Diet-Induced Obesity and Its Differential Impact on Periodontal Bone Loss.

Obesity is associated with abnormal lipid metabolism and impaired bone homeostasis. The aim of our study was to investigate the impact of specific elevated fatty acid (FA) levels on alveolar bone loss in a Porphyromonas gingivalis-induced model of periodontal disease and to analyze underlying cellular mechanisms in bone-resorbing osteoclasts and bone-forming osteoblasts in mice. Four-week-old male C57BL/6 mice were randomly divided in groups and subjected to a palmitic acid (PA)- or oleic acid (OA)-enriched high-fat diet (HFD) (20% of calories from FA) or a normal caloric diet (C group) (10% of calories from FA) for 16 wk. Starting at week 10, mice were infected orally with P. gingivalis (W50) or placebo to induce alveolar bone loss. Animals were sacrificed, and percentage fat, serum inflammation (tumor necrosis factor [TNF]-α), and bone metabolism (osteocalcin [OC], carboxy-terminal collagen crosslinks [CTX], and N-terminal propeptides of type I procollagen [P1NP]) markers were measured. Osteoblasts and osteoclasts were cultured in the presence of elevated PA or OA levels and exposed to P. gingivalis. Animals on FA-enriched diets weighed significantly more compared with animals on a normal caloric diet (P < 0.05). Both obese groups had similar percentages of fat (P = nonsignificant); however, alveolar bone loss was significantly greater in animals that were on the PA-enriched HFD (P < 0.05). TNF-α levels were highest in the PA group (P < 0.001) and increased in all groups in response to P. gingivalis inoculation (P < 0.01), whereas bone remodeling markers OC, CTX, and P1NP were lowest in the PA group (P < 0.001) and highest in the C group. Bacterial challenge decreased bone metabolism markers in all groups (P < 0.01). Further, osteoclasts showed an augmented inflammatory response to P. gingivalis in the presence of hyperlipidemic PA levels as opposed to OA cultures, which responded similarly to controls. These findings indicate that the specific FA profile of diet rather than weight gain and obesity alone modulates bone metabolism and can therefore influence alveolar bone loss.

[Endoscopic neodymium YAG laser therapy of colorectal adenomas and cancers]. / Endoskopische Neodym- YAG-Lasertherapie kolorektaler Adenome und Karzinome.

Endoscopic Nd:YAG laser therapy (lambda = 1.06 microns; 80-100 W) of colorectal neoplasia is indicated in: 1. Premalignant, sessile adenoma. After snare resection for histologic estimation of dignity laser ablation is curative when it is benign. 2. Obstructed colorectal cancer can be recanalized preoperatively to perform orthograde bowel lavage, total colonoscopy and elective primary tumour resection. 3. Inoperable colorectal cancer can be irradiated palliatively by the laser to arrest bleeding, to avoid obstruction and to reduce protein and electrolyte secretion.

[Endoscopic use of the neodymium YAG laser in the upper and lower gastrointestinal tract]. / Der endoskopische Einsatz des Neodym-YAG Lasers im oberen und unteren Gastrointestinaltrakt.

Endoscopic neodymium-YAG laser therapy for the gastrointestinal tract has been proved since 1975. Mortality and time of convalescence of patients treated with laser for acute or potential bleeding lesions have been markedly reduced in contrast to surgery. Sessile neoplastic polyps can be removed endoscopically by laser. Laser recanalization of obstructed carcinoma or scars in the upper and lower gastrointestinal tract to relieve dysphagia or ileus improves the patient's quality of life and has benefits for subsequent operations.

Palliative and pre-operative endoscopic neodymium-YAG laser treatment of colorectal carcinoma.

Using endoscopic neodymium-YAG laser application permits successful treatment of ulcerated bleeding cancer. Further, palliative, ablative laser irradiation of tumors in inoperable patients avoids obstruction. Pre-operative recanalization of obstructive colorectal cancer causing ileus or subileus permits pre-operative orthograde bowel lavage as well as total colonoscopy, thus converting emergency surgery with staged procedures or intra-operative colon lavage into normal elective primary resection with all preoperative diagnostic and treatment modalities.

Endoscopic neodymium:YAG laser coagulation in gastrointestinal hemorrhage.

The aim of a resolute, endoscopic treatment in acute gastrointestinal hemorrhage by a neodymium:YAG laser is to prevent massive loss of blood and to avoid transformation of the hemorrhagic shock event into an irreversible state. Parallel to endoscopic procedure treatment of coagulopathies is necessary. 1,029 (94%) out of 1,092 acute bleeding episodes of 852 unselected patients were treated successfully. In bleeding esophageal varices, reduction of mortality from 70% to 36.2% has been achieved by sclerotherapy following laser coagulation of the acute bleeding. Compared with the results of surgery the mortality rate of bleeding acute ulcers has been reduced from 58% to 23.4%, and of bleeding chronic ulcers from 25% for resection and 15% for vagotomy to 0%. For optimal treatment of the patients close cooperation with surgeons is also desirable.

Preoperative neodymium-YAG laser treatment of obstructive colon cancer.

Present conventional surgical therapy of obstructive colon cancers of the right colon is primary resection, whereas in the left colon it is a two-stage or three-stage operation with a temporary colostomy. Morbidity and mortality rates in staged operations are still as high as 40% and 24%, respectively. Preoperative recanalization of obstructive cancers by neodymium-YAG laser vaporization will tend to relieve the symptoms of ileus and will permit preoperative peroral bowel lavage. For this reason primary resection with primary anastomosis is practicable in patients who have recovered from symptoms of ileus. In 27 cases who had been operated on with left-side hemicolectomy or anterior resection, the mortality rate was 3.7% (1/27). The total inpatient mortality rate of all laser-treated patients who had been operated on by different operative procedures, or who had not been surgically treated, was 8.8% (5/57).