Weight loss seems associated with a decrease in bone mineral density (BMD) as measured by absorptiometry, which may be the result of accuracy errors caused by differences in soft tissue between non-bone and bone pixels. The aim was to study the abdominal fat% and thickness in regions corresponding to non-bone, soft tissue-only and bone pixels for spinal BMD measurements by dual energy X-ray absorptiometry (DXA), and to calculate the theoretical errors in measurement of changes in BMD by DXA as a result of changes in soft tissue heterogeneity with weight loss. Abdominal computed tomography (CT) and DXA scans were performed in 34 obese subjects (42.1+/-10.1 years (mean +/- SD), wt: 102.1+/-12.8 kg and BMI: 36.6+/-3.8 kg m(-2)) before and after weight loss (11.3+/-6.9 kg after 1 year). There were some significant differences in fat% and thickness of soft tissue between abdominal regions corresponding to non-bone and bone pixels, respectively, for spinal BMD measurements by DXA, both before and after weight loss. With weight loss there were some changes in the soft tissue heterogeneity, which caused a minor theoretical error (apparent, but false decrease of 1-2%) of borderline significance for the anterior-posterior (AP) spinal BMD by DXA.

OBJECTIVE: To investigate whether total body fat mass or fat distribution and associated metabolic disturbances in glucose and lipid metabolism influence the well known gallstone pathogenetic factors in obese subjects in order to explain why some obese subjects develop gallstones and some do not. DESIGN: Cross sectional study of gallstone pathogenetic factors, body composition, fat distribution, glucose and lipid metabolism. SUBJECTS: 57 healthy overweight subjects (aged 26–64 y, body mass index (BMI) 30–45 kg/m 2 ). MEASUREMENTS: Total and intra-abdominal fat masses were measured by dual X-ray absorptiometry and abdominal CT scanning, respectively. The lithogenic index was measured in aspirated bile. The gallbladder volume was determined by ultrasound and the gallbladder ejection fraction% by dynamic cholescintigraphy. Plasma cholecystokinin (CCK) concentrations during a meal were measured with a specific radioimmunoassay. Insulin sensitivity was measured by the Minimal Model and glucose tolerance by an oral glucose tolerance test (OGTT). Serum lipid concentrations were measured by standard methods. RESULTS: The gallbladder volume in the fasting state increased with increasing intra-abdominal fat mass ( P =0.006) and was increased in subjects with impaired glucose tolerance (41 vs 27 ml, P =0.001). The lithogenic index was >1 in all subjects and correlated with total fat mass ( P =0.04). CONCLUSION: Gallstone pathogenesis in obesity seems to be influenced by the total body fat mass and its regional distribution possibly via mutual association with the glucose tolerance.

Tissues and interstitial compartments of cod Gadus morhua embryos which were infected by an endoparasite in the yolk were investigated by transmission electron microscopy. Small enigmatic organisms, presumed to be of parasitic nature, were observed in the embryonic cells and tissues. The organisms lacked a cell wall. In addition to intermediate stages, at least 3 distinct stages of the organism were observed. The organisms were located both extra-and intracellularly, in the latter case often surrounded by vacuoles. The stages of the organism differed in their chromatin configurations. One stage contained groups of finely and coarsely flocculated chromatin without a nucleolemma. Juxtapositioned chromatin groups were separated by annulate lamellae. Another stage had one or more nucleus-like elements, each surrounded by a dilated cisterna with a few pores. The cisternae of such adjoining elements formed annulate lamellae, which could break to form a common vacuole. Vacuoles might then fuse with the outer membrane of the organism thereby freeing the nucleus-like elements as daughter elements. Such daughter elements were observed extra-and intracellularly in embryonic cod. The third stage contained several nucleated daughter cells, and lacked annulate lamellae. The identity of the organism is unknown.

Rates of growth, protein synthesis and oxygen consumption were measured in herring larvae, Clupea harengus, in order to estimate the contribution that protein synthesis makes to oxygen consumption during rapid growth at 8°C. Protein synthesis rates were determined in larvae 9 to 17 d after hatching. Larvae were bathed in 3H phenylalanine for several hours and the free pool and protein-bound phenylalanine specific radioactivities were determined.

