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

Seventeen patients were operated on with intestinal shunts for morbid obesity, in eight a biliointestinal bypass (BI) was constructed and in the rest a conventional jejunoileal (JI)-shunt. The reduction in weight was similar in both groups, and so was malabsorption of fat, but the BI-group had significantly less bowel motions with less watery diarrhoea. Bile acid malabsorption was measured both chemically by estimating the total amount of faecal bile acids excreted, as well as indirectly by using a 75Se-labelled synthetic bile acid (SeHCAT). Both techniques revealed a substantial loss of bile acid after both types of operation, but patients with BI bypass surgery had significantly lower elimination time of the bile acid than those with JI-shunts. There was a significant negative correlation between SeHCAT retention and total faecal bile acids. However, some patients with low SeHCAT retention had normal or even reduced output of faecal bile acids. Estimation of faecal bile acids may display false negative results when the bile acid pool is decreased. The SeHCAT-test seems to be a better technique for measuring bile acid losses. The study suggests that BI bypass surgery for obesity seems to be advantageous over the JI shunt in reducing the postoperative loss of bile acids and choleretic diarrhoea, without influencing the weight loss.
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PMID:Bile acid malabsorption after intestinal bypass surgery for obesity. A comparison between jejunoileal shunt and biliointestinal bypass. 231 16

Gastric-restrictive operations for the treatment of morbid obesity are well established. Postoperative stricture is one complication of this procedure. In a large obesity practice, 40 patients presented with this complication. The authors reviewed retrospectively the management of these strictures, using endoscopic dilatation. All patients were morbidly obese, defined as greater than 100 pounds more than ideal weight. The original gastric-restrictive procedure included vertical-banded gastroplasty (35 patients); revision vertical-banded gastroplasty (2 patients); and revision of gastric bypass to vertical-banded gastroplasty (3 patients). Three methods were used: dilatation with endoscope, balloon dilatation, and Savary-Guilliard dilatation. Twenty-seven patients became asymptomatic after dilatation (68%). Occasionally, multiple dilatations were necessary. In 13 patients (32%), dilatation was unsuccessful and revision surgery was needed. In early postoperative (6 to 12 weeks) stricture, dilatation with the endoscope was often successful. When strictures were associated with an angulated channel, dilatation was almost uniformly unsuccessful. In summary, endoscopic dilatation for postgastroplasty strictures is a useful and effective technique, obviating the need for operative revision in the majority of patients; however, when the stenosis is associated with channel angulation, dilatation is almost uniformly unsuccessful. Such patients should not be subjected to repeated dilatation but rather proceed promptly to revision surgery.
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PMID:Strictures following gastric stapling for morbid obesity. Results of endoscopic dilatation. 231 38

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

The Garren-Edwards Gastric Bubble (GEGB) was introduced in 1984 as an alternative to surgery (jaw wiring, gastrointestinal bypass, vertical banded gastroplasty) for the treatment of morbid obesity in patients who had failed behavior modification therapy or dietary management for weight reduction. Its mechanism of action is unclear and previous reports have not demonstrated any significant consistent alteration in gastric emptying (GE) as measured by radionuclide techniques. Other proposed mechanisms include: placebo, hormonal, mechanical "satiety", behavioral modification, and neuronal. In order to determine the effect of the GEGB on GE, ten obese (mean % overweight = 89%) patients, 27-50 yr old (mean = 36 yr), had solid GE scans before and 5 wk after endoscopic placement of the bubble. GE scans were performed in six patients after removal (12 = wk residence time). The meal consisted of 300 microCi [99mTc]sulfur colloid in the form of a 300 kcal egg sandwich (egg white 248 g, white bread 40 g, butter 6 g; composition = CHO 40:PR 40: FAT 20) with 180 ml deionized water. Images were obtained in the anterior and posterior projections at 15-min intervals for 1 hr (four patients) or 2 hr (six patients) and the %GE (decay corrected geometric mean) was calculated. Unlike other studies involving the GEGB, adjunctive therapy in the form of dieting and behavior modification were not employed in this study. The effect of the GEGB alone in the treatment of obesity has not been previously evaluated. There was a significant (p less than 0.025) delay in gastric emptying at 1 hr (pre-bubble mean % gastric retention = 46%; bubble mean = 57%; n = 10). After removal, GE returned toward baseline (mean % gastric retention = 51%; n = 6) (p less than 0.05) (Student's t-test). The average weight loss was 5.5 lb (n = 10; p less than 0.025). One mechanism of action of the GEGB may be delayed gastric emptying resulting in early satiety and decreased food intake with resultant weight loss.
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PMID:Effect of the Garren-Edwards gastric bubble on gastric emptying. 271 31

Obesity continues as before to be a widespread condition. Obesity is defined as a body weight of over 120% of the ideal weight, corresponding roughly to the 85th percentile of the weight distribution. According to the "Build Study" (1979), the ideal weight is assumed to be rather higher than formerly; in men it is 8%, in women 6% less than the so-called normal weight. The latter corresponds roughly to the average weight and is defined as: height (cm) minus 100 in kg. In obese subjects both somatic and psychological complications arise; these are related exponentially to the degree of overweight. More recent findings in the Framingham Study show that obesity leads to coronary heart disease and premature death independently of the classical risk factors. Evaluation of the patient should include a personal and familial history of the obesity, together with individual eating habits and the degree of physical activity indulged in. As assessment should be made of the body fat distribution (android or gynoid obesity); android obesity carries a relatively high risk. Complications should be looked for, together with other risk factors for arteriosclerosis. Treatment depends on the severity of the condition and on the motivation. In general, it should consist of a moderate reduction in the caloric value of the food intake together with advice on eating habits and an increase in bodily activity. Group therapy often gives good results on account of the dynamic interactions within groups. Patients with morbid obesity will profit from a very hypocaloric, "ketogenic" diet (ca. 600-700 kcal/day). One of the author's own studies showed that a very hypocaloric diet resulted in mood elevation and a reduction in the need for sleep. Conservative measures such dietary weight reduction, changes in eating habits and encouragement of bodily activity are to be preferred to surgical treatment (eg, gastric stapling). Weight reductions in hospital do not lead to a change in eating habits and are therefore of doubtful value; drug therapy as a form of long-term treatment is likewise of questionable usefulness.
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PMID:[Evaluation and treatment of obesity in clinical practice]. 274 Nov 31

