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

In the majority of patients admitted to an Intensive Care Unit with acute respiratory failure (ARF), the aetiology for ARF is quite evident. In a minority of patients no obvious aetiology is apparent at presentation. In this group a previously unrecognized sleep-related breathing disorder (SRBD) may be the cause of the ARF. In spite of clinical suspicion SRBD remains infrequently diagnosed in ARF also because the technology necessary for this type of diagnosis (polysomnography) is usually unavailable in Intensive Care Units. The aim of this study was to evaluate the utility of portable polysomnography system (PSGp) in a group of patients with ARF of unclear aetiology and with a clinical suspicion of SRBD. We studied a selected group of 14 patients (eight males, six females) admitted to an Intermediate Intensive care unit with varying degree of acute respiratory failure. Mean (SD) age was 57 (13) years, pH 7.28 (0.04), PaO2 5.6 (0.7) kPa), PaO2 (8.8 (1.6) kPa), Body mass index 42.7 (9.6) kg m(-2). The patients had no history of skeletal, neuromuscular or cardiovascular disease. None of them had a history of overt chronic lung diseases or had obvious respiratory tract infections. They were submitted to cardiac and respiratory functional evaluation and to nightly PSGp (VITALOG HMS 5000, Respironics Inc., Redwood City, CA, U.S.A.) which was performed in an intermediate intensive care unit. Ten subjects had obstructive sleep apnoea-hypopnoea syndrome (OSAS), with mean respiratory disorder index h(-1) (RDI) 60.1 (25.9) [in five associated with obesity-hypoventilation syndrome (OHS)]; two had central sleep apnoea with mean RDI 45 (28.3) (one with hypothyroidism and one with cerebral multiple infarctions and right hemidiaphragmatic paralysis) and two had OHS with mean RDI 12.5 (3.5). Nocturnal hypoventilation was present in almost all patients. Continuous positive airway pressure (CPAP) was effective in three patients. Eight patients needed to be treated with BILEVEL (BiPAP, Respironics Inc.) airway positive pressure in timed or spontaneous/timed modes. Two patients required intubation and mechanical ventilatory treatment. In one patient with hypothyroidism was sufficient to institute hormonal therapy. Our study shows that acute respiratory failure due to SRBD is not exceptional in an Intermediate Intensive Care Unit and that if clinical suspicion is strong, portable polysomnography may yield diagnostic confirmation and help in establishing appropriate treatment and in avoiding the invasive ventilatory treatment.
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PMID:Sleep-related breathing disorders in acute respiratory failure assisted by non-invasive ventilatory treatment: utility of portable polysomnographic system. 1071 17

The author examines the therapeutics for African pygmy hedgehogs and prairie dogs. The African or Asian hedgehog differs from the larger European hedgehog. Pronounced differences in size, seasonal behavior, and natural diet exist. Since the prairie dog's increase in popularity in the pet trade, numerous interrelated syndromes have been reported, including respiratory disease, obesity, cardiac disease, and oral neoplasia. This article describes the routes of administration and the common disease syndromes and appropriate therapeutics for each.
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PMID:Therapeutics of African pygmy hedgehogs and prairie dogs. 1122 25

The obesity-hypoventilation syndrome (or alveolar hypoventilation in the obese) is a new name for an old syndrome, Pickwickian syndrome. It is defined as chronic alveolar hypoventilation (PaO(2)<70 mmHg, PaCO(2) > 45 mmHg) in obese patient with a body mass index > 30 kg/m(2) who have no other respiratory disease explaining the gas anomalies. The large majority of obese subjects are not hypercapnic, even in case of severe obesity. There are three principal causes explaining alveolar hypoventilation in obese subjects: high cost of the work of respiration, dysfunction of the respiratory centers, repeated episodes of nocturnal obstructive apnea. The obesity-hypoventilation syndrome is generally found in males aged over 50 years. Exercise-induced breathlessness is a constant finding. Diagnosis is often made after an episode of severe respiratory failure. Associated diseases favored by obesity are frequent: diabetes, high blood pressure, heart disease. By definition, there is a hypoxemia-hypercapnia syndrome persisting after an acute episode. Spirography usually demonstrates moderate volume restriction. Pulmonary hypertension is frequent but not constant. Obesity-hypoventilation syndrome must be distinguished from obstructive sleep apnea, although the two conditions are often associated. Obstructive sleep apnea may be absent in certain patients with obesity-hypoventilation syndrome (we have had several cases) and inversely, obesity is not observed in certain patients with obstructive apnea. It should be recalled that the term Pickwickian syndrome designates obesity-hypoventilation syndrome (with or without obstructive apnea) and not obstructive sleep apnea syndrome.
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PMID:[Alveolar hypoventilation in the obese: the obesity-hypoventilation syndrome]. 1208 46

