Christian Traweger

Psychosocial Predictors of Weight Loss after Bariatric Surgery

Background: The authors investigated the predictive value of various parameters such as age, preoperative weight, eating behavior, psychiatric disorders, adverse childhood experiences and self-efficacy with regard to weight loss after gastric restrictive surgery. Methods: After a minimum follow-up of 30 months (median follow-up 50 months; range 30-84 months), a questionnaire concerning extent of, satisfaction with, and consequences of weight loss was mailed to 220 morbidly obese female patients following laparoscopic Swedish adjustable gastric banding (SAGB). Results: Questionnaires were completed and returned by 140 patients (63%). Average BMI loss was 14.6 kg/m2. Most patients (85%) were happy with the extent of weight loss. Satisfaction with weight loss showed a significant correlation with extent of weight loss. BMI loss was greatest in the obese with an atypical eating disorder (20.0 kg/m2), and BMI loss was least in the obese with no eating-disordered behavior before surgery (13.4 kg/m2). Obese patients with two or more psychiatric disorders showed significantly less weight loss than did obese patients with one or no psychiatric disorder (BMI units 10.8 vs 14.0 vs 16.1; P=.047). Conclusions: The findings indicate a less successful outcome for obese patients with psychiatric disorders (particularly adjustment disorders, depression and/or personality disorders), compared to patients not mentally ill. An eating disorder preceding surgery, however, was not a negative predictor of success following bariatric surgery. To improve outcome of bariatric surgery in obese patients with psychiatric disorders, more individual psychosocial intervention strategies are necessary.

Changes of serum antibodies to heat-shock protein 65 in coronary heart disease and acute myocardial infarction

Accumulating evidence indicates the involvement of heat shock proteins (hsp), a family of stress-inducible proteins, in atherosclerosis. For carotid atherosclerosis an association with an increase in hsp65 antibodies has been demonstrated. To investigate whether such antibodies are also associated with coronary heart disease (CHD) and acute myocardial infarction (MI), an age- and sex-matched study with patients suffering from CHD (n = 114) and MI (n = 89) and healthy controls (n = 76) was performed. All study participants (n = 279) were consecutively recruited according to typical diagnostic criteria. Determination of antibody titres to hsp65 was performed by an enzyme-linked immunosorbent assay (ELISA). Hsp65 antibody titres in CHD showed a significant increase compared to the healthy control group (P = 0.029), however, hsp65 antibody titres were found to be significantly lower in acute MI, compared to CHD (P = 0.005). Alteration in hsp65 antibody titres showed no correlation to established cardiovascular risk factors, e.g. serum total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, blood pressure, smoking, alcohol intake and body weight. In conclusion, serum concentrations of hsp65 antibodies were elevated independently in coronary heart diseases and declined in patients with acute myocardial infarction, indicating a possible involvement of the antibodies in the pathogenesis of this disease.

Early Determination of Neurological Outcome After Prehospital Cardiopulmonary Resuscitation

BACKGROUND AND PURPOSE Although there are various methods of determining neurological prognosis after cardiopulmonary resuscitation, the final outcome of patients often remains unclear for quite a long time. METHODS We investigated 30 consecutively admitted patients who had been successfully resuscitated by the team of the local mobile intensive care unit after cardiac arrest. Determinations of the period of anoxia and of the cardiopulmonary resuscitation time, clinical investigation, echocardiography, electroencephalography, evoked potentials, magnetic resonance imaging, and magnetic resonance spectroscopy were performed. RESULTS Demonstration of brain lactate in proton magnetic resonance spectroscopy (P < .01) and absent N20 waves in short-latency somatosensory evoked potentials (P < .01) proved to be significant in terms of a poor prognosis. Correlations between both duration of anoxia and cardiopulmonary resuscitation time and neurological outcome could be shown as well (both P < .05). CONCLUSIONS Proton magnetic resonance spectroscopy and short-latency evoked potentials are of great benefit in the prognostic evaluation after cardiopulmonary resuscitation.

Psychosocial Consequences of Weight Loss following Gastric Banding for Morbid Obesity

Background: This study was performed to determine what consequences surgery for morbid obesity has on weight loss, problems in eating behavior, quality of life, physical appearance and mental state. Method: After a minimum follow-up of >8 months (median follow-up 21 months, range 8-48 months), a questionnaire concerning extent of, satisfaction with and consequences of weight loss was mailed to 250 morbidly obese patients after laparoscopic Swedish adjustable gastric banding (SAGB). In addition, the partners opinion regarding the operation was evaluated as well as the consequences of weight loss for partnership and sexual relationship. Results: 160 patients (64%) completed and returned the questionnaire. Most patients (87%) were happy with the extent of weight loss. Weight loss, however, was connected with negative consequences for the body such as flabby skin (53%), abdominal skin overhang (47%) and pendulous breasts (42%). Patients who were satisfied with their postoperative physical appearance showed significantly less weight loss than did patients who were unhappy with their appearance (38 vs 54 kg). Most of the partners (91%) believed that the decision for SAGB was right. An improvement in partnership was reported by more than half of the partners (59%), and an improved sexual relationship by 45%. Conclusion: Laparoscopic SAGB is an effective surgical treatment for morbid obesity. However, the consequences of excess and rapid weight loss for physical appearance are negative in many cases. Well-directed information about the consequences of excess weight loss before SAGB and the possibilities and limits of plastic surgery must be given preoperatively to offset high and often unrealistic expectations.

Sexual dysfunctions: Relationship to childhood sexual abuse and early family experiences in a nonclinical sample

Studies investigating a possible relationship between childhood sexual abuse and adult sexual dysfunction have reported highly discrepant results. The purpose of the present study was to examine 202 female university students for early familial experience and childhood sexual abuse in relation to adult sexual disorders. Each student was asked to complete three questionnaires on victimization, sexual dysfunction, early familial experiences. Results indicated that: (a) victims of multiple CSA more frequently reported sexual desire disorders and orgasm disorders than did single-incident victims and nonvictims; (b) single-incident victims and nonvictims reported no significantly different rates for any kind of sexual dysfunction; (c) negative early familial experiences were significantly related to any kind of sexual disorder; and (d) women who reported orgasm disorders more often reported an inadequate sex education than did women with another or no sexual dysfunction. The data suggest that both family dysfunction and sexual victimization contribute to sexual disorders in adulthood, and that later sexual disorders are to a large extent the result of sexual abuse-related factors in particular and family dysfunction in general.

Binge eating disorder in females: a population-based investigation.

OBJECTIVE The authors investigated the prevalence of binge eating behavior in a general female Austrian population. METHOD A random sample of 1,000 women (age range 15a to 85a) was interviewed by dieticians over the phone. Some screening instruments were used to detect binge eating behavior. RESULTS Of the entire sample, 122 met the diagnostic criteria for binge eating, 84 for binge eating syndrome, and 33 for binge eating disorder (BED). The point prevalence of bulimia nervosa was 1.5%. Women with binge eating episodes carried out more frequently one or more diets within the previous year, and more frequently exhibited a restrained eating behavior than did women without binge eating behavior. Underweight women more often met the diagnostic criteria for bulimia nervosa nonpurging type than did normal weight, overweight, and obese women, while overweight and obese women more frequently met the diagnostic criteria for BED. DISCUSSION Our findings indicate that binge eating appears to be a fairly common behavior in women. Dieting, chronic restrained eating, and excessive exercise may be important triggers for BED and bulimia nervosa.

Significance of working conditions on burnout in anesthetists

Background:  The influence of working conditions on the development of burnout syndrome was assessed in anesthetists working at a university hospital.

Eating-disordered behavior in males: The impact of adverse childhood experiences

OBJECTIVE The authors examined the possible relationship of childhood sexual abuse, physical abuse, and dysfunctional family background and the risk for developing an eating disorder in adult males. METHOD Several anonymous questionnaires were distributed to male university students. RESULTS Of the 301 men, 12 (4.0%) had experienced childhood sexual abuse, 11 (3.6%) had been victims of physical abuse, 79 (26.2%) reported an adverse family background, and 14 (4.6%) had an increased risk for developing an eating disorder. There were no significant differences in the risk for developing an eating disorder and in total EDI between victims and nonvictims, but a significantly increased risk for eating disorders in men with an adverse family background. DISCUSSION The findings suggest that long-lasting negative familial relationships, particularly in connection with physically abusive experiences, may increase the risk for eating disorders.

The prognostic significance of coma-rating, duration of anoxia and cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Abstract Early determination of outcome after successful prehospital cardiopulmonary resuscitation (CPR) is a common problem with great ethical, economic, social, and legal consequences. We prospectively investigated 112 adult patients who had been resuscitated after out-of-hospital cardiac arrest (CA). The aim of our study was to determine whether coma rating by the mobile intensive care unit (MICU) is a useful tool for outcome prediction. For neurological assessment the Innsbruck Coma Scale (ICS) was used initially and after return of spontaneous circulation (ROSC) or 20–30 min after the start of CPR, before any sedating drugs were given. The duration of anoxia and CPR were determined with the automatically recorded emergency call protocol of the dispatch centre and the protocol of the MICU. For estimation of cerebral outcome at the time of discharge from hospital we used the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). Restoration of spontaneous circulation was achieved in 42 patients (37%), and 15 (13%) were discharged from hospital. The first coma rating performed immediately at the time of arrival on scene had no significant prognostic value for prediction of neurological outcome (P = 0.204) and survival (P = 0.103). The second coma rating (performed after ROSC or 20–30 min after the start of CPR), however, demonstrated a significant correlation with neurological outcome (P = 0.0000) and survival (P = 0.0000), a correlation which was comparable to both duration of anoxia and duration of CPR. In patients with out-of-hospital cardiac arrest prognostic information could be obtained with the ICS as early as 20– 30 min after the start of cardiopulmonary resuscitation.

Binge eating disorder in males: A population-based investigation

The authors investigated the prevalence of binge eating behavior in a general male Austrian population. A randomly selected sample of 1000 male adults aged 18 to 88 was interviewed by dieticians over the phone. Some screening instruments were used to detect binge eating behavior. The results showed a total prevalence of eating disorders of 14.9%. Eight subjects (0.8%) met the full diagnostic criteria for binge eating disorder (BED), 42 (4.2%) exhibited a partial binge eating syndrome, 94 (9.4%) an Eating Disorder Not Otherwise Specified, and five subjects (0.5%) a bulimia nervosa. Most subjects with a eating disorder were overweight or obese, particularly those with a full BED syndrome. Our findings indicate that full BED syndromes are very rare in a nonclinical male sample, whereas partial syndromes are fairly common in males.