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Massive weight loss following bariatric surgery is often accompanied by functional impairments due to the resulting excess skin and soft tissues. To achieve both functional reconstruction and restoration of the body silhouette, it is imperative to undergo body contouring surgery involving the strategic transposition of tissues. Several surgical techniques are available for the affected body regions and their application for treatment is determined by the unique circumstances specific to each patient. When conducted by skilled practitioners, postbariatric body reconstruction can be executed safely, leading to outcomes that are both functionally and esthetically satisfying, ultimately contributing to an enhanced quality of life for patients. This article provides the fundamental principles for patient selection, surgical preparation, treatment planning, surgical techniques and the postoperative care following bariatric surgery. [ABSTRACT FROM AUTHOR]

In horses, reduced insulin sensitivity, obesity or abnormal fat distribution and a predisposition to laminitis occur collectively and are summarized as equine metabolic syndrome (EMS). The incidence of the disease is increasing not only in humans but also in horses, and in addition to dietary measures for weight reduction, various drug therapy approaches from human medicine are being pursued as treatment. The aim of this work was to analyze the influence of signalment and management (exercise and feeding) as well as the severity of obesity on the EMS and to determine whether a change in management can or should improve the equine metabolic syndrome or if a reversibility of the EMS factors occurs. For this purpose, 32 horses suffering from EMS were examined and the owners were surveyed about the husbandry, exercise and feeding of the horses. This was followed by an intervention phase in which all horse owners received information on how to change/optimize posture, feeding and exercise with the aim of losing weight or reducing abnormal fat deposits. Finally, a follow-up examination was carried out after three to six months. The results showed that horse management influenced the level of insulin resistance. Horses that were exercised in a controlled manner showed significantly lower degrees of severity (p = 0.002). Feeding also had a significant impact on the severity of insulin resistance. Horses fed unrestricted were moderately or highly insulin resistant (p < 0.001). Horses with severe insulin resistance also had higher heart rates (p = 0.024), as did generally obese horses (p = 0.047). The heart rate of animals with laminitis (p = 0.020) was also significantly higher. At the follow-up after the intervention, 14 of the 32 horses could be re-examined. As a result of the intervention, insulin resistance was no longer detectable in five horses. In summary, the results show that feeding and exercise have a significant influence on the development of insulin resistance in horses with EMS and that optimization in these areas can lead to a significant improvement or even to the disappearance of insulin resistance. [ABSTRACT FROM AUTHOR]

Equine Gastric Ulcer Syndrome (EGUS) is a common problem in equine athletes. The ECEIM consensus statement and the manufacturers recommend omeprazole at a dosage of 2–4 mg/kg PO SID (buffered formulations) or 1–2 mg/kg PO SID (enteric coated granules) for the treatment of ESGD (Equine Squamous Gastric Disease) and the same dosages in combination with sucralfate (12 mg/kg PO BID) for EGGD (Equine Glandular Gastric Disease). In this study, the two formulations were compared in an equine hospital setting. A modified clinical scoring was used to include 87 horses (January 2019-December 2020) presented for recurrent colic, weight loss, exercise insufficiency or typical behavior (bruxism, groaning), in which gastroscopy was performed. Horses were classified as 0–4 for ESGD (consensus statement) and 0–3 for EGGD (modified from non-remarkable/mild/moderate/severe findings according to the Consensus statement) by the veterinarian performing the gastroscopy and led to the recommendation of therapy in 63 cases. Omeprazole therapy (buffered formulation 4 mg/kg PO SID, GastroGard™, Boehringer Ingelheim or enteric coated granules 2 mg/kg PO SID, Equizol™, CP Pharma), in case of EGGD combined with sucralfate (12 mg/kg PO BID, Sucrabest™, Combustin) was recommended in combination with improvements concerning housing, feeding and reduction of stress according to the ECEIM consensus statement. Gastroscopy was repeated about 4 weeks later in 23 horses. Standing images were randomized and scored twice by two blinded, experienced observers (ECEIM diplomats), so that 4 scorings for both time-points were available of ESGD and EGGD. The mean values of these scorings were the basis for the evaluation of treatment success. Additionally, inter- and intra-observer agreement were compared for ESGD and EGGD. Both formulations were highly effective in improving ESGD by ≥ 2 subgrades or by achieving grade 0 in 93 % and 100 % of horses treated with buffered (n = 15 GastroGard™) and encapsulated formulations (n = 8, Equizol™), respectively. EGGD was improved by ≥ 1 subgrade or achieving grade 0 in 64 % and 71 % of horses treated with buffered and enteric coated formulations combined with sucralfate, respectively. No significant differences between the two formulations were found for either ESGD or EGGD (P > 0.999). Inter- and intra-observer-agreement were excellent for ESGD (κ = 0.832–0.975), while the inter-observer agreement for EGGD was found to be fair (κ = 0,390). In conclusion, both omeprazole formulations can be recommended for the treatment of EGUS, in particular ESGD. Differences in long-term effect and recurrence rates should be studied in future studies. [ABSTRACT FROM AUTHOR]

