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Bad Essen, Germany

Otto M.,University of Mannheim | Elrefai M.,University of Mannheim | Krammer J.,University of Mannheim | Weiss C.,University of Heidelberg | And 2 more authors.
Obesity Surgery

Background: Bariatric surgery is a safe and established treatment option of morbid obesity. Mere percentage of excess weight loss (%EWL) should not be the only goal of treatment. Methods: One hundred seventy-three obese patients were included in the study. They underwent either Roux-en-Y gastric bypass (RYGB; n = 127, mean body mass index (BMI) 45.7 ± 5.7 kg/m2) or sleeve gastrectomy (SG; n = 46, mean BMI 55.9 ± 7.8 kg/m2) for weight reduction. Body weight and body composition were assessed periodically by bioelectrical impedance analysis. Results: After 1 year of observation, %EWL was 62.9 ± 18.0 % in RYGB and 52.3 ± 15.0 % in SG (p = 0.0024). Body fat was reduced in both procedures with a slight preference for SG, and lean body mass was better preserved in the RYGB group. Due to significant differences in the initial BMI between the two groups, an analysis of covariance was performed, which demonstrated no significant differences in the %EWL as well as in the other parameters of body composition 1 year after surgery. Using percentage of total weight loss to evaluate the outcomes between the two procedures, no significant difference was found (31.7 ± 8.4 % in RYGB and 30.5 ± 7.6 % in SG patients, p > 0.4). Conclusions: Excess weight loss is highly influenced by the initial BMI. Total weight loss seems to be a better measurement tool abolishing initial weight differences. SG and RYGB do not differ in terms of body composition and weight loss 1 year after surgery. © 2015, Springer Science+Business Media New York. Source

Betzler M.,Alfried Krupp Krankenhaus
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie

In the context of the controversy regarding the appropriate management of colon diverticulitis without generalised peritonitis conservative or operative a review of the literature was performed. The progress in diagnostic and therapeutic measures has led to a change in the therapeutic approach during the last 10years. Because of the lack of randomised controlled trials in patients with diverticulitis (without generalised peritonitis) comparing medical and surgical treatments, there are still several unanswered questions, such as whether and when to operate and what the recurrence rate is, especially after medical treatment. The therapeutic management should be oriented to the individual symptoms, the comorbidity and the age of the patients. © Georg Thieme Verlag KG Stuttgart. Source

Fitzgerald G.,University of Massachusetts Medical School | Boonen S.,Catholic University of Leuven | Compston J.E.,University of Cambridge | Pfeilschifter J.,Alfried Krupp Krankenhaus | And 4 more authors.
Journal of Bone and Mineral Research

The purposes of this study were to examine fracture risk profiles at specific bone sites, and to understand why model discrimination using clinical risk factors is generally better in hip fracture models than in models that combine hip with other bones. Using 3-year data from the GLOW study (54,229 women with more than 4400 total fractures), we present Cox regression model results for 10 individual fracture sites, for both any and first-time fracture, among women aged ≥55 years. Advanced age is the strongest risk factor in hip (hazard ratio [HR] = 2.3 per 10-year increase), pelvis (HR = 1.8), upper leg (HR = 1.8), and clavicle (HR = 1.7) models. Age has a weaker association with wrist (HR = 1.1), rib (HR = 1.2), lower leg (not statistically significant), and ankle (HR = 0.81) fractures. Greater weight is associated with reduced risk for hip, pelvis, spine, and wrist, but higher risk for first lower leg and ankle fractures. Prior fracture of the same bone, although significant in nine of 10 models, is most strongly associated with spine (HR = 6.6) and rib (HR = 4.8) fractures. Past falls are important in all but spine models. Model c indices are ≥0.71 for hip, pelvis, upper leg, spine, clavicle, and rib, but ≤0.66 for upper arm/shoulder, lower leg, wrist, and ankle fractures. The c index for combining hip, spine, upper arm, and wrist (major fracture) is 0.67. First-time fracture models have c indices ranging from 0.59 for wrist to 0.78 for hip and pelvis. The c index for first-time major fracture is 0.63. In conclusion, substantial differences in risk profiles exist among the 10 bones considered. © 2012 American Society for Bone and Mineral Research. Source

