Resección no planificada en sarcomas de partes blandas del aparato locomotor / Unplanned excision of soft tissue sarcomas of the musculoskeletal system

Introducción: El proceso diagnóstico de los sarcomas de partes blandas del aparato locomotor (SPBAL) sigue siendo comprometido, con casos de resecciones no planificadas (cirugías «whoops»). Este estudio evalúa la frecuencia de este tipo de procedimientos, tratando de identificar características de los pacientes, tumores, tratamiento quirúrgico y resultados. Material y métodos: Se revisan de forma retrospectiva 131 pacientes tratados de forma quirúrgica en nuestro centro entre octubre de 2018 y diciembre de 2021 de un SPBAL. Se excluyen los pacientes con SPBAL localizados en vísceras, mediastino, corazón, retroperitoneo, peritoneo y aparato genital. Las diferencias entre pacientes con resecciones planificadas y no planificadas fueron evaluadas con pruebas χ2 y un modelo de regresión multivariado de Cox. Resultados: Las resecciones no planificadas de SPBAL han tenido lugar en 18% de los pacientes de nuestra área, principalmente en tumores menos de 5 cm y localizados superficiales a la fascia; 29,2% de estos pacientes no disponían de una prueba de imagen previa. No se ha demostrado que una cirugía «whoops» pueda suponer una disminución de la supervivencia o una mayor tasa de recidivas. Conclusiones: Recomendamos la realización de una prueba de imagen siempre previa a la extirpación de cualquier tipo de tumoración de tejidos blandos, así como la adherencia a las guías de remisión a centros de referencia.(AU)

Introduction: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions (“whoops” surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. Material and methods: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. Results: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a “whoops” surgery can lead to a decrease in survival or a higher rate of recurrences. Conclusions: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.(AU)

[Translated article] Unplanned excision of soft tissue sarcomas of the musculoskeletal system / Resección no planificada en sarcomas de partes blandas del aparato locomotor

Introducción: El proceso diagnóstico de los sarcomas de partes blandas del aparato locomotor (SPBAL) sigue siendo comprometido, con casos de resecciones no planificadas (cirugías «whoops»). Este estudio evalúa la frecuencia de este tipo de procedimientos, tratando de identificar características de los pacientes, tumores, tratamiento quirúrgico y resultados. Material y métodos: Se revisan de forma retrospectiva 131 pacientes tratados de forma quirúrgica en nuestro centro entre octubre de 2018 y diciembre de 2021 de un SPBAL. Se excluyen los pacientes con SPBAL localizados en vísceras, mediastino, corazón, retroperitoneo, peritoneo y aparato genital. Las diferencias entre pacientes con resecciones planificadas y no planificadas fueron evaluadas con pruebas χ2 y un modelo de regresión multivariado de Cox. Resultados: Las resecciones no planificadas de SPBAL han tenido lugar en 18% de los pacientes de nuestra área, principalmente en tumores menos de 5 cm y localizados superficiales a la fascia; 29,2% de estos pacientes no disponían de una prueba de imagen previa. No se ha demostrado que una cirugía «whoops» pueda suponer una disminución de la supervivencia o una mayor tasa de recidivas. Conclusiones: Recomendamos la realización de una prueba de imagen siempre previa a la extirpación de cualquier tipo de tumoración de tejidos blandos, así como la adherencia a las guías de remisión a centros de referencia.(AU)

Introduction: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions (“whoops” surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. Material and methods: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. Results: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a “whoops” surgery can lead to a decrease in survival or a higher rate of recurrences. Conclusions: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.(AU)

Unplanned excision of soft tissue sarcomas of the musculoskeletal system. / Resección no planificada en sarcomas de partes blandas del aparato locomotor.

INTRODUCTION: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. MATERIAL AND METHODS: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. RESULTS: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.

[Translated article] Unplanned excision of soft tissue sarcomas of the musculoskeletal system.

INTRODUCTION: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to identify patient characteristics, tumours, surgical treatment and final results. MATERIAL AND METHODS: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with Chi2 tests and a Cox multivariate regression model. RESULTS: Unplanned excisions of SPBAL have taken place in 18% of the patients in our area, mainly in tumours of less than 5cm and located superficial to the fascia. 29.2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumour, as well as adherence to the referral guidelines to reference centres.

