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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the sensitivity and specificity of standard electrocardiographic criteria for left ventricular (LV) and right ventricular (RV) hypertrophy in morbid obesity, resting electrocardiograms and M-mode echocardiograms were obtained in 65 patients whose actual body weight was more than twice their ideal body weight and who were free from hypertension and organic heart disease not directly attributable to obesity. Electrocardiographic criteria for LV hypertrophy were tested using increased LV wall thickness, LV enlargement and increased LV mass (all determined echocardiographically) as diagnostic standards. Electrocardiographic criteria for RV hypertrophy were tested using echocardiographic RV enlargement or RV hypertrophy as a diagnostic standard. Sensitivity values for the electrocardiographic criteria for LV hypertrophy ranged from 0 to 13%, 0 to 20% and 0 to 12% using echocardiographic increased LV wall thickness, LV enlargement and increased LV mass, respectively, as diagnostic standards. Specificity values ranged from 73 to 100%, 87 to 100% and 83 to 100%, respectively, using these diagnostic standards. Sensitivity values for the electrocardiographic criteria for RV hypertrophy ranged from 0 to 16% and specificity values ranged from 95 to 100%. Combining electrocardiographic criteria within groups did not appreciably increase sensitivity and often decreased specificity to unacceptably low levels. The electrocardiogram is very limited in its ability to detect ventricular hypertrophy and chamber enlargement in morbidly obese patients.
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PMID:Sensitivity and specificity of electrocardiographic criteria for left and right ventricular hypertrophy in morbid obesity. 296 39

New surgical procedures have revolutionized the treatment of morbid obesity (more than 100% overweight), a condition associated with serious medical complications and for which conservative treatment has been largely ineffective. These procedures, which are surprisingly safe, produce large weight losses and marked improvement in hypertension, diabetes, and other disorders influenced by obesity. Striking changes also occur in vocational and psychosocial functioning, including marital and sexual relations, in eating behavior, in food preferences, and in body image. The emotional state of patients during weight loss following surgery is far superior to that during attempts at weight reduction by other methods. The surgical procedures appear to produce a major biological change, perhaps lowering a body weight set point.
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PMID:Psychological and social aspects of the surgical treatment of obesity. 351 32

There has been only one previous report on pregnancies following gastric bypass for the treatment of morbid obesity. In this study 57 such pregnancies were compared to a group of control pregnancies occurring in morbidly obese women before their bypass surgery. There was a significantly lower incidence of hypertension and large-for-gestational-age infants in the postoperative pregnancies. There was no significant difference in a number of other pregnancy complications studied.
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PMID:Pregnancy after gastric bypass for morbid obesity. 357 96

A silicone collar containing circumferential tape was tied around the cardio-esophageal junction in eight patients with symptomatic, refractory reflux, who were not good candidates for a standard antireflux procedure. A fine polypropylene tie or clip secured the knot. In two patients with large hiatal defects, the crura were approximated loosely. Mean operating time, including one cholecystectomy and one ventral hernia repair, was 51 minutes. Patients who underwent this simple operation had a combination of hypertension, heart disease, obesity and old age, and two had undergone horizontal gastroplasty previously for morbid obesity. The reflux was associated with hiatal hernia in seven of the eight patients. Preoperative studies included barium swallow roentgenography in all eight patients, and endoscopy, manometry and Bernstein test in six. All the studies were repeated postoperatively. Follow-up ranged from 17 to 48 months (mean 37.8 +/- 10.6 months). Postoperatively, there was a significant (p less than 0.01) improvement in symptoms, endoscopic findings and lower esophageal sphincter pressures. No prosthesis has migrated yet.
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PMID:The Angelchik antireflux prosthesis. 397 Dec 43

Although often coexisting in the same patient, obesity and essential hypertension exert disparate cardiovascular effects. An excess of adipose tissue augments cardiac output, stroke volume, and left ventricular filling pressure, expands intravascular volume, and lowers total peripheral resistance. In contrast, essential hypertension in a non-obese patient is associated with a contracted intravascular volume, high total peripheral resistance, and normal cardiac output, but increased left ventricular stroke work due to high afterload. Left ventricular adaptation will consist of eccentric hypertrophy in the obese (irrespective of arterial pressure) and concentric hypertrophy in the non-obese hypertension patient. The combination of obesity and hypertension burdens the heart with high preload and high afterload, thereby greatly enhancing the risk of congestive heart failure. Peripheral resistance and intravascular volume may be normal in mildly hypertension obese patients because of the mutually antagonising effects of the increase in arterial pressure and the increase in body weight. The fall in arterial pressure associated with weight loss seems to be caused by a decrease in adrenergic activity which leads to a fall in cardiac output without change in vascular resistance. Obesity hypertension may be the result of an inappropriately raised cardiac output in the presence of a relatively restricted arterial capacity due to the low vascularity of adipose tissue. In morbid obesity increased blood viscosity may contribute to the raised arterial pressure.
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PMID:Cardiovascular effects of obesity and hypertension. 612 45

