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

A case of acute intestinal vascular necrosis in a 19-year-old user of oral contraceptives (OCs) is described, and hypotheses explaining the digestive complications of synthetic estrogens are reviewed. The patient had originally presented with a violent gastric pain that subsequently spread to the entire abdomen. An abrupt worsening of her condition involved cardiovascular collapse associated with a peritoneal syndrome, vomiting and dehydration, and hyperleukocytosis. Emergency opening of the peritoneum was followed by evacuation of a large quantity of fetid gas and alimentary debris, and observation of a completely necrosed stomach. A careful lavage of the entire intestinal cavity led to temporary improvement, but it became clear during an attempt at gastrectomy that further treatment would be unavailing and the patient died shortly thereafter. Estrogens were believed to be responsible for the digestive necrosis because it occurred in a young woman who had used an estrogen-rich OC for 3 years and who smoked; a hapatic biopsy confirmed the diagnosis. No traces of other risk factors such as hypertension, hyperlipidemia, diabetes, neoplasia, or obesity were observed. Recent publications indicate that OCs are responsible for a certain number of digestive problems, which may include acceleration of intestinal transit, severe diarrhea, rectorrhagia, ischemic or ulcerative colitis, intestinal infarct which is usually localized, and hepatocellular problems ranging from moderate hepatic insufficiency to malignant tumor and Budd-Chiari syndrome. OCs do not modify hemodynamic regimes, but they may cause elevation of fibrinogen and thrombin, diminution of antithrombin III acitivty, increased platelet adhesivity, and decreased fibrinolysis leading to hypercoagulability. These modifications in hemostasis occur in all OC users and are not statistically correlated with occurence of thrombotic accidents. OCs are probably responsible for parietal vascular lesions; experimental injection of synthetic estrogens is associated with both arterial and venous lesions. The most characteristic anomaly is at the level of the intima, with proliferation of smooth muscle cells and increased conjunctive tissue fibers associated with proliferation of the media or the endothelium. The absence of lipid deposits, the simultaneous appearance of arterial and venous lesions, and other evidence argues against and atheromatous origin of parietal lesions. A significant correlation has been found between high levels of anti-synthetic ethinyl estradiol antibodies and the presence of vascular lesions. It is hypothesized that these circulating immune complexes penetrate the vascular walls of OC users and produce lesions, which may depend on factors such as smoking.
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PMID:[Digestive complications of oral contraceptives: a case of extensive digestive necrosis in a young woman]. 647 54

A report is presented on gastric bypass (n = 27) and gastroplasty (n = 2) in patients with morbid obesity. One patient died postoperatively (mortality 3.4%). Mean weight prior to operation was 129 kg (96 to 205 kg), i.e. 117% (63 to 253%) in excess of the ideal weight. During a follow-up period of 6 to 46 months, the mean loss of weight amounted to 38 kg (3 to 77 kg). 86% of the patients judged their condition as being very good to good. Diseases related to obesity were reduced to a remarkable degree: hypertension from 43 to 5%, hypertriglyceridaemia from 50 to 5% and diabetes mellitus from 52 to 13%. Two patients had to be reoperated on due to a peptic jejunal ulcer, five because of an incisional hernia. No patient suffered from diarrhoea, calculi of the biliary or urinary tract or electrolyte disorders. On the basis of these results gastric bypass would appear to be indicated for the treatment of obesity not amenable to conventional therapy.
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PMID:[Indications and results of gastric bypass in the treatment of extreme obesity]. 674 Nov 46