Infarto agudo de miocardio en menor de 30 años. La edad no es excluyente / Acute myocardial infarction in a patient less than 30 years. Age is not exclusive

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Brachial plexus tumors in a tertiary referral center: a case series and literature review.

INTRODUCTION: Brachial plexus (BP) tumors are very rare tumors, with less than 800 cases been described in the literature worldwide since 1970. These tumors often present as local or radicular pain, with scant or no neurological deficits. These symptoms are shared by many other more common rheumatologic diseases, thus making their diagnosis difficult in most cases. Additionally, these tumors often present as lumps and are therefore biopsied, which carries a significant risk of iatrogenic nerve injury. MATERIAL AND METHODS: In this paper the authors describe their experience with the management of 5 patients with BP tumors followed up for at least 2 years. There were 4 males and 1 female. Median follow-up time was 41 ± 21 months. Average age at diagnosis was 40,0 ± 19,9 years. The most common complaints at presentation were pain and sensibility changes. All patients had a positive Tinel sign when the lesion was percussed. In all patients surgery was undertaken and the tumors removed. In 4 patients nerve integrity was maintained. In one patient with excruciating pain a segment of the nerve had to be excised and the nerve defect was bridged with sural nerve grafts. RESULTS: Pathology examination of the resected specimens revealed a Schwannoma in 4 cases and a neurofibroma in the patient submitted to segmental nerve resection. Two years postoperatively, no recurrences were observed. All patients revealed clinical improvement. The patient submitted to nerve resection had improvement in pain, but presented diminished strength and sensibility in the involved nerve territory. CONCLUSION: Surgical excision of BP tumors is not a risk free procedure. Most authors suggest surgery if the lesion is symptomatic or progressing in size. If the tumor is stationary and not associated with neurological dysfunction a conservative approach should be taken.

Thermal behaviour and kinetics of coal/biomass blends during co-combustion.

The thermal characteristics and kinetics of coal, biomass (pine sawdust) and their blends were evaluated under combustion conditions using a non-isothermal thermogravimetric method (TGA). Biomass was blended with coal in the range of 5-80 wt.% to evaluate their co-combustion behaviour. No significant interactions were detected between the coal and biomass, since no deviations from their expected behaviour were observed in these experiments. Biomass combustion takes place in two steps: between 200 and 360 degrees C the volatiles are released and burned, and at 360-490 degrees C char combustion takes place. In contrast, coal is characterized by only one combustion stage at 315-615 degrees C. The coal/biomass blends presented three combustion steps, corresponding to the sum of the biomass and coal individual stages. Several solid-state mechanisms were tested by the Coats-Redfern method in order to find out the mechanisms responsible for the oxidation of the samples. The kinetic parameters were determined assuming single separate reactions for each stage of thermal conversion. The combustion process of coal consists of one reaction, whereas, in the case of the biomass and coal/biomass blends, this process consists of two or three independent reactions, respectively. The results showed that the chemical first order reaction is the most effective mechanism for the first step of biomass oxidation and for coal combustion. However, diffusion mechanisms were found to be responsible for the second step of biomass combustion.

Lip cancer: a 5-year review in a tertiary referral centre.

INTRODUCTION: Lip cancer is second only to skin cancer in terms of frequency in the head and neck region. Surgery is the treatment of choice for most of these cancers. Although there are several strategies to reconstruct lip tumours after tumour ablation, scarce attention has been paid to the impact of the specific reconstructive modality on recurrence and survival. PATIENTS AND METHODS: A retrospective review of 228 patients treated for lip cancer in the Head and Neck Surgery Department of the Portuguese Institute of Oncology Francisco Gentil, Lisbon, Portugal, from 1993 to 2000 with at least 2 years of follow-up was conducted. All the cases were evaluated for demographic features, tumour characteristics, lip reconstructive surgery used and recurrence and survival. RESULTS: There were 184 male and 44 female patients (4:1 ratio), with an average age of 67.6±13.3 years. Most tumours were squamous cell carcinomas (94.7%), and were located in the lower lip (99.5%). Squamous cell carcinomas were well differentiated in 70.8% of cases. Tumour size and neck staging were strongly correlated (Pearson's coefficient of 0.805; p<0.001). Microscopical signs of neuroinvasion or lymphatic invasion were associated an increased risk of death due to cancer (chi-square=18.5; df=3; p=0.016). The different strategies used for lip reconstruction after tumour ablation did not differ significantly in the probability of later recurrence or death. CONCLUSIONS: Our data seem to lend support to the classical view that the most significant aspect of lip cancer surgery is tumour ablation, and that this is not affected by the subsequent reconstructive strategy. Hence, this seems to indicate that experienced surgeons are rightly not willing to compromise complete excision of the tumour for the sake of an easier or better reconstruction.

