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Background: The increased prevalence of obesity has led to a significant increase in the occurrence of metabolic syndrome, a recognized risk factor for increased morbidity and mortality from cardiovascular diseases. Hyperglycemia or type 2 diabetes mellitus, dyslipidemia and arterial hypertension are its main components. Since 2015, international guidelines have recognized the benefits of bariatric surgery in each isolated factor of this syndrome. Aim: To evaluate the impact of Roux-en-Y gastric bypass in this syndrome comparing pre- and postoperative periods with laboratory analysis and to compare waist/height ratio and BMI in relation to the determination of the cardiometabolic risk profile. Methods: A retrospective study was carried out, selecting 80 patients undergoing Roux-en-Y gastric bypass. Total cholesterol, HDL, LDL, triglycerides, fasting glucose, glycated hemoglobin, insulin, body mass index (BMI), vitamin D, vitamin B12, waist circumference and waist/height ratio in three periods were analyzed: the preoperative period from 1 to 6 months, postoperative from 1 to 6 months and postoperative from 1 to 2 years. Results: There was an improvement in all parameters of the clinical analyses. The preoperative BMI had a mean value of 39.8, in the preoperative period from 1 to 6 months, the values dropped to 33.2 and in the postoperative period of 1 year, the mean was 26. The perimeter mean values of 118.5 preoperatively, 105.2 postoperatively from 1 to 6 months and 90.3 postoperatively from 1 to 2 years. Waist/height ratio was 0.73, 0.65 and 0.56 in pre, post 1 to 6 months and 1 to 2 years respectively. Conclusion: Roux-en-Y gastric bypass improves metabolic syndrome and waist-to-height ratio is superior to BMI in the assessment of the cardiometabolic risk profile. RESUMO Racional: O aumento da prevalência da obesidade levou ao aumento significativo da ocorrência de síndrome metabólica, fator de risco reconhecido para aumento da morbimortalidade por doenças cardiovasculares. A hiperglicemia ou diabetes mellitus do tipo 2, dislipidemia e hipertensão arterial são seus principais componentes. Desde 2015, diretrizes internacionais reconheceram os benefícios da cirurgia bariátrica em cada fator isolado desta síndrome. Objetivos: Avaliar o impacto do bypass gástrico em Y-de-Roux nesta síndrome comparando períodos pré e pós-operatório com análise laboratorial, e comparar a razão cintura/estatura e o IMC em relação a determinação do perfil de risco cardiometabólico. Métodos: Realizou-se um estudo retrospectivo com base prospectiva selecionando 80 pacientes submetidos à bypass gástrico em Y-de-Roux. Foram analisados o colesterol total, HDL, LDL, triglicerídeos, glicemia de jejum, hemoglobina glicada, insulina, índice de massa corpórea (IMC), vitamina D, vitamina B12, perímetro abdominal e relação cintura/estatura em três períodos: o pré-operatório de 1 a 6 meses, pós-operatório de 1 a 6 meses e pós-operatório de 1 a 2 anos. Resultados: Houve melhora em todos os parâmetros das análises clínicas. O IMC, no pré-operatório, teve a média dos valores de 39,8, no pré-operatório de 1 a 6 meses, os valores caíram para 33,2 e no pós-operatório de 1 ano média foi de 26. O perímetro abdominal teve média dos valores de 118,5, no pré-operatório, 105,2 no pós-operatório de 1 a 6 meses e 90,3 no pós-operatório de 1 a 2 anos. A relação cintura/estatura teve 0,73, 0,65 e 0,56 no pré, pós 1 a 6 meses e 1 a 2 anos respectivamente. Conclusão: O bypass gástrico em Y-de-Roux melhora a síndrome metabólica e a relação cintura/estatura é superior ao IMC na avaliação do perfil do risco cardiometabólico.

Ki-67 in ascending colon: A) experiment and B) control, Background: Intestinal diversions have revolutionized the treatment of morbid obesity due to its viability and sustained response. However, experimental studies suggest, after these derivations, a higher risk of colon cancer. Aim: To analyze the histological and immunohistological changes that the jejunojejunal shunt can produce in the jejunum, ileum and ascending colon. Method: Twenty-four male Wistar rats were randomly divided into two groups, control (n=12) and experiment (n=12) and subdivided into groups of four. Nine weeks after the jejunojejunal shunt, segmental resection of the excluded jejunum, terminal ileum and ascending colon was performed. Histological analysis focused on the thickness of the mucosa, height of the villi, depth of the crypts and immunohistochemistry in the expression of Ki-67 and p53. Results: Significant differences were found between the experiment and control groups in relation to the thickness of the mucosa in the jejunum (p=0.011), in the ileum (p

