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

Between October 1967 and November 1977, the jejunoileal bypass was performed on 177 patients for morbid exogenous obesity. The female--male ratio was 9:1. The mean follow-up period was 3.4 years and their ages ranged from 15 to 58 years. Eighty-five per cent of this patient population base were between the ages of 21 and 49 years, and in 83% the onset of obesity was in childhood. Four parameters were used to assess the effectiveness of this procedure: 1) the ponderal index, 2) the per cent of ideal weight, 3) complications, and 4) diarrhea. Using the ponderal index, 38% of the results were excellent, 20% satisfactory, and 25% poor. When the per cent of ideal weight was used, the results were 24, 27 and 32% respectively. For complications, the results were 55, 23 and 5% and with diarrhea, 53, 22 and 8%. A summary of these mean values was 42.5, 23 and 17.5% for excellent, satisfactory and poor results. There were four deaths in this series, occurring 2--16 months postoperatively, due to sepsis, pulmonary embolism, drug overdose, and liver failure. Of the 28 patients (17%) requiring revision, eight were revised for inadequate weight loss, four for excessive weight loss, 15 for uncontrollable diarrhea, and 11 for metabolic electrolyte problems. In 14% the revision was required for multiple indications. A review of 100 of these patients to determine their response to the procedure revealed that 91% were able to recommend the procedure to other patients and intrepreted their results as being excellent in 51%, good in 36% and fair in 11%. Continued use of this procedure should be deferred pending much needed investigation of the associated complications.
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PMID:Jejunoileal bypass. Long-term results. 740 62

The development of postoperative deep vein thrombosis (DVT) was determined in 50 South Indian patients aged 50 years or more using the 125I-fibrinogen uptake technique. The overall incidence was 28 per cent. In patients with malignancy the incidence was 47.6 per cent. Predisposing factors such as varicose veins, oral contraceptives and obesity did not appear important. A retrospective analysis of post-mortem examinations performed on 432 patients dying after operation showed major pulmonary embolism to have occurred in only 1.9 per cent. The disproportion between the frequent occurrence of postoperative DVT and the infrequence of fatal pulmonary embolism warrants further study.
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PMID:Incidence of postoperative venous thromboembolism in South India. 742 43

Patients with morbid obesity have high rates of sudden, unexpected cardiac death. The mechanism of death in these patients is uncertain. Twenty-eight patients with morbid obesity (22 sudden cardiac deaths, 6 unnatural deaths) were compared to 11 age-matched nonobese patients with traumatic deaths. Heart weight, left ventricular cavity diameter, left and right ventricular wall thickness, ventricular septal thickness, epicardial fat thickness, and extent of coronary artery atherosclerosis were determined; myocyte size, nuclear size, and degree of interstitial fibrosis were calculated morphometrically. Mean heart weights in the patients with morbid obesity were increased but remained constant as a percentage of body weight. Of the gross parameters, only heart weight and left ventricular cavity size were independent predictors of obesity. Of microscopic parameters, only nuclear area was an independent predictor of obesity. Of 22 patients with morbid obesity, dilated cardiomyopathy was the most frequent cause of sudden cardiac death in (10 patients), followed by severe coronary atherosclerosis (6), concentric left ventricular hypertrophy without left ventricular dilatation (4), pulmonary embolism (1), and hypoplastic coronary arteries (1). The cardiomyopathy of morbid obesity is characterized by cardiomegaly, left ventricular dilatation, and myocyte hypertrophy in the absence of interstitial fibrosis. It is the most common cause of sudden cardiac death in these patients.
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PMID:Sudden death as a result of heart disease in morbid obesity. 763 12

Respiratory insufficiency is one of the most common and most serious complications of the postoperative period. Preexisting risk factors include cardiopulmonary disease, significant smoking history, obesity and advanced age. The risk of postoperative respiratory insufficiency is increased in emergency surgical procedures (particularly those related to trauma), procedures involving the chest or upper abdomen and procedures requiring prolonged anesthesia. Postoperatively, prolonged sedation or neuromuscular blockade, cardiovascular instability, respiratory problems and immobilization are important risk factors. Common clinical causes of respiratory insufficiency are atelectasis, aspiration, pulmonary edema and pulmonary embolism. Management strategies are directed at treatment of the cause of the insufficiency and restoration of pulmonary function. All surgical patients should be carefully assessed before surgery, monitored closely during and after the procedure, and aggressively treated to prevent or correct respiratory insufficiency.
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PMID:Postoperative respiratory insufficiency. 773 49

500 consecutive patients undergoing diagnostic coronary angiography were studied for vascular complications using either a conventional (n = 250) or a special mechanical device for compression dressing (n = 250). In both groups one case of arterial occlusion occurred. Using the conventional pressure dressing, we observed four pseudoaneurysms, whereas there were none in the special mechanical device dressing group (p < 0.05). In contrast, eight patients developed a deep vein thrombosis after mechanical device pressure dressing compared to only 1 venoust in the conventional dressing group (p < 0.02). Five patients, four of the eight patients with mechanical device dressing, suffered from clinical apparent pulmonary embolism (p = 0.1801). Thus, a mechanical device pressure dressing may decrease the number of arterial pseudoaneurysms but is associated with an increased risk of deep vein thrombosis and pulmonary embolism. Therefore, we recommend the use of the mechanical device pressure dressing only in selected patients with severe obesity.
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PMID:[Effect of a pressure dressing on angiologic complications after diagnostic coronary angiography]. 780 63

