Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0028754 (obesity)
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The sleep apnea syndrome (SAS), which is defined by more than 5 apneas or hypopneas per hour of sleep (9), is quite a frequent affection which concerns 1.4 to 10% of general population (1.7). The major daytime complaints of the SAS are daytime sleepiness, memory and attention disorders, headaches and asthenia especially in the morning, and sexual impotence (9). The nocturnal manifestations are dominated by sonorous and generally long standing snoring, increased by dorsal decubitus and intake of alcohol, with repeated interruptions by respiratory arrests. These manifestations are always noted but rarely spontaneously reported. The sleep, non refreshing, is agitated and perturbed by numerous awakenings. The findings of the clinical examination are poor: obesity is found in 2/3 of the cases and arterial hypertension in 1/2 of the cases (20). Polygraphic recording during sleep only permits an absolute diagnosis. This frequent affection is a real problem of public health because of its numerous complications (3, 10, 12, 13, 18, 21). Symptoms of depression are often found when a patient with a SAS is examined and conversely, symptoms which evoke a SAS can be found in the clinical examination of depressed patients. We decided so to study the thymic and anxious status of 24 patients investigated for a SAS and submitted to a polygraphic recording during sleep. Four clinical parameters were studied: DSM III-R diagnosis criteria, Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HARS) and thymasthenia rating scale of Lecrubier, Payan and Puech. We also reported Total Sleep Time (TST = 6.5 +/- 1.5), Apnea Hypopnea Index (AHI = 26.7 +/- 21.6), number (2.1 +/- 2.8/h) and duration (174.2 +/- 150.8 s/h) of hypoxic events. Results showed that among 24 patients, 8 were depressed according to DSM III-R diagnosis criteria and had MADRS > 25, 22 were anxious, 11 had a major anxiety (HARS > 15) and 15 presented thymasthenia (SET > 15). Significative correlations existed between anxiety and depression (r = 0.82; p < 0.0001), depression and thymasthenia (r = 0.77; p < 0.0001) and thymasthenia and anxiety (r = 0.75; p < 0.0001). Among the 8 depressed patients a correlation existed between AHI and depression (r = 0.72; p = 0.04), but no correlation was found between depression and hypoxic events. These results were comparable to those of Guilleminault (10), Reynolds (21), Kales (12), Bliwise (3), Klonoff (13) and Millman (18) who studied relations between SAS and depression. The evaluation of thymasthenia gave a more precise typology of the depressive state associated to SAS: the type of the mood disorder is more "blunted" and "anhedonic" than "sorrowful", particularly characterised by asthenia, lack of energy, reduction of interests (leisures, libido, work), loss of initiative, difficulties to organise tasks, fall of performances and reduction of pleasure usually felt in pleasant events (15). The physic symptomatology dominated the psychic one. The sleep disorganization, more than metabolic consequences of apneas, could be involved in this associated depressive state. Other neuropsychiatric troubles can be associated to the SAS. In fact, cognitive troubles (2, 8, 14, 16, 19, 22, 24) and personality disorders (12, 18) have been described. Our data confirm previous observations suggesting a frequent association between SAS, depression, fatigue and anxiety. Clinicians should consequently be aware that a depression with severe complaints of fatigue should deserve an investigation oriented towards SAS. Conversely, when a SAS is diagnosed, it is necessary to look for a possible depression in order to set up the most appropriate treatment. The frequency of SAS, like depression's one, increases with age. Prescription and consummation of sedative psychotropic drugs increase too with age. Since respiratory depressant effects of these drugs have been clearly demonstrated, it is important to evoke SAS when depressive and/or anxious states are diagnosed and not to aggravate it. An efficacious treatment of SAS can also cure the associated depressive state, but this one can persist. It is necessary, in this case, to select a non sedative antidepressant.
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PMID:[Depressive symptomatology and sleep apnea syndrome]. 1240 78

