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

Open cholecystectomy causes changes in pulmonary function test volumes; such changes can be related to respiratory complications of hypoxemia and atelectasis. Little data is available on lung volume changes after laparoscopic cholecystectomy. We measured preoperative and postoperative vital capacity (VC), functional residual capacity (FRC), arterial PO2, and chest X-ray atelectasis in 31 patients undergoing laparoscopic cholecystectomy and found small but significant decreases (p < 0.01) in VC (13 +/- 19%) and FRC (7 +/- 17%). The PO2 decreased from 89 +/- 11 mm Hg to 82 +/- 14 mm Hg, with only one patient's PO2 less than 60 mm Hg. Three patients demonstrated new segmental lobar collapse on postoperative chest X-ray. The postoperative changes in FRC (R2 = 0.40, p < 0.04) and atelectasis (R2 = 0.46, p < 0.03) could be predicted by multiple regression of risk factors, including obesity, smoking, use of narcotics, age, and symptoms of prior respiratory disease. We conclude that the respiratory changes after laparoscopic surgery are small in comparison to those expected after open cholecystectomy.
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PMID:Postoperative respiratory function after laparoscopic cholecystectomy. 134 35

Respiratory events are between the most frequent postoperative complications. The preoperative conditions associated with postoperative respiratory failure were evaluated in a prospective study of 1182 patients from six Italian Surgical Units. Multiple regression logistic analysis was employed for statistical evaluation and a predictive prognostic score was derived. Only the presence of the following conditions was significant in affecting postoperative respiratory outcomes: preoperative respiratory and cardiac failure, hypotransferrinemia, prolonged surgical procedures (above the 2 hours) and peroperative bacterial contamination. Advanced age did not appear as a major risk factor. Studies on the predetermination of the pulmonary complications have been widely published. Historical risk factors include the presence of respiratory disease, smoking habits, obesity and thoracic or upper abdominal surgical procedures. Although the results of the present study need a prospective confirmation, the predictive scoring system proves to be a usefull tool that can be employed in most of the General Surgery Units.
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PMID:[Multifactorial surgical risk index of the development of respiratory complications]. 146 55

From a conceptual standpoint, the tests of pulmonary function can be divided into those that assess the ventilatory function of the lungs and those concerned with gas exchange. Tests of ventilatory function reflect alterations of the elastic resistance and flow resistance of the respiratory apparatus. The elastic properties of the lungs are assessed by determining the position and shape of the curve representing the relationship between the pressure across the lungs and absolute lung volume. When there is reduced distensibility of either the lungs or the chest wall, the volume-pressure curve is shifted down and to the right. The slope of the curve is reduced in the patient with pulmonary fibrosis, while it is normal in the patient with obesity. In asthma (or chronic bronchitis) and emphysema, the volume-pressure curve is shifted up and to the left. In emphysema, the slope of the curve is increased, while it is normal in patients with asthma or bronchitis. In practice, lung volume is used as an index of alterations of the volume-pressure characteristics of the lungs and/or chest wall. The vital capacity is often used as a surrogate for the TLC but it is lower than expected in both restrictive and obstructive disorders. The FEV1.0 reflects the degree of expiratory flow limitation. In a restrictive disorder, lung volume and the FEV1.0 are reduced, but the FEV1.0/FVC ratio is normal. In airflow limitation, lung volume, the FEV1.0, and the FEV1.0/FVC ratio are lower than expected. In airflow limitation, the reversibility with inhaled bronchodilator should be determined. Tests of airway responsiveness are indicated when evaluating patients with unexplained chronic cough, chest tightness, or wheezing, particularly if other lung function tests are normal. The adequacy of gas exchange is assessed by determining the arterial blood gas tensions--PaO2 and PaCO2--and the alveoloarterial pO2 gradient--P(A-a)O2. A lower-than-expected PaO2 can result from several different physiologic disturbances. When alveolar hypoventilation is the sole disturbance, the oxygen in the alveoli and in the blood perfusing them virtually comes into equilibrium, so that the P(A-a)O2 is normal. An elevated P(A-a)O2 is caused by either mismatching of ventilation and perfusion, true venous admixture, a diffusion abnormality, or a combination of these disturbances. Because dyspnea on exertion is a cardinal symptom of respiratory disease, exercise tolerance should be assessed. A reduced exercise tolerance may result from ventilatory limitation, impaired gas exchange, cardiac impairment, impaired delivery of the oxygen to the working muscles, or an inability to use the energy.
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PMID:Evaluation of respiratory function in health and disease. 160 91

