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Lead exposure is known to affect the pituitary-thyroid axis. Likewise, ascorbic acid (AA) has a protective action against lead poisoning. We examine the protective role of AA in lead-induced damage to the thyroid gland. The Wistar rats were divided into three groups: control that received 0.2% AA in drinking water throughout the experiment (15 days), intoxicated with lead acetate (20 mg/kg) intraperitoneally every 48 h for 15 days, and the experimental group treated with lead acetate and 0.2% AA in drinking water throughout the experiment. Plasma thyroid-stimulating hormone, triiodothyronine, thyroxine, and lead were determined. The thyroid gland was weighed, then epithelial cell height and nuclear volume were measured on histological slides. The results show that AA reduced the thyroid atrophy caused by lead acetate, as well as the loss of weight of the gland. In addition, it prevented the decrease of the hormone triiodothyronine, although the thyroxine hormone remained lower than the control values ​​and the thyroid-stimulating hormone remains high. Our results indicated that AA could play a protective role in lead poisoning in the thyroid gland.

BackgroundObesity is a major challenge for people with schizophrenia.AimsWe assessed whether STEPWISE, a theory-based, group structured lifestyle education programme could support weight reduction in people with schizophrenia.MethodIn this randomised controlled trial (study registration: ISRCTN19447796), we recruited adults with schizophrenia, schizoaffective disorder or first-episode psychosis from ten mental health organisations in England. Participants were randomly allocated to the STEPWISE intervention or treatment as usual. The 12-month intervention comprised four 2.5 h weekly group sessions, followed by 2-weekly maintenance contact and group sessions at 4, 7 and 10 months. The primary outcome was weight change after 12 months. Key secondary outcomes included diet, physical activity, biomedical measures and patient-related outcome measures. Cost-effectiveness was assessed and a mixed-methods process evaluation was included.ResultsBetween 10 March 2015 and 31 March 2016, we recruited 414 people (intervention 208, usual care 206) with 341 (84.4%) participants completing the trial. At 12 months, weight reduction did not differ between groups (mean difference 0.0 kg, 95% CI −1.6 to 1.7, P = 0.963); physical activity, dietary intake and biochemical measures were unchanged. STEPWISE was well-received by participants and facilitators. The healthcare perspective incremental cost-effectiveness ratio was £246 921 per quality-adjusted life-year gained.ConclusionsParticipants were successfully recruited and retained, indicating a strong interest in weight interventions; however, the STEPWISE intervention was neither clinically nor cost-effective. Further research is needed to determine how to manage overweight and obesity in people with schizophrenia.Declaration of interestR.I.G.H. received fees for lecturing, consultancy work and attendance at conferences from the following: Boehringer Ingelheim, Eli Lilly, Janssen, Lundbeck, Novo Nordisk, Novartis, Otsuka, Sanofi, Sunovion, Takeda, MSD. M.J.D. reports personal fees from Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, Servier, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceuticals International Inc.; and, grants from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, Janssen. K.K. has received fees for consultancy and speaker for Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Servier and Merck Sharp & Dohme. He has received grants in support of investigator and investigator-initiated trials from Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme. K.K. has received funds for research, honoraria for speaking at meetings and has served on advisory boards for Lilly, Sanofi-Aventis, Merck Sharp & Dohme and Novo Nordisk. D.Sh. is expert advisor to the NICE Centre for guidelines; board member of the National Collaborating Centre for Mental Health (NCCMH); clinical advisor (paid consultancy basis) to National Clinical Audit of Psychosis (NCAP); views are personal and not those of NICE, NCCMH or NCAP. J.P. received personal fees for involvement in the study from a National Institute for Health Research (NIHR) grant. M.E.C. and Y.D. report grants from NIHR Health Technology Assessment, during the conduct of the study; and The Leicester Diabetes Centre, an organisation (employer) jointly hosted by an NHS Hospital Trust and the University of Leicester and who is holder (through the University of Leicester) of the copyright of the STEPWISE programme and of the DESMOND suite of programmes, training and intervention fidelity framework that were used in this study. S.R. has received honorarium from Lundbeck for lecturing. F.G. reports personal fees from Otsuka and Lundbeck, personal fees and non-financial support from Sunovion, outside the submitted work; and has a family member with professional links to Lilly and GSK, including shares. F.G. is in part funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care Funding scheme, by the Maudsley Charity and by the Stanley Medical Research Institute and is supported by the by the Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.

