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

The prevalence and mechanisms of daytime pulmonary hypertension were examined in 24 cases of obstructive sleep apnea syndrome (OSAS). All patients were free from chronic lung disease. They underwent pulmonary function tests and blood gas analysis in the sitting and supine position, hypercapnic ventilatory response test, exercise test and right heart catheterization. Elevation of mean pulmonary arterial pressure (m-PAP) above 20 mmHg was observed in 5 out of 24 cases (20.8%). The group with pulmonary hypertension (PG+: m-PAP = 22.2 +/- 2.7 mmHg) showed marked obesity (p < 0.001), significant decrease of supine FRC/TLC (p < 0.05), increase of supine CC/FRC (p < 0.01), decrease of supine PaO2 (p < 0.02) and desaturation during exercise (p < 0.05) in comparison with the group without pulmonary hypertension (PH-: 13.9 +/- 3.1 mmHg). m-PAP was positively correlated with %IBW and desaturation during exercise (p < 0.01, p < 0.02) and negatively correlated with supine PaO2 (p < 0.01). Various changes in pulmonary function and pulmonary hemodynamics due to obesity seem to lead to daytime pulmonary hypertension of OSAS.
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PMID:[Pulmonary function and pulmonary hemodynamics in obstructive sleep apnea syndrome]. 148 30

The records of 172 patients with repair of incisional hernia in 1976-1985 were reviewed. Follow-up data were collected with a questionnaire and the 40% of patients with symptoms were clinically re-examined. The follow-up time was 3 months to 12 years, mean 4.5 years. The median time between primary operation and first symptoms of incisional hernia was 7 months. Sex, age, smoking, chronic lung disease, obesity, fascial diastasis, site of hernia, surgeon's experience, closure method and suture material were among the factors evaluated as possibly causal. At the time of follow-up 34% of the patients had recurrent hernia. A multifactorial logistic regression analysis revealed obesity as the only factor clearly impairing the result of incisional hernioplasty--good in 87% of the patients with normal weight and in 61% of the overweight. Repeat hernioplasty was performed in 35 cases, but succeeded in only 17. In obese patients repair of an incisional hernia that does not cause serious symptoms is not indicated. More careful selection of patients would improve the results of incisional hernia repair.
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PMID:Results of incisional hernia repair. A retrospective study of 172 unselected hernioplasties. 167 78

Between 1973 and 1977 169 patients underwent implantation of bifurcated prostheses for arterial occlusive disease. Perioperative and follow-up data 10-14 years after operation were retrospectively assessed. The angiologic status of living patients was compiled. Impact of following risk factors was investigated with multivariant analysis. Coronary artery disease, hypertension, smoking, diabetes mellitus, Pulmonary disease, renal insufficiency, obesity. Follow-up was 98.8%. Preoperatively over 90% of the patients investigated had been in grade IIb (Fontaine) or worse (33% grade IV). Early mortality was 5.3% (1973 = 15%, 1977 = 5.3%, 1987/1988 = 1.8%) and was mainly related to cardiopulmonary factors. Reoperation was necessary in 69 patients (149 procedures, no mortality, 38 amputations). Late mortality was 75% (120 of 160 patients) and mainly due to cardiac problems. The 10-year-actuarial-survival (37%) was reduced due to following combinations of risk factors: Myocardial infarction/smoking/obesity (n = 41) 17%, diabetes/smoking (n = 36) 17% hypertension/myocardial infarction (n = 24) 8%. Clinical condition of the living patients (n = 40) was: 48% grade I, 28% grade IIa, 18% grade IIb, none grade III, 8% grade IV. Long term results following implantation of bifurcated prostheses for arterial occlusive disease show, that quality of life is consistently improved. Reoperation is necessary in almost half of the patients due to the progressive disease. Late mortality is closely related to the underlying arteriosclerosis. Life expectancy of our patients does not significantly differ from the normal population and is probably a sequelae of the close follow-up.
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PMID:[Long-term results 10-14 years following implantation of Y-prostheses for arterial occlusive disease]. 203 1

