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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We are presenting a series of 23 patients with Cushing disease selected from a larger study in which the ectopic production of ACTH (paraneoplastic or tumoral), adrenal adenoma or carcinoma were discarded. Sixteen were female and seven male. Diagnosis was fundamentally realized by clinical manifestations derived from hypercortisolism (obesity, muscular atrophy, diabetes, osteoporosis or polyglubulia). The polytomography demonstrated a deformed sella in 19 patients. Endocrine exams showed an alteration in rhythm of Cortisol and elevated levels of urinary metabolites. Others exams, Liddle Test, Metopirona Test, or stimulation of exogenic ACTH did not always permit diagnosis of pituitary adenoma. Plasmatic dosage of ACTH is the best test although results did not always agree with clinical manifestations. In each case we performed clinical treatment in preparation for surgery and later selective removal of adenoma or total pituitary ablation by transphenoidal approach. Of 21 patients, we found an adenoma during surgery in 15; the other 6 on whom we performed a total hypophysectomy, the pathological study showed an adenoma in 5 and a hyperemic gland with thick capillaries in 1. Another type of treatment was used on 2 due to their age. Nine patients were given post-operative radiotherapy. We conclude that microsurgery by transphenoidal approach offers the best possibilities for patients with Cushing disease.
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PMID:[Surgical treatment in Cushing's disease (authors' translation)]. 731 90

A reappraisal of endometrial cancer over the past decade reveals: 1) new concepts in its pathologic nature; 2) increase in incidence; 3) acceptance of the theory of hormonal relation; and 4) acceptance of individualization of treatment. Although endometrial carcinoma is still thought of as a predominantly well-differentiated adenocarcinoma, an increase in more virulent tumors has been seen in recent years. These include: adenosquamous carcinoma; adenoacanthoma; mesodermal sarcomas; and adenometous hyperplasia. Women at high risk for these tumors include those suffering from obesity, infertility, failure of ovulation, dysfunctional uterine bleeding, and those on long-term estrogen therapy. These women can be recognized and monitored by means of endometrial biopsy of the aspiration-curettage type. Adenomatous hyperplasia, the precursor of cancer, requires treatment with progestin or hysterectomy according to patient's age and reproductive status. Estrogens should be used only when indications are clear and in the smallest possible dose for the shortest period of time until the therapeutic goal is achieved. Aggressiveness of treatment should correspond to virulence of tumor. Dilatation and curettage under anesthesia should be used for clinical staging of endometrial cancer. Other means of treating endometrial cancers' include: total hysterectomy; bilateral salpingo-oophorectomy; iliac-aortic lymphadenectomy; pelvic irradiation; radical hysterectomy; chemotherapy, and a drug regimen (including cyclophosphamide, doxorubicin, fluorouracil, megestrol acetate).
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PMID:Current concepts in cancer: The changing nature of endometrial cancer. 735 80

Clinical and histopathological investigations were carried out in 71 cases of carcinoma of the corpus uteri treated at the Department of Obstetrics and Gynecology, Tohoku University Hospital over the 10 year period from 1968 through 1977. The ratio of cases of the corpus uteri to those of the cervix was 6.5/100. The average age of the former group was 58 years and 30% of them were nulligravida. The rates of accompanying hyprtension and obesity were 21% and 20%, respectively. With regard to clinical stages, 75% were Stage I, 13% were Stage II, 10% were Stage III and 1% were Stage IV. The histological grade was G1 in 61%, G2 in 26%, and G3 in 13%. In Stage I, 80% of the cases had myometrial invasion into less than 1/3 of the uterine wall, but in Stage II invasion was limited to 1/3 in less than 25%. Metastasis to pelvic lymph nodes was found in 3 of 34 cases (9%): 1 of 24 cases of Stage I (4%) and 2 of 9 (cases of Stage II (22%). All three of these cases had myometrial invasion reaching deeper than 1/3 of the uterine wall. Those with deep myometrial invasion showed a diffuse invasive pattern, as did those of G2 or G3 lesions. Cases of G1 lesions showed a relatively shallow myometrial invasion, whereas there was a tendency for cases of G2 or G3 lesions to have deep myometrial invasion. The over-all 5 year relative survival rate was 83%, while that for the Stage I patients was 98%. All 12 of the patients who died of recurrence of carcinoma of the corpus uteri died within 2 years of treatment.
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PMID:Clinical and histopathological study of carcinoma of the corpus uteri. 740 75

