Pregnancy denial: a complex symptom with life context as a trigger? A prospective case-control study.

OBJECTIVE: To identify risk factors for a woman to experience pregnancy denial. DESIGN, SETTING AND POPULATION: A French multicentric prospective case-control study with 71 mother-infant dyads having experienced a pregnancy denial versus a control group of 71 dyads. METHODS: Data were collected in the week after delivery using an observational leaflet and two psychiatric scales (MINI and QSSP). MAIN OUTCOME MEASURES: Statistically significant differences between the two groups regarding social, demographic, medical and psychiatric data. RESULTS: Not being in a stable relationship (odds ratio [OR] 17.18, 95% CI 3.37-87.60]; P < 0.0001), not having a high school diploma (OR 1.11, 95% CI 1.04-1.38]; P < 0.0001) and having a psychiatric history (OR 6.33, 95% CI 1.62-24.76; P = 0.0002) were risk factors to experience pregnancy denial, whereas being older was a protective factor (OR 0.86, 95% CI 0.79-0.93; P = 0.0054) (logistic regression, Wald 95% CI). Other risk factors included late declarations of pregnancy history and past pregnancy denials (case n = 7, 9.7% versus 0% in controls; P = 0.01), past pregnancy denials in the family (case n = 13, 18% versus control n = 4, 5.6%; P = 0.03), and use of a contraceptive method (75% for cases versus 7% in control; P < 0.0001), primarily an oral contraceptive (75%). CONCLUSION: Family or personal history of pregnancy denial should be part of the systematic anamnesis during the first visit of a patient of child-bearing age. Further, our study points out that life context (young age, single status, socio-economic precarity, pill-based contraception) could be a trigger for pregnancy denial in certain women. TWEETABLE ABSTRACT: Life context can be a trigger for pregnancy denial.

Evaluation of the Tekscan F-SCAN system for measurement of the kicking force in horses.

INTRODUCTION: The incidence of fractures after a kick, coupled with marked soft tissue trauma at the site of injury, suggests that the force of a kick from the hind limb of a horse is enormous. The goal of this study was to measure this force and to investigate whether the Tekscan F-SCAN in-shoe pressure measuring system is suitable for quantification of the impact strength of a kick from a horse. The system was tested in 6 horses that had undergone clinical examination and gait analysis. The sensor-shoe combination was attached to each hind foot and the horse was stimulated to kick against a wall. The F-SCAN system measured the maximum vertical and horizontal force (N), the main contact area (cm2) of the sole with the floor (stance phase limb) or wall (kicking limb) and the duration (sec) that the sole was in contact with the floor or wall. In addition, each kicking event was recorded with a video camera for subjective evaluation. The mean kicking force measured was lower than that recorded in horses trotting on a treadmill, where the forces exerted on one limb were similar to the horse's body weight. The results of this study indicate that the Tekscan F-SCAN system is not ideally suited to measure the force of a kick of a horse in vivo.

INTRODUCTION: La fréquence des fractures et les importants dégâts aux tissus mous consécutifs à des coups de pieds laissent à penser que la force de frappe transmise à cette occasion doit être très importante. Le but du présent travail était de mesurer cette force et de voir si le système F-Scan Tekscan est adapté pour quantifier la force de frappe d'un cheval. Après un examen clinique et orthopédique, le système a été utilisé sur 6 chevaux, en incluant le senseur dans une hipposandale et en stimulant ensuite le cheval pour qu'il rue contre une paroi. Le système F-Scan a mesuré lors de chaque coup de pied la force maximale verticale respectivement horizontale (N), la surface de contact (cm2) de la sole avec le sol (membre à l'appui) ou avec la paroi (membre donnant le coup) ainsi que la durée de contact avec le sol respectivement avec la paroi. Chaque coup de pied a simultanément été enregistré sur vidéo et le force du coup a été estimée subjectivement. Les forces mesurées étaient toutefois plus faibles que celles enregistrées chez des chevaux au trot sur un tapis roulant dans une étude précédente. Les forces exercées sur les membres étaient globalement égales au poids du cheval. Les résultats de notre étude laissent à penser que le système F-Scan Tekscan n'est pas idéal pour mesurer la force de frappe d'un cheval.

