Search

To prospectively assess the efficacy of the lymphatic microsurgical preventive healing approach (LYMPHA) to prevent lymphedema after axillary dissection (AD) for breast cancer treatment. Among 49 consecutive women referred from March 2008 to September 2009 to undergo complete AD, 46 were randomly divided in 2 groups. Twenty-three underwent the LYMPHA technique for the prevention of arm lymphedema. The other 23 patients had no preventive surgical approach (control group). The LYMPHA procedure consisted of performing lymphatic-venous anastomoses (LVA) at the time of AD. All patients underwent preoperative lymphoscintigraphy (LS). Patients were followed up clinically at 1, 3, 6, 12, and 18 months by volumetry. Postoperatively, LS was performed after 18 months in 41 patients (21 treatment group and 20 control group). Arm volume and LS alterations were assessed. Lymphedema appeared in 1 patient in the treatment group 6 months after surgery (4.34%). In the control group, lymphedema occurred in 7 patients (30.43%). No statistically significant differences in the arm volume were observed in the treatment group during follow-up, while the arm volume in the control group showed a significant increase after 1, 3, and 6 months from operation. There was significant difference between the 2 groups in the volume changes with respect to baseline after 1, 3, 6, 12, and 18 months after surgery (every timing P value

We studied the safety, activity and peripheral blood progenitor cell mobilizing capability of a dose-dense combination of vinorelbine (VNB) and paclitaxel (PTX) as first-line chemotherapy for patients with metastatic breast cancer (MBC). Forty-three MBC patients were submitted to four cycles of VNB 30 mg/m2 and PTX 175 mg/m2 intravenously, every 2 weeks, as the first induction step of a tandem high-dose chemotherapy program. Granulocyte colony-stimulating factor (G-CSF) 5 microg/kg was administered daily from day +5 to +10 in order to accelerate hematopoietic recovery, or 48h after the last VNB-PTX when a leukapheresis was planned (after the third or fourth cycle). A total of 172 cycles were administered. The mean delivered dose-intensity of VNB and PTX was 14.7 and 86 mg/m2/week, respectively (98% of the planned dose-intensity). The main per-patient toxicities were: peripheral neurotoxicity (G1/2 60%, G3 5%), constipation (G1/2 10%), oral mucositis (G1/2 20%), and asthenia (G1/2 35%). Hematological toxicity was unremarkable, except for anemia with hemoglobin (Hb) values < 10 g/dl (28%), and lymphopenia with lymphocyte counts < 1000/mm3 (28%). Two complete (5.1%) and 24 partial (61.5%) responses were observed in 39 assessable patients, for an overall response rate of 66.6% (95% CI 51.6-80.9). A median of one apheretic procedure (range 1-3) was required to achieve the target number of 6 x 10(6)/kg CD34+ cells. The median number of CD34+ harvested per patient was 15 x 10(6)/kg (range 6.4-36.5). Four cycles of dose dense VNB and PTX showed a favorable toxicity profile, a relevant anti-tumor activity and a high peripheral blood progenitor cell mobilizing activity.

Background. Surgical attempts to treat obsity began because of the discouraging results of conservative medical treatment, which successfully achieved initial weight loss but failed to maintain it. Gastric restrictive procedures, currently the most popular surgical methods for obesity therapy, have proved to be effective in initiating weight loss, but some concerns regarding their long-term efficacy in weight maintenance have arisen. Methods. Of a total of 1968 obese patients who underwent biliopancreatic diversion since 1976, the last consecutive 1217 underwent the “ad hoc stomach” type of diversion with a 200 cm alimentary limb, a 50 cm common limb, and a gastric volume varying between 200 and 500 ml. Mean age was 37 years old (11 to 69 years), and mean excess weight was 117%. Maximum follow-up was 115 months with nearly 100% participation. Results. In the last half of the series, operative mortality was 0.4% with no general complications and with early surgical complications of wound dehiscence and infection (total, 1.2%) and late complications of incisional hernia (8.7%) and intestinal obstruction (1.2%). Mean percent loss of initial excess weight (IEW) at 2, 4, 6, and 8 years was 78±16, 75±16, 78±18, and 77±16 in the patients with IEW up to 120% and 74±12, 73±13, 73±12, and 72±10 in those with IEW more than 120%. A group of 40 patients who underwent the original “half-half” biliopancreatic diversion maintained a mean 70% reduction of IEW during a 15-year follow-up period. Specific late complications included anemia (less than 5%), stomal ulcer (2.8%), protein malnutrition (7% with 1.7% requiring surgical revision by common limb elongation or by restoration). Clinical problems from bone demineralization were minimal in the short term and almost absent in the long term. Conclusions. Biliopancreatic diversion is a very effective procedure but is potentially dangerous if used incorrectly.

