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

After bypass operation for obesity the remaining lactose-hydrolyzing capacity of the functioning shunt is very low, especially if the shunt is constructed from a shorter jejunal and a longer ileal segment. In most cases a temporary decrease in the lactase activity of the jejunal part of the shunt occurs during the first postoperative months. In the present study lactose provoked or aggravated diarrhoea and other symptoms in 20 of 33 shunt-operated patients, and 10 patients reported milk intolerance postoperatively. Oral glucose tolerance tests indicated that the lactase activity was rate limiting for lactose absorption postoperatively.
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PMID:Lactose malabsorption after bypass operation for obesity. 9 6

The jejunoileal bypass for patients 125 lb or more above their ideal body weight as an experimental procedure exchnages almost certain weight loss for many known and many yet undescribed problems. Study of the known complications has led to altered operative procedures and management techniques that lessen the impact of nearly all of the complications. All patients need occasional advice on potential complications, and most experience episodes of depletions or diarrhea that require hospital intervention. The improved versions of this surgery have not been present sufficiently long to indicate the real nature of long term changes, and careful evaluation is essential for at least small groups of these patients in order for all interested physicians to provide proper advice to the 10,000 or so patients who have already had this procedure. Careful selection of patients to identify those who will accept follow-up and seek help when needed, and to identify those with sufficient social adaptability to adjust to a change in body image, and a competent, experienced acute and chronic team for management lead to the majority of patients having a very satisfactory result. Many specific complications of massive obesity are specifically helped by this procedure. In America, this is the only treatment effective more than half of the time in the massively obese.
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PMID:Jejunoileal bypass for the treatment of massive obesity. Prevalence, morbidity, and short- and long-term consequences. 29 93

One hundred one carefully screened morbidity obese patients underwent jejunoileal bypass and were followed closely over a mean follow-up period of 32 months. Although there were no operative deaths, three per cent of patients died postoperatively of liver failure or its complications. A fourth patient died of a pulmonary embolus after reoperation, and the fifth patient died cachectic with severe diarrhea after excessive weight loss. Nineteen per cent of the patients required restoration of intestinal continuity (reversal), most for either liver failure or late fluid and electrolyte derangements. All but two survived reversal and are doing well despite massive weight gain. Fifty-eight per cent of the patients had major complications which either required major reoperation (reversal, cholecystectomy or incisional hernia repair) or were potentially life-threatening (liver failure, hepatic fibrosis or urinary tract stones). As described in other series, abnormalities in serum electrolytes and vitamins were seen. In addition, hypovitaminosis D occurred in a number of patients and as with other serum parameters measured, was time-dependent in that improvement was seen in most patients over the postoperative interval studied. Because of the high rate of complications and reversals, we believe that jejunoileal bypass should be reserved for patients with morbid obesity whose lives are imminently threatened by obesity or its sequellae.
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PMID:Jejunoileal bypass for morbid obesity. A critical appraisal. 34 3

This is an interim report of a prospective, randomized study involving 194 consecutive patients who underwent elective operation for treatment of duodenal ulcer. The results of parietal cell vagotomy without drainage (PCV) and selective vagotomy-antrectomy and Billroth I anastomosis (SV-A-B I) were compared. There was no mortality. Postoperatively patients were examined at two, six, 12 months and every 12 months thereafter. The two operations showed no statistical difference in the frequency of diarrhea. Dumping was less (p < .01) after PCV than after SV-A-B I. Weight loss was less (p < .01) after PCV than after SV-A-B I. There were no recurrent ulcers after SV-A-B I and five after PCV. In each instance but one the recurrent ulcer healed on withdrawal of an ulcerogenic drug. One patient required reoperation. Reoperations in the PCV group consisted of one for recurrent ulcer, one for gastric outlet obstruction and three for intestinal obstruction. The reoperations after SV-A-B I consisted of four for gastric outlet obstruction, three for intestinal obstruction, one for ruptured spleen and two for incisional hernia. PCV was technically feasible and practical to perform except in the occasional patient with severe pyloric stenosis. Obesity was never a deterrent. After PCV it is reasonable to assume that a recurrent ulcer rate in the range of 5-10% can be expected by surgeons who have been properly trained. This recurrence rate is higher than that after SV-A-B I but no higher than that encountered with TV-P. The recurrence rate is acceptable and is a fair exchange for the avoidance of dumping and weight loss that accompany SV-A-B I with significantly greater frequency and which on occasion can produce gastric crippling, although this did not occur in this study. All recurrent ulcers after PCV do not require reoperation but when operative treatment is required the patient has all the options that he had prior to PCV.
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PMID:An interim report on parietal cell vagotomy versus selective vagotomy and antrectomy for treatment of duodenal ulcer. 44 16

Jejunoileal bypass operations have been used for more than 20 years for the treatment of massive obesity. This treatment results in malabsorption with diarrhoea, especially during the first year after the operation. A high incidence of urinary tract calculi have been found in these patients (4, 5, 15, 19, 24). Other known late complications are transient disturbances in liver function and electrolyte balance (5).
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PMID:The incidence of urinary tract calculi after small-intestinal bypass operations for treatment of obesity. 50 81