Identification of sperm head proteins involved in zona pellucida binding.

STUDY QUESTION: Which human sperm proteins interact with zona pellucida (ZP) glycoproteins, ZPA/2, ZPB/4 and ZPC/3? SUMMARY ANSWER: Co-precipitation experiments with recombinant human ZP (rhZP) coated beads demonstrated interactions with various proteins, including glutathione S-transferase M3 (GSTM) with ZPB/4 and voltage-dependent anion channel 2 (VDAC2) with ZPA/2 and ZPC/3. WHAT IS KNOWN ALREADY: Regarding sperm-ZP binding, several target spot/proteins have been detected in several species, but not all have been characterized. The limit of these studies was that a mixture of the different ZP glycoproteins was used and did not allow the identification of the specific ZP glycoprotein (ZPA/2, ZPC/3 or ZPB/4) involved in the interaction with the sperm proteins. STUDY DESIGN, SIZE, DURATION: To identify the human sperm proteins interacting with the oocyte ZP, we combined two approaches: immunoblot of human spermatozoa targeted by antisperm antibodies (ASAs) from infertile men and far western blot of human sperm proteins overlayd by each of the rhZP proteins. MATERIALS, SETTING, METHODS: We used rhZP expressed in Chinese hamster ovary (CHO) cells and ASA eluted from infertile patients undergoing IVF failure. Sperm proteins separated by two-dimensional (2D) electrophoresis recognized by both sperm-eluted ASAs from infertile patients and rhZP were identified by mass spectrometry (MALDI-MS/MS). Some of these proteins were further validated by co-precipitation experiments with rhZP and functional zona binding tests. MAIN RESULTS AND THE ROLE OF CHANCE: We identified proteins that are glycolytic enzymes such as pyruvate kinase 3, enolase 1, glyceraldehyde-3-phosphate dehydrogenase, aldolase A, triosephosphate isomerase, detoxification enzymes such as GSTM or phospholipid hydroperoxide glutathione peroxidase, ion channels such as VDAC2 and structural proteins such as outer dense fibre 2. Several of the proteins were localized on the sperm head. However, these proteins have also been described to exert other functions in the flagellum. Co-precipitation experiments with rhZP-coated beads confirmed the direct interaction of GSTM with ZP4 and of VDAC2 with ZP2 and ZP3. LIMITATIONS, REASONS FOR CAUTION: We used recombinant ZP in place of native ZP. Thus, the post-translational modifications of the proteins, such as glycosylations, can be different and can influence their function. However, CHO cell-expressed rhZP are functional, e.g. can bind human spermatozoa and induce the acrosome reaction. Moreover, the identification of relevant proteins was limited by the need for sufficient amounts of proteins on the preparative 2D-gel to be subsequently analysed in MALDI-TOF MS/MS. WIDER IMPLICATIONS OF THE FINDINGS: Our results bring new insights on the ability of sperm proteins to exert several functions depending on their sub-cellular localization, either the head or flagellum. Their multiple roles suggest that these sperm proteins are multifaceted or moonlighting proteins. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by the grant ReproRio (CNRS, INRA, INSERM and CEA) and the Société d'Andrologie de Langue Française. TRIAL REGISTRATION NUMBER: Not applicable.

Treatment of type 2 and 4 olecranon fractures with locking compression plate osteosynthesis in horses: a prospective study (2002-2008).

