Enrique Lanzarini S

Hiperobesidad y obesidad mórbida: estudio comparativo

Hiperobesity v/s morbid obesity: a comparative study Introduction: Bariatric surgery is effective and safe in treating obese patients with BMI > 40, howe- ver, higher preoperative weight could increases morbidity and mortality. Aim: To describe and compare the perioperative and mid term outcomes between hiperobese and morbidly obese patients submitted to gastric bypass. Material and Method: A prospective study of hiperobese patients submitted to gastric bypass over the past 10 years. We analyzed clinical characteristics, perioperative morbimortality and resolution of comor- bidities. The results were compared with a group of morbidly obese patients matched by age and sex. Results: 146 hiperobese were operated and compared with 165 morbidly obese patients. 66.8% were female and the average age of the total group was 39.9 ± 12.4 years, with no signifi cant differences between groups by sex and age. The average BMI was 53 and 44.4 respectively. 21.5% had diabetes mellitus 2, 39.5% hypertension, 31% dislipidemia and 8.4% osteoarthritis, with no signifi cant differences between groups except for a higher prevalence of dyslipidemia in the morbidly obeses (p = 0.001). 10.4% had surgical complications during the postoperative period, with no differences between both groups (p = 0.24). One year later all patients had a signifi cant decrease in weight, however, hiperobeses showed a more pronounced decrease (p = 0.001). The fasting glucose, cholesterol and triglycerides levels also showed a signifi cant decrease without reaching differences between the groups. Conclusions: The gastric bypass is effective in achieving weight loss and resolution of comorbidities in morbidly obese as well as hiperobese patients, with no signifi cant differences in surgical complications and mortality.

Efecto del bypass gástrico a largo plazo (7 a 10 años) en pacientes con obesidad severa y mórbida sobre el peso corporal, diabetes, dislipidemia y desarrollo de anemia

weight and complications of obesity, seven to 10 years after gastric bypass surgery. Material and Methods: One hundred eighteen subjects with morbid obesity, aged 15 to 66years (103 women), were followed for a mean of 94 months after surgery. Body weight, fasting blood glucose, total cholesterol, triglycerides and hemoglobin were measured before surgery and during follow up. Results: At 24 months of follow up, all patients lost weight and there was a mild weight increase at 94 months, that paralleled the preo-perative body mass index. Diabetes, hypercholesterolemia and hypertriglyceridemia subsided in 95, 87 and 94% of cases, respectively. Twenty percent of patients had mild anemia and 11% moderate or severe anemia. No patient recovered the preoperative weight. Conclusions: Weight reducing effects of gastric bypass are maintained after 94 months of follow up with the expected health benefits.

Carcinoma medular de tiroides: Experiencia de 20 años

Antecedentes: El carcinoma medular de tiroides (CMT) es un tumor maligno poco frecuente, originado a partir de las celulas C. Su tratamiento quirurgico y resultados son controvertidos, por lo que hemos decidido estudiarlo. Objetivo: Describir clinicamente el CMT, tratamiento y resultados a largo plazo. Material y metodo: Se revisaron retrospectivamente las fichas clinicas de pacientes con CMT operados en nuestro hospital entre 1987 y el 2007. Se analizaron las caracteristicas clinicas, tratamiento, morbilidad y seguimiento a largo plazo. Resultados: Se operaron 24 pacientes, cuya edad media fue 46,1 ± 16,6 anos. La principal forma de presentacion fue aumento de volumen cervical (56,2%). Un 15% formaba parte de una NEM 2b. A todos se les realizo una tiroidectomia total, ampliada en el 50% de los casos. El 35,2% eran multifocales, el 29,4% bilaterales y el 62,5% tenia metastasis ganglionar. Cinco pacientes mantuvieron niveles de calcitonina elevados en el postoperatorio y nueve pacientes recurrieron clinicamente, en promedio, a los 4,5 anos. La enfermedad persistente se asocio significativamente con CMT hereditario (p = 0,0088) y la recurrencia clinica a tiroidectomia total no ampliada (p = 0,0196). La probabilidad de sobrevivir mas de 19 anos fue 66,6% (IC 95% = 0,24 a 0,89). Conclusiones: EL CMT es un tumor raro cuyo tratamiento de eleccion es la cirugia. La persistencia de enfermedad se asocia con la forma hereditaria, y la recurrencia clinica con la tiroidectomia total no ampliada, lo que nos hace recomendar una tiroidectomia total asociada a vaciamiento central y diseccion yugular radical modificada.

Prevalencia de displasia de vesícula biliar

Introduction: Gallbladder dysplasia is considered a premalignant stage, preceding the appearance of carcinoma. Aim: To assess the prevalence of gallbladder dysplasia in gallbladder biopsies. Material and methods: Review of pathology reports of 1237 gallbladders obtained during cholecystectomies, during 2003. Results: Thirty one reports informed the presence of dysplasia (2.5 %). Of these, 12 were in stage 1 (39 %), 14 were in stage 2 (45 %) and 5 in stage 3-ISC (in-situ carcinoma, 16 %). The mean age of patients with gallbladder dysplasia was 54 years. Discussion: Gallbladder dysplasia is common. The pathological study of the excised gallbladders is the only way to make the diagnosis.

RESULTADOS DE LA CIRUGÍA ACTUAL PARA EL TRATAMIENTO DEL CÁNCER DE ESÓFAGO

Resumen La cirugia del cancer de esofago ha sido y sigue siendo un desafio pese a los avances en tecnica quirurgica y cuidados peri operatorios y a pesar de que las complicaciones postoperatorias y la morbimortalidad sigue siendo alta, aun en centros con alto volumen de procedimientos y mas aun en centros no dedicados a laatencion de estos pacientes. En este articulo se revisaran algunos aspectos epidemiologicos, las herramientasdiagnosticas actuales, su etapificacion, y las opciones terapeuticas de acuerdo al estadio, sea en etapas precoces o avanzadas, la localizacion y tipo de tumor, opciones de reconstruccion del transito digestivo en base alo reportado en la literatura internacional, la experiencia nacional y en base a nuestros propios resultados enel Departamento de Cirugia del Hospital Clinico de la Universidad de Chile.

Diabetes tipo 2 y obesidad leve: tratamiento quirúrgico

Resumen es: Introduccion: En la actualidad la diabetes mellitus tipo 2 (DM2) y la obesidad representan un serio problema de salud, comportandose como enfermedades ep...