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

Major alteration in respiratory mechanics occur in all patients following anaesthesia and thoracotomy because of a decrease in the functional residual capacity with minimal change in the closing volume leading to airway closure during tidal breathing and atelectasis. Diminished pulmonary reserve, because of non-pulmonary and pulmonary risk factors before operation, and/or restrictive ventilation and abnormal pattern of breathing due to postoperative pain sustain and aggravate these changes. These can proceed to postoperative pulmonary complications in some normal, and in many high risk, patients. Detection and correction of pre-existing pulmonary disease, smoking, sepsis and obesity is essential to reduce postoperative morbidity and mortality. Effective postoperative regional analgesia minimizes impairment of pulmonary function, aids in its recovery, and prevents postoperative pulmonary complications. The adjuvant use of chest physiotherapy and incentive spirometry should also help in decreasing the adverse affects of anaesthesia and surgery on the chest and thereby reduce the frequency and severity of postoperative complications.
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PMID:Alterations in respiratory mechanics following thoracotomy. 220 2

Current practice of investigating abnormal uterine bleeding via dilatation and curettage is sometimes open to question, and outpatient procedures are emphasised. The therapeutic effect of curettage in normalising menstrual patterns is being discussed. In a prospective study we answered the question of diagnostic and therapeutic effects of curettage. Over a period of 6 months, all patients with curettage treated in our department were investigated (history, risk factors, previous hormonal treatment, preoperative haemoglobin value, type of anaesthesia, complications, histology). Curettages performed for the purpose of abortion, as well as in combination with conisation of the uterine cervix, were not included in the study. 234 curettages were carried out. Clinical indications were as follows: in 29% of the cases recurrent preclimacteric metrorrhagia, in 27% climacteric metrorrhagia, in 24% PMB (postmenopausal bleeding). In 19 cases we found an Hb value lower than 10.5 g%. Risk factors (obesity, hypertension, diabetes mellitus) for endometrial cancer were found in 38% of MB and in 20% of climacteric metrorrhagia. In 9 cases, the histological diagnosis was endometrial cancer (clinical indications: 5 PMB, 3 climacteric metrorrhagia, 1 recurrent preclimacteric metrorrhagia). Our study shows, that the indication for curettage should be applied generously, especially in cases of abnormal postmenopausal and perimenopausal bleeding.
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PMID:[The value of curettage in the assessment of abnormal uterine bleeding]. 221 Mar 9

In a one year period from July 1985 to July 1986 226 upper and 62 distal ureteric calculi were treated. In situ ESWL represents the therapy of first choice for upper and distal ureteric calculi with a success rate of 81% and 76% respectively. Retrograde mobilization of the calculus was used only in cases where in situ ESWL was impossible because of localization difficulties (obesity, stone close to the spine, skeleton deformation). Although ESWL after successful mobilization succeeded in 95%, retrograde mobilization was possible only in 80%. Antegrade ureterorenoscopy via percutaneous nephrostomy was performed to avoid open surgery after impossible retrograde mobilization and succeeded in 90%. Two second generation lithotripters suitable for treatments without invasive forms of the anesthesia, the modified Dornier HM 3- and the Wolf Piezolith 2,200 were compared in terms of efficacy for ureteric calculi. In situ ESWL was successful with the Piezolith 2,200. In situ ESWL of middle ureteric calculi was successful 81.8% with modified HM 3+, while in situ treatment of middle ureteric calculi was impossible with the Piezolith 2,200 due to insufficient localization with ultrasound of middle ureteric calculi were treated successfully in 71.4% with the modified Dornier HM 3+ and in 64% with the Piezolith 2,200. First clinical experience of ESWL in prone position for iliac ureteric calculi was reported. 8 of 10 cases were treated successfully in situ.
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PMID:ESWL for ureteral calculi. Using the Dornier HM 3, HM 3+ and Wolf Piezolith 2,200. 221 8

