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THE EFFECT OF LEAN BODY MASS ON INSULIN RESISTANCE AND OTHER CARDIOMETABOLIC RISK FACTORS IN HEALTHY POSTMENOPAUSAL WOMEN
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
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with the generation of reactive oxygen species. Increased oxidative stress could lead to cancer development. The aim of this study was to evaluate the level of antioxidants in patients with pancreatic cancer (PC) and patients with chronic pancreatitis (CHP) in comparison with healthy controls (CON). Methods: This study includes 34 patients suffering from PC, 34 patients with CHP and 34 CON. Patients and controls are sex and age matched. Levels of conjugated dienes in precipitated LDL (CD/LDL), reduced glutathione (GSH) and activities of superoxide dismutase (CuZnSOD), catalase (CAT), glutathione peroxidase (GPX1), glutathione reductase (GR) and paraoxonase (PON1) were estimated. Results: Lowered activity of GPX1 in PC and CHP patients in comparison with controls and lowered levels of antioxidant GSH in PC patients compared to CHP patients were observed. Activity of PON1 was decreased in both patients group compared with controls and also in PC than in CHP. Furthermore activity of SOD was lower in CHP patients in comparison with controls and in addition in CHP compared to KP. Increased levels of CD/LDL in CHP patients in comparison with PC were found. Conclusion: The results of our study suggest that in both pancreatic diseases the antioxidant defense mechanism is weakened, while the lipid peroxidation is enhanced. Acknowledgment: Supported by the grant IGA NS9769-4, Ministry of Health, Czech Republic.
Methods: This is the story of a 19 year old lady who presented with a five year history of intermittent painful cervical lymphadenopathy and fever. Investigations for HIV, TB and malaria were negative. CT of chest, abdomen and pelvis showed bilateral cervical, axillary, subpectoral, paraortic, iliac and inguinal lymphadenopathy (Figure 1). Biopsy of a cervical lymph node showed a histiocytic necrotising lymphadenitis of the Kikuchi-Fujimoto type with absence of haematoxylin bodies.
THE EFFECT OF LEAN BODY MASS ON INSULIN RESISTANCE AND OTHER CARDIOMETABOLIC RISK FACTORS IN HEALTHY POSTMENOPAUSAL WOMEN
On further investigation specific anti-Ro antibodies were positive and therefore a diagnosis of Systemic Lupus Erythematosus (SLE) which complicated the underlying Kikuchi-Fujimoto disease was made. The Patient was treated with immunosuppressants and control of symptoms was achieved. To our knowledge this is a histologically rare case of Kikuchi-Fujimoto disease complicated by SLE although haematoxylin bodies were absent. Subpectoral lymphadenopathy was another uncommon feature. Results: Kikuchi disease is an idiopathic self-limited lymphadenitis, first described by Kikuchi and Fujimoto in 1972. The disease usually runs a benign course. It can be complicated by SLE and the differential between them is often very difficult requiring specialist advice [1]. Conclusion: The Internist is not just a generalist. In many occasions he can get involved as a coordinator in specialty specific areas of a diagnostic problem. In this case involvement of the relevant specialties (histopathology and rheumatology) and thorough overall assessment were essential to make the correct diagnosis. Reference 1. Marinez-Vazquez C, Hughes G et al. Histiocytic necrotizing lymphadenitis, Kikuchi–Fujimoto’s disease, associated with systemic lupus erythematosus. Q J Med 1997;90:531–3.