Background: The BodyLab is a body sculpting system that uses innovative FMS (Focused Magnetic Stimulation) technology. The patient's muscles are stimulated with supramaximal contractions (up to 2.5 Tesla), which stimulates metabolism and leads to significant fat loss. The goal of supramaximal muscle stimulation is to improve muscle tone and elicit a strong metabolic response, which in turn stimulates fat loss. Objective: To gain clinical experience under real-life conditions, an application observation was initiated. Material and Methods: The subject received a total of 8 treatments with a program duration of approximately 30 minutes each, 3-5 days apart, using the 2 BodyLab applicators placed on the abdomen. Results: After completion of the 8 treatments and a period of exactly 4 weeks, the reduction in abdominal circumference was 4 cm (initial measurement 86 cm, end 82 cm). Her weight changed insignificantly throughout the period and was finally found to be 64.5 kg, which is approximately the same as the initial value of 64.3 kg. Conclusions: Weight changed only insignificantly throughout the period and was finally found to be 64.5 kg, which is about the same as the initial value of 64.3 kg. It can be assumed here that the reduced abdominal circumference is not due to a reduction in body weight (e.g. due to dieting or as a function of the menstrual cycle) but to a decrease in adipose tissue. This could also be perceived visually. [ABSTRACT FROM AUTHOR]

We report the case of a 30-year-old woman presenting with fatigue, loss of weight, nausea, emesis and hyponatremia. The evaluation proved Addison's disease due to an autoimmune polyendocrine syndrome type 2 with Hashimoto thyreoiditis. Under substitution with hydrocortisone and fludrocortisone all the symptoms subsided completely. [ABSTRACT FROM AUTHOR]

Dysphagia is a common problem in clinical daily routine and neurological diseases, such as amyotrophic lateral sclerosis (ALS), are often the reason for this symptom. We show difficulties in diagnostic work-up of dysphagia based on two clinical cases, especially dysphagia as being a symptom of ALS. For finding the cause of dysphagia und diagnosing ALS a systematic examination and anamnesis are very important. [ABSTRACT FROM AUTHOR]

Background: Increasing numbers of interventions for obesity and metabolic surgery have led to an increase of primary bariatric operations as well as redo operations and revisional surgery after various primary bariatric procedures. Evidence-based guidelines for indications and choice of procedure for revisional surgery do not currently exist. Aim: The spectrum of various revisional and redo operations following standard operative procedures for obesity and metabolic surgery is presented based on current data from the German bariatric surgery registry (GBSR, German nationwide survey on quality assurance in bariatric surgery) and a literature search. Material and methods: Since 1 January 2005, the current situation of bariatric surgery has been examined using the GBSR. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg. Since 2005 a total of 24,070 primary bariatric procedures, 2070 revisional procedures and 1124 redo operations were analyzed. The study evaluated 1021 revisional and 491 redo operations after gastric banding (GB), 443 redo operations after sleeve gastrectomy (SG) and 306 revisional procedures and 10 redo operations after a Roux-en-Y gastric bypass (RYGBP). Results: Reoperations of GB to SG were performed in 240 cases. The complication rate for GB removal and SG showed a significantly higher leakage rate for one step operations than for two step procedures of 3.3 % vs. 0.0 %. Conversion of GB to RYGBP was performed in 402 operations without any significant differences between one and two step approaches (1.9 % vs. 2.2 %). The specific complication rate in the 443 interventions in patients for conversion from SG to RYGBP was 10.8 % which is higher than for primary SG (4.9 %) and RYGBP (5.3 %). Conclusion: Compared with the primary surgical procedures redo operations and revisional procedures have significantly higher complication rates. The data evaluated show that strong and differentiated indications are necessary for revisional and redo operations particularly in cases of therapy or metabolic failure. [ABSTRACT FROM AUTHOR]

Morbid obesity and the associated comorbidities are rapidly increasing worldwide. Bariatric surgery has proven to be an effective treatment option. In 2011 more then 340,000 bariatric procedures were performed worldwide which is accompanied by a growing demand for revision bariatric procedures due to complications or failure, such as insufficient weight loss or weight regain. Redo operation procedures as well as the management of complications require a profound preoperative medical history and diagnostic investigation in combination with an exact knowledge of the anatomical changes made in the primary procedure. [ABSTRACT FROM AUTHOR]