Breast cancer-related lymphedema (LE) represents an important morbidity that jeopardizes breast cancer patients' quality of life. Different attempts to prevent LE brought about improvements in the incidence of the pathology but LE still represents a frequent occurrence in breast cancer survivors. Over 4 years ago, Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) was proposed and long-term results are reported in this study. From July 2008 to December 2012, 74 patients underwent axillary nodal dissection for breast cancer treatment together with LYMPHA procedure. Volumetry was performed preoperatively in all patients and after 1, 3, 6, 12 months, and once a year. Lymphoscintigraphy was performed in 45 patients preoperatively and in 30 also postoperatively after at least over 1 year. Seventy one patients had no sign of LE, and volumetry was coincident to preoperative condition. In three patients, LE occurred after 8-12 months postoperatively. Lymphoscintigraphy showed the patency of lymphatic-venous anastomoses at 1-4 years after operation. LYMPHA technique represents a successful surgical procedure for primary prevention of arm LE in breast cancer patients.

Background This study aimed to establish if women with a diagnosis of flat epithelial atypia (FEA) without residual microcalcifications at stereotactic vacuum-assisted breast biopsy (VABB) could be managed with mammographic follow-up (FU) instead of surgery and to compare 9-gauge and 11-gauge devices. Patients and Methods From October 2003 to January 2011, 2382 VABB procedures were performed (1373 with 11-gauge and 1009 with 9-gauge). We found 121 cases of pure FEA that were surgically treated: 57 with a 9-gauge device (group 1) and 64 with an 11-gauge device (group 2). The underestimation rate (UR) of malignancy for patients without and those with residual microcalcifications for each VABB device was calculated. Differences between groups were analyzed with the Fischer exact test. Results The overall UR of FEA was 4% (2 of 57) with the 9-gauge device and 8% (5 of 64) with the 11-gauge device. With a 9-gauge device, the UR for patients without residual microcalcifications was 0% (0 of 46), and the UR for patients with residual microcalcifications was 18% (2 of 11). With an 11-gauge device, the UR for patients without residual microcalcifications was 0% (0 of 39), the UR for patients with residual microcalcifications at post-biopsy mammograms was 16% (5 of 25). With a 9-gauge device, 80% (46 of 57) of patients did not have residual microcalcifications after VABB. With an 11-gauge device, 60% (39 of 64) of patients had no residual microcalcifications after VABB. Differences between the 9-gauge and 11-gauge devices were statistically significant ( P Conclusion Women with FEA without residual microcalcifications after VABB can be managed conservatively. Nine-gauge VABB is associated with a lower percentage of residual microcalcifications compared with an 11-gauge device, but it is safe to follow patients with FEA if all calcifications are removed with the core biopsy.

Patient-related, tumor-related, and sentinel node (SN)-related factors have been identified with the aim of predicting non-SN status in patients with SN micrometastases. According to our previous experience, primary tumor size (p=0.005) and the presence of lymphovascular invasion (LVI) (p=0.000) significantly predicted non-SN status in patients with SN micrometastasis; moreover, non-SN metastases were never detected in patients with pT1a-1b, G1, and no LVI. A prospective assessment was undertaken in a validation set of 126 patients to confirm these findings. Univariate analysis indicated that primary tumor size (p=0.05), Scarff-Bloom-Richardson (SBR) grade (p=0.008), LVI (p=0.001), and the number of mitoses/mm(2) (p=0.01) were significant predictors of non-SN status. By logistic regression analysis, tumor size (p=0.03), LVI (p=0.001), grade (p=0.003) and the number of mitoses/mm(2) (p=0.01) were the only variables remaining in the model. Three subsets of patients were identified: i) 18.3% of patients (pT1, G1, and no LVI) had tumor-negative non-SN (no risk group); ii) 37.3% of patients (number of mitoses/mm(2)10, SBR grade II-III) had a rate of tumor-positive non-SN15% (intermediate risk); iii) 44.4% of patients had a mean rate of non-SN involvement of 46% (high risk). By these parameters, more than 50% of patients could be selectively spared unnecessary axillary lymph node dissection without staging or therapeutic benefit, especially in patients with well-differentiated pT1 tumors without LVI.

