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

A prospective study of 208 consecutive survivors of acute myocardial infarction was undertaken to determine the differences between Q- and non-Q-wave infarction, concerning data from the history, clinical course, and 6-month follow-up. There were 177 patients with Q-wave infarction and 31 patients with non-Q-wave infarction. There were no significant differences for the following variables: age, sex, diabetes mellitus, smoking, positive family history, hypertension, obesity, previous infarction, history of unstable angina, heart failure or chronic obstructive pulmonary disease (COPD), Killip class in the Coronary Care Unit (CCU), arrhythmias and conduction defects in the CCU as well as drugs used. Patients with non-Q wave infarction had a higher incidence of stable angina before the myocardial infarction and a lower value of creatine kinase (CK) and serum glutamic oxalacetic transferase (SGOT). During the 6-month follow-up, 9 cardiac deaths and 17 reinfarctions occurred, while 74 patients presented angina. There were no differences between the two groups concerning the incidence of cardiac death or angina, but patients with non-Q-wave infarction had a higher incidence of reinfarction at 6 months (p less than 0.001). We conclude that although patients with non-Q-wave myocardial infarction have a lesser degree of myocardial damage, they have a high incidence of early reinfarction which puts them in a high-risk group.
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PMID:Q- versus non-Q-wave myocardial infarction: clinical characteristics and 6-month prognosis. 671 48

To evaluate clearly the Marshall-Marchetti-Krantz cystourethropexy in defined populations we did a retrospective study of 151 women who underwent the procedure as a first attempt to correct stress incontinence. Of 140 patients for whom data were available 126 (90 per cent) were cured, 12 (8.6 per cent) were improved and 2 (1.4 per cent) failed. Preoperative cystoscopy was normal in 83 women (67.5 per cent). The most common abnormality was inflammatory change (82.5 per cent). Preoperative findings failed to correlate with postoperative irritative symptoms, indicating that surgical correction of documented mechanical instability is warranted. Concurrent medical problems, such as obesity and chronic obstructive pulmonary disease, were not associated with failures. Significant complications occurred in 11.4 per cent of the patients but there were no deaths. In view of a 90 to 98 per cent success rate with long-term followup (average 45.7 months) the Marshall-Marchetti-Krantz operation should be considered the procedure of choice in cases of primary stress incontinence. In addition, comparisons with other well defined groups and with modifications of the original procedure will be facilitated.
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PMID:Primary management of urinary stress incontinence by the Marshall-Marchetti-Krantz vesicourethropexy. 720 Jan 54

A sex-, age-, obesity, and protease inhibitor-matched study of pulmonary function and ventilatory control was performed on 26 sons of 19 patients with chronic obstructive pulmonary disease (COPD) and 26 control subjects. Mean values for FEV1/FVC and V25 were significantly lower and CV/VC was significantly higher in sons of patients than in the controls. VC, airway resistance, static pulmonary compliance. delta N2, arterial blood gases and pH were not different between sons and controls. When the sons of patients were divided into two groups according to the arterial blood gases of their parents, sons of hypoxemic, hypercapnic parents showed significantly lower hypoxic ventilatory responses than sons of normoxemic, normocapnic parents. Hypercapnic ventilatory responses were not different between sons and controls. Abnormal pulmonary function and low ventilatory responses were more frequently detected in sons than in controls. The association of smoking with abnormalities of pulmonary function was not clearly seen in sons. These results suggest that familial factors (either genetic or environmental) play a significant role in determining the pathogenesis and clinical types of COPD.
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PMID:Familial aggregation of abnormal ventilatory control and pulmonary function in chronic obstructive pulmonary disease. 722 84

A retrospective analysis was made of the case records of 1568 surgical patients admitted in 1975 to a tertiary care hospital in the Province of Newfoundland, to determine and classify the incidence of concurrent systemic disease. Almost 60 percent of patients had symptoms or signs of concurrent disease, the numbers increasing progressively from below 30 per cent at 21-30 years, to 90 per cent at ages 71-80. The predominant abnormalities were cardiovascular (60 per cent), followed by respiratory and metabolic conditions (41 and 40 per cent respectively). Detailed findings are presented, including those relating to the incidence of ischaemic heart disease and hypertension, to the coexistence of several diseases, to smoking and chronic obstructive lung disease, to obesity, to diabetes, and to alcoholism. This review documents the high incidence of concurrent disease in surgical patients and has implications for the training of anaesthetists and the organization of their work.
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PMID:Incidence of concurrent systemic disease in the surgical population of a tertiary care hospital. 723 6

