MORRICONE, LELIO, ALEXIS ELIAS MALAVAZOS) by an Mmode, color-doppler videofluoroscope. VAT in the obese patients was assessed by computed tomography (at L4 level). Results: The obese patients had a significantly larger internal diastolic left ventricular (LV) diameter (p Ͻ 0.05), a thicker end-diastolic septum (p Ͻ 0.001) and posterior wall (p Ͻ 0.001), a greater indexed (g/m 2.7 ) LV mass (p Ͻ 0.001), a higher atrial diastolic filling wave velocity (p Ͻ 0.001), a lower ratio between early and atrial diastolic filling wave velocities (p Ͻ 0.01), and a prolonged isovolumic relaxation time (p Ͻ 0.05). End-diastolic septum and posterior wall thickness and the LV mass were significantly greater in patients with a VAT area Ͼ130 cm 2 than with Ͻ130 cm 2 . In the multivariate regression analysis, only VAT (p Ͻ 0.0001), waist-to-hip ratio (p Ͻ 0.001), and sex (p Ͻ 0.001) were associated with the most important echocardiographic alterations. Discussion: The morphological and functional echocardiographic alterations usually found in normotensive obese patients closely correlate with the amount of intra-abdominal fat deposition, even in the presence of diabetes or IGT.

Diabetes is a well-recognized independent risk factor for mortality due to coronary artery disease. When diabetic patients need cardiac surgery, either coronary-aortic by-pass (CABP) or valve operations (VO), the presence of diabetes represents an additional risk factor for these major surgical procedures. Because of controversial data on mortality rates and post-operative complications in diabetic patients, probably due to not exactly comparable groups of patients, this retrospective study aimed to compare two homogeneous populations, which were different only for the presence or absence of diabetes. We studied 700 patients undergoing cardiac surgery: 350 with and 350 without diabetes, mean age 62 +/- 9 years (67% males); 441 underwent CABP and 259 VO. Apart from the diabetes, the two groups were strictly matched for age, body mass index, concomitant pathologies and smoking habits, except for previous neurological injuries (more frequent in diabetic patients), and for a slightly lower ejection fraction in the diabetic group. Intra- and post-operative complications or events were evaluated carefully: death, number staying in post-operative intensive care unit (ICU), renal, hepatic and respiratory complications, necessity for reoperation and hemotransfusions. Anesthesia and surgical procedures (including extra-corporeal circulation techniques) remained substantially unchanged over the period of recruitment of patients (1996-1998) and applied equally to both groups of patients. All diabetic patients were treated with insulin by using standard procedures in order to optimize metabolic control. Diabetic patients in our study, did not show higher rates of mortality in comparison with non-diabetic patients, but had more total neurological complications, more renal complications, a higher re-opening rate, more prolonged ICU stay, and they needed more blood transfusions. Diabetes remains an independent risk factor for these events even in a multivariate logistic regression model analysis. In the subgroup of diabetic patients who underwent CABP a higher rate of renal dysfunction, re-opening, need for hemotransfusions and prolonged ICU stay were confirmed. In the subgroup of diabetic patients undergoing VO we found a higher rate of renal dysfunction, reopening, prolonged ICU stay and major lung complications. In conclusion, diabetes does not seem to increase the mortality rates of cardiac surgery, but diabetic patients undergoing CABP have, on the basis of the relative risk evaluation, a 5-fold risk for renal complications, a 3.5-fold risk for neurological dysfunction, a double risk of being hemotransfused, reoperated or being kept 3 or more days in the ICU in comparison with non-diabetic patients. Moreover, diabetic patients undergoing VO have a 5-fold risk of being affected by major lung complications.

Effects of long-term antiepileptic therapy on the hypothalamic-pituitary axis were evaluated from the basal and stimulated plasma levels of growth hormone (GH) and prolactin (PRL) and from circadian adrenocorticotropic hormone (ACTH)/cortisol rhythms. Data for patients with well-controlled epilepsy of mild-to-moderate severity were compared with those for normal healthy volunteers. Analysis of the effects of each antiepileptic drug (AED) and of combined AEDs revealed minor abnormalities of stimulated GH secretion in all treated patients. In epileptic men, all individual AEDs (except valproate) and AED polytherapy increased both basal and stimulated plasma levels of PRL. In epileptic women, this effect was more variable and less marked, probably because of early depletion of PRL reserves. Each AED and combined AEDs did not significantly change circadian ACTH/cortisol rhythms in epileptic patients. The effects observed seem not to be related to epilepsy per se. Clinical implications, pathways, and neurotransmitters involved and possible mechanisms of the neuroendocrine effects of long-term AED therapy are discussed.

GIROLA,ANDREA, RICCARDO ENRINI, FRANCESCA GARBETTA, ANTONIETTA TUFANO, AND FRANCESCO CAVIEZEL. QT dispersion in uncomplicated human obesity. Obes Res. 2001;9:71-77. Objective: Because obese patients generally may be prone to ventricular arrhythmias, this study was designed to measure the interval between Q-and T-waves of the electrocardiogram (QT) interval dispersion (QTD) in uncomplicated overweight and obese patients. QTD is an electrocardiographic parameter whose prolongation is thought to be predictive of the possibility of sudden death caused by ventricular arrhythmias. To better evaluate the association between obesity per se and QTD, the study population was intentionally selected because they were free of complications. 2 , 10 males and 25 females), and 57 normal weight healthy control subjects (Group C: mean BMI of 21.9 Ϯ 0.2 kg/m 2 , 17 males and 40 females). The obese and overweight patients had no heart disease, hypertension, diabetes, or impaired glucose tolerance and did not have any hormonal, hepatic, renal or electrolyte disorders. The study subjects were matched in terms of age (mean age 38.4 Ϯ 1.2 years) and sex. Results: The QTDs were comparable among the three groups: Group A, 56.4 Ϯ 2.6 ms; Group B, 56.7 Ϯ 2.1 ms; and Group C, 59.4 Ϯ 2.1 ms; not significant. The QTc intervals of Group A and Group B were similar to that of Group C (411.8 Ϯ 3.3, 407.2 Ϯ 3.9, and 410.3 Ϯ 3.9 ms, respectively [not significant]) and did not correlate with BMI. An association was found between QTD and QTc (r ϭ 0.24, p Ͻ 0.005). Using multivariate stepwise regression analysis of the study population, QTD did not correlate with age, BMI, waist circumference, or abdominal sagittal diameter. Discussion: These data suggest that QTD in uncomplicated obese or overweight subjects is comparable with that in age-and sex-matched normal weight healthy controls. In this study population, no association was found between QTD and anthropometric parameters reflecting body fat distribution. Research Methods and Procedures

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