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

The new diagnostic procedures developed during the last several years present a confusing dilemma. The state of the art of ultrasound, computed tomography and nuclear scintigraphy is progressing so rapidly that what one says today is generally out of date tomorrow. However, certain guidelines should be followed in evaluating various organ systems. Generally, ultrasound is the procedure of choice in the upper part of the abdomen in most patients who are not extremely obese or filled with intestinal gas. A sonogram is less expensive than computed tomography and, at the present time, is considered noninvasive compared with compound tomography, which produces a small, but significant, radiation exposure. The accuracy of the two modalities is quite similar. Using the slight advantage that computed tomography may have in a given organ system does not generally override other factors, such as cost and radiation dose. However, mitigating factors, such as obesity, presence or absence of intestinal gas or barium, should be taken into account when selecting patients for either procedure. In many clinical situations, neither computed tomography nor ultrasound should be used until other modalities, such as conventional radiography or scintigraphy, have first been tried. Should the problem not be resolved by these more conventional techniques, an ultrasound or computer tomographic examination may be indicated to delineate further the pathologic condition of the abdomen.
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PMID:Dagnostic imaging of the upper part of the abdomen. 46 46

A patient without previous history of peptic ulcer disease had gastrointestinal bleeding from a duodenal ulcer four years after having a gastric bypass procedure for obesity. The use of the technetium-labeled red blood cell scan helped localize the source of bleeding in this patient after routine endoscopy and barium studies failed to show any abnormality of the upper and lower gastrointestinal tracts. The patient has done well after subtotal gastrectomy for treatment of this disorder.
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PMID:Bleeding duodenal ulcer after gastric bypass procedure for obesity. 366 53

A silicone collar containing circumferential tape was tied around the cardio-esophageal junction in eight patients with symptomatic, refractory reflux, who were not good candidates for a standard antireflux procedure. A fine polypropylene tie or clip secured the knot. In two patients with large hiatal defects, the crura were approximated loosely. Mean operating time, including one cholecystectomy and one ventral hernia repair, was 51 minutes. Patients who underwent this simple operation had a combination of hypertension, heart disease, obesity and old age, and two had undergone horizontal gastroplasty previously for morbid obesity. The reflux was associated with hiatal hernia in seven of the eight patients. Preoperative studies included barium swallow roentgenography in all eight patients, and endoscopy, manometry and Bernstein test in six. All the studies were repeated postoperatively. Follow-up ranged from 17 to 48 months (mean 37.8 +/- 10.6 months). Postoperatively, there was a significant (p less than 0.01) improvement in symptoms, endoscopic findings and lower esophageal sphincter pressures. No prosthesis has migrated yet.
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PMID:The Angelchik antireflux prosthesis. 397 Dec 43

A 13-year-old girl with Prader-Willi syndrome was admitted to our hospital with an 18-month history of anal bleeding and mucus discharge on defecation. Physical examination revealed obesity, hypogonadism, hypotonia and hypomentia. On digital examination, a nodular mass was palpated on the right wall of the ampulla recti, which was suspected to be carcinoma on a barium enema study. Proctoscopic examination revealed a large, irregular ulceration with white slough at the base, surrounded by the nodular and lumpy mucosa. The lesion was excised by the abdomino-anal pull-through method. The resected specimen showed a lesion of large, shallow, irregular ulcer, 5.0 x 2.2 cm in size. Microscopic examination revealed obliterated lamina propria by fibroblasts and muscle fibers derived from the muscularis mucosae, and misplaced cystic dilated glands in the submucosa at the margin of the ulcer. The gross and microscopic appearances are identical to those of "solitary ulcer of the rectum" described by Madigan and others, and similar to those of "colitis cystica profunda" described by Goodall and others. According to these findings, this lesion was diagnosed as solitary ulcer of the rectum. In the present report, the relationship between solitary ulcer of the rectum and colitis cystica profunda was discussed.
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PMID:Solitary ulcer of the rectum: report of a case and review of the literature. 702 2

Twenty-nine patients who had undergone four different types of jejunoileal bypass for obesity were examined roentgenologically after ingestion of barium contrast. Functional intestinal length, blind loop reflux and speed of contrast through the small intestine were recorded. Weight loss was not correlated to any of the mentioned parameters or to operative method. Length of functioning intestine increased and speed of contrast decreased with time after surgery.
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PMID:A roentgenological study of the small intestine after different intestinal bypass operations for treatment of morbid obesity. 709 76

With westernization of diet and lifestyle among South African Blacks, particularly urban dwellers, hitherto unknown gastro-intestinal diseases are becoming evident. Previously unreported is hiatus hernia, now a definite disease entity, although still very uncommon. At Baragwanath Hospital, Johannesburg, over 17 months in 1977-1978, 46 patients with hiatus hernia were detected from barium meal examinations on 1392 persons, i.e. 3,3%, or 0,07% of total hospital admissions of adults. The disease affected mainly middle-aged and elderly women. Prevalences of obesity, comparative physical inactivity and hypertension appeared commoner than in the general urban adult population. Just as appendicitis is a marker of westernization in young urban Blacks, hiatus hernia may be regarded as a marker in the middle-aged and elderly.
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PMID:Hiatus hernia in Johannesburg blacks. 740 65

