Sandra J. Wallner

Body fat distribution of overweight females with a history of weight cycling

Weight cycling may cause a redistribution of body fat to the upper body fat compartments. We investigated the distribution of subcutaneous adipose tissue (SAT) in 30 overweight women with a history of weight-cycling and age-matched controls (167 normal weight and 97 overweight subjects). Measurements of SAT were performed using an optical device, the Lipometer. The SAT topography describes the thicknesses of SAT layers at 15 anatomically well-defined body sites from neck to calf. The overweight women with a history of weight cycling had significantly thicker SAT layers on the upper body compared to the overweight controls, but even thinner SAT layers on their legs than the normal weight women. An android fat pattern was attributed to overweight females and, even more pronounced, to the weight cyclers. The majority of normal weight women showed a gynoid fat pattern. Using stepwise discriminant analysis, 89.0% of all weight cyclers and overweight controls could be classified correctly into the two groups. These findings show the importance of normal weight maintenance as a health-promoting factor.

Agenesis of the Dorsal Pancreas and Associated Diseases

Background Agenesis of the dorsal pancreas is a very rare congenital pancreatic malformation and is associated with some other diseases. Methods A PubMed search revealed 53 cases of agenesis of the dorsal pancreas. Results In 28 patients with this congenital malformation hyperglycemia was demonstrated, 27 had abdominal pain, 16 had pancreatitis, 14 had an enlarged or prominent pancreatic head visible on computed tomography, and in a few cases, polysplenia, which may occur with various congenital anomalies of visceral organs, was described. Conclusions Difficulties involved in obtaining a firm diagnosis have led to a variety of terms being used to describe this congenital disease. Diagnosis of agenesis of the dorsal pancreas is inconclusive without demonstration of the absence of the dorsal pancreatic duct. Here we describe the embryological development of the pancreas, the so-far known cases of agenesis of the dorsal pancreas with associated medical problems, and the diagnostic measures to find the right conclusions.

Trace elements in coronary heart disease: Impact of intensified lifestyle modification.

Concentrations of 14 trace elements (Bi, Cd, Co, Cs, Cu, Hg, Mn, Pb, Rb, Sb, Sn, Sr, Tl, and Zn) were determined by inductively coupled plasma mass spectrometry (ICP-MS) in 120 whole-blood and 121 plasma samples of 56 patients with angiographically documented coronary heart disease (CHD). One serum and two wholeblood reference materials were analyzed for quality control. At baseline, patients had elevated Co plasma as well as diminished Cu blood concentrations compared to healthy adults. The Zn concentrations in whole blood were below or at the lower end of the normal range, but the concentrations in plasma were elevated. All other trace elements were within the normal concentration ranges for healthy adults. After initial investigations, patients were randomly assigned to an experimental group (N = 27) and to a usual care group (N = 29). Experimental group patients were prescribed a lifestyle program that included a low-fat diet and a weekly moderate exercise. Patients were examined at baseline, after 6 and 12 mo for clinical assessment and fasting venous blood samples. No significant time-course changes in concentrations of trace elements in blood and plasma during the clinical treatment in both groups of patients could be observed. The experimental group patients lost weight and had lower blood pressure after 12 mo compared to baseline. The interventional therapy reduced the need for further revascularization procedures.

Differences of subcutaneous adipose tissue topography between type-2 diabetic men and healthy controls

Men with noninsulin-dependent diabetes mellitus (type 2 DM) provide a different subcutaneous body fat distribution and a concentration of fatness on the upper trunk compared with healthy subjects. However, subcutaneous fat distribution is always measured in an inaccurate and/or very simplified way (e.g., by caliper), and to date, there exists no study reporting on the exact and complete subcutaneous adipose tissue distribution of type 2 DM men. A new optical device, the LIPOMETER, enables the nonivasive, quick, and safe determination of the thickness of subcutaneous adipose tissue layers at any given site of the human body. The specification of 15 evenly distributed body sites allows the precise measurement of subcutaneous body fat distribution, so-called subcutaneous adipose tissue topography (SAT-Top). SAT-Tops of 21 men with clinically proven type 2 DM (mean age of 57.5 ± 6.7 years) and 111 healthy controls of similar age (mean age 59.0 ± 5.4 years) were measured. In this paper, we describe the precise SAT-Top differences of these two groups and we present the multidimensional SAT-Top information condensed in a two-dimensional factor value plot. In type 2 DM men, especially in the upper trunk, SAT-Top is significantly increased (up to +50.7% at the neck) compared with their healthy controls. One hundred eleven of the 132 individuals (84.1%) are correctly classified (healthy or type 2 DM) by their subcutaneous fat pattern by stepwise discriminant analysis.

