Afferent Loop Syndrome after Roux-en-Y Total Gastrectomy Caused by Volvulus of the Roux-Limb

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Hideki Katagiri

2016-01-01

Full Text Available Afferent loop syndrome is a rare complication of gastric surgery. An obstruction of the afferent limb can present in various ways. A 73-year-old man presented with one day of persistent abdominal pain, gradually radiating to the back. He had a history of total gastrectomy with a Roux-en-Y reconstruction. Abdominal computed tomography scan revealed dilation of the duodenum and small intestine in the left upper quadrant. Exploratory laparotomy showed volvulus of the biliopancreatic limb that caused afferent loop syndrome. In this patient, the 50 cm long limb was the cause of volvulus. It is important to fashion a Roux-limb of appropriate length to prevent this complication.

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

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L.E. Duinhouwer (Lucia); 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

Achalasia 5 years following Roux-en-y gastric bypass

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Mehyar Hefazi Torghabeh

2015-01-01

Full Text Available Oesophageal achalasia is a rare, but serious condition in which the motility of the lower oesophageal sphincter (LES is inhibited. This disorder of idiopathic aetiology complicates the peristaltic function and relaxation of the LES that may cause symptoms such as dysphagia, epigastric pain, and regurgitation of an obstructed food. The following case describes achalasia in a patient 5 years following a laparoscopic Roux-en-Y gastric bypass (RYGB. The patient underwent a laparoscopic Heller myotomy without a fundoplication. Although achalasia seems to be a rare occurrence in obese patients, this is the third case documented in a patient who previously had an RYGB. The role of performing a fundoplication in these patients remains to be elucidated.

Medical image of the week: Dobhoff tube placement with Roux-en-Y gastric bypass

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Ali H

2018-04-01

Full Text Available No abstract available. Article truncated after 150 words. Roux-en-Y gastric bypass is one of the most commonly performed bariatric operations in the United States. It involves partitioning a small gastric pouch off the proximal stomach and attaching that pouch directly to the intestine, thereby bypassing the large remainder of the stomach (1,2. Placing a Dobhoff tube (DHT and confirming its placement can be challenging due to the change in anatomy after the procedure. Here, we have a 65-year-old woman who presented to the hospital with acute encephalopathy and acute hypoxic respiratory failure due to multifocal pneumonia requiring intubation and prolonged ICU stay. A DHT was inserted after intubation for feeding purposes. An abdominal X-ray was obtained to confirm placement of the DHT (Figure 1. Normally the DHT tip should be placed in the 2nd to 3rd portion of the duodenum and would create a C-shaped tracing on the X-ray. However, in our patient who had history of Roux-en-Y …

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

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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.

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

International Nuclear Information System (INIS)

Carucci, Laura R.; Turner, Mary Ann

2005-01-01

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

Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial.

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Peterli, Ralph; Wölnerhanssen, Bettina Karin; Peters, Thomas; Vetter, Diana; Kröll, Dino; Borbély, Yves; Schultes, Bernd; Beglinger, Christoph; Drewe, Jürgen; Schiesser, Marc; Nett, Philipp; Bueter, Marco

2018-01-16

Sleeve gastrectomy is increasingly used in the treatment of morbid obesity, but its long-term outcome vs the standard Roux-en-Y gastric bypass procedure is unknown. To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss, changes in comorbidities, increase in quality of life, and adverse events. The Swiss Multicenter Bypass or Sleeve Study (SM-BOSS), a 2-group randomized trial, was conducted from January 2007 until November 2011 (last follow-up in March 2017). Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers, 217 patients were enrolled and randomly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period. Patients were randomly assigned to undergo laparoscopic sleeve gastrectomy (n = 107) or laparoscopic Roux-en-Y gastric bypass (n = 110). The primary end point was weight loss, expressed as percentage excess body mass index (BMI) loss. Exploratory end points were changes in comorbidities and adverse events. Among the 217 patients (mean age, 45.5 years; 72% women; mean BMI, 43.9) 205 (94.5%) completed the trial. Excess BMI loss was not significantly different at 5 years: for sleeve gastrectomy, 61.1%, vs Roux-en-Y gastric bypass, 68.3% (absolute difference, -7.18%; 95% CI, -14.30% to -0.06%; P = .22 after adjustment for multiple comparisons). Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass (60.4%) than after sleeve gastrectomy (25.0%). Gastric reflux worsened (more symptoms or increase in therapy) more often after sleeve gastrectomy (31.8%) than after Roux-en-Y gastric bypass (6.3%). The number of patients with reoperations or interventions was 16/101 (15.8%) after sleeve gastrectomy and 23/104 (22.1%) after Roux-en-Y gastric bypass. Among patients with morbid obesity, there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y

Roux-en-Y duodenojejunostomy in the treatment of Bouveret syndrome.

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Erlandson, Michael D; Kim, Anthony W; Richter, Harry M; Myers, Jonathan A

2009-09-01

Bouveret syndrome is a rare complication of cholelithiasis occurring when a gallstone passes through a cholecystoduodenal or choledochoduodenal fistula and lodges in the pylorus or proximal duodenum causing a gastric outlet obstruction. The case of a 70-year-old male who developed Bouveret syndrome is presented, and the management of this presentation of gallstone ileus by Roux-en-Y duodenojejunostomy is discussed in detail.

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

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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...

"Candy cane syndrome:" an underappreciated cause of abdominal pain and nausea after Roux-en-Y gastric bypass surgery.

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Aryaie, Amir H; Fayezizadeh, Mojtaba; Wen, Yuxiang; Alshehri, Mohammed; Abbas, Mujjahid; Khaitan, Leena

2017-09-01

"Candy cane" syndrome (a blind afferent Roux limb at the gastrojejunostomy) has been implicated as a cause of abdominal pain, nausea, and emesis after Roux-n-Y gastric bypass (RYGB) but remains poorly described. To report that "candy cane" syndrome is real and can be treated effectively with revisional bariatric surgery SETTING: All patients underwent "candy cane" resection at University Hospitals of Cleveland. All patients who underwent resection of the "candy cane" between January 2011 and July 2015 were included. All had preoperative workup to identify "candy cane" syndrome. Demographic data; pre-, peri-, and postoperative symptoms; data regarding hospitalization; and postoperative weight loss were assessed through retrospective chart review. Data were analyzed using Student's t test and χ 2 analysis where appropriate. Nineteen patients had resection of the "candy cane" (94% female, mean age 50±11 yr), within 3 to 11 years after initial RYGB. Primary presenting symptoms were epigastric abdominal pain (68%) and nausea/vomiting (32%), particularly with fibrous foods and meats. On upper gastrointestinal study and endoscopy, the afferent blind limb was the most direct outlet from the gastrojejunostomy. Only patients with these preoperative findings were deemed to have "candy cane" syndrome. Eighteen (94%) cases were completed laparoscopically. Length of the "candy cane" ranged from 3 to 22 cm. Median length of stay was 1 day. After resection, 18 (94%) patients had complete resolution of their symptoms (Psyndrome is a real phenomenon that can be managed safely with excellent outcomes with resection of the blind afferent limb. A thorough diagnostic workup is paramount to proper identification of this syndrome. Surgeons should minimize the size of the blind afferent loop left at the time of initial RYGB. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Late intestinal obstruction due to an intestinal volvulus in a pregnant patient with a previous Roux-en-Y gastric bypass.

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Gazzalle, Anajara; Braun, Débora; Cavazzola, Leandro Totti; Wendt, Luiz Roberto; Navarini, Daniel; Fauri, Marcelo de Azevedo; Vitola, Santo Pascual

2010-12-01

This is a case of a 33 weeks pregnant woman, presented 2 years after laparoscopic Roux-en-Y gastric bypass, with abdominal pain for 2 days. A laparoscopic cholecystectomy was performed 1 day earlier in another hospital, without improving the pain. She presented at our hospital with acute abdominal pain and clinical signs of intestinal obstruction, undergoing an exploratory laparotomy that revealed a volvulus and necrosis of the jejunum from the gastroenteroanastomosis through the lateral enteroenterostomy, which was resected with the reconstruction of the Roux-en-Y limb performed at the same operation. Patient and neonate presented with improvement after surgery and the patient was discharged on postoperative day 15. Internal hernias after bariatric surgery have been reported as the cause of acute abdomen problems during pregnancy, which may progress to necrosis and perforation. The delay of surgical intervention could have brought a tragic outcome for mother and neonate.

Many complications after Roux-en-Y gastric bypass surgery can be prevented and treated

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Gribsholt, Sigrid Bjerge; Richelsen, Bjørn

2016-01-01

A wide range of complications may occur after Roux-en-Y gastric bypass (RYGB) surgery, including surgical, medical/nutritional, and psychiatric complications. Some of the nutritional complications such as anaemia, dumping and hypoglycaemia may present rather unspecific symptoms that may easily no...

Small-bowel volvulus in late pregnancy due to internal hernia after laparoscopic Roux-en-Y gastric bypass.

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Naef, Markus; Mouton, Wolfgang G; Wagner, Hans E

2010-12-01

Internal hernias are a specific cause of acute abdominal pain and are a well-known complication after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Although internal hernias are a rare cause of intestinal obstruction, they may evolve towards serious complications, such as extensive bowel ischemia and gangrene, with the need for bowel resection and sometimes for a challenging reconstruction of intestinal continuity. The antecolic position of the Roux limb is associated with a decrease in the incidence of small-bowel obstruction and internal hernias. The best prevention of the formation of these hernias is probably by closure of potential mesenteric defects at the initial operation with a non-absorbable running suture. We present a patient in late pregnancy with a small-bowel volvulus following laparoscopic Roux-en-Y gastric bypass for morbid obesity and discuss the available literature. For a favorable obstetric and neonatal outcome, it is crucial not to delay surgical exploration and an emergency operation usually is mandatory.

Small intestinal volvulus following laparotomy for endometrial clear cell carcinoma in a woman with a past history of total gastrectomy and Roux-en-Y anastomosis for gastric carcinoma.

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Chin, Georgiana S M; Heng, Robert; Neesham, Deborah E; Petersen, Rodney W

2002-12-01

Small intestinal volvulus is a rare complication following Roux-en-Y anastomosis. A 63-year-old woman was diagnosed with small intestinal volvulus following laparotomy for clear cell carcinoma of the endometrium. Her past medical history included a total gastrectomy and antecolic Roux-en-Y anastomosis for Duke's B gastric carcinoma. Operative findings were of transmesenteric herniation of the ileum through the Roux-en-Y small intestinal mesenteric window, with metastatic deposits fixing the hernia at its base to create a volvulus. The proximal transverse colon was very dilated and thin due to partial obstruction by the volvulus. Her treatment involved adhesiolysis and unraveling of the small intestinal volvulus. This is the first case report of a small intestinal volvulus following a Roux-en-Y anastomosis involving a metastatic gynacological malignancy.

Biliary reconstruction options for bile duct stricture in patients with prior Roux-en-Y reconstruction.

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Shah, Mihir M; Martin, Benjamin M; Stetler, Jamil L; Patel, Ankit D; Davis, S Scott; Lin, Edward; Sarmiento, Juan M

2017-09-01

Comprehensive description with illustrations of the 4 biliary reconstruction options for bile duct injury in patients with history of Roux-en-Y gastric bypass. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Esophagogastrostomy plus gastrojejunostomy: a novel reconstruction procedure after curative resection for proximal gastric cancer.

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Chen, Shicai; Li, Jianchang; Liu, Haiying; Zeng, Jun; Yang, Guohua; Wang, Jin; Lu, Weiqun; Yu, Nanrong; Huang, Zhiliang; Xu, Houwei; Zeng, Xiang

2014-03-01

The choice of surgical strategy for patients with proximal gastric cancer remains controversial. In this study, we recommend that a new reconstruction procedure be performed following proximal gastrectomy. We conducted a retrospective study involving 71 patients who underwent gastrectomy for proximal gastric cancer. Clinicopathological features, postoperative complications, nutritional status, and overall survival (OS) rate were compared among three different reconstruction approaches. There were 34 cases of proximal gastrectomy followed by esophagogastrostomy reconstruction (EG), 16 cases of total gastrectomy and Roux-en Y reconstruction (RY) and 21 cases of proximal gastrectomy followed by esophagogastrostomy plus gastrojejunostomy reconstruction (EGJ). Though the clinicopathological features, the nutritional status and OS rate were similar among the three groups of patients, the incidence of reflux esophagitis was significantly higher in the EG group (35.3%) than the RY (6.2%) and EGJ (9.6%) groups(P < 0.05). Few EGJ patients suffered from either reflux esophagitis or anastomotic stenosis. The EGJ reconstruction method helps to resolve the syndrome of reflux esophagitis. Our data indicates that it is a simple, safe, and effective reconstruction procedure for PGC.

Better long-term outcomes with hilar ductoplasty and a side-to-side Roux-en-Y hepaticojejunostomy.

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Xia, Hong-Tian; Liu, Yang; Yang, Tao; Liang, Bin; Wang, Jing; Dong, Jia-Hong

2017-07-01

Whether a wide hilar hepaticojejunostomy after bile duct cyst (BDC) excision can prevent the development of postoperative complications remains an unanswered question. We compared our outcomes after a minimum of 2-y follow-up in patients with Todani type Ia choledochal cyst treated with hilar ductoplasty followed by a side-to-side Roux-en-Y hepaticojejunostomy (ductoplasty group) or radical cyst resection with an end-to-side Roux-en-Y hepaticojejunostomy (conventional group). We retrospectively reviewed the records of patients with Todani type Ia choledochal cyst who received radical cyst excision from January 1997 to December 2012, and we compared the groups' postoperative complications and surgical outcomes. The groups' baseline demographics were similar, except for age. The gender distribution and preoperative presenting symptoms were comparable in the ductoplasty (n = 72) and conventional (n = 53) groups (all P > 0.05). Average age was 37.0 y for the ductoplasty group and 41.8 y for the conventional group (P = 0.024). The short-term complication rate of the groups was not significantly different (conventional group, 13.2% [7/53]; ductoplasty group, 8.3% [6/72]; all P > 0.05). A significant between-group difference was found in the long-term complication rate of biliary-enteric anastomotic strictures (9.4% in the conventional group and 0% in the ductoplasty group, P = 0.012). The rates of satisfactory surgical outcomes were 91.1% and 77.1% in the ductoplasty and conventional groups, respectively (P = 0.036). The application of hilar ductoplasty with a side-to-side Roux-en-Y hepaticojejunostomy as the primary surgery for bile duct cyst excision significantly reduced the postoperative complication of biliary-enteric anastomotic stricture and greatly improved our patients' prognosis with regard to biliary function. Copyright © 2017 Elsevier Inc. All rights reserved.

Successful treatment of recurrent cholangitis by constructing a hepaticojejunostomy with long Roux-en-Y limb in a long-term surviving patient after a Whipple procedure for pancreatic adenocarcinoma.

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Tsalis, Konstantinos; Antoniou, Nikolaos; Koukouritaki, Zambia; Patridas, Dimitrios; Sakkas, Leonidas; Kyziridis, Dimitrios; Lazaridis, Charalampos

2014-08-20

Female, 74. Recurrent cholangitis. -. -. -. Gastroenterology and Hepatology. Unusual clinical course. Cholangitis may result from biliary obstruction (e.g., biliary or anastomotic stenosis, or foreign bodies) or occur in the presence of normal biliary drainage. Although reflux of intestinal contents into the biliary tree after hepaticojejunostomy appears to be a rare complication, it is important to emphasize that there are few available surgical therapeutic techniques. A 74-year-old woman presented to our hospital after 17 years of episodes of cholangitis. The patient had undergone a pancreatoduodenectomy (Whipple procedure) 18 years earlier due to pancreatic adenocarcinoma. The reconstruction was achieved through the sequential placement of pancreatic, biliary, and retrocolic gastric anastomosis into the same jejunal loop. The postoperative course was uneventful and the patient received adjuvant chemotherapy. Approximately 6 months after the initial operation, the patient started having episodes of cholangitis. Over the next 17 years she experienced several febrile episodes presumed to be secondary to cholangitis. A computing tomography (CT) scan of the abdomen revealed intrahepatic bile ducts partially filled with orally administered contrast material (Gastrografin). Magnetic resonance cholangiopancreatography (MRCP) showed dilatation of the left intrahepatic bile ducts. A percutaneous transhepatic cholangiography showed that the bilioenteric anastomosis was normal, without stenosis. Based on these findings, a diagnosis of a short loop between the hepaticojejunostomy and the gastrojejunostomy permitting the reflux of intestinal juice into the biliary tree was made. During the re-operation, a new hepaticojejunal anastomosis in a 100-cm long Roux-en-Y loop was performed to prevent the reflux of the intestinal fluid into the biliary tree. The patient was discharged on postoperative day 10. One year after the second procedure, the patient enjoys good health and has

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

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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

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

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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 behavio...... to consume highly palatable foods. Still, in order to fully understand the complexity of these changes, we need studies combining sociological and psychological approaches with objective measures of actual food choices examining different measures of hedonic drive....

Biodistribution of technetium-99m pertechnetate after Roux-en-Y gastric bypass (Capella technique) in rats

International Nuclear Information System (INIS)

Rego, Amalia Cinthia Meneses do; Jacome, Daniel Torres; Ramalho, Rachel de Alcantara Oliveira; Araujo-Filho, Irami; Azevedo, Italo Medeiros; Medeiros, Aldo Cunha

2010-01-01

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 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 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 99m Tc - . (author)

Roux-en-Y gastric bypass augments the feeding responses evoked by gastrin releasing peptides

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Washington, Martha C.; Mhalhal, Thaer R.; Berger, Tanisha Johnson-Rouse Jose; Heath, John; Seeley, Randy; Sayegh, Ayman I.

2016-01-01

Background Roux-en-Y gastric bypass (RYGB) is the most effective method for the treatment of obesity and metabolic disease Roux-en-Y gastric bypass (RYGB) may reduce body weight by altering the feeding responses evoked by the short term satiety peptides. Materials and Methods Here, we measured meal size (MS, chow), intermeal interval (IMI) length and satiety ratio (SR, IMI/MS; food consumed per a unit of time) by the small and the large forms of gastrin releasing peptide (GRP) in rats, GRP-10 and GRP-29 (0, 0.1, 0.5 nmol/kg) infused in the celiac artery (CA, supplies stomach and upper duodenum) and the cranial mesenteric artery (CMA, supplies small and large intestine) in a RYGB rat model. Results GRP-10 reduced MS, prolonged the IMI and increased the SR only in the RYGB group, whereas GRP-29 evoked these responses by both routes and in both groups. Conclusion The RYGB procedure augments the feeding responses evoked by exogenous GRP, possibly by decreasing total food intake, increasing latency to the first meal, decreasing number of meals or altering the sites of action regulating MS and IMI length by the two peptides. PMID:27884350

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

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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

A new endoscopic therapeutic method for acute obstructive suppurative cholangitis post Roux-en-Y anastomosis: endoscopic retrograde cholangiography through jejunostomy

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Zhuo YANG

2012-01-01

Full Text Available  Objective  To probe the value of endoscopic retrograde cholangiography (ERC through jejunostomy in patients in whom ERC could not be performed via the mouth after Roux-en-Y anastomosis on the upper gastrointestinal tract. Methods  In two patients suffering from acute obstructive suppurative cholangitis after a radical operation for cholangiocarcinoma, ERC could not be performed through the mouth due to the presence of a long non-functional jejunal loop. A jejunostomy was first done in the afferent loop of the jejunum, and a gastroscope was then inserted via the jejunostomy and passed retrogradely, to find the stoma of the cholangiointestinal anastomosis. ERC was then successfully performed, and followed by endoscopic retrograde biliary drainage (ERBD. Results  The operation was successful. It was found that cholangio-jejunostomy stoma was narrow, and a large amount of purulent mucus was present in the enlarged intrahepatic duct. ERC was done to enlarge the stoma, and a stent was placed into the main branch of the intrahepatic duct. Two patients achieved surgical success and smooth recovery after the operation. Conclusion  ERC through a jejunostomy in the patients who had Roux-en-Y cholangiojejunostomy following radical resection for cholangiocarcinoma, is a safe and effective surgical procedure.

Nutrient re-routing and altered gut-islet cell crosstalk may explain early relief of severe postprandial hypoglycaemia after reversal of Roux-en-Y gastric bypass

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Svane, M S; Toft-Nielsen, M B; Kristiansen, V B

2017-01-01

BACKGROUND: Roux-en-Y gastric bypass is associated with an increased risk of postprandial hyperinsulinaemic hypoglycaemia, but the underlying pathophysiology remains poorly understood. We therefore examined the effect of re-routing of nutrient delivery on gut-islet cell crosstalk in a person...... insulin and glucagon-like peptide-1 hypersecretion and eliminated postprandial hypoglycaemia, which emphasizes the importance of altered gut-islet cell crosstalk for glucose metabolism after Roux-en-Y gastric bypass. This article is protected by copyright. All rights reserved....

Internal hernia in late pregnancy after laparoscopic Roux-en-Y gastric bypass.

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Gruetter, Florian; Kraljević, Marko; Nebiker, Christian A; Delko, Tarik

2014-12-23

A 27-year-old patient in late pregnancy presented to the department of obstetrics with crampy abdominal pain located in the right flank, 3 years after a laparoscopic Roux-en-Y gastric bypass. Clinical investigation showed tenderness on palpation in the upper abdomen without signs of peritonitis. The cardiotocogram and blood tests were normal. The ultrasound showed a hydronephrosis on the right side, and a pigtail catheter was inserted. The abdominal symptoms did not abate and the abdominal surgeon was consulted 36 hours after admission. Diagnostic laparoscopy was performed promptly because of high suspicion of internal hernia (IH). Laparoscopy showed IH at the mesojejunal intermesenteric defect with a herniated common channel and volvulus of the anastomosis. Conversion to open reduction and complete closure with non-absorbable interrupted sutures was performed. Small bowel resection was avoided. The patient was discharged 10 days after the operation and a healthy boy was born 4 weeks later. 2014 BMJ Publishing Group Ltd.

Isolated Roux-en-Y anastomosis of the pancreatic stump in a duct-to-mucosa fashion in patients with distal pancreatectomy with en-bloc celiac axis resection.

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Okada, Ken-Ichi; Kawai, Manabu; Tani, Masaji; Hirono, Seiko; Miyazawa, Motoki; Shimizu, Atsushi; Kitahata, Yuji; Yamaue, Hiroki

2014-03-01

A pancreatic fistula is one of the most serious complications in distal pancreatectomy with en bloc celiac axis resection (DP-CAR), because the pancreatic transection is performed on the right side of the portal vein, which results in a large cross-section surface, and because post-pancreatectomy hemorrhage is hard to treat by interventional radiology. Therefore, a procedure to decrease the incidence of postoperative pancreatic fistula is urgently needed. Twenty-six consecutive patients who underwent DP-CAR between April 2008 and August 2012 were reviewed retrospectively. The first 13 consecutive patients underwent DP-CAR with no anastomosis, and the subsequent 13 consecutive patients were treated with Roux-en-Y pancreaticojejunostomy (PJ) in a duct-to-mucosa fashion. Extremely high amylase levels (>4000 IU/l) of all drainage fluid specimens on postoperative day (POD) 1, 3 and 4 were detected more frequently in cases with no anastomosis (n = 7) compared to those with PJ (n = 1) (P = 0.056). The incidence of grade B/C pancreatic fistulas was 15.4% in cases with isolated Roux-en-Y anastomosis of the pancreatic stump performed in a duct-to-mucosa fashion, and we are currently examining whether this anastomosis method reduces the pancreatic fistula rate in a multicenter, randomized controlled trial for distal pancreatectomy patients (ClinicalTrials.gov NCT01384617). © 2013 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

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...

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...... for bariatric surgery. MATERIAL AND METHODS: Participants (n = 55) completed the Short Form Health Survey v2 (SF-36) before and 22 ± 4.2 months after surgery. Information on socio-demographics, body mass index (BMI), co-morbidity and satisfaction with surgery were collected through patient questionnaires...

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

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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.)

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

International Nuclear Information System (INIS)

Sandrasegaran, Kumaresan; Rajesh, Arumugam; Lall, Chandana; Maglinte, Dean D.; Gomez, Gerardo A.; Lappas, John C.

2005-01-01

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.)

Reconstruction Options for Pancreaticoduodenectomy in Patients with Prior Roux-en-Y Gastric Bypass.

Science.gov (United States)

Shah, Mihir M; Martin, Benjamin M; Stetler, Jamil L; Patel, Ankit D; Davis, S Scott; Sarmiento, Juan M; Lin, Edward

2017-11-01

Patients with prior Roux-en-Y gastric bypass (RYGB) operations for weight loss present reconstruction challenges during a pancreaticoduodenectomy (PD). With over 60,000 RYGB performed annually, the increasing odds of encountering such patients during a PD make it imperative to understand the RYGB anatomy and anticipate reconstruction options. This article describes the possible reconstruction options and their rationale. We reviewed our PD reconstruction options, compared them to what have been described in the literature, and derived a consensus from internal conferences comprising bariatric and hepatopancreatobiliary surgeons to describe known reconstruction options. In general, reconstruction options can include one of three options: (1) remnant gastrectomy, (2) preservation of gastric remnant, or (3) reversal of gastric bypass. This article describes individualized reconstruction options for RYGB patients undergoing PD. The reconstruction options can be tailored to the needs of the patient.

Hybrid laparoscopic-robotic management of type IVa choledochal cyst in the setting of prior Roux-en-Y gastric bypass: video case report and review of the literature.

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Chang, Julietta; Walsh, R Matthew; El-Hayek, Kevin

2015-06-01

Choledochal cysts are rare congenital disease of the biliary system. The recommended treatment of these lesions is surgical excision with biliary enteric reconstruction. In patients with normal anatomy, Roux-en-Y hepaticojejunostomy is preferred. However, different options in biliary reconstruction must be entertained in those with abnormal anatomy. Our patient is a 39-year-old female, who during workup for bariatric surgery two years prior to presentation, was found to have a 6 cm dilation of her common bile duct. She underwent a laparoscopic Roux-en-Y gastric bypass (LRYGB) in 2011 at an outside facility, with no planned intervention on her biliary tree. Ultimately, she developed right upper quadrant pain two years following her RYGB. Upon further workup including right upper quadrant ultrasound, an extrahepatic choledochal cyst was confirmed and she was referred to our institution for definitive care. The patient was taken to the operating room for resection of the choledochal cyst with hepatoenteric reconstruction. The dissection and resection of the cyst commenced laparoscopically. After performing a generous Kocher maneuver, we demonstrated that there was adequate mobilization of the duodenum to perform a tension free hepaticoduodenostomy, which was performed robotically. Her postoperative course was uneventful, and she was discharged home on postoperative day 3. At one month follow up, the patient was doing well with symptom resolution. Her final pathology revealed a choledochal cyst which was negative for dysplasia or carcinoma. Long-term follow up has been recommended with yearly alkaline phosphatase levels. Here we present a video of the technical considerations during a robot-assisted laparoscopic biliary reconstruction in a patient with a prior Roux-en-Y gastric bypass with a type IVA choledochal cyst.

Randomized controlled trial of uncut Roux-en-Y vs Billroth II reconstruction after distal gastrectomy for gastric cancer: Which technique is better for avoiding biliary reflux and gastritis?

Science.gov (United States)

Yang, Dong; He, Liang; Tong, Wei-Hua; Jia, Zhi-Fang; Su, Tong-Rong; Wang, Quan

2017-09-14

To identify which technique is better for avoiding biliary reflux and gastritis between uncut Roux-en-Y and Billroth II reconstruction. A total of 158 patients who underwent laparoscopy-assisted distal gastrectomy for gastric cancer at the First Hospital of Jilin University (Changchun, China) between February 2015 and February 2016 were randomized into two groups: uncut Roux-en-Y (group U) and Billroth II group (group B). Postoperative complications and relevant clinical data were compared between the two groups. According to the randomization table, each group included 79 patients. There was no significant difference in postoperative complications between groups U and B (7.6% vs 10.1%, P = 0.576). During the postoperative period, group U stomach pH values were lower than 7 and group B pH values were higher than 7. After 1 year of follow-up, group B presented a higher incidence of biliary reflux and alkaline gastritis. However, histopathology did not show a significant difference in gastritis diagnosis ( P = 0.278), and the amount of residual food and gain of weight between the groups were also not significantly different. At 3 mo there was no evidence of partial recanalization of uncut staple line, but at 1 year the incidence was 13%. Compared with Billroth II reconstruction, uncut Roux-en-Y reconstruction is secure and feasible, and can effectively reduce the incidence of alkaline reflux, residual gastritis, and heartburn. Despite the incidence of recanalization, uncut Roux-en-Y should be widely applied.

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.

Predictive Factors of Secondary Normocalcemic Hyperparathyroidism after Roux-en-Y Gastric Bypass

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Claudio Casella

2018-01-01

Full Text Available Objective. Aim of this study is to evaluate determinants of secondary normocalcemic hyperparathyroidism (SNHPT persistence in patients who have undergone Roux-en-Y gastric bypass on vertical-banded gastroplasty. Methods. 226 consecutive patients submitted to bariatric surgery were prospectively enrolled and divided in two groups on the basis of preoperative presence of SNHPT. For each patient, we evaluated anthropometric and laboratory parameters. Calcium metabolism (calcemia, PTH, and 25-hydroxy vitamin D serum levels was studied before surgery and at 6-month intervals (6, 12, and 18 months as surgical follow-up. Results. Based on presurgical SNHPT presence or absence, we defined group 1—201 patients and group 2—25 patients, respectively. Among the group 1, 153 (76% recovered from this endocrinopathy within 6 months after surgery (group 3, while the remaining 48 patients (24% had persistent SNHPT (group 4. Comparing the anthropometric and laboratory data of group 3 with group 2, the only statistically significant factor was the elapsed time since a prior effective medically controlled diet that led to a steady and substantial weight loss. We found also a statistically significant difference (p<0.05 between group 3 and group 4 in term of % of weight loss and PTH levels. Conclusions. Patients suitable for bariatric surgery must have history of at least one efficient medically controlled diet, not dating back more than 5 years before surgery. This elapsed time represent the cut-off time within which it is possible to recover from SNHPT in the first semester after Roux-en-Y gastric bypass on vertical-banded gastroplasty. The treatment of vitamin D insufficiency and the evaluation of SNHPT before bariatric surgery should be recommended. The clinical significance of preoperative SNHPT and in particular SNHPT after bariatric surgery remains undefined and further studies are required.

Transjejunal Extraction of Gallbladder After Mini-Laparoscopic Cholecystectomy in Patients with Previous Roux-en-Y Gastric Bypass: A Small Case Series.

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Kayaalp, Cuneyt; Tardu, Ali; Yagci, Mehmet Ali; Sumer, Fatih

2015-07-01

The length of incisions on the abdominal wall directly correlates with wound-related morbidities and patient comfort. Both mini-laparoscopy (only ≤5-mm trocars) and natural orifice specimen extraction avoid larger abdominal incisions. This study described a new natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) cholecystectomy technique by combination of these two advanced laparoscopic techniques for cholelithiasis in patients who had prior laparoscopic Roux-en-Y gastric bypass (LRYGB) for obesity. Three patients (two males, one female; 39, 62, and 34 years old, respectively) were admitted with symptomatic cholelithiasis (multiple millimeter-sized gallstones), and all had previously had LRYGB. They were treated by mini-laparoscopic cholecystectomy using three 5-mm trocars. The gallbladder was removed through the dilated efferent limb of the jejunum, 5 cm distal from the gastrojejunostomy. Transjejunal extraction was performed under endoscopic guidance. The gallbladder in the jejenum was passed through the anastomosis and extracted with an endoscopic snare by the transoral way. The enterotomy was closed intracorporeally. There was no conversion or additional trocar requirement. All the procedures were completed successfully without problems. Respective operating times were 95, 75, and 120 minutes. Only 1 patient required postoperative analgesic; the others did not. The patients started to get a liquid diet on the night of surgery and were discharged on Days 1, 1, and 2, respectively, with normal diet recommendations. There were no morbidities. Mini-laparoscopic cholecystectomy is technically feasible in patients with previous LRYGB. Prior LRYGB was not an obstacle for transoral specimen extraction. The dilated efferent jejunal limb is a good alternative route for natural orifice specimen extraction. This

Comparison of outcome in roux-y hepaticoje junostomy with and without transanastmotic tube drainage in tertiary care hospital

International Nuclear Information System (INIS)

Shakir, J.

2015-01-01

Aim: To compare the incidence of post operative bile leakage in Roux- Y hepaticojejunostomy with and with out transanastmotic Tube drainage placement. Background: A biliary-enteric anastrnosis (Roux-en-Y hepaticojejunostomy) is usually needed after complex injuries and for benign biliary pathologies. Placement of transanastmotic Tube drainage is a matter of debate and to our knowledge there is no study that compares the results regarding biliary leakage in Rou- x- Y hepaticojejunostomy with and without transanastmotic Tube drainage. Design: Randomized controlled Trial. Setting: Tertiary care center, Fatima Memorial Hospital Lahore. Methods: All the adult patients who were either admitted through OPD or referred to our hospital from September 2009 to September 2013 for Roux- Y he paticojejunostomy for acute or elective reconstruction of the biliary tract. The patients were randomized into 2 groups: group A those who underwent Roux-en- Y he- paticojejunostomy with transanastmotic Tube drainage and group B without transanastmotic Tube drainage. Main Outcome Measures: Anastmosis leakage, hospital stay. Results: Total 50 patients including high and complex biliary injuries (Bismuth type III, IV; Strasberg 0, E) choledochal cyst and biliary strictures. Twenty five cases had reconstruction with the placement of transanastmotic Tube drainage and 25 cases without transanastmotic Tube drainage. No operative mortality was observed. The postoperative outcomes of both groups were compared and significant differences observed. Good results were observed in more than 90% of the patients with biliary drainage. Biliary leakage more frequent in patients having no external biliary drainage (24% vs. 4%). Conclusions: Good results are obtained with a Rouxen- Y epaticojcjunostomy with transanastmotic Tube drainage. We recommend that all patients who under go Roux-en- Y hepaticojejunostomy should have Transanastmotic Tube drainage. (author)

Long-Term Effects of Laparoscopic Roux-en-Y Gastric Bypass on Diabetes Mellitus, Hypertension and Dyslipidaemia in Morbidly Obese Patients

NARCIS (Netherlands)

Dogan, K.; Betzel, B.; Homan, J.; Aarts, E.O.; Ploeger, N.; Boer, H. de; Aufenacker, T.J.; Laarhoven, C.J.H.M. van; Janssen, I.M.; Berends, F.J.

2014-01-01

BACKGROUND: Severely obese patients have an increased risk for developing metabolic complications such as type 2 diabetes mellitus (T2DM), dyslipidaemia (DL) and hypertension (HT). The aim of the present study is to research the effect of a primary laparoscopic Roux-en-Y gastric bypass (LRYGB) on

Hedonic Changes in Food Choices Following Roux-en-Y Gastric Bypass.

Science.gov (United States)

Hansen, Thea Toft; Jakobsen, Tine Anette; Nielsen, Mette Søndergaard; Sjödin, Anders; Le Roux, Carel W; Schmidt, Julie Berg

2016-08-01

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. Here, we review the literature examining postoperative changes in mechanisms contributing to hedonic drive (food preferences, reinforcing value of food, dopamine signaling, and activity reward-related brain regions). The majority of studies reviewed support that RYGB decrease the hedonic drive to consume highly palatable foods. Still, in order to fully understand the complexity of these changes, we need studies combining sociological and psychological approaches with objective measures of actual food choices examining different measures of hedonic drive.

Compression of the superior mesenteric vein - a sign of acute internal herniation in patients with antecolic laparoscopic Roux-en-Y gastric bypass

International Nuclear Information System (INIS)

Maier, Jens; Herrasti Gallego, Amaya; Floyd, Andrea K.

2017-01-01

To investigate whether compression of the superior mesenteric vein (SMV) on computed tomography (CT) can serve as a valid sign of internal herniation (IH) in patients with antecolic laparoscopic Roux-en-Y gastric bypass (LRYGBP). With institutional review board approval, we performed a retrospective analysis of 41 patients with antecolic LRYGBP referred for acute CT of the abdomen with suspicion of IH or another cause of acute abdomen. CT scans were randomly reviewed for signs of IH by two radiologists in a blinded manner, and the findings were correlated with the results of the patients' bariatric workup. Sensitivity, specificity, and inter-observer agreement were calculated for each sign. Five patients were classified as having intermittent IH and were excluded. Eighteen patients were found to have IH at laparoscopy and served as the study group; 18 patients served as the control group. SMV compression had the best sensitivity (67 % for both reviewers) and inter-observer agreement (kappa = 0.82) of all investigated signs. The swirl sign showed a lower sensitivity (39 and 50 % respectively) and kappa (0.37). SMV compression is a reliable sign of IH in patients with antecolic LRYGBP. circle CT can help detect internal herniation after laparoscopic Roux-en-Y gastric bypass. (orig.)

Compression of the superior mesenteric vein - a sign of acute internal herniation in patients with antecolic laparoscopic Roux-en-Y gastric bypass

Energy Technology Data Exchange (ETDEWEB)

Maier, Jens; Herrasti Gallego, Amaya [Koege Sygehus, Department of Radiology, Koege (Denmark); Floyd, Andrea K. [Holbaek Sygehus, Department of Abdominal Surgery, Holbaek (Denmark)

2017-04-15

To investigate whether compression of the superior mesenteric vein (SMV) on computed tomography (CT) can serve as a valid sign of internal herniation (IH) in patients with antecolic laparoscopic Roux-en-Y gastric bypass (LRYGBP). With institutional review board approval, we performed a retrospective analysis of 41 patients with antecolic LRYGBP referred for acute CT of the abdomen with suspicion of IH or another cause of acute abdomen. CT scans were randomly reviewed for signs of IH by two radiologists in a blinded manner, and the findings were correlated with the results of the patients' bariatric workup. Sensitivity, specificity, and inter-observer agreement were calculated for each sign. Five patients were classified as having intermittent IH and were excluded. Eighteen patients were found to have IH at laparoscopy and served as the study group; 18 patients served as the control group. SMV compression had the best sensitivity (67 % for both reviewers) and inter-observer agreement (kappa = 0.82) of all investigated signs. The swirl sign showed a lower sensitivity (39 and 50 % respectively) and kappa (0.37). SMV compression is a reliable sign of IH in patients with antecolic LRYGBP. circle CT can help detect internal herniation after laparoscopic Roux-en-Y gastric bypass. (orig.)

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.

Current evidence for a role of GLP-1 in Roux-en-Y gastric bypass-induced remission of type 2 diabetes

DEFF Research Database (Denmark)

Rhee, Nicolai Alexander; Vilsbøll, T; Knop, F K

2012-01-01

Weight-reducing surgical procedures such as Roux-en-Y gastric bypass (RYGB) have proven efficient as means of decreasing excess body weight. Furthermore, some studies report that up to 80% of patients with type 2 diabetes mellitus (T2DM) undergoing RYGB experience complete remission of their T2DM......-induced remission of T2DM are lacking. This article critically evaluates the current evidence for a role of GLP-1 in RYGB-induced remission of T2DM.......Weight-reducing surgical procedures such as Roux-en-Y gastric bypass (RYGB) have proven efficient as means of decreasing excess body weight. Furthermore, some studies report that up to 80% of patients with type 2 diabetes mellitus (T2DM) undergoing RYGB experience complete remission of their T2DM...... antidiabetic effects of GLP-1 are thought to be key mediators in RYGB-induced remission of T2DM. However, the published studies on the impact of RYGB on GLP-1 secretion are few, small and often not controlled properly. Furthermore, mechanistic studies delineating the role of endogenous GLP-1 secretion in RYGB...

The influence of nutrients, biliary-pancreatic secretions, and systemic trophic hormones on intestinal adaptation in a Roux-en-Y bypass model

DEFF Research Database (Denmark)

Taqi, Esmaeel; Wallace, Laurie E; de Heuvel, Elaine

2010-01-01

The signals that govern the upregulation of nutrient absorption (adaptation) after intestinal resection are not well understood. A Gastric Roux-en-Y bypass (GRYB) model was used to isolate the relative contributions of direct mucosal stimulation by nutrients, biliary-pancreatic secretions......, and systemic enteric hormones on intestinal adaptation in short bowel syndrome....

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...... to physical fitness, mental distress, health-related quality of life, and weight-related body image (). The interaction between follow-up time and type 2 diabetes at baseline significantly predicted six of the thirteen psychological subscales () 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....

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

Science.gov (United States)

Wen, Yi; Lin, Ning; Yan, Hong-Tao; Luo, Hao; Chen, Guang-Yu; Cui, Jian-Feng; Shi, Li; Chen, Tao; Wang, Tao; Tang, Li-Jun

2015-01-01

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 insulin signal pathway in the renal cortex and increased circulating adiponectin concentrations may contribute to the decline of renal gluconeogenesis following RYGB surgery. PMID:25832593

Emotional eating behavior hinders body weight loss in women after Roux-en-Y gastric bypass surgery.

Science.gov (United States)

Novelli, Isabelle Romero; Fonseca, Laís Gomes; Gomes, Daniela Lopes; Dutra, Eliane Said; Baiocchi de Carvalho, Kênia Mara

2018-05-01

Successful weight loss and maintenance after Roux-en-Y gastric bypass (RYGB) may be related to eating behavior. The aim of this study was to assess the eating behavior domains that prevail in women during the RYGB postoperative period and their associations with surgery outcome. This cross-sectional study investigated eating behavior in 95 women (47.3 ± 9.8 y old)  ≥ 2 y after Roux-en-Y gastric bypass. Patients were grouped according to surgery outcome: successful group (SG; n = 67), defined as having lost ≥ 50% of the preoperative excess weight loss (EWL), and an unsuccessful group (UG; n = 28). Mean postoperative time was 59.5 ± 21.2 mo (55.7 ± 19.9 in the SG and 68.6 ± 21.9 in the UG). The short version of the Three-Factor Eating Questionnaire was used to assess cognitive restraint, emotional eating, and uncontrolled eating behaviors. Multivariate analysis was used to investigate associations between eating behavior scores and EWL. The highest score in both groups was for the cognitive restraint domain, followed by emotional and uncontrolled eating. Emotional eating was negatively associated with percentage of EWL (β = -0.286; P = 0.033), regardless of age, educational attainment, and postoperative time. The cognitive restraint domain was the main type of eating behavior observed, and patients with higher emotional eating score were at a higher risk for having insufficient weight loss after RYGB. These results indicate the relevance of monitoring emotional components during the long-term nutritional follow-up of bariatric patients to achieve better surgery outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Specialty Article: so You Think You Got a Bypass? A Case Series of Adventures in Bariatric Surgery.

Science.gov (United States)

Wang, Eugene Y; Shope, Timothy R

2018-05-01

To raise awareness for surgeons encountering bariatric patients with anatomy that deviates from the standard Roux-en-Y gastric bypass (RYGB). This is a single-institution retrospective case series over 12 years (2003-2014) involving patients who believed they received RYGBs, but actually did not. Data was obtained reviewing physician encounters, imaging, and operative reports. There were six cases with confusing clinical pictures, found to have aberrant RYGB anatomy: (1) gastric bypass with jejuno-jejunostomy only without gastrojejunostomy, (2) distal partial vertical gastrectomy without expected prosthetic band, (3) inverse vertical banded gastroplasty, (4) non-divided gastric bypass with no gastrojejunostomy, (5) 20-cm Roux limb, with gastro-gastric fistula, and (6) 200-cm bilio-pancreatic limb similar to the traditional Scopinaro procedure. There are cases of "Roux-en-Y gastric bypasses" that have no resemblance to the named procedure at all. Adjunctive upper gastrointestinal studies and upper endoscopies help surgeons make diagnoses that are incongruent with the surgical history. It is important to keep in mind that there could be anatomic or surgical variations which were born out of necessity or based on other surgeons' creativities.

Early 24-hour blood pressure response to Roux-en-Y gastric bypass in obese patients

DEFF Research Database (Denmark)

Pedersen, Julie S; Borup, Christian; Damgaard, Morten

2017-01-01

Recently, it has been proposed, that the blood pressure (BP) lowering effect of gastric bypass surgery not only is explained by the obtained weight loss, but that the anatomical rearrangement of the gut after 'malabsorptive' surgical techniques, such as the laparoscopic Roux-en-Y gastric bypass...... (LRYGB), may affect BP through a change in a putative 'entero-renal' axis. If so one could anticipate a reduction in BP even before a noticeable weight loss was obtained. The purpose of the present study was to investigate the very early BP response to LRYGB surgery. Ten severely obese hypertensive (mean...

Evolution of nutritional, hematologic and biochemical changes in obese women during 8 weeks after Roux-en-Y gastric bypasss Evolución de los cambios nutricionales, hematológicos y bioquímicos en mujeres obesas durante 8 semanas después de bypass gástrico en Y de Roux

OpenAIRE

V. Custódio Afonso Rocha; L. Ramos de Arvelos; G. Pereira Felix; D. Nogueira Prado de Souza; M. Bernardino Neto; E. Santos Resende; N. Penha-Silva

2012-01-01

Obesity is a chronic disease of multifactorial origin and currently is a serious public health problem. The treatment of morbid obesity can be effectively done by bariatric surgery. The present study aimed to evaluate the influence of changes in food intake on body composition and some hematologic and biochemical variables in the period of eight weeks after Roux-en-Y gastric bypass (RYGB). The study included 22 women submitted to RYGB. We evaluated anthropometric, nutritional, hematologic and...

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...

Pancreatic and Intestinal Function Post Roux-en-Y Gastric Bypass Surgery for Obesity

DEFF Research Database (Denmark)

O'Keefe, Stephen J D; Rakitt, Tina; Ou, Junhai

2017-01-01

OBJECTIVES: Despite the fact that the most effective treatment for morbid obesity today is gastric bypass surgery, some patients develop life-threatening nutritional complications associated with their weight loss. METHODS: Here we examine the influence of the altered anatomy and digestive...... physiology on pancreatic secretion and fat absorption. Thirteen post Roux-en-Y gastric bypass (RYGB) patients who had lost >100 lbs in the first year following surgery and who gave variable histories of gastrointestinal (GI) dysfunction, were selected for study. Food-stimulated pancreatic enzyme secretion...... balance study when a normal diet was given containing ~100 g fat/d. RESULTS: Result showed that all patients had some fat malabsorption, but eight had coefficients of fat absorption associated with significantly lower feed-stimulated secretion rates of trypsin...

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-c...

Metabolic phenotype-microRNA data fusion analysis of the systemic consequences of Roux-en-Y gastric bypass surgery.

OpenAIRE

Wu, Q; Li, JV; Seyfried, F; le Roux, CW; Ashrafian, H; Athanasiou, T; Fenske, W; Darzi, A; Nicholson, JK; Holmes, E; Gooderham, NJ

2015-01-01

Background/Objectives: Bariatric surgery offers sustained marked weight loss and often remission of type 2 diabetes, yet the mechanisms of establishment of these health benefits are not clear. Subjects/Methods: We mapped the coordinated systemic responses of gut hormones, the circulating miRNAome and the metabolome in a rat model of Roux-en-Y gastric bypass (RYGB) surgery. Results: The response of circulating microRNAs (miRNAs) to RYGB was striking and selective. Analysis of 14 significantly ...

Laparoscopic Roux-en-Y gastric bypass in super obese Göttingen minipigs

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Birck, Malene Muusfeldt; Vegge, Andreas; Støckel, Mikael

2013-01-01

Background: The specific mechanisms behind weight loss and comorbidity improvements in obese patients after Roux-en-Y gastric bypass (RYGBP) are still poorly understood. The aim of this study was to establish and evaluate the feasibility of a long-term survival RYGBP model in super obese Göttingen...... minipigs in order to improve the translational potential relative to current animal models. Methods: Eleven Göttingen minipigs with diet-induced obesity underwent laparoscopic RYGBP and were followed up to 9 months after surgery. Intra-and post-operative complications, body weight (BW), food intake......, biliary and common limb between minipigs. Conclusion: The use of obese Göttingen minipigs as a translational RYGBP model is feasible and has potential for the study of RYGBP-related changes in gut function, type-2 diabetes and appetite regulation. Still, the surgical procedure is technically highly...

The impact of Roux-en-Y gastric bypass surgery on normal metabolism in a porcine model

DEFF Research Database (Denmark)

Lindqvist, Andreas; Ekelund, Mikael; Garcia-Vaz, Eliana

2017-01-01

BACKGROUND: A growing body of literature on Roux-en-Y gastric bypass surgery (RYGB) has generated inconclusive results on the mechanism underlying the beneficial effects on weight loss and glycaemia, partially due to the problems of designing clinical studies with the appropriate controls. Moreover......, RYGB is only performed in obese individuals, in whom metabolism is perturbed and not completely understood. METHODS: In an attempt to isolate the effects of RYGB and its effects on normal metabolism, we investigated the effect of RYGB in lean pigs, using sham-operated pair-fed pigs as controls. Two...... weeks post-surgery, pigs were subjected to an intravenous glucose tolerance test (IVGTT) and circulating metabolites, hormones and lipids measured. Bile acid composition was profiled after extraction from blood, faeces and the gallbladder. RESULTS: A similar weight development in both groups of pigs...

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

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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 for...

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

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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)

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

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Stoll, Aluisio; Rosin, Leandro; Dias, Mariana Fernandes; Marquiotti, Bruna; Gugelmin, Giovana; Stoll, Gabriela Fanezzi

Roux-en-Y gastric bypass is one of the most common bariatric surgery and leads to considerable weight loss in the first months. To quantify the main early postoperative complications in patients submitted to the gastric bypass. 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. 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. 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. Bypass gástrico em Y-de-Roux é uma das operações bariátricas mais comuns e leva a perdas consideráveis de peso já nos primeiros meses. Quantificar as principais complicações pós-operatórias precoces em pacientes submetidos ao bypass gástrico. Coorte retrospectiva observacional. Amostra de 1051 pacientes portadores de obesidade grau II associada à comorbidades ou grau III submetidos ao bypass gástrico com acompanhamento de 30 dias a partir da data da operação. A idade média dos pacientes foi de 36 anos com predominância de mulheres (81,1%). O índice de massa corporal pré-operatório médio foi de 43 kg/m². A principal complicação foi fístula (2,3%), seguida de obstrução intestinal (0,5%) e tromboembolismo pulmonar (0,5%). Óbito ocorreu em 0,6% dos casos. No período de 30 dias de pós-operatório a taxa geral de complicações foi de 3,8%; a de reoperação de 2,6% e óbito em 0,6%. A fístula foi a principal complicação e a principal causa de internamento em

Esôfago de barrett após gastrectomia total com reconstrução em Y de roux

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Deomir Germano Bassi

Full Text Available Reflux esophagitis and Barrett's esophagus after total gastrectomy is related to reconstructive procedure of intestinal continuity. The Roux-en-Y operation with length of limb of 40 cm occasionally is not enough to prevent biliary reflux to distal esophagus. Barrett's esophagus is thought to develop as a consequence of biliary reflux and has a malignant potential. Symptoms of retroesternal burning and dysphagia that does not improve with conservative management has to be treated by an operative procedure. To prevent biliary reflux to distal esophagus after total gastrectomy the lenght of limb of Roux-en-Y should be at lest 60 cm.

