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

Published "normal" values of some hormones have an excessively wide range and unequal mean values because the material on which these values are based is from subjects suffering from different diseases which only apparently are not associated with the investigated hormone, or else the specimens are obtained under non-standard conditions (malnutrition, stress, alcohol etc.). This wide range of normal values may hide incipient pathological processes and is not suitable even as control group. The investigation is based on the assessment of insulin, growth hormone (GH), cortisol, thyroxine (T4) and triiodothyronine (T3) in a group of blood donors. The assembled results were compared with two other groups of blood donors and a group of obese subjects. The following findings were assembled: We recommend to lower the upper borderline of "normal" insulinaemia from the recommended value of 26 to 20 i.u./l, as the original range may comprise milder forms of hyperinsulinism which is recently assumed to participate in the genesis of type 2 diabetes, hypertension, coronary ischemia and polycystic ovaries. Elevated normal values of serum insulin may be obtained also from blood donors who usually have breakfast before the blood is collected. The wide range of cortisolaemia is due to the diurnal rhythm. The basal value is raised by a declining blood sugar level, alcohol, obesity and of course, varying forms of stress. The upper range of cortisolaemia at 8 a.m. should not be beyond the range of 140-690 nmol/l. GH secretion is governed by an individual 3.5-hour cycle as well as changes of the blood sugar level, e. g. during the OGTT: the declining blood sugar level raises the GH level.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Factors affecting normal levels of insulin, cortisol, STH, thyroxine and triiodothyronine]. 226 67

This retrospective study compared the results of percutaneous transluminal angioplasty (PTA) with those of infrainguinal bypass procedures in patients with critical arterial ischemia to determine which procedure had superior patency, limb salvage, and durability. The records of 54 patients who underwent 54 PTAs and 56 patients who underwent 63 infrainguinal bypasses (29 femoropopliteal and 34 femorodistal) from 1981 to 1987 were reviewed. In each patient PTA or bypass was the initial vascular procedure. Patients in both groups were comparable with respect to age, sex, and the presence of diabetes, hypertension, obesity, hypercholesterolemia, and smoking. Mean follow-up was 40 months (4 to 88 months) for the PTA group and 28 months (6 to 78 months) for the surgery group. Thirty-nine of the 54 patients (72%) were initially improved after PTA, whereas 15 patients (28%) showed no improvement. During follow-up, 20 initially successful PTAs reoccluded. Thirty-two of 54 patients (59%) underwent subsequent procedures, which included repeat PTA (10) and distal bypass (14). Patency determined by noninvasive Doppler studies was 18% at 2 years. Limb salvage, which included such secondary procedures, was 78%. Two-year patency for femoropopliteal bypasses was 68% with a limb salvage of 90%. Femorodistal bypasses had a 2-year patency of 47% and a limb salvage of 74%. No perioperative deaths occurred. Twenty-one of the 63 patients (33%) had subsequent procedures, which included thrombectomy (5) and bypass revision (9). In patients treated for limb-threatening ischemia the 2-year patency after femoropopliteal bypass (68%) or femorodistal bypass (47%) is significantly better than that from PTA (18%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Percutaneous transluminal angioplasty versus surgery for limb-threatening ischemia. 213 83

Major risk factors have been identified that enhance the chances of cardiovascular morbidity and mortality. These include such modifiable factors as hypertension, hyperlipidemia, obesity, diabetes mellitus, smoking and hyperuricemia. Other factors that also increase risk are not modifiable and include advancing age, male gender and black race. The development of left ventricular (LV) hypertrophy imposes another significant risk for increased morbidity and mortality. Development of LV hypertrophy may be produced by hemodynamic as well as nonhemodynamic mechanisms. Included in the latter group are some of the same factors that in and of themselves participate in the production of increased LV mass (i.e., aging, gender and race, obesity, coronary disease, diabetes and the underlying mechanisms that subserve the hypertensive disease). This article discusses the concept, drawn from clinical and experimental studies, that demonstrate that the additional increased risk of LV hypertrophy may be ascribed to loss of reserve cardiac function, accelerated atherosclerosis, development of abnormal cardiac rhythm secondary to ischemia, fibrosis or drug-induced hypokalemia, inherent predisposition to ventricular dysrhythmias and sudden death, risks directly or coincidentally related to associated diseases or perhaps even the paradoxical risk of beneficial antihypertensive therapy.
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PMID:Potential mechanisms explaining the risk of left ventricular hypertrophy. 294 82

