The prevalence of selected physical activities and their relation with coronary heart disease risk factors in elderly men: the Zutphen Study, 1985

Physical activity patterns and their relation with coronary heart disease risk factors are described for a representative sample of 863 Dutch men, 65-84 years old, who participated in the 1985 survey of the Zutphen cohort of the Seven Countries Study. Cross-sectional results revealed a median total of reported physical activity of about 1 hour and 20 minutes per day; only 5.8% reported no physical activity. The percentage of participation and total weekly time spent in physical activity decreased as age increased; the decrease was less pronounced for walking, bicycling, gardening, and doing odd jobs than for sports, hobbies, and work. Statistically significant mean differences were found among quartiles of total weekly physical activity for both total cholesterol and high-density lipoprotein cholesterol (HDL cholesterol); however, only the differences for HDL cholesterol remained significant (p = 0.045) after adjusting for potential confounders. Statistically significant regression coefficients (p less than 0.05) were found for the independent association between walking and total cholesterol and between gardening and total cholesterol, HDL cholesterol, and systolic blood pressure, after adjusting for confounders. Total weekly physical activity and specific activities, e.g., gardening and walking, demonstrated generally favorable associations with cholesterol and systolic blood pressure.     

Sources of hepatic glucose production by 2H2O ingestion and Bayesian analysis of 2H glucuronide enrichment

The contribution of gluconeogenesis to hepatic glucose production (GP) was quantified after ²H₂O ingestion by Bayesian analysis of the position 2 and 5 ²H‐NMR signals (H2 and H5) of monoacetone glucose (MAG) derived from urinary acetaminophen glucuronide. Six controls and 10 kidney transplant (KTx) patients with cyclosporine A (CsA) immunosuppressant therapy were studied. Seven KTx patients were lean and euglycemic (BMI = 24.3 ± 1.0 kg/m²; fasting glucose = 4.7 ± 0.1 mM) while three were obese and hyperglycemic (BMI = 30.5 ± 0.7 kg/m²; fasting glucose = 7.1 ± 0.5 mM). For the 16 spectra analyzed, the mean coefficient of variation for the gluconeogenesis contribution was 10% ± 5%. This uncertainty was associated with a mean signal‐to‐noise ratio (SNR) of 79:1 and 45:1 for the MAG H2 and H5 signals, respectively. For control subjects, gluconeogenesis contributed 54% ± 7% of GP as determined by the mean and standard deviation (SD) of individual Bayesian analyses. For the lean/normoglycemic KTx subjects, the gluconeogenic contribution to GP was 62% ± 7% (P = 0.06 vs. controls), while hyperglycemic/obese KTx patients had a gluconeogenic contribution of 68% ± 3% (P < 0.005 vs. controls). These data suggest that in KTx patients, an increased gluconeogenic contribution to GP is strongly associated with obesity and hyperglycemia. Magn Reson Med 60:517–523, 2008. © 2008 Wiley‐Liss, Inc.     

Preoperative lumbar epidural morphine improves postoperative analgesia and ventilatory function after transsternal thymectomy in patients with myasthenia gravis

OBJECTIVE: To test the hypothesis that preoperative lumbar epidural morphine improves postoperative pain control and ventilatory function after transsternal thymectomy in patients with myasthenia gravis. DESIGN: The study design was randomized, placebo-controlled, and double-blind. SETTING: After surgery, all patients were admitted to the Neuroscience Critical Care Unit for evaluation and treatment. PATIENTS: All patients with myasthenia gravis who presented to the hospital for thymectomy were asked to participate in the study. Twenty patients were randomized to either the placebo or epidural morphine groups. INTERVENTIONS: Patients received either epidural morphine (7 mg in 14 mL of sterile saline) or saline (14 mL) before induction of anesthesia. Supplemental iv opioids were administered intraoperatively, with need determined by the anesthesiologist. MAIN OUTCOME MEASURES: The main outcome measures were indicators of postoperative pain (e.g., Visual Analog Pain Score, requirement for supplemental opioid administration, respiratory rate) and ventilatory function (e.g., forced vital capacity, negative inspiratory pressure). RESULTS: Immediately after surgery, the Visual Analog Pain Score in the placebo group was twice as high as the score in the epidural morphine group (placebo 7.0 +/- 1.3; epidural morphine 3.5 +/- 1.2, p less than or equal to .05). During the first eight postoperative hours, the placebo group required more opioids (0.22 +/- 0.03 vs. 0.12 +/- 0.04 mg/kg morphine equivalents, p less than or equal to .06) than the epidural morphine group. Later, both groups received similar amounts of opioids. Patients receiving epidural morphine had better initial recovery of forced vital capacity (at 8 hrs: 55 +/- 6% [epidural morphine] vs. 34 +/- 5% [placebo] of preoperative value, p less than or equal to .05). Respiratory rate was lower for the first 12 postoperative hours in the epidural morphine group, without a difference in PaCO2. There was no difference between groups for the duration of postoperative intubation or ventilation. CONCLUSIONS: Preoperative lumbar epidural morphine facilitates postoperative analgesia and improves initial postoperative ventilatory performance.     

