<p>Roux-en-Y gastric bypass (RYGBP) sustains weight loss and ameliorates diseases common in the morbid obese (BMI>40 kg/m²), but leaves the stomach and duodenum inaccessible. Morbidly obese patients have increased operative risks and in other fields minimal surgery is known to facilitate the postoperative course.</p><p>The aim of this thesis was to evaluate hand-assisted laparoscopy in RYGBP and develop techniques to study the excluded stomach.</p><p>The hand-assisted technique was developed in 13 patients and subsequently compared to open surgery in a blinded, prospective, randomised trial of 50 patients.</p><p>Hand-assistance was feasible with a low need for conversions or re-operations. The duration of surgery was longer (150 versus 85 minutes) and postoperative results were similar to those in open surgery. Thus, the patients did not appear to derive benefits from hand-assisted laparoscopy. Interventional radiology accessed the excluded stomach and allowed endoscopy, barium studies and acid measurements. Chronic gastritis and low acid production were found. After RYGBP, 8 of 22 patients (36%) had duodenogastric bile reflux (DGBR), when studied by HIDA-scintigraphy. No DGBR was seen among controls. The gastric mucosa was evaluated by serology</p><p>(pepsinogen I (PGI), H. pylori and H,K-ATPase) in 64 patients before and 1-4 years after operation. RYGBP, in contrast to gastric restriction, had reduced PGI levels postoperatively. According to serology, the mucosa is atrophic or in a resting state.</p><p>This study focuses on safety in RYGBP. Hand-assisted laparoscopy was feasible, but not favourable compared to an optimised open procedure. The excluded stomach is no longer inaccessible and characterised by chronic gastritis, low acid production and frequent bile reflux.</p>

Roux-en-Y gastric bypass (RYGBP) sustains weight loss and ameliorates diseases common in the morbid obese (BMI&gt;40 kg/m2), but leaves the stomach and duodenum inaccessible. Morbidly obese patients have increased operative risks and in other fields minimal surgery is known to facilitate the postoperative course. The aim of this thesis was to evaluate hand-assisted laparoscopy in RYGBP and develop techniques to study the excluded stomach. The hand-assisted technique was developed in 13 patients and subsequently compared to open surgery in a blinded, prospective, randomised trial of 50 patients. Hand-assistance was feasible with a low need for conversions or re-operations. The duration of surgery was longer (150 versus 85 minutes) and postoperative results were similar to those in open surgery. Thus, the patients did not appear to derive benefits from hand-assisted laparoscopy. Interventional radiology accessed the excluded stomach and allowed endoscopy, barium studies and acid measurements. Chronic gastritis and low acid production were found. After RYGBP, 8 of 22 patients (36%) had duodenogastric bile reflux (DGBR), when studied by HIDA-scintigraphy. No DGBR was seen among controls. The gastric mucosa was evaluated by serology (pepsinogen I (PGI), H. pylori and H,K-ATPase) in 64 patients before and 1-4 years after operation. RYGBP, in contrast to gastric restriction, had reduced PGI levels postoperatively. According to serology, the mucosa is atrophic or in a resting state. This study focuses on safety in RYGBP. Hand-assisted laparoscopy was feasible, but not favourable compared to an optimised open procedure. The excluded stomach is no longer inaccessible and characterised by chronic gastritis, low acid production and frequent bile reflux.

