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

The authors survey 131 publications on the epidemiology of leg ulcers in the obese patient, by successively interrogating computer data banks. By analysing this information they aim to determine the frequency of obesity in a population of patients with stasic ulcers, to see whether the ulcer has particular clinical characteristics in the obese patient, and finally, to know whether obesity affects the speed with which the ulcer heals. The results are given and assessed.
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PMID:[Leg ulcers in the obese: data from the literature]. 306 95

We report a case of 47 years old patient who was admitted to hospital because of bilateral leg ulcers for 6 years. Chromosome analysis revealed XXY karyotype, confirming the clinical diagnosis of Klinefelter's syndrome. Testosterone level was low and Plasminogen Activator Inhibitor (PAI-1) was elevated. The patient was given androgen therapy which resulted in a normalization of the PAI-1 activity. The frequency of leg ulcers in patients with Klinefelter syndrome is between 6 and 12% according to studies. Different causes would explain the tendency towards leg ulcers in Klinefelter's syndrome: conjunctive tissues abnormalities were revealed in some studies. A higher frequency of venous insufficiency is reported in patients with Klinefelter's syndrome, either due to the particular morphology (obesity, taller size) or due to an androgen deficiency. A few arterial dysplasias cases of arteries's legs were described in patients with leg ulcers and Klinefelter syndrome. Haemostasis disorders presented in this case and normalized after androgen therapy will contribute to the physiopathologic discussion.
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PMID:[Leg ulcer and Klinefelter syndrome]. 854 3

This study was undertaken to see if the multiple pathology previously found in elderly patients with leg ulcers (other than the ulcer) differed in older and younger patients. A retrospective survey of the case notes of 42 consecutive patients (19 males, 23 females) admitted to a medically staffed leg ulcer clinic based in a geriatric day hospital was carried out. Twenty one patients were aged < or = 74 years (including seven aged < or = 59 years) and 21 aged > or = 75 years. Medical conditions known on referral and illnesses diagnosed during attendance were identified. The high incidence of disease in both age groups was identical, with 57% of patients with four or more diagnoses. No patient had no medical illness in addition to their ulcer. The commonest was cardiovascular disease followed by arthritis, obesity and endocrine disease. Nineteen per cent of all diagnoses were made at the clinic. Medical treatment, including drug reviews, in addition to compression bandaging and other local treatment, was found to be helpful for healing the ulcer. Medical input to leg ulcer clinics is therefore important.
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PMID:Medical pathology in patients with leg ulcers: a study carried out in a leg ulcer clinic in a day hospital for the elderly. 1259 85

Chronic ulceration of the lower leg is a frequent condition, with a prevalence of 3-5% in the population over 65 years of age. The incidence of ulceration is rising as a result of the ageing population and increased risk factors for atherosclerotic occlusion such as smoking, obesity and diabetes. Ulcers can be defined as wounds with a 'full thickness depth' and a 'slow healing tendency'. In general, the slow healing tendency is not simply explained by depth and size, but caused by an underlying pathogenetic factor that needs to be removed to induce healing. The main causes are venous valve insufficiency, lower extremity arterial disease and diabetes. Less frequent conditions are infection, vasculitis, skin malignancies and ulcerating skin diseases such as pyoderma gangrenosum. But even rarer conditions exist, such as the recently discovered combination of vasculitis and hypercoagulability. For a proper treatment of patients with leg ulcers, it is important to be aware of the large differential diagnosis of leg ulceration.
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PMID:Causes, investigation and treatment of leg ulceration. 1265 29

Obesity is a chronic multifactorial disease representing a major health problem. Among its consequences, diverse facets of the cutaneous physiology are altered. Some dermatoses are also more prevalent. The most typical ones are acanthosis nigricans, skin tags, signs of hyperandrogeny, striae distensae, stasis acroangiodermatitis, leg ulcers, lymphoedema and intertrigo.
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PMID:[Skin diseases and obesity]. 1269 6

The present article focuses on the prevalence and risk factors for varicose veins and the severe stage of chronic venous insufficiency (CVI). The evaluation was made by reviewing the results of specific well-designed studies performed on the general population (case-control studies, cross-sectional studies, and large case series). Data from the literature were compared with the results of a recent multicenter cross-sectional study in Poland, in which 40,095 individuals from 803 registers of primary care physicians were clinically examined and assigned a clinical CEAP class. Analysis of the associations between varicose veins or severe CVI prevalence and factors that are usually considered as representing a risk for the development of CVI was performed. In Poland, a prevalence of varicose veins and severe CVI (skin changes, leg ulcer) similar to that observed in the other developed countries was reported. It was more common in women, but female sex was not found to be a strong risk factor. Among the risk factors most closely associated with CVI were age, family history of varicose veins, and constipation, whatever the sex. This is in keeping with findings from recent epidemiologic studies. Obesity and lack of physical activity were strongly associated with CVI in women, more so than in men. The number of pregnancies (more than 2 pregnancies) significantly distinguished between women with and without CVI. Regarding these latter risk factors, the Polish results do not contradict the commonly held beliefs that are found in the literature. A modest association was found with female sex, previous injury in legs (DVT), and remaining in the standing position for a long time, although these parameters are usually among those mostly agreed as being risk factors. The role of the prolonged sitting position was not established. The Polish epidemiologic survey provided updated figures on the prevalence of and risk factors for varicose veins and severe CVI, using clear and globally accepted clinical definitions for the venous disease based on the CEAP classification.
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PMID:The influence of environmental factors in chronic venous insufficiency. 1293 54