Subacute bacterial endocarditis is associated with significant morbidity and mortality. Valvular destruction, congestive heart failure, embolic phenomena, failure of medical therapy, and death are all more common in patients with echocardiographically discernible valvular lesions. Transthoracic echocardiography is often unsatisfactory for evaluation of vegetations in patients with chest wall deformities, lung disease, obesity, or prosthetic valves. The transesophageal approach affords uniformly high-quality images with excellent structural resolution. We present a case of suspected subacute bacterial endocarditis in a patient with equivocal diagnoses of vegetations on three separate transthoracic echocardiograms in whom transesophageal evaluation revealed obvious large vegetations that involved the aortic and mitral valves. Subsequent autopsy confirmed this diagnosis. The case illustrates the utility of a new imaging method for the detection of valvular vegetations. In view of the prognostic implications of detected vegetations, transesophageal echocardiography probably should be performed on all patients with suspected subacute bacterial endocarditis and equivocal results by transthoracic study.
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PMID:Use of transesophageal echocardiography for improving detection of valvular vegetations in subacute bacterial endocarditis. 262 41

One hundred and sixty-one ASA physical status I-III patients undergoing elective surgery were evaluated using nasal catheters versus 40 per cent O2 venturi masks. Twenty-one per cent of the patients arrived in the recovery room with hypoxia as measured with a pulse oximeter (SaO2 less than 90 per cent). Fifteen minutes later all patients who arrived hypoxic were well oxygenated on their chosen oxygen therapy. Only one patient that arrived normoxic became hypoxic using a nasal catheter 15 minutes later. There was no statistical difference between patients given 40 per cent O2 by mask versus patients given oxygen by nasal catheter. The mean SaO2 for the group given 40 per cent O2 at 15 minutes was 96.7 +/- 2.15 per cent versus 96.6 +/- 2.48 per cent for nasal catheters. Nasal catheters are as effective as 40 per cent O2 masks for treating hypoxia in the recovery room. Obesity and age were statistically significant risk factors in the patients that arrived hypoxic. Patients were 47.4 +/- 15.6 years in the hypoxic group versus 38.3 +/- 15.6 years in the non-hypoxic group (p less than 0.001). Patients having an endotracheal tube with intermittent positive pressure ventilation or having a premedication were more apt to be hypoxic on arrival. These last two factors were closely associated and may reflect bias. The patient's gender, history of smoking, presence of obstructive lung disease, not including asthma, location of incision, or type of anaesthetic were not statistically significant risk factors.
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PMID:Recovery room oxygenation: a comparison of nasal catheters and 40 per cent oxygen masks. 264 49

Morbid obesity is a major health problem in this country and throughout the world. In addition to its social stigma (in the western world), obesity exacerbates several disease states such as diabetes, hypertension, cardiac disease and restrictive lung disease. When effective medical treatment of obesity becomes available, it will depend in part upon understanding the physiologic factors that control satiety. This review summarizes the information available on brain and gut control mechanisms of satiety. Brain nuclei located in the lateral hypothalamus, ventromedial hypothalamus, and other paraventricular areas are the sites of action for potent neuropeptides, such as cholecystokinin (CCK) and neuropeptide Y, that appear to regulate feeding. Exogenous CCK has been used clinically to decrease meal size in obese patients. The sites of the satiety cascade that are most often manipulated are the gastric and intestinal phases. Physiologic gastric distension is a potent inhibitor of feeding, whereas the intermeal interval may be regulated by intestinal signals released by food in the gut. Jejunal-ileal bypass has fallen from favor and has been replaced by gastric restrictive procedures that create a small proximal gastric pouch that empties into the small bowel (gastric bypass) or the distal stomach (gastroplasty). These operations rely partially on their ability to produce gastric distension in the proximal gastric pouch at an early stage during a meal. Thus, failure results if the pouch compensates by distending or if the stoma widens with subsequent loss of slow emptying. Improved medical and surgical treatment will be designed to intervene at specific sites of the satiety cascade as knowledge of the physiologic control mechanisms of satiety increases.
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PMID:Physiologic approaches to the control of obesity. 229 39