Ectopic breast tissue comes in two forms: supernumerary and aberrant. Despite morphologic differences, ectopic breast tissue presents characteristics analogous to orthotopic breast tissue in terms of function and, most importantly, pathologic degeneration. Data in the literature concerning its precise incidence, the probability of malignant degeneration, and its standardized management are scarce and controversial. This study selected more than 100 years of literature, and this report discusses a case of ectopic breast cancer treatment, suggesting novel therapeutic advice that could bring considerable clinical advantages, improve cosmetic results, and reduce the psychological impact on patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The purpose of our study was to establish whether it might be safe for women with a diagnosis of atypical ductal hyperplasia (ADH) at stereotactically guided vacuum-assisted breast biopsy without any residual microcalcification after the procedure to undergo mammographic follow-up instead of surgical biopsy.From October 2003 to January 2009, 1173 consecutive 11-gauge vacuum-assisted breast biopsy procedures were performed. ADH was found in the specimens of 114 patients who underwent vacuum-assisted breast biopsy for a single cluster of suspicious microcalcifications smaller than 15 mm; 49 had residual microcalcifications, and 65 had microcalcifications completely removed by the procedure. Of 49 patients with residual microcalcifications, 41 underwent surgical biopsy. Of 65 patients without residual microcalcifications, 26 underwent surgical biopsy, 35 were not surgically treated and were managed conservatively with mammographic follow-up, and 4 had follow-up of less than 24 months.In 41 patients with residual microcalcifications who underwent surgical biopsy, 8 malignant lesions were found at surgery. The underestimation rate was 20% (8/41). In 26 patients without residual microcalcifications who underwent surgical biopsy, no malignant lesions were found. One malignant lesion was found in the 35 patients managed conservatively at follow-up. The underestimation rate in patients without residual microcalcifications using surgical biopsy or mammographic follow-up as the reference standard was 1.6% (1/61).Patients without residual microcalcifications after vacuum-assisted breast biopsy could possibly be managed in a conservative way with mammographic follow-up.

Body composition was measured with bioelectric impedance analysis (BIA) in 30 patients with protein malnutrition following biliopancreatic diversion. Determinations were carried out prior to, during, and at the completion of intravenous nutritional support when the nutritional parameters had completely reverted to normal. Before treatment, body weight (BW), lean body mass (LBM), and body fat (BF) values were similar to those of controls, whereas the total body sodium/total body potassium (TBNa/TBK) and extracellular mass/body cell mass (ECM/BCM) ratios were considerably higher. During the support, no changes in BW, LBM, and BF were demonstrated, although a sharp decrease of TBNa/TBK and ECM/BCM was observed, thus demonstrating improved LBM composition. At the end of parenteral feeding, the BW, LBM, and BF values were similar to those observed before the support, while a further decrease in TBNa/TBK and ECM/BCM demonstrated a recovery towards normal of body composition. The full correspondence between clinical and BIA findings therefore suggests that this method may be valuable for monitoring body composition changes during nutritional support.

Introduction The frequency of intra-orbital metastasis in systemic cancer is a controversial topic. Of all metastatic tumors to the orbit of the eye, breast carcinoma is considered to be the most prevalent. Orbital findings typically present themselves after the diagnosis of the primary tumor, with an average delay of three to six years. In spite of that, this study reports a case in which orbital manifestation was the initial symptom in breast carcinoma diagnosis. Case presentation A 66-year-old Italian Caucasian woman presented with a swelling located on the lower orbit of her right eye. Conclusions Previous cases report orbital manifestations discovered secondary to breast cancer. This case demonstrates that orbital symptoms may be the primary presentation of the disease. Orbital metastasis originating from breast cancer predicts widespread metastatic disease in other organs. In the presence of an ambiguous infiltrative orbital process, diagnostic examination of the breast is recommended.

The purpose of this manuscript is to assess the efficacy of direct lymphatic venous microsurgery in the prevention of lymphedema following axillary dissection for breast cancer.Nineteen patients with operable breast cancer requiring an axillary dissection underwent surgery, carrying out LVA between the blue lymphatics and an axillary vein branch simultaneously. The follow-up after 6 and 12 months from the operation included circumferential measurements in all cases and lymphangioscintigraphy only in 18 patients out of 19 cases.Blue nodes in relation to lymphatic arm drainage were identified in 18/19 patients. All blue nodes were resected and 2-4 main afferent lymphatics from the arm could be prepared and used for anastomoses. Lymphatic-venous anastomoses allowed to prevent lymphedema in all cases. Lymphangioscintigraphy demonstrated the patency of microvascular anastomoses.Disruption of the blue nodes and closure of arm lymphatics can explain the significantly high risk of lymphedema after axillary dissection. LVA proved to be a safe procedure for patients in order to prevent arm lymphedema.

