Made available in DSpace on 2016-05-02T13:54:48Z (GMT). No. of bitstreams: 1 JusleneAparecidaOliveiraCosta-dissertacao.pdf: 896769 bytes, checksum: 1744062ba6c85af80f07a70043a38f54 (MD5) Previous issue date: 2009-10-09 / Helianthus annus is a plant known as "sunflower". The use of plants as medicine for human use dates back to the old age. The hydroalcoholic extract of sunflower seed (HESS) has been indiscriminately used for gastric lesions, without scientific support to validate their action. This study assessed quantitatively and qualitatively the probable gastric protection of HESS in stress, and in the use of ethanol and indomethacin; checked the acidity (pH) through the gastric pylorus ligation (gastric residue, either pure or added with water); and compared differences in pH values in both techniques. A total of 120 rats (5 in each group) of the species Rattus norvegicus albinus, weighing 150-230g,were divided into 24 groups, which received the following treatments: HESS: 250mg/kg, 500mg/kg, 1000mg/kg and 2000mg / kg; ethanol; cimetidine; indomethacin; water; cimetidine and ethanol; cimetidine and endomethacin; pylorus ligation and water; pylorus ligation and cimeditine; HESS and ethanol; HESS and indomethacin; pylorus ligation and HESS. The results were submitted to analysis of variance (ANOVA) followed by Tukey test for evaluation of gastric lesions, and Kruskal-Wallis test followed by Dunn, to evaluate the gastric pH, with a statistically significance at p <0.05. This work was approved by the Ethics Committee of the Universidade José do Rosário Vellano, with protocol no. 04 A / 2009. The results showed that HESS 250 mg/kg and 1000mg/kg suggests probable gastric protection in stress. In the ethanol-induced gastric ulcer model, the doses of 250 and 1000 mg / kg showed probable gastric protection; the HESS 250 mg / kg + indomethacin, the dose of 250 mg / kg suggests gastric protection. Regarding the pH, the gastric residue, when pure, is more acidic than water, thus indicating that the model of addition of 3 ml of water is increasing the pH, thus proving that the pure pH model is more appropriate and more practical. Therefore, the data obtained in this study show that HESS probably provides gastric protection at certain doses. So, the results show that the sunflower,should be further studied for the development of phytomedicines or new chemicals with antiulcerogenic activity. / Helianthus annus é uma planta conhecida como girassol . A utilização das plantas, como medicamento para o tratamento das enfermidades que acometem a espécie humana remonta à idade antiga. O uso do extrato hidroalcoólico de semente de girassol (EHSG) para lesões gástricas é utilizado de forma indiscriminada, sem base em estudos científicos que tenham validado sua ação. O presente estudo tem como objetivo comparar quantitativamente e qualitativamente a provável proteção gástrica do EHSG com a cimetidina, frente ao estresse, ao uso da indometacina e do etanol e o pH gástrico por meio da ligadura pilórica (resíduo gástrico puro e com adição de água). Foram estudados 120 ratos (5 em cada grupo) da espécie Rattus norvegicus albinus, com peso de 150-230g, divididos em 24 grupos distintos, os quais receberam o EHSG nas dosagens de 250mg/kg, 500mg/kg, 1000mg/kg e 2000mg/kg, etanol 0,5ml, cimetidina 150mg/ml, indometacina 20mg/Kg e água 1ml. Estes grupos foram submetidos à associação da cimetidina com etanol e indometacina, às 4 dosagens do EHSG com etanol 70% e indometacina, aos grupos submetidos à ligadura pilórica e administração de água, cimetidina e às 4 dosagens de EHSG. As análises estatísticas dos resultados foram realizadas por meio de análise de variância (ANOVA), seguidas pelo teste de Tukey, para avaliação das lesões no estômago, e Kruskal-Wallis, seguido pelo teste Dunn, para avaliação do pH do estômago, utilizando diferença estatisticamente significante para p<0,05. O presente trabalho foi encaminhado e aprovado pelo Comitê de Ética em Pesquisa da Universidade José do Rosário Vellano, com o protocolo 04 A / 2009. Os resultados do estudo mostraram que o EHSG nas dosagens 250 e 1000mg/kg sugerem proteção contra as lesões gástricas no estresse. No modelo de indução de úlcera gástrica por etanol, as dosagens de 250 e 1000 mg/kg apresentaram provável proteção gástrica; no grupo utilizando EHSG 250 mg/kg + indometacina, a dosagem de 250 mg/kg sugere proteção gástrica. Em relação ao valor de pH, o resíduo gástrico, quando verificado puro, mostrou-se mais ácido que pelo modelo da adição de água, significando que este último aumentou o pH, verificando assim que o modelo do resíduo gástrico puro é mais indicado e mais prático. Portanto, os resultados obtidos no presente estudo apontam provável efeito protetor gástrico do EHSG em determinadas doses. Assim, pode-se concluir que a planta em questão constitui interessante alvo de estudo, visando ao desenvolvimento de fitomedicamentos ou à busca de novas entidades químicas com ação antiulcerogênica.