Background: Obesity changes the anatomy of the patient. In addition to the aesthetic change, the high percentage of fat determines evident functional changes. Anthropometric normality in measuring abdominal circumference and height can serve as a basis for measuring cardiometabolic risks of obesity. Aim: To verify if it is possible to determine parameters of normality between waist and height in people with normal BMI and fat percentages, to serve as a basis for assessing risks for obesity comorbidities. Methods: A sample of 454 individuals with BMI and percentages of fat considered within the normal range was extracted. It was divided into age groups for both men and women between 18 and 25; 26 to 35; 36 to 45; 46 to 55; 56 to 65. A total of 249 men and 205 women were included. Results: Regarding the percentage of height as a measure of the abdominal perimeter, the total female sample had an average of 44.2±1.1% and the male 45.3%+1.5. For women, this percentage determined the equation of the waist-height ratio represented by X=(age+217) / 5.875, and for men X=(age+190.89) / 5.2222. “X” represents the percentage of the height measurement so that the individual falls into the category of adequate percentage of fat and BMI. Conclusion: Between the stature of adult men and women with normal fat percentage and BMI, there is a common numerical relationship, with is on average 44% for women and 45% for men. RESUMO Racional: A obesidade modifica a anatomia de seu portador. Além da mudança estética o alto percentual de gordura determina evidentes alterações funcionais. A normalidade antropométrica na mensuração do perímetro abdominal e estatura pode servir de base na mensuração dos riscos cardiometabólicos da obesidade. Objetivo: Verificar se é possível determinar parâmetros de normalidade entre cintura e estatura em pessoas que apresentem IMC e percentuais de gordura normais, para servir de base na avaliação de riscos para co-morbidades da obesidade. Métodos: Foi extraída amostra de 454 indivíduos com IMC e percentuais de gordura considerados dentro da normalidade. Ela foi dividida em faixas de idade tanto para homens como para mulheres entre 18 a 25; 26 a 35; 36 a 45; 46 a 55; 56 a 65. Totalizou 249 homens e 205 mulheres. Resultados: Em relação ao percentual da estatura como medida do perímetro abdominal, a amostra total feminina apresentou média de 44,2±1,1% e a masculina 45,3%+1,5. Para as mulheres este percentual determinou a equação da relação cintura-estatura representado por X=(idade+217)/5,875, e para homens X= (idade+190,89) /5,2222. “X” representa o percentual da medida da estatura para que o indivíduo se enquadre na categoria de adequados percentual de gordura e IMC. Conclusão: Entre a estatura de homens e mulheres adultos possuidores de percentuais de gordura e IMC normais, existe relação numérica comum, sendo em média 44% para mulheres e 45% para homens.

Background: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. Aim: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. Methods: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. Results: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. Conclusion: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.

Pentraxine-3 (PTX3) is a member of the humoral innate immune system and serves a role in protection against infections, inflammation control and matrix deposition. The aim of the present study was to measure the PTX3 levels in obese patients and its association with glycemic and lipid profiles, and to analyze the effects of weight loss provided by bariatric surgery in serum PTX3 levels. PTX3 was measured in 84 obese patients whom underwent bariatric surgery and 94 healthy controls. Lipid and glycemic profiles were determined using a clinical chemistry analyzer, and PTX3 levels were measured in patients prior to and following bariatric surgery using ELISA. PTX3 levels prior to surgery were significantly lower compared with the normal controls (median of 0.10 vs. 0.80 ng/ml; P

PURPOSE: To compare the two lines suture (total and seromuscular) after partial gastrectomy in normal and overweight rats. METHODS: Forty Wistar rats were distributed in two groups. Group A received normal diet; group B, normal diet and supplementation with saccharose in the water. When group B progressed to a statistically greater weight than the animals of group A, the experiment (sleeve-like gastrectomy) was conducted with gastrorraphy in two sutures lines (total and seromuscular).The animals were distributed into two subgroups of 10. A1 and A2 subgroups were sacrificed at 7 and 14 days postoperatively as well as B1 and B2. Mortality, morbidity, complications attributed to the gastric suture, biochemical dosages, Lee index, macroscopy, weight of retroperitoneal and gonadal fat, optical microscopy with hematoxylin-eosin and picrosirius-red, were the evaluation parameters. RESULTS: The overweight group achieved statistically greater weight after 16 weeks in induced obesity; there was no mortality or complications with clinical consequences attributable to morbidity. The overweight group had statistically greater weight of gonadal and retroperitoneal fat. The difference was observed in urea, albumin, total cholesterol and indirect bilirubin. CONCLUSION: There was no outcome difference between the overweight and non-overweight group in two suture lines in gastrorrhaphy after sleeve-like gastrectomy.

