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

Sexual sterilization is the major form of fertility control in women who are more than 30 years old. Clinicians usually use laparoscopy to perform female sterilization. They may occlude the fallopian tubes with a clip or ring or coagulate the tubes using bipolar diathermy. It is usually performed on an outpatient basis. Nonsteroidal anti-inflammatory drugs can generally control the postoperative pain. A serious immediate but rare complication is death, which is often associated with the anesthesia. Complications related to the experience of the surgeon include damage to bowel or blood vessels and tearing of mesosalpinx. Obesity or pelvic adhesions often necessitates either laparotomy or abandonment of sterilization. Some long term complications are hysterectomy and menstrual disorders. Presterilization counseling needs to examine the possibility of regret and to discuss failure rates and complications. Reasons for regret are young at time of sterilization, psychosexual disorder, change of partner, change in financial circumstances, sterilization performed at time of crisis, and death of a child. The failure rate for the Filshie clip is 0.1%. Reasons for failure include pregnant at the time of the procedure, clips placed across the round or ovarian ligament, incomplete occlusion, and fistula formation and recanalization. Failure rates are higher when the sterilization is done during pregnancy because the tubes are thicker and more vascular. Vasectomy involves severing and ligating the vas deferens in both scrotums. Immediate complications are hematoma and infection. Vasectomy patients need to bring 2 semen samples for sperm counts 3-4 months after the procedure. Azoospermia signals a successful vasectomy. If sperm are still present 5-6 months after the procedure, the surgeon should conduct exploratory surgery under general anesthesia. Long term side effects include testicular discomfort and perhaps prostate cancer. The evidence is unclear about the link between vasectomy and prostate cancer, however.
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PMID:Male and female sterilisation. 807 40

A comparative study of endoscopic plantar fasciotomy versus traditional type heel spur surgery has been performed involving 76 patients and 92 procedures. Sixty-six of those procedures consisted of endoscopic fasciotomy, whereas 26 involved traditional type surgery. Those patients in which the endoscopic fasciotomy was performed had significantly less postoperative pain, returned to regular activities 4 weeks earlier, and had fewer complications postoperatively than those patients involving traditional heel spur surgery. An overview of the surgical technique involving endoscopic fasciotomies is presented, as well as factors influencing the postoperative outcome, such as duration of preoperative symptoms, extent of conservative care, and obesity.
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PMID:Endoscopic plantar fasciotomy versus traditional heel spur surgery: a prospective study. 808 43

Osteoarthritis (OA) is a common age-related disorder which can result in severe pain and disability, and which is becoming one of the most important health-care challenges of the future. Previous negative attitudes to this condition are being dispelled by current research findings, which indicate that prevention and effective treatment will be possible in the future. Risk-factor analyses suggest that many cases can be prevented by reducing the amount of obesity in the community, and by changing certain high-risk occupations, as well as reducing the incidence of joint trauma. Work on the processes involved in the generation of OA have led to strategies for the secondary prevention of the condition, through drugs that either inhibit connective-tissue breakdown and/or stimulate repair. Recent developments in the management of established OA indicate that much of the pain and disability suffered in the community as a result of this disease is also preventable.
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PMID:Strategies for the prevention of osteoarthritis. 818 50

The 2-year experience of one neurosurgeon with Kambin's orthopedic instruments and frame for arthroscopic microdiscectomy is reported. Arthroscopy using a unilateral approach and monoportal technique is a valuable adjunct to fluoroscopic monitoring. One hundred patients underwent same-day microsurgical arthroscopic lateral-approach laser-assisted (SMALL) fluoroscopic discectomy. In addition, suspected spinal tumors in three patients were treated by biopsy and infection of the disc space was drained in one. A prototype operating discoscope was employed for delivery of the neodymium:yttrium-aluminum-garnet laser beam to assist with hemostasis. Seventy-five "ideal" cases were identified that exhibited the following features: 1) up to a 6-month history of unilateral sciatica symptoms, which responded to bed rest; 2) mechanical signs of nerve root irritation when the patient was erect; 3) computerized tomography or magnetic resonance imaging studies interpreted as showing one protruding or prolapsed disc without extrusion; 4) no segmental spondylosis at the level of a herniated nucleus pulposus; 5) no motor weakness; 6) no prior disc surgery; 7) no obesity; and 8) no diabetes mellitus. Twenty-five "nonideal" cases failed to meet one or more of the above criteria. Good outcome rates were not substantially different in the two groups, success being judged in part by patient satisfaction. Complete success was evidenced in two-thirds of cases by early return to work, but improvement was also determined by increased mobility and a reduction in pain medication from narcotic to analgesic agents. Three patients underwent repeat surgery (laminotomy), but only one improved. Two years has provided sufficient clinical experience to determine that a percutaneous endoscopic procedure under neuroleptanalgesia may become a significant surgical alternative.
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PMID:Same-day microsurgical arthroscopic lateral-approach laser-assisted (SMALL) fluoroscopic discectomy. 793 5

