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

Thirty-four patients were studied 2--6 years after jejunoileal bypass for morbid obesity. The serum concentration of 25-hydroxyvitamin D (25-OHD) were reduced and related to the frequency fo stools and to the weight reduction. Fifteen patients were not able to normalize serum 25-OHD following a long-term regular vitamin D intake. The serum immunoreactive parathyroid hormone concentration (iPTH) and the alkaline phosphatase levels were elevated in this group, indicating a secondary hyperparathyroidism. The mean bone mineral content of the forearm was reduced 3--6 years after the operation, most severely in those with elevated serum iPTH. The desired weight reduction by jejunoileal shunt was obtained at the expense of a severely disturbed vitamin D metabolism. We suggest, that all patients with an intestinal bypass for obesity should receive regular vitamin D supplement, and serum 25-OHD should be measured in order to monitor the effect of therapy.
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PMID:Impairment of vitamin D and bone metabolism in patients with bypass operation for obesity. 28 17

One hundred one carefully screened morbidity obese patients underwent jejunoileal bypass and were followed closely over a mean follow-up period of 32 months. Although there were no operative deaths, three per cent of patients died postoperatively of liver failure or its complications. A fourth patient died of a pulmonary embolus after reoperation, and the fifth patient died cachectic with severe diarrhea after excessive weight loss. Nineteen per cent of the patients required restoration of intestinal continuity (reversal), most for either liver failure or late fluid and electrolyte derangements. All but two survived reversal and are doing well despite massive weight gain. Fifty-eight per cent of the patients had major complications which either required major reoperation (reversal, cholecystectomy or incisional hernia repair) or were potentially life-threatening (liver failure, hepatic fibrosis or urinary tract stones). As described in other series, abnormalities in serum electrolytes and vitamins were seen. In addition, hypovitaminosis D occurred in a number of patients and as with other serum parameters measured, was time-dependent in that improvement was seen in most patients over the postoperative interval studied. Because of the high rate of complications and reversals, we believe that jejunoileal bypass should be reserved for patients with morbid obesity whose lives are imminently threatened by obesity or its sequellae.
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PMID:Jejunoileal bypass for morbid obesity. A critical appraisal. 34 3

Sixty-six patients who had a jejunoileal bypass with ileosigmoidostomy for intractable obesity were reviewed. Thirty-three patients had sudden, severe, upper pain develop in the abdomen with distention from one to four years after the original operation. All 33 patients had a repeat laparotomy from one to six years after the initial bypass procedure. In every instance, a dilated, hypertrophied defunctioned ileum was found proximal to the ileosigmoidostomy. In 11 patients, an ileosigmoid volvulus was present. In every instance, the ileosigmoid anastomosis was dismantled and an end-to-side ileotransversostomy performed. In one patient, an ileal volvulus developed proximal to the ileotransversostomy because of an inadvertent technicality and this was corrected by reoperation. The remaining 32 patients have been asymptomatic since the ileosigmoidostomy was converted to ileotransversostomy. To date, in more than 200 primary operations for morbid obesity, the ileum has been drained into the transverse colon. None of these patients have had obstruction of the defunctioned small bowel develop.
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PMID:Jejunoileal bypass and the defunctioned bowel syndrome. 45 6

Dietary management of morbid obesity has been uniformally unsuccessful. although abdominal surgery is a drastic therapeutic modality, it may offer the only hope for many morbidly obese patients. In addition to producing weight loss in the vast majority of patients, metabolic complications of obesity have been markedly improved in the post-operative period. Metabolic complications of the procedure are many and varied, but in certain high risk patients the benefits may outweigh the risks.
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PMID:Jejunoileal bypass in the treatment of morbid obesity. 71 63

Obesity was found in 18% of 475 adolescents of both sexes by subtraction of lean body weight from whole body weight. Severe obesity is more frequent in male while lower degrees are more often seen in female adolescents. Obese youths are not only fatter than lean ones: their lean body weight is also higher, shoulders, chest and hips are broader. Their weight at birth was higher than that of none-obese subjects. Their mothers more often classify themselves as "well developed", "stout" or "fat"; the same is true for the fathers of obese girls but not for the obese boys' fathers. The results are discussed in context with the new findings of adipose tissue hyperplasia. It is felt that hereditary constitution of an individuum is of great importance in the development of obesity.
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PMID:[Constitution and obesity in adolescents (author's transl)]. 99 39

Failure of conservative methods of control of gross obesity has led to the adoption of surgical measures. The operation of intestinal bypass, may be associated with the number of unpleasant complications. As a result there has been recent interest in the operation of gastric bypass involving an 80 to 90 percent gastric exclusion procedure. We report on the results of our first 19 patients undergoing this operation, a six to 15 month follow-up. The early results would suggest that gastric bypass in the treatment of morbid obesity is likely to prove superior to the various forms of intestinal bypass.
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PMID:Gastric bypass for morbid obesity. 106 20

