Intragastric Balloon for the Treatment of Obesity: Evaluation of Pulmonary Function Over a 3-Month Period

Background

Obesity has become a global epidemic in the 21st century, and the placement of an intragastric balloon (IB) is a therapeutic modality used to treat it. Our objectives for this study were to evaluate changes in lung function resulting from IB use and to correlate the pattern of body fat distribution with changes in lung function.

Methods

This was an interventional study with 30 overweight and obese patients with metabolic syndrome. All of the subjects underwent anthropometric measurements, assessment of their body fat distribution pattern by dual-energy X-ray absorptiometry, and pulmonary function testing before implantation of the IB.

Results

During the initial evaluations, the main pulmonary function abnormalities observed were decreased expiratory reserve volume (ERV), decreased total lung capacity (TLC), and increased diffusing capacity of carbon monoxide (DL_CO), which occurred in 56.7, 40, and 23.3?% of patients, respectively. We observed a statistically significant positive correlation between the DL_CO and the percentage of trunk fat mass (???=?0.42; p?<?0.01). Three months after placement of the IB, there was a significant reduction in the body mass index (p?<?0.0001) and the maximal inspiratory pressure (p?<?0.009). We also observed a significant increase in the forced vital capacity (p?<?0.0001), TLC (p?<?0.001), and ERV (p?<?0.0001).

Conclusions

Weight loss as a result of IB causes increased static lung volumes and decreased inspiratory muscle strength. Additionally, being overweight and obese is related to increased DL_CO, especially in individuals with truncal obesity.     

Angiosarcoma associated with a vascular graft: Case report

We describe a case of retroperitoneal angiosarcoma in association with an aorta-bifemoral Dacron graft. Surgery was not performed and the patient died. At autopsy, a local extensive, high-grade angiosarcoma was confirmed and a left pulmonar metastase was found. A sarcoma should always be considered in the differential diagnosis of any mass associated with vascular grafts, and an extensive investigation of possible and unsuspected distant metastasis is mandatory in all cases.     

Effects of a Lipophilic Environmental Pollutant (DDT) on the Phospholipid and Fatty Acid Contents of Bacillus stearothermophilus

Cultures of Bacillus stearothermophilus grown in a complex medium containing 1 μM DDT, exhibited longer lag adapting periods, decreased specific growth rates, and lower growth yield as compared to control cultures. The membrane lipid composition from cells grown in the presence of the insecticide was significantly different from that of control cells. The effects of DDT (2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane) on growth and lipid composition of bacterial cells were also determined in cultures grown in a medium supplemented with Ca²⁺ (membrane stabilizer) to further clarify the influence of growth conditions on bacterial responses to the toxicant. The main membrane-lipid changes induced by DDT relate to a very significant increase (74%) of the relative concentration of a phosphoglycolipid, an increase of the phosphatidylethanolamine content, with a parallel decrease of phosphatidylglycerol and an unidentified phospholipid X₀. The changes of the phospholipid acyl chains relate to an increase of straight chains and a parallel decrease of branched chains. The effects of DDT-induced lipid composition alterations on membrane physical properties were monitored by fluorescence polarization studies with bacterial polar lipid dispersions. Changes in the membrane lipids upon growing the bacteria in a DDT-containing medium promoted, as expected, more ordered membranes with a shift of the phase transition temperature to higher values. Data are interpreted in the frame of an adaptation mechanism to counteract the membrane perturbation resulting from the accumulation of the insecticide molecules in the lipid bilayer. Received: 9 March 1997/Accepted: 6 August 1997     

Effects of paraquat,dinoseb and 2,4-D on intracellular calcium and on vasopressin-induced calcium mobilization in isolated hepatocytes

