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

The desensitization process of beta-adrenergic system was assessed by in vivo administration to 7-week old rats of a mixed beta-agonist, metaproterenol (3,5-dehydroxyphenyl-N-isopropyl-amine-beta-ethanol sulphate; T1/2=6 hours), (2 mg/kg/d) in treatments of 12 hours, 2 days and 10 days. The in vitro lipolytic effect of selective beta-adrenergic agonists, dobutamine, salbutamol and BRL 37344, as well as plasma free fatty acid concentrations were measured in treated and control animals given vehicle. Different times of exposure to a beta-agonist induced a loss of responsiveness on lipolytic response mediated by beta1 and beta2-adrenoceptors, as demonstrated by decreased affinity and intrinsic activity (maximal effect) of dobutamine and salbutamol. In contrast, no changes were found in beta3 mediated lipolysis. These observations suggest that beta1, beta2 and beta3-adrenoceptors follow different regulatory patterns. Lack of beta3-adrenoceptor desensitization may have important physiological and therapeutic consequences in the treatment of diseases such as obesity and heart failure.
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PMID:Desensitization effect of in vivo treatment with metaproterenol on beta1, beta2 and beta3-adrenergic responsiveness in rat adipocytes. 859 5

Hypertension directly predisposes to all of the major atherosclerotic cardiovascular disease outcomes, including coronary artery disease, stroke, cardiac failure, and peripheral artery disease. Coronary artery disease deserves a high priority in treatment of hypertension because it is the most common and lethal sequela. However, reduction of blood pressure as the sole therapeutic goal of antihypertensive therapy is no longer appropriate. Hypertension tends to cluster with other atherogenic risk factors, including dyslipidemia, glucose intolerance, insulin resistance, obesity, and elevated uric acid. Hypertension is only one of the many risk factors for atherosclerotic cardiovascular disease and is variably hazardous, depending on the number and severity of these coexistent metabolically linked risk factors. The presence of coexistent, already overt cardiovascular disease and left ventricular hypertrophy also greatly influence the hazard and choice of therapy. The urgency for, and choice of, therapy should be based on the multivariate cardiovascular risk profile rather than relying solely on the character and severity of the blood pressure elevation. In this way at-risk hypertensive persons can be more appropriately targeted for treatment designed to improve their multivariate risk profile and to provide maximum benefit and cost effectiveness.
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PMID:Cardioprotection and antihypertensive therapy: the key importance of addressing the associated coronary risk factors (the Framingham experience). 884 93

Twelve Caesarean section-associated maternal deaths were encountered over a 15-year period. The major operative risk factors were pregnancy-induced hypertension, obesity and general anaesthesia. Severe preeclampsia was the forerunner to postoperative cardiac failure, consumptive coagulopathy and difficult airway manipulation. We conclude that pregnancy-induced hypertension and its ramifications pose the greatest threat to maternal survival from a Caesarean section.
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PMID:Maternal deaths associated with caesarean section. 903 30

We reviewed clinical data, autopsy reports, and microscopic slides on 10 patients with sleep apnea/obesity hypoventilation syndrome (SA/OHS) to define the cardiopulmonary pathological features and establish clinicopathologic correlations. Ten obese (>136 kg) patients without SA/OHS were studied as controls. Patients with SA/OHS exhibited biventricular cardiac failure and pulmonary hypertension with a higher prevalence of moderate/severe pulmonary hemosiderosis (8 v 0 patients), alveolar hemorrhage (7 v 4 patients), capillary proliferation (4 v 0 patients), iron encrustation of elastica (1 v 0 patients) and medial hypertrophy of muscular pulmonary arteries (11.9 +/- 2.4 v 9.7 +/- 1.6%) (P < .05). In two patients capillary proliferation resembled capillary hemangiomatosis. Mean right ventricular thickness was higher in the SA/OHS group (0.71 +/- 0.17 v 0.42 +/- 0.1 cm) (P < .01). Four patients with SA/OHS and three controls had moderate/severe myocardial fibrosis. Biventricular cardiac failure caused death in seven patients with SA/OHS. Hypoxia is probably the most important cause of pulmonary hypertension, arterial muscularization, and right ventricular hypertrophy in SA/ OHS. Left ventricular failure in some SA/OHS patients may be the result of hypertensive cardiac disease. In others, the etiology of left ventricular failure was not determined morphologically, suggesting functional abnormalities related to obesity and/or apneic episodes.
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PMID:Cardiopulmonary pathology in patients with sleep apnea/obesity hypoventilation syndrome. 938 47

