Screening for pre-eclampsia in the first trimester: role of maternal hemodynamics and bioimpedance in non-obese patients

OBJECTIVE

To test if maternal hemodynamics and bioimpedance, assessed at the time of combined screening for PE, are able to identify in the first trimester of gestation normotensive non-obese patients at risk for pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR).

METHODS

One hundred and fifty healthy nulliparous non-obese women (body mass index < 30 kg/m² ) in the first trimester of pregnancy underwent assessment by UltraSonic Cardiac Output Monitor (USCOM) to detect hemodynamic parameters, bioimpedance analysis to characterize body composition, and combined screening for PE (assessment of maternal history, biophysical and maternal biochemical markers). Patients were followed until term, noting the appearance of PE and/or IUGR.

RESULTS

One hundred and thirty-eight patients had an uneventful pregnancy (controls), while 12 (8%) developed complications (cases). USCOM showed, in cases compared with controls, lower cardiac output (5.6 ± 0.3 vs 6.7 ± 1.1 L/min, P < 0.001), lower inotropy index (1.54 ± 0.38 vs 1.91 ± 0.32 W/m² , P < 0.001) and higher total vascular resistance (1279.8 ± 166.4 vs 1061.4 ± 179.5 dynes × s/cm⁵ , P < 0.001). Bioimpedance analysis showed, in cases compared with controls, lower total body water (53.7 ± 3.3% vs 57.2 ± 5.6%, P = 0.037). Combined screening was positive for PE in 8% of the controls and in 50% of the cases (P < 0.001). After identification of cut-off values for USCOM and bioimpedance parameters, forward multivariate logistic regression analysis identified as independent predictors of complications in pregnancy the inotropy index (derived by USCOM), fat mass (derived from bioimpedance analysis) and combined screening.

CONCLUSIONS

Combined screening for PE and assessment of bioimpedance and maternal hemodynamics can be used to identify early markers of impaired cardiovascular adaptation and body composition that may lead to complications in the third trimester of pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Correlation between maternal body composition and haemodynamic changes in pregnancy: different profiles for different hypertensive disorders

OBJECTIVES

To assess and correlate changes in body composition and haemodynamic function during pregnancy. To identify different haemodynamic profiles based on the onset of hypertensive diseases such as gestational hypertension and preeclampsia.

METHODS

We enrolled 265 healthy, normotensive pregnant women throughout pregnancy (from 6+0 to 36+0weeks). They were subjected to assessment of body composition and haemodynamic function using non-invasive methods. We divided our population in three groups: group A with physiological pregnancy, group B with gestational hypertension and group C with preeclamptic patients.

RESULTS

In patients who developed gestational hypertension we found lower total body water (TBW) percentage, higher Fat Mass (FM), associated with lower Cardiac Output (CO) and higher Total Vascular Resistance (TVR) during the second trimester. In the third trimester we didn't find haemodynamic differences, but a significative increase in extracellular water (ECW) percentage. In patients who developed preeclampsia we found since the first trimester significative higher TVR and hypodynamic circulation, associated with lower FM percentage.

CONCLUSIONS

Assessment of body composition and maternal cardiac function may help to identify earlier in pregnancy, patients with different (mal) adaptations to pregnancy. Women with high TVR, hypodynamic circulation and low fat mass during the first trimester, might be at higher risk to develop preeclampsia. Patients with higher BMI and FM percentage, and increased TVR in the second trimester, might be at risk of gestational hypertension and excessive fluid retention at the end of pregnancy.

Heart-brain interactions in cerebral ischaemia: a non-invasive cardiologic study protocol

The cardiologic evaluation of patients with cerebral ischaemia should be aimed at: (1) identifying potential cardiac sources for cerebral emboli, (2) detecting a coexisting ischaemic heart disease, even asymptomatic. The present data concerns a ten-year experience of a systematic cardiologic evaluation of patients admitted to the 1st Division of Neurosurgery, Bellaria Hospital, Bologna, Italy, for cerebral ischaemia. A two-dimensional echocardiography was carried out in 344 consecutive patients (mean age 53 years), cardiac abnormalities were observed in 92 (28%) out of the 328 cases with technically adequate examination, embologenic lesions in 57 (17%). In 18 cases the cardiac lesion was unknown before the cerebral event. An exercise ECG testing was carried out in 322 patients (mean age 56 years), resulting in abnormal in 69 out of the 258 with adequate examination (17%). A subsequent exercise 201Tl myocardial scintigraphy confirmed the presence of ischaemic heart disease in 58 cases. Among patients unable to perform an adequate exercise, a dipyridamole 201Tl myocardial scintigraphy was performed in 38 cases showing perfusional defects in 23 (60%), while a dipyridamole echocardiography was performed in 25 cases showing wall motion abnormalities in 9 (36%). A 24-h Holter monitoring was performed in 65 cases: arrhythmias were detected in 27 patients (41%), but a correlation with the cerebral event was suggested only in 3 cases with atrial fibrillation. According to our experience patients with recent ischaemia should be submitted to the following non-invasive cardiologic screening: (1) exercise ECG testing followed, if abnormal or indeterminant, by 201Tl myocardial scintigraphy in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Disappointed Love and Suicide: A Randomized Controlled Trial of "Abandonment Psychotherapy" Among Borderline Patients

