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

Endometrial cancer occurs more than twice as frequently as cervical cancer. The main risk factors are age, estrogen use, and obesity. Increasing life expectancy and more liberal use of estrogen to prevent postmenopausal bone loss will probably increase the magnitude of the problem. Endometrial cancer is a heterogeneous disease. Good prognosis is associated with obesity and estrogen use and with carcinomas preceded by precancerous hyperplasia. A bad prognosis may be found in women without major risk factors and is associated with a normal or atrophic endometrium. Because of a high prevalence of asymptomatic disease (6.9 per 1,000) and because the group with a poor prognosis is usually asymptomatic, all postmenopausal women should be screened at least one time. For screening, the use of one of the cytologic instruments is recommended; these instruments are safe, easy to handle, and can be used in the office setting without anesthesia. Yields are comparable to dilation and curettage. Family physicians are encouraged to familiarize themselves with cytologic instruments and to use them for screening postmenopausal women in their office.
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PMID:Detection of and screening for endometrial cancer. 327 9

A novel model of nutritionally induced hypertension in the rat is described. Dietary obesity was produced by providing sweet milk in addition to regular chow, which elicited a 52% increase in caloric intake. Despite 54% greater body weight gain and 139% heavier retroperitoneal fat pads, 120 days of overfeeding failed to increase systolic pressure in the conscious state (125 +/- 8 vs. 121 +/- 4 mmHg in chow-fed controls) or mean arterial pressure under urethan anesthesia (71 +/- 4 vs. 63 +/- 3 mmHg). In contrast, mild hypertension developed in intermittantly fasted obese animals (a 21-mmHg increase in systolic blood pressure measured in the conscious state and a 16-mmHg increase in mean arterial pressure under anesthesia relative to chow-fed controls). The first 4-day supplemented fast was initiated 4 wk after the introduction of sweet milk, when the animals were 47 g overweight relative to chow-fed controls. Thereafter, 4 days of starvation were alternated with 2 wk of refeeding for a total of 4 cycles. A rapid fall in systolic blood pressure (12 +/- 2 mmHg at 2 days) accompanied the onset of supplemented fasting and was maintained thereafter (2.7 +/- 2.6 mmHg further decrease during the latter half of the fast). With refeeding, blood pressure rose precipitously (13 +/- 3 mmHg in the 1st 2 days), despite poststarvation anorexia. Blood pressure tended to rise slightly over the remainder of the realimentation period (5.2 +/- 2.8 mmHg). After the 4th supplemented fast, hypertension was sustained during 30 days of refeeding. Cumulative caloric intake in starved-refed rats fell within 2% of that in chow-fed controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Refeeding hypertension in dietary obesity. 333 69

Pulse oximetry was used to assess the prevalence of hypoxemia (arterial oxygen saturation of 90% or less) at various times in the immediate postoperative period: five minutes after arrival, 30 minutes later, and just before discharge. Among 149 inpatients studied, one or more hypoxemic measurements were made in 21 (14%) during their postoperative course. Of 92 outpatients, 1 (1%) was found to be hypoxemic. For inpatients, the prevalence of hypoxemia preoperatively, 5 minutes after arrival in recovery, 30 minutes later, and at discharge was 2%, 4%, 6%, and 9%, respectively. Patient factors associated with a significantly higher prevalence of hypoxemia were obesity (22%), body cavity surgical procedures (24%), age over 40 years (18%), American Society of Anesthesiologists physical status (I, 7%; II, 17%; III, 18%; IV, 100%), duration of anesthesia longer than 90 minutes (18%), and intraoperative administration of greater than 1,500 ml of fluid (20%). Unrecognized hypoxemia in postsurgical inpatients with or without these risk factors is common. Therefore routine monitoring of these patients with a pulse oximeter is suggested.
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PMID:The prevalence of hypoxemia detected by pulse oximetry during recovery from anesthesia. 333 87

