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Biomedical subjects

T Andersen

Publications and source records attributed to T Andersen.

At least 37 records · Page 2Linked to original sources
PubMed1989

A randomized comparison of horizontal and vertical banded gastroplasty: what determines weight loss?

Pouch volume, stoma diameter, and pouch emptying rate were measured postoperatively and after 6 months in 45 morbidly obese patients who had been assigned to either horizontal gastroplasty (HGP) or vertical banded gastroplasty (VBGP) after pretreatment with diet alone. Pouch volume and stoma diameter were measured by a standardized radiographic method with blinded assessment by two observers. Pouch emptying rate was determined by a standardized scintigraphic method and expressed as the mean transit time (t60). Pouch volume and stoma diameter did not change, whereas t60 decreased by 36% during the first 6 months after HGP (p less than 0.001). Pouch volume was larger after HGP (p less than 0.001). Pouch emptying was faster after VBGP (p less than 0.001), but these patients had the better weight loss (p less than 0.001). Variation in weight loss after either operation was unrelated to pouch volume, stoma diameter, and t60. Stoma diameter was not correlated with t60. The study provides further evidence against the significance of stoma diameter and pouch emptying rate as determinants of weight loss after gastroplasty. The much smaller pouch volume after VBGP may favor weight loss.

Adult↗
PubMed1988

Secondary hyperparathyroidism of morbid obesity regresses during weight reduction.

In order to test the relation between obesity and the secondary hyperparathyroidism found in markedly overweight subjects, 24 morbidly obese patients were studied before and after a weight loss of 35.9 kg obtained by a nutritionally adequate, intermittent very-low-calorie diet. Overweight was reduced from 98 +/- 34% to 44 +/- 19%. Serum total calcium did not change, but serum ionized calcium (Ca2+) increased from 1.22 +/- 0.04 mmol/L to 1.25 +/- 0.04 mmol/L (P less than .001). A corresponding fall was observed in serum parathyroid hormone (s-PTH), which decreased from 47.2 +/- 21.7 pmol/L to 35.2 +/- 19.4 pmol/L (P = .01). The change of s-PTH was positively associated with the reduction of body weight (r = .50, P less than .05) and with the reduction of overweight (r = .55, P less than .01). Regarding calcium binding substances, serum albumin remained low. The initially lowered serum phosphate and bicarbonate both rose (P less than .001). Plasma lactate and plasma free fatty acids (FFAs) decreased (P less than .001). The study supports our hypothesis that the change profile of calcium complexing anions in obesity interferes with the tubular reabsorption of calcium, which in turn lowers serum Ca2+, thus promoting hyperparathyroidism. Along with weight loss, concentrations of calcium complexing anions returns towards normal values and the secondary hyperparathyroidism regresses.

Adult↗
PubMed1988

Food intake in relation to pouch volume, stoma diameter, and pouch emptying after gastroplasty for morbid obesity.

This study investigated possible determinants of food intake change after gastroplastry. Preoperatively and 6 and 12 months postoperatively, 27 morbidly obese patients were prospectively examined with 7-day food registration and radiologic measurement of pouch volume and stoma diameter. Pouch emptying was determined as the mean transit time by a scintigraphic method. None of the measured variables was found to influence the change in food intake taking place during the first 6 months, when most of the weight loss was observed. Between 6 and 12 months, the change of stoma diameter was positively associated with the change of solid foods consumed (by weight, p = 0.01; by energy content, p = 0.02). The change of pouch volume was negatively associated with the change of energy from beverages (p = 0.005). In conclusion, it seems impossible to tailor the reduction of food intake through adjustments of the surgical dimensions, at least within the ranges of our observations. Increased food consumption and decreased energy intake with beverages may be caused by late dilations, or vice versa.

Adult↗
PubMed1988

Long-term (5-year) results after either horizontal gastroplasty or very-low-calorie diet for morbid obesity.