The possible involvement of nerves containing vasoactive intestinal polypeptide in Crohn's disease was investigated by immunocytochemistry and radioimmunoassay of specimens from 17 patients with well-defined clinical and histologic features of the disease. The characteristic pattern of slender fibers, evenly distributed across the gut wall, was seen in specimens taken from controls, which consisted of (a) specimens from uninvolved areas of gut from carcinoma resection (n = 17) and (b) jejunoileal specimens obtained during bypass operation for obesity (n = 8) as well as in four of the six specimens from patients with ulcerative colitis. In contrast, this characteristic pattern was lost in all 17 patients with Crohn's disease, the pattern being replaced by thickened and more intensely immunostained fibers. These changes were consistently found in the mucosa and submucosa, and in 13 of the Crohn's disease cases, the abnormal pattern was totally transmural, involving both the myenteric and submucous plexus as well as the muscle layers. There was a > 200% increase in VIP content, as determined by radioimmunoassay, in Crohn's disease (294 +/- 29 pmol/g wet wt, mean +/- SEM) in comparison with (a) ulcerative colitis (93 +/- 5 pmol/g [P < 0.001]), and (b) controls consisting of carcinoma resection (108 +/- 39) and bypassed gut from obese patients (86 +/- 27 [P < 0.001]). At least part of the previously documented autonomic nerve changes in Crohn's disease are, thus, due to an increase in vasoactive intestinal polypeptide innervation.
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PMID:Abnormalities of vasoactive intestinal polypeptide-containing nerves in Crohn's disease. 741 8

The steadily increasing frequency of breast cancer, especially in elderly women, may be owing to the following three factors, among others: natural aging, the increased use of mammography leading to earlier diagnosis of in-situ carcinoma and occult carcinoma, and the indiscriminate use of hormone replacement therapy (HRT). That there is a correlation of estrogen with breast cancer cannot be refuted. Early menarche, late menopause, late first pregnancy, obesity and dietary factors are directly or indirectly connected with an increased likelihood of breast cancer. The recent flurry of interest in attempting to prevent osteoporosis-induced bony fractures and coronary artery disease among elderly women has not been fully tested as to its efficacy by a scientific, prospectively randomized clinical trial. Therefore, it seems timely to indicate clearly that the use of HRT should be made on an individual basis, with the tacit understanding and approval of the patients, some of whom are symptomatic but the majority of whom have no signs or symptoms of the diseases for which prevention is being advocated.
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PMID:Hormone replacement therapy: boon or bane? 755 58

Carcinoma of the endometrium is the most common gynecologic malignancy. The majority of women present with stage I disease, and the most common presenting symptom is postmenopausal bleeding. Early detection of endometrial cancer is important, because up to 90 percent of patients with stage I disease can be successfully treated. Certain risk factors, such as obesity, hypertension and diabetes mellitus, are associated with the development of this malignancy. Office endometrial sampling has a sensitivity of up to 97 percent for diagnosing carcinoma of the endometrium and can often eliminate the need for dilatation and curettage. Endometrial cancer is treated by total abdominal hysterectomy, bilateral salpingo-oophorectomy and, in many cases, postoperative radiation therapy.
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PMID:Carcinoma of the endometrium. 773 53

