DENIS PAJECKI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
18 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 18
- 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.
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. DeconferenceObject 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.conferenceObject Assessment of Body Composition in Morbid Obesity: a Comparative Study Between Body Impedance and Adiposity index Methods(2012) SANTO, M. A.; RICCIOPPO, D.; PAJECKI, D.; KAWAMOTO, F.; MATSUDA, M.; CECCONELLO, IIntroduction Obesity has become an epidemic public health problem. A reliable method to assess body composition and monitor the effectiveness of treatments for the morbid obesity is mandatory. However, there is still controversy as to which method to use for this purpose. Two Methods are validated in the literature, bioelectrical impedance analysis (BIA) and body adiposity index (BAI). The present study compared these methodologies. Materials & Methods We evaluated 167 patients undergoing bariatric surgery, women prevailed (82.59 %), averaging 44 years-old and mean BMI of 49.48 kg/m2. Weight, height and hip circumference were measured. Body fat (BF) was calculated by BIA and BAI. The following formulas were used: BIA: BF in kg=023.25+(0.09x resistance in ohms)+(1.00x weight in kg)-(0.08xheight in cm)+(0.13x age in years). BAI: BF% of the total weight 0 (hip circumference in centimeters/height in meters x height in meters)-18. Results The patients had an average of 53.35 % (± 5.37) of BF according to BIA, and BAI showed 50.51 % (± 13.59) of BF. There is no difference between the two Methods (p<0,05), even when stratified by BMI (BMI<45, 4550). Essa diferença variou quando o IMC foi dividido em três faixas, abaixo de 45 kg/m2 a diferença foi de 3,1 %, entre 45,1 a 49,99 kg/m2 a diferença foi de 3,78 %, acima de 50 kg/m2 a diferença foi de 1,86%. Discussion The BAI is a simple method of implementation, low cost and effective, when compared to other Methods validated for morbidly obese patients. Conclusion BAI is an effective method to assess BF, comparable to BIA, and also proved to be effective in super obese patients.conferenceObject Preoperative Weight Loss in Super Obesity: Influence on Perioperative Morbidity and Mortality in Patients undergoing Gastric Bypass(2012) SANTO, M. A.; RICCIOPPO, D.; PAJECKI, D.; KAWAMOTO, F.; MATSUDA, M.; CECCONELLO, IIntroduction Super obesity (SO) is increasing in greater proportions, and now represents 30 % of morbidly obese patients. In SO morbidity and mortality rates are greater. The preoperative weight loss in SO decreases operative time, and apparently diminishes morbidity. Based on these data, we initiated a program of preoperative weight loss for the SO. The treatment is based on hospitalization, low-calorie diet, biometrics control and physical activities, aiming to analyze weight loss and influence of weight loss in the perioperative outcome. Materials & Methods Thirty patients underwent our SO preop weight loss program, from 2006 to 2011. The mean age was 46 years, and mean BMI of 66 kg/m2 and the majority was female. All patients underwent gastric bypass after the weight loss. The average caloric intake was 5 cal/Kg/day. Results The mean weight loss was 1.9 kg/week, and after 14 weeks the mean weight loss was15.2 % of initial weight. The mean hospital stay was 21.3 weeks, and the mean weight loss was 19.7 %. All had satisfactory recovery from surgery. The mortality was null. In the last five years, from the total of 592 surgeries, 193 was performed in SO. The SO and general morbidity was 11.14 % and 20.2 %, respectively, and mortality 0.84 % and 2.07 %. Discussion In SO a preoperative weight loss is an important tool to reduce surgical risks. Hospitalization, with low-calorie diet and multidisciplinary follow-up is a safe and effective way to achieve weight loss preoperatively. Conclusion After a mean of 19,7 % of initial body weight loss, the studied group showed an important decreasing in morbimortality when compared with our previous experience. Preoperative weight loss should be encouraged in SO, and a specific program can significantly diminish surgical risks in this complex group of obeses.conferenceObject LAPAROSCOPIC SLEEVE GASTRECTOMY AFTER LIVER TRANSPLANTATION - VL.071(2014) PAJECKI, D.; SANTO, M.; JOAQUIM, H. D.; KAWAMOTO, F.; CESCONETTO, D.; MACACARI, R.; ANDRAUS, W.; D'ALBUQUERQUE, L. C.; CECCONELLO, I.conferenceObject LAPAROSCOPIC TREATMENT OF OPEN GASTRIC BYPASS RING SLIPPAGE: GASTRIC POUCH REDO(2014) PAJECKI, D.; SANTO, M.; KAWAMOTO, F.; JOAQUIM, H. D.; CESCONETTO, D.; MACACARI, R.; CECCONELLO, I.conferenceObject FALL PREVALENCE AND BONE