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

A case-control analysis was done of 19 cases of uterine perforations which occurred during laparoscopic sterilization at Gardy Memorial Hospital in Atlanta, between February 1, 1974, and January 31, 1976. The over-all perforation rate, 30.4 per 1,000 procedures, is three to 30 times that commonly reported for dilatation and suction or sharp curettage (D&C) of the uterus. Case women were 10.4 times more likely than control women to combine two of the following three characteristics: age greater than 34, parity greater than 4, and obesity greater than 20 per cent above the ideal body weight for height. Surgeons with fewer months of formal Ob/Gyn training were no more likely than their relatively more experienced colleagues to perforate the uterus. No other risk factors were delineated. It is believed that the perforation rate, higher in this study than in earlier ones, reflects better ascertainment of perforations. The bleeding site was always visualized with the laparoscope in this series.
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PMID:A case-control study of uterine perforations documented at laparoscopy. 14 36

100 IUD users (8 Dana super, 62 Dana super lux, and 30 Copper T) underwent an ultrasonic B-scan to localize their IUDs. For best results the patient must have a full bladder during the scanning. In 82 cases the IUD could be completely localized and in 11 cases partially localized. One case of erroneous interpretation due to uterus myomatosus was recorded. 6 dislocated IUDs were detected. The Dana super model could often be detected more quickly due to its form and the intensity of the echo complexes it produced. Localizations were also attempted on 6 IUD users in the first trimester of pregnancy. The IUD could be localized only in 4 of those cases; from the 10th week of pregnancy the IUD and the fetal sac could not be discerned separately. An insufficiently full bladder, a retroflex uterus, echoes caused by the intestine, and obesity made the ultrasonic scanning more difficult. This ultrasonic method of localization of IUDs is to be preferred to hysterography or hysteroscopy. It is recommended that such a localization be performed during the first three months after an IUD insertion to control its position or before the removal of an IUD and abrasio due to bleeding disturbances or other complications.
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PMID:[Applicability of ultrasonic B-scan diagnosis to localisation of intra-uterine contraceptive devices (author's transl)]. 38 50

More than 80 patients were examined by parallel B-scan ultrasonic equipment (Vidoson 635, Siemens). 30 have been followed in time sequences up to 8 months. It is important that the patient have a full bladder which elevates the uterus out of the small pelvis. Loops are easily identifiable if the uterus is in the anteverted-fected position, difficult to visualize in the retroflected position, and outlined only if the uterus is extremely retroflected. The middle position can allow for misinterpretation. The IUD may be in the uterus, cervix, or vagina and the ultrasonic echo of the string may cause further error. Proper localization can be accomplished if the applicator is placed in a longitudinal position. If this fails the uterus can be lifted out of the pelvis and tipped anteriorly by digital elevation from the vagina. This requires an additional investigator. Proper localization of an IUD failed in about 10% of examinations. Obesity and intraabdominal adhesions provided for many errors. In more than 90% the technique is qualified for follow-up controls. The authors use it routinely to check proper insertion. In 3 cases early partial expulsion was diagnosed, which prompted extraction of the IUD.
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PMID:The identification of IUDs by ultrasound in the uterine cavity. 117 68

In 182 cases the jet wash technique proved very suitable in the detection of malignant changes in the endometrium. It should in no way replace the curettage as a diagnostic tool. The jet wash offers the possibility of a regular endometrial investigation to larger numbers of patients. Those to be considered in particular are 1. symptom-free women with an increased risk of carcinoma of the body of the uterus, i.e. women over 40 with obesity, hypertension and diabetes mellitus, 2. patients with recurrent bleeding who have already had a curettage with negative histological results, 3. primary irradiated endometrial carcinoma patients in order to detect a recurrence early, 4. patients who pose a high anaesthetic risk. The exact detection reliability of the endometrial jet wash technique remains uncertain until results of larger investigation series are published. Good experience up to now with the jet wash technique should stimulate its wider use.
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PMID:[Cytological investigations of the endometrium using the jet wash technique (author's transl)]. 124 86