To determine whether ambulatory psychotherapy targeted to abandonment experiences and fears can reduce suicidality and improve outcome in borderline patients referred to the emergency room with major depressive disorder and self-destructive behavior severe enough to require medical/surgical treatment and a brief psychiatric hospitalization. A total of 170 subjects were randomized at hospital discharge into three treatment groups: treatment as usual (TAU), abandonment psychotherapy delivered by certified psychotherapists, and abandonment psychotherapy delivered by nurses. Assessments were performed before randomization and at 3-month follow-up. Continued suicidality and other outcome measures were significantly worse in the treatment-as-usual as compared to both abandonment psychotherapy groups, but there were no differences between the two psychotherapy groups. These results suggest the efficacy of manualized psychotherapy that specifically targets the abandonment fears and experiences that are so common as precipitants to suicidal and self-destructive acts in borderline patients. It does not appear that formal psychotherapy training is associated with better outcomes.

The ALPPS procedure for hepatocellular carcinoma

BACKGROUND

The main limiting factor to major hepatic resections is the amount of the future liver remnant (FLR). Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a procedure which induces a rapid hypertrophy of the FLR in patients with non-resectable liver tumours.

METHODS

ALPPS is a surgical technique of in-situ splitting of the liver along the main portal scissura or the right side of the falciform ligament, in association with portal vein ligation in order to induce a rapid hypertrophy of the left FLR.

RESULTS

The median FLR volume increase was 18.7% within one week after the first step and 38.6% after the second step. At the first step the median operating time was 300 min, blood transfusions were not required in any case, median blood loss was 150 cc. At the second step median operating time was 180 min, median blood loss was 50 cc, none of the patients required intra-operative blood. All patients are alive at a median follow up of 9 months.

CONCLUSIONS

This novel strategy seems to be feasible even in the context of a cirrhotic liver, and demonstrates the capacity to reach a sufficient FLR within a shorter interval of time.

The ALPPS procedure for hepatocellular carcinoma

BACKGROUND

The main limiting factor to major hepatic resections is the amount of the future liver remnant (FLR). Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a procedure which induces a rapid hypertrophy of the FLR in patients with non-resectable liver tumours.

METHODS

ALPPS is a surgical technique of in-situ splitting of the liver along the main portal scissura or the right side of the falciform ligament, in association with portal vein ligation in order to induce a rapid hypertrophy of the left FLR.

RESULTS

The median FLR volume increase was 18.7% within one week after the first step and 38.6% after the second step. At the first step the median operating time was 300 min, blood transfusions were not required in any case, median blood loss was 150 cc. At the second step median operating time was 180 min, median blood loss was 50 cc, none of the patients required intra-operative blood. All patients are alive at a median follow up of 9 months.

CONCLUSIONS

This novel strategy seems to be feasible even in the context of a cirrhotic liver, and demonstrates the capacity to reach a sufficient FLR within a shorter interval of time.

Prevalence and clinical feature of the "overlap syndrome", obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), in OSA population

PURPOSE

The association of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), defined overlap syndrome by Flenley, is frequent. Aims of the present study were to assess the frequency of overlap syndrome in 168 consecutive OSA patients, and to evaluate the functional pulmonary hemodynamic, and polysomnographic consequences of this association by comparing Overlap patients with OSA patients.

