Agreement between BMI and body fat obesity definitions in a physically active population

ABSTRACT Objectives Body mass index (BMI) is a widely used proxy of body composition (BC). Concerns exist regarding possible BMI misclassification among active populations. We compared the prevalence of obesity as categorized by BMI or by skinfold estimates of body fat percentage (BF%) in a physically active population. Subjects and methods 3,822 military firefighters underwent a physical fitness evaluation including cardiorespiratory fitness (CRF) by the 12 min-Cooper test, abdominal strength by sit-up test (SUT) and body composition (BC) by BF% (as the reference), as well as BMI. Obesity was defined by BF% > 25% and BMI ≥ 30 kg/m2. Agreement was evaluated by sensitivity and specificity of BMI, positive and negative predictive values (PPV/NPV), positive and negative likelihood (LR+/LR-), receiver operating characteristic (ROC) curves and also across age, CRF and SUT subgroups. Results The prevalence of obesity estimated by BMI (13.3%) was similar to BF% (15.9%). Overall agreement was high (85.8%) and varied in different subgroups (75.3-94.5%). BMI underestimated the prevalence of obesity in all categories with high specificity (≥ 81.2%) and low sensitivity (≤ 67.0). All indices were affected by CRF, age and SUT, with better sensitivity, NPV and LR- in the less fit and older groups; and higher specificity, PPV and LR+ among the fittest and youngest groups. ROC curves showed high area under the curve (≥ 0.77) except for subjects with CRF ≥ 14 METs (= 0.46). Conclusion Both measures yielded similar obesity prevalences, with high agreement. BMI did not overestimate obesity prevalence. BMI ≥ 30 was highly specific to exclude obesity. Because of systematic under estimation, a lower BMI cut-off point might be considered in this population.

New ischemic brain lesions after carotid artery stenting.

Carotid artery stenting is associated with the risk of periprocedural stroke. Moreover, modern magnetic resonance (MR) imaging techniques have found high rates of clinically silent ischemic brain lesions on post-treatment diffusion-weighted MR imaging (DWI) scans. The clinical significance of procedure-related DWI lesions, however, is still a matter of debate. This review article considers the frequency, location and pathophysiology of new DWI lesions on post-treatment MR images and summarizes available data on their clinical significance.

Impact of protein content on proton diffusibility in intracranial cysts.

PURPOSE: The physical background of diffusion phenomena in intracranial cysts is unclear in some cases. To evaluate a potential dependency of proton diffusion on the concentration of proteins in cystic lesions we investigated the correlation of diffusion weighted imaging (DWI) and magnetization transfer ratio imaging (MTR) in intracranial cystic pathologies in vivo and in vitro with protein solutions. MATERIALS AND METHODS: 21 patients (14 male/7 female) with intracranial cystic lesions underwent preoperative MRI (1.5T) including MTR and DWI sequences. For comparison a series of samples with declining concentration of albumin was investigated in vitro with a 7T animal scanner. RESULTS: In the patients examination mean ADC values were 1.93×10-3mm2/sec and mean MTR values were 0.2. Mean ADC value of the albumin solutions was 0.22× 0-3mm2/sec and mean MTR was 0.12. ADC and MTR values showed a strong negative correlation in the patients (Spearman's rank correlation rs=-0.80, p<0.01) and a very strong negative correlation in the in vitro examinations (rs=-1.0, p<0.01). CONCLUSION: The strong negative correlation of ADC and MTR values suggest a strong influence of proteins on proton diffusion in intracranial cysts. The phenomena can be explained by macromolecules that bind nearby protons in their vicinity.

[A comparative study of cytological and histological studies of the thyroid gland]. / Vergleichende Untersuchung zytologischer und histologischer Befunde der Schilddrüse.