Fifty-seven patients allocated at random to either diet supported by gastroplasty or very-low-calorie diet (VLCD) were followed for 5 years. One patient was lost to follow-up 1 year after surgery. Data were analyzed by survival statistics and success was liberally defined as a maintained weight loss of at least 10 kg. The cumulative success rate declined steadily in both groups, but it remained higher in the gastroplasty group (16 versus 3 percent, the 95 percent confidence limits being 11-21 percent and 1-5 percent, respectively; P less than 0.05). At 5 years, eight of 27 gastroplasty patients (30 percent, 95 percent confidence limits 14-50 percent) had not relapsed. Of 30 VLCD patients, relapse had not occurred in five (17 percent, 6-35 percent). The weight loss of patients without relapse did not differ significantly (medians of gastroplasty and VLCD patients 18 kg and 27 kg, respectively). Complications and side-effects were more numerous and serious among the gastroplasty patients. Although in this long-term study, the horizontal gastroplasty proved to be somewhat more effective than the diet alone, the surgical risks and the unsatisfactory maintenance of weight loss speak against the use of this operation.

Adult↗
PubMed1987

Increased plasma fibronectin concentrations in obesity: normalization during weight loss.

In 23 morbidly obese patients we investigated the influence of a large weight loss (30.6 kg, range 17.5-90.8) on the plasma fibronectin concentrations. Further, changes in plasma fibronectin were related to serum insulin levels and to liver biochemistry. Between the measurements patients had been treated with an intermittent very-low-calorie formula diet sufficient in respect to protein, minerals and vitamins. They were investigated in weight-stable states. Before weight reduction, 14 patients (61%, 95% confidence limits 39-80%) had elevated plasma fibronectin levels. Plasma fibronectin decreased (medians 1.22 and 0.59 mumol/l before and after weight loss, p less than 0.01) and was after weight loss within the normal range in 14 patients. The change in plasma fibronectin was unassociated with the magnitude of the weight loss as well as with the reduction of overweight. The resulting plasma fibronectin levels were also uncorrelated with the body weight and with the final degree of overweight. Serum insulin decreased (p less than 0.01) during the weight reduction and the change correlated (p less than 0.05) with the change in plasma fibronectin. Serum lactate dehydrogenase, which is associated with the degree of hepatic fatty change, declined (p less than 0.01), but the individual change was unrelated with the change in plasma fibronectin. In conclusion, the elevated plasma fibronectin levels in morbidly obese subjects seem to normalize during weight loss. We suggest the normalization to be mediated--at least in part--by a reduction of the insulin levels.

Adult↗
PubMed1987

The reflecting team: dialogue and meta-dialogue in clinical work.

A "stuck" system, that is, a family with a problem, needs new ideas in order to broaden its perspectives and its contextual premises. In this approach, a team behind a one-way screen watches and listens to an interviewer's conversation with the family members. The interviewer, with the permission of the family, then asks the team members about their perceptions of what went on in the interview. The family and the interviewer watch and listen to the team discussion. The interviewer then asks the family to comment on what they have heard. This may happen once or several times during an interview. In this article, we will first describe the way we interview the family because the interview is the source from which the reflections flow. We will then describe and exemplify the reflecting team's manner of working and give some guidelines because the process of observation has a tendency to magnify every utterance. Two case examples will be used as illustrations.

Adult↗
PubMed1987

Low serum free T3 concentrations in postobese patients previously treated with very-low-calorie diet.

Thirteen postobese patients with stable body weights were studied and compared with obese patients and normal subjects. Six had previously been treated with a very-low-calorie diet (VLCD) whereas seven had been treated with gastroplasty (GP). The median observation time of post-obesity was 20 months for GP patients, but significantly (P less than 0.001) shorter by 2 months in VLCD patients. The median serum concentration of free triiodothyronine (T3) was significantly (P less than 0.005) reduced in the postobese VLCD patients (3.4 pmol/l) but normal in postobese GP patients (4.2 pmol/l) and obese patients (4.5 pmol/l). The serum level of total T3 was correspondingly lowered in the postobese VLCD patients. Also the postobese GP patients had a small, but significant (P less than 0.01) reduction in the median serum concentration of total T3 suggesting a slight decrease in the binding capacity. The serum levels of thyroxine-binding globulin and thyroxine-binding prealbumin were normal in both postobese and obese patients. Furthermore, the serum levels of thyroxine were normal showing that the postobese patients were euthyroid. The study shows that serum concentrations of T3 are not associated with body weights and low serum concentration may be seen in postobese patients after VLCD.

