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PubMed1993

Trunk asymmetry and screening for scoliosis: a longitudinal cohort study of pubertal schoolchildren.

A cohort of children was followed-up annually from an average age of 10.8-13.8 years to assess various measures of trunk asymmetry for their predictive value in the screening of scoliosis. Of 1060 children, 855 (80.7%) participated in the final examination. Trunk asymmetry was measured by the forward bending test and moiré topography. A posteroanterior standing radiograph of the spine was taken of those 250 (29.2%) children who had a trunk hump > or = 8 mm. Only 8.3% of the children were found to be symmetric (hump 0-2 mm) in the forward bending test: 65.5% had a hump of 3-7 mm and 26.2% had a hump > or = 8 mm at 13.8 years. Also, moiré fringe asymmetry proved to be common (prevalence of asymmetry > 1 fringe 47.3%), but its correlations with rib hump (r = 0.16) and Cobb angle (r = 0.12) were low. At the final examination, the prevalence of scoliosis (Cobb angle > or = 10 degrees) was 9.2%. Two girls (0.2%) needed brace treatment. The forward bending test is preferable to moiré topography in screening for scoliosis, and a hump size of 6 mm at an average age of 10.8 years is the nearest to optimal as a screening threshold.

Adolescent↗

PubMed1998

Inhibitory interactions in the patterning of trunk neural crest migration.

In avian embryos, trunk neural crest migrate segmentally through the somites, entering the rostral but not caudal somitic sclerotome. Inhibitory molecules in the caudal somite could prohibit entry of neural crest caudally, and thus restrict cell migration to rostral somite territories. Two sets of cues, peanut agglutinin (PNA) binding glycoproteins and members of the Eph family of receptor tyrosine kinases (RTKs) and their ligands appear to play this role in segmenting cell migration. Addition of exogenous PNA to neural crest migrating in trunk explants disrupts the normal segmental pattern of migration; neural crest travel in rostral and caudal regions of the somites. Members of the Eph family display the correct spatiotemporal localization to influence neural crest migration; the RTK EphB3 is expressed by neural crest, whereas the transmembrane ligand ephrin-B1 is expressed by caudal sclerotomal cells. Exogenous ephrin-B1 added to neural crest migrating in trunk explants also specifically disrupts the segmental organization of neural crest migration. Isolated neural crest avoid lanes containing ephrin-B1 in vitro; this avoidance is abolished by addition of soluble ligand. Time-lapse imaging reveals that neural crest exhibit a typical collapse response followed by process retraction upon encountering ligand. The results of these studies implicate PNA-binding glycoproteins and Eph family members in sculpting the migratory patterns of neural precursors in the peripheral nervous system.

Animals↗

PubMed1996

Head and trunk movement adaptations in horses with experimentally induced fore- or hindlimb lameness.

The kinematic patterns of head and trunk were studied in horses during induced supporting limb lameness to understand the mechanisms horses use to compensate for lameness and to evaluate different symmetry indices for their significance as lameness indicators. Using the locomotion analysis system CODA-3 the kinematics of 11 clinically nonlame Dutch Warmblood horses were recorded while walking (1.6 m/s) and trotting (3.5 m/s) on a treadmill. A transient lameness model, evoking pressure induced pain on the hoof sole, was used to induce 3 degrees of fore- and hindlimb lameness. Peak vertical displacement, velocity and acceleration of head, withers, tuber sacrale and both tuber coxae were quantified at different phases of the stride. Changes in these variables due to lameness and symmetry indices calculated as quotients of the values during the lame and nonlame stance phase were analysed using a 2-way analysis of variance. The head, withers and tuber sacrale showed a similar sinusoidal pattern in their vertical displacement, velocity and acceleration. During both fore- and hindlimb lameness at the trot, the vertical velocity of the trunk at impact of the lame limb decreased (P < 0.05), during the lame stance phase the trunk was kept higher above the ground, maximal acceleration decreased and displacement amplitude was smaller than without lameness. Changes in movements of the head were much more expressed than movements of the withers during forelimb lameness and reversed during hindlimb lameness. At the walk, head movement patterns changed in the same way as at the trot, while withers and tuber sacrale patterns were hardly changed. Symmetry indices of all landmarks showed changes due to increasing lameness at the trot. The maximal vertical acceleration of the head and displacement amplitude of the tuber sacrale proved to be the best indicators to quantify a fore- and hindlimb lameness, respectively.