Evolution of nutritional, hematologic and biochemical changes in obese women during 8 weeks after Roux-en-Y gastric bypasss

OpenAIRE

Custódio Afonso Rocha, V.; Ramos de Arvelos, L.; Pereira Felix, G.; Nogueira Prado de Souza, D.; Bernardino Neto, M.; Santos Resende, E.; Penha-Silva, N.

2012-01-01

Obesity is a chronic disease of multifactorial origin and currently is a serious public health problem. The treatment of morbid obesity can be effectively done by bariatric surgery. The present study aimed to evaluate the influence of changes in food intake on body composition and some hematologic and biochemical variables in the period of eight weeks after Roux-en-Y gastric bypass (RYGB). The study included 22 women submitted to RYGB. We evaluated anthropometric, nutritional, hematologic and...

¿Cambio de paradigma desde el bypass gástrico Roux-en-Y al (mini) bypass gástrico debido a problemas de glucosa?

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Himpens, Jaques

2014-01-01

El bypass gástrico Roux-en-Y funciona de la siguiente manera sobre la diabetes mellitus tipo 2: En obesos mórbidos la diabetes tipo2 inicia con la presencia de resistencia a la insulina con un incremento del péptido C, o sea incremento de las necesidades de insulina que los no obesos tienen para mantener el estado euglucemico. Cuando la secreción de insulina es insuficiente, se desarrolla la diabetes. Esta secreción de insulina está modulada por las incretinas y posiblemente por anti-incretin...

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...

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

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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.

Single Balloon Enteroscopy-Assisted ERCP Using Rendezvous Technique for Sharp Angulation of Roux-en-Y Limb in a Patient with Bile Duct Stones

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Itoi, Takao; Ishii, Kentaro; Sofuni, Atsushi; Itokawa, Fumihide; Kurihara, Toshio; Tsuchiya, Takayoshi; Tsuji, Shujiro; Umeda, Junko; Moriyasu, Fuminori

2009-01-01

The acute angulation of Roux-en-Y (R-Y) limb precludes endoscopic access for endoscopic retrograde cholangiopancreatography (ERCP) even using a balloon enteroscopy. Here, we describe a case of successful single balloon enteroscopy (SBE)-assisted ERCP using a rendezvous technique in a patient with sharply angulated R-Y limb in a 79-year-old woman who had bile duct stones. Method. At first, a guidewire was passed antegradely through the major papilla after the needle puncture using percutaneous transhepatic biliary drainage technique. A hydrophilic guidewire with an ERCP catheter was antegradely advanced beyond the Roux limb. After a guidewire was firmly grasped by a snare forceps, it was pulled out of the body, resulting that the enteroscope could advance to the papilla. After papillary dilation, complete removal of bile duct stones was achieved without any procedure-related complication. In conclusion, although further study is needed, SBE-assisted ERCP using a rendezvous technique may have a potential for selected patients. PMID:20169091

Single Balloon Enteroscopy-Assisted ERCP Using Rendezvous Technique for Sharp Angulation of Roux-en-Y Limb in a Patient with Bile Duct Stones

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Takao Itoi

2009-01-01

Full Text Available The acute angulation of Roux-en-Y (R-Y limb precludes endoscopic access for endoscopic retrograde cholangiopancreatography (ERCP even using a balloon enteroscopy. Here, we describe a case of successful single balloon enteroscopy (SBE-assisted ERCP using a rendezvous technique in a patient with sharply angulated R-Y limb in a 79-year-old woman who had bile duct stones. Method. At first, a guidewire was passed antegradely through the major papilla after the needle puncture using percutaneous transhepatic biliary drainage technique. A hydrophilic guidewire with an ERCP catheter was antegradely advanced beyond the Roux limb. After a guidewire was firmly grasped by a snare forceps, it was pulled out of the body, resulting that the enteroscope could advance to the papilla. After papillary dilation, complete removal of bile duct stones was achieved without any procedure-related complication. In conclusion, although further study is needed, SBE-assisted ERCP using a rendezvous technique may have a potential for selected patients.

Current status of robotic bariatric surgery: a systematic review

Science.gov (United States)

2013-01-01

Background Bariatric surgery is an effective treatment to obtain weight loss in severely obese patients. The feasibility and safety of bariatric robotic surgery is the topic of this review. Methods A search was performed on PubMed, Cochrane Central Register of Controlled Trials, BioMed Central, and Web of Science. Results Twenty-two studies were included. Anastomotic leak rate was 8.51% in biliopancreatic diversion. 30-day reoperation rate was 1.14% in Roux-en-Y gastric bypass and 1.16% in sleeve gastrectomy. Major complication rate in Roux-en-Y gastric bypass resulted higher than in sleeve gastrectomy ( 4,26% vs. 1,2%). The mean hospital stay was longer in Roux-en-Y gastric bypass (range 2.6-7.4 days). Conclusions The major limitation of our analysis is due to the small number and the low quality of the studies, the small sample size, heterogeneity of the enrolled patients and the lack of data from metabolic and bariatric outcomes. Despite the use of the robot, the majority of these cases are completed with stapled anastomosis. The assumption that robotic surgery is superior in complex cases is not supported by the available present evidence. The major strength of the robotic surgery is strongly facilitating some of the surgical steps (gastro-jejunostomy and jejunojejunostomy anastomosis in the robotic Roux-en-Y gastric bypass or the vertical gastric resection in the robotic sleeve gastrectomy). PMID:24199869

The impact of Roux-en-Y gastric bypass surgery on normal metabolism in a porcine model

DEFF Research Database (Denmark)

Lindqvist, Andreas; Ekelund, Mikael; Garcia-Vaz, Eliana

2017-01-01

BACKGROUND: A growing body of literature on Roux-en-Y gastric bypass surgery (RYGB) has generated inconclusive results on the mechanism underlying the beneficial effects on weight loss and glycaemia, partially due to the problems of designing clinical studies with the appropriate controls. Moreov...... were compensated for by increased plasma amino acids, suggesting a switch from lipid to protein metabolism during fasting in the immediate postoperative period......., RYGB is only performed in obese individuals, in whom metabolism is perturbed and not completely understood. METHODS: In an attempt to isolate the effects of RYGB and its effects on normal metabolism, we investigated the effect of RYGB in lean pigs, using sham-operated pair-fed pigs as controls. Two...... weeks post-surgery, pigs were subjected to an intravenous glucose tolerance test (IVGTT) and circulating metabolites, hormones and lipids measured. Bile acid composition was profiled after extraction from blood, faeces and the gallbladder. RESULTS: A similar weight development in both groups of pigs...

Application of Y-shaped, coated self-expandable metallic stents for anastomotic stenosis after gastrojejunostomy (Billroth II).

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Li, Teng-Fei; Wu, Gang; Han, Xin-Wei; Shui, Shao-Feng; Ren, Jian-Zhuang; Li, Zhen; Ren, Ke-Wei

2017-01-01

Anastomotic stenosis is an infrequent but life-threatening complication after gastrojejunostomy (Billroth II). Tubular or single tubular stents have limited efficacy due to the particular anatomy. To assess the feasibility of a Y-shaped, fully-coated, self-expandable, metallic stent (SEMS) for anastomotic stenosis after gastrojejunostomy (Billroth II). Between January 2008 and August 2014, 14 patients (10 with gastric carcinoma and four with duodenal ulcers) had anastomotic stenoses following Billroth II reconstructions. Eight patients with gastric cancer had tumor recurrence near the anastomosis; two had benign strictures. The four duodenal ulcer patients had benign stenoses. An integrated Y-shaped, fully coated SEMS was designed to accord with the anatomy of residual gastrojejunal anastomotic strictures. Fourteen stents were inserted under fluoroscopic control. Follow-up was at 1, 3, 9, and 12 months, and then annually. All 14 stents were inserted successfully at the first attempt with a technical success rate of 100%. After stenting, abdominal symptoms resolved in all patients. All patients were followed up for 4-27 months (mean, 13.9 months). One of the eight recurrent cases died of multiple tumor metastases and liver failure after 7 months, without obstruction symptoms. In all six patients with benign anastomotic stenosis, the stents were removed successfully without complication and with no evidence of restenosis based on clinical evaluation and imaging. A Y-shaped, fully-coated SEMS proved to be a feasible and minimally invasive procedure for treating anastomotic stenosis after gastrojejunostomy (Billroth II). © The Foundation Acta Radiologica 2016.

Upper gastrointestinal series after Roux-en-Y gastric bypass for morbid obesity: effectiveness in leakage detection. a systematic review of the literature.

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Quartararo, Giovanni; Facchiano, Enrico; Scaringi, Stefano; Liscia, Gadiel; Lucchese, Marcello

2014-07-01

The aim of this study is to evaluate the results of routine and selective postoperative upper gastrointestinal series (UGIS) after Roux-en-Y gastric bypass (RYGB) for morbid obesity in different published series to assessing its utility and cost-effectiveness. A search in PubMed's MEDLINE was performed for English-spoken articles published from January 2002 to December 2012. Keywords used were upper GI series, RYGB, and obesity. Only cases of anastomotic leaks were considered. A total of 22 studies have been evaluated, 15 recommended a selective use of postoperative UGIS. No differences in leakage detection or in clinical benefit between routine and selective approaches were found. Tachycardia and respiratory distress represent the best criteria to perform UGIS for early diagnosis of anastomotic leak after a RYGB.

Removal of Nasogastric Tube Accidentally Stitched to Roux-en-Y Oesophagojejunostomy Following a Radical Gastrectomy for Stomach Cancer: Case report and review of the literature

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Ayman Z. Azzam

2018-04-01

Full Text Available Nasogastric tubes (NGTs are important for feeding, stenting and decompression after gastrointestinal surgeries, particularly in the upper gastrointestinal tract. Resistance in the removal of a NGT is a rare surgical complication and may be due to a knot in the tube or a stitch anchoring the tube to an anastomosis. We report a 41-year-old male patient who was admitted to the King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, in 2015 with stomach cancer. He underwent a radical total gastrectomy with a Roux-en-Y oesophagojejunostomy. One week after the surgery, removal of the NGT was attempted; however, this was very difficult and the proximal end of the tube was cut off as a temporary measure. Six weeks later, an upper gastrointestinal tract endoscopy revealed that the distal end of the NGT had been accidentally stitched to the Roux-en-Y oesophagojejunostomy. The stitch was removed and the rest of the NGT was successfully extracted using a snare.

[Laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity. Experience at the Nacional de Ciencias Médicas y Nutrición Salvador Zubirán].

Science.gov (United States)

Romero-Lbargüengoitia, María Elena; Lerman-Garber, Israel; Herrera-Hernández, Miguel Francisco; Pablo-Pantoja, Juan; Sierra-Salazar, Mauricio; López-Rosales, Federico; Zamora-Barrón, Margarita; Vargas-Martínez, Angeles; García-García, Eduardo

2009-01-01

Morbid obesity is a serious health problem associated to a significant reduction in life expectancy. To evaluate the anthropometric and metabolic changes observed in obese patients, 3, 6 and 12 months after laparoscopic Roux-en-Y gastric bypass surgery and the complications associated with the procedure. Retrospective study that included 128 consecutive obese patients submitted for bariatric surgery at the INCMNSZ (2004-2006). Their mean age was 38 +/- 10 years, 83% were women with a BMI of 48 +/- 6 Kg/m2. 65% were hypertensives, 55% had hypertriglyceridemia and 34% diabetes. A year after surgery all patients had at least reduced 20% their body weight and the percentage of excess body weight loss was 73%. The prevalence of hypertension, hypertrigliceridemia and diabetes was reduced to 24%, 17% and 12%, respectively (p < 0.001). Four patients died (3%), all of them had a leak of the anastomosis and intra-abdominal abscess. One died because pulmonary embolism, another with a myocardial infarction (after surgical reinterventions) and the other two with sepsis. Laparoscopic Roux-en-Y gastric bypass surgery in morbid obese patients favors significant reductions in body weight and associated co morbidities. This surgery is not free of complications and mortality, reason why it must be done only by surgical and interdisciplinary groups with experience in these procedures.

Roux en Y gastric bypass hypoglycemia resolves with gastric feeding or reversal: Confirming a non-pancreatic etiology

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Dawn Belt Davis

2018-03-01

Full Text Available Objective: Postprandial hypoglycemia is an infrequent but disabling complication of Roux-en-Y gastric bypass (RYGB surgery. Controversy still exists as to whether the postprandial hyperinsulinemia observed is due to inherent changes in pancreatic β-cell mass or function or to reversible alterations caused by RYGB anatomy. We aimed to determine if gastric feeding or reversal of RYGB would normalize postprandial glucose and hormone excursions in patients with symptomatic hypoglycemia. Methods: We completed a prospective study of six patients with severe symptomatic RYGB hypoglycemia who underwent RYGB reversal. An additional subject without hypoglycemia who underwent RYGB reversal was also studied prospectively. Mixed meal tolerance testing (MTT was done orally (RYGB anatomy, via gastrostomy tube in the excluded stomach in the setting of RYGB, and several months after RYGB reversal. Results: All subjects reported symptomatic improvement of hypoglycemia after reversal of RYGB. Weight gain after reversal was moderate and variable. Postprandial glucose, insulin, and GLP-1 excursions were significantly diminished with gastric feeding and after reversal. Insulin secretion changed proportional to glucose levels and insulin clearance increased after reversal. Glucagon/insulin ratios were similar throughout study. We further compared the impact of modified sleeve gastrectomy reversal surgery to those with restoration of complete stomach and found no significant differences in weight regain or in postprandial glucose or hormone levels. Conclusions: Reversal of RYGB is an effective treatment option for severe postprandial hypoglycemia. The pathophysiology of this disorder is primarily due to RYGB anatomy resulting in altered glucose, gut, and pancreatic hormone levels and decreased insulin clearance, rather than inherent β-cell hyperplasia or hyperfunction. Keywords: Hypoglycemia, Insulin, Glucagon-like peptide 1, Roux en Y gastric bypass, Gastric bypass

Effect of Roux-en-Y gastric bypass on satiety and food likes: the role of genetics.

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Thirlby, Richard C; Bahiraei, Frohar; Randall, Jim; Drewnoski, Adam

2006-02-01

Among factors influencing the outcome of bariatric surgery may be genetics and familial risk. The purpose of this study was to assess the etiology of obesity and its impact on hunger, satiety, and food likes in obese patients undergoing Roux-en-Y gastric bypass (RYGB). This study was based on 76 patients undergoing RYGB procedures performed by a single surgeon. A previously described 100-point obesity risk index (ORI) was used to assess familial obesity risk. Hunger and satiety were assessed using a standardized Visual Analog Scale "Snickers" test, and food preferences for regular vs. low-fat potato chips were measured preoperatively and postoperatively. Patients were stratified preoperatively into high ORI (n = 34) and low ORI (n = 42) groups. Before operation, high-ORI patients preferred high-fat (regular) potato chips to low-fat (baked) potato chips, whereas the low-ORI patients liked both food types equivalently (P food and a significantly prolonged drop in hunger ratings after a fast and after a standard 282 kcal meal. The success of bariatric surgery may be influenced by the etiology of obesity.

Decreased Cardiovascular Risk after Roux-en-Y Gastric Bypass Surgery in Chinese Diabetic Patients with Obesity.

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Zhao, Xue; Duan, Wenyan; Sun, Chenglin; Li, Zhuo; Liu, Yujia; Xiao, Xianchao; Wang, Gang; Gang, Xiaokun; Wang, Guixia

2017-01-01

The influence of bariatric surgery on cardiovascular risks in Chinese diabetic patients remains unclear. Here, we aimed to explore the impact of Roux-en-Y gastric bypass surgery (RYGB) on cardiovascular risks in Chinese diabetic patients with obesity. Twenty Chinese patients with T2DM and obesity undergoing RYGB surgery were included in this study. Cardiovascular risk factors were measured before and 18 months after surgery. A 10-year cardiovascular risk was calculated by the UKPDS risk engine. Linear regression analysis was performed on CHD risk, stroke risk, and baseline metabolic parameters. The complete remission rate of diabetes was 90% after RYGB surgery, with significant improvements in blood pressure, BMI, glucose, and lipid metabolism ( P women,  5 years, using noninsulin therapy presented more obvious improvements in the 10-year cardiovascular risk after RYGB surgery. WHR, age, LDL-C, and HbA1c were the most important factors influencing CHD or stroke risk after RYGB surgery ( P treatment to reduce cardiovascular risk in Chinese diabetic patients with obesity.

Diabetes-associated microbiota in fa/fa rats is modified by Roux-en-Y gastric bypass

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Arora, Tulika; Seyfried, Florian; Docherty, Neil G

2017-01-01

Roux-en-Y gastric bypass (RYGB) and duodenal jejunal bypass (DJB), two different forms of bariatric surgery, are associated with improved glucose tolerance, but it is not clear whether the gut microbiota contributes to this effect. Here we used fa/fa rats as a model of impaired glucose tolerance...... to investigate whether (i) the microbiota varies between fa/fa and nondiabetic fa/+ rats; (ii) the microbiota of fa/fa rats is affected by RYGB and/or DJB; and (iii) surgically induced microbiota alterations contribute to glucose metabolism. We observed a profound expansion of Firmicutes (specifically......, Lactobacillus animalis and Lactobacillus reuteri) in the small intestine of diabetic fa/fa compared with nondiabetic fa/+ rats. RYGB-, but not DJB-, treated fa/fa rats exhibited greater microbiota diversity in the ileum and lower L. animalis and L. reuteri abundance compared with sham-operated fa/fa rats in all...

Changes in Gut Hormones After Roux en Y Gastric bypass, Sleeve Gastrectomy, and Adjustable Gastric Banding

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Miroslav Ilić

2015-12-01

Full Text Available The obesity epidemic has burdened healthcare systems worldwide. Bariatric surgery is currently the most effective method for long-term weight loss in obese adults, but the exact mechanism of weight loss is poorly understood. Bariatric procedures were initially classified by their presumed mechanism of action into restrictive, malabsoptive, or mixed procedures; however, due to recent advancements in the field of neuroendocrinology, hormones are increasing being recognized as important regulators of satiation, hunger, and energy expenditure. Studies examining changes in gut hormones following bariatric surgery have yielded conflicting results and the relationship between these hormones and weight loss is nothing but clear. This review will summarize the effect of Roux en Y gastric bypass, sleeve gastrectomy and adjustable gastric banding on various gut hormones including ghrelin, cholecystokinin, glucagon-like polypeptide-1, peptide YY3, and pancreatic polypeptide. Furthermore, the relationship between these hormones and weight loss will be examined.

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.

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

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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.

Comparison of Harmonic scalpel and Ligasure devices in laparoscopic Roux-en-Y gastric bypass.

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Kirmizi, Serdar; Kayaalp, Cuneyt; Karagul, Servet; Tardu, Ali; Ertugrul, Ismail; Sumer, Fatih; Yagci, Mehmet Ali

2017-01-01

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most preferred bariatric procedures in the world for surgical treatment of morbid obesity. The Harmonic scalpel (HS) and LigaSure (LS) are the most commonly used devices in laparoscopic surgery. As far as we know, there is no comparative study of the two energy devices in LRYGB for morbid obesity. To compare the intraoperative performances of the two energy devices in LRYGB for morbid obesity. The HS and LS were used in 43 and 42 cases, respectively. The patient demographics of both groups were comparable. The duration of the procedures (gastric pouch creation time and total operation time), quantity of bleeding (during gastric pouch creation and total quantities of bleeding) and the number of pneumoperitoneum desufflations due to smoking that impaired sight fields were recorded prospectively. Gastric pouch creation time (HS: 22.5 ±9.5 vs. LS: 19.5 ±9.7 min, p = 0.15), bleeding during gastric pouch preparation (HS: 15.3 ±30.5 vs. LS: 17.5 ±31.3 ml, p = 0.74), total operation time (HS: 183.2 ±47 vs. LS: 165.3 ±37.1 min, p = 0.06) and total bleeding (HS: 110 ±195.5 vs. LS: 102.5 ±70 ml, p = 0.81) were similar in the two groups. Only the mean number of pneumoperitoneum desufflations due to smoking was lower in the HS group (HS: 0.28 ±0.49 vs. LS: 0.57 ±0.78, p = 0.04). The HS and LS performed similarly in LRYGB, with fewer desufflations from smoking in the HS group.

Metabolic Changes After Roux-N-Y Bariatric Surgery In Hispanics.

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Hernández-Gil de Lamadrid, José; Nieves-Rivera, Juan J; Mora, Laura; Corretjer, Lisa; Altieri, Pablo I; Suárez, Albert; Banchs, Héctor L; Muñiz, Jesús; Soto, Marie Ivelisse; Escobales, Nelson; Crespo, María

2015-01-01

The objective was to describe the metabolic outcomes 12 months after bariatric surgery (Roux-N-Y) in morbidly obese Hispanic patients, and evaluate the correlation between weight loss and the observed changes. Medical records from a hundred-and-two Hispanic obese patients who underwent bariatric surgery were identified at the University of Puerto Rico (UPR) Hospital. The following variables were obtained before and 12 months after surgery: Body Mass Index (BMI), body weight, total cholesterol (TC), triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), and fasting blood sugar (FBS). Ninety-seven percent of patients underwent Roux-N-Y surgery; 79.4% were females and 44% were diabetics. We observed statistically significant reductions (p N-Y significantly improves the lipid profile and FBS levels in obese Hispanic patients. The poor correlation factor between weight loss and these variables suggests that other mechanisms, independent from weight loss, are responsible for these changes.

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

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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...... of enteroendocrine cells and their expression of hormonal genes are seen after RYGB and include increased density of GLP-1-, PYY-, CCK-, GIP- and PC2-positive cells, reduced gene expression of GHRL, SCT and GIP and increased expression of GCG....

Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial.

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Salminen, Paulina; Helmiö, Mika; Ovaska, Jari; Juuti, Anne; Leivonen, Marja; Peromaa-Haavisto, Pipsa; Hurme, Saija; Soinio, Minna; Nuutila, Pirjo; Victorzon, Mikael

2018-01-16

Laparoscopic sleeve gastrectomy for treatment of morbid obesity has increased substantially despite the lack of long-term results compared with laparoscopic Roux-en-Y gastric bypass. To determine whether laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass are equivalent for weight loss at 5 years in patients with morbid obesity. The Sleeve vs Bypass (SLEEVEPASS) multicenter, multisurgeon, open-label, randomized clinical equivalence trial was conducted from March 2008 until June 2010 in Finland. The trial enrolled 240 morbidly obese patients aged 18 to 60 years, who were randomly assigned to sleeve gastrectomy or gastric bypass with a 5-year follow-up period (last follow-up, October 14, 2015). Laparoscopic sleeve gastrectomy (n = 121) or laparoscopic Roux-en-Y gastric bypass (n = 119). The primary end point was weight loss evaluated by percentage excess weight loss. Prespecified equivalence margins for the clinical significance of weight loss differences between gastric bypass and sleeve gastrectomy were -9% to +9% excess weight loss. Secondary end points included resolution of comorbidities, improvement of quality of life (QOL), all adverse events (overall morbidity), and mortality. Among 240 patients randomized (mean age, 48 [SD, 9] years; mean baseline body mass index, 45.9, [SD, 6.0]; 69.6% women), 80.4% completed the 5-year follow-up. At baseline, 42.1% had type 2 diabetes, 34.6% dyslipidemia, and 70.8% hypertension. The estimated mean percentage excess weight loss at 5 years was 49% (95% CI, 45%-52%) after sleeve gastrectomy and 57% (95% CI, 53%-61%) after gastric bypass (difference, 8.2 percentage units [95% CI, 3.2%-13.2%], higher in the gastric bypass group) and did not meet criteria for equivalence. Complete or partial remission of type 2 diabetes was seen in 37% (n = 15/41) after sleeve gastrectomy and in 45% (n = 18/40) after gastric bypass (P > .99). Medication for dyslipidemia was discontinued in 47% (n�

[Routine fluoroscopic investigations after primary bariatric surgery].

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Gärtner, D; Ernst, A; Fedtke, K; Jenkner, J; Schöttler, A; Reimer, P; Blüher, M; Schön, M R

2016-03-01

Staple line and anastomotic leakages are life-threatening complications after bariatric surgery. Upper gastrointestinal (GI) tract X-ray examination with oral administration of a water-soluble contrast agent can be used to detect leaks. The aim of this study was to evaluate the impact of routine upper GI tract fluoroscopy after primary bariatric surgery. Between January 2009 and December 2014 a total of 658 bariatric interventions were carried out of which 442 were primary bariatric operations. Included in this single center study were 307 sleeve gastrectomies and 135 Roux-en-Y gastric bypasses. Up to December 2012 upper GI tract fluoroscopy was performed routinely between the first and third postoperative days and the detection of leakages was evaluated. In the investigation period 8 leakages (2.6 %) after sleeve gastrectomy, 1 anastomotic leakage in gastrojejunostomy and 1 in jejunojejunostomy after Roux-en-Y gastric bypass occurred. All patients developed clinical symptoms, such as abdominal pain, tachycardia or fever. In one case the leakage was detected by upper GI fluoroscopy and in nine cases radiological findings were unremarkable. No leakages were detected in asymptomatic patients. Routine upper GI fluoroscopy is not recommended for uneventful postoperative courses after primary bariatric surgery.

Can low BMI Chinese patients with type 2 diabetes benefit from laparoscopic Roux-en-Y gastric bypass surgery?

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Wang, Guohui; Zhu, Liyong; Li, Weizheng; Yang, Xiangwu; Li, Pengzhou; Zhu, Shaihong

2016-12-01

The efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) in type 2 diabetes mellitus (T2D) is closely associated with the preoperative body mass index (BMI) of the patient. There is a lack of long-term and large sampling evidence on the efficacy of LRYGB in T2D patients with low BMI in China. This retrospective study aimed to evaluate the efficacy of surgical treatment in a Chinese population with T2D (especially patients with BMIBMI≥27.5 kg/m 2 in group 1 (high BMI group) had significant improvements in waist circumference, blood glucose levels, homeostasis model assessment-insulin resistance index, and C-peptide levels after LRYGB (PBMIBMI group, including 19 T2D patients with BMIBMI<27.5 kg/m 2 in China. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Effect of Roux-en-Y Bariatric Surgery on Lipoproteins, Insulin Resistance, and Systemic and Vascular Inflammation in Obesity and Diabetes

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Rahul Yadav

2017-11-01

Full Text Available PurposeObesity is a major modifiable risk factor for cardiovascular disease. Bariatric surgery is considered to be the most effective treatment option for weight reduction in obese patients with and without type 2 diabetes (T2DM.ObjectiveTo evaluate changes in lipoproteins, insulin resistance, mediators of systemic and vascular inflammation, and endothelial dysfunction following Roux-en-Y bariatric surgery in obese patients with and without diabetes.Materials and methodsLipoproteins, insulin resistance, mediators of systemic and vascular inflammation, and endothelial dysfunction were measured in 37 obese patients with (n = 17 and without (n = 20 T2DM, before and 6 and 12 months after Roux-en-Y bariatric surgery. Two way between subject ANOVA was carried out to study the interaction between independent variables (time since surgery and presence of diabetes and all dependent variables.ResultsThere was a significant effect of time since surgery on (large effect size weight, body mass index (BMI, waist circumference, triglycerides (TG, small-dense LDL apolipoprotein B (sdLDL ApoB, HOMA-IR, CRP, MCP-1, ICAM-1, E-selectin, P-selectin, leptin, and adiponectin. BMI and waist circumference had the largest impact of time since surgery. The effect of time since surgery was noticed mostly in the first 6 months. Absence of diabetes led to a significantly greater reduction in total cholesterol, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol although the effect size was small to medium. There was a greater reduction in TG and HOMA-IR in patients with diabetes with a small effect size. No patients were lost to follow up.ConclusionLipoproteins, insulin resistance, mediators of systemic and vascular inflammation, and endothelial dysfunction improve mostly 6 months after bariatric surgery in obese patients with and without diabetes.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT02169518. https

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

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

2015-01-01

-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......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...

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

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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......) to assimilate multiple energy sources using transporters and phosphotransferase systems, (ii) to use aerobic respiration, (iii) to shift from protein degradation to putrefaction, and (iv) to use amino acids and fatty acids as energy sources. Conclusions: Within 3 months after morbidly obese individuals had...... with obesity and some of its co-morbidities, like type 2 diabetes, and major changes of gut microbial communities have been hypothesized to mediate part of the beneficial metabolic effects observed after RYGB. Here we describe changes in gut microbial taxonomic composition and functional potential following...

Elevated Postoperative Endogenous GLP-1 Levels Mediate Effects of Roux-en-Y Gastric Bypass on Neural Responsivity to Food Cues

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Ten Kulve, Jennifer S; Veltman, Dick J; Gerdes, Victor E A

2017-01-01

of the GLP-1 receptor antagonist exendin 9-39 (Ex9-39) and placebo were assessed in 10 women before and after RYGB. We used functional MRI to investigate CNS activation in response to visual food cues (pictures) and gustatory food cues (consumption of chocolate milk), comparing results with Ex9-39 versus...... in response to visual and gustatory food cues may be mediated by central effects of GLP-1. Our findings provide further insights into the mechanisms underlying the weight-lowering effects of RYGB.......OBJECTIVE: It has been suggested that weight reduction and improvements in satiety after Roux-en-Y gastric bypass (RYGB) are partly mediated via postoperative neuroendocrine changes. Glucagon-like peptide-1 (GLP-1) is a gut hormone secreted after food ingestion and is associated with appetite...

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

RYGB. Methods: We recruited 13 morbidly obese patients who underwent RYGB, carefully phenotyped them, and had their gut microbiomes quantified before (n = 13) and 3 months (n = 12) and 12 months (n = 8) after RYGB. Following shotgun metagenomic sequencing of the fecal microbial DNA purified from stools......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...... with obesity and some of its co-morbidities, like type 2 diabetes, and major changes of gut microbial communities have been hypothesized to mediate part of the beneficial metabolic effects observed after RYGB. Here we describe changes in gut microbial taxonomic composition and functional potential following...

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.

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

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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

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.

Roux-en-Y gastric bypass in the treatment of non-classic congenital adrenal hyperplasia due to 11-hydroxylase deficiency.

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Kalani, Amir; Thomas, Nithin; Sacerdote, Alan; Bahtiyar, Gül

2013-03-18

Non-classic adrenal hyperplasia (NCAH) has been associated with insulin resistance (IR). Therapies such as metformin, thiazolidinediones and lifestyle alterations improve IR and also ameliorate the biochemical and clinical abnormalities of NCAH, much as they do in polycystic ovarian syndrome (PCOS). More recently, bariatric surgery, such as Roux-en-Y gastric bypass (RYGBP), has also been associated with improvement in IR and amelioration of PCOS and may, therefore, be beneficial in NCAH. We report a case of a 39-year-old, deaf-mute, obese woman with NCAH due to 11-hydroxylase deficiency who underwent RYGBP followed by improvement of NCAH manifestations. She was initially treated with metformin and pioglitazone, which lowered serum 11-deoxycortisol from 198 ng/dl (irregular menses normalised as well. We conclude that RYGBP, like other interventions that reduce IR, may be another way of treating non-classic 11-hydroxylase deficiency in selected patients.

Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics

International Nuclear Information System (INIS)

Shinoto, Koichi; Ochiai, Takenori; Suzuki, Takao; Okazumi, Shin-ichi; Ozaki, Masahiko

2003-01-01

To evaluate the efficiency of Roux-en-Y reconstruction (RY) after distal gastrectomy we compared postoperative physiological functions and disorders among patients who underwent RY, conventional Billroth I reconstruction (BI), or Billroth II reconstruction (BII). The subjects were 91 patients who had undergone distal gastrectomy for gastric cancer more than 1 month earlier. To examine the severity of gastroesophageal reflux, acid reflux and alkali reflux were assessed, and to examine the severity of duodenal reflux into the remnant stomach, biliary scintigraphy was performed. The degree of inflammation in the esophagus and remnant stomach was examined by endoscopy. Questionnaires on postoperative complaints were sent out to the patients to determine how serious their reflux symptoms were. Both acid and alkali reflux were mild in the RY group. Biliary reflux into the remnant stomach, as assessed by biliary scintigraphy, was significantly less severe in the RY group than in the BI and BII groups. Endoscopy showed that inflammation of the lower esophagus and remnant stomach was much less severe in the RY group than in the BI and BII groups. According to the questionnaire survey, none of the patients in the RY group reported any reflux symptoms. In this series, RY was found to be a superior reconstruction method after distal gastrectomy since it was rarely accompanied by the reflux of duodenal juice into the remnant stomach or gastric reflux into the lower esophagus. (author)

Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics

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Shinoto, Koichi; Ochiai, Takenori; Suzuki, Takao; Okazumi, Shin-ichi; Ozaki, Masahiko [Chiba Univ. (Japan). School of Medicine

2003-03-01

To evaluate the efficiency of Roux-en-Y reconstruction (RY) after distal gastrectomy we compared postoperative physiological functions and disorders among patients who underwent RY, conventional Billroth I reconstruction (BI), or Billroth II reconstruction (BII). The subjects were 91 patients who had undergone distal gastrectomy for gastric cancer more than 1 month earlier. To examine the severity of gastroesophageal reflux, acid reflux and alkali reflux were assessed, and to examine the severity of duodenal reflux into the remnant stomach, biliary scintigraphy was performed. The degree of inflammation in the esophagus and remnant stomach was examined by endoscopy. Questionnaires on postoperative complaints were sent out to the patients to determine how serious their reflux symptoms were. Both acid and alkali reflux were mild in the RY group. Biliary reflux into the remnant stomach, as assessed by biliary scintigraphy, was significantly less severe in the RY group than in the BI and BII groups. Endoscopy showed that inflammation of the lower esophagus and remnant stomach was much less severe in the RY group than in the BI and BII groups. According to the questionnaire survey, none of the patients in the RY group reported any reflux symptoms. In this series, RY was found to be a superior reconstruction method after distal gastrectomy since it was rarely accompanied by the reflux of duodenal juice into the remnant stomach or gastric reflux into the lower esophagus. (author)

Laparoscopic treatment of congenital choledochal cyst and hepaticojejunostomy with extracorporeal Roux-en-Y anastomosis: technical aspects and early experience with three cases

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Mario Lima

2016-06-01

Full Text Available Choledochal cyst (CDC is a congenital dilatation of the extra and/or intrahepatic bile ducts and it is a rare condition in western countries. Classical treatment consists of cyst excision and hepaticojejunostomy. The first case of a laparoscopic CDC excision was described in 1995 and since that time an increasing number of institutions have adopted this technique, with good success. We describe our early experience of 3 cases of CDC treated with laparoscopic approach. We used a 10 mm umbilical port for the camera, and four 3-5 mm operative ports. We performed the laparoscopic removal of the cyst and gallbladder, videoassisted preparation of the Roux-en-Y loop and laparoscopic hepaticjejunostomy. No post-operative complications occurred. Laparoscopic excision of CDCs has been supposed to give better observation, a better cosmetic result, potentially less postoperative pain, and a shorter recovery. The main argument for performing an extracorporeal anastomosis is that it decreases the operative time. We recommend caution to prevent injury to the pancreatic duct and biliary structures during dissection and anastomosis. Lifelong surveillance is mandatory, even after resection of the choledochal cyst.

Macrophage Area Content and Phenotype in Hepatic and Adipose Tissue in Patients with Obesity Undergoing Roux-en-Y Gastric Bypass

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Kristensen, Marianne D; Lund, Michael Taulo; Hansen, Merethe

2017-01-01

OBJECTIVE: To investigate hepatic and adipose tissue macrophage content in subjects with obesity and the role of adipose tissue macrophages in weight loss-induced improved insulin sensitivity (IS). METHODS: A cross-sectional and a longitudinal study were combined to investigate the role...... of macrophages in subcutaneous (SAT) and visceral (VAT) adipose tissue and the liver in obesity-induced impaired IS and improvements with weight loss. Macrophage markers (CD68, CD163, and CD206) in SAT, VAT, and the liver from patients with obesity were investigated. The same macrophage markers were investigated...... in SAT from 18 patients with obesity before and ∼18 months after a diet- and Roux-en-Y gastric bypass-induced weight loss. RESULTS: SAT macrophage markers did not decrease with weight loss, but macrophage concentration may have increased, concomitant with improved IS. Hepatic macrophage markers did...

[Body weight evolution and classification of body weight in relation to the results of bariatric surgery: roux-en-Y gastric bypass].

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Novais, Patrícia Fátima Sousa; Rasera Junior, Irineu; Leite, Celso Vieira de Souza; Oliveira, Maria Rita Marques de

2010-03-01

The objective of this study was to assess the evolution and classification of body weight in relation to the results of bariatric surgery in women who underwent the procedure more than two years ago. A total of 141 women underwent banded Roux-en-Y gastric bypass (RYGB). The participants were divided according to the time elapsed since surgery and the percentage of excess weight lost (%EWL): 75. The women in the group with %EWL 75 (36.2%) ranged from normal to pre-obese and presented lower late weight gain than the women in the other groups. Weight evolution two or more years after surgery showed the expected reductions, with some individuals responding better to surgery than others. This shows that it is necessary to monitor, investigate and intervene to obtain the desired results.

Management of Excessive Weight Loss Following Laparoscopic Roux-en-Y Gastric Bypass: Clinical Algorithm and Surgical Techniques.

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Akusoba, Ikemefuna; Birriel, T Javier; El Chaar, Maher

2016-01-01

There are no clinical guidelines or published studies addressing excessive weight loss and protein calorie malnutrition following a standard Roux-en-Y gastric bypass (RYGB) to guide nutritional management and treatment strategies. This study demonstrates the presentation, clinical algorithm, surgical technique, and outcomes of patients afflicted and successfully treated with excessive weight loss following a standard RYGB. Three patients were successfully reversed to normal anatomy after evaluation, management, and treatment by multidisciplinary team. Lowest BMI (kg/m(2)) was 18.9, 17.9, and 14.2, respectively. Twelve-month post-operative BMI (kg/m(2)) was 28.9, 22.8, and 26.1, respectively. Lowest weight (lbs) was 117, 128, and 79, respectively. Twelve-month post-operative weight (lbs) was 179, 161, and 145, respectively. Pre-reversal gastrostomy tube was inserted into the remnant stomach to demonstrate weight gain and improve nutritional status prior to reversal to original anatomy. We propose a practical clinical algorithm for the work-up and management of patients with excessive weight loss and protein calorie malnutrition after standard RYGB including reversal to normal anatomy.

Pancreaticojejunostomy, hepaticojejunostomy and double Roux-en-Y digestive tract reconstruction for benign pancreatic diseases

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Jia, Chang-Ku; Lu, Xue-Fei; Yang, Qing-Zhuang; Weng, Jie; Chen, You-Ke; Fu, Yu

2014-01-01

Surgery such as digestive tract reconstruction is usually required for pancreatic trauma and severe pancreatitis as well as malignant pancreatic lesions. The most common digestive tract reconstruction techniques (e.g., Child’s type reconstruction) for neoplastic diseases of the pancreatic head often encompass pancreaticojejunostomy, choledochojejunostomy and then gastrojejunostomy with pancreaticoduodenectomy, whereas these techniques may not be applicable in benign pancreatic diseases due to...

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

Roux-en-Y gastric bypass reverses the effects of diet-induced obesity to inhibit the responsiveness of central vagal motoneurones.

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Browning, Kirsteen N; Fortna, Samuel R; Hajnal, Andras

2013-05-01

Diet-induced obesity (DIO) has been shown to alter the biophysical properties and pharmacological responsiveness of vagal afferent neurones and fibres, although the effects of DIO on central vagal neurones or vagal efferent functions have never been investigated. The aims of this study were to investigate whether high-fat diet-induced DIO also affects the properties of vagal efferent motoneurones, and to investigate whether these effects were reversed following weight loss induced by Roux-en-Y gastric bypass (RYGB) surgery. Whole-cell patch-clamp recordings were made from rat dorsal motor nucleus of the vagus (DMV) neurones in thin brainstem slices. The DMV neurones from rats exposed to high-fat diet for 12-14 weeks were less excitable, with a decreased membrane input resistance and decreased ability to fire action potentials in response to direct current pulse injection. The DMV neurones were also less responsive to superfusion with the satiety neuropeptides cholecystokinin and glucagon-like peptide 1. Roux-en-Y gastric bypass reversed all of these DIO-induced effects. Diet-induced obesity also affected the morphological properties of DMV neurones, increasing their size and dendritic arborization; RYGB did not reverse these morphological alterations. Remarkably, independent of diet, RYGB also reversed age-related changes of membrane properties and occurrence of charybdotoxin-sensitive (BK) calcium-dependent potassium current. These results demonstrate that DIO also affects the properties of central autonomic neurones by decreasing the membrane excitability and pharmacological responsiveness of central vagal motoneurones and that these changes were reversed following RYGB. In contrast, DIO-induced changes in morphological properties of DMV neurones were not reversed following gastric bypass surgery, suggesting that they may be due to diet, rather than obesity. These findings represent the first direct evidence for the plausible effect of RYGB to improve vagal

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

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Neinast, Michael D.; Frank, Aaron P.; Zechner, Juliet F.; Li, Quanlin; Vishvanath, Lavanya; Palmer, Biff F.; Aguirre, Vincent; 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 natriuretic peptides (NPs) promote BRITE/beige adipocyte enrichment of WAT depots, an effect known as “browning.” Here, we investigate the effect of RYGB surgery on NP, NP receptors, and browning in the gonadal adipose tissues of female mice. We propose that such changes may lead to improvements in metabolic homeostasis commonly observed following RYGB. Methods Wild type, female, C57/Bl6 mice were fed a 60% fat diet ad libitum for six months. Mice were divided into three groups: Sham operated (SO), Roux-en-Y gastric bypass (RYGB), and Weight matched, sham operated (WM-SO). Mice were sacrificed six weeks following surgery and evaluated for differences in body weight, glucose homeostasis, adipocyte morphology, and adipose tissue gene expression. Results RYGB and calorie restriction induced similar weight loss and improved glucose metabolism without decreasing food intake. β3-adrenergic receptor expression increased in gonadal adipose tissue, in addition to Nppb (BNP), and NP receptors, Npr1, and Npr2. The ratio of Npr1:Npr3 and Npr2:Npr3 increased in RYGB, but not WM-SO groups. Ucp1 protein and mRNA, as well as additional markers of BRITE/beige adipose tissue and lipolytic genes increased in RYGB mice to a greater extent than calorie-restricted mice. Conclusions Upregulation of Nppb, Npr1, Npr2, and β3-adrenergic receptors in gonadal adipose tissue following RYGB was associated with increased markers of browning. This browning of gonadal adipose tissue may underpin the positive

Zinc nutritional status of morbidly obese patients before and after Roux-en-Y gastric bypass: a preliminary report.

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Cominetti, Cristiane; Garrido, Arthur Belarmino; Cozzolino, Silvia Maria Franciscato

2006-04-01

Previous researchers have found that the nutritional zinc status in obese and diabetic subjects is altered: low zinc concentrations in plasma and erythrocytes with high urinary zinc excretion were observed. This study assessed the influence of the Roux-en-Y gastric bypass (RYGBP) on the plasma, erythrocyte and urinary zinc concentrations before the beginning of the mineral supplementation. 24 morbidly obese patients were studied before and 2 months after RYGBP (the period in which the patients were still not ingesting mineral supplements). Fast blood sample, 24-hour urine, and 3-day food records were collected in the pre- and postoperative phases. Zinc concentration in the samples was analyzed by flame atomic absorption spectrophotometry, and dietary analysis of the food records were performed using the software Virtual Nutri with the inclusion of zinc concentration in the database for regional foods. Pre- and postoperative results were respectively: plasma 68.0 and 66.3 microg/dL; erythrocytes 36.6 and 43.8 microg/g Hb; urine 884.7 microg/24h and 385.9 microg/24h; and zinc intake 10.5 and 6.7 mg/day. These results suggest that RYGBP changed mainly the zinc erythrocyte and urinary concentrations. As expected, the zinc intake was lower in the postoperative phase, which in the medium and long term, could cause problems for the patients.

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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Anne-Sophie Schneck

2016-08-01

Full Text Available 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 9 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 3levels 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.

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/m(2)) 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/m(2)), 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.

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

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Silva, Cátia Ferreira da; Cohen, Larissa; Sarmento, Luciana d'Abreu; Rosa, Felipe Monnerat Marino; Rosado, Eliane Lopes; Carneiro, João Régis Ivar; Souza, Antônio Augusto Peixoto de; Magno, Fernanda Cristina Carvalho Mattos

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. 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. 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. 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 pEm função do alto grau de falência que se observa no tratamento clínico da obesidade mórbida, observa-se um aumento da procura pela cirurgia bariátrica como alternativa para o controle da obesidade e comorbidades. Avaliar a evolução do diabete melito tipo 2, da hipertensão arterial sistêmica e da dislipidemia em pacientes submetidos à gastroplastia redutora em Y-de-Roux no período de pós-operatório tardio. Análise retrospectiva de 59 pacientes inseridos em programa de cirurgia bariátrica. Foram coletados dados antropométricos (altura e peso corporal) e laboratoriais (LDLc, HDLc, VLDLc, triglicerídeo -TG - e glicose) nos períodos pré e pós-operatório por meio de prontuários médicos. Entre os pacientes, 86% eram mulheres com idade de 43±11 anos e 52% tinham cursado o ensino médio. O tempo médio de pós-operatório foi de 7±3 anos. Houve redução no peso e no índice de massa corporal no pós-operatório, respectivamente (133±06 kg vs 91±04 kg pem tratamento para hipertensão arterial sistêmica. Houve remissão do diabete melito tipo 2 e da dislipidemia em 81

The impact of Roux-en-Y gastric bypass surgery on normal metabolism in a porcine model.

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Andreas Lindqvist

Full Text Available A growing body of literature on Roux-en-Y gastric bypass surgery (RYGB has generated inconclusive results on the mechanism underlying the beneficial effects on weight loss and glycaemia, partially due to the problems of designing clinical studies with the appropriate controls. Moreover, RYGB is only performed in obese individuals, in whom metabolism is perturbed and not completely understood.In an attempt to isolate the effects of RYGB and its effects on normal metabolism, we investigated the effect of RYGB in lean pigs, using sham-operated pair-fed pigs as controls. Two weeks post-surgery, pigs were subjected to an intravenous glucose tolerance test (IVGTT and circulating metabolites, hormones and lipids measured. Bile acid composition was profiled after extraction from blood, faeces and the gallbladder.A similar weight development in both groups of pigs validated our experimental model. Despite similar changes in fasting insulin, RYGB-pigs had lower fasting glucose levels. During an IVGTT RYGB-pigs had higher insulin and lower glucose levels. VLDL and IDL were lower in RYGB- than in sham-pigs. RYGB-pigs had increased levels of most amino acids, including branched-chain amino acids, but these were more efficiently suppressed by glucose. Levels of bile acids in the gallbladder were higher, whereas plasma and faecal bile acid levels were lower in RYGB- than in sham-pigs.In a lean model RYGB caused lower plasma lipid and bile acid levels, which were compensated for by increased plasma amino acids, suggesting a switch from lipid to protein metabolism during fasting in the immediate postoperative period.

Comparison of quality of life between Billroth-І and Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: A randomized controlled trial.

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Yang, Kun; Zhang, Wei-Han; Liu, Kai; Chen, Xin-Zu; Zhou, Zong-Guang; Hu, Jian-Kun

2017-09-12

Studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) anastomosis are still lacking and inconsistent. The aim of this trial was to compare the quality of life (QoL) of B-I with R-Y reconstruction after curative distal gastrectomy for gastric cancer. A total of 140 patients were randomly assigned to the B-I group (N = 70) and R-Y group (N = 70) with the comparable baseline characteristics. The overall postoperative morbidity rates were 18.6% and 25.7% in the B-I group and R-Y group without significant difference. More estimated blood loss and longer surgical duration were found in the R-Y group. At the postoperative 1 year time point, the B-I group had a higher score in pain, but lower score in global health. However, the R-Y anastomosis was associated with lower incidence of reflux symptoms at postoperative 6 months (P = 0.002) and postoperative 9 months (P = 0.007). The multivariable analyses of variance did not show any interactions between the time trend and grouping. For the results of endoscopic examination, the degree and extent of remnant gastritis were milder significantly in the R-Y group. The stronger anti-reflux capability of R-Y anastomosis contributes to the higher QoL by reducing the reflux related gastritis and pain symptoms, and promotes a better global health.

Longitudinal trends in hedonic hunger after Roux-en-Y gastric bypass in adolescents.

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Cushing, Christopher C; Benoit, Stephen C; Peugh, James L; Reiter-Purtill, Jennifer; Inge, Thomas H; Zeller, Meg H

2014-01-01

Initial outcome studies have reported that Roux-en-Y gastric bypass (RYGB) is safe and efficacious for adolescents with extreme obesity. Although rapid weight loss is seen initially, data also show that modest weight regain typically occurs as early as the second postoperative year. The contribution of various psychological factors, including hedonic hunger, to postoperative weight regain has not previously been studied in adolescents. The objective of this study was to examine the variability in hedonic hunger and body mass index (BMI) over the initial 2-year period of weight loss and modest weight regain in adolescent RYGB recipients. A total of 16 adolescents completed the Power of Food Scale before surgery and at 3, 6, 12, 18, and 24 months postoperatively. Height and weight were measured at each time point, from which BMI was calculated. Nonlinear trends were observed for time on both overall hedonic hunger and hedonic hunger specifically related to food available in the adolescent's environment. The BMI reduction during the first 18 months postoperatively was paralleled by reduction in hedonic hunger; increases in hedonic hunger also paralleled the modest BMI increase at 24 months. In growth analysis, significant power gains are available to models using 4 or more points of data. However, only large effect sizes that are>.85 were detectable with a sample of 16 patients. These data provide preliminary evidence that hedonic hunger is in need of further study in adolescent patients receiving RYGB both preoperatively and postoperatively. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Changes in eating behaviour and meal pattern following Roux-en-Y gastric bypass.

