[The concept of constitution].
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Body Constitution↗
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[Problems of constitution].
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Body Constitution↗
Retrieving foreign bodies from upper aerodigestive tracts of children.
Ingestion is foreign body lodgment in the esophagus, whereas aspiration is lodgment of foreign bodies in the larynx, trachea, or bronchi. Foreign bodies constitute an emergency when actual or potential airway obstruction occurs, when there is an esophageal perforation, or when disc batteries are ingested and lodged in the esophagus. A ventilating bronchoscope of appropriate size is essential to the removal of a foreign body in the airway or esophagus. Successful management of foreign bodies in the upper aerodigestive tracts of children is directly proportional to the time and effort spent in preoperative preparation.
Child↗
Scoring CT/HRCT findings among asbestos-exposed workers: effects of patient's age, body mass index and common laboratory test results.
We studied the effects of age, body mass index (BMI) and some common laboratory test results on several pulmonary CT/HRCT signs. Five hundred twenty-eight construction workers (age 38-80, mean 63 years) were imaged with spiral and high resolution CT. Images were scored by three radiologists for solitary pulmonary nodules, signs indicative of fibrosis and emphysema, ground glass opacities, bronchial wall thickness and bronchiectasis. Multivariate statistical analyses were adjusted for smoking and asbestos exposure. Increasing age, blood haemoglobin value and erythrocyte sedimentation rate correlated positively with several HRCT signs. Increasing BMI was associated with a decrease in several signs, especially parenchymal bands, honeycombing, all kinds of emphysema and bronchiectasis. The latter finding might be due to the suboptimal image quality in obese individuals, which may cause suspicious findings to be overlooked. Background data, including patient's age and body constitution, should be considered when CT/HRCT images are interpreted.
Adult↗
Correlation of bone density to strength and physical activity in young men with a low or moderate level of physical activity.
The objective of this study was to evaluate the relationship among bone mineral density (BMD), physical activity, muscle strength, and body constitution, in young men with a low or moderate level of physical exercise. Another aim was to investigate whether the head is unaffected by physical activity. The subjects consisted of 33 Caucasian healthy men, mean age 24.8 +/- 2.3 years. BMDs of the total body, lumbar spine (L2-L4), femoral neck, Ward's triangle and trochanter, humerus, and head were measured using dual-energy-X-ray absorptiometry (DXA). Bivariate correlations were measured among the different BMD sites and age, weight, height, body mass index (BMI), fat mass, lean body mass, amount of physical activity (hours/week), hamstrings strength, and quadriceps strength. Significant predictors were found for all BMD sites except the head. Using all these variables, only 6% of the variation in BMD of the head could be explained, whereas 46% (total body), 31% (humerus), 17% (lumbar spine), 38% (femoral neck, Ward's), and 41% could be explained for the trochanter. Physical activity and muscle strength were found to be independent significant predictors of BMD of the total body and the sites at the proximal femur. These results suggest that at the time of peak bone mass attainment, physical activity is an important predictor of the clinically relevant proximal femur in young men with a low or moderate level of physical activity. Furthermore, since head BMD was not related to the level of physical activity, we suggest that head BMD may be used as an internal standard, to control for selection bias, in studies investigating the effect of physical activity on bone mass.
Absorptiometry, Photon↗
Clinical pharmacokinetics of drugs in obesity. An update.
