1
|
Petrola Chacón CG, Vilallonga R, González López Ó, García Ruiz de Gordejuela A, Beisani M, Caubet Busquet E, Fort JM, Armengol Carrasco M. Analysis of the Management of Cholelithiasis in Bariatric Surgery Patients: a Single-Center Experience. Obes Surg 2022; 32:704-711. [PMID: 34981326 DOI: 10.1007/s11695-021-05883-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Cholelithiasis is an issue in bariatric surgery patients. The incidence of cholelithiasis is increased in morbidly obese patients. After bariatric surgery, the management maybe sometimes challenging. There is no consensus about how to deal with cholelithiasis prior to bariatric surgery. MATERIALS AND METHODS A retrospective review from our prospectively collected bariatric surgery database. Primary bariatric procedures from 2009 to 2020 were included. Prevalence of cholelithiasis and its management prior to bariatric surgery and the incidence and management of postoperative biliary events were analyzed. RESULTS Over 1445 patients analyzed, preoperatively cholelithiasis was found in 153 (10.58%), and 68 out of them (44.44%) were symptomatic. Seventy-six patients had a concomitant cholecystectomy. In those cases, the bariatric procedure did not show increased operative time, length of stay, morbidity, or mortality compared to the rest of primary bariatric procedures. Twelve patients (15.58%) with previous cholelithiasis and no concomitant cholecystectomy presented any kind of biliary event and required cholecystectomy. De novo cholelithiasis rate requiring cholecystectomy was 3.86%. Postoperative biliary events both in de novo and persistent cholelithiasis population did not show any difference between the type of surgery, weight loss, and other characteristics. CONCLUSIONS Cholelithiasis was present in 10.58% of our primary bariatric surgery population. Concomitant cholecystectomy was safe in our series. Non-surgical management of asymptomatic cholelithiasis did not lead to a higher risk of postoperative biliary events. The global postoperative cholecystectomy rate was equivalent to the general population.
Collapse
Affiliation(s)
- Carlos Gustavo Petrola Chacón
- General and Digestive Surgery Department, Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramón Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcellona, Spain
| | - Óscar González López
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcellona, Spain.
| | - Amador García Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcellona, Spain
| | - Marc Beisani
- Bariatric Surgery Unit, General and Digestive Surgery Department, Moises Broggi Hospital, CSI, Sant Joan Despi, Barcelona, Spain
| | - Enric Caubet Busquet
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcellona, Spain
| | - Jose Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcellona, Spain
| | - Manel Armengol Carrasco
- General and Digestive Surgery Department, Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Roriz-Silva R, Vilallonga R, Fort JM, Khoraki J, de Gordejuela AGR, Gonzalez O, Caubet E, Rodríguez-Luna MR, Armengol M. Robotic and laparoscopic Roux-en-Y gastric bypass after learning curve: 30-day and 12-month outcomes. J Robot Surg 2022; 16:1257-1263. [PMID: 35218480 DOI: 10.1007/s11701-022-01384-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/06/2022] [Indexed: 01/01/2023]
Abstract
This study compares laparoscopic RYGB (L-RYGB) and robotic RYGB (R-RYGB) performed by the same team after the learning curve in both approaches. A retrospective cohort study was done, and the surgical outcome was analyzed in 30 days and 12 months for patients with similar characteristics and an equal number of cases in each group (233 cases). Four hundred and sixty-six patients were included in this study. Mean age was 46.8 ± 8.3 years and 2/3 were women. R-RYGB presented a longer operative time (150.7 versus 135.4 min; p < 0.001) with no differences in the length of hospital stay. The main 30-day complications were G-J stricture, leakage, and intraluminal bleeding. The reoperation rate was 1.6% by leakage (G-J anastomosis) and was higher in R-RYGB (2.1 versus 0.4; p = 0.108). The multivariate analysis identified that L-RYGB was the factor independently associated with a LOS longer than 2 days (odds ratio: 4.7, 95% CI: 2.6-8.2, p value < 0.001). At the FU time (12 months), no differences between the groups were found. The outcomes between the groups after the learning curve did not present differences in terms of 30 days and 12 months of FU when same preoperative characteristics and an equal number of cases in each group are considered. L-RYGB was the unique independent factor associated with long LOS.
Collapse
Affiliation(s)
- Renato Roriz-Silva
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. .,Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Medical College of Virginia, Virginia Commonwealth University School of Medicine, Richmond, USA. .,Department of Medicine, Federal University of Rondônia, Porto Velho, Brazil.