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Laurenius, A; Larsson, I; Bueter, M; Melanson, K J; Bosaeus, I; Forslund, H Bertéus; Lönroth, H; Fändriks, L; Olbers, T

2012-03-01

Little is known about eating behaviour and meal pattern subsequent to Roux-en-Y gastric bypass (RYGB), knowledge important for the nutritional care process. The objective of the study was to obtain basic information of how meal size, eating rate, meal frequency and eating behaviour change upon the RYGB surgery. Voluntary chosen meal size and eating rate were measured in a longitudinal, within subject, cohort study of 43 patients, 31 women and 12 men, age 42.6 (s.d. 9.7) years, body mass index (BMI) 44.5 (4.9) kg m(-2). Thirty-one non-obese subjects, 37.8 (13.6) years, BMI 23.7 (2.7) kg m(-2) served as a reference group. All subjects completed a meal pattern questionnaire and the Three-Factor Eating Questionnaire (TFEQ-R21). Six weeks postoperatively meal size was 42% of the preoperative meal size, (Pmeal size increased but was still lower than preoperative size 57% (Pmeal duration was constant before and after surgery. Mean eating rate measured as amount consumed food per minute was 45% of preoperative eating rate 6 weeks postoperatively (Pmeals per day increased from 4.9 (95% confidence interval, 4.4,5.4) preoperatively to 6 weeks: 5.2 (4.9,5.6), (not significant), 1 year 5.8 (5.5,6.1), (P=0.003), and 2 years 5.4 (5.1,5.7), (not significant). Emotional and uncontrolled eating were significantly decreased postoperatively, (both Pmeal patterns, which may lead to sustained weight loss.

Balloon dilatation for the treatment of stricture of gastrojejunostomy

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Choi, Yeon Hwa [Lee Rha Hospital, Chungju (Korea, Republic of); Song, Ho Young [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Han, Young Min; Chon, Su Bin; Chung, Gyung Ho; Kim, Chong Soo; Choi, Ki Chul [Chonbuk National University College of Medicine, Chungju (Korea, Republic of)

1993-07-15

Enteroenteric anastomotic strictures of UGI tract are common and require treatment if significant obstruction occurs. We performed fluoroscopic guided balloon dilatation in 6 patients who had symptomatic stricture of gastrojejunostomy. The stricture was successfully resolved in 4 patients with benign stricture. But 2 patients with malignant stricture had recurrence of obstructive symptoms 2 weeks later, and they required a stent. Asymptomatic balloon rupture was seen in one patients, but other procedural complications did not occur. We found that fluoroscopic guided balloon dilatation is an effective and safe method in the treatment of anastomotic stricture of gastrojejunostomy. We also found transient effect in malignant gastrojejunal anastomotic strictures, which required an interventional procedure, such as placement of a stent.

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

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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

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)

Reduction in cardiovascular risk factors and insulin dose, but no beta-cell regeneration 1 year after Roux-en-Y gastric bypass in an obese patient with type 1 diabetes

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

2013-01-01

Experience with Roux-en-Y gastric bypass in patients with type 1 diabetes is very limited, despite an increasing prevalence of obesity also in this population. We describe changes in anthropometric measures, insulin dose, HbA1c, blood pressure, lipid status, and metabolic response to a liquid mixed...... meal throughout the first year after RYGB in an obese patient with type 1 diabetes. No change in HbA1c was observed, but a 48% reduction in weight-adjusted insulin dose and improvements in cardiovascular risk factors was seen 1 year after surgery. Exaggerated secretions of anorexigenic gut hormones...

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

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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...... or vertical banded gastroplasty and matched for weight and fat mass loss. The two surgical procedures induced similar and durable changes on the gut microbiome that were not dependent on body mass index and resulted in altered levels of fecal and circulating metabolites compared with obese controls....... By colonizing germ-free mice with stools from the patients, we demonstrated that the surgically altered microbiota promoted reduced fat deposition in recipient mice. These mice also had a lower respiratory quotient, indicating decreased utilization of carbohydrates as fuel. Our results suggest that the gut...

Impact of Roux-en-Y Gastric Bypass on Metabolic Syndrome and Insulin Resistance Parameters

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Gestic, Martinho Antonio; Utrini, Murillo Pimentel; Machado, Ricardo Rossetto; Geloneze, Bruno; Pareja, José Carlos; Chaim, Elinton Adami

2014-01-01

Abstract Background: Metabolic syndrome (MetS) is a complex association of clustering metabolic factors that increase risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease. Surgical treatment has become an important tool to achieve its control. The aim of this study was to evaluate the impact of Roux-en-Y gastric bypass (RYGB) on MetS and its individual components, clinical characteristics, and biochemical features. Subjects and Methods: The study is a retrospective cohort of 96 subjects with MetS who underwent RYGB and were evaluated at baseline and after surgery. Clinical and biochemical features were analyzed. Results: After surgery, significant rates of resolution for MetS (88.5%), T2DM (90.6%), hypertension (85.6%), and dyslipidemias (54.2%) were found. Significant decreases in levels of fasting glucose, fasting insulin, hemoglobin A1c, low-density lipoprotein, and triglycerides and an increase in high-density lipoprotein level were also shown. The decrease in insulin resistance evaluated by homeostasis model assessment (HOMA-IR) was consistent. MetS resolution was associated with postoperative glycemic control, decreases in levels of fasting glucose, hemoglobin A1c, HOMA-IR, and triglycerides and in antihypertensive usage, and percentage weight loss. Conclusions: This study found high rates of resolution for MetS, T2DM, hypertension, and dyslipidemias after RYGB in obese patients. This finding was consistent with current literature. Hence RYGB should be largely indicated for this group of subjects as it is a safe and powerful tool to achieve MetS control. PMID:24299427

Self-expanding metal stents versus antrectomy for the palliative treatment of obstructive adenocarcinoma of the gastric antrum Prótesis metálicas autoexpandibles versus antrectomía en el tratamiento paliativo del adenocarcinoma obstructivo del antro gástrico

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Juan Octavio Alonso-Larraga

2012-04-01

Full Text Available Background: gastric cancer patients are first diagnosed with an unresectable tumor in up to 40% of cases. Gastric outlet obstruction causes nausea, vomiting, dehydration and malnutrition. The aim of the study was to compare self-expanding metal stents to antrectomy and Roux-en Y gastrojejunostomy for palliation of obstructive adenocarcinoma of the gastric antrum. Methods: retrospective study in patients with obstructing cancer of the gastric antrum. Patients were divided into two groups: group A, underwent endoscopic placement of self-expanding metal stents and group B underwent surgical treatment with antrectomy and Roux-en Y gastrojejunostomy. Collected Data included: age, gender, performance status (Karnofsky's score, body mass index, histopathology, clinical stage (TNM classification, technical and clinical success of the procedure, time to oral intake, in-hospital stay, re-intervention rate, and complications related to the treatment and survival. Results: a total of 39 patients with gastric adenocarcinoma were included, 21 male and 18 female. Nineteen patients were assigned to group A and 20 patients to group B. There were no statistically significant differences between groups in regards to age, body mass index, Karnofsky's score and clinical stage. The technical and clinical success was similar for both groups. There was a statistically significant difference between groups favoring Self-expanding metal stent in time to oral intake (1 ± 0 vs. 4.9 ± 0.6 days, p = 0.0001 and in-hospital stay (0.94 ± 1.18 vs. 7.8 ± 7.7 days, p = 0.0005. We did not find statistically significant differences with regards to long-term survival. Conclusions: in patients with malignant gastric outlet obstruction due to gastric cancer, endoscopic palliation with self-expanding metal stents provide a shorter interval to oral intake, shorter in-hospital stay and lower rate of complications.Introducción: los pacientes con cáncer gástrico tienen un tumor

EUS-directed Transgastric ERCP (EDGE) Versus Laparoscopy-assisted ERCP (LA-ERCP) for Roux-en-Y Gastric Bypass (RYGB) Anatomy: A Multicenter Early Comparative Experience of Clinical Outcomes.

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Kedia, Prashant; Tarnasky, Paul R; Nieto, Jose; Steele, Stephen L; Siddiqui, Ali; Xu, Ming-Ming; Tyberg, Amy; Gaidhane, Monica; Kahaleh, Michel

2018-04-17

The standard of care for managing pancreaticobiliary disease in altered Roux-en-Y gastric bypass patients is laparoscopy-assisted endoscopic retrograde cholangiopancreatography (LA-ERCP), but is limited by cost and adverse events. Recently a minimally invasive, completely endoscopic approach using endoscopic ultrasound (EUS) directed transgastric ERCP (EDGE) has been described. We aim to compare EDGE to LA-ERCP in this study. Patients from May 2005 to June 2017 with Roux-en-Y gastric bypass anatomy having undergone LA-ERCP or EDGE at 4 tertiary centers were captured in a registry. Patient demographics, procedural details, and clinical outcomes were measured for each group. Seventy-two patients (n=29 EDGE, n=43 LA-ERCP) were included in this study. There was no significant difference in the technical success of EDGE gastrogastric fistula (96.5%) versus LA-gastrostomy creation (100%). The success rate of achieving therapeutic ERCP (EDGE 96.5% vs. LA-ERCP 97.7%) and number of ERCP (EDGE 1.2 vs. LA-ERCP 1.02) needed to achieve clinical resolution was similar between both groups. Adverse event rate for EDGE, 24% (7/29) and LA-ERCP, 19% (8/43) was similar. The total procedure time (73 vs. 184 min) and length of hospital stay (0.8 vs. 2.65 d) was significantly shorter for EDGE compared to LA-ERCP. The overall weight change after EDGE was -6.6 lbs at an average 28-week follow-up. This study suggests that the EDGE procedure has similar technical success and adverse events compared with LA-ERCP with the benefit of significantly shorter procedure times and hospital stay. EDGE may offer a minimally invasive, effective option, with less resource utilization, and without significant weight gain.

Single- and double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y plus hepaticojejunostomy anastomosis and Whipple resection.

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Itokawa, Fumihide; Itoi, Takao; Ishii, Kentaro; Sofuni, Atsushi; Moriyasu, Fuminori

2014-04-01

In patients with Roux-en-Y hepaticojejunostomy (HJ with R-Y) and Whipple resection, endoscopic retrograde cholangiopancreatography (ERCP) can be challenging. We report our experience with ERCP using balloon-assisted enteroscopy (BAE) (BAE-ERCP) in patients with HJ with R-Y, and Whipple resection. BAE-ERCP procedures were carried out in 62 patients (HJ with R-Y:Whipple resection=34:28). Overall, the rates of reaching the anastomosis were 85.3% (29/34) in HJ with R-Y and 96.4% (27/28) in Whipple resection. In terms of HJ with R-Y, insertion success rate by standard single-balloon enteroscopy (SBE) was 89.3% (25/28). Insertion success rate by short BAE, including SBE and double-balloon enteroscopy (DBE), was 50% (3/6). There was a statistically significant difference of insertion success rate between standard long BE and short BE (P=0.021). However, in the Whipple patients, insertion success rate by standard and short SBE was 93.8% (15/16) and 91.7% (11/12), respectively. Initial insertion success rate by short BAE in Whipple patients was significantly higher than in HJ with R-Y (91.7% vs 50%, P=0.045). Therapeutic interventions included dilation of anastomosis stricture, stone extraction, endoscopic mechanical lithotripsy, biliary stent placement, stent extraction, endoscopic nasobiliary drainage, direct cholangioscopy, and electrohydraulic lithotripsy. Our HJ with R-Y series and Whipple series treatment success rate was 90% (18/20) and 95.0% (19/20), respectively. BAE-ERCP enabled ERCP to be carried out in patients with HJ. It is considered safe and feasible. Further experience and device improvement are needed. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

Roux-en Y gastric bypass surgery reduces hedonic hunger and improves dietary habits in severely obese subjects.

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Ullrich, Jennifer; Ernst, Barbara; Wilms, Britta; Thurnheer, Martin; Schultes, Bernd

2013-01-01

Many obese subjects suffer from an increased hedonic drive to consume palatable foods, i.e., hedonic hunger, and often show unfavorable dietary habits. Here, we investigated changes in the hedonic hunger and dietary habits after Roux-en-Y gastric bypass (RYGB) surgery. Forty-four severely obese patients were examined before and on average 15.9 ± 0.9 months after RYGB surgery with the Power of Food Scale (PFS), a questionnaire that reliably measures an individual's motivation to consume highly palatable foods but not actual consumptive behavior. Dietary habits were assessed by a food frequency questionnaire. After the RYGB procedure, patients showed markedly lower aggregated PFS scores and sub-domain scores related to generally available, physically present, as well as tasted foods than before the surgery (all P habits after the surgery were characterized by a more frequent consumption of poultry, fish, eggs, and cooked vegetables (P habits characterized by an increased intake of protein-rich foods and vegetables and a reduced consumption of sugar-containing snacks and beverages after RYGB surgery. Based on these findings, it can be speculated that the reduction of the hedonic drive to consume palatable foods induced by RYGB surgery helps severely obese patients to establish healthier dietary habits.

Roux-en-Y or Billroth II Reconstruction After Radical Distal Gastrectomy for Gastric Cancer: A Multicenter Randomized Controlled Trial.

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So, Jimmy Bok-Yan; Rao, Jaideepraj; Wong, Andrew Siang-Yih; Chan, Yiong-Huak; Pang, Ning Qi; Tay, Amy Yuh Ling; Yung, Man Yee; Su, Zheng; Phua, Janelle Niam Sin; Shabbir, Asim; Ng, Enders Kwok Wai

2018-02-01

The aim of the study was to compare the clinical symptoms between Billroth II (B-II) and Roux-en-Y (R-Y) reconstruction after distal subtotal gastrectomy (DG) for gastric cancer. Surgery is the mainstay of curative treatment for gastric cancer. The technique for reconstruction after DG remains controversial. Both B-II and R-Y are popular methods. This is a prospective multicenter randomized controlled trial. From October 2008 to October 2014, 162 patients who underwent DG were randomly allocated to B-II (n = 81) and R-Y (n = 81) groups. The primary endpoint is Gastrointestinal (GI) Symptoms Score 1 year after surgery. We also compared the nutritional status, extent of gastritis on endoscopy, and quality of life after surgery between the 2 procedures at 1 year. Operative time was significantly shorter for B-II than for R-Y [mean difference 21.5 minutes, 95% confidence interval (95% CI) 3.8-39.3, P = 0.019]. The B-II and R-Y groups had a peri-operative morbidity of 28.4% and 33.8%, respectively (P = 0.500) and a 30-day mortality of 2.5% and 1.2%, respectively (P = 0.500). GI symptoms score did not differ between R-Y versus B-II reconstruction (mean difference -0.45, 95% CI -1.21 to 0.31, P = 0.232). R-Y resulted in a lower median endoscopic grade for gastritis versus B-II (mean difference -1.32, 95% CI -1.67 to -0.98, P Y versus B-II mean difference -0.31, 95% CI -3.27 to 2.65, P = 0.837) and quality of life at 1 year between the 2 groups too. Although BII is associated with a higher incidence of heartburn symptom and higher median endoscopic grade for gastritis, BII and RY are similar in terms of overall GI symptom score and nutritional status at 1 year after distal gastrectomy.

Predictive factors of Gastrointestinal motility Dysfunction after gastrojejunostomy for peptic ulcer stenosis.

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Ayadi, Sofiene; Daghfous, Amine; Saidani, Ahmed; Haddad, Anis; Magherbi, Houcine; Jouini, Mohamed; Kacem, Montassar; Ben Safta, Zoubeir

2014-10-01

Despite the establishment of effective medical therapies in peptic ulcer disease, gastric outlet obstruction remains one of the most common health problem in Tunisia. Various operations have been attempted, which may lead to postoperative morbidity. Gastrointestinal (GI) motility dysfunction is the most common complications. to determine the predictive factor of gastrointestinal motility dysfunction after gastrojejunostomy for peptic ulcer stenosis. We carried out a retrospective study to evaluate the postoperative recovery of the motility of the upper gastrointestinal tract after gastrojejunostomy for peptic ulcer stenosis. During the 9- year study, 138 patients underwent operations for ulcer peptic stenosis. Among the patients, 116 (84,1%) were treated with gastrojejunostomy. Descriptive statistics, univariate and multivariate analyses were performed. The mean age of patients was 47.85 years (range: 19- 92years) and most. Were male (84, 5 %). Ninety two (79.3%) patients had a documented history of peptic ulcer disease. The duration of symptoms ranged from 10 to 372 days (mean: 135.86 days). Eighty two (71%) patients were operated on through laparotomy. Laparoscopic procedure was performed in 29% of the patients. There was no operative mortality. Perioperative morbidity occurred in 12.4% (14 patients). Gastrointestinal motility dysfunction occurred in 12 patients (10.3%). It was treated by nasogastric aspiration and prokinetics. By univariate analysis; diabetes (0,010), cachexia (0,049), ASA class (0.05) were all statistically associated with gastrointestinal motility dysfunction in this series. Multivariate logistic regression analysis (table 2) showed that the cachexia (0,009), ASA class (0.02) were the main predictors of gastrointestinal motility dysfunction after gastrojejunostomy for peptic ulcer stenosis in the followed patients. Gastrointestinal motility dysfunction is the most common complications after gastrojejunostomy for pyloric adult stenosis. Surgery

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

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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.

Trends in Weight Regain Following Roux-en-Y Gastric Bypass (RYGB) Bariatric Surgery.

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Cooper, Timothy C; Simmons, Elizabeth B; Webb, Kirsten; Burns, James L; Kushner, Robert F

2015-08-01

The primary purpose of this study was to assess weight loss and occurrence of weight regain among patients who underwent Roux-en-Y gastric bypass (RYGB) using categorical analysis. Study participants were selected from patients who underwent RYGB from a single institution. Participants (n = 300, mean procedure age = 45.6 ± 9.9) completed surveys for self-reported preoperative weight, current weight, and subsequent weights over postoperative years. Measured weights and confirmed procedure dates were acquired from patient medical records. Mean preoperative weight and BMI were 140.8 kg ± 32.1 and 49.7 ± 9.9, respectively, and mean years since surgery was 6.9 ± 4.9. Study subjects were mostly Caucasian (56.7 %) and female (80.3 %). Participants were stratified a priori into four cohorts based on percent of weight loss at 1 year, 35 % (n = 113). General linear model analyses were conducted to assess the effect of year one weight loss on percent weight regain. The mean weight regain for all patients was 23.4 % of maximum weight loss. Using categorical analysis, mean weight regain in the 35 % weight loss cohorts was 29.1, 21.9, 20.9, and 23.8 %, respectively. Excessive weight regain, defined as ≥25 % of total lost weight, occurred in 37 % of patients. Weight gain is a common complication following RYGB surgery. Despite the percentage of weight loss over the first year, all cohort patient groups regained on average between 21 and 29 % of lost weight. Excessive weight gain was experienced by over one third of patients. Greater initial absolute weight loss leads to more successful long-term weight outcomes.

Excepcionalismo y performances marianistas en Gabriela Mistral

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Antonieta Vera Gajardo

2015-07-01

Full Text Available El presente trabajo propone la noción "performances marianistas" como clave de lectura de algunas de las auto-representaciones que Gabriela Mistral habría utilizado en un contexto sociopolítico específico, en el cual el "excepcionalismo" se presenta como estrategia conducente a la promesa de igualdad. Este análisis nos llevará a pensar en las construcciones de género y "raza" de las cuales dependen los sistemas de valores que sostuvieron "la femineidad legítima" en la época en la que Mistral vivió. El texto tiene tres partes: la primera enunciará algunos debates y tomará posición con respecto al relato del marianismo latinoamericano. La segunda, problematizará las estrategias paradójicas del "excepcionalismo". La última, propone una lectura de las figuras que sugiero leer bajo las claves del marianismo y del excepcionalismo: "la Maestra de América Latina" y "la Poeta Redentora".

Roux-en-Y gastric bypass surgery suppresses hypothalamic PTP1B protein level and alleviates leptin resistance in obese rats.

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Liu, Jia-Yu; Mu, Song; Zhang, Shu-Ping; Guo, Wei; Li, Qi-Fu; Xiao, Xiao-Qiu; Zhang, Jun; Wang, Zhi-Hong

2017-09-01

The present study aimed to explore the effect of Roux-en-Y gastric bypass (RYGB) surgery on protein tyrosine phosphatase 1B (PTP1B) expression levels and leptin activity in hypothalami of obese rats. Obese rats induced by a high-fat diet (HFD) that underwent RYGB (n=11) or sham operation (SO, n=9), as well as an obese control cohort (Obese, n=10) and an additional normal-diet group (ND, n=10) were used. Food efficiency was measured at 8 weeks post-operation. Plasma leptin levels were evaluated and hypothalamic protein tyrosine phosphatase 1B (PTP1B) levels and leptin signaling activity were examined at the genetic and protein levels. The results indicated that food efficiency was typically lower in RYGB rats compared with that in the Obese and SO rats. In the RYGB group, leptin receptor expression and proopiomelanocortin was significantly higher, while Neuropeptide Y levels were lower than those in the Obese and SO groups. Furthermore, the gene and protein expression levels of PTP1B in the RYGB group were lower, while levels of phosphorylated signal transducer and activator of transcription 3 protein were much higher compared with those in the Obese and SO groups. In conclusion, RYGB surgery significantly suppressed hypothalamic PTP1B protein expression. PTP1B regulation may partially alleviate leptin resistance.

Gastrojejunostomy without partial gastrectomy to manage duodenal stenosis in a dog

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Johannes J. Nel

2015-12-01

Full Text Available A nine-year-old female Rottweiler with a history of repeated gastrointestinal ulcerations and three previous surgical interventions related to gastrointestinal ulceration presented with symptoms of anorexia and intermittent vomiting. Benign gastric outflow obstruction was diagnosed in the proximal duodenal area. The initial surgical plan was to perform a pylorectomy with gastroduodenostomy (Billroth I procedure, but owing to substantial scar tissue and adhesions in the area a palliative gastrojejunostomy was performed. This procedure provided a bypass for the gastric contents into the proximal jejunum via the new stoma, yet still allowed bile and pancreatic secretions to flow normally via the patent duodenum. The gastrojejunostomy technique was successful in the surgical management of this case, which involved proximal duodenal stricture in the absence of neoplasia. Regular telephonic followup over the next 12 months confirmed that the patient was doing well.

Gastrojejunostomy without partial gastrectomy to manage duodenal stenosis in a dog.

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Nel, Johannes J; du Plessis, Cornelius J; Coetzee, Gert L

2015-12-09

A nine-year-old female Rottweiler with a history of repeated gastrointestinal ulcerations and three previous surgical interventions related to gastrointestinal ulceration presented with symptoms of anorexia and intermittent vomiting. Benign gastric outflow obstruction was diagnosed in the proximal duodenal area. The initial surgical plan was to perform a pylorectomy with gastroduodenostomy (Billroth I procedure), but owing to substantial scar tissue and adhesions in the area a palliative gastrojejunostomy was performed. This procedure provided a bypass for the gastric contents into the proximal jejunum via the new stoma, yet still allowed bile and pancreatic secretions to flow normally via the patent duodenum. The gastrojejunostomy technique was successful in the surgical management of this case, which involved proximal duodenal stricture in the absence of neoplasia. Regular telephonic followup over the next 12 months confirmed that the patient was doing well.

Time course metabolome of Roux-en-Y gastric bypass confirms correlation between leptin, body weight and the microbiome.

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Loqmane Seridi

Full Text Available Roux-en-Y gastric bypass (RYGB is an effective way to lose weight and reverse type 2 diabetes. We profiled the metabolome of 18 obese patients (nine euglycemic and nine diabetics that underwent RYGB surgery and seven lean subjects. Plasma samples from the obese patients were collected before the surgery and one week and three months after the surgery. We analyzed the metabolome in association to five hormones (Adiponectin, Insulin, Ghrelin, Leptin, and Resistin, four peptide hormones (GIP, Glucagon, GLP1, and PYY, and two cytokines (IL-6 and TNF. PCA showed samples cluster by surgery time and many microbially driven metabolites (indoles in particular correlated with the three months after the surgery. Network analysis of metabolites revealed a connection between carbohydrate (mannosamine and glucosamine and glyoxylate and confirms glyoxylate association to diabetes. Only leptin and IL-6 had a significant association with the measured metabolites. Leptin decreased immediately after RYGB (before significant weight loss, whereas IL-6 showed no consistent response to RYGB. Moreover, leptin associated with tryptophan in support of the possible role of leptin in the regulation of serotonin synthesis pathways in the gut. These results suggest a potential link between gastric leptin and microbial-derived metabolites in the context of obesity and diabetes.

Clinical application of percutaneous gastrostomy and gastrojejunostomy under fluoroscopic guidance

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Zhou Jianping; Wang Zhongmin; Liu Tao; Chen Kemin; Gong Ju; Zheng Yunfeng; Chen Zhijin; Shen Jieyun

2011-01-01

Objective: To evaluate the safety and effectiveness of percutaneous gastrostomy (PRG) and gastrojejunostomy (PRGJ) under fluoroscopic guidance, and to discuss its technical manipulation, the indications and contraindications as well as the complications. Methods: During the period from May 2002 to June 2010 in authors' hospital fluoroscopically-guided PRG or PRGJ was carried out in 40 patients. The clinical data were retrospectively analyzed. With Seldinger technique and under fluoroscopic guidance, a 14 F radiopaque gastrostomy or gastrojejunostomy feeding catheter was successfully placed. The indications, operation procedures, clinical success rate, procedure-related complications, and tube indwelling time, etc. were discussed and analyzed. Results: PRG was conducted in 30 patients. The reasons for performing PRG included neurologic disease (n=13), recurrent aspiration pneumonia (n=6), gastroesophageal reflux due to disfunction of gastrointestinal tract (n=3), subtotal gastrectomy (n=2), esophagomediastinal fistula (n=1) and esophageal carcinoma (n=5). PRGJ was carried out in 10 patients. The disorders included bulbar paralysis (n=3), malignant duodenal obstruction (n=4) and previous gastrostomy-related complications (n=3). Two anchors were used in all patients receiving PRG or PRGJ. Clinical success was achieved in all study patients. No procedure-related or severe complications occurred. Minor complications were observed in four patients (10%), which included local soft tissue infection (n=1), severe puncture site pain (n=1), gastrostomy tube dislodgement (n=1) and obstruction of gastrojejunostomy tube (n=1). During the follow-up period, no aggravation of gastroesophageal reflux or aspiration pneumonia was observed in all patients. The tube indwelling time was 115 to 585 days (mean of 150 days) after tube placement. Conclusion: Fluoroscopically-guided percutaneous gastrostomy or gastrojejunostomy is a safe, simple and minimally-invasive technique. This

Alterações nos parâmetros pré e pós-operatórios de pacientes com síndrome metabólica, submetidos a Bypass gastrointestinal em Y de Roux Changes in the pre- and postoperative parameters in metabolic syndrome patients submitted to Roux-en-Y gastric bypass

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Paulo Afonso Nunes Nassif

2009-09-01

Full Text Available RACIONAL: A epidemia mundial de sobrepeso e obesidade afeta aproximadamente 1,7 bilhão de pessoas, havendo aumento nos casos de obesidade mórbida de 80% para mulheres e de 400% para homens desde 1970. A síndrome metabólica é transtorno complexo relacionado com resistência à insulina e obesidade abdominal, provocando alterações no metabolismo da glicose em vários tecidos e hiperinsulinemia. OBJETIVO: Verificar as alterações nos parâmetros pré e pós-operatórios em pacientes obesos mórbidos com síndrome metabólica, submetidos a bypass gastrointestinal em Y de Roux. MÉTODO: Casuística de 74 pacientes obesos, que apresentavam síndrome metabólica e submetidos a procedimento cirúrgico. Foram avaliados, além do IMC, a relação cintura-quadril, pressão arterial, colesterol total, HDL, LDL, triglicerídeos, glicemia de jejum no pré-operatório e no 1º e 4º meses de pós-operatório. Para variáveis que apresentaram simetria na sua distribuição, foi usado o teste t de Student para amostras pareadas. Para variáveis com distribuição assimétrica, foi usado o teste não-paramétrico de Wilcoxon. Valores de PBACKGROUND: Overweight and obesity affects approximately 1.7 billion people, with increase in morbid obesity of 80% for women and 400% for men, since 1970. Metabolic syndrome is a complex disorder associated with insulin resistance and abdominal obesity, causing changes in glucose metabolism in various tissues and hyperinsulinemia. AIM: To verify changes in the pre and post-operative parameters in morbidly obese patients with metabolic syndrome who underwent to Roux-en-Y gastrointestinal bypass. METHOD: Seventy four patients with obesity with metabolic syndrome submitted to gastrointestinal bypass Roux-en-Y were included. All of them had measured waist-hip ratio, blood pressure, total cholesterol, HDL, LDL, triglycerides and fasting glucose pre-operatively and at the first and fourth month post-operatively. RESULTS: In

Is Daily Low-Dose Aspirin Safe to Take Following Laparoscopic Roux-en-Y Gastric Bypass for Obesity Surgery?

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Kang, Xian; Hong, Dennis; Anvari, Mehran; Tiboni, Maria; Amin, Nalin; Gmora, Scott

2017-05-01

Laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery is a safe and effective procedure for patients with severe obesity. One potential complication of LRYGB is the development of marginal ulcers (MUs). Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to significantly increase the likelihood of developing marginal ulcers after surgery. However, the risk associated with low-dose aspirin consumption is not well defined. We examined the impact of daily low-dose aspirin (81 mg) on the development of marginal ulcers following LRYGB. A retrospective cohort design studied patients undergoing LRYGB surgery, between January 2009 and January 2013, at a single, high-volume bariatric center in Ontario, Canada. The marginal ulcer rate of patients taking low-dose aspirin after surgery was compared to that of the control patients who did not take any NSAID. Diagnosis of MU was confirmed by upper endoscopy in patients presenting with symptoms and a history indicative of marginal ulceration. A chi-square test of independence was performed to examine the difference in marginal ulcer rates. A total of 1016 patients underwent LRYGB. Patients taking aspirin were more likely to be male, older, and have diabetes than patients not taking NSAIDs. Of the 1016 patients, 145 (14.3%) took low-dose aspirin following LRYGB and the rest did not (n = 871, 85.7%). The incidence of marginal ulceration was not significantly different between the two treatment groups (12/145, 8.3% versus 90/871, 10.3%; p = 0.45). Patients treated with LRYGB at our institution were not at increased risk of marginal ulcer formation when taking low-dose aspirin after surgery.

Enhanced glucose metabolism in cultured human skeletal muscle after Roux-en-Y gastric bypass surgery.

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Nascimento, Emmani B M; Riedl, Isabelle; Jiang, Lake Qunfeng; Kulkarni, Sameer S; Näslund, Erik; Krook, Anna

2015-01-01

Roux-en-Y gastric bypass (RYGB) surgery rapidly increases whole body insulin sensitivity, with changes in several organs including skeletal muscle. Objectives were to determine whether improvements in insulin action in skeletal muscle may occur directly at the level of the myocyte or secondarily from changes in systemic factors associated with weight loss. Myotubes were derived before and after RYGB surgery. The setting was Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden. Eight patients (body mass index (BMI) 41.8 kg/m(2); age 41 yr) underwent RYGB surgery. Before and 6 months after RYGB surgery, skeletal muscle biopsies were collected from vastus lateralis muscle. Satellite cells derived from skeletal muscle biopsies were propagated in vitro as myoblasts and differentiated into myotubes. Expression of myogenic markers is increased in myoblasts derived from biopsies taken 6 months after bypass surgery, compared with their respective presurgery condition. Furthermore, glycogen synthesis, tyrosine phosphorylation of insulin receptor (IRS)-1-Tyr612 and Interleukin (IL)-8 secretion were increased, while fatty acid oxidation and circulating IL8 levels remain unaltered. Myotubes derived from muscle biopsies obtained after RYGB surgery displayed increased insulin-stimulated phosphorylation of protein kinase B (PKB)-Thr308 and proline-rich Akt substrate of 40 kDa (PRAS40)-Thr246. RYGB surgery is accompanied by enhanced glucose metabolism and insulin signaling, altered IL8 secretion and changes in mRNA levels and myogenic markers in cultured skeletal muscle cells. Thus, RYGB surgery involves intrinsic reprogramming of skeletal muscle to increase peripheral insulin sensitivity and glucose metabolism. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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.

Differential effects of Roux-en-Y gastric bypass surgery on brown and beige adipose tissue thermogenesis.

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Hankir, Mohammed K; Bronisch, Felix; Hintschich, Constantin; Krügel, Ute; Seyfried, Florian; Fenske, Wiebke K

2015-10-01

There are numerous reports of increased energy expenditure after Roux-en-Y gastric bypass (RYGB) surgery in humans and rodent models but the underlying mechanisms remain poorly understood. In the present study we assessed at the gene expression level whether RYGB leads to recruitment of brown adipose tissue (BAT) and/or beige adipose tissue (BeAT) as a means of enhanced facultative thermogenesis and increased energy expenditure after surgery. Diet-induced obese male Wistar rats were randomized into RYGB-operated (n=10), sham-operated ad libitum fed (Sham) (n=7) or sham-operated body weight matched (BWM) to RYGB groups (n=7). At a stage of postoperatively stabilized weight reduction, BAT (interscapular), subcutaneous (inguinal) and visceral (epididymal and perirenal) white adipose tissue (WAT) depots were collected in the fasted state. Expression of thermoregulatory genes (UCP1, CIDEA and PRDM16) in BAT and WAT as well as specific markers of BeAT (Ear2 and TMEM26) in WAT was analyzed using RT-qPCR. Compared to Sham rats, UCP1 mRNA expression in BAT was significantly reduced in BWM, but not in RYGB rats. No differences in mRNA expression were found for thermoregulatory proteins or for markers of BeAT in subcutaneous or visceral WAT depots between RYGB and Sham groups. The compensatory decrease in BAT thermogenic gene expression typically associated with body weight loss is attenuated after RYGB which, as opposed to recruitment of BeAT, may contribute to overall increases in energy expenditure and weight loss maintenance after surgery. Copyright © 2015 Elsevier Inc. All rights reserved.

Impact of Roux-en-Y Gastric Bypass Surgery on Pharmacokinetics of Administered Drugs: Implications and Perspectives.

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Srinivas, Nuggehally R

Obesity epidemic has grown out of proportion with increased heath cost because of comorbidity associated with obesity. Due to mediocre benefit from pharmacological interventions, bariatric surgery popularly known as Roux-en-Y gastric bypass (RYGB) surgery has been increasingly practiced. Although RYGB significantly reduces body mass index, it also alters the local gut environment leading to significant changes in the drug absorption and bioavailability. The focus of the review is to present and critically evaluate case studies pertaining to pharmacokinetic data gathered till date on subjects after RYGB. A large portion of the reviewed examples showed reduced area under the concentration versus time curve [area under curve (AUC)] of drugs after RYGB (44%), whereas equal number of investigations showed increased (26%) or unaltered AUC (26%) after RYGB. There was one instance (4%), where the AUC was highly variable and individual subject dependent. Examination of drugs that showed reduced bioavailability suggested that a complex interplay of various factors such as solubility, permeability, metabolic enzymes, and transporters may have contributed for the observed effect. The increased bioavailability seemed to be related to permeability enhancement and generally in drug classes that have reduced metabolism. Based on the review, there is a significant risk of therapy failure for certain drugs because of subtherapeutic plasma levels. The need to readjust doses immediately after RYGB may be considered based on the therapeutic drug monitoring (TDM) findings. It seems prudent to initiate TDM for certain disease areas or drug classes until stable doses are established after RYGB through the appropriate pharmacokinetic and/or pharmacodynamics surrogate, as appropriate.

Effect of Roux-en-Y gastric bypass on liver mitochondrial dynamics in a rat model of obesity.

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Sacks, Jessica; Mulya, Anny; Fealy, Ciaran E; Huang, Hazel; Mosinski, John D; Pagadala, Mangesh R; Shimizu, Hideharu; Batayyah, Esam; Schauer, Philip R; Brethauer, Stacy A; Kirwan, John P

2018-02-01

Bariatric surgery provides significant and durable improvements in glycemic control and hepatic steatosis, but the underlying mechanisms that drive improvements in these metabolic parameters remain to be fully elucidated. Recently, alterations in mitochondrial morphology have shown a direct link to nutrient adaptations in obesity. Here, we evaluate the effects of Roux-en-Y gastric bypass (RYGB) surgery on markers of liver mitochondrial dynamics in a diet-induced obesity Sprague-Dawley (SD) rat model. Livers were harvested from adult male SD rats 90-days after either Sham or RYGB surgery and continuous high-fat feeding. We assessed expression of mitochondrial proteins involved in fusion, fission, mitochondrial autophagy (mitophagy) and biogenesis, as well as differences in citrate synthase activity and markers of oxidative stress. Gene expression for mitochondrial fusion genes, mitofusin 1 (Mfn1; P fasting plasma insulin. In the RYGB group, citrate synthase activity was increased (P < 0.02) and reactive oxygen species (ROS) was decreased compared to the Sham control group (P < 0.05), although total antioxidant capacity was unchanged between groups. These data are the first to show an association between RYGB surgery and improved markers of liver mitochondrial dynamics. These observed improvements may be related to weight loss and reduced energetic demand on the liver, which could facilitate normalization of glucose homeostasis and protect against hepatic steatosis. © 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

Results of The Comparative Study of 200 Cases: One Anastomosis Gastric Bypass vs Roux-en-Y Gastric Bypass.

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Navarrete, Salvador; Leyba, José Luis; Ll, Salvador Navarrete; Borjas, Guillermo; Tapia, José León; Alcázar, Ruben

2018-05-01

Obesity has experienced worldwide increase and surgery has become the treatment that has achieved the best results. Several techniques have been described; the most popular are vertical gastrectomy (GV) and the Roux-en-Y gastric bypass (RYGB). However, mini-gastric bypass/one anastomosis gastric bypass (MGB/OAGB) has gained popularity due to its simplicity and good results. To comparatively evaluate the results of MGB/OAGB with those of RYGB with 1-year follow-up. The paper presents a comparative case and control study of 100 patients that underwent MGB/OAGB surgery and another 100 with RYGB surgery, operated between 2008 and 2016. Patients were not submitted to revision surgery and had the following pre-operative variables: age 40.46 ± 12.4 vs. 39.43 ± 10.33 years; sex 64 and 54 women, 36 and 46 men; BMI 44.8 ± 12.06 and 45.29 ± 8.82 kg/m 2 ; 50 and 54 cases with comorbidities, respectively, these being non-significant differences. The surgical time was 69.01 ± 4.62 (OAGB) vs. 88.98 ± 3.44 min; the time of hospitalization was 2 days, reaching a BMI of 27.7 ± 7.85 and 29 ± 4.52 kg/m 2 , with an excess weight loss 1 year after surgery of 89.4 vs. 85.9%, respectively. The morbidity rates are 9% for OAGB and 11% for the RYGB. There was a comorbidity resolution of 84.4 and 83.7% respectively, without mortality. The results show the benefits of both techniques, OAGB being the easiest to perform and with less surgical time.

Tier 3 multidisciplinary medical weight management improves outcome of Roux-en-Y gastric bypass surgery.

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Patel, P; Hartland, A; Hollis, A; Ali, R; Elshaw, A; Jain, S; Khan, A; Mirza, S

2015-04-01

In 2013 the Department of Health specified eligibility for bariatric surgery funded by the National Health Service. This included a mandatory specification that patients first complete a Tier 3 medical weight management programme. The clinical effectiveness of this recommendation has not been evaluated previously. Our bariatric centre has provided a Tier 3 programme six months prior to bariatric surgery since 2009. The aim of our retrospective study was to compare weight loss in two cohorts: Roux-en-Y gastric bypass only (RYGB only cohort) versus Tier 3 weight management followed by RYGB (Tier 3 cohort). A total of 110 patients were selected for the study: 66 in the RYGB only cohort and 44 in the Tier 3 cohort. Patients in both cohorts were matched for age, sex, preoperative body mass index and pre-existing co-morbidities. The principal variable was therefore whether they undertook the weight management programme prior to RYGB. Patients from both cohorts were followed up at 6 and 12 months to assess weight loss. The mean weight loss at 6 months for the Tier 3 cohort was 31% (range: 18-69%, standard deviation [SD]: 0.10 percentage points) compared with 23% (range: 4-93%, SD: 0.12 percentage points) for the RYGB only cohort (p=0.0002). The mean weight loss at 12 months for the Tier 3 cohort was 34% (range: 17-51%, SD: 0.09 percentage points) compared with 27% (range: 14-48%, SD: 0.87 percentage points) in the RYGB only cohort (p=0.0037). Our study revealed that in our matched cohorts, patients receiving Tier 3 specialist medical weight management input prior to RYGB lost significantly more weight at 6 and 12 months than RYGB only patients. This confirms the clinical efficacy of such a weight management programme prior to gastric bypass surgery and supports its inclusion in eligibility criteria for bariatric surgery.

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

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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...

Long-term hypovitaminosis D and secondary hyperparathyroidism outcomes of the Roux-en-Y gastric bypass: a systematic review.

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Switzer, N J; Marcil, G; Prasad, S; Debru, E; Church, N; Mitchell, P; Billington, E O; Gill, R S

2017-05-01

Pre-operative Vitamin D deficiency is markedly prevalent in prospective bariatric surgery patients. While bariatric surgery leads to significant weight loss, it can exacerbate or prolong Vitamin D deficiency. We systematically reviewed the literature to assess whether secondary hyperparathyroidism is maintained in the medium to long term in patients following the Roux-en-Y gastric bypass. A comprehensive literature search was conducted through Medline, Embase, Scopus, Web of Science, Dare, Cochrane library and HTA database. The search terms used were bariatric surgery, gastric bypass and hyperparathyroidism. Fourteen studies were included (n = 2688 subjects). Parathyroid hormone levels rose gradually from a mean pre-operative level of 5.69 ± 1.2 pmol/L to 6.36 ± 0.77 pmol/L, 7.59 ± 0.73 pmol/L and 8.29 ± 1.41 pmol/L at 2 years, between 2 and 5 years, and beyond 5 years, respectively. Vitamin D levels slowly fell to a mean of 20.50 ± 4.37 ng/mL and 20.76 ± 3.80 ng/mL between follow-up intervals 2-5 years and beyond 5, respectively. It appears that hyperparathyroidism persists at 5-year follow-up after gastric bypass, despite most patients being supplemented with calcium and Vitamin D. © 2017 World Obesity Federation.

Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery.

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Shantavasinkul, Prapimporn Chattranukulchai; Omotosho, Philip; Corsino, Leonor; Portenier, Dana; Torquati, Alfonso

2016-11-01

Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity and results in long-term weight loss and resolution of co-morbidities. However, weight regain may occur as soon as 1-2 years after surgery. This retrospective study aimed to investigate the prevalence of weight regain and possible preoperative predictors of this phenomenon after RYGB. An academic medical center in the United States. A total of 1426 obese patients (15.8% male) who underwent RYGB during January 2000 to 2012 and had at least a 2-year follow-up were reviewed. We included only patients who were initially successful, having achieved at least 50% excess weight loss at 1 year postoperatively. Patients were then categorized into either the weight regain group (WR) or sustained weight loss (SWL) group based upon whether they gained≥15% of their 1-year postoperative weight. Weight regain was observed in 244 patients (17.1%). Preoperative body mass index was similar between groups. Body mass index was significantly higher and percent excess weight loss was significantly lower in the WR group (Pweight regain was 19.5±9.3 kg and-.8±8.5 in the WR and SWL groups, respectively (Pweight loss. Moreover, a longer duration after RYGB was associated with weight regain. Multivariate analysis revealed that younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The present study confirmed that a longer interval after RYGB was associated with weight regain. Younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The findings of this study underscore the complexity of the mechanisms underlying weight loss and regain after RYGB. Future prospective studies are needed to further explore the prevalence, predictors, and mechanisms of weight regain after RYGB. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Acute transverse colon volvulus with secondary gastric isquemia. Case report.

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Sala-Hernández, Ángela; Pous-Serrano, Salvador; Lucas-Mera, Elí; Carvajal-Amaya, Nicolás

2016-03-01

Acute colonic volvulus accounts for 10% of all intestinal obstructions being the transverse colon volvulus an exceptional localization (2-4%). Late diagnosis is made as there are no pathognomonic clinical or radiological findings for this pathology. We present the case of an 81 year-old male with acute transverse colon volvulus that involved the gastric antrum causing irreversible ischemia. Subtotal gastrectomy, subtotal colectomy and reconstruction with Y en Roux gastrojejunostomy and ileosigmoid anastomosis was performed given the good overall status of the patient. Decompressive colonoscopy is not advised given the high probability of ischemic lesions in these cases; surgical exploration is mandatory in these circumstances. Surgical detortion with or without colopexia carries important recurrence rates. Treatment of choice includes colectomy with or without primary anastomosis. There are no reports on gastric ischemic necrosis in the setting of a transverse colon volvulus making this case unusual and unique.

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

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...

S100A8/A9 (Calprotectin), Interleukin-6, and C-Reactive Protein in Obesity and Diabetes before and after Roux-en-Y Gastric Bypass Surgery

DEFF Research Database (Denmark)

Lylloff, Louise; Bathum, Lise; Madsbad, Sten

2017-01-01

Background: In obesity, which is a major contributor to insulin resistance and diabetes, the circulating level of S100A8/A9 (calprotectin) is elevated and declines after Roux-en-Y gastric bypass surgery (RYGB). However, studies on S100A8/A9 and the pathophysiological mechanisms in insulin...... resistance and diabetes are few and contradictory. Methods: We studied 48 subjects who underwent RYGB, comprising a non-diabetic control group and two diabetic groups in whom diabetes either regressed or persisted, 6-12 months post-surgically. S100A8/A9, interleukin 6 (IL-6) as well as other inflammatory...... and diabetes-related markers were measured pre- A nd post-surgically. Results: Significant and similar decreases of BMI were found in all groups. S100A8/A9 and IL-6 decreased significantly in the group with diabetes remission and in the control group, but not in the group with persistent diabetes. The relative...

Plastic surgery improves long-term weight control after bariatric surgery.

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Balagué, Nicolas; Combescure, Christophe; Huber, Olivier; Pittet-Cuénod, Brigitte; Modarressi, Ali

2013-10-01

The positive impact of Roux-en-Y gastric bypass on weight, comorbidities, and health-related quality of life is well documented. However, 50 percent of patients regain some of the lost weight after 2 years with Roux-en-Y gastric bypass and present a mean weight regain of 10 to 15 percent after several years, partially losing the previously obtained benefits. The authors hypothesize that body contouring could decrease weight regain, leading to better long-term weight control after Roux-en-Y gastric bypass. In a matched control study, variations in weight for 98 patients with body contouring after Roux-en-Y gastric bypass were compared with those of 102 matched control patients with Roux-en-Y gastric bypass alone. Data were collected prospectively at 1, 3, 6, 9, 12, and 18 months after Roux-en-Y gastric bypass and then yearly until 7 years. After a massive mean weight loss of 45.2 kg during the first 2 years after Roux-en-Y gastric bypass, patients with Roux-en-Y gastric bypass alone presented a higher continuous mean weight regain than those with Roux-en-Y gastric bypass and body contouring (1.78 kg/year versus 0.51 kg/year of weight regain, respectively; p = 0.001). After 7 years, patients with Roux-en-Y gastric bypass presented significantly higher mean weight regain than patients with Roux-en-Y gastric bypass and body contouring (i.e., 10.8 percent versus 3.6 percent mean weight gain, respectively; p weight of 2.04 kg by body contouring, the weight regain was 22.9 kg for patients with Roux-en-Y gastric bypass alone and only 6.2 kg for those with Roux-en-Y gastric bypass and body contouring. The authors demonstrated that patients with body contouring present better long-term weight control after Roux-en-Y gastric bypass. Therefore, body contouring must be considered as a reconstructive operation in the treatment of morbid obesity. Therapeutic, III.

Effects of Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass on Eating Behavior and Sweet Taste Perception in Subjects with Obesity

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Katie Nance

2017-12-01

Full Text Available The goal of this study was to test the hypothesis that weight loss induced by Roux-en-Y gastric bypass (RYGB has greater effects on taste perception and eating behavior than comparable weight loss induced by sleeve gastrectomy (SG. We evaluated the following outcomes in 31 subjects both before and after ~20% weight loss induced by RYGB (n = 23 or SG (n = 8: (1 sweet, savory, and salty taste sensitivity; (2 the most preferred concentrations of sucrose and monosodium glutamate; (3 sweetness palatability, by using validated sensory testing techniques; and (4 eating behavior, by using the Food Craving Inventory and the Dutch Eating Behavior Questionnaire. We found that neither RYGB nor SG affected sweetness or saltiness sensitivity. However, weight loss induced by either RYGB or SG caused the same decrease in: (1 frequency of cravings for foods; (2 influence of emotions and external food cues on eating behavior; and (3 shifted sweetness palatability from pleasant to unpleasant when repetitively tasting sucrose (all p-values ≤ 0.01. Therefore, when matched on weight loss, SG and RYGB cause the same beneficial effects on key factors involved in the regulation of eating behavior and hedonic component of taste perception.

Should Roux-en-Y gastric bypass biliopancreatic limb length be tailored to achieve improved diabetes outcomes?

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Nora, Mário; Morais, Tiago; Almeida, Rui; Guimarães, Marta; Monteiro, Mariana P

2017-12-01

The objective is to access the role of Roux-en-Y gastric bypass (RYGB) biliopancreatic limb (BPL) length in type 2 diabetes (T2D) outcomes.RYGB is more effective than medical intervention for T2D treatment in obese patients. Despite the scarcity of available data, previous reports suggest that modifications of the RYGB limb lengths could improve the antidiabetic effects of the surgery.A cohort of obese T2D patients (n = 114) were submitted to laparoscopic RYGB, either with a standard BPL (SBPL) (n = 41; BPL 84 ± 2 cm) or long BPL (LBPL) (n = 73; BPL = 200 cm) and routinely monitored for weight loss and diabetic status up to 5 years after surgery.Baseline clinical features in the 2 patient subgroups were similar. After surgery, there was a significant reduction of body mass index (BMI) in both the groups, although the percentage of excess BMI loss (%EBMIL) after 5 years was higher for LBPL (75.50 ± 2.63 LBPL vs 65.90 ± 3.61 SBPL, P = .04). T2D remission rate was also higher (73% vs 55%, P < .05), while disease relapse rate (13.0% vs 32.5%; P < .05) and antidiabetic drug requirement in patients with persistent diabetes were lower after LBPL. Preoperative T2D duration predicted disease remission, but only for SBPL.RYGB with a longer BPL improves %EBMIL, T2D remission, and glycemic control in those with persistent disease, while it decreases diabetes relapse rate over time. The antidiabetic effects of LBPL RYGB also are less influenced by the preoperative disease duration. These data suggest the RYGB procedure could be tailored to improve T2D outcomes.

