No abstract

The effect of glucocorticoid administration on energy metabolism and food intake was studied in 20 healthy, nondiabetic Caucasian male volunteers [27 +/- 5 (SD) yr, 72 +/- 9 kg, 20 +/- 7% body fat] randomly and blindly assigned to glucocorticoid (methylprednisolone, METH; n = 10) or placebo (PLAC; n = 10) treatment. Each subject was studied twice: during a weight maintenance diet and during ad libitum food intake. Energy metabolism was measured by indirect calorimetry and food intake by an automated food-selection system. Twenty-four-hour urinary norepinephrine excretion (24-h NE) was used as an estimate of sympathetic nervous system activity. During weight maintenance, METH intravenous infusion (125 mg/30 min) increased energy expenditure compared with PLAC, and after 4 days of oral therapy, METH (40 mg/day) decreased 24-h NE and increased energy expenditure compared with PLAC. During ad libitum food intake, after 4 days of METH (40 mg/day) or PLAC oral therapy, both groups increased their energy intake over weight maintenance, but the increase was significantly larger in the METH group compared with the PLAC group (4,554 +/- 1,857 vs. 2,867 +/- 846 kcal/day; P = 0.04). Our data suggest that therapeutic doses of glucocorticoids induce obesity mostly by increasing energy intake, an effect which may be related to the ability of glucocorticoids to act directly or indirectly on the central regulation of appetite.

Digoxin did not reduce overall mortality, but it reduced the rate of hospitalization both overall and for worsening heart failure. These findings define more precisely the role of digoxin in the management of chronic heart failure.

SUMMARY A new method to determine left ventricular (LV) ejection fraction (EF) with wide-angle, twodimensional echocardiography (2-D echo) has been developed using the parasternal long-axis, apical fourchamber and apical long-axis views. End-diastolic and end-systolic measurements of LV short axes at the base and mid-LV cavity in the parasternal long-axis view and at the upper, middle and lower thirds of the cavity in the apical views are made, from which an averaged minor axis at end-diastole and at end-systole is calculated. Wide-angle 2-D echoes were obtained in each patient using a commercially available mechanical sector scan (Advanced Technology Laboratories Mark V). The scan head consists of three rotating 3-MHz piezoelectric crystals that are sequentially pulsed as they pass through a 900 sector. The frame rate of the system varies from 45.5 frames/sec at a scan depth of 5 cm to 18.5 frames/sec at a depth of 21 cm. The images are converted to digital format by a digital scan converter and presented in video format to the observer, allowing greater resolution and an enhanced gray scale. All studies were video-taped on a ¾h-inch Umatic video-cassette recorder (Panasonic VD-2600) interfaced to a back spacer search module (Dynasciences EJ-104 model 1), which allows frameby-frame bidirectional playback. The video frame rate of the system is approximately 60 frames/sec.All patients were studied in the left lateral recum-