In 1988, the Diagnosis-Related Group for "Medical Back Problems" was the seventh leading reason for all U.S. hospitalizations. The authors sought to describe the content of these hospitalizations and consider the potential for shifting nonsurgical care to the outpatient setting. Three complementary data sources (the 1988 National Hospital Discharge Survey, a statewide Washington hospital discharge registry, and medical records) were used to examine the diagnoses, tests, treatments, resource use, and subsequent care associated with these hospitalizations. Nationally, nonspecific back pain and herniated discs were the most common diagnoses. Nearly half the hospitalizations were for diagnostic tests (especially myelography) and the other half for pain control. In Washington state, 43% of patients were admitted by family physicians or internists, and 40% by orthopedic or neurologic surgeons. Twenty percent of patients underwent subsequent back surgery within 1 year (most within 3 months), suggesting that many hospitalizations were "presurgical." Most of the tests and treatments identified are known to be safe in the outpatient setting. Focused medical record review indicated frequent psychosocial problems or complicating factors, including obesity, substance abuse, prior back surgery, psychologic diagnoses, or lack of a caregiver at home. The findings support other evidence that many hospitalizations for "medical back problems" are unnecessary, but also suggest a need for improved outpatient and home-based alternatives to hospitalization.
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PMID:Nonsurgical hospitalization for low-back pain. Is it necessary? 823 55

Four hundred and thirty patients with grade 2 or 3 esophagitis were treated after 2/1 randomization for 8 weeks with omeprazole 20 mg (n = 294) or ranitidine 150 mg bid (n = 136). Apart from treatment, 8 epidemiological factors (gender, age, occupation, obesity, smoking, alcohol, NSAID, and coffee or tea consumption), 5 clinical factors (day/night pain distribution, burning score, severity of regurgitation and of dysphagia, number of painful episodes requiring prescription of an antisecretory agent during the previous year, and onset of symptoms before age 30) and 3 endoscopic factors (grade and upward extension of esophagitis, and existence of hiatal hernia > or = 5 cm) were analysed. The influence of these factors on healing at 8 weeks and on changes in symptoms was evaluated by multivariate analysis. 92.1% of patients enrolled were analyzed. In comparison with ranitidine, omeprazole increased the percentage of healed patients (93% v. 67.5%, p < 0.001) and the rapidity of disappearance of symptoms (5 days v. 7 days, p < 0.001). Independent good prognostic factors associated with healing rate were treatment with omeprazole (p < 0.001) and grade 2 esophagitis (p < 0.001) while those associated with the disappearance of symptoms were a low burning score (p = 0.001), advanced age (p = 0.004), treatment with omeprazole (p = 0.005), the absence of any occupation (p = 0.01) and male gender (p = 0.017). The results of this study show that, apart from treatment, endoscopic factors are predictive of the healing of reflux esophagitis treated by antisecretory agents while clinical factors are more important with regard to the disappearance of symptoms.
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PMID:[Prognostic factors influencing healing of reflux esophagitis. A controlled trial of omeprazole versus ranitidine. Study group Omega]. 823 92

Rheumatic symptoms are often associated with obesity. The usual symptom is pain in the knee due to gonarthrosis, of which one of the causes is obesity; there is a correlation between the degree of overweight and the severity of gonarthrosis. It is likely, though not demonstrated, that overweight aggravates the arthrosis of supporting joints. On the other hand, obesity limits the post-menopausal bone loss. The intestinal bypass created to obtain a loss of weight may generate complications, and in particular an inflammatory rheumatism due to proliferation of bacteria in a blind intestinal loop, and osteomalacia caused by disorders of vitamin D absorption sometimes develops. The risk of perioperative complications is increased in obese patients. The mid-term results of hip or knee surgical replacement seem to be good. In the present state of our knowledge, its seems to be rational to convince obese patients complaining of rheumatic illness that they should lose weight.
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PMID:[Osteoarticular pathology and massive obesity]. 831 Feb 46

