Laparoscopic gastric banding in older patients.

HYPOTHESIS: Older patients experience the same benefits from a laparoscopic gastric banding (LGB) operation as younger patients. DESIGN: A case series of 320 morbidly obese and superobese patients who underwent LGB within a 46-month period. SETTING: University Hospital Innsbruck, General Surgical Department, Innsbruck, Austria. PATIENTS: A consecutive sample of 320 patients who met the criteria for a bariatric procedure and were aged 18 years or older. Patients were divided into the following 2 age groups: younger patients (group A, 18-49 years) and older patients (group B, > or =50 years). INTERVENTION: Laparoscopic gastric banding with an adjustable gastric band. MAIN OUTCOME MEASURES: Clinicopathologic features, including weight loss, complications, length of hospital stay, and operative times, were reviewed retrospectively, and a multivariate analysis was carried out. RESULTS: Of 320 patients, we identified 68 older patients (21.5%, group B). The mean postoperative follow-up period was 12 months (range, 6-28 months). The average preoperative weight was 127.8 kg (body mass index [calculated as weight in kilograms divided by the square of height in meters], 44.29). The average total weight loss was 4.3 kg per month for the first 3 months, reaching an average total of 31.0 kg after 1 year. The excess weight loss after 12 months was 68%. Complications requiring reoperation occurred in 10.3% of patients. Ninety-seven percent of the patients reported an improvement in their comorbid conditions. CONCLUSIONS: Older patients receive the same benefits from LGB as younger patients, with an acceptable postoperative complication rate. Presently, our upper age limit is 70 years.

Tamoxifen and vitamin E treatments delay symptoms in the mouse model of Niemann-Pick C.

Niemann-Pick C disease (NPC) is an irreversible neurodegenerative disorder without current treatment. It is the result of deficient intracellular cholesterol movement. We investigated the effects of tamoxifen and vitamin E (D-alpha tocopherol) treatment on patterns of weight loss and motor function in the mouse model of Niemann-Pick C disease (Npc1-/- mice). Tamoxifen has multiple metabolic effects, including reducing oxidative damage, while vitamin E primarily has this property. Npc1-/- mice were identified and treatment was initiated at an approximate age of 21 days. Tamoxifen suspended in peanut oil was administered via intraperitoneal injection (weekly, at a dose calculated to deliver 0.023 microg/g/day). Vitamin E (25 IU) was administered orally via gavage once a week. weight loss and Rota-Rod performance were analyzed by using Kaplan-Meyer survival curves. Tamoxifen treatment by itself significantly delayed weight loss (an endpoint of neurodegeneration) in male and female mice compared to untreated controls. Motor function was evaluated by performance on a Rota-Rod. Tamoxifen maintained Rota-Rod performance for about an extra week. Vitamin E treatment significantly delayed weight loss in females only. Rota-Rod performance was maintained slightly longer in mice treated with vitamin E. Simultaneous use of both treatments did not delay weight loss longer than tamoxifen-only treatment but had a greater effect than either treatment alone on Rota-Rod performance and demonstrated a significant positive effect on the early "learning curve" portion of the Rota-Rod evaluations. We found significant but relatively small improvements in rate of disease progression by treating Npc1-/- mice with tamoxifen and/or vitamin E. Some sex differences in response and an early improvement in Rota-Rod performance suggest areas for further study.

For the treatment of obesity, an adecuate control of associated cardiovascular risk factors (CRF) is fundamental. The objective of this study was to assess the relationship between body mass index (BMI) and CRF, and the effect of a weight loss program on overweight subjects. PATIENTS AND METHOD: A single-centered cross-sectional prospective study was carried out during 1997-2001 on 1,018 overweight subjects (788 women and 230 men) who were seeking aid to lose weight at an obesity clinic. A program involving a hypocaloric, Mediterranean diet was prescribed plus recommendations for spare-time exercise. Variables measured included weight, height, blood pressure, serum lipids and blood glucose concentrations, measured both at baseline and at the end of the weight loss program. RESULTS: After adjusting for age, variables showing a significant increase upon higher BMI were: blood pressure, HDL cholesterol (HDL-C) (inverse relationship, only in women), triglycerides and blood glucose. Total cholesterol (CLT), LDL cholesterol (LDL-C) and CLT/HDL-C showed no relationship with BMI. weight loss had beneficial effects on blood pressure and triglycerides, regardless of the initial values, and on CLT, LDL-C and CLT/HDL-C when the initial levels were increased. No significant changes were found with regard to HDL-C. CONCLUSIONS: Overweight and obese subjects carry a burden of common coronary risk factors which ncrease upon greater obesity. weight loss has important beneficial effects with regard to coronary risk factors associated with overweight and obesity, particularly if these factors are previously altered, even when weight loss is < 5% of initial weight.

In vitro ageing of brushite calcium phosphate cement.

In vivo studies investigating the use of brushite cements have demonstrated mixed results with one or more of dissolution, hydrolysis, fragmentation and long term stability being demonstrated. It has been suggested that sample volume, implant location, and species can affect in vivo behaviour. As few in vitro studies on this cement system have been performed, this study aimed to compare the effects of static and dynamic in vitro ageing protocols on the phase composition, weight loss and mechanical properties of brushite cement. The effects of immersion liquid to cement volume ratio (LCVR) and sample volume on phase composition were investigated and comparative in vitro experiments were also performed in foetal bovine serum. It was determined that the weight loss after 28 days was up to seven times higher in serum than in phosphate buffered saline (PBS) and that fragmentation accounted for most of the weight loss observed. Hydroxyapatite was formed in PBS but not in serum when aged in refreshed media at all LCVRs investigated. This study has highlighted that LCVR, media refresh rate and media composition are critical to brushite cement performance. It appears that brushite cement removal from an implant site may be complex and dependent on physiological processes other than simple dissolution. A better understanding of these processes could provide the means to engineer more precise calcium phosphate cement degradation profiles.