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Horizontal and vertical banded gastroplasty (GP) were compared as to their effectiveness and side-effects in patients pre-treated for morbid obesity with a very-low-calorie formula diet (VLCD). The pre-treatment served to select the compliant patients, to minimize the surgical hazard, and to optimize the total weight reduction. Seventy-four consecutive patients (median age 34 years, median body weight 125.1 kg, and median overweight 93 per cent) were included according to the criteria for entry. The median weight loss on VLCD was 25.7 kg (range, 5.8-92.6 kg) and the median overweight reduction reached 46 per cent of the initial overweight (range, 9-83 per cent). Only few and mild side-effects were observed. Sixty-nine per cent of the patients fulfilled our criterion for surgery by reducing their initial overweight by at least 40 per cent. Of these, 23 and 22 patients were assigned respectively to either vertical banded or to horizontal GP. Patients and dietitians were not informed of the assignment. A significant weight loss occurred in both groups. Three months after surgery weight loss after vertical banded GP proved to be the larger (P less than 0.001). The difference became even more pronounced due to an earlier regain among patients treated with the horizontal GP. Thus, at 12 months, the net weight loss after surgery was 9.7 kg (range, -28.2-28.7 kg) in the vertical banded GP group and -1.0 kg (range, -15.0-36.5 kg) in patients treated with horizontal GP (P less than 0.0005). At this time, the total weight loss in the groups was 48.5 kg (range, 6.4-104.0 kg) and 32.6 (range, 3.7-125.1 kg) respectively (P less than 0.02), and the total reduction of overweight was greater in the group treated with vertical banded GP (80 per cent (range, 10-96) versus 56 per cent (range, 8-92), P less than 0.005). There were no deaths, and side-effects to VLCD as well as to GP were generally mild. It is concluded that vertical banded GP is more effective than horizontal GP and that the former operation adds a significant weight loss to that obtained by VLCD. The combined treatments offer a weight reduction comparable to that observed after jejunoileal bypass. However, some regain within 1 year makes it questionable if the vertical banded GP is sufficient to prevent weight regain.
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PMID:Horizontal or vertical banded gastroplasty after pretreatment with very-low-calorie formula diet: a randomized trial. 331 50

Morbid obesity still remains a controversial topic with varied therapeutic approaches. In cases of unsuccessful conservative management we implant a gastric balloon or bubble. 30 balloons have been introduced in 24 patients with a mean age of 43 years (26-68 y.) and a mean body weight of 115 kg (87-160 kg). Mean overweight was 47 kg. The balloons were introduced immediately after gastroscopy performed to identify possible contraindications. Except in the initial 3 patients this procedure was carried out in the outpatient clinic. 25 silicon mammary prostheses were implanted until a special balloon (Ballobes-Balloon) became available for the last 5 cases. Implantation and follow-up has been uneventful in all cases. Our data suggest that a combination of this approach with close dietary management provides more efficient and rapid weight reduction than any diet alone.
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PMID:[Morbid obesity. Our results with the appetite-depressing stomach balloon]. 334 16

This article defines obesity, ideal body weight, morbid obesity, and indexes of overweight, pointing out some of the difficulties in studies of the epidemiology of morbid obesity.
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PMID:Morbid obesity: definitions, epidemiology, and methodological problems. 350 Sep 20

New surgical procedures have revolutionized the treatment of morbid obesity (more than 100% overweight), a condition associated with serious medical complications and for which conservative treatment has been largely ineffective. These procedures, which are surprisingly safe, produce large weight losses and marked improvement in hypertension, diabetes, and other disorders influenced by obesity. Striking changes also occur in vocational and psychosocial functioning, including marital and sexual relations, in eating behavior, in food preferences, and in body image. The emotional state of patients during weight loss following surgery is far superior to that during attempts at weight reduction by other methods. The surgical procedures appear to produce a major biological change, perhaps lowering a body weight set point.
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PMID:Psychological and social aspects of the surgical treatment of obesity. 351 32

During the years 1981-85, 163 patients were treated with gastric banding for morbid obesity. Mean preoperative body weight (+/- s.e.m.) was 121.3 kg +/- 1.4, and mean overweight was 71.5% +/- 1.6 according to Broca's formula. Twenty-four patients had postoperative complications during the first 30 days, mostly minor. Four required reoperation and one of these died. Seventeen patients had late complications, six persistent vomiting necessitating reoperation, eight incisional hernia and three penetration of gastric wall by band. The weight loss was rapid during the first 6 months, and thereafter levelled off. After 2 years the weight loss was 33.4 kg +/- 2.4, corresponding to a mean weight loss of 27.6 percent +/- 1.9 of preoperative weight. There was no significant difference in weight loss expressed as a percentage of preoperative weight between patients operated with an outlet of 12 mm (45 patients) or 15 mm (118 patients), nor between males (37 patients) or females (126 patients). We conclude that our technique of gastric banding seems to be a relatively safe and reliable surgical treatment for morbid obesity. But our follow-up period has been limited to 2 years or less, and a longer follow-up is necessary before the method can be fully evaluated.
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PMID:Gastric banding for morbid obesity: early results. 366 69

