Clinical significance of epicardial fat measured using cardiac multislice computed tomography.

Cardiac adiposity defined as increased epicardial adipose tissue and massive deposits of fat within the atrial septum (lipomatous hypertrophy) is seen in overweight persons and is associated with coronary artery disease (CAD), atrial arrhythmias, and increased risk of left ventricular free wall rupture after acute myocardial infarction. Unlike subcutaneous fat, epicardial fat is metabollically active and produces hormones, cytokines, and other vasoactive substances that work systemically or locally to alter vascular endothelial function and may be implicated in the pathogenesis of CAD. The aim of the study was to assess the feasibility of measuring epicardial fat volume (EFV) and identify its clinical correlates using (64-slice) multislice computed tomography (MSCT). A protocol was devised to measure EFV using MSCT in 151 adults (age 26 to 83 years, mean 51 +/- 12; 55% men). Cross-sectional tomographic cardiac slices (2.5-mm thick) from base to apex (range 28 to 40 per heart) were traced semiautomatically using an off-line workstation, and EFV was measured by assigning Hounsfield units ranging from -30 to -250 to fat. Coronary computed tomographic angiography was performed using a standard protocol. EFV ranged from 25 to 274 ml (mean 121 +/- 47), corresponding to 2.4% to 30.5% (mean 15 +/- 5%) of total cardiac volume and correlated with age, atrial septum thickness, body weight, and body mass index. Coronary calcium score was significantly higher in patients with EFV >100 ml (67 +/- 155 vs 216 +/- 639; p = 0.03), and a higher percentage of patients with increased EFV had CAD (46% vs 31%; p <0.05) or metabolic syndrome (44% vs 29%; p <0.05). In conclusion, quantification of EFV was feasible using MSCT. Large deposits of fat around the heart and within the atrial septum were associated with obesity, coronary calcium, metabolic syndrome, and CAD. Measurement of EFV may provide another useful noninvasive indicator of heightened risk of CAD in addition to calcium score and coronary angiography.

Changes in sexual drives of patients on oral contraceptives.

PIP: 169 married and 42 single women attending the Family Planning Clinic at Wilford Hall U.S. Air Force Medical center were surveyed over a 4-month interval to study changes in sexual drives associated with oral contraceptives (OCs). 74.4% reported they were without side effects. The menstrual flow was decreased in 62% and increased in 4%. Duration of the menstrual cycle was decreased in 57% and unchanged in 41%. 34% indicated less dysmenorrhea while taking OCs. There were some differences between married and single women when questioned about their sexual drive. 68% of the married women and 71% of the single were without change in their libido. 21% of the married women felt that their libido diminished. 22% of single women experienced increased libido. 31% of the single women had a heightened sexual response while only 17% of the married women reported this. Sexual activity increased in 40% of the single women and 16% of the married women. Libido decreased as family size increased. There were only minor differences in changes among those who use different OCs. There was a progressive decrease in libido, sexual response, and sexual activity during the first 2-3 years of medication. After 5 years, however, sexual response was progressively heightened. Fear of pregnancy was uniformly lessened with OCs in 72-75% of all patients. Individuals may have changes in their sexual drives secondary to OCs. However, as many have increased as have decreased drive.^ieng