Evaluation of systemic markers related to anemia of chronic disease in the peripheral blood of smokers and non-smokers with chronic periodontitis

OBJECTIVES

The aim of this study was to investigate the effect of cigarette smoking on clinical parameters and signs anemia of chronic disease in chronic periodontitis patients.

METHODS

The study base consisted of 88 patients with chronic periodontitis including 45 volunteer current smokers with age range of 30-69 (45.5+/-8.5) and 43 volunteer non-smokers with age range of 32-61 years (45.8+/-7.9). The clinical parameters including plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL) were recorded and several red blood cell parameters were determined from peripheral blood samples.

RESULTS

In smokers, PI, PD and CAL were significantly higher than non-smokers (P<.05). The number of erythrocytes and the levels of hemoglobin, hematocrit and iron were lower in smokers compared to non-smokers (P<.05).

CONCLUSIONS

In the present study, it is concluded that cigarette smoking may be effective on the signs of anemia of chronic disease in patients with chronic periodontitis.

Continuous measurement of hematocrit using an intravascular catheter equipped with a fiberoptic transmission cell

PURPOSE

The purpose of this study was to measure intravascular hematocrit values continuously by using a fiberoptic probe based on near-infrared photometry.

METHODS

We produced a catheter 1.5 mm in diameter that use a pair of plastic fibers. One of the fibers, the measuring fiber, was used to measure the optical density of blood, and the other, the reference fiber, was used to decrease the signal-to-noise ratio. We employed an 805-nm laser diode as the light source. Two photodiodes were used to measure the intensity of the light transmitted through the two fibers, and the output signals were amplified and sent to a personal computer through an analog-to-digital converter.

RESULTS

The hematocrit values obtained by this fiberoptic continuous measurement agreed well with those obtained by microcentrifugation within physiological ranges.

CONCLUSIONS

This method is effective for monitoring the rapid changes in hematocrit.

Plasmodium falciparum-associated anemia in children at a large urban hospital in Zaire

Chloroquine-resistant Plasmodium falciparum malaria and human virus (HIV) infection through blood transfusions used to treat malaria-associated anemia are causes of increasing morbidity and mortality among children in Africa. To evaluate the role of malaria and other risk factors for pediatric anemia, we conducted a study of children brought to the emergency ward of a large urban hospital in Kinshasa, Zaire. A total of 748 children ages six through 59 months were enrolled; 318 (43%) children were anemic (hematocrit < 33%), including 74 (10%) who were severely anemic (hematocrit < 20%). Plasmodium falciparum parasites were detected in 166 children (22%); hematocrits for these children (mean 25.8%) were significantly lower than for aparasitemic children (mean 33.7%; P < 10(-6)). Fever with splenomegaly (odds ratio [OR] = 6.5, P = 0.02), parasitemia (OR = 3.5, P < 0.001), lower socioeconomic status (OR = 2.0, P = 0.004), and malnutrition (OR = 1.8, P = 0.06) were independently associated with anemia in a multivariate model. Recent antimalarial therapy was also associated with a lower hematocrit, suggesting that chloroquine may have aggravated the anemia. A reassessment of the effectiveness of strategies to diagnose and treat malaria and malnutrition is necessary to decrease the high prevalence of anemia and the resultant high rate of blood transfusions in areas endemic for malaria and HIV.

Depressed erythropoietic activity of Nigerian pregnant women

Reticulocytes production index was determined in 63 pregnant women and in 96 patients. The results show that 86% of the pregnant women, who were registering their pregnancy for the first time, were anaemic. There was significant reticulocytopenia in all the anaemic pregnant women and in the patients. Erythropoiesis was found to be depressed in all subjects patients by two to seven times those expected in normal responsive bone marrows. There was no correlation of the bone marrow impairment with parity of the pregnancy. The bone marrow impairment was more pronounced during the 16th week of gestation and less so in older pregnancies. Malnutrition and infection (especially malaria) are suggested as the aetiological factors of the bone marrow depression of erythropoiesis.

