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

Obesity, especially morbid obesity, is reported to be a relative contraindication to laparoscopy. A technique for trocar introduction and laparoscopy of the obese patient to eliminate this contraindication is described. The technique presented herein differs from the traditional method by: 1, primary trocar entry at a 90 degree angle to the horizontal plane, and 2, confirmation for intraperitoneal position of the instruments before creating the pneumoperitoneum. A retrospective study was done to compare demographic, medical and surgical data of obese and non-obese patients. No important differences were found and it was also found that obesity was not a relative contraindication to laparoscopy. Obesity was defined by a ponderal index of less than 11.7. No operative complications were found for the 344 obese patients studied and all laparoscopy procedures were completed as intended. These differences in technique can avoid the pitfalls commonly reported concerning laparoscopy of the obese patient.
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PMID:Trocar introduction performed during laparoscopy of the obese patient. 358 28

The long term ingestion of a sugar-rich diet (low fat) caused severe obesity in adult rats. In a separate experiment, the habitual consumption of a fat-rich diet (40% kcal from fat) also caused severe obesity. Severe obesity developed in both groups of animals even though they did not overeat. Voluntary food intake for the sugar-fed rats averaged 28,314 +/- 756 calories/rat per 55 wks which was similar to the value of 28,884 +/- 953 calories/rat per 55 wks for the fat-fed rats. However, both values were lower than that of 32,869 +/- 588 for the control rats eating Purina chow. Despite a lower caloric intake, carcass fat averaged 45 +/- 1% for rats eating the sugar-rich diet and 46 +/- 2% for rats eating the fat-rich diet, but only 33 +/- 2% for rats eating a diet of Purina chow. These results provide evidence that severe obesity can develop in the absence of hyperphagia in animals eating a sugar-rich or fat-rich diet. Finally, a rat model for severe obesity is presented in which carcass fat ranged from 18% (lean) to 61% (severe obesity) using dietary intervention alone at critical stages of the animal's life.
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PMID:Effects of dietary sugar and of dietary fat on food intake and body fat content in rats. 362 94

Morbid obesity is a disease of modern society. Surgery is indicated when there is no endocrinopathy, medical treatment failed and Body Mass index (W/H2) is more than 40 (III degree obesity of Garrow). Many different methods were suggested in connection with the type of obesity, the associated diseases and the psychical state of the patient. Jejuno-ileal by-pass intend to produce a generic malabsorption syndrome. Personal experience is however good, possibly due to the blind loop jejunostomy that we always prepare as a conclusion of the operation and which gives an excellent support for the early post-operative time.
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PMID:[Surgical treatment of obesity]. 365 20

19 patients underwent a subtotal gastric bypass following Griffen as the treatment of their morbid obesity. All patients had a complete follow-up ranging from 18 to 36 months. All patients had a weight reduction, into the proposed norms, f.i. below 20 to 30% above the ideal body weight. The sequelae of the obesity disappeared progressively with the weight reduction. Two patients however developed an anastomotic ulcer more than one year after the intervention (11.2%-2/19 patients). 21 patients died of a leakage after Mason-plasty (1/40 patients-2.5%). A minimal morbidity and mortality can only be obtained by using a meticulous operative technique and a team approach of the patient by medical, nursing, dietary and physiotherapist staffs.
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PMID:[The surgical treatment of exogenous morbid obesity]. 366 Sep 99

Morbid obesity is often associated with severe respiratory insufficiency, commonly known as the pickwickian syndrome. This can be divided into the following two primary breathing disorders which can affect patients alone or in combination: the obstructive sleep apnea syndrome (SAS); and the obesity-hypoventilation syndrome (OHS). Thirty-eight (14 percent) of 263 morbidly obese patients with respiratory insufficiency of obesity underwent gastric surgery for weight reduction. Ten had OHS, nine has SAS, and 19 had both. Of these patients, one died of postoperative complications, one died at five weeks with an inconclusive autopsy, one was lost to follow-up, and the time since surgery was too short (less than three months) in three. A total of 30 patients lost 45 +/- 25 percent (p less than 0.0001) of excess body weight within 3 to 12 months following surgery, when repeat pulmonary studies were done. Most patients continued to lose additional weight until two years, when they had lost 62 +/- 26 percent of excess weight. Nine patients failed initial surgery (gastroplasty); seven of these were successfully converted to gastric bypass. Weight loss was associated with a significant decrease in the percentage of sleep apnea from 44 +/- 15 to 8 +/- 11 (p less than 0.0001). In patients with OHS, the arterial oxygen pressure (PaO2) increased from 53 +/- 9 to 68 +/- 11 mm Hg (p less than 0.0001), and the arterial carbon dioxide tension decreased from 51 +/- 7 to 41 +/- 4 mm Hg (p less than 0.0001). Pulmonary function tests in the patients with OHS revealed significant increases, as a percentage of predicted normal, in the forced vital capacity, forced expiratory volume in one second, expiratory reserve volume, functional residual capacity, and total lung capacity. Secondary polycythemia, defined as a hemoglobin level greater than 16 g/dl associated with a PaO2 less than 60 mm Hg, was noted in 13 of 29 patients with OHS. This fell from 16.9 +/- 1.1 to 14.9 +/- 1.7 g/dl (p less than 0.001) after weight loss and improved pulmonary function.
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PMID:Gastric surgery for respiratory insufficiency of obesity. 372 Mar 90