We report a case of sudden death in a 19-year-old adolescent male who had been receiving hospital treatment because of a persistent right calf pain which had started about 18 days previously. The pain had not been relieved by analgesics, and had extended to the right thigh. The post-mortem examination revealed that the cause of death was pulmonary embolism by thrombi which had arisen in the right calf veins. The bilateral pulmonary arteries were packed with thrombi, and many pulmonary branches were occluded with fresh thrombi. The right calf veins contained thrombi of differing ages. In old thrombi, massive collagen formation and hemosiderin granules were present but elastic fibers had not yet formed. Therefore, it was considered that the old thrombi had formed at the time of the patient's first visit to the hospital. The right calf pain for which the deceased had sought medical advice was considered to have been caused by the vein thrombosis. Although various risk factors for the formation of thrombi are known, in the present case no precedent causes other than obesity were identified.
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PMID:Sudden and unexpected death due to undiagnosed pulmonary thromboembolism in an adolescent male without previous history of trauma. 780 16

A descriptive term nonbacterial thrombotic endocarditis (NBTE) is used currently instead of the former name marantic endocarditis. The study describes 171 cases of NBTE encountered in autopsies over a period of 22 years (an incidence of 0.93% in adults). Malignancy was present in 59% of cases. Tumors relatively most frequently associated with NBTE were carcinomas of the ovaries, biliary system, pancreas, lung, and stomach. The vegetations were located mostly on the left-sided valves (mitral 64%, aortic 24%, both 9%). The involved valves were otherwise normal in 82%, and they were previously damaged in 18%. Systemic emboli from valvular vegetations occurred in 41% of patients, with splenic, cerebral, and renal circulations being most frequently affected. Pulmonary embolism was noted in 43%. The state of nutrition at autopsy was within normal limits in 35%; there was undernourishment or cachexia in 40%, and overweight or obesity in 22% of patients. The main pathogenetic factor in NBTE seems to be a state of hypercoagulation.
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PMID:[Nonbacterial thrombotic endocarditis--a study of 171 case reports]. 833 26

The pattern of postoperative pyrexia in Khartoum was prospectively studied in 260 patients who underwent a variety of surgical operations. Ninety four patients (36.1%) developed postoperative pyrexia. The commonest causes of pyrexia encountered were wound sepsis (10%), malaria (9.6%) and respiratory tract infection (7.3%). Less frequent causes were urinary tract infection, thrombophlebitis, intra-abdominal sepsis and deep vein thrombosis. In 14.6% of the patients, the cause of pyrexia was undetermined. The risk factors for postoperative pyrexia were the patient's age, diabetes mellitus, obesity, preoperative chest infection, smoking, duration of surgery, operator's surgical experience and urethral catheterisation. The postoperative pyrexia was associated with 7.4% mortality rate which was due to intra-abdominal sepsis and pulmonary embolism. The incidence of postoperative pyrexia can be minimised by adequate preoperative preparation, meticulous surgical technique and good postoperative care.
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PMID:Pattern of postoperative pyrexia in Khartoum. 862 71

Pulmonary embolism is the third most common acute cause of death in the United States. There are approximately 500,000 cases annually in this country, leading to death in 50,000. Subjective symptoms and objective findings can oftentimes be confusing and nonspecific. A pulmonary embolism is defined as an occlusion of one or more pulmonary vessels by material that has traveled there from outside of the lung and is usually caused by a dislodged thrombus that originated in the deep veins of the legs or pelvis. Risk factors include older age, prior thromboembolism, immobility, cancer, chronic disease, congestive heart failure, pelvic and lower extremity surgery, varicosities, obesity, and oral contraception. This article will discuss current modalities that are used in the evaluation of deep venous thromboembolism and pulmonary embolism and include ventilation/perfusion scan, ultrasonography, impedance plethysmography, pulmonary angiography, and newer tests including D-dimer assays and spiral computed tomography. Medical management including simple and complex decision making, anticoagulation, and thrombolytic therapy will also be discussed. An ounce of prevention is worth a pound of gold--identification of risk factors and the use of appropriate therapeutic measures can reduce an individual's risk for deep venous thromboembolism and pulmonary embolism.
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PMID:Clinical diagnosis and management of the patient with deep venous thromboembolism and acute pulmonary embolism. 871 Feb 57

In this retrospective investigation we carried out a thorough physical examination, ventilation/perfusion scintigraphy, echocardiography and lung function test in 19 of all 21 long-term survivors consecutively operated on for massive pulmonary embolism between 1968 and 1992. Two patients refused these investigations but were both asymptomatic. The mean follow-up was 8.4 years and 12 (57%) of the patients were in NYHA I and 6 (29%) in NYHA II. The three patients in NYHA III (there were none in class IV) underwent right heart catheterization and pulmonary angiography additionally. Our findings suggest that, generally, the results of scintigraphy, echocardiography, lung function tests and physical examination correspond to the subjective status expressed as NYHA (dyspnea) class, when evaluated in combination. However, in classes III and IV other causes of dyspnea apart from residual pulmonary vascular obstruction can be found. These may also occur in combination. We observed severe chronic obstructive lung disease, hemidiaphragmatic paralysis, obesity, pulmonary hypertension of unknown origin, atrial septal defect (ASD) and neurologic residual deficit with depressive state. Thus, in evaluating long-term results of pulmonary embolectomy with regard to vascular desobliteration, NYHA classification does not seem to be reliable for classes III and IV.
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PMID:Long-term follow-up in pulmonary embolectomy: is NYHA (dyspnea) classification reliable? 877 83


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