Three hundred and twenty-two percutaneous umbilical blood samplings were performed over 4 years in our prenatal diagnostic centre. A 3.5 MHz sector ultrasound transducer was used to guide a 22.5-gauge needle under local anaesthesia. Sampling was performed for rapid fetal karyotyping (within 72 h) in 120 cases, for diagnosis of fetal toxoplasmosis in 133 cases, for determination of the severity of Rh immunization in 15 cases, and for diagnosis of congenital rubella in 4 cases. Pure fetal blood was obtained in 98.7 per cent of the cases after two attempts. The approach to the cord was either transamniotic or transplacental. Puncturing was preferentially done at the placental insertion of the cord (72.2 per cent of the cases) and the mean blood sample volume was 3.5 ml. The rate of fetal death in utero was 1.9 per cent, including two cases of amnionitis, one trisomy 18, and one severe bradycardia. The failures were due to sampling at an early stage of pregnancy (before gestation week 18), to maternal obesity, oligohydramnios, and the inexperience of the operator.
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PMID:Pure fetal blood samples obtained by cordocentesis: technical aspects of 322 cases. 234 27

In patients undergoing open-heart surgery pulmonary functions can be deranged by primary cardiac disorders, associated chronic pulmonary disease, as well as by other factors, such as obesity and smoking. Cardiac surgery involves a complex of several factors adversely affecting pulmonary functions, i.e. the cardiosurgical procedure itself, extracorporeal circulation, anesthesia, postoperative pain, delayed chest physiotherapy, immobilization of the patient. There is a direct correlation between pulmonary functions and postoperative pulmonary complications. The paper analyzes postoperative pulmonary complications and their causes, as well as possibilities of identifying of the patients at risk, and it evaluates the value of pulmonary function testing in this process. The possibilities of prophylaxis and prevention of pulmonary complications in the preoperative, peroperative, and postoperative period are surveyed.
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PMID:[Pulmonary function in heart surgery patients]. 238 78

In a one year period from July 1985 to July 1986, 224 upper and 62 distal ureteric calculi were treated. In situ ESWL represents the therapy of first choice for upper and distal ureteric calculi with a success rate of 81% and 76%, respectively. Retrograde mobilization of the calculus was used only in cases where in situ ESWL was impossible because of localization difficulties (obesity, stone close to the spine, skeleton deformation). Although ESWL after successful mobilization succeeded in 95%, retrograde mobilization was possible only in 80%. Antegrade ureterorenoscopy via percutaneous nephrostomy was performed to avoid open surgery after impossible retrograde mobilization and succeeded in 90%. Two second generation lithotripters suitable for treatments without invasive forms of anesthesia, the modified Dornier HM3+ and the Wolf Piezolith 2200, were compared in terms of efficacy for ureteric calculi. In situ ESWL was successful for upper ureter calculi in 70.7% with the HM3+ and 37.9% with the Piezolith 2200. In situ ESWL of middle ureteric calculi was successful in 81.8% with the modified HM3+, while in situ treatment of middle ureteric calculi was impossible with the piezolith 2200 due to insufficient localization of middle ureteric calculi with ultrasound. Distal ureteric calculi were treated successfully in 71.4% with the modified Dornier HM3+ and in 64% with the Piezolith 2200. Our initial clinical experience with ESWL in the prone position for iliac ureteric calculi is reported. Eight of 10 cases were treated successfully in situ.
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PMID:Minimal invasive therapy of ureteral calculi using modern techniques. 238 85

Prader-Willi syndrome is characterized by hypotonia, hypomentia, hypogonadism and obesity. A case of a 10-year-5-month-old girl who was diagnosed to have the typical symptoms associated with the Prader-Willi syndrome is described in the present report. The following are the dental findings. 1) Enamel hypoplasia, crowding over the anterior teeth and narrow dental arch were found. However there was no high palate in the maxilla. 2) The mesio-distal width of the present teeth were small compared with the national average. 3) According to X-ray cephalometric analysis, a retardation of the growth of the maxilla and mandible was found. 4) Because of hypomentia and the difficult management of the patient, dental treatment was performed under general anesthesia.
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PMID:[A case of Prader-Willi syndrome]. 248 83

