Blood pressure relation to body composition and age: analysis of a nurse-led investigation and consultation program.

BACKGROUND: Blood pressure (BP) increases with age and obesity. We have assessed the relative contribution of age and fatness to BP regulation in a healthy population investigated by nurse practitioners. MATERIAL AND METHODS: Preventive investigation and counseling was offered at the entrance hall of the regional authority´s office in the town of Nitra by 2 nursing specialists who investigated 120 men and 276 women. In men the mean body mass index (BMI) was 26.8 kg/m2, mean weight was 84.4 kg, mean fat percentage was 23.3, mean age was 46.1 years, mean systolic BP was 133.1 mmHg, and mean diastolic BP was 82.5 mmHg. In women the mean BMI was 24.8 kg/m2, mean weight was 67.3 kg, mean fat percentage was 29.4, mean age was 45.4 years, mean systolic BP was 127.7 mmHg, and mean diastolic BP was 78.5 mmHg. Correlation analysis was performed and in multiple regression analysis we used BP values as the dependent variable and fat percentage and age as independent variables. Normality of variables distribution was checked and found satisfactorily. RESULTS: Most of the subjects had an untreated component of metabolic syndrome. There was a correlation between BP values, age, and percent body fat. BP was regulated only to a certain degree by fatness and age, with the influence being relatively small. Our results showed that BP was more influenced by fatness than age, and body fatness was more related to higher systolic than to diastolic BP. CONCLUSIONS: Age and fatness could explain BP values by only 3-30%, although BP was more influenced by fatness than by age. Nurse practitioners can effectively detect and motivate people with metabolic syndrome.

High-dose selenium substitution in sepsis: a prospective randomized clinical trial.

OBJECTIVE: Systemic inflammatory response syndrome (SIRS) and sepsis remain the leading cause of death in the critically ill. A reduction in the antioxidant capacity, including selenoenzymes that are dependent on selenium (Se), could be a contributing factor. Se supplementation in septic patients have yielded conflicting results. We hypothesized that a high-dose Se supplementation would (1) improve markers of inflammation, nutrition and antioxidant defence, and (2) decrease mortality. METHODS: This prospective, randomized, open-label, single-centre clinical trial included 150 patients with SIRS/sepsis and a SOFA score of >5. Patients in the Se+ group (n = 75) received Se for 14 days (1,000 µg on day 1,500 µg/day on days 2-14). Patients in both the control (Se-) group (n = 75) and the Se+ group received a standard Se dose (<75 µg/day). Plasma Se, whole-blood glutathione peroxidase (GPx) activity, C-reactive protein (CRP), procalcitonin (PCT), albumin, prealbumin and cholesterol levels, along with APACHE II and SOFA scores, were determined at baseline and on days 1-7 and day 14. Mortality was assessed at day 28. RESULTS: Plasma Se and GPx activity were increased in the Se+ group from day 1 onwards. Negative correlations were demonstrated between plasma Se, CRP (P = 0.035), PCT (P = 0.022) and SOFA (P = 0.001) at admission but not on days 7 or 14. Prealbumin and cholesterol increased in the Se+ group versus the respective baselines. Mortality was similar between groups, with no gender differences. CONCLUSION: High-dose Se substitution in patients with SIRS/sepsis increased plasma Se and GPx levels, but did not reduce mortality. Markers of inflammation were reduced similarly in both groups.

Selected metabolic parameters and the risk for uterine fibroids.

OBJECTIVE: To analyze the possible association between insulin resistance and dyslipidemia with uterine fibroids, using objective metabolic measurements. METHOD: A cross-sectional study of 56 women with uterine fibroids (case group) and 20 women without fibroids (control group). Levels of fasting glucose, insulin, C-peptide, sex hormone-binding globulin, and the lipid panel were measured. The short insulin tolerance test was performed. Body mass index, atherogenic index, and the indicator of insulin resistance (Kitt) were also calculated. RESULTS: Women with fibroids had significantly higher levels of serum HDL-cholesterol compared with control patients (1.8+/-0.3 vs 1.6+/-0.5; P<0.05). Women with fibroids aged 30-45 years had significantly lower LDL-cholesterol levels than comparative control patients (2.9+/-0.7 vs 3.4+/-0.9; P<0.05). A positive correlation between volume of the largest fibroid and serum HDL-cholesterol level was found in women aged 30-45 years. There were no differences in indicators of insulin resistance between the groups. CONCLUSION: Insulin resistance was not shown to be a risk factor for fibroids. There is a negative association between some parameters of metabolic syndrome and fibroid volume.

