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

The aim of the study was to assess the feasibility and effect of treating atypical endometrial hyperplasia (AEH) with transcervical resection of endometrium (TCRE). Five cases of AEH incapable of hysterectomy for various reasons were treated with TCRE. All patients were followed up for 3-4 years postoperation to evaluate the thickness of endometrium, uterine cavity, and prognosis of the disease. All the patients provided informed consent for TCRE. In all five cases treated with TCRE, case 1 was for senility, hypertension, diabetes mellitus, and obesity; case 4 for senility, obsolete cerebral infarction, and hemiplegia; case 5 for uremia and chronic dysfunction of coagulation after renal transplantation; cases 2 and 3 for rejection of hysterectomy. All cases were followed up for more than 3 years after operation. Four had amenorrhea and one had dropping menses. The thickness of endometrium was no more than 5 mm in all the cases. TCRE is one available microinvasive surgery alternative to hysterectomy for AEH patients contraindicated to hysterectomy.
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PMID:Management of abnormal uterine hemorrhage with atypical endometrial hyperplasia by transcervical resection of endometrium. 1680 56

Cardiovascular complications represent the leading cause of mortality in renal transplant recipients, with ischemic heart disease accounting for more than 50% of deaths. Besides the well known risk factors that affect the general population, risk for development of atherosclerosis in renal transplant patients is further increased by previous uremia and dialysis, as well as by the use of immunosuppressive agents. Diabetes mellitus, arterial hypertension, dyslipidemia, smoking, hyperhomocysteinemia, hyperuricemia, coagulation abnormalities, increased expression of cell adhesion molecules, persistent inflammation, frequent infections and obesity all increase the risk for development of atherosclerosis in transplanted patients. There is a growing body of evidence suggesting that the risk of cardiovascular disease falls significantly with smoking cessation, reduction of alcohol consumption, reduction of excessive weight, and appropriate and aggressive control of blood pressure and dyslipidemia. Patients should be instructed, and every effort should be invested to increase their compliance with the modified lifestyle and drug adherence. Novel immunosuppressive regimens tend to decrease the risk of atherosclerosis by being individualized according to the characteristics of the particular patient.
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PMID:[Cardiovascular diseases after kidney transplantation]. 1708 39

Advances in surgical techniques and immunosuppression (IS) have led to an appreciable reduction in postoperative complications following transplantation. However, wound complications as probably the most common type of post-transplantation surgical complication can still limit these improved outcomes and result in prolonged hospitalization, hospital readmission, and reoperation, consequently increasing overall transplant cost. Our aim was to review the literature to delineate the evidence-based risk factors for wound complications following kidney and liver transplantation (KTx, LTx), and to present the preventive and therapeutic modalities for this bothersome morbidity. Generally, wound complications are categorized as superficial and deep wound dehiscences, perigraft fluid collections and seroma, superficial and deep wound infections, cellulitis, lymphocele and wound drainage. The results of several studies showed that the most important risk factors for wound complications are IS and obesity. Additionally, there are surgical and/or technical factors, including type of incision, reoperation, and surgeon's expertise, as well as comorbidities such as advanced age, diabetes mellitus, malnutrition, and uremia. Preventive management of wound complications necessitates defining their etiological factors so that their detrimental effects on healing processes can be addressed and reduced. IS modalities and agents, especially sirolimus (SRL), and steroids (ST) should be adjusted according to the patient's co-existing risk factors. SRL should be administered three months after transplantation and ST should be tapered as soon as possible. A body mass index (BMI) lower than 30 kg/m2 is advisable for inclusion in a transplantation program, but higher BMIs do not exclude recipients. Surgical risk factors can be prevented by applying precise surgical techniques. Therapeutic modalities must focus on the most efficient and cost-effective medications and/or interventions to facilitate and improve wound healing.
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PMID:Wound complications following kidney and liver transplantation. 1710 Jul 9