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jose Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jad Khoraki
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Medical College of Virginia, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Amador Garcia Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Manel Armengol
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
3
|
Cambras T, Pardina E, Carmona J, Ricart-Jane D, Minarro A, Ferrer R, Lecube A, Balibrea JM, Caubet E, González O, Vilallonga R, Cuello E, Fort JM, Baena-Fustegueras JA, Díez-Noguera A, Peinado-Onsurbe J. Seasonal variation of body weight loss after bariatric surgery. Chronobiol Int 2019; 36:672-680. [PMID: 30843440 DOI: 10.1080/07420528.2019.1580716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Seasonal variations have been described in humans in several variables such as sleep, mood, appetite, food preferences, or body weight. We hypothesized that these variations could also influence the decrease in body weight rate in patients submitted to body weight loss interventions. Thus, here we tested the variations of weight loss according to the time of the year the surgery took place in a group patients (n = 1322) submitted to bariatric surgery in the Hospital Universitari de la Vall d'Hebron in Barcelona (geographical coordinates: 41°25'41″N 2°8'32″E). For the analysis, the percentage of total body weight loss (%TWL), excess body weight loss (%EWL) and percentage of body mass index loss (%BMIL) were calculated at 3 (n = 1255), 6 (n = 1172), 9 (n = 1002), and 12 months (n = 1076) after surgery. For %EWL and %BMIL a statistically significant seasonal variation was detected when the variables were calculated at 3 months, but not at the other times, with more weight loss in summer-fall. However, seasonal variations were not detected for %TWL (p = 0.09). The mean amplitude of the seasonal rhythm for %EWL was of 1.8%, while for the rhythm of %BMIL was 0.7%. Moreover, a second peak was detected in January-February modulating the seasonal rhythm of the two variables. Results confirm seasonal variations in humans and indicate that short term responses to weight loss can be modulated by the time of year.
Collapse
Affiliation(s)
- Trinitat Cambras
- a Department of Physiology and Biochemistry, Faculty of Pharmacy and Food Sciences , Universitat de Barcelona , Barcelona , Spain
| | - Eva Pardina
- b Department of Biochemistry and Molecular Biomedicine, Faculty of Biology , Universitat de Barcelona , Barcelona , Spain
| | - Julia Carmona
- b Department of Biochemistry and Molecular Biomedicine, Faculty of Biology , Universitat de Barcelona , Barcelona , Spain
| | - David Ricart-Jane
- b Department of Biochemistry and Molecular Biomedicine, Faculty of Biology , Universitat de Barcelona , Barcelona , Spain
| | - Antonio Minarro
- c Department of Genetics, Microbiology and Statistics, Faculty of Biology , Universitat de Barcelona , Barcelona , Spain
| | - Roser Ferrer
- d Department of Biochemistry , Institut de Recerca Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Albert Lecube
- e Department of Endocrinology and Nutrition , Arnau de Vilanova University Hospital, CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM) , Lleida , Spain
| | - Jose María Balibrea
- f Endocrinology Surgery Unit , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Enric Caubet
- f Endocrinology Surgery Unit , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Oscar González
- f Endocrinology Surgery Unit , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Ramón Vilallonga
- f Endocrinology Surgery Unit , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Elena Cuello
- g Endocrinology Surgery Unit , Arnau de Vilanova University Hospital (UdL) , Lleida , Spain
| | - Jose Manuel Fort
- f Endocrinology Surgery Unit , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | | | - Antoni Díez-Noguera
- a Department of Physiology and Biochemistry, Faculty of Pharmacy and Food Sciences , Universitat de Barcelona , Barcelona , Spain
| | - Julia Peinado-Onsurbe
- b Department of Biochemistry and Molecular Biomedicine, Faculty of Biology , Universitat de Barcelona , Barcelona , Spain
| |
Collapse
|
4
|
Vilallonga R, Fort JM, Gonzalez O, Balibea JM, Caubet E, Roriz-Silva R, Protti GP, Jofra M. REVERSAL GASTRIC BYPASS TO NORMAL ANATOMY WITH SLEEVE GASTRECTOMY BY HYPOGLYCEMIA. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
5
|