Edema persistente de miembro inferior debido a quistes sinoviales en un paciente con artritis reumatoide / Persistent lower limb edema caused by synovial cysts in a patient with rheumatoid arthritis

Introducción. Las bursitis del iliopsoas son una entidad clínica poco frecuente como causa de compresión de estructuras vasculonerviosas de la región inguinal. Ésta a menudo se encuadra asociada a diversas patologías de la cadera y es raro encontrarla como entidad clínica aislada. Caso clínico. Se presenta el caso de un paciente de 75 años diagnosticado de artritis reumatoide de larga evolución, con edemas persistentes en miembro inferior derecho, así como dolor e incapacidad funcional de la misma cadera debido a una amplia sinovitis. Los estudios de imagen demuestran un quiste sinovial ectópico gigante del iliopsoas con compresión de las estructuras vasculares inguinales. Fue tratado, en principio, con punciones repetidas e infiltraciones de corticoides que no resolvieron el caso, por lo que se decide extirparlo quirúrgicamente, para en un segundo tiempo proceder a la sustitución total de la cadera. Conclusión. Los autores concluyen que la bursitis del iliopsoas debe ser considerada en la evaluación de los pacientes con dolor inespecífico de la ingle o la pelvis. El tratamiento con corticoides se debería intentar como alternativa previa a la cirugía

Introduction. Bursitis of the iliopsoas infrequently causes compression of the vascular and nerve bundle in the inguinal region. Compression of vascular and nerve structures in the inguinal region is more frequently associated with different hip conditions and is rarely found as an isolated clinical entity. Case report. We present the case of a 75 year old patient diagnosed with long term rheumatoid arthritis and persistent edema in his lower right leg. The patient also reported pain and had decreased functionality of his right hip due to a large synovitis. Images showed a giant ectopic synovial cyst on the iliopsoas with compression of inguinal vascular structures. The patient was initially treated with repeated punctures and steroid injections, but did not resolve. Therefore it was decided to excise the cyst surgically and subsequently, in a second operation, perform total hip replacement. Conclusion. The authors conclude that iliopsoas bursitis must be considered when patients with non-specific pain in the groin or pelvis are assessed. Steroid treatment must be used before deciding on a surgical approach

Nefropatía por reflujo. Estudio de 15 años / Reflux nephropathy. 15 year study

Introducción: La nefropatía por reflujo (NFR), constituye la complicación más importante del reflujo vesicoureteral (RVU). Material y método: Se estudiaron retrospectivamente 200 pacientes con RVU en un período de 15 años, en ellos se determinó el tiempo en que apareció la proteinuria, la hipertensión arterial (HTA), tipo de cicatriz y de reflujo. Resultados: El 9% de la serie estudiada (18 pacientes) evolucionaron a la nefropatía por reflujo, todos estos pacientes tenían RVU de alto grado y cuadros recurrentes de infección del tracto urinario (ITU), el 72,2% evolucionó a la NFR antes de los 5 años de evolución del RVU y de ellos el 76,1% tenían RVU secundario. La proteinuria se observó en el 100% de los casos, asociado, en ocasiones, a la HTA. Conclusiones: La presencia de cicatrices renales bilaterales en pacientes con reflujo vesicoureteral de alto grado, con infecciones urinarias recurrentes, unido a malformaciones del tracto urinario, representan los factores fundamentales que se relacionan con la aparición de la nefropatía de reflujo; constituye la proteinuria un elemento precoz y constante en pacientes que desarrollan una nefropatía por reflujo, la cual, unida a la hipertensión arterial, constituye un riesgo importante en el deterioro de la función renal en estos pacientes

