Histamine metabolism in severe obesity before and after jejuno-ileostomy

Surgery for obesity

The medical risks of obesity increase exponentially as weight increases, and these risks are reduced by sustained weight loss. Behavior modification and dieting provide an approximately 6% loss of body weight at 1 year. Fenfluramine provides an approximately 8% weight loss at 1 year, which can be doubled to 16% when a drug such as phentermine, which works through a different biochemical mechanism, is added to it. This amount of weight loss is insufficient for many severely obese individuals. It was with these facts in mind that the National Institutes of Health Consensus Conference in 1992 recommended that obesity surgery is an appropriate treatment for patients with a body mass index greater than 40 kg/m2 who had failed in attempts at medical treatment and for patients with a body mass index greater than 35 kg/m2 with severe complications of obesity. Vertically banded gastroplasty and Roux-en-Y gastric bypass are the two operations presently recommended because of their relative safety and effectiveness. This article reviews previous procedures that have provided insight into the mechanisms by which these surgeries cause weight loss. The presently used surgeries and their results also are reviewed because until medical therapy improves substantially, surgery remains the most reasonable treatment option for most morbidly obese patients.

Influence of decontamination of the digestive tract on the urinary excretion of histamine and some of its metabolites

Urinary excretions of histamine, N tau-methylhistamine and N tau-methylimidazoleacetic acid have been determined for 8 healthy volunteers during 14 consecutive days. Selective decontamination of the digestive tract was performed from day 3 to day 6, followed by total decontamination from day 7 to day 10. Urinary excretions of N tau-methylhistamine and N tau-methylimidazoleacetic acid decreased to a small though significant degree (about 15-20%) after total decontamination, suggesting a histamine production by anaerobic bacteria. Cadaverine decreased for about 70% under both selective and total decontamination, suggesting that this amine in human urine mainly originates from aerobic bacteria in the intestinal tract.

Determination of N tau-methylhistamine in plasma and urine by isotope dilution mass fragmentography

The determination in N tau-methylhistamine by gas chromatography-mass spectrometry is described using bis-heptafluorobutyryl derivatives and deuterium labelled N tau-methylhistamine as internal standard. A description of the synthesis of the internal standard, N tau-trideuteromethylhistamine, is given. Normal concentrations for plasma were 1.4 +/- 0.4 microgram/l (mean +/- 1 S.D., n = 10). The normal values for urine ranged from 60 to 280 microgram/24 h (n = 20). Five asthmatic patients showed above-normal plasma concentrations.