Effects of selective blockage of utero-ovarian anastomoses on clinical results of uterine artery occlusion.

BACKGROUND: We assessed the results and impact of blockage of utero-ovarian anastomoses (UOA) on clinical outcome in women treated by laparoscopic uterine artery occlusion for uterine fibroids. METHODS: Between 2004 and 2005, we prospectively analyzed the clinical data for 23 laparoscopic uterine artery occlusion cases combined with blockage of utero-ovarian anastomoses (Group A) and 67 laparoscopic uterine artery occlusion cases alone (Group B). RESULTS: Of these 23 patients with UOA (mean age, 36.7+/-2.8 years), 10 patients (43.4%) had anastomoses bilaterally and 13 patients (56.6%) had unilateral anastomoses. Mean fibroid size reduction after LUAO and anastomoses blockage was 32.5% from baseline (P<0.001). In patients with LUAO, the mean DF size after surgery was estimated at 38.7+/-19.2 mm, which translated to a mean fibroid size reduction of 30.6% from baseline (P<0.001). No case of clinical failure or recurrence was found in Group A patients with UOA (mean follow-up, 15.6 months), who were treated with combined surgery. At a mean clinical follow-up of 18.2 months (Group B), 6 patients (8.9%) elected to undergo further surgical intervention for clinical failure and recurrence, including 4 myomectomies and 2 hysterectomies. The statistical difference between groups was not significant (P=0.33). CONCLUSION: Laparoscopic blockage of utero-ovarian anastomoses combined with uterine artery occlusion is a safe, feasible surgical procedure in women with symptomatic fibroids. Combining the uterine artery occlusion and blockage of UO anastomoses may be a useful procedure for the decreasing rate of clinical failure and recurrence. This premise should be confirmed in a larger prospective multicenter study.

Cystatin C as a marker of residual renal function during continuous hemodiafiltration.

BACKGROUND: The level of residual renal function (RRF) has an important impact on follow-up in critically ill patients with renal failure. There is currently no clear marker of RRF. METHODS: Cystatin C (cysC) concentrations were measured before and during the first 48 h of CVVHDF in 33 mechanically ventilated patients suffering from renal failure. Samples were drawn both from the ports proximal and distal to the filter. Each of the two control groups consisted of 10 patients. RESULTS: The levels of cysC were significantly higher in the group where diuresis (Vu) remained low or decreased after 48 h of treatment (n = 21, Vu median 380 (80-935) ml/24 h, cysC range 4.44-3.42 mg/l) than in the group where Vu increased to the level of 1.5 ml.kg(-1).h(-1) or higher after 48 h of treatment (n = 12, Vu 4,570 (4,000-5,130) ml/24 h, cysC 3.17-2.46 mg/l, p < 0.01). Creatinine clearance taken before treatment was not different between the groups. Significant correlation between cysC levels and Vu was found (r = -0.44, p < 0.0001). CysC levels were significantly higher in non-survivors than in survivors (3.54 +/- 1.38 vs. 3.07 +/- 1.24, p < 0.03). CONCLUSION: The levels of cysC are inversely related to Vu. High levels of cysC are associated with low residual diuresis, longer duration of CVVHDF and higher intensive care unit mortality in patients treated with CVVHDF.

Relationship between natriuretic peptides and residual diuresis during continuous hemodiafiltration.