Cambras T, Pardina E, Carmona J, Ricart-Jané D, Miñarro A, Ferrer R, Lecube A, Balibrea JM, Caubet E, González O, Vilallonga R, Fort JM, Cuello E, Baena-Fustegueras JA, Díez-Noguera A, Peinado-Onsurbe J. Seasonal variations of changes in lipid and glucidic variables after bariatric surgery. Chronobiol Int 2018; 36:250-257. [PMID: 30351989 DOI: 10.1080/07420528.2018.1533560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Seasonality is a phenomenon that is characterized by changes over the year in sleep, mood, behaviour, appetite and body weight. In humans, seasonal variations have been found in certain variables, such as lipid variables and body mass index. We hypothesize that this rhythm could influence the expected variation of the levels of biochemical variables in cases of body weight loss. Thus, the goal of this study was to observe whether the time of year in which bariatric surgery (BS) took place modulated the changes in several variables related to glucidic and lipid metabolism. Blood samples were obtained from 24 women and 10 men before BS and 1 and 3 months after BS. We calculated the percentage of variation that occurred for each individual and for each variable as a function of the time of the year. Data were adjusted to a 12-month period sinusoidal curve, with significance being set at p < 0.05. The results showed that almost all of the studied variables changed due to the BS according to a seasonal rhythm. Most of the variables showed a decrease that was most prominent in winter. In the cases of body mass index (BMI), adrenocorticotropin hormone (ACTH), and cortisol, the highest variation occurred in winter. Insulin and cholesterol in high-density lipoproteins (cHLD) variations were higher in springtime. Glucose variation showed a decrease after surgery with acrophase in summer-fall and plasminogen activator inhibitor-1 (PAI-1) and homeostatic model assessment-insulin resistance (HOMA-IR) in spring-summer. Ghrelin levels showed increases with a rhythm of variation with an acrophase in summer-fall. The seasonal rhythm found in this study fits nearly with the inverse of the endogenous circannual rhythm of the variables studied. The time of the year when the highest variation takes place is related to the circannual rhythm of the variable. The results agree with the manifestation of seasonal rhythm in human biochemical variables, which are reflected in the responses to weight loss after BS.
Collapse
Affiliation(s)
- Trinitat Cambras
- a Department of Physiology and Biochemistry, Faculty of pharmacy and Food Sciences , Universitat de Barcelona , Barcelona , Spain
| | - Eva Pardina
- b Department of Biochemistry and Molecular Biomedicine, Biology Faculty , Barcelona University , Barcelona , Spain
| | - Júlia Carmona
- b Department of Biochemistry and Molecular Biomedicine, Biology Faculty , Barcelona University , Barcelona , Spain
| | - David Ricart-Jané
- b Department of Biochemistry and Molecular Biomedicine, Biology Faculty , Barcelona University , Barcelona , Spain
| | - Antonio Miñarro
- c Department of Genetics, Microbiology and Statistics, Biology Faculty , Barcelona University , Barcelona , Spain
| | - Roser Ferrer
- d Department of Biochemistry , Institut de Recerca Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Albert Lecube
- e Department of Endocrinology and Nutrition , Arnau de Vilanova University Hospital, CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM, Spain) , Lleida , Spain
| | - José María Balibrea
- f Endocrinology Surgery Unit , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Enric Caubet
- f Endocrinology Surgery Unit , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Oscar González
- f Endocrinology Surgery Unit , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Ramón Vilallonga
- f Endocrinology Surgery Unit , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Jose Manuel Fort
- f Endocrinology Surgery Unit , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Elena Cuello
- g Endocrinology Surgery Unit , Arnau de Vilanova University Hospital (UdL) , Lleida , Spain
| | | | - Antoni Díez-Noguera
- a Department of Physiology and Biochemistry, Faculty of pharmacy and Food Sciences , Universitat de Barcelona , Barcelona , Spain
| | - Julia Peinado-Onsurbe
- b Department of Biochemistry and Molecular Biomedicine, Biology Faculty , Barcelona University , Barcelona , Spain
| |
Collapse
|
6
|