We compare the results of fine-needle aspiration cytology of the thyroid gland with postoperative histological findings in 533 patients with thyroidectomy operated on between 1987 and 1994. The classification of the cytological preparations followed the proposal of Weiss and Pilz [35] with the groups 0-IV. In group 0 the most frequent findings were cystic changes in multinodular goitre or malpuncture, respectively. The groups I and II contained cases with multinodular goitre, thyroiditis and follicular adenomas, but 4 carcinomas too. The group III comprised particularly follicular adenomas and carcinomas (8 cases). Both cases in group IV were carcinomas. In group III (cytologic group with suspicious findings) there were 65 cases with false positive results of the cytologic investigation resulting in a specificity of 86.4%. 4 out of 14 thyroid carcinomas could not be detected by cytologic preparations corresponding to a sensitivity of 71.4% for carcinomas. The false negative rate for thyroid carcinomas in group II was caused by regression areas in the center of the tumors (3 cases) as well as one microcarcinoma. Preoperative fine-needle aspiration cytology of the thyroid gland reduces the number of patients operated on for multinodular goitre or cold nodules especially in cases suspicious of carcinoma.

Intercellular communication, tumor promotion and non-genotoxic carcinogenesis: relationships based upon structural considerations.

An SAR model for inhibition of metabolic cooperation (iMC) was developed. The structural and physicochemical features associated with the ability to cause iMC are primarily lipophilic moieties consistent with the possibility that they represent receptor-binding ligands. There are also significant parallels between the structural descriptors associated with iMC and those associated with tumor promotion and with carcinogenesis in rodents. Overall, the present study provides structural evidence that iMC is a feature associated with the carcinogenic process.

[Primary angiosarcoma of the breast]. / Primäres Angiosarkom der Mamma.

We report on a 39 year old woman with a biopsy diagnosed angiosarcoma of the breast. Surgical treatment consisted of a modified radical mastectomy with axillary lymph node dissection (level I and II). The size of the tumor was 4.5 x 3.5 x 2.3 cm with G II grading. In addition the patient was put on postoperative chemotherapy (EC). Soft tissue sarcomas of the breast are very rare tumors (0.04 to < 1 % of all malignant breast tumors). The etiology of most of the vascular neoplasias of the breast is therapy associated such as preexisting surgery and radiotherapy. We found a primary angiosarcoma of the breast and tried to demonstrate aspects of the morphological diagnosis, prognosis and treatment of this disease.

[Immune activity and serum interleukin-2-receptor concentration in autoimmune thyroid diseases]. / Immunaktivität und Interleukin-2-Rezeptor-Konzentration im Serum bei autoimmunbedingten Schilddrüsenerkrankungen.

Serum interleukin-2 receptor (IL-2R) concentrations were compared in 55 patients with thyrotoxicosis (14 men, 41 women, mean age 43.5 +/- 17 years), 18 patients with Hashimoto's thyroiditis (5 men, 13 women, mean age 47 +/- 15 years) and 28 healthy subjects (12 men, 16 women, mean age 30 +/- 10 years). The patients with thyrotoxicosis were divided into three groups depending on the activity or stage of the disease: 17 patients with florid untreated hyperthyroidism, 23 euthyroid patients receiving treatment with antithyroid drugs and 15 patients with thyrotoxicosis in remission after completing one year's antithyroid treatment. The patients with untreated thyrotoxicosis had significantly higher IL-2R values than the euthyroid patients receiving treatment or those in remission (207 +/- 112 vs 139 +/- 66 and 91 +/- 26 U/ml, P < 0.05 and P < 0.01). The IL-2R values of patients with thyrotoxicosis in remission were, however, significantly lower than those of the 28 healthy subjects (126 +/- 34 U/l; P < 0.01) or the euthyroid patients receiving treatment (P < 0.05). The 18 patients with Hashimoto's thyroiditis had significantly lower serum IL-2R values (70 +/- 39 U/ml) than the healthy controls. These data show that the serum IL-2R level depends on the state of thyroid metabolism and on the activity phase of the thyrotoxicosis. The low serum levels of IL-2R in patients with Hashimoto's thyroiditis could signify a genetically determined decrease in IL-2R production or might be linked with the destruction of thyroid tissue by the chronic autoimmune process.

Increased serum neopterin levels in patients with Graves' disease.