Introdução: A prevalência de obesidade cresce rapidamente na população brasileira. Para obesidade mórbida, o único tratamento efetivo é a cirurgia bariátrica, que proporciona redução do peso, das comorbidades associadas e aumento da qualidade de vida. O objetivo deste estudo foi verificar o impacto da cirurgia bariátrica na saúde bucal dos pacientes com obesidade mórbida através de uma coorte prospectiva. A hipótese é que a cirurgia bariátrica poderia causar piora da saúde bucal. Método: Todos os pacientes que realizaram cirurgia bariátrica no Hospital Nossa Senhora da Conceição entre outubro de 2009 e janeiro de 2011 foram convidados a participar do estudo. Medidas: foram realizados exames bucais (cárie, pelo índice ICDAS; índices de placa e sangramento gengival; fluxo salivar em repouso e estimulado; uso de próteses) e entrevistas (dados sócio-demográficos, hábitos bucais, sensação subjetiva de boca seca, doenças sistêmicas e medicamentos em uso) em duas etapas, uma linha de base um dia antes da cirurgia e um exame de acompanhamento seis meses após a cirurgia. Foi realizada análise descritiva das variáveis, qui-quadrado, teste exato de Fischer, teste t de student para amostras pareadas e teste de Mann-Whitney. 9Continua) Resultados: Trinta e nove pacientes concluíram as duas etapas do estudo. Houve redução estatisticamente significativa na prevalência de hipertensão arterial (p<0,01), diabetes (p<0,01), número de medicamentos utilizados diariamente (p<0,01), sensação subjetiva de boca seca (p<0,01) e aumento do fluxo salivar estimulado (p<0,01). Conclusão: Os resultados mostram melhora na saúde bucal dos pacientes submetidos à cirurgia bariátrica, já que a sensação de boca seca diminuiu e o fluxo salivar aumentou. Estes 6 resultados rejeitam a hipótese do estudo e podem ser reflexo da melhora na saúde sistêmica destas pessoas e da redução significativa do número de medicamentos utilizados por elas diariamente. / Background: The prevalence of obesity is increasing in the Brazilian population. For morbid obesity, the only effective treatment is bariatric surgery, resulting in weight reduction, less comorbidities and icreased quality of life. The aim of this study was to assess the impact of bariatric surgery in oral health parameters of morbid obese patients by a prospective cohort study. The hypothesis is that bariatric surgery causes oral health deterioration. Methods: All patients who underwent bariatric surgery at the Nossa Senhora da Conceição Hospital between October 2009 an January 2011 were invited to participate. Thirty-nine patients completed the two stages of the study, a baseline one day before surgery and a follow-up after six months. Measurements: Oral examinations were performed (caries by means of the ICDAS index, plaque index, gingival index, rest and stimulated saliva flow and use of prostheses) and followed by a questionnaire (socio-demographic data, oral health behavior, xerostomia, systemic diseases and medicines intake) in two distinct moments, a baseline 1 day before surgery and a follow-up examination six months after surgery. Analysis was carried out by means of, chi-square, Fischer’s exact test, paired samples Student’s t test and Mann-Whitney test. Results: There was a statistically significant reduction in the prevalence of hypertension (p<0,01), diabetes (p<0,01), number of medications taken daily (p<0,01), subjective sensation of dry mouth (p<0,01) and increased stimulated salivary flow (p<0,01). Conclusions: The results show improvement in oral health of patients undergoing bariatric surgery, as the sensation of dry mouth decreased and salivary flow increased. These results reject the hypothesis of the study and may reflect the improvement in the systemic health of morbid obese people and the significant reduction in the number of drugs used by them.

