Morbid obesity: evaluation of metabolic indexes after adjustable silicone gastric banding

Morbid obesity is frequently associated with other characteristics of metabolic syndrome and is related to an increased risk of cardiovascular disease. This study aimed at evaluating time-course changes in body weight, body mass index (BMI), insulin sensitivity indexes and lipid profile in severely obese patients who underwent adjustable silicone gastric banding. We studied 19 obese subjects before and 6-36 months after surgery. An oral glucose tolerance test was performed in all non-diabetic patients. All subjects were evaluated using insulin sensitivity indexes (ISI-HOMA and QUICKI), lipid profile, and anthropometric parameters (WHR, WC, BMI), and body composition was assessed with bioelectrical impedance analysis (BIA). Most of the weight reduction occurred within the first 6-12 months, followed by near stabilisation or even weight regain. We found a significant decrease in fasting insulin, improvement in waist-hip ratio, reduction in BMI and fat mass percent. We observed an improvement in insulin sensitivity evaluated by means of ISI-HOMA and QUICKI. Bariatric surgery was an effective therapeutic approach for these obese patients because it reduced both weight and insulin resistance, along with improving metabolic parameters. Improvement in metabolic parameters appears to precede body weight reduction.     

Peritoneal Ultrafiltration in Refractory Heart Failure: A Cohort Study

♦ Introduction: Acutely decompensated heart failure (HF) in patients with diuretic resistance is often treated with extracorporeal ultrafiltration. Peritoneal ultrafiltration (PUF) has been proposed for the long-term management of severe HF after resolution of the acute episode. The aim of the present study was to evaluate the use of PUF in the treatment of chronic refractory HF in patients without end-stage renal disease.♦ Methods: This multicenter (10 nephrology departments throughout Italy) retrospective observational study included patients with severe HF refractory to maximized drug treatment. The patients were proposed for PUF because they had experienced at least 3 hospital admissions in the preceding year for acutely decompensated HF requiring extracorporeal ultrafiltration.♦ Results: Of the 48 study patients (39 men, 9 women; mean age 74 ± 9 years), 30 received 1 nocturnal icodextrin exchange, 5 required 2 daily exchanges, and 13 received 2 - 4 sessions per week of automated peritoneal dialysis. During the first year, renal function remained stable (initial: 20.8 ± 10.0 mL/min/1.73 m²; end: 22.0 ± 13.6 mL/min/1.73 m²), while pulmonary artery systolic pressure declined to 40 ± 6.09 mmHg from 45.5 ± 9.18 mmHg (p = 0.03), with a significant concomitant improvement in New York Heart Association functional status. Hospitalizations decreased to 11 ± 17 days/patient-year from 43 ± 33 days/patient-year before the start of PUF (p < 0.001). The incidence of peritonitis was 1 episode in 45 patient-months. Patient survival was 85% at 1 year and 56% at 2 years.♦ Conclusions: This study confirms the satisfactory results of using PUF for chronic HF in elderly patients.     

Evidence that human and porcine insulin differently affect the human insulin receptor: studies with monoclonal anti-insulin receptor antibodies.

Binding studies have been carried out with radioiodinated monoclonal antibodies directed to various epitopes of the insulin receptor in order to detect differences between human and porcine insulin in the interaction with the human insulin receptor. Human insulin was more effective that porcine insulin at inhibiting the binding of 125I-MA-5 to IM-9 cells, Hep-2 human larynx cells and human placenta membranes. On the contrary, human and porcine insulin showed similar inhibitory effect on the binding of two other labeled anti-insulin receptor monoclonal antibodies, thus ruling out the possibility that results were due to experimental artifacts. Although several interpretations are possible, data reported suggest that human insulin and porcine insulin might differently affect the insulin receptor, even if, the biological significance of these findings remains unknown.     

High-frequency audiometry in children

On the grounds of recent literature and of their own previous studies, the authors have examined a group of 25 normal-hearing children, ranging from 7 to 10 years of age, with high-frequency audiometry. The results were compared with those obtained in a group of young adults. On the basis of these findings, average threshold values were derived for this age group; such data have not yet been published for this simple headset technique. Furthermore, the comparison between the two age groups enabled the authors to determine a deterioration of the high-frequency hearing threshold which takes place at a fairly early age. Reliability of the equipment, in which headphones were used as transducers, was checked and the reproducibility for this test was shown to be adequate, as seen from the low test-retest variability.     

Echocardiographic and hemodynamic assessment of right heart impairment in chronic obstructive lung disease

42 patients with chronic obstructive lung disease underwent right heart hemodynamics (Swan-Ganz catheter) and M mode echocardiography. Echocardiographic study showed that right ventricular index (RVI) and right ventricular anterior wall thickness (RVAWT) were increased in most patients, while septal thickness and motion were nearly always normal. The finding of impaired RVI and normal RVAWT in several patients, while no one showed normal RVI and increased RVAWT, suggests that arterial pulmonary hypertension results in initial dilatation and only later in hypertrophy of the right ventricle. Echocardiographic parameters were well correlated with hemodynamic and pulmonary function parameters. The good correlations between echocardiographic and hemodynamic data suggest that echocardiography may be a useful technique in the noninvasive assessment of the effects of pulmonary hypertension on the right heart in COLD.     

In vitro induction of CFU-S proliferation by a non viral splenic activity from myeloproliferative sarcoma virus infected mice

The myeloproliferative sarcoma virus (MPSV) induces a myeloproliferative syndrome in DBA/2 mice. It is characterized by a considerable increase in the number (100-fold) and in the concentration (10-fold) of pluripotent hematopoietic stem cells detected in vivo (CFU-S) in the spleens of infected animals. Prior studies have shown the presence of a mixed-colony promoting activity (MPA) in neoplastic spleens. In the presence of a small quantity of erythropoietin, MPA induces the proliferation and differentiation of pluripotent hematopoietic stem cells, detected in vitro (Mix-CFU). We tested the effect of factors produced by neoplastic spleen cells on the proliferation of day 10 CFU-S and their entry into the cell cycle. This was done by comparing the number of day 10 CFU-S present in suspensions of normal bone marrow cells incubated for 2 days on agar underlays containing cells from either normal or neoplastic spleens. Our results show the existence of an activity secreted by cells from the spleens of MPSV-infected animals which starts CFU-S cycling and which is physically distinct from MPSV. The presence of this activity, whose identity with MPA remains to be proven, would enable us to explain the proliferation of CFU-S in the course of the disease.