Idiopathic subglottic stenosis and the consequences in cardiopulmonary exercise testing.

A 15-year-old male patient with progressive dyspnoea and exercise-related wheezing was analysed with spirometry, ECG and a cardiopulmonary exercise test with blood gas analysis. Earlier analysis by a paediatrician concluded no abnormalities. However, the previously performed spirometry test may have clarified the diagnosis in an earlier stage.Severe hypoventilation was seen during the exercise test with hypercapnia and hypoxaemia while hearing a stridor during exercise. Eventually, a circular subglottic stenosis was seen on a CT scan of the chest. No malignancy or granulomatosis with polyangiitis was seen in biopsy and pathologic examination. There was no history of trauma, intubation or infection. Therefore, the diagnosis idiopathic subglottic stenosis was established. Bronchoscopic balloon dilation followed several times, leading to full recovery.

Systematic Review of Lumbar Elastic Tape on Trunk Mobility: A Debatable Issue.

OBJECTIVES: To systematically review the literature to analyze the effect of lumbar elastic tape application on trunk mobility, surpassing the minimal detectable change of the used outcome measurement tool, and to analyze the additional effect of applied tension and direction of elastic tape application in low back pain and participants without low back pain. DATA SOURCES: Four databases were used: PubMed, Web of Science, Physiotherapy Evidence Database (PEDro), and Google Scholar. STUDY SELECTION: The inclusion criteria were randomized and clinical controlled trials evaluating the effectiveness of lumbar elastic tape application on trunk mobility. DATA EXTRACTION: Two researchers executed the search and a third author was consulted to resolve disagreements. The methodological quality was scored using the PEDro scale, with studies scoring ≤5 being excluded. DATA SYNTHESIS: Eight out of 6799 studies were included; 5 studied individuals with low back pain, and 3 studied participants without low back pain. Two studies scored low on the PEDro scale and were excluded. None of the reported significant changes in trunk mobility due to elastic tape application exceeded the indicated minimal detectable change. No conclusions can be drawn from the direction and applied tension of elastic tape application. CONCLUSIONS: Based on the results of this systematic review, there is no evidence supporting the effect of lumbar elastic tape application. We recommend consensus in the use of more reliable and valid instruments in future studies.

High-Dose, Diazoxide-Mediated Insulin Suppression Boosts Weight Loss Induced by Lifestyle Intervention.

Context: Obesity-related hyperinsulinism may impede lifestyle-initiated weight loss. Objective: Proof-of-concept study to investigate the amplifying effects of diazoxide (DZX)-mediated insulin suppression on lifestyle-induced weight loss in nondiabetic, hyperinsulinemic, obese men. Design: Twelve-month study comprising an initial 6-month, double-blind trial, followed by a partially de-blinded 6-month extension in men with obesity with a body mass index of 30 to 37.5 kg/m2 and a fasting serum C-peptide level >1.00 nM. Patients were randomized into three treatment groups: DZX + placebo (DZX + PL), DZX + metformin (DZX + MTF), and double PL (PL + PL). Results: At 6 months, DZX treatment was associated with a 6.1-kg PL-subtracted decline in fat mass (FM), and at 12 months, FM had decreased by a total of 15.7 ± 2.5 kg. Twelve months of DZX treatment was also associated with a significant decline in systolic (-6.6%) and diastolic (-8.6%) blood pressure and low-density lipoprotein-cholesterol (-18%) and triglycerides (-43%) and a 39% rise in high-density lipoprotein-cholesterol. These effects were achieved at the cost of a small rise in fasting glucose (95% CI: 0.2 to 1.0 mM) and hemoglobin A1c (95% CI: -0.08% to 0.44%). There were no differences between DZX monotherapy and the combination of DZX + MTF. Conclusion: High-dose DZX treatment of 1 year resulted in a substantial decrease in FM, blood pressure, and lipid levels at the cost of a small rise in blood glucose levels.

Effects of Diazoxide-Mediated Insulin Suppression on Glucose and Lipid Metabolism in Nondiabetic Obese Men.

Context: It has been suggested that stimulation of lipolysis by diazoxide (DZX)-mediated insulin suppression may be useful in treating obesity. However, the optimal dose to promote lipolysis without causing hyperglycemia is unknown. Objective: To assess the effects of DZX in nondiabetic obese men on lipid and glucose metabolism. Design: Double-blind, placebo (PL)-controlled, 6-month trial in men with a body mass index of 30 to 37.5 kg/m2 treated with a combination of caloric restriction, a standardized exercise program, and DZX or PL dose escalation. Results: The mean maximal tolerated dose of DZX was 422 ± 44 mg/d (range, 200 to 700 mg/d). Dose-limiting events were edema (n = 11), hyperglycemia (n = 6), and nausea (n = 2). After dose reduction to a level free of clinical side effects, DZX treatment was associated with a markedly greater decrease in fasting insulin levels than PL (-72.3 ± 3.5% vs -23.0 ± 12.6%; P < 0.001) and a significant improvement of blood pressure and plasma lipid levels. The decline in insulin levels occurred at the cost of a small increase in plasma glucose (0.6 ± 0.2 mmol/L vs -0.1 ± 0.1 mmol/L; P = 0.04) and hemoglobin A1C (0.2 ± 0.1% vs 0.0 ± 0.1%; P = 0.17). Conclusion: In nondiabetic obese men, insulin levels can be reduced up to 70% without major metabolic side effects. The marked intersubject variation in maximal tolerated dose indicates that DZX dose titration needs to be individualized.

Performance of the Lausanne questionnaire and the 2010 European Society of Cardiology criteria for ECG interpretation in athletes.

BACKGROUND: In recent years various proposals and subsequent changes have been made to improve pre-participation screening (PPS) methods. This study examines the Lausanne questionnaire and the old and new ESC criteria for a positive electrocardiogram (ECG) in athletes. DESIGN: Retrospective cohort study. METHODS: All consecutive students undergoing a PPS between January and July 2011 were included. The screening consisted of the Lausanne questionnaire, a physical examination, and a 12-lead ECG. RESULTS: A total of 561 students were screened. A total of 310 students (55%) answered positively to one or more of the Lausanne questions and 49 (9%) of these abnormalities were assessed as medically relevant. Physical examination was abnormal in nine (1.6%) students. In total, 120 (21%) ECGs were found positive following the old criteria. According to the new criteria, 68 (12%) ECGs were found positive. Four (already known) congenital cardiac disorders and four new diagnoses were found. When using the new ECG criteria, two out of four new cardiovascular diagnoses would have been missed. CONCLUSIONS: The use of the Lausanne questionnaire provides many irrelevant findings causing unnecessary positive screening outcomes. With the new ESC criteria for a positive 12-lead ECG in athletes, the number of false-positive screenings greatly decrease: however, at the cost of an increase in the number of false-negatives. To reach a conclusive judgment on the cost:benefit ratio of PPS, it is necessary to have a validated discriminating questionnaire, specific medical knowledge of PPS and clear definitions of a normal and abnormal 12-lead ECG in athletes.