OBJETIVOS: Caracterizar o perfil de imunoexpressão de MLH1, MSH2, MSH6 e PMS2 em adenocarcinomas gástricos, explorando seu desempenho na identificação de características clínicas e patológicas, bem como sua influência prognóstica isolada e em relação aos demais parâmetros. MÉTODOS: Cento e trinta e três casos de adenocarcinomas gástricos esporádicos localmente avançados (pT2a ou mais) operados no Hospital das Clínicas/FMUSP foram incluídos pela ausência de metástases a distância ao diagnóstico (M0) e caracterizados clínica (idade, sexo e sobrevida) e patologicamente (tamanho, local, tipo de Borrmann, tipo histológico, infiltração vascular, perineural e variáveis de estadiamento locorregional). Amostras de 1,0 mm foram dispostas em micromatrizes teciduais (TMA) para pesquisa imuno-histoquímica das enzimas MLH1, MSH2, MSH6 e PMS2, com detecção por sistema de polímeros curtos conjugados a peroxidase. Casos com resultados negativos ou incertos nas amostras de TMA tiveram repetidas as reações em secções convencionais. A associação entre o estado de expressão dos marcadores com variáveis clínicopatológicas foi avaliada através do teste do qui-quadrado ou exato de Fisher. O impacto dos parâmetros clínico-patológicos e estado de expressão das enzimas na sobrevida foi explorado em modelos uni e multivariados de Cox, com construção de curvas de Kaplan-Meyer. Todas as análises estatísticas foram consideradas significativas ao nível de p<0,05. RESULTADOS: Quarenta e cinco casos (33,6%) exibiram perda de expressão de ao menos uma enzima, sendo frequente a perda de duas (9/45: 20%), três (14/45:31,2%) ou quatro enzimas (7/45:15,5%). Anormalidade mais frequente ocorreu com o MLH1 (26,7%), seguida de MSH6 (23%), PMS2 (21%) e MSH2 (20,8%). Quando avaliadas em conjunto, houve correlação entre o estado de expressão de todos os possíveis pares, com destaque para MLH1/PMS2 (rho=0,467, p<0,001) e MSH2/MSH6 (rho=0,666, p<0,001). Perda de MLH1 associou-se a tipos I/II de Borrmann (p<0,001), fenótipo intestinal de Lauren (p=0,005), tubular/túbulo-papilífero (p=0,009), expansivo de Ming (p=0,027) e infiltração em muscular própria (p=0,011). Com relação a perda de MSH2, tipos I/II de Borrmann (p<0,001), padrões tubular/túbulo-papilífero (p=0,008), intestinal (p=0,001), expansivo (p=0,001), infiltração da muscular própria (p=0,025), reação desmoplásica ausente a discreta (p=0,021) e ausência de infiltração perineural (p=0,016) foram mais frequentes. Perda de MSH6 associou-se aos tipos macroscópicos de Borrmann e histológicos de Lauren, OMS e Ming (p<0,001) e ausência de infiltração perineural (p=0,036). Idade mais avançada (p=0,046), tipos I/II de Borrmann (p=0,002), padrão intestinal de Lauren (p=0,021) e menos frequente infiltração perineural (p=0,035) foram identificados nos casos com perda de PMS2. A co-negatividade para os pares MLH1/PMS2 e MSH2/MSH6, além de reproduzir as associações mencionadas, identificou infiltrado linfoplasmocitário intra/peritumoral acentuado (p=0,011 e p=0,013), reação estromal desmoplásica ausente a leve para MSH2/MSH6 (p=0,037) e tamanho maior do tumor primário para MLH1/PMS2 (p=0,021). Pior sobrevida associou-se ao sexo masculino (LogRank: 5,11, p=0,024), tamanho do tumor (3,98, p=0,046), tipos III/IV de Borrmann (4,75, p=0,029), histologia mucinosa/anel-de-sinete da OMS (8,61, p=0,003) e difuso (11,62, p=0,003), infiltração perineural (12,62, p<0,001), metástase linfonodal (23,25, p<0,001) e estadio TNM (35,60, p<0,001) em análises univariadas. Melhor sobrevida associou-se a perda de MLH1, MSH6 e PMS2 isoladamente (5,46, p=0,019; 6,08, p=0,014; 7,46, p=0,006) e dos pares MLH1/PMS2 (7,89, p=0,005) e MSH2/MSH6 (5,29, p=0,021). Em modelos multivariados compostos pelos parâmetros clínicopatológicos, apenas o sexo masculino (HR=2,42, p=0,047), tipo histológico difuso (4,94, p=0,037) e estadios II, IIIA e IV (2,23, p=0,088; 3,12, p=0,022; 33,24, p=0,005), constituíram variáveis independentes de determinação prognóstica. Nas análises multivariadas incluindo o estado de expressão das enzimas, evidenciou-se que as perdas de PMS2 e do par MLH1/PMS2 associaram-se significativamente a maior sobrevida (3,84, p=0,029 e 9,82, p=0,028).CONCLUSÕES: O presente estudo demonstra o valor da imunohistoquímica na identificação de alterações na expressão de enzimas MMR, sendo a mais frequentemente negativa a MLH1. A frequente co-negatividade aponta para a importância da dimerização na funcionalidade do sistema de reparo. A perda isolada destes marcadores, e especialmente do par MLH1/PMS2, define perfil clínico-patológico característico, permitindo avanços no conhecimento previamente atribuído a fenótipo microssatélite instável conforme determinado em métodos moleculares. Em análises multivariadas, o estado de expressão de PMS2 isoladamente ou do par MLH1/PMS2 constitui fator independente de determinação prognóstica / OBJECTIVES: To characterize immunoexpression profile of MLH1, MSH2, MSH6 e PMS2 in gastric adenocarcinomas, exploring its performance to identify distinctive clinico-pathological features, as well as their prognostic implications in univariate and multivariate analyses. METHODS: A hundred and thirty three cases of locally advanced (pT2a or higher) sporadic gastric adenocarcinomas operated on Hospital das Clínicas/FMUSP were included due to absence of distant metastases at diagnosis (M0). Clinical (age, gender and survival) and pathological features (size, local, Borrmann´s type, histological type, vascular and perineural infiltration and locorregional staging parameters) were characterized. One millimeter samples were placed on tissue microarray blocks (TMA) and immunohistochemical detection of MLH1, MSH2, MSH6 and PMS2 performed on obtained sections, with revelation developed by peroxidase conjugated short-polymer based reagents. Negative or equivocal results obtained with TMA samples were repeated on conventional sections. Association between expression status for these markers and clinico-pathological features were evaluated by chisquare or Fisher´s exact test when appropriate. Impact of clinico-pathological features and expression status on disease specific survival were explored by Cox uni and multivariate models, with Kaplan-Meyer curves being fitted to illustrate these. All statistical results were considered significant at p<0,05. RESULTS: Forty five cases (33.6%) showed loss of at least one mismatchrepair enzyme, being frequent loss of two (9/45: 20%), three (14/45:31.2%) or even the four evaluated enzymes (7/45:15.5%). The most frequent abnormality addressed MLH1 (26.7%), followed by MSH6 (23%), PMS2 (21%) and MSH2 (20.8%). When analyses were performed in conjunction, correlation was identified for the expression status of all possible pairs, mainly the functional heterodimers MLH1/PMS2 (rho=0.467, p<0.001) and MSH2/MSH6 (rho=0.666, p<0.001). MLH1 loss was associated to Borrmann´s types I/I (p<0.001), Lauren´s intestinal phenotype (p=0.005), tubular/tubulo-papillary architecture (p=0.009), Ming´s expansile type (p=0.027) and infiltration limited by muscular propria (p=0.011). Among cases showing MSH2 loss, Borrmann´s I/I (p<0.001), tubular/tubulo-papillary (p=0.008), intestinal (p=0.001), expansile (p=0.001), muscular propria infiltration (p=0.025), absent to mild stromal desmoplasia (p=0.021) and absent perineural infiltration (p=0.016) were more frequent. MSH6 loss was associated to Borrmann´s gross type and Lauren, WHO and Ming´s histological types (p<0.001), as well as absent perineural infiltration (p=0.036). More advanced age (p=0.046), Borrmann´s types