DENIS PAJECKI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
64 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 64
- Surgical options in type 2 diabetes(2015) PAJECKI, D.; RICCIOPPO, D.; KAWAMOTO, F.; SANTO, M. A.The onset of type 2 diabetes is characterized by a nonreversible complex cycle that includes severe deleterious effects on glucose metabolism. Obesity, but mainly visceral adipose tissue accumulation, is an important factor in this process. The goals of diabetes management in clinical practice, despite the improvement over the years, are often not met. In the last 20 years, based on observations of bariatric surgery series that have shown great improvement of type 2 Diabetes in morbid obese patients, metabolic surgery has emerged as a therapeutic possibility. In 2011 the International Diabetes Federation released its position statement mentioning that bariatric surgery was an accepted option for T2DM patients with BMI > 35 kg/m2 and might be considered an alternative therapy for patients with BMI ≤ 35 kg/m2 who do not respond to standard medical therapy. Metabolic/bariatric surgery includes the application of conventional bariatric procedures (Roux-en-Y gastric bypass, biliopancreatic diversion, sleeve gastrectomy) and the introduction of new procedures (ileal interposition, intestinal bipartition) designed with the specific aim of having metabolic effects, irrespective of causing massive weight loss. The reversal of T2DM occurs due to mechanisms such as the increase in insulin sensitivity associated with an improvement in beta-cell function, including recovering the first phase of insulin secretion. This recovery is a consequence of the increase of GLP-1 production, and change in circulating bile acids. Remission of diabetes is observed on the first postoperative days after the operation. © Springer International Publishing Switzerland 2015.
- Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity(2014) SANTO, Marco Aurelio; RICCIOPPO, Daniel; PAJECKI, Denis; CLEVA, Roberto de; KAWAMOTO, Flavio; CECCONELLO, IvanOBJECTIVES: The incidence of obesity and particularly super obesity, has increased tremendously. At our institution, super obesity represents 30.1% of all severely obese individuals in the bariatric surgery program. In super obesity, surgical morbidity is higher and the results are worse compared with morbid obesity, independent of the surgical technique. The primary strategy for minimizing complications in these patients is to decrease the body mass index before surgery. Preoperative weight reduction can be achieved by a hypocaloric diet, drug therapy, an intragastric balloon, or hospitalization. The objective of this study was to analyze the results of a period of hospitalization for preoperative weight loss in a group of super-obese patients. METHODS: Twenty super-obese patients were submitted to a weight loss program between 2006 and 2010. The mean patient age was 46 years (range 21-59). The mean BMI was 66 kg/m(2) (range 51-98) and 12 were women. The average hospital stay was 19.9 weeks and the average weight loss was 19% of the initial weight (7-37%). The average caloric intake was 5 kcal/kg/day. After the weight loss program, the patients underwent gastric bypass surgery. RESULTS: The statistical analysis revealed that after 14 weeks of treatment (15% loss of initial weight), the weight loss was not significant. All patients had satisfactory surgical recovery and were discharged after an average of 4.6 days. CONCLUSION: In super obesity, preoperative weight loss is an important method for reducing surgical risks. Hospitalization and a hypocaloric diet are safe and effective. After 14 weeks, the weight loss rate stabilized, signaling the time of surgical intervention in our study.
- Comment on: Sleeve gastrectomy versus Roux-En-Y gastric bypass in patients aged >= 65 years: a comparison of short-term outcomes(2021) DANTAS, Anna Carolina Batista; PAJECKI, Denis; SANTO, Marco Aurelio
- The Edmonton Obesity Staging System: assessing a potential tool to improve the management of obesity surgery in the Brazilian public health services(2020) OGASSAVARA, Nicolas Chiu; DIAS, Joao Gabriel Magalhaes; PAJECKI, Denis; SIQUEIRA, Jose de Oliveira; SANTO, Marco Aurelio; TESS, Beatriz HelenaBackground: Limited access to publicly funded, insurance-covered, and self-paid obesity surgery is a reality worldwide. Waiting lists for procedures are usually based on chronologic criteria and body mass index (BMI)-defined obesity categorization. Obesity classification systems assess overall health and have been proposed as an alternative. Objective: To investigate the correlation between BMI-based classification and the Edmonton Obesity Staging System (EOSS) to support current evidence that the assessment of the clinical severity of obesity could be a helpful tool to maximize access to surgery. Setting: University hospital, Brazil. Methods: Retrospective analysis of all 2011 to 2014 adult patients who underwent obesity surgery under the public health system. Data on sex, age, presurgical BMI, and co-morbidities were extracted from hospital records. Spearman correlation coefficients were used to assess the strength and direction of the relationship between BMI classification and EOSS. Results: Of 565 patients, 79% were female, mean age 44.1 +/- 10.9 years and mean BMI 46.9 +/- 6.2 kg/m(2). The most common EOSS stage was 2 (86.5%), followed by stages 3 (8.5%) and 1 (4.9%). There was no correlation between the severity of obesity measured by BMI and EOSS (p = - .030, P = .475). Older patients had higher Edmonton scores (p = .308, P < .001). No difference was observed regarding sex. Conclusions: No correlation was found between EOSS and BMI and between these and sex. Age correlated with both obesity indicators. EOSS was reproducible in Brazilian surgical patients and may be an important tool from a health services perspective contributing to the more efficient use of limited resources for obesity surgery.
