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

Sixteen extremely obese patients were anaesthetized for intestinal short circuiting operations. Severe obesity may cause pathological cardio-pulmonary changes. Cardiovascular alterations include increased systemic, pulmonary artery and pulmonary capillary venous pressure. Cardiac output, total blood volume and left ventricular work increase. Expiratory reserve volume and consequently functional residual capacity decrease with gross obesity. Functional residual capacity falls below closing volume and inspired gas may be distributed to non-dependent lung zones, resulting in decreased ventilation/perfusion ratios and arterial hypoxaemia. Low total respiratory compliance increases the oxygen cost of the work of breathing. Obesity may change the dose requirements for regional anaesthesia and long-acting muscle relaxants. General anaesthesia may also reduce functional residual capacity. We used a technique of anaesthesia which consisted of epidural analgesia with intra-operative mechanical ventilation and which specifically avoided volatile inhalation agents and long-acting muscle relaxants. All patients were extubated immediately after operation and returned to the recovery room for an average duration of 26 hours. Post-operative treatment included humidified oxygen, chest physiotherapy and elevation of the head of the bed to 45 degrees. Each patient's respiratory progress was monitored by repeated determinations of arterial blood gases and vital capacity and by serial chest X-rays. None of the patients in this group required post-operative tracheal intubation and mechanical ventilation.
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PMID:Anaesthesia for intestinal short circuiting in the morbidly obese with reference to the pathophysiology of gross obesity. 113 75

A study of exercise performance was carried out in 17 obese girls and young adults. During submaximal steady-state bicycle exercise oxygen intake (Vo2) for a given work output (W) was raised in obese subjects but minute ventilation at a fixed carbon dioxide output, gas exchange, blood gases, and cardiac output at a given VO2 were similar to the values previously found for normals. In obese subjects high levels of VO2 for fixed W were also obtained on the treadmill but when these were standardized for body weight (unlike the bicycle test) it was shown that the obese girls and women exercised within the normal (expected) range of aerobic energy expenditure. During maximal performance the absolute VO2 max was the same in obese and nonobese subjects but for a given body weight, lean body mass, and leg muscle (plus) bone volume, VO2max was reduced by 23.8, 16.3, and 24.5% respectively, in the former group. It was concluded that obesity though having minimal affect on responses to submaximal exercise is nevertheless associated with a marked reduction in physiological performance at or near maximal effort.
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PMID:Cardiopulmonary responses to exercise in obese girls and young women. 115 May 48

Eight patients are presented in whom obesity developed in association with documented hypothalamic lesions. These lesions included trauma, inflammatory disease, an aneurysm of the internal carotid artery, and five cases of tumor. Detailed metabolic studies were performed in four patients with hypothalamic obesity and in five age- and weight-matched patients with essential obesity(i.e., obesity with no definable etiology). Fasting insulin concentrations were significantly higher in the patients with hypothalamic obesity. During a seven-day fast the insulin levels in patients with essential obesity decreased by 24 to 48 hours, whereas patients with hypothalamic obesity showed a variety of changes; In three out of four of these patients with hypothalamic obesity there was no evidence for hyperplasia of the fat cells. Basal oxygen consumption, body composition, and metabolism of adipose tissue did not differ between the patients with essential obesity and those with hypothalamic obesity. There was no difference in activity of the enzymes in the glycerophosphate cycle. Our data on eight patients with hypothalamic obesity were compared with data on patients in literature. Most cases of hypothalamic obesity occur with space-occupying tumors arising at the base of the hypothalamus. However, trauma, inflammatory diseases, and leukemia are also associated with hypothalamic obesity. Patients with hypothalamic obesity rarely weigh more than 140 kg.
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PMID:Manifestations of hypothalamic obesity in man: a comprehensive investigation of eight patients and a reveiw of the literature. 115 72

