CAMILA MICHIKO YAMAGUCHI
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- Does Roux-en-Y gastrectomy for gastric cancer influence glucose homeostasis in lean patients?(2013) HAYASHI, Silvia Y.; FAINTUCH, Joel; YAGI, Osmar K.; YAMAGUCHI, Camila M.; FAINTUCH, Jacob J.; CECCONELLO, IvanCancer gastrectomy seems to benefit type 2 diabetes; however, results are conflicting. In a prospective protocol, including retrospective information, the aim was assessment of changes in glucose profile in patients with both normal and deranged preoperative glucose homeostasis. Patients (N = 164) with curative subtotal or total Roux-en-Y gastrectomy for gastric cancer (n = 92), or Roux-en-Y gastric bypass for morbid obesity (RYGB, n = 72) were preoperatively classified into diabetes (including prediabetes) and control group. Postoperative diabetes outcome was stratified as responsive or refractory, and results in controls were correspondingly defined as stable or new-onset diabetes (NOD), according to fasting blood glucose and HbA1c. Dietary intake and biochemical profile was documented. Statistical methods included analysis of variance, multivariate logistic regression, and propensity score matching according to postoperative weight loss. Age of cancer cases was 67.9 +/- A 11.5 years, 56.5 % males, initial body mass index (BMI) 24.7 +/- A 3.7, current BMI 22.6 +/- A 3.8 kg/m(2), and follow-up 102.1 +/- 51.0 months, whereas in bariatric individuals age was 51.4 +/- A 10.1 years, 15.3 % males, initial BMI 56.7 +/- A 12.2, current BMI 34.8 +/- A 8.1 kg/m(2), and follow-up 104.1 +/- 29.7 months. Refractory disease corresponded to 62.5 % (cancer) versus 23.5 % (bariatric) (P = 0.019), whereas NOD represented 69.2 versus 23.8 % respectively (P = 0.016). Weight loss (Delta BMI) was associated with diabetes response in cancer patients but not with NOD. No difference between subtotal and total gastrectomy was detected. Divergent outcomes (refractory vs. responsive) were confirmed in BMI-similar, propensity-matched cancer gastrectomy patients with preoperative diabetes, consistent with weight-dependent and -independent benefits. Diabetes response was confirmed, however with more refractory cases than in bariatric controls, whereas high proportions of NOD occurred. Such dichotomous pattern seems unusual albeit consistent with previous studies.
- Refractory and new-onset diabetes more than 5 years after gastric bypass for morbid obesity(2012) YAMAGUCHI, Camila M.; FAINTUCH, Joel; HAYASHI, Silvia Y.; FAINTUCH, Jacob J.; CECCONELLO, IvanFew studies about long-term glucose homeostasis in bariatric patients are available. In a prospective protocol that included retrospective information, outcome of patients with both impaired and normal fasting blood glucose (FBG) was monitored to assess frequencies and correlates. Patients submitted to Roux-en-Y gastric bypass were classified as group I, elevated FBG, and group II, normal controls. Those in group I with improvement in FBG were defined as responsive and the others as refractory. Group II participants progressing to new-onset diabetes (NOD) or prediabetes represented NOD cases; the remaining were listed as stable controls. FBG was the main endpoint, but HbA1c results were considered, along with diet composition and general biochemical profile. Among 97 selected patients, 51 belonged to group I (52.4 +/- A 10.5 years, 29.6 % males, initial body mass index (BMI) 58.4 +/- A 13.4, current BMI 35.1 +/- A 8.4 kg/m(2)) and 46 to group II (48.2 +/- A 10.5 years, 19.6 % males, initial BMI 55.5 +/- A 8.8, current BMI 33.9 +/- A 6.9 kg/m(2)). Follow-up was 7-9 years, and 31.4 % (16/51) of group I were classified as refractory, whereas 15.2 % (7/46) of the controls converted to NOD. Multivariate analysis pointed out higher current BMI, older age, consumption of antidiabetic drugs, and male gender as features of refractory cases, whereas NOD participants were not significantly different from non-progressing controls. This is the first investigation, to the best of our knowledge, to underscore the correlates of refractory and NOD within the bariatric context. Further studies are recommended as such information could be valuable for patient selection, prognostic scoring, and outcome monitoring.
- Systemic Inflammatory Reaction After Silicone Breast Implant(2011) SILVA, Maira M.; MODOLIN, Miguel; FAINTUCH, Joel; YAMAGUCHI, Camila M.; ZANDONA, Cintia B.; CINTRA JR., Wilson; FUJIWARA, Haroldo; CURI, Rui; GEMPERLI, Rolf; FERREIRA, Marcos C.Systemic inflammation after augmentation mammaplasty with modern silicone implants is not currently recognized. In a prospective controlled study, C-reactive protein and other variables were monitored, aiming to test this hypothesis in a young cohort of patients. Females (18-30 years old, BMI = 18.5-30 kg/m(2), N = 52) were consecutively recruited for breast implant (n = 24, Group I) and for abdominal liposuction (n = 28, Group II/Controls). Patients were interviewed at baseline and followed until 6 months after operation. Variables included demographic and clinical information, surgical outcome, inflammatory markers and autoantibodies. Operations were well tolerated, without surgical or infectious complications. Mean prosthesis size was 258 +/- A 21 ml (range = 220-280) and mean aspirate of liposuction was 1972 +/- A 499 ml (range = 1200-3000). Preoperative, 2-month, and 6-month C-reactive protein concentrations for breast implant patients were 1.3 +/- A 1.2, 4.8 +/- A 3.0, and 4.3 +/- A 6.4 mg/l and for liposuction 3.5 +/- A 2.7, 3.5 +/- A 2.1, and 2.2 +/- A 2.2 mg/l, respectively. Change at 2 months was significant (p = 0.001). Autoantibody investigation failed to reveal remarkable aberrations, except for anticardiolipin elevation, which was nearly symmetrical in the two groups. C-reactive protein levels increased after operation and correlated with proinflammatory and procoagulatory indices. A mild increase in anticardiolipin IgM occurred but differences between populations were lacking. Despite excellent cosmetic outcomes and lack of complications, acute phase reaction could signal ongoing immunogenicity of silicone and long-term monitoring is recommended.