In 176 Japanese women aged 20-79, participating in a health assessment programme, we studied the associations between several metabolic features and the type of obesity based on body mass index and waist to hip circumference ratio. We propose the existence of three types of obesity based on BMI and WHR : Type-I, obese women who have a high BMI and a low WHR, Type-II, obese women who have a low BMI and a high WHR, and Type-III, obese women who have both a high BMI and a high WHR. Age was categorized into three levels for all analyses (≤49, 50 - 59, and ≥60 yr) . There was no significant association of WHR with any metabolic variable after adjustment for the effects of the BMI in any group. The results of the present study show that the amount of body fat is in itself more important than the WHR. Where p values were significant, levels of metabolic risk factors for disease increased across the tertiles composed from a combination of the BMI and WHR, except for HDL-ch and HDL-ch/T-ch, where levels fell. Although the means of these metabolic parameters in each type of obesity were all within the normal range, significant differences were observed between the group with Type-III obesity and the nonobese group for these parameters.
In conclusion, the most“dangerous”subgroup of obesity appeared to be Type-III obesity in which high levels of BMI and WHR coexist.

A study was conducted to investigate the validity of bioelectrical impedance measurement (BIM) for determining changes in body composition during treatment of obesity with an exercise and diet regimen. Eleven obese women, aged 38-57 yr (44±6.0 yr), participated in a weight reduction study. Before and after the weight reduction period, body composition was measured by the deuterium oxide (D₂O) dilution and BIM methods. For both methods, the correlation coefficients were of the same order of magnitude under both pre- and postregimen conditions. Mean weight reduction was 3.59±1.518 kg and loss of total body fat was estimated to be 4.8±1.72 kg by the D₂O method and 2.5±1.14 kg by the BIM method. Thus the BIM method underestimated the change in body fat compared with the D₂O method. Changes in resistance (R) and height squared divided by R were not significant at the p>0, 05 level. However, the mean change in fat-free mass (FFM) found by the D₂O method was significantly greater than that found by the BIM method. Furthermore, there was no significant correlation between the changes in FFM estimated by the D₂O and BIM methods. These results show that after weight reduction the BIM method overestimates body composition. It is concluded that the BIM method is not a valid approach for measuring the small changes in body composition that occur during treatment of obesity.

In the present study, we investigated the associations of the body mass index (BMI ; kg/m²) and the waist to hip circumference ratio (WHR) with metabolic features in 134 Japanese women ranging in age from 24 to 79 years. We found that the BMI was reasonably well correlated with the WHR (r=0.693, p<0.001), which may be related to the health risk profile. The BMI and WHR both showed significant negative correlation with high-density lipoprotein cholesterol (HDL) level, and positive correlation with triglyceride (TG) and plasma glucose (GL) levels and systolic blood pressure (SBP) and diastolic blood pressure (DBP) . Following adjustment for the effect of the BMI, the partial correlation coefficients of WHR with HDL, TG, and GL were lower than those obtained before adjustment, and were not significant. However, the partial correlation coefficient of WHR with HDL/total cholesterol ratio (HDL/TC), SBP, and DBP were significant. These results suggest that the levels of HDL, TG and GL are associated with the BMI among subjects with similar WHR. We therefore propose that a combination of the BMI and WHR would be a superior indicator in obesity screening than the BMI alone.

A study was conducted to assess gender differences of body fat distribution (i. e., total body fat mass, subcutaneous fat mass, and internal fat mass) in a homogeneous group of Japanese children. Body composition was estimated in 141 boys and 139 girls (aged 3-6 yr) using bioelectrical impedance analysis (BIA) . All subjects were apparently healthy. Determinations of impedance were made using a four-terminal impedance analyzer (TP-95 K, Toyo Physical, Inc., Fukuoka) . The lean body mass (LBM) was calculated using the equation of Kushuner et al. (1992) and Goran et al. (1993) . Total body fat mass (TFM) was calculated as the difference between body weight and LBM. The subcutaneous fat mass (SFM) was calculated using a modification of the equation derived by Skerjl et al. (1953) . The internal fat mass (IFM) was calculated as the difference between TFM and SFM. From ages 3 through 6 years, the mean LBM increased with age in boys and girls, but showed no significant gender differences. There were also no obvious gender differences in TFM and IFM within the same age range. Percentage body fat decreased in both sexes until the age of approximately 5-yr, and then increased again slightly at 6 yr, although it showed no significant differences between the sexes. The gender-specific pattern of fat accumulation during childhood was characterized by an almost steady increase of SFM in girls. These differences were independent of gender differences in physical characteristics.