Effect of silent hemoglobin variants on A1C measurement with the IFCC reference method and 6 routine methods

Glycated hemoglobin (GHb), measured as A1C, is used for evaluating long-term glycemic control in patients with diabetes mellitus and is directly related to the risk for diabetes complications. In the National Glycohemoglobin Standardization Program (NGSP) samples with variant hemoglobins are specifically excluded from certification testing and there are no specific guidelines or requirements for comparability of results from samples containingHbvariants [1]. In previous studies using boronate affinity HPLC as a comparative method, we demonstrated interference in A1C determination from silent Hb variants using certain ion-exchange HPLC and immunoassay methods [2]. The IFCC Reference Method developed by the International Federation of Clinical Chemistry and LaboratoryMedicine (IFCC) Working Group on A1C standardization is specific for the β-chain glycated N-terminal hexapeptide [3]. The present study describes the results of A1C determinations in patients with silent Hb variants (Hb Graz, Hb O Padova, Hb D) with boronate affinity HPLC, ion-exchange HPLC, an immunoassay and the IFCC Reference Methods. Blood samples from patients with Hb variants were collected in EDTA. Erythrocyte hemolysates were prepared following the IFCC procedure and stored alongwith correspondingwhole blood at −70 °C until being shipped on dry ice by overnight courier to the Diabetes Diagnostics Laboratory at the University of Missouri School of Medicine. A1Cwas determined using the Tosoh 2.2 Plus HPLC, Tosoh G7 HPLC (Tosoh Bioscience, South San Francisco, CA), Bio-Rad Variant HPLC, Bio-Rad Variant II HPLC (Bio-Rad Laboratories, Hercules, CA), Primus boronate affinity HPLC (Primus Corporation, Kansas City, MO), DCA 2000 immunoassay (Bayer Corporation, Pittsburgh, PA) and the IFCC Reference Method using the analytical technique of HPLC/capillary electrophoresis (HPLC-CE). These analyses were performed in the Diabetes Diagnostic Laboratory, using in-house calibrator materials and assigned values for the HPLC methods and IFCC calibrators with assigned values for the IFCC methods. The IFCC hemolysates were shipped to the Centers for Disease Control and Prevention, Atlanta, GA, for analysis using the IFCC HPLC/mass spectroscopy (HPLC-MS). Fructosamine was determined with a colorimetric test using nitroblue tetrazolium in alkaline solution (Unimate FRA, Roche, Diagnostics) at Medical University, Graz, Austria. The study describes A1C determinations in three patients (two type 2 diabetic patients and one non-diabetic patient) with the silent β-chain variant Hb Graz [α2β22(NA2) His→Leu], a type 2 diabetic patient with the silent β-chain variant Hb D [α2β2121(GH4) Glu→Gln], and a type 1 diabetic patient and a type 2 diabetic patient with the α-chain variant Hb O Padova [β2α230(B11) Glu→Lys]. Amino acid and sequence analysis of DNA were performed, as described previously, and the routine hematologic data of all patients were

N-terminal pro-B-type natriuretic peptide in early and advanced phases of obesity.

Abstract Background: Increased plasma amino-terminal-cleavage-fragment of NP (NT-proBNP) is an established indicator for heart failure. Moreover, obese adults had low circulating NT-proBNP suggesting an obesity-related dysregulation (natriuretic handicap). Secretion and/or clearance of NT-proBNP were discussed to be impaired in obesity. As only older adults were investigated so far, it remains unclear when during the evolution of obesity the state of a natriuretic handicap develops, and whether NT-proBNP may still serve as a relevant cardiac marker in obese juveniles. Methods: We analysed NT-proBNP in juvenile (n=274, 10–18 years) and middle-aged (n=277, 18–50 years) normal weight (n=213) and obese (n=338) probands together with complex anthropometry, carotis sonography, clinical, and laboratory parameters. Results: NT-proBNP showed a significant gender and age interaction. Adult females had significant higher NT-proBNP than adult males, and higher levels than juvenile females. Adult males had lower levels than juvenile males. Only a weak age and weight interaction was seen with obese juveniles which showed higher NT-proBNP than obese adults. Moreover, normal weight probands had higher NT-proBNP than overweight and obese. In a multiple regression including all probands, gender, creatinine and uric acid were the best predictors for NT-proBNP. In adults, female gender is the strongest driver for increased NT-proBNP. Conclusions: These results argue against an essential influence of obesity to B-type cardiac natriuretic hormone system regulation in the absence of heart failure, and suggest NT-proBNP as a useful cardiac marker irrespective of age and obesity.

