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

The genetically obese mouse, C57 B1/6J ob/ob, has been suggested as an appropriate model for the study of obesity associated with diabetes mellitus. Employing glucose 14C(microliter) as a tracer, the data presented here indicate that obese mice are able to clear glucose from the blood compartment at the same rate as their lean littermates. This was demonstrated with or without an associated cold glucose load. The abnormal glucose tolerance curves observed in the obese animals may be a result of secretion of glucose into the blood. Removal of the adrenal glands from the obese mice and their lean littermate does not impair their ability to clear a glucose load from the vascular compartment. The capacity for endogenous glucose secretion of ob/ob mice is severely curtailed by adrenalectomy, in that the glucose tolerance curves of these adrenalectomized animals become similar to those of sham-operated lean littermates. Thus, it appears that a considerable component of the hyperglycemia in ob/ob mice reflects major adrenal involvement that is activated by stress, ie, ether anesthesia and blood sampling. The hyperglycemia in ob/ob mice may reflect glucocorticoid-dependent gluconeogenesis.
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PMID:Effect of adrenalectomy on the metabolism of glucose in obese (C57 Bl/6J ob/ob) mice. 664 60

500 adult Nigerian patients presenting for elective general surgery under anesthesia were studied with regard to age, sex, obesity, smoking and drinking habits and associated medical diseases. The results showed equal sex distribution with 60% of the patients in the 21-40 years age group. About 30% of the patients (predominantly females) were obese. Smoking and drinking habits were relatively low especially in the females. About 25% of the patients have associated medical disorders of which hypertension and anemia were the commonest. Chronic obstructive lung disease and atherosclerotic heart disease were relatively uncommon. Multiple drug therapy was not a problem in this series.
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PMID:A study of certain personal details of adult Nigerian patients presenting for elective general surgery under anesthesia. 667 91

Cerebrospinal fluid (CSF) pressure was measured in four groups of patients: 116 with acute pseudotumor cerebri, 18 with chronic pseudotumor cerebri, 41 obese and 15 nonobese normal patients undergoing spinal anesthesia. Spinal fluid pressure between 200 and 250 mm H2O was found in members of each group. This suggests that when elevated CSF pressure is suspected, confirmation requires values greater than 250 mm H2O. The CSF pressure and degree of obesity could not be correlated in any meaningful way. There was no significant statistical difference between the mean CSF pressures obtained in the obese and nonobese normal populations.
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PMID:Cerebrospinal fluid pressure in normal obese subjects and patients with pseudotumor cerebri. 668 40

Preferences in methods of contraception and sterilization among the U.S. population are assessed. Oral contraceptives, low-dose, are the leading reversible contraceptive method in the U.S., despite the risk of side effects. The diaphragm, among highly motivated women, is in second place. Sterilization methods are more diverse, but basically double incision laparoscopic tubal coagulation is preferred in the U.S. as an interval technique. Some clinics use the Yoon band and Hulka clip instead of coagulation. The favorite method of sterilization in the East has been the suprapubic mini laparotomy and it is gaining currency in the U.S. now. Contraindications to laparotomy are obesity, fixed uterine retroversion, and suspected adnexal pathology; in most patients who are nonobese, however, suprapubic minilaparotomy with Pomeroy tubal ligation, Yoon banding, or clip application is simpler, safer, and less expensive. And both the laparoscopy and minilaparotomy can be performed under local anesthesia. The IUD is recommended for women who are the least motivated, and is thought inappropriate for using in nulliparous women because of the likelihood of tubal scarring resulting from infection.
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PMID:Contraception and female sterilization. 693 46

Recent studies have identified clinical features that are major risk factors for puerperal infection. Patients of low socioeconomic status undergoing cesarean section who have had prolonged labor and rupture of membranes (ROM) incur a 40 to 85% risk of endometritis. Infection occurs generally in less than 10% of women undergoing vaginal delivery, even when complicated by prolonged ROM, and often in considerably fewer cases. Other features such as internal monitoring, obesity, anemia, and general anesthesia have not been consistent determinants in recent studies.
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PMID:Clinical risk factors for puerperal infection. 699 Mar 33

The normoxic ventilatory drive contributes to the normal level of ventilation, and the hypoxic ventilatory drive contributes to the maintenance of adequate gas exchange in the presence of ventilation/blood flow maldistribution and increased mechanical load to breathing. This respiratory drive arises principally from stimuli at the carotid chemoreceptors. The reflex cardiovascular responses to hypoxia also contribute to the delivery of O2 to vital organs, and their efficacy depends on the integrity of the respiratory response and the autonomic nervous system as well as the function of the vascular system. Prolonged exposure to hypoxemia from altitude, cyanotic congenital heart disease, and chronic pulmonary disease impair the ventilatory response to hypoxia. In addition, the respiratory and cardiovascular responses to hypoxemia are impaired by familial or acquired abnormalities of the autonomic effector system. There is growing evidence that impaired respiratory response to hypoxemia is a major factor in recurrent respiratory failure in obesity, obstructive pulmonary disease, idiopathic or familial "hypoventilation," and contributes to disturbances in oxygenation during sleep [152, 189, 192, 202]. Although the ventilatory response to hypoxemia was traditionally thought to be resistant to the effects of inhalational anesthetics, barbiturates, and narcotics, there is abundant evidence that in fact the ventilatory response to hypoxia is more sensitive to depression by drugs than the ventilatory response to CO2. In addition, the hemodynamic responses to hypoxia are modified by anesthesia and anesthetic techniques. The clinical implications of these observations are wide. The ventilatory and cardiovascular response to hypoxemia will be altered, and usually depressed by age, disease processes, premedicant and anesthetic drugs, and autonomic blocking drugs. The cardiovascular responses will be modified indirectly by altered ventilatory control due to neuromuscular blocking drugs and controlled ventilation. Thus, not only will the responses to hypoxemia be depressed by anesthesia but the early clinical hemodynamic signs will be modified or absent, or indeed the cardiovascular response will further impair oxygen delivery. Furthermore, it is not only anesthetic doses that impair the reflex respiratory responses, but also subanesthetic doses of inhalational anesthetics and premedicant doses of barbiturates and narcotics. Hence the patient in the perioperative period continues to have impaired respiratory response to hypoxemia. As anesthetic and surgical care extends to older patients, patients with systemic disease, and recipients of cardiovascular peripheral and central drugs, the clinical implications of the impairment of ventilatory and cardiovascular responses to hypoxia, and the maintenance of organ and system function, escalate. Only a few hesitant steps have been taken into this vast arena of clinical and experimental research.
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PMID:Respiratory and cardiovascular responses to hypoxemia and the effects of anesthesia. 702 55

