Hypertension Is Associated with White Matter Disruption in Apparently Healthy Middle-Aged Individuals.

BACKGROUND AND PURPOSE: Traditional cardiovascular risk factors have been associated with white matter disease. Because hypertension results in vascular stiffness and impaired cerebral perfusion, we hypothesized that it would be the most relevant risk factor for microstructural white matter disruption in apparently healthy middle-aged individuals with a family history of early-onset coronary artery disease. MATERIALS AND METHODS: This was a cross-sectional analysis of participants in the Genetic Study of Atherosclerosis Risk with DTI. Regional fractional anisotropy of 181 segmented brain regions was measured using Eve WM Atlas. Risk factors were examined using univariate analysis for 48 regions representing deep WM structures. Minimal multivariable linear regression models adjusting for age, sex, and race and maximal linear regression models adjusting for cardiovascular risk factors were performed for regions meeting the Bonferroni threshold in the initial analysis. RESULTS: Included were 116 subjects (mean age, 49 ± 11 years; 57% men) with a moderate load of cardiovascular risk factors. Subjects with hypertension had significantly lower regional fractional anisotropy in the right cingulum and left stria terminalis in the minimal and maximal regression models. Additionally, there was lower regional fractional anisotropy in the left fornix in the maximal model and right sagittal stratum in the minimal model. Systolic blood pressure values were significantly associated with regional fractional anisotropy in the left superior longitudinal fasciculus in the maximal model. There were no significant differences among regional fractional anisotropy values for other cardiovascular risk factors. CONCLUSIONS: In middle-aged apparently healthy individuals with susceptibility to vascular disease, among all known cardiovascular risk factors, hypertension was associated with microstructural WM disruption.

Absceso cerebral por Nocardia spp. en pacientes inmunocompetentes: presentación de 2 casos / Cerebral abscess by Nocardia spp. in immunocompetent patients: report of 2 cases

Nocardia corresponde a un género de bacterias gram positivo que puede producir compromiso pulmonar, sistémico y abscesos cerebrales, especialmente en pacientes inmunocomprometidos. La infección cerebral por Nocardia spp es extremadamente infrecuente en pacientes inmunocompetentes, por lo cual se reportan dos casos: caso 1: mujer de 61 años, sana, consulta por cefalea y paresia en hemicuerpo izquierdo. Estudio con TAC y RM de encéfalo demuestran absceso cerebral. Se inició tratamiento con ceftriaxona mas cloxacilina y fue drenado quirúrgicamente. En el cultivo del LCR se aisló Nocardia spp. cambiándose esquema a cotrimoxazol con meropenem por 6 semanas. Caso 2: varón de 72 años, hipertenso y tabáquico crónico. Consultó por cefalea, paresia de extremidad inferior derecha y pérdida de visión de ojo derecho. Estudio con TAC y RM de encéfalo objetiva absceso cerebral parietal izquierdo. Se inició tratamiento con ceftriaxona, metronidazol y vancomicina. Se realizó drenaje quirúrgico. El cultivo de absceso resultó positivo para Nocardia spp, ajustándose esquema a cotrimoxazol y meropenem por 6 semanas. Requirió tratamiento prolongado por presentar lenta regresión clínica e imagenoló- gica.

Nocardia is a gram positive bacterial genus. Is involved in pulmonary, systemic and brain abscess usually in immunocompromised patients. Nocardia spp. brain infection is extremely rare in immunocompetent patients, hereby we report 2 cases: case 1: 61 years old woman, without morbid conditions, consulted for headache and left hemiparesis. Study with CT and MRI of encephalon shows brain abscess. Treatment with ceftriaxone plus cloxacilin and surgical drainage were started. In CSF culture, Nocardia spp. was obtained. Scheme was changed to cotrimoxazole with meropenem to complete 6 weeks. Case 2: male of 72 years old, history of smoking and hypertension. Consulted for headache, paresis of right leg and loss of vision of the right eye. CT and MRI showed left parietal brain abscess. Treatment with ceftriaxone, metronidazole and vancomycin were started. Surgical drainage was performed. Abscess culture was positive for Nocardia spp., adjusting scheme to cotrimoxazole and meropenem for 6 weeks. It required prolonged treatment due to slow imaging and clinical regression.

