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Sample records for anti-obesity gastric bypass

  1. Euglycemia and normolipidemia after anti-obesity gastric bypass Euglucemia y normolipidemia después de derivación gástrica anti-obesidad

    Directory of Open Access Journals (Sweden)

    A. G. Ribeiro

    2009-02-01

    Full Text Available Weight loss and resolution of comorbidities is well established after modern bariatric procedures, however chronology of glyco-lipidic biochemical response is still debated. Objective: Aiming to analyze this variable as well as its correlation with food amount and composition, a prospective study was designed. Methodology: Eighty consecutive patients undergoing Roux-en-Y gastric bypass were investigated every three months until one year after surgery. Females only were accepted and variables included general and nutritional course as well as glucose and lipid measurements. Energy intake was documented including percentage of macronutrients in the diet. Results: Surgery was successful with about 71% excess body weight loss at the end of the first year. Mean energy intake on the 4 postoperative quarters was respectively 519.6 ± 306.6, 836.0 ± 407.9, 702.1 ± 313.1 and 868.8 ± 342.8 kcal/day (mean ± SD. Fat intake was initially low but reached 34.1 ± 7.9% of total calories at final measurement. Blood glucose and lipid fractions tended to be borderline or abnormal preoperatively, and favorably changed by 12 months. Consumption of glucose-and lipid-lowering medication significantly diminished, but each of these was still necessary in 6.3% of the group. Correlation between body mass index and also calorie intake versus glucose and lipid measurements was highly significant (P = 0.000. Conclusions: 1 Energy intake after operation was very low; 2 Weight loss proceeded rapidly and correlated with meal pattern; 3 Improvement of glucose and lipid tests was adequate but took several quarters to normalize; 4 Decreased requirements for glucose- and lipid-lowering medication was significant but not absolute; 4 Fat percentage of total calories exceeded 30% at the end of the observation period, despite recommendations to the contrary.Pérdida de peso y resolución de las comorbidades estan bien establecidas luego de los modernos procedimientos bari

  2. Gastric bypass surgery

    Science.gov (United States)

    ... Roux-en-Y; Weight-loss surgery - gastric bypass; Obesity surgery - gastric bypass ... bypass surgery is not a quick fix for obesity. It will greatly change your lifestyle. After this surgery, you must eat healthy foods, control portion sizes of ...

  3. Your diet after gastric bypass surgery

    Science.gov (United States)

    Gastric bypass surgery - your diet; Obesity - diet after bypass; Weight loss - diet after bypass ... You had gastric bypass surgery. This surgery made your stomach smaller by closing off most of your stomach with staples. It changed ...

  4. Gastric infarction following gastric bypass surgery

    Science.gov (United States)

    Do, Patrick H; Kang, Young S; Cahill, Peter

    2016-01-01

    Gastric infarction is an extremely rare occurrence owing to the stomach’s extensive vascular supply. We report an unusual case of gastric infarction following gastric bypass surgery. We describe the imaging findings and discuss possible causes of this condition. PMID:27200168

  5. Gastric emptying after a new, more physiological anti-obesity operation: the Magenstrasse and Mill procedure

    International Nuclear Information System (INIS)

    The Magenstrasse and Mill (M and M) procedure for obesity is designed to preserve normal gastric emptying mechanisms. The hypothesis investigated in this study was that gastric emptying would be normal after the M and M gastroplasty. Gastric emptying studies were performed using both liquid and solid test meals, in ten morbidly obese patients (MO group) and in 13 patients after the M and M procedure (MM group). Seven people of normal weight served as controls and were matched for age, sex and height to the M and M and MO groups. Three years after the M and M procedure, mean (SD) weight loss was 42 (19) kg, with a mean loss of excess weight of 58% (20%). Gastric emptying half-times (t1/2) are expressed in minutes, as median values (25th and 75th percentiles). The t1/2 for solids was 97 (85-110) min in the control group, 140 (86-220) min in the MO group and 79 (46-150) min in the MM group. Median gastric emptying for solids was 0.7% (0.6%-0.8%) per minute in the control group, 0.5% (0.3%-0.8%) in the MO group and 0.9% (0.4%-1.4%) in the M and M group. There were no statistically significant differences in the emptying times of the three groups. It is concluded that the M and M procedure achieves acceptable weight loss, while preserving gastric emptying mechanisms and thus minimising possible side-effects such as vomiting, dumping and diarrhoea, which are common complications of gastric bypass procedures. (orig.)

  6. Gastric emptying after a new, more physiological anti-obesity operation: the Magenstrasse and Mill procedure

    Energy Technology Data Exchange (ETDEWEB)

    Carmichael, A.R.; Johnston, D.; Barker, M.C.J.; Bury, R.F.; Boyce, J.; Sue-Ling, H. [Leeds General Infirmary (United Kingdom)

    2001-09-01

    The Magenstrasse and Mill (M and M) procedure for obesity is designed to preserve normal gastric emptying mechanisms. The hypothesis investigated in this study was that gastric emptying would be normal after the M and M gastroplasty. Gastric emptying studies were performed using both liquid and solid test meals, in ten morbidly obese patients (MO group) and in 13 patients after the M and M procedure (MM group). Seven people of normal weight served as controls and were matched for age, sex and height to the M and M and MO groups. Three years after the M and M procedure, mean (SD) weight loss was 42 (19) kg, with a mean loss of excess weight of 58% (20%). Gastric emptying half-times (t{sub 1/2}) are expressed in minutes, as median values (25th and 75th percentiles). The t{sub 1/2} for solids was 97 (85-110) min in the control group, 140 (86-220) min in the MO group and 79 (46-150) min in the MM group. Median gastric emptying for solids was 0.7% (0.6%-0.8%) per minute in the control group, 0.5% (0.3%-0.8%) in the MO group and 0.9% (0.4%-1.4%) in the M and M group. There were no statistically significant differences in the emptying times of the three groups. It is concluded that the M and M procedure achieves acceptable weight loss, while preserving gastric emptying mechanisms and thus minimising possible side-effects such as vomiting, dumping and diarrhoea, which are common complications of gastric bypass procedures. (orig.)

  7. Analgesic Treatment in Laparoscopic Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Andersen, Lars P H; Werner, Mads U; Rosenberg, Jacob;

    2014-01-01

    This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines. The litera...... analgesic treatment in LRYGB surgery....

  8. Atypical complications of gastric bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Mitchell, Myrosia T. [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States)]. E-mail: mmitchell@radiology.bsd.uchicago.edu; Pizzitola, Victor J. [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States); Knuttinen, M-Grace [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States); Robinson, Tiffany [University of Chicago, Department of Internal Medicine, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States); Gasparaitis, Arunas E. [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States)

    2005-03-01

    Although gastric bypass surgery continues to grow in popularity for weight loss and weight maintenance in the morbidly obese, there has been little attention given to the imaging of complications associated with these surgeries. The purpose of our study is to demonstrate the variety of gastric bypass surgery complications that can be identified radiographically, with attention to the more unusual complications. This study was performed with institutional Internal Review Board approval. We performed a 5-year retrospective review of all patients who had undergone gastric bypass surgery, had complications of the surgery, and had studies performed in our department to image these complications. These studies consisted of contrast fluoroscopy and CT. We identified the more common complications of anastomotic stenoses and anastomotic leaks. We also identified six unusual complications as follow: (1) internal herniation through the small bowel mesentery, (2) internal herniation through the transverse mesocolon, (3) external herniation through the abdominal wall incision, (4) enterocutaneous fistulas, (5) antiperistaltic construction of the Roux-en-Y, and (6) incorrect anstomoses of the Roux limbs resulting in a Roux-en-O configuration. Our findings show that a thorough understanding of expected postoperative bowel configuration is essential in the evaluation of these patients. In addition, fluoroscopic evaluation should assess not only anatomy, but also motility.

  9. Perforation in the bypassed stomach following laparoscopic Roux-en-Y gastric bypass.

    Science.gov (United States)

    Papasavas, Pavlos K; Yeaney, Woodrow W; Caushaj, Philip F; Keenan, Robert J; Landreneau, Rodney J; Gagné, Daniel J

    2003-10-01

    Access to the bypassed stomach is difficult following laparoscopic Roux-en-Y gastric bypass (LRYGBP). The bypassed stomach is not readily available for endoscopic or radiographic evaluation. Diagnosis and treatment of peptic ulcer disease and its complications in the excluded stomach becomes difficult. We present a case of perforation in the bypassed stomach following LRYGBP secondary to peptic ulcer disease.

  10. Diagnostic tools for post-gastric bypass hypoglycaemia

    NARCIS (Netherlands)

    Emous, M.; Ubels, F. L.; van Beek, A. P.

    2015-01-01

    In spite of its evident success, several late complications can occur after gastric bypass surgery. One of these is post-gastric bypass hypoglycaemia. No evidence-based guidelines exist in the literature on how to confirm the presence of this syndrome. This study aims to describe and compare the tes

  11. Obstetrical and neonatal outcomes in women following gastric bypass

    DEFF Research Database (Denmark)

    Berlac, Janne Foss; Skovlund, Charlotte Wessel; Lidegaard, Ojvind

    2014-01-01

    OBJECTIVE: To assess obstetrical and neonatal outcomes in women following gastric bypass, compared with adipose women without surgery and with a normal weight control population. DESIGN: Historical controlled cohort study. SETTING: Denmark. POPULATION: All women undergoing gastric bypass during...... the period 1996-2011, and subsequently giving birth. METHODS AND MAIN OUTCOME MEASURES: Obstetrical and neonatal outcomes in women without gastric bypass matched on age, parity, plurality, year, and body mass index, and normal weight women. RESULTS: In 415 women giving birth after gastric bypass we found...... more admissions to neonatal intensive care unit compared with newborn of normal weight mothers; RR = 1.5 (1.1-2.0). CONCLUSIONS: Gastric bypass may reduce the risk of preeclampsia, emergency cesarean section, and perinatal asphyxia, compared with adipose women without surgery. Compared with normal...

  12. Current status of mini-gastric bypass

    Science.gov (United States)

    Mahawar, Kamal K.; Kumar, Parveen; Carr, William RJ; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K.

    2016-01-01

    Mini-gastric bypass (MGP) is a promising bariatric procedure. Tens of thousands of this procedure have been performed throughout the world since Rutledge performed the first procedure in the United States of America in 1997. Several thousands of these have even been documented in the published scientific literature. Despite a proven track record over nearly two decades, this operation continues to polarise the bariatric community. A large number of surgeons across the world have strong objections to this procedure and do not perform it. The risk of symptomatic (bile) reflux, marginal ulceration, severe malnutrition, and long-term risk of gastric and oesophageal cancers are some of the commonly voiced concerns. Despite these expressed fears, several advantages such as technical simplicity, shorter learning curve, ease of revision and reversal, non-inferior weight loss and comorbidity resolution outcomes have prompted some surgeons to advocate a wider adoption of this procedure. This review examines the current status of these controversial aspects in the light of the published academic literature in English. PMID:27251826

  13. Current status of mini-gastric bypass

    Directory of Open Access Journals (Sweden)

    Kamal K Mahawar

    2016-01-01

    Full Text Available Mini-gastric bypass (MGP is a promising bariatric procedure. Tens of thousands of this procedure have been performed throughout the world since Rutledge performed the first procedure in the United States of America in 1997. Several thousands of these have even been documented in the published scientific literature. Despite a proven track record over nearly two decades, this operation continues to polarise the bariatric community. A large number of surgeons across the world have strong objections to this procedure and do not perform it. The risk of symptomatic (bile reflux, marginal ulceration, severe malnutrition, and long-term risk of gastric and oesophageal cancers are some of the commonly voiced concerns. Despite these expressed fears, several advantages such as technical simplicity, shorter learning curve, ease of revision and reversal, non-inferior weight loss and comorbidity resolution outcomes have prompted some surgeons to advocate a wider adoption of this procedure. This review examines the current status of these controversial aspects in the light of the published academic literature in English.

  14. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... to check their blood sugar several times a day. Other problems that patients with morbid obesity have ... a lap band and he’s discharged the next day. With the gastric bypass, the patient comes in ...

  15. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... you a detailed account of how the operation works. During that time, I’d like to answer ... you’ll understand it. Basically, the gastric bypass works on two different principals for weight loss, one ...

  16. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... later, there was laparoscopic gastric bypass surgery. The learning curve, which is the time that it takes ... that you can do it proficiently; however the learning curve with robotic surgery is much shorter. In ...

  17. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... Loss Surgery: The Fully Robotic Gastric Bypass Baptist Health South Florida Miami, FL May 20, 2010 I ... study in 1991 at the National Institute of Health in Washington, D.C. And what they looked ...

  18. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

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    Full Text Available ... Health South Florida Miami, FL May 20, 2010 I am Dr. Anthony Gonzalez, and welcome to South ... live webcast, a fully robotic gastric bypass, as I mentioned, we’re in the operating room at ...

  19. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... Anthony Gonzalez, and welcome to South Miami Hospital. We’re here for a live webcast, a fully robotic gastric bypass, as I mentioned, we’re in the operating room at South Miami ...

  20. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... The feet are in this direction. And the robot is brought and docked over the patient’s body ... this location where I will be using the robot to perform this fully robotic gastric bypass. So ...

  1. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... done in two dimensions. Here we have an added dimension, and the depth perception is incredible and ... just a restrictive type of procedure. There’s no combined procedure like with the gastric bypass. So the ...

  2. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... Loss Surgery: The Fully Robotic Gastric Bypass Baptist Health South Florida Miami, FL May 20, 2010 I ... robotic prostatectomy, which is probably the standard of care today for prostate cancer. This is our eighth ...

  3. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass Baptist Health South Florida Miami, FL May 20, 2010 I am Dr. Anthony Gonzalez, and welcome to South Miami Hospital. We’ ...

  4. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... of reinforce this. This has been a really beautiful case. There’s really no bleeding, even though we ... on BAPTISTHEALTH.NET and joining us for this beautiful fully robotic gastric bypass. I hope that Dr. ...

  5. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... gastric bypass. So without further adieu, let me send you out, right outside our doors to my ... everything else that’s going into it, it will send the same signal to the brain that you’ ...

  6. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... operative procedure, the live procedure, you’ll understand it. Basically, the gastric bypass works on two different ... a small portion of the stomach and divide it from the rest of the stomach, and that’s ...

  7. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... gastrectomy. Another question is, “Does gastric bypass eliminate diabetes?” The morbidly obese patients that we see are those patients that have diabetes mellitus type II, and that’s diabetes associated with ...

  8. Prolonged successful therapy for hyperinsulinaemic hypoglycaemia after gastric bypass

    DEFF Research Database (Denmark)

    Myint, K S; Greenfield, J R; Farooqi, I S;

    2012-01-01

    Spontaneous hyperinsulinaemic hypoglycaemia following gastric bypass surgery (GBS) is increasingly recognised. However, its pathophysiology remains unclear. Some patients require pancreatectomy. Medical therapy with calcium channel blockers, acarbose and diazoxide has been reported to be beneficial...

  9. Post-gastric bypass hypoglycaemia: a review.

    Science.gov (United States)

    Shantavasinkul, Prapimporn C; Torquati, Alfonso; Corsino, Leonor

    2016-07-01

    Bariatric surgery is a highly effective treatment for severe obesity, resulting in substantial weight loss and normalizing obesity-related comorbidities. However, long-term consequences can occur, such as postbariatric surgery hypoglycaemia. This is a challenging medical problem, and the number of patients presenting with it has been increasing. Roux-en-Y gastric bypass (RYGB) is the most popular bariatric procedure, and it is the surgery most commonly associated with the development of postbariatric surgery hypoglycaemia. To date, the pathogenesis of this condition has not been completely established. However, various factors - particularly increased postprandial glucagon-like peptide (GLP)-1 secretion - have been considered as crucial mediator. The mechanisms responsible for diabetic remission after bariatric surgery may be responsible for the development of hypoglycaemia, which typically occurs 1-3 h after a meal and is concurrent with inappropriate hyperinsulinaemia. Carbohydrate-rich foods usually provoke hypoglycaemic symptoms, which can typically be alleviated by strict dietary modifications, including carbohydrate restriction and avoidance of high glycaemic index foods and simple sugars. Few patients require further medical intervention, such as medications, but some patients have required a pancreatectomy. Because this option is not always successful, it is no longer routinely recommended. Clinical trials are needed to further determine the pathophysiology of this condition as well as the best diagnostic and treatment approaches for these patients.

  10. Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy

    DEFF Research Database (Denmark)

    Patti, M E; McMahon, G; Mun, E C;

    2005-01-01

    AIMS/HYPOTHESIS: Postprandial hypoglycaemia following gastric bypass for obesity is considered a late manifestation of the dumping syndrome and can usually be managed with dietary modification. We investigated three patients with severe postprandial hypoglycaemia and hyperinsulinaemia unresponsive...... was assessed in all three patients. RESULTS: All three patients had evidence of severe postprandial hyperinsulinaemia and hypoglycaemia. In one patient, reversal of gastric bypass was ineffective in reversing hypoglycaemia. All three patients ultimately required partial pancreatectomy for control...... of neuroglycopenia; pancreas pathology of all patients revealed diffuse islet hyperplasia and expansion of beta cell mass. CONCLUSIONS/INTERPRETATION: These findings suggest that gastric bypass-induced weight loss may unmask an underlying beta cell defect or contribute to pathological islet hyperplasia, perhaps via...

  11. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... that we see are those patients that have diabetes mellitus type II, and that’s diabetes associated with obesity. And there’s no question that ... The other question is, “Does gastric bypass eliminate diabetes and does the sleeve?” It’s not the type of -- it’s not actually the type of procedure ...

  12. Changes in Hematology and Calcium Metabolism After Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Worm, Dorte; Madsbad, Sten; Kristiansen, Viggo B;

    2015-01-01

    BACKGROUND: Concerns regarding nutritional deficiencies have recently emerged after Roux-en-Y gastric bypass (RYGB). METHODS: A total of 835 subjects underwent RYGB, age 43.3 years, body mass index (BMI) 47.2 kg/m(2). Hematological and calcium metabolic variables were measured before, 6, 12, and 24...

  13. Gastric bezoar after Roux-en-Y gastric bypass for morbid obesity: A case report

    Science.gov (United States)

    Ertugrul, Ismail; Tardum Tardu, Ali; Tolan, Kerem; Kayaalp, Cuneyt; Karagul, Servet; Kirmizi, Serdar

    2016-01-01

    Introduction We aimed to present a patient with gastric pouch bezoar after having a bariatric surgery. Presentation of case Sixty-three years old morbid obese female had a laparoscopic Roux-en-Y gastric bypass surgery 14 months ago. She has lost 88% of her excess body mass index; but started to suffer from nausea, abdominal distention and vomiting lately, especially for the last two months. The initial evaluation by endoscopy, computed tomography (CT) and an upper gastrointestinal contrast series overlooked the pathology in the gastric pouch and did not display any abnormality. However, a second endoscopy revealed a 5 cm in diameter phytobezoar in the gastric pouch which was later endoscopically removed. After the bezoar removal, her complaints relieved completely. Discussion The gastric bezoars may be confused with the other pathologies because of the dyspeptic complaints of these patients. The patients that had a bariatric surgery; are more prone to bezoar formation due to their potential eating disorders and because of the gastro-enterostomy made to a small gastric pouch after the Roux-en-Y gastric bypass surgery. Conclusion Possibility of a bezoar formation should be kept in mind in Roux-en-Y gastric bypass patients who has nausea and vomiting complaints. Removal of the bezoar provides a dramatic improvement in the complaints of these patients. PMID:27107501

  14. [Simplified laparoscopic gastric bypass. Initial experience].

    Science.gov (United States)

    Hernández-Miguelena, Luis; Maldonado-Vázquez, Angélica; Cortes-Romano, Pablo; Ríos-Cruz, Daniel; Marín-Domínguez, Raúl; Castillo-González, Armando

    2014-01-01

    Antecedentes: la cirugía de la obesidad comprende diversos procedimientos gastrointestinales. El bypass gástrico en Y de Roux es el prototipo de los procedimientos mixtos y el más practicado en el mundo en sus diversas variedades. Una técnica similar y novedosa es la adoptada por Cardoso-Ramos y Galvao denominada "bypass simplificado" que rápidamente se aceptó por la mayor facilidad y resultados muy parecidos a la técnica convencional. Objetivo: describir los resultados a un año del bypass gástrico simplificado para el tratamiento de la obesidad mórbida. Material y métodos: estudio retrospectivo y descriptivo de todos los pacientes a quienes se realizó bypass gástrico de enero de 2008 a julio de 2012, en la clínica de obesidad de un hospital privado de la Ciudad de México. Resultados: se estudiaron 90 pacientes con diagnóstico de obesidad mórbida, con límites de edad de 18 y 65 años, operados para bypass gástrico simplificado. En 10% de los pacientes hubo complicaciones, las más frecuentes fueron: hemorragia y hernia interna. Durante el periodo de estudio la mortalidad fue de 0%. La pérdida de peso promedio a los 12 meses fue de 72.7%. Conclusión: el bypass gástrico simplificado laparoscópico es una cirugía segura, con buenos resultados a mediano plazo, y con una pérdida del exceso de peso adecuada en 71% de los casos.

  15. Psoriasis remission after gastric bypass surgery: a case report

    Directory of Open Access Journals (Sweden)

    Ornella De Pità

    2014-03-01

    Full Text Available Case reports suggest that gastric bypass surgery in patients with psoriasis may result in complete remission of the disease. A substantial weight loss is achieved in the months following surgery, which is likely to reduce psoriasis symptoms and risk of comorbidities. A 50-year-old man was followed in our Department for several years. He had severe plaque psoriasis requiring superpotent topical steroids and methotrexate. His medical history included morbid obesity (138 kg, dyslipidemia , hypertension and positive family history for psoriasis. He underwent gastric bypass surgery on November 2011. Eight months later, his weight decreased to 86 kg, and he noted a marked improvement in his psoriasis, with reduction of body surface area involvement. In our opinion weight loss may be a useful adjunctive therapy for obese patients with psoriasis.http://dx.doi.org/10.7175/cmi.v8i1.898  

  16. Krukenberg tumor after gastric bypass for morbid obesity: Bariatric surgery and gastric cancer

    Directory of Open Access Journals (Sweden)

    Pablo Menéndez

    2013-06-01

    Full Text Available Gastric by-pass is one of the most performed surgical procedure in bariatric surgery. Neoplasm within gastric remnant is a slightly frequent complication (only six cases have been described but with important survival consequences. We present a case of a patient who developed an adenocarcinoma in excluded stomach, after three years of bariatric surgery; the tumor was incidentally discovered after a gynecological surgery for uterine myomas. Different diagnostic modalities for the excluded stomach were analyzed.

  17. Breast cancer biomarkers predict weight loss after gastric bypass surgery

    Directory of Open Access Journals (Sweden)

    Sauter Edward R

    2012-01-01

    Full Text Available Abstract Background Obesity has long been associated with postmenopausal breast cancer risk and more recently with premenopausal breast cancer risk. We previously observed that nipple aspirate fluid (n levels of prostate specific antigen (PSA were associated with obesity. Serum (s levels of adiponectin are lower in women with higher body mass index (BMI and with breast cancer. We conducted a prospective study of obese women who underwent gastric bypass surgery to determine: 1 change in n- and s-adiponectin and nPSA after surgery and 2 if biomarker change is related to change in BMI. Samples (30-s, 28-n and BMI were obtained from women 0, 3, 6 and 12 months after surgery. Findings There was a significant increase after surgery in pre- but not postmenopausal women at all time points in s-adiponectin and at 3 and 6 months in n-adiponectin. Low n-PSA and high s-adiponectin values were highly correlated with decrease in BMI from baseline. Conclusions Adiponectin increases locally in the breast and systemically in premenopausal women after gastric bypass. s-adiponectin in pre- and nPSA in postmenopausal women correlated with greater weight loss. This study provides preliminary evidence for biologic markers to predict weight loss after gastric bypass surgery.

  18. EARLY POSTOPERATIVE COMPLICATIONS IN ROUX-EN-Y GASTRIC BYPASS

    Science.gov (United States)

    STOLL, Aluisio; ROSIN, Leandro; DIAS, Mariana Fernandes; MARQUIOTTI, Bruna; GUGELMIN, Giovana; STOLL, Gabriela Fanezzi

    2016-01-01

    ABSTRACT Background: Roux-en-Y gastric bypass is one of the most common bariatric surgery and leads to considerable weight loss in the first months. Aim: To quantify the main early postoperative complications in patients submitted to the gastric bypass. Method: Observational retrospective cohort. Data of 1051 patients with class II obesity associated with comorbidities or class III obesity submitted to the gastric bypass with 30 days of follow-up starting from the date of the surgery. Results: The age average was 36 years with a predominance of females (81.1%). The mean preoperative body mass index was 43 kg/m². The major complication was fistula (2.3%), followed by intestinal obstruction (0.5%) and pulmonary embolism (0.5%). Death occurred in 0.6% of the cases. Conclusion: In the period of 30 days after surgery the overall complication rate was 3.8%; reoperation was necessary in 2.6% and death occurred in 0.6%. Fistula was the main complication and the leading cause of hospitalization in intensive care unit, reoperation and death. PMID:27683781

  19. Dynamic changes of body mass in patients with morbid obesity in the remote terms after gastric banding and gastric bypass.

    Directory of Open Access Journals (Sweden)

    Valeriy Nikolaevich Egiev

    2015-05-01

    Full Text Available Since January 2005 till December 2013 655 patients with morbid obesity were operated on, 457 (69,7% from which, had gastric banding with using different models of regulating bandages: AMI (AMI, Austria, SAGB (Ethicon, USA, Lap Band (ALLEGRAN, USA. Gastric bypass was made to 198 patients, that made 30,3%. The degree of lowering of overweight in general is more after gastric bypass, than after gastric banding. At the same time during the period of 1–1,5 year the degree of lowering of overweight with women is the same after both the operation. The degree of lowering of overweight with men after gastric bypass is a little higher. In the period of 2–4 years the degree of lowering of overweight both with men and women after gastric bypass is higher. In 5 years men after gastric bypass actually lose weight better than after gastric banding. The men older than 40 years having BMI more than 40 kg/m2 after gastric banding lose weight worst of all. In the period of more than 5 years the women in the age group of 30–39 years having BMI more than 40 kg/m2 had better results after gastric bypass. The women older than 50 years having BMI more than 40 kg/m2 after gastric banding had the worst results.

  20. Perforated peptic ulcer following gastric bypass for obesity.

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    Macgregor, A M; Pickens, N E; Thoburn, E K

    1999-03-01

    Peptic ulcer in the excluded segment of a gastric bypass performed in the management of morbid obesity has only rarely been reported in the literature. The purpose of this study is to review our experience with the condition in a series of 4300 patients who underwent gastric-restrictive surgery between 1978 and 1997. Eleven patients presented with acute perforation of a peptic ulcer in the excluded gastric segment. Nine ulcers were duodenal, one was gastric, and one patient had both gastric and duodenal perforations. The time between primary gastric-restrictive surgery and ulcer perforation varied from 20 days to 12 years. All patients presented with upper abdominal pain. The classical radiological sign of perforated peptic ulcer, free air under the diaphragm, did not occur in any patient. Nine patients were initially treated by primary closure of the perforation with subsequent definitive ulcer therapy by vagotomy, pyloroplasty, or gastrectomy. One case, initially treated elsewhere, was managed by placement of a Malecot catheter through the duodenal perforation, gastrostomy, and peritoneal drainage. One recent case remains symptom-free on H2 blockers after simple closure. There was no mortality. Six cases were previously reported in the literature with a 33 per cent mortality rate.

  1. Laparoscopic gastric bypass to robotic gastric bypass: time and cost commitment involved in training and transitioning an academic surgical practice.

    Science.gov (United States)

    Lyn-Sue, Jerome R; Winder, Josh S; Kotch, Shannon; Colello, Jacob; Docimo, Salvatore

    2016-06-01

    The Roux-en-Y gastric bypass is the gold standard procedure for weight loss. This relatively complex procedure has excellent outcomes when performed via laparoscopy. The advent of the DaVinci robotic platform has been a technological advancement. Our goal is to provide information regarding the cost, time commitment, and advantages of transitioning an LRYGB program to an RRYGB program in an academic setting. We retrospectively reviewed the last 25 laparoscopic gastric bypass procedures and the first 25 robotic gastric bypass procedures performed by a single surgeon. We compared clinical outcomes and focused on time and hospital cost during this transition phase. There was no significant demographic difference between the groups. The mean age was 41.7 (RRYGB) years vs 43.4 (LRYGM) years. The mean BMI were similar between groups, 45.3 vs 46.5 kg/m(2) for RRYGB and LRYGB. No anastomotic leaks or mortalities were noted. There was one anastomotic stricture in both groups. Excess weight loss was similar in both groups at 1 year. There was a significant increase in operative time with RRYGB, mean 241 min vs mean 174 min (p = 0.0005). Operative time fell by 25 min after the first 10 cases. The hospital cost was also increased with RRYGB mean $5922 vs $4395 (p = 0.03). Transitioning from a laparoscopic to a robotic practice can be done safely, however, the initial operative times were longer and the hospital cost was higher for robotic gastric bypass. We hope in the future that these will decrease after overcoming the learning and as the technology becomes widespread.

  2. COMPLICATIONS RELATED TO GASTRIC BYPASS PERFORMED WITH DIFFERENT GASTROJEJUNAL DIAMETERS

    Science.gov (United States)

    SAMPAIO-NETO, José; BRANCO-FILHO, Alcides José; NASSIF, Luis Sérgio; BROSKA, Anne Caroline; KAMEI, Douglas Jun; NASSIF, André Thá

    2016-01-01

    ABSTRACT Background: Among the options for surgical treatment of obesity, the most widely used has been the Roux-en-Y gastric bypass. The gastrojejunal anastomosis can be accomplished in two ways: handsewn or using circular and linear stapled. The complications can be divided in early and late. Aim: To compare the incidence of early complications related with the handsewn gastrojejunal anastomosis in gastric bypass using Fouchet catheter with different diameters. Method: The records of 732 consecutive patients who had undergone the bypass were retrospectively analyzed and divided in two groups, group 1 with 12 mm anastomosis (n=374), and group 2 with 15 mm (n=358). Results: The groups showed anastomotic stenosis with rates of 11% and 3.1% respectively, with p=0.05. Other variables related to the anastomosis were also analyzed, but without statistical significance (p>0.05). Conclusion: The diameter of the anastomosis of 15 mm was related with lower incidence of stenosis. It was found that these patients had major bleeding postoperatively and lower surgical site infection, and in none was observed presence of anastomotic leak. PMID:27683767

  3. Conversion to Gastric Bypass in Patients with Unsuccessful Weight Loss after Gastric Banding May Depend on Mental Quality of Life

    NARCIS (Netherlands)

    Larsen, J.K.; Zijlstra, H.; Ramshorst, B. van; Geenen, R.

    2010-01-01

    Background: A low quality of life has been regarded a cue to action. Some patients with unsuccessful weight loss after laparoscopic adjustable gastric banding (LAGB) undergo a conversion of gastric banding to gastric bypass. This study examines whether patients who did or did not undergo conversion

  4. The Gastric Remnant in Roux-en-Y Gastric Bypass: Challenges and Possibilities.

    Science.gov (United States)

    Mala, Tom

    2016-08-01

    Laparoscopic Roux-en-Y gastric bypass (RYGB) is widely applied in the treatment of morbid obesity. Health personnel meeting these patients should thus be familiar with the potential clinical consequences of the modified anatomy induced by the surgery. After a RYGB, the stomach is left in situ after the closure of the upper part of the organ. This blind-ended gastric remnant may cause complications and surgical emergencies, but also opportunities for diagnostic and therapeutic intervention. The present review focuses on complications related to the gastric remnant including bleeding and acute dilatation in the early postoperative period and later adverse events such as gastroduodenal peptic disease, tumors, gastrogastric fistulas, and late dilatation. Opportunities offered by the remnant, including minimal invasive or open access for enteral nutrition, and therapeutic and diagnostic access to the bile ducts, the duodenum, and the gastric remnant, which is challenged by the modified anatomy, are discussed. Reversal of the gastric bypass and gastrointestinal reconstruction after esophageal resection have been commented on. The review aims to improve the awareness of issues related to the gastric remnant for physicians involved in the treatment and the follow-up of patients after a RYGB. PMID:27203428

  5. Effects of Peripheral Neurotensin on Appetite Regulation and Its Role in Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Ratner, Cecilia; Skov, Louise J; Raida, Zindy;

    2016-01-01

    increased proopiomelanocortin mRNA in the arcuate nucleus. We also investigated the importance of NT for the decreased food intake after gastric bypass surgery in a rat model of Roux-en-Y gastric bypass (RYGB). NT was increased in plasma and in the gastrointestinal tract in RYGB rats, and pharmacological...

  6. Plummer-Vinson syndrome following gastric bypass surgery.

    Science.gov (United States)

    Sapthavee, Andrew; Kircher, Matthew L; Akst, Lee M

    2014-09-01

    Plummer-Vinson syndrome (PVS) is the combination of dysphagia, angular cheilitis, atrophic glossitis, and esophageal webbing in the setting of iron deficiency anemia. Although it is relatively uncommon, this condition is important to recognize because it is a source of dysphagia and it confers an increased risk for hypopharyngeal cancer. Cases of PVS associated with gastrointestinal conditions such as celiac disease and gastric cancer have been previously reported in the literature, but as far as we know, no case of PVS associated with bariatric surgery has been previously reported. We describe the case of a 39-year-old woman who developed PVS following gastric bypass surgery, and we briefly discuss the current knowledge of this syndrome.

  7. Fetal Growth in Pregnancies Conceived after Gastric Bypass Surgery in Relation to Surgery-to-Conception Interval

    DEFF Research Database (Denmark)

    Nørgaard, Lone Nikoline; Gjerris, Anne Cathrine Roslev; Kirkegaard, Ida;

    2014-01-01

    OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton...... and early or late fetal growth in pregnancies conceived after gastric bypass surgery....

  8. Malabsorption and intestinal adaptation after one anastomosis gastric bypass compared with Roux-en-Y gastric bypass in rats.

    Science.gov (United States)

    Cavin, Jean-Baptiste; Voitellier, Eglantine; Cluzeaud, Françoise; Kapel, Nathalie; Marmuse, Jean-Pierre; Chevallier, Jean-Marc; Msika, Simon; Bado, André; Le Gall, Maude

    2016-09-01

    The technically easier one-anastomosis (mini) gastric bypass (MGB) is associated with similar metabolic improvements and weight loss as the Roux-en-Y gastric bypass (RYGB). However, MGB is controversial and suspected to result in greater malabsorption than RYGB. In this study, we compared macronutrient absorption and intestinal adaptation after MGB or RYGB in rats. Body weight and food intake were monitored and glucose tolerance tests were performed in rats subjected to MGB, RYGB, or sham surgery. Carbohydrate, protein, and lipid absorption was determined by fecal analyses. Intestinal remodeling was evaluated by histology and immunohistochemistry. Peptide and amino acid transporter mRNA levels were measured in the remodeled intestinal mucosa and those of anorexigenic and orexigenic peptides in the hypothalamus. The MGB and RYGB surgeries both resulted in a reduction of body weight and an improvement of glucose tolerance relative to sham rats. Hypothalamic orexigenic neuropeptide gene expression was higher in MGB rats than in RYGB or sham rats. Fecal losses of calories and proteins were greater after MGB than RYGB or sham surgery. Intestinal hyperplasia occurred after MGB and RYGB with increased jejunum diameter, higher villi, and deeper crypts than in sham rats. Peptidase and peptide or amino acid transporter genes were overexpressed in jejunal mucosa from MGB rats but not RYGB rats. In rats, MGB led to greater protein malabsorption and energy loss than RYGB. This malabsorption was not compensated by intestinal overgrowth and increased expression of peptide transporters in the jejunum.

  9. Severe scurvy after gastric bypass surgery and a poor postoperative diet

    DEFF Research Database (Denmark)

    Hansen, Esben P K; Metzsche, Carsten; Henningsen, Emil;

    2012-01-01

    After bariatric gastric bypass surgery patients are at risk of developing micronutrient deficiencies. If gastric bypass surgery is followed by a vitamin deficient diet the patients have a risk of developing vitamin-C deficiency. When spontaneous ecchymosis is observed in the skin, in at......-risk patients, scurvy must be considered. When treated with large doses of vitamin-C the symptoms of scurvy rapidly improve even if the patient has developed multiple organ dysfunction syndrome. KEYWORDS: Scurvy; Gastric bypass surgery; Multiorgan dysfunction....

  10. Effects of Gastric Bypass and Gastric Banding on Bone Remodeling in Obese Patients with Type 2 Diabetes

    DEFF Research Database (Denmark)

    Yu, Elaine W; Wewalka, Marlene; Ding, Su-Ann;

    2016-01-01

    CONTEXT: Roux-en-Y gastric bypass (RYGB) leads to high-turnover bone loss, but little is known about skeletal effects of laparoscopic adjustable gastric banding (LAGB) or mechanisms underlying bone loss after bariatric surgery. OBJECTIVE: To evaluate effects of RYGB and LAGB on fasting...

  11. Gastric Bypass Reduces Symptoms and Hormonal Responses in Hypoglycemia.

    Science.gov (United States)

    Abrahamsson, Niclas; Börjesson, Joey Lau; Sundbom, Magnus; Wiklund, Urban; Karlsson, F Anders; Eriksson, Jan W

    2016-09-01

    Gastric bypass (GBP) surgery, one of the most common bariatric procedures, induces weight loss and metabolic effects. The mechanisms are not fully understood, but reduced food intake and effects on gastrointestinal hormones are thought to contribute. We recently observed that GBP patients have lowered glucose levels and frequent asymptomatic hypoglycemic episodes. Here, we subjected patients before and after undergoing GBP surgery to hypoglycemia and examined symptoms and hormonal and autonomic nerve responses. Twelve obese patients without diabetes (8 women, mean age 43.1 years [SD 10.8] and BMI 40.6 kg/m(2) [SD 3.1]) were examined before and 23 weeks (range 19-25) after GBP surgery with hyperinsulinemic-hypoglycemic clamp (stepwise to plasma glucose 2.7 mmol/L). The mean change in Edinburgh Hypoglycemia Score during clamp was attenuated from 10.7 (6.4) before surgery to 5.2 (4.9) after surgery. There were also marked postsurgery reductions in levels of glucagon, cortisol, and catecholamine and the sympathetic nerve responses to hypoglycemia. In addition, growth hormone displayed a delayed response but to a higher peak level. Levels of glucagon-like peptide 1 and gastric inhibitory polypeptide rose during hypoglycemia but rose less postsurgery compared with presurgery. Thus, GBP surgery causes a resetting of glucose homeostasis, which reduces symptoms and neurohormonal responses to hypoglycemia. Further studies should address the underlying mechanisms as well as their impact on the overall metabolic effects of GBP surgery.

  12. The Quality of life of patients with morbid obesity before and after gastric banding and gastric bypass

    Directory of Open Access Journals (Sweden)

    V Egiev

    2014-06-01

    Full Text Available In order to estimate the quality of life in bariatric surgery patients usually two scales are used: GIQLI (gastrointestinal Quality of life index and BAROS (Bariatric analysis and reporting outcome system. In our work we used the original estimation of the quality of life, based on the questionnaire GIQLI. This questionnaire consists of two parts: universal and specific. For the estimation of the level of morbid obesity two main scores are utilized: overweight and the Body Mass Index (BMI. We estimated the quality of life of patients with morbid obesity before the operation (25 patients, after gastric banding (25 patients and gastric bypass (25 patients. For the control group we show the answers for the same questionnaire of 26 volunteers without any chronic diseases, including morbid obesity. Gastric bypass was performed in patients with BMI more than 40 kg/m2, gastric banding was performed in patients with BMI less than 40 kg/m2. The median periods of supervising the patients after gastric bypass and gastric banding were 3±1,9 years and 4,3±1,7 years for each. After the surgery the percentage of reduction of the overweight was significantly higher in the patients after the gastric bypass. It means that the weight loss is more effective after gastric bypass than gastric banding. The index of the quality of life of the patients with the morbid obesity was much lower than in the control group (р<0,05. After the surgical treatment all the scores increased in the group of the patients being operated on, than in the group of the patients with obesity before the operations (р<0,05. While comparatively estimating the two operations we got practically the same results after gastric bypass and gastric banding. For gastric banding a very important index of the improvement of the quality of life is the level of the weight loss, but after the gastric bypass there were no such outcome.

  13. Increased hepatic insulin clearance after Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Bojsen-Møller, Kirstine N; Dirksen, Carsten; Jørgensen, Nils B;

    2013-01-01

    Context:Roux-en-Y gastric bypass (RYGB) improves glucose tolerance and ameliorates fasting hyperinsulinemia within days after surgery. Improvements in hepatic insulin sensitivity and insulin clearance could contribute importantly to these effects.Objective:The objective of the investigation...

  14. Psychological characteristics and associations with weight outcomes two years after gastric bypass surgery

    DEFF Research Database (Denmark)

    Beck, Nina N; Mehlsen, Mimi; Støving, René Klinkby

    2012-01-01

    This study investigated symptoms of eating disorder, depression, and anxiety among Roux-en-Y gastric bypass patients two years after surgery, and the relationship between these characteristics and weight loss. Respondents completed assessment questionnaires including Eating Disorder Inventory-2...

  15. Severe Scurvy After Gastric Bypass Surgery and a Poor Postoperative Diet

    OpenAIRE

    Hansen, Esben P.K.; Metzsche, Carsten; Henningsen, Emil; Toft, Palle

    2012-01-01

    After bariatric gastric bypass surgery patients are at risk of developing micronutrient deficiencies. If gastric bypass surgery is followed by a vitamin deficient diet the patients have a risk of developing vitamin-C deficiency. When spontaneous ecchymosis is observed in the skin, in at-risk patients, scurvy must be considered. When treated with large doses of vitamin-C the symptoms of scurvy rapidly improve even if the patient has developed multiple organ dysfunction syndrome. Keywords Scurv...

  16. Management of gallstones and gallbladder disease in patients undergoing gastric bypass

    Institute of Scientific and Technical Information of China (English)

    Bernabé; M; Quesada; Gustavo; Kohan; Hernán; E; Roff; Carlos; M; Canullán; Luis; T; Chiappetta; Porras

    2010-01-01

    The appropriate management of gallstones and gallbladder disease in patients undergoing gastric bypass remains unknown.Several therapeutic modalities are used and include performing cholecystectomy on all patients at the time of gastric bypass,performing concomitant cholecystectomy only when patients have gallstones and performing cholecystectomy only in the presence of both symptoms and gallstones.Some groups administer ursodeoxycholic acid for gallstone prevention in the postoperative period.All treatment...

  17. Retrograde intussusception seven years after a laparoscopic Roux-en-Y gastric bypass

    Directory of Open Access Journals (Sweden)

    Leon D Boudourakis

    2013-01-01

    Full Text Available Intussusception after Roux-en-Y gastric bypass is more common than previously believed. It usually occurs between one and three years post-operatively, though we present a case that presented with a retrograde intussusception necessitating bowel resection seven years after a laparoscpic Roux-en-Y gastric bypass. The diagnosis and etiological theories are discussed based on findings from the literature.

  18. The Impact of Upper Abdominal Pain During Pregnancy Following a Gastric Bypass

    DEFF Research Database (Denmark)

    Petersen, Liselotte; Lauenborg, Jeannet; Svare, Jens;

    2016-01-01

    OBJECTIVE: The aim of the present study was to describe the risk of internal herniation (IH) and the obstetric outcome in pregnant women with Roux-en-Y gastric bypass (RYGB) and episodes of upper abdominal pain. METHODS: The cohort included 133 women with RYGB: 94 with 113 pregnancies, from....... CONCLUSIONS: Upper abdominal pain during pregnancy is frequent among women with Roux-en-Y gastric bypass, is often due to IH and is associated with adverse pregnancy outcome....

  19. Intussusception after Laparoscopic Gastric Bypass Surgery: An Underrecognized Complication

    Directory of Open Access Journals (Sweden)

    Smit Singla

    2012-01-01

    Full Text Available Introduction. Intussusception after bariatric surgery is an uncommon complication that is now being frequently reported. Most people consider dysmotility to be the causative mechanism in the absence of obvious etiology. Material and Methods. A worldwide search identified literature describing intussusception after bariatric surgery. We also included our own patients and analyzed information regarding demographic profile, risk factors, presentation, diagnosis, and post treatment course. Results. Seventy one patients were identified between 1991 and 2011. Majority of the affected patients were females (=70, 98.6%; median time to presentation after gastric bypass surgery was 36 months. Most patients presented with abdominal pain, nausea and vomiting, but without obvious peritonitis. Sixty eight patients (96% required surgery; 48 (70.6% underwent revision of anastomosis, 16 (23.5% had reduction without resection, while 4 patients (5.9% had plication only. Amongst these, most patients (=51, 75% were found to have retrograde intussusception. Post-operatively, 9 patients presented with recurrence (range, 0.5–32 months. Five patients, who had earlier been treated without resection, eventually required revision of the anastomosis. There was no mortality noted. Conclusion. Intussusception after bariatric surgery is uncommon and its diagnosis is based on a combination of physicial, radiological and operative findings. An early surgical intervention reduces morbidity and prevents recurrence.

  20. Anaesthetic Management for Laparoscopic Gastric Bypass Procedure in Morbid Obesity

    Directory of Open Access Journals (Sweden)

    P Mandal

    2008-01-01

    Full Text Available Gastric bypass procedure (GBP is one of the effective operative methods for weight loss in patients with morbid obesity. The anaesthesia team has a crucial role to play in managing these patients. Therefore it is important for anaesthesiologists to be familiar with the anatomical and physiological changes along with pharmacological alter-ations associated with obesity.So that they can offer optimal perioperative care to these patients. This study describes the anaesthetic management of a series of 100 consecutive patients with an average body mass index (BMI of 46.5 kg.m -2 who underwent laparoscopic GBP over a period of three years (September′04 to September′07 in the hands of nonbariatric surgeons.Patients were aged between 16 - 36 years with more female preponderance (73: 27 and had mean duration of the procedure of 2.82 ± 1.44 hours under standard endotracheal balanced anaesthesia tech-nique. The initial mortality is 1% along with 4% incidence of both difficult intubation and postoperative respiratory failure in this series which is quite comparable with world famous bariatric surgical centers.

  1. Reversal of Gastric Bypass Resolves Hyperoxaluria and Improves Oxalate Nephropathy Secondary to Roux-en-Y Gastric Bypass

    Science.gov (United States)

    Agrawal, Varun; Wilfong, Jonathan B.; Rich, Christopher E.; Gibson, Pamela C.

    2016-01-01

    Hyperoxaluria after Roux-en-Y gastric bypass (RYGB) increases the risk for kidney injury. Medical therapies for hyperoxaluria have limited efficacy. A 65-year-old female was evaluated for acute kidney injury [AKI, serum creatinine (Cr) 2.1 mg/dl, baseline Cr 1.0 mg/dl]. She did not have any urinary or gastrointestinal symptoms or exposure to nephrotoxic agents. Sixteen months prior to this evaluation, she underwent RYGB for morbid obesity. Her examination was unremarkable for hypertension or edema and there was no protein or blood on urine dipstick. Kidney biopsy revealed acute tubulointerstitial nephritis with oxalate crystals in tubules. The concurrent finding of severe hyperoxaluria (urine oxalate 150 mg/day) confirmed the diagnosis of oxalate nephropathy. Despite medical management of hyperoxaluria, her AKI worsened. Laparoscopic reversal of RYGB was performed and within 1 month, her hyperoxaluria resolved (urine oxalate 20 mg/day) and AKI improved (Cr 1.7 mg/dl). Surgical reversal of RYGB may be considered in patients with oxalate nephropathy at high risk of progression who fail medical therapy. Physicians need to be aware of the possibility of oxalate nephropathy after RYGB and promptly treat the hyperoxaluria to halt further kidney damage. PMID:27781207

  2. The Rationale and Results of Gastroplasty/Distal Gastric Bypass.

    Science.gov (United States)

    Salmon; McArdle

    1992-02-01

    A recent review of the results of gastroplasties done at the University of Alberta Hospital showed that there was a high incidence of late weight loss failure. Therefore a new operation, gastroplasty/distal gastric bypass, has been performed on 263 patients. This operation results In a profound (mean greatest percentage excess weight loss of 87% at approximately 2 years) and lasting weight loss (mean final percentage excess weight loss of 78%) at 4 years, range 2-7.5 years post-operatively. Only 0.9 % of patients failed to maintain at least a 40% excess weight loss. The operation achieves its effect through a moderate restriction that permits patients to eat normal table food from the time of discharge and with a mild metabsorption that is not ordinarily associated with diarrhea or notable deficiencies. Certain patients required debanding of the stoma and others developed staple-line eventration. Neither of these events after long-term follow-up resulted in weight loss failure nor in other serious side-effects. It Is concluded that moderate failure of the gastroplasty stoma and staple line does not necessarily result in weight loss failure, because the malabsorptive portion of the operation remains intact. Low hemoglobin occurred in 16% of cases and deficiency of serum iron In 34%; a much smaller number of patients had chronic or Intermittent deficiencies of these entities. Correction was easily achieved with oral replacement. Deficiencies in albumin, calcium, phosphorus and folate were rarely seen and minimal elevation of serum AST values occurred In just over 1% of patients. Chronic deficiencies or elevations were not seen in these patients. Stomal ulcer occurred in 6% of patients and bleeding associated with stomal ulcer in 1%. Half the patients with ulcer were managed with H&inf2; blockers, the other half with vagotomy. Both forms of treatment when individualized effectively prevent re-ulceration.

  3. Gastric bypass surgery: Improving psoriasis through a GLP-1-dependent mechanism?

    DEFF Research Database (Denmark)

    Faurschou, Annesofie; Zachariae, Claus; Skov, Lone;

    2011-01-01

    bypass surgery in patients with psoriasis may result in complete remission of the disease. A substantial weight loss is achieved in the months following surgery, which is likely to reduce psoriasis symptoms and risk of comorbidities. Interestingly, however, it has been described that improvement...... of psoriasis is initiated immediately following surgery before any weight loss could have happened. We hypothesize that the glucose-lowering gut incretin hormone glucagon-like peptide-1 (GLP-1) is responsible for this effect. The levels of GLP-1 have been shown to increase up to 20 times after gastric bypass...... surgery. This most likely contributes importantly to the acute remission of type 2 diabetes, which is often induced by gastric bypass operations. The hormone is not hypersecreted after the purely restrictive bariatric procedure gastric banding and no case reports exist on improvement in psoriasis...

  4. GLP1 and glucagon co-secreting pancreatic neuroendocrine tumor presenting as hypoglycemia after gastric bypass

    DEFF Research Database (Denmark)

    Guimarães, Marta; Rodrigues, Pedro; Pereira, Sofia S;

    2015-01-01

    Post-prandial hypoglycemia is frequently found after bariatric surgery. Although rare, pancreatic neuroendocrine tumors (pNET), which occasionally are mixed hormone secreting, can lead to atypical clinical manifestations, including reactive hypoglycemia. Two years after gastric bypass surgery...... (471 pmol/g), insulin (139 pmol/g) and somatostatin (23 pmol/g). This is the first report of a GLP1 and glucagon co-secreting pNET presenting as hypoglycemia after gastric bypass surgery. Although pNET are rare, they should be considered in the differential diagnosis of the clinical approach...... to the post-bariatric surgery hypoglycemia patient. LEARNING POINTS: pNETs can be multihormonal-secreting, leading to atypical clinical manifestations.Reactive hypoglycemic episodes are frequent after gastric bypass.pNETs should be considered in the differential diagnosis of hypoglycemia after bariatric...

  5. Laparoscopic Revision of an Omega Loop Gastric Bypass to Treat Afferent Loop Syndrome.

    Science.gov (United States)

    Kassir, Radwan; Blanc, Pierre; Lointier, Patrice; Breton, Christophe; Debs, Tarek; Tiffet, Olivier

    2015-10-01

    The omega loop gastric bypass (OLGB) has become a very commonly performed bariatric procedure because of the advantages it carries over the Roux en Y gastric bypass (RYGBP). However, mini gastric bypass is a misnomer, as this procedure is more malabsorptive than the RYGBP. Recently, it is called single or one anastomosis gastric bypass. The omega loop procedure is associated with a risk of afferent loop syndrome, a known complication of the Billroth II (Finsterer) operation. This rare complication of the OLGB can be debilitating, serious, and deadly. Afferent loop syndrome should be suspected in case of malabsorption syndrome with chronic diarrhea, steatorrhea, iron-deficiency anemia, edema, emaciation, and osteomalacia and also in case of simple biological anomalies such as macrocytosis or megaloblastic anemia. The diagnosis can be confirmed by measuring bacterial overgrowth, although this requires a jejunal aspirate performed during endoscopy with jejunal intubation. A microbial population of more than 106 organisms per milliliter of aspirate is pathological. Afferent loop syndrome is encountered less frequently now that the number of gastrectomies has dropped. Yet, with the omega loop bypass procedure becoming more common, surgeons must again be made aware of this potential complication. PMID:26210192

  6. Pregnant woman with fatal complication after laparoscopic Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Renault, Kristina; Gyrtrup, Hans Jørgen; Damgaard, Karen;

    2012-01-01

    In Europe, an increasing number of women have bariatric surgery; therefore, obstetricians are likely to encounter these patients. We report a 22-year-old woman, who had previously undergone uncomplicated laparoscopic Roux-en-Y gastric bypass. She was admitted with severe abdominal pain at 35 weeks...... illustrates a potential complication and difficulties in the management of pregnant women who have undergone Roux-en-Y gastric bypass. In these women, observation and investigations based on a multidisciplinary approach are vital if abdominal pain develops, with involvement of intestinal surgeons experienced...

  7. Improvement in health-related quality of life following Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Hansen, Nina Beck; Gudex, Claire; Støving, René Klinkby

    2014-01-01

    INTRODUCTION: This study explored whether health-related quality of life (HRQOL) changes following Roux-en-Y gastric bypass surgery were associated with identifiable socio-demographic or clinical characteristics, and it examined the impact on health outcomes of changes in the Danish criteria...... with this poorer outcome. Co-morbidity and preoperative PCS/MCS showed a strong correlation with change in PCS/MCS score. CONCLUSION: Gastric bypass had a positive overall effect on HRQOL, but further investigation of individual variations is needed. We found no significant differences in HRQOL outcome between...

  8. Effect of closure of the mesenteric defect during laparoscopic gastric bypass and prevention of internal hernia

    DEFF Research Database (Denmark)

    Kristensen, Sara Danshøj; Naver, Lars; Jess, Per;

    2014-01-01

    INTRODUCTION: The aim of this study is to evaluate the benefits and disadvantages of closing the mesenteric defects during gastric bypass to avoid internal herniation (IH). MATERIAL AND METHODS: The study is performed as a single-centre, randomised, controlled, blinded trial. Patients are randomly...... assigned to either conventional laparoscopic Roux-en-Y gastric bypass (LRYGB) without closing the mesenteric defects (n = 250) or RYGB with closing of the defects with hernia clips (n = 250). Follow-up is conducted at six months, one year, two years and five years after RYGB. The primary endpoint...

  9. Gastric bypass surgery: Improving psoriasis through a GLP-1-dependent mechanism?

    DEFF Research Database (Denmark)

    Faurschou, Annesofie; Zachariae, Claus; Skov, Lone;

    2011-01-01

    of psoriasis is initiated immediately following surgery before any weight loss could have happened. We hypothesize that the glucose-lowering gut incretin hormone glucagon-like peptide-1 (GLP-1) is responsible for this effect. The levels of GLP-1 have been shown to increase up to 20 times after gastric bypass...... surgery. This most likely contributes importantly to the acute remission of type 2 diabetes, which is often induced by gastric bypass operations. The hormone is not hypersecreted after the purely restrictive bariatric procedure gastric banding and no case reports exist on improvement in psoriasis......Psoriasis is a common inflammatory skin disease and obesity constitutes a risk factor for the disease. Obese patients with psoriasis are often more difficult to treat and are at increased risk for dyslipidemia, diabetes, hypertension and cardiovascular disease. Case reports suggest that gastric...

  10. SIMPLIFIED LAPAROSCOPIC GASTRIC BYPASS WITH GASTROJEJUNAL LINEAR MECHANICAL ANASTOMOSIS: TECHNICAL ASPECTS

    Science.gov (United States)

    PALERMO, Mariano; SERRA, Edgardo

    2016-01-01

    ABSTRACT Background: Gastric bypass is a restrictive and malabsorptive surgery. The restrictive part consists in the creation of a small gastric pouch. The gastrointestinal bypass serves as the malabsorptive element. Aim: To describe a simplified gastric bypass approach for morbid obese patients, showing our results, and also remarking the importance of this technique for reducing the learning curve. Method: The patient is positioned in a split legs position and carefully strapped to the operating room table, with the surgeon between the patient's legs. Five trocars are inserted after pneumoperitoneum at the umbilicus. Dissection of the esophagogastric angle and lesser curvature is mandatory before the gastric pouch manufacturing. This pouch is done with two blue load staplers. Using a blue load linear stapler inserted only half way into the hole in the pouch is used to perform the gastrojejunal anastomosis and in order to create an anastomosis that is about 2 cm in length. A side-to-side jejunojejunostomy is done with a white load linear stapler. The last step of the gastric bypass consists in the cut of the jejunum between the two anastomosis with a white load linear stapler. Blue test is performed in order to detect leaks. Results: From January 2012 to December 2015, 415 simplified RYGB were performed. Gender: 67% female and 33 % males. Average of BMI 44.7. Mean age was 42 years old. Mean operative time 79 min. 39 % of this sample had T2 diabetes. Regarding complications were observed, one fistula, one gastrojejunal stenosis and one obstruction due to a bezoar. Conclusion: The described technique is a simplified approach in which all the anastomosis are performed in the upper part of the abdomen, allowing the surgeons to be more systematized and avoiding them to make mistakes in the confection of the Roux-en-Y anastomosis. This simplified gastric bypass is a safe and reproducible technique. PMID:27683785

  11. Nutritional and Protein Deficiencies in the Short Term following Both Gastric Bypass and Gastric Banding.

    Directory of Open Access Journals (Sweden)

    Judith Aron-Wisnewsky

    Full Text Available The number of morbidly obese patients undergoing bariatric surgery (BS has increased dramatically in recent years. Therefore, monitoring food intake and its consequences in terms of nutritional status is necessary to prevent nutritional deficiencies. The aim of this study was to analyze the effect of food restriction on nutritional parameters in the short-term (≤3 months period after BS in morbid obesity.In a prospective study, we followed 22 obese women who underwent Roux-en-Y gastric bypass (GBP or adjustable gastric banding (AGB at baseline (T0 and 1 (T1 and 3 (T3 months after surgery. We evaluated food intake, nutrient adequacy and serum concentrations of vitamins and minerals known to be at risk for deficiency following BS.Before surgery, we observed suboptimal food intakes, leading to a risk of micronutrient deficiencies. Serum analysis confirmed nutritional deficiencies for iron and thiamine for 27 and 23% of the patients, respectively. The drastic energy and food reduction seen in the short term led to very low probabilities of adequacy for nutrients equivalent across both surgeries. Serum analysis demonstrated a continuous decrease in prealbumin during the follow-up, indicating mild protein depletion in 21 and 57% of GBP patients and 50 and 63% of AGB patients, respectively, at T1 and T3. Regarding vitamins and minerals, systematic supplementation after GBP prevented most nutritional deficiencies. By contrast, AGB patients, for whom there is no systematic supplementation, developed such deficiencies.Our results suggest that cautious monitoring of protein intake after BS is mandatory. Furthermore, AGB patients might also benefit from systematic multivitamin and mineral supplementation at least in the short term.

  12. Nutritional and Protein Deficiencies in the Short Term following Both Gastric Bypass and Gastric Banding

    Science.gov (United States)

    Aron-Wisnewsky, Judith; Verger, Eric O; Bounaix, Carine; Dao, Maria Carlota; Oppert, Jean-Michel; Bouillot, Jean-Luc; Chevallier, Jean-Marc; Clément, Karine

    2016-01-01

    Background The number of morbidly obese patients undergoing bariatric surgery (BS) has increased dramatically in recent years. Therefore, monitoring food intake and its consequences in terms of nutritional status is necessary to prevent nutritional deficiencies. The aim of this study was to analyze the effect of food restriction on nutritional parameters in the short-term (≤3 months) period after BS in morbid obesity. Method In a prospective study, we followed 22 obese women who underwent Roux-en-Y gastric bypass (GBP) or adjustable gastric banding (AGB) at baseline (T0) and 1 (T1) and 3 (T3) months after surgery. We evaluated food intake, nutrient adequacy and serum concentrations of vitamins and minerals known to be at risk for deficiency following BS. Results Before surgery, we observed suboptimal food intakes, leading to a risk of micronutrient deficiencies. Serum analysis confirmed nutritional deficiencies for iron and thiamine for 27 and 23% of the patients, respectively. The drastic energy and food reduction seen in the short term led to very low probabilities of adequacy for nutrients equivalent across both surgeries. Serum analysis demonstrated a continuous decrease in prealbumin during the follow-up, indicating mild protein depletion in 21 and 57% of GBP patients and 50 and 63% of AGB patients, respectively, at T1 and T3. Regarding vitamins and minerals, systematic supplementation after GBP prevented most nutritional deficiencies. By contrast, AGB patients, for whom there is no systematic supplementation, developed such deficiencies. Conclusions Our results suggest that cautious monitoring of protein intake after BS is mandatory. Furthermore, AGB patients might also benefit from systematic multivitamin and mineral supplementation at least in the short term. PMID:26891123

  13. DIET MICRONUTRIENT ADEQUACY OF WOMEN AFTER 1 YEAR OF GASTRIC BYPASS

    Science.gov (United States)

    LEIRO, Larissa Silveira; Melendez-ARAÚJO, Mariana Silva

    2014-01-01

    Background The more effective treatment for severe obesity is bariatric surgery. Gastric bypass is a surgical technique used worldwide; however, as well as other techniques; it has postoperative risks, including nutrient deficiency. Aim To determine the amounts of dietary iron, calcium, vitamin D and vitamin B12 ingested by patients of a public hospital one year after gastric bypass, and compare with the recommendations of the Recommended Dietary Allowances. Methods This was a transverse descriptive study and the sample consisted of 36 women, with at least one year of gastric bypass. Data collected included sociodemographic, anthropometric and diet variables. Dietetic information was collected through a validated food frequency questionnaire. Ingestion of iron, calcium, vitamin D and vitamina B12 was evaluated in comparison with the Recommended Dietary Allowances, as well as correlation of micronutrient ingestion with time of surgery. Results There was inadequate consumption of iron, calcium and vitamin D. The vitamin B12 intake was considered adequate. There was statistically significant positive correlation between the time of surgery and the ingestion of iron, vitamin B12 and vitamin D. Conclusion The intake of iron, calcium and vitamin D of women one year after gastric bypass was inadequate, emphasizing the importance of multiprofessional monitoring postoperatively to prevent nutrient deficiencies. PMID:25409960

  14. Functional Imaging in Hyperinsulinemic Hypoglycemia after Gastric Bypass Surgery for Morbid Obesity

    NARCIS (Netherlands)

    de Heide, Loek J. M.; Glaudemans, Andor W. J. M.; Oomen, Peter H. N.; Apers, Jan A.; Totte, Eric R. E.; van Beek, Andre P.

    2012-01-01

    Context: Hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass (RYGB) has been increasingly reported. It is induced by beta-cell hyperplasia often referred to as nesidioblastosis. Positron emission tomography (PET) with [11C]-5-hydroxytryptophan (C-11-HTP) and 6-[18F]fluoro-3,4-dihydroxy-L-ph

  15. Drug disposition and modelling before and after gastric bypass: immediate and controlled-release metoprolol formulations

    OpenAIRE

    Gesquiere, Ina; Darwich, Adam S; Van der Schueren, Bart; de Hoon, Jan; Lannoo, Matthias; Matthys, Christophe; Rostami, Amin; Foulon, Veerle; Augustijns, Patrick

    2015-01-01

    The aim of the present study was to evaluate the disposition of metoprolol after oral administration of an immediate and controlled-release formulation before and after Roux-en-Y gastric bypass (RYGB) surgery in the same individuals and to validate a physiologically based pharmacokinetic (PBPK) model for predicting oral bioavailability following RYGB.

  16. Iron Deficiency After Roux-en-Y Gastric Bypass: Insufficient Iron Absorption from Oral Iron Supplements

    OpenAIRE

    Gesquiere, Ina; Lannoo, Matthias; Augustijns, Patrick; Matthys, Christophe; Van der Schueren, Bart; Foulon, Veerle

    2014-01-01

    Roux-en-Y gastric bypass (RYGB) may reduce the absorption of iron, but the extent to which this absorption is impeded is largely unknown. First, we determined the prevalence of iron deficiency following RYGB and explored the risk factors for its development. Second, we examined to what extent oral iron supplements are absorbed after RYGB.

  17. Hypoglykæmi efter gastric bypass er en diagnostisk og behandlingsmæssig udfordring

    DEFF Research Database (Denmark)

    Nielsen, Joan Bach; Gribsholt, Sigrid Bjerge; Pedersen, Michael Høgild;

    2014-01-01

    Treatment of severe obesity by Roux-en-Y gastric bypass (RYGB) causes sustained weight losses and improves health complica-tions. RYGB is, however, also associated with adverse effects. Dumping is a well-known complication causing invalidating symptoms, and lately there have been mounting concerns...

  18. Effects of Roux-en-Y Gastric Bypass on Energy Expenditure and Appetite

    DEFF Research Database (Denmark)

    Schmidt, Julie Berg

    that gastric bypass (GBP) surgery attenuates these processes, explaining the superiority of this weight loss intervention. However, the effect of GBP on EE has never been investigated independently of acute changes in energy balance. After GBP, decreased motivation to eat coincides with hormonal changes...

  19. Hedonic changes in food choices following Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Hansen, Thea Toft; Jakobsen, Tine Anette; Nielsen, Mette Søndergaard;

    2016-01-01

    It has been suggested that a shift in food choices leading to a diet with a lower energy density plays an important role in successful weight loss after Roux-en-Y gastric bypass (RYGB) surgery. A decreased hedonic drive to consume highly palatable foods may explain these changes in eating behavior...

  20. Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Dirksen, C; Jørgensen, N B; Bojsen-Møller, K N;

    2012-01-01

    Roux-en-Y gastric bypass (RYGB) greatly improves glycaemic control in morbidly obese patients with type 2 diabetes, in many even before significant weight loss. Understanding the responsible mechanisms may contribute to our knowledge of the pathophysiology of type 2 diabetes and help identify new...

  1. Weight loss after gastric bypass surgery in human obesity remodels promoter methylation

    DEFF Research Database (Denmark)

    Barres, Romain; Kirchner, Henriette; Rasmussen, Morten;

    2013-01-01

    DNA methylation provides a mechanism by which environmental factors can control insulin sensitivity in obesity. Here, we assessed DNA methylation in skeletal muscle from obese people before and after Roux-en-Y gastric bypass (RYGB). Obesity was associated with altered expression of a subset...

  2. Bone Structural Changes and Estimated Strength After Gastric Bypass Surgery Evaluated by HR-pQCT

    DEFF Research Database (Denmark)

    Frederiksen, Katrine Diemer; Hanson, Stine; Hansen, Stinus;

    2016-01-01

    Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral density...

  3. Prospective diagnosis of marginal ulceration following Roux-en-Y gastric bypass with computed tomography

    Directory of Open Access Journals (Sweden)

    Alexander J. Adduci, MD, PhD

    2015-01-01

    Full Text Available Marginal ulcers are reported to be the most common complication following Roux-en-Y gastric bypass surgery. Despite their frequency, they are rarely diagnosed prospectively with cross-sectional imaging. We present four cases in which the diagnosis of marginal ulceration was made prospectively with CT and confirmed with endoscopy.

  4. Oral bioavailability of moxifloxacin after Roux-en-Y gastric bypass surgery

    NARCIS (Netherlands)

    De Smet, Julie; Colin, Pieter; De Paepe, Peter; Ruige, Johannes; Batens, Helene; Van Nieuwenhove, Yves; Vogelaers, Dirk; Blot, Stijn; Van Bocxlaer, Jan; Van Bortel, Luc M.; Boussery, Koen

    2012-01-01

    Objectives: Roux-en-Y gastric bypass surgery is the most commonly performed procedure for the treatment of morbid obesity. This anatomical alteration may affect the absorption and consequently the bioavailability of oral drugs. This study aims to investigate the oral bioavailability of moxifloxacin

  5. Central 5-HT Neurotransmission Modulates Weight Loss following Gastric Bypass Surgery in Obese Individuals

    DEFF Research Database (Denmark)

    Haahr, M. E.; Hansen, D. L.; Fisher, P. M.;

    2015-01-01

    The cerebral serotonin (5-HT) system shows distinct differences in obesity compared with the lean state. Here, it was investigated whether serotonergic neurotransmission in obesity is a stable trait or changes in association with weight loss induced by Roux-in-Y gastric bypass (RYGB) surgery...

  6. Hematological Disorders following Gastric Bypass Surgery: Emerging Concepts of the Interplay between Nutritional Deficiency and Inflammation

    Directory of Open Access Journals (Sweden)

    Mingyi Chen

    2013-01-01

    Full Text Available Obesity and the associated metabolic syndrome are among the most common and detrimental metabolic diseases of the modern era, affecting over 50% of the adult population in the United States. Surgeries designed to promote weight loss, known as bariatric surgery, typically involve a gastric bypass procedure and have shown high success rates for treating morbid obesity. However, following gastric bypass surgery, many patients develop chronic anemia, most commonly due to iron deficiency. Deficiencies of vitamins B1, B12, folate, A, K, D, and E and copper have also been reported after surgery. Copper deficiency can cause hematological abnormalities with or without neurological complications. Despite oral supplementation and normal serum concentrations of iron, copper, folate, and vitamin B12, some patients present with persistent anemia after surgery. The evaluation of hematologic disorders after gastric bypass surgery must take into account issues unique to the postsurgery setting that influence the development of anemia and other cytopenias. In this paper, the clinical characteristics and differential diagnosis of the hematological disorders associated with gastric bypass surgery are reviewed, and the underlying molecular mechanisms are discussed.

  7. Treatment of giant hiatal hernia by laparoscopic Roux-en-Y gastric bypass

    NARCIS (Netherlands)

    L. Duinhouwer (L.); L.U. Biter (L. Ulas); B.P.L. Wijnhoven (Bas); G.H.H. Mannaerts (Guido)

    2015-01-01

    textabstractIntroduction Obesity is a risk factor for hiatal hernia. In addition, much higher recurrence rates are reported after standard surgical treatment of hiatal hernia in morbidly obese patients. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective surgical treatment for morbid obesi

  8. The IGF-Axis and Diabetic Retinopathy Before and After Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Brynskov, Troels; Laugesen, Caroline Schmidt; Floyd, Andrea Karen;

    2016-01-01

    BACKGROUND: Laparoscopic gastric bypass (LGB) abruptly causes remission of type 2 diabetes (T2D). Such dramatic metabolic changes have previously been found to cause worsening of diabetic retinopathy (DR) and circulating insulin-like growth factor I (IGF-I) has been suggested as a causal mediator...

  9. Alterations of hormonally active fibroblast growth factors after Roux-en-Y gastric bypass surgery

    NARCIS (Netherlands)

    P.L.M. Jansen; J. van Werven; E. Aarts; F. Berends; I. Janssen; J. Stoker; F.G. Schaap

    2011-01-01

    Thirty-five morbidly obese patients underwent Roux-en-Y gastric bypass surgery (RYGB). In addition to weight loss, these patients showed significant improvement of insulin resistance and a reduction of hepatic fat content. Three months after surgery, the serum bile salts were slightly but significan

  10. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... and are morbidly obese have higher incidents of heart problems. The other things that we see are ... used for multiple surgical procedures. It’s used for heart procedures, the CABG, coronary artery bypass, valve procedures, ...

  11. Effectiveness and safety of laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus

    OpenAIRE

    Zhang, Pin; Zhang, Hongwei; Han, Xiaodong; Di, Jianzhong; Zhou, Yulong; Li, Kun; Zheng, Qi

    2016-01-01

    Gastric bypass may be conducted to aid in glycemic control in adults with type 2 diabetes mellitus (T2DM). The aim of the present study was to investigate the clinical results of diabetes remission and metabolic syndrome in individuals with T2DM after undergoing a gastric bypass. A total of 85 patients (39 men and 46 women) with T2DM underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). Data regarding patient demographics, body mass index (BMI), co-morbidities and details of diabetes melli...

  12. Clinical observation of gastric bypass in treatment of type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    PU Yong-dong; YANG Bo; HE Jiao-miao; WU You-jun; WANG Yi; L(U) Gang; ZHANG Bo; WANG Yue; LIU Wei-ping; WENG Jian-feng; LI Jing-quan; CAO Zhi-yu; WANG Li; HU Xiao; DONG Li-guo; LI Yue-min; ZHAO Hua-zhou; QIN Rong

    2012-01-01

    Background Roux-en-Y gastric bypass (GBP) is the main surgical procedure used in type 2 diabetes.The objective of this study was to evaluate the different types of GBP in treatment of type 2 diabetes.Methods Patients with type 2 diabetes were randomly divided into two groups:those who underwent gastrojejunal loop anastomosis bypass and those who underwent gastrojejunal Roux-en-Y bypass.Blood glucose alterations,operation time,and operation complicatiors were observed.Results Gastrojejunal loop anastomosis bypass and gastrojejunal Roux-en-Y bypass were both effective in the treatment of selected patients with type 2 diabetes.Compared with gastrojejunal Roux-en-Y bypass,gastrojejunal loop anastomosis bypass had the advantages of easier implementation,shorter operation time,and fewer operation complications.Conclusions Gastrojejunal loop anastomosis is effective in treatment of type 2 diabetes.It is safe,easy to implement,and worthy of clinical popularization.

  13. Management of Super-super Obese Patients: Comparison Between Mini (One Anastomosis) Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Madhok, Brijesh; Mahawar, Kamal K; Boyle, Maureen; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

    2016-07-01

    Management of super-super obese patients poses a particular challenge for bariatric surgeons. Many staged algorithms exist for these patients. Essentially all of these involve a lower-risk procedure like sleeve gastrectomy first before a definitive second-stage procedure like gastric bypass or duodenal switch. This study compares our results with 19 mini (one anastomosis) gastric bypass and 56 sleeve gastrectomy in super-super obese patients. Sleeve gastrectomy patients were significantly older. There was no mortality or major complication in either group. There was no minor complication in mini (one anastomosis) gastric bypass group compared to two in the sleeve gastrectomy group. Mini (one anastomsosis) gastric bypass patients experienced significantly higher weight loss compared to sleeve gastrectomy patients at 6 months, 1 year, and 2 years after surgery.

  14. Fast pouch emptying, delayed small intestinal transit, and exaggerated gut hormone responses after Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Dirksen, C; Damgaard, M; Bojsen-Møller, K N;

    2013-01-01

    Roux-en-Y gastric bypass (RYGB) causes extensive changes in gastrointestinal anatomy and leads to reduced appetite and large weight loss, which partly is due to an exaggerated release of anorexigenic gut hormones.......Roux-en-Y gastric bypass (RYGB) causes extensive changes in gastrointestinal anatomy and leads to reduced appetite and large weight loss, which partly is due to an exaggerated release of anorexigenic gut hormones....

  15. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... that’s where the food is going to be traveling. And what the patient is eating will be traveling through the gastric pouch and into the small ... study in 1991 at the National Institute of Health in Washington, D.C. And what they looked ...

  16. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... it’s liquid and fluid, and when you’re eating something, the stomach will start to dilate. As ... then the patient is satisfied, and they stop eating. So what we’re doing with the gastric ...

  17. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    Medline Plus

    Full Text Available ... morning, we’re going to get an upper GI, and the upper GI is going to make sure that the anastomosis ... So tomorrow, after the patient gets an upper GI and everything looks good, the patient’s nasal gastric ...

  18. Complications of banded laparoscopic Roux-en-Y gastric bypass in a 33-week pregnant woman

    Science.gov (United States)

    de Raaff, Christel A.L.; Eshuis, Wietse J.; van Wagensveld, Bart A.; van Veen, Ruben N.

    2016-01-01

    Women desiring pregnancy might fail to conceive due to their obesity. Bariatric surgery has shown to reduce this infertility up to 58% and is therefore considered a successful strategy for morbidly obese infertile women. Nevertheless, when pregnancy has succeeded, surgery-related complications might occur. Banded laparoscopic Roux-en-Y gastric bypass (B-LRYGB) is a relatively new technique in which a band is placed around the small gastric pouch. We report a case of a 30-year-old woman who succeeded to become pregnant after weight loss due to B-LRYGB, but presented with acute abdominal pain in Week 33 of her pregnancy. PMID:27562576

  19. Conversion of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass is safe as a single-step procedure

    NARCIS (Netherlands)

    Emous, M.; Apers, J.; Hoff, C.; van Beek, A. P.; Totte, E.

    2015-01-01

    Several different procedures have been proposed as a revisional procedure for treatment of failed laparoscopic adjustable gastric banding (LAGB). Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been advocated as the procedure of choice for revision. In this study, we compare the single- and two-st

  20. Exaggerated glucagon-like peptide-1 and blunted glucose-dependent insulinotropic peptide secretion are associated with Roux-en-Y gastric bypass but not adjustable gastric banding

    DEFF Research Database (Denmark)

    Korner, Judith; Bessler, Marc; Inabnet, William;

    2007-01-01

    BACKGROUND: The aim of this study was to measure the circulating levels of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and glucagon in patients who had undergone adjustable gastric banding (BND) or Roux-en-Y gastric bypass (RYGB) to understand the differences...

  1. Roux-en-Y gastric bypass: effects on feeding behavior and underlying mechanisms

    OpenAIRE

    Manning, Sean; Pucci, Andrea; Batterham, Rachel L.

    2015-01-01

    Bariatric surgery is the most effective treatment for severe obesity, producing marked sustained weight loss with associated reduced morbidity and mortality. Roux-en-Y gastric bypass surgery (RYGBP), the most commonly performed procedure, was initially viewed as a hybrid restrictive-malabsorptive procedure. However, over the last decade, it has become apparent that alternative physiologic mechanisms underlie its beneficial effects. RYGBP-induced altered feeding behavior, including reduced app...

  2. Mini-gastric bypass to control morbid obesity and diabetes mellitus: What radiologists need to know

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hyun Jeong [Dept. of Radiology, Chung-Ang University Hospital, Seoul (Korea, Republic of); Hong, Seong Sook; Hwang, Ji Young; Hur, Kyung Yul [Soonchunhyang University Seoul Hospital, Seoul (Korea, Republic of)

    2015-04-15

    Laparoscopic mini-gastric bypass surgery is a safe and simple surgical intervention for treating morbid obesity and diabetes mellitus and is now being performed more frequently. Radiologists must be critical in their postoperative evaluation of these patients. In this pictorial review, we explain and illustrate the surgical technique, normal postoperative anatomy, and associated complications as seen on imaging examinations, including fluoroscopy and computed tomography.

  3. Reversible hyperinsulinemic hypoglycemia after gastric bypass: a consequence of altered nutrient delivery

    DEFF Research Database (Denmark)

    McLaughlin, Tracey; Peck, Marcia; Holst, Jens;

    2010-01-01

    Severe hypoglycemia after Roux-en-Y gastric bypass surgery (RYGB) is an increasingly recognized condition, characterized by neuroglycopenia and inappropriately elevated insulin concentrations that occur primarily in the postprandial state. Both pathophysiology and treatment of this disorder remai...... elusive, but it has been postulated that hyperplasia and/or hypertrophy of beta-cells due to morbid obesity and/or postsurgical nesidioblastosis may contribute....

