The use of growth factors accelerates healing, stimulates greater angiogenic activity, and accelerates fibroplasia and collagen maturation.
Background The gastric bypass has nutritional and electrolyte disturbances rate of approximately 17%. The most common deficits are protein malnutrition, ferric and zinc, in addition to the vitamin. Although rare, some malnutrition stages reach such severity that ends up being necessary hospitalization and sometimes revisional or reversal surgical procedures.Aim: To present a proposal of surgical revision for treatment of severe malnutrition after bariatric surgery.Methods: The procedure is to reconstitute the food transit through the duodenum and proximal jejunum, keeping the gastric bypass restrictive component. As an additional strategy, the gastric fundus resection is performed, aiming to intensify the suppression of the greline and avoiding excessive weight regain.Results: After initial stabilization, nutritional and electrolytic support, the procedure was performed in two patients as definitive treatment of malnutrition status. Good results were observed at one year follow up.Conclusion: As improvement option and/or resolution of the nutritional alterations, surgical therapy is one of the alternatives. There is still no consensus on the surgical technique to be performed. This procedure is based on pathophysiological factors for the treatment of this condition, with good initial results, without significant clinical alterations. Longer follow-up will determine its effectiveness.
Background : Hyperinsulinemic hypoglicemia with severe neuroglycopenic symptoms has been identified as a late and rare complication in patients submitted to Roux-en-Y gastric bypass. However, the potential gravity of its manifestations requires effective treatment of this condition. The absence of treatment makes it necessary to develop more effective clinical or surgical methods. Aim : To present one surgical option to revisional surgery in the treatment of hyperinsulinemic hypoglicemia Methods : The procedure consists in reconstituting alimentary transit through the duodenum and proximal jejunum, while keeping the restrictive part of the gastric bypass. As an additional strategy to maintain weight loss, is realized gastric fundus resection, aiming to suppress ghrelin production more effectively. Results : It was used in three patients with successful results in one year of follow-up. Conclusion : The procedure to reconstruct the food transit through the duodenum and proximal jejunum, keeping the restrictive component of gastric bypass in the treatment of hyperinsulinemic hypoglycemia showed good initial results and validated its application in other cases with this indication.
Exceto onde especificado diferentemente, a matéria publicada neste periódico é licenciada sob forma de uma licença Creative Commons -Atribuição 4. ABSTRACT Background and Objectives:To estimate the prevalence of Mycobacterium tuberculosis infection in undergraduate medical students and associated factors. An adequate assessment increases the institutional biosafety strategies, in addition to providing adequate chemoprophylaxis. Methods: Cross-sectional study carried out from August 2013 to July 2014, which included 62 undergraduate medical students submitted to tuberculin skin test and interview. The tuberculin test was performed using the Mantoux technique. The test reading was performed by the palpation method, 48 to 72 hours after the injection. The data collected at the interview were: year of medical school, history of atopy, history of hypersensitivity to PPD, BCG vaccination history, vaccination with live attenuated virus in the last 4 weeks, prior tuberculosis, potential exposure, time of exposure. Results:30.6% of students showed reaction at the Mantoux test. The highest prevalence of reagent cases was observed among male students. Conclusion: The prevalence of a strong reaction at the tuberculin test is relatively low among medical students, but relevant for the risk stratification of this population. Justificativa e Objetivos: Estimar a prevalência da infecção pelo Mycobacterium tuberculosis em acadêmicosde medicina e fatores associados. Uma avaliação adequada incrementa as estratégias de biossegurança institucional, além de prover uma quimioprofilaxia adequada. Métodos: Estudo transversal, realizado de agosto de 2013 a julho de 2014 onde foram incluídos 62 estudantes de medicina Foi realizado teste tuberculínico e entrevista. O teste tuberculínico foi realizado através da técnica de Mantoux. A leitura do teste foi realizada pelo método palpatório, 48 a 72 horas após a injeção. Os dados coletados na entrevista foram os seguintes: período que se encontra no curso, história de atopia, história de hipersensibilidade ao PPD, histórico vacinal da BCG, vacinação de vírus vivo atenuado nas últimas 4 semanas, tuberculose prévia, exposição potencial, tempo de exposição. Resultados: 30,6% dos estudantes eram reagentes. A maior prevalência de casos reagentes foi em estudantes do sexo masculino. Conclusão: A prevalência de teste tuberculínico reator forte é relativamente baixa entre os estudantes de medicina, porém relevante para a estratificação de risco desta população.
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