Made available in DSpace on 2014-06-11T19:29:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-08-08Bitstream added on 2014-06-13T18:39:57Z : No. of bitstreams: 1 souza_fac_me_botfm.pdf: 470759 bytes, checksum: b7008fa062892d597243273954f53192 (MD5) / Faculdade de Medicina da Unoeste / A obesidade classe III ou mórbida determina um risco significativamente aumentado para complicações metabólicas. Também são referenciadas alterações ginecológicas, como as irregularidades menstruais, o hirsutismo e as alterações hormonais. Avaliação dos aspectos clínicos-epidemiológicoslaboratoriais de pacientes com obesidade classe III, portadoras de distúrbios metabólicos e hormonais. Foram analisadas 58 mulheres com obesidade classe III ou mórbida e divididas em 2 grupos de estudo; sendo um grupo com mulheres obesas grau III sem disfunção menstrual ou hirsutismo, (Grupo C) e outro grupo com mulheres obesas grau III apresentando disfunção menstrual associada ou não a hirsutismo (Grupo E). Foram avaliadas a idade, cor, paridade, estado civil, profissão, nível sócio-econômico, escolaridade, idade da menarca, peso corporal, estatura, índice de massa corpórea, presença de hirsutismo (Índice de Ferriman e Gallwey), medida da circunferência abdominal (CA), medida da circunferência do quadril (CQ), relação cintura-quadril (RCQ), ciclo menstrual, medida da pressão arterial, presença da acantose nigricans, avaliação da resistência a insulina, glicemia de jejum (GJ), colesterol total (CT), HDL-C, LDL-C, triglicerídeos (TG), hormônio tireo-estimulante (TSH), T4 livre, hormônio luteinizante (LH), o hormônio folículo-estimulante (FSH), prolactina (PRL), Testosterona total, sulfato de dehidroepiandrosteron (DHEA-S), a insulina e o HOMA test. Os aspectos clínicos-epidemiológicos não apresentaram diferenças estatísticas. Os parâmetros clínicos e laboratoriais não apresentaram alterações estatisticamente significativas; entretanto, os valores do HOMA test para o grupo E foram significantemente maiores que os pacientes do grupo C. Em mulheres obesas classe III a presença da resistência... / Class-III or morbid obesity determines significantly increased risk for metabolic complications. Gynecologic alterations, such menstrual irregularity, hirsutism and hormonal alterations are also reported. To evaluate the clinical, epidemiological and laboratory aspects of patients with class-III obesity showing metabolic and hormonal disorders. Fiftyeight women with class-III or morbid obesity were evaluated. They were divided into 2 groups: one group comprising grade-III obese women without menstrual dysfunctions or hirsutism (Group C), and another with grade-III obese women showing menstrual dysfunction associated with hirsutism or not (Group E). The following aspects were evaluated age, color, parity, marital status, profession, socioeconomic level, education, age at menarche, body weight, height, body mass index, presence of hirsutism (Ferriman and Gallwey Index), abdominal circumference measurement (AC), hips circumference measurement (HC), waist-to-hip ratio (WHR), menstrual cycle, blood pressure, presence of acanthosis nigricans, evaluation of insulin resistance, fasting glycemia (FG), total cholesterol (TC), HDL-C, LDL-C, triglycerides (TG), thyroidstimulating hormone (TSH), free T4, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), total testosterone, dehydroepiandrosterone sulfate (DHEA-S), insulin and the HOMA test. The clinical and epidemiological aspects did not present statistical differences. The clinical and laboratory parameters did not show statistically significant alterations; however, the HOMA test values for group E were significantly higher than those for patients in group C. In class-III obese women, the presence of insulin resistance can cause menstrual dysfunctions, such as amenorrhea or oligomenorrhea even in the absence of hyperandrogenism, thus suggesting... (Complete abstract click electronic access below)