The adipose tissue of genetically obese Zucker rats is characterized by coordinated tissue specific overtranscription of a subset of genes related to lipid storage such as Glyceraldehyde-3-Phosphate Dehydrogenase (GAPDH). We show that CCAAT/Enhancer Binding Protein alpha (C/EBP alpha) is an activator of GAPDH proximal promoter in transiently transfected mature rat adipocytes. C/EBP alpha mRNA levels were increased in adipose tissue but not in liver of obese as compared to lean rats at 30 days of age, i.e., when obesity is fully expressed. Nevertheless at 16 days of age, although overdevelopment of adipose tissue could be detected in preobese rats, C/EBP alpha mRNA levels were similar whatever the genotype. In conclusion C/EBP alpha mRNA is overexpressed in adipose tissue of obese rats, suggesting a possible role for this factor in the activation of lipid storage-related genes in adipose tissue of obese rats. However, C/EBP alpha overexpression is not temporally related to the onset of obesity.
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PMID:C/EBP alpha expression in adipose tissue of genetically obese Zucker rats. 786 70

Most operations in the abdominal cavity and chest can be performed using minimally invasive techniques. As yet it has not been determined which laparoscopic procedures are preferable to the same operations done through conventional laparotomy. However, most surgeons who have completed the learning curves of these procedures believe that most minimally invasive techniques will be scientifically recognized soon. The evolution, validation and justification of advanced laparoscopic surgical methods seem inevitable. Most believe that the trend towards procedures that minimize or eliminate the trauma of surgery while adhering to accepted surgical principles is irreversible. The functional results of laparoscopic antireflux surgery in the seven years since its inception have been virtually identical to the success curves generated with open fundoplication in past years. Furthermore, overall patient outcomes with laparoscopic procedures have been superior to outcomes with the traditional approach. Success is determined by patient selection and operative technique. Patient evaluation should include esophagogastroduodenoscopy, barium swallow, 24 h pH study and esophageal motility study. Gastric emptying also should be evaluated. Patients who have abnormal propulsion in the esophagus should not receive a complete fundoplication (Nissen) because it adds a factor of obstruction. Dor or Toupet procedures are adequate alternatives. Prokinetic agents, dilation or pyloroplasty are used for pyloric obstruction ranging from little to more severe. Correcting reflux laparoscopically is more difficult in patients with obesity, peptic strictures, paraesophageal hernias, short esophagus, or a history of previous upper abdominal or antireflux surgery.
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PMID:Correcting reflux laparoscopically. 977 11

BACKGROUND: Pouch volume appears to be of major importance for subsequent weight loss following any gastric restriction type of surgery for morbid obesity. In order to be able to evaluate pouch volume following Swedish Adjustable Gastric Banding (SAGB), an endoscopic pouch volume classification system was designed in which pouch volume is classified in five categories. The aim of this study was to validate the endoscopic classification system using MRI and barium swallow as reference methods for pouch volume measurement. METHODS: Twenty patients (13 women and seven men) were operated for obesity with SAGB. They were investigated a mean of 3 years (6 weeks-5.5 years) after surgery and had at that time lost a mean of 60 (12-112) kg. During the same afternoon they sequentially underwent endoscopy, MRI and barium swallow with an empty stomach. RESULTS: The mean pouch volume measured with MRI was 70 ml (0-1 80 ml) and with barium swallow was 72 ml (0-1 95 ml). In 17/20 patients the volume as measured by MRI and barium swallow was in the same volume category as with endoscopy. The correlation measured according to Pearson was significant between endoscopy on one hand and MRV barium swallow both independently and together (p < 0.001). CONCLUSION: Based on these results we are confident in using our endoscopic classification system for postoperative follow-up of pouch volume.
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PMID:Validation of Pouch Size Measurement Following the Swedish Adjustable Gastric Banding Using Endoscopy, MRI and Barium Swallow. 1072 93

Cellular differentiation involves transcriptional responses to environmental stimuli. Adipocyte differentiation is inhibited under hypoxic conditions, indicating that oxygen (O(2)) is an important physiological regulator of adipogenesis. Hypoxia inhibits PPAR gamma 2 nuclear hormone receptor transcription, and overexpression of PPAR gamma 2 or C/EBP beta stimulates adipogenesis under hypoxia. Mouse embryonic fibroblasts deficient in hypoxia-inducible transcription factor 1 alpha (HIF-1 alpha) are refractory to hypoxia-mediated inhibition of adipogenesis. The HIF-1-regulated gene DEC1/Stra13, a member of the Drosophila hairy/Enhancer of split transcription repressor family, represses PPAR gamma 2 promoter activation and functions as an effector of hypoxia-mediated inhibition of adipogenesis. These data indicate that an O(2)-sensitive signaling mechanism regulates adipogenesis. Thus, agents that regulate HIF-1 activity or O(2) sensing may be used to inhibit adipogenesis and control obesity.
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PMID:Inhibition of PPAR gamma 2 gene expression by the HIF-1-regulated gene DEC1/Stra13: a mechanism for regulation of adipogenesis by hypoxia. 1187 38


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