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 26,365 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A clinical and body compositional study has been made of 150 patients with morbid obesity and their responses to four different dimensional alterations of jejunoileal bypass. Total body potassium was estimated by measuring 40K with the whole body counter and total body water by tritiated water dilution. Body compositional data derived from these measurements were compared in the 4 groups during followup periods up to 4 years and related to clinical results. Initially, patients were two or more times overweight due to excess (60 to 65%) body fat and increased hydration (21%) of lean tissues. The 80 end-to-end jejunoileal bypass procedures of Groups 3 and 4 (30 cm jejunum to 15 or 20 cm ileum) had better weight losses and clinical results in followup were rated "good" in 60% and 81% respectively. These results were accompanied by a greater degree of improvement in body composition than was observed in the other groups under study.
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PMID:Body composition in morbidly obese patients before and after jejunoileal bypass. 118 May 78

Seventy patients who averaged 155% overweight and requested jejunoileal bypass surgery as a treatment intervention for morbid obesity were studied preoperatively for prominent psychological characteristics. By use of standard personality tests and a structured psychiatric interview, it was found that 89% were judged to be psychologically favorable risks for the operation. Most frequently the diagnostic opinion was of a mild personality disorder.
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PMID:Jejunoileal bypass procedures in morbid obesity: preoperative psychological findings. 124 41

Difficulties associated with outcome assessment of operations performed for treatment of morbid obesity include lack of uniform standards for reporting results, failure to account for the response of related medical problems to weight loss, and lack of actuarial data for patients greater than or equal to 45 kg overweight. The purpose of this report is to critically analyze various methods of outcome assessment including the 5-y postoperative weight loss results of vertical banded gastroplasty and Roux-en-Y gastric bypass. Weight loss after these procedures usually reaches a nadir between 18 and 24 mo postoperatively. Mean percent excess weight loss at greater than or equal to 5 y ranged from 48% to 74% after gastric bypass and from 50% to 60% after vertical banded gastroplasty. Medical problems are almost invariably improved with satisfactory weight loss. Surgery remains the mainstay in treatment of morbid obesity because of the nearly 100% failure rate of nonoperative treatment in these patients.
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PMID:Critical analysis of results: weight loss and quality of data. 173 31

15 consecutive persons aged under 50 with an overweight exceeding 75% were examined clinically, biochemically and with liver biopsy after gastric bypass (7 patients) or gastroplasty (8 patients). After 1 year the occurrence of steatosis had fallen from 73 to 40% which, together with a marked decrease in individual gradings of fatty changes, represented a significant regression of the steatosis. Likewise, discrete inflammatory and granulomatous changes largely disappeared. In no case was fibrosis present. Serum alkaline phosphatases preoperatively increased above normal range in 20% but their mean level was significantly reduced after 12 months of weight loss. Other liver function tests remained normal and stable. In contrast to published experience with jejunoileal bypass operations liver steatosis associated with morbid obesity seems to be morphologically and biochemically reversed together with the weight reduction obtained by gastroplasty or gastric bypass.
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PMID:Regression of liver steatosis following gastroplasty or gastric bypass for morbid obesity. 210 Feb 71

The paper evaluates the results of vertical gastroplasty in the treatment of morbid obesity. A series of 34 patients (24 F and 10 M) with the following characteristics was included in the study: mean age 41 years, preoperative weight 141 kg, % of ideal weight 204%, BMI 49; mean follow-up was 35 months. Postoperative mortality was zero and there were reduced early and long-term complications. Mean weight loss, expressed as a percentage of overweight, at 6 months was 48.5%, 56.8% at 12 months, 63.4% at 24 months and 67.2% at 36 months. The authors conclude that, given the low incidence of complications and the satisfactory weight loss which was maintained long after the operation, vertical gastroplasty appears to be the preferred operation, since it represents a safe and effective method of treating pathological obesity.
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PMID:[Vertical gastroplasty. Evaluation of efficacy]. 210 42

The Garren-Edwards Gastric Bubble (GEGB) was introduced in 1984 as an alternative to surgery (jaw wiring, gastrointestinal bypass, vertical banded gastroplasty) for the treatment of morbid obesity in patients who had failed behavior modification therapy or dietary management for weight reduction. Its mechanism of action is unclear and previous reports have not demonstrated any significant consistent alteration in gastric emptying (GE) as measured by radionuclide techniques. Other proposed mechanisms include: placebo, hormonal, mechanical "satiety", behavioral modification, and neuronal. In order to determine the effect of the GEGB on GE, ten obese (mean % overweight = 89%) patients, 27-50 yr old (mean = 36 yr), had solid GE scans before and 5 wk after endoscopic placement of the bubble. GE scans were performed in six patients after removal (12 = wk residence time). The meal consisted of 300 microCi [99mTc]sulfur colloid in the form of a 300 kcal egg sandwich (egg white 248 g, white bread 40 g, butter 6 g; composition = CHO 40:PR 40: FAT 20) with 180 ml deionized water. Images were obtained in the anterior and posterior projections at 15-min intervals for 1 hr (four patients) or 2 hr (six patients) and the %GE (decay corrected geometric mean) was calculated. Unlike other studies involving the GEGB, adjunctive therapy in the form of dieting and behavior modification were not employed in this study. The effect of the GEGB alone in the treatment of obesity has not been previously evaluated. There was a significant (p less than 0.025) delay in gastric emptying at 1 hr (pre-bubble mean % gastric retention = 46%; bubble mean = 57%; n = 10). After removal, GE returned toward baseline (mean % gastric retention = 51%; n = 6) (p less than 0.05) (Student's t-test). The average weight loss was 5.5 lb (n = 10; p less than 0.025). One mechanism of action of the GEGB may be delayed gastric emptying resulting in early satiety and decreased food intake with resultant weight loss.
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PMID:Effect of the Garren-Edwards gastric bubble on gastric emptying. 271 31