Introduction: Reflux nephropathy (RN) is the main complication of vesicoureteral reflux (VUR). Material and methods: A retrospective study of 200 patients with VUR was made during 15 years. The time when proteinuria appeared, arterial hypertension, kind of scar and of reflux were determined. Result: Nine percent of the patients (18 individuals) developed RN, all of them had high grade VUR and also had frequent episodes of urinary tract infections (UTI). Seventy two percent of patients developed RN during the first five years after the diagnosis of VUR and 76.1% of them had secondary VUR. Proteinuria was observed in 100% of patients and it was accompanied by arterial hypertension in some patients. Conclusions: Bilateral renal scars in patients with high grade VUR, recurrent UTI associated to urinary tract malformations are the main risk factors for the developing of RN. Proteinuria is a constant and early element in patients with RN, and together with arterial hypertension are risk factors for the deterioration of renal function in these patients

Comparison of bone and total alkaline phosphatase and bone mineral density in postmenopausal osteoporotic women treated with alendronate.

Alendronate therapy in osteoporotic women decreases bone turnover and increases bone mineral density (BMD). Optimal patient management should include verification that each patient is responding to therapy. Markers of bone turnover and BMD have both been proposed for this purpose. We have investigated changes resulting from alendronate therapy with an enzyme immunoassay for bone alkaline phosphatase (BAP) and compared it with total alkaline phosphatase (TAP) and BMD of the lumbar spine, hip, and total body. Subjects were drawn from a multicenter randomized, placebo-controlled trial of alendronate in postmenopausal women with osteoporosis. BAP and TAP levels were measured at baseline and following 3, 6 and 12 months of therapy with either placebo (n = 180) or alendronate 10 mg/day (n = 134). All subjects also received 500 mg/day supplemental calcium. BMD was measured at baseline and following 3, 6, 12, 18, 24 and 36 months of therapy. To compare BAP, TAP and BMD at each site for identifying women that experienced a skeletal effect of alendronate, we calculated least significant change (LSC) values from the long-term intraindividual variability in each placebo-treated woman. Median levels of BAP decreased by 34%, 44% and 43% at 3, 6 and 12 months, respectively, in alendronate-treated women (p < 0.0001 compared with baseline and with placebo). These changes were significantly greater (p < 0.0001) than changes observed for TAP. Following 6 months of alendronate therapy, 90% of the women had experienced a decrease in BAP exceeding the LSC compared with only 71% for TAP. The greatest number of women similarly identified with BMD at any site (i.e. a gain in BMD exceeding the LSC) was 81% for spinal BMD at 36 months. All other sites were less than 70% at 36 months. Short-term changes in BAP and TAP were modestly associated with subsequent changes in BMD at all sites (Spearman's rho -0.22 to -0.52, p < 0.05). Compared with TAP and BMD, BAP testing rapidly and sensitively identified skeletal effects of alendronate thus enabling appropriate drug monitoring of osteoporotic women. Though BAP and TAP changes were modestly predictive of BMD changes, the value of the bone marker tests is their ability to detect rapidly a skeletal effect of therapy.

A comparison of the effect of different bicycle helmet laws in 3 New York City suburbs.

OBJECTIVES: This study was conducted to evaluate the effectiveness of 3 different bicycle helmet laws. METHODS: A direct observational study of nearly 1000 cyclists at 20 matched sites in each of 3 contiguous counties--Rockland and Westchester in New York and Fairfield in Connecticut--was carried out. Rockland's bicycle helmet law requires approved helmets for all cyclists regardless of age; Westchester's, by state law, requires cyclists younger than 14 years to wear helmets; and Fairfield's, also by state law, requires cyclists younger than 12 years to wear helmets when riding on highways. RESULTS: Rockland cyclists had the highest helmet use rate (35%), followed by Westchester (24%) and Fairfield (14%) cyclists. As a subgroup, teenagers used helmets least, a trend that was seen in all 3 counties. CONCLUSIONS: Our study suggests a positive effect of bicycle helmet legislation with no age limitation.

