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Poe E, Bosley R, Steele R, Chesnut C. Trigeminocardiac Reflex: A Review and Key Implications to Dermatologic Surgery. Dermatol Surg 2023; 49:654-658. [PMID: 37134251 DOI: 10.1097/dss.0000000000003808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND The trigeminocardiac reflex is a common but underreported occurrence that can vary from benign to life threatening. This reflex can be elicited by placing direct pressure on the globe of the eye or from traction of the extraocular muscles, stimulating the trigeminal nerve. OBJECTIVE To provide a review of potential stimuli for the trigeminocardiac reflex within dermatologic surgery and to discuss management options for the treatment of the trigeminocardiac reflex. METHODS PubMed and Cochrane were used to identify articles and case reports that established scenarios in which the trigeminocardiac reflex was provoked and subsequently how the reflex was managed. RESULTS Within the field of dermatologic surgery, the trigeminocardiac reflex can be stimulated during biopsies, cryoablations, injections, laser treatments, Mohs micrographic surgery, and oculoplastic interventions, most often occurring in an office setting. The most common presentations include significant bradycardia, hypotension, gastric hypermobility, and lightheadedness. The most definitive treatment is cessation of the inciting stimulus, monitoring, and symptomatic management. Glycopyrrolate and atropine are common treatments for severe, intractable cases of the trigeminocardiac reflex. CONCLUSION The trigeminocardiac reflex, while underreported and underrepresented in dermatologic literature and dermatologic surgery settings, should be considered in the setting of bradycardia and hypotension during dermatologic procedures.
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Affiliation(s)
- Emily Poe
- Washington State University College of Medicine, Spokane, Washington
| | - Rawn Bosley
- Chesnut MD Cosmetic Surgery Fellowship, Spokane, Washington
| | - Robert Steele
- Chesnut MD Cosmetic Surgery Fellowship, Spokane, Washington
| | - Cameron Chesnut
- University of Washington School of Medicine, Seattle, Washington
- Chesnut MD Cosmetic Surgery Fellowship, Spokane, Washington
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2
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Nikolis A, Chesnut C, Biesman B, Alsufyani M, Boyd C, Lee W, Schwarcz R, Berros P, Andriopoulos B, Durairaj K. Expert Recommendations on the Use of Hyaluronic Acid Filler for Tear Trough Rejuvenation. J Drugs Dermatol 2022; 21:387-392. [PMID: 35389598 DOI: 10.36849/jdd.6597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Restylane® Lidocaine is one of the most widely used hyaluronic acid (HA) fillers to replace lost or displaced volume during tear trough correction. Patient goals for tear trough correction include looking less tired or removing dark circles and this may be achieved by administering HA filler into the infraorbital region to correct the lower eyelid relative to the volume deficit, thereby smoothing the transition from the lower eyelid to the cheek. To achieve patient satisfaction and consistent results with Restylane, optimal application is essential; however, clinical guidance based on experience is limited. This paper reflects the recommendations of an interdisciplinary expert panel for the use of Restylane in correcting tear trough deformity, including patient selection, dosing, injection technique, and post-treatment care. Recommendations were discussed and agreed as a consensus, according to cross-sectional expertise and clinical experience. J Drugs Dermatol. 2022;21(4):387-392. doi:10.36849/JDD.6597.
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3
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Neill B, Chesnut C. Parallel vibrating kinetic anesthesia devices to reduce pain with scalp injections. J Cutan Aesthet Surg 2022; 15:187-188. [PMID: 35965908 PMCID: PMC9364465 DOI: 10.4103/jcas.jcas_135_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The scalp is a frequent site of dermatologic procedures, and a patient’s experience with the dermatologic procedure is often shaped by the pain associated with it. In this article, a technique using multiple kinetic anesthesia devices is described to both reduce pain and improve patient satisfaction with scalp injections.