Iron, folic acid and zinc intakes and status of low socio-economic pregnant and lactating Amazonian women

Dietary intakes were obtained by 24-h recall from 25 women in the first and third trimesters of pregnancy and 25 women in the first 3 months of lactation from eight towns in the Amazon valley. No consistent differences were found between the towns, so the results have been analysed together. Intakes of iron, free and total folate and zinc were nearly all very low compared with current recommendations. Despite their low intakes, the majority of the women had acceptable values of haemoglobin, haematocrit and MCHC. Serum folate concentrations were almost all extremely low (less than 2.5 ng/ml). The levels of RBC folate were also low, but in general not as severely so as those for serum folate. Serum zinc concentrations ranged from 0.2 to 0.7 microgram/ml, whereas the lower limit of acceptability has been put by various authors as 0.59-0.69 microgram/ml according to the stage of pregnancy. In breast milk, total folate in the majority of women ranged from 25 to 50 ng/ml, the greater part of it being in the free form. Zinc levels in breast milk were within the range 0-2 microgram/ml.

Iron, zinc, folate and vitamin B12 nutritional status and milk composition of low-income Brazilian mothers

The purpose of this study was to assess the nutritional status of low-income Brazilian mothers, who were supplemented with iron and vitamin B12 during pregnancy, in terms of iron, zinc, folate and vitamin B12, in different stages of lactation and to determine the influence of the maternal nutritional status on milk composition. The effect of folate supplementation during pregnancy on folate status of the nursing mothers and milk composition was investigated. The effect of partial weaning on maternal status and milk composition was also studied. In general, the nutritional status of iron, zinc, folate and vitamin B12 of the mothers appears adequate. However, some of the mothers had indices of status lower than normal limits for non-pregnant women. These values, particularly after 30 d post-partum, indicate that these mothers might be at nutritional risk and that the nutrient supplementation received during pregnancy was insufficient to meet demands. There was an increase with the stage of lactation for haematocrit, serum vitamin B12, serum zinc, serum albumin, milk folate and saturation of its binding protein, but there was a decrease for milk protein, total and whey-bound iron and zinc, and lactoferrin. Mothers who took folate supplements during pregnancy had higher serum folate levels immediately after birth than those not taking the supplements but no differences were found at later stages of lactation. Milk composition was not affected. Partial weaning did not affect the maternal nutritional status or the milk composition except for iron which was higher in milk from mothers who were partially breastfeeding.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of Norplant on clinical chemistry in Singaporean acceptors after 1 year of use: I. Haemostatic changes

A longitudinal study of coagulation parameters was carried out on 100 Singaporean acceptors using the levonorgestrel subdermal implants NORPLANT for contraceptive purposes. At the end of 1 year of use, results from this on-going study indicate that these subjects may have an increased predisposition to thrombosis as evidenced by significant increase in platelet count and aggregability. The results also show that NORPLANT acceptors may have an enhanced potential for hypercoagulation - with a significant shortening of their Prothrombin Time and Activated Partial Thromboplastin Time and increases in Factors V and X. As previously documented, mean values for haemoglobin and haematocrit were significantly elevated by the end of 1 year. A number of other parameters achieved statistically significant differences by the end of 1 year but these were probably due to the large sample size involved and were therefore not likely to be of much clinical importance.

Some fetal and pregnancy parameters in Nepal

In Patan Hospital, Kathmandu, 4600 single live births were analysed concerning birth weight in relation to gestational age. At term, the median birth weight of females was 2900 g and of males 3010 g. Compared with Norwegian newborns, the birthweights of Nepali babies were lower for all corresponding gestational lengths. The differences increased with gestational age. Fundal height was lower in Nepali than in Norwegian pregnant women for all periods of pregnancy. An increase in the differences between Norwegian and Nepali women was also noted. Hematocrit values of Nepali women who did not take supplementary iron, correspond well to findings in Norwegian women without iron supplementation. Only a slight degree of hemoconcentration was noted towards term. For Norwegian women with iron supplementation the hematocrit values were much higher, with a tendency towards hemoconcentration near term. In Nepal the average woman probably has small iron stores, and without iron supplementation the hematocrit values will remain low throughout the pregnancy. The high altitude does not seem to cause hemoconcentration in pregnancy to a greater extent than at lower altitude. Hemoconcentration is therefore not a major causative factor of the lower birth weights.