Objective:To evaluate the prevalence of carpal tunnel syndrome in candidates for bariatric surgery comparing with the non-obese population and verify the effects on it of bariatric treatment. Methods:We studiedthree groups of individuals: 1) patients waiting for bariatric surgery (preoperative); 2) individuals who had already undergone the procedure (postoperative); and 3) control group. We collected demographic and clinical data of carpal tunnel syndrome. The Ultrasound examination was carried out to diagnose the syndrome by measuring the median nerve area. Results:We included 329 individuals (114 in the preoperative group, 90 in the postoperative group and 125 controls). There was a higher prevalence of paresthesias (p=0.0003), clinical tests (p=0.0083) on the preoperative group when compared with controls (p

Studies related to obesity have shown association with metabolic syndrome. Data showing that obesity is capable to cause low grade chronic inflammation, without its classic signs and symptoms, call attention to researches to study different cells types and the mechanism of the inflammatory process.To evaluate the variation of glycated hemoglobin (HbA1c) and the pro-inflammatory cytokine interleukin-6 (IL6) in diabetic patients with BMI35 kg/m2 in the pre and postoperative of partial duodenal switch.Nine patients were studied before and one year after the operation and the variation of the serum IL6 was measured by Elisa. The changes of HbA1c were also registered.The pre-operative IL6 levels reached 65,50436±2,911993 pg/ml and one year after de operation 39,47739±3,410057 and the HbA1c average of 10,67 and 5.8 in the same period.The partial duodenal switch was efficient to control one year after the procedure the chronic inflammatory process caused by the diabetes mellitus type 2 with BMI35 by dropping the IL6 levels and bringing the HbA1c to normal.Os estudos relacionados à obesidade têm evidenciado sua associação com a síndrome metabólica. A descoberta que a obesidade é capaz de promover inflamação, sem os sinais clássicos, tem levado vários grupos de pesquisa a caracterizar os tipos celulares que agem e o mecanismo envolvido neste processo.Avaliar a variação da hemoglobina glicada e a secreção da citocina inflamatória, interleucina-6, em indivíduos diabéticos com IMC35 kg/m² no pré e pós-operatório da técnica de desvio duodenal parcial.Nove pacientes foram avaliados antes e um ano após a operação e a variação da concentração da interleucina-6 foi avaliada pela metodologia de Elisa. Também foi avaliada a variação da HbA1c.A quantificação de interleucina-6 apresentou no pré-operatório valor de 65,50436±2,911993 pg/ml e de 39,47739+3,410057 pg/ml após um ano da operação e a hemoglobina glicada apresentou média de 10,67 no pré-operatório e de 5,8 após um ano da operação.O desvio duodenal parcial foi capaz de, um ano após o procedimento, diminuir os efeitos da inflamação crônica demonstrada pela diminuição da concentração da interleucina-6 plasmática e normalizar a hemoglobina glicada em pacientes diabéticos com IMC35 kg/m2.

Background : Bariatric operations have variable range of complications and postoperative benefits. Gastroesophageal reflux is considered potential factor that may result in damage to the esophageal mucosa and this subject is quite controversial in the literature. Aim: To evaluate patients who underwent to Roux-en-Y gastrojejunal bypass correlating epidemiologic and endoscopic findings in pre and postoperative periods. Method: A retrospective, paired study which evaluated 110 patients. Inclusion criteria were formal indication for bariatric surgery and patients with pre and postoperative endoscopy. Exclusion criteria were previous bariatric surgery, patients subjected to other types of bariatric surgery and those who had no pre or postoperative upper digestive endoscopy. The epidemiological variables were: sex, age, body mass index, type 2 diabetes mellitus or impaired glucose tolerance, and preoperative dyslipidemia. Results: The preoperative upper endoscopy was normal in 26.4% of the patients. Among endoscopic alterations, the hiatus hernia was the most prevalent followed by non-erosive gastritis. The postoperative upper endoscopy was normal in 40.9% and stenosis was the most prevalent followed by marginal ulcer. Correlation on pre and postoperative endoscopies, was found 100% reduction of hiatal hernias and 88% of esophagitis. There was no statistical significance in relationship to anastomotic stenosis with preoperative other variables. Conclusions . There was significant decrease in postoperative hiatus hernia, erosive esophagitis, non-erosive esophagitis, erosive gastritis and non-erosive gastritis with the operation. Stenosis of the gastrojejunostomy anastomosis was the most prevalent postoperative complication with no correlation with preoperative variables.

