A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue.

Exercise training ('exercise') and hypocaloric diet ('diet') are frequently prescribed for weight loss in obesity. Whilst body weight changes are commonly used to evaluate lifestyle interventions, visceral adiposity (VAT) is a more relevant and stronger predictor for morbidity and mortality. A meta-analysis was performed to assess the effects of exercise or diet on VAT (quantified by radiographic imaging). Relevant databases were searched through May 2014. One hundred seventeen studies (n = 4,815) were included. We found that both exercise and diet cause VAT loss (P < 0.0001). When comparing diet versus training, diet caused a larger weight loss (P = 0.04). In contrast, a trend was observed towards a larger VAT decrease in exercise (P = 0.08). Changes in weight and VAT showed a strong correlation after diet (R(2) = 0.737, P < 0.001), and a modest correlation after exercise (R(2) = 0.451, P < 0.001). In the absence of weight loss, exercise is related to 6.1% decrease in VAT, whilst diet showed virtually no change (1.1%). In conclusion, both exercise and diet reduce VAT. Despite a larger effect of diet on total body weight loss, exercise tends to have superior effects in reducing VAT. Finally, total body weight loss does not necessarily reflect changes in VAT and may represent a poor marker when evaluating benefits of lifestyle-interventions.

Physical fitness can partly explain the metabolically healthy obese phenotype in women.

To investigate whether physical fitness and/or fat distribution and inflammation profile may explain why approximately 30% of the women with obesity are protected against obesity-related disorders.10 metabolically healthy obese women and 10 age- and weight-matched women with the metabolic syndrome were enrolled. Physical fitness (VO2max), daily physical activity levels (METs, steps per day), insulin sensitivity (clamp), body fat distribution (DXA scan) and, inflammation markers and adipokines were determined.The metabolically healthy obese women had a 17% higher VO2max (25.1±3.9 vs. 21.5±3.1 ml ∙ min-1 ∙ kg-1, p=0.04) and tended to take more steps per day (7 388±1 440 vs. 5 927±1 301, p=0.06) than women with the metabolic syndrome. Despite equivalent levels of fat mass, metabolically healthy obese women had significantly lower circulating TNF-α levels compared to women with the metabolic syndrome (3.55±3.83 vs. 0.43±0.97 ng/ml, p=0.03). No differences were seen in insulin sensitivity, adipokines, and inflammatory markers between both groups.Metabolically healthy obese women have a higher cardio-respiratory fitness and lower TNF-α levels, which may partly explain why these women are protected from the detrimental effects of obesity compared to obese women with the metabolic syndrome.

Incidence and predictors of phantom shocks in implantable cardioverter defibrillator recipients.

BACKGROUND: Implantable cardioverter defibrillators (ICDs) are designed to deliver shocks or antitachycardia pacing (ATP) in the event of ventricular arrhythmias. During follow-up, some ICD recipients experience the sensation of ICD discharge in the absence of an actual discharge (phantom shock). The aim of this study was to evaluate the incidence and predictors of phantom shocks in ICD recipients. METHODS: Medical records of 629 consecutive patients with ischaemic or dilated cardiomyopathy and prior ICD implantation were studied. RESULTS: With a median follow-up of 35 months, phantom shocks were reported by 5.1 % of ICD recipients (5.7 % in the primary prevention group and 3.7 % for the secondary prevention group; p=NS). In the combined group of primary and secondary prevention, there were no significant predictors of the occurrence of phantom shocks. However, in the primary prevention group, phantom shocks were related to a history of atrial fibrillation (p=0.03) and NYHA class

Time sparing and effective procedure for dural closure in the posterior fossa using a vicryl mesh (Ethisorb®) / Cierre de duramadre en cirugía de fosa posterior con una malla de vicryl (Ethisorb®): un procedimiento simple y efectivo

