Biomedical subjects
Publications and source records attributed to N Solomons.
In a patient presenting with haematemesis, known to have oesophageal varices, the bleeding would be expected to be from those varices. This case demonstrates an unusual presentation of a base of skull fracture; blood from a fracture of the temporal bone had run from the middle ear through the eustachian tube to the pharynx. It demonstrates the need to remain vigilant even when the diagnosis appears to be obvious.
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A rare case of supraglottitis complicated by mediastinitis is presented. Despite aggressive treatment with broadspectrum intravenous antibiotics, the patient persisted to have generalized supraglottitis. Subsequent computed tomography (CT) scanning revealed that she had developed a frank fluid collection starting at the suprasternal notch, extending retrosternally into the superior mediastinum. She recovered with conservative management and did not require aggressive mediastinal drainage as advocated by the literature.
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BACKGROUND: There are limited data on the influence of body composition, sex, seasonality, ethnicity, and geographic location on the components of energy expenditure in children. OBJECTIVE: The objective was to examine the determinants of total energy expenditure (TEE), resting energy expenditure (REE), and activity-related energy expenditure (AEE) in children. DESIGN: Cross-sectional data from 232 children (4-10 y of age) from 4 ethnic groups (white American, African American, Guatemalan Mestizo, and Native American Mohawk) were examined. RESULTS: In 104 white children studied in Vermont and Alabama, TEE was significantly higher in spring than in fall, higher in boys than in girls, and higher in children in Vermont (all effects: approximately 0.42 MJ/d, P < 0.05). The significant effect of sex was explained through REE; the influences of season and location were explained through AEE. In all children, there was no effect of sex but a significant effect of ethnicity (P < 0.01) on TEE: a significant effect of sex (P < 0.01) and no effect of ethnicity (P = 0.16) on REE; and no effect of sex and a significant effect of ethnicity on AEE. The significant effects of ethnicity were due to lower values in Guatemalan children. TEE correlated most strongly with weight (r = 0.81) and fat-free mass (r = 0.79-0.81); REE with weight (r = 0.85) and fat-free mass (r = 0.80-0.87); and AEE with maximal oxygen consumption (r = 0.54), fat-free mass (r = 0.50), and fat mass (r = 0.49). CONCLUSIONS: 1) Season and location influenced TEE in children through their effects on AEE, 2) a higher REE in boys was consistent across all groups examined, 3) Guatemalan children had lower TEE due to a lower AEE, 4) body weight may be the best predictor of TEE, and 5) maximal oxygen consumption was the strongest marker of AEE.
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We examined body composition using bioelectrical impedance analysis and isotope dilution (18O and 2H), resting metabolic rate (RMR) by indirect calorimetry, and total energy expenditure (TEE) by doubly labeled water in 15 short-stature (height-for-age < or = -1.5 SD) and 15 normal-stature (height-for-age > -1.5 SD) Guatemalan children aged 4-6 y. Although, in absolute terms significant group differences were found in fat-free mass (FFM), fat mass, and total body water (TBW), there were no significant differences in fat mass and TBW after adjustment for FFM. RMR of the short-stature children (3791 +/- 376 kJ/d) was not significantly different from that of normal-stature children (4038 +/- 531 kJ/d), and the regression between RMR and FFM was also not significantly different between groups. TEE was not significantly different in short-stature (4753 +/- 761 kJ/d) compared with normal-stature children (5304 +/- 1020 kJ/d); the regression between TEE and FFM was not significantly different between the two groups. There were no significant group differences in RMR and TEE after adjustment for FFM. FFM was the strongest predictor of TEE, but could only explain 29% of the variance. We conclude that 1) the lower TBW and fat mass in the short-stature group is proportional to their lower FFM, 2) there is no significant difference in either RMR or TEE between short- and normal-stature children, and 3) TEE is highly variable among these children and cannot be explained by differences in body size alone.
Aging is associated with diminished secretion of growth hormone and the major endogenous mediator of growth hormone action, insulin-like growth factor I (IGF-I). Aging is also associated with decreased physical activity. Alterations in body composition characteristic of the aging process (increased fat mass and decreased lean body mass) may be related to the decline in anabolic effects of IGF-I with aging, decreased physical activity, or both. Guatemalan women often maintain a high level of physical activity during aging. The purpose of this study was to determine whether IGF-I concentrations correlated with physical activity level (determined by standardized scoring of a self-report questionnaire) and body composition (determined by bioelectrical impedance analysis) in elderly Guatemalan women. In 112 women aged 20-87 y, we found a progressively lower serum IGF-I with age (r = -0.732). In subjects > 60 y of age, the self-reported activity level was associated with a lower percentage body fat (P < 0.001) but there was no significant relation between physical activity level and either lean body mass or IGF-I. We conclude that there is a significant age-related decline in serum IGF-I concentrations in Guatemalan women, similar to that observed in both men and women in the United States. An increased level of physical activity in the elderly Guatemalan population was associated with reduced body fat but did not modify the expected reduction in circulating IGF-I concentrations that occurs with aging.
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There is evidence that zinc is important for maintenance of the special senses: vision, taste, and smell. Rod function is impaired in zinc deficiency due partly to its role in vitamin A metabolism. However, optic nerve function may also be affected by zinc status. Microophthalmia, anophthalmia, and optic nerve abnormalities have all been found in the offspring of female rats fed zinc-deficient diets. Zinc deficiency clearly decreases taste acuity in both animals and humans. However, other nutritional and non-nutritional conditions also produce hypogeusia. There is limited evidence that zinc deficiency impairs olfactory acuity in humans. New approaches to the assessment of taste and smell abnormalities may provide reliable and reproducible associations between zinc deficiency and taste and smell defects.