Flow-mediated vasodilatation in the patients with anorexia nervosa.

OBJECTIVE: To compare flow-mediated vasodilatation in patients with anorexia nervosa and healthy subjects. BACKGROUND: Endothelial dysfunction is present in the patients with anorexia nervosa. However, flow-mediated vasodilatation in the patients with anorexia nervosa in comparison with control subjects has not been yet evaluated. METHODS: Flow-mediated vasodilatation in the brachial artery was examined in 30 patients with anorexia nervosa admitted to metabolic care unit for realimentation and compared to 30 control subjects. RESULTS: The average age of the patients with mental anorexia was 25.0±5.2 compared to 25.5±4.5 years of the healthy control subjects (NS). BMI was in 14.0±1.7 kg/m2 in patients with anorexia nervosa comparing to 20.4±1.0 kg/m2 in the healthy control subjects (p<0.001). The baseline mean diameter of the right brachial artery was 0.33±0.06 cm in the anorexia nervosa patients and 0.35±0.05 cm in the control subjects (NS). The absolute increase of brachial artery size after reactive hyperemia was 0.029±0.006 cm (9%) in the anorexia nervosa patients and 0.039±0.006 cm (11 %) in the control subjects (p=0.002). After realimentation, the baseline mean diameter of the right brachial artery was comparable to the result before nutrition intervention - 0.34±0.05 cm but brachial artery increase due to reactive hyperemia was 0.036±0.05 cm (10.5 %). It was for 19 % higher compared to the first examination (p<0.001). CONCLUSION: Flow-mediated vasodilatation is decreased in the patients with anorexia nervosa in comparison with the healthy control subjects and improves after realimentation (Tab. 1, Ref. 20).

ECG body surface mapping changes in type 1 diabetic patients with and without autonomic neuropathy.

ECG body surface mapping (BSM) parameters in patients with diabetes mellitus Type 1 (DM1) are significantly different comparing to healthy non-diabetic subjects. Hypothesis that these changes are more pronounced in DM1 patients with autonomic neuropathy (AN) was tested. The parameters of BSM were registered by diagnostic system Cardiag 112.2 in 54 DM1 patients including 25 with AN and 30 control subjects. AN was diagnosed according to Ewing criteria when two or more Ewing tests were abnormal. In classic 12-lead ECG the heart rate was increased, QRS and QT shortened (p<0.01) and QT(C) prolonged in DM1 patients. The VCG measurement of QRS-STT angles and spatial QRS-STT angle showed non-significant differences. The absolute values of maximum and minimum in depolarization and repolarization isopotential, isointegral, isoarea maps were significantly different in DM1 patients in comparison with controls (p<0.01). The changes were more pronounced in DM1 patients with AN than in DM patients without AN (p<0.05). The QT duration measured in 82 leads of thorax was significantly shortened in 68 leads of both groups of DM 1 patients (p<0.01) when compared with controls. In 34 of them this shortening was more pronounced in DM1 patients with AN than in DM1 patients without AN (p<0.05). The results showed that the method of ECG BSM is capable to confirm the presence of autonomic neuropathy in diabetic patients.

Comparison of soybean oil- and olive oil-based lipid emulsions on hepatobiliary function and serum triacylglycerols level during realimentation.

This study compared the effects of soybean oil- versus olive oil-based lipid emulsions on hepatobiliary function and serum triacylglycerols in patients who required transient parenteral nutrition support for significant weight loss. Patients who received a parenteral ready-to-use industry admixture including either soybean oil- (n = 10) or olive oil-based lipid emulsion (n = 11) for 2 weeks were retrospectively analysed. Cholestatic and cytolytic enzymes, conjugated bilirubin and serum triacylglycerols were sampled before and 1 day after completing parenteral nutrition support. Significant deterioration of cholestatic enzymes occurred in five patients in the soybean oil group and in one in the olive oil group. Serum triacylglycerols significantly deteriorated in seven patients in the soybean oil group and in one patient in the olive oil group. No differences were recorded for cytolytic enzyme abnormalities. In conclusion, the olive oil-based emulsion induced abnormalities of cholestatic enzymes and serum triacylglycerols significantly less frequently than the soybean oil-based emulsion.