Chrysi Koliaki1, Melpomeni Peppa1, Eleni Boutati2, Efstathios Garoflos1, Athanasios Papaefstathiou1, Nicholas Katsilambros3, Sotirios A. Raptis2,4, George Dimitriadis2, Dimitrios Hadjidakis1,2. 1Endocrine Unit, Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, Attikon University Hospital, Athens University Medical School, Athens, Greece; 2Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, Attikon University Hospital, Athens University Medical School, Athens, Greece; 3Evgenidion Hospital, Athens University Medical School, Athens, Greece; 4Hellenic National Diabetes Center for the Prevention, Research and Treatment of Diabetes Mellitus and its Complications (H.N.D.C), Athens, Greece Background: Recent data suggest a “paradoxically” adverse contribution of lean body mass (LBM) to metabolic risk in obese postmenopausal women. Aim of the present study was to investigate the association of LBM, assessed with Dual-energy X-ray Absorptiometry (DXA), with a number of cardiometabolic parameters in healthy postmenopausal women. Methods: A total of 150 postmenopausal women (age 54±7 years, BMI 29.6±5.8 Kg/m2, waist circumference 93±12 cm) underwent a detailed body composition analysis using DXA, and a number of indices of total fat and muscle mass and their distribution, were obtained. For all participants, a full cardiometabolic risk profile was evaluated including glucose homeostasis, blood pressure, lipids and high-sensitivity C-reactive protein (hs-CRP). Results: After controlling for age, physical activity and total fat mass, all muscle indices (MI) were positively associated with fasting insulin levels, HOMA index, mean blood pressure, triglycerides, total cholesterol/HDL ratio, triglycerides/HDL cholesterol ratio, J-glutamyltransferase and hs-CRP, and negatively associated with HDL cholesterol (p0.05 for all). All the above associations were significantly attenuated after adjusting for waist circumference. All MI showed a strong positive correlation with waist circumference and DXA-derived indices of central fat distribution. Similar associations were observed separately in normal-weight and obese women, but they were more pronounced in the obese subjects. Conclusions: LBM is positively associated with insulin resistance, hypertension, dyslipidaemia and chronic low-grade inflammation, independently of BMI and total fat mass, in healthy postmenopausal women. This “paradoxical” adverse association is proposed to be partially mediated by the coexistent central fat distribution. THE ROLE OF THE GENERAL INTERNIST IN MODERN MEDICINE THROUGH AN UNCOMMON CASE-KIKUCHI LYMPHADENOPATHY Dimitris Konstantinou1, Anastasia Vamvakidou2. 1Specialty Registrar Acute Medicine and General Internal Medicine, City Birmingham Hospital, UK; 2CT2 Medway Maritime Hospital, UK Background: The initial careful assessment by the General Internist in terms of history and appropriate diagnostic tests can help in the solution of difficult diagnostic problems.
Fig. 1. CT chest: Right Subpectoral lymphadenopathy.
OUTCOMES AND FACTORS PREDICTING SURVIVAL FOLLOWING INHOSPITAL CARDIOPULMONARY ARREST Apostolos Konstantis1, Triada Exiara1, Maria Kouroupi2, Ali Risggits1, Sofia Saridou1, Anastasia Georgoulidou1, Evaggelos Gidaris1, Lambros Simoglou1, Konstantina Nikolaou1, Louiza Mporgi1, Sofia Papanastasiou1, Leonidas Papazoglou3. 1General Hospital Of Komotini “Sismanoglio”; 2General Hospital of Didimoteixo; 3Military Hospital of Alexandroupolis Background: The aim of this study was to determine the clinical characteristics and outcomes of in-hospital patients who had cardiopulmonary arrest (CA) and received cardiopulmonary resuscitation (CPR) and to evaluate the factors predicting short and long term survival following CA. Methods: This is a retrospective study of all CA over a 24-month period in our hospital. Data was retrieved from cardiac arrest data collection form based on Utstein template. Results: 146 in-hospital patients, 82(56.2%) male with mean age of 67±13.4 years, were included in this study. 