Obesity continues as before to be a widespread condition. Obesity is defined as a body weight of over 120% of the ideal weight, corresponding roughly to the 85th percentile of the weight distribution. According to the "Build Study" (1979), the ideal weight is assumed to be rather higher than formerly; in men it is 8%, in women 6% less than the so-called normal weight. The latter corresponds roughly to the average weight and is defined as: height (cm) minus 100 in kg. In obese subjects both somatic and psychological complications arise; these are related exponentially to the degree of overweight. More recent findings in the Framingham Study show that obesity leads to coronary heart disease and premature death independently of the classical risk factors. Evaluation of the patient should include a personal and familial history of the obesity, together with individual eating habits and the degree of physical activity indulged in. As assessment should be made of the body fat distribution (android or gynoid obesity); android obesity carries a relatively high risk. Complications should be looked for, together with other risk factors for arteriosclerosis. Treatment depends on the severity of the condition and on the motivation. In general, it should consist of a moderate reduction in the caloric value of the food intake together with advice on eating habits and an increase in bodily activity. Group therapy often gives good results on account of the dynamic interactions within groups. Patients with morbid obesity will profit from a very hypocaloric, "ketogenic" diet (ca. 600-700 kcal/day). One of the author's own studies showed that a very hypocaloric diet resulted in mood elevation and a reduction in the need for sleep. Conservative measures such dietary weight reduction, changes in eating habits and encouragement of bodily activity are to be preferred to surgical treatment (eg, gastric stapling). Weight reductions in hospital do not lead to a change in eating habits and are therefore of doubtful value; drug therapy as a form of long-term treatment is likewise of questionable usefulness.
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PMID:[Evaluation and treatment of obesity in clinical practice]. 274 Nov 31

The influence of moderate obesity on the liver was assessed in 4613 male company employees including 534 moderately obese subjects (30-50 percent overweight). Serum levels of transaminases and gammaglutamyl transferase activities were significantly higher in moderately obese male non-drinkers than in non-obese non-drinkers. Twenty-four percent of male non-drinkers with moderate obesity had abnormal levels of sGPT and 47 percent of moderately obese male non-drinkers had significant hepatic steatosis as assessed by computed tomography. Although most previous studies on this subject were concerned with morbid obesity accompanying only those of more than 50 percent overweight or those who required surgery, the results of this study clearly indicate that moderately obese subjects also have frequent liver dysfunction.
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PMID:Liver function in moderate obesity--study in 534 moderately obese subjects among 4613 male company employees. 287 56

Gastric banding for morbid obesity was performed on 73 patients between April 1983 and December 1986. Early complications occurred in 16% and late complications in 15% of the cases. A second operation was performed on 12 patients, with removal of the band in 11 (15%). Initial weight loss was rapid. Re-examination of 67 patients indicated that this initial loss was followed by a time-related weight gain. Weight reduction occurred as a fairly constant proportion of preoperative weight, irrespective of the degree of obesity. Weight loss to body mass index less than or equal to 30 seems to be a realistic expectation only for moderately overweight patients, not for the hyperobese. Older patients had least weight loss. The data suggest that dietary restrictions will still be needed after gastric banding.
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PMID:Gastric banding in the treatment of morbid obesity. Factors influencing immediate and long-term results. 292

To evaluate whether changed plasma calcium binding might lead to a secondary increase of parathyroid hormone in morbid obesity, fasting measurements of serum ionized, ultrafiltrable and total calcium, calcium binding substances, and parathyroid hormone were undertaken in age- and sex-matched groups of obese (n = 44) and normal weight subjects (n = 52). The 24-hour urinary calcium excretion and clearance of creatine were also measured. Calcium binding to proteins was changed. Serum total proteins and protein-bound calcium did not differ, but serum albumin was decreased in obesity. Consequently, obese subjects did not reveal the normal dependency of protein-bound calcium upon albumin. Calcium binding to other substances was also changed. Serum phosphate and bicarbonate were decreased, while the concentrations of citrate, lactate, acetoacetate, 3-hydroxybutyrate, free fatty acids, and urate were all increased, leaving the total concentration of plasma complex-bound calcium unchanged. Nevertheless, these reciprocal changes increase the concentrations of less readily reabsorbable anions in the renal ultrafiltrate. The changed pattern of calcium binding in serum of the obese subjects may serve to explain our findings of increased urinary calcium excretion, lowering of serum ionized calcium and increased parathyroid hormone levels, changes being significantly correlated with degree of overweight.
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PMID:Increased parathyroid hormone as a consequence of changed complex binding of plasma calcium in morbid obesity. 308 Jun 52


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