Although recent advances have been made in understanding its epidemiology, diagnosis and treatment, pulmonary embolism (PE) is still largely undetected and untreated, and the mortality rate has not appreciably changed in the last decades. The aim of this study was to: compare the postmortem frequency of massive and sub-massive PE during two different time periods in the same general hospital; ascertain whether the percentage of correct clinical diagnosis of PE has changed; identify factors which might contribute to the inaccuracy of the clinical diagnosis of PE. Altogether, 288 patients with autopsy-proven PE and adequate clinical data were collected in the first period; 182 subjects with the same characteristics were found in the second period. Cases observed from 1989 through 1994 were evaluated in terms of frequency of false negatives and false positives, predictive value of the clinical diagnosis of PE, and correlations between clinical and post-mortem diagnosis of PE on one side and several independent variables such as age, gender, associated diseases, recent surgery on the other. In our hospital the frequency of massive and submassive PE at autopsy was 8.6% from 1966 through 1974, 12.6% from 1989 through 1994 (p < 0.01). The percentage of correct clinical diagnosis of PE was 19.6% in the former period, 21.6% in the latter (NS) with 78.57% of false negatives and only 1.73% of false positives. Altogether the true positives were 21.42%, most of them being patients with massive PE. Clinical findings showed the coexistence of heart disease in 51.6% of the cases, congestive heart failure in 20.15%, metabolic disease in 7%, stroke in 12.5%, recent surgery in 12.5%. Autopsy revealed the presence of pulmonary infarction in 22% of cases, malignancy in 24.0%, pneumonia in 17.05%, acute myocardial infarction in 14.8%. Seventy percent of the cases in whom the point of origin of thromboemboli could be demonstrated had one or more thrombus in the district of inferior vena cava, more frequently at the level of the femoral and iliac veins. The positive predictive value of the clinical diagnosis of PE was 0.60, the negative predictive value 0.84. Multivariate logistic regression analysis showed that the clinical diagnosis of PE was hindered by the presence of pneumonia, facilitated by admission to the Cardiological Department. Age, duration of hospitalization, presence of pulmonary infarction, cancer, obesity, stroke, heart failure and recent surgery did not influence the clinical diagnosis of PE in this series. A positive correlation (p < 0.05) was found between autopsy rate and the percentage of correct clinical diagnosis of PE in the various hospital departments. This relationship needs further investigation, all the more so as in most countries the autopsy rate has been dramatically declining in recent times, especially in late life. In conclusion, at least in some institutions, the autopsy frequency of PE has increased during the last decades, and this increase has not been paralleled by a significant improvement in clinical diagnosis.
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PMID:"False negatives" and "false positives" in acute pulmonary embolism: a clinical-postmortem comparison. 909 Jan 62

The average prevalence of obesity (BMI > 30 kg/m2) among European centers participating in the WHO-MONICA study between 1983 and 1986 was about 15% in men and 22% in women Prevalence figures ranged in men from 7% in Gothenburg and 22% in Lithuania and in women from 9% to 45% in the same places. Some monitoring projects or repeated surveys suggest that the prevalence of obesity has been increasing during the past 15 years in some European countries. A closer look at data from The Netherlands suggest that average weight increase in the order of about 1 kilo can be responsible for quite dramatic increases in the prevalence of obesity. This suggest that only small changes in the daily caloric balance may be sufficient to increase the number of obese subjects in populations. In The Netherlands a decrease in energy intake and fat consumption was observed between 1987 and 1993 and smoking rates remained relatively stable. This could imply that reductions in energy expenditure are the main factors responsible for the increase in the prevalence of obesity. Since the increase in the prevalence of obesity seems to occur particularly in younger age-groups, the consequences of the increase in the prevalence of obesity only become apparent many years later. Especially chronic conditions such as arthritis or conditions related to obesity but occurring later in life such as cerebrovascular accidents, chronic heart failure or breast cancer in women. The rising prevalence of non-insulin dependent diabetes mellitus may be one of the first signs of the increasing problem of obesity in European countries.
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PMID:Time trends in obesity: an epidemiological perspective. 917 22

