1/10. Topiramate monotherapy in the maintenance treatment of bipolar I disorder: effects on mood, weight and serum lipids.Topiramate is a newly developed anticonvulsant agent with possible mood-stabilizing properties. Little is known about the short- and long-term effects of topiramate monotherapy in bipolar disorder. We here present the case of a 60-year-old female bipolar patient who received topiramate alone as maintenance treatment after recovering from euphoric mania. During 7 months, she was free from new manic symptomatology and she was able to reduce her overweight by 16.5 kg. The patient who is known to have a strongly hyperthymic temperament described symptoms of fatigue and sedation and eventually discontinued topiramate monotherapy. When she presented again in our bipolar clinic, severe euphoric mania had developed. After hospitalization, she slowly responded to oral sodium valproate loading plus zotepine. Her weight increased again and so did her triglyceride serum levels. Topiramate treatment and discontinuation did not seem to affect cholesterol serum levels.- - - - - - - - - - ranking = 1keywords = overweight (Clic here for more details about this article) |
2/10. Psychological aspects of diabetes mellitus.diabetes mellitus (DM) presents itself in two forms: insulin-dependent (type 1 DM) and non-insulin-dependent (type 2 DM). Although type 2 DM usually has an adult onset, in recent years there has been a significant rise in the number of children diagnosed with type 2 DM in the united states. Reasons for this increased frequency are believed to be a larger percentage of children who are overweight, a family history of diabetes, and a considerable increase in the use of psychotropic medication in children. The diagnosis of DM is a significant stressor not only for patients but also for their environment. Children with DM are sometimes stigmatized by their peers and relatives who do not understand the illness or are frightened by it. Some children also may need to alter several of their customary routines and are often scared to participate in activities in which they were previously engaged. The family's response to the diagnosis of DM may have a negative effect on glycemic control. Differences have been found in the way patients with type 1 DM and type 2 DM cope with and adapt to their diagnosis.- - - - - - - - - - ranking = 1keywords = overweight (Clic here for more details about this article) |
3/10. The long-term management of obesity with continuing pharmacotherapy.OBJECTIVE: Long-term, possibly lifetime, use of medications for the management of obesity may be thought to be similar to the use of pharmacotherapy for other chronic diseases such as hypertension or diabetes. Because there have been no systematic studies of this extended use, the experience of eight patients who have used obesity medications in a sustaining manner was studied. research methods AND PROCEDURES: The clinical characteristics of eight adult patients, each of whom has experience with long-term (more than 10 years) use of medications for weight loss and weight maintenance, were studied. RESULTS: The clinical experience of these eight patients was analyzed. Each chose to sustain the use of weight management medications for more than 10 years because of perceived benefit, comfort, and the absence of significant side effects. There has been no evidence of the development of tolerance, addiction, or misuse and no adverse events related to the medication. The beneficial effects of the medication have not diminished with time. DISCUSSION: The clinical characteristics of eight patients, each of whom has used obesity pharmacotherapy for more than 10 years, are described. The experience of these eight individuals cannot be generalized to the entire population of overweight or obese patients. It does suggest, however, that some patients respond successfully to this form of therapy and that they will derive value from it for the management of this disease. Efforts should be made to identify these patients, and consideration should be given to the use of chronic medications for the continuing management of obesity.- - - - - - - - - - ranking = 1keywords = overweight (Clic here for more details about this article) |
4/10. Paternal isodisomy of chromosome 7 with cystic fibrosis and overgrowth.We have diagnosed a boy with cystic fibrosis (CF) due to paternal UPD presenting with overweight and developmental delay, not typical features to CF patients. Two previously reported patients with paternal UPD(7) did not present overgrowth. The discrepancy between the phenotype of this boy and the other two patients raises the question of imprinted genes or homozygotization of a disease-causing gene in paternal UPD7.- - - - - - - - - - ranking = 1keywords = overweight (Clic here for more details about this article) |
5/10. chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition.A white female, now age 40 and receiving total parenteral nutrition for more than 5 years, developed unexpected 15% weight loss after 3 1/2 years of regimen, together with peripheral neuropathy confirmed by nerve conduction measurements. An intravenous glucose tolerance test showed that the fractional rate (K) had decreased to 0.89%/min (normal greater than 1.2). There was observed during this glucose infusion a borderline normal insulin response with a fall in plasma free fatty acids and in plasma leucine. During daily infusion of well over 400 g of glucose, the respiratory quotient was 0.66. chromium balance was negative. chromium levels were, in blood 0.55 ng/ml (normal 4.9 to 9.5) and in hair 154 to 175 ng/g (normal greater than 500). Regular insulin daily (45 micron) in the infusate nearly maintained euglycemia but despite this, and even with further glucose intake to restore weight loss, intravenous glucose tolerance test (K) and respiratory quotient were unchanged. Administration of insulin was then stopped and 250 microng of Cr added to the daily total parenteral nutrition infusate for 2 weeks. After this the intravenous glucose tolerance test (K) and respiratory quotient became normal (1.35 and 0.78, respectively). Over the next 5 months insulin was not needed and glucose intake had to be reduced substantially to avoid overweight. In this period nerve conduction and well-being returned to normal. With a maintenance addition of chromium to the total parenteral nutrition infusate (tentatively this addition is 20 microng/day) the patient has remained well for 18 months (to July 1976). These results suggest that relatively isolated chromium deficiency in man, hitherto poorly documented, causes 1) glucose intolerance, 2) inability to utilize glucose for energy, 3) neuropathy with normal insulin levels, 4) high free fatty acid levels and low respiratory quotient and, 5) abnormalities of nitrogen metabolism.- - - - - - - - - - ranking = 1keywords = overweight (Clic here for more details about this article) |