Ferrer R, Pardina E, Rossell J, Oller L, Viñas A, Baena-Fustegueras JA, Lecube A, Vargas V, Balibrea JM, Caubet E, González O, Vilallonga R, Fort JM, Peinado-Onsurbe J. Morbidly "Healthy" Obese Are Not Metabolically Healthy but Less Metabolically Imbalanced Than Those with Type 2 Diabetes or Dyslipidemia. Obes Surg 2016; 25:1380-91. [PMID: 25515498 DOI: 10.1007/s11695-014-1528-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND We have investigated the differences between metabolically "healthy" morbidly obese patients and those with comorbidities. MATERIALS AND METHODS Thirty-two morbidly obese patients were divided by the absence ("healthy": DM-DL-) or presence of comorbidities (dyslipidemic: DM-DL+, or dyslipidemic and with type 2 diabetes: DM+DL+). We have studied various plasma parameters and gene expression adipose tissue, before and after gastric bypass. RESULTS The group DM+DL+ tends to have lower values than the other two groups for anthropometric parameters. Regarding the satiety parameters, only leptin (p = 0.0024) showed a significant increase with comorbidities. Lipid parameters showed significant differences among groups, except for phospholipids and NEFA. For insulin resistance parameters, only glucose (p < 0.0001) was higher in DM+DL+ patients, but not insulin or homeostasis model assessment of insulin resistance (HOMA-IR). The gene expression of adiponectin, insulin receptor (INSR) and glucose receptor-4 (GLUT4), in the subcutaneous fat, decreased in all groups vs. a non-obese control. Interleukin-6 (IL6) and the inhibitor of plasminogen activator type 1 (PAI-1) genes decreased only in DM-DL+ and DM+DL+, but not in "healthy" patients. Leptin increased in all groups vs. the non-obese control. The visceral fat from DM+DL+ patients showed a sharp decrease in adiponectin, GLUT4, IL6 and PAI-1. All parameters mentioned above improved very significantly by surgery, independent of the occurrence of comorbidities. CONCLUSIONS The morbidly obese "healthy" individual is not really metabolically healthy, but morbidly obese individuals with diabetes and dyslipidemia are more metabolically imbalanced.
Collapse
Affiliation(s)
- Roser Ferrer
- Biochemistry Department, Hospital Universitari Vall D'Hebron, Universitat Autònoma De Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Pardina E, Ferrer R, Rossell J, Baena-Fustegueras JA, Lecube A, Fort JM, Caubet E, González Ó, Vilallonga R, Vargas V, Balibrea JM, Peinado-Onsurbe J. Diabetic and dyslipidaemic morbidly obese exhibit more liver alterations compared with healthy morbidly obese. BBA Clin 2016; 5:54-65. [PMID: 27051590 PMCID: PMC4802404 DOI: 10.1016/j.bbacli.2015.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/17/2015] [Accepted: 12/22/2015] [Indexed: 12/14/2022]
Abstract
Background & aims To study the origin of fat excess in the livers of morbidly obese (MO) individuals, we analysed lipids and lipases in both plasma and liver and genes involved in lipid transport, or related with, in that organ. Methods Thirty-two MO patients were grouped according to the absence (healthy: DM − DL −) or presence of comorbidities (dyslipidemic: DM − DL +; or dyslipidemic with type 2 diabetes: DM + DL +) before and one year after gastric bypass. Results The livers of healthy, DL and DM patients contained more lipids (9.8, 9.5 and 13.7 times, respectively) than those of control subjects. The genes implicated in liver lipid uptake, including HL, LPL, VLDLr, and FAT/CD36, showed increased expression compared with the controls. The expression of genes involved in lipid-related processes outside of the liver, such as apoB, PPARα and PGC1α, CYP7a1 and HMGCR, was reduced in these patients compared with the controls. PAI1 and TNFα gene expression in the diabetic livers was increased compared with the other obese groups and control group. Increased steatosis and fibrosis were also noted in the MO individuals. Conclusions Hepatic lipid parameters in MO patients change based on their comorbidities. The gene expression and lipid levels after bariatric surgery were less prominent in the diabetic patients. Lipid receptor overexpression could enable the liver to capture circulating lipids, thus favouring the steatosis typically observed in diabetic and dyslipidaemic MO individuals. The criteria used to define the “metabolically healthy” obese is not applicable to morbidly obese patients. Virtually no studies of how bariatric surgery affects depending on comorbidities and less how affect to the liver. Anthropometrics, fat, lipid profile and inflammation parameters are different depending of comorbidities, not only in plasma but also in liver. The extent of lipases and lipids in the liver biopsies could help not only the diagnosis but also to follow the course of recovery after surgery. The morbidly obese individuals with diabetes and dyslipidemia have more altered metabolic profiles than the other two groups.
