ROBERTO DE CLEVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
21 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 21
- Left Ventricular Dilation and Pulmonary Vasodilatation after Surgical Shunt for Treatment of Pre-Sinusoidal Portal Hypertension(2016) SANTAREM, Orlando Luis de Andrade; CLEVA, Roberto de; SASAYA, Flavia Megumi; ASSUMPCAO, Marianna Siqueira de; FURTADO, Meive Santos; BARBATO, Alfonso Julio Guedes; HERMAN, PauloObjective The aim of this study was to prospectively investigate the long-term cardiovascular and pulmonary hemodynamic effects of surgical shunt for treatment of portal hypertension (PH) due to Schistosomiasis mansoni. Location The University of Sao Paulo Medical School, Brazil; Public Practice. Methods Hemodynamic evaluation was performed with transesophageal Doppler and contrast-enhanced echocardiography (ECHO) on twenty-eight participants with schistosomal portal hypertension. Participants were divided into two groups according to the surgical procedure used to treat their schistosomal portal hypertension within the last two years: group 1-distal splenorenal shunt (DSRS, n = 13) and group 2-esophagogastric devascularization and splenectomy (EGDS, n = 15). Results The cardiac output (5.08 +/- 0.91 L/min) and systolic volume (60.1 +/- 5.6 ml) were increased (p = 0.001) in the DSRS group. DSRS participants had a significant increase (p < 0.0001) in their left ventricular end-systolic and end-diastolic diameters as well as in their left ventricular end-diastolic and end-systolic volumes (p < 0.001) compared with the preoperative period. No statistically significant difference was found in the patients who underwent EGDS. ECHO revealed intrapulmonary vasodilatation (IPV) in 18 participants (64%), 9 DSRS and 9 EGDS (p > 0.05). Conclusions The late increase in the cardiac output, stroke volume and left ventricular diameters demonstrated left ventricular dilatation after a distal splenorenal shunt. ECHO revealed a greater prevalence for IPV in patients with schistosomiasis than has previously been described in patients with PH from liver cirrhosis.
- C-peptide level as predictor of type 2 diabetes remission and body composition changes in non-diabetic and diabetic patients after Roux-en-Y gastric bypass(2021) CLEVA, Roberto de; KAWAMOTO, Flavio; BORGES, Georgia; CAPRONI, Priscila; CASSENOTE, Alex Jones Flores; SANTO, Marco AurelioOBJECTIVES: Several predictors of type 2 diabetes mellitus (T2DM) remission after metabolic surgery have been proposed and used to develop predictive scores. These scores may not be reproducible in diverse geographic regions with different baseline characteristics. This study aimed to identify predictive factors associated with T2DM remission after Roux-en-Y gastric bypass (RYGB) in patients with severe obesity. We hypothesized that the body composition alterations induced by bariatric surgery could also contribute to diabetes remission. METHODS: We retrospectively evaluated 100 patients with severe obesity and T2DM who underwent RYGB between 2014 and 2016 for preoperative factors (age, diabetes duration, insulin use, HbA1c, C-peptide plasma level, and basal insulinemia) to identify predictors of T2DM remission (glycemia<126 mg/dL and/or HbA1c<6.5%) at 3 years postoperatively. The potential preoperative predictors were prospectively applied to 20 other patients with obesity and T2DM who underwent RYGB for validation. In addition, 81 patients with severe obesity (33 with T2DM) underwent body composition evaluations by bioelectrical impedance analysis (InBody 770 (R)) 1 year after RYGB for comparison of body composition changes between patients with and those without T2DM. RESULTS: The retrospective analysis identified only a C-peptide level >3 ng/dL as a positive predictor of 3-year postoperative diabetes remission, which was validated in the prospective phase. There was a significant difference in the postoperative body composition changes between non-diabetic and diabetic patients only in trunk mass. CONCLUSION: Preoperative C-peptide levels can be useful for predicting T2DM remission after RYGB. Trunk mass is the most important difference in postoperative body composition changes between non-diabetic and diabetic patients.
- 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.