This prospective study describes a series of 18 olecranon fractures in 16 horses that were treated with locking compression plates (LCP). Twelve of the 18 fractures were simple (type 2), whereas six were comminuted (type 4). Six fractures were open and 12 were closed. Each horse underwent LCP osteosynthesis consisting of open reduction and application of one or two LCP. Complete fracture healing was achieved in 13 horses. Three horses had to be euthanatized: two because of severe infection and one because of a comminuted radial fracture 11 days after fixation of the olecranon fracture. Complications encountered after discharge of the horses from the Equine Hospital at the Vetsuisse Faculty (University of Zurich) included implant infection (n=2) and lameness (n=3), which were successfully treated with implant removal. Despite being easier to use, LCP osteosynthesis resulted in a clinical outcome similar to DCP osteosynthesis.

[Complications during exercise testing]. / Komplikationen bei der Ergometrie.

Exercise electrocardiogram forms the basis for diagnosis of ischemia in coronary heart disease. Blood pressure behavior, physical fitness, training heart rate and possible cardiac arrhythmias can additionally be assessed using bicycle ergometry or treadmill testing. When the indications for and contraindications to exercise testing (either bicycle ergometry or treadmill testing) are closely observed, serious complications are rare. However, it is important that the treating physician is aware of and able to recognize possible complications. The present article discusses possible cardiovascular complications and their incidence.

Alpha-Gal specific IgG immune response after implantation of bioprostheses.

BACKGROUND: We have previously shown that the alpha-Gal (Galalpha1.3-Galbeta1-4GlcNAc-R) epitope is a relevant xenoantigen present on bioprostheses utilized in cardiac surgery and elicits an alpha-Gal specific IgM immune response. We sought to investigate whether that immune response continues after valve implantation. MATERIALS AND METHODS: We collected plasma samples from patients who underwent bioprosthesis implantation (n = 19) or mechanical valve replacement (n = 8), respectively, prior to, at 10 days and at 3 months after cardiac surgery. ELISA was utilized to quantify alpha-Gal specific IgG and IgG subclasses. 3 bioprosthetic tissue samples were obtained from patients who had to undergo re-operation within 1 week (n = 1) or at 12-15 months (n = 2) after the initial operation. We utilized confocal laser scanning microscopy (CLSM) to detect the presence of alpha-Gal epitopes (IB4) and cell nuclei (DAPI). RESULTS: alpha-Gal specific IgG was significantly increased 3 months after implantation of bioprostheses compared to preoperative values (p < 0.001) and was significantly higher than alpha-Gal specific IgG levels of the control group (p < 0.05). IgG3 was the major subclass directed against alpha-Gal (p < 0.05, pre- vs. postoperative values). In CLSM analysis we demonstrated that bioprostheses explanted 1 week after implantation contained IB4/DAPI positive cells within the collagen matrix. In contrast, in patients who underwent reoperation after 12 months, porcine tissue showed a complete lack of IB4/DAPI. CONCLUSION: Our results indicate that the implantation of bioprostheses elicits a specific humoral immune response against alpha-Gal bearing cells compared to controls within 3 months after cardiac surgery. The complete absence of IB4/DAPI positive structures 12 months after implantation indicates a specific degradation of alpha-Gal bearing cells through previous exposure to the human blood circuit.

Surgical management of complete diaphyseal third metacarpal and metatarsal bone fractures: clinical outcome in 10 mature horses and 11 foals.