Nocturnal intrinsic disorders of sleep are much more common than hitherto assumed. In middle-aged men, a prevalence of 0.3 to 3% of severe obstructive sleep apnea syndromes necessitating treatment is expected. The international classification of sleep disorders (ICSD 1990) contains the definitions and descriptions of the different entities. A patient with combined obstructive sleep apnea and a hypoventilation syndrome due to obesity serves to illustrate problems with diagnosis and particularly treatment of this respiratory disorder during sleep. The most frequent sleep disorders are briefly presented and placed in the context of other concomitant somatic diseases. Because of the possible serious course of nocturnal hypoxemias, the conclusion is justified that a timely and accurate diagnosis is essential for the patient. Transcutaneous oximetry during the night is sufficient as screening procedure. It can be applied to outpatients. In depth, evaluation should be carried out at a specialized center with polysomnography.
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PMID:[Pickwick syndrome. A case example of an obesity-hypoventilation syndrome, combined with obstructive sleep apnea]. 192 36

Evaluation without catheterization of patients with valvular heart disease implies that diagnosis based upon non-invasive techniques alone are qualitatively and quantitatively correct. The diagnosis should indicate not only the valvular lesion in question but should give information about associated conditions that could influence management decisions (whether to operate or not or whether to modify the intended operation). A review of the literature shows that in mitral stenosis (MS), both pressure gradient and valve area can be obtained non-invasively (rest/exercise). These data, combined with the ultrasound appearance of the valve, subvalvular apparatus, chamber sizes, assessment of associated regurgitation and eventual pulmonary hypertension, permit a complete evaluation of the MS patient. Thus, it can be concluded that in experienced hands, the large majority of patients with MS can be assessed reliably non-invasively for clinical screening and for valve surgery. Excluding those in whom coronary angiography is mandatory, cardiac catheterization should be required only infrequently (in less than 10%). Cardiac catheterization should, however, be carried out in patients in whom technical reasons make ultrasound examinations incomplete (obesity or respiratory disease), and in patients in whom there is a discrepancy between the physical signs and the Doppler ultrasound.
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PMID:Does mitral stenosis need invasive investigation? 193 32

Snoring was investigated in a survey of respiratory disease in Hispanic-Americans of a New Mexico community. A population-based sample of 1222 adults was studied with questionnaires and measurements of height, weight, and blood pressure. The age-adjusted prevalence of regular loud snoring was 27.8% in men and 15.3% in women. Snoring prevalence increased with age and obesity in both men and women. Cigarette smoking was also associated with snoring, but chronic obstructive lung disease and alcohol consumption were not. Snorers more frequently had hypertension, ischemic heart disease, and excessive daytime sleepiness. In contrast to other studies, after adjustment for confounding factors, there was no effect of snoring on hypertension (odds ratio, 1.0; 95% confidence interval, 0.7 to 1.5), but an effect on myocardial infarction was still demonstrable (odds ratio, 1.8; 95% confidence interval, 0.9 to 3.6). The association of snoring with sleepiness suggests that respiratory disturbance of sleep related to upper airway obstruction, such as sleep apnea, occurs more frequently in snorers in this population.
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PMID:Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity. 231 Feb 78

Sleep apnea syndrome is a condition characterized by recurrent interruption of breathing during sleep. Triad of symptoms for the disease are insomnia, daytime sleepiness and snoring. Recently, the patients complained of these symptoms have progressively increased. And so serious attention has been given to investigate the entity of this new clinical syndrome in medical and dental aspects. Three types of sleep apnea are classified; central, obstructive and mixed type. Most of patients identified this syndrome include obstructive or mixed types of sleep apnea. Obstructive sleep apnea has been presumed to have close relationships with obesity, micrognathia, retrognathia, tonsillary hypertrophy, tongue hypertrophy and so on. This study was designed to evaluate the characteristics of the dentofacial morphology in the obstructive, included mixed, sleep apnea syndrome (OSA) patients. The samples consisted of 25 adult male patients (average age of 48 years 2 months) with OSA as diagnosed by the division of respiratory disease, department of internal medicine, Kanazawa Medical University Hospital. One lateral radiographic cephalogram with the teeth in occlusion and the recording of somatic measurements, body weight and height, were obtained for each patient at visiting our orthodontic clinic. On the lateral cephalograms of whole samples, 10 angular and 6 linear measurements were carried out. Simultaneously, the body mass index (BMI) was assessed for each patient. Based on the cephalometric and somatometric measurements, the pathogenesis of obstructive sleep apnea was discussed in association with the obesity and dentofacial morphology. Results were summarized as follows: 1. The body mass index (kg/m2) ranged between 21.0 to 45.7, with a mean value of 31.0 for OSA patients. Of whom, 3 patients were mildly obese (25 or more of BMI) and 12 patients severely obese (exceeding 30 of BMI). 2. Compared with normal control samples, the means of cephalometric variables of whole samples showed the tendency of micrognathia, large gonial angle, protruded maxilla and large cranial base. 3. By principal component analysis, it was revealed that the components for the shape and position of the mandible were of more importance in OSA patients than controls. 4. Discriminatory analysis clarified significant differences in dentofacial morphology between 12 obese and 13 non-obese patients. 5. The dentofacial morphology in non-obese patients were characterized by retrognathia, micrognathia, large gonial angle and small maxilla. In accordance with previous reports, the patients with OSA were presented the tendency of obesity and micrognathia. Furthermore it was revealed that particularly in non-obese OSA patients the morphological abnormalities might be the major contributor to the pathogenesis of sleep apnea.
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PMID:[Dentofacial morphology of obstructive sleep apnea syndrome patients]. 264 Sep 22