 The effects of the herbicides paraquat, dinoseb and 2,4-D on intracellular Ca²⁺ levels and on vasopressin-induced Ca²⁺ mobilization were investigated in intact isolated hepatocytes. Incubation of rat hepatocytes with paraquat (5 mM for 60 min) and dinoseb (10 μM) resulted in a time-dependent loss of viability by approximately 25%. Viability of cells treated with 2,4-D decreased significantly, dropping to about 20% at 10 mM and 60 min incubation. Exposure of hepatocytes to paraquat (1–10 mM) for 60 min had no effect on the basal level of [Ca²⁺] _i . Additionally, exposure to paraquat had no effect on the magnitude and on the duration of the [Ca²⁺] _i response to vasopressin. In the presence of 2,4-D (1–10 mM), basal [Ca²⁺] _i increases as a function of herbicide concentration. The magnitude of the Δ[Ca²⁺] _i response decreases from 256±8 nM in control to 220±5 nM, at 10 mM 2,4-D. Exposure of hepatocytes to dinoseb (1–10 μM) had no effect on the basal level of [Ca²⁺] _i . However, a strong concentration-dependent decrease in the magnitude of Δ[Ca²⁺] _i in response to vasopressin was noticed at 60 min incubation. Dinoseb markedly inhibited the stimulation of the production of inositol phosphates by vasopressin stimulus. The present study demonstrates that paraquat, 2,4-D and dinoseb cause cell death in hepatocytes by mechanisms not related to an early increase in [Ca²⁺] _i . Additionally, it has been shown for the first time that dinoseb disturbs the transduction mechanism promoted by vasopressin by inhibiting the formation of IP₃. Received: 11 October 1994/Accepted: 5 December 1994     

Effects of cardiac resynchronization therapy on right ventricular function--evaluation with tissue Doppler echocardiography.

INTRODUCTION AND OBJECTIVE: Ventricular resynchronization therapy improves cardiac function in patients (pts) with dilated cardiomyopathy and intraventricular conduction disturbances. The effects of ventricular resynchronization on right ventricular function have been poorly studied. Tricuspid annular motion can be studied with tissue Doppler echocardiography, which enables quantitative assessment of right ventricular function. The aim of this study was to evaluate the effects of ventricular resynchronization on right ventricular function with pulsed tissue Doppler. PATIENTS: We studied ten pts, eight male, mean age 65 +/- 10 years, with dilated cardiomyopathy, intraventricular conduction disturbances and heart failure, New York Heart Association functional class III or IV. Five pts had coronary artery disease and the others idiopathic dilated cardiomyopathy. All pts had an implanted cardioverter-defibrillator with ventricular resynchronization. METHODS: Before and one month after device implantation right ventricular function was evaluated with pulsed wave tissue Doppler study of tricuspid annular motion. The maximum velocity of the S wave (MV-S), E wave (MV-E), and A wave (MV-A), E/A ratio, isovolumetric contraction time (IVCT) and ejection time (ET) were determined. Right ventricular size and left ventricular ejection fraction (EF) were measured. Functional class before and after implantation was assessed. RESULTS: MV-S, MV-E and MV-A did not change significantly. The E/A ratio decreased significantly (p = 0.017). There were no differences in IVCT and ET, nor in right ventricular size before and after resynchronization. EF improved in all but one patient (p = 0.003). All pts had an improvement in functional class, except the one without increased EF. CONCLUSIONS: Ventricular resynchronization therapy does not appear to have a deleterious effect on right ventricular function in pts with dilated cardiomyopathy and intraventricular conduction disturbances. The main beneficial effect of this type of therapy appears to be improvement in left ventricular function.     

Cardiac resynchronization therapy with sequential biventricular pacing: impact of echocardiography guided VV delay optimization on acute results.