Introduction. Dural defects and cerebrospinal fluid (CSF) leaks are a common problem following posterior fossa surgery. The management includes either nonoperative management (e.g. external lumbar drainage) or surgical re-exploration. Objectives. We present our surgical, clinical and histopathological experience of dural closure in the posterior fossa. In order to avoid CSF leaks we developed a simple but effective and time-sparing method using a well-cut sheet of a vicryl-poly-pdioxanone mesh (Ethisorb®) covering the whole defect of the craniectomy. Additional fibrin glue or sealant is not necessary. Special attention was focused upon the frequency of postoperative complications, in particular infection rate and CSF leaks. Patients. 85 patients were treated with vicryl mesh as dural substitute after posterior fossa surgery due to distinct pathologies. An illustrative case is presented. Results. In none of the patients a postoperative infection was observed. Four patients presented postoperative CSF leakage and were treated by percutaneous lumbar drainage. Three of the patients improved completely, requiring no additional treatment. Only in one case defect covered by a vicryl mesh, a surgical reexploration became necessary. Conclusion. We consider the vicryl mesh (Ethisorb®) as an ideal dural substitute especially for the dural closure of the posterior fossa (AU)

Introducción. Los defectos en el cierre de duramadre y por consiguiente fístulas de líquido cefalorraquídeo son comunes en cirugía de fosa posterior. El tratamiento incluye manejo conservador o no quirúrgico como drenaje lumbar externo de líquido cefalorraquídeo, cuando éstas medidas fallan se requiere de una nueva cirugía. Objetivos. Con el propósito de evitar fístulas de líquido cefalorraquídeo en cirugía de fosa posterior desarrollamos un método simple, pero efectivo, que permite ahorrar tiempo quirúrgico utilizando una malla de viyril-poly-p-dioxanone (Ethisorb®) para cubrir por completo el defecto de la craniectomía. No se requiere del uso adicional de adhesivo de fibrina. Nuestra experiencia clínica, quirúrgica y hallazgos histopatológicos con ésta técnica de cierre dural se discuten en el presente artículo así como las complicaciones, en particular infección y presencia de fístulas de líquido cefalorraquídeo. Pacientes. En 85 pacientes sometidos a cirugía de fosa posterior debida a diferentes patologías, se utilizó una malla de vicryl (Ethisorb®) como sustituto de duramadre. Se presenta un caso que ilustra nuestra técnica. Resultados. En ninguno de los casos se presentó infección postoperatoria. Cuatro casos presentaron fístula de líquido cefalorraquídeo y fueron tratados con drenaje lumbar externo; tres pacientes mejoraron por completo sin requerir otras medidas. Sólo en un caso se requirió de exploración quirúrgica. Conclusiones. De acuerdo con los resultados y complicaciones, consideramos que la malla de vicryl (Ethisorb®) es un sustituto de duramadre ideal, en particular para cirugías de fosa posterior (AU)

Time-sparing and effective procedure for dural closure in the posterior fossa using a vicryl mesh (Ethisorb).

INTRODUCTION: Dural defects and cerebrospinal fluid (CSF) leaks are a common problem following posterior fossa surgery. The management includes either nonoperative management (e.g. external lumbar drainage) or surgical re-exploration. OBJECTIVES: We present our surgical, clinical and histopathological experience of dural closure in the posterior fossa. In order to avoid CSF leaks we developed a simple but effective and time-sparing method using a well-cut sheet of a vicryl-poly-pdioxanone mesh (Ethisorb) covering the whole defect of the craniectomy. Additional fibrin glue or sealant is not necessary. Special attention was focused upon the frequency of postoperative complications, in particular infection rate and CSF leaks. PATIENTS: 85 patients were treated with vicryl mesh as dural substitute after posterior fossa surgery due to distinct pathologies. An illustrative case is presented. RESULTS. In none of the patients a postoperative infection was observed. Four patients presented postoperative CSF leakage and were treated by percutaneous lumbar drainage. Three of the patients improved completely, requiring no additional treatment. Only in one case defect covered by a vicryl mesh, a surgical reexploration became necessary. CONCLUSION: We consider the vicryl mesh (Ethisorb) as an ideal dural substitute especially for the dural closure of the posterior fossa.

Correction of skull defects using hydroxyapatite cement (HAC)--evidence derived from animal experiments and clinical experience.