METHODS

From the results of the pulmonary and polysomnographic investigation, patients were classified as OSA patients (group 1), having an apneas/hypopneas index (AH/I) > 15/hr, and Overlap patients (group 2), i. e. OSA patients with an obstructive spirographic pattern (FEV1<60%, FEV1/FVC<65%, RV>130%, RV/TLC>140% of predicted value) not reversible after beta2 agonist inhalation. Group 1 consisted of 135 Patients (115 males, 20 females, age 56+/-10 yr, BMI 32+/-6 Kg/m(2)); the group 2 included 33 patients (30 males, 3 females, age 56+/-11 yr., BMI 34 +/- 6 Kg/m(2)).

RESULTS

The OSA and Overlap patients were similar in most respects: age, BMI, clinical characteristic. In awake Overlap patients had lower PaO(2), higher PaCO(2) and Ppa (p<0.001), and an obstructive spirographic pattern, as compared to OSA patients. During sleep the overlap group had a higher AH/I and a lower mean SaO(2) (p<0.05), a reduction of the sleep efficency (p<0.05), and a reduction in the duration of 1NREM and REM sleep stage (p<0.05), as compared to group 1.

CONCLUSION

In conclusion, an associated COPD is observed in more than 19% of OSA patients. Overlap patients are at increased risk of developing pulmonary hypertension and show a poorer quality of sleep as compared with OSA patients. The possibility of developing cor pulmonale should be given particular attention in the diagnosis and follow-up of Overlap patients.

Relationship between body composition, body mass index and bone mineral density in a large population of normal, osteopenic and osteoporotic women

PURPOSE

The knowledge of factors modulating the behaviour of bone mass is crucial for preventing and treating osteoporotic disease; among these factors, body weight (BW) has been shown to be of primary importance in postmenopausal women. Nevertheless, the relative effects of body composition indices are still being debated. Our aim was to analyze the relationship between body mass index (BMI), fat and lean mass and bone mineral density (BMD) in a large population of women. Moreover, this study represents a first important report on reference standard values for body composition in Italian women.

MATERIALS AND METHODS

Between 2005 and 2008, weight and height of 6,249 Italian women (aged 30-80 years) were measured and BMI was calculated; furthermore BMD, bone mineral content, fat and lean mass were measured by dual-energy X-ray absorptiometry. Individuals were divided into five groups by decades (group 1, 30.0-39.9; group 2, 40.0-49.9; group 3, 50.0-59.9; group 4, 60.0-69.9; group 5, 70.0-79.9). Differences among decades for all variables were calculated using a one-way analysis of variance (ANOVA) and Bonferroni test by the SPSS programme.

RESULTS

Mean BW was 66.8±12.1 kg, mean height 159.1±6.3 cm and mean BMI 26.4±4.7 kg/m(2). According to BW and BMI, there was an increase of obesity with age, especially in women older than 50 years (p<0.001). Lean mass increased until 50 years of age but significantly decreased after this age (p<0.001). The percentage of osteopenia and osteoporosis in the examined population was 43.0% and 16.7%, respectively.

CONCLUSIONS

Our data show that obesity significantly decreased the risk for osteoporosis but did not decrease the risk for osteopenia. It is strongly recommended that a strong policy regarding prevention of osteopenia and osteoporosis be commenced. An overall examination of our results suggests that both fat and lean body mass can influence bone mass and that their relative effect on bone could be modulated by their absolute amount and ratio to total BW.

New trends in nutritional status assessment of cancer patients

BACKGROUND

Nutritional status assessment and support should be considered a valuable measure within the overall oncology strategy. Despite extensive research in the field of clinical nutrition, definite guidelines to base rational nutritional assessment and support in cancer patients are still debated. This review examines different approaches to nutritional status in cancer patients.

DESIGN

The assessment of nutritional status is usually based on anthropometric measures, biochemical or laboratory tests, clinical indicators and dietary assessment. At present, body composition (BC) is rarely measured in the clinical setting because it is thought to be too unmanageable and time-consuming. However, using new technologies, the estimation of fat, lean and body fluids, that is significant in the management of nutrition therapies in oncology, has become easy. The present study evaluates the different methods of nutrition assessment today available, especially body composition (BC) measurements. Furthermore, nutrition assessment, relevance of nutritional support and choice of nutritional strategy, in surgical patients, are discussed.

DISCUSSION

Given the clinical relevance of nutritional intervention in patients' quality of life, the nutritional status assessment has a key role in oncological and surgical practice and should include BC assessment in order to tailor nutritional treatment to patients' individual requirements. Furthermore, administration of the supplemented diet before and after surgery seemed to be the best strategy to reduce complications and length of hospital stay.

