[Laparoscopic gastric banding in morbid obesity]. / Laparoskopisches "Gastric Banding" bei Adipositas permagna.

Laparoscopic "Gastric Banding" is a modern, minimally invasive technique to induce significant weight loss in morbidly obese individuals. If performed according to the established principles of elective surgery, the procedure has to be classified as a serious offer to a specific group of patients, who have, as yet, been confronted with the option of futile conservative therapies or irreversible interventions in the gastrointestine. The technique comprises the laparoscopic placement of a silicone band below the cardia, connected to a port-system. By the hourglass-like segmentation of the stomach a "pouch" and an artificial "stoma" (outlet) is created, with the effect of decreasing food intake and--psychologically intended--inducing an early feeling of satiety. The complexity of the pathogenetic impulses leading to severe nutritional obesity requires a serious risk/benefit appreciation with multidisciplinary responder-analyse. Apart from the main indications like overweight, patient history and obesity-associated disorders it is indispensable to include the psychological status of the patient and his capability of compliance into the decision-finding. With the inflatable inner surface of the band connected to the access port, the system is designed to permit postoperative regulation of the therapeutic outcome by percutaneous stoma size adjustment without further surgery. The placement of the band as well as the specific anatomical conditions of extremely obese patients involve severe risks such as primary organ lesions, post-operative pouch dilatation or "slippage" by herniation of the gastric wall. Therefore the technical performance of the implantation demands a high level of experience and practical knowledge of abdominal laparoscopic procedures. It is to assume, that prospective validation to establish operation standards will have a critical look to the modification of the surgical procedure, the size of the implant, the pouch and the stoma.

[Assessment of the MESAM and Biox 3700 early warning methods for the diagnosis of sleep-related respiratory disorders in young men]. / Uberprüfung der Früherkennungsmethode MESAM und Biox 3700 zur Erfassung schlafbezogener Atmungsregulationsstörungen bei jungen Männern.

We can use pulse oximetry as a method for diagnosis of the sleep apnoea syndrome, as well as L-EKG, MESAM II and the actigraph. In this study MESAM II and pulse oximetry were combined for finding out discrete sleep-related breathing disorders. The results were compared with polysomnography. 5 (15.1%) of 32 patients had an index of apnoea (AI) greater than 10, whereas 4 (12.1%) patients showed an AI greater than 5. All of the patients with positive signs in MESAM II/pulse oximetry had an AI greater than 5 in polysomnography, whereas non of the patients with negative signs in MESAM II/pulse oximetry had an AI greater than 5 in polysomnography.

MESAM: a heart rate and snoring recorder for detection of obstructive sleep apnea.

The high prevalence of sleep-related breathing disorders demands the development of ambulatory recording devices that can handle data with a high degree of selectivity and are easy to use and to interpret. A digital device based on the recording of heart rate and breathing sounds was developed. Patients with sleep-related breathing disorders can be preselected before they undergo sleep laboratory investigations. Treatment control can be achieved ambulatory, having an initial recording.

[Diagnosis of sleep apnea: required equipment for staged diagnosis]. / Diagnostik der Schlafapnoe: Apparative Voraussetzungen zur Stufendiagnostik.

In view of the high prevalence of sleep apnoea (SA) a stepped concept for diagnosis and therapy is needed. Such a concept requires appropriate instrumentation. The apparative requirement for a five-stage concept, and the experience gained with it, are presented, in particular these newly introduced stages: screening instrument, based on an analysis of heart rate and breathing sounds, and a mobile sleep laboratory based on oxygen saturation measurement combined with inductive plethysmography and four further parameters. Experience obtained with such a stepped concept demonstrates its efficiency and necessity in the diagnosis of sleep-related breathing disturbances.

[Snoring and sleep apnea syndrome]. / Schnarchen und Schlafapnoesyndrome.

Sleep apnea and obstructive snoring are sleep related breathing disorders (SRBD). Nevertheless, there is only a quantitative difference between snoring and the obstructive form of sleep apnea. Snoring occurs in at least 20% of the population; 50% of the 50 year old male snore. Although in most of the cases only harmless snoring is concerned. It becomes serious if it leads as the independent SRBD "obstructive snoring" to a continuous oxygen desaturation and a sleep disturbance or, if in cases of sleep apnea a postapnoic snoring is concerned. The snoring pattern "loud and irregular" is always a sign for a serious SRBD. Still, no exact statement can be given concerning the frequency of obstructive snoring. However, the prevalence of sleep apnea in men of the mean age group has been determined to 10%. By the so-called sleep apnea syndrome are summarized clinical pictures with symptoms and findings caused by sleep apnea, respectively with those which can be reduced by sufficiently early introduced therapy. Most frequent symptoms and findings are: hypertension, loud and irregular snoring, daytime sleepiness and nocturnal cardiac arrhythmias. Especially hypersomnia has always to be taken seriously. In relation with other symptoms and findings associated with apnea it is always an indication for the examination for sleep apnea and obstructive snoring.