The effect of breakfasts varying in glycemic index and glycemic load on dietary induced thermogenesis and respiratory quotient.

BACKGROUND AND AIM: Glycemic index (GI) and Glycemic Load (GL) are parameters of carbohydrate bioavailability able to influence risk of chronic diseases. GL can be lowered either by reducing carbohydrate intake or by reducing the GI of the carbohydrate moiety of a mixed meal. These two approaches might have a different impact on Dietary-Induced Thermogenesis (DIT) and preferential substrate oxidation in the postprandial period, which are variables known to be involved in the regulation of body weight and body composition. This dietary, crossover intervention trial was designed to evaluate the effect on DIT and Respiratory Quotient (RQ) of three isocaloric breakfasts different in GI and/or GL (high GI and high GL [HGI-HGL] vs. low GI and low GL [LGI-LGL]; vs. high GI and low GL [HGI-LGL]) followed by a standard meal. METHODS AND RESULTS: RQ and DIT were measured in 16 lean young males by indirect calorimetry for 8h. DIT resulted significantly higher after the LGI-LGL compared to the HGI-HGL breakfast (p<0.05). Postprandial changes in RQ differed among all breakfasts (p<0.001). RQ increased from baseline after the two breakfasts with highest carbohydrate content and significantly more after the HGI-HGL than after the LGI-LGL (p<0.02), whereas it decreased after the HGI-LGL breakfast, which contained a higher amount of fat. CONCLUSIONS: Reducing the GL of a meal by reducing GI seems an effective strategy to increase energy expenditure while maintaining a good rate of lipid oxidation. This might be related to different profiles of postprandial hormones affecting substrate oxidation.

Long term results of isolated mitral and aortic valve replacement. A statistical evaluation.

589 patients were followed up between 1972 and 1977 after aortic (285) or mitral valve (304) replacement. Three hundred and thirty patients had a ball valve (Starr-Edwards) and 259 a disc valve (Björk-Shiley). The average follow up was 37 months for the mitral patients and 40 months for the aortic. The results were analyzed by statistical methods based on multifactor analysis (cluster) in order to test the homogeneity of the different groups of patients. Survival and embolism were followed by actuarial rates. The survival rate between AVR patients at 72 months was 93 per cent for the Björk and 71 per cent for the Starr valve was a statistically significant difference. The survival of MVR at 48 months was 84 per cent for Starr and 78 per cent for Björk prostheses; no significant difference was found on statistical analysis. Embolic episodes occurred at a rate of 16 per cent for the Björk and 14 per cent for the Starr valves in AVR, and 10 per cent for the Björk and 18 per cent for Starr prostheses in MVR. These differences were not significant. By the cluster analysis based on different parameters (age, valve lesion, NYHA class, duration of symptoms, C/T ratio, size of the left atrium) it was shown that no proper risk factors were found between the parameters under consideration. We conclude that in both aortic and mitral valve replacement, the most important risk factor is the type of prosthesis and the presence of the prosthesis itself.

Results of valve replacement surgery with mechanical prostheses.

The clinical study is reported of the results of heart valve replacement surgery with a new pyrolytic carbon tilting disc prosthesis manufactured in Italy. From March 1977 to January 1981, at the "De Gasperis" Cardiosurgery Center, this prosthesis has been implanted in 644 patients: 283 for mitral valve replacement, 240 for aortic valve replacement, and 121 for the replacement of both mitral and aortic valves. To have a sufficiently long period of post-surgery follow-up, we considered the results of 207 patients (124 cases of isolated mitral valve replacement and 83 cases of isolated aortic valve replacement), who underwent surgery consecutively from March 1977 to December 1979. The hospital mortality was 10.5% for mitral valve replacement and 4.8% for aortic valve replacement. All patients who were discharged from hospital, except 2, were subjected to clinical, electrocardiographic, phonocardiographic, echocardiographic and radiological checks. The average follow-up period was approximately 20 months: clinical results were satisfactory. The probability of survival, expressed by actuarial curve, was, three years after surgery, 94% for patients who underwent mitral valve replacement and 97.5% for those who underwent aortic valve replacement. The probability of embolism was, three years after surgery, 8.5% for patients with mitral replaced and 5% for aortic. Even if further confirmations are needed the mortality rate and the probability of embolism related to this new prosthesis, are lower, over the same period of follow-up, than that found in the groups of patients who underwent valve replacement surgery, at the same Center, with Starr-Edwards and Björk-Shiley prostheses. The phonocardiographic and echocardiographic characteristics of this new prosthesis were also investigated.

[Aortic valve replacement with Starr-Edwards and Björk-Shiley prosthesis. Long term results and statistical analysis of some risk factors (author's transl)]. / Sostituzione valvolare aortica con protesi di Starr-Edwards e Björk-Shiley. Risultati a distanza e analisi statistica di alcuni fattori di rischio.