Tamoxifen is the anti-estrogen the most widely used in breast cancer. The duration of its prescription, as adjuvant treatment, tends to increase (5 years, and even more) and now it is used in chemoprevention. A slight increase of thromboembolic complications was noted in some studies. This article evaluates the frequency of thromboembolic accidents (TEA) in 441 postmenopausal patients treated by an association of conservative radiosurgery, tamoxifen +/- chemotherapy, for a breast carcinoma T0, T1T2 < 4 cm. Nineteen patients (4.3%), all in remission, presented a TEA, between 1 and 44 months after the beginning of the tamoxifen treatment. We observed seven pulmonary embolisms (PE), 11 deep venous thromboses (DVT) and an acute arterial ischemia. Two patients aged 74 and 80 years died, the others had a favourable evolution under anticoagulant treatment. Among these 19 patients, six presented known risks factors (phlebitis, cardiovascular disorders) and ten had a "favouring circumstance" aggravating the risk of TEA (surgical operation, severe infection, fracture). Their median age was 65 years (61 for all the 441 patients). We noted eight cases of breast lobular cancer (42%) among these 19 patients (11% for all the patients). Among postmenopausal patients, the indication of tamoxifen must be evaluated according to the benefits expected in those with high risk factors of TEA (history of heart failure, obesity, spread varix, age > 65 years). In case of DVT and/or PE, this treatment seems contra-indicated. In case of "favouring circumstances", a hypocoagulant or systematic anticoagulant treatment must be proposed. In case of combined chemotherapy, it is better to start tamoxifen at the end of the treatment. These simple prophylactic measures should allow to reduce significantly the risk of TEA in postmenopausal patients with adjuvant anti-estrogenotherapy.
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PMID:[Thromboembolic accidents in postmenopausal patients with adjuvant treatment by tamoxifen. Frequency, risk factors and prevention possibilities]. 774 16

Obesity has been associated with poor prognosis of breast cancer, but studies investigating indicators of adiposity, independent of height, such as skinfold thickness and weight/height ratio, have been limited. From a cohort of 89,835 women in the National Breast Screening Study, data on histologically confirmed, incident cases of invasive carcinoma of breast, diagnosed between January 1981 to June 1992, were analyzed. Body measurements were taken at enrollment and other risk-factor information from a self-administered questionnaire completed prior to diagnosis of the breast cancer. Mortality data were obtained by linkage to Statistics Canada, provincial cancer registries, and annual follow-up of cases through physicians. Of the 5 measures of body size studied among cases, poor prognosis was associated with higher triceps skinfold thickness only. With every 5 mm increase in skinfold, the risk of dying increased approximately 12% (relative risk, 1.12; 95% confidence intervals, 1.01 to 1.24) in the 1033 cases examined and adjusted for age at diagnosis, number of positive axillary nodes involved, and body weight. Compared with women in the lowest quartile of skinfold thickness, women in the fourth quartile had a relative risk (RR) of 1.64 (95% CI, 0.99 to 2.73). None of the other measures--weight, height, body mass index or weight/height ratio--reached any statistical significance. Since the reliability and validity of skinfold measures used in our study were never established, and no data were available for changes in body size after diagnosis, the results of this study on skinfold thickness should be used only as indicative of a need for further studies.
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PMID:Pre-morbid body size and the prognosis of women with breast cancer. 792 42

A case of endometrial ciliated carcinoma mixed with foci of mucinous adenocarcinoma and argyrophil cells is described. The patient suffered from diabetes mellitus, hypertension and obesity, but had no history of estrogen use. Although the tumor presented well differentiated histologic features, it showed complete diffuse, endophytic extension. Approximately half of the cilia had abnormal inner structures, with 8 + 2 microtubular pattern. Some ciliated cells contained intracytoplasmic mucin, while others contained neurosecretory granules. These findings suggest that malignant ciliated cells have the capacity of further transformation into mucinous or endocrine cells.
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PMID:Ciliated carcinoma of the endometrium associated with mucinous and neuroendocrine differentiation: a case report with immunohistochemical and ultrastructural study. 805 16

A population-based case-control study of risk factors for renal-cell carcinoma was conducted in Denmark from 1989 to 1992. A total of 368 histologically verified cases and 396 controls were included. Information on weight, height, physical activity and reproductive factors were collected in a structured interview, along with information on other suspected risk factors. A significant increase in risk was seen for obese women but not obese men. Although there was no clear gradient, the risk was highest among women with a relative weight in the upper 5% (OR 6.1; 95% CI, 2.3 to 16.1). The increased risk was most evident for high relative weight in ages 30 to 50. No association was observed for height or physical activity. Use of amphetamines was associated with increased risk but, because of the close link with obesity, we were unable to provide evidence that amphetamines are an independent risk factor. We found some evidence for an association with reproductive variables, including decreased risk for women with late menarche and first pregnancy and birth. We observed no association with number of pregnancies or age at menopause, or use of estrogen-containing medication.
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PMID:Risk factors for renal-cell carcinoma in Denmark. III. Role of weight, physical activity and reproductive factors. 826 80


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