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4
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Walker B, Hand M, Chesnut C. Forehead Movement Discrepancies After Botulinum Toxin Injections: A Review of Etiology, Correction, and Prevention. Dermatol Surg 2022; 48:94-100. [PMID: 34537780 DOI: 10.1097/dss.0000000000003218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Forehead rhytides are a popular target for botulinum toxin injections, but neuromodulation of the frontalis can be fraught with complications because of its anatomic complexity and integral role in brow position and expressivity. OBJECTIVE This article explores common forehead movement discrepancies that can occur after neuromodulation of the frontalis, as well as how to correct and prevent them. METHODS A review of the literature was conducted and combined with clinical experience to examine underlying forehead anatomy, etiology and correction of forehead movement discrepancies, and important factors to consider before injecting the frontalis with botulinum toxin. RESULTS AND CONCLUSION Variable anatomy from person to person necessitates an individualized treatment approach to achieve the best cosmetic results and prevent the occurrence of forehead movement discrepancies.
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Affiliation(s)
- Bridget Walker
- Department of Dermatology, Geisinger Health System, Danville, Pennsylvania
| | - Matthew Hand
- University of Washington School of Medicine, Seattle, Washington
- Chesnut MD Cosmetic Surgery Fellowship, Spokane, Washington
| | - Cameron Chesnut
- University of Washington School of Medicine, Seattle, Washington
- Chesnut MD Cosmetic Surgery Fellowship, Spokane, Washington
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5
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Vandiver AR, Thomas BJ, Karimzada M, Knowles BC, Botten GA, Spreafico R, Rotman JN, Gharavi NM, Chesnut C, Wesel K, Mangul S, Soriano T, Scumpia PO. Detection of viral gene expression in risk-stratified biopsies reveals no active HPV in cutaneous squamous cell carcinoma. Exp Dermatol 2021; 30:1711-1716. [PMID: 34036652 PMCID: PMC9639216 DOI: 10.1111/exd.14385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/05/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) infection is known to promote the development of mucosal squamous cell carcinoma (mSCC), including pathologically high-grade lesions, but its role in cutaneous squamous cell carcinoma (cuSCC) remains unclear, particularly in lesions that are considered high risk. OBJECTIVE We aimed to determine whether enhanced HPV transcriptional activity can be detected in high-risk cuSCC samples compared with low-grade SCC samples or normal skin. METHODS We performed RNA sequencing of cuSCC across 23 risk-stratified skin lesions. A subset of samples was tested for the presence of HPV DNA. High-quality, non-human reads from each sample group were used for viral analysis using Microbiome Coverage Profiler. RESULTS None of the samples analysed had detectable expression of HPV RNA, while 64% of samples tested positive for HPV DNA. All samples were found to have expression of human endogenous retrovirus, and multiple samples showed expression of other viruses. CONCLUSIONS Viral and prophage gene expression can be monitored in cuSCC or normal skin biopsies, yet no sample in our study showed evidence of active HPV gene expression despite evidence of HPV genome presence. This suggests HPV transcription does not play a role in differentiating high-risk cuSCCs from low-risk cuSCCs or normal skin.
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Affiliation(s)
- Amy R. Vandiver
- Department of Medicine, Division of Dermatology, University of California, Los Angeles, CA, USA
| | - Brandon J. Thomas
- David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Mohammad Karimzada
- David Geffen School of Medicine, University of California at Los Angeles, CA, USA
| | - Byron C. Knowles
- Department of Dermatology, University of California at San Francisco, CA, USA
| | - Giovanni A. Botten
- Institute for Quantitative and Computational Biosciences, University of California, Los Angeles, CA, USA
| | - Roberto Spreafico
- Institute for Quantitative and Computational Biosciences, University of California, Los Angeles, CA, USA
| | - Jeremy N. Rotman
- Department of Computer Science, University of California, Los Angeles, CA, USA
| | - Nima M Gharavi
- Department of Dermatology and Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cameron Chesnut
- University of Washington School of Medicine, Spokane, WAS, USA,Chestnut MD Cosmetic Surgery Fellowship at Clinic 5C, Spokane, WAS, USA
| | - Kevin Wesel
- Department of Computer Science, University of California, Los Angeles, CA, USA
