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

An elderly obese male with a lengthy history of melanotic stools was admitted and was shown to have a posterior duodenal ulcer by endoscopy. He became obtunded and developed infected ascites. Because of his obesity, ascites, and inability to cooperate, the GI radiologist felt that a Gastrografin upper GI series would not be helpful. We therefore gave the patient 99mTc-labeled sulfur colloid and tap water through his nasogastric tube. We were able to clearly image a site of perforation at the duodenal bulb communicating with the lesser sac.
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PMID:Radionuclide detection of duodenal ulcer perforation. 271 33

Beta-blockers are among the most widely used antihypertensive drugs. They differ from each other in regard to several factors such as: beta-agonist activity, beta 1-selectivity and solubility. Aim of this work was to evaluate the influence of obesity on the kinetics and the antihypertensive effect of two Beta-blockers with different solubility such as: the water-soluble, atenolol and the liposoluble, metoprolol. The study was carried out according to an open randomized cross-over design. Eight obese hypertensive patients, after a two week washout period, were randomly allocated to a four week treatment. After a two week intermediate washout period, each patient switched to the other treatment for an additional four week period. On the first and the last day of each treatment the subjects were hospitalized to collect blood samples for the assay of the two drugs and to measure cardiovascular parameters. Obesity does not exert any effect on the kinetics of the water-soluble beta-blocker, atenolol, while markedly interferes with that of the liposoluble, without any apparent influence on its anti-hypertensive effect. These findings extend to obese hypertensives the concept that the plasma concentrations of beta-blocking agents are not reliable predictors of their therapeutic effect.
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PMID:Obesity and beta-blockers: influence of body fat on their kinetics and cardiovascular effects. 272 7

A high-pressure liquid chromatographic method for bromide measurement is used to determine extracellular water volume in humans. The method uses 5 microL serum ultrafiltrate and has a sensitivity of 7.5 pmol. Because of the extreme sensitivity of this method, relatively small quantities of Br can be administered and small amounts of blood are needed for the analysis. By this method, the mean corrected Br space in 82 healthy adults representing a wide range of body weights was 0.218 +/- .034 L/kg (mean +/- 1 SD) with a range of 0.153-0.295 L/kg, which is consistent with reported values. There was a significant, inverse relationship between corrected Br space per kilogram and obesity as measured by body mass index. The corrected Br space in six children aged 3-36 mo was 0.335-0.394 L/kg, which is also consistent with reported values in children of this age. This method for Br measurement can easily and readily be applied for the determination of extracellular water volume.
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PMID:Bromide space determination using anion-exchange chromatography for measurement of bromide. 275 Jun 89

Lignocaine (lidocaine) and beta-adrenoceptor antagonists are widely used after acute myocardial infarction. The therapeutic value of these agents depends on the achievement and maintenance of safe and effective plasma concentrations. Lignocaine pharmacokinetics after acute myocardial infarction (MI) are controlled by a number of variables. The single most important is left ventricular function, which affects both volume of distribution and plasma clearance. Other major factors include bodyweight, age, hepatic function, the presence of obesity, and concomitant drug therapy. Lignocaine is extensively bound to alpha 1-acid glycoprotein, a plasma protein which is also an acute phase reactant. Increases in alpha 1-acid glycoprotein concentration occur after an acute MI, decreasing the free fraction of lignocaine in the plasma and consequently decreasing total plasma lignocaine clearance without altering the clearance of non-protein-bound lignocaine. Complex changes in lignocaine disposition occur with long term infusions, and therefore early discontinuation of lignocaine infusions (within 24 hours) should be undertaken whenever possible. Because the risk of ventricular tachyarrhythmia declines rapidly after the onset of an acute MI, lignocaine therapy can be rationally discontinued within 24 hours in most patients. Lignocaine has a narrow toxic/therapeutic index, so that pharmacokinetic factors are critical in dose selection. In contrast, beta-adrenoceptor antagonists' adverse effects are more related to the presence of predisposing conditions (such as asthma, heart failure, bradyarrhythmias, etc.) than to plasma concentration. The pharmacokinetics of beta-adrenoceptor antagonists are important to help assure therapeutic efficacy, to provide information about the anticipated time course of drug action, and to predict the possible role of ancillary drug effects (such as direct membrane action) and loss of cardioselectivity. Lipid solubility is the main determinant of the pharmacokinetic properties of a beta-adrenoceptor antagonist. Lipid-soluble agents like propranolol and metoprolol are well absorbed orally, and undergo rapid hepatic metabolism, with important presystemic clearance and a short plasma half-life. Water-soluble drugs like sotalol, atenolol, and nadolol are less well absorbed, and are eliminated more slowly by renal excretion. Clinical assessment of beta-adrenoceptor antagonism is more valuable than plasma concentration determinations in evaluating the adequacy of the dose of a particular beta-adrenoceptor antagonist.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The pharmacokinetics of lignocaine and beta-adrenoceptor antagonists in patients with acute myocardial infarction. 289 61