A report is presented on 82 gastric bypass operations performed from 1979 to 1988. The average preoperative body weight was 132 kg, the body mass index (BMI) 45.0 +/- 7.0. 1 patient died (mortality 1%). 88 per cent of all patients were followed up 2 months to 9 years (2.5 years on average) postoperatively. The mean weight loss was 40.8 kg (reduction of BMI 15.1). Obesity-related diseases decreased remarkably, 3 stomal ulcers and 5 cases of anemia occurred as late complications. On the basis of these results gastric bypass is shown to be an effective and safe treatment of morbid obesity.
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PMID:[Gastric bypass in the management of morbid obesity]. 281 77

Pancreatic islet peptides, as well as other gastrointestinal hormones, have been implicated in both the pathogenesis of obesity and the etiology of associated metabolic derangements. This study evaluated the pancreatic islet and gastrointestinal (GI) hormone response to oral glucose in 20 morbidly obese (151% above ideal body weight) patients. Glucose intolerance, hyperinsulinism, and exaggerated gastric inhibitory polypeptide (GIP) release occurred following glucose ingestion. Significant release of PP occurred in 14 patients, while only six patients had release of somatostatin. No significant changes in plasma concentrations of glucagon occurred. Since GIP is insulinotropic in the presence of hyperglycemia, the hyperinsulinism of morbid obesity may be secondary to the abnormally high glucose-stimulated GIP levels in these patients. Failure of glucagon suppression in response to oral glucose many contribute to the hyperglycemia noted. Somatostatin and pancreatic polypeptide may be responsible for some of the metabolic derangements of morbid obesity.
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PMID:Pancreatic islet hormone response to oral glucose in morbidly obese patients. 286 Aug 76

The prevalence of fatty liver disease at autopsy ranges from 40% to 80% in Europe and North America, and liver injury tests are abnormal in up to 8% of healthy populations. Liver injury tests were therefore examined in a group of 325 workers without exposure to hepatotoxins to identify the influence of obesity and gender. Obesity was a strong predictor of the degree of abnormality for serum levels of arginine and alanine aminotransferase and of alkaline phosphatase, even in the normal range. Women generally demonstrated lower levels of these enzymes. Workers with morbid obesity were substantially more likely to have abnormal liver injury tests. Obesity and gender must be considered in the interpretation of abnormal liver injury tests in hazardous waste workers.
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PMID:Liver injury tests in hazardous waste workers: the role of obesity. 291 8

Gastric banding for morbid obesity was performed on 73 patients between April 1983 and December 1986. Early complications occurred in 16% and late complications in 15% of the cases. A second operation was performed on 12 patients, with removal of the band in 11 (15%). Initial weight loss was rapid. Re-examination of 67 patients indicated that this initial loss was followed by a time-related weight gain. Weight reduction occurred as a fairly constant proportion of preoperative weight, irrespective of the degree of obesity. Weight loss to body mass index less than or equal to 30 seems to be a realistic expectation only for moderately overweight patients, not for the hyperobese. Older patients had least weight loss. The data suggest that dietary restrictions will still be needed after gastric banding.
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PMID:Gastric banding in the treatment of morbid obesity. Factors influencing immediate and long-term results. 292

To determine the sensitivity and specificity of standard electrocardiographic criteria for left ventricular (LV) and right ventricular (RV) hypertrophy in morbid obesity, resting electrocardiograms and M-mode echocardiograms were obtained in 65 patients whose actual body weight was more than twice their ideal body weight and who were free from hypertension and organic heart disease not directly attributable to obesity. Electrocardiographic criteria for LV hypertrophy were tested using increased LV wall thickness, LV enlargement and increased LV mass (all determined echocardiographically) as diagnostic standards. Electrocardiographic criteria for RV hypertrophy were tested using echocardiographic RV enlargement or RV hypertrophy as a diagnostic standard. Sensitivity values for the electrocardiographic criteria for LV hypertrophy ranged from 0 to 13%, 0 to 20% and 0 to 12% using echocardiographic increased LV wall thickness, LV enlargement and increased LV mass, respectively, as diagnostic standards. Specificity values ranged from 73 to 100%, 87 to 100% and 83 to 100%, respectively, using these diagnostic standards. Sensitivity values for the electrocardiographic criteria for RV hypertrophy ranged from 0 to 16% and specificity values ranged from 95 to 100%. Combining electrocardiographic criteria within groups did not appreciably increase sensitivity and often decreased specificity to unacceptably low levels. The electrocardiogram is very limited in its ability to detect ventricular hypertrophy and chamber enlargement in morbidly obese patients.
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PMID:Sensitivity and specificity of electrocardiographic criteria for left and right ventricular hypertrophy in morbid obesity. 296 39


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