  4. EFFECT OF SIZE OF INTESTINAL DIVERSIONS IN OBESE PATIENTS WITH METABOLIC SYNDROME SUBMITTED TO GASTRIC BYPASS

    Science.gov (United States)

    RAMOS, Rafael Jacques; MOTTIN, Cláudio Corá; ALVES, Letícia Biscaino; BENZANO, Daniela; PADOIN, Alexandre Vontobel

    2016-01-01

    ABSTRACT Background: There is no consensus on the ideal size of intestinal loops in gastric bypass of bariatric surgeries. Aim: To evaluate the metabolic outcome of patients submitted to gastric bypass with alimentary and biliopancreatic loops of different sizes. Methods: Was conducted a retrospective cohort study in diabetic obese patients (BMI≥35 kg/m2) with metabolic syndrome submitted to gastric bypass. The patients were divided into three groups according to the size of the intestinal loop: group 1, biliopancreatic limb 50 cm length and alimentary limb 100 cm length; group 2 , biliopancreatic limb 50 cm length and alimentary limb 150 cm length; and group 3, biliopancreatic limb 100 cm length and alimentary limb 150 cm length. The effect of gastric bypass with different sizes of intestinal loops in relation to the parameters that define metabolic syndrome was determined. Results: Sixty-three patients were evaluated, and they had a mean age of 44.7±9.4 years. All were diabetics, with 62 (98.4%) being hypertensive and 51 (82.2%) dyslipidemic. The three groups were homogeneous in relation to the variables. In 24 months, there was a remission of systemic arterial hypertension in 65% of patients in group 1, 62.5% in group 2 and 68.4% in group 3. Remission of diabetes occurred in 85% of patients in group 1, 83% in group 2 and 84% in group 3. There was no statistical difference in %LEW between the groups, and waist measurements decreased in a homogeneous way in all groups. The size of loops also had no influence on the improvement in dyslipidemia. Conclusion: Variation in size of intestinal loops does not appear to influence improvement in metabolic syndrome in this group of patients. PMID:27683768

  5. Zinc-deficiency acrodermatitis in a patient with chronic alcoholism and gastric bypass: a case report

    Directory of Open Access Journals (Sweden)

    Dariush Shahsavari

    2014-07-01

    Full Text Available Acquired adult-onset zinc deficiency is occasionally reported in patients with malnutrition states, such as alcoholism, or malabsorptive states, such as post-bariatric surgery. The defining symptoms of hypozincemia include a classic triad of necrolytic dermatitis, diffuse alopecia, and diarrhea. We report a case of zinc deficiency in a 39-year-old man with history of gastric bypass surgery and alcoholism. For this patient, severe hypozincemia confirmed acrodermatitis, and zinc supplementation was met with gradual improvement.

  6. Changes in Vertebral Bone Marrow Fat and Bone Mass After Gastric Bypass Surgery: A Pilot Study

    OpenAIRE

    Schafer, AL; Li, X; Schwartz, AV; Tufts, LS; Wheeler, AL; Grunfeld, C; Stewart, L; Rogers, SJ; Carter, JT; Posselt, AM; Black, DM; Shoback, DM

    2015-01-01

    Bone marrow fat may serve a metabolic role distinct from other fat depots, and it may be altered by metabolic conditions including diabetes. Caloric restriction paradoxically increases marrow fat in mice, and women with anorexia nervosa have high marrow fat. The longitudinal effect of weight loss on marrow fat in humans is unknown. We hypothesized that marrow fat increases after Roux-en-Y gastric bypass (RYGB) surgery, as total body fat decreases. In a pilot study of 11 morb...

  7. CONTROL OF HYPERTENSION AFTER ROUX-EN-Y GASTRIC BYPASS AMONG OBESE DIABETIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Everton CAZZO

    2014-03-01

    Full Text Available Context Hypertension is a common disorder in general practice and has a widely known association with type 2 diabetes mellitus. Low adhesion to clinical treatment may lead to poor results. Obesity surgery can bring early and relevant resolution rates of both morbidities. Objective To describe hypertension evolution after Roux-en-Y gastric bypass in patients with type 2 diabetes mellitus. Method Descriptive observational study designed as a historical cohort of 90 subjects with hypertension and diabetes who underwent Roux-en-Y gastric bypass and were evaluated before and after surgery. Results It was observed a hypertension resolution rate of 85.6% along with markedly decrease in anti-hypertensive usage. Mean resolution time was 3.2 months. Resolution was associated with homeostasis model assessment – insulin resistance, preoperative fasting insulin, anti-hypertensive usage, hypertension time, body mass index and percentage of weight loss. Resolution of hypertension was not statistically associated with diabetes remission within this sample. Conclusion Roux-en-Y gastric bypass was a safe and effective therapeutic tool to achieve hypertension resolution in patients who also had diabetes mellitus.

  8. Significance of oxidative stress changes in type 2 diabetic patients after gastric bypass

    Directory of Open Access Journals (Sweden)

    Li SHI

    2011-08-01

    Full Text Available Objective To observe the changes in oxidative stress in type 2 diabetic(T2DM patients after gastric bypass,and investigate the mechanism of gastric bypass treatment for T2DM.Methods Thirty T2DM patients who underwent gastric bypass(T2DM group and thirty healthy subjects(control group were included in present study from Aug.2009 to Apr.2010.Values of fasting plasma glucose(FPG,2-hour postprandial plasma glucose(2hPG,glycosylated hemoglobin(HbA1c,fasting plasma insulin(FIns,superoxide dismutase(SOD,malondialdehyde(MDA and glutathione peroxidase(GSH-PX were determined in T2DM group before surgery and 1,3,6 months after surgery.All the parameters were determined once in control group.Results Compared with control group,MDA was significantly higher(3.6±1.3 vs 2.2±0.7μmol/L,P < 0.01,and SOD and GSH-PX were significantly lower(45.2±18.8 vs 87.6±20.4kU/L,P < 0.01;53.6±16.8 vs 78.9±15.6mmol/L,P < 0.01 in T2DM group.Compared with the preoperative values,the MDA decreased significantly(P < 0.05,and SOD and GSH-PX increased significantly(P < 0.01 in T2DM group 3 months after operation.Compared with preoperative values,FPG,2hPG and HbA1c decreased significantly(P < 0.01 in T2DM group one month after operation.Compared with the values one month after operation,2hPG and HbA1c decreased significantly(P < 0.01,P < 0.05 3 months after operation.Values of HOMA-IR decreased significantly from one month to six months after surgery(P < 0.01.Conclusions Oxidative stress can be improved markedly after gastric bypass in T2DM patients.It may be one of the mechanisms of suceessful treatment of T2DM with gastric bypass.

  9. Postprandial diabetic glucose tolerance is normalized by gastric bypass feeding as opposed to gastric feeding and is associated with exaggerated GLP-1 secretion: a case report

    DEFF Research Database (Denmark)

    Dirksen, Carsten; Hansen, Dorte L; Madsbad, Sten;

    2010-01-01

    OBJECTIVE: To examine after gastric bypass the effect of peroral versus gastroduodenal feeding on glucose metabolism. RESEARCH DESIGN AND METHODS: A type 2 diabetic patient was examined on 2 consecutive days 5 weeks after gastric bypass. A standard liquid meal was given on the first day...... into the bypassed gastric remnant and on the second day perorally. Plasma glucose, insulin, C-peptide, glucagon, incretin hormones, peptide YY, and free fatty acids were measured. RESULTS: Peroral feeding reduced 2-h postprandial plasma glucose (7.8 vs. 11.1 mmol/l) and incremental area under the glucose curve (i......AUC) (0.33 vs. 0.49 mmol . l(-1) . min(-1)) compared with gastroduodenal feeding. beta-Cell function (iAUC(Cpeptide/Glu)) was more than twofold improved during peroral feeding, and the glucagon-like peptide (GLP)-1 response increased nearly fivefold. CONCLUSIONS: Improvement in postprandial glucose...

  10. Gastric bypass alters the dynamics and metabolic effects of insulin and proinsulin secretion

    OpenAIRE

    Johansson, H-E.; Öhrvall, M.; Haenni, A.; Sundbom, M; Edén Engström, B.; Karlsson, F A; Zethelius, B.

    2007-01-01

    Aims Hyperproinsulinaemia is associated with obesity and is a risk factor for Type 2 diabetes. We explored the dynamics of proinsulin and insulin and postprandial effects on glucose and lipids in subjects who had undergone gastric bypass (GBP) surgery compared with morbidly obese (MO) subjects and normal weight control subjects (NW). Methods Subjects free from diabetes were recruited: 10 previously MO subjects [body mass index (BMI)±sd, 34.8±6.2kg/m2] who had undergone GBP surgery, 10 MO subj...

  11. Incidence and risk factors for the development of anemia following gastric bypass surgery

    Institute of Scientific and Technical Information of China (English)

    Dimitrios; V; Avgerinos; Omar; H; Llaguna; Matthew; Seigerman; Amanda; J; Lefkowitz; I; Michael; Leitman

    2010-01-01

    AIM:To evaluate the incidence and risk factors for the development of anemia after RouxenY gastric bypass (RYGB).METHODS: A retrospective analysis of patients undergoing RYGB from January 2003 to November 2007 was performed. All patients had a preoperative body mass index > 40 kg/m2. A total of 206 patients were evaluated. All patients were given daily supplements of ferrous sulfate tablets for 2 wk following their operation. Hematological and metabolic indices were routinely evaluated following surgery. Pa...

  12. Potential Mechanisms Mediating Sustained Weight Loss Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Makaronidis, Janine M; Batterham, Rachel L

    2016-09-01

    Bariatric surgery is the only effective treatment for severe obesity. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the most commonly performed procedures, lead to sustained weight loss, improvements in obesity-related comorbidities and reduced mortality. In humans, the main driver for weight loss following RYGB and SG is reduced energy intake. Reduced appetite, changes in subjective taste and food preference, and altered neural response to food cues are thought to drive altered eating behavior. The biological mediators underlying these changes remain incompletely understood but changes in gut-derived signals, as a consequence of altered nutrient and/or biliary flow, are key candidates.

  13. Radiologic evaluation following Roux-en-Y gastric bypass surgery for morbid obesity

    Energy Technology Data Exchange (ETDEWEB)

    Carucci, Laura R. [Department of Radiology, Virginia Commonwealth University Medical Center, P.O. Box 980615, Richmond, VA 23298-0615 (United States)]. E-mail: lcarucci@vcu.edu; Turner, Mary Ann [Department of Radiology, Virginia Commonwealth University Medical Center, P.O. Box 980615, Richmond, VA 23298-0615 (United States)

    2005-03-01

    Morbid obesity is an increasing health problem, and bariatric surgery is becoming a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical postoperative findings of the Roux-en-Y gastric bypass (RYGBP) procedure for morbid obesity on upper gastrointestinal (UGI) series are presented. An overview of the potential complications that may be diagnosed with contrast studies and computed tomography (CT) is provided in addition to a description of potential pitfalls in interpreting these studies.

  14. Pregnancy and perinatal outcomes according to surgery to conception interval and gestational weight gain in women with previous gastric bypass

    DEFF Research Database (Denmark)

    Stentebjerg, Louise Laage; Andersen, Lise Lotte Torvin; Renault, Kristina;

    2016-01-01

    OBJECTIVE: To compare perinatal and pregnancy outcomes including adherence to the Institute of Medicine's (IOM) recommendations for gestational weight gain (GWG) in pregnant women with conception gastric bypass (late group). METHODS......: Retrospective cohort study comprising 71 women with gastric bypass and a singleton pregnancy presenting at Odense University Hospital, November 2007-October 2013. Data were extracted from medical records and laboratory systems. The primary outcomes were timing of pregnancy and adherence to the IOM......'s recommendations for GWG. Secondary outcomes were birthweight, preterm delivery, cesarean section (CS), iron deficiency and post partum hemorrhage (PPH). RESULTS: Forty-three (61%) women conceived less than 18 months after gastric bypass surgery. Women in the late group had a significantly higher risk of requiring...

  15. Roux-en-Y gastric bypass alleviates hypertension and is associated with an increase in mid-regional pro-atrial natriuretic peptide in morbid obese patients

    DEFF Research Database (Denmark)

    Bonfils, Peter K; Taskiran, Mustafa; Damgaard, Morten;

    2015-01-01

    OBJECTIVE: To examine 24-h blood pressure (24BP), systemic haemodynamics and the effect of sodium intake on 24BP in obese patients before and after gastric bypass surgery [laparoscopic Roux-en-Y gastric bypass (LRYGB)], and to determine whether weight loss from LRYGB might be related to an increase...

  16. The Effect of Preoperative Type 2 Diabetes and Physical Fitness on Mental Health and Health-Related Quality of Life after Roux-en-Y Gastric Bypass

    DEFF Research Database (Denmark)

    Wimmelmann, Cathrine L.; Lund, Michael T.; Hansen, Merethe;

    2016-01-01

    Objective: To investigate the predictive value of type 2 diabetes and lack of physical activity for mental health and health-related quality of life after Roux-en-Y gastric bypass. Method: Forty severely obese patients undergoing Roux-en-Y gastric bypass were included in the GASMITO study...

  17. Gastrointestinal complications of bariatric Roux-en-Y gastric bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Sandrasegaran, Kumaresan; Rajesh, Arumugam; Lall, Chandana; Maglinte, Dean D. [Indiana University Medical Center, UH 0279, Department of Radiology, Indianapolis, IN (United States); Gomez, Gerardo A. [Wishard Memorial Hospital, Department of Surgery, Indianapolis (United States); Lappas, John C. [Wishard Memorial Hospital, Department of Radiology, Indianapolis (United States)

    2005-02-01

    Obesity is rapidly becoming the most important public health issue in USA and Europe. Roux-en-Y gastric bypass is now established as the gold standard for treating intractable morbid or super obesity. We reviewed the imaging findings following this surgery in 234 patients. In this pictorial essay we present the CT and upper gastrointestinal contrast study appearances of the expected postoperative anatomy as well as a range of abdominal complications. The complications are classified into leaks, fistula and obstruction. Postoperative gastric outlet and small bowel obstruction can be caused by anastomotic stenosis, mesocolic tunnel stenosis, adhesions, stomal ulcer, obturation, intussusception and internal or external hernia. Small bowel obstruction may be of a simple, closed loop and/or strangulating type. The radiologist should be able to diagnose the type and possible cause of obstruction. (orig.)

  18. [Perforated duodenal ulcer in a Roux-en-Y gastric bypass operated patient can be a diagnostic challenge].

    Science.gov (United States)

    Wied, Christian; Akralið, Guðny B; Lauritsen, Morten Laksáfoss; Naver, Lars Peter Skat

    2013-02-25

    Roux-en-Y gastric bypass (RYGBP) is an increasingly used procedure when treating morbid obesity. Due to the extensive gastrointestinal rearrangement, diagnostic evaluation of patients with gastric bypass and acute abdominal pain can be difficult. We present a case of a perforated duodenal ulcer in a RYGBP operated patient, where free abdominal fluid, but hardly any pneumoperitoneum was seen on a computed tomography. Free intraperitoneal fluid is an important finding and should give suspicion of the need for emergency surgery in RYGBP operated patients with abdominal pain.

  19. Effects of Peripheral Neurotensin on Appetite Regulation and Its Role in Gastric Bypass Surgery.

    Science.gov (United States)

    Ratner, Cecilia; Skov, Louise J; Raida, Zindy; Bächler, Thomas; Bellmann-Sickert, Kathrin; Le Foll, Christelle; Sivertsen, Bjørn; Dalbøge, Louise S; Hartmann, Bolette; Beck-Sickinger, Annette G; Madsen, Andreas N; Jelsing, Jacob; Holst, Jens J; Lutz, Thomas A; Andrews, Zane B; Holst, Birgitte

    2016-09-01

    Neurotensin (NT) is a peptide expressed in the brain and in the gastrointestinal tract. Brain NT inhibits food intake, but the effects of peripheral NT are less investigated. In this study, peripheral NT decreased food intake in both mice and rats, which was abolished by a NT antagonist. Using c-Fos immunohistochemistry, we found that peripheral NT activated brainstem and hypothalamic regions. The anorexigenic effect of NT was preserved in vagotomized mice but lasted shorter than in sham-operated mice. This in combination with a strong increase in c-Fos activation in area postrema after ip administration indicates that NT acts both through the blood circulation and the vagus. To improve the pharmacokinetics of NT, we developed a pegylated NT peptide, which presumably prolonged the half-life, and thus, the effect on feeding was extended compared with native NT. On a molecular level, the pegylated NT peptide increased proopiomelanocortin mRNA in the arcuate nucleus. We also investigated the importance of NT for the decreased food intake after gastric bypass surgery in a rat model of Roux-en-Y gastric bypass (RYGB). NT was increased in plasma and in the gastrointestinal tract in RYGB rats, and pharmacological antagonism of NT increased food intake transiently in RYGB rats. Taken together, our data suggest that NT is a metabolically active hormone, which contributes to the regulation of food intake.

  20. 胃转流手术护理%Gastric bypass operation nursing

    Institute of Scientific and Technical Information of China (English)

    罗明瑞

    2012-01-01

      糖尿病是严重危害人类健康的主要慢性疾病之一,糖尿病传统的治疗方法是饮食、运动、口服药物及注射胰岛素等治疗。现如今,由于科学技术的发展,由减肥手术延伸而来的胃转流手术已用于糖尿病患者的手术治疗。本人通过半年来83例胃转流手术护理,总结以下护理体会,与广大同仁分享。%  diabetes is a serious hazard to human health is one of the major chronic diseases, diabetes, the traditional treatment is diet, exercise, oral drugs and insulin injection therapy. Nowadays, with the development of science and technology, by bariatric operation extension of gastric bypass operation has been used in the treatment of diabetic patients with operation. Through the first half of 83 cases of gastric bypass operation nursing, the folowing summary of nursing experience, with the majority of my coleagues share

  1. Effects of Peripheral Neurotensin on Appetite Regulation and Its Role in Gastric Bypass Surgery.

    Science.gov (United States)

    Ratner, Cecilia; Skov, Louise J; Raida, Zindy; Bächler, Thomas; Bellmann-Sickert, Kathrin; Le Foll, Christelle; Sivertsen, Bjørn; Dalbøge, Louise S; Hartmann, Bolette; Beck-Sickinger, Annette G; Madsen, Andreas N; Jelsing, Jacob; Holst, Jens J; Lutz, Thomas A; Andrews, Zane B; Holst, Birgitte

    2016-09-01

    Neurotensin (NT) is a peptide expressed in the brain and in the gastrointestinal tract. Brain NT inhibits food intake, but the effects of peripheral NT are less investigated. In this study, peripheral NT decreased food intake in both mice and rats, which was abolished by a NT antagonist. Using c-Fos immunohistochemistry, we found that peripheral NT activated brainstem and hypothalamic regions. The anorexigenic effect of NT was preserved in vagotomized mice but lasted shorter than in sham-operated mice. This in combination with a strong increase in c-Fos activation in area postrema after ip administration indicates that NT acts both through the blood circulation and the vagus. To improve the pharmacokinetics of NT, we developed a pegylated NT peptide, which presumably prolonged the half-life, and thus, the effect on feeding was extended compared with native NT. On a molecular level, the pegylated NT peptide increased proopiomelanocortin mRNA in the arcuate nucleus. We also investigated the importance of NT for the decreased food intake after gastric bypass surgery in a rat model of Roux-en-Y gastric bypass (RYGB). NT was increased in plasma and in the gastrointestinal tract in RYGB rats, and pharmacological antagonism of NT increased food intake transiently in RYGB rats. Taken together, our data suggest that NT is a metabolically active hormone, which contributes to the regulation of food intake. PMID:27580810

  2. Investigation of the excluded stomach after Roux-en-Y gastric bypass: The role of percutaneous endoscopy

    Institute of Scientific and Technical Information of China (English)

    Kanwar RS Gill; J Mark McKinney; Mark E Stark; Ernest P Bouras

    2008-01-01

    Accessing the bypassed portion of the stomach via conventional endoscopy is difficult following Roux-en-Y gastric bypass surgery. However, endoscopic examination of the stomach and small bowel is possible through percutaneous access into the bypassed stomach (BS) with a combined radiologic and endoscopic technique. We present a case of obscure overt gastrointestinal (GI) bleeding where the source of bleeding was thought to be from the BS. After conventional endoscopic methods failed to examine the BS, percutaneous endoscopy (PE) was used as an alternative to surgical exploration.

  3. Outcome of gastroplasty and gastric bypass in a single centre in the UK

    Directory of Open Access Journals (Sweden)

    Sintler M

    2009-09-01

    Full Text Available Abstract Background Morbid obesity is defined as BMI>40 kg/m2. It affects 124,000 men and 412,000 women in England and Wales (NICE, July 2002. According to NICE guidelines, Bariatric surgery is indicated if the treatments for obesity such as exercise, diet and drugs fail. Procedures include laparoscopic gastric banding (LGB, vertical banded gastroplasty (VBG, and Gastric Bypass (GB. Aims The aim of this audit was to determine if NICE guidelines on the use of Bariatric surgery in the Manor Hospital, Walsall was being adhered to. Secondary aims were also to establish if Bariatric surgery is achieving its goal in the long-term and if weight reduction is being maintained in this group of patients. Methods A retrospective cohort study was carried out on patients who underwent Bariatric surgery between 1990 and 2004. Retrieved records were scrutinised and the following parameters were collated: pre-operative morbidities, intra and post-operative complication rates and weight reduction on follow-up. Results 129 patients were operated on in the 14 year period. For VBG, 40 out of 105 patients had weight gain by the 5th follow-up visit. This compared with 5 out of 18 patients after the same timescale for the GB group and 1 out of 6 in the LGB group. The most common post-operative complication was stenosis (28% of VBG group. Conclusion Bariatric surgery is relatively safe as an intervention for morbid obesity. Weight loss however is not maintained in the long term. VBG and LGB are short term interventions. Further research is required to look into the merits of gastric bypass surgery.

  4. Safety Evaluation of Laparoscopic Sleeve Gastrectomy Compared with Two Procedures of Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Adjustable Gastric Banding for Individuals with Morbid Obesity: A Systemic Review

    Directory of Open Access Journals (Sweden)

    F Arabi Basharic

    2015-10-01

    Full Text Available Introduction: Laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding are the most common bariatric surgery procedures. Therefore, this study aims to compare the safety of the newer procedure of Laparoscopic sleeve gastrectomy compared to Laparoscopic Roux-en-Y gastric bypass and Laparoscopic adjustable gastric bonding. Method: A systematic review was conducted on the most important and most relevant search data bases, including Cochrane library, Pubmed, Ovid Medline as well as Iranian sites of Magiran , Iranmedex , SID, not taking the time limit into consideration. The results found in the literature were classified and were then analyzed. Results: Out of 384 articles obtained in the search, 4 randomized clinical trials (RCT were included in this study. There were no reports of death comparing surgical procedures of Roux-en-Y gastric bypass and sleeve gastrectomy. Moreover, in adjustable gastric banding and Roux-en-Y gastric bypass comparison, one death was observed in each group. Regarding the side effects of Roux-en-Y gastric bypass and sleeve gastrectomy, 10% early complications were reported in the Roux-en-Y gastric  bypass group , and 13% were observed in the sleeve gastrectomy group between which no statistically significant difference was revealed. The comparison between adjustable gastric banding and Roux-en-Y gastric bypass demonstrated that the occurrence of early and late complications was reported to be higher in the gastric bypass group, though no statistically significant difference was observed. Conclusion: The present study findings demonstrated no statistically significant difference between these methods in regard with the safety aspect. As a result, selection as well as success of the bariatric surgery procedures depend on the patient's and surgeon's preferences.

  5. Attachment Anxiety Predicts Poor Adherence to Dietary Recommendations : an Indirect Effect on Weight Change 1 Year After Gastric Bypass Surgery

    NARCIS (Netherlands)

    Aarts, Floor; Geenen, Rinie; Gerdes, Victor E. A.; van de Laar, Arnold; Brandjes, Dees P. M.; Hinnen, Chris

    2015-01-01

    Weight loss after gastric bypass surgery depends on the adoption of healthy dietary recommendations, which may be influenced by psychological issues and patients' attachment representations (habitual states of mind with respect to interpersonal relations). The present study tests (1) whether attachm

  6. Effects of gastric bypass surgery on glucose absorption and metabolism during a mixed meal in glucose-tolerant individuals

    DEFF Research Database (Denmark)

    Jacobsen, Siv H; Bojsen-Møller, Kirstine N; Dirksen, Carsten;

    2013-01-01

    AIMS/HYPOTHESIS: Roux-en-Y gastric bypass surgery (RYGB) improves glucose tolerance in patients with type 2 diabetes, but also changes the glucose profile in response to a meal in glucose-tolerant individuals. We hypothesised that the driving force for the changed postprandial glucose profiles...

  7. Attachment anxiety predicts poor adherence to dietary recommendations : an indirect effect on weight change 1 year after gastric bypass surgery

    NARCIS (Netherlands)

    Hinnen, C.; Aarts, F.; Geenen, R.

    2014-01-01

    BACKGROUND: Weight loss after gastric bypass surgery depends on the adoption of healthy dietary recommendations, which may be influenced by psychological issues and patients' attachment representations (habitual states of mind with respect to interpersonal relations). The present study tests (1) whe

  8. Cerebral markers of the serotonergic system in rat models of obesity and after Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Ratner, Cecilia; Ettrup, Anders; Bueter, Marco;

    2012-01-01

    markers. Using receptor autoradiography, brain regional-densities of the serotonin transporter (SERT) and the 5-HT(2A) and 5-HT(4) receptors were measured in (i) selectively bred polygenic diet-induced obese (pgDIO) rats, (ii) outbred DIO rats, and (iii) Roux-en-Y gastric bypass (RYGB)-operated rats. pg...

  9. Altered promoter methylation of PDK4, IL1 B, IL6, and TNF after Roux-en Y gastric bypass

    DEFF Research Database (Denmark)

    Kirchner, Henriette; Nylen, Carolina; Laber, Samantha;

    2014-01-01

    Background Early benefits of Roux-en Y gastric bypass (RYGB) are partly mediated by the caloric restriction that patients undergo before and acutely after the procedure. Altered DNA methylation occurs in metabolic diseases including obesity, as well as in skeletal, muscle eight months after RYGB...

  10. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal

    DEFF Research Database (Denmark)

    Goldfine, A B; Mun, E C; Devine, E;

    2007-01-01

    CONTEXT AND OBJECTIVE: Hyperinsulinemic hypoglycemia is newly recognized as a rare but important complication after Roux-en-Y gastric bypass (GB). The etiology of the syndrome and metabolic characteristics remain incompletely understood. Recent studies suggest that levels of incretin hormones...

  11. Attachment anxiety predicts poor adherence to dietary recommendations : an indirect effect on weight change one year after gastric bypass surgery

    NARCIS (Netherlands)

    Aarts, F.; Geenen, R.; Gerdes, V.E.A.; Van de Laar, A., A.; Brandjes, D.P.M.; Hinnen, C.

    2015-01-01

    BACKGROUND: Weight loss after gastric bypass surgery depends on the adoption of healthy dietary recommendations, which may be influenced by psychological issues and patients' attachment representations (habitual states of mind with respect to interpersonal relations). The present study tests (1) whe

  12. Anti-inflammatory role of GLP-1 and the effect of gastric bypass on diabetes- and obesity-associated inflammation

    DEFF Research Database (Denmark)

    Bovbjerg, Kirsten Katrine Lindegaard

    in the adipose tissue, is involved in the metabolic dysregulation and therefore plays an important role in the pathogenesis of this deteriorating disease.Bariatric surgery, including the Roux-en Y gastric bypass (RYGB), is one of the most effective treatments for severe obesity. In addition to weight loss...

  13. Effects of endogenous GLP-1 and GIP on glucose tolerance after Roux-en-Y gastric bypass surgery

    DEFF Research Database (Denmark)

    Svane, Maria S; Bojsen-Moller, Kirstine N; Nielsen, Signe;

    2016-01-01

    Exaggerated secretion of glucagon-like peptide 1 (GLP-1) is important for postprandial glucose tolerance after Roux-en-Y gastric bypass (RYGB), whereas the role of glucose-dependent insulinotropic polypeptide (GIP) remains to be resolved. We aimed to explore the relative importance of endogenously...

  14. Roux-en-Y Gastric Bypass Surgery Induces Early Plasma Metabolomic and Lipidomic Alterations in Humans Associated with Diabetes Remission

    DEFF Research Database (Denmark)

    Arora, Tulika; Velagapudi, Vidya; Pournaras, Dimitri J;

    2015-01-01

    Roux-en-Y gastric bypass (RYGB) is an effective method to attain sustained weight loss and diabetes remission. We aimed to elucidate early changes in the plasma metabolome and lipidome after RYGB. Plasma samples from 16 insulin-resistant morbidly obese subjects, of whom 14 had diabetes, were...

  15. Renal protection effect of gastric bypass and its mechanism in type 2 diabetes mellitus rats

    Directory of Open Access Journals (Sweden)

    Zhen-yu CHEN

    2014-08-01

    Full Text Available Objective To observe the renal protection effect of gastric bypass, and explore its possible mechanism in type 2 diabetes mellitus (T2DM rats. Methods Forty SD rats were randomly divided into normal control group (n=8 and diabetes model group (n=32. Rats in diabetes model group were injected STZ (35 mg/kg. After the diabetes model was reproduced successfully, they were randomly divided into diabetes control group (n=8, diabetes sham-operation group (n=8 and diabetes operation group (n=14. Roux-en-Y gastric bypass was performed in rats of diabetes operation group. The fasting blood glucose (FBG, renal hypertrophy index (kidney weight/body weight, blood urea nitrogen (BUN, serum creatinine (Cr, activity of total superoxide dismutase (TSOD and glutathione peroxidase (GSH-PX, content of malondialdehyde (MDA, activity of aldose reductase (AR and AR mRNA expression in the kidney were determined 8 weeks after operation. The renal tissue was examined with light microscopy. Results Compared with normal control group, the renal hypertrophy index, FBG, BUN, Cr, content of MDA, activity of AR and AR mRNA expression in the kidney significantly increased in diabetes control group and diabetes sham-operation group, while the activity of TSOD and GSH-PX decreased (P<0.05. Compared with diabetes control group and diabetes sham operation group, the kidney hypertrophy index, FBG, BUN, Cr, content of MDA, activity of AR and AR mRNA expression in diabetes operation group markedly decreased (P<0.05, while the activity of TSOD and GSH-PX increased (P<0.05. HE staining showed that the renal structure was normal in normal control group. The glomeruli became obviously enlarged, mesangial proliferation was marked, and the mesangial zone expanded in diabetes control group and diabetes sham-operation group. Such renal changes appeared milder in diabetes operation group. Conclusion The gastric bypass could protect the kidney of T2DM rats, which may be ascribed to

  16. Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Arpad; Ivanecz; Marko; Sremec; Davorin; ?erani?; Stojan; Potr?; Pavel; Skok

    2014-01-01

    Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidenceof bariatric operations and coherently possible complications after such procedures, which modify patient’s anatomy and physiology.

  17. Accelerated protein digestion and amino acid absorption after Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Bojsen-Møller, Anna Kirstine; Jacobsen, Siv H; Dirksen, Carsten;

    2015-01-01

    BACKGROUND: Roux-en-Y gastric bypass (RYGB) involves exclusion of major parts of the stomach and changes in admixture of gastro-pancreatic enzymes, which could have a major impact on protein digestion and amino acid absorption. OBJECTIVE: We investigated the effect of RYGB on amino acid appearance......: RYGB accelerates caseinate digestion and amino acid absorption, resulting in faster and higher but more transient postprandial elevation of plasma amino acids. Changes are likely mediated by accelerated intestinal nutrient entry and clearly demonstrate that protein digestion is not impaired after RYGB...... and phenylalanine kinetics were determined under basal conditions and during 4 postprandial hours by intravenous infusions of [3,3,3-(2)H3]-leucine and [ring-(2)D5]-phenylalanine combined with ingestion of [1-(13)C]-leucine intrinsically labeled caseinate as the sole protein source of the meal. Changes in body...

  18. Enhanced insulin signaling in human skeletal muscle and adipose tissue following gastric bypass surgery

    DEFF Research Database (Denmark)

    Albers, Peter Hjorth; Bojsen-Moller, Kirstine N; Dirksen, Carsten;

    2015-01-01

    12 months post-surgery. Adipose tissue from glucose tolerant subjects was the most responsive to RYGB compared to type 2 diabetic patients, whereas changes in skeletal muscle were largely similar in these two groups. In conclusion, an improved molecular insulin sensitive phenotype of skeletal muscle......Roux-en-Y gastric bypass (RYGB) leads to increased peripheral insulin sensitivity. The aim of this study was to investigate the effect of RYGB on expression and regulation of proteins involved in regulation of peripheral glucose metabolism. Skeletal muscle and adipose tissue biopsies from glucose...... and glycogen synthase activity were enhanced 12 months post-surgery. In adipose tissue, protein expression of GLUT4, Akt2, TBC1D4 and acetyl-CoA carboxylase (ACC), phosphorylated levels of AMP-activated protein kinase and ACC as well as insulin-induced changes in phosphorylation of Akt and TBC1D4 were enhanced...

  19. Prevalence of Self-reported Symptoms After Gastric Bypass Surgery for Obesity

    DEFF Research Database (Denmark)

    Gribsholt, Sigrid Bjerge; Pedersen, Ane Mathilde; Svensson, Elisabeth;

    2016-01-01

    Importance: Population-based studies on the prevalence of symptoms after Roux-en-Y gastric bypass (RYGB) surgery are sparse. Knowledge about possible predictors of these symptoms is important for prevention. Objectives: To examine patients' overall well-being and the prevalence and predictors of...... [34.2%]), fatigue (488 [34.1%]), and anemia (396 [27.7%]). The risk of symptoms was higher among women (crude PR, 1.23; 95% CI, 1.11-1.37), among patients younger than 35 years (PR, 1.24; 95% CI, 1.13-1.36), among smokers (PR, 1.11; 95% CI, 1.02-1.20), among unemployed persons (PR, 1.15; 95% CI, 1...

  20. Continuous Glucose Monitoring for Evaluation of Glycemic Excursions after Gastric Bypass

    Directory of Open Access Journals (Sweden)

    Florencia Halperin

    2011-01-01

    Full Text Available Background. Hyperinsulinemic hypoglycemia with neuroglycopenia is a rare complication of Roux-en-Y gastric bypass (RYGB. We hypothesized that continuous glucose monitoring (CGM would be useful to characterize glycemic variability after RYGB. Methods. CGM and mixed meal tolerance testing (MMTT were performed on sixteen post-RYGB subjects, ten with a history of neuroglycopenia on medical treatment and six asymptomatic controls. Results. 9 of 10 subjects with neuroglycopenia developed hypoglycemia defined by glucose <70 mg/dL on CGM, and 3 of 9 on MMTT. In asymptomatic subjects, 3 of 6 had asymptomatic hypoglycemia during CGM, and 3 of 5 on MMTT. Therefore, the sensitivity and specificity to detect clinically significant hypoglycemia was 90% and 50% for CGM and 33% and 40% for MMTT.Conclusions. Asymptomatic hypoglycemia after RYGB is more frequent than commonly recognized. For clinicians evaluating patients for postbypass neuroglycopenia, CGM may be a valuable diagnostic tool.

  1. Mechanistic comparison between gastric bypass vs. duodenal switch with sleeve gastrectomy in rat models.

    Directory of Open Access Journals (Sweden)

    Yosuke Kodama

    Full Text Available BACKGROUND: Both gastric bypass (GB and duodenal switch with sleeve gastrectomy (DS have been widely used as bariatric surgeries, and DS appears to be superior to GB. The aim of this study was to better understand the mechanisms leading to body weight loss by comparing these two procedures in experimental models of rats. METHODS: Animals were subjected to GB, DS or laparotomy (controls, and monitored by an open-circuit indirect calorimeter composed of comprehensive laboratory animal monitoring system and adiabatic bomb calorimeter. RESULTS: Body weight loss was greater after DS than GB. Food intake was reduced after DS but not GB. Energy expenditure was increased after either GB or DS. Fecal energy content was increased after DS but not GB. CONCLUSION: GB induced body weight loss by increasing energy expenditure, whereas DS induced greater body weight loss by reducing food intake, increasing energy expenditure and causing malabsorption in rat models.

  2. An Effort to Develop an Algorithm to Target Abdominal CT Scans for Patients After Gastric Bypass.

    Science.gov (United States)

    Pernar, Luise I M; Lockridge, Ryan; McCormack, Colleen; Chen, Judy; Shikora, Scott A; Spector, David; Tavakkoli, Ali; Vernon, Ashley H; Robinson, Malcolm K

    2016-10-01

    Abdominal CT (abdCT) scans are frequently ordered for Roux-en-Y gastric bypass (RYGB) patients presenting to the emergency department (ED) with abdominal pain, but often do not reveal intra-abdominal pathology. We aimed to develop an algorithm for rational ordering of abdCTs. We retrospectively reviewed our institution's RYGB patients presenting acutely with abdominal pain, documenting clinical and laboratory data, and scan results. Associations of clinical parameters to abdCT results were examined for outcome predictors. Of 1643 RYGB patients who had surgery between 2005 and 2015, 355 underwent 387 abdCT scans. Based on abdCT, 48 (12 %) patients required surgery and 86 (22 %) another intervention. No clinical or laboratory parameter predicted imaging results. Imaging decisions for RYGB patients do not appear to be amenable to a simple algorithm, and patient work-up should be based on astute clinical judgment.

  3. PREDICTORS FOR WEIGHT LOSS FAILURE FOLLOWING ROUX-EN-Y GASTRIC BYPASS

    Directory of Open Access Journals (Sweden)

    Everton CAZZO

    2014-12-01

    Full Text Available Context Weight loss failure is a widely recognized occurrence following Roux-en-Y gastric bypass. Objectives This study aims to identify predictors associated with weight loss failure. Methods It is a retrospective cohort which enrolled 187 subjects who underwent RYGB. Comparisons were made between patients’ features at baseline and 24 months after surgery. Results A weight loss failure rate of 11.2% was found. Advanced age and diabetes were statistically associated with failure. Conclusions The results found were close to previous reports. As weight loss failure represents an important concern, there is the possibility to perform revisional surgeries, which may emphasize the restrictive or malabsorptive characteristics of RYGB, leading to varied results. It is reinforced that weight loss cannot be used as the unique outcome to evaluate the success of surgery.

  4. Risk of Post-Gastric Bypass Surgery Hypoglycemia in Nondiabetic Individuals: A Single Center Experience

    Science.gov (United States)

    Lee, Clare J.; Craig Wood, G.; Lazo, Mariana; Brown, Todd T.; Clark, Jeanne M.; Still, Christopher; Benotti, Peter

    2016-01-01

    Objective The epidemiology of post-gastric bypass surgery hypoglycemia (PGBH) is incompletely understood. This study aimed to evaluate the risk of PGBH among nondiabetic patients and associated factors. Methods A cohort study of nondiabetic patients who underwent Roux-en-Y gastric bypass (RYGB) was conducted. PGBH was defined by any postoperative record of glucose hypoglycemia, or any medication use for treatment of PGBH. Kaplan-Meier analysis was used to describe PGBH occurrence, log-rank tests, and Cox regression to examine associated factors. Results Of the 1,206 eligible patients, 86% were female with mean age of 43.7 years, mean preoperative BMI of 48.7 kg/m2, and a mean follow-up of 4.8 years. The cumulative incidence of hypoglycemia at 1 and 5 years post-RYGB was 2.7% and 13.3%, respectively. Incidence of PGBH was identified in 158 patients and was associated with lower preoperative BMI (P = 0.048), lower preoperative HbA1c (P = 0.012), and higher 6-month percent of excess body weight loss (%EWL) (P = 0.001). A lower preoperative HbA1c (HR = 1.73, P = 0.0034) and higher 6-month %EWL (HR = 1.96, P = 0.0074) remained independently correlated with increased risk for PGBH in multi-regression analysis. Conclusions The 5-year incidence of PGBH among nondiabetic individuals was 13.3% and was associated with a lower preoperative HbA1c and greater weight loss at 6 months following surgery. PMID:27225597

  5. Mini Gastric Bypass: first report of 125 consecutive cases from United Kingdom.

    Science.gov (United States)

    Parmar, C D; Mahawar, K K; Boyle, M; Carr, W R J; Jennings, N; Schroeder, N; Balupuri, S; Small, P K

    2016-02-01

    Mini Gastric Bypass is a promising bariatric procedure with multiple apparent benefits. Ours is the first unit within the National Health Service of the United Kingdom to be routinely performing this procedure. This retrospective cohort study reports our experience with first 125 procedures. Data were retrospectively analysed from a prospective database. Information was further supplemented by interviewing team members, contacting patients' general practitioners and telephonic follow-up. The mean follow-up was 11.4 months. There were 86 (68.8%) females and the mean age was 45 (range 20-70) years. Mean weight and body mass index was 135.8 (range 85-244) kilograms and 48.1 (range 34.5-73.8) kg m(-2) , respectively. The mean operating time was 92.4 (range 45-150) minutes and the mean post-operative hospital stay was 2.2 (range 2-17) days. There was no leak, one 30-day reoperation and no mortality in this study. Three patients required late reoperations and four patients developed marginal ulcers. At 6 months follow-up (n = 114), 27.5 (range 11.4-47.4) % total body weight loss and 60.1 (range 23.2-117.5) % excess body weight loss was seen. The figures at 12 months follow-up (n = 65) were 36.8 (range 23.7-55.4) % and 79.5 (range 44.9-138.3) %, respectively. This study demonstrates early safety and efficacy of Mini Gastric Bypass in a carefully selected British obese population in a high-volume centre.

  6. The predictive value of psychological assessment of candidates for gastric bypass: A medical chart review

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    Nathalie Aubert

    2010-06-01

    Full Text Available Background and Objectives: Guidelines for bariatric surgery demand a psychological evaluation of applicants. The aim of this study was to evaluate if the presence of "psychological risk factors" predicts postoperative weight loss after gastric bypass. Methods: Medical records of obese women who underwent bariatric surgery between 2000 and 2004 were reviewed. Psychological assessment consisted of a one-hour semi-structured interview, summarized in a written report. Anthropometric assessment at baseline and 6,12,18 and 24 months after surgery included body weight, height and body mass index. Results: The mean BMI of included patients (N = 92 was 46.2 + 6,3 kg/m² (range 38.4 - 69.7. Based on the psychological assessment, 27% (N = 25 of the patients were classified as having "psychological risk factors" and 28% (N = 26 were diagnosed with a psychiatric diagnosis, most often major depression. Two years after gastric bypass, 16% of patients with "psychological risk factors" achieved an excellent result (%EWL > 75 versus 39% of those without (p < 0.05. About 1 out of 4 patients was in postoperative psychiatric treatment, but only half of them were identified as having "psychological risk factors" at baseline. Weight loss of patients initiating a psychiatric treatment only after surgery was less than of patients who continued psychiatric treatment already initiated before surgery (55.7 + 14.8 versus 66.5 + 14.2 %EWL. Conclusions: A single semi-structured psychological interview may identify patients who are at risk for diminished postoperative weight loss; however, psychological assessment did not identify those patients who were in need of a psychiatric postoperative treatment.

  7. Eating in mice with gastric bypass surgery causes exaggerated activation of brainstem anorexia circuit

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    Mumphrey, Michael B.; Hao, Zheng; Townsend, R. Leigh; Patterson, Laurel M.; Münzberg, Heike; Morrison, Christopher C.; Ye, Jianping; Berthoud, Hans-Rudolf

    2016-01-01

    Background/Objective Obesity and metabolic diseases are at an alarming level globally and increasingly affect children and adolescents. Gastric bypass and other bariatric surgeries have proven remarkably successful and are increasingly performed worldwide. Reduced desire to eat and changes in eating behavior and food choice account for most of the initial weight loss and diabetes remission after surgery, but the underlying mechanisms of altered gut-brain communication are unknown. Subjects/Methods To explore the potential involvement of a powerful brainstem anorexia pathway centered around the lateral parabrachial nucleus (lPBN) we measured meal-induced neuronal activation by means of c-Fos immunohistochemistry in a new high-fat diet-induced obese mouse model of Roux-en-Y gastric bypass (RYGB) at 10 and 40 days after RYGB or sham surgery. Results Voluntary ingestion of a meal 10 days after RYGB, but not after sham surgery, strongly and selectively activates calcitonin gene-related peptide neurons in the external lPBN as well as neurons in the nucleus tractus solitaries, area postrema, and medial amygdala. At 40 days after surgery, meal-induced activation in all these areas was greatly diminished and did not reach statistical significance. Conclusions The neural activation pattern and dynamics suggest a role of the brainstem anorexia pathway in the early effects of RYGB on meal size and food intake that may lead to adaptive neural and behavioral changes involved in the control of food intake and body weight at a lower level. However, selective inhibition of this pathway will be required for a more causal implication. PMID:26984418

  8. Is there an association between urolithiasis and roux-en-y gastric bypass surgery?

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    Andre Costa-Matos

    2009-08-01

    Full Text Available Purpose: Several studies have documented high incidence of urinary lithiasis after jejunoileal by-pass. Roux-en-y gastric bypass surgery (RYGB is currently the most common bariatric procedure. Because of its difficult for absorption, RYGB has a potential risk to increase the incidence of lithiasis. This study was conducted in order to test the hypothesis that RYGB increases the incidence urolithiasis after 50% of excessive weight loss. Materials and Methods: We performed a retrospective cohort study to evaluate 58 patients who underwent RYGB at the Obesity Service at Santa Casa de Misericordia de Sao Paulo, between 2000 and 2005, with minimum follow-up of 10 and maximum of 72 months, after the procedure. Results: Forty-five (77.6% patients had ≥ 50% loss of weight excess. There was no difference between the frequency of urolithiasis before and after the procedure, and nephrolithiasis was observed after surgery in only one patient, however this had been detected before the procedure. Conclusion: In the period studied, RYGB does not seem to affect the incidence of urolithiasis after weight reduction. This may be due to its smaller malabsorptive component as compared with jejunoileal “by-pass”, thereby possibly not significantly influencing the oxalate metabolism.

  9. INFLAMMATORY DISORDERS ASSOCIATED WITH HELICOBACTER PYLORI IN THE ROUX-EN-Y BYPASS GASTRIC POUCH

    Science.gov (United States)

    CHAVES, Luiz Claudio Lopes; BORGES, Isabela Klautau Leite Chaves; de SOUZA, Maíra Danielle Gomes; SILVA, Ian Passos; SILVA, Lyz Bezerra; MAGALHÃES, Marcelo Alexandre Prado; FONSECA, Allan Herbert Feliz; CAMPOS, Josemberg Marins

    2016-01-01

    ABSTRACT Background: The prevalence of Helicobacter pylori in obese candidates for bariatric surgery and its role in the emergence of inflammatory lesions after surgery has not been well established. Aim: To identify the incidence of inflammatory lesions in the stomach after bariatric surgery and to correlate it with H. pylori infection. Methods: This is a prospective study with 216 patients undergoing Roux-en-Y gastric bypass. These patients underwent histopathological endoscopy to detect H. pylori prior to surgery. Positive cases were treated with antibiotics and a proton inhibitor pump followed by endoscopic follow-up in the 6th and 12th month after surgery. Results: Most patients were female (68.1%), with grade III obesity (92.4%). Preoperative endoscopy revealed gastritis in 96.8%, with H. pylori infection in 40.7% (88/216). A biopsy was carried out in 151 patients, revealing H. pylori in 60/151, related to signs of inflammation in 90% (54/60). In the 6th and 12th month after surgery, the endoscopy and the histopathological exam showed a normal gastric pouch in 84% of patients and the incidence of H. pylori was 11% and 16%, respectively. The presence of inflammation was related to H. pylori infection (p<0,001). Conclusion: H. pylori has a similar prevalence in both obese patients scheduled to undergo bariatric surgery and the general population. There is a low incidence of it in the 6th and 12th months after surgery, probably owing to its eradication when detected prior to surgery. When inflammatory disease is present in the new gastric reservoir it is directly related to H. pylori infection. PMID:27683772

  10. Tamoxifen malabsorption after Roux-en-Y gastric bypass surgery: case series and review of the literature.

    Science.gov (United States)

    Wills, Shannon M; Zekman, Richard; Bestul, Daniel; Kuwajerwala, Nafisa; Decker, David

    2010-02-01

    Roux-en-Y gastric bypass is a gastric reduction duodenal switch with a combination of restrictive and malabsorptive procedures. It is the most common gastric bypass procedure performed in the United States. Malabsorption causing nutritional deficiencies does occur, yet a PubMed literature search (1955-2009) returned no reports of malabsorption of anticancer agents after gastric bypass. To our knowledge, this is the first report of three cases of malabsorption of the anticancer agent tamoxifen after this procedure. The first patient was a 58-year-old woman who underwent Roux-en-Y bypass for morbid obesity. Two years later, she developed estrogen receptor-positive ductal carcinoma in situ of the breast, underwent lumpectomy and irradiation, and tamoxifen was started. Two years after that, she presented with concerns of potential malabsorption of the drug. Her plasma tamoxifen level was 28 ng/ml, which was below the lower limit of the therapeutic range (77-274 ng/ml for 10-30-mg/day regimens). The second patient was a 51-year-old woman who sought medical advice on risk reduction for breast cancer after receiving a diagnosis of atypical ductal hyperplasia of the breast. She also had a history of morbid obesity and underwent Roux-en-Y bypass. Tamoxifen was started to reduce her risk of breast cancer; her plasma tamoxifen level was subtherapeutic at 14 ng/ml. The third patient was a 53-year-old woman with estrogen receptor-positive breast cancer who underwent lumpectomy and was prescribed anastrozole, an aromatase inhibitor. She also underwent Roux-en-Y bypass for morbid obesity. As she experienced adverse effects while receiving anastrozole, the drug was discontinued, and tamoxifen 20 mg/day was started. Her tamoxifen plasma level was 52 ng/ml. Therefore, her tamoxifen dosage was increased to 20 mg twice/day. Six weeks later, her tamoxifen level was 120 ng/ml (therapeutic range 95-520 ng/ml for the increased dosage). These three cases suggest that steady-state serum

  11. Hernia de Petersen: Complicación del bypass gástrico: hallazgos tomográficos Petersen's hernia: Complication of gastric bypass: CT findings

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    Cecilia Carrera

    2012-09-01

    Full Text Available El bypass gástrico en Y de Roux (BGYR es una de las técnicas de elección en pacientes con obesidad mórbida y en la actualidad es el procedimiento de cirugía bariátrica más utilizado. Consiste en una técnica mixta, es decir, tiene un carácter principalmente restrictivo y genera un cierto grado de malabsorción. Puede realizarse por cirugía convencional o laparoscópica, siendo esta última la de elección. La anastomosis retrocólica crea un espacio en el mesenterio, posibilitando la formación de un tipo de hernia transmesentérica denominada "hernia de Petersen". El objetivo de este trabajo es describir y analizar los hallazgos tomográficos de la hernia de Petersen en pacientes con antecedente de bypass gástrico. Se analizaron las historias clínicas de 92 pacientes con antecedente de BGYR (realizados todos en nuestra institución. Tres pacientes presentaron un cuadro de obstrucción intestinal y se les realizó tomografía computada multislice (TCMS de abdomen. En función de los hallazgos tomográficos consistentes con hernia interna, los pacientes fueron intervenidos quirúrgicamente y se confirmó la presencia de hernia de Petersen. El conocimiento de la técnica quirúrgica, los cambios anatómicos y las posibles complicaciones es de gran utilidad para diagnosticar la causa de dolor abdominal en pacientes sometidos a bypass gástrico. La TCMS brinda información sobre las estructuras extraluminales y su alta resolución espacial permite examinar tanto los cambios anatómicos como las probables complicaciones secundarias al bypass gástrico.The Roux-en-Y gastric bypass (RYGBP is one of the techniques of choice in patients with morbid obesity, and at present, it is the most commonly performed bariatric procedure. It is a mixed technique, it is mainly restrictive but it also generates some degree of malabsorption. This procedure may be performed with a conventional surgical approach or with laparoscopic techniques, with the latter

  12. A Simpler Method for Predicting Weight Loss in the First Year after Roux-en-Y Gastric Bypass

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    John P. Sczepaniak

    2012-01-01

    Full Text Available Factors postulated to predict weight loss after gastric bypass surgery, include race, age, gender, technique, height, and initial weight. This paper contained 1551 gastric bypass patients (85.9% female. Operations were performed by one surgeon (MLO at community hospitals in Southern California from 1989 to 2008 with 314 being laparoscopic and 1237 open. We created the following equation: In[percent weight] =2−, where was the time after operation (days and and are constants. Analysis was completed on R-software. The model fits with 2 value 0.93 and gives patients a realistic mean target weight with a confidence interval of 95% for the first year. Conclusion. We created a curve predicting weight loss after surgery as a percentage of initial weight. Initial weight was the single most important predictor of weight loss after surgery. Other recorded variables accounted for less than 1% of variability. Unknown factors account for the remaining 6-7%.

  13. Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report

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    Steinemann Daniel C

    2011-12-01

    Full Text Available Abstract Background Anastomotic or marginal ulcers occur in 0.6 to 16% of patients after laparoscopic Roux-en-Y-Gastric Bypass. Initial therapy aims at eliminating known risk factors including smoking, Helicobacter pylori infection, use of non-steroidal anti-inflammatory drugs and inhibition of gastric acid secretion. While this approach is successful in 68 to 88% of the cases, up to one third of patients need a subsequent surgical revision. However, marginal ulcers still recur in up to 10% of cases after revisional surgery, thus constituting a serious challenge for bariatric surgeons. Case presentation We herein report a case of an insidious marginal ulcer refractory to both medical therapy with high-dosed proton pump inhibitors and sucralfate as well as surgical therapy consisting of the lengthening of a short alimentary limb and later resection of the gastroenterostomy and construction of a new tension-free anastomosis. Only after gastrectomy by laparoscopic en-bloc resection of the gastrojejunostomy, the gastric pouch and resection of the gastric remnant with reconstruction by esophagojejunostomy the patient remained free of symptoms. Conclusion By laparoscopic resection of the entire gastric pouch and the gastric remnant the risk to leave a suboptimally vascularised or even ischemic pouch in situ was avoided. The esophagojejunostomy was then created in healthy, good vascularised tissue. In our case this novel approach was effective in the management of a refractory anastomotic ulcer and might represent a rescue option when simple revision of the gastrojejunostomy fails.

  14. Gastric bypass surgery has a weight-loss independent effect on post-challenge serum glucose levels

    DEFF Research Database (Denmark)

    Hofsø, Dag; Birkeland, Kåre I; Holst, Jens J;

    2015-01-01

    BACKGROUND: Gastric bypass surgery seems to have an effect on glucose metabolism beyond what is mediated through weight reduction. The magnitude of this effect on fasting and post-challenge glucose levels remains unknown. RESULTS: Morbidly obese subjects without known diabetes performed a 75 g oral...... glucose tolerance test before and after either gastric bypass surgery (n = 64) or an intensive lifestyle intervention programme (n = 55), ClinicalTrials.gov identifier NCT00273104. The age-adjusted effects of the therapeutic procedures and percentage weight change on fasting and 2-h glucose levels at 1......-h glucose levels were significantly lower in the surgery group than in the lifestyle group, 4.7 (0.4) versus 5.4 (0.7) mmol/l and 3.4 (0.8) versus 6.0 (2.4) mmol/l, respectively (both p Gastric bypass and weight-loss had both independent glucose-lowering effects on 2-h glucose levels [B...

  15. OUTCOMES ON QUALITY OF LIFE, WEIGHT LOSS, AND COMORBIDITIES AFTER ROUX-EN-Y GASTRIC BYPASS

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    Roberto Coelho Netto da Cunha COSTA

    2014-09-01

    Full Text Available Context Bariatric surgery has become the most effective method for producing weight loss in obese patients. The evaluation of improvement of comorbidities and changes in the quality of life are important outcome factors; however, it is necessary to investigate whether they persist over the long term. Methods A cross-sectional study was conducted on 143 obese patients from our institution from February 2007 to February 2008. These patients were divided into five independent groups, one being a control group, plus four other groups with 1, 2, 3, 4 or more years following surgical Roux-en-Y gastric bypass with a silicon ring banded. quality of life forms and anthropometric measurements were performed and its scores correlated with social factors, weight loss success, and status of obesity-related conditions. Results For the group that was 1 year postoperative, a significant percentage of excess body weight loss (EBWL% of 81.7% was observed. The groups with 2, 3, 4 or more years of post-surgical follow-up showed a EBWL decline, but without significant difference. The main comorbidity percentages in all patients who had the surgery was as follows: 69.7% for hypertension; 88.2% for diabetes mellitus; and 27.5% for arthropathy. There was a significant decrease in the rate for diabetes resolution (P = 0.035 observed by evolutionary assessment of the comorbidity resolution. The results obtained by BAROS were good, very good, or excellent in more than 96% of patients in all evaluations that were performed. The use of the Moorehead-Ardelt Questionnaire (M/A demonstrated improvement in the quality of life. Moreover, the quality of life, when evaluated through SF-36, also showed improvement in all related areas after 1 year; however, after 4 years, improvement remained elevated only in the areas of general state of health and functional capacity. Conclusions The Roux-en-Y gastric bypass procedure was able to achieve EBWL of 81.7% after 1 year following

  16. Link Between Increased Satiety Gut Hormones and Reduced Food Reward After Gastric Bypass Surgery for Obesity

    Science.gov (United States)

    Miras, Alexander D.; Scholtz, Samantha; Jackson, Sabrina; Neff, Karl J.; Pénicaud, Luc; Geoghegan, Justin; Chhina, Navpreet; Durighel, Giuliana; Bell, Jimmy D.; Meillon, Sophie; le Roux, Carel W.

    2016-01-01

    Context: Roux-en-Y gastric bypass (RYGB) surgery is an effective long-term intervention for weight loss maintenance, reducing appetite, and also food reward, via unclear mechanisms. Objective: To investigate the role of elevated satiety gut hormones after RYGB, we examined food hedonic-reward responses after their acute post-prandial suppression. Design: These were randomized, placebo-controlled, double-blind, crossover experimental medicine studies. Patients: Two groups, more than 5 months after RYGB for obesity (n = 7–11), compared with nonobese controls (n = 10), or patients after gastric banding (BAND) surgery (n = 9) participated in the studies. Intervention: Studies were performed after acute administration of the somatostatin analog octreotide or saline. In one study, patients after RYGB, and nonobese controls, performed a behavioral progressive ratio task for chocolate sweets. In another study, patients after RYGB, and controls after BAND surgery, performed a functional magnetic resonance imaging food picture evaluation task. Main Outcome Measures: Octreotide increased both appetitive food reward (breakpoint) in the progressive ratio task (n = 9), and food appeal (n = 9) and reward system blood oxygen level-dependent signal (n = 7) in the functional magnetic resonance imaging task, in the RYGB group, but not in the control groups. Results: Octreotide suppressed postprandial plasma peptide YY, glucagon-like peptide-1, and fibroblast growth factor-19 after RYGB. The reduction in plasma peptide YY with octreotide positively correlated with the increase in brain reward system blood oxygen level-dependent signal in RYGB/BAND subjects, with a similar trend for glucagon-like peptide-1. Conclusions: Enhanced satiety gut hormone responses after RYGB may be a causative mechanism by which anatomical alterations of the gut in obesity surgery modify behavioral and brain reward responses to food. PMID:26580235

  17. Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity

    Institute of Scientific and Technical Information of China (English)

    Konstantinos Vagenas; Spyros Panagiotopoulos; Ioannis Kehagias; Stavros Nikolaos Karamanakos; Nancy Mead; Fotis Kalfarentzos

    2008-01-01

    AIM: To evaluate and present our experience with laparoscopic Roux en Y gastric bypass (RYGB) in a selected patient population.METHODS: A cohort of 130 patients with a body mass index (BMI) between 35 and 50 kg/m2 were evaluated in relation to postoperative morbidity, weight loss and resolution of co-morbidities for a period of 4 years following laparoscopic RYGB.RESULTS: Early morbidity was 10.0%, including 1 patient with peritonitis who was admitted to Intensive Care Unit (ICU) and 1 conversion to open RYGB early in the series. There was no early or late mortality. Maximum weight loss was achieved at 12 mo postoperatively, with mean BMI 30 kg/m2, mean percentage of excess weight loss (EWL%) 66.4% and mean percentage of initial weight loss (IWL%) 34.3% throughout the follow-up period. The majority of preexisting comorbidities were resolved after weight loss and no major metabolic disturbances or nutritional deficiencies were observed.CONCLUSION: Laparoscopic RYGB appears to be a safe and effective procedure for patients with BMI 35-50 kg/m2 with results that are comparable to previously published data mostly from the USA but from Europe as well.

  18. Gastric Bypass Surgery Reverses Diabetic Phenotypes in Bdnf-Deficient Mice.

    Science.gov (United States)

    Jiang, Shujun; Wang, Qinghua; Huang, Zan; Song, Anying; Peng, Yu; Hou, Siyuan; Guo, Shiying; Zhu, Weiyun; Yan, Sheng; Lin, Zhaoyu; Gao, Xiang

    2016-08-01

    Duodenum-jejunum gastric bypass (DJB) has been used to treat morbid diabetic patients. However, neither the suitability among patients nor the mechanisms of this surgical treatment is clear. Previously, we reported a new mouse strain named Timo as type 2 diabetes model caused by brain-derived neurotrophic factor (Bdnf) deficiency. In this study, we found that DJB on Timo mice reversed their metabolic abnormalities without altering the expression of Bdnf. Glucose tolerance and insulin sensitivity were improved greatly, along with reduction of fat accumulation in liver and white adipose tissue. The gut flora population was altered by DJB with increased proportion of Firmicutes and decreased Actinobacteria and Proteobacteria in the ileum after surgery. Systemic inflammation in Timo mice was greatly suppressed with less macrophage infiltration and lower tumor necrosis factor-α levels in liver and white adipose tissue after surgery. Interestingly, the alteration of gut microflora abundance and improved metabolism preceded the inflammation alleviation after DJB surgery. These results suggested that DJB can reverse Bdnf deficiency-associated metabolic abnormality. In addition, the reduced inflammation may not be the initial cause for the DJB-associated metabolic and microbiota alterations. The increased BDNF protein levels in hypothalamus and hippocampus may result from microbiota change after DJB surgery. PMID:27418549

  19. Intestinal adaptations in chronic kidney disease and the influence of gastric bypass surgery.

    Science.gov (United States)

    Hatch, Marguerite

    2014-09-01

    Studies have shown that compensatory adaptations in gastrointestinal oxalate transport can impact the amount of oxalate excreted by the kidney. Hyperoxaluria is a major risk factor in the formation of kidney stones, and oxalate is derived from both the diet and the liver metabolism of glyoxylate. Although the intestine generally absorbs oxalate from dietary sources and can contribute as much as 50% of urinary oxalate, enteric oxalate elimination plays a significant role when renal function is compromised. While the mechanistic basis for these changes in the direction of intestinal oxalate movements in chronic renal failure involves an upregulation of angiotensin II receptors in the large intestine, enteric secretion/excretion of oxalate can also occur by mechanisms that are independent of angiotensin II. Most notably, the commensal bacterium Oxalobacter sp. interacts with the host enterocyte and promotes the movement of oxalate from the blood into the lumen, resulting in the beneficial effect of significantly lowering urinary oxalate excretion. Changes in the passive permeability of the intestine, such as in steatorrhoea and following gastric bypass, also promote oxalate absorption and hyperoxaluria. In summary, this report highlights the two-way physiological signalling between the gut and the kidney, which may help to alleviate the consequences of certain kidney diseases. PMID:24951497

  20. Hepatic phosphoenolpyruvate carboxykinase expression after gastric bypass surgery in rats with type 2 diabetes mellitus.

    Science.gov (United States)

    Wu, J; Hou, S S; Wang, W; Yin, M; Cheng, N; Ge, L L; Yin, J J; Xu, J

    2015-01-01

    The objective of this study was to investigate the mRNA expression of hepatic phosphoenolpyruvate carboxykinase (PEPCK) after gastric bypass surgery (GBS) in rats with type 2 diabetic mellitus (T2DM). Thirty-six male Goto-Kakizaki rats, aged 12 weeks, were randomly divided into the GBS, sham operation with diet restriction (SO), and sham operation alone (control) groups (N = 12 per group). Liver specimens from all rats were obtained during the operation and 8 weeks after operation. Blood lipid levels were measured before and 8 weeks after operation. Fasting blood glucose (FBG), food intake, and body weight were recorded at weekly time points after operation. The blood glucose area under the curve (AUC) was calculated, and insulin sensitivity indices (ISI) were assessed. The expression PEPCK mRNA and protein were measured by real-time polymerase chain reaction and western blot. Compared with those of the SO and control groups, the blood lipid levels and the FBG in the GBS group was significantly decreased (P rats while improving glucose tolerance and hyperglycemia, and the mechanism appears to be associated with a decrease of hepatic PEPCK mRNA and protein expression. PMID:26681041

  1. Gastrojejunal Anastomosis Complications and Their Management after Laparoscopic Roux-en-Y Gastric Bypass

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    Yannick Fringeli

    2015-01-01

    Full Text Available Background. Complications at the gastrojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass (LRYGB are challenging in terms of diagnosis, therapy, and prevention. This study aims at identifying these complications and discussing their management. Methods. Data of 228 patients who underwent a LRYGB between October 2008 and December 2011 were reviewed retrospectively to evaluate the frequency and treatment of complications such as stenoses, marginal ulcers, perforated marginal ulcers, or anastomotic leaks related to the operation. Results. Follow-up information was available for 209 patients (91.7% with a median follow-up of 38 months (range 24–62 months. Of these patients 16 patients (7.7% experienced complications at the gastrojejunostomy. Four patients (1.9% had stenoses and 12 patients (5.7% marginal ulcers, one of them with perforation (0.5%. No anastomotic leaks were reported. One case with perforated ulcer and one with recurrent ulcers required surgical revision. Conclusion. Gastrojejunal anastomotic complications are frequent and occur within the first few days or up to several years after surgery. Stenoses or marginal ulcers are usually successfully treated nonoperatively. Laparoscopic repair, meanwhile, is an appropriate therapeutic option for perforated ulcers.

  2. Presurgical Weight Is Associated with Pain, Functional Impairment, and Anxiety among Gastric Bypass Surgery Patients

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    Sharlene Wedin

    2012-01-01

    Full Text Available Chronic pain and obesity are significant public health concerns in the United States associated with significant levels of health-care expenses and lost productivity. Previous research suggests that obesity is a risk factor for chronic pain, mainly due to excessive weight placed on the joints. However, the obesity-pain relationship appears to be complex and reciprocal. Little work to date has focused on the relationship between weight and pain among patients undergoing gastric bypass surgery for weight loss. Patients scheduled to undergo bariatric surgery for weight loss at a large southeastern academic medical center ( completed the Brief Pain Inventory (BPI, the Center for Epidemiological Studies 10-item Depression scale (CESD-10, and the Beck Anxiety Inventory (BAI. Higher presurgical weight was associated with higher pain-on-average ratings, higher functional impairment due to pain across the domains of physical activity, mood, walking ability, relationships, and enjoyment of life. Higher presurgical weight was associated with higher BAI scores, but weight was not related to depression. Findings suggest that bariatric surgery candidates report a moderate amount of pain prior to surgery and that presurgical weight is associated with higher pain, increased functional impairment due to pain, and increased anxiety. Anxiety was found to mediate the relationship between increased weight and pain.

  3. Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Alter the Gut-Brain Communication

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    L. A. Ballsmider

    2015-01-01

    Full Text Available This study investigated the anatomical integrity of vagal innervation of the gastrointestinal tract following vertical sleeve gastrectomy (VSG and Roux-en-Y gastric bypass (RYGB operations. The retrograde tracer fast blue (FB was injected into the stomach to label vagal neurons originating from nodose ganglion (NG and dorsal motor nucleus of the vagus (DMV. Microglia activation was determined by quantifying changes in the fluorescent staining of hindbrain sections against an ionizing calcium adapter binding molecule 1 (Iba1. Reorganization of vagal afferents in the hindbrain was studied by fluorescent staining against isolectin 4 (IB4. The density of Iba1- and IB4-immunoreactivity was analyzed using Nikon Elements software. There was no difference in the number of FB-labeled neurons located in NG and DMV between VSG and VSG-sham rats. RYGB, but not RYGB-sham rats, showed a dramatic reduction in number of FB-labeled neurons located in the NG and DMV. VSG increased, while the RYGB operation decreased, the density of vagal afferents in the nucleus tractus solitarius (NTS. The RYGB operation, but not the VSG procedure, significantly activated microglia in the NTS and DMV. Results of this study show that the RYGB, but not the VSG procedure, triggers microglia activation in vagal structures and remodels gut-brain communication.

  4. Roux-en-Y gastric bypass increases intravenous ethanol self-administration in dietary obese rats.

    Directory of Open Access Journals (Sweden)

    James E Polston

    Full Text Available Roux-en-Y gastric bypass surgery (RYGB is an effective treatment for severe obesity. Clinical studies however have reported susceptibility to increased alcohol use after RYGB, and preclinical studies have shown increased alcohol intake in obese rats after RYGB. This could reflect a direct enhancement of alcohol's rewarding effects in the brain or an indirect effect due to increased alcohol absorption after RGYB. To rule out the contribution that changes in alcohol absorption have on its rewarding effects, here we assessed the effects of RYGB on intravenously (IV administered ethanol (1%. For this purpose, high fat (60% kcal from fat diet-induced obese male Sprague Dawley rats were tested ~2 months after RYGB or sham surgery (SHAM using both fixed and progressive ratio schedules of reinforcement to evaluate if RGYB modified the reinforcing effects of IV ethanol. Compared to SHAM, RYGB rats made significantly more active spout responses to earn IV ethanol during the fixed ratio schedule, and achieved higher breakpoints during the progressive ratio schedule. Although additional studies are needed, our results provide preliminary evidence that RYGB increases the rewarding effects of alcohol independent of its effects on alcohol absorption.

  5. Remodeling of the residual gastric mucosa after roux-en-y gastric bypass or vertical sleeve gastrectomy in diet-induced obese rats.

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    Konstantinos Arapis

    Full Text Available Whereas the remodeling of intestinal mucosa after bariatric surgeries has been the matter of numerous studies to our knowledge, very few reported on the remodeling of the residual gastric mucosa. In this study, we analyzed remodeling of gastric mucosa after Roux-en-Y gastric bypass (RYGB and vertical sleeve gastrectomy (VSG in rats. Diet-induced obese rats were subjected to RYGB, VSG or sham surgical procedures. All animals were assessed for food intake, body-weight, fasting blood, metabolites and hormones profiling, as well as insulin and glucose tolerance tests before and up to 5 weeks post-surgery. Remodeling of gastric tissues was analyzed by routine histology and immunohistochemistry studies, and qRT-PCR analyses of ghrelin and gastrin mRNA levels. In obese rats with impaired glucose tolerance, VSG and RYGB caused substantial weight loss and rats greatly improved their oral glucose tolerance. The remaining gastric mucosa after VSG and gastric pouch (GP after RYGB revealed a hyperplasia of the mucous neck cells that displayed a strong immunoreactivity for parietal cell H+/K+-ATPase. Ghrelin mRNA levels were reduced by 2-fold in remaining fundic mucosa after VSG and 10-fold in GP after RYGB. In the antrum, gastrin mRNA levels were reduced after VSG in line with the reduced number of gastrin positive cells. This study reports novel and important observations dealing with the remaining gastric mucosa after RYGB and VSG. The data demonstrate, for the first time, a hyperplasia of the mucous neck cells, a transit cell population of the stomach bearing differentiating capacities into zymogenic and peptic cells.

  6. The relationship of pre-operative health status to sustained outcome in gastric bypass surgery.

    Science.gov (United States)

    Lanyon, Richard I; Maxwell, Barbara M; Wershba, Rebecca E

    2014-02-01

    The task of sustaining initial weight loss after gastric bypass surgery has been identified as the area of greatest concern in this intervention. The present study investigated the role of good vs. poor pre-operative health as a moderator variable in identifying useful pre-operative predictors of continued weight loss. Follow-up data at a mean of 12.8 months and again at 3.2 years post-operatively were available for 79 patients on 227 interview variables and four psychological assessment instruments. These measures were studied for their success in predicting continued weight loss over the 1–3-year period separately for patients who were in good and in poor general pre-operative health. Previous findings showed that the overall mean simple weight loss to 12.8 months was 45.61 kg, but additional weight loss to 3.2 years was only 0.28 kg. The good and poor pre-operative health groups differed little on these figures. However, the significant predictors of continued weight loss for good-health patients (high anxiety and distress, low self-esteem, poor eating habits, strong expectations of life improvement, and good achievement and coping skills) were quite different from those for poor-health patients (good psychological health and happiness, strong personal support and life satisfaction, good eating habits, and little knowledge about their health). Thus, pre-operative health status served as a powerful moderator in predicting continued weight loss from pre-operative characteristics. These findings offer a means of making more accurate predictions as to which patients are the best candidates for surgery, and also suggest that different psychological and other interventions should be selected according to pre-operative health status. PMID:24122659

  7. Transformation of postingestive glucose responses after deletion of sweet taste receptor subunits or gastric bypass surgery.

    Science.gov (United States)

    Geraedts, Maartje C P; Takahashi, Tatsuyuki; Vigues, Stephan; Markwardt, Michele L; Nkobena, Andongfac; Cockerham, Renee E; Hajnal, Andras; Dotson, Cedrick D; Rizzo, Mark A; Munger, Steven D

    2012-08-15

    The glucose-dependent secretion of the insulinotropic hormone glucagon-like peptide-1 (GLP-1) is a critical step in the regulation of glucose homeostasis. Two molecular mechanisms have separately been suggested as the primary mediator of intestinal glucose-stimulated GLP-1 secretion (GSGS): one is a metabotropic mechanism requiring the sweet taste receptor type 2 (T1R2) + type 3 (T1R3) while the second is a metabolic mechanism requiring ATP-sensitive K(+) (K(ATP)) channels. By quantifying sugar-stimulated hormone secretion in receptor knockout mice and in rats receiving Roux-en-Y gastric bypass (RYGB), we found that both of these mechanisms contribute to GSGS; however, the mechanisms exhibit different selectivity, regulation, and localization. T1R3(-/-) mice showed impaired glucose and insulin homeostasis during an oral glucose challenge as well as slowed insulin granule exocytosis from isolated pancreatic islets. Glucose, fructose, and sucralose evoked GLP-1 secretion from T1R3(+/+), but not T1R3(-/-), ileum explants; this secretion was not mimicked by the K(ATP) channel blocker glibenclamide. T1R2(-/-) mice showed normal glycemic control and partial small intestine GSGS, suggesting that T1R3 can mediate GSGS without T1R2. Robust GSGS that was K(ATP) channel-dependent and glucose-specific emerged in the large intestine of T1R3(-/-) mice and RYGB rats in association with elevated fecal carbohydrate throughout the distal gut. Our results demonstrate that the small and large intestines utilize distinct mechanisms for GSGS and suggest novel large intestine targets that could mimic the improved glycemic control seen after RYGB.

  8. The mechanistic basis of hyperoxaluria following gastric bypass in obese rats.

    Science.gov (United States)

    Hatch, Marguerite; Canales, Benjamin K

    2016-06-01

    Roux-en-Y gastric bypass (RYGB) surgery is a popular and extremely effective procedure for sustained weight loss in the morbidly obese. However, hyperoxaluria and oxalate kidney stones frequently develop after RYGB and steatorrhea has been speculated to play a role. We examined the effects of RYGB and the role of dietary fat in an obese rat model by measuring fecal fat content and transmural oxalate fluxes across the distal colon compared to sham-operated controls (SHAM). Direct measurements of fecal fat content confirmed that RYGB on a 10 % fat diet excreted 40-fold more fecal fat than SHAM and, on a 40 % fat diet, RYGB excreted sevenfold more fecal fat than SHAM fed similarly. Results from the transport studies revealed a clear effect of high dietary fat (40 %) on colonic oxalate permeability and tissue conductance (G T) with comparable oxalate fluxes in RYGB and in SHAM. Administering a diet containing 10 % fat to both groups distinguished differences between RYGB and SHAM, revealing a 40 % increase in G T in RYGB and a reversal in the direction of net oxalate flux from absorption in SHAM to secretion in RYGB. These changes in colonic oxalate permeability were associated with a fourfold increase in urinary oxalate excretion in RYGB compared to SHAM. Therefore, oxalate solubility and permeability in the RYGB model are promoted by steatorrhea and result in enhanced passive oxalate absorption and hyperoxaluria. To our knowledge, these are the first measurements of intestinal oxalate transport in rats with RYGB. PMID:26584912

  9. Hypertrophy dependent doubling of L-cells in Roux-en-Y gastric bypass operated rats.

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    Carl Frederik Hansen

    Full Text Available BACKGROUND AND AIMS: Roux-en-Y gastric bypass (RYGB leads to a rapid remission of type 2 diabetes mellitus (T2DM, but the underlying mode of action remains incompletely understood. L-cell derived gut hormones such as glucagon-like peptide-1 (GLP-1 and peptide YY (PYY are thought to play a central role in the anti-diabetic effects of RYGB; therefore, an improved understanding of intestinal endocrine L-cell adaptability is considered pivotal. METHODS: The full rostrocaudal extension of the gut was analyzed in rats after RYGB and in sham-operated controls ad libitum fed or food restricted to match the body weight of RYGB rats. Total number of L-cells, as well as regional numbers, densities and mucosa volumes were quantified using stereological methods. Preproglucagon and PYY mRNA transcripts were quantified by qPCR to reflect the total and relative hormone production capacity of the L-cells. RESULTS: RYGB surgery induced hypertrophy of the gut mucosa in the food exposed regions of the small intestine coupled with a doubling in the total number of L-cells. No changes in L-cell density were observed in any region regardless of surgery or food restriction. The total gene expression capacity of the entire gut revealed a near 200% increase in both PYY and preproglucagon mRNA levels in RYGB rats associated with both increased L-cell number as well as region-specific increased transcription per cell. CONCLUSIONS: Collectively, these findings indicate that RYGB in rats is associated with gut hypertrophy, an increase in L-cell number, but not density, and increased PYY and preproglucagon gene expression. This could explain the enhanced gut hormone dynamics seen after RYGB.

  10. Roux-en-Y Gastric Bypass Surgery Increases Respiratory Quotient and Energy Expenditure during Food Intake.

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    Malin Werling

    Full Text Available The mechanisms determining long-term weight maintenance after Roux-en-Y gastric bypass (RYGB remain unclear. Cross sectional studies have suggested that enhanced energy expenditure (EE may play a significant role and the aim of this study was to reveal the impact of RYGB on each major component constituting total EE.Six obese female subjects, without other co-morbidities, were assessed before and at 10 days, 3 and 20 months after RYGB. Indirect calorimetry in a metabolic chamber was used to assess 24 h EE at each study visit. Other measurements included body composition by DEXA, gut hormone profiles and physical activity (PA using high sensitivity accelerometers.Median Body Mass Index decreased from 41.1 (range 39.1-44.8 at baseline to 28 kg/m2 (range 22.3-30.3 after 20 months (p<0.05. Lean tissue decreased from 55.9 (range 47.5-59.3 to 49.5 (range 41.1-54.9 kg and adipose tissue from 61 (range 56-64.6 to 27 (range 12-34.3 kg (both p<0.05. PA over 24 h did not change after surgery whereas 24 h EE and basal metabolic rate (BMR decreased. EE after a standard meal increased after surgery when adjusted for total tissue (p<0.05. After an initial drop, RQ (respiratory quotient had increased at 20 months, both as measured during 24 h and after food intake (p<0.05.RYGB surgery up-regulates RQ and EE after food intake resulting in an increased contribution to total EE over 24 h when corrected for total tissue.

  11. Leptin Is Required for Glucose Homeostasis after Roux-en-Y Gastric Bypass in Mice.

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    Mohamad Mokadem

    Full Text Available Leptin, the protein product of the ob gene, increases energy expenditure and reduces food intake, thereby promoting weight reduction. Leptin also regulates glucose homeostasis and hepatic insulin sensitivity via hypothalamic proopiomelanocortin neurons in mice. Roux-en-Y gastric bypass (RYGB induces weight loss that is substantial and sustained despite reducing plasma leptin levels. In addition, patients who fail to undergo diabetes remission after RYGB are hypoletinemic compared to those who do and to lean controls. We have previously demonstrated that the beneficial effects of RYGB in mice require the melanocortin-4 receptor, a downstream effector of leptin action. Based on these observations, we hypothesized that leptin is required for sustained weight reduction and improved glucose homeostasis observed after RYGB.To investigate this hypothesis, we performed RYGB or sham operations on leptin-deficient ob/ob mice maintained on regular chow. To investigate whether leptin is involved in post-RYGB weight maintenance, we challenged post-surgical mice with high fat diet.RYGB reduced total body weight, fat and lean mass and caused reduction in calorie intake in ob/ob mice. However, it failed to improve glucose tolerance, glucose-stimulated plasma insulin, insulin tolerance, and fasting plasma insulin. High fat diet eliminated the reduction in calorie intake observed after RYGB in ob/ob mice and promoted weight regain, although not to the same extent as in sham-operated mice. We conclude that leptin is required for the effects of RYGB on glucose homeostasis but not body weight or composition in mice. Our data also suggest that leptin may play a role in post-RYGB weight maintenance.

  12. Insulin Sensitivity and β-Cell Function Improve after Gastric Bypass in Severely Obese Adolescents

    Science.gov (United States)

    Inge, Thomas H.; Prigeon, Ronald L.; Elder, Deborah A.; Jenkins, Todd M.; Cohen, Robert M.; Xanthakos, Stavra A.; Benoit, Stephen C.; Dolan, Lawrence M.; Daniels, Stephen R.; D’Alessio, David A.