Adaptation, Physiological↗

PubMed1984

Phasic modulation of trunk muscle efferents during fictive spinal locomotion in cats.

In high spinal paralysed cats electromyograms were recorded from nerves supplying lumbar back muscles (longissimus dorsi) and abdominal muscles (obliquus abdominis externus) during fictive locomotion induced by I.V. injection of nialamide and L-DOPA. Activity in nerves to hind-limb muscles was also recorded. During periods of stable 'locomotor' activity in the hind-limb nerves the efferents to the back and abdominal trunk muscles were generally also rhythmically active. Three different patterns of activity were observed. The predominant rhythmic pattern showed a synchronous activation of the efferents to the back and abdominal muscles of one side together with an activation of the hind-limb flexors of that side, alternating with activation of the efferents to the corresponding contralateral muscles. This pattern was very stable and could last for about 3 h. Such a pattern of activity would be expected during the alternate stepping characteristic of walking and trotting. The second type of rhythmic locomotor activity was characterized by a synchronous bilateral activation of the efferents to the back muscles, alternating with activation of the abdominal muscles on both sides. This pattern occurred only for short periods and appears to correspond to the activity during in-phase stepping such as occurs during a gallop. Beside these well co-ordinated patterns less well co-ordinated rhythmic activities were also observed. These included regular rhythmic activity which occurred independently in different muscle groups as well as irregular rhythmic activity with unstable phase relations between different muscle groups. The rhythmic locomotor activity in efferents to trunk and limb muscles could be modulated by afferent nerve stimulation and by hypoxia. The results reveal that the spinal cord deprived of its supraspinal and peripheral control may generate a variety of different locomotor patterns, which incorporate the trunk muscles in an apparently meaningful way.

Abdominal Muscles↗

PubMed1987

Properties of the inspiration-related activity of sympathetic preganglionic neurones of the cervical trunk in the cat.

1. The experiments reported here have examined some temporal characteristics of the inspiration-related sympathetic discharge of the cat in control conditions and during forcing of the respiratory oscillator into marked deviations from its natural frequency. The purpose of these experiments was to establish whether or not the relation of sympathetic to phrenic nerve activity shows properties consistent with the hypothesis that the inspiration-related sympathetic discharge is driven by a neural oscillator, independent of, but coupled and stably entrained to, the brain-stem respiratory oscillator. 2. The electrical activity of the whole cervical sympathetic trunk (n = 26) or of small strands of the cervical trunk containing single units (n = 20) and of the phrenic nerve was recorded in pentobarbitone-anaesthetized, paralysed, artificially ventilated, sino-aortic denervated cats. Most of the cats were bilaterally vagotomized. 3. The onset of the inspiratory burst of the sympathetic preganglionic neurones had a fixed delay from the onset of the phrenic nerve burst. The level of activity within the burst, in whole cervical trunk recording, reached a maximum in early inspiration and then was maintained at approximately this level for the rest of inspiration (twenty-two out of twenty-six cats). In four cats the activity level increased throughout the burst. Individual sympathetic preganglionic neurones displaying inspiration-related burst firing were characteristically recruited in early inspiration and thereafter maintained an approximately constant firing frequency for the rest of inspiration. 4. Electrical stimulation of afferents in the superior laryngeal nerve during various phases of the respiratory cycle caused equivalent, phase-dependent, resetting patterns of both phrenic nerve and inspiration-related sympathetic discharge. 5. In cats with intact vagus nerves, entrainment of the brain-stem respiratory oscillator to the frequency of the respiratory pump was used to change the frequency of the former, within limits, by changing the frequency of the latter. Over the range of frequencies tested, the pump-to-phrenic delay varied as a function of frequency, while the delay between phrenic and sympathetic burst onset was essentially independent of frequency. 6. In hyperthermic, hypocapnic cats phrenic nerve burst frequency increased up to about 300 bursts/min from a value of 15 bursts/min in normothermia-normocapnia. At all frequencies within this range the sympathetic burst maintained a delay, with respect to the phrenic burst, which was essentially independent of frequency.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗

PubMed2002

The trunk muscles of elite oarsmen.