Effect of volume and dose on the pulmonary distribution of exogenous surfactant administered to normal rabbits or to rabbits with oleic acid lung injury

Administration of exogenous lung surfactant to infants with or at risk for respiratory distress syndrome has been demonstrated to improve gas exchange and survival; administration of surfactant to patients with the adult respiratory distress syndrome is currently undergoing clinical evaluation. Although it is currently assumed the optimal effect will occur when administered surfactant is distributed homogeneously throughout the lung, little is known of the influence of variables inherent in the administration procedure on subsequent distribution. To address this question, we studied the effect of the volume size in which the surfactant is suspended for instillation, and demonstrated a marked relationship in the normal rabbit lung between this volume and the subsequent homogeneity of surfactant distribution. In the rabbit lung that was acutely injured by oleic acid, this relationship was not evident. Concentration of administered surfactant was not demonstrated to be of major influence on its distribution after administration. Our results focus attention on the importance of parameters of the administration procedure, and also demonstrate the usefulness of the techniques used for determination of surfactant distribution.     

Exercise compliance and the gym ball: a case study

Manipulation and exercise are recommended by chiropractors for treatment and prevention of low back problems. Many patients stop their exercise program with improvement in their symptoms. The success of exercises for the prevention of low back pain is dependent on several factors, one being continued compliance to the program. Only a small percentage of the general population do regular exercise; therefore, it is essential that patients recognize the importance of regular exercise in reducing the recurrence of their low back pain. This case study shows how the use of a gym ball appears to have improved compliance and reduced the incidence of low back pain for one patient with a history of re-occurring low back pain and a poor record of exercise compliance. The question must be asked, is this an case incident or is use of the gym ball an appropriate treatment for low back pain?     

Roentgenographic evaluation of the augmented breast.

We performed a retrospective study to determine the sensitivity of mammography in detecting breast cancer arising in women with augmented breasts. Of eight women with breast implants in whom breast cancer developed, six had mammograms before biopsy. Only two of the six cancers were identified mammographically (sensitivity = 33%), and one of these two was seen only in retrospect. In both cases, the mammographic findings suggested a benign rather than a malignant process. All eight women had a palpable mass and early disease, and all are clinically disease-free at present. The sensitivity of mammography in detecting palpable cancers in a control group of women without implants was 92% (118 of 128). For tumors of 2 cm or less, the sensitivity was 88% (58 of 66). These results suggest that the sensitivity of mammography in detecting breast cancer is decreased when implants are present. Further investigations are needed to determine the effects of prostheses on mammographic evaluations.     

Endogenous Bacillus cereus panophthalmitis

Over the past seven years we have treated three cases of drug abusers in whom endogenous Bacillus cereus endophthalmitis rapidly progressed to panophthalmitis. Ocular features of infection with this organism include severe pain, chemosis, proptosis, corneal infiltration and ring abscess, subretinal exudation, retinal hemorrhages, and perivasculitis. The process becomes fulminant in an explosive manner and may be accompanied by fever and leukocytosis. Ophthalmologists should be cognizant of the apparent susceptibility of drug abusers to Bacillus cereus infections and should consider this organism in any severe, rapidly evolving intraocular infectious process.