From April 1981 to April 1985, 128 limbs in 120 patients who had primary femoropopliteal bypasses were entered in a randomized comparative study. Grafts used were 56 randomized and five obligatory reversed saphenous veins (RSVs), 41 randomized and 24 obligatory superficial femoral-popliteal veins (SF-PVs), and two obligatory prosthetic grafts. The primary patency rates of randomized SF-PVs (64% at 3 years) and RSVs (60% at 3 years) were not significantly different. Similarly, there was no statistically significant difference in the secondary patency rates of 68% for SF-PVs and 63% for RSVs at 3 years. Combinations of obesity, hypertension, and poor medical condition mandated obligatory RSV use. Obligatory SF-PV use was necessitated by absence (eight cases) or inadequacy (16 cases) of the saphenous vein. Indications for bypass were critical ischemia (RSVs, 93% and SF-PVs, 92%) and claudication (RSVs, 7% and SF-PVs, 8%). Diabetes was present in 69% of patients with SF-PV bypass and 49% of those with RSV bypass. Limb retention, operative mortality, and patient survival rates were not significantly different with each graft. Continuation of the study as originally structured, with nonselective SF-PV use, became ethically untenable when it was appreciated that results in black patients and patients with excessively large grafts were markedly inferior and that construction of 3 cm moderately tapered anastomoses significantly reduced the incidence of distal anastomotic hyperplasia. These results, obtained during a period when important lessons about SF-PV use were being learned, indicate that during the first three years of observation after primary femoropopliteal bypass, the differences in cumulative primary and secondary patency rates of SF-PVs and RSVs were not statistically significant. Results in the most recent 76 SF-PV grafts, with primary and secondary patency rates of 82% and 89% at 3 years, provide a more realistic picture of the effectiveness of SF-PVs as primary femoropopliteal bypass grafts.
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PMID:Superficial femoral-popliteal veins and reversed saphenous veins as primary femoropopliteal bypass grafts: a randomized comparative study. 359 76

A single subcutaneous injection of 3.3'-methyliminobis-(N-methylpropylamine) caused edema and necrosis in the hypothalamus and medulla oblongata of rats, mice, and gerbils. Most other aliphatic triamines were ineffective. The lesions were very similar in character and distribution to those caused by goldthioglucose or bipiperidyl mustard. When compared to closely-related analogs, the biological activity of each of these three compounds is determined by a highly specific chemical structure, yet they have no structural similarities to each other. These data cast doubt on the theory that goldthioglucose causes lesions and, eventually, obesity by binding to a hypothalamic glucoreceptor. Alternatively, the localization of brain damage in hypothalamus and medulla has been attributed to proximity to median eminence and area postrema, and to the lack of a blood-brain barrier in the latter structures. This theory is supported by our finding that artificial disruption of blood-brain barrier in the cerebral cortex induced the localization of necrosis from the triamine in that area. Furthermore, these experiments provide evidence for the role of ischemia in the development of necrotic triamine-induced lesions.
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PMID:Hypothalamic and medullary lesions caused by an aliphatic triamine unrelated to goldthioglucose. 679 73

Obesity is characterized by a number of cardiovascular alterations, and whether these alterations involve arterial compliance is unknown. In 12 young, obese, normotensive subjects (age, 23.9 +/- 1.3 years; mean +/- SEM) and 12 age- and sex-matched lean control subjects we measured blood pressure, radial artery diameter, and radial artery compliance continuously over the systodiastolic pressure range with a Finapres device and recently developed echo-tracking device. Measurements were obtained at baseline and after prolonged ischemia, that is, when diameter and compliance are increased. Blood pressure values were normal in both groups (obese subjects: 109.2 +/- 4.9/68.2 +/- 2.7 mm Hg; lean control subjects: 108.2 +/- 4.1/60.7 +/- 3.8 mm Hg), but in addition to a marked increase in body mass index (38.5 +/- 0.8 versus 23.1 +/- 0.9 kg/m2, P < .01), obese subjects showed a slight and nonsignificant increase in heart rate (71.1 +/- 3.2 versus 66.7 +/- 3.3 beats per minute, P = NS), increases in left ventricular wall thickness and left ventricular mass index (121.5 +/- 4.8 versus 103.4 +/- 3.3 kg/m2, P < .01), no changes in plasma renin activity and plasma norepinephrine (compared with normal values), and a marked reduction in total body glucose uptake (glucose clamp technique). Obese subjects showed radial artery diameter and compliance values that were greater than those seen in control subjects throughout the systodiastolic pressure range. The differences were 13% (P < .05) and 96% (P < .01), respectively, and both diameter and compliance remained higher in obese than lean subjects after forearm ischemia. In obese and lean subjects baseline radial artery diameter values correlated highly with body weight, body surface area, and body mass index.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Radial artery compliance in young, obese, normotensive subjects. 749 Jan 59

