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

Acanthosis nigricans (AN) is a dermatologic condition of the flexor surfaces of the body consisting of papular hypertrophy, hyperpigmentation, and rugae. AN is commonly associated with malignancy when in adults but is primarily associated with endocrinologic disorders and obesity when found in adolescents. A special search for occult malignancy is not warranted in adolescents with AN unless no associated benign condition is found. Careful follow-up is recommended, however, since AN may be the first indication of a serious systemic disease.
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PMID:Acanthosis nigricans in adolescents. Two case reports and guidelines for management. 686 10

The normoxic ventilatory drive contributes to the normal level of ventilation, and the hypoxic ventilatory drive contributes to the maintenance of adequate gas exchange in the presence of ventilation/blood flow maldistribution and increased mechanical load to breathing. This respiratory drive arises principally from stimuli at the carotid chemoreceptors. The reflex cardiovascular responses to hypoxia also contribute to the delivery of O2 to vital organs, and their efficacy depends on the integrity of the respiratory response and the autonomic nervous system as well as the function of the vascular system. Prolonged exposure to hypoxemia from altitude, cyanotic congenital heart disease, and chronic pulmonary disease impair the ventilatory response to hypoxia. In addition, the respiratory and cardiovascular responses to hypoxemia are impaired by familial or acquired abnormalities of the autonomic effector system. There is growing evidence that impaired respiratory response to hypoxemia is a major factor in recurrent respiratory failure in obesity, obstructive pulmonary disease, idiopathic or familial "hypoventilation," and contributes to disturbances in oxygenation during sleep [152, 189, 192, 202]. Although the ventilatory response to hypoxemia was traditionally thought to be resistant to the effects of inhalational anesthetics, barbiturates, and narcotics, there is abundant evidence that in fact the ventilatory response to hypoxia is more sensitive to depression by drugs than the ventilatory response to CO2. In addition, the hemodynamic responses to hypoxia are modified by anesthesia and anesthetic techniques. The clinical implications of these observations are wide. The ventilatory and cardiovascular response to hypoxemia will be altered, and usually depressed by age, disease processes, premedicant and anesthetic drugs, and autonomic blocking drugs. The cardiovascular responses will be modified indirectly by altered ventilatory control due to neuromuscular blocking drugs and controlled ventilation. Thus, not only will the responses to hypoxemia be depressed by anesthesia but the early clinical hemodynamic signs will be modified or absent, or indeed the cardiovascular response will further impair oxygen delivery. Furthermore, it is not only anesthetic doses that impair the reflex respiratory responses, but also subanesthetic doses of inhalational anesthetics and premedicant doses of barbiturates and narcotics. Hence the patient in the perioperative period continues to have impaired respiratory response to hypoxemia. As anesthetic and surgical care extends to older patients, patients with systemic disease, and recipients of cardiovascular peripheral and central drugs, the clinical implications of the impairment of ventilatory and cardiovascular responses to hypoxia, and the maintenance of organ and system function, escalate. Only a few hesitant steps have been taken into this vast arena of clinical and experimental research.
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PMID:Respiratory and cardiovascular responses to hypoxemia and the effects of anesthesia. 702 55

A retrospective analysis was made of the case records of 1568 surgical patients admitted in 1975 to a tertiary care hospital in the Province of Newfoundland, to determine and classify the incidence of concurrent systemic disease. Almost 60 percent of patients had symptoms or signs of concurrent disease, the numbers increasing progressively from below 30 per cent at 21-30 years, to 90 per cent at ages 71-80. The predominant abnormalities were cardiovascular (60 per cent), followed by respiratory and metabolic conditions (41 and 40 per cent respectively). Detailed findings are presented, including those relating to the incidence of ischaemic heart disease and hypertension, to the coexistence of several diseases, to smoking and chronic obstructive lung disease, to obesity, to diabetes, and to alcoholism. This review documents the high incidence of concurrent disease in surgical patients and has implications for the training of anaesthetists and the organization of their work.
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PMID:Incidence of concurrent systemic disease in the surgical population of a tertiary care hospital. 723 6