Background: It is estimated that approximately 1 million adults in Germany suffer from grade III obesity. The aim of this article is to describe the challenges faced when constructing an operative obesity center. Methods: The inflow of patients as well as personnel and infrastructure of the interdisciplinary Diabetes and Obesity Center in Heidelberg were analyzed. The distribution of continuous data was described by mean values and standard deviation and analyzed using variance analysis. Results: The interdisciplinary Diabetes and Obesity Center in Heidelberg was founded in 2006 and offers conservative therapeutic treatment and all currently available operative procedures. For every operative intervention carried out an average of 1.7 expert reports and 0.3 counter expertises were necessary. The time period from the initial presentation of patients in the department of surgery to an operation was on average 12.8 months (standard deviation SD ± 4.5 months). The 47 patients for whom remuneration for treatment was initially refused had an average body mass index (BMI) of 49.2 kg/m and of these 39 had at least the necessity for treatment of a comorbidity. Of the 45 patients for whom the reason for the refusal of treatment costs was given as a lack of conservative treatment, 30 had undertaken a medically supervised attempt at losing weight over at least 6 months. Additionally, 19 of these patients could document participation in a course at a rehabilitation center, a Xenical® or Reduktil® therapy or had undertaken the Optifast® program. For the 20 patients who supposedly lacked a psychosomatic evaluation, an adequate psychosomatic evaluation was carried out in all cases. Conclusions: The establishment of an operative obesity center can last for several years. A essential prerequisite for success seems to be the constructive and targeted cooperation with the health insurance companies. [ABSTRACT FROM AUTHOR]

Postbariatric plastic surgery after major weight loss can improve quality of life through functional reconstruction and restoration of a normal body contour. Comorbidities associated with obesity necessitate individual indications and precise preoperative planning in order to reduce the rate of postoperative complications. Postbariatric plastic surgery includes a variety of sophisticated surgical techniques and therefore requires profound knowledge and experience in this special field. Satisfactory results can be achieved by complying with basic principles and through the use of established methods. The present article provides an overview of current concepts and trends in postbariatric plastic surgery. [ABSTRACT FROM AUTHOR]

We report the case of a 58-years-old soldier with a history of movement related neck pain, weight loss and exercise intolerance. Blood tests presented signs of an inflammatory syndrome. The CT-scan showed extended thickening of the aortic wall characteristic for aortitis. The diagnosis of giant cell arteritis could be histologically confirmed by biopsy of the temporal arteries. Our case report emphasizes the importance of the various imaging modalities. We discuss the different forms of disease evolution and the treatment regimen. [ABSTRACT FROM AUTHOR]

We report the case of a 58-years-old soldier with a history of movement related neck pain, weight loss and exercise intolerance. Blood tests presented signs of an inflammatory syndrome. The CT-scan showed extended thickening of the aortic wall characteristic for aortitis. The diagnosis of giant cell arteritis could be histologically confirmed by biopsy of the temporal arteries. Our case report emphasizes the importance of the various imaging modalities. We discuss the different forms of disease evolution and the treatment regimen. [ABSTRACT FROM AUTHOR]

The Wernicke Encephalopathy (WE) as a result of a (sub)acute thiamine deficiency remains, unfortunately, still under-diagnosed, especially among non-alcoholics. It should be considered in each occurrence of delirium as well as in any ocular motor disorder and ataxia, in particular if there is a history of weight loss with or without gastrointestinal symptoms. In cases with suspected WE an immediate intravenous substitution of 3x200 mg/d is recommended. [ABSTRACT FROM AUTHOR]

Arteriosclerosis is the most common cause of chronic mesenteric ischemia, which is characterized by postprandial pain, unintentional weight loss and food avoidance. The use of endovascular techniques for revascularization of chronic stenoses and occlusions of the mesenteric arteries has rapidly increased over the last 10 years. The results of endovascular therapy have shown less morbidity and mortality compared to open surgical procedures, such as bypass and thrombendarterectomy. Early publications have reported higher rates of restenosis, symptomatic recurrence and reinterventions but recent case series show comparable patency rates. This article reviews visceral arterial anatomy and anomalies and endovascular techniques for the revascularization of mesenteric arteries. [ABSTRACT FROM AUTHOR]