BACKGROUND: The success rate of laparoscopic adjustable gastric banding (LAGB)in the treatment of morbid obesity isvery variable. A reasonable preoperative selection of eligible patients seems to be important for a successful outcome of LAGB. In the present study, criteria were investigated to predict the outcome of LAGB. METHODS: 85 morbidly obese patients were operated with LAGB between 1999 and 2005. 71of these patients were analysed according to several possible predictive parameters of success or failure of LAGB. Success was defined as excess bodyweight loss (EBWL) > 50% without band removal, failure was defined as EBWL < 20% and/or band removal. Median follow-up was 27 months (range 8–90 months). RESULTS: After LAGB a median EBWL of 43%(−41 to171.5%) was observed in all patients with a decrease in BMI of 8.0 kg/m(2) (– 9 to 35 kg/m(2)). The success rate after LAGB was 37%, the failure rate 19.7%. Female sex (p = 0.023), baseline weight (p = 0.024), and eating behaviour after LAGB (p = 0.008) were significant predictors of success following LAGB, whereas complications such as port dislocation and reoperation after LAGB did not have a significant impact on a successful course following LAGB. Significant predictors of failure were male sex (p = 0.038) and missing physical activity after LAGB (p = 0.045), where as the eating behaviour did not have a significant effect concerning failure following LAGB. Baseline excess body weight (EBW) was identified as an independent predictor of failure in a multivariate analysis. CONCLUSION: According to the results of this study, female patients with a lower EBW who improve their postoperative eating behaviour have the best chanceof success following LAGB.

BACKGROUND: Laparoscopic sleeve gastrectomy is becoming increasingly established as a stand-alone procedure for weight reduction. The restrictive as well as humoral characteristics of this operation assure postoperative weight loss of up to 70–80% after 1 year. Complications also occur with this procedure. METHODS: The technical details of the sleeve gastrectomy surgical procedure are described, while elaborating on potential complications and on calibration. In our case, we perform gastrectomy under intraoperative gastroscopic control for calibration as well as for suture control as a standard procedure. As a general practice, the staple line is reinforced with the bioabsorbable material Seamguard®. RESULTS: Since June 2006, 38 patients have undergone sleeve gastrectomy. Postsurgical bleeding occurred in 1 case (2.6%) and had to be treated surgically.1 patient developed cicatricial stenosis and required dilatation (2.6%). After 1 year, 85% of patients had a weight loss of 70–80%. CONCLUSION: Thanks to the standardisation of this procedure using staple line reinforcement and intraoperative gastroscopic control, the complication rate can be reduced and the successful outcome of this stand-alone, weight-reduction operation can beoptimised.

BACKGROUND: Gastric balloon therapy (GBT)is a temporay, nonsurgical treatment for obesity. This retrospective study evaluates safety and efficacy of GBT in obese patients. METHODS: The BioEnterics® Intragastric Balloon (BIB) was endoscopically implanted into each patient's stomach and inflated with saline (450–750 ml). Extraction was planned after 6 months. Data from 190 patients receiving GBT were evaluated. Mean weight was 168.4 − 58.9 kg (range 76.5–310.0) and mean BMI was 55.6 − 17.5 kg/m(2) (range 27.0–95.7). RESULTS: Mean weight loss at the time of balloon removal was 21.2 − 14.0 kg (range 0–80.0). The mean BMI loss and EBL (Excess BMI Loss) were 7.2 − 4.9 kg/m(2) (range 0–28.9) and 30.1 − 26.4% (0–184.4), respectively. The most substantial weight and BMI loss was observed in the most massively obese patients. Minor complications at implantation were encountered in 2 cases (1.1%) due to leakage of the balloon, and in 3 cases at explantation (1.6%). No mortality or major complications such as gastric perforation or ulcers occurred. Of the 190 patients, 76 received subsequent surgery (40.0%). Of those, 7 patients had a BMI < 50 kg/m(2) while all other patients where super-obese(BMI > 50 kg/m(2)). 58 patients (30.5%) with a BMI > 60 kg/m(2) which had an extra ordinary high operation risk were able to receive subsequent surgical treatment because of a substantial weight loss and/or reduced comorbidity. CONCLUSION: GBT appears to be a safe, tolerable, and potentially effective procedure for the initial treatment of morbid obesity.