Collapse
Key Words
- ALT, Alanine transaminase
- AST, Aspartate transaminase
- ATGL, Adipose Tissue Glycerol Lipase
- ApoA1, Apolipoprotein A1
- BMI, Body Mass Index
- CPT1a, Carnitine Palmitoyltransferase 1a
- CRP, C-reactive protein
- CYP7a1, Cholesterol 7 Alpha-Hydroxylase
- DL, Dyslipidaemia
- DM, Type 2 diabetes mellitus
- DM + DL +, Obese patients with type 2 diabetes and dyslipidaemia
- DM − DL +, Dyslipidemic obese patients
- DM − DL −, “Healthy” obese patients, or patients without type 2 diabetes or dyslipidaemia
- Diabetes
- FAT/CD36, Fatty Acid Translocase or Cluster of Differentiation 36
- GGT, gamma-glutaryl transferase
- HL, Hepatic lipase
- HMGCR, 3-Hydroxy-3-Methylglutaryl-CoA Reductase
- HOMA-IR, Homeostasis Model Assessment of Insulin Resistance
- HSL, Hormone-sensitive lipase
- HTA, Hypertension
- IL6, Interleukin-6
- IR, Insulin resistance
- KBs, Ketone bodies
- LDLr, Low-Density Lipoprotein receptor
- Lipases
- Lipids
- Liver
- MO, Morbidly obese
- NAFLD
- NAFLD, Non-alcoholic fatty liver disease
- NASH, Non-alcoholic liver steatohepatitis
- NEFA, Non-esterified fatty acid
- PAI1, Plasminogen Activator Inhibitor of Type 1
- PLs, Phospholipids
- PPARα, Peroxisome Proliferator-Activated Receptor alpha
- PPARα, Peroxisome Proliferator-Activated Receptor gamma Coactivator 1-alpha
- QMs, Chylomicrons
- RYGBP, Roux-en-Y gastric bypass
- SAT, Subcutaneous adipose tissue
- SCARB1, Scavenger Receptor Class B, Member 1
- Steatosis
- TAGs, Triacylglycerides
- TC, Total cholesterol
- TNFα, Tumour Necrosis Factor-alpha
- UCP2, Uncoupling Protein 2
- VAT, Visceral adipose tissue
- VLDLr, Very-Low-Density Lipoprotein receptor
- apoB, Apolipoprotein B
- cHDL, High-Density Lipoprotein Cholesterol
- cLDL, Low-Density Lipoprotein Cholesterol
- eNOS3, Endothelial Nitric Oxide Synthase 3
- iNOS2, Inducible Nitric Oxide Synthase 2
Collapse
Affiliation(s)
- Eva Pardina
- Biochemistry and Molecular Biology Department, Biology Faculty, Barcelona University, Spain
| | - Roser Ferrer
- Biochemistry Department, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Joana Rossell
- Biochemistry and Molecular Biology Department, Biology Faculty, Barcelona University, Spain
| | | | - Albert Lecube
- Endocrinology and Nutrition Department, Arnau de Vilanova University Hospital (UdL), Diabetes and Metabolism Research Unit (VHIR, UAB), CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM) del Instituto de Salud Carlos III, Spain
| | - Jose Manuel Fort
- Endocrinology Surgery Unit, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Enric Caubet
- Endocrinology Surgery Unit, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Óscar González
- Endocrinology Surgery Unit, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ramón Vilallonga
- Endocrinology Surgery Unit, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Víctor Vargas
- CIBER de Enfermedades Hepáticas y Digestivas (CIBEREHD) del Instituto de Salud Carlos III (ISCIII), Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Spain
| | - José María Balibrea
- Endocrinology Surgery Unit, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Julia Peinado-Onsurbe
- Biochemistry and Molecular Biology Department, Biology Faculty, Barcelona University, Spain
| |
Collapse
|
8
|
Ferrer R, Pardina E, Rossell J, Baena-Fustegueras JA, Lecube A, Balibrea JM, Caubet E, González O, Vilallonga R, Fort JM, Peinado-Onsurbe J. Decreased lipases and fatty acid and glycerol transporter could explain reduced fat in diabetic morbidly obese. Obesity (Silver Spring) 2014; 22:2379-87. [PMID: 25132069 DOI: 10.1002/oby.20861] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/16/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The possible differences were investigated in 32 morbidly obese patients depending on whether they were "healthy" or had dyslipidemia and/or type 2 diabetes. METHODS Lipid metabolism and insulin resistance were analyzed in subcutaneous (SAT) and visceral adipose tissue (VAT) before and during 6 and 12 months after Roux-en-Y gastric bypass. RESULTS Significant differences have been found in lipoprotein lipase (LPL) and hormone-sensitive lipase (HSL) activities in SAT from the different obese group versus normal weight (control) but not between them. The reduced lipase activities in VAT were 43 and 19% smaller (22 and 4% smaller, respectively, vs. control) than the "healthy" obese group for LPL and HSL, respectively, and were accompanied with a reduced expression of these lipases, as well as decreased expression of FAT/CD36, FABP4, and AQ7 in that tissue. In addition, the expression of the other genes measured showed a downregulation not only versus the "healthy" obese but also versus the normal weight group. CONCLUSIONS Being obese is not "healthy," but it is even less so if morbidly obese patients with diabetes and dyslipidemia were considered. The reduced fat accumulation in these patients may be attributed to the decrease of the expression and activity of the lipases of their adipose tissue.