I/I (p=0.002), Lauren´s intestinal morphology (p=0.021) and less frequent perineural infiltration (p=0.035) were identified as associated to PMS2 loss. Conegativity for MLH1/PMS2 and MSH2/MSH6 pairs resumed all the above mentioned associations and additionally identified heavy lymphoplasmacytic infiltrate (p=0.011 e p=0.013), absent to mild stromal desmoplasia for MSH2/MSH6 (p=0.037) and increased primary tumor size for MLH1/PMS2 (p=0.021). In univariate analyses, decreased disease-specific survival was associated to male gender (LogRank: 5.11, p=0.024), tumor size (3.98, p=0.046), Borrmann´s types III/IV (4.75, p=0.029), mucinous/signet-ring cell morphology according to WHO (8.61, p=0.003) and Lauren´s diffuse morphology (11.62, p=0.003), perineural infiltration (12.62, p<0.001), lymph node metastases (23.25, p<0.001) and TNM staging (35.60, p<0.001). Better survival was seen in cases showing loss of MLH1, MSH6 and PMS2 when individually analyzed (5.46, p=0.019; 6.08, p=0.014; 7.46, p=0.006), as well as MLH1/PMS2 (7.89, p=0.005) and MSH2/MSH6 heterodimeric pairs (5.29, p=0.021). In multivariate models addressing clinico-pathological features, only male gender (HR=2.42, p=0.047), diffuse histological type (4.94, p=0.037) and stages II, IIIA and IV (2.23, p=0.088; 3.12, p=0.022; 33.24, p=0.005, respectively) were independent prognostic features. Multivariate analyses including status of MMR enzymes and the most significant clinicopathological features disclosed that PMS2 and MLH1/PMS2 losses were independent predictors of increased disease-specific survival (3.84, p=0.029 e 9.82, p=0.028). CONCLUSIONS: The present study demonstrates immunohistochemical detection of mismatch-repair enzymes as a tool to identify losses of these markers, being the most frequently negative MLH1. The frequently observed co-negativity points toward the importance of heterodimerization of these proteins in functional activity of mismatch-repair system. Losses of these markers, mainly MLH1/PMS2 pair, define a distinctive clinico-pathological profile and add knowledge to the previously reported associations with microsatellite instability as defined by molecular approach. In multivariate analyses, expression status of PMS2, as well as MLH1/PMS2 pair, revealed independent prognostic impact on diseasespecific survival

No description available.

Gastric and esophagogastric junction cancers are heterogeneous and aggressive tumors with an unpredictable response to cytotoxic treatment. New methods allowing for the analysis of drug resistance are needed. Here, we describe a novel technique by which human tumor specimens can be cultured ex vivo, preserving parts of the natural cancer microenvironment. Using a tissue chop- per, fresh surgical tissue samples were cut in 400 μm slices and cultivated in 6-well plates for up to 6 days. The slices were processed for routine histopa- thology and immunohistochemistry. Cytokeratin stains (CK8, AE1/3) were ap- plied for determining tumor cellularity, Ki-67 for proliferation, and cleaved caspase-3 staining for apoptosis. The slices were analyzed under naive conditions and following 2–4 days in vitro exposure to 5-FU and cisplatin. The slice culture technology allowed for a good preservation of tissue morphology and tumor cell integrity during the culture period. After chemotherapy exposure, a loss of tumor cellularity and an increase in apoptosis were observed. Drug sensitivity of the tumors could be assessed. Organotypic slice cultures of gastric and es- ophagogastric junction cancers were successfully established. Cytotoxic drug effects could be monitored. They may be used to examine mechanisms of drug resistance in human tissue and may provide a unique and powerful ex vivo platform for the prediction of treatment response.