| | - Serghei Mangul
- Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Teresa Soriano
- Department of Medicine, Division of Dermatology, University of California, Los Angeles, CA, USA
| | - Philip O. Scumpia
- Department of Medicine, Division of Dermatology, University of California, Los Angeles, CA, USA,Department of Dermatology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Carqueville JC, Chesnut C. Histologic Comparison of Upper Blepharoplasty Skin Excision Using Scalpel Incision Versus Microdissection Electrocautery Needle Tip Versus Continuous Wave CO2 Laser. Dermatol Surg 2021; 47:1376-1378. [PMID: 34352836 DOI: 10.1097/dss.0000000000003178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The various techniques of upper blepharoplasty have been compared based on surgical time to perform the procedure, postoperative healing, scar cosmesis, and cost. Few studies have evaluated the histology of the excised tissue, and no study has compared the tissue histology of 3 blepharoplasty methods using scalpel, microdissection needle with electrocautery, and CO2 laser excision in the same patient. OBJECTIVE To evaluate the histologic changes of tissue after removal of upper eyelid skin using scalpel incision, microdissection electrocautery needle, and CO2 laser. METHODS Upper blepharoplasty skin excisions were examined from specimens obtained using scalpel incision, microdissection needle tip with electrocautery, and CO2 continuous wave beam. The specimens were sent for permanent sections for histologic evaluation. RESULTS The skin that was removed using cold steel scalpel incision showed no cellular necrosis or heat artifact. The tissue treated with the CO2 laser demonstrated significant thermal injury, including loss of cellular polarity, keratinocyte necrosis, and separation of the epidermis from the basement membrane. The skin excised using the electrocautery microdissection needle demonstrated fulguration artifact, including spindling of the epidermal nuclei with palisading of the keratinocytes. Necrosis was not prominent in the electrocautery microdissection needle specimens. CONCLUSION The amount of histologic tissue injury was greatest in the skin treated with continuous wave CO2 laser, followed by the microdissection needle with electrocautery. The cold steel scalpel incision showed no cellular necrosis.
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Affiliation(s)
- Jordan C Carqueville
- Derm Institute of Chicago, Chicago, Illinois
- Division of Dermatology, Cook County Hospital
- Department of Dermatology, Rush University, Chicago, Illinois
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7
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Crimp C, Hand M, Chesnut C. Identification and Management of Postoperative Sialoceles in Dermatologic Surgery. Dermatol Surg 2021; 47:1163-1165. [PMID: 34115689 DOI: 10.1097/dss.0000000000003123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Caitlin Crimp
- University of Washington School of Medicine, Seattle, Washington
| | - Matthew Hand
- University of Washington School of Medicine, Seattle, Washington
- Cosmetic Surgery Fellowship at Clinic 5C, Spokane, Washington
| | - Cameron Chesnut
- University of Washington School of Medicine, Seattle, Washington
- Cosmetic Surgery Fellowship at Clinic 5C, Spokane, Washington
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8
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Lleonart E, Dong J, Abrouk M, Chesnut C. Technology-Based Postural Apparel as a Sustainable and Cost-Effective Solution to Musculoskeletal Pain and Injury in the Dermatologic Surgeon. Dermatol Surg 2021; 47:1326-1328. [PMID: 33988548 DOI: 10.1097/dss.0000000000003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Elizabeth Lleonart
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Joanna Dong
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael Abrouk
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Cameron Chesnut
- University of Washington School of Medicine, Spokane, Washington.,Chesnut MD Cosmetic Surgery Fellowship, Spokane, Washington
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Abstract
There has been an increasing interest in addressing the issue of submental fat (SMF) when it comes to cosmetic medicine. With the rise of social media, video calls, and the now almost omnipresent accessibility of cameras, there is perhaps now more than ever an emphasis on the facial image. Although invasive procedures such as liposuction and neck lift still play a significant role in reducing SMF, the trend toward minimally invasive methods has finally given rise to a single Food and Drug Administration-approved injectable that is both safe and effective: ATX-101, also known as Kybella in the United States.