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

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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.

Metabolic responses to exogenous ghrelin in obesity and early after Roux-en-Y gastric bypass in humans.

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Tamboli, Robyn A; Antoun, Joseph; Sidani, Reem M; Clements, Austin; Harmata, Emily E; Marks-Shulman, Pam; Gaylinn, Bruce D; Williams, Brandon; Clements, Ronald H; Albaugh, Vance L; Abumrad, Naji N

2017-09-01

Ghrelin is a gastric-derived hormone that stimulates growth hormone (GH) secretion and has a multi-faceted role in the regulation of energy homeostasis, including glucose metabolism. Circulating ghrelin concentrations are modulated in response to nutritional status, but responses to ghrelin in altered metabolic states are poorly understood. We investigated the metabolic effects of ghrelin in obesity and early after Roux-en-Y gastric bypass (RYGB). We assessed central and peripheral metabolic responses to acyl ghrelin infusion (1 pmol kg -1  min -1 ) in healthy, lean subjects (n = 9) and non-diabetic, obese subjects (n = 9) before and 2 weeks after RYGB. Central responses were assessed by GH and pancreatic polypeptide (surrogate for vagal activity) secretion. Peripheral responses were assessed by hepatic and skeletal muscle insulin sensitivity during a hyperinsulinaemic-euglycaemic clamp. Ghrelin-stimulated GH secretion was attenuated in obese subjects, but was restored by RYGB to a response similar to that of lean subjects. The heightened pancreatic polypeptide response to ghrelin infusion in the obese was attenuated after RYGB. Hepatic glucose production and hepatic insulin sensitivity were not altered by ghrelin infusion in RYGB subjects. Skeletal muscle insulin sensitivity was impaired to a similar degree in lean, obese and post-RYGB individuals in response to ghrelin infusion. These data suggest that obesity is characterized by abnormal central, but not peripheral, responsiveness to ghrelin that can be restored early after RYGB before significant weight loss. Further work is necessary to fully elucidate the role of ghrelin in the metabolic changes that occur in obesity and following RYGB. © 2017 John Wiley & Sons Ltd.

Higher plasma motilin levels in obese patients decrease after Roux-en-Y gastric bypass surgery and regulate hunger.

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Deloose, E; Janssen, P; Lannoo, M; Van der Schueren, B; Depoortere, I; Tack, J

2016-07-01

Motilin-induced phase III contractions of the migrating motor complex (MMC) signal hunger in healthy volunteers. The current aim was to study the role of motilin as a hunger-inducing factor in obese patients and to evaluate the effect of Roux-en-Y gastric bypass (RYGB) surgery on plasma motilin levels and hunger scores. Motilin and ghrelin plasma levels were determined during a complete MMC cycle in controls and obese patients selected for RYGB before, 6 months and 1 year after surgery. 20 min after the end of the second phase III, obese patients received an intravenous infusion of 40 mg erythromycin. Hunger was scored every 5 min. Hedonic hunger was assessed in obese patients with the Power of Food Scale questionnaire. Obesity caused a switch in the origin of phase III from antrum to duodenum. Obese patients had significantly higher motilin levels compared with controls during the MMC but tended to lack the motilin peak prior to phase III necessary to trigger hunger. Hunger scores during phase III were significantly lower in obese patients, but could be restored to control levels through the administration of a low dose of the motilin agonist, erythromycin. After RYGB surgery motilin, but not ghrelin, levels decreased in parallel with hedonic hunger scores. Motilin may be an important regulator involved in the pathogenesis of obesity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Long-term follow-up after choledochojejunostomy for bile duct stones with complex clearance of the bile duct

NARCIS (Netherlands)

Gouma, D. J.; Konsten, J.; Soeters, P. B.; Von Meyenfeldt, M.; Obertop, H.

1989-01-01

In this retrospective study, the long-term follow-up of patients undergoing choledochojejunostomy (Roux-en-Y) for bile duct stones with complex clearance of the bile duct is evaluated. Bile duct exploration and subsequent choledochojejunostomy (Roux-en-Y) was performed in 43 patients (median age 67

Laparoscopic Roux-En-Y Gastric Bypass Improves Lipid Profile and Decreases Cardiovascular Risk: a 5-Year Longitudinal Cohort Study of 1048 Patients.

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Gero, Daniel; Favre, Lucie; Allemann, Pierre; Fournier, Pierre; Demartines, Nicolas; Suter, Michel

2018-03-01

Dyslipidemia is a known risk factor for cardiovascular (CV) events. The aim of the study was to assess lipid profiles and their impact on CV risk changes in a large patient cohort 5 years after Roux-en-Y gastric bypass (RYGB). All patients who underwent primary RYGB for severe obesity in our two hospitals between January 1999 and December 2009 were included. The Framingham risk score was used. One thousand and forty-eight patients were included, 791 women and 257 men. Five-year complete lipid profile was available for 77% of patients. At 5 years, mean body mass index (BMI) decreased from 45.7 ± 6 to 31 ± 5.8 kg/m 2 (p profile improved more in patients with greater weight loss (%EBMIL ≥ 50 or %TWL ≥ 25%). Assuming that all patients were non-smokers and other baseline risk factors (hypertension, diabetes) remained unchanged at 5 years, the amelioration of the lipid profile itself yielded to a 27% reduction of CV risk (p profile from the first to fifth postoperative year. This improvement translates into significantly lower CV risk from the first year after surgery.

Guanylin and uroguanylin mRNA expression is increased following Roux-en-Y gastric bypass, but guanylins do not play a significant role in body weight regulation and glycemic control

DEFF Research Database (Denmark)

Fernandez-Cachon, María L; Pedersen, Søren L; Rigbolt, Kristoffer T

2018-01-01

AIM: To determine whether intestinal expression of guanylate cyclase activator 2A (GUCA2A) and guanylate cyclase activator 2B (GUCA2B) genes is regulated in obese humans following Roux-en-Y gastric bypass (RYGB), and to evaluate the corresponding guanylin (GN) and uroguanylin (UGN) peptides...... for potentially contributing to the beneficial metabolic effects of RYGB. METHODS: Enteroendocrine cells were harvested peri- and post-RYGB, and GUCA2A/GUCA2B mRNA expression was compared. GN, UGN and their prohormones (proGN, proUGN) were administered subcutaneously in normal-weight mice to evaluate effects...... on food intake. GN and UGN, as well as their prohormones, were evaluated for effects on glucose-stimulated insulin secretion (GSIS) in rat pancreatic islets and perfused rat pancreas. RESULTS: GUCA2A and GUCA2B mRNA expression was significantly upregulated in enteroendocrine cells after RYGB. Peripheral...

Endoscopic stenting versus operative gastrojejunostomy for malignant gastric outlet obstruction.

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Chandrasegaram, Manju D; Eslick, Guy D; Mansfield, Clare O; Liem, Han; Richardson, Mark; Ahmed, Sulman; Cox, Michael R

2012-02-01

Malignant gastric outlet obstruction represents a terminal stage in pancreatic cancer. Between 5% and 25% of patients with pancreatic cancer ultimately experience malignant gastric outlet obstruction. The aim in palliating patients with malignant gastric outlet obstruction is to reestablish an oral intake by restoring gastrointestinal continuity. This ultimately improves their quality of life in the advanced stages of cancer. The main drawback to operative bypass is the high incidence of delayed gastric emptying, particularly in this group of patients with symptomatic obstruction. This study aimed to compare surgical gastrojejunostomy and endoscopic stenting in palliation of malignant gastric outlet obstruction, acknowledging the diversity and heterogeneity of patients with this presentation. This retrospective study investigated patients treated for malignant gastric outlet obstruction from December 1998 to November 2008 at Nepean Hospital, Sydney, Australia. Endoscopic duodenal stenting was performed under fluoroscopic guidance for placement of the stent. The operative patients underwent open surgical gastrojejunostomy. The outcomes assessed included time to diet, hospital length of stay (LOS), biliary drainage procedures, morbidity, and mortality. Of the 45 participants in this study, 26 underwent duodenal stenting and 19 had operative bypass. Comparing the stenting and operative patients, the median time to fluid intake was respectively 0 vs. 7 days (P < 0.001), and the time to intake of solids was 2 vs. 9 days (P = 0.004). The median total LOS was shorter in the stenting group (11 vs. 25 days; P < 0.001), as was the median postprocedure LOS (5 vs. 10 days; P = 0.07). Endoscopic stenting is preferable to operative gastrojejunostomy in terms of shorter LOS, faster return to fluids and solids, and reduced morbidity and in-hospital mortality for patients with a limited life span.

Baseline Anthropometric and Metabolic Parameters Correlate with Weight Loss in Women 1-Year After Laparoscopic Roux-En-Y Gastric Bypass.

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Sans, Arnaud; Bailly, Laurent; Anty, Rodolphe; Sielezenef, Igor; Gugenheim, Jean; Tran, Albert; Gual, Philippe; Iannelli, Antonio

2017-11-01

In this study, we explored in a prospective cohort of morbidly obese women undergoing laparoscopic Roux-en-Y gastric bypass (LRYGP) correlations between baseline anthropometrics, metabolic parameters, resting energy expenditure (REE), body composition, and 1-year % excess body mass index loss (%EBMIL). We also investigated risk factors for insufficient %EBMIL. One hundred three consecutive women were prospectively evaluated at baseline (age 40.6 ± 11.2, weight 113.9 kg ± 15.3, BMI 43.3 ± 4.9 kg/m 2 ) and 1 year after LRYGP. Weight, excess weight, brachial circumference, waist circumference, fat mass (FM) and fat-free mass (FFM) (measured with bioelectrical impedance analysis), REE, inflammation, insulin resistance, and lipid disturbances were determined before and 1 year after LRYGP. At 1 year, mean weight loss was 39.8 kg ± 11.7 and mean EBMIL was 15.2 kg/m 2  ± 4.2. Mean %EBMIL was 86% ± 21% (range 30-146%). Baseline brachial circumference, waist circumference and triceps skinfold thickness decreased significantly at 1 year (P baseline body composition parameters, only preoperative FM was negatively correlated with %EBMIL (r = -0.23; p = 0.02). One year after surgery FM change was negatively correlated with EBMIL% (r = -0.49; P baseline blood glucose level (OR = 1.77; CI 95%: [1.3-2.4]) was the only predictive factor of EBMIL Baseline glucose level may be helpful in identifying poor responders to LRYGBP. NCT02820285y ( https://clinicaltrials.gov/ct2/show/NCT02820285?term=Characterization+of+Immune+Semaphorin+in+Non-Alcoholic+Fatty+Liver+Disease+and+NASH&rank=1 ).

Gastrojejunostomy for gastric outlet obstruction in patients with ...

African Journals Online (AJOL)

Sixty patients were discharged from hospital having resumed normal eating. Their median survival after surgery was 9 months. Conclusion. Gastrojejunostomy offers worthwhile palliation and may prolong survival in a significant group of patients with irresectable gastric carcinoma and gastric outlet obstruction. South African ...

Activismo católico antiabortista en Argentina: performances, discursos y prácticas

OpenAIRE

Bessone, Pablo Gudiño

2017-01-01

Resumen Este artículo se interesa en el accionar político del activismo católico antiabortista en Argentina y las distintas performances de acción colectiva que tales grupos desarrollan en el espacio público urbano. Repara en la forma en que dichos grupos autodenominados pro-vida mantienen un discurso de oposición a la legalización del aborto con base en el despliegue de argumentaciones científicas y bioéticas. Esto, en tanto modo de contrarrestar la presencia y movilización de las organizaci...

Meal patterns, satiety, and food choice in a rat model of Roux-en-Y gastric bypass surgery.

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Zheng, Huiyuan; Shin, Andrew C; Lenard, Natalie R; Townsend, R Leigh; Patterson, Laurel M; Sigalet, David L; Berthoud, Hans-Rudolf

2009-11-01

Gastric bypass surgery efficiently and lastingly reduces excess body weight and reverses type 2 diabetes in obese patients. Although increased energy expenditure may also play a role, decreased energy intake is thought to be the main reason for weight loss, but the mechanisms involved are poorly understood. Therefore, the aim of this study was to characterize the changes in ingestive behavior in a rat model of Roux-en-Y gastric bypass surgery (RYGB). Obese (24% body fat compared with 18% in chow-fed controls), male Sprague-Dawley rats maintained for 15 wk before and 4 mo after RYGB or sham-surgery on a two-choice low-fat/high-fat diet, were subjected to a series of tests assessing energy intake, meal patterning, and food choice. Although sham-operated rats gained an additional 100 g body wt during the postoperative period, RYGB rats lost approximately 100 g. Intake of a nutritionally complete and palatable liquid diet (Ensure) was significantly reduced by approximately 50% during the first 2 wk after RYGB compared with sham surgery. Decreased intake was the result of greatly reduced meal size with only partial compensation by meal frequency, and a corresponding increase in the satiety ratio. Similar results were obtained with solid food (regular or high-fat chow) 6 wk after surgery. In 12- to 24-h two-choice liquid or solid diet paradigms with nutritionally complete low- and high-fat diets, RYGB rats preferred the low-fat choice (solid) or showed decreased acceptance for the high-fat choice (liquid), whereas sham-operated rats preferred the high-fat choices. A separate group of rats offered chow only before surgery completely avoided the solid high-fat diet in a choice paradigm. The results confirm anecdotal reports of "nibbling" behavior and fat avoidance in RYGB patients and provide a basis for more mechanistic studies in this rat model.

Metabolic phenotype-microRNA data fusion analysis of the systemic consequences of Roux-en-Y gastric bypass surgery.

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Wu, Q; Li, J V; Seyfried, F; le Roux, C W; Ashrafian, H; Athanasiou, T; Fenske, W; Darzi, A; Nicholson, J K; Holmes, E; Gooderham, N J

2015-07-01

Bariatric surgery offers sustained marked weight loss and often remission of type 2 diabetes, yet the mechanisms of establishment of these health benefits are not clear. We mapped the coordinated systemic responses of gut hormones, the circulating miRNAome and the metabolome in a rat model of Roux-en-Y gastric bypass (RYGB) surgery. The response of circulating microRNAs (miRNAs) to RYGB was striking and selective. Analysis of 14 significantly altered circulating miRNAs within a pathway context was suggestive of modulation of signaling pathways including G protein signaling, neurodegeneration, inflammation, and growth and apoptosis responses. Concomitant alterations in the metabolome indicated increased glucose transport, accelerated glycolysis and inhibited gluconeogenesis in the liver. Of particular significance, we show significantly decreased circulating miRNA-122 levels and a more modest decline in hepatic levels, following surgery. In mechanistic studies, manipulation of miRNA-122 levels in a cell model induced changes in the activity of key enzymes involved in hepatic energy metabolism, glucose transport, glycolysis, tricarboxylic acid cycle, pentose phosphate shunt, fatty-acid oxidation and gluconeogenesis, consistent with the findings of the in vivo surgery-mediated responses, indicating the powerful homeostatic activity of the miRNAs. The close association between energy metabolism, neuronal signaling and gut microbial metabolites derived from the circulating miRNA, plasma, urine and liver metabolite and gut hormone correlations further supports an enhanced gut-brain signaling, which we suggest is hormonally mediated by both traditional gut hormones and miRNAs. This transomic approach to map the crosstalk between the circulating miRNAome and metabolome offers opportunities to understand complex systems biology within a disease and interventional treatment setting.

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

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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.

Surgical Elimination of the Gastric Digestion by Roux-en-Y Gastric Bypass Impacts on Food Sensitisation-a Pilot Study.

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Shakeri-Leidenmühler, Soheila; Lukschal, Anna; Schultz, Cornelia; Bohdjalian, Arthur; Langer, Felix; Birsan, Tudor; Diesner, Susanne C; Greisenegger, Elli K; Scheiner, Otto; Kopp, Tamara; Jensen-Jarolim, Erika; Prager, Gerhard; Untersmayr, Eva

2015-12-01

Impairment of gastric digestion due to pH elevation increases the risk for food allergy induction. As patients after Roux-en-Y gastric bypass (RYGB) surgery have lower gastric acidity and less gastric gland secretion, we aimed to analyse in a prospective study the effect of limiting gastric digestion capacity by surgical intervention on the immune response towards allergens. Nine patients undergoing RYGB surgery for morbid obesity and one control patient having undergone surgery for treatment of an incisional hernia were enrolled in the study. Before and 1, 3, 6, 9 and 12 months after surgery, blood was collected for analysis of specific IgE antibodies, and patients were subjected to skin prick testing with 16 food and 18 aeroallergens. Skin prick test results revealed an increase of positive reactions indicating sensitisations towards the tested food and aeroallergens in 77.8 and 88.9 % of the patients, respectively, after surgical elimination of gastric digestion. These results were in line with elevated titers of food- and aeroallergen-specific IgE antibodies in 7 out of 9 (7/9) and 5/9 patients, respectively, after RYGB surgery. Serum cytokine levels revealed a mixed response for IFN-γ and were mostly beneath detection limit for IL-4. A change of IgE reactivity pattern occurred after impairment of gastric digestion due to surgical elimination underlining the important gastric gatekeeping function during oral sensitisation. Even though this study indicates an increased allergy risk for gastric bypass patients, further studies are needed to investigate in-depth the immunological changes associated with RYGB surgery.

The exaggerated glucagon-like peptide-1 response is important for the 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...... consisted of two experimental days, allowing a meal test with infusion of saline or Ex-9 in random order. After RYGB, glucose tolerance improved, β-cell glucose sensitivity (β-GS) doubled, the GLP-1 response greatly increased and glucagon secretion was augmented. GLP-1R blockade did not affect β......-cell function and meal-induced glucagon release before the operation, but did impair glucose tolerance. After RYGB, β-GS decreased to preoperative levels, glucagon secretion increased and glucose tolerance was impaired by Ex-9 infusion. Thus, the exaggerated effect of GLP-1 after RYGB is of major importance...

Experiencias e interpretaciones en performances rituales (Iruya y El Cajón, noroeste argentino

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Karen Avenburg

2014-07-01

Full Text Available Este artículo se propone reflexionar acerca del modo en que dos performances rituales del noroeste argentino recrean en sus puestas en escena diferentes experiencias. Desde un enfoque etnográfico apoyado en los respectivos trabajos de campo de las autoras, se analizan comparativamente la Fiesta Patronal de la Virgen del Rosario de Iruya (Salta y la Semana Santa de El Cajón (Catamarca. En particular, se discuten algunas de las razones por la cuales en un contexto ritual la puesta en escena implica la recreación de su historia sociocultural y política, mientras que en el otro el eje central transcurre reactualizando eventos cosmológicos. El marco teórico utilizado se basa en el concepto de performance y su relación con la experiencia, siguiendo los aportes realizados por Edward Bruner y Victor Turner.

Clinical effects in resection of congenital choledochal cyst of children and jejunum Roux-Y anastomosis by laparoscope.

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Yu, B-H; Lin, F

2016-11-01

We compared the effects and complications in resection of the congenital choledochal cyst (CCC) and hepatic duct jejunum Roux-Y anastomosis by laparoscopy and open surgery. We continuously selected 156 cases of pediatric patients with CCC, which were divided into 70 cases of the laparoscopic group and 86 cases of laparotomy group according to the treatment methods. Then the success rate of surgery, intraoperative and postoperative bleeding, intraoperative and postoperative complications was compared. It was found that after 65 cases (92.9%) completed in the laparoscopic group and all completed in laparotomy group there was less intra-operative blood loss of laparoscopic group than that of the open surgery group. However, the difference of postoperative hemorrhage in two groups was not statistically significant (p >0.05). The intra-operative complications in the two groups were not significantly different (p >0.05); in the laparoscopic group, the postoperative complication rate was significantly lower than open surgery group (p resection of CCC combined with jejunum Roux-Y anastomosis has good prospects.

Unusual Development of Iatrogenic Complex, Mixed Biliary and Duodenal Fistulas Complicating Roux-en-Y Antrectomy for Stenotic Peptic Disease of the Supraampullary Duodenum Requiring Whipple Procedure: An Uncommon Clinical Dilemma.

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Polistina, Francesco A; Costantin, Giorgio; Settin, Alessandro; Lumachi, Franco; Ambrosino, Giovanni

2010-10-23

Complex fistulas of the duodenum and biliary tree are severe complications of gastric surgery. The association of duodenal and major biliary fistulas occurs rarely and is a major challenge for treatment. They may occur during virtually any kind of operation, but they are more frequent in cases complicated by the presence of difficult duodenal ulcers or cancer, with a mortality rate of up to 35%. Options for treatment are many and range from simple drainage to extended resections and difficult reconstructions. Conservative treatment is the choice for well-drained fistulas, but some cases require reoperation. Very little is known about reoperation techniques and technical selection of the right patients. We present the case of a complex iatrogenic duodenal and biliary fistula. A 42-year-old Caucasian man with a diagnosis of postoperative peritonitis had been operated on 3 days earlier; an antrectomy with a Roux-en-Y reconstruction for stenotic peptic disease was performed. Conservative treatment was attempted with mixed results. Two more operations were required to achieve a definitive resolution of the fistula and related local complications. The decision was made to perform a pancreatoduodenectomy with subsequent reconstruction on a double jejunal loop. The patient did well and was discharged on postoperative day 17. In our experience pancreaticoduodenectomy may be an effective treatment of refractory and complex iatrogenic fistulas involving both the duodenum and the biliary tree.

Unusual Development of Iatrogenic Complex, Mixed Biliary and Duodenal Fistulas Complicating Roux-en-Y Antrectomy for Stenotic Peptic Disease of the Supraampullary Duodenum Requiring Whipple Procedure: An Uncommon Clinical Dilemma

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Francesco A. Polistina

2010-10-01

Full Text Available Complex fistulas of the duodenum and biliary tree are severe complications of gastric surgery. The association of duodenal and major biliary fistulas occurs rarely and is a major challenge for treatment. They may occur during virtually any kind of operation, but they are more frequent in cases complicated by the presence of difficult duodenal ulcers or cancer, with a mortality rate of up to 35%. Options for treatment are many and range from simple drainage to extended resections and difficult reconstructions. Conservative treatment is the choice for well-drained fistulas, but some cases require reoperation. Very little is known about reoperation techniques and technical selection of the right patients. We present the case of a complex iatrogenic duodenal and biliary fistula. A 42-year-old Caucasian man with a diagnosis of postoperative peritonitis had been operated on 3 days earlier; an antrectomy with a Roux-en-Y reconstruction for stenotic peptic disease was performed. Conservative treatment was attempted with mixed results. Two more operations were required to achieve a definitive resolution of the fistula and related local complications. The decision was made to perform a pancreatoduodenectomy with subsequent reconstruction on a double jejunal loop. The patient did well and was discharged on postoperative day 17. In our experience pancreaticoduodenectomy may be an effective treatment of refractory and complex iatrogenic fistulas involving both the duodenum and the biliary tree.

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.

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Crusell, Mie; Nilas, Lisbeth; Svare, Jens; Lauenborg, Jeannet

2016-10-01

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. 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 pregnancy, gestational hypertension, length of pregnancy, mode of delivery and foetal birth weight. The two groups were comparable regarding age, parity and prepregnancy body mass index. The frequency of iron deficiency anaemia (ferritin pregnancy outcome or birth weight between the two groups. 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, including intrauterine growth restriction. Specific attention is needed on iron deficit with increasing surgery-to-pregnancy time interval.

Performance: travestismos y política en las crónicas de Pedro Lemebel

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Regina Vanesa Cellino

2015-08-01

Full Text Available En este trabajo se indagará sobre la relación que existe entre las crónicas urbanas de Pedro Lemebel, La esquina es mi corazón (1995 y Loco afán. Crónicas de sidario (1996, en el contexto de la posdictadura chilena, y su participación en las performances de Las Yeguas del Apocalipsis, a las que consideramos una articulación entre cuerpo, política y teatralidad. Este texto parte de las siguientes preguntas: ¿Qué afinidad/es hay entre las crónicas literarias de Lemebel y las performances de Las Yeguas del Apocalipsis? ¿Qué relación existe entre el cuerpo, la homosexualidad, el travestismo y la performance? ¿Cómo se manifiesta ese vínculo en las crónicas de Pedro Lemebel? 

Oratoria y performance en la Atenas clásica

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Michael J. Edwards

2013-02-01

Full Text Available En griego antiguo el término empleado para la “acción”, una de las cinco partes de la retórica en la teoría retórica desarrollada, era hypokrisis, que también fue la palabra usada para hablar de “actuación” y no hay duda de que los ciudadanos atenienses, ya fuera sentados como jurados en los dikasteries atenienses o decidiendo sobre políticas en las reuniones de la asamblea, esperaban de aquellos que les hablaban que montaran una entretenida performance oratoria. Mucho se ha escrito sobre el tema en los últimos tiempos, y trato de adoptar un acercamiento diferente aquí al considerar once posibles indicadores de cómo se realizaban los discursos judiciales. Baso la discusión en el acrónimo “performance” y esbozo algunas inferencias a partir de los textos mismos. Los temas que se abordarán son: la importancia de la apertura del discurso (proemio para dar la impresión correcta en los jurados; de qué manera los oradores que se encuentran en circunstancias particularmente difíciles pueden usar una forma alternativa de proemio llamada ephodos; el uso común de preguntas retóricas, por parte de los oradores, para lograr un acercamiento con el auditorio; la importancia de contar con una voz fuerte (phone y las implicaciones de no poseer una; los temas interrelacionados de la oralidad, la estilística, el ritmo y la memoria (mneme, otra de las cinco partes de la retórica; la estratagema de dirigirse al oponente en segunda persona (apostrophe como una forma de alejarlo de los jurados; algunos aspectos de la narración, que era un elemento clave de los discursos forenses; algunas referencias al reloj de agua (klepsydra que cronometraba los discursos; finalmente, la importancia de dejar una buena impresión en los jurados al final del discurso (epilogos.

Liver Function in Patients With Nonalcoholic Fatty Liver Disease Randomized to Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy: A Secondary Analysis of a Randomized Clinical Trial.

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Kalinowski, Piotr; Paluszkiewicz, Rafał; Ziarkiewicz-Wróblewska, Bogna; Wróblewski, Tadeusz; Remiszewski, Piotr; Grodzicki, Mariusz; Krawczyk, Marek

2017-11-01

The aim of the study was to compare the influence of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) on liver function in bariatric patients with non-alcoholic fatty liver disease (NAFLD) in a randomized clinical trial (NCT01806506). Rapid weight loss and malabsorption after bariatric surgery in patients with NAFLD or steatohepatitis (NASH) may impair liver function. Sixty-six morbidly obese patients randomized to SG or RYGB were included in a secondary outcome analysis. Intraoperative liver biopsies were categorized with NAFLD Activity Score (NAS) and liver function tests were done before surgery and after 1, 6 and 12 months. NASH was present in 54.5% RYGB and 51.5% SG patients (P > 0.05). At 12 months excess weight loss was 68.7 ± 19.7% after SG and 62.8 ± 18.5% after RYGB (P > 0.05). At 1 month international normalized ratio (INR) increased after RYGB (0.98 ± 0.05 vs 1.14 ± 0.11; P liver function than after SG.

Jejunal gluconeogenesis associated with insulin resistance level and its evolution after Roux-en-Y gastric bypass.

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Gutierrez-Repiso, Carolina; Garcia-Serrano, Sara; Moreno-Ruiz, Francisco J; Alcain-Martinez, Guillermo; Rodriguez-Pacheco, Francisca; Garcia-Fuentes, Eduardo

2017-04-01

Intestinal gluconeogenesis (GNG) may play an important role in glucose homeostasis, but there is little information about the condition in humans. To study the relationship between intestinal GNG and insulin resistance, its association with the evolution of morbidly obese patients after bariatric surgery, and the effect of insulin and or leptin. Regional university hospital, Malaga (Spain). Jejunal mRNA expression of genes involved in GNG was analyzed in 3 groups of morbidly obese patients who underwent Roux-en-Y gastric bypass: with low insulin resistance (MO-low-IR), with high insulin resistance (MO-high-IR), and with type 2 diabetes treated with metformin (MO-metf-T2D). Also, intestinal epithelial cells (IEC) from MO-low-IR were incubated with different doses of insulin and or leptin. In MO-high-IR, glutaminase, phosphoenolpyruvate carboxykinase (PEPCK), glucose 6-phosphatase (G6 Pase), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1 α), and sterol regulatory element-binding proteins 1 c (SREBP-1 c) expressions were significantly higher than in MO-low-IR. In MO-metf-T2 D, only PEPCK was significantly lower than in MO-high-IR. In IEC, an incubation with a high glucose and insulin dose produced an increase of PEPCK and SREBP-1 c, and a decrease of glutaminase, fructose 1,6-bisphosphatase (FBPase), and PGC-1 α expression. At high doses of leptin, G6 Pase and FBPase were significantly increased. The improvement of insulin resistance 3 months after bariatric surgery was positively associated with high G6 Pase and FBPase expression. mRNA expression of genes involved in GNG is increased in the jejunum of MO-high-IR, and regulated by insulin and or leptin. High mRNA expression of genes involved in GNG is associated with a better evolution of insulin resistance after bariatric surgery. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Outcomes following 50 consecutive endoscopic gastrojejunal revisions for weight gain following Roux-en-Y gastric bypass: a comparison of endoscopic suturing techniques for stoma reduction.

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Patel, Lava Y; Lapin, Brittany; Brown, Craig S; Stringer, Thomas; Gitelis, Matthew E; Linn, John G; Denham, Woody E; Farwell, Elizabeth; Haggerty, Stephen; Ujiki, Michael B

2017-06-01

Approximately 20-30 % of morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGB) will experience significant weight regain in the years following surgery. Endoscopic gastrojejunal revision (EGJR) has been shown to be a safe, effective and less invasive alternative to revisional surgery, with promising weight loss outcomes. However, minimal data exist regarding how to perform the procedure most effectively and what factors may predict good outcomes. We compared weight loss outcomes between patients undergoing endoscopic stoma revision by one of two full-thickness suturing techniques. A retrospective review of patients undergoing EGJR between 06/2012 and 09/2015 was performed. Included patients were adults 18-74 years of age who had experienced weight regain ≥2 years after initial RYGB with stoma dilation ≥15 mm in diameter. Revision was done with either an interrupted (IRT) or purse-string (PST) suture technique. A linear mixed effects model was constructed to predict postoperative weight loss. Fifty revisions (IRT = 36, PST = 14) were performed in 47 patients (92 % female, mean age of 50.9 ± 10.9 years and body mass index of 41.4 ± 7.1 kg/m 2 ). Technical success (stoma diameter ≤10 mm) was achieved in all cases. Final diameter was significantly smaller in the PST group, 6.6 ± 2.2 mm versus 4.8 ± 1.8 mm (p weight loss over time compared to IRT. Sixteen comorbid conditions resolved among 12 patients. No major complications occurred. Endoscopic revision of the gastric outlet results in meaningful weight loss and comorbidity resolution in select patients experiencing weight regain following RYGB. A PST revision likely results in higher and more sustainable weight loss when compared to IRT.

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

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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.

Inhibition of Vascular c-Jun N-Terminal Kinase 2 Improves Obesity-Induced Endothelial Dysfunction After Roux-en-Y Gastric Bypass.

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Doytcheva, Petia; Bächler, Thomas; Tarasco, Erika; Marzolla, Vincenzo; Engeli, Michael; Pellegrini, Giovanni; Stivala, Simona; Rohrer, Lucia; Tona, Francesco; Camici, Giovanni G; Vanhoutte, Paul M; Matter, Christian M; Lutz, Thomas A; Lüscher, Thomas F; Osto, Elena

2017-11-14

Roux-en-Y gastric bypass (RYGB) reduces obesity-associated comorbidities and cardiovascular mortality. RYGB improves endothelial dysfunction, reducing c-Jun N-terminal kinase (JNK) vascular phosphorylation. JNK activation links obesity with insulin resistance and endothelial dysfunction. Herein, we examined whether JNK1 or JNK2 mediates obesity-induced endothelial dysfunction and if pharmacological JNK inhibition can mimic RYGB vascular benefits. After 7 weeks of a high-fat high-cholesterol diet, obese rats underwent RYGB or sham surgery; sham-operated ad libitum-fed rats received, for 8 days, either the control peptide D-TAT or the JNK peptide inhibitor D-JNKi-1 (20 mg/kg per day subcutaneous). JNK peptide inhibitor D-JNKi-1 treatment improved endothelial vasorelaxation in response to insulin and glucagon-like peptide-1, as observed after RYGB. Obesity increased aortic phosphorylation of JNK2, but not of JNK1. RYGB and JNK peptide inhibitor D-JNKi-1 treatment blunted aortic JNK2 phosphorylation via activation of glucagon-like peptide-1-mediated signaling. The inhibitory phosphorylation of insulin receptor substrate-1 was reduced, whereas the protein kinase B/endothelial NO synthase pathway was increased and oxidative stress was decreased, resulting in improved vascular NO bioavailability. Decreased aortic JNK2 phosphorylation after RYGB rapidly improves obesity-induced endothelial dysfunction. Pharmacological JNK inhibition mimics the endothelial protective effects of RYGB. These findings highlight the therapeutic potential of novel strategies targeting vascular JNK2 against the severe cardiovascular disease associated with obesity. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Relationship between the Nutritional Status of Vitamin A per Trimester of Pregnancy with Maternal Anthropometry and Anemia after Roux-en-Y Gastric Bypass.

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Cruz, Sabrina; Matos, Andréa; da Cruz, Suelem Pereira; Pereira, Silvia; Saboya, Carlos; Ramalho, Andréa

2017-09-08

The aim of this study was to compare the nutritional status of vitamin A per trimester of pregnancy, as well as to assess its influence on pre-pregnancy BMI, total gestational weight gain (TGWG) and presence of anemia in women who had previously undergone Roux-en-Y gastric bypass (RYGB). An analytical, longitudinal and retrospective study comprising 30 pregnant women who had previously undergone RYGB was undertaken. In all trimesters of pregnancy, the serum concentrations of retinol, β-carotene, stages of vitamin A deficiency (VAD), night blindness (NB), anemia and anthropometric variables were assessed. VAD in pregnancy affected 90% of women, 86.7% developed NB and 82.8% had mild VAD. TGWG above/below the recommended range was related to the low serum concentrations of β-carotene ( p = 0.045) in the second trimester and women with TGWG above the recommended range showed 100% of inadequacy of this nutrient in the third trimester. Among the pregnant women with anemia, 90.9% had VAD and 86.4% had NB. This study highlights the importance of monitoring the nutritional status of vitamin A in prenatal care, due to its relationship with TGWG and the high percentage of VAD and NB found since the beginning of pregnancy. It also reaffirms the use of the cut-off <1.05 μmol/L for determining VAD.

Suppressed Fat Appetite after Roux-en-Y Gastric Bypass Surgery Associates with Reduced Brain μ-opioid Receptor Availability in Diet-Induced Obese Male Rats.

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Hankir, Mohammed K; Patt, Marianne; Patt, Jörg T W; Becker, Georg A; Rullmann, Michael; Kranz, Mathias; Deuther-Conrad, Winnie; Schischke, Kristin; Seyfried, Florian; Brust, Peter; Hesse, Swen; Sabri, Osama; Krügel, Ute; Fenske, Wiebke K

2016-01-01

Brain μ-opioid receptors (MORs) stimulate high-fat (HF) feeding and have been implicated in the distinct long term outcomes on body weight of bariatric surgery and dieting. Whether alterations in fat appetite specifically following these disparate weight loss interventions relate to changes in brain MOR signaling is unknown. To address this issue, diet-induced obese male rats underwent either Roux-en-Y gastric bypass (RYGB) or sham surgeries. Postoperatively, animals were placed on a two-choice diet consisting of low-fat (LF) and HF food and sham-operated rats were further split into ad libitum fed (Sham-LF/HF) and body weight-matched (Sham-BWM) to RYGB groups. An additional set of sham-operated rats always only on a LF diet (Sham-LF) served as lean controls, making four experimental groups in total. Corresponding to a stage of weight loss maintenance for RYGB rats, two-bottle fat preference tests in conjunction with small-animal positron emission tomography (PET) imaging studies with the selective MOR radioligand [ 11 C]carfentanil were performed. Brains were subsequently collected and MOR protein levels in the hypothalamus, striatum, prefrontal cortex and orbitofrontal cortex were analyzed by Western Blot. We found that only the RYGB group presented with intervention-specific changes: having markedly suppressed intake and preference for high concentration fat emulsions, a widespread reduction in [ 11 C]carfentanil binding potential (reflecting MOR availability) in various brain regions, and a downregulation of striatal and prefrontal MOR protein levels compared to the remaining groups. These findings suggest that the suppressed fat appetite caused by RYGB surgery is due to reduced brain MOR signaling, which may contribute to sustained weight loss unlike the case for dieting.

Body composition, anthropometrics, energy expenditure, systemic inflammation, in premenopausal women 1 year after laparoscopic Roux-en-Y gastric bypass.

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Iannelli, Antonio; Martini, Francesco; Rodolphe, Anty; Schneck, Anne-Sophie; Gual, Philippe; Tran, Albert; Hébuterne, Xavier; Gugenheim, Jean

2014-02-01

Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is currently the most common bariatric procedure and results in a substantial weight loss and recovery from obesity-related comorbidities, both of which are maintained in the long term. However, besides the desired loss of fat mass, LRYGBP is also followed by the loss of fat-free mass (FFM). We aimed to determine the factors associated with the loss of ≥20 % of the initial FFM 1 year after LRYGBP in a prospective series of 115 Caucasian, premenopausal women. Anthropometrics, body composition (bioelectrical impedance analysis), resting energy expenditure (REE) (indirect calorimetry), inflammation, insulin resistance, and lipid disturbances were determined before and 1 year after LRYGBP. The mean loss of initial FFM was 15.3 ± 13.8 %. 1 year after LRYGBP, 81 women lost FFM group) and 35 lost ≥20 % (≥20 % FFM group) of the initial FFM. Before surgery, the FFM, weight, BMI, excess BMI, brachial circumference, waist circumference, and REE were significantly higher in the ≥20 % FFM group while inflammation, insulin resistance, and lipid disturbances were comparable between the two groups. 1 year after LRYGBP, the FFM, weight, BMI, excess BMI, brachial circumference, waist circumference, and REE decreased significantly and were comparable between the two groups. Inflammation, insulin resistance, and lipid disturbances improved comparably between the two groups after surgery. The only variable associated with the loss of ≥20 % of the initial FFM in the multivariable analysis was the presence of more FFM before surgery (67.0 ± 9.9 vs. 53.5 ± 6.7 kg). One year after LRYGBP the loss of ≥20 % of the initial FFM occurred mainly in women with more FFM before surgery and resulted in the same body composition of women who lost FFM.

Roux-en-Y Gastric Bypass Surgery Suppresses Hepatic Gluconeogenesis and Increases Intestinal Gluconeogenesis in a T2DM Rat Model.

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Yan, Yong; Zhou, Zhou; Kong, Fanzhi; Feng, Suibin; Li, Xuzhong; Sha, Yanhua; Zhang, Guangjun; Liu, Haijun; Zhang, Haiqing; Wang, Shiguang; Hu, Cheng; Zhang, Xueli

2016-11-01

Roux-en-Y gastric bypass (RYGB) is an effective surgical treatment for type 2 diabetes mellitus (T2DM). The present study aimed to investigate the effects of RYGB on glucose homeostasis, lipid metabolism, and intestinal morphological adaption, as well as hepatic and intestinal gluconeogenesis. Twenty adult male T2DM rats induced by high-fat diet and low dose of streptozotocin were randomly divided into sham and RYGB groups. The parameters of body weight, food intake, glucose tolerance, insulin sensitivity, and serum lipid profiles were assessed to evaluate metabolic changes. Intestinal sections were stained with hematoxylin and eosin (H&E) for light microscopy examination. The messenger RNA (mRNA) and protein expression levels of key regulatory enzymes of gluconeogenesis [phosphoenolpyruvate carboxykinase (PEPCK), glucose-6-phosphatase (G6Pase)] were determined through reverse-transcription PCR (RT-PCR) and Western blotting, respectively. RYGB induced significant improvements in glucose tolerance and insulin sensitivity, along with weight loss and decreased food intake. RYGB also decreased serum triglyceride (TG) and free fatty acid (FFA) levels. The jejunum and ileum exhibited a marked increase in the length and number of intestinal villi after RYGB. The RYGB group exhibited downregulated mRNA and protein expression levels of PEPCK and G6Pase in the liver and upregulated expression of these enzymes in the jejunum and ileum tissues. RYGB ameliorates glucose and lipid metabolism accompanied by weight loss and calorie restriction. The small intestine shows hyperplasia and hypertrophy after RYGB. Meanwhile, our study demonstrated that the reduced hepatic gluconeogenesis and increased intestinal gluconeogenesis may contribute to improved glucose homeostasis after RYGB.

Energy restriction and Roux-en-Y gastric bypass reduce postprandial α-dicarbonyl stress in obese women with type 2 diabetes.

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Maessen, Dionne E; Hanssen, Nordin M; Lips, Mirjam A; Scheijen, Jean L; Willems van Dijk, Ko; Pijl, Hanno; Stehouwer, Coen D; Schalkwijk, Casper G

2016-09-01

Dicarbonyl compounds are formed as byproducts of glycolysis and are key mediators of diabetic complications. However, evidence of postprandial α-dicarbonyl formation in humans is lacking, and interventions to reduce α-dicarbonyls have not yet been investigated. Therefore, we investigated postprandial α-dicarbonyl levels in obese women without and with type 2 diabetes. Furthermore, we evaluated whether a diet very low in energy (very low calorie diet [VLCD]) or Roux-en-Y gastric bypass (RYGB) reduces α-dicarbonyl stress in obese women with type 2 diabetes. In lean (n = 12) and obese women without (n = 27) or with type 2 diabetes (n = 27), we measured the α-dicarbonyls, methylglyoxal (MGO), glyoxal (GO) and 3-deoxyglucosone (3-DG), and glucose in fasting and postprandial plasma samples obtained during a mixed meal test. Obese women with type 2 diabetes underwent either a VLCD or RYGB. Three weeks after the intervention, individuals underwent a second mixed meal test. Obese women with type 2 diabetes had higher fasting and particularly higher postprandial plasma α-dicarbonyl levels, compared with those without diabetes. After three weeks of a VLCD, postprandial α-dicarbonyl levels in diabetic women were significantly reduced (AUC MGO -14%, GO -16%, 3-DG -25%), mainly through reduction of fasting plasma α-dicarbonyls (MGO -13%, GO -13%, 3-DG -33%). Similar results were found after RYGB. This study shows that type 2 diabetes is characterised by increased fasting and postprandial plasma α-dicarbonyl stress, which can be reduced by improving glucose metabolism through a VLCD or RYGB. These data highlight the potential to reduce reactive α-dicarbonyls in obese individuals with type 2 diabetes. ClinicalTrials.gov NCT01167959.

Bariatric Roux-En-Y Gastric Bypass Surgery: Adipocyte Proteins Involved in Increased Bone Remodeling in Humans.

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Biagioni, Maria Fernanda G; Mendes, Adriana L; Nogueira, Célia Regina; Leite, Celso V; Gollino, Loraine; Mazeto, Gláucia Mfs

2017-07-01

Bariatric surgery has been associated with bone remodeling changes. The action of adipokines on the expression of receptor activator of nuclear factor kappa β ligand (RANKL) and osteoprotegerin (OPG) and on an increase in sclerostin could be related to these changes. This study aimed to assess the repercussions of weight loss, fat mass (FM), and fat-free mass (FFM) loss and biochemical and hormonal changes on bone remodeling markers after Roux-en-Y gastric bypass (RYGB). Anthropometric data, parathyroid hormone (PTH), bone-specific alkaline phosphatase (BSAP), collagen type 1 C-telopeptide (CTX), 25-hydroxy vitamin D (25-OH-VitD), leptin, adiponectin, RANKL, OPG, and sclerostin of 30 menstruating women were measured preoperatively (Pre), and 3, 12, and 24 months (m) after RYGB. Leptin (34.4 (14.7; 51.9) vs. 22.5 (1.9; 52.7) ng/mL) and OPG (3.6 (1.1; 11.5) vs. 3.4 (1.5; 6) pmol/L) decreased, and adiponectin (7.4 (1.7; 18.4) vs. 13.8 (3.0; 34.6) μg/mL), CTX (0.2 (0.1; 2.2) vs. 0.6 (0.4; 6.0) ng/mL), RANKL (0.1 (0.0; 0.5) vs. 0.3 (0.0; 2.0) pmol/L), and sclerostin (21.7 (3.2; 75.1) vs. 34.8 (6.4; 80.5) pmol/L) increased after 3 m. BSAP increased after 12 m (10.1 (5.4; 18.9) vs. 13.9 (6.9; 30.2) μg/mL) (p < 0.005). CTX correlated positively with adiponectin at 24 m and inversely with leptin Pre; OPG at 3 m; weight, FM, FFM, and leptin at 24 m. RANKL correlated directly with weight at 3 m. Sclerostin correlated inversely with weight Pre and FM at 3 m. BSAP correlated negatively with 25-OH-VitD at 12 m, and positively with PTH at 24 m. RYGB induced weight loss, and biochemical, hormonal, and body composition changes are associated with higher bone remodeling.

Relationship between intraoperative non-technical performance and technical events in bariatric surgery.

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Fecso, A B; Kuzulugil, S S; Babaoglu, C; Bener, A B; Grantcharov, T P

2018-03-30

The operating theatre is a unique environment with complex team interactions, where technical and non-technical performance affect patient outcomes. The correlation between technical and non-technical performance, however, remains underinvestigated. The purpose of this study was to explore these interactions in the operating theatre. A prospective single-centre observational study was conducted at a tertiary academic medical centre. One surgeon and three fellows participated as main operators. All patients who underwent a laparoscopic Roux-en-Y gastric bypass and had the procedures captured using the Operating Room Black Box ® platform were included. Technical assessment was performed using the Objective Structured Assessment of Technical Skills and Generic Error Rating Tool instruments. For non-technical assessment, the Non-Technical Skills for Surgeons (NOTSS) and Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) tools were used. Spearman rank-order correlation and N-gram statistics were conducted. Fifty-six patients were included in the study and 90 procedural steps (gastrojejunostomy and jejunojejunostomy) were analysed. There was a moderate to strong correlation between technical adverse events (r s  = 0·417-0·687), rectifications (r s  = 0·380-0·768) and non-technical performance of the surgical and nursing teams (NOTSS and SPLINTS). N-gram statistics showed that after technical errors, events and prior rectifications, the staff surgeon and the scrub nurse exhibited the most positive non-technical behaviours, irrespective of operator (staff surgeon or fellow). This study demonstrated that technical and non-technical performances are related, on both an individual and a team level. Valuable data can be obtained around intraoperative errors, events and rectifications. © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

Evolução ponderal oito anos após a derivação gástrica em Y-de-Roux

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Antonio Carlos Valezi

Full Text Available OBJETIVO: Avaliar a eficácia da derivação gástrica com bandagem em Y-de-Roux na promoção da perda de peso após oito anos de seguimento. MÉTODOS: Duzentos e onze obesos foram submetidos à derivação gástrica com bandagem em Y-de-Roux, pela mesma equipe cirúrgica. O desenho do estudo foi longitudinal, prospectivo e descritivo. A análise da diminuição do peso no pós-operatório foi baseado na perda do excesso de peso em percentual e no cálculo do IMC. Falha terapêutica foi considerada quando os pacientes perderam <50% do excesso de peso. RESULTADOS: A perda de seguimento foi de 36,5%, portanto, 134 pacientes foram incluídos neste estudo. A perda do excesso de peso em percentual média global no pós-operatório foi de: 67,6 ± 14,9% no primeiro ano, 72,6 ± 14,9% no segundo ano, 69,7 ± 15,1% no quinto ano e 66,8 ± 7,6 em oito anos. Falha no tratamento cirúrgico ocorreu em 15 pacientes (7,1% ao longo dos oito anos. CONCLUSÃO: A derivação gástrica com bandagem em Y-de-Roux foi efetiva na promoção e manutenção da perda de peso no longo prazo, com baixa taxa de falhas.

Sex Effect on Obesity Indices and Metabolic Outcomes in Patients with Obese Obstructive Sleep Apnea and Type 2 Diabetes After Laparoscopic Roux-en-Y Gastric Bypass Surgery: a Preliminary Study.

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Xu, Huajun; Zhang, Pin; Han, Xiaodong; Yu, Haoyong; Di, Jianzhong; Zou, Jianyin; Wang, Yuyu; Qian, Yingjun; Tu, Yinfang; Bao, Yuqian; Yi, Hongliang; Guan, Jian; Yin, Shankai; Jia, Weiping

2016-11-01

Roux-en-Y gastric bypass (RYGB) surgery is an effective therapy for obstructive sleep apnea (OSA). However, little attention has been paid to the treatment goals systematically stratified by sex. The objective of this study was to assess how sex differences affect obesity indices and metabolic outcomes after RYGB surgery. A sleep questionnaire was conducted and medical histories were taken. Full-night polysomnography (PSG), anthropometric variables, and blood samples were collected. Thirty-five consecutive patients with OSA who underwent laparoscopic RYGB surgery were prospectively examined for at least 6 months were included in the study. Significant improvements (p obesity indices, and metabolic outcomes [except low-density lipoprotein in men and high-density lipoprotein (HDL) in women] were obtained in men and women with OSA. Men had higher baseline triglyceride (TG) (p women. However, only TG in men improved more than in women (p = 0.02). Sleep parameters, obesity indices, and metabolic outcomes after RYGB surgery were of similar magnitude in women and men with OSA. Alleviating sleep and obesity problems was correlated with metabolic outcomes in men and women.

