms were significant negative predictors of nutritional status and health-related quality of life (p &lt;0.01 for both). Weak but significant correlations were found between gastric emptying half-times and the function of both the sympathetic (rs = -0.4, p &lt;0.01) and parasympathetic (rs = -0.3, p &lt;0.01) nervous systems. The densities of c-Kit-immunoreactive ICC were significantly lower in the circular (median density 0.0 vs. 2.6, p &lt;0.01) and longitudinal (median density 0.0 vs. 1.8, p &lt;0.01) muscle layers of the gastric wall in patients compared to controls. Yet, no significant differences in protein gene product 9.5-immunoreactive nervous cells were found between patients and controls either in the circular (median density 3.0 vs. 6.8, p = 0.17) or longitudinal (median density 1.4 vs. 2.5, p = 0.10) muscle layers. Lastly, the patients’ GI symptoms scores had increased slightly from before liver transplantation to the follow-ups performed in median two and nine years after transplantation (median score 7 vs. 10 vs. 13, p &lt;0.01). However, their gastric emptying half-times (median half-time 137 vs. 132 vs. 125 min, p = 0.52) and nutritional statuses (median mBMI 975 vs. 991 vs. 973, p = 0.75) were maintained at follow-ups in median two and five years after transplantation. Conclusion GI disturbances are common in hereditary ATTR amyloidosis and have a negative impact on the patients’ nutritional status and health-related quality of life. Fortunately, a liver transplantation appears to halt the progressive GI involvement of the disease, although the patients’ GI symptoms tend to increase after transplantation. An autonomic neuropathy and a depletion of gastrointestinal ICC seem to contribute to the GI disturbances, but additional factors must be involved.

Visame pasaulyje skrandžio vėžys yra didelė problema, kasmet diagnozuojama apie 875000 naujų atvejų ir 645000 miršta nuo šios ligos. Lietuvos vėžio registro duomenimis, 2005 m. Lietuvoje sergamumas skrandžio vėžiu buvo 35,0 vyrų ir 22,1 moterų tarpe 100000 gyventojų. Šis susirgimas vis dar dažniausiai diagnozuojamas vėlyvose stadijose, kuomet radikali operacija jau nėra galima. Skrandžio vėžio vystymasis yra kompleksinis ir šiuo metu dar pilnai neišaiškintas procesas. Nauji tyrimai patvirtino, kad epigenetinė pažaida – TPEF/HPP1 geno metilinimas yra dažnas reiškinys tulžies ir šlapimo pūsles, kolorektalinio vėžio atvejais. Vis dėlto, nebuvo pakankamai duomenų apie TPEF/HPP1 geno metilinimo reikšmę skrandžio kancerogenezėje. Atliktame tyrime nustatyta, kad TPEF/HPP1 geno metilinimas gali būti ankstyvas šio pažeidimo požymis. Taip pat galima daryti prielaidą, kad TPEF/HPP1 genas yra skrandžio naviką slopinantis genas. Kitas svarbus skrandžio vėžio rizikos faktorius yra H. pylori sąlygotas atrofinis gastritas. Tyrimo metu nustatytas didelis vyresnių nei 55 m. dispepsija sergančių pacientų infekuotumas H. pylori. Statistiškai patikimo skirtumo tarp atrofijos ir žarninės metaplazijos dažnumo dispepsija sergantiems pacientams Taivanyje, Lietuvoje, Latvijoje negauta. Buvo nustatyta stipri koreliacija tarp skrandžio atrofijos ir žarninės metaplazijos. Klinikinėje praktikoje atrofinis gastritas patvirtinamas histologiškai (pagal 1994 m. Hiūstone modifikuotą Sidnėjaus klasifikaciją)... [toliau žr. visą tekstą] / INTRODUCTION Gastric cancer is rampant in many countries around the world and it accounts for approximately 875000 new cases and 645000 deaths annually [Jemal A et al, 2004]. While overall incidence of gastric cancer is falling, in many countries of the world it remains one the most frequent causes of cancer related deaths. According to GLOBOCAN age-standardized cancer incidence data, in Germany 15.1 males and 8.8 females per 100.000 persons developed gastric cancer in 2002, in Lithuania – 25.3 males and 13.0 females, in Latvia – 24.6 males and 11.1 females, respectively. According to the data of Lithuanian