Obesity is a chronic disease that is linked to the presence of numerous chronic illnesses, including venous disease. Venous disease can lead to chronic wounds, which may be exacerbated by vitamin, mineral, and macro-nutritional deficiencies. A cross-sectional observational design was used to examine the nutritional status of patients with chronic venous leg ulcers (VLUs) who are overweight or obese and to explore the relationship between nutritional status and severity of venous ulceration. Nutritional status was evaluated using anthropometric measurements, nutrient analysis from a 3-day dietary intake log, serum albumin, vitamins A and C, and zinc levels. Wound severity was assessed using the Leg Ulcer Measurement Tool (LUMT). Eight patients participated; six patients were men, and all eight patients were more than 50 years of age. Patients had an average daily caloric intake below their estimated caloric need. When compared with recommended daily intake levels, dietary nutrient intake was suboptimal for protein, vitamin C, and zinc. Serum levels were below normal for at least one of these nutrients in six patients. A positive correlation was found only between serum albumin, average daily intake, and percent recommended daily intake of protein (r(s) = 0.93, P = .003). An inverse relationship was found between LUMT score and serum vitamin A levels (r(s) = -0.83, P = .01), and a positive correlation was observed between LUMT score and serum vitamin C (r(s) = 0.74, P = .04). No clear relationships were shown among serum zinc, albumin, and LUMT scores. Overweight and obese patients with VLU show nutritional deficits that are similar to those of the broader population of patients with leg ulcers. The relationships found between vitamins A and C and leg ulcer severity warrant further exploration. The nutritional differences in the study need to be examined in a larger sample of overweight and normal-weight patients to determine whether overweight patients are at greater risk for prolonged VLU because of poor nutrition than non-overweight patients.
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PMID:Nutritional status and wound severity of overweight and obese patients with venous leg ulcers: a pilot study. 1849 57

The St Vincent Amazon parrot (Amazona guildingii), listed as a CITES appendix I animal, is endemic only to the mainland of St Vincent and the Grenadines (SVG), Lesser Antilles. A health assessment that included physical examination, hematology, blood parasite evaluation, plasma biochemical analysis, plasma protein electrophoresis, level of exposure to selected infectious agents, and fecal parasites was performed in July 2002 on 37 (51%) of the parrots in the captive population in SVG. Clinical abnormalities noted in the 37 parrots included poor feathers, lipomas, abnormal choanal papillae, obesity, leg ulcers, respiratory abnormalities, cardiac abnormalities, seizure activity, old fractures, missing digits, skin disease associated with mites (Knemidokoptes species), oral granuloma, and a thin, friable beak. Only 7 of the birds were clinically normal on physical examination. Results of hematologic testing, plasma biochemical analysis, and plasma electrophoresis were not statistically different between female and male parrots. No blood parasites were found in any of the 32 samples examined. None of the 36 parrots evaluated had antibodies to the 12 infectious agents tested. Of the 21 fecal samples available, Capillaria species was detected in 1 bird. Findings from this study, in addition to nutritional, genetic, and husbandry evaluations, have been used to make recommendations to the Forestry Department of SVG for improvements in husbandry and veterinary care of this ex situ population.
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PMID:Health assessment of the ex situ population of St Vincent parrots (Amazona guildingii) in St Vincent and the Grenadines. 1868 72

Telemedical wound care is one of the applications of teledermatology. We present our experience using telemedicine in the successful assessment and treatment of three patients with hard-to-heal ulcers. Three patients were seen at the PEMEX General Hospital in Veracruz, Mexico. The first patient was a 53-year-old man with hypertension, morbid obesity, chronic venous insufficiency, recurrent erysipelas, leg ulcers and lymphoedema. There was one ulcer on his left lower leg (20 x 10 cm) and one on his right leg (9 x 7 cm). The second patient was a 73-year-old woman with class III obesity and ulcers in her right leg, secondary to surgical debridement of bullous erysipelas. The third patient was a 51-year-old female with rheumatoid arthritis with one ulcer on each leg and chronic lymphostasis. Photographs with a digital camera were taken and sent weekly via email to a wound care specialist in Mexico City. The photographs allowed the expert to diagnose and evaluate the chronic wounds periodically. In the present cases, telemedicine allowed us to have a rapid evaluation, diagnosis and treatment. The images were of enough quality to be useful and small enough to be sent via regular email to the remote physician who immediately gave his feedback. The expert was confident to give therapeutic recommendations in this way, and we considered this method to be very cost-effective, saving the patient and the health care system, especially in transportation.
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PMID:Telemedicine in wound care. 1880 29

Varicose veins are twisted, dilated veins most commonly located on the lower extremities. Risk factors include chronic cough, constipation, family history of venous disease, female sex, obesity, older age, pregnancy, and prolonged standing. The exact pathophysiology is debated, but it involves a genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure. A heavy, achy feeling; itching or burning; and worsening with prolonged standing are all symptoms of varicose veins. Potential complications include infection, leg ulcers, stasis changes, and thrombosis. Some conservative treatment options are avoidance of prolonged standing and straining, elevation of the affected leg, exercise, external compression, loosening of restrictive clothing, medical therapy, modification of cardiovascular risk factors, reduction of peripheral edema, and weight loss. More aggressive treatments include external laser treatment, injection sclerotherapy, endovenous interventions, and surgery. Comparative treatment outcome data are limited. There is little evidence to preferentially support any single treatment modality. Choice of therapy is affected by symptoms, patient preference, cost, potential for iatrogenic complications, available medical resources, insurance reimbursement, and physician training.
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PMID:Management of varicose veins. 1906 22


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