    2016-01-01

    Objective To test the hypothesis that insulin secretion and insulin sensitivity would be improved in adolescents after Roux-en-Y gastric bypass (RYGB). Study design A longitudinal study of 22 adolescents and young adults without diabetes undergoing laparoscopic RYGB (mean age 17.1 ± 1.42 years; range 14.5–20.1; male/female 8/14; Non-Hispanic White/African American 17/5) was conducted. Intravenous glucose tolerance tests were done to obtain insulin sensitivity (insulin sensitivity index), insulin secretion (acute insulin response to glucose), and the disposition index as primary outcome variables. These variables were compared over the 1 year of observation using linear mixed modeling. Results In the 1-year following surgery, body mass index fell by 38% from a mean of 61 ± 12.3 to 39 ± 8.0 kg/m2 (P < .01). Over the year following surgery, fasting glucose and insulin values declined by 54% and 63%, respectively. Insulin sensitivity index increased 300% (P < .01), acute insulin response to glucose decreased 56% (P < .01), leading to a nearly 2-fold increase in the disposition index (P < .01). Consistent with improved β-cell function, the proinsulin to C-peptide ratio decreased by 21% (P < .01). Conclusions RYGB reduced body mass index and improved both insulin sensitivity and β-cell function in severely obese teens and young adults. These findings demonstrate that RYGB is associated with marked metabolic improvements in obese young people even as significant obesity persists. Trial registration ClinicalTrials.gov: NCT00360373. PMID:26363548

  13. Utility of barium studies for patients with recurrent weight gain after Roux-en-Y gastric bypass

    International Nuclear Information System (INIS)

    Aim: To determine the utility of barium studies for detecting abnormalities responsible for recurrent weight gain after gastric bypass surgery. Methods: A computerized search identified 42 patients who had undergone barium studies for recurrent weight gain after gastric bypass and 42 controls. The images were reviewed to determine the frequency of staple-line breakdown and measure the length/width of the pouch and gastrojejunal anastomosis. A large pouch exceeded 6 cm in length or 5 cm in width and a wide anastomosis exceeded 2 cm. Records were reviewed for the amount of recurrent weight gain and subsequent weight loss after additional treatment. Results: Staple-line breakdown was present in 6/42 patients (14%) with recurrent weight gain. When measurements were obtained, 13/35 patients (37%) with recurrent weight gain had a large pouch, three (9%) had a wide anastomosis, and four (11%) had both, whereas 22/42 controls (52%) had a large pouch, one (2%) had a wide anastomosis, and two (5%) had both. Ten patients (24%) with recurrent weight gain underwent staple-line repair (n = 3) or pouch/anastomosis revision (n = 7). These 10 patients had a mean weight loss of 38.1 lbs versus a mean loss of 8.6 lbs in 19 patients managed medically. Conclusion: Only 14% of patients with recurrent weight gain after gastric bypass had staple-line breakdown, whereas 57% had a large pouch, wide anastomosis, or both. Not all patients with abnormal anatomy had recurrent weight gain, but those who did were more likely to benefit from surgical intervention than from medical management. - Highlights: • Only 14% of patients with recurrent weight gain after gastric bypass had GGFs. • The majority of patients with recurrent weight gain had a large pouch/wide GJA. • Many patients without recurrent weight gain also had a large pouch/wide GJA. • Those with weight gain and a large pouch/wide GJA are likely to benefit from surgery

  14. Meal-Induced Hormone Responses in a Rat Model of Roux-en-Y Gastric Bypass Surgery

    OpenAIRE

    Shin, Andrew C.; Zheng, Huiyuan; Townsend, R. Leigh; Sigalet, David L.; Berthoud, Hans-Rudolf

    2010-01-01

    Roux-en-Y gastric bypass (RYGB) surgery is the most effective treatment for morbid obesity and remission of associated type 2 diabetes, but the mechanisms involved are poorly understood. The aim of the present study was to develop and validate a rat model for RYGB surgery that allows repeated measurement of meal-induced changes in gut and pancreatic hormones via chronic venous catheters. Male Sprague Dawley rats made obese on a palatable high-fat diet were subjected to RYGB or sham surgery an...

  15. Prediction of severe complicatons and death in superobese patients undergoing open gastric bypass with the Recife Score

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    Euclides Dias Martins-Filho

    2011-03-01

    Full Text Available CONTEXT: Superobese patients who undergo gastric bypass have a greater incidence of complications. The greater incidence of comorbidity in this group leads to a higher surgical risk, and a need for special care. By analyzing the risk factors identified in the preoperative period, scoring them, constructing a score and assessing the occurrence of serious complications and death, we will have elements to identify which patients are at greater risk. OBJECTIVE: To determine the accuracy of the Recife Score for predicting serious postoperative complications and death in superobese patients who undergo Roux-en-Y gastric bypass surgery by the conventional method. METHODS: An ambidirectional study was conducted to validate the diagnostic test on 203 severely obese patients submitted to Roux-en-Y gastric bypass at the Hospital das Clínicas of the Federal University of Pernambuco, Recife, PE, Brazil, from September 1997 to May 2007. The dependent variables were major postoperative complications and death. The independent variable was the Recife Score. The data were analyzed using the Epi-Info 3.5.1 program. The accuracy of the Recife Score was analyzed considering the following parameters: sensitivity, specificity, positive predictive value, negative predictive value, positive verisimilitude ratio and negative verisimilitude ratio. RESULTS: The accuracy of the Recife Score with cut-off points higher than 3 and higher than 5 to predict serious postoperative complications was, respectively, a frequency of complications of 12.3%, with a risk ratio of 2.83, sensitivity of 57.1% and specificity of 69.8%, and 12.5%, with a risk ratio of 1.88, sensitivity of 7.1% and specificity of 96.3%. The accuracy of the Recife Score with cut-off points higher than 3 and higher than 5 to predict death was, respectively, a frequency of death of 7.7%, with a risk ratio of 10.62, sensitivity of 83.3% and specificity of 69.5%, and 12.5%, with a risk ratio of 4.88, sensitivity

  16. Effect of Modified Roux-en-Y Gastric Bypass Surgery on GLP-1, GIP in Patients with Type 2 Diabetes Mellitus

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    Shao-Wei Xiong

    2015-01-01

    Full Text Available The type 2 diabetes mellitus (T2DM is one of the most serious diseases that threaten public health. Modified gastric bypass surgery has been applied to the treatment of T2DM patients in the 1990s, but the therapeutic mechanism to this function is still unclear. The aim of this study was to further clarify the effect and the mechanism of modified gastric bypass surgery on glucose metabolism in patients with T2DM. In the study, the incretin indexes and blood glucose indexes were analyzed before surgery and 1 week and 1, 3, and 6 months after surgery. The results suggested that modified Roux-en-Y gastric bypass can promote GLP-1 secretion in patients with T2DM, while reducing the secretion of GIP. Thus it could effectively control blood glucose of patients with T2DM.

  17. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

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    Vincent Ochieng

    2016-01-01

    Conclusion: This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP.

  18. Acute Kidney Disease Due to Excessive Vitamin C Ingestion and Remote Roux-en-Y Gastric Bypass Surgery Superimposed on CKD.

    Science.gov (United States)

    Sunkara, Vasu; Pelkowski, Timothy D; Dreyfus, Darren; Satoskar, Anjali

    2015-10-01

    A 69-year-old woman presented with acute kidney failure of unknown cause that ultimately required dialysis. Kidney biopsy revealed the diagnosis of oxalate nephropathy. In retrospect, the patient had several risk factors for this entity, including excessive vitamin C intake, a remote history of Roux-en-Y gastric bypass for weight loss, and chronic kidney disease. This presentation of multiple risk factors for oxalate nephropathy is especially relevant to patients and physicians considering the increase in the United States of vitamin C supplementation use and gastric bypass surgery. It is important for physicians to maintain an awareness of this diagnosis and its risk factors.

  19. Increased glucose-stimulated FGF21 response to oral glucose in obese non-diabetic subjects after Roux-en-Y Gastric Bypass

    DEFF Research Database (Denmark)

    Vienberg, S G; Jacobsen, S H; Worm, D;

    2016-01-01

    OBJECTIVE: The positive metabolic outcome of Roux-en-Y Gastric Bypass (RYGB) surgery may involve Fibroblast Growth Factor 21 (FGF21), both in the fasting state and postprandially. We measured the fasting levels of FGF21 before and after bariatric surgery as well as the postprandial FGF21 responses...... of FGF21 response to a mixed meal may have important implications for the physiologic role of FGF21. The increase in postprandial FGF21 in response to glucose in the early post-operative period may contribute to the metabolic improvements observed after gastric bypass. This article is protected...

  20. Cirugía bariátrica laparoscópica: bypass gástrico proximal Laparoscopic bariatric surgery: proximal gastric bypass

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    F. Rotellar

    2005-01-01

    Full Text Available El espectacular aumento en la prevalencia de la obesidad en nuestra sociedad y las importantes complicaciones y comorbilidades que origina ha despertado el interés de científicos y público en esta patología. El tratamiento quirúrgico es en la actualidad el único tratamiento eficaz y duradero para la obesidad mórbida y en muchos casos, mejora sensiblemente e incluso cura definitivamente complicaciones asociadas como es el caso de la diabetes o la hipertensión. De entre las diversas técnicas de cirugía bariátrica, parece imponerse definitvamente el by-pass gástrico (BPG, al ofrecer un excelente balance entre pérdida de peso (70% del exceso y riesgo quirúrgico y calidad de vida posterior. La posiblidad de realizar esta técnica mediante un abordaje laparoscópico ha mejorado su aceptación por parte de médicos y pacientes al tiempo que ha permitido disminuir morbimortalidad, estancia y costes. El BPG proximal se realiza en aquellos pacientes con un IMC The spectacular increase in the prevalence of obesity in our society and the significant complications and comorbidities that it gives rise to have stimulated the interest of scientists and public in this pathology. Surgical treatment is at present the only efficient and lasting treatment for morbid obesity and in many cases it appreciably improves, and even definitively cures, associated complications such as the case of diabetes or hypertension. Amongst the different techniques of bariatric surgery, the gastric bypass (GBP seems to be definitively establishing itself, since it offers an excellent balance between loss of weight (70% of the excess, surgical risk and subsequent quality of life. The possibility of carrying out this technique employing a laparoscopic approach has improved its acceptance by doctors and patients while it has made it possible to reduce morbidity and mortality, length of hospital stay and costs. Proximal GBP is carried on those patients with an BMI <60 Kg

  1. Effect of Roux-en-Y gastric bypass surgery on intestinal Akkermansia muciniphila

    Science.gov (United States)

    Yan, Ming; Song, Mao-Min; Bai, Ri-Xing; Cheng, Shi; Yan, Wen-Mao

    2016-01-01

    AIM: To investigated changes in intestinal Akkermansia muciniphila (A. muciniphila) and explored the mechanism underlying the therapeutic effects of Roux-en-Y gastric bypass (RYGB) surgery on type 2 diabetes in diabetic Goto-Kakizaki (GK) rats. METHODS: Male diabetic GK rats (n = 12) aged 8 wk were randomly assigned to the surgery group (GK-RYGB) or sham surgery group (GK-Sham) (n = 6 per group), and another 6 male Wistar rats aged 8 wk served as controls (WS-Sham). In the surgery group, RYGB surgery was conducted, and a sham operation was performed in both sham groups. Fasting blood glucose (FBG) levels before and after surgery, fasting levels of serum insulin and serum glucagon-like peptide-1 (GLP-1) and levels 30 min after intragastric injection of glucose, and the amount of A. muciniphila in the stool were determined. Insulin and GLP-1 were measured by enzyme-linked immunosorbent assay, and A. muciniphila were detected by fluorescence-based quantitative polymerase chain reaction. RESULTS: The FBG was improved, and serum GLP-1 and insulin increased significantly (P < 0.05) in the GK-RYGB group after surgery compared to levels before surgery and to levels in the GK-Sham group. Before surgery, the amounts of A. muciniphila in the GK-RYGB and GK-Sham groups were significantly lower than in the WS-Sham group (P < 0.05). After surgery, the amount of A. muciniphila in the GK-RYGB group increased markedly compared to that before surgery and to that in the GK-Sham and WS-Sham groups (P < 0.05). In addition, the A. muciniphila amount was positively related to GLP-1 (r = 0.86, P < 0.05). CONCLUSION: Our results demonstrated RYGB surgery may increase GLP-1 secretion, elevate serum insulin after intragastric injection of glucose, and improve insulin resistance in diabetic GK rats, thereby contributing to a significant reduction in blood glucose. The increased amount of A. muciniphila after RYGB surgery may be related to elevated GLP-1 secretion. PMID:27152136

  2. Alterations in hypothalamic gene expression following Roux-en-Y gastric bypass

    Science.gov (United States)

    Barkholt, Pernille; Pedersen, Philip J.; Hay-Schmidt, Anders; Jelsing, Jacob; Hansen, Henrik H.; Vrang, Niels

    2016-01-01

    Objective The role of the central nervous system in mediating metabolic effects of Roux-en-Y gastric bypass (RYGB) surgery is poorly understood. Using a rat model of RYGB, we aimed to identify changes in gene expression of key hypothalamic neuropeptides known to be involved in the regulation of energy balance. Methods Lean male Sprague-Dawley rats underwent either RYGB or sham surgery. Body weight and food intake were monitored bi-weekly for 60 days post-surgery. In situ hybridization mRNA analysis of hypothalamic AgRP, NPY, CART, POMC and MCH was applied to RYGB and sham animals and compared with ad libitum fed and food-restricted rats. Furthermore, in situ hybridization mRNA analysis of dopaminergic transmission markers (TH and DAT) was applied in the midbrain. Results RYGB surgery significantly reduced body weight and intake of a highly palatable diet but increased chow consumption compared with sham operated controls. In the arcuate nucleus, RYGB surgery increased mRNA levels of orexigenic AgRP and NPY, whereas no change was observed in anorexigenic CART and POMC mRNA levels. A similar pattern was seen in food-restricted versus ad libitum fed rats. In contrast to a significant increase of orexigenic MCH mRNA levels in food-restricted animals, RYGB did not change MCH expression in the lateral hypothalamus. In the VTA, RYGB surgery induced a reduction in mRNA levels of TH and DAT, whereas no changes were observed in the substantia nigra relative to sham surgery. Conclusion RYGB surgery increases the mRNA levels of hunger-associated signaling markers in the rat arcuate nucleus without concomitantly increasing downstream MCH expression in the lateral hypothalamus, suggesting that RYGB surgery puts a brake on orexigenic hypothalamic output signals. In addition, down-regulation of midbrain TH and DAT expression suggests that altered dopaminergic activity also contributes to the reduced intake of palatable food in RYGB rats. PMID:27069869

  3. Gastric Bypass Promotes More Lipid Mobilization Than a Similar Weight Loss Induced by Low-Calorie Diet

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    Joel Kullberg

    2011-01-01

    Full Text Available Background. Recently, we found large reductions in visceral and subcutaneous fat one month after gastric bypass (GBP, without any change in liver fat content. Purpose. Firstly to characterize weight loss-induced lipid mobilization after one month with preoperative low-calorie diet (LCD and a subsequent month following GBP, and secondly, to discuss the observations with reference to our previous published findings after GBP intervention alone. Methods. 15 morbidly obese women were studied prior to LCD, at GBP, and one month after GBP. Effects on metabolism were measured by magnetic resonance techniques and blood tests. Results. Body weight was similarly reduced after both months (mean: −8.0 kg, n=13. Relative body fat changes were smaller after LCD than after GBP (−7.1±3.6% versus −10±3.2%, P=.029, n=13. Liver fat fell during the LCD month (−41%, P=.001, n=13 but was unaltered one month after GBP (+12%. Conclusion. Gastric bypass seems to cause a greater lipid mobilization than a comparable LCD-induced weight loss. One may speculate that GBP-altered gastrointestinal signalling sensitizes adipose tissue to lipolysis, promoting the changes observed.

  4. AGE AND GENDER MAY INFLUENCE THE RESULTS OF ROUX-EN-Y GASTRIC BYPASS? Metabolic syndrome parameters

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    Stephan Garcia ANDRADE-SILVA

    2014-09-01

    Full Text Available Context Severe obesity affects the body favoring the development of serious diseases, including hypertension, diabetes mellitus, atherosclerosis and non alcoholic fatty liver disease. Bariatric procedures increased in Brazil in the last decade. Objectives The purpose of this study was to verify if gender and age in date of procedure resulted significant differences in metabolic syndrome parameters after surgery. Methods The study involved 205 medical records of adult patients undergoing Roux-en-Y gastric bypass, stratified by gender and age groups and followed one year by a multidisciplinary team. Results It was observed significant decrease in body mass index, fasting glucose and insulin at all ages and both genders. Lipid profile showed significant improvements except high density lipoprotein cholesterol. Ectopic fat in the liver has decreased after 6 months in patients classified with steatosis at baseline. Patients classified as hypertensive blood pressure levels decreased 6 months after surgical intervention. Conclusions Roux-en-Y gastric bypass proved to be an important tool in remission of metabolic syndrome parameters. The reduction of body mass accompanied to decrease in insulin resistance resulted in lower prevalence of comorbidities associated with obesity. The benefits were similar and extended both genders and all age groups between 18 and 65 years old.

  5. Early dumping syndrome is not a complication but a desirable feature of Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Laurenius, A; Engström, M

    2016-10-01

    Early dumping syndrome after gastric bypass surgery due to rapid delivery of hyperosmolar nutrients into the bowel causing intense symptoms is often described as a complication. Twelve patients, mean age 47 years, were interviewed approximately 9 years post-operation. The interviews were audiotaped and transcribed verbatim, followed by an inductive content analysis to reveal patients' experience of the dumping syndrome. The core category 'Dumping syndrome is a positive consequence of Roux-en-Y gastric bypass surgery and a tool to control food intake' was identified based on the following four sub-categories: (i) 'The multidimensional emergence and effects of dumping syndrome', (ii) 'Dumping syndrome as something positive although unpleasant', (iii) 'Developing coping mechanisms and ingenious strategies' and (iv) 'My own fault if I expose myself to dumping syndrome'. From the patients' perspective, dumping syndrome gives control over food intake; although the symptoms were unpleasant, patients considered dumping syndrome as a positive protection against over-consumption. Hence, healthcare professionals should not present dumping syndrome as a complication but rather as an aid to control eating behaviour and excessive food intake.

  6. Biodistribution of technetium-{sup 99m} pertechnetate after Roux-en-Y gastric bypass (Capella technique) in rats

    Energy Technology Data Exchange (ETDEWEB)

    Rego, Amalia Cinthia Meneses do; Jacome, Daniel Torres; Ramalho, Rachel de Alcantara Oliveira [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil); Araujo-Filho, Irami; Azevedo, Italo Medeiros; Medeiros, Aldo Cunha, E-mail: aldo@ufrnet.b [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Dept. of Surgery

    2010-01-15

    Purpose: The biodistribution of sodium pertechnetate, the most used radiopharmaceutical in nuclear medicine, has not been studied in details after bariatric surgery. The objective was to investigate the effect of Roux-en-Y gastric bypass (RYGB) on biodistribution of sodium pertechnetate (Na{sup 99m}Tc-) in organs and tissues of rats. Methods: Twelve rats were randomly divided into two groups of 6 animals each. The RYGB group rats were submitted to the Roux-en-Y gastric bypass and the control group rats were not operated. After 15 days, all rats were injected with 0.1mL of Na{sup 99m}Tc- via orbital plexus with average radioactivity of 0.66 MBq. After 30 minutes, liver, stomach, thyroid, heart, lung, kidney and femur samples were harvested, weighed and percentage of radioactivity per gram (%ATI/g) of each organ was determined by gamma counter Wizard Perkin-Elmer. We applied the Student t test for statistical analysis, considering p<0.05 as significant. Results: Significant reduction in mean %ATI/g was observed in the liver, stomach and femur in the RYGB group animals, compared with the control group rats (p<0.05). In other organs no significant difference in %ATI/g was observed between the two groups. Conclusion: This work contributes to the knowledge that the bariatric surgery RYGB modifies the pattern of biodistribution of Na{sup 99m}Tc{sup -}. (author)

  7. Application of side-to-side anastomosis of the lesser curvature of stomach and jejunum in gastric bypass

    Science.gov (United States)

    Bai, Ri-Xing; Yan, Wen-Mao; Li, You-Guo; Xu, Jun; Zhong, Zhi-Qiang; Yan, Ming

    2016-01-01

    AIM To evaluate the feasibility of side-to-side anastomosis of the lesser curvature of stomach and jejunum in laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS Seventy-seven patients received side-to-side anastomosis of the lesser curvature of stomach and jejunum by utilization of linear stapler in LRYGB from April 2012 to July 2015 were retrospectively analyzed. RESULTS All patients were successfully completed laparoscopic gastric bypass with the side-to-side anastomosis of the lesser curvature of stomach and jejunum. No patient was switched to laparotomy during operation. No early complications including gastrointestinal anastomotic bleeding, fistula, obstruction, deep vein thrombosis, incision infections, intra-abdominal hernia complications were found. One patient complicated with stricture of gastrojejunal anastomosis (1.3%) and six patients complicated with incomplete intestinal obstruction (7.8%). BMI and HbA1c determined at 3, 6, 12, 24 mo during follow up period were significantly reduced compared with preoperative baselines respectively. The percentage of patients who maintain HbA1c (%) < 6.5% without taking antidiabetic drugs reached to 61.0%, 63.6%, 75.0%, and 63.6% respectively. The outcome parameters of concomitant diseases were significantly improved too. CONCLUSION Present surgery is a safety and feasibility procedure. It is effective to lighten the body weight of patients and improve type 2 diabetes and related complications. PMID:27729746

  8. Resveratrol: Anti-Obesity Mechanisms of Action

    Directory of Open Access Journals (Sweden)

    Leixuri Aguirre

    2014-11-01

    Full Text Available Resveratrol is a non-flavonoid polyphenol which belongs to the stilbenes group and is produced naturally in several plants in response to injury or fungal attack. Resveratrol has been recently reported as preventing obesity. The present review aims to compile the evidence concerning the potential mechanisms of action which underlie the anti-obesity effects of resveratrol, obtained either in cultured cells lines and animal models. Published studies demonstrate that resveratrol has an anti-adipogenic effect. A good consensus concerning the involvement of a down-regulation of C/EBPα and PPARγ in this effect has been reached. Also, in vitro studies have demonstrated that resveratrol can increase apoptosis in mature adipocytes. Furthermore, different metabolic pathways involved in triacylglycerol metabolism in white adipose tissue have been shown to be targets for resveratrol. Both the inhibition of de novo lipogenesis and adipose tissue fatty acid uptake mediated by lipoprotein lipase play a role in explaining the reduction in body fat which resveratrol induces. As far as lipolysis is concerned, although this compound per se seems to be unable to induce lipolysis, it increases lipid mobilization stimulated by β-adrenergic agents. The increase in brown adipose tissue thermogenesis, and consequently the associated energy dissipation, can contribute to explaining the body-fat lowering effect of resveratrol. In addition to its effects on adipose tissue, resveratrol can also acts on other organs and tissues. Thus, it increases mitochondriogenesis and consequently fatty acid oxidation in skeletal muscle and liver. This effect can also contribute to the body-fat lowering effect of this molecule.

  9. The Effect of Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients on Pharmacokinetics of (Acetyl)Salicylic Acid and Omeprazole : the ERY-PAO Study

    NARCIS (Netherlands)

    Mitrov-Winkelmolen, Lieke; van Buul-Gast, Marie-Christine W; Swank, Dingeman J; Overdiek, Hans W P M; van Schaik, Ron H N; Touw, Daan J

    2016-01-01

    BACKGROUND: Data on the absorption of orally administered drugs following Roux-en-Y gastric bypass (RYGB) surgery in obese patients are limited and inconclusive. As it is difficult to predict changes in absorption, studies on frequently used drugs in this population are necessary. Acetylsalicylic ac

  10. No Islet Cell Hyperfunction, but Altered Gut-Islet Regulation and Postprandial Hypoglycemia in Glucose-Tolerant Patients 3 Years After Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Dirksen, Carsten; Eiken, Aleksander; Bojsen-Møller, Kirstine N;

    2016-01-01

    Postprandial hyperinsulinemia characterizes Roux-en-Y gastric bypass (RYGB) and sometimes leads to reactive hypoglycemia. We prospectively evaluated changes in beta cell function in seven RYGB-operated patients with a median follow-up of 2.9 years with hyperglycemic clamps and oral glucose...

  11. Effect of Roux-en-Y gastric bypass on the distribution and hormone expression of small-intestinal enteroendocrine cells in obese patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Rhee, Nicolai A; Wahlgren, Camilla D; Pedersen, Jens;

    2015-01-01

    AIMS/HYPOTHESIS: We studied the impact of Roux-en-Y gastric bypass (RYGB) on the density and hormonal gene expression of small-intestinal enteroendocrine cells in obese patients with type 2 diabetes. METHODS: Twelve patients with diabetes and 11 age- and BMI-matched controls underwent RYGB followed...

  12. The Effect of Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients on Pharmacokinetics of (Acetyl)Salicylic Acid and Omeprazole: the ERY-PAO Study

    NARCIS (Netherlands)

    Mitrov-Winkelmolen, Lieke; van Buul-Gast, Marie Christine W; Swank, Dingeman J.; Overdiek, Hans W P M; van Schaik, Ron H N; Touw, Daan J.

    2016-01-01

    Background Data on the absorption of orally administered drugs following Roux-en-Y gastric bypass (RYGB) surgery in obese patients are limited and inconclusive. As it is difficult to predict changes in absorption, studies on frequently used drugs in this population are necessary. Acetylsalicylic aci

  13. Preoperative β-cell function in patients with type 2 diabetes is important for the outcome of Roux-en-Y gastric bypass surgery

    DEFF Research Database (Denmark)

    Lund, Michael Taulo; Hansen, Merethe; Skaaby, Stinna;

    2015-01-01

    INTRODUCTION: A major part of the patients with type 2 diabetes (T2DM) show remission after Roux-en-Y gastric bypass (RYGB). This is the result of increased postoperative insulin sensitivity and β-cell secretion. The aim of the present study was to elucidate the importance of the preoperative β...

  14. Carotid intima-media thickness is reduced 12 months after gastric bypass surgery in obese patients with type 2 diabetes or impaired glucose tolerance

    DEFF Research Database (Denmark)

    Lundby-Christensen, Louise; Tarnow, Lise; Hansen, Dorte L;

    2014-01-01

    AIM: To investigate whether Roux-en-Y gastric bypass surgery (RYGB) - an in vivo model for normalisation of hyperglycaemia - improves carotid intima-media thickness (IMT) in patients with type 2 diabetes (T2D)/impaired glucose tolerance (IGT) and normal glucose tolerance (NGT). METHODS...

  15. Acute and long-term effects of Roux-en-Y gastric bypass on glucose metabolism in subjects with Type 2 diabetes and normal glucose tolerance

    DEFF Research Database (Denmark)

    Jørgensen, N B; Jacobsen, S H; Dirksen, C;

    2012-01-01

    Our aim was to study the potential mechanisms responsible for the improvement in glucose control in Type 2 diabetes (T2D) within days after Roux-en-Y gastric bypass (RYGB). Thirteen obese subjects with T2D and twelve matched subjects with normal glucose tolerance (NGT) were examined during a liquid...

  16. Changes in Gastrointestinal Hormone Responses, Insulin Sensitivity, and Beta-Cell Function Within 2 Weeks After Gastric Bypass in Non-diabetic Subjects

    DEFF Research Database (Denmark)

    Jacobsen, S H; Olesen, S C; Dirksen, C;

    2012-01-01

    Roux-en-Y gastric bypass (RYGB) surgery causes profound changes in secretion of gastrointestinal hormones and glucose metabolism. We present a detailed analysis of the early hormone changes after RYGB in response to three different oral test meals designed to provide this information without...

  17. Changes in Glucose Homeostasis after Roux-en-Y Gastric Bypass Surgery for Obesity at Day Three, Two Months, and One Year after Surgery

    DEFF Research Database (Denmark)

    Falkén, Y; Hellström, P M; Holst, Jens Juul;

    2011-01-01

    Context: Endocrine effects of gastric bypass (GBP) surgery for obesity on glucose homeostasis are not fully understood. Main Objective: The main objective of the study was to assess the changes in plasma glucose, insulin, glucagon-like peptide-1 (GLP-1), leptin, somatostatin, glucose...

  18. Peptide YY and glucagon-like peptide-1 contribute to decreased food intake after Roux-en-Y gastric bypass surgery

    DEFF Research Database (Denmark)

    Svane, M S; Jørgensen, N B; Bojsen-Møller, K N;

    2016-01-01

    BACKGROUND/OBJECTIVES: Exaggerated postprandial secretion of glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) may explain appetite reduction and weight loss after Roux-en-Y gastric bypass (RYGB), but causality has not been established. We hypothesized that food intake decreases after surgery...

  19. The Effect of Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients on Pharmacokinetics of (Acetyl)Salicylic Acid and Omeprazole : the ERY-PAO Study

    NARCIS (Netherlands)

    Mitrov-Winkelmolen, Lieke; van Buul-Gast, Marie-Christine W.; Swank, Dingeman J.; Overdiek, Hans W. P. M.; van Schaik, Ron H. N.; Touw, Daan J.

    2016-01-01

    Data on the absorption of orally administered drugs following Roux-en-Y gastric bypass (RYGB) surgery in obese patients are limited and inconclusive. As it is difficult to predict changes in absorption, studies on frequently used drugs in this population are necessary. Acetylsalicylic acid (ASA) and

  20. Roux-en-Y gastric bypass surgery of morbidly obese patients induces swift and persistent changes of the individual gut microbiota

    DEFF Research Database (Denmark)

    Palleja, Albert; Kashani, Alireza; Allin, Kristine Højgaard;

    2016-01-01

    BACKGROUND: Roux-en-Y gastric bypass (RYGB) is an effective means to achieve sustained weight loss for morbidly obese individuals. Besides rapid weight reduction, patients achieve major improvements of insulin sensitivity and glucose homeostasis. Dysbiosis of gut microbiota has been associated...

  1. Gut hormones, early dumping and resting energy expenditure in patients with good and poor weight loss response after Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Dirksen, C; Jørgensen, N B; Bojsen-Møller, K N;

    2013-01-01

    Objective:To identify factors contributing to the variation in weight loss after Roux-en-Y gastric bypass (RYGB).Design:Cross-sectional study of patients with good (excess body mass index lost (EBL) >60%) and poor weight loss response (EBL 12 months after RYGB and a lean control group matched...

  2. Immediate enhancement of first-phase insulin secretion and unchanged glucose effectiveness in patients with type 2 diabetes after Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Martinussen, Christoffer; Bojsen-Moller, Kirstine N; Dirksen, Carsten;

    2015-01-01

    Roux-en-Y gastric bypass surgery (RYGB) in patients with type 2 diabetes often leads to early disease remission, and it is unknown to what extent this involves improved pancreatic β-cell function per se and/or enhanced insulin- and non-insulin-mediated glucose disposal (glucose effectiveness). We...

  3. Roux-en-Y Gastric Bypass and Vertical Banded Gastroplasty Induce Long-Term Changes on the Human Gut Microbiome Contributing to Fat Mass Regulation

    DEFF Research Database (Denmark)

    Tremaroli, Valentina; Karlsson, Fredrik; Werling, Malin;

    2015-01-01

    Bariatric surgery is currently the most effective procedure for the treatment of obesity. Given the role of the gut microbiota in regulating host metabolism and adiposity, we investigated the long-term effects of bariatric surgery on the microbiome of patients randomized to Roux-en-Y gastric bypass...

  4. Improvements in glucose metabolism early after gastric bypass surgery are not explained by increases in total bile acids and fibroblast growth factor 19 concentrations

    DEFF Research Database (Denmark)

    Jørgensen, Nils B; Dirksen, Carsten; Bojsen-Møller, Kirstine N;

    2015-01-01

    Context: Bile acids and fibroblast growth factor 19 (FGF19) have been suggested as key mediators of the improvements in glucose metabolism after Roux-en-Y gastric bypass (RYGB). Objective: To describe fasting and postprandial state total bile acid (TBA) and FGF19 concentrations before and after...

  5. Exaggerated release and preserved insulinotropic action of glucagon-like peptide-1 underlie insulin hypersecretion in glucose-tolerant individuals after Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Dirksen, Carsten; Bojsen-Møller, Kirstine N; Jørgensen, Nils Bruun;

    2013-01-01

    Roux-en-Y gastric bypass (RYGB) improves glycaemic control in part by increasing postprandial insulin secretion through exaggerated glucagon-like peptide (GLP)-1 release. However, it is unknown whether islet cell responsiveness to i.v. glucose, non-glucose (arginine) and incretin hormones...

  6. The Use of Gastrostomy Tube for the Long-Term Remission of Hyperinsulinemic Hypoglycemia After Roux-en-y Gastric Bypass

    DEFF Research Database (Denmark)

    Craig, CM; Lamendola, C; Holst, Jens Juul;

    2015-01-01

    Objective: Hyperinsulinemic hypoglycemia is an increasingly reported complication of Roux-en-Y gastric bypass surgery (RYGB), for which there is currently no acceptable treatment. We present a case of the reversal of severe hyperinsulinemic hypoglycemia through gastrostomy tube (GT) feeding...

  7. Gastrojejunal Anastomosis Perforation after Gastric Bypass on a Patient with Underlying Pancreatic Cancer: A Case Report and Review of the Literature.

    Science.gov (United States)

    Bellorin, Omar; Kundel, Anna; Ramirez-Valderrama, Alexander; Castro, Armando

    2015-01-01

    Introduction. We describe a case of gastrojejunal anastomosis perforation after gastric bypass on a patient with underlying pancreatic cancer. Case Description. A 54-year-old female with past surgical history of gastric bypass for morbid obesity and recent diagnosis of unresectable pancreatic cancer presents with abdominal pain, peritonitis, and sepsis. Computerized axial tomography scan shows large amount of intraperitoneal free air. The gastric remnant is markedly distended and a large pancreatic head mass is seen. Intraoperative findings were consistent with a perforated ulcer located at the gastrojejunal anastomosis and a distended gastric remnant caused by a pancreatic mass invading and obstructing the second portion of the duodenum. The gastrojejunal perforation was repaired using an omental patch. A gastrostomy for decompression of the remnant was also performed. The patient had a satisfactory postoperative period and was discharged on day 7. Discussion. Perforation of the gastrojejunal anastomosis after Roux-en-Y gastric bypass is an unusual complication. There is no correlation between the perforation and the presence of pancreatic cancer. They represent two different conditions that coexisted. The presence of a gastrojejunal perforation made the surgeon aware of the advanced stage of the pancreatic cancer.

  8. Gastrojejunal Anastomosis Perforation after Gastric Bypass on a Patient with Underlying Pancreatic Cancer: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Omar Bellorin

    2015-01-01

    Full Text Available Introduction. We describe a case of gastrojejunal anastomosis perforation after gastric bypass on a patient with underlying pancreatic cancer. Case Description. A 54-year-old female with past surgical history of gastric bypass for morbid obesity and recent diagnosis of unresectable pancreatic cancer presents with abdominal pain, peritonitis, and sepsis. Computerized axial tomography scan shows large amount of intraperitoneal free air. The gastric remnant is markedly distended and a large pancreatic head mass is seen. Intraoperative findings were consistent with a perforated ulcer located at the gastrojejunal anastomosis and a distended gastric remnant caused by a pancreatic mass invading and obstructing the second portion of the duodenum. The gastrojejunal perforation was repaired using an omental patch. A gastrostomy for decompression of the remnant was also performed. The patient had a satisfactory postoperative period and was discharged on day 7. Discussion. Perforation of the gastrojejunal anastomosis after Roux-en-Y gastric bypass is an unusual complication. There is no correlation between the perforation and the presence of pancreatic cancer. They represent two different conditions that coexisted. The presence of a gastrojejunal perforation made the surgeon aware of the advanced stage of the pancreatic cancer.

  9. Roux-en-Y gastric bypass and bone metabolism%胃旁路术与骨代谢

    Institute of Scientific and Technical Information of China (English)

    朱紫薇; 金晖

    2011-01-01

    肥胖症在世界范围内的发病率逐渐升高,胃旁路术是近年来减肥手术的主要方法之一.手术成功减肥后,骨代谢指标以及骨质量的变化正日益受到重视.术后患者体内钙、维生素D的缺乏引发了PTH升高与BMD下降,PTH升高可引起继发性甲状旁腺功能亢进,骨生成尤其是骨吸收活跃,严重者可导致骨质疏松症.胃旁路术后患者体内脂肪组织减少,导致瘦素产生减少、脂联素产生增加,进而引起骨密度下降.术后补充一定量钙及维生素D可部分纠正二者的缺乏,但具体剂量尚不清楚.定期检测患者体内PTH、Ca、Vit D、骨转换指标、监测骨密度变化等有利于了解胃旁路术对骨代谢的长期影响.%With the increasing prevalence of obesity, Roux-en-Y gastric bypass has become one of the major bariatric surgeries in recent years. More attention has been paid in the changes of bone metabolic markers and bone mass after the successful surgery for weight reduction. After the surgery, the deficiency of calcium and vitamin D (Vit D) can lead to a increase of the parathyroid hormone ( PTH ) and decrease of the bone marrow density (BMD). The increase of PTH can cause the secondary hyperparathyroidism, which activates bone formation and especially bone resorption, resulting in osteoporosis in severe cases. Because of the reduction of the adipose tissue in patients with gastric bypass, the leptin production decreases and the adiponectin production increases, resulting in the decrease of BMD. Postoperative supplementation of calcium and vitamin D can partially correct of the insufficiency, however, the specific doses are unknown.Periodic follow-up of PTH, calcium, serum Vit D, markers of bone turnover, and the change of BMD can help us understand the long-term effect of gastric bypass on bone metabolism.

  10. Changes in problematic and disordered eating after gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy: a systematic review of pre-post studies.

    Science.gov (United States)

    Opozda, M; Chur-Hansen, A; Wittert, G

    2016-08-01

    Despite differences in their mechanisms and outcomes, little is known about whether postsurgical changes in eating behaviours also differ by bariatric procedure. Following a systematic search, 23 studies on changes in binge eating disorder (BED) and related behaviours, bulimia nervosa and related behaviours, night eating syndrome, grazing and emotional eating after Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB) and vertical sleeve gastrectomy (VSG) were reviewed. Significant methodological problems and a dearth of literature regarding many behaviours and VSG were seen. Regarding BED and related behaviours, although later re-increases were noted, short to medium-term reductions after RYGB were common, and reported changes after AGB were inconsistent. Short to medium-term reductions in emotional eating, and from a few studies, short to long-term reductions in bulimic symptoms, were reported after RYGB. Reoccurrences and new occurrences of problem and disordered eating, especially BED and binge episodes, were apparent after RYGB and AGB. Further conclusions and comparisons could not be made because of limited or low-quality evidence. Long-term comparison studies of changes to problematic and disordered eating in RYGB, AGB and VSG patients are needed. It is currently unclear whether any bariatric procedure leads to long-term improvement of any problematic or disordered eating behaviours. PMID:27296934

  11. Incidental oesophageal leiomyoma during laparoscopic Roux-en-Y gastric bypass: finding the unexpected does not affect outcomes.

    Science.gov (United States)

    Jain, Mishank; Atherton, Laura; Acharya, Vikas; Sengupta, Neel; Barreca, Marco

    2015-01-01

    Most bariatric procedures are now performed laparoscopically. Here, we describe a case of incidental oesophageal leiomyoma found during laparoscopic Roux-en-Y gastric bypass (LRYGB). To our knowledge, this is the first such case reported. Our patient was admitted for an elective LRYGB. She had no upper gastrointestinal symptoms, and therefore did not undergo preoperative oesophagogastroduodenoscopy (OGD). During surgery, a hiatus hernia and an incidental oesophageal leiomyoma were found and treated with hernia repair and enucleation. The end outcome was unaffected. We were able to concomitantly treat the unexpected finding of an oesophageal leiomyoma and a hiatus hernia during the LRYGB. The routine use of OGD prior to bariatric surgery is still controversial. While surgeons should be prepared for unexpected pathologies, when performing laparoscopic bariatric surgery, a routine OGD prior to LRYGB is probably not necessary in asymptomatic patients. Laparoscopic enucleation of oesophageal leiomyoma during LRYGB is feasible and safe. PMID:25994827

  12. Acute small bowel obstruction due to a large intraluminal blood clot after laparoscopic Roux-en-Y gastric bypass.

    Science.gov (United States)

    Green, Jessica; Ikuine, Tomoko; Hacker, Shoshana; Urrego, Hernan; Tuggle, Karleena

    2016-01-01

    Small bowel obstructions (SBOs) are a known perioperative complication of laparoscopic Roux-en-Y gastric bypass and common etiologies include internal hernia, port site hernia, jejunojejunostomy stricture, ileus and adhesions. Less commonly, SBO can be caused by superior mesenteric artery syndrome, intussusception and intraluminal blood clot. We present a case of SBO caused by intraluminal blood clot from jejunojejunostomy staple line bleeding in a patient with a normal coagulation profile. Computed tomography was used to elucidate the cause of perioperative SBO, and diagnostic laparoscopy was used to both diagnose and treat the complication. In this case, the intraluminal clot was evacuated laparoscopically by enterotomy, thrombectomy and primary closure without anastomotic revision since there was no evidence of continued bleeding. Administration of enoxaparin and Toradol post-operatively may have exacerbated mild intraluminal bleeding occurring at the stapled jejunojejunal anastomosis. Prompt recognition and treatment of perioperative SBO can prevent catastrophic consequences related to bowel perforation. PMID:27554828

  13. Acute small bowel obstruction due to a large intraluminal blood clot after laparoscopic Roux-en-Y gastric bypass

    Science.gov (United States)

    Green, Jessica; Ikuine, Tomoko; Hacker, Shoshana; Urrego, Hernan; Tuggle, Karleena

    2016-01-01

    Small bowel obstructions (SBOs) are a known perioperative complication of laparoscopic Roux-en-Y gastric bypass and common etiologies include internal hernia, port site hernia, jejunojejunostomy stricture, ileus and adhesions. Less commonly, SBO can be caused by superior mesenteric artery syndrome, intussusception and intraluminal blood clot. We present a case of SBO caused by intraluminal blood clot from jejunojejunostomy staple line bleeding in a patient with a normal coagulation profile. Computed tomography was used to elucidate the cause of perioperative SBO, and diagnostic laparoscopy was used to both diagnose and treat the complication. In this case, the intraluminal clot was evacuated laparoscopically by enterotomy, thrombectomy and primary closure without anastomotic revision since there was no evidence of continued bleeding. Administration of enoxaparin and Toradol post-operatively may have exacerbated mild intraluminal bleeding occurring at the stapled jejunojejunal anastomosis. Prompt recognition and treatment of perioperative SBO can prevent catastrophic consequences related to bowel perforation. PMID:27554828

  14. Omental Torsion after Laparoscopic Roux-en-Y Gastric Bypass Mimicking Appendicitis: A Case Report and Review of the Literature

    Science.gov (United States)

    Basilicata, Giacinto; Nocito, Antonio

    2016-01-01

    Introduction. Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a common procedure in obesity surgery. The aim of an antecolic approach is to reduce the rate of internal herniation. Our aim is to make bariatric surgeons aware of another possible complication of antecolic LRYGBP. Methods and Results. We present a case report of omental torsion 24 months after antecolic LRYGBP presenting as an acute abdomen, suggesting appendicitis. During diagnostic laparoscopy, omental infarction due to torsion was observed. Resection of the avital omentum was performed. Discussion. Omental torsion after antecolic LRYGBP is a rare complication. When appearing in the early postoperative phase, it may mimic an anastomotic leakage. It may also occur as late complication, presenting with acute abdomen as an appendicitis. PMID:27019758

  15. Altered ghrelin secretion in mice in response to diet-induced obesity and Roux-en-Y gastric bypass

    Directory of Open Access Journals (Sweden)

    Aki Uchida

    2014-10-01

    Full Text Available The current study examined potential mechanisms for altered circulating ghrelin levels observed in diet-induced obesity (DIO and following weight loss resulting from Roux-en-Y gastric bypass (RYGB. We hypothesized that circulating ghrelin levels were altered in obesity and after weight loss through changes in ghrelin cell responsiveness to physiological cues. We confirmed lower ghrelin levels in DIO mice and demonstrated elevated ghrelin levels in mice 6 weeks post-RYGB. In both DIO and RYGB settings, these changes in ghrelin levels were associated with altered ghrelin cell responsiveness to two key physiological modulators of ghrelin secretion – glucose and norepinephrine. In DIO mice, increases in ghrelin cell density within both the stomach and duodenum and in somatostatin-immunoreactive D cell density in the duodenum were observed. Our findings provide new insights into the regulation of ghrelin secretion and its relation to circulating ghrelin within the contexts of obesity and weight loss.

  16. Simultaneous occurrence of metabolic, hematologic, neurologic and cardiac complications after Roux-en-Y gastric bypass for morbid obesity.

    Science.gov (United States)

    Kara, Merve; Gundogdu, Yasemin; Karsli, Merve; Ozben, Volkan; Onder, Fatih Oguz; Baca, Bilgi

    2016-10-01

    Roux-en-Y gastric bypass (RYGB) is a commonly performed procedure in the surgical treatment of morbid obesity. Since a major anatomical alteration is made, this procedure may lead to significant postoperative complications, including nutritional deficiencies related to malabsorption. As a consequence of micronutrient deficiencies, secondary metabolic, hematologic and neurologic complications might also develop. Each of these complications is well reported in the literature; however, there are limited data on the simultaneous occurrence of these complications in a single patient. In this report, we aimed to present the diagnosis and management of metabolic, hematologic, neurologic and cardiac complications, which occurred simultaneously in a 57-year-old female patient after undergoing laparoscopic RYGB procedure.

  17. Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass

    Directory of Open Access Journals (Sweden)

    Wasmuth Hermann E

    2011-06-01

    Full Text Available Abstract Background Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage. Case presentation In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient. Conclusion Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

  18. Metabolite profiling identifies candidate markers reflecting the clinical adaptations associated with Roux-en-Y gastric bypass surgery.

    Directory of Open Access Journals (Sweden)

    David M Mutch

    Full Text Available BACKGROUND: Roux-en-Y gastric bypass (RYGB surgery is associated with weight loss, improved insulin sensitivity and glucose homeostasis, and a reduction in co-morbidities such as diabetes and coronary heart disease. To generate further insight into the numerous metabolic adaptations associated with RYGB surgery, we profiled serum metabolites before and after gastric bypass surgery and integrated metabolite changes with clinical data. METHODOLOGY AND PRINCIPAL FINDINGS: Serum metabolites were detected by gas and liquid chromatography-coupled mass spectrometry before, and 3 and 6 months after RYGB in morbidly obese female subjects (n = 14; BMI = 46.2+/-1.7. Subjects showed decreases in weight-related parameters and improvements in insulin sensitivity post surgery. The abundance of 48% (83 of 172 of the measured metabolites changed significantly within the first 3 months post RYGB (p<0.05, including sphingosines, unsaturated fatty acids, and branched chain amino acids. Dividing subjects into obese (n = 9 and obese/diabetic (n = 5 groups identified 8 metabolites that differed consistently at all time points and whose serum levels changed following RYGB: asparagine, lysophosphatidylcholine (C18:2, nervonic (C24:1 acid, p-Cresol sulfate, lactate, lycopene, glucose, and mannose. Changes in the aforementioned metabolites were integrated with clinical data for body mass index (BMI and estimates for insulin resistance (HOMA-IR. Of these, nervonic acid was significantly and negatively correlated with HOMA-IR (p = 0.001, R = -0.55. CONCLUSIONS: Global metabolite profiling in morbidly obese subjects after RYGB has provided new information regarding the considerable metabolic alterations associated with this surgical procedure. Integrating clinical measurements with metabolomics data is capable of identifying markers that reflect the metabolic adaptations following RYGB.

  19. Improvement of C peptide zero BMI 24-34 diabetic patients after tailored one anastomosis gastric bypass (BAGUA

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    M. Garcia-Caballero

    2013-01-01

    Full Text Available Background: Although bariatric surgery proved to be a very effective method in the treatment of patients in whose pancreas still produce insulin (type 2 diabetes, the accompanied metabolic syndrome and their diabetes complications, there is no information on the effect of this type of surgery in BMI24-34 patients when pancreas do not produce insulin at all (type 1, LADA and long term evolution type 2 diabetes among others. Patients and methods: We report preliminary data of a serie of 11 patients all with a C-peptide values below 0.0 ng/ml. They were followed for 6 to 60 months (mean 19 months after surgery. We studied the changes in glycemic control, evolution of the metabolic syndrome and diabetes complications after one anastomosis gastric bypass (BAGUA. Results: All values relative to glycemic control were improved HbA1c (from 8.9 ± 0.6 to 6.7 ± 0.2%, FPG (Fasting Plasma Glucose [from 222.36 ± 16.87 to 94 ± 5 (mg/dl] as well as the daily insulin requirement of rapid (from 40.6 ± 12.8 to 0 (U/d and long-lasting insulin (from 41.27 ± 7.3 U/day to 15.2 ± 3.3 U/day. It resolved 100% of the metabolic syndrome diseases as well as severe hypoglycaemia episodes present before surgery and improved some serious complications from diabetes like retinopathy, nephropathy, neuropathy, peripheral vasculopathy and cardiopathy. Conclusions: Tailored one anastomosis gastric bypass in BMI 24-34 C peptide zero diabetic patients eliminated the use of rapid insulin, reduced to only one injection per day long-lasting insulin and improved the glycemic control. After surgery disappear metabolic syndrome and severe hypoglycaemia episodes and improves significantly retinopathy, neuropathy, nephropathy, peripheral vasculopathy and cardiopathy.

  20. Ischemic colitis after mesotherapy combined with anti-obesity medications

    Institute of Scientific and Technical Information of China (English)

    Jong; Bin; Kim; Won; Moon; Seun; Ja; Park; Moo; In; Park; Kyu-Jong; Kim; Jae; Nam; Lee; Seong; Joo; Kang; Lee; La; Jang; Hee; Kyung; Chang

    2010-01-01

    Mesotherapy and anti-obesity medications are gradually gaining worldwide popularity for purposes of body contouring and weight loss.Their adverse effects are various,but there is a tendency to disregard them.Ischemic colitis is one of the most common diseases associated with non-obstructive blood vessel disorders.However,there have been no case reports about the adverse effects resulting from mesotherapy only or in combination with anti-obesity medications.We report on an interesting case of ischemic coliti...

  1. A novel technique of Roux-en-Y gastric bypass reversal for postprandial hyperinsulinemic hypoglycaemia: A case report

    Science.gov (United States)

    Qvigstad, E.; Gulseth, H.L.; Risstad, H.; le Roux, C.W.; Berg, T.J.; Mala, T.; Kristinsson, J.A.

    2016-01-01

    Background We describe an evaluation of the effects of partial Roux-en-Y gastric bypass (RYGB) reversal on postprandial hyperinsulinaemic hypoglycaemia, insulin and GLP-1 levels. Case summary A 37 year old man was admitted with neuroglycopenia (plasma–glucose 1.6 mmol/l) 18 months after RYGB, with normal 72 h fasting test and abdominal CT. Despite dietary modifications and medical treatment, the hypoglycaemic episodes escalated in frequency. Feeding by a gastrostomy tube positioned in the gastric remnant did not prevent severe episodes of hypoglycaemia. A modified reversal of the RYGB was performed. Mixed meal tests were done perorally (PO), through the gastrostomy tube 1 (GT1), 4 weeks (GT2) after placement and 4 weeks after reversal (POr), with assessment of glucose, insulin and GLP-1 levels. Results Plasma–glucose increased to a maximum of 9.6, 5.4, 6.5 and 5.8 mmol/l at the PO, GT1, GT2 and POr tests respectively. The corresponding insulin levels were 2939, 731, 725 and 463 pmol/l. A decrease of plasma–glucose followed: 2.2, 3.0, 3.9 and 2.9 mmol/l respectively and insulin levels were suppressed at 150 min: 45, 22, 21 and 14 pmol/l, respectively. GLP-1 levels increased in the PO test (60 min: 122 pmol/l, 21 fold of basal), but was attenuated in the two latter tests (12–23 pmol/l at 60 min). Conclusions Reduction of plasma–glucose, insulin and GLP-1 excursions and symptoms were seen after gastric tube placement and partial RYGB reversal. This attenuation of GLP-1 response to feeding could reflect an adaptation to nutrients. PMID:26957187

  2. Laparoscopic adjustable banded roux-en-y gastric bypass as a primary procedure for the super-super-obese (body mass index > 60 kg/m2

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    Van Dessel Els

    2010-11-01

    Full Text Available Abstract Background Currently, there is no consensus opinion regarding the optimal procedure of choice in super-super-morbid obesity (Body mass index, BMI > 60 kg/m2. Roux-en-Y gastric bypass (RYGB is associated with failure to achieve or maintain 50% excess weight loss (EWL or BMI 35 following RYGB surgery in this group. The addition of adjustable gastric band (AGB to RYGB has been reported as a revisional procedure but this combined bariatric procedure has not been explored as a primary operation. Methods In a primary laparoscopic RYGB, an AGB is drawn around the gastric pouch through a small opening between the blood vessels on the lesser curve and the gastric pouch. The band is then fixed by suturing the gastric remnant to the gastric pouch both above and below the band to prevent slippage. Results Between November 2009 and March 2010, 6 consecutive super-super-obese patients underwent a primary laparoscopic adjustable banded Roux-en-Y gastric bypass procedure at our institution. One male patient (21 years, BMI 70 kg/m² developed a pneumonia postoperatively. No other postoperative complications were observed. Conclusion To the best of our knowledge, this is the first series of patients that underwent a laparoscopic adjustable banded RYGB as a primary operation for the super-super obese in the indexed literature. With the combined procedure, a sequential action mechanism for weight loss is to be expected. The restrictive, malabsorptive and hormonal working mechanism of the RYGB will induce weight loss from the start reaching a stabilised plateau of weight after 12 - 18 months. At that time, filling of the band can be started resulting in further gastric pouch restriction and increased weight loss. Moreover, besides improving the results of total weight loss, a gradual filling of the band can as well prevent the RYGB patient from weight regain if restriction would fade away with time.

  3. Serious adverse events reported for anti-obesity medicines

    DEFF Research Database (Denmark)

    Aagaard, L; Hallgreen, C E; Hansen, Ebba Holme

    2016-01-01

    of consumer, seriousness, system organ class (SOC) and medicine. The unit of analysis was one AE and one AE report, respectively. RESULTS: We located 4941 AE reports corresponding to 13 957 AEs for anti-obesity medicines in EV. More than 90% of all AE cases were serious, including 159 deaths. The majority...

  4. Comparative effectiveness and safety of gastric bypass, sleeve gastrectomy and adjustable gastric banding in a population-based bariatric program: prospective cohort study

    Science.gov (United States)

    Gill, Richdeep S.; Majumdar, Sumit R.; Rueda-Clausen, Christian F.; Apte, Sameer; Birch, Daniel W.; Karmali, Shahzeer; Sharma, Arya M.; Klarenbach, Scott; Padwal, Raj S.

    2016-01-01

    Background Bariatric surgery in Canada is primarily delivered within publicly funded specialty clinics. Previous studies have demonstrated that bariatric surgery is superior to intensive medical management for reduction of weight and obesity-related comorbidities. Our objective was to compare the effectiveness and safety of laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (LSG) and adjustable gastric banding (LAGB) in a publicly funded, population-based bariatric treatment program. Methods We followed consecutive bariatric surgery patients for 2 years. The primary outcome was weight change (in kilograms). Between-group changes were analyzed using multivariable regression. Last-observation-carried-forward imputation was used for missing data. Results We included 150 consecutive patients (51 RYGB; 51 LSG; 48 LAGB) in our study. At baseline, mean age was 43.5 ± 9.5 years, 87.3% of patients were women, and preoperative body mass index (BMI) was 46.2 ± 7.4. Absolute and relative (% of baseline) weight loss at 2 years were 36.6 ± 19.5 kg (26.1 ± 12.2%) for RYGB, 21.4 ± 16.0 kg (16.4 ± 11.6%) for LSG and 7.0 ± 9.7 kg (5.8 ± 7.9%) for LAGB (p < 0.001). Change in BMI was greater for the RYGB (−13.0 ± 6.6) than both the LSG (−7.6 ± 5.7) and the LAGB (−2.6 ± 3.5) groups (p < 0.001). The reduction in diabetes, hypertension and dyslipidemia was greater after RYGB than after LAGB (all p < 0.05). There were no deaths. The anastomotic and staple leakage rate was 1.3%. Conclusion In a publicly funded, population-based bariatric surgery program, RYGB and LSG demonstrated greater weight loss than the LAGB procedure. Bypass resulted in the greatest reduction in obesity-related comorbidities. All procedures were safe. PMID:27240132

  5. Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy vs. Gastric Banding: The First Multicenter Retrospective Comparative Cohort Study in Obese Korean Patients

    Science.gov (United States)

    Lee, Sang Kuon; Park, Joong-Min; Kim, Yong-Jin; Kim, Seong-Min; Park, Do-Joong; Han, Sang-Moon; Shim, Kyung Won; Lee, Yeon-Ji; Kwon, Jin-Won

    2016-01-01

    Purpose Bariatric surgery is relatively new in Korea, and studies comparing different bariatric procedures in Koreans are lacking. This study aimed to compare the clinical outcomes of laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) for treating morbidly obese Korean adults. Materials and Methods In this multicenter retrospective cohort study, we reviewed the medical records of 261 obese patients who underwent different bariatric procedures. Clinical outcomes were measured in terms of weight loss and resolution of comorbidities, such as diabetes, hypertension, and dyslipidemia. Safety profiles for the procedures were also evaluated. Results In terms of weight loss, the three procedures showed similar results at 18 months (weight loss in 52.1% for SG, 61.0% for LAGB, and 69.2% for RYGB). Remission of diabetes, hypertension, and dyslipidemia was more frequent in patients who underwent RYGB (65.9%, 63.6%, and 100% of patients, respectively). Safety profiles were similar among groups. Early complications occurred in 26 patients (9.9%) and late complications in 32 (12.3%). In the LAGB group, five bands (6.9%) were removed. Among all patients, one death (1/261=0.38%) occurred in the RYGB group due to aspiration pneumonia. Conclusion The three bariatric procedures were comparable in regards to weight-loss outcomes; nevertheless, RYGB showed a higher rate of comorbidity resolution. Bariatric surgery is effective and relatively safe; however, due to complications, some bands had to be removed in the LAGB group and a relatively high rate of reoperations was observed in the RYGB group. PMID:27189291

  6. Use of 24 h Esophageal pH Monitoring to Demonstrate Alkaline Reflux as a Complication of Gastric Bypass Surgery

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    J Patrick Shoenut

    1994-01-01

    Full Text Available A 35-year-old female who had previously undergone a gastric stapling procedure for morbid obesity presented with a persistent nocturnal cough that was treated over a three-year period as a gastric acid reflux complication of the bypass surgery. A barium swallow demonstrated gastroesophageal reflux, but the symptoms did not resolve after treatment with omeprazole and cisapride. Twenty-four hour esophageal pH monitoring subsequently found alkaline reflux in excess of 17% of the total time, with no acid reflux demonstrated. Surgical revision of the bypass Leaving the hiatus alone corrected the reflux complication and the symptoms resolved without further treatment. The diagnostic capability of pH monitoring is illustrated in a patient with an unusual surgical complication.

  7. Activation of natriuretic peptides and the sympathetic nervous system following Roux-en-Y gastric bypass is associated with gonadal adipose tissues browning

    OpenAIRE

    Neinast, Michael D.; Frank, Aaron P.; Zechner, Juliet F.; Quanlin Li; Lavanya Vishvanath; Palmer, Biff F.; Vincent Aguirre; Gupta, Rana K.; Clegg, Deborah J.

    2015-01-01

    Objective: Roux-en-Y gastric bypass (RYGB) is an effective method of weight loss and remediation of type-2 diabetes; however, the mechanisms leading to these improvements are unclear. Additionally, adipocytes within white adipose tissue (WAT) depots can manifest characteristics of brown adipocytes. These ‘BRITE/beige’ adipocytes express uncoupling protein 1 (UCP1) and are associated with improvements in glucose homeostasis and protection from obesity. Interestingly, atrial and B-type natriure...

  8. The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass

    Science.gov (United States)

    Arndtz, Katherine; Steed, Helen; Hodson, James; Manjunath, Srikantaiah

    2016-01-01

    Background This study aimed to assess the endoscopic burden of bariatric surgical procedures at our trust. This is an enhanced parallel study to “The Hidden Endoscopic burden of Roux-en-Y Gastric Bypass” published in Frontline Gastroenterology in 2013 incorporating the data for sleeve gastrectomy and comparison with Roux-en-Y gastric bypass (RYGB). Methods This is a retrospective study that included 211 patients undergoing sleeve gastrectomy over a 34-month period. We utilized previously collected data for the RYGB patient cohort which included 553 patients over a 29-month period. We searched our hospital endoscopic database for patients who underwent post-operative endoscopy for indications related to their surgery. Results 16.6% of the sleeve gastrectomy patients required post-operative endoscopy, of whom 11.4% underwent therapeutic procedures. This compares to 20.4% of the RYGB cohort of whom 50.4% needed therapeutic procedures (P<0.001). 1.9% of sleeve gastrectomy patients encountered a post-operative staple line leak and collectively required 29 endoscopic procedures. One patient also developed stricturing (0.47%) requiring 18 pneumatic dilatations. 11.4% of the RYGB cohort developed an anastomotic stricture requiring 57 balloon dilatation procedures. To date, these procedures have accumulated an equivalent cost of €159,898 in endoscopy tariffs, or €177 per RYGB and €373 per sleeve gastrectomy performed. Conclusions Bariatric surgery can have significant implications in terms of patient morbidity and financial cost. Having a local bariatric surgery service increases the demand for endoscopic procedures in our hospital, both in investigating for and dealing with post-operative complications. Provision of extra resources and expertise needs to be taken into account. PMID:26752949

  9. [Complications of conventional and laparoscopic gastric bypass. Prospective and comparative study].

    Science.gov (United States)

    Gramática, Luis; Palas Zúñiga, César E; Moreno, Walter; Álvarez Padilla, Facundo; Arias, Ariel; Lerda, Gustavo

    2014-01-01

    Antecedentes: el bypass gástrico en y de roux para el tratamiento de la obesidad mórbida representa hoy en día la opción terapéutica más segura y eficiente. la era laparoscópica ha demostrado sus beneficios en este tipo de cirugía, por lo que algunos autores abogan por su implementación en forma casi sistemática, conduciendo en los últimos años al inexorable cambio en la vía de abordaje. Objetivos: evaluar y comparar las complicaciones del bypass gástrico laparoscópico y convencional en pacientes con obesidad mórbida. Lugar de aplicación: hospital nacional universitario de autogestión. Diseño: estudio comparativo, prospectivo no randomizado. Población: entre el 2002 y 2011, 420 pacientes con obesidad mórbida recibieron un tratamiento quirúrgico para la obesidad ya sea en forma laparoscópica (253) o convencional (167). Resultados: el porcentaje de complicaciones postoperatorias tempranas fue del 4% en el grupo bgl y del 34% en el bgc (p obesidad mórbida.

  10. Management of Refractory Noninsulinoma Pancreatogenous Hypoglycemia Syndrome with Gastric Bypass Reversal: A Case Report and Review of the Literature

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    Bhavana B. Rao

    2015-01-01

    Full Text Available Background. Roux-en-Y gastric bypass (RYGB is a commonly performed, effective bariatric procedure; however, rarely, complications such as postprandial hypoglycemia due to noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS may ensue. Management of refractory NIPHS is challenging. We report a case that was successfully treated with RYGB reversal. Case Report. A 58-year-old male with history of RYGB nine months earlier for morbid obesity presented for evaluation of postprandial, hypoglycemic seizures. Testing for insulin level, insulin antibodies, oral hypoglycemic agents, pituitary axis hormone levels, and cortisol stimulation was unrevealing. Computed tomography (CT scan of the abdomen was unremarkable. A 72-hour fast was completed without hypoglycemia. Mixed meal testing demonstrated endogenous hyperinsulinemic hypoglycemia (EHH and selective arterial calcium stimulation testing (SACST was positive. Strict dietary modifications, maximal medical therapy, gastrostomy tube feeding, and stomal reduction failed to alleviate symptoms. Ultimately, he underwent laparoscopic reversal of RYGB. Now, 9 months after reversal, he has markedly reduced hypoglycemia burden. Discussion. Hyperfunctioning islets secondary to exaggerated incretin response and altered intestinal nutrient delivery are hypothesized to be causative in NIPHS. For refractory cases, there is increasing skepticism about the safety and efficacy of pancreatic resection. RYGB reversal may be successful.

  11. Radiofrequency ablation coupled with Roux-en-Y gastric bypass: a treatment option for morbidly obese patients with Barrett's esophagus

    Science.gov (United States)

    Parikh, Keyur; Khaitan, Leena

    2016-01-01

    Barrett's esophagus (BE) is a premalignant condition that is associated with the development of esophageal adenocarcinoma. Risk factors that have been associated with the development of BE include male gender, Caucasian race, chronic gastroesophageal reflux disease, smoking, age >50 and obesity. The current management of BE is dependent on underlying pathological changes and treatment can range from surveillance endoscopy with daily proton pump inhibitor (PPI) therapy in the setting of intestinal metaplasia or low-grade dysplasia (LGD) to radiofrequency ablation (RFA), endoscopic mucosal resection or surgical resection in the setting of high-grade dysplasia. We report the case of a morbidly obese patient who was found to have long-segment BE with LGD during preoperative work-up for weight loss surgery with Roux-en-Y gastric bypass (RYGBP). The patient underwent successful RFA for the treatment of her BE before and after her RYGBP procedure. At 5-year follow-up, there was minimal progression of BE after treatment. PMID:26945777

  12. Recombinant Human Leptin Does Not Alter Gut Hormone Levels after Gastric Bypass but May Attenuate Sweet Cravings

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    Rushika Conroy

    2014-01-01

    Full Text Available Bariatric surgery improves glucose homeostasis and alters gut hormones partly independent of weight loss. Leptin plays a role in these processes; levels are decreased following bariatric surgery, creating a relative leptin insufficiency. We previously showed that leptin administration in a weight-reduced state after Roux-en-Y gastric bypass (RYGB caused no further weight loss. Here, we discuss the impact of leptin administration on gut hormones, glucostasis, and appetite. Weight stable women after RYGB were randomized to receive placebo or recombinant human metreleptin (0.05 mg/kg twice daily. At weeks 0 and 16, a liquid meal challenge was performed. Glucose, insulin, C-peptide, GLP-1, PYY, glucagon, and ghrelin (total, acyl, and desacyl were measured fasting and postprandially. Appetite was assessed using a visual analog scale. Mean post-op period was 53±2.3 months; mean BMI was 34.6±0.2 kg/m2. At 16 weeks, there was no significant change in weight within or between groups. Fasting PYY was significantly different between groups and the leptin group had lower sweets craving at week 16 than the placebo group (P<0.05. No other differences were observed. Leptin replacement does not alter gut hormones or glucostasis but may diminish sweet cravings compared to placebo in this population of post-RYGB women.

  13. Reversible Adrenal Insufficiency in Three Patients With Post–Roux-en-Y Gastric Bypass Noninsulinoma Pancreatogenous Hypoglycemia Syndrome

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    Shelly Mathur MD

    2014-03-01

    Full Text Available Objective. Noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS is a disorder of endogenous hyperinsulinemia that is clinically distinguishable from insulinoma, with a greater preponderance after Roux-en-Y gastric bypass (RYBG. Hyperinsulinemic hypoglycemia can predispose to attenuation of counterregulatory hormone responses to hypoglycemia, and consequent suppression of the hypothalamic–pituitary–adrenal (HPA axis. This case series describes 3 individuals who were diagnosed with adrenal insufficiency (AI after undergoing RYGB, complicated by NIPHS. Methods. A retrospective chart review was performed for each individual. Chart review applied particular attention to the onset of hyperinsulinemic hypoglycemia following bariatric surgery and the dynamic testing leading to the diagnoses of NIPHS and AI. Results. In each case, reactive hypoglycemia ensued within months to years after RYGB. Cosyntropin stimulation testing confirmed the diagnosis of AI. Hydrocortisone therapy reduced the frequency and severity of hypoglycemia and was continued until successful medical and/or surgical management of hyperinsulinism occurred. Follow-up testing of the HPA axis demonstrated resolution of AI. In all cases, hydrocortisone therapy was finally discontinued without incident. Conclusion. We speculate that transient AI is a potential complication in patients who experience recurrent hyperinsulinemic hypoglycemia after RYGB. The putative mechanism for this observation may be attenuation of the HPA axis after prolonged exposure to severe, recurrent hypoglycemia. We conclude that biochemical screening for AI should be considered in individuals who develop post-RYGB hyperinsulinemic hypoglycemia. If AI is diagnosed, supportive treatment should be maintained until hyperinsulinemic hypoglycemia has been managed effectively.

  14. Effect of binge eating disorder on the outcomes of laparoscopic gastric bypass in the treatment of morbid obesity

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    Eduardo García Díaz

    2013-06-01

    Full Text Available Introduction: Previous studies about the effect of binge eating disorder (BED on the outcomes of laparoscopic gastric bypass (LGBP are controversial. These studies have not compared patients with and without BED according to the Bariatric Analysis and Reporting Outcome System (BAROS, which takes into account weight loss, correction of comorbidities, improvement in quality of life and complications. Objectives: To assess whether BED predicts worse outcomes after LGBP, according to BAROS parameters. Methods: We carried out a cohort study which included 45 morbidly obese patients operated with LGBP. Patients with preoperative BED were identified by Questionnaire on Eating and Weight Patterns-Revised and results were evaluated by BAROS system. Results: Prevalence of BED was 21.4%. Median postoperative follow-up was 12 months. BED patients experienced after LGBP lower rates of resolution of hypertension (42.9% vs. 92.9%; p = 0.025 and were complicated by stenosis of the gastrojejunal anastomosis more frequently (70% vs. 17.1%; p = 0.003 than patients without binge eating. No differences in BAROS score, percentage of excess weight loss and quality of life were found. Conclusions: BED patients experienced after LGBP lower rates of resolution of hypertension and higher rates of anastomotic stenosis. BAROS score, weight loss and quality of life are comparable to that of patients without.

  15. Cardiovascular effects of current and future anti-obesity drugs

    DEFF Research Database (Denmark)

    Comerma-Steffensen, Simon; Grann, Martin; Andersen, Charlotte;

    2014-01-01

    The prevalence of obesity increases and is associated with increases in co-morbidities e.g. type 2 diabetes, hyperlipidemia, hypertension, obstructive sleep apnea, heart disease, stroke, asthma, several forms of cancer, depression, and may result in reduction of expected remaining lifespan. We have...... reviewed the adverse effects on the cardiovascular system of anti-obesity drugs now retracted from the market as well as the cardiovascular profile of current drugs and potential pathways which are considered for treatment of obesity. Fenfluramine, and sibutramine were withdrawn due to increased...... side effects need to be clarified regarding phentermine and lorcaserin. Drugs approved for type 2 diabetes including glucagon like peptide (GLP-1) analogues and metformin also cause moderate weight losses and have a favourable cardiovascular profile, while the anti-obesity potential of nebivolol...

  16. Anti-Obesity Activity of the Marine Carotenoid Fucoxanthin

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    Maria Alessandra Gammone

    2015-04-01

    Full Text Available Nowadays the global tendency towards physical activity reduction and an augmented dietary intake of fats, sugars and calories is leading to a growing propagation of overweight, obesity and lifestyle-related diseases, such diabetes, hypertension, dyslipidemia and metabolic syndrome. In particular, obesity, characterized as a state of low-level inflammation, is a powerful determinant both in the development of insulin resistance and in the progression to type 2 diabetes. A few molecular targets offer hope for anti-obesity therapeutics. One of the keys to success could be the induction of uncoupling protein 1 (UCP1 in abdominal white adipose tissue (WAT and the regulation of cytokine secretions from both abdominal adipose cells and macrophage cells infiltrated into adipose tissue. Anti-obesity effects of fucoxanthin, a characteristic carotenoid, exactly belonging to xanthophylls, have been reported. Nutrigenomic studies reveal that fucoxanthin induces UCP1 in abdominal WAT mitochondria, leading to the oxidation of fatty acids and heat production in WAT. Fucoxanthin improves insulin resistance and decreases blood glucose levels through the regulation of cytokine secretions from WAT. The key structure of anti-obesity effect is suggested to be the carotenoid end of the polyene chromophore, which contains an allenic bond and two hydroxyl groups. Fucoxanthin, which can be isolated from edible brown seaweeds, recently displayed its many physiological functions and biological properties. We reviewed recent studies and this article aims to explain essential background of fucoxanthin, focusing on its promising potential anti-obesity effects. In this respect, fucoxanthin can be developed into promising marine drugs and nutritional products, in order to become a helpful functional food.

  17. Screening of anti-obesity agent from herbal mixtures.

    Science.gov (United States)

    Roh, Changhyun; Jung, Uhee; Jo, Sung-Kee

    2012-01-01

    Globally, one in three of the World's adults are overweight and one in 10 is obese. By 2015, World Health Organization (WHO) estimates the number of chubby adults will balloon to 2.3 billion--Equal to the combined populations of China, Europe and the United States. The discovery of bioactive compounds from herbs is one possible way to control obesity and to prevent or reduce the risks of developing various obesity-related diseases. In this study, we screened anti-obesity agents such as methyl gallate from the herbal composition known as HemoHIM that actively inhibits lipid formation as evidenced by Oil Red O staining and triglyceride (TG) contents in 3T3-L1 adipocytes, suggesting their use as an anti-obesity agent. Furthermore, the amount of glycerol released from cells into the medium had increased by treatment of methyl gallate in a concentration-dependent manner. The present study suggests that a promising anti-obesity agent like methyl gallate might be of therapeutic interest for the treatment of obesity. PMID:22447026

  18. Screening of Anti-Obesity Agent from Herbal Mixtures

    Directory of Open Access Journals (Sweden)

    Sung-Kee Jo

    2012-03-01

    Full Text Available Globally, one in three of the World’s adults are overweight and one in 10 is obese. By 2015, World Health Organization (WHO estimates the number of chubby adults will balloon to 2.3 billion—Equal to the combined populations of China, Europe and the United States. The discovery of bioactive compounds from herbs is one possible way to control obesity and to prevent or reduce the risks of developing various obesity-related diseases. In this study, we screened anti-obesity agents such as methyl gallate from the herbal composition known as HemoHIM that actively inhibits lipid formation as evidenced by Oil Red O staining and triglyceride (TG contents in 3T3-L1 adipocytes, suggesting their use as an anti-obesity agent. Furthermore, the amount of glycerol released from cells into the medium had increased by treatment of methyl gallate in a concentration-dependent manner. The present study suggests that a promising anti-obesity agent like methyl gallate might be of therapeutic interest for the treatment of obesity.

  19. Screening of anti-obesity agent from herbal mixtures.

    Science.gov (United States)

    Roh, Changhyun; Jung, Uhee; Jo, Sung-Kee

    2012-03-23

    Globally, one in three of the World's adults are overweight and one in 10 is obese. By 2015, World Health Organization (WHO) estimates the number of chubby adults will balloon to 2.3 billion--Equal to the combined populations of China, Europe and the United States. The discovery of bioactive compounds from herbs is one possible way to control obesity and to prevent or reduce the risks of developing various obesity-related diseases. In this study, we screened anti-obesity agents such as methyl gallate from the herbal composition known as HemoHIM that actively inhibits lipid formation as evidenced by Oil Red O staining and triglyceride (TG) contents in 3T3-L1 adipocytes, suggesting their use as an anti-obesity agent. Furthermore, the amount of glycerol released from cells into the medium had increased by treatment of methyl gallate in a concentration-dependent manner. The present study suggests that a promising anti-obesity agent like methyl gallate might be of therapeutic interest for the treatment of obesity.

  20. Bypass gástrico laparoscópico com uso reduzido de suturas mecânicas Laparoscopic gastric bypass with low use of stapler sutures

    Directory of Open Access Journals (Sweden)

    Josemberg Marins Campos

    2008-06-01

    Full Text Available RACIONAL: A execução de bypass gástrico laparoscópico em hospital universitário público tem sido difícil devido ao elevado custo dos grampeadores cirúrgicos que prejudica o treinamento de médicos residentes e tem motivado a busca por técnicas alternativas, de baixo custo, mantendo a eficácia. OBJETIVO: Apresentar a viabilidade de um método com menor uso de suturas mecânicas. MÉTODOS: Foram operados 63 pacientes em 2 hospitais universitários, sendo 12 homens e 51 mulheres (81%, com média de 33,5 anos de idade e IMC médio de 43. Aplicou-se a seguinte padronização técnica: Secção da alça com bisturi elétrico a 50 cm do ângulo duodeno-jejunal, anastomose término-lateral, passagem da alça retrocólica e retrogástrica, confecção da parede lateral da bolsa gástrica com 1 carga azul de 45 e outra de 60 mm após a secção horizontal com bisturi elétrico, sutura do estômago excluso e anastomose gastrojejunal. As anastomoses foram manuais e contínuas com fio absorvível. RESULTADOS: O tempo operatório médio foi de 5,5 horas. As complicações precoces foram: fístula no ângulo de esôfago-gástrico (1,6%, estenose (1,6% e fístula na anastomose gastrojejunal (1,6% e torção da anastomose intestinal (1,6%. A estenose foi tratada por dilatação endoscópica e as outras complicações através de 3 re-operações (2 laparoscópicas e 1 laparotômica. O tempo de internação variou de 2 a 20 dias, com média de 4 dias, não havendo óbito. CONCLUSÃO: Este método é viável e com baixo custo operacional; todavia, é complexo e requer habilidade principalmente em suturas laparoscópicas.BACKGROUND: To perform laparoscopic gastric bypass in public university hospital has been difficult due to the high cost of the surgical staplers. This fact induced to look for different technical options, with low cost, maintaining the efficacy. AIM: To present the viability of a new method with the use of a low number of stapler devices

  1. [LONG-TERM FULMINANT HEPATIC FAILURE IN PATIENTS UNDERGOING GASTRIC BYPASS FOR MORBID OBESITY].

    Science.gov (United States)

    Mayo Ossorio, M Angeles; Pacheco Garcia, José Manuel; Pérez Gomar, Daniel; Bazán Hinojo, M Del Carmen; Vilchez Lopez, Francisco Javier; Aguilar Diosdad, Manuel; Fernández Serrano, José Luis

    2015-07-01

    La obesidad mórbida es un factor de riesgo para numerosas enfermedades, incluidas las enfermedades hepáticas, siendo la incidencia de esteatosis hepática de un 70 a 80%. Aunque el tratamiento quirúrgico es eficaz en la reducción del peso, sus efectos sobre el hígado no se han establecido convincentemente. Presentamos dos casos de pacientes intervenidas de cirugía bariátrica y que presentaron un fallo hepático fulminante con resultado de muerte. Material y método: caso clínico n.º 1: mujer de 36 años intervenida de obesidad en 1995 con gastroplastia vertical anillada con IMC 52,5 que tras reganancia ponderal posterior se realiza cirugía de revisión en 2009, realizándose by-pass gástrico distal. Caso clínico n.º2: mujer de 42 años intervenida de obesidad en 2009 mediante by-pass gástrico distal con IMC de 51 y colocación de malla profiláctica de composix kugel midline. A los tres años con buena pérdida ponderal presenta absceso de pared por fístula enterocutánea y se interviene quirúrgicamente, extrayendo malla, identificándose dos fístulas en asa alimentaria y común que se extirpan y se realizá nueva anastomosis. Resultados: caso clínico n.º1: a los dos meses de la cirugía de revisión inicia cuadro de vómitos secundarios a estenosis de anastomosis gastroyeyunal que se trata mediante dilatación, y cuadro de ictericia progresiva, ascitis y encefalopatía por fallo hepático fulminante con resultado de muerte. Caso clínico n.º2: en el postoperatorio inmediato inicia incremento del debito del drenaje, así como ascenso de enzimas de citolisis hepática y coagulopatía. Se reinterviene por sospecha de fuga anastomótica y sepsis abdominal, desarrollando fallo hepático fulminante con coagulopatía y encefalopatía que se trata mediante sistema MARS, falleciendo a las cuatro horas de la instauración de la terapia. Conclusiones: si bien las técnicas quirúrgicas actuales de cirugía bariátrica se consideran bastante seguras, se

  2. Gastroplastia redutora com bypass gastrojejunal em Y-de-Roux: conversão para bypass gastrointestinal distal por perda insuficiente de peso - experiência em 41 pacientes Gastric bypass Roux-en-Y gastrojejunostomy: conversion to distal gastrojejunoileostomy for weight loss failure - experience in 41 patients

    Directory of Open Access Journals (Sweden)

    José Carlos Pareja

    2005-12-01

    Full Text Available RACIONAL: O tratamento cirúrgico é a única modalidade efetiva de tratamento da obesidade mórbida. O insucesso do bypass gastrointestinal (percentagem de perda de excesso de peso inferior a 50% pode chegar a 10% dos pacientes operados a longo prazo (acima de 5, num ideal de 10 anos. OBJETIVOS: Avaliar os resultados, em termos de perda de peso, dos pacientes submetidos a reoperação com a finalidade de aumentar o componente disabsortivo. CASUÍSTICA E MÉTODOS: Estudaram-se 41 doentes, sendo 32 submetidos a reoperação por uma de três técnicas cirúrgicas (Fobi, Brolin e bypass gastrojejunoileal distal nas quais foi realizada diminuição da área absortiva do intestino delgado. RESULTADOS: Os doentes submetidos a bypass gastrojejunoileal distal apresentaram resultados superiores aos demais (69,7%. CONCLUSÃO: O emprego do bypass distal pode ser utilizado em casos selecionados com o intuito de melhorar os resultados em termos de perda de peso. É aconselhável a centralização desses procedimentos em serviços de referência com experiência na área específica de cirurgia bariátrica, para acompanhamento rigoroso desses doentes.BACKGROUND: Surgery is the only effective treatment for morbid obesity. Gastric bypass could fail in up to 10% of the patients (excess weight loss under 50%. AIMS: To evaluate the weight loss determined by reoperation performing disabsortive variation of gastric bypass. PATIENTS AND METHODS: The records of 41 patients, in whom 32 were submitted to reoperation by one of three surgical techniques (Fobi, Brolin, distal gastrojejunoileal bypass which consisted in increasing the disabsortive length of intestinal limb. RESULTS: The patients submitted to distal gastrojejunoileal bypass showed the best results (69,7%. CONCLUSION: The distal gastric bypass as a revisional procedure could be done in selected cases with the aim to improve the weight loss. It is advisable to refer these patients to selected centers (known as

  3. 23-hour/next day discharge post-laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery is safe.