Aim To identify by means of clinical and histopathological features a subset of breast cancer patients with sentinel lymph-node (sN) micrometastases and metastatic disease confined only to the sN in order to spare them an unnecessary axillary lymph node dissection (ALND). Materials and methods From January 1998 to December 2004, 116 patients with sN micrometastases underwent standard ALND for early-stage (T 1–2 N 0 M 0 ) invasive breast cancer; clinical and histopathologic parameters were prospectively collected and evaluated by means of univariate and logistic regression analysis in order to identify which patients with sN micrometastases were free of metastasis in axillary non-sN. Results Sixteen of 116 patients with sN micrometastases had tumour involvement of non-sN, with six and 10 patients having non-sN micrometastases and macrometastases, respectively. None of 19 patients with primary tumour measuring ≤10 mm had tumour-positive non-sN; moreover, none of 15 patients with G1 tumours had non-sN metastases. The mean tumour size in patients with non-sN involvement was 21.3 mm (range, 12–40 mm). Univariate test of association between clinical and histopathologic features and non-sN status showed that the primary tumour size ( P =0.005) and the presence of lymphovascular invasion ( P =0.000) were the only significant predictors of non-sN involvement. By logistic regression, primary tumour size ( P =0.011), lymphovascular invasion ( P =0.001), and size of sN micrometastases were the only variables remaining into the model, although the latter parameter was not statistically significant. Conclusions In patients with sN micrometastases, primary tumour size and lymphovascular invasion significantly predict non-sN status; notably, no patient with T 1a –T 1b and/or G1 tumours had non-sN metastases so that they could be spared an unnecessary ALND.

Portal vein thrombosis may complicate splenectomy in patients with hemolytic anemia and myeloproliferative disease, whereas the frequency of portal vein thrombosis in case of trauma is not defined. A case of right portal vein thrombosis after splenectomy for trauma is reported in this paper. Hematologic workup did not reveal an underlying platelet or coagulation disorder. The patient was promptly anti-coagulated with complete recanalization of the portal vein. We conclude that mild symptoms, like abdominal pain and fever, after splenectomy should be investigated with a color Doppler ultrasonography to confirm or rule out a diagnosis of portal thrombosis and to anti-coagulate the patient with thrombosis, thus preventing bowel infarction and secondary portal hypertension. Routine postoperative color Doppler might also be justified in all postsplenectomy patients (without hematologic diseases) for early detection of a portal vein thrombosis.

Biliopancreatic diversion (BPD) has made reacceptable the malabsorptive approach to the surgical treatment of obesity. The procedure, in a series of 2241 patients operated on during a 21-year period, caused a mean permanent reduction of about 75% of the initial excess weight. The indefinite weight maintenance appears to be due to the existence of a threshold absorption capacity for fat and starch, and thus energy, and the weight loss is partly due to increased resting energy expenditure. Beneficial effects other than those consequent to weight loss or reduced nutrient absorption included permanent normalization of serum glucose and cholesterol without any medication and on totally free diet in 100% of cases, both phenomena being due to a specific action of the operation. Operative mortality was less than 0.5%. Specific late complications included anemia, less than 5% with adequate iron or folate supplementation (or both); stomal ulcer, reduced to 3.2% by oral H2-blocker prophylaxis; bone demineralization, increasing up to the fourth year and tending to decrease thereafter, with need of calcium and vitamin D supplementation; neurologic complications, totally avoidable by prompt vitamin B administration to patients at risk; protein malnutrition, which was reduced to a minimum of 3% with 1.3% recurrence, in exchange with a smaller weight loss, by adapting the volume of the gastric remnant and the length of the alimentary limb to the patient's individual characteristics. It is concluded that the correct use of BPD, based on the knowledge of its mechanisms of action, can make the procedure an effective, safe one in all hands.

