mtor inhibitors Decreased lipoprotein lipase LPL activity

Decreased lipoprotein lipase (LPL) activity is also a prominent cause of hypertriglyceridemia. One study found that enhancing LPL activity by using insulin and heparin reduced TG levels and appeared to improve pancreatitis. For patients with repeated pancreatitis due to hypertriglyceridemia, metabolic surgery for hyperlipidemia has also been proposed. The first partial ileal bypass was performed specifically for the reduction of plasma lipids in 1963. The partial ileal bypass differs from the jejunoileal bypass performed between 1950 and 1970. The jejunoileal bypass consists of anastomosis of the proximal 40cm of the jejunum with the distal 4cm of the ileum. With more than 90% of the small intestine bypassed, the therapeutic goal is weight loss, and lipid reduction is an accompanying benefit. However, this procedure has been abandoned because of long-term nutritional adverse events. A partial ileal bypass sacrifices only the distal 200cm of the small intestine, or one-third of the small intestinal length. The operation lowers both cholesterol and TG levels but it does not result in significant body weight loss compared with other bypass surgeries. Gastric bypass is the most commonly performed bariatric surgery today. In our previous study, a simplified gastric bypass, LMGB, was demonstrated to have a low risk and acceptable efficacy compared with a laparoscopic Roux-en-Y gastric bypass. The rising prevalence of obesity is associated with the increasing prevalence of obesity comorbidities, including type 2 diabetes, hypertension, hyperlipidemia/hypertriglyceridemia, and obstructive sleep mtor inhibitors syndrome. In 1991, the National Institutes of Health established guidelines for the surgical therapy of morbid obesity (BMI≥40, or BMI≥35 with significant comorbidities). By modifying the anatomy of the gastrointestinal tract and affecting hormone (e.g., ghrelin) secretion, bariatric surgery, as a form of metabolic surgery, helps obese patients to lose body weight and improves their obesity-related comorbidities. Recently, metabolic surgery has also been proposed as a treatment option for diabetes in nonmorbid obese patients. In our patient, hypertriglyceridemia was not related to obesity. His TG level did not consistently decrease to less than 500mg/dL, even after apheresis. As bariatric surgery would help obese patients improve their metabolic problems, we performed LMGB to improve our patient’s hypertriglyceridemia. His TG level was decreased to less than 500mg/dL within 3 weeks after surgery. This satisfying improvement may be related to malabsorption after the procedure. Thus, when compared with lifestyle modification, lipid-lowering agents, and the other aforementioned methods, surgery may have a better long-term outcome.
Introduction Laparoscopic cholecystectomy (LC) is the gold standard procedure that is performed worldwide for symptomatic cholelithiasis. Overall, it has an approximately 3% complication rate. Stone formation in the common bile duct (CBD) has been reported following erosion by silk ligatures used for cystic duct ligation, and it is perhaps not surprising that the much more rigid and nonabsorbable laparoscopic clips may occasionally cause problems with migration and erosion. We report an unusual case of postcholecystectomy pain that was due to migration of the clip to the duodenum.
Case report A man 54 years of age presented with occasional intermittent, localized dull aching pain in the epigastrium for 3.5 months. He had had LC for chronic calculus cholecystitis 4 months previously. He was otherwise healthy. Clinical examination and biochemical investigations including liver function tests were normal. Ultrasonography did not show any common bile duct dilatation/stone or any cystic duct abnormality. An esophagogastroduodenoscopy (EGD) was requested. It showed a small ulcer at the inferior wall of the duodenal bulb (Forrest Grade III) with two metal clips at its base (Fig. 1). Both were removed endoscopically. No active bleeding was noted. Multiple biopsies were taken from the ulcer, all of which were benign but positive for Helicobacter pylori. The patient was given the H. pylori eradication regimen. The patient recovered completely and was discharged. After 2 years of follow-up he was doing well.