Seven lean and five obese boys, aged 9-12 yr, exercised in four environments: 21.1, 26.7, 29.4, and 32.2 degrees C Teff. Subjects walked on a treadmill at 4.8 km/h, 5% grade for three 20-min exercise bouts separated by 5-min rest periods. Rectal temperature (Tre), skin temperature (Tsk), heart rate (HR), sweat rate, and oxygen uptake (VO2) were measured periodically throughout the session. Lean boys had lower Tre and HR than obese boys in each of the environments. Increases in Tre were significantly greater for the obese at 26.7 and 29.4 degrees C Teff. No significant differences in Tsk and sweat rate (g-m-2-h-1) were observed between lean and obese boys. Obese boys had significantly lower oxygen consumptions per kg but worked at a significantly higher percentage of VO2max than lean boys when performing submaximal work. Responses of the obese boys to exercise in the heat were similar to those of heavy prepubertal girls studied previously, except that the boys were more tolerant of exercise at 32.2 degrees C Teff than the girls. Lean boys had lower HR than lean girls in each environment, but lower Tre only at 32.2 degrees C Teff.
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PMID:Heat tolerance of exercising lean and obese prepubertal boys. 117 12

Lung volumes and other ventilatory variables were measured in 10 women with a mean age of 28 years, a mean height of 163 cm., and weights which were 50 to 140 per cent above the normal. Measurements were made during the last trimester of pregnancy and after the second month postpartum. Mean values of lung volumes in liters during these two time periods were: vital capacity (VC), 3.7 and 3.92; expiratory reserve volume (ERV), 0.79 and 0.94; functional residual capacity (FRC), 2.06 and 2.14; and forced expiratory volume at one second (FEV1) 3.2 and 3.3. Mean blood gas values were as follows: pH, 7.44 during both times; PaCO2, 29.7 and 35 torr; standard bicarbonate, 22 and 28.8 mEq; base excess, -4.2 and 0.03 PaO2 breathing air, 85 and 86 and breathing 100 per cent oxygen, 527 and 515 torr; AaDO2, 162 and 167 torr. We conclude that, with the exception of FRC, pregnant obese women who are 50 to 140 per cent overweight develop respiratory changes similar to those seen in normal-weight gravidas. These findings suggest that obesity of this magnitude does not exaggerate changes in ventilation induced by pregnancy as generally believed. Why in this obese population the decrease in FRC during pregnancy did not occur to the same degree as that seen in normal-weight gravidas cannot be defined from our study. Evidence is presented for a ventilation/perfusion imbalance in obese subjects which is not corrected during pregnancy.
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PMID:Respiratory function in pregnant obese women. 118 Feb 88

The authors have studied the response of the cardiovascular system and kinetics of some indices of fat and carbohydrate metabolism during the operation under different kinds of anesthesia in 175 patients with obesity. A comparative estimation of local anesthesia and narcosis with ether, fluothane, ntirogen monoxide during operative procedures in obese patients is given. It is believed that in patients with obesity for short-time operative procedures it is rational to use fluothane-nitrogen monoxide-oxygen anesthesia.
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PMID:[Effect of different types of anesthesia on hemodynamics and certain indicators of metabolism in obesity]. 120 71

Whereas short-term cold exposure depletes glycogen reserves, repeated and prolonged moderate exercise in a cold environment creates an energy deficit that is satisfied by an increased metabolism of depot fat. Factors contributing to the fat loss include an exercise-induced hypertrophy of lean tissue, a loss of energy through a cold-induced ketonuria, a stimulation of resting metabolism, increases in the energy cost of movement, and a lower yield of energy per litre of oxygen consumed. Biochemical explanations of the enhanced lipolysis include increased catecholamine secretion, altered sensitivity of catecholamine receptors, and decreases of circulating insulin. The enhanced fat loss with combinations of cold and exercise may be helpful in the therapy of obesity, although the response seems less well developed in women than in men. Moreover, there may be other objections to cold exposure in an older obese population. Short-term glycogen depletion has negative implications for the endurance competitor. Cold acclimation, by favoring an insulative response to cold, reduces glycogen depletion; endurance training may supplement this effect by enhancing the activity of fat-metabolizing enzymes.
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PMID:Fat metabolism, exercise, and the cold. 132 16