CORRELATION BETWEEN PRE AND POSTOPERATIVE LEVELS OF GLP-1/GLP-2 AND WEIGHT LOSS AFTER ROUX-EN-Y GASTRIC BYPASS: A PROSPECTIVE STUDY

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CAZZO, Everton; GESTIC, Martinho Antonio; UTRINI, Murillo Pimentel; PAREJA, José Carlos; CHAIM, Elinton Adami; GELONEZE, Bruno; BARRETO, Maria Rita Lazzarini; MAGRO, Daniéla Oliveira

2016-01-01

ABSTRACT Background: The role of gut hormones in glucose homeostasis and weight loss achievement and maintenance after bariatric surgery appears to be a key point in the understanding of the beneficial effects observed following these procedures. Aim: To determine whether there is a correlation between the pre and postoperative levels of both GLP-1 and GLP-2 and the excess weight loss after Roux-en-Y gastric bypass (RYGB). Methods: An exploratory prospective study which enrolled 11 individuals who underwent RYGB and were followed-up for 12 months. GLP-1 and GLP-2 after standard meal tolerance test (MTT) were determined before and after surgery and then correlated with the percentage of excess loss (%EWL). Results: GLP-2 AUC presented a significant postoperative increase (945.3±449.1 vs.1787.9±602.7; p=0.0037); GLP-1 AUC presented a non-significant trend towards increase after RYGB (709.6±320.4 vs. 1026.5±714.3; p=0.3808). Mean %EWL was 66.7±12.2%. There was not any significant correlation between both the pre and postoperative GLP-1 AUCs and GLP-2 AUCs and the %EWL achieved after one year. Conclusion: There was no significant correlation between the pre and postoperative levels of the areas under the GLP-1 and GLP-2 curves with the percentage of weight loss reached after one year. PMID:28076481

Antegrade bowel intussusception after remote Whipple and Puestow procedures for treatment of pancreas divisum.

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Gigena, Manuel; Villar, Hugo V; Knowles, Negar G; Cunningham, John T; Outwater, Erik K; Leon, Luis R

2007-11-28

To date, antegrade intussusception involving a Roux-en-Y reconstruction has been reported only once. We report a case of acute bowel obstruction due to an intussusception involving two Roux-en-Y limbs in a 40-year-old woman with a history of chronic pancreatitis due to pancreas divisum. Four years preceding this event, the patient had undergone a Whipple procedure, and three years prior to that, a Puestow operation. The patient was successfully treated with bowel resection and a side-to-side anastomosis between the most distal aspect of the bowel and the most distal Roux-en-Y reconstruction, which preserved both Roux-en-Y reconstructions.

MORPHOLOGICAL VARIATION AND GEOGRAPHIC DISTRIBUTION OF Pseudogonatodes lunulatus (Roux, 1927 (SAURIA, SPHAERODACTYLIDAE IN VENEZUELA | VARIACIÓN MORFOLÓGICA Y DISTRIBUCIÓN GEOGRÁFICA DE Pseudogonatodes lunulatus (Roux, 1927 (SAURIA, SPHAERODACTYLIDAE EN VENEZUELA

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Luis Felipe Esqueda

2016-02-01

Full Text Available Pseudogonatodes lunulatus (Roux, 1927 was described from a single specimen collected in the village El Mene, Acosta municipality, northeastern Falcón state, Venezuela. Although the species has been reported for other Venezuelan and Colombian localities, an extensive study on taxonomy and geographic distribution in the country had not been performed. In this sense, we examined and compared a larger sample of 20 specimens deposited in several national and foreign museums. Additionally, we substantially expand the known distribution of the species to the north of the Orinoco River.

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.

“Omics” Prospective Monitoring of Bariatric Surgery: Roux-En-Y Gastric Bypass Outcomes Using Mixed-Meal Tolerance Test and Time-Resolved 1H NMR-Based Metabolomics

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Lopes, Thiago I.B.; Geloneze, Bruno; Pareja, José C.; Calixto, Antônio R.; Ferreira, Márcia M.C.

2016-01-01

Abstract Roux-en-Y gastric bypass (RYGB) surgery goes beyond weight loss to induce early beneficial hormonal changes that favor glycemic control. In this prospective study, ten obese subjects diagnosed with type 2 diabetes underwent bariatric surgery. Mixed-meal tolerance test was performed before and 12 months after RYGB, and the outcomes were investigated by a time-resolved hydrogen nuclear magnetic resonance (1H NMR)-based metabolomics. To the best of our knowledge, no previous omics-driven study has used time-resolved 1H NMR-based metabolomics to investigate bariatric surgery outcomes. Our results presented here show a significant decrease in glucose levels after bariatric surgery (from 159.80 ± 61.43 to 100.00 ± 22.94 mg/dL), demonstrating type 2 diabetes remission (p < 0.05). The metabolic profile indicated lower levels of lactate, alanine, and branched chain amino acids for the operated subject at fasting state after the surgery. However, soon after food ingestion, the levels of these metabolites increased faster in operated than in nonoperated subjects. The lipoprotein profile achieved before and after RYGB at fasting was also significantly different, but converging 180 min after food ingestion. For example, the very low-density lipoprotein, low-density lipoprotein, N-acetyl-glycoproteins, and unsaturated lipid levels decreased after RYGB, while phosphatidylcholine and high-density lipoprotein increased. This study provides important insights on RYGB surgery and attendant type 2 diabetes outcomes using an “omics” systems science approach. Further research on metabolomic correlates of RYGB surgery in larger study samples is called for. PMID:27428253

Transgastric endoluminal gastrojejunostomy: technical development from bench to animal study (with video).

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Chiu, Philip Wai Yan; Wai Ng, Enders Kwok; Teoh, Anthony Yun Bun; Lam, Candice Chuen Hing; Lau, James Yun Wong; Sung, Joseph Jao Yiu

2010-02-01

Gastrojejunal anastomosis is commonly performed for palliative management of malignant gastric outlet obstruction and bariatric surgery. Natural orifice transluminal endoscopic surgery revolutionized the surgical approach to intra-abdominal surgery. This study explored the possibility of performing gastrojejunostomy (GJ) by using a hybrid natural orifice transluminal endoscopic surgery approach. To develop a surgical technique for the performance of transgastric endoscopic GJ (TGEJ) in a porcine model. Prospective series of animal experiments. University hospital animal laboratory. Thirteen female domestic pigs. With the animals under general anesthesia, the endoscope is passed through the gastrotomy and a segment of small bowel is retrieved into the stomach. An enterotomy is then created, and an EndoGIA stapler is introduced through an intragastric port and passed between the small bowel and stomach wall. A GJ is formed after firing of the EndoGIA stapler. The pigs are allowed to resume their diet 1 day after the operation and are allowed to survive for 2 weeks before they are euthanized. The patency of the GJ is confirmed with a repeat endoscopy, contrast study, and postmortem examination. A total of 13 TEGJs were performed, 11 of which were successful. The mean operative time was 53.6 +/- 45.7 minutes. The mean time for gastrotomy was 4.7 minutes, and that for GJ was 42.5 minutes. One TEGJ was converted to open surgery because of malpositioning of the intragastric port, and the other failed because the enterotomy was too extensive. Ten of 11 pigs survived for 2 weeks, and endoscopic examination with contrast study confirmed that all the gastrojejunostomies were patent. On postmortem examination, the average size of the GJ was 30 mm. The length between duodenojejunal flexure and the site chosen to perform the GJ could not be determined. TEGJ is technically feasible with a patent and sizable anastomosis.

Incidência da deficiência de vitamina B12 em pacientes submetidos à cirurgia bariátrica pela técnica Fobi-Capella (Y-de-Roux Incidence of vitamin B12 deficiency in patients submitted to Fobi-Capella Roux-en-Y bariatric surgery

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Iara Ribeiro Carvalho

2012-03-01

Full Text Available RACIONAL: Os pacientes submetidos à cirurgia bariátrica podem desenvolver, ao longo do tempo, algumas complicações e a anemia é quadro importante decorrente da ressecção gástrica, levando à deficiência de ferro, ácido fólico ou vitamina B. OBJETIVO: Verificar a incidência da deficiência de vitamina B12 e comparar dados antropométricos e bioquímicos do pré e pós-operatório (seis meses, em pacientes submetidos à cirurgia bariátrica Fobi-Capella (Y de Roux. MÉTODOS: Análise retrospectiva e descritiva de 91 prontuários de pacientes submetidos à operação. Foram coletadas informações pessoais, data do procedimento e valores do pré e pós-operatório (seis meses, redução de peso, co-morbidades, colesterol, triglicérides, glicemia, vitamina B12, hemoglobina e hematócrito. Para análise estatística foi utilizado nível de significância de 5% (pBACKGROUND: Patients undergoing bariatric surgery may develop over time, some complications and anemia is an important one due to gastric resection, leading to iron, folic acid or vitamin B12 deficiency. AIM: To determine the incidence of deficiency of vitamin B12 and other anthropometric and biochemical data comparing the preoperative and postoperative (six months period in patients who underwent bariatric surgery with Fobi-Capella (Roux-en-Y technique. METHODS: Retrospective and descriptive analysis of 91 charts of patients who underwent surgery. It was collected personal information, date of surgery and pre-and postoperative (six months values, weight loss, comorbidities, serum analysis of total cholesterol, triglycerides, glucose, vitamin B12, hemoglobin and hematocrit. For statistical analysis, it was considered significance level of 5% (p<0.05. RESULTS: It was found that there was a reduction in weight of 25,0% compared with the preoperative value and the average BMI was from 41,2±4,9 kg/m² to 30,7±3,9 kg/m². The most common co-morbidities were dyspnea (93,4%, spine

Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series.

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Jones, Kenneth B; Afram, Joseph D; Benotti, Peter N; Capella, Rafael F; Cooper, C Gary; Flanagan, Latham; Hendrick, Steven; Howell, L Michael; Jaroch, Mark T; Kole, Kerry; Lirio, Oscar C; Sapala, James A; Schuhknecht, Michael P; Shapiro, Robert P; Sweet, William A; Wood, Michael H

2006-06-01

Laparoscopic bariatric surgery has experienced a rapid expansion of interest over the past 5 years, with a 470% increase. This rapid expansion has markedly increased overall cost, reducing surgical access. Many surgeons believe that the traditional open approach is a cheaper, safer, equally effective alternative. 16 highly experienced "open" bariatric surgeons with a combined total of 25,759 cases representing >200 surgeon years of experience, pooled their open Roux-en-Y gastric bypass (ORYGBP) data, and compared their results to the leading laparoscopic (LRYGBP) papers in the literature. In the overall series, the incisional hernia rate was 6.4% using the standard midline incision. Utilizing the left subcostal incision (LSI), it was only 0.3%. Return to surgery in <30 days was 0.7%, deaths 0.25%, and leaks 0.4%. Average length of stay was 3.4 days, and return to usual activity 21 days. Small bowel obstruction was significantly higher with the LRYGBP. Surgical equipment costs averaged approximately $3,000 less for "open" cases. LRYGBP had an added expense for longer operative time. This more than made up for the shorter length of stay with the laparoscopic approach. The higher cost, higher leak rate, higher rate of small bowel obstruction, and similar long-term weight loss results make the "open" RYGBP our preferred operation. If the incision is taken out of the equation (i.e. use of the LSI), the significant advantages of the open technique become even more obvious.

Analgesic Treatment in Laparoscopic Gastric Bypass Surgery

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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......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...

Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass is Effective for Gastro-Oesophageal Reflux Disease but not for Further Weight Loss.

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Parmar, Chetan D; Mahawar, Kamal K; Boyle, Maureen; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

2017-07-01

Inadequate weight loss (IWL)/weight regain (WR) and gastro-esophageal reflux disease (GERD), unresponsive to medical management, are two most common indications for conversion of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB). This study reports detailed outcomes of conversion of SG to RYGB for these two indications separately. We interrogated our prospectively maintained database to identify patients who underwent a conversion of their SG to RYGB in our unit. Outcomes in patients converted for IWL/WR and those converted for GERD were evaluated separately. We carried out 22 SG to RYGB in our unit between Aug 2012 and April 2015 with a mean follow-up of 16 months. Indication for conversion was GERD in 10/22 (45.5%) patients and IWL/WR in 11/22 (50.0%) patients. Patients undergoing conversion for GERD were significantly lighter (BMI 30.5) than those converted for IWL/WR (BMI 43.3) at the time of conversion. The conversion was very effective for GERD with 100% patients reporting improvement in symptoms, and 80% patients were able to stop their antacid medications. IWL/WR group achieved a further BMI drop of 2.5 points 2 years after surgery (final BMI 40.8) in comparison with 2.0 points BMI drop achieved by the GERD group (final BMI 28.5). This study demonstrates that conversion of SG to RYGB is effective for GERD symptoms but not for further weight loss, which was modest in both groups. Future studies need to examine the best revisional procedure for IWL/WR after SG.

Coreografía de una matanza: memoria y performance de la masacre de Accomarca en el carnaval ayacuchano en Lima, Perú

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Renzo Aroni

2015-01-01

Full Text Available El 14 de agosto de 1985, durante el largo conflicto armado interno entre la guerrilla maoísta de Sendero Luminoso - SL y el Estado peruano, una patrulla del Ejército entró en el pueblo andino de Accomarca, ubicado en la región de Ayacucho, y asesinó a 69 personas indígenas, incluyendo niños y ancianos, supuestos simpatizantes del grupo insurgente. La mayoría de los sobrevivientes y familiares de las víctimas se desplazaron a Lima y se integraron en una organización de víctimas y en la Asociación Hijos del Distrito de Accomarca - AHIDA. Desde el año 2011, con motivo de la extradición desde los Estados Unidos del mayor Telmo Hurtado, principal responsable de la masacre, la AHIDA ha recreado la dolorosa experiencia de la matanza a través de una performance anual del carnaval ayacuchano, incorporando coreografías y canciones testimoniales para exigir la justicia para las víctimas de la masacre. Esta performance carnavalesca integra a los niños y jóvenes que no vivieron la masacre, pero imaginan, interpretan y crean su propia memoria mediante la comunicación con los sobrevivientes y la participación en la producción cultural del evento. En este artículo expongo cómo los sobrevivientes y familiares de las víctimas recuerdan la masacre y transmiten sus memorias a sus hijos a través de una actuación carnavalesca. Describo la producción de una memoria intergeneracional a través de la transmisión intergeneracional, que se construye en el espacio doméstico (familia, el espacio comunal/institucional (AHIDA, y el espacio público (carnaval. Sin duda, la ocasión del carnaval es un espacio de gran alcance para la producción de otras formas de memoria, y para la demanda de la justicia a través de una coreografía participativa y performance musical.

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

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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.

Vitamin D and its relation with ionic calcium, parathyroid hormone, maternal and neonatal characteristics in pregnancy after roux-en-Y gastric bypass.

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Medeiros, Marina; Matos, Andréa C; Pereira, Silvia E; Saboya, Carlos; Ramalho, Andréa

2016-03-01

The objective of this study was to evaluate vitamin D nutritional status and its relation with ionic calcium, parathyroid hormone (PTH), maternal anthropometry and perinatal outcomes in pregnant women who previously underwent Roux-en-Y gastric bypass (RYGB) surgery. In a clinic specialized in obesity control located in the city of Rio de Janeiro (Brazil), the following information were collected for adult women who underwent RYGB before pregnancy: serum concentrations of vitamin D [25(OH)D], calcium and PTH per gestational trimester and data on maternal anthropometry, gestational intercurrences and perinatal outcomes. The present study included 46 post-RYGB pregnant women. The prevalence of pregnant women with deficiency (≤20 ng/mL) or insufficiency (≥21 and 29 ng/mL) of vitamin D was above 70% in all trimesters. The prevalence of calcium deficiency was 15.2% in the first and in the second trimesters and 20% in the third trimester, while the prevalence of excess PTH was 19.6, 30.4 and 32.6% in the first, the second and the third trimesters, respectively. In the second and the third trimesters, a significant difference was observed between concentrations of 25(OH)D, and a negative correlation was observed between concentrations of calcium and PTH. Association of 25(OH)D with urinary tract infection (UTI) was found, but there was no association with calcium, PTH, maternal anthropometry, type of delivery and weight and gestational age at birth The post-RYGB pregnant women showed an elevated serum inadequacy (deficiency or insufficiency) of 25(OH)D during pregnancy. Maternal vitamin D status showed no association with maternal variables, except UTI, and the neonatal variables analyzed.

"Alguien tocaba la puerta. … Tú te envolviste en una bata y abriste”:narrativa y rito en la novela y performance El cuerpo de Giulia-no de Jorge Eduardo Eielson

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Rebaza-Soraluz, Luis

2005-01-01

De manera general, este ensayo explora la relación entre literatura y artes visuales en la obra del escritor y artista plástico peruano Jorge Eduardo Eielson (1924). De manera particular, es un análisis de las estructuras narrativas que sostienen tanto su novela El cuerpo de Giulia-no (México, 1971) como su performance del mismo nombre y su instalación "247 metros de tela de algodón crudo" presentados estos dos últimos en la Bienal de Venecia de 1972.

Motilidade esofágica após derivação gástrica em Y-de-Roux para obesidade mórbida: achados à manometria de alta resolução

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Cassão,Bruna Dell'acqua; Herbella,Fernando Augusto Mardiros; Silva,Luciana C.; Vicentine,Fernando Pompeu P.

2013-01-01

RACIONAL:A cirurgia bariátrica pode provocar alterações na motilidade esofágica. Entretanto, existe paucidade de estudos com a manometria de alta resolução. OBJETIVO: Avaliar a motilidade esofágica em pacientes submetidos à derivação gástrica em Y-de-Roux para obesidade mórbida. MÉTODOS: Foram estudados 18 pacientes assintomáticos submetidos à derivação gástrica em Y-de-Roux por laparotomia. Todos foram submetidos à manometria de alta resolução em média três anos após a operação. RESULTADOS: ...

Abdomen after a Puestow procedure: postoperative CT appearance, complications, and potential pitfalls.

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Freed, K S; Paulson, E K; Frederick, M G; Keogan, M T; Pappas, T N

1997-06-01

To evaluate the postoperative computed tomographic (CT) appearance, complications, and potential pitfalls after a Puestow procedure (lateral side-to-side pancreaticojejunostomy). Forty CT examinations were performed after the Puestow procedure in 20 patients. Images were retrospectively reviewed by three radiologists. The pancreaticojejunal anastomosis was identified at 30 examinations and was immediately anterior to the pancreatic body or tail. The anastomosis contained fluid or gas on 11 scans and oral contrast material on four scans. On 15 scans, the anastomosis appeared as collapsed bowel without gas, fluid, or oral contrast material. The Roux-en-Y loop was identified on 28 (70%) scans and contained fluid or gas on 16 scans and oral contrast material on six scans. The Roux-en-Y loop appeared as collapsed bowel on six scans. When the anastomosis or Roux-en-Y loop contained fluid and gas, the appearance mimicked that of a pancreatic or parapancreatic abscess. Peripancreatic stranding was present on 28 scans and was due to either ongoing pancreatitis or postoperative change. Complications included 15 transient fluid collections, three abscesses, four pseudocysts, one hematoma, and one small-bowel and Roux-en-Y obstruction. Knowledge of the anatomy after a Puestow procedure is essential for accurate interpretation of CT scans.

Transmedia y moda: realismo y virtualidad en Chanel y Gaultier

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Manuel Viñas Limonchi

2017-11-01

Full Text Available La evolución de la industria de la moda en su parcela creativa depende, principalmente, del aporte estilístico que realiza el diseñador a cargo de la ideación y manufactura del producto, así como de su exhibición teatralizada y/o mediática. Ese mismo producto encuentra en el apartado tecnológico de la comunicación la justificación idónea para su expansión artística y persuasiva. En este artículo se abordará una revisión de recursos, especialmente de naturaleza iconográfica, que favorecen el emplazamiento de esta vertiente creativa dentro de los dominios de la narrativa transmedia. Un análisis constatado en clave publicitaria mediante la dirección de arte de dos autores, Lagerfeld y Gaultier, que plantean en sus intervenciones una migración de contenidos a distintos medios como complemento a la performance natural que se desenvuelve en la pasarela.

The concept of laparoscopy-assisted pancreatobiliary EUS (LAP-EUS).

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Ramesh, Jayapal; Christein, John; Varadarajulu, Shyam

2013-05-01

While laparoscopy-assisted endoscopic retrograde cholangiopancreatography can be performed for the diagnosis and management of pancreaticobiliary diseases in patients with Roux-en-Y (RY) anatomy; the technical feasibility of performing laparoscopy-assisted endoscopic ultrasound (EUS) is unknown. In this report, we describe the technique for performing laparoscopy-assisted EUS in two patients with RY gastric bypass anatomy who presented with obstructive jaundice, abnormal liver function tests, and dilated biliary tree. While the examination was normal in one patient, EUS-guided fine needle aspiration of pancreatic head mass revealed adenocarcinoma in the other. Laparoscopic assisted EUS examination including FNA is feasible in Roux-en-Y surgical anatomy.

Rates of secondary hyperparathyroidism after bypass operation for super-morbid obesity: An overlooked phenomenon.

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White, Michael G; Ward, Marc A; Applewhite, Megan K; Wong, Harry; Prachand, Vivek; Angelos, Peter; Kaplan, Edwin L; Grogan, Raymon H

2017-03-01

With over 110,000 bariatric operations performed in the United States annually, it is important to understand the biochemical abnormalities causing endocrine dysfunction associated with these procedures. Here we compare 2 malabsorptive procedures, duodenal switch and Roux-en-Y gastric bypass, to determine the role malabsorption plays in secondary hyperparathyroidism in this population. Data from all super-obese patients undergoing duodenal switch or Roux-en-Y gastric bypass between August 2002 and October 2005 were prospectively collected. Postoperatively, all patients received 1,200 mg of calcium citrate and 1,000 IU vitamin D3 per American Society for Metabolic and Bariatric Surgery guidelines. Beginning in 2007, duodenal switch patients were instructed to add daily vitamin D3 10,000 IU. Statistical analyses included Student t test, multivariate, and univariate logistic regression. Of 283 patients with a body mass index ≥50, 170 (60.1%) underwent duodenal switch, while 113 (39.9%) underwent Roux-en-Y gastric bypass. Of 132 (46.6%) patients with secondary hyperparathyroidism, 101 (59.4%) had undergone duodenal switch and 31 (27.4%) had undergone Roux-en-Y gastric bypass. Symptoms were more common in the duodenal switch group (33 patients [19.4%]) than Roux-en-Y gastric bypass (11 patients [9.7%]). Multivariate logistic regression demonstrated that the extent of bypass and duration of follow-up were the only 2 independent predictive risk factors for developing secondary hyperparathyroidism. Although vitamin D levels improved with increased vitamin D3 supplementation in 2007, rates of secondary hyperparathyroidism increased. Despite routine postoperative calcium and vitamin D3 supplementation, secondary hyperparathyroidism is common after Roux-en-Y gastric bypass and duodenal switch. The degree of iatrogenic malabsorption correlates with the incidence of secondary hyperparathyroidism. These rates suggest current supplementation guidelines are not sufficient in

The Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Surgery on Dietary Intake, Food Preferences, and Gastrointestinal Symptoms in Post-Surgical Morbidly Obese Lebanese Subjects: A Cross-Sectional Pilot Study.

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El Labban, Sibelle; Safadi, Bassem; Olabi, Ammar

2015-12-01

Data on gastrointestinal (GI) and dietary changes following bariatric surgery are scarce in the Middle Eastern region. The objective of this work was to retrospectively compare dietary intake, food preferences, and GI symptoms in subjects with extreme obesity after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Sixty subjects equally divided between RYGB and SG with a postoperative period of ≥6 months were recruited for a retrospective, non-randomized, and observational study. All subjects completed three questionnaires (GI symptoms, food preferences, and quantitative food frequency questionnaire (FFQ)) and three 24-h recalls. At one year postoperatively, both surgical groups showed similar percentage of excess weight loss that exceeded 50%. In addition, percentage of carbohydrate, protein, and sugar intake from total energy, frequency of daily consumption from the eight food categories and daily energy intake were comparable between surgical groups. RYGB subjects consumed significantly more fruits and juices from total energy (P fast heartbeat (P food preferences between RYGB and SG groups. There was a trend for sweet-eating in SG subjects with less dumping symptoms to suggest different mechanisms of action for each procedure, which might impact eating behavior.

Ciberpunk y arte de los nuevos medios: performance y arte digital

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Psarra, Afroditi

2016-01-01

La tesis doctoral Ciberpunk y Arte de los Nuevos Medios: Performance y Arte Digital consiste en la aproximación del fenómeno ciberpunk como expresión literaria y cinematográfica, en el estudio del arte de los nuevos medios, y en la reflexión artística que surge de la amalgama de estos conceptos. Su objetivo es comentar a un nivel multidisciplinario la influencia de la teoría y la estética ciberpunk en la construcción de mecanismos creativos, y estudiar la integración de las ideas del ciberpun...

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

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Chaves, Luiz Claudio Lopes; Borges, Isabela Klautau Leite Chaves; Souza, Maíra Danielle Gomes de; Silva, Ian Passos; Silva, Lyz Bezerra; Magalhães, Marcelo Alexandre Prado; Fonseca, Allan Herbert Feliz; Campos, Josemberg Marins

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. To identify the incidence of inflammatory lesions in the stomach after bariatric surgery and to correlate it with H. pylori infection. 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. 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 (pgrupos de pacientes. Em ambos os grupos verificou-se a prevalência do H. pylori no pré-operatório através de histopatologia, mas em apenas um dos grupos, nos casos de H. pylori positivo realizou-se o tratamento com antibioticoterapia e inibidor de bomba de próton com realização de nova endoscopia no 6° e 12° mês pós-operatório. Avaliou-se 216 pacientes, com as seguintes características: sexo feminino (68,1%), faixa etária entre 30-40 anos, com 31,9% e 31%, respectivamente. De acordo com o IMC, 17,6% apresentavam obesidade moderada, 82,4% obesidade severa/mórbida e 9,7% superobesidade. Nos pacientes submetidos à endoscopia, a positividade do H. pylori se manifestou em 40,7%, sendo responsável pela atividade inflamatória na mucosa gástrica (p<0,001). No pós-operatório, investigou-se a

Cardioplasty and Roux-en-Y partial gastrectomy (Serra-Dória procedure for reoperation of achalasia Cardioplastia e gastrectomia parcial em Y-de-Roux (operação de Serra-Dória para reoperações no megaesôfago

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Helio Ponciano

2004-09-01

Full Text Available BACKGROUND: After cardiomyotomy for the treatment of megaesophagus, recurrence of symptoms occur in up to 15% of the patients, but only some require a reoperation. AIM: To evaluate the results of reoperation - cardioplasty with Roux-en-Y partial gastrectomy, a technique proposed by Serra-Dória. CASUISTIC AND METHODS: Twenty patients with achalasia previously treated by cardiomyotomy, were retrospectively studied. The etiology of symptoms recurrence was reflux esophagitis in nine (45.0% patients, healing of the myotomy in five (25.0%, end staging megaesophagus in five (25.0% and incomplete myotomy in one (5%. Intra and postoperative complications were analyzed. The patients were studied by clinical (dysphagia, regurgitation, heartburn and weight gain, radiological and endoscopic evaluation, in the pre- and postoperative period. RESULTS: Five (25.0% patients had complications in the immediate postoperative period. No deaths were observed. Dysphagia improved in all the patients. Regurgitation and heartburn almost disappeared in the whole group. Weight was maintained or increased in 64.7% of the patients. Radiological studies showed a decrease in the caliber of the esophagus in 53.0%, while the remaining patients maintained the pre-operative diameter. Endoscopy, performed during the late postoperative period in 17 patients, showed that 6 among the 9 with reflux esophagitis improved; 2 among the 8 with a normal esophagus during the preoperative period, developed esophagitis. CONCLUSIONS: The Serra-Dória procedure for the treatment of megaesophagus in patients who had already undergone cardiomyotomy and whose symptoms recurred, presented a low morbidity and no mortality. It offered a significant relief of symptoms with a decrease of the caliber of the esophagus in several patients. The patients also improved with regards to reflux esophagitis. In some cases reflux was still present after surgery. Others with normal esophagus in the preoperative

Actas del III Encuentro Platense de Investigadores/as sobre Cuerpo en las Artes Escénicas y Performáticas

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Sáez, Mariana Lucía

2016-01-01

Los días 4, 5 y 6 de septiembre de 2013, en el Centro Cultural Islas Malvinas de la ciudad de La Plata, se desarrolló el III ECART, Encuentro Platense de Investigadores sobre Cuerpo en las Artes Escénicas y Performáticas, organizado por el Grupo de Estudio sobre Cuerpo-Centro Interdisciplinario Cuerpo, Educación y Sociedad y la Compañía Proyecto en Bruto. En el transcurso de las tres jornadas de este nuevo encuentro se sucedieron talleres, conferencias, mesas de ponencias, obras de danza y...

Pedidos y saludos en español peruano y en sueco

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Pettersson, Camilla

2012-01-01

El objetivo de este estudio es mostrar diferencias y similitudes en la comunicación en los actos de habla de pedir y de saludar en el español de la variante peruana y en el sueco, y además acercarnos a eventuales problemas que puedan surgir en el encuentro entre estas dos culturas. Muchos autores han realizado estudios sobre actos de habla en relación con la cortesía, pero ninguno se ha centrado en estos dos actos de habla específicos entre las culturas peruana y sueca, es por ello interesant...

Prediction of Excess Weight Loss after Laparoscopic Roux-en-Y Gastric Bypass: Data from an Artificial Neural Network

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Wise, Eric S.; Hocking, Kyle M.; Kavic, Stephen M.

2015-01-01

Introduction Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) has become the gold standard for surgical weight loss. The success of LRYGB may be measured by excess body-mass index loss (%EBMIL) over 25 kg/m2, which is partially determined by multiple patient factors. In this study, artificial neural network (ANN) modeling was used to derive a reasonable estimate of expected postoperative weight loss using only known preoperative patient variables. Additionally, ANN modeling allowed for the discriminant prediction of achievement of benchmark 50% EBMIL at one year postoperatively. Methods Six-hundred and forty-seven LRYGB included patients were retrospectively reviewed for preoperative factors independently associated with EBMIL at 180 and 365 days postoperatively (EBMIL180 and EBMIL365, respectively). Previously validated factors were selectively analyzed, including age; race; gender; preoperative BMI (BMI0); hemoglobin; and diagnoses of hypertension (HTN), diabetes mellitus (DM), and depression or anxiety disorder. Variables significant upon multivariate analysis (P<.05) were modeled by “traditional” multiple linear regression and an ANN, to predict %EBMIL180 and %EBMIL365. Results The mean EBMIL180 and EBMIL365 were 56.4%±16.5% and 73.5%±21.5%, corresponding to total body weight losses of 25.7%±5.9% and 33.6%±8.0%, respectively. Upon multivariate analysis, independent factors associated with EBMIL180 included black race (B=−6.3%, P<.001), BMI0 (B=−1.1%/unit BMI, P<.001) and DM (B=−3.2%, P<.004). For EBMIL365, independently associated factors were female gender (B=6.4%, P<.001), black race (B=−6.7%, P<.001), BMI0 (B=−1.2%/unit BMI, P<.001), HTN (B=−3.7%, P=.03) and DM (B=−6.0%, P<.001). Pearson r2 values for the multiple linear regression and ANN models were .38 (EBMIL180) and .35 (EBMIL365), and .42 (EBMIL180) and .38 (EBMIL365), respectively. ANN-prediction of benchmark 50% EBMIL at 365 days generated an area under the curve of 0.78±0.03 in

La performance teatral de las máquinas maravillosas. Configuraciones ambivalentes de la técnica y el teatro en los siglos XVI y XVII

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Sabine Friedrich

2015-12-01

Full Text Available El artículo explora las formas de representación y a la dimensión epistemológica de la máquina en el campo discursivo de los siglos XVI y XVII, cuando todavía no existe una diferencia fundamental entre los discursos científicos, paracientíficos, filosóficos y estéticos. A partir de las investigaciones de Jan Lazardzig, analiza el carácter paradójico de la ingeniería mecánica entre la funcionalidad y la admiración, la racionalidad y lo maravilloso dentro del contexto español en el Siglo de Oro. En este sentido, el artículo examina las formas de performance teatral de la máquina como objeto admirable y maravilloso: por un lado en el teatro de máquinas cortesano y por el otro en los libros de máquinas en la tradición del Theatrum machinarum. Analizamos así los paralelismos y las diferencias respecto a sus estructuras, sus modos de representación y sus dimensiones pragmáticas.

Comparative evaluation of two reconstructive methods following laparoscopic assisted subtotal gastrectomy in dogs

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Bakhtiari Jalal

2012-12-01

Full Text Available Abstract Background Laparoscopic gastrectomy is a new and technically challenging surgical procedure with potential benefit. The objective of this study was to investigate clinical and para-clinical consequences following Roux-en-Y and Jejunal Loop interposition reconstructive techniques for subtotal gastrectomy using laparoscopic assisted surgery. Results Following resection of the stomach attachments through a laparoscopic approach, stomach was removed and reconstruction was performed with either standard Roux-en-Y (n = 5 or Jejunal Loop interposition (n = 5 methods. Weight changes were monitored on a daily basis and blood samples were collected on Days 0, 7 and 21 post surgery. A fecal sample was collected on Day 28 after surgery to evaluate fat content. One month post surgery, positive contrast radiography was conducted at 5, 10, 20, 40, 60 and 90 minutes after oral administration of barium sulfate, to evaluate the postoperative complications. There was a gradual decline in body weight in both experimental groups after surgery (P  0.05. Fecal fat content increased in the Roux-en-Y compared to the Jejunal loop interposition technique (P  0.05. Conclusion Roux-en-Y and Jejunal loop interposition techniques might be considered as suitable approaches for reconstructing gastro-intestinal tract following gastrectomy in dogs. The results of this study warrant further investigation with a larger number of animals.

Fatores associados ao reganho de peso após 24 meses de gastroplastia redutora em Y-de-Roux

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Silva, Fernanda Bassan Lopes da

2012-01-01

Introdução: A cirurgia bariátrica tem como resultados esperados a perda de peso massiva e a remissão de comorbidades. No entanto, o reganho de peso é uma realidade no pós-operatório, podendo comprometer os benefícios alcançados com a cirurgia. O presente estudo teve como objetivo investigar os fatores associados ao reganho de peso após a gastroplastia redutora em Y-de-Roux (GRYR). Métodos: Estudo transversal, que avaliou 80 indivíduos com mais de 24 meses de GRYR em ...

Representaciones Sociales de Ambiente y Sustentabilidad en docentes en formación y en ejercicio

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Yair Alexander Porras Contreras

2015-12-01

Full Text Available El ambiente como un sistema complejo, emerge de las interacciones efectivas entre los subsistemas biofísicos, sociales y culturales, constituyéndose en una representación que trasciende el dominio material, para posicionarse en una categoría que involucra el significado y el sentido de la realidad. De esta manera, las ideas, creencias y concepciones que elaboran los profesores en formación inicial y los profesores en ejercicio sobre el ambiente y la sustentabilidad, se convierten en derroteros sobre los cuales se construye un saber pedagógico y una praxis educativa que entra en relación directa con el ideario de ciudadanía que se promueve en el ámbito escolar. El  propósito del presente artículo consiste en reconocer las representaciones sociales sobre el ambiente y la sustentabilidad que elicitan docentes en ejercicio de Escuelas Normales Superiores y  docentes en formación inicial de la UPN, con el objeto de fomentar una cultura ambiental para la ecociudadanía.

Ceremonial en performance de viento teatro: pamuri mahse

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Fernando Duque Mesa

2011-09-01

Full Text Available Se aborda el Ceremonial en Performance de Viento Teatro: Pamuri Mahse, mito fundacional de los Desana del Vaupés (Colombia, investigación dada desde el Teatro Ceremonial de la Máscara Mítica, mundo de lenguajes inscritos en los imaginarios a través de claves y simbolizaciones de la tierra, el espíritu y el cosmos vueltos a leer e interpretar en el tiempo y en el espacio, a partir de los discursos mágicos y asombrosos de las máscaras, la plástica de las tierras, los movimientos en danza, teatro, música, escenografía y cantos. La performer recuerda el acto fundacional mítico de unas culturas milenarias, quienes profesan las más antiguas y a la vez las más modernas artes, articulando en el performance, artes que no les son extrañas, en el mundo de la creatividad y de la imaginación. Les puede sonar muy extraño el término performance, porque para ellos todo esto es sencillamente un Ceremonial.

Expresionismo, racionalismo y arquitectura orgánica en Alemania y en Dinamarca: Häring y Scharoun; Jacobsen y Utzon

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González Capitel, Antón

1996-01-01

1. Expresionismo, racionalismo y arquitectura orgánica en Alemania y en Dinamarca: Haring y Scharoun; Jacobsen y Utzon 1. 1. La obra tardía de Hugo Haring 1. 2. La integración del expresionismo y del organicismo en la obra de Scharoun 1. 2. 1. Los edificios escolares como lugares orgánicos 1. 2. 2. Los extremos de la complejidad formal en Scharoun. Uno: viviendas 1. 2. 3. Los extremos de la complejidad formal. Dos: varios auditorios y una biblioteca 1. 3. Continuidad ...

Decreased serum betatrophin levels correlate with improved fasting plasma glucose and insulin secretion capacity after Roux-en-Y gastric bypass in obese Chinese patients with type 2 diabetes: a 1-year follow-up.

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Guo, Kaifeng; Yu, Haoyong; Lu, Junxi; Bao, Yuqian; Chen, Haibing; Jia, Weiping

2016-08-01

There is increasing evidence that serum betatrophin levels, a hormone derived from adipose tissue and liver, are elevated in type 2 diabetes (T2D). To investigate the relationships among betatrophin and metabolic control, insulin resistance, and pancreatic β-cell function in obese Chinese patients with T2D who underwent Roux-en-Y gastric bypass (RYGB). University hospital, China. This 1-year follow-up study included 34 obese individuals with T2D (18 males, 16 females) who underwent RYGB in our hospital. Anthropometric results, glucose levels, lipid profiles, and serum betatrophin levels were determined before and 1 year after RYGB. The serum betatrophin level decreased significantly after RYGB (72.0 ng/mL [33.4-180.9] versus 35.7 ng/mL [14.8-103.3]); Pfasting plasma glucose and negatively correlated with the changes in the 2-hour C-peptide/fasting C-peptide and homeostasis model of assessment of β-cell function (Pfasting plasma glucose (β = .586, Pfasting C-peptide (β = -.309, P = .021). Circulating betatrophin might be involved in the regulation of glucose control and insulin secretion in obese Chinese with T2D soon after RYGB. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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)

Kakizaki, Satoru; Takizawa, Daichi; Yamazaki, Yuichi; Nakajima, Yuka; Ichikawa, Takeshi; Sato, Ken; Takagi, Hitoshi; Mori, Masatomo; Kasama, Kazunori

2008-01-01

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/m 2 , 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)

Conocimientos y actitudes en salud sexual y reproductiva

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Estudiantes - Enfermería

2004-12-01

Full Text Available La sexualidad debe considerarse como la expresión y el instrumento del amor entre dos personas. En la adolescencia existen dificultades para integrar lo que se considera por amor, como el amor sexualizado y el amor no sexualizado. Para la misma época se siente con gran intensidad las preocupaciones relativas a una adecuada imagen y a otras con dificultades características del despertar de la sexualidad normal. Los adolescentes inician su vida sexual y reproductiva tempranamente y no conscientes de la responsabilidad y consecuencias como tempranamente y no conscientes de la responsabilidad y consecuencias en la gestación y un aumento en la tasa de morbimortalidad que conlleva aun gran riesgo de lesiones físicas, psicológicas, afectivas dejando secuelas futuras que se ven reflejadas en la adultez. Surge entonces la motivación de realizar una investigación que Permita describir los conocimientos y actitudes en salud sexual y reproductiva que se ven reflejados en las actitudes en los y las adolescentes del barrio El Salado

Alexitimia y consumo de drogas en hombres y mujeres en tratamiento

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Valeriano Raúl García Aurrecoechea

2016-12-01

Full Text Available Introducción: la alexitimia es un rasgo de la personalidad caracterizado por la dificultad para identificar y expresar emociones, con mayor prevalencia en hombres que en mujeres y presente en la mitad de los consumidores de drogas. Objetivo: comparar la presencia de alexitimia en hombres y mujeres que acuden a solicitar tratamiento por consumo de drogas y explorar diferencias según el tipo de droga por la que se solicita atencin (droga de mayor impacto. Método: estudio transversal comparativo por sexo y por droga de consumo. Resultados: la mitad de los 264 participantes presenta rasgos de personalidad alexitímicos, cuatro veces más que la población general, observándose diferencias por sexo únicamente en la dificultad para identificar emociones (mayor entre los hombres. También destaca que no existan diferencias en el nivel de alexitimia por tipo de droga. Discusión: en concordancia con lo reportado por la literatura, se observa una alta proporción de alexitimia entre los usuarios participantes, lo cual es relevante si se considera que los pacientes con este rasgo presentan una particular dificultad para responder a los tratamientos cognitivo conductuales, los cuales constituyen abordajes ampliamente utilizados en el tratamiento de adicciones. Asimismo, destaca la escasa diferencia entre hombres y mujeres respecto a la presencia de este rasgo, en comparación con lo que se observa en la población general, donde este rasgo es claramente mayor entre los hombres. Lo anterior pone en evidencia la necesidad de desarrollar estrategias que contribuyan a mejorar la capacidad introspectiva y de comunicación afectiva de estos pacientes.

Desarrollo de la microbiota gastrointestinal en lactantes y su rol en salud y enfermedad

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Carolina A. Serrano Honeyman

2016-05-01

Full Text Available Durante la última década, con la aparición de técnicas de secuenciación de última generación basadas en la filogenia del gen 16S rRNA y complejas plataformas bioinformáticas, la composición del microbioma y su rol en salud y enfermedad ha sido sujeto de investigación activa. Existe una creciente evidencia entre la disbiosis microbiana y un riesgo aumentado de desarrollar enfermedades de tipo inflamatorio, autoinmune, y metabólico tales como asma, diabetes, obesidad y enfermedades gastrointestinales crónicas. El ensamblaje de la microbiota intestinal en los humanos comienza antes y durante el proceso de parto y evoluciona con la alimentación durante la infancia y debe ser entendido en profunda  relación con el microbioma de su madre. La comprensión del impacto de la microbiota en la morbilidad en humanos necesariamente requerirá de una etapa previa como es el conocimiento del desarrollo y ensamblaje precoz de la microbiota en recién nacidos, y como intervenciones médicas precoces como es la elección en la ruta de parto (parto cesárea versus parto vaginal, uso precoz de antibióticos, selección de fórmula láctea (lactancia materna versus formulas artificiales, entre otros, pueden modificar en forma sustancial su conformación y a través de cambios en el desarrollo del sistema inmune, ejercer un impacto en salud y enfermedad en neonatos, lactantes y posteriormente a lo largo de la vida de un ser humano.

Lecciones aprendidas en desastres y la gestión del conocimiento en salud y desastres

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Vivian María Céspedes Mora

2003-06-01

Full Text Available Se revisan los últimos trabajos publicados sobre la conciencia que se tiene acerca de la producción y diseminación de las lecciones aprendidas en desastres para la gestión del conocimiento en materia de medicina y desastres. Se destaca la influencia de las lecciones aprendidas como elemento importante en la toma de decisiones ante el manejo de los desastres. Se expone la inquietud que para el Centro Latinoamericano de Medicina de Desastres constituye la necesidad de rescatar e incentivar la producción de las lecciones aprendidas por el personal de la salud en su enfrentamiento a catástrofes y en el desempeño de sus funciones en Cuba y en Latinoamérica.This paper reviewed the last papers published about the awareness of the production and dissemination of lessons learned on disasters for the knowledge management in terms of medicine and disaster. It underlined the effect of the lessons learned as an important element in the decision-taking on disaster management. It showed the concern of the Latin-American Center of Disaster Medicine about the need of rescuing and encouraging the production of the lessons learned by the health personnel in facing up to catastrophes and in performing its work in Cuba and Latin America

Diferencias en habilidades y conducta entre grupos de preescolares de alto y bajo rendimiento escolar. [Differences in skills and behaviour between preschool groups of high and low educational performance ].

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Calero, M. Dolores

2010-12-01

Full Text Available The aim of this study has been to analyze the relationship between psychological variables and school performance in preschool children. A collection of cognitive and behavioural variables were selected, that according to the most current bibliography are related to student learning, with the goal of identifying the factors that appear to influence educational performance in childhood. The final goal would be to try to prevent future performance problems by means of identifying early these variables in the children that present low performance. The sample is composed of 47 children: 23 children with high performance and 24 with low performance. The instruments used were the Kauffman Brief Intelligence Test, the EHPAP (Spanish version of ACFS de Lidz y Jepsen, 2003 and a questionnaire about metacognition. The results showed significant differences between both groups in the profile of skills, in behavioral variables, and in the use of metacognitive strategies. However, both groups present a similar learning potential. El objetivo ha sido analizar la relación entre variables psicológicas y rendimiento escolar en niños preescolares. Se ha seleccionado un conjunto de variables cognitivas y conductuales, que según la bibliografía más actualizada se relacionan con el aprendizaje escolar, con el fin de identificar los factores que parecen influir en el rendimiento educativo en la etapa infantil. La meta final sería intentar prevenir problemas de rendimiento futuros mediante la identificación temprana de estas variables en los niños que parecen presentar bajo rendimiento. La muestra ha estado compuesta por 47 niños: 23 con alto rendimiento y 24 con bajo rendimiento. Se han utilizado medidas de inteligencia (K-BIT, potencial de aprendizaje (EHPAP y metacognición. Los resultados muestran que los grupos difieren en el perfil de habilidades, en variables conductuales y en la utilización de estrategias metacognitivas. Sin embargo, todos presentan

Apariencia y realidad en Hamlet y Las Meninas

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Antonio PRIETO MARTÍNEZ

2009-11-01

Full Text Available La obra de Shakespeare comenzó a ser estudiada en profundidad a finales del siglo XVII y, sobre todo, en el siglo XVIII. Desde ese siglo hasta el momento actual la investigación en torno a la obra shakesperiana se ha desarrollado hasta tal punto que resulta inabordable. De entre la obra de Shakespeare, Hamlet es probablemente la que suscita mayor interés a causa de su compleja estructura y su contenido ambiguo. Del mismo modo, la obra de Velázquez comenzó a estudiarse con rigor en el siglo XVIII, aunque hasta el siglo XX no se investigan sus características e influencias. Como en el caso de Shakespeare, la bibliografía existente en la actualidad sobre su obra resulta inaccesible para el investigador. De entre todas sus pinturas, Las Meninas, del mismo modo que Hamlet, es la que despierta mayor interés y tiene una proyección universal. Haciendo un recorrido por las investigaciones más importantes realizadas sobre ambas obras en los tres últimos siglos, intento encontrar semejanzas entre ellas, basándome fundamentalmente en su estructura. Apoyando mi investigación en la teoría deconstructivista, según la propuesta de J. Derrida, y siguiendo el esquema formal de ambas obras, propongo el tema general de apariencia y realidad como núcleo de sus semejanzas. Los puntos de analogía entre Hamlet y Las Meninas son, en síntesis, los siguientes: - Texto (expresado en el ser o no ser y el reverso del lienzo sobre el que pinta Velázquez. - El personaje del espectro en Hamlet y el personaje invisible en el cuadro (María Teresa de Austria o el espectador. - Velázquez significante representado en el cuadro y la obra dentro de la obra que representan los cómicos. - El personaje de Claudio, como símbolo del tirano y los reyes representados en el espejo. - Finalmente considero la vigencia y proyección que tienen ambas obras en el mundo actual.

POLÍTICAS Y SUJETOS DEL SIDA en Brasil y Colombia

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César Ernesto Abadía-Barrero

2004-01-01

Full Text Available BASADO EN DATOS HISTÓRICOS Y DE INVESTIGACIONES ETNOGRÁFICAS, Y EN UNA SERIE de entrevistas a profundidad, este artículo analiza las respuestas exitosas de Brasil y muy deficientes de Colombia frente a la epidemia del sida, y propone vínculos entre estas respuestas, los sujetos que las han liderado y las reformas en salud en marcha en los dos países. Los datos sugieren que existe retroalimentación entre las políticas en salud, las respuestas frente al sida y lo que piensan los actores involucrados en los procesos, y que ésta se relaciona con el momento histórico de ideologías de izquierda en Brasil y de derecha en Colombia.

Quality of Life 1 Year After Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-en-Y Gastric Bypass: a Randomized Controlled Trial Focusing on Gastroesophageal Reflux Disease.

Science.gov (United States)

Biter, L Ulas; van Buuren, Michiel M A; Mannaerts, Guido H H; Apers, Jan A; Dunkelgrün, Martin; Vijgen, Guy H E J

2017-10-01

Bariatric surgery is the only treatment option that achieves sustained weight loss in obese patients and that also has positive effects on obesity-related comorbidities. Laparoscopic sleeve gastrectomy (LSG) seems to achieve equal weight loss as laparoscopic Roux-en-Y gastric bypass (LRYGB), but there is still much debate about the quality of life (QOL) after LSG, mainly concerning the association with gastroesophageal reflux. Our hypothesis is that QOL after LSG is comparable with QOL after LRYGB. Between February 2013 and February 2014, 150 patients were randomized to undergo either LSG or LRYGB in our clinic. Differences in QOL were compared between groups by using multiple QOL questionnaires at follow-up moments preoperatively and 2 and 12 months after surgery. After 12 months of follow-up, 128 patients had returned the questionnaires. Most QOL questionnaires showed significant improvement in scores between the preoperative moment and after 12 months of follow-up. The Gastroesophageal Reflux Disease Questionnaire (GerdQ) score deteriorated in the LSG group after 2 months, but recovered again after 12 months. After 2 months of follow-up, the mean GerdQ score was 6.95 ± 2.14 in the LSG group versus 5.50 ± 1.49 in the LRYGB group (p < 0.001). After 1 year, the mean GerdQ score was 6.63 ± 2.26 in the LSG group and 5.60 ± 1.07 in the LRYGB group (p = 0.001). This randomized controlled trial shows that patients who underwent LSG have significantly higher GerdQ scores at both 2 and 12 months postoperatively than patients who underwent LRYGB, whereas overall QOL did not differ significantly.

