Abstract Introduction: Obesity is associated with multiple comorbidities such as dyslipidemia. Objective: To analyze the changes in lipid parameters in patients undergoing bariatric surgery procedures. Material and methods: Longitudinal study in patients undergoing bariatric surgery in 2016. Post-procedure changes were recorded. Results: 66 patients were included. Gastric sleeve was performed in 33.3%, Roux-en-Y gastric bypass (RYGB) in 22.7% and an anastomosis bypass in 43.9%. Initial weight of 122 ± 26.9 kg and initial BMI of 46.72 ± 8.7 kg/m2. Atherogenic dyslipidemia (AD) occurred in 83.3%. Significant differences were found in all the variables studied at the year of follow-up; no difference between the different techniques in weight: p = 0.674, %EBWL: p = 0.420, TGC: p = 0.287 and c-HDL: p = 0.432; if in the changes of CT (p = 0.0001) and c-LDL (p = 0.01). When evaluating the indexes, a significant difference was found in all at the beginning and at 12 months of follow-up (p = 0.001); no difference between the techniques studied. With respect to AD, significant improvement was observed at one year follow-up (p = 0.05) with remission in 74%. Conclusions: Bariatric surgery is associated with improvement of the different lipid parameters, with remission of AD in most patients regardless of the type of procedure performed.

Resumen Introducción: La obesidad se asocia a múltiples comorbilidades como la dislipidemia. Objetivo: Analizar los cambios en los parámetros lipídicos en pacientes sometidos a procedimientos de cirugía bariátrica. Material y métodos: Estudio longitudinal en pacientes sometidos a cirugía bariátrica en 2016. Se registraron los cambios posteriores al procedimiento. Resultados: Se incluyeron 66 pacientes. Se realizó manga gástrica en 33.3%, bypass en Y de Roux en 22.7% y bypass de una anastomosis en 43.9%. Peso inicial de 122 ± 26.9 kg e IMC inicial de 46.72 ± 8.7 kg/m2. Se presentó dislipidemia aterogénica (DA) en 83.3%. Se encontraron diferencias significativas en todas las variables estudiadas al año de seguimiento; sin diferencia entre las diferentes técnicas en peso: p = 0.674, %EPP: p = 0.420, TGC: p = 0.287 y c-HDL: p = 0.432; si en los cambios de CT (p = 0.0001) y c-LDL (p = 0.01). Al evaluar los índices, en todos se encontró diferencia significativa al inicio y a los 12 meses de seguimiento (p = 0.001) sin diferencia entre las técnicas estudiadas. Con respecto a la DA, se observó mejoría significativa al año de seguimiento (p = 0.05) con remisión en 74%. Conclusiones: La cirugía bariátrica se asocia a mejoría de los diferentes parámetros lipídicos con remisión de la DA en la mayoría de los pacientes independientemente del tipo de procedimiento realizado.

Resumen El carcinoma similar al linfoepitelioma (LELC) del cuello uterino es una variante infrecuente del carcinoma de células escamosas. Se presenta el caso de una mujer con un tumor exofítico en el cuello uterino de consistencia aumentada, sangrado al tacto y parametrios libres de tumor clasificándose como etapa clínica IBI; el estudio histopatológico reportó LELC con recurrencia a distancia al año de seguimiento. Debido a su buen pronóstico existen pocos casos reportados de recurrencia posterior al tratamiento inicial.

Abstract Lymphoepithelioma-like carcinoma (LELC) of the cervix is an uncommon variant of squamous cell carcinoma. We present the case of a woman with an exophytic tumor on the cervix of increased consistency, bleeding to the touch and tumor-free parametriums classified as clinical stage IBI; the histopathological study reported LELC with distant recurrence at one year of follow-up. Due to its good prognosis, there are few reported cases of recurrence after initial treatment.