Studies examining the increased surgical morbidity among obese gravidas have focused mainly on differences in outcome between obese and nonobese mothers. Little is known, however, about the cause for worsened operative outcome in obese mothers or the potential impact of perioperative interventions. To define more precisely the clinical determinants of postoperative morbidity, multivariate analysis was used to relate antepartum and intrapartum variables to three measures of morbidity in 107 consecutively delivered obese women undergoing cesarean. Although obesity is clearly an operative risk factor, this study suggested that among obese gravidas, varying degrees of maternal obesity and accompanying medical complications, such as diabetes and hypertension, were not associated with greater operative morbidity. Furthermore, neither choice of skin incision nor type of anesthesia appeared to be related to operative morbidity. However, two factors potentially under the control of the clinician, increased length of surgery and operative blood loss, were associated significantly with measures of operative morbidity. A finding of worsened outcome with prophylactic antibiotics and heparin requires further study.
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PMID:Determinants of morbidity in obese women delivered by cesarean. 335 56

A review of all maternal deaths occurring in Michigan in 1972-84 uncovered 15 deaths in which anesthesia was considered the primary cause and an additional 4 deaths in which anesthesia was a contributory factor. Overall, anesthesia-related deaths contributed 6.9% of the direct maternal mortality in the state during the period under review. The mean age of the 15 women was 24 years (range, 16-34 years). 13 of the 15 deaths involved black women, resulting in an anesthesia-related mortality rate of 4.26/100,000 live births for blacks compared to only 0.14/100,000 among whites. The causes of deaths attributable to anesthesia were pulmonary complications in 1 case, cardiac complications in 9 cases, central nervous system complications in 2 cases, and reactions to spinal or lumbar puncture in 3 cases. Complications of regional anesthesia were the main cause of death during the early part of the study period, while the inability to accomplish endotracheal intubation has been the principal cause in recent years. 11 women had undergone cesarean section. Risk factors included obesity in 12 cases, the emergent nature of the operation in 12 cases, and hypertensive disease in 8 cases. All 3 of these risk factors were present in 40% of the women who died, at least 2 were present in 80%, and at least 1 was present in 93%. Specific steps recommended to reduce the incidence of anesthesia-related maternal mortality include the use of regional anesthesia where indicated, development of a plan to deal with airway problems, use of up-to-date equipment and monitoring instruments, and use of antacids.
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PMID:Anesthesia-related maternal mortality in Michigan, 1972 to 1984. 339 38

Pulmonary complications remain the most important cause of postoperative morbidity and mortality. The many advances of modern surgical care over the last 30 years have not appreciably altered the incidence of these complications. Many risk factors have been shown to contribute to this problem, but no studies have examined the impact of preoperative protein depletion on respiratory function and related this to the development of postoperative pulmonary complications. 80 patients (42 men, 38 women, median age of 64 years, with a range of 15-91 years) awaiting major elective gastrointestinal (G.I.) surgery were divided into two categories on the basis of a direct measurement of protein depletion: nonprotein-depleted patients (n = 41, mean protein loss, 2% +/- 1.7 SEM) and protein-depleted patients (n = 39, mean protein loss, 36% +/- 3.5 SEM). There was no significant difference between these two categories in regard to age, height, sex, surgical diagnosis, the presence of chronic lung disease, smoking, proportion of upper abdominal incisions, degree of obesity, the duration of anesthesia, and the use of prophylactic antibiotics and physiotherapy. There was a significant difference between these two categories of patients in regard to respiratory muscle strength (p less than .025), vital capacity (p less than .05), and peak expiratory flow rate (p less than .005). Pneumonia developed in a significantly higher proportion of protein-depleted patients with atelectasis (p less than .05), and their stay in the hospital after surgery was longer (p less than .05). These data show that protein depletion is associated with an impairment of respiratory function, and is in itself a significant risk factor in the development of postoperative pneumonia.
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PMID:Risk factors for postoperative pneumonia. The importance of protein depletion. 340 Oct 64