Dietary alteration or intervention is an ideal method of preventing or treating hypertension. Medication may be eliminated or reduced in many cases. Correction of obesity and alcohol abuse are confirmed methods of treating hypertension. Reduction of sodium intake is effective in that portion of the population which is salt-sensitive. Probably, the ratio of sodium to potassium is of importance and increasing potassium intake while reducing sodium intake is effective in many situations. Evidence is being reported which indicates that adequate intake of calcium, and perhaps magnesium, is effective in preventing hypertension. Limited information indicates that a sufficiency of dietary essential fatty acids and fibre are effective in hypertension prevention. The role of dietary protein, carbohydrates, fat, cholesterol, vitamins, and essential elements (other than those mentioned above) in the pathogenesis has not been fully elucidated at this time, but there are indications that adequate intakes are beneficial in hypertension. Water hardness may have some effect in reducing hypertension incidence, and any effectiveness would probably result from calcium and magnesium in the drinking water. Animal studies and limited human studies indicate some detrimental effects of heavy metals, such as lead and cadmium, upon the pathogenesis of hypertension. Information regarding caffeine intake is inconclusive.
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PMID:Dietary factors in essential hypertension. 300 94

Technological advances have reduced and refined man's plant food intake and consequently brought about an unprecedented decline in his consumption of dietary fibre (DF). The emergence of certain diseases selectively in regions which have been affected the most by this dietary change has led to an enhanced awareness of the functions of DF. DF is a heterogeneous group of substances which resist digestion by the endogenous enzymes of the human gut, although they are fermented to a substantial extent by the bacterial flora of the large intestine. Chemically, DF essentially consists of nonstarch polysaccharides and lignin, and its major constituents are cellulose, hemicelluose, lignin and pectin. The physiological effects of DF are attributable largely to its physicochemical properties. DF primarily affects gastrointestinal (GI) function; its effects are observable at all stages from ingestion through defaecation. It restricts caloric intake, shows gastric and small intestinal transit, and affects the activity of digestive enzymes and release of GI hormones. Its overall impact is to reduce apparent digestibility of nutrients marginally but consistently. In the large intestine, DF accelerates transit, supports bacterial growth and serves to hold water. As a result, the faecal weight and water content increase, and the transit time generally becomes shorter. Secondary to its GI effects, DF attenuates postprandial glycaemia and has long term effects on glucose tolerance and lipoprotein metabolism. These effects have important implications in the aetiopathogenesis of constipation and its sequelae including diverticulosis, cholesterol gallstones, colorectal cancer, obesity, diabetes mellitus and atherosclerosis. DF has traditionally been used therapeutically for constipation; now its use in diabetes is also well established. Our appreciation of the role of DF in human nutrition has undergone a major change in the last two decades. From a redundant constituent of plant foods, it has now moved to the position of an essential nutrient, the deficiency of which seems to have serious consequences.
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PMID:Dietary fibre: consensus and controversy. 301 Mar 80

