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

Snoring usually is trivial and unimportant, but it can turn into a social or medical problem. Obesity, hypertension and heart disease are more frequent among snorers than among nonsnorers, and especially snorers with hypersomnia during the day are at risk. Hypersomnia in association with snoring usually signifies obstructive sleep apnea. Increased resistance in the upper airways, together with negative inspiratory pharyngeal pressure and muscular hypotonia during deep non-REM and REM sleep, lead to collapse of the pharynx, hypoxia and hypercapnia. Only after arousal from sleep does muscle tone return, pharyngeal obstruction reopen and airflow resume. Since this process can occur 300 or 400 times a night, repetitive alveolar hypoventilation leads to pulmonary-arterial hypertension and cor pulmonale, and the repetitive sympathetic activations can cause systemic hypertension or serious cardiac arrhythmias. The countless arousals deprive the sufferer of deep non-REM and REM sleep and their consequence is sleep fragmentation. The symptoms are excessive daytime sleepiness, intellectual deterioration and personality and behavioral changes. Oronasomaxillofacial, endocrine and neuromuscular anomalies and diseases predispose to sleep apnea, and alcohol or CNS-depressant drugs can favour its occurrence. Diagnosis is made by nighttime oxymetry, and if this is abnormal, by polysomnography. After polysomnography it is possible to distinguish between obstructive and nonobstructive sleep apnea, and the decisions for an adequate treatment can be made.
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PMID:[Dangerous snoring. Sleep-apnea syndrome]. 331 92

The effectiveness of short-term peri-operative prophylaxis with cefotaxim (Claforan) in gynaecological and obstetric operations was prospectively tested in 764 women (randomized by day of week). The incidence of postoperative infectious complications after vaginal or abdominal hysterectomy was significantly lower in the cefotaxim group than the control group. The rate was also clearly lower after laparotomy without hysterectomy and after abdominal section, but the differences were not statistically significant. In the patients with risk factors, i.e. obesity, cardiopulmonary disease or after laparotomy, which in the control group were correlated with a significantly higher rate of infectious complications, cefotaxim prophylaxis significantly reduced the rate of complications too. There were no side-effects from cefotaxim.
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PMID:[Short-term perioperative prophylaxis with cefotaxim in obstetric and gynecological surgery]. 392 13

A child with respiratory failure and cor pulmonale secondary to the obesity hypoventilation syndrome (OHS) was found to have abnormal beta-endorphin levels in cerebrospinal fluid (CSF) and serum. A single iv dose of 10 microgram/kg of naloxone early in the course of respiratory failure resulted in dramatic improvement which lasted approximately 3 to 4 h. The patient failed to response to progesterone, and because of deteriorating respiratory status a low-dose continuous infusion of naloxone, 2 microgram/kg.h, was begun and gradually increased to 10 microgram/kg.h, during which time there was a dramatic improvement in respiratory status and clinical condition. After 5 days, naloxone infusion was discontinued and progressive respiratory deterioration recurred. The child died of over-whelming sepsis and disseminated intravascular coagulation.
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PMID:Narcotic antagonist therapy of the obesity hypoventilation syndrome. 628 52

Twenty-four patients, all of them over 15 years, with the Prader-Willi syndrome are described. Obesity, often extreme, associated with an insatiable appetite, was their principal handicap and this was made worse by educational subnormality and hypogonadism. Three of the them developed diabetes. Each attended a special school or an adult training centre. Although most of them were of short stature and had scoliosis, 2 were tall but they even more severely mentally retarded than is usually the case. Nine other patients died aged between 3 and 23 years. The most common cause of death was cor pulmonale.
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PMID:Prader-Willi Syndrome after age 15 years. 721 56

The relationship of level of baseline serum cholesterol to the seven-year incidence of death from all causes and from specific causes was examined in a cohort of 11,121 Yugoslav males aged 35--62 years at the time of their initial examination (1964--1965). Serum cholesterol was negatively related to mortality, i.e., those with a lower cholesterol experienced a higher mortality than those with a higher cholesterol. The negative relationship was significant (as assessed by logistic regression) and remained significant after adjusting for obesity, systolic blood pressure, cigarette smoking, age, history of intestinal parasitism, and socioeconomic status (as measured by years of education). The negative association of serum cholesterol and subsequent mortality appeared to be due to the relationship of cholesterol to deaths due to cancer and to deaths due to respiratory disease (tuberculosis and cor pulmonale). The cancer death-serum cholesterol relationship was not statistically significant but the respiratory disease death-serum cholesterol relationship was. Serum cholesterol, as expected, was positively related to the incidence of coronary heart disease death.
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PMID:Serum cholesterol and mortality: the Yugoslavia Cardiovascular Disease Study. 724 27