OBJECTIVES: 1) To assess the changes in body weight and body mass index in grade 2 and 3 obese patients with type 2 diabetes mellitus, pre and postoperatively; 2) to assess the changes in pre and postoperative fasting blood glucose, postprandial glucose, glycated hemoglobin and insulin. METHODS: A prospective study was undertaken with 40 selected patients with grade 2 and 3 obesity and type 2 diabetes mellitus, all with indication for surgical treatment of obesity. All patients underwent Roux-en-Y gastric bypass without ring. The clinical parameters weight and body mass index were analyzed, as well as the laboratory parameters fasting blood glucose, postprandial glucose, glycated hemoglobin, and insulin. The analyses were carried out in the preoperative period and at 60 days postoperatively. Statistical analysis was conducted with Student's t and the Kolmogorov-Smirnov tests. RESULTS: Mean preoperative weight was 107.3 kg, declining to 89.5 kg postoperatively. Mean initial body mass index was 39.5 kg/m2, and 32.9 kg/m2 at 60 postoperative days. Preoperative fasting blood glucose was 132 mg/dL, which was reduced to 40.4 mg/dL, on average, postoperatively. Postprandial blood glucose was 172 mg/dL in the preoperative period and 111.6 mg/dL in the postoperative measurement. Initial glycated hemoglobin was 7%, declining to 5.7% postoperatively. Preoperative and postoperative insulin levels were 29.6 µIU/mL and 13.9 µIU/mL, respectively. The level of significance was p

RACIONAL: A obesidade é doença multifatorial. A coleta de dados exerce papel fundamental para realização de pesquisas de alto grau de qualidade e, na atualidade, a cirurgia da obesidade carece de meios para realização de pesquisas prospectivas com elevado nível de confiabilidade. Os dados obtidos em protocolos eletrônicos são mais completos, têm poucos erros, são mais consistentes e apresentam baixo percentual de violação em relação aos prontuários de papel. OBJETIVO: 1) Criar base teórica de dados clínicos referentes à multiprofissionalidade na abrangência da Cirurgia Bariátrica e Metabólica; 2) informatizar essa base transformando-a em protocolo eletrônico multiprofissional; 3) incorporá-la ao SINPE©; 4) disponibilizar este protocolo eletrônico e suas coletas para visualização via internet utilizando SINPE WEB©. MÉTODO: A criação da base teórica em Word© - depois transformada em forma digital para ser utilizada como protocolo eletrônico - foi baseada na revisão bibliográfica de nove livros-texto em obesidade mórbida, cirurgia bariátrica e metabólica, livros de multiprofissionalidade, livros específicos em psicologia e nutrição aplicados ao tema. Adicionou-se revisão sistemática da literatura atual com base em artigos científicos publicados nos últimos cinco anos no Medline/Pubmed, Lilacs e Scielo e também em teses e dissertações realizadas com protocolos eletrônicos. Assim, foram informatizados 10.306 itens de forma hierarquizada e ramificada contendo dados relacionados à medicina, fisioterapia, psicologia e nutrição. RESULTADOS: O protocolo completo poderá ser acessado para visualização no site www.sinpe.com.br. CONCLUSÕES: 1) Foi possível criar base eletrônica de dados clínicos referentes à multiprofissionalidade em cirurgia bariátrica e metabólica para coleta padronizada de informações; 2) foi possível informatizar esta base de dados; 3) ela está incorporada ao SINPE©; 4) o protocolo eletrônico e suas coletas foram disponibilizados para visualização via internet utilizando SINPE WEB©. BACKGROUND: Obesity is a multi factorial disease. Data collection plays a fundamental role for conducting papers with high level of quality and obesity surgery lacks the means to carry out prospective studies with high reliability. Data from electronic protocols are more complete, have fewer errors, are more consistent and have a low percentage of violations in relation to paper charts. AIM: 1) To create a theoretical basis of clinical data regarding the multiprofessionalism on metabolic and bariatric surgery; 2) to computerize this basis by transforming it into electronic multi professional protocol; 3) to incorporate it into the SINPE©; 4) to provide the protocol address and their collections for viewing via the Internet using SINPE WEB©. METHOD: The creation of the theoretical background was done in Word© - later transformed into digital form to be used as electronic protocol - based on literature review of nine textbooks in morbid obesity, bariatric surgery and metabolic multi professionalism books, special books in psychology and nutrition applied to the subject. Was added systematic review of the literature based on scientific articles published over the last five years in Medline/Pubmed, Lilacs and Scielo and in theses and dissertations done with electronic protocols. Thus, 10,306 items were computerized in a hierarchical and branched containing data related to medicine, physiotherapy, psychology and nutrition applied to the subject. RESULTS: The complete protocol can be accessed to view in site www.sinpe.com.br CONCLUSIONS: 1) It was possible to create electronic database regarding the clinical multi professionalism on bariatric and metabolic surgery to collect standardized information; 2) it was possible to computerized the database; 3) it is incorporated into the SINPE©; 4) the electronic protocol and its collections were made available for viewing via the Internet using SINPE WEB©.

