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

Intussusception of the defunctionalized intestinal segment following jejuno-ileal bypass for obesity has rarely been reported. Persistent crampy abdominal pain (often accompanied by nausea and vomiting) and normal radiologic evaluation are suggestive of this entity. The routine use of silver clips, although helpful in some instances, cannot exclude this diagnosis. A high index of suspicion and the use of sonography may prove that intussusception of the defunctionalized segment is more common than has been previously reported.
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PMID:Intussusception of the excluded segment following jejuno-ileal bypass. 44 76

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

Sixty women with breast cancer (mean age: 61 years; range 36-78 years) were treated with Epirubicin (4'epi-Doxorubicin), 60 mg m-2, as single drug therapy. The drug was administered as 2 hours' constant rate infusions. The pharmacokinetics of the drug during the first course of treatment was evaluated by measurements of the plasma concentration of Epirubicin at the end of the infusion period. There was a five-fold inter-individual variation of the dose-normalized maximum plasma concentration, which increased with increasing age of the patients. There was no correlation between this pharmacokinetic parameter and degree of obesity. An increase in maximum plasma concentration was associated with an increasing degree of alopecia (p = 0.025). Also the degree of nausea and vomiting showed a tendency to increase with increasing maximum plasma concentration (p = 0.07). Fifty four of the sixty patients entered in the present study were evaluable for clinical response. There was one CR (complete remission). Seventeen patients achieved PR (partial response), and twenty five patients had SD (stable disease). Eleven patients did not respond to treatment. The median maximum plasma concentrations were 322, 316, 336 and 288 ng ml-1 in patients with CR, PR, SD and PD, respectively. The results in the present study showed that 60 mg m-2 of Epirubicin given as a constant rate infusion over 2 hours is a useful alternative to more aggressive combination drug therapy for the treatment of breast cancer.
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PMID:Epirubicin as a single agent therapy for the treatment of breast cancer--a pharmacokinetic and clinical study. 134 19

In a recent editorial, Kapur described perioperative nausea and vomiting as "the big 'little problem' following ambulatory surgery."257 Although the actual morbidity associated with nausea is relatively low in health outpatients, it should not be considered an unavoidable part of the perioperative experience. The availability of an emesis basin for every patient in the postanesthesia recovery unit is a reflection of the limited success with the available therapeutic techniques.257 There had been little change in the incidence of postoperative emesis since the introduction of halothane into clinical practice in 1956. However, newer anesthetic drugs (e.g. propofol) appear to have contributed to a recent decline in the incidence of emesis. Factors associated with an increased risk of postoperative emesis include age, gender (menses), obesity, previous history of motion sickness or postoperative vomiting, anxiety, gastroparesis, and type and duration of the surgical procedure (e.g., laparoscopy, strabismus, middle ear procedures). Anesthesiologists have little, if any, control over these surgical factors. However, they do have control over many other factors that influence postoperative emesis (e.g., preanesthetic medication, anesthetic drugs and techniques, and postoperative pain management). Although routine antiemetic prophylaxis is clearly unjustified, patients at high risk for postoperative emesis should receive special considerations with respect to the prophylactic use of antiemetic drugs. Minimally effective doses of antiemetic drugs can be administered to reduce the incidence of sedation and other deleterious side effects. Potent nonopioid analgesics (e.g., ketorolac) can be used to control pain while avoiding some of the opioid-related side effects. Gentle handling in the immediate postoperative period is also essential. If emesis does occur, aggressive intravenous hydration and pain management are important components of the therapeutic regimen, along with antiemetic drugs. If one antiemetic does not appear to be effective, another drug with a different site of action should be considered. With the availability of new antiserotonin drugs, the incidence of recurrent (intractable) emesis could be further decreased. Research into the mechanisms of this common postoperative complication may help in improving the management of emetic sequelae in the future. As suggested in a recent editorial, improvement in antiemetic therapy could have a major impact for surgical patients, particularly after ambulatory surgery. Patients as well as those involved in their postoperative care look forward to a time when the routine offering of an emesis basin after surgery becomes a historical practice.
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PMID:Postoperative nausea and vomiting. Its etiology, treatment, and prevention. 843 45