Collapse
Affiliation(s)
- Roser Ferrer
- Biochemistry Department, Hospital Universitari Vall D'Hebron, Universitat Autònoma De Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
Epidemiological studies have shown that plasma SHBG levels correlate with plasma adiponectin levels, both in men and women. There are no reports describing any molecular mechanism by which adiponectin regulates hepatic SHBG production. The aim of the present study is to explore whether adiponectin regulates SHBG production by increasing HNF-4α levels through reducing hepatic lipid content. For this purpose, in vitro studies using human HepG2 cells, as well as human liver biopsies, were performed. Our results show that adiponectin treatment increased SHBG production via AMPK activation in HepG2 cells. Adiponectin treatment decreased the mRNA and protein levels of enzymes related to hepatic lipogenesis (ACC) and increased those related to fatty acid oxidation (ACOX and CPTI). These adiponectin-induced changes in hepatic enzymes resulted in a reduction of total TG and FFA and an increase of HNF-4α. When HNF-4α expression was silenced by using siRNA, adiponectin-induced SHBG overexpression was blocked. Furthermore, adiponectin-induced upregulation of SHBG production via HNF-4α overexpression was abrogated by the inhibition of fatty acid oxidation or by the induction of lipogenesis with a 30mM glucose treatment in HepG2 cells. Finally, adiponectin levels correlated positively and significantly with both HNF-4α and SHBG mRNA levels in human liver biopsies. Our results suggest for the first time that adiponectin increases SHBG production by activating AMPK, which reduces hepatic lipid content and increases HNF-4α levels.
Collapse
Affiliation(s)
- Rafael Simó
- Diabetes and Metabolism Research Unit (R.S., C.S.-L., C.H., D.M.S.), Vall d'Hebron Institut de Recerca, 08035 Barcelona, Universitat Autónoma de Barcelona, 08193 Barcelona, Centro de Investigación Biomédica en Red, 28029 Madrid, Spain Endocrinology and Nutrition Unit (A.L.), Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain; Endocrine, Metabolic and Bariatric Unit (J.M.F.), General Surgery Department, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
10
|
Ferrer R, Pardina E, Rossell J, Baena-Fustegueras JA, Lecube A, Balibrea JM, Caubet E, González O, Vilallonga R, Fort JM, Peinado-Onsurbe J. Haematological parameters and serum trace elements in "healthy" and "unhealthy" morbidly obese patients before and after gastric bypass. Clin Nutr 2014; 34:276-83. [PMID: 24792189 DOI: 10.1016/j.clnu.2014.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/04/2014] [Accepted: 04/06/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND & AIMS We have investigated the differences in plasma parameters and serum trace elements between "healthy" and unhealthy morbidly obese patients before and after Roux-en-Y gastric bypass surgery. METHODS A group of 32 morbidly obese patients undergoing bariatric surgery were divided into three groups. Group 1 subjects were free of dyslipidemia and type II diabetes mellitus (defined as "healthy" obese, DM-DL-); Group 2 subjects had only the presence of dyslipidemia (DM-DL+), while group 3 patients demonstrated the presence of both (DM + DL+). In all patients, we studied haematological, haemostasis, anaemia, coagulation plasma and trace elements parameters before and 1, 6 and 12 months after gastric bypass surgery. RESULTS We found significant differences in some haematological parameters, including haemostasis (e.g., T-Quick, p = 0.0048) and coagulation (e.g., ATIII and PAI-1, p = 0.001 and p < 0.0001, respectively) and in anaemia parameters (e.g., folate, cobalamin and transferrin, p = 0.0002, p < 0.0001 and p = 0.0001, respectively) but also in serum trace elements between the groups. However, the response to bariatric surgery was similar in the three groups. CONCLUSION Any healthy morbid obese subject is really metabolically "unhealthy" because he or she has many other haematologic or serum abnormalities that are often not included in the criteria for the definition of "healthy" in these obese subjects.