Breast milk is a complete food for the first 4-6 months of life. It helps prevent diarrhea and obesity, and discourages the development of allergies. It is extremely difficult to put in economic terms the value of breastfeeding. Some of its benefits can be quantified in nonmonetary terms, such as morbidity, mortality, and population growth, while psychological benefits cannot be quantified. The authors of this article, however, attempt to estimate the economic value of breastfeeding in Ghana, and in the Ivory Coast. Calculated on a basis of a 2 year period, the cost of artificial feeding amounted to 310 U.S. dollars, to which another 210 should be added for the cost of the time spent in breastfeeding. This sum would be almost 3 times higher than that for breastfeeding in the same countries. Other economic implications must include the health-producing effects of breastfeeding, and the fact that lactation amenorrhea plays a crucial role in birth spacing, especially in developing countries.
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PMID:Economic importance of breastfeeding. 54 Jun 68

Small-bowel ischaemia is the least familiar cardiovascular complication of the oral contraceptive but is 1 associated with a high mortality rate and much morbidity. Hoyle et al have recently reviewed 21 cases and found that 1/2 the patients had died and 1/2 had required 2 or more operations, resulting in the removal of much of the small bowel. Small-bowel ischaemia occurs in women taking the oral contraceptive as a result of either mesenteric artery or mesenteric vein thrombosis. The dominant presenting symptom in small-bowel ischaemia, found in all patients, is abdominal pain. Some patients had associated nausea and vomiting; others complained of diarrhea. On examination the patient has usually been found to be febrile with generalized abdominal tenderness. Bowel sounds are present unless infarction has occurred. In nearly all cases reported the diagnosis has been made only at laparotomy, when the bowel was usually infarcted. Since many of the patients had had pain for 2 or more weeks, the condition might be reversible if it could be detected earlier. A diagnosis of small-bowel ischaemia should be carefully considered in any woman taking an oral contraceptive who presents with vague abdominal pain and has an associated condition known to predispose to circulatory disorders: cigarette smoking, hyperlipidaemia, diabetes, hypertension, obesity, or blood group A. If it seems like small-bowel ischaemia is the likely diagnosis, the contraceptive pill should be stopped immediately and treatment started with heparin.
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PMID:Flap lacerations. 62 Jan 42

The case reported is that of a young woman who underwent a termino-terminal jejno-ileal by-pass procedure for obesity which was refactory to usual forms of treatment. Eight months later, a cholecystectomy was carried out for lithiasis, presenting with abdominal pain. At the time of operation, lesions of cystic pneumatosis were discovered on the excluded length of small bowel. This complication frequently manifests itself in the form of pseudosurgical abdominal pain, or as diarrhoea. More rarly, it is a radiological finding. The pathogenesis remains a subject of discussion. The mechanical theory would seem the most logical, since colonic intraluminal pressure is higher than that in the intestine excluded from the circuit. Bacterial proliferation, classical in blind loops, would be a farourising factor.
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PMID:[Cystic pneumatosis of the small intestine following jejuno-ileal by-pass for obesity (author's transl)]. 64 80

In 40 obese patients, the liver function and the morphological picture were examined before and after jejuno-ileostomy. In 94% of the patients, distinct fatty liver was observed already before the small bowel exclusion, and the function tests showed an impaired function of this organ in 25% of the subjects before the operation. No clinical symptoms of liver insufficiency were recorded during the postoperative period. During one to three months after surgery, an increased impairment of the liver function was ascertained but, later on, a gradual improvement. More than one year after jejuno-ileostomy, the function test results were considerably better than before the operation. The degree of steatosis increased in the majority of the patients within 6 months after surgery, and some time later a considerable decrease in fatty liver was observed. Within 18 to 24 months after the jejunoileostomy, the morphological picture of the liver did not differe from the normal. The impaired function and the increased degree of steatosis were noted during diarrhea and rapid loss of body weight. The reson for this is most probably the protein malnutrition caused by the radical reduction in the absorption surface of the small bowel. The improved function and morphological picture of the liver are related to the progress of adaptation changes of the active part of small bowel. The results of the author's research do not confirm the hypothesis of permanent, harmful effect of jejuno-ileostomy on the state of the liver. The symptoms observed are definitely of a periodical and transient character, and are therefore not contra-indicated in the application of this operation in morbid extreme obesity treatment.
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PMID:Function and morphological picture of the liver in obese patients before and after jejunoileostomy. 74 72

Fenfluramine has been used for a number of years as a short-term adjunct to diet in the management of obesity. Controlled studies and clinical experience have shown that it possesses anorectic activity at least as good as that of other therapeutically useful drugs of its type, but like these drugs it has only a limited role in the overall management of obesity. Tolerance to the anorectic effects of fenfluramine may possibly develop more slowly than to other chemically related drugs in patients with refractory obesity. The mechanism of its anorectic action is probably by an effect on the appetite control centres in the hypothalamus, rather than by an effect on glucose and lipid metabolism. However, its effect in enhancing glucose uptake into skeletal muscle may be of advantage in diabetes mellitus, preliminary studies suggesting that it is of potential use in maturity-onset obese diabetics who cannot be adequately controlled by dietary measures alone. The starting dosage in obesity of 40mg daily should be increased gradually over 2 to 4 weeks to 60 to 120mg. In general, little extra benefit is gained by higher dosage. When a course of therapy is to be discontinued, fenfluramine dosage should be reduced gradually over a period of 2 to 4 weeks in order to avoid mood depression which has occurred in some patients on abrupt withdrawal of the drug. With these recommendations, the majority of patients tolerate fenfluramine satisfactorily, although some patients may have to discontinue the drug because of troublesome gastro-intestinal problems, diarrhoea, drowsiness or dizziness. Unlike other amphetamine-derived anorectics, fenfluramine is not a central stimulant in therapeutic doses, and it probably has little abuse potential.
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PMID:Fenfluramine: a review of its pharmacological properties and therapeutic efficacy in obesity. 76


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