Children recovering from severe malnutrition on a milk based diet have low plasma zinc concentrations: children recovering on a soya based diet have much lower plasma zinc concentrations, lower rates of weight gain, and higher energy costs of tissue deposition. However, they do not demonstrate the clinical features of anorexia, diarrhea, and skin lesions usually associated with zinc deficiency. We therefore supplemented 16 children with zinc acetate on the basis that a therapeutic response to zinc constitutes the best evidence of a preexisting zinc deficiency. Fourteen of the 16 children had an immediate and definite increase in their rate of weight gain with zinc supplementation. This was associated with a decrease in the energy cost of tissue deposition, regrowth of the thymus, and activation of the sodium pump. We conclude that the children were indeed zinc deficient. We suggest that the anorexia of zinc deficiency is related to an inability to metabolize nitrogen in the zinc deficient state, and that our children did not show an appetitive response because of the relatively low protein content of the diets we used. Based on the premise that the abnormalities seen in our children may have been secondary to mild zinc deficiency, we suggest that limitation of lean tissue synthesis, with resultant obesity, and a propensity to infection are the major features of a mild zinc deficiency. Children undergoing a period of "catch up" weight gain or growth should have supplemental zinc, particularly if they have had diarrhea or if the use of a soya based formula is contemplated.
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PMID:Effect of zinc supplementation on the dietary intake, rate of weight gain, and energy cost of tissue deposition in children recovering from severe malnutrition. 678 72

Jejuno-ileal 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 operation. A high incidence of urinary tract calculi was found in these patients (Backman & Hallberg, 1972; Dickstein & Frame, 1973; O'Leary, Thomas & Woodward, 1974; Backman et al., 1975; Gregory et al., 1975). Other known late complications are transient disturbances in liver function and electrolyte balance (Backman et al., 1975). Different types of operations result in different frequencies of kidney stones.
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PMID:Difference in kidney stone incidence after three types of intestinal bypass operations. 693 90

A case of an adult woman with a Bartter-like syndrome after jejunoileal bypass for obesity is described. Diarrhoea, hypokalaemia, high plasma renin activity, hyperaldosteronism, alkalosis, increased urinary prostaglandin E and hyperplasia of the juxtaglomerular apparatus with low or normal blood pressure were the major features. After corrective surgery the values turned only transiently towards normal, despite permanent disappearance of the diarrhoea. Spironolactone, amiloride or propranolol had no real effect on clinical symptoms or biochemical aberrations. Indomethacin, a prostaglandin synthetase inhibitor, normalized most of the aberrations, but--inexplicably--not the prostaglandinuria.
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PMID:A Bartter-like syndrome after jejunoileal bypass for obesity. 711 66

Pancreatic polypeptide was infused into obese-hyperglycemic (ob/ob) mice and lean littermates to determine its effect on weight gain. Obese mice continuously infused with 30, 60, or 100 micrograms/day for 7 days developed both diarrhea and weight loss in a dose dependent fashion. Lean littermates infused with 100 micrograms/day developed neither diarrhea nor weight loss. Light microscopic study of ileum and colon revealed no abnormalities. These studies indicate that the effects of pancreatic polypeptide are in part genetically determined since the obese and non-obese mice differ at only one gene locus.
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PMID:Pancreatic polypeptide causes diarrhea and weight loss in obese mice but not in lean littermates. 717 27

Fourteen patients with jejunoileal bypass for obesity were treated for one week with a calcium supplement of 3g daily. During this period diarrhoea was significantly (P < 0.005) reduced by 23 per cent (97 per cent confidence limits: 7-46 per cent). Ten of the patients had hyperoxaluria (median value 961 mumol/24 h; range 633-2742 mumol/24 h). The treatment with calcium significantly (P < 0.005) decreased the concentration of oxalate in urine by 23 per cent (98 per cent confidence limits: -5-+54 per cent). The calcium supplement did not increase urinary calcium-excretion rate or albumin-corrected serum calcium.
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PMID:Calcium in the treatment of diarrhoea and hyperoxaluria after jejunoileal bypass for obesity. 739 1