Formulation and evaluation of supplementary foods for Thai pregnant women

To improve maternal nutritional status and to ameliorate protein-energy malnutrition in pregnant women and infants, supplementary foods for rural pregnant women were formulated and evaluated. Six formulas with protein and energy contents of 16-22 g and 350-500 kcal/100 g food, respectively, were developed from locally available raw materials. A field evaluation of formulas I and V was conducted at the regional MCH Center at Rajchaburi, about 120 km from Bangkok. Formulas providing 13 g protein and 350 kcal per day were given to two groups of mothers in the first or second pregnancy, starting at 28 +/- 2 wk of gestation. A third group, unsupplemented, served as controls. Maternal weight gain and left mid-arm circumference were measured every 2 wk. Birth weight, length, head and chest circumferences of newborns, and placental weight were significantly higher in both supplemented groups. These findings suggest that among undernourished mothers, supplementation of as little as 13 g protein and 350 kcal daily during the last trimester can significantly improve maternal weight gain and birth weight of newborns.

The effect of smoking during pregnancy on cord blood and maternal serum immunoglobulin levels

The effect of smoking on the fetal and maternal humoral immune parameters was evaluated in cord and maternal blood, collected at delivery from 163 mothers who smoked and 130 mothers who did not smoke, and their offspring. There was no difference in time of gestation between the two groups, but the mean birth weight of the offspring of mothers who smoked was decreased, as previously observed. There were higher levels of IgA (p less than 0.01), IgM (p less than 0.001), and IgG (p less than 0.001) in cord sera of children of mothers who smoked than in the offspring of mothers who did not smoke. Mothers themselves who smoked had higher levels of IgM (p less than 0.001) and IgG (p less than 0.001), but not IgA, as compared to control mothers who did not smoke. Since cord IgA and IgM are produced by the fetus, these results could be interpreted as being due to either a higher incidence of infection in utero or metabolic differences in the children of mothers who smoke. Either of these possibilities may explain the increased frequency of postpartum endometritis, increased incidence of fetal distress, and the characteristic of meconium-stained amniotic fluid in mothers who smoke.

Long-term reversible contraception with levonorgestrel-releasing Silastic rods

Subcutaneously placed Silastic capsules containing levonorgestrel are effective for 5 years and have a higher continuation rate than other methods of reversible contraception. Six 3 cm capsules are required to achieve satisfactory circulating levels of levonorgestrel. Two 4 cm covered Silastic rods containing levonorgestrel, which are easier to manufacture, insert, and remove than the capsules, produce similar in vitro release rates. This study compared clinical and metabolic effects as well as bleeding patterns in 23 women using either six capsules (n = 11) or two covered rods (n = 12). Serum levels of levonorgestrel, lipids, and lipoproteins as well as frequency of elevated progesterone levels were compared in serum samples obtained before treatment and 1, 6, 12, 18, and 24 months after insertion with the two systems. While bleeding patterns were similar for users of the two systems, rod users had slightly higher serum levels of levonorgestrel and a lower incidence of cycles with elevated progesterone levels. Therefore, rods could replace capsules as a long-term, reversible contraceptive method.

Zinc and copper concentrations in leucocytes and erythrocytes in healthy adults and the effect of oral contraceptives

The content of zinc and copper of whole blood, plasma, erythrocytes and white cells, has been measured in normal controls. The concentrations of zinc and copper in leucocytes are about seven and ten times respectively higher than those in erythrocytes. Women taking oral contraceptives showed significant increases in the concentrations of copper in plasma and whole blood but not in leucocytes or erythrocytes. Oral contraceptives did not alter the concentration of zinc in any of the fractions or in whole blood. These data provide a baseline for the assessment of the body status of zinc and copper in various disease states in which deficiencies may be present.

Predictive value of serum ferritin in anemia development after insertion of T Cu 220 intrauterine device

A one-year follow-up study in 30 healthy women was undertaken to study serum ferritin as well as other hematological parameters prior, six and twelve months after insertion of an intrauterine device, T Cu 220. Women were allocated into one of two groups according to the baseline ferritin serum levels; Group I abnormal ferritin and Group II normal ferritin levels. Other hematological parameters were normal and no iron supplement was given throughout the study. A direct relationship between low ferritin serum values (Group I), and anemia development was found. Seven out of 15 developed anemia, whereas only 2 out of 15 had anemia at twelve months in Group II with normal ferritin values. The overall data suggested that measurement of serum ferritin levels could be a useful tool to anticipate anemia development in women with intrauterine devices.

Nutritional status of women attending family planning clinics

A study was carried out to define nutritional problems of women attending family planning clinics (FPCs). Methods of nutritional assessment were chosen to examine relationships between diet and biochemical measures of folacin, riboflavin, and vitamin A status. Findings showed that in the sample of 219 FPC women, 30 percent were obese, 75 percent were low or deficient in plasma folacin, 58 percent were low or deficient in erythrocyte folacin, and 39 percent were low or deficient in riboflavin status (by erythrocyte glutathione reductase assay). Monotonous diets, low plasma folacin, and obesity were characteristic of less well-educated women. Women on contraceptive steroids had slightly lower red blood cell folacin. Riboflavin status was not related to intake of contraceptive steroids but was related to ethnicity.

