This study shows that severely obese, non-diabetic patients who had pronounced weight loss after bariatric surgery had an overall improvement in brachial flow-mediated dilation, CIMT, high-sensitivity CRP, and glucose and lipid metabolism. The best responses of the brachial flow-mediated dilation after surgery were observed in non-smokers and in younger subjects.

Background. Bariatric surgery is considered an effective option for the management of morbid obesity. The incidence of obesity has been gradually increasing all over the world reaching epidemic proportions in some regions of the world. Obesity can cause a reduction of up to 22% in the life expectancy of morbidly obese patients. Objective. The objective of this paper is to assess the weight loss associated with the first 6 months after bariatric surgery using bioelectric impedance analysis (BIA) for the evaluation of fat mass and fat-free mass. Method. A total of 36 morbidly obese patients were subjected to open gastric bypass surgery. The patients weight was monitored before and after the procedure using the bioelectric impedance analysis. Results. Bariatric surgery resulted in an average percentage of weight loss of 28.6% (40 kg) as determined 6 months after the procedure was performed. Analysis of the different components of body weight indicated an undesirable loss of fat-free mass along with the reduction of total body weight. Conclusion. Open gastric bypass induced a significant loss of total weight and loss of fat-free mass in patients six months after the surgery. The use of bioelectric impedance analysis resulted in an appropriate estimation of the total weight components in individuals subjected to bariatric surgery allowing a more real analysis of the variation of weight after the surgery.

The purpose of the study was to evaluate the outcome of ureteroscopic holmium laser lithotripsy (UHLL) in children, taking into consideration different stone locations. Records of 15 children with ureteral calculi managed with UHLL were reviewed. All patients were evaluated with history, clinical, radiological and laboratory assessment prior to treatment. All patients were managed on an outpatient basis. After stone disintegration, if sizable fragments remained, they were retrieved using grasping forceps or stone basket extraction. Patient records were reviewed for age, sex, stone laterality, location, number and size, need for ureteral dilation, stenting and residual fragment extraction. Of the 15 children, 11 were female and 4 were male. Mean age was 8.5 years (age range 2-15 years). There was no significant difference in stone laterality (eight left and seven right ureteral stones). Main presenting symptoms were renal colic, hematuria and urinary tract infection or a combination of these symptoms. The 15 children harbored 15 ureteral stones (range 5-11 mm, mean 7.8 mm) and underwent 15 UHLL procedures. Ureteral dilation was performed in 14 patients using balloon dilators. Stone retrieval was done in all patients. DJ stents were placed at the conclusion of the procedure in 11 patients. Complete stone clearance was achieved at the end of the procedure in all patients (success rate 100%). No complications were encountered during or after the procedure. This study confirms the effectiveness and safety of ureteroscopy and holmium laser in the treatment of ureteral stones in children regardless of stone location.

A holmium laser is a safe and effective modality of ureteroscopic lithotripsy in patients with significant renal impairment or even obstructive anuria. The use of holmium laser with ureteroscopy may be considered in this group of patients as long as the general condition of the patient permits the safe administration of anesthesia.

ARTIGO ORIGINAL 69 INTRODUÇÃOApesar dos grandes progressos da cirurgia nas últi-mas décadas, o diagnóstico e o seguimento das doenças hepáticas continuam a oferecer dificuldades para a práti-ca médica 1,2 .A punção hepática, utilizada inicialmente para o diagnóstico e tratamento de abscessos hepáticos, passou a ter finalidades diagnósticas a partir de 1883, quando Paul Ehrlich realizou a primeira biopsia hepática para estudar o conteúdo de glicogênio em fígados diabéticos 1 .Há seis décadas o método passou a ser mais freqüen-temente utilizado com finalidades diagnósticas, tendo sido consolidado a partir da Segunda Guerra Mundial para o estudo de numerosos casos de hepatites virais que acometeram os soldados envolvidos no conflito 1 .As duas únicas contra-indicações absolutas ao mé-todo são o cisto hidático e o hemangioma cavernoso do fígado 1 . Outra contra-indicação para a biopsia hepática são os distúrbios graves de coagulação, medidos pelo alargamento do tempo de protrombina. Alguns autores consideram ainda indispensável para avaliação da coagulação a contagem de plaquetas, cujo limite de segurança estaria em torno de 80.000 [1][2][3][4][5][6][7] .A hemorragia representa cerca de metade das complicações, sendo a principal causa de mortalidade. Estudos realizados relatam que as taxas de hemorragias com necessidade de reposição volêmica atingiram 0,2% a 0,25% das biopsias realizadas, e 6% a 25% destes pacientes necessitaram de laparotomia [2][3][4][5][6][7] .A peritonite biliar representa cerca de 15% das complicações. A disseminação tumoral pelo trajeto da punção é uma complicação rara, porém descrita na literatura. Alguns autores recomendam que a biopsia só deva ser realizada em pacientes não candidatos à ressecção cirúrgica 2,3 .