Nocturnal oxygen desaturation correlates with glycemia levels in patients with coronary artery disease.

AIM: Sleep-disordered breathing (SDB) has a high occurrence in patients with coronary artery disease. The aim of the present study was to examine the relationships between the overnight oxygen desaturation index (ODI) and metabolic and anthropometric parameters in a sample of patients who underwent percutaneous transluminal coronary angioplasty (PTCA). METHODS: The overnight pulse-oximetry recording ODI (desaturation >4%, length >10 s/events per hour) was performed in 29 patients with coronary heart disease, after they underwent PTCA. All study participants performed dynamic spirometric test, echocardiography, anthropometric measurements, bio impedance analysis. Fasting blood sample was collected to measure metabolic parameters. Using ODI category, the patients were grouped as follows: group N, N.=9 (ODI= or <5 events/hour); group A, N.=14 (515 events/hour). RESULTS: Among the studied patients, 69% had a nocturnal ODI>5 and 48% had a nocturnal ODI between 5 and 15 events/hour. ODI values were correlated with body mass index (BMI) (P<0.05) but not with waist to hip ratio, or percent body fat. After adjustment for BMI values, there was a significant positive correlation of ODI values with fasting glucose serum levels (P<0.05). CONCLUSION: These data suggest that early metabolic dysfunction may occur with SDB before overt clinical manifestation of underlying disease in patients with preobesity and ischemic heart disease. Patients with ischemic heart disease should be screened for SDB by ODI, also according to fasting glucose levels.

Role of magnetic resonance imaging in heavy eye syndrome.

PurposeThe aim of this study is to assess the importance of magnetic resonance imaging (MRI) before surgery in highly myopic patients, evaluating the capability of imaging to identify muscles displacement and orbital pulley abnormalities and their role in the pathogenesis of heavy eye syndrome (HES).MethodsWe reviewed the medical records and high-resolution orbital MRIs of highly myopic adults with HES, who underwent surgery for strabismus at the Sant'Orsola-Malpighi University Hospital of Bologna from January 2007 to June 2016. The measure of the angle of dislocation between lateral rectus and superior rectus and lateral rectus-superior rectus band (LR-SR band) were evaluated on coronal MRI imaging.ResultsA total of 54 patients with HES were evaluated by MRI. Mean axial length was 30.5±3 mm. Mean distance esotropia was 49.2±14.4 prism diopters (PD) and the mean hypotropia was 4.3±4.4 PD. All subjects exhibited severe superotemporal globe prolapse that displaced the lateral rectus inferiorly and the superior rectus muscle medially with mean angle of dislocation of 167.5±12.9° on MRI. The LR-SR band was thinned in 56 eyes, ruptured in 8 and not evaluable in 1 case.ConclusionsIn our study, we detected muscles displacement in all subjects and we discovered alteration of the LR-SR band in patients with HES, suggesting a possible role in the pathogenesis of this disease. The evaluation of preoperative orbital MRI imaging in patients with highly myopic strabismus is helpful to detect different anatomical etiology and eventually to drive the choice of appropriate surgery.

[Guidelines and malpractice in obesity treatment]. / Orientamenti terapeutici e malpractice nel trattamento dell'obesità.

BACKGROUND: Obesity, is one of the most common nutritional disorder in developed countries. The association with several health disorders (i.e., type 2 diabetes mellitus, hypertension, hyperlipidemias, cholelithiasis, obstructive sleep apneas, coronary heart disease, cancer) is frequently present. DESIGN: Obesity is, actually, measured using body mass index (BMI) determination. However, BMI isn't useful to predict body fat content. Skin-fold thickness, bioelectrical impedance analysis and/or dual energy x ray absorptiometry are specific tools with different capability to measure body composition (i.e., fat mass and fat-free mass). All these methods need a large data-base of age, sex and population reference values. CONCLUSIONS: Obesity management (dietary treatment, monitoring of weight loss, pharmacologic approach, and surgery ) is associated with several complications and errors.

Body composition analysis and changes in airways function in obese adults after hypocaloric diet.