RACIONAL: No indivíduo portador de obesidade há evidentes alterações morfofuncionais, que caracterizam a síndrome. São empregados vários parâmetros e índices perimétricos na análise de suas medidas antropométricas, que possuem relação com as alterações endocrinometabólicas. Muitos destes índices são aplicados de forma generalizada à população de uma maneira geral. OBJETIVO: Verificar a existência de uma razão cintura-estatura comum em indivíduos masculinos, de 18 a 25 anos de idade, portadores de percentuais de gordura normais, para fornecer modalidade de medida da cintura (perímetro) abdominal personalizada e não generalizada. MÉTODOS: Foram selecionados de forma não probabilística intencional 380 sujeitos do sexo masculino, da faixa etária entre 18 e 45 anos, estratos de estatura de 160 a 169 cm, 170 a 179 cm e de 180 a 189 cm, do banco de dados do Ambulatório da Clínica Escola da empresa IBRATE - Instituto Brasileiro de Therapias e Ensino, sede de Curitiba/PR, com dados inclusos entre os anos de 2004 a 2008. Desta população foram triados 174 indivíduos, da faixa etária entre 18 e 25 anos, possuidores de percentuais de gordura dentro da faixa de normalidade, ou seja, entre 4% e 16% de gordura. Foi determinado coeficiente de correlação de Pearson (r) entre o percentual de gordura e o perímetro abdominal; foi determinada a média e o desvio-padrão de todas as variáveis dispostas, e o intervalo de confiança para 95% para média do perímetro abdominal e as razões cintura-estatura da população foram transcritos em percentuais, e determinadas as médias do perímetro abdominal. RESULTADOS: A análise da amostra de 174 indivíduos resultou estarem na faixa etária de 21,2 + 2,1 anos; com estatura de 174,3 + 6,2 cm; com percentual de gordura de 10,8 %; com medida do perímetro abdominal de 75,5 + 5,7 cm e com a razão cintura/estatura apresentando o valor de 0,43 + 0,033. CONCLUSÃO: Existe relação comum da razão cintura-estatura entre indivíduos do sexo masculino de faixa etária entre 18 e 25 anos portadores de percentual normal de gordura de 43% do valor de sua estatura. BACKGROUND: Obese people have evident morphologic changes characterizing the syndrome. Different parameters and index are used to analyze their anthropometric measurements related to metabolic diseases. Many of these are applied widely to the population in general. AIM: To verify the existence of the waist-height common in male individuals from 18 to 25 years of age, with normal percentages of fat, to provide a method for measuring the circumference (perimeter) abdominal. METHODS: It was selected a non-probabilistic intentional 380 male subjects group, aged between 18 and 45 years (2004 to 2008) with160 to 169 cm, 170 to 179 cm and 180 to 189 cm of height, taken from the database Outpatient Clinic School Company IBRATE - Brazilian Institute of Therapy and Education, based in Curitiba, PR, Brasil. From this population were screened 174 individuals, aged between 18 and 25 years, owners of percentage of fat within the normal range between 4% and 16%. Spearman's correlation coefficient (r) was used between fat percentage and waist circumference, determined by mean and standard deviation of all variables, with confidence interval of 95% for average waist circumference and population reasons waist-height. RESULTS: The analysis showed 174 men with age 21,2 + 2,1 y; height 174,3 + 6,2 cm; fat percentage of 10,8 %; abdominal circumference of 75,5 + 5,7 cm and waist-height reason of 0,43 + 0,033. CONCLUSION: There is a correlation in the waist-height among men from 18 and 25 years old with normal fat percentage of 43% of the stature.