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

Propofol, the recently marketed intravenous induction agent for anaesthesia, is chemically unrelated to earlier anaesthetic drugs. This highly lipophilic agent has a fast onset and short, predictable duration of action due to its rapid penetration of the blood-brain barrier and distribution to the CNS, followed by redistribution to inactive tissue depots such as muscle and fat. On the basis of pharmacokinetic-pharmacodynamic modelling, a mean blood-brain equilibration half-life of only 2.9 minutes has been calculated. In most studies, the blood concentration curve of propofol has been best fitted to a 3-compartment open model, although in some patients only 2 exponential phases can be defined. The first exponential phase half-life of 2 to 3 minutes mirrors the rapid onset of action, the second (34 to 56 minutes) that of the high metabolic clearance, whereas the long third exponential phase half-life of 184 to 480 minutes describes the slow elimination of a small proportion of the drug remaining in poorly perfused tissues. Thus, after both a single intravenous injection and a continuous intravenous infusion, the blood concentrations rapidly decrease below those necessary to maintain sleep (around 1 mg/L), based on both the rapid distribution, redistribution and metabolism during the first and second exponential phases (more than 70% of the drug is eliminated during these 2 phases). During long term intravenous infusions cumulative drug concentrations and effects might be expected, but even then the recovery times do not appear to be much delayed. The liver is probably the main eliminating organ, and renal clearance appears to play little part in the total clearance of propofol. On the other hand, because the total body clearance may exceed liver blood flow, an extrahepatic metabolism or extrarenal elimination (e.g. via the lungs) has been suggested. Approximately 60% of a radiolabelled dose of propofol is excreted in the urine as 1- and 4-glucuronide and 4-sulphate conjugates of 2.6-diisopropyl 1,4-quinol, and the remainder consists of the propofol glucuronide. Thus for hepatic and renal diseases, co-medication, surgical procedure, gender and obesity do not appear to cause clinically significant changes in the pharmacokinetic profile of propofol, but the decrease in the clearance value in the elderly might produce higher concentrations during a long term infusion, with an increased drug effect. In addition, the lower induction dose observed in relation to increased age might be partly explained by a smaller central volume of distribution.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Pharmacokinetic implications for the clinical use of propofol. 268 71

The overconsumption of rich and palatable foods and "yo-yo" dieting are feeding patterns involved in obesity and possibly hypertension in humans. We therefore examined the effects of diet-induced obesity and weight cycling on the blood pressure and heart rate levels of 60-day-old male normotensive Sprague-Dawley (S-D) and spontaneously hypertensive (SHR) rats. Six months on a high-fat and high-sucrose diet (HF/M) produced a greater obesity in S-D rats than in SHR rats. The caloric intakes of S-D rats fed the HF/M diet were greater than the caloric intakes of pellet-fed controls, whereas those of SHR rats were similar. The obesity of both strains was associated with hyperinsulinemia, heavier white (retroperitoneal) and brown (interscapular) fat pads, heavier heart weights, and tachycardia. Despite these changes, diet-induced obesity failed to increase systolic blood pressure obtained under light ether anesthesia or mean arterial pressure in the conscious state. Paradoxically, the blood pressures of SHR rats fed HF/M diet were reduced perhaps as a result of the high polyunsaturated fat component of the diet. A second S-D dietary obese group was alternated between 2-wk periods of unrestricted HF/M diet and 50% restricted pellet chow. Although their body weights were similar to pellet-fed controls, three cycles of weight loss and weight regain resulted in the consumption of increased dietary fat, increased food efficiency, heavier fat pads, and hyperinsulinemia. Heart rate and to some extent blood pressure fluctuated with diet, being elevated during HF/M feeding and reduced during restricted pellet feeding. Although weight cycling intensified the physiological responses to food ingestion, we found that weight cycling in dietary obese S-D rats did not elevate blood pressure levels.
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PMID:Dietary obesity and weight cycling: effects on blood pressure and heart rate in rats. 273 46


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