Biomedical subjects

Bruno Zilberstein

Publications and source records attributed to Bruno Zilberstein.

22 records · Page 2Linked to original sources

PubMedDate not supplied

Simultaneous gastric banding and cholecystectomy in the treatment of morbid obesity: is it feasible?

BACKGROUND: In the last decade, laparoscopic surgery for morbid obesity has become widely employed, including a marked increase in the placement of adjustable gastric bands (AGB). Among the co-morbidities of morbid obesity is cholelithiasis. The question arises whether concomitant cholecystectomy increases the risk of postoperative infectious complications due to the association of a potentially contaminated procedure with a clean operation, placement of an AGB. The aim of this study is to evaluate the postoperative outcome in patients submitted to laparoscopic AGB with cholecystectomy. METHODS: From January 2000 to January 2004, 308 patients (85 men and 223 women) had AGB placed. BMI ranged from 38.9 to 65.6 kg/m(2) (mean 41.6). In 17 patients (5.5%), gallstones were detected by ultrasonography, and cholecystectomy was performed together with the AGB. Mean operative time for placement of the AGB was 58 +/- 18 min, and in those with cholecystectomy 86 +/- 17 min (P =0.20). RESULTS: All patients that had placement of AGB and cholecystectomy had satisfactory postoperative outcome. No infectious complications were observed. CONCLUSION: Laparoscopic cholecystectomy performed simultaneously with placement of an AGB has been a safe procedure.

Adolescent↗

PubMedDate not supplied

Results of biliopancreatic diversion in two patients with Prader-Willi syndrome.

Prader-Willi Syndrome (PWS) is a genetic disorder characterized by hypotonia, mental retardation or learning disability, hyperphagia and compulsive eating due to hypothalamic dysfunction. Obesity is a major cause of increased morbidity and mortality among patients with PWS. Gastric restrictive surgery has been associated with partial breakdown of the staple-line in PWS. We report two patients with PWS associated with morbid obesity and obstructive sleep apnea who underwent biliopancreatic diversion (BPD). A 27-year-old male with BMI 52 kg/m(2) and a 20 year-old female with BMI 64 kg/m(2) underwent BPD. No perioperative complications were observed. After BPD, the male's BMI was 36.7 kg/m(2) at 12 months and the female's BMI was 48.4 kg/m(2) at 28 months, with excess weight loss 58% and 48%, respectively. They developed loose stools associated with eating. These patients have shown a considerable improvement in hypersomnia and respiratory difficulties. BPD proved to be an effective approach to weight loss in PWS, resulting in improvement of sleep apnea, behavior problems and quality of life.

Adult↗

PubMedDate not supplied

Prevalence of pulmonary hypertension in patients with hepatosplenic Mansonic schistosomiasis--prospective study.

BACKGROUND/AIMS: Thirty-four patients with portal hypertension and previous history of esophageal varices hemorrhage due to hepatosplenic Mansonic schistosomiasis were prospectively studied. METHODOLOGY: All patients underwent invasive hemodynamic monitoring with introduction of a pulmonary artery catheter. Hemodynamic evaluation was characterized by an increased cardiac index (4.90 +/- 1.27 L/min/m2) associated to a decrease in systemic vascular resistance index (1461 +/- 443.04 dynes.sec/cm5.m2). RESULTS: Mean pulmonary artery pressure (17.97 +/- 6.97 mmHg) and right atrial pressure (7.65 +/- 3.67 mmHg) were increased while pulmonary vascular resistance index was decreased (147.95 +/- 126.21 dynes.sec/cm5.m2). Twenty-four patients (70.5%) presented pulmonary hypertension (mean pulmonary artery pressure > 15 mmHg); in fifteen (44.1%) pulmonary pressure was between 15 and 20 mmHg, in three between 20 and 25 mmHg and, in four patients, pulmonary pressure was higher than 25 mmHg. CONCLUSIONS: In conclusion, pulmonary hypertension is a frequent complication in patients with portal hypertension due to hepatosplenic Mansonic schistosomiasis and, in 20.6% of the cases, it can be considered as moderate or severe. Our results suggest that shunt surgeries, which can aggravate pulmonary hypertension, should be employed very cautiously in the treatment of schistosomal portal hypertension.

Adolescent↗

PubMedDate not supplied

Postoperative portal vein thrombosis in patients with hepatosplenic mansonic schistosomiasis: relationship with intraoperative portal pressure and flow. A prospective study.

BACKGROUND/AIMS: Portal vein thrombosis is a frequent postoperative complication after esophagogastric devascularization with splenectomy. The aim of this study was to analyze biochemical, hematological, coagulation blood tests and intraoperative portal vein hemodynamics after surgical treatment of hepatosplenic Mansonic schistosomal portal hypertension. METHODOLOGY: Forty patients with hepatosplenic schistosomiasis with indication for surgical treatment were prospectively studied. All patients underwent routine pre- and postoperative biochemical, hematologic, coagulation blood tests and intraoperative portal hemodynamic evaluation (portal pressure and portal flow) before and after esophagogastric devascularization and splenectomy using a 4-F thermodilution catheter introduced inside the portal vein. RESULTS: Portal vein thrombosis, diagnosed by routine postoperative Doppler ultrasonography was found in 22 patients (55%). It was partial in nineteen and total in three. In patients with postoperative portal thrombosis, we observed a reduction in portal flow of 971 +/- 592 mL/min (42 +/- 16%) at the end of the surgery, while this reduction was of 720 +/- 644mL/ min (33 +/- 30%) in those with postoperative pervious portal vein (p = 0.245). The decrease in portal pressure was the same in both groups: 7.2 +/- 3.0 mmHg (23 +/- 10%) and 7.6 +/- 3.8 mmHg (27 +/- 14%) with and without thrombosis respectively (p=0.759). There was also no significant difference between patients with and without portal vein thrombosis regarding pre- and postoperative hemoglobin level or platelet levels, coagulation tests, portal vein diameter and spleen's weight. CONCLUSIONS: Portal vein thrombosis was observed in 55% of the patients but this complication did not show any correlation with the decrease in portal flow or pressure or with biochemical, hematologic, coagulation blood tests, portal vein diameter or spleen's weight.

Endoscopy, Digestive System↗