Calidad de vida y satisfacción postquirúrgica en pacientes pediátricos operados de pectus excavatum mediante técnica de nuss / Quality of life and postsurgical satisfaction among pediatric patients operated on for pectus excavatum using nuss procedure

Antecedentes: El Pectus excatavum es la deformidad congénita más frecuente de la pared anterior del tórax. Esta condición es abordada quirúrgicamente por causas estéticas y/o funcionales. La técnica quirúrgica de Nuss destaca por tener mejores resultados estéticos y menor grado de traumatismo y complicaciones en comparación con otras técnicas. El objetivo del presente estudio fue conocer el cambio en la calidad de vida y el grado de satisfacción post operatoria, en los pacientes pediátricos y sus padres, operados mediante técnica de Nuss. Pacientes y Método: Se realizó un estudio descriptivo, de cohorte única, sometiendo a los pacientes y a sus padres a evaluación de la calidad de vida y satisfacción post operatoria mediante el cuestionario de Nuss y Krasopoulos, siendo los datos analizados, en base al n de la muestra, mediante mediana, rangos intercuartiles y t-student, con p < 0,05, según prueba pareada de Wilcoxon. Resultados: Se registraron 31 pacientes operados de Pectus excatavum, siendo la gran mayoría de causa tanto estética como funcional. Tanto en el cuestionario de Nuss, como en el de Krasopoulos, todas las respuestas a preguntas sobre diferencias pre cirugía y post cirugía fueron estadísticamente significativas, con un t-student de p < 0,05. Conclusión: La corrección del Pectus excatavum mediante técnica de Nuss ha mostrado un efecto positivo, tanto en la esfera física, como biopsicosocial de los pacientes al corregir su deformidad, lo que se ve claramente reflejado en una mejora de la autoestima y en la percepción de su estado de salud, por parte de los pacientes.

Pectus excatavum is the most common congenital deformity of the anterior wall of the chest. This condition is approached surgically for cosmetic and/or functional purposes. The Nuss procedure is a minimally-invasive procedure with excellent cosmetic outcomes and is less traumatic than other techniques. This study was conducted to determine pediatric patients and their parents' postoperative satisfaction and changes in quality of life after the Nuss technique. Patients and Method: A descriptive and single cohort study was performed subjecting patients and their parents to evaluate their quality of life and postoperative satisfaction using the Nuss and Krasopoulos questionnaires. The data was analyzed based on sample of n, median, interquartile ranges and t-student test, with p <0.05, according to paired-sample Wilcoxon test. Results: 31 patients were operated on for Pectus excatavum; most of the patients required operation for aesthetics and functional reasons. All the answers to questions in both questionnaires, Nuss and Krasopoulos, regarding differences between pre surgery and post-surgery were statistically significant, with p < 0.05 using t-student values. Conclusion: The correction of Pectus excatavum using the Nuss procedure has shown a positive effect physically and biopsy-chosocially on patients to correct the deformity, resulting in improved patients' self-esteem and perception of their health.

Racial differences in low-density lipoprotein particle size in families at high risk for premature coronary heart disease.