BACKGROUND: The development of satisfactory cranioplasty material and technique has been a continuing bio-engineering challenge. Cranial defects resulting from trauma, tumour or infection are most frequently reconstructed with nonviable alloplastic materials. At present, all synthetic or biological materials in the use for human cranioplasty are more or less ideal. METHODS: The in vivo properties of a fully resorbable bony substitute--hydroxyapatite cement (HAC, BoneSource) are described in clinical investigations and animal experiments. HAC is prepared from calcium phosphate precursors which are hydrated and harden endothermically at 37 degrees C to form hydroxyapatite. Bone formation and resorption characteristics of HAC are examined in an adult minipig cranial defect model. FINDINGS: Cranial bone integrity has been restored in ten of eleven patients. Radiographic examination 6 months after surgery reveal a successful reconstruction of the skull defects. Sections of the cranial defect site from animals sacrificed at 12, 18 and 40 weeks demonstrate that new bone formation proceeds in HAC filled osseous defects. Histomorphological evaluation of HAC resorption and new bone formation indicates that HAC is nearly completely resorbed within 40 weeks and replaced by new bone with no loss in size or volume. INTERPRETATION: Hydroxyapatite cement (HAC) has an excellent biocompatibility (non-immunogenic and non-toxic), seems to be an optimal implant for cranial reconstruction and provides a biological scaffold for bone formation. However, further studies need to be conducted to determine the long-term stability of HAC.

A case of neurocysticercosis-differential diagnostic aspects.

Neurocysticercosis is no medical rarity but in non-endemic countries especially, a high degree of physician awareness is necessary for diagnosis. The case of a German female patient who had focal seizures for the first time at the age of 23 caused by a cerebral cyst of cysticercus cellulosae is presented. Only surgical removal and subsequent histological examination allowed diagnosis while diagnostic investigation yielded no pathological findings.

5-HT1B receptor-mediated contractions in human temporal artery: evidence from selective antagonists and 5-HT receptor mRNA expression.

1. In the human temporal artery both 5-HT1-like and 5-HT2A receptors mediate the contractile effects of 5-hydroxytryptamine (5-HT) and we have suggested that the 5-HT1-like receptors resemble more closely recombinant 5-HT1B than 5-HT1D receptors. To investigate further which subtype is involved, we investigated the blockade of 5-HT-induced contractions by the 5-HT1B-selective antagonist SB-224289 (2,3,6,7-tetrahydro-1'-methyl-5-[2-methyl-4'[(5-methyl-1,2,4-oxadiazole- 3-yl) biphenyl-4-yl] carbonyl] furo[2,3-f]indole-3-spiro-4'-piperidine oxalate) and the 5-HT1D-selective antagonist BRL-15572 (1-phenyl-3[4-3-chlorophenyl piperazin-1-yl] phenylpropan-2-ol). We also used RT-PCR to search for the mRNA of 5-HT1B, 5-HT1D and other 5-HT receptors. 2. The contractile effects of 5-HT in temporal artery rings were partially antagonized by SB-224289 (20, 200 nM) (apparent KB = 1 nM) and ketanserin (1 microM) but not by BRL-15572 (500 nM). 3. Sumatriptan evoked contractions (EC50, 170 nM) that were resistant to blockade by BRL-15572 (500 nM) but antagonized by SB-224289 (20, 200 nM). 4. The potency of 5-HT (EC50) was estimated to be 94 nM for the ketanserin-sensitive receptor and 34 nM for the SB-224289-sensitive receptor. The fraction of maximal 5-HT response mediated through SB-224289-sensitive receptors was 0.20-0.67, the remainder being mediated through ketanserin-sensitive receptors. 5. We detected arterial receptor mRNA for the following receptors (incidence): 5-HT1B (8/8), 5-HT1D (2/8), 5-HT1F (0/4), 5-HT2A (0/8) 5-HT2B (0/8), 5-HT2C (0/8), 5-HT4 (4/8) and 5-HT7 (4/8). 6. We conclude that the ketanserin-resistant fraction of the 5-HT effects and the effects of sumatriptan are mediated by 5-HT1B receptors. The lack of antagonism by BRL-15572 rules out 5-HT1D receptors as mediators of the contractile effects of 5-HT and sumatriptan.

Hangman's fracture: arguments in favor of surgical therapy for type II and III according to Edwards and Levine.