Impact of mechanical vascular injury on whole blood and plasma concentrations of trace elements and electrolytes in patients with coronary heart disease

Concentrations of the seven trace elements—cobalt (Co), cesium (Cs), copper (Cu), lead (Pb), rubidium (Rb), strontium (Sr), and zinc (Zn)—were determined in 76 whole blood and 76 plasma samples of patients with coronary heart disease undergoing percutaneous transluminal coronary angioplasty (PTCA) by inductively coupled plasma mass spectrometry. Additionally, concentrations of iron (Fe) and the electrolytes sodium (Na), potassium (K), magnesium (Mg), and calcium (Ca) in the plasma of these patients were determined. To investigate the impact of PTCA on the concentrations of these elements, blood and plasma samples were collected 4–12 hours prior to (n = 16) and 24–30 hours after (n = 60) the clinical intervention. Concentrations for Rb and Cs in whole blood and plasma decreased after PTCA, but remained within the normal ranges reported for healthy adults. Concentrations of Co in whole blood and plasma were higher than the reported reference ranges and decreased significantly (P < 0.0001) in the plasma after the clinical intervention. Plasma Fe prior to PTCA was in the middle of the reference range and decreased significantly (P < 0.001) after PTCA to the very low end of the normal range. All blood Cu concentrations were at the lower end of the normal range and did not change during the clinical intervention. Concentrations of all other elements in the plasma and whole blood of our patients were within the normal ranges for healthy adults and remained unchanged. J. Trace Elem. Exp. Med. 13:185–194, 2000.

Autoimmune hepatitis associated with motor-axonal polyneuropathy.

antibody and rheumatoid factor were not found. Biochemical screening for viral hepatitis did not reveal antibodies against any type of viral hepatitis. Immunofixa-tion was normal and cryoglobulins were not detected. Histological evaluation of liver biopsy demonstrated macronodular cirrhosis, portal tract fibrosis and prolifer-ating biliary tracts with infiltrates of mainly T lymphocytes and few plasma cells. As an associated autoimmune dis-ease, Hashimoto’s thyroiditis with slightly elevated thyroid-stimulating hormone 3.9 mU/l (0.2–3.8) and thyroid autoantibodies 8 U/l (0–5) were found and a therapy with 50 g levothyroxine was initiated.I n our patient the diagnosis of AIH was made according to suggested parameters [4] . AIH is known to respond to steroid therapy with clinical and biochemical im-provement to normal liver parameters. Af-ter initiation of a corticosteroid therapy the patient recovered and all liver labora-tory parameters remained within normal limits. A 6-mg budesonide therapy was suggested but incompletely continued. However, for 2 years the controls showed GOT and GPT elevated up to 96 U/l ( ! 35 )and 100 U/l ( !3 5), respectively, but all oth-er laboratory parameters remained within normal limits. De, r S i arT he association of hepatitis C infection and peripheral neuropathy has been de-scribed with and without cryoglobulin-emia [1]. A utoimmune hepatitis (AIH) is a chronic autoimmune disease of the liver with unexplained etiology, potentially progressing to hepatic failure [2] . So far, AIH associated with neuropathy has been described in a few individual patients [3] . Here we describe a patient suffering from AIH who developed a motor-axonal poly-neuropathy. In 2004, a 61-year-old female Cauca-sian patient presented with an 8-kg weight loss during the preceding 3 months, fa-tigue, abdominal distension, yellow scler-ae, jaundice, pale stool, and dark urine. Physical examination revealed an enlarged liver and laboratory values were total bili-rubin 10.6 mg/dl (normal 0.2–1.3), alka-line phosphatase 172 U/l (35–104), glutam-ic-oxaloacetic transaminase (GOT) 1,134 U/l ( !aanm 35uramstpt cg yu-l cr),vni ei asi(GPT) 915 U/l ( ! 35 ), amu -gtanprpesl -t yl titase 340 U/l ( ! 39), smooth muscle anti-bodies 1: 1,280 and hypergammaglobu-linemia IgG 3,332 mg/dl (700–1,600). Oth-er AIH-associated antibodies including anti-liver-kidney microsomal antibody, antibodies against soluble liver antigen, antinuclear antibody, antimitochondrial