Between October 1967 and November 1977, the jejunoileal bypass was performed on 177 patients for morbid exogenous obesity. The female--male ratio was 9:1. The mean follow-up period was 3.4 years and their ages ranged from 15 to 58 years. Eighty-five per cent of this patient population base were between the ages of 21 and 49 years, and in 83% the onset of obesity was in childhood. Four parameters were used to assess the effectiveness of this procedure: 1) the ponderal index, 2) the per cent of ideal weight, 3) complications, and 4) diarrhea. Using the ponderal index, 38% of the results were excellent, 20% satisfactory, and 25% poor. When the per cent of ideal weight was used, the results were 24, 27 and 32% respectively. For complications, the results were 55, 23 and 5% and with diarrhea, 53, 22 and 8%. A summary of these mean values was 42.5, 23 and 17.5% for excellent, satisfactory and poor results. There were four deaths in this series, occurring 2--16 months postoperatively, due to sepsis, pulmonary embolism, drug overdose, and liver failure. Of the 28 patients (17%) requiring revision, eight were revised for inadequate weight loss, four for excessive weight loss, 15 for uncontrollable diarrhea, and 11 for metabolic electrolyte problems. In 14% the revision was required for multiple indications. A review of 100 of these patients to determine their response to the procedure revealed that 91% were able to recommend the procedure to other patients and intrepreted their results as being excellent in 51%, good in 36% and fair in 11%. Continued use of this procedure should be deferred pending much needed investigation of the associated complications.
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PMID:Jejunoileal bypass. Long-term results. 740 62

The authors report their experience in the care of severely obese patients undergoing biliopancreatic diversion (BPD) surgery. The success of this surgical technique not only depends on its correct application but also on correct postoperative management, both immediately and over time. After a short summary of the methods of management used immediately after surgery, the authors focus in greater detail on the most frequent complications in this type of surgery: these are divided into early and late. Among the former, the authors discuss thromboembolic disease, the most severe complications and bronchopneumonia disorders. The authors illustrate the methods of treating both as well as therapies for their prevention. The most frequent and potentially dangerous late complications are examined in detail: protein malnutrition, sideropenic anemia and diarrhea. Lastly, the authors underline the need for a constant rather than episodic approach to the problem of severe obesity since, in their opinion, only continuous and long term application ensures the best results with the fewest complications.
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PMID:[Care of the patient after biliopancreatic diversion (BPD) surgery]. 799 Nov 92

PAHO member countries maintain food and nutrition surveillance systems. The prevalence of malnutrition among children aged 0-4 in Latin American and Caribbean countries ranges from 0.8% in Chile to 38.5% in Guatemala. It is 2.9% in the US. Low height-for-age is most common among children aged 0-4 in Guatemala (57.9%), Bolivia (38.3%), Peru (35.2%), and Ecuador (34%). The interval between observations of malnutrition prevalence ranged from 22 years in Honduras to 3-4 years in Nicaragua and Panama. Overall, there was a downward trend in malnutrition rates in the Americas. Yet, malnutrition is increasing in Guatemala and Panama. Breast feeding, good weaning practices, appropriate feeding during disease episodes, nutrition education, and programs for immunization and control of diarrhea and respiratory diseases account for the downward trend. Anemia rates among pregnant women (=or 11 g Hb/dl) vary from 13% in Asuncion, Paraguay, to 61% in Misiones, Argentina. Those for preschoolers range from 22% to 45% in Brazil and 27% to 53% in Peru. The prevalence of goiter is more than 50% in Merida, Venezuela, and Chameza, Colombia. It differs greatly in different areas within the same country. Most countries have laws requiring iodination of all salt for human consumption, yet violations are common. Certain areas of the countries in the Americas have vitamin A deficiency rates ranging from 5% to 48.8%. Some countries have enacted laws for sugar enrichment with retinol palmitate to reduce vitamin A deficiency. During the 1970s, deaths from chronic diseases related to nutrition increased 105% in South America, 56% in Central America, Mexico, and Panama, and 21% in the Caribbean. Prevalence of obesity among children aged 0-6 varies from 2.2% in Nicaragua and Brazil to 10.7% in Chile. Adult obesity is most common in Uruguay (about 50%). It is more common among females than males. The highest rates among 20-29 year olds are in Chile, Costa Rica, Cuba, and Peru. The US adult obesity rate is 12%.
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PMID:Nutritional situation in the Americas. 799 15


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