Safety of transesophageal echocardiography in patients who are obese.

Patients with obesity tend to have a higher incidence of hypertension, coronary artery disease, and sleep apnea, conditions that could potentially predispose to complications during transesophageal echocardiography (TEE). In addition, patients who are obese are more likely to have oxygen desaturation during upper gastrointestinal endoscopy. However, the safety of TEE in a large cohort of patients with obesity has not been reported. Thus, the safety of TEE in 341 patients who were obese (body mass index >/= 27.5 kg/m(2), mean 41.0 +/- 10.3) and in 323 control patients who were not obese was compared. Minor complications (ie, complications of a transient duration and requiring no or only simple intervention) occurred with equal frequency in the control and obese groups (16.5% vs 16.7%, P = not significant). Transient oxygen desaturation did not differ between the control versus obese group (2.5% vs 3.8%, P = not significant), but was more common (6.7%) in a subgroup (n = 150) of patients who were morbidly obese as compared with control patients (P <.05). Transient hypotension was observed in 3.5% of the obese group compared with 7.4% in the control group (P <.05). However, transient hypertension was noted in 10.6% of the patients who were obese compared with 6.5% in the control group (P =.072). A major complication occurred in 2 patients with obesity, one who required vasopressor medication for persistent hypotension and another needing pharmacologic rate control of atrial fibrillation. One patient in the control group had provoked supraventricular tachycardia and angina. No deaths occurred in either group. Subjective tolerance for the procedure was similar (P = not significant) in both groups with 84% of patients with obesity having good to excellent tolerance compared with 88% in that of the control group. Thus, TEE can be safely performed in patients who are obese.     

Computer-assisted detection of monoclonal components: results from the multicenter study for the evaluation of CASPER (Computer Assisted Serum Protein Electrophoresis Recognizer) algorithm

BACKGROUND: To investigate the potential use of Artificial Neural Network (ANN) in the evaluation of serum protein electrophoresis, we set up a multicenter study involving six Italian laboratories. For this purpose, we developed an algorithm named CASPER (Computer Assisted Serum Protein Electrophoresis Recognizer). METHODS: A total of 59,516 samples from the six centers were divided into three groups. Training and validation sets were used to develop the neural network, whereas evaluation set was used to test the performance of CASPER in recognizing abnormal electrophoretic profiles. RESULTS: CASPER showed 93.0% sensitivity and 47.4% specificity. CASPER sensitivity and specificity ranged in the six sites from 88% (site 3) to 97% (site 5) and from 36% (site 6) to 53% (site 3), respectively. Sensitivity for gamma zone was 94.6%, for beta zone 89.7% and for oligoclonal patterns 92.0%. CONCLUSIONS: The sensitivity of the CASPER algorithm does not allow us to recommend its use as a replacement for the visual inspection, but it could be helpful in avoiding accidental misclassifications by the operator. Moreover, the CASPER algorithm may be a useful tool for training operators and students. This study evidenced a high inter-observer variability, which should be addressed in a dedicated study. Data set to train and validate ANNs should contain a huge range and an adequate number of different abnormalities.     

Effects of two 1-year calcium and vitamin D3 treatments on bone remodeling markers and femoral bone density in elderly women

The aim of this study was to compare the effects of a 1-year treatment with calcium and vitamin D₃ combined in a tablet (Orocal^®) with the effects of a reference treatment of calcium administered in a sachet (Ostram^®) and vitamin D₃ as a tablet (Devaron^®) on bone remodeling markers and bone mineral density (BMD) in elderly women. The study population comprised 119 women ?70 years of age, 80% of whom were institutionalized. The women were randomly allocated to receive treatment for 1 year with elemental calcium 0.5 g and vitamin D₃ 400 IU combined in one chewable tablet taken twice daily (group 1) or elemental calcium 0.6 g (1 sachet) and vitamin D₃ 400 IU (1 chewable tablet) taken twice daily (group 2). BMD of the proximal femur was measured at four sites before and after the 1-year treatment period; serum 1–84 intact parathyroid hormone (PTH) concentration, serum 25-hydroxyvitamin D₃ (25[OH]D₃) concentration, and bone alkaline phosphatase activity were measured at baseline and after 6 and 12 months of treatment. At month 12, BMD had increased at all sites in patients in group 1; the increase was statistically significant at the trochanter (2.34%). In group 2, BMD had increased slightly at the femoral neck and decreased slightly at the other sites, without any statistically significant differences. BMD changes were not statistically different between the two groups except at the trochanter, where we observed a 2.34% increase in group 1 versus a 0.32% decrease in group 2. In group 1, PTH decreased significantly from baseline to month 6 (13%) and then did not change significantly from month 6 to month 12. In group 2 the decrease was not statistically significant. In addition, 25(OH)D₃ increased significantly in the two groups from baseline to month 6 (group 1, 107%; group 2, 96%). This significant increase continued but became less marked from month 6 to month 12 (13% and 15%, respectively). Bone alkaline phosphatase values decreased significantly in both groups from baseline to month 6; however, this decrease was significantly greater in group 1 (35%) than in group 2 (22%). From month 6 to month 12, values remained constant in both groups. In this study, results with the calcium and vitamin D₃ combination tablet were comparable to those of the separated calcium and vitamin D₃ supplementation concerning parameters involved in senile osteoporosis. Densitometric data showed some prevention of age-related bone loss; biochemical data showed the correction of vitamin D₃ deficiency and the reduction of PTH secretion, both of which are responsible for increased bone remodeling in the elderly. The results of this study confirm those of previous studies on the effects of calcium and vitamin D₃ supplementation in institutionalized elderly patients.     