REASONS FOR PERFORMING STUDY: Osteosynthesis of third metacarpal (McIII) and third metatarsal (MtIII) bone fractures in horses is a surgical challenge and complications surrounding the repair are common. Retrospective studies evaluating surgical repair, complications and outcome are necessary to increase knowledge and improve success of long bone fracture repair in the horse. OBJECTIVES: To evaluate clinical findings, surgical repair, post operative complications and outcome of 10 mature horses and 11 foals with McIII or MtIII fractures that were treated with open reduction and internal fixation (ORIF). METHODS: Medical records were reviewed and follow-up information obtained by means of radiographs and/or telephone questionnaire. RESULTS: Survival was achieved in 62% of the horses (3 mature/10 foals). On long-term evaluation (> 6 months) 11 horses (2 mature/9 foals) were fit for their intended activity, one mature horse had a chronic low grade lameness, and one foal was lost to follow-up because it was sold. The main fracture types were simple transverse (333%) or simple oblique (28.6%) and 71.4% of the fractures were open, 3 Type I (one mature/2 foals) and 12 type II (7 mature/5 foals). The preoperative assessment revealed inadequate emergency treatment in 10 horses (5 mature/5 foals; 47.6%). Survival rate of horses with open fractures was 12.5% (1/8) in mature and 85.7% (6/7) in foals. Post operative incisional infection (4 mature, 3 foals) was only managed successfully in 2 foals. Fracture instability related to inadequate fracture fixation technique occurred in 4 horses (all mature) and was always associated with unsuccessful outcome. CONCLUSIONS: Age, bodyweight and infection are strongly associated with outcome in treatment of complete McIII/MtIII fractures. CLINICAL RELEVANCE: Rigid fixation using plates and screws can be successful in treatment of closed or open, complete diaphyseal McIII/MtIII fractures in mature horses and foals. Instable fixation, infection and a bodyweight > 320 kg are major risk factors for unsuccessful outcome.

Locking compression plate osteosynthesis of complicated mandibular fractures in six horses.

Complicated mandibular fractures were recognised in one foal, one pony and four horses. The foal was two months old while the adult animals ranged in age from 12 to 24 years. Three horses had a unilateral horizontal ramus fracture. Two fractures were open and one was closed. Comminution was present in one of these patients while the other two horses had marked displacement of the fragments. Two suffered from comminuted fractures of the horizontal and vertical ramus of the mandible. One of these patients had open and infected fractures. One foal had a bilateral horizontal ramus fracture with marked periosteal 'new bone' formation and malalignement which required corrective osteotomy. Each horse underwent locking compression plate (LCP) osteosynthesis consisting of open fracture reduction and application of one to three 4.5/5.0 mm LCP at the ventral, lateral or caudal aspect of the mandible under fluoroscopic control. Two 3.5 mm LCP were used in the foal. Plate fixation was supported by application of a cerclage wire construct between the incisor and premolar teeth in most patients. Complete fracture healing, with an excellent functional and cosmetic outcome, was achieved in all of the patients. Complications encountered included seroma formation, screw and wire breakage, as well as implant and apical tooth root infections. The LCP was removed after fracture healing had occurred in four patients.

Cardiac rupture in embolic myocardial infarction after implantation of a valved aortic conduit.

We report a case of an apical myocardial infarction complicated by left ventricular wall rupture due to coronary artery embolism four years after surgery of an acute type A dissection of an aortic aneurysm with implantation of a valved aortic conduit.

[Frequency of diseases and injuries in the Swiss horse population]. / Häufigkeiten von Erkrankungen und Verletzungen in der Schweizer Pferdepopulation.

Through a written questionnaire, which was sent to a representatively distributed and randomly selected sample of Swiss horse owners, data of 2912 horses and ponies were acquired to extrapolate prevalence data of health disorders. General questions about the horse and associated factors of housing and use, as well as questions about the current health status and the occurrence of diseases and injuries had been asked. 718 horses (24.7% of the sample) had been examined by a veterinarian within the 12 months prior to the survey. Orthopaedic and traumatic disorders (41.5%) had the largest proportion, followed by gastrointestinal--(27.1%) and respiratory (14.0%) diseases. Half of the lameness cases occurred as a direct consequence of a injury. The injuries were associated with pasture/paddock (38.1%), kicking and biting (21.6%), boxstall (7.8%), terrain and hacking (13.4%), training (3.5%), competition (3.5%), transportation (3.0%) or other circumstances (9.1%). A change in feeding management up to 4 weeks before development of a colic episode occurred in 26.5% of all colic cases. In 13.8% of all respiratory cases the same disease was diagnosed in other horses in the same barn. 8.1% of all cases had to be treated surgically, 6.7% required hospitalization for several days. Information about diagnostic or therapeutic procedures was related to specific disease categories. In 25.6% of all cases diagnosed by a veterinarian alternative therapeutic methods were used either in addition to traditional medicine or exclusively.