[Reasons I liked DSM: the challenge of medical diagnosis in psychiatry]

The first draft of the fifth version of the American Diagnostic and Statistical Manual (DSM-V) provides an opportunity to clarify the several issues associated with the debate on diagnostic process in psychiatry. Several peculiar aspects of the DSM approach showed stability over time suggesting that this project is rooted in an original conception of mental disease, innovative epistemology of medical judgement and empirically grounded choice of diagnostic categories. Attention will be paid to reasons for actual reject of this clinical philosophy in the US and long-lasting misunderstanding in French speaking countries.

[Borderline personality disorder is easy to treat: are we ready to accept this good news?]

Recent research indicated that the outcome of borderline patients is better than previously reported. We assessed the impact of co-morbid personality disorders (PD) on response to treatment and 1-year outcome among 206 borderline patients assigned to crisis intervention program. An overwhelming majority (89%) of borderline patients without supplementary Axis 11 psychopathology exhibited good to very good treatment response at acute treatment discharge as well as good to very good global outcome at 1-year followup (85%). Borderline patients meeting criteria for paranoid, schizotypal, antisocial, narcissistic and dependant personality disorder showed, contrarily, significantly more treatment failures.

[Medea syndrome: the sadistic fate of impaired mourning of love]

This work investigated the Medea syndrome, an harassment behaviour endorsed from a spouse suppressing access to children from his partner. The Medea myth adds a psychopathological background to the Parental Children Alienation construct focusing on using children to inflict a revenge, sadistic mourning of love, return of sacrificial rites associated with realm of primitive superego figures among people with severe personality disorder confronting traumatic love. The clinical, diagnostic and legal aspects of the disorder will be presented as well as a range of treatment strategies allowing valuable medical decision. Overall, the Medea syndrome appears to be an extremely destructive reaction with major negative impact on both children and adults. New law roles should be introduced to discourage such behaviour and improve victims protection.

[Expansion of the sphere of crisis: the question of the intrusiveness of the disease]

The passage to ambulatory care of a patient with a long hospital stay due to a wrenching disease is not something obvious. The doctor and the care staff will have to take up the challenge of dealing with an important amount of care. The quality of life of the patient and his caregivers is influenced by the neuropsychiatric disorders, the illness intrusiveness and the depression that come along with them. The chronic disease intruding causes a crisis in their lives. In order to better evaluate these factors we are using the Illness Intrusiveness Rating Scale developed by Devins. This article addresses the high complexity of clinical situations handled in an environment of rehabilitation care with the support of the consultants, nurses and doctors, of the liaison psychiatry.

Assessment of total body potassium in healthy Italian men

BACKGROUND

Whole-body (40)K counting is a valuable tool for assessing cellular changes in body composition with ageing.

AIM

The objectives of this study were to assess total body potassium (TBK) and body cell mass (BCM) differences with age, and to compare TBK and BCM between individuals with a body mass index (BMI) < 25 kg m(-2) versus > 25 kg m(-2).

SUBJECTS AND METHODS

Body composition of 840 healthy Italian men, 18-70 years of age, was measured by whole-body counting of (40)K. BCM (kg) was calculated as 0.00833 x TBK (mmol).

RESULTS

Body weight did not differ among groups. TBK, TBK/height, TBK/body weight, and BCM were significantly lower for the 51-70-year-old group compared with all other groups. The 51-70-year-old group with a BMI < 25 kg m(-2) had significantly lower TBK, TBK/height, and BCM than all other decades with a BMI < 25 kg m(-2); whereas TBK/body weight was significantly lower than the 18-30 and 31-40-year-old groups. The 51-70-year-old group with a BMI > 25 kg m(-2) had significantly lower TBK, TBK/height, TBK/body weight, and BCM than all other decades with a BMI > 25 kg m(-2).

CONCLUSION

TBK and BCM decrease significantly with ageing, which could result in decreased functional capacity in older adults.

[Chronic pain and depression]

Chronic pain and depression are frequently associated. Links between them are numerous and well documented. It is known for example that depression is associated with a greater number and higher intensity of pain symptoms. Similarly the presence of pain complicates the diagnostic evaluation and aggravates the prognosis of depression. The question of the causality link has no clear answer. Taking care of these patients implies to acknowledge the different aspects of their suffering in a holistic bio-psycho-social model. Treatment or medication, for instance antidepressants, should be a post-scriptum to the construction of a therapeutic relationship.