OBJECTIVE: Although small, dense low-density lipoprotein (LDL) has been implicated in atherogenesis and coronary heart disease (CHD) events, little is known about possible racial differences in LDL particle size. This study was designed to examine racial differences in the prevalence of small, dense LDL among 159 African-American and 477 White siblings of persons with premature (<60 years of age) CHD. METHODS AND RESULTS: This study examined fasting levels of total cholesterol, LDL cholesterol, high-density lipoprotein cholesterol, apolipoprotein B (ApoB), apolipoprotein A-1, and triglycerides, as well as factors known to be associated with small, dense LDL, including age, sex, obesity, hypertension, and diabetes. Relative LDL particle size was defined by the LDL cholesterol to ApoB ratio. Direct measurement of LDL particle size was obtained by proton NMR spectroscopy in a subset of 64 siblings. Despite similar levels of total and LDL cholesterol, White siblings were more likely to have low LDL cholesterol to ApoB ratios, indicative of atherogenic small, dense LDL, compared with African-American siblings. Multiple logistic regression analysis predicting the presence of LDL cholesterol/ApoB < or = 1.0 demonstrated that race (P = .009), triglyceride level (P = .0001), and diabetes (P = .02) were independent predictors, controlling for age and all other variables. Direct measurement of LDL particle size by NMR spectroscopy supported these findings. CONCLUSION: These findings provide the first known evidence that White individuals from a population at high risk for premature CHD have a greater probability of having a preponderance of small, dense LDL particles than do African Americans, independent of triglyceride levels, and despite comparable levels of total and LDL cholesterol.

[Inhalation of high-doses of ipratropium bromide (Atrovent) does not cause any changes in systemic or pulmonary hemodynamics]. / Inhalovaný ipratropium bromid (Atrovent) ve vysokých dávkách nepusobí zmeny ani systémové ani plicní hemodynamiky.

BACKGROUND: Parasympatolytics are recommended as the first choice remedy in patients with the chronic obstructive lung disease. Though their side effects are rare, some physicians are afraid of they can in high doses influence the cardiovascular system. The aim of the work was to ascertain whether the inhalation of 0.12 mg of ipratropium bromide might affect the systemic and pulmonary circulation. METHODS AND RESULTS: 15 patients (10 males, 5 females, average age 61.8 +/- 10.3 years) with chronic obstructive lung disease (13) and idiopathic pulmonary fibrosis (2) were examined during the period of disease stabilisation. Results of the right-side catheterization were not statistically changed (p < 0.91) 30 or 60 minutes after the inhaling of 0.12 of ipratropium. Also the value of the pick expiratory forced rate (PEFR) was not statistically increased (p < 0.25). CONCLUSIONS: Inhaling of 0.12 mg of ipratropium in patients with serious chronic pneumopathies did not affect systemic or pulmonary hemodynamics. Such dose appears to be safe even for patients with the chronic ischaemic hart disease.

Higher prevalence of GPIIIa PlA2 polymorphism in siblings of patients with premature coronary heart disease.

BACKGROUND: The Pl(A2) polymorphism of GPIIIa has been associated with unstable coronary syndromes in some studies, but the association has remained debated. None of the previous studies have focused on families at high risk. Risk factors tend to cluster within kindreds with high prevalence of premature coronary heart disease (CHD). Therefore, a heightened prevalence of the Pl(A2) polymorphism among siblings of patients with CHD would support the hypothesis that Pl(A2) is linked, directly or indirectly, to CHD. OBJECTIVES: To measure the prevalence of the Pl(A2) polymorphism among siblings of patients with CHD before the age of 60 years and to seek an association between the Pl(A2) polymorphism and established atherosclerotic and thrombogenic risk factors. METHODS: From January 1994 to April 1996, we genotyped 116 asymptomatic siblings (60 Caucasians, 56 Afro-Caribbeans) of patients with CHD manifestations before the age of 60 years for the Pl(A) polymorphism (also called HPA-1). A control cohort was used for comparison, consisting of individuals that were matched for race and geographic area but were free of CHD (n = 268, 168 Caucasians and 100 Afro-Caribbeans). In addition, we have characterized the sibling cohort for other atherogenic and thrombogenic risk factors. RESULTS: The prevalence of Pl(A2)-positive individuals (Pl(A2)[+], Pl(A1/A2) heterozygotes plus Pl(A2/A2) homozygotes) in the sibling cohort was high: 41.4%. When analyzed separately, the prevalence of Pl(A2)(+) siblings was 53.3% among Caucasians and 28.6% among Afro-Caribbeans. There was no association between Pl(A2) and other established atherogenic or thrombogenic risk factors. Interestingly, the clustering of other risk factors was lesser among Pl(A2)(+) siblings than their Pl(A1) counterparts. CONCLUSIONS: This study supports the hypothesis that the prevalence of Pl(A2)(+) individuals is high in kindreds with premature CHD. Hence, like the established risk factors that tend to cluster in families with premature CHD and contribute strongly to the accelerated atherosclerotic process affecting these individuals, the Pl(A2) polymorphism of GPIIIa may represent an inherited risk that promotes the thromboembolic complications of CHD. That these asymptomatic Pl(A2)(+) siblings had overall less established risk factors than their Pl(A1) counterparts might represent an explanation for why they remained asymptomatic despite their Pl(A2) positivity.

