Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 44-year-old woman who weighed 130 kg (height 158 cm, BMI 52) with a complicated psychiatric history was referred for obesity surgery because of severe sleep apnea, obesity hypoventilation syndrome with frequent pneumonias, arterial hypertension, diabetes mellitus, polyarthralgia and back pain, venous insufficiency, dysmenorrhea, severe heartburn, and incisional hernia. From childhood until 1983, she had undergone 106 operations, mainly for septic/pyemic and intra-abdominal abscesses, 86 of them under general anesthesia. In the 4 years before undergoing bariatric surgery, she had gained 40 kg, nonoperative attempts at weight reduction had failed. Some months before obesity surgery she could fall asleep while standing, and she noticed an entire loss of capacity for work. Respiratory disturbance index measured during sleep by Mesam-4 device was 68 events per hour. Preoperative controlled positive airway pressure (C-PAP) therapy was used. Vital indications for weight reduction were established. Bariatric surgical steps included six operations: (1) vertical banded gastroplasty (VBG); (2) relaparotomy with suspicion of peritonitis, no complications found; (3) hernioplasty simultaneously with panniculectomy; (4) revision and removal of additional flap because of marginal skin necrosis; (5) bilateral thigh dermatolipectomy simultaneously with right-side saphenectomy; and (6) removal of intramammary abscess. Twenty-four months after VBG, she had lost 39 kg (56.5 % EWL) and was doing rather well. Obesity-related diseases except back pain were relieved.
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PMID:Successful bariatric surgery in a patient who underwent more than 100 various operations. 1048 18

This article reviews several aspects of the association between obesity and cancer. Current perspectives of cancers of the breast, endometrium, colon and prostate are described. Obesity is a growing problem in contemporary societies, due to the rapid adoption of a modernized lifestyle that results in increased carbohydrate and fat-rich dietary intake, reduced physical activity and extended life expectancy. More than half of adult Americans are overweight or obese, and so is the population of many other countries. There are several definitions for the state of obesity. The body mass index (BMI), which measures overall adiposity, is universally available, the easiest to determine, and therefore the most commonly studied. Anthropometric measurements of subcutaneous fat distribution, such as measurement of girth, circumference of the arms, hips and thighs, or of skinfolds in various body regions are also often used. They allow to categorize the distribution of subcutaneous fat into android and gynoid types (den Tonkelaar, Seidell et al., 1994; Huang, Willett et al., 1999). The android, or abdominal, fat is determined from the waist to hip ratio, and is of particular relevance to cancer. Increased body weight and fat are associated with high health risks, and therefore body fat distribution and BMI are major predictors of obesity associated risks (Calle, Thun et al., 1999; "Overweight, obesity, and health risk," Yanovski, 2000). These include diabetes mellitus type 2, coronary heart disease, sleep apnea and pulmonary dysfunction, stroke, diseases of the gallbladder, liver and the musculoskeleton, reproductive dysfunction, venous insufficiency, deep vein thrombosis, poor wound healing, and more (Pi Sunyer, 1993; "Overweight, obesity, and health risk", Yanovski, 2000). All these are associated with increased mortality, especially in individuals with other risk factors (Calle, Thun et al., 1999). Cancer is also associated with obesity (Garfinkel, 1985), and the present paper attempts to summarize current perspectives of this association, especially in cancers of the breast, endometrium, colon and prostate.
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PMID:Obesity and cancer. 1293 6

We compared the safety, excess weight loss (EWL), and improvement in comorbidities after Roux-en-Y gastric bypass (RYGB) in morbidly obese and superobese patients (body mass index, <70 kg/m2 or >or=70 kg/m2). Of 825 patients who underwent RYGB by our group between 1995 and 2003, 79 (9.6%) were superobese (group A) and 746 were morbidly obese (group B). There were significant differences in age (A, 40.8 years; B, 43.2 years; P=0.01), gender (males: A, 40.5%; B, 17.6%; P<0.0001), and type of access (laparoscopic RYGB: A, 4.1%; B, 34.2%; P<0.0001). Sleep apnea (A, 57%; B, 31.4%; P<0.0001) and venous insufficiency (A, 16.5%; B, 2.4%; P<0.0001) were more common in superobese patients. Hospital stay was similar (A, 6.3 days; B, 5.3 days) with adjustment for differences in type of access. Although morbidity was comparable, mortality was higher in the superobese group (A, 2.5%; B, 0.5%; P<0.05). At a comparable follow-up (A, 17.7 months; B, 18.25 months), percent EWL at 1 year was lower in the superobese group (A, 54.6%; B, 64.3%; P<0.0001), but it became similar at 3 years (A, 66.5%; B, 60.7%). Postoperative improvement of comorbidities was equally dramatic in both groups with the exception of venous insufficiency. In conclusion, complications are not increased in the superobese, but they are more often fatal. Superobese patients achieve their maximum weight loss in a longer period of time and reach their nadir at year 3.
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PMID:Outcomes of Roux-en-Y gastric bypass stratified by a body mass index of 70 kg/m2: a comparative analysis of 825 procedures. 1562 44

A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. We were unable to find existing practice guidelines that address this problem in a comprehensive manner. This article provides clinically oriented recommendations for the management of leg edema in adults. We searched on-line resources, textbooks, and MEDLINE (using the MeSH term, "edema") to find clinically relevant articles on leg edema. We then expanded the search by reviewing articles cited in the initial sources. Our goal was to write a brief, focused review that would answer questions about the management of leg edema. We organized the information to make it rapidly accessible to busy clinicians. The most common cause of leg edema in older adults is venous insufficiency. The most common cause in women between menarche and menopause is idiopathic edema, formerly known as "cyclic" edema. A common but under-recognized cause of edema is pulmonary hypertension, which is often associated with sleep apnea. Venous insufficiency is treated with leg elevation, compressive stockings, and sometimes diuretics. The initial treatment of idiopathic edema is spironolactone. Patients who have findings consistent with sleep apnea, such as daytime somnolence, loud [corrected] snoring, or neck circumference >17 inches, should be evaluated for pulmonary hypertension with an echocardiogram. If time is limited, the physician must decide whether the evaluation can be delayed until a later appointment (eg, an asymptomatic patient with chronic bilateral edema) or must be completed at the current visit (eg, a patient with dyspnea or a patient with acute edema [<72 hours]). If the evaluation should be conducted at the current visit, the algorithm shown in Figure 1 could be used as a guide. If the full evaluation could wait for a subsequent visit, the patient should be examined briefly to rule out an obvious systemic cause and basic laboratory tests should be ordered for later review (complete blood count, urinalysis, electrolytes, creatinine, blood sugar, thyroid stimulating hormone, and albumin).
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PMID:Approach to leg edema of unclear etiology. 1651 3