STUDY OBJECTIVES: To determine the relationship between weight-loss and pulmonary function indexes, focusing on forced expiratory flows (ie, FEV(1), forced expiratory flow at 50% of vital capacity [FEF(50)], forced expiratory flow at 75% of vital capacity, and forced expiratory flow at 25 to 75% of vital capacity [FEF(25--75)]). Specifically, to determine the effect of losses in total and segmental fat mass (FM) and of modifications in lean body mass, after restricted hypocaloric diet, on pulmonary function among obese adults. DESIGN: Cross-sectional, observational. SETTINGS: Human Physiology Division, Faculty of Medicine and Surgery, "Tor Vergata" University, Rome, Italy. PATIENTS: Thirty obese adults (mean [+/- SD] baseline body mass index [BMI], 32.25 +/- 3.99 kg/m(2)), without significant obstructive airway disease, were selected from among participants in a weight-loss program. MEASUREMENTS AND RESULTS: Anthropometric, body composition (BC), and respiratory parameters of all participants were measured before and after weight loss. Total and segmental lean body and FM were obtained by dual-energy x-ray absorptiometry. Dynamic spirometric tests and maximum voluntary ventilation (MVV) were performed. The BC parameters (ie, body weight [BW], BMI, the sum skinfold thicknesses, thoracic inhalation circumference, thoracic expiration circumference, total FM, and trunk FM [FMtrunk]) were significantly decreased (p < or = .0001) after a hypocaloric diet. The mean vital capacity, FEV(1), FEF(50), FEF(25-75), expiratory reserve volume, and MVV significantly increased (p < or = 0.05) with weight loss. The correlation coefficient for Delta FEF(25--75) (r = 0.20) was numerically higher than Delta FEF(50) and Delta FEV(1) (r = 0.14 and r = 0.08, respectively) for the BW loss. Moreover, the correlation coefficient for Delta FEF(25--75) (r = 0.45) was significantly higher (p < or = 0.02) than those for Delta FEF(50) and Delta FEV(1) (r = 0.38 and r = 0.15, respectively) for FMtrunk loss. CONCLUSIONS: This study shows that a decrease in total and upper body fat obtained by restricted diet was not accompanied by a decrease in ventilatory muscle mass. FMtrunk loss was found to have improved airflow limitation, which can be correlated to peripheral airways function.

Orolaryngeal sarcoidosis presenting as obstructive sleep apnoea.

A 53-year-old man was evaluated for snoring, dysphagia for solid foods and difficulty of breathing and a polysomnographic recording was consistent with a diagnosis of obstructive sleep apnoea syndrome (OSAS). A flexible fiberoptic bronchoscopy (FFB) showed the presence of a nodular lesion of the posterior ventral surface of the tongue strictly connected to the left lateral border of the epiglottis. The biopsy specimen taken from the lesion was consistent with sarcoidosis. No involvement of pulmonary parenchyma, lymph nodes or other organs was recognized. After two months of steroid treatment, symptoms disappeared and resolution of the nodular lesion at the FFB and normalization of the polysomnographic recording were observed. This is the first report of orolaryngeal sarcoidosis associated with OSAS as the only clinical presentation of the disease.

Lower intestinal bleeding due to aorto-enteric fistula.

The case is described of a man who complained of intermittent fever and fatigue. After three digestive endoscopies and computed tomography, a 99m technetium-HM-PAO-labelled white cell scan was usefully employed to establish diagnosis. Anaerobic aortic Graft infection and anaemia due to lower intermittent occult intestinal bleeding were found. The intestinal bleeding was caused by secondary aorto-jejunal fistula. This condition is rare, but should be suspected whenever a patient with aortic prosthesis presents with occult digestive bleeding and unexplained fever.

Body composition and respiratory function.

