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

An association between the ingestion tryptophan and a syndrome characterized by scleroderma-like skin abnormalities, fasciitis, and eosinophilia has recently been recognized in the United States. We report the clinical and histopathological findings in nine patients and the results of biochemical analyses of tryptophan metabolism in seven patients with this syndrome. Edema of the extremities, frequently accompanied by pruritus, paresthesia, and myalgia, developed in the nine patients (six women and three men; age range, 30 to 66 years) 1 to 18 months after the start of therapy with tryptophan (1.5 to 3.0 g daily) for insomnia, depression, or obesity. Five patients were taking drugs (benzodiazepines) known to inhibit hypothalamic-pituitary-adrenal function, and one had adrenal insufficiency. All had blood eosinophilia in the acute phase of their illness (mean eosinophil count [+/- SD], 3.62 +/- 2.87 X 10(9) cells per liter). All had histopathological changes in the dermis and subcutaneous tissue typical of scleroderma, and seven patients had eosinophils. The fascia was inflamed and fibrotic, and adjacent skeletal muscle often showed perifascicular inflammation. Tryptophan was discontinued in all patients, and eight received prednisone. The cutaneous symptoms improved, but only two patients had complete resolution of their illness. The patients had plasma levels of tryptophan before and after an oral dose of tryptophan that were similar to those in normal subjects. Plasma levels of L-kynurenine and quinolinic acid, which are metabolites of tryptophan, were significantly higher in four patients with active disease than in three patients studied after eosinophilia had resolved or in five normal subjects (P less than 0.001)--findings consistent with the activation of the enzyme indoleamine-2,3-dioxygenase. This illness resembles eosinophilic fasciitis and probably represents one aspect of the recently reported eosinophilia-myalgia syndrome. The development of the syndrome may result from a confluence of several factors, including the ingestion of tryptophan, exposure to agents that activate indoleamine-2,3-dioxygenase, and possibly, impaired function of the hypothalamic-pituitary-adrenal axis.
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PMID:Scleroderma, fasciitis, and eosinophilia associated with the ingestion of tryptophan. 231 25

Six patients who had a total hip replacement, as well as a trochanteric osteotomy, while they were in the lateral decubitus position had complications involving the contralateral side. The complications included transient paresthesias, massive swelling of the thigh with myonecrosis, acute renal failure secondary to myoglobinuria, and arterial insufficiency that resulted in a below-the-knee amputation. In order to elucidate the causes of the complications, the external pressure of the contralateral femoral triangle and the blood flow to the contralateral foot were monitored intraoperatively in seventeen patients. The results supported the postulate that pressure at the groin is increased intraoperatively and that this can cause vascular compromise. Other proposed causes of the complications were pre-existing vascular disease, obesity, the lateral decubitus position of the patient on the operating table, and the use of hypotensive anesthesia. We found several techniques that may minimize complications in the contralateral limb during operations on the hip.
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PMID:Complications after total hip replacement. The contralateral limb. 253 83

Of the 31 patients who developed polyarthritis following jejunoileal bypass for obesity, 24 had cutaneous vasculitis (urticarial, pustular, and nodular), 11 paresthesias, 10 Raynaud's phenomenon, and 1 pericarditis. Blind loop symptoms (14 of 26 patients), cryoglobulinemia (10 of 28), and immune deposits in biopsied skin lesions (5 of 7) support the theory of a relationship between bowel bacteria and immune complexes. Treating the blind loop with antibiotics and sphincteroplasty to prevent bacterial reflux into the blind loop helped 5 of 10 and 6 of 9 patients, respectively. A comparison is made to other bowel associated arthritides.
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PMID:The intestinal bypass: arthritis-dermatitis syndrome. 723 24

The case of a decompression sickness in woman, diving to 26 meter depth is reported. The patient was helped by instructor's computer (error!) and she presented risk factors for embolic disease (obesity, smoke, estroprogestinic therapy). She presented with many symptoms of decompression sickness during immersion and during re-ascent (headache, vertigoes and paresthesias). She was not treated on the place of incident, but only 36 hours later at our center of hyperbaric medicine. Her Magnetic Resonance imaging showed hyperintensity lesions of white matter.
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PMID:[NMR in the diagnosis and treatment of neurologic lesions in decompression sickness]. 1047 48

To determine the prevalence of fibromyalgia in diabetes mellitus and obesity, 121 consecutive patients have been observed: 27 with obesity (6 males and 21 females; mean age 57 years, range 20-57; mean body mass index [BMI] 34); 88 with type 2 diabetes mellitus (T2DM; 40 males and 48 females; mean age 63 years, range 44-78; mean BMI 28.8; mean glycated haemoglobin [HbA1c] in the last year 8.3%); 6 with type 1 diabetes mellitus (T1DM; 2 males and 4 females; mean age 52 years, range 26-76; mean BMI 24.5; mean HbA1c < 7%). An original questionnaire has been proposed (answer yes/not) as follows: 1) chronic (more than 3 months) and diffuse musculoskeletal pain; 2) sleep disturbances; 3) generalized fatigue; 4) paresthesias at the extremities; 5) swollen impression at hands and feet; 6) symptoms referred to irritable bowel syndrome; 7) headache; 8) symptoms change related with environmental climatic variations and/or exercise. A chronic and diffuse musculoskeletal pain has been reported by 62% of patients as well as in 9% of patients 11/18 positive tender points have been documented. In the patients with a BMI less that 26 the diagnosis of fibromyalgia was negative. Our data seem to reveal the presence of a significant clinical association between obesity, diabetes mellitus and fibromyalgia.
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PMID:[Prevalence of fibromyalgia in diabetes mellitus and obesity]. 1267 86

