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

The role played by the epidural fat has been reported in lipomatosis induced by exogenous glucocorticoids and in severe obesity with lipomatosis. The role played by the "normal" posterior epidural fat (PEF) in lumbar canal stenosis (LCS) is less well known. The purpose of this study was to determine the part taken by PEF in LCS patients without endocrine disease, corticosteroid therapy or obesity. For this, we tried to specify the amount and distribution of PEF among the soft tissues in the vertebral canal, to demonstrate the involvement of PEF in dural sac compression, to describe the radiological features observed in cases of LCS and to look for associated morphological factors. The records of 30 LCS patients without exogenous or endogenous lipomatosis and in whom the essential pathogenic factor in 40 levels was PEF were reviewed retrospectively. At disc level, PEF was evaluated in the lower part of the mobile segment by means of CT or MRI axial sections cut through one or two spaces between L2-L3 and L4-L5. Measurements were made in 25 men (80%) and 6 women (20%) aged from 33 to 83 years (mean: 58 years). Most patients were suffering from lumbar pain, radiculopathy and/or neurogenic intermittent claudication. The data measured were: antero-posterior (AP) diameter of the dural sac, AP diameter of the bony lumbar canal (BLC), interligamentous distance (ILD) opposite the articular facets, and surface of PEF. The soft elements present on the midline--anterior epidural space (AES) and posterior epidural (PEF)--were expressed as percentage of the AP diameter of the bony lumbar canal.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Posterior epidural adipose tissue and the narrow lumbar canal: replacement tissue or cause of impingement?]. 762 71

We report the case of a 9-year-old girl with multiple problems due to hypothalamic dysfunction of obscure origin: apnoeic spells, behavioural problems, developmental delay, hypodipsia with bouts of hypernatraemia, episodes of spontaneous hypothermia, obesity, petit-mal seizures, non-progressive precocious puberty, absence of respiratory response to CO2 and probably insensitivity of hyposensitivity to pain. She also had hyperprolactinaemia and decreased human growth hormone secretion. Hypothyroidism of central origin and hyposecretion of cortisol were also present. Multiple brain CT-scans failed to reveal any tumour or other anatomical abnormality. Her clinical course was improved initially by treatment with clomipramine, but she died suddenly, and the autopsy failed to disclose any anatomical lesion. We compare this case with three similar previously reported cases.
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PMID:Hypothalamic dysfunction in a child: a distinct syndrome? Report of a case and review of the literature. 768 46

Caffeine is widely consumed in beverages to obtain mild CNS stimulant effects. Long term use produces tolerance to some of the pharmacological effects. Withdrawal of caffeine, even from moderate intake levels, can produce symptoms such as headache, fatigue and anxiety. Caffeine is used therapeutically in combination with ergotamine for migraine headaches and in combination with nonsteroidal anti-inflammatory drugs in analgesic formulations. Caffeine alone is used as a somnolytic, to treat various headache conditions, respiratory depression in neonates, postprandial hypotension and obesity, and to enhance seizure duration in electroconvulsive therapy. In some headache and in pain paradigms, caffeine may produce direct adjuvant analgesic properties, while in other headache conditions (perioperative, postdural puncture) caffeine may be effective by alleviating a manifestation of caffeine withdrawal. Other uses, such as to promote wakefulness, for respiratory stimulation and seizure prolongation, rely on central stimulant properties of caffeine. Effects of caffeine on the vasculature may contribute to the relief of some headaches and in postprandial hypotension. Blockade of methylxanthine-sensitive adenosine receptors is the currently accepted mechanism of action of caffeine.
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PMID:Pharmacological rationale for the clinical use of caffeine. 770 15