Many initial studies related to identification of the boundaries and structural components, nuclei, tracts and interconnections of the hypothalamus; this continues. Early interest also focused on hypothalamic control of somatic activities and autonomic nervous system functions. During the present century chiefly, interest has developed in the hypothalamus and control of water balance, thirst, water retention and loss (diabetes insipidus and polydipsia). Its role in control of metabolism, body weight (obesity), and the regulation of body temperature has attracted the attention of physiologists for many years. Others have studied hypothalamic regulation of sex and reproductive phenomena. The hypothalamus is now attracting much attention because of its production of neuroendocrine secretions and role in control of the endocrine system. Physiologists realized very early that the hypothalamus is involved in emotional expression, in reaction to stress and adaptive adjustments. Its involvement in disease states and resistance thereto and in determining the nature of behavior has now been recognized as a matter of great importance. The origins of all these interests are reviewed.
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PMID:The history of thought concerning the hypothalamus and its functions. 304 17

Total free living energy expenditure was compared in lean and obese women by the new doubly labelled water method and partitioned into basal metabolism and thermogenesis plus activity by whole body calorimetry. Average energy expenditure was significantly higher in the obese group (10.22 versus 7.99 MJ/day (2445 versus 1911 kcal/day); p less than 0.001) resulting from an increase in the energy cost of both basal metabolism and physical activity. Self recorded energy intakes were accurate in the lean subjects but underestimated expenditure by 3.5 MJ/day (837 kcal/day) in the obese group. Basal metabolic rate and energy expenditure on thermogenesis plus activity were identical in the two groups when corrected for differences in fat free mass and total body mass. In the obese women in this series there was no evidence that their obesity was caused by a metabolic or behavioural defect resulting in reduced energy expenditure.
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PMID:High levels of energy expenditure in obese women. 308 78

Obesity is not a single disease, but a variety of conditions resulting from different mechanisms and associated with various types and degrees of risks. To determine who should lose weight, how much weight should be lost, and how to undertake weight loss, the following types of information are needed: personal-demographic data, developmental patterns, family history, energy balance, body composition/fat distribution, psychological/behavioral measures, endocrine/metabolic measures, complications and associated conditions. Weight reduction should be undertaken by women with morbid obesity, with complications secondary to the obesity, with a strong family history of conditions associated with obesity, or with increased abdomen:hip ratios. In contrast, women who have excess weight localized in the hips and thighs and no personal or family history of associated conditions may not benefit from dietary restriction. Low calorie diets result in adaptive changes, "designed" to prolong survival in the face of famine. These include changes in water balance, metabolic rate, and appetite. Metabolic rate declines, allowing the individual to burn fewer and fewer calories. Each time a woman diets she tends to lose weight less rapidly than the time before. "Restrained eating" predisposes binge eating. Indeed, bulimia rarely occurs in the absence of prior caloric restrictions. Current medical definitions of obesity do not consider these nuances. Existing definitions "over-diagnose" obesity in women, in general, and in older women and nonwhite women, in particular. For example, by existing standards, more than 60 percent of black women more than 45 years of age are considered obese. In contrast, the health risks of similar degrees of obesity are substantially greater for men than for women. Part of the problems lies in the fact that many women have pear-shaped fat distribution,a pattern which is not associated with increased health risks.Current cultural definitions of obesity for women distort the picture even further. In the past 20 years,there has been a progressive decline in the weight-for height of such "culture models" as Playboy centerfold subjects and Miss America contestants. Attempting to achieve such low weights predisposes women to an endless cycle of dieting and regaining, and contributes to the growing problems of eating disorders, including anorexia nervosa and bulimia.
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PMID:Obesity. 312 Feb 16

The doubly labeled water method is a form of indirect calorimetry that has been developed only recently to the stage of application to human studies. The method measures integral CO2 production for up to 3 wk from the difference in elimination rates of deuterium and 18O from labeled body water. Validations against near-continuous respiratory gas exchange have demonstrated that the method is accurate and has a precision of 2-8% depending on the isotope dose and the length of the elimination period. Although the method has been validated, there is still some debate on refinements of the kinetic model that may lead to improved accuracy and precision. Because the method only requires periodic sampling of body fluids, it is non-restrictive and ideally suited to use in free-living subjects. Recent applications of the method have included obesity research, determination of energy requirements in both developing and developed countries and studies of human growth.
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PMID:Measurement of energy expenditure in free-living humans by using doubly labeled water. 314 75


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