This article reviews the literature on the use of paper diaries for self-monitoring food intake, identifies the strengths and limitations of paper-and-pencil diaries and their new counterpart, the electronic diary or personal digital assistant (PDA), and reports how participants were trained to use a PDA with dietary software in two pilot studies--one with hemodialysis patients and the other with participants in a weight loss study. The report of the pilot studies focuses on the practical issues encountered in training participants in the use of a PDA and addresses the pros and cons of different dietary software programs. Six hemodialysis patients were trained in the first study and seven participants attempting to lose or maintain their weight were trained in the second pilot study. The training focused on how to use a PDA and how to navigate the dietary software to self-monitor food intake. The goals of using the PDA were to improve adherence to the therapeutic diets and to self-monitoring. Lessons learned from the pilot studies are shared.

Objective: To determine the rate and correlates of weight change in a large, well characterised sample of patients with Huntington’s disease followed at 44 sites by the Huntington Study Group. Participants and methods: Weight change was assessed in 927 adults with a definite diagnosis of Huntington’s disease who were followed prospectively for (mean (SD)) 3.4 (1.4) years. The unified Huntington’s disease rating scale was used to assess weight, motor dysfunction (including chorea and dystonia), depressive symptoms, and functional decline. Results: Random effects modelling determined that patients gained an average of 0.11 (1.7) kg/year and their chorea scores increased by 0.36 (0.78) points/year. There were significant but weak relations between weight loss and increasingly severe chorea ( r = −0.13), worse baseline motor performance ( r = −0.12), less severe baseline depressed mood ( r = 0.14), and poorer baseline independence ratings ( r = 0.07). Patients who were within 0 to 2 years of symptom onset at the time of the baseline visit gained more weight than those with longer disease duration. Conclusions: Weight loss following symptom onset is not a consistent feature of Huntington’s disease. The mechanisms contributing to weight change in this condition are unclear and probably multifactorial. Future studies examining asymptomatic carriers of the mutation could be helpful in identifying incipience of low body weight and may be better suited for identifying clinical correlates of weight loss than studies in symptomatic patients.

Die Adipositaschirurgie bei Kindern und Jugendlichen findet in Deutschland bisher keine breite Akzeptanz, obwohl es auch bei uns zahlreiche Patienten gibt, die ihr Gewicht trotz intensiver Therapien nicht dauerhaft reduzieren kÖnnen. Wie auch bei Erwachsenen weisen viele dieser Kinder und Jugendlichen bereits eine oder mehrere metabolische und/oder kardiovaskulÄre VerÄnderungen des metabolischen Syndroms auf. Der folgende Artikel vergleicht die nationalen mit den internationalen Erfahrungen hinsichtlich der Leitlinien, Operationstechniken und Ergebnisse. Dabei zeigt sich, dass es in Deutschland bisher weder eine einheitliche Leitlinie noch ein zentrales Register fÜr Adipositaschirurgie bei Kindern und Jugendlichen gibt. Internationalgelten die Empfehlungen der Bariatric Scientific Collaborative Group (BSCG) auch fÜr Kinder als Standard. Operativ finden sich in der Literatur im Wesentlichen der Roux-Y-Magenbypass und das Magenband, in letzter Zeit auch die Schlauchmagenbildung (sleeve gastrectomy). Diese werden insbesondere in den USA in designierten pÄdiatrischen Zentren durchgefÜhrt. Deren Erfolgs- und Komplikationsraten scheinen Ähnlich wie bei Erwachsenen zu sein. Allerdings bleibt dabei vÖllig offen, wie diese Ergebnisse angesichts der sehr viel lÄngeren Lebenserwartung zu beurteilen sein werden. Als Konsequenz ergibt sich, dass fÜr Kinder und Jugendliche mit morbider Adipositas a) spezielle Zentren mit dem gesamten Behandlungsspektrum etabliert werden sollten, b) Leitlinien fÜr diese Adipositaschirurgie definiert werden mÜssen und c)eine langfristige Nachsorge aller Patienten im Rahmen einerzentralen Studie gewÄhrleistet sein mÜsste, um Erfahrungen fÜr die Zukunft zu generieren. Bariatric Surgery for Morbid Obesity in Childhood and Adolescence: Where Do We Stand in 2008? Bariatric surgery for children and adolescents with morbid obesity has not gained broad acceptance in Germany yet. Nevertheless, these children often fail to reduce weight despite intensive weight loss programmes and suffer from an associate metabolic syndrome, just like adults. Thus, bariatric surgery may be a favourable option. The present article compares national and international experiences concerning guidelines, surgical procedures, and results. It becomes obvious that Germany has neither specific guidelines for children and adolescents nor a central registry. Internationally, the recommendation from the Bariatric Scientific Collaborative Group (BSCG) should be taken as the standard. As in adults, most surgeons performRoux-Y gastric bypass or gastric banding. Additionally, sleeve gastrectomy is gaining some popularity. These procedures are performed in designated pediatric centres especially in the US. Their success and complication rates are similar to those found in adults. The overall long-term consequences, however, remain unclear. Thus, for bariatric surgery in children and adolescents it may be concluded that a) these patients should be treated in designated centres that offer the full range of therapeutic options, b) specific guidelines should be established, especially in Germany, and c) a long-term postoperative study of all patients is necessary to collect all data and refine the techniques used.