Change in MGMT methylation status between first and second surgery for recurrence: Clinical implications

2027

Background: MGMT promoter methylation status is known to be a potent prognostic factor in newly diagnosed glioblastoma (GBM) patients (pts). However, it is not yet clear whether and, if so, how MGMT methylation status may change; nor is it known whether the prognostic role of this epigenetic feature is retained during the disease course. Methods: A retrospective analysis was made using a database of 614 GBM pts treated prospectively from January 2000 to August 2008. We evaluated only patients who met the following inclusion criteria: age ≥18; PS 0–2; two distinct surgical procedures; histological diagnosis of GBM both at first and at second surgery for recurrence; postoperative treatment consisting of: a) radiotherapy (RT) followed by temozolomide (TMZ) until 2005, and b) TMZ concurrent with and adjuvant to RT after 2005; a time interval ≥3 month between first and second surgery. The study aim was to evaluate changes of MGMT status during the course of GBM. The log-rank test was employed to evaluate the significance of the prognostic variables. The percentages of MGMT methylated cases at first and second surgery were compared using the McNemar test. Results: MGMT status, evaluated at first and second surgery in all 44 pts (M:F 32:12, median age: 49 years, range: 27–67), was assessable in 38 (86.4%) cases: MGMT promoter was methylated in 13 (34.2%) pts at first surgery. MGMT methylation status, unchanged in 63.2% of second surgery samples, changed more frequently in methylated than in unmethylated pts (61.5% vs 24%, p = 0.03). The median survival was 24.3 months (95% CI: 20.8–27.7), being 35.2 months (95% CI: 10.1–60.2) and 21.9 months (95% CI: 17.3–26.5) for pts with methylated and unmethylated MGMT assessed at first surgery, respectively (p = 0.04). However, MGMT status at second surgery was no longer prognostic for survival (p = 0.1). Conclusions: Significant changes in MGMT methylation status during the course of GBM occur more frequently in MGMT methylated than unmethylated cases. Moreover, while MGMT methylation status is prognostic at first surgery, it appears to be of no prognostic utility at the time of second surgery.

No significant financial relationships to disclose.

Giant calcified thoracic herniated disc: considerations aiming a proper surgical strategy

AIM

Giant herniated thoracic disc (HTD) is a rare disease that, unlike other thoracic disc herniations of different size, need a different surgical management. The copresence of ''giant'' volume and calcification of the herniated disc heavily affects the surgical difficulty and is not elsewhere described.

METHODS

Seven cases of surgically treated giant calcified HTDs were considered in this study. Five of them were females and two males, age range 18-63 years. Before and after surgery, all patients underwent computed tomography myelography, magnetic resonance imaging or both pre-and postoperatively. Functional outcomes were assessed using the Asia grading system preoperatively, immediately after surgery, and at long-term follow-up examination. The mean overall follow-up period was 36 months. All patients presented with various grades of myelopathy: according to the Asia impairment scale, two were grade B, four were grade C and one were grade D. Six patients underwent an anterior approach, i.e. thoracotomy, and one patients underwent a posterolateral approach, i.e. peduncolocostotrasversectomy.

RESULTS

Based on an analysis of the long-term follow-up data, the Asia grade improved in five patients (71.4%), stabilized (no grade change) in one (14.3%), and worsened in one (14.3%).

CONCLUSIONS

Giant calcified HTDs are particularly challenging surgical lesions and their volume and consistency are additional elements of difficulty. This article presents authors' personal experience on a small but extraordinary series of giant and calcified thoracic herniated discs and the problems encountered in the management of this peculiar pathology since an accurate surgical planning leads to better clinical results.

[Increased referral to psychiatric hospitalization: a challenge for better mental health policies]

This paper aims at investigating causes and potential remedies of increased psychiatric hospitalization in this country. The data suggest that there was growing pressure on psychiatric hospitals from 1950 to 2000. This may result from inappropriate management of a new type of acute psychiatric patient rather than severed epidemiology of acute psychiatric disorders. More focus on innovative crisis intervention programs emphasizing the central role of the general hospital in contemporary psychiatry may strongly contribute to better mental care. Despite significant advances in psychotherapy and medical research such an evolution is contended from the exquisite entropy of psychiatric systems. Those cultural and psychological factors associated with this issue require careful consideration and further studies.