A protistan endoparasite has recently been discovered in the yolk of embryos and yolksac larvae of cod Gadus morhua and turbot Scophthalmusmaximus.Eight batches of cod embryos were studied, and all batches were infected with minimum prevalences ranging from 14 to 88 %.The endoparasite seemed to be transmitted to the cod embryos via the fish gametes, and the infection occurred in cod from all the major seas surrounding Denmark.Infected cod embryos and yolk-sac larvae have a higher mortality rate than uninfected ones.Several stages of the parasite were identified.The smaller stages of the cod endoparasite invaded the larval tissues and bloodstream.The large, multinucleated stages of the parasite can multiply by budding off small parasites.Other features are associated with endoparasitic infection, i.e. thin-walled and thick-walled spherical structures were observed in the yolk.The thin-walled structures ejected multiple parasite-like bodies of varying sizes into the yolk.The thick-walled, highly refractile hollow spheres in the yolk were of protistan origin.Light microscopy of the turbot endoparasite has previously indicated a strong resemblance with the cod endoparasite.Present transmission electron microscopy reveals that the turbot and cod endoparasites are identical or very closely related.

Following yolk resorption, laboratory-reared larval Baltic herring (Clupea harengus L.) were exposed to two sequences of food restriction for 5 d and re-alimentation for 10 d. Comparisons regarding larval growth (standard length and content of water-soluble protein), mortality and content of the sum of trypsin and trypsinogen were made with larvae at a continuous high ration. Larvae exposed to varying prey abundance grew less in length than the control, and during the second high-ration period (Day 22 to 32) growth in length ceased. From the first low-ration period onwards, the content of water-soluble protein in these larvae was lower than that of the control larvae, and the survival rate of the low-high ration group was 59% compared to 77% in the larvae at a continuous high ration. In contrast, the effects of varying food availability were minor on larval content of trypsin and trypsinogen. Results are compared with previous findings in larval Clyde herring, and the effects of larval stock and timing and duration of food restriction on larval growth performance are discussed.

A protistan endoparasite was discovered in the yolk of embryos and larvae of cod Gadus morhua L. from the Baltic. The prevalence of infestation ranged from 0 to 30 %. Two stages of the parasite were identified under transmission electron microscopy. One stage was apparently mononucleated; the other stage was multinucleated and seemed to be breaking-up into numerous, mononucleated organisms. The endoparasite is compared with the single example in the literature of infestations in the yolk of marine fish larvae - caused by the dinoflagellate Ichthyodinium chabelardi - and the consequences for larval health are briefly discussed.

An organism which under light microscopy is indistinguishable from a protistan endoparasite found in larval cod Gadus morhua was discovered in turbot Scophthalmus maximus embryos and yolk-sac larvae. The organism exhibits a predilection for the same sites as the cod parasite and is probably lethal for the fish larvae.

In order to assess possible effects of a transitory, low food supply on later development, three groups of Clyde herring larvae (Clupea harengus L.) were exposed in 1989 to different feeding regimes immediately after yolk resorption. Group 1 received a high daily ration of 80 copepods larvae−1 for 31 d, Group 2 a low daily ration of 15 copepods larva−1 for 10 d followed by a high ration (80 copepods larva−1) for 21 d and Group 3 a low ration of 15 to 20 copepods larva−1 for 31 d. After 31 d of feeding, digestive capacity, expressed as the sum of trypsin and trypsinogen, was markedly reduced in Group 2 compared to Group 1, while Group 3 had an even lower digestive capacity. After the switch from low to high ration Group 2 exhibited compensatory growth and caught up with Group 1 both in standard length and content of soluble protein. Group 3 had the lowest growth rates. Mortality was equal in Groups 1 and 2, while Group 3 showed an excess mortality of 40% of the start population. Although Group 2 larvae had caught up with Group 1 in growth at the end of the study, content of trypsin and trypsinogen in Group 2 was only half of that found in Group 1. Thus, comparing effects of a short period of food limitation on future growth, mortality and content of digestive enzymes, the study indicates content of trypsin and trypsinogen to be the most sensitive variable for detection of food limitation in the early stages of exogenous feeding.

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.

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.

In a prospective, blinded study we investigated 30 patients with Crohn's disease (CD) and 27 normal controls by means of dynamic grey-scale ultrasound scan. Within a few weeks the patients were also examined by radiography of the small bowel. Of the 30 patients, 21 had CD lesion of the small bowel as judged by radiography. A target lesion at the ultrasound scan indicating thickened bowel wall was seen in 15 CD patients, of which 14 showed radiographic signs of CD in the ileum and/or right side of the large bowel, whereas one had normal radiographic findings. Seven patients out of 15 without sonographic changes had radiographic signs of CD. The patients with discrepancy between the two examinations could not be clinically characterized as an entity. None of the 27 normal controls showed signs of intestinal disease at the ultrasound examination. We conclude that dynamic grey-scale ultrasound examination is a new tool in depicting the CD lesion, but it does not seem to be able to replace the radiographic examination. However, it may find a place in the follow-up study of patients with known CD, thereby avoiding repeated radiographic examinations. Furthermore, the possibility of diagnosing abscesses and fistulae by sonography is well known and has relevance in CD.