Tendinopathies and tendon tears account for over 30% of all musculoskeletal consultations. Obesity, which is becoming one of the world´s most prevalent public health issues, may be associated with this condition.To review the literature about tendinopathies and obesity association.This is a descriptive exploratory study using the portal Medline. Literature in English language from 2006 to 2014 were reviewed.The pathogenesis of tendinopathies includes inflammatory, regenerative and degenerative processes that happen simultaneously from early to late phases of the disease. Mechanical stress upon tendons seems to be one of the most important factors to initiate the inflammatory response, but it´s not the only one that can deflagrate it: there are other extrinsic, genetic and metabolic factors that may be involved. Therefore, tendinopathies in obese patients can be due to tendon overload because of the excess of weight, but also because of increased production of pro-inflammatory mediators related to fat tissue such as adipokines. This pro-inflammatory state that obese people can suffer is known as adiposopathy, or sick fat syndrome. Weight loss is associated with decrease in adipokines and improvement of musculoskeletal symptoms.The relation of obesity and tendinopathies is supported by evidences of recent studies, exemplified in this review of literature.As tendinopatias e as fissuras em tendões respondem por 30% de todas as consultas médicas. A obesidade, que está se tornando um dos problemas de saúde pública mais prevalentes no mundo, pode estar associada com esta condição.Revisar a literatura acerca da associação entre obesidade e tendinopatias.Este é um estudo exploratório e descritivo utilizando artigos em língua inglesa do portal médico Medline, do período de 2006 a 2014.Na patogênese das tendinopatias incluem-se elementos inflamatórios, regenerativos e degenerativos que aparecem de maneira simultânea em todos os estágios da doença. O estresse mecânico sobre os tendões parece ser um dos mais importantes na promoção do processo inflamatório inicial. Todavia não é o único. Existem fatores ambientais, genéticos e metabólicos atuando de maneira ativa. Portanto, as tendinopatias em indivíduos obesos podem se dever à sobrecarga mecânica pelo excesso de peso, mas, também, pelo aumento na produção de mediadores pró-inflamatórios relacionados ao tecido adiposo, como as adipocinas. O estado pró-inflamatório existente no indivíduo obeso é conhecido como adiposopatia ou síndrome da "gordura doente". A perda de peso está associada com decréscimo das adipocinas e diminuição da sintomatologia musculoesquelética.A associação da obesidade com tendinopatias tem sido fundamentada em estudos recentes como os desta revisão de literatura.

Introduction : Concurrently with the pandemic obesity is observed global aging phenomenon, with a significant increase of obesity in the elderly population. Aim : To review the indications for bariatric surgery for the elderly, mainly focusing on the morbidity and mortality of procedures. Method : Review of the literature in PubMed/Medline and Scielo focusing on the relationship of risk factors with different techniques of bariatric surgery in the elderly. The following descriptors were crossed in the form of AND/OR: Obesity; Bariatric surgery; Complications; Elderly. Conclusion : In people older than 60 years bariatric procedures represent acceptable and effective treatment option. The elderly should be treated in specialized centers with experience in major surgical procedures and low morbimortality. Going in this way, they experience the benefits of bariatric surgery with acceptable morbidity and mortality. However, age alone should not be considered as an absolute impediment for surgical indication. Introdução: Concomitantemente com a pandemia da obesidade, observa-se fenômeno de envelhecimento global, com aumento significativo na população de idosos obesos. Objetivo: Revisar as indicações da cirurgia bariátrica para os idosos, focando principalmente a morbimortalidade dos procedimentos. Método : Revisão da literatura nas bases PubMed/Medline e Scielo com foco na relação dos fatores de risco com diversas técnicas de cirurgia bariátrica em idosos. Foram cruzados os seguintes descritores na forma de AND/OR: Obesidade; Cirurgia bariátrica; Complicações; Idosos. Conclusão: Nas pessoas com idade superior a 60 anos os procedimentos bariátricos representam opção aceitável e efetiva de tratamento. Os idosos devem ser tratados em centros especializados, de grande movimento cirúrgico e baixos índices de morbidade e mortalidade13. Com isso, eles experimentam os benefícios da cirurgia bariátrica com aceitável morbimortalidade. Contudo, a idade por si só não deve funcionar como um impeditivo absoluto na indicação cirúrgica.