BACKGROUND: The reasons for the decrease or increase of urine output following the start of continuous venovenous hemodiafiltration (CVVHDF) have not yet been explained sufficiently. The renoprotective properties of natriuretic peptides were described. METHODS: The levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured in 23 mechanically ventilated patients before and during the first 48 h of CVVHDF. Samples were drawn both from the ports proximal and distal to the filter. The results were compared between the group where daily diuresis (Vu) remained low or decreased and the group where diuresis increased to the level of 1.5 ml x kg(-1) x h(-1) or higher after 48 h of treatment. Left ventricular dysfunction (LVD) was defined as LV ejection fraction below 40%. A control group consisted of 10 patients exposed to abdominal surgery. RESULTS: The average AVdiff (%) of ANP and BNP on filter were insignificant. Patients with increasing diuresis (n = 12) had significantly lower levels of both ANP (p < 0.001) and BNP (p < 0.005) than the patients with decreasing diuresis (n = 11). Significant correlations were revealed for ANP and Vu (p < 0.01) and for BNP and Vu (p < 0.05). The levels of both peptides were grossly elevated in comparison to controls and were predictive of survival. The differences between cardiac and non-cardiac patients were significant both for ANP and for BNP. CONCLUSIONS: The elimination of ANP and BNP by the CVVHDF is negligible. The levels of natriuretic peptides are inversely related to Vu and predict survival. ANP and BNP levels correlate with left ventricular function even during acute renal failure and CVVHDF.

Laparoscopic surgery in women with endometrial cancer: the learning curve.

OBJECTIVE: The aim of this study was to assess the effect of increasing surgeons's experience in the laparoscopic surgery of women with endometrial cancer (EC) on the surgical outcome of these patients. STUDY DESIGN: Data were obtained from a prospectively collected database of 108 patients two oncolaparoscopic centers in Czech Republic who underwent laparoscopically assisted surgical staging (LASS) from April 1996 to March 2001. Patients were arranged in chronological order and divided into three groups, based on the date of their surgery. The three groups were compared in patient characteristics and surgical outcome using one-way analysis of variance (ANOVA) and Wilcoxon rank sum test. SETTING: Department of Obstetrics and Gynecology, Endoscopic Training Center, Baby Friendly Hospital Kladno, Czech Republic. RESULTS: The three groups were similar in patient characteristics. Operative times for laparoscopic staging with pelvic lymphadenectomy (LN) decreased significantly from mean of 156.3 min for group 1 to 142.8 min for group 3 (P < 0.05). In cases LASS with pelvic lymphadenectomy was significant increase in the number lymph nodes harvested (12.4 for group 1, 13.9 for group 2, and 15.4 for group 3, P < 0.05). In cases LASS without lymphadenectomy was not significant difference in operating time, estimated blood loss, rate of conversion to laparotomy, operative complications, and length of hospital stay among the compared groups. The number of patients who underwent para-aortic lymphadanectomy was too small (n = 22), and their distribution was asymmetrical for comparison. CONCLUSION: A learning curve is demonstrated in the LASS of women with endometrial cancer. With increasing surgeon's team experience, there is significant decrease in operative time for staging with pelvic lymph node dissection and increase in the number of pelvic lymph nodes removed. The para-aortic lymphadenectomy (PALN) was found to be more challenging than pelvic lymphadenectomy.

Effect of the degree of tricuspid regurgitation on cardiac output measurements by thermodilution.

OBJECTIVE: To determine the relationship between the degree of tricuspid regurgitation (TR) and accuracy of cardiac output measurement by thermodilution in mechanically ventilated patients. DESIGN AND SETTING. Prospective observational study in a 20-bed general intensive care unit in the university hospital. PATIENTS: We examined 27 patients (not undergoing cardiac surgery): 8 with no or 1st degree TR, 9 with 2nd degree, and 10 with 3rd degree TR. INTERVENTIONS: All patients were measured twice using simultaneously transesophageal echocardiography and pulmonary artery catheter for cardiac output. MEASUREMENTS AND RESULTS: Continuous Doppler measurements were taken in the left ventricular outflow tract at the level of the aortic valve. Cardiac output was calculated by multiplying the velocity-time integral by aortic valve area and heart rate. Simultaneous pulmonary artery catheter measurements were taken averaging the results of the three 10-cc boluses of iced saline. The difference between the methods was 0.5+/-1.1 l/min (mean +/-2 SD) in patients with no or 1st degree TR (r=0.96), 0.8+/-2.0 l/min in those with 2nd degree TR (r=0.92), and 1.9+/-2.3 l/min in those with 3rd degree TR (r=0.69). CONCLUSIONS: A high degree of TR is associated with underestimation of cardiac output measured by thermodilution.