    Science.gov (United States)

    Waydia, S; Gunawardene, A; Gilbert, J; Cota, A; Finlay, I G

    2014-11-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) is well established, yet practice varies as to when patients should be discharged post operation. After noting that many LRYGB patients met our unit's discharge criteria sooner than anticipated, we implemented a policy of aiming for 23-h inpatient stay post LRYGB in January 2012. This retrospective study aimed to assess the safety of this policy. We reviewed data of all patients undergoing LRYGB at our unit from September 2010 to October 2013. We compared the lengths of inpatient stay, complication rates and re-admission rates of patients treated before and after the introduction of the 23-h length of stay policy. Of 161 LRYGB procedures, 38 patients (29 female) underwent LRYGB from September 2010 to December 2011 (pre-policy change) and 123 (107 female) underwent operation after this date (post-policy change). The two groups were similar in terms of mean age (46.5 vs. 46.7 years, p = 0.932), mean BMI (46.8 vs. 46.6 kg/m(2), p = 0.868) and median number of pre-operative comorbidities (3 vs. 3, p = 0.9). There were significant reductions in median length of inpatient stay (2 vs. 1 day, p Post-policy changes, there were four complications: adhesional obstruction (n = 2), staple line bleeding (n = 1) and persistent dysphagia (n = 1). There were no deaths. Patients undergoing LRYGB can be safely discharged on the first post-operative day. This reduction in length of inpatient stay offers significant cost savings.

  4. Metabolic responses to xenin-25 are altered in humans with Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Sterl, Karin; Wang, Songyan; Oestricker, Lauren; Wallendorf, Michael J; Patterson, Bruce W; Reeds, Dominic N; Wice, Burton M

    2016-08-01

    Xenin-25 (Xen) is a neurotensin-related peptide secreted by a subset of enteroendocrine cells located in the proximal small intestine. Many effects of Xen are mediated by neurotensin receptor-1 on neurons. In healthy humans with normal glucose tolerance (NGT), Xen administration causes diarrhea and inhibits postprandial glucagon-like peptide-1 (GLP-1) release but not insulin secretion. This study determines (i) if Xen has similar effects in humans with Roux-en-Y gastric bypass (RYGB) and (ii) whether neural pathways potentially mediate effects of Xen on glucose homeostasis. Eight females with RYGB and no history of type 2 diabetes received infusions with 0, 4 or 12pmol Xen/kg/min with liquid meals on separate occasions. Plasma glucose and gastrointestinal hormone levels were measured and insulin secretion rates calculated. Pancreatic polypeptide and neuropeptide Y levels were surrogate markers for parasympathetic input to islets and sympathetic tone, respectively. Responses were compared to those in well-matched non-surgical participants with NGT from our earlier study. Xen similarly increased pancreatic polypeptide and neuropeptide Y responses in patients with and without RYGB. In contrast, the ability of Xen to inhibit GLP-1 release and cause diarrhea was severely blunted in patients with RYGB. With RYGB, Xen had no statistically significant effect on glucose, insulin secretory, GLP-1, glucose-dependent insulinotropic peptide, and glucagon responses. However, insulin and glucose-dependent insulinotropic peptide secretion preceded GLP-1 release suggesting circulating GLP-1 does not mediate exaggerated insulin release after RYGB. Thus, Xen has unmasked neural circuits to the distal gut that inhibit GLP-1 secretion, cause diarrhea, and are altered by RYGB. PMID:27288245

  5. Roux-en-Y Gastric Bypass Surgery Induces Early Plasma Metabolomic and Lipidomic Alterations in Humans Associated with Diabetes Remission.

    Directory of Open Access Journals (Sweden)

    Tulika Arora

    Full Text Available Roux-en-Y gastric bypass (RYGB is an effective method to attain sustained weight loss and diabetes remission. We aimed to elucidate early changes in the plasma metabolome and lipidome after RYGB. Plasma samples from 16 insulin-resistant morbidly obese subjects, of whom 14 had diabetes, were subjected to global metabolomics and lipidomics analysis at pre-surgery and 4 and 42 days after RYGB. Metabolites and lipid species were compared between time points and between subjects who were in remission and not in remission from diabetes 2 years after surgery. We found that the variables that were most discriminatory between time points were decanoic acid and octanoic acid, which were elevated 42 days after surgery, and sphingomyelins (18:1/21:0 and 18:1/23:3, which were at their lowest level 42 days after surgery. Insulin levels were lower at 4 and 42 days after surgery compared with pre-surgery levels. At 4 days after surgery, insulin levels correlated positively with metabolites of branched chain and aromatic amino acid metabolism and negatively with triglycerides with long-chain fatty acids. Of the 14 subjects with diabetes prior to surgery, 7 were in remission 2 years after surgery. The subjects in remission displayed higher pre-surgery levels of tricarboxylic acid cycle intermediates and triglycerides with long-chain fatty acids compared with subjects not in remission. Thus, metabolic alterations are induced soon after surgery and subjects with diabetes remission differ in the metabolic profiles at pre- and early post-surgery time points compared to patients not in remission.

  6. Effect of Roux-en-Y Gastric Bypass on the NLRP3 Inflammasome in Adipose Tissue from Obese Rats.

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    Andreea Oana Mocanu

    Full Text Available Obesity is associated with low-grade chronic inflammation. We hypothesized that Roux-en-Y gastric bypass (RYGB surgery would reduce activation of the NLRP3 inflammasome in metabolically active adipose tissue (AT of obese rats, and this change would be related to decreases in body weight and improved glycemic control.Omental, mesenteric and subcutaneous fat depots were collected from Sprague-Dawley rats: Sham control and RYGB; 90-days after surgery. NLRP3, caspase-1, apoptosis-associated speck-like protein (ASC, IL-1β, IL-18, IL-6 and MCP-1 gene and protein expression were quantified. Glucose metabolism was assessed by oral glucose tolerance test (OGTT.Compared to Sham surgery controls, RYGB surgery decreased IL-6, MCP-1, NLRP3, IL-18, caspase-1 and ASC in omental fat, and decreased IL-6, MCP1, IL-1β, IL-18, caspase-1 and ASC gene expression in mesenteric fat. We observed differential gene expression between visceral and subcutaneous fat for IL-6 and IL-1β, both being downregulated by RYGB in visceral, and upregulated in subcutaneous depots. These changes in gene expression were accompanied by a decrease in NLRP3, ASC, IL-18, caspase-1 and IL-1β protein expression in omental tissue. We found a positive correlation between caspase-1, ASC, MCP-1, IL-18 and IL-6 gene expression following surgery and glucose AUC response in omental fat, while the change in glucose AUC response correlated with caspase-1 gene expression in subcutaneous fat.This study demonstrates that bariatric surgery reverses inflammation in visceral adipose tissue by suppressing NLRP3 inflammasome activation. These are the first data to implicate the NLRP3 inflammasome in diabetes remission after RYGB surgery.

  7. Efficacy of Laparoscopic Mini Gastric Bypass for Obesity and Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yingjun Quan

    2015-01-01

    Full Text Available Background. Controversies on the utility of laparoscopic mini gastric bypass (LMGB in weight loss and type 2 diabetes mellitus (T2DM control still exist. Methods. We conducted a comprehensive literature search of PubMed, EMBASE, and Cochrane Library. Review Manager was used to perform the meta-analysis and the weighted mean difference (WMD and/or odds ratio with 95% confidence interval (95% CI were used to evaluate the overall size effect. Results. The literature search identified 16 studies for systematic review and 15 articles for meta-analysis. Compared with LAGB, LSG, and LRYGB, LMGB showed significant weight loss [WMD, −6.58 (95% CI, −9.37, −3.79, P<0.01 (LAGB; 2.86 (95% CI, 1.40, 5.83, P=0.004 (LSG; 10.33 (95% CI, 4.30, 16.36, P<0.01 (LRYGB] and comparable/higher T2DM remission results [86.2% versus 55.6%, P=0.06 (LAGB; 89.1% versus 76.3%, P=0.004 (LAGB; 93.4% versus 77.6%, P=0.006 (LAGB]; LMGB also had shorter learning curve and less operation time than LRYGB [WMD, −35.2 (95% CI, −46.94, −23.46]. Conclusions. LMGB appeared to be effective in weight loss and T2DM remission and noninferior to other bariatric surgeries. However, clinical utility of LMGB needs to be further validated by future prospective randomized controlled trials.

  8. Quality assessment and anti-obesity activity of Stellaria media (Linn.) Vill

    OpenAIRE

    Rani Neerja; Vasudeva Neeru; Sharma Surendra

    2012-01-01

    Abstract Background Obesity is recognized as a social problem, associated with serious health risks and increased mortality. Numerous trials have been conducted to find and develop new anti-obesity drugs through herbal sources to minimize side effects associated with the present anti-obesity drugs. The present study was designed to evaluate the quality control parameters, quantitative phytochemical analysis (total phenolic, total flavonoids and total saponin content), and the anti-obesity eff...

  9. Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Iannuccilli, J.D. [Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States)], E-mail: jiannuccilli@lifespan.org; Grand, D.; Murphy, B.L.; Evangelista, P. [Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States); Roye, G.D. [Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States); Mayo-Smith, W. [Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States)

    2009-04-15

    Aim: To evaluate the sensitivity and specificity of eight previously reported computed tomography (CT) signs in diagnosing internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Materials and methods: Preoperative CT images of nine patients with surgically proven internal mesenteric hernia as a complication of gastric bypass surgery and 10 matched control patients were reviewed in a blinded fashion by three radiologists. The presence of eight previously reported signs of internal mesenteric hernia was assessed: mesenteric swirl sign, hurricane eye sign, mushroom sign, small bowel obstruction, clustered small bowel loops, small bowel other than duodenum located behind the superior mesenteric artery (SMA), presence of the jejunal anastomosis to the right of the midline, and engorged mesenteric lymph nodes. The sensitivity and specificity were calculated for each sign, as well as inter-observer reliability in recognizing these signs. Results: Mesenteric swirl was the most predictive sign of internal hernia (sensitivity 78-100%, specificity 80-90%). Other CT signs showed good specificity (70-100%), but sensitivities were low (0-44%). The presence of a small-bowel obstruction and engorged mesenteric nodes was found to be 100% specific in predicting the presence of an underlying hernia. There was substantial inter-observer agreement in detecting mesenteric swirl sign ({kappa} = 0.48-0.79), but agreement was relatively poor for all other signs. Conclusion: Mesenteric swirl is an easily recognized CT sign, and is the best indicator of internal hernia following Roux-en-Y gastric bypass surgery. Other reported CT signs are diagnostically insensitive. The presence of small-bowel obstruction with engorged mesenteric nodes is highly specific in diagnosing internal mesenteric hernia.

  10. Down-Regulation of Renal Gluconeogenesis in Type II Diabetic Rats Following Roux-en-Y Gastric Bypass Surgery: A Potential Mechanism in Hypoglycemic Effect

    Directory of Open Access Journals (Sweden)

    Yi Wen

    2015-03-01

    Full Text Available Objective: This study was initiated to evaluate the effects of Roux-en-Y gastric bypass surgery on renal gluconeogenesis in type 2 diabetic rats and its relationship with hormonal parameters. Methods: Diabetic rats were induced by intraperitoneal injection of streptozotocin (STZ; 35 mg/kg combined with a high-fat diet. They were then randomly divided into three groups: diabetes model group (DM group, n = 8, sham Roux-en-Y gastric bypass group (SRYGB group, n = 8, and Roux-en-Y gastric bypass group (RYGB group, n = 14. Another 8 normal rats comprised the normal control group (NC group, n = 8. Body weight, glucose, serum lipid, insulin, glucagon-like peptide-1 (GLP-1, leptin, and adiponectin were measured pre- and postoperatively. Glucose-6-phosphatase (G6Pase, phosphoenolpyruvate carboxykinase (PEPCK, insulin receptor-α (IR-α, insulin receptor-β (IR-β, and glycogen synthase kinase 3 beta (Gsk3b were measured in renal cortex by using RT-PCR and Western immune-blot analyses on the 4th week after operation. Results: Following RYGB surgery, surgery-treated rats showed significantly improved oral glucose tolerance, dyslipidemia and insulin resistance as well as increased post-gavage insulin levels and serum circulating levels of GLP-1 and adiponectin. RT-PCR and Western immune-blot analyses showed PEPCK and G6Pase protein and mRNA to be significantly decreased in the renal cortex in the RYGB group (p Conclusion: Down-regulation of renal gluconeogenic enzymes might be a potential mechanism in hypoglycemia. An improved insulin signal pathway in the renal cortex and increased circulating adiponectin concentrations may contribute to the decline of renal gluconeogenesis following RYGB surgery.

  11. Fetal growth in pregnancies conceived after gastric bypass surgery in relation to surgery-to-conception interval: a Danish national cohort study.

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    Lone Nikoline Nørgaard

    Full Text Available OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton pregnancy in which first trimester screening was performed between January 2008 and June 2011. Data were derived from national registers (Danish National Registry of Patients and Danish National Birth Registry, Pregnancy Complications and Abortion-clinical quality database (PreCAb and the Danish Fetal Medicine Database. Main outcome measures were early and late fetal growth in relation to time from bariatric surgery to conception of the pregnancy. Early fetal growth was expressed as "Fetal Growth Index": the ratio between the estimated number of days from first trimester ultrasound to second trimester ultrasound biometries and the actual calender time elapsed in days. Late fetal growth was expressed as the observed versus expected birthweight according to gestational age (GA. RESULTS: The surgery-to-conception interval ranged from 3 to 1851 days with a mean value of 502 (SD, 351 days. The mean "fetal growth index" was 0.99 (SD, 0.02 days/day and thus significantly lower than in the background population (mean, 1.04 (SD, 0.09 days/day, p<0.0001. The proportion of infants being small for gestational age was 18.8% and the proportion of large for gestational age infants was 6.7%. The correlation coefficients between surgery-to-conception time and "fetal growth index" and birthweight according to GA were 0.01 (p = 0.8 and 0.04 (p = 0.4, respectively. CONCLUSION: Fetal growth index was lower than reported in the background population. No correlation was found between the surgery-to-conception interval and early or late fetal growth in pregnancies conceived after gastric bypass surgery.

  12. Diabetes surgery in type 2 BMI 24-29 vs IMC 30-34 diabetic patients: is there differences among restrictive, malabsorptive and gastric bypass procedures?

    Science.gov (United States)

    Garciacaballero, M; Navarrete, S; Favretti, F; Celik, A; Del Castillo, D

    2013-03-01

    Diabetes mellitus (DM) is a public health problem with a prevalence of 345 million people worldwide that it may double by the year 2030 and have a high costs and mortality. Gastrointestinal surgery is accepted as a form of treatment that was already suggested for obese in 1987 by Pories, confirmed for obese patients by the metaanalysis of Buchwald and the direct comparison of gastric bypass with medical treatment in the study of Schauer that demonstrate a 4 fold greater resolution rate of DM with surgery. Improvement occurs immediately after surgery, before the patients lose weight in with BMI > 35; but there is doubt if the existent evidence is enough to extrapolate these results to patients with BMI < 35 and especially with BMI < 30, in spite that four reviews in patients with this BMI and DM2 demonstrated the same results when stomach, duodenum and part of jejunum is bypassed as happen gastric bypass (better results with this of one anastomosis than of two anastomosis, Roux-en-Y) BPD. For patients with a BMI between 30 and 35 restrictive techniques: LAGB and SGL are good but not better than the mixed: RYGB, BAGUA, or SG-DJB with remission from 60 to 100%, minor in the derivative: BPD and above on the IID with a 81% of remission. There are no differences in the metabolic control in comparison to the obese, It is progressively better with DJB, SDS, IID and BAGUA especially in patients who do not require insulin, have less time with disease, have normal C peptide levels, and not so much relation with the initial BMI that is only important to decide the degree of restriction. Although several mechanisms has been suggested for explaining these results such as caloric intake, hormonal changes, bypass of the anterior or early stimulation of posterior intestine, fundectomy, intestinal gluconeogenesis and others, new ones will appear in the near future.

  13. Diabetes surgery in type 2 BMI 24-29 vs IMC 30-34 diabetic patients: is there differences among restrictive, malabsorptive and gastric bypass procedures?

    Directory of Open Access Journals (Sweden)

    M. Garciacaballero

    2013-01-01

    Full Text Available Diabetes mellitus (DM is a public health problem with a prevalence of 345 million people worldwide that it may double by the year 2030 and have a high costs and mortality. Gastrointestinal surgery is accepted as a form of treatment that was already suggested for obese in 1987 by Pories, confirmed for obese patients by the meta-analysis of Buchwald and the direct comparison of gastric bypass with medical treatment in the study of Schauer that demonstrate a 4 fold greater resolution rate of DM with surgery. Improvement occurs immediately after surgery, before the patients lose weight in with BMI > 35; but there is doubt if the existent evidence is enough to extrapolate these results to patients with BMI < 35 and especially with BMI < 30, in spite that four reviews in patients with this BMI and DM2 demonstrated the same results when stomach, duodenum and part of jejunum is bypassed as happen gastric bypass (better results with this of one anastomosis than of two anastomosis, Rouxen-Y BPD. For patients with a BMI between 30 and 35 restrictive techniques: LAGB and SGL are good but not better than the mixed: RYGB, BAGUA, or SG-DJB with remission from 60 to 100%, minor in the derivative: BPD and above on the IID with a 81% of remission. There are no differences in the metabolic control in comparison to the obese, It is progressively better with DJB, SDS, IID and BAGUA especially in patients who do not require insulin, have less time with disease, have normal C peptide levels, and not so much relation with the initial BMI that is only important to decide the degree of restriction. Although several mechanisms has been suggesed for explaining these results such as caloric intake, hormonal changes, bypass of the anterior or early stimulation of posterior intestine, fundectomy, intestinal gluconeogenesis and others, new ones will appear in the near future.

  14. Roux-en-Y gastric bypass promotes expression of PDX-1 and regeneration of β-cells in Goto-Kakizaki rats

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To study the effects of Roux-en-Y gastric bypass(RYGB) on the expression of pancreatic duodenal homeobox-1(PDX-1) and pancreatic β-cell regeneration/neogenesis,and their possible mechanisms in diabetics.METHODS:Three groups of randomly selected nonobese diabetic Goto-Kakizaki(GK) rats were subjected to RYGB,sham-RYGB and sham-operation(sham-op) surgery,respectively.The rats were euthanized at postoperative 1,2,4 and 12 wk.Their pancreases were resected and analyzed using reverse transcription polymerase...

  15. Oxyntomodulin Identified as a Marker of Type 2 Diabetes and Gastric Bypass Surgery by Mass-spectrometry Based Profiling of Human Plasma

    DEFF Research Database (Denmark)

    Wewer Albrechtsen, Nicolai J; Hornburg, Daniel; Albrechtsen, Reidar;

    2016-01-01

    applicability of this platform by studying a hitherto neglected glucose- and appetite-regulating gut hormone, namely, oxyntomodulin. Our results show that the secretion of oxyntomodulin in patients with type 2 diabetes is significantly impaired, and that its level is increased by more than 10-fold after gastric...... bypass surgery. Furthermore, we report that oxyntomodulin is co-distributed and co-secreted with the insulin-stimulating and appetite-regulating gut hormone glucagon-like peptide-1 (GLP-1), is inactivated by the same protease (dipeptidyl peptidase-4) as GLP-1 and acts through its receptor. Thus...

  16. Screening of Anti-Obesity Agent from Herbal Mixtures

    OpenAIRE

    Sung-Kee Jo; Uhee Jung; Changhyun Roh

    2012-01-01

    Globally, one in three of the World’s adults are overweight and one in 10 is obese. By 2015, World Health Organization (WHO) estimates the number of chubby adults will balloon to 2.3 billion—Equal to the combined populations of China, Europe and the United States. The discovery of bioactive compounds from herbs is one possible way to control obesity and to prevent or reduce the risks of developing various obesity-related diseases. In this study, we screened anti-obesity agents such as methyl ...

  17. Small lipidated anti-obesity compounds derived from neuromedin U.

    Science.gov (United States)

    Micewicz, Ewa D; Bahattab, Omar S O; Willars, Gary B; Waring, Alan J; Navab, Mohamad; Whitelegge, Julian P; McBride, William H; Ruchala, Piotr

    2015-08-28

    A small library of truncated/lipid-conjugated neuromedin U (NmU) analogs was synthesized and tested in vitro using an intracellular calcium signaling assay. The selected, most active analogs were then tested in vivo, and showed potent anorexigenic effects in a diet-induced obese (DIO) mouse model. The most promising compound, NM4-C16 was effective in a once-weekly-dose regimen. Collectively, our findings suggest that short, lipidated analogs of NmU are suitable leads for the development of novel anti-obesity therapeutics. PMID:26204509

  18. Effect of Roux-en-Y gastric bypass surgery on bile acid metabolism in normal and obese diabetic rats.

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    Hina Y Bhutta

    Full Text Available In addition to classic functions of facilitating hepatobiliary secretion and intestinal absorption of lipophilic nutrients, bile acids (BA are also endocrine factors and regulate glucose and lipid metabolism. Recent data indicate that antiobesity bariatric procedures e.g. Roux-en-Y gastric bypass surgery (RYGB, which also remit diabetes, increase plasma BAs in humans, leading to the hypothesis that BAs may play a role in diabetes resolution following surgery. To investigate the effect of RYGB on BA physiology and its relationship with glucose homeostasis, we undertook RYGB and SHAM surgery in Zucker diabetic fatty (ZDF and normoglycemic Sprague Dawley (SD rats and measured plasma and fecal BA levels, as well as plasma glucose, insulin, Glucagon like peptide 1 (GLP-1 and Peptide YY (PYY, 2 days before and 3, 7, 14 and 28 days after surgery. RYGB decreased body weight and increased plasma GLP-1 in both SD and ZDF rats while decreasing plasma insulin and glucose in ZDF rats starting from the first week. Compared to SHAM groups, both SD-RYGB and ZDF-RYGB groups started to have increases in plasma total BAs in the second week, which might not contribute to early post-surgery metabolic changes. While there was no significant difference in fecal BA excretion between SD-RYGB and SD-SHAM groups, the ZDF-RYGB group had a transient 4.2-fold increase (P<0.001 in 24-hour fecal BA excretion on post-operative day 3 compared to ZDF-SHAM, which paralleled a significant increase in plasma PYY. Ratios of plasma and fecal cholic acid/chenodeoxycholic acid derived BAs were decreased in RYGB groups. In addition, tissue mRNA expression analysis suggested early intestinal BA reabsorption and potentially reduced hepatic cholic acid production in RYGB groups. In summary, we present novel data on RYGB-mediated changes in BA metabolism to further understand the role of BAs in RYGB-induced metabolic effects in humans.

  19. Reduction in inflammatory gene expression in skeletal muscle from Roux-en-Y gastric bypass patients randomized to omentectomy.

    Directory of Open Access Journals (Sweden)

    Robyn A Tamboli

    Full Text Available To examine the effects of Roux-en-Y gastric bypass (RYGB surgery with and without laparoscopic removal of omental fat (omentectomy on the temporal gene expression profiles of skeletal muscle.Previously reported were the whole-body metabolic effects of a randomized, single-blinded study in patients receiving RYGB surgery stratified to receive or not receive omentectomy. In this follow up study we report on changes in skeletal muscle gene expression in a subset of 21 patients, for whom biopsies were collected preoperatively and at either 6 months or 12 months postoperatively.RNA isolated from skeletal muscle biopsies of 21 subjects (8 without omentectomy and 13 with omentectomy taken before RYGB or at 6 and 12 months postoperatively were subjected to gene expression profiling via Exon 1.0 S/T Array and Taqman Low Density Array. Robust Multichip Analysis and gene enrichment data analysis revealed 84 genes with at least a 4-fold expression difference after surgery. At 6 and 12 months the RYGB with omentectomy group displayed a greater reduction in the expression of genes associated with skeletal muscle inflammation (ANKRD1, CDR1, CH25H, CXCL2, CX3CR1, IL8, LBP, NFIL3, SELE, SOCS3, TNFAIP3, and ZFP36 relative to the RYGB non-omentectomy group. Expressions of IL6 and CCL2 were decreased at all postoperative time points. There was differential expression of genes driving protein turnover (IGFN1, FBXW10 in both groups over time and increased expression of PAAF1 in the non-omentectomy group at 12 months. Evidence for the activation of skeletal muscle satellite cells was inferred from the up-regulation of HOXC10. The elevated post-operative expression of 22 small nucleolar RNAs and the decreased expression of the transcription factors JUNB, FOS, FOSB, ATF3 MYC, EGR1 as well as the orphan nuclear receptors NR4A1, NR4A2, NR4A3 suggest dramatic reorganizations at both the cellular and genetic levels.These data indicate that RYGB reduces skeletal muscle

  20. The Effect of Preoperative Type 2 Diabetes and Physical Fitness on Mental Health and Health-Related Quality of Life after Roux-en-Y Gastric Bypass.

    Science.gov (United States)

    Wimmelmann, Cathrine L; Lund, Michael T; Hansen, Merethe; Dela, Flemming; Mortensen, Erik L

    2016-01-01

    Objective. To investigate the predictive value of type 2 diabetes and lack of physical activity for mental health and health-related quality of life after Roux-en-Y gastric bypass. Method. Forty severely obese patients undergoing Roux-en-Y gastric bypass were included in the GASMITO study. Information about physiological and psychological factors was prospectively assessed at four time points, two times prior to surgery and two times after surgery. Measures included oral and intravenous glucose tolerance tests, VO2max test, Symptoms Checklist (SCL-90), Short Form Health Survey 36 (SF-36), Body Image Questionnaire, and a questionnaire assessing sociodemographic factors and medical status. Results. Mean % excess weight loss was 65% (±12) at 18-month follow-up and 50% of the participants with diabetes experienced total remission. Also, significant improvements were observed with regard to physical fitness, mental distress, health-related quality of life, and weight-related body image (p physical fitness level made modest contributions to variations in mental symptoms and HRQOL but not weight-related body image. Conclusion. The results suggest that baseline difference in mental symptoms and physical HRQOL between diabetic and nondiabetic patients declines across follow-ups and resolves around the time of surgery. PMID:27379183

  1. Evaluation of laparoscopic sleeve gastrectomy compared with laparoscopic Roux-en-Y gastric bypass for people with morbid obesity: A systematic review and meta-analysis

    Science.gov (United States)

    Arabi Basharic, Fateme; Olyaee Manesh, Alireza; Ranjbar Ezzat Abadi, Mohammad; Shiryazdi, Seyed Mostafa; Shabahang, Hussein; Jangjoo, Ali

    2016-01-01

    Background: Prevalence of obesity in the world, in both developed and developing countries, is growing rapidly. Bariatric surgery is now accepted as the treatment for morbid obesity. Objective: This study compares laparoscopic sleeve gastrectomy's effectiveness (LSG) with the most common bariatric surgery, laparoscopic Roux-en-Y (LRYGB) gastric bypass. Methods: A systematic review was performed using relevant search data bases, including Cochrane library, PubMed, Magi ran, Iranmedex, SID and Trip database, with no time limit. Data bases were searched until July 2014 for randomized control trials. The studied population included people aged between 18–60 years, with BMI≥35 and at least one obesity-related disease, or people with BMI≥40. BMI change, as the research outcome, was investigated at least in one-year follow-up period. Cochrane criteria were used to assess quality of studies. The results were extracted from the articles. Results: In total, 384 articles were obtained in the search; six RCTs were included in this study. There was no significant difference between the two laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass procedures in BMI, and both groups were similar in weight loss CI [-.1.31, 0.43], p=0.32. Conclusion: The two procedures of bariatric surgery are effective and reliable treatments. Performing more trial studies with greater sample size and longer follow-up period for making final decision in selecting a certain surgical procedure is essential.

  2. The Effect of Preoperative Type 2 Diabetes and Physical Fitness on Mental Health and Health-Related Quality of Life after Roux-en-Y Gastric Bypass

    Directory of Open Access Journals (Sweden)

    Cathrine L. Wimmelmann

    2016-01-01

    Full Text Available Objective. To investigate the predictive value of type 2 diabetes and lack of physical activity for mental health and health-related quality of life after Roux-en-Y gastric bypass. Method. Forty severely obese patients undergoing Roux-en-Y gastric bypass were included in the GASMITO study. Information about physiological and psychological factors was prospectively assessed at four time points, two times prior to surgery and two times after surgery. Measures included oral and intravenous glucose tolerance tests, VO2max test, Symptoms Checklist (SCL-90, Short Form Health Survey 36 (SF-36, Body Image Questionnaire, and a questionnaire assessing sociodemographic factors and medical status. Results. Mean % excess weight loss was 65% (±12 at 18-month follow-up and 50% of the participants with diabetes experienced total remission. Also, significant improvements were observed with regard to physical fitness, mental distress, health-related quality of life, and weight-related body image (p<0.05. The interaction between follow-up time and type 2 diabetes at baseline significantly predicted six of the thirteen psychological subscales (p<0.05 and, across the follow-ups, physical fitness level made modest contributions to variations in mental symptoms and HRQOL but not weight-related body image. Conclusion. The results suggest that baseline difference in mental symptoms and physical HRQOL between diabetic and nondiabetic patients declines across follow-ups and resolves around the time of surgery.

  3. The Effect of Preoperative Type 2 Diabetes and Physical Fitness on Mental Health and Health-Related Quality of Life after Roux-en-Y Gastric Bypass

    Science.gov (United States)

    Wimmelmann, Cathrine L.; Lund, Michael T.; Hansen, Merethe; Dela, Flemming; Mortensen, Erik L.

    2016-01-01

    Objective. To investigate the predictive value of type 2 diabetes and lack of physical activity for mental health and health-related quality of life after Roux-en-Y gastric bypass. Method. Forty severely obese patients undergoing Roux-en-Y gastric bypass were included in the GASMITO study. Information about physiological and psychological factors was prospectively assessed at four time points, two times prior to surgery and two times after surgery. Measures included oral and intravenous glucose tolerance tests, VO2max test, Symptoms Checklist (SCL-90), Short Form Health Survey 36 (SF-36), Body Image Questionnaire, and a questionnaire assessing sociodemographic factors and medical status. Results. Mean % excess weight loss was 65% (±12) at 18-month follow-up and 50% of the participants with diabetes experienced total remission. Also, significant improvements were observed with regard to physical fitness, mental distress, health-related quality of life, and weight-related body image (p < 0.05). The interaction between follow-up time and type 2 diabetes at baseline significantly predicted six of the thirteen psychological subscales (p < 0.05) and, across the follow-ups, physical fitness level made modest contributions to variations in mental symptoms and HRQOL but not weight-related body image. Conclusion. The results suggest that baseline difference in mental symptoms and physical HRQOL between diabetic and nondiabetic patients declines across follow-ups and resolves around the time of surgery. PMID:27379183

  4. Outcomes of Roux-en-Y gastric bypass surgery for severely obese patients with type 1 diabetes: a case series report

    Directory of Open Access Journals (Sweden)

    Carlos E Mendez

    2010-08-01

    Full Text Available Carlos E Mendez, Robert J Tanenberg, Walter PoriesDiabetes and Obesity Institute, East Carolina University, Greenville, NC, USAAbstract: Roux-en-Y gastric bypass surgery (RYGB reverses type 2 diabetes (DM2 in approximately 83% of patients with morbid or severe obesity. This procedure has been performed in small numbers of severely obese patients with type 1 diabetes (DM1, but the impact on glycemic control and insulin requirement in this population has not been widely described. We report three patients with DM1 and severe obesity that underwent RYGB. Weight, glycemic control, and insulin requirements before and one year after the procedure were compared. Significant weight loss was achieved by all three patients but insulin requirements decreased in only 2 patients. In contrast, glycemic control (A1C remained suboptimal in all three patients up to one year after the surgery. These findings suggest that RYGB leads to important weight loss and positively affects insulin sensitivity. However, reaching optimal glycemic control in patients with DM1 diabetes remains challenging due to persisting insulin deficiency.Keywords: gastric bypass, Roux-en-Y, obesity, diabetes, insulin

  5. Mechanisms of gastric bypass surgery on type 2 diabetes mellitus%胃转流术治疗2型糖尿病的机制

    Institute of Scientific and Technical Information of China (English)

    唐锦; 魏寿江; 杨正伟; 沈成义

    2011-01-01

    2型糖尿病是一种常见的内分泌代谢性疾病,传统的治疗方法以内科为主,但不能达到终身治愈的目的.外科治疗主要是针对其并发症.近年来研究发现,胃转流术可有效治疗2型糖尿病,减少糖尿病各种并发症.目前胃转流术治疗2型糖尿病的具体作用机制仍未完全阐明,可能与胃肠道激素、脂肪细胞因子、炎性反应因子、氧化应激及胰岛素信号转导等多方面因素有关.%Type 2 diabetes mellitus is a common endocrine and metabolic disease,which can not be a life-long cure by using traditional internal methods. Surgical treatment is mainly directed against its complications. Recently studies have showed gastric bypass surgery can control diabetes mellitus effectively and alleviate its complications. The mechanisms of gastric bypass surgery on type 2 diabetes mellitus are not fully understood, which are related to gut hormones, inflammatory factors, oxidative stress, insulin signaling pathway and so on.

  6. Self-nanoemulsifying drug delivery systems ameliorate the oral delivery of silymarin in rats with Roux-en-Y gastric bypass surgery

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    Chen CH

    2015-03-01

    Full Text Available Chun-Han Chen,1,2 Cheng-Chih Chang,1 Tsung-Hsien Shih,2 Ibrahim A Aljuffali,3 Ta-Sen Yeh,4,5 Jia-You Fang6–8 1Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, 2Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan; 3Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 4Department of Surgery, Chang Gung Memorial Hospital, 5School of Medicine, College of Medicine, 6Pharmaceutics Laboratory, Graduate Institute of Natural Products, 7Chinese Herbal Medicine Research Team, Healthy Aging Research Center, Chang Gung University, 8Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Kweishan, Taoyuan, Taiwan Abstract: Roux-en-Y gastric bypass (RYGB is a popular surgery to reduce the body weight of obese patients. Although food intake is restricted by RYGB, drug absorption is also decreased. The purpose of this study was to develop novel self-nanoemulsifying drug delivery systems (SNEDDS for enhancing the oral delivery of silymarin, which has poor water solubility. The SNEDDS were characterized by size, zeta potential, droplet number, and morphology. A technique of RYGB was performed in Sprague-Dawley rats. SNEDDS were administered at a silymarin dose of 600 mg/kg in normal and RYGB rats for comparison with silymarin aqueous suspension and polyethylene glycol (PEG 400 solution. Plasma silibinin, the main active ingredient in silymarin, was chosen for estimating the pharmacokinetic parameters. SNEDDS diluted in simulated gastric fluid exhibited a droplet size of 190 nm with a spherical shape. The nanocarriers promoted silibinin availability via oral ingestion in RYGB rats by 2.5-fold and 1.5-fold compared to the suspension and PEG 400 solution, respectively. A significant double-peak concentration of silibinin was detected for RYGB rats receiving SNEDDS. Fluorescence

  7. O efeito em curto prazo do bypass gástrico sobre pacientes obesos diabéticos Short-term effect of gastric bypass in obese diabetic patients

    Directory of Open Access Journals (Sweden)

    Aluisio Stoll

    2013-02-01

    Full Text Available OBJETIVO: estudar o efeito do bypass gástrico sobre a glicemia e o uso de medicação antidiabética em pacientes obesos portadores de diabetes. MÉTODOS: estudo de coorte retrospectivo com 44 pacientes obesos portadores de DM2, provenientes de 469 pacientes submetidos ao bypass gástrico no período de dezembro de 2001 a março de 2009. Os desfechos primários avaliados foram: glicemia em jejum e a necessidade de medicação antidiabética. RESULTADOS: a população foi composta de dez (22,7% homens e 34 (77,3% mulheres, com média de idade de 45,3 (±8,23 anos e índice de massa corporal de 40,9 (±5,03 kg/m². O tempo médio de evolução do DM2 foi 63,6 (±60,9 meses. Dos 40 pacientes que utilizavam medicação para controle do DM2, 20 (50% tiveram sua medicação suspensa na alta hospitalar e 13 (32,5% até nove meses depois. Em uma paciente não foi possível avaliar o uso de medicação, sendo essa a única exclusão. A insulina foi suspensa nos dez (100% pacientes que a utilizavam, sendo seis (60% na alta hospitalar. Houve redução (POBJECTIVE: To study the effect of gastric bypass on blood glucose levels and the use of antidiabetic medication in obese patients with diabetes. METHODS: We carried out a retrospective cohort study with 44 obese patients with DM2, from 469 patients undergoing gastric bypass from December 2001 to March 2009. The primary endpoints evaluated were fasting glucose and the need for antidiabetic medication. RESULTS: The study population consisted of ten (22.7% men and 34 (77.3% women, with a mean age of 45.3 (±8.23 years and a body mass index of 40.9 (±5.03 kg/m². The average time to progression of DM2 was 63.6 (±60.9 months. Of the 40 patients who used medication to control type 2 diabetes, 20 (50% had their medication discontinued at discharge and 13 (32.5%, until nine months later. In one patient it was not possible to evaluate the use of medication, this being the only exception. Insulin was suspended in

  8. Effects of Roux-en-Y Gastric Bypass on Fasting and Postprandial Levels of the Inflammatory Markers YKL-40 and MCP-1 in Patients with Type 2 Diabetes and Glucose Tolerant Subjects

    DEFF Research Database (Denmark)

    Thomsen, Stine Brinkløv; Rathcke, Camilla Noelle; Jørgensen, Nils Bruun;

    2013-01-01

    , following Roux-en-Y gastric bypass (RYGB) in subjects with type 2 diabetes (T2D) and normal glucose tolerance (NGT). Methods. Ten obese patients with T2D and 10 subjects with NGT were examined in the fasting state and after a standard meal prior to and after (1 week, 3 months, and 1 year) RYGB. Results...

  9. Exaggerated Glucagon-Like Peptide 1 Response Is Important for Improved β-Cell Function and Glucose Tolerance After Roux-en-Y Gastric Bypass in Patients With Type 2 Diabetes

    DEFF Research Database (Denmark)

    Jørgensen, Nils B; Dirksen, Carsten; Bojsen-Møller, Kirstine N;

    2013-01-01

    β-cell function is improved in patients with type 2 diabetes in response to an oral glucose stimulus after Roux-en-Y gastric bypass (RYGB) surgery. This has been linked to an exaggerated glucagon-like peptide 1 (GLP-1) secretion, but causality has not been established. The aim of this study...

  10. Effects of Roux-en-Y gastric bypass on fasting and postprandial inflammation-related parameters in obese subjects with normal glucose tolerance and in obese subjects with type 2 diabetes

    DEFF Research Database (Denmark)

    Bovbjerg, Kirsten Katrine Lindegaard; Jorgensen, Nils Bruun; Just, Rasmus;

    2015-01-01

    explored the hypothesis that Roux-en-Y gastric bypass (RYGB) reduces circulating levels of pro-inflammatory cytokines, while increasing anti-inflammatory cytokines in obese subjects with type 2 diabetes (T2D) and in obese normal glucose tolerant (NGT) subjects. Methods: Thirteen obese subjects with T2D...

  11. Efecto del bypass gástrico en el síndrome metabólico y en el riesgo cardiovascular Effect of gastric bypass on the metabolic syndrome and on cardiovascular risk

    Directory of Open Access Journals (Sweden)

    J. Ocón

    2010-02-01

    are a high risk of developing cardiovascular disease (CVD. The aim of this study was to determine the prevalence of the MS in morbidly obese patients enrolling in a bariatric surgery program and to evaluate the impact of weigh loss induced by gastric bypass on the MS and on the predicted 10-year cardiovascular risk. Material and methods: We studied 46 morbidly obese patients who underwent laparoscopic gastric bypass and were followed for 2 years. MS was defined following the IDF 2005 criteria and the insulin resistance (IR was calculated by using HOMA index. Risk assessment for estimating 10-year ECV risk was carried out according to Framingham score. Results: Before surgery, 67.2% of patients had IR and 60,9% met the definition of the MS. 17.3% of patients had an elevated cardiovascular risk category. 2 years after gastric bypass, the percentage of excess body weight lost was 72%. All patients restored their HOMA index and only 1 patient (3.6% had MS. Resolution of hypertension, disglucemia and dislipemia has been observed in 85%, 93.8% and 95.6% of patients. Estimated cardiovascular risk decreased from 4.5% at baseline to 1% at 2 years after surgery. Conclusions: SM is common in morbidly obese patients. Bypass gastric is associated with an improvement or resolution in cardiovascular risk factors and IR and result in a significant reduction in MS prevalence and of predicted 10-year cardiovascular risk.

  12. Weighing the Options: Gastric Sleeve Surgery

    Medline Plus

    Full Text Available ... over the past 10 years. Absolutely. The gold standard is the laparoscopic roux-en-y gastric bypass, ... an alternative to the other two. The gold standard is the roux-en-y gastric bypass. The ...

  13. 腹腔镜胃旁路手术并发症分析%Analysis of complications of laparoscopic gastric bypass surgery

    Institute of Scientific and Technical Information of China (English)

    杨雁灵; 丁睿; 窦科峰; 陶开山

    2015-01-01

    目的:总结腹腔镜胃旁路手术的并发症及其处理方法。方法:回顾分析2011年5月至2014年12月我院217例肥胖合并2型糖尿病病人腹腔镜胃旁路手术的临床资料,总结并分析并发症情况。结果:本研究所有病人均顺利完成手术,无中转开腹。术后腹腔出血2例,Peterson裂孔疝1例,胃肠吻合口漏2例,胃肠吻合口狭窄3例,术后严重腹泻6例,吻合口溃疡3例,出现胆囊结石2例。结论:对于胃旁路手术并发症,应注意细节和积极预防。%Objective To examine the complications of laparoscopic gastric bypass surgery and the treatment of complications. Methods The clinical data including the surgical complications of 217 obese patients combined with dia-betes mellilus type 2 performed with laparoscopic gastric bypass in Xijing Hospital from May 2011 to December 2014 were analyzed retrospectively. Results All patients were completed surgery successfully without conversion to open surgery. The complications consisted of intraperitoneal bleeding in 2 cases, Peterson hiatal hernia in 1 case, gastrointesti-nal anastomotic leakage in 2 cases, gastrointestinal anastomotic stenosis in 3 cases severe diarrhea in 6 cases, anastomo-sis ulcer in 3 cases, and gallbladder stone in 2 cases. Conclusions Laparoscopic gastric bypass surgery has certain inci-dence of complications. Much attention should be paid with careful procedure to avoid the postoperative complications.

  14. A novel technique of Roux-en-Y gastric bypass reversal for postprandial hyperinsulinemic hypoglycaemia: A case report

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    E. Qvigstad

    2016-01-01

    Conclusions: Reduction of plasma–glucose, insulin and GLP-1 excursions and symptoms were seen after gastric tube placement and partial RYGB reversal. This attenuation of GLP-1 response to feeding could reflect an adaptation to nutrients.

  15. [A Case of Laparoscopic Surgery for Early Gastric Cancer that Occurred after Coronary Artery Bypass Grafting using the Right Gastroepiploic Artery].

    Science.gov (United States)

    Kusumoto, Eiji; Ota, Mitsuhiko; Tsutsumi, Norifumi; Hashimoto, Kenkichi; Egashira, Akinori; Sakaguchi, Yoshihisa; Kusumoto, Tetsuya; Ikejiri, Koji

    2015-10-01

    We herein report a case involving a 70-year-old man who was diagnosed with early gastric cancer that occurred after coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) for effort-induced angina. He was successfully treated by laparoscopic surgery. Preoperative cardiac three-dimensional computed tomography and coronary angiography showed an occlusion of the RGEA graft, which could lead to ligation of the RGEA to dissect the lymph nodes along the RGEA. The laparoscopic approach helps to identify and avoid injury to the RGEA graft because of its enlarged and precise viewing field compared with laparotomy followed by retractor placement. Laparoscopic surgery is a useful method in such cases to reduce perioperative complications risk.

  16. The influence of improved gastric bypass on resistin of GK rats%改良胃旁路术对GK大鼠抵抗素的影响

    Institute of Scientific and Technical Information of China (English)

    翁山耕; 徐常国; 吴书清; 张斌

    2012-01-01

    目的:探讨改良胃旁路手术(improved gastric bypass)对2型糖尿病GK大鼠(Goto-Kakizaki rats)的降糖作用及其机制.方法:20只雄性GK大鼠随机分为手术组和对照组,每组10只.对手术组大鼠行改良胃旁路术,对照组大鼠在十二指肠球部远端0.5 cm处切断吻合.检测术前1周及术后第8周两组GK大鼠体重、空腹血糖(FPG)、血脂、血浆胰岛素、血浆抵抗素水平.结果:术后8周,手术组大鼠FPG由术前的(5.2±0.3)mmol/L降至(4.0±0.2)mmol/L,血浆抵抗素由术前的(9.9±1.7)mmol/L降至(5.7±1.0)mmol/L,与术前相比,差异均有统计学意义(P<0.05).结论:改良胃旁路术能降低GK大鼠的血糖,并且能够降低GK大鼠的血脂和血浆抵抗素,其可能是胃旁路术治疗2型糖尿病的机制之一.%Objective To study the antidiabetic effects and the mechanisms of improved gastric bypass (GBP) in Goto-Kakizaki (GK) rats with type 2 diabetes. Methods Twenty male GK rats were randomized into two groups; operation group and control group. Operation group underwent improved gastric bypass, while control group underwent sham operation. Body weight, fasting plasma glouse (FPG) , blood lipid, plasma insuline and plasma resistin of two groups were detected one week before surgery and eight weeks after surgery, respectively. Results No differences were found in body weight between operation group and control group in the same week. But eight weeks after surgery, the average level of fasting plasma glucose was decreased from (5.2 ?0.3) mmol/L to (4.0 ?0.2) mmol/L and the average level of plasma resistin was decreased from (9.9 ?1.7) mmol/L to (5.7 ?1.0) mmol/L in operation group, which were significantly lower than that of control group. Conclusions The improved gastric bypass not only can significantly decrease blood glucose of GK rats, but it also can decrease the blood lipid and plasma resistin of GK rats, which may be one of mechanisms of surgical treatment of type 2 diabetes.

  17. Mechanism of type 2 diabetes control after gastric bypass surgery%胃旁路术缓解2型糖尿病的机制

    Institute of Scientific and Technical Information of China (English)

    曹怡; 邹大进

    2009-01-01

    @@ 目前已有证据表明,外科手术治疗能够使50%~85%的严重肥胖者获得持久的体质量减轻以及糖尿病的缓解,并且显著降低患者的死亡率 [1].在众多外科减肥手术中,Roux-en-Y胃旁路术(Roux-en-Y gastric bypass,RYGB)由于具有长期稳定的减重以及改善胰岛素抵抗的作用而成为重度肥胖的首选治疗方法之一.

  18. Effect of Roux-en-Y gastric bypass surgery on ventricular function and cardiac risk factors in obese patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Alireza Abdollahi Moghaddam

    2016-03-01

    Full Text Available Introduction: Weight gain and obesity are two important public health problems, which are associated with many diseases such as cardiovascular disorders. Various policies such as bariatric surgery have been proposed for the treatment of morbid obesity. Methods: PubMed and Scopus were searched thoroughly with the following search terms (roux-en-y gastric bypass surgery AND (ventricular function, OR cardiac risk factors OR heart AND (BMI OR body mass index to find the articles in which the effect of roux-en-Y gastric bypass (RYGB surgery had been evaluated in severely obese patients.Result: Out of 120 articles which were found in PubMed, and 28 records which were found in Scopus, only 18 articles fully met the inclusion criteria. Out of 2740 participants in the included studied, 1706 were patients with body mass index (BMI over 40 kg/m2 who had undergone RYGB surgery, and 1034 were control participants. Results of the studies showed that RYGB surgery could reduce BMI, and cardiac risk factors, and improve diastolic function, systolic and diastolic blood pressures, and aortic function, postoperatively.Discussion: Obesity is associated with increased risk of cardiovascular diseases, impaired cardiac function, and hypertension. It is shown that RYGB surgery reduces the serum level of biochemical markers of cardiac diseases. Cardiac structure, parasympathetic indices of autonomic function, coronary circulatory function, hypertension, epicardial fat thickness, and ventricular performance improve after bariatric surgery.Conclusions: It is concluded that RYGB surgery is an effective strategy to improve ventricular function and cardiac risk factors in morbid obese patients.

  19. Estudos endoscópico e histológico prospectivos e sequenciais da bolsa gástrica em 130 pacientes obesos mórbidos submetidos à bypass gástrico em Y-de-Roux Prospective sequential endoscopic and histologic studies of the gastric pouch in 130 morbidly obese patients submitted to Roux-en-Y gastric bypass

    Directory of Open Access Journals (Sweden)

    Attila Csendes

    2012-12-01

    Full Text Available RACIONAL: Bypass gástrico em Y-de-Roux é a operação bariátrica mais comumente realizada. Pequena bolsa gástrica é criada, deixando uma anastomose gastrojejunal estreita, com uma alça jejunal mais comprida. Muito pouco é conhecido sobre o comportamento desta bolsa em anos após o procedimento. OBJETIVO: Determinar através de estudos prospectivos endoscópico e histológico seqüenciais o tamanho da bolsa gástrica, o diâmetro da anastomose e o comportamento da infecção por H. pylori após a operação. MÉTODOS: Em 130 pacientes submetidos ao bypass gástrico foram realizadas várias avaliações sequenciais endoscópica (até 120 meses e histológica de rotina da bolsa gástrica. RESULTADOS: Após a operação, foram realizadas em média 3,6 endoscopias por paciente. Macroscopicamente quase 95% das pequenas bolsas gástricas eram normais, e o principal achado patológico foi uma úlcera marginal. Esofagite erosiva desapareceu em 93% dos pacientes. Não houve aumento no tamanho orocaudal da bolsa durante o período de observação. Não houve dilatação do diâmetro da anastomose gastrojejunal. Perto de 54% de todos os pacientes tinham mucosa fúndica normal, enquanto 18% tinham gastrite crônica ativa, coincidente com a infecção por H. pylori. Cinco pacientes tinham metaplasia intestinal. CONCLUSÃO: Com base nesta avaliação endoscópica sequencial, não houve aumento no tamanho orocaudal da bolsa gástrica, nem do diâmetro da anastomose gastrojejunal. O comportamento do H. pylori foi inconsistente e difícil de interpretar.BACKGROUND: Roux-en-Y gastric bypass is the most common performed bariatric surgery. A small gastric pouch is created, leaving a narrow gastrojejunal anastomosis, with a long jejunal limb. Very little is known regarding the behavior of this pouch years after surgery. AIM: To determine through prospective sequential endoscopic studies the size of the gastric pouch, the diameter of the anastomosis, and the

  20. Lower fetuin-A, retinol binding protein 4 and several metabolites after gastric bypass compared to sleeve gastrectomy in patients with type 2 diabetes.

    Directory of Open Access Journals (Sweden)

    Mia Jüllig

    Full Text Available BACKGROUND: Bypass of foregut secreted factors promoting insulin resistance is hypothesized to be one of the mechanisms by which resolution of type 2 diabetes (T2D follows roux-en-y gastric bypass (GBP surgery. AIM: To identify insulin resistance-associated proteins and metabolites which decrease more after GBP than after sleeve gastrectomy (SG prior to diabetes remission. METHODS: Fasting plasma from 15 subjects with T2D undergoing GBP or SG was analyzed by proteomic and metabolomic methods 3 days before and 3 days after surgery. Subjects were matched for age, BMI, metformin therapy and glycemic control. Insulin resistance was calculated using homeostasis model assessment (HOMA-IR. For proteomics, samples were depleted of abundant plasma proteins, digested with trypsin and labeled with iTRAQ isobaric tags prior to liquid chromatography-tandem mass spectrometry analysis. Metabolomic analysis was performed using gas chromatography-mass spectrometry. The effect of the respective bariatric surgery on identified proteins and metabolites was evaluated using two-way analysis of variance and appropriate post-hoc tests. RESULTS: HOMA-IR improved, albeit not significantly, in both groups after surgery. Proteomic analysis yielded seven proteins which decreased significantly after GBP only, including Fetuin-A and Retinol binding protein 4, both previously linked to insulin resistance. Significant decrease in Fetuin-A and Retinol binding protein 4 after GBP was confirmed using ELISA and immunoassay. Metabolomic analysis identified significant decrease of citrate, proline, histidine and decanoic acid specifically after GBP. CONCLUSION: Greater early decrease was seen for Fetuin-A, Retinol binding protein 4, and several metabolites after GBP compared to SG, preceding significant weight loss. This may contribute to enhanced T2D remission observed following foregut bypass procedures.

  1. Endoluminal Revision (OverStitch (TM) , Apollo Endosurgery) of the Dilated Gastroenterostomy in Patients with Late Dumping Syndrome After Proximal Roux-en-Y Gastric Bypass.

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    Stier, Christine; Chiappetta, Sonja

    2016-08-01

    Dumping syndrome is a long-term postoperative complication of Roux-en-Y gastric bypass procedures. Morphologically, dumping syndrome usually correlates with a dilatation of the gastroenterostomy with accelerated pouch emptying. Conservative therapy includes diet changes, complementary pharmacotherapy and, if symptoms persist, surgical revision. Surgical options include endoscopic, endoluminal surgery to constrict the gastrojejunostomy using a novel endoscopic suturing device (OverStitch(TM), Apollo). In our study, we aimed to assess the viability, safety and efficacy of this procedure in patients with late dumping; 14 patients who had developed late dumping syndrome underwent surgery using an endoscopic suturing technique (OverStitch(TM), Apollo). Late dumping was confirmed by Sigstad score and an oral glucose tolerance test (OGTT). Prior to surgery, objective analysis of pouch emptying speed was assessed by gastric scintigraphy. Surgery was performed under general anaesthesia. None of the 14 patients suffered intra- or postoperative complications. No postsurgical increase in inflammation parameters was observed. The postinterventional pain scale (visual analogue scale) showed a mean score of 0.5 (range 0-10). In 13 of the 14 patients, no dumping was observed 1-month postsurgery. The postoperative Sigstad score (3.07 ± 2.06; range 1-9) showed an impressive reduction compared with the preoperative score (12.71 ± 4.18; range 7-24) (p dumping syndrome involving minimal trauma and offering rapid reconvalescence. PMID:27318467

  2. Intestinal obstruction after Roux-en-Y gastric bypass by Higa's technique for treatment of morbid obesity: radiological aspects

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    Labrunie, Ester Moraes [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia]. E-mail: emlabrunie@superig.com.br; Marchiori, Edson [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia

    2007-05-15

    Objective: The aim of this study is to describe the main radiological aspects of postoperative intestinal obstruction in patients submitted to Roux-en-Y gastric bypass by means of the Higa's technique. Materials and methods: A total of 10 patients presenting with postoperative intestinal obstruction following a gastric reduction procedure were evaluated in the period between November 2001 and April 2006, in seven different medical centers. Results: In the ten patients, the obstruction occurred in the small bowel, five of them because of internal hernias, three because of adhesions, one because of an umbilical hernia and one because of intussusception. Four patients presented obstruction early in the postoperative period (by the seventh post-op day), and six, late in the postoperative period (between the third month and the fifth year). Conclusion: All of the cases of intestinal obstruction were found in the small bowel. Internal hernia was the most frequent cause, followed by adhesion. Other causes included umbilical hernia and intussusception. (author)

  3. Hepaticojejunostomy for the management of sump syndrome arising from choledochoduodenostomy in a patient who underwent bariatric Roux-en-Y gastric bypass: A case report

    Science.gov (United States)

    Alqahtani, Mohammed S.; Alshammary, Shadi A.; Alqahtani, Enas M.; Bojal, Shoukat A.; Alaidh, Amal; Osian, Gelu

    2016-01-01

    Introduction Rapid weight loss following bariatric surgery is associated with high incidence of gallstones and complications that may need bilioenteric diversion. This presents a specific challenge in the management of this group of patients. Case presentation A 37 years old female underwent a Roux-en-Y gastric bypass (RYGB) in 2008 for morbid obesity. In 2009 she presented with obstructive jaundice and was diagnosed with choledocholithiasis successfully managed by open cholecystectomy and choledochoduodenostomy. In the following years, she developed recurrent attacks of fever, chills, jaundice, and right upper quadrant pain and her weight loss was not satisfactory. Imaging of the liver showed multiple cholangitic abscesses. Reflux at the choledochoduodenostomy site was suggestive of sump syndrome as a cause of her recurrent cholangitis and a definitive surgical treatment was indicated. Intraoperative findings confirmed sump at the choledochoduodenostomy site and also revealed the presence of a large superficial accessory duct arising from segment four of the liver with separate drainage into the duodenum distal to the choledochoduodenostomy site. A formal hepaticojejunostomy was done after ductoplasty. The Roux limb was created by transecting the jejunum 40 cm distal to the foot anastomosis of the RYGB. The gastric limb was lengthened as part of this procedure which afforded the patient the additional benefit of weight loss. Conclusion Choledochoduodenostomy should be avoided in patients with RYGB due to the risk of sump syndrome which requires conversion to a formal hepaticojejunostomy. PMID:26921534

  4. Roux-en-Y Gastric Bypass Versus Medical Treatment for Type 2 Diabetes Mellitus in Obese Patients

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    Yan, Yong; Sha, Yanhua; Yao, Guoxiang; Wang, Shiguang; Kong, Fanzhi; Liu, Haijun; Zhang, Guangjun; Zhang, Haiqing; Hu, Cheng; Zhang, Xueli

    2016-01-01

    Abstract The aim of the study is to compare Roux-en-Y gastric bypass (RYGB) surgery versus medical treatment for type 2 diabetes mellitus (T2DM) in obese patients. Bariatric surgery can achieve remission of T2DM in obese patients. RYGB surgery has been performed as one of the most common surgical treatment options for obese patients with T2DM, but the efficacy of RYGB surgery comparing with medical treatment alone has not been conclusively determined. A systematic literature search identified randomized controlled trials (RCTs) evaluating RYGB surgery versus medical treatment for T2DM in obese patients was conducted in PubMed, Embase, Cochrane Database, and Cochrane Clinical Trials Registry. This systematic review and meta-analysis were performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The primary outcome was T2DM remission. Additional analyses comprised hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), body mass index (BMI), waist circumference, serum lipid level, blood pressure, medication use, and adverse events. Random-effects meta-analyses were calculated and presented as weighted odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). Six RCTs concerning 410 total obese T2DM patients were included. Follow-up ranged from 12 to 60 months. RYGB surgery was associated with a higher T2DM remission rate (OR: 76.37, 95% CI: 20.70–281.73, P < 0.001) and serum level of high-density lipoprotein cholesterol (MD: 0.24 mmol/L, 95% CI 0.18–0.30 mmol/L, P < 0.001) than medical treatment alone. HbA1c (MD: –1.25%, 95% CI: –1.88% to –0.63%, P < 0.001), BMI (MD: –6.54 kg/m2, 95% CI: –9.28 to –3.80 kg/m2, P < 0.001), waist circumference (MD: –15.60 cm, 95% CI: –18.21 to –13.00 cm, P < 0.001), triglyceride (MD: –0.87 mmol/L, 95% CI: –1.17 to –0.57 mmol/L, P < 0.001), low-density lipoprotein cholesterol (MD: –0.32

  5. Gastrojejunal anastomosis stricture after laparoscopic gastric bypass: Our experience with 62 patients Estenosis de la anastomosis gastroyeyunal en el bypass gástrico laparoscópico: Nuestra experiencia con 62 pacientes

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    A. Campillo-Soto

    2010-03-01

    Full Text Available Objective: gastrojejunal stricture (GYS, not only is a common complication after laparoscopic gastric bypass (LGBP, but its frequency is about 15% according to bibliography. Our aim is to present our experience after 62 LGBP. Patients and method: from January 2004 to September-2006, we performed 62 consecutive laparoscopic gastric bypass (Wittgrove's technique. The gastrojejunal anastomosis is performed with auto suture material type CEAA No 21 termino-lateral (ILS, Ethicon. In 4 cases (6.45% was converted to laparotomy, perform the anastomosis in the same way. Monitoring has a range of 3-35 months, conducted in 61 patients because one patient died of pulmonary thromboembolism in the immediate postoperative period after reoperation, after two weeks of gastric bypass, by necrosis of a small fragment of the remnant gastric. In all patients with persistent feeding intolerance were performed barium transit and/or gastroscopy. When gastrojejunal stricture showed proceeded to endoscopic pneumatic dilation (recommending dilate the anastomosis to a maximum 1.5 cm. Results: five cases (8.1% developed a gastrojejunal stricture, in 4 of these cases the initial diagnosis was made by barium transit and in 1 case by endoscopy. Two patients had a history of digestive bleeding that required endoscopic sclerosis of the bleeding lesion (circumferentially sclerosis within 48 hours of surgery and sclerosis of bleeding points. All cases were resolved by endoscopic dilatation. At follow-up has not been detected re-stricture. Conclusion: Clinically, gastrojejunal stricture results in a progressive oral intolerance, revealing stenosis between 1 and 3 months postoperatively. The situations of sclerosis of the bleeding lesions favor, especially in cases of extensive sclerosis. In cases of suspected barium transit offers us a high diagnostic yield. Endoscopic dilatation resolved, so far, all cases.Objetivo: la estenosis de la anastomosis gastroyeyunal representa una

  6. Anesthesia Management of the Gastric Bypass of Type ⅡDiabetes%2型糖尿病胃转流术的麻醉管理

    Institute of Scientific and Technical Information of China (English)

    彭海风; 曹渊; 付光周

    2014-01-01

    Objective To explore a more reasonable and feasible anesthesia management mode so as to provide a reference for the gastric bypass anesthesia management of patients with type II diabetes. Methods 1. 32 patients with type Ⅱdiabetes underwent gastric bypass were selected. Before the operation, the blood glucose of the patients was controlled below 11.1mmol/l by the insulin pump infusion; the blood glucose of the patients was controlled below 12.0mmol/l except patients whose blood glucose was below 8.6mmol/l during the operation; 2. According to the anesthesia method, the patients were randomly divided into two groups, the general anesthesia combined with epidural block group and general anesthesia group. Results The blood glucose of the general anesthesia combined with epidural block group is smaller, and the hemodynamics is more stable, postoperative awake is quicker and the total dosage of insulin used in the operation is significantly less than that of the general group. Conclusion The general anesthesia combined with epidural block is a kind of safe, feasible and reasonable anesthesia management mode for patients with type II diabetes undergoing gastric bypass surgery and controlling blood glucose during the perioperative period.%目的:探讨一种较为合理可行的麻醉管理模式,为2型糖尿病患者行胃转流术的麻醉管理提供借鉴。方法选择行胃转流术的2型糖尿病患者32例,术前用胰岛素泵注,将血糖控制在11.1 mmol/l以下,术中使用胰岛素调控血糖在12.0 mmol/l以下,血糖在8.6 mmol/l以下不使用胰岛素,麻醉方法选择随机分成两组,硬膜外复合全身麻醉组和全身麻醉组。结果硬膜外复合全身麻醉组患者在术中血糖波动小,血流动力学稳定,术毕清醒快,术中胰岛素使用总量较全身麻醉组明显减少。结论Ⅱ型糖尿病患者行胃转流术,围术期合理调控血糖,麻醉选择硬膜外复合全身麻醉,是一种安

  7. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    Science.gov (United States)

    Ochieng, Vincent; Hendrickx, Leo; Valk, Jody

    2016-01-01

    Background The management of chronic abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGP) is complex and challenging. Foreign body intestinal perforation including that caused by fish bones has previously been reported in the literature and if clinically unrecognized, can cause significant morbidity and mortality. Fish bone perforation as a cause of chronic abdominal pain after LRYGP has rarely been reported. Summary The unusual case of a 54 year old female presenting with recurrent episodes of postprandial pain 2 years after LRYGP is reported. Previous radiological and endoscopic investigations did not reveal any abnormality and after the most recent clinical presentation, a laparoscopic exploration was performed. A protruding fish bone at the biliary-digestive junction was discovered intra-operatively and successfully extracted. Dense adhesions between the involved intestinal loops were lysed in an attempt to improve intestinal transit and subsequently relieve post-prandial pain. Conclusion This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP. PMID:27107305

  8. 腹腔镜胃旁路手术治疗2型糖尿病的围手术期护理%Perioperative nursing of patients with type Ⅱ diabetes mellitus treated by laparoscopic gastric bypass surgery

    Institute of Scientific and Technical Information of China (English)

    穆丽茜; 尹建花; 周晓俊

    2012-01-01

    目的 探讨2型糖尿病患者行腹腔镜下胃旁路手术围手术期的护理方法.方法 对25例2型糖尿病行腹腔镜下胃旁路手术患者实施围手术期护理,并进行术后随访.结果 对25例患者按糖尿病诊断标准做葡萄糖耐量试验,空腹血糖、餐后2h血糖提示糖尿病病情明显好转.结论 针对性的围手术期护理对2型糖尿病腹腔镜胃旁路手术患者的康复具有积极的意义.%Objecyive To investigate the perioperative nursing of type Ⅱ diabetes mellitud treated by laparoscopic gastric bypass surgery.Methods Pefioperative nursing and follow up were performed for twenty five patients with type Ⅱ diabetes who were treated by laparoscopic gastric bypass surgery.Results The conditions of these patients were improved significantly by prompts of fasting blood glucose and 2h post-prandial blood glucose after glucose tolerance test was performed for every patient.Conclusions Pertinent perioperative nursing has proactive effect on recovery of patients with type diabetes mellitus and treated by laparoscopic gastric bypass.

  9. EFFECTS OF LONG-TERM ROUX-EN-Y GASTRIC BYPASS ON BODY WEIGHT AND CLINICAL METABOLIC COMORBIDITIES IN BARIATRIC SURGERY SERVICE OF A UNIVERSITY HOSPITAL

    Science.gov (United States)

    da SILVA, Cátia Ferreira; COHEN, Larissa; SARMENTO, Luciana d'Abreu; ROSA, Felipe Monnerat Marino; ROSADO, Eliane Lopes; CARNEIRO, João Régis Ivar; de SOUZA, Antônio Augusto Peixoto; MAGNO, Fernanda Cristina Carvalho Mattos

    2016-01-01

    ABSTRACT Background: Due to the high failure rate observed in the clinical treatment of morbid obesity an increase in bariatric surgery indications, as an alternative for the control of obesity and comorbidities, is noticeable. Aim: To evaluate the performance of type 2 diabetes mellitus, high blood pressure and dyslipidemia in patients submitted to Roux-en-Y gastric bypass in late follow-up. Methods: Retrospective analysis of 59 patients included in the bariatric surgery program. Anthropometric (height and body weight) and laboratory (LDLc, HDLc, VLDLc, triglyceride -TG - and glucose) data were collected on pre- and postoperative stages, through medical records. Results: Among the patients, 86% were female aged 43±11, of whom 52% had attended high school. The average postoperative time was 7±3 years. During the postoperative period, there were decreases of weight and body mass index, respectively (133±06 kg vs 91±04 kg p<0.05 e 49±74 kg/m2 vs 33±79 kg/m2, p<0.05). In comparison to the preoperative stage, lower concentrations of glucose (101.00±26.99 vs 89,11±15.19, p=0.014), total cholesterol rates (179.00±37,95 vs 167.48±28,50, p=0.016), LDLc (104.30±33.12 vs 91.46±24.58, p=0.016), VLDLc (25.40±11,12 vs 15.68±7.40, p<0.01), and TG (143.35±86.35 vs 82.45±37.39, p<0.01) and higher concentrations of HDLc (43.53±8.23 vs 57.90±15.60, p<0.01) were identified in the postoperative stage. 40% of hypertensive patients were still undergoing high blood pressure treatment during the postoperative stage. There was remission of type 2 diabetes mellitus and dyslipidemia on 81% and 94% of the cases, respectively. Conclusion: Roux-en-Y gastric bypass has proven itself to be an effective long term procedure, promoting weight loss, remission of DM2 and dyslipidemia. PMID:27683769

  10. Comparison of weight loss outcomes 1 year after sleeve gastrectomy and Roux-en-Y gastric bypass in patients aged above 50 years

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    Palanivelu Praveenraj

    2016-01-01

    Full Text Available Introduction: Safe, effective weight loss with resolution of comorbidities has been convincingly demonstrated with bariatric surgery in the aged obese. They, however, lose less weight than younger individuals. It is not known if degree of weight loss is influenced by the choice of bariatric procedure. The aim of this study was to compare the degree of weight loss between laparoscopic sleeve gastrectomy (LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB in patients above the age of 50 years at 1 year after surgery. Materials and Methods: A retrospective analysis was performed of all patients more than 50 years of age who underwent LSG or LRYGB between February 2012 and July 2013 with at least 1 year of follow-up. Data evaluated at 1 year included age, sex, weight, body mass index (BMI, mean operative time, percentage of weight loss and excess weight loss, resolution/remission of diabetes, morbidity and mortality. Results: Of a total of 86 patients, 54 underwent LSG and 32 underwent LRYGB. The mean percentage of excess weight loss at the end of 1 year was 60.19 ± 17.45 % after LSG and 82.76 ± 34.26 % after LRYGB (P = 0.021. One patient developed a sleeve leak after LSG, and 2 developed iron deficiency anaemia after LRYGB. The remission/improvement in diabetes mellitus and biochemistry was similar. Conclusion: LRYGB may offer better results than LSG in terms of weight loss in patients over 50 years of age.

  11. Comparison of weight loss outcomes 1 year after sleeve gastrectomy and Roux-en-Y gastric bypass in patients aged above 50 years

    Science.gov (United States)

    Praveenraj, Palanivelu; Gomes, Rachel M; Kumar, Saravana; Perumal, Sivalingam; Senthilnathan, Palanisamy; Parthasarathi, Ramakrishnan; Rajapandian, Subbiah; Palanivelu, Chinnusamy

    2016-01-01

    INTRODUCTION: Safe, effective weight loss with resolution of comorbidities has been convincingly demonstrated with bariatric surgery in the aged obese. They, however, lose less weight than younger individuals. It is not known if degree of weight loss is influenced by the choice of bariatric procedure. The aim of this study was to compare the degree of weight loss between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients above the age of 50 years at 1 year after surgery. MATERIALS AND METHODS: A retrospective analysis was performed of all patients more than 50 years of age who underwent LSG or LRYGB between February 2012 and July 2013 with at least 1 year of follow-up. Data evaluated at 1 year included age, sex, weight, body mass index (BMI), mean operative time, percentage of weight loss and excess weight loss, resolution/remission of diabetes, morbidity and mortality. RESULTS: Of a total of 86 patients, 54 underwent LSG and 32 underwent LRYGB. The mean percentage of excess weight loss at the end of 1 year was 60.19 ± 17.45 % after LSG and 82.76 ± 34.26 % after LRYGB (P = 0.021). One patient developed a sleeve leak after LSG, and 2 developed iron deficiency anaemia after LRYGB. The remission/improvement in diabetes mellitus and biochemistry was similar. CONCLUSION: LRYGB may offer better results than LSG in terms of weight loss in patients over 50 years of age. PMID:27279392

  12. Roux-En Y Gastric Bypass Results in Long-Term Remission of Hepatocyte Apoptosis and Hepatic Histological Features of Non-alcoholic Steatohepatitis

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    Schneck, Anne-Sophie; Anty, Rodolphe; Patouraux, Stéphanie; Bonnafous, Stéphanie; Rousseau, Déborah; Lebeaupin, Cynthia; Bailly-Maitre, Beatrice; Sans, Arnaud; Tran, Albert; Gugenheim, Jean; Iannelli, Antonio; Gual, Philippe

    2016-01-01

    The long-term effects of bariatric surgery on non-alcoholic steatohepatitis (NASH), focusing on liver injury and hepatocyte apoptosis, are not well-established. We here performed a longitudinal study with paired liver biopsies of nine morbidly obese women (median BMI: 42 [38.7; 45.1] kg/m2) with NASH with a median follow-up of 55 [44; 75] months after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. LRYGB surgery was associated with significant weight loss (median BMI loss −13.7 [−16.4; −9.5] kg/m2), improved hepatic steatosis in all patients (55.5% with total resolution), and resolution of hepatic inflammation and hepatocyte ballooning in 100 and 88.8% of cases, respectively. Alanine aminotransferase levels dropped to normal values while hepatic activated cleaved caspase-3 levels strongly decreased after a median follow-up of 55 months. Hepatocyte apoptosis, as evaluated by serum caspase-generated keratin-18 fragment, improved within the first year following LRYGB and these improvements persisted for at least 55 months. LRYGB in morbidly obese patients with NASH is thus associated with a long-lasting beneficial impact on hepatic steatohepatitis and hepatocyte death. PMID:27594839

  13. Development of a gastric bypass animal model in Goto-Kakizaki rats%Goto-Kakizaki大鼠胃转流手术模型的建立

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    高宏凯; 郑春秀; 张全义; 李晗; 郭晓博; 张新国

    2010-01-01

    目的 建立Goto-kakizaki(GK)大鼠胃转流手术(gastric bypass, GBP)的动物模型. 方法 GK大鼠16只,随机分2组(n=8),Wistar大鼠8只.Ⅰ组:GK大鼠假手术组;Ⅱ组:Wistar大鼠GBP手术组;Ⅲ组:GK大鼠GBP手术组,于术前、术后1周、4周检测空腹血糖、OGTT. 结果 (1)全部实验动物大鼠均术后长期存活;(2) 与Ⅰ组相比,Ⅲ组术后空腹血糖明显下降(P<0.05);(3) 与Ⅰ组相比,Ⅲ组在OGTT各时间点血糖水平明显下降 (P<0.05).结论 成功建立GK大鼠的GBP动物模型; GBP 能显著降低GK大鼠术后空腹血糖和改善糖代谢.

  14. Oxyntomodulin Identified as a Marker of Type 2 Diabetes and Gastric Bypass Surgery by Mass-spectrometry Based Profiling of Human Plasma

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    Nicolai J. Wewer Albrechtsen

    2016-05-01

    Full Text Available Low-abundance regulatory peptides, including metabolically important gut hormones, have shown promising therapeutic potential. Here, we present a streamlined mass spectrometry-based platform for identifying and characterizing low-abundance regulatory peptides in humans. We demonstrate the clinical applicability of this platform by studying a hitherto neglected glucose- and appetite-regulating gut hormone, namely, oxyntomodulin. Our results show that the secretion of oxyntomodulin in patients with type 2 diabetes is significantly impaired, and that its level is increased by more than 10-fold after gastric bypass surgery. Furthermore, we report that oxyntomodulin is co-distributed and co-secreted with the insulin-stimulating and appetite-regulating gut hormone glucagon-like peptide-1 (GLP-1, is inactivated by the same protease (dipeptidyl peptidase-4 as GLP-1 and acts through its receptor. Thus, oxyntomodulin may participate with GLP-1 in the regulation of glucose metabolism and appetite in humans. In conclusion, this mass spectrometry-based platform is a powerful resource for identifying and characterizing metabolically active low-abundance peptides.

  15. Dilatação endoscópica de anastomose gastrojejunal após bypass gástrico Endoscopic dilation of gastrojejunal anastomosis after gastric bypass

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    Josemberg Marins Campos

    2012-12-01

    Full Text Available INTRODUÇÃO: Bypass gástrico em Y-de-Roux pode resultar em estenose de anastomose gastrojejunal. Não há protocolo de tratamento bem definido para essa complicação. OBJETIVO: Analisar os resultados da dilatação endoscópica em pacientes com estenose, através de revisão sistemática, incluindo complicações e taxa de sucesso. MÉTODOS: Foi realizada busca dos estudos relevantes publicados de 1988 a 2010 na base de dados do PubMed, sendo identificados 23 estudos para análise. Apenas os que descreviam o tratamento de estenose de anastomose após bypass gástrico em Y-de-Roux foram incluídos e relatos de caso que apresentavam menos de três pacientes foram excluídos. RESULTADOS: A idade média da população foi de 42,3 anos e o índice de massa corpórea pré-operatório médio foi de 48,8 kg/m². No total, 760 pacientes (81% feminino foram submetidos a 1298 procedimentos, sendo realizadas 1,7 dilatações por paciente. Balões Through-the-scope foram utilizados em 16 estudos (69,5% e dilatador de Savary-Gilliard em quatro. Apenas 2% dos pacientes necessitaram revisão cirúrgica após a dilatação; a taxa de complicações reportada foi de 2,5% (n=19. A taxa de sucesso anual foi maior que 98% nos anos 1992 a 2010, exceto por uma de 73% em 2004. Sete estudos relataram complicações, sendo perfuração a mais comum, relatada em 14 pacientes (1,82%, necessitando operação imediata em dois pacientes. Outras complicações foram também relatadas: um hematoma esofágico, uma lesão de Mallory-Weiss, um caso grave de náusea e vômito, e dois casos de dor abdominal importante. CONCLUSÃO: Tratamento endoscópico de estenose é seguro e eficaz; entretanto, mais estudos controlados randomizados devem ser realizados a fim de confirmar esses achados.INTRODUCTION: Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication. AIM: Through

  16. One anastomosis gastric bypass: a simple, safe and efficient surgical procedure for treating morbid obesity El bypass gástrico de una anastómosis: un procedimiento simple, seguro y eficaz para tratar la obesidad mórbida

    Directory of Open Access Journals (Sweden)

    M. García-Caballero

    2004-11-01

    Full Text Available The One Anastomosis Gastric Bypass has been developed from the Mini Gastric Bypass procedure as originally described by Robert Rutledge. The modification of the original procedure consists of making a latero-lateral gastro-jejunal anastomosis instead of a termino-lateral anastomosis, as is carried out as described in the original procedure. The rationale for these changes is to try to reduce exposure of the gastric mucosa to biliopancreatic secretions because of their potentially carcinogenic effects with longer term exposure, which is the major criticism of the original technique. If we fix the jejunal loop to the gastric pouch some centimetres up to the gastro-jejunal anastomosis the biliopancreatic secretions have less possibility of coming into the gastric cavity (gravity force. Furthermore, if the anastomosis is latero-lateral this possibility is reduced even more. In addition, the intestinal loop reinforces the staple line against disruption, and also the gastric pouch against dilatation.El Bypass Gástrico de Una Anastomosis se ha desarrollado a partir del Mini Bypass Gástrico descrito por Robert Rutledge. La modificación del procedimiento original consiste en hacer una anastomosis latero-lateral en lugar de termino-lateral como se hace en la técnica original. Este cambio intenta reducir la exposición de la mucosa gástrica a la secreción bilio-pancreática, evitando así el posible efecto carcinogénico de la exposición crónica que constituye la más importante crítica del procedimiento original. Al fijar el asa de yeyuno a la nueva bolsa gástrica unos centímetros por encima de la anastomosis gastro-yeyunal, la secreción bilio-pancreática tiene menos posibilidades de entrar en la cavidad gástrica (fuerza de gravedad. Al ser la anastomosis latero-lateral esta posibilidad se reduce aún más. Además, el asa de yeyuno refuerza la línea de grapas contra su disrupción y previene la posible dilatación de la bolsa gástrica.