129(88.4%) episodes were CA, 17(11.6%) were primary respiratory arrests, 132(90.4%) were witnessed and 14(9.6%) unwitnessed. 104(71.2%) of the patients had non-shockable rhythm. The mean number of CPR cycles were 3 (range 1-14). 83(56.8%) patients were intubated during CPR, 58(39.7%) patients received defibrillation, 118(80.8%) adrenaline, 93(63.7%) atropine, 18(12.3%) amiodarone and 9(6.2%) sodium bicarbonate. Successful resuscitation was achieved in 58(39.7%) patients. 36(24.6%) patients were discharged from the hospital. 1-month and 1-year survival following CPR was 24% and 16% respectively. Non-shockable rhythm
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with the generation of reactive oxygen species. Increased oxidative stress could lead to cancer development. The aim of this study was to evaluate the level of antioxidants in patients with pancreatic cancer (PC) and patients with chronic pancreatitis (CHP) in comparison with healthy controls (CON). Methods: This study includes 34 patients suffering from PC, 34 patients with CHP and 34 CON. Patients and controls are sex and age matched. Levels of conjugated dienes in precipitated LDL (CD/LDL), reduced glutathione (GSH) and activities of superoxide dismutase (CuZnSOD), catalase (CAT), glutathione peroxidase (GPX1), glutathione reductase (GR) and paraoxonase (PON1) were estimated. Results: Lowered activity of GPX1 in PC and CHP patients in comparison with controls and lowered levels of antioxidant GSH in PC patients compared to CHP patients were observed. Activity of PON1 was decreased in both patients group compared with controls and also in PC than in CHP. Furthermore activity of SOD was lower in CHP patients in comparison with controls and in addition in CHP compared to KP. Increased levels of CD/LDL in CHP patients in comparison with PC were found. Conclusion: The results of our study suggest that in both pancreatic diseases the antioxidant defense mechanism is weakened, while the lipid peroxidation is enhanced. Acknowledgment: Supported by the grant IGA NS9769-4, Ministry of Health, Czech Republic.
Methods: This is the story of a 19 year old lady who presented with a five year history of intermittent painful cervical lymphadenopathy and fever. Investigations for HIV, TB and malaria were negative. CT of chest, abdomen and pelvis showed bilateral cervical, axillary, subpectoral, paraortic, iliac and inguinal lymphadenopathy (Figure 1). Biopsy of a cervical lymph node showed a histiocytic necrotising lymphadenitis of the Kikuchi-Fujimoto type with absence of haematoxylin bodies.
THE EFFECT OF LEAN BODY MASS ON INSULIN RESISTANCE AND OTHER CARDIOMETABOLIC RISK FACTORS IN HEALTHY POSTMENOPAUSAL WOMEN
On further investigation specific anti-Ro antibodies were positive and therefore a diagnosis of Systemic Lupus Erythematosus (SLE) which complicated the underlying Kikuchi-Fujimoto disease was made. The Patient was treated with immunosuppressants and control of symptoms was achieved. To our knowledge this is a histologically rare case of Kikuchi-Fujimoto disease complicated by SLE although haematoxylin bodies were absent. Subpectoral lymphadenopathy was another uncommon feature. Results: Kikuchi disease is an idiopathic self-limited lymphadenitis, first described by Kikuchi and Fujimoto in 1972. The disease usually runs a benign course. It can be complicated by SLE and the differential between them is often very difficult requiring specialist advice [1]. Conclusion: The Internist is not just a generalist. In many occasions he can get involved as a coordinator in specialty specific areas of a diagnostic problem. In this case involvement of the relevant specialties (histopathology and rheumatology) and thorough overall assessment were essential to make the correct diagnosis. Reference 1. Marinez-Vazquez C, Hughes G et al. Histiocytic necrotizing lymphadenitis, Kikuchi–Fujimoto’s disease, associated with systemic lupus erythematosus. Q J Med 1997;90:531–3.