We conducted a retrospective multicenter study by questionnaire to evaluate the results of laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP). Between 1991 and 1998, 209 patients with a mean age of 41.2 years (range, 10-83) had a laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Preoperatively, 178 patients (85%) underwent medical treatment aimed at achieving a satisfactory platelet count. Twenty-nine patients were obese, with a body mass index greater than 30%, and 14% were HIV-seropositive. The so-called hanging spleen technique in the right lateral decubitus position was used most often. The average duration of surgery was 144 minutes (45-360). This was significantly longer in cases of conversion (170 minutes; P < 0.01). The factors influencing the duration of laparoscopy were operator experience and patient obesity (P < 0.01). A conversion was necessary in 36 cases (17.2%) because of hemorrhage. The conversion rate varied from 5.3% to 46.7%, depending on the surgical team. A multivariate analysis of factors disposing to conversion identified two causes: obesity and operator experience. One or more accessory spleens were found in 34 patients (16.2%). The average weight of the spleens was 194.2 g. There were no deaths. There were no complications in 187 patients (89.5%), with a mean hospital stay of 6.1 days. Patients who did not require a conversion had a significantly earlier return of intestinal transit, used less analgesic, and had a shorter length of hospitalization. Overall morbidity was 10.5% (22 cases), due to subphrenic collections (7 cases), abdominal wall complications (6 cases), re-intervention for actual or suspected hemorrhage or pancreatitis (3 cases), pneumopathology (2 cases) and others (4 cases). A multivariate analysis about morbidity shows a statistically significant difference in conversions (P < 0.05) but not in obesity or in surgeon's experience. Normal activity was achieved on average by the twentieth postoperative day--earlier if conversion was not required (18.4 versus 33.9 days). The average preoperative platelet count was 92.7 x 10(9)/L (range, 3 to 444). Twenty patients had a count of less than 30 x 10(9)/L and in this group the conversion rate was 30% (6 cases). Ninety-six patients were seen in the outpatient clinic, with an average follow-up time of 16.2 months (3 to 72 months), and the average platelet count was 242 x 10(9)/L (6 to 780). Eight patients (8.3%) were failures with a platelet count of <30 x 10(9)/L. In the 20 patients with a preoperative platelet count <30 x 10(9)/L, there were 3 early failures and 5 late relapses. There were 2 late deaths: chest infection at 3 months in an HIV seropositive patient and one case of pulmonary embolus at 6 months. Laparoscopic splenectomy constitutes a real alternative to conventional splenectomy for the treatment of idiopathic thrombocytopenic purpura. It is associated with fewer postoperative complications, a shorter duration of hospitalization and an earlier return to normal activity. The limiting factors are the experience of the operator and patient obesity. The long-term results are identical to those of conventional splenectomy, with a better than average success rate in patients that have failed preoperative medical treatment.
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PMID:Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. 1249 47

Rhabdomyolysis has been reported in all postoperative patients including those in prone, supine, lithotomy and lateral decubitus positions. Only a few reports suggest that bariatric surgical patients are at risk for rhabdomyolysis. We describe a male (BMI 69 kg/m2) who underwent an uneventful open Roux-en-Y gastric bypass for weight reduction lasting 5 hours. Postoperatively the patient suffered oliguria. Evaluation included subjective pain in both hips, a normal temperature and physical examination, creatinine increase to 3.5 mg/dl, CPK levels as high as 41,000 IU/L, and urinalysis showing a large amount of occult blood with 5-7 RBCs/HPF. Intravenous hydration with 0.9% normal saline, bicarbonate, and mannitol demonstrated initial success, but the patient eventually developed renal failure, respiratory distress, and tachycardia leading to cardiac arrest. Prior to his death, intraoperative evaluation demonstrated intact anastomoses. Obese patients undergoing bariatric surgery should be considered at risk for rhabdomyolysis, especially in view of prolonged surgeries, difficult physical examination, low volume status, and larger or immobile patients.
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PMID:Postoperative rhabdomyolysis with bariatric surgery. 1473 87