conferenceObject ROBOTIC-ASSISTED REVISIONAL ROUX-EN-Y GASTRIC BYPASS FOR LARGE HIATAL HERNIA AND MASSIVE INTRATHORACIC SLEEVE MIGRATION(2023) SANTO FILHO, Marco Aurelio; DANTAS, Anna Carolina Batista; ARABI, Arthur Youssif Mota; PAJECKI, Denis; SANTO, Marco Aurelio- Bariatric surgery (sleeve gastrectomy) after liver transplantation: case report(2014) PAJECKI, Denis; CESCONETTO, Danielle Menezes; MACACARI, Rodrigo; JOAQUIM, Henrique; ANDRAUS, Wellington; CLEVA, Roberto de; SANTO, Marco Aurelio; ALBUQUERQUE, Luiz Augusto Carneiro D'; CECCONELLO, Ivan
conferenceObject LACTATE AS MARKER OF METABOLIC SYNDROME IN SEVERE OBESITY Basic science and research in bariatric surgery(2019) VIEIRA, A. Gadducci; CARDIA, L.; OLIVEIRA, F. Costa De; MARIA, J. Greve De; SANTOS, P. Silva Roberto; PAJECKI, D.; AURELIO, M. Santo; CLEVA, R. DebookPart Modalidades cirúrgicas na cirurgia bariátrica e metabólica(2023) COHEN, Ricardo Vitor; PAJECKI, DenisconferenceObject LIVER FUNCTION IMPROVEMENT AFTER BARIATRIC SURGERY: USING THE INDOCYANINE GREEN TEST IN THE FOLLOW-UP OF OBESE PATIENTS NASH and bariatric surgery(2019) SILVA, M. B. D. B. E.; MESQUITA, G. H. A. D.; DANTAS, A. C. B.; MOTA, F. C.; KAWAMOTO, F. M.; PAJECKI, D.; RICCIOPPO, D.; CLEVA, R. D.; ANDRAUS, W.; SANTO, M. A.; CECCONELLO, I.- Tratamento de curto prazo com liraglutide no reganho de peso após cirurgia bariátrica(2013) PAJECKI, Denis; HALPERN, Alfredo; CERCATO, Cintia; MANCINI, Marcio; CLEVA, Roberto de; SANTO, Marco AurélioOBJECTIVE: To evaluate the results of the use of liraglutide in a group of patients undergoing surgical treatment of morbid obesity with unsatisfactory weight loss or regain of more than 15% of minimum reached weight. METHODS: The authors conducted a retrospective analysis of 15 operated patients who had excess weight loss <50% after two years of follow-up or regained weight more than 15% of the minimum reached weight. We included only patients who had the expected ""surgical anatomy"", assessed by contrast radiography and endoscopy. Mean age was 47.2 ± 12.5 years, and patients received liraglutide at doses from 1.2 to 3.0 mg/day for eight to 28 weeks follow-up. RESULTS: Surgical treatment induced a weight loss of 34.1 ± 16.5 kg. The average weight regain after 5.3 ± 3.3 years was 14.2 ± 12.1 Kg. The average weight was significantly reduced after treatment with liraglutide (100.9 ± 18.3 kg. vs Kg 93.5 ± 17.4, p <0.0001). Six patients had nausea and two discontinued therapy due to the cost of medication. CONCLUSION: medical treatment directed to the control of satiety using liraglutide may be an alternative treatment of patients with poor weight loss or weight regain after surgery when no technical problem has been identified.