BACKGROUND: The association between obesity and gastroesophageal reflux disease has a high incidence and may be present in half of obese patients with surgical indication. Bariatric operations can also induce reflux alone - differently from BMI factors - and its mechanisms are dependent on the type of procedure performed. OBJECTIVE: To perform a literature review comparing the two procedures currently most used for surgical treatment of obesity and analyze their relationship with the advent of pre-existing reflux disease or its appearance only in postoperative period. METHOD: The literature was reviewed in virtual database Medline/PubMed, SciELO, Lilacs, Embase and Cochrane crossing the following MeSH descriptors: gastric bypass AND / OR anastomosis, Roux-en-Y AND / OR gastroesophageal reflux AND / OR gastroenterostomy AND / OR gastrectomy AND / OR obesity AND / OR bariatric surgery AND / OR postoperative period. A total of 135 relevant references were considered but only 30 were used in this article. Also was added the experience of the authors of this article in handling these techniques on this field. CONCLUSION: The structural changes caused by surgical technique in vertical gastrectomy shows greater commitment of antireflux mechanisms predisposing the induction of GERD postoperatively compared to the surgical technique performed in the gastrointestinal Bypass Roux-en-Y. INTRODUÇÃO: A associação entre obesidade e doença do refluxo gastroesofágico apresenta alta incidência e pode estar presente em metade dos obesos com indicação cirúrgica. Operações bariátricas podem também induzir refluxo por si só - de modo diferente do fator IMC -, e seus mecanismos são dependentes do tipo do procedimento realizado. OBJETIVO: Efetuar revisão bibliográfica comparando os dois procedimentos atualmente mais utilizados para tratamento cirúrgico da obesidade e analisar a relação deles com o advento de doença do refluxo gastroesofágico pré-existente ou de surgimento somente no pós-operatório. MÉTODO: Foi realizada revisão bibliográfica nas bases virtuais Medline/Pubmed, Scielo, Lilacs, Embase e Cochrane cruzando os seguintes descritores MeSH: gastric bypass AND/OR anastomosis, Roux-en-Y AND/OR gastroesophageal reflux AND/OR gastroenterostomy AND/OR gastrectomy AND/OR obesity AND/OR bariatric surgery AND/OR postoperative period. Foram consideradas pertinentes 135 referências e utilizadas 30 neste artigo. Também foi adicionada a experiência dos autores deste artigo no manuseio dessas técnicas com esse mister. CONCLUSÃO: As alterações estruturais causadas pela técnica operatória na gastrectomia vertical apresenta maior comprometimento dos mecanismos anti-refluxo predispondo a indução da DRGE no pós-operatório quando comparado à técnica operatória realizada no Bypass gastrointestinal em Y-de-Roux.

The surgical technique of sleeve gastrectomy has not been fully standardized and, therefore, there are issues to be solved. There is a tendency to increase its application due to proved efficiency in weight loss, low morbidity and good postoperative results. However, gastroesophageal reflux disease, which can result from it, is still not well understood.To present variant technique for sleeve gastrectomy that leaves the stomach totally with the appearance of a homogeneous tube, without manipulation in pyloric and lower esophageal sphincters.Vertical gastrectomy starts with vessel ligation of the greater curvature at the pylorus till esophagogastric angle. Stapling also starts from the pylorus in the same direction. For modeling was used Fouchet 32 F and all the staple line was done just to it. At the end, oversuture of the staple line and "sump" drainage were done.The procedure was used in 55 patients with BMI between 35 and 41. Complications in this group were two fistulas at the esophagogastric angle, one twist of the gastric tube and one postoperative conversion to Roux-en-Y gastric bypass due to untreatable gastroesophageal reflux disease. Fistulas were treated by endoscopic procedure with dilation and septotomy. Mild dysphagia due to tube twisting responded satisfactorily to dilatation. The longest follow-up was two years. The loss of overweight was 67.7% at one year and 69.7% in two. Patients who were suffering from type 2 diabetes mellitus showed disease control in 84.6 % in the first year and 91.6 % in the second. Comorbidities were controlled in all cases.The variant technique proposed here for sleeve gastrectomy leaves the stomach homogeneously in a shape of a tube and in small caliber, providing small free gastric cavity and keeping natural functional activity of the sphincters. However, it may lead to unwanted gastroesophageal reflux, which needs to be better measured in future research.

Although is complex to identify the factors responsible for the important growth in obesity all over the world, the main causes are increased consumption of energy, highly saturated fats and sugars, and reduced physical activity.To compare rats with normal and supplemented diet with sucrose in relationship to body mass, weight of gonadal and retroperitoneal fat and Lee index.Forty rats were divided into two groups: 20 in the control group that received normal chow diet and water for three months, and 20 animals in the experimental group who received the same diet but supplemented with sucrose 300 g/l of water. The animals were weighed once a week during 91 days. At scheduled death, they had measured the naso-anal length, body weight and Lee index. After laparotomy, retroperitoneal and gonadal fat were isolated, dried and the percentage of weight in relation to body weight at the date of death was evaluated.There was a statistic significant difference between the 14th and 78th day favoring the experiment group indicating that sucrose interferes with weight gain in rats. The average weight was higher in the experimental group in all periods in comparison to initial weight. There was also significant difference in the weight of the gonadal and retroperitoneal fat. There was no significant difference comparing the Lee index.The body mass index was higher in animals treated with diet supplemented with sucrose and had higher gonadal and retroperitoneal fat, but no difference in the Lee index.

