Tumour necrosis factor alpha and oxidative stress as maintaining factors in the evolution of anorexia nervosa.

OBJECTIVE: Aim of the study was to evaluate tumour necrosis factor α (TNF-α) axis and oxidative status in patients with anorexia nervosa (AN) seeking a possible correlation with both nutritional status and evolution of the disease. SUBJECTS AND METHODS: Thirty-nine consecutive women with AN and an age-matched healthy control group were studied. Patients were 26±9 yr, with a body mass index (BMI) of 13.9±2 kg/m(2). TNF-α, its receptors TNF-R55 and TNF-R75, and oxidative status markers (selenium, ascorbic/ dehydroascorbic acid, retinol, α-tocopherol, selenium-dependent gluthatione peroxidase, reduced/oxidated gluthatione) were measured. A correlation with both nutritional indexes (body weight, BMI, albumin, prealbumin, transferrin, lymphocyte count) and disease duration was investigated. Pearson's correlation and unpaired Student's t-test were used to compare patients and controls. RESULTS: TNF-α and oxidative status markers were significantly higher in patients than controls and TNF-α was directly related to dehydroascorbic acid (p<0.05). Both TNF-R55 and TNF-R75 were higher in patients with duration of disease longer than one year as compared to controls and patients with shorter duration. Receptors inversely correlated with BMI (p<0.05 and p<0.01) and directly with disease duration (p<0.05). Inverse correlation between disease duration and BMI was present (p<0.01). CONCLUSIONS: The study showed activation of TNF-α axis and oxidative stress in AN patients, as well as correlation between the two systems. Due to the correlation between TNF receptors and both BMI and disease duration, a possible role of pro-inflammatory cytokines in the evolution of the eating disorder is suggested.

[The nutritional aspects in autologous bone marrow transplantation]. / Aspetti nutrizionali nel trapianto di midollo osseo autologo.

The use of total parenteral nutrition (TPN) in bone marrow transplant recipients is well recognized. These patients, as a result of treatment with chemotherapy and immunosuppressive agents, undergo catabolic stress. In stressed patients attention has been focused on the optimal calorie: nitrogen ratio of total parenteral nutrition formulations. Theoretically, TPN formulas of low calorie: nitrogen ratio impede body protein catabolism. In bone marrow transplant patients negative nitrogen balance may persist despite high nitrogen intake. The purpose of the present study is to determine the effect of increasing nitrogen intake on nutritional and metabolic parameters in bone marrow transplant patients. The metabolic effect of an increased nitrogen dose during TPN was studied in 33 bone marrow transplant patients, divided into 2 groups. Patients were given total parenteral nutrition formulas providing a protein intake of 1.4 +/- 0.2 g of protein/kg IBW/day for the first group, and 2.3 +/- 0.12 g of protein/kg IBW/day for the II group. Total calories, non protein and protein, were held constant at 40 kcal/kg IBW/day for all patients. Data have been calculated for 4 weeks starting from the first week pretransplant. As we had expected, the patients who are the object of the present study were well nourished at the time of hospital admission, confirming the description of bone marrow transplant recipients published by other transplant centers. Relative body weight, total serum protein, albumin, prealbumin and cholesterol were not significantly different at any study period.(ABSTRACT TRUNCATED AT 250 WORDS)

[Possibilities and limitations of nutritional support in Crohn disease]. / Possibilità e limiti del supporto nutrizionale nella malattia di Crohn.

Crohn's disease involves a great risk of malnutrition. Malabsorption, bacterial contamination, frequent abdominal surgery, meal-related pain, protein loss through the damaged mucosa contribute to creating nutritional problems. Malnutrition can worsen the outcome, both in medical and surgical patients, and deteriorate an often already altered immune response. Weight loss, low levels of blood protein, electrolytes, micronutrients and vitamins are usually related to the extension of the mucosal damage. Nutritional assessment can be difficult due to oedema and bleeding, who interfere with both clinical and laboratory evaluation. The exact amount of nitrogen, lipids, minerals stool loss can be useful. It is widely accepted the use of nutritional support in Crohn's disease, but many Authors do not agree concerning the route (enteral or parenteral) and the kind of nutrient to be used. Still controversial is the role of nutrition: just support or real therapy? Most recent hypothesis concerning the pathogenesis of Crohn's disease indicate food and/or bacterial antigens as involved in determining the pathology. The "bowel rest", considered for many years as a fasting period necessarily supported by parenteral nutrition, can also be obtained by the temporarily reduction or stop in presenting those antigens to the bowel mucosa. This new concept can be achieved not only by parenteral nutrition, but with an enteral elemental diet as well. The elemental diet contains all nutrients in the simplest way and thus succeeds in lowering or eliminating the antigenic power. The reported results seem to indicate an equivalence of enteral and parenteral nutrition; anyway enteral is advisable when feasible, being more physiological and less expensive and involving a lower risk of serious complications.(ABSTRACT TRUNCATED AT 250 WORDS)

[The role of the intestine in the pathogenesis and treatment of multiple organ failure]. / Il ruolo dell'intestino nella patogenesi e nel trattamento della "multiple organ failure".

