Telemonitoring to improve nutritional status in community-dwelling elderly: design and methods for process and effect evaluation of a non-randomized controlled trial.

BACKGROUND: A good nutritional status is key for maintaining health and quality of life in older adults. In the Netherlands, 11 to 35% of the community-dwelling elderly are undernourished. Undernutrition or the risk of it should be signalled as soon as possible to be able to intervene at an early stage. However, in the context of an ageing population health care resources are scarce, evoking interest in health enabling technologies such as telemonitoring. This article describes the design of an intervention study focussing at telemonitoring and improving nutritional status of community-dwelling elderly. METHODS: The PhysioDom Home Dietary Intake Monitoring intervention was evaluated using a parallel arm pre-test post-test design including 215 Dutch community-dwelling elderly aged > 65 years. The six-month intervention included nutritional telemonitoring, television messages, and dietary advice by a nurse or a dietician. The control group received usual care. Measurements were performed at baseline, after 4.5 months, and at the end of the study, and included the primary outcome nutritional status and secondary outcomes behavioural determinants, diet quality, appetite, body weight, physical activity, physical functioning, and quality of life. Furthermore, a process evaluation was conducted to provide insight into intervention delivery, feasibility, and acceptability. DISCUSSION: This study will improve insight into feasibility and effectiveness of telemonitoring of nutritional parameters in community-dwelling elderly. This will provide relevant insights for health care professionals, researchers, and policy makers. TRIAL REGISTRATION: The study was retrospectively registered at Clinical-Trials.gov (identifier NCT03240094 ) since August 3, 2017.

Effect of glucose on the distribution of iodine-123-IHA-16 between esterification and oxidation in canine myocardium.

To evaluate the effect of glucose perfusion on the myocardial metabolism of [123I]-16-iodo-9-hexadecenoic acid (IHA), the latter was injected intravenously into six fasting dogs perfused with a solution lacking glucose (controls) and seven fasting dogs perfused with glucose and insulin. The distribution of myocardial 123I among iodides, free IHA, and esterified IHA was measured in myocardial biopsy specimens. The increase in esterification and decrease in oxidation of IHA due to glucose were quantified using a compartmental mathematical model of myocardial IHA metabolism. Subsequently, in six control and six glucose-perfused dogs, cardiac radioactivity was measured with a scintillation camera for 1 hr following i.v. injection of IHA. Four different methods were used to analyze the myocardial time-activity curves and to calculate the distribution of IHA between oxidation and esterification. Results comparable to those provided by analysis of biopsy specimens can be obtained by considering the curve to be the sum of an exponential and a constant, or by analyzing it with a compartmental mathematical model.

[Can we reduce the number of exploratory thoracotomies using mediastinoscopy?]. / Peut-on réduire le nombre de thoracotomies exploratrices grâce à la médiastinoscopie?

Between 1975 and 1988, 965 cases of bronchogenic carcinoma were submitted to surgery. A cervical mediastinoscopy (CM) was performed in 548 cases (57%). A nodal involvement was found in 35% of these 548 cases, thus 4 patients out of 5 did not undergo thoracotomy. One patient out of 5 underwent a thoracotomy in case of right ipsilateral and intranodal metastasis. Among 803 thoracotomies,-sixty were purely exploratories (7.5%), mainly because of a non resectable tumor. The rate of exploratory thoracotomy (ET) is decreasing (1975-1977 = 15%, less than 5% in recent years) as the rate of CM is increasing (1975-1979: 10-20%, 60-70% in recent years). The study of 60 cases of ET shows that 16 upon 39 performed CM revealed some nodal or mediastinal involvement. Nevertheless, among these 16 patients, the need of thoracotomy was under the pressure of necessity. Twenty-three patients had a negative CM: half of them had a left upper lobe carcinoma. Thus CM was inefficient to establish nodal mediastinal involvement in these cases.

Iodomethylated fatty acid metabolism in mice and dogs.

The myocardial uptake of fatty acids labeled with radioactive iodine and injected i.v. can only be evaluated with SPECT if their oxidation kinetics is slow enough. For this reason, we evaluated different iodomethylated fatty acids in mice and dogs to determine which of them shows the highest myocardial uptake and the slowest oxidation. The most suitable was found to be 16-iodo-3-methyl hexadecanoic acid (mono beta) since its myocardial fixation was the same as that of the reference, i.e. 16-iodo-9-hexadecenoic acid (IHA), whereas it was degraded more slowly. Thirty min after injection of mono beta into dogs, the decrease in myocardial activity with respect to the maximum was two fold less than after IHA injection. The myocardial uptake of the two dimethylated fatty acids studied, i.e. 16-iodo-2,2-methyl hexadecanoic acid and 16-iodo-3,3-methyl hexadecanoic acid, was less than that of IHA in mice and dogs. In the latter, the myocardial uptake was so small that we were unable to study the time course of its activity. Consequently, these dimethylated fatty acids are not suitable for the study of the myocardial uptake of fatty acids in man.

Fracture and embolization of a Lillehei-Kaster mitral valve prosthesis disc: one case successfully operated.

We report the fracture of the poppet of a Lillehei-Kaster prosthesis. A 40 years old man was operated upon for endocarditis of the mitral valve. A Lillehei-Kaster tilting disc valve was implanted. Three years later the disc fractured and the two parts escaped in the aorto-iliac axis. Emergency surgical procedure permitted implantation of a Wessex bioprosthesis and removal of the fragments with good results.