Oral rehydration therapy of infantile diarrhea: a controlled study of well-nourished children hospitalized in the United States and Panama

Although oral glucose-electrolyte solutions containing 90 mmol of sodium per liter have been widely used in the treatment of acute diarrhea among under-nourished children in the developing world, they have rarely been studied in well-nourished children. We therefore conducted a controlled randomized study among well-nourished children three months to two years who were hospitalized with acute diarrhea (52 in the United States, and 94 in Panama), to compare the efficacy of this solution with that of one containing 50 mmol of sodium per liter and with standard intravenous therapy. Oral rehydration with both solutions according to protocol was successful in 97 of 98 children (one required unscheduled intravenous therapy), and in 87 (89 per cent) no intravenous therapy was required. All of six children admitted with hypernatremia were successfully treated with oral therapy alone. We conclude that glucose-electrolyte oral solutions containing either 50 or 90 mmol of sodium per liter are effective and safe in the treatment of well-nourished children hospitalized with acute diarrhea, and that they may completely replace the intravenous fluids in the majority of such children.

Anemia of pregnancy in Liberia, West Africa: a therapeutic trial

Research was conducted in Liberia, West Africa to ascertain which hematinics produce the best Hb response in women during the 3rd trimester of pregnancy. After obtaining background information, each of the 621 subjects was randomly assigned to one of four treatment groups. Group 1 was given 60 mg iron once daily, group 2 was given 60 mg iron 3 times daily, group 3 was given 60 mg iron 3 times daily plus a 5-mg folic acid tablet once daily, and group 4 was given the same treatment as group 3 but also a weekly antimalarial prophylactic. For comparison, 58 untreated women in their 3rd trimester were also studied. Before therapy the five groups were similar with respect to selected socioeconomic status, health, and dietary variables. Hb response to therapy was measured at 4-wk intervals from the 24th wk of gestation until term. The Hb rises in all four treatment groups were significantly (p less than 0.001) higher than the base-line values at 4, 8, and 12 wk after the interventions. The percentage of anemic women was reduced from 78 to 45% over the 12 wk of supplementation. Hb rises in groups 3 and 4 were not significantly different from those in groups receiving iron alone. It is concluded that iron deficiency is the main cause of anemia in this population.

Serum vitamin A, carotene and cholesterol levels in Nigerian women using various types of contraceptives

The diet in southern Nigeria is unusually high in carotenoids and low in preformed vitamin A. We studied the changes in serum vitamin A carotene and cholesterol induced in women in this region by the use of 3 types of contraceptives: IUD, injectable progestogen (INJ), and oral combination estrogen-progestogen (OC). The mean serum vitamin A and carotene levels were high in all groups. As expected, the serum vitamin A level in OC users was higher than in the other groups, but unexpectedly, the serum vitamin A was lower in IUD users. Serum carotene was lower in OC users than in other groups. Serum cholesterol was lower in the IUD and INJ groups than in the control and OC groups. A more detailed study of plasma transport forms of vitamin A is needed to determine if the very high serum vitamin A levels seen in some OC users in this population are potentially harmful.

Hematologic characteristics in IUD users

Increased uterine bleeding has often been cited as a frequent side effect of IUD usage. Previous reports have consistently linked IUD usage to increased menstrual blood loss; however, the role of the IUD as an etiologic agent in the development of iron deficiency with or without anemia is still unclear. This study examines hematologic and menstrual parameters in 52 IUD subjects and 40 control subjects. 90% of subjects with an IUD reported an increase in the amount and duration of menstrual flow and 35% noted intermenstrual bleeding. However, in a group of healthy women, the use of an IUD was not associated with significant or detrimental changes in common hematologic parameters.