Cancer Registry, gastric cancer incidence was 35.0 in male, 22.1 in female per 100.000 persons in 2005, 30.4 in male, 17.8 in female in 2004, respectively [Kurtinaitis J, 2004]. At present, primary or secondary prevention is likely to be the most effective means of reducing the incidence and mortality from this disease. However, to be successful, this strategy depends upon knowledge of the etiological factors and pathogenetic mechanisms involved in gastric carcinogenesis. Helicobacter pylori (H. pylori) has been categorized as a group I carcinogen by the International Agency for Research on Cancer and World Health Organization (WHO) in 1994. Development of gastric cancer is a complex and poorly understood process. It is clear that besides chronic gastritis caused by H. pylori, dietary factors, high salt and nitrate intake, smoking and, possibly, alcohol consumption are... [to full text]

It has been estimated that LAGB represents about 42% of bariatric operations performed worldwide. There are a number of different adjustable gastric bands available. Few attempts have been made to compare the influence of band design differences for efficiency and complication rate. There are no accepted criteria for choosing this particular operation. In the dissertation we compared one year results after adjustable gastric banding using different adjustable gastric bands – SAGB and MiniMizer Extra. We have determined that laparoscopic adjustable gastric banding is effective and safe bariatric procedure: the average percentage of initial excess body mass index loss was 33,1 ± 21,9%; 34.1% of patients achieved fair, 30,6% - good, 9,4% - very good and 2,4% - excellent results according to BAROS; only 5 (4,9%) major complications were diagnosed. No radical differences were stated between the efficiency and complication rate of the compared adjustable gastric bands: the average percentage of initial excess body mass index loss in SAGB and MiniMizer Extra groups was 28,9 ± 21,3% and 36,8 ± 22.1% respectively, p=0.075; major complication rate was 0 (0%) and 5 (9.3%) respectively, p=0.069. Patients at the age of 40 and older achieved better results using MiniMizer Extra band - the average percentage of initial excess body mass index loss was 37,5 ± 20,8% versus 23,6 ± 13,8% in SAGB group, p=0.002. Patients with initial BMI ≤ 47 achieved better results using MiniMizer Extra band... [to full text] / Šiuo metu Pasaulyje skrandžio apjuosimo reguliuojama juosta operacijos sudaro apie 43 % visų chirurginių operacijų, atliekamų nutukimui gydyti. Iki šiol nėra pilnai ištirta operacijoje naudojamų skrandį apjuosiančių reguliuojamų juostų konstrukcijos skirtumų įtaka gydymo rezultatams, taip pat nėra priimtų pacientų atrankos šiai operacijai kriterijų. Disertacijoje palyginome vienerių metų nutukimo chirurginio gydymo rezultatus naudojant skirtingas skrandį apjuosiančias reguliuojamas juostas – SAGB ir MiniMizer Extra. Nustatėme, kad skrandžio apjuosimo reguliuojama juosta operacija yra efektyvus ir saugus nutukimo gydymo būdas: vidutinis procentinis perteklinio kūno masės indekso sumažėjimas buvo 33,1 ± 21,9%; vertinant pagal BAROS, 34.1% pacientų pasiekė patenkinamą, 30,6% - gerą, 9,4% – labai gerą ir 2,4% – puikų gydymo rezultatą; pasitaikė 5 (4,9%) „didžiosios” komplikacijos. Esminių skirtumų tarp lygintų juostų efektyvumo ir komplikacijų skaičiaus po vienerių metų po operacijos nenustatyta: vidutinis procentinis perteklinio kūno masės indekso sumažėjimas SAGB ir MiniMizer Extra grupėse buvo atitinkamai 28,9 ± 21,3% ir 36,8 ± 22.1%, p=0.075, o „didžiųjų” komplikacijų skaičius atitinkamai 0 (0%) ir 5 (9.3%), p=0.069. 40 metų ir vyresni pacientai geresnių rezultatų pasiekė naudojant MiniMizer Extra juostą - vidutinis procentinis perteklinio kūno masės indekso sumažėjimas buvo 37,5 ± 20,8% prieš 23,6 ± 13,8 % SAGB grupėje, p=0.002. Pacientai, kurių pradinis KMI ≤ 47, geresnių... [toliau žr. visą tekstą]