Coronary artery disease (CAD) was evaluated by noninvasive examination in abdominal aortic aneurysm (AAA) patients. A simultaneous operation or a 2-staged operation was performed depending on the seriousness of the condition when both diseases were combined. A total of 36 patients underwent elective repair of AAA between 1996 and 2001. Coronary angiography (CAG) was performed only in patients with suspected CAD by dipyridamole myocardial scintigraphy. Significant CAD was found in 8 patients. Simultaneous operation was performed in 4 patients, and off-pump coronary artery bypass grafting (OPCAB) was performed in all cases of simultaneous operation. In 4 patients receiving 2-staged operations, 1 standard coronary artery bypass grafting (CABG), 1 OPCAB and 2 percutaneous transluminal coronary angioplasties (PTCA) were performed prior to AAA surgery. Twenty-eight patients underwent only AAA operation. Though there were no incidents of perioperative myocardial infarction or cardiac related deaths in this group, 2 patients died due to other causes (hemorrhage and duodenal perforation). In the 8 patients associated with CAD, 1 patient died of MNMS after simultaneous operation. The other 7 patients revived their social function soon of the discharge. Dipyridamole cardiac scintigraphy was considered to be an effective examination for evaluation of CAD in AAA patients. There was no need to perform CAG in all AAA patients. The policy of choosing simultaneous operation or 2-staged operation according to the seriousness of the 2 diseases seemed to be appropriate.

In dialysis cases complicated with ischemic heart disease, there are many problems, such as poor preoperative general condition, calcified aorta, water-electrolyte control, and the necessity for other simultaneous operations. Off-pump coronary artery bypass grafting (OPCAB) was considered very useful in coping with these problems. OPCAB, employed in five cases, was compared with conventional coronary artery bypass grafting with extracorporeal circulation (ECC group, 9 cases). Regarding preoperative coexisting diseases, collagen diseases, porcelain aorta, cerebral infarction, and others were recognized in the OPCAB group in 3 of 5 cases. Emergency operations were performed in 5 of 9 cases in the ECC group, and in 2 of 5 cases in the OPCAB group. The bypass number (3.2 vs. 2.0) and complete revascularization rate (7 of 9 vs. 2 of 5), tended to be higher in the ECC group. The OPCAP group was significantly superior in blood transfusion (6.7 vs. 3.0u), postoperative CK-MB (63 vs. 33u), and the postoperative usual hemodialysis commencing time (4.2 vs. 1.0 day). Concerning use of postoperative IABP (3 of 9 vs. 0 of 5), and postoperative ventilator weaning time (2.7 vs. 1.0 day), a good tendency was shown in the OPCAB group. Although a high mortality rate (2 of 5) was recognized in OPCAB group compared with ECC group (1 of 9), those were urgent cases who had a very poor preoperative condition, and both cases suffered non-cardiac deaths. Excluding special cases, such as an unstable hemodynamic state requiring assisted circulation, and poor coronary run off, OPCAB seems useful for the treatment of coronary artery disease in dialysis patients.

No abstract available.
Angioplasty ; Angioscopy ; Lasers, Excimer ; Stents

We studied the mechanism for slowing surface electromyography (EMG) during fatiguing contraction using superimposed M-wave analysis. Seven healthy male subjects exerted 60% maximum voluntary contraction of isometric abductions in the left first dorsal interosseous muscle (FDI) until exhaustion. Simultaneously with voluntary contractions, the ulnar nerve was electrically stimulated at supramaximal intensity, and volitional EMG and superimposed M-waves were obtained. We examined the behavior of muscle fiber conduction velocity (MFCV) and median frequency (MDF) for both EMG, with the following results:
1) MFCV calculated from volitional EMG of FDI was about 6 m/s during 60% MVC.
2) The waveform of voluntary EMG detected from FDI slowed in all subjects during fatiguing contraction at 60% MVC, indicating fatigue had developed in the muscle.
3) As fatigue progressed, the waveform of the superimposed M-wave tended to decrease in amplitude and increase in duration.
4) As fatigue progressed, MDF and MFCV in volitional EMG decreased significantly (p<0.04) . The rate of change was larger in MDF than in MFCV (p<0.01) .
5) As fatigue progressed, MDF and MFCV in the superimposed M-wave decreased significantly (p<0.01) . The rate of change was larger in NIDF than in MFCV (p<0.05) .
These results suggested that MFCV and other peripheral factors affected the slowing of volitional EMG. Elongation of the depolarization zone in muscle fiber is proposed as a peripheral factor.

The purpose of this study was to examine the effects of short-term immobilization on the maximum voluntary contraction (MVC) force. The first dorsal interosseus (FDI) of 10 healthy male adults was immobilized for 1 week using casting tape. Atrophy of the muscle was estimated from a cross sectional view of magnetic resonance images (MRI) . To clarify the factors of a peripheral neuromuscular system contributing to the change in the MVC force, twitch force at rest was measured. The contribution of central factors was estimated from a voluntary activation (VA) index, which was obtained by the twitch interpolation method.
The MRI showed no significant changes in the cross sectional area. The MVC force declined after immobilization (p<0.01), and recovered after 1 week from the termination of immobilization (p<0.01) . Both the twitch force at rest and the VA at MVC declined after immobilization (p<0.01), and recovered after 1 week (p<0.05) .
The results indicate that the temporary decline of the MVC force was not accompanied by atrophy of the muscle. Furthermore the decline of the MVC was caused both by the deterioration of peripheral and central functions in the neuromuscular system. Possible factors in the peripheral and central neuromuscular systems affected by the immobilization were discussed.