Surgery for bullous emphysema.

The present indications for surgery are mainly large or increasing bullae that result in compression of apparently good lung tissue, and the complications of bullous diseases such as pneumothorax. The results of local resection of localized giant bullae are dramatic. The resection of small bullae generally has little effect on lung function. Lobectomy should not be done until bullae have been removed locally and the remaining lung has been tested by positive ventilation. The indications for the resection of large bullae in the presence of diffuse emphysema require very careful individual study. Pulmonary function tests are mandatory but computed tomography is the single most useful method of assessing the extent of the bullous disease and the underlying lung disease. If the underlying lung is diffusely cystic then any surgical treatment is palliative only.

Nurse-mediated cholesterol management compared with enhanced primary care in siblings of individuals with premature coronary disease.

BACKGROUND: Siblings of individuals with premature coronary heart disease have a high prevalence of low-density lipoprotein cholesterol (LDL-C) levels requiring treatment. OBJECTIVE: To evaluate management strategies for high LDL-C levels in apparently healthy 30- to 59-year-old siblings of individuals with documented coronary heart disease prior to age 60 years. METHODS: In a 2-year trial of care provided by either a nurse trained in lipid management (NURS) or enhanced primary care (EPC), in which physicians received recommendations based on national guidelines, 156 siblings with LDL-C levels of 4.14 mmol/L (160 mg/dL) were randomized by family. The LDL-C goal levels below 3.36 mmol/L (130 mg/dL) were compared between and within intervention groups. Multiple logistic regression analyses were applied to predict 2-year achievement of the goal. RESULTS: The NURS group achieved a significantly greater percentage of goal LDL-C levels than the EPC group (26% vs 10%; P=.008). The NURS LDL-C levels decreased an average of 0.91 mmol/L (35 mg/dL) while EPC levels decreased by 0.52 mmol/L (24 mg/dL) (P=.09). In the final multivariate model, siblings taking lipid-lowering drug treatment were 6.02 times more likely (95% confidence interval, 2.24-16.18) than those not receiving pharmacotherapy to achieve LDL-C goals; nurse management (P=.09) was marginally significant. Pharmacotherapy was instituted in 45.2% of NURS and 16.7% of EPC siblings (P=.001). CONCLUSIONS: High LDL-C levels in siblings were more effectively treated by a trained nurse, probably related to greater adherence to the application of national guidelines. Nonetheless, the majority of siblings with high LDL-C levels did not meet goal levels 2 years after an index case coronary heart disease event.

Decreased peripheral blood gamma delta T cells in patients with bronchial asthma.

Many cell populations are thought to be involved in the etiopathogenesis of bronchial asthma. We examined by flow cytometry the relative and absolute number of CD3+, CD4+, CD8+, alpha beta TcR+ or gamma delta TcR+ T cells, CD19+ B cells; and CD56+ natural killer (NK) cells in the peripheral blood of 26 adult patients with difficult-to-control asthma (DCA) and 22 patients with minimally symptomatic asthma (MSA). Statistically higher relative and absolute numbers of NK cells (18.39 +/- 10.67% and 0.38 +/- 0.17 x 10(9)/l) in comparison with healthy controls (11.77 +/- 8.06% and 0.25 +/- 0.19 x 10(9)/l) and significantly decreased relative and absolute numbers of gamma delta T cells (3.02 +/- 2.16% and 0.06 +/- 0.04 x 10(9)/l) in comparison with controls (5.65 +/- 2.90% and 0.13 +/- 0.08 x 10(9)/l) in the DCA patient group were found. After pooling of data from both MSA and DCA patients and dividing the patients according to the presence of allergy, the relative and absolute numbers of gamma delta T cells were found to be diminished in both the allergy (3.77 +/- 2.98 and 0.07 +/- 0.05 x 10(9)/l) and nonallergy (3.06 +/- 1.78% and 0.06 +/- 0.03 x 10(9)/l) groups in comparison with healthy controls. The reason for the low number of gamma delta T cells in the peripheral blood of patients suffering from bronchial asthma is under investigation.