About 90% of type 2 diabetic patients are obese or overweight. The obvious clinical improvement observed with surgeries, such as Roux-en-Y gastric bypass, has opened space for research by different factors than only weight loss, as responsible for the return to euglycemia and reduction of medication use.To evaluate the efficacy and safety of surgical treatment of diabetes in obese patients with BMI above 35 kg/m2 underwent to gastric bypass, for the control of diabetes, weight loss, improvement of laboratory findings and complications of diabetes.The protocol was implemented in three stages: initial, after losing 10% of weight, and after a year.Seventeen patients who have lost weight in 10% were included in the surgical protocol. From the total, 11.8% continued needing medication (p0.001). The time for weight loss was a month with significant reduction in fasting glucose, HOMA-IR index, insulin, HbA1c, hemoglobin, AST, urea and C-peptide and there was no variation in hematocrit, albumin, ALT and creatinine. With a year of monitoring, the surgical group showed a significant difference in weight, BMI, blood glucose, HbA1c, C-peptide, insulin and HOMA-IR. The percentage of patients with neuropathy (31.3%) was lower than the number of cases at baseline (52.9%) (p0.05).Gastric bypass with Roux-en-Y derivation is a safe procedure, with good results in control of diabetes type 2 in obese patients with BMI above 35 kg/m2.

RACIONAL: Cerca de 90% dos diabéticos tipo 2 são obesos ou têm sobrepeso. A evidente melhora clínica observada com o tratamento cirúrgico, como a derivação gástrica em Y-de-Roux, abriu caminhos para a pesquisa de outros fatores, que não somente a perda de peso, como responsáveis pelo retorno à euglicemia ou redução no tratamento medicamentoso. OBJETIVO: Avaliar a eficácia e segurança do tratamento cirúrgico do diabete melito em obesos com IMC acima de 35 Kg/m2 submetidos ao by-pass visando o controle do diabetes, perda de peso, melhora nos parâmetros laboratoriais e complicações do diabete. MÉTODOS: O protocolo do estudo foi aplicado em três momentos: o inicial; após perda de 10% do peso; e após um ano. RESULTADOS: Foram analisados 17 pacientes que perderam 10% de peso; 11,8% continuaram com necessidade de medicamento (p0,05). CONCLUSÃO: A derivação gástrica em Y-de-Roux é procedimento seguro, com bons resultados no controle do diabete em obesos com IMC acima de 35 Kg/m2. BACKGROUND: About 90% of type 2 diabetic patients are obese or overweight. The obvious clinical improvement observed with surgeries, such as Roux-en-Y gastric bypass, has opened space for research by different factors than only weight loss, as responsible for the return to euglycemia and reduction of medication use. AIM: To evaluate the efficacy and safety of surgical treatment of diabetes in obese patients with BMI above 35 kg/m2 underwent to gastric bypass, for the control of diabetes, weight loss, improvement of laboratory findings and complications of diabetes. METHOD: The protocol was implemented in three stages: initial, after losing 10% of weight, and after a year. RESULTS: Seventeen patients who have lost weight in 10% were included in the surgical protocol. From the total, 11.8% continued needing medication (p 0.05). CONCLUSION: Gastric bypass with Roux-en-Y derivation is a safe procedure, with good results in control of diabetes type 2 in obese patients with BMI above 35 kg/m2.

RACIONAL: Cálculos metabólicos e de atividade física são realizados a partir do tecido ativo presente no corpo, conhecido como massa corporal magra, que resulta da soma da massa magra isenta de gordura com a gordura essencial. A cinesioterapia é a musculação terapêutica que auxilia na força e flexibilidade. OBJETIVOS: No paciente submetido a tratamento cirúrgico para obesidade mórbida: 1) avaliar o efeito da fisioterapia contra-resistida na massa magra; 2) avaliar os fatores associados às variações de massa corporal magra com tratamento fisioterapêutico; 3) comparar o grupo de pacientes que perdeu com o que ganhou massa magra com o tratamento fisioterapêutico, analisando as co-morbidades que interferiram para esses resultados. MÉTODO: Foram incluídos 100 pacientes operados pela técnica de Fobi-Capella, ou derivação em Y-de-Roux, sem anel e divididos em grupo A composto por pacientes que perderam massa corporal magra nos dois períodos avaliados (entre 30 dias e três meses e entre três meses e seis meses) e o grupo B pelos demais pacientes que apresentaram ganho de massa corporal magra em pelo menos um dos períodos avaliados. A coleta de dados foi realizada através do Protocolo Eletrônico Multiprofissional em Cirurgia Bariátrica e Metabólica com Ênfase em Fisioterapia, identificado pela siga SINPE© (Sistema Integrado de Protocolos Eletrônicos). Os pacientes realizaram avaliação fisioterapêutica pré-operatória e foram acompanhados no período pós-operatório em quatro fases: na internação hospitalar, submetidos à musculação terapêutica em 30 dias após a operação, aos três meses e aos seis meses do pós-operatório. RESULTADOS: Houve diferença significativa entre as três avaliações (p

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 P