Background This study evaluates a 5-year experience of the management of the most frequent abdominal wall hernias in an elderly population. Methods From April 1990 to December 1995, 231 inguinal, 12 femoral and seven umbilical hernias were repaired in 221 patients (mean age 74 (range 66–93) years). Concomitant diseases were present in 157 patients, A mesh repair was performed with ‘tension-free’ or ‘plug’ techniques in all but 23 inguinal and two femora! hernia repairs, in which the Bassini or Shouldice procedures were adopted. Ten emergency hernia repairs were performed for strangulation. A total of 232 operations, including four emergency hernia repairs, were carried out under local anaesthesia. Results There was no perioperative mortality. Acute intestinal bleeding occurred 2 days after surgery in a patient with colonic diverticular disease. Urinary retention occurred once following emergency hernia repair under general anaesthesia and twice after elective hernia repair under local anaesthesia. Local complications included four scrotl haematomas (2 per cent), three wound infections (1 per cent) and one case of orchitis with atrophy after repair of a recurrent hernia. There was one recurrence after a Bassini repair and one after Shouldice inguinal herniorrhaphy. No recurrence was observed after mesh repair. Conclusion Local anaesthetic mesh hernia repair is safe and effective in elderly patients. Age should be no bar to elective hernia repair. This policy should avoid the complications of emergency operation.

Background: Immunohistochemistry (IHC) and fluorescence-in-situ hybridization (FISH) are the standard methods to assess human epidermal growth factor receptor 2 (HER-2) status in breast cancer (BC) patients. Real-time quantitative polymerase-chain-reaction (Q-PCR) and quantitative reverse transcriptase PCR (qRT-PCR) allow quantitative determination of gene copy number and gene expression on, respectively, DNA and RNA. These molecular methods are available to assess HER-2 amplification/overexpression but their use remains controversial. Here we performed a parallel comparison of these four methods to define their concordance rates and evaluate their relative role in HER-2 status determination. Patients and Methods: HER-2 status was determined by IHC, FISH, Q-PCR and qRT-PCR in a retrospectively assessed cohort of 130 BC patients. The studied set was enriched in cases scoring as 3+ by standard IHC analysis. Tests were performed blindly in parallel. Western blotting was performed on a subset of equivocal cases. Kappa statistics and ROC curves were used as appropriate, and concordance analyses were interpreted according to the ASCO/CAP guidelines. Results: Of the 130 enrolled patients, 47 (36%) were classified as positive and 27 (21%) as equivocal by IHC. With FISH, 50 patients (38%) were HER-2 amplified, while 80 (62%) were not. The overall agreement between FISH and Q-PCR was 98.5% (95% CI, 94.6% to 99.6%) with a k value of 0.97 (95% CI, 0.92 to 1). Assuming FISH as the standard reference, Q-PCR showed a sensitivity of 98% (95% CI, 89.5% to 99.6%) and a specificity of 98.8% (95% CI, 93.3% to 99.8%), with a global accuracy of 98%. The overall agreement between FISH and qRT-PCR was 96.9% (95% CI, 92.3% to 98.8%) with a k value of 0.94 (95% CI, 0.87 to 1). For both comparisons, the observed concordance values were greater than the 95% threshold required by the ASCO/CAP guidelines to validate novel approaches for HER-2 testing. 3% of samples showed HER-2 overexpression only by qRT-PCR analysis, in all cases belonging to the equivocal range as defined by either IHC or FISH. In these patients, WB confirmed higher HER-2 protein levels compared to healthy diploid controls. Conclusions: The high concordance between FISH and both Q-PCR and qRT-PCR supports the use of molecular tests as an alternative to current standard methods. Present results also suggest that qRT-PCR may be able to unequivocally classify patients belonging to the IHC/FISH equivocal range. Non-amplified HER-2 overexpressing BCs may account for the rare trastuzumab-responders observed in phase III trials, where trastuzumab response was assessed in HER-2-amplified vs. non-amplified cases. Citation Format: Gabriele Zoppoli, Anna Garuti, Ilaria Rocco, Claudia Palermo, Gabriella Cirmena, Enrico Carminati, Daniele Friedman, Ludovica Verdun di Cantogno, Anna Sapino, Franco Patrone, Alberto Ballestrero. Agreement of immunohistochemistry, fluorescence in situ hybridization, real-time quantitative polymerase-chain reaction, and quantitative reverse transcriptase PCR for Her-2/Neu status assessment in breast cancer patients: a single center, retrospective m [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 49. doi:10.1158/1538-7445.AM2013-49