Factors affecting broadband ultrasound attenuation results of the calcaneus using a gel-coupled quantitative ultrasound scanning system.

This study aimed to assess the factors that may influence the distribution and description of broadband ultrasound attenuation (BUA) and to identify specific criteria for diagnostic consideration when collecting BUA reference data. Two hundred Caucasian women (aged 20-79 years) without a history of atraumatic fractures or medicines known to affect bone metabolism were selected for this study. Medical and menstrual history, medication usage, family history of osteoporosis (FHO), physical activity, activities of daily living (ADL), dietary calcium intake, as well as smoking and alcohol consumption were obtained. Broadband ultrasound attenuation (BUA, dB/MHz) was determined in the right foot using a new gel-coupled ultrasound system. BUA was significantly associated with age (p<0.001), body weight (p<0.001), level of physical activity (p = 0.024) and dietary calcium intake (p = 0.023). Smoking, alcohol and coffee consumption and ADL were not associated with BUA (p>0.05). There were no differences in BUA (p>0.05) between those women who reported taking medications or had diseases (known to not affect bone metabolism), were using contraceptives, taking vitamin/mineral supplements and/or had traumatic fractures and their counterparts who did not report these characteristics. Premenopausal women with a FHO had significantly lower BUA values compared with those without a FHO (p = 0.013). When those participants with a FHO were removed from the sample, the peak BUA value was 1.1-4.4% higher and the variability (SD) was reduced by about 3.3-9.3% depending on which age range was used to define the peak BUA value. Consequently, an additional 4.5% of the population were classified as having a T-score <-2. Our results suggest that the impact on BUA of risk factors such as a FHO, body weight, physical activity and dietary calcium intake is similar to that on bone mineral density obtained by dual-energy X-ray absorptiometry (DXA), and thus provides further information on the comparability of quantitative ultrasound and DXA for assessment of risk of fracture. The criteria for calculating the T-score need further study to determine whether young adults with FHO should be included and what cutoff age range should be used in collecting peak values of quantitative ultrasound parameters.

Fetal fibronectin: a new tool for the prediction of successful induction of labor.

OBJECTIVE: The Bishop score is the only available tool for predicting successful labor induction. Vaginal fetal fibronectin has been shown to predict which patients will enter labor spontaneously, usually within 2 weeks. This study was designed to determine whether fetal fibronectin can also predict the success of labor induction. STUDY DESIGN: Term patients undergoing labor induction had a single swab from the vagina tested for fetal fibronectin before initiation of cervical ripening or oxytocin. The swab was tested with a blinded qualitative immunoassay for fetal fibronectin (positive > or = 50 ng/ml). RESULTS: Of the overall 160 subjects, 108 had a positive and 52 had a negative fetal fibronectin result. Patients with a positive result had a lower cesarean section rate (15% vs 27%, p = 0.05) and shorter intervals to delivery, including first dose of prostaglandin to delivery interval (21.3 vs 35.8 hours, p = 0.0001) and first stage of labor (14.8 vs 21.2 hours, p = 0.0009). These differences remain similar even in nulliparous women with Bishop scores < or = 5, with patients with positive results having statistically shorter intervals to delivery and similar differences in cesarean section rates (22% vs 35%), although this difference was not significant. In this subgroup more than half the patients in the negative results group (11/20) were undelivered after 24 hours and were judged to require a second dose of prostaglandin compared with only 2 of 53 in the group with positive results (p = 0.000001). By stepwise logistic regression analysis the predictive ability of a positive result for fetal fibronectin was found to be independent of the Bishop score. CONCLUSIONS: Vaginal fetal fibronectin appears to be an efficacious new test that independently predicts which patients will have shorter and easier inductions of labor and lower cesarean section rates, even nulliparous patients with low Bishop scores. This test has the potential for clinical utility and cost reduction.

Value of fetal fibronectin as a predictor of preterm delivery for a low-risk population.