Adult↗
PubMed1987

Horizontal or vertical banded gastroplasty after pretreatment with very-low-calorie formula diet: a randomized trial.

Horizontal and vertical banded gastroplasty (GP) were compared as to their effectiveness and side-effects in patients pre-treated for morbid obesity with a very-low-calorie formula diet (VLCD). The pre-treatment served to select the compliant patients, to minimize the surgical hazard, and to optimize the total weight reduction. Seventy-four consecutive patients (median age 34 years, median body weight 125.1 kg, and median overweight 93 per cent) were included according to the criteria for entry. The median weight loss on VLCD was 25.7 kg (range, 5.8-92.6 kg) and the median overweight reduction reached 46 per cent of the initial overweight (range, 9-83 per cent). Only few and mild side-effects were observed. Sixty-nine per cent of the patients fulfilled our criterion for surgery by reducing their initial overweight by at least 40 per cent. Of these, 23 and 22 patients were assigned respectively to either vertical banded or to horizontal GP. Patients and dietitians were not informed of the assignment. A significant weight loss occurred in both groups. Three months after surgery weight loss after vertical banded GP proved to be the larger (P less than 0.001). The difference became even more pronounced due to an earlier regain among patients treated with the horizontal GP. Thus, at 12 months, the net weight loss after surgery was 9.7 kg (range, -28.2-28.7 kg) in the vertical banded GP group and -1.0 kg (range, -15.0-36.5 kg) in patients treated with horizontal GP (P less than 0.0005). At this time, the total weight loss in the groups was 48.5 kg (range, 6.4-104.0 kg) and 32.6 (range, 3.7-125.1 kg) respectively (P less than 0.02), and the total reduction of overweight was greater in the group treated with vertical banded GP (80 per cent (range, 10-96) versus 56 per cent (range, 8-92), P less than 0.005). There were no deaths, and side-effects to VLCD as well as to GP were generally mild. It is concluded that vertical banded GP is more effective than horizontal GP and that the former operation adds a significant weight loss to that obtained by VLCD. The combined treatments offer a weight reduction comparable to that observed after jejunoileal bypass. However, some regain within 1 year makes it questionable if the vertical banded GP is sufficient to prevent weight regain.

Adult↗
PubMed1987

Blood pressure and arm circumference during large weight reduction in normotensive and borderline hypertensive obese patients.

Blood pressure (BP) and arm circumference were measured in 44 normotensive and borderline hypertensive obese patients during treatment with either a very low calorie diet or diet supported with gastroplasty. The patients had reductions in sodium, energy, and carbohydrate intake. BP was determined with both a normal cuff (12-by-35 cm bladder) and a large cuff (15-by-43 cm bladder), using a random-zero sphygmomanometer. Both systolic and diastolic BP declined (p less than 0.005) (from 133 to 124 +/- 4 mmHg and from 87 to 81 +/- 3 mmHg (mean +/- SED), respectively), but reached a plateau after an average weight loss of 11 kg. No further reduction in BP was seen despite a maximal weight loss of 40 kg. At the same time arm circumference decreased from 36.4 to 30.5 cm. Moreover, the study showed that reductions in systolic and diastolic BP were closely associated with the pretreatment BP but not with the weight loss. The normal cuff overestimated the systolic BP by 8 +/- 4 mmHg and the diastolic BP by 6 +/- 3 mmHg (mean +/- SED) in patients with arm circumference of 35 cm and more.

Adult↗
PubMed1987

Impaired glucose-induced thermogenesis in skeletal muscle in obesity. The role of the sympathoadrenal system.

From a 7-day food recording in 29 morbidly obese patients two groups of six patients each were selected: a high-energy-intake group (HEI) and a low-energy-intake group (LEI). The groups were otherwise comparable. Five lean subjects served as controls for some observations. Oral glucose tolerance tests showed that all patients in the HEI group and the lean controls had normal glucose tolerance, whereas it was abnormal in all subjects in the LEI group. The fasting metabolic rate did not differ between the obese groups but was significantly lower in the lean group. The glucose-induced thermogenesis during 180 min expressed as a percentage of the energy content of the glucose load was lower in both obese groups compared with the lean controls (lean: +11.5 per cent, HEI: +5.3 per cent and LEI: -4.2 per cent, HEI vs lean: P = 0.04 and LEI vs lean: P = 0.005), and lower in the LEI group compared with the HEI group (P = 0.02). The integrated increase in leg oxygen consumption after glucose was also smaller in the LEI group than in the HEI group (15 +/- 269 vs 987 +/- 356 ml, P less than 0.05). The arterial noradrenaline response to glucose was significantly diminished in both obese groups compared with the lean controls. Glucose induced a similar increase in leg noradrenaline release in both obese groups, whereas the arterial adrenaline level was lower in the LEI group compared with the HEI group and with the lean controls (P = 0.04). Among the obese subjects the degree of glucose intolerance was inversely correlated with the post-glucose arterial adrenaline level (r = -0.55, and P = 0.04), and positively correlated with the fractional leg adrenaline extraction (r = 0.71, and P = 0.003). The results suggest that patients who are obese in spite of a fairly low energy intake have a reduced glucose-induced facultative thermogenesis, and that the defect is at least in part located in skeletal muscle. Since the sympathetic nervous system is partly responsible for the glucose-induced thermogenesis, the reduced thermogenic response in the obese patients may be due to an impaired activation of the sympathetic nervous system. It is hypothesized that the reduced arterial adrenaline level in the LEI group is caused by hyperglycaemic suppression of the adrenomedullary secretion and further that this may be a link connecting deterioration of glucose tolerance and a thermogenic defect in obesity.

Adrenal Glands↗
PubMed1986

Increased parathyroid hormone as a consequence of changed complex binding of plasma calcium in morbid obesity.

To evaluate whether changed plasma calcium binding might lead to a secondary increase of parathyroid hormone in morbid obesity, fasting measurements of serum ionized, ultrafiltrable and total calcium, calcium binding substances, and parathyroid hormone were undertaken in age- and sex-matched groups of obese (n = 44) and normal weight subjects (n = 52). The 24-hour urinary calcium excretion and clearance of creatine were also measured. Calcium binding to proteins was changed. Serum total proteins and protein-bound calcium did not differ, but serum albumin was decreased in obesity. Consequently, obese subjects did not reveal the normal dependency of protein-bound calcium upon albumin. Calcium binding to other substances was also changed. Serum phosphate and bicarbonate were decreased, while the concentrations of citrate, lactate, acetoacetate, 3-hydroxybutyrate, free fatty acids, and urate were all increased, leaving the total concentration of plasma complex-bound calcium unchanged. Nevertheless, these reciprocal changes increase the concentrations of less readily reabsorbable anions in the renal ultrafiltrate. The changed pattern of calcium binding in serum of the obese subjects may serve to explain our findings of increased urinary calcium excretion, lowering of serum ionized calcium and increased parathyroid hormone levels, changes being significantly correlated with degree of overweight.

Adult↗
PubMed1986

Intracranial glossopharyngeal schwannoma, a tumour imitating an acoustic schwannoma.

Neurinomas originating from the ninth cranial nerve are rarely observed. The early signs and symptoms of a glossopharyngeal neurinoma are rather discrete, and it can happen that a tumour here will often first be recognised with the signs and symptoms of an expanding posterior fossa lesion--thus often closely resembling an acousticus neurinoma.

Cranial Nerve Neoplasms↗