No abstract

Abstract-Structural alterations of subcutaneous small resistance arteries, as indicated by an increased media:lumen ratio, are frequently present in hypertensive and/or diabetic patients and may represent the earliest alteration observed. In addition, media:lumen ratios of small arteries have a strong prognostic significance. However, no data are available about the structure of small resistance arteries of obese patients, particularly after weight loss. We have investigated 27 patients with severe obesity. Twelve of them were normotensive, and 15 were hypertensive. All of the obese patients underwent bariatric surgery. We compared results obtained with those observed in 13 normotensive lean controls and in 13 hypertensive lean patients. All of the subjects and patients underwent a biopsy of subcutaneous fat during surgical intervention. In 8 obese patients, a second biopsy was obtained after consistent weight loss, during a surgical intervention for abdominoplasty. Subcutaneous small resistance arteries were dissected and mounted on a wire myograph, and structural parameters were measured. A concentration-response curve to acetylcholine was performed to evaluate endothelial function. Obese patients, independent from the presence of hypertension, show the presence of an increased media:lumen ratio and media cross-sectional area, together with an impaired endothelial-dependent vasodilatation. After surgical correction of obesity and consistent weight loss, a significant improvement of microvascular structure and of some oxidative stress/inflammation markers were observed. In conclusion, our data suggest that the presence of obesity is associated with structural alterations of subcutaneous small resistance arteries, mainly characterized by hypertrophic remodeling. Weight loss may improve microvascular structure. (Hypertension. 2011;58:29-36.)Key Words: remodeling Ⅲ hypertension Ⅲ obesity Ⅲ microcirculation Ⅲ small arteries A lterations in the microcirculation are common accompaniments of cardiovascular and metabolic diseases 1,2 and may involve small resistance arteries, arterioles, capillaries, and postcapillary venules. 3 In particular, the structure of subcutaneous 1-3 and cerebral 4 small resistance arteries (lumen diameter: 100 to 300 m) may be altered in the presence of cardiovascular or metabolic diseases. Essential hypertension is associated with a narrowing of the internal lumen and with an increase of media wall thickness, with consequent increase in the media:lumen ratio. 1 The observed increase in the media:lumen ratio may be the consequence of an eutrophic remodeling (rearrangement of otherwise normal material around a narrowed lumen) or of a hypertrophic remodeling (vascular smooth muscle cell hypertrophy or hyperplasia). 5 Eutrophic remodeling of subcutaneous small arteries is commonly seen in essential hypertension, whereas an inward hypertrophic remodeling, with evident smooth muscle cell growth, was shown in patients with type 2 diabetes mellitus, regardless of the presence of elevated or normal ...

Weight regain is commonly observed during long-term follow-up after IGB removal. Nevertheless, the maintenance of at least 10% of the BWL%, as reported at 1-year follow-up, is associated with an improvement in metabolic syndrome.

All available evidence indicates that SSO should be the procedure of choice for rectal cancer, even in the lower one-third. An APER should only be performed when cancer invades the anal sphincters and negative resection margins cannot be achieved by a SSO.

Under the aforementioned conditions, an attempt to extend NoM to include patients with AAST-grade III lesions can be justified. However, such a strategy demands continuous patient monitoring, because should the case worsen, surgery might become necessary.