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 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The results of two studies about the course of pregnancy and delivery in adipose women in our hospital are combined and discussed. We found a higher rate of EPH-gestosis in overweight patients. The frequency of Cesarean section was increased. Belated uterine involution post partum is more frequent in adipose women, also the occurrence of urinary tract infections. There is a significant increase in perinatal mortality, mainly due to an increase in still-born. Pneumonia due to aspiration and birth traumata occur more frequently as well and endanger the children.
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PMID:[Obese patients in obstetrics]. 97 92

An 11-year-old boy developed influenza with glucosuria. An oral glucose test performed during the infection revealed values within the diabetic range. Type 1 diabetes was wrongly diagnosed and insulin therapy initiated. A 19-year-old overweight adolescent developed pneumonia with hyperglycemia but without polydipsia or polyuria. Further investigation revealed incipient type 1 diabetes. As insulin therapy was not initiated the diabetes rapidly decompensated. It is recommended that further investigations be conducted in patients with hyperglycemia following infections.
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PMID:[Diabetes or hyperglycemia?]. 335 3

Insurance companies have dominated the development of height-weight tables. Initially, tables indicated average weights for insurees, revealing weight gains with increasing age. While pneumonia and tuberculosis were leading causes of death, underweight was considered undesirable because it was associated with those conditions. Extra weight was then thought to represent a reserve that could be drawn upon in time of illness. As those diseases were brought under control, the risk factors in overweight received increased attention. Since the 1940s, tables have been developed by the Metropolitan Life Insurance Company for "ideal" and "desirable" weights, defined as weights associated with the lowest mortality rate. Body frame size, although poorly defined, was factored into the tables. The data base and philosophy of the tables have been questioned by some researchers. Recently, Metropolitan issued 1983 height and weight tables based on life insurance statistics. Weights for height are slightly higher than in the previous (1959) tables. Although stated weights are those associated with the lowest mortality, they are not labeled "ideal" or "desirable". A method for determining body frame size through measurements of elbow breadth is presented. Health care providers should be aware of the latest revisions of these widely used tables, their philosophy, and data source to ensure most suitable use.
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PMID:Average? Ideal? Desirable? A brief overview of height-weight tables in the United States. 670 96

Routine examinations done in patients with pneumonia are following: chest radiograph, Gram stain and culture of sputum. For patients who require hospitalization two sets of blood culture should also be performed. Gram stain and culture of pleural fluid are advised in patients with pleural effusion. Serological testing is important in the diagnosis of atypical pneumonia, but they usually provide retrospective information useful mainly in epidemiological studies. Less frequently used methods are following: bacterial antigen-detection and molecular biology techniques, which may be applied to sputum samples and other biological specimens (pleural fluid, blood, urine etc.). Invasive diagnostic techniques (bronchoalveolar lavage (BAL), protected specimen brush (PSB) or transtracheal aspiration (TTA)) are performed mainly in patients with nosocomial pneumonia especially in critically ill ones. For intubated and mechanically ventilated patients those methods are used to confirm the diagnosis of pneumonia, but for other nosocomial patients the aim is to find causative organism. In spite of higher efficiency of invasive techniques (comparing to non-invasive), one should remember that they may cause dangerous complications and thus before applying them it is necessary to consider if potential benefits overweight risk.
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PMID:[Survey of diagnostic methods used in the management of pneumonia]. 1050 42

Questionnaires intended to determine the factors involved in deaths in infants under 1 year have been completed in the province of Havana, Cuba, since 1980. The questionnaires are completed by obstetricians and pediatricians of the municipal health areas and analyzed at the secondary care level. This work examines the factors present in the 133 infant deaths occurring in Havana Province in 1983. The infant mortality rate in the province in 1983 was 14.1/1000 live births, the lowest ever recorded in the province. 74 of the deaths occurred in the early neonatal period, 13 in the late neonatal, and 46 in the postneonatal period. 22 of the early neonatal deaths were due to intrapartum anoxia, 15 to hyaline membrane disease, 10 to prematurity, 7 to bronchoaspiration, 3 to sepsis, 1 to bronchial pneumonia, and 13 to malformations. In the late neonatal and postneonatal periods, 11 deaths were attributed to acute diarrheal disease, 6 to meningitis, and 5 to accidents. 8 of the mothers were under 17 years old, 30 were 18-20, 57 were 21-30, and 16 were 31 or over. Maternal age was unknown for 22. 22 of the mothers were overweight, 29 were malnourished, 55 were of normal nutritional status, and the status of 27 was unknown. 67.7% of the early neonatal deaths were in low birth weight babies. Low educational level and rural residence were social factors in infant mortality.
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PMID:[Factors influencing infant mortality. Havana Province, 1983]. 1231 79