Chrysi Koliaki1, Melpomeni Peppa1, Eleni Boutati2, Efstathios Garoflos1, Athanasios Papaefstathiou1, Nicholas Katsilambros3, Sotirios A. Raptis2,4, George Dimitriadis2, Dimitrios Hadjidakis1,2. 1Endocrine Unit, Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, Attikon University Hospital, Athens University Medical School, Athens, Greece; 2Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, Attikon University Hospital, Athens University Medical School, Athens, Greece; 3Evgenidion Hospital, Athens University Medical School, Athens, Greece; 4Hellenic National Diabetes Center for the Prevention, Research and Treatment of Diabetes Mellitus and its Complications (H.N.D.C), Athens, Greece Background: Recent data suggest a “paradoxically” adverse contribution of lean body mass (LBM) to metabolic risk in obese postmenopausal women. Aim of the present study was to investigate the association of LBM, assessed with Dual-energy X-ray Absorptiometry (DXA), with a number of cardiometabolic parameters in healthy postmenopausal women. Methods: A total of 150 postmenopausal women (age 54±7 years, BMI 29.6±5.8 Kg/m2, waist circumference 93±12 cm) underwent a detailed body composition analysis using DXA, and a number of indices of total fat and muscle mass and their distribution, were obtained. For all participants, a full cardiometabolic risk profile was evaluated including glucose homeostasis, blood pressure, lipids and high-sensitivity C-reactive protein (hs-CRP). Results: After controlling for age, physical activity and total fat mass, all muscle indices (MI) were positively associated with fasting insulin levels, HOMA index, mean blood pressure, triglycerides, total cholesterol/HDL ratio, triglycerides/HDL cholesterol ratio, J-glutamyltransferase and hs-CRP, and negatively associated with HDL cholesterol (p0.05 for all). All the above associations were significantly attenuated after adjusting for waist circumference. All MI showed a strong positive correlation with waist circumference and DXA-derived indices of central fat distribution. Similar associations were observed separately in normal-weight and obese women, but they were more pronounced in the obese subjects. Conclusions: LBM is positively associated with insulin resistance, hypertension, dyslipidaemia and chronic low-grade inflammation, independently of BMI and total fat mass, in healthy postmenopausal women. This “paradoxical” adverse association is proposed to be partially mediated by the coexistent central fat distribution. THE ROLE OF THE GENERAL INTERNIST IN MODERN MEDICINE THROUGH AN UNCOMMON CASE-KIKUCHI LYMPHADENOPATHY Dimitris Konstantinou1, Anastasia Vamvakidou2. 1Specialty Registrar Acute Medicine and General Internal Medicine, City Birmingham Hospital, UK; 2CT2 Medway Maritime Hospital, UK Background: The initial careful assessment by the General Internist in terms of history and appropriate diagnostic tests can help in the solution of difficult diagnostic problems.
Fig. 1. CT chest: Right Subpectoral lymphadenopathy.
OUTCOMES AND FACTORS PREDICTING SURVIVAL FOLLOWING INHOSPITAL CARDIOPULMONARY ARREST Apostolos Konstantis1, Triada Exiara1, Maria Kouroupi2, Ali Risggits1, Sofia Saridou1, Anastasia Georgoulidou1, Evaggelos Gidaris1, Lambros Simoglou1, Konstantina Nikolaou1, Louiza Mporgi1, Sofia Papanastasiou1, Leonidas Papazoglou3. 1General Hospital Of Komotini “Sismanoglio”; 2General Hospital of Didimoteixo; 3Military Hospital of Alexandroupolis Background: The aim of this study was to determine the clinical characteristics and outcomes of in-hospital patients who had cardiopulmonary arrest (CA) and received cardiopulmonary resuscitation (CPR) and to evaluate the factors predicting short and long term survival following CA. Methods: This is a retrospective study of all CA over a 24-month period in our hospital. Data was retrieved from cardiac arrest data collection form based on Utstein template. Results: 146 in-hospital patients, 82(56.2%) male with mean age of 67±13.4 years, were included in this study. 129(88.4%) episodes were CA, 17(11.6%) were primary respiratory arrests, 132(90.4%) were witnessed and 14(9.6%) unwitnessed. 104(71.2%) of the patients had non-shockable rhythm. The mean number of CPR cycles were 3 (range 1-14). 83(56.8%) patients were intubated during CPR, 58(39.7%) patients received defibrillation, 118(80.8%) adrenaline, 93(63.7%) atropine, 18(12.3%) amiodarone and 9(6.2%) sodium bicarbonate. Successful resuscitation was achieved in 58(39.7%) patients. 36(24.6%) patients were discharged from the hospital. 1-month and 1-year survival following CPR was 24% and 16% respectively. Non-shockable rhythm