[Value of magnetic resonance imaging in a lipoma of the left ventricle]. / Intérêt de l'imagerie par résonance magnétique au cours d'un lipome du ventricule gauche.

A patient with benign left ventricular lipoma was explored pre- and post-operatively with echocardiography, computerized tomography (CT) and magnetic resonance imaging (MRI). With MRI spin-echo sequences the lipoma emitted a bright signal similar to that of normal fatty tissue on the two echoes of the sequence (28 ms and 65 ms). MRI was not better than CT to demonstrate that the tumour was a lipoma, but it proved to be the best technique to obtain information on tumoral spread to the myocardium and pericardium, and it showed the intracavitary extension without the need for contrast medium injection. After surgery, MRI displayed the remains of a septal lipomatous lesion. This case underlines the usefulness of MRI for the evaluation of cardiac tumours, and particularly lipomas.

[Magnetic resonance imaging in dissection of the aorta]. / Imagerie par résonance magnétique au cours des dissections de l'aorte.

In order to evaluate the usefulness of this new exploratory method in dissection of the aorta, 13 patients (10 men and 3 women, mean age 58 +/- 14 years) were examined by means of an 0.5 Tesla Magniscan 5000 nuclear magnetic resonance machine. Fifteen examinations were performed: 5 in patients with actual aortic dissection (type A 4 including one acute, type B1), 5 in patients previously operated upon for type A dissection and 5 for suspected acute aortic dissection unconfirmed by other examinations. Magnetic resonance imaging (MRI), synchronized with electrocardiography, was carried out using spin-echo techniques with 1 to 3 echoes and multiple contiguous sections along several planes. In the 5 patients with actual dissection the 2 channels separating the membrane could be demonstrated, thus providing a firm diagnosis (MRI proved superior to angiography in 2/5 patients). All 5 patients could be classified as either type A or type B. Extension to the cervical vessels was observed in 3 cases and the portal of entry was seen in one case, but the origin of the coronary arteries was never visualized. In the 5 patients previously operated upon MRI provided detailed analysis of the prosthesis of the supra-coronary ascending aorta implanted in all cases, of the aorta proximal and distal to that segment and of the periaortic mediastinum. By studying the signal from the false channel distal to the prosthesis information was obtained as to the presence in it (2 patients) or absence of circulating blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Mediastinal chondrohamartoma.

Chondromatous hamartomas of the lung are usually intraparenchymal and are rarely located in the bronchial lumen. Mediastinal chondrohamartomas are rare. A case is reported in which the close relationship with the esophagus suggests that this tumor is a choristoma rather than a hamartoma. To our knowledge, such a theory has not been previously proposed.

[Tumors of the organ of Zuckerlandl. Diagnostic approach apropos of 2 cases]. / Tumeurs de l'organe de Zuckerkandl. Démarche diagnostique à propos de 2 cas.

We report 2 cases of both functional and non functional paragangliomas. Emphasis is put on preoperative localization. CT along with echography is recommended as the initial radiographic procedure. If the tumor is not detected or in case of multiple tumors, a scintigram using MIBG is performed as a second still difficult to define. This feature is of importance in the long term follow up.

[Secondary rupture of the spleen after external cardiac massage]. / Rupture secondaire de rate après massage cardiaque externe.

A case of delayed splenic rupture occurring 18 days after external cardiac massage is reported. A 30 year old woman underwent mitral valve replacement. Two cardiac arrests in the immediate postoperative period were successfully treated by external cardiac massage. Recovery was uneventful until the 18th day, when the patient began to suffer from dizziness. Haemodynamic and biological data suggested hypovolaemia by dehydration. The day after, her abdomen became painful and anaemia was discovered. Splenic rupture was diagnosed by abdominal ultrasonography and splenectomy was carried out; no other lesion was found. In spite of the widespread practice of external cardiac massage, splenic rupture without any other lesion is unusual. It is suggested that abdominal ultrasonography should follow all cardiac massages.

[Pulmonary wounds (author's transl)]. / Les plaies pulmonaires.

A study of 22 patients with pulmonary wounds has confirmed the advantages of the traditional therapeutic attitude adopted in the majority of cases, and the rare indications requiring urgent or early operation for pulmonary lesions. Hunting gun pulmonary wounds, in which there is predominant "contusion" require individual treatment, and in 2 of the 4 cases treated in this serie, secondary excision was necessary.

[Flow through various cardiac valves prostheses (author's transl)]. / Ecoulement à travers différents types de prothèses valvulaires cardiaques.

We have studied the flow through various cardiac valves prostheses, with the assistance of an artificial left ventricular pump. We took photographs during the whole of the cardiac cycle but we present here only the view of the middle systolic period. As regards the mechanics prostheses (Bjork-Shiley, Lillehei-Kaster, Saint-Jude-Medical, Starr-Edwards) the flow changes with the shape and opening of the valve. Biologic prostheses (Carpentier-Edwards, Hancock, Ionescu-Shiley) present an impertubated flow.

[Surgical treatment of complex forms of congenital heart malformations associated with situs inversus (nine cases) (author's transl)]. / Cardiopathies congénitales et situs inversus. Neuf cas opérés sous circulation extra-corporelle.

Although are, situs inversus is nevertheless encountered in the surgical treatment of heart malformations. This series concerns 1 000 patients who where operated with heart-lung by-pass between 1974 and 1977. In nine cases, the heart was in the situs inversus position and the cardiac malformations associated with this condition, were complex. Yet the results were comparable to those obtained when the heart was in the normal position.