Thiazolidinedione response in familial lipodystrophy patients with LMNA mutations: a case series.

Type 2 familial partial lipodystrophy (FPLD2) patients show impaired glucose and lipid metabolism resulting from lipodystrophic 'lipid pressure' and an intrinsic defect in skeletal muscle metabolism. Since mutated lamin A may interfere with peroxisome proliferator activator gamma (PPARγ) expression, we hypothesized that PPARγ stimulation improves fat distribution and metabolic abnormalities in these patients. 5 nondiabetic FPLD2 patients were treated with rosiglitazone over 12 months. We assessed body composition, body fat distribution, and skinfold thickness/subcutaneous tissue thickness. We also determined venous glucose, insulin, and free fatty acid (FFA) concentrations, and respiratory quotient (RQ) before and during oral glucose tolerance testing. Adipose tissue and muscle fasting and postprandial metabolism were studied by microdialysis. Within 12 months treatment, hip circumference increased from 93.6±2.78 cm to 96.2±2.3 cm (p<0.05). Rosiglitazone reduced fasting glucose levels and liver transaminases. Baseline and postprandial FFA concentrations were significantly lower after 12 months treatment. RQ and muscle interstitial pyruvate and lactate did not respond to treatment. We conclude that PPARγ stimulation with rosiglitazone modestly improves glucose metabolism in FPLD2 patients presumably through proximal adipose tissue expansion. The intrinsic muscular metabolic defect does not respond to rosiglitazone.

Epigallocatechin-3-gallate and postprandial fat oxidation in overweight/obese male volunteers: a pilot study.

OBJECTIVES: Drinking green tea is associated with many health benefits, including increased fat oxidation. We tested the hypothesis that epigallocatechin-3-gallate (EGCG), the main green tea catechin, increases fat oxidation in obese men. METHODS: Ten healthy overweight/obese males (body mass index 31.3+/-0.8 kg/m(2)) were studied in a randomized, placebo-controlled, double-blind crossover trial. Study supplements were low EGCG (300 mg), high EGCG (600 mg), caffeine (200 mg), EGCG/caffeine (300 mg/200 mg) or placebo and were taken orally for 3 days. At the third day of supplementation, O(2) consumption and CO(2) production was measured by indirect calorimetry to assess energy expenditure and fat oxidation over 4 h each after overnight fasting and after a standardized test meal. RESULTS: Energy expenditure was not affected by any supplementation, neither after overnight fasting nor after the test meal. During the first 2 h after overnight fasting, fat oxidation increased by 7.7 (not significant, NS), 15.2 (NS), 26.3 (P<0.05 vs placebo) and 35.4% (P<0.01 vs placebo and low EGCG), for low EGCG, high EGCG, caffeine and EGCG/caffeine, respectively. During the first 2 h after the meal, the mean increase in fat oxidation was 33.3 (P<0.05 vs placebo), 20.2 (NS), 34.5 (P<0.05 vs placebo) and 49.4% (P<0.05 vs placebo) for low EGCG, high EGCG, caffeine and EGCG/caffeine, respectively. CONCLUSIONS: Low EGCG increases postprandial fat oxidation in obese men and this to the same extent as 200 mg caffeine, whereas high EGCG does not exert this effect. Fasting fat oxidation is increased only by caffeine (with or without EGCG). There is no synergism of low EGCG and 200 mg caffeine. Energy expenditure is not affected by EGCG.

Factors related to the provision of hospital discounts for HMO inpatients.

Using 1986 AHA hospital survey data, we analyzed hospital-HMO contract provisions, hospital operating characteristics, and market conditions for a national sample of 801 hospitals with HMO contracts to determine the factors related to provision of a discount and the magnitude of the discount if present. Seventy-eight percent of the hospitals reported that at least one of their HMO contracts provided a discount for inpatient services. Risk-sharing provisions, the number of hospitals within a five-mile radius, the proportion of the population enrolled in HMOs, and the number of HMOs operating in the metropolitan statistical area (MSA) were directly related to provision of discounts. Public hospitals were less likely than other facilities to provide discounts. For the magnitude of the discounts, risk-sharing provisions and the number of hospitals within a five-mile radius were again related, as was the number of HMOs operating in the MSA--but this time the number-of-HMOs variable had an inverse relationship. The results suggest that increased HMO market activity does result in price competition for hospital services but that hospital discounting strategies are extremely complex and may not follow conventional market theories. Hospitals appear to be using contracts both to stabilize their relationships with HMOs and increase market share, and they are increasingly giving discounts to achieve those ends.

Confirmatory assay for ivermectin in cattle tissue using chemical ionization mass spectrometry/mass spectrometry (MS/MS).

A method based on direct exposure, positive ion, chemical ionization mass spectrometry/mass spectrometry (ms/ms) was developed for the confirmatory assay of the antiparasitic drug, ivermectin, in animal tissue. Following extraction, column and preparative liquid chromatography, mass spectrometric/mass spectrometric analysis of the drug in liver samples provided reliable detection limits to 8-10 parts-per-billion at a signal: noise of greater than 10:1. Blank tissue consistently displayed no chemical/matrix interference. Besides the development of a confirmatory assay, the study also demonstrates the analytical capability and the role of MS/MS vis-a-vis other applied mass spectrometric techniques.

[Avulsion fractures of the foot]. / Abrissbrüche im Fussbereich.

The avulsion (strain) fractures of the foot can be divided into two groups. Indications for conservative or operative treatment are discussed in detail.