The purposes of this article are to discuss the effects of some common systemic diseases on cardiopulmonary function and oxygen transport and to describe the implications for physical therapists. Pathology of every major organ system can manifest secondary effects on cardiopulmonary function and oxygen transport. Such effects are of considerable clinical significance given that they can be life threatening and that physical therapy usually stresses the oxygen transport system. This article reviews the cardiopulmonary effects of hematologic, neuromuscular, musculoskeletal, gastrointestinal, hepatic, renal, collagen vascular and connective tissue, endocrine, and immunologic conditions. The cardiopulmonary manifestations of some common nutritional disorders (eg, obesity, anorexia nervosa) are also discussed. Physical therapists need to be able to anticipate, detect, and manage the cardiopulmonary manifestations of systemic disease given medical advances and the increasing number of patients with multisystem problems, the aging of the population, the expanding scope of physical therapy practice, and the increased professional and ethical responsibility associated with direct patient access.
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PMID:Oxygen transport deficits in systemic disease and implications for physical therapy. 903 19

Acute unilateral or bilateral rupture of the patellar tendon was diagnosed in 5 aged obese female Pere David's deer housed at a zoological park. Rupture occurred after an episode of sudden exertion in 4 of 5 deer. Fragmentation, degeneration, necrosis, and mineralization of ruptured patellar tendon fibers were found on histologic examination. Similar changes were often seen in intact contralateral tendons that did not have gross lesions. Patellar tendon rupture in humans is associated with concurrent systemic disease, such as systemic lupus erythematosus, rheumatoid arthritis, or chronic renal failure. Without evidence of underlying systemic disease, spontaneous patellar tendon rupture in deer can be considered a sequela to age-related tendinous degeneration compounded by sudden exertion and chronic overload attributable to obesity.
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PMID:Patellar tendon rupture in five deer. 962 88

Sixteen cases of necrotizing fasciitis were seen at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria from 1990 to 2000. Primary craniocervical involvement was recorded in seven patients (five men and two women). The clinical records of five patients were sufficiently detailed to allow us to report their age, aetiology, predisposing illness, clinical features, complications, management regimen and outcome. The patients were aged 30-75 years and in four of them odontogenic infections were the cause of the condition. Hypertension, diabetes mellitus and obesity were the underlying systemic diseases in three cases and the body/angle region of the mandible was the predominant site of the infection on the face. All five cases had involvement of the neck. Mediastinal extension was recorded in three cases. Two patients had complications: one had septicaemia and renal failure and the other developed bone necrosis. Pre-existing ill health, old age, late surgical intervention, and mediastinal and thoracic extension of infection were responsible for the only death. Treatment involved frequent and multiple surgical debridement, aggressive antimicrobial treatment and control of systemic disease. Early recognition, prompt surgical intervention, and aggressive antimicrobial treatment are essential to minimize morbidity and mortality. Rapid progression of infection, financial constraints, delayed referrals from rural clinics and distance to the tertiary hospital caused problems.
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PMID:Craniocervical necrotizing fasciitis in Ile-Ife, Nigeria. 1188 74

The vascular placental pathology (VPP) is associated with many etiologies. Some are the consequence of a maternal genetic or acquired predisposition. Others are associated with a chronic maternal disease (hypertension, lupus, obesity, diabetes, ...). Finally, some others are associated with placental implantation leading to fetal ischemia (multiple pregnancy, chorioangioma, primiparity, feto-placental hydrops) or to environmental (altitude) or nutritional factors (famine and specific alimentary depressions). We classify these factors into three categories according to the risk level (moderate, significant and elevated). While any of these factors can increase the risk of VPP, no one is sufficiently sensitive or specific in predict inevitable onset of VPP. In most cases VPP results from a combination of two (or more) risk factors. The risk factors of VPP classified as moderate include age (> or = 35 years), increased blood pressure during the second trimester of pregnancy, a new paternity, dietetic factors or environmental factors, smoking and controlled diabetes (class B, C), or inactive systemic diseases. Risk is significantly elevated among obese (BMI > or = 25), primiparous women, women with a past familial history (first degree) of preeclampsia or eclampsia, cocaine use or association of tobacco and caffeine use, increased placental mass (associated with twin pregnancy, fetal hydrops or molar pregnancy), uncontrolled diabetes, lupus, active scleroderma. Risk is considered to be high among patients with chronic hypertension, women with a past history of preeclampsia, diabetes (class D, F, R), patients with active systemic disease or with antiphospholipid antibodies or women with lupus or renal lesions and/or proteinuria as well as chronic kidney disease resulting in proteinuria, hypertension and renal insufficiency. Finally, the risk of VPP is considered to be increased in the presence of acquired thrombophilia. It remains moderate in the presence of isolated genetic thrombophilia, except in forms presenting with multiple genetic mutations or associated with an hyperhomocysteinemia. A "high-risk group" is defined among women with past history of deep venous thromboembolic events outside pregnancy, or with a past history of placental vascular pathology (intra-uterine death, placental abruptio, severe and precocious placental, intra-uterine growth retardation, early and repetitive fetal loss) and who, in addition, present with acquired thrombophilia (antiphospholipid antibodies, thrombocytemia), unique homozygous genetic thrombophilia, amultiple genetic thrombophilia or unique heterozygous genetic thrombophilia associated with hyperhomocysteinemia. Prophylactic treatment of acquired thrombophilia and of the multiple genetic forms or associated with hypercysteinemia is a logical rationale, particularly among women with a past history of placental vascular pathology, or with a past history of venous thromboembolic events. On the contrary, prophylaxis using low-molecular-weight heparin in the event of asymptomatic genetic thrombophilic mutations and for women without a past history of deep venous thromboembolism or vascular placental pathology remains controversial.
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PMID:[Vascular placental pathology in high-risk groups: definition and synopsis]. 1502 87