[Experience with early enteral nutrition application in critically ill patients in medical intensive care unit]. / Zkusenosti s podáváním casné enterální výzivy kriticky nemocným na jednotce intenzivní metabolické péce.

BACKGROUND: Early enteral nutrition is recommended in patients with critical illness. Generally implementing of nutritional support algorithm is advised. The aim of study was evaluation of early enteral nutrition application in critically ill patients in medical intensive care unit. METHODS AND RESULTS: Early enteral nutrition was given according to written protocol in medical intensive care unit. During the first 96 hours hypocaloric nutrition 20-25 calories/kg was applied, followed by increase to 25-30 calories/kg at the end of the first week of admission. Apart from the patients who reached 25-30 calories/kg we recorded the number of patients who tolerated hypocaloric enteral nutrition and evaluated the number of patients with complications due to enteral nutrition. Early enteral nutrition was given to 44 out of 99 patients admitted to intensive care unit with life threatening diasese and indication for nutrition support. Out of 44 critically ill patients (35 with sepsis, 9 with another medical emergency) 22 died during admisssion in intensive care unit (50%). Hypocaloric enteral nutrition during the first 96 hours was given to 36 patients (82%). In 8 patients enteral nutrition had to be stopped and substituted for parenteral one due to complications. Three patients suffered from abdominal distension, 2 from profused diarrhea, 1 from combination of diarrhea and abdominal distension and 2 from aspiration. Twenty seven patients tolerated the application of enteral nutrition via nasogastric tube. In 10 patients nasogastric tube had to be replaced for nasojejunal one for high gastric aspirate volume. The caloric intake of 25-30 calories/kg was reached by the end of the first week of admission in 26 patients (60%). CONCLUSIONS: Early enteral nutrition applied according to protocol was given succesfully to the substantial number of the critical patients. In 18% of the patients enteral nutrition had to be replaced for parenteral one due to complications. The caloric intake 25-30 calories/kg was reached in 60% of patients.

[Our experience in continuous administration of insulin using infusion dispenser at a metabolic intensive care unit (MICU)]. / Nase zkusenosti s kontinuálním podáváním inzulinu pomocí infuzního dávkovace na jednotce intenzivní metabolické péce (JIMP).

INTRODUCTION: The article summarises the experience of the authors in the administration of insulin using an infusion dispenser at a metabolic intensive care unit (MICU) both to patients with decompensated diabetes mellitus and to patients admitted with a sepsis or other life-threatening condition of internal nature. PATIENTS AND RESULTS: Insulin was administered with the use of a dispenser to a total of 50 patients during 6 months of 2005. 13 of those patients showed signs of ketoacidotic or hyperosmolar coma in the course of diabetes mellitus. All of these patients were compensated within 24 hours and transferred to a standard ward for further treatment within 48 hours. 37 patients were admitted in a critical condition, the cause ofwhich was sepsis and a serious internal disease in 29 and 8 patients, respectively. 12 of the patients died during their hospitalisation at MICU, of which 8 in the first 3 days after admission. No significant correlation between the age, diabetes mellitus diagnosis or an associated cardiovascular morbidity and the death at MICU was discovered, but there was a very close ling between the mortality at the intensive care unit and the baseline blood level of C-reactive protein (160 mg/l; 32-352 in the patients who died, and 111 mg/l 15-168 in the patients who survived), p < 0.01. Glycaemia at admission did not differ significantly for the patients who dies and those who survived, but average glycaemia for all three measurements at MICU was significantly higher in the patients who died (10.4 mmol/l; 6.2-22.4) as compared with those who survived (7.8 mmol/l; 5.8-16.6), p < 0.01. The time of insulin administration was significantly shorter in patients who died (3.3 days; 1-6) as compared with those who survived (5.2 days; 3-10), p < 0.01. There was no significant difference between hourly insulin dose in the patients who died (2.8 j/hour; 0.6-8.6) and in those who survived (2.6 j/hour; 0.8-7.6). A trend towards lower mortality was recorded for the group of patients with average glycaemia below 8 mmol/l and/or those in whom glycaemia mostly ranged between 4.4 and 8.0 mmol/l, but the difference was not statistically significant. A significantly lower consumption of insulin was recorded for the patients with average glycaemia below 8 mmol/l and/or those whose glycaemia measurements mostly ranged between 4.4 and 8.0 mmol/l. Hypoglycaemia defined as glycaemia below 4.4 mmol/l was present in 2% of all measurements, in 11 patients on the total, and their results were not significantly associated with mortality at MICU. CONCLUSION: Mortality of patients admitted with sepsis or other life-threatening condition of internal nature was significantly higher in the group of patients with higher average glycaemia among all the measurements performed at MICU. In patients who died, the total time of insulin administration was significantly shorter, but there was no difference between the average hourly insulin dose in the group of the patients who died and those who survived.