Improved case identification of children with upper airway obstruction during sleep should result if physicians are aware of such signs and symptoms as excessive daytime sleepiness, loud snoring, restless sleep, recurrent nocturnal enuresis, systemic and pulmonary hypertension, undergrowth or obesity, and cor pulmonale. Furthermore, partial airway obstruction during wakefulness may be a risk factor for the development of sleep apneas or hypopneas. In suspected cases, polysomnography is a useful method for confirming and quantitating the type (central, obstructive, or mixed) and extent of ventilatory disturbance during sleep and its functional significance (such as arterial oxyhemoglobin desaturation or cardiac arrhythmia). Other methods may be employed to yield similar data. There seem to be at least two groups of children reported in the literature, those in whom there is a specific surgically correctable lesion (such as adenotonsillar hypertrophy) versus those who eventually need tracheotomy because of collapse of upper airway musculature during sleep. In the latter group of children, it is necessary to hypothesize an additional defect in the CNS regulation of respiration during sleep. Further research is necessary to define the boundary between normal and abnormal breathing during sleep, and to understand more thoroughly the effects of intermittent hypoventilation on daytime functioning.
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PMID:Sleep disorders associated with upper airway obstruction in children. 731 58

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

Although obesity and trauma both are common in the general population, discussion of the care of the critically injured obese patient has been relatively absent. Obesity is associated with significant clinical and occult multisystem disease. Because host factors are key determinants of post-traumatic course and outcome, obesity appears to be a marker of high risk. Obesity should be considered with age, pregnancy, cardiopulmonary disease, and substance abuse as a host factor that has significant post-traumatic ramifications. Only by employing a comprehensive, multidisciplinary approach to the critical care management of such patients will post-traumatic complications be prevented and treated effectively.
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PMID:Obesity. 792 41

Recent studies have used preoperative cardiopulmonary exercise testing to improve risk assessment of pulmonary resection for lung cancer. These studies have demonstrated inconsistent correlation between peak oxygen uptake (VO2) and postoperative complications but have not systematically examined other methods of risk stratification. We analyzed the findings in 42 patients who had cardiopulmonary exercise testing prior to lung cancer resection. Preoperative clinical data combining pulmonary factors (obesity, productive cough, wheezing, tobacco use, ratio of the forced expiratory volume in 1 s over the forced vital capacity [FEV1/FVC] < 70 percent, and PaCO2 > 45 mm Hg), and an established cardiac risk index were used to generate a cardiopulmonary risk index (CPRI). When analyzed using the risk index, the incidence of postoperative complications increased with higher CPRI scores. Those with a CPRI of 4 or greater were 22 times more likely to develop a complication, compared to a CPRI of less than 4 (p < 0.0001). We found that patients with a peak VO2 less than 500 ml/m2/min (body surface area) were 6 times more likely to experience a cardiopulmonary complication (p < 0.05). With multiple logistic regression analysis, peak VO2 was not an independent predictor of postoperative complications. Analysis also demonstrated that a CPRI of 4 or greater was associated with significant reductions in peak VO2. We conclude that both the peak VO2 during cardiopulmonary exercise testing and a multifactorial CPRI are highly predictive of complications after lung resection. Adding the peak VO2 did not enhance the risk estimation generated by the CPRI. The association between postoperative complications and peak VO2 may be explained by the correlation between identifiable cardiopulmonary disease (CPRI) and reduced oxygen uptake with exercise.
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PMID:Predicting complications after pulmonary resection. Preoperative exercise testing vs a multifactorial cardiopulmonary risk index. 836 78

The obese patients undergoing upper abdominal surgery are at particularly high risk to develop postoperative pulmonary complications, and hypoxemia is one of the most common ones reported. During the initial postoperative period, they are often advised to maintain a semi-sitting position to optimize oxygenation. Although chest physical therapy usually avoids a Trendelenburg position, no published data indicate this position as being able to induce desaturation in obese patients following upper abdominal surgery. We studied fifteen adult obese patients without cardiopulmonary disease undergoing upper abdominal surgery. All patients were tested for 5 minutes during the first 3 postoperative days in each of 3 positions: semi-sitting, bed-flat lateral decubitus, and 15 degrees of Trendelenburg lateral decubitus positions. A statistically significant difference in oxygen saturation related to position was found only on the first postoperative day between semi-sitting and bed-flat lateral decubitus positions. The difference in mean SaO2 value between these 2 positions, however, was only 0.88%; and no significant correlation between the magnitude of obesity and the mean SaO2 difference was found. Although arterial oxygen saturation demonstrated statistically significant daily improvement during the first 3 postoperative days, the mean SaO2 values for any 2 consecutive days differed by less than 0.78%. Thus, in obese patients following upper abdominal surgery, 15 degrees of Trendelenburg lateral decubitus and bed-flat lateral decubitus positions do not induce clinically significant desaturation and can be used if necessary and appropriate. In obese patients with borderline oxygenation, supplemental oxygen used postoperatively can maintain adequate oxygenation and allow aggressive positioning.
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PMID:The effect of selective drainage positions on oxygen saturation in obese patients after upper abdominal surgery. 849 Jul 92


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