Ductus diverticulum aneurysm and coronary stenosis: repair using circulatory arrest.

The case of a 68-year-old man with advanced symptomatic coronary artery disease and large aneurysm of the diverticulum of the ductus arteriosus is presented. Both the coronary artery disease and the aneurysm were successfully repaired at the same time via median sternotomy using cardiopulmonary bypass and a brief period of profound hypothermic circulatory arrest. To our knowledge, this is the 27th reported case of such an aneurysm in an adult.

Serial transvaginal ultrasound scans and beta-human chorionic gonadotropin levels in early singleton and multiple pregnancies.

OBJECTIVE: To determine if serum beta-hCG levels are higher in multiple gestation than in singleton pregnancy at the time of intrauterine sac visualization and the first appearance of fetal heart activity as documented by serial transvaginal ultrasound (US). DESIGN: Prospective analysis of serial transvaginal US findings in 19 pregnancies correlated with serum hCG levels during early gestation. SETTING: Reproductive endocrinology division of the University of Arkansas for Medical Sciences, Little Rock, Arkansas. PATIENTS: Nineteen infertility patients were studied after conceiving. Thirteen underwent IVF or GIFT, 4 received hMG therapy, 1 was treated with clomiphene citrate, and 1 pregnancy followed spontaneous ovulation. INTERVENTIONS: Transvaginal US and hCG levels were obtained every Monday, Wednesday, and Friday from 20 to 22 days after ovulation until the appearance of fetal heart activity. RESULTS: Initial sac visualization occurred at lower serum hCG levels in singleton versus multiple pregnancies (2,180 +/- 1,170 versus 7,028 +/- 4,280 mIU/mL, mean +/- SD). Sacs were always seen when the serum hCG level (mIU/mL) was > or = 1,161 in singleton, 1,556 in twin, 3,372 in triplet, and 9,399 in quadruplet pregnancies. CONCLUSION: Failure to observe an intrauterine sac by transvaginal US in the presence of serum hCG levels in the 1,000 to 2,000 mIU/mL range is not pathognomonic for an ectopic gestation. Clinical symptomatology, risk of multiple pregnancies, and gestational age must also be considered.

Safety and efficacy evaluation of a fitness club weight-loss program.

It is well documented that excess weight is a major risk factor for many chronic diseases, and, despite considerable expenditure of time, money, and effort, little or no progress has been made in reversing the trend toward increased weight. Although fitness and athletic clubs offer one potential for tackling this problem, few provide information about the efficacy of their weight-loss programs. There is general agreement that an efficacious weight-loss program should reduce body fat, maintain or increase fat-free mass (FFM), and lower total and low-density lipoprotein (LDL) cholesterol. This study was designed to compare changes in body composition and serum cholesterol associated with participation in a fitness club program (EXP) versus changes that occurred when participants pursued a program of their own choosing (CTL). The EXP group participated in the Bally's Total Fitness program that included exercise, behavior modification, and dietary supplements. Although only small differences in body weight were noted between groups, participation in the EXP program led to significant (sixfold) reductions in fat mass, increases in FFM, and improvements in body composition. These data highlight the importance of using measures of body composition rather than scale weight in evaluating the efficacy of weight-loss programs. Additionally, the EXP group achieved significant reductions in total and LDL cholesterol, particularly among individuals with baseline total cholesterol levels above 200 micrograms/dL. It is also worth noting that respective cholesterol levels were maintained for participants with total cholesterol levels between 150 and 199 micrograms/dL and were increased for those with levels at or below 150 micrograms/dL.