1) Widespread cinematic impairment was the rule in the studied population. 2) These findings are consistent with poor skeletal muscle performance, high metabolic expenditure and constant physical exhaustion. 3) Attention should be paid not only to the metabolic management but also to the physical rehabilitation required in cases of advanced obesity.

1) Individuals with morbid obesity present important postural alterations. 2) Seriously altered posture was the rule for the obese population in this study, especially in the spine, knees and feet. 3) Most patients had compatible clinical complaints, but they rarely associated the bone and joint pain with the obesity and axial skeleton deviations. 4) Planned physical activity should be part of the treatment of severe obesity, in order to correct deviations, prevent new ones, and improve quality of life.

PURPOSE:To evaluate the diagnostic accuracy of magnetic resonance imaging of the knee in identifying traumatic intraarticular knee lesions. METHOD: 300 patients with a clinical diagnosis of traumatic intraarticular knee lesions underwent prearthoscopic magnetic resonance imaging. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for a positive test, likelihood ratio for a negative test, and accuracy of magnetic resonance imaging were calculated relative to the findings during arthroscopy in the studied structures of the knee (medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, and articular cartilage). RESULTS: Magnetic resonance imaging produced the following results regarding detection of lesions: medial meniscus: sensitivity 97.5%, specificity 92.9%, positive predictive value 93.9%, positive negative value 97%, likelihood positive ratio 13.7, likelihood negative ratio 0.02, and accuracy 95.3%; lateral meniscus: sensitivity 91.9%, specificity 93.6%, positive predictive value 92.7%, positive negative value 92.9%, likelihood positive ratio 14.3, likelihood negative ratio 0.08, and accuracy 93.6%; anterior cruciate ligament: sensitivity 99.0%, specificity 95.9%, positive predictive value 91.9%, positive negative value 99.5%, likelihood positive ratio 21.5, likelihood negative ratio 0.01, and accuracy 96.6%; posterior cruciate ligament: sensitivity 100%, specificity 99%, positive predictive value 80.0%, positive negative value 100%, likelihood positive ratio 100, likelihood negative ratio 0.01, and accuracy 99.6%; articular cartilage: sensitivity 76.1%, specificity 94.9%, positive predictive value 94.7%, positive negative value 76.9%, likelihood positive ratio 14.9, likelihood negative ratio 0.25, and accuracy 84.6%. CONCLUSION: Magnetic resonance imaging is a satisfactory diagnostic tool for evaluating meniscal and ligamentous lesions of the knee, but it is unable to clearly identify articular cartilage lesions.

In the preoperative period, the obese group individuals showed higher oxidation and inflammation levels and lower indices of antioxidant defense than those of the control group. One year after RYGBP, an improvement in antioxidant protection, associated with a reduction in inflammatory and oxidative markers, was observed, indicating that these individuals presented a lower degree of oxidative stress.

