Background/ObjectivesThe pathological condition of obesity is accompanied by a dysfunctional adipose tissue. We postulate that subcutaneous, preperitoneal and visceral obese abdominal white adipose tissue depots could have stromal vascular fractions (SVF) with distinct composition and adipose stem cells (ASC) that would differentially account for the pathogenesis of obesity.MethodsIn order to evaluate the distribution of SVF subpopulations, samples of subcutaneous, preperitoneal and visceral adipose tissues from morbidly obese women (n = 12, BMI: 46.2±5.1 kg/m2) were collected during bariatric surgery, enzymatically digested and analyzed by flow cytometry (n = 12). ASC from all depots were evaluated for morphology, surface expression, ability to accumulate lipid after induction and cytokine secretion (n = 3).ResultsA high content of preadipocytes was found in the SVF of subcutaneous depot (p = 0.0178). ASC from the three depots had similar fibroblastoid morphology with a homogeneous expression of CD34, CD146, CD105, CD73 and CD90. ASC from the visceral depot secreted the highest levels of IL-6, MCP-1 and G-CSF (p = 0.0278). Interestingly, preperitoneal ASC under lipid accumulation stimulus showed the lowest levels of all the secreted cytokines, except for adiponectin that was enhanced (p = 0.0278).ConclusionsASC from preperitoneal adipose tissue revealed the less pro-inflammatory properties, although it is an internal adipose depot. Conversely, ASC from visceral adipose tissue are the most pro-inflammatory. Therefore, ASC from subcutaneous, visceral and preperitoneal adipose depots could differentially contribute to the chronic inflammatory scenario of obesity.

Background: Hepatopancreatoduodenectomy is one of the most complex abdominal operations mainly indicated in advanced biliary carcinoma. Aim: To present 10-year experience performing this operation in advanced malignant tumors. Methods: This is a retrospective descriptive study. From 2004 to 2014, 35 hepatopancreatoduodenectomies were performed in three different institutions. The most common indication was advanced biliary carcinoma in 24 patients (68.5%). Results: Eighteen patients had gallbladder cancer, eight Klatskin tumors, five neuroendocrine tumors with liver metastasis, one colorectal metastasis invading the pancreatic head, one intraductal papillary mucinous neoplasm with liver metastasis, one gastric cancer recurrence with liver involvement and one ocular melanoma with pancreatic head and right liver lobe metastasis. All patients were submitted to pancreatoduodenectomy with a liver resection as follows: eight right trisectionectomies, five right lobectomies, four left lobectomies, 18 central lobectomies (IVb, V and VIII). The overall mortality was 34.2% (12/35) and the overall morbidity rate was 97.4%. Conclusion: Very high mortality is seen when major liver resection is performed with pancreatoduodenectomy, including right lobectomy and trisectionectomy. Liver failure in combination with a pancreatic leak is invariably lethal. Efforts to ensure a remnant liver over 40-50% of the total liver volume are the key to obtain patient survival.

Macrophage infiltration into adipose tissue (AT) is a hallmark of the chronic inflammatory response in obesity and is supported by an intense monocyte migration towards AT. Although it has been detected an increased proportion of circulating CD16 monocyte subsets in obese subjects, the mechanisms underlying this effect and the contribution of these cells to the inflamed profile of obese AT are still poorly understood. We investigated whether factors secreted by human obese omental AT could polarize monocytes to CD16 enriched phenotype, and how these changes could modify their migratory capacity towards adipose tissue itself. We show that explants of human obese omental AT, obtained during bariatric surgery, released higher levels of MIP1-α, TNFα, leptin and also VEGF, together with increasing amounts of microparticles (MP), when compared to explants of lean subcutaneous AT. A higher content of circulating MP derived from preadipocytes and leukocytes was also detected in plasma of obese subjects. Conditioned media or MP released from obese omental AT increased CD16 and CCR5 expression on CD14CD16 monocytes and augmented their migratory capacity towards the conditioned media from obese omental AT, itself. This effect was inhibited when MIP1-α was neutralized. Additionally, we demonstrate that MP derived from obese omental AT carry and transfer TLR8 to monocytes, thus triggering an increase in CD16 expression in those cells. Our data shows a positive feedback loop between blood monocytes and obese omental AT, which releases chemotactic mediators and TLR8-enriched MP, thus inducing an up-regulation of CD16 monocytes, favoring leukocyte infiltration in the obese omental AT.