Ectopic pregnancy: a review of 147 cases

From July 1, 1972, to June 30, 1979, 149 patients with ectopic pregnancy were treated at Truman Medical Center. The history and physical findings, diagnostic procedures, etiologic factors and patient management were reviewed. Abdominal pain (98.6%), amenorrhea (74.1%) and irregular vaginal bleeding (56.4%) were the most common presenting symptoms. Abdominal tenderness (97.3%) and adnexal tenderness (98%) were the most common physical findings. Culdocentesis was performed in 118 cases and was positive for nonclotting blood in 94.1%. In 115 cases (78.2%) the ectopic pregnancy was ruptured prior to the time of admission. The incidence of diagnostic error was 35.9%. There were no maternal deaths; however, the incidence of morbidity was 26.5%. Our data reemphasize the need for a high degree of suspicion and early utilization of definitive diagnostic procedures if the morbidity and mortality of ectopic pregnancy are to be reduced.

Termination of very early pregnancy by vaginal suppositories-(15S)-15-methyl prostaglandin F2 alpha methyl ester

A new approach to terminate very early pregnancy was tried on 49 healthy women who were proven to be pregnant from 31 to 47 days from their last menstrual period. All pregnancies were confirmed either by UCG or serum HCG-B subunit. (15S)-15-Methyl PGF2 alpha Methyl Ester in a suppository form was administered in two separate doses: 1.0 mg initial dose followed by 3.0 mg one hour later. Patients were kept under observation for 8 hours. Blood sampling for progesterone, HCG-B, and prostaglandin levels were assayed at 0 degree, 30', 1 degree, 4 degrees, 8 degrees and 14 days. Patients were re-examined at a two week follow-up visit. Pelvic examination and pregnancy tests were performed to confirm whether the pregnancy was successfully terminated. There were no significant changes in serums progesterone and HCG-B levels during the 8-hour observation period. Both levels declined significantly to very low levels at 14 days post-therapy, confirming the clinical impression of successful termination of pregnancy. Plasma prostaglandin levels rose as early as 30 minutes after initiation of therapy, peaked at 4 hours and declined gradually afterwards. Most side effects such as nausea, vomiting, diarrhea and cramps, although clinically manageable, were still bothersome. One patient experienced an episode of vasovagal syncope. The majority of patients required medical observation up to 6 hours. Clinical implications of this new approach of termination of very early pregnancy are discussed.

Comparison of the metabolic effects of two hormonal contraceptive methods: an oral formulation and a vaginal ring. I. Carbohydrate metabolism and liver function

A prospective, long-term study was undertaken to compare the metabolic effects of a contraceptive vaginal ring releasing levonorgestrel (about 290 microgram per day) and estradiol (about 180 microgram per day) and a combined oral contraceptive containing 30 microgram ethinylestradiol and 150 microgram levonorgestrel in two groups of women (n = 22 and 20, respectively). An intravenous glucose tolerance test, including determination of the insulin response to glucose, and liver function tests were performed. Both the glucose tolerance and fasting values of glucose were unaltered. The early insulin response to glucose increased by 50 percent in the contraceptive ring roup after one year of treatment, but not in the oral contraceptive group. All other insulin values were unchanged. All liver function values remained within the normal range in all subjects. There was a small significant decrease in alkaline phosphatases in both groups, which is in contrast to the effects of the early combined pills, which could cause an elevation. It is concluded that neither of these two contraceptive methods, the effects of which are predominantly gestagenic, seems to cause impairment of glucose tolerance or hepatic function.

The menstrual cycle in women using an intrauterine device

The duration and hormonal characteristics of the menstrual cycles of women using Copper T intrauterine devices (IUDs) were studied. Daily load samples were obtained during both the pre- and postovulatory phases of 30 IUD-associated cycles and the hormone values were compared with those of 15 normally menstruating women not using contraception. The ovulation rate and peak levels of 17 beta-estradiol and luteinizing hormone (LH) were not significantly different between the two groups. The average number of days from the 1st day of menstrual bleeding to the LH peak (the proliferative phase) was longer in the IUD users. The number of days from the LH peak to the onset of menstrual bleeding (the luteal phase) was shorter in the IUD users. Because of the compensating nature of these statistically significant differences, the total cycle length appeared to be unchanged. At the time of menstruation, the plasma levels of both progesterone and 17 beta-estradiol were significantly higher among IUD users. It is concluded that the presence of an IUD does not influence ovarian function, but that ovarian steroid production and endometrial events become asynchronous.