  17. 胃转流手术治疗2型糖尿病机制的研究进展%Advanced in mechanism research about the gastric bypass operation for the treatment of type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    侯亚勃; 高寅生; 杨晓军; 高鹏

    2014-01-01

    胃转流手术治疗2型糖尿病的疗效已经得到明确的肯定,但其确切的治疗机制尚不清楚,目前,临床认为可能是由于术后胃肠道正常解剖结构的改变,引起与血糖代谢有关的胃肠道激素的变化,使糖尿病病情得到缓解,本文就近年来有关胃转流手术治疗2型糖尿病的机制研究作一综述.%It has been confirmed clearly that gastric bypass operation could be used for tbe treatment of type 2 diabetes mellitus.However,the curative mechanism underlying this therapy remain unclear up to now.Referencing the curative mechanisms research progress from domestic and abroad,the possible mechanism is considered as the secretion of gastrointestinal hormones can be changed after gastric by~ss operation,which has altered the normal anatomy structure of the gastrointestinal,and so as to the situation of type 2 diabetes mellitus can be controlled.This review will summarize recent papers related to mechanism research about the gastric bypass operatiou for the treatment of type 2 diabetes mellitus.

  18. Routine supplementation does not warrant the nutritional status of vitamin d adequate after gastric bypass Roux-en-Y.

    Science.gov (United States)

    da Rosa, Cintia Leticia; Dames Olivieri Saubermann, Ana Paula; Jacqueline, Jacqueline; Pereira, Silvia Elaine; Saboya, Carlos; Ramalho, Andréa

    2013-01-01

    La cirugía bariátrica puede llevar deficiencias nutrionales, incluyendo aquellas relacionadas a perdida ósea. El objetivo de este estudio fue avaluar las concentraciones séricas de cálcio, vitamina D y PTH en adultos obesos, antes y seis meses pos cirugía de bypass Gástrico en Y-de-Roux (RYGB) y avaluar las dosis de calcio y vitamina D utilizada después da la cirugía. Métodos: Estudio longitudinal retrospectivo con pacientes adultos de ambos sexos que fueron submetidos al RYGB. Fueron obtenidos datos de peso, estatura e IMC y las concentraciones de 25-hidroxivitamina D, calcio iónicos y PTH. Pos cirugía, los pacientes recibieron la suplementación dietética diaria de 500 mg de carbonato de calcio y 400 UI de vitamina D. Resultados: Fueron avaluados 56 mujeres y 27 hombres. El preoperatorio las concentraciones séricas de vitamina D presentaron inadecuadas en 45% de las mujeres y 37% de los hombres, mientras en el periodo posoperatorio 91% de las mujeres y 85% de los hombres presentaron deficiencia de esta vitamina. Ninguna alteración en las concentraciones séricas de calcio fue encontrada antes ni pos la cirugía. Las concentraciones séricas de PTH en el preoperatorio se mantuvieron adecuadas en 89% de los individuos de ambos sexos. Pos la cirugía las concentraciones séricas se mantuvieron adecuadas en 89% y mujeres y 83% de los hombres avaluados. Conclusión: la obesidad puede ser un factor de riesgo para el desarrollo de la deficiencia de vitamina D. Los resultados enseñan que la suplementación fue incapaz de sanar y prevenir la deficiencia de vitamina D en adultos obesos submetidos RYGB.

  19. Improvement of C peptide zero BMI 24-34 diabetic patients after tailored one anastomosis gastric bypass (BAGUA).

    Science.gov (United States)

    Garciacaballero, M; Martínez-Moreno, J M; Toval, J A; Miralles, F; Mínguez, A; Osorio, D; Mata, J M; Reyes-Ortiz, A

    2013-03-01

    Introducción: Aunque la cirugía bariátrica ha demostrado ser un método muy eficaz en el tratamiento de pacientes diabéticos cuyo páncreas aún es capaz de producir insulina (diabetes tipo 2), así como del síndrome metabólico y las complicaciones relacionadas con la diabetes, no hay información sobre el efecto de este tipo de cirugía en pacientes IMC 24-34 cuando el páncreas no produce insulina en absoluto (tipo 1, tipo LADA y diabetes tipo 2 de larga evolución, entre otros). Métodos: Presentamos datos preliminares de una serie de 11 pacientes todos con valores de Péptido C insulina, tanto de insulina rápida (de 40,6 ± 12,8 a 0 U/día) como de insulina retardada (41,27 ± 7,3 U/día a 15,2 ± 3,3 U/día). Se resolvieron el 100% de las comorbilidades estudiadas y se mejoraron algunas complicaciones graves derivadas de la diabetes como retinopatía o nefropatía. Conclusiones: El bypass gástrico de una anastomosis adaptado a pacientes diabéticos IMC24-34 con péptido C cero elimina el uso de insulina de acción rápida, reduce a una sola inyección diaria la insulina retardada y mejora el control glucémico. Tras la cirugía desaparecen el síndrome metabólico y los episodios severos de hipoglucemia, y mejora significativamente la retinopatía, neuropatía, nefropatía, vasculopatía periférica y cardiopatía.

  20. 一种新型胃转流手术治疗2型糖尿病GK大鼠模型的建立%Establishment of a new gastric bypass animal-model with GK rats

    Institute of Scientific and Technical Information of China (English)

    孙庆磊; 王宇; 张新国; 高宏凯; 赵靓

    2009-01-01

    Objective To establish a new gastric bypass animal-model with Goto-Kakizaki rats whose different parts of the small intestine were bypassed while stomach was not bypassed. Methods Forty male 3-month-old GK rats were randomly divided into 4 groups: group Ⅰ (sham operation), group Ⅱ (duodenum bypassed), group Ⅲ (jejunum bypassed), group Ⅳ(ileum bypassed). Fasting plasma glucose was measured before operation and the 1st, 4th,and 8th week after operation in all the rats, the body weight of all the rats were measured simultaneously. Results The survival rate of opration for the rats was 95%. Two rats in group Ⅳ died on the first day after operation. The mean fasting plasma glucose concentration of the rats in group Ⅱ, Ⅲ, Ⅳ declined obviously 4 weeks after gastric bypass [group Ⅱ (12.02±1.97) vs (6.36±0.50) mmol/L, group Ⅲ (13.42±1.66) vs (5.96± 0.53) mmol/L, group Ⅳ (14.32±2.82) vs (5.18±0.49) mmol/L, all P0.05).4组大鼠术前体质量依次为(253.6±9.37)g、(268.2±7.95)g、(253.0±6.20)g和(262.0±13.47)g,术后4周则分别为(367.0±23.70)g、(384.8±16.12)g、(323.0±16.40)g、和(185.8±11.56)g,除Ⅳ组大鼠体质量明显降低(P<0.01)外,其他组均较术前明显增加(P<0.05).结论 保留全胃的GBP对GK大鼠有明显降糖作用,但降糖效果并不随转流肠袢长度的增加而增加,且与大鼠的体质量增减无关.

  1. Gastric bypass in morbid obese patients is associated with reduction in adipose tissue inflammation via N-oleoylethanolamide (OEA)-mediated pathways.

    Science.gov (United States)

    Montecucco, Fabrizio; Lenglet, Sébastien; Quercioli, Alessandra; Burger, Fabienne; Thomas, Aurélien; Lauer, Estelle; da Silva, Analina Raquel; Mach, François; Vuilleumier, Nicolas; Bobbioni-Harsch, Elisabetta; Golay, Alain; Schindler, Thomas H; Pataky, Zoltan

    2015-04-01

    Paradoxically, morbid obesity was suggested to protect from cardiovascular co-morbidities as compared to overweight/obese patients. We hypothesise that this paradox could be inferred to modulation of the "endocannabinoid" system on systemic and subcutaneous adipose tissue (SAT) inflammation. We designed a translational project including clinical and in vitro studies at Geneva University Hospital. Morbid obese subjects (n=11) were submitted to gastric bypass surgery (GBS) and followed up for one year (post-GBS). Insulin resistance and circulating and SAT levels of endocannabinoids, adipocytokines and CC chemokines were assessed pre- and post-GBS and compared to a control group of normal and overweight subjects (CTL) (n=20). In vitro cultures with 3T3-L1 adipocytes were used to validate findings from clinical results. Morbid obese subjects had baseline lower insulin sensitivity and higher hs-CRP, leptin, CCL5 and anandamide (AEA) levels as compared to CTL. GBS induced a massive weight and fat mass loss, improved insulin sensitivity and lipid profile, decreased C-reactive protein, leptin, and CCL2 levels. In SAT, increased expression of resistin, CCL2, CCL5 and tumour necrosis factor and reduced MGLL were shown in morbid obese patients pre-GBS when compared to CTL. GBS increased all endocannabinoids and reduced adipocytokines and CC chemokines. In morbid obese SAT, inverse correlations independent of body mass index were shown between palmitoylethanolamide (PEA) and N-oleoylethanolamide (OEA) levels and inflammatory molecules. In vitro, OEA inhibited CCL2 secretion from adipocytes via ERK1/2 activation. In conclusion, GBS was associated with relevant clinical, metabolic and inflammatory improvements, increasing endocannabinoid levels in SAT. OEA directly reduced CCL2 secretion via ERK1/2 activation in adipocytes. PMID:25413674

  2. Nonalcoholic fatty liver disease in Japanese patients with severe obesity who received laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) in comparison to non-Japanese patients

    International Nuclear Information System (INIS)

    The number of patients with morbid obesity is increasing worldwide. However, the prevalence of morbid obesity is still low in Japan, and therefore few systematic investigations of liver dysfunction in this population have so far been carried out. This study aimed to investigate the clinical characteristics in severe obese Japanese patients undergoing laparoscopic Roux-en-Y gastric bypass surgery (LRYGB). Eighty-four patients with severe obesity, including 61 Japanese and 23 non-Japanese patients, were analyzed. The mean body mass index (BMI) was 43.7±7.8 kg/m2, and there was no difference between Japanese and non-Japanese patients. Nonalcoholic fatty liver disease (NAFLD) was observed in 45/59 (76.2%) of the Japanese patients. Although there were no differences in the BMI and body weight, serum alanine aminotransferase (ALT) was higher in Japanese patients in comparison to non-Japanese patients (P<0.05). The indices for insulin resistance were significantly higher in the Japanese patients in comparison to non-Japanese patients (P<0.01). The liver/spleen computed tomography (CT) ratios were lower in Japanese patients (P<0.05). The laboratory data and BMI significantly improved at 1 year after LRYGB in both groups. Racial difference may exist difference may exist in NAFLD in patients with severe obesity. When the BMI is similar, liver dysfunction among Japanese patients with severe obesity tends to be higher than in non-Japanese patients. Japanese patients with severe obesity must therefore reduce their body weight to a greater degree in comparison to non-Japanese patients with the same BMI. LRYGB can achieve effective weight control and lower ALT levels in Japanese patients with severe obesity. (author)

  3. Association of Rev-erbα in adipose tissues with Type 2 diabetes mellitus amelioration after gastric bypass surgery in Goto-Kakizaki rats.

    Science.gov (United States)

    Zhang, Rui; Yan, Caifeng; Zhou, Xinrong; Qian, Bangguo; Li, Fuqiang; Sun, Yidan; Shi, Chen; Li, Bing; Saito, Shigeru; Horimoto, Katsuhisa; Zhou, Huarong

    2013-07-15

    We estimated the key molecules related to Type 2 diabetes mellitus (T2DM) in adipose, liver, and muscle tissues, from nonobese diabetic Goto-Kakizaki (GK) rats and their Wistar controls, by computationally analyzing the expression profiles in open source data. With the aid of information from previous reports, Rev-erbα in adipose tissue emerged as one of the most plausible candidates. Here, in animal models, including GK rats surgically treated to ameliorate T2DM, we examined the association of Rev-erbα in adipose tissue with T2DM progression. After analyses of the Rev-erbα mRNA expression in the adipose tissue of our animal models, we compared the Rev-erbα protein expression levels in the adipose, liver, and muscle tissues of GK and Wistar controls at the ages of 1 mo (M), 3M, and 6M. The Rev-erbα protein levels in adipose tissue showed a distinctive pattern, with the negative correlation of an increasing trend in GK rats, and a decreasing trend in Wistar rats during aging, from those in liver and muscle tissues. Moreover, dysregulation of the circadian Rev-erbα expression in the adipose tissue of 6-mo-old GK rats was also observed. In particular, we ameliorated T2DM in GK rats by gastric bypass surgery, and revealed that T2DM amelioration in diabetic GK rats was associated with improved circadian Rev-erbα expression, in a comparison between the surgically treated and untreated GK rats. The roles of Rev-erbα in adipose tissue were further investigated by observations of Rev-erbα-related molecules, with reference to previous reports.

  4. Alcohol reward is increased after Roux-en-Y gastric bypass in dietary obese rats with differential effects following ghrelin antagonism.

    Directory of Open Access Journals (Sweden)

    Andras Hajnal

    Full Text Available Roux-en-Y gastric bypass (RYGB is one of the most successful treatments for severe obesity and associated comorbidities. One potential adverse outcome, however, is increased risk for alcohol use. As such, we tested whether RYGB alters motivation to self-administer alcohol in outbred dietary obese rats, and investigated the involvement of the ghrelin system as a potential underlying mechanism. High fat (60%kcal from fat diet-induced obese, non-diabetic male Sprague Dawley rats underwent RYGB (n = 9 or sham operation (Sham, n = 9 and were tested 4 months after surgery on a progressive ratio-10 (PR10 schedule of reinforcement operant task for 2, 4, and 8% ethanol. In addition, the effects of the ghrelin-1a-receptor antagonist D-[Lys3]-GHRP-6 (50, 100 nmol/kg, IP were tested on PR10 responding for 4% ethanol. Compared to Sham, RYGB rats made significantly more active spout responses to earn reward, more consummatory licks on the ethanol spout, and achieved higher breakpoints. Pretreatment with a single peripheral injection of D-[Lys3]-GHRP-6 at either dose was ineffective in altering appetitive or consummatory responses to 4% ethanol in the Sham group. In contrast, RYGB rats demonstrated reduced operant performance to earn alcohol reward on the test day and reduced consummatory responses for two subsequent days following the drug. Sensitivity to threshold doses of D-[LYS3]-GHRP-6 suggests that an augmented ghrelin system may contribute to increased alcohol reward in RYGB. Further research is warranted to confirm applicability of these findings to humans and to explore ghrelin-receptor targets for treatment of alcohol-related disorders in RYGB patients.

  5. Patients lacking sustainable long-term weight loss after gastric bypass surgery show signs of decreased inhibitory control of prepotent responses.

    Directory of Open Access Journals (Sweden)

    Pleunie S Hogenkamp

    Full Text Available A considerable number of bariatric patients report poor long-term weight loss after Roux-en-Y gastric bypass (RYGB surgery. One possibility for an underlying cause is an impairment of cognitive control that impedes this patient group's dietary efforts.To investigate if patients having either poor or good weight loss response, ~12 years after RYGB-surgery, differ in their ability to inhibit prepotent responses when processing food cues during attentional operations-as measure of cognitive control.In terms of weight loss following RYGB-surgery, 15 'poor responders' and 15 'good responders', matched for gender, age, education, preoperative body mass index, and years since surgery, were administered two tasks that measure sustained attention and response control: a go/no-go task and a Stroop interference task; both of which are associated with maladaptive eating behaviours.The poor responders (vs. good responders needed significantly more time when conducting a go/no-go task (603±134 vs. 519±44 msec, p = 0.03, but the number of errors did not differ between groups. When conducting a Stroop interference task, poor responders read fewer inks than good responders (68±16 vs. 85±10 words, p = 0.002.Patients lacking sustainable weight loss after RYGB-surgery showed poorer inhibitory control than patients that successfully lost weight. In the authors' view, these results suggest that cognitive behavioral therapies post-RYGB-surgery may represent a promising behavioral adjuvant to achieve sustainable weight loss in patients undergoing this procedure. Future studies should examine whether these control deficits in poor responders are food-specific or not.

  6. Super obese behave different from simple and morbid obese patients in the changes of body composition after tailored one anastomosis gastric bypass (BAGUA

    Directory of Open Access Journals (Sweden)

    M. Garciacaballero

    2014-05-01

    Full Text Available Introduction: Super obese patients behave different from simple and morbid obese patients when they reach final changes of body composition (BC after bariatric surgery. This has led us to tailor One Anastomosis Gastric Bypass (BAGUA to achieve better results in this group of patients. Patients and Methods: We studied 83 (37 diabetic and 46 nondiabetic BMI 30 and up patients who completed all evaluation appointment (preoperative, 10 days, 1, 3, 6 and 12 months after tailored BAGUA for diabesity. We used the Tanita body composition analyzer BC-420 MA by the method of single frequency impedance to analyze the evolution of BC in patients classified by BMI 30 - 34,9, 35 - 50, and >50. Results: While preoperative excess weight presented dramatic decreases after tailored BAGUA in all the groups, super obese have different final BC. Diabetics retained more fat mass and visceral fat, where super obese have double (14 kg that simple obese patients (6 kg, they lost more muscle mass, and have higher basal metabolism. The final BC is altered in all parameters if diabetes is added. Conclusions: The reduction of the preoperative excess weight is motivated largely by the tailored effect of BAGUA. Patients BMI 30-50 behaved homogeneous in BC after surgery while patients BMI >50 behave different. Super obese lose less weight, retained more fat mass, visceral fat, bone mass, and total water. This effect should be treated by more aggressive surgery by measuring the entire small intestine to make a proper exclusion (tailored to achieve homogeneous effects.

  7. A genetic variant in proximity to the gene LYPLAL1 is associated with lower hunger feelings and increased weight loss following Roux-en-Y gastric bypass surgery

    Science.gov (United States)

    Bandstein, Marcus; Mwinyi, Jessica; Ernst, Barbara; Thurnheer, Martin; Schultes, Bernd; Schiöth, Helgi B.

    2016-01-01

    Abstract Objective: Bariatric surgery is the most efficient treatment of severe obesity. We investigated to what extent BMI- or waist-hip ratio (WHR)-related genetic variants are associated with excess BMI loss (EBMIL) two years after Roux-en-Y gastric bypass (RYGB) surgery, and elucidated the affected biological pathways. Methods: Two-hundred fifty-one obese patients (age: 43 ± 10.7, preoperative BMI: 45.1 ± 6.1 kg/m2, 186 women) underwent RYGB surgery and were followed up after two years with regard to BMI. Patients were genotyped for 32 single-nucleotide polymorphisms (SNPs) that were investigated with regard to their impact on response to RYGB and preoperatively measured Three Factor Eating Questionnaire (TFEQ) scores. Results: Homozygous T carriers of the SNP rs4846567 in proximity to the Lysophospholipase-like 1 (LYPLAL1) gene showed a 7% higher EBMIL compared to wild-type and heterozygous carriers (p = 0.031). TT-allele carriers showed furthermore lower scores for Hunger (74%, p < 0.001), lower Disinhibition (53%, p < 0.001), and higher Cognitive restraint (21%, p = 0.017) than GG/GT carriers in the TFEQ. Patients within the lowest quartile of Hunger scores had a 32% greater EBMIL compared to patients in the highest quartile (p < 0.001). Conclusion: The LYPLAL1 genotype is associated with differences in eating behavior and loss of extensive body weight following RYGB surgery. Genotyping and the use of eating behavior-related questionnaires may help to estimate the RYGB-associated therapy success. PMID:27181159

  8. CHANGES IN QUALITY OF LIFE AFTER SHORT AND LONG TERM FOLLOW-UP OF ROUX-EN-Y GASTRIC BYPASS FOR MORBID OBESITY

    Directory of Open Access Journals (Sweden)

    Rafael M. LAURINO NETO

    2013-09-01

    Full Text Available Context It is unclear whether health-related quality of life (HRQL is sustained in a long-term follow-up of morbidly obese patients who underwent Roux-en-Y gastric bypass (RYGB. Objective This study aims to analyze the HRQL changes following RYGB in short and long-term follow-up. Methods We compared the health-related quality of life among three separate patient groups, using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36. Group A - 50 preoperative morbidly obese patients; Group B - 50 RYGB patients 1-2 years post-surgery; Group C - 50 RYGB patients more than 7 years post-surgery. Results The groups were similar for gender, age and body mass index before surgery. We observed that physical functioning, social function, emotional role functioning and mental health scales did not vary between the three groups. The physical role functioning scale was unchanged in the short-term and decreased compared to the preoperative scale in the long-term follow-up. Bodily pain improved after the operation but returned to the initial level after 7 years. The vitality and general health perceptions improved after the operation and maintained these results after 7 years compared with the preoperative perceptions. Conclusions RYGB improved health-related quality of life in three SF-36 domains (bodily pain, general health perceptions and vitality in the short-term and two SF-36 domains (general health perceptions and vitality in the long-term.

  9. Preoperative determinants of outcomes of laparoscopic gastric bypass in the treatment of morbid obesity Determinantes preoperatorios de resultados del bypass gástrico laparoscópico en el tratamiento de la obesidad mórbida

    Directory of Open Access Journals (Sweden)

    E. García Díaz

    2011-08-01

    Full Text Available Introduction: Laparoscopic gastric bypass (LGBP is the predominant technique in surgical treatment of morbid obesity. Objectives: To evaluate the results of LGBP and measure the validity of some hypothetical variables as predictors of these outcomes. Methods: We carried out a historical cohort study which included 50 morbidly obese patients operated with LGBP. The results were assessed by the Bariatric Analysis and Reporting Outcome System (BAROS, which measures the following parameters: the percentage of excess weight loss (EWL, changes in co-morbidities, quality of life and complications. The independent variables were age, body mass index (BMI, sex, history of depression and presence of more than one cardiovascular risk factor (CVRF. Results: Following LGBP, 11% of the results was classified as excellent, 54% as very good, 25% as good and 9% as fair (median follow-up period: 17 months, 7-37. The best scores were found among younger patients. The EWL (mean: 55.4 ± 16.6% was higher in patients with lower BMI and with no more than one cardiovascular risk factor. We obtained rates of resolution of CVRF of 43.7 to 68.7%, complication rates Introducción: El bypass gástrico laparoscópico (BPGL es la técnica predominante en el tratamiento quirúrgico de la obesidad mórbida. Objetivos: Evaluar los resultados del BPGL y medir la capacidad de algunas variables como hipotéticas predictoras de estos resultados. Métodos: En un estudio de cohorte histórico se han incluido 50 obesos mórbidos intervenidos mediante BPGL, valorando los resultados según el sistema BAROS; este considera el porcentaje de sobrepeso perdido (PSP, evolución de comorbilidades, calidad de vida y complicaciones. Las variables independientes han sido la edad, índice de masa corporal (IMC, sexo, presencia o no de historia depresiva y de más de un factor de riesgo cardiovascular (FRCV. Resultados: La clasificación de los resultados del BPGL fue: 11% resultado excelente, 54

  10. Quality assessment and anti-obesity activity of Stellaria media (Linn.) Vill

    Science.gov (United States)

    2012-01-01

    Background Obesity is recognized as a social problem, associated with serious health risks and increased mortality. Numerous trials have been conducted to find and develop new anti-obesity drugs through herbal sources to minimize side effects associated with the present anti-obesity drugs. The present study was designed to evaluate the quality control parameters, quantitative phytochemical analysis (total phenolic, total flavonoids and total saponin content), and the anti-obesity effect of lyophilized juice (LJ) of Stellaria media (Linn.) Vill. by employing in vitro and in vivo models. Methods In vitro studies were performed to evaluate the inhibitory activity of LJ on pancreatic amylase and lipase. The in vivo pancreatic lipase activity was evaluated by measurement of plasma triacylglycerol levels after oral administration of lipid emulsion to swiss albino mice. Furthermore, the anti-obesity effect of LJ was assessed at two doses, 400 mg/kg and 900 mg/kg body weight in mice fed a high-fat-diet with or without LJ for 6 weeks. Results The LJ inhibited pancreatic amylase and lipase activity in vitro and elevated plasma triacylglycerol level in mice. LJ suppressed the increase in body weight, retroperitoneal adipose tissue, liver weights and serum parameters viz., total cholesterol, total triglyceride, LDL-cholesterol level at the dose of 900 mg/kg body weight of the mice fed with high fat diet. The total phenolic, flavonoid and saponin contents were found to be 0.26 mg/g, 1.4 mg/g and 1.19 μg/g respectively of LJ. Conclusion The anti-obesity effects of LJ in high-fat-diet fed mice may be partly mediated through delaying the intestinal absorption of dietary fat and carbohydrate by inhibiting digestive enzymes. PMID:22943464

  11. 胃转流手术对代谢综合征患者体脂分布改变的影响%Impact of gastric bypass surgery on body fat distribution in patients with metabolic syndrome

    Institute of Scientific and Technical Information of China (English)

    王瑜; 陈自谦; 戴露倢; 刘斌; 王畅; 黄盛

    2012-01-01

    目的 探讨胃转流术后代谢综合征患者体脂分布的改变情况.方法 2009年7月至2010年2月间南京军区福州总院前瞻性入组收治26例胃癌合并代谢综合征病例,行胃转流手术.分别于术前和术后1、4、12、48周,检测体质量指数(BMI)、腰围、臀围和脂肪面积等体脂参数,以及胰岛素抵抗指数(HOMA-IR)等生化指标.结果 胃转流术后,26例代谢综合征患者肥胖、高血压、血脂紊乱及高血糖均获得了不同程度的好转.术后48周,26例患者HOMA-IR由术前的5.7±1.5降至3.4±1.0,BMI由术前的(27.1±3.8) kg/m2降至(22.6± 1.4) kg/m2(P<0.05).其中心性肥胖指标腰围由术前的(95.3±2.5) cm降至(75.3±1.1) cm,内脏脂肪面积由术前的(101.7±13.8) cm2降至(78.7±11.2) cm2(P<0.05);而外周性肥胖指标皮下脂肪面积未见下降(P>0.05).结论 胃转流术后体脂分布由中心性肥胖向外周性肥胖转变;胰岛素抵抗改善与中心性体脂参数下降有关.%Objective To evaluate the changes in body fat distribution after gastric bypass in gastric cancer patients with metabolic syndrome. Methods From July 2009 to February 2010, 26 patients with gastric cancer and concurrent metabolic syndrome were prospectively enrolled and underwent gastric bypass surgery at the Fuzhou General Hospital of Nanjing Military Command.Body mass index (BMI),waist circumference,hip circumference,insulin and insulin resistance index were measured before operation and at postoperative 1,4,12,24,48 weeks. Results After gastric bypass surgery,metabolic syndrome was improved including obesity,hypertension,disturbance of lipid and hyperglycemia.After 48 weeks postoperatively HOMA-IR decreased from 5.7±1.5 to 3.4±1.0 (P<0.05).BMI decreased from (27.1±3.8) kg/m2 to (22.6±1.4) kg/m2 (P<0.05).Indices for central obesity:waist circumference decreased from (95.3±2.5)cm to (75.3±1.1)cm,and visceral fat area decreased from (101.7±13.8) cm2 to (78.7±11.2) cm2

  12. Comparison of Virtual Nutri Plus® and Dietpro 5i® software systems for the assessment of nutrient intake before and after Roux-en-Y gastric bypass

    Directory of Open Access Journals (Sweden)

    Mariane Marques da Silva

    2014-11-01

    Full Text Available OBJECTIVES: The assessment of nutritional intake before and after bariatric surgery assists in identifying eating disorders, nutritional deficiencies and weight loss/maintenance. The 7-day record is the gold standard for such an assessment and is interpreted using specialized software. This study sought to compare the Virtual Nutri Plus® and Dietpro 5i® software systems in assessing nutrient intake in obese patients with type 2 diabetes mellitus who underwent a Roux-en-Y gastric bypass. METHODS: Nutritional intake was assessed in 10 obese women with type 2 diabetes mellitus before and 3 months after Roux-en-Y gastric bypass. The 7-day record was used to assess food intake and then, the Virtual Nutri Plus® and Dietpro 5i® software systems were used to calculate calorie, macronutrient and micronutrient intake based on validated food chemical composition databases. Clinicaltrials.gov: NCT01251016. RESULTS: During the preoperative period, deficits in the ingestion of total fiber and 15 out of 22 estimated micronutrients were observed when using the Virtual Nutri Plus®, compared to deficiencies in total fiber and 4 micronutrients when using the Dietpro 5i®. During the postoperative period, both the Virtual Nutri Plus® and Dietpro 5i® systems detected deficits in the ingestion of total fiber, carbohydrates and 19 micronutrients, but only the Virtual Nutri Plus® detected deficits in complex B vitamins (except B12 and minerals. CONCLUSION: Virtual Nutri Plus® was more sensitive than Dietpro 5i® for the identification of deficits in nutrient intake in obese, type 2 diabetes mellitus patients undergoing Roux-en-Y gastric bypass.

  13. 胃旁路术大鼠模型的建立及其对体质量的影响%Establishment of Gastric Bypass Model and Its Impact on Weight Loss in Rats

    Institute of Scientific and Technical Information of China (English)

    王一龙; 姜明哲; 蔡景理; 陈登刚; 谢杰斌; 李立军; 刘长宝; 陈荣

    2013-01-01

    Objective To establish the model of gastric bypass surgery (RYGB) in SD rats, and to study the effect of gastric bypass surgery on weight loss. Methods Thirty five male SD rats were randomly divided into three groups£ °gastric bypass surgery was performed in 15 male rats as the study group (O group), sham operation was performed in 10 male rats which were given diet control after operation as the study control group (C group), and laparotomy was performed in 10 male rats which were given normal diet control after operation as the blank control group (B group). Body weight and food intake were recorded before and after surgery. Results The number of death rats was 7 in the study group, and the survival rate is 53.3%; the maximum weight loss was happened in the first week after surgery, thereafter weight rebounded slower than group B and C (P<0.05). Conclusions It is feasible to established gastric bypass surgery model in rats. RYGB can control weight of rat effectively.%目的 探讨胃旁路术对SD大鼠体质量减轻的影响.方法 将35只12周龄的雄性SD大鼠随机分为手术组(O)15只、假手术饮食控制组(C)10只及假手术空白对照组(B)10只,O组行胃旁路术,C组饲料量与O组相同,B组给予足量饲料,观察各组大鼠术前及术后每日体质量变化及每周进食量.结果 O组大鼠死亡7只,存活率53.3%;O组大鼠在术后第1周内体质量下降幅度最大,其后体质量出现反弹但较其他各组上升缓慢.结论 通过SD大鼠建立胃旁路术模型是可行的,胃旁路术可有效控制SD大鼠体质量.

  14. Efectividad y seguridad a largo plazo del bypass gástrico en "Y" de Roux y de la banda gástrica: revisión sistemática Long-term efficacy and safety of Roux-en-Y gastric bypass and gastric

    Directory of Open Access Journals (Sweden)

    R. Camberos-Solis

    2010-12-01

    Full Text Available Antecedentes: La cirugía bariátrica se ha incrementado sustancialmente en los últimos años. Sin embargo, existen controversias sobre la efectividad y seguridad a largo plazo. Objetivo: Evaluar la efectividad y seguridad a largo plazo del bypass gástrico en Y de Roux (BGRY y de la banda gástrica (Band. Metodología: Se realizó una búsqueda de estudios clínicos aleatorizados y de cohorte, que utilizaron el BGRY y la Band , con seguimiento de > 48 meses, con descripción de pérdida de peso, complicaciones y mortalidad. Resultados: Cuatro trabajos aleatorizados y un estudio prospectivo cumplieron con los criterios de inclusión. La pérdida de peso promedio fue mayor con el BGRY (27%-39% que con la Band (13%-35%. El índice de complicaciones es alto con ambos procedimientos. El índice de reoperaciones es más alto con la Band. Conclusiones: Los resultados observados en esta revisión no son suficientes para generalizar la efectividad y seguridad de la cirugía bariátrica en diferentes sistemas sanitarios.Background: Bariatric surgery has increased substantially in the last years. However, there are controversies of the long-term efficacy and safety. Objective: To evaluate the long-term efficacy and safety of Roux-en-Y gastric bypass (BGRY and gastric banding (Band in randomized controlled trials and cohort studies. Methods: We searched for randomized controlled trials and cohort studies of BGRY and Band, with a follow-up > 48 months, with description of weight loss, complications and mortality. Results: Four randomized trials and one cohort study met the inclusion criteria. Mean weight loss was greater with BGRY (27%-39% than with Band (13%-35%. In both procedures the complication rate is high. Second operation rate is higher with Band. Conclusions: The outcomes observed from this revision are not sufficient to generalize the efficacy and safety of bariatric surgery to population attended at different health care systems.

  15. Stenosis in laparoscopic gastric bypass: management by endoscopic dilation without fluoroscopic guidance Estenosis tras derivación gástrica laparoscópica: tratamiento mediante dilataciones endoscópicas sin control radiológico

    Directory of Open Access Journals (Sweden)

    Jesús Espinel

    2011-10-01

    Full Text Available Objectives: gastric bypass is the surgical procedure that is carried out most frequently in the treatment of morbid obesity. Stenosis of the gastro-jejunal anastomosis is a relatively frequent complication that requires endoscopic management. However, the optimal dilation technique is yet to be determined. The purpose of this study was to evaluate the safety and efficacy of dilation with a hydrostatic balloon (CRE without radioscopic guidance in morbidly obese patients treated by laparoscopic bypass. Material and methods: retrospective review of the data elicited from 525 patients treated against morbid obesity with laparoscopic gastric bypass from January, 2006 to November, 2010. Results: a total of 22/525 patients (4.1% developed stenosis of the anastomosis [20 women (91%, 2 men (9%]. In four patients (18.2%, there was an associated anastomotic ulcer, and in one case, there was a history of bleeding of an ulcer treated with sclerosis one month earlier. The diagnosis of stenosis was done in most patients during the first 90 days after the bypass. All cases were resolved by means of endoscopic dilation without radioscopic guidance, 15 cases (68.1% required a single session, 6 cases (27.2% two sessions, and 1 case (4.5% required four sessions. This last case had an associated anastomotic ulcer. The diameter of the balloons ranged from 12 to 20 mm, generally using diameters of 12-15 mm in the first session, and increasing them in the following sessions according to the previous result. One patient treated with a 20 mm balloon presented with a small tear, without showing any evidence of leak of contrast medium in the radioscopic guidance, and was thus managed conservatively. In the follow-up, no re-stenoses were detected. Conclusions: in our experience, stenosis of the anastomosis in the laparoscopic gastric bypass is an infrequent complication. When it happens, dilation with a hydrostatic balloon is an effective and safe treatment. Radioscopic

  16. Enhanced Anti-Obesity Activities of Red Mold Dioscorea When Fermented Using Deep Ocean Water as the Culture Water

    OpenAIRE

    Tzu-Ming Pan; Chun-Lin Lee; Jyh-Jye Wang; Tsung-Yu Tsai; Bai-Luh Wei; Yi-Hsin Kung; Tzu-Ying Lung; Li-Chun Wang

    2013-01-01

    Deep ocean water (DOW) has, in previous studies, been found to be a novel anti-obesity drink and useful in raising Monascus-produced monascin and ankaflavin levels. This may resolve the limited anti-obesity ability of red mold dioscorea (RMD) known as the Monascus purpureus-fermented Disocorea batatas. This study aims to compare the anti-obesity effect of DOW-cultured RMD (DOW-RMD) and ultra-pure water-cultured RMD (UPW-RMD) in rats fed on a high fat diet. Moreover, the effect of ions composi...

  17. Bypass gástrico en el tratamiento de la obesidad mórbida y la superobesidad: estudio comparativo Gastric bypass in the surgical treatment of the morbid obesity and super obesity: comparative study

    Directory of Open Access Journals (Sweden)

    J. Carvajal-Balaguera

    2007-10-01

    ísticamente significativas en los dos grupos (P Introduction: Gastric Bypass (GB constitutes the surgical treatment of election of morbid obesity (BMI 50. Objective: The purpose of this work is one of to analyze the results of loss of weight of the first 52 open GB of our series, and to compare the losses of weight in morbid obesity (MO and super obesity (SO, to determine if the superobese patient looses enough weight with this technique or if it would be more indicated another technique more malabsorptive, like some authors recommend. Materials and method: Retrospective study of the first 52 patients operated of open GB pathway. The weight loss of 32 patients' with MO are compared with the weight loss of 20 patients with super obesity after five year follow-up. The parameters analyzed are: age, sex, height, initial weight, current weight, initial BMI, current BMI, % BMI lost, % overweight lost, incidence of incisional hernia, acceptable oral tolerance and metabolic alterations. The malabsorptive procedure associated in patients with super obesity was a 200 cm Roux-en-Y and a patients with BMI between 40 and 50 was a 150 cm Roux-en-Y. The results are compared by means of the X² and Mann Whitney statistical test. Results: The age, the sex and the stature are homogeneous in the two groups. In the group of MO the initial weight was of 121,5 kg; initial BMI, 45; current BMI; 28,9, the median loss of weight in 5 years was of 48 kg; the percentage loss of the excess of BMI is of 80% and the percentage loss of the excess of weight is of 74,6%. In the group of SO the initial weight was of 142,7 kg; initial BMI, 54,9; current BMI, 34,9; the median loss of weight in 5 years was of 54 kg; the percentage loss of the excess of BMI was of 65,3% and the percentage loss of the excess of weight was of 63,2%.The analysis of the results ponders shows that it exists statistically significant differences (P < 0,05 among the two groups, however the rate of success, according to the classic parameter of loss of

  18. Short-term outcome of laparoscopic gastric bypass and minigastric bypass on obesity patients with type 2 diabetes mellitus%腹腔镜胃旁路术和迷你胃旁路术对肥胖症合并2型糖尿病患者的短期治疗效果

    Institute of Scientific and Technical Information of China (English)

    胡旭光; 郑成竹; 季新荣; 周东雷; 陈丹磊; 印慨; 柯重伟

    2009-01-01

    Objective To evaluate the short-term outcome of laparoscopic gastric bypass on obesity patients with type 2 diabetes mellitus. Methods Seven obesity patients with type 2 diabetes mellitus received laparoscopic gastric bypass (n=1) or laparoscopic minigastric bypass (n=6), and their data of treatment outcomes were analyzed. Results The operations were all successfully performed without any complications. The average operation time was 125 minutes (range:100 to 170 minutes). The patients underwent 1-18 months follow-up after operation. Diabetic indicators returned to normal without any medication and body weight reduced by on average of 24.3 kg. Conclusion Laparoscopic gastric bypass and minigastric bypass have good short-term outcome in the treatment of obesity patients with type 2 diabetes mellitus.%目的 探讨腹腔镜胃旁路手术和迷你胃旁路术对合并2型糖尿病的病态肥胖症患者的治疗效果.方法 7例伴有2型糖尿病的单纯性肥胖症患者中1例行腹腔镜胃旁路术,6例行腹腔镜迷你胃旁路术,观察患者术后2型糖尿病治疗效果.结果 7例患者手术顺利,手术时间100~170(平均135)min.无手术并发症.术后平均随访1年,体质量平均减少24.3 kg,均已停用所有降糖药物,各项糖尿病检查指标均正常.结论 腹腔镜胃旁路术或迷你胃旁路术对2型糖尿病短期治疗有效.

  19. Weighing the Options: Gastric Sleeve Surgery

    Medline Plus

    Full Text Available ... bariatrics over the past 10 years. Absolutely. The gold standard is the laparoscopic roux-en-y gastric ... as an alternative to the other two. The gold standard is the roux-en-y gastric bypass. ...

  20. Duodenum inclusion in alimentary transit for preventing or correcting nutritional deficiencies resulting from Roux-en-y gastric bypass in obesity treatment.

    Science.gov (United States)

    Ceneviva, Reginaldo

    2016-01-01

    Nutritional and metabolic complications can develop after Roux-en-Y gastric bypass (RYGB) when there is an exaggerated response to the anatomical and functional changes or when there is inadequate nutritional supplementation. Severe malnutrition is rare, but deficiencies of vitamin B12, iron, calcium and thiamin, metabolic bone disease and gallstones are common after RYGB. Shortage of vitamin B12, iron, calcium and also cholelithiasis are caused at least partially by excluding the duodenum and proximal jejunum from food transit. We designed a new procedure, with the maintenance of the duodenum and proximal jejunum in the gastrointestinal transit through interposition of jejunal loop, as a primary operation to prevent such deficiencies or as corrective surgery for severe malnutrition after RYGB with failure in responding to conservative treatment. Complicações nutricionais e metabólicas podem se desenvolver após a derivação gástrica em Y de Roux (DGYR) quando há uma resposta exagerada às mudanças anatômicas e funcionais ou quando há suplementação nutricional inadequada. A desnutrição grave é rara, mas deficiências de vitamina B12, ferro, cálcio e tiamina, doença óssea metabólica e cálculos biliares são comuns após a DGYR. Dessas deficiências mencionadas, a de vitamina B12, de ferro, de cálcio e também a colelitíase, são causadas, ao menos parcialmente, pela exclusão do duodeno e jejuno proximal. Um novo procedimento com a manutenção do duodeno e do jejuno proximal no trânsito gastrointestinal, mediante interposição de alça jejunal, foi idealizado como operação primária para prevenir essas deficiências ou como cirurgia corretiva de desnutrição grave após DGYR com falha na resposta a exaustivas tentativas de tratamento conservador. PMID:27275596

  1. Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI < 28 kg/m2: a multi-institutional study

    Institute of Scientific and Technical Information of China (English)

    Hui Liang; Wei Guan; Yanling Yang; Zhongqi Mao; Yijun Mei; Huan Liu; Yi Miao

    2015-01-01

    Roux-en-Y gastric bypass surgery (RYGB) has been demonstrated to be successful for treating type-Ⅱ diabetes mellitus (T2DM) patients with a body mass index (BMI) <30 kg/m2,but reports of RYGB for T2DM patients with a BMI <28 kg/m2 are lacking.T2DM patients with a BMI <28 kg/m2 were prospectively recruited to participate in this study in four hospitals.The endpoint was T2DM remission (defined by fasting blood glucose (FBG) level <110 mg/dL and hemoglobin (Hb)A1c level <6.0% at 12 months postoperatively).Predictors of remission were investigated by univariate and multivariate analyses.Eighty-six patients were assessed.Eighty-five patients underwent RYGB,with one conversion to open surgery.We compared the values of various variables before and after surgery.The mean BMI decreased from 24.68 ± 2.12 to 21.72 ± 2.43 kg/m2 (P<0.001).Fifty-eight (67.4%) patients were not treated by drugs or insulin after surgery,and 20 patients (23.3%) had complete remission of T2DM at 12 months after surgery with an acceptable number of complications.The mean HbA1c level in the remission group was significantly lower than that in the non-remission group.Patients with a higher weight,lower HbA1c level,higher C-peptide level,and higher FBG level were more likely to have T2DM remission in multivariate analyses.In conclusion,RYGB was effective and safe for treating T2DM patients with a BMI <28 kg/m2.Complete remission can be predicted by cases having a higher weight,lower HbA1c level,higher C-peptide level,and higher FBG level.

  2. Comparing Outcomes of Two Types of Bariatric Surgery in an Adolescent Obese Population: Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Giovana D Maffazioli

    2016-07-01

    Full Text Available Background: Obesity is prevalent among adolescents and is associated with serious health consequences. Roux-en-Y Gastric Bypass (RYGB and Sleeve Gastrectomy (SG are bariatric procedures that cause significant weight loss in adults and are increasingly being performed in adolescents with morbid obesity. Data comparing outcomes of RYGB versus SG in this age-group are scarce. This study aims to compare short-term (1-6 months and longer-term (7-18 months body mass index (BMI and biochemical outcomes following RYGB and SG in adolescents/young adults.Methods: A retrospective study using data extracted from medical records of patients 16-21 years who underwent RYGB or SG between 2012-2014 at a tertiary care academic medical center. Results: Forty-six patients were included in this study: 24 underwent RYGB and 22 underwent SG. Groups did not differ for baseline age, sex, race or BMI. BMI reductions were significant at 1-6 months and 7-18 months within groups (p<0.0001, but did not differ by surgery type (p= 0.65 and 0.09, for 1-6 months and 7-18 months, respectively. Over 7-18 months, within-group improvement in low density lipoprotein (LDL (-24±6 in RYGB, p=0.003, vs. -7±9mg/dL in SG, p=0.50 and non-high density lipoprotein (non-HDL cholesterol (-23±8 in RYGB, p=0.02, vs. -12±7 in SG, p=0.18 appeared to be of greater magnitude following RYGB. However, differences between groups did not reach statistical significance. When divided by non-alcoholic steatohepatitis stages (NASH, patients with Stage II-III NASH had greater reductions in ALT levels vs. those with Stage 0-I NASH (-45±18 vs -9±3, p=0.01 after 7-18 months. RYGB and SG groups did not differ for the magnitude of post-surgical changes in liver enzymes. Conclusion: RYGB and SG did not differ for the magnitude of BMI reduction across groups, though changes trended higher following RYGB. Further prospective studies are needed to confirm these findings.

  3. Bariatric surgery in old age: a comparative study of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an Asia centre of excellence

    Institute of Scientific and Technical Information of China (English)

    Chih-Kun Huang; Amit Garg; Hsin-Chih Kuao; Po-Chih Chang; Ming-Che Hsin

    2015-01-01

    Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly population.The aim of our study was to compare the safety and efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) in patients aged more than 55 years.We performed a retrospective review of a prospectively collected database.All patients with body mass index (BMI) > 32 kg/m2 and aged more than 55 years undergoing LRYGB or LSG in BMI Surgery Centre,E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the analysis.Demography,peri-operative data,weight loss and surgical complications were all recorded and analyzed.Mean age and BMI of these 68 patients (22 males and 46 female) were 58.8 years (55-79 years) and 39.5 kg/m2 (32.00-60.40 kg/m2).LRYGB was performed in 44 patients and LSG in 24 patients.The two groups were comparable in their preoperative BMI,American Society of Anaesthesia (ASA) score and gender distribution.LSG patients were significantly older than patients receiving LRYGB.The proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients (88.63% vs.50%; P < 0.01).The prevalence of other co-morbidities was similar and comparable between the groups.Mean BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 kg/m2 and 28.2 kg/m2,respectively,and there was no statistically significant difference in mean percentage of excess weight loss (%EWL) at 1 year.The percentage of resolution of diabetes was significantly higher in LRYGB (69.2%) as compared to LSG (33.3%).On the other hand,there was no statistical difference in the percentage of resolution of hypertension,hyperlipidemia and fatty liver hepatitis.The overall morbidity and re-operation rate was higher in LRYGB patients.In morbidly elderly patients,both surgeries achieved good weight loss and

  4. Sleeve gastrectomy versus Roux-en-Y gastric bypass for type 2 diabetes and morbid obesity: double-blind randomised clinical trial protocol

    Science.gov (United States)

    Murphy, Rinki; Evennett, Nicholas J; Clarke, Michael G; Robinson, Steven J; Humphreys, Lee; Jones, Bronwen; Kim, David D; Cutfield, Richard; Plank, Lindsay D; Hammodat, Hisham; Booth, Michael W C

    2016-01-01

    Introduction Type 2 diabetes (T2D) in association with obesity is an increasing disease burden. Bariatric surgery is the only effective therapy for achieving remission of T2D among those with morbid obesity. It is unclear which of the two most commonly performed types of bariatric surgery, laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), is most effective for obese patients with T2D. The primary objective of this study is to determine whether LSG or LRYGB is more effective in achieving HbA1c<6% (<42 mmol/mol) without the use of diabetes medication at 5 years. Methods and analysis Single-centre, double-blind (assessor and patient), parallel, randomised clinical trial (RCT) conducted in New Zealand, targeting 106 patients. Eligibility criteria include age 20–55 years, T2D of at least 6 months duration and body mass index 35–65 kg/m2 for at least 5 years. Randomisation 1:1 to LSG or LRYGB, used random number codes disclosed to the operating surgeon after induction of anaesthesia. A standard medication adjustment schedule will be used during postoperative metabolic assessments. Secondary outcomes include proportions achieving HbA1c<5.7% (39 mmol/mol) or HbA1c<6.5% (48 mmol/mol) without the use of diabetes medication, comparative weight loss, obesity-related comorbidity, operative complications, revision rate, mortality, quality of life, anxiety and depression scores. Exploratory outcomes include changes in satiety, gut hormone and gut microbiota to gain underlying mechanistic insights into T2D remission. Ethics and dissemination Ethics approval was obtained from the New Zealand regional ethics committee (NZ93405) who also provided independent safety monitoring of the trial. Study commenced in September 2011. Recruitment completed in October 2014. Data collection is ongoing. Results will be reported in manuscripts submitted to peer-reviewed journals and in presentations at national and international meetings

  5. 胃转流术治疗2型糖尿病的围手术期护理体会%The experience of peri-operation period nursing of type 2 diabetes treated with gastric bypass surgery

    Institute of Scientific and Technical Information of China (English)

    赵鑫

    2015-01-01

    本文总结10例2型糖尿病患者行胃转流术围手术期的护理经验,包括术前与术后的护理。对胃转流术治疗2型糖尿病的患者充分做好围手术期的护理,对患者术后恢复有着举足轻重的作用,精心的围手术期护理,可确保手术顺利进行,减少术后并发症的发生。%We summarize the experience of peri-operation period nursing of type 2 diabetes treated with gastric bypass surgery in 10 cases,including preoperative and postoperative nursing.We believe that full good round surgical operation period nursing for type 2 diabetes treated with gastric bypass surgery play a decisive role for the postoperative recovery of patients,careful peri-operation period nursing can ensure operation smoothly,reduce the postoperative complications.

  6. 胃旁路手术治疗肥胖伴2型糖尿病的现状%The status quo of gastric bypass surgery to treat obesity with type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    秦超; 徐田磊; 白日星

    2015-01-01

    随着肥胖和2型糖尿病人群的急剧增加,减重外科发展迅速,其中胃旁路手术被广泛应用于治疗肥胖合并2型糖尿病,其疗效得到越来越多的外科医师关注和认可,逐渐成为金标准术式。本文仅就胃旁路手术的由来、疗效和机制进行综述。%With the rapid increase of obesity and type 2 diabetes mellitus group, bariatric surgery has developed rapidly, the gastric bypass surgery has been widely applied in the treatment of obesity with type 2 diabetes, its curative effect attracted more and more surgeons' attention and recognition, and gradually become the gold standard. In this paper, only the origin, curative effect and mechanism of gastric bypass surgery were reviewed.

  7. The anti-obesity effect of Taheebo (Tabebuia avellanedae Lorentz ex Griseb) extract in ovariectomized mice and the identification of a potential anti-obesity compound.

    Science.gov (United States)

    Iwamoto, Kazuko; Fukuda, Youichi; Tokikura, Chisato; Noda, Mayuko; Yamamoto, Ayami; Yamamoto, Misato; Yamashita, Mitsuaki; Zaima, Nobuhiro; Iida, Akira; Moriyama, Tatsuya

    2016-09-23

    Estrogen deficiency-induced obesity has a high risk of visceral fat accumulation and body weight gain. It is also associated with many adverse health conditions. Taheebo extract from Tabebuia avellanedae has been recognized as playing several biological and pharmacological roles. Therefore, we investigated whether the intake of n-BuOH extract of Taheebo shows anti-obesity effect in ovariectomized (OVX) mice. After 16 weeks of feeding, the mice administrated with 0.5% n-BuOH extract of Taheebo showed significantly decreased body weight compared with that of the control mice, and the fat mass also showed a significant decrease. In 3T3-L1 cells, supplementation with n-BuOH extract of Taheebo significantly reduced the triglyceride (TG) levels. Furthermore, bioassay-guided purification of the n-BuOH extract based on the TG levels in 3T3-L1 cells led to the isolation of compound 2 (1-dehydroxy-3,4-dihydroaucubigenin). These results suggested that the anti-obesity effect of Taheebo extract is due to its capability in preventing the accumulation of adipocyte in mice. Taheebo extract might be a promising functional food resources capable of protecting against OVX-induced obesity. PMID:27539320

  8. Lotus seed epicarp extract as potential antioxidant and anti-obesity additive in Chinese Cantonese Sausage.

    Science.gov (United States)

    Qi, Suijian; Zhou, Delong

    2013-02-01

    The antioxidative activities of a lotus seed epicarp extract in different concentrations (6.25, 12.5, 25, 50 and 100 μg.mL(-1)) in pork homogenates representative of Chinese Cantonese Sausage were evaluated using three methods: thiobarbituric acid-reactive substances (TBARS) values, peroxide values (POVs) and acid values (AVs). Also the cytotoxic and anti-obesity effects of the lotus seed epicarp extracts were evaluated using an in vitro 3T3-L1 preadipocyte cell model. Results showed that the lotus seed epicarp extracts were non-toxic and effective in inhibiting preadipocyte differentiation. Supplementation of pork homogenate with lotus seed epicarp extracts was effective in retarding lipid oxidation. Moreover, the antioxidative and preadipocyte differentiation inhibition effects of the lotus seed epicarp extracts were dose-dependent. Thus, the lotus seed epicarp extract might be a good candidate as an antioxidant and anti-obesity natural additive in Chinese Cantonese Sausage.

  9. Review: Evidence-based Clinical Research of Anti-obesity Supplements in Japan

    OpenAIRE

    Yasueda, Asuka; Ito, Toshinori; MAEDA, KAZUHISA

    2013-01-01

    Background: The prevalence of obesity has increased dramatically throughout the world, and weight reduction through lifestyle management is urgently warranted. At present, numerous supplements advertised for their anti-overweight property are available in the Japanese market, but most of these lack proper evidence. Thus, we investigated dietary supplements that have been tested in clinical trials. Search Strategy: We researched anti-obesity supplements in the Japanese market using the google ...

  10. Attitudes and Reported Practice for Obesity Management in Korea After Introduction of Anti-obesity Agents

    OpenAIRE

    Park, Hye Soon; Park, Jee-Young; Cho, Hong-Jun

    2005-01-01

    This study aimed to evaluate current clinical assessments and management of obesity in the primary care setting in Korea since anti-obesity agents have become available. A questionnaire was sent to eligible primary care physicians selected from a national probability sample in two specialties: family physicians and internists. Of 939 randomly selected physicians, 452 (48.1%) replied. We found that 51.8% of physicians were aware of the definition of obesity, and 33.8% were aware of the definit...

  11. 胃转流术后2型糖尿病恢复的分子机制研究进展%Study of the Molecular Mechanisms of Recovery from Type 2 Diabetes after Gastric Bypass Surgery

    Institute of Scientific and Technical Information of China (English)

    杨洪范

    2012-01-01

    Recent studies have shown that gut hormone release is significantly altered after gastric bypass surgery, secondary to exclusion of food from the intestinal transit. The change of gut hormone secretion may contribute not only to modulating the pancreas islet function by the enteroinsular axis but also to promoting the proliferation of pancreatic islet and improve insulin resistance,then finally to affect glucose homeo-stasis. Here is to make a review on the relationship between gut hormones and cytokines such as glucagon-like peptide-l( GLP-1 ),gastric inhibitory polypeptide( GIP ),Ghrelin,peptideYY( PYY ),leptin( LPT ),adi-ponectin( APN ), insulin growth factor-l( IGF-1 )and glucose metabolism after gastric bypass surgery.%近年来研究发现,胃转流术后由于食物流向改变,肠道激素的释放明显发生了变化.肠道激素分泌的改变不仅通过肠-胰岛轴调节胰岛内分泌功能,还促进胰岛增殖和改善胰岛素抵抗,并最终影响糖代谢.胰高血糖素样多肽1、葡萄糖依赖性促胰岛素释放肽、Ghrelin、多肽YY、瘦素、脂联素、胰岛素样生长因子1等激素和细胞因子参与胃转流术后血糖调节,是目前研究的热点,现就其机制进行探讨.

  12. Bypass gástrico en el tratamiento de la obesidad mórbida y la superobesidad: estudio comparativo Gastric bypass in the surgical treatment of the morbid obesity and super obesity: comparative study

    OpenAIRE

    J. Carvajal-Balaguera; M. Martín García-Almenta; S. Oliart Delgado de Torres; J. Camuñas-Segovia; L. Peña-Gamarra; I. P. Fernández; P. Gómez-Maestro; A. Prieto Sánchez; S. Viso-Ciudad; C. M.ª Cerquella-Hernández

    2007-01-01

    Introducción: El Bypass Gástrico (BG) constituye en la actualidad el tratamiento quirúrgico de elección de la obesidad mórbida (IMC 50). Objetivo: El objetivo de éste trabajo es el de analizar los resultados de pérdida de peso de los primeros 52 Bypass Gástricos abiertos consecutivos de nuestra serie y comparar las pérdidas de peso en obesos mórbidos (OM) y superobesos (SO), para determinar si los pacientes supe...

  13. Influence of gastric bypass on expressions of insulin receptor and insulin receptor substrate 2 in islet cells of rats with type 2 diabetes mellitus%胃转流术对2型糖尿病大鼠胰岛细胞胰岛素受体及胰岛素受体底物2表达的影响

    Institute of Scientific and Technical Information of China (English)

    石力; 文艺; 张少华; 陈涛; 崔剑锋; 闫洪涛; 汤礼军

    2015-01-01

      结论:2型糖尿病大鼠胰岛细胞中IRc及IRS-2表达下调,而胃转流术能够使其表达显著增加,这可能是该手术产生对2型糖尿病产生疗效的机制之一。%Objective:To investigate the influence of gastric bypass surgery on expressions of insulin receptor (IRc) and insulin receptor substrate 2 (IRS-2) in islet cells of rats with type 2 diabetes mellitus. Methods:The model of type 2 diabetes mellitus in rats was induced by a high fat and high glucose diet plus intraperitoneal streptozotocin injection, and then the rats with establishment of successful model were divided into model group and gastric bypass group, using the normal rats as normal control group. The rats in gastric bypass group underwent gastrojejunostomy and side-to-side jejunojejunostomy, and those in model group and normal control group underwent sham operation. The fasting glucose and serum insulin levels were measured and insulin sensitivity index (ISI) was calculated before and at 8 weeks atfer operation, and the IRc and IRS-2 expressions in pancreatic tissues were determined by immunohistochemical staining. Results:hTe fasting glucose levels were increased and ISI values were decreased signiifcantly in both model group and gastric bypass group compared with normal control group before operation, but these two parameters were signiifcantly improved in gastric bypass group compared with model group atfer operation (all P0.05). In gastric bypass group at 8 weeks atfer operation, both IRc and IRS-2 expression levels were signiifcantly higher than those in model group (both P0.05). Conclusion:IRc and IRS-2 expressions are decreased in islet cells of rats with type 2 diabetes mellitus, and gastric bypass surgery can increase IRc and IRS-2 expression, which may be one of the mechanisms for the therapeutic effect of this surgical procedure on type 2 diabetes mellitus.

  14. Laparoscopic Aastrectomy for Gastric cancer and Roux-en Y Gastric Bypass on type 2 Diabetes Mellitus%腹腔镜下胃癌根治术联合胃转流术治疗胃癌合并2型糖尿病

    Institute of Scientific and Technical Information of China (English)

    郭浩; 胡远超; 田庆中

    2014-01-01

    目的:探讨腹腔镜下胃癌根治术联合胃转流术治疗胃癌合并2型糖尿病患者的临床疗效及安全性。方法回顾性分析接受腹腔镜胃癌根治术联合胃转流术治疗4例2型糖尿病患者的临床资料。结果4例患者均完成腹腔镜下胃癌根治联合胃转流术,手术顺利,无中转开放,术后未发生严重并发症。术前空腹血糖(FPG)6.6-9.0mmol/L,平均8.1mmol/L;糖化血红蛋白(HbAlC)6.8%-9.5%,平均7.8%。术后 l -12个月复查 FPG4.8-7.9mmoL/L,平均6.4mmoL/L;HbAlC5.5%-7.2%,平均6.3%。据美国糖尿病协会(ADA)糖尿病疗效判断标准,3例治愈,1例改善。结论腹腔镜下胃癌根治术联合胃转流术对胃癌合并2型糖尿病患者临床疗效显著,能有效治疗2型糖尿病,手术安全可行。%Objective To investigate the Clinical efficacy and safety of the Laparoscopic gastrectomy for gastric cancer and Roux -en Y gastric bypass on type 2 di-abetes mellitus.Method Retrospectively analyzed the clinical data of 4 patients under the laparoscopic gastrectomy for gastric cancer in combination with the Roux -en Y gastric bypass on type 2 diabetes mellitus.Result Four patients all completed accomplishes the Laparoscopic gastrectomy for gastric cancer and Roux -en Y gastric by-pass on type 2 diabetes mellitus.Operation smoothly,no opening,no postoperative serious complications occurred.Preoperative fasting plasma glucose(FPG)was 6.6-9. 0 mmoL/L,the average data was8.1mmol/L Glycosylated hemoglobin(HbAlC)was 6.8%-9.5%,the average data was 7.8%.after review 1-12 months,FPG was4. 8-7.9 mmoL/L,the average data was 6.4 mmoL/L,HbAlC 5.5%7.2%,the average data was 6.3%.According to the American diabetes association(ADA)curative effect judgment standard,3 cases were cured,1 case of improvement.Conclusion The Clinical efficacy and safety of the Laparoscopic gastrectomy for gastric cancer and Roux-en Y gastric

  15. Clinical analysis of gastric bypasses operation in the treatment of the patients with type 2 diabetes mellitus%胃转流手术治疗2型糖尿病临床分析

    Institute of Scientific and Technical Information of China (English)

    刘学军; 齐德军; 靳和平

    2013-01-01

    Objective To investigate the curative effect, the operation indications, the long-term effect and cautions of gastric bypass operation in the treatment of the patients with type 2 diabetes mellitus. Methods The data of 126 cases of the gastric bypass operation in the treatment of patients with type 2 diabetes mellitus from March 2009 to July 2012 in our hospital were analyzed and concluded, and had a follow-up. Results Among 126 cases of patients, 113 cases were cured, taking up 89.68%; 13 cases became belter, taking up 10.32%, no case was ineffective, there was no evidence of recurrence after follow-up 1 month to 40 months. Conclusion The curative effect of gastric bypass operation in the treatment of patients with type 2 diabetes mellitus is reliable; operation indication uses fasting C peptide values as absolute index, reference duration, age factors; operation mode uses gastrointestinal short type "Y" as its first choice; the long-term therapeutic effect is stable; we should pay attention to prevent cardiac complications, postoperative prevention of gastroparesis during the operation period.%目的 探讨胃转流手术治疗2型糖尿病的疗效、手术适应证、远期效果和注意事项.方法 对我院2009年3月~2012年7月开展的胃转流手术治疗2型糖尿病的126例病例资料进行回顾性分析,并进行严格随访.结果 全组126例,治愈113例,占89.68%;好转13例,占10.32%;无效0例.随访1~40个月,治愈者无复发.结论 胃转流手术治疗2型糖尿病疗效确切;手术适应证以空腹C肽值为绝对指标,参考病程、年龄因素;手术方式以胃肠"Y"形短路术式为首选;手术远期治疗效果稳定;围术期注意防止心脏并发症,术后防止胃瘫.

  16. Curative effect analysis of gastric bypass on type 2 diabetes mellitus%胃旁路术治疗2型糖尿病的疗效分析

    Institute of Scientific and Technical Information of China (English)

    段君英; 王玉林; 林宝行

    2015-01-01

    Objective To explore the long-term curative effect of gastric bypass surgery on T2DM. Methods Clinical and follow-up data of 36 patients with T2DM undergoing gastric bypass in Longgang Central Hospital from January 2006 to December 2010 was retrospectively studied. There were 27 males and 9 females with age ranging from 17 to 54 years old. Weight, blood glucose level and correlative clinical data was collected at different stages postoperatively, and explored the long-term curative effect.Results Thirty-six patients were accepted into this research. 22 cases achieved remission of T2DM, 10 cases were in effect and 4 in vain. 6 cases of hypertension achieved remission or cured, 5 cases of hyperlipidemia returned to normal, and 4 cases of diabetic nephropathy disappeared. The conditions of all the cases in remission were stable without recurrence.Conclusions Gastric bypass surgery can lower the levels of blood glucose, blood pressure, lipid and weight of patients with T2DM with stable long-term effects.%目的探讨胃旁路术治疗2型糖尿病的远期疗效。方法回顾性分析2006年1月至2010年12月在深圳市龙岗中心医院接受胃旁路术治疗的36例2型糖尿病患者的临床和随访资料。其中男27例,女9例;年龄17~54岁。收集术后不同时期的体重、血糖等临床数据,探讨该术式的远期疗效。结果共有36名患者被纳入到该研究中,术后2型糖尿病缓解22例,有效10例,无效4例。6例高血压得到缓解或治愈,5例高血脂恢复正常,4例糖尿病肾病消失。疾病缓解者能维持状态稳定无复发。结论胃旁路手术能降低2型糖尿病患者的血糖、血压、血脂和体重水平,安全可行,远期疗效稳定。

  17. The selection and current situation of animal models for gastric bypass%胃转流术的动物模型选择及现状

    Institute of Scientific and Technical Information of China (English)

    冯犁; 李广阔

    2014-01-01

    2型糖尿病是严重危害人类健康的慢性疾病,经过多年的临床及基础研究,证实了胃转流术(GBP)对2型糖尿病具有很好的治疗作用,但其机制尚未完全阐明。为了明确GBP治疗2型糖尿病的具体机制,运用动物模型研究其机制是必不可少的,而选择适宜的动物模型显得尤为重要。与广泛运用于动物研究中的2型糖尿病大鼠模型相比较,非啮齿类2型糖尿病动物模型具有以下优点:更加贴近人类生理,能够更好地模拟2型糖尿病的发病过程,更适宜外科手术操作。非啮齿类2型糖尿病动物模型主要通过动物本身的基因缺陷(自发性)、基因敲除技术、高脂饮食诱导、化学药物诱导四种方法建立。该篇综述着眼于GBP术的基础研究需求,总结了较为常用的2型糖尿病动物模型资料。%Type 2 diabetes mellitus is a chronic disease which is endangered the human’s health seriously, people have confirmed that the gastric bypass surgery (GBP) has beneficial treatments effects on the type 2 diabetes mellitus by many years of clinical and basic research, however its mechanism is not clear. For explore the mechanism of the GBP, building animal models to study the mechanism is necessary, so it is particularly important to choose a suitable animal model. Compared with the type 2 diabetes mellitus rats model which are widely used in animal experiment, the non rodent type 2 diabetes mellitus animal models are more closed to human physiology, could better simulate the process of type 2 diabetes mellitus and more suitable for surgery operation. The non rodent type 2 diabetes mellitus animal models were mainly induced by the four methods: the genetic defect of the animal (spontaneity), gene knockout technology, high fat diet-induced, chemical drug induced. For the needs of GBP basic research, this review summarized the data of the commonly used type 2 diabetes mellitus animal models.

  18. Valoración diagnóstica y psicopatológica del trastorno por atracón en obesos mórbidos intervenidos de bypass gástrico Diagnostic and psychopathologic evaluation of binge eating disorder in gastric bypass patients

    Directory of Open Access Journals (Sweden)

    E. García Díaz

    2012-04-01

    Full Text Available Introducción: La presencia de trastorno por atracón (TA podría influir en los resultados del bypass gástrico laparoscópico (BPGL en el tratamiento de la obesidad mórbida. En población anglosajona, el TA suele valorarse mediante los cuestionarios Eating Disorder Examination-Questionnaire (EDE-Q y Questionnaire on Eating and Weight Patterns-Revised (QEWP-R. Objetivos: Estudiar la validez y concordancia del EDEQ y QEWP-R para el diagnóstico y valoración psicopatológica del TA en población española con obesidad mórbida intervenida mediante BPGL. Métodos: En un estudio transversal se le ha solicitado a 27 obesos mórbidos recién intervenidos mediante BPGL que cumplimentaran el EDE-Q y QEWP-R traducidos al español. Según las respuestas se han identificado los pacientes con y sin TA, evaluando posibles diferencias entre estos grupos en los ítems con interés psicométrico y midiendo la concordancia entre ambos cuestionarios. Resultados: El QEWP-R permitió diagnosticar un 25,9% de TA y el EDE-Q un 18,5%. Los pacientes con TA tuvieron mayores puntuaciones en los ítems sobre la importancia del peso o figura en la autovaloración, la interferencia en la capacidad de concentración por pensar en la comida, silueta o peso y la frecuencia del sentimiento de culpa después de comer. Entre ambos cuestionarios la concordancia diagnóstica fue escasa, pero se encontró una asociación fuerte entre los ítems con interés psicométrico. Conclusiones: El TA es frecuente en obesos mórbidos intervenidos mediante BPGL y forma un subgrupo de pacientes con más alteraciones psicopatológicas. El QEWP-R y el EDE-Q en español son cuestionarios adecuados para su valoración.Introduction: The presence of binge eating disorder (BED can influence the outcomes of laparoscopic gastric bypass (BPGL in the treatment of morbid obesity. In English population, BED is assessed usually through the Eating Disorder Examination-Questionnaire (EDE-Q and Questionnaire

  19. New advances in models and strategies for developing anti-obesity drugs

    Science.gov (United States)

    Kim, Gilbert W.; Lin, Jieru E.; Blomain, Erik S.; Waldman, Scott A.

    2014-01-01

    Introduction Obesity is a worldwide pandemic. Obesity-related health and economic costs are staggering. Existing strategies to combat obesity through lifestyle improvements and medical intervention have had limited success. Pharmacotherapy, in combination with lifestyle modification, may play a vital role in reversing the disease burden. However, past and current weight-loss medications have had serious safety risks, notably cardiovascular and psychiatric events. Areas covered We review the strategies for designing new anti-obesity drugs by describing those currently in development. We describe their target, mechanism of action, and developmental or regulatory status. We also discuss the problem of weight regain following weight loss, and its relevance to the long-term success of anti-obesity pharmacotherapy. Expert opinion For weight management drugs to achieve the safety and efficacy required to be impactful, current studies are uncovering and characterizing new targets, including new signaling circuits and hormones regulating appetite and metabolism, and re-evaluating the role of pharmacotherapy in weight management. To avoid the safety failures of many past weight-loss drugs, the models and strategies covered in this article incorporate recent advances in knowledge and technology. We discuss the emergence of cGMP signaling as a potentially transformative target in weight management. Modulating cGMP signaling may represent an ideal goal for an anti-obesity pharmacotherapy, reflecting some of the major themes described in the present review: targeting pathways that are newly realized as relevant for weight management; promoting safety by re-purposing drugs that are safe, proven, and approved for clinical use; and having a synergistic effect on multiple, reinforcing pathways. PMID:23621300

  20. A Time Interval of More Than 18 Months Between a Pregnancy and a Roux-en-Y Gastric Bypass Increases the Risk of Iron Deficiency and Anaemia in Pregnancy

    DEFF Research Database (Denmark)

    Crusell, Mie Korslund Wiinblad; Nilas, Lisbeth; Svare, Jens;

    2016-01-01

    OBJECTIVE: The aim of the study is to explore the impact of time between Roux-en-Y gastric bypass (RYGB) and pregnancy on obstetrical outcome and nutritional derangements. METHODS: In a retrospective cross-sectional study of pregnant women admitted for antenatal care at two tertiary hospitals, we...... examined 153 women with RYGB and a singleton pregnancy of at least 24 weeks. The women were stratified according to a pregnancy nutritional parameters and glycated haemoglobin 1Ac (HbA1c) in second and third trimester...... of adverse pregnancy outcome or birth weight between the two groups. CONCLUSION: A long surgery-to-pregnancy time interval after a RYGB increases the risk of iron deficiency anaemia but not of other nutritional deficits. Time interval does not seem to have an adverse effect on the obstetrical outcome...

  1. Establish of GK rat with gastric bypass surgery by different length of small intestine exclusion%GK 大鼠旷置不同长度小肠胃旁路术模型的建立

    Institute of Scientific and Technical Information of China (English)

    周玉龙; 韩晓东; 狄建忠; 张弘玮; 杜贻豹; 李昆; 张频

    2013-01-01

    目的:应用 GK 大鼠建立旷置不同长度小肠的 Roux-en-Y 胃旁路术(RYGBP)动物模型。方法50只GK大鼠随机分为5组,每组10只,分别实施旷置不同长度小肠的胃旁路术式。A组:假手术组,无肠段旷置;B组:旷置十二指肠;C组:旷置十二指肠+近端1/5空肠;D组:旷置十二指肠+近端1/3空肠;E组:旷置十二指肠+近端1/2空肠。观察各组大鼠存活情况;比较各组大鼠术前、术后空腹血糖变化情况。结果共死亡3只大鼠,余各组大鼠长期健康存活,全组大鼠手术存活率94%。除假手术组外,余各组空腹血糖均有不同程度改善。结论 RYGBP对GK大鼠具有确切的改善糖代谢的作用,通过GK大鼠建立旷置不同长度小肠的RYGBP动物模型是可行的,可用于长期观察及相关检测研究,有助于胃旁路术机制研究、小肠旷置长度与降糖效果研究及手术远期效果的观察。%Objective To establish of Goto-Kakizaki diabetes prone rat model with Roux-en-Y gastric bypass (RYGBP) surgery by different length of small intestine exclusion. Methods 50 GK rats were randomly divided into 5 groups, Group A:sham-operation, no small intestine exclusion, Group B:The duodenal exclusion, Group C: The duodenal and the proximal 1/5 jejunum exclusion, Group D: The duodenal and the proximal 1/3 jejunum exclusion, Group E:The duodenal and the proximal 1/2 jejunum exclusion. Fasting glucose changes were compared with that on 1, 4, 8, 12 weeks after operation. Results Three rats died, the rest group rats live healthy, surgical survival rate 94%. Every group fasting glucose was improved to varying degrees except the control group. Conclusions Roux-en-Y gastric bypass surgery exactly improve glucose metabolism in GK rats. The establishment of Goto-Kakizaki diabetes prone rat model with RYGBP surgery by different length of small intestine exclusion is feasible, and can be used for long

  2. 腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病患者的护理%Perioperative Nursing of Laparoscopic Roux-en-Y Gastric Bypass Treatment on Type-2 Diabetes Mellitus Patients

    Institute of Scientific and Technical Information of China (English)

    喻娟; 张敏; 罗琴; 雷慧容

    2011-01-01

    目的 探讨腹腔镜Roux- en Y胃旁路术治疗2型糖尿病(type 2 diabetes mellitus,T2DM)患者的护理方法.方法 回顾性分析2010年6月至2011年1月在广州军区武汉总医院普通外科进行腹腔镜下Roux-en-Y胃肠旁路术治疗的12例T2DM患者的临床资料及治疗过程.所有患者均行腹腔镜Roux-en-Y胃旁路术,术前进行详细评估和准备,包括血糖控制、心理护理干预、膳食控制;术后密切观察病情、定时监测并控制血糖、加强各种管道护理、提供合理的营养支持,观察、预防并发症的发生,并注重对出院患者宣教及随访.结果 本组患者均成功完成全腹腔镜下操作.患者术后2周,1、3个月及1年随访率均为100%.术后1个月随访,仅1例患者仍需使用胰岛素,但胰岛素用量从术前68 U/d减少至26 U/d;其他11例患者均摆脱了胰岛素及其他药物,空腹血糖恢复正常.结论 腹腔镜Roux-en-Y胃旁路术治疗T2DM效果较好,精心护理是确保手术顺利进行、减少术后并发症、促进术后良好恢复的关键.%Objective To explore the nursing measures of the laparoscopic roux-en-Y gastric bypass treatment on type-2 diabetes mellitus (T2DM) patients. Methods From June 2006 to January 2011 ,the clinical data and treatment procedures of 12 T2DM patients with the laparoscopic roux-en-Y gastric bypass treatment were analyzed retrospectively. All the T2DM patients underwent accurate preoperative assessment and preparation,including strict blood sugar controlling, psychological nursing intervention and reasonable diet controlling as well as close observation of the illness status after operation,regular monitor of blood glucose and reasonable control blood sugar, varied strengthened pipelines nursing, reasonable nutrition support,observation and prevention of the occurrence of complications,and enhanced discharge education and follow-up. Results All the patients completed the laparoscopic roux-en-Y gastric

  3. 胃旁路术治疗2型糖尿病的研究进展%Gastric bypass surgery for the treatment of type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    杨垒; 丁卫星

    2013-01-01

    全球糖尿病的发病率逐年上升,现有的规范化内科治疗仍不能完全阻止其病情进展及其并发症的发生,其治疗已成为世界性的难题.减重手术治疗2型糖尿病已在临床使用多年,其中应用最广泛的是胃旁路术,它可引起持久的体重减轻、缓解肥胖相关并发症,尤其是2型糖尿病.然而其治疗机制、适用人群、术后部分患者糖尿病复发的机制尚不明确,有待进一步研究阐明.%The prevelance of diabetes increased significantly year by year around the world,while medicine couldn't prevent its progression and develoment of complications.The treatment of diabetes had become a worldwide problem.Bariatric surgeries had been used to treat type 2 diabetes for many years,of which the nost frequently performed operation,gastric bypass,caused profound weight loss and ameliorated obesity-related comorbid conditions,especially type 2 diabetes mellitus.However,the therapeutic mechanism,targetpopulation and mechanism of recurrence of type 2 diabetes after gastric bypass surgery are not very clear.Further studies need to be performed to verify these problems.

  4. Banda gástrica com desvio jejunoileal: nova opção técnica em cirurgia bariátrica Gastric band with jejunoileal by-pass: new option in bariatric surgery

    Directory of Open Access Journals (Sweden)

    Bruno Zilberstein

    2010-06-01

    Full Text Available RACIONAL: Os procedimentos cirúrgicos para tratamento da obesidade morbida têm sido eficientes na resolução desta afecção a curto e longo prazo. Com exceção da banda gástrica ajustável todos estes procedimentos de alguma forma são capazes de induzir a liberação de hormônios intestinais em função do desvio intestinal e desta forma exercerem um efeito metabólico. OBJETIVO: Com a intenção de obter efeitos semelhantes às operações que promovem um desvio intestinal, com as vantagens de baixa morbidade e mortalidade da BGA, foi proposto novo procedimento técnico associando à banda gástrica ajustável a um desvio jejunoileal. MÉTODO: O procedimento cirúrgico totalmente conduzido por videolaparoscopia, consiste na aplicação inicial da banda gástrica e a seguir a realização de anastomose látero-lateral a 80 cm do ângulo duodenojejunal e 120 cm da válvula ileocecal. RESULTADOS: Foram operados 10 pacientes com esta técnica, seis mulheres e quatro homens com IMC médio de 40 kg/m². A perda média de excesso de peso nos seis primeiros meses foi de 51,56%. Em quatro pacientes diabéticos houve normalização dos níveis glicêmicos e suspensão do uso da medicação antidiabética. CONCLUSÃO: Adição de desvio jejunoileal látero-lateral à banda gástrica pode melhorar a perda de peso em pacientes portadores de obesidade mórbida e contribuir para o controle da diabete tipo II.BACKGROUND: Current procedures for surgical treatment of morbid obesity have proved to be efficient in controlling the process in the short and long follow-up. The bariatric surgical procedures, with the exception of the adjustable gastric banding are capable, in one way or another, of inducing hormonal release due to the intestinal by-pass that they may promote and therefore offering a metabolic effect. AIM: With the intention to maintain the same results promoted by gastrojejunal diversion, while maintaining the lower mortality rates of the

  5. Anti-Obesity Effects of Onion Extract in Zucker Diabetic Fatty Rats

    Directory of Open Access Journals (Sweden)

    Kiharu Igarashi

    2012-10-01

    Full Text Available Anti-obesity effects of onion extract were determined in obesity and diabetes-prone Zucker diabetic fatty rats by measuring the efficacy of markers concerned with diabetes and obesity. Body and adipose tissue weights in 5% of onion extract-fed group were found to be significantly lower than the control group without onion extract. Fasting blood glucose and HOMA-IR levels were also improved, although the serum insulin and leptin levels did not show any remarkable difference. Serum triglyceride and free fatty acid levels in both the 3% and 5%-fed group were found to be reduced compared to the control group. Additionally the feeding of the onion extract increased the glucose tolerance. These results suggest that dietary onion extract is beneficial for improving diabetes by decreasing lipid levels. We also examined differentiation ability of rat white preadipocyte cells using the onion extract and its sulfur-containing components. Cycloalliin, S-methyl-l-cysteine, S-propyl-l-cysteine sulfoxide, dimethyl trisulfide, especially S-methyl-l-cysteine sulfoxide were reported to be effective in inhibiting formation of oil drop in the cells, suggesting that these compounds may be involved in the anti-obesity effect of the onion extract.

  6. Anti-obesity effect of resveratrol-amplified grape skin extracts on 3T3-L1 adipocytes differentiation

    OpenAIRE

    Zhang, Xian-Hua; Huang, Bo; Choi, Soo-Kyong; Seo, Jung-Sook

    2012-01-01

    Resveratrol (3,4,5-trihydroxy-trans-stilbene), a phytoalexin found in grape skin, grape products, and peanuts as well as red wine, has been reported to have various biological and pharmacological properties. The purpose of this study was to investigate the anti-obesity effect of resveratrol-amplified grape skin extracts on adipocytes. The anti-obesity effects of grape skin extracts were investigated by measuring proliferation and differentiation in 3T3-L1 cells. The effect of grape skin ethan...