Collapse
Affiliation(s)
- Roser Ferrer
- Biochemistry Department, Hospital Universitari Vall D'Hebron, Universitat Autònoma De Barcelona, Spain
| | - Eva Pardina
- Biochemistry and Molecular Biology Department, Biology Faculty, Barcelona University, Diagonal 643, 08028 Barcelona, Spain
| | - Joana Rossell
- Biochemistry and Molecular Biology Department, Biology Faculty, Barcelona University, Diagonal 643, 08028 Barcelona, Spain
| | | | - Albert Lecube
- Endocrinology and Nutrition Department at Arnau de Vilanova University Hospital (UdL) and Diabetes and Metabolism Research Unit (VHIR, UAB) and CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM) at the Instituto de Salud Carlos III, Spain
| | - José María Balibrea
- Endocrinology Surgery Unit, Hospital Universitari Vall D'Hebron, Universitat Autònoma De Barcelona, Spain
| | - Enric Caubet
- Endocrinology Surgery Unit, Hospital Universitari Vall D'Hebron, Universitat Autònoma De Barcelona, Spain
| | - Oscar González
- Endocrinology Surgery Unit, Hospital Universitari Vall D'Hebron, Universitat Autònoma De Barcelona, Spain
| | - Ramón Vilallonga
- Endocrinology Surgery Unit, Hospital Universitari Vall D'Hebron, Universitat Autònoma De Barcelona, Spain
| | - Jose Manuel Fort
- Endocrinology Surgery Unit, Hospital Universitari Vall D'Hebron, Universitat Autònoma De Barcelona, Spain
| | - Julia Peinado-Onsurbe
- Biochemistry and Molecular Biology Department, Biology Faculty, Barcelona University, Diagonal 643, 08028 Barcelona, Spain.
| |
Collapse
|
11
|
Vilallonga R, Zafon C, Ruiz-Marcellan C, Obiols G, Fort JM, Baena JA, Villanueva B, Garcia A, Sobrinho-Simões M. Malignant thyroid teratoma: report of an aggressive tumor in a 64-year-old man. Endocr Pathol 2013; 24:132-5. [PMID: 23702575 DOI: 10.1007/s12022-013-9250-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Malignant teratoma of the thyroid is a rare and aggressive tumor, frequent in children than in adults. Histologically, thyroid teratomas usually show a predominance of a neuroectodermal component. Mature cartilage and bone may be present. We present the case of primary malignant teratoma of the thyroid in a 64-year-old man. Histologically, the tumor displayed a predominant neuroectodermal component. The diagnosis was confirmed by immunohistochemistry. The patient underwent a radical thyroidectomy with central neck dissection as primary treatment and radioiodine treatment afterwards. The patient had local and distant recurrence. A second surgery was performed with poor results and the patient died 3 months afterwards.
Collapse
Affiliation(s)
- R Vilallonga
- Endocrine, Bariatric and metabolic Unit, Center of Excellence, General Surgery Department, Universitary Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Vilallonga R, Fort JM, Iordache N, Armengol M, Clèries X, Solà M. Use of images in a surgery consultation. Will it improve the communication? Chirurgia (Bucur) 2012; 107:213-217. [PMID: 22712351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The interviews and interactions with patients are part of everyday health care provider. However, there is sometimes a difficulty in communication, linked to several factors. For this reason, the use of images to illustrate the medical conditions in the outpatient clinic can improve patient communication. We report our initial experience with the use of images to manage the quality of care to surigcal patients. METHODOLOGY He used a computer to show pictures of the following conditions: surgery for an inguinal hernia, cholelithiasis, cholecystitis and the choledocholithiasis and finally thyroid pathology. Were randomized two groups of patients. Each of the affected patients in any stage of the disease, they explained their problems. In one of the groups also showed the patient was using the current image and continued to give appropriate explanations related to pathology. Thereafter, patients in both groups filled in an anonymous questionnaire in which they responded to what degree it was considered useful this methodology, and degree of satisfaction received outpatient treatment with or without the deployment of images by computer. We have analyzed the average time expected and made a visit. RESULTS 187 patients will be visited in the consultations over a period of 8 months. In 83 patients have been using images to give the explanations in external consultations. Of these, 24 patients suffering from thyroid, 24 hernias or incisional hernias and 35 patients with biliary tract pathology. Patients in the group were shown images of conditions have responded mostly be very satisfied with the use of images while the explanations are given on the patient's illness. Also, over 80% of patients report being satisfied with this system. The visiting time was not lengthened. DISCUSSION Despite the existence of different variables that can influence patient satisfaction, use of images to illustrate surgical diseases to patients improves communication and flow of the explanations of the physician. CONCLUSIONS The relationship doctor-patient communication is the key event in an outpatient setting. It determines a good overall result of the clinical interview. The use of images in an outpatient improves communication between patients and doctors. Moreover, the degree of satisfaction is high and the degree of understanding of the disease. It seems useful to incorporate in our outpatient clinic.