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Affiliation(s)
- Michael Liu
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Cameron Chesnut
- University of Washington School of Medicine, Spokane, Washington.,Chesnut MD Cosmetic Surgery Fellowship at Dermatology Specialists of Spokane, Spokane, Washington
| | - Gary Lask
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California
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Chesnut C, Mednik S, Lask G. Hypertrophic scar treatment with intralesional triamcinolone acetonide and pulsed dye laser results in necrosis. Cutis 2014; 94:E12-E13. [PMID: 25474460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Cameron Chesnut
- UCLA Division of Dermatology, 10833 Le Conte Ave, 52-121 CHS, Los Angeles, CA 90095, USA.
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Chesnut C, Majumdar S, Gardner J, Shields A, Newitt DC, Erickson E, Glott M, Kriegman A, Mindeholm L. Assessment of bone quality, quantity, and turnover with multiple methodologies at multiple skeletal sites. Adv Exp Med Biol 2002; 496:95-7. [PMID: 11783630 DOI: 10.1007/978-1-4615-0651-5_10] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Chesnut
- University of Washinton Medical Center, USA
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12
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Newitt DC, Majumdar S, van Rietbergen B, von Ingersleben G, Harris ST, Genant HK, Chesnut C, Garnero P, MacDonald B. In vivo assessment of architecture and micro-finite element analysis derived indices of mechanical properties of trabecular bone in the radius. Osteoporos Int 2002; 13:6-17. [PMID: 11878456 DOI: 10.1007/s198-002-8332-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Measurement of microstructural parameters of trabecular bone noninvasively in vivo is possible with high-resolution magnetic resonance (MR) imaging. These measurements may prove useful in the determination of bone strength and fracture risk, but must be related to other measures of bone properties. In this study in vivo MR imaging was used to derive trabecular bone structure measures and combined with micro-finite element analysis (microFE) to determine the effects of trabecular bone microarchitecture on bone mechanical properties in the distal radius. The subjects were studied in two groups: (I) postmenopausal women with normal bone mineral density (BMD) (n = 22, mean age 58 +/- 7 years) and (II) postmenopausal women with spine or femur BMD -1 SD to -2.5 SD below young normal (n = 37, mean age 62 +/- 11 years). MR images of the distal radius were obtained at 1.5 T, and measures such as apparent trabecular bone volume fraction (App BV/TV), spacing, number and thickness (App TbSp, TbN, TbTh) were derived in regions of interest extending from the joint line to the radial shaft. The high-resolution images were also used in a micro-finite element model to derive the directional Young's moduli (E1, E2 and E3), shear moduli (G12, G23 and G13) and anisotropy ratios such as E1/E3. BMD at the distal radius, lumbar spine and hip were assessed using dual-energy X-ray absorptiometry (DXA). Bone formation was assessed by serum osteocalcin and bone resorption by serum type I collagen C-terminal telopeptide breakdown products (serum CTX) and urinary CTX biochemical markers. The trabecular architecture displayed considerable anisotropy. Measures of BMD such as the ultradistal radial BMD were lower in the osteopenic group (p<0.01). Biochemical markers between the two groups were comparable in value and showed no significant difference between the two groups. App BV/TV, TbTh and TbN were higher, and App TbSp lower, in the normal group than the osteopenic group. All three directional measures of elastic and shear moduli were lower in the osteopenic group compared with the normal group. Anisotropy of trabecular bone microarchitecture, as measured by the ratios of the mean intercept length (MIL) values (MIL1/MIL3, etc.), and the anisotropy in elastic modulus (E1/E3, etc.), were greater in the osteopenic group compared with the normal group. The correlations between the measures of architecture and moduli are higher than those between elastic moduli and BMD. Stepwise multiple regression analysis showed that while App BV/TV is highly correlated with the mechanical properties, additional structural measures do contribute to the improved prediction of the mechanical measures. This study demonstrates the feasibility and potential of using MR imaging with microFE modeling in vivo in the study of osteoporosis.