OBJECTIVES: To investigate the trunk strength of elite rowers and the impact of low back pain on these measures in order to determine if asymmetries or weakness were present. METHODS: Twenty two elite rowers were recruited: 13 reported previous low back pain, five current low back pain, and the remainder had no history of low back pain. All subjects were scanned during simulated rowing in an interventional open magnetic resonance imaging scanner. In each simulated rowing position, axial scans were obtained at the level of the L4-5 and L5-S1 disc interspace to determine the cross sectional area of the posterior trunk muscles. RESULTS: Considerable differences were observed between the three groups of rowers. In contrast with expectations and previous literature, the trunk muscles of rowers with low back pain had significantly larger cross sectional areas (p<0.001). No left/right asymmetries were observed and no differences between oarside and non-oarside in terms of muscle cross sectional area. CONCLUSION: These findings suggest that low back pain in rowers does not arise as a result of muscle weakness.

Adult↗

PubMed2006

Tick paralysis with atypical presentation: isolated, reversible involvement of the upper trunk of brachial plexus.

Tick paralysis is a disease that occurs worldwide. It is a relatively rare but potentially fatal condition. The only way to establish the diagnosis is to carefully search for the tick paralysis. It is caused by a neurotoxin secreted by engorged female ticks. Tick paralysis generally begins in the lower extremities and ascends symmetrically to involve the trunk, upper extremities and head within a few hours. Although early-onset prominent bulbar palsy and isolated facial weakness without generalised paralysis are rare, there is no report in the English literature concerning isolated, reversible involvement of the upper trunk of brachial plexus caused by tick bite. We report a case of isolated, reversible involvement of the upper trunk of brachial plexus as a variant of tick paralysis. Diagnosis was confirmed with needle electromyography and nerve conduction examination. Within 2 weeks, the patient was fully recovered. The purpose of presenting this case is to remind clinicians that tick paralysis should be considered even in cases with atypical neurological findings admitted to the emergency department.

Aged↗

PubMed1989

Distinguishing between anomalous origin of the left coronary artery from the pulmonary trunk and dilated cardiomyopathy: role of echocardiographic measurement of the right coronary artery diameter.

Patients with anomalous origin of the left coronary artery from the pulmonary trunk usually have a large right coronary artery. This study examines the diagnostic value of measuring the diameter of the right coronary artery by echocardiography in distinguishing between this lesion and other causes of dilated cardiomyopathy. The diameter of the right coronary artery and the right coronary artery/aorta ratio were measured in the parasternal short axis view in 40 controls, 11 patients with dilated cardiomyopathy, and 10 with anomalous origin of the left coronary artery from the pulmonary trunk. In the controls, the diameter of the right coronary artery increased with age, but the right coronary artery/aorta ratio remained constant. In the control group the 95% upper limits of prediction for right coronary artery diameter were 1.6 mm for one month of age, 1.8 mm for three months, 2.0 mm for one year, 2.2 mm for two years, 2.4 mm for three years, 2.6 mm for four years, 2.7 mm for six years, 3.0 mm for eight years, and 3.2 mm for 10 years; and for right coronary/aorta ratios the limits were 0.17 for one month to one year, 0.18 for one to six years, 0.19 for six to 10 years, and 0.20 for more than 10 years. All patients with dilated cardiomyopathy had normal right coronary artery diameters and right coronary artery/aorta ratios (0.10-0.13). Those patients with anomalous origin of the left coronary artery from the pulmonary trunk had larger than normal right coronary artery diameter and a significant increase in the right coronary artery/aorta ratio (0.21-0.29). The presence of an anomalous left coronary artery was likely if the diameter of the right coronary artery or the right coronary artery/aorta ratio was larger than the normal 95% limits of prediction.

Cardiomyopathy, Dilated↗

PubMed2000

Children dying in car trunks: how adequate are child death databases?