- 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
- SMALL INTESTINAL L CELL DENSITY IN PATIENTS WITH SEVERE OBESITY AFTER ROUX-EN-Y GASTRIC BYPASS(2022) ESTABILE, Priscila Costa; SANTO, Marco Aurelio; MOURA, Eduardo Guimaraes Horneaux de; KUGA, Rogerio; CAPRONI, Priscila; CLEVA, Roberto de; MOTA, Filippe Camarotto; MILLEO, Fabio Quirillo; ARTONI, Roberto FerreiraBACKGROUND: Enteroendocrine L cells can be found in the entire gastrointestinal tract and their incretins act on glycemic control and metabolic homeostasis. Patients with severe obesity and type 2 diabetes mellitus may have lower density of L cells in the proximal intestine.AIMS: This study aimed to analyze the density of L cells in the segments of the small intestine in the late postoperative of Roux-en-Y gastric bypass in diabetic patients with standardization of 60 cm in both loops, alimentary and biliopancreatic.METHODS: Immunohistochemistry analysis assays were made from intestinal biopsies in three segments: gastrointestinal anastomosis (GIA= Point A), enteroentral anstomosis (EEA= Point B= 60 cm distal to the enteroenteral anastomosis (Point C).RESULTS: A higher density of L cells immunostaining the glucagon-1 peptide was onwerved in the distal portion (Point C) When compared to the more proximal portions (Points A and B).CONCLUSIONS: The concentration of L cells is higher 60 cm distal to enteroenteral anastomosis when comparing to proximal segments and may explain the difference in intestinal lumen sensitization and enterohormonal response after Roux-en-Y gastric bypass.HEADINGS:calibre das Gastcvarizes Bypass. Immunohistochemistry. L Cell. Glucagon-Lke Peptiedo 1. Diabets Mellitus, Type 2.
- 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.
- Muscle strength and body composition in severe obesity(2017) GADDUCCI, Alexandre Vieira; CLEVA, Roberto de; SANTAREM, Gabriela Correia de Faria; SILVA, Paulo Roberto Santos; GREVE, Julia Maria D'Andrea; SANTO, Marco AurelioOBJECTIVE: The aim of our study was to evaluate associations between maximum voluntary contraction torques of the lower limbs and body composition for subjects with severe obesity. METHODS: Body composition was evaluated by bioelectrical impedance analysis, and maximum voluntary contraction torques of the lower limbs were measured using an isokinetic dynamometer. One hundred thirty-two patients were enrolled (100 females and 32 males). Eighty-seven patients had a body mass index between 40 and 49.9 kg/m(2) (the A group), and 45 patients had a body mass index between 50 and 59.9 kg/m(2) (the B group). RESULTS: Absolute extension and flexion torques had weak associations with fat-free mass but a moderate association with absolute extension torque and fat-free mass of the lower limbs. There were no significant differences between the A and B groups with respect to absolute extension and flexion torques. For the A group, absolute extension and flexion torques were moderately associated with fat-free mass and with fat-free mass of the lower limbs. For the B group, there were only moderate associations between absolute extension and flexion torques with fat-free mass of the lower limbs. CONCLUSIONS: Our findings demonstrate that both groups exhibited similar absolute torque values. There were weak to moderate associations between absolute extension and flexion torques and fat-free mass but a moderate association with fat-free mass of the lower limbs. Individuals with severe obesity should strive for greater absolute torques, fat-free mass and especially fat-free mass of the lower limbs to prevent functional limitations and physical incapacity.