  7. Comparison of results from different imputation techniques for missing data from an anti-obesity drug trial

    DEFF Research Database (Denmark)

    Jørgensen, Anders W.; Lundstrøm, Lars H; Wetterslev, Jørn;

    2014-01-01

    of handling missing data in a 60-week placebo controlled anti-obesity drug trial on topiramate. METHODS: We compared an analysis of complete cases with datasets where missing body weight measurements had been replaced using three different imputation methods: LOCF, baseline carried forward (BOCF) and MI....... In anti-obesity drug trials, many data are usually missing, and the most used imputation method is last observation carried forward (LOCF). LOCF is generally considered conservative, but there are more reliable methods such as multiple imputation (MI). OBJECTIVES: To compare four different methods...

  8. The complications and countermeasures of accurate after laparoscopic gastric bypass surgery%精准腹腔镜下胃旁路手术后并发症及其对策

    Institute of Scientific and Technical Information of China (English)

    刘剑

    2015-01-01

    目的:总结精准腹腔镜下胃旁路术(LGBP)后可能出现的并发症及其危险因素、治疗对策。方法回顾性分析2010年6月~2013年12月我院119例采用精准腹腔镜胃旁路术治疗的患者,详细记录并分析其临床资料。结果119例患者出现术后并发症11例(9.2%),其中术后出血3例,肠梗阻2例,短期功能性胃排空障碍6例。其中年龄>50岁、糖尿病史、BMI升高为术后并发症的危险因素(OR值分别为1.87、2.14、1.78,P均<0.05),所有患者经对症处理后病情均得到缓解。结论腹腔镜下胃旁路手术并发症并不少见,年龄大、合并糖尿病、肥胖的患者更容易出现术后并发症,临床上更应注意此类患者的术后情况,其出现并发症应积极采取对症处理。%Objective To investigate the rate of complications after precise gastric bypass (LGBP) with laparoscopic, discussed the measurements of complications.Methods119 cases of patients were selected who had precised laparoscopic gastric bypass surgery treatment from June 2010 to December 2013 in our hospital.Results 11 cases (9.2%) of patients accureed postoperative complications, included 3 cases appeared postoperative bleed, 2 case had intestinal obstruction ,and 6 cases short term functional delayed gastric emptying. Patients which age more than 50 years-old, combined diabetes, or with higher BMI score were the risk factors of postoperative complications (OR value were respectively of 1.87,2.14、1.78,P <0.05 ) , all patients in this study were had remission after taken appropriate treatment. Conclusion Laparoscopic gastric bypass surgery complications are not uncommon, and patients of older, combined diabetes, or with higher BMI score hare more possible to occurred postoperative complications. Such kinds of patients should be pay more attention in clinical work, taken appropriate treatment in the first time Once occurred of complications.

  9. Research on effect factors of gastric bypass surgery in treatment of type 2 diabetes mellitus%影响胃转流术治疗2型糖尿病效果的因素研究

    Institute of Scientific and Technical Information of China (English)

    闫军; 董光龙; 季刚; 杨雁灵

    2012-01-01

    目的:总结胃转流术治疗2型糖尿病疗效的影响因素,并探讨其手术适应证.方法:回顾分析为32例2型糖尿病患者行胃转流术的临床资料,对比手术前、后相关指标的变化情况.结果:胃转流术后12个月9例完全缓解,23例未缓解,术后无严重并发症发生.完全缓解组患者年龄、病史、术前空腹血糖、餐后2小时血糖、糖化血红蛋白( hemoglobin A1c,HbA1c)均小于未缓解组,差异有统计学意义(P<0.05);两组患者性别组成、BMI差异无统计学意义(P>0.05).开腹组与腹腔镜组患者年龄、病史、术前空腹血糖、餐后2h血糖、HbA1c、术后12个月降糖效果差异均无统计学意义(P>0.05).结论:2型糖尿病患者术前年龄、病史、血糖控制情况及术中剩余胃囊的大小明显影响胃转流术后降糖效果.%Objective:To summarize the effect factors of gastric bypass surgery in treatment of type 2 diabetes mellitus.and explore the surgical indications. Methods:Clinical data of type 2 diabetes patients (n =32) who underwent gastric bypass were retrospectively analyzed and the preoperative and postoperative related index changes were compared. Results;Nine cases were completely remitted and 23 cases were not remitted by the end of 12 months after gastric bypass and postoperative complications were not severe. Preop-eratire age, medical history, fasting plasma glucose (FPG) ,2h plasma glucose (PC), hemoglobin Ale (HbAlc) of complete remission group were lower than those of non-remission group,and differences were statistically significant (P 0.05). There were no statistically significant differences between the open group and the laparoscopic group in preoperative age,gender,medical history,FPG,2h PG,HbAlc and postoperative result after 12 months (A>>0.05). Conclusions:Postoperative result is significantly effected by preoperative age,medical history,controlled levels of blood glucose and intraoperative volume of residual gastric

  10. Significance of oxidative stress changes in type 2 diabetic patients after gastric bypass%胃转流术后2型糖尿病患者氧化应激状态的改变及其意义

    Institute of Scientific and Technical Information of China (English)

    石力; 汤礼军; 陈涛; 崔建峰; 邹洪; 田伏洲

    2011-01-01

    Objective To observe the changes in oxidative stress in type 2 diabetic (T2DM) patients after gastric bypass, and investigate the mechanism of gastric bypass treatment for T2DM.Methods Thirty T2DM patients who underwent gastric bypass (T2DM group) and thirty healthy subjects (control group) were included in present study from Aug.2009 to Apr.2010.Values of fasting plasma glucose (FPG), 2-hour postprandial plasma glucose ( 2hPG), glycosylated hemoglobin (HbAlc), fasting plasma insulin (FIns),superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione peroxidase (GSH-PX) were determined in T2DM group before surgery and 1, 3, 6 months after surgery.All the parameters were determined once in control group.Results Compared with control group, MDA was significantly higher (3.6±1.3 vs 2.2±0.7μmol/L, P<O.01), and SOD and GSH-PX were significantly lower (45.2±18.8 vs 87.6±20.4kU/L, P<0.01; 53.6±16.8 vs 78.9±15.6mmol/L, P<0.01) in T2DM group.Compared with the preoperative values, the MDA decreased significantly (P<0.05), and SOD and GSH-PX increased significantly (P<0.01) in T2DM group 3 months after operation.Compared with preoperative values, FPG, 2hPG and HbAlc decreased significantly (P<0.01) in T2DM group one month after operation.Compared with the values one month after operation, 2hPG and HbAlc decreased significantly (P<0.01, P<0.05) 3 months after operation.Values of HOMA-IR decreased significantly from one month to six months after surgery (P<0.01).Conclusions Oxidative stress can be improved markedly after gastric bypass in T2DM patients.It may be one of the mechanisms of suceessful treatment of T2DM with gastric bypass.%目的 观察2型糖尿病(T2DM)患者行胃转流术后氧化应激指标的变化,探讨胃转流术治疗T2DM的作用机制.方法 选取2009年8月-2010年4月间收治的30例T2DM患者作为T2DM组,同期30例健康体检者作为对照组.检测T2DM患者行胃转流手术前及手术后1、3、6个月

  11. Heart bypass surgery

    Science.gov (United States)

    Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery; Coronary artery disease - CABG; CAD - CABG; Angina - ...

  12. Enhanced Anti-Obesity Activities of Red Mold Dioscorea When Fermented Using Deep Ocean Water as the Culture Water

    Directory of Open Access Journals (Sweden)

    Tzu-Ming Pan

    2013-10-01

    Full Text Available Deep ocean water (DOW has, in previous studies, been found to be a novel anti-obesity drink and useful in raising Monascus-produced monascin and ankaflavin levels. This may resolve the limited anti-obesity ability of red mold dioscorea (RMD known as the Monascus purpureus-fermented Disocorea batatas. This study aims to compare the anti-obesity effect of DOW-cultured RMD (DOW-RMD and ultra-pure water-cultured RMD (UPW-RMD in rats fed on a high fat diet. Moreover, the effect of ions composition of DOW and DOW-influenced functional metabolites change of RMD on the differentiation and lipogenesis regulation were investigated using 3T3-L1 pre-adipocytes. In the animal test, compared to UPW-RMD, DOW-RMD possessed better ability to inhibit increases in weight gain, and better feed efficiency, body-fat pad and cross-sectional area of adipocytes. In the cell test, the anti-obesity abilities of DOW-RMD in inhibiting PPARγ and C/EBPα expression in differentiation and lipoprotein lipase activity in lipogenesis were contributed to by the DOW-increased monascin and ankaflavin levels and the ions of DOW, respectively.

  13. Anti-obesity effect of Dioscorea nipponica Makino with lipase-inhibitory activity in rodents.

    Science.gov (United States)

    Kwon, Chong-Suk; Sohn, Ho Yong; Kim, Sung Hee; Kim, Ji Hyun; Son, Kun Ho; Lee, Jeong Soon; Lim, Jin Kyu; Kim, Jong-Sang

    2003-07-01

    In the process of screening for pancreatic lipase inhibitors, which could be used as an anti-obesity measure, the methanol extract of Dioscorea nipponica Makino powder (DP) appeared to have potent inhibitory activity against porcine pancreatic lipase with an IC50 value of 5-10 microg/ml, where the enzyme activity was assayed by using 4-methylumbelliferyl oleate as a substrate. Further purification of active components present in the herb generated dioscin that belongs to the saponin family. Dioscin and its aglycone, diosgenin, both suppressed the time-dependent increase of blood triacylglycerol level when orally injected with corn oil to mice, suggesting their inhibitory potential against fat absorption. Sprague-Dawley rats fed on a high-fat diet containing 5% Dioscorea nipponica Makino and 40% beef tallow gained significantly less body weight and adipose tissue than control animals fed on a high-fat diet alone during an 8-week experimental period (P<0.05). PMID:12913286

  14. Endoscopic and ultrasonographic evaluation before and after Roux-en-Y gastric bypass for morbid obesity Avaliação endoscópica e ultra-sonográfica antes e depois de gastroplastia com derivação intestinal em Y-de-Roux para obesidade mórbida

    OpenAIRE

    Marcelo Passos Teivelis; Joel Faintuch; Robson Ishida; Paulo Sakai; Adriano Bresser; Joaquim Gama-Rodrigues

    2007-01-01

    BACKGROUND: Esophagogastric abnormalities are recognized prior and after bariatric procedures, but frequency and severity are debated. Liver and biliary tract findings are also of clinical importance, especially gallstones and liver steatosis. AIM: To compare pre-operative findings of hepatobiliary ultrasound and upper digestive endoscopy with post-operative results in patients submitted to open Roux-en-Y gastric bypass for morbid obesity. METHODS: A total of 80 patients were enrolled 16.8 &p...

  15. Anti-obesity and cardioprotective effects of cinnamic acid in high fat diet- induced obese rats.

    Science.gov (United States)

    Mnafgui, Kais; Derbali, Amal; Sayadi, Sami; Gharsallah, Neji; Elfeki, Abdelfattah; Allouche, Noureddine

    2015-07-01

    Obesity is a chronic metabolic disorder that is associated with numerous diseases including hyperlipidemia, diabetes mellitus, hypertension, atherosclerosis, cardiovascular disease, and cancer. Cinnamic acid is a phytochemical compound having many biological effects and could be considered for the management of obesity. This study is aimed to assess the possible anti-obesity and cardioprotective properties of cinnamic acid (CA) in high fat diet-fed rats (HFD). Male Wistar rats were divided into 4 groups. They received normal diet, HFD diet, HFD supplemented with fluvastatin (2 mg/kg/day) or cinnamic acid (30 mg/kg/day) for 7 weeks. The results showed an increase in body weight of HFD rats by ~27 % as compared to control group. Moreover, serum lipase activity underwent a significant rise by 103 % which led to an increase in the levels of total cholesterol (T-Ch), triglycerides (TG), LDL-cholesterol in serum of untreated HFD-fed rats. Furthermore, the concentration of leptin and angiotensin-converting enzyme (ACE) activity exhibited remarkable increases in serum of HFD-fed rats as compared to controls. Whereas, the administration of CA to HFD-fed rats improved the body weight gain and serum lipid profile and reverted back near to normal the activities of lipase and ACE. In addition, the echocardiography evidenced that CA is able to protect the aorta and aortic arch and avoided vasoconstriction by increasing their diameters and improved liver steatosis and kidney indices of toxicity. Overall, these results suggest that cinnamic acid exerts anti-obesity and antihypertensive effects through inhibition of lipid digestive enzymes and ACE. PMID:26139902

  16. 胃旁路术对GK大鼠糖代谢影响及其与Ghrelin的关系%Gastric bypass surgery improves glucose metabolism possibly by decreasing ghrelin levels in Goto-Kakizaki rats

    Institute of Scientific and Technical Information of China (English)

    曹超; 曾荣; 张鹏; 周晓磊; 尤胜义

    2011-01-01

    目的:观察胃旁路术(gastric bypass,GBP)对非肥胖型2型糖尿病大鼠(Goto-Kakizaki rats; GK 大鼠)血糖的影响,并探讨其机制.方法:GK大鼠20只,Wistar大鼠10只,均为雄性.分为GK手术组、GK假手术组和Wistar假手术组,每组10只.手术组行胃旁路术.测定术前1wk及术后第1、2、4、8、12 wk各组大鼠的空腹血糖(FPG)、糖化血红蛋白(HbAlc)和血清胰岛素(INS),并同期检测血清Ghrelin水平.结果:术后第12周,GK手术组大鼠FPG和HbAlc分别由术前的11.36 mmol/L±1.14mmol/L和8.91%±0.36%下降到8.36±0.62mmol/L和6.35%±0.46%,血清INS由术前32.76 mlU/L±2.37 mlU/L上升到55.14 mlU/L±5.45 mIU/L,而Ghrelin由术前928.53 ng/L±58.66 ng/L下降到367.83 ng/L±27.78 ng/L,差异均有统计学意义(P<0.05).结论:GBP可以明显改善GK大鼠的糖代谢,其作用机制可能与降低Ghrelin水平,进而促进胰岛素分泌有关.%AIM: To investigate the influence of gastric bypass (GBP) surgery on glucose metabolism in Goto-Kakizaki (GK) rats and to explore the possible mechanisms involved.METHODS: Twenty male GK rats and 10 male Wistar rats were randomized into three groups: GK operation group, GK sham operation group and Wistar sham operation group. The GK operation group underwent gastric bypass surgery. The levels of fasting plasma glucose (FPG), glycosylated hemoglobin (HbAlc), serum insulin (INS) and ghrelin were monitored 1 week before surgery and 1,2,4,8 and 12 weeks after surgery.RESULTS: In the GK operation group, FPG level decreased from (11.36 ± 1.14) mmol/L be-fore surgery to (8.36 ± 0.62) mmol/L 12 weeks after surgery, and HbAlc from (8.91 ± 0.36)% to (6.35 ± 0.46)%. Serum INS increased from (32.70 ± 2.37) mIU/L before surgery to (55.14 ± 5.45) mIU/L 12 weeks after surgery, while serum ghrelin level decreased from (928.53 ± 58.66) pg/mL to (367.83 ± 27.78) pg/mL. All the above parameters differed significantly between before surgery and 12 weeks after surgery

  17. 胃旁路术对糖尿病肾病蛋白尿影响的随访研究%Effect of gastric bypass on diabetic nephropathy with microalbuminuria:one year follow-up study

    Institute of Scientific and Technical Information of China (English)

    张弘玮; 狄建忠; 于浩泳; 韩晓东; 张频

    2015-01-01

    目的:探讨胃旁路术对糖尿病肾病(diabetic nephropathy,DN)的疗效。方法:回顾性分析58例接受胃旁路术的肥胖合并DNⅢ/Ⅳ期病人,随访1年分析手术对2型糖尿病、血压、肾功能以及蛋白尿的影响。结果:术后1年降糖及降压药物用量显著减少,体重、血糖、糖化血红蛋白以及胰岛素抵抗指标均显著下降,DNⅢ期和Ⅳ期糖尿病缓解率分别为83.9%和77.8%。手术前、后肾功能无显著变化,24 h尿蛋白(正常值为<30 mg/24 h)各组均有下降, DNⅢ期于术后1年恢复至正常水平[(78.68±58.48) mg/24 h 比(17.67±14.45) mg/24 h, P<0.001],DNⅣ期组较术前持续降低[(1143.51±969.68) mg/24 h 比(493.57±725.72) mg/24 h, P>0.05]。结论:胃旁路术对2型糖尿病合并肥胖有显著减重、降糖的疗效,且有缓解DN进展的可能。%Objective To investigate the short-term effect of gastric bypass on diabetic nephropathy (DN). Methods A retrospective study was done of 58 obese patients with DN stage ⅢtoⅣperformed Roux-en-Y gastric bypass. The surgical effects on type 2 diabetes mellitus (T2DM), blood pressure, renal function and albuminuria were analyzed with one year follow-up. Results There was significant reduction of medication use for diabetes and hypertension after one year of surgery. The weight, blood glucose level, glycosylated haemoglobin A1c (HbA1c) and insulin resistance reduced significantly compared with those preoperative. Remission of T2DM of DN stage Ⅲ and Ⅳ were 83.9% and 77.8% respectively. Renal function profile had no significant difference before and after surgery. Preoperative albuminuria level in DN stage Ⅲ reduced to normal [(78.68±58.48) mg/24 h vs (17.67±14.45) mg/24 h, P0.05. Conclusions Gastric bypass shows the great improve-ment of T2DM with obesity and DN.

  18. Comparative study between laparoscopic gastric bypass and sleeve gastrectomy for simple obesity%腹腔镜胃旁路术与袖状胃切除术治疗单纯性肥胖症的对比研究

    Institute of Scientific and Technical Information of China (English)

    张光辉; 张进峰; 周宏建; 张春明

    2015-01-01

    目的探讨腹腔镜Roux-en-Y胃旁路术和腹腔镜袖状胃切除术治疗单纯性肥胖症的疗效差异。方法回顾性分析2010年8月至2012年12月在郑州市第二人民医院接受减肥手术治疗的单纯性肥胖患者的临床资料,其中接受腹腔镜胃旁路术28例,接受袖状胃切除术9例,临床检测指标包括术后6个月、12个月、24个月的BMI、空腹血糖水平(FPG)、血红蛋白(HGB)和微量元素(Ca2+、Fe2+、VitB12)。结果两组患者的手术时间存在明显差异(P<0.05),术后6个月、12个月、24个月的BMI、FPG、HGB和微量元素水平均未见明显差异。结论腹腔镜Roux-en-Y胃旁路术和袖状胃切除术均有确切的减肥疗效,疗效差异仍有待于更大样本更长时间的深入研究以发现。%Objective To explore the difference of efficacy between laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for simple obesity.Methods Clinical data of simple obese patients undergoing bariatric surgeries in the Second Hospital of Zhengzhou from August 2010 to December 2012 were retrospectively studied, including laparoscopic Roux-en-Y gastric bypass group (n=28) and sleeve gastrectomy group (n=9). Clinical data included BMI、FPG、HGB、microelements (Ca2+、Fe2+、VitB12) at 6、12、24 months postoperatively.Results There was statistical difference in operation time (P<0.05), but the levels of BMI、FPG、HGB and microelements had no statistical differences at 6、12、24 months postoperatively between the two groups.Conclusions Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy have a definite effect for simple obesity. Longer investigation duration and larger sample size are needed to verify the long-term differences between the two groups.

  19. 胃旁路术联合营养干预对肥胖型2型糖尿病的疗效观察%Therapeutic Effects of Laparoscopic Gastric Bypass and Nutritional Intervention on Type 2 Diabetes Mellitus

    Institute of Scientific and Technical Information of China (English)

    邱小文; 金迪; 刘慧

    2013-01-01

    Objective To observe the therapeutic effects of laparoscopic Roux-en-Y gastric bypass and nutritional intervention in type 2 diabetes mellitus (T2DM).Methods A total of 76 T2DM patients were randomly assigned into treatment group and control group B with or without nutritional supplements.Three months and six months after the surgery,the index of glycometabolism,islet cell function,nutrition status,and other related indicators or complications were observed and recorded.Results After surgery,the clinical complete remission rate was 84.21% (64/76),and the partial remission rate was 15.79% (12/76).In both groups the levels of fasting blood glucose,glycated hemoglobin and serum iron levels were decreased (P<0.01),the fasting insulin and C peptide were increased (P<0.01).Compared with the control group,the serum iron and ferritin levels were significantly increased (P<0.01),the incidence of alopecia and anemia were lower (P<0.05).Conclusion Therapeutic effect of laparoscopic Roux-en-Y gastric bypass on T2DM is satisfactory.Nutritional interventions helps the patients to maintain good nutrition status,and can reduce the occurrence of the complications.%目的 观察胃旁路术(gastric bypass,GBP)联合营养干预,对肥胖型2型糖尿病(type 2 diabetes mellitus,T2DM)的疗效.方法 76例实施GBP的肥胖型T2DM患者,随机分为联合营养治疗组与对照组,每组38例.于术后3个月、6个月观察其糖代谢、胰岛细胞功能、营养状态等相关指标和并发症.结果 术后,患者临床完全缓解率为84.21%(64/76),部分缓解率15.79%(12/76);两组空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、血清铁水平显著下降(P<0.01),空腹胰岛素和空腹C肽显著升高(P<0.01).与对照组比较:联合营养治疗组血清铁、血清铁蛋白水平显著升高(P<0.01);脱发、贫血等发生率显著减少(P<0.05).结论 GBP对肥胖型T2DM病情控制疗效满意

  20. 腹腔镜下胃转流术治疗2型糖尿病患者的围术期护理%Perioperative nursing of type 2 diabetes patients suffered from laparoscopic gastric bypass surgery

    Institute of Scientific and Technical Information of China (English)

    肖玲; 刘丽秀; 李淑娟; 姜涛

    2014-01-01

    Objective To explore perioperative nursing of type 2 diabetes patients suffered from laparoscopic gastric bypass surgery .Methods Sixteen patients with type 2 diabetes underwent laparoscopic gastric bypass surgery patients , with preoperative comprehensive assessment , psychological counseling , strict monitoring and control of blood sugar , reasonable diet guide; postoperative closely cardiopulmonary function , blood glucose monitoring , decompression care , a reasonable nutritional support , prevention of complications , while focusing on hospital discharge follow-up dietary guidance and health .Results Sixteen patients were operated smoothly, and diabetes-related indicators (C-peptide, glycated hemoglobin, fasting blood glucose, postprandial blood glucose , etc.) were reduced to normal after one month , three months, six months and twelve months.Varying degrees of diabetes-related complications ease or even cure .Conclusions To give careful perioperative care , reduce the incidence of postoperative complications , and promote rapid recovery after surgery is a strong guarantee for the smooth operation and rehabilitation of type 2 diabetes patients suffered from laparoscopic gastric bypass surgery .%目的:探讨2型糖尿病患者行腹腔镜下胃转流术的围术期护理。方法对16例2型糖尿病行腹腔镜下胃转流术的患者进行术前综合评估,给予心理疏导,严格监测并控制血糖,指导合理膳食;术后密切关注患者心肺功能,监测血糖,加强胃肠减压护理,给予合理的营养支持,观察、预防并发症的发生,同时注重出院饮食指导及健康随访。结果16例患者手术均顺利进行,术后1,3,6,12个月复查糖尿病相关指标(C-肽、糖化血红蛋白、空腹血糖、餐后血糖等)均降至正常;糖尿病相关并发症均有不同程度缓解甚至治愈。结论对2型糖尿病行腹腔镜下胃转流术患者给予精心围术期护理,减少术后

  1. Treatment of late pancreatic carcinoma with laparoscopic cholecystojejunostomy and gastric bypass combined with endoscopy%腹腔镜联合内镜胆肠、胃肠内引流术治疗晚期胰腺癌

    Institute of Scientific and Technical Information of China (English)

    田东生; 孙学良

    2015-01-01

    目的:探讨内镜、腹腔镜联合内引流术治疗晚期胰腺癌的效果。方法38例胰腺癌患者行内镜鼻胆管引流( ENBD)术后,采用腹腔镜行内引流术,观察治疗前后肝功能情况。结果所有患者手术均获成功。行ENBD术后3 d,患者总胆红素( TBil)、直接胆红素(DBil)、碱性磷酸酶(ALP)均比治疗前明显降低(P 均<0.05);术后5 d,谷氨酰转肽酶(GGT)、谷氨酸转肽酶(ALT)比治疗前明显降低(P均<0.05)。腹腔镜手术时间(96.3±7.4)min,术中出血量(69.7±25.3)mL,住院时间(13.7±7.5)d;术后3 d,TBil、DBil、GGT比术前明显降低(P均<0.05)。全组患者无严重手术并发症。结论 ENBD联合腹腔镜内引流术治疗晚期胰腺癌,术后肝功能恢复快,黄疸明显改善,而且具有创伤小、住院期短等优点。%Objective It is to assess the clinical effect of the treatment of late pancreatic carcinoma with laparoscopic cho-lecystojejunostomy and gastric bypass combined with endoscopy.Methods Endoscopic naso-biliary drainage was performed firstly in 38 patients with late pancreatic carcinoma, and laparoscopic cholecystojejunostomy and gastric bypass was performed consecutively.Liver function was observed before and after treatment.Results All the operations were completed successfully in 38 cases.3 d after ENBD, TBil, DBil, ALP of the patients were lower than that before operation(P<0.05);5 d after EN-BD, TBil, DBil, ALP and GGT, ALT of the patients were all lower than that before operation(P<0.05).The mean time of laparoscopic operation was(96.3 ±7.4) min, the mean operative blood loss was (69.7 ±25.3) mL, the average length of hospital stay was (13.7 ±7.5) days;3 d after laparoscopic operation, TBil, DBil, GGT of the patients were lower than that before operation(P<0.05).No severe operative complications occurred in all the patients.Conclusion The clinical effect of

  2. 腹腔镜胃旁路精准术后并发症及其对策%The Complications and Countermeasures of Accurate after Laparoscopic Gastric Bypass Surgery

    Institute of Scientific and Technical Information of China (English)

    蒲国士

    2015-01-01

    Objective:To investigate the rate of complications after precise gastric bypass(LRYGB)with laparoscopic,discuss the measurements of complications. Method:89 cases of patients were selected who had precised laparoscopic gastric bypass surgery treatment from June 2010 to December 2013 in our hospital.Result:9 cases(10.1%) patients accureed early postoperative complications,patients which age more than 50 years-old,combined diabetes, or with higher BMI score were the risk factors of early postoperative complications(OR value were respectively of 1.87, 2.14,1.78,P50 years,female,and combined chronic gastrointestinal disease history were the risk factors of late postoperative complications(OR values were 1.82,1.96,1.67, P50岁、糖尿病史、BMI升高为术后早期并发症的危险因素(OR值分别为1.87、2.14、1.78,P50岁、女性、合并慢性消化道疾病史为术后晚期并发症的危险因素(OR值分别为1.82、1.96、1.67,P<0.05),所有患者经对症处理后病情均得到缓解。结论:腹腔镜下胃旁路手术并发症并不少见,年龄大、合并糖尿病、肥胖的患者更容易出现早期术后并发症,年龄大、女性、合并慢性消化道疾病史的患者更容易出现晚期术后并发症,临床上更应注意此类患者的术后情况,其出现并发症应积极采取对症处理。

  3. 重度肥胖患者胃肠分流术后低氧血症机制的分析%Hypoxaemia following gastric bypass surgery in morbidly obese patients

    Institute of Scientific and Technical Information of China (English)

    李靖; GeorgeSMCowan; 等

    2001-01-01

    Objective To investigate the influence of morbidly obesity on arterial oxygen partial pressure (PaO2) following gastric bypass surgery. Methods Preoperative lung function and blood gas analysis before and 1 to 5 days after abdominal surgery were performed on 61 morbidly obese patients and 55 patients with normal body weight. Results PaO2 first five days in obese group post-operatively and first 2 days after the surgery in control group were significantly lower than preoperative values(P<0.05). PaO2 first two days after surgery in obese group was significantly correlated with maximal voluntary ventilation and waist-hip ratio (P<0.000 1). Conclusion Postoperative hypoxaemia in morbidly obese patients following gastric bypass surgery is more severe and lasted longer than that in patients with normal body weight after selective abdominal surgery.%目的 研究重度肥胖对胃肠分流术后动脉血氧分压的影响。方法 对61例进行胃肠分流术的重度肥胖患者及55例择期腹部手术的正常体重患者进行术前肺功能、术前及术后1~5 d的血气分析检测。结果 肥胖组术后1~5 d、对照组术后1~2 d的动脉血氧分压较术前显著下降(P<0.05);肥胖组术后1~2 d动脉血氧分压与其最大分钟通气量及腰臀比显著相关(P<0.000 1)。结论 重度肥胖者较正常体重患者在腹部手术后发生低氧血症的程度较严重且持续时间长。

  4. 腹腔镜胃旁路术治疗低BMI2型糖尿病患者效果观察%Laparoscopic gastric bypass surgery in treatment of patients with type 2 diabetes mellitus and low BMI

    Institute of Scientific and Technical Information of China (English)

    靳和平

    2016-01-01

    Objective To investigate the effect of laparoscopic gastric bypass surgery in the treatment of patients with type 2 diabetes mellitus and low BMI.Methods 50 patients with type 2 diabetes mellitus and low BMI undertaking laparoscopic gastric bypass surgery at our hospital were selected as study objects.The blood lipid,body mass index (BMI),fasting plasma glucose (FPG),meal 2 hours blood glucose (PBG),glycosylated hemoglobin (HbA 1 c),and quality of life were observed in the patients.Results 6 months after laparoscopic gastric bypass surgery,the total cholesterol level was (4.66 ± 0.39) mmol/L,triglyceride level (1.65 ± 0.24) mmol/L,low density lipoprotein level (2.63 ± 0.15) mmol/L,high density lipoprotein level (1.54 ± 0.32) mmol/L,BMI (20.67± 2.01) kg/m2,FPG (5.12 ± 0.31) mmol/L,PBG (5.82 ± 0.65) mmol/L,HbA1C (5.36 ± 0.47)%,physiological function (70.83 ± 4.58),physiological function (61.74 ± 4.35),bodily pain (70.23 ± 4.37),general health (75.46 ±4.28),energy (58.46 ± 4.35),social function (61.81 ± 4.71),emotional function (60.74 ± 4.49),and mental health (60.42 ± 4.82),which were all better than those before treatment in all the patients,with statistical differences (P<0.05).Conclusions Laparoscopic gastric bypass surgery in the treatment of patients with type 2 diabetes and low BMI has definite clinical efficacy and can significantly improve the patients' indicators and quality of life,so it can be regarded as medication or insulin therapy in patients with type 2 diabetes and worth for clinical application.%目的 探讨腹腔镜胃旁路术治疗低体重指数(BMI)2型糖尿病患者效果.方法 选取本院收治的50例实施腹腔镜胃旁路术治疗的低BMI 2型糖尿病患者为研究对象,观察患者血脂、BMI、空腹血浆葡萄糖(FPG)、餐后 2h 血糖PBG、糖化血红蛋白(HbA1C)及其生活质量.结果 实施腹腔镜胃旁路术后6个月,患者总胆固醇为(4.66±0.39) mmol/L、甘油三酯为(1.65±0.24) mmol

  5. Effects of Roux-en-Y Gastric Bypass on Fasting and Postprandial Levels of the Inflammatory Markers YKL-40 and MCP-1 in Patients with Type 2 Diabetes and Glucose Tolerant Subjects

    Directory of Open Access Journals (Sweden)

    Stine Brinkløv Thomsen

    2013-01-01

    Full Text Available Background. The inflammatory markers YKL-40 and monocyte chemoattractant protein-1 (MCP-1 are elevated in morbidly obese patients and decline after weight loss. The objective of our study was to investigate the possible changes of YKL-40 and MCP-1, in both the fasting and the postprandial states, following Roux-en-Y gastric bypass (RYGB in subjects with type 2 diabetes (T2D and normal glucose tolerance (NGT. Methods. Ten obese patients with T2D and 10 subjects with NGT were examined in the fasting state and after a standard meal prior to and after (1 week, 3 months, and 1 year RYGB. Results. Fasting state MCP-1 levels decreased after RYGB in both groups (P values < 0.0001 whereas fasting YKL-40 levels were unchanged (P values ≥ 0.120. Postprandial MCP-1 levels showed a tendency towards a decrease on most study days; however, the changes were only significant at 1 week (P=0.001 and 1 yr (P<0.0001 in the T2D group and at 3 mo after RYGB in the NGT group (P=0.009. YKL-40 levels showed a slight, postprandial suppression on all study days in the T2D group (all P values ≤ 0.021. Conclusions. Fasting MCP-1 levels, but not YKL-40 levels, decrease after RYGB in subjects with T2D and NGT. Postprandial changes of inflammatory markers are discrete and inconsistent.

  6. HELICOBACTER PYLORI (HP) INFECTION IN OBESE PATIENTS UNDERGOING ROUXEN- Y GASTRIC BYPASS; EFFICACY OF TWO DIFFERENT TREATMENT REGIMENS IN HP ERADICATION.

    Science.gov (United States)

    Cuesta Hernández, Martín; Pérez Peña, Celia; Matía Martín, Pilar; Cabrerizo García, Lucio; Pérez-Ferre, Natalia; Sánchez-Pernaute, Andrés; Torres García, Antonio; Rubio Herrera, Miguel Ángel

    2015-08-01

    Introducción: las causas implicadas en el aumento de incidencia de úlcera gástrica tras el bypass en Y de Roux no son completamente conocidas. El tratamiento de la infección por HP se recomienda antes de la cirugía en países cuya prevalencia sea elevada, como el caso de España, de cara a disminuir dicha complicación. Sin embargo, las pautas actuales de tratamiento pueden no ser adecuadas dados los elevados índices de resistencia. Pacientes y métodos: análisis retrospectivo de 243 pacientes operados de bypass en Y de Roux. De ellos, 111 pacientes (45%) presentaban infección por HP. Objetivo principal: comparación de la eficacia de dos terapias de erradicación de la infección por HP. Resultados: 70 pacientes recibieron OCA( Omeprazol 20 mg/12 h, Claritromicina 500 mg/12 h y Amoxicilina 1 g/12h durante 10 días), mientras que 41 pacientes recibieron OLA (Omeprazol 20 mg/12 h, Levofloxacino 500 mg/12 h y Amoxicilina 1 g/12 h durante 10 días). En 56/70 pacientes (80%) que recibieron OCA HP fue erradicado, comparado con 37/41 (91%) del grupo que recibió OLA como primera terapia (p = 0,283). La terapia con OLA usada de segunda línea fue eficaz en 13/14 pacientes con HP resistente a la terapia OCA. Conclusión: la resistencia de HP a Claritromicina es significativa en nuestra serie de pacientes, siendo la terapia con OLA una alternativa adecuada en las cepas resistentes.

  7. Gastric blow-out: komplikation efter fedmekirurgi

    DEFF Research Database (Denmark)

    Torrens, Ayoe Sabrina; Born, Pernille Wolder; Naver, Lars

    2009-01-01

    Laparoscopic gastric bypass is the most common type of surgery for morbid obesity in Denmark. The most frequent late complications after gastric bypass are ulcer, internal hernia and stenosis. Two cases of stenosis of the bileopancreatic limb with gastric blow-out are described. Urgent diagnosis...... with computed tomography and acute surgical treatment is vital as the complication can lead to gastric necrosis, pancreatitis, biliary stasis, sepsis and multi-organ failure within a very short time. Prompt contact to specialized surgeons is advocated. Udgivelsesdato: 2009-Nov...

  8. 胃旁路手术对糖耐量正常犬血糖、糖依赖性胰岛素释放肽和胰高血糖素样肽-1的影响%The effects of gastric bypass procedures on blood glucose, gastric inhibitory polypeptide and glucagon-like peptide-1 of normal glucose tolerance dogs

    Institute of Scientific and Technical Information of China (English)

    潘立镇; 白日星; 宋茂民; 李有国; Lisa Zhou; 钟志强; 许俊; 袁辉生; 崔真

    2013-01-01

    目的 通过对糖耐量正常犬行胃旁路手术,观察术后糖耐量、糖依赖性胰岛素释放肽(gastric inhibitory polypeptide,GIP)和胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)的变化,探讨胃旁路手术治疗2型糖尿病的机制.方法 选取6只糖耐量正常犬行胃旁路手术,于术前、术后1、2、4周行口服与静脉糖耐量实验,观察各时点血糖、胰岛素、GIP、GLP-1变化,以及术前、术后4周胰腺组织形态改变.结果 与术前比较,术后第2周空腹血糖[(3.58 ±O.33) mmol/L]明显降低(t=3.571,P<0.05);术后第1周空腹及口服葡萄糖后30 min时GLP-1升高[分别为(0.90±0.21)、(0.91±0.19) pmol/L,t=-3.660、-2.971,P<0.05],第2周时开始下降;术后第4周各指标基本恢复至术前水平.术后第4周时与术前比较,胰岛组织形态、胰岛数量(分别为6.8±0.8、7.1±0.8)及胰岛细胞数量(分别为16.7±2.5、16.3±3.1)均无明显变化(P>0.05).结论 胃旁路手术对糖耐量正常犬的血糖、胰岛素及部分糖尿病相关胃肠激素仅有短暂的影响.%Objective To observe postoperative glucose tolerance,gastric inhibitory polypeptide (GIP),and glucogan-like peptide-1 (GLP-1) in normal glucose level dogs after undergoing gastric bypass procedures,and to explore the mechanism of gastric bypass procedures to treat type 2 diabetes.Methods The 6 dogs with normal glucose tolerance had undergone gastric bypass procedures,and measure preoperative and postoperative oral and intravenous glucose tolerance (at time points 1,2,and 4 weeks) through changes in blood glucose,insulin,gastric inhibitory polypeptide (GIP),glucagon-like peptide-1 (GLP-1),and measure preoperative and postoperative week 4 pancreatic tissue morphology.Results Second weeks after operation,the fasting blood sugar was (3.58 ± 0.33) mmol/L,and significantly lower than preoperative (t =3.571,P <0.05).The GLP-1 level before oral glucose tolerance test (OGTT) and 30 minutes after

  9. Anti-obesity effects of chikusetsusaponins isolated from Panax japonicus rhizomes

    Directory of Open Access Journals (Sweden)

    Okuda Hiromichi

    2005-04-01

    Full Text Available Abstract Background The rhizomes of Panax japonicus are used as a folk medicine for treatment of life-style related diseases such as arteriosclerosis, hyperlipidemia, hypertension and non-insulin-dependent diabetes mellitus as a substitute for ginseng roots in China and Japan. Obesity is closely associated with life-style-related diseases. This study was performed to clarify whether chikusetsusaponins prevent obesity induced in mice by a high-fat diet for 9 weeks. Methods We performed two in vivo experiments. In one, female ICR mice were fed a high-fat diet with or without 1 or 3% chikusetsusaponins isolated from P. japonicus rhizomes for 9 weeks. In the other, lipid emulsion with or without chikusetsusaponins was administered orally to male Wistar rats, and then the plasma triacylglycerol level was measured 0.5 to 5 h after the orally administered lipid emulsion. For in vitro experiments, the inhibitory effects of total chikusetsusaponins and various purified chikusetsusaponins on pancreatic lipase activity were determined by measuring the rate of release of oleic acid from triolein in an assay system using triolein emulsified with lecithin. Results Total chikusetsusaponins prevented the increases in body weight and parametrial adipose tissue weight induced by a high-fat diet. Furthermore, consumption of a high-fat diet containing 1 or 3% total chikusetsusaponins significantly increased the fecal content and triacylglycerol level at day 3 compared with the high-fat diet groups. Total chikusetsusaponins inhibited the elevation of the plasma triacylglycerol level 2 h after the oral administration of the lipid emulsion. Total chikusetsusaponins, chikusetsusaponin III, 28-deglucosyl-chikusetsusaponin IV and 28-deglucosyl-chikusetsusaponin V inhibited the pancreatic lipase activity. Conclusion The anti-obesity effects of chikusetsusaponins isolated from P. japonicus rhizomes in mice fed a high-fat diet may be partly mediated through delaying the

  10. Sen perforation af tyndtarm efter laparoskopisk gastrisk bypass

    DEFF Research Database (Denmark)

    Spanager, Lene; Sigild, Ulf Henrik; Neuenschwander, Anders Ulrich

    2010-01-01

    We present two cases in which the patients were admitted to a local hospital with acute abdominal pain four or five months after having undergone laparoscopic gastric bypass. In both cases, operation revealed a perforation of the small bowel close to the distal anastomosis. In the first case...... bypass but as our two cases illustrate they are important to keep in mind....

  11. Weighing the Options: Gastric Sleeve Surgery

    Medline Plus

    Full Text Available ... can always make the hole bigger. With enough force - - (laughing). It’s going to come out one way ... y gastric bypass, you lose about three to five pounds a week, an average of about 70 ...

  12. Weighing the Options: Gastric Sleeve Surgery

    Medline Plus

    Full Text Available ... of them, and it really depends on the companies. Some insurances will cover the gastric bypass and ... is the band, called the realized band, another product of J&J and Ethicon, correct? Same people ...

  13. Anti-obesity effect of alkaline reduced water in high fat-fed obese mice.

    Science.gov (United States)

    Ignacio, Rosa Mistica Coles; Kang, Tae-Young; Kim, Cheol-Su; Kim, Soo-Ki; Yang, Young-Chul; Sohn, Joon-Hyung; Lee, Kyu-Jae

    2013-01-01

    Whether or not alkaline reduced water (ARW) has a positive effect on obesity is unclear. This study aims to prove the positive effect of ARW in high-fat (HF) diet-induced obesity (DIO) in C57BL/6 mice model. Toward this, obesity was induced by feeding the C57BL/6 male mice with high-fat diet (w/w 45% fat) for 12 weeks. Thereafter, the animals were administered with either ARW or tap water. Next, the degree of adiposity and DIO-associated parameters were assessed: clinico-pathological parameters, biochemical measurements, histopathological analysis of liver, the expression of cholesterol metabolism-related genes in the liver, and serum levels of adipokine and cytokine. We found that ARW-fed mice significantly ameliorated adiposity: controlled body weight gain, reduced the accumulation of epididymal fats and decreased liver fats as compared to control mice. Accordingly, ARW coordinated the level of adiponectin and leptin. Further, mRNA expression of cytochrome P450 (CYP)7A1 was upregulated. In summary, our data shows that ARW intake inhibits the progression of HF-DIO in mice. This is the first note on anti-obesity effect of ARW, clinically implying the safer fluid remedy for obesity control.

  14. Anti ­ diabetic and anti-obesity effects of plant extract from Cleome droserifolia (SAMWA

    Directory of Open Access Journals (Sweden)

    Eman G. E. Helal, **Hafiza A. Sharaf and ***Fathy E. Mattar

    2002-12-01

    Full Text Available In this work the mechanism of the hypoglycemic effect of an aqueous extract from Cleome droserifolia (SAMWA was studied in a group of glucose intolerant senile rats and compared with normal senile control rats. The plant extract significantly suppressed the rise in blood glucose concentration. The hypoglycemic effect of the plant extract without increasing insulin secretion was explained by: 1 potentiation of peripheral and hepatic insulin sensitivity, 2 by diminishing intestinal glucose absorption, which was evident by blunting plasma glucose levels throughout the oral glucose challenge. This was accompanied by a significant decrease of liver glycogen content and a highly significant increase in leptin concentration which may suggest an anti-obesity role for the plant extracts. Plant extracts also decreased serum urea nitrogen. No changes on liver or heart function were observed. In histological sections of liver and kidney minor changes were noticed. These extracts might prove to have a promising therapeutic value in the treatment of diabetes mellitus. Besides its suppression to hepatic glucose output, SAMWA beneficial therapeutic finding in favor of the plant as a replacement for insulin which is the most important drug that brings bout this effect.

  15. Molecular Mechanisms of the Anti-Obesity and Anti-Diabetic Properties of Flavonoids

    Directory of Open Access Journals (Sweden)

    Mohammed Kawser Hossain

    2016-04-01

    Full Text Available Obesity and diabetes are the most prevailing health concerns worldwide and their incidence is increasing at a high rate, resulting in enormous social costs. Obesity is a complex disease commonly accompanied by insulin resistance and increases in oxidative stress and inflammatory marker expression, leading to augmented fat mass in the body. Diabetes mellitus (DM is a metabolic disorder characterized by the destruction of pancreatic β cells or diminished insulin secretion and action insulin. Obesity causes the development of metabolic disorders such as DM, hypertension, cardiovascular diseases, and inflammation-based pathologies. Flavonoids are the secondary metabolites of plants and have 15-carbon skeleton structures containing two phenyl rings and a heterocyclic ring. More than 5000 naturally occurring flavonoids have been reported from various plants and have been found to possess many beneficial effects with advantages over chemical treatments. A number of studies have demonstrated the potential health benefits of natural flavonoids in treating obesity and DM, and show increased bioavailability and action on multiple molecular targets. This review summarizes the current progress in our understanding of the anti-obesity and anti-diabetic potential of natural flavonoids and their molecular mechanisms for preventing and/or treating obesity and diabetes.

  16. Anti-obesity and antioxidant activity of dietary flavonoids from Dioscorea steriscus tubers

    Institute of Scientific and Technical Information of China (English)

    Pamhidzai Dzomba; Cexton Musekiwa

    2014-01-01

    Objective:To investigate antioxidant and anti-obesity activity of flavonoids extracted by solvent cold percolation and preparative thin liquid chromatography from Dioscorea steriscus tubers. Methods: 1-diphenyl-2-picrylhydrazyl (DPPH) antiradical activity was employed to investigate antioxidant activity while chromogenic method was used to determine alpha amylase inhibition activity and spectrophotometric methods using triolein as a substrate was used to investigate lipase activity. Results: Thin liquid chromatography profiling revealed eight different flavonoid types. Ethyl acetate extract yielded two types, Rf values 0.38 and 0.40;chloroform extract also yielded two types Rf values 0.06 and 0.51, while ethanol extract yielded four types with Rf values 0.16, 0.33, 0.65 and 0.96. All the extracted flavonoids exhibited antioxidant activity with ethanol extracts exhibiting the greatest antiradical activity. The order of enzyme inhibition capacity was ethyl acetate Conclusions: Results of the present study show that Dioscorea steriscus consists of bioactive compounds that can act as lipase and α-amylase inhibitors and therefore can be useful for the development of functional foods against obesity. It can also be used as a source of lead compounds for designing new ant-obesity therapeuticals.

  17. A Review of Potential Marine-derived Hypotensive and Anti-obesity Peptides.

    Science.gov (United States)

    Manikkam, V; Vasiljevic, T; Donkor, O N; Mathai, M L

    2016-01-01

    Bioactive peptides are food derived components, usually consisting of 3-20 amino acids, which are inactive when incorporated within their parent protein. Once liberated by enzymatic or chemical hydrolysis, during food processing and gastrointestinal transit, they can potentially provide an array of health benefits to the human body. Owing to an unprecedented increase in the worldwide incidence of obesity and hypertension, medical researchers are focusing on the hypotensive and anti-obesity properties of nutritionally derived bioactive peptides. The role of the renin-angiotensin system has long been established in the aetiology of metabolic diseases and hypertension. Targeting the renin-angiotensin system by inhibiting the activity of angiotensin-converting enzyme (ACE) and preventing the formation of angiotensin II can be a potential therapeutic approach to the treatment of hypertension and obesity. Fish-derived proteins and peptides can potentially be excellent sources of bioactive components, mainly as a source of ACE inhibitors. However, increased use of marine sources, poses an unsustainable burden on particular fish stocks, so, the underutilized fish species and by-products can be exploited for this purpose. This paper provides an overview of the techniques involved in the production, isolation, purification, and characterization of bioactive peptides from marine sources, as well as the evaluation of the ACE inhibitory (ACE-I) activity and bioavailability. PMID:25569557

  18. The anti-obesity drug orlistat reveals anti-viral activity.

    Science.gov (United States)

    Ammer, Elisabeth; Nietzsche, Sandor; Rien, Christian; Kühnl, Alexander; Mader, Theresa; Heller, Regine; Sauerbrei, Andreas; Henke, Andreas

    2015-12-01

    The administration of drugs to inhibit metabolic pathways not only reduces the risk of obesity-induced diseases in humans but may also hamper the replication of different viral pathogens. In order to investigate the value of the US Food and Drug Administration-approved anti-obesity drug orlistat in view of its anti-viral activity against different human-pathogenic viruses, several anti-viral studies, electron microscopy analyses as well as fatty acid uptake experiments were performed. The results indicate that administrations of non-cytotoxic concentrations of orlistat reduced the replication of coxsackievirus B3 (CVB3) in different cell types significantly. Moreover, orlistat revealed cell protective effects and modified the formation of multi-layered structures in CVB3-infected cells, which are necessary for viral replication. Lowering fatty acid uptake from the extracellular environment by phloretin administrations had only marginal impact on CVB3 replication. Finally, orlistat reduced also the replication of varicella-zoster virus moderately but had no significant influence on the replication of influenza A viruses. The data support further experiments into the value of orlistat as an inhibitor of the fatty acid synthase to develop new anti-viral compounds, which are based on the modulation of cellular metabolic pathways. PMID:25680890

  19. The anti-obesity effect of natural vanadium-containing Jeju ground water.

    Science.gov (United States)

    Park, Seon-Joo; Youn, Cha-Kyung; Hyun, Jin Won; You, Ho Jin

    2013-02-01

    This study investigated the anti-obesity effects of Jeju ground water containing the vanadium components S1 (8.0 ± 0.9 μg/l) and S3 (26.0 ± 2.09 μg/l) on the differentiation of 3 T3-L1 preadipocytes and obesity in mice that were fed a high-fat diet (HFD). The 3 T3-L1 preadipocyte cells were cultured and differentiated in media consisting of Jeju ground water (S1, S3) or deionized water (DW) containing dexamethasone, isobutylmethylxanthine, and insulin. Oil Red O staining showed that lipid accumulation was attenuated in adipocyte cells treated with Jeju ground water. S3 significantly decreased peroxisome-activated receptor γ and CCAAT-enhancer-binding protein α mRNA expression levels, which play major roles in the transcriptional control of adipogenesis, compared to DW. Furthermore, mRNA expression levels of targeted genes, such as adipocyte fatty acid, lipoprotein lipase, and leptin, were decreased by S3 treatment compared with the control group. In mice with HFD-induced obesity, Jeju ground water decreased HFD-induced body weight gain and reduced total cholesterol, triglyceride, and glucose levels in the plasma compared to control mice. Taken together, Jeju ground water inhibits preadipocyte differentiation and adipogenesis in obesity animal models.

  20. New insights into the anti-obesity activity of xanthones from Garcinia mangostana.

    Science.gov (United States)

    Liu, Qian-Yu; Wang, Yi-Tao; Lin, Li-Gen

    2015-02-01

    Obesity has reached epidemic proportions worldwide. This condition, and its related diseases such as diabetes and cardiovascular diseases, have become major public health challenges. Fruits are important dietary components, and bioactive constituents from fruits are considered to be a promising source for developing effective and safe anti-obesity drugs. Garcinia mangostana Linn. (Clusiaceae) is a tropical evergreen tree, and its fruit, mangosteen, is called 'Queen of Fruit'. The pericarp of G. mangostana has been used for centuries in Southeast Asia as a medicinal agent for treatment of various diseases. Products derived from mangosteen are widely consumed to ameliorate metabolic dysfunction and resultant metabolic syndrome. However, the chemical principles and mechanisms underlying these effects are unclear. This review summarizes the recent chemical and pharmacological studies related to G. mangostana, including weight reduction, anti-adipogenesis, anti-inflammation and anti-oxidation activity. The aim of this review is to shed light on the role of G. mangostana and its constituents in preventing and treating obesity, which should encourage more interest in the development of relevant therapeutic methods. PMID:25520256

  1. Anti-obesity and anti-diabetic actions of histamine neurons

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    The present study aimed to examine roles of histamine neurons in leptin signaling pathways and leptin resistant states. H1-receptor knockout (H1KO) mice showed no change in daily food intake, adiposity, growth curve, basal expression of hypothalamic neuropeptides, uncoupling proteins (UCPs) or ob gene. However, H1KO mice fed with high fat diet increased fat deposition and ob gene expression more excessively. Leptin-induced feeding suppression was attenuated in H1KO mice. Chronic leptin treatment decreased visceral fat and up-regulated UCPs expression in brown and white fat. These effects of leptin were attenuated in pair-fed H1KO mice. Chronic histamine or histidine treatment decreased body weight, body fat deposition, and serum glucose and insulin in diet-induced obese, ob/ob and db/db mice. Activation of histamine neurons suppressed ob gene expression in the fat tissue together with elevation of seurm leptin and UCPs mRNA. These actions of neuronal histamine were attenuated in the double knockout mice, i.e., db/db mice with H1KO. Taken together, H1KO mice, a novel leptin resistant model, elucidate essential roles of H1-R in energy intake and expenditure as a down-stream-signaling message of leptin actions in the brain. The anti-obesity and anti-diabetic effects of histamine neurons provide a new insight into therapeutic strategies on human obesity and diabetes with leptin resistance.

  2. New insights into the anti-obesity activity of xanthones from Garcinia mangostana.

    Science.gov (United States)

    Liu, Qian-Yu; Wang, Yi-Tao; Lin, Li-Gen

    2015-02-01

    Obesity has reached epidemic proportions worldwide. This condition, and its related diseases such as diabetes and cardiovascular diseases, have become major public health challenges. Fruits are important dietary components, and bioactive constituents from fruits are considered to be a promising source for developing effective and safe anti-obesity drugs. Garcinia mangostana Linn. (Clusiaceae) is a tropical evergreen tree, and its fruit, mangosteen, is called 'Queen of Fruit'. The pericarp of G. mangostana has been used for centuries in Southeast Asia as a medicinal agent for treatment of various diseases. Products derived from mangosteen are widely consumed to ameliorate metabolic dysfunction and resultant metabolic syndrome. However, the chemical principles and mechanisms underlying these effects are unclear. This review summarizes the recent chemical and pharmacological studies related to G. mangostana, including weight reduction, anti-adipogenesis, anti-inflammation and anti-oxidation activity. The aim of this review is to shed light on the role of G. mangostana and its constituents in preventing and treating obesity, which should encourage more interest in the development of relevant therapeutic methods.

  3. Recent Progress in Anti-Obesity and Anti-Diabetes Effect of Berries.

    Science.gov (United States)

    Tsuda, Takanori

    2016-01-01

    Berries are rich in polyphenols such as anthocyanins. Various favorable functions of berries cannot be explained by their anti-oxidant properties, and thus, berries are now receiving great interest as food ingredients with "beyond antioxidant" functions. In this review, we discuss the potential health benefits of anthocyanin-rich berries, with a focus on prevention and treatment of obesity and diabetes. To better understand the physiological functionality of berries, the exact molecular mechanism of their anti-obesity and anti-diabetes effect should be clarified. Additionally, the relationship of metabolites and degradation products with health benefits derived from anthocyanins needs to be elucidated. The preventive effects of berries and anthocyanin-containing foods on the metabolic syndrome are not always supported by findings of interventional studies in humans, and thus further studies are necessary. Use of standardized diets and conditions by all research groups may address this problem. Berries are tasty foods that are easy to consume, and thus, investigating their health benefits is critical for health promotion and disease prevention. PMID:27058561

  4. New ethanol extraction improves the anti-obesity effects of black tea.

    Science.gov (United States)

    Park, Bongju; Lee, Sangjin; Lee, Bonggyeong; Kim, Ingyum; Baek, Namjoon; Lee, Tae Ho; Lee, Seok-Yong; Son, Miwon; Park, Hyunsung

    2016-03-01

    Black tea has been reported to have anti-obesity effects in both rodents and humans. Gallic acid, an active component of black tea, decomposes quickly into pyrogallol in high-temperature solutions. This study introduced a new, aqueous ethanol extraction of black tea, which resulted in extracts with higher concentrations of gallic acid than conventional black tea extracts prepared by hot-water extraction or hot-ethanol extraction. We confirmed that, compared with the hot-water extract of black tea, the cold-ethanol extract of black tea (CE-BTE) had greater effects on reducing body weight and body fat, improving fatty liver, regulating blood glucose, and reducing blood cholesterol in the high-fat diet-induced obese mouse model. Nonetheless, although CE-BTE significantly reduced fat content, it did not reduce peroxisome proliferator-activated receptor (PPARγ) protein in epididymal fat tissue of HFD mice. We also showed that CE-BTE did not inhibit the function of PPARγ protein to drive adipogenesis of mouse 3T3-L1 preadipocytes. Considering that PPARγ is a master transcription factor not only for adipocyte differentiation, but also for adipose tissue function, such as glucose and lipid metabolism and insulin sensitivity, these results suggest that CE-BTE reduced fat mass and body weight without dampening fat cell homeostasis and insulin sensitivity.

  5. Clinical Study of the Effect of Gastric Bypass with Different Residual Stomach Volume on Non-Obese Patients with Type 2 Diabetes Mellitus%不同残胃容积胃旁路术对胃癌合并非肥胖型2型糖尿病患者降糖效果的影响

    Institute of Scientific and Technical Information of China (English)

    林克荣; 刘斌; 黄盛; 王畅; 王俊杰; 喻敏; 王瑜

    2012-01-01

    目的 探讨不同残胃容积的Roux-en-Y胃旁路术(RYGBP)对胃癌合并非肥胖型2型糖尿病(T2DM)患者降糖效果的影响.方法 回顾性分析2007年6月-2009年12月我科收治的77例胃癌合并非肥胖型T2DM患者,其中37例行全胃切除RYGBD,40例行胃大部切除RYGBD.比较术前(0月)和术后1、3、6、12个月两组患者体质指数(BMI)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)水平变化及术后12个月的手术疗效.结果 与术前相比,两组患者术后的BMI及FPG、HbA1c水平均显著下降(P<0.05);术后同一时间点组间比较差异无统计学意义(P>0.05).术后12个月两组患者手术疗效比较差异无统计学意义 (P>0.05).结论 不同残胃容积的RYGBP均可有效改善胃癌合并非肥胖型T2DM患者的血糖,且残胃容积大小并不影响RYGBP对此类患者的降糖效果.%Objective To evaluate the effect of Roux - en - Y gastric bypass with different residual stomach volume on non - obese patients with type 2 diabetes mellitus. Methods From June 2007 to December 2009, 77 non - obese patients with type 2 diabetes mellitus and gastric lesions underwent Roux - en - Y gastric bypass with total gastrectomy ( n = 37 ) or subtotal gastrectomy ( n = 40 ) in the department of general surgery. Patients were observed for twelve months after surgery. The body mass index, the fasting blood glucose and the glycosylated haemoglobin concentrations were retrospectively analyzed before surgery ( 0 month ) and 1, 3 , 6, 12 months after surgery, and the efficiency of the surgery was analyzed 12 months after surgery. Results The body mass index, fasting blood glucose and glycosylated haemoglobin concentrations in the two groups were both significantly decreased after surgery ( P 0. 05 ) .As to the efficiency of the surgery after 12 month, there were also no significant differences between the group of Roux - en - Y gastric bypass with total gastrectomy and the group of Roux - en - Y gastric bypass

  6. 胃转流手术对肥胖型成人隐匿性自身免疫糖尿病降糖效果的观察%Effects of gastric bypass on latent autoimmune diabetes in adults

    Institute of Scientific and Technical Information of China (English)

    张野; 高连中; 闫四梅; 贾元利

    2012-01-01

    Objective To evaluate the clinical therapeutic effects of gastric bypass (GBP) on obesity-latent autoimmune diabetes (LADA). Methods Eleven patients with obesity-LADFA underwent GBP. The blood glucose concentrations, Oral glucose tolerance test (OGTT), homeostasis model assessment insulin resistance index (HOMA-I), and glycosylated hemoglobin (HbAIc). Results The glucose concentrations of the 11 patients were dramatic decline, and their OGTT values were significantly higher one month after GBP (all P < 0.01). 4 cases had been followed up for one year, although they did not take any drugs their glucose concentrations returned to normal (all P<0.01). The levels of HOME-IR and HbAIc 6 months after GBP in 7 cases were significantly lower than those before GBP (all P<0.01). The symptoms of diabetes-related complications had been mitigated at different degrees. Three cases showed postoperative gastric emptying dysfunction, which was recovered after conservative treatment. Conclusion GBP is safe and effective in treating obesity-LADA.%目的 探讨胃转流术治疗肥胖型成人隐匿性自身免疫糖尿病(LADA)的临床疗效.方法 11例肥胖型LADA患者接受胃转流术治疗,观察手术前后血糖,口服葡萄糖耐量试验(OGTT)、稳态模型胰岛素抵抗(HOMA-IR)、糖化血红蛋白(HbAIc)、的改变.结果 11例患者术后1个月血糖均有明显下降,葡萄糖耐量试验明显增强(均P<0.01),4例术后随访1年,血糖在正常范围,不需药物控制,患者7例术后6月,HOMA-IR、HbAIc显著低于手术前(均P<0.01),糖尿病相关并发症均有不同程度缓解,3例手术后并发胃排空障碍,经保守治疗后痊愈.结论 胃转流术能有效治疗肥胖型LADA,手术安全可行.

  7. 胃旁路手术治疗2型糖尿病研究现状%The Research Status of Gastric Bypass Surgery for the Treatment of Type 2 Diabetes Mellitus

    Institute of Scientific and Technical Information of China (English)

    林允信

    2011-01-01

    糖尿病是严重威胁人类健康的代谢性疾病,全球发病率已呈逐年上升趋势.胃旁路手术(GBP)在用于治疗肥胖症时,发现该手术可以治疗2型糖尿病.这一成果受到全世界医学界的关注,为2型糖尿病彻底根治带来新的希望.欧美国家和我国都用这种方法治疗2型糖尿病患者,且疗效显著,无不良反应.改进GBP手术方式和探讨治疗2型糖尿病机制是今后研究的重点.%Diabetes mellitus is a serious metabolic disease threatening human health. The worldwide prevalence of diabetes has been already increasing year by year. Gastric bypass ( GBP ) for bariatric surgery can be used for the treatment for type 2 diabetes mellitus. This result draws the global medical attention as a new hope for the cure of type 2 diabetes mellitus. European and American countries and China have been using this modality to treat type 2 diabetes mellitus. The curative effect is remarkable, without any side effect.Further studies should be performed to improve GBP procedure and investigate the mechanisms of type 2 diabetes mellitus.

  8. Possible mechanisms of Roux-en-Y gastric bypass treatment for type 2 diabetes mellitus%胃转流术治疗2型糖尿病的机制

    Institute of Scientific and Technical Information of China (English)

    董光龙; 徐晓

    2014-01-01

    胃转流术是目前2型糖尿病外科治疗的主流术式之一,但其治疗2型糖尿病的相关机制并不完全清楚.现有的相关研究表明,胃转流术对2型糖尿病的治疗作用可能通过如下机制:摄入受限和吸收不良、胰岛素抵抗的改善和胰岛β细胞功能的恢复、胃肠道激素水平的变化等.此外,脂肪因子以及血清胆汁酸水平的变化也可能发挥了一定作用.下一步的研究需要进一步明确胃转流术对于机体神经内分泌系统的影响机制,并探讨胃转流术消化道重建方式对于相关激素的影响情况.%Roux-en-Y gastric bypass (RYGB) is a classic procedure for the treatment of type 2 diabetes mellitus (T2DM),but it remains unclear why this procedure works.There might be several mechanisms that RYGB works through to treat T2DM,including calorie restriction and malabsorption,improvement of insulin resistance and β-cell functions,and altered secretion of gastrointestinal hormones.Altered levels of adipokines and serum bile acids might also play a role after RYGB.Future researches should concentrate on the exact mechanism of the altered hormone levels after RYGB,and whether different methods of gastrointestinal tract reconstruction could lead to various hormone levels.

  9. Short term results of gastric bypass in the treatment of type 2 diabetes mellitus%胃转流术治疗2型糖尿病的近期效果

    Institute of Scientific and Technical Information of China (English)

    闫军; 董光龙; 杨雁灵

    2012-01-01

    目的 研究胃转流术(gastric bypass,GBP)对2型糖尿病(type 2 diabetes mellitus,T2DM)的治疗作用.方法 分析2009年9月至2010年9月在第四军医大学西京医院住院的32例T2DM患者接受GBP的临床资料,比较手术前后空腹血糖(FBG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbAlc)及体质量、血压和脂肪肝的变化.结果 本组32例患者在GBP后无严重并发症.术后1、6、12个月的FBG[(7.8±2.2)mmol/L、( 7.7±2.2)mmol/L、(7.2±1.8) mmol/L]均低于术前的PBG[ (11.1±2.7)mmol/L],P<0.05;术后l、6、12个月的2hPG[( 10.2±2.6) mmol/L、(10.5±2.8)mmol/L、(10.5±3.1)mmol/L]均低于术前的2hPG[ (14.0±3.5)mmol/L],P<0.05;术后1、6、12个月的HbAlc[(7.6%±1.4%)、(7.5%±1.7%)、(7.1%±1.9%)]均低于术前的HbAlc[(9.0%±2.3%)],P<0.05.BMI< 25 kg/m2的非超重者的术后12个月FBG[(6.9±1.5) mmol/L]、2hPG[ (10.0±3.2)mmol/L]、HbAlc[(6.9%±1.9%)]均低于术前的FBG[( 10.7±2.9) mmol/L]、2hPG[(14.3±4.1) mmol/L]、HbAlc[(8.8%±2.0%)],P<0.05;BMI≥25 kg/m2的非超重者的术后12个月FBG[ (7.5 ±2.3)mmol/L]、2hPG[ (11.3 ±2.9)mmol/L]、HbAlc[(7.3%±1.9%)]均低于术前的FBG[ (11.7±2.3)mmol/L]、2hPG[( 13.5±2.4)mmol/L]、HbAlc[(9.2%±2.7%)],P<0.05.6例合并有高血压的T2DM患者术后1年血压正常5例.17例合并有脂肪肝的T2DM患者术后1年脂肪肝减轻8例.结论 GBP对T2DM患者的糖代谢失常及合并症有明显的治疗作用.%Objective To evaluate gastric bypass on relieving type 2 diabetes mellitus. Methods From September 2009 to September 2010,Thirty two cases of type 2 diabetes mellitus patients underwent gastric bypass operation in Xijing Hospital.Preoperative FBG,2hPG,HbAlc,weight,blood pressure and fatty liver were compared with that on 1 month,6 months,12 months after operation. Result There was no significant postoperative complications.FBG on 1 month,6 months,12 months postop and preoperative level was respectively 7

  10. 胃旁路术对血糖的影响及其机制%Influence of gastric bypass surgery on fasting blood-glucose in type 2 diabetic rats

    Institute of Scientific and Technical Information of China (English)

    史逸华; 郑志坚; 戴灵波; 宋军; 江玲雅

    2013-01-01

    Objective To investigate the influence of gastric bypass surgery on fasting blood- glucose (FBG) levels in type 2 diabetic rats. Methods Forty rates were randomly divided into 4 groups with 10 in each groups:type 2 diabetes mel itus were induced by injection of stretozotocin in DO and DC group, gastric bypass operation was performed in DO and NO groups and sham operation was performed in DC and NC groups. The FBG levels were determined before operation and 72h, 1, 4 and 8 weeks after operation. The tissue sections were HE- stained and examined histopathological y. Results There were no signif-icant differences in FBG levels before operation between DO and DC groups or between NO and NC groups (P>0.05). FBG levels in DO group gradual y declined after operation and were lower than those before operation (P0.05). The inter- group and intra- group differences of FPG levels in NO and NC groups were not statistical y sig-nificant(P>0.05). HE staining showed that there was regeneration of pancreas islets and the morphology was similar to the nor-mal in DO group at 8 weeks after operation. Conclusion Gastric bypass operation can reduce the FBG levels in type 2 diabetic rats, which is associated with the regeneration of pancreas islets.%目的研究胃旁路术(GBP)对糖尿病大鼠血糖的控制效果以及对胰岛细胞的影响。方法采用链脲佐菌素建立糖尿病SD大鼠模型(20只),随机分为糖尿病手术组(DO组)和糖尿病对照组(DC组),另取20只非糖尿病大鼠随机分为正常手术组(NO组)和正常对照组(NC组)。DO组和NO组大鼠行GBP,DC组和NC组大鼠行假手术,分别检测各组大鼠术前、术后72h,1、4和8周空腹血糖水平。术后8周,取胰腺组织行HE染色和免疫荧光检查,观察组织学变化。结果术前DO组与DC组以及NC组与NO组大鼠空腹血糖均无统计学差异(均P>0.05)。DO组大鼠术后空腹血糖进行性下降(均P<0.05

  11. Effect of Roux-en-Y gastric bypass postoperative on the blood glucose expression of type 2 diabetic rats%胃旁路术预防2型糖尿病的实验研究

    Institute of Scientific and Technical Information of China (English)

    谢杰斌; 庞月珊; 魏寿江; 王崇树; 唐锦

    2016-01-01

    Objective Recent studies have found that Roux-en-Y gastric bypass( RYGB) can inhibit the levels of blood glucose in type 2 diabetes,but its mechanism still remains unknown. In present study,we observed the effect of RYGB on insulin and GLP-1of type 2 diabetes mice. Methods The 12-week-old male SD rats were divided into four groups:group A ( no surgery,normal diet) ,Group B ( no surgery,DM diet+STZ injection) ,group C ( gastric bypass surgery+normal diet) ,group D ( gastric bypass surgery+DM diet+STZ injection) . One week after surgery rehabilitation,the diabetes model was built by STZ ( revulsant of the classical diabetes model) and high-fat-control diet. After four months,the changes of blood glucose,OGTT,body weight,food intake,water intake in each group were examined. Furthermore,the patho-logical changes of insulin and pancreatic were detected by HE staining. Meanwhile,the liver PEPCK gene and protein expression were detec-ted by using RT-PCR and Western blot. Results Four groups of rats all have significant changes in diet and weight. HE staining suggests the disseminated hyperemia and edema in pancreas and showed that islet has been severe damaged. Compared with no treatment normal diet,nor-mal rat+DM diet+STZ injection,has a markedly elevated blood glucose level 3 days later,insulin,OGTT,GLP,and ITT all have remarkable changes in different time periods,with a statistically significance (P<0. 05). Compared with the normal rat+DM diet+STZ injection group, RYGB + DM diet+ STZ injection group showed that these indicators of pancreas pathological changes significantly,glucose,insulin,OGTT, GLP,ITT all have significantly drop,as well as the gene and protein expression of PEPCK (P<0. 05). Conclusion RYGB can exert influ-ence on the change of insulin,OGTT,GLP,ITT and PEPCK in islets of type 2 diabetes rats,which may play a positive role in the further clini-cal applications.%目的:通过检测实验大鼠胰岛素及GLP-1等指标的

  12. Individualized Care of Laparoscopic Gastric Bypass Surgery in the Treatment of Type 2 Diabetes%腹腔镜胃转流术治疗2型糖尿病的个体化护理

    Institute of Scientific and Technical Information of China (English)

    曹牡华

    2015-01-01

    Objective:To research the clinical effect of individualized care model for type 2 diabetes patients receiving care during the treatment of laparoscopic gastric bypass.Method:80 patients with type 2 diabetes underwent laparoscopic gastric bypass surgery treatment in our hospital from February 2013 to February 2015 were selected and divided into the control group and the observation group according to the random number table method,40 cases in each group.The control group was given conventional diabetes care model,the observation group was given individualized nursing model.The treatment effect,satisfaction with care during treatment,the time of blood sugar levels return to normal after treatment,the total treatment time of type 2 diabetes and adverse reactions during treatment between the two groups were observed and compared.Result:The total effective rate of the observation group was 90.0%,which was significantly higher than 67.5%of the control group,the satisfaction with care during treatment of the observation group was 95.0%(38/40),which was significantly higher than 80.0%(32/40)of the control group,the time of blood sugar levels return to normal after treatment and the total treatment time of type 2 diabetes in the observation group were significantly shorter than those in the control group,the incidence of adverse reaction in the observation group was(2.5%)significantly lower than 20.0%in the control group,the differences were statistically significant(P<0.05).Conclusion:The clinical nursing effect of individualized care model for patients with type 2 diabetes during the treatment of laparoscopic gastric bypass is significant,is worthy of clinical popularization and application.%目的:研究应用个体化护理服务模式对2型糖尿病患者在接受腹腔镜胃转流术治疗期间实施护理的临床效果。方法:选择2013年2月-2015年2月在本院就诊的接受腹腔镜胃转流术治疗的2型糖尿病患者80例,按照随机数字表

  13. Exploiting anti-obesity mechanism of Clerodendrum phlomidis against two different models of rodents

    Directory of Open Access Journals (Sweden)

    Vijay R Chidrawar

    2011-01-01

    Full Text Available Roots of Clerodendrum phlomidis are used by the local people of Dibrugarh district of Assam state India as a dietary supplement for treating weight issues and are also mentioned in the traditional system of Indian medicine as a remedy for obesity. We examined the anti-obesity effect of Clerodendrum phlomidis (family Verbenaceae L. roots against cafeteria diet (CD and progesterone-induced obesity. In CD-induced model obesity was induced by feeding CD for 48-days and increase in body weight and fat storage was suppressed co-administration with methanolic extract of Clerodendrum phlomidis (MECP at 400 mg/kg. Blood analysis showed that the levels of triglyceride and cholesterol were significantly lowered by MECP administration and there is subsequent rise in HDL-cholesterol level. From this experiment, we demonstrated that MECP is effective in ameliorating the CD-induced hyperglycemia, hyperinsulimenia, dyslepidemia, increase in wet weight of white adipose tissue, and hypertrophy of fat cells. In drug induced obesity model hyperphagia was induced by progesterone (10 mg/kg s.c. for 28 days and was suppressed by co-administration with MECP in dose dependent manner. It is tempting to speculate that these protective effects shown by Clerodendrum phlomidis is by multiple mechanisms. MECP contains β-sitosterol in the abundant quantity because of the structural similarity it do the physical competition with natural sterols while absorption of food stuffs from GIT and moreover the crude saponin and flavonoid has been reported for it′s the appιtit suppressant property and hence reduces hyperphagia produced by progesterone. This is the first report demonstrating that Clerodendrum phlomidis is effective in ameliorating insulin resistance and visceral obesity induced by CD and Progesterone.

  14. Variations in dietary intake after bypass surgery for obesity. Possible relation to development of fatty liver after jejunoileal bypass

    Energy Technology Data Exchange (ETDEWEB)

    Rogus, J.; Blumenthal, S.A.

    1981-01-01

    Consumption of nutrients and food energy was compared, with concomitant chemical and radiologic measurements of hepatic fat content, preoperatively and postoperatively in 25 patients who underwent gastric or jejunoileal bypass for obesity. Patients in the two operative groups ingested similar quantities of food before surgery. After surgery, caloric intake from all sources decreased in both groups but to a significantly greater extent in the gastric bypass patients. During the first six months postoperatively, the 13 gastric bypass patients showed no changes in hepatic fat content, whereas substantial increases in liver fat uniformly occurred in the 12 patients who had jejunoileal bypasses. It is suggested that dietary carbohydrate may have contributed to the accretion of liver fat in these 12 patients.

  15. Baseline of visceral fat area and decreased body weight correlate with improved pulmonary function after Roux-en-Y Gastric Bypass in Chinese obese patients with BMI 28–35 kg/m2 and Type 2 diabetes: a 6-month follow-up

    OpenAIRE

    Tu, Yinfang; Yu, Haoyong; Bao, Yuqian; Zhang, Pin; Di, Jianzhong; Han, Xiaodong; Jia, Weiping

    2015-01-01

    Background Associations between demographic data and pulmonary function have not been adequately examined in patients that underwent Roux-en-Y Gastric Bypass (RYGB). This study was designed to examine changes in body fat distribution and metabolic parameters after RYGB and whether these changes correlated with improved lung function. Methods A retrospective review of 32 ethnic Chinese with obesity with body mass index (BMI) 28–35 kg/m2 and type 2 diabetes (T2DM) was conducted, focusing on met...

  16. Appraisal of adaptive neuro-fuzzy computing technique for estimating anti-obesity properties of a medicinal plant.

    Science.gov (United States)

    Kazemipoor, Mahnaz; Hajifaraji, Majid; Radzi, Che Wan Jasimah Bt Wan Mohamed; Shamshirband, Shahaboddin; Petković, Dalibor; Mat Kiah, Miss Laiha

    2015-01-01

    This research examines the precision of an adaptive neuro-fuzzy computing technique in estimating the anti-obesity property of a potent medicinal plant in a clinical dietary intervention. Even though a number of mathematical functions such as SPSS analysis have been proposed for modeling the anti-obesity properties estimation in terms of reduction in body mass index (BMI), body fat percentage, and body weight loss, there are still disadvantages of the models like very demanding in terms of calculation time. Since it is a very crucial problem, in this paper a process was constructed which simulates the anti-obesity activities of caraway (Carum carvi) a traditional medicine on obese women with adaptive neuro-fuzzy inference (ANFIS) method. The ANFIS results are compared with the support vector regression (SVR) results using root-mean-square error (RMSE) and coefficient of determination (R(2)). The experimental results show that an improvement in predictive accuracy and capability of generalization can be achieved by the ANFIS approach. The following statistical characteristics are obtained for BMI loss estimation: RMSE=0.032118 and R(2)=0.9964 in ANFIS testing and RMSE=0.47287 and R(2)=0.361 in SVR testing. For fat loss estimation: RMSE=0.23787 and R(2)=0.8599 in ANFIS testing and RMSE=0.32822 and R(2)=0.7814 in SVR testing. For weight loss estimation: RMSE=0.00000035601 and R(2)=1 in ANFIS testing and RMSE=0.17192 and R(2)=0.6607 in SVR testing. Because of that, it can be applied for practical purposes. PMID:25453384

  17. Observation of the effect of different gastric bypass on nonobese patients with type 2 diabetes mellitus%不同胃旁路术对非肥胖型2型糖尿病降糖疗效的观察

    Institute of Scientific and Technical Information of China (English)

    王俊杰; 刘斌; 王瑜; 黄盛; 王畅; 王祎波; 林克荣

    2012-01-01

    Objective: To discuss the effect of different Roux-en-Y gastric bypass (RYGBP)on non-obese patients with type 2 diabetes mellitus. Methods: Retrospectively analyze the clinical data of the 77 non-obese patients with type 2 diabetes mellitus and gastric cancer who were underwent Roux-en-Y gastric bypass in the department of general surgery from June 2007 to December 2009. Based on the tumor location, size during the surgery, patients were underwent Roux-en-Y gastric bypass with total gastrectomy (n=37) or subtotal gastrectomy (n=40). The fasting plasma glucose (FPG), OGTT 2h PG, and the free glucagon-like peptide 1 (FGLP-1 )were analyzed before surgery (0 month) and 1, 3, 6, 12 months after surgery. Results: The fasting plasma glucose and the 2h PG concentrations were significantly decreased after surgery (P0.05). Conclusions: Roux-en-Y gastric bypass with different residual stomach volume can effectively improve glucose metabolism in type 2 diabetic patients, but no significant differences can be found between the two groups on the glucose metabolism, the therapeutic effect of gastric bypass has no obvious contact with the size of residual stomach volume.%目的:探讨不同Roux-en-Y胃旁路术(RYGBP)对非肥胖型2型糖尿病(T2DM)患者降糖效果的影响.方法:回顾性分析2007年6月-2009年12月我院普通外科研究所收治的77例胃癌合并T2DM的非肥胖型患者的临床资料,术中依据肿瘤部位、大小分别行全胃切除RYGBP(37例)、胃大部切除RYGBP(40例),对术前(0月)、术后1、3、6、12个月空腹血糖(FPG)、OGTT 2小时血糖浓度(2hPG)、空腹胰高血糖素样肽(FGLP-1)水平进行统计分析.结果:全胃切除RYGBP组、胃大部切除RYGBP组术后FPG、2h PG较术前均逐渐降低(P<0.01);FGLP-1水平明显升高(P<0.01);同一时间点组间对比FPG、2h PG、FGLP-1水平均无统计学差异(P>0.05).结论:全胃切除和胃大部切除的RYGBP均对血糖具有控制作用,且保留不同

  18. Anti-obesity effects of boiled tuna extract in mice with obesity induced by a high-fat diet.

    Science.gov (United States)

    Kim, Youngmin; Kwon, Mi-Jin; Choi, Jeong-Wook; Lee, Min-Kyeong; Kim, Chorong; Jung, Jaehun; Aprianita, Heny; Nam, Heesop; Nam, Taek-Jeong

    2016-10-01

    The aim of this study was to examine the anti-obesity effects of boiled tuna extract in C57BL/6N mice with obesity induced by a high-fat diet (HFD). We determined the anti-obesity effects of boiled tuna extract (100, 200, or 400 mg/kg) on the progression of HFD-induced obesity for 10 weeks. The mice were divided into 5 groups as follows: the normal diet (ND) group (n=10); the HFD group (n=10); the mice fed HFD and 100 mg/kg boiled tuna extract group (n=10); those fed a HFD and 200 mg/kg boiled tuna extract group (n=10); and those fed a HFD and 400 mg/kg boiled tuna extract group (n=10). Changes in body weight, fat content, serum lipid levels and lipogenic enzyme levels were measured. The consumption of boiled tuna extract lowered epididymal tissue weight and exerted anti-obesity effects, as reflected by the serum glucose, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL‑C), low-density lipoprotein cholesterol (LDL-C), insulin and leptin levels. In addition, we demonstrated changes in liver adipogenic- and lipogenic-related protein expression by western blot analysis. Boiled tuna extract downregulated the levels of the CCAAT/enhancer-binding protein α, β and δ (C/EBPα, β, δ), and peroxisome proliferator-activated receptor-γ (PPAR-γ) adipocyte marker genes. Boiled tuna extract also attenuated adipogenic and lipogenic gene expression, namely the levels of fatty acid synthase (FAS), lipoprotein lipase (LPL), acetyl-CoA carboxylase (ACC), glucose transporter type 4 (Glut4) and phosphorylated adenosine monophosphate-activated protein kinase α and β (AMPKα, β) in a dose-dependent manner. Moreover, the consumption of boiled tuna extract restored the levels of superoxide dismutase (SOD), catalase (CAT), glutamic oxaloacetic transaminase (GOT), glutamic-pyruvate transaminase (GPT), aspartate transaminase (AST) and alanine transaminase (ALT) to those of the control group. These results

  19. Anti-obesity effects of Rapha diet® preparation in mice fed a high-fat diet

    OpenAIRE

    Kim, Jihyun; Kyung, Jangbeen; Kim, Dajeong; Choi, Ehn-Kyoung; Bang, Paul; Park, Dongsun; Kim, Yun-Bae

    2012-01-01

    The anti-obesity activities of Rapha diet® preparation containing silkworm pupa peptide, Garcinia cambogia, white bean extract, mango extract, raspberry extract, cocoa extract, and green tea extract were investigated in mice with dietary obesity. Male C57BL/6 mice were fed a high-fat diet (HFD) containing 3% Rapha diet® preparation for 8 weeks, and blood and tissue parameters of obesity were analyzed. The HFD markedly enhanced body weight gain by increasing the weights of epididymal, perirena...