OBJECTIVE: To determine the frequency of and circumstances surrounding child deaths resulting from inadvertent entrapment in motor vehicle trunks in the US by querying child fatality review databases. METHOD: A telephone survey was conducted with the persons or offices identified as having primary responsibility for child fatality review programs in each state. The survey requested information on the number of child deaths resulting from trunk entrapments, the ages of the victims, the time period covered by the surveillance system, and variables concerning the circumstances surrounding each incident. RESULTS: All states reported that these deaths are exceedingly rare, with most reporting no such events in recent history. However, state databases could not be readily accessed to identify such deaths. There was enormous interstate variation in guidelines governing the population covered by the child fatality review process. The age range varied greatly from one jurisdiction to another, and often only children in the state's welfare system were included. Interstate differences in practices preclude meaningful compilation of data across jurisdictions. CONCLUSIONS: It was not possible to ascertain the incidence of inadvertent entrapment of children in vehicle trunks because there is no consistency in the available databases. A national database of child fatalities, based on standardized guidelines and definitions, is needed to identify causes and magnitude of specific child deaths, in order to design, implement, and evaluate interventions.

Adolescent↗

PubMed1978

Evagination of smooth muscle cells in the hypoxic pulmonary trunk.

Six female Wistar albino rats were exposed to the hypoxia of a simulated altitude of 5500 m, three for a period of one week and three for a month. They developed ultrastructural changes in the pulmonary trunk consisting of evaginations of muscle cells of its media through gaps in the internal elastic lamina to press into the underlying endothelial cells. Such evaginations were usually devoid of myofilaments and organelles. Some appeared so electron-lucent as to be unrecognisable as muscle apart from the unequivocal connection with the parent smooth muscle cells. Elsewhere we have demonstrated that muscular evaginations in normal pulmonary blood vessels are an artefact brought about by collapse of lung tissue and that they can be avoided by distending the lung. Hence in the present investigation, in which the pulmonary trunk was fixed in distension, the evaginations are interpreted as indicating contraction of the muscle cells able to overcome the distending force. We interpret them as evidence of constriction of muscle cells in the media of the pulmonary trunk in response to hypoxia.

Animals↗

PubMed2004

Kinematic and kinetic constraints on arm, trunk, and leg segments in target-reaching movements.

We studied target reaching tasks involving not only the arms but also the trunk and legs, which necessitated some trunk flexion. Such tasks can be successfully completed using an infinite number of combinations of segment motions due to the inherent kinematic redundancy with the excessive degrees of freedom (DOFs). Sagittal plane motions of six segments (shank, thigh, pelvis, trunk, humerus, and forearm) and dynamic torques of six joints (ankle, knee, hip, lumbar, shoulder, and elbow) were analyzed separately by principal component (PC) analyses to determine if there was a commonality among the shapes of the respective waveforms. Additionally, PC analyses were used to probe for constraining relationships among the 1) relative magnitudes of segment excursions and 2) the peak-to-peak dynamic joint torques. In summary, at the kinematic level, the tasks are simplified by the use of a single common waveform for all segment excursions with 89.9% variance accounted for (VAF), but with less fixed relationships among the relative scaling of the magnitude of segment excursions (62.2% VAF). However, at the kinetic level, the time course of the dynamic joint torques are not well captured by a single waveform (72.7% VAF), but the tasks are simplified by relatively fixed relationships among the scaling of dynamic joint torque magnitudes across task conditions (94.7% VAF). Taken together, these results indicate that, while the effective DOFs in a multi-joint task are reduced differently at the kinematic and kinetic levels, they both contribute to simplifying the neural control of these tasks.

Adult↗

PubMed1992

Velocity- and acceleration-sensitive units in the trunk lateral line of the trout.