- OBESITY AND SEVERE STEATOSIS: THE IMPORTANCE OF BIOCHEMICAL EXAMS AND SCORES(2021) SILVA, Miller Barreto de Brito e; TUSTUMI, Francisco; DANTAS, Anna Carolina Batista; MIRANDA, Barbara Cristina Jardim; PAJECKI, Denis; DE-CLEVA, Roberto; SANTO, Marco Aurelio; NAHAS, Sergio CarlosINTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is considered a public health problem, mainly in severely obese patients. OBJECTIVE: The aim of the present study was to investigate different biochemical-based scores available and determine which one could best serve as an NAFLD predicting tool in a severely obese population. METHODS: This was a cross-sectional study involving severely obese patients. All patients were evaluated with serum laboratory parameters for 1 week before biopsy, and all patients were treated with intraoperative liver biopsy, during bariatric surgery. RESULTS: A total of 143 severely obese patients were included. The median body mass index (BMI) was 48 kg/m(2) (35-65). Diabetes mellitus was present in 36%, and steatosis was present in 93% (severe steatosis in 20%). Only aspartate transaminase (AST) to platelet ratio index (APRI=0.65 (95% CI: 0.55-0.8) and homeostatic model assessment for insulin resistance (HOMA-IR=0.7 (95% CI: 0.58-0.82) showed significant capacity for the prediction of severe steatosis. Hepatic steatosis index (HSI), NAFLD fibrosis score (NAFLDS), alanine aminotransferase (ALT)/AST, and fibrosis-4 (FIB-4) were not able to correctly predict severe steatosis on liver biopsy. APRI showed high specificity of 82% and low sensitivity of 54%. In contrast, HOMA-IR showed high sensitivity of 84% and low specificity of 48%. CONCLUSIONS: NAFLDS, FIB-4, AST/ALT, and HSI have no utility for the evaluation of severe steatosis in severely obese patients. Diabetes and insulin-resistance-related biochemical assessments, such as HOMA-IR, can be used as good screening tools for severe steatosis in these patients. APRI score is the most specific biochemical diagnostic tool for steatosis in severely obese patients and can help clinicians to decide the need for bariatric or metabolic surgery.
- Constraints of Weight Loss as a Marker of Bariatric Surgery Success: An Exploratory Study(2021) GIL, Saulo; GOESSLER, Karla; DANTAS, Wagner S.; MURAI, Igor Hisashi; MEREGE-FILHO, Carlos Alberto Abujabra; PEREIRA, Rosa Maria R.; CLEVA, Roberto de; SANTO, Marco Aurelio; KIRWAN, John P.; ROSCHEL, Hamilton; GUALANO, BrunoPurpose The aim of this exploratory study was to investigate whether the degree of weight loss properly reflects improvements in cardiometabolic health among patients who underwent Roux-en-Y gastric bypass. Methods In this ancillary analysis from a clinical trial, patients were clustered into tertiles according to the magnitude of the percentage weight loss (1st tertile: ""higher weight loss"": -37.1 +/- 5.8%; 2nd tertile: ""moderate weight loss"": -29.7 +/- 1.4%; 3rd tertile: ""lower weight loss"": -24.2 +/- 2.3%). Delta changes (9 months after surgery-baseline) in clustered cardiometabolic risk (i.e., blood pressure index, fasting glucose, high-density lipoprotein [HDL] and triglycerides [TG]), glycated hemoglobin (HbA1c), homeostasis model assessment (HOMA-IR), and C-reactive protein (CRP) were calculated. Results A total of 42 patients who had complete bodyweight data (age = 40 +/- 8 year; BMI = 47.8 +/- 7.1 kg/m(2)) were included. Surgery led to substantial weight loss (-37.9 +/- 11.3 kg, P < 0,001), and clinically significant improvements in blood pressure index (-17.7 +/- 8.2 mmHg, P < 0.001), fasting glucose (-36.6 +/- 52.5 mg/dL, P < 0.001), HDL (9.4 +/- 7.1 mg/dL, P < 0.001), TG (-35.8 +/- 44.1 mg/dL P < 0,001), HbA1c (-1.2 +/- 1.6%, P < 0.001), HOMA-IR (-4.7 +/- 3.9 mg/dL, P < 0.001) and CRP (-8.5 +/- 6.7 mu g/mL P < 0.001). Comparisons across tertiles revealed no differences for cardiometabolic risk score, fasting glucose, HbAc1, HOMA-IR, blood pressure index, CRP, HDL, and TG (P > 0.05 for all). Individual variable analysis confirmed cardiometabolic improvements across the spectrum on weight-loss. There were no associations between weight loss and any dependent variable. Conclusion Weight loss following bariatric surgery does not correlate with improvements in cardiovascular risk factors. These findings suggest that weight loss alone may be insufficient to assess the cardiometabolic success of bariatric surgery, and the search for alternate proxies that better predict surgery success are needed.
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