The central autonomic network (CAN) is an integral component of an internal regulation system through which the brain controls visceromotor, neuroendocrine, pain, and behavioral responses essential for survival. It includes the insular cortex, amygdala, hypothalamus, periaqueductal gray matter, parabrachial complex, nucleus of the tractus solitarius, and ventrolateral medulla. Inputs to the CAN are multiple, including viscerosensory inputs relayed on the nucleus of the tractus solitarius and humoral inputs relayed through the circumventricular organs. The CAN controls preganglionic sympathetic and parasympathetic, neuroendocrine, respiratory, and sphincter motoneurons. The CAN is characterized by reciprocal interconnections, parallel organization, state-dependent activity, and neurochemical complexity. The insular cortex and amygdala mediate high-order autonomic control, and their involvement in seizures or stroke may produce severe cardiac arrhythmias and other autonomic manifestations. The paraventricular and other hypothalamic nuclei contain mixed neuronal populations that control specific subsets of preganglionic sympathetic and parasympathetic neurons. Hypothalamic autonomic disorders commonly produce hypothermia or hyperthermia. Hyperthermia and autonomic hyperactivity occur in patients with head trauma, hydrocephalus, neuroleptic malignant syndrome, and fatal familial insomnia. In the medulla, the nucleus of the tractus solitarius and ventrolateral medulla contain a network of respiratory, cardiovagal, and vasomotor neurons. Medullary autonomic disorders may cause orthostatic hypotension, paroxysmal hypertension, and sleep apnea. Neurologic catastrophes, such as subarachnoid hemorrhage, may produce cardiac arrhythmias, myocardial injury, hypertension, and pulmonary edema. Multiple system atrophy affects preganglionic autonomic, respiratory, and neuroendocrine outputs. The CAN may be critically involved in panic disorders, essential hypertension, obesity, and other medical conditions.
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PMID:The central autonomic network: functional organization, dysfunction, and perspective. 841 66

Previous literature indicates possible interrelationships between the endogenous opioids or endorphins, pain response, and obesity or eating behaviour. The pain response was, therefore, examined in a rat model of obesity induced by palatable food high in unsaturated fats. Pellet-fed control and energy-dense obese and nonobese rats were tested for latency of response to a thermal stimulus using the tail flick test. Obese rats exhibited a statistically significant increase in tail flick latency compared to controls. In addition, the observed latencies were significantly correlated to the body weight of the rats (r = 0.52, p < 0.01). These data suggest that dietary-induced obese rats are similar to obese humans in being less sensitive to painful stimuli, consistent with an increase in endogenous opioids in obesity.
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PMID:Pain sensitivity in dietary-induced obese rats. 841 33

One thousand and three women aged 45-64 from the Chingford general population survey were studied cross sectionally to find the effect of quantity and distribution of body fat on the prevalence of radiologically confirmed osteoarthritis (OA) in the knee, carpometacarpal (CMC), distal interphalangeal (DIP), and proximal interphalangeal (PIP) joints. Obesity was classified as the upper tertile of body mass index (BMI kg/m2); the boundaries of the middle tertile were 23.4 and 26.4 kg/m2. The age adjusted odds ratio (OR) [and 95% confidence interval (CI)] of radiographic OA at the knee comparing the high and low tertile of BMI was 6.17 (3.26-11.71) and for bilateral knee radiographic OA was 17.99 (6.25-51.73). Comparing the middle and low tertile of BMI, the odds ratio for radiographic OA knee was 2.86 (1.44-5.68). For other joints the association between BMI and radiographic OA was less strong; the OR at CMC was 1.71 (1.05-2.78), at DIP was 1.52 (0.90-2.57), and at PIP was 1.23 (0.52-2.91). For all joints except PIP these OR increased if the diagnostic criteria included knee pain for at least a month, clinically evident swelling at the DIP or PIP, and pain or tenderness at the CMC. Recalled weight at age 20 years, or recalled maximum weight improved prediction of radiographic OA from current BMI, but measurement of fat distribution from circumference of waist, hip and thigh did not. Our results confirm that excess body weight is a powerful predictor of OA of the knee in middle aged women, and a modest predictor of DIP and CMC OA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. 847 72


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