Obese Female Patients Research Articles

Metabolic observations during the treatment of obese patients by periods of total starvation

Ten very obese female patients were treated by periods of total starvation lasting 10 days each. In the interval between these starvation periods, a diet of 600 calories was given. Twenty-one periods were completed, 6 patients went through 3 periods each. The fasting was generally well tolerated; with the appearance of ketone bodies in the urine the feeling of hunger diminished. The average weight loss during total starvation was 447 Gm./day ranging from 290 to 600 Gm. Nitrogen excretion was on the average 4.15 Gm./day (2.6–7.2). There was no significant decrease in BMR neither a lowering of body temperature. During the third starvation period weight loss was less than during the other two, but the BMR did not decrease. There were no changes in serum electrolytes, HCO 3-, pH, urea, creatinine or serum proteins. The excretion of 17-OHCS dropped significantly but remained within the normal range. The excretion of 17-KS dropped to subnormal values. Plasma FFA were elevated at the start of the experiment. Generally there was some rise from the first to the seventh day of the starvation periods. In the patients who completed 3 periods the FFA values were lower during the third than during the first period. Serum cholesterol, total fat and phospholipids did not show significant changes. The blood sugar values showed some decrease during starvation which was statistically not significant. The implications of these findings are discussed. We are of the opinion that our patients did not exhibit signs of a disturbance in fat mobilization.

Obstruction of the alimentary tract from gallstones

1. 1. In a consecutive series of 130 cases of acute intestinal obstruction gallstones were responsible in four cases. 2. 2. During the same period of observation a fifth case with intermittent pyloric obstruction from a large intragastric gallstone was encountered. 3. 3. There is an antecedent history of gall-bladder disease in about 50 per cent of the cases. 4. 4. The usual clinical picture is that of an elderly, obese female patient with intermittent partial intestinal obstruction, ultimately becoming complete. 5. 5. A preoperative diagnosis of the type of obstruction is rarely made. The stones are rarely radiopaque and x-ray assists only through demonstrating intestinal obstruction with occasionally the presence of air or barium in the extrahepatic biliary system. 6. 6. The recorded mortality in the group of cases is unduly high, being the result of the age and obesity of the patients, delayed diagnosis and too extensive surgery. 7. 7. In our five reported cases there was no mortality, obstructing stones being successfully removed from the ileum in three instances, the sigmoid in one and the stomach in one. 8. 8. Gallstone obstruction should be suspected in elderly obese patients with a previous history of gallbladder disease who develop a picture of progressive partial intestinal obstruction.

BENZEDRINE SULFATE IN OBESITY

THE past few years benzedrine sulfate (amphetamine sulfate) has been widely used in various branches of medicine. Among the side-efFects attributed to it, loss of weight has been frequently mentioned. This loss may be un-desirable, particularly in mental patients already underweight (1-4), but it is usually followed by a rapid gain when therapy is discontinued. Moreover, loss is most fre-quent and most pronounced in obese patients (4-7). Lesses and Myerson (8) reported favorably on the clinical use of benzedrine sulfate as an aid in weight reduction. We have been using the drug for the same pur-pose at Bellevue Hospital1 since May, 1937. We give here the results of our observa-tions. Twelve of the patients in our series were more than 50% overweight (some even more than 100%), and there were 5 between 40% and 50%. We first administered benzedrine sulfate to 13 obese female patients who had already been under our care for periods ranging from 4 to 71 weeks, with an average of 31.5 weeks.