[New ways of treatment of borderline patients with suicidal crisis]

Suicidal attempts are not rare in the general population (about 4.5%) and the presence of personality disorder aggravates the clinical issue of these patients who also repeat suicidal attempts. Caring for these patients is particularly difficult for physicians and other caregivers, in the means of choice of specific treatment and prevention of relapse. Despite the existence of many psychiatric facilities that can welcome these patients, there is a high rate of treatment failure or drop-out. This constitutes a major issue for systems of care politics. This article describes a specific form of treatment, psychotherapeutic and risk-management oriented, of borderline patients with suicidal attempt admitted at the ER.

[A combined medical-psychiatric unit for the management of complex cases]

The management of patients with coexisting medical and psychiatric disorders constitutes a serious challenge for the hospital team in charge of their care. Medical teams working in traditional hospital settings often find themselves ill-equipped when faced with the complex care needs of such patients. This article describes a unit at the University Hospital of Geneva specifically designed to manage the care of patients with combined medical and psychiatric disorders. It discusses the comprehensive management of such patients using clinical vignettes.

Psychodynamically Oriented Crisis Hospitalisation and Ambulatory Combination Treatement for Borderline Patients: An Introduction

The following educational topics will be carefully addressed:a.

The course is intended for people with an experience in the field of personality disorders and an interest in combining psychobiological science and psychotherapeutic wisdom to improve acute treatment and psychiatric services.

Sonographic features of penile-gland lithiasis

A 52-year-old man presented with a small, red, tender swelling near the penile frenulum at the lower edge of the base of the glans. Lower urinary tract symptoms were absent. Ultrasonography revealed a stone lodged in the distalmost portion of the glands of Littre. Combined with a good knowledge of penile anatomy, use of this simple imaging tool allows reliable diagnosis of even the rarest cases of penile pathology.

Body cell mass measured by bioelectrical impedance spectroscopy in professional football (soccer) players

AIM

The aim of this study was to measure body cell mass (BCM) in two football (soccer) teams and assess if there are differences in body composition among players of different field positions.

METHODS

Two professional Italian (male) football teams, representing two different divisions (A and C), have been recruited. There were 14 players (4 forwards, 4 defenders, 6 midfielders) in A and 18 players (4 forwards, 4 defenders, 8 midfielders, 2 goalkeepers) in C. Fat free mass (FFM), fat mass (FM), percent body fat (%BF), and BCM have been assessed using bioelectrical impedance spectroscopy (BIS).

RESULTS

There were no significant differences in age, body weight, height or body mass index between teams. Team A's BCM was approximately 4 kg greater than C (P=0.001). FFM was significantly greater in midfielders and defenders in A vs C (P=0.02). FFM was significantly lower in forwards compared to defenders within A (P=0.02). Within A, FM and %BF were significantly lower for defenders compared to forwards and midfielders (P=0.01), and BCM was significantly greater in forwards vs defenders (P=0.01), with no significant differences among other field positions. BCM was significantly greater in forwards vs midfielders and defenders within C (P=0.02), with no significant differences between midfielders and defenders.

CONCLUSIONS

BCM, measured using BIS, represents an innovative, simple approach to assess body composition. The present study demonstrates that it is very important to analyze body composition in football players, not only with the aim to evaluate the variation of weight in a quantitative and qualitative way, but also with the purpose of selecting players for specific roles. Although these results must be considered not yet conclusive, they could be an important information for coaches, especially during the selection of young football players.

Effect of a moderately hypoenergetic Mediterranean diet and exercise program on body cell mass and cardiovascular risk factors in obese women

OBJECTIVE

To assess the effects of a moderately hypoenergetic Mediterranean diet (MHMD) and exercise program on body cell mass (BCM) and cardiovascular disease risk factors in obese women.

SUBJECTS/METHODS

Forty-seven obese women, 39.7+/-13.2 years of age, with a body mass index (BMI)=30.7+/-6.0 kg/m(2), completed the study. The following were measured at baseline, 2 and 4 months: BCM, BCM index (BCMI), body weight, BMI, fat-free mass (FFM), fat mass (FM), total body water (TBW), extracellular water (ECW) and intracellular water (ICW) using bioelectrical impedance analysis; fasting blood glucose (FBG), serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) concentrations; systolic (SBP) and diastolic (DBP) blood pressure.

RESULTS

Body weight, BMI, FM, TC and TG significantly decreased (P<0.001; P<0.002 (TG)) at 2 and 4 months. FFM, TBW, ECW, FBG and DBP significantly decreased at 2 months (P<0.05 (FFM); P<0.001). LDL-C significantly decreased (P<0.001), while HDL-C significantly increased (P<0.002) at 4 months. BCM, BCMI, ICW and SBP remained stable over time.

