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Pulmonary function and its correlation to the degree of obesity in 294 patients
CURRENT LlTERATURE
Werner’s syndrome with associated malignant neoplasms. Hrabka RP, Milgrom H, Schwartz RA. Arch
Anatomical Dead Space and Airway Resistance after Glycopyrrolate or Atropine Premeditation. Gotta AW,
Dermatol
Ray C, Sullivan CA, Goldiner 363, 1981
118: 106, 1982
Werner’s syndrome is an autosomal recessive disease of connective tissue characterized by features of accelerated aging, bilateral juvenile cataracts, scleroderma-like skin changes, and a high incidence of neoplasms. This report presents a 57-year-old man who was originally referred for the excision of two basal cell carcinomas on the dorsum of his nose. His surgical history consisted of removal of bilateral juvenile cataracts at age 8, correction of undescended testes and diverticulosis at age 39, and thoracotomy at age 46 for removal of a significant mediastinal mass, which was later histologically diagnosed as a weli-differentiated fibrosarcoma. Physical examination disclosed a well-developed man with the characteristic facies of Werner’s syndrome. Pseudoexophthalmos and a bound down beaklike nose were prominent findings. Scleroderma-like skin changes were noted, such as atrophic facial skin with numerous telangiectases, and tightly drawn circumoral skin with numerous radial furrows. The lenses were absent, and the remaining testis was atrophic. Two crusted, translucent plaques were present on the nose, and there was a similar lesion on the upper lip. A glucose tolerance test showed latent diabetes mellitus, with other laboratory values being relatively normal. This case is significant in that multiple basal cell epitheliomas have been rarely reported with this syndrome. The authors suggest that early recognition of Werner’s syndrome allows early detection of associated malignant neoplasms, which are a common cause of death in these patients.-BRAD A. THERIOT
25:
Anatomic dead space (VD anal), I- and 3-second forced expiratory volumes (FEV, and FEVA, total forced expiratory volume (FEV). and maximal expiratory flow variables were determined before and four hours after intramuscular injection of saline, 0.0085 mg/kg atropine. or 0.005 mg/kg of glycopyrrolate. Both atropine and glycopyrrolate increased dead space in all subjects. Maximal effect of atropine occurred at one hour and was diminished by four hours. Glycopyrrolate was maximal at two hours and was stable at four hours. Both drugs increased FEV,, but the increase was significant one-half hour after injection. Both FEV and FEV:, were unchanged for both medications. Atropine and glycopyrrolate have a known bronchodilation capacity. However, this study demonstrates that both drugs dilate smaller conducting airways without affecting airway resistance.-TIMOTHY KABOT A Case-control Study of the Possible Association Between Oral Contraceptives and Malignant Melanoma.
Adam SA, Sheaves JK, Wright NH, Mosser G, Harris RW, Vessey MP. Br J Cancer 44:45. 1981 The incidence and mortality of malignant melanoma have increased more in recent years than most other cancers. In 1977 Beral et al reported an association between oral contraceptives and malignant melanoma in three separate sets of data collected in California. The purpose of this study was to reexamine the relationship between oral contraceptives and malignant melanoma. This casecontrol study consisted of 169 women with malignant melanoma, aged 15 to 49 years, and 507 matched controls. Data about medical, reproductive. drug. and smoking histories were obtained by a review of general practitioners’ records as well as by direct answers from the subjects on a mailed questionnaire. The authors state that there was no significant evidence of any overall increase in the risk of melanoma in the users of oral contraceptives. However, the risk estimated from the data in the mailed questionnaire was higher in women who had used oral contraceptives for five years or more. Previously demonstrated risk factors for melanoma, such as fair skin, blonde or red hair, and Celtic origin were found to be more common in the cases than in the COnWOk-JOHN A. GASSER
Postmenopausal osteoporosis: A heterogenous disorder as assessed by histomorphometric analysis of iliac crest bone from untreated patients. Whyte MP,
Bergtield MA, Murphy WA, Avioli LV, Teitelbaum Am J Med 72:193, 1982
PL. Surv Anesthesiol
SL.
