Agustín Domínguez-Díez

Are there Predictive Factors of Severe Liver Fibrosis in Morbidly Obese Patients with Non-alcoholic Steatohepatitis?

Background: Non-alcoholic steatohepatitis (NASH) is a clinicopathological entity characterized by the presence of steatosis and lobular and/or portal inflammation with or without fibrosis. Patients with non-alcoholic fatty liver and fibrosis on liver biopsy have increased liver-related deaths. Methods: 181 wedge liver biopsies, taken at the time of bariatric surgery from patients with a mean body mass index (BMI) of 47, were studied. In all cases, the liver biopsy was performed without knowledge of the patients clinical and biochemical data, which were then examined with univariate and multivariate analysis. Results: Diagnosis of NASH was established in 105 patients (91%); 74 patients (70%) showed mild steatosis, 20 (19%) had moderate inflammation and fibrosis, and 11 (10%) had steatosis with severe fibrosis. None of the liver biopsies showed cirrhosis. Age was the only independent predictor of moderate and severe fibrosis (p=0.001). Conclusions: Since only age was a predictor of moderate or severe fibrosis, and no clinical or biochemical abnormalities detected slowly progressive hepatic fibrosis, liver biopsy is the only means of detecting progression to more advanced liver disease in a NASH patient.

Effects of weight loss after biliopancreatic diversion on metabolism and cardiovascular profile.

Background: Obesity is associated with increased prevalence of cardiovascular risk factors. Biliopancreatic diversion (BPD) for morbid obesity has been reported to produce anemia and malnutrition in short-term follow-up. The aim of our study was to analyze the effect of weight reduction on cardiovascular profile, renal function and nutritional status. Methods: 35 morbidly obese patients underwent BPD. We analyzed the presence of cardiovascular risk factors, renal status, proteinuria and nutritional status before and 1 year after BPD. Results: Excess weight loss was 67% at 1 year after BPD. All cardiovascular risk factors (hypertension, diabetes, hyperlipidemia) improved during follow-up. We could not find any relevant signs of malnutrition in the patients. Microalbuminuria decreased and proteinuria disappeared after weight loss. We observed less urinary calcium and citrate excretion, with an increase in oxaluria, but these changes did not increase the incidence of renal stones. Conclusions: BPD was followed by improved cardiovascular profile and a lower pro-inflammatory state. BPD did not produce significant malnutrition, anemia or renal stone disease.

Fasting Plasma Ghrelin Levels Increase Progressively after Biliopancreatic Diversion: One-year Follow-up

Background: The role of ghrelin in weight control after surgery is not clear. We examined plasma ghrelin and leptin levels in patients with morbid obesity undergoing biliopancreatic diversion (BPD) of Scopinaro. Methods: 30 adult patients (27 females, 3 males), undergoing elective BPD were recruited from the Hospital Surgery Service. Fasting blood samples for biochemical determinations were drawn before surgery and 1, 3 and 12 months after BPD. Human plasma ghrelin was measured by RIA. Results: During the study period, weight, BMI and serum leptin levels decreased significantly at all sample points compared to preoperative values. Ghrelin plasma levels increased during the study, with statistical significance at 3 months and 1 year after surgery compared with preoperative levels. While leptin changes correlated with changes in BMI, no correlation was found between ghrelin and leptin or BMI changes. Conclusion: Plasma ghrelin levels could be decreased in obese patients as a compensatory mechanism to their nutritional state, but our results do not support the postulated beneficial role of ghrelin in the 1-year weight loss after BPD. They rather suggest that weight loss somehow stimulates ghrelin secretion, even in the absence of part of the stomach.

Increased soluble CD36 is linked to advanced steatosis in nonalcoholic fatty liver disease.

Soluble CD36 (sCD36) clusters with insulin resistance, but no evidence exists on its relationship with hepatic fat content. We determined sCD36 to assess its link to steatosis in nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis C (CHC) patients.

Cirugía del cáncer gástrico precoz. Experiencia en 25 años

Resumen Objetivos Estudiar la influencia de la profundidad de la invasion parietal (mucosa-submucosa), presencia o no de metastasis ganglionares y tipo de gastrectomia practicada (subtotal o total) sobre la supervivencia del cancer gastrico precoz. Diseno del Estudio Estudio longitudinal. Pacientes Se realiza un estudio clinicopatologico de 101 pacientes operados de Cancer Gastrico Precoz. La probabilidad de supervivencia se estimo mediante las pruebas de Kaplan-Meier y rangos logaritmicos, y el analisis multivariante, mediante la prueba de Cox. Resultados Existia afeccion mucosa en 46 pacientes (45,5%) y afeccion submucosa en 55 pacientes (54,5%). La presencia de metastasis ganglionares fue mayor en tumores que alcanzaron la submucosa (n = 14; 25,5%) que en tumores limitados a la mucosa (n = 4; 8,7%). Se practicaron gastrectomias parciales segun la localizacion del tumor en 84 pacientes (83,2%), gastrectomias totales en 16 (15,8%) asi como una reseccion en cuna. El seguimiento medio postoperatorio ha sido de 84,04 ± 55,89 meses (limites, 2-264). En la comparacion de la supervivencia en pacientes con tumores limitados a mucosa o submucosa se ha hallado una p = 0,06 (NS). En la comparacion de la supervivencia en relacion sin metastasis o con metastasis se ha encontrado una p Conclusiones La afeccion ganglionar, pero no la invasion submucosa, influye sobre la supervivencia. La gastrectomia parcial puede ser un procedimiento adecuado, ya que permite una supervivencia similar a la asociada a la gastrectomia total.

Cáncer diferenciado de tiroides. Metástasis pulmonares y cerebrales

Resumen La tiroidectomia total es el tratamiento de eleccion en el cancer diferenciado de tiroides. A pesar de esta intervencion, pueden aparecer metastasis regionales y a distancia. El control posterior de la enfermedad se realiza con la determinacion de los valores de tiroglobulina, y el rastreo corporal con 201 Tl y 131 I. Estos son mas fiables en los pacientes a los que se ha practicado una tiroidectomia total. Queremos enfatizar en la importancia del seguimiento medico tras el tratamiento quirurgico, incluso en ausencia de sintomas.