Seit 1983 ist das Konzept des Mukosa-assoziierten lymphatischen Gewebes (MALT) im Magen auf dem Boden einer chronischen Helicobacter(H.)-pylori-Infektion bekannt. Viele epidemiologische, biologische und molekulargenetische Studien haben die Rolle von H. pylori in der Lymphomgenese unterstützt. Bis heute wurden weltweit mehr als 650 Patienten mit gastralem MALT-Lymphom und H.-pylori-Infektion antibiotisch behandelt. Bei etwa 75% der Fälle kann mit Hilfe dieser Therapie eine komplette Lymphomremission induziert werden. Klinische prädiktive Faktoren helfen dabei, Patienten bezüglich ihres Risikos besser zu stratifizieren und damit die Probabilität des Ansprechens zu verbessern. Neue zytogenetische Erkenntnisse haben zudem dazu beigetragen, ein besseres Verständnis der Lymphomgenese zu erlangen. Mit der kürzlich beschrieben Translokation t(11;18) (q21;q21) könnte in Zukunft ein prädiktiver genetischer Faktor verfügbar sein. / The Role of Helicobacter pylori Infection for the Development and Treatment of Gastric MALT Lymphomas Since 1983, it is well known that mucosa-associated lymphoid tissue (MALT)-type lymphoma of the stomach is due to chronic Helicobacter pylori (H. pylori) infection. Many epidemiological, biological, and moleculargenetic studies have implicated the role of H. pylori in lymphomagenesis. Nowadays, more than 650 patients with gastric MALT lymphoma worldwide have been treated with antibiotics for H. pylori infection, achieving a complete remission in about 75% of cases. Clinical predictive factors help to stratify patients into risk groups, and help to predict the probability of lymphoma remission. New insights into cytogenetics have also contributed to the understanding of lymphomagenesis, and with the newly identified translocation t(11;18)(q21;q21) we might have also a genetic factor at hand to predict treatment response. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

<p>Obesity and nutrition-related non-communicable diseases continue to be major challenges that are increasing in severity worldwide. Science-centered carbohydrate dietary strategies may be a viable approach to help address such challenges. Recent reports from our laboratory indicate that certain carbohydrates with slow digestion profiles have the ability to trigger the gut-brain axis and reduce food intake and to slow gastric emptying and potentially affect appetite. Slow carbohydrate digestion may have other impacts on energy metabolism that have not been explored. In the current investigations, we sought to better understand the delayed gastric emptying profile of pearl millet-based foods as well as to understand how altering carbohydrate digestion rate impacts substrate utilization for energy.</p> <p>In the first study, the physical breakdown of pearl millet couscous particles in a simulated gastric environment (Human Gastric Simulator) was studied compared to wheat couscous matched in particle size, and select physicochemical properties of each type of couscous were characterized. Because we previously showed that pearl millet couscous had a marked delay in gastric emptying compared to white rice, boiled potatoes, and pasta in a human study in Mali, the objective of the first investigation was to test the hypothesis that pearl millet couscous was more resistant to breakdown in the stomach than wheat couscous and would take longer to empty. Our findings indicated that pearl millet couscous instead broke down into smaller, more numerous particles than wheat couscous. However, pearl millet had a slower starch hydrolysis property compared to wheat couscous per unit surface area. Pearl millet also had a smaller amylose chain length (839-963 DP) compared to wheat (1225-1563 DP), which may enable a denser packing of millet starch molecules that hinders hydrolysis. We also visually observed that the pearl millet particles formed a paste while breaking down that could reasonably generate viscosity in the stomach to potentially delay gastric emptying. </p> <p>Based off the findings from simulated gastric digestion, we next conducted a human study (<i>n</i>=14) in the U.S. to test the hypothesis that pearl millet-based foods (couscous – commercial and self-made, thick porridge) would reduce glycemic response, increase satiety, and delay gastric emptying compared to wheat couscous and white rice. We complemented this human study with additional <i>in vitro </i>work using an advanced gastrointestinal digestion system (TIMagc) to determine if the viscosity of pearl millet couscous particles as they were breaking down in the stomach was contributing to a decrease in gastric emptying. Our findings indicated that all the pearl millet-based foods and wheat couscous had lower overall glycemic response than white rice, but only the self-made millet couscous showed higher satiety through subjective appetitive response ratings. Surprisingly, there were no differences in gastric emptying among the foods. Additionally, the half-emptying times for these