1/127. obesity and life underwriting.obesity is increasing in the US population and currently affects one-third of adults. The physiology of obesity is complex and predisposition to obesity is influenced by multiple genes and environment. obesity may be measured by body fat percentage, body mass index (BMI), or visceral adiposity. life insurance companies generally use height and weight (build) determinations. The purpose of this paper is to review the life risks and physiology of obesity, and to suggest that the current trend to liberalize traditional build table ratings may not be prudent. A case history will be utilized to demonstrate these points.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
2/127. Fat embolism syndrome in a case of abdominal lipectomy with liposuction.Fat embolism syndrome is reported in a patient who underwent abdominoplasty and suction lipectomy for body contouring. Within 48 hours after surgery, she experienced adult respiratory distress syndrome, secondary to fat embolism syndrome. This was proven on bronchoscopy by evidence of fat laden macrophages. Aggressive respiratory support over 12 days resulted in patient survival.- - - - - - - - - - ranking = 2keywords = fat (Clic here for more details about this article) |
3/127. Interpersonal resistance to change: a study of a fat woman who became thin.The paper reports on the psychoanalytically-oriented psychotherapy of a very obese woman who, after a rather prolonged therapy, "decided" to reduce. During the weight loss process, significant reactions were noted from her son, daughter, brothers, sisters-in-law, customers, employees, husband, and therapist, which became crucial interferences with the continuing weight loss and specific resistances in the therapy. The identification of and the working through of these resistances significantly increased and consolidated her self-understanding. In that the response to major psychological changes was minimal as compared to the response to her physical change, it is hypothesized that physical change is more basically related to sense of self-continuity and hence more threatening to experience and observe.- - - - - - - - - - ranking = 4keywords = fat (Clic here for more details about this article) |
4/127. hiv-1 protease inhibitor-associated partial lipodystrophy: clinicopathologic review of 14 cases.BACKGROUND: A novel type of acquired partial lipodystrophy resulting from chronic treatment with hiv-1 protease inhibitor drugs has recently been described. OBJECTIVE: We studied the clinical and histopathologic features of a series of patients with hiv-1 protease inhibitor-associated lipodystrophy to evaluate the frequency of associated abnormalities. methods: The study group consisted of 14 consecutive HIV-infected patients receiving treatment with hiv-1 protease inhibitors, who experienced partial lipodystrophy. Clinical (including anthropometric data) and histopathologic findings, as well as biochemical and virologic data, were evaluated. RESULTS: A significant loss of fat in the face and extremities was associated with fat deposition on the abdomen, breast, and dorsocervical fat pad. Central obesity was frequently present. Histopathologic features disclosed a peculiar type of involutional lipodystrophy. hypertriglyceridemia was detected in 78.5% of patients. Low serum levels of cholesterol-high-density lipoprotein and high cholesterol-very-low-density lipoprotein were noted. hyperglycemia, hypercholesterolemia, or hyperinsulinemia were occasionally detected. CONCLUSION: hiv-1 protease inhibitor-associated lipodystrophy represents a new entity with peculiar clinical and histopathologic features. Metabolic associated abnormalities may imply a risk of future atherogenic complications.- - - - - - - - - - ranking = 3keywords = fat (Clic here for more details about this article) |
5/127. Soluble leptin receptor in serum of subjects with complete resistance to leptin: relation to fat mass.leptin resistance and obesity have been related to mutations of the leptin receptor gene in rodents and, recently, in a consanguineous family. The latter mutation results in a receptor lacking transmembrane and intracellular domains. Homozygous and heterozygous individuals with this mutation had serum leptin levels higher than expected, given their BMIs: 600, 670, and 526 ng/ml and 145, 362, 294, 240, and 212 ng/ml, respectively. Their serum leptin was fractionated by gel filtration: >80% was present as a high-molecular size complex vs. 7.5% in the nonmutated sister. Western blot analysis showed a band at 146 kDa reacting specifically with an antibody directed against the leptin receptor ectodomain. In 10 obese control subjects, as in the mutated patients, free leptin levels correlated with BMI (r = 0.70, P = 0.0011) and reflected fat mass, regardless of leptin receptor functioning. In the patients, bound leptin levels correlated with BMI (r = 0.99, P = 0.0002) and were related to the number of mutated alleles. These data demonstrate that the truncated receptor is secreted into blood and binds the majority of serum leptin, markedly increasing bound and total leptin. Free serum leptin was similarly correlated with BMI in the mutated and nonmutated obese individuals, providing evidence that the relationship between BMI and circulating free leptin is preserved in this family. This finding suggests that the leptin receptor itself may not be specifically involved in the control of leptin secretion, and it supports the concept of relative resistance to leptin in common obesity.- - - - - - - - - - ranking = 5keywords = fat (Clic here for more details about this article) |