METABOLISM IN OBESE ELDERLY PATIENTS UNDERGOING BARIATRIC SURGERY(2016) SANTO, M. A.; KANAJI, A. L.; ANDRADE, J. P.; PAJECKI, D.; CLEVA, R. deconferenceObject Body Composition in Morbid Obesity: Correlation Between Body Adiposity Index and Bioelectric Impedance(2013) SANTO, M.; CLEVA, R. de; PAJECKI, D.; BERNHARD, A. Biasetto; RICCIOPPO, D.; CECCONELLO, I.Introduction: Obesity has become an important public health problem. According, prevalence of morbid obesity is also growing. There is no consensus about the best method to measure body composition in morbid obesity individuals. A simple, easy, accurate, reproducible and inexpensive method is desirable. The aim of this study was to compare two methods that estimate body fat percentage (%BF), Body Adiposity Index (BAI) and Bioelectric Impedance (BI). Population and Methods: We prospectively evaluated 233 adults with indication for surgical treatment of morbid obesity at Bariatric and Metabolic Group at Hospital das Clinicas, University of Sao Paulo Medical School. All patients over eighteen years old were included after an Informed Consent and Agreement (Ethics Committee protocol number 8848). The data were collected before any intervention. Weight (Wgt) and height (Hgt) were measured in a Welmy scale. The circumferences were made with an inelastic tape-measure in a horizontal line. Waist circumference was the midpoint between the lower margin of the last palpable rib and the top of the iliac crest. Hip circumference (HC) was the maximum circumference of the buttocks. BI was made using Biodinamics equipment (model 310) with the person lies. Four electrodes were fixed in pairs in the right hand and bare feet. An electrical signal is introduced and an impedance value is obtained. This is then entered into an equation: BI= 23,25+(0,09xR)+ (1,00xWgt)-(0,08xHtg)+(0,13xYrs) (BI in kilograms of BF, R=resistance in owns, Wgt in kilograms, Htg in centimeters and age in years). BAI was determined according to the equation: BAI=(HC/Hgt x Hgt)-18 (BAI in %BF, HC in centimeters and Hgt in meters); Results: Mean age was 44±11.34 years and mean body mass index (BMI) was 49.13±7.65kg/m 2. The female prevalence was higher (78.5%) and 41.2% was super obese (BMI50kg/m 2). Mean BF was 52.15% (±6.04%) by BI and 51.49% (±8.22%) by BAI. The difference between than was 0.67% (±5.21%), interclass correlation of 0.74 (CI 95%:0.67-0.79). BAI had no significant error in women (p=0.611) and in super obese (p=0.368). A significant error was observed in men (p=0.06), in patients with BMI<50 kg/m 2 (p<0.001) and when the waist-hip ratio (WHR) was more than 1.06 (p=0,010). We observed that BAI underestimated %BF BI in men (2,44%), in patients with BMI<50 kg/m 2 (1,49%) and when the waist-hip ratio (WHR) was more than 1.06 (5,35%). Conclusion: BAI is an inexpensive and non-invasive method that was successfully used to determine BF in morbid obese adults, especially in women and super obese patients with a WHR less than 1.06.conferenceObject Influence of the Axcess Weight Loss on Control of Type II Diabetes After Gastric Bypass(2012) SANTO, M. A.; KAWAMOTO, F.; RICCIOPPO, D.; PAJECKI, D.; GARMS, A.; MATSUDA, M.; PINTO JR., P. E.; CLEVA, R.; CECCONELLO, IIntroduction The gastric bypass has influence on the improvement of type II diabetes. The weight loss is related to amelioration of diabetes, but it is not clear the relationship between the amount of weight loss and diabetes control. Objective Analyze the influence of EWL on improving diabetes after one year of gastric bypass. Materials and methods 29 patients type II diabetes, 24 women and 5 men, meanage of 56.9 years, mean BMI: 48.2kg/m2, mean HbA1c: 8.1, underwent standard gastric bypass retrospectively analysed one year after operation with EWL>40 % (mean 57 %). Concerning diabetes control, the patients were divided into two groups: Group A, patients who achieve HbA1c <6.5 (n=21) and in group B those maintained HbA1c>6.5 (n=08). Results In all patients the decrease of mean A1c was significant (8.1 to 6.1, p<0.05). In both groups the decrease was also significant and similar (8 to 5.9 in group A, and 9.2 to 7.6 in group B). The %EWL in group A was 59 % and in group B 57 % (p>0.05) with no difference in the Mann Whitney test. Discussion With at least 40 % of EWL there was improvement on diabetes. In the patients who did not achieve the control target (A1c<6.5) the weight loss was similar that the patients who achieve it. Conclusion Weight loss after gastric bypass is an important factor for the improvement of type 2 diabetes. Despite of amelioration of diabetes in all patients studied, similar EWL in some patients did not result in control of the disease (A1c<6.5).