Rationale: Women with breast IEN have an annual risk of invasive disease equal to 8-10 times the general population, thus representing an important target for chemoprevention. In the NSABP-P1 trial, tamoxifen use at 20 mg/day was associated with an 86% reduction of invasive breast cancer in women with previous ADH (RR=0.14, 95% IC, 0.03-0.47) and with a 56% risk reduction in women with previous LCIS (RR=0.44, 0.16-1.06). However, the increased risk of endometrial cancer and of venous thromboembolism, have significantly limited its broad use in chemoprevention. To improve the risk-benefit ratio, the use of lower doses of the drug has been proposed. Recent trials from our group have shown that a dose of 5 mg/day does not increase endometrial proliferation and is associated with a decrease of the estrogenic activity of tamoxifen on IGF-I, SHBG and antithrombin-III, with a potential decrease of venous thromboembolic events. Moreover, tamoxifen exhibits a high tissue distribution, so that a dose of 5 mg/day attains at the breast tissue level a concentration 10 times higher than that needed to inhibit cell growth in vitro. The CYP2D6 enzyme mediates oxidation of N-desmethyl tamoxifen to endoxifen, the most active metabolite of tamoxifen. The SNP CYP2D6*4 (1846G>A) allele accounts for 75% of CYP2D6 poor metabolizer phenotype which have been associated with a higher risk to develop a breast event compared to wildtype (Serrano D et al. Pharmacogenomics J. 2010 Mar 23). Study design and enrollment report: This is a multicenter randomized double-blind placebo-controlled phase III trial with two parallel arms: tamoxifen at daily dose of 5 mg or placebo for a total treatment time of 3 years, to assess the efficacy and the safety of 5 mg/day tamoxifen to reduce breast cancer incidence in women with previous IEN (LIN 2-3 and ER-positive or unknown DIN 1b-3). At present no standard treatment exists to treat these women, particularly in Europe, where tamoxifen is not registered in women with prior DCIS (DIN 2-3). A total of 1400 women will be recruited in 3 years to detect a 50% reduction (Hazard Ratio = 0.5) in the incidence of breast cancer in the tamoxifen arm with an 80% power and a 1-sided 5% alpha level. Secondary endpoints include: incidence of other non-invasive breast disorders (i.e., LIN, ductal atypical hyperplasia), endometrial cancer, clinical bone fractures, cardiovascular events, venous thromboembolic events, and clinically manifest cataract. The pharmacogenetic endpoints include to assess whether CYP2D6 genotype can explain modulation on surrogate biomarkers of tamoxifen efficacy and safety, including circulating IGF-I, hormones, mammographic density, endometrial thickness and hot flashes, but also on clinical events. As of July 27, 2010, 10 enrolment centers have been activated, n=128 women have been screened and n=44 have been randomized. 58 women refused to participate and 26 women were excluded for the following ineligibility reasons: 6 women for use of raloxifene, tamoxifen or other SERMs; 4 women for ER negative primary breast cancer; 3 women for bilateral mastectomy, 2 for previous thromboembolic events, 2 for age limits and 9 for other reasons. No serious adverse events or suspected unexpected serious adverse reactions were registered. Citation Information: Cancer Prev Res 2010;3(12 Suppl):A70.

The nutritional status prior to and 3 months and 1 year after biliopancreatic bypass surgery was evaluated. The common nutritional indexes (serum albumin and transferin concentrations, daily urinary creatinine excretion and delayed hypersensitivity) were determined. The body compartments were derived from total body water (TBW) and total body sodium (TBNa), measured by dilutional technique, and total body potassium (TBK), calculated from TBW, TBNa, and the ratio of the sodium plus potassium content divided by the water content in a sample of whole blood. Before surgery, obese patients showed a dilatation of both fat an lean compartments with a normal lean body mass (LBM) qualitative composition, as indicated by TBNa/TBW, and TBNa/TBK ratios not greater than those measured in controls. Three months following very-little-stomach biliopancreatic bypass (VLS BPB), a consistent reduction of body weight and body fat were observed. The body cell mass value fell and reached a level closely similar to that found in lean control subjects. LBM showed only a slight decrease. A sharp increase of TBNa/TBW and TBNa/TBK ratios demonstrated a dilatation of the extracellular space. This malnutritional status was not detected by the usual nutritional parameters. One year after VLS BPB surgery, the patients' body composition became very similar to that of lean subjects, though a TBNa greater than that of controls suggested that a slightly expanded extracellular space was still present.

Biliopancreatic diversion is a very effective method for weight reduction. In some instances it is too effective and needs to be revised.

Protein malnutrition is the main early problem with biliopancreatic diversion; gastric volume greatly influences the incidence of protein malnutrition.