OBJECTIVE: We examined clinical value of cervical fetal fibronectin detection by a quantitative enzyme-linked immunosorbent assay as a predictor of preterm delivery in a population (n = 111) of middle-class pregnant women considered to be at low risk for preterm delivery. STUDY DESIGN: In this prospective study, fetal fibronectin samples from cervicovaginal secretions were obtained biweekly from 24 to 34 weeks' gestation. RESULTS: Twenty-two (20%) patients had at least one positive fetal fibronectin test result. Eleven women (10%) were delivered spontaneously at < 37 weeks; seven of these had at least one positive fetal fibronectin test result (positive predictive value = 31.8%, sensitivity = 63.6). An additional three women were delivered prematurely because of other obstetric indications, and all had negative fetal fibronectin test results. The remaining 15 patients with at least one positive fetal fibronectin test result were delivered at term (> or = 37 weeks). Of the seven women with positive fetal fibronectin results who were delivered prematurely, five were delivered within 2 weeks of obtaining a positive result. However, there were no obvious clinical discriminators between true-positive and false-positive fetal fibronectin results. Eighty-nine women tested negative, and 85 of these women were delivered at term (specificity = 82.0%). The negative predictive value of fetal fibronectin as a predictor of term delivery in this low-risk population is 96.6%, with odds ratio = 8.8 (95% confidence interval 1.9 to 40.3), relative risk = 6.9 (95% confidence interval 1.8 to 26.6), and Fisher Exact Test p = 0.007. CONCLUSIONS: Although negative biweekly fetal fibronectin determinations for prediction of preterm delivery in this low-risk obstetric population correlate well with the absence of preterm delivery, they are of limited clinical value for the prediction of preterm birth.

Effects of 2,000 kcal per week of walking and stair climbing on physical fitness and risk factors for coronary heart disease.

BACKGROUND: Epidemiologic evidence suggests that 8,368 kJ or 2000 kcal per week of moderate physical activity, including walking and stair climbing, can reduce risk of coronary heart disease (CHD). The goal of this study was to assess the effects of this amount of these two activities on physical fitness and risk factors for CHD. METHODS: Twenty-two healthy, slightly overweight, sedentary, normotensive, normolipemic men, age 22 to 44 years, were randomly assigned to an exercise or control group for 12 weeks followed by a 4-week washout period. The subjects then were crossed-over to the alternate group for an additional 12-week period. Exercise consisted of 5 days per week of supervised treadmill exercise plus stair climbing. Treadmill exercise consisted of walking for 45 minutes at 5.15 km per hour at 2% grade for a total of 19.3 km per week. Subjects also climbed 10 floors of stairs at a time at their own pace without prescribed target heart rates for a total of 50 floors per week. The estimated total weekly energy cost of the treadmill walking plus stair climbing was 8,368 kJ or 2,000 kcal. Mean observed heart rates were 55% and 82% of maximal heart rate during treadmill walking and stair climbing, respectively. Data from the two exercise periods and two control periods were pooled and compared by analysis of variance. RESULTS: Sixteen subjects completed all phases of the study. Maximal oxygen uptake (VO2max) by the Bruce treadmill exercise protocol with metabolic gas measurements was below average for age at baseline, and was not significantly affected by 12 weeks of training. No significant changes were noted between groups in body weight or percent body fat (hydrostatic weighing), although there was a trend for loss of weight and fat with exercise training. Mean systolic blood pressure (119 mm Hg) was unchanged in both groups. However, diastolic blood pressure (72 mm Hg and 78 mm Hg for the treatment and control groups, respectively) showed an unexpected 6 mm Hg increase during the exercise period and a 5 mm Hg decline during the control period. Mean plasma lipid and lipoprotein levels were unaffected by training, except for a 16% reduction in triglycerides (P < .05). However, a 28% increase in plasma high density lipoprotein (HDL)-cholesterol (P < .01) was noted during the initial 12-week training period, which regressed during the washout period, and was not replicated during the second 12-week exercise period. CONCLUSIONS: Twelve weeks of walking and stair climbing at a moderate pace and intensity at an energy cost of about 2,000 kcal per week failed to improve physical fitness or risk factors for CHD. A reduction in physical activities other than the prescribed exercise program, as reported by a physical activity recall questionnaire, probably contributed to an absence of an exercise response. A longer and/or a more intense activity program is apparently required to improve these modalities.

Regulation of fetal fibronectin production in human amnion cells.