Neuropathy is the most common symptomatic chronic complication in diabetic patients and accounts for substantial morbidity in the diabetic population. It is predominently a disease of the older diabetic population, and shows a progressive course with limb amputation as the final end-point of the disease. Pathologically the disorder is characterised by progressive degeneration as well as impaired regenerative ability of peripheral nerve fibers, resulting in a progressive loss and dying-back of the longest nerve fibres innervating the distal limbs. These changes are associated with progressive impairment of nerve function leading to impaired sensitivity in the limbs, which sometimes is associated with troublesome pain. Qualitatively similar but much milder functional and structural changes occur during normal aging processes, which potentially could make elderly diabetic patients more susceptible to an additional hyperglycaemic insult. The mechanisms underlying the development of diabetic neuropathy involve hyperglycaemia-induced metabolic abnormalities of peripheral nerve fibres and the supporting nutritive vascular supply. One of the major abnormalities involves activation of the polyol pathway with subsequent impairments in nerve function and vascular supply. Since hyperglycaemia appears to be the major culprit in the development of diabetic neuropathy, good glycaemic control is paramount in the long term treatment of diabetic patients to attenuate the development and/or progression of the disorder. Furthermore, elimination of risk factors such as obesity, smoking and excessive alcohol (ethanol) consumption, as well as patient education, are all important factors in the care of diabetic patients. In symptomatic neuropathic patients, including those with painful neuropathy, symptomatic and palliative measures are often effective. Stepwise addition of antidepressants to simple analgesics has proven to be effective in patients with troublesome pain. During recent years a class of drugs have been developed that inhibits the activation of the polyol pathway in diabetic nerves. These so-called aldose reductase inhibitors hold promise for a targeted treatment regimen in the near future. The aldose reductase inhibitors are already available in several European countries and in Japan.
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PMID:Diabetic neuropathy in the elderly. 771 59

Consecutive obese (n = 53) and non-obese parturients (n = 609) were prospectively evaluated during labour to analyse the influence of maternal obesity on labour pain and outcome. Excessive pre-pregnancy weight was classified as a body mass index of 30 kg.m-2 or more. Pain intensity was measured using an 11 point visual scoring scale. Obese parturients had more complicated pregnancies (hypertension and diabetes) and their babies weighed significantly more (3865 g versus 3592 g, p < 0.001). These differences did not affect labour pain experience, or the duration or mode of delivery. Eighty-five percent of the obese parturients and 83% of the controls had high maximal pain scores during the first stage (> 7). Both groups received similar analgesia. More technical problems (p = 0.03) were experienced in establishing epidural analgesia for obese parturients, but this did not influence the success of pain treatment. After delivery, obese women were significantly more content with the pain relief received; only 12% vs 23% in the control group complained of poor pain control (p = 0.03). In this study, obesity and increased fetal size did not complicate labour or its outcome. Critical patient assessment should be emphasised, however, due to the physiological and medical problems present in obese parturients.
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PMID:The effect of maternal obesity on labour and labour pain. 774 49

Surgery and anaesthesia, including positioning and mechanical ventilation, encompass alterations in respiratory mechanics and gas exchange persisting through the postoperative period and may cause respiratory complications. The closer the anatomical ties between the surgical site and the respiratory system, the higher the pulmonary risks. Pre-existing respiratory and pulmonary diseases further increase the patient's risk. In addition to the numerous patients suffering from chronic obstructive pulmonary disease, patients with restrictive disorders, e.g. obesity, are concerned as well. Arterial oxygen saturation tracked by pulse oximetry is recommended for screening the respiratory system. Patients at an increased risk of respiratory complications should be scheduled individually for preoperative preparation, anaesthesia requirements, and postoperative management. When anaesthetizing patients with coexisting pulmonary disease, regional anaesthesia is preferred unless limited by the surgical procedure or for obvious technical reasons. Pasch provides recommendations for the management of anesthesia: Acute respiratory obstruction should be prevented by personal attention and pharmacological protection. Anaesthetics and relaxants with parasympathomimetic and histamine liberating effects should be avoided. Attention should be paid to hazardous pharmacological interactions with existing respiratory therapy. Bronchospasm should be avoided by deep anaesthesia and by smooth intubation and extubation. Pain therapy is an essential requirement for respiratory therapy in the postoperative period to maintain or to restore pulmonary function with improved performance.
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PMID:[The risk of anesthesia in bronchopulmonary diseases]. 780 90