Sixteen extremely obese patients were anaesthetized for intestinal short circuiting operations. Severe obesity may cause pathological cardio-pulmonary changes. Cardiovascular alterations include increased systemic, pulmonary artery and pulmonary capillary venous pressure. Cardiac output, total blood volume and left ventricular work increase. Expiratory reserve volume and consequently functional residual capacity decrease with gross obesity. Functional residual capacity falls below closing volume and inspired gas may be distributed to non-dependent lung zones, resulting in decreased ventilation/perfusion ratios and arterial hypoxaemia. Low total respiratory compliance increases the oxygen cost of the work of breathing. Obesity may change the dose requirements for regional anaesthesia and long-acting muscle relaxants. General anaesthesia may also reduce functional residual capacity. We used a technique of anaesthesia which consisted of epidural analgesia with intra-operative mechanical ventilation and which specifically avoided volatile inhalation agents and long-acting muscle relaxants. All patients were extubated immediately after operation and returned to the recovery room for an average duration of 26 hours. Post-operative treatment included humidified oxygen, chest physiotherapy and elevation of the head of the bed to 45 degrees. Each patient's respiratory progress was monitored by repeated determinations of arterial blood gases and vital capacity and by serial chest X-rays. None of the patients in this group required post-operative tracheal intubation and mechanical ventilation.
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PMID:Anaesthesia for intestinal short circuiting in the morbidly obese with reference to the pathophysiology of gross obesity. 113 75

Severe liver dysfunction and even death from hepatic failure after jejunocolic anastomosis has led to the virtual abandonment of that procedure for the surgical treatment of massive obesity. This complication after the currently employed jejunoileal anastomosis has rarely been described before. We present two cases of hepatic necrosis and death after end to side jejunoileal anastomosis and compare the clinical data and liver function test results in these two patients with findings in 124 other patients who underwent a similar procedure for treatment of morbid obesity. No significant differences could be found that would allow early identification of those patients in whom massive hepatic necrosis was developing. Careful follow-up study and perhaps repeated liver biopsy may be necessary to monitor the hepatic status after jejunoileal anastomosis so that reanastomosis can be undertaken at a time when the damage may be reversible.
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PMID:Death from hepatic failure after jejunoileal anastomosis. 115 22

From 1975 to 1989, 97 patients with ulcer diseases and concomitant obesity were operated on at the Tashkent branch of the All-Union Scientific Surgical Centre, Academy of Sciences of the USSR. The patients with a gastroduodenal ulcer, II and higher degree of morbid obesity accounted for 2.4% of the total number of patients operated on for ulcer disease. Gastric ulcer was diagnosed in 20 patients, a duodenal one--in 77. All the patients were operated on for disease complications. Of them, 36 underwent Billroth-II gastric resection, the remaining patients--Billroth-I gastric resection and truncal vagotomy with drainage operation. The best immediate result was noted after performance of truncal vagotomy with drainage operation. Use of gastric resection in a given category of patients is accompanied by the development of a large number of local and general complications.
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PMID:[Immediate result of surgical treatment of ulcer disease in morbidly obese patients]. 128 36

The effects of impaired glucose tolerance and obesity, in isolation and in combination, on basal (postabsorptive) intermediary metabolism were examined in four groups of subjects (n = 10 for each) matched for age and gender: Group 1: Non-obese healthy controls with normal glucose tolerance (75 g); Group 2: Non-obese subjects with impaired glucose tolerance; Group 3: Morbidly obese subjects with normal glucose tolerance; Group 4: Morbidly obese subjects with impaired glucose tolerance. While there was no significant difference in fasting blood glucose concentrations between the four groups plasma immuno-reactive insulin concentrations were elevated (p < 0.01 or less) in the obese subjects relative to the non-obese subjects within each category of glucose tolerance. Basal immunoreactive insulin concentrations in non-obese subjects with impaired glucose tolerance were also elevated (p < 0.01) relative to the non-obese healthy controls. Concentrations of glycerol (p < 0.01), non-esterified fatty acids (p < 0.01), and total ketone bodies (p < 0.001) were significantly higher in the obese/normal glucose tolerance and obese/impaired glucose tolerance groups relative to their matched non-obese counterparts. Compared with the subjects with normal glucose tolerance, only lactate (p < 0.05) and pyruvate (p < 0.05) concentrations were elevated in the non-obese/impaired glucose tolerance and obese/impaired glucose tolerance groups, respectively. In conclusion, in addition to fasting hyperinsulinaemia the regulation of lipolysis and ketone body metabolism is abnormal in the basal state in morbid obesity. By contrast, despite normal fasting blood glucose concentrations, impaired glucose tolerance is associated with disturbances of other aspects of basal carbohydrate metabolism.
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PMID:Basal intermediary metabolism in impaired glucose tolerance and morbid obesity. 134 2


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