Mercadeo en las Pymes y cooperativas en el estado Zulia

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María W. Schlesinger

2005-07-01

Full Text Available El objetivo del presente trabajo es identificar las fortalezas y las debilidades de la formación en mercadotecnia de los nuevos empresarios en las pequeñas y medianas empresas y cooperativas en el estado Zulia, para la comercialización de bienes y servicios en el ámbito regional. En tal sentido, fue necesario realizar una investigación de tipo descriptivo– transeccional y recopilar información a través de cuestionarios y entrevistas. Se concluyó que los empresarios poseen en su mayoría un conocimiento empírico, y debilidad en el dominio teórico en el área de mercado. Esto genera una subutilización de recursos que se evidencia en la carencia de formalización en la estructura y los procesos organizacionales, así como en el diseño de estrategias de desarrollo y comercialización de los bienes y servicios.

y mujeres en España en 2004

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Montserrat García Gómez

2006-01-01

Full Text Available Fundamento: El conocimiento de la incidencia de las enfermedades derivadas del trabajo es un requisito esencial para la adopción de un enfoque racional de su control. La estadística oficial de las enfermedades profesionales no incluye la variable sexo. El objetivo de este estudio es describir las enfermedades profesionales reconocidas por el sistema de seguridad social español en el año 2004, buscando las diferencias en la morbilidad declarada entre hombres y mujeres. Métodos: Se describe la información contenida en el Registro de Enfermedades Profesionales correspondiente al año 2004. Las variables incluidas son: sexo, edad, actividad económica, ocupación, antigüedad en el puesto de trabajo, tamaño de la empresa y Comunidad Autónoma. Como indicadores se han calculado porcentajes, tasas de incidencia brutas y específicas, y razón de tasas. Resultados: En el año 2004 se notificaron 28.728 enfermedades profesionales. La incidencia en mujeres fue de 188,7 por 100.000 trabajadoras, y en hombres fue de 217,8. La edad media de presentación en hombres fue de 39,4 ± 11 años, y en mujeres de 37,6 ± 11 años. El 52,7% de las enfermedades se declaran en las mujeres en los 3 primeros años de permanencia en el puesto. Conclusiones: Se constatan aspectos diferenciales de género en las enfermedades profesionales notificadas en España en el año 2004. Aunque la incidencia global es mayor en hombres que en mujeres, en la mayoría de actividades económicas y ocupaciones, las tasas específicas son mayores en mujeres. Son sobretodo las grandes empresas las que notifican enfermedades profesionales en las mujeres.

Arquitecturas multiprocesador en HPC: software, métricas y aplicaciones

OpenAIRE

De Giusti, Armando Eduardo; Tinetti, Fernando Gustavo; Naiouf, Marcelo; Chichizola, Franco; De Giusti, Laura Cristina; Villagarcía Wanza, Horacio A.; Montezanti, Diego Miguel; Encinas, Diego; Pousa, Adrián; Rodriguez, Ismael Pablo; Eguren, Sebastián; Iglesias, Luciano; Paniego, Juan Manuel; Pi Puig, Martín; Dell'Oso, Matías

2016-01-01

Caracterizar las arquitecturas multiprocesador distribuidas enfocadas especialmente a cluster y cloud computing, con énfasis en las que utilizan procesadores de múltiples núcleos (multicores, GPUs y Xeon Phi), con el objetivo de modelizarlas, estudiar su escalabilidad, analizar y predecir performance de aplicaciones paralelas, estudiar el consumo energético y su impacto en la perfomance así como desarrollar esquemas para detección y tolerancia a fallas en las mismas. Profundizar el estudio...

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

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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.

Uncut Esophagojejunostomy with Double Jejunal Pouch: An Alternative Reconstruction Method that Improves the Quality of Life of Patients after Total Gastrectomy.

Science.gov (United States)

Gong, Jia Qing; Cao, Yong Kuan; Zhang, Guo Hu; Wang, Pei Hong; Luo, Guo De

2017-04-01

Currently, there is no optimal digestive tract reconstruction technique well recognized by scholars after total gastrectomy. In this study, a new reconstruction method, which is modified from the classic Roux-en-Y procedure, an uncut jejunal esophageal anastomosis with double jejunal pouch (UJEA-DJP) was established, and its advantages for improving the quality of life of patients who undergo total gastrectomy were analyzed. Altogether 160 patients with gastric cancer enrolled in our center from September 2009 to March 2012 received radical D2 total gastrectomy. According to the reconstruction methods used, these patients were divided into three groups: UJEA-DJP (n = 63), Roux-en-Y (n = 45), and P-loop with Roux-en-Y esophagojejunostomy (P-RY; n = 52). The operation time for reconstruction, complications, prognostic nutritional index (PNI), and the Visick classification among the three groups were analyzed. We found that UJEA-DJP has advantages over Roux-en-Y and P-RY regarding the time of digestive tract reconstruction, incidence rates for long-term complications, postoperative nutritional index, body weight recovery, and the Visick classification for subjective feelings (p quality of life of patients after surgical procedure.

Educar y trabajar en contextos de precariedad y desigualdad en América Latina. Jóvenes en debate

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Pablo Christian Aparicio-Castillo

2013-10-01

Full Text Available El presente artículo tiene como objetivo analizar y comparar los resultados investigativos acerca de la situación de los jóvenes afectados por contextos de desigualdad y procesos de desigualación educativa y laboral en América Latina y el Caribe, tomando como referencia el impacto de las nuevas políticas públicas implementadas para fortalecer la cohesión y los procesos de inclusión social. La metodología se remite a la interpretación, síntesis y comparación de estudios cualitativos y cuantitativos elaborados en torno al impacto alcanzado por programas y políticas de vasto alcance orientados a potenciar la participación de los jóvenes en el sistema educativo y la transición hacia el mercado de trabajo y la vida adulta. Las conclusiones más trascendentes de la presente reflexión demuestran que pese a los avances logrados en materia de reconocimiento de la pluralidad y de la complejidad inherente a las situaciones socioeconómicas de vida, los acervos culturales, el género y la dimensión geográfica de hábitat, sigue resultando insatisfactorio el modo en cómo se piensa y apoya a los actores juveniles en las diferentes áreas estratégicas del desarrollo. En consecuencia, una mayor vinculación empoderizante de los jóvenes al momento de diseñar y transponer estrategias políticas en la práctica podría optimizar la calidad e impacto de los emprendimientos y las acciones acometidas.

Actualidad y prospectiva de La electrónica en Colombia y en el mundo

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Adolfo Mora Villate

1997-05-01

Full Text Available En muchos artículos y ponencias se ha resaltado la importancia que ha adquirido la electrónica en los últimos lustros, en primer lugar por la creciente influencia que ejerce sobre la automatización y por consiguiente sobre la productividad de la industria, y en general sobre la productividad de todos los sectores de la economía, influencia que es muy notoria en casos como los de la banca y el comercio. En segundo lugar la electrónica se destaca por haberse constituido en la industria de mayores ventas en el mundo, las que en 1992 llegaron a 1013 billones de dólares (1 billón = 1000 millones, superando incluso a la industria automotriz. En tercer lugar, la industria electrónica se ha convertido en la principal industria empleadora de los países avanzados: en los EEUU ya ocupa más trabajadores que las industrias automotriz, del acero y aeronáutica juntas. Cuando se trata la actualidad y la prospectiva de la electrónica no se puede omitir el tema de la microelectrónica, un sector considerado como el factor dirigente de la industria electrónica. Pero ¿Qué es la microelectrónica? Vocablo tan trajinado y que algunos mencionan aparentemente sin entender su significado. Esta es una de las preguntas que se tratara de resolver en la siguiente sección.

Conductas antisociales y delictivas en adolescentes infractores y no infractores

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Ana María Sanabria

2009-01-01

Full Text Available Se estudian las manifestaciones de la conducta antisocial y delictiva en dos grupos de adolescentes hombres y mujeres, entre los 12 y los 18 años de edad. La muestra estuvo conformada por 179 adolescentes, 72 infractores de ley y 107 no infractores. La edad promedio de la muestra fue de 15.0 años, con una desviación estándar de 1.828. Los resultados muestran que existen diferencias en la frecuencia de comportamientos antisociales y delictivos entre los dos grupos de adolescentes. Los adolescentes no infractores informaron una mayor frecuencia de conductas antisociales y delictivas en comparación con los infractores. En cuanto a la edad, se observa que existen diferencias significativas entre los adolescentes de 12 a 13 años y los de 16 a 17 años y 18 años, siendo los últimos quienes más presentaron estos comportamientos; datos que muestran el inicio temprano y progresivo del comportamiento. Los varones adolescentes presentan una media mayor en la conducta antisocial y en la conducta delictiva comparada con las mujeres, diferencias estadísticamente significativas. Se sugiere tener en cuenta, en estudios similares, las diferencias biológicas y evolutivas que puedan estar influyendo en la manifestación de estos tipos de comportamientos, y en consecuencia, la generación de programas que puedan prevenir su manifestación, teniendo en cuenta su carácter progresivo y, en algunos grupos, persistente en el tiempo.

Los cabos atados y sueltos en los estudios agrarios y étnicos en Ecuador

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Fernando García

2014-11-01

Full Text Available En este ensayo se analiza que, a pesar del avance en el reconocimiento de los derechos colectivos de las nacionalidades y pueblos indígenas y afroecuatorianos, en Ecuador persisten procesos de desigualdad económica y de exclusión étnica y cultural. Para ello, se revisan siete temas vinculados a los estudios agrarios y étnicos ecuatorianos desarrollados en los últimos cincuenta años: el acceso a la tierra, la fuerza de trabajo campesina, las relaciones étnicas y de clase, la noción de comunidad, el racismo, la participación de las mujeres y la relación entre los organismos internacionales, Estado y movimientos sociales.

Quality certification, firm performance and organizational structre in spanish hotel industry Quality certification, firm performance and organizational structre in spanish hotel industry Certificación en calidad, resultados empresariales y estructura organizativa en el sector hotelero español

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José Francisco Molina Azorín

2013-01-01

Full Text Available Purpose: Quality certification helps companies to improve efficiency and performance. The aim of this study is to analyze the differences between certified and non-certified hotels regarding the implementation of quality management practices, the performance and the competitive advantage, and the changes in organizational structure. Design/methodology/approach: The paper classifies the hotels in two groups: quality certified and non-certified hotels. It then examines the differences between both groups. Findings: The findings show that certified hotels develop quality management practices in a higher extent, achieve better performance levels and a differentiation competitive advantage, and have higher levels of formalization and interdepartmental coordination. Originality/value: The contribution of the paper is to analyze if quality certification adds value for the hotel industry.Purpose: Quality certification helps companies to improve efficiency and performance. The aim of this study is to analyze the differences between certified and non-certified hotels regarding the implementation of quality management practices, the performance and the competitive advantage, and the changes in organizational structure. Design/methodology/approach: The paper classifies the hotels in two groups: quality certified and non-certified hotels. It then examines the differences between both groups. Findings: The findings show that certified hotels develop quality management practices in a higher extent, achieve better performance levels and a differentiation competitive advantage, and have higher levels of formalization and interdepartmental coordination. Originality/value: The contribution of the paper is to analyze if quality certification adds value for the hotel industry.Objeto: La certificación en calidad puede ayudar a las empresas a mejorar su eficiencia y sus resultados. El objetivo de este artículo es analizar las diferencias entre los hoteles

Productividad en materia seca y captura de carbono en un sistema silvopastoril y un sistema tradicional en cinco fincas ganaderas de piedemonte en el departamento de Casanare

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Estrella Cárdenas Castro

2012-12-01

Full Text Available El objetivo fue comparar, en cuanto a productividad en materia seca y captura de carbono, entre un sistema silvopastoril y un sistema tradicional en cinco fincas ganaderas de piedemonte del departamento de Casanare. En el lote experimental de cada finca se sembró una mezcla de cuatro especies de pastos, de los cuales Brachiaria brizantha fue la especie que tuvo un desarrollo exitoso en las cinco fincas, y con la cual se analizó su productividad en materia seca y captura de carbono. A los cinco meses después de la renovación de pastos en los lotes experimentales se obtuvo una productividad en materia seca entre 6,3 y 14,9 tMS/ha, y en captura de carbono entre 2,7 y 6,4 tCOT/ha; mientras que en los lotes tradicionales estuvo entre 4 y 5 tMS/ha, y en captura de carbono entre 1,7 y 2,9 tCOT/ha. A los 20 meses en los lotes experimentales se obtuvo una productividad en materia seca entre 12 y 13,7 tMS/ha, y en captura de carbono entre 4,1 y 4,5 tCOT/ha; mientras que en los lotes tradicionales estuvo entre 4,4 y 6,5 tMS/ha, y en captura de carbono entre 1,4 y 2,1 tCOT/ha. Esto indica que la renovación de praderas con pastos adecuados y el pastoreo de rotación favorecen la producción en materia seca y la captura de carbono.

Violencia y salud en Colombia

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Saúl Franco Agudelo

1997-02-01

Full Text Available La violencia en Colombia parece incontenible. A las masacres y asesinatos colectivos, de una crueldad desconcertante, se suman los secuestros y desapariciones, el maltrato de niños y ancianos y las violaciones de adolescentes. Cada día, sin tregua, los colombianos son espectadores o víctimas de atracos callejeros y de discriminación racial, sexual y socioeconómica. Sin quererlo, se convierten en agentes de agresiones en el transporte urbano, el hogar, la escuela y el trabajo. Colombia tiene las tasas de mortalidad por homicidio más altas del mundo. Independientemente de la enorme sobrecarga institucional que impone a los servicios de salud y medicina legal, la violencia constituye actualmente en Colombia el principal problema de salud pública. Para hacerle frente, el sector de la salud debe elaborar políticas y financiar acciones; crear nuevos procesos de formación de personal, poner en marcha procesos de educación pública, y dedicar mayor esfuerzo y creatividad al campo de la investigación, que hasta ahora ha dado respuestas importantes pero aún insuficientes. Al reflexionar sobre la violencia, que es la sustitución de toda argumentación por la fuerza, es necesario ubicarla en el contexto de la vida y la salud. No se pretende solo racionalizarla, y menos aún sustituir la acción por la palabra o por las reflexiones, sino tratar de comprenderla a fondo con el objeto de buscarle alternativas. En el presente artículo se analiza, con esta finalidad, el tema de la violencia en Colombia, principalmente desde el punto de vista de su efecto en la salud de los colombianos y de sus implicaciones para el sector sanitario. El autor expone sus puntos de vista con plena conciencia de su subjetividad y limitaciones.

POLIOMIELITIS ANTERIOR AGUDA; SU PASADO Y SU PRESENTE EN EL MUNDO Y EN COLOMBIAl

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Valentín Malagón Castro

1984-06-01

Full Text Available

*Primera parte del Simposio sobre poliomielitis presentado a la Academia.

RESUMEN Y CONCLUSIONES.

• La P.A.A. es una enfermedad que ha acompañado al hombre en toda su historia. No ha respetado límites geográficos, raciales ni sociales. En Colombia ha sido una enfermedad endémica, con presentación de casos esporádicos y brotes epidémicos.

• El descubrimiento de las vacunas antipoliomielíticas por Salk y Sabin en los años 1954 y 1958 respectivamente, determinaron un descenso radical y progresivo en su frecuencia hasta prácticamente desaparecer en los países desarrollados. En las naciones del tercer mundo, en cambio, la frecuencia de la enfermedad ha persistido.

• La edad a la cual con mayor incidencia aparece el polio en los países en desarrollo está entre 1 y los 4 años; esta edad es más tardía en los países desarrollados. Esto es debido a la precoz inmunización natural adquirida en aquellos países.

• La relación mortalidad-morbilidad por polio ha aumentado en forma progresiva, especialmente en los países desarrollados, pese a la disminución en ellos en el número de casos.Nsea radicada en este siglo, del mundo entero.

Ectopic jejunal pacemakers and gastric emptying after Roux gastrectomy: Effect of intestinal pacing

International Nuclear Information System (INIS)

Karlstrom, L.; Kelly, K.A.

1989-01-01

The aims of this study were to determine whether ectopic pacemakers are present after meals in the Roux limbs of dogs after vagotomy and Roux gastrectomy, whether these pacemakers slow gastric emptying of liquids or solids, and whether abolishing the pacemakers with electric pacing might speed any slow emptying that occurs. In six dogs that underwent vagotomy and Roux gastrectomy and in four dogs that underwent vagotomy and Billroth gastrectomy (controls), myoelectric activity of the Roux limb or duodenum was measured during gastric emptying of a 500 kcal mixed meal of 99mTc-labeled cooked egg and 111In-labeled milk. Roux dogs were tested with and without pacing of the Roux limb. Roux dogs showed ectopic pacemaker in the Roux limb that drove the pacesetter potentials of the limb in a reverse, or orad, direction during 57% of the postprandial recordings. Billroth dogs had no ectopic pacemakers (p less than 0.05). Liquids emptied more slowly in Roux dogs (half-life (t1/2) = 121 +/- 15 minutes) than in Billroth dogs (t1/2 = 43 +/- 9 minutes; p less than 0.05), but solids emptied similarly in both groups of dogs (t1/2 approximately 8 hours). Pacing the Roux limb abolished the ectopic pacemakers, restored the slow emptying of liquids to the more rapid rate found in the Billroth dogs (t1/2: paced Roux, 72 +/- 15 minutes; Billroth, 43 +/- 9 minutes; p greater than 0.05) and did not change emptying of solids. The conclusion was that ectopic pacemakers present in the Roux limb after vagotomy and Roux gastrectomy drove the limb in a reverse direction and slowed emptying of liquids after the operation. The defect was corrected by pacing the Roux limb in a forward direction

Ectopic jejunal pacemakers and gastric emptying after Roux gastrectomy: Effect of intestinal pacing

Energy Technology Data Exchange (ETDEWEB)

Karlstrom, L.; Kelly, K.A. (Mayo Clinic, Rochester, MN (USA))

1989-11-01

The aims of this study were to determine whether ectopic pacemakers are present after meals in the Roux limbs of dogs after vagotomy and Roux gastrectomy, whether these pacemakers slow gastric emptying of liquids or solids, and whether abolishing the pacemakers with electric pacing might speed any slow emptying that occurs. In six dogs that underwent vagotomy and Roux gastrectomy and in four dogs that underwent vagotomy and Billroth gastrectomy (controls), myoelectric activity of the Roux limb or duodenum was measured during gastric emptying of a 500 kcal mixed meal of 99mTc-labeled cooked egg and 111In-labeled milk. Roux dogs were tested with and without pacing of the Roux limb. Roux dogs showed ectopic pacemaker in the Roux limb that drove the pacesetter potentials of the limb in a reverse, or orad, direction during 57% of the postprandial recordings. Billroth dogs had no ectopic pacemakers (p less than 0.05). Liquids emptied more slowly in Roux dogs (half-life (t1/2) = 121 +/- 15 minutes) than in Billroth dogs (t1/2 = 43 +/- 9 minutes; p less than 0.05), but solids emptied similarly in both groups of dogs (t1/2 approximately 8 hours). Pacing the Roux limb abolished the ectopic pacemakers, restored the slow emptying of liquids to the more rapid rate found in the Billroth dogs (t1/2: paced Roux, 72 +/- 15 minutes; Billroth, 43 +/- 9 minutes; p greater than 0.05) and did not change emptying of solids. The conclusion was that ectopic pacemakers present in the Roux limb after vagotomy and Roux gastrectomy drove the limb in a reverse direction and slowed emptying of liquids after the operation. The defect was corrected by pacing the Roux limb in a forward direction.

Criminalidad, violencia y gasto público en defensa, justicia y seguridad en Colombia

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Posada , Carlos Esteban

2001-06-01

Full Text Available Este documento muestra la evolución del gasto en defensa, justicia y seguridad (GDJS y la criminalidad en Colombia desde 1950 hasta hoy. Presenta algunas consideraciones sobre la eficiencia del GDJS y analiza algunos de sus indicadores en el país. Además propone unas medidas que a juicio de los autores son útiles para elevar la eficiencia de las actividades y organizaciones estatales diseñadas para proveer seguridad, defensa y justicia a los ciudadanos. Entre ellas, el perfeccionamiento del sistema de asignación de recompensas a particulares y la reforma de códigos y normas de procedimiento penal.

Brassolis isthmia (LEPIDOPTERA: NYMPHALIDAE, EN PEJIBAYE Y EN COCOTERO EN COSTA RICA

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Ram\\u00F3n G. Mexz\\u00F3n

2011-01-01

Full Text Available El objetivo de este trabajo fue describir el ciclo de vida de Brassolis isthmia asociado al pejibaye bajo condiciones de campo y de laboratorio, y su actividad en cocotero. El ciclo de vida de B. isthmia fue estudiado en condiciones de campo y de laboratorio en Guápiles, Limón, Costa Rica, entre setiembre y noviembre de 1994, durante un incremento poblacional del insecto en una plantación de pejibaye. En los años siguientes se realizaron observaciones de las actividades alimentarias de la mariposa en cocotero en varias localidades de la Vertiente Caribeña. Varios centenares de huevos y de larvas de primer estadio fueron recolectadas y colocadas en grupos de diez individuos, y alimentadas con pedazos de hojas de pejibaye, de 30 x 80 mm. El número de larvas necesario para causar defoliaciones de 5% y 20% fue calculado para cada estado de desarrollo larval. El ciclo de vida promedio duró 159 días, distribuidos en las etapas de: huevo: 20, larva: 114, pupa: 20 y adulto: 5 días. Las larvas son gregarias, se alimentan durante la noche y permanecen durante el día en nidos construidos con restos de hojas secas y seda. El consumo promedio durante la etapa larva es de 820,62 cm² de follaje; el séptimo estado larval requiere un 72,8% de éste.

Empatía y distorsiones cognitivas en personas no reclusas y en condenados por delitos sexuales y delitos violentos en Boyacá

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Cepeda Rodríguez, Zulma Yadira

2012-01-01

El fin de esta investigación consistió en explorar, describir y comparar las variables empatía y distorsiones cognitivas en tres grupos: agresores sexuales de menores de edad, delincuentes violentos no sexuales y personas sin historia de reclusión en establecimientos carcelarios por medio de una investigación transeccional de tipo descriptivo-comparativo. Para evaluar las variables de estudio se tradujo y adaptó al castellano tanto la Escala de Cognición de Becker y cols (1989), como la Medid...

Crisis y Respuestas: Tarifa Social en Agua y Saneamiento en Argentina

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Petrecolla, Diego; Ferro, Gustavo

2003-01-01

En un trabajo reciente del Banco Mundial, se procesó una encuesta sobre consumo de servicios públicos en la Argentina, y se procesó, y algunos resultados se aprovechan en este artículo. La hipótesis del trabajo es que es posible diseñar un esquema nacional de subsidio al uso del servicio, con un conjunto relativamente pequeño de indicadores objetivos de pobreza estructural y riesgo sanitario, tal que cruzado con ingreso –emanado de información muestral- arroje un nivel empíricamente razonable...

Impulsividad y consumo de alcohol y tabaco en adolescentes

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María del Carmen Pérez-Fuentes

2015-12-01

Full Text Available La etapa de la adolescencia se caracteriza por una prematura experimentación de nuevas experiencias y sensaciones. Estas experiencias, pasan en ocasiones por el consumo de drogas, que aun siendo legales y socialmente aceptadas, las consecuencias negativas en el desarrollo del adolescente comienzan a hacerse patentes. En los últimos años se ha observado una disminución en el consumo de tabaco en los adolescentes españoles, no así en el consumo de alcohol. Una de las causas de inicio en las drogas es la personalidad o conducta impulsiva. Así, el objetivo de este estudio es analizar la relación entre la impulsividad y la frecuencia de consumo de alcohol y tabaco en 822 alumnos de entre 13 y 18 años. Para ello, se utilizó la Escala de Impulsividad Estado (EIE y un cuestionario elaborado ad hoc para conocer las características demográficas y el consumo de alcohol y tabaco. Los resultados mostraron que aquellos estudiantes que se declararon consumidores obtuvieron puntuaciones significativamente más altas en impulsividad. De este modo, analizar detalladamente el perfil de los sujetos con este factor de riesgo puede favorecer la creación de programas más adecuados para la intervención.

PRODUCCIÓN Y FOTOSÍNTESIS EN TRÉBOL SUBTERRÁNEO EN SECANO Y REGADÍO

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Cabot, J. C.; Medrano, H.

2011-01-01

Se presentan los primeros resultados de un estudio sobre producción, fotosíntesis y transpiración en dos cultivares Seaton Park y Clare de trébol subterráneo cultivados en condiciones de secano y regadio en Mallorca. El rendimiento superior de Clare en secano se corresponde con unos valores significativamente más altos de tasa de fotosíntesis y con una más ventajosa relación entre tasa de transpiración y de fotosíntesis.

PRESENCIA DE ARSÉNICO EN POZOS Y EN CULTIVOS EN OAXACA, MÉXICO

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Pablo Ubaldo Caballero-Guti\\u00E9rrez

2010-01-01

Full Text Available El objetivo de este trabajo fue determinar la presencia de arsénico en agua de pozos y en cultivos. Se muestrearon pozos noria y semip rofundos, y diferentes cultivos (tomate, lechuga, frijol y maíz, pertenecie ntes al paraje "Flor de Guayabal", en Tlacolula, Oaxaca, México, durante un periodo de 10 meses (julio 2006 a abril 2007.Hubo dos fases: la primera fue el diagnóstico que se obtuvo de la determinación mensual del arsénico en los pozos, y en la segunda, el establecimie nto de cultivos y el muestreo de plantas para los análisis químicos. En los resultados del análisis de agua (julio-abril, hubo arsénico (¿=0,1 mg/l en niveles que superan lo establecido en la norma oficial mexicana (0,025 mg/l. En la segunda fase, en los órganos comestibles de jitomate, lechuga, zanahoria, maíz y frijol cultivados en el paraje, no se encontró evidencias sobre la presencia de este metal.

Comparison of the outcomes for laparoscopic gastrectomy performed by the same surgeon between a low-volume hospital and a high-volume center.

Science.gov (United States)

Kim, Min Gyu; Kwon, Sung Joon

2014-05-01

The volume-outcome relationship in laparoscopic surgery is controversial. This study was designed to identify differences in laparoscopic gastrectomy outcomes between a low-volume hospital and a high-volume center and to provide guidelines for overcoming the problems associated with a low-volume hospital. From April 2009 to November 2012, one surgeon performed 134 totally laparoscopic distal gastrectomies (TLDGs) at a high-volume center (HVC; ASAN Medical Center) and at a low-volume hospital (LVH; Hanyang University Guri Hospital). All laparoscopically assisted gastrectomies were excluded from this study. During the early period of laparoscopic gastrectomy at the low-volume hospital, TLDG with Roux-en-Y gastrojejunostomy (RYGJ) was performed according to the surgeon's choice. The reconstruction method was classified as gastroduodenostomy (GD) or RYGJ. Early surgical outcomes achieved at the LVH were investigated and compared with those obtained at the HVC. The early surgical outcomes differed significantly between the two hospitals. In particular, the postoperative complication rate for the patients who underwent TLDG RYGJ at the LVH was higher than at the HVC (LVH 15.4 % vs. HVC 0 %; p = 0.037). Furthermore, significant differences were observed in the mean operation time (TLDG GD: LVH 141.0 min vs. HVC 117.4 min, p = 0.001; TLDG RYGJ: LVH 186.3 min vs. HVC 134.6 min, p = 0.009) and length of hospital stay (TLDG GD: LVH 8.1 days vs. HVC 7.2 days, p = 0.044; TLDG RYGJ: LVH 11.5 day vs. HVC 6.8 day, p = 0.009). Although all the operations were performed by one experienced surgeon, the early surgical outcomes differed significantly between the low- and high-volume hospitals. Low-volume hospitals often lack well-trained surgical professionals such as first assistants and scrub nurses. Therefore, the authors recommend that a surgeon who works at an LVH should assess potential personnel shortages and find a solution before operating.

Nuevas concepciones de autoridad y cambios en las relaciones de violencia en la familia y la escuela

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Bárbara Yadira García-Sánchez

2011-01-01

Full Text Available Este artículo presenta algunas reflexiones sobre las transformaciones en las concepciones de la autoridad y su relación con las violencias difusas en la familia y la escuela configuradas en el marco conceptual del proyecto de investigación Violencia escolar en Bogotá, una mirada desde las familias, los maestros y los jóvenes. Aplicación de un modelo cualitativo de investigación y prevención en familia, escuela y barrio, el cual aplicó metodologías cualitativas, con base en el modelo Núcleos de Educación Social para la prevención de violencias difusas con grupos de padres y madres, profesores, estudiantes y líderes barriales durante los años 2009 y 2010 en cinco instituciones educativas oficiales, modelo basado en fundamentos de la Investigación Acción Participativa, IAP.

Parámetros inflamatorios en saliva y sangre en niños y adolescentes sanos

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Ninoska Tahis Viera Sirit

2011-09-01

Full Text Available En la actualidad se ha mostrado interés en el empleo de la saliva para ser utilizada como una alternativa de diagnóstico, predicción y progresión de diversas enfermedades con relación a otros fluidos corporales. Los objetivos trazados para la realización de este trabajo fueron: correlacionar las concentraciones en saliva y sangre de IL-1, IL-6, TNF-a, sustancias reactivas al ácido tiobarbitúrico y O2- de niños y adolescentes sistémicamente sanos. Se realizó un estudio de corte transversal en 23 niños y adolescentes sanos, entre 4 y 17 años de edad. Se les realizaron evaluaciones clínicas para determinar las condiciones bucales y estudios inmunológicos con el propósito de identificar los niveles de citosinas, a través del ensayo inmunoenzimático indirecto, el O2- por método citoquímico y las sustancias reactivas al ácido tiobarbitúrico, a través del ensayo colorimétrico. Hubo diferencia significativa entre las muestras de saliva y las de sangre periférica respecto a las citosinas y sustancias reactivas al ácido tiobarbitúrico estudiadas. Los resultados fueron: IL-1 en sangre= 1,646 ± 0,13 pg/mL y de IL-1 en saliva= 552,36 ± 75,7 pg/mL; IL-6 en sangre= 3,506 ± 1,85 pg/mL, e IL-6 en saliva= 26,89 ± 9,97 pg/mL. Al analizar el TNF-a en sangre fue de 12,91 ± 3,05 pg/mL y en saliva= 43,56 ± 6,44 pg/mL, las sustancias reactivas al ácido tiobarbitúrico en sangre= 9,46 ± 3,26 nmol/mL y en saliva= 1,26 ± 0,03 nmol/mL. No se observó correlación estadísticamente significativa entre las muestras de sangre y saliva para los valores de IL-1, IL-6 y sustancias reactivas al ácido tiobarbitúrico. En cuanto al TNF-a se evidenció una correlación significativa, r s= 0,78. No se evidenciaron células positivas para el O2- en las muestras estudiadas. Los resultados del análisis de correlación obtenido entre las muestras salivales y séricas, no aportaron evidencias suficientes para sugerir que la saliva pueda ser utilizada

Resonancias Vocales y Memoria Sonora en Helen Brown

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Andrés Grumann Sölter

2016-09-01

Full Text Available El artículo se concentra en indagar aspectos referidos a la intensificación de los usos de la voz y la sonorización musical que proponen Trinidad Piriz y Daniel Marabolí en Helen Brown (2013. Dando cuenta de un marco teórico que cuestiona la dimensión referencial con la que se analiza frecuentemente al teatro y proponiendo una aproximación fenomenológica que dé cuenta de la materialidad performativa que insta a intensificar las resonancias de la voz y la capacidad audible del sonido, el escrito analiza dos escenas o tracks en los que la memoria hecha cuerpo compromete de un modo particular a los espectadores que participan de la performance escénica.

Fórmulas cooperativas y redes en turismo. Aplicación y potencial en Andalucía

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Francisco M. Fernández-Latorre

2013-12-01

Full Text Available Las formulas cooperativas y redes tienen relevancia en turismo, al ser éste un fenómeno inherentemente reticular. El trabajo identifica redes y formulas cooperativas en turismo, especialmente las desarrolladas en Andalucía. Primero desde el enfoque de la planificación territorial y turística. A continuación se centra en un análisis de clusters económicos y turismo. Se observa una correlación estadística entre riqueza de clusters y competitividad turística de las comunidades autónomas españolas, medidas por Monitur. Por último se propone un modelo de turismo de clusters y se aplica en Andalucía. Se concibe como un modelo-red, que trata de maximizar las relaciones colaborativas entre el turismo y los clusters presentes en cada destino.

Enseñar y aprender Seguridad y Privacidad en Redes en la UNLP: SyPeR

OpenAIRE

Díaz, Francisco Javier; Venosa, Paula; Macia, Nicolás; Sabolansky, Alejandro Javier; Bogado García, Joaquín Ignacio

2014-01-01

Este artículo cuenta la experiencia del equipo de la cátedra de Seguridad y Privacidad en Redes, materia optativa de las actuales carreras de Licenciatura en Informática y Licenciatura en Sistemas, de la Facultad de Informática de la Universidad Nacional de la Plata. Seguridad y Privacidad en Redes forma a los alumnos en el análisis de problemas de seguridad de sistemas, redes y servicios así como en el diseño e implementación de soluciones a los mismos. El estudiante aprende normas, pr...

MODELAMIENTO DE LA INCERTIDUMBRE EN GEOLOGIA Y LEYES Y SU IMPACTO EN LA SELECTIVIDAD DE EXPLOTACIONES MINERAS

OpenAIRE

MAGRI VARELA, EDUARDO

2009-01-01

En la actualidad, la evaluación de recursos y reservas mineras suele basarse en un modelamiento determinístico de las unidades geológicas del depósito y en estimaciones de las leyes obtenidas mediante interpolación espacial. Este enfoque conduce a modelos que no reflejan la variabilidad real de ley y geología en el depósito y no permite evaluar los riesgos asociados a esta variabilidad. El proyecto consistió en desarrollar metodologías para modelar la incertidumbre que existe en las leyes y e...

Slow Design: "cultivar" cultura y sensorialidad en la forma y en el uso de los artefactos

OpenAIRE

Lupo, Eleonora

2012-01-01

Este artículo pretende aportar principios clave y ejemplos de aplicación de un "enfoque slow" en el diseño de las funciones y experiencias propias de un producto. Algunos ejemplos mostrarán como incorporar las "cualidades soft" y los elementos culturales/intangibles presentes en los "artefactos culturalmente intensivos", en pro de una experiencia verdaderamente slow, pero al mismo tiempo densa y profunda, en el ámbito de las relaciones y la apropiación entre las personas y la producción de ma...

Conocimientos sobre derechos y deberes en salud en profesionales de medicina y enfermería, Bucaramanga, Colombia: Conocimientos sobre derechos-deberes en salud

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Ludivia Esther Montaño Villalba

2013-04-01

Full Text Available Objetivo: Describir el nivel de conocimientos que profesionales en medicina y enfermería, que laboran en instituciones de salud públicas y privadas de la ciudad de Bucaramanga (Santander-Colombia, tienen sobre derechos y deberes en salud establecidos en la Constitución Política y en el Sistema General de Seguridad Social en Salud, 2010. Método: Estudio descriptivo, exploratorio, transversal. Se seleccionaron aleatoriamente instituciones, servicios y profesionales participantes. Se indagaron los conocimientos en cinco componentes que cobijaron temas sobre derechos y deberes en salud inscritos en la Constitución Política, en el Sistema General de Seguridad Social colombiano y en la jurisprudencia constitucional; igualmente, se indagó sobre el conocimiento de mecanismos jurídicos para acceder al derecho a la salud en el territorio nacional. Se construyeron promedios en términos de porcentaje total y por componente. Resultados: El promedio global de conocimientos fue 57,7 %, el de conocimientos generales sobre Constitución Política 39,4 % y el de conocimientos sobre el SGSSS 55,1 %. Los profesionales que reportaron mayores niveles de conocimientos fueron: hombres, especialistas administrativos, médicos, personas con mayor experiencia laboral y trabajadores del sector privado. Los egresados menores a cinco años obtuvieron menores promedios de conocimientos. Conclusiones: El nivel de conocimientos en derechos y deberes en salud entre los profesionales de medicina y enfermería en Bucaramanga fue deficiente.A pesar de que el conocimiento de estos temas es central en el desempeño de los profesionales del sector salud, se evidencia a partir de estos resultados, carencia de procesos de formación o educación continuada en el tema de derechos. Salud UIS 2013; 45 (1: 15-22

Propiedad intelectual y plagio en trabajos académicos y profesionales

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Fernando M. Toller

2011-11-01

Full Text Available El texto estudia un área poco explorada de la propiedad intelectual. En efecto, el plagio suele estudiarse en relación con la defraudación de la autoría ajena que tiene relevancia comercial y, por tanto, resonancias penales y civiles. El plagio en escritos científicos, exámenes universitarios y monografías estudiantiles, así como el plagio en escritos profesionales de jueces y abogados, han quedado sin embargo desdibujados en los estudios del área. En el artículo se plantea, en primer lugar, la importancia que ha cobrado el problema del plagio en el ámbito académico, a partir del auge de Internet y las facilidades que esto implica para el mal hacer de estudiantes y, en ocasiones, de profesores. En el escrito se establecen tipologías del plagio en trabajos científicos, deslindando los relevantes de los irrelevantes. El autor defiende la postura de que el “plagio académico” es siempre socialmente reprochable y merecedor de sanciones disciplinares en el ámbito universitario, aun cuando no importe un delito penal o un ilícito de carácter civil. Se dan, por último, una serie de pautas de buenas prácticas éticas y científicas en la investigación jurídica, exponiendo, entre otros elementos, el derecho de cita y el uso honrado de las fuentes, a fines de respetar la propiedad ajena y para no incurrir en esta figura que, en definitiva, falta a la verdad, destruye la creatividad y se apropia de los derechos de terceros.

en la escuela secundaria y media

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Pedro Fernando Núñez

2008-01-01

Full Text Available En este trabajo el autor realiza un análisis orientado a desentrañar algunos rasgos que permitan caracterizar la manera en que el vínculo juventud-política está siendo redefinido en estos tiempos en la Argentina. Se espera de esta manera poder contribuir a la producción de un estado del arte de la investigación en América Latina sobre la condición juvenil y sus representaciones y prácticas políticas. En un primer momento se sitúa el trabajo en el diálogo con otras investigaciones que han analizado las características del ser joven hoy. En segundo lugar, se analizan las transformaciones ocurridas por estos años en la escuela secundaria y media* y en la esfera política en la Argentina. El análisis se estructura a partir del estudio del papel de los vínculos familiares en la decisión de participar políticamente, la manera de concebir las violencias –en particular la deslegitimación de la violencia política y el surgimiento de discursos que hacen énfasis en la violencia delictiva y la violencia de los jóvenes y las jóvenes– y los sentidos que el estar en la escuela tiene para las juventudes. A partir de estas dimensiones se exploran las configuraciones políticas construidas en las instituciones escolares, entendidas como parte de la socialización política juvenil

Scientific aptitude and academic performance in incoming students of medicine Aptitud científica y rendimiento académico en histología y genética en alumnos de medicina

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Miguel Angel Vinuesa

2005-04-01

performance. Actuar científicamente es una competencia que debe desarrollar el estudiante y poseer el egresado de Medicina. El objetivo del estudio fue relacionar la aptitud científica de los alumnos ingresantes a la Facultad de Medicina de Rosario de la UAI con su desempeño académico en Genética e Histología. De 102 alumnos ingresantes, 74 (29 del sexo masculino y 45 del sexo femenino completaron el instrumento evaluador de habilidades cognitivas relacionadas con la aptitud científica creado por D’Ottavio y Bassan. Para cada asignatura se consideró como de rendimiento satisfactorio a aquellos alumnos que obtuvieron un mínimo de 85% de respuestas correctas en las evaluaciones periódicas objetivas y aprobaron la evaluación final. Como de rendimiento poco satisfactorio se consideró a aquellos alumnos que no lograron lo anterior. El rendimiento de aptitud científica fue de 3.89 ± 1.96 respuestas correctas por alumno sobre 12 totales. Por sexo se encuentra en los varones una media de 4.50 ± 1.99 y en las mujeres 3.48 ± 1.83, (p < 0.025. Los alumnos de rendimiento satisfactorio en Histología poseían mayor aptitud científica (n = 34 4.67 ± 2.04 que los de bajo rendimiento (n = 40 3.02 ± 1.36 (p < 0.001. En los varones (n = 14 5.42 ± 2.37 frente a (n = 15 3.20 ± 1.14 (p< 0.01 y en las mujeres (n = 22 4.18 ± 1.56 frente a (n = 23 2.78 ± 1.47 (p < 0.01. En Genética los de rendimiento satisfactorio (n = 46 mostraron una media de 4.00 ± 2.00 frente a (n= 28 2.71 ± 1.04 (p < 0.01. En varones (n =18 5.22 ± 2.12 frente a (n = 11 3.54 ± 1.21 (p< 0.05 y en mujeres (n = 30 3.90 ± 1.70 frente a (n=15 2.33 ± 1.70 (p < 0.01. En todos los casos los alumnos de rendimiento satisfactorio mostraron una media de aptitud científica superior a la de la población estudiada. Interpretamos que el grado de aptitud científica puede considerarse una variable predictiva del rendimiento académico de los alumnos ingresantes.

Computed tomographic features of afferent loop syndrome: pictorial essay

Energy Technology Data Exchange (ETDEWEB)

Zissin, R. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel); Hertz, M. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Paran, H. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Surgery ' A' , Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel); Osadchy, A. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel); Gayer, G. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Assaf Harofe Medical Center, Zrifin, Sackler Faculty of Medicine, Tel Aviv (Israel)

2005-04-15

This pictorial essay reviews the computed tomography (CT) findings of afferent loop syndrome (ALS) in various pathological conditions to demonstrate the contribution of a common imaging modality-that is, abdominal CT, used nowadays for various abdominal complaints-to the diagnosis of ALS. ALS is caused by obstruction of the duodenum and jejunum proximal to a gastrojejunostomy anastomosis. It is a rare complication after Billroth II subtotal gastrectomy and even more rare after total or subtotal gastrectomy with Roux-en-Y reconstruction. Although currently advanced medical treatment and endoscopic interventions have dramatically decreased the necessity of surgery for peptic ulcer disease, ALS may appear years after previously common operations. Alternatively, the use of surgical resection for early gastric cancer nowadays leads to an increasing rate of malignancy-related ALS. Clinically, ALS may be difficult to diagnose as its presentation may be vague and nonspecific, but it has a characteristic appearance on CT. Clinicians and radiologists should therefore be familiar with this rare complication. Prompt recognition and correct diagnosis of this syndrome and its probable etiology are important as a guide for treatment. This review illustrates the CT features of ALS in various conditions. (author)

Populismo y neopopulismo en Ecuador

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Hernán Moreano

2006-11-01

Full Text Available El presente artículo hace una breve descripción de los períodos de Velasco Ibarra, Assad Bucaram, Abdalá Bucaram y Lucio Gutiérrez donde la simbología del líder frente a su pueblo fue esencial dentro de la cultura política ecuatoriana. En sí el objetivo está en describir las diferencias entre populismo y neopopulismo en el Ecuador, y a la vez entender cómo ha funcionado el sistema clientelar y caudillista en cada gobierno; sin dejar de lado, el contexto social y económico por el que se atravezaba.

Populismo y neopopulismo en Ecuador

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Claudia Donoso

2006-01-01

Full Text Available El presente artículo hace una breve descripción de los períodos de Velasco Ibarra, Assad Bucaram, Abdalá Bucaram y Lucio Gutiérrez donde la simbología del líder frente a su pueblo fue esencial dentro de la cultura política ecuatoriana. En sí el objetivo está en describir las diferencias entre populismo y neopopulismo en el Ecuador, y a la vez entender cómo ha funcionado el sistema clientelar y caudillista en cada gobierno; sin dejar de lado, el contexto social y económico por el que se atravezaba

EL RENDIMIENTO ACADÉMICO DE LAS MUJERES EN MATEMÁTICAS: ANÁLISIS BIBLIOGRÁFICO Y UN ESTUDIO DE CASO EN EDUCACIÓN SUPERIOR EN MÉXICO (ACADEMIC PERFORMANCE OF WOMEN IN MATH: LITERATURE REVIEW AND A CASE STUDY IN HIGHER EDUCATION IN MEXICO

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Aguiar Barrera Martha Elena

2011-08-01

Full Text Available Resumen:En este artículo se investiga el rendimiento académico de las mujeres en matemáticas en los niveles preuniversitario y universitario. El estudio consta de dos partes; en la primera, se indaga en la literatura los reportes sobre dicho rendimiento en la etapa preuniversitaria en América Latina, con énfasis en México, y se concluye que en términos generales los puntajes promedio obtenidos por las mujeres son menores de los obtenidos por los hombres, y esto contribuye, entre otras cosas, a que una menor cantidad de mujeres opten por carreras universitarias científico - tecnológicas. En la segunda parte, se investiga el rendimiento en matemáticas de las mujeres en nivel superior; se hace un análisis estadístico de su rendimiento en un medio masculinizado, como lo es el Centro Universitario de Ciencias Exactas e Ingenierías (CUCEI de la Universidad de Guadalajara. Se utilizan los datos de evaluaciones estandarizadas y continuas de los estudiantes en las materias de matemáticas del CUCEI; y se encuentra que las alumnas obtienen en promedio mejores resultados que los alumnos. Además se deduce que las profesoras tienen mejor desempeño, en el sentido de que sus estudiantes, de ambos sexos, superan en su puntaje promedio a los estudiantes de los profesores varones.Abstract: Academic performance of women in mathematics is analyzed. The study consists of two parts. The aim of the first part was to perform a literature review about such performance at the pre-university level in Latin America, with emphasis on Mexico; it is concluded that the average performance of boys was higher than girls. In the second part, female performance in mathematics was investigated at the Centro Universitario de Ciencias Exactas e Ingenierías (CUCEI of Universidad de Guadalajara (UdeG, Mexico; where men predominate in number and positions. The study was performed on the basis of periodic standardize assessment and continuing evaluation of learning. It

ASPECTOS HISTÓRICOS, EPIDEMIOLÓGICOS Y PATOLÓGICOS DE LAS HELICOBACTERIAS EN HUMANOS Y EN CANINOS

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Diana Naranjo Restrepo

2012-04-01

Full Text Available El Helicobacter pylori -bacteria del género Helicobacter- está presente en la mucosa gástrica de los humanos- y se relaciona con la etiología de enfermedades ácido-pépticas benignas y malignas, de las cuales hacen parte las gastritis, úlceras de tipo gástrico y duodenal, adenocarcinoma gástrico y linfoma gástrico no Hodgkin del tejido linfoide asociado a la mucosa (MALT. Esto le ha dado relevancia a su diagnóstico temprano y tratamiento, incentivando el estudio sobre factores de riesgo, medio de contagio y prevalencia con alta implicación en salud pública. A su vez se han realizado investigaciones que han evidenciado la presencia de especies Helicobacter en la mucosa de animales domésticos, de los géneros H. heilmanni, felis y rappini, con posible colonización en mucosa gástrica humana, implicando un componente zoonótico. Existe gran interés por parte del personal de salud en el conocimiento de su prevalencia en la población en general, tipos de transmisión, manifestaciones clínicas, diagnóstico y tratamiento. Debido a la popularidad del tema del H. pylori -tanto en manifestaciones clínicas como en el pronto tratamiento farmacológico- se ha venido encontrando resistencia bacteriana de manera creciente en la población tratada. Esto ha obligado a la comunidad científica a desarrollar vacunas con efecto profiláctico y terapéutico.

La “Merced de Dios” y los “duelos y quebrantos”. Calas en algunos enunciados metafóricos y comparaciones en el Quijote

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María José Rodilla

2015-06-01

Full Text Available El Quijote es un rico acervo de enunciados metafóricos, verdaderos tesoros de sabiduría que nos acercan a la época áurea, nos aportan el significado de costumbres perdidas o aluden a alguna circunstancia histórica. Muchos de ellos perviven en la actualidad porque se han convertido en frases proverbiales, cargadas del saber ancestral tan elogiado por los erasmistas y que el mismo Cervantes derramaba en su obra en forma de refranes caídos de la boca de Sancho. Se verán algunos campos semánticos en que podemos clasificar estos enunciados metafóricos y algunas expresiones comparativas: la gastronomía, los animales, referencias espaciales y temporales, metáforas eufemísticas y burlescas. Lo que se pretende, en suma, es hacer algunas calas en una selección de metáforas y comparaciones en el Quijote, con el objetivo no sólo de agruparlas y categorizarlas sino para razonar sobre ellas y, en la medida de lo posible, documentarlas, buscando sus orígenes y significados, y las funciones que ejercen en el texto: describir personajes, compararlos con animales, lograr la comicidad de una situación, desinflar un discurso, visualizar y concretizar imágenes.

Actitudes hacia la Compra y el Consumo de estudiantes de Pedagogía y profesores en ejercicio en Chile

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Marianela del Carmen Denegri Coria

2011-01-01

Full Text Available La presente investigación, enmarcada en el Proyecto Fondecyt N.° 1090179, buscó identificar diferencias en las actitudes hacia la compra y el consumo entre estudiantes de Pedagogía y profesores en ejercicio de la ciudad de Temuco. La muestra estuvo conformada por 88 estudiantes y 103 profesores en ejercicio, a los cuales se aplicó la escala de actitudes hacia el consumo y la compra (Tang y Luna, 1999, citado en Gebauer, Schäfer y Soto, 2003 y escala de materialismo (Richins y Dawson, 1992. Los resultados muestran que las mujeres presentan actitudes racionales en coexistencia con actitudes impulsivas. Por otro lado, los profesores en ejercicio tienen una actitud más racional y tienden a considerar al materialismo como central en sus vidas en comparación con los estudiantes de Pedagogía. Los hallazgos se discuten con relación a los antecedentes existentes en esta línea de investigación.

Democracia y conflicto en Venezuela.

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Juan Eduardo Romero

2011-08-01

Full Text Available El presente trabajo aborda el tema de la democracia en Venezuela desde una perspectiva múltiple y variada. Parte de la consideración de un conjunto de variables (papel del Estado en la sociedad globalizada, la política y el ejercicio del poder, la economía, la política social, los movimientos sociales y las protestas colectivas, medio ambiente y grupos étnicos para realizar una ponderación del curso y los retos de la sociedad democrática venezolana en el período 1988-2008. El trabajo maneja el análisis desde la óptica de la comparación histórica, la historia crítica, la sociología histórica y el pensamiento político para establecer las principales tendencias que ha adquirido la democracia venezolana en cada una de esas variables en el período estudiado, así como la prospectiva que pueden adquirir en los próximos años.

Las franquicias en México en 1999 y 2007

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Ma. Cristina Alba Aldave

2010-01-01

Full Text Available La información económica generada sobre el mercado de franquicias en México es deficiente porque no existe una institución u organismo que ofrezca cifras confiables y suficientes en las que sea posible apreciar la dinámica y volumen total del mercado. El objetivo de esta investigación es determinar el crecimiento, el cambio en la estructura y características de las franquicias de México en 1999 y 2007. Para ello se recopiló y sistematizó información de 720 empresas mediante la revisión de fuentes especializadas del tema, visitas a empresas y entrevistas a franquiciatarios y franquiciantes con lo que se estructuró una base de datos. Entre los principales resultados se encontró un cambio de estructura donde las franquicias mexicanas crecen y las extranjeras disminuyen, especialmente las de Estados Unidos. El cambio de cultura empresarial parece positivo para aquellos que desarrollaron franquicias en México y ahora las exportan, pero las franquicias extranjeras de comida rápida perjudican la salud de la población y no promueven la formación de proveedores locales.