Osteoporosis is a disorder generally characterized by a decreased skeletal mass without an abnormality in either composition or proportion of the mineral and organic phases of bone. In this study, 26 women with untreated postmenopausal osteoporosis underwent tetracycline bone labeling and mineral studies followed by iliac crest bone biopsy. Histomorphometric assessment of their bone remodeling revealed a histologically heterogenous disorder with morphologic expression in bone that could not be predicted by clinical and biochemical studies. Eight women had no evidence of active bone formation (inactive remodeling osteoporosis), whereas the others showed a spectrum of bone formation (active remodeling osteoporosis). These findings suggest that the rate of bone turnover is heterogeneous and varies considerably from patient to patient. Bone biopsy, necessary to identify the histologic lesion and assess skeletal dynamics, may prove useful in determining optimal therapy for osteoporosis, as a variety of agents with different effects on bone remodeling are available.-PHYLLIS CLARK
Pulmonary Function and Its Correlation to the Degree of Obesity in 294 Patients. Lee JJ, Larsen RH, Buckley
JJ, Roberts RR. Surv Anesthesiol
25:356, 1951
A retrospective study was made of pulmonary function test results of 294 morbidly obese patients who underwent jejunoileal bypass surgery. The objective was to correlate the pulmonary function in these patients with the degree of obesity, expressed as the ratio of actual weight to ideal weight, and with age. The weight distribution of the patients was from 85 kg to 260 kg with a mean of 130 kg. The ratio of actual to 609
610
CURRENT
ideal weight distribution ranged from 1.46 to 3.58 with a mean of 2.1. Ages ranged from 16 to 64 years with a mean of 35.6. The mean value of expiratory reserve volume (ERV) was considerably lower than the predicted value for patients of normal weight. Plotted graphically, ERV as a function of degree of obesity showed a negative linear relationship. Vital capacity (VC) and maximum breathing capacity (MBC) decreased linearly with increasing obesity, while Pace, increased significantly. ERV. FEV, ,d FVC, per cent, and PaO, decreased with increasing age faster than in the normal population. The conclusion reached is that the older obese patient is expected to have increasingly compromised pulmonary function.-LINDA HIME Controlled Study of Treatment for Disseminated and Intravascular Coagulation in the Neonate. Gross ST,
Filston HC, Anderson
JC. J Pediatr 100:445, 1982
Disseminated intravascular coagulation (DIC) is an acquired condition characterized by intravascular consumption of platelets and plasma-clotting factors, resulting in the formation of fibrin thrombi in the vasculature and a generalized hemorrhagic diathesis. In this study three types of treatments were compared for degree of abnormality in initial coagulation and underlying pathologic processes. The three study groups were (1) exchange transfusion, (2) administration of freshfrozen plasma and platelets, and (3) control group with no treatment. The neonates for these groups were selected randomly from 33 neonates with DIC. In 85% of all neonates, shock was a common accompaniment. Aggressive treatment for shock and underlying diseases was offered in all cases. It was concluded that there was no difference in the three groups regarding resolution and survival and the outcome of DIC treatment. Success was dependent on the treatment of the underlying pathologic states and aggressive supportive care.-REDA A. ABDEL-FATTAH Axon Number and Size Distribution ing Feline Inferior Alveolar Nerve.
in the DevelopFried K, Hilde-
with age-related dentitions.-JOHN
LITERATURE
changes in the primary and permanent C. MITCHELL
Audiovisual Reviews Tension
Management
and
Relaxation.
