ROBERTO DE CLEVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
5 resultados
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- 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.
- EARLY COMPLICATIONS IN BARIATRIC SURGERY: incidence, diagnosis and treatment(2013) SANTO, Marco Aurelio; PAJECKI, Denis; RICCIOPPO, Daniel; CLEVA, Roberto; KAWAMOTO, Flavio; CECCONELLO, IvanContext Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control. Method The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery) were reviewed. Ninety-three (17.2%) patients were male and 445 (82.8%) were female. The ages of the patients ranged from 18 to 70 years (average = 46), and their body mass indices ranged from 34.6 to 77 kg/m2. Results Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5%) patients experienced pulmonary thromboembolism. The mortality rate was 0,55%. Conclusion The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years.
conferenceObject 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 Functional Assessment of Older Obese Patients Candidates for Bariatric Surgery(2013) SANTO, M.; KANAGI, A.; PAJECKI, D.; CLEVA, R. de; CECCONELLO, I.Introduction: Obesity in the elderly is associated with exacerbation of functional decline that occurs with aging and therefore to loss of independence and autonomy impairing quality of life. Objective: To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods: Patients with age 60 and BMI 35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, and pain, mability to perform basic activities of daily living (ADL), instrumental activities of daily living (IADL) and the "Timed Upand Go" test (TUG) whose cut-off point was 10 seconds. Results: 60 subjects with a mean age of 64.1 years (60–72) and 75% women. They had an average 121.1kg (72.7-204) and mean BMI 47.2 kg/m2 (35–68.9). About 80% of patients had a BMI 40 and almost half (47.5%) reported some difficulty in IADL. 31 (77.5%) complained of daily pain. TUG test was compromised (>10 sec.) in half the population and the need for auxiliary instrument for walking in 10 patients (25%). No correlation was found between BMI and impairment of IADL or ADL in this study. Moreover, there was a significant association between impairment of IADL and TUG, 2 (1) = 8.12 (p <0.05), as well as impairment of IADL and complaint of pain daily, 2 (1) = 6.16 (p <0.05), and use of auxiliary instrument for walking, 2 (1) = 5.64 (p <0.05). Conclusion: The prevalence of functional limitation in elderly candidates for bariatric surgery is high as well as complaints of dailypain. The association between impairment of IADL and use of auxiliary instrument and difficulty for walking emphasizes and demonstrates the importance of functional assessment in planning strategies for obesity treatment. Functional impairment should be cons idered a comorbidity in surgical indication.bookPart Abscessos do Fígado(2013) COELHO, Fabricio Ferreira; VIANA, Eduardo Freitas; CLEVA, Roberto de; HERMAN, Paulo