Repercussão da perda de peso sobre parâmetros nutricionais e metabólicos de pacientes obesos graves após um ano de gastroplastia em Y-de-Roux 97 Rev. Col. Bras. Cir. 2010; 37(2): 096-101 peso acarretaria não só redução de PCR como também de interleucina-1 concomitantemente à diminuição na resistência periférica à insulina, diminuindo o risco de doença cardiovascular 8 . . . . . Sabe-se que, embora ocorra melhora clíni-ca após tratamento cirúrgico, o paciente necessitará de acompanhamento nutricional regular com o objetivo de promover uma reeducação alimentar para a aquisição de hábito dietético saudável, prevenindo deficiências de vitaminas e micronutrientes 9 . O objetivo do presente estudo é avaliar, em pacientes com obesidade grave submetidos à gastroplastia vertical em Y de Roux, os efeitos da perda de peso sobre a glicemia, o perfil de lipídios, o metabolismo do ferro e a atividade inflamatória. MÉTODOS MÉTODOS MÉTODOS MÉTODOS MÉTODOSO objetivo do presente estudo é avaliar, em pacientes com obesidade grave submetidas à gastroplastia vertical em Y de Roux, os efeitos da perda de peso sobre a glicemia, o perfil de lipídios, o metabolismo do ferro e a atividade inflamatória.Todos os pacientes assinaram termo de consentimento e o protocolo de estudo foi totalmente aprovado pelo Comitê de Ética da Universidade Estadual de Londrina.Realizou-se estudo prospectivo, clínico-nutricional, envolvendo 56 pacientes, 50 mulheres (89%) e seis homens (11%), média de idade de 40,2 ± 9,9 anos, submetidos à gastroplastia vertical em Y-de-Roux, no Serviço de Cirurgia do Aparelho Digestivo do Hospital Universitário de Londrina, Paraná.Todos os pacientes foram avaliados, mediante parâmetros clínicos, laboratoriais e nutricionais, antes do procedimento cirúrgico e após seis e 12 meses. Avaliação nutricional foi realizada mediante questionário de freqüên-cia alimentar e índice de massa corpórea (IMC (kg/m 2 ) = peso/estatura 2 ), e os pacientes classificados de acordo com recomendação da Organização Mundial de Saúde 10 . . . . . Após jejum de 12 horas, os pacientes foram submetidos aos seguintes exames laboratoriais sanguíneos: hemoglobina (automated counter -Pentra 120 Retic ABX), ferro, transferrina e ferritina (Método Ferrozine com analizador químico automático -Dimension AR, DadeBehring), glicose, colesterol total (colesterol oxidase), HDLcolesterol (precipitação seletiva) e triacilglicerol (lipase/ glicerol dehidrogenase -auto-analisador bioquímico Dade AR); LDL-colesterol (calculado pela equação de Friedwald); albumina (Método do verde de bromcresol) e proteína Creativa (nefelometria).Todos os dados estão apresentados como média ± desvio padrão. As variáveis medidas nos diferentes momentos do estudo foram testadas pela ANOVA, sendo o valor de P < 0,05 considerado como estatisticamente significante. RESULTADOS RESULTADOS RESULTADOS RESULTADOS RESULTADOSApós a gastroplastia em Y de Roux, foram observadas várias mudanças na ingestão alimentar habitual dos pacientes, haja vista que muitos relatavam diminuição na ingestão de arroz...

Excessive forefoot pressure and enlarged support area were a consequence of obesity, mirroring the efforts of the obese subject to acquire a wider and stronger support base. Although this is originally a physiological change, it may result in maladaptative and degenerative musculoskeletal consequences. Re-education exercises may be advised, in combination with bariatric surgery in the morbidly obese, aiming at restoration of normal gait and posture, as well as at minimization of stress damage to bones and joints in the axial skeleton.

RYGBP determined profound changes in urinary composition which predisposed to a lithogenic profile. The prevalence of urinary lithiasis increased almost 70% in the postoperative period. Postoperative urinary oxalate and uric acid were the only predictors for new stone formers.

PURPOSE:Aerobic capacity and respiratory function may be compromised in obesity, but few studies have been done in highly obese bariatric candidates. In a prospective study, these variables were documented in the preoperative period, aiming to define possible physiologic limitations in a apparently healthy and asymptomatic population.METHOD: Forty-six consecutively enrolled adults (age 39.6 ± 8.4 years, 87.0% females, body mass index /BMI 49.6 ± 6.3 kg/m 2 ) were analyzed. Ventilatory variables were investigated by automated spirometry, aerobic capacity was estimated by a modified Bruce test in an ergometric treadmill, and body composition was determined by bioimpedance analysis.RESULTS: Total fat was greatly increased (46.4 ± 4.6% of body weight) and body water reduced (47.3 ± 4.6 % body weight), as expected for such obese group. Spirometric findings including forced vital capacity of 3.3 ± 0.8 L and forced expiratory volume-1 second of 2.6 ± 0.6 L were usually acceptable for age and gender, but mild restrictive pulmonary insufficiency was diagnosed in 20.9%. Aerobic capacity was more markedly diminished, as reflected by very modest maximal time (4.5 ± 1.1 min) and distance (322 ±142 m) along with proportionally elevated maximal oxygen consumption (23.4 ± 9.5 mL/kg/min) achieved by these subjects during test exercise.CONCLUSIONS: 1) Cardiopulmonary evaluation was feasible and well-tolerated in this severely obese population; 2) Mean spirometric variables were not diminished in this study, but part of the population displayed mild restrictive changes; 3) Exercise tolerance was very negatively influenced by obesity, resulting in reduced endurance and excessive metabolic cost for the treadmill run; 4) More attention to fitness and aerobic capacity is recommended for seriously obese bariatric candidates;