A report is presented on gastric bypass (n = 27) and gastroplasty (n = 2) in patients with morbid obesity. One patient died postoperatively (mortality 3.4%). Mean weight prior to operation was 129 kg (96 to 205 kg), i.e. 117% (63 to 253%) in excess of the ideal weight. During a follow-up period of 6 to 46 months, the mean loss of weight amounted to 38 kg (3 to 77 kg). 86% of the patients judged their condition as being very good to good. Diseases related to obesity were reduced to a remarkable degree: hypertension from 43 to 5%, hypertriglyceridaemia from 50 to 5% and diabetes mellitus from 52 to 13%. Two patients had to be reoperated on due to a peptic jejunal ulcer, five because of an incisional hernia. No patient suffered from diarrhoea, calculi of the biliary or urinary tract or electrolyte disorders. On the basis of these results gastric bypass would appear to be indicated for the treatment of obesity not amenable to conventional therapy.
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PMID:[Indications and results of gastric bypass in the treatment of extreme obesity]. 674 Nov 46

Severe obesity affects the health and quality of life of 4 million Americans. The major cost of treating severe obesity and its associated comorbidities of hypertension, diabetes, cardiovascular disease, pulmonary insufficiency, cancer, and degenerative arthritis as well as the poor long-term results of medical, drug, and behavioral therapy has increased the numbers of patients being referred for surgical treatment. Gastric bypass and vertical banded gastroplasty are the two procedures recommended for severely obese patients. These operations currently have low morbidity and mortality. Surgery should be considered adjuvant therapy and must be part of a multidisciplinary approach. The significant long-term weight control resulting from the surgical therapy is associated with improvement and, often, resolution of comorbidities, including diabetes, hypertension, hyperlipidemia, and pulmonary insufficiency.
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PMID:The role of gastric surgery in the multidisciplinary management of severe obesity. 787 45

When overweight surpasses 100% of the ideal weight, morbid obesity, the obese patients is condemned to a complete inability to work, social and sexual inability, and shall suffer from an increase in its morbidity and mortality. This depends to a large degree on the additions to the obesity of insulin resistance, carbohydrates intolerance, hypertriglyceridemia, hypercholesterolemia, and arterial hypertension, all of which is enveloped in a atmosphere of neuroendocrine alterations. An efficient method of treating this syndrome is weigh loss. Medical treatments have not achieved prolonged weight losses during long periods in morbid obese patients, which is a reason for surgery to try and propose new lines of treatment for these patients. The purpose of our study is to examine the effect of weight loss in 100 patients treated with vertical gastroplasty, on the metabolic disorders (triglycerides, cholesterol, glucose) and the arterial hypertension, which are considered to be risk factors in the mortality associated with morbid obesity. Our results indicate that the weight loss modified the metabolic conditions of the patients, with there being a decrease of the levels of triglycerides, cholesterol, glucose, and arterial pressure, after 6 to 12 months after the weigh loss.
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PMID:[Endocrine metabolic and arterial pressure changes in morbidly obese patients treated with vertical gastroplasty]. 869 9

Failure of conservative treatment of obesity stimulated the development of bariatric surgery. The authors performed in 1988-1995 GB in 248 obese patients with a mean overweight of 48.2 kg and with serious comorbidity. The mortality in the group was 1.6%, the morbidity 12.5%. Within 12 months after operation the overweight of the patients declined by 70%, within 24 months by 57%. In the majority of patients the comorbidity receded, the blood sugar level reached normal levels, dyspnoea and hypertension improved as well as the psychic state and social position. The attained results confirm that this treatment of morbid obesity is justified and the authors recommend its wider use. Perspectively laparoscopic gastric banding is associated with a reduced mortality and morbidity, however it is also associated with higher costs.
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PMID:[Gastric banding in the treatment of obesity]. 876 6

A total of 325 patients, aged 80 to 92 (mean 82), underwent cardiac operations with cardiopulmonary bypass over a 4-year period (1991-1995). Hypothermia (22 degrees C) and hyperkalemic cardioplegia were used in each. Coronary bypass procedures only (Group I) were performed in 255 patients with 22 early deaths (8.6%), and the average number of grafts was 3.7 per patient. Single or double valve replacement, with coronary bypass (Group II) was performed in 46 patients, with six early deaths (13%). Single or double valve replacement, without coronary bypass (Group III) was performed in 24 patients, with two early deaths (8.3%). Total hospital mortality was 30 deaths in 325 patients (9.2%). Fifty-six procedures (22%) from Group I and four (9%) from Group II were performed as emergencies, and all operations in Group III were elective. Seventy-two patients (27%) from Group I, 18 patients (39%) from Group II, and nine patients (37%) from Group III had major complications including renal failure, cerebrovascular accident, myocardial infarction, postoperative hemorrhage, sepsis, and ventilatory dependency. Mean hospital stay was 10.5 days for Group I, 13.3 days for Group II, and 15.2 days for Group III, with an overall mean of 13 days (range, 6-52) days. Higher mortality was related to a cardiac index <1.8, cardiogenic shock, emergency operation, creatinine >2.0, and morbid obesity. Mean left ventricular ejection fractions were 0.51 for Group I, 0.45 for Group II, and 0.49 for Group III. Preoperative risk factors associated with a higher mortality included hypertension, smoking, diabetes, and pulmonary hypertension. Two hundred seventy-two of the 299 operative survivors were followed for a mean of 18 (range, 3-52) months. The actuarial survival of octogenarians is 92 per cent, 80 per cent, and 65 per cent at 1, 3, and 5 years, respectively, and of the patients surviving operation it was 85 per cent, 70 per cent, and 55 per cent at 1, 3, and 5 years, respectively. At postoperative follow up, 80 per cent of the survivors reported an active functional status, and there was a low incidence of cardiac-related deaths.
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PMID:Coronary artery bypass and valve replacement in octogenarians. 889 18


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