Introdução: A prevalência de obesidade cresce rapidamente na população brasileira. Para obesidade mórbida, o único tratamento efetivo é a cirurgia bariátrica, que proporciona redução do peso, das comorbidades associadas e aumento da qualidade de vida. O objetivo deste estudo foi verificar o impacto da cirurgia bariátrica na saúde bucal dos pacientes com obesidade mórbida através de uma coorte prospectiva. A hipótese é que a cirurgia bariátrica poderia causar piora da saúde bucal. Método: Todos os pacientes que realizaram cirurgia bariátrica no Hospital Nossa Senhora da Conceição entre outubro de 2009 e janeiro de 2011 foram convidados a participar do estudo. Medidas: foram realizados exames bucais (cárie, pelo índice ICDAS; índices de placa e sangramento gengival; fluxo salivar em repouso e estimulado; uso de próteses) e entrevistas (dados sócio-demográficos, hábitos bucais, sensação subjetiva de boca seca, doenças sistêmicas e medicamentos em uso) em duas etapas, uma linha de base um dia antes da cirurgia e um exame de acompanhamento seis meses após a cirurgia. Foi realizada análise descritiva das variáveis, qui-quadrado, teste exato de Fischer, teste t de student para amostras pareadas e teste de Mann-Whitney. 9Continua) Resultados: Trinta e nove pacientes concluíram as duas etapas do estudo. Houve redução estatisticamente significativa na prevalência de hipertensão arterial (p<0,01), diabetes (p<0,01), número de medicamentos utilizados diariamente (p<0,01), sensação subjetiva de boca seca (p<0,01) e aumento do fluxo salivar estimulado (p<0,01). Conclusão: Os resultados mostram melhora na saúde bucal dos pacientes submetidos à cirurgia bariátrica, já que a sensação de boca seca diminuiu e o fluxo salivar aumentou. Estes 6 resultados rejeitam a hipótese do estudo e podem ser reflexo da melhora na saúde sistêmica destas pessoas e da redução significativa do número de medicamentos utilizados por elas diariamente. / Background: The prevalence of obesity is increasing in the Brazilian population. For morbid obesity, the only effective treatment is bariatric surgery, resulting in weight reduction, less comorbidities and icreased quality of life. The aim of this study was to assess the impact of bariatric surgery in oral health parameters of morbid obese patients by a prospective cohort study. The hypothesis is that bariatric surgery causes oral health deterioration. Methods: All patients who underwent bariatric surgery at the Nossa Senhora da Conceição Hospital between October 2009 an January 2011 were invited to participate. Thirty-nine patients completed the two stages of the study, a baseline one day before surgery and a follow-up after six months. Measurements: Oral examinations were performed (caries by means of the ICDAS index, plaque index, gingival index, rest and stimulated saliva flow and use of prostheses) and followed by a questionnaire (socio-demographic data, oral health behavior, xerostomia, systemic diseases and medicines intake) in two distinct moments, a baseline 1 day before surgery and a follow-up examination six months after surgery. Analysis was carried out by means of, chi-square, Fischer’s exact test, paired samples Student’s t test and Mann-Whitney test. Results: There was a statistically significant reduction in the prevalence of hypertension (p<0,01), diabetes (p<0,01), number of medications taken daily (p<0,01), subjective sensation of dry mouth (p<0,01) and increased stimulated salivary flow (p<0,01). Conclusions: The results show improvement in oral health of patients undergoing bariatric surgery, as the sensation of dry mouth decreased and salivary flow increased. These results reject the hypothesis of the study and may reflect the improvement in the systemic health of morbid obese people and the significant reduction in the number of drugs used by them.