BACKGROUND: The optimal therapy for traumatic fractures of the neural arch of the axis, the so-called hangman's fractures, is still controversial. Indications for surgery depend on the type of hangman's fracture and/or additional injuries of the intervertebral disc or ligaments. METHODS: Sixteen patients sustaining fractures of the neural arch of the axis were treated by the screw fixation technique evolved by Judet. The passive mobility of the cervical spine was analyzed postoperatively by the radiographic evaluation method of Dvorak and coworkers and Penning. The angulation and anterior translation of C2 on C3 was measured before and after surgery. RESULTS: Follow-up investigations 3, 12, and in some cases 45 months later confirmed sufficient functional results especially regarding the mobility of the upper cervical spine. Comparison of pre- and postoperative angulation and anterior translation of C2 on C3 revealed a significant improvement especially in cases with type IIa fractures. CONCLUSION: The stabilization technique of Judet facilitates an exact reconstruction of anatomical conditions thereby preserving the atlantoaxial rotational mobility. A negligible hypomobility of the C2-C3 segment was observed on average 18 months after surgery.

A new technique of dural closure--experience with a vicryl mesh.

Treatment of postoperative dural CSF leaks following posterior fossa surgery remains a difficult and often perplexing problem. Their management includes either non-operative management or surgical re-exploration. In order to avoid CSF leaks we developed a simple but effective method using a well-cut sheet of a vicryl-poly-p-dioxanone mesh (Ethisorb) covering the whole defect of the craniectomy. This paper presents our technique of dural closure, experiences with and advantages of the vicryl mesh in comparison with conventional procedures using muscle patches in combination with fibrin sealant or fibrin glue alone. Attention is focused upon the frequency of postoperative complications, in particular infection rate and CSF leaks. Furthermore, histomorphological observations after implantation of a vicryl mesh are demonstrated. In conclusion, due to its specific qualities we consider the vicryl mesh as a suitable dural substitute with potential advantages over currently used material.

Focal neurologic deficits in infective endocarditis and other septic diseases.

INTRODUCTION: Focal neurologic deficits in sepsis frequently result from parenchymal lesions due to cerebral embolism. The aim of this study was to characterize clinical, laboratory and radiologic patterns of those patients. PATIENTS AND METHODS: Medical records of 30 patients with focal neurologic symptoms during sepsis were analyzed retrospectively. RESULTS: 24 patients (22 with infective endocarditis) had ischemic stroke. Cerebrospinal fluid (CSF) analyses revealed inflammation in 11 of 12 patients. Patients who died (11/24) suffered more frequently from secondary intracerebral hemorrhage (p = 0.0031), which was significantly associated with intravenous high-dose anticoagulation (p = 0.0059). Six patients had slowly progressive focal neurologic deficits without evidence for stroke. All showed CSF inflammation and three developed multiple cerebral abscesses. CONCLUSIONS: There are two distinctive groups of patients with focal neurologic deficits during sepsis. One presents with stroke and CNS inflammation (septic embolic focal encephalitis). The other group develops slowly progressive focal neurologic deficits and sometimes multiple cerebral abscesses (septic metastatic focal encephalitis).

Immunoscintigraphy for the detection of brain abscesses.

The aim of this prospective study was to assess the diagnostic usefulness of a 99Tcm-anti-granulocyte antibody in the early differentiation of the aetiology of a ring-enhancing structure on computed tomography (CT) scans following neurosurgical intervention. In 26 patients (15 males, 11 females) aged 20-82 years with suspected intracranial infection, 29 SPET scans of the head were obtained 4-6 h following the intravenous injection of 555 MBq 99Tcm-anti-granulocyte antibody. The patients had antibiotic, antimycotic or corticosteroid therapy. The diagnosis was confirmed by surgery (19 cases) or subsequent CT/MRI (magnetic resonance imaging) scans and clinical follow-up (10 cases). The immunoscan was true-positive (abscess) in 6 (sensitivity = 100%), true-negative in 19 and false-positive in 4 (specificity 83%) cases. There was no obvious detrimental effect on the results due to the antibiotic, antimycotic or corticosteroid therapy. In conclusion, despite false-positive results, the 99Tcm-anti-granulocyte antibody is a useful tool in the early detection and exclusion of intracranial abscess after neurosurgical interventions.

Atypical and malignant meningiomas: evaluation of different radiological criteria based on CT and MRI.

The following are our results of a retrospective analysis of 214 patients, operated on meningiomas, in order to investigate radiological criteria of malignancy. Among these cases there were 31 patients with a histologically confirmed diagnosis of malignant subtypes. As uncertain signs of malignancy of ensuing radiological features are an irregular enhancement of contrast-media and the size of cerebral edema. Based upon CT and MR images we have developed a standardised, computerised evaluation method which enables us to study in detail the internal architecture of meningiomas.