Some serum activity markers of airways inflammation in difficult-to-control asthma patients.

UNLABELLED: The main aim of the present study was a search for a characteristic serum marker of inflammatory activity in the airways of asthmatics with difficult-to-control disease. Therefore, serum levels of interleukin-4 (IL-4), serum low-affinity Fc Epsilon Receptor II (sFcER II), Interferon-gamma (INF-gamma) Immunoglobulin-E (IgE), Interleukin-2 (IL-2), serum Interleukin Receptor 2 (sIL-2R) and Intercellular Adhesion Molecule-1 (sICAM-1) were measured in 2 groups of asthmatics: 1-26 patients with difficult-to-control asthma (DTCA), 2-22 asthmatics, minimally symptomatic (MSA). RESULTS: No significant difference in either measured parameters between the DTCA and MSA group in peripheral blood samples was found. CONCLUSION: The above mentioned serum markers of T- and B-cell activation as well as the serum ICAM-1 level are not sensitive enough to determine the type, activity and severity of the inflammatory process in the asthmatic airways.

[Analysis of perception in patients during an acute attack of bronchial asthma]. / Analýza pocitu nemocných pri akutním záchvatu asthma bronchiale.

An analysis of subjective sensations during an asthmatic attack in 51 asthma patients was performed. A difficult inspiration or inspiration and expiration was the most prevalent sensation, while isolated difficult expiration was only sparse finding. A tightness on the chest was often noticed as well. The probable explanation for these observation could be the breathing a high lung volume (hyperinflation), caused by closing small airway a mostly due to bronchoconstriction during the asthmatic attack. The authors suggest not to generally use the term "expiratory breathlessness" when describing the clinical picture of an asthmatic attack.

Exaggerated reactivity to mental stress is associated with exercise-induced myocardial ischemia in an asymptomatic high-risk population.

BACKGROUND: This study was done to determine whether cardiovascular reactivity to mental stress is associated with exercise-induced occult ischemia in an asymptomatic population at high risk for premature coronary heart disease (CHD). METHODS AND RESULTS: One hundred fifty-two siblings of persons with premature CHD underwent mental stress testing. Exercise thallium tomography and 24-hour Holter monitoring were also performed. Hemodynamic changes were monitored during both stressors. Siblings positive for exercise-induced ischemia were offered cardiac catheterization. During mental stress, siblings with an abnormal exercise ECG and/or thallium scan (n=15) had greater maximal increases in systolic blood pressure (SBP, P=.0004) and diastolic blood pressure (DBP, P=.05) and had greater heart rate variability in the normalized low frequency domain of an analysis of Holter monitor recordings, compared with siblings without exercise-induced ischemia. Coronary arteriography confirmed coronary atherosclerosis in 85% of siblings with exercise-induced ischemia. Regression analyses showed that occult ischemia during exercise was a strong independent predictor of maximal change in SBP and DBP during mental stress. A multivariate logistic model demonstrated that siblings with exercise-induced occult ischemia were 21 times more likely to be "hot" responders (top quartile of change in SBP and DBP) during mental stress. CONCLUSIONS: An exaggerated cardiovascular response to mental stress is associated with exercise-induced myocardial ischemia in persons with preclinical coronary heart disease.

[Satellite cells in pulmonary carcinoid tumorlets and carcinoids]. / Satelitní bunky v plicních karcinoidových tumorletech a karcinoidech.