We studied 17 severely obese subjects (age range 26 to 42 years), without hypertension, diabetes mellitus, angina, or clinical signs of heart failure or respiratory disease, and 16 age-matched control subjects. X-teleroentgenographic findings (transverse cardiac diameter and cardiothoracic ratio), blood pressure, and mechanocardiographic parameters were analyzed in both groups. By means of conventional simultaneous recordings of ECG, phonocardiogram, and carotid pulse (100 mm/sec), systolic time intervals were calculated as mean values from 10 beats in the morning. The following comparisons were made by means of analysis of variance: heart rate, preejection period (PEP), rate-corrected PEPI (PEPI), left ventricular ejection time (LVET), and QS2 interval (QS2); the latter two were both corrected for heart rate, respectively, as LVETI and QS2I and the PEP/LVET ratio. Abnormal x-ray data were shown in the obese group along with higher values for heart rate, PEP, PEPI, and PEP/LVET and a shorter LVETI; there were no differences in QS2I or blood pressure. There was a correlation between the amount of overweight and, respectively, transverse cardiac diameter (r = 0.84), heart rate (r = 0.69), PEP (r = 0.49), PEPI (r = 0.59), LVETI (r = -0.61), and PEP/LVET ratio (r = 0.72). A correlation was also found between transverse cardiac diameter and PEP/LVET (r = 0.67). We conclude, therefore, that abnormalities in the mechanocardiographic parameters are related to cardiac enlargement, suggesting a preclinical cardiac dysfunction secondary to chronic cardiocirculatory overload in severe obesity. Thus systolic time intervals appear to be affected by preclinical abnormalities of cardiac performance in these subjects.
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PMID:Abnormal systolic time intervals in obesity and their relationship with the amount of overweight. 294 49

To determine predictors of postoperative morbidity in elective cholecystectomy patients, the authors examined prospectively the consequences of age, sex, active and past smoking, respiratory history, obesity, type of surgical incision, and preoperative pulmonary function, upon the incidence of postoperative pulmonary complications and length of hospitalization. They identified 31 (14.8%) complications in 209 patients; 21 had atelectasis, 8 purulent bronchitis, and 2 pneumonia. These patients averaged 1.5 days longer in the hospital (p less than 0.001 by analysis of variance) than control patients. Abnormal spirometry (MEFV) and the single-breath nitrogen test (SBN2) were significant predictors of postoperative pulmonary complications (p less than 0.001 by discriminant analysis method). Active smoking and history of respiratory disease were associated with abnormal small airway function (p less than 0.001 by chisquare test), but did not predict postoperative morbidity. By analysis of variance, only a reduction in preoperative FVC emerged as predictive of prolonged hospitalization (p less than 0.001). These results were used to determine if the selection of patients by preoperative pulmonary function testing permits more cost-effective administration of respiratory therapy (RT) services. Neither the MEFV nor SBN2 had sufficient specificity to enhance the cost effectiveness of postoperative RT.
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PMID:Can postoperative pulmonary complications after elective cholecystectomy be predicted? 312 67

The aim of this study was to determine the need for supplemental oxygen during recovery from general anesthesia for ambulatory surgery in healthy women without obesity or respiratory disease. Arterial oxygen saturation by pulse oximetry (SpO2) was monitored throughout the first postoperative hour in 164 patients. The patients breathed room air during recovery. Supplemental oxygen was given only to those who became hypoxemic (SpO2 less than or equal to 92%). It was discontinued at the end of 15 minutes and reinstituted for another 15 minutes if hypoxemia recurred. Twelve patients (7%) became hypoxemic and required supplemental oxygen for various periods of time up to 105 minutes. The need for supplemental oxygen increased with increasing age (P less than 0.05) but was not associated with a history of cigarette smoking, tracheal intubation, amount of opioids or sedatives given intraoperatively, anesthetic duration, or level of consciousness during recovery. Hypoxemia was neither predictable nor clinically apparent. We recommend that, unless arterial oxygenation is monitored, ambulatory patients should routinely receive supplemental oxygen during recovery from general anesthesia.
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PMID:Supplemental oxygen after ambulatory surgical procedures. 342


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