The metabolic syndrome is a highly complex breakdown of normal physiology characterized by obesity, insulin resistance, hyperlipidemia, and hypertension. Type 2 diabetes is a major manifestation of this syndrome, although increased risk for cardiovascular disease (CVD) often precedes the onset of frank clinical diabetes. Prevention and cure for this disease constellation is of major importance to world health. Because the metabolic syndrome affects multiple interacting organ systems (i.e., it is a systemic disease), a systems-level analysis of disease evolution is essential for both complete elucidation of its pathophysiology and improved approaches to therapy. The goal of this review is to provide a perspective on systems-level approaches to metabolic syndrome, with particular emphasis on type 2 diabetes. We consider that metabolic syndromes take over inherent dynamics of our body that ensure robustness against unstable food supply and pathogenic infections, and lead to chronic inflammation that ultimately results in CVD. This exemplifies how trade-offs between robustness against common perturbations (unstable food and infections) and fragility against unusual perturbations (high-energy content foods and low-energy utilization lifestyle) is exploited to form chronic diseases. Possible therapeutic approaches that target fragility of emergent robustness of the disease state have been discussed. A detailed molecular interaction map for adipocyte, hepatocyte, skeletal muscle cell, and pancreatic beta-cell cross-talk in the metabolic syndrome can be viewed at http://www.systems-biology.org/001/003.html.
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PMID:Metabolic syndrome and robustness tradeoffs. 1556 23

An association between skin tags and insulin resistance, obesity, impaired carbohydrate and lipid metabolism has been suggested. However, there still is a need for comprehensive and controlled clinical studies. We aimed to evaluate the atherogenic risk factors in patients with skin tags. Thirty-six patients with skin tags who were admitted to the dermatology department and 22 healthy controls were included in this study. Possible subjects who were taking systemic drugs or who had a systemic disease that may be associated with lipid or carbohydrate metabolism abnormalities were excluded from the study. All the measurements were completed in 26 patients. Standard oral glucose tolerance tests were performed on the patient and control groups. Serum insulin, total cholesterol, triglyceride and HDL-cholesterol levels were measured. LDL-cholesterol and VLDL-cholesterol ratios and HOMA-IR and body mass indices were calculated. The mean levels of body mass index, HOMA-IR, and total cholesterol were significantly higher in patients than in controls. In conclusion, skin tags may not be innocent tumoral proliferations; instead, follow-up of such patients with regard to the development of diseases associated with atherosclerosis may be beneficial.
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PMID:Skin tags and atherosclerotic risk factors. 1604

Chronic kidney disease (CKD) is now considered as one of the strongest risk factors for all cause mortality and cardiovascular events. However, the link between CKD and systemic events is unclear. The role of the kidney is primarily considered a target organ during the development of obesity as altered production of adipokines from visceral adipocytes, however, it should also be recognized that the kidney itself could alter the clearance and production of adiopokines. In this chapter, we provide a discussion of renal handling of a variety of adipokines. Specifically, there is a growing body of data supporting a major role for the kidney in clearance of insulin, leptin, and TGF-Beta. In addition, plasminogen activator inhibitor-1, vascular endothelial growth factor, angiotensin II, and resistin may also be altered by the kidney. The mechanistic regulation of renal handling by the kidney of a variety of circulating adipokines, however is poorly defined. We conclude that the kidney has pivotal roles in the regulation of adipokines and that altered renal handling of adipokines may contribute to the imbalance of factors that ultimately lead to progressive cardiovascular and systemic disease.
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PMID:Renal handling of adipokines. 1692 35


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