Decreased expression and function of adipocyte hormone-sensitive lipase in subcutaneous fat cells of obese subjects. (1/871)

Decreased lipolytic effect of catecholamines in adipose tissue has repeatedly been demonstrated in obesity and may be a cause of excess accumulation of body fat. However, the mechanisms behind this lipolysis defect are unclear. The role of hormone-sensitive lipase was examined using abdominal subcutaneous adipocytes from 34 obese drug-free and otherwise healthy males or females and 14 non-obese control subjects. The enzyme catalyzes the rate-limiting step of the lipolysis pathway. The maximum lipolytic capacity of fat cells was significantly decreased in obesity when measured using either a non-selective beta-adrenergic receptor agonist (isoprenaline) or a phosphodiesterase resistant cyclic AMP analogue (dibutyryl cyclic AMP). Likewise, enzyme activity, protein expression, and mRNA of hormone-sensitive lipase were significantly decreased in adipocytes of obese subjects. The findings were not influenced by age or gender. The data suggest that a decreased expression of hormone-sensitive lipase in subcutaneous fat cells, which in turn causes decreased enzyme function and impaired lipolytic capacity of adipocytes, is present in obesity. Impaired expression of the hormone-sensitive lipase gene might at least in part explain the enzyme defect.  (+info)

Human body composition: in vivo methods. (2/871)

In vivo methods used to study human body composition continue to be developed, along with more advanced reference models that utilize the information obtained with these technologies. Some methods are well established, with a strong physiological basis for their measurement, whereas others are much more indirect. This review has been structured from the methodological point of view to help the reader understand what can be examined with each technique. The associations between the various in vivo methods (densitometry, dilution, bioelectrical impedance and conductance, whole body counting, neutron activation, X-ray absorptiometry, computer tomography, and magnetic resonance imaging) and the five-level multicompartment model of body composition are described, along with the limitations and advantages of each method. This review also provides an overview of the present status of this field of research in human biology, including examples of reference body composition data for infants, children, adolescents, and adults.  (+info)

Relationship between gibbosity and Cobb angle during treatment of idiopathic scoliosis with the SpineCor brace. (3/871)

The objective of this study was to quantify the relationship between gibbosity and spinal deformation expressed by the angle of Cobb before and during treatment with a brace for different classes of idiopathic scoliosis patients. As part of the standard treatment with the Dynamic Corrective Brace (SpineCor), 89 idiopathic scoliosis patients underwent an initial radiological examination and gibbosity measurement with a scoliometer wearing and not wearing the brace. The 89 patients were classified in relation to the apex of the scoliosis curves: thoracic (n = 29); thoracolumbar (n = 40); lumbar (n = 7) and double (n = 13). With the dynamic corrective brace, the patients showed a mean decrease of 8.3 degrees for the major Cobb angle, and a mean decrease of 2.3 degrees for their gibbosity. There was a significant positive relationship between gibbosity and Cobb angle with and without the brace for the thoracic and thoracolumbar curves. A linear regression analysis identified a small mean estimation error for the thoracic curves (7.4 degrees no-brace; 2.7 degrees with brace) and thoracolumbar curves (5.2 degrees no-brace; 5.3 degrees with brace), indicating a predictive potential of the scoliometer. The measure of gibbosity with the scoliometer provides a fairly reliable estimation of Cobb angle at the initial clinical examination of a scoliosis patient. However, when initial Cobb angle and gibbosity are considered, the measure of gibbosity when wearing a brace provides the clinician with a highly reliable estimation of the Cobb angle while in a brace. This relationship also exists for the follow-up with a brace, permitting a judgement of the patient's evolution under the treatment with SpineCor.  (+info)

Why should diagnostic benign breast biopsies weight less than twenty grams? (4/871)

To reduce the cosmetic deformity resulting from diagnostic biopsies, current breast screening guidelines recommend that 80% of biopsy specimens that subsequently prove to be benign should weigh less than 20 g. The relationship between specimen weight and cosmesis is unknown and evidence to support a 20 g upper limit is lacking. Patient satisfaction following all benign biopsies weighing more than 20 g (n = 49) and a random sample of 30 of those weighing less than 20 g (n = 103) performed by one screening unit, over a 6 year period, was assessed by a postal questionnaire. Overall, 32% of patients were unhappy with the cosmetic outcome of their surgery. Patient dissatisfaction appeared to increase with specimen weight (6/23 [26%] < 20 g versus 13/36 [36%] > 20 g) but no statistically significant relationship between weight and cosmesis was apparent (P = 0.57). Reducing benign breast biopsy specimen weights to a minimum is a desirable objective. However, the current quality standard is not evidence-based, is too stringent and should be revised. Strategies need to be introduced to improve patient satisfaction following breast wire-localisation biopsies. In particular, patients should be counselled pre-operatively regarding possible adverse cosmetic outcome.  (+info)