  20. Anti-obesity activity of hen egg anti-lipase immunoglobulin yolk, a novel pancreatic lipase inhibitor

    OpenAIRE

    Hirose, Mai; Ando, Taishi; Shofiqur, Rahman; Umeda, Kouji; Kodama, Yoshikatsu; Van Nguyen, Sa; Goto, Tsuyoshi; Shimada, Masaya; Nagaoka, Satoshi

    2013-01-01

    Background There is completely no report about both hen egg anti-lipase immunoglobulin yolk (IgY) and its anti-obesity action. Thus, we tried to isolate and characterize a novel anti-lipase immunoglobulin from hen egg yolk. Moreover, we investigated whether hen egg yolk anti-lipase IgY inhibits pancreatic lipase activity in vitro, and examined its ability to prevent obesity in a murine high fat diet-induced obesity model. Methods We determined the inhibitory action of Anti-lipase IgY on lipas...

  1. Anti-obesity activity of diglyceride containing conjugated linoleic acid in C57BL/6J ob/ob mice

    OpenAIRE

    Hue, Jin-Joo; Lee, Ki Nam; Jeong, Jae-Hwang; Lee, Sang-Hwa; Lee, Young Ho; Jeong, Seong-woon; Nam, Sang Yoon; Yun, Young Won; Lee, Beom Jun

    2009-01-01

    This study was to investigate the anti-obesity effects of diglyceride (DG)-conjugated linoleic acid (CLA) containing 22% CLA as fatty acids in C57BL/6J ob/ob male mice. There were four experimental groups including vehicle control, DG, CLA, and DG-CLA. The test solutions of 750 mg/kg dose were orally administered to the mice everyday for 5 weeks. CLA treatments significantly decreased mean body weight in the obese mice throughout the experimental period compared to the control (p < 0.01). All...

  2. Uso de drogas antiobesidade entre estudantes universitários Use of anti-obesity drugs among college students

    Directory of Open Access Journals (Sweden)

    Maria do Carmo de Carvalho e Martins

    2011-10-01

    Full Text Available OBJETIVO: Avaliar o uso de drogas antiobesidade entre estudantes de uma universidade pública. MÉTODOS: Estudo transversal com amostra probabilística constituída por 664 universitários. Foram observadas variáveis socioeconômicas, antropométricas e uso das drogas. O índice de massa corpórea (IMC e circunferência da cintura (CC foram classificados segundo critérios da Organização Mundial de Saúde. RESULTADOS: Uso atual ou anterior de agentes antiobesidade foi referido por 6,8% dos estudantes. As anfetaminas e as aminas simpaticomiméticas (40,5% foram as drogas mais usadas. Entre aqueles que referiram uso de agentes antiobesidade, 62,2% eram do sexo feminino. Apenas 31,1% das prescrições foram indicadas por médicos. As médias de IMC e CC foram maiores entre estudantes que referiram uso de tais drogas, mas 47% deles foram classificados como eutróficos pelo IMC, e 76,5% apresentavam medida de CC normal. CONCLUSÃO: O uso de drogas antiobesidade se mostrou preocupante, principalmente pela elevada proporção de uso sem indicação ou prescrição médica.OBJECTIVE: To evaluate the use of anti-obesity drugs among students attending a public university. METHODS: This was a cross sectional random study of 664 college students. Drug use, socioeconomic, and anthropometric variables were observed. Body mass index (BMI and waist circumference (WC were classified according to World Health Organization criteria. RESULTS: Current or previous use of anti-obesity drugs was reported by 6.8% of students. Amphetamine and sympathomimetic amines (40.5% were the most commonly used drugs. Among those who reported use of anti-obesity agents, 62.2% were female. Only 31.1% of medications were prescribed by doctors. Mean BMI and WC were higher among students reporting the use of such drugs, but 47% of them were classified as eutrophic by BMI, and 76.5% had normal WC measure. CONCLUSION: The use of anti-obesity drugs among college students is of concern

  3. Anti-obesity effects of boiled tuna extract in mice with obesity induced by a high-fat diet.

    Science.gov (United States)

    Kim, Youngmin; Kwon, Mi-Jin; Choi, Jeong-Wook; Lee, Min-Kyeong; Kim, Chorong; Jung, Jaehun; Aprianita, Heny; Nam, Heesop; Nam, Taek-Jeong

    2016-10-01

    The aim of this study was to examine the anti-obesity effects of boiled tuna extract in C57BL/6N mice with obesity induced by a high-fat diet (HFD). We determined the anti-obesity effects of boiled tuna extract (100, 200, or 400 mg/kg) on the progression of HFD-induced obesity for 10 weeks. The mice were divided into 5 groups as follows: the normal diet (ND) group (n=10); the HFD group (n=10); the mice fed HFD and 100 mg/kg boiled tuna extract group (n=10); those fed a HFD and 200 mg/kg boiled tuna extract group (n=10); and those fed a HFD and 400 mg/kg boiled tuna extract group (n=10). Changes in body weight, fat content, serum lipid levels and lipogenic enzyme levels were measured. The consumption of boiled tuna extract lowered epididymal tissue weight and exerted anti-obesity effects, as reflected by the serum glucose, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL‑C), low-density lipoprotein cholesterol (LDL-C), insulin and leptin levels. In addition, we demonstrated changes in liver adipogenic- and lipogenic-related protein expression by western blot analysis. Boiled tuna extract downregulated the levels of the CCAAT/enhancer-binding protein α, β and δ (C/EBPα, β, δ), and peroxisome proliferator-activated receptor-γ (PPAR-γ) adipocyte marker genes. Boiled tuna extract also attenuated adipogenic and lipogenic gene expression, namely the levels of fatty acid synthase (FAS), lipoprotein lipase (LPL), acetyl-CoA carboxylase (ACC), glucose transporter type 4 (Glut4) and phosphorylated adenosine monophosphate-activated protein kinase α and β (AMPKα, β) in a dose-dependent manner. Moreover, the consumption of boiled tuna extract restored the levels of superoxide dismutase (SOD), catalase (CAT), glutamic oxaloacetic transaminase (GOT), glutamic-pyruvate transaminase (GPT), aspartate transaminase (AST) and alanine transaminase (ALT) to those of the control group. These results

  4. A systematic review of anti-obesity medicinal plants - an update.

    Science.gov (United States)

    Hasani-Ranjbar, Shirin; Jouyandeh, Zahra; Abdollahi, Mohammad

    2013-01-01

    Obesity is the most prevalent health problem affecting all age groups, and leads to many complications in the form of chronic heart disease, diabetes mellitus Type 2 and stroke. A systematic review about safety and efficacy of herbal medicines in the management of obesity in human was carried out by searching bibliographic data bases such as, PubMed, Scopus, Google Scholar, Web of Science, and IranMedex, for studies reported between 30th December 2008 to 23rd April 2012 on human or animals, investigating the beneficial and harmful effects of herbal medicine to treat obesity. Actually we limited our search to such a narrow window of time in order to update our article published before December of 2008. In this update, the search terms were "obesity" and ("herbal medicine" or "plant", "plant medicinal" or "medicine traditional") without narrowing or limiting search items. Publications with available abstracts were reviewed only. Total publications found in the initial search were 651. Total number of publications for review study was 33 by excluding publications related to animals study.Studies with Nigella Sativa, Camellia Sinensis, Crocus Sativus L, Seaweed laminaria Digitata, Xantigen, virgin olive oil, Catechin enriched green tea, Monoselect Camellia, Oolong tea, Yacon syrup, Irvingia Gabonensi, Weighlevel, RCM-104 compound of Camellia Sinensis, Pistachio, Psyllium fibre, black Chinese tea, sea buckthorn and bilberries show significant decreases in body weight. Only, alginate-based brown seaweed and Laminaria Digitata caused an abdominal bloating and upper respiratory tract infection as the side effect in the trial group. No other significant adverse effects were reported in all 33 trials included in this article.In conclusion, Nigella Sativa, Camellia Synensis, Green Tea, and Black Chinese Tea seem to have satisfactory anti-obesity effects. The effect size of these medicinal plants is a critical point that should be considered for interpretation. Although there

  5. Parent and child interactions with two contrasting anti-obesity advertising campaigns: a qualitative analysis

    Science.gov (United States)

    2014-01-01

    Background Social marketing has been proposed as a framework that may be effectively used to encourage behaviour change relating to obesity. Social advertising (or mass media campaigning) is the most commonly used social marketing strategy to address the issue of obesity. While social advertising has the potential to effectively communicate information about obesity, some argue that the current framing and delivery of these campaigns are ineffective, and may cause more harm than good. Methods We used a qualitative advertising reception study. 150 family groups (comprised of 159 parents and 184 children) were shown two Australian government anti-obesity advertisements: Measure Up (focused on problems associated with obesity) and Swap It (focused on solutions for obesity). Families were engaged in a discussion about the visual appeals, verbal messages and their perceptions about the impact of the advertisements on behavioural change. Open coding techniques and a constant comparative method of analysis was used to interpret the data. Results Many parents had strong personal resonance with the visual imagery within the campaigns. While Swap It had strong ‘likeability’ with children, many children believed that the messages about overweight and obesity were less personally relevant because they did not perceive themselves to be overweight. The content and delivery style of the verbal messages (the serious risk focused message in Measure Up compared to the upbeat, fun practical message in Swap It) influenced how different audiences (parents and children) interpreted the information that was presented. Parents assimilated practical and instructive messages, while children assimilated messages about weight loss and weight gain. Parents and children recognised that the campaigns were asking individuals to take personal responsibility for their weight status, and were at times critical that the campaigns did not tackle the broader issues associated with the causes and

  6. Clinical observation of gastric bypass in treatment of patients with type 2 diabetes mellitus%胃转流术治疗2型糖尿病的临床疗效:附214例报告

    Institute of Scientific and Technical Information of China (English)

    郭渝明; 李广阔; 霍芊竹; 陈俊; 邓开

    2013-01-01

      目的Roux-en-Y式胃转流术(RY-GBP)是2型糖尿病患者接受外科手术治疗的主要术式之一。本研究旨在进一步验证RY-GBP的手术治疗效果。方法214例2型糖尿病(T2DM)患者均行RY-GBP术,术中根据体质指数和胰岛素抵抗情况,选择合适的残胃(Pouch)容积和空肠袢长度。患者于术前和术后3,6,12个月行OGTT试验,并测定空腹血清胰岛素(FIns)、空腹血清C肽(FC-P)、糖化血红蛋白(HbAlc)、体重指数(BMI),密切关注患者术后的降糖药服用情况及糖尿病并发症改善情况。结果214例患者中,51例(23.8%)术后出院时即达治愈标准,停用降糖药物,78例(36.4%)于术后0~3个月内停药,21例(9.8%)于术后3~6个月内停药,18例(8.4%)于术后6~12个月内停药。另外46例(21.5%)12个月后仍服用降糖药物,但药物剂量有不同程度地减少,尚在进一步观察中。上述病例在术后3,6,12个月的各项检测指标均有所改善,近期治愈率达78.5%(168/214)。本组无死亡病例,相关并发症包括吻合口出血2例,吻合口溃疡7例,胃瘫21例,营养不良3例,贫血8例,在给予相应治疗后均缓解。结论RY-GBP胃转流术对肥胖型和非肥胖型2型糖尿病均有良好治疗效果,对非肥胖型2型糖尿病的治疗效果更值得进一步深入研究。%  Objective Gastric bypass(GBP), especially Roux-en-Y, is the main surgical procedure in patients with type 2 diabetes mellitus(T2DM). The present study focused on the evaluation of efficiency of Roux-en-Y Gastric bypass(RY-GBP) in T2DM patients. Methods Two hundred and fourteen patients with T2DM were operated according to the RY-GBP procedures, and gastric pouch as well as Roux limb were selected respectively by the BMI and insulin resistance. Blood glucose alterations(OGTT), Fins, FC-P, HbAlc, BMI, related complications and anti-sugar drugs were observed at

  7. Estudos endoscópico e histológico prospectivos e sequenciais da bolsa gástrica em 130 pacientes obesos mórbidos submetidos à bypass gástrico em Y-de-Roux Prospective sequential endoscopic and histologic studies of the gastric pouch in 130 morbidly obese patients submitted to Roux-en-Y gastric bypass

    OpenAIRE

    Attila Csendes; Gladys Smok; Ana Maria Burgos; Moira Canobra

    2012-01-01

    RACIONAL: Bypass gástrico em Y-de-Roux é a operação bariátrica mais comumente realizada. Pequena bolsa gástrica é criada, deixando uma anastomose gastrojejunal estreita, com uma alça jejunal mais comprida. Muito pouco é conhecido sobre o comportamento desta bolsa em anos após o procedimento. OBJETIVO: Determinar através de estudos prospectivos endoscópico e histológico seqüenciais o tamanho da bolsa gástrica, o diâmetro da anastomose e o comportamento da infecção por H. pylori após a operação...

  8. Current status and problems of the treatment of type 2 diabetes mellitus by laparoscopic (Roux-en-Y) gastric bypass surgery%腹腔镜胃旁路手术治疗2型糖尿病的现状及存在问题

    Institute of Scientific and Technical Information of China (English)

    胡友主; 喻海波

    2011-01-01

    Laparoscopic gastric bypass surgery was proved to be safe, effective and durable in treating obesity and type 2 diabetes mellitus. The Roux-en-Y gastric bypass procedure was the mainstream approach applied to the treatment of type 2 diabetes mellitus. In the article, different bariatric procedures were compared in terms of the mechanism, patient selection criteria, treatment effect and postoperative complications. Current status and problems of the surgeries were discussed.%腹腔镜Roux-en-Y分流胃旁路手术在肥胖症及2型糖尿病的外科治疗中已被证明是一种疗效显著、持久的安全手术方式,也是治疗2型糖尿病的主流术式.该文通过几种减肥术式的比较,阐述了该手术的相关机制、患者的选择、疗效及并发症等,并对其现状及存在问题进行了讨论.

  9. 腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病的疗效分析%Curative effect analysis of laparoscopic Roux-en-Y gastric bypass to treat type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    刘昶; 杨凯; 纪艳超; 王东

    2015-01-01

    Objective To investigate the effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) in treating type 2 diabetes mellitus (T2DM) and the operation essentials of LRYGB.Methods The clinical data of 41 T2DM patients who underwent LRYGB in the Fourth Affiliated Hospital of Harbin Medical University during January 2011 to January 2012 was analyzed. Changes of weight, blood glucose and blood lipid levels before and after operations were compared. The measurement data was compared by Independent-Samplest Test.Results All procedures were successfully without conversion to open operation. No serious postoperative complications were happened. The operative time was (148±21) min. time to ambulation was (3.0±1.4) d, liquid intake at (3.3±1.2) d, and postoperative hospitalization (15.0±4.1) d. Symptoms of T2DM and metabolic disorders were relieved significantly, and the obesity indexes were also decreased significantly(P<0.05).Conclusions LRYGB is effective for obese T2DM which is worthy of clinical application.%目的探讨腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)对2型糖尿病的治疗效果及手术操作要点。方法收集2011年1月至2012年1月在哈尔滨医科大学附属第四医院接受LRYGB的41例2型糖尿病患者的临床资料,对比术前及术后体重、血糖及血脂水平的变化情况,采用两样本t检验进行计量资料的比较。结果所有患者均成功完成手术,无中转开放,无严重术后并发症发生。手术时间(148±21)min,术后(3.0±1.4)d下地活动,术后(3.3±1.2)d恢复流食,术后住院时间为(15.0±4.1)d。所有患者均随访3年,随访期间,糖尿病及代谢异常综合征均明显缓解,各项肥胖指标明显降低,且差异有统计学意义(P<0.05)。结论 LRYGB对合并肥胖的2型糖尿病患者有良好的治疗效果,值得临床广泛开展。

  10. 保留不同胃容量的Roux-en-Y胃旁路术对糖尿病大鼠降糖效果的比较%Comparative effects of Roux-en-Y gastric bypass procedures preserving different gastric volume on blood glucose in Goto-Kakizaki rats

    Institute of Scientific and Technical Information of China (English)

    邹忠东; 焦亚彬; 王祎波; 王畅; 刘斌; 王瑜; 黄盛

    2012-01-01

    Objective To compare the effects of Roux-en-Y gastric bypass (RYGBP) procedures preserving different gastric volume on blood glucose of rats with non-obese type 2 diabetes.Methods A total of 36 Goto-Kakizaki rats randomly underwent one of the following procedures:gastric bypass with different types of anastomosis including the Roux-en-Y of total stomach excision (n=12),the Roux-en-Y of partial stomach excision (n=12) and the Roux-en-Y of stomach preservation (n=12).Rats were observed for 24 weeks after surgery.Body weight,food intake and fasting blood glucose level were tested at 0 (preoperative),1,3,6,12,24 weeks.Hematoglobin Alc (HbAlc) level was measured at 0, 12,24 weeks and glucose tolerance test (OGTF) was performed in conscious rats before (baseline) and then 30,60,120,and 180 minutes.Change of blood glucose over time was depicted. Area under curve (AUC) of glucose tolerance were calculated.Results Compared with preoperative levels,the weight and food intake of all the rats were significantly decreased at 1 week after surgery (P<0.01).At 3 weeks after operation,the weight and food intake were significantly increased compared with 1 week after operation in the Roux-en-Y of partial stomach excision and the Roux-en-Y of stomach retention (P<0.01).In the Roux-en-Y of total stomach excision,the weight and food intake were significantly lower compared with other two groups (P<0.05).At 24 weeks after operation,the levels of fasting blood glucose were (7.3±1.5),(7.5±2.0) and (8.3±1.3) mmol/L,which were lower than the preoperative levels [(13.2±1.6),(13.6±2.5) and (12.9±2.0) mmol/L,P<0.01 ] in the three groups.There were no significant differences among the three groups (P>O.05).At 24 weeks after operation,the HbA1c levels were (6.3±1.3)%,(6.4±2.0)% and (7.0±1.3)%,which were lower than the preoperative level[ (10.2±2.6)%,(9.6±2.5) and (9.9±2.0)%,P<0.01 ].There were no significant differences among the three groups(P>0.05).The trend

  11. Visfatin level after laparoscopic Roux-en-Y gastric bypass surgery in patients with Type 2 diabetes%2型糖尿病患者行腹腔镜Roux-en-Y胃旁路手术后内脂素水平变化

    Institute of Scientific and Technical Information of China (English)

    刘轶群; 熊静; 何红晖; 朱晒红; 莫朝晖

    2013-01-01

    目的:观察2型糖尿病(Type 2 diabetes mellitus,T2DM)患者行腹腔镜下Roux-en-Y胃旁路手术后血清内脂素水平变化,并探讨其与术后胰岛素抵抗、糖尿病改善的关系.方法:33例T2DM患者行腹腔镜下Roux-en-Y胃旁路术,采用酶联免疫吸附实验检测其术前及术后3个月空腹血清内脂素水平,并同时检测空腹血糖(fasting plasm glucose,FPG)、糖化血红蛋白(human glycated hemoglobin Alc,HbAlc)、空腹胰岛素(fasting insulin,FINS)等.结果:腹腔镜Roux-en-Y胃旁路手术后,HbAlc,FINS,胰岛素抵抗指数均较术前下降,体质量指数[(24.53±0.62) kg/m2]较术前[(26.71±0.69) kg/m2]下降,且差异有统计学意义(P<0.001),血清内脂素水平[(9.79±0.64) ng/mL]也明显低于术前[(38.24±5.32) ng/mL],差异具有统计学意义(P<0.001).结论:T2DM患者腹腔镜Roux-en-Y胃旁路手术后内脂素水平变化可能与术后胰岛素抵抗、糖尿病改善有一定的关系.%Objective: To investigate the change in serum visfatin level after laparoscopic Roux-en-Y gastric bypass surgery in patients with Type 2 diabetes mellitus (T2DM) and to explore the relationship between visfatin insulin resistance and diabetes. Methods: Thirty-three patients with Type 2 diabetes were studied before and after the gastric bypass surgery. The level of fasting serum visfatin was measured by enzyme-linked immunosorbent assay. Fasting plasma glucose (FPG), glycated hemoglobin (HbAlc) and fasting insulin (FINS) were measured before and after the gastric bypass surgery. Results: Compared with before the operation, the indicators of HbAlc, FINS, and insulin resistance index (HOMA-IR) were decreased after the laparoscopic Roux-en-Y gastric bypass surgery. The body mass index (BMI) [(24.53 ± 0.62) kg/m2 vs (26.71 + 0.69) kg/m2] was decreased, with significant difference (P<0.00l). The serum visfatin level [(9.79 ± 0.64) ng/mL] was significantly lower than before the operation [(38.24 ± 5.32) ng

  12. 不同体重指数的2型糖尿病腹腔镜胃旁路术后临床疗效对比研究%Clinical effect comparison of the type 2 diabetes mellitus with different BMI after the laparoscopic gastric bypass

    Institute of Scientific and Technical Information of China (English)

    黎飞; 金迪; 张玉新; 吴良平; 戴晓江; 张红兵; 康慧鑫; 郄文斌; 宋丹丹; 唐柚青

    2015-01-01

    目的:探索体重指数( BMI)对糖尿病腹腔镜胃旁路术临床疗效的影响。方法从我院2010年至2013年实施腹腔镜胃旁路术的2型糖尿病患者中,随机从25 kg/m2gastric bypass. Methods Twenty patients were randomly selected from type 2 diabetes mellitus patients with BMI of 25 ~28 kg/m2 after laparoscopic gastric bypass surgery in our hospital from 2010 to 2013,20 patients from type 2 diabetes mellitus patients with BMI of 28~35 kg/m2 and 20 patients from type 2 diabetes mellitus patients with BMI≥35 kg/m2 . Accordingly,the total of 60 patients were divided into low BMI group,middle BMI group and high BMI group. The difference of the rate of blood glucose control and other indicators between three groups were compared and analyzed. Results The rate of blood glucose control in low BMI group was 75%,middle BMI group was 85%, and high BMI group was 90%. There was no statistical difference of the rate of blood glucose control between three groups at 12 months after laparoscopic gastric bypass surgery. The blood glucose and weight obviously improved in all patients,and fasting insulin and postprandial ser-um insulin decreased at 12 months after laparoscopic gastric bypass surgery. Conclusion All the patient of type 2 diabetes mellitus with dif

  13. 袖状胃切除术与Roux-en-Y胃转流术治疗肥胖及2型糖尿病疗效的Meta分析%A META-ANALYSIS OF SLEEVE GASTRECTOMY VERSUS ROUX-EN-Y GASTRIC BYPASS FOR MORBID OBESITY AND DIABETES MELLITUS

    Institute of Scientific and Technical Information of China (English)

    颜朝阳; 颜振民; 张志; 尉建安; 孙少华; 张忠涛; 孟化

    2016-01-01

    Objective:To review the effect of sleeve gastrectomy ( SG ) and Roux-en-Y gastric bypass( RYGB) for the treatment of obesity and type 2 diabetes. Methods:Electronic literature search was performed on PubMed,EMBASE,Cochrane Library,CNKI and Wanfang database from inception to October 1 ,2014 . The following medical subject headings ( MeSH ) and keywords were used:“bariatric surgery”、“T2 DM”、“gastric bypass”、“sleeve gastrectomy”、“RCT”. Finally we got 9 literatures focused on the comparison of the effect of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of obesity and type 2 diabetes to review. Results:Among all the 9 included studies,a total of 713 cases were reported,including 315 patients in the sleeve gastrectomy group and 398 patients in the Roux-en-Y gastric bypass group. The results of the Meta analysis showed that there were no significant difference in the remission rate of T2DM(RR=0. 85,95%CI:0. 67 ~1. 09,P>0. 05),no significant difference in the percentage excess weight loss ( MD=0 . 29 , 95%CI:-6 . 51 ~7 . 10 , P>0 . 05 ) , no significant difference in the change of BMI(MD=-0. 32,95%CI:-1. 16~0. 51,P>0. 05). But in the incidence of complications,the sleeve gastrectomy showed significant advantage(RR=0. 55,95%CI:0. 33~0. 94,P0.05),术后多余体重降低百分比(MD=0.29,95%CI:-6.51~7.10,P>0.05)和术后体重指数(body mass index,BMI)变化(MD=-0.32,95%CI:-1.16~0.51,P>0.05)方面效果相当;在术后并发症方面,袖状胃切除术优于Roux-en-Y胃转流术(RR=0.55,95%CI:0.33~0.94,P<0.05)。结论:袖状胃切除术在对肥胖及2型糖尿病的治疗上可作为优选术式。

  14. Bypass gástrico en Y de Roux para el tratamiento de pacientes con diabetes mellitus tipo II con IMC de 30 a 35 kg/m² Roux-en-Y gastric bypass for treatment of patients with DM type 2 and BMI of 30 to 35 Kg/m²

    Directory of Open Access Journals (Sweden)

    S. Navarrete Aulestia

    2012-08-01

    Full Text Available La incidencia de obesidad y una de sus comorbilidades más temida la diabetes mellitus tipo II está en aumento y no pareciera haber tratamiento médico que ayude a controlar estas pandemias. Existe una técnica quirúrgica bariátrica, el Bypass Gástrico en Y de Roux (BGYR que es segura y no sólo ayuda a controlar el exceso de peso sino también produce resultados alentadores en el control y remisión de la diabetes. Métodos: Se presentan 15 pacientes con IMC entre 30 y 35 kg/mt² diabéticos tipo II seleccionados sometidos a BGYR por laparoscopia con seguimiento de un año. Resultados: Se operaron 14 mujeres y un hombre con los siguientes valores promedios: Edad: 37 años, Peso: 88,3 kg, IMC: 32,8 kg/mt², Glicemia: 120 ± 38,8 mg%, HbA1c: 7,6% ± 0,73. 40% de hipertensión arterial y 33,3% dislipidémicos. El tiempo quirúrgico promedio fue de 75 minutos, dos días de hospitalización bajo índice de complicaciones y sin mortalidad. Se logró una remisión de la diabetes en el 93%, de los casos, con descensos de la glicemia y HbA1c significativos (p ≤ 0,05 y p ≤ 0,001 respectivamente con un control de la dislipidemia del 100% y 83,3% de la HTA. Conclusiones: El BGYR en obesos tipo I diabéticos seleccionados es una técnica segura y eficaz en el control metabólico y de la obesidad.Background: The incidence of obesity and its most feared comorbidity, diabetes mellitus type 2, is increasing and there would not seem to be any medical treatment to help control these pandemics. However, there is a bariatric surgery technique, the Roux-en-Y Gastric Bypass (RYGB, which is safe and not only helps control excess weight, but produces encouraging results in the control and remission of diabetes. Methods: We present 15 selected patients with a BMI between 30 and 35 kg/mt² and diabetes type 2 who underwent a laparoscopic RYGB with of one-year follow-up. Results: A total of 14 women and one man were operated with the following average values: age

  15. Effect of gastric bypass surgery on fasting blood glucose and pancreatic islet cell in type 2 diabetic rats%胃旁路术对血糖及胰岛细胞的影响

    Institute of Scientific and Technical Information of China (English)

    史逸华; 郑志坚; 戴灵波

    2013-01-01

    Objective To study the effect and mechanism of gastric bypass surgery on type 2 diabetic rats.Methods The models of type 2 diabetic rats were induced by stretozotocin and 20 diabetic rats were randomly divided into 2 groups:diabetes-operation group (DO group,n =10)and diabetes-control group(DC group,n =10).20 normal rats were randomly divided into 2 groups:normal-operation(NO group,n =10) and normalcontrol group(NC group,n =10).Rats in DO and NO group underwent GBP and rats in DC group and NC group underwent sham operation.Fasting blood glucose(FBG) levels of rats in each group were detected before operation and on 72 h,1th week,4th week,8th week after operation.On the 8th week after operation,pancreas tissues were harvested for HE staining and immunofluorescence,histological changes observed.Results The FBG levels of rats were not statistically significant different before operation between DO group and DC group or between NO group and NC group (P > 0.05).After operation,the FBG levels of rats in DO group gradually declined (P < 0.05).FBG levels of rats in DO group were lower after operation than before operation(P <0.05) ; After operation FBG levels of rats were higher in DO group than in NO group and NC group at the same time point (P <0.05).In DC group,the difference of FBG levels of rats at different time point was not statistically significant(P > 0.05).The difference of FBG had no statistically significance between the different time points of the same group or between the same time point of different groups (P > 0.05).HE staining showed that,in DO group,newborn small islets appeared in pancreas which increased the number of islet.The new islets were smaller,mostly around the pancreatic duct and the structure was similar to that of the normal islets.Immunofluorescence staining also showed that the number of islets increased.Insulin immunofluorescence found more isolated small islets composed of two or three insulin positive cells.Insulin and

  16. Resolution of diabetes mellitus and metabolic syndrome in normal weight 24-29 BMI patients with one anastomosis gastric bypass Resolución de la diabetes mellitus y del síndrome metabólico

    Directory of Open Access Journals (Sweden)

    M. García-Caballero

    2012-04-01

    Full Text Available Introduction: Diabetes mellitus type 2 (DMT2 is a major cause of death in the world. The medical therapy for this disease has had enormous progress, but it still leaves many patients exposed to the complications developed from the disease. It is well known the beneficial effects of bariatric surgery in obese diabetic patients, however it is important to investigate if the same principles of bariatric surgery that improve diabetes in obese patients, could be applied to non obese normal weight diabetics. Material and methods: Thirteen diabetic patients operated by One Anastomosis Gastric Bypass (BAGUA, were evaluated in the preoperative period and 1,3 and 6 months after surgery. Body weight and composition, Fasting Plasma Glucose, HbA1c levels, blood pressure and serum lipids levels were analyzed, as well as the monitoring of the immediate postoperative treatment necessities for Diabetes and other metabolic syndrome comorbidities. Results: After the surgery the 77% of the patients resolves its T2DM, 46% from surgery, and rest noted an significant improvement of the disease in spite of having a C peptide level near to zero some of the patients. The comorbidities, mainly hypertension and lipid abnormalities experience improvement early. All patients reduce their weight and the amount of fat mass until values consistent with their age and height. Conclusions: The One Anastomosis Gastric Bypass leads to resolution or improvement of T2DM in non obese normal weight patients. The best results are obtained in patients with few years of diabetes, without or short term use of insulin treatment and high C-peptide levels.Introducción: La diabetes mellitus de tipo 2 (DMT2 es una causa principal de muerte a escala mundial. El tratamiento médico de esta enfermedad ha progresado tremendamente pero sigue dejando a muchos pacientes expuestos a las complicaciones derivadas de la enfermedad. Son bien conocidos los efectos beneficiosos de la cirugía bariátrica en

  17. 十二指肠空肠旷置术与Roux-en-Y胃旁路术治疗2型糖尿病的疗效对比%Effect of duodenal-jejunal bypass vs.Roux-en-Y gastric bypass for type Ⅱ diabetes

    Institute of Scientific and Technical Information of China (English)

    都敏; 鲍兴; 张杰; 戴璟瑜; 张环; 彭海峰

    2012-01-01

    Objective To study the curative effects of Roux-en-Y gastric bypass vs.duodenal-jejunal bypass for STZ-induced type 2 diabetic SD rats.Methods Twenty-one type Ⅱ diabetic rats were randomly divided into Roux-en-Y gastric bypass group and duodenal-jejunal bypass group.The fasting blood glucose,fasting plasma insulin level,the body weight and the food intake were measured and recored before and after operation at the 1st,2nd,3rd,4th and 8th week postoperatively.Results As compared with preoperation,fasting plasma glucose levels in DJB group were markedly declined at the 3rd,4th and 8th week (18.30 ±4.4 vs.11.30 ±5.02 vs.9.80 ±4.81 vs.7.90 ±3.38,P <0.05),fasting plasma insulin levels increased significantly at the 3rd,4th and 8th week (11.10 ± 5.69 vs.15.50 ± 3.68 vs.16.60 ±3.67 vs.16.70 ±3.74,P <0.05).Body weight was decreased but the difference was statistically significant only at the 8th week after surgery (368.30 ±23.69 vs.352.20 ±35.28,P<0.05).Food intake was markedly declined only at the 1st week after DJB (30.40 ± 1.94 vs.15.30 ± 10.78,P <0.05).In the RYGB group,as compared with preoperation,fasting plasma glucose levels were markedly declined at 3rd,4th and 8th week (19.30±4.89 vs.13.50±4.05 vs.9.80±3.08 vs.8.60 ±2.71,P<0.05),and body weight was also markedly declined at 3rd,4th and 8th week (370.70 ±41.88 vs.343.20 ±31.16 vs.322.70 ± 34.76 vs.304.70 ± 29.70,P < 0.05),insulin levels significant increased at 3rd,4th and 8th week (10.50 ± 4.13 vs.16.50 ± 4.93 vs.18.80 ± 3.36 vs.18.40 ± 2.82,P < 0.05).Food intake was decreased significantly after surgery (12.90 ± 7.82 vs.20.10 ± 1.41 vs.19.80 ± 2.35 vs.20.70 ± 1.83 vs.20.30 ±2.42,P <0.05).From the baseline to 8th week,no significant difference was found between RYGB group and DJB group in fasting plasma glucose and insulin levels (P > 0.05),but there was significant difference in weight loss between two groups (P < 0.05).Food intake after surgery was

  18. Comparative clinical study of the effects of gastric bypass with different types of anastomosis on type 2 diabetes mellitus%不同吻合方式胃转流术对2型糖尿病疗效对比研究

    Institute of Scientific and Technical Information of China (English)

    王烈; 张再重; 黄盛; 焦亚彬; 邓治洲; 王瑜

    2011-01-01

    Objective To assess the effects of gastric bypass with different types of anastomosis on type 2 diabetes mellitus (T2DM). Methods From June 2006 to February 2009, 61 patients with gastric lesions combined with type 2 diabetes mellitus performed gastrectomy were prospectively assigned into Billroth Ⅰ group (n=11), Billroth Ⅱ group (n=26) and Roux-en-Y group (n=24) in Fuzhou General Hospital of Nanjing Military Command. The pre- and postoperative clinical parameters associated with glycometabolism and body mass index were measured during a 6-month follow-up period. Results Fasting blood glucose and glycated hemoglobin levels were significantly decreased after surgery in both Billroth Ⅱ and Roux-en-Y groups (P<0.01 or P<0.05). At 3 and 6 months, patients in both Billroth Ⅱ and Roux-en-Y groups had significantly increased fasting C-peptide and significant improved oral glucose tolerance test (P<0.01 or P<0.05). The changes of those parameters above in Roux-en-Y group were greater than those in Billroth Ⅱ group(P<0.01 or P<0.05). However, the effects were not shown in Billroth Ⅰ group through the entire follow-up period. T2DM control rate in Roux-en-Y group was higher than that in Billroth I and Billroth Ⅱ group (P<0.01 or P<0.05). Conclusion As compared with Billroth Ⅰ and Billroth Ⅱ reconstruction after gastrectomy, Roux-en-Y gastric bypass seems to be more effective on T2DM control. The therapeutic effect of gastric bypass is independent on loss of body weight. Roux-en-Y gastric bypass may be as a potential management option for T2DM.%目的 评估不同吻合方式胃转流术对2型糖尿病的临床疗效.方法 2006年6月至2009年2月南京军区福州总医院收治合并2型糖尿病的胃部病变行胃转流术病人61例,按术式分为毕Ⅰ式(n=11)、毕Ⅱ式(n=26)和Roux-en-Y(n=24)吻合3组.统计分析手术前和术后6个月内体质量指数和糖代谢指标变化.结果 术后,Roux-en-Y和毕Ⅱ式组空腹血

  19. Derivações gástricas em y- de- roux com anel de silicone para o tratamento da obesidade: estudo das complicações relacionadas com o anel Roux-en-y gastric bypass with silicone ring for the obesity treatment: study of the complications related to the ring

    Directory of Open Access Journals (Sweden)

    Alexandre Amado Elias

    2011-12-01

    Full Text Available RACIONAL: O anel de silicone é utilizado como fator de contensão do bypass gástrico em Y-de-Roux para induzir maior perda ponderal. No entanto, ele pode ter alguns inconvenientes nesta restrição forçada. OBJETIVO: Analisar as complicações relacionadas ao anel em pacientes submetidos à operação de bypass gástrico em Y-de-Roux. MÉTODOS: De 1994 a 2005, 7 000 pacientes foram submetidos à bypass gástrico em Y-de-Roux com anel de silicone para o tratamento da obesidade mórbida. Apenas 50% foram acompanhados de dois a 11 anos. A perda média de peso em excesso foi de cerca de 85%. Mas complicações do anel foram registrados em 160 pacientes (2,28% do total e 4,56% dos pacientes seguidos. Assim, esta série é composta de 38 pacientes do sexo masculino (23,8% e 122 pacientes do feminino (76,2% com idade média de 44 anos e IMC de 54,4 kg/m². RESULTADOS: Cinco tipos de complicações do anel foram encontradas. A mais frequente foi o de deslocamento (61% causando sintomas de obstrução. A segunda, foi a erosão do anel de luz (22%, causando dor epigástrica e náuseas. A presença de anel estreito, anel aberto e a inadequação do mesmo são outras complicações que acorreram, porém em menor percentual. CONCLUSÕES: As complicações do anel ocorrem em baixa frequência. Sua remoção, cirúrgica ou endoscópica, é o tratamento mais usual, mas com sua realização o paciente tende a recuperar o peso perdido.BACKGROUND: The silicone ring is used as containment factor of the Roux-en-Y gastric bypass to induce greater ponderal loss. However, it may have some inconveniences from this stressed restriction. AIM: To analyze the complications related to silicone ring in patients who underwent Roux-en-Y gastric bypass surgery with silicon ring. METHODS: From 1994 to 2005, 7 000 patients were submitted to Roux-in-Y gastric bypass with silicone ring in order to treat morbid obesity. Only 50% were followed from two to 11 years. The mean excess

  20. Mitochondria as pharmacological targets: the discovery of novel anti-obesity mitochondrial uncouplers from Africa's medicinal plants.

    Science.gov (United States)

    Ocloo, Augustine; Dongdem, Julius Tieroyaare

    2012-01-01

    Obesity results from prolonged positive imbalance between energy in take and expenditure. When food intake chronically exceeds the body's energy need, an efficient metabolism results in the storage of the excess energy as fat. Mitochondria are the main centre for energy production in eukaryotic cells. Mitochondrial proton cycling is responsible for a significant proportion of basal or standard metabolic rate, therefore, further uncoupling of mitochondria may be a good way to increase energy expenditure and hence represent a good pharmacological target for the treatment of obesity. This implies that, any chemical agent or photochemical compound that further uncouples the mitochondria in vivo without having any effect on mitochondria activity could be a potential target in finding treatment for obesity. In the past, uncoupling by 2, 4-dinitrophenol has been used this way with notable success. This paper discusses the mitochondria as targets in the discovery of potential plant natural anti-obesity products from Africa's rich rainforests. PMID:23983343

  1. Micronutrients deficiencies following laparoscopic gastric bypass in patients with morbid obesity%腹腔镜胃旁路术后病态肥胖症患者微量营养素缺乏的诊治

    Institute of Scientific and Technical Information of China (English)

    宫轲; Michel Gagner; Sergio J Bardaro

    2010-01-01

    Objective To evaluate the changes of micronutrients in patients with morbid obesity after laparoscopic Roux-en-Y gastric bypass surgery (LRYGBP). Methods We retrospectively reviewed 121 patients diagnosed with morbid obesity who underwent LRYGBP and evaluated serum Iron (Fe),calcium (Ca), zinc (Zn), selenium (Se), vitamin A (VitA), 25-hydroxy vitamin D3 (VitD), vitamin B12( VitB12 ) and parathormone (PTH) measured at 6-month, 12-month and 24-month after LRYGBP. Results A cohort of 121 patients underwent LRYGBP. The mean body mass index (BMI) before LRYGBP was (47 ±7) kg/m2. At 6 months after surgery, the mean BMI was (34 ±6) kg/m2. Postoperative mean BMI decreased significantly ( P< 0.01 ) 6 months after the surgery. Within the following 2 years, serum Fe, Ca,Zn, Se, VitA, VitD, VitB12 was normal. In contrast serum PTH remained continuously at a higher level than normal. Conclusions This study confirms that LRYGBP is a reliable and safe weight loss method for the patients suffering from morbid obesity. After surgery, serum Ca, Zn, Se metabolisms and PTH levels are altered in these patients. Therefore multi-vitamin and mineral supplementation are strongly recommended in all patients after LRYGBP.%目的 探讨行腹腔镜胃旁路术后病态肥胖症患者血清微量营养素的变化. 方法回顾性分析121例病态肥胖症患者腹腔镜胃旁路术后6、12、24个月血清铁(Fe)、钙(Ca)、锌(Zn)、硒(Se)及维生素A(VitA)、维生素D(VitD)、维生素B12(VitB12)和甲状旁腺素(PTH)水平的变化.结果 本组121例病态肥胖症患者术前1个月平均体质量指数(body mass index,BMI)为(47±7)kg/m2,术后6个月平均BMI为(34±6)kg/m2,术后BMI平均下降(13±5)kg/m2(P<0.01).在术后的2年随访中,血清Fe、Ca、Zn、Se、VitA、VitD、VitB12均在正常范围.虽然一些患者的血清Zn、Se和VitA水平偏低,但接近正常.而血清PTH始终高于正常水平,术后6、12、24个月分别升高了(22±34)pg/ml、(28±34)pg

  2. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: Follow-up results in 121 patients%121例腹腔镜Roux-en-Y胃空肠吻合术后随访结果

    Institute of Scientific and Technical Information of China (English)

    宫轲; Michel Gagner; Alfons Pomp; Taghreed A

    2007-01-01

    目的 探讨腹腔镜Roux-en-Y胃空肠吻合术(laparoscopic Roux-en-Y gastric bypass,LRYGBP)治疗病态肥胖的术后营养和代谢方面的变化.方法 121例LRYGBP,男40例,女81例.分别测定术前1个月及术后6个月的体重指数(body mass index,BMI).对比分析6个月、12个月,24个月血清铁(Fe)、钙(Ca)、锌(Zn)、硒(Se)及维生素A(VitA)、维生素D(VitD)、维生素B12(VitB12)和甲状旁腺素(parathyroid hormone,PTH)的水平变化.结果 术前1个月BMI(47.00±7.15)kg/m2,术后6个月BMI(33.79±6.06) kg/m2,BMI下降(13.21±5.47)kg/m2 (t=26.103,P=0.000).术后血清Fe 、 Ca 、Zn、 Se及VitA、VitD、VitB12均在正常范围,其中术后6个月血清Zn、Se和VitA水平虽然在正常范围内,但分别有19.5%(17/87)、22.7%(20/88)和33.7%(28/83)的患者低于正常水平,但术后2年仅有6.7%(2/30)、11.5%(3/26)和17.2%(5/29)的患者低于正常水平.血清PTH术后 6个月11~161 pg/ml,(66±34)pg/ml、1年24~154 pg/ml,(72±34)pg/ml、2年21~194 pg/ml,(75±40)pg/ml (正常值9~44 pg/ml).结论 LRYGBP治疗病态肥胖是有效、安全的.术后2年血清Fe、Ca及VitD 、VitB12均正常;血清锌、硒及维生素A经术后6个月给予补充剂大多接近正常;血清PTH水平明显高于正常.建议患者术后长期服用复合维生素、矿物质补充剂,定期到医院随访.

  3. Effects of gastric bypass on blood glucose in rats with diabetes mellitus%胃转流术对糖尿病大鼠降糖作用的实验研究

    Institute of Scientific and Technical Information of China (English)

    李蔚; 刘宁青; 李萌; 赵莉

    2012-01-01

    目的 研究胃肠转流手术(GBP)对非肥胖型糖尿病大鼠的降糖效果与术后进食量、体重的关系.方法 健康雄性wistar大鼠,腹腔注射链脲佐菌素(STZ)建立糖尿病模型.随机分成3组,O组:GBP手术组;F组:饮食控制组;C组:空白对照组.观察各组大鼠体重、平均进食量,分别测定术前、术后1、2、3、4、8周空腹及灌服葡萄糖30 min后血糖水平.结果 O组GBP后4周,空腹和灌服葡萄糖后血糖分别由(20.8±4.9)、(30.2±3.1)mmol/L下降到(11.6±2.9)、(16.6±3.1)mmol/L (P<0.01).O组体重改变无统计学意义.F组控制平均进食量约为O组的1/3并致体重显著下降,血糖下降没有O组明显.结论 胃转流术对糖尿病大鼠具有明显治疗作用,其降糖作用与术后体重下降及进食量无关.%Objective To investigate the effects of gastric bypass ( GBP ) on hypoglycemic activity, food-intake after GBP and body weight in rats with non-obesity diabetes mellitus. Methods The animal models with diabetes mellitus were established in 24 male Wistar rats by intraperitoneal injection with STZ, then the rats were randomly divided into 3 groups:group 0 ( GBP ),group F ( food restriction ) and group C ( blank controls ). The blood glucose concentrations were measured respectively at fasting and postprandial condition before and on the 1st,2nd,3rd,4th and 8th week after GBP for all the rats, and the rats'body weight and average food-intake were detected simultaneously. Results At the 4th week after GBP,the fasting and postprandial blood glucose levels in group 0 were significantly decreased from ( 20. 8±4. 9 ),( 30. 2±3. 1 ) mmol/L to (11. 6±2. 9),( 16. 6±3. 1 ) mmol/L,respectively ( P < 0. 01 ). However there was no significant difference in the rats' weight changes in group 0. The average food-intake in group F was about one-third of group 0,furthermore,the rats' body weight was decreased, but the decrease of body weight was not as obvious as that in group 0

  4. Potency of turmeric (Curcuma longa L. extract and curcumin as anti-obesity by inhibiting the cholesterol and triglycerides synthesis in HepG2 cells

    Directory of Open Access Journals (Sweden)

    Iwan Budiman

    2015-05-01

    Full Text Available Background: Adipocytes accumulate triacylglycerol when excessive food consumption. Adipocyte dysfunction plays an important role in the obesity development. People with a body weight 40 % heavier than the average body weight population at risk of death two times greater than the average body weight. The use of anti-obesity drugs have many side effects, so it is necessary to find the anti-obesity drug with low toxicity. This ex vivo study was conducted to determine the activity of C. longa L. extract in inhibiting triglycerides and cholesterol synthesis and lipid droplet formation on HepG2 cells compared to curcumin. Methods: Anti-obesity activity includes reduced formation of lipid droplet in HepG2 cells can be observed using oil red O staining method. The measurement of triglyceride level was performed according to Randox protocol using Randox TR 210 assay kit. Lipolytic activity by measuring cholesterol levels was performed based on Randox CH 200 kits. Results: This study suggested that the extract of C. longa L. and curcumin have potential anti-obesity compounds. C. longa L. extract have higher activity in inhibiting triglycerides and cholesterol synthesis compared to curcumin with inhibition activities 70.43% and 66.38% respectively in the highest concentration. Conclusion: The C. longa extract posses the anti-adipogenesis potential on inhibiting the synthesis of triglycerides and cholesterol and lipid droplet formation in HepG2 cell as anti-obesity parameters better than curcumin. [Int J Res Med Sci 2015; 3(5.000: 1165-1171

  5. 2型糖尿病患者胃旁路术治疗后脂联素水平的变化研究%Research on the Changes of Adiponectin after Gastric Bypass Surgery in Patients with Type 2 Diabetes

    Institute of Scientific and Technical Information of China (English)

    刘轶群; 熊静; 何红晖; 朱晒红; 莫朝晖

    2012-01-01

    Objective To investigate the changes of serum adiponectin levels before and after gastric bypass surgery in patients with type 2 diabetes mellitus (T2DM) and to explore its relationship with postoperative insulin resistance and diabetes improvement.Methods 33 T2DM patients were given laparoscopic Roux-en-Y gastric bypass surgery.Fasting serum adiponect in levels, body mass index (BMI), waist to hip ratio (WHR), fasting plasma glucose (FPG), 2 hours postprandial blood glucose (2 hPG), glycated hemoglobin (HbA1c), fasting insulin (FINS) and insulin resistance index (HOMA-IR) were detected before surgery and three months after surgery.Results (1) After gastric bypass surgery, levels of BMI, WHR, HbA1c, FPG, 2 hPG, TG were all decreased significantly (P <0.01), while the serum adiponectin level was significantly increased after surgery [ (1.60 ±0.09) μg/L vs (1.36 ±0.07) μg/L, P <0.01 ] .(2) Correlation analysis showed that the changes of serum adiponectin before and after surgery were negatively correlated with HOMA-IR and FINS (r values were-0.722, -0.713 , P <0.01; and -0.482, -0.505, P <0.01) .Conclusion The changes of adiponectin level after gastric bypass surgery among T2DM patients may relate to postoperative insulin resistance and diabetes improvement.%目的 观察2型糖尿病(T2DM)患者胃旁路术治疗前后血清脂联素水平的变化,探讨其与术后胰岛素抵抗、糖尿病改善的关系.方法 选取33例行腹腔镜下Roux-en-Y胃旁路术T2DM患者,检测其术前及术后3个月的空腹血清脂联素水平,并观察体质指数(BMI)、腰臀比(WHR)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)等的变化.结果 (1)术后T2DM患者BMI、WHR及HbA1c、FPG、2 hPG、TG水平较术前显著下降(P<0.01),而血清脂联素水平(1.60±0.09)μg/L则显著高于术前(1.36±0.07)μg/L,差异有统计学意义(P<0.01).(2)相关性分析显示,术前血

  6. Curative effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus and correlation analysis%腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病的疗效及指标相关性分析

    Institute of Scientific and Technical Information of China (English)

    朱利勇; 李鹏洲; 赵磊; 杨湘武; 李伟正; 刘升平; 朱晒红

    2015-01-01

    目的探讨腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病的早中期疗效及手术后疗效预判的预测指标。方法回顾性分析2010年10月至2012年10月因2型糖尿病在中南大学湘雅三医院接受腹腔镜胃旁路术治疗的78例患者的临床资料。其中男52例,女26例。所有患者在气管插管全麻下行腹腔镜胃旁路术。术后观察体重、血糖、血脂等相关指标,比较术后不同时期各测量指标的差异及初步探讨术后疗效的预测指标。结果78例患者术后2型糖尿病完全缓解34例,44例胰岛素或药物使用量明显下降。BMI、腰臀比、胆固醇脂、空腹血糖、2小时血糖、空腹C肽(FCp)、HbA1c和胰岛素抵抗指数(HOMA-IR)均较术前明显改善(P<0.05)。BMI、甘油三酯、餐后2h胰岛素分泌量、FCp、2hCp、HOMA-IR对手术治疗2型糖尿病的疗效有相关性。结论腹腔镜胃旁路术治疗T2DM的临床疗效确切,BMI、胰岛分泌功能、HOMA-IR可推荐作为手术疗效预判的预测指标。%Objective To investigate the early and middle stage outcomes of laparoscopic Roux-en-Y gastric bypass surgery in the treatment of type 2 diabetes mellitus(T2DM) and the predictors of postoperative effect.Methods Clinical and follow-up data of 78 patients undergoing laparoscopic Roux-en-Y gastric bypass surgery in Xiangya Third Hospital from October 2010 to October 2012 were retrospectively studied. Among the 78 patients, 52 were males and 26 were females. All the patients received laparoscopic Roux-en-Y gastric bypass under intubation anesthesia. Postoperative weight, blood glucose, blood lipid and correlative indexes were observed and compared with the data before surgery to analyse the predictors of curative effects.Results Among the 78 patients, 34 cases had complete remission of T2DM, 44 cases obviously decreased the usage of insulin and correlative medicine postoperatively. BMI, waist hip rate, cholesterol, FPG, 2h

  7. Avaliação da vitalidade fetal e resultados perinatais em gestações após gastroplastia com derivação em Y de Roux Assessment of fetal vitality and perinatal results in pregnancies after gastroplasty with Roux-en-Y gastric bypass

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2010-01-01

    Full Text Available OBJETIVO: Analisar os resultados da avaliação da vitalidade fetal de gestações após gastroplastia com derivação em Y de Roux, verificando as complicações maternas e os resultados perinatais. MÉTODOS: No período de julho de 2001 a setembro de 2009, foram analisados, retrospectivamente, dados de prontuário de pacientes com gestação após gastroplastia com derivação em Y de Roux, acompanhadas em pré-natal especializado e cujo parto foi realizado na instituição. Foram analisados os exames de avaliação da vitalidade fetal (cardiotocografia, perfil biofísico fetal e dopplervelocimetria das artérias umbilicais realizada na semana anterior ao parto. As variáveis maternas investigadas foram: dados demográficos, complicações clínicas maternas, tipo de parto, complicações no parto e pós-parto, exames hematimétricos maternos e resultados perinatais. RESULTADOS: Trinta gestações após gastroplastia com derivação em Y de Roux foram identificadas e 24 delas foram submetidas à avaliação da vitalidade fetal. Todas as pacientes apresentaram resultados normais na cardiotocografia, no perfil biofísico fetal e na dopplervelocimetria das artérias umbilicais. Houve um caso de oligohidrâmnio. A principal complicação observada foi anemia materna (Hb OBJECTIVE: To study fetal vitality assessed in pregnancies after gastroplasty with Roux-en-Y gastric bypass'and verify maternal complications and perinatal results. METHODS: Hospital charts of all pregnancies after gastroplasty with Roux-en-Y gastric bypass were reviewed retrospectively. All cases followed at the specialized prenatal care that gave birth in this institution, between July 2001 and September 2009, were reviewed. The assessment of fetal vitality (cardiotocography, fetal biophysical profile and umbilical artery Doppler velocimetry performed in the last week before delivery were analyzed. The maternal variables investigated were: demographic data, maternal complications

  8. Coronary Artery Bypass

    Science.gov (United States)

    ... to 3 days in the Intensive Care Unit (ICU). Life After Bypass After bypass surgery, your doctor will recommend that you join a cardiac rehabilitation program. These programs help you make lifestyle changes ...

  9. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... don't help, you may need coronary artery bypass surgery. The surgery creates a new path for ... narrowed area or blockage. This allows blood to bypass (get around) the blockage. Sometimes people need more ...

  10. Efficacies of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus: a Meta-analysis%胃袖状切除术与Roux-en-Y胃旁路术治疗2型糖尿病疗效的Meta分析

    Institute of Scientific and Technical Information of China (English)

    谢晓峰; 王琛; 李娜; 李倩; 张文亮; 李敏

    2013-01-01

    目的 系统评价胃袖状切除术与Roux-en-Y胃旁路术治疗2型糖尿病的疗效.方法 以减重手术、胃切除术、胃绕道术、胃旁路手术、胃转流术、胃袖状切除术、糖尿病、bariatric surgery、gastric bypass、sleeve gastrectomy、diabetes、T2DM等为关键词检索Cochrane library、PubMed、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库和万方数据库.检索时间为各数据库建库至2012年12月.最终纳入胃袖状切除术对比Roux-en-Y胃旁路术治疗2型糖尿病的相关文献,再由2名研究者分别独立提取数据并进行文献质量评价,用RevMan 5.1.2软件进行Meta分析.计数资料采用相对危险度(risk ratio,RR)或比值比(odds ratio,OR)分析统计,计量资料采用均数差(mean difference,MD)或标准差(standardmean difference,SMD)分析统计.采用I2对异质性进行定量分析.结果 共纳入符合标准的文献5篇,其中胃袖状切除术组164例,Roux-en-Y胃旁路术组184例.Meta分析结果显示:与胃袖状切除术比较,Roux-en-Y胃旁路术能更显著地提高患者糖尿病的缓解率(OR =0.48,95% CI:0.26 ~0.91,P<0.05),提高随访期间停止服药的比例(OR =0.37,95% CI:0.16 ~0.84,P <0.05),更有效降低糖化血红蛋白水平(MD=0.28,95%CI:0.14 ~0.43,P<0.05)和体质量(MD=-0.44,95% CI:-0.76 ~-0.13,P<0.05).胃袖状切除术与Roux-en-Y胃旁路术患者术后并发症发生率比较,差异无统计学意义(OR=1.81,95% CI:0.20~16.73,P>0.05).结论 Roux-en-Y胃旁路术较胃袖状切除术在治疗2型糖尿病的疗效方面具有一定的优势.%Objective To review the efficacies of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus.Methods The Cochrane library,PubMed,China Journal Full Text Database,Chinese Scientific Journal Full Text Database,Chinese Biomedical Literature Database and Wanfang Database were searched with key

  11. Palliative surgical bypass for unresectable periampullar y carcinoma

    Institute of Scientific and Technical Information of China (English)

    Shivendra Singh; Ajay Kumar Sachdev; Adarsh Chaudhary; Anil Kumar Agarwal

    2008-01-01

    BACKGROUND:Around 60% to 80% of patients with periampullary carcinoma are unresectable either due to distant metastasis or local vascular invasion. With the advancement of endoscopic interventional procedures, the role of surgical bypass has diminished. However, surgical bypass is still appropriate in patients with unresectable disease discovered at the time of surgery. This study was conducted to assess the results of palliative surgical bypass for patients with unresectable periampullary carcinoma at our hospital, a tertiary referral center of Northern India. METHOD:The study group comprised 204 patients who had undergone surgical bypass for advanced periampullary carcinoma over the last 15 years. RESULTS:Between January 1990 and December 2004, 204 patients (128 males, 76 females) consisting of 179 patients with carcinoma of head of the pancreas, 14 patients with ampullary carcinoma, 8 patients with lower end cholangiocarcinoma and 3 patients with duodenal carcinoma underwent surgical bypass. Their average age was 51 years (range 20-78 years). Both biliary and gastric bypasses were done in 158 (77.45%), biliary bypass alone in 37 (18.13%), and gastric bypass alone in 9 (4.32%). Biliary bypass was done by Roux-en-Y hepaticojejunostomy, and gastric bypass by retrocolic gastrojejunostomy. The overall postoperative mortality and morbidity were 0.98%and 26.9%, respectively. The patients who died had undergone previously endoscopic intervention. Complications included wound infection in 12.25% of the patients, bile leak in 5.12%, delayed gastric emptying in 5.38%, ascitic leak from drains in 8.8%, and upper gastrointestinal bleeding in 1.96%. The incidences of wound infection and bile leak both were signiifcantly higher in patients who had had preoperative biliary stenting. None of the patients who had undergone Roux-en-Y hepati-cojejunostomy+retrocolic gastrojejunostomy required any intervention later in their life. CONCLUSIONS:Surgical bypass is a safe procedure with

  12. The anti-obesity effects of Lactobacillus casei strain Shirota versus Orlistat on high fat diet-induced obese rats

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    Golgis Karimi

    2015-12-01

    Full Text Available Background: Obesity and overweight are major public health problems. Various factors, such as daily nutritional habits, physical inactivity, and genetic, are related to the prevalence of obesity. Recently, it was revealed that the gut microflora may also play an important role in weight management. Thus, this study aimed to determine the anti-obesity effects of Lactobacillus casei strain Shirota (LcS compared with those of orlistat in an animal model fed a high-fat diet (HFD. Design: Thirty-two male Sprague-Dawley rats were assigned to four groups fed various diets as follows: a standard diet group, HFD group, HFD supplemented with LcS (108109 colony-forming units (HFD-LcS group, and HFD group treated with Orlistat (10 mg/kg body weight. After 15 weeks, the weights of organs, body weight, body fat mass and serological biomarkers were measured. In addition, histological analysis of the liver and adipose tissue was performed. Results: Body weight, body mass index, fat mass, leptin and glucose levels were lower, and high-density lipoprotein and adiponectin levels were higher in the HFD-LcS and HFD-orlistat groups than in the HFD group. In addition a significant difference in body fat mass was observed between HFD-LcS group with HFD-orlistat group (19.19±5.76 g vs. 30.19±7.98 g. Although the interleukin-6 level was significantly decreased in the HFD-LcS and HFD-orlistat groups compared with the HFD group, no significant change was observed in other inflammatory biomarkers. Conclusion: The results of the present study show that LcS supplementation improves body weight management and the levels of some related biomarkers. In addition, LcS supplementation showed a better result in fat mass and alanine aminotransferase reduction than Orlistat. Further studies are needed to elucidate the anti-obesity effects of LcS, with a longer period of supplementation.

  13. Anti-obesity efficacy of nanoemulsion oleoresin capsicum in obese rats fed a high-fat diet

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    Kim JY

    2014-01-01

    Full Text Available Joo-Yeon Kim,1,* Mak-Soon Lee,1,* Sunyoon Jung,1 Hyunjin Joo,1 Chong-Tai Kim,2 In-Hwan Kim,3 Sangjin Seo,1 Soojung Oh,1 Yangha Kim11Department of Nutritional Science and Food Management, Ewha Womans University, Seoul, Republic of Korea; 2Functional Materials Research Group, Korea Food Research Institute, Seongnam, Gyeonggi, Republic of Korea; 3Department of Food and Nutrition, Korea University, Seoul, Republic of Korea *These authors contributed equally to this workPurpose: This study determined the effects of oleoresin capsicum (OC and nanoemulsion OC (NOC on obesity in obese rats fed a high-fat diet.Methods: The rats were randomly separated into three groups: a high-fat (HF diet group, HF + OC diet group, and HF + NOC diet group. All groups were fed the diet and water ad libitum for 14 weeks.Results: NOC reduced the body weight and adipose tissue mass, whereas OC did not. OC and NOC reduced mRNA levels of adipogenic genes, including peroxisome proliferator-activated receptor (PPAR-γ, sterol regulatory element-binding protein-1c, and fatty acid-binding protein in white adipose tissue. The mRNA levels of genes related to β-oxidation or thermogenesis including PPAR-α, palmitoyltransferase-1α, and uncoupling protein-2 were increased by the OC and NOC relative to the HF group. Both OC and NOC clearly stimulated AMP-activated protein kinase (AMPK activity. In particular, PPAR-α, palmitoyltransferase-1α, uncoupling protein-2 expression, and AMPK activity were significantly increased in the NOC group compared to in the OC group. NOC decreased glycerol-3-phosphate dehydrogenase activity whereas OC did not.Conclusion: From these results, NOC could be suggested as a potential anti-obesity agent in obese rats fed a HF diet. The effects of the NOC on obesity were associated with changes of multiple gene expression, activation of AMPK, and inhibition of glycerol-3-phosphate dehydrogenase in white adipose tissue.Keywords: oleoresin capsicum

  14. Potent anti-obese principle from Rosa canina: structural requirements and mode of action of trans-tiliroside.

    Science.gov (United States)

    Ninomiya, Kiyofumi; Matsuda, Hisashi; Kubo, Mizuho; Morikawa, Toshio; Nishida, Norihisa; Yoshikawa, Masayuki

    2007-06-01

    The 80% aqueous acetone extracts from the fruit (50 mg/kg/d) and seeds (12.5 and 25 mg/kg/d) of Rosa canina L., but not from the pericarps, were found to show substantial inhibitory effect on the gain of body weight and/or weight of visceral fat without affecting food intake in mice for 2 weeks after administration of the extracts. With regard to the active constituents, the principal constituent, trans-tiliroside (0.1-10 mg/kg/d), potently inhibited the gain of body weight, especially visceral fat weight, and significantly reduced blood glucose levels after glucose loading (1 g/kg, ip) in mice. On the other hand, kaempferol and p-coumaric acid lacked such effect and kaempferol 3-O-beta-D-glucopyranoside tended to reduce the gain of body weight and visceral fat weight, but not significantly, at a dose of 10 mg/kg/d. These results indicate the importance of both kaempferol 3-O-beta-D-glucopyranoside and p-coumaroyl moieties for anti-obese effects. Furthermore, a single oral administration of trans-tiliroside at a dose of 10 mg/kg increased the expression of PPAR-alpha mRNA of liver tissue in mice.

  15. Piceatannol Exerts Anti-Obesity Effects in C57BL/6 Mice through Modulating Adipogenic Proteins and Gut Microbiota

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    Yen-Chen Tung

    2016-10-01

    Full Text Available Obesity is a global health concern. Piceatannol (Pic, an analog of resveratrol (Res, has many reported biological activities. In this study, we investigated the anti-obesity effect of Pic in a high-fat diet (HFD-induced obese animal model. The results showed that Pic significantly reduced mouse body weight in a dose-dependent manner without affecting food intake. Serum total cholesterol (TC, low-density lipoprotein (LDL, high-density lipoprotein (HDL levels, and blood glucose (GLU were significantly lowered in Pic-treated groups. Pic significantly decreased the weight of liver, spleen, perigonadal and retroperitoneal fat compared with the HFD group. Pic significantly reduced the adipocyte cell size of perigonadal fat and decreased the weight of liver. Pic-treated mice showed higher phosphorylated adenosine 5′-monophosphate-activated protein kinase (pAMPK and phosphorylated acetyl-CoA carboxylase (pACC protein levels and decreased protein levels of CCAAT/enhancer-binding protein C/EBPα, peroxisome proliferator-activated receptor PPARγ and fatty acid synthase (FAS, resulting in decreased lipid accumulation in adipocytes and the liver. Pic altered the composition of the gut microbiota by increasing Firmicutes and Lactobacillus and decreasing Bacteroidetes compared with the HFD group. Collectively, these results suggest that Pic may be a candidate for obesity treatment.

  16. Anti-obesity effects of Rapha diet® preparation in mice fed a high-fat diet.

    Science.gov (United States)

    Kim, Jihyun; Kyung, Jangbeen; Kim, Dajeong; Choi, Ehn-Kyoung; Bang, Paul; Park, Dongsun; Kim, Yun-Bae

    2012-12-01

    The anti-obesity activities of Rapha diet® preparation containing silkworm pupa peptide, Garcinia cambogia, white bean extract, mango extract, raspberry extract, cocoa extract, and green tea extract were investigated in mice with dietary obesity. Male C57BL/6 mice were fed a high-fat diet (HFD) containing 3% Rapha diet® preparation for 8 weeks, and blood and tissue parameters of obesity were analyzed. The HFD markedly enhanced body weight gain by increasing the weights of epididymal, perirenal, and mesenteric adipose tissues. The increased body weight gain induced by HFD was significantly reduced by feeding Rapha diet® preparation, in which decreases in the weight of abdominal adipose tissue and the size of abdominal adipocytes were confirmed by microscopic examination. Long-term feeding of HFD increased blood triglycerides and cholesterol levels, leading to hepatic lipid accumulation. However, Rapha diet® preparation not only reversed the blood lipid levels, but also attenuated hepatic steatosis. The results indicate that Rapha diet® preparation could improve HFD-induced obesity by reducing both lipid accumulation and the size of adipocytes. PMID:23326287

  17. Anti-obesity effects of chitosan and psyllium husk with L-ascorbic acid in guinea pigs.

    Science.gov (United States)

    Jun, Sung Chul; Jung, Eun Young; Hong, Yang Hee; Park, Yooheon; Kang, Duk ho; Chang, Un Jae; Suh, Hyung Joo

    2012-04-01

    The aim of this study was to investigate whether L-Ascorbic acid would facilitate the anti-obesity effects of chitosan and psyllium husk in vivo. The study was carried out with male Hartley guinea pigs for 5 weeks. The results show that chitosan itself did not influence body weight gain and food efficiency ratio (FER). However, the addition of L-Ascorbic acid to chitosan decreased these parameters; the body weight gain and FER in the chitosan-2 group (high-fat diet group with 5 % chitosan containing 0.5 % L-Ascorbic acid) was significantly (p psyllium husk did not differ from psyllium husk alone in terms of changes in weight gain, plasma lipid levels, and fat pad weight. We found that the addition of L-Ascorbic acid to chitosan influenced the reduction in body weight gain and FER, and the increase in total fecal weight and fecal fat excretion in guinea pigs fed a high-fat diet. PMID:23065836

  18. MicroRNA Functions in Brite/Brown Fat — Novel Perspectives towards Anti-Obesity Strategies

    Directory of Open Access Journals (Sweden)

    Michael Karbiener

    2014-09-01

    Full Text Available Current anti-obesity strategies are aiming at restricting energy uptake, but still, obesity treatment is far from being satisfactory. The discovery of active brown adipose tissue (BAT in adult humans currently opens new avenues to combat obesity and follow-up complications as it tackles the other site of the energy balance: energy expenditure via non-shivering thermogenesis. This process of energy dissipation in the adipose tissue is tightly controlled, and the elucidation of its regulatory network is a key plank for therapeutic applications. MicroRNAs (miRNAs belong to a novel class of regulatory determinants which are small non-coding RNAs with vital roles in regulating gene expression that also play a role in many human diseases. In this review we summarize miRNAs which have been shown to govern thermogenic, i.e. brite or brown, adipocyte recruitment and physiology. Notably, most miRNAs in this context have so far been characterized solely in mice, revealing a great demand for more human studies. As in the context of other diseases, RNA-based therapeutics have meanwhile entered clinical trials, further exploring the functions of miRNAs in brown and white adipose tissues could result in novel therapeutic approaches to treat obesity and its follow-up complications.

  19. Comparative evaluation of anti-obesity effect of Aloe vera and Gymnema sylvestre supplementation in high-fat diet fed C57BL/6J mice

    Science.gov (United States)

    Pothuraju, Ramesh; Sharma, Raj Kumar; Rather, Sarver Ahmed; Singh, Satvinder

    2016-01-01

    Background: The aim of the present study was to investigate, anti-obesity effect of Aloe vera (AV), and Gymnema sylvestre (GS) whole extract powders administration to high-fat diet (HFD) fed C57BL/6J mice for 12 weeks. Materials and Methods: At the end of experiment, different parameters such as body weight, feed intake, organ weights, fasting blood glucose, oral glucose tolerance test, plasma lipid levels, and expression analysis of adipocytokines were evaluated. Results: At the end of experimental period, oral administration of both herbs showed a significant (P < 0.05 and P < 0.001) decrease in the plasma glucose and lipid levels in HFD fed mice. In addition, increased in the epididymal fat (E. fat) weight in the HFD group was significantly (P < 0.05) reduced on GS administration alone. Finally, quantitative mRNA expression analysis of adiponectin gene was significantly up-regulated in AV supplementation. Further, no effect was observed with the both herbs on pro-inflammatory cytokines (interleukin 6 and tumor necrosis factor-a) in the E. fat tissue of HFD fed group. Conclusions: The anti-obesity and other metabolic studies depend on the type of diet, different parts of herbal extractions, and animal models used. Further studies are required in this area to strengthen the anti-obesity effects of herbs with active component, and it can be used a pro-drug instead of whole extract. PMID:27757271

  20. Pre-clinical evolutionary study of Clerodendrum phlomidis as an anti-obesity agent against high fat diet induced C57BL/6J mice

    Institute of Scientific and Technical Information of China (English)

    Vijay R Chidrawar; Krishnakant N Patel; Havagiray R Chitme; Shruti S Shiromwar

    2012-01-01

    Objective: Anti-obesity activity of alcoholic and methanolic extracts of roots of Clerodendrumphlomidis was evaluated against high fat diet (HFD) induced obesity in C57BL/6J female mice. Methods: Obesity was induced by feeding high fat diet for 13 weeks to C57BL/6J female mice and one group was kept on normal chow diet in order to evaluate the effect of Clerodendrumphlomidis on food intake, body weight changes, digestive enzyme activity, lipid metabolism, theromogenesis, adiposities diameter and histology of fat pad. Results: Among these two extracts methanolic extract of Clerodendrum phlomidis (MECP) have shown strong anti-obesity effect compare to alcoholic extract of Clerodendrum phlomidis (AECP). LD50 value was found to be more than 2000 mg/kg. Conclusions: MECP have shown more promising effects than AECP may be because of its multiple mechanisms. Anti-obesity activity produced by MECP is because of inhibition of pancreatic lipase activity which delays the intestinal absorption of dietary fat. Inhibition of pancreatic lipase activity was confirmed by in-vitro studies. MECP also containsβ-sitosterol in abundant amount which was confirmed by HPTLC analysis. Moreover flavonoid content in the plant has anorexic property. By this study we concluded that MECP is beneficial for the suppression of obesity and associated complications like T2DM.

  1. A water-soluble extract from Cucurbita moschata shows anti-obesity effects by controlling lipid metabolism in a high fat diet-induced obesity mouse model.

    Science.gov (United States)

    Choi, Hyounjeong; Eo, Haekwan; Park, Kyoungcheol; Jin, Mirim; Park, Eun-Jin; Kim, Seon-Hee; Park, Jeong Euy; Kim, Sunyoung

    2007-08-01

    During the screening of a variety of plant sources for their anti-obesity activity, it was found that a water-soluble extract, named PG105, prepared from stem parts of Cucurbita moschata, contains potent anti-obesity activities in a high fat diet-induced obesity mouse model. In this animal model, increases in body weight and fat storage were suppressed by 8-week oral administration of PG105 at 500 mg/kg, while the overall amount of food intake was not affected. Furthermore, PG105 protected the development of fatty liver and increased the hepatic beta-oxidation activity. Results from blood analysis showed that the levels of triglyceride and cholesterol were significantly lowered by PG105 administration, and also that the level of leptin was reduced, while that of adiponectin was increased. To understand the underlying mechanism at the molecular level, the effects of PG105 were examined on the expression of the genes involved in lipid metabolism by Northern blot analysis. In the liver of PG105-treated mice, the mRNA level of lipogenic genes such as SREBP-1c and SCD-1 was decreased, while that of lipolytic genes such as PPARalpha, ACO-1, CPT-1, and UCP-2 was modestly increased. Our data suggest that PG105 may have great potential as a novel anti-obesity agent in that both inhibition of lipid synthesis and acceleration of fatty acid breakdown are induced by this reagent.

  2. 胃转流术对2型糖尿病大鼠血糖、胰岛素水平及胰岛数目的影响%Effect of gastric bypass operation on blood glucose, insulin and islands of langerhans in rats with type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    任泽强; 黄智龙; 张蓬波; 张秀忠; 章红

    2014-01-01

    目的 观察胃转流术(GBP)对2型糖尿病大鼠的降糖效果及对胰岛数目的影响.方法 健康雄性SD大鼠随机分为糖尿病手术组(DO组)、糖尿病假手术组(DS组)、糖尿病对照组(DC组)和正常手术组(NO组),每组8只.术前及术后第1、2、4、8周分别测各组空腹血糖(FPG)、胰岛素(Fins)水平;术后2个月苏木素-伊红(HE)染色观察胰腺病理变化.结果 DO组术后第2周FPG由术前的(17.80±2.26) mmol/L降至(14.93 ±1.78) mmol/L(P< 0.05),术后第8周降至(6.18 ±0.53) mmol/L(P <0.05),DO组术后各时间点FPG明显低于DS、DC组相应时间点(P<0.05).DO组术后第8周Fins由术前的(11.89±0.87) mmoL/L升高到(14.70±1.04) mmol/L(P<0.05).术后病理可见平均胰岛数量,DO组比DC、DS组增加(P <0.05);DO组胰岛较大,胰岛细胞密度增多.结论 GBP能明显降低2型糖尿病大鼠的血糖,提高胰岛素水平,与术后胰岛数目增多有关.%Objective To observe the hypoglycemic effect and influence on islands of langerhans of gastric bypass operation in type 2 diabetes rats.Methods Healthy male SD rats were randomly divided into type 2 diabetes-operation group (DO group),type 2 diabetes-sham operation group (DS group),type 2 diabetes-control group (DC group) and normal-operation group (NO group) (n =8 each).Plasma glucose concentration and insulin levels were measured respectively at fasting condition before,and 1 week,2 weeks,4 weeks and 8 weeks after operation.Pancreas pathological changes were observed two months after gastric bypass operation.Results The fasting blood glucose concentrations in DO group at the second week postoperation was decreased from (17.80 ± 2.26) to (14.93 ± 1.78) mmol/L (P < 0.05),and those at 8th week postoperation decreased to (6.18 ±0.53) mmol/L (P <0.05).The fasting blood glucose concentration in DO group was significantly lower than in DS and DC groups postoperation (P < 0.05).The fasting plasma insulin levels in DO group

  3. Gastric giardiasis.

    OpenAIRE

    Doglioni, C; De Boni, M.; Cielo, R.; Laurino, L.; Pelosio, P.; P. Braidotti; Viale, G

    1992-01-01

    AIMS: To assess the prevalence of gastric giardiasis in patients undergoing upper gastrointestinal endoscopy, and to define the clinicopathological correlates of gastric Giardia lamblia infection. METHODS: Consecutive gastric biopsy specimens (n = 15,023) from 11,085 patients, taken at Feltre City Hospital (north eastern Italy) from January 1986 to December 1991, were histologically and immunocytochemically examined for the occurrence of G lamblia trophozoites. Three gastric biopsy specimens ...