Uremic wasting is strongly associated with increased risk of death and hospitalization events in patients with advanced chronic kidney disease (CKD). Recent evidence indicates that patients with advanced chronic kidney disease are prone to uremic wasting due to several factors, which include the dialysis procedure and certain comorbid conditions, especially chronic inflammation and insulin resistance or deficiency. While the catabolic effects of dialysis can be readily avoided with intradialytic nutritional supplementation, there are no established alternative strategies to avoid the catabolic consequences of comorbid conditions other than treatment of their primary etiology. To this end, there is no indication that simply increasing dietary protein and energy intake above the required levels based on level of kidney disease is beneficial in patients with advanced chronic kidney disease. However, aside from the potential adverse effects such as uremic toxin production, dietary protein and energy intake in excess of actual needs might be beneficial in maintenance dialysis patients as it may lead to weight gain over time. Clearly, the role of obesity in advanced uremia needs to be examined in detail prior to making any clinically applicable recommendations, both in terms of ''low'' and ''high'' dietary protein and energy intake.
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PMID:Protein and energy intake in advanced chronic kidney disease: how much is too much? 1724 11

Peritoneal dialysis (PD) patients present an extremely high mortality rate, but the mechanisms mediating the increased risk of mortality observed in this group of patients are still largely unknown, which limits the perspective of effective therapeutic strategies. The leading hypothesis that tries to explain this high mortality risk is that PD patients are exposed to a number of traditional risk factors for cardiovascular disease (CVD) already at the onset of their chronic kidney disease (CKD), since many of these risk factors are common to both CVD and CKD. Of particular importance, chronic inflammation recently emerged as an important novel risk factor related to multiple complications of CKD. There are many stimuli of the inflammatory response in CKD patients, such as fluid overload, decreased cytokine clearance, presence of uremia-modified proteins, presence of chronic infections, metabolic disturbances (including hyperglycemia), obesity. Many of these factors are related to PD. Latin America has made some progress in economic issues; however, a large portion of the population is still living in poverty, in poor sanitary conditions, and with many health-related issues, such as an increasing elderly population, low birth weights, and increasingly high energy intake in the adult population, which, in combination with changes in lifestyle, has provoked an increase in the prevalence of obesity, diabetes, and CVD. Therefore, in Latin America, there seems to be a peculiar situation combining high prevalence of low education level, poor sanitary conditions, and poverty with increases in obesity, diabetes, and sedentary lifestyle. Since inflammation and mortality risk are intimately related to both sides of those health issues, in this review we aim to analyze the peculiarities of inflammation and mortality risk in the Latin-American PD population.
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PMID:Inflammation in peritoneal dialysis: a Latin-American perspective. 1746 89

Insulin resistance often characterizes chronic uremia, and is associated with enhanced morbidity and mortality, because it may contribute to protein-energy wasting (in turn, an independent predictor of reduced survival), atherosclerosis, and cardiovascular death. Causes of insulin resistance in chronic uremia are complex and multifactorial. Obesity is emerging as an independent risk factor for chronic kidney disease, and an expected rise in number of obese uremic patients because of the ongoing worldwide obesity epidemic is likely to increase the prevalence of insulin resistance in chronic uremia in the near future. Similar to the general population, reported associations between obesity and insulin resistance in chronic uremia support a role of adipose tissue and altered adipokine profiles in insulin resistance in obese chronic kidney disease patients. Hormonal imbalances, chronic acidosis, and systemic inflammation and oxidative stress are uremia-associated relevant causes of insulin resistance in nonobese individuals. A further understanding of the causes of insulin resistance in chronic uremia represents a potential important tool in the design of more effective therapeutic strategies to reduce uremia-associated morbidity and mortality.
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PMID:Insulin resistance in chronic uremia. 1912 65

Metabolic syndrome (MetS) is defined as a cluster of risk factors for type 2 diabetes and cardiovascular disease; it is also an independent risk factor for developing chronic kidney disease (CKD) in the general population. Therefore, CKD has many similarities and associations with MetS, and the individual risk factors constituting MetS-especially insulin resistance and glucose intolerance, hypertension, dyslipidemia, and obesity-are also common features of the early stages of CKD. In the later stages of CKD, uremia per se and uremic complications such as fluid retention, protein-energy wasting, inflammation, and oxidative stress further contribute to an increase in the prevalence of MetS in CKD patients. In addition, PD patients exposed to glucose-based PD fluids have an increased risk of developing metabolic complications. The broad use of MetS in clinical research has raised the awareness of the public and of individual patients concerning the value of lifestyle interventions. However, the definition and pathogenesis of MetS are still debated, and no standardized definition nor proven prognostic value has been established for MetS as a cluster of risk factors for diabetes or cardiovascular disease in PD patients. Furthermore, considering the paradoxical associations of some of the risk factors in MetS with decreased mortality, another set of risk factors-those specific to patients with uremia (for example, inflammation and malnutrition)-and the appropriate cut-off levels to individual MetS risk factors should be taken account at the same time. Also, the benefit of interventions targeting these risk factors should be clarified in further clinical studies.
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PMID:Definition of metabolic syndrome in peritoneal dialysis. 1927 Feb 3