Although the effects of sex, ageing, height, race, and current and past health on pulmonary function tests have been described, only non-significant associations have been observed between body weight and lung function among healthy persons after having accounted for the effects of age and height. However, few studies have considered the influence of body compartments (e. g. lean and fat masses and their distribution) on lung function and respiratory gas exchange. The present work consists of a review of the literature on the effects of body weight components and body composition measurements on lung function. One of the important findings of this review was that the central (or upper body) pattern of fat distribution is negatively associated with airway function and that increases in body muscular mass result in linear increases for all spirometric variables in healthy persons. Nonetheless, the role that body composition plays in lung function still needs to be clarified.

Assessing body composition in gastrointestinal disorders.

The assessment of body composition and energy requirements is important for the nutrition of healthy and pathological states such as gastrointestinal disorders, which are known to be associated with abnormalities in body composition among persons with malnutrition and malabsorption. Careful monitoring of body composition is thus recommended for assessing body water compartments, predicting caloric needs and physical performance, and evaluating the development of muscle mass in persons with malabsorption. In the present review we briefly describe the basic body composition models and various techniques used for their assessment and discuss the utility of measuring caloric requirements in persons with gastrointestinal disorders. Assessing body composition may improve the prognosis of malnutrition caused by gastrointestinal disorders and may be useful in monitoring diet treatment.

A comparative analysis of body water compartments for Egyptian patients with Schistosoma mansoni infection.

In light of reports that schistosomiasis is associated with alterations in nutritional status, and considering that the assessment of body composition and water spaces is important for nutritional and hydration management, we conducted a study to evaluate the reproducibility of estimates of total body water, extracellular water, and intracellular water for Egyptians with Schistosoma mansoni infection using various bioelectric impedance analysis (BIA) formulae in comparison with reference values obtained using dilution techniques. The estimates obtained using the various formulae varied from the reference values, representing either overestimates or underestimates. These differences were attributed to possible limitations inherent to the mathematical formulae, including the fact that they are population specific. These results stress the need to develop universal formulae for estimating body water compartments which would include race and pathology as independent parameters, in addition to BIA and anthropometric variables.

Predicting the intracellular water compartment using artificial neural network analysis.

Artificial neural networks (ANN) are used for a wide variety of data-processing applications such as predicting medical outcomes and classifying clinical data and patients. We investigated the applicability of an ANN for estimating the intracellular water compartment for a population of 104 healthy Italians ranging in age from 19 to 68 years. Anthropometric variables, bioelectric impedance analysis (BIA) variables, and reference values for intracellular water, measured using whole-body (40)K counting (ICW(K40)), were measured for all study participants. The anthropometric variables and the impedance index (height(2)/resistance) were fed to the ANN input layer, which produced as output the estimated values for intracellular water (ICW(ANN)). We also estimated intracellular water using a BIA formula for the same population (ICW(DeLorenzo)) and another for Caucasians (ICW(Gudivaka)). Errors in the estimations generated by ANN and the BIA equations were calculated as the root mean square error (RMSE). The mean (+/-SD) reference value (ICWK40) was 25.01+/-4.50 l, whereas the mean estimated value was 15.20+/-1.79 l (RMSE=11.06 l) when calculated using ICW(DeLorenzo), 18.07+/-1.14 l (RMSE=8.72 l) when using ICW(Gudivaka), and 25.01+/-2.74 l (RMSE=3.22 l) when using ICW(ANN). Based on these results, we deduce that the ANN algorithm is a more accurate predictor for reference ICW(K40) than BIA equations.

Artificial neural network analysis: a novel application for predicting site-specific bone mineral density.

Dual X-ray absorptiometry (DXA), which is the most commonly used method for the diagnosis and followup of human bone health, is known to produce accurate estimates of bone mineral density (BMD). However, high costs and problems with availability may prevent its use for mass screening. The objective of the present study was to estimate BMD values for healthy persons and those with conditions known to be associated with BMD, using artificial neural networks (ANN). An ANN was used to quantitatively estimate site-specific BMD values in comparison with reference values obtained by DXA (i. e. BMD(spine), BMD(pelvis), and BMD(total)). Anthropometric measurements (i. e. sex, age, weight, height, body mass index, waist-to-hip ratio, and the sum of four skinfold thicknesses) were fed to the ANN as independent input variables. The estimates based on four input variables were generated as output and were generally identical to the reference values for all studied groups. We believe the ANN is a promising approach for estimating and predicting site-specific BMD values using simple anthropometric measurements.