foods were all ~3 h, which is similar to the comparably low half-emptying times observed for white rice, boiled potatoes, and pasta in the previous Mali study. We now hypothesize that there may be diet-induced changes in gut-brain axis signaling when slowly digestible carbohydrates are consumed repeatedly over time, perhaps through modulating the number or sensitivity of small intestinal L-cells. We also found that millet couscous did not exhibit high viscosity in the TIMagc, suggesting that viscosity was not impacting its rate of gastric emptying. We conclude that at least some pearl millet-based foods possess a slow digestion property that may act to trigger the gut-brain axis or ileal brake to increase feelings of satiety or slow gastric emptying, but the discrepancy between U.S. and Malian populations requires further study. </p> <p>In the final investigation, we examined how altering carbohydrate digestion affected partitioning of carbohydrate versus fat for oxidation as well as the efficiency of switching oxidation between these two substrates (termed “metabolic flexibility”) in mice. Metabolic flexibility has been associated with good health related to decreased adipose tissue in the body and improved insulin sensitivity and may have implications on weight management. Carbohydrate digestion was adjusted by: (1) testing mice that lacked a complete set of enzymes by knocking out maltase-glucoamylase (Mgam; null) for moderating starch digestion versus testing wild-type mice; (2) using diets in these two groups of mice to moderate starch digestion that had different levels of resistant starch (53%, 35%, and 18%), had only raw corn starch or sucrose, or were high in fat; and (3) providing a supplement of fungal amyloglucosidase (AMG) to the mice treatment groups to increase starch digestion. Respiratory exchange ratio (RER) was measured through indirect calorimetry and mathematical modeling was used to characterize the diurnal shifts in RER (sine equation) as well as carbohydrate versus fat oxidation and metabolic flexibility (percent relative cumulative frequency [PRCF] with Weibull and Mixed Weibull Cumulative Distribution functions). Our results suggest that null mice lacking Mgam had somewhat increased metabolic flexibility than wild-type mice despite exhibiting minimal to no effects on carbohydrate oxidation. Intriguingly, the raw corn starch diet increased fat oxidation and generally promoted metabolic flexibility, although it did not increase carbohydrate oxidation relative to the other carbohydrate-predominant diets. Increasing carbohydrate digestion through AMG supplementation increased carbohydrate oxidation, and generally prompted earlier shifts to carbohydrate oxidation than without AMG supplementation. These findings provide a basis for better understanding the metabolic consequences of altering carbohydrate digestion and establish novel tools that can be utilized in future investigations. Overall, we propose that moderating carbohydrate digestion provides the ideal combination of balancing carbohydrate and fat oxidation while promoting metabolic flexibility. </p> <p>In conclusion, a slow digestion property may enable some types of pearl millet to trigger the ileal brake and gut-brain axis feedback systems to decrease glycemic response and increase satiety. Moreover, consuming carbohydrates with slow digestion may optimize substrate utilization for energy by the body. In addition to triggering the ileal brake and gut-brain axis, modulating carbohydrate digestion to more effectively switch between carbohydrate and fat for oxidation may be beneficial for weight management and metabolic disease prevention.</p>

1) INTRODUCTION: Obesity is a global problem and its the prevalence is constantly rising. Overweight and obesity are key risk factors for many diseases. Obese patients are a greater economic burden for the state, they often rely on the help of others. The goal of obesity treatment is to reduce weight and then keep it within the recommended range. In an obese patient, it is not always just about the actual weight loss, but also about treating the associated diseases caused by obesity. Bariatric surgery allows patients to lose weight in a relatively short period of time and has a very positive effect on associated diseases. 2) OBJECTIVE: The aim of this diploma thesis was to evaluate the physical and mental condition before and after gastric bypass and to determine whether this surgery has a positive or negative effect on the physical and mental condition of the patient. The objective was further divided into sub-goals and hypotheses. 3) METHODOLOGY: The research was carried out using a quantitative method. This is an observational study, in which the mental and physical condition and advancement of patients who were about to undergo bariatric surgery - gastric bypass - were monitored for 6 months. Mental status was monitored using four standardized questionnaires: MAF, HADS, iADL, SF-36 in four time...