Bile acid metabolism was studied by means of the fractional turnover rate or orally ingested 14C-labeled taurocholic acid and by gas chromatographic determination of fecal excretion of the bile acids cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA), and lithocholic acid (LCA). Thirty patients with Crohn's disease (CD) of the small bowel, of whom 19 had been operated on with limited ileal resections, were studied and compared with 11 healthy volunteers. The unoperated group of CD patients did not show significant increase in bile acid excretion in the stools in contrast to the CD patients with ileal resection. The fecal excretion consisted mostly of primary bile acids, and a significant correlation between length of resection and bile acid excretion was found (rs = 0.81, p less than 0.01). The fractional turnover rate of CA + DCA was significantly increased in both unoperated (0.21 l/day) and operated (0.44 l/day) patients compared with normal controls (0.06 l/day). The bile acid pool of CA + DCA, however, was normal in patients with ileal resections, indicating a compensatory increase in bile acid synthesis. In unoperated patients the bile acid pool of CA + DCA was slightly decreased (3.1 mmol) compared with operated patients (6.2 mmol) and normal controls (4.8 mmol). The pool size was not significantly correlated to mean transit time of dietary residue, feces excretion, loss of weight, or amount of fat in feces. The mean transit time of dietary residue was decreased in both operated and unoperated CD patients.

Biliary metabolism in 11 patients with ileum reservoirs with anal anastomosis and a long efferent leg was studied. Eleven healthy persons served as controls. A significantly higher excretion of bile acids was found in the patients, but they seemed to have a normal cholic acid pool size. The bile acids excreted were cholic acid and chenodeoxycholic acid, the so-called primary bile acids, for more than 90%, whereas the normal controls mainly excreted secondary bile acids (deoxycholic acid and lithocholic acid). Fat excretion was generally not increased in the group but was above normal in two patients. Vitamin B12 absorption was subnormal in two patients and was not correlated to bile acid excretion. Bile acid excretion was not correlated to the weight of feces. The bacterial flora was more feces-like than would have been expected from a normal terminal ileum but was correlated neither to the bile acid excretion nor to the quantity of feces. We conclude that the patients showed dysfunction of the terminal ileum with regard to biliary acid absorption comparable to that found in patients with partial ileal resections.

The dietary habits and defecation patterns of 12 patients were examined 8-34 months after total colectomy with mucosal proctectomy and the construction of an ileal reservoir attached to an anal anastomosis. The reservoir was provided with a long efferent leg (12 cm) through the anal canal. The patients were divided into two groups in accordance with the frequency of defecation--one with fewer than six defecations per 24 h and another with more than six defecations per 24 h. The fecal output, however, was not significantly different in the two groups. The fecal content of sodium and potassium was the same as in feces from conventional ileostomies. The dietary intake was insufficient in energy content, vitamins, minerals, and trace elements. Dietary supplement was recommended.

To obtain information on possible determinants of weight loss after horizontal gastroplasty, pouch emptying was prospectively investigated in 27 morbidly obese patients. A scintigraphic method was used. Examinations were carried out every 6 months until 2 years after surgery. Pouch emptying was described by means of delay, time until half emptying, mean transit time, and emptying rate. The measures all showed a significant (p less than 0.05) acceleration of pouch emptying during the first 6 months after gastroplasty. Thereafter pouch emptying was unaltered. No significant association could be detected between measures of pouch emptying and weight loss. From calculation of 95% confidence intervals for coefficients of correlation it proved very unlikely that pouch emptying is an important determinant of weight loss.

In gastroplasty and gastric bypass procedures for obesity much importance has been attached to obtaining a small fundic pouch combined with a narrow outlet, factors considered to determine weight loss. The present study is a prospective investigation of the influence of these stomach dimensions on the clinical outcome. With a standardized radiological procedure 72 examinations were carried out in 27 patients during the first 18 months after gastroplasty by the method of Gomez. Median pouch volume and stoma diameter were unaltered through the observation period. Early pouch volumes ranged from 51 to 244 ml, and stoma size ranged from 6 to 24 mm after 6 months. Within these limits pouch and stoma size were not significantly correlated to the weight loss obtained. Other factors seem to be of major importance for the weight-reducing effect of gastroplasty.