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

The authors analyzed the effects of obesity/non-obesity in 162 epidoses of severe metabolic disturbances. Ketoacidosis and hypoglycaemics comas were more frequent in the non-obese group of diabetics, who were often insulin treated; whereas hyperosmolar coma and lactic acidosis were frequent in the obese group of diabetics, usually not treated with insulin. In the obese group both advanced age as well as a higher frequency of degenerative complications impaired the prognosis of these metabolic accidents. However the mortality rate was not significantly different in the two groups of patients. Despite the importance of the weight balance in the natural history of diabetes mellitus, it did not seem to influence the clinical aspects nor did it modify the therapeutic management of the major metabolic disturbances which occur in diabetes.
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PMID:[Major metabolic disturbances occur in diabetic patients whether they are obese or not (author's transl)]. 11 Dec 20

752 diabetic comata (150 non-ketoacidotic and 602 ketoacidotic) from the period between 1931 and 1973 were investigated with regard to type of coma, age, sex, blood sugar, body type, previous therapy, presence of infections and their location and lethality. The blood sugar rose from 521 mg percent in the period from 1931-1940 to 701 mg percent in the period from 1971-73, and age from 33.9 to 53.7 years. Patients without ketoacidosis had higher blood sugar and were older than those with ketoacidosis. Lethality was higher in women than in men. Mortality was higher with obesity (28.8 percent compared to 20.1 percent). 23.9 percent of them were "manifestation" comata of which 43.1 percent died. The lowest lethality was found in the 453 diabetics who had been treated with insulin (14.6 percent). Infections were demonstrable in 431 patients (57.3 percent). Of these, 30.1 percent died, of patients without infections 19.6 percent died. Mortality was 74.6 percent where infections were present in two or more organs.
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PMID:[Diabetic coma. A report of 752 cases between 1931 and 1973]. 80 25

4 cases of thrombosis of the intracranial venous sinuses (TIVS) which occurred in patients 22-38 years of age who used oral contraceptives are discussed. Of the 29 reported cases of this type, 19 of the patients died. There are 3 stages in the evloution of TIVS: headache, hemispheric focus symptoms (e.g., Bravis-Jacksonian crises), and a phase of dramatic aggravation (e.g., severe headache, coma). Arteriography of the carotid artery and cerebral scintigraphy are the methods used to diagnose TIVS. Besides such predisposing factors as diabetes, obesity, migraines, etc., the use of oral contraceptives containing estrogen seem to be a factor in the development of TIVS, particularly within the 1st year of estrogen use. The reduction of cerebral volume seems to be the best treatment for TIVS: anticoagulants and thrombolytic compounds can cause fatal hemorrhaging
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PMID:[Thrombosis of the intracranial venous sinuses after ingestion of estroprogestative agents. 4 cases]. 88 3

The authors report on the monitoring in the Diabetology Service of the Territorial Hospital Center of Papeete (French Polynesia) of 51 Polynesians, diabetics non insulin-dependent over periods of 12 to 30 months (average 26.5 months) from July 1988 to December 1991. 31 males and 20 females (sex-ratio 1.5). Mean age: 55.9 (extremes: 22 and 76 old years). Non insulin-dependent diabetes risk factors: heredity (43%), obesity (67%), new-born babies with a weight more than 4 kg (10%). Revealing factors of diabetes: systematic check-up (37%), clinical complications (36%), cardinal signs (20%). Recorded complications are: 1. microangiopathy: nephropathy (25%) including 7 renal insufficiency and 2 patients under dialysis; retinopathy (29%); 2. macroangiopathy: cardiovascular accident 1 case; angor 4 cases; obliterative arteritis of inferior limbs 5 cases; 3. neuropathy 9 cases (17%); 4. high arterial tension 55%; 5. metabolic complications (20%): 4 acidocetosis; 2 hyperosmolar coma; 4 severe hypoglycemia; 6. 16 diabetic feet (32%) among them 8 amputations; 7. 45 infectious complications in 27 patients are reviewed. Review of the complications according to diseases ancientness; before 10 years of evolution, each patient suffered of at least one complication, after 10 years, each patient got an average of 2 complications. Review of diabetic balance: 80% of the patients present a mean glycemia greater than 1.50; 54% present a postprandial glycemia greater than 2 gr. and 34% a A1 C Hb greater than 9%. The possible treatments are reviewed. During this monitoring, mortality was one case; 35 patients were admitted totaling 881 days of hospitalization.
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PMID:[The non-insulin-dependent diabetic (type II) in Tahiti]. 160 52