A series of 117 consecutive unselected patients with clinically reducible unilateral inguinal herniae were admitted for short-stay repair. Seven expressed a strong preference for one form of anaesthesia (6 general (GA)) local (LA) and 7 were unfit for GA; these were excluded from the trial. The remaining 103 patients were allocated at random to receive either LA or GA in order to compare the two methods of anaesthesia. The resulting groups (53 LA, 50 GA) were well matched for age and obesity. Perand postoperative symptoms were assessed with linear analogues self-assessment questionnaires. Statistically significant differences were demonstrated between the groups; those patients having LA were able to walk, eat, and pass urine earlier than those having GA, who experienced more nausea, vomiting, sore throat, and headache. The postoperative course and additional symptoms were otherwise similar. Forty-five LA patients experienced mild pain during the operation, but nevertheless 85% of the total group said they would consent to its use again. Ninety-three patients (90%) were discharged at 24 h. LA was applicable to all types of clinically reducible inguinal hernia and was an acceptable, safe, and satisfactory alternative to GA.
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PMID:A randomised controlled trial to compare local with general anaesthesia for short-stay inguinal hernia repair. 704 4

Eight hundred cases of interval sterilization using suprapubic minilaparotomy were performed between August 1976 and November 1980. The high-risk population was defined as patients who had any preexisting medical condition, including obesity. No significant differences were found when the control patients were compared with the high-risk group in terms of operative and postoperative problems. All procedures were done under intravenous sedation and local anesthesia on an outpatient basis. The follow-up rate at 1 week was 100%. As of August 1980, 480 of the 482 patients due for 1-year follow-up were seen; the remaining 2 were contacted by telephone. Neither serious complications nor readmission to the hospital was found. There were no patients rejected on medical grounds and no failures to achieve tubal occlusion. In 3 patients, because of findings during minilaparotomy, laparotomy was carried out under general anesthesia as a continuation of the original procedure.
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PMID:Minilaparotomy tubal sterilization: a comparison between normal and high-risk patients. 707 65

The risk of surgery for the morbidly obese is well known. Suprisingly little information is available regarding the hemodynamic changes during surgery. This study provides data on this important subject and compares them with those of normal nonobese patients. Obese patients demonstrated signifying elevated preoperative, intraoperative, and postoperative right atrial, mean pulmonary artery, and pulmonary artery wedge pressures. Preoperatively, hemodynamic variables were in the high range of normal in obese patients. Significantly greater decreases in cardiac index, right ventricular stroke work (RVSW), and left ventricular stroke work (LVSW) were noticed intraoperatively. Although the RVSW returned to baseline values in the postoperative period, the cardiac index and LVSW remained depressed. Left ventricular function as assessed by Sarnoff curves demonstrated persistent shifts to the right during and after operation. No such shifts were noticed in nonobese patients. Although they were hemodynamically stable and without any other clinical evidence of cardiac abnormality, asymptomatic obese patients had reduced left ventricular contractility (LVSW/pulmonary artery wedge [PAW] pressure ratio) even in the resting state. Obese patients reacted to the stress of surgery and anesthesia by a more specific left ventricular dysfunction that was greater after intubation and in the immediate postoperative period.
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PMID:Hemodynamic and respiratory changes in surgery of the morbidly obese. 710 Nov 24

Epidural anesthesia using 20 ml of 0.75% bupivacaine at L3-4 with the patient in the left lateral position and the table horizontal was employed for cesarean section in 147 A.S.A. class 1 or 2 parturients under the age of 35 with a single fetus. The height of the analgesia was positively correlated with the body mass index (BMI) (weight in kilograms divided by the height in square meters), a measure of adiposity, and with body weight. Both correlations were statistically significant (p less than 0.001). There was no statistically significant correlation with the patients' height or age. It is concluded that higher levels of epidural block should be anticipated in obese obstetrical patients in proportion to their obesity. Twenty milliliters of 0.75% bupivacaine must frequently be augmented to provide adequate analgesia for cesarean section in thin parturients (BMI below 28) whereas it is too high a dosage for obese patients.
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PMID:Obesity and the cephalad spread of analgesia following epidural administration of bupivacaine for Cesarean section. 718 43


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