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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This report cites the usefulness of fiberoptic scope-guided endotracheal tube intubation through a classical laryngeal mask airway (LMA) during spontaneous breathing. Treacher Collins Syndrome (TCS) is a condition where airway management is stressful to anesthesiologists. We report a pediatric patient with TCS undergoing cleft palate repair. The patient had a history of sleep apnea syndrome, chronic lung disease, and congenital heart disease. Intubation by rigid laryngoscopy was unsuccessful at the first attempt. One month later, under spontaneous ventilation, tracheal intubation was smoothly performed with the use of a fiberoptic scope through an LMA under intravenous anesthesia with propofol. Fiberoptic scope-guided endotracheal intubation through an LMA with the push of another ETT of the same size to curb the back slippage of the endotracheal tube already inserted in the trachea can be easily and safely performed under spontaneous breathing in a pediatric patient with TCS.
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PMID:Fiberoptic tracheal intubation through a classicial laryngeal mask airway under spontaneous ventilation in a child with Treacher Collins syndrome. 1723 67

Attendees of 15 health centers in urban and rural areas in the Riyadh region were screened for obesity during May and June 1994. Systemic selection yielded 1580 Saudi males for analysis. The mean age was 33.6 +/- 13.5 years and body mass index (BMI) was 26.9 +/- 5.7 kg/m(2). Only 36.6% of subjects were their ideal weight (BMI < 25 kg/m(2)), while 34.8% were overweight (BMI 25-29.9 kg/m(2)), 26.9% were moderately obese (BMI 30-40 kg/m(2)) and 1.7% were morbidly obese (BMI > 40 kg/m(2)). Middle age, lower education and joblessness predicted a higher risk for obesity. Patients living in a rural areas had greater BMIs than those living in urban areas (P <0.01). Forty percent of overweight participants did not think they were so. The high prevalence of obesity and the lack of awareness among those afflicted emphasizes the need for community-based programs for preventing and reducing obesity, since weight control is effective in ameliorating most of the disorders associated with obesity, such as Type II non-insulin-depedent diabetis mellitus, hypertension, stroke, heart disease, sleep apnea syndrome and osteoarthritis of the knees. Young parents who are at risk of developing obesity and who play a central role in perpetuating it in their offspring should be the target of obesity-prevention programs.
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PMID:The prevalence of obesity among saudi males in the Riyadh region. 1737 33

Hypercapnic cerebrovascular reactivity is decreased in obstructive sleep apnoea and congestive heart disease perhaps as a result of repeated apnoeas. To test the hypothesis that repeated apnoeas blunt cerebrovascular reactivity to hypercapnia, we studied breath hold divers and determined cerebrovascular reactivity by measuring changes in middle cerebral artery velocity (MCAV, cm s(-1)) per mmHg change in end-tidal partial pressure of CO2(PET,CO2 ) in response to two hyperoxic hypercapnia rebreathing manoeuvres (modified Read protocol) in elite breath-hold divers (BHD, n=7) and non-divers (ND, n=7). In addition, ventilation and central (beat-to-beat stroke volume measurement with Modelflow technique) haemodynamics were determined. Ventilatory responses to hypercapnia were blunted in BHD versus ND largely due to lower breathing frequency. Cerebrovascular reactivity did not differ between groups (3.7 +/- 1.4 versus 3.4 +/- 1.3% mmHg(-1) in BHD and ND, respectively; P=0.90) and the same was found for cerebral vascular resistance and MCAV recovery to baseline after termination of the CO2 challenge. Cardiovascular parameters were not changed significantly during rebreathing in either group, except for a small increase in mean arterial pressure for both groups. Our findings indicate that the regulation of the cerebral circulation in response to hypercapnia is intact in elite breath-hold divers, potentially as a protective mechanism against the chronic intermittent cerebral hypoxia and/or hypercapnia that occurs during breath-hold diving. These data also suggest that factors other than repeated apnoeas contribute to the blunting of cerebrovascular reactivity in conditions like sleep apnoea.
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PMID:Cerebrovascular reactivity to hypercapnia is unimpaired in breath-hold divers. 1741 71

Abdominal -- and not peripheral -- obesity induces insulin resistance. Morbid obesity is not always accompanied by either diabetes mellitus or metabolic syndrome. Development of morbid obesity can require appropriate insulin secretion and recruitment of small insulin-sensitive adipocytes, able to store fatty acids. These fatty acids are therefore not stored in ectopic sites (muscle, liver, islets of Langerhans), and neither insulin resistance nor glucolipid toxicity develops and causes insulin deficiency. This explains the relative rarity of diabetes in morbid obesity. Patients with morbid obesity are at greater risk of developing mechanical complications (e.g. cardiac, pulmonary, or locomotor system, or sleep apnea) than metabolic complications or cardiovascular heart disease.
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PMID:[Obesity, immune resistance and metabolic complications: what morbid obesity can teach the doctor]. 1745 53

While much is known about the negative health implications of insufficient sleep, relatively little is known about risks associated with excessive sleep. However, epidemiological studies have repeatedly found a mortality risk associated with reported habitual long sleep. This paper will summarize and describe the numerous studies demonstrating increased mortality risk associated with long sleep. Although these studies establish a mortality link, they do not sufficiently explain why such a relationship might occur. Possible mechanisms for this relationship will be proposed and described, including (1) sleep fragmentation, (2) fatigue, (3) immune function, (4) photoperiodic abnormalities, (5) lack of challenge, (6) depression, or (7) underlying disease process such as (a) sleep apnea, (b) heart disease, or (c) failing health. Following this, we will take a step back and carefully consider all of the historical and current literature regarding long sleep, to determine whether the scientific evidence supports these proposed mechanisms and ascertain what future research directions may clarify or test these hypotheses regarding the relationship between long sleep and mortality.
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PMID:Who are the long sleepers? Towards an understanding of the mortality relationship. 1762 32