Autosomal-dominant polycystic kidney disease (ADPKD) is a systemic disease with multiple extrarenal manifestations. It accounts for 7% to 11% of patients receiving dialysis or renal transplantation (RT) for end-stage renal disease (ESRD) in Europe. We analyzed retrospectively the causes of death, the prevalence of cardiovascular risk factors (CVRF) and the patient and graft survivals in 62 consecutive ADPKD patients who received 63 cadaveric grafts (29 men and 34 women), of the 600 RTs performed between 1980-2001. The diagnosis of ADPKD was established by family history and ultrasound techniques. At present, 50 patients (79.4%) have functioning grafts, with a mean follow-up of 84.7 months (range, 12-255), and 13 patients have lost their grafts. The main cause of failure was patient death with a functioning graft (9 cases). Malignancies occurred in 5 patients, including 2 lymphomas, 1 renal carcinoma, 1 pancreas sarcoma, and 1 lung cancer associated with infection. Three patients died of cardiocerebrovascular events, and 1 patient of pneumonia. One patient lost the graft after decreasing the immunosuppression for an obstructing colon cancer. Three additional patients now on dialysis lost their grafts due to chronic rejection in 2 cases and primary nonfunction in 1 case. The prevalence of cardiovascular risk factors among the 50 patients with functional grafts were: hypertension, 70%; hypercholesterolemia, 62%; hyperhomocysteinemia, 30%; hyperfibrinogenemia, 68%; increased lipoprotein (a), 18%; microalbuminuria, 22%; hyperuricemia, 48%; hyperparathyroidism, 24%; overweight status, 24%; and nonlethal myocardial infarction, 10%. We conclude that ADPKD patients have good graft and patient survivals, and that the presence of malignancy is the main cause of death and graft failure at our center.
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PMID:Autosomal-dominant polycystic kidney disease: high prevalence of graft loss for death-related malignancies and cardiovascular risk factors. 1296 69

A 33-year-old woman was trapped in a car following an accident. Because of her size (241 kg; BMI: 85 kg/m2) it was difficult to free, transport, examine and treat her. A few days after she had been discharged with a knee injury, she was again admitted for pneumonia. Partly as a result of para-infectious rhabdomyolysis, she died 5 days later. More and more people in The Netherlands are overweight, and more and more often to an extreme degree. Complicated accident kinetics, problems with diagnosis and treatment, comorbidity and an increased risk of complications in obese patients contribute to the poorer prognosis following blunt trauma. It is therefore practically impossible to give obese patients the usual care according to the protocol. Adaptations like positioning in the anti-Trendelenburg, left lateral-tilt position, as well as bigger and stronger equipment, may improve the care of trauma patients with morbid obesity.
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PMID:[Problematic care for a trauma patient with morbid obesity]. 1558 37

Three patients with myotonic dystrophy (MD) developed respiratory failure. The first was a 55-year-old man with MD who had been admitted elsewhere with pneumonia and respiratory failure. After discharge he was re-admitted with respiratory failure due to respiratory pump failure. Ultimately, he was given a tracheostomy and was ventilated during the night. The second patient was a 38-year-old man who was admitted to the intensive care unit when he could not be weaned off the ventilator following cholecystectomy for symptomatic gall stones. It appeared that he had partial respiratory failure due to MD and overweight. Ultimately he was able to be weaned during the day with nightly non-invasive ventilation. The third patient was a 55-year-old woman who was admitted with recurrent pneumonia and respiratory failure. She appeared to have chronic respiratory failure due to MD. She was ventilated at night via a tracheostomy. All three patients reported a gradual decline in physical and mental performance in the years preceding this acute episode. All three experienced a remarkable recovery of performance after the institution of mechanical ventilatory support. Respiratory failure that develops over a number of years can be easily missed in aging patients with slowly progressing neuromuscular disease. Timely recognition may lead to improved survival and quality of life by the application of non-invasive ventilatory support.
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PMID:[Respiratory insufficiency in patients with progressive neuromuscular disease can sometimes be treated effectively with ventilatory support]. 1790 57

Obesity is perceived as a risk factor in general thoracic surgery. We conducted a single-center retrospective evaluation of perioperative complications in 822 patients who underwent thoracic surgery between 2000 and 2005. According to body mass index, 82 were underweight (< 18.5 kg m(-2)), 568 were normal (18.5-24.9 kg m(-2)), 155 were overweight (25.0-29.9 kg m(-2)), and 17 were obese (>or=30 kg m(-2)). A significant increase in preoperative comorbidity (hypertension and ischemic heart disease) was observed with increasing body mass index. There was no significant difference in operation time or length of stay in the operating room, but extubation time was significantly different among the 4 groups. Of the intraoperative complications, alveolar-arterial oxygen difference increased significantly with increasing obesity, and hypoxia was least common in the normal group. Postoperatively, there was more pulmonary leakage in the underweight group and less pneumonia in the normal group. Both the underweight and the obese are at increased risk of perioperative complications and need to be carefully observed and managed intraoperatively and postoperatively.
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PMID:Effect of body mass index on perioperative complications in thoracic surgery. 1898 55

Obesity is a worldwide epidemic and is known to increase the risk of cardiovascular disease, type 2 diabetes, and certain forms of cancer. In addition, obesity is now recognized as an important risk factor in the development of several respiratory diseases. Of these respiratory diseases, it has already been well established that obesity can lead to obstructive sleep apnea (OSA) and obesity-hypoventilation syndrome (OHS). More recent data suggest that the prevalence of wheezing and bronchial hyper-responsiveness, two symptoms often associated with asthma, are increased in overweight and obese individual. Indeed, epidemiological studies have reported that obesity is a risk factor for the development of asthma. Furthermore, a number of studies indicate that obesity is also associated with a higher risk of developing deep vein thrombi, pulmonary emboli, pulmonary hypertension, and pneumonia. Finally, weight reduction has been shown to be effective in improving the symptoms and severity of several respiratory diseases, including OSA and asthma. Thus, overweight and obese patients should be encouraged to lose weight to reduce their risk of developing respiratory diseases or improve the course of pre-existing conditions.
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PMID:Obesity and respiratory diseases. 1902 35


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