Since 1980 we have performed the identical Greenville gastric bypass (GGB) procedure on 479 morbidly obese patients with an acceptable morbidity and a mortality rate of 1.2%. The weight loss in the series was well maintained over the follow-up period of 10 y. The GGB can control non-insulin-dependent diabetes mellitus (NIDDM) in most patients. The group of 479 patients included 101 (21%) with NIDDM and another 62 (13%) who were glucose impaired. Of these 163 individuals, 141 reverted to normal and only 22 (5%) remained with inadequate control of their carbohydrate metabolism. Those patients who were older or whose diabetes was of longer duration were less likely to revert to normal values. The gastric bypass operation is an effective approach for the treatment of morbid obesity. Along with its control of weight, the operation also controls the hyperglycemia, hyperinsulinemia, and insulin resistance of the majority of patients with either glucose impairment or frank NIDDM.
Vocal tract acoustic resonance was evaluated in a group of 10 untreated adult males with diagnosed obstructive sleep apnea (OSA) syndrome compared to 10 non-OSA adult males. Subjects were required to prolong the vowels /i/, /u/ and /a/, which were subsequently submitted to acoustic analysis of formant frequency and formant bandwidth. Results of the formant frequency analysis indicated lower formant values among the OSA group compared to the non-OSA group, for each vowel type. The lower formant frequencies among the OSA group were attributed to greater vocal tract length compared to non-OSA speakers. The corresponding formant bandwidths for each vowel produced by the OSA group were significantly wider compared to the non-OSA group. The wide formant bandwidths were interpreted to reflect significantly greater vocal tract damping in the OSA subjects, resulting from either excessive vocal tract tissue compliance or general size differences in the length and cross-sectional area of the vocal tract. Discussion focuses on the potential applications of acoustic analysis to aid in the diagnosis and follow-up treatment of OSA.
Passive elevation of the body core temperature (Tc) induces rapid, shallow breathing in resting man. We wondered if exercise-induced Tc elevation would also lead to decreased tidal volume (VT) and increased breathing frequency (f) during exercise. To investigate this question, 10 subjects each performed 47 min of cycle ergometer exercise at 50--60% of the maximal aerobic capacity, with the work rate adjusted to maintain ventilation (VE) constant. This long ride raised mean Tc (rectal) 0.8 degrees C. Before and immediately after the long ride, ranges of VE and VT were obtained from short 6-min rides that progressed from unloaded pedaling to the anaerobic threshold. At the constant VE of the long ride, f rose and VT fell as Tc rose (P less than 0.05). The fall in VT was associated with a fall in inspiratory time (TI); drive (VT/TI) and timing (TI/Ttot)components of VE were unchanged. These effects were consistent over the entire range of VE obtained from the short 6-min rides. Passive heating in warm water to produce equal Tc elevation in the same subjects yielded similar exercise breathing-pattern changes. These findings suggest that increased Tc mediates the VT fall during prolonged exercise, possibly through stimulation of the central respiratory pacemaker.
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