CONCLUSION

BCM was preserved and cardiovascular disease risk factors improved in obese women placed on a MHMD and exercise program for 4 months.

Facteurs prédictifs de la récidive du comportement suicidaire chez des patients souffrant d’un trouble de personnalité borderline

OBJECTIVES

The high prevalence of suicidal behavior (SB) in patients with borderline personality disorder (BPD) raises clinical questions in terms of screening and prevention, particularly for an emergency psychiatric department. The purpose of this prospective study was to determine the risk factors of the recurrence of SB during a one year follow-up in BPD patients consulting the emergency unit of the University Hospitals of Geneva (HUG) following a suicide attempt.

METHODOLOGY

All subjects included in the study (age 18-65) had been diagnosed with BPD according to DSM IV criteria. Furthermore, they all consulted the emergency psychiatric unit after a suicide attempt. The exclusion criteria were the presence of cognitive, bipolar or psychotic disorders. Almost all SB patients from the Canton of Geneva (350 000 inhabitants) are directed to the HUG emergency department. After one year, 95 subjects were included in the study, while the total number of emergency psychiatric consultations was of about 10 000. During the emergency consultations, the clinicians checked the DSM IV criteria for BPD and current Major Depressive Episode, following the usual guidelines, independently of the study. The clinicians were specifically trained to set up the diagnosis of BPD by means of the International Personality Disorder Examination (IPDE). The gravity of depressive disorders was assessed with the Hamilton Depression Rating Scale (HDRS). The recurrence of SB was recorded for every patient during one year.

RESULTS

Among the 95 patients included in the study, 34 patients (36%) were re-admitted to the emergency unit for one or several SB during the first year after inclusion. The recurrence of the SB was significantly higher in women (OR=9.8), in patients with past history of SB (OR=8.9) and in patients living alone (OR=2.5). Interestingly, the presence of a farewell letter seems to be a protective factor (OR=0.1) for SB. Furthermore, low economic status appears to be associated with a higher recurrence risk, but the trend is not statistically significant. Recurrence and intensity (HDRS) of the major depressive episode, drug addiction, and other disorders on axis I of DSM IV did not differ statistically in patients with or without SB recurrence.

CONCLUSION

In this preliminary study, we tried to identify patients at risk for SB, relating to early secondary prevention, starting from the first assessment at the emergency unit.

[Dissociative disorders: clinical, neurobiological and therapeutical approaches]

Dissociation is a dysfunction of normally integrated functions like memory, consciousness and perception of environment. This review discusses the clinical and etiological issues of dissociative disorder and highlights the importance of differential diagnosis and psychiatric comorbidities, with special attention for the development of reliable evaluation instruments and treatment guidelines. New approaches of dissociative disorder focus on the importance of the integration of anatomical and functional neuroimaging data, combined with endocrinological and biological studies (lipids), in order to develop some specific neurobiological models. Beyond the inherent singularity of psychotherapeutic intervention, the therapeutic approach varies according to frequently associated comorbidities.

[Alpha-thalassemias and bipolar disorders: a genetic link?]

After a previous paper discussing the possible association between beta-thalassemias and bipolar disorder, this article considers a possible association between alpha-thalassemia and the bipolar disorder. We report the case of a 36 year old woman with bipolar disorder and alpha-thalassemia. The patient, native of Reunion Island, has a family history of bipolar disorder (both parents, one brother, and a paternal uncle). The severity of the bipolar disorder type I in her family, is illustrated by the suicides of both parents, one brother and the paternal uncle, in intervals of only a few years. After a Medline review (1980-2004) we found only two studies suggesting a possible relationship between bipolar disorders and alpha-thalassemias, but without clinical case report information. Some genetic studies described the existence of possible genetic susceptibility for bipolar disorder on the short arm of chromosome 16, close to the gene involved in certain alpha-thalassemias, on the region 16p13.3. An interesting finding is that the sequencing of 258 kb of the chromosome region 16p13.3 not only allowed the identification of genes involved in the alpha-thalassemia and in the vulnerability to bipolar disorders, but also the identification of genes implicated in tuberous sclerosis, in polycystic kidney disease, in cataract with microophtalmia, and in vulnerability genetic factors for ATR-16 syndrome, asthma, epilepsy, certain forms of autism and mental retardation. Numerous clinical descriptions and some familial studies on linkage suggested a possible relationship between tuberous sclerosis, polycystic kidney disease, cataract with microophtalmia, ATR-16 syndrome, asthma, epilepsy, certain forms of autism, mental retardation and bipolar disorder, given the closeness of these vulnerability genes on the short arm of the chromosome 16. A vulnerability gene of alcohol dependence was also identified on this same chromosome region (16p13.3), by a study concerning 105 families. Taking into account the methodological difficulties due to the clinical and genetic heterogeneity of bipolar disorder, we suggest that linkage techniques should be used to confirm the presence of susceptibility genetic factor for bipolar disorders on chromosome 16. Thus a known genetic disease (alpha-thalassemia) could contribute to confirming the presence on the short arm of chromosome 16 of a susceptibility genetic factor for bipolar disorders. Linkage studies should be performed in families with a strong association for both diseases. Thanks to linkage techniques, one could hope for an improvement in understanding the physiopathology of bipolar disorder, with possible implications at a therapeutic level.