In the course of a sterilization by tubal electrocoagulation, the patient suffered perforation of the abdominal aorta, causing a large hematoma and danger of bleeding to death. The aorta was repaired with a Teflon patch and the patient recovered, but the potentially fatal incident occasioned a review of the legal status of sterilization and of its complications. In the Dohrn case (1964), the Federal Court of Justice determined that voluntary sterilization is nonpunishable under German law. However, sterilization has increased less in Germany than, e.g., in England or Japan, and in 1969 the German Doctors' Conference declared sterilization permissible only for medical, genetic-eugenic, or pressing social reasons. As for complications, electrocoagulation of the tubes - involving anesthesia, inhibition of respiration by means of Trendelenburg's position, introduction of carbon dioxide into the abdomen, and manipulation of instruments through incisions - must be considered a complex procedure. Among 11,956 published cases described by 29 authors between 1969-1974, the complication rate was 1.71%; probably the actual rate is higher. 3 fatalities - from heart failure, peritonitis, and suffocation - were reported. In addition, there were 117 hemorrhages (.98% of the cases reported), 22 burns or mechanical injuries of the gastrointestinal tract (.19%), 26 perforations of the uterus (.22%), 44 infections (.37%), 25 skin burns (.21%), and 24 cases of skin or organ emphysema (.2%). Mechanical injuries carry the danger of perforation of organs over time, and the injuries reported included 13 perforations of colon, ileum, or stomach, requiring laparotomy and excision. Complications under electrocoagulation are reported to be less severe than in conventional operations; nevertheless, electrocoagulation should never be performed as an outpatient operation, and follow-up to check for delayed complications is advisable. Contraindications are poor general health, severely reduced respiration, and such conditions as anatomical anomalies, tumors, endometriosis, and obesity.
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PMID:[Aortic perforation following electrocoagulation of the tubes]. 126 30

Transvaginal ultrasonography has provided new anatomic and pathophysiologic information about the female pelvis. Because of probe proximity to the organ of interest and higher insonating frequency, resolution is dramatically improved. Problems previously encountered during transabdominal scanning, such as obesity, bowel gas, and a retroverted uterus, no longer preclude accurate diagnosis. Patient acceptance is nearly universal. Physiologic information concerning the endometrium and ovarian follicles has improved infertility diagnosis and treatment. Hormonal and vascular Doppler changes can be correlated with cyclic endometrial patterns and follicle size. Oocyte retrieval, management of pre-existing inflammatory disease, and treatment of complications of pregnancy are easier and safer with a transvaginal approach. Uterine malformations, leiomyomas, and cancers are more easily detected in premenopausal and postmenopausal women. The documentation of early intrauterine or ectopic pregnancy has decreased maternal morbidity and mortality. Tube-sparing procedures with preservation of reproductive potential are now more commonly employed due to earlier recognition of unruptured tubal pregnancy. Interventional TVS has led to improved recognition and treatment of pelvic cysts and abscesses and multiple pregnancy. Chorionic villous sampling can be performed more easily without the need for anesthesia, with adequate tissue obtained.
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PMID:Transvaginal ultrasonography. 151 39

Obesity is associated with many comorbid disease states including neoplasia. The increased risk of developing endometrial cancer is thought to be due to the higher level of circulating estrogens in obese women. Uterine leiomyomata (fibroids) are also thought to be influenced by estrogens. To determine whether patients presenting with symptomatic uterine fibroids were more obese than the general population, we retrospectively reviewed the hospital records of 144 women who underwent either hysterectomy or myomectomy for uterine fibroids. Obesity was defined as preoperative weight greater than 120% of desirable body weight (DBW) for the patient's height. In our investigation, 51% of the study population were obese. Moreover, 16% were severely obese (defined as greater than 150% DBW). When compared with the general population of women in the United States matched for height and age, the study population was significantly heavier. (p less than 0.0002). Patient age, parity, menopausal status, and degree of obesity did not correlate with the number of fibroids within the uterus. Fibroid size was significantly larger in nulliparous women (p less than 0.005). These results suggest that symptomatic uterine fibroids may be another comorbid disease state associated with obesity.
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PMID:Relationship between obesity and uterine leiomyomata. 180 14