During breath holding, correlations have been demonstrated between the rate of fall of arterial oxyhemoglobin saturation (dSaO2/dt) and the following: thoracic gas volume at apnea onset, resting oxygen consumption, preapneic arterial oxyhemoglobin saturation (SaO2) and obesity. A key factor influencing dSaO2/dt is mixed venous oxyhemoglobin saturation (SvO2) as recently demonstrated in an animal model of obstructive apnea. The purpose of the present study was to see if dSaO2/dt was related to SvO2 during sleep in a group of subjects with severe obstructive sleep apnea (OSA) and varying levels of SvO2. Eight OSA subjects were studied during sleep with indwelling arterial and central venous catheters. Continuous SaO2 was measured by ear oximetry while continuous SvO2 was measured through the fiberoptic bundle of a Shaw Opticath catheter. Thirty percent or more of all obstructive apneas were scored for duration, preapneic SaO2, SvO2 and dSaO2/dt. Least squares regression was used to examine the relationship between dSaO2/dt and other measured variables. The dSaO2/dt showed a consistent negative correlation with preapneic SvO2 and was not related to duration. Mean dSaO2/dt during sleep correlated to some degree with the degree of gas exchange (Qva/Qt) abnormality prior to sleep. It is concluded that in humans, SvO2 plays a substantial role in determining dSaO2/dt. Potentially, the presence of gas exchange abnormalities (eg, found in intrinsic lung disease) causing hypoxemia and low SvO2 may steepen dSaO2/dt, lowering the nadir level of apneic desaturation for the same duration of apnea found in a patient with more normal gas exchange.
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PMID:The rate of fall of arterial oxyhemoglobin saturation in obstructive sleep apnea. 279 63

Fifty-five patients with obstructive sleep apnea syndrome (OSAS) were evaluated following inferior mandibular osteotomy with hyoid myotomy and suspension. Patients were objectively examined by polysomnography before and 6 months following the surgical procedure. Thirty-seven patients (67%) had a good response from surgery, and 18 patients (33%) were considered nonresponders. Lung disease, mandibular deficiency, and obesity were factors found to affect the success of surgical treatment.
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PMID:Inferior mandibular osteotomy and hyoid myotomy suspension for obstructive sleep apnea: a review of 55 patients. 291 51

The 247 eventrations operated upon concerned 230 patients (60% women and 40% men) mean age 54.5 years. Eventrations were large (collar greater than 10 cm) in 18, 5% and were in the median line in 81%. Serial laparotomies by the same approach had been performed in 21%, the principal causes of eventration being biliary and gynecologic surgery. Parietal sepsis developed in 31,5% of cases after operation for the original affection. Classical favoring factors found included obesity (51%), multiparity (42% of women) and chronic lung disease (14%). Preoperative preparation involved the use of Goni Moreno's progressive pneumoperitoneum in 18,5% of patients. Procedures used were parietal repair by raphe (22%), the same but with the addition of a dacron prosthesis (6%) or the large dacron tulle prosthesis for wide reinforcement of the visceral sac (67% of cases). Early sepsis was a slightly more frequent occurrence after dacron tulle, predisposing factors being the prosthesis itself, a previous history of parietal sepsis, swabs and the number of Redon tubes. After use of dacron tulle complications were mainly also hematoma (3.2%) and skin necrosis (2,6%). Postoperative course in general was uncomplicated in 91% of the 247 operations. Follow up of 67% of operated patients for a mean of 5 1/2 years showed recurrence in 50% of raphe procedures and 18.5% of prosthesis implantations; factors of aseptic recurrence (16,5%) were multiparity and chronic lung disease. Delayed sepsis after dacron tulle use affected 8% of patients and were related to chronicity of early sepsis, nonresorbable sutures and sepsis complicating the primary laparotomy. Doming of the parietal wall was noted in 4% of cases repaired by prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Postoperative eventrations. Apropos of 247 surgically treated cases]. 293 19

Factors related to risk of perioperative pulmonary complications include site of incision, obstructive lung disease, prolonged anesthesia time, smoking history with productive cough, and obesity. Hypercapnia is a consistent indicator of high risk. There is no difference between spinal and general anesthesia with regard to risk of pulmonary complications. In patients being evaluated for lung resection, high-risk indicators include predicted postoperative forced expiratory volume in one second of less than 1000 mL, hypercapnia, severe dyspnea on exertion, or advanced age when it is associated with advanced cardiopulmonary disease. Newer methods of assessing cardiopulmonary reserve may prove useful in identifying which patients with one or more of these risk factors are suitable operative candidates. Prevention of postoperative complications in chronic obstructive pulmonary disease patients should begin in the preoperative period with discontinuation of smoking at least eight weeks before surgery and vigorous pulmonary toilet in the 48 to 72 hours before surgery. Prophylactic lung expansion maneuvers can be effective in decreasing the incidence of postoperative atelectasis in high-risk patients undergoing high-risk operations.
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PMID:Preoperative pulmonary evaluation. 233 Nov 91


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