Orientador: Sarah Monte Alegre / Dissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T07:51:04Z (GMT). No. of bitstreams: 1 Ortiz_JosianeNovetiMorais_M.pdf: 1470071 bytes, checksum: 08c02e85220eefda78e3311ccc0a0153 (MD5) Previous issue date: 2007 / Resumo: A obesidade é uma doença cuja prevalência vem aumentando de forma global em todas as faixas etárias, raças e em ambos os sexos, e está associada a altas taxas de morbidade e mortalidade. Obesos desenvolvem também hiperinsulinemia e resistência à insulina, o que pode levar ao aparecimento de diabetes tipo 2 (DM). Recentemente foi demonstrado que o tecido adiposo, mais que um local de acúmulo de reservas energéticas, desempenha papel de um verdadeiro órgão secretor de moléculas sinalizadoras (adipocinas) que atuam em diversos locais do organismo. O acúmulo de tecido adiposo causado pela obesidade acarreta um aumento da produção de adipocinas, como o Fator de Necrose Tumoral Alfa (TNF-a) e a Interleucina-6 (IL-6), que ao estimular a produção de proteínas de fase aguda pelo fígado, conduzem a um estado inflamatório subclínico, associado ao surgimento das comorbidades presentes na obesidade. A adiponectina, produzida pelo tecido adiposo, ao contrário, exerce um papel protetor, diminuindo a resistência à insulina, porém encontra-se paradoxalmente diminuída em obesos. Ajudar a entender as interações existentes entre obesidade, adipocinas e resistência à insulina, avaliando concentrações séricas de adiponectina, TNF-a, IL-6, Proteína C-reativa (CRP) em pacientes obesos graves com (IT) ou sem (NT) intolerância à glicose, bem como em controles, antes e após infusão de insulina, é o objetivo deste trabalho. Para tanto, 32 indivíduos obesos (15 NT, 11 IT e 6 DM; IMC=50,2±2,2; 48,3±2,2 e 51,0±3,0Kg/m2) e 9 indivíduos eutróficos (CT=22,3±0,6Kg/m2) classificados a partir de teste oral de tolerância à glicose, pareados por idade e sexo, realizaram clamp euglicêmico hiperinsulinêmico (180 min; infusão de insulina - 40µU/min·m2). Adiponectina, TNF-a, IL-6, e CRP foram dosados em jejum e aos 180 minutos do clamp. Antes do início do estudo foi realizada bioimpedância elétrica (BIA) para determinação da composição corporal. Os pacientes obesos eram resistentes à insulina (sensibilidade à insulina ou ¿M¿: NT=28,5±3,4 IT=23,3±1,6 e DM=16,8±3,4; todos p<0,001 vs. CT=52,5±2,7 µmol/min/KgMM). As concentrações basais de TNF-a, IL-6 e CRP eram similares entre os subgrupos de obesos, maiores que nos controles (todos p<0.01) e relacionadas independentemente ao IMC e/ou à % gordura corporal. As concentrações basais de adiponectina eram menores nos obesos (NT=7,5±1,4; IT=5,6±0,9; DM=3,3±0,7 vs. CT=11,6±1,4 µg/ml) e direta e independentemente relacionadas à sensibilidade à insulina e inversamente com as medidas de adiposidade, glicemia e insulinemia. A infusão de insulina diminuiu a adiponectinemia nos obesos independentemente do grau de tolerância à glicose (p =0,009) e exerceu pouco efeito sobre as demais citocinas. Portanto, as concentrações circulantes elevadas de TNF-a, IL-6 e CRP em pacientes com obesidade grau III não dependem do grau de tolerância à glicose e não se modificam sob infusão aguda de insulina. As concentrações circulantes de adiponectina encontram-se diminuídas, variando de acordo com o grau de tolerância à glicose, e sofrem ação inibitória da insulina. A hiperinsulinemia presente nos pacientes obesos pode contribuir para diminuir a adiponectinemia acarretando um aumento ainda maior da resistência à insulina e da conseqüente hiperinsulinemia / Abstract: Obesity is associated with a cluster of metabolic alterations such as insulin resistance, hypertension, and dyslipidemia and with a low-grade systemic inflammation, which is presumed to play a role in the development of insulin resistance, cardiovascular disease (CVD) and type 2 diabetes mellitus (DM). Adipocytokines or adipokines are synthesized by adipose tissue, released into the circulation and may act as signaling molecules. High circulating levels of Tumor Necrosis Factor-Alpha (TNF-a) and Interleukin-6 (IL-6) in adipose tissue have been demonstrated in obesity. Adiponectin, abundantly expressed in white adipose tissue, seems to play a protective role against atherosclerosis and insulin resistance but is decreased in obesity. The role of insulin sensitivity and insulin levels on the modulation of adiponectin concentrations in humans remains unclear. Aim: to evaluate the acute insulin effect on circulating