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Métodos: Métodos: Métodos: Métodos: Foi realizada uma análise dos sintomas descritos como dumping em 34 pacientes obesos mórbidos submetidos ao bypass gástrico com reconstrução em Y de Roux, por meio do preenchimento de um questionário que incluiu um sistema de escore para o diagnóstico clínico da síndrome de dumping, descrito por Sigstad. Resultados:Resultados: Resultados: Resultados: Resultados: A ocorrência de dumping com base em critérios subjetivos foi de 44%. Aplicando o escore para diagnóstico clínico, a ocorrência foi de 76%. Os sintomas mais freqüentes foram "vontade de deitar" (88%), cansaço (69%) e sono (69%). Apenas 28% dos pacientes com dumping se sentiram incapacitados para a realização das atividades cotidianas. Não foi observada diferença entre o percentual de perda de peso dos pacientes dumpers e não-dumpers. Conclusão:Conclusão: Conclusão: Conclusão: Conclusão: O escore de Sigstad se mostrou uma ferramenta útil para o diagnóstico de dumping, embora uma visão crítica deva ser adotada quando utilizado em pacientes submetidos ao bypass gástrico. A síndrome de dumping foi frequente nesta população, embora geralmente subestimada, não sendo incapacitante para a realização das atividades cotidianas dos pacientes, assim como não se mostrou um fator relevante no auxílio à perda de peso. A obesidade é uma doença universal, de prevalência crescente, e que vem adquirindo proporções epidêmicas, sendo um dos principais problemas de saúde pú-blica da sociedade moderna. É a mais comum e dispendiosa morbidade nutricional nos Estados Unidos e, junto com o tabagismo, a principal causa de mortes precoces no mundo 1 . As operações bariátricas se firmaram como a terapia mais eficaz para o tratamento da obesidade grave e refratária 2 e a operação de bypass gástrico em Y de Roux, como uma das técnicas mais empregadas no mundo para este fim. Mas não veio isenta de complicações. DescritoresComo as operações para obesidade têm como base as ressecções gástricas e reconstruções com alças jejunais das mais diversas formas, uma gama de complicações da cirurgia bariátrica se sobrepõe ao rol de complicações inerentes às gastrectomias para doenças dispépticas, conhecidas desde os primórdios do desenvolvimento cirúr-gico para tais doenças como síndromes pós-gastrectomias: síndrome de alças aferente e eferente, síndrome do estô-mago pequeno e a síndrome de dumping 3 . Apesar das causas de muitas dessas desordens permanecerem obscuras, a perda da inervação vagal, o bypass, a ablação ou a destruição do piloro claramente estão envolvidos na patogênese de muitas, senão de todas estas complicações [1][2][3][4][5][6][7] . A crise de dumping típica aparece ainda enquanto o paciente se alimenta, ou dentro dos primeiros 30 minutos após a ingestão. Inicia-se com uma sensação de plenitude, é acompanhada por calor e transpiração na parte superior do tórax, e em alguns casos, pode envolver todo o corpo. Segue-se intenso estado de prostração, astenia e mal estar, chegando o paciente a um estado de fraqueza tamanho que é compelido a deitar-se -...

Despite being considered present in most vascularised tissues, lymphatic vessels have not been properly shown in human adipose tissue (AT). Our goal in this study is to investigate an unanswered question in AT biology, regarding lymphatic network presence in tissue parenchyma. Using human subcutaneous (S-) and visceral (V-) AT samples with whole mount staining for lymphatic specific markers and three-dimensional imaging, we showed lymphatic capillaries and larger lymphatic vessels in the human VAT. Conversely, in the human SAT, microcirculatory lymphatic vascular structures were rarely detected and no initial lymphatics were found.

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

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