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

A 26-year-old woman, who had undergone jejunoileal bypass surgery six years previously for obesity, had symptoms of intermittent fever, myalgia, polyarthralgia, and aseptic joint swelling. These symptoms commenced one year after her surgery and gradually grew in intensity and frequency of occurrence. The patient, observed to have moderately decreased renal function, hyperoxaluria, and circulating cryoglobulins, underwent liver and renal biopsies. Both organ specimens demonstrated granulomatous involvement, but the kidneys exhibited no evidence of oxalate deposition. The findings of circulating cryoglobulins and suppression of symptoms with doxycycline, taken collectively with the circumstances surrounding this case, suggest that the observed granulomatous disease may be due to systematically adsorbed bacterial antigen(s).
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PMID:Jejunoileal bypass surgery and granulomatous disease of the kidney and liver. 63 46

Ileostomy of the distal end of the bypassed segment of small intestine was done twenty-three months after a 28 to 20 cm (12 to 8 inch) end-to-end jejunoileal bypass for obesity (Scott operation) in a forty-eight year old white female, thus creating a Thiry fistula. Weight prior to jejunoileal bypass was 130 kg (287 pounds). Before ileostomy it had stabilized at 80.3 kg (177 pounds). Indications for ileostomy were three episodes of blind loop syndrome and three episodes of severe bleeding from the ileotransverse colostomy anastomotic site. Culture of the bypassed segment at laparotomy revealed bacteroides, clostridia, and other anaerobes as well as the usual aerobic large bowel flora. After ileostomy the bypassed segment contained no anaerobic bacteria. Daily fluid output from the ileostomy has decreased with time, averaging 436 ml per day for the first postileostomy month and 50 ml per day for the ninth month. Beneficial effects of the ileostomy include: (1) better sense of well being; (2) no further episodes of blind loop syndrome or intestinal bleeding; and (3) cessation of anal itching. Nine months after ileostomy, hyperoxaluria and acquired megacolon were present. Weight was 5.9 kg (13 pounds) greater than before ileostomy.
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PMID:Ileostomy of the distal end of the bypassed intestine in a patient with jejunoileal bypass for obesity. 64 46

A 45-year-old man underwent a jejunoileal shunt procedure for obesity. Twenty months later he developed severe oxalosis and chronic renal failure, which required maintenance hemodialysis. The sequential observation of two biopsy specimens and the necropsy (over a span of 39 months) suggests that oxalate deposition caused tubular obstruction and destruction with subsequent atrophy of nephrons. This indicates that patients undergoing intestinal bypass are at risk for developing irreversible renal failure due to enteric hyperoxaluria.
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PMID:Oxalosis and chronic renal failure after intestinal bypass. 83 9

Of 93 patients with small bowel bypass for massive exogenous obesity, three developed calcium oxalate urinary calculi, four stones in their gallbladder, and one developed both gallstones and urinary calculi during a mean follow-up period of 17.6 plus or minus 9.0 months. The urinary oxalate excretion increased from 21.6 to 67.8 mg/24 hours (P smaller than .001); simultaneously, the urinary output decreased from 1,775 to 1,101 ml/24 hours (P smaller than .001). Postoperatively, there was a significant increase in the rate of bile salt synthesis from 1.6 to 4.9 gm/day (P smaller than .02) and in the bile sale glycine/taurine ratio from 4.6 to 6.8 (P smaller than .05). It is suggested that the postbypass increase in the biliary glycine/taurine ratio, with its consequent decrease in the zeta potential of the micelles in bile, is at least partly responsible for the increased incidence of cholelithlasis. The pathogenic basis for the increased incidence of urinary calculi is hyperoxaluria, which is probably related to an increased bile salt and glycine synthesis.
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PMID:Biliary and urinary calculi: pathogenesis following small bowel bypass for obesity. 115 48

Jejunoileal bypass (JIB) has been widely performed for treatment of excessive obesity. Formation of calcium oxalate stones is a common side effect. Since, under physiological conditions, the intestinal absorption of calcium and that of oxalate are interrelated, intestinal oxalate and calcium absorption were measured in the present study by isotope techniques in 19 JIB patients and 20 healthy controls. The JIB patients showed pronounced hyperoxaluria and markedly increased absorption of oxalate, with a urinary excretion of 14C-oxalate of 29 +/- 19% (controls 6.2 +/- 3.7%; p less than 0.001). There was a strong correlation between the intestinal absorption and urinary excretion of oxalate in the JIB patients (r = 0.72; p less than 0.001). Furthermore, their oxalate kinetics was altered, with continued urinary excretion of 14C-oxalate for up to 48 hours. The JIB patients also had reduced calcium absorption (36 +/- 9.1% vs. 47 +/- 9.0%; p less than 0.001) and patients with malabsorption of calcium and low urinary calcium had the highest intestinal absorption and urinary excretion of oxalate. It is concluded that hyperoxaluria in JIB patients is due to a significant extent to hyperabsorption of oxalate.
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PMID:Intestinal absorption of oxalate and calcium in patients with jejunoileal bypass. 259 24