BACKGROUND: The choice between different bariatric procedures for each patient is an important question in bariatric surgery. In this article, we explain criteria for patient selection for laparoscopic Roux-en-Y gastric bypass at the Obesity Center Wuerzburg and compare the corresponding outcomes for these selection criteria. METHODS: 60 consecutive patients underwent gastric bypass surgery (34 female, 26 male; mean age 45.1–10.2 years). Mean preoperative BMI was 53.7 − 8.7 kg/m(2). Selection criteria were age > 40, male sex, BMI > 50, metabolic syndrome, and/or reduced compliance. RESULTS: 42 patients (70%) were > 40 years old, 26 patients (43%) were male, 42 patients (70%) had a BMI > 50, and 28 patients had a metabolic syndrome (47%). 10 out of these 60 patients were reoperated after failed gastric banding. Overall weight loss was 43.7–18.7 kg, BMI loss was 15.0–6.4 kg/m(2), and excess body weight loss (EBWL) was 54.3–19.7%. There were 34 patients with an EBWL of ≥50%. Age, sex, and presence or absence of metabolic syndrome were irrelevant for postoperative weight loss. Although the EBWL wass lightly higher in patients with a BMI < 50, patients with a BMI > 50 lost significantly more weight. DISCUSSION: The indication for a gastric bypass may be substantiated by the higher weight reduction in patients with a BMI > 50. Other selection criteria had no influence on the postoperative outcome.

HINTERGRUND: Der temporÄre Einsatz eines Magenballons zur Behandlung der Adipositas Grad1 und 2 nimmt weltweit zu; bei der Adipositas Grad 3 wird der Magenballon als adjuvantes Hilfsmittel zur prÄoperativen Gewichtsreduktion implantiert. Ziel dieser retrospektiven Kohorten analyse ist, die Wirksamkeit des Magenballons auf Gewichtsreduzierung und das Risikoprofil der Methode zu evaluieren. METHODEN: Retrospektive Kohortenanalysen aus 4 Adipositas-Zentren, in denen der Magenballon seit 2001 regelmÄßig implantiert wurde. ERGEBNISSE: Von Februar2001 bis April 2008 wurde bei 634 Patienten ein Magenballon implantiert (BIBTM Intragastric Balloon System; Allergan Medical, Irvine, CA, USA). Die Geschlechterverteilung war 31,5% MÄnnerzu 68,5% Frauen; das Durchschnittsalter betrug 41,5 Jahre. Das durchschnittliche Ausgangsgewicht lag bei 126 kg. Der initiale BMI bei Implantation des Magenballons war 42,5 kg/m(2). Die Implantation der Prothese war in allen FÄllen unkompliziert. Der durchschnittliche Gewichtsverlust lag bei 20,75 kg bzw. 7,05 BMI-Punkten. SUMMARY: The Gastric Balloon — a Retrospective Cohort Analysis with 634 Patients BACKGROUND: The temporary use of a gastric balloon for the treatment of obesity grade 1 and 2 is increasing worldwide, whereas in grade 3 obesity, it is implanted as a tool for preoperative adjuvant weight loss. The aim of this retrospective cohort analysis is to evaluate the effectiveness of weight reduction and to describe the risk profile of the method. METHODS: Retrospective cohort analysis of 4 obesity centers where gastric balloons had been regularly implanted since 2001. RESULTS: Between February 2001 and April 2008, the gastric balloon (BIBTM Intragastric Balloon System; Allergan Medical, Irvine, CA, USA) was implanted in 634 patients. The gender ratio was 31.5% males to 68.5% females; the average age was 41.5 years. The average initial weight was 126 kg. The initial BMI at implantation of the gastric balloon was 42.5 kg/m2. The implantation of the prosthesis was uncomplicated in all cases. Average weight loss was 20.75 kg or 7.05 BMI points, respectively.