  4. 胃旁路术与胆胰转流术治疗2型糖尿病机制的研究%Gastric bypass and biliopancrtic diversion in the treatment type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    狄建忠; 韩晓东; 张宏玮; 杜贻豹; 汪昱; 郑起; 张频

    2011-01-01

    目的 比较胃旁路术(GBP)与胆胰转流术(BPD)对非胰岛素依赖性糖尿病大鼠的治疗效果,探讨其机制.方法 40只糖尿病GK大鼠按数字表法随机分为GBP组、BPD组、饮食控制组和对照组,每组10只.GBP组、BPD组分别行GBP及BPD手术;饮食控制组大鼠每天给予基础饲料15 g,自由进水;对照组不限食量.记录手术时间、死亡率.每周测空腹体重.检测治疗前及治疗后1、2、3、4、8、16周的空腹血糖、瘦素、胰岛素样生长因子-1(IGF-1)水平.结果 GBP组平均手术时间为(25±4)min,BPD组为(35±6)min;GBP组大鼠死亡1只,BPD组死亡3只,两组差异均有统计学意义(P值均<0.01).治疗前各组大鼠血糖、瘦素及IGF-1水平无统计学差异.治疗后对照组大鼠血糖及瘦素均无明显变化.饮食控制组大鼠治疗后2周起血糖及瘦素水平开始下降,第4周时显著降低,并持续至16周(P<0.05),但血IGF-1水平无明显变化.GBP组与BPD组大鼠治疗后2周起血糖及瘦素水平开始下降,而血IGF-1水平开始升高,并持续至16周[血糖:(6.8±1.0)、(6.3±0.8)mmol/L比(13.9±2.6)、(14.1±2.4)mmol/L;瘦素:(16.1±3.3)、(17.2±3.2)pg/ml比(29.4±3.9)、(29.4±3.9) pg/ml;IGF-1:( 166.1±8.3)、(142.2±8.2) ng/L比(119.4±8.8)、(109.8±7.9)ng/L,P值均<0.01],但这两组的血糖及瘦素水平无统计学差异;而GBP组大鼠血IGF-1水平较BPD组升高更显著(P<0.05).结论 GBP和BPD均能较好地控制糖尿病大鼠的血糖水平,其机制可能与瘦素的降低及IGF-1的升高有关.GBP在手术时间、死亡率及增加血IGF-1水平等方面优于BPD.%Objective To compare the treatment effects of gastric bypass (GBP) and biliopancrtic diversion (BPD) in non-insulin dependent diabetes mellitus rats,and investigate the mechanism.Methods Forty GK rats with diabetes mellitus were randomly allocated into four groups:GBP group; BPD group; food restriction group ( FR group) and control group with 10

  5. 2型糖尿病患者腹腔镜下胃旁路手术的护理干预效果评价%The effect of nursing intervention evaluation on type 2 diabetic patients after laparoscopic gastric bypass surgery

    Institute of Scientific and Technical Information of China (English)

    韩云红

    2014-01-01

    目的:探讨2型糖尿病(T2DM)患者腹腔镜下胃旁路手术治疗后护理干预效果。方法将80例腹腔镜下胃旁路手术治疗的T2DM患者分为对照组与观察组各40例,分别采用常规护理与个性化护理,比较两组护理前后各项指标(BMI、FPG、餐后2 h血糖、HbA1c及空腹C肽)、SAS及SDS评分、术后各项指标恢复所需时间。结果两组护理前后BMI、FPG、餐后2 h血糖、HbA1c及空腹C肽水平差异均有统计学意义(P<0.05),且两组护理后上述指标差异也均有统计学意义(P<0.05);两组护理前后SAS及SDS评分差异均有统计学意义(P<0.05),且护理后观察组上述评分显著小于对照组(P<0.05);观察组首次下床活动时间、首次排气时间及伤口拆线时间均显著短于对照组(P<0.05)。结论针对性护理干预在腹腔镜下胃旁路手术治疗T2DM患者护理中效果显著,值得在临床上推广应用。%Objective To investigate the effect of nursing interventions on type 2 diabetic ( T2DM ) patients after laparoscopic gastric bypass surgery treatment. Methods Eighty patients with T2DM cases of laparoscopic gastric bypass surgery in accordance with balloting were divided into control group and observation group, each of 40 cases, which were treated with routine care and personalized care respectively, the indicators (including BMI, FPG, 2 h postprandial blood glucose, HbA1c and fasting C-peptide), SAS and SDS scores, postoperative recovery time indicators were compared before and after treatment. Results BMI, FPG, 2 h postprandial blood glucose, HbA1c and fasting C-peptide levels were statistically significant differences between two groups before and after nursing ( P<0 . 05 ) , and these indicators were statistically significant difference between two groups after treatment ( P<0 . 05 ); SAS and SDS scores were statistically significant differences in two groups before and after nursing (P<0.05), and post-treatment observation

  6. Clinical experience of the prevention of postoperative complications after Roux-en-Y Gastric bypass operation for type 2 Diabetes mellitus, report of 180 cases%180例胃转流手术治疗2型糖尿病术后并发症防治体会

    Institute of Scientific and Technical Information of China (English)

    邵得志; 冯志毅; 张海生; 王晓翠; 富忱

    2016-01-01

    目的:总结胃转流手术治疗2型糖尿病术后并发症,探讨其防治方法。方法对2012年5月至2014年5月180例接受胃转流手术的2型糖尿病患者术后并发症进行回顾性分析。结果本组患者术后近期并发症总发生率为16.11%(29/180),其中术后胃瘫综合征发生率最高为7.78%(14/180);其次是术后胃出血2.78%(5/180);术后急性左心衰竭2.22%(4/180);术后全身瘙痒2.22%(4/180);术后烟雾病0.55%(1/180);术后切口液化0.55%(1/180)。结论术后胃瘫综合征是胃转流手术后最常见的并发症,其次是术后胃出血,以上并发症如术前采取预防措施、术后采用积极治疗手段均可避免和治愈。%Objective To summarize the experience of the prevention of postoperative complications after Roux-en-Y Gastric bypass operation for type 2 Diabetes mellitus . Methods A retrospectively analysis was performed from May 2012 to May 2014, postoperative complications of 180 patients with type 2 diabetes mellitus who received Roux-en-Y Gastric bypass operation . Results The early postoperative complication rate was 16.11% ( 29/180 ), including most common complication of postoperative gastroparesis of 7.78% (14/180), postoperative bleeding of 2.78% (5/180), acute postoperative left heart failure of 2.22% (4/180), postoperative pruritus of 2.22% (4/180), postoperative moyamoya disease of 0.55%(1/180), and postoperative incision fat liquefaction of 0.55% (1/180). Conclusion Postoperative gastroparesis syndrome and bleeding is the most common postoperative complication after Roux-en-Y Gastric bypass treatment for the type 2 diabetes mellitus .All of them could be avoided and cured if we take preventive management and adopt active therapeutic treatment .

  7. Effect of Gastric Bypass Surgery on Glucose Metabolism of Non-obese Type 2 Diabetes Mellitus in Goto-Kakizaki Rats%胃旁路术对非肥胖型2型糖尿病大鼠糖代谢的影响

    Institute of Scientific and Technical Information of China (English)

    曹超; 周晓磊; 尤胜义

    2012-01-01

    Objective To investigate the influence of gastric bypass surgery on glucose metabolism in Goto- Kakizaki (GK) rats. Methods Twenty male GK rats and 10 male Wistar rats were randomized into 3 groups; GK operation, GK sham-operation and Wistar sham-operation groups, gastric bypass surgery was pro-cessed in the GK operation group . Body weight, fasting plasma glucose (FPG), glycosylated hemoglobin (HbAlc) level and serum insulin (INS) were moni-tored at 1 week before surgery and at the 1st, 2nd, 4th, 8th and 12th week after surgery. Result In the GK operation group the weight increased from 255.10±21.09 g before surgery to 364.55±25.73 g, and the FPG decreased from 11.36±1.14 mmol/L before surgery to 8.36±0.62 mmol/L,and HbAlc decreased from 8.91±0.36%to 6.35±0.46% at the 12th week after surgery in GK operation rats. Meanwhile the serum INS increased from 32.76±2.37μIU/mL before surgery to 55.14±5.45 μIU/mL at the 12th week after surgery in the GK operation rats, with statistical significance(P<0.05). Conclusion Gastric bypass surgery can significantly reduce fasting plasma glucose levels ,and improve glycometabolism in non-obese type 2 diabetes GK rats.%目的:观察胃旁路术对非肥胖型2型糖尿病大鼠(GK大鼠)糖代谢的影响.方法:GK大鼠20只,Wistar大鼠10只,随机分为GK手术组、GK假手术组和Wistar假手术组,每组10只;手术组行胃旁路术;测定术前1周及术后第1、2、4、8、12周各组体质量、空腹血糖(FPG)、糖化血红蛋白(HbA1c)水平和血清胰岛素(INS)含量.结果:术后12周,GK手术组大鼠体质量由术前的(255.10±21.09)g上升到(364.55±25.73)g,FPG和HbA1c分别由术前的(11.36±1.14)mmol/L和(8.91±0.36)%下降到(8.36±0.62)mmol/L和(6.35±0.46)%,而血清INS由术前(32.76±2.37)μIU/mL上升到(55.14±5.45)μIU/mL.结论:胃旁路术可以明显降低GK大鼠的空腹血糖,改善糖代谢障碍.

  8. Anti-Obesity Effects of Aster spathulifolius Extract in High-Fat Diet-Induced Obese Rats.

    Science.gov (United States)

    Kim, Sa-Jic; Bang, Chae-Young; Guo, Yuan-Ri; Choung, Se-Young

    2016-04-01

    The aim of this study was to investigate the anti-obesity and antihyperlipidemic efficacy and molecular mechanisms of Aster spathulifolius Maxim extract (ASE) in rats with high-fat diet (HFD)-induced obesity. Rats were separately fed a normal diet or a HFD for 8 weeks, then they were treated with ASE (62.5, 125, or 250 mg/kg) for another 4.5 weeks. The ASE supplementation significantly lowered body weight gain, visceral fat pad weights, serum lipid levels, as well as hepatic lipid levels in HFD-induced obese rats. Histological analysis showed that the ASE-treated group showed lowered numbers of lipid droplets and smaller size of adipocytes compared to the HFD group. To understand the mechanism of action of ASE, the expression of genes and proteins involved in obesity were measured in liver and skeletal muscle. The expression of fatty acid oxidation and thermogenesis-related genes (e.g., PPAR-α, ACO, CPT1, UCP2, and UCP3) of HFD-induced obese rats were increased by ASE treatment. On the other hand, ASE treatment resulted in decreased expression of fat intake-related gene ACC2 and lipogenesis-related genes (e.g., SREBP-1c, ACC1, FAS, SCD1, GPATR, AGPAT, and DGAT). Furthermore, ASE treatment increased the level of phosphorylated AMPKα in obese rats. Similarly, the level of phosphorylated ACC, a target protein of AMPKα in ASE groups, was increased by ASE treatment compared with the HFD group. These results suggest that ASE attenuated visceral fat accumulation and improved hyperlipidemia in HFD-induced obese rats by increasing lipid metabolism through the regulation of AMPK activity and the expression of genes and proteins involved in lipolysis and lipogenesis. PMID:26908215

  9. In vitro anti-diabetic, anti-obesity and antioxidant proprieties of Juniperus phoenicea L. leaves from Tunisia

    Institute of Scientific and Technical Information of China (English)

    2014-01-01

    Objective: To examine chemical composition and antioxidant activity as well as the in vitroα-amylase and pancreatic lipase inhibitory activities of the essential oil and various extracts of Juniperus phoenicea (J. phoenicea). Methods: Essential oil obtained by steam distillation were analyzed by gas chromatography-mass spectrometry technique. The antioxidant activity of the essential oil and various extracts of J. phoenicea were determined by DPPH andβ-carotene bleaching methods. Results: Gas chromatography-mass spectrometry analysis of the J. phoenicea essential oil resulted in the identification of 37 compounds, representing 96.98% of the oil; α-Pinene (24.02%), limonene (7.94%), D-3-Carene (16.9%), Germacrene D (11.98%), Germacrene B (5.40%) and δ-cadinene (6.52%) were the major compounds. The IC50 values of essential oil, hexane and methanol extracts against α-amylase were 35.44, 30.15 and 53.76 µg/mL respectively, and those against pancreatic lipase were 66.15, 68.47 and 60.22 µg/mL respectively, suggesting powerful anti-diabetic and anti-obesity effects. Antioxidant activity (IC50=2 µg/mL) and total phenolics content (265 mg as gallic acid equivalent/g extract) of the methanol extract were found to be the highest compared to the other extracts. Conclusions:The findings showed that the extents ofα-amylase and pancreatic lipase inhibitory activities of the J. phoenicea extracts as well as their antioxidant activity are in accordance with total phenolics contents. Leaves of J. phoenicea being rich in phenolics may provide a good source of natural products with interesting medicinal properties.

  10. Anti-Obese Effect of Glucosamine and Chitosan Oligosaccharide in High-Fat Diet-Induced Obese Rats

    Directory of Open Access Journals (Sweden)

    Lanlan Huang

    2015-04-01

    Full Text Available Objective: This study is to evaluate the anti-obese effects of glucosamine (GLC and chitosan oligosaccharide (COS on high-fat diet-induced obese rats. Methods: The rats were randomly divided into twelve groups: a normal diet group (NF, a high-fat diet group (HF, Orlistat group, GLC high-, middle-, and low-dose groups (GLC-H, GLC-M, GLC-L, COS1 (COS, number-average molecular weight ≤1000 high-, middle-, and low-dose groups (COS1-H, COS1-M, COS1-L, and COS2 (COS, number-average molecular weight ≤3000 high-, middle-, and low-dose groups (COS2-H, COS2-M, COS2-L. All groups received oral treatment by gavage once daily for a period of six weeks. Results: Rats fed with COS1 gained the least weight among all the groups (P < 0.01, and these rats lost more weight than those treated with Orlistat. In addition to the COS2-H and Orlistat groups, the serum total cholesterol (CHO and low-density lipoprotein cholesterol (LDL-C levels were significantly reduced in all treatment groups compared to the HF group (P < 0.01. The various doses of GLC, COS1 and COS2 reduced the expression levels of PPARγ and LXRα mRNA in the white adipose tissue. Conclusions: The results above demonstrated that GLC, COS1, and COS2 improved dyslipidemia and prevented body weight gains by inhibiting the adipocyte differentiation in obese rats induced by a high-fat diet. Thus, these agents may potentially be used to treat obesity.

  11. Anti-obesity Effect of Yogurt Fermented by Lactobacillus plantarum Q180 in Diet-induced Obese Rats.

    Science.gov (United States)

    Park, Sun-Young; Seong, Ki-Seung; Lim, Sang-Dong

    2016-01-01

    This study aimed to investigate the anti-obesity effects of yogurt fermented by Lactobacillus plantarum Q180 in diet-induced obese rats. To examine the effects, male Sprague-Dawley rats were fed on six different diets, as follows: Group A was fed an ND and orally administrated saline solution; Group B, an HFD and orally administrated saline solution; Group C, an HFD and orally administrated yogurt fermented by ABT-3 and L. plantarum Q180; Group D, an HFD and orally administrated yogurt with added Garcinia cambogia extract, fermented by ABT-3 and L. plantarum Q180; Group E, an HFD and orally administrated yogurt fermented by L. plantarum Q180; and Group F, an HFD and orally administrated yogurt with added Garcinia cambogia extract, fermented by L. plantarum Q180 for eight weeks. After eight weeks, the rate of increase in bodyweight was 5.14%, 6.5%, 3.35% and 10.81% lower in groups C, D, E and F, respectively, compared with group B; the epididymal fat weight of groups E and F was significantly lower than that of group B; and the level of triglyceride and leptin was significantly reduced in groups C, D, E and F compared to group B. In addition, the level of AST was reduced in group C compared to the other groups. To examine the effects of yogurt on the reduction of adipocyte size, the adipocyte sizes were measured. The number of large-size adipose tissue was less distributed in groups A, C, D, E and F than in group B. PMID:27499667

  12. Impact of weight-loss medications on the cardiovascular system: focus on current and future anti-obesity drugs.

    Science.gov (United States)

    Drolet, Benoit; Simard, Chantale; Poirier, Paul

    2007-01-01

    Overweight and obesity have been rising dramatically worldwide and are associated with numerous co-morbidities such as cardiovascular disease (CVD), type 2 diabetes mellitus, hypertension, certain cancers, and sleep apnea. In fact, obesity is an independent risk factor for CVD and CVD risks have also been documented in obese children. The majority of overweight and obese patients who achieve a significant short-term weight loss do not maintain their lower bodyweight in the long term. This may be due to a lack of intensive counseling and support from a facilitating environment including dedicated healthcare professionals such as nutritionists, kinesiologists, and behavior specialists. As a result, there has been a considerable focus on the role of adjunctive therapy such as pharmacotherapy for long-term weight loss and weight maintenance. Beyond an unfavorable risk factor profile, overweight and obesity also impact upon heart structure and function. Since the beginning, the quest for weight loss drugs has encountered warnings from regulatory agencies and the withdrawal from the market of efficient but unsafe medications. Fenfluramine was withdrawn from the market because of unacceptable pulmonary and cardiac adverse effects. Nevertheless, there is extensive research directed at the development of new anti-obesity compounds. The effect of these molecules on CVD risk factors has been studied and reported but information regarding their impact on the cardiovascular system is sparse. Thus, instead of looking at the benefit of weight loss on metabolism and risk factor management, this article discusses the impact of weight loss medications on the cardiovascular system. The potential interaction of available and potential new weight loss drugs with heart function and structure is reviewed. PMID:17696568

  13. Heart bypass surgery - minimally invasive

    Science.gov (United States)

    Minimally invasive direct coronary artery bypass; MIDCAB; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery ... doctor may recommend a minimally invasive coronary artery bypass if you have a blockage in one or ...

  14. Effect of postoperative care of the laparoscopic Roux - en - Y gastric bypass surgery in patients with type 2 di-abetes%腹腔镜胃旁路手术治疗2型糖尿病术后长效护理效果研究

    Institute of Scientific and Technical Information of China (English)

    方方; 徐亚香; 刘楠; 王道荣

    2015-01-01

    目的:探讨腹腔镜下胃旁路手术治疗Ⅱ型糖尿病患者的术后护理效果。方法:将34例行腹腔镜胃旁路手术治疗Ⅱ型糖尿病的患者随机分成试验组和对照组,比较两组患者术后第1周、15天、1个月、2个月、3个月的餐后两小时血糖及术后3个月的糖化血红蛋白、体重指数。结果:试验组患者术后各时间点血糖、糖化血红蛋白、体重指数(BMI)恢复优于对照组;患者满意度、健康教育效果得到认可和提高。结论:手术治疗糖尿病效果显著,同时有效的术后护理干预能优化手术治疗Ⅱ型糖尿病的效果,促进Ⅱ型糖尿病的恢复,减少并发症。%Objective To explore the effect of postoperative care of the laparoscopic Roux - en - Y gastric bypass surgery in patients with type 2 diabetes. Method 34 cases of laparoscopic mini - gastric bypass in the treatment of type 2 diabetes were randomly into experi-mental group and control group,two groups were compared postoperative 1 week,1 month,2 months,3 months,fasting glucose,two - hour postprandial blood glucose,glycosylated hemoglobin,body mass index. Results The patients blood glucose,glycosylated hemqoglobin,body mass index(BMI)was better than the control group recovered at each time point;patient satisfaction,health education to be recognized and enhanced. Conclusion Surgical treatment of diabetes has significant effect. Effective nursing intervention can optimize postoperative surgical treatment of type 2 diabetes,and promote the recovery and reduce complications.

  15. A importância do anel de silicone na derivação gástrica em Y-de-ROUX para o tratamento da obesidade The importance of the silastic ring in the ROUX-en-Y gastric bypass for the treatment of obesity

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Valezi

    2008-02-01

    Full Text Available OBJETIVO: Analisaram prospectivamente pacientes obesos submetidos à derivação gástrica em y-de-roux com anel de silicone de diferentes tamanhos. MÉTODO: Os pacientes foram acompanhados durante cinco anos e através de exame endoscópico foram classificados em dois Grupos: anel com diâmetro interno até 10 mm (184 pacientes e anel com diâmetro interno maior que 10 mm (107pacientes. Foi mensurada a porcentagem de perda do excesso de peso com um, dois e cinco anos de pós-operatório, e comparados os grupos entre si em cada ano da coleta dos dados. RESULTADOS: Houve maior emagrecimento no grupo com anel de diâmetro interno até 10 mm. A análise estatística mostrou que houve significância comparando-se os dois grupos entre si, um, dois e cinco anos após a cirurgia, sendo o emagrecimento sempre maior no grupo com anel de menor diâmetro. Não houve diferença estatisticamente significante ao se comparar outros dados da amostra como idade, sexo e IMC. CONCLUSÃO: A restrição determinada pelo anel aumenta a porcentagem de perda do excesso de peso.BACKGROUND: The aim of the study is to state if the ring used in the Roux-en-Y gastric bypass is related to the weight loss after surgery. METHODS: The study has a 5 years follow up. After endoscopic examination the patientes were divided in two groups: internal diameter of the ring till 10mm (184 patients and other group with internal diameter of the ring more than 10 mm (107 patients.The excess of weight loss were measured one, two and five years after surgery and compared one with each other. RESULTS: The excess of weight loss was higher for those patients with tighter ring. Statistc analysis was significant comparing the two groups one, two and five years after surgery, the excess of weight loss was higher in the tighter ring groups for each time after surgery. There were no difference related to sex, age and BMI. CONCLUSION: The restriction determined by ring increases the excess of weight

  16. Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study Úlcera perianastomótica após derivação gástrica em Y-de-Roux mesmo em uso de inibidor de bomba de prótons: estudo prospectivo multicêntrico

    Directory of Open Access Journals (Sweden)

    Arthur Belarmino Garrido Jr.

    2010-06-01

    Full Text Available CONTEXT: Causal factors of gastrojejunal ulcers after Roux-en-Y gastric bypass include peptic acid secretion from the gastric pouch. Esomeprazole is a potent inhibitor of acid secretion. OBJECTIVE: To assess the occurrence of dyspepsia and gastrojejunal ulcers within the first 2 months after Roux-en-Y gastric bypass during the use of esomeprazole. METHODS: One hundred eighteen morbid obese subjects were submitted to Roux-en-Y gastric bypass. Preoperative upper gastrointestinal tract endoscopy was negative for H. pylori. All subjects received esomeprazole for 60 days after surgery. RESULTS: Two weeks after surgery only 13 mild symptoms were reported. After 2 months, 17 also moderate complaints were registered. Endoscopy around the 60th day showed esophagitis in 10 (8.5%, hiatal hernia in 2 (1.7%, foreign body in the anastomotic line in 12 (10.2% and gastrojejunal ulcers was observed in 9 (7.6% subjects, 2 of which had a suture material or metallic staple granuloma in the gastrojejunostomy. Ten subjects took nonsteroidal anti-inflammatory drugs at least once during study, but none of them developed ulcer. None of the subjects with ulcer had dyspeptic symptoms. CONCLUSION: The incidence of ulcer in the gastrojejunal anastomosis within the first 2 months following Rouxen-Y gastric bypass under proton pump inhibitors is considerable. It was not related to the use of non-steroidal anti-inflammatory drugs, highlighting the possibility of ischemia and foreign body as causal factors. The ulcers were asymptomatic, and all post-surgical dyspeptic symptoms were moderate in severity.CONTEXTO: Sintomas dispépticos são comuns após derivação gástrica em Y-de-Roux. Podem decorrer de úlceras de boca anastomótica, cujos possíveis fatores causais incluem a secreção cloridropéptica da bolsa gástrica, isquemia, efeito de corpo estranho dos materiais de sutura e uso de antiinflamatórios não-esteróides. O esomeprazol é um redutor potente da secre

  17. Endoscopic gastric pouch plication – a novel endoluminal incision free approach to revisional bariatric surgery

    Directory of Open Access Journals (Sweden)

    Virk CS

    2010-04-01

    Full Text Available 10-40% of Roux-en-Y gastric bypass (RYGB patients regain significant weight after Roux-en-Y gastric bypass surgery due to dilation of the pouch and/or the gastrojejunal (GJ anastomosis. Traditional revision surgery is associated with significant morbidity (e.g. post-anastomotic GJ leak where less invasive endoluminal procedures may represent safer alternatives. The present article reports a case of the safe and successful use of endoluminal gastric pouch plication (EGPP using the StomaphyX™ device to correct both a dilated gastric pouch and a dilated gastrojejunostomy in a post-RYGB patient who regained significant weight.

  18. Flood Bypass Capacity Optimization

    Science.gov (United States)

    Siclari, A.; Hui, R.; Lund, J. R.

    2015-12-01

    Large river flows can damage adjacent flood-prone areas, by exceeding river channel and levee capacities. Particularly large floods are difficult to contain in leveed river banks alone. Flood bypasses often can efficiently reduce flood risks, where excess river flow is diverted over a weir to bypasses, that incur much less damage and cost. Additional benefits of bypasses include ecosystem protection, agriculture, groundwater recharge and recreation. Constructing or expanding an existing bypass costs in land purchase easements, and levee setbacks. Accounting for such benefits and costs, this study develops a simple mathematical model for optimizing flood bypass capacity using benefit-cost and risk analysis. Application to the Yolo Bypass, an existing bypass along the Sacramento River in California, estimates optimal capacity that economically reduces flood damage and increases various benefits, especially for agriculture. Land availability is likely to limit bypass expansion. Compensation for landowners could relax such limitations. Other economic values could affect the optimal results, which are shown by sensitivity analysis on major parameters. By including land geography into the model, location of promising capacity expansions can be identified.

  19. Estudo da gastrinemia pré e pós-operatória em pacientes submetidos à gastroplastia vertical com banda e reconstrução em Y de Roux por obesidade mórbida The behaviour of pre and post operative gastrinemia in patients submitted to vertical banded gastroplasty with Roux-em-Y gastric bypass for morbid obesity

    Directory of Open Access Journals (Sweden)

    Edmundo Anderi Jr

    2008-12-01

    for the treatment of morbid obesity. Key-words: morbid obesity*, gastric bypass*, gastrin*.

  20. 胃旁路手术对常用药物的药代动力学影响的研究进展%Progress in effects of Roux -en -Y gastric bypass surgery on pharmacokinetics of some kinds of common drugs

    Institute of Scientific and Technical Information of China (English)

    菅凌燕; 何晓静

    2014-01-01

    胃旁路手术是目前国内外治疗病理性肥胖的金标准;但因其改变患者的解剖结构和生理功能,可对药物的药代动力学产生影响。本文综述了胃旁路手术对维生素和微量元素、抗菌药物等药代动力学的影响。胃旁路手术后,药物的生物利用度可不变、减少或增加,与药物的吸收、代谢特点密切相关。%Roux -en -Y gastric bypass (RYGB) is the golden standard surgeon to treat pathological obesity at present in the world .RYGB sur-geon could change the physical function and anatomic structure , it thus may make some uncertain effects on pharmacokinetics and pharmacody -namics of drugs.We retrieve references in recent years and make a review about how RYGB surgeon effect pharmacokinetics of vitamins , trace elements and antibacterials , et al.After RYGB surgeon, bioavail-ability of drugs may unchange, decrease or increase.Such variability is correlated with the absorption and metallization of drugs in vivo.

  1. 葡萄糖依赖性促胰岛素释放肽在胃肠转流术治疗2型糖尿病中的作用%Glucose-dependent insulinotropic peptide in Type 2 diabetes after gastric bypass surgery

    Institute of Scientific and Technical Information of China (English)

    李鹏洲; 朱晒红; 张大伟; 刘岩; 王国慧; 朱利勇; 叶飞

    2011-01-01

    Glucose-dependent insulinotropic peptide (GIP) , the incretins, is synthesized and released from the duodenum and proximal jejunum. Continual high-fat diet powerfully stimulated GIP secretion, leading to obesity and harmful lipid deposition in islet cells and peripheral tissues, and giving rise to insulin resistance and major disturbances in the secretion of insulin. We can improve Type 2 diabetes by compromising GIP action. The exclusion of proximal small intestine and reduction of GIP secretion may be the important reasons for Type 2 diabetes after gastric bypass surgery.%葡萄糖依赖性促胰岛素释放肽(glucose-dependent insulinotropic peptide,GIP)是十二指肠及空肠上段合成、分泌的一种肠促胰岛素.长期高脂饮食可以刺激GIP的大量分泌,引起脂质在胰岛细胞和外周组织中沉积,导致胰岛素抵抗和分泌功能受损;抑制GIP可以明显改善2型糖尿病.胃肠转流手术通过对近端小肠的旷置,从而减少GIP的分泌可能是其能够治疗2型糖尿病的重要原因.

  2. Observation and Experience in Prevention of Postoperative Complications for 100 Cases of Gastric Bypass in Treatment of Type 2 Diabetes Mellitus Patients%100例胃转流术治疗2型糖尿病患者术后并发症观察及防治体会

    Institute of Scientific and Technical Information of China (English)

    朱林超; 王云; 孙英; 刘红彬

    2011-01-01

    目的 观察总结胃转流术(Gastric bypass,GBP)治疗2型糖尿病术后常见并发症,探讨其防治方法.方法 对100例胃转流术治疗2型糖尿病患者的临床资料进行回顾性分析. 结果 本组100例患者手术方法为胃转流术或胃转流术+胆囊切除术,术后胃瘫综合征(Postoperative gastroparesis syndrome,PGS )21例,术后切口脂肪液化20例,术后出血4例.结论 术后胃瘫综合征是胃转流术治疗2型糖尿病术后最常见并发症,其次为切口脂肪液化,第三为术后出血,以上情况术前采取预防措施、术后采用积极治疗手段均可治愈.

  3. 胃转流手术与口服药物对2型糖尿病肥胖患者的疗效评价%Effects of gastric bypass versus medicine administration in obese patients with type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    魏振刚; 郭小虎; 魏丰贤; 王满才; 张有成

    2015-01-01

    Objective To assess the effects of gastric bypass versus medical therapy in patients with obesity and type 2 diabetes. Methods The Cochrane library, Embase, PubMed, Chinese biomedical literature database and Wanfang database up to April 2014 were searched. Randomized controlled trails(RCTs) of frequently-used bariatric surgery for obese patients with type 2 diabetes were included. Study selection, data extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Results Four RCTs involving 157 patients in the gastric bypass groups and 152 patients in the medical therapy group were enrolled. Compared with medical therapy, gastric bypass for type 2 diabetes significantly decreased the levels of HbA1C(mean difference = -1. 85% , 95% CI -2. 15 ~ -1. 56, P< 0. 01), fasting blood glucose( standard mean difference = - 0. 90 mmol/ L, 95% CI-1. 24 ~ -0. 57, P<0. 01), body weight(mean difference=-23. 39 kg, 95% CI -29. 17 ~ -17. 61, P<0. 01), waist circumference(mean difference= -15. 36 cm, 95% CI -17. 51 ~ -13. 22, P<0. 01) and the dose of hypoglycemic medicine; while it increased the number of patients with HbA1C<6% (RR=5. 49, 95% CI 2. 22 ~ 13. 56, P<0. 01), the rate of adverse events(RR=1. 96, 95% CI 1. 42 ~ 2. 70, P<0. 01), and the level of high-density lipoprotein-cholesterol(mean difference=1. 24 mmol/ L, 95% CI 0. 64 ~ 1. 84, P<0. 01). Conclusions Gastric bypass surgery is more effective compared with medical therapy alone for obese patients with type 2 diabetes. Further intensive RCTs of high-quality in multiple centers with long-term follow-up should be carried out to provide more reliable evidences.%目的:系统性评价胃转流手术与药物治疗肥胖患者2型糖尿病疗效的优劣。方法检索PubMed、Embase、Cochrane library、中国期刊全文数据库、中国生物医学文献数据库、万方数据库中胃转流手术治疗糖尿病的随机对照试验,时间截止至2014年4月。由2名研究员

  4. The roles of ghrelin/agouti-related protein/peptide YY signal pathway in gastric bypass operation for type 2 diabetes%胃饥饿素/肽YY/刺鼠相关蛋白信号在胃旁路手术治疗2型糖尿病中的作用

    Institute of Scientific and Technical Information of China (English)

    高寅生; 侯亚勃; 杨晓军; 高鹏; 曹农

    2016-01-01

    Objective To study the roles of ghrelin,agouti-related protein (AGRP) and peptide YY (PYY) signal in treatment of type 2 diabetes mellitus by gastric bypass operation.Methods Twenty adult SD rats were used to establish the model of type 2 diabetes mellitus,and divided into 2 groups:No operation group (NO,n =10) and Roux-en-Y gastric bypass operation group (RYGB,n =10),and another ten adult rats were used as the Normal Control group (NC,n =10).The RYGB group were performed operation after the rat model of type 2 diabetes mellitus were established successfully.The blood were separately collected to examine ghrelin,blood sugar,cholesterol and triglyceride before and after operation,and we monitored the consumption of food and water everyday.The hypothalamus tissues were collected at the 4th week after operation to examine the expression of AGRP and PYY mRNA.Results At the 4th week after operation,the blood sugar dropped to (6.18 ±0.77) mmol/L,Triglycerides dropped to (2.45 ±0.23) mmol/L;Cholesterol dropped to (2.07 ± 0.22) mmoL/L and the consumption of food,water of RYGB group were nearly down to normal level.The level of ghrelin dropped to (410.60 ± 58.33) ng/L,AGRP mRNA dropped to 0.80 ±0.13 in hypothalamus were lower than NO group after operation,the level of PYY mRNA rised to 1.60 ± 0.25 were significantly increased (P < 0.05).Conclusion We can conclude that the situation of type 2 diabetes mellitus can be controlled by Roux-en-Y gastric bypass operation.Ghrelin may regulate the energy metabolism of type 2 diabetes mellitus via AGRP and PYY signals.Our results suggest that the roles of ghrelin,AGRP and PYY signals may play an important role in the control of type 2 diabetes mellitus after Roux-en-Y gastric bypass operation.%目的 探讨胃饥饿素(Ghrelin)、肽YY(PYY)、刺鼠相关蛋白(AGRP)信号通路在胃旁路手术治疗2型糖尿病中的作用及其机制.方法 采用20只成年SD雄性大鼠成功建立2型糖尿病大鼠模型,随机分

  5. The clinical analysis of the laparoscopic Roux-en-Y gastric bypass in the treatment of type 2 diabetes mellitus%腹腔镜Roux-en-Y胃转流术治疗2型糖尿病临床分析

    Institute of Scientific and Technical Information of China (English)

    李建军

    2014-01-01

    目的:评价腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)治疗2型糖尿病的临床疗效.方法:回顾分析2009年5月至2011年7月为32例2型糖尿病患者行LRYGB的临床资料,观察手术前后BMI、空腹血糖及糖化血红蛋白等指标的变化情况,分析与手术治疗效果及预后相关的因素.结果:32例患者均成功接受LRYGB,并完成术后6个月的随访.术后4例患者发生并发症.术后第6个月,26例(81.25%)患者达到糖尿病治愈,4例(12.5%)血糖得到控制,2例(6.25%)无效.结论:LRYGB治疗2型糖尿病可取得较满意的临床疗效,但也存在一定问题,尚需进一步研究.

  6. Efficacy comparison between 2 methods of laparoscopic gastric bypass surgery in the treatment of type 2 diabetes mellitus%腹腔镜Roux-en-Y胃旁路术与腹腔镜迷你胃旁路术治疗2型糖尿病疗效比较

    Institute of Scientific and Technical Information of China (English)

    郭翔; 印慨; 卓光鑽; 常绪生; 丁丹; 郑成竹

    2012-01-01

    Objective To investigate the outcomes after 2 methods of laparoscopic gastric bypass surgery for patients with type 2 diabetes mellitus(T2DM).Methods From December 2009 to June 2011,21 patients with T2DM underwent laparoscopic gastric bypass surgery,including laparoscopic Roux-en-Y gastric bypass(LRYGB,n=11),and laparoscopic mini-gastric bypass(LMGB,n=10).Clinical data wcre analyzed retrospectively.Results The clinical complete remission rate of T2DM was 64%(7/11)in LRYGB group,and 60%(6/10)in LMGB group.The clinical partial remission rate of T2DM was 36%(4/11)in LRYGB group,and 40%(4/10)in the LMGB group.There was no significant difference between the two groups(both P>0.05).The levels of BMI,waist circumference,HOMA-IR and HbA1c within the postoperative 6 months were improved in each group(all P<0.05),but there was no significant difference between the two groups(all P>0.05).There were no conversion or perioperative deaths in both groups.Compared to LMGB,the LRYGB group had longer operative time[(147.0±35.9)min vs.(110.5±39.7)min,P=0.038]and postoperative hospital stay[(8.9±2.3)d vs.(7.1±1.4)d,P=0.046).One patient suffered from ileus in LRYGB group,one patient suffered from reflux esophagitis and one suffered chronic diarrhea in LMGB group.The incidence of postoperative complication was similar between the two groups(P>0.05).Conclusion LRYGB and LMGB may result in satisfactory and safe effects for the treatment of T2DM,while the LMGB is simpler and associates with quicker recovery.%目的 比较腹腔镜Roux-en-Y胃旁路术(LRYGB)与腹腔镜迷你胃旁路术(LMGB)治疗2型糖尿病(T2DM)的效果及安全性.方法 回顾性分析2009年12月至2011年6月间在上海第二军医大学附属长海医院接受腹腔镜胃旁路术治疗的21例T2DM患者的临床资料,其中LRYGB组11例,LMGB组10例.结果 LRYGB组T2DM临床完全缓解率为64%(7/11),临床部分缓解率为36%(4/11);LMGB组临床完全缓解率为60%(6/10),

  7. Oral administration of O-2 lean, an anti-obesity herbal composition increased 5-HT metabolism, decreased food intake and body weight in overweight rats

    International Nuclear Information System (INIS)

    Feeding behavior is complex processes controlled by the neruroendocrine system.5-HT play an important role in regulation of energy balance by suppressing food intake. Depletion of brain serotonin increase feeding behavior and develop obesity. Many serotoninergic compounds are available in market for the management of body weight. 02-Lean is an anti-obesity herbal formulation prepared by combination of different herbs. Oral administration of aqueous suspension of 02-Lean caused a significant decrease in body weight, food intake, and increase in whole brain 5-HT 5HIAA, tryptophan and plasma tryptophan in over weight rats treated with 0.096g/2ml 02-Lean in comparison to control group. (author)

  8. Evaluation of Anti-obesity Effects of Aqueous and Ethanolic Extracts of Pomegranate Fruit Peel Using Anthropometrical Indices in Male Wistar Rats

    Directory of Open Access Journals (Sweden)

    Mohammad Hassanpour fard

    2015-04-01

    Results: Comparison of weight change before and after the intervention showed a significant reduction in the Group E and a significant increase in group N (p≤0.05. Waist circumference was significantly increased in the experimental group A and control group N (p≤0.05 and reduced in group X (p≤0.05.There was no significant difference in plasma lipid profile between the groups. Conclusion: The ethanolic extract of pomegranate fruit peel can be considered as an anti-obesity compound in further studies.

  9. Preformulation characterization and in vivo absorption in beagle dogs of JFD, a novel anti-obesity drug for oral delivery.

    Science.gov (United States)

    Fan, Yunzhou; Yang, Meiyan; Wang, Yuli; Li, Yanyou; Zhou, Yuanda; Chen, Xiaoping; Shan, Li; Wei, Jun; Gao, Chunsheng

    2015-05-01

    JFD (N-isoleucyl-4-methyl-1,1-cyclopropyl-1-(4-chlorine)phenyl-2-amylamine·HCl) is a novel investigational anti-obesity drug without obvious cardiotoxicity. The objective of this study was to characterize the key physicochemical properties of JFD, including solution-state characterization (ionization constant, partition coefficient, aqueous and pH-solubility profile), solid-state characterization (particle size, thermal analysis, crystallinity and hygroscopicity) and drug-excipient chemical compatibility. A supporting in vivo absorption study was also carried out in beagle dogs. JFD bulk powders are prismatic crystals with a low degree of crystallinity, particle sizes of which are within 2-10 μm. JFD is highly hygroscopic, easily deliquesces to an amorphous glass solid and changes subsequently to another crystal form under an elevated moisture/temperature condition. Similar physical instability was also observed in real-time CheqSol solubility assay. pK(a) (7.49 ± 0.01), log P (5.10 ± 0.02) and intrinsic solubility (S0) (1.75 μg/ml) at 37 °C of JFD were obtained using potentiometric titration method. Based on these solution-state properties, JFD was estimated to be classified as BCS II, thus its dissolution rate may be an absorption-limiting step. Moreover, JFD was more chemically compatible with dibasic calcium phosphate, mannitol, hypromellose and colloidal silicon dioxide than with lactose and magnesium stearate. Further, JFD exhibited an acceptable pharmacokinetic profiling in beagle dogs and the pharmacokinetic parameters T(max), C(max), AUC(0-t) and absolute bioavailability were 1.60 ± 0.81 h, 0.78 ± 0.47 μg/ml, 3.77 ± 1.85 μg·h/ml and 52.30 ± 19.39%, respectively. The preformulation characterization provides valuable information for further development of oral administration of JFD. PMID:24694186

  10. Ethnobotanical Study of Medicinal Plants Used as Anti-Obesity Remedies in the Nomad and Hunter Communities of Burkina Faso

    Directory of Open Access Journals (Sweden)

    Dramane Pare

    2016-04-01

    Full Text Available Background: Obesity is a global epidemic that affects both developed and developing countries. According to World Health Organization (WHO, in 2014, over 1.9 billion adults were overweight. Burkina Faso, like other countries, faces the problem of obesity, with a prevalence of 7.3%. The main cause is excessive intake of caloric foods combined with low physical activity, although genetic, endocrine and environmental influences (pollution can sometimes be predisposing factors. This metabolic imbalance often leads to multiple pathologies (heart failure, Type II diabetes, cancers, etc.. Drugs have been developed for the treatment of these diseases; but in addition to having many side effects, locally these products are not economically accessible to the majority of the population. Burkina Faso, like the other countries bordering the Sahara, has often been confronted in the past with periods of famine during which populations have generally used anorectic plants to regulate their food needs. This traditional ethnobotanical knowledge has not been previously investigated. An ethnobotanical survey was conducted in Burkina Faso in the provinces of Seno (North and Nayala (Northwest to list the plants used by local people as an anorectic and/or fort weight loss. Methods: The survey, conducted in the two provinces concerned traditional healers, herbalists, hunters, nomads and resourceful people with knowledge of plants. It was conducted over a period of two months and data were collected following a structured interview with the respondents. The approach was based on dialogue in the language of choice of the respondent and the use of a questionnaire. The data have been structured and then statistically analyzed. Results: The fifty-five (55 respondents of the survey were aged between 40 and 80 years. Sixty-one (61 plant species, belonging to thirty-one (31 families were listed as appetite suppressants and/or for their anti-obesity properties. The main

  11. Timing of Pregnancy After Gastric Bypass—a National Register-Based Cohort Study

    DEFF Research Database (Denmark)

    Kjær, Mette Karie Mandrup; Nilas, Lisbeth

    2013-01-01

    Current recommendations suggest postponing pregnancy by at least 1 year after gastric bypass. During the first postoperative year, women are in a catabolic phase with a rapid weight loss which may increase the risk of adverse pregnancy and neonatal outcomes. This study tested the hypothesis...... that the risk of adverse pregnancy and neonatal outcomes is increased in women who conceive during the first year after gastric bypass surgery....

  12. Bypassing damaged nervous tissue

    CERN Document Server

    Shneider, M N

    2016-01-01

    We show the principal ability of bypassing damaged demyelinated portions of nervous tissue, thereby restoring its normal function for the passage of action potentials. We carry out a theoretical analysis on the basis of the synchronization mechanism of action potential propagation along a bundle of neurons, proposed recently in [1]. And we discuss the feasibility of implement a bypass to restore damaged nervous tissue and creating an artificial neuron network.

  13. The anti-obesity effects of the dietary combination of fermented red ginseng with levan in high fat diet mouse model.

    Science.gov (United States)

    Oh, Jin sun; Lee, Seung Ri; Hwang, Keum Taek; Ji, Geun Eog

    2014-04-01

    In this study, to evaluate the anti-obesity effects of fermented red ginseng (FG), levan (L), and their combination (FGL), we investigated their effects on the weights of body, liver and white adipose tissue, lipid profiles, and biomarkers for insulin resistance in high fat diet (HFD)-induced obese C57BL/6J male mice. Furthermore, the levels of leptin in the serum were measured. FG (150 mg/kg/d), L (100 mg/kg/d), and FGL (150 mg/kg/d of FG plus 100 mg/kg/d of L) were administered orally to mice daily for 11 weeks. After 11 weeks feeding, FGL showed significantly lower body weight and fat mass with decreasing food efficiency ratio than the HFD control mice. In addition, the FGL group was significantly lower in the levels of total cholesterol and fasting blood glucose and score of the homeostatic model assessment of insulin resistance. Furthermore, FGL decreased serum leptin levels compared to the HFD control group. Taken together, FGL showed a significant anti-obesity effect in HFD-induced obese mice and prevent insulin and leptin resistance. FGL may be potentially useful for the prevention of obesity. PMID:23873605

  14. Anti-Obesity and Hypoglycemic Effects of Poncirus trifoliata L. Extracts in High-Fat Diet C57BL/6 Mice

    Directory of Open Access Journals (Sweden)

    Sheng Jia

    2016-04-01

    Full Text Available The present study investigated the possible anti-obesity and hypoglycemic effects of Poncirus trifoliata L. extracts. Mature fruit were divided into flavedo (PF and juice sacs (PJ, and extracts from them were tested on C57BL/6 mice fed a high-fat diet (HFD for thirteen weeks. Both fruit extracts (40 mg/kg body weight, respectively showed anti-obesity and hypoglycemic effects. Consumption of PF and PJ extracts reduced body weight by 9.21% and 20.27%, respectively. Liver and adipose weights, fasting glucose, serum triglyceride (TG, and low density lipoprotein cholesterol (LDL-c levels decreased significantly, while serum high density lipoprotein cholesterol (HDL-c and oral glucose tolerance levels increased significantly in response to two fruit extracts. These effects were due in part to the modulation of serum insulin, leptin, and adiponectin. Furthermore, transcript levels of fatty acid synthase (FAS and stearoyl-CoA desaturase 1 (SCD1 were reduced while those of carnitine palmitoyltransferase 1α (CPT1α and insulin receptor substrate 2 (IRS2 were increased in the liver of C57BL/6 mice, which might be an important mechanism affecting lipid and glucose metabolism. Taken together, P. trifoliata fruit can be potentially used to prevent or treat obesity and associated metabolic disorders.

  15. Gastric carcinogenesis

    Institute of Scientific and Technical Information of China (English)

    Ismail Gomceli; Baris Demiriz; Mesut Tez

    2012-01-01

    Gastric cancer is the second most common cancer worldwide and the second most common cause of cancer-related deaths.Despite complete resection of gastric cancer and lymph node dissection,as well as improvements in chemotherapy and radiotherapy,there are still 700 000 gastric cancer-related deaths per year worldwide and more than 80% of patients with advanced gastric cancer die of the disease or recurrent disease within 1 year after diagnosis.None of the treatment modalities we have been applying today can influence the overall survival rates:at present,the overall 5-year relative survival rate for gastric cancer is about 28%.Cellular metaplasia due to chronic inflammation,injury and repair are the most documented processes for neoplasia.It appears that chronic inflammation stimulates tumor development and plays a critical role in initiating,sustaining and advancing tumor growth.It is also evident that not all inflammation is tumorigenic.Additional mutations can be acquired,and this leads to the cancer cell gaining a further growth advantage and acquiring a more malignant phenotype.Intestinalization of gastric units,which is called "intestinal metaplasia";phenotypic antralization of fundic units,which is called "spasmolytic polypeptide-expressing metaplasia"; and the development directly from the stem/progenitor cell zone are three pathways that have been described for gastric carcinogenesis.Also,an important factor for the development of gastrointestinal cancers is peritumoral stroma.However,the initiating cellular event in gastric metaplasia is still controversial.Understanding gastric carcinogenesis and its precursor lesions has been under intense investigation,and our paper attempts to high-light recent progress in this field of cancer research.

  16. Gastric partitioning gastrojejunostomy in unresectable distal gastric cancer patients.

    Science.gov (United States)

    Kwon, Sung Joon; Lee, Ha Gyoon

    2004-04-01

    The main purpose of bypass surgery in patients with unresectable distal gastric cancer is to improve their quality of life (QoL). However, the result of conventional gastroenterostomy is dismal including continuous bleeding due to the contact of food material on the tumor surface and early obstruction of the stoma by tumor growth. Developing more effective surgery is warranted to improve the QoL of these patients. Among the 1158 patients with gastric cancer who underwent surgery from March 1993 to July 2002 at Hanyang University Medical Center, 54 (4.7%) had unresectable cancers. Various types of gastrojejunostomy (G-Jstomy), including conventional G-Jstomy (CGJ) (n = 18), antral exclusion G-Jstomy (n = 7), and gastric partitioning G-Jstomy (GPGJ) (n = 17), as well as exploratory laparotomy only (n = 12) were performed in these unresectable cases. In this study, survival and postoperative QoL were compared for the CGJ and GPGJ groups. The median survivals were 120 and 209 days for the CGJ and GPGJ groups, respectively (p = 0.046). The rates of postoperative body weight loss compared to the preoperative weight were 9.3% and 3.1% in the CGJ and GPGJ groups, respectively; the difference showed borderline significance (p = 0.067). The volume of blood transfusion was much less during the postoperative period than during the preoperative period in the GPGJ group but not in the CGJ group. The GPGJ procedure minimized food contact on the tumor surface, which was confirmed by an upper gastrointestinal barium meal series. GPGJ can be recommended as the procedure of choice for bypass surgery in patients with unresectable distal gastric cancer considering their improved survival and postoperative QoL compared to those who underwent CGJ. PMID:14994143

  17. Application of positive psychology for individualized nursing in type 2 diabetes mellitus patients with gastric bypass%积极心理学在2型糖尿病胃转流术患者个体化护理中的应用

    Institute of Scientific and Technical Information of China (English)

    张敏; 聂雷霞; 张海霞; 李威; 杜艳玲

    2014-01-01

    目的:探讨以积极心理学为基础的个体化护理在2型糖尿病胃转流术患者中的应用效果。方法将2012年6月-2013年6月收治的38例行胃转流术的2型糖尿病患者采用随机数字表法分为对照组18例和干预组20例,对照组采用传统护理干预,干预组实施以积极心理学为基础的个体化护理干预,对两组患者干预前后心理状态、知识掌握及满意度进行评定。结果干预后,两组患者乐观指数、幸福指数、护患信任度均有所提高,且干预组明显高于对照组,差异有统计学意义( P<0.05)。干预组患者对疾病知识掌握程度(28.20±1.96)分和满意度(3.80±0.41)分均高于对照组的(24.94±2.51),(3.39±0.78)分,差异有统计学意义(t分别为4.479,2.068;P<0.05)。结论以积极心理学为基础的个体化护理干预,可改善2型糖尿病胃转流术患者心理健康水平,提高患者知识掌握程度和满意度,对疾病恢复有积极的作用。%Objective To explore the effect of individualized nursing based on positive psychology in the type 2 diabetes mellitus patients with gastric bypass .Methods Thirty-eight cases of type 2 diabetes mellitus patients from June 2012 to June 2013 were randomly divided into the control group ( eighteen cases ) and the intervention group ( twenty cases ) .The control group received the traditional methods of nursing , while the intervention group received individualized nursing based on positive psychology .The patients of the two groups were assessed in the mental status , knowledge and satisfaction .Results After the intervention , both the two groups of patients with optimism , happiness , nurse-patient confidence , the degree of understanding and satisfaction were improved ,the intervention group was significantly higher than that in the control group ( P<0.05).Mastery of the knowledge of the disease (28.20 ±1.96) and

  18. Uso da mirtazapina no tratamento da náusea e vômito refratários a terapia habitual após derivação gástrica em Y de Roux Intractable nausea and vomiting following Roux-en-Y gastric bypass controlled with mirtazapine

    Directory of Open Access Journals (Sweden)

    Alexandre Coutinho Teixeira de Freitas

    2008-03-01

    Full Text Available RACIONAL: A cirurgia bariátrica é procedimento com significativa morbidade. A náusea a vômito geralmente ocorrem devido à presença de complicações mecânicas como as estenoses das anastomoses. Alguns casos apresentam sintomas importantes na ausência dessas complicações. OBJETIVO: Relato do uso da mirtazapina no pós-operatório de cirurgia bariátrica em um paciente com náuseas de vômitos refratários ao tratamento clínico habitual, na ausência de complicações mecânicas. RELATO DO CASO: Paciente portador de obesidade mórbida foi submetido à derivação gástrica em Y de Roux laparoscópica. Evoluiu com náusea persistente associada a episódios de vômitos refratários a ondansetron, metoclopramida e bromoprida. Não foram identificadas causas mecânicas para o quadro. Foi iniciado mirtazapina (Remeron® via oral na dose de 30mg por dia durante 60 dias. Após dois dias do início da medicação foi observado melhora total do quadro. A mirtazapina é um antidepressivo que apresenta efeito antiemético através do bloqueio de receptores para a serotonina (5-HT3 no centro do vômito no tronco cerebral. CONCLUSÃO: A mirtazapina pode ser útil nos casos de náusea e vômito refratários à terapia antiemética habitual no pós-operatório de derivação gástrica em Y de Roux, quando causas mecânicas são excluídas.BACKGROUND: Bariatric surgery is related to significant morbidity. Mechanical complications such as stricture of the anastomotic sites are the most common causes of persistent nausea and vomiting. Some patients present such symptoms in the absence of these complications. AIM: To report the use of mirtazapine in a patient submitted to bariatric surgery, presenting persistent nausea and vomiting in the absence of mechanical complications, and unresponsive to conventional antiemetic drugs. CASE REPORT: A morbidly obese patient submitted to laparoscopic Roux-en-Y gastric bypass presented persistent nausea and vomiting

  19. Fístulas de anastomose superior pós-gastroplastia redutora pela técnica de Higa para tratamento da obesidade mórbida: aspectos por imagem Anastomotic leaks after Roux-en-Y gastric bypass surgery by Higa's technique for treatment of morbid obesity: radiological findings

    Directory of Open Access Journals (Sweden)

    Ester Moraes Labrunie

    2008-04-01

    Full Text Available OBJETIVO: Descrever os principais aspectos radiológicos encontrados nas fístulas pós-operatórias de anastomose superior em pacientes submetidos a derivação gastrintestinal em Y de Roux pela técnica de Higa. MATERIAIS E MÉTODOS: Foram estudados 24 pacientes com fístula de anastomose no pós-operatório de gastroplastia redutora, avaliados por tomografias computadorizadas e/ou seriografias esofagogastrojejunais. RESULTADOS: As fístulas de anastomose superior ocorreram até o 30º dia de pós-operatório. Dezenove pacientes realizaram exame radiológico no momento do diagnóstico, sendo observado extravasamento de contraste, considerado sinal direto de fístula de anastomose, em dez pacientes. Dos nove restantes, em sete foi evidenciado extravasamento em exames subseqüentes, sendo ainda identificados sinais indiretos de fístula em seis destes. Sinais indiretos foram observados também em pacientes com extravasamento de contraste nos exames iniciais, sendo o pneumoperitônio o aspecto mais freqüente. Dos cinco pacientes sem exame radiológico no momento do diagnóstico, exames subseqüentes evidenciaram extravasamento de contraste em um e sinais indiretos em quatro pacientes. CONCLUSÃO: O achado radiológico mais comum foi o extravasamento de contraste (sinal direto de fístula. Os sinais indiretos foram: nível líquido bizarro, coleção intracavitária, pneumoperitônio desproporcional ao tempo pós-operatório, líquido na cavidade peritoneal, edema da anastomose inferior e distensão de delgado.OBJECTIVE: The present study was aimed at describing main radiological findings in patients who developed leaks as a complication of Roux-en-Y gastric bypass surgery by the Higa's technique. MATERIALS AND METHODS: Twenty-four patients with post-gastric bypass anastomotic leaks were evaluated by means of computed tomography or gastrointestinal series. RESULTS: Leaks of superior anastomoses generally occurred within 30 postoperative days

  20. Gastric Banding

    Science.gov (United States)

    ... gastric banding before deciding to have the procedure. Advertisements for a device or procedure may not include ... feeds Follow FDA on Twitter Follow FDA on Facebook View FDA videos on YouTube View FDA photos ...

  1. 胃转流术对2型糖尿病大鼠胰高血糖素样肽1及小肠黏膜的影响%The mechanism of glucagon-like peptide-1 on hypoglycemic effect of diabetic type 2 rats treated by gastric bypass operation

    Institute of Scientific and Technical Information of China (English)

    任泽强; 章红; 张蓬波; 黄智龙; 张秀忠; 陈守坤

    2014-01-01

    目的 观察胃转流术(GBP)对2型糖尿病大鼠胰高血糖素样肽1(GLP-1)及小肠黏膜的影响,探讨GBP术降糖机制.方法 健康雄性SD大鼠随机分为正常手术组(NO组)、正常对照组(NC组)、糖尿病手术组(DO组)、糖尿病对照组(DC组).术前及术后第1、2、4、8周分别检测各组GLP-1、空腹血糖(FPG)、胰岛素.术后2个月苏木素-伊红(HE)染色观察末段回肠黏膜病理变化,测量肠黏膜厚度和绒毛高度.结果 DO、NO组GBP术后第8周空腹GLP-1分别由术前的(7.38±1.71) pmol/L和(7.23±1.59) pmol/L升高到(17.80±1.39) pmol/L和(15.48±1.21) pmol/L(P<0.05).DO组术后第8周FPG由术前的(17.71 ±1.99) mmol/L下降到(5.95 ±0.51) mmol/L (P<0.05).术后各时相点DO组GLP-1、FPG明显低于相应时间点DC组(P<0.05),NO组手术前后FPG无明显变化.DO组术后第8周胰岛素由术前的(11.93±0.75) mmol/L升高到(14.80±0.78) mmol/L(P<0.05).DO、NO组肠黏膜厚度和绒毛高度均显著高于DC组和NC组(P<0.05).结论 GBP术后肠黏膜的增生导致GLP-1升高可能为降糖机制之一.%Objective To observe the and influence on intestinal mucosa on type 2 diabetes rats and to research the function of glucagon-like peptide-1 (GLP-1).Methods Healthy male SD rats were randomly divided into normal operation group (NO),normal control group (NC),diabetic operation group (DO) and diabetic control group (DC).The GLP-1,plasma glucose and insulin were tested preoperatively and 1,2,4,8 weeks postoperatively.Intestinal mucosa were examined by hematoxylin and eosin (HE) stain 2 months after operation.The mucosal thickness and villus height were measured by histological analysis.Results The DO group' s and NO group' s GLP-1 increased from (7.38 ± 1.71) pmol/L and (7.23 ± 1.59) pmol/L to (17.80 ± 1.39) pmol/L and (15.48 ± 1.21) pmol/L (P < 0.05) at 8th week after gastric bypass operation respectively.The GLP-1 level of DO group was higher than that of DC and NC groups

  2. Bypass Flow Study

    International Nuclear Information System (INIS)

    The purpose of the fluid dynamics experiments in the MIR (Matched Index of-Refraction) flow system at Idaho National Laboratory (INL) is to develop benchmark databases for the assessment of Computational Fluid Dynamics (CFD) solutions of the momentum equations, scalar mixing, and turbulence models for the flow ratios between coolant channels and bypass gaps in the interstitial regions of typical prismatic standard fuel element (SFE) or upper reflector block geometries of typical Modular High-temperature Gas-cooled Reactors (MHTGR) in the limiting case of negligible buoyancy and constant fluid properties. The experiments use Particle Image Velocimetry (PIV) to measure the velocity fields that will populate the bypass flow study database.

  3. Bypass Flow Study

    Energy Technology Data Exchange (ETDEWEB)

    Richard Schultz

    2011-09-01

    The purpose of the fluid dynamics experiments in the MIR (Matched Index of-Refraction) flow system at Idaho National Laboratory (INL) is to develop benchmark databases for the assessment of Computational Fluid Dynamics (CFD) solutions of the momentum equations, scalar mixing, and turbulence models for the flow ratios between coolant channels and bypass gaps in the interstitial regions of typical prismatic standard fuel element (SFE) or upper reflector block geometries of typical Modular High-temperature Gas-cooled Reactors (MHTGR) in the limiting case of negligible buoyancy and constant fluid properties. The experiments use Particle Image Velocimetry (PIV) to measure the velocity fields that will populate the bypass flow study database.

  4. Microalgal Oil Supplementation Has an Anti-Obesity Effect in C57BL/6J Mice Fed a High Fat Diet.

    Science.gov (United States)

    Yook, Jin-Seon; Kim, Kyung-Ah; Park, Jeong Eun; Lee, Seon-Hwa; Cha, Youn-Soo

    2015-12-01

    This study investigated the impact of microalgal oil (MO) on body weight management in C57BL/6J mice. Obesity was induced for 8 weeks and animals were orally supplemented with the following for 8 additional weeks: beef tallow (BT), corn oil, fish oil (FO), microalgal oil (MO), or none, as a high fat diet control group (HD). A normal control group was fed with a normal diet. After completing the experiment, the FO and MO groups showed significant decreases in body weight gain, epididymal fat pad weights, serum triglycerides, and total cholesterol levels compared to the HD and BT groups. A lower mRNA expression level of lipid anabolic gene and higher levels of lipid catabolic genes were observed in both FO and MO groups. Serum insulin and leptin concentrations were lower in the MO group. These results indicated that microalgal oil has an anti-obesity effect that can combat high fat diet-induced obesity in mice.

  5. The Best Bypass Surgery Trial

    DEFF Research Database (Denmark)

    Møller, Christian H; Jensen, Birte Østergaard; Gluud, Christian;

    2007-01-01

    Recent trials suggest that off-pump coronary artery bypass grafting (OPCAB) reduces the risk of mortality and morbidity compared with conventional coronary artery bypass grafting (CCAB) using cardiopulmonary bypass. Patients with a moderate- to high-risk of complications after CCAB may have...

  6. Anti-obesity effects of germinated brown rice extract through down-regulation of lipogenic genes in high fat diet-induced obese mice.

    Science.gov (United States)

    Ho, Jin-Nyoung; Son, Mi-Eun; Lim, Won-Chul; Lim, Seung-Taik; Cho, Hong-Yon

    2012-01-01

    Lipid accumulation using Oil Red O dye was measured in 3T3-L1 murine adipocytes to examine the anti-obesity effect of four types of germinated rice, including germinated brown rice (GBR), germinated waxy brown rice (GWBR), germinated black rice (GB-R), and germinated waxy black rice (GWB-R). GBR methanol extract exhibited the highest suppression of lipid accumulation in the 3T3-L1 cell line and also the anti-obesity effect of GBR on high fat induced-obese mice. The mice were divided into three groups and were administered: ND, a normal diet; HFD control, a high fat diet; and GBR, a high fat diet plus 0.15% GBR methanol extract for 7 weeks. GBR administration significantly decreased body weight gain and lipid accumulation in the liver and epididymal adipose tissue as compared to the HFD control group. In addition, serum triglycerides (TGs) and total cholesterol (TC) levels were significantly decreased by following GBR administration compared with those in the HFD control group, whereas the high-density lipoprotein (HDL) cholesterol level increased. Furthermore, the mRNA levels of adipogenic transcriptional factors, such as CCAAT enhancer binding protein (C/EBP)-α, sterol regulatory element-binding protein (SREBP)-1c, and peroxisome proliferator activated receptors (PPAR)-γ, and related genes (aP2, FAS), decreased significantly. Taken together, GBR administration suppressed body weight gain and lipid accumulation in the liver and epididymal adipocytes, and improved serum lipid profiles, in part, by controlling adipogenesis through a reduction in transcriptional factors. These results suggest that GBR is a potential agent against obesity.

  7. The New Research about Anti-obesity Components in Food%食品中抗肥胖成分的最新研究进展

    Institute of Scientific and Technical Information of China (English)

    李磊; 周昇昇

    2016-01-01

    With the change of lifestyle and diet, obesity and overweight were prevalence caused by increased food intake, reduced energy expenditure and fat metabolism disorder. Obesity has become a public health prob-lem in developing countries.The research about the anti-obesity food ingredients(such as diglycerides and con-jugated linoleic acid) mechanism of action, develop anti-obesity functional food focused on decrease energy intake (such as lowering energy density of foods or reducing the food intake) or increasing energy expenditure (stimulation of thermogenesis) will become new food research and development focus.%随着生活方式的改变和饮食结构的变化,食物摄入量增加、能量支出减少和脂肪代谢紊乱造成肥胖和超重的流行。肥胖已经成为发展中国家的公共卫生问题,研究食品中的抗肥胖成分(如甘油二酯和共轭亚油酸)的作用机理,把抗肥胖功能性食品的开发集中于减少能量的摄入(如降低食品的能量密度或减少食物的摄入)或增加能量的消耗(促进新陈代谢),将成为食品研究与开发的重点。

  8. Anti-Obesity and Anti-Diabetic Effects of Acacia Polyphenol in Obese Diabetic KKAy Mice Fed High-Fat Diet

    Directory of Open Access Journals (Sweden)

    Nobutomo Ikarashi

    2011-01-01

    Full Text Available Acacia polyphenol (AP extracted from the bark of the black wattle tree (Acacia meansii is rich in unique catechin-like flavan-3-ols, such as robinetinidol and fisetinidol. The present study investigated the anti-obesity/anti-diabetic effects of AP using obese diabetic KKAy mice. KKAy mice received either normal diet, high-fat diet or high-fat diet with additional AP for 7 weeks. After the end of administration, body weight, plasma glucose and insulin were measured. Furthermore, mRNA and protein expression of obesity/diabetic suppression-related genes were measured in skeletal muscle, liver and white adipose tissue. As a result, compared to the high-fat diet group, increases in body weight, plasma glucose and insulin were significantly suppressed for AP groups. Furthermore, compared to the high-fat diet group, mRNA expression of energy expenditure-related genes (PPARα, PPARδ, CPT1, ACO and UCP3 was significantly higher for AP groups in skeletal muscle. Protein expressions of CPT1, ACO and UCP3 for AP groups were also significantly higher when compared to the high-fat diet group. Moreover, AP lowered the expression of fat acid synthesis-related genes (SREBP-1c, ACC and FAS in the liver. AP also increased mRNA expression of adiponectin and decreased expression of TNF-α in white adipose tissue. In conclusion, the anti-obesity actions of AP are considered attributable to increased expression of energy expenditure-related genes in skeletal muscle, and decreased fatty acid synthesis and fat intake in the liver. These results suggest that AP is expected to be a useful plant extract for alleviating metabolic syndrome.

  9. Cardiopulmonary bypass in pregnancy.

    Science.gov (United States)

    Pomini, F; Mercogliano, D; Cavalletti, C; Caruso, A; Pomini, P

    1996-01-01

    The cardiopathic patient can sustain acute heart failure during pregnancy. In such cases, if open heart operation is necessary to save the patient's life, the fetus could be seriously compromised after exposure to cardiopulmonary bypass. From 1958 to 1992, 69 reports of cardiac operations during pregnancy with the aid of cardiopulmonary bypass have been published. Maternal mortality was 2.9%. Embryofetal mortality was 20.2%. Examining only the last 40 patients, maternal and embryofetal mortality were 0.0% and 12.5%, respectively. Embryofetal mortality was 24.0% when hypothermia was used, compared with 0.0% while operating in normothermia. Maternal mortality did not change. The use of hypothermia during cardiopulmonary bypass provoked uterine contractions in several patients. Hypothermia decreases O2 exchange through the placenta. Pump flow and mean arterial pressure during cardiopulmonary bypass seem to be the most important parameters that influence fetal oxygenation. We speculate that cardiac operation is not a contraindication to pregnancy prolongation. PMID:8561577

  10. Bypassing AMPK Phosphorylation

    OpenAIRE

    Viollet, Benoit; Foretz, Marc; Schlattner, Uwe

    2014-01-01

    AMP-activated protein kinase (AMPK) functions as a signaling hub to balance energy supply with demand. Phosphorylation of activation loop Thr172 has been considered as an essential step in AMPK activation. In this issue of Chemistry & Biology, Scott and colleagues show that the small molecule direct AMPK activator, A-769662, bypasses this phosphorylation event, and acts synergistically with AMP on naive AMPK.

  11. Aortic valve bypass

    DEFF Research Database (Denmark)

    Lund, Jens T; Jensen, Maiken Brit; Arendrup, Henrik;

    2013-01-01

    In aortic valve bypass (AVB) a valve-containing conduit is connecting the apex of the left ventricle to the descending aorta. Candidates are patients with symptomatic aortic valve stenosis rejected for conventional aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI...

  12. Experimental laparoscopic aortobifemoral bypass.

    Science.gov (United States)

    Dion, Y M; Chin, A K; Thompson, T A

    1995-08-01

    The goal of the present study is to develop a technique for laparoscopic aortobifemoral bypass. Piglets weighing between 60 and 78 kg were anesthetized with halothane. The lateral retroperitoneal approach was preferred to the more familiar anterior transperitoneal approach and was successfully completed in 19 piglets. The piglets were placed in the right lateral decubitus position. The first port (2 cm) was inserted halfway between the tip of the 12th rib and the iliac crest. Four other trocars were placed in the retroperitoneum after balloon inflation had allowed creation of a space which permitted visualization of the aorta from the left renal artery down to the aorto-iliac junction. After evacuation of the retropneumoperitoneum, the cavity was maintained using an abdominal lift device and a retractor. Using this approach, we performed four aorto-bifemoral bypasses (end-to-end aortic anastomosis) after conventional intravenous heparinization (100 IU/kg) in less than 4 h. Blood loss did not exceed 250 ml and the hematocrit remained stable. Postmortem evaluation of the grafts revealed they were positioned as in a conventional bypass, their limbs having followed in the created retroperitoneal tunnels along the path of the native arteries. No mortality occurred before sacrifice of the animals. We believe that this first performed series of totally retroperitoneal laparoscopic aortobifemoral bypasses in the porcine model is useful in preparation for human application due to the anatomical similarities in the periaortic region.

  13. 腹腔镜Roux-en-Y胃旁路术在治疗2型糖尿病及相关合并症中的应用价值%Application value of laparoscopic Roux-en-Y gastric bypass for type 2 diabetes mellitus and related diseases

    Institute of Scientific and Technical Information of China (English)

    高羽; 陈静; 童卫东; 李春穴; 李凡; 孙芳; 周训美; 阎振成; 祝之明

    2015-01-01

    Objective To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (RYGB) in treating type 2 diabetes mellitus (T2DM) and related complications.Methods The clinical data of 70 patients with T2DM who underwent laparoscopic Roux-en-Y gastric bypass from April 2010 to December 2014 was analysed. In the follow up, patients’body mass index (BMI), waist circumference, fasting plasma glucose, Hb1Ac, blood pressure and blood lipid in the postoperative time of 1, 3, 6, 12 and 24 months were checked in time. Preoperative and postoperative indexes were compared by one-factor ANOVA.Results The mean age of patients was 46 years (ranging from 25 to 69 years), the mean BMI was 29.3 kg/m2 (ranging from 22.2 to 44.6 kg/m2) and the mean disease course of T2DM was 4.8 years (ranging from 1 month to 16 years). 70 cases were preformed smoothly without deaths. 3 (4.3%) marginal ulcers occurred and were cured with conservative treatment. The postoperative follow up time was from 1 to 24 months, the indexes of BMI, waist circumference, FPG, Hb1Ac were significantly decreased(P<0.05). In the 70 cases,45 cases (64.3%) showed complete remission of T2DM, 18 cases(25.7%)showed glycemic control, 7 cases (10%) showed improvement, and 0 showed invalidity. The levels of blood pressure and blood lipid were improvedsignificantly for 34 cases with hypertension and 32 cases with hyperlipidemia.Conclusions LRYGB has good effects for treating T2DM and relative complications such as hypertension and hyperlipidemia.%目的分析腹腔镜胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)治疗2型糖尿病(type 2 diabetes mellitus,T2DM)及相关合并症的疗效。方法回顾性分析2010年4月至2014年12月在第三军医大学大坪医院接受LRYGB治疗的70例T2DM患者的临床资料,术后1、3、6、12、24个月定期随访并检测人体质量指数(BMI )、腹围、空腹血糖、糖化血红蛋白(HbA1c )、血压及血脂等指标。术前和

  14. Endoscopic and ultrasonographic evaluation before and after Roux-en-Y gastric bypass for morbid obesity Avaliação endoscópica e ultra-sonográfica antes e depois de gastroplastia com derivação intestinal em Y-de-Roux para obesidade mórbida

    Directory of Open Access Journals (Sweden)

    Marcelo Passos Teivelis

    2007-03-01

    Full Text Available BACKGROUND: Esophagogastric abnormalities are recognized prior and after bariatric procedures, but frequency and severity are debated. Liver and biliary tract findings are also of clinical importance, especially gallstones and liver steatosis. AIM: To compare pre-operative findings of hepatobiliary ultrasound and upper digestive endoscopy with post-operative results in patients submitted to open Roux-en-Y gastric bypass for morbid obesity. METHODS: A total of 80 patients were enrolled 16.8 ± 12.1 months after operation, all of them on routine follow-up program, and 8 were excluded. Retrospective analysis aimed at pre-operative clinical, endoscopic and ultrasonographic examinations and were prospectively repeated. RESULTS: Pre-operative endoscopical report was available in 42 cases, and 52 examinations were performed post-operatively. Frequency of esophagitis changed from 16.7% (7/42 to 15.4% (8/52, and of gastritis from 45.2% (19/42 to 21.2% (11/52. Gastric or gastrojejunal ulcers were initially present in 4.8% (2/42 and increased to 9.6% (5/52. Post-operatively, an unusual abnormality was silastic band erosion: 7.7% (4/52. Helicobacter pylori was present in 50.0% (21/42 before and 3.5% (2/52 after operation. Ultrasonographic study had been done before intervention in 63 subjects, and 57 were executed on follow-up. Liver steatosis occurred previously in 58.7% (37/63 and in 43.9% (25/57 later on. Only 12.7% (8/63 of the patients had undergone cholecystectomy before bariatric operation, 29.1%(16/55 suffered simultaneous resection of gallbladder because of stones during Roux-en-Y gastric bypass, and an additional 26.8% (10/36 developed gallstones post-operatively. CONCLUSIONS: Liver steatosis did not statistically improve, nor did inflammatory conditions of the upper digestive tube, despite reduction of H. pylori infections; gallbladder stones requiring intervention were common.RACIONAL: Anormalidades esôfago-gástricas são reconhecidas

  15. Efficiency Biliopancreatic bypass surgery in bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Yu I Yashkov

    2008-06-01

    Full Text Available A clinical significance in the treatment of bulimia nervosa patients with morbid obesity had already been raised [10, 13], but we did not find publications on the effectiveness of bariatric surgery in these cases. There is also information about the possibility of applying the operation bilio-pancreatic bypass, effective in patients with morbid obesity with uncontrolled eating behavior for the treatment of patients with anorexia BILIM not suffering from morbid obesity. In this article the data of clinical observation of a small sample of patients. As a result, the treatment of these patients found that severe nervous BILIM can be seen as a latent form of morbid obesity. The choice of treatment should depend not only on the initial body weight of the patient, but also on the severity of the nervous BILIM. Unsuccessful attempts at organized-balanced, conservative treatment of patients with severe bulimia nervosa may be considered a variant of surgical treatment, while bilio-pancreatic bypass surgery is considered as the most preferred operation, compared with the installation of the gastric balloon and others. All candidates for surgical treatment of obesity must identify clinical signs of bulimia nervosa, as this may influence the choice of method of operation. Further study of the role of hyperinsulinemia, secretion of ghrelin, leptin, intestinal peptide may contribute to the elucidation of the true causes of bulimia nervosa, probably has a similar origin with morbid obesity.

  16. Axillobifemoral bypass grafting

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2004-01-01

    Full Text Available INTRODUCTION Axillo-femoral bypass (AxF means connecting the axillar and femoral artery with the graft that is placed subcutaneously [1]. Usually, this graft is connected with contralateral femoral artery via one accessory subcutaneous graft, and this connection is known as axillobifemoral bypass (AxFF. This extra-anatomic procedure is an alternative method to the standard reconstruction of aortoiliac region when there are contraindications for general or local reasons. OBJECTIVE The objective of this paper is to show early and late results of AxFF bypass grafting as well as to show the indications for AxFF bypass. METHODS The sample consisted of 37 patients. The procedure was performed in 28 patients who suffered from aortoiliac occlusive disease and who were at high risk due to the comorbidity- in one patient with the rupture of juxtarenal aneurysm of abdominal aorta; in five patients with aortoenteric fistula, in two patients with iatrogenic lesion of abdominal aorta and in one female patient with anus preternaturalis definitivus who was treated for rectovaginal fistula. Donor's right axillary artery was used in 26 cases (70.3%, and donor's left axillary artery was used in 9 cases (29.7%. Dacron graft was used in 34 patients and Polytetrafluo-roethlylene graft was used in three patients. Simultaneously, profundo-plastic was done in four patients and femoro-popliteal bypass was performed in three patients. In five patients who suffered from aortoenteric fistula, simultaneous intervention of gastrointerstinal system has been done, x2 test was used for statistical evaluation and life table method was used for verification of late graft patency. RESULTS The rate of early postoperative mortality was 13.5%. The causes of death were: sepsis -1, MOFS - 3, and infarct myocardium -1. The mean follow up period was 40.1 months, ranging from six months to 17 years. During the follow up period, an early graft thrombosis was identified in two and late graft

  17. 胃旁路术对2型糖尿病大鼠脂肪组织胰岛素受体β及胰岛素受体底物-1表达的影响%Effect of gastric bypass operation on expressions of adipic insulin receptor and insulin receptor substrate-1 in rats with type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    徐键; 林杉; 尹家俊

    2015-01-01

    Objective To investigate the expressions of adipic insulin receptor β (IR-β) and insulin receptor substrate-1 (IRS-1) after gastric bypass (GBP) operation in spontaneous rats with type 2 diabetes mellitus (GK rats) and to elucidate the mechanisms of GBP in improving insulin resistance. Methods Thirty male GK rats aged 8 weeks were randomly divided into 3 groups according to the table of random number:the operation group (GBP, 10 rats), the sham operation group (the same sites were cut off as GBP and end to end anastomosis was performed in site, 10 rats) and the diet pairing group (the same kind and weight dieting as the operation group, 10 rats), besides 10 male SD rats aged 8 weeks were used as blank control group (free eating and drinking). Four weeks before and after operation, levels of fasting blood glucose (FPG) and fasting insulin (FINS) were measured, HOMA-IR was calculated respectively, and compared among 4 groups. Then rats were decapitated to retrieve the omentum. Expressions of adipic IR-βand IRS-1 protein were detected by Western blot. Results Compared with the preoperative levels, the FPG and HOMA-IR decreased significantly 4 weeks after surgery in operation group [(5.13±0.22) vs. (11.73±0.37) mmol/L, 2.16± 0.18 vs. 5.10±0.29, P0.05). FINS showed no obvious change in these 4 groups after operation(all P>0.05). Expressions of IR-β and IRS-1 were significantly higher in operation group than those in other 3 groups 4 weeks after the operation (all P0.05);而假手术组和饮食配对组较术前无显著变化(均P>0.05);术后4周手术组IR-β及IRS-1表达量均明显高于其他3组(均P<0.05)。结论胃旁路术能上调2型糖尿病大鼠胰岛素信号转导通路中IR-β及IRS-1的表达,改善脂肪组织胰岛素抵抗,提高胰岛素的敏感性。

  18. Relação entre o estado nutricional de vitamina a e a regressão da esteatose hepática após gastroplastia em Y- de- Roux para tratamento da obesidade classe III Relationship of the nutritional status of vitamin a and the regression of hepatic steatosis after Roux-en-Y gastric bypass surgery for treatment of class III obesity

    Directory of Open Access Journals (Sweden)

    Luiz Gustavo de Oliveira e Silva

    2012-12-01

    Full Text Available RACIONAL: A vitamina A participa de várias funções primordiais no organismo humano e as suas concentrações séricas podem estar diminuídas nas doenças crônicas não transmissíveis. OBJETIVO: Avaliar a relação entre o estado nutricional da vitamina A, e a regressão da esteatose hepática em indivíduos submetidos à gastroplastia em Y-de-Roux para tratamento da obesidade classe III. MÉTODOS: Foram estudados 30 pacientes obesos classe III, de ambos os sexos, com esteatose hepática, submetidos à gastroplastia em Y-de-Roux. Seis meses após a operação, os pacientes foram submetidos à ultrassonografia abdominal e distribuídos em dois grupos: grupo 1 - pacientes com esteatose detectada na ultrassonografia e grupo 2 - pacientes sem esteatose detectada na ultrassonografia. No pré-operatório e seis meses após a operação foram realizadas análises antropométricas e exames bioquímicos: insulina basal, glicemia, Homeostasis Model Assessment Index (HOMA IR, colesterol, HDL, LDL, triglicerídeos, AST, ALT, Gama-GT, albumina, bilirrubina total, retinol, e beta caroteno. RESULTADOS: A média de perda de peso foi de 35,05 + 10,47 (pBACKGROUND: Vitamin A participates in several essentials functions in the human body and their serum concentrations may be decreased in non-transmissible diseases. AIM: To assess the relationship of the nutritional status of Vitamin A through the serum concentrations of retinol and beta carotene, with regression of hepatic steatosis in individuals who undergone Roux-en-Y gastric bypass surgery for treatment of class III obesity. METHODS: Were included 30 individuals, male and female, submitted to Roux-en-Y gastric bypass for treatment of class III obesity, who were diagnosed through an abdominal ultrasonography as presenting hepatic steatosis. From the result of an ultrasonography screened six months after the surgical procedure those subjects were divided into two groups: group 1 - patients with steatosis

  19. [Gastric Acid].

    Science.gov (United States)

    Ruíz Chávez, R

    1996-01-01

    Gastric acid, a product of parietal cells secretion, full fills multiple biological roles which are absolutely necessary to keep corporal homeostasis. The production of the acid depends upon an effector cellular process represented in the first step by histamine, acetilcholine and gastrin, first messengers of the process. These interact with specific receptors than in sequence activate second messengers -cAMP and the calcium-calmodulin system- which afterwards activate a kinase. An specific protein is then phosphorilated by this enzyme, being the crucial factor that starts the production of acid. Finally, a proton bomb, extrudes the acid towards the gastric lumen. The secretion process mentioned above, is progressive lyactivated in three steps, two of which are stimulators -cephalic and gastric phases- and the other one inhibitor or intestinal phase. These stages are started by mental and neurological phenomena -thought, sight, smell or memory-; by food, drugs or other ingested substances; and by products of digestion. Changes in regulation of acid secretion, in the structure of gastro-duodenal mucosal barrier by a wide spectrum of factors and agents including food, drugs and H. pylori, are the basis of acid-peptic disease, entity in which gastric acid plays a fundamental role. From the therapeutic point of view, so at the theoretical as at the practical levels, t is possible to interfere with the secretion of acid by neutralization of some of the steps of the effector cellular process. An adequate knowledge of the basics related to gastric acid, allows to create strategies for the clinical handling of associated pathology, specifically in relation to peptic acid disease in all of the known clinical forms. PMID:12165790

  20. Relationship of femorodistal bypass patency to clinical outcome. Iloprost Bypass International Study Group

    DEFF Research Database (Denmark)

    Watson, H R; Schroeder, T V; Simms, M H;

    1999-01-01

    To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures.......To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures....