Flemming Quaade

Randomized Trial of Diet and Gastroplasty Compared with Diet Alone in Morbid Obesity

We compared the weight-reducing effect of diet and gastroplasty with that of diet alone in a randomized trial in 60 morbidly obese patients followed for two years. Initial median body weight was 120 kg in patients randomly assigned to gastroplasty plus diet and 115 kg in those assigned to diet alone. Maximum weight losses did not differ significantly between the groups (26.1 kg in the gastroplasty group and 22.0 kg in the group treated with diet alone, P greater than 0.05). The risk of a Type II error with a true difference larger than 9.5 kg was less than 5 per cent. However, the group treated with diet alone regained significantly more weight after maximum weight loss had been achieved, so that the gastroplasty group had a more favorable net outcome at two years (P less than 0.05).

Blood flow through human adipose tissue during lipolysis

Nielsen, S. L., Bitsch, V., Larsen, O. A., Lassen, N. A. & Quaade, F. Blood flow through human adipose tissue during lipolysis. Scand. J. clin. Lab. Invest. 22, 124-130, 1968. The influence of lipolysis on the adipose tissue blood flow measured with the 133Xe clearance technique has been examined. In seven subjects norepinephrine was infused intravenously during 30-40 minutes in a dose of 5-10 μg/min. The adipose tissue blood flow (FBF) increased in all patients, from an average of 1.7 ml/100 mg·min before to a maximum average value of 4.5 ml/100 g·min during the infusion. In eleven subjects 5 mg glucagon was injected intravenously during the measurement. In nine of these cases an increase in flow was seen: the average value for the whole group was 2.3 ml/100 g·min before and 3.4 ml/100 g·min after the glucagon injection. Four very obese females were treated with total fasting for 96 hours. In this period the patients had an average weight loss of 6.3 kg and the average prefasting and fasting FBF values w...

Liver Morphology and Biochemistry in Eight Obese Patients Treated with Jejunoileal Anastomosis

Abstract Ten patients were treated for obesity with jejunoileal shunt operation. Liver biopsies were performed in seven both during and 10 to 27 months after operation. The degree of fatty infiltration showed no distinct trend. Steatosis increased in three, decreased in three and remained unchanged in one. Two liver specimens were entirely normal at follow-up examination. Serum aspartate transaminase and sulfobromophthalein retention tests showed a transient deterioration after surgery, but later improved as compared with preoperative values. Prothrombin values decreased, but remained within normal limits. All other liver-function tests were unchanged. The present investigation does not support the contention that jejunoileal shunt for obesity should be abandoned for fear of severe liver damage.

Blind-Loop Reflux in Relation to Weight Loss in Obese Patients Treated with Jejunoileal Anastomosis

In 10 patients operated on with jejunoileal anastomosis for obesity, rate and degree of weight loss showed no significant correlation to the following roentgenological parameters: gastric emptying time, small bowel transit time, and degree and duration of reflux to the excluded ileum. A predominant feature in all patients was a slowness of gastrointestinal passage. The absolute size of the weight loss was approximately the same in all patients irrespective of their initial weight. This means that the most obese patients (150 kg and more) stabilized their weight at a too high level. It is concluded that a more effective treatment of patients with extreme obesity should consist in shortening the intestine left in function, and not in an extended surgical procedure aiming at avoiding reflux into the blind loop.

Effect of jejunoileostomy on glucose and insulin metabolism in ten obese patients

Abstract Ten subjects underwent a jejunoileostomy in the treatment of obesity. The blood glucose and serum immunoreactive insulin response to oral and intravenous glucose was determined ten days before, and with varying intervals up to 18 months after the operation. The reduced intestinal glucose absorption was compensatorily improved without reaching the preoperative capacity. Fasting blood sugar levels tended to be low for a long time after the operation but rose later on. The intestinal insulinotropic action remained preserved. A generally improved glucose tolerance and normalization of hyperinsulinism was correlated to weight reduction. We conclude that none of the reported effects of jejunoileostomy on glucose and insulin metabolism contraindicate this surgical treatment of obesity.

Fatal outcome after jejunoileal bypass for obesity

A review of all literature on jejunoileal bypass for obesity disclosed 282 deaths, corresponding to a mortality rate of 4.2 percent. This rate has been fairly constant through the last 8 years. The causes of death and the postoperative duration are quantified. Pulmonary embolism, mostly early, and liver disease, sometimes late, dominate among the numerous causes of death. Details are too scarcely reported to allow guidance to better results.