1. The two main types of lateral line organs of lower vertebrates are the superficial neuromasts (SN), with a cupula that protrudes in the surrounding water, and the canal neuromasts (CN), located in the lateral line canal. The scales of the trunk lateral line canal of fish contain SNs as well as CNs. In this study, we examine whether there exist two functional classes of afferent fibers in the trunk lateral line nerve of the rainbow trout that can be attributed to the SNs and CNs. 2. The response properties of the afferent fibers in the trunk lateral line nerve have been determined during stimulation with sinusoidally varying water motion generated by a small vibrating sphere. Linear frequency response analysis revealed the presence of two distinct populations of afferent fibers in the lateral line nerve. The fibers belonging to the two populations showed significant differences in the frequency at which the sensitivity was maximal, the low-frequency response slope and the low-frequency asymptotic phase angle. 3. One population of fibers has a maximum sensitivity at 36 +/- 13 (SD) Hz (n = 22) and responds up to this frequency to water velocity. The low-frequency slope of the frequency response of these fibers was 20 +/- 3 (SD) dB/decade and the low-frequency phase lead was 121 +/- 11 degrees (mean +/- SD), both with respect to sphere displacement. The fibers of the other population have a maximum sensitivity at 93 +/- 14 (SD) Hz (n = 12) and respond up to this frequency to water acceleration. The low-frequency slope of these fibers was 35 +/- 5 (SD) dB/decade, and the low-frequency phase lead was 188 +/- 13 degrees (mean +/- SD). 4. Analysis of the stochastic properties of the spontaneous activity of both types of fibers revealed that the mean firing rate of the fibers responding to water velocity (26 +/- 12 spikes/s, mean +/- SD; n = 22) was significantly higher than that of the fibers responding to acceleration (36 +/- 11 spikes/s, mean +/- SD; n = 12). The other statistical properties of the spontaneous activity were found to be indistinguishable. 5. From comparison of the results with the available quantitative data on frequency responses of lateral line organs in other species, it has been concluded that the fibers responding (< or = 40 Hz) to water velocity innervate SNs and that the fibers responding (< or = 90 Hz) to water acceleration innervate CNs.(ABSTRACT TRUNCATED AT 400 WORDS)

Acceleration↗

PubMed1983

Protein synthesis in the rat pulmonary trunk during the early development of hypoxia-induced pulmonary hypertension.

The purpose of this study was to determine the temporal alterations in protein synthesis and accumulation in the rat pulmonary trunk during the early development of hypoxia-induced pulmonary hypertension and to correlate these results with the pattern of development of polycythemia, right ventricular hypertrophy (RVH) and increased right ventricular pressure (RVP). In vitro synthesis of collagen and noncollagen protein was determined in the pulmonary trunks (PT) of rats exposed to chronic hypobaric hypoxia (0.5 atm/380 Torr) for 3, 7, 10, 14 or 21 days and in respective control groups of pair-fed normoxic rats. In vitro collagen synthesis was increased 1,150% (p less than 0.01) in PT from rats exposed to hypoxia for 3 days compared to PT from normoxic rats. When duration of hypoxic exposure increased, the percentage increase in collagen synthesis in PT from hypoxic vs. normoxic rats declined but remained significantly elevated (340%, p less than 0.005) after 21 days. Comparison of in vitro synthesis of noncollagen protein demonstrated a similar pattern of alteration with increasing hypoxic exposure. Synthesis of noncollagen protein was increased 750% in PT from hypoxic rats compared to normoxic controls at 7 days (p less than 0.0005) and decreased in parallel with collagen synthesis until 21 days when the difference in mean noncollagen protein synthesis was no longer statistically significant. In contrast, the accumulation of protein in vitro during hypoxic exposure, as determined from measurement of absolute protein and hydroxyproline content, demonstrated a pattern of continued increase with hypoxic exposure. Absolute protein content (microgram protein/vessel) was increased 330% in PT from hypoxic rats after 3 days compared to controls (p less than 0.005). By 21 days, mean absolute protein content of hypoxic PT was increased 500% compared to controls (p less than 0.0005). Absolute hydroxyproline content became significantly elevated in PT from hypoxic rats compared to controls after 7 days (123%, p less than 0.005 and the difference increased to 135% at 21 days (p less than 0.025). From comparison of these results with the pattern of changes in established indicators of pulmonary hypertension, herein reproduced, it is deduced that increased protein synthesis is a very early response of the pulmonary trunk to the stimulus of increased arterial blood pressure. Protein synthesis then declines while accumulation increases in a manner which suggests that the newly synthesized protein alters the response of the vessel to the continuing stimulus. It is proposed that increased accumulation of protein, particularly collagen, decreases the distension of the vessel wall caused by increased transmural pressure.