Individuals with schizophrenia have standardised mortality rates which are double that of the general population. In addition to suicide, high rates of cardiovascular and respiratory disease contribute to this raised mortality rate. Although clozapine has been reported to improve psychotic symptoms and decrease suicide rates, attention has recently focussed on its potential to increase cardiovascular risk factors including obesity, dyslipidemia and diabetes mellitus. This study aimed to ascertain the prevalence of these risk factors in a cohort of Irish outpatients treated with clozapine.
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PMID:Prevalence of obesity, lipid and glucose abnormalities in outpatients prescribed clozapine. 1209 Apr 43

Obesity and asthma are common chronic diseases in the industrialised world. The aim of the present study was to investigate a possible relationship between asthma and obesity among persons on sick leave due to respiratory disorder. The diagnosis of asthma (n = 237) was made in a three-stage model (questionnaire, telephone interview and clinical examination) in persons on sick leave due to any respiratory disorder. Persons on sick leave due to non-specific spinal pain, (n = 1231) and a general population sample (n = 5092) were used as references. Obesity (body mass index > 30 kg/m2) was found in 20.7% of the asthmatic patients on sick leave compared with 13.7% in the non-specific pain patients on sick leave and in 6.5% of the controls (P < 0.001). It is not clear whether the increased prevalence of obesity among asthmatics reflects a true increase in asthma in obese persons or whether asthma-like symptoms occur because of obesity. Weight reduction schemes and weight maintenance programmes should be important components in treatment and rehabilitation plans for persons with asthma.
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PMID:High prevalence of obesity in asthmatic patients on sick leave. 1219 47

CERTAIN OF THE ACUTE PHASE REACTANT TESTS WERE PERFORMED ON THE SAME SPECIMEN OF BLOOD FROM PERSONS WITH THE FOLLOWING STATES: Normal, acute respiratory disease, streptococcosis, acute rheumatic fever, acute glomerulonephritis, acute rheumatoid arthritis, inactive rheumatic fever, lupus erythematosus, malignant disease, obesity, asthma, and allergic rhinitis. Of the tests performed, the mucoprotein-tyrosine and the antistreptolysin-0 titer when done together appeared to be the most discriminating. It is suggested that the performance of such tests on the same sample of blood might aid in differentiating mild acute rheumatic fever and acute rheumatoid arthritis from each other and also from other disease states.
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PMID:Diagnosis of rheumatic fever and like conditions; evaluation of certain of the acute phase reactants in a single specimen of blood. 1334 8

Over the last few years, obesity has been constantly increasing, thus turning it into a serious public health problem, with the subsequent impact on health-related expenditure, particularly in developed countries. The main peculiarity of obesity is its association with numerous pathologies (respiratory disease, cardiovascular problems, endocrinological or metabolic disorders, etc.) that leads it to be related with high levels of mortality and morbidity, affecting both the quality and duration of the life of sufferers. The attempts to prevent obesity and, when these fail, the treatments that can be resorted to cover many aspects: behavioural, dietary and medical. But these are frequently doomed to failure because of their potentially very demanding nature, at which times, after complying with certain minimal requirements and a detailed assessment, it is possible to move on to the next step: bariatric surgery. This is a part of the therapeutic armoury that is enjoying a constant boom, with very favourable results that mean the physiopathology of this condition should be known in greater detail by all of the multidisciplinary team dealing with the problem: GPs, endocrinologists, psychiatrists, general surgeons and anaesthesiologists, with the latter being involved in all of the peri-surgical activity (pre-, intra- and post-operative stages, in the reanimation units). From the standpoint of anaesthesia (the focus of this paper as it is the least well-known of those mentioned), obese individuals are at a disadvantage with respect to other non-obese patients as the process is complicated and the risk increases. With this review of the subject, it is intended to recall the physiopathological changes produced by obesity as well as the anaesthetic implications within the framework of bariatric surgery, so as to achieve the most favourable possible results from the surgery.
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PMID:[Obesity and bariatric surgery: anesthesia implications]. 1498 40