Fracture configurations of the equine radius and tibia after a simulated kick.

The objective of this postmortem study was to determine the fracture configurations of the equine radius and tibia after a simulated kick. Fracture configurations of 35 radii and 36 tibiae from 19 adult horses were evaluated after a simulated kick in an experimental ex-vivo study. The bones were dissected, the proximal and distal ends were embedded in resin, fixed horizontally and preloaded in compression, and a steel impactor, designed to simulate a shod equine hoof, was dropped from a height of three to six metres onto the diaphysis. The experiments were filmed with a high-speed camera (30,000 pictures/second). The bones were then photographed and radiographed using a C-arm based 3D imaging device. A software programme (Osirix) was used to reconstruct the fissured and fractured bones three-dimensionally on a computer screen for assessment of the fracture configuration and fissure lines. Incomplete fractures occurred in 26 bones and complete fractures in 42. The complete fractures included 22 butterfly and 20 simple fractures; the latter included 17 oblique, two transverse and one longitudinal fracture. Additional longitudinal fissures occurred in 98% of the fractures. The butterfly fragment was always located on the side opposite the impact. There was a significant correlation between the type of bone and the fracture configuration: butterfly and oblique fractures occurred more frequently in the tibia, and incomplete fractures occurred more frequently in the radius. The data collected can be used to optimize evaluation of fractures and fissures caused by a kick and thereby improve surgical stabilization.

Does surface anodisation of titanium implants change osseointegration and make their extraction from bone any easier?

OBJECTIVES: Titanium implants have a tendency for high bone-implant bonding, and, in comparison to stainless steel implants are more difficult to remove. The current study was carried out to evaluate, i) the release strength of three selected anodized titanium surfaces with increased nanohardness and low roughness, and ii) bone-implant bonding in vivo. These modified surfaces were intended to give improved anchorage while facilitating easier removal of temporary implants. MATERIAL AND METHODS: The new surfaces were referenced to a stainless steel implant and a standard titanium implant surface (TiMAX). In a sheep limb model, healing period was 3 months. Bone-implant bonding was evaluated either biomechanically or histologically. RESULTS: The new surface anodized screws demonstrated similar or slightly higher bone-implant-contact (BIC) and torque release forces than the titanium reference. The BIC of the stainless steel implants was significant lower than two of the anodized surfaces (p = 0.04), but differences between stainless steel and all titanium implants in torque release forces were not significant (p = 0.06). CONCLUSION: The new anodized titanium surfaces showed good bone-implant bonding despite a smooth surface and increased nanohardness. However, they failed to facilitate implant removal at 3 months.

[Do hoof cracks represent a superficial hoof-problem?]. / Sind die Hornspalten ein oberflächliches Hufproblem?

Fifty-four horses with hoof cracks were referred to the Equine Hospital of the University of Zurich, for treatment. The horses were admitted because of lameness or other symptoms caused by the cracks. Deep or complicated quarter cracks were the most common type of cracks diagnosed. Poor conformation and abnormal hoof shape were the most important causes of hoof crack development, whereas injury to the coronary band was a less frequently encountered cause. Effective treatment of this problem includes corrective shoeing, removing horn from the weight-bearing surface as well as from the crack with a Dremel tool and immobilization of the borders of the crack. However, even with such a therapy, the recurrence rate of hoof cracks was with 20% very high.

Treatment of chronic proximal suspensory desmitis in horses using focused electrohydraulic shockwave therapy.

