Es ist festzustellen, dass die Erfolge der bariatrischen Chirurgie und die geringen Komplikationen gerade durch die QualitÄt der laparoskopischen Operationstechnik zu erklÄren sind. Der Zugangsweg scheint in der Gesamtheit der laparoskopischen Eingriffe und ihrer Probleme sicher eine nachgeordnete Bedeutung zu haben, weil sich durch diesen die Komplikationsrate nicht wesentlich ableiten lÄsst. An die Erstplatzierung der Verres-Nadel oder eines Arbeitstrokars ohne vorherige Insufflation ist der Zugangsweg Über den Palmerschen Punkt geknÜpft. Die PrimÄrinsufflation durch Verwendung der Verres-Nadel durch einen erfahrenen bariatrischen Chirurgen scheint angesichts der genannten Komplikationsraten ebenso sicher zu sein wie der Zugangsweg Über einen Optiktrokar, Über den nach unmittelbarer Penetration des Peritoneums das Pneumoperitoneum angelegt werden kann. Letzterer Zugangsweg scheint einen Zeitvorteil zu besitzen, so dass wir uns im Rahmen der bariatrischen Chirurgie fÜr diesen Standard entschieden haben.

Background: Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Ottovon-Guericke University of Magdeburg (Germany) since January 1, 2005. Methods: In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an internet online data registry. Perioperative characteristics such as the spectrum of diagnostic measurements, type of surgical procedures, and short- and long-term outcomes were investigated. Results: During the study period 3,123 surgical procedures were performed. In 2005 and 2006, gastric banding (GB) was the operation performed most frequently, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean BMI ranged from 48.5 kg/m(2) in 2005 to 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients operated in 2005 and 2006. The mortality was 0.1% (30 days) and 0.16% (overall). Conclusion: As indicated by the worldwide trend, there is an ongoing change from GB to sleeve gastrectomy (SG) and malabsorptive procedures. The BMI of German bariatric surgical patients is substantially higher than that of patients from most other countries. There were no differences in overall outcomes during follow-up as compared to published studies.

Since January 1, 2005, the situation of bariatric surgery has been examined in Germany. The data are registered in cooperation with the An-Institute of Quality Assurance in the Surgery Department at the Otto-von-Guericke-University Magdeburg. Materials and Methods: The data registration occurs prospectively in an internet online data bank. All clinics performing bariatric procedures in Germany were asked to submit their data All primary bariatric procedures that have been performed since January 1, 2005 as well as re-operations in patients that have been operated before this time were analyzed. Results: During the first year of the study 629 patients were operated in 21 hospitals. The most frequently performed operation in the first year was gastric banding with 44.1% followed by Roux-en-Y-Gastric Bypass with 43.8%. 74.4% of the patients were female. The mediumBMI of all patients was 48.5 kg/m2. Conclusion: During the first year of the study, there is a trend from restrictive bariatric procedures to the malabsorptive approach. In Germany the BMI of the patients undergoing bariatric surgery is higher than in the most countries worldwide. Form and frequency of intra- and postoperative complications were not different from those described in the literature.

Migration is a rare complication after laparoscopic gastric banding, occurring in 1-3% of cases. Apart from weight gain after initial weight loss, the symptoms are nonspecific and can occur after an average of 15-22 months after initial operation. Band migration is secured by gastroscopy. Treatment involves removal of the band, which can usually be achieved by gastroscopy. In the case of partial migration, severity of symptoms will dictate whether full migration to the stomach can be allowed to continue or whether a further bariatic operation is performed simultaneously. Without a further bariatric operation, continued weight gain is to be expected. If there is no failure of gastric banding, it is possible to do a laparoscopic rebanding procedure. Furthermore, we recommend a Roux-en-Y bypass or a biliopancreatic division.