Mulry R. St
Louis, CV Mosby Co, 1981 This presentation consists of a book, an inventory form, and four 60-minute cassette tapes. On the introductory tapes-parts I and II-Dr. Mulry presents a condensed version of the material given in the book. He helps the listener to understand the relationship of today’s cultural pressures and stress to the production of bodily tensions. He then talks about how chronic tension can lead to many different physical illnesses. Dr. Mulry’s central theme is that in order to cope with stress, a person must learn to become aware of tension and control it through systematic relaxation techniques. A person surrounded by stress and pressure must try to place himself or herself in a center of calm, the “eye of the storm.” A unique item in this package is the personal concerns inventory. Fifty-two items of possible personal concern are given on a chart. Some examples are these: noise at home, cigarette smoking, pill consumption, ulcers, general unhappiness, and sex difficulties. The listener is instructed to rate these concerns as they apply (from not at all to very much) on a daily basis for three weeks. By looking at the completed chart, it is very easy to determine which issues are of primary and chronic concern. The stress of these issues is producing tension. The three other tapes provide a guide to progressive relaxation followed by sounds to help the listener imagine different scenes. Sounds of nature, gentle rainfall, the evening, the surf, the desert at sunrise, and a quiet place are recorded on separate sides of these tapes. Dr. Mulry suggests that the listener pick the sounds that are most conducive to imagery and are most pleasant. The relaxation guide is repeated on every tape so that the listener need not change tapes for imagining but may glide gently from deep relaxation to favorite sounds. This is an excellent package for teaching oneself tension management and relaxation.-RON OLSON
brand C. J Neurol Sci 53:169. 1982 The number and size distribution of axons in the developing inferior alveolar nerve were examined by electron microscopy. Seven cat fetuses and 30 kittens and cats ranging in age from 25 days after conception to 11 years were used. The total number of inferior alveolar nerve axons increased from 4400 to 16-17.000 between 75 and 40 days after conception, and then decreased to about 13,000 before birth. This level was maintained for as long as 11 years. Myelinated axons first appeared by 45 days post conception and constituted 28% at birth. The young adult proportion of about 45% myelinated axons was established at two months. In the old adult (11 years), 55% of the inferior alveolar nerve axons were myelinated. Size measurements showed that unmyelinated axons had diameters of 0.1-0.5 mm at 25 days post conception. From 55 days post conception to old adulthood, the size range extended from O.l- 1 mm. The size range of myelinated axons was 1.0-4.5 mm at birth and 1.0-8.0 mm two months postnatally. A bimodal size distribution first appeared by two months, and the range was 1.0-13.0 from six months onward. The findings were compared
Prophylaxis for Viral Hepatitis. With Richard H. Parker, MD. Color; running time, 15 minutes. The Network for Continuing Medical Education, 15 Columbus Circle, New York, 10023 This is a short but effective review of the epidemiology, immunology, and care of the patient who may contract any of the three different types of viral hepatitis. It is estimated that there are 200,000 chronic carriers of this disease. Oral and maxillofacial surgeons, together with their clinical auxiliaries, are in the highest risk category for acquiring the infection. Because a health delivery system has great potential for disseminating the disease, its practitioners are obligated to understand its origin, prevention, and appropriate care. The main theme is the availability and relative success of prophylactic measures with hepatitis B immune globulin for the patient who has been exposed to hepatitis B virus carrier. Hepatitis A and hepatitis non A and B are also reviewed. This is an excellent summary of a very important subject. 0
Werner’s syndrome with associated malignant neoplasms. Hrabka RP, Milgrom H, Schwartz RA. Arch
Anatomical Dead Space and Airway Resistance after Glycopyrrolate or Atropine Premeditation. Gotta AW,
Dermatol
Ray C, Sullivan CA, Goldiner 363, 1981
118: 106, 1982
Werner’s syndrome is an autosomal recessive disease of connective tissue characterized by features of accelerated aging, bilateral juvenile cataracts, scleroderma-like skin changes, and a high incidence of neoplasms. This report presents a 57-year-old man who was originally referred for the excision of two basal cell carcinomas on the dorsum of his nose. His surgical history consisted of removal of bilateral juvenile cataracts at age 8, correction of undescended testes and diverticulosis at age 39, and thoracotomy at age 46 for removal of a significant mediastinal mass, which was later histologically diagnosed as a weli-differentiated fibrosarcoma. Physical examination disclosed a well-developed man with the characteristic facies of Werner’s syndrome. Pseudoexophthalmos and a bound down beaklike nose were prominent findings. Scleroderma-like skin changes were noted, such as atrophic facial skin with numerous telangiectases, and tightly drawn circumoral skin with numerous radial furrows. The lenses were absent, and the remaining testis was atrophic. Two crusted, translucent plaques were present on the nose, and there was a similar lesion on the upper lip. A glucose tolerance test showed latent diabetes mellitus, with other laboratory values being relatively normal. This case is significant in that multiple basal cell epitheliomas have been rarely reported with this syndrome. The authors suggest that early recognition of Werner’s syndrome allows early detection of associated malignant neoplasms, which are a common cause of death in these patients.-BRAD A. THERIOT
25:
Anatomic dead space (VD anal), I- and 3-second forced expiratory volumes (FEV, and FEVA, total forced expiratory volume (FEV). and maximal expiratory flow variables were determined before and four hours after intramuscular injection of saline, 0.0085 mg/kg atropine. or 0.005 mg/kg of glycopyrrolate. Both atropine and glycopyrrolate increased dead space in all subjects. Maximal effect of atropine occurred at one hour and was diminished by four hours. Glycopyrrolate was maximal at two hours and was stable at four hours. Both drugs increased FEV,, but the increase was significant one-half hour after injection. Both FEV and FEV:, were unchanged for both medications. Atropine and glycopyrrolate have a known bronchodilation capacity. However, this study demonstrates that both drugs dilate smaller conducting airways without affecting airway resistance.-TIMOTHY KABOT A Case-control Study of the Possible Association Between Oral Contraceptives and Malignant Melanoma.