Injury to the lateral femoral cutaneous nerve during harvest of iliac bone graft, with reference to the size of the graft. (5/871)

In patients who underwent autogenous iliac bone grafting we studied prospectively injury to the lateral femoral cutaneous nerve (LFCN) in relation to the size (length, depth, width) of the graft. We also examined the neurological deficit, by questioning them about numbness and/or pain in the lateral thigh. The risk of injury was significantly higher in those in whom the depth of the graft was more than 30 mm. With regard to the length of the graft the incidence of nerve injury was 20% when the graft was 45 mm long or more, 16% when it was between 30 mm and 45 mm long, and 8% when it was less than 30 mm long. We should inform patients of the possibility of such injury, and take size into consideration when harvesting grafts from the ilium.  (+info)

Migration of the femoral stem after impaction bone grafting. First results of an ongoing, randomised study of the exeter and elite plus femoral stems using radiostereometric analysis. (6/871)

We report the initial results of an ongoing randomised, prospective study on migration of the Exeter and Elite Plus femoral stems after impaction allografting, as measured by radiostereometry. Clinically, the impaction technique gave good results for both stems. The mean subsidence in the first year was 1.30 mm and 0.20 mm for the Exeter and the Elite Plus stems, respectively. In the second year, the Exeter stem continued to subside further by a mean of 0.42 mm, while the Elite Plus stem did not do so. Subsidence of the Exeter stem correlated with deficiency of bone stock as graded on the Gustilo and Pasternak scale. This correlation was not found for the Elite Plus stem. None of the other parameters which were studied predisposed to subsidence. There was no significant association between the amount of subsidence and the radiological appearance of the graft for either stem. Our findings do not support the theory that radial compression, due to subsidence of the Exeter stem, is the essential stimulus for remodelling in impaction allografting.  (+info)

Tourniquet-induced restriction of the quadriceps muscle mechanism. Fact or fiction? (7/871)

Many knee surgeons flex the knee and sometimes also extend the hip before inflating a tourniquet on the thigh. This practice stems from the belief that these manoeuvres prevent excessive strain on the quadriceps during surgery, the assumption being that movement of the muscle is restricted by an inflated tourniquet. We therefore examined, using ultrasound, the movement of the quadriceps muscle above and below the tourniquet before and after inflation. We applied a tourniquet of standard size to the thigh of five volunteers for approximately five minutes. A bubble of air was injected into the quadriceps muscle above the tourniquet and was the proximal point of reference. The musculotendinous junction was the distal point. The movement of the reference point was measured by ultrasound before and after inflation of the tourniquet. Each measurement was repeated with either the knee flexed and the hip extended, or the hip flexed and the knee extended. The mean and standard deviation were recorded. Before inflation the mean amount of passive movement was 1.1 +/- 0.13 cm proximal and 4.0 +/- 0.08 cm distal to the tourniquet, with a range of movement of the knee of 0 degrees to 137 degrees (6.7 degrees). After inflation the mean passive movement was 1.0 +/- 0.07 cm proximal and 4.0 +/- 0.08 cm distal to the tourniquet with a range of 0 degrees to 132 degrees (+/- 7.6 degrees). The ultrasound findings therefore have shown no evidence of restriction of the quadriceps muscle by an inflated tourniquet.  (+info)

Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment. (8/871)

We undertook a prospective, randomised study of 135 total knee arthroplasties to determine the most accurate and reliable technique for alignment of the tibial prosthesis. Tibial resection was guided by either intramedullary or extramedullary alignment jigs. Of the 135 knees, standardised postoperative radiographs suitable for assessment were available in 100. Correct tibial alignment was found in 85% of the intramedullary group compared with 65% of the extramedullary group (p = 0.019). We conclude that intramedullary guides are superior to extramedullary instruments for alignment of the tibial prosthesis.  (+info)

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