adiponectin, TNF-a, IL-6 and C-reactive protein (CRP) and their relationship with insulin resistance in normal subjects and in class III obese subjects with normal (NGT) or impaired glucose tolerance (IGT). Methods: 32 obese, 15 NGT, 11 IGT and 6 DM subjects (BMI=50.2±2.2; 48.3±2.2 and 51.0±3.0Kg/m2) and 9 lean subjects (CT 22.3±0.6Kg/m2) received an OGTT and a 3h-euglycemic clamp (insulin infusion - 40µU/min·m2). Adiponectin, TNF-a, IL-6 and CRP were assayed at fasting and at 180min of insulin infusion. BIA was performed before the study to assess body composition. Results: Obese patients were insulin resistant (M:NGT=28.5±3.4; IGT=23.3±1.6 and DM=16.8±3.4; all p<0.001 vs. CT=52.5±2.7 µmol/KgFFM·min). Fasting TNF-a IL-6 and CRP were similar among obese subgroups, higher than CT (p<0.01) and related to BMI and/or fat mass. Adiponectin was lower in obese (NGT=7.55±1.26; IGT=5.55±0.95; DM=3.31±0.75 vs. CT=11.56±1.37 µg/ml) and directly and independently related to M after adjustment for waist, fat mass and BMI (p<0.001). Insulin infusion lowered adiponectin only in obese subjects and little affected the other cytokines. Discussion: In severely obese subjects, TNF-a, IL-6 and CRP are increased independently of glucose tolerance status, and are not affected in the short-term by insulin. Adiponectin levels are decreased in these subjects, according to the glucose tolerance degree, and are downregulated by insulin infusion. More importantly, the persistent hyperinsulinemia can contribute to reduce the adiponectin expression, contributing to further insulin resistance and hyperinsulinemia / Mestrado / Ciencias Basicas / Mestre em Clinica Medica

<p>Ambulanspersonal skall i sitt dagliga arbete lyfta och behandla patienter. I varje ambulans finns två ambulanssjukvårdare (kan även vara sjuksköterskor med eller utan specialistutbildningar) som har genomgått ett lyftprov som bekräftar att de på två man klarar att lyfta en patient som väger 90kg. Då en patient väger 150kg (gravt obes patient) eller mer blir det problematiskt, både ergonomiskt och medicintekniskt. Antalet överviktiga ökar, även de som räknas som gravt obesa. Syftet med denna uppsats vara att beskriva ambulanspersonalens erfarenheter då det gäller ambulanstransport av gravt obesa patienter.Enkäter besvarades anonymt av personal på en ambulansstation i södra Sverige. Svarsfrekvensen blev 29 av 55 personal efter att ett påminnelsebrev delats ut. Svaren bearbetades med beskrivande statistik. Resultatet visade att det inte fanns en fullt fungerande rutin för gravt obesa patienter. Personalen ansåg överlag att hjälpmedel inte var tillräckliga för att snabbt och säkert kunna transportera patienter med en vikt över 150kg till sjukhuset. Förbättring av rutiner samt hjälpmedel skulle kunde minska riskerna för skador hos personal samt innebära en bättre och säkrare vård vid transport till sjukhus.</p>

Ambulanspersonal skall i sitt dagliga arbete lyfta och behandla patienter. I varje ambulans finns två ambulanssjukvårdare (kan även vara sjuksköterskor med eller utan specialistutbildningar) som har genomgått ett lyftprov som bekräftar att de på två man klarar att lyfta en patient som väger 90kg. Då en patient väger 150kg (gravt obes patient) eller mer blir det problematiskt, både ergonomiskt och medicintekniskt. Antalet överviktiga ökar, även de som räknas som gravt obesa. Syftet med denna uppsats vara att beskriva ambulanspersonalens erfarenheter då det gäller ambulanstransport av gravt obesa patienter.Enkäter besvarades anonymt av personal på en ambulansstation i södra Sverige. Svarsfrekvensen blev 29 av 55 personal efter att ett påminnelsebrev delats ut. Svaren bearbetades med beskrivande statistik. Resultatet visade att det inte fanns en fullt fungerande rutin för gravt obesa patienter. Personalen ansåg överlag att hjälpmedel inte var tillräckliga för att snabbt och säkert kunna transportera patienter med en vikt över 150kg till sjukhuset. Förbättring av rutiner samt hjälpmedel skulle kunde minska riskerna för skador hos personal samt innebära en bättre och säkrare vård vid transport till sjukhus.