Obesity is common enough to constitute a serious medical and public health problem. Drug prescription for obese patients is difficult since dosages based on pharmacokinetic data obtained in normal-weight individuals could induce errors. In obese patients, physiopathological modifications are likely to affect drug tissue distribution and elimination. Body constitution is characterised by a higher percentage of fat and a lower percentage of lean tissue and water. Although the cardiac output and total blood volume are increased, the blood flow per gram of fat is less than in nonobese individuals. Histological hepatic alterations are commonly reported in morbidly obese individuals. A higher glomerular filtration rate is also observed. Most of the pharmacokinetic information concerning obesity deals with distribution. Published data concerning molecules with moderate and weak lipophilicity are homogeneous. In obese compared with normal weight individuals, the total volume of distribution (Vd) is moderately increased (aminoglycosides, caffeine) or similar (H2-blockers, neuromuscular blockers), but the Vd corrected by kilogram of actual bodyweight is significantly smaller. These drugs distribute to a limited extent in excess bodyweight. For highly lipophilic drugs, despite this common characteristic, discrepancies in distribution in obesity exist between drugs belonging to different pharmacological classes. Some drugs show a clear augmentation of Vd and elimination half-life (benzodiazepines, carbamazepine, trazodone, verapamil, sufentanil), indicating a marked distribution into adipose tissue. For others, Vd and Vd/kg are decreased (cyclosporin, propranolol), suggesting that factors other than lipid solubility intervene in tissue distribution. As a general trend, the total clearance (CL) of drugs metabolised by oxidation, conjugation or reduction, and also of drugs with flow-dependent hepatic clearance, is not diminished in obesity. Usually CL is identical in obese and nonobese individuals, sometimes it is increased in obesity (enflurane, halothane, prednisolone, some benzodiazepines). With some drugs a significant reduction in CL is observed in obese individuals (methylprednisolone, propranolol). Renal clearance of aminoglycosides and cimetidine increases in obese individuals. Practical guidelines for dosage adjustment are proposed. For drugs with distribution restricted to lean tissues, the loading dose should be based on the ideal bodyweight of patients. For drugs markedly distributed into fat tissue the loading dose is based on total bodyweight. Adjustment of the maintenance dose depends on possible changes in CL. In some cases (atracurium, prednisolone) dosage adjustment does not follow these recommendations, owing to pharmacodynamic data.
Humans↗
Giant cell tumor of soft parts. An ultrastructural study.
The light-microscopic and ultrastructural findings in a case of so-called giant cell tumor of soft parts, localized at the dorsal side of the left foot of a 23-years-old male are described. An amputation of the lower extremity was performed and subsequently chemotherapy with adriamycin was given for 3 months. Despite the histology and cytologic malignant appearance and the evident vascular invasion, already present at the time of the first excision, the last known status 2 years later seems favorable. There are no pathologic lymph nodes in the groins and no signs of metastases on chest X-rays. From the electron-microscope study no definite conclusion can be drawn as regards the histogenesis of this tumor. we feel, as do others, that many of the principal mononuclear tumor cells are poorly differentiated mesenchymal cells. Some of the neoplastic cells, however, show ultrastructural features suggestive of chondro- or osteoblasts (a well-developed r.e.r. containing electron-dense material; multiple Golgi complexes; masses of glycogen; interdigitating cell membrane villi; cytoplasmic filaments; an extracellular amorphous matrix). Some of the larger tumor cells have the submicroscopic aspects of histiocytes as described in osseous, cutaneous, or pulmonary lesions of the histiocytosis X group. As yet undetermined cytoplasmic inclusion bodies constitute another rare observation in our material.
Adult↗
Ventilatory reflexes originated from carotid and extracarotid chemoreceptors in rats.
Ventilatory responses to transient stimulation and inhibition of arterial chemoreceptors--by hypoxia and hyperoxia, respectively--were studied in 10 pentobarbitone-anesthetized rats. N2 tests and intravenous injections of NaCN provoked transient increases in tidal volume and respiratory frequency, while O2 tests elicited decreases of these parameters. After bilateral carotid neurotomy, ventilatory responses to N2 and NaCN were still present although reduced in all rats, while ventilatory depression in response to O2 tests was observed in 60% of these rats. Further bilateral sectioning of main vagus, aortic, and superior laryngeal nerves immediately below the nodose ganglia abolished the ventilatory responses to NaCN in only one of the five rats subjected to this procedure, the remaining animals showing moderate hyperventilation in response to large doses of this drug. Mild ventilatory depression in response to hyperoxia, indicative of a persistent peripheral chemosensory drive, was still present in two of these rats. It is concluded that, although the carotid bodies constitute the main source of ventilatory chemoreflexes in rats, other vagally and nonvagally innervated chemoreceptors (presumably thoracic and abdominal) may elicit ventilatory reflexes in this species.
Animals↗
Effect of body mass index and follicular synchrony in the ovarian response to ovulation induction with menotropins.
OBJECTIVE: To determine the correlation between body mass index, follicular synchrony, and pregnancy rate in a controlled ovarian hyperstimulation program with menotropins. SUBJECTS AND METHODS: Seventy-nine hyperstimulation cycles were evaluated. Transvaginal ultrasonographic control was performed and 10,000 IU of human chorionic gonadotropin were administered when the dominant follicle reached a diameter > 16 mm. In order to evaluate the follicular response, the ovarian synchrony factor was used (# follicles > or =16 mm/# follicles > 10 mm). For the statistical analysis, linear correlation and chi-square tests were used. RESULTS: When patients had a normal body mass index there was a positive correlation ( r = .52) between body mass index (kg/m(1.5)) and the ovarian synchrony factor. Weight deficiency and obesity had a deleterious effect on the ovarian response ( r = -.47 and r = -.77, respectively). There was a significant difference in the number of pregnancies in patients with ideal weight in relationship to the subgroup with weight deficit. CONCLUSIONS: An adequate body constitution increases the possibilities of achieving success in ovulation induction programs; on the other hand, weight disturbances have a deleterious effect on ovulation.