Hyperoxaluria occurs in most patients after the conventional jejunoileal bypass procedure for obesity. The mechanism of hyperoxaluria is complex, involving persistence of dietary oxalate in solution as well as increased colonic permeability to oxalate. Endogenous oxalate formation also contributes to hyperoxaluria. Treatment is unsatisfactory and involves a low-oxalate diet and simultaneous administration of agents which bind oxalate and bile acids, such as aluminum hydroxide. Hyperoxaluria was not present in 21 of 22 patients who had undergone the pancreato-biliary bypass procedure.
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PMID:Hyperoxaluria associated with intestinal bypass surgery for morbid obesity: occurrence, pathogenesis and approaches to treatment. 679 33

Balance studies and oxalate loading tests were carried out in order to define the pathogenesis of hyperoxaluria in 8 patients with jejunoileal bypass surgery for severe obesity; two healthy volunteers were also studied. In the bypass patients, urinary oxalate was markedly elevated (118 +/- 43 mg/day, mean +/- SD) when they were on a high oxalate diet (252 mg/day). Hyperabsorption of dietary oxalate was confirmed by the markedly increased urinary recovery of [14C]oxalate given in a test meal. In addition, the oxalate radioactivity was excreted in urine far more slowly than in healthy volunteers, suggesting that the colon was a major site of oxalate absorption. Elevated urinary oxalate excretion persisted, averaging 38 +/- 12 mg/day, despite ingestion of a very low oxalate diet (approximately 6 mg/day), suggesting that the diet contained "oxalogenic" substances other than preformed dietary oxalate which also contributed to dietary oxalate in these patients. Urinary oxalate decreased in 7 of 8 patients, however, when protein-rich foods were removed from the diet, suggesting that at least one dietary factor was digestive products of protein or creatinine. These results confirm the current view that in patients with hyperoxaluria secondary to jejunoileal bypass, the majority of urinary oxalate derives from dietary oxalate that is absorbed from the colon. Tissue or bacterial production of oxalate or an oxalate precursor from dietary constituents associated with protein, however, also appears to contribute to urinary oxalate. The results provide an explanation for the reported difficulty of eliminating secondary hyperoxaluria by restriction of dietary oxalate alone.
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PMID:Complex pathogenesis of hyperoxaluria after jejunoileal bypass surgery. Oxalogenic substances in diet contribute to urinary oxalate. 684 9

Fourteen patients with jejunoileal bypass for obesity were treated for one week with a calcium supplement of 3g daily. During this period diarrhoea was significantly (P < 0.005) reduced by 23 per cent (97 per cent confidence limits: 7-46 per cent). Ten of the patients had hyperoxaluria (median value 961 mumol/24 h; range 633-2742 mumol/24 h). The treatment with calcium significantly (P < 0.005) decreased the concentration of oxalate in urine by 23 per cent (98 per cent confidence limits: -5-+54 per cent). The calcium supplement did not increase urinary calcium-excretion rate or albumin-corrected serum calcium.
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PMID:Calcium in the treatment of diarrhoea and hyperoxaluria after jejunoileal bypass for obesity. 739 1

Chocolate, a foodstuff rich in sucrose, fat and oxalate, is considered unsuitable in cases of obesity, diabetes mellitus, urolithiasis and postprandial hypoglycemia. However the pathophysiological effects of chocolate are poorly documented. Therefore we investigated the effects of ingestion of 100 g dark chocolate bar (45 g cocoa and 55 g sucrose) on carbohydrate, calcium and oxalate metabolisms in 10 healthy subjects. Results were compared to those of 55 g sucrose intake (control group) performed on another day. Chocolate caused i) a lesser but longer increase in plasma glucose, insulin, and C-peptide than sucrose (respectively +23% of baseline vs +60%, p < 0.001; +436% of baseline vs +755%, p < 0.01 and +200% of baseline vs +331%, p < 0.01), ii) a striking increase in triglyceridemia, calciuria and oxaluria (respectively +96%, p < 0.01; +147%, p < 0.01 and +213%, p < 0.001). Thus, chocolate (cocoa+sucrose) causes a lesser pancreatic stimulation than sucrose. However, the increases in both calciuria and oxaluria (induced respectively by sucrose and cocoa) following chocolate ingestion might contribute to urinary conditions favoring the development of calcium oxalate calculi.
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PMID:Increase in calciuria and oxaluria after a single chocolate bar load. 780 35

Urolithiasis is a multifactorial recurrent disease of world-wide distribution in rural, urban, industrial and non-industrial regions. Changes in urinary pH is a risk factor especially with hyperuricosuria, hypercalciuria or hyperoxaluria. With recurrence, hypercalcuria and higher urinary oxalate levels are more frequent. Hypercalciuria and hyperuricosuria showed correlation with family history of stones. The ionic relations between various stone forming salts in urine of patients are opposite to that in controls and are well represented in stone composition. Obesity is a risk factor in both genders. Over eating a diet rich in all nutrients was associated with hyperuricosuria while a diet high only in fat was associated with other urinary disturbances. High protein and fat intake are risk factors. High or low calcium diet was associated with urolithiasis and supplemental calcium is not a risk factor. Potassium and magnesium citrate are potent in inhibiting the growth of stone fragments after extracorporeal shock wave lithotripsy. Whether in patients or normal subjects, drinking hard water should be avoided; tap water or low calcium content water is preferable. Seasonal variations in temperature affected urinary volume, pH and relative saturation of uric acid. To prevent recurrence, patients should maintain high fluid intake achieving a urine volume of 2 liters per day.
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PMID:Urolithiasis in adults. Clinical and biochemical aspects. 1595 54


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