Disordered nocturnal breathing with significant arterial oxygen desaturation and sleep apnoea is a feature of extreme obesity which is often difficult to manage in the short term. We have evaluated the effect of fluoxetine, a centrally acting 5-HT re-uptake inhibitor, on sleep-breathing patterns in asymptomatic extremely obese subjects. A double-blind cross-over study was used to compare fluoxetine (60 mg for three days) to placebo. Eleven obese subjects (ten males, one female, mean weight +/- s.d. 131 +/- 2 kg) slept overnight in a sleep laboratory with the polysomnographic study recorded after an initial acclimatization night. The obese subjects had normal respiratory function and normal fully awake arterial oxygen saturation (%SaO2 97 +/- 1). Marked O2 desaturation was seen in all the subjects during sleep but the average asleep %SaO2 did not differ between the two treatment phases (placebo 90 +/- 5; fluoxetine 92 + 2%). However, fluoxetine significantly increased the minimum %SaO2 recorded during the study night either by abolishing or reducing REM sleep (placebo 73 +/- 2%; fluoxetine 81 +/- 8%; P < 0.05, 95% CI -12.3 to -2.03). Frequent hypopnoea was observed in all subjects in both REM and non-REM sleep whereas apnoea was uncommon. The total apnoea/hypopnoea index fell in six subjects during the fluoxetine night, the largest reduction being seen in the most severely affected. In five of the six the improvement was associated with the abolition of REM sleep. Total sleep time did not differ between the placebo and fluoxetine nights nor did a qualitative assessment of sleep using a visual analogue score.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Short-term use of fluoxetine in asymptomatic obese subjects with sleep-related hypoventilation. 133 Sep 62

The ester methyl [4-[2-[(2-hydroxy-3-phenoxypropyl)amino]ethoxy]phenoxy]acetate (8) has been identified as the most interesting member of a series of selective beta 3-adrenergic agonists of brown adipose tissue and thermogenesis in the rat. In vivo it acts mainly via the related acid 10. Potency was generally markedly reduced by placing substituents on the phenyl ring of the phenoxypropanolamine unit of 8; only the 2-fluoro analogue 16 had comparable potency to 8. Other structure-activity relationships are discussed. Further testing of 8 (ICI 198157) has shown that in the rat it stimulates the beta 3-adrenergic receptor in brown adipose tissue at doses lower than those at which it affects beta 1 and beta 2 adrenergic receptors in other tissues. It increases metabolic rate, as judged by an increase in oxygen consumption, and in the genetically obese Zucker rat it causes a reduced rate of weight gain. This class of compound may be useful in the treatment of obesity in man.
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PMID:Selective beta 3-adrenergic agonists of brown adipose tissue and thermogenesis. 1. [4-[2-[(2-Hydroxy-3-phenoxypropyl)amino]ethoxy]phenoxy]acetates. 135 Mar 9

Although upper gastrointestinal endoscopy is generally a safe procedure, it is known to be associated with arterial oxygen desaturation. We studied 82 patients undergoing diagnostic upper gastrointestinal endoscopy following a standard premedication consisting of xylocaine throat spray and intravenous midazolam. The mean duration of endoscopy was 8.5 +/- 0.42 min and the mean dose of midazolam was 6.3 +/- 0.15 mg. The baseline SaO2 was 94.91 +/- 0.27% and it decreased after pre-medication to 92.84 +/- 0.40% (p < 0.001) and after intubation to 91.21 +/- 0.40% (p < 0.001). A fall greater than 4% saturation occurred for 15.68% of the total endoscopy time. SaO2 < 90% was seen for 16.7% and SaO2 < 85% occurred for 2.33% total endoscopy time. In patients > 65 years old, hemoglobin < 10 g/dl, or body mass index > 28, the baseline saturation was significantly lower and a reduced SaO2 was seen throughout the procedure. We identify old age, anemia, and obesity as independent risk factors for arterial oxygen desaturation. We recommend continuous monitoring before sedation, and giving supplemental oxygen to patients with these risk factors from the outset of upper gastrointestinal endoscopy.
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PMID:Age, anemia, and obesity-associated oxygen desaturation during upper gastrointestinal endoscopy. 147 70


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