Body composition in advanced-stage Parkinson's disease.

Little is known about body composition in Parkinson's disease (PD). We studied 35 patients (20 male, 15 female subjects; mean age 69.7+/-5.8 years) with advanced PD by anthropometry, dual-energy X-ray absorptiometry (DEXA), and serum 25-OH vitamin D measurement. Over 70% of patients had a disease duration of more than 4 years; all were on L-dopa treatment. Low levels of serum 25-OH vitamin D were present in 41% of the patients. The mean body mass index (BMI) was 25.3+/-4.3 kg/m(2) (range 17.1-37.3). Mid-arm muscle circumference was below the 10th percentile in 23%. For whole-body mean (+/-SD) bone mineral density, the T score was below -1 SD in 35% of patients, and the Z score was below -1 SD in 24%. Percent fat mass measured with DEXA was 30.6+/-11.4% (range 10.1-45.5) in the overall sample; it was 21.1+/-8.8% (range 10.1-30.4) in male subjects and 38.1+/-9.2% (range 25.8-45.5) in female subjects. We conclude that advanced-stage PD may show excess adiposity coexisting with depletion of lean body mass (sarcopenic obesity), in addition to decreased whole-body bone mineral density associated with low serum 25-OH vitamin D. A low level of physical activity and inadequate exposure to sunlight are likely to be among the putative causes.

Conversão em cirurgia laparoscópica colorretal / Conversion in laparoscopic colorectal surgery

A necessidade de conversão é um problema inerente à cirurgia laparoscópica. Os objetivos da presente revisão foram: caracterizar a conversão em cirurgias laparoscópicas colo-retais, conhecer sua freqüência, causas e conseqüências, além de apontar ações que objetivem diminuir a morbidade das colectomias convertidas para laparotomia. Em revisão da literatura recente, constatou-se que as taxas de conversão variaram de 7por cento a 77por cento. Alguns fatores mostraram-se preditivos de conversão para cirurgia aberta: doença maligna, obesidade e curva de aprendizado do cirurgião. As razões que mais determinaram conversão foram representadas por problemas técnicos (aderências, obesidade, operação inadequada do ponto de vista oncológico, anatomia incerta) e complicações intraoperatórias (sangramentos, enterotomias). A importância da curva de aprendizado é evidenciada quando se analisam os índices de conversão nos diversos estudos. A seleção cuidadosa do doente é fundamental para reduzir as taxas de morbi-mortalidade em cirurgia laparoscópica colo-retal.

Sit-to-stand movement analysis in obese subjects.

OBJECTIVES: The aim of this study was to evaluate the typical strategies of obese subjects during a sit-to-stand task (a typical daily living activity) and to assess the load conditions of hip, knee and ankle joints. DESIGN: Cross-sectional, controlled (obese patients vs controls) study on sit-to-stand movement analysis SUBJECTS: Ten adult young volunteers (five men and five women, mean age 28, s.d. 3 y; mean BMI 22, s.d. 2.3 kg/m2) and 30 obese subjects 25 women and five men, mean age 39.4, s.d. 13.7 y, mean BMI 40, s.d. 5.9 kg/m2) suffering from chronic lower back pain were analyzed in a sit-to-stand task (10 trials for each subject). MEASUREMENTS: Angle parameters carried out from a quantitative three-dimensional analysis of sit-to-stand (STS) movement, using an optoelectronic system. RESULTS: STS task in controls was characterized by a fully forward bending strategy of the trunk, while in obese patients at the beginning (first trial) of the STS task they limited the forward bending in order to protect the vertebral column. When fatigue increased during the execution of multiple STS tasks, the protection of the vertebral column was secondary to the execution of the task. In order to limit the muscle fatigue they increased the forward bending in order to decrease knee joint torque. DISCUSSION: The analysis of the strategy used by obese patients in STS task can be used in the design of future trials to assess the efficacy of rehabilitative treatment.