A case of advanced cervical carcinoma of the uterus with ectopic adrenocorticotrophic hormone (ACTH) syndrome is described. The patient was seen for general malaise 21 months after surgical treatment of the primary lesion whose histology was undifferentiated small cell carcinoma of the uterine cervix. She had extensive metastases in the liver and the abdominal wall. In addition to the typical clinical manifestations of Cushing's syndrome such as moon face, central obesity and acne vulgaris, hyperglycemia was so severe that she was in a hyperosmolar non-ketotic coma. Endocrinological examinations revealed elevated plasma ACTH and cortisol, and urinary excretion of 17-hydroxycorticosteroids and 17-ketosteroids, which were not suppressed by high-dose dexamethasone administration. Based on these clinical and laboratory findings, a diagnosis of ectopic ACTH syndrome was made. Among the results of other endocrinological examinations conducted to find the etiological cause of the hyperglycemic coma, which seemed to be unusual for ectopic ACTH syndrome, the plasma somatostatin level was abnormally high. Metastatic tumors in the liver obtained at the time of autopsy contained large amounts of both ACTH and somatostatin, and gel filtration studies revealed that the peptides produced by the tumor had the molecular sizes of the biologically active forms of the respective peptides. These observations suggest possible involvement of the somatostatin in deteriorating glucose intolerance to develop hyperglycemic hyperosmolar non-ketotic coma as a drastic disturbance of metabolism.
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PMID:A case of cervical carcinoma of the uterus presenting with hyperosmolar non-ketotic coma as a manifestation of ectopic adrenocorticotropic hormone syndrome. 164 12

Hyperglycemia and other metabolic derangements resulting from absolute or functional deficiency of insulin are accompanied by typical signs and symptoms of diabetes. The clinical signs and the findings of hyperglycemia over 200 mg/dl should establish a diagnosis of diabetes mellitus. An oral glucose tolerance test (O-GTT) is rarely necessary for diagnosis of diabetes in a child. A small proportion of children, however, present less severe symptoms, and may require an O-GTT. Approximately 14% of IDDM children were in coma at diagnosis in Tokyo, and 11 onset deaths (0.94%) were observed among the 1172 newly diagnosed IDDM cases in Japan. A significant decline in the onset mortality, however, has been observed in the past 20 years in Japan in association with the improvement of early management of childhood diabetes. The clinical distinction of IDDM from NIDDM is often difficult in diabetic children of Oriental origin without obesity. Japanese IDDM can be divided into two forms, abrupt and slow onset forms, but they may be essentially the same disease. There was no difference in the frequency of being tested positive for circulating ICA between the two groups of the patients. But a difference in the frequency of HLA DR4 and DRW9 was noticed between the two groups. Clinical features of 107 children with NIDDM were studied and about 75% of these cases were obese. All of them can be detected by routine urinalysis for glucose. Diet and exercise therapy in most of the newly diagnosed patients resulted in remission but some of them may require insulin or an oral hypoglycemic agent to get better glycemic control.
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PMID:Initial signs and diagnosis of diabetes--special considerations of Oriental patients. 263 91

The pathogenesis of the abnormal metabolic state in patients with non-insulin-dependent diabetes (NIDDM) is controversial. Even the term NIDDM stirs controversy because of the easily drawn inference that individuals with this form of diabetes do not need insulin treatment. Yet many patients with NIDDM are treated with insulin; some even develop hyperosmolar coma if not given insulin. Ketoacidosis, however, is very infrequent in this syndrome, implying that these patients are not dependent on insulin treatment to prevent mass mobilization of fatty acids and ketone bodies. The phrase noninsulin-dependent is therefore appropriate when used in this restricted fashion but inappropriate when used to imply adequacy of insulin secretion. The evaluation of the adequacy of islet function in this syndrome has been complex, since there is no standard of insulin output that can be defined for normal islets without specifying the physiologic setting under which the assessment has been made. For example, individuals with normal glucose levels but variable degrees of obesity have widely varying insulin secretion rates. Thus, the choice of controls is critical when comparing islet function in NIDDM to normal. In addition, the efficiency of the B-cell response to a challenge (e.g., oral glucose tolerance test) can markedly influence the magnitude of the stimulatory glucose level during the period of testing. For example, a subject with some impairment of insulin output will tend to become more hyperglycemic during the test. The hyperglycemia may then stimulate more insulin secretion so that the overall insulin output may appear equal to or even greater than that of a normal individual. In such a closed-loop system, strict control of input variables is necessary to evaluate whether or not insulin secretion is normal. As will be discussed, control of glucose level and other variables is seldom accomplished in dynamic glucose tolerance tests. As will be presented in this review, the development of appropriately controlled studies of islet function has provided convincing evidence that islet B-cell function is abnormal in patients with NIDDM. Since these studies are based on an understanding of normal islet function, normal islet B-cell physiology is discussed before pathophysiology. Finally, the implications of this analysis for the treatment of NIDDM with diet, hypoglycemic sulfonylureas, and insulin will be discussed.
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PMID:Pathophysiology of insulin secretion in non-insulin-dependent diabetes mellitus. 609 29