RESUMO Racional: A obesidade é um grande problema de saúde. Bypass gástrico com uma anastomose (OAGB) é operação de perda de peso restritiva e disabsortiva que carrega as mesmas características do bypass gástrico em Y-de-Roux em seu status de mecanismo de perda de peso, mas seus resultados permanecem controversos. Objetivo: Descrever a técnica e os resultados do OAGB e seus efeitos na perda de peso e na remissão de comorbidades. Método: Revisão retrospectiva de todos os pacientes que foram submetidos a OAGB de janeiro de 2017 a janeiro de 2018. As características basais dos pacientes foram registradas. O acompanhamento de rotina foi de 1, 3, 6 e 12 meses. Resultados: Um total de 51 pacientes foi submetido a OAGB-HGM. A idade média foi de 43,8±9,3 anos, o peso médio foi de 125±31 e o IMC médio de 55,8±12 kg/m2. Em relação às comorbidades, 64,7% apresentavam diabete melito tipo 2 (DM2), 43,1% hipertensão arterial sistêmica (HAS) e 51% dislipidemia. O IMC diminuiu para 48,4±1,3 a 31±4,4 em 12 meses (p=0,0001) e a redução média foi de 65% de perda de excesso de peso (EWL) em 12 meses de seguimento. Houve melhora nos valores do colesterol total (CT) (p=0,348); triglicéridos (TGC) (p=0,0001); LDL (p=0,06), HDL (p=0,029) e A1C (p=0,405). A remissão do DM2 ao seguimento de 12 meses após a operação foi de 57% (p=0,124), remissão da HAS 37% (p=0,040) e remissão da dislipidemia de 43% (p=0,967). Conclusões: OAGB-HGM é procedimento comumente realizado e seguro. Resultados de curto prazo parecem promissores; no entanto, o acompanhamento em longo prazo é necessário para avaliar as complicações e possíveis efeitos nutricionais

ABSTRACT Background: Obesity is a major health problem. One anastomosis-gastric bypass (OAGB) is a restrictive and malabsorptive weight loss surgery that carries the same characteristics of Roux-en-Y gastric bypass in its status as a weight loss mechanism; but, its results remain controversial. Aim: To describe the technique and outcomes of OAGB and its effects on weight loss and remission of comorbidities. Methods: Retrospective review of all patients who underwent OAGB procedure from January 2017 to January 2018. Patients’ baseline characteristics were recorded. The routine in follow-up were at 1, 3, 6 and 12 months. Results: A total of 51 patients underwent OAGB. The mean age was 43.8±9.3 years, mean weight was 125±31 and mean BMI was 55.8±12 kg/m2. With regard to comorbidities, 64.7% had type 2 diabetes mellitus (T2DM), 43.1% systemic arterial hypertension (SAH) and 51% dyslipidemia. The BMI decreased for 48.4±1.3 to 31±4.4 at 12 months (p=0.0001) and we obtained an average decreased of 65% excess weight loss (EWL) at 12 months of follow-up. There was improvement in the values of total cholesterol (CT) (p=0.348); triglycerides (TGC) (p=0.0001); LDL (p=0.06), HDL (p=0.029) and A1C (p=0.405). Remission of T2DM al 12 months follow-up after surgery was 57% (p=0.124), remission of SAH 37% (p=0.040) and remission of dyslipidemia of 43% (p=0.967). Conclusions: OAGB is a commonly performed and safe procedure. Short term results appear promising; however, long-term follow-up is necessary to evaluate complications and possible nutritional effects.

Abstract: Introduction: Superior mesenteric artery syndrome or Wilkie’s syndrome is a rare cause of intestinal obstruction after massive weight loss. The definitive diagnosis is established by imaging studies and the initial treatment is conservative; when this fails, surgical management is necessary. Case report: We present the case of a 43 year old woman with Wilkie’s syndrome who presents with symptoms of intestinal obstruction for three weeks. The abdominal tomography showed a large gastric and duodenal dilatation that required urgent surgical treatment, performing an open duodenojejunostomy without complications. Conclusion: Wilkie syndrome is a rare complication after weight loss that may require urgent surgical treatment and must be in a patient with this history and a picture of intestinal occlusion.

Resumen: Introducción: El síndrome de la arteria mesentérica superior o síndrome de Wilkie es una causa poco frecuente de obstrucción intestinal posterior a la pérdida masiva de peso. El diagnóstico definitivo se establece mediante estudios de imagen y el tratamiento inicial es conservador; cuando éste falla, es necesario el manejo quirúrgico. Informe de caso: Mujer de 43 años con síndrome de Wilkie se presenta con síntomas de obstrucción intestinal de tres semanas de evolución. La tomografía de abdomen demostró dilatación gástrica y duodenal considerable que requirió manejo quirúrgico de urgencia, se realizó una duodenoyeyunostomía abierta sin complicaciones. Conclusión: El síndrome de Wilkie es una complicación rara posterior a la pérdida acelerada de peso que puede requerir manejo quirúrgico de urgencia y debe considerarse en pacientes con dicho antecedente y un cuadro de oclusión intestinal.