Infection and sepsis remain major causes of death in medical and surgical services, despite the availability of potent antibiotics, aggressive surgery and close monitoring of patients in intensive-care units. Actually the terminology to define this type of events in multiple organ failure: we considered the role of intestine in its pathogenesis and its management.

[Use of elemental diet in intestinal lesions]. / L'uso della dieta elementare nelle lesioni intestinali.

The recognition of potentially noxious physiological substances in the intestinal milieu, prompted the use of an "elemental" semi-hydrolysed formula diet in the prophylaxis of experimental acute ischemic enteropathy. An elemental diet protects the intestinal mucosa of rodents from radiation injury and facilitates mucosal healing. Clinical trials have shown the benefits of this form of treatment in the prevention of acute radiation enteritis and therapy of delayed enteropathy and Crohn's disease.

[Changes in biliary secretory immunoglobulins A in mice fed whey proteins]. / Modificazioni sulle immunoglobuline A biliari di tipo secretorio in topi nutriti con proteine del siero di latte.

A whey protein diet has been shown to enhance splenic immune response to sheep red blood cells (SBRC) in mice. This study was designed to investigate the influence of the type of dietary protein on the biliary secretory IgA. A/J mice were fed defined formula diets containing either 20% whey protein, or 20% casein. Another group was fed Purina mouse chow. After 3 weeks of dietary treatment the body weight of each mouse was recorded and the gall-bladder was removed and its whole content analyzed by ELISA to determine S-IgA secretion. Body weight curves were similar in all dietary groups; higher biliary levels of S-IgA appeared in the whey protein fed mice than in the casein (p less than 0.025) or purine (p less than 0.025) fed mice. Dietary protein type may have a direct influence on the immune response in the gastrointestinal tract, without affecting body weight.

[Influence of coffee on plasma lipids]. / Influenza del caffè sui lipidi plasmatici.

The influence of coffee on plasma lipids has been largely investigated during the last twenty years, but still many doubts remain about this subject. For this reason the influence of the assumption of coffee on plasma lipids, in healthy people, during six weeks has been studied. The coffee was prepared with an Italian coffee-machine (moka). No relationship was found between coffee assumption and increase of hematic cholesterol.

[Brief notes on IgA particularly in reference to intestinal secretory IgA]. / Brevi note sulle IgA con particolare riferimento alle "secretory" IgA intestinali.

This review is un update of current data regarding the IgA. The synthesis, transport and biologic function of this class of immunoglobulin with special emphasis on secretory IgA is presented.

Metaplastic breast carcinoma with epithelial phenotype of pseudosarcomatous components.

A case of metaplastic breast carcinoma was subjected to an immunohistochemical study to characterize its apparent fibrosarcomatous and chondrosarcomatous elements. Polyclonal and monoclonal antibodies against epithelial cell components such as keratin proteins, epithelial membrane antigen, membrane and cytoplasmic antigens of human mammary carcinoma cells, and carcinoembryonic antigen were used, as well as antibodies against the mesenchymal antigens, desmin, and vimentin. The cells with a mesenchymal appearance had an epithelial derivation, as shown by the presence of epithelial cell markers and absence of mesenchymal cell markers.

Immunohistochemical study of solid cell nests of the thyroid gland found from an autopsy study.

An immunohistochemical study was performed to identify the histogenesis of solid cell nests (SCN) found in 30 of 202 thyroids obtained at autopsy. Immunoperoxidase staining was used to detect the presence of calcitonin, thyroglobulin, thyroxin, low and high molecular weight keratins, and carcinoembryonic antigen (CEA). Results showed that cells forming solid nests had immunoreactivity for calcitonin, low molecular weight keratin, and CEA, but not for thyroglobulin, thyroxin and high molecular weight keratin. Thus, SCN do not result from tangentially cut thyroid follicles (absence of staining for thyroglobulin and thyroxin), nor from a squamous metaplastic process (absence of staining for high molecular weight keratin), but instead they are formed by C-cells because they showed calcitonin immunoreactivity, and neurosecretory granules.