Symptomatology, surgical therapy and postoperative results of sphenoorbital, intraorbital-intracanalicular and optic sheath meningiomas.

A series of 7 patients with optic sheath meningiomas, 3 intracanalicular and intraorbital, 2 intraosseus meningiomas of the sphenoid wing involving the optic canal, and 4 sphenoorbital meningiomas were reported. The choice of a surgical approach to the orbit was appropriate to the location and size of the tumour relative to the optic nerve. The most common complaints were proptosis, reduction of visual acuity and paresis of eye muscles. Patients with optic sheath meningiomas are threatened postoperatively by visual loss whereas the high recurrence rate has to be taken into consideration in cases of sphenoorbital meningiomas.

Participation of 5-HT1-like and 5-HT2A receptors in the contraction of human temporal artery by 5-hydroxytryptamine and related drugs.

1. We investigated the hypothesis that, as in some other large human arteries, 5-HT-induced contraction of the temporal artery is mediated through two co-existing receptor populations, 5-HT1-like- and 5-HT2A. Temporal arterial segments were obtained from patients undergoing brain surgery and rings prepared set up to contract with 5-HT and related agents. Fractions of maximal 5-HT responses mediated through 5-HT1-like and 5-HT2A receptors, f1 and f2 = 1-f1, were estimated by use of the 5-HT2A-selective antagonist ketanserin. 2. In rings with intact endothelium 5-HT evoked contractions with a -log EC50, M of 7.0. Ketanserin (10-1000 nM) antagonized part of the 5-HT-induced contractions. Ketanserin-resistant components of 5-HT-induced contractions were found with -log EC50, M of 6.9 and f1 of 0.17 (100 nM ketanserin) and -log EC50, M of 6.4 and f1 of 0.20 (1000 nM ketanserin). 3. In rings with endothelial function attenuated by enzymatic treatment, 5-HT caused contractions with a -log EC50, M of 7.2 that were partially blocked by ketanserin. Ketanserin-resistant components of 5-HT-induced contractions were found with -log EC50, M 7.4 and f1 of 0.16 (100 nM ketanserin) and -log EC50, M of 7.5 and f1 of 0.14 (1000 nM ketanserin). 4. The ketanserin-resistant component of 5-HT-evoked contraction was blocked by methiothepin (100-1000 nM) consistent with mediation through 5-HT1-like receptors. 5. In rings with intact endothelium the 5-HT1-like-selective agonist, sumatriptan, caused small contractions with a -log EC50, M of 6.5 and intrinsic activity of 0.21 with respect to 5-HT that were resistant to blockade by 1000 nM ketanserin but antagonized by 100 nM methiothepin. 6. In rings with intact endothelium the 5-HT2A receptor partial agonist SK&F 103829 (2,3,4,5-tetrahydro-8[methyl sulphonyl]-1H3-benzazepin-7-ol methensulphonate) contracted rings with a -log EC50, M of 5.0 and an intrinsic activity of 0.49 with respect to 5-HT; the effects were antagonized by ketanserin 1000 nM. 7. We conclude that 80-86% of the maximum 5-HT-evoked contraction of human temporal artery is mediated through 5-HT2A receptors, the remainder through 5-HT1-like-receptors, regardless of whether or not endothelium is functional. The 5-HT1-like-receptors are more likely to be 5-HT1D beta receptors than 5-HT1D alpha receptors and sumatriptan is a full agonist for these receptors. As found in arteries of other species, SK&F 103829 is a partial agonist for 5-HT2A receptors of human temporal artery.

Fractures of the odontoid process: analysis of the functional results after surgery.

Eighteen patients who sustained type II/III fractures of the odontoid process, as classified by Anderson and D'Alonzo [2], underwent anterior screw fixation, as described in detail by Böhler [4] as well as Grob and Magerl [16]. Follow-up investigations 3, 12 and in some cases up to 60 months later confirmed sufficient functional results regarding the mobility of the upper cervical spine. The passive mobility of the cervical spine was analyzed by the radiographic evaluation technique of Dvorak and co-workers [12] and Penning [26], which revealed a hypomobility of the C2-3 segment 1 year after surgery in 11 patients and a fusion of the C2-3 vertebral bodies in 2 cases. The postoperative results including the rate of complications were compared with other authors's findings and different therapy concepts (e.g., posterior C1-2 arthrodesis, halo-vest treatment).