Kaestner S.,Klinikum Kassel | Dimitriou I.,Alfried Krupp Krankenhaus
Journal of Neurological Surgery, Part A: Central European Neurosurgery

Objective Posthemorrhagic hydrocephalus (pHC) is a serious complication following subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH). Besides known clinical predictors, different cytokines have drawn attention to the development of chronic hydrocephalus. Transforming growth factor (TGF) β1 and TGF β2 are involved in fibrogenesis, scar formation, cell survival, and tissue differentiation and may play a role in the occurrence of pHC. TGF β1 is stored in platelets in large amount and is released in the cerebrospinal fluid (CSF) after SAH and IVH. Both TGF β1 and TGF β2 can be expressed by various intracranial cells. Methods TGF β1 and β2 were measured in CSF and blood samples of 42 patients with SAH or IVH with acute hydrocephalus during the first 10 days after ictus. Furthermore, albumin was measured in CSF as an indicator for the amount of blood. Patients were categorized as developing pHC requiring shunt treatment or not-developing pHC within 6 months. Results After adjusting for age, SAH resulted significantly more often in pHC than did IVH. Plasma levels of TGF β1 showed a marked increase over time, whereas CSF levels of TGF β1 constantly decreased. The time course of TGF β1 and albumin in CSF was paralleled and did not correlate with the development of shunt dependent pHC. Also, TGF β1 plasma concentrations did not correlate with shunt dependent pHC. TGF β2 concentrations in plasma showed stable values over time without any variations. TGF β2 in CSF described a parabolic course with a peak at day 6 after ictus. No correlation was found concerning TGF β2 in plasma or CSF and shunt dependent pHC. Conclusion TGF β1 in CSF is derived by platelets from the cisternal or ventricular clot. TGF β2 in CSF is derived as a general reaction of traumatized brain tissue. These data do not confirm a crucial role of TGF β1 and TGF β2 release in the development of pHC. © 2013 by Thieme Medical Publishers, Inc. Source

Compston J.E.,University of Cambridge | Flahive J.,University of Massachusetts Medical School | Hosmer D.W.,University of Massachusetts Amherst | Watts N.B.,Mercy Health Osteoporosis and Bone Health Services | And 21 more authors.
Journal of Bone and Mineral Research

Low body mass index (BMI) is a well-established risk factor for fracture in postmenopausal women. Height and obesity have also been associated with increased fracture risk at some sites. We investigated the relationships of weight, BMI, and height with incident clinical fracture in a practice-based cohort of postmenopausal women participating in the Global Longitudinal study of Osteoporosis in Women (GLOW). Data were collected at baseline and at 1, 2, and 3 years. For hip, spine, wrist, pelvis, rib, upper arm/shoulder, clavicle, ankle, lower leg, and upper leg fractures, we modeled the time to incident self-reported fracture over a 3-year period using the Cox proportional hazards model and fitted the best linear or nonlinear models containing height, weight, and BMI. Of 52,939 women, 3628 (6.9%) reported an incident clinical fracture during the 3-year follow-up period. Linear BMI showed a significant inverse association with hip, clinical spine, and wrist fractures: adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) per increase of 5 kg/m2 were 0.80 (0.71-0.90), 0.83 (0.76-0.92), and 0.88 (0.83-0.94), respectively (all p < 0.001). For ankle fractures, linear weight showed a significant positive association: adjusted HR per 5-kg increase 1.05 (1.02-1.07) (p < 0.001). For upper arm/shoulder and clavicle fractures, only linear height was significantly associated: adjusted HRs per 10-cm increase were 0.85 (0.75-0.97) (p = 0.02) and 0.73 (0.57-0.92) (p = 0.009), respectively. For pelvic and rib fractures, the best models were for nonlinear BMI or weight (p = 0.05 and 0.03, respectively), with inverse associations at low BMI/body weight and positive associations at high values. These data demonstrate that the relationships between fracture and weight, BMI, and height are site-specific. The different associations may be mediated, at least in part, by effects on bone mineral density, bone structure and geometry, and patterns of falling. © 2014 American Society for Bone and Mineral Research. © 2014 American Society for Bone and Mineral Research. Source

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