Adam SA, Sheaves JK, Wright NH, Mosser G, Harris RW, Vessey MP. Br J Cancer 44:45. 1981 The incidence and mortality of malignant melanoma have increased more in recent years than most other cancers. In 1977 Beral et al reported an association between oral contraceptives and malignant melanoma in three separate sets of data collected in California. The purpose of this study was to reexamine the relationship between oral contraceptives and malignant melanoma. This casecontrol study consisted of 169 women with malignant melanoma, aged 15 to 49 years, and 507 matched controls. Data about medical, reproductive. drug. and smoking histories were obtained by a review of general practitioners’ records as well as by direct answers from the subjects on a mailed questionnaire. The authors state that there was no significant evidence of any overall increase in the risk of melanoma in the users of oral contraceptives. However, the risk estimated from the data in the mailed questionnaire was higher in women who had used oral contraceptives for five years or more. Previously demonstrated risk factors for melanoma, such as fair skin, blonde or red hair, and Celtic origin were found to be more common in the cases than in the COnWOk-JOHN A. GASSER
Postmenopausal osteoporosis: A heterogenous disorder as assessed by histomorphometric analysis of iliac crest bone from untreated patients. Whyte MP,
Bergtield MA, Murphy WA, Avioli LV, Teitelbaum Am J Med 72:193, 1982
PL. Surv Anesthesiol
SL.
Osteoporosis is a disorder generally characterized by a decreased skeletal mass without an abnormality in either composition or proportion of the mineral and organic phases of bone. In this study, 26 women with untreated postmenopausal osteoporosis underwent tetracycline bone labeling and mineral studies followed by iliac crest bone biopsy. Histomorphometric assessment of their bone remodeling revealed a histologically heterogenous disorder with morphologic expression in bone that could not be predicted by clinical and biochemical studies. Eight women had no evidence of active bone formation (inactive remodeling osteoporosis), whereas the others showed a spectrum of bone formation (active remodeling osteoporosis). These findings suggest that the rate of bone turnover is heterogeneous and varies considerably from patient to patient. Bone biopsy, necessary to identify the histologic lesion and assess skeletal dynamics, may prove useful in determining optimal therapy for osteoporosis, as a variety of agents with different effects on bone remodeling are available.-PHYLLIS CLARK
Pulmonary Function and Its Correlation to the Degree of Obesity in 294 Patients. Lee JJ, Larsen RH, Buckley
JJ, Roberts RR. Surv Anesthesiol
25:356, 1951
A retrospective study was made of pulmonary function test results of 294 morbidly obese patients who underwent jejunoileal bypass surgery. The objective was to correlate the pulmonary function in these patients with the degree of obesity, expressed as the ratio of actual weight to ideal weight, and with age. The weight distribution of the patients was from 85 kg to 260 kg with a mean of 130 kg. The ratio of actual to 609
610
CURRENT
ideal weight distribution ranged from 1.46 to 3.58 with a mean of 2.1. Ages ranged from 16 to 64 years with a mean of 35.6. The mean value of expiratory reserve volume (ERV) was considerably lower than the predicted value for patients of normal weight. Plotted graphically, ERV as a function of degree of obesity showed a negative linear relationship. Vital capacity (VC) and maximum breathing capacity (MBC) decreased linearly with increasing obesity, while Pace, increased significantly. ERV. FEV, ,d FVC, per cent, and PaO, decreased with increasing age faster than in the normal population. The conclusion reached is that the older obese patient is expected to have increasingly compromised pulmonary function.-LINDA HIME Controlled Study of Treatment for Disseminated and Intravascular Coagulation in the Neonate. Gross ST,
Filston HC, Anderson
JC. J Pediatr 100:445, 1982
Disseminated intravascular coagulation (DIC) is an acquired condition characterized by intravascular consumption of platelets and plasma-clotting factors, resulting in the formation of fibrin thrombi in the vasculature and a generalized hemorrhagic diathesis. In this study three types of treatments were compared for degree of abnormality in initial coagulation and underlying pathologic processes. The three study groups were (1) exchange transfusion, (2) administration of freshfrozen plasma and platelets, and (3) control group with no treatment. The neonates for these groups were selected randomly from 33 neonates with DIC. In 85% of all neonates, shock was a common accompaniment. Aggressive treatment for shock and underlying diseases was offered in all cases. It was concluded that there was no difference in the three groups regarding resolution and survival and the outcome of DIC treatment. Success was dependent on the treatment of the underlying pathologic states and aggressive supportive care.-REDA A. ABDEL-FATTAH Axon Number and Size Distribution ing Feline Inferior Alveolar Nerve.