We report a case of sudden death in a 19-year-old adolescent male who had been receiving hospital treatment because of a persistent right calf pain which had started about 18 days previously. The pain had not been relieved by analgesics, and had extended to the right thigh. The post-mortem examination revealed that the cause of death was pulmonary embolism by thrombi which had arisen in the right calf veins. The bilateral pulmonary arteries were packed with thrombi, and many pulmonary branches were occluded with fresh thrombi. The right calf veins contained thrombi of differing ages. In old thrombi, massive collagen formation and hemosiderin granules were present but elastic fibers had not yet formed. Therefore, it was considered that the old thrombi had formed at the time of the patient's first visit to the hospital. The right calf pain for which the deceased had sought medical advice was considered to have been caused by the vein thrombosis. Although various risk factors for the formation of thrombi are known, in the present case no precedent causes other than obesity were identified.
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PMID:Sudden and unexpected death due to undiagnosed pulmonary thromboembolism in an adolescent male without previous history of trauma. 780 16

One hundred five patients (70% female and 30% male; average age, 48 years) with 132 symptomatic heels were treated according to a standard nonoperative protocol and then reviewed at an average follow-up of 29 months. The treatment protocol consisted of nonsteroidal anti-inflammatory medications, relative rest, viscoelastic polymer heel cushions, Achilles tendon stretching exercises, and, occasionally, injections. Obesity, lifestyle (athletic versus sedentary), sex, and presence or size of heel spur did not influence the treatment outcome. Ninety-four patients (89.5%) had resolution of heel pain within 10.9 months. Six patients (5.7%) continued to have significant pain, but did not elect to have operative treatment, and five patients (4.8%) elected to have surgical intervention. Despite attention to the outcome of surgical treatment for heel pain in the current literature, initial treatment for heel pain is nonoperative. The treatment protocol used in this study was successful for 89.5% of the patients.
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PMID:Painful heel syndrome: results of nonoperative treatment. 783 59

To clarify the natural history of osteoarthritis of the knee joint, a field study of the knee joint was performed on the inhabitants of Matsudai Town, Niigata Prefecture in 1979 and 1986. The study included the same 979 individuals, involving 820 women and 159 men, aged between 40 and 65 years in 1986 as in 1979. Narrowing of the femoro-tibial joint space was found in 17.7% and 26.1% of the women, and in 5.3% and 12.0% of the men, in 1979 and 1986, respectively. The individuals without osteoarthritic change and those with subchondral sclerosis or osteophytes in the femoro-tibial joint space exhibited less progressive changes in symptoms and radiographic findings. On the other hand, many of those in whom the joint space was more than 50% narrowed compared with the contralateral joint space had persistent pain, suggesting that they were candidates for active treatment. There were about twice as many women as men with symptomatic osteoarthritis of the knee. A comparative study of a group of women with, and a group of women without, radiographic progression in arthritic changes, indicated that the factors correlated with worsening osteoarthritis of the knee included aging, obesity, varus deformity of the knee, severity of inflammation, and flexion contracture of the knee.
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PMID:[Osteoarthritis of the knee joint: a field study]. 796 28

Ingestion of highly palatable diets (HPDs), rich in sucrose and fat, has been shown to lead to obesity and alterations in cardiovascular function in animal models. A hypothesis has been advanced which suggests that ingestion of an HPD increases hypothalamic beta-endorphin release, an effect which results in an increase in sympathetic nerve outflow during the development of obesity. The hypothesis was tested by chronic (10 weeks) feeding of male spontaneously hypertensive rats (SHRs) and Wistar-Kyoto rats (WKYs) with the HPD or normal rat chow (ND). Cardiovascular function (systolic blood pressure, heart rate) and body weight gain were monitored during the feeding period. Pain sensitivity was tested weekly by measuring tail-flick latency. Body weight gain was greater in WKY rats than in SHRs, but ingestion of the HPD had no effect in either strain. Terminal organ analysis indicated differences between strains of SHRs and WKYs in the heart, the adrenal and pituitary glands, peri-testicular fat pad, and testis weights expressed by organ weight/body weight. The heart weight was greater in SHRs on the HPD than in SHRs on the ND. The ingestion of the HPD significantly increased blood pressure only in SHRs, following 10 weeks of dietary intervention. However, tail-flick latency was prolonged in both SHRs and WKYs during ingestion of the HPD. Increases in tail-flick latency suggest that the HPD increases brain opiate levels in both SHRs and WKYs. Exaggerated increases in heart weight and blood pressure were noted in SHRs following feeding with the HPD, indicating enhanced sensitivity of SHRs to HPD-induced hypertension.
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PMID:Cardiovascular and analgesic effects of a highly palatable diet in spontaneously hypertensive and Wistar-Kyoto rats. 802 5


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