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Affiliation(s)
- D C Newitt
- Magnetic Resonance Science Center, University of California, San Francisco 94143-1290, USA
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13
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Eastell R, Mallinak N, Weiss S, Ettinger M, Pettinger M, Cain D, Fressland K, Chesnut C. Biological variability of serum and urinary N-telopeptides of type I collagen in postmenopausal women. J Bone Miner Res 2000; 15:594-8. [PMID: 10750575 DOI: 10.1359/jbmr.2000.15.3.594] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Measurement of N-telopeptides of type I bone collagen (NTX) provides a specific indicator of the current level of bone resorption. The biological intrasubject variability of NTX in urine and serum was studied in 277 postmenopausal women, mean age, 63.6 years +/- 10.2 (+/-SD) years. Second-morning void urine and serum specimens were collected at baseline and for two consecutive days to determine short-term variability (% CV). Long-term variability was determined by comparing NTX results at baseline and two consecutive months. Subjects were instructed to maintain current diet, lifestyle, and medications during the study. The median short-term %CV was 13.1% for urine NTX. This compared with 6.3% for serum NTX. Calculation of long-term %CV showed similar trends, with the %CV for NTX measured in serum (7.5%) lower than when measured in urine (15.6%). Using the least significant change (LSC) calculation, our data show that to be 90% confident that a decrease in NTX after initiation of antiresorptive therapy in an individual patient is not caused by variability alone, a 31 % decrease in urine NTX and a 14% decrease in serum NTX is required. As reported changes in NTX caused by antiresorptive therapy are greater than these calculations; our results support the use of either specimen to measure NTX to monitor the effect of therapy.
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Friday KE, Drinkwater BL, Bruemmer B, Chesnut C, Chait A. Elevated plasma low-density lipoprotein and high-density lipoprotein cholesterol levels in amenorrheic athletes: effects of endogenous hormone status and nutrient intake. J Clin Endocrinol Metab 1993; 77:1605-9. [PMID: 8263148 DOI: 10.1210/jcem.77.6.8263148] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To determine the interactive effects of hormones, exercise, and diet on plasma lipids and lipoproteins, serum estrogen and progesterone levels, nutrient intake, and plasma lipid, lipoprotein, and apolipoprotein concentrations were measured in 24 hypoestrogenic amenorrheic and 44 eumenorrheic female athletes. When compared to eumenorrheic athletes, amenorrheic athletes had higher levels of plasma cholesterol (5.47 +/- 0.17 vs. 4.84 +/- 0.12 mmol/L, P = 0.003), triglyceride (0.75 +/- 0.06 vs. 0.61 +/- 0.03 mmol/L, P = 0.046), low-density lipoprotein (LDL; 3.16 +/- 0.15 vs. 2.81 +/- 0.09 mmol/L, P = 0.037), high-density lipoprotein (HDL; 1.95 +/- 0.07 vs. 1.73 +/- 0.05 mmol/L, P = 0.007), and HDL2 (0.84 +/- 0.06 vs. 0.68 +/- 0.04 mmol/L, P = 0.02) cholesterol. Plasma LDL/HDL cholesterol ratios, very low-density lipoprotein and HDL3 cholesterol, and apolipoprotein A-I and A-II levels were similar in the two groups. Amenorrheic athletes consumed less fat than eumenorrheic subjects (52 +/- 5 vs. 75 +/- 3 g/day, P = 0.02), but similar amounts of calories, cholesterol, protein, carbohydrate, and ethanol. HDL cholesterol levels in amenorrheic subjects correlated positively with the percent of dietary calories from fat (r = 0.42, n = 23, P = 0.045) but negatively with the percent from protein (r = -0.49, n = 23, P = 0.017). Thus, exercise-induced amenorrhea may adversely affect cardiovascular risk by increasing plasma LDL and total cholesterol. However, cardioprotective elevations in plasma HDL and HDL2 cholesterol may neutralize the risk of cardiovascular disease in amenorrheic athletes.
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Affiliation(s)
- K E Friday
- Department of Medicine, Pacific Medical Center, Seattle, Washington
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Milhaud G, Christiansen C, Gallagher C, Reeve J, Seeman E, Chesnut C, Parfitt A. Pathogenesis and treatment of postmenopausal osteoporosis. Calcif Tissue Int 1983; 35:708-11. [PMID: 6689136 DOI: 10.1007/bf02405109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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