Body Mass Index↗
Bone mineral density and degenerative changes of the lumbar spine in former elite athletes.
The aim of this study was to assess bone mineral density (BMD) and degenerative changes in the lumbar spine in male former elite athletes participating in different track and field disciplines and to determine the influence of body composition and degenerative changes on BMD. One hundred and fifty-nine former male elite athletes (40 throwers, 97 jumpers, 22 endurance athletes) were studied. Anthropometric (age, body mass index [BMI]) and sport-specific data (personal best, intensity, duration, and time since termination of competitive sports career as well as current sporting activity) were collected. Degenerative changes of the lumbar spine in lateral view were evaluated by using the Kellgren and Lawrence Score. Bone mineral density of the lumbar spine was measured in an anterior-posterior view with dual energy X-ray absorptiometry (DEXA, T-score). Throwers had a higher body mass index than jumpers and endurance athletes. Throwers and jumpers had higher BMD (T-LWS) than endurance athletes. Bivariate analysis revealed a negative correlation of BMD (T-score) with age and a positive correlation with BMD and Kellgren score (p<0.05). Even after multiple adjustment for confounders lumbar spine BMD is significantly higher in throwers, pole vaulters, and long- and triple jumpers than in marathon athletes. Different types of mechanical loading caused by sporting activities seem to influence the BMD of the lumbar spine, even if different body constitutions (i.e. BMI) and age, training history, and degenerative changes in the lumbar spine of former throwers, jumpers, and endurance athletes are taken into consideration.
Absorptiometry, Photon↗
Estimation of time since death by heat-flow Finite-Element model part II: application to non-standard cooling conditions and preliminary results in practical casework.
The present paper is part of a study investigating the application of the Finite-Element-Method to temperature-based death time determination. Part I introduced a three-dimensional Finite-Element model of the human body containing different tissue compartments with different thermal tissue properties. The initial temperature distribution is modelled inhomogeneously with a gradient between core and shell. Boundary conditions such as heat loss by convection or radiation as well as heat gain by supravital energy production or irradiation can be modelled. One model parameter, the decrease rate of the supravital energy production, was calibrated using the empirical model by Marshall and Hoare. Validation was successful using the Marshall and Hoare model as well for standard cooling situations. Part II now concentrates on the application of the model to non-standard cooling conditions and in practical casework. The parameters that have to be recorded at the crime scene are discussed. Special attention has to be paid to the insertion depth of the rectal temperature probe and to the thickness of the clothing material. Five real cases are presented, where the time of death is meanwhile known. The different steps of adjusting the standard Finite-Element model to the actual body and environmental conditions are described. In all cases, the victims were completely clothed. In one case, the victim was turned from a ventral to a dorsal position. In another case, the victim was killed and transported at room temperature in still air and then deposited outside in a much lower temperature and in slight wind. The model produced plausible results in all cases. The Finite-Element cooling curves are compared to the curves produced by the empirical model of Henssge. In two cases with strong body constitutions, the time since death was considerably overestimated by the Henssge model, in the other cases slightly. The results indicate that the heat transfer approach by Finite Elements is suited to considerably improve death time estimation.
Adult↗
Heme oxygenase-1, heme oxygenase-2 and biliverdin reductase in peripheral ganglia from rat, expression and plasticity.