The results of jejunoileal bypass for morbid obesity were studied in 192 operated patients. Mean weight loss was 39.3% of initial weight and 80.5% of overweight. Medical benefits (such as improved glucose tolerance, lowered blood pressure, healed Pickwick syndrome, etc.) were maintained during the follow-up (average five years). The most feared complication of the jejunoileal bypass is severe hepatic failure, which appeared in 2.3% of the cases, only after the end-to-end jejunoileal bypass, and never more than 12 months after surgery. Most patients had satisfactory and lasting results due to a careful and assiduous postoperative follow-up, and to the strict co-operation between the medical staff and the patient. Medical therapy in the preoperative period was useful to control the weight gain by administration of a hypocaloric definite diet. In the postoperative period, we usually got benefits for the bypass induced intestinal malabsorption by administration of supportive vitamins and electrolytes. To prevent liver diseases we often found intestinal-specific antibiotics, aminoacidic solutions, hyperproteical diet and anti-steatosis agents helpful.
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PMID:Surgical therapy for morbid obesity. 373 61

Fourteen patients originally presented with hyperphagia and intractable morbid obesity have had maxillomandibular fixation (MMF) applied in an effort to control their obesity. In 10 patients who were massively obese or considered poor risk candidates for surgical control of their obesity, MMF was applied with the aim of reducing the obesity to a level where a surgical gastric restrictive bariatric procedure could be safely carried out. Eight of these patients had been rejected for surgical control of obesity elsewhere and two were edentulous. Five of these patients after successful weight loss over periods from 16 to 40 weeks (mean percentage overweight lost 84.8, range 39-150) safely underwent a gastric restrictive procedure. All five patients have had continuous weight loss after bariatric surgery. Two patients requested removal of MMF 1 and 2 weeks after application. The remaining three patients, who were candidates for surgery, after successful weight loss over periods from 12 to 28 weeks (mean percentage of overweight lost 45, range 38-50) decided not to proceed with surgical control. All have subsequently regained the lost weight. Four originally morbidly obese patients, who had had a previously successful gastric restrictive procedure followed by weight loss, requested MMF in an effort to lose further weight. Over periods from 8 to 16 weeks three of the four had further weight loss (mean percentage of overweight lost 18.3, range 5-30). After removal of MMF all four patients regained some weight. In only one was there a significant maintenance of weight lost during MMF.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Jaw wiring in the treatment of morbid obesity. 386 88

Measured longitudinal growth data in a sample of 66 patients with anorexia nervosa (AN) (58 females and 8 males) is compared to expected growth from normative standards. The data was subject to cross-sectional as well as longitudinal analysis. Females had a normal growth rate and pattern, in particular a normal sequence and timing of pubertal events. Distribution of weight for age indicated a slight (non-significant) overweight before onset of anorexia nervosa. Weight by height was significantly above the expected before onset of AN. Mean age at Peak Height Velocity (PHV) was 11.5 yr. Mean size of PHV 8.03 cm/yr. A subsample of females (those with onset of AN after menarche) had a mean age of menarche of 12.88 yr. Mean distance in time from age at PHV to age at menarche was 1.34 yr. These results are normal for Scandinavian girls. Male anorexics were tall for age, heavy for age and, where a PHV could be seen (5 out of 8 cases), had signs of early puberty. Mean age at PHV was 11.8 yr, a highly significant difference from the normal mean age at PHV which is 14.06 yr for Scandinavian boys. Weight by height was distributed as in the reference population, that is, with no indication of pre-morbid obesity for male probands.
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PMID:Evaluation of growth in anorexia nervosa from serial measurements. 404 40

Liver biopsies from 61 consecutive patients with morbid obesity (less than 60% overweight) and from 48 patients with alcoholic liver disease were examined for the presence of Mallory bodies. For the detection both routine haematoxylin and eosin stained sections and sections exposed to an immunohistochemical technique were employed. The latter uses an antiserum which recognizes antigenic determinants in Mallory bodies. Using haematoxylin and eosin staining. Mallory bodies were not detected in any of the biopsies from the obese patients, but found to be present in 63% of the patients with alcoholic liver disease. Using the immunohistochemical technique, Mallory bodies were found in the liver of 2 obese patients (3%) and in 36 patients with alcoholic liver disease (75%). None of the Mallory body positive obese patients showed signs of diabetes mellitus, cholestasis or hypocholesterolemia, but both patients admitted previous excessive alcohol consumption. It is concluded that the immunohistochemical detection of Mallory bodies is more sensitive than routine staining. Further, Mallory bodies are rare findings in livers of obese patients and may be related to excessive alcohol consumption.
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PMID:Occurrence and significance of Mallory bodies in morbidly obese patients. An immunohistochemical study. 619 45

Research has demonstrated that obesity is far more complex than simply eating too much. Although the individual who is only modestly overweight is probably guilty of overindulgence, the grossly obese individual is the victim of a far more complex disorder with genetic, metabolic, psychosocial, and perhaps central nervous system malfunctions all interacting in a poorly understood fashion. The medical consequences of morbid obesity are considerable and demand the patient's and the physician's attention. This article discusses pathogenesis, consequences, and approaches to treatment.
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PMID:Obesity. Pathogenesis, consequences, and approaches to treatment. 647 86


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