[Quick detection of depression: a significant clinical issue]

Detection of depression is a major issue for public health. In a study performed in the HUG, we tested the concordance of the self-report Patient Health Questionnaire (PHQ-9) with the Hamilton depression scale (HDRS) administered by a psychiatrist, as measures of the severity of depression. The comparison shows that the PHQ-9 distinguishes subjects with and without depressive disorders and is a good screener for severe disorders but has a poor capacity of discrimination when disorders are mild. This instrument is insufficient if the aim is to detect mild or moderate depressive disorders, wich is the most frequent occurrence in patients consulting primary care physicians.

Multicompartment model to assess body composition in professional water polo players

AIM

The aim of this study was to compare differences between skinfold thicknesses (SK), bioelectrical impedance analysis (BIA), a 2-compartment model (2C), and 2, 3-compartment models (3C) of percent body fat (%BF) assessment with a 4-compartment model (4C) in professional water polo athletes.

METHODS

Ten male subjects, 18 to 29 years of age, participated in this study. Under water weighing, deuterium dilution, and dual-energy X-ray absorptiometry (DXA) were used to provide the required values for the models. The two, 3C models used were established by Withers et al. (3C-W) and by the DXA manufacturers (3C-DXA). 4C was also established by Withers et al.

RESULTS

There were no significant differences between 2C, 3C-W, and 3C-DXA when compared with 4C (criterion model). There were no significant differences between 2C and 3C-W. %BF was significantly greater using 2C compared with 3C-DXA. %BF derived from SK and BIA were significantly greater than all other

METHODS

4C was best correlated with 3C-W (R2=0.998), followed by 2C (R2=0.806), 3C-DXA (R2=0.5071), SK (R2=0.2945), and BIA (R2=0.2377).

CONCLUSION

We conclude that 2C and 3C-W assess %BF equally as well as 4C; however, SK and BIA significantly over-estimated %BF in water polo athletes.

How fat is obese?

The aim of the study was a comparison between body fat measurements and body mass index. We analyzed the data of 890 subjects, 596 females and 294 males, ranging in age from 18 to 83 years, in body mass index (BMI) from 14 to 54 kg/m(2), and in body fat percentage (BF%) from 4% to 57%. A considerable number of subjects, both males and females, could not be classified as obese based on their BMI alone. Such a misclassification is undesirable, especially in general practice, and it calls for diagnostic criteria other than the BMI alone to be used for obesity.

Effect of different sports on body cell mass in highly trained athletes

The objective of this study was to verify the impact of various sports on body cell mass (BCM). Ninety-eight male subjects, 17-33 years of age, participated in the study. The sample included athletes from three professional Italian football (soccer) teams, representing three different divisions (A, n=16; B, n=14; and C, n=18), judo athletes (J, n=10), and water polo athletes (W, n=14) who all competed at the national level. Twenty-six age-matched individuals served as the control group (CG). Fat-free mass (FFM), fat mass (FM), percent body fat (%BF), and BCM were assessed using bioimpedance spectroscopy (BIS). There were no significant differences in body weight and FFM among the groups. A and B were significantly taller than J and CG. B had a significantly lower body mass index (BMI; kg/m(2)) than CG, while C had a significantly lower BMI than J and CG. CG had a significantly greater FM and %BF than A, B, and C. C had a significantly lower BCM than Aand B. CG had a significantly lower BCM than A, B, J, and W. In conclusion, differences in BCM exist among athletes of different sports, and among athletes within the same sport who compete at different levels.