Η λαπαροσκοπική γαστρική παράκαμψη κατά Roux-en-Y είναι μία από τις πιο ευρέως χρησιμοποιούμενες βαριατρικές επεμβάσεις για την αντιμετώπιση της νοσογόνου παχυσαρκίας. Η απώλεια βάρους μετά από βαριατρικού τύπου επεμβάσεις έχει συσχετισθεί με τις επερχόμενες μεταβολές των γαστρεντερικών ορμονών, που έχει δειχθεί ότι συνδέονται με τον έλεγχο του μεταβολισμού και της όρεξης. Σκοπός: Η μελέτη της επίδρασης της εκτομής του θόλου του στομάχου σε ασθενείς με νοσογόνο παχυσαρκία που υποβάλλονται σε λαπαροσκοπική γαστρική παράκαμψη στην έκκριση των ορμονών, τα επίπεδα της γλυκόζης αλλά και την απώλεια βάρους. Μέθοδος: Δώδεκα ασθενείς υποβλήθηκαν σε λαπαροσκοπική γαστρική παράκαμψη και δώδεκα σε λαπαροσκοπική γαστρική παράκαμψη και εκτομή του θόλου του στομάχου. Όλοι οι ασθενείς μελετήθηκαν προοπτικά πρίν και τρείς, έξι και δώδεκα μήνες μετά την επέμβαση. Η συλλογή των δειγμάτων έγινε μετά από δωδεκάωρη νηστεία και 30, 60 και 120 λεπτά μετά την χορήγηση πρότυπου γεύματος θερμιδικού φορτίου 300 Kcal. Αποτελέσματα: Το σωματικό βάρος και ο δείκτης μάζας σώματος μειώθηκαν σημαντικά (p<0.001) και στις δύο ομάδες χωρίς όμως διαφορές μεταξύ των ομάδων. Για την ομάδα της γαστρικής παράκαμψης τα επίπεδα γκρελίνης νηστείας μειώθηκαν στους τρείς μήνες μετεγχειρητικά και αυξήθηκαν στούς δώδεκα μήνες σε επίπεδα υψηλότερα σε σχέση με τα προεγχειρητικά (p<0.01), αντίθετα, μετά από λαπαροσκοπική γαστρική παράκαμψη και εκτομή του θόλου, τα επίπεδα γκρελίνης νηστείας μειώθηκαν σημαντικά και παρέμειναν χαμηλά σε όλες τις χρονικές στιγμές της μελέτης (p<0.01). H μεταγευματική απόκριση του PYY, του GLP-1 και της ινσουλίνης ενισχύθηκαν μετεγχειρητικά (p<0.01) και στις δύο επεμβάσεις αλλά η απόκριση ήταν σημαντικά μεγαλύτερη και τα μεταγευματικά σάκχαρα χαμηλότερα μετά από γαστρική παράκαμψη και εκτομή του θόλου του στομάχου (p for interaction <0.05). Μετεγχειρητικά οι μεταβολές της γκρελίνης συσχετίστηκαν αρνητικά με τις μεταβολές του GLP-1. Συμπεράσματα: Η εκτομή του θόλου του στομάχου σε ασθενείς που υποβάλλονται σε λαπαροσκοπική γαστρική παράκαμψη οδηγεί σε χαμηλότερα βασικά επίπεδα γκρελίνης, σε μεγαλύτερη μεταγευματική απόκριση GLP-1, PYY και ινσουλίνης και σε χαμηλότερα σάκχαρα σε σχέση με την λαπαροσκοπική γαστρική παράκαμψη. Η εκτομή του θόλου του στομάχου με συνοδό γαστρική παράκαψη μπορεί να αποδειχθεί μια πολύ χρήσιμη καινούργια χειρουργική τεχνική για την αντιμετώπιση της νοσογόνου παχυσαρκίας και του σακχαρώδη διαβήτη τύπου ΙΙ. / Background: Laparoscopic Roux-en Y-Gastric bypass (LRYGBP) is the commonest available option for the surgical treatment of morbid obesity. Weight loss following bariatric surgery has been linked to changes of gastrointestinal peptides, shown to be implicated also in metabolic effects and appetite control. The purpose of this study was to evaluate whether gastric fundus resection in patients undergoing LRYGBP enhances the efficacy of the procedure in terms of weight loss, glucose levels and hormonal secretion. Methods: 12 patients underwent LRYGBP and 12 patients LRYGBP plus gastric fundus resection (LRYGBP+FR). All patients were evaluated before and at 3, 6, and 12 months postoperatively. Blood samples were collected after an overnight fast and 30, 60 and 120 min after a standard 300 kcal mixed meal. Results: Body weight and body mass index decreased markedly and comparably after both procedures. Fasting ghrelin decreased three months after LRYGBP, but increased at 12 months to levels higher than baseline while after LRYGBP+FR was markedly and persistently decreased. Postprandial GLP-1, PYY and insulin responses were enhanced more and postprandial glucose levels were lower after LRYGBP+FR compared to LRYGBP. Postoperatively, ghrelin changes correlated negatively with GLP-1 changes. Conclusions: Resection of the gastric fundus in patients undergoing LRYGBP was associated with persistently lower fasting ghrelin levels, higher postprandial PYY, GLP-1 and insulin responses and lower postprandial glucose levels compared to LRYGBP. These findings suggest that fundus resection in the setting of LRYGBP may be more effective than RYGBP for the management of morbid obesity and diabetes type 2.