Obesity is associated with the development of some of the most prevalent diseases of modern society. The greatest risk is for diabetes mellitus where a body mass index above 35 kg/m2 increases the risk by 93-fold in women and by 42-fold in men. The risk of coronary heart disease is increased 86% by a 20% rise in weight in males, whereas in obese women the risk is increased 3.6-fold. Elevation of blood pressure, hyperlipidaemia and altered haemostatic factors are implicated in this high risk from coronary heart disease. Gallbladder disease is increased 2.7-fold with an enhanced cancer risk especially for colorectal cancer in males and cancer of the endometrium and biliary passages in females. Endocrine changes are associated with metabolic diseases and infertility, and respiratory problems result in sleep apnoea, hypoventilation, arrhythmias and eventual cardiac failure. Obesity is not a social stigma but an actual disease with a major genetic component to its aetiology and a financial cost estimated at $69 billion for the USA alone.
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PMID:Obesity as a disease. 924 38

We describe the anesthetic management of an obese myotonic patient who underwent bilio-pancreatic diversion for severe obesity. A female, 35 years old (weight 137 kg, height 160 cm, excess body weight 120%) suffered from myotonic dystrophy and obesity, complicated by a mild heart failure and restrictive disease. Induction of anesthesia and tracheal intubation were performed after propofol (1 mg/kg). Anesthesia was maintained with isoflurane and fentanyl muscular blockade by vecuronium bromide. Perioperatively extensive hemodynamic monitoring has been performed. The patient was discharged successfully the 12th day postoperatively. One year later she had lost 50 kgs of body weight; oxygen blood tension and pulmonary function tests were greatly improved.
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PMID:Anesthetic management of a patient combining myotonic dystrophy and obesity. 925 74

Severe obesity with co-morbidity such as diabetes mellitus, cardiac failure, obesity hypoventilation, degenerative bone diseases and increased incidence of malignancy give rise to shorter life expectancy and have an impact on quality of life. This results in higher costs of health care and work absence. Surgical procedures have become commonplace in the therapy of morbid obesity because of the infrequent success of medical treatment. We performed a horizontal gastroplasty by laparoscopic adjustable silicon gastric banding (LASGB) on 60 patients between 1. 11. 1995 and 28. 2. 1997. The average excess above normal weight was 62 kg, the median BMI (Body-Mass-Index) was 46.44 kg/m2. Fifty-nine procedures were performed by the laparoscopic method and one with an open technique. The average postoperative hospital stay was five days. Due to dorsal slipping or pouch enlargement the procedure had to be repeated on 6 patients (10%). The median loss of weight in the first three months was 14.78 kg, after six months 24.14 kg and after nine months 35.1 kg. Insulin treatment for three patients suffering diabetes mellitus could be discontinued-in addition blood sugar levels in six patients normalised. Two patients with obstructive sleep-apnea syndrome no longer needed a nocturnal Nasal-Continuous-Positive-Airway-Pressure-(nCPAP-)Therapy. To provide a better quality of life to this group of patients, the gastric banding is a suitable method for carefully evaluated and followed patients. In addition improved ability to work and reduction of health care costs due to co-morbidity and joint diseases have a positive economic impact.
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PMID:[Surgical therapy of morbid obesity: indications, technique of laparoscopic gastric banding and initial results]. 941 44

Essential hypertension, obesity, and congestive heart failure are characterized by an increase in muscle sympathetic nerve activity. Whether in these conditions skin sympathetic nerve activity is also increased has never been systematically examined, however. In 10 untreated mild essential hypertensive, 12 untreated normotensive obese, 10 mild (New York Heart Association class II) heart failure, and 10 normotensive lean healthy control subjects, we measured beat-to-beat arterial blood pressure (Finapres technique), body mass index, and postganglionic sympathetic nerve activity in skeletal muscle and skin areas (microneurographic technique, peroneal nerve). The muscle and skin nerve measurements were made in a randomized sequence. All data were obtained with the subject supine in a quiet, semidark environment at constant temperature over two periods of 30 minutes each, separated by a 20- to 30-minute interval. Blood pressure was increased only in hypertensive and body mass index only in obese subjects. Muscle sympathetic nerve activity quantified as bursts/min was markedly and significantly (P<.01) greater in essential hypertensive (33.3+/-1.7), obese (42.2+/-2.8), and congestive heart failure subjects (55.8+/-4.3) in comparison with control subjects (23.9+/-1.6). This was the case also for muscle sympathetic nerve activity, quantified as bursts per 100 heart beats. In contrast, skin sympathetic nerve activity (bursts per minute) was superimposable in hypertensive, obese, heart failure, and control subjects, its ability to increase being documented in all four groups by the marked response to an acoustic stimulus. Thus, in various diseases, muscle but not skin sympathetic activity is increased, with the sympathetic activation not being uniformly distributed over the whole cardiovascular system.
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PMID:Dissociation between muscle and skin sympathetic nerve activity in essential hypertension, obesity, and congestive heart failure. 1456


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