[Surgical therapy of morbid obesity using an adjustable gastric band. Report of experiences over 2 1/2 years with 71 patients]. / Chirurgische Therapie des krankhaften Ubergewichts mit Hilfe des justierbaren Magenbandes. Ein Erfahrungsbericht über 2 1/2 Jahre an 71 Patienten.

BACKGROUND: At present, long-term results after conservative treatment of morbid obesity (body mass index > 40) are not satisfying, given a relapse rate > 95%. In comparison, surgical treatment is about 10 times more efficient and, thus, more cost-effective. SURGICAL TECHNIQUES: Currently performed surgical interventions to induce weight loss are dominated by two major surgical procedures: (1) Mason's vertical gastroplasty, and (2) the insertion of an adjustable gastric band, developed by Kuzmak in 1983. Essential advantages of gastric banding include the possibility of laparoscopic performance and complete reversibility of the operation. After removal of the gastric band, stomach and upper intestine are left in their anatomic and functional integrity. PATIENTS AND RESULTS: During a 30-month period, we implanted the adjustable gastric band in 71 patients (65 female and six male patients). All procedures were performed laparoscopically. In none of the cases did intraoperative complications occur. Postoperatively 1.4% of the patients developed a slippage of the gastric band, 2.1% had complications concerning the subcutaneously placed port, and, eventually, the gastric band had to be removed in 1.4%.

The effect of stepwise cerebral hypoperfusion on energy metabolism and amyloid precursor protein (APP) in cerebral cortex and hippocampus in the adult rat.

To study the relationship between cerebral blood flow, energy metabolism, and the formation of amyloid precursor protein (APP), an in vivo animal model was established in which stepwise long-term cerebral hypoperfusion states were induced. Adult rats underwent a stepwise chronic cerebral hypoperfusion by crosswise occlusion of the carotid and vertebral arteries with different periods and severity of hypoperfusion until the final steady-state experiment. Investigations of metabolic compounds were done in hippocampus and parietotemporal cerebral cortex. The analysis of energy-rich phosphates and adenosine was examined by HPLC analysis. Substrate concentrations of pyruvate and lactate were measured spectrophotometrically. The APP holoprotein was investigated by immunblot technique. Long-term cerebral hypoperfusion induced a decrease of energy-rich phosphates in the brain areas studied, whereas the concentration of adenosine and the ATP turnover were increased. Pyruvate decreased, and lactate was increased, pointing to a shift in the cytoplasmatic redox state. More severe changes were found in parietotemporal cerebral cortex in comparison to the hippocampus. After 2-vessel occlusion, the concentration of APP decreased, whereas the APP concentration was significantly increased in rat brain after 4-vessel occlusion. It has been demonstrated for the first time in vivo that the reduction in cerebral energy metabolism alters the formation of APP due to cerebral hypoperfusion.

Structural change and environmental impact: Empirical evidence on thirty-one countries in east and west.

Although structural change in many industralized countries has increased since the early 1970s, the environmental policy aspects of this change have hardly been investigated. The more pronounced the positive environmental effects of structural change become, the more positive will be the structure-oriented options of environmental policy.Using a set of four indicators, in this study thirty-one Eastern and Western industrialized countries are being tested with regard to economic structure and environmentally significant structural change. The authors come to the conclusion that the strong correlation between economic performance and environmental pollution, unequivocal in 1970, had become much weaker by 1985. The de-linking of economic growth from material-intensive industrial production processes is particularly evident. In some cases automatic environmental benefits ('environmental gratis effects') were generated in this way.However, the development profiles of the countries investigated differ greatly. There are countries, in particular Sweden, with absolute structural improvement in the ecological sense; countries like Japan and Norway with structural improvement relative to economic growth; and countries, including most Eastern and Southern European states, featuring no structural improvement or even environmentally negative structural change.The question is being left open to what extent the modernized economic structures are accompanied by 'modernized' forms of environmental pollution.