Pulmonary tissue of twenty-four patients with carcinoid tumorlets and twenty-three typical carcinoid tumors was studied immunohistochemically for stellate-shaped S-100 protein positive (sustentacular) cells. Sustentacular cells (SCs) have been calculated per 10,000 tumorlet or carcinoid elements. The presence of SCs was proved in 18 subjects (75%) of all examined tumorlet cases with quantitative frequency between 13 and 196 SCs per 10,000 tumorlet cells. These elements were also found in 18 carcinoid tumors (79%) of all 23 investigated cases with quantitative frequency between 5 and 927 SCs per 10,000 carcinoid cells. The cluster analysis showed two separate clusters in both groups of lesions with strikingly high frequency of SCs, i.e., from 66 up to 196 SCs/10,000 tumorlet elements and from 138 up to 923 CSs/10.000 carcinoid cells, respectively. SCs may not be used as an indicator of biological behaviour of pulmonary neuroendocrine tumors for their a broad frequency spectrum in examined benign lesions, i.e. tumorlets and typical carcinoid tumors.

S-100 protein positive (sustentacular) cells in pulmonary carcinoid tumorlets: a quantitative study of 24 cases.

Stellate-shaped S-100 protein positive sustentacular cells (SCs) appear to correlate inversely with the degree of tumor malignancy in some neuroendocrine tumors. Therefore, the SCs have been investigated in carcinoid pulmonary tumorlets and subsequently examined quantitatively in order to provide a basis for estimation of this phenomenon in tumorlet related lesions, especially carcinoids and neuroendocrine carcinomas. Pulmonary tissue from twenty-four patients with carcinoid tumorlets was studied immunohistochemically for S-100 protein positive SCs together with glial fibrillary acidic protein, actin, desmin, vimentin and cytokeratins. Tumorlet SCs were calculated per 10,000 tumorlet elements. The presence of SCs was proven in 18 subjects (75%) of all examined cases with quantitative frequency between 13 and 196 SCs per 10,000 tumorlet elements. The histogram showed three separate clusters of cases. Cluster 2 and cluster 3 with strikingly high frequency of SCs, i.e. from 66 up to 196 SCs per 10,000 tumorlet cells, may represent the biphasic differentiation potential of tumorlet elements. The mentioned lesions could be regarded as the possible precursors of pulmonary paragangliomas or paraganglioid carcinoids.

[Perception of dyspnea in asthmatics--long-term study]. / Vnímání dusnosti u astmatiku--dlouhodobá studie.

The authors investigated the relationship between perception of dyspnoea and some respiratory parameters (vital capacity - FVC, one-second vital capacity - FEV 1) in 43 patients with bronchial asthma. They followed up the changes of this relationship during repeated examinations within 3 - 60 months following the first examination. They were also interested to find out whether the patients perceive a reduction of the bronchial obstruction after Berotec. The authors provided evidence that: 1. a small proportion of the patients (18.4%) do not report subjective dyspnoea even in case of major obstruction of the respiratory pathways. 2. Another part of asthmatic patients (23.2%) have an increased perception of dyspnoea, i. e. they report a certain degree of dyspnoea when FEV 1 is higher than 85% of the appropriate value. 3. Acute reduction of bronchial obstruction is inadequately perceived by 39.5% of the patients. 4. During repeated assessment the perception of dyspnoea frequently changed markedly in the same patients. These findings justify the conclusion that treatment of asthmatic patients should depend not only on the score of the patient's symptoms but also on objective monitoring of the degree of obstruction in the home environment.

[Carcinoid tumorlets and pulmonary hypoxia]. / Karcinoidové tumorlety a plicní hypoxie.