Using National Data Sets on CD-ROM to Teach Nursing Research

Purpose : To explore the use of national data sets on CD-ROM for teaching graduate nursing research.
Significance: Secondary data analysis of national health data sets is economical and provides a useful experience for students learning research.
Scope: The advantages and disadvantages of using national health data sets on CD-ROM are described. Students in three majors in nursing worked in groups to address research questions that could be answered using variables in the National Health Interview Survey. Several computer laboratory sessions were held to teach students how to extract the data and apply SPSS to analyze data.
Findings: The pilot program was a success, but not without problems. Ten steps to ensure better attainment of objectives were formulated.
Conclusions: National data sets on CD-ROM are an inexpensive, rich data source that allow flexibility for students and faculty. Secondary data analysis using national health data sets is an underused approach in nursing. Graduate students can have a significant research experience while curbing the costs-to organizations and themselves-associated with primary data collection.     

Losartan and lercanidipine attenuate low-density lipoprotein oxidation in patients with hypertension and type 2 diabetes mellitus: a randomized,prospective crossover study

OBJECTIVES: Lipoprotein oxidation, dyslipidemia, and hypertension are important underlying causes of accelerated atherosclerosis in patients with diabetes mellitus. The potential of antihypertensive medications to reduce lipid oxidation is, therefore, an important determinant in the choice of agents for patients with diabetes mellitus. The aim of this study was to compare the lowering effect of a new dihydropyridine calcium antagonist, lercanidipine, with that of the first angiotensin-receptor blocker, losartan, on low-density lipoprotein (LDL) oxidation. METHODS: Forty patients in metabolically stable condition who had type 2 diabetes mellitus with hypertension were studied in this single-blind, randomized, prospective crossover study, comprising 2 treatment periods of 16 weeks each, separated by a 4-week washout period. LDL oxidation was evaluated by dialdehyde analysis by means of the thiobarbituric acid-reactive substances assay with and without cupric sulfate, as well as determination of conjugated dienes in the LDL lipid extract. RESULTS: Lercanidipine and losartan both significantly reduced the propensity of the serum to oxidize LDL (P =.001). With one method of estimation (conjugated dienes), the effect of lercanidipine was superior to that of losartan (P =.04). Losartan lowered urinary albumin excretion but lercanidipine did not. CONCLUSIONS: Both lercanidipine and losartan attenuate LDL oxidation in patients with type 2 diabetes mellitus and hypertension. This observation may offer insight into the mechanisms of the therapeutic effects of these agents in patients with diabetes mellitus.     

Duodenocolic fistula due to adenocarcinoma of the pancreas

A case of duodenocolic fistula due to pancreatic adenocarcinoma is presented. The causes and clinical and radiographic features of duodenocolic fistulae are discussed.     

Impairment and activity limitation associated with epiphyseal dysplasia in children

OBJECTIVES: To develop a profile of impairment and activity limitation among children with epiphyseal dysplasia (ED) and to identify the relationship between these 2 domains. DESIGN: Cross-sectional study. SETTING: Acute, pediatric academic and health sciences center. PARTICIPANTS: Eleven subjects with multiple epiphyseal dysplasia (MED) and 17 subjects with spondyloepiphyseal dysplasia (SED), with a mean age of 12.9 years. INTERVENTIONS: Not applicable.Main outcome measures Anthropometric indexes of growth and nutrition, joint range of motion (ROM) and alignment, muscle strength, pain, and activity limitation. RESULTS: Subjects with SED had significantly shorter stature than the reference population (P<.01). Seventy-three percent of participants with MED and 77% of those with SED were above average or overweight for their height (P<.01). Both groups presented with moderate to severe joint ROM impairment, with greater lower-extremity involvement. Subjects with SED had worse outcomes with respect to overall ROM and alignment impairments (P<.01), particularly in their upper extremities (P<.01), than subjects with MED. Significant overall muscle weakness was noted in all subjects (z=-1.81; P<.01). Ninety-four percent of subjects with SED reported pain with activity, compared with 64% of those with MED (P=.04), although pain intensity did not differ between groups. Fifty percent of subjects had undergone orthopedic surgery. Mild activity limitation was reported by all subjects (mean score, 87.7+/-18.83). Significant correlations were identified between height for age and strength (r=.50) and pain and activity limitation (r=-.50). CONCLUSIONS: Despite moderate to severe impairments, all subjects reported surprisingly mild activity limitation. A positive correlation was identified between pain and activity limitation. This study also identified and described patterns of muscle weakness, pain, and nutritional concerns not previously reported in the ED literature.     

Revision of the Facts on Osteoporosis Quiz

BACKGROUND: Few instruments exist that measure knowledge of osteoporosis, a health risk for 28 million Americans. The original Facts on Osteoporosis Quiz (FOOQ), which was theoretically informed by Orem's (1995) Self-Care Theory, was published in 1998. In 2000, the National Institutes of Health (NIH) held a consensus conference on osteoporosis in which previous knowledge was modified based on current science. OBJECTIVES: The goal was to update the original instrument based on the latest scientific evidence and to determine its psychometric properties. METHOD: The quiz content was validated by osteoporosis experts and is theoretically informed by Orem's (2001) Self-Care Theory. An iterative process was used to design an instrument with an acceptable reading level. Reliability, item discrimination, and item difficulty were assessed in a convenience sample of 256 participants. RESULTS: The revised quiz, content-based on the 2000 NIH osteoporosis consensus conference, includes 20 questions. The quiz has a content validity index of.87, an internal consistency reliability of.76 and a 6th grade reading level. Item difficulty and item discrimination are also reported. CONCLUSIONS: The revised version of the FOOQ provides a valid, reliable, and theoretically informed instrument with acceptable psychometric properties.