The metabolic syndrome is discussed in terms of insulin resistance linked to an increased regulation of metabolism by cortisol and fatty acids. This change in hormonal balance is associated with diabetes, android (visceral) obesity, hypertension, hypertriglyceridemia, hyperapobetalipoproteinemia and low concentrations of HDL; a cluster of risk-factors that predisposes to the development of premature atherosclerosis. It is proposed that the metabolic syndrome is accompanied by a derangement in the hypothalamic-pituitary-adrenal-axis such that the effects of cortisol are exaggerated relative to those of CRF. Excessive action of fatty acids and cortisol causes insulin resistance and increase the hepatic secretion of glucose and VLDL. Furthermore, cortisol can decrease the uptake of LDL by the liver. Cortisol in the presence of relatively high insulin concentrations can promote the deposition of energy and lead to obesity. Chronic treatment of rats with D-fenfluramine has been shown to decrease the release of cortisol and fatty acids in response to stress, and to improve insulin sensitivity. The effects of D-fenfluramine were also tested in male JCR:LA corpulent rats which are prone to develop atherosclerosis and myocardial lesions. D-fenfluramine improved insulin sensitivity, decreased the hypertriglyceridemia, and prevented the development of necrotic myocardial lesions caused by ischemia. The data presented demonstrates a link between excessive action of cortisol and fatty acids in predisposing to insulin resistance and the pathologies that are associated with the metabolic syndrome.
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PMID:Role of glucocorticoids and fatty acids in the impairment of lipid metabolism observed in the metabolic syndrome. 755 May 41

The effects of warm ischemia were investigated in obese Zucker rats with severe hepatic steatosis in order to develop a nontransplant fatty liver ischemia model. Obese (Ob) and lean (Ln) Zucker rats were subjected to in vivo partial hepatic warm ischemia of 45 or 90 min. Injury was assessed by serum alanine aminotransferase, animal survival, and liver histology. Liver lipids were quantified in control animals. After 90-min ischemia and 2-hr reperfusion, liver malondialdehyde was measured and neutrophils in 12 microscopic fields were counted after esterase staining. After 45 and 90 min of ischemia, Ob animals had significantly higher alanine aminotransferase at 1-hr and 24-hr reperfusion, compared with Ln animals (P < 0.01). After 90 min of ischemia, none of the Ln and 8/9 Ob animals died within 48 hr (P < 0.01). Histologically, Ob animals had more hepatocyte necrosis than did Ln animals. Hepatic neutral and phospholipid content (mg/g) in Ob versus Ln animals was 45.2 +/- 2.6 versus 8.2 +/- 0.7 (P < 0.01) and 36.2 +/- 1.9 versus 27 +/- 2.2 (P < 0.05), respectively. After reperfusion, liver malondialdehyde content increased significantly in Ob animals (8.5 +/- 0.4 vs. 12.3 +/- 0.8 pM/mg protein; P < 0.05), but not in Ln animals. Neutrophils, scant in control livers, increased significantly (P < 0.01) after ischemia/RP, but it increased to a similar degree in Ob and Ln animals. Obese Zucker rats with hepatic steatosis are more susceptible to warm ischemia/reperfusion injury than lean animals, and lipid peroxidation may be an important contributory mechanism. Further studies in this model might help to investigate the human problem.
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PMID:Studies of hepatic warm ischemia in the obese Zucker rat. 770 52

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

Reduced plasma concentrations of high-density lipoprotein cholesterol (HDL-C) are a risk factor for coronary artery disease (CAD). In this study, we examined the sequential effects of an isocaloric American Heart Association (AHA) step I diet and a hypocaloric AHA step I diet (AHA step I diet + weight loss) on lipoprotein lipid levels in 14 middle-aged and older (60 +/- 6 years, mean +/- SD) obese (body mass index [BMI] > 27 kg/m2) nondiabetic men with exercise-induced silent myocardial ischemia (SI) and reduced HDL-C levels (0.85 +/- 0.14 mmol/L). Nine men of comparable age and obesity and with no evidence of exercise-induced ischemia that were evaluated longitudinally served as metabolic controls. In men with SI, after 3 months on the isocaloric AHA step I diet plasma triglyceride (TG) levels decreased by 26% (2.25 +/- 0.66 to 1.67 +/- 0.69 mmol/L, P < .005), cholesterol by 12% (5.24 +/- 0.84 to 4.62 +/- 0.78 mmol/L, P < .01), and low-density lipoprotein cholesterol (LDL-C) by 10% (3.40 +/- 0.69 to 3.05 +/- 0.70 mmol/L, P < .01). However, plasma HDL-C levels also decreased by 7% (0.85 +/- 0.14 to 0.79 +/- 0.13 mmol/L, P < .05). Subsequent weight loss (11 +/- 4 kg) in conjunction with the AHA step I diet resulted in an additional decrease of 24% in TG (P < .005), 10% in cholesterol (P < .05), and 10% in LDL-C (P < .05). Plasma HDL-C levels increased by 8% (P < .01), thereby correcting the decline seen on the AHA step I diet alone.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of an American Heart Association step I diet and weight loss on lipoprotein lipid levels in obese men with silent myocardial ischemia and reduced high-density lipoprotein cholesterol. 788 74


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