6/127. Primary pulmonary hypertension with central sleep apnea: sudden death after bilevel positive airway pressure therapy.An obese 23-year-old man with sleep-disordered breathing and primary pulmonary hypertension (PPH) had been administered oral beraprost sodium, anticoagulant warfarin, and home oxygen therapy, at another hospital as treatment for the PPH, but he had not experienced any symptomatic improvement. The patient had a body mass index of 32.4kg/m2, and complained of fatigue, shortness of breath on exertion, excessive daytime sleepiness, and snoring. Arterial blood gas analysis showed a PaO2 and a PaCO2 of 70.9 and 31.2mmHg, respectively. A polysomnographic study revealed central sleep apnea with an apnea-hypopnea index (AHI) of 29.7episodes/h. The patient showed improvement of daytime sleepiness after starting nocturnal nasal bilevel positive airway pressure (BiPAP) therapy for the central sleep apnea, but his pulmonary hypertension, measured in the daytime, worsened. The patient died suddenly while walking to the bathroom in the morning 1 month after initiation of BiPAP therapy. It is necessary to consider the possibility of sudden death when nasal BiPAP therapy is given to a PPH patient with central sleep apnea.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
7/127. Acute lymphoblastic leukemia in one of two siblings with alstrom syndrome.alstrom syndrome is a rare autosomal recessive disease; less than 60 cases have been reported. No Chinese patient with this disease has been reported previously in the literature. Here, we describe an 11-year-old Chinese boy with this condition. His elder sister also had alstrom syndrome, and his father had non-insulin-dependent diabetes mellitus. Both siblings had degenerative retinopathy, obesity, mental retardation, perceptive hearing loss, short stature, non-insulin-dependent diabetes mellitus, nephropathy, hyperlipidemia, acanthosis nigricans, and hepatic dysfunction. The boy also developed acute lymphoblastic leukemia, which was confirmed by cytochemistry and immunophenotyping findings. He received chemotherapy and radiotherapy for the malignancy. The present case suggests that acute lymphoblastic leukemia may be coincident with or may be a previously undescribed systemic manifestation of alstrom syndrome.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
8/127. Body habitus alterations in HIV-infected women treated with combined antiretroviral therapy.Fat distribution alterations are among the most frequent and unexpected side effects of combined antiretroviral therapy. They may occur in patients receiving protease inhibitor-containing regimens and those treated with combinations of only nucleoside reverse transcriptase inhibitors. The broad spectrum of body fat alterations, which are variably associated with metabolic abnormalities, raises the question as to whether they represent different components of the same syndrome or are manifestations of different pathogenetic mechanisms. Recent clinical evidence is consistent with a higher risk of developing body fat alterations in females. We here report three different aspects of body habitus changes in women treated with various antiretroviral regimens and describe their short-term follow-up. We also discuss the possible pathogenetic implications and the role of different drug classes according to present knowledge.- - - - - - - - - - ranking = 2keywords = fat (Clic here for more details about this article) |
9/127. liver failure after jejunoileal shunt.Reports of fatty infiltration of the liver following jejunoileal shunt for obesity and hyperlipemia are frequent. Cases of overt liver failure, in contrast, are rare and poorly documented following the various types of small bowel bypass. Fifteen months after jejunoileal bypass, a 41-year-old nonalcoholic woman whose preshunt liver function was chemically normal was found to have morbidly abnormal liver chemistry values. A biopsy examination demonstrated severe fatty metamorphosis bordering on frank cirrhosis. Reversal of her shunt led to return of her liver chemistry values to normal and reversal of the morphologic changes noted at biopsy examination. Close follow-up of patients subjected to small bowel bypass for obesity or hyperlipemia is mandatory. If liver function abnormalities persist for more than six months, strong consideration should be given to reversal of the shunt.- - - - - - - - - - ranking = 2keywords = fat (Clic here for more details about this article) |
10/127. diabetes mellitus and life-style--for the primary prevention of diabetes mellitus: the role of diet.Diet treatment for diabetes requires restriction of the food amount (energy intake). It is desirable that patients have a proper relative consumption of the three main nutrients (proteins, carbohydrates, fats) and also habitually take low-energy foods such as vegetables, mushrooms and seaweeds, etc. as often as possible in each meal. Therefore, we can replace the expression 'a diet for diabetes' with 'a diet for healthy living'. By showing a clinical case of an obese diabetic patient, who succeeded to reduce their body weight, HbA1c and oral agents through diet treatment, and finally could go on diet treatment only, the importance of diet therapy can be emphasized. Furthermore, the estimation index was examined to evaluate how accurately diabetic patients could estimate food energy. According to this study, a large amount of food on the plate leads most patients to underestimate the amount of real energy, and patients are apt to eat too much compared with having smaller amounts of food on the plate. By analyzing questionnaires on the diet therapy of approximately 3000 diabetics, it has been shown that the majority of patients at our hospital recognize that diet therapy is the most important factor in the treatment of diabetes. Interestingly, patients who ate all the food served showed a significantly higher body mass index compared with those who left served food.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
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