TICs y procesos productivos en PyMES

OpenAIRE

De Giusti, Armando Eduardo; Pesado, Patricia Mabel; Naiouf, Marcelo; Thomas, Pablo Javier; Estrebou, César Armando; Galdámez, Nicolás; Moralejo, Lucrecia; Delía, Lisandro Nahuel

2008-01-01

En el marco del Proyecto PAE EICAR, el Instituto de Investigación y Desarrollo en Informática participa en los temas específicos de “Planificación, supervisión y optimización de la producción en Pymes” y “Tecnología en Gestión de stocks (fijos y en movimiento)” en conjunto con la Facultad de Ciencias Económicas de la UNLP, la Universidad Nacional de La Matanza y la Universidad del Centro de la Pcia. de Bs. As. y de la creación de la “RED (EICAR) de Centros Regionales de investigación y desarr...

Columna y columnata en Concepción

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Eduardo Meissner Grebe

1985-12-01

Full Text Available En un paseo urbano por Concepción y hecho con atención aparecerán las columnas de cuando en cuando: adornarán fachadas y se individualizarán en los pórticos. Simularán baldaquinos en las casonas señoriales y celebrarán triunfos en las monumentales columnatas de los palacios de justicia. Pero también se elevarán graciosas y repetidas en los abanicos circulares de Odeones y Rotondas y las veremos magníficas flanqueando estatuas ecuestres o sosteniendo triunfante una diosa, Ceres, en el centro mismo de nuestra plaza mayor. También en traquilos barrios penquistas la veremos reducida innumerables veces a mero ornamento en zócalos y frontones. En otros sectores de factura social más opulenta se convertirá en pilarotes graciosos y hasta en balaustros innecesarios. Como minicolumnatas en balcones y remates y se multiplica en pilares de ventana, relojes de arena, jarrones de argamasa, pérgolas de techoplano otorgando a mansiones dignidades de ostentación. Sobre todo en estos últimos casos el uso de la columna se destaca más como elemento de significación que como mero pilar constructivo. El Concepción decimonónico de fines del siglo pasado destaca la columna en sus afanes de representación cultural y del status social. No podemos pasar entonces indiferentes frente a los vestigios de la arquitectura republicana repartida por la ciudad.

Calcificaciones vasculares y fragilidad ósea en pacientes en hemodiálisis y en población general: Impacto sobre morbilidad y mortalidad

OpenAIRE

Rodríguez García, Minerva

2009-01-01

El presente estudio pretende aportar información sobre la relación existente entre calcificaciones vasculares, masa ósea, fracturas y mortalidad tanto en pacientes en hemodiálisis como en población general. Se estudiaron 193 pacientes en hemodiálisis de 7 hospitales de Asturias que se les siguió durante dos años. Se les realizó una encuesta y se revisó su historia clínica recogiendo 84 parámetros diferentes incluyendo información clínica, fracturas previas, variables bioquímicas y tratamiento...

Decolonizando acciones públicas contra el feminicidio con cuerpos disidentes: el performance y la plataforma arte acción en Chiapas México

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Brittany Chávez

2014-12-01

Full Text Available Proponemos una forma alternativa de denunciar y visibilizar la violencia feminicida en la región de Chiapas por medio de la plataforma de performance y activismo Arte Acción. Tres partes constituyen este artículo: la situación del feminicidio en Chiapas y nuestra metodología desde lo erótico, lo decolonial y lo pedagógico; la creación de la memoria colectiva a través de acciones públicas; y nuestro trabajo continuado con la plataforma como un modo de activismo alternativo.

El cuerpo-huella en el performance digital 10 minutos

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Daniel Enrique Ariza Gómez, PhD

2017-01-01

Full Text Available Este artículo de reflexión aborda el concepto de cuerpo-huella, eje principal del performance “El fajadito”. Esta puesta en escena forma parte de una creación escénica más grande llamada 10 minutos, performance digital que pone en tensión la relación cuerpo-máquina en el entorno de una unidad de cuidados intensivos (UCI, y se entrelaza junto con otros tres para ofrecer al público la totalidad de una obra que surge del proceso de investigación-creación 10 minutos. El discurso del presente artículo se abrirá hacia la comprensión de la manera en que fue abordado, para el performance “El fajadito”, el cuerpo de las personas víctimas de minas antipersona en Colombia. Un cuerpo-huella que aparece en la puesta en escena como un cuerpo en suspensión proponiendo con ello una postura política y social sobre lo que ha significado, para Colombia, el uso de armas que no buscan la muerte del individuo, sino la provocación del dolor y exhibe un cuerpo mutilado como huella de guerra. Palabras clave: fajaditos, cuerpo-huella, 10 minutos, performance digital, minas antipersona.

Infecciones virales en piel y mucosas

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María José Martínez G., Dra.

2011-11-01

Full Text Available Diversos virus pueden infectar la piel y las mucosas de los seres humanos, manifestándose en diferentes patologías, de acuerdo a la edad, género y estado inmunológico. Un grupo importante de éstos tiene capacidad de replicar en células epiteliales, originando cuadros clínicos en los cuales se evidencia la destrucción celular o bien la hiperplasia del tejido infectado. Gran parte de estos virus persisten en células infectadas por años y tienen la capacidad de reactivarse y de manifestar nuevamente enfermedades cutáneas o mucosas. En algunos casos, ésta sólo se expresa de manera subclínica en una excreción del virus por secreciones que son fuente de infección. En los últimos años, los avances en técnicas moleculares han permitido contar con metodologías diagnósticas cada vez más sensibles, específicas y rápidas. Así como también el progreso en el área de vacunas y antivirales nos entrega mayores herramientas profilácticas y terapéuticas.

Una puesta en escena: la oralidad como performance en la vida escolar

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DIEGO ARIAS CORTÉS

2017-01-01

Full Text Available El objetivo del artículo es presentar una revisión de los Derechos Básicos de Aprendizaje (DBA y de los Estándares Básicos de Competencias del Lenguaje (EBCL relacionados con la oralidad que en estos se propone, específicamente de grado sexto a undécimo. A ello se suma una comparación con las propuestas de autores cuyo trabajo con el discurso oral tiene un reconocimiento a nivel nacional e internacional, y que está emparentado con la oralidad entendida como performance . A partir de este ejercicio se proponen unas estrategias pedagógicas procedentes de las discusiones y experiencias que se han tenido con los estudiantes del grupo de estudio El discurso oral en el Quindío: de la Academia a la cotidianidad (DOQAC, encaminadas a explorar y experimentar algunas características de la oralidad, que apenas se sugieren en los DBA y en los EBCL.

Propiedad intelectual y plagio en trabajos académicos y profesionales

OpenAIRE

Fernando M. Toller

2011-01-01

El texto estudia un área poco explorada de la propiedad intelectual. En efecto, el plagio suele estudiarse en relación con la defraudación de la autoría ajena que tiene relevancia comercial y, por tanto, resonancias penales y civiles. El plagio en escritos científicos, exámenes universitarios y monografías estudiantiles, así como el plagio en escritos profesionales de jueces y abogados, han quedado sin embargo desdibujados en los estudios del área. En el artículo se plantea, en primer lugar, ...

Situación y Perspectivas de la Industria del Caucho en el Mundo y en Colombia

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Bustamante B. Orlando

1993-09-01

Full Text Available Este trabajo constituye la primera etapa del “Estudio de factibilidad para la siembra de caucho en el proyecto Porce II” que se realizó para las Empresas Públicas de Medellín. En el se presenta un estudio completo sobre lo que es la industria del caucho en el mundo y particularmente en Colombia Se analiza la producción del caucho natural, sus ventajas y perspectivas en el mercado interno e internacional. Para ello se revisaron los trabajos de varias entidades privadas y gubernamentales, así como la bibliografía de países productores. Se visitaron las zonas productoras en Colombia y las que están ampliando para la exploración del caucho Se encontró en el estudio realizado, que Colombia tiene amplias zonas aptas para este cultivo y que el mercado posee más de 300 fábricas que consumen caucho natural importado de Malasia principalmente. El consumo anual en Colombia es de 28000 toneladas y en el país sólo se producen 1000 toneladas en las 483 hectáreas que tiene en producción. Colombia para auto-abastecerse requiere sembrar unas 30.000 hectáreas que generarían unos 3.500 empleos en las zonas rurales con ingresos apreciables. Se encontró que en la zona del Caquetá una familia puede tener ingresos brutos por más de 700.000 mensuales en una unidad de producción de 5 hectáreas. Las labores de mantenimiento, sangrado y proceso son manuales, lo cual garantiza que la familia gane un gran porcentaje en el ingreso bruto. Las posibilidades son grandes ya que este cultivo también sería una solución para la conservación de las cuencas hidrográficas.

EMPRENDIMIENTO VERDE EN TORNO A LA CONSERVACIÓN Y RECUPERACIÓN DEL AGUA Y SUS ESPACIOS EN BOGOTÁ Y MEDELLÍN (COLOMBIA

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SONIA E. SANABRIA

2018-01-01

Full Text Available El emprendimiento verde es entendido en este documento, como el desarrollo de actividades orientadas a la mitigación, reducción o eliminación de problemáticas ambientales, las cuales son consideradas de entrada como innovadoras, en la medida en que proponen cambios en los patro- nes de producción y consumo que deterioran las condiciones naturales del planeta y en el relacio- namiento del ser humano con el entorno. En este caso, el objeto de análisis es el emprendimiento verde orientado a la restauración y conservación del agua y sus espacios en Bogotá y Medellín. La investigación desarrollada se sustentó en la aplicación de entrevistas semi-estructuradas a actores de diferente tipo, involucrados en estas actividades. Se consideró que los espacios del agua son bienes comunes, alrededor de los cuales prevalece el sentir general de que pertenecen a todos y a la vez a nadie. Se concluye que un modelo eficaz para lograr su gestión adecuada implica la co- gestión participativa, lo que abre la posibilidad al emprendimiento verde promulgado por diferen- tes actores. En este sentido, se encontraron emprendimientos promovidos por actores del sector público, empresas privadas, organizaciones sin ánimo de lucro, organizaciones sociales, fondos de agua, entre otros actores; algunos de los cuales intervienen directamente sobre los espacios del agua y otros indirectamente, a través de la optimización del consumo. La intervención en los espacios del agua en Bogotá y Medellín ha generado impactos positivos, no obstante, los esfuerzos aún son muy incipientes y de alcance local, teniendo en cuenta la extensión de los espacios del agua en el territorio.

Actitudes hacia la Compra y el Consumo de estudiantes de Pedagogía y profesores en ejercicio en Chile

OpenAIRE

Marianela del Carmen Denegri Coria; Jocelyne Sepúlveda Aravena; María Pía Godoy Bello

2011-01-01

La presente investigación, enmarcada en el Proyecto Fondecyt N.° 1090179, buscó identificar diferencias en las actitudes hacia la compra y el consumo entre estudiantes de Pedagogía y profesores en ejercicio de la ciudad de Temuco. La muestra estuvo conformada por 88 estudiantes y 103 profesores en ejercicio, a los cuales se aplicó la escala de actitudes hacia el consumo y la compra (Tang y Luna, 1999, citado en Gebauer, Schäfer y Soto, 2003) y escala de materialismo (Richins y Dawson, 1992). ...

Efectos del ejercicio en condiciones de normopeso y obesidad : Estudios en animales y humanos /

OpenAIRE

Cigarroa Cuevas, Igor Iván,

2016-01-01

El objetivo principal de la tesis fue evaluar, en estudios con animales y humanos, el impacto que tiene la práctica de ejercicio físico sobre variables conductuales, metabólicas y nutricionales, considerando diferencias de género en individuos de peso normal o con sobrepeso/obesidad. En los estudios con animales, se usaron ratas macho y hembra adultas de peso normal o con obesidad inducida por dieta (OID). Las ratas fueron entrenadas a una intensidad moderada (12 metros/minutos) y más alta (1...

Literatura y derecho en Jacques Derrida

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Carlos Antonio Contreras Guala

2013-01-01

Full Text Available Se estudia el vínculo entre literatura y derecho en el pensamiento de Jacques Derrida. Se indican algunos recorridos de lectura y se dilucida lo que se entiende por literatura como institución, y su vínculo y alcances en relación con el plagio y con el derecho a decirlo todo en literatura.

AGROBIODIVERSIDAD ÚTIL EN ALIMENTACIÓN Y EN MEDICINA TRADICIONAL EN DOS MUNICIPIOS DEL CAUCA

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CONSUELO MONTES-ROJAS

Full Text Available En El Tambo y Timbío la base de la economía son las actividades del sector primario, especialmente producción agropecuaria y actividades forestales. Este trabajo tuvo por objeto reconocer e identificar especies vegetales útiles en alimentación y medicina local y el conocimiento asociado a su uso y manejo en fincas de El Tambo y Timbío, Cauca, como estrategia para contribuir a la conservación de la agrobiodiversidad y al fortalecimiento de la seguridad alimentaria de las comunidades de la región. La metodología del trabajo se fundamentó en la 'Investigación Acción Participativa'. El área de la investigación incluyó nueve veredas en El Tambo y dos en Timbío, se realizaron talleres, encuestas semiestructuradas y entrevistas personalizadas. En total se seleccionaron 25 fincas con alta agrobiodiversidad vegetal, donde se identificaron especies y el conocimiento tradicional asociado a su uso y manejo. Se pudo constatar que la agrobiodiversidad de plantas de uso alimenticio y medicinal, y el conocimiento tradicional asociado a ellas, se encuentra en alto grado de vulnerabilidad, porque existe un fuerte proceso de erosión genética y de pérdida de conocimiento ancestral que amenaza la seguridad alimentaria de los núcleos familiares de los campesinos asentados en esta región. Se espera contribuir con esta investigación en la conservación de los recursos naturales y en la concientización de la problemática actual.

Elite hit ball performance profile: technical and tactical, and heart rate aspects, and effects of competition on jump and strength performance. [Perfiles de rendimiento en hit ball de elite: aspectos técnicos, tácticos y frecuencia cardíaca, y los efectos de la competición en la capacidad de salto y rendimiento de fuerza].

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Corrado Lupo

2018-04-01

Full Text Available Abstract This study aimed to define a performance profile of elite hit ball matches. Eighty-six male Italian Serie A hit ball players (29.3±5.0 yrs participated in the study. A technical and tactical analysis (18 indicators was performed on eleven matches; heart rate (HR was monitored during matches on 25 players; countermovement jump (CMJ and maximal grip strength (GS were measured on all participants before and after match. Differences (P<0.05 between winning (W and losing (L teams for technical and tactical analysis (Chi-square, and between match phases for HR, CMJ, and GS (ANOVA for repeated measurements were tested. Hit ball teams meanly performed 297±10 rallies per match (W: 41±6 goals; L: 23±3 goals, P=0.042. No differences between quarters emerged for HR (171-190 bpm for 57±21 % of match duration. Opposite trends emerged for CMJ (after: 36.2±6.3 cm; before: 33.1±4.8 cm; P=0.001 and GS (after: 433±102 N; before: 463±98 N; P=0.018 performances. Findings show that hit ball is performed at high HR intensity, and that CMJ improves and GS declines after matches. This could be determined by a neuromuscular activation of lower limbs and repeated harm concussions due to shots. Resumen El estudio tenía como objetivo definir los perfiles de rendimiento en partidos de hit ball de elite. Un total de 81 jugadores italianos de la Serie A (29.3±5.0 años tomaron parte en el estudio. El análisis técnico y táctico (18 indicadores se realizó durante once partidos; la variable frecuencia cardíaca (FC fue monitorizada durante los partidos en 25 jugadores; el test de salto en contramovimiento (SCM y el test de fuerza máxima de prensión (FMP se midieron antes y después de cada partido. Las diferencias (P<0.05 entre equipos ganadores (G y perdedores (P en los aspectos técnicos y tácticos se realizó mediante el test de Chi-cuadrado, y para las diferencias entre las fases del partido en las variables FC, SCM y FMP se empleó el ANOVA de

Parámetros inflamatorios en saliva y sangre en niños y adolescentes sanos

OpenAIRE

Ninoska Tahis Viera Sirit; Thais Teresita Morales Rojas; Alejandra Isabel Morón Medina; Rita Mireya Navas Perozo; Adriana Beatriz Pedreañez Santana

2011-01-01

En la actualidad se ha mostrado interés en el empleo de la saliva para ser utilizada como una alternativa de diagnóstico, predicción y progresión de diversas enfermedades con relación a otros fluidos corporales. Los objetivos trazados para la realización de este trabajo fueron: correlacionar las concentraciones en saliva y sangre de IL-1, IL-6, TNF-a, sustancias reactivas al ácido tiobarbitúrico y O2- de niños y adolescentes sistémicamente sanos. Se realizó un estudio de corte transversal en ...

A 10 year follow-up study after Roux-Elmslie-Trillat treatment for cases of patellar instability

OpenAIRE

Endres, Stefan; Wilke, Axel

2011-01-01

Abstract Background A retrospective study concerning patients presenting with patella instability, treated using a Roux-Elmslie-Trillat reconstruction operation and followed up for 10 years following surgery, is presented. Methods Pre-operative and follow-up radiographic evaluation included the weight-bearing anteroposterior and merchant views. Evaluation was carried out using the Insall-Salvati index, sulcus and congruence angle. The Roux-Elmslie-Trillat reconstruction operation was performe...

Identidades y memorias en Londres 38, Paine y Chacabuco (Chile

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Gloria Alejandra Ochoa Sotomayor

2017-06-01

Full Text Available Este artículo estudia la relación entre identidad y memoria, entendida esta última en una doble dimensión: como continuadora de identidad y como constructora de identidad. Desde esta perspectiva, el texto indaga la relación identidad-memoria en cuatro organizaciones que denuncian la violación de los derechos humanos y el terrorismo de Estado en Chile luego del golpe militar de 1973. Se analiza la relación entre la manifestación pasada de estos grupos y su expresión presente y la identidad, que se define como una sutura y un posicionamiento estratégico que permite historizar las expresiones de memoria y reflexionar respecto a ellas más allá de una aproximación contingente. A través de la memoria militante de Londres 38, la memoria campesina de Memorial Paine y la comunidad hecha memoria en el caso de Chacabuco, se postula la doble dimensión que se mencionó y se explica cómo esta permite entender las distintas aproximaciones a un hecho aceptado por las organizaciones analizadas. Así, sus características y sus particularidades, su acción y su devenir llevan a reconocer las diferencias, manifestaciones y posibilidades de estas organizaciones para mantenerse en el espacio de las narrativas sociales sobre el pasado y el presente y, principalmente, sobre las identidades de las que son expresión. Por ello, en este trabajo se señala la relevancia de reconocer la doble dimensión de la memoria. Al mismo tiempo, invita a reflexionar e indagar sobre la relación identidad-memoria mayormente aceptada y acerca de la manifestación de esta en el espacio discursivo de los nuevos contextos sociales en los que se produce y a los que cada grupo debe hacer frente.

Bariatric surgery in Singapore from 2005 to 2009

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Rajat Goel

2013-01-01

Conclusion: There is a flux of newer procedures in Singapore. Adjustable gastric banding, which was the only available procedure being performed in 2004, was gradually being replaced by other procedures such as sleeve gastrectomy and Roux-en-Y gastric bypass in 2009.

Duct-to-duct biliary reconstruction after radical resection of Bismuth IIIa hilar cholangiocarcinoma.

Science.gov (United States)

Wu, Wen-Guang; Gu, Jun; Dong, Ping; Lu, Jian-Hua; Li, Mao-Lan; Wu, Xiang-Song; Yang, Jia-Hua; Zhang, Lin; Ding, Qi-Chen; Weng, Hao; Ding, Qian; Liu, Ying-Bin

2013-04-21

At present, radical resection remains the only effective treatment for patients with hilar cholangiocarcinoma. The surgical approach for R0 resection of hilar cholangiocarcinoma is complex and diverse, but for the biliary reconstruction after resection, almost all surgeons use Roux-en-Y hepaticojejunostomy. A viable alternative to Roux-en-Y reconstruction after radical resection of hilar cholangiocarcinoma has not yet been proposed. We report a case of performing duct-to-duct biliary reconstruction after radical resection of Bismuth IIIa hilar cholangiocarcinoma. End-to-end anastomosis between the left hepatic duct and the distal common bile duct was used for the biliary reconstruction, and a single-layer continuous suture was performed along the bile duct using 5-0 prolene. The patient was discharged favorably without biliary fistula 2 wk later. Evidence for tumor recurrence was not found after an 18 mo follow-up. Performing bile duct end-to-end anastomosis in hilar cholangiocarcinoma can simplify the complex digestive tract reconstruction process.

Proteccion Social en Salud en America Latina y el Caribe ...

International Development Research Centre (IDRC) Digital Library (Canada)

Dentro de la salud pública, y con vistas a contribuir en los procesos de cambio de ... la PSS en el marco de las reformas de la salud en América Latina y el Caribe. ..... neoliberal” en tanto extiende la racionalidad mercantil a todas las esferas de la ... Excluyentes como El Salvador, Honduras, Bolivia, Ecuador y Guatemala.

Leer y escribir en las ciencias sociales en universidades argentinas

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Paula Carlino

2017-06-01

Full Text Available Este trabajo explora los puntos de vista de docentes y alumnos universitarios sobre la escritura y lectura involucradas en el estudio de las ciencias sociales. Los datos fueron recogidos predominantemente a través de entrevistas, complementadas con grupos focales. Los resultados muestran que leer y escribir son requerimientos ubicuos en las materias estudiadas pero suelen pasar inadvertidos: no aparecen mencionados en los programas de cátedra, y resultan escasamente orientados por los docentes ya que se dan por sabidos. Sin embargo, los entrevistados revelan que la lectura y escritura requeridas en estas materias son prácticas novedosas y desafiantes para los alumnos porque difieren de los modos de leer y escribir ejercitados en la escuela secundaria. A pesar de que los problemas de los alumnos son reconocidos, los docentes no suelen ocuparse de cómo leen y escriben sus estudiantes por limitaciones institucionales y por considerarlo impropio de su función, en base a ciertos supuestos, cuestionados por las investigaciones. Estos resultados son relevantes para la discusión de políticas institucionales, atinentes a quienes cabe la responsabilidad de ayudar a participar en las prácticas de estudio que la universidad demanda. La respuesta debería considerar también el cómo y el porqué.

Aprendizaje basado en problemas y proyectos en espacios híbridos

DEFF Research Database (Denmark)

Ryberg, Thomas; Davidsen, Jacob; Hodgson, Vivien

2017-01-01

Hay una necesidad dentro del aprendizaje en red por entender y conceptualizar la interacción entre espacios físicos y digitales o los que podríamos llamar espacios híbridos. Así, trataremos un estudio reciente con estudiantes de dos programas diferentes que están involucrados en el aprendizaje...... incorporan tecnologías en red y digitales en su trabajo en grupo y en los lugares de estudio que ellos crean para sí mismos. Describimos cómo en uno de los programas grupos ”nómadas" de estudiantes utilizaron diferentes tecnologías y espacios para ”crear un lugar". A continuación, mostramos cómo su...... experiencia y enfoque sobre trabajo colaborativo son diferentes a los de grupos más estáticos o ” artesanales" de estudiantes del otro programa. En ambos casos, las formas de utilizar espacio, lugares, herramientas y actividades era un entretejido extremadamente complejo entre lo digital, lo físico y...

Violencia e inseguridad contextual percibida y roles en bullying en escolares mexicanos

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Carlos Hidalgo-Rasmussen, México.

2015-07-01

Full Text Available (analítico: Estudio observacional, transversal y analítico realizado con 2201 niños y adolescentes, estudiantes de primaria, secundaria y preparatoria de México con el objetivo de analizar la relación entre sus percepciones de violencia del país y su municipio, inseguridad en su colonia y escuela y su rol en bullying escolar: observador, víctima o acosador. En México existen dos preocupantes fenómenos: la violencia vinculada al narcotráfico y los eventos de bullying escolar y en este trabajo se buscó aportar a explicar sus posibles relaciones. Se usó un cuestionario autoaplicado en línea y análisis estadístico con Ji cuadrado y regresión logística encontrando algunas asociaciones significativas entre la violencia, inseguridad percibida y los roles en bullying. Las variables contextuales como la violencia deben considerarse en programas de prevención y atención del bullying.

Redes sociales y comunicación en Internet. Medio ambiente y participación ciudadana en México

OpenAIRE

Gómez Isassi, José Alberto

2013-01-01

Las características de las redes sociales y la comunicación en Internet son un gran reto para las organizaciones que buscan promover la participación ciudadana en temas relacionados al medio ambiente, especialmente en México. El calentamiento global y otros problemas medioambientales son en el siglo XXI, probablemente la mayor amenaza que enfrenta a la humanidad. En la actualidad, el gran avance en tecnologías de información y comunicación y el aumento de la penetración de Internet en la s...

Internal Hernia in a Liver Transplant Recipien: A Case Report

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Hironori Hayashi

2013-01-01

Full Text Available Biliary complications have great importance for liver transplant recipients because of affecting long-term prognosis. In rare situations, an internal hernia of the Roux-en-Y loop cause graft injury. A 42-year-old woman with a history of living donor liver transplantation 6 years ago presented with prolonged graft injury during the past 6 months. She suddenly developed ileus of the small bowel with internal hernia through the defect of the mesentery around the Roux-en-Y limb of the hepaticojejunostomy. Emergent surgery was performed to reduce the hernia and volvulus; also the mesenteric rent was closed with interrupted suture of silk. Internal hernia of the small bowel after liver transplantation is rare but causes graft injury due to associated biliary complications and rapid deterioration of patient’s condition.

LA INCORPORACIÓN Y ACOGIDA EN LA ESCUELA INFANTIL Y PRIMARIA EN CATALUNYA: PERCEPCIONES DE MAESTROS, TUTORES Y DIRECTORES

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Anna Aloguín

2009-01-01

Full Text Available Existen múltiples factores que impactan la manera como los maestros principiantes perciben y viven el primer año de experiencia docente. La incorporación y acogida en el centro escolar está mediada por la percepción del maestro acerca del tipo de acogida en el nuevo contexto de trabajo, en especial el apoyo de los pares y la dirección, y la madurez profesional. Este artículo presenta una investigación sobre el primer año de experiencia docente en centros públicos de infantil y primaria de Catalunya. El estudio ha previsto la realización de estudios de caso en cinco centros educativos de distintas características. Para cada estudio de caso se han realizado entrevistas individuales y grupales a maestros principiantes, a los tutores de los principiantes y a los equipos directivos. También se han llevado a cabo grupos de discusión con los formadores y principiantes del curso de iniciación a la docencia promovido por la Generalitat de Catalunya y entrevistas a distintos servicios de educación (inspección, equipos psicopedagógico y centros de recursos. Finalmente se han realizado y analizado documentos videográficos y textuales (observaciones de prácticas docentes de profesores principiantes y planes de acogida de distintos centros. Los resultados que aquí se presenta resumen una parte del estudio, esto es las percepciones de maestros, tutores y directivos, y confirman la necesidad de ofrecer una formación para la inducción a los profesores de primer año que contemple la reflexión sobre la realidad diaria en base a casos prácticos, así como planificar la acogida mediante un plan contextualizado que observe tanto la información necesaria sobre el centro como las estrategias de acompañamiento e inducción a la práctica docente por parte de profesores más expertos y el rol del equipo directivo.

Estado punitivo y control criminal. Cárceles, prisiones y penitenciarías en Colombia en el siglo XIX

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José Wilson Márquez Estrada

2013-04-01

Full Text Available El trabajo comienza citando una serie de reflexiones sobre la prisión y luego presenta el análisis de la historia de la prisión en el periodo republicano en Colombia y cuáles fueron sus principales características, problemáticas y transformaciones durante el siglo XIX. Este análisis pasa por el estudio del sistema penitenciario y carcelario en el periodo federal republicano, y pone énfasis en los casos particulares de los Estados de Antioquia, Santander y Bolívar, al resaltar las diferentes dificultades administrativas y financieras que se presentaron en su aplicación como máximo dispositivo de control social. Finalmente, se analiza el perfil que adoptó el sistema penitenciario y carcelario en el periodo de la Regeneración al final del siglo XIX.

TIC y productividad en las industrias de servicios en Colombia

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Maria Veronica Alderete

2012-01-01

Full Text Available Este trabajo analiza los determinantes de la productividad laboral en las empresas de servicios de Colombia. En particular, se examina la relación entre las tecnologías de la información y de la comunicación –TIC– (en términos de inversión y uso y la productividad. El estudio encuentra que en conjunto, la inversión en TIC y el uso de las TIC incrementan la productividad laboral en un 18% en promedio, aproximadamente. La evidencia empírica sustenta la hipótesis de que los recursos tecnológicos de las TIC (tanto inversiones en equipo como uso de TIC, junto con el capital no TIC, la capacitación, el porcentaje de capital extranjero y el porcentaje de empleados permanentes son los recursos más importantes que impactan positivamente sobre la productividad de las empresas de servicios de Colombia.

La zeolita y su efecto en la eficiencia del nitrógeno en arroz y maíz

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Miguel Soca

2014-12-01

Full Text Available Este trabajo evaluó el efecto de la zeolita en las reducciones de volatilización del nitrógeno amoniacal (RVNA y volumen de lixiviados (RVL así como en rendimientos de arroz Oryza sativa L. y maíz Zea mays L. En el primer experimento bajo un Diseño Completamente al Azar (DCA se evaluó el tamaño de partícula de zeolita (< 1 mm, 1 - 2 mm, 2 - 3 mm y 3-5 mm en RVNA. El segundo experimento, consistió en evaluar RVL con la aplicación de cuatro tratamientos: testigo (T, zeolita (Z, urea (U y urea + zeolita (UZ. El tercer experimento se desarrolló en un cultivo de arroz, donde se evaluaron dos métodos de aplicación (al voleo y trasplante con cuatro tratamientos (T, U, UZ10% y UZ15% y su efecto en el rendimiento del cultivo. El cuarto experimento realizado en un campo de maíz con dos tratamientos (U y UZ15% evaluó el rendimiento del cultivo en dos suelos (aluvial y esquelético. Los tamaños de partícula entre 3 y 5 mm obtuvieron RVNA del 50% y RVL del 48%. La aplicación de zeolita en arroz obtuvo RVNA de 60% y mejoró los rendimientos sin encontrar diferencias entre método de aplicación. También su aplicación mejoró el peso de grano por mazorca y el peso seco de grano de maíz. La zeolita mejoró la eficiencia de la fertilización nitrogenada.

Identidades y tendencias migratorias desde la pesca en Chiapas y Tabasco

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Práxedes Muñoz-Sánchez

2013-01-01

Full Text Available A partir de una etnografía, se revisan las nociones migratorias de los pobladores de dos regiones pesqueras en el sureste de México: Arriaga, estado de Chiapas, en la Costa del Pacífico, y La Barra de San Pedro, estado de Tabasco, en la Costa del Golfo de México, así como sus identidades y tendencias. La costa de Arriaga se localiza en una región de ámbito pesquero y paso fronterizo hacia Estados Unidos; por su parte, La Barra de San Pedro ha sido un lugar receptor de población veracruzana desde 1980 y en la actualidad laboralmente activa en la pesquería artesanal de mediana altura, compartiendo un espacio marino con la explotación petrolera. Como territorios de economía pesquera, observamos realidades, migración y tendencias en jóvenes de familias de pescadores, quienes con identidades similares y diferencias regionales están revirtiendo en el futuro de la pesca las intenciones de que perdure esta actividad y sus necesidades migratorias.

Mosaicos romanos y elites locales en el N. de África y en Hispania

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López Monteagudo, G.

2002-12-01

Full Text Available Several North African and Hispanic mosaic pavements, especially those of the 2nd and 3rd centuries, already show figure- scenes and symbolic motifs connected with the economy and the political and commercial activities of the several social states. These mosaics also confirm the litterary and epigraphical sources, among the other archaeological evidences. Specifically, there are noted two important cities located on the coast and inside of Africa Proconsularis, Hadrumetum and Althiburos, closely related to some cities of the Baetica.A través de las escenas figuradas y de ciertos motivos simbólicos representados en algunos pavimentos romanos del Norte de África y de Hispania, especialmente de los siglos II y III, es posible entrever aspectos de la economía en esas zonas del Imperio Romano y su relación con las actividades políticas y comerciales de algunos estamentos de la sociedad, que vienen a confirmar los datos proporcionados por las fuentes literarias y epigráficas, así como por otros documentos arqueológicos. El estudio se centra en los mosaicos procedentes de dos importantes ciudades del África Proconsular, Hadrumetum y Althiburos, situadas en la costa y en el interior de la provincia, con referencias comparativas a algunas ciudades de la Bética.

Susceptibilidad a insectos en selecciones y variedades de annona muricata l. y persea americana m. en Puerto Rico

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Irma Cabrera

2001-01-01

Full Text Available En Puerto Rico se han reportado varios insectos en las guanábanas (Annona muricata L. y los aguacates (Persea americana M, sin embargo los de mayor importancia son el barrenador de la semilla Bephratelloides cubensis (A. y Apate monacha (F. en A. muricata y Pseudacysta persea (F. en P. americana. El objetivo principal de esta investigación fue determinar la incidencia de B. cubensis y A. monacha en seis selecciones de guanábana y en siete variedades de aguacate. De las evaluaciones realizadas en A. muricata, se observó que las selecciones IV-10, VII-14 y VI-1 mostraron la mayor incidencia y la IV-16 mostró la menor incidencia de B. cubensis en relación al número de barrenos por fruta. En cuanto a la incidencia de A. monacha en A. muricata las selecciones IV-16, IV-2, IV-3, VII-14 presentaron la mayor incidencia de barrenos por árbol. En las evaluaciones realizadas en Persea americana se seleccionaron las variedades Ávila, Semil 34, Wilson Popenoe, Pollock, Candelaria, Semil 43 y Butler como las variedades comerciales más sembradas en Puerto Rico. Se observó que la variedad Avila obtuvo el mayor número de huevos, ninfas, hembras y machos de P. persea por hojas comparadas con las demás variedades. Respecto al número de hojas infestadas por árbol se encontró valores significativos (P≤0,01 en la variedad Avila. Resultando tener un 90% de las hojas dañadas. No se observó que las variedades evaluadas tuviese baja o ninguna preferencia a P. Persea

Bases y perspectivas latinoamericanas sobre Medicina y Salud Centradas en la Persona

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Patrick Wagner

2015-01-01

Full Text Available Antecedentes: Este artículo emerge como parte de un proceso liderado por la Academia Nacional de Medicina del Perú en estrecha colaboración con otras Academias de Medicina Latinoamericanas, e importantes instituciones universitarias y profesionales relacionadas con la salud. Objetivo: Describir y fundamentar la importancia de la Medicina Centrada en la Persona (MCP en el contexto latinoamericano. Metodología: Revisión de artículos y experiencias latinoamericanas sobre el tema, realización de reuniones académicas para deliberar sobre contenidos afines, dos preliminares en Lima en diciembre 2013 y enero 2014, una tercera en Buenos Aires, a propósito del 2° Congreso Internacional de Medicina Centrada en la Persona, con la presencia de las Academias de Medicina de Argentina, Bolivia, Chile y Perú (noviembre 2014 y una cuarta en Lima, Reunión de las Academias de Medicina de Bolivia, Colombia, Chile, Paraguay y Perú (diciembre 2014. Resultados: Se puntualizan los precedentes históricos y contemporáneos, universales y locales, pertinentes a la gestación y desarrollo de una re-priorización de la medicina en torno a la persona y su contexto, articulando para el efecto ciencia y humanismo. Se discute el nivel filosófico del concepto Persona en medicina, incluyendo bases terminológicas, históricas, y derechos humanos. Sobre estas bases se examina la evolución de los conceptos centrales de la MCP, resaltando su pertinencia tanto en la medicina clínica como en la salud pública, la atención, educación e investigación y las políticas en salud. Con respecto a la práctica y educación clínicas, se plantea la noción de MCP como principio estratégico fundamental, sus aplicaciones educacionales programáticas, y su posible institucionalización a nivel de facultades de medicina. Se resalta la importancia de la formación en ética y comunicación clínica y del apropiado uso de la tecnología y la evidencia científica al servicio de

Sindicatos y centrales sindicales en Brasil en los años 80 y 90

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Alvaro A. COMIN

2009-11-01

Full Text Available RESUMEN: El objetivo de este artículo es realizar un balance de la trayectoria de las principales centrales sindicales brasileñas en esta última década y media y reflexionar sobre los límites y posibilidades existentes para su efectiva consolidación como organismos centralizados de representación de los intereses de los trabajadores. En primer lugar, el artículo menciona algunas diferencias que separan la experiencia de la formación de las centrales sindicales en los países desarrollados y en Brasil. Posteriormente se analizan el proceso de formación de las centrales sindicales, los principales clivages que determinan la división del movimiento sindical en el inicio de los años 80 y la trayectoria de las principales centrales a lo largo de aquella década. En el siguiente punto, se presenta un cuadro corporativo de las dos principales centrales (CUT y FS que polarizan la escena en los años 90. Finalmente, se concluye con algunas especulaciones sobre las posibilidades de cambio en el interior del cuadro jurídico-institucional que regula la actual estructura de las relaciones capital-trabajo y de la organización sindical en Brasil y sus consecuencias en términos de consolidación de las centrales sindicales.ABSTRACT: The goal of this article is to make a historical balance of the main brazilean trade unions in the last ten years. The author deals about its possibilities to fit its function: to represent the interest of workers. At first time, it is mentioned some differences between the experiences of brazilean trade unionsand the european ones. Then, the author analyzes the process of formation and history of brazilean trade unions and the main cleavages of these ones during the eighties. The next item is a comparative analysis of the two main trade unions (CUT an FS during the nineties. Finally, the article finishes with some reflections about the possibilities of change within the rules between capital and work in Brazil.

Performance e identidad en la fiesta "carnavalesca" de la Virgen de la Candelaria en Puno : la puesta en escena de dos mundos que entran en tensión

OpenAIRE

Tito Mamani, Charo

2012-01-01

La problemática de la identidad y performance en una ―puesta en escena‖como lo es la fiesta de la Candelaria en Puno nos muestra todo un mundo de encuentros y desencuentros, de diálogo y de tensiones a la vez. Pues estas construcciones colectivas de identidad local– las identidades son tanto hegemónicas como subalternas; originarias, mestizas o modernas– buscan mecanismos de auto-afirmación situados en un espacio y en un tiempo determinado asignado por este magnífico evento como es la fies...

Antegrade bowel intussusception after remote Whipple and Puestow procedures for treatment of pancreas divisum

OpenAIRE

Gigena, Manuel; Villar, Hugo V; Knowles, Negar G; Cunningham, John T; Outwater, Erik K; Leon Jr, Luis R

2007-01-01

To date, antegrade intussusception involving a Roux-en-Y reconstruction has been reported only once. We report a case of acute bowel obstruction due to an intussusception involving two Roux-en-Y limbs in a 40-year-old woman with a history of chronic pancreatitis due to pancreas divisum. Four years preceding this event, the patient had undergone a Whipple procedure, and three years prior to that, a Puestow operation. The patient was successfully treated with bowel resection and a side-to-side ...

Procesos cognitivos distorsionados en la conducta agresiva y antisocial en adolescentes

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David Roncero

2016-01-01

Full Text Available En el presente trabajo se realiza una revisión de diferentes aportaciones teóricas y empíricas que abordan la relación entre las conductas agresivas y antisociales en la adolescencia y un conjunto de procesos cognitivos distorsionados que interfieren en la percepción y comprensión de los eventos o experiencias sociales. A partir de las diferentes aproximaciones teóricas, en esta revisión se sugiere la necesidad de contar con una perspectiva más integradora que permita una mejor conceptualización y tipificación de estos procesos cognitivos distorsionados, a fin de clarificar la naturaleza y la función específica que cada uno de ellos desempeña en la explicación del comportamiento agresivo y antisocial en adolescentes.

Contenido de metales pesados en agua y sedimento en el bajo Nanay

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Victor Sotero Solís

2013-06-01

Full Text Available Se presenta en este estudio la evaluación de la concentración de metales pesados en agua y mercurio en sedimentos del rio Nanay, s realizó el muestreo desde el caserío Libertad, hasta su desembocadura en el rio Amazonas, en las épocas de creciente y vaciante del año 2011. La cuenca del rio Nanay comprende 340 km2 s y alberga a cuatro comunidades nativas y ocho campesinas y además tiene influencia sobre los distritos de San Juan, Iquitos y Punchana, además de ser la fuente de agua potable para la población de estos distritos. Los análisis de metales pesados se realizarán utilizando la técnica de la absorción atómica en el laboratorio de Sustancias Naturales Bioactivas del Instituto de Investigaciones de la Amazonia Peruana (IIAP. Según los resultados de añiláis de agua el plomo y mercurio se encuentran presentes sen concentraciones mayores que lo indicado por las normas nacionales. El plomo tanto en creciente es en promedio de 0,111 ppm y 0,053 ppm respectivamente y el mercurio en vaciante se encuentra en 0,008 ppm Del mismo modo la presencia de mercurio es alta en los sedimentos que acompañan a este rio con 1,636 ppm en creciente y 3,03 ppm en vaciante.

Contenido de metales pesados en agua y sedimento en el bajo Nanay

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Víctor Sotero Solís

2013-06-01

Full Text Available Se presenta en este estudio la evaluación de la concentración de metales pesados en agua  y mercurio en sedimentos del rio Nanay, s realizó el muestreo desde el caserío Libertad, hasta su desembocadura en el rio Amazonas, en las épocas de creciente y vaciante del año 2011. La cuenca del rio Nanay comprende 340 km2 s y alberga a cuatro comunidades nativas y ocho campesinas y además tiene influencia sobre los distritos de San Juan, Iquitos y Punchana, además de ser la fuente de agua potable para la población de estos distritos. Los análisis de metales pesados se realizaran utilizando la técnica de la absorción atómica en el laboratorio de Sustancias Naturales Bioactivas del Instituto de Investigaciones de la amazonia Peruana (IIAP. Según los resultados de añiláis de agua el plomo y mercurio se encuentran presentes sen concentraciones mayores que lo indicado por las normas nacionales. El plomo tanto en creciente es en promedio de 0,111 ppm y 0,053 ppm respectivamente y el mercurio en vaciante se encuentra en 0,008 ppm Del mismo modo la presencia de mercurio es alta en los sedimentos que acompañan a este rio con 1,636 ppm en creciente y 3,03 ppm en vaciante.

Cambios en los precios de bebidas y alimentos con impuesto en áreas rurales y semirrurales de México

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M Arantxa Colchero

2017-03-01

Full Text Available Objetivo. Analizar cambios en precios asociados con la implementación de los impuestos a bebidas azucaradas y alimentos no básicos con alta densidad energética imple­mentados en 2014. Material y métodos. Se recolectaron precios en áreas rurales y semiurbanas en diciembre de 2013, y abril y diciembre de 2014. Se analizaron cambios en precios por tipo de bebidas y alimento con impuesto usando modelos de efectos fijos y estratificando por región, tipo de establecimiento y tamaño de presentación. Resultados. El impuesto a bebidas azucaradas no pasó por completo a los precios; en promedio, los precios aumentaron 0.73 pesos por litro. Para alimentos con alta densidad energética, el impuesto pasó igual o mayor al monto del impuesto para galletas, barras de cereal y cereales de caja. Conclusión. El potencial efecto de los impuestos en consumo podría ser menor al esperado en áreas rurales dado que los impuestos no pasaron por completo a los precios.

Mejora de la productividad y calidad en el proceso de diseño y desarrollo en las líneas de refrigeradoras y cocinas en la empresa Induglob

OpenAIRE

Ordóñez Velecela, Anita Lucía

2012-01-01

Ante el reto continuo de ser competitivos en diseño, precio y prestaciones, durante su existencia Induglob ha sabido responder apropiadamente y mantener niveles adecuados de cobertura y eficiencia, lo que ha llevado a estudiar las posibilidades de mejorar la productividad y la calidad en el proceso de Diseño y Desarrollo en las líneas de refrigeradoras y cocinas. El proceso de pruebas y ensayos se realiza dentro de las líneas de ensamble tanto de refrigeradoras como de cocinas, mensualmente s...

Continuidad y longitudinalidad en medicina general en cuatro países europeos

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Pastor-Sánchez Raimundo

1997-01-01

Full Text Available FUNDAMENTO: El objetivo fue comparar la continuidad y longitudinalidad de la medicina general en cuatro países europeos del modelo público asalariado. MÉTODOS: Estudio descriptivo y prospectivo. 63 médicos generales/de familia asalariados registraron todos los encuentros (directos/indirectos con sus pacientes durante una semana, en centros públicos y estatales de atención primaria de España, Finlandia, Portugal y Suecia. RESULTADOS: El 92% de los encuentros fueron en el despacho médico; fueron directos el 75%; la media de consultas por semana y médico fue de 103. El problema principal de salud fue crónico en el 42% de los casos y agudo en el 31%. El paciente había sido atendido previamente por ese problema en el 63% de los encuentros y por otro problema en el 79%. El médico conocía profesionalmente a algún familiar en el 66% de los pacientes atendidos. CONCLUSIONES: Los países estudiados presentan un grado variable de continuidad y longitudinalidad en medicina general (de mayor a menor: Portugal, España, Suecia y Finlandia. En España las consultas son de corta duración, y con un escaso uso de sistemas de prescripción repetida; en Portugal se forma lista de espera de pacientes, bloqueando la asistencia de los problemas agudos; en Finlandia falta el listado de pacientes, lo que despersonaliza la asistencia; y en Suecia también se forman listas de espera y se hace un mayor uso de la consulta indirecta (especialmente mediante el teléfono.

Effects of Fat and Protein Preloads on Pouch Emptying, Intestinal Transit, Glycaemia, Gut Hormones, Glucose Absorption, Blood Pressure and Gastrointestinal Symptoms After Roux-en-Y Gastric Bypass.

Science.gov (United States)

Nguyen, Nam Q; Debreceni, Tamara L; Burgstad, Carly M; Neo, Melissa; Bellon, Max; Wishart, Judith M; Standfield, Scott; Bartholomeusz, Dylan; Rayner, Chris K; Wittert, Gary; Horowitz, Michael

2016-01-01

The aim was to determine the effects of fat and protein preloads on pouch emptying (PE), caecal arrival time (CAT), glucose absorption, blood glucose (BSL), gut hormones, haemodynamics and gastrointestinal (GI) symptoms in subjects who had undergone Roux-en-Y gastric bypass (RYGB) >12 months previously. Ten RYGB subjects were studied on three occasions, in randomised order, receiving 200-ml preloads of either water, fat (30 ml olive oil) or whey protein (55 g), 30 min before a mixed meal. PE, CAT, BSL, plasma 3-O-methyl-D-glucopyranose (3-OMG), insulin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1) and glucagon, blood pressure (BP), heart rate (HR) and GI symptoms were assessed over 270 min. Although fat and protein preloads did not alter PE of either solids or liquids, the CAT of solids, but not liquids, was longer than that after the water preload (fat 68 ± 5 min and protein 71 ± 6 min vs. water 46 ± 5 min; P = 0.02). BSL elevated promptly after the meal on all days (P area under the curve (AUC(0-75 min)), 18.7 ± 18.2 vs. 107.2 ± 30.4 and 76.1 ± 19.3 mmol/L/min; P < 0.05). Compared to water preload, the protein and fat preloads were associated with greater increases in plasma insulin, GLP-1 and glucagon concentrations, a reduction in BP, and greater increases in HR, fullness, bloating and nausea. Plasma 3-OMG levels were lower after the protein than after the water and fat preloads (P < 0.001). Given its effects to attenuate post-prandial glycaemia, reduce intestinal glucose absorption and potentiate the "incretin response", without inducing more adverse post-prandial GI symptom, protein preload may prove clinically useful in RYGB patients and warrant further evaluation, particularly in those with type 2 diabetes (T2DM) and/or dumping syndrome.

NIÑOS Y JÓVENES EN LA GUERRA EN COLOMBIA. APROXIMACIÓN A SU RECLUTAMIENTO Y VINCULACION

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Ana Milena Montoya Ruiz

2008-05-01

Full Text Available El presente texto se acerca a la categorización y descripción del fenómeno de reclutamiento y vinculación de los menores de edad en las filas de los ejércitos ilegales en Colombia, teniendo como referentes las investigaciones realizadas sobre el tema por entidades gubernamentales y no gubernamentales (nacionales e internacionales y archivos de prensa nacional. Responde a uno de los resultados de investigación del proyecto “Campaña de documentación, educación y opinión pública hacia una cultura de respeto a los derechos de los niños y las niñas en zonas de conflicto en Colombia, incidente en la formulación y aplicación de políticas públicas relacionadas con el tema” Desarrollada por las ONG Instituto Popular de Capacitación -Medellín- y la Fundación Cultura Democrática -Bogotá-.

Diferencias en variables psicosociales en sujetos VIH homosexuales y heterosexuales

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Pablo E. Vera-Villarroel

2004-01-01

Full Text Available Desde hace algunos años el VIH-SIDA ha dejado de ser una enfermedad asociada a sólo a algunas poblaciones. El objetivo de este estudio de tipo descriptivo transversal fue evaluar las diferencias en variables psicosociales en distintas muestras de personas portadoras y no portadoras de VIH. La muestra estuvo compuesta por un total de 83 sujetos, de los cuales 38 eran portadores asintomáticos de VIH (15 hombres homosexuales, 8 hombres heterosexuales y 15 mujeres heterosexuales y 45 son no portadores (15 hombres homosexuales, 15 hombres heterosexuales y 15 mujeres heterosexuales. Se evaluaron catorce variables psicosociales, entre ellas, estrés, estilos de afrontamiento, apoyo social, ansiedad y depresión. Los resultados indicaron que sólo se encontraron diferencias estadísticamente significativas en ansiedad y depresión, destacándose mayores índices de ansiedad en hombres y mujeres seropositivos y heterosexuales. En relación a la depresión se encuentran mayores índices sólo en hombres heterosexuales seropositivos (p<0,05. Se analiza la posible influencia de las presiones culturales, prejuicios y poca ayuda específica para estos sujetos que podrían explicar los resultados.