6/10. In-hospital mortality as a function of body mass index: an age-dependent variable.In a retrospective review of 8428 hospital admissions, the relationship between age, sex, disease category, body mass index, and mortality during hospitalization was examined. Records were analyzed for adult admissions whose principal diagnosis fell into one of three categories: malignant disease, heart and cerebrovascular disease, and other diseases. In this study, age, disease category, and body mass index were predictors of survival; sex and race were not. Predicted mortality calculated by logistic regression was greatest at the extremes of body weight in all age groups and in each disease category describing a U-shaped relationship. obesity was associated with higher mortality only when subjects were 100% or more overweight, whereas being at or below ideal weight was usually associated with increased mortality. Lowest mortality occurred at moderate overweight. The deleterious effects of extremes of body weight take on increasing importance the older the age of the patient. Underweight seems to be a more important predictor of mortality than overweight in older hospitalized subjects. The higher mortality in thin patients could not be explained by weight loss between hospitalizations.- - - - - - - - - - ranking = 3keywords = overweight (Clic here for more details about this article) |
7/10. Nonalcoholic steatohepatitis in obesity: a reversible condition.Nonalcoholic steatohepatitis is a rare complication of obesity with laboratory and histological features indistinguishable from alcoholic hepatitis. Three patients with 50-60% overweight and steatohepatitis are reported. All responded with normalization of the biochemical and/or histological changes after modest weight reduction.- - - - - - - - - - ranking = 1keywords = overweight (Clic here for more details about this article) |
8/10. Energy requirement for defibrillation of a markedly overweight patient.Recommendations have been made recently that the energy output of present-day defibrillators be increased above the 400 wsec limit. These recommendations are based largely on experimental studies in animals. We report a case of a man weighing 190.1 kg (418.2 lb), successfully resuscitated with a single 400 wsec shock after a prolonged episode of ventricular fibrillation. The observation in this patient as well as data derived from cardiovascular experience indicates that weight is not a significant factor in the successful outcome following defibrillation in adults. Many variables primarily related to the clinical condition of the heart influence the results of countershock. There are no valid studies at present to support the claim that high-energy defibrillators are necessary. In fact, implementation of such a recommendation is premature and possibly dangerous.- - - - - - - - - - ranking = 4keywords = overweight (Clic here for more details about this article) |
9/10. metformin improves blood lipid pattern in nondiabetic patients with coronary heart disease.OBJECTIVES: To study whether the addition of metformin further improves the blood lipid pattern in non-diabetic patients with coronary heart disease already treated with lovastatin, diet and lifestyle advice. DESIGN: An open, prospective, randomized study in a university hospital setting. SUBJECTS: Sixty non-diabetic male patients previously treated with coronary artery bypass surgery or angioplasty and with serum cholesterol > or = 6.0 mmol L-1 and/or HDL-cholesterol < or = 1.2 mmol L-1. INTERVENTIONS: After a 4-week run-in period with lovastatin (40 mg day-1), and diet and lifestyle advice, patients were randomized into two groups, both continuing the run in treatment. One group received metformin up to 2000 mg day-1; the control group got no additional treatment. MAIN OUTCOME MEASURES: fasting serum lipids, glucose and weight were registered at entrance (= week-4), and at weeks 0, 4 and 12. Changes from week 0 to week 4 and from week 0 to week 12 were compared. Side-effects of the treatment were also registered. RESULTS: metformin lowered the LDL/HDL-cholesterol ratio by 12 and 6% at weeks 4 and 12, respectively, and reduced body weight by 1.8 kg at week 12. There was also a transient lowering effect on LDL-cholesterol and apolipoprotein B. In the normal weight subgroup of patients (body mass index < 27 kg m-2), metformin induced a decrease in total cholesterol (-9%). LDL-cholesterol (-12%). LDL/HDL-cholesterol ratio (-10%) and apolipoprotein B (-7%), as compared to the control group. In this subgroup, body weight and fasting glucose were unaffected by metformin. Thus, the lipid lowering effect in normal weight patients was not secondary to changes in body weight or fasting glucose. In overweight patients (body mass index > 27 kg m-2), metformin had no significant effects on blood lipids, but induced a weight loss of -3.0 kg and a transient reduction of fasting glucose. No side-effects were registered apart from those expected from each individual drug. CONCLUSIONS: metformin given for 12 weeks as a supplement to lovastatin, diet and lifestyle advice to non-diabetic male patients with coronary heart disease further improves the lipid pattern in normal weight patients, and reduces weight in the overweight patients. Because metformin is cheap and other lipid lowering drugs are expensive, the potential of metformin as a lipid lowering agent should be further investigated.- - - - - - - - - - ranking = 2keywords = overweight (Clic here for more details about this article) |
10/10. Femoral loosening in total hip replacement.Ten cases of loosening of the femoral component following a Charnley total hip replacement were noted in a series of 160 patients. In 3 patients, the femoral component bent without fracturing. All of the patients were overweight. Loosening occurred despite the fact that the femoral component was in a valgus position in 9 of the 10 cases. Collapse of the cancellous bone in the region of the calcar may be a manifestation of the stress of excessive body weight upon the femoral component.- - - - - - - - - - ranking = 1keywords = overweight (Clic here for more details about this article) |
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