The overall annual IDDM incidence rates by area in Japan for 1985-1989 for children 0-14 years of age at diagnosis were from 1.65 to 2.07 per 100,000. The incidence in males and females did not show any temporal trends during the period between 1980 and 1989. The prevalence of IDDM was about 1 per 10,000. The clinical features at diagnosis among Japanese IDDM children identified during the 2-year period between 1979 and 1980 were as follows. Fourteen percent of the cases were in coma and 12% of the cases were asymptomatic at diagnosis. There is a suggestion that slow onset IDDM is often seen in Japan. In these children, the decline of serum CPR levels and the prevalence of ICA (islet cell antibodies) over the course of diabetes was slower than in those with an abrupt onset classical IDDM. During the period from 1975 through 1990 the incidence rates of NIDDM in school children showed as much as an approximate 1.5-fold increase along with a similar increase in the prevalence of obesity. About eighty percent of these NIDDM children were obese. A predominance of female children developing diabetes was seen in both type of diabetes, IDDM and NIDDM, in Japan. Non-obese type NIDDM in children was more common in females than in males. It is interesting to note that the mean height of Japanese children with IDDM was not different from the national average, but children with NIDDM were significantly taller than the national average.
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PMID:Epidemiology of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus in Japanese children. 785 37

A 48-year-old patient with massive obesity developed a dramatic increase of serum glucose and sodium concentration as first symptom of a so far unknown diabetes mellitus. A treatment with intravenous insulin infusion and administration of free water was initiated. Two weeks after this event he became comatose, developed dysphagia, a speech disorder and ocular bobbing; finally, he showed the picture of a complete tetraparesis. Computertomographic findings of the brain were unremarkable. Two weeks later physical findings of the patient showed a significant improvement. Dysphagia, speech disorder and even the tetraparesis disappeared. Computertomography of the brain now yielded a hypodense area within the pons. The symptoms can be understood as signs of central pontine myelinolysis, which may be due to hypo-osmolarity or fast equilibration of a hypo-osmolarity. The history of this patient is a rare example of a central pontine myelinolysis with spontaneous remission.
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PMID:[Acute tetraplegia, diabetes mellitus (clin conference)]. 876 24

A 36-year-old man was admitted to Kanto Chuo Hospital because of hearing loss and dysphagia. On admission physical and neurological findings revealed obesity, hypertension, nystagmus, right hearing loss, dysarthria, and dysphagia. Routine laboratory findings disclosed leukocytosis, liver dysfunction, hypercholesterolemia, proteinuria, and glucosuria. Immunological, coagulopathic, and endocrinological findings, electrocardiogram, echocardiogram, and brain CT scan were unremarkable. He was diagnosed as brainstem infarction, and then conservative therapies were begun. Seven hours after admission, he suddenly fell into coma and apneutic state, requiring artificial ventilation. The next day he was fully conscious, but could'nt make any voluntary movements except for vertical eye movements, suggesting locked-in syndrome (LIS). Brain MRI showed infarction of pons, medulla oblongata, and right cerebellum. Cerebral angiography revealed hypoplasia of bilateral vertebral arteries, a persistence of right primitive trigeminal artery (PTA), and retrograde blood flow of basilar artery from the PTA. Then he made a rapid recovery, and on 80th day he was discharged only with right hearing disturbance and mild left cerebellar sign. We speculated that hypoplasia of the bilateral vertebral arteries caused the brain infarction, and that back flow of the basilar artery from the PTA, in part, contributed to the early recovery from the LIS.
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PMID:[Early recovery from locked-in syndrome due to brain infarction in a young patient with hypoplasia of bilateral vertebral arteries and a persistence of primitive trigeminal artery]. 895 55


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