Insulin resistance (IR) and inflammation are now identified as common features in chronic kidney disease (CKD) patients. These metabolic abnormalities are both predictors of adverse cardiovascular (CV) outcome and are associated with worst nutritional status. Unequivocal experimental, epidemiological and clinical evidence produced during the past decade causally links inflammation to the development of metabolic syndrome or the complications that emerge from these pathologies particularly in the context of obesity or type II diabetes patients. These observations lead to the hypothesis of "meta-inflammation" : metabolically triggered inflammation, with a key role played by adipose tissue. In CKD patients, many other factors related with uremia can be causative but the abnormal cytokine and adipokine concentrations and the cluster of metabolic abnormalities push us to think like other metabolic diseases, that adipose tissue dysfunction may be among the pathways that induce inflammation and IR. Therapeutic approaches of traditional CV risk factors have been inconclusive or failed to improve the outcome of these patients. Further studies assessing the impact of renal failure on adipose tissue function and the pathways that are altered in this disease may allow to have therapeutic approaches targetting adipose tissue dysfunction or inflammation.
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PMID:[Insulin resistance and inflammation in chronic kidney diseases]. 1976 71

Obesity is a global health threat because of its associated metabolic and cardiovascular complications. Metabolic and hemodynamic complications of obesity (insulin resistance and hyperglycemia, hypertension, atherogenic dyslipidemia) are often clustered in the metabolic syndrome, leading to high cardiovascular morbidity and mortality. In recent years, epidemiological studies have clearly indicated that both obesity and the metabolic syndrome are independent risk factors for chronic kidney disease and these associations are at least in part independent of diabetes and hypertension per se. Additional mechanisms associated with obesity and metabolic syndrome leading to reduced renal function may include altered levels of adipose tissue hormones, inflammation, and oxidative stress. The ongoing worldwide obesity epidemic is therefore likely to increase the number of patients with chronic uremia and features of the metabolic syndrome in the next few years. Moreover, the onset and maintenance of renal damage may worsen metabolic syndrome features including insulin resistance and hypertension, leading to potential vicious cycles with negative clinical effect. Further understanding of the interactions between obesity, metabolic syndrome, and chronic kidney disease represents a potential strategy to design more effective treatments aimed at reducing morbidity and mortality in uremic patients.
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PMID:Metabolic syndrome and chronic kidney disease. 2079 64

About 50% of patients who undergo dialysis are overweight or obese. Rather than being a disadvantage, the extra weight is associated with improved survival in this patient group. However, the relationship between weight and outcome is complex among dialysis patients. In the general population obesity constitutes a clear cardiovascular risk factor. By contrast, in obese dialysis patients the nutritional status may be better, and obesity thus provides, at least in the short term, some protection against malnutrition and the associated morbidity. On the other hand, some studies suggest that mortality in the long term is directly correlated with excess weight and obesity, which indicates that fat represents a risk factor also in uremia. In the elderly, particularly those affected by end-stage renal disease, endocrine and metabolic effects on the nitrogen balance cause the loss of muscle mass despite an excess of adipose tissue, which is a condition known as sarcopenic obesity. While a good nutritional state is found in some obese dialysis patients, which probably accounts for the improved survival of the obese group as a whole, there is a sizable proportion of sarcopenic obese, which is probably increasing. Sarcopenic obesity is not only characterized by the reduction of muscle mass but also by the accumulation of fat surrounding the abdominal viscera (visceral fat syndrome), which may be associated with a greater degree of metabolic and atherosclerotic disease. Several studies have shown that malnutrition associated with obesity, including sarcopenic obesity, is the risk factor most closely correlated with morbidity and mortality both in dialysis patients and the general population. The timely identification of this condition has therefore become necessary in the dialysis population now dominated by the elderly and very elderly. Body mass index is inadequate as a measure of sarcopenic obesity since it cannot define muscle mass nor indicate the localization of the fat in the visceral compartment. Other indices must be developed and validated in well performed clinical trials to identify fat localization and the presence of sarcopenia.
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PMID:[Obesity in dialysis and reverse epidemiology: true or false?]. 2113 45


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