The expression of inducible and constitutive heme oxygenase and biliverdin reductase was studied in normal and cultured peripheral ganglia from adult rats, using immunocytochemistry and in situ hybridization. Dramatic changes were induced by one to two days' culturing of dorsal root ganglia, nodose ganglia, otic ganglia, sphenopalatine ganglia and superior cervical ganglia. An up-regulation of inducible heme oxygenase was found in satellite cells of the cultured nodose ganglia, dorsal root ganglia, sphenopalatine ganglia and otic ganglia, whereas only a few satellite cells in the superior cervical ganglia responded with an increase in inducible heme oxygenase immunoreactivity. In the superior cervical ganglia inducible heme oxygenase also appeared in a subpopulation of macrophages. During culturing, expression of inducible heme oxygenase immunoreactivity also increased in axons and in nerve cell bodies. In situ hybridization corroborated the immunocytochemical findings, revealing a strong up-regulation of inducible heme oxygenase messenger RNA in satellite cells, and less pronounced up-regulation in nerve cell bodies. Constitutive heme oxygenase immunoreactivity was found in most neurons in all of the ganglia studied. No significant changes in constitutive heme oxygenase immunoreactivity could be observed in cultured ganglia. Biliverdin reductase immunoreactivity was barely detectable in any of the normal ganglia; however, after culturing it appeared in axons, single nerve cell bodies and nerve cell nuclei. The results show that inducible heme oxygenase is up-regulated in peripheral ganglia after axonal injury, and suggest a role for carbon monoxide in cellular signaling and a requirement for the antioxidant (bilirubin) during the regeneration process.
Animals↗
Efficacy of breast shielding during CT of the head.
In light of increasing frequency of CT examinations in the past decades, the aims of this prospective study were to investigate scatter radiation breast exposure in head CT and its dependence upon body constitution, and to assess the efficacy of lead shielding as a means of breast dose reduction. In 49 women referred to head CT for objective medical reasons one breast was covered with lead apron during CT scanning. Radiation doses were measured by use of thermoluminescent dosimeters, at skin of both breasts and over the apron. The doses were then compared as well as correlated to body mass index and meatus acusticus externus-to-dosimeter distance, respectively. Average exposure at the skin of the unshielded breast was 0.28 mGy (range 0.15-0.41 mGy), compared with 0.13 mGy (range 0.05-0.29 mGy) at the shielded breast. The doses showed a mean reduction by 57% due to lead shielding. At least half of breast exposure was imparted to the breast from outside, whereas the remainder results from internal scatter. The higher the body mass index, the higher the percentage of internal scatter in total breast dose. Although the level of scatter radiation to the breast is generally low during head CT examination, the use of lead cover enables recognizable further reduction of the exposure, and is recommended as a feasible and effective procedure of breast protection during CT of the head.
Adult↗
The influence of birthweight and intrauterine environment on adiposity and fat distribution in later life.
OBJECTIVE: To review the literature on the association between birthweight and body mass index (BMI) and obesity in later life. METHODS: Included in the review were papers appearing in Medline since 1966 and identified using the search terms obesity, body fat, waist, body constitution, birthweight and birth weight. Further papers were identified by examining bibliographies. RESULTS: There is good evidence that there is an association between birthweight and subsequent BMI and overweight in young adults and children, which is linear and positive in some studies and J- or U-shaped in others. The evidence is less strong for middle-aged subjects. Studies that have assessed lean body mass (LBM) and fat body mass have tended to find that birthweight is positively associated with LBM and negatively associated with relative adiposity. This suggests that the association between birthweight and BMI/overweight does not necessarily reflect increased adiposity at higher birthweights. On controlling for current body mass there is fairly consistent evidence of a negative association between birthweight and a central pattern of fat distribution as measured by central:peripheral skinfold ratios. It has been suggested that the prenatal period is a 'critical' period for the development of adiposity, but it is unclear how far associations between birthweight and subsequent body habitus are genetic in origin and how far they result from intrauterine 'programming'. Two lines of evidence would suggest that the association is predominantly genetic. Studies of monozygotic twins have found environmentally determined differences in birthweight to be unrelated to subsequent BMI, and the association between birthweight and BMI is substantially reduced on controlling for parental BMI. However, some evidence of an influence of intrauterine environment on later obesity comes from studies of subjects who were exposed in utero to the effects of diabetes, famine conditions or smoking. CONCLUSIONS: The reasons for the positive association between birthweight and BMI remain unclear. More studies including accurate measurement of body composition are needed to assess how far this relation is accounted for by changes in fat mass or by changes in lean mass. Studies with accurate measures of parental BMI would also be useful in assessing the importance of this confounder.
Adipose Tissue↗
[Nutrition mixes in the complex rehabilitation of young men with constitutional deficit of body weight].
It was investigated peculiarities of the constitutional malnutrition in 94 young men. The influence of oral supplementation by enteral nutrition on recovering 54 young men with constitutional malnutrition was examined. The results of investigation indicated a high efficacy of using oral supplementation in the complex treatment of malnourished young men. It results in improvement of patient's rehabilitation and reduce the time of hospitalization.