Animals↗

PubMed2002

Direct percutaneous transluminal angioplasty for acute middle cerebral artery trunk occlusion: an alternative option to intra-arterial thrombolysis.

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the safety and efficacy of direct percutaneous transluminal angioplasty (PTA) for patients with acute middle cerebral artery (MCA) trunk occlusion. METHODS: Over the past 9 years, a total of 70 patients with acute MCA trunk occlusion were treated with intra-arterial reperfusion therapy. In the last 5 years, 34 patients were treated with direct PTA, and subsequent thrombolytic therapy was added if necessary for distal embolization. The other 36 patients, mainly in the first 4 years, were treated with thrombolytic therapy alone and were used as controls. Pretherapeutic neurological status was evaluated with National Institutes of Health Stroke Scale scores. The modified Rankin Scale (mRS) was used to assess clinical outcome at 90 days. RESULTS: There were no significant differences in pretherapeutic National Institutes of Health Stroke Scale score and duration of ischemia between the 2 groups. The rate of partial or complete recanalization in the PTA group was 91.2%, whereas that in the thrombolysis-alone group was 63.9% (P<0.01). The incidence of large parenchymal hematoma with neurological deterioration in the PTA group was 2.9%, while that in the thrombolysis-alone group was 19.4% (P=0.03). Although direct PTA did not improve the rate of favorable outcome (mRS score 0 or 1; 41.7% for the thrombolysis-alone group versus 52.9% for the PTA group; P=0.48), outcome in terms of independence (mRS score 0, 1, 2) was significantly better in the PTA group (73.5%) than in the thrombolysis-alone group (50.0%; P=0.04). CONCLUSIONS: Although definitive conclusions on the comparative merits of these 2 therapies cannot be drawn because of an open trial, direct PTA may be an effective alternative option to intra-arterial thrombolysis for acute MCA trunk occlusion.

Acute Disease↗

PubMedDate not supplied

Bilateral occlusion of the trunk of the middle cerebral artery. Results of an international randomized trial. The EC/IC Bypass Study Group.

Bilateral occlusion of the middle cerebral artery (MCA) trunk theoretically should be a very severe condition, but its actual prognosis has never been studied. Nine of 1,377 patients (7 Asians, 1 Black, 1 Caucasian) from the Cooperative Study of Extracranial/Intracranial Arterial Anastomosis were found to have atherosclerotic bilateral occlusion of the middle cerebral artery (MCA) trunk before entering the trial. Three presented with a stroke followed by a contralateral stroke, two experienced a unilateral stroke, two had a unilateral stroke preceded by ipsilateral TIAs, one had a unilateral stroke preceded by TIAs on both sides and one experienced isolated unilateral TIAs. Retrograde filling to the distal MCA was universally present. During follow-up (mean: 45 months), only one (non-operated) patient had further cerebrovascular events, and ultimately a fatal stroke. One additional patient died of sepsis and one had a silent myocardial infarct. All survivors resumed their previous activities. This study shows that in bilateral MCA trunk occlusion, the long-term prognosis is reasonable in the patients who do not present with a devastating stroke.

Adult↗

PubMed2005

Hybrid approaches to thoracic aortic aneurysms: the role of endovascular elephant trunk completion.