In situ hybridization (ISH) to detect and to quantitate viral nucleic acid sequences in cryopreserved central nervous system (CNS) tissue is a reliable, valid and sensitive molecular technique. On the other hand, utilization of formaldehyde fixed paraffin embedded (FFPE) tissue to improve cytomorphology requires fundamental changes in the procedure since it is necessary to cleave the elaborate protein network cross-linked by formaldehyde using elevated concentration of proteinases in order to permit diffusion of complementary DNA probes to the targets (genomic viral nucleic acid sequences and/or viral mRNA). Adversely, this procedure hydrolized the proteinaceous glues generally used to fix tissue to glass slides resulting in loss of tissue sections during the ISH protocol. This report describes the application of a novel procedure utilizing a silano-organic compound to covalently bond to glass slides FFPE sections as well as cryopreserved tissue sections and cultured cells with and without virus infections. This covalent bonding procedure has permitted optimization of the ISH procedure for virus detection and quantification, especially for exploratory studies of specificity and wash stringency in relation to the Tm of the hybridized product. Progressive multifocal leucoencephalopathy (PML) caused by an opportunistic papovavirus (JC) was chosen because of the ready availability of tissue, stability of papovavirus nucleic acids, and specificity of3H-and35S-radiolabeled JC cloned DNA probes. Further, this laboratory is utilizing the optimized sensitive procedure to search for several virus etiologies in human diseases such as multiple sclerosis, temporal lobe epilepsy, Alzheimer's disease, schizophrenia, and Parkinson's disease, as well as normal aging. Fanally, the procedure permits study of 100% of thin serial sections; hence, alternate sections can be hybridized with sense and antisense riboprobes to detect viral genome and its mRNA or stained, immunocytochemically, to detect viral proteins. Accordingly, it is anticipated that the mechanism of persistent CNS viral infections will be deciphered, at least in part by advances in cytological molecular hybridization.

Studies various manifestations of parity mixing in nuclei in the hope of discriminating between weak interaction theories. It is difficult to reconcile the observed circular polarization of the photon in the reaction n+p to d+ gamma with any of the theories considered here. On the other hand, the observed asymmetry of the 110 keV photon of 19F with respect to the spin direction of the initial state and the circular polarization of the 396 keV photon of 175Lu are consistent with many of the theories, but rule out those which have a strong Delta T=1 part of the weak Hamiltonian. As an important byproduct of our calculations they present evidence that the effective single-particle potential method of calculating parity mixtures is very good approximation to the more accurate two-nucleon potential method.

We apply a scalar-meson pole model to the parity-violating hyperon decays and to the parity-violating $\mathrm{NN}\ensuremath{\pi}$ vertex. In this model we obtain the usual octet-dominance results for the hyperon decay amplitudes: the $I=\frac{1}{2}$ rule, the Lee-Sugawara triangle, and a vanishing amplitude for $s$-wave ${\ensuremath{\Sigma}}^{+}\ensuremath{\rightarrow}n+{\ensuremath{\pi}}^{+}$ decay. The model is distinguished from the vector-meson pole models by the fact that it gives the current-algebra sum rule for the parity-violating $\mathrm{NN}\ensuremath{\pi}$ amplitude whereas the vector pole model predicts that this amplitude vanishes in the limit of isospin symmetry. Using the SU(3)\ifmmode\times\else\texttimes\fi{}SU(3) $\ensuremath{\sigma}$ model for the currents we compute the amplitudes without arbitrary constants and find that they are about half the observed amplitudes.

We construct a model of parity-violating nonleptonic baryon decays in which the effective Hamiltonian has the $\mathrm{SU}{(6)}_{W}$ transformation properties of the Cabibbo Hamiltonian. This model reproduces the well-known current-algebra results for the $S$-wave hyperon decays and the parity-violating $\mathrm{NN}\ensuremath{\pi}$ and ${N}^{*}N\ensuremath{\pi}$ couplings. With the further assumption of octet dominance we can obtain the parity-violating $\mathrm{NNV}$ amplitudes, where $V$ is a vector meson. We find the important result that the parity-violating $\mathrm{NN}{\ensuremath{\rho}}^{0}$ and $\mathrm{NN}\ensuremath{\omega}$ amplitudes cannot both vanish in the Cabbibo theory, as has heretofore been assumed. The $\mathrm{NNV}$ amplitudes cannot be obtained without additional assumptions. Various assumptions lead to coupling constants which may vary in sign and in magnitude by a factor of 8, but are of the order of magnitude of those obtained by the factorization hypothesis.

Using the hypothesis of pion-pole dominance of the divergence of the weak parity-noncon-serving $\mathrm{NN}\ensuremath{\rho}$ amplitude we express the axial-vector form factor for the amplitude in terms of the amplitude for the parity-nonconserving transition $\ensuremath{\rho}\ensuremath{\rightarrow}\ensuremath{\pi}$. This result enables us to fix one of the unknown parameters in our previous calculation of the $\mathrm{NN}\ensuremath{\rho}$ amplitude using the $\mathrm{SU}{(6)}_{W}$ symmetry properties of the Hamiltonian. Reasonable assumptions for the other parameter suggest that the $\mathrm{NN}\ensuremath{\rho}$ amplitude is about 6 times larger than the factorization value.

The possibility of detecting the ΔS = 0 weak interaction by observing the longitudinal polarisation of the recoil nucleon in πN scattering is considered. It is found that the longitudinal polarisation is in the range 10−6 to 10−7, which seems to be beyond the capabilities of the experimental techniques of the immediate future.