The aim of this study was to determine the need for supplemental oxygen during recovery from general anesthesia for ambulatory surgery in healthy women without obesity or respiratory disease. Arterial oxygen saturation by pulse oximetry (SpO2) was monitored throughout the first postoperative hour in 164 patients. The patients breathed room air during recovery. Supplemental oxygen was given only to those who became hypoxemic (SpO2 less than or equal to 92%). It was discontinued at the end of 15 minutes and reinstituted for another 15 minutes if hypoxemia recurred. Twelve patients (7%) became hypoxemic and required supplemental oxygen for various periods of time up to 105 minutes. The need for supplemental oxygen increased with increasing age (P less than 0.05) but was not associated with a history of cigarette smoking, tracheal intubation, amount of opioids or sedatives given intraoperatively, anesthetic duration, or level of consciousness during recovery. Hypoxemia was neither predictable nor clinically apparent. We recommend that, unless arterial oxygenation is monitored, ambulatory patients should routinely receive supplemental oxygen during recovery from general anesthesia.
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PMID:Supplemental oxygen after ambulatory surgical procedures. 342

Many factors seem to influence the recurrence rate after adult inguinal hernia repair. A statistical analysis of data derived from 726 transversalis fascia repairs examined by the authors (with a follow-up rate of 82.5% and a mean follow-up time of 5.5 years) revealed a significantly higher recurrence rate in patients with chronic bronchitis (p less than 0.05) or with postoperative complications (p less than 0.001). Lower recurrence rates were found after resection of lipomas of the cord (p less than 0.01) or cremasteric muscle resection (p less than 0.05). No significant difference of recurrence rate could be established for following parameters: Sex, side, age distribution, profession, prostatism, obesity, type of hernia (direct, indirect, combined, sliding), suture material (silk, polyglycolic acid), surgeon, anesthesia (local, spinal, full), elective or emergency operation, and whether the repair was unilateral or simultaneously bilateral. Recurrent repairs showed no significantly higher recurrence rate than primary repairs.
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PMID:[10 years' experience using a modified Shouldice surgical technic for inguinal hernia in adults. II. Which factors modify the recurrence of inguinal hernia?]. 355 81

The first 200 consecutive laparoscopic sterilizations at the Churchill Hospital, Oxford, using local anesthesia and Filshie clips, are presented in detail. 4 or 5 operations were scheduled per half day, with a gynecologist-surgeon, an anesthetist, and 4 nurses. Most patients received only local anesthesia, with care to reach the peritoneal layer; those with anxiety also received midazolam. Lignocaine was dropped on the clip sites. The laparoscope was a 7 mm Storz. After the procedure, gas was expelled with the Valsalva maneuver, and No. 1 silk sutures were applied where necessary. Vaginal manipulation was needed in 38 women for retroverted uterus. Other difficulties included adhesions precluding completion of the operation in 1 and obesity in another, and in 10 others minor adhesions, or omentum or bowel overlying the field. Postoperative complaints included pain in 148 treated with iv or oral analgesics, vomiting in 10, hypotension in 8. 194 of the women returned questionnaires about the experience, and 91% of these said they would recommend laparoscopic sterilization under local anesthesia to a friend. It was felt that elimination of preoperative pain medication, used in the first few patients, as well as early mobilization, sped up recovery. The specific pain complaints were fewer than those in several reports, possibly because of the gentler handling entailed in a procedure done by local, rather than general, anesthesia.
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PMID:Two hundred out-patient laparoscopic clip sterilizations using local anaesthesia. 358 Mar 29

Obese patients are known to metabolise anaesthetic agents more than patients of normal weight. The extent of this was investigated by the measurement of serum fluoride concentrations in 10 morbidly obese patients undergoing gastroplasty. Five were allocated to receive enflurane and five to receive isoflurane supplemented anaesthesia. The mean peak serum fluoride concentrations after enflurane anaesthesia were greater (22.7 mumol/litre, SE 2.9) than after isoflurane anaesthesia (6.5 mumol/litre, SE 0.6). The mechanisms and implications of this finding are discussed.
Anaesthesia 1987 Jul
PMID:Serum fluoride levels in morbidly obese patients: enflurane compared with isoflurane anaesthesia. 363 69


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