Lifestyle modifications are first-line therapy for patients with gastroesophageal reflux disease (GERD). We applied an evidence-based approach to determine the efficacy of lifestyle measures for GERD management. We used PubMed and Ovid to perform a search of the literature published between 1975 and 2004 using the key words heartburn, GERD, smoking, alcohol, obesity, weight loss, caffeine or coffee, citrus, chocolate, spicy food, head of bed elevation, and late-evening meal. Each study was reviewed by 2 reviewers who assigned one of the following ratings: evidence A, randomized clinical trials; evidence B, cohort or case-control studies; evidence C, case reports or flawed clinical trials; evidence D, investigator experience; or evidence E, insufficient information. We screened 2039 studies and identified 100 that were relevant. Only 16 clinical trials examined the impact on GERD (by change in symptoms, esophageal pH variables, or lower esophageal sphincter pressure) of the lifestyle measure. Although there was physiologic evidence that exposure to tobacco, alcohol, chocolate, and high-fat meals decreases lower esophageal sphincter pressure, there was no published evidence of the efficacy of dietary measures. Neither tobacco nor alcohol cessation was associated with improvement in esophageal pH profiles or symptoms (evidence B). Head of bed elevation and left lateral decubitus position improved the overall time that the esophageal pH was less than 4.0 (evidence B). Weight loss improved pH profiles and symptoms (evidence B). Weight loss and head of bed elevation are effective lifestyle interventions for GERD. There is no evidence supporting an improvement in GERD measures after cessation of tobacco, alcohol, or other dietary interventions.
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PMID:Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. 1721 52

The prevalence of the symptoms of reflux (hearthburn and acid regurgitation) and of gastro-esophageal reflux disease is high. Numerous lifestyle modifications have been advocated in the prognosis of reflux. Obesity, the decubitus, eating rapidly, tobacco, alcohol and exercise provoke symptoms of the reflux (hearthburn and acid regurgitation). The proportion of fat in the food and stress aren't factors associated with reflux. Some works point at the chocolate, at the acid juices, at the carbonated beverages and at the onions as factors that unleash symptoms of reflux. Nevertheless larger prospective controlled trials are warranted. Gum-chewing after eating, keep standing up and to go to bed 4 h after dinner improves the symptoms of the reflux and the gastro-esophageal reflux disease.
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PMID:[Influence of lifestyle in patients with gastroesophageal reflux disease]. 1743 11

The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long-term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes. In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P<.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities. Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care.
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PMID:Collaborative clinical quality improvement for pressure ulcers in nursing homes. 1790 67

Inactivity and muscular adaptations following spinal cord injury (SCI) result in secondary complications such as cardiovascular disease, obesity, and pressure sores. Functional electrically stimulated (FES) cycling can potentially reduce these complications, but previous studies have provided inconsistent results. We studied the effect of intensive long-term FES cycle training on muscle properties in 11 SCI subjects (mean +/- SEM: 41.8 +/- 2.3 years) who had trained for up to 1 hour/day, 5 days/week, for 1 year. Comparative measurements were made in 10 able-bodied (AB) subjects. Quadriceps maximal electrically stimulated torque increased fivefold (n = 5), but remained lower than in AB individuals. Relative force response at 1 HZ decreased, relaxation rate remained unchanged, and fatigue resistance improved significantly. Power output (PO) improved to a lesser extent than quadriceps torque and not to a greater extent than has been reported previously. We need to understand the factors that limit PO in order to maximize the benefits of FES cycling.
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PMID:Long-term intensive electrically stimulated cycling by spinal cord-injured people: effect on muscle properties and their relation to power output. 1881 13