Neopterin (NPT) a marker of activation of the T-lymphocyte/monocyte axis has been measured in serum of 89 patients with autoimmune thyroid disease (72 patients with Graves' disease and 17 patients with autoimmune thyroiditis) and compared to a group of 24 normal controls and 24 patients with nontoxic goitre. There was a significant correlation between NPT levels and age in the patients with nontoxic goitre (r = 0.447, p < 0.001) but not in patients with autoimmune thyroid disease. Significantly higher NPT levels were found in all patients with Graves' disease (GD) compared to age and sex matched healthy controls, and patients with nontoxic goitre (5.7 +/- 2.4 vs 4.1 +/- 1.7, and 4.0 +/- 1.5, p < 0.01). However, there was no difference in NPT levels between each group of patients with GD when subdivided in: hyperthyroid newly diagnosed GD, treated GD, GD in remission and relapse. Patients with autoimmune thyroiditis did not have abnormal NPT levels compared to age and sex matched normal controls. Neopterin serum levels were not influenced by hyperthyroidism as no significant differences in NPT levels could be found in 24 patients with hyperthyroid Graves' disease and 13 patients with toxic goitre or toxic adenoma when compared to age and sex matched euthyroid patients with Graves' disease or normal controls. Moreover, there was no significant difference in mean NPT levels 1. before and after restoration of euthyroidism in 10 patients with hyperthyroid Graves' disease and 2. before and under T3 supplementation in 18 patients with Graves' disease in remission who underwent a T3 thyroid suppression test.(ABSTRACT TRUNCATED AT 250 WORDS)

[The value of placental histology for the detection of genetically-induced abortions]. / Wertigkeit der Plazentahistologie für die Erkennung genetisch bedingter Aborte.

The majority of early spontaneous abortions is caused by genetic disorders. Chromosomal aberrations do not only imply characteristical morphologic alterations in embryo/fetus, but also in chorionic villi. Its possible to draw conclusions through the combination of a small amount of histological findings on chorionic villi to explain the kind of aneuploidy. Among 968 early spontaneous abortions 18.3% were defined as genetically caused by histological examination. 87.6% are probably trisomies, 7.3% polyploidies. 5.1% were diagnosed as complete hydatidiform moles with a diploid, androgenetic chromosome set. The value of histological examination of early spontaneous abortion tissue are discussed and it is pointed out to remaining problems. In a different percentage it is possible to establish the type of aneuploid by microscopic examination alone. Frequently there are sings to allow the conclusion there is a developmental disorder like genetic aberration.

[Clear cell hidradenoma: a rare differential diagnosis in suspected skin metastasis]. / Klarzellhidradenom: seltene Differentialdiagnose bei einem Verdacht auf Hautmetastase.

A case report is given about 55 years old female patient with a small tumor mass 2.5 cm on the left inguinal region, she underwent a Wertheim-Meigs-Operation because of cervical carcinoma stage Ib 1978, and left sided ureterolysis 1979 because of obstruction.

[The immunologic situation of the placenta and its significance for disorders in early pregnancy]. / Zur immunologischen Situation an der Plazenta und zu ihrer Bedeutung für Störungen in der Frühschwangerschaft.

Reference is made in numerous recent immunological studies to immunological mechanisms which were found to play a role in acceptance of pregnancy or habitual abortions. The most important theories likely to offer explanations for these phenomena are reviewed in some detail, including hormonal immunosuppression, immunologic-anatomic barrier at the placenta as well as blocking factors and anti-sperm antibodies. Molar pregnancy is associated with a particular immunological situation. None of the theories mentioned can be preferred, for the time being, to explain acceptance of normal pregnancy or the causes of recurrent spontaneous abortions.

[Genetic aspects of early spontaneous abortion]. / Genetische Aspekte bei frühen Spontanaborten.

Spontaneous abortions are the most frequent complications in pregnancy. Especially in early pregnancy abortions are often genetically caused. The most important role between chromosomal disorders play the Trisomy, Triploidy and X0-Monosomy. Against the background of more recent findings the frequency, origins of several genetic disorders and the morphological expression in placental tissue are discussed in this review. The chromosomal situation of hydatidiform and partial mole as well as the question for the causes of malignancy-tendence of complete moles from genetic view are also considered. The importance of the knowledge of genetic disorders to correlate the microscopic placental findings and the karyotype and to support medical consultation is referred, too.

[Computed tomographic diagnosis of rectal tumors]. / Computertomographische Diagnostik bei Rektumtumoren.