Total body water estimation using bioelectrical impedance: a meta-analysis of the data available in the literature.

Bioelectric impedance analysis (BIA) is commonly used in clinical settings and field studies for estimating total, extracellular, and intracellular water compartments. The objective of the present study was to carry out a meta-analysis of published reports in which total body water (TBW) was estimated using BIA techniques and comparisons were made with reference values. We identified 16 reports conducted among healthy and obese adults and individuals with chronic renal failure. Based on the weighted mean difference, we found that those studies using only multi-frequency BIA did not significantly overestimate the TBW compared with the reference values. Thus, among BIA techniques, multi-frequency BIA seems to be a more accurate method for estimating the TBW compartment for healthy and obese adults and for those with chronic renal failure.

The application of body cell mass index for studying muscle mass changes in health and disease conditions.

Body mass index (BMI) fails to detect altered nutritional state in the presence of overweight or obesity, since malnutrition can be present and masked by the abnormal amount of fat mass. Measuring body cell mass (BCM) contents for the evaluation of muscle mass and protein tissue states is well accepted. The aim of the present study was to apply body cell mass index (BCMI) to monitor the muscular mass changes of male and female Olympic athletes, renal dialysis patients, and anorexia nervosa patients in comparison with healthy subjects. The BCMI values of male subjects from the healthy group and Olympic athletes groups, but not the renal dialysis group, were significantly higher ( p<0.0001) than those of female subjects from the same groups. In addition, subjects with normal or high BMI values may be malnourished as highlighted by a low BCMI. We believe the BCMI is more sensitive than the BMI for studying the nutritional status of the individual.

The effect of physical activities of various intensities on the energy expenditure of type 2 diabetic men.

Interventions that focus on changing lifestyles through the combined use of dietary management, weight reduction, and increased physical activity are essential for managing type 2 diabetes mellitus (T2DM). The objective of the present study was to examine mildly obese T2DM patients [ n=10; mean age (+/-SD), 51.29+/-6.80 years; body mass index (BMI), 30.26+/-6.19 kg/m(2); and glycosylated haemoglobin (HbA(1c)), 8.16+/-1.16%)] and to compare them with normoglycaemic persons ( n=10; age, 53.00+/-9.48 years; BMI, 27.63+/-3.33 kg/m(2), and HbA(1c), 5.85+/-0.56%) in terms of energy expenditure while performing physical activities of various intensities (i. e. light, moderate, and heavy). The resting metabolic rate for T2DM patients was significantly higher than that for healthy controls (2200+/-354 kcal/day vs. 1628+/-176 kcal/day, respectively; p<0.0001). The values of energy expenditure at all three levels of physical activity were comparable between the two groups. Physical activity seems to have various beneficial effects on mildly obese T2DM patients because it increases the plasma glucose consumption, resulting in similar energy expenditure in comparison with normoglycaemic individuals.

Evaluating body composition of Italian prostate cancer patients without metastases.

Prostate cancer (PCa) is becoming an increasingly important public health problem worldwide, and anthropometric studies have revealed that body composition is a potential risk factor for this type of cancer. The objective of the present study was to compare Italians with PCa and no history of androgen deprivation therapy or bone metastases with healthy controls in terms of body composition. We recruited 11 PCa patients [mean age (+/-SD), 68.67+/-4.93 years; body mass index (BMI), 28.42+/-2.96 kg/m(2)] and 11 healthy controls matched for age and BMI. Anthropometric and body composition parameters were measured for all participants using dual X-ray absorptiometry and bioelectric impedance analysis techniques. We found that lean body mass, but not fat mass, was significantly lower for PCa patients in comparison with healthy controls (50.24+/-5.03 vs. 53.63+/-5.61 kg, p<0.05). Thus, PCa patients with no history of androgen deprivation therapy and no bone metastasis suffer muscle mass depletion.

Analysis of body water compartments after a short sauna bath using bioelectric impedance analysis.