BACKGROUND: Thoracic aortic aneurysm affecting the arch and proximal descending thoracic aorta requires 2-stage repairs that include proximal elephant trunk graft placement and completion of thoracic or thoracoabdominal repair. The application of endovascular grafting to complete the proximal procedure avoids a thoracotomy and may improve the morbidity and mortality of the patient population at risk. METHODS AND RESULTS: A retrospective review of 399 thoracic endovascular grafts at our institution between 2000 and 2004 identified 22 patients who required elephant trunk and endovascular completion. Three patients underwent mesenteric bypass in addition to their proximal repairs. Mean follow-up was 10 months (range 1 to 42 months); there were no ruptures, and all patients returned for follow-up. Technical success was achieved in all patients. The 1-, 12-, and 24-month mortality rates (by Kaplan-Meier analysis) were 4.5%, 15.8%, and 15.8%, respectively. Caudal migration of the endograft occurred in 1 patient, and all but 2 aneurysms decreased or remained stable in size. The 2 patients with growth included a type III endoleak (which resolved after treatment) and pressurization through an expanded PTFE stentgraft. Three cases of transient paraparesis occurred (all in patients requiring mesenteric bypass or abdominal aortic aneurysm repair), and there were no paraplegias or strokes. CONCLUSIONS: Endovascular completion of elephant trunks is feasible and can be accomplished with minimal mortality. Meticulous imaging follow-up is required to detect persistent aneurysm pressurization and to verify the integrity of the repair. Improvements in implant design and delivery systems will further simplify the second-stage portion of these complex aneurysm repairs.

Aorta, Thoracic↗

PubMed2002

Trunk fat and blood pressure in children through puberty.

BACKGROUND: Fat distribution is well recognized as a cardiovascular risk factor in adults. The association between android fat distribution and cardiovascular risk factors, such as blood pressure (BP), was previously reported in an African-American and Caucasian pediatric population. The aim of the present study was to investigate the relationship between BP and body fat distribution in a large cross-sectional pediatric sample. The effects of race, sex, and puberty on this relationship were assessed. METHODS AND RESULTS: BP was measured in 920 healthy children and adolescents (African-American, Asian, and Caucasian, ages 5 to 18 years). Fat distribution was determined by skinfold thickness and dual-energy X-ray absorptiometry (DXA). Pubertal status was assessed by the criteria of Tanner. Regression analysis was used to explore the association between BP and fat distribution. Significant positive relationships between systolic and diastolic BP and trunk fat adjusted for total fat were seen in boys at all pubertal stages in all 3 races by both DXA and skinfold measurements. In girls, trunk fat was not a significant predictor of BP. CONCLUSIONS: Our results demonstrate a sex difference in the relationship between BP and trunk fat in that a significant positive relationship was present in boys only. These findings, based on 2 independent measures of fat distribution, may help identify the specific features of individuals at risk, allow earlier intervention, and suggest sex-specific determinants for BP.

Abdomen↗

PubMed2001

Staged repair of extensive aortic aneurysms: morbidity and mortality in the elephant trunk technique.

BACKGROUND: Extensive aortic aneurysms (ascending aorta, aortic arch, and descending or thoracoabdominal aorta) require innovative surgical techniques. Some surgeons advocate a single procedure with long periods of profound hypothermia, whereas others use a staged approach. We adopted a two-staged procedure (elephant trunk technique) in 1991 for elective repair of extensive aortic aneurysms. METHODS AND RESULTS: Between February 1991 and May 2000, we performed a total of 1146 aortic aneurysm operations. Of these, 182 (15.9%) operations were first- or second-stage elephant trunk procedures, performed in a total of 117 patients. Stage 1 was completed in all 117 patients. Stage 2 was completed in 65 (55.6%) of 117 patients. Thirty-day mortality rate for the first stage was 5.1% (6 of 117). Mortality rate during the interval between operations was 3.6% (4 of 111), of which 75% (3 of 4) were the result of aneurysm rupture. Thirty-day mortality rate for the second stage was 6.2% (4 of 65). A total of 43 patients did not return for second-stage repair. Among these patients, within an average period of 3.4 years (range, 1.5 months to 4.9 years), 13 of 43 (30.2%) died, 4 of 13 (30.8%) as the result of rupture. Two of 117 (1.7%) first-stage patients had postoperative stroke. No spinal cord dysfunction occurred in second-stage patients. CONCLUSIONS: Extensive aortic aneurysms can be repaired with acceptable morbidity and mortality rates through the use of the elephant trunk technique. Death was most commonly the result of rupture, both in interval patients awaiting scheduled second-stage repair and in patients who did not return. After the first stage, prompt treatment of the remaining segment is crucial to the success of staged repair.

Adolescent↗