Collapse
Affiliation(s)
- R Vilallonga
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Universitary Hospital Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
13
|
Ponseti JM, Azem J, Fort JM, López-Cano M, Vilallonga R, Buera M, Cervera C, Armengol M. Long-term results of tacrolimus in cyclosporine- and prednisone-dependent myasthenia gravis. Neurology 2005; 64:1641-3. [PMID: 15883336 DOI: 10.1212/01.wnl.0000160392.32894.6d] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Seventy-nine patients with cyclosporine- and prednisone-dependent myasthenia gravis (MG) after thymectomy received tacrolimus for a mean of 2.5 +/- 0.8 years. Prednisone was withdrawn in all but two patients. Anti-acetylcholine antibodies and MG score for disease severity decreased significantly and muscular strength increased by 39%. Complete stable remission was achieved in 5% of patients and pharmacologic remission in 87.3%. All patients resumed full activities of daily living.
Collapse
Affiliation(s)
- J M Ponseti
- Myasthenia Gravis Unit, Department of Surgery, Hospital General Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Ponseti JM, Fort JM, Carbó C, Marco V. [Myasthenia gravis, thymoma and intestinal pseudoobstruction]. Med Clin (Barc) 2000; 114:597. [PMID: 10846680 DOI: 10.1016/s0025-7753(00)71371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
15
|
Sánchez JL, Espín E, Fort JM, de Lara F, de Torres I, Armengol M. [Sarcoma in the diverticulum of Meckel]. Rev Esp Enferm Dig 1997; 89:334-5. [PMID: 9221027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
16
|
Abstract
BACKGROUND & AIMS Scarce data suggest that cholecystectomy may alter bowel habit. The aim of this study was to determine whether cholecystectomy modifies gut transit. METHODS Five experimental groups were studied: 29 patients with uncomplicated gallstones before and 1 month after elective cholecystectomy, 22 patients 4 years after elective cholecystectomy, 14 patients with postcholecystectomy diarrhea, 5 patients with acute infectious diarrhea (disease controls), and 13 patients before and 1 month after other elective surgery (surgical controls). All participants underwent measurement of colonic transit by a modified radiopaque pellet method and orocecal transit by the standard lactulose breath H2 test. RESULTS One month postoperatively, cholecystectomy had substantially accelerated total colonic transit (51 +/- 5 hours before vs. 38 +/- 5 hours after; P < 0.05) and delayed slightly orocecal transit (80 +/- 4 minutes before vs. 103 +/- 8 minutes after; P = 0.05). Similar colonic and orocecal transit times were measured 4 years after cholecystectomy (40 +/- 4 hours and 105 +/- 8 minutes, respectively). Colonic transit times in patients with the postcholecystectomy diarrhea syndrome were accelerated as much as in patients with infectious diarrhea, who served as controls (19 +/- 3 hours and 15 +/- 4 hours, respectively). Surgery per se had no effect on gut transit. CONCLUSIONS Cholecystectomy shortens gut transit by accelerating colonic passage. These sequelae develop early and persist at least 4 years after cholecystectomy. The postcholecystectomy diarrhea syndrome probably represents a magnification of the above colonic sequelae.
Collapse
Affiliation(s)
- J M Fort
- Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain
| | | | | | | | | |
Collapse
|
17
|
Fort JM. Bacteria and What We Know about Them. Tex Med J (Austin) 1905; 20:487-496. [PMID: 36955386 PMCID: PMC9612999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
|
18
|
Fort JM. Reminiscences of an Old Doctor. Tex Med J (Austin) 1905; 20:357-364. [PMID: 36955415 PMCID: PMC9613045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
|