Studies have suggested that long-term sauna bathing may lower blood pressure in persons with hypertension by causing a direct loss of extracellular water and plasma minerals. The objective of the present study was to evaluate the effect of short-term sauna bathing on body water compartments as estimated by bioelectric impedance analysis (BIA). We recruited 15 men [mean age (+/-SD) of 23.93+/-5.12 years and mean body mass index (BMI) of 23.25+/-2.84 kg/m(2)] and 10 women matched for age and BMI. Total body resistance, reactance, and impedance were measured for all participants using BIA, at baseline, after a short sauna bath, and after a rest period. Total, extracellular, and intracellular water compartments were calculated using BIA formulae. There were no significant differences for any of the body water compartments when comparing the measurements taken before and after the sauna bath and after the rest period. However, it remains to be determined whether or not BIA is sensitive to rapid changes in water volume.

Body composition analysis for healthy Italian vegetarians.

The elementary nutritional needs of vegetarians are totally, or in great part, supplied by vegetarian food; thus the body composition of vegetarians could differ from that of omnivorous persons. The objective of the present study was to compare healthy Italian vegetarians to healthy omnivorous individuals in terms of body composition, determined using dual X-ray absorptiometry. The study population consisted of 20 vegetarians [mean age (+/-SD), 34.78+/-15.07 years; mean BMI, 22.41+/-2.15 kg/m(2)] and 10 omnivorous persons matched for age and BMI. We found no significant differences between the two groups in terms of fat mass, lean body mass, soft tissue, bone mineral content, or bone mineral density. These findings suggest that the vegetarian diet does not induce negative alterations in body composition.

Variation in condensation pressure during clinical packing of amalgam restorations.

Clinical measurements were made of the condensation pressures applied by a specialist prosthodontist to each amalgam increment during the packing of two pinned Class II restorations. The technique employed involved taking simultaneous video recordings of the operative procedures and the output of a strain gauge stress measuring system attached to the plugger. The condensation pressure applied during each thrust of the plugger could then be related directly to a particular stage of the packing process. In Cavity A, a maxillary left second premolar, an "admix" amalgam containing both spherical and lathe-cut particles was used while Cavity B, a mandibular right first molar, was filled with a spherical particle amalgam. The measurements indicated that the condensation pressures applied decreased substantially as the filling of each cavity proceeded. A marked reduction accompanied the change from a 1.5 mm diameter to a 2.5 mm diameter plugger but in addition, the dentist modified the force applied to each plugger according to the particular task which he was undertaking. For Cavity A, the condensation pressure applied during the filling of the base of the mesial proximal box was 12.6 +/- 1.9 MPa whereas the final increment was subjected to a condensation pressure of only 2.2 +/- 0.7 MPa. Corresponding figures for Cavity B were 7.6 +/- 2.0 MPa and 1.9 +/- 0.5 MPa.

Accuracy of indirect estimation of oxyhaemoglobin saturation in patients with respiratory failure.

The indirect estimate of oxyhaemoglobin saturation (Sa,O2) is largely used in the management of patients with respiratory failure. The aim of this study was to evaluate the accuracy of the Sa,O2 values calculated by using both the Siggaard-Andersen (SA) and the Severinghaus (SE) equation, in comparison with the real Sa,O2 values measured by a co-oximeter. A total of 558 arterial blood samples were analysed. On average, only a slight overestimation was found for Sa,O2 estimated by the SA (2.35 +/- 5.75%) and the SE (2.37 +/- 5.65%) equations in comparison with the real values. However, a difference higher than 5% between estimated and real Sa,O2 values was demonstrated in more than 20% of the blood samples evaluated. This difference was higher than 10% in 9% of the samples, with similar results obtained with the two equations. The discrepancy between real and estimated values, probably due, at least in part, to errors in measurement of arterial oxygen tension (Pa,O2) and pH, was maximally evident for Sa,O2 values lower than 70%. An indirect estimate of Sa,O2 is not homogeneously accurate, and the clinical consequence of this finding might be especially dangerous in monitoring patients with severe respiratory failure.