This is a report of a pilot program for laparoscopic sterilization with emphasis on surgical and anesthetic technics. In 1971 the program was developed at the North Carolina Memorial Hospital. Subjects were 129 private patients, mostly white, of middle income with 2 or more children, and from 19 to 47 years of age. Follow up of over 90% indicated high patient satisfaction. Complications were few but may occasionally require surgical management and the method should not be considered a minor procedure. At first patients were handled as inpatients for 1 day preceding surgery. Later an outpatient status was adopted. At an earlier visit a history is taken, instructions given by a nurse, the assigned physician (who may be a physician in training) reviews the history, performs a physical examination, and explains the operation to both the patient and her husband. Laboratory work is performed, operative permits are signed, and patients are asked at this time to agree to sterilization by laparotomy if the laparoscopic approach proves infeasible. On the morning of surgery suitable intravenous medication (Valium 5 mg), fentanyl, and atropine are given and followed by pure oxygen inhalation for 3-5 minutes. Pentothal followed by succinylcholine are given and the patient intubated. Anesthesia is maintained by succinylcholine drip and inhalation of nitrous oxide and oxygen. After surgical preparation with Betadine solution, a combination tenaculum-sound is placed in the cervical canal. Pneumoperitoneum is established with carbon dioxide gas through a Verres needle inserted through a small subumbilical incision. The laparoscopic trocar is introduced by enlarging the same incision. After inspection a second 6 mm trocar is inserted just about the tubes and biopsy forceps introduced. The tenaculum in the cervix is used to position the uterus and tubes. After cauterization tubes are divided with the biopsy forceps and a biopsy specimen obtained if possible without undue action on the tube. After inspection for bleeding or injury to other viscera, the instruments are withdrawn. The procedure can be completed in 15 minutes. After recovery from the anesthesia the patient is removed to the recovery area and then the holding area. After 2 or 3 hours she is seen by a physician and discharged if vital signs are stable. Oral and written instructions for her convalescence are given. Patients are requested to return in 2 weeks or to consult a physician in their home area. 30 patients required postoperative hospital admissions: 15 for non-medical reasons (i.e., distance to travel home) and 15 for observation at the physicians' request. These stayed 14 to 24 hours. Nausea and vomiting were indications in 5. :In one case nosebleed following intubation combined with slight elevation of temperature caused a stay of 48 hours. Retrospectively, only 8 of the 15 hospitalized or 6% of all cases required this extra service. In the initial series there was 1 technical failure due to obesity. The average time to resume normal activities was 3 1/2 days. 115 patients (97.4%) of those responding to a questionnaire stated they would recommend the procedure to a friend. The 3 dissatisfied respondents gave no specific reason. Thorough training of the physicians is urged. Use as an office procedure with local anesthesia is not recommended. Single-puncture technic is being tried. Subsequently over 100 additional procedures have been performed.
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PMID:An outpatient program for laparoscopic sterilization. 426 75

Eight morbidly obese subjects and 12 controls were studied with an oral test meal and a heavy duodenal infusion with fat and glucose. Five of the controls were excluded because of nausea and vomiting after the duodenal stimulation whereas none of the obese subjects noted any discomfort. There was no difference in plasma GIP secretion between the two groups neither after the oral nor after the duodenal stimulation. The present study supports our previous conclusion of an unaltered GIP secretion in obesity.
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PMID:Similar plasma GIP responses in obese and lean subjects after an oral test meal and after intraduodenal stimulation with fat and glucose. 639 18

A recent meta-analysis showed that omitting N2O significantly reduced postoperative vomiting (POV) compared with a N2O regime. Our study was designed to evaluate the effect of the combination of desflurane with N2O versus desflurane alone on postoperative nausea and vomiting (PONV) in a subgroup of female patients and PONV was considered as the primary endpoint. After approval of the local Ethics Committee and informed consent 60 female in-patients (ASA I & II), aged 18-65 y, scheduled for breast surgery with a duration of 1-3 h were included. Obese patients or patients with a history of PONV and motion sickness were excluded. No prophylactic anti-emetic therapy was allowed during the study. Patients received a standardized anesthetic technique consisting of propofol for induction, vecuronium and fentanyl for intubation, followed by desflurane with or without N2O (randomisation list) and fentanyl supplements if required for maintenance of anesthesia. At the end of anesthesia PONV was recorded during 24 h in different periods. There were no significant differences between the groups with respect to demographic data and duration of anesthesia. In addition, there were no significant differences in the amount of intraoperative fentanyl or postoperative narcotics. The incidence of PONV was significantly higher in the group of patients receiving desflurane in N2O-O2 mixture compared with the group receiving desflurane in AIR-O2 mixture. The combination of desflurane with N2O in female patients undergoing breast surgery is associated with a significantly higher incidence of PONV and a higher need of antiemetic drugs, when compared to a N2O free regime.
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PMID:The impact of nitrous oxide on postoperative nausea and vomiting after desflurane anesthesia for breast surgery. 1041 46