Perirectal spreading of rectal carcinoma is significant for their therapy. Moreover, possible metastasis of the regional lymph nodes and/or of the liver must be detected before therapy. For preoperative staging CT-investigations in 52 patients were performed. For the tumour stages pT1 and pT2 correct CT-staging was achieved in 60% of the cases. CT-information on lymphogenic metastases is not satisfactory, liver metastases were detected with a sensitivity of 72%. 56 patients were investigated after abdominosacral rectum ablation. In 34 cases no local recidivation was detected, but 3 cases of liver metastases were found, also one metastasis of the kidney. Of 22 patients with regional recurrences 5 had liver metastases. 3 cases of lymphogenic metastasis were found.

[Morphologic evaluation and clinical significance of papillomavirus (HPV)-associated changes in the portio vaginalis uteri]. / Morphologische Wertung und klinische Bedeutung Papillomvirus-(HPV)-assoziierter Veränderungen an der Portio vaginalis uteri.

HPV-induced changes in the portio vaginalis uteri can and have lead to misinterpretations since they frequently occur in combination with or resemble precancerous or cancerous changes. The morphological peculiarities and growth patterns of koilocytotic changes in the portio vaginalis uteri are described. Among 684 conizations performed, 169 (24.7%) were found to have features of an HPV-infection. Of these, 75.7% also had preneoplastic or neoplastic changes. Review of the cytological findings revealed that in 66.7% of the cases with histologically verified koilocytosis a false positive finding of malignancy had been recorded.

[Prognostic significance of different therapeutic procedures in stage I endometrial cancer]. / Zur prognostischen Bedeutung des differenzierten therapeutischen Vorgehens bei Endometriumkárzinomen im Stadium I.

The prognostic importance of the different lines of therapeutic management are retrospectively reviewed from 230 patients who have been primarily operated on for endometrial carcinoma stage I (FIGO). The postoperative radiation therapy taking into consideration the prognostic significance of the tumour criteria (tumour type, degree of differentiation and extent of myometrial invasion) as well as the age and the general condition of the patient would largely be individualized. 56 (24%) patients has been operated on only. There were no significant prognostic differences for vaginal and abdominal hysterectomies with bilateral salpingo-oophorectomy. Extensive operative measures have been carried out seldom and could not yet be included in the evaluation. A simultaneous gestagen administration in 39 (17%) of the cases with invasively growing carcinomas (greater than 1/3 myometrial invasion), independent from the previous therapeutic regimen, is shown not to have improved the healing results. The favourable prognosis of women mostly with lower primary risk and operated on only as opposed to postoperatively radiated ones underlines the primary prognostic significance of morphological characteristics of the tumour although no definite conclusions can be derived from the concurrent effectivity of the adjuvant radiotherapy for early tumour stages. A postoperative radiation therapy, because of its late consequences which have been observed during tumour follow up, is indicated only in those cases with unfavourable prognostic criteria.

[Histomorphologic prognostic factors in stage I endometrial cancers]. / Histomorphologische Prognosefaktoren bei Endometriumkarzinomen im Stadium I.

The prognostic significance of qualitative and quantitative morphological tumour characteristics for endometrial carcinoma of stage I (FIGO) is to be ascertained from the available 230 operation specimens from 1976 to 1983 (inclusive). The fundamental objective is to design a standardized and reliably reproducible histological technique. By utilizing a multi-dimensional statistical comparison (multiple regression analysis), the maximal relative extent of the endometrial invasion as a determinant prognostic feature shall also be ascertained. Furthermore, the degree of differentiation (Grading) and tumour type (Typing) influence the survival rate whereas the maximal superficial extension of the carcinoma has no significant prognostic importance.

Transplantation of stem cells of embryonic liver in a patient with severe combined immunodeficiency.

A patient had severe combined immunodeficiency syndrome and X-chromosomal recessive heredity. Since the parents and siblings were not suitable as HLA-compatible bone marrow donors, stem cells from embryonic liver were transplanted intravenously in 3 stages (6 X 10(6); 3.5 X 10(6), and 9 X 10(7]. Transplantation was tolerated well; there were no signs of a graft-versus-host reaction. Examination of the immunological condition after transplantation showed evidence of T-cell reconstitution, immunohistochemistry revealed beginning immune globulin production. The child died at the age of 5 months due to respiratory failure.