BACKGROUND: Cardiac resynchronization therapy (CRT) improves left ventricular synchrony as evaluated by tissue Doppler imaging (TDI), leading to improved left ventricular performance and reverse remodeling. New CRT devices enable programming of left and right VV delay. The aim of this study was to determine whether sequential biventricular (BiV) pacing by echo-guided programming of VV delay would enhance the response to CRT. METHODS: 15 consecutive patients with severe heart failure and left bundle branch block underwent CRT by BiV device implantation. They were studied with conventional and TDI echo the day before implantation. Left ventricular ejection fraction (LVEF) was determined, and the electromechanical delay (QS), defined as the time interval from the beginning of the QRS to the S wave in pulsed TDI, was assessed in each of the four left ventricular basal segments. The dyssynchrony index was calculated as the difference between the longest and shortest electromechanical delay (QS(max-min)). The parameters were re-evaluated the day after implantation during simultaneous BiV pacing and with seven different VV delays. The optimal VV delay was determined by finding the VV interval corresponding to the maximum aortic velocity time interval (VTI). RESULTS: QS(max-min) decreased from 85.3 +/- 27.0 msec to 46.7 +/- 23.0 msec (p = 0.0002), LVEF increased from 21.7 +/- 7.3% to 30.0 +/- 7.7% (p = 0.0001) and aortic VTI increased from 12.7 +/- 3.6 cm to 15.2 +/- 4.0 cm (p < 0.0001), with simultaneous BiV pacing. The VV intervals were programmed as follows: LV pre-excitation by 10 msec in five patients, 20 msec in three, 30 msec in two, and 40 msec in three; and RV pre-excitation by 10 msec in one and by 20 msec in one. The maximal aortic VTI obtained with VV delay programming increased from 15.2 +/- 4.0 cm to 17.7 +/- 4.0 cm (p = 0.0005). During optimized sequential BiV pacing, QS(max-min) further decreased from 46.7 +/- 23.0 msec to 30.6 +/- 21.0 msec (p = 0.02) and LVEF further increased from 30.0 +/- 7.7% to 35.0 +/- 7.7% (p = 0.0003). CONCLUSIONS: Sequential BiV pacing with VV delay optimized by evaluation of aortic VTI enhanced the response to CRT with additional improvements in left ventricular synchrony and left ventricular function compared to simultaneous CRT.     

Long-term low-protein diet reduces the number of hippocampal mossy fiber synapses

Previously we have reported a loss of the dentate granule cells and hippocampal CA3 pyramidal cells in adult animals after lengthy periods of low-protein diet. In this study we examined the effects of this cell loss upon the synaptic connections between the granule cell axons (the mossy fibers) and CA3 pyramidal cell dendrites. Three groups of five rats each were given a low-casein (8%) diet for 6, 12, and 18 months, respectively, and the results of the ultrastructural morphometric analysis compared with similarly processed control rats kept on a control diet. The numerical density of synapses was decreased in undernourished rats and the fraction of the mossy fiber terminal membrane occupied by synaptic specializations was reduced. It can be inferred that the synaptic connectivity pattern between mossy fiber terminals and CA3 dendrites is altered due to a reduction in the number of contacts. Besides, as the synapses of low-protein-treated animals do not display any increase in the length of their active zones, evidence is not provided for the existence of morphological synaptic plasticity, contrary to what has been recently described in other experimental circumstances.     

Bone Mineral Density and Microarchitecture in Patients With Autosomal Dominant Osteopetrosis: A Report of Two Cases

The aim of this case study is to describe changes in areal bone mineral density (aBMD) by dual‐energy X‐ray absorptiometry (DXA) scan, as well as volumetric bone density and microarchitecture by high‐resolution peripheral quantitative computed tomography (HR‐pQCT) in two patients with autosomal dominant osteopetrosis (ADO) and compare with 20 healthy subjects. We describe a 44‐year‐old male patient with six low‐impact fractures since he was age 16 years, and a 32‐year‐old female patient with four low‐impact fractures on her past history. Radiographic changes were typical of ADO. Consistent with the much higher aBMD, total volumetric BMD (average bone density of the whole bone, including trabecular and cortical compartments) at distal radius and tibia (HR‐pQCT) was more than twice the mean values found in healthy subjects in both patients. Trabecular number and thickness were higher, leading to an evident increase in trabecular bone volume to tissue volume. Also, an enormous increase in cortical thickness was found. Most important, a great heterogeneity in bone microstructure of the affected patients was evident on HR‐pQCT images: islets of very dense bone were interposed with areas with apparent normal density. The increase in aBMD, volumetric BMD, and most indices of trabecular and cortical bone, associated with the great heterogeneity on bone tridimensional microarchitecture, reflect the accumulation of old and fragile bone randomly distributed along the skeleton. These alterations in bone microstructure probably compromise bone quality, which might justify the high prevalence of low‐impact fractures in patients with ADO, despite abnormally elevated BMD. © 2015 American Society for Bone and Mineral Research.