Total intravenous anaesthesia (TIVA) with short-acting drugs is a standard procedure for day case surgery and is increasingly used for neurosurgical, cardiac surgical and paediatric surgical operations. The combination of propofol with alfentanil or remifentanil is frequently applied due to its favourable pharmacological properties. Propofol is characterized by a large volume of distribution at steady state and a relatively long elimination half time (t1/2 beta). Because of a high metabolic clearance, the clinical effects of propofol decline rapidly even after prolonged intravenous drug infusion. In patients with increased age, obesity or liver or renal failure, decreased doses of propofol for induction of anaesthesia are recommended. The short-acting opioids alfentanil and remifentanil provide small volumes of distribution at steady state, a short blood-brain equilibration time and decreased t1/2 beta. Remifentanil has unique pharmacological properties due to an ester binding and its elimination via extrahepatic hydrolysis by non-specific blood and tissue esterases. The context sensitive half time of remifentanil is significantly shorter than that of other opioids. Its analgetic potency is equal to fentanyl and 20 to 30 times higher than alfentanil. The advantages of total intravenous anaesthesia include fewer haemodynamic side-effects, a decreased incidence of postoperative nausea and vomiting and less neurohumoral stress response to surgery. Adequate pain therapy is mandatory after total intravenous anaesthesia with short-acting drugs. Continuous infusion of remifentanil for postoperative analgesia or supplementation of regional anaesthesia requires careful monitoring of vital functions. The economic aspects of TIVA remain to be determined.
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PMID:[Perioperative management with short-acting intravenous anesthetics]. 1119 82

Food modulates gastrointestinal (GI) function and GI symptoms could alter food intake, but it is not established whether or not obese people experience more or less GI symptoms. We aimed at evaluating the association between body mass index (BMI) and specific GI symptoms in the community. Population-based random samples from Sydney, Australia (n = 777) completed a validated questionnaire. The association of each GI symptom with BMI (kg m(-2)) categories was assessed using logistic regression analysis adjusting for potential confounders. The prevalence of obesity (BMI > or =30 kg m(-2)) was 22%. There were univariate associations (adjusting for age, sex, education level, alcohol and smoking) between increased BMI category and heartburn (OR = 1.9, 95% CI 1.4, 2.5), acid regurgitation (OR = 2.1, 95% CI 1.4, 2.9), increased bloating (OR = 1.3, 95%CI 1.1, 1.6), increased stool frequency (OR = 1.4, 95% CI 1.1, 1.7), loose and watery stools (OR = 1.5, 95% CI 1.1, 2.0) and upper abdominal pain (OR = 1.3, 95% CI 1.03, 1.6). Early satiety was associated with a lower BMI category but this was not significant after adjustment (OR = 0.8, 95% CI 0.6, 1.1). Lower abdominal pain, postprandial fullness, nausea and vomiting were not associated with BMI category. In a regression model adjusting for sex, education, smoking, alcohol and all GI symptoms, older age, less early satiety and increased stool frequency and heartburn were all independently associated with increasing BMI (all P < 0.01). Heartburn and diarrhoea were associated with increased BMI, while early satiety was associated with a lower BMI in this population.
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PMID:Association of upper and lower gastrointestinal tract symptoms with body mass index in an Australian cohort. 1530 96

Cholecystokinin (CCK), glucose dependent insulinotropic peptide (GIP), and glucagon-like peptide 1 (GLP-1) regulate satiety as enterogastrons and incretins. They also directly affect the satiety centers. Therefore, these peptides may participate in the pathogenesis of eating disorders. CCK, GIP, and GLP-1 secretion were studied in 13 adolescent girls suffering from simple obesity, 13 girls with anorexia nervosa, and 10 healthy girls. Each girl was subjected to an oral glucose tolerance test (OGTT) and standard meal test. Blood was collected before stimulation and at 15, 30, 60, and 120 min. The concentrations of all peptides were determined by RIA commercial kits. Fasting and postprandial levels of these peptides as well as integrated outputs were measured. High postprandial levels of CCK observed in the girls with anorexia may aggravate the course of this disease by intensifying nausea and vomiting. Low postprandial level of GLP-1 in girls with simple obesity may be responsible for excessive ingestion of food and weaker inhibition of gastric emptying, which also leads to obesity.
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PMID:Cholecystokinin, glucose dependent insulinotropic peptide and glucagon-like peptide 1 secretion in children with anorexia nervosa and simple obesity. 1564 96


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