One fifth of the German population is obese with increasing prevalence. Psychotherapy plays an important role in weight loss programmes. Cognitive behaviour therapy, targeting lifestyle changes, including exercise and eating behaviour, is the evidence-based treatment of choice. Especially the lack of motivation or absence of weight loss, further weight gain or psychosocial burden makes psychotherapy essential. The treatment of a comorbid binge eating disorder should be initiated prior to focusing on weight loss. Remarkably difficult stages in the treatment of obesity are the initiation of changes as well as the maintenance of the achieved weight loss. Internet-based attempts will become increasingly important. [ABSTRACT FROM AUTHOR]

The beginnings of the diagnosis and treatment of sleep apnea in Germany date back to the 1960s. Given the high prevalence of the disease and the small number of centers with a sleep laboratory, portable monitoring devices were developed early and used in a stepwise manner for diagnosis. The article describes the development of biosensors and recording technology to today's comfortable polysomnographic devices. Originally, the only relevant treatment options were weight loss or tracheostomy. With the introduction of constant positive pressure breathing (CPAP), the frequency of diagnosis and treatment increased significantly. Initially patient care was performed with simple equipment and technology. Because the risk profile of the disease was not well known by patients and doctors, broad dissemination of knowledge by public education, conferences, and workshops was organized. [ABSTRACT FROM AUTHOR]

Patients with acute heart failure usually present with dyspnoe and edema secondary to elevated intracardiac filling pressure resulting from volume overload. Despite significant progress in understanding heart failure, the treatment strategy for acute heart failure did not change in the same way. Diuretics, especially loop diuretics, are the most common therapy used in this setting. Intravenous diuretics act acutely by exerting a modest vasodilatory response and chronically by reducing circulating blood volume. Despite near universal use of diuretics in patients hospitalized with acute heart failure, nearly half of these patients are discharged from hospital without weight loss. This could be due to inadequate diuresis, overdiuresis with subsequent volume replacement and diuretic resistance. Aggressive diuresis carries a significant risk of electrolyte and volume depletion with subsequent arrythmias, hypotension, and worsening renal function. Actually there were scant data available from randomized clinical trials to guide therapeutic choice with diuretics. Thus, the choice and dosing of diuretic therapy must be individualized based on general knowledge of potency and pharmacokinetic and pharmacodynamic considerations. [ABSTRACT FROM AUTHOR]

We herein report on an 80-year old male patient with a history of muscle weakness, fatigue and weight loss since several months. Because of a pathologic synacthen test in combination with decreased levels of ACTH, we diagnosed a secondary chronic adrenal insufficiency. Because of a normo-chromic, normocytic, and hypoproliferativ anemia, bone marrow puncture was performed, showing an anemia of chronic disease. We initiated Hydrocortison and anemia and patients' symptoms were fully reconstituted. [ABSTRACT FROM AUTHOR]

In the last years, obesity has become one of the main problems of health care systems in Western countries. Among morbid obese patients, four out of five will develop comorbidities doubling the mortality risk in women and increase the numbers in men at a threefold risk. According to evidence based guidelines, nowadays surgery is the best and most effective treatment resulting in excellent long-term weight loss, reduction of comorbidities while extending expectation of life. A sound indication is the most important step for successful surgery. In this paper we focus on Swiss regulations and some special indications which have to be taken into consideration. After bariatric surgery clinical follow up on a regular basis is also of great importance. Furthermore, we explain typical mechanical and nutritional complications after different types of surgery and give some recommendations. [ABSTRACT FROM AUTHOR]

Morbid obesity is defined as obesity with body mass index (BMI)≥40 kg/m² with secondary serious diseases. Conservative treatment generally fails to produce long-term weight loss in these patients, since several bariatric surgical techniques have been developed which are based on gastric restriction and/or gastric mal-absorption resulting in permanent weight loss over years. Preoperative evaluation might detect suitable patients and reduce both non-surgical and surgical complications. Postoperative follow-up in a multidisciplinary program, including specialists in various fields of medicine, e.g. surgery, internal medicine, radiology, paediatrics and nutritional surveillance are mandatory in the treatment of patients after obesity surgery. Bariatric surgery results in a major weight loss, with amelioration of most obesity-associated conditions. The most serious side effect of some surgical procedere is malnutrition. [ABSTRACT FROM AUTHOR]

In connection with the biological utilization of tree barks, the degradation of bark of beech and spruce was studied by determining weight losses and the fungal flora of samples exposed in forest stands of same species. The weight losses of samples on the forest floor amounted to 47% in beech and 60% in spruce after three years of exposure. The bark specimens buried in the forest soil exhibited slightly higher weight losses. No effect of site was observed in the two beech stands, but in spruce stands, such an effect could not be ruled out.