Changes in the plasma amino acid profile in anorexia nervosa.

We evaluated and measured by high performance liquid chromatography the plasma amino acid levels in 11 female patients with anorexia nervosa during a period of significant loss of body weight, compared with 11 healthy age-matched controls. Total amino acid and total branched-chain amino acid levels were similar in both groups, however significantly higher levels of glycine and ornithine were found in anorexia nervosa patients, as well as significantly lower levels of leucine, tyrosine and lysine compared with controls. The glycine/valine and phenylalanine/tyrosine ratios were significantly higher in anorexia nervosa patients than in control subjects. The levels and ratios of other amino acids were within the normal range, with no significant differences between the two groups. Changes in the plasma amino acid profile in anorexia nervosa patients can be explained by chronic severe malnutrition and prolonged stress.

[The meaning of the combination of fibrinogen, micro/macroalbuminuria and atheromatosis in the carotid bloodstream for the evaluation of the abnormal finding of the stress myocardial SPECT in the asymptomatic 2nd type diabetic patients]. / Význam kombinace zmen fibrinogenu, mikro/makroalbuminurie a ateromatózy v karotickém recisti pro posouzení rizika abnormálního nálezu zátezového SPECT myokardu u asymptomatických diabetiku 2. typu.

OBJECTIVES: Stress perfusion myocardial scintigraphy (SPECT) is useful in silent ischemia detection in the group of the asymptomatic type 2. diabetic patients. In our paper we present the combinations of the parameters predictive for stress myocardial SPECT result. METHODS: We selected parameters (fibrinogen, micro/macroalbuminuria, ateroma in carotid artery bed) that were significantly associated with stress myocardial SPECT result. We analyzed the combinations of these parameters change and evaluated their significance for stress myocardial SPECT result prediction. RESULTS: We evaluated 121 type 2. diabetic patients without patological ECG changes and with normal left ventricle ejection fraction. Thirty one (26%) had abnormal and 90 (74%) equivocal or normal stress myocardial SPECT result. The combination of ateroma presence in carotid bed and fibrinogen in upper tertile was found in 20 patients. Fifteen of them (75%) had the abnormal SPECT result. The combinations of the ateroma absence, negative micro/macroalbuminuria and fibrinogen in the middle or lower tertile were present almost in the half of all the examined diabetic patients. Such combinations were connected with normal or equivocal SPECT result in 93-96% cases. CONCLUSION: Micro/macroalbuminuria, fibrinogen and ateroma in carotid bed found by sonography are significantly associated with stress myocardial SPECT result. Combinations of these parameters changes lead to the futher stratification that enables the rationale approach in the stress examination indication.