in the DevelopFried K, Hilde-
with age-related dentitions.-JOHN
LITERATURE
changes in the primary and permanent C. MITCHELL
Audiovisual Reviews Tension
Management
and
Relaxation.
Mulry R. St
Louis, CV Mosby Co, 1981 This presentation consists of a book, an inventory form, and four 60-minute cassette tapes. On the introductory tapes-parts I and II-Dr. Mulry presents a condensed version of the material given in the book. He helps the listener to understand the relationship of today’s cultural pressures and stress to the production of bodily tensions. He then talks about how chronic tension can lead to many different physical illnesses. Dr. Mulry’s central theme is that in order to cope with stress, a person must learn to become aware of tension and control it through systematic relaxation techniques. A person surrounded by stress and pressure must try to place himself or herself in a center of calm, the “eye of the storm.” A unique item in this package is the personal concerns inventory. Fifty-two items of possible personal concern are given on a chart. Some examples are these: noise at home, cigarette smoking, pill consumption, ulcers, general unhappiness, and sex difficulties. The listener is instructed to rate these concerns as they apply (from not at all to very much) on a daily basis for three weeks. By looking at the completed chart, it is very easy to determine which issues are of primary and chronic concern. The stress of these issues is producing tension. The three other tapes provide a guide to progressive relaxation followed by sounds to help the listener imagine different scenes. Sounds of nature, gentle rainfall, the evening, the surf, the desert at sunrise, and a quiet place are recorded on separate sides of these tapes. Dr. Mulry suggests that the listener pick the sounds that are most conducive to imagery and are most pleasant. The relaxation guide is repeated on every tape so that the listener need not change tapes for imagining but may glide gently from deep relaxation to favorite sounds. This is an excellent package for teaching oneself tension management and relaxation.-RON OLSON
brand C. J Neurol Sci 53:169. 1982 The number and size distribution of axons in the developing inferior alveolar nerve were examined by electron microscopy. Seven cat fetuses and 30 kittens and cats ranging in age from 25 days after conception to 11 years were used. The total number of inferior alveolar nerve axons increased from 4400 to 16-17.000 between 75 and 40 days after conception, and then decreased to about 13,000 before birth. This level was maintained for as long as 11 years. Myelinated axons first appeared by 45 days post conception and constituted 28% at birth. The young adult proportion of about 45% myelinated axons was established at two months. In the old adult (11 years), 55% of the inferior alveolar nerve axons were myelinated. Size measurements showed that unmyelinated axons had diameters of 0.1-0.5 mm at 25 days post conception. From 55 days post conception to old adulthood, the size range extended from O.l- 1 mm. The size range of myelinated axons was 1.0-4.5 mm at birth and 1.0-8.0 mm two months postnatally. A bimodal size distribution first appeared by two months, and the range was 1.0-13.0 from six months onward. The findings were compared
Prophylaxis for Viral Hepatitis. With Richard H. Parker, MD. Color; running time, 15 minutes. The Network for Continuing Medical Education, 15 Columbus Circle, New York, 10023 This is a short but effective review of the epidemiology, immunology, and care of the patient who may contract any of the three different types of viral hepatitis. It is estimated that there are 200,000 chronic carriers of this disease. Oral and maxillofacial surgeons, together with their clinical auxiliaries, are in the highest risk category for acquiring the infection. Because a health delivery system has great potential for disseminating the disease, its practitioners are obligated to understand its origin, prevention, and appropriate care. The main theme is the availability and relative success of prophylactic measures with hepatitis B immune globulin for the patient who has been exposed to hepatitis B virus carrier. Hepatitis A and hepatitis non A and B are also reviewed. This is an excellent summary of a very important subject. 0