Adolescent↗
Croatian rugby project-Part I. Anthropometric characteristics, body composition and constitution.
BACKGROUND: There are no data in important literature about the anthropometric characteristics of rugby players in countries where rugby is not a popular sport. The goals of this study were to analyze morphological anthropometric characteristics, body composition and constitution of players in the first Croatian-Slovenian rugby league (CSRL) with regard to player's position in the team, team position in the division, and to compare results with the results of rugby players from the more popular rugby leagues. METHODS: The study was carried out in a sample of voluntarily included 111 male rugby players from six clubs members of the CSRL, in the season 1996/97. Eleven anthropometric measures required for the calculations of body mass index (BMI), body fat percentage (BF%), and somatotype components were obtained in the clubs according to the recommendations by Jackson and Pollock and Heath and Carter. RESULTS: Forwards in the CSRL are on the average 93.5 kg heavy, 182.4 cm tall, with BMI 28.3 kg/m2, BF% 20.8% and somatotype 6.7-5.9-1.4. Backs are on average 82.2 kg heavy, 178.3 cm tall, with BMI 26.1 kg/m2, BF% 16.9% and somatotype 5.3-5.3-1.5. Backs from upper half of the division are on the average heavier than those from lower half, BF% in forwards from upper half of the division is higher than in forwards from lower half. Both differences were found to be statistically significant (p<0.05). CONCLUSIONS: Compared with the rugby players from more developed rugby leagues, forwards from the CSRL are lighter, backs are heavier and both have higher body fat percentage. Backs and forwards are more endomorphic and forwards are less mesomorphic compared with the rugby players from more developed rugby leagues.
Adult↗
Anthropometric assessment of nutritional depletion after surgery injury.
Triceps skinfold (TS), arm muscle circumference (AMC) and body weight (BW) were studied prospectively in 20 adults, admitted to elective operations on the digestive tract, in order to evaluate these anthropometric parameters in planned surgical procedures performed in non-critically ill, non-stressed patients. Mean duration of the preoperative period was 19.2 days (range 1--38), and of the postoperative period, 14.1 days (range 6--31). Mean changes for BW were, respectively, -0.2% and -2.5%, AMC decreased -0.5% before operation and -3.4% afterwards, and TS was reduced to -1.9% in the preoperative phase, and to -8.4% postoperatively. These results are consistent with minimal anthropometric changes during the presurgical stay, with more striking decreases after operative injury. Postoperative findings were further examined in relationship to degree of surgical trauma and length of postoperative hospitalization. After the arbitrary selection of a 10% reduction as the limit for significant decrease in any of the analysed parameters, the percentage of impaired measurements was determined in the sub-groups of medium and large operations, two consecutive procedures, as well as postoperative stay of 6 to 14 days, 15 to 21 days, and over 3 wks. Decreased parameters comprised 6.0% (2/33) of the observations after moderate surgical manipulation, 27.7% (5/18) after serious trauma, and 66.6% (6/9) after two operations. Simarilarly they represented 2.7% (1/36) of the findings in patients discharged within 2 weeks, 33.3% (4/12) in those staying between 2--3 weeks, and 66.6% (8/12) in the cases remaining for longer periods. Despite the limited sensitivity of anthropometric parameters in the detection of acute moderate changes in body constitution, they were useful in separating the patients undergoing medium surgical injury from those subjected to more severe metabolic stress, when only changes greater than 10% of initial value were considered.
Adult↗
Retained foreign bodies.
OBJECTIVE: To evaluate the frequency of occurrence and outcome of patients having retained foreign bodies after treatment in an urgent-care setting. MATERIALS AND METHODS: Closed case records from the files of the Medical Professional Mutual Insurance Company involving claims of retained foreign body were reviewed for a 7-year period. MAIN RESULTS: Thirty-two patients filed 54 claims against 32 physicians and 22 health care institutions. Defense costs were $298,906, and indemnity payments were $1,279,171. Glass was the most frequent retained foreign body, constituting 53% of claims. Despite the fact that glass is radiopaque, x-ray films were ordered for only 35% of these patients. Retention of glass fragments when no radiologic study was obtained resulted in unsuccessful defense of 60% of the claims and higher indemnity payments. Radiologic studies were ordered for only 31% of all patients. CONCLUSIONS: All wounds should be considered to be at risk for foreign body entry. Documentation in the medical record of wound exploration and patient follow-up, and ordering of plain films and other diagnostic imaging studies should be used more frequently toward this end.
Diagnostic Errors↗