The health consequences of obesity include increased risk of heart disease, hypertension, diabetes, sleep apnea, cancer, osteoarthritis, and mental health problems. Postmenopausal women have reached an age when the incidence of chronic health conditions becomes more prevalent. In addition to physical disease risks, a lifetime of ridicule and disrespect may seriously and adversely affect general and health-related quality of life. Thus, obese postmenopausal women stand at a crossroads between living the remainder of their lives in essentially good health or facing the likely onset of chronic diseases that might have been prevented. This article reviews the effects of obesity that have particular relevance for postmenopausal women.
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PMID:Postmenopausal women and the health consequences of obesity. 1788 Mar 24

The incidence of obesity worldwide has increased markedly in the past 2 decades, with estimates of increases of 50% in the United States alone. Research indicates that weight loss produced by diet alone is not sustained and that 75% of dieters regain most of the weight lost within 1 year and 90% within 2 years. Morbid obesity is associated with comorbid conditions, including heart disease, hypertension, diabetes, mechanical arthropathy, sleep apnea, and numerous other serious disorders and a shortened life expectancy. Because of limited success with medical management, surgical treatment of morbid obesity has been used increasingly, especially with the development of laparoscopic procedures, including Roux-en-Y gastric bypass (RYGB). RYGB is associated with low surgical mortality, marked decreased food intake, and significant, sustained weight loss. However, in this emerging, unique population there is growing appreciation that these procedures may be associated with the development of bone loss and skeletal fragility because of altered nutrient metabolism. Despite the threat of skeletal fragility and fracture, there is limited data addressing the effects of bariatric surgery on bone metabolism and bone loss.
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PMID:Bone loss. An emerging problem following obesity surgery. 1792 86

A growing body of epidemiologic, experimental, and therapeutic data supports an association between sleep disordered breathing and cardiovascular morbidity and mortality. Pathophysiologic mechanisms including sympathetic activation, oxidative stress, systemic inflammation, hyperleptinemia, insulin resistance, lipidic peroxydation, may influence the development and progression of hypertension, ischemic cardiopathy, cardiac rythm disturbances, cardiac failure, renal failure and stroke. Treatment of apneas is associated with a decrease in new cardiovascular events. These results support the importance of recognising, treating, and if possible preventing OSA.
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PMID:[Cardiovascular consequences of sleep apnea]. 1804 2

Phenolic compounds are widely present in the plant kingdom. Many epidemiological studies have indicated that consumption of some plant-derived foodstuffs with high phenolic content is associated with the prevention of some diseases and that these compounds may have similar properties to antioxidants, antimutagenic agents, antithrombotic agents, anti-inflammatory agents, anti-HIV-1, and anticancer agents. However, obesity is an important topic in the world of public health and preventive medicine. Relationships between body mass index, waist circumference, or waist-to-hip ratio and the risk of development of some diseases (such as heart disease, dyslipidemia, hypertension, non-alcoholic fatty liver disease, diabetes, kidney failure, cancer, stroke, osteoarthritis, and sleep apnea) have been observed. Evidence that phenolic compounds have beneficial effects in fighting obesity is increasingly being reported in the scientific literature. These in vitro and in vivo effects of phenolic compounds on the induction of pre-adipocytic and adipocytic apoptosis and inhibition of adipocytic lipid accumulation are considered in detail here. This review presents evidence of their inhibitory effects on obesity and their underlying molecular signaling mechanisms.
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PMID:Phenolic compounds: evidence for inhibitory effects against obesity and their underlying molecular signaling mechanisms. 1808 Dec 7

One of the most common yet unidentified conditions in heart disease is sleep-disordered breathing (SDB). Although it is most prevalent in patients with heart failure, it has been epidemiologically and pathophysiologically linked to ischemic heart disease, hypertension, sudden cardiac death, atrial fibrillation, and stroke. There are two primary SDB syndromes: obstructive sleep apnea (OSA) and central sleep apnea (CSA; also known as Cheyne-Stokes respiration). The pathophysiologic mechanisms that underlie these disorders appear to be distinct but both involve recurrent cycles of excessive sympathetic activation, hypoxemias and hypercapnias, and increases in ventricular wall stress. Signs and symptoms may include daytime somnolence, snoring, difficult-to-control hypertension, and refractory arrhythmias or angina. In heart failure, half of patients will have SDB and most patients will exhibit evidence of both OSA and CSA, although one or the other may predominate. The current standard diagnostic method is overnight laboratory polysomnography. Primary therapies for OSA include lifestyle changes, various facial and oral appliances, head and neck surgery, and continuous positive airway pressure (CPAP). CPAP is the most effective form of therapy for OSA, with few side effects, but is limited by compliance because of comfort-related issues. In patients with cardiovascular disease who predominantly suffer from OSA, treatment recommendations should be based on current guidelines for OSA. For patients with heart failure with predominant CSA, the current cornerstone of therapy is the optimization of medical therapy and resynchronization therapy when indicated. When SDB persists despite optimal medical management, referral to a sleep medicine consultant should be considered.
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PMID:Diagnosis and treatment of sleep apnea in heart disease. 1822 2


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