Cases reported "Obesity"

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1/84. Myocardial infarction in patients with systemic lupus erythematosus with normal findings from coronary arteriography and without coronary vasculitis--case reports.

    The authors present the cases of two young patients, a man and a woman, who presented with myocardial infarction, in the absence of ischemic heart disease or stenosis of the coronary arteries. The woman was known to have systemic lupus erythematosus (SLE) for the past 3 years (the immunoglobulin m [IgM] anticardiolipins antibodies were positive), without a history of coronary risk factors. Suddenly she presented with acute chest pain on rest that lasted 4 hours and culminated in anterior wall myocardial infarction. She was admitted to the coronary care unit, where no thrombolysis was given. She did not have echocardiographic evidence of Libman-Sacks endocarditis, but myocardial infarction was evident at the electrocardiogram (ECG). The young man had SLE (the IgM anticardiolipins were absent, but he was positive for lupus anticoagulant antibodies), he was hyperlipidemic, was a moderate smoker and moderately obese, and had no history of ischemic heart disease. He suddenly presented with an acute myocardial infarction documented by ECG, enzymes, and gammagraphy. In both patients, coronary angiography findings were normal and myocardial biopsy did not show evidence of arteritis. The relevance of these cases is the rare association of ischemic heart disease in SLE, with normal coronary arteries and without evidence of arteritis or verrucous endocarditis.
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ranking = 1
keywords = chest
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2/84. Intraoperative SSEP detection of ulnar nerve compression or ischemia in an obese patient: a unique complication associated with a specialized spinal retraction system.

    OBJECTIVE: To report a case of peripheral nerve compression caused by a specialized spinal retraction system, the Thompson-Farley retractor system, that most likely would not have been detected without intraoperative monitoring of the ulnar nerve. DESIGN: Bilateral median and peroneal nerve somatosensory evoked potentials (SSEPs) were monitored continuously during a C5 corpectomy, as was core body temperature. RESULTS: Within minutes after cervical soft-tissue retraction, the left ulnar nerve SSEP began to decline in amplitude. peroneal nerve SSEPs were normal throughout the surgery; core body temperature remained at 36 degrees /- 0.2 degrees C. After much effort to reposition the patient, the SSEPs returned to baseline and the Thompson-Farley system was replaced by a self-retracting system. CONCLUSIONS: To our knowledge, this is the first report of peripheral nerve compression caused by the Thompson-Farley retractor system. Even with careful positioning on the operating table, obese patients may be particularly at risk for upper arm compression. Continuous monitoring of SSEPs is suggested to prevent postoperative morbidity.
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ranking = 1.3872526532434
keywords = upper
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3/84. Brachial plexopathy in diabetic ketoacidosis.

    We report the clinical and electrodiagnostic findings of a 39-year-old patient who presented with severe, bilateral and asymmetrical, axon-loss brachial plexopathies occurring in the midst of diabetic ketoacidosis. This patient's unusual presentation is not consistent with the rare diabetic polyradiculopathy of the upper extremities usually occurring in association with diabetic amyotrophy.
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ranking = 1.3872526532434
keywords = upper
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4/84. Pulmonary thrombosis, homocysteinemia, and reperfusion edema in an adolescent.

    Deep vein thrombosis, pulmonary embolism, and pulmonary thrombosis in situ are rare in childhood and adolescence [1,2]. Unfortunately, these diagnoses may be unsuspected in a pediatric patient with dyspnea and chest pain. This article illustrates the diagnostic and therapeutic challenges that arose from unrecognized chronic thrombotic disease in an adolescent.
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ranking = 1
keywords = chest
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5/84. The ultrasonic findings in intussusception of the blind loop in a jejunoileal bypass for obesity.

    A 34 year old woman with bowel bypass surgery and persistent abdominal pain had intussusception of the blind loop, which was visualized on an abdominal ultrasound examination. The ultransonic and radiographic findings are compared and presented. Ultrasound should prove to be an invaluable tool in evaluating abdominal pain in bowel bypass patients.
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ranking = 17.768355732989
keywords = abdominal pain
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6/84. intussusception following jejunoileal bypass: case report and review of the literature.

    jejunoileal bypass carries a number of potential complications, one of which is intussusception of the excluded segment. The incidence of this complication is probably about one to two per cent. The usual symptoms consist of intermittent episodes of colicky abdominal pain. The roentgenographic diagnosis is difficult because the condition occurs at the blind end of the excluded segment and it is not possible to reflux contrast material to this area. If the intussusception is associated with severe gastrointestinal hemorrhage, selective angiography may provide the diagnosis.
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ranking = 8.8841778664947
keywords = abdominal pain
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7/84. Restructuring the therapeutic environment to promote care and safety for the obese patient.

    Fifty-four percent of American adults are overweight. obesity is a chronic disease associated with a number of conditions, such as diabetes, heart disease, hypertension, certain types of cancers, and breathing problems. The direct and indirect costs related to obesity exceed $70 billion annually. Because of the many cost and quality issues related to obesity, national attention is turning toward the special needs of this population. Strategies to restructure therapeutic intervention with attention to risk management, economic implications, and patient satisfaction are important considerations when managing the obese patient.
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ranking = 63.849853424144
keywords = breathing
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8/84. 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.
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ranking = 63.849853424144
keywords = breathing
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9/84. Self-training of new eating behavior for weight reduction.

    The problems of obesity are well documented, but few medical treatment programs have proven successful. Recently developed behavioral techniques have offered promise in the treatment of obesity. However, the time invested by a therapist limited their practical use and adoption by the general physician. A pilot study was conducted which employed a brief period of explanation of behavior modification techniques, development of an individualized program of eating behavior and recording of weight changes to provide feedback on progress. The program is carried out by patients at home with a minimum of physician supervision. The results indicate that such an approach is feasible and successful. Comparing this program to other programs is difficult because of the variability in reporting data and results.
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ranking = 0.24300733981353
keywords = back
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10/84. Postpartum postural headache due to superior sagittal sinus thrombosis mistaken for spontaneous intracranial hypotension.

    PURPOSE: To describe a case of superior sagittal sinus thrombosis in the puerperal period and the difficulties encountered in the diagnosis and management. CLINICAL FEATURES: A 29-yr-old multiparous woman presented with a postural headache four weeks after a normal pregnancy and vigorous delivery. Initial presentation suggested spontaneous intracranial hypotension (SIH) since there was no history of epidural or spinal anesthesia, or trauma or surgery to her back or neck. Conservative therapy was initially offered and then a lumbar epidural blood patch (LEBP) was performed, although it failed to relieve the postural headache. A dural leak could not be demonstrated but an MRV (magnetic resonance venography) revealed a superior sagittal sinus thrombosis (SSST). Although anticoagulant therapy was immediately initiated, the neurologist remained convinced that the postural headache was secondary to SIH, and, consequently, a second epidural blood patch was requested. anesthesia was reluctant to perform an LEBP at this point and suggested continuing anticoagulation until a subsequent MRV demonstrated recannalization of the SSST. This advice was followed and the postural headache resolved spontaneously with intravenous anticoagulation. CONCLUSION: The present case illustrates the importance of a multidisciplinary approach to the management of this rare complication of pregnancy. This case also highlights the importance of reviewing the differential diagnosis when considering treatment of a postural headache in the puerperium.
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ranking = 33.224571017655
keywords = headache, back
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