The objective of the present clinical report was to investigate the short- and long-term outcomes of chronic proximal suspensory desmitis (PSD) treated with Extracorporeal Shockwave Treatment (ESWT). Fifty-two horses with chronic PSD in the forelimb (34 cases) or hindlimb (22 cases) were included in the study. Three horses had lesions in both hindlimbs and one in both forelimbs. The origin of the suspensory ligament was treated every three weeks for a total of three treatments using 2000 impulses applied by a focused ESWT device (Equitron) at an energy flux density of 0.15 mJ/ mm2. This treatment regime was followed by box rest and a controlled exercise program of 12 weeks duration. The horses were assessed 3, 6, 12, 24 weeks and one year after the first treatment. Of the 34 cases with forelimb PSD, 21 (61.8%) had returned to full work by six months after diagnosis and 19 cases (55.9%) were still in full work one year after ESWT. Of the 22 horses with hindlimb PSD, 9 (40.9%) had returned to full work by six months and 4 (18.2%) were still in full work one year after diagnosis. There was no association (chi-square test) between the outcome and the severity of the initial ultrasonographic and/or radiographic findings. Compared with the results of other clinical studies, these findings suggest that in horses with PSD of fore- and hindlimb, the prognosis for returning to full work six months after diagnosis can be improved when ESWT and a controlled exercise program are used. However, a high rate of recurrence occurred in the hindlimb despite treatment.

[The art of horseshoeing--between empiricism and science]. / Die Kunst des Hufbeschlags--zwischen Empirie und Wissenschaft.

To correctly shoe a horse requires the farriers to have a good working knowledge of postural anomalies and movement patterns, as well as of the different concepts of horseshoeing and to be able to apply the appropriate technique to every individual horse they shoe. The correct technique for specific problem cases is frequently a subject of debate amongst specialists and many theories would benefit from objective gait analyses. The case study presented examines the influence of different shoeing conditions on selected gait analysis parameters. The measurements were conducted on a Warmblood mare: (A) shod with long toes, (B) properly trimmed without shoes, (C) conventionally shod with rolled toes and finally (D) shod using the 4-point technique. Data on force-, time- and distance parameters were recorded using an instrumented treadmill. First contact and breakover of the hooves were documented using high-speed videography. A long toe resulted in a prolongation of the breakover time and, therefore, in a prolongation of the second half of the stance phase. Additionally, the prolonged stance duration associated with an unaltered force impulse, led to decreased force peaks. It was possible to objectively record differences between the trimmed, unshod foot, the shod long-toe and the shod rolled toe configurations. The differences between the rolled toe and the 4 point shoe however, were minimal. Gait analysis is a technique well suited for objective evaluation of different shoeing techniques under standardised conditions.

Mosaicplasty with photooxidized, mushroom shaped, bovine, osteochondral xenografts in experimental sheep.

The goal was to study the performance of mushroom shaped, photooxidized, osteochondral grafts in mosaicplasty focusing on graft stability and survival. Mushroom shaped, photooxidized grafts (6 mm for the cartilaginous head of the mushroom, 3 mm for the stem) were implanted in the medial femoral condyle of 10 sheep. Four transplants were inserted per condyle in an overlapping fashion using the pressfit technique (n=40 grafts in 10 condyles). The grafts were followed for 6 and 12 months. Semi-quantitative evaluation of graft performance was performed using a validated score system. All grafts were mechanically stable at 6 and 12 months with one exception, where the mushroom head broke off. The formation of cystic lesions in the subchondral bone area was minimal. Repopulation of the old photooxidized cartilage was noticed with cells invading the matrix from the subchondral bone area and also from the pannus on the surface. Fusion between host and graft cartilage was observed in some of the grafts at 12 months, while remodeling of the calcified cartilage zone and tidemark was noticed in all grafts. Results scored significantly better for the 6 months compared to the 12 months group if cartilage surface integrity was compared (p<0.05). In all other variables no significant differences were found between groups. Despite moderate graft recession in the 12 months group partial fusion of grafts and functional results were satisfactory. The photooxidized mushroom shaped osteochondral transplants may be a suitable type of graft for functional results in cartilage resurfacing if stable anchorage of the grafts can be achieved.