285 patients who underwent aortic valve replacement between 1972 and 1977 have been studied. 197 patients had a Starr-Edwards prosthesis and 88 patients had a Björk-Shiley prosthesis, both groups presented similar risk factors. The follow-up varied between a period of 6 months minimum and 72 months maximum, the mean period is 3.6 years. The statistical results have been realized based on the multi-factor analysis (cluster) which were the basis to define the homogeneous groups of patients with the Starr prosthesis and the Björk prosthesis. One may observe the best survival percentage after 72 months from surgery date in patients with the Björk prosthesis comparing them with those patients who underwent aortic valve replacement with the Starr prosthesis (resp. 93 and 71%). The difference is important from the statistical point of view. The embolic incidence after such a period is nearly equal (16% for Björk and 14% for Starr). The cluster analysis of the considered parameters (age, duration of symptoms before surgery, NYHA class, C/T) did not evince real and proper risk factors such to condition, at long term, the results even if differences in mortality and in embolic incidence, with regards to the relation with NYHA class and symptoms; duration, have been observed. One may conclude that one of most important risks derives form the type of used prosthesis.

[Mitral valve replacement by Starr-Edwards and Björk-Shiley prostheses, long term results and statistical analysis of some risk factors (author's transl)]. / Sostituzione valvolare mitralica con protesi di Starr-Edwards e Björk-Shiley. Risultati a distanza e analisi statistica di alcuni fattori di rischio.

304 patients have been studied between 1972 and 1977 after mitral valve replacement. 133 patients had a Starr-Edwards prosthesis and 171 patients had a Björk-Shiley prosthesis; both groups presented similar risk factors. The follow-up varied between a 6 months and a 72 months period for both types of prosthesis with a mean period of 3.2 years. The statistical results were based on the cluster system and he outcomes helped us to realise curves of homogeneous groups of patients who underwent mitral valve replacement with Starr and Björd prosthesis. One observed that 4 years from date of surgery the survival percentage is 84% for those patients with the Starr prosthesis and 78% for Björk prosthesis; with regards to the log rank test this difference is insignificant. Considering the probability of embolism one observed a percentage of 10% of the patients with the Björk prosthesis and of 18% with the Starr prosthesis; this difference is insignificant from the statistical point of view. The cluster analysis of the considered parameters (age, type of valve defect, NYHA class, duration of symptoms before surgery, C/T, size of left atrium) did not evince real and proper risk factors at least not such to condition the long term results. The only observed relationship is the one between the major incidence of embolism and great left atrium. One may conclude that not exist differences in long term results between both prostheses when placed in mitral valve.

[Cardiac fibroma: a successfully operated case and a review of the literature (author's transl)]. / I fibromi del cuore. Un caso operato con successo e revisione della letteratura

A case of cardiac fibroma in a three years old child successfully operated on is presented. The tumor was localized on the interventricular septum and was provoking an obstacle in the outflow of the right ventricle. The preoperative diagnosis was formulated by angiocardiography. A year after the operation, the hemodynamic control showed that he interventricular pressures were normal. The problems and the importance of an early diagnosis are emphasized in patients affected by cardiac fibroma. Surgical indication, technical aspects related to the operation, the immediate and more long-term results from surgical operation of this kind of pathology, with reference to the data taken from the literature, are discussed.

Ten years' experience in heart valve replacement with artificial prostheses: immediate and long-term results in 1812 cases.

A ten year follow up of 1,812 patients who underwent heart valve replacement with artificial prothesis between October 1963 and December 1973 is reported. Hospital mortality was 8.5% for aortic valve replacement; 13.6% for mitral valve replacement and 19.3% for multiple valve replacement. Late mortality was 13.3% for aortic valve replacement; 25.7% for mitral valve replacement and 25.9% for multiple valve replacement. The survival rate of the different groups of patients were actuarially determined. The survival rates following replacement of the aortic valves was 81% after 9 years. The main late complications are embolism and valve leakage. All surviving patients show a clinical improvement, particularly in the groups of isolated aortic a mitral valve replacement. The heart size reduction after operation has been measured. This is more evident 6 months after surgery: the average reduction was 23% after aortic valve replacement and 20% after mitral valve replacement.

[Multivalvular replacement: short and long term results in 367 cases (author's transl)]. / Sostituzioni multivalvolari. Risultati immediati e a distanza su 367 casi

Early and late results of 273 mitro-aortic, 66 mitro-tricuspid, 28 mitro-aortic-tricuspid valvular replacements performed between 1964-1973, were evaluated. The hospital mortality rate was 17, 5 percent for mitro-aortic, 30, 5 percent for mitro-tricuspid, 10, 7 percent for mitro-aortic-tricuspid replacement. The best results obtained in patients with mitro-aortic replacement, the worse one in patients with mitro-tricuspid replacement, that present also a poor functional rehabilitation. The actuarial curves were calculated: 9 years after operation the probability of survival was of 67 percent for patients operated of mitro-aortic valvular replacement and 47 percent for patients operated of mitro-tricuspid replacement.