Obese patients often are immobile, acutely ill, and at high risk for developing pressure ulcers when admitted to acute care facilities. Pressure-relieving mattresses are an integral part of a pressure ulcer prevention plan of care. Patients with a body mass index (BMI) >35, weight between 250 and 500 lb, and a minimum 3-day length of stay were recruited to participate in a pilot study to evaluate the safety and use of a new low-air-loss, continuous lateral rotation bariatric bed. Skin inspection was performed at the beginning and end of the study (maximum 7 days). Participants included 21 consecutively admitted patients (10 men, 11 women, average age 51.7 years [range 32 to 76], average BMI = 51.4 [range 37 to 71]) with an average Braden pressure ulcer risk score of 14.7 (range 9 to 21). Most (n = 11) were receiving treatment in the intensive care unit. Six patients had 10 pressure ulcers (six Stage I, four Stage II). Average length of stay on the surface was 4.8 days (range: 2 to 8 days); ulcers decreased from an average size of 5.2 cm2 to 2.6 cm2. No new pressure ulcers developed. Controlled clinical studies to assess the efficacy of pressure redistribution mattresses in this high-risk population are needed.
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PMID:The effect of using a low-air-loss surface on the skin integrity of obese patients: results of a pilot study. 1924 84

Thromboembolic complications are very rare after arthroscopic surgery of the shoulder. We report the case of a 25-year-old who presented thrombophlebitis of the brachial vein complicated by pulmonary embolism following arthroscopic surgery for posterior instability of the shoulder. No hemostasis impairment was found in this patient. The factors arguing in favor of thrombosis that had been retained from the literature were the lateral decubitus position with traction of the limb in its axis, prolonged surgical time, use of interscalene brachial plexus block, and a general condition susceptible to thrombosis (personal or family history of thromboembolism, genetic risk factor for thrombosis, smoking, obesity, neoplasia). There are currently no guidelines on the need for thromboembolism prevention during shoulder arthroscopy.
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PMID:Pulmonary embolism following thrombosis of the brachial vein after shoulder arthroscopy. A case report. 1957 63

This partly prospective, partly retrospective trial was performed in adult healthy volunteers to confirm the prevalence of sonographically visible physiological pleural and to establish possible individual variations of the presence and amount of pleural fluid over time as well as to asses relations in between pleural fluid and individual characteristics like age, sex, body mass index, smoking history and hormone therapy (in woman). A reliable threshold between normal and pathological pleural fluid findings was determined. Prospective chest sonography of both pleural spaces was performed with 3-12 MHz transducer in 71 randomly selected healthy adults and presence of pleural fluid was evaluated and measured as an anechoic layer at least 2 mm in thickness. Each individual was reexamined three times in two to four months intervals. Another 86 individuals were prospectively re-examined for the third time, 24 to 36 months after completed previous trials while the data on the baseline and follow up examination were retrospectively acquired. Maximum thickness of the pleural fluid was measured in the elbow position after five minutes leaning in lateral decubitus position. Examinees served as their own controls, with the quantitative measurement of the fluid layer over time. The fluid layer was visible in at least one pleural space in 51/157 (32.5%) subjects, whereas 35 (22.3%) examinees had a positive finding on all three examinations. Consistency of this finding was high between each pair of examinations over time (Cohen's Kappa > or = 0.8, p < 0.001). The maximum thickness of fluid layer ranged from 2.0 to 5.2 mm, with a mean of 2.9 mm independently of left or right pleural space and unilateral or bilateral presence. Regression models indicate that odds for observing pleural fluid in an individual decrease with age ( p = 0.013) and that if observed, the fluid tends to be thicker in women ( p = 0.017) and in subjects with higher BMI ( p = 0.028). Sonography detected small amounts of pleural fluid in 32.5% of healthy individuals. If present, maximum thickness of the fluid layer doesn't exceed the threshold value of 5.2 mm with mean values around 3 mm. The amount of physiological pleural fluid is relative stable over time and is very likely an individual characteristic with lower frequencies in elders while the frequencies of sonographically detected pleural fluid in healthy adults does not correlate with sex, obesity, smoking or hormonal therapy.
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PMID:Sonographic evaluation of pleural fluid in a large group of adult healthy individuals--end trial results. 1986 Jan 7


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