Abdominal fat distribution differently affects muscle strength of the upper and lower extremities in women.

BACKGROUND/OBJECTIVES: In obese subjects, reduced muscle mass and strength are associated with impaired functional and metabolic capacity. We therefore investigated the association between abdominal fat distribution, fat mass index and maximum muscle strength of upper and lower extremities in obese patients. SUBJECTS/METHODS: One hundred and fifty five outpatients with a body mass index (BMI)⩾30 kg/m2 (105 women; 45.1±14.6 years; BMI 43.5±8.2 kg/m2) were included in the study. Grip and knee extension strength were measured with dynamometers. Using bioelectric impedance analysis, fat-free mass and fat mass indices (FFMI, FMI) were calculated. The influence of age, weight, FFMI, FMI and waist-to-hip ratio (WHR) on grip and knee extension strength was investigated in a risk factor-adjusted regression analysis. RESULTS: BMI did not correlate with hand grip or knee extension strength. The regression model confirmed a positive effect of higher weight on strength parameters; however, increased FMI was shown to have a negative effect on strength in both sexes (women, knee: ß: -1.495, confidence interval (CI): -2.075 to -0.0914, P<0.0001; women, hand: ß: -0.714, CI: -1.156 to -0.273, P=0.002; men, hand: ß:-1.448, CI: -2.618 to -0.278, P=0.016). Although increased WHR positively influenced knee extension strength (ß: 24.286, CI: 0.728-47.844, P<0.043), it did not affect grip strength in women. This association was not seen in men. CONCLUSIONS: Body fat distribution rather than BMI alone needs to be considered when evaluating strength parameters in obesity. As the relationship between obesity and strength of the upper versus lower extremities differs, grip strength cannot be considered an indicator of whole body strength in obese individuals.

The exercise-induced myokine irisin does not show an association with depressiveness, anxiety and perceived stress in obese women.

Irisin has recently been proposed to act as a myokine secreted from skeletal muscle following exercise and to exert several health-beneficial effects, although its role is far from being established. In contrast to the growing body of literature on the biological regulation and function of irisin, there is no evidence on potential associations with mental functions. Since physical activity has been reported to have favorable impact on mental functions, we investigated the association of irisin with depressiveness, perceived stress, and anxiety as well as eating disorder symptoms in obese women. We included 98 female obese inpatients (age: mean ± S.D. 43.9 ± 12.5 years; body mass index 49.2 ± 8.3 kg/m(2)) covering a broad spectrum of psychopathology. Depressiveness (PHQ-9), perceived stress (PSQ-20), anxiety (GAD-7), and eating disorder symptoms (EDI-2) were assessed psychometrically. Plasma irisin obtained at the same time was determined by ELISA. Irisin did not correlate with depressiveness (r = -0.03, P = 0.80), anxiety (r = 0.14, P = 0.17) and perceived stress (r = -0.14, P = 0.18) as well as eating disorder symptoms in general (r = -0.09, P = 0.39). No correlation of irisin was observed with any subscales of the PSQ-20 and EDI-2 (after Bonferroni correction). In conclusion, irisin is not associated with depressiveness, anxiety and perceived stress in female obese patients. These results do not support the assumption of irisin being involved in psychoendocrine pathways of the regulation of depression or other mental functions such as anxiety and perceived stress.

Intraoperative indocyanine green videoangiography for identification of pituitary adenomas using a microscopic transsphenoidal approach.

PURPOSE: Initial successful surgical treatment of pituitary adenomas is crucial to reach long-term remission. Indocyanine green (ICG) videoangiography (VA) is well established in vascular neurosurgery nowadays and several reports described ICG application in brain tumor surgery. We designed this study to evaluate the feasibility of intravenous application of ICG and visualisation of a pituitary lesion via the fluorescence mode of the operation microscope. METHODS: 22 patients with pituitary adenomas were treated with transsphenoidal microsurgery and were included in this study. Intraoperatively 25 mg ICG was administered intravenously and visualized via the fluorescence mode of the operation microscope (Pentero/Zeiss). RESULTS: 22 patients qualified for transsphenoidal surgery presenting with different clinical symptoms (13 patients with acromegaly, 6 with M. Cushing and 3 with other symptoms like vision disorder or dizziness) and identification of a pituitary lesion (21 of 22 patients) in preoperative MR-imaging (mean diameter: 9 mm; SD 3.6; 6 macroadenomas, 15 microadenomas, 1 MR-negative). In all 22 patients ICG VA was performed during surgery. No technical failures or adverse events after drug administration occurred. Visualization was optimal approximately 2.4 min after intravenous application. In all patients the adenoma could be detected via two different types of visualization: direct visualization by fluorophore emission versus indirect detection of the adenoma by a lower ICG fluorescence compared to the surrounding tissue. CONCLUSION: Our data show that intraoperative ICG VA can be a useful and easily applicable additional diagnostic tool for visualization of pituitary lesions using the microscopic approach.

[Procedure selection and technique of metabolic surgery]. / Verfahrenswahl und Technik der metabolischen Chirurgie.

Metabolic surgery is becoming an impressive therapeutic option for type 2 diabetes mellitus and other metabolic diseases. Compared to conservative therapy bariatric procedures, such as gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion, seem to achieve significantly higher remission rates and improvements in blood glucose metabolism. Recent studies describe additional effect mechanisms which go beyond the assumed mechanisms of restriction and malabsorption. The results in the current literature suggest that gastric bypass and sleeve gastrectomy provide the best metabolic risk-benefit profiles. Gastric banding and biliopancreatic diversion can only be recommended in specific cases.

[Chronic musculoskeletal pain syndrome in primary hyperparathyroidism]. / Chronisches muskuloskelettales Schmerzsyndrom bei primärem Hyperparathyreoidismus.

Chronic somatic pain disorders with somatic and mental factors (ICD-10: F45.41) are common among psychosomatic patients. In the present case, due to the close temporal association with a trauma and the subsequent development of symptoms including depressive symptoms, a chronic pain disorder with a relevant somatoform component was suspected. However, after a period of several months without significant somatic findings, targeted diagnostic approaches resulted in the diagnoses of primary hyperparathyroidism and a papillary thyroid carcinoma. Surgical therapy resulted in an almost complete decline of symptoms within a short period of time.

[Occupational integration of schizophrenic patients under current treatment conditions]. / Zur beruflichen Integration schizophrener Patienten unter derzeitigen Behandlungsbedingungen.

A cross-sectional study was carried out in Göttingen, Germany, including 100 schizophrenic patients mostly under outpatient treatment. Data were collected concerning the course of the illness, the premorbid and present living circumstances and the self-assessment of those. The average age of the patients (42 female, 58 male) is 38 years, 82% are living without a partner. About one third are chronically ill, another third relapse frequently or suffer from residual symptoms. 84% take neuroleptic medication on a regularly basis. At first manifestation of the illness 84% are employed or undergoing vocational training. After a mean illness duration of 11 years only 34% of the patients are employed on the general or the sheltered labour market. The financial situation is closely connected with the vocational integration of the patients. 43% have a monthly income of less than DM 1000.-(645 US$) and 69% do have an income of less than DM 1500.-(967 US$) per month.