Obwohl Über die laparoskopische Sleeve-Gastrektomie (LSG) noch keine ausreichenden Langzeitergebnisse vorliegen, wird diese Operation mitzunehmender Euphorie durchgefÜhrt. Multicenter-Studien sind in der Rekrutierungsphase, Langzeitergebnisse werden erst in 2–3 Jahren erwartet. Die LSG wird allgemein als eine zÜgig durchfÜhrbare und wenig traumatisierende Operation angesehen. Es gelten aber die gleichen GrundsÄtze der laparoskopischen Chirurgie: sorgfÄltige PrÄparationen, Vermeidung von kreuzenden Klammernahtreihen und das frÜhe Erkennen und Beherrschen von Leckagen. Nur so kann ein hoher operativer Standard gewÄhrleistet werden. Wir verwenden einen 32-CharriÈre-Magenbougie; daraus sollte ein circa 80–100 ml großer Schlauchmagen und ein Magenresektat mit mindestens 1000 ml FÜllungsvolumen resultieren. Werden diese Benchmarks angestrebt, kÖnnen Übergewichtsverluste (EWL) von circa 60% nach 1 Jahr erzielt werden. Sleeve Gastrectomy — Technique, Safety, Success, Trends Despite the lack of sufficient data concerning the long-time results, the morbidity, and the mortality of laparoscopic sleeve resection, this operation is performed with growing enthusiasm. However, general principles of laparoscopic surgery need to be observed to ensure good results. This article describes an operative technique and indication for the operation. Attention must be turned on the complete liberation of the dorsal aspect of the stomach, the absence of crossing staple lines, and the competent handling of intraoperative leakages. The use of a 32 Fr bougie results in a residual stomach volume of about 80—100 ml. Due to a good operative technique and a competent follow-up, excess weight loss (EWL) of about 60% can be achieved within the first postoperative year.

Die Kriterien zur Indikation fÜr ein Gastric Banding (GB) oder einen Bypass sind in den bekannten Leitlinien nur unscharf definiert und orientieren sich meist am BMI der Patienten. In der vorliegenden Arbeitwerden neben dem BMI auch die Rolle von hormonalen Mediatoren, die mit der morbiden Adipositasverbunden sind, die KomplikationstrÄchtigkeit und die Langzeitresultatedes GB dem laparoskopischen Gastric Bypass gegenÜbergestellt, um gegebenenfalls Grenzen des GB aufzuzeigen. Laparoscopic Gastric Banding - Where Are the Limits? The criteria for the indication of gastric banding (GB) or bypass in morbidly obese patients are poorly defined in the available guidelines and usually rely on the BMI of the patients. In this study, the role of the BMI and of hormonal mediators associated with morbid obesity are outlined. Furthermore, the complications and long-termresults of GB are analyzed and compared with laparoscopic gastric bypass in order to define the limits of GB.

Background: The micturition reflex is under the tonic influence of suprapontine structures including the anteromedial frontal cortex, basal ganglia, and hypothalamus. However, there have been few reports about the role of the hypothalamus on the lower urinary tract (LUT) function in humans. Objective: To investigate LUT function in patients with pituitary adenomas. Methods: Urodynamic studies were carried out in three patients with LUT symptoms who had pituitary adenomas extending upwards to the hypothalamus. Results: All three male patients (age 28 to 62 years) developed LUT symptoms (urinary urgency and frequency (3); urinary incontinence (3); voiding difficulty and retention (2)) along with weight loss, psychiatric symptoms, unsteady gait, and/or visual disturbances. One had the syndrome of inappropriate secretion of antidiuretic hormone, but none had diabetes insipidus. Two had resection of the tumour and subsequent radiation therapy, but LUT dysfunction persisted. The third patient had partial resection of the tumour to ameliorate hydrocephalus. Urodynamic studies showed detrusor overactivity during the storage phase in all patients; during the voiding phase there was underactive detrusor in two and non-relaxing sphincter in one. Conclusions: Hypothalamic lesions can cause severe LUT dysfunction in both the storage and voiding phases of micturition. This may reflect the crucial role of the hypothalamus in regulating micturition in humans.