The polycystic ovary syndrome was described for the first time in 1935 and it consists of: menstrual irregularity (amenorrhea or dysfunctional bleeding from the uterus), obesity and hirsutism. The advancement of visualization techniques, especially of the ultrasound method with a high resolution, has enabled simpler diagnostics and a wider recognition of the named syndrome and the defining of it's subvariants, which has led to a tendency that the entity be named polycystic ovary disease (PCOD). The paper presents the clinical, pathoanatomical and laboratory definition of the disease. Also analyzed, are the deviations which occur within each of the mentioned methods for the definition of the disease in patients in whom there was "surgical proof" of polycystic ovary disease. The prevalence of the disease, it's pathoanatomical substrate and pathogenetical mechanisms for individual subgroups are presented. In regard to the heterogeneity of possible etiological causes, we considered the disturbances which occur at the level of the hypothalamo-hypophyseal axis; the ovaries peripheral tissues, adrenal glands as well as the metabolic hypothesis which includes the gonadotropic effect of insulin within itself.
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PMID:[Polycystic ovary syndrome: definition, pathoanatomic substrate and mechanisms of pathogenesis]. 180 95

Between January 1, 1987-January 30, 1990, 374 laparoscopic sterilizations using silastic rings (Falope) were undertaken. Morbidity and major risk factors were analyzed. The most frequent surgical complications were: mesosalpinx rupture and fallopian tube rupture in 22 cases (5.8%); abdominal wall emphysema in 3 cases (0.8%); uterine perforation in 2 cases (0.5%); other pelvic structure lesions in 3 cases (0.8%). Morbidity risk factors were: previous abdominal surgery, obesity, salpingitis, use of a uterine mobilizer in a puerperal uterus, and the practice of tubal occlusion during the luteal hase of the cycle due to the possibility of a luteal phase pregnancy. Therefore, if a risk factor is present, it is advisable to use another contraceptive method. (author's modified)
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PMID:[Morbidity from bilateral tubal ligation, via laparoscopy]. 183 80

We have studied the deliveries of 198 large fetuses over a period of 3 years between 1st January 1987 and 31st December 1989 in the University Hospital of Poitiers. By large fetus we mean the delivery of a child of 4,000 grammes or more. This occurs in 4.5% of deliveries. The following risk factors are present either singularly or together with others: previous delivery of a large child (12.6%), a previous history of pregnancy diabetes or its absence (2.5%), an increase of weight during pregnancy of more than 15 kgs (46.8%), obesity before the onset pregnancy (19.7%), the height of the uterus equal to or above 35 cms (75.8%). These factors were found in nearly 90% of the patients. Their presence should make one look for a large fetus. The obstetrical results were as follows: 18 ceasareans were carried out (9.09%); instrumental delivery was necessary in 43 cases (23.8%); there were 17 cases of shoulder dystocia treated by obstetrical manoeuvres (9.5%). There were therefore 122 vaginal deliveries without any interference (61%). Neonatal complications were: one lost because of malformation (0.5%), serious morbidity in 30 deliveries (15.15%); 16 fractures of the clavicle and two cases of brachial plexus paralysis of which one persisted, two facial palsies which recovered, six infections, three cases of hypoglycaemia and one serious fetal distress which recovered without any sequelae. Maternal complications were: no mortality, serious morbidity in 26 women (14.1%), 9 haemorrhages at delivery, 9 cases of trauma of the perineum, 6 infections, and 2 haematomata in the episiotomy wound.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Delivery of large infants. Management and results of 198 cases]. 195 71


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