Sebum production and plasma testosterone levels in man after high-dose medroxyprogesterone acetate treatment and androgen administration

In 47 healthy male volunteers, the administration of 100 mg of oral medroxyprogesterone acetate daily for 42 consecutive days caused a modest 16.7% decrease in sebum production from a baseline mean of 2.28 mg to a post-treatment mean of 1.90 mg. This represented a considerably smaller decrement than had been reported in the literature. Immediately following the period of medroxyprogesterone acetate administration, the addition of daily oral doses of either 50 mg of fluoxymesterone, methyltestosterone, or calusterone to the 100 mg daily dose of medroxyprogesterone acetate for 42 additional days resulted in the return of sebum production to essentially pre-suppression values.

A statistically significant decrease in serum testosterone levels, from a pre-treatment mean of 862 ng/100 ml to a post-treatment mean of 251 ng/100 ml, was seen in all groups treated during the first 42 days with 100 mg of medroxyprogesterone acetate daily (P < 0.05). The addition of 50 mg of fluoxymesterone, methyltestosterone, or calusterone to the 100 mg of medroxyprogesterone acetate for another 42 day period caused a further decrease in serum testosterone levels (P < 0.001); the fluoxymesterone-medroxyprogesterone acetate combination produced the greatest decrease of serum testosterone levels, from a pre-treatment mean value of 932.8 ng/100 ml (Day 1), to a post-treatment mean value of 70.6 ng/100 ml (Day 85).

The daily dose of 20 mg of medroxyprogesterone acetate for 42 consecutive days caused less suppression of serum testosterone levels (from 831 ng/100 ml to a mean of 585 ng/100 ml) than 100 mg of medroxyprogesterone acetate (from 831 ng/100 ml to a mean of 214 ng/100 ml), but more than that of placebo (pre-treatment mean of 886 ng/100 ml to a post-treatment mean of 871 ng/100 ml). Except for changes in haemoglobin, haematocrit and haptoglobin values, no other medically significant changes were seen in the routine screening chemistries and urineanalyses for any of the drug groups. These changes were not unexpected, as they are known to occur with androgen therapy. Of potentially clinical importance was the absence of any effect of antithrombin-3 levels during the study period.

No major side effects were reported other than in one patient who developed gynaecomastia of his right breast on Day 42 of medroxyprogesterone acetate therapy. After his being removed from the study, the gynaecomastia disappeared rapidly.

Absorption of macronutrients from a rice-vegetable diet before and after treatment of ascariasis in children

The apparent absorption of nitrogen (N), fat, and total energy from a rice and vegetable diet was measured in 13 children of similar nutritional status but infected with varying loads of Ascaris lumbricoides. Apparent N absorption was modestly decreased initially in subjects with heavy infections as compared to those with light infections (57.2% of intake versus 64.1% of intake, 0.05 < P < 0.1). After antihelminthic therapy there ws a significant improvement in apparent N absorption (P < 0.02), apparent N retention (P < 0.05), and apparent fat absorption (P < 0.05) for the group as a whole, particularly for those with heavy infections. Total energy absorption improved slightly, but not significantly, after treatment, and there was no change in xylose excretion tests. Treatment of ascariasis may be nutritionally advantageous for children with heavy worm burdens and marginal protein availability.

Energy expenditures and food intakes of lactating women in Guatemala

Total energy expenditures and intakes were simultaneously assessed in 18 free-ranging lactating women (10 months postpartum) and compared to six similarly-sized, nonlactating, nonpregnant but multiparous women living in the same rural villages in the Guatemalan highlands. Energy intakes were estimated by the 24-hr recall method for each of 4 consecutive days. Energy expenditures were determined for 2 days by monitoring heart rate throughout the day and relating heart rate to oxygen consumption by individually-determined regression lines. The mean energy intake for the 4 consecutive days was estimated to be 1929 +/- 360 kcal/day (39.2 kcal/kg per day) for the lactating group; and 1876 +/- 404 kcal/day (38.3 kcal/kg per day) for the nonlactating group. The 2-day mean energy expenditures were estimated to be 2007 +/- 292 kcal/day for the lactating women (41.8 kcal/kg per day) and 1966 +/- 382 kcal/day for the lactating women (40.1 kcal/kg per day). The way of life of both groups was judged "moderately active" by 1973 FAO/WHO classifications. Most of the lactating women had been losing weight progressively during the past 6 months. Over the 10-week period prior to our measurnth) (P less than 0.01) than in the nonlactating group (-35 g/month) (ns). The high correlation (r = 0.87) between weight loss and the reduction in the sum of the three skinfolds suggested adipose tissue loss. There were no significant differences between the two groups in terms of daily energy intake, daily energy expenditure, the energy cost of specific activities throughout the day. The slope of the heart rate/oxygen consumption regressions suggest adequate cardiorespiratory fitness. This study suggests that the energy cost of lactation was met to a greater extent by fat loss than by either increased energy intake, reduced energy expenditure, or both.