In defining the therapeutic strategy the clinical evaluation of obesity relies on ideal body weight tables and the calculation of the body weight index (kg/m2). The distribution of fat tissue must also be considered, since the increased risk of cardiovascular disease appears to be associated with the android type of obesity. A number of factors influence the development of obesity, including heredity, energy balance and appetite, which is under physiologic and psychological control. A balanced hypocaloric diet remains the basic approach to weight control as it alone provides nutritional education. Under medical supervision, unbalanced diets, such as the protein-sparing modified fast, have been shown to be very effective. The surgical treatment of morbid obesity is controversial, although good results are claimed for gastroplasty. Whatever the approach, appropriate supportive measures must be included in order to modify behavior towards food and maintain weight loss.
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PMID:[Clinical approach to weight control]. 374 43

Gastroplasty, a newer form of surgery for morbid obesity, produces physical and psychosocial benefits equivalent to those of jejunoileal bypass, but with fewer complications. As interest in this approach to intractable obesity has increased, surgeons have looked to psychiatrists to help them to assess psychiatric risk associated with undergoing surgery. Drawing on a review of the literature and long-term experience with patients requesting gastroplasty, this review addresses the benefits of gastroplasty and offers suggestions about when and how to perform preoperative psychiatric evaluations in patients requesting surgery for obesity.
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PMID:Psychiatric evaluation in gastric surgery for obesity. 383 47

Fourteen patients originally presented with hyperphagia and intractable morbid obesity have had maxillomandibular fixation (MMF) applied in an effort to control their obesity. In 10 patients who were massively obese or considered poor risk candidates for surgical control of their obesity, MMF was applied with the aim of reducing the obesity to a level where a surgical gastric restrictive bariatric procedure could be safely carried out. Eight of these patients had been rejected for surgical control of obesity elsewhere and two were edentulous. Five of these patients after successful weight loss over periods from 16 to 40 weeks (mean percentage overweight lost 84.8, range 39-150) safely underwent a gastric restrictive procedure. All five patients have had continuous weight loss after bariatric surgery. Two patients requested removal of MMF 1 and 2 weeks after application. The remaining three patients, who were candidates for surgery, after successful weight loss over periods from 12 to 28 weeks (mean percentage of overweight lost 45, range 38-50) decided not to proceed with surgical control. All have subsequently regained the lost weight. Four originally morbidly obese patients, who had had a previously successful gastric restrictive procedure followed by weight loss, requested MMF in an effort to lose further weight. Over periods from 8 to 16 weeks three of the four had further weight loss (mean percentage of overweight lost 18.3, range 5-30). After removal of MMF all four patients regained some weight. In only one was there a significant maintenance of weight lost during MMF.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Jaw wiring in the treatment of morbid obesity. 386 88

A silicone collar containing circumferential tape was tied around the cardio-esophageal junction in eight patients with symptomatic, refractory reflux, who were not good candidates for a standard antireflux procedure. A fine polypropylene tie or clip secured the knot. In two patients with large hiatal defects, the crura were approximated loosely. Mean operating time, including one cholecystectomy and one ventral hernia repair, was 51 minutes. Patients who underwent this simple operation had a combination of hypertension, heart disease, obesity and old age, and two had undergone horizontal gastroplasty previously for morbid obesity. The reflux was associated with hiatal hernia in seven of the eight patients. Preoperative studies included barium swallow roentgenography in all eight patients, and endoscopy, manometry and Bernstein test in six. All the studies were repeated postoperatively. Follow-up ranged from 17 to 48 months (mean 37.8 +/- 10.6 months). Postoperatively, there was a significant (p less than 0.01) improvement in symptoms, endoscopic findings and lower esophageal sphincter pressures. No prosthesis has migrated yet.
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PMID:The Angelchik antireflux prosthesis. 397 Dec 43

Gastric emptying of a liquid meal was investigated with a radionuclide method before and 1 week and 3 and 12 months after gastroplasty operation for morbid obesity. Gastroplasty results in a small proximal pouch with a narrow stoma to the remaining stomach. The total gastric emptying was delayed 3 months after gastroplasty (p less than 0.01). Twelve months after gastroplasty, emptying of the proximal pouch was faster than at 3 months (p less than 0.01). This may indicate dilatation of the stoma between the two gastric pouches during this period. Surprisingly, the total gastric emptying 12 months after gastroplasty was not only faster than at 3 months but also faster than before surgery. The explanation, therefore, cannot only be attributed to a dilated stoma, and hormonal mechanisms may be involved. A lack of correlation between preoperative weight and emptying was observed, but because the material consists of only obese subjects, no conclusion can be drawn about the postulated role of gastric emptying in developing obesity. Emptying of the total stomach and of the proximal pouch failed to correlate with postoperative weight losses. The weight loss after gastroplasty evidently bears little, if any, relation to the postoperative changes in gastric emptying of liquids.
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PMID:Gastric emptying of liquid before and after gastroplasty for morbid obesity. 402 22


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