Poor respiratory function and obesity are associated with all-cause and cardiovascular disease mortality. Obese persons may also have impaired lung function, but the mechanism is unclear. The authors investigated the relation between abdominal pattern of obesity and respiratory function in the European Prospective Investigation into Cancer and Nutrition-Norfolk (EPIC-Norfolk) cohort in Norfolk, United Kingdom. This analysis included 9,674 men and 11,876 women aged 45-79 years with no known preexisting serious illness who had complete anthropometric and respiratory function measures obtained at a health visit between 1993 and 1997. Waist:hip ratio was used to assess abdominal obesity, and forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), obtained by spirometry, were used to assess respiratory function. Both FEV1 and FVC were linearly and inversely related across the entire range of waist:hip ratio in both men and women. This relation persisted after adjustment for age, body mass index, cigarette smoking, social class, physical activity index, prevalent bronchitis/emphysema, and prevalent asthma. The association remained significant among nonobese nonsmokers without preexisting respiratory disease. In the general adult population, abdominal fat deposition may play a role in the impairment of respiratory function among the abdominally obese.
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PMID:Abdominal obesity and respiratory function in men and women in the EPIC-Norfolk Study, United Kingdom. 1519 31

Reduced functional residual capacity (FRC) is consistently found in obese subjects. In 10 obese subjects (mean +/- SE age 49.0 +/- 6 yr, weight 128.4 +/- 8 kg, body mass index 44 +/- 3 kg/m2) without respiratory disease, we examined 1) supine changes in total lung capacity (TLC) and subdivisions, 2) whether values of total respiratory resistance (Rrs) are appropriate for mid-tidal lung volume (MTLV), and 3) estimated resistance of the nasopharyngeal airway (Rnp) in both sitting and supine postures. The results were compared with those of 13 control subjects with body mass indexes of <27 kg/m2. Rrs at 6 Hz was measured by applying forced oscillation at the mouth (Rrs,mo) or the nose (Rrs,na); Rnp was estimated from the difference between sequential measurements of Rrs,mo and Rrs,na. All measurements were made when subjects were seated and when supine. Obese subjects when seated had a restrictive defect with low TLC and FRC-to-TLC ratio; when supine, TLC fell 80 ml and FRC fell only 70 ml compared with a mean supine fall of FRC of 730 ml in control subjects. Values of Rrs,mo and Rrs,na at resting MTLV in obese subjects were about twice those in control subjects in both postures. Relating total respiratory conductance (1/Rrs) to MTLV, the increase in Rrs,mo in obese subjects was only partly explained by their reduced MTLV. Rnp was increased in some obese subjects in both postures. Despite the increased extrapulmonary mass load in obese subjects, further falls in TLC and FRC when supine were negligible. Rrs,mo at isovolume was increased. Further studies are needed to examine the causes of reduced TLC and increases in Rrs,mo and sometimes in Rnp in obese subjects.
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PMID:Postural changes in lung volumes and respiratory resistance in subjects with obesity. 1547 5

Acutely ill general medical patients are at moderate-to-high risk of venous thromboembolism (VTE); approximately 10-30% may develop deep vein thrombosis or pulmonary embolism, the latter being a leading contributor to deaths in hospital. Medical conditions associated with a high risk of VTE include cardiac disease, cancer, respiratory disease, inflammatory bowel disease, and infectious disease. Predisposing risk factors for VTE in medical patients include history of VTE, history of malignancy, complicating infections, increasing age, thrombophilia, prolonged immobility, and obesity. Unfractionated heparin (UFH), low-molecular weight heparin (LMWH), and fondaparinux sodium have been shown to be effective agents in the prevention of VTE in medical patients. In this setting, UFH has a higher rate of bleeding complications than LMWH. There is no evidence supporting the use of aspirin, warfarin, or mechanical methods to prevent VTE in medical patients. We recommend either LMWH or fondaparinux sodium as well tolerated and effective thromboprophylactic agents in medical patients.
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PMID:Pharmacological prevention of venous thromboembolism in medical patients at risk. 1625 29


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