[Microrheological studies in healthy subjects. Effect of cigarette smoke and oral contraceptives on erythrocyte flexibility]

Erythrocyte flexibility was tested in 29 healthy subjects, using whole-blood filtration through membrane filters with 5 micron pores, special attention being given to cigarette smoking and oral contraceptives as risk factors. Red cell flexibility was significantly reduced in male smokers compared with non-smokers (P is less than 0.0001), and in all male and female smokers (P is less than 0.05) An influence of oral contraceptives to erythrocyte flexibility could not be found. Reduced erythrocyte flexibility in smokers as a factor contributing to an abnormal microcirculation and to the development of arterial occlusive disease is discussed.

Lactation and pregnancy in Iran. II. Diet and nutritional status

Dietary intake in the third month postpartum and nutritional status during pregnancy close to term were assessed in Iranian urban uomen of low and middle socioeconomic status as part of a study investigating nutrition, hormonal status, and lactation in a population where lactation failure is a serious problem. Dietary intake was assessed by the 24-hr-recall method. The greatest differential in food groups consumed was in animal products, fruit, and vegetables. Intake of nutrients equal to or less than 80% of recommendations in both socioeconomic groups were energy, vitamin B6, folacin, calcium, iron, and zinc. In the low socio-economic group, only average intakes of vitamin C, thiamin and protein met the standards. Significant differences were found between the socioeconomic groups in hemoglobin, hematocrit, serum total protein, and protein fractions, but not in weight and height. The only parameters of nutritional status significantly correlated with adequacy of lactation were postpartum weight and percent of standard weight for height in the low socioeconomic group, and hematocrit values in the middle socioeconomic group. Differences between pregnant and postpartum individual values of the blood parameters were in general greater in the middle socioeconomic group than the low socioeconomic group.

Progesterone for outpatient treatment of Pickwickian syndrome

Ten patients with the Pickwickian syndrome, characterized by obesity, hypoxemia, hypercapnia, polycythemia, and cor pulmonale, underwent long-term treatment as outpatients with medroxyprogesterone acetate. Although there was no significant weight change in the group, PaO2 rose 12.6 +/- 2.7 mm Hg (SEM) from 49 +/- 2.6 mm Hg to 62 +/- 2.3 mm Hg (P less than 0.001), while PaCO2 fell 13 +/- 2.6 mm Hg from 51 +/- 1.9 mm Hg to 38 +/- 1.2 mm Hg (P less than 0.001). Hematocrit fell from 56 +/- 2.5% to 50 +/- 1.2%, a mean fall of 6% (P less than 0.01), during medroxyprogesterone acetate therapy. In the 2 patients who had cardiac catheterization before and during medroxyprogesterone acetate therapy, mean pulmonary arterial pressure fell 13 and 19 mm Hg. There were no recurrences of cor pulmonale during treatment. These effects on arterial blood gas values and clinical state were sustained during therapy. On withdrawal of medroxyprogesterone acetate during 1-month period, arterial oxygen and carbon dioxide tensions deteriorated to their previous pretreatment values. Reinstitution of medroxyprogesterone acetate caused improvement in both the oxygen and carbon dioxide tensions. We conclude that sublingual medroxyprogesterone acetate therapy is useful in the management of the Pickwickian syndrome.

Oxymetholone treatment for sickle cell anemia

Seven patients with sickle cell anemia were treated with oxymetholone for at least 2 mo. Markedly increased basal rates of hemolysis and erythropoiesis were confirmed. The urinary erythropoietin excretion was either normal or lower than expected for the red cell mass, and an expanded blood volume was due primarily to an increased plasma volume. After androgen therapy, six patients demonstrated more than a fivefold increase in urinary erythropoietin, with an increase in red cell mass ranging from 17%-75% above the control value. All showed a decline in serum iron level to the 25-75 mug/100 ml range within 4 wk after the start of therapy. Less marked changes followed lower oxymetholone doses. Reversible hepatic toxicity, with a serum bilirubin concentration exceeding 50 mg/100 ml, occurred in one patient. Androgenic hormone therapy may be useful for selected adult patients with sickle cell disease when severe anemia contributes to disease morbidity.