Diseños organizacionales y profesionalización empresarial en hipermercados y supermercados familiares en Venezuela

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Lissette Hernández Fernández

2014-01-01

Full Text Available Las empresas familiares se han convertido en un importante motor de las economías a nivel mundial, representan el 90% del parque empresarial y contribuyen con el 50% del producto y el empleo (Gersick et al, 1997; Gallo, 1997; y Amat, 1998. Uno de los retos que debe afrontar este tipo de empresas es ser competitivas, para ello tendrán que adaptar su estructura organizativa, operativa y administrativa en procura de una mayor eficiencia y agilidad. Entre éstas, emerge el diseño organizativo como fundamental, ya que es el responsable de la configuración y forma de comportarse de una organización en pro de su estrategia y objetivos. De allí que el objetivo del presente trabajo sea determinar el tipo de diseño organizacional con el que operan las cadenas de hipermercados y supermercados familiares en Venezuela. Este estudio se desarrolla empleando un diseño de investigación no experimental de campo, con un tipo de estudio descriptivo, para lo cual se aplicó un cuestionario a los fundadores o sucesores de dichas empresas. Los resultados muestran comportamientos variables en materia de diseños organizativos, características cómo la formalización, especialización y coordinación relevantes para un cabal funcionamiento, no están claramente definidas; además de existir una alta tendencia a centralizar, en vez, de propiciar la descentralización en la toma de decisiones. Los diseños organizativos son parte del sistema de dirección y funcionamiento interno que contribuirá a la profesionalización empresarial, conjuntamente con las políticas de recursos humanos, las tecnologías de información y comunicación (TICs, y las estructuras de gobierno corporativo.

PRINCIPALES TRASTORNOS REPRODUCTIVOS EN BÚFALAS Y VACAS EN HATOS MIXTOS Y DE UNA ESPECIE EN EL DEPARTAMENTO DE CAQUETÁ, COLOMBIA

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J. L. Motta-Giraldo

2014-01-01

Full Text Available Con el objetivo de determinar los principales problemas reproductivos en vacas y bú-falas, su frecuencia y la relación con variables climáticas, se seleccionaron296 hembrasbovinas (150 de rebaños mixtos y 146 de rebaños bovinos y 238 hembras bubalinas(126 de mixtos y 112 de rebaños bubalinos.Se registraron la frecuencia de patologíasreproductivas, los indicadores reproductivos entre 2010 y 2011, así como el promediode las variables climáticas de la zona.El número de patologías reproductivas fue mayoren bovinos (n=11 que en los búfalos (n=5 y la repetición de celo fue la alteración másfrecuente en ambas especies: 36.8% y 12.6% en bovinos y búfalos, respectivamente, condiferencia significativa (P< 0.05 respecto del resto de patologías, pero no entre tiposde hatos. La frecuencia de patologías disminuyó a medida que aumentó el número departos en vacas, pero en el caso de las búfalas, las diferencias no fueron significativas.Entre las variables climáticas, sólo se encontró asociación directa entre el brillo solar ylos partos de vacas y búfalas, así como entre la amplitud térmica y los partos en el casode las búfalas (P< 0.05. Se concluye que las búfalas presentaron menor frecuencia yvariedad de patologías reproductivas que las vacas y que, tanto la frecuencia de los partoscomo de las patologías, están asociadas con el brillo solar.

Sobrepeso y obesidad en profesores

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Lucía Rodríguez-Guzmán

2006-09-01

Full Text Available Objetivo: Determinar la prevalencia de sobrepeso y obesidad en profesores de Guanajuato, México. Diseño: Estudio observacional, transversal, retrospectivo. Lugar: Instituto de Investigación sobre el Trabajo, Facultad de Medicina de la Universidad de Guanajuato. Participantes: La población de estudio consistió en 479 docentes (208 hombres y 271 mujeres. Intervenciones: Los indicadores antropométricos de peso, estatura, medición de circunferencia de cintura e índice de masa corporal fueron calculados para estimar la grasa corporal. Principales medidas de resultados: Sobrepeso y obesidad en profesores. Resultados: Las prevalencias de sobrepeso y obesidad fueron 43% y 21%, respectivamente. Conclusiones: El sobrepeso y la obesidad son importantes factores de riesgo cardiovascular. Los profesores necesitan una dieta saludable y promoción de actividad física.

WEBQUEST Y WIKIS: BÚSQUEDA DE INFORMACIÓN EN RED Y DESARROLLO DE COMPETENCIAS EN COLABORACIÓN

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Lourdes Villalustre Martínez

2011-04-01

Full Text Available En la formación universitaria se está apostando por estrategias y recursos didácticos, -que aprovechan las potencialidades de diferentes instrumentos digitales-, como las Webquests en tanto metodologías de investigación colaborativa apoyada en la búsqueda de información y en la utilización de contenidos alojados en Internet para la realización de proyectos. Los cuales pueden articularse a partir de herramientas 2.0 como las wikis, por su gran versatilidad y capacidad para generar conocimiento de forma colaborativa mediante la creación de contenidos on-line.   En la asignatura virtual de Educación en el ámbito rural1 se ha diseñado una actividad formativa en colaboración basada en la filosofía de las webquests y apoyada en el uso de las wikis, - configurando lo que se denominó Gameproject- Del Moral; Villalustre (2007b, que promueve el acceso y gestión de la información para elaborar un proyecto de intervención socio-educativo. Tras su implementación en varios años, se preguntó a 161 estudiantes sobre las competencias que consideraban haber desarrollado y/o consolidado con el trabajo colaborativo planteado. Éstos destacaron mayoritariamente las habilidades para la investigación, la recogida y tratamiento de la información, y otras más específicas vinculadas al futuro desempeño de su actividad profesional. Hay que destacar que los estudiantes sin experiencia previa en cursos de formación virtual consideraron haber consolidado más las competencias vinculadas al uso de herramientas informáticas.

Cultura alfabética y mercado cultural en Colombia y en España

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Ancízar Narváez

2010-01-01

Full Text Available En el presente artículo se establece una comparación entre la oferta y la demanda de cultura alfabética a través de la descripción de los sistemas educativos; así mismo, se compararan la oferta y el consumo mediáticos a través de la descripción de los sistemas mediáticos de Colombia y España. Con estos insumos, se intenta establecer las características del mercado cultural en cada uno de los dos países y sus posibilidades de inserción en el mercado global del conocimiento.

Barreras y Facilitadores en el Reclutamiento y la Retención de Parejas Heterosexuales en Intervenciones Preventivas en VIH/SIDA

Science.gov (United States)

Hernández-Hernández, Alberto L.; Perez-Jimenez, David

2012-01-01

Compendio El Reclutamiento y la Retención (R&R) de participantes es fundamental para el éxito de estudios y para el desarrollo de intervenciones preventivas. El R&R de participantes determina la validez y efectividad de estos programas. En este trabajo examinamos algunos de los factores que facilitan y dificultan el R&R en los proyectos preventivos y ofrecemos algunas alternativas para mejorar los índices de R&R. Realizamos dos estudios, en el primero administramos el Instrumento de Informatión, Motivatión y Conductas-Español (IIMC-E) a un grupo de 26 parejas heterosexuales (52 participantes). En el segundo, entrevistamos a 5 parejas VIH discordantes (10 participantes). Encontramos que el 75% de los/las participantes indicó que su trabajo era una de las principales barreras que dificultan la asistencia a las actividades. Otras barreras son las responsabilidades laborales y familiares. Encontramos que la principal barrera fue el miedo a la revelación del estado serlógico. Los principales facilitadores del R&R son la coordinación adecuada y el seguimiento telefónico ofrecido por parte del personal del proyecto. Concluimos que en el desarrollo e implantación de programas de prevención el investigador/a debe tomar en cuenta la adaptación de aspectos logísticos como la disponibilidad y las necesidades particulares de los/las participantes. PMID:23264700

Valores hematológicos pre y postejercicio por sexo y por edad en caninos que practican agility en Antioquia

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Silvia Posada Arias

2013-06-01

Full Text Available El objetivo del estudio es describir variables hematológicas pre y postejercicio en caninos practicantes de agility, y el efecto de factores como el sexo y la edad sobre estos parámetros. Se muestrearon 40 caninos durante el 2012 de cualquier sexo y edad, con mínimo seis meses de práctica en Antioquia. Se tomó una muestra de sangre venosa en tres momentos: en reposo, inmediatamente culminado el ejercicio y 30 min después del ejercicio. En Statgraphics versión 15.0 se empleó análisis de varianza con tres factores (sexo, edad y momento de toma de la muestra para evaluar su efecto sobre la línea roja, blanca y plaquetas. El nivel de confianza fue del 95 %, y se empleó el procedimiento de comparaciones múltiples (diferencia mínima significativa. Los eritrocitos y el volumen corpuscular medio presentaron diferencias significativas (p < 0,05 para cada una de las interacciones (sexo y edad en cada uno de los tres momentos. La hemoglobina no presentó diferencias significativas en ninguno de los factores e interacciones evaluadas. El recuento leucocitario en las diferentes edades mostró diferencias significativas (p < 0,05. Los neutrófilos y linfocitos presentaron diferencias significativas entre las distintas edades (p < 0,05 y los eosinófilos no presentaron diferencias significativas respecto a las variables del estudio. Las variaciones hematológicas postejercicio se deben a predominio simpático y liberación de catecolaminas, las cuales estimulan esplenocontracción y liberación de eritrocitos del bazo. En la línea blanca, la liberación de epinefrina en respuesta a miedo, excitación o ejercicio súbito es la responsable de la leucocitosis y neutrofilia fisiológica.

Violencia e inseguridad contextual percibida y roles en bullying en escolares mexicanos

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Carlos Hidalgo-Rasmussen

2015-01-01

Full Text Available Estudio observacional, transversal y analítico realizado con 2201niños y adolescentes, estudiantes de primaria, secundaria y preparatoria de México con el objetivode analizar la relación entre sus percepciones de violencia del país y su municipio, inseguridaden su colonia y escuela y su rol en bullying escolar: observador, víctima o acosador. En Méxicoexisten dos preocupantes fenómenos: la violencia vinculada al narcotráfico y los eventos de bullyingescolar y en este trabajo se buscó aportar a explicar sus posibles relaciones. Se usó un cuestionarioautoaplicado en línea y análisis estadístico con Ji cuadrado y regresión logística encontrandoalgunas asociaciones significativas entre la violencia, inseguridad percibida y los roles en bullying.Las variables contextuales como la violencia deben considerarse en programas de prevención yatención del bullying.

Las crisis bancarias y el sistema monetario internacional en la Gran Depresión y en la actualidad

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Richhild Moessner

2011-12-01

Full Text Available Identificamos las semejanzas y las diferencias en la escala y la naturaleza de las crisis bancarias de 2008-2009 y de la Gran Depresión, y analizamos las diferencias en la respuesta de política a las dos crisis a la luz de los sistemas monetarios internacionales predominantes. Encontramos que la escala de la crisis bancaria, medida por la reducción internacional del endeudamiento de corto plazo y de los depósitos bancarios totales, fue menor en 2008-2009 que en 1931. Sin embargo, la provisión de liquidez del banco central fue mayor en el contexto de tasas de cambio flexibles de 2008-2009 que en 1931, cuando estaba limitada en muchos países por el patrón oro.

Profesoras en el tercer ciclo universitario y en los postgrados sobre EEMM

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Isabel de Torres Ramírez

2006-12-01

Full Text Available En este artículo se analiza la presencia de las mujeres en la universidad española, dentro de la enseñanza y la investigación llevada a cabo en el tercer ciclo de los estudios universitarios y en los programas de postgrado que se llevan a cabo dentro del área de conocimiento Estudios de las Mujeres. El objetivo concreto que se persigue es estudiar la presencia de profesoras en los programas de doctorado, en la dirección y en los tribunales de tesis y también en los másters, programas expertos/as y de especialistas vigentes durante el curso 2005-2006.

Propiedad intelectual y desarrollo en Colombia

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Karl W. Mutter

2010-03-01

Full Text Available Un país sin conocimiento propio está condenado a de­ pender de otros en casi todos los aspectos, y actualmente los países poseedores del conocimiento son, por obvias razones, los baluartes de su protección. Aunque los sistemas de protección de este conocimiento -propiedad intelectual (PI-han sido muy criticados, podrían también ser aprovechados para desarrollar conocimiento propio, lo cual es fundamental para el progreso y avance de los países en desarrollo, en particular Colombia. Este artículo analiza la relación entre propiedad intelectual y desarrollo, y las discusiones que sobre esta relación se están llevando a cabo en el ámbito de organizaciones multilaterales como la OMPI y la OMC; analiza también las experiencias de otros países que han basado de manera exitosa su desarrollo en la creación de conocimiento, como es el caso de Corea del Sur. Igualmente, se estudia el contexto colombiano y los esfuerzos que podrían llevarse a cabo en áreas como iniciativas normativas en transferencia efectiva de tecnología, y la promoción e impuso de áreas económicas no tradicionales en temas como software, biotecnología, industrias creativas, indicaciones geográficas, entre otras.

El discurso en la narrativa legal y el aborto en Argentina, tensiones y perspectivas

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Perugino, Silvina

2016-01-01

La presentación que aquí se propone versa sobre dos de los capítulos del Trabajo Integrador Final de la Especialización en Género y Comunicación de la Facultad de Periodismo UNLP. El trabajo busca dar luz sobre las tensiones a la hora de legalizar el aborto en Argentina. Para ello analizaremos sobre el tópico, el rol del Estado en general y específicamente los argumentos en el Poder Legislativo, dados en el último debate, analizándolo desde una perspectiva feminista. Necesitamos para ello ...

Resiliencia y salud en niños y adolescentes

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Norma Ivonne González Arratia López Fuentes

2009-01-01

Full Text Available En este trabajo se exponen algunas reflexiones en torno a acciones preventivas específicamente en los niños y adolescentes, desde el enfoque de la resiliencia, puesto que hay un creciente interés en los últimos años por el estudio de la capacidad que pueden tener algunos individuos cuando están expuestos a situaciones difíciles y que logran superar e incluso salir fortalecidos a pesar de la adversidad. Por lo que se analizan las implicaciones de promover el desarrollo de la resiliencia en lugar de prevenir daños específicos, como una forma de mejorar las condiciones de vida en el periodo de la infancia y adolescencia que son grupos particularmente vulnerables para la salud.

Mujer y medio ambiente en América Latina y el Caribe

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Silva Ch., Paola; Alvarez, Susana; Cambría, Celeste; Sala, Mariella; de Ochoa, Regina; Corral, Thais; Olivera, Maria del Carmen; González, Nhelsyr; Solís, Vivienne; Rossato, Verónica; Pérez, Magdalena

1991-01-01

1. Mujer y medio ambiente en América Latina y el Caribe: los desafíos hacia el año 2.000. 2. Políticas de población vigentes en los países de América Latina y el Caribe. La mujer como protagonista del desarrollo sustentable. Política de población en Perú: la relación mujer y medio ambiente. Población, mujer y medio ambiente en Honduras. Medio ambiente y población: una visión crítica. 3. La mujer en el manejo de los recursos naturales y tecnologías apropiadas. Participación de la mujer campe...

EFECTO DEL SILICIO Y PLAGUICIDAS EN LA FERTILIDAD DEL SUELO Y RENDIMIENTO DEL ARROZ

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Parm\\u00E9nides Furcal-Beriguete

2013-01-01

Full Text Available El objetivo de este trabajo fue evaluar el efecto del silicio en la fertilidad del suelo, la incidencia de enfermedades y plagas insectiles, el rendimiento y la calidad de granos del cultivo de arroz. El estudio se realizó en La Vega, Florencia, San Carlos, Costa Rica entre mayo y octubre en los años 2010 y 2011, en el mismo lote con la variedad CR 4477. Se establecieron cinco tratamientos: silicio al suelo, silicio al suelo más plaguicidas (alternativas químicas, silicio foliar, silicio foliar más plaguicidas y testigo comercial. Como fuente se utilizaron si- licio en polvo al 70% de SiO2, aplicado quince días antes de siembra en dosis de 100 kg SiO2/ha, y líquido concentrado 40% SiO2 y 36% MgO, aplicado al follaje en dosis de 4 l/ha a los 17 y 30 días después de la siembra. El suelo del orden inceptisol de formación aluvial, al inicio del experimento tenía pH 4,9, valores de P y Si disponibles de 29 ppm y 44,7 ppm, respectivamente, acidez intercambiable 1,2 cmol(+/l y suma de bases 19,11 cmol(+/l. No hubo diferencia estadística significativa del silicio en la fertilidad del suelo, la incidencia de plagas y enfermedades, y en la calidad molinera; sin embargo, la combinación del silicio aplicado al suelo y el uso de plaguicidas incrementaron el contenido de zinc y cobre en el suelo, y del zinc y magnesio en las hojas de arroz, pero este efecto no se tradujo en rendimiento y calidad de granos. La aplicación de plaguicidas influyó positivamente en el peso y rendimiento del arroz en granza (p≤0,05.

Crisis, Comercio y Ciudad. Cambios en la Actividad Comercial y el Consumo en España

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Xosé Somoza-Medina

2017-12-01

Full Text Available Entre 2008 y 2016 se cerraron en España más de 80.000 locales comerciales. La crisis económica redujo el crédito y la sociedad se vio obligada a reconducir sus ansias de consumo. El cierre de establecimientos afectó de forma distinta a las tiendas de barrio, los centros comerciales, o a los ejes emblemáticos de cada ciudad. Paralelamente, el comercio electrónico experimentó un crecimiento fuerte y sostenido, especialmente en los territorios de mayor nivel económico, superando en cada ejercicio el porcentaje de la población que utilizaba diferentes dispositivos para comprar por internet algo que antes compraba en una tienda. Este trabajo estudia la situación del comercio en España en 2016 y los cambios en el modo de consumo de sus habitantes provocados por la crisis económica.

Conocimientos y prácticas en salud sexual y reproductiva de adolescentes escolares en un municipio colombiano

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Rengifo reina, Herney Alonso; Cordoba Espinal, Alexandra; Serrano Rodriguez, Mayerlin

2013-01-01

Objetivo Identificar los conocimientos y prácticas en salud sexual y reproductiva de adolescentes del municipio de Miranda - Cauca en Colombia.Métodos Se realizó un estudio observacional descriptivo de corte transversal. La muestra fue de 406 adolescentes. Se exploraron variables en tres áreas o categorías: sociodemográficas, de conocimiento y de prácticas. Resultados Se presentaron conocimientos en niveles altos y muy alto, donde     90,5 % (362) de adolescentes habían recibido información s...

Convenios y Recomendaciones de la OIT y su Incidencia en las Relaciones Obrero-Patronales en Colombia (2002-2014)

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Alferez Restrepo, Francilena

2015-01-01

El prop?sito de este trabajo es investigar los efectos de los convenios de la Organizaci?n Internacional del Trabajo, en concreto 087 y 098, que protegen el derecho de asociaci?n y las relaciones laborales en Colombia en el per?odo 2002-2014. Inicia con la historia de los derechos laborales y la sindicalizaci?n y, los efectos de la Revoluci?n Industrial, se expone la historia de la mano de obra y los sindicatos en Colombia; de particular importancia dada la historia de Colombia con los malos ...

Análisis de la fuerza isométrica en la propulsión y tracción en slalom en silla de ruedas y su relación con el rendimiento y la clasificación funcional. [Isometric force in wheelchair slalom during traction and propulsion and their relationship with performance and functional classification].

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Raúl Reina

2013-10-01

Full Text Available El sistema de clasificación del slalom en silla de ruedas contempla como elegibles a deportistas con parálisis cerebral y daño cerebral adquirido. La tendencia actual en los sistemas de clasificación es realizar una clasificación integrada y funcional basada en evidencias científicas. En este estudio participaron 9 deportistas (21,2 ± 4,7 años de nivel nacional con parálisis cerebral (5 ♂ y 4 ♀ de las divisiones D2, D3 y D4, relacionadas con los perfiles funcionales de la Cerebral Palsy International Sports and Recreation Association. Se realizaron dos pruebas de fuerza máxima isométrica (propulsión y tracción sobre la silla de competición, donde se midió fuerza máxima (Fmax, fuerza media (Fmed, tiempo de ejecución y tiempo hasta diferentes porcentajes de Fmax. Además, se realizaron dos pruebas de rendimiento específicas: 16 m de desplazamiento lineal con una puerta de inversión situada a 8; y dos desplazamientos lineales de 4 m, realizando un zig-zag de ida y vuelta entre ambos, registrando el tiempo de ejecución con un sistema de cronometraje electrónico. Se encontraron diferencias estadísticamente significativas en las pruebas de propulsión entre los deportistas de D3 y D4 para la Fmax (p = 0,007 y Fmed (p = 0,002, siendo mayores los valores de esta última. En las pruebas de rendimiento específico, se encontraron diferencias entre D2 y D3 (inversión: p = 0,034 y zig-zag: p = 0,010, siendo menores los tiempos de D3. Los resultados muestran que no hay una relación lineal entre las divisiones y el rendimiento mostrado. AbstractAthletes with cerebral palsy and acquired cerebral damage are eligible for competition according to the wheelchair slalom classification system. The current trend in the classification systems is to perform an integrated and functional classification based on scientific evidence. Nine national level wheelchair slalom athletes (21,2 ± 4,7 years from D2, D3 and D4 divisions, as per functional

Necesidades de investigación y formación en salud ambiental y ocupacional en Colombia: un estudio Delphi

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Laura A. Rodríguez-Villamizar

2015-08-01

Full Text Available Introducción. Los factores ambientales contribuyen con el 16 % de la carga de enfermedad en Colombia. Un obstáculo importante para la implementación de políticas en salud ambiental y ocupacional es el conocimiento limitado sobre la capacidad local para estudiar y controlar el impacto de exposiciones ambientales y ocupacionales. Objetivo. Identificar necesidades de investigación y formación en salud ambiental y ocupacional en Colombia. Materiales y métodos. Se hizo un estudio Delphi híbrido en tres rondas. Se reclutó a un grupo de expertos en salud ambiental y ocupacional (n=16 de instituciones gubernamentales, universidades y centros de investigación. Las opiniones de los expertos sobre necesidades de investigación y formación se recolectaron mediante cuestionarios electrónicos, seguidos de una reunión presencial. El porcentaje de acuerdo y el coeficiente de variación se usaron para cuantificar el consenso del grupo. Resultados. La contaminación del aire y los productos químicos fueron considerados por los expertos como las exposiciones más importantes, dado su gran efecto en las enfermedades crónicas no transmisibles. La investigación de los efectos de la contaminación del aire ambiental sobre las enfermedades cardiovasculares y respiratorias, se consideró de importancia máxima. Las áreas prioritarias de formación fueron la evaluación del riesgo, el modelado de la exposición, los métodos estadísticos avanzados, la planeación urbana, la higiene y la seguridad industrial, y la epidemiología y la toxicología aplicadas a la salud ambiental y ocupacional. Conclusiones. Estos resultados son un insumo importante para la implementación de políticas nacionales en salud ambiental y ocupacional, y para el desarrollo de un nodo regional que fortalezca la capacidad de investigación y formación en Colombia.

Horizontalidad, autogestión y protagonismo en Argentina

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Marina Sitrin

2010-02-01

Full Text Available Este artículo trata los movimientos sociales autónomos que surgieron después de la crisis económica y la posterior rebelión popular en Argentina en diciembre de 2001. Los movimientos autónomos en la Argentina, como tantos movimientos en el mundo de hoy, son movimientos basados en la creación de nuevas relaciones sociales y comunidades ahora, al mismo tiempo que proyectan nuevas sociedadesy las relaciones en y para el futuro. Son movimientos con una concepción diferente del tiempo y el espacio. Son movimientos queentienden lo individual y lo colectivo como vinculados entre sí. Hay mucho en común entre la experiencia en la Argentina y las prácticas eideas anarquistas. Eso no significa que los que están creando nuevas relaciones y comunidades en la Argentina sean anarquistas. Lo que este artículo intenta hacer es basarse en las experiencias de los movimientos sociales argentinos para iniciar una reflexión sobre lasprácticas e ideas que los anarquistas pueden prestar a los distintos movimientos y comunidades autónomas; y, a su vez, sobre lo que los movimientos autónomos en la Argentina puede dar a las ideas y prácticas anarquistas.

Relación entre Problemas de Conducta en Adolescentes y Conflicto Interparental en Familias Intactas y Monoparentales

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Cecilia Mayorga Muñoz

2016-01-01

Full Text Available El propósito del estudio fue analizar la influencia del conflicto interparental en la aparición de problemas de conducta en adolescentes de familias intactas y monoparentales. Se utilizó un diseño explicativo que consideró prueba de medias y análisis multivariado de varianza. La muestra estuvo compuesta de 466 adolescentes de 12 a 16 años. Para la medición de las variables se utilizaron las escalas Children’s Perception of Interparental Conflict ( cpic y Youth Self Report ( ysr . Los resultados confirman la asociación entre conflicto interparental y problemas de conducta en los hijos, y muestran que, cuando hay conflicto en las familias intactas, se produce una mayor frecuencia de conductas externalizantes que en familias monoparentales.

ENTIERROS Y OFRENDAS: PRÁCTICAS MORTUORIAS, AGRÍCOLAS Y CULINARIAS EN LOS SIGLOS XIII Y XIV EN TINOGASTA (CATAMARCA, ARGENTINA

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Norma Ratto

2014-01-01

Full Text Available En este trabajo se presentan los análisis realizados sobre las asociaciones arqueobotánicas recupera - das en dos contextos funerarios del oeste de Tinogasta (Catamarca, Argentina. Los sitios Las Champas y Bebé de La Troya presentan macrorrestos vegetales junto a inhumaciones que permiten indagar el rol de dichos restos y sus implicancias dentro de las sociedades tardías catamarqueñas. Nuestro objetivo es caracterizar las prácticas sociales que intervinieron en el depósito de restos de plantas como acom - pañamiento funerario, al identificar la presencia de marcas diagnósticas de procesamiento culinario en dichos restos, que además son identificados taxonómicamente. En ambos sitios tanto los macrorrestos como los sedimentos asociados fueron analizados a ojo desnudo, lupa binocular y microscopio óptico. Las muestras fueron identificadas taxonómicamente siguiendo la descripción de caracteres diagnósticos botánicos y etnoarqueológicos para prácticas de procesamiento. En el sitio Las Champas se recuperaron semillas de Cucurbita aff. maxima subsp. maxima y Chenopodium quinoa var. melanospermum con rasgos de procesamiento, como así también un artefacto confeccionado sobre Lagenaria siceraria . Los análisis microscópicos dieron por resultado la presencia de gramíneas y cf. Zea mays . En Bebé de la Tro - ya se identificaron también semillas de Cucurbita aff. maxima subsp. maxima y endocarpos de Prosopis sp., sin marcas de procesamiento. Los resultados obtenidos permiten sugerir la presencia de restos de plantas como simientes, comidas y vestimenta, formando parte del contexto funerario. Estas tres formas de depósito vegetal demuestran prácticas intencionales diferentes durante las inhumaciones como así también permiten indagar en el aspecto culinario y agrario de las sociedades tardías catamarqueñas.

Creencias y costumbres relacionadas con el embarazo, parto y puerperio en comunidades nativas Awajun y Wampis

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Armando Medina I

2006-01-01

Full Text Available Objetivo: Nuestro país, por su riqueza cultural, presenta diversas concepciones en torno al embarazo, parto y puerperio. Las costumbres y los procesos de embarazo, parto y puerperio, de la mujer Awajun (Aguaruna o Wampis (Huambisa, en el contexto cultural de las comunidades indígenas, son revisadas en el presente estudio. Materiales y métodos: Estudio etnográfico descriptivo, cualitativo, realizado durante octubre de 2002 a abril de 2003, aplicándose 24 entrevistas a profundidad (a parteras, promotores de salud y usuarias, en las comunidades de Puerto Galilea y Chapiza, además de tres grupos focales. Dichas entrevistas se analizaron en función de cinco aspectos, relacionados con señales, peligros, dietas y cuidados durante el embarazo, parto y puerperio. Resultados: Los pobladores reconocen algunas señales de peligro en el embarazo, como el sangrado vaginal y pérdida de líquido amniótico. Los cuidados durante el embarazo se relacionan con las actividades diarias y la ingesta de alimentos (dietas. Existen algunos elementos que dificultan el parto y nacimiento, como el sentimiento de vergüenza para llamar al promotor. Logrado el parto, debe mantenerse los cuidados para la recuperación de la madre, y un adecuado desarrollo del recién nacido. Conclusiones: Las concepciones y percepciones del embarazo, parto y puerperio en comunidades nativas, norman el comportamiento de sus pobladores, repercutiendo esto en la salud materna e infantil. Es necesario comprender esta cultura y capacitar agentes de medicina tradicional, implementando estrategias en promoción de la salud y atención de la gestante, fortaleciendo las capacidades institucionales e incrementando la cobertura.

Pompa, ceremonia y rito en Chiloé

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Gonzalo Cerda Brintrup

2012-07-01

Full Text Available La cultura tradicional de Chiloé es una cultura extraordinariamente ritual. Este se encuentra presente en celebraciones religiosas, en fiestas populares, en la minga, particular trabajo colectivo que reúne y encuentra a la comunidad, la comida y la fiesta asociada a la minga, en la procesión ceremonial y en el entierro. A estos dos últimos temas se refiere el presente texto, destinado a destacar la importancia y proveniencia de la procesión religiosa así como el espacio central que ocupa en la cultura chilota la ceremonia fúnebre y el entierro. A ambos ritos les corresponde un lugar, una arquitectura y una imaginería con características propias que han aportado a la identidad cultural, urbana y arquitectónica de este territorio.

Aplicación de un modelo de ecuaciones estructurales para analizar los sistemas de gestión en la integración de la RSC y su influencia en la estrategia y el performance de las empresas tecnológicas || Applying a structural equation model to analyze management systems in the integration of CSR and its influence on the strategy and performance of technology companies

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Bernal Conesa, Juan Andrés

2016-06-01

Full Text Available La importancia de los sistemas de gestión para la integración de la RSC en la estrategia de la empresa es un recurso vital que ha sido poco estudiado en las empresas tecnológicas. En este artículo se propone un modelo de ecuaciones estructurales para explicar la influencia de la RSC y su integración en el sistema de gestión de la empresa, facilitada por la existencia de sistemas de gestión normalizados previos, y cómo influye dicha integración en la estrategia de la empresa y si esto tiene un reflejo en el performance económico de la empresa tecnológica. El estudio se llevó a cabo en empresas ubicadas en parques científicos y tecnológicos españoles. Los resultados del modelo revelan que existe una relación positiva, directa y estadísticamente significativas entre la integración de la RSC y la estrategia, por un lado, y la integración y el performance, por el otro. Asimismo se evidencia unas relaciones indirectas entre los sistemas de gestión normalizados previos a la implantación de la RSC y el performance y, por tanto, con implicaciones prácticas para la gestión de la RSC en empresas tecnológicas. || The importance of management systems for the integration of CSR in the company strategy is a vital resource that has been little studied in technology companies. In this paper a structural equation model is proposed in order to explain the influence of CSR and its integration into the management system of the company. This influence is facilitated by the existence of previous standardized management systems, and how this integration affects the strategy of the company and if this is a reflection on the economic performance of the technology company. The study was conducted in companies located in Spanish Science and Technology Parks. On the one hand, model results shows that there is a positive, direct and statistically significant relationship between the integration of CSR and strategy; on the other hand, performance and

y avanzado en lengua extranjera

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Francisco Roberto Rojas Caldelas

2006-01-01

Full Text Available Asignar la redacción de ensayos sobre una obra literaria ha sido una praxis cotidiana en las clases de lenguas extranjeras. Esta labor se lleva a cabo cuando el alumno tiene un cierto dominio de la lengua meta y se asume que es capaz de escribir prosa de cierta extensión. Por medio del contacto con el texto literario, el alumno interpreta la visión del autor, los rasgos inherentes de la cultura descrita, así como la temporalidad, continuidad y universalidad de los personajes y eventos descritos en ella. En el presente documento se identifican e ilustran las características formales y conceptuales del ensayo desde la lógica académica literaria. Asimismo, se reflexiona acerca de la importancia de la lectura literaria. Se enmarcan el entorno didáctico y sus momentos más importantes para redactar un ensayo literario en lengua extranjera sobre bases críticoliterarias propuestas por Roland Barthes y bases filosófico-literarias de la interpretación de Hanz Georg Gadamer. Por último, se contextualizan las limitaciones y los alcances de la propuesta.

Poder y resistencia en Michel Foucault

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Reinaldo Giraldo Díaz

2006-01-01

Full Text Available En este artículo se analizan los conceptos de poder y resistencia en las obras del período genealógico de Michel Foucault, es decir, después de El orden del discurso, texto programático y hasta el primer volumen de Historia de la Sexualidad. La voluntad de saber. El artículo realiza sobre todo una elaboración de las concepciones de Foucault sobre el poder y la resistencia en las sociedades disciplinarias y en las sociedades de control. Contrario a lo que sostienen los críticos de Foucault, en este artículo se considera que la resistencia no es negativa, ni reactiva. Nuestra hipótesis de trabajo es que para el pensador francés la resistencia es creativa, productiva y anterior al poder.

Agresores en bullying y conductas antisociales

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Fuensanta Cerezo

2016-04-01

Full Text Available Diversos estudios relacionan las conductas antisociales y las conductas agresivas en los adolescentes. Este trabajo indaga en la relación entre conductas de agresión en bullying y otras conductas antisociales y analiza las diferencias entre los diferentes roles asociados. Un total de 1239 escolares de Educación Secundaria de la Región de Murcia (España completaron una adaptación de la Encuesta Estatal sobre Drogas (ESTUDES y el test BULL-S para la evaluación sociométrica de la agresividad entre escolares. En torno al 30% de la muestra indicó consumir de algún tipo de droga y no se parecían diferencias por sexo y más del 50% realizó algún tipo de conducta disocial. Encontramos diferencias significativas entre los diferentes roles destacando una correlación positiva entre el rol de agresor, consumo y realizar una serie de conductas antisociales relacionadas con acciones de riesgo personal, escolar y familiar como conducir bajo los efectos del alcohol, participar en alguna pelea, ser detenido por las fuerzas del orden público, escapar de casa durante más de un día completo o ser expulsado del centro educativo durante un día completo o más. El conjunto de los adolescentes no mostró diferencias significativas en “tener un conflicto o discusión importante con padres o hermanos”. Se encontraron diferencias en el tipo de droga consumida entre agresores y víctimas.

'Nada se pierde' en "El cielo protector" y "Cita en Tombuctú"

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Santiago Martín

2003-12-01

Full Text Available El presente trabajo pretende comparar dos novelas distantes en el tiempo y en el espacio, a saber, The Protecting Sky (1949, de Paul Bowles, y Cita en Tombuctú (1996, de Joseph Subirós. La novela espaúola remite en más de una ocasión a la obra americana. Varios temas, presentes en ambas obras, que quisiéramos destacar: La fascinación por el continente africano; el desierto como telón de fondo; el viaje (especialmente interior como formación del hombre civilizado en un entorno hostil; el amor carnal entre la mujer civilizada y el hombre salvaje; la huída del hombre civilizado de su habitat en busca de otros valores; y, la derrota, debida al desequilibrio (físico, mental y temporal del hombre civilizado. Así, comparando las obras y mediante una frase ('Nada se pierde en el desierto' que Cita en Tombuctú presta de The Protecting Sky, la novela espaúola ofrece alternativas a los problemas planteados en la novela americana. Si en Bowles hay resignación, en Subirós hay esperanza.

Telenovela y cultura en Brasil

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Fadul, Anamaria

1993-01-01

Trabajo sobre el surgimiento de la telenovela en Brasil. Se habla del papel de la telenovela en la cultura brasileña, de su audiencia, del panorama televisivo en ese país y de sus estrategias de programación. A la par del artículo, se presentan cuadros con información sobre las telenovelas mexicanas. Se incluyen ilustraciones de Lucía Maya, reproducidas en blanco y negro.

Estado del arte de la seguridad y salud en el trabajo en el plan nacional de seguridad y salud en el trabajo Colombia: 2013-2017

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Aguillón Ramírez, Mariana C.

2014-01-01

El presente estudio corresponde al estado del arte del Plan Nacional de Seguridad y Salud en el Trabajo Colombia 2013 – 2017 y la incorporación a este, de los principios de seguridad y salud en el trabajo promulgados por la OIT en 2008, y el marco epistémico de la seguridad y salud en el trabajo de la Universidad Nacional de Colombia. A partir de la revisión detallada de los documentos anteriormente mencionados, se prosiguió con la lectura crítica del Plan Nacional de Seguridad y Salud en el ...

TIC, desarrollo y educación: sociedades en transformación y paradigmas de cambio en Bolivia

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Pablo Andrés Rivero

2013-02-01

Full Text Available El desarrollo de tecnologías ha sido siempre parte de lahistoria de la humanidad. Sin embargo, las tecnologías de la información y lacomunicación (TIC hoy emergen explosivamente incorporándose como determinantesfactores mediadores de las relaciones humanas a toda escala. En esta radicaltransformación, el proceso educativo enfrenta dificultades y también enormesdesafíos. A partir de un marco situacional, donde se describen loscambios socioeconómicos y sociodemográficos importantes en el tejido socialboliviano –que por supuesto no son ajenos a las trasformaciones en el resto deLatinoamérica– este artículo indaga sobre las condiciones de posibilidadsociales, demográficas, y políticas para la gestión de la tecnología y lainformación de manera progresiva y sostenible en la educación, particularmenteenfocándose a la educación superior, que además incida en un masivo acceso yaprovechamiento de la información y contribuya a la genuina democratización,reduzca las asimetrías y contribuya al desarrollo económico sostenible enBolivia. La adopción institucional de principios colaborativos, lageneración de “infoestructuras” y la gestación de una “educación libre” apartir del desarrollo tecnológico son tres propuestas que este artículo ofrecepara comprender un nuevo paradigma educativo que genera sinergia hacia lainnovación y la creación de modelos innovadores de negocio, el desarrollotecnológico propio, mayores y mejores niveles de democratización de lasinformación y el desarrollo sustentable en el tránsito hacia “la sociedad delconocimiento”.

Disponibilidad y uso de TIC en escuelas latinoamericanas: incidencia en el rendimiento escolar

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Marcela Román

2014-12-01

Full Text Available Enriquecer los ambientes de aprendizaje de los estudiantes mediante la incorporación de tecnologías de información y comunicación requiere que los centros educativos dispongan de computadoras y conectividad - en cantidad y calidad suficiente - para que docentes y estudiantes puedan incorporar dichas tecnologías en el proceso de enseñanza y aprendizaje. La investigación que se presenta estima la incidencia del acceso y uso de computadoras en el logro escolar que obtienen los estudiantes latinoamericanos de 6° de primaria en Matemáticas y Lectura. Para ello, y mediante modelos multinivel de cuatro niveles (alumno, aula, escuela y país, se analiza información de dieciséis países de América Latina, cerca de 91.000 estudiantes de sexto grado y algo más de 3.000 docentes, disponible en la base de datos del Segundo Estudio Comparativo y Explicativo (SERCE de la UNESCO. Con importantes variaciones entre países, los resultados dan cuenta de que apenas un tercio de los niños y niñas latinoamericanos que estudian 6º grado dispone de una computadora en casa y más de la mitad de ellos afirma que nunca han utilizado una computadora en la escuela. Entre sus principales hallazgos se constata que un estudiante que cuente con una computadora en su hogar, que concurra a una escuela con más de diez computadoras, que los utilice al menos una vez por semana y tenga un profesor/a que use habitualmente la computadora en su casa, obtendrá un desempeño significativamente más alto en ambas áreas evaluadas: 23 puntos más en matemáticas y 25 en lectura.

Recuento y determinación de viabilidad de giardia spp. y Cryptosporidium spp. en aguas potables y residuales en la cuenca alta del rio Bogotá.

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Marlén Andrea Alarcón

2005-09-01

Full Text Available Introducción. La transmisión de enfermedades de origen hídrico está relacionada con la contaminación de origen fecal en aguas residuales y potables. Estas enfermedades son causadas por la presencia de bacterias, virus y parásitos, los cuales generan altos porcentajes de morbimortalidad, especialmente, en la población infantil. Se han seleccionado Giardia spp. y Cryptosporidium spp. como organismos indicadores de contaminación de origen parasitario y su análisis es útil para evaluar la calidad del agua y determinar el riesgo sanitario. En Colombia se conoce poco sobre la presencia y la concentración de estos parásitos en aguas, razón por la cual es importante continuar su estudio. Objetivo. El objetivo de este trabajo fue evaluar la presencia de estos protozoos en cinco estaciones de muestreo de la cuenca alta del río Bogotá y en dos sistemas de potabilización de la misma área. Materiales y métodos. Las técnicas aplicadas para la determinación y el recuento de las formas quísticas fueron: floculación inorgánica para aguas residuales, filtración para aguas potables y pruebas de colorantes vitales para viabilidad. Resultados. Se confirmó la presencia de Cryptosporidium spp. en dos de las estaciones del río Bogotá y en las dos potabilizadoras. Giardia spp. se encontró en las dos potabilizadoras pero no en el río Bogotá. La viabilidad fue positiva para Cryptosporidium spp. en una muestra proveniente del río, y negativa para las muestras de agua potable. Conclusiones. Estos resultados muestran la presencia de protozoos en aguas potables y residuales lo cual puede generar riesgo sanitario para la población de dicha zona.

Azar y finalidad en Aristóteles y Epicuro

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Rodríguez Donís, Marcelino

1997-01-01

1. Exposicion Critica Del Mecanicismo Presocratico. 2. La Significacion De Lateleologia En La Fisica Y En La Metafisica. 3. Sobre El Accidente Y La Suerte.4. Fracaso Del Finalismo. 5. Sustitucion De La Finalidad Por El Mecanicismoatomista.

Mujer rural, capital social y asociacionismo en Extremadura

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Sánchez-Oro Sánchez, Marcelo; Pérez Rubio, José Antonio; Morán Morán, María Irene

2011-01-01

El interés reciente de los estudios sociales en torno a la mujer rural se centra en los cambios de roles y de funciones que está asumiendo en la sociedad rural, y que le permiten una participación mayor en la economía y el mercado laboral, la política, la cultura y las redes sociales de apoyo local y mancomunal. Desde esta óptica, se plantea una investigación en curso sobre la actividad emprendedora y asociativa de la mujer rural en dos mancomunidades de la provincia de Cáceres, abordando com...

Sustentabilidad y competitividad en empresas hortícolas en méxico

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Luis Alfredo vega

2017-01-01

Full Text Available El futuro de nuestro planeta es incierto ante los distintos problemas que se presentan en el Mundo, derivado del poco interés y cuidado que tiene el ser humano y de algunas organizaciones por el planeta y la relación que tienen los seres humanos con el mismo. El objetivo de este artículo se basa en explicar la importancia que tiene para las empresas hortícolas de Sinaloa en México el proyectar y posicionarse en los mercados regionales, nacionales e internacionales como organizaciones que se preocupan por sus clientes y de todo lo que nos rodea en el planeta; retomando el liderazgo de involucrar en sus procesos de producción y de comercialización el uso de insumos que disminuyan los riesgos de contaminación e inserten la sustentabilidad como una estrategia de posicionamiento. Entre los principales autores que se toman en este trabajo son: Rodríguez y Robles (2014, Pless y Maak (2010, Montoya et al. (2010, Marín y Rubio (2008, Alea (2007, Dixon (2003, Cloke y Goldsmith (2002, Altieri y Nicholls (2000 y Doroujeanni (2000. La Metodología es un estudio documental y un análisis crítico reflexivo que describe y explica la problemática y los retos actuales que enfrentan las empresas hortícolas así como las áreas de oportunidad para lograr la ventaja competitiva.

Gestion, evaluacion y calidad en la diversificacion de la Educacion Superior en America Latina

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Sergio Martínez Romo

2007-12-01

Full Text Available La participación de la Sociedad Académica y sus grupos constituyentes como 'tribus' o grupos de interés en función del conocimiento (Martínez Romo, 1992, 2005 en la gestión, diseño y operación de la política pública en educación superior y la evaluación y acreditación de la calidad del posgrado y en el entrenamiento en investigación, por medio de agencias gubernamentales em México (Martínez Romo y Reséndiz, 2007 logra influir en el diseño de lãs políticas públicas y la gestión en educación superior, y aparentemente, mejores resultados al introducir explícitamente el valor conocimiento -y SUS aplicaciones- a través de los grupos o tribus -diría Becher (1989- en La gestión y los procesos de evaluación en el posgrado. Los datos obtenidos señalan que este valor parece dar a los indicadores y estándares de gestión y calidad de tipo gerencial, un sentido más trascendente que la eficacia y eficiencia esperada tradicionalmente en los modelos privado - empresariales o de servicio público en el sentido tradicional, de la noción de estado de bienestar (que en ocasiones situa la noción en términos de uso privado de bienes públicos. La investigación reportada pone en perspectiva algunas características significativas en la constitución de la Sociedad Académica en México, La distingue del Estado y de la Sociedad Civil (Martínez Romo, 1992, y caracteriza y documenta su participación en la hechura y gestión de lãs políticas para la educación superior y a través de ésta última, en la producción, promoción y difusión de la Ciencia y la Tecnología. Acciones todas ellas de contribución para el desarrollo, en un entorno de diversificación e internacionalización de la educación superior y sus instituciones.

Sobrepeso y dislipidemias en adolescentes

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Lourdes Rodríguez Domínguez

Full Text Available Introducción: actualmente hay consenso en que el proceso aterosclerótico se inicia en la infancia, y la dislipidemia es uno de los principales factores de riesgo aterogénicos que deben ser estudiados, así como la valoración nutricional para una adecuada prevención. Objetivo: identificar algunas señales de aterosclerosis tempranas como el sobrepeso y las dislipidemias en adolescentes. Métodos: se realizó un estudio descriptivo transversal de 372 adolescentes de la Secundaria Básica "Protesta de Baraguá". Se hicieron mediciones de peso, talla, índice de masa corporal y circunferencia de la cintura. Se tomó muestra de sangre venosa con ayuno de 12 horas. Se midió el colesterol total, el colesterol unido a lipoproteína baja y alta densidad, y triglicéridos. En el análisis estadístico se realizaron prueba de comprobación de media entre variables de valoración nutricional y lipídicas entre sexos (prueba t, y se trabajó con una probabilidad de error menor de 0,05. Resultados: la media del peso, talla y circunferencia de la cintura fueron mayores en el sexo masculino (p 0,05. El 18,5 % presentó colesterol total limítrofe alto, el 26,6 % tenía triglicéridos limítrofe alto y 7,5 % alto, con predominio del sexo femenino. Conclusiones: alrededor de la cuarta parte de los adolescentes tenían exceso de peso e incremento de la grasa abdominal, casi la cuarta parte tenía el colesterol total limítrofe y alto, y la alteración lipídica observada con mayor frecuencia fue la hipertrigliceridemia.

PRÁCTICAS DOCENTES EN EDUCACIÓN AMBIENTAL EN BOGOTÁ, QUIBDÓ Y

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Bibiana Alfonso

2015-12-01

Full Text Available Se presenta en este documento el resultado parcial de la investigación denominada “Concepciones y prácticas sobre educación ambiental de los docentes de educación secundaria y media en colegios de Bogotá, Leticia y Quibdó: Implicaciones para los currículos de educación media en diferentes regiones del país”. Dichos resultados se obtienen de uno de los cuatro instrumentos usados en la investigación: el cuestionario a estudiantes. Con este instrumento se obtiene la visión de los estudiantes sobre las prácticas que tienen sus docentes cuando se aborda la educación ambiental en el aula. Las marcadas tendencias en prácticas de corte conservacionista, disciplinar y recursista que identifican los estudiantes, llevan a inferir que, sin importar la región de país, los/as docentes aún perpetúan la idea antropocentrista de la educación ambiental y privilegian la visión de la educación ambiental como una disciplina más del conocimiento ligada, necesariamante, a las denominadas ciencias naturales.  La investigación está enmarcada metodológicamente en el estudio de caso, se usan instrumentos estandarizados y validados en los cuales se proponen cuatro unidades de análisis:   finalidades   de   la   educación   ambiental,   conocimientos  (conceptuales, procedimentales  y  actitudinales  en  educación  ambiental,  modelos  de  enseñanza  y    aprendizaje y finalidades, instrumentos y formas de evaluación en educación ambiental. Estas unidades de análisis se constituyen en los pilares de los lineamientos curriculares que se propondrán al finalizar la investigación.

Bosques y suelos en el contexto de redd+: entre gobierno y gobernanza en México

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Antoine Libert Amico

2016-01-01

Full Text Available El reciente énfasis en la reducción de emisiones por deforestación y degradación (REDD+ ha generado una reconfiguración de las formas de gestión ambiental en México. Mediante el uso de datos generados por los autores dentro de un proyecto de investigación sobre Gobernanza Multinivel y Gestión de Carbono a Nivel de Paisaje, del Centro para la Investigación Forestal Internacional (CIFOR, se muestran los retos que enfrentan nuevos arreglos de gobernanza en torno a bosques y suelos. Se marca la diferencia entre gobierno y gobernanza, buscando ilustrar la transición de uno al otro en el marco de los programas de acción temprana REDD+ y el potencial de innovación que el escenario actual de debates sobre cambio climático ha creado. Al final se invita a una reflexión sobre las posibles contribuciones de una gobernanza forestal democrática, legítima y transparente para la gestión de los suelos y de los desafíos ambientales.

Seroprevalencia de fasciolosis en escolares y en ganado vacuno en la provincia de huancavelica, Perú

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Nicasio Valencia M

2005-04-01

Full Text Available Objetivos: Determinar la seroprevalencia de fasciolosis en escolares y vacunos de la provincia de Huancavelica y describir su percepción sobre ésta. Materiales y métodos: Este estudio se realizó en diferentes pisos ecológicos y altitudes de 2000 a 5000 m.s.n.m. Se realizó una entrevista seroepidemiológica a 842 escolares de educación secundaria de colegios estatales escogidos al azar, así como a 532 vacunos aleatorios criados por la familia del escolar. En ambos casos se realizó la prueba serológica de FAS2-ELISA. El análisis de datos se realizó por tipo de zona (urbana o rural con el programa SPSS v.11, considerando un p<0,05 como estadísticamente significativo. Resultados: La prueba fue positiva en 33 estudiantes (2,6% en zona urbana y en 4,9% en zona rural, p0,05 y en 123 vacunos (23,1%. Los distritos de Izcuchaca y Palca tuvieron 10% de escolares positivos. No hubo asociación entre infección escolar y animal. Un 45% de escolares refirió conocer la enfermedad (28% en zona urbana y 56,5% en zona rural, p<0,01; los escolares de zona rural tuvieron más respuestas correctas sobre fasciolosis. El conocimiento sobre el daño hepático de la fasciolosis fue más frecuente que sobre su transmisión y prevención. Conclusiones: Los distritos de Izcuchaca y Palca son hiperendémicos para fasciolosis humana en la provincia de Huancavelica. Debido a su importancia clínica, se requiere fuerte intervención educativa en prevención, especial-mente en zonas urbanas.

El sihkrutara, en la narrativa y en la memoria del pueblo Miskitu

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Gretta Paiz Malespín

2016-11-01