Obesity is a growing worldwide epidemic that is associated with serious medical complications. Although diet and exercise are often effective treatment in the short run, the weight lost is usually regained unless intensive intervention is maintained. Pharmacological adjunctive measures are clearly needed, and topiramate is currently being investigated as a possible new therapy for obesity. This paper reviews three clinical trials of topiramate for weight reduction in obese subjects: a 6-month dose-ranging study, a 2-year study of weight loss, and a 44-week study in subjects who had previously lost weight on a low-calorie diet. All three studies found topiramate to be significantly more efficacious than placebo. Notably, weight loss continued for 1 year and, perhaps, could have continued for a longer period. Topiramate was generally well tolerated, with adverse events being mild to moderate and mostly related to the central nervous system. Paresthesia was a frequent occurrence, but it did not lead to withdrawal of >5% of the subjects in any study.
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PMID:Topiramate: a new potential pharmacological treatment for obesity. 1568 13

Initially synthesized as an oral hypoglycemic agent, topiramate was approved for use as an anticonvulsant in 1996. Its broad spectrum efficacy in epilepsy, including as monotherapy and in children, is well established. Topiramate has also been used in the management of nonepileptic neurologic and psychiatric conditions, including migraine prophylaxis (with firmly established efficacy), obesity (with some evidence of long-term maintenance of weight loss), substance dependence, bipolar disorder and neuropathic pain, and it has been investigated as a possible neuroprotective agent. Paresthesias and cognitive side effects are the most common troublesome adverse effects. Recent trends towards lower doses may help achieve the best combination of efficacy and tolerability.
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PMID:Topiramate for the treatment of epilepsy and other nervous system disorders. 1646 8

Meralgia paresthetica is a disorder of the lateral femoral cutaneous nerve that results in symptoms of anterolateral thigh paresthesias and dysesthesias without associated loss of reflexes or motor weakness. Chronic meralgia paresthetica, not related to traumatic or lesion-producing compression of the nerve, is associated with obesity, pregnancy, tight-fitting garments, as well as specific duty uniform belts used by police officers and carpenters. Cases are presented in which two U.S. soldiers in Iraq experienced symptoms of meralgia paresthetica, most likely due to repetitive wear of protective body armor. Although use of protective body armor is proven to be lifesaving, modifications to improve current equipment may help to decrease morbidities such as meralgia paresthetica.
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PMID:Meralgia paresthetica due to body armor wear in U.S. soldiers serving in Iraq: a case report and review of the literature. 1761 54

Epidural lipomatosis has been implicated as a cause or contributor of symptomatic lumbar spinal stenosis. Symptomatic spinal epidural lipomatosis (SEL) of the lumbar spine is a rare disease, often associated with steroid overload. Idiopathic lipomatosis is even much less frequent. Signs and symptoms depend upon the level and degree of nerve root compression. Diagnosis is best based on MRI. Weight reduction can be curative, however, after failure of medical treatment or in severe cases surgical decompression should be performed. A 70-year-old man with both lower limb severe paresthesia and radicular symptoms unrelieved with conservative treatments such as medications and physical therapy was treated by surgical decompression. Obesity, endocrinopathic disease, and chronic steroid therapy were excluded. Interlaminar fenestration, lateral recess decompression and fat debulking were applied at all levels through the L2-S1. After surgery there was a gradual improvement in symptoms. We report a rare case of idiopathic SEL which has shown entire evolvement of lumbar spine with specific increase of radiological and clinical severity from L2-3 to L5-S1 in a non-obese patient.
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PMID:Decompression of idiopathic symptomatic epidural lipomatosis of the lumbar spine. 1768 57

Symptomatic spinal epidural lipomatosis (SEL) is very rare and frequently associated to chronic exogenous steroid use, obesity and Cushing syndrome. The idiopathic cases where no identifiable association with SEL are found constitute only 17% of all cases. The usual clinical manifestations of this entity consist of dorsal or lumbar pain with paresthesias and weakness in lower limbs, but acute symptoms of myelopathy are exceptional. We report a case of acute paraparesis and urinary retention caused by thoracic SEL in a 55-year-old male who did not have any recognized predisposing factor for this condition. Urgent surgical decompression was performed in order to relieve the symptoms. Slow but progressive improvement was assessed after surgery. We consider this case to be exceptional due to the needing to perform an urgent decompressive laminectomy to treat a rapidly progressive myelopathy caused by idiopathic SEL.
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PMID:Idiopathic spinal epidural lipomatosis: urgent decompression in an atypical case. 1787 11


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