Surgery and anaesthesia, including positioning and mechanical ventilation, encompass alterations in respiratory mechanics and gas exchange persisting through the postoperative period and may cause respiratory complications. The closer the anatomical ties between the surgical site and the respiratory system, the higher the pulmonary risks. Pre-existing respiratory and pulmonary diseases further increase the patient's risk. In addition to the numerous patients suffering from chronic obstructive pulmonary disease, patients with restrictive disorders, e.g. obesity, are concerned as well. Arterial oxygen saturation tracked by pulse oximetry is recommended for screening the respiratory system. Patients at an increased risk of respiratory complications should be scheduled individually for preoperative preparation, anaesthesia requirements, and postoperative management. When anaesthetizing patients with coexisting pulmonary disease, regional anaesthesia is preferred unless limited by the surgical procedure or for obvious technical reasons. Pasch provides recommendations for the management of anesthesia: Acute respiratory obstruction should be prevented by personal attention and pharmacological protection. Anaesthetics and relaxants with parasympathomimetic and histamine liberating effects should be avoided. Attention should be paid to hazardous pharmacological interactions with existing respiratory therapy. Bronchospasm should be avoided by deep anaesthesia and by smooth intubation and extubation. Pain therapy is an essential requirement for respiratory therapy in the postoperative period to maintain or to restore pulmonary function with improved performance.
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PMID:[The risk of anesthesia in bronchopulmonary diseases]. 780 90

The purpose of this study was to evaluate the effects of the alpha 1-blocking agent terazosin on blood pressure (BP) and blood lipids in a large, variant population of patients with hypertension. A total of 16,917 patients with hypertension were evaluated at 2214 primary and community care facilities; 7808 of these patients had not been treated previously for hypertension; 3928 were switched to terazosin from another antihypertensive agent; and 5181 received terazosin in addition to an agent that had not controlled their hypertension. Terazosin produced highly significant reductions in systolic (-18.2 +/- 0.2 mm Hg) and diastolic (-13.2 +/- 0.1 mm Hg) BP when used as monotherapy (mean dose, 3.1 mg; range, 2 to 10 mg) without causing a significant increase in heart rate. Equal antihypertensive efficacy was demonstrated in men, women, blacks, and whites of all ages, with particular benefit to elderly patients (> or = 65 years of age) with systolic hypertension. Comparative studies indicated that terazosin had equal antihypertensive efficacy in combination with diuretics, beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors. Patients who had not responded to monotherapy with one of these classes of antihypertensive drugs showed significant reductions of BP after terazosin, in the following average doses, was added to diuretics, 3.1 mg; beta-blockers, 3.4 mg; calcium channel blockers, 3.3 mg; and ACE inhibitors, 3.4 mg. Terazosin produced highly significant reductions in blood levels of total cholesterol (-5.0%), triglycerides (-6.1%), and low-density lipoprotein cholesterol (-7.6%) without change in high-density lipoprotein cholesterol when used as monotherapy. Similar favorable effects on blood lipid levels were demonstrated when terazosin was used in combination with all other classes of antihypertensive drugs. The greatest reductions in blood cholesterol (-9.2%) were observed among patients with hyperlipidemia (total cholesterol > or = 240 mg/dL). Terazosin maintained its antihypertensive efficacy and was well tolerated by patients with a variety of concomitant diseases, including congestive heart failure, peripheral vascular disease, chronic obstructive pulmonary disease, benign prostatic hyperplasia, diabetes, and obesity. Adverse effects occurred in 17.9% of patients and caused 2.2% to drop out of the study. The most frequent adverse effects were dizziness (4.8%), headache (2.5%), and asthenia (2.4%). Only 0.4% suffered syncope and 0.2% impotence. These data demonstrate the usefulness of terazosin as monotherapy or add-on therapy for treatment of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Alpha 1-blockade for the treatment of hypertension: a megastudy of terazosin in 2214 clinical practice settings. 792 16

The cardio-respiratory complications of sleep apnea syndrome have been prospectively assessed in 60 patients with massive obesity and free of chronic obstructive lung disease while the associated cardiovascular diseases and the alterations of pulmonary function were taken into account. These cardio-respiratory complications were observed only in patients with a number of apneas per hour of sleep greater than 20. The sleep apneas induced nocturnal hypoxemia that is frequently severe and independently correlated to the apnea index, diurnal hypoxemia and hypercapnia that are usually moderate, and presumably left ventricular hypertrophy that is not related to the development of daytime hypertension. However the nocturnal apneas were not associated with the development of an impairment of right or left ventricular function, or with the occurrence of cardiac arrhythmias or conduction disturbances. The absence of severe cardiac complications in this study may be related to the fact that the patients were relatively young and that the sleep apnea syndrome was diagnosed at an early stage of evolution. The findings of this study could help to define a more rationale approach in several therapeutic indications of sleep apnea syndrome.
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PMID:[Cardio-respiratory complications of sleep apnea in obese patients]. 822 Nov 69