Organization and structure of the Methanococcus transcriptional unit homologous to the Escherichia coli "spectinomycin operon". Implications for the evolutionary relationship of 70 S and 80 S ribosomes.

By means of an immunological approach and a subsequent chromosome-walking strategy a chromosomal region encoding ribosomal proteins in the archaebacterium Methanococcus vannielii was cloned. The determination of the nucleotide sequence of the 7.8 x 10(3) base DNA fragment revealed the existence of 14 putative ribosomal protein genes and two unidentified open reading frames. They are organized in a transcriptional unit that is very similar to the Escherichia coli "spectinomycin operon" in respect of both gene composition and gene order. The Methanococcus transcriptional unit contains, in addition to those genes whose products have a homologue in the E. coli operon, three genes whose products share sequence similarity with eukaryotic 80 S but not with eubacterial ribosomal proteins. The Methanococcus ribosomal proteins almost exclusively exhibit a higher sequence similarity to eukaryotic 80 S ribosomal proteins than to those of eubacteria and many of them have a size intermediate between those of their eukaryotic and eubacterial homologues. These results are discussed in terms of a hypothesis that implies that the recent eubacterial ribosome developed by a "minimization" process from a more complex organelle and that the archaebacterial ribosome has maintained features of this ancestor.

Chronic total occlusion--a definite state?

Successful recanalisation of a chronic coronary occlusion may result in survival advantage. This report describes a 61-year-old man with an initially chronic occluded right coronary artery. A follow-up angiography 2 years later revealed a spontaneous recanalisation.

Catecholamine therapy inducing dynamic left ventricular outflow tract obstruction.

Hypertrophic obstructive cardiomyopathy with significant hypertrophy of the basal septum is the most frequently reported cause of left ventricular outflow tract (LVOT) obstruction. Additionally, other conditions such as dehydration, sepsis, vasodilatation, or mitral valve repair have been associated with LVOT obstruction. In this report, we present a case of a patient without hypertrophy who developed severe dynamic left ventricular outflow tract obstruction during catecholamine stimulation for shock that complicated severe pancreatitis. The present case serves as a reminder that hypovolemia together with a hyperdynamic state resulting from catecholamine administration may result in the development of dynamic LVOT obstruction even if baseline cardiac evaluation is unremarkable. Early detection and intensive efforts to reverse the underlying conditions, including cessation of catecholamine therapy and correction of hypovolemia are essential.

Obesity, body fat and coronary atherosclerosis.

BACKGROUND: Recent prospective studies have provided compelling evidence that obesity is a risk factor for the occurrence of clinical coronary events. However, the link between angiographically determined coronary atherosclerosis and obesity still remains controversial. We conducted this cross-sectional study in a clinical setting to investigate the relation of the obesity and body fat (BF) with angiographically defined coronary atherosclerosis. PATIENTS AND METHODS: Six hundred and seventy-three men (median age 64 years) and four hundred and twenty-eight women (median age 69 years) who underwent coronary angiography for suspected or known coronary heart disease were analyzed. The body mass index (BMI) and the BF were used as main exposure variables, and either the presence of significant (> or =50%) coronary diameter stenosis or a coronary artery disease severity score were defined as outcome variables, in a sex-specific logistic regression analysis. RESULTS: Among male patients, BF was slightly higher with increasing number of vessels involved (adjusted P for trend <0.05). In contrast, BMI showed no association with presence and severity of coronary artery disease (CAD). The odds ratios (ORs) for the presence of significant stenosis across quartiles of BMI were 1.0 (reference), 0.9, 1.1 and 0.7 (adjusted P for trend 0.61). This result did not differ between younger and older men. Among females, however, both BF and BMI were not significantly associated with an increasing number of vessels involved. CONCLUSION: These results suggested that BF may be predictive of an increasing number of coronary vessels involved among male patients, but not among female patients. This study failed to detect a positive association of presence and severity of CAD with BMI.