OBJECTIVE: We evaluated the role of human amnion in the production of fetal fibronectin and assessed the regulation of fetal fibronectin production by inflammatory products and cytokines. METHODS: Human amnion cells were grown in culture. At confluence, the cell were incubated with and without lipopolysaccharide, interleukin-1 beta, tumor necrosis factor-alpha, and interleukin-6. Fetal fibronectin production was measured in the supernatant fluid using an enzyme-linked immunosorbent assay technique. RESULTS: Unstimulated amnion cells produced fetal fibronectin, and production was increased by lipopolysaccharide, interleukin-1 beta, tumor necrosis factor-alpha, and interleukin-6. CONCLUSION: Human amnion cells in vitro produce fetal fibronectin in substantial quantities. This production is stimulated by inflammatory products and mediators that are considered to be important in the initiation of some cases of preterm labor.

Fetal fibronectin in vaginal specimens predicts preterm delivery and very-low-birth-weight infants.

OBJECTIVE: The purpose of this study was to evaluate the association of vaginal fetal fibronectin expression to risk of preterm delivery and delivery of very-low-birth-weight infants. STUDY DESIGN: Vaginal secretions were obtained from women between 22 and 35 weeks' pregnant with minimal cervical dilation (< or = 2 cm) and threatened preterm delivery. The secretions were analyzed for the presence of fetal fibronectin. Other clinical information including cervical dimensions, uterine activity, serum C-reactive protein concentration, vaginal pH, evidence of vaginal or systemic infection, and vaginal bleeding were also obtained. RESULTS: Of the 112 patients recruited, 40 (35.7%) were delivered prematurely (<37 weeks). For prediction of preterm delivery, the fetal fibronectin test result had a sensitivity, specificity, and positive and negative predictive values of 67.5, 90.3, 79.4, and 83.3%, respectively (odds ratio 19.3, p < 0.0001). Women with a positive fetal fibronectin test had a nearly 13-fold increased probability of being delivered of an infant weighing <1500 gm than did women with a negative fetal fibronectin test (32.4% vs 2.5%, p<0.0001). Categoric analysis and multiple logistic regression demonstrated that fetal fibronectin was an independent risk factor for prediction of preterm delivery and birth weight <1500 gm. CONCLUSION: Vaginal fetal fibronectin expression is an independent risk factor for preterm delivery and birth of very-low-birth-weight infants in symptomatic women with intact amniotic membranes and minimal cervical dilatation.

Calf blood pressure: clinical implications and correlations with arm blood pressure in infants and young children.

OBJECTIVE: Indirect measurement of lower extremity blood pressure is often used in the clinical setting, although normative data after the newborn period are not readily available. METHODS: Indirect blood pressure (BP) measurement was obtained in the right arms and right calves of 148 healthy infants and young children 2 weeks to 3 years of age. All measurements were made using an oscillometric device. The infants and children are quiet or asleep and in the supine position. A BP cuff of proper size was chosen. Three measurements were made in both extremities; the average of the second and third measurements was used for all analyses. RESULTS: Age correlated better with calf systolic blood pressure (SBPc) than with arm SBP (SBPa) (r = .52 vs .17). Calf diastolic blood pressure (DBPc) and calf mean blood pressure (MBPc) correlated moderately poorly with age (r = .37 and .39, respectively). There was no order effect. SBPc correlated best with height (r = .53), then age (r = .52), and, finally, weight (r = .51). The correlation between BPc and BPa was moderately low. The correlation of SBPc with SBPa was r = .46; that of DBPc with DBPa was r = .37; and that of MBPc with MBPa was r = .41. From birth to 6 months, SBPc was slightly lower than SBPa (1 to 3 mm Hg). SBPc increased linearly relative to SBPa and began to exceed SBPa at 6 months of age. The pattern of DBP and MBP was similar. Wide variability of blood pressure parameters was noted between the infants and children at all ages. CONCLUSIONS: Reference data are presented for BPc and the difference between BPc and BPa in healthy infants and children from 2 weeks to 3 years of age. BPc is not equivalent to BPa and should not be arbitrarily substituted. Because of the wide variability among healthy infants and children, SBPc measurements should be interpreted with caution when evaluating for coarctation of the aorta.