We report 16 adult men (age, 41 to 75 yr) with neuralgic amyotrophy (NA) who presented with dyspnea due to involvement of the diaphragm. All patients developed breathlessness after a prodrome of acute severe neck and shoulder pain. Bilateral diaphragm paralysis (BDP) was confirmed in 12 patients and unilateral diaphragm paralysis (UDP) in four by the absence of electrical and mechanical responses to percutaneous phrenic nerve stimulation. Global expiratory muscle strength was well preserved in all patients, but inspiratory muscle strength was reduced in proportion to the extent of diaphragmatic involvement. Lung function showed low lung volumes with preservation of carbon monoxide transfer coefficient in all patients. Two BDP patients were hypoxic (PaO2 = 67 and 54 mm Hg, respectively) on daytime arterial blood gas analysis; the latter patient with pre-existing chronic obstructive pulmonary disease and marked obesity also had borderline hypercapnia (PaO2 = 49 mm Hg). Overnight sleep studies in three BDP and two UDP patients showed frequent intermittent arterial oxygen desaturations apparently caused by obstructive sleep apneas, but there was no evidence of alveolar hypoventilation. Follow-up muscle studies in five BDP and four UDP patients between 2 and 4 yr after initial referral showed complete recovery of diaphragmatic function in only two UDP patients, one of whom relapsed a year later. We postulate that NA may be an important but underrecognized cause of diaphragmatic paralysis in otherwise normal patients. Diaphragmatic strength returns very slowly, if at all.
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PMID:Diaphragmatic dysfunction in neuralgic amyotrophy: an electrophysiologic evaluation of 16 patients presenting with dyspnea. 842 Apr 34

Some conditions that predispose to ventilatory failure increase the work of breathing (chronic obstructive pulmonary disease [COPD], obesity, kyphoscoliosis), whereas others cause severe respiratory muscle weakness. Specific reasons for muscle weakness include critical illness (electrolyte imbalance, acidemia, shock, sepsis), chronic illness (poor nutrition, cachexia), and neuromuscular diseases. Inspiratory muscle weakness from mechanical disadvantage to the diaphragm is characteristic of asthma and COPD. The increased work of breathing combined with muscle weakness increases the pressure needed to inspire a breath and decreases maximal inspiratory pressure. When this pressure exceeds 0.4, dyspnea and inspiratory muscle fatigue ensue. One way to lower this pressure and avert fatigue is to lower the tidal volume. Ventilatory drive is high, not low, in ventilatory failure. Concomitant shortening of inspiration and breath duration cause the small tidal volume and increased respiratory rate. Gas exchange is compromised by ventilation/perfusion imbalance, and the ratio of dead space to tidal volume is also increased by rapid, shallow breathing. Reduction in tidal volume minimizes dyspnea, but the small tidal volume is inadequate for gas exchange. Acute treatment of respiratory muscle failure involves respiratory muscle rest through mechanical ventilation and removal of noxious influences (infection, metabolic disarray), whereas chronic treatment involves rebuilding the contractile apparatus by nutritional repletion and training.
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PMID:Respiratory muscles and ventilatory failure: 1993 perspective. 850 1

Chronic alveolar hypoventilation may present in an insidious fashion with nonspecific manifestations. The clinician should be aware of the potential for developing this condition in patients with certain thoracic and systemic diseases. Once chronic alveolar hypoventilation is confirmed with arterial blood gas analysis, a systematic evaluation can often point to the underlying etiology. As sleep in affected individuals is often associated with marked worsening of gas exchange and may also contribute to worsening daytime cardiopulmonary dysfunction, polysomnography is often indicated to determine the severity of nocturnal aberrations and to look for coexistent obstructive sleep apnea. Therapy of chronic alveolar hypoventilation often focuses on elimination of the nocturnal deterioration in gas exchange, and recent applications of noninvasive positive pressure ventilation during sleep have proven useful in the management of individuals with obesity-hypoventilation syndrome, restrictive thoracic disorders, neuromuscular diseases and central causes for hypoventilation. It is unclear whether wide-spread application of nocturnal ventilatory support to patients with chronic ventilatory failure due to chronic obstructive pulmonary disease is of long-term benefit.
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PMID:Chronic alveolar hypoventilation: a review for the clinician. 856 Jan 27


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