Author of this dissertation presentation discuss in the begining definition and historical consequences of origin and consecutive evolution of the method of percutaneous electrogastrography. Intimately is described physiology, anatomy, embryology and function of gastrointestinal tract with special interest on construction and function of the stomach. Next to this author analyses current knowledge about location and function of the gastric pace setter. The technique of used perctutaneous electrogastrography equipmentt is described. In the second part results of original studies monitoring restoration of peristalsis in perioperative period at patients after open and laparoscopic cholecystectomy and laparoscopic non-adjustable gastric banding are discussed. Furthermore results of EGG measurement of patients with mechanic, vascular and paralytic intestinal obstruction are presented in correlation with plasma levels of interleukin 1β, interleukin-6, procalcitonin and C-reactive protein. Key words: Percutanous electrogastrography, laparoscopic cholecystectomy, laparoscopic gastric bandage, inflammatory mediators, intestinal obstruction.

INTRODUCTION TO THE ISSUE: Obesity together with possible occurrence of many difficulties carries with it negative effect on physical and mental health. Many patients with severe obesity (class 3) cannot do physical activities or usual daily activities. These patients suffer from feelings of inferiority, decreased self-esteem and other mental issues. It could be classified as a vicious cycle for patients, but the bariatric surgery offers a way out. A gastric bypass is one of the bariatric procedures which is very helpful to reduce the weight of the patients who belongs into class 3 obesity. OBJECTIVES, METHODOLOGY: The main goal of this study was to find out if applying the gastric bypass to patients has positive or negative effect for their obesity level, quality of life, physical and mental state. The research sample was consisted of patients who were about to undergo gastric bypass. The patient's weight, BMI and body fat ratio were monitored to obtain data related to the assessment of the severity of obesity. The quality of life was evaluated using the SF-36 questionnaire (Short form 36). The standardized MAF (Multidimensional Assessment of Fatigue Scale) was used to review of patient's fatigue. The mental state of patients was subjectively assessed using the standardized HADS scale (Hospital...

Background: Diet may play an important role in the management of patients with short bowel syndrome who have colon in continuity. However, macronutrient absorption has not been well characterized, and the most appropriate dietary constituents have not been well defined. Objective: To define carbohydrate absorption characteristics in patients with short bowel syndrome and determine the potential role of pectin as a dietary substrate. Methods: The authors studied the effect of a custom pectin-based supplement in 6 subjects (3 male/3 female) aged 29-67 years with jejunocolonic anastomosis, 4 of whom required long-term parental nutrition. Small intestinal absorption capacity, macronutrient and fluid balance, gastrointestinal transit time, and energy consumption were measured. Results: Data showed that 53% nitrogen, 50% fat, and 32% total energy were malabsorbed. In contrast, the majority (92%) of total carbohydrate was utilized. Fecal short-chain fatty acids (SCFAs) were increased, an indication of increased fermentation. Although only 4% of starch was recovered in stool, it is indicative of considerable starch malabsorption, thus providing the main carbohydrate substrate, for colonic bacterial fermentation. In contrast, non-starch polysaccharide was a relatively minor fermentation substrate with only 49% utilized. Eighty percent of the pectin was fermented. Supplementation was associated with increased total SCFAs, acetate, and propionate excretion. There was a trend observed toward greater fluid absorption (-5.9% ± 25.2%) following pectin supplementation. Nonsignificant increases in gastric emptying time and orocolonic transit time were observed. Conclusion : Despite malabsorption, starch is the primary carbohydrate substrate for colonic bacterial fermentation in patients with short bowel syndrome, although soluble fiber intake also enhances colonic SCFA production.