Relationship between carcinoid tumourlets and chronic pulmonary hypoxia was studied on a group of 29 patients coming to necropsy (25 cases) in the last 25 years or surgically treated (4 cases) for non-neoplastic pulmonary lesions. All tumourlets expressed the argyrophilia and were immunoreactive for neurone-specific enolase. Pulmonary hypoxia was studied according to the presence of chronic bronchitis, emphysema and microscopical signs of hypoxic arteriopathy. Cigarette smoking was an additional criterion. The results indicated a strong relationship between tumourlets and chronic pulmonary hypoxia. 79% of patients with tumourlets have had the emphysema and in 41% of examined cases with this lesion the chronic bronchitis was diagnosed. The hypoxic arteriopathy was present in 48% of subjects with emphysema and 27% of cases with bronchitis. It was found in the same number of patients with both the examined lung diseases. On the other hand, the possibility of other cause of neuroendocrine cell hyperplasia was to be considered in 17% of investigated subjects in whom no evidence for the above mentioned relationship was found.

[Malnutrition in chronic obstructive bronchopulmonary diseases]. / Malnutrice u chronické obstrukcní choroby bronchopulmonální.

Malnutrition occurs in 23-70% of patients with chronic obstructive pulmonary disease and appears to be an independent factor connected with poor prognosis. Malnutrition stems from a long-term negative balance of energy and nutrients. That is caused by hypermetabolism, with possible role of an increased thermic effect of food, and probably by (at least intermittently) a limited intake of food. The adverse effect of malnutrition may be mediated by a decreased respiratory muscle strength but also by other mechanisms (electrolyte disorders, disturbed respiratory control, immunosuppression). In these patients, realimentation may be difficult to achieve, especially on the out-patient basis. However, with an increased effort of the health professionals and a good compliance of the patients, a substantial improvement is feasible, which might in turn improve the patients' prognosis.

[Indirect calorimetry and pulmonary function in chronic pulmonary disease]. / Indirektní kalorimetrie a plicní funkce u chronických plicních onemocnení.

Data derived from indirect calorimetry in patients with stable chronic pneumopathies were evaluated together with their pulmonary function data (spirometry, diffusing capacity, blood gases). Their basal metabolic rate was significantly higher (116.1% of the predicted value), this increase being more expressed in the patients with hypoxemia and with more severe obstructive disorder. In chronic obstructive pulmonary disease, the increased energy expenditure in hypoxemia was accompanied with increased lipid oxidation. There also was a correlation between the patients' nutritional status (evaluated by their body mass index) and their pulmonary function. These results confirm the impairment of pulmonary function in malnourished patients.

[Basal energy expenditure in smokers and non-smokers with Crohn's disease]. / Základní energetický výdej u kuráku a nekuráku s Crohnovou chorobou.

BACKGROUND: Crohn's disease (CD) is associated with smoking and ulcerative colitis with non-smokers. The aim of study was to compare resting energy status of smokers is worse when compared with non-smokers. The aim of the study was to compare resting energy expenditure (REE) in smokers and non-smokers with CD. METHODS AND RESULTS: REE was measured in the morning in 18 fasting patients with CD (11 non-smokers, 7 smokers) using a metabolic cart (Deltatrac Datex) in a canopy system. In smokers REE was measured before and 30 minutes after having smoked one cigarette, in non-smokers before and 30 minutes after light physical activity. The results were expressed in per cent of the expected values calculated from Harris-Benedict formula (%HB). In CD REE was significantly higher in smokers when compared with non-smokers (mean +/- S.E.M.: 113.3 +/- 12.7 vs 103.1 +/- 10.2; p < 0.03; t-test). The increase of the second measurement was not significant both in smokers (115.4 +/- 9.4) and non-smokers (105.4 +/- 10.3). In 15 CD patients substrate utilization was also estimated from indirect calorimetry and urea production. There was a higher rate of glycides (mean +/- S.E.M.: 185.9 +/- 81.9 gm/min) and a lower rate of protein oxidation (22.7 +/- 15.5) in smokers when compared with non-smokers (glycides: 141.6 +/- 78.0, NS; proteins: 41.8 +/- 36.7, NS). There was no significant difference between smokers and non-smokers with CD in lipids oxidation (33.7 +/- 19.5 vs 32.9 +/- 22.3). CONCLUSIONS: A significantly higher REE was found in smokers with CD when compared with non-smokers with CD. Differences in substrate utilization were not significant. Our results support a recommendation for CD patients to be non-smokers.