A prevalência da obesidade está aumentando de forma alarmante em todo o mundo. A obesidade mórbida está entre as doenças que mais matam e o índice de mortalidade entre homens obesos mórbidos de 25 a 40 anos é doze vezes maior em relação a indivíduos com peso normal. Da mesma forma que aumenta o número de obesos, também está havendo um aumento na realização de cirurgias para redução de peso. Além disso, alguns estudos mostram que o estado nutricional relativo ao zinco em indivíduos obesos e diabéticos é alterado. Dessa forma, o objetivo deste trabalho foi avaliar os efeitos da gastroplastia com derivação em Y de Roux sobre o estado nutricional relativo ao zinco de obesos mórbidos. Participaram do estudo pacientes submetidos ao procedimento cirúrgico, perfazendo um total de 24 (vinte e quatro) indivíduos na primeira fase e 22 (vinte e dois) na segunda fase da pesquisa. Foram coletadas amostras de sangue, urina de 24 horas e registros alimentares de três dias (sendo um dia de final de semana) tanto no pré-operatório (T0) quanto aproximadamente dois meses após a cirurgia (T1) - período no qual os pacientes não receberam suplementação de minerais. As amostras biológicas foram analisadas por meio de um espectrofotômetro de absorção atômica de chama e o consumo alimentar de zinco foi analisado por meio do software Virtual Nutri versão 6.0 (FSP/USP). Os resultados no T0 e T1 foram respectivamente: zinco plasmático: 68 e 66,3 µg/dL; zinco eritrocitário: 36,6 e 43,8 µg/gHb; excreção urinária: 884,7 e 385,9 µg/24h e consumo alimentar de zinco: 10,5 e 6,7 mg/dia. Analisando os resultados, pode-se concluir que, num primeiro momento, a distribuição corporal do zinco melhorou, com redução na excreção urinária e aumento nas concentrações eritrocitárias. Entretanto, percebe-se também que o consumo alimentar de zinco apresentou uma redução significativa, o que em longo prazo, pode acarretar maiores problemas aos pacientes caso estes não recebam suplementação adequada. / The prevalence of obesity is increasing worldwide. Morbid obesity is a life threatening disease and the mortality index between morbid obese men aged 25 - 40 years is twelve - fold higher in relation to normal body weight subjects. Currently, the employment of surgery for weight reduction has also risen. Furthermore, previous research has shown that the nutritional zinc status in obese and diabetics subjects is altered. Thus, the aim of this study was to assess the influence of the Roux-en-Y gastric bypass on the zinc nutritional status of the morbid obese patients. Twenty four morbid obese individuals were studied before and 22 (twenty two) patients were studied two months after this surgical procedure, the period in which the patients were still not ingesting mineral supplements. Fast blood sample and three days food records were collected in the pre and post - operative phases. The zinc concentration in the sample was analyzed by flame atomic absorption spectrophotometry and dietary analysis of the food records performed using the software Virtual Nutri with the inclusion of zinc concentration in the database for regional foods (School of Public Health - USP - Brazil). The results on the pre and post - operative were respectively, plasma: 68 and 66,3 µg/dL; erythrocytes: 36,6 and 43,8 µg/gHb, urine: 884,7 µg/24h and 385,9 µg/24h and zinc intake: 10,5 e 6,7 mg/day. These results suggest that the surgical procedure changed mainly the zinc erythrocyte concentrations and zinc urinary excretion and, as expected, the zinc intake was lower in the post - operative state, which in the medium and long term, could cause problems for the patients.